Exam 1: NR 577/NR577 Primary Care Management of Adolescents and Adults Final Exam Review| Guide with Verified Answers| Latest 2026/ 2027| Chamberlain.

Exam 1: NR 577/NR577 Primary Care Management of Adolescents and Adults Final Exam Review| Guide with Verified Answers| Latest 2026/ 2027| Chamberlain. Q. Principles of Primary care ANSWER health promotion prevention of illness management of those who become sick advocacy for all patients community involvement equitable distribution of health care community participation effective coordination of services with appropriate health care and community sectors appropriate use of technology Q. Goals of Adolescence ANSWER Completion of puberty and growth Social, emotional, and cognitive development Development of abstract thinking Establishment of independent identity Preparation for career or life work Q. Bright Futures ANSWER Life-long health of families and communities Family support Health for children and youth with special health care needs Healthy development Mental health Healthy weight Healthy nutrition Physical activity Oral health Healthy sexual development and sexuality Healthy and safe use of social media Safety and injury prevention Q. Adolescent Morbidity ANSWER Unipolar depressive disorders Iron deficiency anemia Asthma Back and neck pain Anxiety disorders Alcohol use disorder Q. Adolescent risky behaviors ANSWER Sexual activity Tobacco use Self-injurious behaviors Technology and social media Q. Adolescent Mortality ANSWER road injury HIV suicide lower respiratory infections interpersonal violence Q. Tanner Stage 1: Female ANSWER No breast No pubic hair Q. Tanner Stage 2: Female ANSWER Breast budding Downy hair Q. Tanner Stage 3: Female ANSWER Enlargement of areola and breast tissue Scant hair; increase in amount and pigment Q. Tanner Stage 4: Female ANSWER Separation of areola and nipple from breast mound menarche Adult type hair; Incomplete distribution Q. Tanner Stage 5: Female ANSWER Fully developed breast; single breast contour with nipple protrusion Adult hair distribution Q. Tanner Stage 1: Male ANSWER No genital growth No pubic hair Q. Tanner Stage 2: Male ANSWER Enlargement of testes and increased scrotal pigmentation Downy hair Q. Tanner Stage 3: Male ANSWER Enlargement of penis and testes Scant hair; increase in amount and pigment Q. Tanner Stage 4: Male ANSWER Elongation of penis and enlargements of testes; development of axillary and facial hair Adult type hair; Incomplete distribution Q. Tanner Stage 5: Male ANSWER Adult size; increase in body and facial hair, increase in muscle size Adult hair distribution Q. HEADSS assessment ANSWER Home environment Education/employment Activities Drugs Sexuality, Suicide, Depression Safety Q. HEADSS assessment: Home environment questions ANSWER Who lives with the young person/where? Do they have their own room? What are relationships like at home? What do parents and relatives do for a living? Have you ever been institutionalized? Have you ever been incarcerated? Have you had any recent moves? Have you ever run away? Are there any new people in the home environment Q. HEADSS assessment: Education/employment questions ANSWER How is your grade or performance in school? Any recent changes in your grades in school? Favorite and least favorite subjects (include grades)? Any years repeated classes failed? Suspension/dropping out? Future education/employment plans? Any current or past employment? Relations with teachers, employers-school, work attendance? Q. HEADSS assessment: Activities questions ANSWER What do you do for fun? Where do you go? (individually or with peers) Sports/ exercise? Church attendance, clubs, projects? Hobbies or other activities? Reading for fun? What do you like to read? TV-how much weekly? Favorite shows? Favorite music? Have a car? Use seat belts? History of arrest, acting out, crimes? Q. HEADSS assessment: Drugs questions ANSWER Use by peers? (include tobacco and alcohol) Use by a young person? (include tobacco and alcohol) Use by family members? (include tobacco and alcohol) Amounts, frequency, patterns of use/abuse while intoxicated? Drive while under the