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Potpourri Flashcards

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1
Q

Define Hypertension

A

BP >140/90

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2
Q

Define Isolated Systolic Hypertension

A

Systolic BP >140 & diastolic BP less than 90

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3
Q

Associated Conditions with HTN

A 
MI
CVA
PVD
CHF
Renal failure
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4
Q

CV Disease Risks

A

Continuous & consistent HTN & independent of other risks
Each 20/10 mmHg rise doubles risk of CVD

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5
Q

Benefits of Lowering BP

A

Decreased risk of stroke, MI, & HF

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6
Q

Define Dementia

A

Cognitive impairment more common with HTN

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7
Q

Accurately Measuring BP

A

Cuff size
Correct inflation
Appropriate interval
Several readings

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8
Q

Possible Reasons for Secondary HTN

A 
Sleep apnea
Drug-induced
Chronic kidney disease
Primary aldosteronism
Reno vascular disease
Chronic steroid therapy or Cushing's syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
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9
Q

CVD Risk Factors

A 
HTN
Cigarette smoking
Dyslipidemia
Obesity
Physical inactivity
DM
Microalbuminuria or GFR less than 60 mL/min
Age: 55+ for men, 65+ fro women
Family Hx of premature CVD (men less than 55 or women less than 65)
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10
Q

Target Organ Damage

A 
Heart: LVH, angina, prior MI, prior coronary revascularization, CHF
CVA/TIA
Renal disease
PAD
Retinopathy
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11
Q

Aggressive BP Management

A

Weight loss
Sodium restriction
Treatment with all classes of drugs except hydrazine & minoxidil

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12
Q

Laboratory Tests for BP Issues

A 
EKG
UA
CMP
Fasting lipid panel
H/H
TSH
Microalbumin
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13
Q

Lifestyle Modification for HTN

A 
Weight reduction
Adopt DASH eating plan
Dietary sodium reduction
Physical activity
Moderation of alcohol consumption
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14
Q

Medication Classes for HTN with Heart Failure

A 
Thiazides
Beta-blocker
ACEI
ARB
Aldosterone antagonists
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15
Q

Medication Classes for HTN with Status Post MI

A

Beta-blockers
ACEI
Aldosterone antagonists

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16
Q

Medications for HTN with High CAD Risk

A

Thiazides
Beta-blockers
ACEI
CCBs

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17
Q

Medications for HTN with DM

A 
Thiazides
Beta-blockers
ACEI
ARB
CCB
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18
Q

Medications for HTN with Chronic Renal Disease

A

ACEI

ARB

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19
Q

Medications for HTN with Recurrent Stroke Prevention

A

Thiazides

ACEI

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20
Q

What medication class is good for gout, history of hyponatremia, & osteopenia/osteoporosis?

A

Thiazides

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21
Q

What medication class is good for RAD or 2nd/3rd degree heart block, atrial tachycardia, migraines, thyrotoxicosis, essential tremor, or in the perioperative period?

A

Beta-blockers

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22
Q

What medication class is useful in Raynaud’s Syndrome?

A

CCBs

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23
Q

What medication class is useful in BPH?

A

Alpha blockers

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24
Q

What medication classes have a risk of pregnancy?

