Fm: Htn, Diabetes, Hyperlipidemia

Front 1

HTN diagnosis requires

Back 1

SBP > 140 or DBP > 90 at least two visits 2 weeks apart [unless it is SEVERE or there is already evidence of END ORGAN DAMAGE]

Front 2

Best way to make sure HTN is "real" : hospital or ambulatory/home measurement?

Back 2

home

Front 3

mild HTN best next step

Back 3

repeat BP measurement 1-2 weeks later

Front 4

HTN & older than 65. LDL is found to be 175: next step

Back 4

drug therapy; a statin rather than lifestyle (he has 2 RFs)

Front 5

Most useful lifestyle change if you have to pick one to lower BP

Back 5

Weight loss

Front 6

Exception HTN diagnosis that only requires one reading?

Back 6

if SBP >210 or DBP >120. OR already have end organ damage

Front 7

chlorthalidone

Back 7

thiazide

Front 8

best initial tx for htn

Back 8

thiazide

Front 9

most common adverse effect of thiazide

Back 9

hypercalcemia

Front 10

if thiazides don’t work, what is the next best step if no other medical condition?

Back 10

beta blocker, ACE-I, or CCB equal if no other condition

Front 11

HTN + history of BPH - drug of choice?

Back 11

doxazosin, prazosin, terazosin, alpha1 antagonists

Front 12

most common S/E of doxazosin

Back 12

ortho hypo

Front 13

htn drugs associated with hyperkalemia

Back 13

ace inhibs, arbs, beta blockers, spironolactone

Front 14

s/e of ccb

Back 14

constipation

Front 15

HTN + osteoporosis: best drug

Back 15

hydrochlorothiazide.

Front 16

calcium oxalate kidney stones, with HTN, best initial therapy?

Back 16

hydrochlorothiazide. Causes hypercalcemia -> takes calcium out of URINE, into blood therefore helps with kidney stone

Front 17

diabetes, CHF, HTN, migraines. Drugs: metoprolol, enalapril, metformin, HCTZ, spironolactone. Has attack of gout. Start NSAIDS & colchicine: what's next? (stop what drug)?

Back 17

STOP hctz b/c it increases uric acid

Front 18

HTN + heart failure: primary tx

Back 18

beta blocker

Front 19

Diabetes + HTN

Back 19

ace inhibs

Front 20

never use what in acute gouty attacks

Back 20

allopurinol

Front 21

Synergistic with HCTZ

Back 21

ACE-I

Front 22

HTN patient, what is most expected on auscultation

Back 22

S4 gallop due to left vent hypertrophy/stiffness

Front 23

envelope shaped crystals

Back 23

calcium oxalate crystals. antifreeze.

Front 24

HTN pt, what's expected on urinalysis? Hyaline casts, rbc casts, oxalate crystals, granular casts, proteinuria

Back 24

proteinuria. It will be FROTHY

Front 25

left BBB looks like

Back 25

ischemia.

Front 26

left BBB + story of chest pain: tx?

Back 26

thrombolytics, b/c can't see if st elevation or not

Front 27

EKG findings for LV hypertrophy

Back 27

S wave in V1 & R wave in V4 or V5 greater than 35 mm

Front 28

HTN can lead to what neuro findings

Back 28

multi infarct dementia & strokes

Front 29

Pt comes in with hypertensive crisis, best step in management

Back 29

IV labetolol, enalapril, nitroprusside

Front 30

Most common cause of secondary HTN

Back 30

renal artery stenosis.

Front 31

RFs for HTN

Back 31

age, male gender, African American race, obesity, family history, increased sodium intake, alcohol (more than 2 oz)

Front 32

Major cardiac complications of HTN

Back 32

cardiac: CAD, CHF + LVH, aortic dissection stroke, renal failure.

Front 33

Eye cx in HTN

Back 33

visual disturbance & scotoma from AV nicking & cotton wool spots. Papilledema

Front 34

CNS cx in HTN

Back 34

intracerebral hemorrhage, other stroke subtypes

Front 35

Lab tests you should order to evaluate target organ damage & CV risk?

Back 35

UA, chemistry panel, fasting glucose, lipid panel, ECT

Front 36

Stage I HTN? Stage II HTN?

