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157 Cards in this Set
- Front
- Back
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Cardiac Output= ?
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SV x HR
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M/c spot for coronary artery occlusion?
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LAD
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when is the heart supplied with blood?
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diastole
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what is the next best test for a pt who presents with angina but no MI is found upon workup?
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stress testing
1. exercise if pt can tolerate 2. pharm- if pt cannot exercise |
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when do you treat hyperlipidemia?
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LDL >100- if CAD present
LDL >130- if 2 risk factors of CAD present LDL >160- general population |
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when do you treat hyperlipidemia?
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myositis
facial flushing |
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tx of STABLE angina?
further workup? |
sublingual nitroglycerin
stress test w/ nuclear studies PTCA (heart cath) |
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ecg/work up to dx unstable angina?
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neg cardiac enzymes with st-depressions
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tx unstable angina?
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ASA and clopidogrel
heparin O2 nitroglycerin B-blocker consider PTCA or CABG |
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most sensitive cardiac enzyme for MI?
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troponin I
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tx for MI?
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ASA and clopidogrel
heparin O2 nitroglycerin B-blocker consider PTCA or CABG |
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following an MI, what drugs decrease mortality?
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B-blocker
ACEI tPA (if in window) |
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What does DLCO assess?
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diffusion across alveolar membrane
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describe FEV1and FVC in obstuctive pulm dz
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FEV1 = decrease
FVC = increase FEV1/FVC = decrease |
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describe FEV1and FVC in restrictive pulm dz
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FEV1 = decrease
FVC = decrease FEV1/FVC = normal to increase |
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name a few things that can increase A-a gradient?
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PE
CHF Pneumonia Pulmonary edema R to L shunt |
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definitive dx of strep pharyngitis must include what?
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throat culture + for B hemolytic strep
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complications of strep? (2 of them)
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Rheumatic heart disease
post-strep glomerular nephritis |
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a peritonsillar abcess will present how?
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trouble opening mouth
assymetric tonsils uvula pointing away from lesion |
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differentiate between influenza and common cold on a few symptoms?
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flu- DIARRHEA, vomiting, very high FEVER, headache
cold- sneezing, sore throat, nonproductive cough, rhinorrhea |
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M/C cause of sinusitis and otitis media?
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s. pneumo
h. influenza m. cattarhalis |
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complications of strep? (2 of them)
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oral amoxicillin x 2 weeks
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decreased breath sounds, fever, elevated WBC count, dullness to percussion. Dx?
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pneumonia
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+ PPD... next step?
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CXR
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Tx of TB?
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R- rifampin
I-isoniazid (supplement with B6 for neuropathy) P- pyrazinamide E- ethambutol all this for 6 months |
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+PPD, Asymptomatic, with possible TB risk exposure
Tx? |
Isoniazid - do not report b/c no confirmed TB
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m/c cause of neonatal pneumonia?
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oral amoxicillin x 2 weeks
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stocatto cough pneumonia?
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Chlamydia
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infant- 5yo pneumonia
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RSV
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5-20 yo
20-40 yo m/c pneumonia |
Strep pneumo, mycoplasma
mycoplasma, strep pneumo |
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elderly pneumonia?
treatment of this bug? |
strep pneumo
B-lactam + macrolide (azithr0mycin) |
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m/c cause of hospital acquired pneumonia
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staph aureus with abcess formation
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m/c alcoholic pneumonia?
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klebsiella- maroon (currant jelly) sputum
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m/c cystic fibrosis pneumonia?
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pseudomonas
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pneumonia w/ diarrhea and exposure to aerosolized water
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legionella
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m/c fungal pneumonia out of Southwest U.S. ?
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coccidiodomycosis
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m/c fungal pneumonia after cave dwelling especially where?
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histoplasmosis in ohio river valley
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elderly pneumonia?
treatment of this bug? |
cryptococcus
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central America pneumonia?
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blastomycosis
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TB with bone involvement called what?
