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Acute & Chronic I > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Due to coronary vessel spasm. Discomfort occurs mainly at rest

A

variant angina

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2
Q

Pain may occur with less provocation, be prolonged, more sever, associated symptoms

A

Unstable angina non-STEMI

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3
Q

Chest pressure, heaviness, squeezing, crushing. May be associated with N/V, diaphoresis, SOB

A

acute STEMI

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4
Q

Microvascular angina is more often seen in

A

women

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5
Q

May be d/t insufficient dilation of coronary arteries

A

microvascular angina

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6
Q

symptom not typically recognized as a symptom of chest pain

A

headache

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7
Q

EKG markers for hypokalemia

A

U waves, peaked T waves, wide QRS, prolonged PR

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8
Q

changes on EKG with ischemia include

A

T wave inversion

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9
Q

angina pain is caused by myocardial irritation from

A

lactic acid

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10
Q

At risk for HF but w/o structural heart disease or symptoms of HF

A

Stage A

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11
Q

Structural heart disease but w/o S&S of HF

A

Stage B

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12
Q

Structural heart disease with prior or current symptoms of HF

A

Stage C

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13
Q

Refractory HF requiring specialized interventions

A

Stage D

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14
Q

No limitation of physical activity. Ordinary physical activity doesn’t cause symptoms of HF

A

Functional status I

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15
Q

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF

A

Functional status II

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16
Q

Marked limitation of physical activiity. Comfortable at rest, but less than ordinary activities caused symptoms of HF

A

Functional status III

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17
Q

Unable to carry out any physical activity w/o symptoms of HF, or symptoms at rest

A

Functional status IV

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18
Q

adverse effect of ACEI in blacks

A

angioedema

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19
Q

class of drugs used to trx isolated systolic hypertension

A

calcium channel blocker

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20
Q

when men should be screened for dyslipidemia

A

age 35 and older, age 20-35 if at high risk for CHD

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21
Q

when women should be screened for dyslipidemia

A

age 45 and older if at increased risk for CHD

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22
Q

parameters in Framingham scale

A

age, gender, total cholesterol, HDL, systolic BP, smoking, diabetes, BP treatment

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23
Q

statins are contraindicated in

A

pregnancy

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24
Q

initiate moderate to high intensity statin if 10 year ASCVD risk is

A

> 7.5%

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25
Q

start fenofibrate if

A

TG > 500 and at risk for pancreatitis

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26
Q

rechecking cholesterol level 4-12 weeks after starting a statin are to

A

assess for adherence, not to titrate.

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27
Q

4 groups to treat with statins

A
  1. clinical ASCVD
  2. LDL > 190
  3. Diabetics 40-75 with LDL 70-189
  4. LDL 70-189 with 10 year risk > 7.5% w/o ASCVD or DM
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28
Q

this does not need to be routinely measured with statins

A

CK

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29
Q

measure this baseline before starting statins

A

ALT

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30
Q

according to ACA/AHA 2014, if muscle symptoms develop

A

temporarily d/c statin, evaluate for other conditions, rechallenge with lower dose or same statin.

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31
Q

side effect of CCB

A

peripheral edema

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32
Q

drug of choice for isolated systolic HTN

A

CCB

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33
Q

avoid giving this drug in patients with HF

A

CCB

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34
Q

beta blockers can block signs of

A

hypoglycemia in diabetics

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35
Q

which HTN drug can increase lipid levels?

