A&piii-Test4-5

Front 1

what are the BP parameters for HTN

Back 1

>/= 140/90

Front 2

what are the BP parameters for PRE-hypertension

Back 2

systolic=120-139

diastolic=80-89

Front 3

what amt of adults in the US have HTN

Back 3

~ 25%

Front 4

the incidence of HTN increases with what

Back 4

AGE

Front 5

the incidence of HTN is higher in what population

Back 5

AFRICAN AMERICANS

Front 6

HTN is a risk factor for what other dz processes

Back 6

*CAD
*CHF
*CVA
*ESRD
*arterial aneurysm

Front 7

what population has the HIGHEST incidence of HTN

Back 7

black males

Front 8

what are the contributing factors to ESSENTIAL hypertension

Back 8

*increased SNS activity in response to stress
*overproduction of vasoconstictors or Na retaining hormones
*high Na intake
*LOW K and Ca intake
*increased renin secretion
*decreased endogenous vasodilators
*concurrent dz (DM, obesity)

Front 9

what are some endogenous vasodilators

Back 9

*NO

*prostaglandins

Front 10

essential HTN accounts for what percent of all HTN

Back 10

95%

Front 11

if a pt is obese and NORMOtensive what is the result on the heart

Back 11

dilatation

Front 12

if a pt is lean and HYPERtensive what is the result on the heart

Back 12

hypertrophy

Front 13

if a pt is obese and HYPERtensive what is the result on the heart

Back 13

dilatation and hypertrophy leading to CHF

Front 14

what is the optimal range for BP

Back 14

<120 systolic

<80 diastolic

Front 15

what is the normal range for BP

Back 15

<130 systolic

<85 diastolic

Front 16

what is the high normal range for BP

Back 16

130-139 systolic

85-89 diastolic

Front 17

what is the BP for stage I HTN

Back 17

140-159 systolic

or

90-99 diastolic

Front 18

what is the BP for stage II HTN

Back 18

160-179 systolic OR

100-109 diastolic

Front 19

what is the BP for stage III HTN

Back 19

>/= 180 systolic OR

>/= 110 diastolic

Front 20

regarding tx goals for a normal pt what range would you want to get BP into

Back 20

<140/90

Front 21

regarding tx goals with co-existing dz what range would you want to get BP into

Back 21

<130/80

Front 22

what is the reasonable FIRST approach for tx of essential HTN in pts WITHOUT associated risk factors or evidence of end organ damage

Back 22

lifestyle modification

Front 23

what are lifestyle modifications that can be done in the treatment of essential HTN

Back 23

*wt loss
*increased physical activity
*smoking cessation
*decrease ETOH intake
*adequate intake of Ca and K
*dietary salt restriction

Front 24

what is the BIGGEST factor for decreasing BP from lifestyle modifications in essential HTN

Back 24

weight loss

Front 25

with treatment of essential HTN and post-MI what classes of drugs are recommended

Back 25

*ACE inhibitor

*aldosterone antagonist

*beta blocker

Front 26

with tx of essential HTN and heart failure what are the recommended drug classes

Back 26

*ACE inhibitor
*aldosterone antagonist
*ARB
*beta blocker
diuretic

Front 27

with tx of essential HTN and high risk for CAD what are the recommended drug classes

Back 27

*ACE inhibitor
*beta blocker
*Ca channel blocker
*diuretic

Front 28

with tx of essential HTN and DM what are the recommended drug classes

Back 28

*ACE inhibitors
*ARB
*beta blockers
*Ca channel blocker
*diuretic

Front 29

with tx of essential HTN and renal insufficiency what are the recommended drug classes