A

ACEI

ARBs

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25
What medication classes are good for hyperkalemia?
Aldosterone antagonists | K-sparing diuretics
26
Define Orthostatic Hypotension
Drop in standing SBP >10 mmHg
27
When should you always check orthostatic BP?
When adjusting meds
28
Differential Diagnosis of Marked BP Elevations & Acute Target Organ Damage
``` Encephalopaty TIA/CVA Papilledema MI or unstable angina Pulmonary edema Life-threatening arterial bleeding or aortic dissection Renal failure ```
29
Define Hypertensive Emergency
Marked BP elevations & acute target organ damage
30
Define Hypertensive Urgency
Market BP elevation but NO acute target organ damage
31
Define Pseudohypertention
When BP readings may be falsely elevated in some elderly patients with very stiff, calcified arteries
32
Treatment of HTN Reduces Incidence of
MI Stroke HF
33
What should you evaluate for with HTN in the elderly?
Target organ damage | Other CV risk factors
34
What is the 3rd leading cause of death & disability in the developed world?
CVA
35
Complications of Strokes
Venous thromboembolism MI during acute period MI or CVA first?
36
Major Risk Factors
``` HTN Smoking Atrial fibrillation MI Hyperlipidemia DM CHF Acute ETOH abuse TIA with >70% occlusion of carotid arteries OCP + smoking Hypercoagulopathy High RBC count & hemoglobinopathy Age, gender, race, prior stroke, & heredity ```
37
2 Types of Stroke
Ischemic | Hemorrhagic
38
Define TIA
Brief episodes of focal neurological deficits lasting 2-3 minutes to at most a few hours but less than 24 hours with no residual deficits with complete functional recovery
39
TIA Warning Sign of What
Impending stroke
40
Define Completed Stroke
Acute, sustained functional neurological deficit lasting from days to permanent
41
Stroke Syndromes
``` Internal carotid artery (ICA) occlusion ACA occlusion MCA occlusion PCA occlusion Vertebrobasilar occlusion Lacunar infarct Spinal stroke ```
42
Anterior Circulation TIA's & Stroke
Anterior or middle cerebral artery Amaurosis fugax (monocular blindness) Face-hand-arm-leg contralateral hemiparesis Aphasia/dysarthria
43
MCA Occlusion
Contralateral hemiplegia in face-arm-hand Dominant hemisphere = aphasia Non-dominant right hemisphere = confusion, spatial disorientation, sensory & emotional neglect
44
ACA Occlusion
Sensorimotor deficit in contralateral foot & leg Brocas or anterior conduction aphasia in dominant hemisphere TIA's rarely affect ACA distribution
45
Posterior Circulation TIA & Stroke
``` Vertigo Diplopia/dysconjugate gaze, ocular palsy homonymous hemianopsia Sensorimotor deficits Dyarthria Ataxia ```
46
Vertebro-Basilar Posterior Circulation Occlusion
``` VA-PICA syndrome Horner's syndrome PICA-AICA-SCA acute cerebellar infarction BA V-B junction Basilar apex PCA quadrantic or homonymmous hemianopsia PCA thalamus involvement ```
47
VA-PICA Syndrome
Headache Ataxia N/V Ipsilateral paralysis in tongue & swallowing Ipsilateral face & contralateral body
48
V-B Junction
``` Lower extremity paraplegia or tetraplegia Conjugate or dysconjugate gaze paralysis Constricted pupils Respiratory depression Coma ```
49
Basilar Apex
``` PCA junction results in hemiplegia-diplegia Pupillary & occulomotor paralysis Visual field defects Stupor Coma ```
50
PCA (proximal branches) Thalamus Involvement
Memory loss | Sensorimotor hemiplegias
51
Spinal Stroke
Prolonged hypotension | Intraspinal mass lesions
52
Define Lacunar Infarct
Small, deep infarcts caused by occlusion of the small arteries that penetrate deeper brain structures
53
Types of Hemorrhagic Stroke
Subarachnoid hemorrhage | Intracerebral hemorrhage
54
Presentation of Hemorrhagic Stroke
Headache N/V Decreased consciousness
55
Types of Intracerebral Hemorrhage
``` Hypertensive atherosclerotic hemorrhage Lobar hemorrhages Hemorrhage from vascular malformations Bleeding into brain tumors (uncommon) Blood dyscrasias or anticoagulants (uncommon) Inflammatory vasculopathies (uncommon) ```
