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324 Cards in this Set
- Front
- Back
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IVC and SVC empty into what chamber?
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right atrium
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pulmonary veins pump oxygenated blood into what chamber?
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left atrium
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which heart chamber is the strongest? why?
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left ventricle, responsible for systemic circulation
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What determines the rhythm of the heart?
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SA node
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What part of the nervous system controls the SA node during relaxation? during stress?
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relaxation - parasympathetic.
stress - sympathetic |
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What does the AV node do?
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slows down the current, allowing ventricles to fill with blood.
Will NOT transmit every beat to ventricles if heart is beating too fast |
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True or false, ventricles contract in unison
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true
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what does the P wave represent?
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activation of atria
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what does the QRS complex represent
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activation ventricles
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what does the T wave represent?
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recovery wave
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Reading an ECG:
How many squares represent 1 second? |
5 squares
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How do you calculate bpm with an ECG?
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300/# squares for one cycle = bpm
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How do you calculate bpm for an irregular heart beat using an ECG?
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Count the number of cycles in 6 seconds (30 squares) and multiply by 10
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define tachycardia and bradycardia in terms of heart rate.
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Tachycardia HR>100
Bradycardia HR<50 |
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What swill show broad (>3 small boxes) QRS waves?
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Ventricular Tachycardia and pace makers
(ventricular tachycardia gives broad QRS due to cells other than the bundle of HIS conducting current. |
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What is the most dangerous tachycardia?
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Ventricular
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What to do if young patient becomes pale, diaphoretic, and passes out after LA injection with epi?
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AED --> shock if advised
transfer to ER |
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What do you do if patient is light headed and passes out, has no heart beat (asystole)?
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do NOT shock, wont do anything.
CPR, can give 1 mg epi IV. |
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Patient has ICD (implantable cardioverter defibrillator).
Do we use endocarditis prophylaxis? Do we use electrocautery? |
No and No
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How to disable ICD shock
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magnet
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what is the difference between ICD and pacemaker?
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pace makers can not deliver shock
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this is a term for failure of valve to fully open, "narrowing"
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stenosis
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failure of valve to fully close, "leaky"
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incompetent, insufficient, or regurgitant valve
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term for ventricular contraction and blood ejection
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systole
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term for atrial contraction and ventricular relaxation
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diastole
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S1 - lub represents what?
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atrioventricular valves closing
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S2 - dub represents what?
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semilunar valve closing
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Stenosis occurs with age (true or false)
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true
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Regurgitant valves can be due to what conditions
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infection (endocarditis) or heart attack (affecting valve leaflets)
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which prosthetic valve requires anticoagulants?
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synthetic material (metal)
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What are the benefits and shortfalls of bioprosthetic valves?
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do not last as long as mechanical, but do not require blood thinners
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what are the big 3 risk factors for clotting in patients with mechanical valves?
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low EF, AF with stroke, prior history of stroke of clot
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treating a patient with atrial fibrillation. what meds to stop, do you use heparin bridge?
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stop coumadin, do not need to bridge with heparin
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what constitutes a low ejection fraction?
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<30%
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treating a patient with a mitral/tricuspid valve replacement.
meds to stop/start |
stop coumadin 3 days prior to procedure. begin heparin when INR < 2. Stop heparin 6 hrs before procedure, start on coumadin within 24 hrs of procedure
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Risk factors for endocarditis
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prosthetic valve, IV drug use, hemodialysis, HIV, previous episodes of endocarditis
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what is the most common sign and symptom of infective endocarditis?
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fever
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Diagnosing infective endocarditis
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2 or more major Duke criteria OR 1 major and 3 minor Duke criteria
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Major Duke criteria:
Minor Duke criteria: |
Major:
-persistant positive blood culture -evidence of endocardial involvement Minor: -predisposing condition: IV, cardiac abnormality -fever -embolic event |
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What cardiac condions require premed prophy?
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-patients with prosthetic heart valves
-prior endocarditis -congenital heart disease -unrepaired cyanotic heart disease -congenital heart disease with residual materials -cardiac transplantation recipients who develop valvulopathy |
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premed prophy regiment for cardiac conditions
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Amox given 30-60 minutes before procedure (2 gm PO, IV/IM)
For pen allergy: cephalexin (2 gm PO) or clinda (600 mg PO, or azythro(500 mg PO) |
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abnormal thickening and hardening of arterial walls
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atherosclerosis
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Define stable and unstable angina
What is NSTEMI? STEMI? |
Stable angina - plaque limits blood flow but only noticeable upon excercise
Unstable - chest pain at rest (acute coronary syndrome) NSTEMI - ruptured plaque STEMI - occluding thrombus |
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Management of angina during procedure
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stop procedure, give nitro every 5 minutes and aspiring (325 mg)
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aspirin during angina can reduce risk of dying by what percent?
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20%
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What are the two types of stents?
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bare metal and drug-eluting (Taxus, Cypher)
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A patient with a cardiac stent will be on what medication always?