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Potts Disease
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dyspnea, accessory muscle use, hx of sepsis, rales, respiratory alkalosis with low PaO2 and low PaCO2 is enough to dx what?
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ARDS
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what is the difference between AV Nodal tachycardia and AV tachycardia?
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AV Nodal= cycles around the AV node
AV= cycles around an accessory pathway (WPW) |
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mobitz type 1 is characterized by?
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legionella
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what are the most common PSVT (SVT) rhythms?
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AV Nodal Reentrant Tachy
WPW AV reentry tachy A-fib, sinus tach, A-flutter, and MAT are also SVT but the 2 above are of clinical concern |
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when can you use adenosine?
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PSVT- NOT WPW
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how do you tell the difference between Multifocal Atrial Tachycardia and Atrial fibrillation on ECG since they both are irregular rhythms?
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MAT= 3 P-wave morphologies with distinguishable P-waves.
A-fib= No P-wave morphologies, wavy baseline, and irregularly irregular intervals. |
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what are some causes of all forms of heart block?
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increased vagal tone, conduction defect, drugs,
3rd degree= no conduction to ventricles from atria |
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causes of A-fib?
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Pulm dz
Ischemia Rheumatic heart dz Anemia Thyroid (hyper) Ethanol Sepsis |
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as with any tachycardias regardless of origin, what is primary concern?
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rate control with B-blocker or CCB
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treatment of torasades?
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magnesium
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identifying Vtach is at minimum what?
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a run of 3 PVCs at ventricular rate of 160+
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first line tx in vtach?
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electrical cardiovert
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in heart failure, systolic dysfxn is defined as what?
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inadequate CO for systemic demand
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heart failure diastolic dysfxn definition?
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decrease in ventricular filling
usually caused by hypertrophy or restrictive cardiomyopathy |
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why does COPD lead to cor pulmonale (pulm htn)?
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shunting of blood away from hypoxia in the lungs (lung physiology)
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what is the lab you want to order to help dx CHF?
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BNP
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what will the CXR show in CHF?
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cardiomegaly
kerley B lines cephalization of pulm vessels |
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pharm therapy of CHF must include these 2 drugs bc of reduced mortality?
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ACEI- to decrease preload and afterload
Spironalactone- aldosterone block to block cardiac remodeling |
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Tx for Systolic dysfxn CHF?
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loop diuretic- decrease preload
ACEI/ARB- decrease preload and afterload digoxin- increase contractility B-blocker Spironalactone |
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Tx of diastolic dysfxn CHF?
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CCB/ARB/ACEI- control BP
B-blocker- heart rate spironalactone- cardiac remodeling |
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what is the goal of RAAS system?
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increase aldosterone to keep Na retained and increase BP
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systolic ejection murmur that radiates to carotids
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aortic stenosis
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late systolic murmur with mid systolic click
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MVP
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pansystolic murmur that radiates into the axilla
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mitral regurge
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do not give an ACEI in aortic stenosis why?
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will decrease BP way too much... CO is already low...
can use B-blockers though |
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how does aortic stenosis usually first present?
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syncope especially on exertion
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why is hypertrophic cardiomyopathy both systolic and diastolic dysfxn?
what radiographic feature aids in DX? |
hypertrophic septum causes outflow obstruction (systolic)
heart so big not a lot of blood can get into the heart (diastolic) echocardiography |
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what groups are at risk for dilated cardiomyopathy?
what kind of CHF? diastole or systole? |
alcoholic, preggo, and beriberi
systole....can fill a lot but not squirt blood out |
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restrictive cardiomyopathy is common in what patient population?
what kind of CHF? sys or dia? |
sarcoidosis and amyloidosis
diastolic...cannot fill the heart up |
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pt presents with chest pain. it is more painful with inspiration and better with leaning forward. and ecg obtained would show what? next step?
dx? tx? |
diffuse and not contiguous ST elevation with PR depressions
MI workup just to rule it out pericarditis NSAIDs |
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what triad would you expect with cardiac tamponade?
