Exam (elaborations)
PAEA Family Medicine EOR Exam Topic List.
- Course
- Institution
PAEA Family Medicine EOR Exam Topic List. Questions And Answers
[Show more]
Seller
Follow
BrainEdge
Reviews received
Content preview
NURSINGPAEA Family Medicine EOR Exam Topic List
CARDIOVASCULAR (15%)
1. Hypertension:
Essential HTN (90%)- idiopathic
Secondary causes- CKD, renal artery stenosis
Modify RF- salt intake, obesity, EtOH/tobacco, lack of exercise, K intake
Non-mod RF- age, Fhx, race (AA/Hispanic)
Metabolic Syndrome = truncal obesity, Hyperinsulin, insulin resistance, hyperTG, HTN
Stage 1 HTN: ≥ 140-159/90-99
Stage 2 HTN: ≥ 160-100 (need 2 drug regimen)
MC complaint of HTN = non-specific HA
Complication of untx HTN- CVD, CVA, dementia, renal dz, aortic dissect, atherosclerotic complications
HTN dx: Need 2 BP reading on 2 different occasions. Confirm @ subsequent visit 1-4w p initial
BP Goals:
- If patient > 60 <150-90
- If DM <130/80
- If CKD < 140/90
Medications:
- Diuretics (thiazides, loop, K sparing AA)
HCTZ: inhibits Na reabsorption from renal tubules. Work in distal convoluted tubule. AE: hypokalemia,
natremia, uricemia
Loop (furosemide): same as above but works in loop of henle
K sparing (spironolactone)
- ACEI (lisinopril): work thru RAS inhib enzyme that converts ango I II. SE- cough, angioedema
- ARB (losartan): block angiotensin receptor. AE- rash
- CCB (nifedipine, amlodipine, diltiazem, verapamil): AE- edema, bradycardia, dizzy, constipation, HA, flushing
- BB (metoprolol, labetolol): negative inotropic & chronotropic effects on heart. AE- weak, fatigue, dizzy, bradycardia
2. Hyperlipidemia
Treat to prevent CAD, stroke, PVD
Total Chol: < 200 is desirable; 200-239 borderline high; ≥ 240 high
LDL Chol: < 100 optimal; 100-129 above optimal; 130-159 borderline high; 160-189 high; ≥ 190 very high
Trigs < 150; HDL > 45
Cholesterol lowering drugs work in the liver. Obtain fasting lipid panel, calc risk assessment, determine LDL/TG tx goal,
decide on statin, f/u monitoring, pt education
5 major RF: smoking, HTN, HDL, fhx, age
Screening: men > 35, women > 45 (earlier if risk)
Start a stating when: pt has 1 cardiac event, pt ≥ 21 w/ LDL ≥190, pt has DM & LDL is 70-189, no DM & LDL 70-189 but
10 yr risk > 7.5%.
Drug treatment:
- Statin (simvastatin, rosuvastatin): LDL, TG, HDL. AE- myalgia, rhabdo. Get baseline ALT, CK PRN for myositis
- Ezetimibe (zetia): add on for LDL or failed on statin due to myopathy. Not for monotherapy. ALT & alk phos
- Bile acid resins (cholestyramin, coleseyelam): upregulated LDL receptors further LDL. May TG. AE: GI,
constipation, absorption of other meds
- HDL by weight loss, exercise, stress , fibrates, niacin
- Fibrates (fenofibrate): HDL & TG. Use if TG > 200; HDL < 35
- Niacin: HDL & TG. AE- flushing, hyperglycemia/uricemia, hepatotoxicity.
- Fish oil 1g/d for > 3 years – used for hyperTG
3. Hypertriglyceridemia
Abnormal elevation of serum TG. 150-199 borderline high; 200-499 high, ≥ 500 very high
Genetics, diet, and metabolic conditions/drugs can contribute to TG.
Recommend lifestyle changes- weight loss, activity, no smoking.
If 150-199 no drug therapy is indicated
For > 200 fish oil, fibrates, niacin (can use alone or in combo with statin)
4. Coronary Artery Disease
CAD = arteries that supply blood to the heart get clogged w/fatty deposits & atherosclerosis occurs.
Atherosclerosis is lipid deposition, fibrosis, calcification & plaque formation in intima of medium to large vessels.
RF: M>W, smoking, hyperlipid, obese, inactivity, poor diet, AA or Hispanic, HTN, DM
Acute coronary syndrome includes unstable angina (UA), NSTEMI, & STEMI.
