Hypertension and Lipids
What BP defines HTN?
≥130/80
Dx A1c
A1c ≥6.5%
A child with barking cough and stridor most likely has what?
Croup
Colonoscopy age
Age 45
Repeat every 10 years if normal
A 58-year-old man with diabetes has chest pressure that radiates to his left arm.
Rule out:
Rule out myocardial infarction
EKG + troponin → send to ER
What is ASCVD?
10-yr heart attack or stroke risk
First-line drug and MOA
Metformin
→ Activates AMP-activated protein kinase (AMPK), which decreases hepatic gluconeogenesis and increases peripheral insulin sensitivity.
Which symptom in a cough patient means you should order a chest X-ray?
Fever, hypoxia, crackles, chest pain, or age >65
Pap smear timing
Every 3–5 yrs depending on HPV starting at 21 yo
A 45-year-old woman has a sudden “worst headache of her life.”
Rule out:
Next step:
Subarachnoid hemorrhage
Next step
CT head without contrast
When to start a statin (3)
ASCVD ≥7.5%, LDL ≥190, or diabetes age 40–75
Hypoglycemia sx
Sweating, shaking, confusion
Viral URI vs pneumonia
Fever, crackles, hypoxia ==> pneumonia
Upper respiratory infection ==> cough, runny nose, sore throat == symptoms above the clavicles
A 66-year-old woman with no vaccines on file comes to establish care.
What is he due for?
Pneumococcal, Shingrix, flu, COVID
A 24-year-old has worsening right-lower-quadrant pain, fever, and nausea.
Rule out:
Next step:
Appendicitis
Next step:
CT abdomen (or ultrasound in young patients)
First line drugs and MOA
ACE inhibitors (ACE-I)
→ Block conversion of angiotensin I to angiotensin II, causing ↓ vasoconstriction and ↓ aldosterone → ↓ preload and ↓ afterload.
ARBs
→ Block angiotensin II from binding the AT₁ receptor, preventing vasoconstriction and aldosterone release without affecting bradykinin.
Thiazide diuretics
→ Inhibit Na⁺/Cl⁻ reabsorption in the distal convoluted tubule, causing mild diuresis and long-term ↓ peripheral vascular resistance.
Calcium channel blockers (CCBs)
→ Block L-type Ca²⁺ channels in vascular smooth muscle (and heart), causing arterial vasodilation ± decreased cardiac contractility and conduction.
When to start insulin
A1c >10% or symptomatic hyperglycemia
1. Polyuria
2. Polydipsia – extreme thirst
3. Polyphagia – increased hunger
A 70-year-old with orthopnea and cough has crackles and leg swelling.
Dx and Next step
Heart failure
NEXT STEP:
BNP, CXR, echocardiogram
A 71-year-old man with hypertension smoked one pack per day for 20 years but quit at age 60.
What do you order?
One-time abdominal ultrasound for AAA
A 30-year-old with missed period and abdominal pain.
Rule out:
Next step:
Ectopic pregnancy
Next step:
Pregnancy test + ultrasound
A 58-year-old man is on lisinopril and amlodipine. His BP is still 168/94. He snores loudly and is obese. Potassium is low.
What do you do next? (4)
Aldosterone / renin ratio → screen for hyperaldosteronism
Sleep study → screen for OSA
BMP → potassium, creatinine
Renal artery duplex if bruits or CKD
A 55-year-old with type 2 diabetes has numbness in both feet and decreased vibration sense.
What do you do next?
Diabetic neuropathy
A1c
B12 level (metformin can cause deficiency)
Foot exam
Urine microalbumin
A 69-year-old former smoker presents with 2 months of cough, fatigue, night sweats, and blood-tinged sputum. He has been treated twice for bronchitis
What do you do next?
Workup
Chest CT (NOT just X-ray)
Pulmonology referral
Bronchoscopy or CT-guided biopsy
PET scan for staging
Oncology referral
Lung cancer until proven otherwise
A 64-year-old man comes in for his annual physical. He quit smoking 8 years ago after smoking one pack per day for 30 years. He feels well and has no cough, chest pain, or weight loss.
Next step?
Annual low-dose CT scan for lung cancer
Next step
Order low-dose chest CT
Repeat every year
Counsel on continued smoking cessation
A 63-year-old man has lost 20 pounds unintentionally and feels fatigued. He has no dieting or exercise changes.
Rule out:
Workup:
Malignancy until proven otherwise
Workup
CBC, CMP, TSH
Chest X-ray
Age-appropriate cancer screening
CT if abnormalities