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77 Cards in this Set
- Front
- Back
state the classsifications of hypertension
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normal below 120/80
pre below 140/90 stage 1: below 160/100 stage 2 above 160/100 |
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list the risk factors for cardiovascular disease as stated by the JNC7
(9) |
HTN, BMI >30, dyslipidemia, DM, physical inactivity, Age (M>55, F>65), Family Hx of premature CVD (same ages as above), gfr <60, smoking
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JNC & says to rule out other causes of HTN. What are some
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sleep apnea, pheochromo, cushings/steroid therapy, drug related (think long term Birth control), primary aldosteronism, thyroid/para disease, coarctation of the aorta, renovascular disease/kidney disease
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what do you treat BP to?
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140/90
130/80 if diabetic or chronic kidney |
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distinguish Tx between stage 1 and stage 2 HTN
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Stage 1, start w/ one med. Probably HCTZ
Stage 2 probably require two to start, HCTZ and ACE most often |
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Drug classes for HTN and HF
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Thiaz, BB, ACE/ARb, ALDO (for heart only)
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Drug classes for HTN and Post MI
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BB ACE (not ARB) Aldo (for heart only)
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Drug classes for HTN and high CVD risk
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thiaz, BB, ACE (not ARB), CCB
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Drug classes for HTN and kidney disease
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ACE/ARB
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Drug classes for HTN and stroke prevention
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thiaz and ACE
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list some causes of resistant hypertension
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excess NA, medications (NSAIDS, BC, coke) alcohol, inadequate Tx, imporper measurement, and primary identifiable causes
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list some lifestyle mods for HTN
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weight, DASH, d/c sodium, aerobic activity, moderate alcohol
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list cholesterol goals
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LDL optimal <100
40<HDL<60 Totoal cholesterol <200 |
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list risk factors beside LDL that affect goals
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smoking, HTN, low HDL (<40), Fam Hx of CHD, AGE (M>45, F>55), C reactive protein
* HDL >60 negates one risk factor * diabetes is CHD equivalent |
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What are your LDL Goals?
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CHD or CHD risk equiv <100
2+ risk factors <130 0-1 risk factor <160 |
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parasympathetic control of the heart occurs through the
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vagus nerve
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sympathetic control of the heart occurs through
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SA/AC node from the reticular formation
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where does most of our peripheral resistance come from
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arterioles
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histamine is present in what cells
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basophils, mast cells, and platelets
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which tissure factors vasodilate
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the kinins, histamine, Prostoglandin E
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list what drug may cause ___ when used to treat hyperlidemia
myophathy many GI side effects flushing gallstones |
statins
bile acids niacin fibric acids |
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list some herbal remedies for cholesterol
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red yeast rice, plant sterols, garlic, omega 3's, soy proteina
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metabolc syndrome can be diagnosed by presence of 3 or more factors, list them:
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abdominal obesity (M>40, F>35)
triglycerides >150 HDL (M<40 F<50) BP >130/85 FBG >110 |
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the most common site for atherosclerosis
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coronary arteries
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list complications of atherosclerosis
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MI, IHD, stroke, CHD, PVD
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congenital, seccular enlargements of cerebral arteries, of the circle of willis
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berry aneurysm
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most common place for aneurysm
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infrarenal
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the "worst headache I've ever had"
photophobia, visual changes, N/V |
subarachnoid hemorrhage
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painful nodules affecting small and medium sized arteries, often described as a funny feeling in the hands and legs, immune complexes in lesions, infarctions in infected organs.
DX and TX |
classic polyarteritis nodosa (PAN)
corticosteroids and immunosuppressants |
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most common cause of aquired heart disease in children in the us
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Kawasaki disease
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a vasculitis that orginates in small vessels progressing to larger, causes acute febrile illness, distinguished by rash ad red oral mucosa
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Kawasaki disease
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vasculiltis affecting meduim and large muscular arteries, unilateral amaurosis fugax is a classic symptom.
