Clinmed Test 4

Front 1

What three factors determine the effect on cardiac function of accumulation of fluid in the pericardial cavity?

Back 1

1) Amount of fluid (200ml)
2) Rate of accumulation
3) Elasticity of the pericardium

Front 2

Name this life-threatening compression of the heart due to the accumulation of fluid, pus or blood in the pericardial sac and list four common causes...

Back 2

Cardiac Tamponade
1) Trauma
2) Post cardiac surgery
3) Constrictive pericarditis
4) Pericardial effusionf

Front 3

List six signs of rapid accumulation of fluid in the pericardium.

Back 3

1) Increased central venous pressure
2) Jugular venous distention
3) Decline in venous return to the heart
4) Decrease of CO with increase in HR
5) Decrease in SBP
6) Circulatory shock

Front 4

What anomaly would you suspect with >10mmHg fall in BP with inspiration and/or reduced or absent carotid or femoral pulse with inspiration

Back 4

Pulsus Paradoxus

Front 5

Patient with flu-like symptoms complains of chest pain. Dx? Tx?

Back 5

Acute pericarditis
Bacterial - antibiotics
Non-bacterial - colchicine (gout med)
NSAIDS (indomethacin)
STEROIDS can increase MORTALITY

Front 6

Patient has fibrous scar tissue between the visceral and parietal layers of the pericardium. Dx? Tx?

Back 6

Constrictive pericarditis
Pericardiectomy

Front 7

What is the leading indicator for heart transplant?

Back 7

Dilated cardiomyopathy

Front 8

List seven causes of dilated cardiomyopathy.

Back 8

M - metabolic
A - alcohol
N - neuromuscular disease
G - genetics
I - infection
I - immunologic
I - idiopathic

Front 9

What three symptoms will almost every SOAP note contain for cardiomyopathy?

Back 9

1) Dyspnea on exertion (DOE)
2) Paroxysmal Nocturnal Dyspnea (PND)
3) Othopnea (1,2 or 3 pillows)

Front 10

Name this disease:
Enlarged apical beat (PMI)
3rd and 4th heart sounds
Murmur from one or both AV valves
Pulsus alternans (big/little)
Basilar rales
LVH on Echo

Back 10

Dilated Cardiomyopathy

Front 11

Name this disease:
Breathing problems (DOE, PND, orthpnea)
peripheral edema & ascites

Back 11

High suspicion...
Dilated Cardiomyopathy

Front 12

List pharm treatments for dilated cardiomyopathy.

Back 12

digoxin, diuretics, ACEi and Beta blockers (metoprolol or carvadilol)

Front 13

This disease is the most common cause of sudden cardiac death in the young esp. athletes.

Back 13

Hypertrophic cardiomyopathy

Front 14

Because these disease has a strong genetic component a positive family history for early death is often seen in the family history. Screening of 1st degree relatives for murmurs and abnormal ECG is recommended.

Back 14

Hypertrophic cardiomyopathy

Front 15

Stratifying risk is important in treating this disease including echocardiograpy, Holter ECG and stress testing for NYHC staging.

Back 15

Hypertrophic cardiomyopathy

Front 16

A young athlete has ventricular tachycardia and a LBBB pattern. Dx? Tx?

Back 16

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVD)
Anti-arrhythmic agents (BB and CCB)
Treat children with verapamil

Front 17

Patient has ALL signs of heart failure but no cardiomegaly. Dx? Pathology?

Back 17

Restrictive cardiomyopathy
Ventricular filling is restricted due to excess rigidity

Front 18

List etiologies for restrictive cardiomyopathy.

Back 18

M - metastic tumors
A - amyloidosis
R - radiation fibrosis (lung or esophageal cancer)
S - sarcoidosis

Front 19

Insidious deposition of protein-containing fibrils in tissues.

Back 19

Amyloidosis

Front 20

Noncaseating (hard) granulomas and lymphocitic alveolitis

Back 20

Sarcoidosis

Front 21

List five risk factors for peripartum cardiomyopathy.

Back 21

G - gestational HTN
A - age
M - multifetal pregnancy
A - African American
P - Preeclampsia

Front 22

List the seven symptoms of cardiomyopathy.