influence? Source? How paid for? Q. HEADSS assessment: Sexuality questions ANSWER Orientation? Degree and types of experiences? Number of partners? Masturbation (normalize) History of pregnancy/abortion? Sexually transmitted infections? Knowledge and prevention? Contraception? Frequency of use? Comfort with sexual activity, enjoyment/pleasure obtained? History of sexual/physical abuse? Q. HEADSS assessment: Suicide/Depression questions ANSWER Sleep disorders? Appetite/eating behavior changes? Emotional outbursts and impulsive behavior? History or withdrawal/social isolation? Boredom, depression, psychological counseling? Hopeless/helpless feelings? History of suicide attempts by family members or peers? History of recurrent serious accidents? Psychosomatic illness? Suicidal thoughts or history of past suicide attempts? Preoccupation with death? Significant current or past losses? Decreased affect on interview, avoidance of eye contact? Q. Adolescent Vaccination: primary recommendations ANSWER IIV LAIV4 Q. Adolescent Vaccination: secondary recommendations ANSWER PCV13 PPSV23 MenB Hib Screening guidelines breast cancer screening cervical cancer screening thyroid dysfunction screening cholesterol screening for heart disease prevention colorectal cancer screening guidelines dental exams osteoporosis screening (Age 50-70) prostate cancer screening testicular cancer screening Symptoms of early pregnancy Fatigue Darkening of the nipples Nausea Minor bleeding Abdominal pain Sensitive breast Frequent urination Change in taste preferences Headache Rhinitis The change in basal temperature Menstrual delay Presumptive signs of Pregnancy Amenorrhea (missed period) Nausea and vomiting Hyperpigmentation (melasma, linea nigra, darkening of the areola of the breasts) Breast tenderness Fetal movement (quickening) Probable signs of Pregnancy Uterine enlargement Positive pregnancy test Goodell's sign (softening of the tip of the cervix) Chadwick's sign (bluish tinged vagina and cervix) Hegar's sign (softening of the uterus) Ballottement Positive signs of pregnancy Direct visualization of the fetus (ultrasound) Fetal heart tones Fetal movement Naegel's rule Estimated Due Date LMP - 3 months + 7 days + 1 year Prenatal Education o avoid cleaning cat litter boxes o avoid eating raw/undercooked meat, shellfish, or oysters o avoid smoking, alcohol, and illicit drug consumption o limit caffeine intake ( 8oz/day) o avoid hot tubs, saunas, or excessive heat o do not receive live vaccines during pregnancy o Folic Acid Supplementation (400mg/day) Vaccinations during pregnancy o Live vaccines, including MMR, varicella, live influenza vaccine (nasal flu vaccine), and HPV should be avoided o Should receive the influenza injection, Covid, and a Tdap booster Intrauterine device: Copper bearing and levonorgestrel-releasing § MOA: Device acts as a foreign body, producing an inflammatory response to decrease pregnancy. Copper devices= 10 years, hormone devices= 3-5 years § Advantages: Highly effective Removes user error Lasts 5-10 years Reduces menstrual flow § Disadvantages: Requires provider training for insertion , High initial cost Depot Medroxyprogesterone Acetate (DMPA): Depo-Provera § MOA: Prevents LH surge which inhibits ovulation, thickens cervical mucus, and causes the endometrium to atrophy which reduces the likelihood of implantation § Advantages: Highly effective, Reduces menstrual flow and within a year most women have amenorrhea, Lasts 3 months § Disadvantages: Loss of bone mineral density (black box warning; avoid use for more than 2 years), delayed return of fertility Progestin implants: Nexplanon, Norplant § MOA: Slow-release of progestin to suppress ovulation by inhibiting LH surge § Advantages: Highly effective, Removes user error, Lasts 5 years, Reduces menstrual flow and decreases dysmenorrhea symptoms § Disadvantages: Requires provider training for insertion, High initial cost Tubal ligation § MOA: Surgical procedure to occlude Fallopian tubes § Advantages: Can be performed in-office setting by hysteroscopy, Decreased risk of ovarian cancer § Disadvantages: Permanent Vasectomy § MOA: Surgical procedure to occlude the vas