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Giant cell arteritis
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Vasculitis that typically leads to visual disturbances in elderly ladies due to involvement of the temporal artery
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giant cell arteritis
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typically involves large vessels causing stenosis of the aortic arch. AKA pulseless disease
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Takyasu's Arteritis
TX glucocorticoids |
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thrombus formation affecting medioum arteries, specifically digital vessels. most often seen in middle aged male smokers
DX and TX |
thromboangitis Obliterans
smoking cessation |
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medications that may worsen Raynauds
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Ergot, B-blockers, amphetamines, chemo
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disease characterized by color progression from palor->cyanosis->hyperemia
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Raynauds phenomenon
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ischemic pain following exertion. caused by limited blood flow in arteries, most commonly in the legs, alleviated by rest
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claudication
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list tx of varicose veins
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frequent rest, elevated legs, support stockings, surgery, laser therapy, sclerotherapy
*avoid girdles and tight pants |
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list the four common causes of lower leg ulcers
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venous (80%) and arterial insufficiency, neuropathy (diabetes), and pressure ulcers
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Verchows triad, venous thrombosis
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blood stasis, vessel wall injury, INCREASED blood coag
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risk factors for venous stasis
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immobility, acute MI, CHF, shock, venous obstruction
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risk factors for hypercoag of blood
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stress and trauma (including preg and childbirth), BC, cancer, dehydration, familial
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tests used to Dx deep vein thrombosis
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Homan sign, d-dimer, physical exam, compression ultrasound
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pt complains of swelling and tenderness is Left leg, exam shows "red hot cord"
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thrombophlebitis
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tx for septic thrombophelbitis
aseptic |
inpatient IV antibiotics
outpatient NSAIDS and anticoagulants apply heat, elevate, *avoid plastic cannula over 2 days |
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three complications from DVT
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pulmonary emboli, varicose veins, chronic venous insufficiency
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causes of decreased compartment size, leading to compartment syndrome
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constrictive dressings and casts, IV fluids, Thermal injury and frostbite, surgical closure of fascial defects
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causes of increased compartment volume
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fractures, orthopedic surgery, trauma and bleeding, thermal injury and frostbite
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risk factors for pressure ulcers
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altered sensory perception, altered skin moisture, incontinence, altered circulation, altered hydration status
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how can you prevent pressure ulcers
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move, change bed linens, skin care, observation
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hospitalized pt has persistant redness on rump
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stage I ulcer
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hospitalized pt has what appears to be a blister on back, part of the dermis is lost
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stage II pressure ulcer
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renin is produced where and what does it do?
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liver, converts angiotensinogen to angio I
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where is angio I converted to angio II
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lungs by ACE
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what does angio II do?
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causes adrenal cortex to secrete aldosterone, stimulates hypothalamus to stimulate thirst and ADH, vasoconstriction of arteries
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elevation of blood pressure resulting from some other disorder
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secondary hypertension
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list medications that may cause secondary hypertension
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Stimulants, NSAIDS, BC, ST johns wart, ginger
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pt presents with hypertension. Upon further exam you note postural hypotension, characteristics of anxiety, diaphoresis. Your order a complete lab panel. What do you expect
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elevated catecholamines due to a tumor on the adrenal gland
(pheochromocytoma) |
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teenager presents with hyperetension and hypokalemia. You order a PRA and PAC. What might you find througout the endocrine system
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multiple neoplasms
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renal ischemia or stenosis of the renal arteries may lead to
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abrupt onset of renal hypertension
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hypertension in children is decribed as
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average of atleast 3 measurements BP >95th percentile
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a possible cause of childhood hypertension characterized by a femoral pulse lag, decreased pulse pressure in the right arm, and an abnormal contour of the aorta onx ray
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coarctation of the aorta
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the gold standard of invasive studies for hypertension
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digital subtraction angiography
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list some changes in pregnancy affecting blood pressure
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increased fluid volume, increased stroke volume, hr, co, reduced vascular tone
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describe the timeline of bp changes in pregnancy
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bp drops until 16-20 weeks, maintains, then starts to rise after 28 weeks
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diagnosis of hypertension during pregnancy doesn't completely follow the JNC 7. What are the differences
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increase in SBP >30
increase in DBP> 15 and the normal bp>140/90 |
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when should gestational HTN resolve itself
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12 weeks
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what can you use to treat chronic HTN in pregnancy
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Hydralazine and lebatolol, if necessary add nifedipine
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Preeclampsia is defined as
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HTN during pregnancy + Proteinuria
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list risk factors for preeclampsia
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age extremes, is happened in 1st pregnancy, >10 yrs between pregnancies, new partner, pre-existing disorders
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HELLP Syndrome in pregnancy
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for preeclampsia- hemolysis, elevated liver enzymes, low platelets
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differentiate between mild and severe preeclampsia
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severe >160/110 and evidence of other organ involvement
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you can deliver a baby as early as ___ weeks if severe preeclampsia
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34 weeks
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what determines how agressive treament should be in a hypertensive crisis
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degree of target organ damage
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when is rapid bp reduction called for in a hypertensive emergency (bp >225/125)
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acute MI, CHF with pumonary edema, aortic dissection, hypertensive encephlaopathy, pheo, acute renal failure, HTN from MAO, eclampsia
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when is rapid BP reduction not called for (bp >225/125)
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cerebral vascular accident
intercranial hemorrhage |