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Precision > Cardio/Pulm/GI > Flashcards

Cardio/Pulm/GI Flashcards

1
Q

Acute MI Pharm intervention

A

O2, Aspirin, Nitroglycerin, BB, ACE, Statin, Anticoag + Antiplatelet

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2
Q

Leads in Anterior MI

A

V1-V4 = LAD

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3
Q

Leads in Lateral MI

A

1, AVL, V5, V6

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4
Q

Common SE of Amiodarone

A

Eye, Thy, Lungs = Optic neuritis, Thyroid disease, Pulmonary fibrosis

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5
Q

Stable vs Unstable Angina Pharm intervention

A

Stable = Nitro
Unstable = MONA

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6
Q

Aortic insufficiency (FMLD)

A

Aka aortic regurge = LUSB blowing decresendo diastolic murmur that DECREASES with valsalva

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7
Q

Second and 3rd Degree AV block clinical intervention

A

2nd Block initial tx = Transcutaneous pacing; Definitive = Pacemaker
3rd Degree = Pacemaker

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8
Q

A. fib Clinical intervention (3 steps)

A

Unstable = synchronized cardioversion
Stable = 3 Steps
1. Slow heart down with BB or CCB
2. Anticoagulation (almost always)
3. Convert with pharm like amiodarone or electrocardiovert if unstable

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9
Q

Passive junctional rhythm (Basic concepts)

A

P wave inverted/absent in I, II, AVF with a narrow QRS; AV no longer in control of heart rate which makes HR go down to 40-60BPM

MCC inflammation of myocardium aka myocarditis

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10
Q

Junctional tachycardia (Basic concepts)

A

AV node firing instead of SA node which creates 3 different P waves; P waves are either
1. Non-existant
2. Inverted
3. P wave comes after QRS

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11
Q

Cardiogenic shock (Basic concepts)

A

Hypotension + CHF at the same time

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12
Q

Dilated Cardiomyopathy (Basic concepts)

A

S3 gallop + Decreased Ejection fraction
Dilated Left ventricle is weak and cannot pump well

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13
Q

Dilated Cardiomyopathy pharm intervention

A

ACE, BB, Implantable device if EF is 30-35%

BASH heart = Bblockers, Ace, Spironolactone, Hydralazine

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14
Q

Dissecting aortic aneurysm Dx + Lab Studies

A

CT with contrast
MRI angio = GOLD STANDARD
TEE
CXR = Widening mediastinum

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15
Q

Endocarditis (basic concept)

A

If blood cultures are negative, suspect HACEK gram negative organism

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16
Q

Coarctation of aorta clinical intervention

A

Surgical correction with balloon angioplasty

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17
Q

Coarctation of aorta Hx and PE

A

Child with secondary HTN, bilateral claudication, delayed or weak femoral pulses

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18
Q

CHF acute vs chronic pharmaceutical intervention

A

Acute = LMNOP = Lasix, Morphine, Nitro, Oxygen, Bipap
Chronic = ACE, BB

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19
Q

Heart murmur of any kind dx and lab studies

A

ECHO

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20
Q

Hypertensive emergency/crisis pharmaceutical intervention

A

Clonidine, captopril, labetolol, nicardipine, methyldopa

Gradual reduction = Decrease BP by 10-20% in 1 hour and 25% over 24-48hrs

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21
Q

Hyperlipidemia pharmaceutical intervention

A

LDL = Statin
HDL = Niacin +/- Bile acid salts (if pregnant)
Triglycerides = Fibrates like gemfibrozil

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22
Q

Pericardial effusion clinical intervention

A

Small = Observation no tx
Large = Pericardiocentesis + pericardial window if recurrent

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23
Q

Papillary muscle rupture clinical intervention

A

Cardiogenic shock = CHF + Hypotension
SURGERY emergent with mitral valve replacement

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24
Q

Mitral stenosis (FMLD)

A

Loud S1 SNAP, early to mid diastolic rumble at apex, decrease murmur with standing

MCC = Rheumatic heart disease

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25
Q

Pericarditis (scientific concepts)

A

Inflammation of the pericardium; MCC = Coxsackie or echovirus

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26
Q

SVT (FMLD)

A

Definitive with EKG = no P waves + Tachycardia + Narrow QRS

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27
Q

Tetralogy of fallot (FMLD)

A

RV outflow obstruction + RVH + Overriding Aorta + VSD (4 things)

