CardioPulm Flashcards
A patient comes in with SOB. On auscultation, you hear expiratory wheezing and retractions. What is the most likely diagnosis and how would you treat it?
Asthma
Tx:
- short acting beta agonist: albuterol
- anticholingeric: ipratropium
- corticosteroid: prednisone - give within 1 hr of arrival to ED to decrease need for admission
What are the 3 main components to asthma?
Airway inflammation
Intermittent airflow obstruction
Bronchial hyperresponsiveness
How would you test someone for asthma?
Peak flow
Pulmonary function test
CXR - only if febrile and focal lung findings
A patient presents with severe asthma exacerbation, including AMS, hypercapnia, and respiratory exhaustion. What is your most likely management for this patient?
Epinephrine
Mg
Ketamine
CPAP
A patient was admitted for asthma exacerbation. Under what conditions would you consider discharging them?
If peak expiratory flow >70% and they are able to obtain their meds.
A patient comes in with complaints of SOB. On PE, you notice the patient is tachypneic, tachycardic, coughs frequently, and uses their accessory muscles. Lung exam reveals rhonci and wheezing with diminished breaths sounds. What is the most likely diagnosis and how would you treat it?
COPD
Tx:
- Duoneb/ipratropium/albuterol
- O2
- Prednisone
A patient presents with what you believe to be is COPD. How would you test it?
Pulmonary function test - gold standard
EKG
Labs
GOLD criteria
In what disease process is the GOLD criteria used and what does it include?
COPD
Increased dyspnea
Increased sputum production
Sputum purulence or purulence
Pt requiring vent
You determine that the patient with asthma exacerbation must be intubated. They then develop a pneumothorax. What symptoms did this patient show that helped you arrive to this diagnosis? How would you treat it?
Pleuritic chest pain Dyspnea Tachypnea Tachycardia Hypotension Hypoxia
PE: Decreased breath sounds, hyperresonance
Tx: O2 & chest tube
A patient comes in with a cough and SOB. On PE, you notice the patient has a rash, is tachycardic, tachypneic, and has rales, rhonci and wheezing on auscultation. What is the most likely diagnosis and how would you treat it if inpatient?
Pneumonia
Tx:
- ABCs: patients often come in septic
- IV fluoroquinolone (and B-lactam if severe) OR
- B-lactam +macrolide
A patient presents with substernal chest pain. He has a history of HTN, and TDM2. He notes he first noticed it 1 hour ago while doing some yard work, but reports that even with rest, the pain persists. What other pertinent past medical/social history may this patient have?
Acute coronary syndrome
Cocaine use
What’s the difference between stable and unstable angina?
Stable angina:
- chest pain with exertion
- relief with rest
- ST depressions
- 70% occlusion
Unstable angina
- chest pain at rest
- ST segment depressions and T wave inversions
- 90% occlusion (chest pain at rest indicates >90% occlusion)
A patient presents with tachycardia, diaphoresis, N/V, abdominal pain, and dyspnea. How would you manage?
ECG within 10 minutes of presentation (door to doctor)
Worried about ACS
This is an atypical presentation, which is common in women, the elderly, and those with diabetes.
What are the three criteriaused to diagnose infarction in patients with LBBB?
Sgarbossa Criteria
- ≥ 1 lead with ≥1 mm of concordant ST elevation
- ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
- ≥ 1 lead anywhere with ≥ 1 mm ST elevation and proportionally excessive discordant ST elevation, as defined by ≥ 25% of the depth of the preceding S-wave.
A patient with chest pain presents to the ED. ECG shows ST segment elevations. What is the next best step in managment?
Cath lab/PCI within 90 min.
Door to fibrinolysis within 30 min+transfer
While transferring a STEMI patient to a cath lab, what treatment options are available to you?
Morphin - if nitro isn’t relieving pain
Oxygen: if O2 sat is below 92%
Nitro sublingual x 3 doses q 5 min, then drip - make sure they’re not taking any PDE5 inhibitors (viagra)
Aspirin chewable
A patient presents with non ST elevation acute coronary syndrome. How would you treat?
Dual antiplatelet therapy with:
- Clopidogrel
- Aspirin
- Statin
A patient presents with an MI. A 12-lead ECG shows changes in lead I and V6. What artery is involved?
