FM/IMC Flashcards

1
Q

? is the MC type of cardiomyopathy

What PE heart sound is associated w/ this MC

What causes this to occur

A

Dilated

S3 (fluid overload) w/ low EF

Damaged myocardium weakens, causes all chambers to dilate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dilated cardiomyopathy is characterized by ?

What two factors increase these Pts risk for sudden cardiac death

What is the best way to Dx this condition

A

Dec contraction and systolic dysfunction

Ventricular enlargement, Progressive HF

Echo showing LV dilation w/ EF <50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is seen on CXR of dilated myopathy

What is seen on PE

How is Dilated Cardiomyopathy Tx and cardiac out put increased

A

Balloon-heart w/ megaly/pulm congestion

Displaced apical impulse
Inc JVP
Large liver
Edema

Loop+ACEI+BB; Inc CO w/ Digitalis;
Transplant/LVAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What duo is characteristic for HOCM

How does this present on PE

How is this murmur changes

A

Septal hypertrophy >1.5cm w/ ventricular outflow obstruction mimicking AS; diastolic dysfunction d/t autosomal dominant mutation of sarcomeres

Bifid pulse
Medium pitched, cres-decrescendo
Prominent A-wave- atria contracting against closed valve
S4 gallop w/ apical lift

Inc w/ dec volume: valsalva, standing, tachycardia
Dec w/: squat, grips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is HOCM Tx

What drugs are avoided in HOCM and what drug is c/i

Define Restrictive Cardiomyopathy

A

Metoprolol/Verapamil- dec contractility/HR
ICD if syncope/sudden arrest
Surgical/Alcohol ablation of septal hypertrophy

Dec preload: Nitrate ARB Diuretic ACEI;
Digoxin- inc contractility will inc obstruction

Right HF d/t non-compliant ventricals w/ dec diastolic filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is heard on PE of restrictive myopathy

Half of these cases are caused by ?

How is restrictive cardiomyopathy Dx

A

P-HTN; S4 d/t stiff/thick ventricle

Idiopathic

Echo w/ cardiac cath- high atrial pressure
Uncertain= MRI to eval texture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is seen on EKG of restrictive myopathy

What is seen on Echo

How is restrictive cardiomyopathy Tx

A

Non-specific, abnormal ST/T wave w/ low voltage

Dilated atria, Hypertrophy

Diuretics if edema/congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define ASD

ASDs are the ? MC congenital heart Dz and place Pts at risk for ?

ASD Sxs are dependent on size and Sxs don’t present until ? age

A

Interatrial septal hole- diastolic L to R shunt w/ volume overload of R side (atrial contracted= RV vol overload)

2nd (VSD is 1st); paradoxical emboli

ASx <30
>30: dyspnea, angina
>50: Afib, RVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is heard on PE for ASDs

What may be seen on EKG if shunt is significant enough

What will be seen on CXR if ASD is present

A

Wide, fixed S2 (lub dub-dub) w/ systolic murmur at P-area
P-HTN- pulmonic ejection murmur

RAD, RVH, RBBB- rSR pattern in V1

Megaly w/ R side dilation
Prominent pulm artery w/ inc vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most ASDs will spontaneously close if ? size or by ? age

When is surgical closure indicated

Pts w/ ASDs are c/i from ? hobby

A

<3mm; 3-8mm- by 3y/o

RV overload on Echo at 2-6y/o

Diving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define PDA

What do these sound like

What can be the reporting c/c of PDAs

A

PD- normal fetal structure connecting PA w/ aorta to bypass lungs causing L to R shunt

Systolic, machinery murmur w/ thrill at P-area w/ wide pulse pressure and low DBP; accentuates in late systole

LE cyanosis, FTT, Tachy/Tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is seen on PE or PDAs

How are these Tx

? is the MC pathologic murmur of childhood

A

Wide pulse pressure w/ low DBP

Premature: Indomethacin w/ fluid restriction
Surgical/Catheter closure

VSD (ASD- 2nd MC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define VSD

What do these sound like

How are these Tx

A

L-R ventricular shunt overloading pulm artery (P-HTN)

Holosystolic murmur on L sternal border

Watch- refer to Peds Cards for serial echos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Infants w/ large VSDs can develop ? issues and are Tx w/

If the above fails, when is surgical closure performed

? is the classic clinical presentation of Aortic Coarctations

A

CHF, growth retardation; Tx- Digoxin w/ diuretics

First 6mon

Arm BP > leg BP- Bounding arm pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do the majority of aortic coarctations occur

Half of the Pts will have ? valve defect that puts them at risk for ?

How are these Tx w/ surgical interventions and what are the indications for emergent closure

A

Below origin of L sublcavian artery

Bicuspid AV- leads to Berry aneurysm formation

Balloon angioplasty 2-4y/o;
Emergent- HTN Megaly CHF Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Neonates born w/ aortic coarctation need to have ductus arteriosus kept open w/ ?

What happens if these Pts live untreated

What is the only cyanotic, congenital heart Dz of blueprint

A

Prostaglandin E1

Death by 50y/o d/t Rupture, Dissection, CVA

Tetrology d/t R-L shunt through VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do Tetrology Pts need annual EKGs until Tx

Post-surgical survival is >80% but the MCC of death are ?

What complications can still exist after surgery

A

QRS lengthening d/t risk for sudden death

Sudden death, HF

HF, Arrhythmias, Residual obstruction, Pulm regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define Primary HTN

Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN

ACC/AHA and JNC 8 BP targets

A

SBP ≥130/DBP ≥80 on two readings on two visits

N: <120/80 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: ≥140 or ≥90

ACC/AHA: <130/80
JNC: <140/90 for all <60y/o;
<150/90 for all ≥60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is Normal, Elevated, Stage 1 and 2 HTN Tx

A

N: lifestyle w/ f/u q12mon

E: lifestyle and f/u q3-6mon

Stage 1, <10%: lifestyle and f/u q3-6mon

Stage 1, >10%/CVD/DM/CKD: lifestyle w/ 1 med, f/u in 30d
Met- f/u q3-6mon
Not- f/u q30d until met

Stage 2: life style w/ 2 meds, f/u in 30d:
Met- f/u q3-6mon
Not- f/u q30d until met

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What meds are used for HTN Tx in Non-Black or Diabetic Pts

What is used for black Pts

What is their BP target

A

ACE/ARB, Amlodipine, Thiazide-like/Indapamide

Stage 2= two meds from different classes

Thzd-type and/or CCBs

<130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S/e of CCBs for HTN Tx and specifically used for ?

S/e of ACE/ARB for HTN Tx and specifically used for ? and c/i during ?

S/e of using Spironolactone for HTN Tx

A

S/e: Edema; Angina pectoris

Proteinuria;
S/e: HyperK Angioedema Cough (c/i pregnancy)

HyperK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

S/e of using BB for HTN Tx and are c/i during ?