Sx: angina pain that is retrosternal pressure (>30 min) and not relieved c rest or Nitro, can radiate to arms, neck, back,
shoulders, epigastrium, lower jaw. SOB, n/v, sweaty, tachycardia, dizzy, lightheaded.
PE: MC normal. S4 (esp c inferior)
, Dx: EKG, stress test, echo, cardiac cath, CABG.
- EKG:
NSTEMI & UA- +/- T wace inversion/ST depressions, may be nml
STEMI- ST elevations > 1mm in ≥ 2 contiguous leads c reciprocal changes in opposite leads or new LBBB.
I Lateral aVR V1 Septal V4 Anterior
II Inferior aVL Lateral V2 Septal V5 Lateral
III Inferior aVF Inferior V3 Anterior V6 Lateral
Cardiac Markers: CK-MB, Troponin!
Unstable Angina/NSTEMI
- Antithrombotic tx:
ASA: prevents platelet activation/aggregation
Unfractioned heparin: give if hx EKG changes, or + cardiac marker
LMWH (enoxaparin—lovenox): SE is thrombocytopenia
ADp inhibitor (clopidogrel): useful in intial tx of ACS in pts with ASA allergy
- Adjunctive Tx:
BB (metoprolol)
Nitrates- angina sx
Morphine- relive px, anxiety, venodilation
STEMI—reperfusion therapy, antithrombotic therapy, adjunctive therapy. MONA-B
- Mainstay PCI or thrombolytics
Primary PCI: best w/n 3hr of sx onset (c/n 90 min)
Thrombolytic: done if no access to cath lab or surgery is CI
o Tissue plasminogen activators (alteplase)
o Streptokinase
- Anti-thrombotic tx in STEMI: ASA, Unfractioned Heparin/LMWH, GPIIb/IIa inhibs
- Adjunctive: BB, ACEI, Nitrate, Morphine, Statin, Control other RF- no smoking, DM, HTN, dyslipidemia, wt loss,
exercise, diet
5. Heart Failure
Inability of heart to pump sufficient blood to meet demands of body. MC cause is CAD
afterload, preload, contractility
3 major RF: HTN, CAD, valvular heart dz
Left-sided: pulm venous pressure from fluid back up into lungs. Dyspnea MC. Starts as exertional orthopnea &
paroxysmal nocturnal dyspnea. Pulmonary congestion/edema- rales, rhonchi, chronic nonproductive cough esp c pink frothy
sputum. PE- HTN, cheyne stokes breathing, S3 (systolic), S4 (diastolic)
Right sided: systemic venous pressure signs of systemic fluid retention. Peripheral edema, JVD, GI/hepatic congestion
Dx:
- echocardiogram—EF most important prognostic factor (nml 55-60). Systolic- EF, thin ventricular walls, dilated LV
chamber, + s3. Diastolic- normal//EF, thick ventricular walls, small LV chamber, +s4
- CXR- good for CHF. Cephalization kerbey B lines butterfly pattern cardiomegaly, infiltrate, pleural effusion
pulmonary edema
- BNP may identify CHF as the cause for dyspnea in ER.
Tx: unless CI ALL pts should at least be on a ACEI & diuretic!
- Diet/exercise: Na restriction <2g/d, fluid restriction <2L/d, exercise, no smoking
- ACEI (lisinopril, captopril): preload/afterload, aldo production. 1st line tx in HF. mortality, rehospitalization, and
reverses pathology. SE- 1st dose hypoTN, azotemia/renal insufficiency, cough, angioedema
- ARB (losartan, valsartan): patients unable to tolerate ACEI/BB
- BB (carvedilol, labetolol): mortality, EF, of d/c in decompensated CHF.
- Loop diuretics (furosemide, bumetanide): most effective tc for sx for pts c mild-mod CHF. SE:
hypokalemia/natremia/calcemia, hyperglycemia/uricemia.
- K sparing diuretics (sprinolocatone): SE hyperkalemia, gynecomastia
- HCTZ
- Sympathomimetics—Digoxin, dobutamine, dopamine
Used short term in severe acute CHF. Digoxin is only long term one.
Good sx relief in pts c afib, hospitalization but no mortality benefit. + inotropic agent, negative chronotrope.
SE: narrow TI—arrhythmias, seizures, dizzy, anorexia, n/v/d, blurred vision. Digoxin toxicity—digitalis effect on
ECG, need antidote.
Med that mortality = ACEI, BB, ARB, nitrate +hydralazine, sprinolactone.