Back 22

W - weakness
F - fatigue
A - ascites
P - paroxysmal nocturnal dyspnea
D - dyspnea on exertion
O - orthopnea
P - peripheral edema
Weak Fat Asses Put Doughnuts On Pie

Front 23

Significant patent ductus arteriosus (PDA) in 50% of infants weighing < _____ g at birth.

Back 23

1000 g

Front 24

List four signs of patent ductus arteriosus.

Back 24

1) Machinery murmur at 2nd ICS
2) Wide pulse pressure
3) Cardiomegaly
4) CHF

Front 25

List three treatments for patent ductus arteriosus.

Back 25

1) Indomethacin (inhibitor of prostaglandin synthesis)
2) Coils
3) Ligation

Front 26

The blood flow in atrial septal defect is usually _______ to _________.

Back 26

Left to right

Front 27

Atrial septal defect with endocardial cushion defect is _______ _______.

Back 27

Ostium Primum

Front 28

Cyanotic or Acyanotic?
Ventricular Septal Defect

Back 28

Acyanotic

Front 29

Pulmonary HTN that results from any congenital heart defect.

Back 29

Eisenmenger's syndrome

Front 30

What procedure is utilized to 'buy time' in infants with a ventricular septal defect?

Back 30

Pulmonary artery banding

Front 31

A congenital heart condition resulting from downward displacement of the tricuspid valve from the anulus fibrosus causing fatigue, palpitations and dyspnea.

Back 31

Ebstein's anamoly

Front 32

Partial or complete atrioventricular canal defects seen in 50% of Down's syndrome patients.

Back 32

Endocardial cushion defects

Front 33

List the four pathologies associated with Tetrology of Fallot.

Back 33

1) VSD
2) Pulmonary Stenosis
3) Dextroposition of the aorta
4) Right ventricular hypertrophy

Front 34

Cyanotic of Acyanotic?
Tetrology of Fallot

Back 34

Cyanotic

Front 35

You see a child on the playground consistently in the knee-to-chest position. Dx?

Back 35

Tetrology of Fallot

Front 36

Surgery may be contraindicated in patients with Tetrology of Fallot because of this pathology.

Back 36

Marked hypoplasia of the pulmonary arteries

Front 37

In infants with transposition of the great vessels what two concurrent heart defects will extend life?

Back 37

Patent ductus arteriosus
Septal defects

Front 38

____ % of coarctation of the aorta are postductal.

Back 38

98%

Front 39

List one risk factor and two signs for coarctation of the aorta.

Back 39

Risk: Male to Female 2:1
High BP in arms with lower BP in legs
HTN > 95 percentile for age

Front 40

In addition to fever that lasts >5 days without other cause patient must have at least four of the following to be diagnosed with Kawasaki Disease.

Back 40

- desquamenation in extremities
- Polymorphous exanthema
- Bilateral, painless bulbar conjunctival infection w/o exudate
- Changes in lips and oral cavity
- Cervical lymphadenopathy

Front 41

Loud diamond shaped murmur at Erb's point. Dx?

Back 41

Ventricular septal defect

Front 42

Machinery murmur. Dx?

Back 42

Patent ductus arteriosus

Front 43

Two most common viruses implicated in acute pericarditis?

Back 43

coxsackieviruses and echoviruses

Front 44

Two most common bacteria implicated in acute pericarditis?

Back 44

Staphylococcus and Streptococcus

Front 45

The manifestations of acute pericarditis include a triad of...

Back 45

chest pain
pericardial friction rub
electrocardiographic (ECG) changes

Front 46

The pain of acute pericarditis is usually _________ in onset and ______ causing postural changes such as _________.

Back 46

Abrupt/Sharp/tri-poding

Front 47

Laboratory markers of systemic inflammation due to acute pericarditis include...

Back 47

elevated white blood cell count
elevated erythrocyte sedimentation rate (ESR)
Increased C-reactive protein (CRP)

Front 48

________ is used to treat acute pericarditis because the drug produces its anti-inflammatory effects by preventing the polymerization of microtubules, which leads to the inhibition of leukocyte migration and phagocytosis.

Back 48

Colchicine

Front 49

T/F - Because right heart filling pressures are lower than that of the left heart, increases in pressure are usually reflected in signs and symptoms of right-sided heart failure before equalization is achieved.