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hypotension, distant heart sounds, JVD (beck's triad)
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how do you treat cardiac tamponade?
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pericardiocentesis
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name some etiological factors of mycarditis
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Coxsackie virus
doxyrubicin, chlorquine |
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myocarditis + achalasia/megacolon?
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Chagas disease (trypanosoma cruzii)
Vector- Tiduvid or kissing bug |
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What are the 5 major criteria for rheumatic heart disease?
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J-joints
<3- carditis N- nodules E- erythema nodosum S- Sydenham's chorea |
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next step after recognizing beck's triad?
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PERICARDIOCENTESIS
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pts at risk for endocarditis?
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IV drug abusers
congenital heart defects, prosthetic valves |
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Lupus + endocarditis?
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Libman-Sacks endocarditis
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acute (quick) endocarditis bugs?
subacute (slower but not chronic)? |
staph aureus
strep pneumo staph pyogenes strep viridans staph epidermidis |
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presenting features of endocarditis?
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fever, chills, night sweats
janeway lesions- periphery petechia osler nodes- nodules on fingers/toes roth spots-in eyes, retinal hemorrhage splinter hemorrhages- nail petechia |
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properly taking BP?
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quietly sitting for 5 mins
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HTN?
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>140/>90
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tx of HTN?
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first is thiazide unles comorbid conditions
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HTN Tx for these comorbid conditions
1) DM 2) CHF 3) Post-MI 4) BPH 5) osteoporosis 6) migraines |
1- ACEI
2- ACEI and diuretic 3- B-blocker, ACEI 4-terazosin, prazosin 5- thiazide- retains Ca 6- B-blocker |
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HTN emergency definition and Tx?
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>200/>120
tx- nitroprusside, lebetalol, nicardipine |
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If pt has this, diuretics are not reccomended for tx of BP
If pt has this, ACEI are contraindicated for tx of BP |
gout
renal artery stenosis |
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if you hear an abdominal bruit with a pulsating abdominal mass suspect what?
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AAA
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classify the aneurysm in
stanford A stanford B |
A- ascending aorta
B-descending or ascending+ descending |
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m/c reason for secondary HTN?
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renal disease
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pheochromocytoma can present with orthostatic vitals. True or false?
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True
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refractory HTN to all meds think what?
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renal artery stenosis
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classify shock:
1) cardiogenic 2) septic 3) hypovolemic 4) anaphylactic 5) neurogenic |
1) heart pump failure- tx: dobutamine, fluids
2) infection source- tx: antibiotics and pressors 3) low blood vol. tx: fluids, blood 4) allergy tx: fluids, epi, h1 and h2 blockers, intubate 5) widespread vasodilation d/t cns or spinal cord injury tx: fluids and presors |
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Virchow's triad?
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endothelial damage
venous stasis hypercoagulability |
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pt risk factors for DVT?
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preggo
long flights inactive pts surgical pts tobacco users |
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pts who have had surgery with risks of hemorrhage should get what?
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ivc filters instead anticoagulation to prevent DVTs
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polyarteritis nodosa affects small and medium arteries of what organs?
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kidney, heart, GI tract
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anca studies of polyarteritis nodosa are positive for what?
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P-ANCA
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giant cell arteritis is dx how?
presenting features? |
artery biopsy
new onset headache, fever, jaw claudication, transient monocular blindness |
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pt with temporal arteritis should get what?
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prednisone
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inflamed aorta and its branches in an Asian lady, think what?
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Takayasu arteritis
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what is Churg-Strauss Disease?
dx features? |
inflamed small or medium arteries d/t allergic reaction
asthmatic symptoms with eosinophilia |
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what is henoch-schonlein purpura?
