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SU18: Internal Med > Quiz 1 > Flashcards

Flashcards in Quiz 1 Deck (63)
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1
Q

What is the difference between primary and secondary hypertension?

A

Primary: has an unknown cause (90%)

Secondary: has a known cause (10%)

2
Q

T/F: Hypertension is associated with diagnostic clinical symptoms.

A

False

3
Q

What are the arterial changes in hypertension that lead to complications?

A
  1. Fat and calcium build up

2. Plaque stiffens and narrows artery

4
Q

What are the three major target organs of hypertension?

A

Kidneys, brain, heart

5
Q

At which stage of hypertension is pharmacological therapy involved?

A

Stage 1: 130-139 or 80-89

Stage 2: 140 and above or 90 and above

6
Q

T/F: A BP of 125/76 is considered elevated.

A

True

7
Q

T/F: A BP of 118/84 is considered elevated.

A

False

Stage 1 HTN due to diastolic over 80

8
Q

What is the typical BP goal of a patient with HTN?

A

130/80

9
Q

List four classes of HTN drugs.

A
  1. ACE inhibitors
  2. Angiotensin receptor blockers
  3. Thiazide diuretics
  4. Calcium channel blockers
10
Q

What could indicate uncontrolled HTN?

A
  1. Non-compliance
  2. Changing/addition to medication
  3. Complications
11
Q

The ability for a patient to climb a flight of stairs without problems tells us what about the patient?

A

They have a METs score of over four

12
Q

At what BP would you consider sending the patient to the ER?

A

Diastolic >120 or if they are symptomatic

If BP is over 180/110 but patient is asymptomatic should be referred to primary care within 1 week and elective treatment should be deferred

13
Q

T/F: NO should be avoided with HTN patients.

A

False

Can help with anxiety

14
Q

T/F: Retraction cord with epinephrine should be avoided in HTN patients.

A

True

15
Q

Which type of angina will come on during physical effort and will go away with rest and nitroglycerin?

A

Stable angina

16
Q

What characterizes an unstable angina?

A

Comes on during rest, changing character, and hard to get relief from rest and nitroglycerin

17
Q

What are the three types of pharmacological treatments for angina?

A
  1. Nitrates
  2. Beta blockers
  3. Antiplatelets
18
Q

T/F: Many patients will have re-stenosis and return of symptoms 6 months after a balloon angioplasty.

A

True

10-50%

19
Q

T/F: A history of angina/MI is considered a major risk factor for treatment.

A

False

Intermediate. Unstable angina is major risk factor

20
Q

T/F: Patients with heart attacks in the last month are okay for elective care.

A

False

Should defer elective care for unstable angina and MI in last month

21
Q

T/F: Anti-platelets should be discontinued prior to dental treatment.

A

False

22
Q

What is a major contraindication for giving nitroglycerin?

A

Low blood pressure

23
Q

How many doses of nitroglycerin can be given to a patient experiencing an acute episode of angina?

A

Up to 3 doses, 5 minutes apart

24
Q

T/F: If chest pain does not resolve with nitroglycerin, you should have the patient swallow an aspirin.

A

False

CHEW and swallow 325mg aspirin

25
Q

What are some examples of supraventricular arrhythmias?

A
  1. Sinus nodal disturbances
  2. Disturbances of atrial rhythm
  3. Heart block
26
Q

What are some examples of ventricular arrhythmias?

A
  1. Premature ventricular complexes
  2. Ventricular tachycardia
  3. Ventricular fibrillation
27
Q

__________ is characterized by rapid, disorganized, weak atrial contractions bombarding the AV node.

A

Atrial fibrillation (a-fib)

28
Q

A ___________ involved the impulse being slowed or blocked in the AV node. Ventricles may contract slower.

A

Heart block

29
Q

A patient with ___________ will experience rapid, but regular, ventricular contractions and will have inadequate ventricular filling/pumping.