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aspirin on plavix (** if stent placed with last 2 years, talk to cardiologist before discontinuation for treatment)
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2 Etiologies of cardiomyopathy
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prior heart attack and alcoholism
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Two types of cardiomyopathies, which is symptomatic?
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ischemic (due to prior heart attack)
- symptomatic non-ischemic (asymptomatic) |
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What is Predaxa used to treat? What does it do? what are the advantages?
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used in atrial fibrillation. might decrease risk of bleeding and stroke. Advantage: do not need to monitor INR (thrombin factor II inhibitor)
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Aphthous Ulcers are strongly associated with what GI disease?
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Crohn's disease (4-15%)
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This GI condition, catagorized by hamartomatous polyps in small bowel, can cause hyperpigmentation along buccal/labial musoca
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Peutz-Jeghers Syndrome
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Small red lesions - vascular malformations on lips, mouth, throughout GI tract
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Osler-Weber-Rendu disease
(aka Hereditary Hemorrhagic Telangectasias) |
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GERD precipitating factors
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diet, high fat foods, smoking, meds
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What is water brash?
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stomach acid in mouth, (symptom of GERD)
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are dental erosions a typical symptom of GERD?
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no, atypical
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Esophagitis, Esophageal stricture, and barrett's esophagus will present with what symptom?
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heart burn
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What is Barret's esophagus? Is it premalignant?
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ragged transition between squamous (normal in esophagus) and columnar epithelium (intestinal)
Yes, premalignant for adenocarcinoma (0.5%) |
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Lifestyle modification treatments for GERD
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elevate head of bed during sleep, no food 3 hrs before bed, stop smoking, modifying diet (less fat, less peppermint, onions, citrus, coffee, tomatoes)
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medications used to treat GERD
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Acid suppression
-antacid -H2 blockers -Proton pump inhibitors Pro-motility -Reglan (associated with neurological side effect) |
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Important to differentiate between what two types of dysphagia
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Esophageal and oropharyngeal
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Trouble swallowing solid foods hints at what?
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Structural Esophageal issues such as strictures, ring, Zenker's diverticulum, cancer
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Trouble swallowing solids AND liquids hints at what conditions?
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Scleroderma or achelasia
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Types (2) of esophageal cancer
Which is associated with GERD, Barrett's? |
Squamous cell carcinoma (alcohol and smoking) and Adenocarcinoma (associated with GERD, Barrett's. Rising incidence in white males > 40yrs)
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3 causes of upper GI bleed
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Peptic ulcer disease, Esophageal varices, acute pancreatitis
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Etiology of peptic ulcer disease, symptoms.
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Caused by defect in mucosa (H. pylori, NSAIDs, smoking)
symptom: dyspepsia (classic burning pain) |
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Common cause of esophageal varices, treatment.
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Portal hypertension in cirrhotic patients, treated by variceal banding
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Which cause of upper GI bleeding has a very high mortality rate
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Acute Pancreatitis
30% of deaths within first week of presentation from multi-organ failure. |
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Probably an exam question!! Two main causes of Acute pancreatitis?
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Gal Stones, Alcohol
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Acute pancreatitis patients experience pain where?
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Epigastric and back pain
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Treatment of Acute Pancreatitis
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IV hydration, bowel rest, pain control
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Is pancreatic cancer a complication of acute or chronic pancreatitis?
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chronic pancreatitis
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Name three osmotic malabsorption conditions that cause diarrhea
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Celiac disease (mucosal)
lactose intolerance (enzymatic), bacterial overgrowth, parasite (infectious) |
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Crohn's, Cholera, E. Coli, Salmonella cause what?
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Secretory diarrhea
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Irritable Bowel Syndrome, Cathartic Laxatives, Hyperthyroidism are causes of what "flavor" of diarrhea?
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Altered motility
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what population is commonly lactose intolerant?
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Asians
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What is Celiac Sprue?
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a gluten sensitivity
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What tests would be used to detect Celiac disease?
What is the treatment? |
Tissue transglutaminase antibodies (IgA)
-IgA def. are very common so could give false negative Biopsy showing villous flattening Tx: gluten free diet, iron and vitamin supplements |
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This is the MOST COMMONLY DIAGNOSED GI condition
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IBS (up to 15% of population)
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This disease of the lower GI tract can occur after antibiotics (clinda), nosocomial infection, day care, immunocompromised state
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clostridium difficile colitis
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Treatment and avoidance of c. diff colitis
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avoid unnecessary antibiotic use, use metronidazole (Flagyl) or Vancomycin, pro-biotics, fecal transplants
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2 types of Inflammatory Bowel Disease and locations they occur
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1. Ulcerative Colitis (mucosal ulcers in COLON ONLY)
2. Crohn's disease (transmural ulcers ANYWHERE in GI tract) |
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What condition is increasing in incidence in industrialized nations? Why?
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inflammatory bowel disease (ulcerative colitis, crohn's) because of good sanitation and over reaction of immune system
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Which condition presents with bloody diarrhea and can effect the rectum?