Back 29

*ACE inhibitor

*ARB

Front 30

what tx of essential HTN and previous CVA what are the recommended drug classes

Back 30

*ACE inhibitor

*diuretic

Front 31

what type of HTN has a KNOWN cause

Back 31

secondary HTN

Front 32

what percentage of HTN does secondary HTN account for

Back 32

<5%

Front 33

what type of HTN is often amenable to sx therapy

Back 33

secondary HTN

Front 34

what are the common etiologies for secondary HTN

Back 34

*renovascular dz
*hyperaldosteronism
*aortic coarctation
*pheochromocytoma
*cushings syndrome
*renalparenchymal dz
*PIH

Front 35

what is the MOST common cause of secondary HTN

Back 35

renovascular dz

Front 36

what is the BP in a hypertensive crisis

Back 36

>180/120

Front 37

with a hypertensive crisis higher BP are tolerated by what type of pt

Back 37

pts with chronic HTN

Front 38

what is HTN urgency

Back 38

elevated BP WITHOUT evidence of target organ damage

Front 39

what is HTN emergency

Back 39

evidence of target organ damage

Front 40

what is the tx goal in a hypertensive crisis

Back 40

*gradual reduction of BP

-20% reduction in the 1st hr
-reduce to 160/110 range over next 2-6 hrs

Front 41

regarding surgical and anesthetic risk HTN is associated with an increased risk of what

Back 41

silent ishcemia and infarction

Front 42

incidence of magnitude of what perioperative events is increased with pts with HTN

Back 42

hypertensive and hypotensive events

Front 43

there is little evidence that BP in what range increase complication rate in elective sx

Back 43

<180/110 but greater than normal

Front 44

what are concerns with the hypertensive pt with induction

Back 44

hypertension and hypotension

Front 45

what are the maintenance goals of anesthesia with a hypertensive pt

Back 45

minimize wide swings in BP that are common to pts with HTN

Front 46

what needs to be done with central neuraxis anesthesia and a hypertensive pt

Back 46

special attention needs to be payed to fluid status d/t associated sympathetic block and decreased BP

Front 47

what can be used to control HTN intra-op with HTN pt

Back 47

*VA

*anti-hypertensives

Front 48

what can be used to control hypotension intra-op with a HTN pt

Back 48

*adjust anesthetic depth

*fluid resuscitation

*sympathomimetics
-ephedrine
-phenylephrine

Front 49

what drugs that a HTN pt may be on prior to sx may not respond well to ephedrine or phenylephrine

Back 49

*ACE inhibitors

*ARB

Front 50

what are some of the possible etiologies for post-op HTN

Back 50

*pain, agitation
*shivering
*bladder or bowel distention
*emergence excitement
*pre-existing HTN
*hypercapnia
*increased ICP
*autonomic dysreflexia

Front 51

what should be anticipated in a pt who experienced an episode of intra-op HTN

Back 51

post-op HTN

(appropriate orders for antihypertensives should be written)

Front 52

what is the normal SYSTOLIC pulmonary artery pressure

Back 52

18-25 mmHg

Front 53

what is the normal DIASTOLIC pulmonary artery pressure

Back 53

6-10 mmHg

Front 54

what is the normal MEAN pulmonary artery pressure

Back 54

12-16 mmHg

Front 55

what is the definition of pulmonary arterial HTN

Back 55

MEAN PA pressure > 25 ar rest OR

MEAN PA pressure > 30 with exercise

Front 56

how common is primary or idiopathic pulmonary HTN

Back 56

RARE

(1-2 / 1,000,000)

Front 57

what is the median survival following diagnosis of primary pulmonary HTN

Back 57

2.8 yrs

Front 58

who is primary pulmonary HTN predominantly seen in

Back 58

young women

Front 59

primary HTN occurs in the ABSENCE of what

Back 59

*L sided heart or valvular dz
*congenital heart dz
*myocardial dz
*resp dz
*connective tissue disorder
*thromboembolic dz

