Secondary Prevention 2: Common Clinical And Chronic Diseases

Front 1

CAD RFs

Back 1

ApoB to ApoAI ratio
Smoking
Waist to hip ratio
DM
psychosocial factors
HTN

Front 2

CAD benefical factors

Back 2

moderate etoh consumption
exercise
consumption of fruits and veggies

Front 3

what is the most important modifiable CAD RF?

Back 3

ratio of apolipoprotein B to alpolipoprotein AI
IDed in the INTERHEART study, pop attrib risk of 49%

superior to LDL and HDL for predicting risk

Front 4

How do you screen for CAD?

Back 4

Screen Adults 20 years or older every 5 yrs with a (fasting state) lipid profile

Front 5

What are apolipoprotiens?

Back 5

Apolipoprotein B (APOB or ApoB) are the primary apolipoproteins of chylomicrons and low-density lipoproteins (LDL - known commonly by the misnomer "bad cholesterol" when in reference to heart disease), which is responsible for carrying cholesterol to tissues. While it is unclear exactly what functional role APOB plays in LDL, it is the primary apolipoprotein component and is absolutely required for its formation.
Apolipoprotein A-I is the major protein component of high density lipoprotein (HDL) in plasma

targets for clinically significant CAD: LDL <70 this should be replaced with an APOB goal of 80.

Front 6

Waht is the second modifiable CAD RF?

Back 6

smoking - quitting smoking reduces the risk of a heart attack to the level of a nonsmoker within 3 years

Front 7

What is the waist to hip ratio pop attrib risk?

How does this compare to BMI pop attrib risk?

Back 7

in the INTERHEART study the waist to hip ratio was a better predictor of CAD than BMI (pop attrib risk 8%)

the waist to hip ratio was important in all BMI categories including the thin

Front 8

what is the suggested waist to hip ratio for men? for women?

Back 8

less than 0.93 in men
< 0.86 women

Front 9

DM increases the risk of CAD by

Back 9

2-6 fold

Front 10

DM RFs

Back 10

age
BMI
waist to hip ratio
weight gain as an adult
fam h/o
hypertriglyceridemia
tobacco smoking
low birth wt
low HDL
HTN
elevated glucose and HgA1C
ratio of saturated to polyunsat fat in diet
h/o gestational DM or delivery of an infant >4100 g
Polycystic Ovarian Syndrome

Front 11

Protective factors for DM

Back 11

exercise
moderate etoh consumption
whole grain, fruits, veggies, magnesium and fiber intake
low glycemic-index diet

Front 12

what protective measures should you do for DM pts

Back 12

ACE inhibitor for renal protectiono for all diabetic pts with albuminuria
pneumovax
influenza vaccine

Front 13

what is the pop attrib risk for psychosocial factors?

Back 13

33%

Front 14

what helps lower the risk of HLD in an adult

Back 14

a healthy diet in childhood

Front 15

Dietary Txt HLD

Back 15

lifestyle modification (low fat diet high fiber diet) - mediterranena diet
Statins

Front 16

HTN has a pop attrib risk of

Back 16

HTN has a pop attrib risk 18%

Front 17

HTN RFs

Back 17

age
BMI
Waist to hip ratio
wt gain
sedentary lifestyle
poor fitness
television viewing
high salt diet
low veggie fruit diet
diets high in red meat
etoh
type a personality
cigarette smoking
fasting insulin level

Front 18

HTN Stage - normal

Back 18

<120/<80

Front 19

HTN Stage - preHTN

Back 19

120-139/80-89

Front 20

HTN Stage 1

Back 20

140-159/90-99

Front 21

HTN Stage 2

Back 21

>=160/>=100

Front 22

what meds can raise BP?

Back 22

NSAIDs
roids
estrogen
appetite suppressants
sympathomimetics

Front 23

HTN pts should be tested for what?

Back 23

renal artery bruit, BP in both arms
CBC, fasting glucose, lipids, potassium, creatinine, urinalysis, EKG

Front 24

HTN txt special considerations

Back 24

lifestyle modification - exercise, wt reduction, diet

Rx:
ace inhib in diabetic and younger pts
BB who had an MI

Front 25

what is the framingham risk score?

Back 25

The Framingham Risk Score is used to estimate the 10-year cardiovascular risk of an individual. The Framingham Risk Score is based on age, total cholesterol, smoking status, HDL, and systolic BP.

The CHD risk at 10 years in percent can be calculated with the help of the Framingham Risk Score. Individuals with low risk have 10% or less CHD risk at 10 years, with intermediate risk 10-20%, and with high risk 20% or more.

Front 26

what is the ABCDEF for CAD tx?