deferens § Advantages: Less invasive than female sterilization § Disadvantages: Ineffective for first 3 months, Permanent Tier 2 Contraceptives combined oral contraceptive (COC) pills: estrogen and progesterone monophasic oral contraceptive pill: progestin-only "Minipill" emergency contraception transdermal patch cervical ring Tier 3 Contraceptives barrier methods: condom, diaphragm, cervical cap, spermicidal foam, film, sponge natural family planning coitus interruptus Infertility being unable to become pregnant within one year of regular and unprotected intercourse Causes of infertility: Mechanical § Abnormal/insufficient sperm § Abnormal/insufficient eggs Causes of infertility: Hormonal § Anovulation resulting from low progesterone § Abnormal hypothalamus § Hypothyroidism § Hyperprolactinemia Causes of infertility: Structural § Uterine fibroids § Vaginal septum § Adhesions § Scarred/absent fallopian tubes Clinical presentation for PCOS o Trouble conceiving or infertility o Mood changes o Acne o Fatigue o Insulin resistance o High testosterone levels o Excessive body hair growth o Weight changes and trouble losing weight o Ovarian cysts o Low sex drive o Irregular or missed periods o Male pattern baldness thinning hair Diagnostic criteria for PCOS Hyperandrogenism Menstrual Irregularity Polycystic ovaries on utrasoundography Hyperandrogenism § clinical examination: hirsutism, acne, androgenic alopecia, and acanthosis nigricans § laboratory values: high circulating levels of testosterone or androstenedione Menstrual irregularity § clinical examination: oligomenorrhea or amenorrhea § laboratory values: high levels of luteinizing hormone polycystic ovaries on ultrasonography § 12 follicles in each ovary § follicle size between 2 and 9 mm +/- 10 mL ovarian volume Primary Amenorrhea § Never experienced menarche § Turner syndrome: partial/missing X chromosome § Kallmann syndrome low LH and FSH § Obstructed vagina § Uterine dysplasia § Eating disorders § Excessive exercise Secondary Amenorrhea § Cessation of menses after menarche; menses absent longer than 3 months § Pregnancy § Contraception § Antidepressants § Chemotherapy § Polycystic ovarian syndrome § Premature ovarian failure § Hypothyroidism Classifications of abnormal urine bleeding: Structural Abnormalities Polyps Adenomyosis Leiomyoma Malignancy and Hyperplasia Polyps · Cervical: Common, benign growths coming from the surface of the cervix which are smooth and bleed easily. Most often associated with post-coital bleeding but may also cause intermenstrual bleeding. · Endometrial: localized outgrowths of the endometrium which can result in heavy menstrual bleeding, intermenstrual bleeding and post-menopausal bleeding Adenomyosis presence of endometrial tissue in the myometrium of the uterus (see also dysmenorrhea content). Common cause of heavy menstrual bleeding. Leiomyoma benign tumors that arise from uterine smooth muscle cells which contain fibrous tissue. More commonly known as uterine fibroids (see also dysmenorrhea content) and are responsible for heavy menstrual bleeding, intermenstrual bleeding, post-menopausal bleeding and irregular bleeding. Malignancy and Hyperplasia Cervical cancer is associated with intermenstrual bleeding and post-coital bleeding. Endometrial cancer is associated with post-menopausal bleeding, heavy menstrual bleeding and irregular bleeding. Classifications of abnormal urine bleeding: Non-Structural Abnormalities Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified Coagulopathy include thrombocytopenia, chronic liver disease, leukemias, anticoagulant use and vonWillebrand's disease Ovulatory dysfunction · Most common cause of AUB · Encompasses the 3 subcategories of anovulatory uterine bleeding, amenorrhea and ovulatory uterine bleeding · May result from (but not limited to) endocrine disorders, obesity, excessive exercise and mental stress · Patients may present with periods of amenorrhea followed by scant or heavy menstrual bleeding Endometrial · associated with regular ovulatory cycles (predictable bleeding) that are without structural abnormality AND presents with heavy menstrual bleeding · Infections