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Ulcerative colitis
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This disease mimics acute appendicitis and DOES NOT effect rectum?
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Crohn's disease
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This disease shows a string sign on a barium swallow
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Crohn's disease
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What are the two types of colon polyps?
Which are benign and which are neoplastic |
1. Hyperplastic - benign, small smooth
2. Adenomatous - neoplastic, larger, villous |
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What is the ranking of colon cancer as far as most common, most fatal?
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#3 most common, #2 most fatal (after lung)
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Colon cancer is most dangerous when located where in the large intestine?
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right ascending (30%), harder to find/diagnose
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When should screening for colon cancer commence?
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50 yrs old, or 10 yrs earlier than a family member diagnosed.
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What is the largest solid organ?
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liver
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what is the blood supply for the liver?
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30% from hepatic artery (oxygen-rich)
70% from portal vein (nutrient-rich) |
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what is the portal triad?
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hepatic artery + portal vein + bile duct
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hepatocyte lifespan?
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120 days
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roles of the liver:
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metabolism, detoxification, storage, production of bile + clotting factors + cholesterol
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What are the markers of hepatocellular damage?
Which is specific for liver? |
AST, ALT
ALT predominately for the liver |
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What is Alkaline phosphatase a marker of?
What are other sources besides liver? When can it be elevated non-pathologivally? |
cholestatic or infiltrative liver disease
bone, placenta, kidney, intestine, WBCs 3rd trimester of pregnancy, adolescence |
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What is GGT used for?
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test ordered to confirm that elevation of alkaline phosphatase is from liver
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What are the True LFTs?
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Albumin, PT/INR, Cholesterol, Glucose, Total Bilirubin
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Will albumin be reduced in acute liver disease?
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No, only in cirrhosis
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What are causes for Albumin reduction?
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cirrhosis (not acute liver disease), enteropathy, chronic infection, malnutrition, nephrotic syndrome
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What is glucose used to assess?
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the synthetic capacity of the liver
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How does hyperbilirubinemia manifest?
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jaundice
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What conditions show unconjugated hyperbilirubinemia?
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Gilbert's syndrome, hemolysis, drugs, physiologic in newborns
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What conditions show conjugated hyperbilirubinemia?
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Hepatocellular disease, intrahepatic/extrahepatic cholestasis
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What is the hallmark of hepatocellular liver disease?
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elevated ALT and AST
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What are the guidelines for marked elevation, moderate elevation, and mild elevation of ALT and AST in hepatocellular liver disease?
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marked elevation: > 1000 IU
moderate elevation: 250-1000 IU mild elevation: < 250 IU |
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What are causes of SEVERE elevation of ALT and AST?
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drugs/toxins, ischemia, Budd-Chiari syndrome, acute viral infection, autoimmune hepatitis, primary graft failure, Wilson's disease
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What are causes of MODERATE elevation of ALT and AST?
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Viral (EBV, HSV), NSAIDs, Autoimmune hepatitis, Wilson's disease (less than 40 yrs old), alpha 1 antitrypsin deficiency
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What are causes of MILD elevation of ALT and AST?
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NAFLD and NASH, drugs, cholestasis, viral infection, alcohol, granulomatous liver disease, non-liver disease
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What are the characteristic LFTs for Alcoholic Liver Disease?
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AST > ALT
AST:ALT ratio is 2:1 AST < 300 and ALT < 150 |
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What is the hallmark in Cholestatic liver disease?
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increased Alkaline Phosphatase and bilirubin
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What is an extrahepatic cause of cholestatic liver disease?
What are intrahepatic causes of cholestatic liver disease? |
Extra:
Choledocolithiasis (presence of gal stone in common bile duct) Intra: drugs, primary billiary cirrhosis, Primary sclerosing cholangitis, total parenteral nutrition (IV nutrition) |
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What is Primary biliary cirrhosis? who does it affect more commonly? How is it diagnosed?
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Autoimmune destruction of intrahepatic bile ducts.
More common in females Dx: elevated alkaline phosphatase and +AMA (antimitochondrial antibodies) |
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What is Primary Sclerosing Cholangitis? who does it affect more commonly? How is it diagnosed?
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autoimmune destruction of medium and large bile ducts
more common in males Dx: elevated alkaline phosphatase, ERCP (imaging), liver biopsy |
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What are causes of Infiltrative liver disease?
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Sarcoidosis, TB, primary or metastatic cancer
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What has a 15-30 day incubation period; jaundice common; low fatality rate; lifelong immunity; fecal-oral transmission
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hep A
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What is elevated 3-4 weeks after HAV?
After 2 months? |
3-4 weeks: transaminases, IgM antibody levels
2 months: IgG (increases as host develops immunity) |
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How is HBV transmitted?
What is the % transmission with needle stick? |
via blood, 30%
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What percent of HBV infections are acute, what percent are subclinical?
