Test 2 Flashcards
1
Q
what number s are considered HTN
A
140/90
2
Q
how much should one BP drug lower BP
A
by 10% so double it if very high
3
Q
when is HTN a worry in age
A
25-55
4
Q
other names for primary HTN
A
essential
5
Q
what are the names for primary HTN
A
essential and idopathic
6
Q
what are three causes of idiopathic HTN
A
lifestyle, BMI, genetic or environmental
7
Q
what two can cause worse HTN and is more common in blacks
A
polycythemia causing increased blood viscosity and salt
8
Q
what are the two types of HTN
A
primary and secondary
9
Q
what are four causes of secondary htn
A
renal disease, renal artery stenosis, endocrine problems, corticosteroid thearpy
10
Q
describe a headache caused by htn
A
only very high like 220sys, in the morning and in the occiput
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
12
Q
what could loss of peripheral pulse mean
A
atherosclerosis
13
Q
What are male smokers with marfans more at risk for
A
aortic disection, shearing pain
14
Q
What does the ekg do if LVH is present from HTN
A
more than 4 big boxes for the ORS height
15
Q
if the bp is diffrent left to right arm then what could it mean, how many points
A
10 points, atrial issues
16
Q
if what increases by how much after ACE admin then do a renal arteriography
A
serum creatine by more than 25%
17
Q
what will a chest x ray rule out with HTN
A
pulmonary edema
18
Q
what is a key sign for right sideed heart failure
A
peripheral edema
19
Q
name six base line test for htn
A
ekg, ua for protein and glucose, hematocrit, uric acid, lipids, chest x ray
20
Q
if uric acid is increased with htn then what
A
no diurectics
21
Q
what is the inital drug of choice for htn
A
thiazide diuretics
22
Q
first line htn for DM with proteinuria
A
ace1 but if cough rash and swelling happen use arb
23
Q
first line htn drug for heart failure
A
ace1 and or diuretics
24
Q
first line htn drug for mi
A
beta blocker or ace1
25
what htn drug often cause impotence
beta blocker
26
how long should BP be controlled before considering lowering the dosage
1 year
27
when should diuretics be taken
in the morning
28
if a pt has CAD then whats the lowest a diastolic should be
80
29
under what systolic is no longer a decreased stroke risk
130
30
how often should pts have a visit for BP
monthly then every three visits once stable
31
how often should a BP pt have a lipid pannel
yearly
32
What BP med shouldnt be stoped abruptly
bETA BLOCKER, IT CAN CAUSE AN mi
33
how should a beta blocker be stoped
1/2 dose times 1 month or 3 months, then reasses, 1/2 again if able
34
how high is a hypertensive emergency
over 220/125
35
how do you treat hypertensive emergency
if no organ or brain problems then just PO meds
36
what is possible with the use of clonidine
rebound hypertension
37
how to dose clonidine
.2mg then .1mg every hour up to .8mg
38
what bp by mouth med is good in 15-20 min
captopril 12.5-25
39
how high can BP be and still send pt home
under 100 diastolic
40
how much weight should be lost for htn
10% of body weight
41
what diet is for htn
DASH
42
dont give how much diuretic because K will go down
25
43
what htn med is for preg and what is not
give ace do not give beta blocker
44
what bp med is best in blacks
calcium channel blocker
45
thiazides are bad for what two disease
gout and osteoporosis
46
what is best htn med for a fib
beta blocker
47
dont give what with asthma pt or heart block for htn
beta blocker
48
when should potassium sparing drugs be used
if K is below 3.5 or on digoxin
49
what three effects do a beta blocker have
decrease heart rate, drop cardiac output, drop heart stress reaction
50
name four common beta blocker side effects
congestion, bronchospasm, conduction issues, ED, nightmares, confussion
51
if you suspect cocaine use do not use what drug
beta blocker
52
how do ACE inhibitors work
vasodilation, reduces sympathetic nervous system
53
name 4 side effects of ace inhibitor
cough, angioedema, birth defects, rash and hives, hyperkalemia
54
what is a side effect of angiotension 2 receptor blocker
hyperkalemia, worsens renal function with stenosis
55
what medication is good in blacks and what is better
aldosterone receptor antagonist, ccb is better
56
what is important about aldosterone receptor antagonist