Back 36

Stage I: 140-159/90-99 Stage II: 160 +/ 100 +

Front 37

Which anti HTN meds are safe in pregnancy

Back 37

beta blockers and hydralazine

Front 38

S/E of thiazides that merit close watching of levels

Back 38

hypokalemia, hyperuricemia, hyperglycemia, hypomagnesia, elevated cholesterol & TGs, metabolic alkalosis

Front 39

If a patients response to an antiHTN agent is not adequate do you change to another first line agent of a different class or add a seond agent?

Back 39

change to another first line agent.

Front 40

Obese + HTN patient: what screening test is appropriate?

Back 40

Diabetes screening.

Front 41

Abdominal ultrasound used when

Back 41

males who smoke b/w 65-75 to rule out AAA (resect >5cm)

Front 42

Screening chest xray in what population?

Back 42

none. Too many false +s and -s

Front 43

PSA when? Virtual CT colonscopy?

Back 43

Not helpful.

Front 44

Best screening test for diabetes

Back 44

two fasting glucoses >126. random over >200, abnormal glucose tolerance test

Front 45

Pt on HCTZ and has diabetes. Etiology is?

Back 45

DECREASED insulin receptors. (also insufficient insulin release but not most important)

Front 46

Best initial therapy for patient with HTN & Diabetes? Why? MOA of drug?

Back 46

Metformin. Does not cause hypoglycemia or wt gain. (blocks GNG). Best efficacy. (Biguanide)

Front 47

Miglatol MOA? S/E?

Back 47

alpha glucosidase inhibitor. Flatulence

Front 48

Pioglitazone

Back 48

TZD. Decrease insulin resistance in skeletal m & liver.

Front 49

Repaglinide

Back 49

no advantage over sulfonylureas. insulin secretagogue

Front 50

how many can be controlled with diet & exercise

Back 50

25%

Front 51

Patient hypertensive, despite wt loss, glucose remains high. Adverse effect of most appropriate therapy??

Back 51

metformin -> LACTIC ACIDOSIS

Front 52

Which diabetes drugs have s/e of 1) diarrhea 2) exacerbation of CHF 3) hypoglycemia 4) lactic acidosis 5) SIADH

Back 52

1) alpha glucosidase inhibitors (miglatol & acarbose) 2) TZD 3) insulin secretagogues & repaglinides 4) metformin 5) sulfonylureas

Front 53

C/I in metformin

Back 53

renal insufficiency

Front 54

Diabetic, already on HCTZ, most appropriate therapy for HTN?

Back 54

ACE INHIBITOR.

Front 55

What can decrease cravings of opiates?

Back 55

clonidine

Front 56

Target BP in diabetic patient?

Back 56

< 130/80

Front 57

Despite wt loss, glucose remains high. BP 135/87, LDL found to be 134. Next best step in management?

Back 57

Simvastatin. Lower MORTALITY more than other drugs. (Niacin C/I)

Front 58

Goal LDL for diabetics

Back 58

< 100

Front 59

Most common adverse effect of statins

Back 59

increased transaminases. 1%.

Front 60

Worsened glucose control & flushing =

Back 60

niacin

Front 61

bloating, diarrhea, flatulence with what anti cholesterol med

Back 61

choelstyramine

Front 62

Monitor compliance in diabetics with?

Back 62

HbA1C. Avg for last 3 months

Front 63

Diabetic, HTN, sodium & K+ normal, BUN 18, Cr 1.0, normal also. NO evidence of renal dysfxn. Routine management/next action???

Back 63

STILL check for microalbuminuria (below level normally seen in normal dipstick, unlike "trace")

Front 64

If diabetic has microalbuminuria start what drug?

Back 64

ace inhibitor if not already on it

Front 65

Diabetic with renal insufficiency, what histo finding?

Back 65

Kimmelstiel Wilson lesions

Front 66

Normal cup to disc ratio? Glaucoma?

Back 66

cup in saucer or "disc" should be 1/3 size of disc. Glaucoma higher.

Front 67

Glaucoma rx

Back 67

Pilocarpine, beta blockers, & prostaglandin analog

Front 68

Dark reddish macula with very pale background?

Back 68

retinal artery occlusion

Front 69

Neovascularization seen when in eye? Tx?

Back 69

diabetic retinopathy. Laser therapy

Front 70

Cotton wool spots seen in

Back 70

hypertension

Front 71

25 yo G2P1 woman for prenatal check up. What test should be done at this point?

