Preventive Care
List five risk factors for CVD
hypertension, high cholesterol, diabetes, tobacco use, sedentary lifestyle, stress, family history of CVD,
Differentiate Essential and Secondary HTN and list at least one cause of each.
essential hypertension—chronically higher blood pressure readings than normal with no underlying identifiable cause. Hypertension with an identifiable cause is far less common and is known as secondary hypertension.
Causes of secondary HTN include: Obstructive sleep apnea, Primary aldosteronism, Renal disease, Drug or alcohol induced, Pheochromocytoma Coarctation of the aorta, Thyroid or parathyroid disease ,Cushing's syndrome
The ACC/AHA Cholesterol Guidelines recommend reassessing patients' ASCVD risk (including HDL and total cholesterol) every four to six years. Given that they recommend treating with statins all patients over 21 with an LDL-c > 190 mg/dL, it is reasonable to check fasting lipids in all adults over 21 every four to six years.
List 3 lifestyle modifications that reduce BP (Bonus if you can approximate the magnitude of BP reduction for each intervention).
Weight loss 1 mmHg/kilogram weight
loss DASH eating plan ~11 mmHg
Dietary sodium reduction 4-6 mmHg
Physical activity 5-8 mmHg
Moderation of alcohol consumption ~6 mmHg
Dietary potassium 4-5 mmHg
What are the ABCDEs of suspicious skin lesions?
What is white coat hypertension and why is it important to be aware of it?
Some people get high blood pressure readings only when they see their doctor, which is why it is important to assess blood pressure outside of the physician's office. If the home readings are normal, then the patient likely has white coat hypertension. If blood pressure measurements at home remain high, then the patient likely has hypertension. People with white coat hypertension should still receive ongoing surveillance for the development of essential hypertension.
List the steps to interpreting a EKG. (I know I was running out of questions to ask)
Approach to ECG Interpretation
Describe how you would obtain a nutrition history and list at least one screening tool you would use.
A brief history should include the number of meals and snacks eaten in a 24-hour period; dining-out habits; as well as frequency of consumption of fruits, vegetables, meats, poultry, fish, dairy products, and desserts. Nutrients missing in the diet are equally important as those eaten in excess. Tools: 24-hour Dietary Recalls, Food Frequency Questionnaire.
*** DO NOT FORGET TO ASK ABOUT FOOD INSECURITY***
When should you screen someone for HTN?
The USPSTF recommends screening for high blood pressure in adults aged 18 years or older (grade A). The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
Describe the characteristics of a good screening test
The screening test should be acceptable to patients at reasonable cost. The disease of interest should have a latent phase, and treatment available.
An effective screening test should have very good sensitivity (identify most or all potential cases) and high specificity (label incorrectly as few as possible as potential cases).
When should you refer a patient with HTN to a nephrologist or cardiologist?
Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic may warrant referral to a nephrologist or cardiologist.
Describe the four stages of behavior change
Stages of Behavior Change:
What are criteria for diagnosing HTN?
In order to accurately diagnose a patient with hypertension, at least two elevated measurements—five minutes apart, one in each arm—should be made on two or more visits. Note: The USPSTF also recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment
What labs would you consider in a patient with new diagnosis HTN?
Lipid profile, BMP, ECG, Thyroid function tests, urinary albumin excretion or albumin/creatinine ratio
List out three medications used to manage HTN and their MOA
●Thiazide-type diuretics
●Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs)
●Calcium channel blockers
Describe components of a preventive care visit (Hint: RISE mnemonic)
Risk factors: Identify risk factors for serious medical conditions during history and physical exam.
Immunizations: Provide recommended immunizations/chemoprophylaxis.
Screening tests: Order appropriate screening tests.
Education: Educate patients on ways to live healthier while reducing risks for disease.
A preventive visit should include:a comprehensive history and physical examination; anticipatory guidance, and risk factor reduction interventions or counseling; ordering of appropriate immunizations or laboratory / diagnostic procedures; and management of any insignificant problems.
What are the goals of a visit with a patient with a new suspected diagnosis of HTN?
1. Assess for the presence or absence of target end organ disease. 2. Assess cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment. 3. Consider evaluation for secondary causes.
Describe some PE maneuvers you would perform in a patient with elevated BP
eye examination
Assess for the presence of peripheral vascular and cardiovascular disease.
Palpation of the thyroid gland
Assess for nodules, tenderness, or thyromegaly
Cardiovascular and Pulmonary examination
Walk me through a potential pharmacological therapy plan for a patient who has not been able to lower their blood pressure with 12.5 mg of HCTZ.
Reference: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients (PMID: 19052124)
It is suggested combination therapy consist of a long-acting dihydropyridine calcium channel blocker + long-acting ACE inhibitor/ARB. Thus, if the patient is being treated with one of the drugs, add the other. In patients being treated with a thiazide diuretic, it is suggested to discontinue the thiazide and starting combination therapy.