Int. Medicine 1 Flashcards Preview

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Flashcards in Int. Medicine 1 Deck (66):
1

_ % of adults over 65 have hypertension

50%

2

_% of HBP is primary

What does primary mean

90%
Unknown cause

3

What builds up on the intimal layer of arteries to cause HBP

Fat and calcium

4

3 Target organs of hypertension

Kidney
Heart
Brain

5

_ % of patients with HBP don’t know they have it

1/5

6

What main thing (with few symptoms) does hypertension do to the kidney

This leads to symptomatic _

And end stage _

Proteinuria and nephrosclerosis

Chronic renal failure

End-stage renal Disease

7

Hypertension and the heart:
Oligosymptomatic
3 symptomatic diseases
3 end-stage diseases

O: left ventricle

S: angina/coronary artery disease
Systolic/diastolic dysfunction
A fib/ ventricular arrhythmias

E: MI
CHF
Ventricular tachycardia/fibrillation

8

Hypertension and the brain:
Oligosymptomatic:
Symptomatic:
End-stage:

O: retinopathy/binswanger lesions

S: dementia, TIA

E: stroke

9

Classification of HBP

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

10

At what BP will a patient be treatment

>130/80

11

4 main groups of drugs for HBP

ACE inhibitors
Angiotensin receptor blockers
Thiazide diuretics
Ca channel blockers

12

What is a hypertensive emergency

Acute elevation of BP >180 or >120

13

Major risk factors

Unstable coronary syndrome
Decompensated heart failure
Significant arrhythmias
Severe valvular disease

14

At what BP do you defer elective treatment

>180/110

15

What range of BP can you proceed with elective tx but with caution and monitoring and referral to pcp within a month

160-180/100-110

16

Intermediate risk factors (5)

History of Ischemic disease
History of compensated heart failure
History cerebrovascular disease
Diabetes mellitus
Renal insufficiency

17

Minor risk factors (4)

Advanced age
Abnormal ECG
Rhythm other than sinus
Uncontrolled systemic HT

18

What can be used on retraction cords instead of epi

Visine, afrin, neo-synephrine

19

3 steps to atherosclerosis

Inflammation
Plaque
Stenosis

20

Stable vs unstable angina

Stable: physical effort ppts
Unstable: pptd by effort or rest

21

3 types of drugs to treat ischemic heart disease

Nitrates
Beta blockers
Antiplatelet therapy

22

Steps to an MI

Plaque rupture
Thrombus
Blood flow decreased
MI

23

How long to wait to treat patient after MI

At least a month

24

Three things to have on hand in case of an MI emergency

Nitroglycerin
Aspirin
O2 equipment

25

PVC

Worried?

Premature ventricular contraction

No

26

A fib

Rapid, disorganized, weak atrial contractions bombard AV node

27

Treatment for bradycardia vs. tachycardia

B: implant pacemaker

T: drugs

28

3 types of anticoagulant drugs

Vit. K dependent coagulation factor synthesis inhibitor

Antithrombin

Direct factor Xa inhibitor

29

What is different about Coumadin (warfarin) than other oral anticoagulants

Coagulation testing of international normalized ratio

Inhibitis vitamin K dependent coagulation factor synthesis

30

For what 2 kinds of arrhythmias should elective care be deferred

High grade AV blocks
Symptomatic ventricular rhythms

31

What INR can you treat a patient

When tested for INR

Less than 3 (especially for single tooth)

Within 48 hrs

32

What happens to ventricles in CHF

1. Don’t empty during systole (not enough blood to tissues)
Or
2. Don’t fill during diastole

33

Coronary heart disease causes what % of heart failure

60-75%

34

Ejection fraction:
What
Normal
Severe

Blood pumped/blood in ventricle

55-70% normal
<35% severe

35

Symptoms of heart failure

Dyspnea
Fatigue
Orthopnea

36

5 year survival of CHF men and women

Men: 35%
Women: 50%

37

Stages ABCD of heart failure

A: high risk, no symptoms
B: structural disease, no symptoms
C: structural disease, symptoms
D: Bad bad

38

When does medical treatment of CHF start

Stage C

39

HFpEF vs HFrEF

pEF is maintaining ejection fraction
rEF is reduced ejection fraction

40

NYHA classification I-IV

I - no symptoms
II - with normal activity
III - with less than normal activity
IV - at rest

41

When to treat/defer pt with compensated heart failure

History is intermediate

decompensated is major

42

Dual antiplatelet therapy

Aspirin and clopidogrel

43

AB prophylaxis is needed for _ in patients who have _

Anything invasive

Mechanical replacement valves

44

3 things that happen in asthma patients

Contraction of airway smooth muscle

Thickening of airway wall b/c of inflammation

Mucous

45

Intermittent asthma is treated by _
Persistent asthma is treated by that and _

Inhaled quick acting beta-2 agonists
Inhaled glucocorticoid

46

Well controlled asthma

2x/month daytime symptoms
2x/month night symptoms
SABAs <3d/week
Normal activities
Steroids and urgent care 1x year

47

How long to wait since last ED visit for asthma before elective care

3 months

48

COPD is the _ leading killer

3rd

49

COPD is caused by

Smoking and genetic susceptibility

50

Chronic bronchitis is obstruction on _

Inspiration and expiration

51

Emphysema is obstruction on _

Expiration

52

When to avoid treating COPD patients

SOB at rest, productive cough, upper respiratory infection

53

When to avoid nitrous

Severe COPD

54

T/F all of the 5 hepatitis viruses are directly cytopathic

FALSE. None are

55

Most common hep to cause liver failure

Hep B

56

Who has a predisposition to bleeding

Those with a deficiency of vit K dependent coagulation factors

57

Liver disease may cause what effect with drugs

Drugs may need dosage adjustments

58

3 reasons why liver matters in delivery of dental care

Bleeding
Altered drug metabolism
Infection

59

Active hepatitis dental care

No routine, urgent care with consultation of physician

60

Chronic hepatitis dental care

Routine ok, check with physician

61

Thrombocytopenia + _ = increased bleeding

Decrease in coagulation factors

62

_ of world infected with latent TB

1/3

63

3 ways to diagnose tuberculosis

Radiography
Spit testing
Skin test

64

Drug therapy for TB

Intensive: Isoniazid, rifampin, pyrazinamide, ethambutol

Continuation: isoniazid, rifampin

65

Active pulm infection dental treatment?

No elective treatment

66

Positive tuberculin skin test dental care?

Routine dental care with standard universal precaution