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PC1 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

what number s are considered HTN

A

140/90

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2
Q

how much should one BP drug lower BP

A

by 10% so double it if very high

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3
Q

when is HTN a worry in age

A

25-55

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4
Q

other names for primary HTN

A

essential

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5
Q

what are the names for primary HTN

A

essential and idopathic

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6
Q

what are three causes of idiopathic HTN

A

lifestyle, BMI, genetic or environmental

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7
Q

what two can cause worse HTN and is more common in blacks

A

polycythemia causing increased blood viscosity and salt

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8
Q

what are the two types of HTN

A

primary and secondary

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9
Q

what are four causes of secondary htn

A

renal disease, renal artery stenosis, endocrine problems, corticosteroid thearpy

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10
Q

describe a headache caused by htn

A

only very high like 220sys, in the morning and in the occiput

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11
Q

if the blood pressure is diffrent between the upper and lower ext then what, how much

A

rule out coarctation of the aorta, 10 point diff

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12
Q

what could loss of peripheral pulse mean

A

atherosclerosis

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13
Q

What are male smokers with marfans more at risk for

A

aortic disection, shearing pain

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14
Q

What does the ekg do if LVH is present from HTN

A

more than 4 big boxes for the ORS height

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15
Q

if the bp is diffrent left to right arm then what could it mean, how many points

A

10 points, atrial issues

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16
Q

if what increases by how much after ACE admin then do a renal arteriography

A

serum creatine by more than 25%

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17
Q

what will a chest x ray rule out with HTN

A

pulmonary edema

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18
Q

what is a key sign for right sideed heart failure

A

peripheral edema

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19
Q

name six base line test for htn

A

ekg, ua for protein and glucose, hematocrit, uric acid, lipids, chest x ray

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20
Q

if uric acid is increased with htn then what

A

no diurectics

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21
Q

what is the inital drug of choice for htn

A

thiazide diuretics

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22
Q

first line htn for DM with proteinuria

A

ace1 but if cough rash and swelling happen use arb

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23
Q

first line htn drug for heart failure

A

ace1 and or diuretics

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24
Q

first line htn drug for mi

A

beta blocker or ace1

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25
Q

what htn drug often cause impotence

A

beta blocker

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26
Q

how long should BP be controlled before considering lowering the dosage

A

1 year

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27
Q

when should diuretics be taken

A

in the morning

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28
Q

if a pt has CAD then whats the lowest a diastolic should be

A

80

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29
Q

under what systolic is no longer a decreased stroke risk

A

130

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30
Q

how often should pts have a visit for BP

A

monthly then every three visits once stable

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31
Q

how often should a BP pt have a lipid pannel

A

yearly

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32
Q

What BP med shouldnt be stoped abruptly

A

bETA BLOCKER, IT CAN CAUSE AN mi

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33
Q

how should a beta blocker be stoped

A

1/2 dose times 1 month or 3 months, then reasses, 1/2 again if able

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34
Q

how high is a hypertensive emergency

A

over 220/125

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35
Q

how do you treat hypertensive emergency

A

if no organ or brain problems then just PO meds

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36
Q

what is possible with the use of clonidine

A

rebound hypertension

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37
Q

how to dose clonidine

A

.2mg then .1mg every hour up to .8mg

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38
Q

what bp by mouth med is good in 15-20 min

A

captopril 12.5-25

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39
Q

how high can BP be and still send pt home

A

under 100 diastolic

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40
Q

how much weight should be lost for htn

A

10% of body weight

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41
Q

what diet is for htn

A

DASH

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42
Q

dont give how much diuretic because K will go down

A

25

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43
Q

what htn med is for preg and what is not

A

give ace do not give beta blocker

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44
Q

what bp med is best in blacks

A

calcium channel blocker

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45
Q

thiazides are bad for what two disease

A

gout and osteoporosis

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46
Q

what is best htn med for a fib

A

beta blocker

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47
Q

dont give what with asthma pt or heart block for htn

A

beta blocker

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48
Q

when should potassium sparing drugs be used

A