- Mngt of acute pulm edema/CHF = LMNOP = Lasix, morphine, nitrates, oxygen, position
Diastolic HF tx = BB, ACEI, CCB
6. Chest pain Ddx:
Cardiac MI, angina, aortic dissection
, Pulm PR, pneumothorax, PNA, tracheobronchitis
MSK costochondritis, mm strain
GI GERD, esophageal spasm, cholelithiasis
Psych anxiety, somatization
Neurogenic herpes zoster, cervical/thoracic dz
7. Angina
Ask- severity, duration, quality, location, radiation, assoc sx
Reproducible cpx exacerbated by exercise, but relieved with rest or nitro. Due to ischemia. Px lasts < 3 min.
Unstable angina- related to NSTEMI. 3 common patterns of UA = angina @ rest, new onset of angina, ing pattern of px in
previously stable pt
Substernal cpx that is poorly localized, nonpleuritic, exertional, may radiate, short in duration (<30 min but typically 1-5
min), relieved c rest/nitro. Due to fixed coronary artery stenosis. Other sx- dyspnea, nausea, sweating, numbness, fatigue
Dx:
- EKG- ST depression c exertion, t wave inversion, poor r wave progression, +/- nml
- Stress test- most useful noninvasive screen.
- Echo to detect wall motion abnormalities
- Coronary angiography = definitive
- Tx: exercise, weight loss, fat diet, no smoking, mng comorbidities
SL nitro, ASA, BB, CCB
PTCA/PCI; CABG
8. Arrhythmias
Sinus Tachycardia = same as nml but rate > 100 bpm.
Sinus Bradycardia = same as nml but rate < 60 bpm. Because excess vagal stimulation is the cause of most, anticholinergic
ATROPINE is 1st line!
Sinus arrhythmia = same asnml but rhythm is irregular ( c inspiration). Nml variant
Sick sinus syndrome (brady-tachy synd): combo od sinus arrest c alternations of paroxysms of atrial tachy and
bradyarrhythmias. Caused by sinoatrial node dz, corrective cardiac surgery. Tx: +/- PPM if sx
9. Atrial Dysrhythmias
Atrial flutter: flutter “saw tooth” waves (no P’s) @ 250-350 bpm. Rate us regular. Tx- vagal, CCB, BB, DCC if unstable.
Radiofreq ablation is definitive
Atrial Fibrillation: MC chronic arrhythmia. No P wave (350-600 bpm). IRREGULARLY IRREGULAR. Rate control*-
vagal, CCB or BB. Rhythm- DC cardioversion. DCC may also be done p 3-4 weeks of AC or TEE showing no atrial
thrombi. +/- digoxin. Prevention of stroke based on CHADSVASC score! Sx: palpitations, SOB, lightheaded, dizzy, focal
neuro deficit c embolic stoke.
Paroxysmal supraventricular tachycardia (PSVT): sudden onset & termination (MC preceded by a premature atrial
contraction).
- AV nodal reentry tachycardia MC. 2 paths both within AV node.
Orthodromic AVNRT: impulse goes forward down nml AV node path & returns retrograde to atria. ECG =
narrow complex tachycardia. Tx: vagal maneuvers adenosine BB or CCB DCC if unstable.
- AV reciprocating tachycardia: 1 path in AV node & 2nd access path outside AV node
10. Ventricular Dysrhythmias
Frequently unstable and unpredictable. Assoc c wide, bizzare QRS complexes
Premature ventricular complexes ventricular tachycardia
- Premature beat originating from ventricle wide QRS occurring earlier than expected. Us the T wave in opposite
direction of the R. Assoc c compensatory pause. Tx usually none needed.
Ventricular Tachycardia: ≥ 3 consecutive PVCs @ rate > 100 bpm. Must evaluate if pt is hemodynamically stable vs.
unstable and if it is sustained v. non-sustained. Sustained is having a duration of ≥ 30 s. A prolonged QT interval often
cause. Torsades de pointes MC due to hypomagnesium, hypokalemia.
- Stable sustained tx- anti-arrhythmics like amiodarone
- Unstable VT w/ pulse- synchronized cardioversion
- VT no pulse- Defibrillation/CPR
- Torsades- IV magnesium
Ventricular fibrillation
- Coarse vs. fine
- Tx = unsynchronized cardioversion + CPR
PEA: organized rhythm seen in monitor but pt has no palpable pulse. Tx- CPR, epi, checks for shockable rhythm q2min
Asystole: treat same as PEA.
