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138 Cards in this Set

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Name the K sparing diuretics
Spironalactone
Amiloride
Triametrine
what's another name for reactive airway disease
Asthma
What is the principal Tx for asthma
inhaled cortico-steroids-anti-inflammatory

Others:
β2-adrenergic receptor-albuterol(relaxes smooth muscle)
Anticholinergics
Leukotrienne inhibitors-adjunct
Theophylline-bronchodilator; used as adjunct(increases diaphragmatic contractility)
Describe the classifications of asthma
Mild intermittent: Sx <2 x wk; FEV or PEF >80%

Mild persistent: Sx > 2 x wk; FEV or PEF >80%

Moderate persistet: Daily Sx; exacerbations affect activity; FEV or PEF >60,<80

Severe persistent: Continual Sx; limited physical activity; FEV or PEF < 60%
What is the role of spirometry?
Provides a means for measureing FVC, FEV, PEF, tidal volume, ERV, and IRC
what is the difference between COPD and Emphysema?
Emphysema results in cystic, anatomical changes in the lung
What are the two causes of emphysema?
Smoking
Alpha 1,antitrypsin deficiency.
How do you Dx chronic bronchitis?
H/O chronic productive cough of more than 3 months duration for 2 consecutive years
what is the mainstay treatment of COPD?
Beta Adrenergic Agonist
Name an example of a leukotriene inhibitor
singulair
Name the 2 groups of community-acquired pneumonia
Typical:
S pneumoniae (pneumococcus)
Haemophilus
Staphylococcus

Atypical:
Legionella
Mycoplasma
Chlamydia
What causes interstitial pneumonitis?
Viral etiologies:
CMV
Varicella
Influenza
PCP

In contrast to people with interstitial lung disease which is not mediated by viral infection
What causes interstitial lung disease?
sarcoidosis
pneumoconiosis
silicosis
hypersensitivity
Good Pasteur syndrome
SLE
Polyarteritis nodosa
What is the most common cause of a transudative pleural effusion?
CHF

Other causes:
Renal failure
Nephrosis
Liver failure
Malignancy
What are the conditions that produce exudative pleural effusions?
Infections
Pulmonary infarctions
Malignancies
Rheumatoid arthritis
Lupus
What are the values of
Normal
Prehypertensive
stage I hyper
stage II hyper
normal: < 120, <80
Prehyper: 120-139 80-89
stage I: 140-159 90-99
stage II: > 160, > 100
What is malignant hypertension?
Sudden elevation of BP:
Diastolic BP >120
Papilledema
Can lead to renal damage(>BUN, SrCr, Met Acidosis, proteinuria are evidence)
what are the risk factors for essential hypertension?
Family history
Race
Age
Diabetes
Which life-style factors contribute to hypertension?
High sodium diet
Obesity
Sedentary lifestyle
Alcohol
Oral contraceptives
Stress
what is the BP goal for patients with renal disease or diabetes?
130/80 mm/Hg
What are the causes of Secondary hypertension
Pheo
Sleep Apnea
Fibromuscular hyperplasia
Renal artery stenosis
Claudication is a symptom of this disease
PVD
Name some statins (or HMG-CoA reductase inhibitors)
Atorvastatin- Lipitor
Simvastatin- Zocor
Rosuvastatin- Crestor
What is the MOA of CCBs?
blocks calcium channels in the heart and blood vessels leading to less contraction.

Results in:
< total peripheral resistance
< cardiac output
What is the MOA of alpha blockers?
They reduce the effect of the sympathetic nervous system on the vascular smooth muscle tone of the vessels that regulate PVR
What is the MOA of BBs?
Decrease:
Heart Rate
Cardic output
Renin release
What is the MOA of ACEI?
Block conversion of angi I to II
Inhibit degradation of bradykinin
What is the mainstay therapy for asthma?
Inhaled corticosteroids
a sudden fall in blood pressure that occurs when a person assumes a standing position
orthostatic hypotension
an inspiratory reduction in systolic pressure >10 mmHg
Pulsus paradoxus

