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138 Cards in this Set
- Front
- Back
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Name the K sparing diuretics
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Spironalactone
Amiloride Triametrine |
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what's another name for reactive airway disease
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Asthma
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What is the principal Tx for asthma
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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) |
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Describe the classifications of asthma
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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% |
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What is the role of spirometry?
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Provides a means for measureing FVC, FEV, PEF, tidal volume, ERV, and IRC
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what is the difference between COPD and Emphysema?
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Emphysema results in cystic, anatomical changes in the lung
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What are the two causes of emphysema?
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Smoking
Alpha 1,antitrypsin deficiency. |
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How do you Dx chronic bronchitis?
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H/O chronic productive cough of more than 3 months duration for 2 consecutive years
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what is the mainstay treatment of COPD?
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Beta Adrenergic Agonist
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Name an example of a leukotriene inhibitor
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singulair
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Name the 2 groups of community-acquired pneumonia
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Typical:
S pneumoniae (pneumococcus) Haemophilus Staphylococcus Atypical: Legionella Mycoplasma Chlamydia |
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What causes interstitial pneumonitis?
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Viral etiologies:
CMV Varicella Influenza PCP In contrast to people with interstitial lung disease which is not mediated by viral infection |
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What causes interstitial lung disease?
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sarcoidosis
pneumoconiosis silicosis hypersensitivity Good Pasteur syndrome SLE Polyarteritis nodosa |
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What is the most common cause of a transudative pleural effusion?
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CHF
Other causes: Renal failure Nephrosis Liver failure Malignancy |
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What are the conditions that produce exudative pleural effusions?
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Infections
Pulmonary infarctions Malignancies Rheumatoid arthritis Lupus |
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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 |
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What is malignant hypertension?
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Sudden elevation of BP:
Diastolic BP >120 Papilledema Can lead to renal damage(>BUN, SrCr, Met Acidosis, proteinuria are evidence) |
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what are the risk factors for essential hypertension?
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Family history
Race Age Diabetes |
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Which life-style factors contribute to hypertension?
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High sodium diet
Obesity Sedentary lifestyle Alcohol Oral contraceptives Stress |
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what is the BP goal for patients with renal disease or diabetes?
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130/80 mm/Hg
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What are the causes of Secondary hypertension
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Pheo
Sleep Apnea Fibromuscular hyperplasia Renal artery stenosis |
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Claudication is a symptom of this disease
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PVD
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Name some statins (or HMG-CoA reductase inhibitors)
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Atorvastatin- Lipitor
Simvastatin- Zocor Rosuvastatin- Crestor |
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What is the MOA of CCBs?
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blocks calcium channels in the heart and blood vessels leading to less contraction.
Results in: < total peripheral resistance < cardiac output |
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What is the MOA of alpha blockers?
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They reduce the effect of the sympathetic nervous system on the vascular smooth muscle tone of the vessels that regulate PVR
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What is the MOA of BBs?
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Decrease:
Heart Rate Cardic output Renin release |
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What is the MOA of ACEI?
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Block conversion of angi I to II
Inhibit degradation of bradykinin |
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What is the mainstay therapy for asthma?
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Inhaled corticosteroids
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a sudden fall in blood pressure that occurs when a person assumes a standing position
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orthostatic hypotension
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an inspiratory reduction in systolic pressure >10 mmHg
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Pulsus paradoxus
Can happen with COPD, Asthma, Cardiac tamponade, pericardial effusion |
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Finding bullae in a Xray suggest?
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Emphysema
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inhibition of respiratory function while lying down flat because of pulmonary fluid accumulation in the lungs.
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orthopnea
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difficulty breathing after a person has fallen asleep; common with CHF
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PND commonly occurs several hours after a person with CHF has fallen asleep
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What causes PND?
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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. |
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What should you monitor with Statins?
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LFTs
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What is the MOA of Zetia?
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Inhibits fat absorption
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Progressive hypertrophy and dilation of both ventricles
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Dilated Cardiomyopathy
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What are the causes of Dilated cardiomyopathy
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Alcohol
Myocarditis Cocaine This is the most common CM |
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cardiomyopathy assoc. with athletes and sudden death; it is genetic
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Hypertrophic cardiomyopathy
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What is cardiomyopathy?
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is the deterioration of the function of the myocardium for any reason
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What are some diseases that can cause restrictive cardiomyopathy
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Hemochromocytosis
Amyloidosis-multiple myeloma Sarcoidosis |
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What is the triad for Lofgren syndrome (a subtype of sarcoidosis)
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Bilat hilar lymphadenopathy
Erythema nodosum Arthralgia |
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pericarditis weeks after an MI
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Dressler's syndrome
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What is Beck's triad?
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Hypotension
JVD Muffled heart sounds Seen in Cardiac tamponade |
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This longitudinal study identified risk factors for CHD
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Framingham study
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chest pain due to spasms of the coronary arteries
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Prinsmetal's angina
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What types of people can have silent Myocardial ischemia?
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DM pts with autonomic neuropathy, or pts with defects in pain threshold or transmission
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When does Prinzmetal's angina take place?