11. AV Conduction Blocks
Interruption of nml impulse from SA node AV node via AV node. PR interval most helpful in determining AV conduction
blocks
First Degree Block: constant, prolonged PR (>.2s), every p wave followed by QRS. Tx- observation
, Second degree MobitzI—wenckebach: progressive PR lengthening dropped QRS. Tx- atropine, epi, +/- PPM if sxatic.
Observe if no sx
Second degree Mobitz II: common in bundle of His, constant/prolonged PR dropped QRS. Tx= PPM
Third degree block: AV dissociation. P waves not related to QRS. All P’s not followed by QRS. Tx: PPM.
12. Infective Endocarditis
Infection of endothelium/valves 2ry to colonization during transient/persistent bacteremia.
Mitral MC valve involved.
Types:
- Acute bacterial endocarditis: infection of normal valves c a virulent MO (s. aureus)
- Subacute bacterial endocarditis: indolent infection of abnormal valves c less virulent MO (s. viridans)
Manifestation: fever, anorexia, weight loss, fatigue, ECG conduction abnormalities.
Peripheral manifestations
- Janeway lesions: pxless erythematous macules on palms/soles
- Roth spots: retinal hemorrhage c pale center, petechiae
- Oslers Nodes: tender nodules on pads of digits
- Splinter hemorrhages of proximal nail bed, clubbing, hepatosplenomegaly, septic emboli
Dx:
- Blood culture (before initiation of abx)- 2 sets @ least 1 hr apart
- EKG- assess for new conduction abnormalities
- Echocardiogram- obtain TTE first
- Labs: CBC- leukocytosis, anemia. ESR/RF
Duke’s criteria- need 2 major OR 1 major + 3 minor OR 5 minor
- Major: sustained bacteremia 2 + blood cultures, endocardial involvement (+ echo or clearly established new valvular
regurg (AR, MR).
- Minor: predisposing condition, fever, vascular & embolic phenomena (janeway, septic arterial/pulmonary emboli),
immunologic phenomena (oslers, roth spots, + RF), + blood culture not meeting major criteria, + echo not meeting
major criteria
Indications for surgery- refractory CHF, persistent or refract infection, invasive infection, prosthetic valve, recurrent
systemic emboli, fungal infection
Management
- Suggested empiric therapy:
Native valve acute bacterial- Naficillin + gentamicin x 4-6 weeks OR vancomycin (if MRSA suspected of PCN
allergy)
Native valve subacute bacterial- PCN/Ampicillin + Gentamicin. Vanco in IVDA
Prosthetic valves- Vanco + gentamicin + rifampin
Fungal- amphotericin B, caspofungin if severe + valve surgery/replacement
Endocarditis Prophylaxis:
- Cardiac conditions: prosthetic heart valve, heart repairs using prosthetic material, prior history of endocarditits,
congenital heart disease
- Procedures: dental, respiratory, procedures involving infected skin/msk tissue (I&D)
- Regimen = amoxicillin 2g 30-60 min before (clindmycine 600mg if PCN allergy)
13. Peripheral arterial disease
Atherosclerotic disease of LE
Manifestation:
- Intermittent claudication: MC, reproducible pain/discomfort in LE brought on by exercise/walking & relieved c rest.
- Resting leg pain: limb threatening ischemia. Rest pain = advanced disease.
- Acute arterial embolism: usually caused by sudden occlusion. 6 P’s = pallor, pulselessnes, parasthesias, pain, paralysis,
poikilothermia.
- Gangrene: arterial perfusion so poor that spontaneous necrosis occurs. Complication of acute/chronic arterial occlusion
PE: dependent rubor, coolness of skin usually are signs of more advanced ischemia.
- Pulses- /absent pulses; +_ bruits, cap refill
- Skin- atrophic skin changes (mm atrophy, thin/shiny skin, hair loss, thickened nails). Usually no edema.
- Color- pale on elevation, dusky red c dependency, cyanosis, if ulcer present usually involves toes or points of trauma
(lateral malleolus)
Dx:
- Ankle-brachial index: simple, quick, noninvasive most useful screen tool. Normal = 1-1.2. If ABI <0.9 + PAD.
- Arteriography = gold std. shows length, location, degree of occlusion. Clinically usually only done if revascularization
is planned
Mngt:
- Platelet inhibitors: Cilostazol mainstay!! Helpful for intermittent claudication. ASA. Clopidogrel.
- Revascularization: PTA, bypass grafts, endarterectomy
- Supportive: foot care, exercise
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller BrainEdge. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
78310 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now