56
Define Subarachnoid Hemorrhage
Rupture of an artery with bleeding onto the surface of the brain
57
Causes of Subarachnoid Hemorrhage
Aneurysm AVM Bleeding disorder due to anticoagulants
58
Describe Subarachnoid Hemorrhage
``` Worst headache ever Radiates to face & neck Phonophobia Photophobia Maximal intensity immediately after onset ```
59
Subarachnoid Hemorrhage Physical Signs
``` Nuchal rigidity Altered mental status Poor sign if with transient loss of consciousness (seizure, cardiac dysrhythmia) Papilledema May not have neurological defect ```
60
Define Intracerebral Hemorrhage
Rupture of an artery with bleeding into the brain parenchyma
61
#1 Cause of Intracerebral Hemorrhage
Hypertension | Amyloid angiopathy
62
Differential Diagnosis of Stroke
``` Focal seizures Glaucoma Benign vertigo or Menieres disease Cardiac syncope or syncope from other causes Migraine HA Intracranial neoplasm Subdural hematoma Epidural hematoma Hyperglycemia Hypoglycemia Postcardiac arrest ischemia Drug overdose Meningitis, encephalitis Trauma Anoxic encephalopathy Hypertensive encephalopathy ```
63
Diagnosis of Stroke
``` ABCs H&P EKG, monitor, pulse oximetry Labs: CBC, electrolyte, glucose, ABG, PT/PTT, Urine drug screen, LP CT or MR head scan Echo, EEG Carotid duplex ultrasonogrpahy MRA or angiography ```
64
Management of Acute Stroke
Medical management Surgical management Prognosis
65
Medical Management
Prevention, lifestyle modification Early recognition with rapid transport/pre-arrival notification ABCs, O2, IV Rapid evaluation for TPA
66
Thrombolytics
Only for ischemic stroke if given within 3 hours of onset of signs and symptoms Class I AHA recommendation
67
Contraindications Thrombolytics
``` BP >185/110 AMI Seizure Hemorrhage LP within 7 days Atrial puncture at incompressible site Surgery within 14 days Bleeding diathesis Within 3 months of head trauma Hx of intracranial hemorrhage Minor or rapidly improving stroke symptoms ```
68
Chronic Prophylactic Anticoagulation Indications
Acute anterior MI with mural thrombus formation Chronic a-fib with CHF within 3 months, HTN, previous thromboembolism, LV dysfunction and/or enlarged left atrium, or chronic valvular disease A-fib without any risk factors: ASA therapy
69
Chronic Management of Stroke
``` Multidisciplinary approach Psychiatric services PT/OT/speech-language VNS/home health attendant Skilled nursing facility Social services Family support groups ```
70
Perform Carotid Endarterectomy
Good general health HTN controlled Internal carotid stenosis 70-99% Ipsilateral stroke or TIA within 3-6 months Surgeon with morbidity/mortality less than 2% Worse outcome if used to treat stroke
71
Maybe Carotid Endarterectomy
``` Multiple coexisting comorbid conditions HTN poorly controlled Internal carotid artery either completely or less less than 70% occluded No history of ipsilateral TIA or stroke Inexperienced surgeon ```
72
Define Parkinson's Disease
Idiopathic slowly progressive degenerative CNS disorder characterized by tremor, muscular rigidity, bradykinesia
73
Physiology of Parkinson's Disease
Striatal dopamine is deficient & dopaminergic neurons are lost in the substansia nigra
74
Diagnosis of Parkinson's Disease
H&P | Clinically if 2/3 cardinal features
75
Cardinal Features
Tremor Rigidity Bradykinesia
76
Symptoms of Parkinson's Disease
``` Stiffness & slowed movements Tremor or shaking at rest Difficulty getting out of chair or rolling in bed Frequent falls or tripping Difficulty walking Memory loss Speech changes Small handwriting Slowness in performing ADLs Sialorrhea ```
77
Physical Findings in Parkinson's Disease
``` Muscle rigidity, cog wheeling type Bradykinesia Postural instability, stooped forward posture Decreased arm swinging in ambulatory activity Resting/tremor/pill-rolling tremor Masked facies Micrographia Dysarthria, hypokinetic, monotonous low volume Painful dystonia Dementia Depression Akathisia inability to sit still Seborrheic dermatitis face & scalp Autonomic dysfunction ```