may contribute to some abnormal uterine bleeding Iatrogenic · Copper IUD can be associated with heavy menstrual bleeding · LNG-IUS can be associated with intermenstrual bleeding and irregular bleeding · Menopausal hormone therapy & hormonal contraception can cause intermenstrual and irregular bleeding · Other medications which can disrupt the HPOA can be implicated (i.e., tricyclic antidepressants, and phenothiazines) AUB labs: CBC/diff Anemia AUB labs: PT/ aPTT Bleeding disorder AUB labs: Ferritin Iron deficiency AUB labs: TSH Thyroid dysfunction AUB labs: Prolactin Pituitary adenoma AUB labs: FSH Menopause/premature ovarian failure AUB labs: Cervical cytology Atypical cells AUB labs: Vaginal secretion microscopy Vaginal candidiasis/bacterial vaginosis AUB labs: Vaginal secretion screening Sexually transmitted diseases AUB labs: Ultrasound Abnormal masses Common symptoms of perimenopause and menopause o irregular vaginal bleeding o dry and itchy vagina o hot flashes o weight gain o mood changes o depression o stress o night sweats o fatigue o 12 consecutive months with no period o stop smoking o stop drinking alcohol Symptom management for menopause: Hot flashes/Night sweats § Avoid triggers- spicy foods, hot drinks, alcohol, and caffeine § Maintain a cool environment, layer clothing § Increase exercise Symptom management for menopause: Mood changes SSRI's Symptom management for menopause: Vaginal Dryness § Vaginal estrogen § Vaginal moisturizer § Lubricants during sex Symptom management for menopause: Osteoporosis § Calcium and vitamin D supplements § Bone density scans Clinical presentation of genitourinary syndrome of menopause o Symptoms § genital dryness § decreased lubrication § discomfort with sexual activity § irritation, burning, itching § painful urination § urinary frequency, urgency § recurrent UTI o Signs § decreased moisture § decreased elasticity § labial shrinkage § pallor/erythema § loss of vaginal folds Menopause symptoms treatment § vaginal lubricants § vaginal moisturizer: this differs from a lubricant § local vaginal estrogens (rings, creams, suppositories) § selective estrogen receptor modulators (non-estrogen options) § laser: restores the tissue back to its pre-menopausal state Differential diagnosis for postmenopausal bleeding Benign: Uterine fibroids, Endometrial hyperplasia, Cervical polyps Malignant: Endometrial cancer, Ovarian cancer, Cervical cancer, Vaginal/vulva cancer, Fallopian tube cancer Non-gynecologic: Hemorrhoids, Inflammatory bowel disease, Urethritis, Hemorrhagic cystitis, Bladder cancer Management of postmenopausal bleeding Vaginal Atrophy: local or systemic estrogen Endometrial Atrophy: short course of systemic estrogen Endometrial Polyps: Surgical removal Uterine Fibroids: Surgical removal Endometrial Cancer: Hysterectomy, radiation Cyclical Breast Pain · Coincides with menstrual cycle · Engorgement and tenderness · Symptoms worst just before menstruation · Dull or achy · Fibrocystic breast most common cause Non-cyclical Breast pain · Unrelated to menstrual cycle · Specific location · Constant or intermittent · Tightness or burning · Causes: mastitis, cyst, inflammatory cancer, idiopathic Extra-mammary breast pain · Unrelated to breast · Referred pain · Torn/strained chest or shoulder muscle · Rib injuries Fibroadenoma Benign neoplasms occur most frequently in younger individuals within the first 20 years after puberty. They tend to decrease with age but may still occur in menopause. The frequency is slightly higher and tends to occur at an earlier age in Black women compared to Caucasian women. usually discovered accidentally and present as solid, well-defined masses, which are non-tender and mobile. Multiple are possible. The etiology is unknown but there is likely a hormonal relationship since they can increase in size during pregnancy or with estrogen therapy Fibrocystic breast benign fluid-filled sacs that are encapsulated within the breast. Single or multiple may be present in one or both breasts. typically mobile and may be tender, especially with menstrual fluctuations. more common in women between the ages of 35 and 50 years-of-age before