Exam 4 Flashcards
(118 cards)
1
Q
Dyslipidemia
A
Increase total LDL
Increased triglycerides
Decreased HDL
2
Q
What are triglycerides packaged into?
A
Chylomicrons
3
Q
What organ plays the biggest role in triglyceride metabolism?
A
The liver
4
Q
What is released from chylomicrons?
A
Fatty acids
5
Q
Atherosclerosis pathophysiology
A
Damage to vascular endothelium, recruits platelets/monocytes, LDL accumulates
Macrophages ingest oxidized lipids making foam cells
Fatty streak develops
6
Q
Metabolic syndrome
A
High triglycerides Insulin resistance Abdominal obesity Hypertension Low HDL
7
Q
Coronary artery disease equivalents
A
AAA
Diabetes
Peripheral vascular disease
Carotid artery disease
8
Q
Clinical findings of coronary artery dz
A
Angina
MI
9
Q
Cerebrovascular dz clinical findings
A
Stroke
Transient ischemic attack
10
Q
Peripheral artery dz clinical findings
A
Ischemic extremities
Claudication
11
Q
Mesenteric ischemia clinical findings
A
Pain out of proportion to exam
Death of intestine due to ischemia
Patient is sick
12
Q
Eruptive xanthomas
A
Elevated chylomicrons or VLDL
Red-yellow plaques, lipid deposits, especially on butt
13
Q
Tendinous xanthomas
A
Elevated LDL
Nodular yellow/skin-toned lesions
Lipid deposits
14
Q
Arcus senilis
A
Opacity of peripheral iris
Can be normal (aging)
Lipid deposits in younger pts
15
Q
Xanthelasma
A
Lipid deposits around eyelid
Can be hereditary (asian, Mediterranean)
Or hyperlipidemia
16
Q
Lipemia retinalis
A
Orange-yellow retinal vessels
17
Q
Pancreatitis
A
Caused by markedly elevated TGs, often >500
Alcohol abuse compounds risk
18
Q
Who is screened for dyslipidemia?
A
Men >35
Women >45
19
Q
Non fasting lipids
A
HDL and total cholesterol
20
Q
Fasting lipids
A
HDL, total cholesterol, LDL, TGs
21
Q
Fractionated lipids
A
More detailed estimate of risk
Smaller particles are more atherogenic
22
Q
CRP
A
High sensitivity is suggestive of CVD risk, and very high CRP is plaque rupture
23
Q
Statin groups
A
Clinical ASCVD
LDL >190
Diabetics
ASCVD risk of >7.5%
24
Q
What is the reduction is risk with lifestyle modifications?
A
12-14%
25
DASH
Dietary approaches to stop hypertension
High produce, low fat, low sodium
26
What do statin toxicities cause?
Hepatotoxicity
Myopathy
27
Fibrates
TG >200
Also good for excess VLDL
Slight increase in HDL
Slight decrease in LDL
28
What is the most modifiable risk factor for heart attack and stroke?
Hypertension
29
Normal BP
<120 <80
30
Prehypertension
120-139 80-89
31
Stage 1 HTN
140-159 90-99
32
Stage 2 HTN
>160 >100
33
Refractory HTN
Uncontrolled BP despite 3 antihypertensive medications
OR
BP that requires at least 4 antihypertensive medications to achieve control
34
Emergency HTN
Severe HTN plus acute end organ damage
35
urgent HTN
Severe HTN in asymptomatic patient
36
Moderate-severe hypertensive retinopathy
Severe HTN with retinal exudates, hemorrhages, or papilledema
37
Gestational HTN
HTN that develops after the 20th week of pregnancy and returns to normal postpartum
38
Preeclampsia
Development of HTN with proteinuria and edema after 20 weeks of pregnancy
Headache, visual disturbances, epigastric pain
39
Eclampsia
Additional presence of convulsions with preeclampsia that is not explained by neurological reasons
40
Primary factors to determine BP
Sympathetic nervous system
RAA system
Plasma volume (kidneys)
41
Peds secondary HTN
Primary renal disease
42
Young adults secondary HTN
Thyroid disease
43
Middle aged adults secondary HTN
Aldosteronism
44
Elderly secondary hypertension
atherosclerotic renal artery stenosis
45
Primary hyperaldosteronism triad
HTN
Unexplained or easily provoked hypokalemia or potassium wasting
Metabolic alkalosis
46
Cushing syndrome
Hypercortisolism
Usually iatrogenic, could be a tumor
Moon face, buffalo hump, ecchymosis
47
Pheochromocytoma
Catecholamine secreting tumor
Paroxysmal BP elevations
Triad: HA, palpitations, sweating
48
Necessary diagnostics in hypertensive patients
```
CMP
Hgb and Hct
Lipids
Urinalysis
EKG
```
49
What is the definitive test to diagnose renal artery stenosis?