78
Differential Diagnosis of Parkinson's Disease
``` Progressive supranuclear palsy Multisystem atrophy Shy-drager syndrome Olivopontocerebellar atrophy Wilson disease Multiple strokes Subdural hematoma Normal pressure hydrocephalus Basal ganglion lesion Hypothyroidism & hyperparathyroidism Post encephalitis Creutzfeldt-Jacob disease ```
79
Treatment of Parkinson's Disease
``` Carbidopa/levodopa Dopamine MAOIs type B Catechol-O-methyltransferase inhibitors Amantadine DBS Regular exercise ```
80
End of Life Issues for Parkinson's Disease
``` Severely impaire & immobile At risk for aspiration Eating may become impossible Dementia Discuss end-of-life care issues early Advise patient to appoint a surrogate to make medical care decisions ```
81
Define Polymyalgia Rheumatica
Inflammatory condition which is characterized by severe bilateral pain & morning stiffness of the shoulder, neck, & pelvic girdle
82
Epidemiology of Polymyalgia Rheumatica
Increased incidence at higher latitudes | Women > Men (3:1)
83
Presentation of Polymyalgia Rheumatica
Bilateral, severe, persistent pain in the neck, shoulders, & pelvic girdle Pain on active & passive movement of joints Morning stiffness more than 1 hour & after periods of rest Myositis Lethargy Weight loss Depression Fever Joint effusions +/- asymmetric peripheral arthritis, carpal tunnel syndrome, edema of hands, wrists, ankles, & feet
84
Important Differential Diagnosis of Polymyalgia Rheumatica
``` Systemic lupus erythematosus Polymyositis Bacterial endocarditis Paraneoplastic syndromes Amyloidosis ```
85
Labs for Polymyalgia Rheumatica
``` ESR: elevated CRP IL-6 levels: elevated CBC: anemia of chronic disease Rheumatoid & ANA: not elevated LFTs mildly elevated ```
86
Associated Diseases with Polymyalgia Rheumatica
Giant cell arteritis (GCA)
87
Management of Polymyalgia Rheumatica
Document symptoms & level of disability at diagnosis Consider giant cell arteritis Advise to seek treatment if symptoms of GCA Monitor response to treatment via ESR & CRP Manage residual physical or psychosocial disability Consider other possible diagnoses Drug therapy: prednisone, bisphosphonates, calcium & vitamin D Referral to physiotherapist & OT
88
Symptoms of GCA
Headache Jaw claudications Visual disturbances
89
Prednisone & Polymyalgia Rheumatica
Some may produce dramatic response Some may be able to come off treatment all together except exacerbations Some may need to be on long term low dose steroids
90
Age-Related Macular Degeneration Impacts
Ability to drive Increased rates of falls Ability to live independently
91
Define Age-Related Macular Degeneration
Degenerative disease of the central portion of the retina (macula) Results in loss of central vision
92
2 Classifications of Age-Related Macular Degeneration
Dry | Wet
93
Dry Age-Related Macular Degeneration
Ischemic Retinal epithelial cell apoptosis Activating inflammation
94
Wet Age-Related Macular Degeneration
Balance between substances that promote or inhibit blood vessel development Vascular endothelial growth factor (VEGF)
95
Risk Factors for Age-Related Macular Degeneration
``` Age Smoking Genetics CVD Diet Cataract surgery Heavy alcohol use Caucasians ```
96
History of Age-Related Macular Degeneration
``` Rate of vision loss One or both eyes involved Loss near/far vision or both Associated symptoms Acute distortion of loss of central vision: may be wet ```
97
Ophthalmologic Evaluation of Dry Age-Related Macular Degeneration
Durban appears as bright yellow spots Atrophy appears as areas of depigmentation May be increased pigmentation
98
Ophthalmologic Evaluation of Wet Age-Related Macular Degeneration
Subretinal fluid and/or hemorrhage Neovascularization: grayish-green discoloration Often require fluorescein angiogram
99
Treatment of Dry Age-Related Macular Degeneration