A

HCTZ

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36
Q

drug class of choice for CHF

A

ACEI

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37
Q

screen these people for AAA

A

those 65-75 year old men who have ever smoked one time

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38
Q

a decreased risk of AAA is those who are

A

women and diabetics

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39
Q

direct factor Xa inhibitor

A

Xarelto and Eliquis

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40
Q

direct thrombin inhibitor

A

Pradaxa (dabigatran)

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41
Q

direct thrombin and direct factor Xa inhibitors are contraindicated in

A

prosthetic heart valves and renal disease

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42
Q

preferred anticoagulant in pregnant women

A

LMWH

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43
Q

screening for BP begins in people age

A

18 and older

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44
Q

USPSTF screening for high blood pressure

A

every 2 years for people who have normal BP and every year for those who are prehypertensive

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45
Q

goal BP for those > 60

A

less than 150/90

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46
Q

med for all people with CKD present

A

initiate ACEI or ARB

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47
Q

med for black people with diabetes

A

CCB or thiazide

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48
Q

med for white people with diabetes

A

thiazide, ACEI, ARB, CCB

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49
Q

screening for carotid artery stenosis

A

NOT recommended to screen for those asymoptomatic

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50
Q

this test should not be a screening tool for diagnosing CHD

A

coronary artery calcium scoring

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51
Q

The USPSTF recommendations for exercise ECG testing

A

against routine screening for those at low risk for CHD

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52
Q

The USPSTF recommendations for nontraditional risk factors for CHD

A

insufficient evidence to help screen for CHD

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53
Q

nontraditional risk factors

A

CRP, ABI, fasting glucose, homocysteine

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54
Q

USPSTF recommendation for ABI

A

insufficient in screening for PAD

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55
Q

contraindication for exercise ECG stress test

A

baseline ECG abnormality

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56
Q

golden standard in diagnosing CHD

A

angiography

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57
Q

stable angina occurs

A

predictably and at a certain level of exertion and is relieved with rest

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58
Q

drugs for angina

A

beta blockers, CCB, nitrates

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59
Q

reduce HR and contractility

A

beta blockers

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60
Q

only antianginal drug that is proven to prevent reinfarction and improve survival in patients who had an MI.

A

beta blocker

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61
Q

beta blockers should not be used in those with

A

variant (prinzmetal) angina

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62
Q

cause coronary and peripheral vasodilation and reduce contractility.

A

CCB

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63
Q

do not use this CCB with beta blockers for angina

A

nifedipine

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64
Q

add this on if initial trx for angina with beta blockers fail

A

CCB

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65
Q

first line for acute angina

A

nitrates

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66
Q

atypical sign of MI in elderly

A

exertional dyspnea

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67
Q

consider starting statin therapy in children > 10 years old with elevated LDL after

A

6 months of lifestyle counseling.

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68
Q

first DOC for HF with LVEF less than 40%

A

ACE or BB

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69
Q

drugs for HF

A

diuretic, ACE/ARB, beta blocker

70
Q

may lead to an increase in symptoms of HF for 4 to 10 weeks before any improvement is noted.

A

beta blockers

71
Q

Prehypertension

A

120-139, 80-90

72
Q

Stage 1 HTN

A

140-159, 90-99

73
Q

Stage 2 HTN

A

> 160, >100

74
Q

Diastolic pressure is better predictor of mortality in those

A

under age 50

75
Q

BP percentiles for children are based on

A

age, gender, height

76
Q

Both systolic and diastolic BP less than 90th percentil

A

Normal BP

77
Q

Systolic and/or diastolic BP ≥90th percentile but but less than 95th percentile or if BP exceeds 120/80

A

Prehypertension

78
Q

Systolic and/or diastolic BP between the 95th percentile and 5 mmHg above the 99th percentile

A

Stage 1 HTN

79
Q

Systolic and/or diastolic BP ≥99th percentile plus 5 mmHg

A

Stage 2 HTN

80
Q

primary HTN is caused by

A

genetic and environmental factors

81
Q

Prepubertal children generally have some form of

A

secondary HTN

82
Q

adolescents and postpubertal children usually have

A

primary HTN

83
Q

Primary HTN is associated with

A

being overweight and having a positive family hx of HTN

84
Q

meds for HTN should be started in children if

A

they are in stage 2 HTN or if stage 1 persists after 4-6 months of nonpharm therapy

85
Q

first DOC for HTN in children

A

ACEI, BB, CCB

86
Q

HTN meds contraindicated in pregnancy

A

ACEI and ARB

87
Q

these kids should be restricted from high-static sports.

