Cardio/Pulm/GI Flashcards
Acute MI Pharm intervention
O2, Aspirin, Nitroglycerin, BB, ACE, Statin, Anticoag + Antiplatelet
Leads in Anterior MI
V1-V4 = LAD
Leads in Lateral MI
1, AVL, V5, V6
Common SE of Amiodarone
Eye, Thy, Lungs = Optic neuritis, Thyroid disease, Pulmonary fibrosis
Stable vs Unstable Angina Pharm intervention
Stable = Nitro
Unstable = MONA
Aortic insufficiency (FMLD)
Aka aortic regurge = LUSB blowing decresendo diastolic murmur that DECREASES with valsalva
Second and 3rd Degree AV block clinical intervention
2nd Block initial tx = Transcutaneous pacing; Definitive = Pacemaker
3rd Degree = Pacemaker
A. fib Clinical intervention (3 steps)
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
Passive junctional rhythm (Basic concepts)
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
Junctional tachycardia (Basic concepts)
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
Cardiogenic shock (Basic concepts)
Hypotension + CHF at the same time
Dilated Cardiomyopathy (Basic concepts)
S3 gallop + Decreased Ejection fraction
Dilated Left ventricle is weak and cannot pump well
Dilated Cardiomyopathy pharm intervention
ACE, BB, Implantable device if EF is 30-35%
BASH heart = Bblockers, Ace, Spironolactone, Hydralazine
Dissecting aortic aneurysm Dx + Lab Studies
CT with contrast
MRI angio = GOLD STANDARD
TEE
CXR = Widening mediastinum
Endocarditis (basic concept)
If blood cultures are negative, suspect HACEK gram negative organism
Coarctation of aorta clinical intervention
Surgical correction with balloon angioplasty
Coarctation of aorta Hx and PE
Child with secondary HTN, bilateral claudication, delayed or weak femoral pulses
CHF acute vs chronic pharmaceutical intervention
Acute = LMNOP = Lasix, Morphine, Nitro, Oxygen, Bipap
Chronic = ACE, BB
Heart murmur of any kind dx and lab studies
ECHO
Hypertensive emergency/crisis pharmaceutical intervention
Clonidine, captopril, labetolol, nicardipine, methyldopa
Gradual reduction = Decrease BP by 10-20% in 1 hour and 25% over 24-48hrs
Hyperlipidemia pharmaceutical intervention
LDL = Statin
HDL = Niacin +/- Bile acid salts (if pregnant)
Triglycerides = Fibrates like gemfibrozil
Pericardial effusion clinical intervention
Small = Observation no tx
Large = Pericardiocentesis + pericardial window if recurrent
Papillary muscle rupture clinical intervention
Cardiogenic shock = CHF + Hypotension
SURGERY emergent with mitral valve replacement
Mitral stenosis (FMLD)
Loud S1 SNAP, early to mid diastolic rumble at apex, decrease murmur with standing
MCC = Rheumatic heart disease
Pericarditis (scientific concepts)
Inflammation of the pericardium; MCC = Coxsackie or echovirus
SVT (FMLD)
Definitive with EKG = no P waves + Tachycardia + Narrow QRS
Tetralogy of fallot (FMLD)
RV outflow obstruction + RVH + Overriding Aorta + VSD (4 things)
Stable V. tach pharmaceutical intervention
Amiodarone
Unstable = Cardioversion or Defib if no pulse
Acute Epiglottitis (Health Maint +Prevention)
MEDICAL EMERGENCY
MCC = HiB; Children 3mo-6mo; Prevention with vaccine
Acute Epiglottitis Dx and Labs
Definitive dx = Laryngoscopy = provides direct visualization
ARDS clinical intervention
Positive pressure ventilation = Intubation or BiPAP
ARDS clinical intervention
Positive pressure ventilation = Intubation or BiPAP
ARDS (FMLD)
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
ARDS dx and labs
- ABG = refractory hypoxemia
- CXR = diffuse bilateral pulmonary infiltrates = white out pattern
- Cardiac cath pf pulmonary artery (swanz cath) measuring pulmonary cap wedge pressure of less than 18
Asbestosis dx +labs
CXR = Pleural calfications/pleural plaques/pleural thickening
MC= Affects lower lobes
Biopsy = Linear asbestos bodies
Aspergillosis clinical intervention
- Allergic= Tapered steroids, chest physio , +/- Itraconazole
- Severe/Invasive = Voriconazole is DOC; high dose itraconazole, Amp B
- Aspergiolloma - FUNGAL BALL = Symptomatic surgical resection; asx = Observation
Atelectasis (scientific concepts)
Collapse of lung/lobe of lung; Multiple causes; MCC = Postop day #1 fever, tx with incentive spirometry
Bronchiectasis hx + pe
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
Bronchiectasis dx + lab studies
Study of choice = CT = tram tracking + signet ring sign
PFT = Obstructive cause
Bronchiolitis clinical intervention
Mainstay - Supportive tx with humidified oxygen, IVF, nebulized saline, cool mist, antipyretics
Carbon monoxide poisoning dx and labs
O2 pulse ox cant differentiate between HbO2 and carboxyhemoglobin; Must evaluate carboxyhemoglobin on ABG or VBG
Chronic bronchitis Hx+ PE
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)
COPD Drug Effect, Anticholinergics
Bronchodilation dries up secretions, ipatropium
Cor pulmonale (FMLD)
MC cadiac finding w/ chronic bronchitis; EKG = RVH + right atrial enlargement + Right axis deviation
Cor Pulmonale Dx + Labs
EKG = RVH + right atrial enlargement + Right axis deviation due to right heart failure
Cystic fibrosis (scientific concepts)
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