Left circumflex artery
A patient presents with an MI. A 12-lead ECG shows changes in leads II and avF. What artery is involved?
R circumflex artery
Posterior descending
A patient presents with an MI. A 12-lead ECG shows changes in leads V1 and V2. What artery is involved?
Posterior descending
A patient presents with an MI. A 12-lead ECG shows changes in lead V4. What artery is involved?
Left anterior descending artery
A patient presents with tearing chest and upper back pain. She notes it occasionally radiates between the scapula. What would you find on PE?
Aortic dissection
PE:
- unequal BP in both arms
- pulse deficit
- focal neurological deficits
- new murmur of aortic insufficiency + pain
- hypotension
A patient presents with anterior, knife-like chest pain. What imaging must be done and what would they show?
Aortic dissection
CXR: widened mediastinum, double density sign
CT angiogram
How would you treat someone who comes in with an aortic dissection?
Surgery!
Medical - Beta blocker - esmolol or labetalol to manage BP
A hypertensive 50 yo male patient comes in presenting with abrupt abdominal pain and unequal blood pressures in both arms. What other characteristics would this patient have that puts him at increased risk of this diagnosis?
Aortic dissection
Marfan/connective tissue disorders
Bicuspid aortic valve
A patient presents with palpitations, dizziness, fatigue, and dyspnea. What would you expect to see on an EKG if AFib was on your differential?
Rapid irregularly irregular ventricular response.
No discernible P waves.
HR variable 100-200 (consider WPW)
A patient who drank A LOT over the holidays comes in with palpitations. You determine she has AFib. How would you treat her?
Stable: RATE CONTROL BEFORE RHTYHM CONTROL with Metoprolol or Diltiazem/Verapamil
Unstable: direct synchronized cardioversion
Calculate their coagulation with the CHADSVASC score
- 0: ASA
- 1: ASA or Warfarin
> 2: Warfarin
What criteria must a patient meet in order to be considered having a hypertensive emergency?
> 180/>120 + end organ damage
A patient presents with a hypertensive emergency. How do you treat?
IV BP reduction agents
1st hour: MAP should be reduced gradually by 10-20%
Next 23 hours: 5-15%
Pt reports he began having pain in his left hand late last night. He recently had a dialysis fistula placed in the LUE. This morning, he noted his hand seemed pale/blue and was also cold. Rates his pain a 7/10. What is the most likely diagnosis and how would you treat?
Acute arterial occlusion
Tx: HEPARIN + thrombectomy
A patient presents with what you believe to be an acute arterial occlusion. What risk factors and sxs would the patient present with? What would help you definitively make the dx?
Risk factors:
- Afib/Flutter
- Trauma
- Hypercoagulable state
- Post procedural mitral stenosis
SxS:
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Poikilothermia
- Paralysis
Dx:
- Arteriogram
A patient presents with new onset murmur and persistent fever. What are his most likely risk factors?
Endocarditis
RF: mitral valve prolapse, IV drug use
A patient presents with violaceous nodules on their palms and painless macules on their palms and soles. There are also retinal hemorrhages with central clearing. What are the buzzwords for these? What’s the most likely diagnosis?
Endocarditis
Osler nodes: violaceous nodules on the pads of digits and palms
Janeway lesions: painless erythematous macules on palms and soles
Roth spots: retinal hemorrhages with central clearing
What organisms cause endocarditis and why?
Staph. aureus - IV drug use; affects normal valves
Strep. viridians - affects damaged valves. Dental procedures.
Staph. epidermis - affects prosthetic valves
A patient presents with what you believe to be endocarditis? What criteria do you follow?
Duke Criteria
- 2 major or 1 major + 3 minor
Major:
- sustained bacteremia (positive blood cultures)
- positive echocardiogram, new aortic/mitral regurgitation
Minor:
- Fever
- vascular/embolic phenomena (Janeway lesions, PE, ICH)
- Immunologic phenomena
What’s the causative agent of those who are alcoholics and have pneumonia?
Klebsiella - “currant jelly”
What’s the causative agent of those who have cystic fibrosis and have pneumonia?
pseudomonas
What’s the causative agent of those who have HIV and have pneumonia?
Pneumocystis jirovecii
What’s the causative agent of those who are IV drug users and have pneumonia?
staph aureus