menopause but can be found in women of any age pre-and post-menopause Breast cancer Breast pain is rarely a primary symptom of this, however, the likelihood of it as a symptom increases during menopause, where there is a lack of hormonal influence Lipoma fatty tumors that can appear anywhere in the body, including the breast. They are usually not tender and occur in the later reproductive years Fat necrosis usually the result of breast trauma or surgery. Tenderness may or may not be present. Masses are hard and fixed. May be difficult to distinguish it from carcinoma. Masses due to this usually disappear gradually with intervention Phyllodes tumor rare benign breast tumors that arise from the fibroepithelial cells. These tumors grow quickly and become large. The lesion can be malignant, though this is rare. A biopsy is required for evaluation Intraductal papilloma Growth within the mammary ducts. May present as a mass within the breast, and is associated with bloody nipple discharge. Although often benign, a biopsy is required for evaluation. galactorrhea discharge of milk due to excessive nipple stimulation or pregnancy; or may indicate the presence of a pituitary tumor or systemic illness Drug Induced nipple discharge phenothiazines, oral contraceptives, methyldopa, imipramine, amphetamine, metoclopramide, reserpine, fibrocystic breasts Chest Wall Lesions nipple discharge thoracotomy, herpes zoster Brain Lesions nipple discharge pituitary adenoma, hypothalamic tumor, head trauma Medical Conditions nipple discharge chronic renal failure, sarcoidosis, cushing's disease, hypothyroidism, hepatic cirrhosis, fibrocystic breasts, breast infection (mastitis) Pathological nipple discharge non-milky, spontaneous, and most often unilateral and uniductal · Bloody discharge is a red flag finding suggestive of intraductal malignancy or a benign intraductal papilloma. · Green, brown, or black discharge is often indicative of mammary duct ectasia, a result of mammary duct dilation with surrounding inflammation and fibrosis. bilateral milky discharge diagnostics pregnancy and hyperprolactinemia breast cancer screenings Women between ages 40-75 may require annual or biennial screening mammograms. Mammograms are not routinely recommended for women over 75 Breast cancer diagnostics typically presents as firm, non-tender, ill-defined masses; all masses should be investigated further with a diagnostic mammogram. Unilateral bloody nipple discharge diagnostics diagnostic mammogram and cytology Components of a sexual history: Partners § Are you currently sexually active? § If no, have you ever been sexually active? § In recent months, how many sex partners have you had? § Do your sex partners identify as male, female, or another gender? Components of a sexual history: Practices § What kind of sexual contact do you have, or have you had? (penis in the vagina? Penis in the anus?; Oral-mouth on penis, vagina, or anus? Components of a sexual history: STD protection § Do you or your partner(s) use any protection against STDs? § If not, can you tell me the reason? § If so, what kind of protection do you use § How often do you use this protection? Components of a sexual history: STD history § Have you ever been diagnosed with an STD? When? How were you treated? § Have you ever had and recurring symptoms or diagnoses? § Have you ever been tested for HIV or other STDs? Would you like to be tested? § Has your current partner or any former partners ever been diagnosed or treated for an STD? Components of a sexual history: Pregnancy prevention § Are you currently trying to conceive or father a child? § Are you concerned about getting pregnant or getting your partner pregnant? § Are you using contraception or practicing any form of birth control? Risk factors for cervical cancer o HPV o multiple sexual partners o smoking o sexual activity at early age o low socioeconomic status o oral contraceptive use o HIV Cervical cancer screening recommendations o Start screening at age 21 o 21-29 years: cervical cytology every 3 years o 30-65: cervical cytology every 3 years o for women who want to extend their screening interval, HPV co-testing