if K is below 3.5 or on digoxin

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49
Q

what three effects do a beta blocker have

A

decrease heart rate, drop cardiac output, drop heart stress reaction

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50
Q

name four common beta blocker side effects

A

congestion, bronchospasm, conduction issues, ED, nightmares, confussion

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51
Q

if you suspect cocaine use do not use what drug

A

beta blocker

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52
Q

how do ACE inhibitors work

A

vasodilation, reduces sympathetic nervous system

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53
Q

name 4 side effects of ace inhibitor

A

cough, angioedema, birth defects, rash and hives, hyperkalemia

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54
Q

what is a side effect of angiotension 2 receptor blocker

A

hyperkalemia, worsens renal function with stenosis

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55
Q

what medication is good in blacks and what is better

A

aldosterone receptor antagonist, ccb is better

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56
Q

what is important about aldosterone receptor antagonist

A

not a drug of choice and not monotherapy

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57
Q

what htn drug prevents cva

A

ccb

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58
Q

what ccb should be used with chf pateitns

A

amlodipine

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59
Q

name three side effects of ccb

A

edema, constipation, headache

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60
Q

what htn med is used with ptsd

A

alpha adrenoceptor antagonist

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61
Q

what is a side effect of alpha adrenoceptor antagonist

A

floppy iris

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62
Q

what are two side effects of methyldopa

A

hepatitis and hemolytic anemia

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63
Q

what is used for preg females

A

methyldopa

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64
Q

what is normaly the cause of pediatric htn, what is the first clue

A

renal problems, two vessel umbilical

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65
Q

what is a newborns bp

A

90/65

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66
Q

what three tests are done for high bp in kids

A

cbc, ua, renal us

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67
Q

what does buildup of fatty streaks cause

A

atherosclerosis

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68
Q

three types of cholesterol

A

ldl, hdl, vldl

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69
Q

what is the triglyceride range, what do you do for each range

A

150 normal
199 borderline high, lifestyle change
499 high, drugs
+500 very high, drugs lifestyle change and look for secondary cause

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70
Q

describe primary hyperlipedemia

A

inherited and rare

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71
Q

describe secondary hyperlipedema

A

diet, meds, medical conditions cause it

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72
Q

how do you find the lipid related cv risk

A

cholesterol/ hdl, lower ratio is lower risk

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73
Q

when are lipids screened for in men and women

A

35 in men, 45 in women, repeat every 5 years if low risk

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74
Q

what is special about hdl over 60

A

subtract 1 risk factor from cv

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75
Q

what are xanthomas, what do they mean

A

yellow papules on eye lids, triglycerides over 1000

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76
Q

what may be seen in the eyes with triglycerides over 2000

A

cream colered vessels

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77
Q

thiazide diuretics play what role in lipid treatment

A

they can raise them

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78
Q

what is the framingham score

A

10 year cad risk score

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79
Q

what are the total cholesterol numbers

A

200 normal
240 borderline
+240 high

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80
Q

what are the ldl numbers

A

100 normal
160 borderline
+160 high

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81
Q

what are the hdl numbers

A

above 45 normal
35-45 borderline
-35 high

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82
Q

to lower cholesterol how should the step 1 diet look

A

limit fat to 30% daily calories

saturtaed fat less than 10%

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83
Q

what are the four classes of lipid lowering drugs

A

statins, niacin, fibric acid, bile acid binding

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84
Q

name four statins

A

lipitor, zocor, crestor, pravastatin

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85
Q

what is the most potent statin

A

crestor

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86
Q

what is the professors favorite statin

A

pravastatin

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87
Q

what are three se of statins and the main one

A

abdominal pain is the main one, gas and headache

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88
Q

what is primary concern with statins

A

could cause rhabdo

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89
Q

when should lipid profiles be repeated after drugs started

A

in 4 weeks, then 12 weeks

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90
Q

how often are liver function tests done with lipd drugs

A

every 6 months

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91
Q

when should lipd medications be stopped, a bad reason

A

serum transaminase levels exceed 3x the normal limit or if myopathy myositis occurs

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92
Q

what is special about niacin

A

use with combination lipid disorder

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93
Q

what is main se of niacin and what will help

A

flushing, nausea and headache, take an asprin at evening meal, double each week to reduce se