A

Ventricular tachycardia

30
Q

____________ results in rapid, chaotic impulses to the ventricles and can be fatal.

A

Ventricular fibrillation

31
Q

T/F: Implantable pacemakers can be used for patients with tachycardia.

A

False

Will be used with bradycardia (slow) to speed the heart up

32
Q

T/F: Patients with a-fib would be on anticoagulants.

A

True

33
Q

What should the INR of a patient on Coumadin be for dental treatment?

A

2-3

34
Q

Patients with which arrhythmias should be deferred for elective care?

A

High-grade AV blocks and symptomatic ventricular rhythms

35
Q

When should the INR of a patient on Coumadin be drawn prior to treatment?

A

Within 48 hours

36
Q

What are the cardinal symptoms of heart failure?

A

Dyspnea (SOB) and fatigue

37
Q

T/F: A patient with no symptoms is considered to have compensated heart failure.

A

True

38
Q

What is the difference between class II, III, and IV heart failure?

A

II and III - symptoms with activity

IV - symptoms at rest

39
Q

Which class of heart failure should be deferred for elective treatment?

A

IV - symptoms at rest

40
Q

T/F: Decompensated heart failure is a major risk factor.

A

True

41
Q

What is the key with patients who have had a stent placed?

A

If it has been over 6 months since the stent placement be sure to inquire about the patients current symptoms

42
Q

T/F: A pacemaker will detect when the heart is off of rhythm and will shock the heart back into its normal rhythm.

A

False

Implantable cardioverter-defibrillator

43
Q

What are the most commonly diseased valves?

A

Aortic and mitral

44
Q

T/F: Patients with a mechanical valve replacement need lifelong anticoagulation and antibiotic prophylaxis.

A

True

45
Q

T/F: Patients with a bioprosthetic valve need lifelong anticoagulation and antibiotic prophylaxis.

A

False

Temporary anticoagulation, lifelong antibiotic prophylaxis

46
Q

What level of risk factor is a severe valvular disease?

A

Major risk factor

47
Q

T/F: Aspirin and NSAIDs can make symptoms of asthma worse.

A

True

48
Q

Which drugs would be inhaled to relieve an acute asthma attack?

A

Inhaled quick-acting beta-2 agonists

49
Q

What makes an asthma patient not a candidate for elective care?

A
  1. Symptomatic on day of visit
  2. Poor compliance with drugs
  3. ED visit in last three months
50
Q

What should be done if a patient experiences an asthma attack?

A

2-4 puffs of SABA every 20 minutes

Support with O2 and vital monitoring

EMS if more than 20-30 minutes

51
Q

What is the number one cause of COPD?

A

Smoking

52
Q

What symptoms should be looked for in a COPD patient?

A

SOB at rest, productive cough, upper respiratory infection

53
Q

T/F: NO should be avoided in severe COPD patients.

A

True

54
Q

T/F: Narcotics are safe to give to COPD patients.

A

False

Could decrease respiratory drive

55
Q

T/F: Patients with an active TB infection should be given elective care.

A

False

56
Q

T/F: Patients with a history of TB/positive TB skin test should be given elective care.

A

True

Patient should report a negative exam and chest x-rays

57
Q

Which Hepatitis viruses will are transmitted through serum/body fluids?

A

B, C, and D

58
Q

Most of the chronic viral carriers of hepatitis have which virus?

A

hep C

59
Q

Which hepatitis virus is most likely to cause liver failure?

A

Hep B

60
Q

What is the earliest stage of liver damage from alcohol?

A

Fatty liver - reversible

61
Q

T/F: Local anesthetics, analgesics, and antibiotics may need dosage adjustments in patients with liver disease.

A

True

62
Q

What are three key problems for treating patients with liver dysfunction?

A
  1. Bleeding - vitamin K
  2. Altered drug metabolism
  3. Infection
63
Q

T/F: Patients with chronic hepatitis should not be given elective dental care.

A

False

Active hepatitis