Front 60

responsiveness of pulmonary HTN to vasodilators is determined how

Back 60

by admin of
*prostacyclin
*NO
*adenosine
*prostaglandin E1

Front 61

what is defined as "responsiveness" to a vasodilator in pulmonary HTN

Back 61

a decrease in PVR and a mean PA pressure of >/= 20%

Front 62

what amt of pts with primary pulmonary HTN will have a positive response to vasodilators

Back 62

~25%

Front 63

what are the risks of hypoxemia in pulmonary HTN

Back 63

*R to L shunting thru a patent foramen ovale
*exertion resulting in increased o2 extraction in light of a relatively fixed CO
*perfusion of poorly ventilated alveoli d/t VQ mismatch

Front 64

what are the various tx for pulmonary HTN

Back 64

*o2 *diuretics
*anticoagulation
*Ca channel blockers
*phosphodiesterase inhibitors
*inhaled NO
*prostacyclins
*endothelin receptor anatgonist
*sx

Front 65

with sedation of pt with pulmonary HTN what do you want to do

Back 65

*be judicious to avoid hypoxia and hypercapnia

*supply supplemental o2

Front 66

what agents are good for the induction of a pt with pulmonary HTN

Back 66

thiopental and propofol

Front 67

what agents for induction of a pt with pulmonary HTN may inhibit pulmonary vasodilation

Back 67

*ketamine

*etomidate

Front 68

what are the pros with VA in the maintanence of a pulmonary HTN pt

Back 68

they are potent bronchodilators

Front 69

what are the cons with VA in the maintanence of a pt with pulmonary HTN

Back 69

they decrease systemic vascular resistance with R to L shunt and increase shunt

Front 70

what drugs do you want to avoid in the maintanence of anesthesia with a pulmonary HTN pt

Back 70

drugs which produce histamine release

Front 71

what does positive pressure ventilation do with pulmonary HTN pts

Back 71

improves oxygenation

Front 72

ventilation settings with a pulmonary HTN pt must be appropriate to avoid what things

Back 72

*hypoxia
*hypercapnia
*acidosis
*decrease in venous return

Front 73

what monitors are appropriate in sx's with a pulmonary HTN pt

Back 73

invasive monitors are appropriate in all but minor sx

Front 74

what is the post-op care for a pulmonary HTN pt

Back 74

*adequate pain control

*continued intensive monitoring

Front 75

with labor and delivery and pulmonary HTN what type of anesthetic management would you choose

Back 75

epidural analgesia with dilute local anesthetic and narcotic

Front 76

with a c-section and pulmonary HTN what anesthetic tech would you choose

Back 76

epidural is the most likely choice in the non-emergency setting

(general if emergency)

Front 77

what type of anesthesia should you AVOID with a c-section and pulmonary HTN

Back 77

spinal anesthesia d/t sudden decrease in SVR

Front 78

what type of monitoring would you do for a c-section with pulmonary HTN

Back 78

*a-line

*pulmonary arterial catheter

Front 79

what is the maternal mortality with pulmonary HTN

why?

Back 79

~50%

-primarily d/t CHF in labor and the early postpartum period

Front 80

what is acute benign pericarditis

Back 80

*viral etiology

*does NOT involve a sig effusion or tamponade

*rarely progressive

Front 81

what type of presentation does pericarditis have following an MI

Back 81

acute presentation OR

delayed presentation (dresselers syndrome)

Front 82

acute presentation of pericarditis following an MI is seen when

Back 82

1-3 days following transmural MI

Front 83

delayed presentation of pericarditis following an MI is seen when

Back 83

weeks to months after an MI

Front 84

what is the dx criteria for acute pericarditis

Back 84

*chest pain

*friction rub

*EKG changes

Front 85

what is the tx for acute pericarditis

Back 85

*salicylates

*NSAIDs

*corticosteroids

Front 86

when does a pericardial effusion result in tamponade

Back 86

when the pressure in the pericardial space interferes with cardiac filling

Front 87

normally the pericardial space holds how much fluid

Back 87

15-50 ml

Front 88

symptoms of pericardial effusion and tamponade are related to what

Back 88

compression of adjacent structures

OR

related to pericardial restraint

Front 89

what are the symptoms of pericardial effusion and tamponade r/t compression of adjacent structures