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IgA immunce complex- mediated vasculitis
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presentation of henoch-schonlein purpura
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recent URI
palpable purpura (on buttocks/legs) abdominal pain |
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Kawasaki disease presentation
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fever of 5 days
lymphadenopathy strawberry tongue desquamation of hands and feet |
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how many umbilical artery(ies) or vein(s) are there?
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2 arteries 1 vein
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fixed split s2 murmur think?
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asd
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machine like murmur tx?
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PDA- tx is indomethacin
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transposition of great vessels must have what to be compatible with life?
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patent foramen ovale, PDA, or VSD
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endocardial cushion defect found in what kind of pts?
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downs syndrome
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name the tetrology of falot and radiographic finiding
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1) overriding aorta
2) vsd 3) RVH 4) pulmonary stenosis boot shaped heart |
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what are the cyanotic heart diseases?
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5 t's
terology of falot truncus arteriosus (aorta and pulm art. share a trunk) transposition of great vessels total anomalous venous return tricuspid atresia |
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relatively asymptomatic heart defects at birth?
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ASD, VSD, and PDA
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name some H/P findings in asthma
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Accessory muscle use
prolonged expiratory phase wheezing, coughing, chest tightness decreased O2 sats decreased FEV1/FVC ratio Decreased PEF rate |
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treatment for following class of asthma?
Mild Intermittent |
inhaled B2 agonist
IV steroids- if persistent Sx usually no daily meds |
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treatment for following class of asthma?
Mild persistent |
inhaled B2 agonist
IV steroids- if persistent Sx inhaled low dose steroids mast cell stabilizer, monteleukast, theophylline |
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treatment for following class of asthma?
Mod persistent |
inhaled B2 agonist
IV steroids- if persistent Sx inhaled low-medium dose steroids monteleukast, theophylline |
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treatment for following class of asthma?
severe persistent |
inhaled B2 agonist
IV steroids- if persistent Sx inhaled high dose steroids Long acting B2 agonist consider oral steroids |
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describe features of chronic bronchitis, H/P findings
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a/w tobacco use
BLUE BLOATERS- develop cor pulmonale and cause cyanosis productive cough |
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desribe H/P of Emphysema
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destroy alveoli and bronchioles
dyspnea with pursed lip breathing decreased FEV1/FVC ratio CXR hyperinflation |
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what is bronchiectasis? and what kind of features are a/w it?
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permanent dilatation of small/medium airways 2ndary to chronic airway obstruction, cystic fibrosis
copious sputum production |
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how do you differentiate chronic bronchitis for emphysema?
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DLco
normal in chronic bronchitis decreased in emphysema |
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when do you consider giving supplemental home O2?
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when SaO2 is <88%
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next step in working up a pulm nodule on cxr?
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compare to old cxr films
ct scan benign- f/u cxr 6 mo malignant features- PET scan or FNA, resection |
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squamous cell carcinoma in the lung has hypercalcemia a/w it....why?
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rPTH like peptide
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small cell CA in the lung can cause what paraneoplastic syndromes?
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cushings (ACTH)
eaton-lambert SIADH neuropathy |
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lung adenocarcinoma can cause widespread mets.
true/false? |
true
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pancoast tumors can cause what?
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horner's syndrome (miosis (pinpoint pupil), ptosis, anhidrosis)
SVC syndrome brachial plexus involvement |
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patient with chew tobacco hx and gradual hoarseness... dx? workup?
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laryngeal CA
MRI/CT to detect soft tissue mass |
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pt presents with cough, wt. loss, malaise, bilateral hilar lymphadenopathy on CXR, with increased ACE levels, increased alk phos and increased serum Ca. Dx? tx? bx shows?
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sarcoidosis
steroids noncaseating granulomas |
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ship yard and insulation workers at risk for?
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asbestosis and mesothelioma (pleural tumor)
mesothelioma has pleural thickening |
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in any pneumoconioses (CWP, asbestosis, silicosis, beryliosis (electronic workers)) what would PFTs show?
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low FEV1 low FVC
normal ratio restrictive pattern |
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dyspnea and hemoptysis with hematuria. IgG deposits on kidney Bx. Dx?