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28
Q

Stable V. tach pharmaceutical intervention

A

Amiodarone

Unstable = Cardioversion or Defib if no pulse

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29
Q

Acute Epiglottitis (Health Maint +Prevention)

A

MEDICAL EMERGENCY

MCC = HiB; Children 3mo-6mo; Prevention with vaccine

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30
Q

Acute Epiglottitis Dx and Labs

A

Definitive dx = Laryngoscopy = provides direct visualization

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31
Q

ARDS clinical intervention

A

Positive pressure ventilation = Intubation or BiPAP

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32
Q

ARDS clinical intervention

A

Positive pressure ventilation = Intubation or BiPAP

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33
Q

ARDS (FMLD)

A

MC in critcially ill
1. Severe refractory hypoxemia = Hallmark
2. Bilateral pulmonary infilatrates on CXR
3. Pulmonary capillary wedge pressure (used to assess LV filling) less than 18

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34
Q

ARDS dx and labs

A
  1. ABG = refractory hypoxemia
  2. CXR = diffuse bilateral pulmonary infiltrates = white out pattern
  3. Cardiac cath pf pulmonary artery (swanz cath) measuring pulmonary cap wedge pressure of less than 18
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35
Q

Asbestosis dx +labs

A

CXR = Pleural calfications/pleural plaques/pleural thickening

MC= Affects lower lobes

Biopsy = Linear asbestos bodies

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36
Q

Aspergillosis clinical intervention

A
  1. Allergic= Tapered steroids, chest physio , +/- Itraconazole
  2. Severe/Invasive = Voriconazole is DOC; high dose itraconazole, Amp B
  3. Aspergiolloma - FUNGAL BALL = Symptomatic surgical resection; asx = Observation
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37
Q

Atelectasis (scientific concepts)

A

Collapse of lung/lobe of lung; Multiple causes; MCC = Postop day #1 fever, tx with incentive spirometry

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38
Q

Bronchiectasis hx + pe

A

Impaired clearance of mucus - Recurrent/chronic lung infections (h. flu MCC if not due to cystic fibrosis)

Daily chronic cough with thick mucopurulent foul smelling sputum; hemoptysis; persistent crackles at base of lungs; dyspnea; wheeze, ronchi, clubbing

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39
Q

Bronchiectasis dx + lab studies

A

Study of choice = CT = tram tracking + signet ring sign

PFT = Obstructive cause

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40
Q

Bronchiolitis clinical intervention

A

Mainstay - Supportive tx with humidified oxygen, IVF, nebulized saline, cool mist, antipyretics

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41
Q

Carbon monoxide poisoning dx and labs

A

O2 pulse ox cant differentiate between HbO2 and carboxyhemoglobin; Must evaluate carboxyhemoglobin on ABG or VBG

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42
Q

Chronic bronchitis Hx+ PE

A

Productive cough for 6 MONTHS out of 2 YEARS; usually obese with leg edema = Blue Bloaters

PE = Rales, rhonchi, wheezing, +/- signs of cor pulmonale (peripheral edema, cyanosis)

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43
Q

COPD Drug Effect, Anticholinergics

A

Bronchodilation dries up secretions, ipatropium

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44
Q

Cor pulmonale (FMLD)

A

MC cadiac finding w/ chronic bronchitis; EKG = RVH + right atrial enlargement + Right axis deviation

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45
Q

Cor Pulmonale Dx + Labs

A

EKG = RVH + right atrial enlargement + Right axis deviation due to right heart failure

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46
Q

Cystic fibrosis (scientific concepts)

A

Autosomal recessive defect that prevents chloride transport –> Causing build up of mucus in lungs, pancreas, liver and intestines causing pancreatic insufficiency

CHromosome 7 defect - Life expectancy 3-49; MC affects caucasians + north europeans

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47
Q

Cystic fibrosis pharm interventions

A
  1. Airway clearance = Bronchodilators, mucolytics, abx, decongestants
  2. Pancreatic enzyme replacement (vitamins KADE)
  3. Lung + Pancreatic transplant
  4. Vaccines (Pneumococcocal + flu)
48
Q

Pleural effusion, malignant (Clinical Intervention)

A

Malignancy MC results = Exudative effusion

Thoracentesis= Gold standard for diagnosis

49
Q

PE (FMLD)

A

Sudden SOB + PLEURITIC chest pain + Cough/hemoptysis; Tachypnea + Initial respiratory alkalosis + hypoxemia