every 5 years is an option o Primary high-risk HPV testing is recommended every 5 years for women ages 30-65 years o Women older than 65 can stop screening o Women who have had a hysterectomy with cervical removal (not due to cancer) can stop screening as long as she has had no history of CIN 2, CIN 3 or adenocarcinoma in situ o Women who have been vaccinated for HPV should continue to be screened according to the guidelines Atypical squamous cells of undetermined significance § most common abnormal finding § cells do not appear normal; cause is unknown § does not exclude cervical intraepithelial neoplasia (CIN) 1-3 and cancer § reflex testing for HPV and repeat testing is based on the results Atypical Glandular cells § more common in older women (ages 40-69 years) § 1/3 of cases are associated with pre-malignancy or malignancy § risk of cancer increases with age § refer for endometrial biopsy Low grade squamous intraepithelial lesions § cervical cells are mildly abnormal § usually caused by a low-risk HPV infection § appropriateness of repeat screening vs. referral for diagnostic testing is largely dependent upon age and whether the woman is HPV + High grade squamous intraepithelial lesions § abnormal cervical cells, which are more likely to be associated with premalignancy and malignancy § refer for colposcopy Bacterial Vaginosis Normal vaginal lactobacilli are displaced by anaerobic bacteria, which leads to the overgrowth of bacterial vaginosis-type organisms Vulvovaginal Candidiasis caused by Candida species and is commonly referred to as a yeast infection. It affects most women at some point during the reproductive years. Clinical presentation of vaginal discharge o A complete history, physical examination, and laboratory evaluation are required to diagnose vaginitis accurately. o Inspect the vaginal discharge, the vagina, and the cervix. Cervical inspection will help to rule out cervicitis. During the inspection, the NP should note the following: color, viscosity, adherence to the vaginal walls, presence of an odor o Collect a discharge specimen during the assessment. Saline wet mount § Add cover to 1st slide § Examine under 40x microscopy § Clue cells = BV § Trichomonads = trichomoniasis KOH whiff test § Add drop of KOH solution to 2nd slide § Move slide near nose and "whiff" § Strong fishy odor suggests BV § Add cover slide and examine under 40x microscopy § Yeast cells = candidiasis Vaginal pH § Test litmus paper directly to vaginal wall § pH 4.5 = BV Patient education with regards to vaginal discharge o avoid douching o avoid unnecessary antibiotic therapy to prevent candidiasis o take the full course of the prescribed therapy o intravaginal creams are oil-based and may weaken latex condoms and diaphragm for five days after use o follow-up is generally not necessary unless symptoms persist HIV screening and recommendations The Centers for Disease Control and Prevention (CDC) recommends that all individuals between the ages of 13 and 64 be screened for HIV at least once as part of routine healthcare. Individuals at higher risk for HIV should be tested more frequently, at least annually, and potentially every 3-6 months for men who have sex with men. types of ASCVD -coronary heart disease -cerebrovascular disease -peripheral a disease -aortic atherosclerosis Coronary Artery Disease § myocardial infarction § angina § coronary artery stenosis Cerebrovascular Disease § transient ischemic attack § ischemic stroke § carotid artery stenosis Peripheral Artery Disease claudication Aortic Atherosclerotic Disease § abdominal aortic aneurysm § descending thoracic aneurysm Clinical tools to assess cardiovascular risk: ACC/AHA guidelines o All adults between the ages of 40-75 years are evaluated for cardiovascular disease prevention by using the 10-year ASCVD risk calculator. o Providers should evaluate the social determinants of health that impact the patient's ability to inform treatment decisions. o Providers and patients have a candid discussion before starting pharmacological therapy (antihypertensives, anti-lipid agents, and aspirin). o All adults should consume a healthy diet high in