Two s/e of using hydralazine for HTN Tx

When does USPSTF suggest HTN screenings to begin

A

Cause: Impotence; C/i: asthma

Lupus-like syndrome, Pericarditis

18y/o;
3y/o if conditions associated w/ HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adults w/ RFs need to be screened for HTN ? often or ? previous measurement

How is BP taken and ? reading indicates need for more evaluation and work up

What PE finding can suggest HTN is present

A

q6mon; SBP 120-129

Pt rests x 5min
Cuff covers 2/3 of bicep
>15mmHg between both arms

AV nicking w/ fundoscopy- arteriole crosses venule causing compression and venous bulging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When does ACC/AHA suggest starting Rx management for HTN

What life style modifications are recommended to Pts

Define Secondary HTN and when is this Dx considered?

A

All Stage 2
Stage 1 w/: DMT2 CKDz ASCVDz/Risk ≥10%

DASH diet
<2.3g Na/day
M: two drink/day
W: one drink/day
PT 30min/day x 5d/wk

SBP ≥130/DBP ≥80 w/ an identifiable cause:
HTN refractory to meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the MCC of Secondary HTN Ingestion of ? substances will worsen HTN Tx What are the four populations that are likely to benefit from statin therapy
Primary aldosteronism NSAID CCS Cocaine Licorice LDL ≥190 Any ASCVDz Non-DM 40-75y/o ASCVD risk ≥7.5% DM 40-75y/o w/ LDL 70-189
26
When are lipid screenings started What medications can be used during Tx and what s/e do they have Define Xanthomas
USPSTF: 35y/o w/out RFs NCEP: ≥20y/o regardless Statin- Inc LFTs, Myalgias Fibrate- gallstone Niacin- flushing Bile acid sequestrant- diarrhea Lipid rich histiocytes in skin d/t hyperlipidemia
27
? is the MC area of development for tendonous xanthomas When are medications used for Tx in Pts ≥21y/o Secondary Prevention for wo/men ≤75 w/ ASCVD or LDL ≥190 are Tx w/
Achilles LDL ≥190/Tgc ≥500 w/ high intensity; Goal of 50% reduction High intensity statin
28
How is hyperlipiemia Tx in diabetics w/ LDL 70-189 How is hyperlipidemia Tx in non-diabetics w/ LDL 70-189 ? are the two high intensity statins and dosages
Moderate intensity; ≥7.5% ASCVD score= high intensity ASCVD risk ≥7.5%: mod/high intensity 5-7.5%: mod intensity Average LDL reduction ≥50%: Atorvastatin 40-80mg Rosuvastatin 20-40mg
29
What are the moderate intensity statins w/ dosages What are the low intensity statins w/ dosages
``` Average LDL reducion 30-50%: Atorva 10mg Rosuva 10mg Simva 20-40mg Prava 40-80mg Lova 40mg Fluva XL 80mg Fluva 40mg BID Pita 2-4mg ``` ``` Average LDL reduction ≤30%: Simva 10mg Prava 10-20mg Lova 20mg Fluva 20-40mg Pita 1mg ```
30
# Define Cardiogenic Shock What is the MCC What will be seen on PE
Impaired contractility and overall pump failure Acute MI Pulm congestion AMS Tachy Clammy HOTN JVD UOP <20mL
31
How is Cardiogenic Shock Dx How is this Tx Cardiogenic shock d/t free wall ruptures is MC seen after ? type of MI
Inc pulmonary capillary wedge pressure >15mmHg Fluids and Pressor: Dobutamine, NorEpi Balloon pump Q-wave transmural Lateral wall
32
# Define OHOTN This is MC caused by ? issue and MC by ? drug s/e What would be seen in VS if etiology was d/t autonomic dysfunction or d/t low blood volume
SBP dec x 20mm, DBP dec x 10mm Both <5min after supine to standing Acute MI complication; MAOIs Autonomic: HOTN w/ HR inc <10bpm Volume: HR >15bpm
33
What VS readings suggest OHTON etiology was hypovolemia What VS readings suggest a Dx of POTS How is OHOTN Tx
HR >100bpm or an Inc x 30bpm +Sxs, no HOTN Inc Na/Fluids, Fludrocortisone, Midodrine
34
# Define NSTEMI What will be seen on EKGs What does the "typical" work up include
Necrosis w/out ST elevation ror Q-waves ST depression/inversion d/t incomplete blockage BNP EKG Troponin CXR CBC/CMP
35
What biomarkers are evaluated during MIs
Myoglobin 1-4h 12hr <24hrs Troponin: 4-8hr 12-24hr 7-10d CK-MB: 4-6hr 12-24hr 3-4d
36
How are NSTEMIs Tx Define STEMI What EKG lead indicates location of infarct
BARCHANS: BBs ACEI Reperfusion-(PCI) Clopidogrel Heparin ASA Ntg Statins Necrosis w/ ST elevation/Q-waves d/t complete blockage Anterior: 1, aVL, 2-6; LAD Inferior: 2, 3, aVF; RCA Lateral: 1, aVL, 5-6 w/ reciprocals in 3, aVF; CXA Posterior: depression in V1-3
37
How are STEMIs Tx EKG time requirement How often are markers drawn and assessed
ASA+Clopidogrel at once PCI <90min Thrombolytics <180min <10min Three sets q8hrs
38
Absolute c/is for fibrinolytic therapy for STEMI Tx
Suspect dissection Active bleed/diathesis Malignant intracranial neoplasm Ischemic stroke <3mon Cerebral vascular lesion Hemorrhage, cranial
39
Septal MI is d/t blockage in ? vessel Widow Makers is d/t blockage in ? vessel ? is the MC type of MI
SBA, seen in V1-2 LAD: above LCX, Septal and LAD branch Inferior
40
? medication decreases mortality in N/STEMI and TIA Pts STEMI reperfusion time frame What thrombolytics can be used if no cath lab is available/indicated
ASA <12hrs Gold standard= PCI <3hrs of Sx onset TPA, Streptokinase
41
# Define Stable Angina Time frame is ? ? PE sign can be seen
Pain incraeased w/ exertion/emotion but predictably relieved w/ rest/nitro <15min Levine Sign
42
How is Chronic Angina worked up How is this form Tx ? is a poor prognostic indicator and ? vessel is MC involved
Stress test; definitive w/ angiography Nitro and BBs LVEF <50%; Left main
43
? medication needs to be used ASAP during HF to decrease morbidity/mortality What are the 3 BBs used What lab result is seen in HF and what can cause this to be abnormally low
ACEI Bisprolol Metoprolol succinate Carvedilol BNP; Obesity
44
HF is a syndrome of ? dysfunction ? is the dominant Sx of L-HF ? is the dominant Sxs of R-HF
Ventricular Dyspnea Fluid retention
45
# Define Systolic Left HF How is this Tx How are acute worsenings Tx
Dilated, thin LV w/ EF <40% Loop ACEI BB O2 ACEI Nitro Doubled diuretic via IV; D/c BB
46
# Define Diastolic left HF This MC occurs in Pts w/ ? How is this Tx
Thick LV wall w/ impaired relaxation and normal EF HTN ACEI and BB/CCB No diuretics or Digoxin
47
# Define Right HF What is the gold standard for Dx Define High Output HF
P-HTN induced inability to pump blood R sided cath Inc metabolic demand higher than cardiac output
48
What are 6 examples of Dxs that can cause High Output HF What is the first sign of this issue Best method to Dx HF