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usually at rest and nocturnally
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What are the indications for using ACEI
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HTN
CHF DM |
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Why use Beta-blockers in ACS
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First line in relieving chest pain, reduces infarct size and left ventricular stress
Benefit: Decreases myocardial oxygen demand |
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Name the serum markers for acute MI
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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 |
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Causes of unstable angina
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Cocaine use
Infection Anemia Post MI |
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Right sided HF manifestations
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JVD
Edema Hepatomegaly Ascites Pulm Edema(crackel/rales) |
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Left-sided HF manifestations
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Angina
SOB Tachycardia Diaphoresis Fatigue Acute pulmonary edema |
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MC reason for R-sided HF
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L-sided HF
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MCC of myocarditis
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Viral infections
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A general enlargement of the endocardium
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Cardiomyopathy
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What causes pericarditis?
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Viral etiologies
Autoimmune Drugs Cocaine |
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Difference between TIA and RIND
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TIA- resolves within 24 hrs
RIND- resolves in 48-72 hrs |
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Name the Non-selective BBs
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Propanolol
Nadolol Pindolol Carvedilol Labetalol |
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Name the BBs with ISA
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Pindolol
Acetabutolol |
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What is the MOA of BBs
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Reduce cardiac output by:
<HR <Contractility Blocking BB receptors at the JGA, < renin release |
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What is the MOA of CCBs
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Decrease muscle contraction
Decreases TPR Slows AV conduction(used for arrythmias) |
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What are the indications for ACE-I
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CHF
HTN MI Diabetic nephropathy |
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MOA of ACE-Inhibitors
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Block conversion of Angio I to Angio II
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MOA of ARBs
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Blocks Angio II which leads to decrease in afterload and preload
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Name some ARBs
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Losartan
Valsartan |
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MOA of Alpha 1 blockers
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Vessel dilator
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Name some Alpha 1 blockers
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Prazosin
Doxazosin Terazosin |
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Name some Alpha 2 blockers
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Clonidine
Methyldopa Good for pregnancy |
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What is the MOA of Alpha 2 blockers
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Reduces the release of Norepi at the nerve terminals
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Which antihypertensive drugs do you avoid with pregnancy?
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ACE-I
ARBs |
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Small cell lung CA is assoc. with which types of paraneoplastic syndromes?
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SIADH
Cushing's Eaton-Lambert syndrome Hypercalcemia DIC Endocarditis Migratory Thrombophlebitis(Trousseau's syndrome) |
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Name the 4 types of bronchogenic Carcinomas
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Small cell- most severe
Squamous cell- assoc. with smoking Adenocarcinoma-Most Common type Large cell- |
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What is the treatment of SCLC
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Combination therapy:
Chemo Radiation |
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Treatment for NSCLC
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Surgery, chemo, radiation
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What makes up the Ghon's complex
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Combination of the primary lung lesion and lymph node granulomas
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MCC of exudative pleural effusion
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Pneumonia
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MCC of transudative pleural effusion
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CHF
Renal Failure Cirrhosis |
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What is a hydrothorax
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accumulation of serous transudate in the pleural cavity
MCC is CHF |
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What is a Chylothorax
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effusion of lymph in the thoracic cavity
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What is the MCC of pleural effusion in the fetus or neonate?
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Chylothorax, from congenital defects in the thoracic duct or lymph channels
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Name 3 things you can use to measure airway responsiveness(inhalation challenge tests)
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Methacholine (cholinergic agonist)
Histamine Cold air |
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Name 2 mast cell stabilizers
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Chromolyn sodium (Intal)- used for prevention; DOC in kids
Nedocromil sodium (Tilade) |
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Describe the Pink Puffers (Emphysema patients)
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"Fighters" These patients have loss of ventilation and perfusion area in the lung. They can overventilate and maintain relatively normal blood gases
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Describe "Blue Bloaters" (Chronic Bronchitis pts)
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"Non-fighters" These patients have excessive bronchial secretions and obstruction that causes mismatched ventilation. Overventilation does not help and they become hypoxic and cyanotic
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The amount of air that can be forcibly exhaled after maximal inspiration is called?
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FVC- Forced Vital Capacity
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What is the mainstay Tx of COPD?
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Inhaled B2 agonist
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Name examples of Interstitial lung Diseases
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Sarcoidosis
Occupational lung Dz Hypersinsitivity pneumonitis Lung Dz caused by toxic drugs and radiation |
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Why are interstitial lung diseases classified as fibrotic or restrictive?
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Because they result in a stiff and noncompliant lung
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Name the 2 MC interstitial lung diseases
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Exposure to occupational and environmental inhalants
Sarcoidosis |
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List examples of occupational hazards that cause interstitial lung disease
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Inorganic dust:
Asbestosis Slicosis- inhaled silica dust Coal miner's pneumoconiosis Organic dust: Hypersensitivity pneumonitis Gases: Ammonia Phosgene Sulfur dioxide |
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List examples of drugs and therapeutic agents that cause interstitial lung disease
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Cancer chemo drugs:
Busulfan Bleomycin Methotrexate Ionizing radiation |
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List immunologic lung disease examples that cause interstitial lung disease
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Sarcoidosis
Collagen vascular diseases: SLE Rheumatoid arthritis Scleroderma Dermatomyositis-polymyositis |
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What is sarcoidosis?