Back 49

True

Front 50

Sudden accumulation of _____ mL may raise intracardiac pressure to levels that seriously limit the venous return to the heart

Back 50

200ml

Front 51

A key diagnostic finding in pericardial effusion and cardiac tamponade is _______ _________, or an exaggeration of the normal variation in the systemic arterial pulse volume with respiration sot that when palpating at the carotid or femoral artery the pulse becomes weakened or absent during inspiration and stronger during expiration.

Back 51

pulsus paradoxus

Front 52

A decline in systolic pressure greater than ___ mm Hg during inspiration is suggestive of tamponade.

Back 52

10mmHg

Front 53

Patient with ECG revealing nonspecific T-wave changes and low QRS voltage. Dx?

Back 53

Cardiac tamponade secondary to pericardial effusion

Front 54

The equalization of _____ _____ ______ in all four cardiac chambers is the pathophysiologic hallmark of constrictive pericarditis.

Back 54

end-diastolic pressures

Front 55

This disorder is characterized by progressive loss of myocytes, with partial or complete replacement of the right ventricular muscle with fatty or fibrofatty tissue

Back 55

Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D)

Front 56

Patient is a young athlete complaining of dizziness when competing. Abnormal ECG with ventricular tachycardia and LBBB pattern. Dx? Tx?

Back 56

Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D)
BB and verapimil

Front 57

What is a common cause of heart failure and the leading indication for heart transplantation?

Back 57

Dilated Cardiomyopathy

Front 58

This disease is characterized by ventricular enlargement, a reduction in ventricular wall thickness, and impaired systolic function of one or both ventricles.

Back 58

Dilated Cardiomyopathy

Front 59

In the advanced form of this disease, all the signs of heart failure are present except cardiomegaly?

Back 59

Restrictive Cardiomyopathy

Front 60

The etiologies for this disease include radiation fibrosis, amyloidosis, sarcoidosis and metastatic tumors

Back 60

Restrictive Cardiomyopathy

Front 61

37 year old woman presents with acute STEMI, but who, on cardiac catheterization, has no evidence of CAD. Echocardiogram shows apical ballooning of the left ventricle. Dx?

Back 61

Stress of Tako-Tsubo Cardiomyopathy

Front 62

The single most common identifiable cause of DCM in the United States and Europe?

Back 62

Alcoholic cardiomyopathy

Front 63

Subacute-chronic cases of ______ evolve over months and these patients usually have valve abnormalities; whereas, acute cases involve normal valves.

Back 63

infective endocarditis

Front 64

_____________ infections have now emerged as the leading cause of IE, with _________ and _________ as the other two most common causes. Other causative agents include the so called ______ group.

Back 64

Staphylococcal/streptococci/enterococci/HACEK

Front 65

List three etiologies that can incite the formation of a fibrin-platelet thrombus along the endothelial lining and the thrombus is susceptible to bacterial seeding from transient bacteremia leading to infective endocarditis.

Back 65

Endothelial injury
Bacteremia
Altered hemodynamics

Front 66

In infective endocarditis the aortic and mitral valves are the most common sites of infection, although the right heart may also be involved, particularly in _______ _____ ______.

Back 66

intravenous drug abusers

Front 67

__________ evidence of endocardial involvement is now the major criterion in the modified Duke criteria. It is recommended that this diagnostic test be performed in all suspected cases of infective endocarditis.

Back 67

Echocardiographic

Front 68

If your patient has a fever of unknown (FUO) origin you should have a high suspicion for this disease.

Back 68

Infective endocarditis

Front 69

Which one of the following is NOT implicated in right sided infective endocarditis:
Skin
Lungs
IV drug use
Central line

Back 69

Lungs

Front 70

32 year old male presents with signs of septic phlebitis, fever, pleurisy, hemoptysis and a newly diagnosed mumur (tricuspid regurgitation). Dx? Tx?

Back 70

Right sided infective endocarditis
IV broad spectrum ABx until specific bug is cultured (vancomycin and ceftriaxone). Monitor for signs of valve damage

Front 71

The mortality of infective endocarditis following prosthetic valve surgery is virtually 100% with this microorganism.

Back 71

Aspergillus

Front 72

Infective Endocarditis Prophylaxis or No Prophylaxis?
Before surgery with previous infective endocarditis?

Back 72

Prophylaxis

Front 73

Infective Endocarditis Prophylaxis or No Prophylaxis?
Surgeries for cyanotic conginital heart diseases?