What percent fully recover? percent fulminant hepatitis? percent persistant infection? |
35% acute, 65% subclinical.
90% full recovery, ~1% fulm. hepatitis, 10% persistent infection |
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what percent of the population has abnormal LFTs?
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~6%
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what is the sensitivity and specificity of LFTs?
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both LOW
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What LFT will be increased in infiltrative liver disease?
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alkaline phosphatase
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What are the 3 patterns of liver disease?
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Hepatocellular, Cholestatic, Infiltrative
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Normal serum level for AST, ALT
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<30-40 UI
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Alkaline phosphatase is a marker of what 2 patterns of liver disease?
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cholestatic and infiltrative
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What is the test of choice for evaluating the liver for increased AP?
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RUQ U/S
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What drugs can cause cholestatic liver disease?
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anabolic steroids
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The improvement of the PT by 30% in 24 hours can be accomplished with what?
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Vit K
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What are the clotting factors produced in the liver?
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II, V, VII, IX, X
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What is the #1 drug in acute liver failure?
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acetaminophen
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when would you opt for liver biopsy over observation?
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when ALT and AST are persistantly greater than two fold elevated
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people with Gilbert's syndrome will have an increase in what?
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conjugated bilirubin
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What would be the most likely cause for AST and ALT in the thousands?
a. Sepsis b. EtOH hepatitis c. Ischemic hepatitis d. HBV e. hypothyroidism |
c. Ischemic hepatitis
(other conditions could be: Budd-Chiari syndrome, Acute viral infection, autoimmune hepatitis, primary graft failure, Wilson's, tylenol OD) |
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yellow eyes, RUQ pain, drinks alcohol daily. AST: 203, ALT: 68
Most likely cause of LFT abnormality? |
alcoholic hepatitis
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a RUQ U/S reveals gallstones, a mildly dilated common bile duct and an obstructing gallstone in the distal portion of the duct. The next step in the management of the patient would be to do what?
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ERCP (endoscopic retrograde cholangiopancreatography) , uses a lighted, flexible endoscope to see and perform procedures like removal of stones
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patient admitted to ER after family members report altered mental status. Patient previously had complained of tooth ache. ALT and AST in the thousands.
Likely diagnosis? |
tylenol (acetaminophen OD)
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pt presents with history of obesity, type 2 DM, slightly increased ALT, AST in the hundreds, total cholesterol 290 (normal 160). pt. asymtomatic.
Likely diagnosis? |
fatty liver disease
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This disease has 2 billion people exposed worldwide, 400 million infected, 1 million deaths a year
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hep B
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Chances of hep B, hep C, and HIV from needle stick
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30% HBV, 3% HCV, 0.3% HIV
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What does the presence of Hep B sAg indicate?
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current infection with HBV
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What does the presence of Hep B sAb indicate?
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immunity to HBV
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What does the presence of Hep B core IgM indicate?
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recent infection with HBV
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What does the presence of Hep B core IgG indicate?
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remote infection with HBV
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What does the presence of Hep B eAg indicate?
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Actively replicating virus
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This bloodborne virus leads to chronic infection 75-85% of the time.
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Hep C
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Is there a vaccine for Hep C?
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nope
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Which viral hepatitis has shortest incubation?
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hep A (15-50 days)
hep B (30-160 days) hep C (14-160 days) |
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what does parenteral mean?
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piercing the skin or mucous membrane via the veins
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which viral hep has jaundice most commonly?
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hep A.
hep B (30%) hep C (rare) |
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how long does it take for cirrhosis to develop with HCV infection?
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20-30 years
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what does a test of HCV RNA + mean?
HCV RNA -? |
pt. chronically infected with HCV.
pt. cleared infection |
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T or F, the presence of HCV Ab indicates that the infection was cleared.
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False, Ab+ only indicates that the patient was infected with HCV, does NOT indicate immunity
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This iron deficiency disorder is known as "bronze diabetes" and is associated with a high risk of HCC
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Hemochromatosis
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Autoimmune hepatitis is more common in which sex?
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females 4:1
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This genetic disorder leads to accumulation of copper.
What is it and what is its distinct sign? |
Wilson's disease. Kayser-Fleischer rings
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Gold standard for dx of cirrhosis? next best thing?
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autopsy (1st)
then biopsy |
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Clubbing and Dupuytren's contracture are non specific signs of what liver condition?
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Cirrhosis
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Palmar erythema, spider angiomata, splenomegaly, gynecomastia are all signs of what condition?
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cirrhosis
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What is the most common complication of cirrhosis?
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ascites
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What is astericix?
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a diagnostic test for cirrhosis, person cannot help but let their hand fall
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What condition must be present for ascites to occur?
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portal hypertension
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Paracentesis is performed in ascites to determine what?
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If abdominal fluid is infected.
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What is the SAAG value for cirrhosis?
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>1.1 g/dl = cirrhosis
<1.1 g/dl = something else |
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This is the name of the condition where sinusoids are compressed leading to increased blood flow resistance
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Portal Hypertension
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What are the 3 locations that may have increased resistance leading to portal hypertension?
