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46 Cards in this Set

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Management of exercise-induced (asthma/bronchospasm)
if severe, use prophylactic inhaled beta-2 agonist (eg albuterol) 5-10min before exercise
results of methacholine challenge testing in exercise-induced asthma
equivocal -- exercise-induced asthma not necessarily correlated with allergic asthma
classic presentation of interstitial lung disease
crackles, clubbing, chest radiograph changes
causes of interstitial lung disease
pneumoconiosis (from occupational exposures to dust, asbestos, coal mining, etc.); hypersensitivity pneumonitis (from birds, molds, etc.); medications (eg cytotoxic drugs, abx, antiarrythmics)
defn and mgmt of mild intermittent vs mild persistent asthma
mild intermittent: <= 2 days of sx/wk, <= 2 nocturnal events / month; both treated with albuterol prn, mild persistent also tx with corticosteroid
use of ipratropium bromide in asthma control
only for acute exacerbation in emergency situation; not useful for longterm management
what to do in moderate persistent asthma if steroids are not sufficient?
add long-acting beta agonist
does myesthenia gravis better or worsen as the day progresses?
worsens (unlike lambert eaton)
vocal cord dysfunction vs asthma
difficult to distinguish; vocal cord dysfunction: not responsive to asthma tx, nl spirometry, no nocturnal sx, difficulty with INSPIRATION > EXPIRATION; Tx of vocal cord dysfunction: speech therapy
DOE with nocturnal cough suggestive of what etiology
heart failure
why don’t you always hear rales with chronic heart failure?
dilation of pulmonary lymphatics ==> no pulmonary edema at baseline
what test to rule out heart failure?
BNP: if < 100, HF unlikely
carotid upstrokes in MR vs PDA
brisk in PDA (increased stroke volume); not brisk in MR b/c decreased forward flow
changes to pulse pressure with PDA
widened b/c of diastolic runoff into pulmonary artery
risk factors for stroke in pt with afib
hx of stroke, hx of MI, hx of HTN, age > 65, DM, LAE, LV dysfunction
tx of afib
warfarin + betablocker/amiodarone
pathophys and tx of peripartum cardiomyopathy
in 3rd trimester, increased volume load --> failure (pulm edema, SOB, tachy); tx with delivery (vaginal if possible), no ARB/ACEi (teratogenic)
risk factors for peripartum cardiomyopathy
black women, multi gestations/parity, >30yo, hx
characteristics of mitral stenosis
1) opening snap; 2) diastolic rumble; 3) pre-systolic accentuation (atrial kick)
easy way to tell if pulmonary hypertension is 2/2 ASD or VSD
how to prevent influenza in a high risk pt?
vaccination + amantadine/rimantadine x 2wk (only bc high risk) for Influenza A, oseltamivir for Influ A and B
prophy for influenza B
only tx proven to prolong life in hypoxemic COPD pts
O2 (also smoking cessation, lung-volume-reduction surgery)
nasal O2 prescribed at what PaO2?
<55, or if cor pulmonale, < 60
what causes morning headaches in COPD?
CO2 retention
indications for pulmonary rehabilitation
pts with chronic resp impairment who are dyspneic despite optimal medical management
tx of acute COPD exacerbation
bronchodilators (eg albuterol -- not most effective, but v few s/e)
effectiveness of influenza vax in preventing hospitalization of elderly for PNA / influenza
good! 30-70%
how often does elderly person at risk need to get vax for influenza/pneumococcus?
influenza: yearly; pneumococcus: once
what kind of surgeries pose greatest risk to COPD pts?
upper abdominal / thoracic surgeries
reasons to use ACEi or ARB in hypertension
1) DM; 2) renal failure (elev Cre) -- also beta-blockers; 3)
target BP in diabetics with HTN
what is characteristic of BP in hyperthyroidism?
elevated SYSTOLIC ONLY (nl diastolic)
lifestyle changes that decrease blood pressure
AEROBIC EXERCISE, also weight loss (1kg --> 1mmHg), reduced salt intake, decreased alcohol / smoking
hypertension at young age with hypokalemia
look for hyperaldosteronism by measuring serum renin:aldo ratio; alt: herbal supplements, black licorice, beta agonist inhaler
obstructive sleep apnea a/w what chronic condition?
hypertension (independent of obesity)
tx of gestational hypertension
methyldopa -- doesn't decrease risk of preeclampsia, but also does not affect neonatal outcomes
Cr changes after initiation of ACEi
slight elevation common after BP normalized (kidneys adjusting to lowered renal perfusion pressure); still, need to be vigilant due to potential occult bilateral RAS (usu see >20% inc in Cre)
antihypertension efficacy in african americans
beta blockers, ACEi, and ARBs LESS EFFECTIVE; thiazides, CCBs MORE effective (only when considering monotherapy -- no racial difference with combo therapy)
what to look for if suspect glomerulnephritis?
1) urine microscopy -- look for RBC casts and dysmorphic RBCs; 2) Serum Cre
how to approximate 24hr protein excretion?
spot urinary protein:creatinine ratio
use of alpha-blockers in hypertension
usually not a good idea -- shown by ALLHAT trial to increase risk of cardiovascular events, especially CHF
normal plasma aldo values
<10 ng/dL
plasma aldo:renin ratio in primary hyperaldosteronism
classic sites of cerebral hypertensive hemorrhages
basal ganglia, thalamus/internal capsule, pons, cerebellum
location of cerebral hypertensive hemorrhage vs amyloid angiopathy
amyloid angiopathy usu closer to cortex; hypertensive in BG, thalamus, internal capsule, pons, cerebellum