Can happen with COPD, Asthma, Cardiac tamponade, pericardial effusion
Finding bullae in a Xray suggest?
Emphysema
inhibition of respiratory function while lying down flat because of pulmonary fluid accumulation in the lungs.
orthopnea
difficulty breathing after a person has fallen asleep; common with CHF
PND commonly occurs several hours after a person with CHF has fallen asleep
What causes PND?
caused by increasing amounts of fluid entering the lung during sleep and filling the alveoli

conditions affecting the left ventricle, mitral stenosis, aortic insufficiency, and systemic hypertension.
What should you monitor with Statins?
LFTs
What is the MOA of Zetia?
Inhibits fat absorption
Progressive hypertrophy and dilation of both ventricles
Dilated Cardiomyopathy
What are the causes of Dilated cardiomyopathy
Alcohol
Myocarditis
Cocaine

This is the most common CM
cardiomyopathy assoc. with athletes and sudden death; it is genetic
Hypertrophic cardiomyopathy
What is cardiomyopathy?
is the deterioration of the function of the myocardium for any reason
What are some diseases that can cause restrictive cardiomyopathy
Hemochromocytosis
Amyloidosis-multiple myeloma
Sarcoidosis
What is the triad for Lofgren syndrome (a subtype of sarcoidosis)
Bilat hilar lymphadenopathy
Erythema nodosum
Arthralgia
pericarditis weeks after an MI
Dressler's syndrome
What is Beck's triad?
Hypotension
JVD
Muffled heart sounds

Seen in Cardiac tamponade
This longitudinal study identified risk factors for CHD
Framingham study
chest pain due to spasms of the coronary arteries
Prinsmetal's angina
What types of people can have silent Myocardial ischemia?
DM pts with autonomic neuropathy, or pts with defects in pain threshold or transmission
When does Prinzmetal's angina take place?
usually at rest and nocturnally
What are the indications for using ACEI
HTN
CHF
DM
Why use Beta-blockers in ACS
First line in relieving chest pain, reduces infarct size and left ventricular stress

Benefit:
Decreases myocardial oxygen demand
Name the serum markers for acute MI
Troponin- within 3 hrs/3-4 days
Creatine Kinase MB- 4-8 hrs/2-3 days
Myoglobin- within 1hr/NOT cardiac specific

Other markers used:
CRP-inflammatory
BNP- released in response to vent dilation and press.overload
LDH
AST
Causes of unstable angina
Cocaine use
Infection
Anemia
Post MI
Right sided HF manifestations
JVD
Edema
Hepatomegaly
Ascites
Pulm Edema(crackel/rales)
Left-sided HF manifestations
Angina
SOB
Tachycardia
Diaphoresis
Fatigue
Acute pulmonary edema
MC reason for R-sided HF
L-sided HF
MCC of myocarditis
Viral infections
A general enlargement of the endocardium
Cardiomyopathy
What causes pericarditis?
Viral etiologies
Autoimmune
Drugs
Cocaine
Difference between TIA and RIND
TIA- resolves within 24 hrs
RIND- resolves in 48-72 hrs
Name the Non-selective BBs
Propanolol
Nadolol
Pindolol
Carvedilol
Labetalol
Name the BBs with ISA
Pindolol
Acetabutolol
What is the MOA of BBs
Reduce cardiac output by:
<HR
<Contractility
Blocking BB receptors at the JGA, < renin release
What is the MOA of CCBs
Decrease muscle contraction
Decreases TPR
Slows AV conduction(used for arrythmias)
What are the indications for ACE-I
CHF
HTN
MI
Diabetic nephropathy
MOA of ACE-Inhibitors
Block conversion of Angio I to Angio II
MOA of ARBs
Blocks Angio II which leads to decrease in afterload and preload
Name some ARBs
Losartan
Valsartan
MOA of Alpha 1 blockers
Vessel dilator
Name some Alpha 1 blockers
Prazosin
Doxazosin
Terazosin
Name some Alpha 2 blockers
Clonidine
Methyldopa