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goodpastures (anti-GBM antibodies confirm dx)
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hemoptysis, chronic sinusitis with nasopharyngeal ulcers, and hematuria? lab test to confirm?
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Wegener's granulomatosis
c-ANCA positive |
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dyspnea with tachycardia and tachypnea and maybe a fever. top on Ddx?
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PE
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ECG pattern with PE?
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S1Q3T3
S-wave in lead I and Q-wave and inverted T-wave in V3. |
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test to dx PE?
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spiral CTA or V/Q scan
V/Q is diagnostic |
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tx of PE?
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heparin, O2, IVF, IVC filter
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a Swan-Ganz pulm catheter is useful for what?
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DIFFERENTIATE IF PULMONARY EDEMA IS CAUSED BY:
1) >18= cardiac cause 2) <18 = ARDS |
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what causes pulmonary HTN?
Tx? |
PE
valvular dz (pulm congestion) COPD (shunting) L>R shunts (RVH) Tx of underlying cause, O2, PDE-5 inhibitor, |
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how do you work up pleural effusion?
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thoracentesis to analyze fluid as transudate or exudate
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pleural fluid analyzed as low protein and low LDH. what is it? some causes?
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transudate- CHF, cirrhosis, nephotic dz
exudate (high LDH, high protein)- infxn, cancer |
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a tall, thin male present with sudden onset CP and dyspnea. dx?
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spontaneous pneumothorax
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tension PTX signs?
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TRACHEAL DEVIATION
hyperresonant to percussion decreased chest wall movement |
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tx of ptx?
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<15% just give O2
>15% needs chesttube |
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next step for tension pneumothorax
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needle decompression
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fatigue, daytime sleepiness, and snoring are risks and signs for what? workup? tx?
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obstructive sleep apnea
polysomnography (sleep study) pharyngeal surgery and/or CPAP |
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what is central sleep apnea and tx?
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when central drive to breathe is lost (ondine's curse)
cpap or tracheostomy long term |
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intubation modes with least pt dependent to more pt dependent
assist control, cpap, simv |
AC
SIMV CPAP |
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presenting s/s of croup. etiological agent. radiology?
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inspiratory stridor with seal barking cough
parainfluenza virus steeple sign on ap soft tissue of neck |
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how will a pt with epigotitis present? cause? radiology? tx precaution and alert who?
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drooling, unable to swallow, difficult breathing, leaning forward to breathe
H.influenza type b thumbprint on lateral soft tissue neck xr examine throat only when intubation can quickly be performed d/t increased irritation that can shut down breathing. consult anesthesia and ENT |
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3 mo old infant presents with respiratory distress, wheezing and retractions. cxr shows hyperinflation dx? agent?
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bronchiolitis
RSV |
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2 day old infant in respiratory distress has increasing CO2 on blood gas and a cxr with ground glass appearance. dx? tx?
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resp distress of newborn (hyaline membrane dz, or neonatal resp distress)
intubate/protect airway O2 therapy surfactant replacement the key is this pt is in resp failure at 2 days old or less!!!!!! |
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meconium aspiration syndrome is suspected when?
tx? complications? |
meconium stained amniotic fluid at birth and baby is cyanotic. tx is deep suction and supplement O2
complications are pulm htn and asthma in childhood |
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all resp illnesses in infancy cause a possibility of what later in life?
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asthma
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when do you suspect cystic fibrosis?
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repeated resp. infections-especially with pseudomonas!!
THICK secretions repeated pancreatic related problems |
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Dx of cystic fibrosis is made by?
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sweat chloride test and confirmed by CFTR gene mutation genetic testing
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treat cystic fibrosis?
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antibiotics repeatedly
DNAse- to decrease secretions pancreatic enzymes chest physical therapy supplement vitamins A,D,E,K since pancreatic dysfxn does not allow for fat to absorb these vitamins |