vegetables, fruits, nuts, whole grains, and lean animal protein AND low in trans fats, red meat, processed meats, refined carbohydrates, and sweetened beverages. o Adults who are overweight and obese should undergo counseling and make efforts to optimize weight. o All adults should engage in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity (amounts are cumulative). o For adults with T2DM, lifestyle changes are crucial, but if medication is indicated, metformin is the first-line agent. o All adults should be assessed at every healthcare visit for tobacco use, and users should be strongly encouraged to quit. o Aspirin should not be used routinely as primary prevention due to a lack of net benefit. o Statin therapy is the first-line treatment for the primary prevention of ASCVD in patients with elevated cholesterol. o Nonpharmacological interventions are recommended for all patients with elevated blood pressure or hypertension. For those needing medication, target blood pressure should generally be 130/80 mm Hg. Primary HTN risk factors § older age § obesity § high sodium diets § sedentary lifestyle Secondary HTN risk factors § vasculitis § aortic dissection § atherosclerosis Normal Blood Pressure 120/80 Elevated Blood Pressure 120-129/80 Stage 1 HTN 130-139/80-89 Stage 2 HTN 140/90 Isolated Systolic HTN 130/80 Isolated Diastolic HTN 130/80 Nonpharmacological management of hypertension Salt restriction Potassium supplementation Wt loss DASH diet Exercise Limit ETOH JNC 8 guidelines/pharmacological management of hypertension initiate pharmacologic treatment to lower BP at systolic BP (SBP) ≥150 mm Hg or diastolic BP (DBP) ≥90 mm Hg and treat to a goal SBP 150 mm Hg and goal DBP 90 mm Hg Heart failure with reduced ejection fraction Treatment ACE inhibitor or ARB, beta blocker, diuretic, aldosterone antagonist* Postmyocardial infarction Treatment ACE inhibitor or ARB, beta blocker, aldosterone antagonist Proteinuric chronic kidney disease Treatment ACE inhibitor or ARB Angina pectoris Treatment Beta blocker, calcium channel blocker Atrial fibrillation rate control Treatment Beta blocker, nondihydropyridine calcium channel blocker Atrial flutter rate control Treatment Beta blocker, nondihydropyridine calcium channel blocker Benign prostatic hyperplasia HTN Treatment Alpha blocker Essential tremor HTN Treatment Beta blocker (noncardioselective) Hyperthyroidism HTN Treatment Beta blocker Migraine HTN Treatment Beta blocker, calcium channel blocker Osteoporosis HTN Treatment Thiazide diuretic Raynaud phenomenon HTN Treatment Dihydropyridine calcium channel blocker Angioedema HTN Treatment Do not use an ACE inhibitor Bronchospastic disease HTN Treatment Do not use a non-selective beta blocker Liver disease HTN Treatment Do not use methyldopa Pregnancy (or at risk for) HTN Treatment Do not use an ACE inhibitor, ARB, or renin inhibitor (eg, aliskiren) Second- or third-degree heart block HTN treatment Do not use a beta blocker, nondihydropyridine calcium channel blocker unless a functioning ventricular pacemaker Depression HTN treatment Generally avoid beta blocker, central alpha-2 agonist Gout HTN treatment Generally avoid loop or thiazide diuretic Hyperkalemia HTN Treatment Generally avoid aldosterone antagonist, ACE inhibitor, ARB, renin inhibitor Hyponatremia HTN Treatment Generally avoid thiazide diuretic Renovascular disease HTN treatment Generally avoid ACE inhibitor, ARB, or renin inhibitor Diabetic Nephropathy HTN Treatment ACE inhibitor or ARB Nondiabetic Chronic Kidney Disease HTN Treatment ACE inhibitor or ARB African American HTN Treatment A thiazide-like diuretic or long-acting dihydropyridine calcium channel blocker Hypertensive urgency associated with severe elevations in BP (180/120) without progressive target organ dysfunction. § severe headache § shortness of breath § epistaxis § severe anxiety Hypertensive emergency associated with severe elevations in BP (180/120 mm Hg) complicated by evidence of target organ dysfunction. § hypertensive encephalopathy § intracerebral hemorrhage § acute myocardial infarction § acute left ventricular failure with pulmonary edema § unstable angina pectoris § dissecting aortic aneurysm § eclampsia § malignant hypertension with fundoscopic changes (retinal hemorrhages, soft exudates, and papilledema) Hyperlipidemia guidelines o Young adults 20-39 years § Healthy lifestyle promotion § Drug therapy is indicated for those with moderately high (160) or very high (190) LDL-C o Drug therapy is indicated for those with moderately high (160) or very high (190) LDL-C § Healthy lifestyle promotion § Drug therapy is indicated for those with moderately high (160) or very high (190) LDL-C Statin Benefits lowers LDL; associated with increased survival Fibrates Benefits lowers TG Niacin Benefits primarily increases HDL Bile acid sequestrants Benefits lowers LDL Ezetimibe lowers LDL (used in combination with statins) Risk factors for atrial fibrillation o Hypertensive heart disease o Coronary disease o Valvular heart disease o Heart failure o Hypertrophic cardiomyopathy o Congenital heart disease o Venous thromboembolic disease o Obstructive Sleep Apnea o Obesity o Diabetes o Metabolic syndrome o Chronic Kidney Disease Paroxysmal A Fib AF terminates spontaneously or with intervention within 7 days of onset. Episodes may recur with variable frequency. Persistent A Fib AF fails to self-terminate within 7 days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm. AF may be persistent with later paroxysmal episodes. Long-standing A Fib AF that persists for more than 12 months. Permanent A Fib Persistent AF leads to a joint decision by the patient and clinician to no longer pursue a rhythm control strategy. Lone A Fib AF may be paroxysmal, persistent or permanent without structural heart disease; has a CHADS2 of 0. Subclinical A Fib AF episodes detected by intracardiac, implantable, or wearable monitors and confirmed by intracardiac electrogram or review of the recorded rhythm on the ECG. Usually occurs in individuals without characteristic symptoms of AF and without a prior diagnosis. Most often paroxysmal AF. Restrictive Lung Disease decrease in the total volume of air that the lungs can hold. It often results from a decrease in the elasticity of the lungs or may be related to the inability of the chest wall to expand during inhalation. § interstitial lung disease such as idiopathic pulmonary fibrosis § sarcoidosis § obesity including obesity hypoventilation syndrome § scoliosis § neuromuscular diseases such as muscular dystrophy or amateur amyotrophic lateral sclerosis (ALS) Obstructive Lung Disease conditions that impede exhaled air from the lungs due to narrowing of the airways or actual damage to the lung parenchyma. § asthma § chronic obstructive pulmonary disease (COPD) § cystic fibrosis § bronchiectasis Pulmonary function testing Spirometry Lung Volume Diffusing Capacity Spirometry § evaluates the amount of air exhaled and inhaled during forced maneuvers which provide the following measurements: § forced vital capacity (FVC) - total volume a patient exhales for the total duration of the test § forced expiratory volume (FEV1) - forced expiratory volume in 1 second, or total volume of air exhaled in the 1st second of maximal effort § FEV1/FVC ratio - the percentage of the FVC expired and 1 second Long Volume § refers to the total amount of air in the lungs with maximal inspiration. This is evaluated using the following measurements: § expired reserve volume (ERV) - the maximal volume of air exhaled from end-expiration § inspired reserve volume (IRV) - the maximal volume of air held from end-inspiration § residual volume (RV) - the volume of air remaining in the lungs after a maximal exhalation § tidal volume (Vt) - the volume of air inhaled or XL during each respiratory cycle § functional residual capacity (FRC)- the volume of air in the lungs at resting end-expiration Diffusing Capacity § measures gas exchange and is often done in conjunction with a pulse oximetry reading. This is evaluated using the following measurements: § Total lung capacity (TLC) - the volume of air in the lungs at maximal inflation § Vital capacity (VC) - the largest volume measured on complete exhalation after full inspiration § DLCO -- the diffusing capacity of the lung for carbon monoxide