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prehepatic (portal vein thrombosis), intrahepatic (cirrhosis), & posthepatic (CHF, Budd Chiari)
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what are 4 complications of portal hypertension?
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esophageal varices, encephalopathy, coagulopathy, ascites
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What percent chance of getting HCC do cirrhotic patients have per year
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3%
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In which condition would ERCP come in handy for diagnosis and treatment? Primary biliary cirrhosis or primary sclerosing cholangitis?
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primary sclerosing cholangitis
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in this condition, a patient will present with elevated alk. phos., + AMA, history of pruritus, and is usually a woman.
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Primary biliary sclerosis
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how many lobes does the liver have?
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4.
left, right, quadrate and caudate |
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what are the 3 major stages of alcoholic liver disease?
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fatty liver, alcoholic hepatitis, alcoholic fibrosis/cirrhosis
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What is the drink equivalent of 12 oz of beer for liquor and wine?
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12 oz beer = 1 1/2 oz liquor = 5 oz wine
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This condition is seen in 90% of heavy drinkers
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Alcoholic fatty liver
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How to you treat alcoholic liver disease?
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abstinence.
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Mallory bodies can be seen in what liver condition?
|
alcoholic hepatitis
though they are not specific for this condition |
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This condition affects 3/4 of obese individuals (about 20% population) and and is the MOST COMMON cause of abnormal LFTs
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Non Alcoholic Fatty Liver Disease
NAFLD |
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NAFLD leads to what condition before progressing to cirrhosis?
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NASH (non alcoholic steatohepatitis)
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what is the most commonly overdosed medication?
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tylenol
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max dose of tylenol in adults?
minimal toxic dose? |
4g/day
7.5-10 g/day |
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max dose of tylenol in individuals who drink often or have preexisting liver disease?
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2g/day
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what causes the toxicity in tylenol OD?
|
NAPQI buildup
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treatment of tylenol OD
Antidote |
charcoal to decontaminate GI
antidote: N-Acetyl cystein |
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what is the definition of fulminant liver disease?
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severe acute liver injury with impaired synthetic function and encephalopathy in a patient with a previously normal liver
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How is blood pressure regulated in the glomerulus?
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by having arterioles on both sides of the capillaries
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what are the treatment goals for treating chronic kidney disease?
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relieve obstruction, lower blood pressure and glucose, treat infection and alter immune response (steroids, alkylating agents, calcineurin inhibitor)
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What is the best overall kidney function measure?
|
GFR
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The formula for calculating ideal GFR takes in to consideration what factors?
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age, sex, and body size
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what is the ideal GFR for men, for women?
|
men: 130 ml/min/1.73 m^2
women: 120 ml/min/1.73 m^2 |
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at what rate does GFR decline after age 40?
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1 ml/min/1.73m2/year
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Does blood pressure rise with age?
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only in salt consuming societies
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this is roughly proportional to 1/GFR
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serum creatinine
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what is the current standard for measuring GFR?
What is the gold standard? |
current standard: creatinine based estimating equation (MDRD, CKD-EPI)
gold standard: inulin infusion and clearance |
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Is GFR over or under estimated with low muscle mass?
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over estimated.
Serum creatinine will be low in people with low muscle mass because it is a product of muscle breakdown. |
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What defines chronicity with kidney disease?
|
presence for at least 3 months and at least ONE of these criteria:
eGFR < 60 ml/min/1.73 m2 or abnormal structure (image or biopsy) or functional evidence of kidney damage (proteinuria, hematuria) |
|
|
What does an increased GFR (> 90 ) indicate?
|
stage 1 chronic kidney disease
|
|
|
What GFR range is characteristic of stage 4 severe chronic kidney disease?
|
GFR 15-29
|
|
|
What GFR range is characteristic of kidney failure?
|
<15 or dialysis
|
|
|
Morality from chronic kidney disease usually occurs after what stage?
|
stage 3
|
|
|
True or false, most people under stage 4 chronic kidney disease are unaware of their condition.
|
True
|
|
|
True or false, dialysis in a nursing home setting has shown to improve chances for survival
|
false, dialyzed patients in nursing homes usually fair worse
|
|
|
What are causes for hematuria and proteinuria other than kidney disease?
|
vigorous excercise, orthostatic proteinuria, can come from below the kidneys (ureter, etc), can be from kidney malignancy
|
|
|
Does Chronic Kidney Disease mean inevitable kidney failure?
|
No. some kidney diseases remit spontaneously.
treatment can stop or slow disease progression |
|
|
individuals with chronic kidney disease often die of what condition before reaching kidney failure?
|
cardiovascular disease
|
|
|
controlling _____ is critical to slow kidney disease progression
|
blood pressure
|
|
|
what is a good blood pressure goal?
|
< 140/90
or 130/ in proteinuric kidney disease |
|
|
What is a good blood pressure goal for home monitoring?