Back 73

Prophylaxis

Front 74

Infective Endocarditis Prophylaxis or No Prophylaxis?
Valvular dysfunction acquired via rheumatic fever.

Back 74

Prophylaxis

Front 75

Infective Endocarditis Prophylaxis or No Prophylaxis?
Hypertrophic cardiomyopathy

Back 75

Prophylaxis

Front 76

Infective Endocarditis Prophylaxis or No Prophylaxis?
MVP with valvular regurgitation and/or thickened leaflets

Back 76

Prophylaxis

Front 77

Infective Endocarditis Prophylaxis or No Prophylaxis?
Surgical repair of ASD, VSD or PDA

Back 77

No prophylaxis

Front 78

Infective Endocarditis Prophylaxis or No Prophylaxis?
Previous CABG

Back 78

No prophylaxis

Front 79

Infective Endocarditis Prophylaxis or No Prophylaxis?
MVP without valvular regurgitation

Back 79

No prophylaxis

Front 80

Infective Endocarditis Prophylaxis or No Prophylaxis?
Tonsillectomy/adenoidectomy

Back 80

Prophylaxis

Front 81

Infective Endocarditis Prophylaxis or No Prophylaxis?
Sugery involving respiratory mucosa

Back 81

Prophylaxis

Front 82

Infective Endocarditis Prophylaxis or No Prophylaxis?
Esophageal sclerotherapy for varices or stricture dilation

Back 82

Infective Endocarditis Prophylaxis or No Prophylaxis?

Front 83

Infective Endocarditis Prophylaxis or No Prophylaxis?
Surgical procedures that involve the intestinal mucosa

Back 83

Prophylaxis

Front 84

Infective Endocarditis Prophylaxis or No Prophylaxis?
Prostatic surgery

Back 84

Prophylaxis

Front 85

Infective Endocarditis Prophylaxis or No Prophylaxis?
Cystoscopy or urethral dilation

Back 85

Prophylaxis

Front 86

18 year old with high fever complaining of chills, weakness and night sweats. She has a new heart murmur, splenomegaly and is pale white. What are six other signs that might be present in order to strengthen your Dx?

Back 86

Acute infective endocarditis
1) Splinter hemorrhages
2) Osler's nodes (painful papules on pads)
3) Janeway lesions (painless plaques on palms)
4) Petechiae on trunk
5) Roth spots on optic discs
6) Clubbing of the fingers

Front 87

70-90% of patients with infective endocarditis have this pathologic sign and the _______ is almost always elevated and ______ is often present.

Back 87

Anemia (splenomegaly)/ESR (>40mm/hour)/hematuria

Front 88

Infective endocarditis (IE) can be diagnosed after ____ sets with ____ positive blood cultures in a 24 hour period while ___ sets are necessary to rule out IE.

Back 88

3/2/6

Front 89

T/F A negative echocardiography can rule out infective endocarditis.

Back 89

False: Blood cultures are the single most important test for ruling out IE.

Front 90

All of the following are major criteria for diagnosing infective endocarditis except:
- Multiple positive blood cultures taken several hours apart (see Duke Criteria for specifics)
- High fever (>38 C /100.4 F)
- Positive serum test for Q fever
- Echocardiographic evidence (valvular mass, abscess, prosthetic valve anomaly or new valvular regurgitation

Back 90

Fever is a minor criteria according to the Duke Criteria in the diagnosis of infective endocarditis

Front 91

List the six minor Duke Criteria for diagnosing infective endocarditis.

Back 91

1) Heart condition or IV drug use
2) Fever (>38 C or 100.4 F)
3) Vascular anomalies (ICH, conjuctival hemorrhages, Janeway's lesions)
4) Immunologic anomalies (Osler's nodes or Roth's spots)
5) Microbiologic evidence that does not meet the major criteria
6) Suggestive endocardiogram that does not meet the major criteria
4)

Front 92

If you suspect rheumatic heart disease in order to diagnose you must have evidence of what in the past ~3 weeks in addition to __ major or __ major and __ minor Jone's Criteria?

Back 92

Group A (beta hemolytic) Strep (GAS) infection of the pharynx
2/1/2

Front 93

List the five MAJOR Jone's Criteria for the diagnosis of rheumatic fever.

