Cardiovascular Exam Iv

Front 1

2 components of extracellular fluid volume

Back 1

Plasma volume

Interstitial Fluid Volume

Front 2

Pressure that tends to drive fluid out of capillary

Back 2

Hydrostatic pressure

Front 3

Pressure that tends to drive fluid into capillary

Back 3

Colloid oncotic pressure

Front 4

Causes of extracellular edema

Back 4

- Increased capillary pressure (excessive kidney retention, high venous pressure, decreased resistance)

- Decreased plasma proteins (proteinuria, burns, failure to produce proteins)

- Increased capillary permeability (immune reactions, toxins, bacterial infections, vit defficiency,prolonged ischemia, burns)

- Blockage of lymphatic return (cancer, infections, surgery, congenital abnormalities)

Front 5

3 stages of shock

Back 5

- Compensated hypotension

- Signs of cerebral, renal, and myocardial insufficiency and increased sympathetic activity

- Severe ischemia with capillary and endothelial damage + acidosis

Front 6

Management of shock (general)

Back 6

- Ensure adequate oxygenation

- Bladder catheter to measure urine output

- Vasopressors

Front 7

Cardiogenic treatment of shock

Back 7

Inotropic agents, Intra aortic balloon pump, diuretics, correction of underlying lesion (if possible)

Front 8

Hypovolemic treatment of shock

Back 8

Fluids/blood products

Correction of underlying pathology

Front 9

Anaphylactic shock treatment

Back 9

Epinephrine

Antihistamines

Front 10

Systemic illness caused by spread of microbes (or toxins) via bloodstream

Back 10

Septicemia

Front 11

Sepsis is a syndrome - T/F

Back 11

True

Front 12

Describe progression of sepsis

Back 12

SIRS --> Sepsis --> Severe sepsis --> Septic shock --> Multiorgan dysfunction syndrome

Front 13

General syndrome that may have causes other than microbial - pancreatitis, trauma, burns, ischemia, tissue injury etc

Back 13

Systemic Inflammatory Response Syndrome SIRS

Front 14

Criteria for SIRS

Back 14

Oral temperature more than 38 or less than 36 C

Respiration rate over 20 breaths a minute

Heart rate over 90 beats per minute

Leukocyte count over 12000 or less than 4000 or more than 10% of bands

Front 15

SIRS + confirmed (suspected) infection

Back 15

Sepsis

Front 16

Patient presents with fever or hypothermia, tachycardia, subnormal BP, subnormal urinary output, increased CO, or decreased peripheral vascular resistance - ?

Back 16

Clinical sepsis

Front 17

Sepsis + hypotension that can be corrected by administration of fluids

Back 17

Severe sepsis

Front 18

Sepsis + persistant hypotension that cannot be corrected by administration of fluids

Back 18

Septic shock

Front 19

Patient presents with sepsis with hypotension that is unresponsive to fluid resuscitation, organ dysfunction and perfusion abnormalities - diagnosis

Back 19

Septic shock

Front 20

Sepsis + altered organ function

Back 20

MODS - multiorgan dysfunction syndrome

Front 21

#1 cause of bacteremia

Back 21

Gram positive organisms

Front 22

#1 cause of septic shock

Back 22

Gram negative rods

Front 23

Important cause of invasive fungal infections in sepsis

Back 23

Aspergillus

Front 24

Things necessary for sepsis to occur

Back 24

Large inoculum

Immune defect

Microbes escape host defence

Stimulation of cytokine cascade

Toxin production and distribution

Front 25

Gram negative rods risk factors

Back 25

Diabetes mellitus

Lymphoproliferative diseases

Cirrhosis of liver

Burns, invasive procedures, treatment with drugs that cause neutropenia

Front 26

Bacterial mediator of sepsis in gram negative bacteria

Back 26

LPS

Front 27

Bacterial mediators of sepsis in gram positive bacteria

Back 27

Peptidoglycan

Lipoteichoic acid

Superantigens

Front 28

Extremely potent toxin - elicits production of cytokinesm activates complement cascade and activates coagulation cascade

Back 28

LPS

Front 29

Pyrogenic cytokines

Back 29

TNF alpha

IL 1

IL 6

Front 30

Cytokine that activates T cells

Back 30

IL 12

Front 31

Cytokine chemotactic for leukocytes

Back 31

IL8

Front 32

Pro inflammatory response leads to early or late mortality

Back 32

Early mortality

Front 33

Anti inflammatory response leads to early or late mortality

Back 33

Late mortality

Front 34

This cytokine contributes to fever, wasting, increased breathing and HR, hypotension and hemorrhages in organs

Back 34

TNF alpha

Front 35

This cytokine stimulates prostaglandin release in hypothalamus - fever, contributes to hypotension, anorexia and increase in PMN's

Back 35

IL1

Front 36

_ promotes neutrophil reactions - chemotaxis and aggregation, degranulation and radical production