|
135/85
|
|
|
ACE inhibitors and angiotensin receptor blockers are used to treat what condition?
|
high blood pressure
|
|
|
encephalopathy, pericarditis and pleuritis, intractable hyperkalemia, metabolic acidosis, and volume overload would be tell tale signs that what therapy should be started?
|
dialysis
|
|
|
many patients that begin dialysis have a GFR of what range?
|
5-10
|
|
|
what are the two types of dialysis?
|
peritoneal and hemodialysis
|
|
|
is the solution pumped into the peritoneal cavity for dialysis hypertonic or hypotonic?
|
hypertonic. Want to draw out fluids (filter)
|
|
|
what two machines can be used for peritoneal dialysis?
|
CAPD for daytime use, or CCPD for nightime
|
|
|
what are the 3 means of achieving hemodialysis?
|
shunt, fistula, indwelling catheter
|
|
|
what is the most popular treatment for kidney failure?
|
hemodialysis in-center (3 times a week or nocturnal)
|
|
|
what kidney conditions would antibiotic prophylaxis be desirable?
|
New AVF, Synthetic or bovine kidney graft, hemodialysis catheter, anticipated high grade bacteremia, peritoneal dialysis catheter
|
|
|
would it be necessary to premedicate someone with antibiotics if they had a kidney transplant?
|
no
|
|
|
would it be necessary to premedicate someone with antibiotics if they had a peritoneal catheter?
|
yes
|
|
|
what is the interval adjustment for amoxicillin in patients with a decreased GFR?
10-50 GFR: <10 GFR: what is the interval adjustment for cephalexin in patients with a decreased GFR? |
azithro:
10-50 GFR: q8-12 <10 GFR: q24 cephalexin give q12 if GFR <50 |
|
|
what drug regiments are not adjusted in decreased GFR?
|
clinda and azithro
|
|
|
what is the dose adjustment for clarithro for a decreased GFR?
|
10-50 GFR: 75%
<10 GFR: 50% |
|
|
what should NOT be used in pain control for kidney failure/dialysis patients? what is a good alternative?
|
Do NOT use Meperidine (demerol)
hydromorphone (dilaudid) is safer |
|
|
when should dental work be performed on a patient undergoing hemodialysis?
why? |
on non-HD days because of heparin use
|
|
|
as a side effect, these drugs can increase blood pressure in women
|
oral contraceptives
|
|
|
what are the criteria for diagnosing hypertension in pregnant patients?
|
increase in systolic of 30 mmHg or diastolic 15 mmHg compared to average before 20 wks.
or > or = 140/90 mmHg if BP previously unknown |
|
|
What constitutes preeclampsia-eclampsia?
|
it is a classification of HTN in pregnant women.
proteinuria with or without edema after 20wks pregnant. medical emergency, occurs most commonly with 1st pregnancy |
|
|
What constitutes normal BP, prehypertension, stage I hypertension, and stage II hypertension?
|
normal: 120/80
pre: 120-139/80-89 stage 1: 140-159/90-99 stage 2: 160+/100+ |
|
|
when should followup to check BP happen with a stage 1 hypertensive patient?
with a prehypertensive patient? |
2 months stage 1
1 year prehypertensive |
|
|
compression stockings may be helpful to treat what condition?
|
postural hypotension
|
|
|
what should be avoided 30 minutes before blood pressure reading?
|
tobacco and caffeine
|
|
|
how to take blood pressure?
|
inflate cuff and palpate to find occlusion pressure. while listening inflate to 20 mmHg above occlusion pressure. SBP is the first sound upon pressure release, DBP is the disappearance of sound.
|
|
|
what 4 lifestyle modifications can help to lower high blood pressure?
|
1. weight reduction - 5-20 mmHg/10 kg
2. DASH eating plan - low in sat fat, cholesterol, total fat 3. sodium reduction 4. physical activity |
|
|
true or false, hypertension is silent
|
true
|
|
|
what is the serial sevens test? what is it checking for?
|
starting from 100, have patient count down by 7s about 5 times.
tests for attention, mental status |
|
|
how would you test recent memory? remote memory?
|
recent memory, tell them 3 words, ask them to recall later
remote memory: with the help of family member, or historical events |
|
|
types of aphasia, parts of brain affected, characteristics.
|
receptive: wernicke's, temporal lobe, fluent but jibberish, wont follow commands
expressive: broca's, frontal lobe, broken speach, comprehension intact, repitition difficult global: aspects of both (most common) |
|
|
what is gnosis, neglect?
|
non-dominant hemisphere lesions cause neglect on contralateral side
|
|
|
clock drawing test is a measure of function of what lobe?
|
frontal
|
|
|
people with frontal lobe lesions will express what "Frontal release" signs?
|
grasp, paratoniam (resist), glabbelar (cant stop blinking upon head tap), palmomental (twitch of chin when stroking palm), visual suck
|
|
|
what is an example of expressive aphasia?
