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Major Clinical Sciences (Big 4) > IM > Flashcards

IM Flashcards

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1
Q

Clinical definition of Hypertension

A

Level of blood pressure where institution of pharmacotherapy will lead to decrease cardiovascular morbidity and mortality

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2
Q

White Coat Hypertension vs Masked Hypertension

A

White coat - high at office, normal at home

Masked - normal at office, high at home

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3
Q

Criteria that needs to be fulfilled in order to diagnose Hypertension in just one visit

A

BP > 180/110

with evidence of cardiovascular disease

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4
Q 
Ranges for: 
Normal BP
Pre-hypertension
Hypertension Stage I
Hypertension Stage II
A

Normal BP: <120/<80
Pre-hypertension: 120-39/80-89
Stage I: 140-59/90-99
Stage II: 160/100

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5
Q

Definition of Isolated Systolic Hypertension

A

Systolic BP of >140, with Diastolic BP <90

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6
Q

What is the difference between a high-renin activity hypertension and low-renin activity hypertension

A

High-renin - hypertension is mainly from increased vascular resistance

Low-renin - hypertension is mainly from increased volume

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7
Q

Relationship between BMI and Hypertension?

A

Studies have shown that higher BMI is correlated with increased risk of hypertension

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8
Q

Components of Metabolic Syndrome

A

Hypertension
Dyslipidemia
Obesity
Insulin Resistance

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9
Q

2 etiologies of Renovascular Hypertension?

A

Atherosclerosis

Fibromuscular dysplasia

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10
Q

Gold standard for investigations of Renal Artery Disease

A

Contrast Arteriography

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11
Q

What is primary aldosteronism?

A

Increased production of aldosterone independent of Renin and Angiotensin

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12
Q

2 most common etiologies of primary aldosteronism?

What are their key differences?

A

Aldosterone-producing adenoma

  • more responsive to ACTH
  • hypertension is particularly worse in the morning
  • either surgical or medical treatment

Bilateral adrenal hyperplasia

  • more responsive to Angiotensin
  • orthostatic hypertension is common
  • medical treatment
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13
Q

Most common congenital cause of hypertension?

A

Coarctation of the Aorta

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14
Q

Examples of monogenic forms of hypertension?

How do they cause hypertension?

What are some of their clinical features?

A

17a-hydroxylase deficiency

  • decreased production of both cortisol and sex hormones
  • increased production of deoxycorticosterone (mineralocorticoid)
  • hypokalemia
  • absent secondary sexual development

11B-hydroxylase deficiency

  • decreased production of cortisol and estrogen
  • increased production of deoxycorticosterone and androgens
  • hypokalemia
  • ambiguous female genitalia, enlarged male genitalia

11B-dehydroxysteroid dehydrogenase deficiency
-decrease in degradation of cortisol

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15
Q

What are the phases in the pathogenesis of Lobar Pneumonia? (4)

Describe each phase

A

Edema Phase
Red Hepatization
Gray Hepatization
Resolution Phase

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16
Q

CURB 65 Criteria for CAP prognosis

A 
C - Change in mental status 
U - Urea > 7 mmol/L 
R - RR > 30 
B - BP < 90/60
65 - Age > 65 yrs old
17
Q

Common clinical manifestations of CAP

A

Acute Cough
Tachypnea
Tachycardia
Fever

w/ abnormal chest findings on PE

18
Q

Criteria for discharge of admitted CAP patients

A 
Temp: 36 - 37.5 C 
RR: 16 - 24 cpm 
HR: < 100 bpm 
SBP: > 90 mmHg 
O2: > 90% 
Able to take oral medications
19
Q

Enumerate the criteria for:
CAP - LR
CAP - MR
CAP - HR

A

CAP - LR
Normal vital signs, no aspiration, no change in mental status, stable comorbids, no abscess, no effusion

CAP - MR
Abnormal vital signs, aspiration component, change in mental status, unstable comorbids, w/ abscess, w/ effusion

CAP - HR
CAP - MR + sepsis, mechanical ventilation requirement

20
Q

Empiric antibiotic treatment for:
CAP - LR
CAP - MR
CAP - HR

A

CAP - LR
w/o comorbids - amox OR extended macrolide
w/ comorbids - co-amox/sultamicillin OR extended macrolides

CAP - MR
IV non-pseudomonas Beta-Lactam PLUS
extended macrolides OR
respiratory fluoroquinolones

CAP - HR
w/o pseudomonas - IV non-pseudomonas Beta-Lactam PLUS IV extended macrolide
OR IV respiratory fluoroquinolones

w/ pseudomonas 1 - IV anti-pseudomonas Beta Lactam
PLUS IV extended macrolide
PLUS IV aminoglycoside

w/ pseudomonas 2 - IV anti-pseudomonas Beta Lactam
PLUS IV respiratory fluoroquinolones

w/ MRSA - Vancomycin, Linezolid, or Clindamycin

21
Q

Differentiate HAP and VAP

A

HAP

  • not associated with ventilator use
  • lower risk of having MDR pathogen

VAP

  • associated with ventilator use
  • higher risk of having MDR pathogen
22
Q

Risk factors for MDR VAP

A

Prior antibiotic use within the past 90 days
Sepsis
ARDS
>5 days hospital stay prior to VAP
Acute renal replacement therapy prior to VAP

23
Q

Risk factor for MDR Pathogens in general

A

Prior antibiotic use within the past 90 days

24
Q

Triple antibiotic regimen for patients with risk of having MDR pathogen

A 
1. Beta-lactam 
Ceftazidime 2 mg IV q8 
Cefepime 2 mg IV q8-12
Pip-Tazo 4.5 mg IV q6
Imipenem 1 g IV q8
Meropenem 1 g IV q8
Aztreonam 2 g IV q8
  1. Against G(-)
    Aminoglycosides:
    Gentamicin 7 mg/kg IV q24
    Amikacin 20 mg/kg IV q24

OR Respiratory Fluoroquinolones:
Ciprofloxacin 400 mg IV q8
Levofloxacin 750 mg IV q24

  1. Against MRSA/G(+)
    Vancomycin 15 mg/kg IV q 12
    Linezolid 600 mg IV q 12

Major Clinical Sciences (Big 4) (3 decks)

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