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A multisystem granulomatous disorder that primarily affects the lungs and lymphatic systems
Primarily adults younger than 40 |
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These diseases affect the supporting collagen and elastic tissues that lie between the airways and blood vessels
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Interstitial lung diseases
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What 3 systems are most commonly affected by sarcoidosis?
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Lungs- interstitial Dz
Skin-granulomatous lesions Eyes- chorioretinitis |
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What causes obstructive airway disorders?
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Disorders that limit expiratory airflow:
Asthma COPD Bronchiectasis |
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Describe restrictive airway disorders
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conditions which cause a reduction in the functional volume of the lungs:
Interstitial lung Dz Lung CA Pleural effusion Kyphosis |
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What test is useful in diagnosing CHF
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BNP: B-type natriuretic peptide
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MC cardiomyopathy
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Dilated
Symptoms: Pulmonary congestion DOE, PND, Orthopnea |
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This cardiomyopathy results in impaired diastolic filling and may be caused by amyloidosis, radiation, fibrosis, or s/p heart surgery
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Restrictive cardiomyopathy
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Name some risk factors for endocarditis
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Valvular disease
prosthetic heart valves IV drug abuse |
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MCC of acute endocarditis
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Staph Aureus- affects tricuspid valve
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MCC of Subacute endocarditis
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Streptococcus viridans- assoc. with dental procedures
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MCC of Chronic endocarditis
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Legionella
Brucella |
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This disease involves the formations of vegetative lesions on the endocardial surface
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Infective endocarditis
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What is the most definitive diagnostic procedure for endocarditis?
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Blood culture: At least 6 blood cultures should be obtained
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What criteria can be used to diagnose infective endocarditis
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The Duke Criteria:
Two major or One major and three minor |
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MCC of Bacterial Endocarditis
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Streptococci (75%)
Staph. Aureus (25%) |
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What is Kussmaul sign?
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Can be found in cardiac tamponade; it is JVD on inspiration
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"Water Bottle" shaped heart on Xray suggest?
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Pericarditis
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How do you treat pericarditis?
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NSAIDS
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What is the MCC of Myocarditis?
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Coxsackie Virus
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What are the causes of nonobstructive, generalized bronchiectasis?
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Cystic fibrosis
Immunosupression Lung infection Toxic Gases |
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Name the Signs/symptoms of bronchietasis
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Fever
Large amounts of purulent, bloody sputum that is foul smelling Weight loss Clubbing |
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What test is used in newborns to detect cystic fibrosis?
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Tripsinogen: it is produced in the pancreas. Obstruction of the ducts by mucus prevents tripsinogen exit and it accumulates leading to high tripsinogen levels
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T/F Interstitial lung diseases DECREASE lung compliance
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TRUE
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Describe systolic dysfunction
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Impairment of ejection fraction (normal is ~60%)
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Describe Diastolic dysfunction
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Impaired filling of the left ventricle
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What causes Restrictive Cardiomyopathy
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Involves an infiltrative processes:
Hemochromatosis Amyloidosis Sarcoidosis Scleroderma |
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What is the function of BNP(B-type Natriuretic peptide) and ANP?
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Promote salt and water excretion by the kidneys
Results in arterial vasodilation They're excreted in response to the increase in ventricular filling pressures |
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What are the side effects of Calcium channel blockers
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Constipation
Flushing Headache Dizziness Peripheral edema Rebound hypertension |
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What is the MOA of Statins
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They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, increasing clearance of LDLs
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What are the side effects of Niacin?
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GI dyscomfort
Flushing Pruritus Elevated LFTs |
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What is the MOA of Zetia?
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Inhibits absorption of dietary fats
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What are the side effects of Statins?
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Elevated LFTs and CPK
Myositis Myalgias |
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What percentage of MIs are silent?
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20%
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What percentage of MIs have normal EKGs?
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50%
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Which cholesterol drugs do you avoid with liver disease?
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Statins- absolute
Niacin Fibric Acids You can give Bile Acid sequestrants: Questran |
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What is the best drug to increase HDL?
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Niacin
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Hypercalcemia is a paraneoplastic syndrome assoc. with this type of lung CA
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Squamous cell
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MAC (Mycobacterium Avium intracellulare) affects what body systems?
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Lungs and GI
Very common with HIV patients |
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Name conditions that can cause orthopnea
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Pericarditis
Dilated Cardiomyopathy Mitral Stenosis Aortic Regurgitation Pulmonary diseases(asthma) |
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What is Polyarteritis nodosa
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a medium vessel inflammatory vasculitis involving segmental necrotizing lesions, often at arterial branch points, leading to stenoses, aneurysms, thromboses, infarction, or hemorrhage
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What class of drugs can cause inpotence?
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Beta Blockers
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What is the DOC for preventing a thrombus in a pt with CHD?
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Aspirin
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What is the MCC of mortality in a pt with PVD?
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MI
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