HTN in Adults
A 65 yo patient is diagnosed with stage 1 hypertension and wants to avoid pharmacotherapy. What lifestyle recommendation would most effectively lower the patients systolic blood pressure?
DASH diet with sodium restriction.
(DASH diet combined with sodium restriction results in a systolic blood pressure reduction of 11.5 mm Hg vs. a reduction of 5.9 mm Hg using the DASH diet alone. Weight loss and exercise lower systolic blood pressure 4.1 to 5.6 mm Hg and 4.5 mm Hg, respectively. Potassium salt substitute lowers systolic blood pressure by 4.8 mm Hg.)
What commonly recommended acne treatment should be avoided in pregnancy?
retinols (adapalene)
What are the first line therapies for CRS? How long should these treatments be continued before you consider the patient not responsive?
Intranasal saline irrigation, intranasal corticosteroids. Minimum 4 weeks, best 8 weeks.
A bivalent RSV vaccine given to pregnant women between ____________ gestation safely reduces the likelihood of severe RSV in their newborns
24 and 36 weeks
What is my favorite dinosaur?
Ankylosaurus
The American Academy of Family Physicians recommends treating adults with hypertension to a blood pressure goal of less than _______mmHg to reduce the risk of...?
140/90 mmHg; all-cause and cardiovascular mortality.
During which weeks of pregnancy are medication adverse affects most dangerous to the fetus?
2-8th week- a critical time to limit medication exposure
What are the cardinal symptoms of chronic rhinosinusitis?
nasal blockage, obstruction, or congestion; anterior or posterior nasal drainage; facial pain or pressure; hyposmia
2/4 for >3 months
Should mild hypertension in pregnancy be treated?
Yes.
Evidence and expert opinion previously suggested that nonsevere chronic hypertension should not be treated during pregnancy because lowering the patient’s blood pressure too much could lead to placental hypoperfusion, fetal growth restriction, preeclampsia, or preterm birth.
The use of low dose aspirin in patients with HTN can decrease the risk of?
Non fatal cardiovascular events. Does not reduce risk of all cause mortality or cardiovascular mortality. Does increase risk of bleeding.
Treat adults with HTN to a goal of less than 135/80 to reduce risk of?
MI (B rating). Treating to goal of less than 140/90 reduces risk of all cause and cardiovascular mortality (A rating)
Prolonged use of high potency topical corticosteroids in pregnant women increases the risk of?
When should you order a noncontrast CT of the sinuses?
To rule out alternative diagnoses or when the symptoms are unilateral. X ray is not recommended.
What is the first line treatment for infantile scabies?
permethrin cream 5% +/- oral antihistamines
What is BRASH syndrome?
Combination of bradycardia, renal failure, AV block, shock, hyperkalemia.
Discuss the lifestyle modifications recommended for improved blood pressure control in adults
DASH diet with sodium restriction, potassium enrichment, regular exercise, weight loss, moderation of alcohol exposure
For women at increased risk of preeclampsia, what medication needs to be started and at what gestational age?
Aspirin 81mg; 12-28 weeks. Significant risk reduction in perinatal mortality, preterm birth, fetal growth restriction, and risk of preeclampsia without increased risk of bleeding
What are the "alarm symptoms" that warrant further workup in patients with chronic rhinosinusitis?
Periorbital swelling, diplopia, reduced visual acuity, severe headache, new neurologic symptoms, and uncontrolled epistaxis.
What recommendation was discussed regarding return to activity in children with concussions
Early return to activity leads to improved symptoms and quality of life. Bed rest is not recommended.
What lab values need to be monitored after starting patients on ACE, ARB, or thiazide?
Serum Cr, serum K+. MCr annually. Once BP is stable, can monitor 1-2x yearly.
In patients with stage 1 HTN without significant comorbidities, it is acceptable to attempt 3-6 months of lifestyle modifications before considering medications. However, patients with stage 1 HTN and certain risk factors, medication should be initiated with 3 elevated readings. What are those risk factors?
ASCVD, estimated 10-yr ASCVD risk >10%, diabetes, kidney disease, end organ damage
Restricting the use of NSAIDs before second trimester is prudent to prevent increased risk of major congenital anomalies. List the anomalies associated with NSAID use prior to the second trimester.
hypoplastic left heart, TOF, gastroschisis, and spina bifida.
NSAIDs after 20 weeks- increased risk of fetal kidney injury and subsequent development of oligohydramnios.
NSAIDs after 30 weeks increased risk of premature ductus arteriosus closure
What physical exam finding points to the diagnosis of type 2 chronic rhinosinusitis and warrants an ENT referral?
Nasal polyps.
Type 2- polyps, adult onset asthma, allergic diseases. Eosinophil and IgE can be elevated in CRS2.
What risks are associated with acetaminophen use during pregnancy?
Asthma. New studies investigating risk of ADHD/ASD
The addition of magnesium sulfate for acute COPD exacerbations results in?
Decreased length of stay, decreased hospital admissions.
IV > nebulized.
40mg/kg