``` BeriBeri/Thiamine deficient Anemia Hyperthyroidism Pregnancy AV fistula Paget's Dz ``` Tachycardia fading to systolic failure Echo- most important for prognosis
49
What is normal EF EF under ? is associated w/ increased mortality What can be seen on CXR
55-60 <35, place defib Kerley B lines in bat wing pattern
50
Why do ventricles release BNP BNP levels over ? suggest CHF is likely What are the four NYHA classifications of HF
Dec RAAS activation to decrease fluid volume and increase Na excretion >100 1: ASx 2: Sx w/ mod activity 3: Sx w/ mild activity 4: Sx at rest
51
AR MS PR TS AS PS HOCM MVP MR TR VSD
Sit, lean fwd; Diaphragm at Erbs L lat-decubits; Bell at mitral Sit, lean fwd: Diaphragm at Pulmonic Supine; Bell at Tricuspid Sit; Diaphragm at Aortic Supine; Bell at Tricuspid Supine; Diaphragm at Mitral Supine, Diaphragm at Mitral Supine, Diaphragm at Mitral apex Supine, Diaphragm at Tricuspid Supine; Diaphragm at Tricuspid LLSB
52
Triad of AS What type of murmur is heard What makes the murmur louder/softer
Syncope Angina Dyspnea Systolic cres/decres at aortic area w/ radiation to neck/apex w/ split S2 Inc: lean forward/squat Dec: grips
53
What PE finding suggest AS is a congenital cause What type of cells may be reported w/ lab results MCC of AR
Aortic ejection sound Helmet- schistocytes Age
54
AR can present w/ ? unique c/c What finding on PE helps w/ Dx What finding suggests a large regurgitation flow is present
Pt aware of heart when laying down Water hammer pulse Austin Flint- diastolic murmur from blood hitting anterior mitral leaflet
55
What causes MS Pts can present w/ ? c/c What is heard on PE
Rheumatic heart dz Paroxysmal nocturnal dyspnea Opening snap after S2
56
MR can present w/ ? issues What may be heard on PE What causes MVP
SOB w/ activity/laying down Inc urination at night Apical S3 Mitral valve balloons into LA
57
What is the MC Sxs of MVP How is this Dx How are Sxs managed
Palpitations from arrhythmia TTE/TEE BB is palpitations present
58
What is the MCC of TS What is the MCC of TR How is the JVP wave different for TR
Rheumatic heart Dz RV failure and dilation Large V-waves
59
How is TR differed from MR PS is MC found in ? population What will be heard on PE
Radiates to LLSB and inc w/ inspiration Peds Wide split S2 w/ dec P2
60
What is the MC Sx of PR What type of murmur is heard Define Afib
Dyspnea w/ exertion Graham steel: diastolic pulmonary murmur d/t dilated annulus; mis-Dx as AR Irregular, irregular w/out P-waves and narrow QRS
61
Tx AFib aims to keep HR below ? How is this accomplished How is rhythm control accomplished
110 Diltiazem Metoprolol Verapamil <48hr: TEE prior to conversion w/ amiodarone >48hr: anticoag x 21days then convert Unstable: synch'd conversion
62
How is the need for anticoagulation in Afib calculated
CA2DS2VASc: | CHF/LVEF
63
What DOAC meds are used to anticoagulate Pts w/ Afib When is Warfarin needed What is the goal INR for warfarin w/ these Pts
Dabigatran Edoxaban Apixaban Rivaroxaban Mechanical valves MS EGFR <30 Pheyntoin/Antiretroviral meds 2.5
64
What DOAC has the best balance of safety vs efficacy What DOAC is best for once daily dosing What DOAC is reversible
Apixaban Rivaroxaban Dabigatran
65
# Define PSVT These rhythms can be caused by ? What is the hallmark EKG for one of these
SVT w/ abrupt on/offset d/t short circuited arrhythmia w/out structural heart dz AVNRT- dysrhthmia above Bundle of His WPW: accessory path in Bundle of Kent Short PR, Wide QRS, D-wave
66
WPW can AKA ? How are PSVTs Dx How are these Tx
AV reciprocating tachycardia Holter monitor Stable: Vagal Carotid massage Valsalva Sxs: adenosine Definitive: ablation
67
What two meds need to be avoided in WPW What are the three types of premature beats How are these Dx
Adenosine, CCBs PAC: abnormal P-wave PJC: narrow QRS PVC: bizarre/wide QRS EKG or Holter monitor
68
How do PACs appear on EKG When do these develop Where are they commonly seen Pts w/ heart Dz and develop frequent PACs are at risk for developing ?
Abnormally shaped P-waves Can occur in normal hearts w/out precipitating factors COPD PSVT, Afib/flutter
69
How do PVCs appear on EKG What can cause these to develop Pts that are Sx will complain of ?
Early, wide QRS w/out P-waves Hypoxemia, E+ imbalance Palpitations felt in throat
70
How do PJCs appear on EKG What causes these to develop How are premature beats Tx
Narrow QRS w/out P-waves Irritable site in AV node fires impulse before SA node interrupting sinus rhythm PAC: reassure PJC: Tx if >10/min or multifocal= lidocaine or antiarrhythmic PVC: Tx if Sxs, BBs then ablation
71
# Define V-tach This rhythm is a common complication for ? two Dxs How is stable VTach Tx How is unstable, monomorphic VT Tx How is unstable, polymorphic VT Tx
≥3 consecutive premature ventricular beats Acute MI, Dilated myopathy In order: Amiodarone Lidocaine Procainamide Synch'd direct conversion starting at 100j Defib
72
# Define V-Fib How is this Tx What is the MCC of AV blocks
Uncoordinated quivering of ventricles w/out useful contractions CPR Defib (non-cynch'd conversion) 120, 150, 180 Amiodarone x 2 Idiopathic fibrosis/sclerosis, Ischemia
73
# Define SSS What are the 4 categories What is the MCC
Dyfunction in automaticity and impulse generation Brady, Pause, Arrest, Tachy/Brady SA node fibrosis
74
How is SSS Tachy-Brady Syndrome Tx Criteria for arrest What 3 nodal agents need to be avoided
Pacemaker Absent of P-waves x 3sec BB, CCB, Digoxin
75
Infective endocarditis is MCC by ? microbes Define Acute endocarditis Define Subacute endocarditis IVDA endocarditis is MCC by ? Prosthetic valve endocarditis is MCC by ?
Strep V**, Staph, Fungi HACEK infected normal valves w/ Staph A Infected abnormal valves w/ Strep viridians Staph A Staph epidermis
76
What is the MCC of candida endocarditis infections and how does it present How is this Tx ? is the MCC of endocarditis and it presents as ?
Contaminated lines leading to slow growing but large vegetation Amphotericin B Step Viridians w/ small, slow growing vegetation post valve replacement w/ embolization
77
What are the peripheral S/Sxs of infective endocarditis What is the gold standard for Dx
``` Janeway- evidence of septic emboli Osler nodes Splinter hemorrhages in finger nails Hematuria d/t emboli/nephritis Roth spots in retina Petechiae, palate/conjunctiva Splenomegaly ``` TEE