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94
Q

when should niacin not be used

A

gout or peptic ulcer

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95
Q

what is special about using fibric acid

A

dont use with statins, take 30 min before meals

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96
Q

what is special about effects on lipids with bile acid drug

A

could increase triglycerides

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97
Q

what is special about instructions for bile acid resins

A

take 1 hour before and four hours after any medications to prevent binding

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98
Q

what is important about lipids and lipid drugs in preg

A

dont give lipid drugs to preg women, lipids could raise 150 and its normal in preg

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99
Q

how is lipids treated in kids

A

screen at 2 if family history present, drugs can start at 10 but diet and exercise must be tried for 1 year before meds

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100
Q

name a niacin drug

A

nispan

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101
Q

name a fibrate

A

lopid, tricor

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102
Q

name a bile acid resin

A

colestid

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103
Q

who do you not give statins to

A

liver disease

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104
Q

why should fibric acid not be given with statins

A

it increases muscle toxicity

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105
Q

what are the two types of heart failure and what are the keys to them

A

dystolic heart failure is a filling problem, systolic heart failure is a problem ejecting the blood

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106
Q

what is the most common type of systolic heart failure

A

decreased ejection fraction is most common type

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107
Q

what are four symptoms of left ventricular heart failure

A

exertional dyspnea, cough, trouble lying flat, fatigue, PND

108
Q

what are two signs of right ventricle heart failure

A

hepatomegaly, dependent edema

109
Q

what is usually the cause of right ventricle failure

A

left ventricle failure

110
Q

what is the ejection fraction of systolic HF

A

less than 40

111
Q

what are the key diffrences with right and left HF in relation to lungs

A

systolic cause progressive SOB, diastolic causes acute pulm edema

112
Q

what age does left anf right HF start

A

systolic is under 65 diastolic is over 65

113
Q

what will the ekg show with left and right HF

A

systolic has q waves, diastolic has LVH

114
Q

the physical exam when listening to the heart shows what with systolic HF

A

displaced point of maximal impulse

115
Q

what is definitive diagnostic test for HF

A

echocardiogram with doppler flow

116
Q

what will BNP differintiate

A

dyspnea of HF vs pulmonary disease

117
Q

what is the numbered classification system for HF

A
  1. cardiac dz but no physical limitation
  2. cardiac disease slight physical limits like stairs
  3. cardiac dz little activity causes symptoms like the mail
  4. cardiac dz with symptoms at rest
118
Q

