Cardio 4 geriatrics

Question 1

Blood pressure stages

Answer 1

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

Question 2

MCC secondary HTN

Answer 2

renovascular

Question 3

blood pressure goals

Answer 3

< 140/90

<150/90 for 60 and older

Question 4

HTN emergency/urgency

Answer 4

SBP > 180 or DBP > 120

Question 5

tx HTN emergency

Answer 5

IV BP agents - MAP reduced by 10-20% in the first hour and an additional 5-15% over the next 23 hours

Question 6

tx HTN urgency

Answer 6

gradual reduction of MAP by 25% over 24-48 hours with clonidine or captopril

Question 7

what is restrictive cardiomyopathy

Answer 7

diastolic dysfunction in a non-dilated, rigid ventricle –> impedes ventricular filling

Question 8

causes of restrictive cardiomyopathy

Answer 8

amyloidosis (MC)
sarcoidosis
hemochromatosis

Question 9

what heart sound is MC in restrictive cardiomyopathy

Answer 9

S4

Question 10

dx restrictive cardiomyopathy

Answer 10

echo
endomyocardial biopsy - criterion standard

Question 11

echo for restrictive cardiomyopathy

Answer 11

non-dilated ventricles
diastolic dysfunction
biatrial enlargement

if amyloidosis - bilateral ventricular wall and inter ventricular septal thickness

Question 12

endomyocardial biopsy for amyloidosis/restrictive cardiomyopathy

Answer 12

apple-green birefringence with Congo red stain

Question 13

what is HCM

Answer 13

autosomal dominant genetic disorder of inappropriate LV and/or RV hypertrophy –> LV outflow obstruction, diastolic dysfunction, and ischemia

Question 14

PE for HCM

Answer 14

S4
pulsus bisferiens - double pulse

Question 15

EKG for HCM

Answer 15

LVH
prominent Q waves

Question 16

echo for HCM

Answer 16

asymmetric ventricular wall thickness 15 mm or greater

Question 17

tx HCM

Answer 17

BB - first line
CCB

Question 18

what is dilated cardiomyopathy

Answer 18

systolic dysfunction and dilation of both ventricles

Question 19

PE for dilated cardiomyopathy

Answer 19

S3
lateral displacement of the PMI

Question 20

echo for dilated cardiomyopathy

Answer 20

systolic dysfunction
dilated chambers and thin-walled ventricles

Question 21

what meds should be avoided for dilated cardiomyopathy

Answer 21

NSAIDs
CCBs

Question 22

what is giant cell arteritis

Answer 22

immune mediated large and medium vessel granulomatous vasculitis of the extra cranial branches of the carotid artery

Question 23

risks for giant cell arteritis

Answer 23

women
> 50
caucasian

Question 24

sx giant cell arteritis

Answer 24

HA - new onset or change in baseline
jaw claudication - relieved by stopping jaw movement
visual changes - eye pain, vision loss, diplopia, amaurosis fugax

may have decreased temporal artery pulsation

Question 25

dx giant cell arteritis

Answer 25

ESR and CRP
temporal artery biopsy - criterion standard

Question 26

tx giant cell arteritis

Answer 26

high dose systemic steroids