Week 1- PVD and HTN

Question 1

Differentiate Essential VS Secondary HTN

Answer 1

Essential there’s no cause

Secondary there is a cause

Question 2

List several causes of 2nd HTN

Answer 2

1. Renal Artery Stenosis
2. Hyperthyroidism
3. Sleep Apnea
4. Obesity
5. NSAIDS
6. hyperaldosteronism
7. phemochromocytoma

Question 3

Symptoms of HTN

Answer 3

LVH, retinopathy, nephropathy, microalbumin in UA, PAD, stroke, CKD

Question 4

Goals for hypertensive therapy for patients greater than 60 without comorbidity?

Answer 4

150/90

Question 5

Define Type I and Type II Hypertension

Answer 5

Type I > 140/90

Type 2 > 160/100

Question 6

First Choice Drug with NO comorbidities

Answer 6

Thiazide Diruretic

Question 7

HTN: First Choice for black

Answer 7

CCB and/or HCTZ

Question 8

HTN: First Choice with CKD

Answer 8

ACE

Question 9

HTN: First Choice with DM

Answer 9

ACE

Question 10

HTN: First Choice with Stroke

Answer 10

HCTZ + ACE

Question 11

HTN: First Choice with CHF/ CAD

Answer 11

ACE + BB

Question 12

HTN: In clinic drug for high B/P

Answer 12

Clonidine

Question 13

HTN: Thiazide Diuretic: Name

Answer 13

HCTZ- 12.5 QD –> ;25 BiD
Caution: Gout, hyponatremia
Also helps decrease bone demineralization

Question 14

HTN: Beta Blocker

Answer 14

Metoprolol 50 mg 1-2 per day

Question 15

HTN: ACE

Answer 15

Lisinopril 10 mg QD

Contraindicated in Pregnancy, Renal Artery Stenosis, may cause hyperkalemia

Question 16

HTN: Dihydropyridines VS Non-dihydro

Answer 16

Dihydro: Amlodipine 2.5 QD
Can cause peripheral edema
Nondihydro- verapamil, diltiazem

Dikes spike the heart rate

Question 17

What do you suspect when on lots of meds or HTN doesn’t meet the patient’s typical profile?

Answer 17

Renal Ultrasound for Renal Artery Stenosis

Question 18

Five P’s of PVD

Answer 18

Pain, Pulselessness, palor, parathesia, paralysis

Question 19

ABI Normal, impaired, and severe

Answer 19

Ankle / Brachial
> 1 normal
.9 Obstructive lesion
.5 or less- severe disease

Question 20

Postural Color Change of Chronic Arterial Insufficiency

Answer 20

Pinkness in 10 sec = normal

> 15 seconds impaired

Question 21

Differential Diagnosis for PAD

Answer 21

chronic venous insufficiency, throbosis, phelbitis, polycythemia, anemia, Raynaud’s vasculitis, merger’s disease, aneurysms, and peripheral neuropathy

Question 22

Treatment for PAD

Answer 22

Main: walking and exercise- most effective
Smoking cessation
Angioplasty, stents, grafts

Question 23

Medications for PAD

Answer 23

Don’t necessarily help the PAD, but are more for associated CAD.
ASA first, then Plavix

Question 24

Differential Diagnosis of DVT

Answer 24

Strained muscle, cellulitis, lymphedema, baker’s cyst

Question 25

Causes of DVT

Answer 25

Estrogen therapy, immobilization

Question 26

Treatment for DVT

Answer 26

Good Kidneys- Lovenox, 1 mg/kg Q12 hours

If kidneys are bad, admit to hospital for heparin

Question 27

First step in low/interm possibility of DVT

Answer 27

D. Dimer

Question 28

First step in high possibility DVT

Answer 28

Ultrasound

Question 29

What do you do if ultrasound is negative for DVT, but d-dimer was positive?

Answer 29

Redo ultrasound in a week

Question 30

Define postural blood pressure change.

Answer 30

BP change by >10 mmHg

Question 31

What is resistant HTN and Treatment?

Answer 31

DBP>100 with 4 medications, also add aldosterone and refer

Question 32

What line of therapy is a beta blocker?

Answer 32

One of the last lines.

First lines: ACE/ARB, HCTZ, CCB