not a drug of choice and not monotherapy
57
what htn drug prevents cva
ccb
58
what ccb should be used with chf pateitns
amlodipine
59
name three side effects of ccb
edema, constipation, headache
60
what htn med is used with ptsd
alpha adrenoceptor antagonist
61
what is a side effect of alpha adrenoceptor antagonist
floppy iris
62
what are two side effects of methyldopa
hepatitis and hemolytic anemia
63
what is used for preg females
methyldopa
64
what is normaly the cause of pediatric htn, what is the first clue
renal problems, two vessel umbilical
65
what is a newborns bp
90/65
66
what three tests are done for high bp in kids
cbc, ua, renal us
67
what does buildup of fatty streaks cause
atherosclerosis
68
three types of cholesterol
ldl, hdl, vldl
69
what is the triglyceride range, what do you do for each range
150 normal
199 borderline high, lifestyle change
499 high, drugs
+500 very high, drugs lifestyle change and look for secondary cause
70
describe primary hyperlipedemia
inherited and rare
71
describe secondary hyperlipedema
diet, meds, medical conditions cause it
72
how do you find the lipid related cv risk
cholesterol/ hdl, lower ratio is lower risk
73
when are lipids screened for in men and women
35 in men, 45 in women, repeat every 5 years if low risk
74
what is special about hdl over 60
subtract 1 risk factor from cv
75
what are xanthomas, what do they mean
yellow papules on eye lids, triglycerides over 1000
76
what may be seen in the eyes with triglycerides over 2000
cream colered vessels
77
thiazide diuretics play what role in lipid treatment
they can raise them
78
what is the framingham score
10 year cad risk score
79
what are the total cholesterol numbers
200 normal
240 borderline
+240 high
80
what are the ldl numbers
100 normal
160 borderline
+160 high
81
what are the hdl numbers
above 45 normal
35-45 borderline
-35 high
82
to lower cholesterol how should the step 1 diet look
limit fat to 30% daily calories
| saturtaed fat less than 10%
83
what are the four classes of lipid lowering drugs
statins, niacin, fibric acid, bile acid binding
84
name four statins
lipitor, zocor, crestor, pravastatin
85
what is the most potent statin
crestor
86
what is the professors favorite statin
pravastatin
87
what are three se of statins and the main one
abdominal pain is the main one, gas and headache
88
what is primary concern with statins
could cause rhabdo
89
when should lipid profiles be repeated after drugs started
in 4 weeks, then 12 weeks
90
how often are liver function tests done with lipd drugs
every 6 months
91
when should lipd medications be stopped, a bad reason
serum transaminase levels exceed 3x the normal limit or if myopathy myositis occurs
92
what is special about niacin
use with combination lipid disorder
93
what is main se of niacin and what will help
flushing, nausea and headache, take an asprin at evening meal, double each week to reduce se
94
when should niacin not be used
gout or peptic ulcer
95
what is special about using fibric acid
dont use with statins, take 30 min before meals
96
what is special about effects on lipids with bile acid drug
could increase triglycerides
97
what is special about instructions for bile acid resins
take 1 hour before and four hours after any medications to prevent binding
98
what is important about lipids and lipid drugs in preg
dont give lipid drugs to preg women, lipids could raise 150 and its normal in preg
99
how is lipids treated in kids
screen at 2 if family history present, drugs can start at 10 but diet and exercise must be tried for 1 year before meds
100
name a niacin drug
nispan
101
name a fibrate
lopid, tricor
102
name a bile acid resin
colestid
103
who do you not give statins to
liver disease
104
why should fibric acid not be given with statins
it increases muscle toxicity
105
what are the two types of heart failure and what are the keys to them
dystolic heart failure is a filling problem, systolic heart failure is a problem ejecting the blood
106
what is the most common type of systolic heart failure
decreased ejection fraction is most common type
107
what are four symptoms of left ventricular heart failure
exertional dyspnea, cough, trouble lying flat, fatigue, PND
108
what are two signs of right ventricle heart failure
hepatomegaly, dependent edema
