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84 Cards in this Set
- Front
- Back
How much of the pulmonary vascular bed must be occluded before reistance or pressure increases?
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~50%
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What mediators released b/c of platelets adhering results in the systemic phenomenon including bronchconstriction?
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histamine, serotonin, prostoglandins
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Common symptoms of pulmonary embolism?
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SOB, CP, cough, but often ASYMPTOMATIC
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Common compensatory feature seen in patients suffering from PE?
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hyperventilating, but overall there is not hallmark symptom
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What lab value is elevated in the presence of a clot?
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D-dimer
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How do you find DVT's?
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doppler ultrasound
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What are two findings on CXR that are highly suggestive of PE?
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Westermark's sign (enlarged left hilum, L lung hyperlucent) & Hampton's hump (infarct is opacified region)
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Common ABG findings in PE?
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resp. alkalosis + hypoxemia
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What imaging test is highly sensitive and specific for PE?
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Spiral CT
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What is the first step if you have any suspicion of DVT or PE?
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start on heparin or LMWH
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What lab do you use to monitor anticoagulation TX and what range is effective?
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INR: 2-3 is effective
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What is the minimum length of coumadin therapy post-PE?
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3 months
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When is it good to use to inferior vena cava filter to prevent future VTEs?
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bled on coumadin, or still clotted despite appropriate treatment
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Major complication of inferior vena cava filter?
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leg swelling
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What in-hospital patients are at highest risk of developing DVT/PE?
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orthopedic surgery
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What is the most common origin of DVTs?
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distal calf veins
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Virchow's Triad?
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hypercoagulability, venous stasis, vessel wall damage
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How many people have latent TB?
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1/3 of the world
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Three types of TB infection?
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primary infection, primary progressive, and reactivation infection
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Who is likely to get TB?
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greater innoculum, less defense
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Common pathological finding of TB?
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Ghon lesion (focus): organism reaches distal lung parenchyma
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When does reactivation normally occur in TB patients?
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months, years, decades later
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Common pathological finding in healing TB lesions?
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fibrosis, scarring, and calcium deposition
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Common clinical featues of active TB infection?
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weight loss, anorexia, fever, night sweats, cough, sputum, CP, hemoptysis
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CXR findings in TB primary progressive versus reactivation?
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primary: lower lobe infiltrate, reactivation: upper lobe infiltrate
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What TB test is a better diagnostically than mantoux?
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Quantiferon gold assay
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What is the regimen for treating LTBI?
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INH 300 mg daily for 9 mos
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What is the genetic defect of CF?
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CFTR mutation in >70% of cases (gene codes for transmembrane conductance regulator)
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What cells are affected by CF mutations?
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epithelial cells
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What organs (systems) are affected in CF?
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lungs, GI tract (pancrease too), sweat glands, reproductive glands
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What is the significance of CF PANCREAS
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clinical presentation: Chronic resp. disease, Failure to thrive, Polyps, Alkalosis (metabolic), Neonatal intestinal obstruction, Clubbing of fingers, Rectal prolapse, Electrolyte inc. in sweat, Aspermia, Sputum (stap and pseudomonas)
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What is the direct effect of a mutated CF gene?
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normal CFTR inhibits Na channel; mutated allows inc. Na absorption (and water) leaving airway surface liquid depletion (thick mucous)
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80% of CF pts. eventually become chronically infected w/ what?
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Pseudomonas aeruginosa
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Excluding pseudomonas, what are 3 common pediatric pathogens in CF pts.?
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S. aureus, H. influenza, and burkholderia cepacia
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Common neonatal GI problem seen in CF pts.?
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meconium ileus
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What is a common childhood clinical presentation of CF?
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failure to thrive
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What lab value is highly suggestive of CF?
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>70 meq/L Cl of sweat
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in the sweat chloride test, what range is considered positive
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60-165 meq/L Cl
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What is the primary cause of death in most CF pts?
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respiratory failure
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Hallmark of chronic bronchitis?
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Cough w/ chronic mucous hypersecretion
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Hypertrophy of what 2 things in CB?
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bronchial mucous glands and smooth muscle
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How do you estimate "pack-years" of smoking history?
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# packs/day x # years
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What lab value is increased in CB?
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hematocrit (polycythemia)
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What three types of drugs may improve bronchoconstriction associated with CB?
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beta-agonists, anti-cholinergics, and methylxanthines (theophylline)
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What are common pathogens seen in acute exacerbations of CB?