78
What criteria is used for Dx endocarditis What are the major criteris What are the minor criteria
Modified Duke: Definite= 2 major//1 major, 3 minor/5 minor Possible= 1 major and 1 minor/3 minor Pos Echo New valve regurgitation Two positive cultures from different sites Single pos w/ C burnetti Previous heart Dx/IVDA Fever ≥100.4 Vascular/Immune phenomenon
79
How is IE in native valves w/out IVDA Tx How is prosthetic valve IE Tx How is IVDA IE Tx
Naficillin Ampicillin Genta Vanc Genta Rifampin Nafcillin (Rosh said Cefepime and Vanc)
80
What is used for IE prophylaxis to prevent recurrent episodes Rheumatic fever MC affects ? valve This follows an infection w/ ?
2g Amox 30-60min prior Mitral Step throat d/t antistreptolysin Abs reacting to heart proteins
81
First episode of acute rheumatic fever is Dx w/ ? What are the minors of this criteria
``` Jones Criteria: Joints- polyarthritis Oh no, carditis Nodules, SQ Erythema marginatum Sydenhams chorea ``` Fever Arthralgia Prolonged PR Elevated ESR/CRP
82
How is Rheumatic Fever Tx When is ABX prophylaxis indicated
``` ASA- fever/pain Pred PCN G benzathine Anti-injection: PCN-V or Sulfadiazine Allergy- erythromycin ``` Peds w/out carditis: for 5yrs or until 21y/o Peds w/ carditis and no residual damage: 10yrs Peds w/ carditis and residual damage: >10yrs
83
Acute pericarditis can often progress into developing ? issue ? type of pericarditis appears 2-5d post-MI What is the MCC of pericarditis
Pericardial effusion Dresslers Coxsackie
84
How is pericarditis Dx What type of JVD abnormality would be seen How is this Tx
EKG: diffuse, precordial ST elevation w/ PR depression- 2, aVF, V4-6 Kussmaul- inc CVP w/ inspiration NSAIDs/ASA CCS if Sxs >48hrs
85
Myocarditis is MC associated w/ ? cause How is a Dx definitively made How does a pericardial effusion present
Viral infection: Coxsackie B Endomyocardial biopsy Low voltage QRS Alternans Distant sounds
86
How is pericaridal effusion Dx How is it Tx ? triad is seen in Cardiac Effusion w/ Tamponades
EKG: low voltage w/ alternans Echo: swinging heart CXR: water bottle Centesis; Window if recurrent Becks: HOTN Inc JVD Muffles
87
? is a classic PE finding for a cardiac tamponade ? is the gold standard for Dx How does an effusion look differently from a tamponade
Pulsus paradoxus- SBP drops x 10mmHG w/ narrow pulse pressure Echo showing diastolic collapse of RV Effusion doesn't have RV collapse
88
How are Cardiac Tamponades Tx What is the triad of a AAA presentation When does USPSTF recommend screenings
Inc preload prevents RV collapse; Centesis- therapeutic Back pain Pulsatile mass HOTN 65-75y/o w/ +smoke Hx
89
How/When are AAAs screened for When is surgical repair indicated When is monitoring indicated
US in males >65y/o w/ smoking MedHx >5.5cm or expands >0.6cm/year q12mon 3cm-4.4cm q6mon >4.5-5cm w/ referral q3mon 5-5.4cm
90
What is used for Pts w/ Dx AAA prior to surgical repair How are AAAs different from dissections What PE finding suggest aortic dissection
BBs AAA- three layers Dissection- intima Different BPs in arms
91
What is the gold standard for evaluating aortic dissections How are AAAs assessed What are the Sxs of an arterial embolism and what is a common cause
MRI angiography** US then CT then Angiography 6 Ps- Pain Paralysis Pallow Paresthesia Polar Pulseless; LE > UP d/t Afib or MS
92
What is the gold standard for Dx of an arterial embolism How are these Tx Half of AV malformations inthe brain initially present w/ ?
Angiography Heparin bolus then infusion Bleeding > Epilepsy
93
What is the gold standard for Dx, Tx planning and f/u for brain MVMs Define AVMs and the MC statistic they hold What is the MC type of lesion
Angiography Connected artery and veins bypassing capillaries; most dangerous of vascular malformations Supratentorial
94
What are the two RFs for cerebral AVMs How are these Tx How does Venous Insufficiency appear on PE
Male, FamHx Surgical excision- mainstay Radiosurgery- high risk Endovascular embolization- adjunct Hyperpigmentation Atrophic shiny skin Stasis dermatitis
95
Where do ulcers appear in Pts w/ venous insufficiency Define Postphlebotic Syndrome How is insufficiency Tx
Medial malleolus Sx chronic venous insufficiency after DVTs Wound management Elevation/exercise Topical derm agents
96
What is first line imaging for suspected DVT What is the gold standard image How are these Tx
Duplex US Venography LMWH/Fondaparinux/Xa inhibitors
97
How can varicose veins present if Sxs How are these Tx How does Peripheral Arterial Dz present
Pain w/ exertion or hyperesthesia Compression Elevate Wound care Sclerotherapy Surgery Painful ulcers MC d/t atherosclerosis
98
What is usually the first Sx of Peripheral Artery Dz What is the gold standard for Dx What lab result is used for screening for PADz
Intermittent claudication relieved w/ rest Angiography Elevated homocysteine
99
S/e of Nitro Where is the location of Type 2 blocks What is the first drug of choice for mild/mod HTN pregnancy
Reflex tachycardia d/t dec BP Flushing/HA Dec cardiac o2 demand and preload Vein > Coronary artery dilation d/t NO release 1*: AV node 2*: His-Purkinje system Methyldopa- central A-agonist
100
# Define Inotropic, Chronotropic, and Drootropic Drug Tx of choice for HTN Urgency Drug Tx of choice for HTN Emergency
I: Alters force of myocardial contraction C: Alters HR D: Alters conduction Clonidine Sodium Nitroprusside
101
Drug Tx of choice for Malignant HTN (HTN retinopathy) How quickly should BP be lowered during HTN emergency When HTN is newly Dx, consider ? lab orders
Clevidipine/Sodium Nitroprusside No more than 25% first hour 160/100 w/in 2-6hrs To normal w/in 24-48hrs UA Alb/Cr ratio Cr, K, Na, Fasting glucose, Lipids, TSH EKG
102
Hypertriglyceridemia screenings begin at ? age What level is considered normal What are the ranges for mild, mod and severe
20y/o then q5yrs <150 Mild: 150-499 Mod: 500-886 Sev: >886
103
How is hypertriglyceridemia Tx What is the goal of Tx What benefit comes from managing the flushing s/e of meds used for Tx
Fibrates- Gemfibrozil, Fenofibrate Niacin Prevent pancreatitis Inc HDL
104
When Tx hypertriglyceridemia, using niacin can create ? s/e so caution is needed w/ ? population How is the flushing s/e managed Define Prinzmetal Angina