what numbers of the HF class system corespond to the letter system

A

a. is nothing
b. 1
c. 2 and 3
d. 4 and specialized interventions

119
Q

what is tx for stage a HF

A

prevent it

120
Q

what is tx for stage b HF

A

ACE or ARB, repair or replace valvues

121
Q

what is tx for stage c HF

A

ACE and BB in everyone, digoxin, diuretic, aldactone, vaccines

122
Q

what is tx for stage d HF

A

pace maker and stuff

123
Q

name three loop diuretics

A

lasix, bumetamide, toremide

124
Q

what should blacks get for HF

A

ACE, hydralazine, nitrates

125
Q

when will pedi HF show

A

by 6 months

126
Q

what is special about preg and HF

A

cardiomyopathy can happen the last month of preg and 6 months after

127
Q

how fast do ischemic symptoms resolve

A

5-20 min

128
Q

what is prinzmetals angina

A

variant coronary artery spasm

129
Q

when do prinzmetals angina typicaly happen

A

in the morning

130
Q

what is prinzmetals angina treated with

A

nitrates, the ccb nifedipine, can have st elevation

131
Q

how is prinzmetals angina dx

A

off history

132
Q

what does a angina attack longer than 30 min suggest

A

unstable angina MI or alternative dx

133
Q

what is first line angina treatment

A

BB

134
Q

what should be refered to cardiology

A

pos stress test, or worsening symptoms

135
Q

what is the best stress test

A

stress echo

136
Q

what has kerley B lines on x ray

A

CHF

137
Q

what must be excluded when chest pain present

A

CAD

138
Q

name three types of gi problems that cause chest pain

A

PUD, GERD, gall bladder dz

139
Q

CAD chest pain is normaly in who

A

older males or postmenopause womean

140
Q

what dz in kids can cause chest pain

A

kawasakis

141
Q

what is preg cardiac symptom mean

A

go to cardiology

142
Q

name four types of angina

A

chronic stable, variant, unstable, asymptomatic

143
Q

who is asymptomatic CAD common in

A

women and diabetics

144
Q

what is angina pectoris normaly from

A

atherosclerotic heart dz

145
Q

what 5 questions are there for angina

A

circumstance, characteristic, location, duration, effects of NTG

146
Q

what is stable angina treated with

A

ntg

147
Q

what is long term nitro called and what is special about it

A

isosorbidedinitrate, wipe off before bed

148
Q

when is BB not used in stable angina or MI

A

if severe bronchospastic dz

149
Q

what does ASA do

A

interfears with platlet agrigation

150
Q

what are the 4 points to metabloic syndrome

A

HTN, obesity, dyslipidemia, DM

151
Q

metabolic syndrome if more than three of what is present

A

abdominal obesity, triglycerides over 150, hdl under 40 in males and under 50 in females, fasting glucose over 110, HTN

152
Q

what is risk factor lab for CAD

A

increased CRP less than 1 or over 3

153
Q

what must be specified in acute coronary syndrome

A

STEMI or non STEMI

154
Q

what should not be done with non stemi

A

dont cath and dont use fibrinolytic therapy

155
Q

how is NSTENI dx

A

st depression, positive cardiac markers, give antiplatlet and anticoagulant

156
Q

what is the killip classification

A

MI signs

  1. no rales
  2. rales in 1/3 lung not cleared by cough
  3. more than 1/3 rales in lung
  4. cardiogenic shock (rales, hypotension, hypoperfusion)
157
Q

what htn drug not used with mi

A

ccb

158
Q

what two meds are given at dc with mi

A

asa and clopidrogrel for 1 year

159
Q

were is the foramen ovale in a newborn heart

A

between atria

160
Q

what are the two types of newborn heart disese

A

acyanotic and cyanotic

161
Q

name 4 left to right shunting congenital heart dz that cause increased pulmonary blood flow

A

atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular septal defect

162
Q

name 1 left to right shunting congenital heart dz that cause obstruction of blood flow to the right side

A

pulmonary stenoisis

163
Q

name 4 left to right shunting congenital heart dz that cause obstruction of blood flow to the left side of the heart

A

coarcation of the aorta, aortic stenosis, mitral valve stenosis, other congenital lessions

164
Q

three common s/s of acyanotic CHD

A

CHF, pulmonary HTN, lung infections

165
Q

what catagory is atrial septal defect

A

increases pulmonary blood flow

166
Q

how does small or moderate ASD present

A

non symptomatic

167
Q

how is ASD dx

A

transesophegeal echo

168
Q

how is asd tx

A

only large is surgery or cath

169
Q

how large is an ASD that will close

A

4mm

170
Q

at what ratio for shunting does an adult need surgery for something like ASD

A

more than 2

171
Q

what catagory of congenital defect is ventricular septal defect

A

increased pulmonary blood flow

172
Q

what is the most comon congenital heart dz

A

ventricular septal defect

173
Q

what is done about VSD

A

most close themselves, surgery if ratio is greater than 2

174
Q

how big is a large vsd

A

6-10mm

175
Q

what is seen on exam with vsd

A

pansystolic murmur, sternal buldge

176
Q

how do you dx VSD

A

echo or mri

177
Q

what should be done with VSD and PDA

A

abx before dental work

178
Q

when is VSD surgery contraindicated

A

id right to left shunting

179
Q

what is eisenmengers syndrome

A

right to left VSD shunting

180
Q

what catagory is PDA

A

increased pulmonary blood flow

181
Q

what is pda

A

blood flows from the aorta to the pulmonary artery

182
Q

when does a pda normaly close

A

day 3-5

183
Q

how does a PDA present

A

machinery like rough murmer, split s2, bouwnding pulse,

184
Q

never do what for a pda

A

cardiac cath

185
Q

how to dx pda

A

echo or mri or doppler us

186
Q

what drug will help close pda, what should be watched

A

indomethacin, urine

187
Q

what catagory is atrioventricular septal defect

A

increased pulmonary blood flow

188
Q

Atrioventricular SD is common in who

A

downs syndrome

189
Q

partial atrioventricular defect is what

A

cleft mitral valve and little or no vsd

190
Q

a complete atrioventricular defect is what

A

large left to right shunt, both atrial and ventricle, tricuspid and mitral regurgitation, pulmonary HTN and pulmonary valve regurgitation