Renal arteriography
50
If you are greater than 60, according to JNC 8 guidelines, the what is the threshold for SBP?
150 mm Hg
51
What is the recommended BP goal for patients with DM or CKD?
<140/90
52
What is the recommended BP goal in all HTN patients greater than 60 yo?
<150/90
53
Urgent BP management
Need to lower BP over hours to days to <160/100
54
Emergency HTN management
Lower pressure by 10-20% in the first hour, 5-15% over the next 23 hours
55
Follow up for HTN treatment
4-6 week intervals until goal achieved
56
Absolute hypotension
SBP <90
57
Relative Hypotension
Drop in SBP >40
58
Postural/orthostatic hypotension
Drop in BP when going from supine to standing position with associated symptomatolgy
59
Orthostatic response values
>20 fall in SBP
| >10 fall in DBP
60
Symptoms of orthostatic hypotension
Generalized weakness, dizziness, lightheadedness, visual changes, syncope
Maybe even angina or stroke
61
Blood pressure
Cardiac output x systemic vascular resistance
62
PCWP
Pulmonary capillary wedge pressure
63
Shock
Reduction in systemic tissue perfusion, decreased oxygen delivery
64
Hypovolemic shock
Decreased preload induced by volume loss
Decreased CO
Increased SVR
Decreased PCWP
65
Cardiogenic shock
Consequence of cardiac pump failure
Decreased CO
Increased SCR
increased PCWP
66
Distributive shock
Most common, severely decreased SVR
| Increase CO
67
Obstructive shock
Extracardiac causes of cardiac pump failure
Pulmonary vascular or mechanical
68
Cardinal findings of shock
```
Hypotension
Oliguria
Cool, clammy skin
Abnormal mental status
Metabolic acidosis
```
69
Management of shock
First, resuscitative efforts (ABCs)
Then IV fluids
70
Primary varicosities
Inherent wall defect
71
Secondary varicosities
Results from valve damage
Thrombophlebitis, trauma, DVT, etc.
72
Is symptom severity related to number or size of varicosities?
No!!
73
Varicose veins symptoms
Dull, aching heaviness, leg fatigue, pruritus, dark blue/twisted veins, maybe edema
Most common posterior/medial
74
What is the gold standard diagnosis for varicose veins?
Duplex ultrasonography
75
Superficial thrombophelbitis
Venous inflammation, thrombus develops in a superficial vein
76
Superficial thrombophlebitis clinical findings
Usually self limiting
May have dull pain, maybe mild swelling, tenderness, redness
Fever if septic version from IV catheter
77
Virchow's triad
Venous stasis
Endothelial injury
Hypercoaguable state
78
Deep venous thrombosis
Venous thromboembolism- DVT- PE
80% in deep veins of the calf
79
DVT clinical findings
Edema
Calf pain on dorsiflexion (homan's sign)
Low grade fever, tachycardia
Unilateral
80
DVT diagnosis
Well's criteria
Low protest probability- D dimer
Intermediate to high probability- ultrasound
81
Chronic venous insufficiency
Result of sustained venous hypertension in the leg
Primary: valve failure
Secondary: post thrombotic syndrome from DVT
82
Chronic venous insufficiency clinical
Varicose veins or telangiectasias
Ankle and calf dependent edema
Hyperpigmentation
Stasis dermatitis
83
Superior vena cava obstruction clinical findings
```
Dyspnea
Swelling of arms and face
Cough/hoarseness/dysphagia
Chest pain
Distended neck and chest veins
Head fullness/headaches
Syncope
```
84
Classic SCV obstruction picture
Elderly male with increased risk for lung cancer
85
Acute arterial occlusion
Surgical emergency
Golden period of 4-6 hours
Caused by embolis, thrombosis, trauma, or cardiac
86
6 P's of acute ischemic limb
```
Pain
Pallor
Pulselessness
Perishing cold
Parasthesias
Paralysis
```
87
Acute arterial occlusion clinical findings
```
Absence of distal pulses
Pallor
Weakness/paralysis
Pain- sudden and severe
Cold
```
88
Gold standard diagnosis for acute arterial occlusion
Angiography
89
Peripheral vascular disease
Claudication, arterial insufficiency, etc.