50
Q

Emphysema clinical intervention

A

O2 therapy; Pneumococcal + flu vaccines

51
Q

Emphysema Hx + PE

A

MCC = Smoking
MC sx = Dyspnea + mild cough

Hyperinflation, hyperresonance, decreased/absent breath sounds, decreased fremitus (vibration of air pt saying 99), barrel chest (increased AP diameter), quiet chest, pursed lip breathing, PINK PUFFER

52
Q

Empyema Dx + Labs

A
  1. CXR - PA/Lateral- blunting of costophrenic angles
  2. Thoracentesis = Test of choice
  3. CT = Confirm empyema
53
Q

H. Flu pneumonia scientific concepts

A

2nd MCC of CAP after strep pneumo

Increased incidence with underlying pulmonary disease like COPD

Gram (-) bacilli rods

Green sputum seen with H.flu + Pseudomonas; Lobar pneumonia

54
Q

Interstitial lung dz (FMLD)

A

Males who smoke and are over 40; MCC = long term exposure to asbestos; can be caused by RA

CT = Reticular opacities/honeycombing and GROUND GLASS opacities

Increased FEV1/FVC

55
Q

Klebsiella pneumo (scientific concepts)

A

Severe alcoholics, debilitated, chronic illness, aspirators, cavitary lesions; current jelly sputum

MC affects - Upper lobe especially Right side + bulging fissures

56
Q

Legionella pneumonia pharm intervention

A

Levofloxacin or Azithromycin

57
Q

Transudate effusion causes

A
  1. Hypoalbumin from cirrhosis or nephrotic syndromes
  2. CHF
  3. Constrictive pericarditis
58
Q

Negative pressure pulmonary edema clinical intervention

A

Seen in post extubation laryngospasm; Must open airway

59
Q

Pertussis clinical intervention

A
  1. Supportive - O2, nebs, ventilators
  2. Abx = Shorten duration like a macrolde (erythromycin/azithro) or Bactrim if allergic
60
Q

Pertussis (FMLD)

A
  1. Catarrhal phase = URI sx for 1-2 weeks MOST CONTAGIOUS
  2. Paroxysmal phase = Cough fits, inspiratory whoop
  3. Convalescent phase
61
Q

Pleural effusion clinical intervention

A
  1. Tx underlying cause; Diuretics, restrict sodium
  2. Thoracentesis = Gold standard
  3. Chest tube pleural fluid drainage (if empyema)
  4. Pleurodesis= Usually caused by malignancy = TALC is the MC of doxy
62
Q

Pleural effusion Hx + PE

A

Clinically asymptomatic; If sx = Dyspnea or PLEURITIC chest pain, cough

PE = Decreased tactile fremitues, decreased breath sounds, dullness to percussion; pleural friction rub

63
Q

Pneumococcal pneumonia (scientific concepts)

A

MCC of CAP (Strep pneumo)

Gram (+) Cocci in pairs

Single rigor, pleuritic chest pain, bronchial breath sounds, dullness to percussion, increased tactile fremitus, rales, rusty blood tinged sputum

64
Q

Pneumococcal pneumonia (pharm intervention)

A

Combination of beta-lactam like ceftriaxone/amox or amox/clauv

AND

Macrolide like Azithromycin

65
Q

Pneumoconiosis (FMLD)

A

Chronic fibrosis from mineral duses

Silicosis = Mining, quarry, granite/slate/quartz/pottery

Pnuemonoconiosis : Black lung disease

Berrylliosis: Aerospace/ceramics/tools/Dye

66
Q

Pneumothroax clinical intervention

A

Small/simple = Observe for at least 6 hours with repeat CXR to confirm no progression

Symptomatic = CHEST TUBE (Tube thoracostomy)

IF IN SHOCK = Immediate needle throacostomy

67
Q

PE MC Sx and MC Sign

A

MC sx = Dyspnea
MC sign = Tachypnea

68
Q

Pulmonary fibrosis (scientific concepts)

A

Chronic progressive interstitial scarring (fibrosis) from persistent inflammation which causes loss of pulmonary function

69
Q

Restrictive lung disease (FMLD)

A

Decreased total lung capacity (TLC), Residual volume (RV), functional residual capacity, forced vital capacity (FVC)

Normal FEV/FVC (these are decreased in obstructive)