Back 26

A - asprin and ACE inhib
B - BBlocker
C - Choleterol
D - Diet
E - Exercise
F - Fish Oil 1000mg daily

Front 27

What is the most important risk factor for cerebrovascular disease

Back 27

HTN
(cholesterol is for CAD)

Front 28

What is a useful agent for primary and secondary stroke prevention

Back 28

asprin

Front 29

What is etoh risk in stokes

Back 29

it overall decreases the risk of strokes but it increases hemorrhagic stroke

Front 30

what reduces the risk of stroke

Back 30

healthy diet, exercise, asa, statins

Front 31

what is the most common nutritional deficiency worldwide?

Back 31

iron deficiency

Front 32

how is iron deficiency diagnosed?

Back 32

low serum ferritin levels

hypochromic, microcytic anemia

Front 33

iron deficency in pregnancy is associated with what?

Back 33

low birth weight
preterm delivery
perinatal mortality
postpartum depression
poor performance on mental and psychomotor testing in offspring

Front 34

how much iron is recommended for pregnant women

Back 34

preggos with iron deficiency - 100mg/d

prevention of iron deficiency - start early in pregnancy 40mg/d

Front 35

USPSTF iron defic recs

Back 35

routine screening for iron defic anemia in asymptomatic preggs

Front 36

what causes MACROcytic anemia?

Back 36

Vit B12 deficiency and folic acid deficiency

Front 37

how do you test for vit b12 defic?

Back 37

serum methylmalonic acid and homocysteine levels - these are increased

Schilling test (vit b12 absorption test) to detect pernicious anemia - but now most test for serologic parietal cell and intrinsic factor Abs.

Front 38

what increases the risk for asthma

Back 38

tobacco exposure in utero and after birth increases the risk of asthma and reduced lung function for children without asthma.

Other triggers dust mites, outdoor air pollution, cockroack Ag, pets, mold

Front 39

what accounts for 10% of newly diagnosed asthma in adults?

Back 39

occupational asthma

isocyanates
laboratory animal Ags
flour and grain dust
crab and salmon,
acid anhydrieds,
platinum salts
latex
wood dust

Front 40

asthma is confirmed by what?

Back 40

observing a forced expiratory volume in 1 second (FEV1) improvement of 12% or more with a bronchodilator

Front 41

what is the mainstay tx for asthma?

Back 41

inhaled corticosteroids

Front 42

what is the fourth leading cause of death in the US?

Back 42

COPD

in contrast to CAD, the mortality rate of COPD is rising drastically

Front 43

what is the main RF for COPD

Back 43

cigarette smoking

Front 44

what is the second main RF for COPD worldwide

what are the other RFs

Back 44

cooking and heating in poorly ventilated areas

this is the primary cause in women worldwide

occupational dust, chemicals, outdoor air pollution

Front 45

how do you test for COPD

Back 45

spirometry

An FEV1/FVC ratio less than 0.70 after a bronchodilator is diagnostic for COPD

Front 46

who gets screened for COPD

Back 46

the USPSTF recommends AGAINST screening for COPD UNLESS they have chronic cough, chronic sputum production, dyspnea

Front 47

prevention measures in those with COPD

Back 47

influenza vaccine
pneumovax
exercise programs to strengthen chest muscles and reduce dyspnea and fatigue

Front 48

what is the most common cause of dementia?

Back 48

alzheimers - accounts for 3/4 of dementia cases

Front 49

what is the genetic RF for late alzheimers?

Back 49

This gene, called APOE, produces a protein called apolipoprotein E. APOE comes in several forms, or alleles—ε2, ε3, and ε4:

•The APOE ε2 allele is relatively rare and may provide some protection against the disease. If AD does occur in a person with this allele, it develops later in life than in those with an APOE ε4 allele.
•APOE ε3 is the most common allele. Researchers think it plays a neutral role in AD.
•APOE ε4 occurs in about 40 percent of all people who develop late-onset AD and is present in about 25 to 30 percent of the population. People with AD are more likely to have an APOE ε4 allele than people who do not have AD. However, at least one-third of people with AD do not have an APOE ε4 allele.

Front 50

what is the main toxic substance implicated in alzheimers

Back 50

B-amyloid has been implicated ast the toxic substance that is thought to destroy neurons by generating free radicals.

some studies have shown large amounts of antioxidants reduced the risk of AD.

Front 51

what is the other toxic substance implicated in alzheimers

Back 51

homocystine can be neurotoxic and excess amounts are associ with vascular dementia and rapidly progressing AD.

Low levels of vit B6 and B12 is assoc with cognitive impairment and increased risk of AD.