Back 93

S - Sydenham's chorea (St. Vitus' Dance)
P - polyarthritis
E - erythema marginatum
C - carditis
S - subcutaneous nodules
S-P-E-C-S

Front 94

List the five MINOR Jone's Criteria for the diagnosis of rheumatic fever.

Back 94

P - Pyrexia
E - ECG (long P-R interval)
A - Arthralgia
C - CRP or ESR increased
E - history of prEvious RF
P-E-A-C-E

Front 95

Large and elongated myocardial cells with multiple and large nuclie are referred to as ________ ______ and are diagnostic or rheumatic fever post mortum.

Back 95

Aschoff bodies

Front 96

A patient with rheumatic fever may complain of __________ polyarthritis.

Back 96

migratory

Front 97

Rapidly enlarging papular, confluent and macular rash with ring or crescent and clear center that is non-pruitic, localized to the trunk, inner arms and thighs (not on the face) and often coincides with subcutaneous nodules.

Back 97

Erythema marginatum

Front 98

Severe carditis may lead to painless, firm and movable nodules, 0.5 to 2cm on extensor surfaces (back, knees, wrists and elbows) which is suggestive of this disease.

Back 98

Rheumatic fever

Front 99

If patient is allergic to Benzathine PCN G list two alternative ABx treatments for rheumatic fever.

Back 99

erythromycin or cephalosporin

Front 100

St. Vitis' Dance (Sedynham chorea) is treated with what?

Back 100

Haliperidol

Front 101

List the valvular complication of rheumatic fever in order of most likely occurrence to least.

Back 101

Mitral (70%)
Aortic (40%)
Tricuspid (10%)
Pulmonary (2%)

Front 102

Recurrence of rheumatic fever is precipitated by what three factors?

Back 102

1) recurrence of a strep infection
2) Oral Contraceptives
3) Pregnancy

Front 103

The _________, are potent vasoconstrictors. Like angiotensin II, these peptides can also be synthesized and released by a variety of cell types, such as cardiac myocytes and can increase vascular smooth muscle cell proliferation and cardiac myocyte hypertrophy; increase the release of ANP, aldosterone, and catecholamines; and exert antinatriuretic effects on the kidneys

Back 103

Endothelins

Front 104

Prolonged sympathetic stimulation may exhaust myocardial stores of __________ and reduce ___ - _________ __________

Back 104

norepinephrine/B-adrenergic receptors

Front 105

Kidneys receive __% of cardiac output normally but in CHF, renal blood flow may be only __ to __ of cardiac output causing a decrease in what?

Back 105

25%/8-10%/GFR

Front 106

This potassium sparing aldosterone antagonist decreases mortality by 30% in CHF.

Back 106

Sprionolactone

Front 107

Released from the cells lining vessel walls, these potent vasoconstrictors also induce vascular smooth muscle cell proliferation and myocyte hypertrophy.

Back 107

Endothelins

Front 108

Which form of cardiac hypertrophy is considered a 'good' increase especially in athletes:
Symmetric (m. length)
Concentric (wall thickness)
Eccentric (wall dilation)

Back 108

Symmetric

Front 109

Label the type of hypertrophy (e.g. symmetric)
Increased diastolic wall stress?
Increased systolic wall stress?

Back 109

Eccentric (dilation) /Concentric (thickening)

Front 110

Systolic HF causes ventricular ________ whereas diastolic HF causes ventricular __________ both types of cardiac remodeling.

Back 110

dilation (eccentric)/ hypertrophy (concentric)

Front 111

Name the pathology behind each diastolic dysfunction:
1) Those that restrict diastolic filling
2) Those that increase ventricular wall thickness and reduce chamber size
3)Those that delay diastolic relaxation (2)

Back 111

1) Mitral stenosis
2) Hypertrophic cardiomyopathy
3) Ischemic heart disease and aging

Front 112

One pint of fluid = __ pound of weight gain
__ lb in 1 day or ___ lb in 1 wk is a sign of worsening CHF

Back 112

1/2/5

Front 113

Name three organs affected by visceral congestion due to _____ sided HF

Back 113

Right sided HF
Liver
Spleen
GI tract

Front 114

Name a classic sign indicative of right-sided HF.

Back 114

JVD

Front 115

List two valvular pathologies that cause right-sided HF.

