1. BP goal for patients <60? (w/ DM, CKD)
  2. Pt BP goal if >60 yrs old?
  3. Side effects of ACE inhibitor?
    • Cough
    • Angioedema
    • Hyperkalemia
  4. Side effect of the use of diuretics?
  5. Calcium channel blockers is a good choice BP med for what patients?
    Side effect?
    Black Patients

    Lower Extremity Edema
  6. Causes of secondary hypertension?
    Renal, Vascular, Endocrine, Neurological, Pharmacological, Pregnancy after 20 weeks
  7. Elevated systolic with normal diastolic is known as what type of hypertension?
    Isolated Systolic Hypertension (due to reduced vascular compromise in large arteries)
  8. What are he initial BP choices to start in black patient’s with/without DM?
    • Thiazide Diuretic (mild HTN 5-8pts high)
    • Ca Channel Blocker (severe >10pts high)
  9. What are the initial BP choices in non black patients with or without DM?
    • Thiazide Diuretic (hctz)
    • Ca Channel Blocker (-pine)
    • ACE (-pril)
    • ARB (-artan)
  10. Diagnosis for HTN?
    Must have 2 elevated BPs on different occasions
  11. What BP medication should someone with lung problems never be placed on?
    Beta Blocker
  12. A patient is already on a ACE inhibitor, what other BP medication should he never be started on with an ACE?
    Arb - never start a patient on an ACE & ARB
  13. What causes a dry hacking cough in patients who are on an ACE inhibitor?
    Bradykinin build up in the Lungs that trigger a cough (switch the ACE to an ARB)
  14. What type of Ca Channel Blockers do you want to use for hypertension?
    DHPs (-end in pine) Doesn’t Hurt Pulse (non-DHPs such as diltiazam hurt pulse)
  15. Diltiazem & Verapamil are what type ofCa Channel Blockers?
    Non-DHPs (decrease Heart Rate)
  16. A patient has a pulsitile abdominal mass on exam, what are you worried about as the provider and how should you follow up?
    Aortic Aneurysm - order Abdominal Ultrasound/CT
  17. Insulin Insensitivity (DMII) is determined by what 2 lab values?
    Increased Triglycerides & decreased HDL
  18. A patient has a history of gout and kidney problems, what BP medication should you not prescribe?
    Thiazides (HCTZ)
  19. What is considered first line to treat hyperlipidemia?
    Lifestyle modifications
  20. What class of medication has been shown to reduce morbidity & mortality in hyperlipidemia?
    HMG Co-A reductase inhibitor (Statin Therapy)
  21. A patient who has been diagnosed with dyslipidemia complains of muscle pain, what are you concerned about and how should it be assessed?!
    Concerned for Rhabdomylisis - check CPK level
  22. The valve most commonly affected by rheumatic heart disease is?
  23. S/S of heart Failure?
    • Tank 1 - heart (different sounds s3/4, tachycardia)
    • Tank 2 - lungs (crackles, tachypnea)
    • Tank 3 - peripheries (peripheral Edema)
  24. A patient has heart failure, what medication class should you not place the patient on?
    Calcium Channel Blocker
  25. Diastolic Murmurs?
    • Aortic Regurgitation
    • Mitral Stenosis
  26. Systolic Murmurs?
    • Mitral Regugitarion
    • Physiologic Murmur
    • Aortic Stenosis
    • Mitral Valve Prolapse
  27. What murmurs are always abnormal?
    Diastolic Murmurs
  28. Who are physiologic Murmurs most common in?
    Younger patients (16 yr old growing athlete)
  29. The apex of the heart is the listening point for what murmur?
  30. The turbulent noise you hear is in conjunction with the carotid pulse, what type of murmur is it?
    Systolic Murmur
  31. Listening points: Aortic?
    Right of Sternum - 2nd ICS
  32. Listening point: Pulmonic?
    Left of sternum - 2nd ICS
  33. Listening point: Tricuspid?
  34. Listening point: Mitral?
    Left of Sternum - 5th ICS (Apex)
  35. A patient has a sulfa allergy, which BP med should they never be placed on?
    HCTZ (steven Johnson’s)
  36. Heart sound S2 is caused by? What 2 valves?
    Closure of Semilunar Valves (aortic/pulmonic)
  37. CHF is accompanied by what 3 heart sounds?
    S1 S2 & ***S3***
  38. Which systolic murmur is heard best at the apical area during auscultation of the chest, that’s the only murmur accompanied by a mid to late systolic CLICK?
    Mitral Valve Prolapse (women of child bearing age complain of chest pain/palpitations)
  39. Which anti-hypertensive med is associated with erectile dysfunction?
  40. Subungual (splinter) hemorrhages on the nailbed, petechia on the palate, painful violet colored nodes on the fingers or feet (Osler nodes), and tender red spots on the palms/soles (Janeway lesions) are accompanied with what ? What
    Bacterial Endocarditis
  41. Where is the apical impulse located?
    5th ICS midclavicular line
  42. Heart sound S1 is made by? What 2 valves?
    Closure of Atrioventricular Valves (mitral/tricuspid)
  43. Which heart sound is caused by increased resistance due to stiff left ventricle, left ventricular hypertrophy?
  44. First time a thrill is present is what grade of murmur?
    Grade IV
  45. All benign Murmurs occur when?
    During Systole (S2)
  46. Which systolic mumur radiates to the axilla?
    Mitral Regurgiation
  47. Which systolic murmur radiates to the neck?
    Aortic Stenosis
  48. Simvastatin with amiodarone can cause what?
  49. INR goal in patient with AFib?
  50. INR goal with patient who has synthetic/prosthetic valves?
  51. Patient complains of abrupt onset of palpitations, rapid pulse, lightheaded ness, soa, and anxiety. Heart rate is 150-250. What does the patient have and how should is be managed?
    Paroxysmal Atrial Tachycardia - Valsalva Maneuvers
  52. How do you assess for pulsus paradoxus?
    Inflate BP cuff on arm where the radial pulse can no longer be felt and the apical pulse should still be able to be heard
  53. What should you order with the INR in a patient who is on Coumadin and you suspect bleeding?
  54. A patient is newly diagnosed HTN, what should be ordered as a baseline?
    EKG & CXray
  55. Coarctation of the aorta is accompanied by what 2 physical exam findings?
    • BP arms > legs
    • Weak femoral pulses
  56. Spironolactone causes what major side effect?

