Cardio/Pulm/GI Flashcards
1
Q
Acute MI Pharm intervention
A
O2, Aspirin, Nitroglycerin, BB, ACE, Statin, Anticoag + Antiplatelet
2
Q
Leads in Anterior MI
A
V1-V4 = LAD
3
Q
Leads in Lateral MI
A
1, AVL, V5, V6
4
Q
Common SE of Amiodarone
A
Eye, Thy, Lungs = Optic neuritis, Thyroid disease, Pulmonary fibrosis
5
Q
Stable vs Unstable Angina Pharm intervention
A
Stable = Nitro
Unstable = MONA
6
Q
Aortic insufficiency (FMLD)
A
Aka aortic regurge = LUSB blowing decresendo diastolic murmur that DECREASES with valsalva
7
Q
Second and 3rd Degree AV block clinical intervention
A
2nd Block initial tx = Transcutaneous pacing; Definitive = Pacemaker
3rd Degree = Pacemaker
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
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
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
11
Q
Cardiogenic shock (Basic concepts)
A
Hypotension + CHF at the same time
12
Q
Dilated Cardiomyopathy (Basic concepts)
A
S3 gallop + Decreased Ejection fraction
Dilated Left ventricle is weak and cannot pump well
13
Q
Dilated Cardiomyopathy pharm intervention
A
ACE, BB, Implantable device if EF is 30-35%
BASH heart = Bblockers, Ace, Spironolactone, Hydralazine
14
Q
Dissecting aortic aneurysm Dx + Lab Studies
A
CT with contrast
MRI angio = GOLD STANDARD
TEE
CXR = Widening mediastinum
15
Q
Endocarditis (basic concept)
A
If blood cultures are negative, suspect HACEK gram negative organism
16
Q
Coarctation of aorta clinical intervention
A
Surgical correction with balloon angioplasty
17
Q
Coarctation of aorta Hx and PE
A
Child with secondary HTN, bilateral claudication, delayed or weak femoral pulses
18
Q
CHF acute vs chronic pharmaceutical intervention
A
Acute = LMNOP = Lasix, Morphine, Nitro, Oxygen, Bipap
Chronic = ACE, BB
19
Q
Heart murmur of any kind dx and lab studies
A
ECHO
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
21
Q
Hyperlipidemia pharmaceutical intervention
A
LDL = Statin
HDL = Niacin +/- Bile acid salts (if pregnant)
Triglycerides = Fibrates like gemfibrozil
22
Q
Pericardial effusion clinical intervention
A
Small = Observation no tx
Large = Pericardiocentesis + pericardial window if recurrent
23
Q
Papillary muscle rupture clinical intervention
A
Cardiogenic shock = CHF + Hypotension
SURGERY emergent with mitral valve replacement
24
Q
Mitral stenosis (FMLD)
A
Loud S1 SNAP, early to mid diastolic rumble at apex, decrease murmur with standing
MCC = Rheumatic heart disease
25
Pericarditis (scientific concepts)
Inflammation of the pericardium; MCC = Coxsackie or echovirus
26
SVT (FMLD)
Definitive with EKG = no P waves + Tachycardia + Narrow QRS
27
Tetralogy of fallot (FMLD)
RV outflow obstruction + RVH + Overriding Aorta + VSD (4 things)
28
Stable V. tach pharmaceutical intervention
Amiodarone
Unstable = Cardioversion or Defib if no pulse
29
Acute Epiglottitis (Health Maint +Prevention)
MEDICAL EMERGENCY
MCC = HiB; Children 3mo-6mo; Prevention with vaccine
30
Acute Epiglottitis Dx and Labs
Definitive dx = Laryngoscopy = provides direct visualization
31
ARDS clinical intervention
Positive pressure ventilation = Intubation or BiPAP
32
ARDS clinical intervention
Positive pressure ventilation = Intubation or BiPAP
33
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
34
ARDS dx and labs
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
35
Asbestosis dx +labs
CXR = Pleural calfications/pleural plaques/pleural thickening
MC= Affects lower lobes
Biopsy = Linear asbestos bodies
36
Aspergillosis clinical intervention
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
37
Atelectasis (scientific concepts)
Collapse of lung/lobe of lung; Multiple causes; MCC = Postop day #1 fever, tx with incentive spirometry
38
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
39
Bronchiectasis dx + lab studies
Study of choice = CT = tram tracking + signet ring sign
PFT = Obstructive cause
40
Bronchiolitis clinical intervention
Mainstay - Supportive tx with humidified oxygen, IVF, nebulized saline, cool mist, antipyretics
41
Carbon monoxide poisoning dx and labs
O2 pulse ox cant differentiate between HbO2 and carboxyhemoglobin; Must evaluate carboxyhemoglobin on ABG or VBG
42
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)
43
COPD Drug Effect, Anticholinergics
Bronchodilation dries up secretions, ipatropium
44
Cor pulmonale (FMLD)