Back 71

oral glucose tolerance test for gestational diabetes. (greater sensitivity)

Front 72

early satiety, bloating, constipation in diabetic. Single greatest stimulant of GI motility?

Back 72

stretch. Same neuropathy occurs in stomach causing gastric paresis, don’t feel it, no gastrin for motility.

Front 73

How to treat gastric paresis in diabetic?

Back 73

erythromycin

Front 74

Acidotic, hyperglycemia, weird black stuff in roof of mouth:

Back 74

mucormycosis

Front 75

another presentation of mucormycosis

Back 75

cavernous sinus thrombosis. CN 3, 6, 4th palsy.

Front 76

Tx for mucormycosis?

Back 76

amp B

Front 77

Amp B s/e

Back 77

RTA.

Front 78

Amp B + mucormycosis + what else do you do?

Back 78

surgical debridement

Front 79

T2DM, on glargine & aspart, presents with HA & fever, CT mastoid air cells open: dx? Organism responsible? Tx?

Back 79

malignant otitis externa. Pseudomonas. Piperacillin/tazobactam

Front 80

diabetic, starts exercising, begins having lightheadedness & HA: explain

Back 80

reactive hyperglycemia. Too much insulin at night, glucose too low, stress hormones cause reactive hyperglycemia (epi & glucagon)

Front 81

T1DM, short of breath, tachycardic, light headed. Most likely to lead to this problem? Dehydration, infection, ischemia, renal failure, wt gain

Back 81

INFECTION

Front 82

Which lab value is most important indication of severity in DKA?

Back 82

bicarbonate.

Front 83

DKA best initial therapy

Back 83

Bolus of normal saline (more important than IV insulin)

Front 84

MOA of hyperkalemia in DKA

Back 84

total K+ is depleted, HOWEVER, blood level is up because of cellular buffering so MOA is: Increased entry of H+ into cells

Front 85

HyperVN in DKA is most similar to effect of which? Acetaminophen, CO, salicylates, TCA toxicity

Back 85

CO poisoning. Acts like lactic acidosis.

Front 86

U wave is a sign of?

Back 86

hyPOkalemia (purkinje fiber depolarization)

Front 87

Peak T waves?

Back 87

hyperkalemia

Front 88

What explains relationship b/w glucose & sodium (translational hyponatremia)

Back 88

increased glucose 100 mg/dL, decrease sodium 1.6 mEq/L

Front 89

Why low BP in DKA?

Back 89

Hyperglycemia acts as osmotic diuresis

Front 90

When correcting low BP in a pt with DKA, what is an adverse effect of lowering glucose too quickly?

Back 90

SEIZURES. Cells are still hypertonic so now blood tonicity dropped, shifts into cells, cells swell and causes cerebral edema

Front 91

Raising HDL

Back 91

statins, niacin?, estrogen, exercise, lowering TGs

Front 92

Goal LDL < 160

Back 92

normal, no RFs

Front 93

Goal LDL < 130

Back 93

mild RFs

Front 94

Goal LDL < 100

Back 94

diabetes

Front 95

Goal LDL < 70

Back 95

CAD

Front 96

RFs for CAD in hyperlipidemia

Back 96

smoking, HTN, DM, low HDL (<35), male >45, female >55, male, premature CAD in first degree relative (Male < 55, female < 65)

Front 97

Type 1 hypercholesterolemia

Back 97

exogenous hyperlipidemia, elevated CMs, due to diet

Front 98

Type Iia

Back 98

familial, LDL, tx: statins

Front 99

Type III

Back 99

increased IDL

Front 100

Type IV

Back 100

vLDL tx niacin,gemfibrozil

Front 101

Type V

Back 101

hypertriglyceridemia vLDL & CMs, niacin & gemfibrozil

Front 102

Dietary factors in hyperlipidemia

Back 102

saturated fatty acids & cholesterol, high calorie neutral except increase TG, alcohol increases TG & HDL

Front 103

medications that can contribute to hyperlipidemia

Back 103

thiazides increase otal, LDL, TG. Beta blockers increase TG and lower HDL, estrogen, corticosteroids and HIV protease inhibitors

Front 104

How to calculate LDL

Back 104

LDL = Total cholesterol - HDL - TG/5

Front 105

Total cholesterol to HDL ratio

Back 105

Lower risk of CAD the lower it is. <4.5 is desirable.