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Summer 2018 > Int. Medicine 1 > Flashcards

Int. Medicine 1 Flashcards

1
Q

_ % of adults over 65 have hypertension

A

50%

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2
Q

_% of HBP is primary

What does primary mean

A

90%

Unknown cause

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3
Q

What builds up on the intimal layer of arteries to cause HBP

A

Fat and calcium

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4
Q

3 Target organs of hypertension

A

Kidney
Heart
Brain

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5
Q

_ % of patients with HBP don’t know they have it

A

1/5

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6
Q

What main thing (with few symptoms) does hypertension do to the kidney

This leads to symptomatic _

And end stage _

A

Proteinuria and nephrosclerosis

Chronic renal failure

End-stage renal Disease

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7
Q

Hypertension and the heart:
Oligosymptomatic
3 symptomatic diseases
3 end-stage diseases

A

O: left ventricle

S: angina/coronary artery disease
Systolic/diastolic dysfunction
A fib/ ventricular arrhythmias

E: MI
CHF
Ventricular tachycardia/fibrillation

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8
Q

Hypertension and the brain:
Oligosymptomatic:
Symptomatic:
End-stage:

A

O: retinopathy/binswanger lesions

S: dementia, TIA

E: stroke

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9
Q

Classification of HBP

A

<120, <80 = normal
120-129, <80 = elevated
130-139 or 80-89 = stage 1
>140 or >90 = stage 2

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10
Q

At what BP will a patient be treatment

A

> 130/80

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11
Q

4 main groups of drugs for HBP

A

ACE inhibitors
Angiotensin receptor blockers
Thiazide diuretics
Ca channel blockers

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12
Q

What is a hypertensive emergency

A

Acute elevation of BP >180 or >120

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13
Q

Major risk factors

A

Unstable coronary syndrome
Decompensated heart failure
Significant arrhythmias
Severe valvular disease

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14
Q

At what BP do you defer elective treatment

A

> 180/110

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15
Q

What range of BP can you proceed with elective tx but with caution and monitoring and referral to pcp within a month

A

160-180/100-110

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16
Q

Intermediate risk factors (5)

A 
History of Ischemic disease
History of compensated heart failure
History cerebrovascular disease
Diabetes mellitus
Renal insufficiency
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17
Q

Minor risk factors (4)

A

Advanced age
Abnormal ECG
Rhythm other than sinus
Uncontrolled systemic HT

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18
Q

What can be used on retraction cords instead of epi

A

Visine, afrin, neo-synephrine

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19
Q

3 steps to atherosclerosis

A

Inflammation
Plaque
Stenosis

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20
Q

Stable vs unstable angina

A

Stable: physical effort ppts
Unstable: pptd by effort or rest

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21
Q

3 types of drugs to treat ischemic heart disease

A

Nitrates
Beta blockers
Antiplatelet therapy

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22
Q

Steps to an MI

A

Plaque rupture
Thrombus
Blood flow decreased
MI

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23
Q

How long to wait to treat patient after MI

A

At least a month

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24
Q

Three things to have on hand in case of an MI emergency

A

Nitroglycerin
Aspirin
O2 equipment

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25
Q

PVC

Worried?

A

Premature ventricular contraction

No

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26
Q

A fib

A

Rapid, disorganized, weak atrial contractions bombard AV node

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27
Q

Treatment for bradycardia vs. tachycardia

A

B: implant pacemaker

T: drugs

28
Q

3 types of anticoagulant drugs

A

Vit. K dependent coagulation factor synthesis inhibitor

Antithrombin

Direct factor Xa inhibitor

29
Q

What is different about Coumadin (warfarin) than other oral anticoagulants

A

Coagulation testing of international normalized ratio

Inhibitis vitamin K dependent coagulation factor synthesis

30
Q

For what 2 kinds of arrhythmias should elective care be deferred

A

High grade AV blocks

Symptomatic ventricular rhythms

31
Q

What INR can you treat a patient

When tested for INR

A

Less than 3 (especially for single tooth)

Within 48 hrs

32
Q

What happens to ventricles in CHF

A
  1. Don’t empty during systole (not enough blood to tissues)
    Or
  2. Don’t fill during diastole
33
Q

Coronary heart disease causes what % of heart failure

A

60-75%

34
Q

Ejection fraction:
What
Normal
Severe

A

Blood pumped/blood in ventricle

55-70% normal
<35% severe

35
Q

Symptoms of heart failure

A

Dyspnea
Fatigue
Orthopnea

36
Q

5 year survival of CHF men and women

A

Men: 35%
Women: 50%

37
Q

Stages ABCD of heart failure

A

A: high risk, no symptoms
B: structural disease, no symptoms
C: structural disease, symptoms
D: Bad bad

38
Q

When does medical treatment of CHF start

A

Stage C

39
Q

HFpEF vs HFrEF

A

pEF is maintaining ejection fraction

rEF is reduced ejection fraction

40
Q

NYHA classification I-IV

A

I - no symptoms
II - with normal activity
III - with less than normal activity
IV - at rest

41
Q

When to treat/defer pt with compensated heart failure

A

History is intermediate

decompensated is major

42
Q

Dual antiplatelet therapy

A

Aspirin and clopidogrel

43
Q

AB prophylaxis is needed for _ in patients who have _

A

Anything invasive

Mechanical replacement valves

44
Q

3 things that happen in asthma patients

A

Contraction of airway smooth muscle

Thickening of airway wall b/c of inflammation

Mucous

45
Q

Intermittent asthma is treated by _

Persistent asthma is treated by that and _

A

Inhaled quick acting beta-2 agonists

Inhaled glucocorticoid

46
Q

Well controlled asthma

A 
2x/month daytime symptoms
2x/month night symptoms
SABAs <3d/week
Normal activities
Steroids and urgent care 1x year
47
Q

How long to wait since last ED visit for asthma before elective care

A

3 months

48
Q

COPD is the _ leading killer

A

3rd

49
Q

COPD is caused by

A

Smoking and genetic susceptibility

50
Q

Chronic bronchitis is obstruction on _

A

Inspiration and expiration

51
Q

Emphysema is obstruction on _

A

Expiration

52
Q

When to avoid treating COPD patients

A

SOB at rest, productive cough, upper respiratory infection

53
Q

When to avoid nitrous

A

Severe COPD

54
Q

T/F all of the 5 hepatitis viruses are directly cytopathic

A

FALSE. None are

55
Q

Most common hep to cause liver failure

A

Hep B

56
Q

Who has a predisposition to bleeding

A

Those with a deficiency of vit K dependent coagulation factors

57
Q

Liver disease may cause what effect with drugs

A

Drugs may need dosage adjustments

58
Q

3 reasons why liver matters in delivery of dental care

A

Bleeding
Altered drug metabolism
Infection

59
Q

Active hepatitis dental care

A

No routine, urgent care with consultation of physician

60
Q

Chronic hepatitis dental care

A

Routine ok, check with physician

61
Q

Thrombocytopenia + _ = increased bleeding

A

Decrease in coagulation factors

62
Q

_ of world infected with latent TB

A

1/3

63
Q

3 ways to diagnose tuberculosis

A

Radiography
Spit testing
Skin test

64
Q

Drug therapy for TB

A

Intensive: Isoniazid, rifampin, pyrazinamide, ethambutol

Continuation: isoniazid, rifampin

65
Q

Active pulm infection dental treatment?

A

No elective treatment

66
Q

Positive tuberculin skin test dental care?

A

Routine dental care with standard universal precaution

Summer 2018 (2 decks)

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