Screening
Name 3 RF that should prompt hyperlipidemia screening?
Clinical evidence of atherosclerosis
AAA, DM, HTN, CKD, Obesity, ED, HIV, COPD
• Current cigarette smoking
• Dyslipidemia stigmata
• FHx premature CVD
• Inflammatory diseases
• COPD
• Hx hypertensive disorder of pregnancy
Age 40+
Post-menopausal
At risk ethnic groups e.g., South Asian
What condition should you suspect if you palpate a tender pulsatile midline abdominal mass?
Abdominal aortic aneurysm
What investigations should be ordered at the time a diagnosis of hypertension is established?
U/A, K, Na, Creatinine
FG +/- A1C, Lipids
ECG
What symptoms suggest the presence of acute limb ischemia?
sudden pain, pallor, pulselessness, paresthesias, or paralysis
What is the main difference between phlebitis and a DVT?
The location of the affected vein (superficial- phlebitis/deep-DVT) and the presence of a blood clot (present in DVT; not present in phlebitis).
How is a FHx history of premature CVD defined?
men <55 years; female <65 years
What are the symptoms of Raynaud’s syndrome?
Well-demarcated color changes (white/blue/red) of the skin of the digits in response to cold exposure or stress.
Should an ABI be offered as routine screening for all adults?
No, it should be offered to asymptomatic adults >50 w PAD RF (e.g., smoking/DM)
What is the key red flag for suspected PE?
hemodynamic stability (i.e. persistent tachycardia, hypotension: SBP <90)
How do the symptoms of chronic venous insufficiency differ from PAD?
CVI: limb pain, swelling, heaviness, fatigue worse with dependency, improves w elevation
PAD: exertional lower extremity pain, improves with rest
Name two tools for evaluating CV risk.
Framingham and CLEM
If your objective findings include and an elevated JVP, bibasilar crackles, and peripheral edema, what diagnosis is likely?
CHF
How often should lipoprotein a be ordered?
Once in a lifetime
What are 3 red flags indicating worsening CHF?
weight gain (2kg in 2/7 or 2.5kg in 1/52), worsening dyspnea, fatigue with less exertion, increased edema, lightheadedness/postural symptoms
What is white coat hypertension and how can you rule it out?
BP is elevated in office and normal at home. It can be excluded through home blood pressure monitoring or ABPM.
Describe AAA screening in Ontario?
All persons age 65+ are eligible for a once in a lifetime abdominal ultrasound.
What is the threshold for the diagnosis of hypertension?
130/80
What initial investigations are recommended for a suspected DVT?
Wells, D-dimer, +/- Venous compression U/S
What is a hypertensive emergency?
Acute severe elevation in BP (>180/110) with end organ damage
What four systems are impacted by Rheumatic Fever?
Cardiac, neurological, integumentary, MSK
Name four PAD risk factors?
Age 65+, DM, Smoking, Hyperlipidemia, HTN, CKD, FHx PAD, Hx athlerosclerotic disease, Black ethnicity
Explain Virchow’s Triad
Three main factors that contribute to thrombus formation: hypercoagulability, venous stasis, endothelial injury
What is the gold standard investigation for assessing heart function?
ECHO
What are the signs and symptoms of an aortic dissection?
Symptoms: sudden excruciating chest/abdomen pain
Signs: Tachycardia, increased pulse pressure, hypotension, weak pulse.
Name three differential diagnoses for pulmonary embolism?
Acute coronary syndrome, pneumothorax, COPD, CHF, Pneumonia