None | Slow progression: vitamin C, E, beta carotene, zine & copper
100
Treatment of Wet Age-Related Macular Degeneration
VEGF inhibitors Photocoagulation Surgery
101
Tool for Detecting Age-Related Macular Degeneration
Amsler grid
102
Types of Glaucoma
Acute angle Secondary Congenital Primary open-angle
103
Secondary Glaucoma Due to
Uveitis Old trauma Steroid therapy
104
What glaucoma is the most common?
Primary open-angle glaucoma
105
What is the leading cause of irreversible blindness in the world?
Glaucoma
106
Primary Open-Angle Glaucoma
Optic neuropathy: "cupping" Peripheral visual field loss followed by central field loss Must be screened for
107
Risk Factors for Primary Open-Angle Glaucoma
Elevated IOP Increasing age with increase risk of blindness African Americans 4-5 x risk Family history
108
Screening for Primary Open-Angle Glaucoma
Specialist with special equipment | Can examine optic disc for cupping
109
Treatment of Primary Open-Angle Glaucoma
Topical & systemic medications Laser therapy Surgery
110
Types of Angle-Closure Glaucoma
Primary | Secondary
111
Primary Angle-Closure Glaucoma
Anatomically predisposed | No identifiable secondary cause
112
Secondary Angle-Closure Glaucoma
Responsible for closure of the anterior chamber angle | Ex: fibrovascular membrane, mass, or hemorrhage
113
Risk Factors for Angle-Closure Glaucoma
``` Family history Older than 40-50 Female Hyperopia (farsightedness) Pseudoexfoliation Race: Inuit & Asian populations ```
114
Symptoms of Pressure Rising Acutely in Angle-Closure Glaucoma
``` Decreased vision Halos around lights Headache Severe eye pain N/V ```
115
Signs of Angle-Closure Glaucoma
Conjunctival redness Corneal edema or cloudiness Shallow anterior chamber Mid-dilated pupil that reacts poorly to light
116
Treatment of Angle-Closure Glaucoma
Ophthalmologic emergency | Immediate referral for further evaluation
117
What is the leading cause of blindness in the world?
Cataract
118
Risk Factors for Cataracts
``` Age Smoking Alcohol Sunlight exposure Metabolic syndrome DM Systemic corticosteroid use ```
119
Presentation of Cataracts
Painless, progressive process Complain of problems with night driving, reading road signs or difficulty with fine print Increase in nearsightedness
120
Physical Exam Findings in Cataracts
Lens opacity | Darkening of the red reflex, opacities, or obscuration of ocular funds detail
121
Treatment of Cataracts
Surgery
122
Pre-Op for Cataract Surgery
Controlled HTN | Maintain medication use
123
Complications of Cataract Surgery
Endophthalmitis | Retinal detachment
124
Common Etiologies of Presbycusis
Sensorineural Bilateral Beginning in the high frequency range
125
Risk Factors for Presbycusis
``` Lifetime exposure to noise Genetics Medications Older age DM Cerebrovascular disease Smoking HTN White ```
126
Presentation of Presbycusis
Complain of inability to hear/understand speech in crowded or noisy environment Difficulty understanding consonants Inability to hear high pitched voiced
127
Associated Symptoms of Presbycusis
Tinnitus | Hearing pulsatile noise in one ear (need MRA or MRI)
128
Differential Diagnosis of Presbycusis
Cerumen impaction TIA CVA
129
What can presbycusis lead to?
Isolation Depression Low self-esteeem
130
Hearing Amplification
Done through licensed audiologist Do not restore hearing to normal Need to be fit and programmed properly
131
Signs/Symptoms of Hypothyroidism
``` Fatigue Cold intolerance Weakness Lethargy Weight gain Constipation Myalgias, arthralgias Menstrual irregularities Hair loss Dry, course skin Hoarse voice Brittle nails Myxedema Delayed reflexes Slow reaction time Bradycardia ```
132
Define Subclinical Hypothyroidism
Normal T4 | Elevated TSH
133
Define COPD
Slow progressive irreversible airway obstruction
134
Signs of COPD Exacerbations
Increased dyspnea Infections Respiratory failure
135
Risk Factors for COPD