MC cadiac finding w/ chronic bronchitis; EKG = RVH + right atrial enlargement + Right axis deviation
45
Cor Pulmonale Dx + Labs
EKG = RVH + right atrial enlargement + Right axis deviation due to right heart failure
46
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
47
Cystic fibrosis pharm interventions
1. Airway clearance = Bronchodilators, mucolytics, abx, decongestants
2. Pancreatic enzyme replacement (vitamins KADE)
3. Lung + Pancreatic transplant
4. Vaccines (Pneumococcocal + flu)
48
Pleural effusion, malignant (Clinical Intervention)
Malignancy MC results = Exudative effusion
Thoracentesis= Gold standard for diagnosis
49
PE (FMLD)
Sudden SOB + PLEURITIC chest pain + Cough/hemoptysis; Tachypnea + Initial respiratory alkalosis + hypoxemia
50
Emphysema clinical intervention
O2 therapy; Pneumococcal + flu vaccines
51
Emphysema Hx + PE
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
Empyema Dx + Labs
1. CXR - PA/Lateral- blunting of costophrenic angles
2. Thoracentesis = Test of choice
3. CT = Confirm empyema
53
H. Flu pneumonia scientific concepts
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
Interstitial lung dz (FMLD)
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
Klebsiella pneumo (scientific concepts)
Severe alcoholics, debilitated, chronic illness, aspirators, cavitary lesions; current jelly sputum
MC affects - Upper lobe especially Right side + bulging fissures
56
Legionella pneumonia pharm intervention
Levofloxacin or Azithromycin
57
Transudate effusion causes
1. Hypoalbumin from cirrhosis or nephrotic syndromes
2. CHF
3. Constrictive pericarditis
58
Negative pressure pulmonary edema clinical intervention
Seen in post extubation laryngospasm; Must open airway
59
Pertussis clinical intervention
1. Supportive - O2, nebs, ventilators
2. Abx = Shorten duration like a macrolde (erythromycin/azithro) or Bactrim if allergic
60
Pertussis (FMLD)
1. Catarrhal phase = URI sx for 1-2 weeks MOST CONTAGIOUS
2. Paroxysmal phase = Cough fits, inspiratory whoop
3. Convalescent phase
61
Pleural effusion clinical intervention
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
Pleural effusion Hx + PE
Clinically asymptomatic; If sx = Dyspnea or PLEURITIC chest pain, cough
PE = Decreased tactile fremitues, decreased breath sounds, dullness to percussion; pleural friction rub
63
Pneumococcal pneumonia (scientific concepts)
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
Pneumococcal pneumonia (pharm intervention)
Combination of beta-lactam like ceftriaxone/amox or amox/clauv
AND
Macrolide like Azithromycin
65
Pneumoconiosis (FMLD)
Chronic fibrosis from mineral duses
Silicosis = Mining, quarry, granite/slate/quartz/pottery
Pnuemonoconiosis : Black lung disease
Berrylliosis: Aerospace/ceramics/tools/Dye
66
Pneumothroax clinical intervention
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
PE MC Sx and MC Sign
MC sx = Dyspnea
MC sign = Tachypnea
68
Pulmonary fibrosis (scientific concepts)
Chronic progressive interstitial scarring (fibrosis) from persistent inflammation which causes loss of pulmonary function
69
Restrictive lung disease (FMLD)
Decreased total lung capacity (TLC), Residual volume (RV), functional residual capacity, forced vital capacity (FVC)
Normal FEV/FVC (these are decreased in obstructive)
70
Caseating vs noncaseating granulomas
Caseating = TB = Body senses it and it walls it off
Noncaseating = Sarcoid= Weird autoimmune, goes undetected
71
Silicosis (FMLD)
Sand-blast/quarry work/pottery
Small round opacities throughout lungs; "EGGSHELL CALCIFICATIONS" of hilar and mediastinal lymph nodes; usually affects upper lobes
72
Superior vena cava syndrome (FMLD)
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
Whooping cough aka pertussis health maint + prevention
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
Acute Hep B Dx + Lab studies
HBsAG (+)
Anti-HBs (-)
Anti-HBc = IgM
75
Ascites clinical intervention
Sodium restriction/Spironolactone;
Diuretic resistant = TIPS procedure
76
Biliary dysfunction (FMLD)
N/V cholestasis Increased alk phos + GGT+ bilirubin
77
Boerhaave syndrome - rupture of esophagus (FMLD)
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
Hepatocellular carcinoma clinical intervention
Contrast CT or MRI for liver lesion + liver biopsy
Surgical resection if confined to 1 lobe AND not associated with cirrhosis
79