191
Q

what does atrioventricular septal defect look like on x ray

A

all 4 chambers are enlarged on x ray

192
Q

what should not be done for atrioventricular septal defect

A

cardiac cath

193
Q

how is atrioventricular septal defect dx, looks for what

A

ECHO, angiography looks for goosneck deformity in complete form

194
Q

how is atrioventricualr septal defect treated

A

always surgery

195
Q

what catagory is pulmonary stenosis

A

obstruction of blood flow to right side of heart

196
Q

how does pulmonary stenosis present on x ray

A

right ventricular enlargment

197
Q

how does pulmonary stenosis sound in stethoscope

A

high pitched harsh systolic murmer

198
Q

how is pulmonary stenois tx

A

balloon valvuloplasty then surgery if that dosnt work

199
Q

what catagory is coarcation of the aorta

A

obstruction of blood flow to left side of the heat

200
Q

what is coarcation of the aorta

A

narrowing of the aorta

201
Q

when might coarcation of the aorta be noticed

A

days after birth once pda closes

202
Q

how is a coarctation of the aorta heard

A

blowing systolic murmer in the left axilla/back

203
Q

what is a classic sign of coarctation of the aorta

A

weak femoral pulse after pda closes, right arm htn and nosebleeds

204
Q

how is coarctation of the aorta tx

A

prostoglandins until surgery is done or balloon angioplasty

205
Q

how is coarctation treated in adults

A

stents cuz it can reoccur

206
Q

what catagory is aortic stenosis

A

obstruction of blood flow to left side of the heat

207
Q

how is aortic stenosis heard

A

systolic ejection murmur at upper right sternal boarder systolic click at apex with thrill in carotid arterys

208
Q

how is aortic stenosis tx

A

once chf shows then immediate surgery or cath

209
Q

what is the fourth catagory of acyanotic heart disease

A

myocardial dz

210
Q

name four types of myocardial dz

A

glycogen storage dz (amyloidosis), anomolus origin of left coronary artery, endocardial fibroelastosis, cardiomyopathy

211
Q

name three types of cyanotic heart dz

A

tetrology of fallot, transposition of the great arteries, double outlet right ventricle

212
Q

what catagory is tetralogy of fallot

A

cyanotic heart dz

213
Q

what are the four components of tetralogy of fallot

A
  1. right ventricle hypertrophy
  2. VSD
  3. narrowed pulmonary artery, and abnormal valve
  4. aorta straddles the ventrical septum
214
Q

what is a key sign of tetralogy of fallot

A

squatting during exercise d/t right to left shunt

215
Q

what is “tets”

A

sudden cyanosis

216
Q

what does tetralogy of fallot look like on chest x ray

A

boot shaped

217
Q

what catagory is transposition of the great arteries

A

cyanotic heart dz

218
Q

who gets trasposition of the great arteries

A

large males moslty

219
Q

what must happen for transposition of the great arteries

A

VSD or PFO

220
Q

what does transposition of the great arteries look like on an x ray

A

egg on a string

221
Q

what are the seven points to a murmur

A 
timing
pitch
intensity
pattern
quality
loaction/ raditation
resp phase variations
222
Q

what is murmur timing

A

systolic or diastolic

223
Q

what is murmur pitch

A

high or low

224
Q

what is murmur intensity

A

grade 1-6

225
Q

what are the murmur intensity descriptions

A
  1. very faint not everywere
  2. quite with stethoscope
  3. moderatly loud with no thrill
  4. loud and possible thrill
  5. very loud with thrill
  6. heard without stethoscope and has a thrill
226
Q