109
what is usually the cause of right ventricle failure
left ventricle failure
110
what is the ejection fraction of systolic HF
less than 40
111
what are the key diffrences with right and left HF in relation to lungs
systolic cause progressive SOB, diastolic causes acute pulm edema
112
what age does left anf right HF start
systolic is under 65 diastolic is over 65
113
what will the ekg show with left and right HF
systolic has q waves, diastolic has LVH
114
the physical exam when listening to the heart shows what with systolic HF
displaced point of maximal impulse
115
what is definitive diagnostic test for HF
echocardiogram with doppler flow
116
what will BNP differintiate
dyspnea of HF vs pulmonary disease
117
what is the numbered classification system for HF
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
what numbers of the HF class system corespond to the letter system
a. is nothing
b. 1
c. 2 and 3
d. 4 and specialized interventions
119
what is tx for stage a HF
prevent it
120
what is tx for stage b HF
ACE or ARB, repair or replace valvues
121
what is tx for stage c HF
ACE and BB in everyone, digoxin, diuretic, aldactone, vaccines
122
what is tx for stage d HF
pace maker and stuff
123
name three loop diuretics
lasix, bumetamide, toremide
124
what should blacks get for HF
ACE, hydralazine, nitrates
125
when will pedi HF show
by 6 months
126
what is special about preg and HF
cardiomyopathy can happen the last month of preg and 6 months after
127
how fast do ischemic symptoms resolve
5-20 min
128
what is prinzmetals angina
variant coronary artery spasm
129
when do prinzmetals angina typicaly happen
in the morning
130
what is prinzmetals angina treated with
nitrates, the ccb nifedipine, can have st elevation
131
how is prinzmetals angina dx
off history
132
what does a angina attack longer than 30 min suggest
unstable angina MI or alternative dx
133
what is first line angina treatment
BB
134
what should be refered to cardiology
pos stress test, or worsening symptoms
135
what is the best stress test
stress echo
136
what has kerley B lines on x ray
CHF
137
what must be excluded when chest pain present
CAD
138
name three types of gi problems that cause chest pain
PUD, GERD, gall bladder dz
139
CAD chest pain is normaly in who
older males or postmenopause womean
140
what dz in kids can cause chest pain
kawasakis
141
what is preg cardiac symptom mean
go to cardiology
142
name four types of angina
chronic stable, variant, unstable, asymptomatic
143
who is asymptomatic CAD common in
women and diabetics
144
what is angina pectoris normaly from
atherosclerotic heart dz
145
what 5 questions are there for angina
circumstance, characteristic, location, duration, effects of NTG
146
what is stable angina treated with
ntg
147
what is long term nitro called and what is special about it
isosorbidedinitrate, wipe off before bed
148
when is BB not used in stable angina or MI
if severe bronchospastic dz
149
what does ASA do
interfears with platlet agrigation
150
what are the 4 points to metabloic syndrome
HTN, obesity, dyslipidemia, DM
151
metabolic syndrome if more than three of what is present
abdominal obesity, triglycerides over 150, hdl under 40 in males and under 50 in females, fasting glucose over 110, HTN
152
what is risk factor lab for CAD
increased CRP less than 1 or over 3
153
what must be specified in acute coronary syndrome
STEMI or non STEMI
154
what should not be done with non stemi
dont cath and dont use fibrinolytic therapy
155
how is NSTENI dx
st depression, positive cardiac markers, give antiplatlet and anticoagulant
156
what is the killip classification
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
what htn drug not used with mi
ccb
158
what two meds are given at dc with mi
asa and clopidrogrel for 1 year
159
were is the foramen ovale in a newborn heart
between atria
160
what are the two types of newborn heart disese
acyanotic and cyanotic
161
name 4 left to right shunting congenital heart dz that cause increased pulmonary blood flow
atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular septal defect
162
name 1 left to right shunting congenital heart dz that cause obstruction of blood flow to the right side
pulmonary stenoisis
163