Good for pregnancy
What is the MOA of Alpha 2 blockers
Reduces the release of Norepi at the nerve terminals
Which antihypertensive drugs do you avoid with pregnancy?
ACE-I
ARBs
Small cell lung CA is assoc. with which types of paraneoplastic syndromes?
SIADH
Cushing's
Eaton-Lambert syndrome
Hypercalcemia
DIC
Endocarditis
Migratory Thrombophlebitis(Trousseau's syndrome)
Name the 4 types of bronchogenic Carcinomas
Small cell- most severe
Squamous cell- assoc. with smoking
Adenocarcinoma-Most Common type
Large cell-
What is the treatment of SCLC
Combination therapy:
Chemo
Radiation
Treatment for NSCLC
Surgery, chemo, radiation
What makes up the Ghon's complex
Combination of the primary lung lesion and lymph node granulomas
MCC of exudative pleural effusion
Pneumonia
MCC of transudative pleural effusion
CHF
Renal Failure
Cirrhosis
What is a hydrothorax
accumulation of serous transudate in the pleural cavity

MCC is CHF
What is a Chylothorax
effusion of lymph in the thoracic cavity
What is the MCC of pleural effusion in the fetus or neonate?
Chylothorax, from congenital defects in the thoracic duct or lymph channels
Name 3 things you can use to measure airway responsiveness(inhalation challenge tests)
Methacholine (cholinergic agonist)
Histamine
Cold air
Name 2 mast cell stabilizers
Chromolyn sodium (Intal)- used for prevention; DOC in kids

Nedocromil sodium (Tilade)
Describe the Pink Puffers (Emphysema patients)
"Fighters" These patients have loss of ventilation and perfusion area in the lung. They can overventilate and maintain relatively normal blood gases
Describe "Blue Bloaters" (Chronic Bronchitis pts)
"Non-fighters" These patients have excessive bronchial secretions and obstruction that causes mismatched ventilation. Overventilation does not help and they become hypoxic and cyanotic
The amount of air that can be forcibly exhaled after maximal inspiration is called?
FVC- Forced Vital Capacity
What is the mainstay Tx of COPD?
Inhaled B2 agonist
Name examples of Interstitial lung Diseases
Sarcoidosis
Occupational lung Dz
Hypersinsitivity pneumonitis
Lung Dz caused by toxic drugs and radiation
Why are interstitial lung diseases classified as fibrotic or restrictive?
Because they result in a stiff and noncompliant lung
Name the 2 MC interstitial lung diseases
Exposure to occupational and environmental inhalants

Sarcoidosis
List examples of occupational hazards that cause interstitial lung disease
Inorganic dust:
Asbestosis
Slicosis- inhaled silica dust
Coal miner's pneumoconiosis

Organic dust:
Hypersensitivity pneumonitis

Gases:
Ammonia
Phosgene
Sulfur dioxide
List examples of drugs and therapeutic agents that cause interstitial lung disease
Cancer chemo drugs:
Busulfan
Bleomycin
Methotrexate

Ionizing radiation
List immunologic lung disease examples that cause interstitial lung disease
Sarcoidosis
Collagen vascular diseases:
SLE
Rheumatoid arthritis
Scleroderma
Dermatomyositis-polymyositis
What is sarcoidosis?
A multisystem granulomatous disorder that primarily affects the lungs and lymphatic systems

Primarily adults younger than 40
These diseases affect the supporting collagen and elastic tissues that lie between the airways and blood vessels
Interstitial lung diseases
What 3 systems are most commonly affected by sarcoidosis?
Lungs- interstitial Dz
Skin-granulomatous lesions
Eyes- chorioretinitis
What causes obstructive airway disorders?
Disorders that limit expiratory airflow:

Asthma
COPD
Bronchiectasis
Describe restrictive airway disorders
conditions which cause a reduction in the functional volume of the lungs:

Interstitial lung Dz
Lung CA
Pleural effusion
Kyphosis
What test is useful in diagnosing CHF
BNP: B-type natriuretic peptide
MC cardiomyopathy
Dilated