Back 115

TiPs
Tricuspid insufficiency
Pulmonary stenosis

Front 116

Pulmonary edema occurs when pulmonary capillary filtration pressure is > ___ mm Hg

Back 116

25 mmHg

Front 117

Patient has shortness of breath with hypotension and narrowed pulse pressures. Dx?

Back 117

CHF

Front 118

Patient has parasternal lift, decreased first heart sound and an S3 gallop. Dx?

Back 118

CHF

Front 119

Systemic diastolic HTN and JVD are signs of what disease?

Back 119

CHF

Front 120

Signs of pulmonary edema and Kerly B lines on a CXR. Dx?

Back 120

CHF

Front 121

Central Venous Pressure (CVP) is monitored through a catheter inserted into the ______ atrium. PCWP assesses the pumping ability of the ______ side of the heart.

Back 121

Right/Left

Front 122

Used in the treatment of CHF this drug improves contractility (in systolic dysfunction) and slows ventricular rate in atrial fibrillation.

Back 122

Digoxin

Front 123

Patient treated for CHF is showing signs of hyperkalemia. What drug may be the cause?

Back 123

Sprionolactone (potassium sparing)

Front 124

Used to decrease afterload
this class of drugs is shown to increase survival in CHF patients while improving general symptomatology and overall exercise capacity

Back 124

ACEi

Front 125

Used to treat acute CHF this drug may be of short-term benefit by decreasing preload, afterload, and systemic resistance

Back 125

Nitroglycerine

Front 126

This human BNP is Indicated for IV treatment of patients with acutely decompensated CHF

Back 126

Nesiritide (Natrecor)

Front 127

List drugs used to treat CHF

Back 127

Digoxin
Diuretics
ACE Inhibitors / ARB’s
Beta-Blockers
Vasodilators
Nesiritide

Front 128

Patient is sitting, gasping for air and apprehensive. She has a rapid pulse; cool, moist skin; cyanosis of lips and nail beds; confusion and stupor and a productive cough with frothy sputum. You hear crackles when listening to her lungs. Dx? Tx?

Back 128

Pulmonary Edema
Sit up /stand up
Diuretics (Furosemide 20-80mg IV)
Vasodilator drugs (nitroglycerin)
Morphine sulfate 2-5mg IV

Front 129

During cardiogenic shock, if vasopressor support is required for > 30 minutes consider this alternative treatment to increase perfusion of the organs.

Back 129

Intra-aortic balloon pump

Front 130

Name the procedure that involves fashioning a latissimus dorsi back muscle into a wrap that embraces the heart and adding a pacemaker to stimulate the muscle to contract.

Back 130

Cardiomyoplasty

Front 131

List clinical assessment when shock is suspected.

Back 131

HEART RATE increased
Peripheral perfusion
Temperature
Urine output
Mentation
Acid-Base Status

Front 132

Opposite of CHF, shock will have either low or normal __________ fluid volumes.

Back 132

extracellular

Front 133

JVD. Dx (3)?

Back 133

CHF
Cardiac tamponade
Tension pneumothorax

Front 134

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Hemorrhage

Back 134

Hypovolemic

Front 135

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Severe burns

Back 135

Hypovolemic (loss of plasma)

Front 136

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Acute pericardial tamponade

Back 136

O/C

Front 137

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Massive pulmonary embolism

Back 137

O/C

Front 138

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Tension pneumothorax

Back 138

O/C

Front 139

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Aortic dissection

Back 139

O/C

Front 140

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Sepsis

Back 140

Distributive

Front 141

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
SIRS

Back 141

Distributive

Front 142

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Anaphylaxis

Back 142

Distributive

Front 143

Shock: Hypovolemic/Obstructive or Compressive/Distributive?
Hyper/Hypothermia

Back 143

Distributive

Front 144

Orthostatic hypotension: within three minutes decreased systolic b/p >______ or decreased diastolic b/p >______

Back 144

20mmHg
10mmHg

Front 145

Diagnostic criteria for oliguria as a sign of shock (/hour, /day)

Back 145

<5-10 ml/hour
<400 ml/day

Front 146

List two functions of ADH.

Back 146

Water retention
Thirst

Front 147

List the two organs unaffected by sympathetic stimulation of vascular beds (vasoconstriction)

Back 147

Brain
Heart

Front 148

Metabolic acidosis dilates _________ vessels.