``` Smoking Exposure to inhalants Alph-1 antitrypsin Asthma Age Genetics ```
136
Pathophysiology of COPD
Inflammation Increased mucus Decreased ciliary movement Air flow obstruction
137
Pathophysiology of Chronic Bronchitis
Hypertrophy of the mucus cells Increase in number of mucus cells Inflammation leads to formation of more mucus
138
Why Acute Exacerbations in COPD
Infections Environmental pollution Unknown
139
Treatment of COPD
``` Oxygen Long term inhaled glucocorticoids SABAs (add on) Short acting anticholinergics (add on) Glucocorticosteroids (add on) ```
140
Complications of COPD
``` Cor pulmonale Pneumonia Pneumothorax Polycythemia Arrhythmias ```
141
Local Deposition Effects of Inhaled Glucocorticoids
Dyphonia Thrush Cough/throat irritation/reflex bronchoconstriction
142
Systemic SE of Inhaled Glucocorticoids
Consider pharmacokinetics Osteoporosis Adrenal suppression Increase intra-ocular pressure/cataracts
143
Signs of Worsening COPD
Decrease in BMI Decrease in FEV1 Increased dyspnea on exertion Need for O2
144
End Stage COPD
``` Hospice Control pain Bedridden Support family Get living will from patient ```
145
Predisposing Conditions for Community Acquired Pneumonia
``` Smoking Alcohol consumption Pulmonary edema Malnutrition Administration of immunosuppressive agents Being 65+ COPD Previous episode of pneumonia ```
146
Pathogens of Community Acquired Pneumonia
H. flue Chlamydia Strep pneumo
147
Risk Factors for Drug Resistance
``` 65+ years old Antibiotic therapy within last 3-6 months Alcoholism Medical comorbidities Immunosuppressive illness or therapy ```
148
Treatment of Uncomplicated Community Acquired Pneumonia
Azithromycin Erythromycin Clarithromycin
149
Treatment of Complicated Community Acquired Pneumonia (cormobidities or recent antibiotic use)
Respiratory fluoroquinolones | Amoxacillin-clavulanate (Augmentin)
150
Indications for Hospitalization of Community Acquired Pneumonia
``` CRB-65 Confusion Respiratory rate: >30 BP: less than 90 systolic or 60 diastolic Age: >65 ```
151
Underlying Factors of Patients in Long Term Care Facilities with Pneumonia
COPD Left heart failure Aspiration
152
Parameters for Long Term Care Facility Residents for Treatment
``` Able to eat & drink Pulse: less than 100 Respiratory rate: less than 30 BP: >90 or decrease of less than 20 from baseline O2 sat: >92% or 90% if COPD ```
153
Common Causes of Pain in the Elderly
``` Osteoarthritis Other joint diseases Night time leg cramps Claudication Neuropathies: diabetics, herpetic, idiopathic Cancer ```
154
Why is pain underrated in the elderly?
Patients underreport | Health care providers hesitant to prescribe opiates
155
WHO Guidelines for Pain Management
Mild: non-opioid +/- adjuvant Moderate: opioid +/- adjuvant Severe: stronger opioid +/- adjuvant
156
Medications NOT to Use for Pain Management in the Elderly
Amitriptyline | Propoxyphene
157
SE of NSAIDs in the Elderly
Renal toxicity GI Cardiotoxicity: worsen CHF & HTN Interacts with aspirin & warfarin
158
First Line Treatment of Pain in the Elderly
Tylenol | Arthritis strength Tylenol
159
Treatment of Neuropathic Pain in the Elderly
Gabapentin Lyrica Cymbalta
160
Opioids & the Elderly
Small doses spread apart | Talk heavily about SE including constipation & confusion
161
Adjuvant Therapies for Pain Management
``` Exercise: PT, OT, strengthening Physical methods: ice, heat, massage CBT Chiropractic therapy Acupuncture Relaxation & guided imagery Biofeedback ```
162
Define Osteoporosis
Disease characterized by low bone mass with micro architectural disruption & skeletal fragility
163
Risk Factors for Fractures
``` Advanced age Previous fracture Long-term glucocorticoid therapy Low body weight (less than 127 pounds) Family history of hip fracture Smoking Excess alcohol intake ```
164
Treatment for Fractures
``` Surgery Analgesics Calcitonin Vertebroplasty Kyphoplasty ```

Geriatrics (15 decks)

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