70
Q

Caseating vs noncaseating granulomas

A

Caseating = TB = Body senses it and it walls it off

Noncaseating = Sarcoid= Weird autoimmune, goes undetected

71
Q

Silicosis (FMLD)

A

Sand-blast/quarry work/pottery

Small round opacities throughout lungs; “EGGSHELL CALCIFICATIONS” of hilar and mediastinal lymph nodes; usually affects upper lobes

72
Q

Superior vena cava syndrome (FMLD)

A

Cancer pushing on SVC = Causes JVD, edema in face and arms + swollen collateral veins of the front of chest wall

Facial Plethora = Morning puffy, goes away later

73
Q

Whooping cough aka pertussis health maint + prevention

A

Complications = Pneumonia, sinusitis, otitis media, seizures

Prevention = 5 doses of vaccine at 2 mo, 4, mo, 6mo, 15-18mo, 4-6yo + booster at 11-18yo

Close contacts treated with macrolide (azithromycin)

74
Q

Acute Hep B Dx + Lab studies

A

HBsAG (+)
Anti-HBs (-)
Anti-HBc = IgM

75
Q

Ascites clinical intervention

A

Sodium restriction/Spironolactone;

Diuretic resistant = TIPS procedure

76
Q

Biliary dysfunction (FMLD)

A

N/V cholestasis Increased alk phos + GGT+ bilirubin

77
Q

Boerhaave syndrome - rupture of esophagus (FMLD)

A

Full thickness rupture of distal esophagus associated with repeated vomiting like bulimia;

Retrosternal chest pain worsened with deep inspiration + swallowing; crepitus due to pneumomediastinum

78
Q

Hepatocellular carcinoma clinical intervention

A

Contrast CT or MRI for liver lesion + liver biopsy

Surgical resection if confined to 1 lobe AND not associated with cirrhosis

79
Q

Budd-Chiari (FMLD)

A

Condition caused by thormbotic or nonthrombotic obstuction of hepatic venous outflow; characterized by hepatomegaly, ascites, RUQ abd pain

MC in women 20-30

80
Q

Celiac disease dx + labs

A

Screening = TTG IgA antibodies
Confirm = Small bowel biopsy = atrophy of villi

81
Q

Choledocholithiasis clinical intervention

A

ERCP = diagnostic and therapeutic

82
Q

Chronic hep C health maint + prevention

A

Pts at risk for liver cancer - screening with alpha fetoprotein

AFP also used to screen testicular cancer

83
Q

Cirrhosis pharmaceutical interventions

A

Tx symptoms

Encephalopathy = Lactulose
Ascites = sodium restriction/spironolactone
Pruritus = Cholestyramine

84
Q

Tumor marker for colon cancer

85
Q

MC site of metastatic spread of colon cancer

A

Liver (also lungs, lymph nodes)

86
Q

Diverticulitis clinical intervention

A

NPO + IV ABX (cipro or bactrim AND metronidazole

Clear liquid diet, fiber supp

SURGERY if abscess or perforation

87
Q

Duodenal peptic ulcer pharm intervention

A
  1. H. Pylori eradication (Triple therapy CAP)
  2. H. Pylori negative = OTC antacids, H2 blockers, PPI, Misprostal, Bismuth
88
Q

Esophageal cancer health maint + prevention

A

Avoid ETOH, tobacco

GET GARDASIL vaccine to protect against HPV

89
Q

Esophageal cancer dx and labs

A

Dx = Upper endoscopy with biopsy

Hypercalcemia associated with squamous cell

90
Q

Esophagus perforation (FMLD)

A

Hematemsis, tachycardia, difficulty breathing

Can be complication of procedures (EGD)

91
Q

Food poisoning, Vibrio cholerea (scientific concepts)

A

Toxin activates enzyme in small intestine which leads to hypersecretion of water and chloride causing severe DIARRHEA and DEHYDRATION

Gram (-) rod transmitted by food and water; Outbreaks in poor sanitation areas ; traveling abroad

92
Q

G6PD (FMLD)

A

X-linked recessive; episodic acute hemolytic anemia- back of abdominal pain, jaundice, dark urine, splenomegaly

93
Q

GI hemorrhage Hx + PE

A

Upper GI hemorrhage = Hx of ulcers, ETOH, gastritis, bulimia, retching/vomiting

PE = Coffee ground emesis, dark tarry stools., tachycardia, pale, dizziness/confusion

94
Q

Gastroparesis (FMLD)