Back 148

Cerebral

Front 149

Uncompensated shock involves _________ metabolism.

Back 149

Anaerobic

Front 150

In shock this pathological state is the result of coagulation molecules depleted due to the formation of small clots system wide.

Back 150

Disseminated intravascular coagulation (DIC)

Front 151

Patient has tachycardia, tachypnea, fever and thrombocytopenia. Dx?

Back 151

Systemic Inflammatory Response Syndrome (SIRS)

Front 152

Pathological state resulting in the activation of numerous humoral cascades and the reticular endothelial system.

Back 152

Stage III SIRS

Front 153

SIRS results in a state of ______________ leading the exhaustion of the bodies reserve oxygen and fuel supplies.

Back 153

hypermetabolism

Front 154

T/F Hematocrit is a good indicator of the severity of blood loss.

Back 154

False: hematocrit is a percentage unaffected by blood volume

Front 155

ATLS Hemorrhage Criteria?
Minimal tachycardia with no changes in b/p.

Back 155

Class I

Front 156

Capillary refill > 3 seconds corresponds to blood lose of ___ %

Back 156

10%

Front 157

ATLS Hemorrhage Criteria?
Tachycardia, tachypnea, decreased pulse pressure, cool clammy skin, delayed capillary refill and anxiety but MAP is maintained.

Back 157

Class II (15-30%)

Front 158

ATLS Hemorrhage Criteria?
Decreased SBP and oliguria.

Back 158

Class III (30-40%)

Front 159

ATLS Hemorrhage Criteria?
Immediate threat to life

Back 159

Class IV (>40%)

Front 160

Septic or Cardiogenic Shock?
Increased atrial pressures, JVD and increased wedge pressure.

Back 160

Cardiogenic

Front 161

Patient has intrapericardial pressure of 16mmHg, pulsess paradoxes, falling pulse pressure with rising HR and venous pressure.

Back 161

Pericardial tamponade

Front 162

EKG - S1Q3T3, RBBB, tachycardia, tall P wave and new right axis deviation.

Back 162

Pulmonary embolus

Front 163

Type of shock in which blood is pooled in the peripheral veins.

Back 163

Neurogenic (low output) shock

Front 164

Patient has high fever and other signs of inflammation with warm and pink fingers and increased heart rate. You diagnose a gram (-) UTI. Dx?

Back 164

Septic shock

Front 165

Patient has signs of pulmonary edema but no increase in Pulmonary Capillary Wedge Pressure. Dx?

Back 165

Adult Respiratory Distress Syndrome (ARDS) or shock lung

Front 166

What is the primary pathogenesis of ARDS?

Back 166

Inflammatory damage

Front 167

List three mechanisms for Multiple Organ Dysfunction Syndrome.

Back 167

- Neuroendocrine activation (vasoconstriction and increased HR)
- Endothelial damage (leaky caps)
- Inflammatory mediators (hyperinflammation and hypercoagulation)

Front 168

Decreased PCWP, increased CO, decreased SVR and increased MVOS. Dx? Tx?

Back 168

Distributive shock
Dopamine (early and small doses)

Front 169

Increased PCWP, decreased CO, increased SVR and decreased MVOS. Dx? Tx?

Back 169

Cardiogenic shock
Dobutamine

Front 170

Decreased PCWP, decreased CO, increased SVR and decreased MVOS. Dx? Tx?

Back 170

Hypovolemic shock
Milrionone (peripheral vasodilation esp. in the pulmonary circulation)

Front 171

T/F Time to initiation of treatment is the greatest predictor of mortality in the treatment of shock (treatment within the first hour). The first step in treating shock is to RECOGNIZE shock!!!

Back 171

True

Front 172

Abx control of septic shock when pseudomonas is NOT suspected?

Back 172

Vancomycin + (cephalosporin, penicillin or carbapenem)

Front 173

Abx control of septic shock when pseudomonas IS suspected?

Back 173

Vancomycin + 2 (Antipseudomonal ceph, pen or carb; floroquinolone or aminoglycoside)

Front 174

This drug is used to treat coagulation abnormalities in septic shock.

Back 174

Drotrecogin alfa (Xigris)

Front 175

Adequate nutrition in the treatment of shock results in higher _________ counts and higher __________ levels.

Back 175

neutrophil/albumin