name 4 left to right shunting congenital heart dz that cause obstruction of blood flow to the left side of the heart
coarcation of the aorta, aortic stenosis, mitral valve stenosis, other congenital lessions
164
three common s/s of acyanotic CHD
CHF, pulmonary HTN, lung infections
165
what catagory is atrial septal defect
increases pulmonary blood flow
166
how does small or moderate ASD present
non symptomatic
167
how is ASD dx
transesophegeal echo
168
how is asd tx
only large is surgery or cath
169
how large is an ASD that will close
4mm
170
at what ratio for shunting does an adult need surgery for something like ASD
more than 2
171
what catagory of congenital defect is ventricular septal defect
increased pulmonary blood flow
172
what is the most comon congenital heart dz
ventricular septal defect
173
what is done about VSD
most close themselves, surgery if ratio is greater than 2
174
how big is a large vsd
6-10mm
175
what is seen on exam with vsd
pansystolic murmur, sternal buldge
176
how do you dx VSD
echo or mri
177
what should be done with VSD and PDA
abx before dental work
178
when is VSD surgery contraindicated
id right to left shunting
179
what is eisenmengers syndrome
right to left VSD shunting
180
what catagory is PDA
increased pulmonary blood flow
181
what is pda
blood flows from the aorta to the pulmonary artery
182
when does a pda normaly close
day 3-5
183
how does a PDA present
machinery like rough murmer, split s2, bouwnding pulse,
184
never do what for a pda
cardiac cath
185
how to dx pda
echo or mri or doppler us
186
what drug will help close pda, what should be watched
indomethacin, urine
187
what catagory is atrioventricular septal defect
increased pulmonary blood flow
188
Atrioventricular SD is common in who
downs syndrome
189
partial atrioventricular defect is what
cleft mitral valve and little or no vsd
190
a complete atrioventricular defect is what
large left to right shunt, both atrial and ventricle, tricuspid and mitral regurgitation, pulmonary HTN and pulmonary valve regurgitation
191
what does atrioventricular septal defect look like on x ray
all 4 chambers are enlarged on x ray
192
what should not be done for atrioventricular septal defect
cardiac cath
193
how is atrioventricular septal defect dx, looks for what
ECHO, angiography looks for goosneck deformity in complete form
194
how is atrioventricualr septal defect treated
always surgery
195
what catagory is pulmonary stenosis
obstruction of blood flow to right side of heart
196
how does pulmonary stenosis present on x ray
right ventricular enlargment
197
how does pulmonary stenosis sound in stethoscope
high pitched harsh systolic murmer
198
how is pulmonary stenois tx
balloon valvuloplasty then surgery if that dosnt work
199
what catagory is coarcation of the aorta
obstruction of blood flow to left side of the heat
200
what is coarcation of the aorta
narrowing of the aorta
201
when might coarcation of the aorta be noticed
days after birth once pda closes
202
how is a coarctation of the aorta heard
blowing systolic murmer in the left axilla/back
203
what is a classic sign of coarctation of the aorta
weak femoral pulse after pda closes, right arm htn and nosebleeds
204
how is coarctation of the aorta tx
prostoglandins until surgery is done or balloon angioplasty
205
how is coarctation treated in adults
stents cuz it can reoccur
206
what catagory is aortic stenosis
obstruction of blood flow to left side of the heat
207
how is aortic stenosis heard
systolic ejection murmur at upper right sternal boarder systolic click at apex with thrill in carotid arterys
208
how is aortic stenosis tx
once chf shows then immediate surgery or cath
209
what is the fourth catagory of acyanotic heart disease
myocardial dz
210
name four types of myocardial dz
glycogen storage dz (amyloidosis), anomolus origin of left coronary artery, endocardial fibroelastosis, cardiomyopathy
211
name three types of cyanotic heart dz
tetrology of fallot, transposition of the great arteries, double outlet right ventricle
212
what catagory is tetralogy of fallot
cyanotic heart dz
213
what are the four components of tetralogy of fallot
1. right ventricle hypertrophy
2. VSD
3. narrowed pulmonary artery, and abnormal valve
4. aorta straddles the ventrical septum
214