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H. Flu (35-70%), S. pneumo, moraxella catarrhalis, and viral infections (1/3 of pts)
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What are the 3 cardinal symptoms of acute CB?
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worsening dyspnea, inc. sputum production, inc. sputum purulence (onset > 2 wks suggests worsening condition)
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When do you give antibiotics to a CB pt. ?
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2/3 cardinal symptoms
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Low risk CB treatment drugs?
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macrolide, 2nd cephalosporin, doxycycline
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High risk CB treatment drugs?
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amox-clavulanate, fluoroquinolones
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What part of the lungs is effected bronchiectasis and to what extent?
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bronchi dilation; may involve only one segment of lung or entire lung DEPENDING ON CAUSE
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What are the 2 prerequisites for developing bronchiectasis?
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1. infectious insult
2. impariment of drainage, airway obstruction, or defect in host defense |
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What are 4 causes of DIFFUSE bronchiectasis?
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post-Infectious, Immunodeficiecy, Immune-mediated disease, congenital (Infancy) = 4 I's
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What is the most common cause of bronchiectasis?
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CF
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What are 4 findings on CT indicative of bronchiectasis?
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peribronchial thickening, dilated bronchioles, tram tracks, ring shadows
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What can corticosteroids positively affect in pts. w/ bronchiectasis?
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preserve FEV1 by decreasing inflammation
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Are mucolytics effective treatment of bronchiectasis?
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not enough evidence to support
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What is the most common bleeding disorder?
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thrombocytopenia
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What defines thrombocytopenia (lab value)?
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platelet count <100,000
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What is the best treatment for drug-induced thrombocytopenic purpura?
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discontinue and avoid the offending agent.... duh
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What are 5 commonly implicated drugs of drug-induced thrombocytopenic purpura?
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heparin, digitalis/digoxin, loop diuretic (furosemide) and H2 blockers
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What is an associated feature of antiphospholipid syndrome found on MRI?
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an unidentified bright object (UBO)
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What are the 2 main components of primary hemostasis?
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platelets and vascular endothelium
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What is an important question to ask in regards to clinical assessment of bleeding disorders?
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Have you had any bleeding problems related to medications before?
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What is normal PT?
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10-13 seconds
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What is the range of normal PTT?
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25-40 seconds
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Common findings in the history of pts. w/ idiopathic thrombocytopenic purpura?
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history of viral URI, IgG antibodies on platelet surface
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What is the common treatment for seevre ITP?
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prednisone (1-2 mg/kg/d)
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What are the 3 components of TTP?
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microangiopathic hemolytic anemia (MAHA), thrombocytopenia (<50,000), and fever
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What are the 5 components of hemolytic uremic syndrome (HUS)?
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TTP + renal failure + hepatic dysfunction
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What labs can help you distinguish early TTP from DIC?
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early in TTP, PT and PTT are normal, in DIC they would be abnormal
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Besides treating the underlying cause, how can one quickly treat TTP?
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plasmapheresis (100% life-saving)
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Pt. presents w/ large platelets, bleeding time of 20+ minutes, and mucocutaneous hemorrhaging. Diagnosis?
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Bernard-Soulier syndrome
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Inherited factor VIII deficiency. What disease?
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hemophilia A
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Inherited factor IX deficiency. What disease?
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hemophilia B
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Treatment for pt. w/ deficiency of Vit. K-dependent factors and liver disease?
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fresh frozen plasma
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What is the only (inherited) endothelial syndrome associated w/ hemostatic complications?
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hereditary hemorrhagic telangiectasia
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What is the pattern of inheritance and defective gene in hereditary hemorrhagic telangiectasia
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AD inheritance, defect in endoglin
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Chronic treatment for AT-III deficiency?
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warfarin for life
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Action of Protein C?
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inactivates factors V and VIII (dependent on Vit K)
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Action of protein S?
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cofactor for Protein C
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What is the action of vWF?
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allows platelets to bind to exposed collagen via glycoprotein receptors
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What substances are associated with the anticoagulant properties of intact endothelium?
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ADPase, NO, PGI2, heparan sulfate, tPA, and thrombomodulin
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What is required to turn a soft clot into a hard clot?
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calcium, XIIIa, and covalent cross-links between fibrin monomers
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What is the most common mutation leading to CF?
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CTT deletion (functionally deletes phenylalanine)
the F508 is where this takes place |