A

Stage 2 HTN

88
Q

secondary HTN is caused by

A

medical conditions or medications

89
Q

meds that can cause secondary HTN

A

OCP, NSAIDs, antidepressants, steroids, stimulants

90
Q

administer BB cautiously in patients with

A

DM and asthma

91
Q

hypertensive crisis is when

A

diastolic greater than 120 mmHG

92
Q

new goals for cholesterol is

A

basing off CVD risk rather than LDL goal

93
Q

Framingham risk calculator

A

age, gender, smoking, trx of HTN, total cholesterol, HDL, systolic BP

94
Q

Pooled cohort risk calculator

A

gender, age, race, total cholesterol, HDL, systolic BP, diabetes, smoking, on HTN meds

95
Q

when to check LDL when starting statins

A

6 weeks after starting then every 6-12 months

96
Q

these are NOT recommended as primary prevention for high cholesterol

A

nonstatins as they have high cardiovascular mortality

97
Q

changes in lipid therapy

A

NO LDL goals

98
Q

patients with ACS should be treated with

A

atorvastatin 80 mg

99
Q

statin with the least risk of myopathy

A

pravastatin

100
Q

The major effect of fibrates are to

A

lower triglycerides and raise HDL levels

101
Q

lowers the LDL-C when used alone and may be helpful for avoiding high doses of statins

A

ezetimibe

102
Q

Acceptable values for cholesterol in children

A

below the 75th percentile, except for HDL, which is being above the 20th percentile

103
Q

Normal total cholesterol in children

A

less than 170

104
Q

Normal LDL in children

A

less than 110

105
Q

normal HDL in children

A

greater than 45

106
Q

normal TG in children 0-9 years old

A

less than 75

107
Q

normal TG for children 10-19 years old

A

less than 90

108
Q

High LDL for children

A

greater than 130

109
Q

Bad HDL in children

A

less than 40

110
Q

High TG in children 0-9

A

greater than 100

111
Q

High TG in children 10-19

A

greater than 130

112
Q

abnormal cholesterol values in children

A

more than 95th percentile, except for HDL which is less than 10th percentile

113
Q

marker for children for pediatric dyslipidemia

A

first degree relative with CAD less than 55 years old

114
Q

when to screen for dyslipidemia in children

A

at 9-11 years old, then at 17-21 years old.

115
Q

Pharmacotherapy for dyslipidemia should not be used in children less than

A

10 years old

116
Q

niacin is effective in

A

raising HDL levels

117
Q

A key difference between the pediatric and adult primary prevention approach is that

A

adults use 10 year risk and children use lifetime risk

118
Q

self-limited condition that lasts up to 12 days

A

Kawasaki disease

119
Q

Incidence of kawasaki disease

A

Asian descent; boys less than 5

120
Q

kawasaki disease mainly affects

A

coronary arteries

121
Q

s/s of kawasaki disease

A

fever more than 5 days, conjunctivitis, red lips/strawberry tongue, rash, cervical lymphadenopathy

122
Q

labs for kawasaki disease

A

high ESR and CRP, leukocytosis, thrombocytosis, high ferritin

123
Q

elderly and warfarin

A

require smaller dose

124
Q

elderly should not take warfarin with

A

NSAIDs and Plavix

125
Q

direct thrombin inhibitor

A

pradaxa

126
Q

large aneurysms are more than

A

5.5 cm

127
Q

risk factors for AAA

A

smoking, male gender, advanced age, caucasian, atherosclerosis, HTN, family hx of AAA

