CardioPulm1

Question 1

Characterize the pathophysiology of ARDS:

Answer 1

ARDS = fever, respiratory distress, hypoxemia, and bilateral opacities

ARDS is proinflammatory condition. Lung injury&raquo_space; release of proteins, inflammatory cytokines, and neutrophil into alveolar space&raquo_space; leakage of bloody and proteinaceous fluid into alveoli, alveolar collapse due to loss of surfactant&raquo_space; impaired gas exchange + physiologic shunting.

Question 2

Normal sinus rhythm, narrow QRS, widened PR (>5 small blocks/.2 sec) =

Answer 2

First degree Heart Block

Question 3

What is the acute mgmt. of acute decompensated heart failure?

Answer 3

ADHF = sx of L heart failure and pulmonary edema.

Acute mgmt. = supplemental O2 and IV loop diuretics (furosemide). IV nitroglycerin is a possible adjunctive therapy in Pt without hypotension (especially those with MR or symptomatic MI)

** cardioselective BB (carvedilol, metoprolol) can acutely worsen HF Sx.

Question 4

What is a hepatojugular reflux and what does it indicate?

Answer 4

Hepatojugular reflux = pressure on upper abdomen&raquo_space; sustained elevation of jugular venous pressure

Reflects failing R ventricle that cannot accommodate ^ venous return. MCC are restrictive cardiomyopathy, constrictive pericarditis, and RV infarct.

Question 5

What is the initial test of choice in diagnosing aortic dissection in hemodynamically stable and hemodynamically unstable patients?

Answer 5

Stable = CT angio 
Unstable = Transesophageal echo (TEE)

Question 6

What is a first line treatment for vasospastic angina?

Answer 6

CCB + nitrates

Question 7

Development of digital clubbing and sudden onset joint arthropathy in a chronic smoker is suggestive of:

Answer 7

hypertrophic osteoarthropathy (subset of COPD)

Question 8

What’s considered normal vs elevated CVP (central venous pressure) when measuring JVD?

Answer 8

Normal CVP = 6-8 cm
Elevated CVP = > 8 cm

CVP = JVD + depth to right atrium (typically measured at sternal angle when Pt lays 30-45% flat). Normal depth to RA = 5 cm

Question 9

Abnormal venous dilation (telangiectasia + varicose veins) + lipodermatosclerosis [skin pigmentation] + skin ulceration on medial aspect of foot are all pathognomonic for:

Answer 9

Chronic venous insufficiency

Question 10

Angiotensin II is a potent vasoconstrictor that promotes production of ___ from adrenal cortex:

Answer 10

aldosterone

Question 11

___ is produced in the JGA of the kidney in response to hypoperfusion:

Answer 11

Renin. Responsible for converting angiotensinogen&raquo_space; Ang I

Question 12

Mid to late peaking systolic murmur, presence of soft and single S2, and diminished + delayed carotid pulse are pathognomonic for:

Answer 12

Aortic Stenosis (AS)

Delayed carotid pulse = pulsus parvus et tardus

Question 13

Why do you hear a single S2 heart sound in aortic stenosis?

Answer 13

Thickened/calcified aortic leaflets&raquo_space; reduced mobility. A2 is delayed and occurs simultaneously with pulmonic valve P2.