Symptoms:
Pulmonary congestion
DOE, PND, Orthopnea
This cardiomyopathy results in impaired diastolic filling and may be caused by amyloidosis, radiation, fibrosis, or s/p heart surgery
Restrictive cardiomyopathy
Name some risk factors for endocarditis
Valvular disease
prosthetic heart valves
IV drug abuse
MCC of acute endocarditis
Staph Aureus- affects tricuspid valve
MCC of Subacute endocarditis
Streptococcus viridans- assoc. with dental procedures
MCC of Chronic endocarditis
Legionella
Brucella
This disease involves the formations of vegetative lesions on the endocardial surface
Infective endocarditis
What is the most definitive diagnostic procedure for endocarditis?
Blood culture: At least 6 blood cultures should be obtained
What criteria can be used to diagnose infective endocarditis
The Duke Criteria:

Two major or
One major and three minor
MCC of Bacterial Endocarditis
Streptococci (75%)
Staph. Aureus (25%)
What is Kussmaul sign?
Can be found in cardiac tamponade; it is JVD on inspiration
"Water Bottle" shaped heart on Xray suggest?
Pericarditis
How do you treat pericarditis?
NSAIDS
What is the MCC of Myocarditis?
Coxsackie Virus
What are the causes of nonobstructive, generalized bronchiectasis?
Cystic fibrosis
Immunosupression
Lung infection
Toxic Gases
Name the Signs/symptoms of bronchietasis
Fever
Large amounts of purulent, bloody sputum that is foul smelling
Weight loss
Clubbing
What test is used in newborns to detect cystic fibrosis?
Tripsinogen: it is produced in the pancreas. Obstruction of the ducts by mucus prevents tripsinogen exit and it accumulates leading to high tripsinogen levels
T/F Interstitial lung diseases DECREASE lung compliance
TRUE
Describe systolic dysfunction
Impairment of ejection fraction (normal is ~60%)
Describe Diastolic dysfunction
Impaired filling of the left ventricle
What causes Restrictive Cardiomyopathy
Involves an infiltrative processes:

Hemochromatosis
Amyloidosis
Sarcoidosis
Scleroderma
What is the function of BNP(B-type Natriuretic peptide) and ANP?
Promote salt and water excretion by the kidneys
Results in arterial vasodilation
They're excreted in response to the increase in ventricular filling pressures
What are the side effects of Calcium channel blockers
Constipation
Flushing
Headache
Dizziness
Peripheral edema
Rebound hypertension
What is the MOA of Statins
They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, increasing clearance of LDLs
What are the side effects of Niacin?
GI dyscomfort
Flushing
Pruritus
Elevated LFTs
What is the MOA of Zetia?
Inhibits absorption of dietary fats
What are the side effects of Statins?
Elevated LFTs and CPK
Myositis
Myalgias
What percentage of MIs are silent?
20%
What percentage of MIs have normal EKGs?
50%
Which cholesterol drugs do you avoid with liver disease?
Statins- absolute
Niacin
Fibric Acids

You can give Bile Acid sequestrants:

Questran
What is the best drug to increase HDL?
Niacin
Hypercalcemia is a paraneoplastic syndrome assoc. with this type of lung CA
Squamous cell
MAC (Mycobacterium Avium intracellulare) affects what body systems?
Lungs and GI

Very common with HIV patients
Name conditions that can cause orthopnea
Pericarditis
Dilated Cardiomyopathy
Mitral Stenosis
Aortic Regurgitation
Pulmonary diseases(asthma)
What is Polyarteritis nodosa
a medium vessel inflammatory vasculitis involving segmental necrotizing lesions, often at arterial branch points, leading to stenoses, aneurysms, thromboses, infarction, or hemorrhage
What class of drugs can cause inpotence?
Beta Blockers
What is the DOC for preventing a thrombus in a pt with CHD?
Aspirin
What is the MCC of mortality in a pt with PVD?
MI