Back 36

C5a

Front 37

Gram positive cocci risk factors

Back 37

Vascular catheterizations

Indwelling mechanical deves

Burns

IV drug use

Malignancy and chemotherapy

Toxin mediated (TSS)

Front 38

Bacteria that produce superantigens

Back 38

S aureus + S pyogenes

Front 39

Activate T cells, induces huge cytokine response and septic shock - do not interact with MHC or TCR like conventional antigens

Back 39

Staph Aureus

Step pyogenes

Front 40

Which cytokine leads to stimulation of TNF alpha and shock

Back 40

IL2

Front 41

Treatment of sepsis

Back 41

Treat with broad spectrum antibiotics until organism is identified

Front 42

This infection:

- Comes from infected foci
- Associated with influx of host neutrophils
- Set off inflammatory cascade
- Doesnt trigger as intense TNF alpha response

Back 42

Gram positive

Front 43

This infection

- arise from within host - GI tract, billiary tract and urinary tract

- may be controlled by antibody and complement

- Have fewer virulence factors but do have endotoxin

Back 43

Gram negative infections

Front 44

_ sources are associated with intermittent bacteremia

Back 44

Extravascular

Front 45

_ sources associated with continuous bacteremia

Back 45

Intravascular (IE, catheter, mycotic aneurysm)

Front 46

Sickle cell patients tend to have what type of sepsis

Back 46

Salmonella

Front 47

How many blood cultures should be taken in patient with sepsis

Back 47

3 - 99% sensitivity

Front 48

p ANCA is found in what diseases

Back 48

Churg Strauss

Microscopic polyangitis

PAN

Front 49

Most common form of systemic vasculitis in adults

Back 49

Temporal arteritis

Front 50

What type of inflammation in Giant cell arteritis

Back 50

Granulomatous

Front 51

What size vessels affected in temporal arteriits

Back 51

Large and medium size

Front 52

Ophthalmic blindness - medical emergency - which vasculitis

Back 52

Temporal arteritis

Front 53

Screen test for temporal arteritis

Back 53

ESR

Front 54

Treatment for temporal arteritis

Back 54

Steroids

Front 55

What type of inflammation in Takayasu arteritis

Back 55

Granulomatous

Front 56

What size vessels in Takayasu

Back 56

Large vessels to medium sized

Front 57

In this type of vasculitis there is thickening of vascular wall and narrowing of the lumen with subsequent thrombosis

Back 57

Temporal arteritis

Front 58

40 year old Asian female with complain of coldness/numbness of fingers, visual disturbances and hypertension

Back 58

Takayasu disease

Front 59

Fibrous thickening of aorta (arch and branches) and narrowing or total occlusion occur in which type of vasculitis

Back 59

Takayasu

Front 60

PAN - what type of inflammation

Back 60

Segmental necrotizing

Front 61

What size arteries involved in PAN

Back 61

Medium size arteries

Front 62

Pulmonary involvement in PAN?

Back 62

NO

Front 63

This problem is usually dominant and cause of death in PAN

Back 63

Renal involvement

Front 64

PAN associated with what other disease

Back 64

Hep B

Front 65

Patient presents with tender erythematous nodules with central "punched out" ulcerations - diagnosis

Back 65

PAN

Front 66

Microscopic polyangitis - type of inflammation

Back 66

Necrotizing

Front 67

Size of vessels involved in microscopic polyangitis

Back 67

Small - arterioles, capillaries, venules

Front 68

Lung involvement in microscopic polyangitis?

Back 68

YES

Front 69

Patient presents with hemoptysis, hematuria, proteinuria, abdominal pain, arthralgia and muscle pain/weakness

Back 69

Microscopic polyangitis

Front 70

UA shows RBC casts -which vasculitis

Back 70

Microscopic polyangitis

Front 71

Splinter hemorrhages - which diseases

Back 71

Microscopic polyangitis

Infective endocarditis

Front 72

Person with asthma + eosinophilia - which vasculitis

Back 72

Churg Strauss syndrome

Front 73

Childhood vasculitis

Back 73

Kawasaki disease

Front 74

Which arteries involved in Kawasaki

Back 74

Coronary arteries

Front 75

4 year old child presents with high fever, conjunctival and oral lesions, rash and lymphadenitis - diagnosis

Back 75

Kawasaki

Front 76

Necrotizing vasculitis of respiratory tract and kidneys

Back 76

Wegener granulomatosis

Front 77

Patient presents with pneumonitis and sinusitis, nodules seen on chest x ray - diagnosis

Back 77

Wegener granulomatosis

Front 78

cANCA present in _

Back 78

Wegener granulomatosis

Front 79

Peripheral vascular disease in smokers

Back 79

Buergers

Front 80

34 year old male presents with intermittant claudication and ulcers on lower leg, heavy smoker

Back 80

Buergers

Front 81

Intermittant bilateral attacks of ischemic vasospasm in skin

Back 81

Raynaud phenomenon

Front 82

Murmur in acute RF

Back 82

Mitral regurgitation