Hyperglycemia, DM Daily ASA Coronary artery spasm causing ST elevations
105
What is the MC and another common RF seen in prinzmetal angina Pts How is this Tx What is the MC type of ASD
Smoking- MC; Cocaine Long acting nitrates w/ Amlodipine Ostium secundum: incomplete adhesion between foramen ovale flap and septum secundum
106
? are the MC forms of ASD in order MOA of ASA What can cause acquired cases of aortic coarctation
O. Secundum, mid-septum O. Primum- low septum Sinus Venosus- upper septum Irreversible inhibition of cyclooxygenase- catalyzes thromboxane enzymes Inflammatory Dz: Takayasu arteritis
107
Characteristics of Venous Hum What inc/dec hum What antiarrhythmic med is c/i during CADz/structural heart dz
Innocent murmur from blood flowing into jugular veins Inc w/ sitting Dec w/ supine, turning head, applying pressure to vein Felcainide- inc risk for polymorphic Vtach
108
Class 1a antiarrhythmics Class 1b antiarrhythmics Class 1c antiarrhythmics
Na blockers w/ prolonged refractory: Disopyramide Quinidine Procainamide Na blocker w/ little effect on refractory: Lidocaine Mexiletine Phenytoine Na blocker w/ slight prolonged refractory: Flecainide Propafenone
109
Class 2 antiarrhythmics Class 3 antiarrhythmics Class 4 antiarrhythmics
BBs: indirect Ca channel blockage by inc adrenergic activation K blockers: prolonged action potential w/ delayed repolarization: Dofetilide Amiodarone Dronedarone Ibutilide Sotalol w/ Class 2 effects CCB: slows Ca channel opening to slow SA pacemaker/conduction (Non-DHPs)
110
How are stable Pts w/ CHF Tx outpatient How is PSVT Tx in stable Pt What side effects are expected
BB ACEI Diuretic +ionotropic Vagal Adenosine 6mg, 12mg Facial flushing Dysrhythmia Seizure Hyper/Hypo-tension
111
How does Acute Hypertensive HF present How is this condition managed What condition develops if too much medication is given
Pulm edema Nitro O2 Furosemide Methemoglobinemia
112
Pts are placed on ? anticoagulant after mechanical tricuspid valve placement Isolated TR is MC seen in ? population Define Kussmaul's Sign and when is it seen
Warfarin IVDA secondary to tricuspid valve endocarditis Paradoxical rise in JVP w/ inspiration during restrictive cardiomyopathy/pericarditis
113
Restrictive cardiomyopathy has poor prognosis if caused by ? What are the two MCCs of this condition Pts w/ the MC systemic vasculitis may report ? MedHx fact
Amyloidosis Tropical Endomyocardial Fibrosis- world Amyloidosis- MC GCA; Polymyalgia rheumatica
114
What does an RBBB look like on EKG What part of the heart's conduction system conducts electricity the slowest When are USPTSTF screening for HTN, cervical Ca, DM, ovarian CA and Vit D deficiency conducted
Wide QRS >120msec Wide S wave in Lead 1, V5-6 Triphasic QRS V1 (RSR variant) AV node ``` HTN: ≥18y/o CCa: ≥21y/o DM: 35y/o weight/obese Pts OCa: none for ASx VitD: no recommendation ```
115
? is the MCC of HF w/ dec EF MCC of pericarditis in USA and world What form of pericarditis is afebrile
Ischemic cardiomyopathy US: Viral (Coxsackie) World: TB Uremic
116
Indications to admit pericarditis Pt What antipsychotic med can cause peri/myocarditis Rosh question
``` Fever PO anticoagulation Out Pt failure Myopericarditis ImmSupp Trauma Effusion ``` Clozapine Cards #26
117
MCC of COPD Why does this MC lead to so many issues COPD is an umbrella term encompassing ?
Smoking Vasoconstriction Chronic bronchitis Emphysema
118
# Define Chronic bronchitis Most of these Pts will be labeled as ? d/t ? PE finding What is the single best variable for predicting which Pt will develop COPD
Productive cough 3mon/yr x 2yrs w/out fever (fever= pneumonia Dx) Blue bloaters: hypoxia Hx 40 pack/year smoker
119
What is the gold standard for making a Dx of Chronic Bronchitis What is seen on CXR What will be seen on PFT in chronic bronchitis
Lung biopsy w/ inc Reid index (gland layer >50% of bronchial wall) Inc interstitial markings, thickened bronchial walls and normal diaphragm FEV/FVC ratio <0.7
120
What lab results are expected for chronic bronchitis What is the most effective therapy for Tx Pts w/ chronic bronchitis When is supplemental O2 indicated
Inc H/H Inc CO2/Dec O2 Respiratory acidosis- PCO2 >45, BiCarb >30 Cessation SaO2 <89% or, PaO2 <55mmHg
121
What vaccinations doe Chronic Bronchitis Pts need How are exacerbations managed What complication can arise from this Dz process
Influenza, Pneumococcal Pred 40mg/day x 5d ABX: Azith/Cefur/Doxy Cor pulmonale d/t hypoxic vasoconstriction
122
COPD Gold Categories
A: Less Sx, Low risk; Breathless when hurrying on flat ground, 0-1 exacerbation, 0 hospitalizations SABA/SAMA B: more Sx, low risk; Breathless when walking slower than peers, 0-1 exacerbations, 0 hospitalizations LAMA/LABA C: less Sx, High risk Breathless when hurrying on flat ground, 2/> exacerbation, 1/> hospitalizations LAMA and SABA D: more Sxs, High risk; Breathless when walking slower than peers, 2/> exacerbations, 1/> hospitalizations LAMA+LABA w/ SABA
123
What causes structural changes seen in emphysema Emphysema almost always co-exists w/ ? Dx What type of breathing habit do these Pts develop
Destroyed alveolar septae d/t elastin loss Chronic bronchitis Purse lip, keeps airway from collapsing
124
What CXR findings are seen w/ emphysema What lab result will be different compared to chronic bronchitis Pts What will emphysema PFT results show
Barrel chest Hyperinflated lungs w/ bullae Flat diaphragm Normal Hct Dec FEV1/FVC ratio Inc TLC
125
What causes acute sinusitis What is the 'little brother' to HFlu What is the gold standard for Dx
Acute: Strep Pneumo Chronic: Staph A Moraxella CT
126
What are the four indications for ABX to Tx sinusitis What is used for first and second line ABX Tx What options are avail if Pt is allergic to PCN containing ABX
Fever >102 Improves then worsens Purulent d/c Sxs >10days First : Amoxicilli Doxy Levo 2nd: fail to improve in 7days: Augmentin Levo/Moxi-floxacin Doxy/Levo/Moxiflox
127
How is chronic rhinosinusitis Tx What is used for Peds What is used if they are allergic to PCN containing ABX
Augmentin Allergic: Clinda Augmentin 3rd Gen: Cefpod/Cefdinir
128
? is the MC type of pneumonia Typical pathogens typically present w/ ? Atypical and viral pathogens present how?