what is murmur pattern

A

crescendo decrescendo

227
Q

what is murmur quality

A

musical, harsh, raspy, blowing

228
Q

whats herd midsystolic

A

semilunar valves

229
Q

whats herd holosystolic

A

regurg av valves

230
Q

whats herd late systolic

A

mitral valve prolapse

231
Q

whats herd systolic early and harsh

A

aortic pulmonary stenosis

232
Q

whats herd continuous diastolic

A

PDA

233
Q

whats herd as crescendo decresendo midsystolic

A

aortic stenosis or inccent

234
Q

whats herd as pansystolic and plateau

A

mitral regurgitation

235
Q

describe a inocent murmur or stills murmur

A

soft, systolic, vibratory, grade 1 or 2, spex to lower sternal border, louder at supine less with breathing, LOUDER WITH FEVER OR TACHY

236
Q

letter thing for systolic heart murmur origin

A 
MR PASS MVP
mitral regurg
physiologic like fever
aortic stenosis
systolic
mitral valve prolapse
237
Q

what are the valves doing in systoly

A

mitral and tricuspid are closed so could regug

aortic and pulmonary are open so stenosis

238
Q

describe mitral valve regurg and keys

A

pansystolic maximal at apex and radiates to axilla, less with valsalva and standing, increased with squatting

239
Q

describe tricuspid regurgitation and keys

A

lower left sternal to right sternal systolic variable blowing, LEFT PARASTERNAL MURMUR THAT INCREASES WITH INSPIRATION

240
Q

what can happen with tricuspid regug

A

hepatomegaly

241
Q

what is a midsystolic murmur do to

A

turbulence due to temporary increase in blood flow

242
Q

describe aortic stenosis and key points

A

radiates to the neck, harsh, loud, HEARD BEST WITH PT SITTING AND LEANING FORWARD

243
Q

what are the physical signs of aortic stenosis

A

SAD
syncope
angina
dyspnea

244
Q

key to valvular aortic stenosis

A

grade 3 loud at 1 and 2 intercostal space radiates to suprasternal notch,

245
Q

describe mitral valve prolapse keys

A

MIDSYSTOLIC CLICK increased with standing and valsalva, more in females

246
Q

term for diastolic heart murmurs

A 
ARMS and PARTS
aortic regurgitation
mitral stenosis
pulmonic regurg
tricuspid stenosis
247
Q

keys to mitral stenosis

A

opening snap following s2, diastolic rumble herd in left lateral position worse with sit ups

248
Q

what does squatting do to murmurs

A

makes them louder except for hypertrophic cardiomyopathy

249
Q

what three drugs are for a fib

A

beta blocker (metopolol), digoxin, warfarin

250
Q

how is wrfarin dosed

A

start at 5mg adjust by 50% for INR between 1-2 then 2-3

251
Q

more than 3 PVCs in a row is what

A

v tach

252
Q

what is a key sign of DVT

A

swelling in one leg

253
Q

what is homan’s sign

A

dorsiflex the foot and look for pain, not a good sign of dvt

254
Q

if you cant give heparin for a emergent dvt give what

A

atroven

255
Q

once home how should warfarin be adjusted

A

5-20%

256
Q

what is intermitent claudication

A

exercise makes artery disease worse

257
Q

how does artery disesase peripheral looks

A

shinny skin with loss of hair

258
Q

what is ABI

A

ankle brachial index

arm systolic BP/ ankle systolic BP

over 1 normal
under 1 LEAD
.6-.8 borderline
under .5 severe ischemia

so higher in leg is bad

259
Q

the three P’s are what and for what

A

pain pallor pulselessness, arterial

260
Q

what is proper pulse

A

2+

261
Q

how is edema rated

A

+1 =2mm then each number up is another 2mm

262
Q

if you think raynauds then think what

A

thats not arterial, rule out burgers

263
Q

what is another name for burgers

A

peripheral thrimbophlebitis obliterans, leads to finger loss

264
Q

who is burgers often in

A

men who smoke

265
Q

what is CEAP

A 
classification of chronic venous disease
0-none
1-reticular veins
2-varicose veins
3-edema
4-skin changes
5-healed ulcerations
6-active ulcers

PC1 (3 decks)

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