what is a key sign of tetralogy of fallot
squatting during exercise d/t right to left shunt
215
what is "tets"
sudden cyanosis
216
what does tetralogy of fallot look like on chest x ray
boot shaped
217
what catagory is transposition of the great arteries
cyanotic heart dz
218
who gets trasposition of the great arteries
large males moslty
219
what must happen for transposition of the great arteries
VSD or PFO
220
what does transposition of the great arteries look like on an x ray
egg on a string
221
what are the seven points to a murmur
```
timing
pitch
intensity
pattern
quality
loaction/ raditation
resp phase variations
```
222
what is murmur timing
systolic or diastolic
223
what is murmur pitch
high or low
224
what is murmur intensity
grade 1-6
225
what are the murmur intensity descriptions
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
what is murmur pattern
crescendo decrescendo
227
what is murmur quality
musical, harsh, raspy, blowing
228
whats herd midsystolic
semilunar valves
229
whats herd holosystolic
regurg av valves
230
whats herd late systolic
mitral valve prolapse
231
whats herd systolic early and harsh
aortic pulmonary stenosis
232
whats herd continuous diastolic
PDA
233
whats herd as crescendo decresendo midsystolic
aortic stenosis or inccent
234
whats herd as pansystolic and plateau
mitral regurgitation
235
describe a inocent murmur or stills murmur
soft, systolic, vibratory, grade 1 or 2, spex to lower sternal border, louder at supine less with breathing, LOUDER WITH FEVER OR TACHY
236
letter thing for systolic heart murmur origin
```
MR PASS MVP
mitral regurg
physiologic like fever
aortic stenosis
systolic
mitral valve prolapse
```
237
what are the valves doing in systoly
mitral and tricuspid are closed so could regug
| aortic and pulmonary are open so stenosis
238
describe mitral valve regurg and keys
pansystolic maximal at apex and radiates to axilla, less with valsalva and standing, increased with squatting
239
describe tricuspid regurgitation and keys
lower left sternal to right sternal systolic variable blowing, LEFT PARASTERNAL MURMUR THAT INCREASES WITH INSPIRATION
240
what can happen with tricuspid regug
hepatomegaly
241
what is a midsystolic murmur do to
turbulence due to temporary increase in blood flow
242
describe aortic stenosis and key points
radiates to the neck, harsh, loud, HEARD BEST WITH PT SITTING AND LEANING FORWARD
243
what are the physical signs of aortic stenosis
SAD
syncope
angina
dyspnea
244
key to valvular aortic stenosis
grade 3 loud at 1 and 2 intercostal space radiates to suprasternal notch,
245
describe mitral valve prolapse keys
MIDSYSTOLIC CLICK increased with standing and valsalva, more in females
246
term for diastolic heart murmurs
```
ARMS and PARTS
aortic regurgitation
mitral stenosis
pulmonic regurg
tricuspid stenosis
```
247
keys to mitral stenosis
opening snap following s2, diastolic rumble herd in left lateral position worse with sit ups
248
what does squatting do to murmurs
makes them louder except for hypertrophic cardiomyopathy
249
what three drugs are for a fib
beta blocker (metopolol), digoxin, warfarin
250
how is wrfarin dosed
start at 5mg adjust by 50% for INR between 1-2 then 2-3
251
more than 3 PVCs in a row is what
v tach
252
what is a key sign of DVT
swelling in one leg
253
what is homan's sign
dorsiflex the foot and look for pain, not a good sign of dvt
254
if you cant give heparin for a emergent dvt give what
atroven
255
once home how should warfarin be adjusted
5-20%
256
what is intermitent claudication
exercise makes artery disease worse
257
how does artery disesase peripheral looks
shinny skin with loss of hair
258
what is ABI
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
the three P's are what and for what
pain pallor pulselessness, arterial
260
what is proper pulse
2+
261
how is edema rated
+1 =2mm then each number up is another 2mm
262
if you think raynauds then think what
thats not arterial, rule out burgers
263
what is another name for burgers
peripheral thrimbophlebitis obliterans, leads to finger loss
264
who is burgers often in
men who smoke
265
what is CEAP
```
classification of chronic venous disease
0-none
1-reticular veins
2-varicose veins
3-edema
4-skin changes
5-healed ulcerations
6-active ulcers
```