Strep pneumo >40y/o; Mycoplasma <40y/o F/C/Tachy/Tachy w/ rusty sputum- lobar pneumonia Fever w/ dry cough- interstitial infiltrate
129
What are the typical pathogens causing CAP What are the atypical pathogens causing CAP What is the exception to the sick/not sick of atypicals
Strep pneumo HFlu Moraxella and more sick Legionella Mycoplasma Chlamydial and not as sick Legionella
130
What microbe causes pneumonia after an influenza infection What microbe infects CF, COPD, malignancy or ventilated Pts ? are the MC nosocomial infections
Staph A Pseudomonas UTI w/ catheter Pneumonia w/ Strep pneumo
131
What vaccination reduces risk for pneumococcal pneumonia What populations should receive this How is lobar pneumonia Tx in sequential order
23-PPSV ``` Chronic liver dz/Alcoholics DM Cigarette smokers Asplenic/Sickle cell Native American/Eskimo ``` Azith/Clarith-romycin Doxy Autmentin Levofloxacin
132
What is the most virulent microbe to cause lobar pneumonia and what does it look like on CXR ? population are at risk for this form How is this form Tx in sequence
HFlu w/ patchy alveolar infiltrates Kids <5y/o in daycare COPD, HIV Augmentin Cefur/Cefdinir/Cefixime Azithromycin Levo- unless COPD, then first
133
? is the MCC of pneumonia in Pts <40y/o What other PE findings suggest this microbes etiology What does this look like on CXR
Mycoplasma w/ late summer/early fall outbreaks Bullous myringitis Erythema multiforme Patchy infiltrates that are more extensive than Pt appears on PE
134
How is Mycoplasma pneumonia Tx in order What form of Legionairres is most dangerous What doe they require for replication
Azith/Clarith-romycin Doxy Levofloxacin Serogroup 1 Amoebas in water
135
What is an early PE finding of Pt infected w/ Legionairres? What are the two phases of the infection What does it look like on CXR
Bradycardia Pontiac fever, Pneumonia Lower lobe patch w/ pleural effusion (inc LDH)
136
How is Legionairres pneumonia Dx How is this Tx in order What causes pneumonia in HIV/AIDS/Ca Pts
Immunofluorescent Ab and ELISA Direct fluorescent of sputum UA Azith, Levo, Doxy P. jiroveci, unicellular fungi
137
How does pneumonia d/t Jiroveci present What does this look like on CXR How is it Dx
F/C, dyspnea w/ dry cough x weeks Interstitial pneumonia w/ inflamed/infected alveolar epithelial cells= bilateral, perihilar infiltrates Bronchial lavage and biopsy
138
What lab result reflects the degree of lung injury in PTs w/ pneumonia d/t jiroveci How is this Tx When is HIV re-Dx as AIDS
Inc LDH levels 1st: TMP/SMX x 21days 2nd/PCN Allergy: Pentadmie (s/e- Qtc prolongation) TMP + Dapsone CD4 <200
139
How is C Pistacci transmitted How is this Tx What are the 3 MCC of viral pneumonia
Inhalation through dried bird droppings 1st: Doxy; 2nd: Azith Para/Influenza Adenovirus
140
How is viral pneumonia Tx The sooner ? med is added the fewer complications Pts tend to have Pts that have been Tx for pneumonia w/in past ? time and are still sick are Tx w/ ?
1st: Ribavirin; 2nd: Palivizumab Decadron <3mon w/ Levofloxacin
141
How are Peds w/ CAP Tx First line ABXs for CAP outpatient Tx What is the risk when prescribing Levofloxacin
<5y/o: Amoxicillin >5y/o: Azithromycin Azith/Erythromycin Clarithro/Doxy Prolonged QTc
142
Strep pneumoniae presents w/ ? color productive cough and in ? Pts MedHx Staph A pneumonia presents as ? Histoplasmosis pneumonia occurs in Pts w/ ? Hx and mimics ? on CXR
Rust colored, Splenectomy Salmon colored sputum after influenza infection Bat/bird droppings from Ohio River valley; Sarcoidosis
143
What three PE findings are common in pneumonia Pts How does fungal pneumonia d/t Coccidioides present ? etiology of pneumonia is detected via CSF
Tactile fremitus Egophony Dull to percussion Non-remitting cough unresponsive to ABX Cryptococcus
144
How is Crytpococcus and Histoplasma pneumonia Tx How is Coccidioides and Aspergillus pneumonia Tx What are the classic findings of TB on PE
Amphotericin B Flu/Itra-conazole Fever Anorexia Weight loss Night sweats
145
What are the PPD rules for TB
``` >5mm: CXR evidence of TB HIV/ImmSupp 15mg/day x 1mon or equivalent of Pred Close contact w/ infectious TB ``` ``` >10mm: IVDA Residents of high populations Immigrants GI surgery ``` >15mm: No RFs
146
How is TB Dx What is seen on CXR What is seen on biopsy results
Acid fast bacilli smears and cultures Apical Ghon complexes Caseating granulomas
147
What are the two forms of miliary TB How is TB Tx
Potts Dz: TB in spine Scrofula: TB to cervical lymph nodes + PPD= CXR Neg CXR: latent TB Tx w/ Isoniazid w/ Vit B6 x 9mon Active CXR: Baseline LFTs RIPE x 8wks RI x 16wks
148
All TB Tx meds have ? s/e so ? is needed prior to Tx What are the s/e of RIPE therapy What is used for prophylaxis for household members
Hepatotoxic; baseline labs R: orange fluids I: neuropaty P: hyperuricemia E: red-green blindness Isoniazid x 12mon
149
When are TB Pts considered fully Tx What part of RIPE needs to be adjusted if CrCl is <30 ? RIPE adjustment is needed if Pt is also on HIV meds
Two negative AFBs and cultures P/E- 3 x/wk Raltegravir, double dose when used w/ Rifampin
150
What are the 4 indications to test for TB w/ NAAT ? is the traditional test for latent TB Define Ranke Complex
Previously Tx for TB Lived in endemic area Contact w/ MDR TB HIV seropositive TST via Mantoux method Calcified hilar lymph node d/t TB
151
How are pregnant Pts w/ TB Tx and w/ ? educational piece Define Asthma Absence of ? Sx on PE indicates medical emergency
R/I/E x 4-8wks R/I x 7months Breast feeding not c/i Chronic, reversible inflammatory airway dz Lack of wheeze
152
# Define FEV1 Define FEV Define FVC How is asthma Dx and what result is Dx
Amount exhaled in 1 second Total amount exhaled during forced breath Total amount exhaled during FEV test Peak expiratory flow rate; FEV1/FVC 75-80%
153
# Define Intermittent Asthma Define Mild Define Moderate Define Severe
Sxs 2/< days/wk Awake 2/< x/month SABA 2/< days/wk No activity interference Sxs >2day/wk Awake 3-4x/mon SABA >2 days/wk Minor limitations Daily Sxs Awake 1/>/wk SABA daily Some limitations Daily Sxs Nightly awakenings SABA several x/day Extreme limitations
154
Step 1 Asthma Tx Step 2 Asthma Tx Step 3 Asthma Tx Step 4 Asthma Tx Step 5 Asthma Tx Step 6 Asthma Tx
1- Intermittent; SABA PRN 2- Mild; Low ICS daily 3- Moderate; Low ICS + LABA daily 4- Moderate; Med ICS + LABA daily 5- Persistent; High ICS + LABA daily 6- Persistent; High ICS + LABA + PO CCS daily