128
Q

imaging of choice for AAA

A

nonruptured- US; ruptured- CT

129
Q

s/s of ruptured AAA

A

hypotension, severe back pain, pulsatile abd mass

130
Q

s/s of nonruptured AAA

A

abdominal/back pain, limb ischemia, fever

131
Q

For patients with suspected ruptured AAA who are hemodynaically stable this is done

A

urgent abdominal imaging

132
Q

trx for asymptomatic AAA less than 5.5 cm

A

watchful waiting

133
Q

PVC in children

A

benign

134
Q

PVCs can turn into

A

Vtach

135
Q

sinus tachycardia is related to

A

anxiety or activity that has a gradual onset and termination

136
Q

trx for acute proximal DVT

A

anticoagulation

137
Q

trx for distal DVT

A

surveillance with US over 2 weeks

138
Q

outpatient treatment for DVT

A

LMWH and warfarin for 5 days, then once INR is therapeutic for 2 days, LMWH can be d/c. Continue warfarin for at least 3 months

139
Q

ambulation with DVT

A

strongly recommended; compression stockings within 2 weeks AFTER starting anticoagulant

140
Q

intermittent claudication

A

pain during activity and relieved within 10 min of rest.

141
Q

arterial ulcers are found

A

tips of toes and between toes

142
Q

arterial ulcers

A

painful, wound is necrotic,

143
Q

PAD

A

skin is shiny and hairless, decreased pulses, pale/cool

144
Q

PVD

A

thickened skin, aching/heaviness in legs, edema, brownish discoloration

145
Q

venous ulcers are found

A

lateral and medial malleoli

146
Q

venous ulcers

A

not as painful, weeping, scaling, exudate

147
Q

most common valvular disorders in elderly adults.

A

aortic stenosis and mitral regurgitation

148
Q

s/s of aortic stenosis

A

dyspnea on exertion, syncope

149
Q

aortic stenosis murmur

A

systolic ejection heard after s1 before s2.

150
Q

aortic stenosis is best heard

A

at second right ICS and carotid arteries

151
Q

s/s of aortic regurgitiation

A

usually asymptomatic; later symptoms are wide pulse pressure, thrill

152
Q

aortic regurgitation murmur

A

high-pitched, blowing diastolic murmur

153
Q

aortic regurgitation is best heard at

A

left sternal border b/t 3-4th ICS when patient is leaning forward, squatting, or valsalva

154
Q

aortic regurgitation is caused by

A

rheumatic heart disease

155
Q

s/s of mitral prolapse

A

palpitations, dyspnea, dizziness

156
Q

mitral prolapse murmur

A

nonejection systolic click

157
Q

those with mitral prolapse have high risk of having

A

mitral regurgitation

158
Q

mitral regurgitation trx for elderly

A

better outcome with mitral valve repair than replacement

159
Q

rheumatic fever remains the leading cause

A

mitral stenosis

160
Q

s/s of mitral stenosis

A

dyspnea and afib

161
Q

mitral stenosis murmur

A

low pitched, diastolic murmur heard at apex; best heard when pt lying on left side with bell

162
Q

opening snap is seen in

A

mitral stenosis

163
Q

evidence to support antimicrobial prophylaxis for prevention of endocarditis

A

weak

164
Q

high risk conditions that need atbx prophylactically for procedures

A

prosthetic heart valves

165
Q

atbx prophylaxis for procedures

A

amoxicillin 30-60 min prior

166
Q

abtx prophylaxis for procedures who are allergic to PCN

A

cephalexin or clindamycin

167
Q

this pediatric murmur decreases in intensity when the child stands

A

Still’s murmur

168
Q

venous hum should disappear when

A

the head is turned or when lying supine, or when pressure is applied over jugular vein

169
Q

signs of a pathologic murmur

A

grade III or higher, diastolic murmur, increase in intensity when standing.

170
Q

stills murmur is best heard when

A

child is lying down

171
Q

which HTN medication can increase triglycerides?

A

beta blockers

Acute & Chronic I (4 decks)

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