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Patient has cotton-wool spots or retinal hemorrhages (flame hemorrhages). What do they have?

Hypertension...don't over think it


What are possible side effects to diuretics (thiazides, K+ sparing, or loop)?

Increased serum glucose, cholesterol, or TGs

(Thiazides --> hyperGLUC)


What are potential side effects of beta-blockers?

Bronchoconstriction (if non-beta1 selective...n+)
HDL reduction
Increased TGs


Where do CCBs work? What are the possible side effects?

Dihydropyridines: vascular smooth muscle (used for HTN)
Nondihydropyridines: coronary arteries (not often used for HTN)

Hypotension, headache, constipation, increased GERD


What is the clinical difference between ACE-Is and ARBs?

Both cause azotemia, hyperkalemia, and teratogenicity
BUT ARBs do NOT cause angioedema or dry cough


Which antiHTN drugs can be used during pregnancy?



How should a HTN emergency be treated?

Reduce DBP by up to 25% with nitroprusside, labetalol, nicardipine, or fenoldopam over 2 hours...then manage with BB and ACE-I


Person is found on the floor, cold and clammy, and with long capillary refill. What is a concern? What are the treatment options?

Cardiogenic shock should be treated with inotropes (dobutamine), intra-aortic balloon pump, PTCA (for MI)


What is the normal size of an aorta? How much bigger does it have to be to be considered aneurysmal?

Normal: 1.5-2.5cm
Aneurysmal: 2x normal


What is seen on ECG with an aortic dissection?

Normal...LVH maybe


When concerned for possible PVD, an ABI can be ordered. What numbers are concerning?



Besides aspirin, what other medications can be used to treat PVD?

Pentoxifylline (xanthine derivative --> phosphodiesterase inhibitor)
Cilostazol (quinolinone derivative --> phosphodiesterase inhibitor)


What is the concern with AVMs?

Mass effect --> pain
Increased risk of thrombus


What is Virchow's triad used to determine? What is the triad?

Risk of DVT

Stasis, hypercoagulability, and vascular damage


A post-op patient has hemorrhage risks. What should be done to prevent detrimental effects of clotting?

IVC-filter placement


Patient presents with fever, hematuria, neuropathy, joint pain, and palpable purpura. What is a possible diagnosis?What labs should be ordered? What would be seen on angiography?

Polyarteritis nodosa

CBC: increased WBC, decreased Hgb and Hct
ESR: increased
UA: proteinuria, hematuria
p-ANCA (perinuclear-AntiNeutrophil Cytoplasmic Antibodies): negative

Numerous aneurysms (beads on a string)


Who typically gets polyarteritis nodosa? How is polyarteritis nodosa treated?

Young males
Corticosteroids or other immunosuppressant agents


An old lady comes in with a new onset headache, temporal tenderness, and jaw pain. What should be checked on exam? What should be done?

This could be Temporal (Giant Cell) Arteritis...check her eyes

Give Prednisone first...then get a biopsy


A youngish Asian woman (10-40yo) presents with malaise, vertigo, syncope, and fever. On exam she has decreased carotid and limb pulses. What is on the differential? What diagnostic tools can be used? How should it be treated?

Takayasu arteritis (inflammation of aorta and its branches)

Angiography, CT, or MRI can be used

Give corticosteroids or other immunosuppressants
Bypass grafting


What is seen on biopsy with Takayasu arteritis?

plasma cells and lymphocytes in media and adventitia
Giant cells
Vascular fibrosis


Patient presents with asthma-like symptoms, mononeuropathy (pain, numb, or weak), and has a rash. What should be considered? What labs should be drawn? How should it be treated?

Allergic granulomatosis with angiitis (Churg-Strauss syndrome)

CBC: increased eosinophils
ESR: increased
p-ANCA: increased

Corticosteroids or immunosuppressants


Patient comes in with abdominal pain and a papular rash on lower limbs. On history, find out had a URI not too long ago. What labs should be drawn? What should be watched for?

Check IgA...serum, purpura biopsy, renal biopsy
Spin down a urine to look for casts...IgA nephropathy


Young patient comes in with fever, lymphadenopathy, conjunctival lesions, maculopapular rash, edema, and desquamation of hands/feet. What is the likely diagnosis? What should be monitored? What are treatment options?

Kawasaki disease

Get an echo (+/- dobutamine) or angiography for coronary vessel irregularities

Treat with aspirin or IV gamma globulin...often self-limited


What are the possible complications to a large VSD that is not fixed?

Eisenmenger's syndrome (not common in developed world)
Increased risk of endocarditis


Patient had a known VSD, but nothing was done, and now presents cyanotic. What happened

Eisenmenger's syndrome

L --> R shunt --> increased pulmonary pressure --> R --> L shunt --> cyanosis...irreversible


What do patients with a known ASD need for surgeries/dental work?

Endocarditis prophylaxis (I'll look this up...because I thought it was changed to just foreign valves)


Would it be a good thing for an extreme-sports enthusiast to have an ASD?

No...more likely to desat at high altitudes and more likely to have decompression sickness during deep sea diving


What are possible complications of an ASD?

Eisenmenger's syndrome
RV dysfunction
Pulmonary HTN


Who is most likely to have a PDA?

Premature girls


How is PDA treated?

Indomethacin...decreases PGE2


A newborn is found to have transposition of great arteries and has actually survived so far. What other vascular defect does this baby likely have? What else is probably going on with the kid?

PDA or VSD (allows mixing of venous and arterial blood)

Apert syndrome, cri-du-chat syndrome, trisomy 13, 18, or 21


In utero, a baby was found to have TGA, what can be done after birth to prolong life?

Give PGE2...keep PDA open


What should be checked in a baby found to have Down Syndrome after birth? (I guess old mom didn't want prenatal ultrasounds...otherwise this could have been seen earlier)

Endocardial cushion defects (20% tris-21 people)


Who is most likely to have tetralogy of Fallot? What are the four parts?

Cri-du-chat, trisomies 13, 18, or 21

Pulmonary stenosis, VSD, overriding aorta, and RVH