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116 Cards in this Set

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RX Tx for HTN
ACE and Diuretics
RX Tx for HTN and stable angina
BB
angina
precordial chest pain usually precipitated by stress/exertion; relieved by rest/nitrates
RX for HTN and unstable angina
Asprin and heparin; nitrates; BB
RX for prinzmetal's angina
nitrates/CCB
TX in hypertensive emergencies
In ER - IV Na nitroprusside(antihypertensive)

[office-oral clonadine(antihypertensive-andrenergic)]
Cardinal sign of HF
1. parasternal lift (thrill/heave)
2. enlarged/displaced PMI
3. S3 gallop
4. diminished 1st heart sound
34 female/exercise/acute SOB/palpitations/hemoptysis
ER: CXR:Interstitial edema
Mitral stenosis
(due to back up in mitral valve)Curly B lines on CXR are interstitial edema
DVT
tenderness/edema/redness of Lower extremity = unilateral
occlusive arterial atherosclerosis
pain with ambulation, claudication, femoral bruits, diminished pedal pulses
6P's - pain, pallor, pulseless, parathesia, paralysis, popcicle
Mild chronic CHF
ACE/Diuretics
CHF w/COPD
avoid BB (b/c blocking of beta cells can cause acute asthmatic rxn)
unequal peripheral pulses/intrascapular pain
Aortic dissection
SVT primary RX
BB, CCB
BB
slow HR/increase strength of contraction
Tamponade classic finding
pulsus paradoxus
risk factors for PAD
**DM and hyperlipidema
coronary syndromes and MI
BB
CCBs used:
acute HTN or if BB contraind.
SVT RX
usually adenosine, then CCB, BB, digoxin(not 1st line b/c of length of action and need for watching bld levels)
Drug of choice for recurrent SVT attacks
digoxin
p362
CABG most patent artery
internal mammary (long term patency/flow)
[saphenous/radial]
AAA
abdominal US
Aortic dissection
unequal pulses; ripping intrascapular chest pain
Unstable angina surgery cut off
75-85% occlusion
CAD risk factors
FM, male, hyperlipidemia, DM, HTN, physical inactivity, obesity, cigarette smoking
TOD
Brain/Heart
Tamponade classic findings
***pulsus paradoxus, JVD, tachycardia
Tamponade side of heart involved
RV bulges into LV
Beck's triad
assoc w/tamponade: muffled heart sounds, JVD, hypotension
Mgt of Tamponade
drain fluid
best diag test for tamponade
echocardiogram
avoid what RX in CHF (esp w/L sided failure)
BB
CHF causes
ischemic heart dz, HTN, aortic/mitral valve dz, nonischemic (infection, alcoholic, toxic, postpardum, infiltrative, idiopathic), arrythmias
at risk for failure but w/o structural heart dz
Stage A
structural dz w/o Sx of HF
Stage B
structural dz w/Sx of HF
Stage C
refractory HF w/special interventions (sx at rest)
Stage D
normal HTN
119/79
preHTN
120-139 / 80-89
Stage I HTN
140-159 / 90-99
Stage II HTN
>160 / >100
DM / HTN
initial ACE/ARB
Aortic insuff
pul. edema (LV failure)
PF: wide arterial pulse press, lg SV
Mitral insuff
lg LA
Clin Char: pansystolic to axilla; LV impluse; carotid upstroke; 3rd heat sound
Marfan's acute Tx RX
BB
3 systems involved in marfan's
ocular, skel, cardio
MI heart sounds
S4 gallop (atrial)
enzyme test for MI
CK -
PSVT Tx RX
1st choice - digoxin
SVT Tx
Procedure: radiofrequency ablation
Rx: long term: verapamil, digoxin, BB
Avoid:BB, CCB, digoxin with Afib
Afib RX
asprin (with no stroke RF);
w/CHF, LV dysfunc, obstructive valve dz, DM, HTN, >75- warfarin
V tach RX
lidocain bolus (w/unstable)
Chronic: ICD (defib)
MVP Tx
surgury
Test for new onset murmur
echo
Raynauds
vasospastic disorder
pallor(white)-cyanosis(blue)-rubor(red)-cold-migraine
Pericarditis
water bottle chest on CXR
Pericarditis Gold star test
echo
Tamponade Tx
pericariectomy
Cor pulmonale
RVH - failure due to pul.dz/hyposia/PVD