|
broca's
|
|
|
what is an example of receptive aphasia
|
wernicke's
|
|
|
this cranial nerve may be affected in parkinson's or the presence of frontal masses
|
olfactory CN I
|
|
|
pleasant smells should be used when testing CN I because noxious smells will often stimulate what nerve?
|
trigeminal
|
|
|
Monocular defects indicate that the lesion is where?
|
anterior to the optic chiasm
|
|
|
what two eye muscles are not controlled by CN III?
|
superior oblique (trochlear IV) and lateral rectus (abducens VI)
|
|
|
What CN is affected if eyes deviate down and out?
|
oculomotor
|
|
|
what CN is affected if eyes deviate down and in?
|
trochlear
|
|
|
where will the eye deviate in a patient with a deficit in CN VI?
|
inward
|
|
|
where is the lesion if a patient complains of hyperacusis in one ear?
|
ipselateral facial nerve lesion
|
|
|
a deficit in this nerve can cause vertigo and nystagmus (eye twitching)
|
CN VIII vestibulocochlear
|
|
|
how would you test for a deficit in CN XI?
|
shoulder shrug test, head turn
|
|
|
if the tongue deviates to the right during protrusion, where is the lesion?
|
right hypoglossal nerve (XII)
|
|
|
COWS means what? tests what?
|
cold opposite, warm same. refers to nystagmus direction upon stimulation with water on ear.
used to test brain stem reflex |
|
|
hypotonia, atrophy and fasciculations indicates a deficit in what group of motor neurons?
|
lower motor neurons
|
|
|
spasticity and lack of muscle atrophy indicates a deficit of what motor neurons?
|
upper motor neurons
|
|
|
a positive babinski sign indicates what?
|
an upper motor neuron lesion
|
|
|
dorsal column pathways cross where?
|
in the medulla
|
|
|
spinothalamic pathways cross where?
|
in the spinal cord
|
|
|
the romberg test assesses what?
|
dorsal column pathways (sensory)
|
|
|
what may be the underlying cause of "thunderclap" headache?
|
ruptured aneurysm
|
|
|
what may be the underlying cause of headache upon awakening?
|
mass lesion
|
|
|
what may be the underlying cause of neck rigidity?
|
meningeal irritation
|
|
|
the red flag sign of having headaches over the age of 50 can commonly indicate what condition?
|
temporal arteritis
|
|
|
this is the most common headache type?
|
tension headache
|
|
|
Do tension headaches have a pulsatile component? an auro involved?
|
no. no aura either.
|
|
|
who has migraines more often, men or women?
|
women (18%) men (6%)
|
|
|
what type of headache do patients commonly report a pain scale of "8/10"?
|
migraine
|
|
|
are migraines unilateral or bilateral? pulsing or non? aura or no?
|
unilateral, pulsing, can occur with out without aura
|
|
|
What is a hemiplagic migraine?
|
a migraine with an aura INCLUDES motor weakness
|
|
|
what gender more commonly has cluster headaches?
|
men 4:1
|
|
|
what is the classic patient for cluster headaches?
|
male, 40s, heavy drinker, smoker
|
|
|
what branches of trigeminal most commonly exhibit trigeminal neuralgia?
|
V2 and V3
V1 rare |
|
|
treatment of trigeminal neuralgia
|
anti-epileptics, muscle relaxants, surgery
|
|
|
what are the 5 types of movement disorders?
|
tremor, chorea, myoclonus, dystonia, tics
|
|
|
this type of movement disorder exhibits rhythmic, oscillatory movements across a fixed axis
|
tremor
|
|
|
this type of movement disorder exhibits random, irregular, jerky movements
|
chorea
|
|
|
this type of movement disorder exhibits rapid, jerk like movement
|
myoclonus
|
|
|
this type of movement disorder exhibits sustained contractions
|
dystonia
|
|
|
this type of movement disorder exhibits "semi-voluntary" stereotyped actions
|
tics
|
|
|
this is a disorder resulting in involuntary, repetitive body movements and frequently appears after high dose, or long term use of antipsychotics
|
tardive dyskinesia
|
|
|
What is the most common movement disorder?
|
essential tremor (10% prevalence over 40)
|
|
|
what movement disorder will improve with alcohol use?
|
essential tremor
|
|
|
what 2 drugs are used to treat essential tremors?
|
beta blockers, primidone
|
|
|
this common disorder (1% of population) experiences motor and vocal tics
|
tourette's
|
|
|
what is coprolalia?
|
tourette's vocal tic expressing profanities
|
|
|
what is echolalia?
|
a vocal tic when a person echos ones own or someone elses words, seen in tourettes
|
|
|
what involuntary movement condition is one of the few that persist in sleep?
|
palatal myoclonus
|
|
|
what is the etiology of hemifacial spasms?
what is an effective treatment? |
idiopathic, or vascular compression, mass, or demylinating lesion (MS) of the facial nerve.