155
What is used for acute Tx of asthma exacerbation ? is the MC of all interstitial lung dzs How is this MC Dx
PO CCS Ipratropium bromide Nebulized SABA O2 Idiopathic pulmonary fibrosis CXR w/ diffuse, patchy fibrosis and pleural base honeycomb
156
What type of PFT results are seen in Idiopathic Pulmonary Fibrosis How is this Tx Define Pneumoconiosis
Restrictive pattern- dec volume, normal/inc FEV1/FVC CCS O2 Transplant Pulmonay fibrosis d/t exposure to mining/dust causing dec lung volume/FVC (restrictive dz)
157
Asbestosis CXR findings Coal Workers CXR findings Sillicosis CXR findings
Linear pattern w/ basilar predominance, opacities and honeycomb Nodular opacities in upper fields and less prominent hilar adenopathy Egg shell classifications of hilar nodes
158
Berylliosis CXR findings ? restrictive lung dz makes Pts at increased risk for TB ? restrictive lung dz needs tobacco cessation more than others
Difuse infiltrates w/ hilar adenopathy Sillicosis- need serial TST/CXRs Asbestosis
159
? tissue finding indicates significant exposure to asbestos ? size lung mass is a nodule or a mass How are incidental findings of pulmonary nodules managed
Ferruginous body <3cm- coin lesion, nodule (<30mm) >3cm- mass CXR or compare to old CXRs, then CT w/out contrast- Ill defined, lobular, spiculated= biopsy <1cm, calcified, smooth/defined border= f/u 3mon, 6mon, annual x 2yrs
160
# Define Carcinoid Tumor These are primarily found ? and MC mets to ? What is the MCC of the mets
Neuroendocrine cells w/ excess secretion of serotonin, histamine and bradykinin GI; Liver then to lungs Appendix carcinoid tumor
161
What is the hallmark presentation of carcinoid syndrome What are the effects of the excess hormone secretion What water soluble vitamin will Pts be deficient in
Flushing Diarrhea Wheeze w/ HOTN Seroto: collagen thickening of R sided heart valves Hist/Brady: vasodilation w/ flushing Inc serotonin decreases tryptophan which dec niacin/B3 leading to pellagra
162
How is carcinoid syndrome Dx What would be seen on CXR What would be seen on bronchoscopy
CT located tumors Octreoscan UA: Inc 5-HIAA, metabolite of serotonin Pedunculated sessile growth in central bronchi Pink/Purple lesion w/ vascularization
163
How is carcinoid syndrome Tx What are the two categories of lung cancer What are the 4 subtypes of one of these categories
Surgical excision d/t resistant to chemo/rad Octerotide to dec serotonin secretion Niacin supplements Non/Small cell Non-Small Cell: Adeno: non-smoker w/ small peripheral lesion; MC bronchogenic Ca SCC: single central mass in smoker w/ hemoptysis Large: fast growth, rarely responds to surgery Carcinoid- lack differentiation
164
? is the MC type of bronchogenic carcinoma What lab results are seen in Pts w/ small cell lung cancer What syndrome can these Pts develop
Non-small cell adenocarcinoma HypoNa, HyperCa Lambert Eaton myasthenic syndrome- limb muscle weakness
165
How are lung Ca Dx Pancoast tumors are more likely to be ? types What two syndromes can pancoast tumors cause
Bronchoscopy w/ biopsy if central or, Fine Needle Transthoracic aspiration (most useful) Adeno/SCC in upper lung Superior VCS: face/arm swelling Pancoast: shoulder pain w/ Horners and bone destruction
166
How is Non-Small Cell lung Ca Tx How is Small Cell Ca Tx Solitary pulmonary nodule that has not grown in ? time suggests benign etiology
Stage 1-2: surgery Stage 3: chemo then surgery Stage 4: palliative Chemo, no surgery option ≥2yrs and <1.cm diameter
167
Pulmonary nodule w/ calcification/central location suggests ? etiology ? measurement is indicative of a Dx of PHTN What is the MCC
Benign, Tuberculoma, Histoplasmona >25mmHg at rest Mitral stenosis
168
What are the 5 WHO groups of P-HTN etiologies What is the first Dx test What is the gold standard for Dx
1: Pulm Aterial HTN 2: L heart Dz 3: Lung Dz 4: blood clots in lungs 5: blood/other d/os TTE R sided heart cath
169
What EKG findings suggest P-HTN How is P-HTN Tx depending on the cause
Inverted T-waves V1-4 and 2,3, aVF LVF: Digoxin, Anticoagulate, Diuretics- caution Cardiogenic: prostanoids, PD-5 inhibitors, endothelin antagonists PA-HTN: endothelin antagonists, prostanoids
170
What type of birth control do women who smoke/>35y/o need to be on to reduce DVT risk How are DVTs Dx How can a DVT be ruled out in Pts w/ low risks
Progestin only Fist: Venous US Gold: venography D-dimer
171
If a DVT is found, how are they Tx What are the 4 specific RFs What triad would be seen if a fat emboli is the cause
LMWH Fondaparinux Factor 10a inhibitors Cancer OCPs Pregnancy Surgery Hypoxemia Neuro abnormals Petechial rash
172
Pregnant Pts w/ amniotic fluid emboli can lead to ? complication What risk stratification method is used for PEs If the above method results in a score of 0-1, ? is the next step
DIC Wells: >4: PE likely 4≤: unlikely, D-dimer to r/o PE R/o Criteria: HAD CLOTS: Hormones Age >50 DVT/PE Hx Coughing blood Leg swelling O2<95% Tachy >100 Surgrey/Trauma <28d
173
How are PEs Dx and If found, how are they Tx Most PEs arise from where in the body What old school PE finding was used to Dx DVT
Spiral CT; Renal insuff: VQ scan: Heparin then Factor 10a/DOACs after x 3mon LMWH- if pregnant Thrombolytics if unstable Embolectomy if unstable and c/i for thrombolytics Iliofemoral DVTs Homans Sign- calf pain w/ dorsiflexion
174
? triad is used for DVTs/PE What two findings may be seen on CXR ? is the gold standard or imaging modalities for Dx
Virchows: Trauma Stasis Hypercoag Westermark, Hampton Hump Pulm angiography
175
OSA usually presents d/t obstruction at ? level What are the 5 RFs for OSA For a Dx, ? sleep study results are needed
Oropharynx ``` Obesity Anatomical FamHx ETOH/Sedative Hypothyroidism ``` 5/> events/hr w/ Tired/Waking/Snoring/HTN 15/> events/hr regardless of other Sxs
176
How is mild/mod OSA Tx How is severe OSA Tx Obesity Hypoventilation Syndrome is AKA ? and includes ? criteris
CPAP; PO appliance CPAP Uvulo-plasty Tracheostomy- if life threat Pickwickian- BMI >30, Sleep d/o breathing, Chronic hypercapnia >45mmHg
177
# Define Central Sleep Apnea What causes transudative pleural effusions What is the MCC
Ventilatory effort absent for duration of apneic period Thin watery ooze d/t back pressure in circulation and loss of osmotic pressure CHF