A

Delayed gastric emptying yet no mechanical obstriction

N/V early satiety, belching, bloating, and or upper abdominal pain

Often seen in DM or patients post surgery

95
Q

Hep A health maint + prevention

A

Postexposure prophy = HAV immune globulin

Preexposure prophy = Hep A vaccine given to high risk populations

96
Q

2 types of hiatal hernias

A

Type 1 - Sliding = MC - GE junction slides into mediastinum

Type 2 = Paraesophageal/rolling - fundus of stomach protrudes through diaphragm with GE junction not affected

97
Q

Hirschsprung disease dx and labs

A
  1. Anorectal MANOMETRY = initial screening
  2. Contrast enema
  3. Abd xray = decreased/absence air in rectum + dilated loops of bowl
  4. Rectal biopsy = DEFINITIVE TEST
98
Q

Ileus clinical intervention

A

Needs NPO + NG tube placed

Electrolyte/fluid replacement

Tx underlying cause (abdominal and/or pelvic surgery)

99
Q

Liver cirrhosis (scientific concepts)

A

Alcohol = MCC, chronic viral hepatitis

NAFLD, hemochromatosis

100
Q

Malabsorption syndrome clinical intervention

A

Gluten free diet if due to Celiac disease

Chronic diarrhea due to proximal small bowel bacteria overgrown (SBO) = tx with metronidazole or Rifaximin

Chidlren with chronic diarrhea 2nd to bile acid = tx with cholestyramine to bind biile acid salts

Try elimination diet, avoid offending agents if allergic

101
Q

Malnutrition clinical intervention

A

If due to anorexia
1. Hospitalize for <75% expected body weight or pts with medical complications
2. Cognitive behavior therapy, supervised meals. weight monitoring
3. SSRIs +/- atypical antipsychotics

102
Q

MALT lymphoma Hx + PE

A

Hx of H.pylori if gastric

Hx of lyme disease or Chlamydia psittaci (from birds) if nongastric

*Subclass of non-hodgkin lymphoma

103
Q

Normal anatomy appendix (scientific concepts)

A

CT Appendix wall <6mm in diameter, absence of wall thickening, and no wall enhancement after contrast media infusion

104
Q

Pancreatic adenocarcinoma health maint + prevention

A

CA-19-9 and CEA markers

Modified whipple if NO Mets

Chemo + radiation, poor prognosis

105
Q

Paralytic ileus (FMLD)

A

Aka post-op ileus

NO BOWEL SOUNDS + NO FLATUS + NO BM

106
Q

Colon cancer screening health maint + prevention

A

Colonoscopy starting at age 50 until 75

1st degree start 10yo prior to when they had cancer

Lynch syndrome = Screen at 20-25 colonoscopy q1-2years
FAP = Screening at 10-12yo via flex sig yearly

107
Q

Small bowel obstruction hx and PE

A

MCC = Post surgical adhesions
2nd MCC = Incarcerated hernia

PE = Abdominal distention, hyperactive bowel sounds early and then NO bowel sounds later

108
Q

Small bowel obstruction dx and labs

A

Abd radiograph = Air fluid levels in step ladder pattern, dilated loops of bowel

Minimal gas in colon = COMPLETE obstriuction

109
Q

UC dx and labs

A

Labs = P Anca

Colonoscopy = Uniform inflammation +/- ulceration, pseudopolyps

110
Q

Vitamin deficiency, Riboflavin (FMLD)

A

Oral-ocular genital syndrome aka FLAVA FLAVE

Oral = Lesions in mouth, MAGENTA colored tongue, angular cheilities
Ocular = Photophobia, corneal lesions
Genital = Scrotal dermatitis

111
Q

Wilson disease dx and labs

A

Decreased CERULOPLASMIN

Increased urinary copper excretion

112
Q

Zollinger Ellison syndrome Dx + Labs

A
  1. Increased fasting gastrin level = Best screening test
  2. (+) secretin test
  3. Increased basal acid ouput = INCREASED CHROMAGRANIN A
  4. Somastatin receptor sctinigraphy helpful in localizing tumor
113
Q

LBBB on EKG

A

RSR pattern in V1

114
Q

RBBB on EKG

A

RSR pattern in V4-V6

115
Q

Aspergillosis (scientific concepts)

A

Produces alfatoxin B1 = associated risk of hepatocellular carcinoma

Precision (5 decks)

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