Back 89

*dyspnea
*cough-hoarsness
*anorexia-dysphagia
*chest pain

Front 90

what are the symptoms of pericardial effusion and tamponade r/t pericardial restraint

Back 90

*tachycardia
*JVD
*hepatmegaly
*peripheral edema

Front 91

what is the mechanism for a cardiac tamponade

Back 91

diastolic collapse d/t pressure imposed by the pericardium impairs diastolic filling of the chambers thereby reducing SV and CO

Front 92

what are the compensatory mech with cardiac tamponade

Back 92

*tachycardia

*peripheral vasoconstriction

Front 93

what are the physical findings with cardiac tamponade

Back 93

*kussmauls sign

*pulsus paradoxus

*becks triad

Front 94

what is becks triad

Back 94

1-quiet heart sounds

2-increased JVD

3-hypotension

Front 95

how is cardiac tamponade dx

Back 95

*echo**

*CT/MRI

*EKG (not a really good diagnostic tool)

Front 96

what is the tx for cardiac tamponade

Back 96

*removal of fluid

*temporizing measures

Front 97

how is fluid removed in cardiac tamponade

Back 97

*pericardiocentesis

*pericardiostomy (pericardial window)

Front 98

what are temporizing measures for cardiac tamponade

Back 98

*intravascular volume expansion

*increase contractility

*correction of any metabolic acidosis

Front 99

what regarding anesthetic management in the presence of hemodynamically significant cardiac tamponade can result in life-threatening hypotension

Back 99

general anesthesia and positive-pressure ventilation

Front 100

in the anesthetic management of pts with cardiac tamponade what things do you want to maintain

Back 100

*CO
*contractility
*adequate preload
*SR

Front 101

in the anesthetic management of pts with cardiac tamponade what things do you want to AVOID

Back 101

*decreases in systemic vascular resistance
*decreases in venous return
*bradycardia

Front 102

what types of monitors should be used in the anesthetic management of pts with cardiac tamponade

Back 102

*arterial line

*central venous pressure

Front 103

what type of induction and maintenance drugs should be used in pts with cardiac tamponade

Back 103

*ketamine (good choice)

*bzd?

*MR?

Front 104

what is constrictive pericarditis

Back 104

pericardium becomes a rigid shell d/t adhesions &/or scarring

(over time may become calcified)

Front 105

what is diastolic filling in constricitive pericarditis

Back 105

IMPAIRED like with cardiac tamponade

Front 106

what is the treatment for constrictive pericarditis

Back 106

stripping of the pericardium

(which may be closely adherent to the myocardium)

Front 107

what may occur during the tx for constrictive pericarditis

Back 107

*may involve sig blood loss

*may require cardiopulmonary bypass

Front 108

what are the goals of anesthetic management of constrictive pericarditis

Back 108

maintenance of:
*HR
*contractility
*SVR
*venous return

Front 109

anesthetic drug selection with constrictive pericarditis will depend on what

Back 109

severity of hemodynamic compromise

Front 110

with severe hemodynamic constrictive pericarditis anesthetic management should be treated similar to what

Back 110

cardiac tamponade

Front 111

when is pericardial laceration common

Back 111

in rapid deceleration injuries to the chest wall

Front 112

if a pericardial laceration is associated with laceration of adjacent structures it may result in what

Back 112

cardiac herniation

Front 113

cardiac herniation would be managed similar to what condition

Back 113

cardiac tamponade

Front 114

when should you have a high suspicion for cardiac contusion

Back 114

with rapid deceleration injuries

Front 115

what should you be alert for in cardiac contusion

Back 115

*ST-T abnormalities

*dysrhythmias