178
What are some causes of transudative pleural effusions What are some causes of exudative effusions Pleural effusions present w/ ? PE findings
HF Cirrhosis/Ascites Nephrotic induced hypoalbuminemia Fluid d/t infection/Ca: Pneumonia Ca PE TB Dec breath sounds and tactile fremitus
179
What criteria is used to Dx pleural exudates What CXR findings help w/ Dx Left sided effusions are more than likely ? while right sided are probably ?
``` Lights; 1 of 3= Dx High protein, LDH Protein >0.5 LDH >0.6 LDH >2/3 upper limit ``` Meniscus sign, Silhouette sign L: exudative; R: transudative
180
How are pleural effusions Tx Define ARDS What is the MCC and possible causes
Small- diuretics, Na restriction Thoracocentesis Chronic/Recurring: pleurodesis Inflamed lungs and accumulation of fluid in alveoli w/ low O2 levels and pink froth Sepsis; Trauma Aspiration Multiple transfusions
181
How is ARDS Dx What would be seen on CXR How is ARDS Tx
Bilateral Sxs, CXR and PAO2/FIO2 ration <300 Air bronchograms w/ bilateral, fluffy infiltrates Mechanical PEEP maintaining PaO2 >60/SaO2 >90
182
What causes the accumulation of the pulmonary edema What score system is used to predict the mortality of Sepsis ? is an indirect marker of tissue perfusion used in sepsis Tx
Inc permeability of alveolar cap membrane qSOFA: New/worse mentation RR >22/min SBP 100/< Lactate
183
? is the MCC of sepsis and ? is the MC manifestation Gram-Pos shock is d/t ? microbes Gram-Neg shock is d/t ? microbes
Pneumonia; Fever Staph/Strep exotoxin EColi, Klebsiella, Proteus, Pseudomonas endotoxins
184
? are the sepsis biomarkers How are septic Pts Tx
Procalcitonin: peak 12-48hrs Lactate: >18 are Dx of septic shock Fluid resuscitation w/ IV crystalloid 30mL/kg in first 3hrs Empiric ABX w/in 1hr NorEpi if MAP is not maintained >65mm
185
What ABG results are seen w/ sepsis MCC of anaphylaxis ? type of reaction is the usually
Resp alk, Metabolic acid Ingested foods MC a Type 1 IgE mediated reaction
186
What is usually the first sign of anaphylaxis ? is first line Tx What medication can cause Pts to be resistant to the above first line Tx
Cutaneous pruritus/urticaria/angioedema IM Epi BBs
187
# Define Cystic Fibrosis How is this Dx What would be seen on CXR
Autosomal recessive d/o causing abnormal production of mucus by exocrine glands NaCL >60mEq on two tests DNA testing Hyperinflation Atelectasis, focal Mucus plugging
188
CF Pts have ? respiratory infections early in life How are these Pts manged What would be seen on PE of Dilated Myopathy if severe HF was present
Staph A, HFlu the Pseudomonas Hypertonic saline cleanings ADEK supplementation Cheyne Stokes- fast/shallow breathing followed by slow/heavy breathing Pulsus alternans
189
Pts w/ Dilated Cardiomyopathy and dyspnea need ? lab drawn and why ? is the imaging modality of choice for RV dysplasia A biopsy in Dilated Cardiomyopathy is only useful for ?
BNP- establish prognosis/severity Cardiac MRI Transplant rejection
190
All PTs w/ Dilated Cardiomyopathy, regardless of etiology, need to be Tx w/ ? If still symptomatic, how is Tx adjusted ? class drug needs to be avoided unless ? is present
ACEI, BB Add aldosterone antagonist- Spironolactone, Eplerone Switch ACEI/ARB for ARNI- Sacubitril/Valsartan CCBs; Afib/flutter ventricular control
191
All diabetics w/ Dilated Cardiomyopathy need ? drug added if LVEF is lower than ? What are the 3 indications to use Ivabradine to slow HR in this population What drug is used second line but is preferred d/t?
Mineralcorticoid antagonist- Spironolactone, Eplerone; <40% Resting HR >70 LVEF <35% Chronic and stable Digoxin; Dec hospitalization
192
? drug combo is recommended for use in AfAm w/ Dilated Cardiomyopathy When are Pts w/ Dilated Cardiomyopathy w/ Afib candidates for biventricular pacing When is an ICD implant a reasonable option
Hydralazine-Nitrate Significant MR and, QRS >150msec ASx ischemic cardiomyopathy w/ LVEF <35% on appropriate medical therapy and >40d post-MI
193
Dilated Cardiomyopathy w/ Afib should be anticoagulated w/ ? unless ? What are four reversible causes of Dilated Cardiomyopathy When is the obstruction of HOCM increased
DOAC; Mitral stenosis Hypothyroid Alcohol Toxins Sarcoidosis Systole w/ anterior motion of MVs anterior leaflet
194
What is the end consequence of HOCMs hypertrophy How is this condition inherited How is this condition differed from athletic heart
Inc LV diastolic pressure Autosomal dominant sarcomere defect: myosin heavy chains/Ca regulating proteins Athletes- no diastolic dysfunction
195
HOCM in Asians is commonly ? type compared to the other MC HOCM in older adults is d/t ? HOCM can present mimicking ? but is differed by ?
Apical; MC- septal HTN; Sigmoid interventricular septum w/ cardiac knob below AV AS- provoking maneuvers are opposite; HOCM inc w/ stand/valsalva Dec- squat, grip. leg raise
196
What are the three most frequent presenting Sxs of HOCM What will be seen on PE of HOCM ? is a poor prognostic sign and what causes this to develop
Post-exertion syncope Angina Dysnpnea Triple apical pulse Bisferiens carotid pulse JVP w/ a-wave S4 gallop w/ lift Afib d/t chronically elevated LA pressures
197
What valvular d/o is commonly seen in HOCM What EKG finding is nearly universal in all symptomatic Pts What else would be seen on EKG
MR LVH Septal Q-wave (2, 3, aVF) High voltage precordium
198
Echos must be done to HOCM Pts to r/o ? other congenital d/o How can the progression of HOCM be stopped When are Pts best managed by ICD
Ventricular noncompaction- trabeculation causing incomplete ventricular filling Dual biventricular pacing Malignat ventricular arrhythmia Unexplained syncope w/ +FamHx sudden death
199
How can HOCM be surgically Tx How can HOCM non-surgically be Tx Pregnant Pts w/ HOCM are at greater risk w/ ? measurement and are best managed w/ ?
Myotomy myomectomy w/ Alfieri Alcohol ablation into LCA Outflow gradient >50mmHg; BBs
200
? test is used to look for amyloid deposition in the heart during Restrictive Cardiomyopathy ? imaging is used for screening How can systemic disease involvement be confirmed but ? is needed to confirm cardiac involvement
Tech-pyrophosphate bone scan Cardiac MRI Rectal Adipose Gingival biopsies; Endomyocardial biopsy