  57. ACEs & ARBs are contraindicated in what disease?
    Severe kidney disease
  58. Alpha-1 Blocker Agonist ends in what suffix?
    What should pt be educated on?
    Which types of patients is it indicated in?
    • -zosin
    • (First dose effect - lay down)
    • Indicated in males with HTN & BPH
  59. Copper/Silver Wire arterioles & AC nicking are caused by what?
  60. Neovascularization, microaneurysms, hard exudates, and cotton wool spots are due to what?
    Diabetic Retinopathy
  61. First line for Isolated systolic hypertension in elderly?
    Thiazide diuretics

    Add CCB or ACE/ARB
  62. How do you measure orthostatic HTN?
    BP sitting and standing
  63. What are 3 side effects of thiazide diuretic?
    • Hyperglycemia
    • Hyperuricemia
    • Hypertriglyceridemia
  64. The BP drug of choose for diabetics
    ACE inhibitors
  65. Pt has renal artery Stenosis which BP med should they not be placed on and why?
    ACE inhibitor because it can precipitate acute renal failure
  66. A female pt who has HTN & osteoporosis/osteopenia should recieve what type of BP med?
    Thiazides because it helps bone loss by slowing down Ca loss and stimulating osteoclasts
  67. Homans sign?
    Lower leg pain on dorsiflexion of the foot
  68. A patient who takes Coumadin has an INR of 3-5, how should this be managed?
    Skip 1 dose, decrease maintenance and check INR in 1-2 days until normal
  69. A patient has an INR of 5-9, how should this be managed?
    Give Vitamin K or omit next 1-2 doses of warfarin and monitor INR daily until normal

    Decrease Coumadin dose
  70. Left heart failure results in symptoms where?
  71. Right heart failure results in symptoms where?
    GI tract (edema, spleenomegaly, anorexia, nausea, abdominal pain)
  72. Ordinary physical activity resulting in fatigue & exertional dyspnea is what class of heart failure?
    Class II
  73. Chronic, recurrent episodes of color changes on fingertips that range from white (pallor), to blue (cyanosis), to red (reperfusion) is known as what conditions?
    Reynauds Phenomenon
  74. What is the treatment for Reynauds phenomenon?
    Ca Channel Blockers such as Amlodipine & Nifedipine
  75. Normal HDL?
  76. Normal LDL?
    <100 is optimal; <130 for low risk pt with less than 2 risk factors
  77. Normal Triglycerides?
  78. Which should be treated first Triglycerides or LDL?
    LDL unless Triglycerides are >500 then start the patient on tricor or niacin (high risk for acute pancreatitis)
  79. What HDL level is a risk factor for CHD even though total cholestorol, Triglycerides, & LDL are normal?
  80. How should a patient be educated to reduce Triglycerides?
    Reduce simple carbs, junk food, & fried foods
  81. Pts who have hypertension should limit their _____ intake.
  82. What 2 things can a patient do to increase their HDL?
    Increase aerobic Exercise & take Niacin
  83. Niacin and fibrates are best at lowering what?
  84. Niacin can increase ______ enzymes.
  85. An elderly patient with isolated systolic hypertension should be started on what BP medication?
    Calcium Channel Blocker
  86. An elderly patient with hypertension that is not isolated systolic HTN should be started on what type of BP medication?
    Thiazide Diuretic
  87. Split S2 is best heard where?
    2nd ICS - Left Sternal Border

    Pulmonic Area
  88. What is pulsus paradoxus?
    Decrease in SBP on inspiration
  89. What 2 medication classes have contraindications for drinking grape fruit juice?
    Statins & CCBs
  90. A patient with stage 2 hypertension should be started on what?
    2 BP medications
  91. What should be done about a fixed split ?
    Always abnormal - refer
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