Budd-Chiari (FMLD)
Condition caused by thormbotic or nonthrombotic obstuction of hepatic venous outflow; characterized by hepatomegaly, ascites, RUQ abd pain
MC in women 20-30
80
Celiac disease dx + labs
Screening = TTG IgA antibodies
Confirm = Small bowel biopsy = atrophy of villi
81
Choledocholithiasis clinical intervention
ERCP = diagnostic and therapeutic
82
Chronic hep C health maint + prevention
Pts at risk for liver cancer - screening with alpha fetoprotein
AFP also used to screen testicular cancer
83
Cirrhosis pharmaceutical interventions
Tx symptoms
Encephalopathy = Lactulose
Ascites = sodium restriction/spironolactone
Pruritus = Cholestyramine
84
Tumor marker for colon cancer
CEA
85
MC site of metastatic spread of colon cancer
Liver (also lungs, lymph nodes)
86
Diverticulitis clinical intervention
NPO + IV ABX (cipro or bactrim AND metronidazole
Clear liquid diet, fiber supp
SURGERY if abscess or perforation
87
Duodenal peptic ulcer pharm intervention
1. H. Pylori eradication (Triple therapy CAP)
2. H. Pylori negative = OTC antacids, H2 blockers, PPI, Misprostal, Bismuth
88
Esophageal cancer health maint + prevention
Avoid ETOH, tobacco
GET GARDASIL vaccine to protect against HPV
89
Esophageal cancer dx and labs
Dx = Upper endoscopy with biopsy
Hypercalcemia associated with squamous cell
90
Esophagus perforation (FMLD)
Hematemsis, tachycardia, difficulty breathing
Can be complication of procedures (EGD)
91
Food poisoning, Vibrio cholerea (scientific concepts)
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
G6PD (FMLD)
X-linked recessive; episodic acute hemolytic anemia- back of abdominal pain, jaundice, dark urine, splenomegaly
93
GI hemorrhage Hx + PE
Upper GI hemorrhage = Hx of ulcers, ETOH, gastritis, bulimia, retching/vomiting
PE = Coffee ground emesis, dark tarry stools., tachycardia, pale, dizziness/confusion
94
Gastroparesis (FMLD)
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
Hep A health maint + prevention
Postexposure prophy = HAV immune globulin
Preexposure prophy = Hep A vaccine given to high risk populations
96
2 types of hiatal hernias
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
Hirschsprung disease dx and labs
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
Ileus clinical intervention
Needs NPO + NG tube placed
Electrolyte/fluid replacement
Tx underlying cause (abdominal and/or pelvic surgery)
99
Liver cirrhosis (scientific concepts)
Alcohol = MCC, chronic viral hepatitis
NAFLD, hemochromatosis
100
Malabsorption syndrome clinical intervention
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
Malnutrition clinical intervention
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
MALT lymphoma Hx + PE
Hx of H.pylori if gastric
Hx of lyme disease or Chlamydia psittaci (from birds) if nongastric
*Subclass of non-hodgkin lymphoma
103
Normal anatomy appendix (scientific concepts)
CT Appendix wall <6mm in diameter, absence of wall thickening, and no wall enhancement after contrast media infusion
104
Pancreatic adenocarcinoma health maint + prevention
CA-19-9 and CEA markers
Modified whipple if NO Mets
Chemo + radiation, poor prognosis
105
Paralytic ileus (FMLD)
Aka post-op ileus
NO BOWEL SOUNDS + NO FLATUS + NO BM
106
Colon cancer screening health maint + prevention
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
Small bowel obstruction hx and PE
MCC = Post surgical adhesions
2nd MCC = Incarcerated hernia
PE = Abdominal distention, hyperactive bowel sounds early and then NO bowel sounds later
108
Small bowel obstruction dx and labs
Abd radiograph = Air fluid levels in step ladder pattern, dilated loops of bowel
Minimal gas in colon = COMPLETE obstriuction
109
UC dx and labs
Labs = P Anca
Colonoscopy = Uniform inflammation +/- ulceration, pseudopolyps
110
Vitamin deficiency, Riboflavin (FMLD)
Oral-ocular genital syndrome aka FLAVA FLAVE
Oral = Lesions in mouth, MAGENTA colored tongue, angular cheilities
Ocular = Photophobia, corneal lesions
Genital = Scrotal dermatitis
111
Wilson disease dx and labs
Decreased CERULOPLASMIN
Increased urinary copper excretion
112
Zollinger Ellison syndrome Dx + Labs
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
LBBB on EKG
RSR pattern in V1
114
RBBB on EKG
RSR pattern in V4-V6
115
Aspergillosis (scientific concepts)
Produces alfatoxin B1 = associated risk of hepatocellular carcinoma