Systemic atherosclerosis
Objectively defined as an ankle-brachial index < .9
90
Leriche's syndrome
Aortoiliac occlusive disease
91
PVD clinical findings
```
Intermitten claudication
Impotence
Rest pain
Smoker
dependent rubor
Poor nail growth
Absent pulses
```
92
Aneurysm
Stretched and bulging section of the vessel wall (focal dilation >50% enlargement)
93
AAA
>90% are below renal arteries
>3 cm diameter
94
Classic triad of AAA rupture
Pain
Hypotension
Abdominal pulsatile mass
May have tachycardia and severe back or flank pain
95
Flank ecchymosis
Grey turner's sign
96
Periumbilical ecchymosis
Cullen's sign
97
Thoracic aortic aneurysm
<10% of aortic aneurysms
Seen more with chest pain, cough or stridor, hoarseness, or dysphagia
98
Type A thoracic aortic aneurysm
Ascending aorta, more concerning
99
Tearing chest or mid back pain is characteristic of ...
Thoracic aortic dissection
100
What is a good test for thoracic aortic aneurysm ?
Transesophageal echo
101
Arteritis of Takayuki
Pulselessness disease
Asian women under age of 40
Large vessel vasculitis!
Usually aorta and main branches
102
Arteritis of takayasu symptoms
Fever, myalgia, arthralgia
Pain over involved artery
103
Physical exam findings arteritis of takayasu
Hypertension
Vascular bruins
Diminished peripheral pulses
104
Raynaud's
Vasospastic disorder
Episodic ischemia of the digits of the hands and sometimes feet
Primary phenomenon- disease
Secondary (underlying connective tissue disorder)- syndrome
105
Raynauds symptoms
Pallor, cyanosis, then rubor
Discomfort, throbbing pain with rubor
106
Thromboangiitis obliterans aka buerger disease
Nonatherosclerotic vascular disease
Inflammatory occlusive disease of arteries of limbs
Usually male smokers < age of 50
Inflammatory process
107
Thromboangiitis obliterans symptoms
Resting pain, ischemic ulcerations, gangrene of digits, decreased distal pulses, buerger color
108
Thromboangiitis obliterans test
Angiogram showing collateralization and blockage
109
Thromboangiitis obliterans traetment
Smoking cessation
110
Giant cell arteritis/temporal arteritis
Chronic vasculitis of large and medium vessels
111
Giant cell arteritis presentation
```
Temporal headache
Scalp tenderness
Thickened temporal arteries
Jaw claudication
Acute visual loss
```
112
Diagnosis for giant cell arteritis
Temporal artery biopsy
113
Kawasaki disease
Acute inflammatory process involving multiple organs
Vasculitis in medium sized arteries
114
Kawasaki disease. Clinically
Febrile child with rash and multiple visits
Coronary artery aneurysms
Abrupt fever onset, rash, LAD
115
Thoracic outlet syndrome
Condition of compression on nerves or vessels in the region around the neck and clavicle (thoracic outlet)
116
TOS risk factors
Trauma
Presence of extra rib
Poor posture
Increased muscle bulk
117
TOS clinical findings
Neurogenic- most common, pain and paresthesias in upper back, inner arm
Venous- arm claudication, cyanosis, swelling
Arterial- not common. Thrombosis, embolism, aneurysm
118
Roos test
Tests for TOS
Patient slowly opens and closes hands for three minutes, positive if arm becomes heavy of paresthesias