Common cause: COPD
Corpulmonale Sx
productive cough, DOE, wheezing, fatigue, weakness
Corpulmonale signs
cyanosis, clubbing, distended neck veins, RV heave/gallop, lower sternal/epigastric pulsations, large/tender liver, edema
Rheumatic fever Dx
jones criteria
Major jones criteria
Carditis, erythema margenatum/subcut. nodules, chorea, arthritis
Rheumatic fever Tx
bed rest; salicylates, penicillin, corticosteroids
aortic stenosis
splitting of S2; 2nd rt ICS/apex/carotids; midsystolic murmur; harsh/rough
mitral stenosis
after S2(middiastolic snap)LSB/apex; Afib is common; low pitch(bell); rumbling
mitral stenosis found with___
interstitial edema
acidotic ABG
<7.35
alkalinic ABG
>7.45
Metabolic
direct rel btwn pH and HCO3
Respiratory
indirect rel btwn pH and PCO2
Metabolic acidosis cause
starvation, excessive diarhhea, ketoacidosis
Metabolic Acidosis S/Sx
Kussmaul's respiration - severe, deep, reg, sighing respiration
Metabolic Alkalosis cause
vomiting/nasogastric suctioning, excessive antiacid, prim aldosteronism, diuretic therapy
No char s/sx; orthostatic htn
Metabolic Alkalosis Tx
correcting fluid imbalance - replace fluid w/NaCL/KCL
Respiratory acidosis (hypercapnia)
COPD b/c CO2 build up; acute: confusion, somnolence, asterixis, myoclonis inc intracranial press (papilledema)
Resp. Alkalosis cause
**hyperventilation, interstitial lung dz, pneumonia, pul embolism, pul edema
Resp Alkalosis S/Sx
light-headed, anxiety, paresthesias, numb mouth, tetany
Resp Alkalosis Tx in acute hyperventilation
paper bag to inc pCO2
mild intermittent asthma
<2x/wk; asymp; normal PEF b/w exacerbations
NO daily meds
quick relief: short acting bronchodilator(beta2antagonist)
mild persistant
>2/wk <1/day; may affect activity
Rx: 1daily anti-inflammatory(inhaled corticosteroid low dose)
quick relief: short act.broncodilator
moderate persistant
daily Sx; affect activity; >2/wk
moderate persistant RX
Rx daily: anti-inflam(med dose) OR
inhaled cortico.(low/med) AND long acting brochodil (b2 agonist/theophylline)
Severe persistant
continual Sx; limited activity; frequent exacerbations
Severe persistant Rx
daily antiinflam(inhaled cort high dose)ANDlong acting bronchodilator AND corticsteroid tablets/syrup
during exacerbations best med
short acting inhaled Beta adrenergic agonist (albuterol, bitolterol, pirbuterol, terbutaline)
if pt does not respond to B agonist
glucocorticoids systemically
To control COPD Sx
bronchodilators
mild COPD
short acting brochodilator prn
moderate COPD
reg tx w/bronchodilator, inhaled glucocorticoid, pul rehab, long term O2, surgury
O2 decreases mortality
1.pO2 <55 or satO2is <89 OR
2.pO2<60 w/sighns or corpulmonale or secodary polythemia or max med therapy or less dyspnic and can inc activity with 2nd therapy
exacerbation tx
inc dose/freq of bronchodil; combine classes of drugs, use nebulizers, change route of admin, abx (vol reduction surgery - 15%pts)
pink puffer
emphysema; dyspnea; no cough, little mucus; THIN; use accessory muscles; NO adventitious breath sounds; NO peripheral edema
Blue Bloater
bronchitis, chronic cough, productve mocopurulent sputum; mild dyspnea, OVERWEIGHT; cyanotic, comfortable at rest; PERIPHERAL EDEMA; noisy chest; wheezes
PFT
pulmonary function test
FEV1
amt of air expired in one second during forceful excertion
Vital Capacity
tot amt of gas exhaled following maximal inhalation
Restriction
reduction in lung vol w/inc. FEV1/FVC ratio; reduced FVC=pul restriction
Causes: dec lung compliance (pul fibrosis), reduced mus strenghth, diaphragm dysfunc, neuromus dz, pleural dz
Forced Vital capacity
tot expired during FEV test
Obstruction
ratio decrease; caused by asthma, COPD, bronchiectasis, bronchiolitis, upper airway obstruction
Sarcoidosis
systemic - granulomatous inflammation (dx with transbronchial lung biopsy)
Pul embolism
dyspnea, chest pain, tachypnea
study of ch: perfusion lung scan pulmonary arteriograph/angiography **gold std
pul. HTN
SYNCOPE, dyspnea, fatigue, chest pain
Dx test: ECG (RVH); CT-pruning of lg pul art
pul effusion
CXR: fluid
CT: fluid
thoracentesis to evaluate fluid
transudate
watery
3 causes:
HF, nephrosis/nephrotic synd, cirrhosis
exudate
less watery / many pr-
all other causes
pleuritis tx
underlying cause (analgesic/antiinflam) codeine to control cough
Pleuritis dx test
CXR/US
nosocomail pneumon
polymicrobial gram neg, pseudomonas aeruginosa, s. aureus
MORE GRAM NEG
commum aquired pneumon
strep p, hemophilius influenaza
MORE GRAM POS
DX: CXR (GOLD)
nosocom tx
broad spec abx: cephalosporin, quinalone, vancomycin
comm aquired tx
macrolides: erythromycin, azithromycin, or doxycylin if high macrolide resistance
TB s/sx
fatigue, wt loss, fever, night sweats, cough
TB tests
CXR- infiltrates at apices of lungs
PPD
PPD pos
>5=HIV, TB pts, organ transplant, immunosupressed
>10=immigrants, Inject users, myobact lab personel, res/employees in high risk
>15 persons with no TB risk