treated with botulinum toxin |
|
|
which brain waves represent stage 1, 2, and 3 of normal sleep?
|
stage 1. (alpha) 5% of sleep
stage 2. (theta) 50% of sleep stage 3. (delta) 20 % of sleep |
|
|
this is the stage of sleep in which dreams occur. how much of our sleep does it constitute?
|
REM stage. 25%
|
|
|
what are the three methods to measure sleep?
|
Electroencephalogram (EEG)
-measures electrical changes in the brain Electrooculogram -measures voltage changes as eyes rotate Electromyography -measures muscle activity and chin relaxation |
|
|
what is the definition of sleep apnea?
|
condition characterized by repetitive episodes of upper airway obstruction in which the person stops breathing for 10 or more seconds
|
|
|
what is the difference between apnea and hypopnea?
|
apnea - decreased airflow of more than 80% for at least 10 seconds with 4% oxygen desaturation
hypopnea - decreased airflow of atleast 30% for at least 10 seconds with 4% oxygen desaturation |
|
|
how is the apnea hypopnea index calculated?
|
apneas + hypopneas divided by hours of sleep
|
|
|
how is the respiratory disturbance index calculated?
|
apneas + hypopneas + RERAs per hour of sleep
|
|
|
how is the Obstructive Sleep Apnea Index calculated?
|
number of respiratory events per hour
|
|
|
How do you diagnose sleep apnea?
|
overnight sleep study or polysomnography
|
|
|
what are common complaints of those who suffer from sleep apnea?
|
excessive daytime sleepiness, loud snoring, witnessed apnea episodes
|
|
|
true or false, people who experience sleep apnea have an increased risk of HTN, cardiovascular disease, and erectile dysfunction.
|
true
|
|
|
large overbite/overjet, narrow maxillary arch, large tongue, large tonsils, extensive missing teeth, palatal or lingual tori, long soft palate all can by anatomical predisposers to what?
|
airway obstruction, sleep apnea
|
|
|
treatment modalities of sleep apnea
|
CPAP - continuous positive air pressure
Surgical - anatomical resection Oral appliances |
|
|
how do oral appliances work to treat sleep apnea?
|
increase the airway size by preventing soft palate collapse
|
|
|
what are indications for oral appliance therapy for sleep apnea?
|
intolerance to CPAP, snoring, mild-moderate apnea
|
|
|
what are common side effects of oral appliance therapy for sleep apnea?
|
excessive salivation, teeth discomfort, TMJ discomfort, change in occlusion, neck pain, headaches
|
|
|
two mechanisms of action for oral appliance therapy for sleep apnea
|
mandibular repositioning device, tongue retaining device
|
|
|
Is TMD pain usually uni or bilateral?
|
unilateral
|
|
|
A patient describing "deep pain" behind the eyes could be suffering from what?
|
TMD
|
|
|
a sharp jabbing pain in the ear, stuffiness and tinnitis could be indicative of what condition?
|
TMD
|
|
|
what is the definition of disk displacement with reduction?
|
disc still is capable of "reducing" to its original position atop of the condyle after being displaced. clicking sound is present.
|
|
|
where does the mandible deviate in cases of displacement with OR without reduction?
|
towards the side of displacement
|
|
|
What is another name for disc displacement without reduction?
|
closed lock
|
|
|
dislocation or subluxation of the jaw is called what?
|
open lock
|
|
|
inflammatory and degenerative disorders affecting the TMJ
|
capsulitis, retrodiscitis, osteoarthrosis, osteoarthritis
|
|
|
which occurs with inflammation? osteoarthrosis or osteoarthritis?
|
osteoarthrosis
|
|
|
what is the fibrous ankylosis and bony ankylosis?
|
fibrous ankylosis has limited jaw opening, bony ankylosis has NO movement
|
|
|
what side does the mandible shift to in a myalgia TMD?
|
to the contralateral side
|
|
|
what is a common area of myofacial pain in TMD patients?
|
the upper molar region
|
|
|
what is the difference between deviation and deflection when observing for TMJ disorders?
|
deviation is when the mandible moves to the side upon opening but ends up in the center.
deflection is when the mandible moves out of the sagital plane during the entire opening motion and ends up lateral |
|
|
which muscle of mastication is very difficult to asses by palpation?
|
lateral pterygoid
|
|
|
true or false, management of TMD can be accomplished by the denist alone.
|
false, it is multifaceted.
|
|
|
what muscles of mastication are intimately related to the left-right balance of the mandible upon tooth closure?
|
medial pterygoids
|
|
|
why would eye pain occur with TMD?
|
a referred pain from other muscular sites, possibly entrapment of greater occipital nerve at occiput level.
|
|
|
true or false. Denists are qualified to diagnose obstructive sleep apnea
|
false, must be diagnosed by physician
|
|
|
what consistutes a normal Obstructive sleep apnea index? a mild, moderate, and severe index?
|
normal = 0-5 respiratory events per hour
mild: 5-15 mod: 15-30 severe: >30 |
