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IPAP > FM/IMC > Flashcards

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

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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%

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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25
Q

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

A

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

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26
Q

When are lipid screenings started

What medications can be used during Tx and what s/e do they have

Define Xanthomas

A

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

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27
Q

? 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/

A

Achilles

LDL ≥190/Tgc ≥500 w/ high intensity; Goal of 50% reduction

High intensity statin

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28
Q

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

A

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

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29
Q

What are the moderate intensity statins w/ dosages

What are the low intensity statins w/ dosages

A 
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
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30
Q

Define Cardiogenic Shock

What is the MCC

What will be seen on PE

A

Impaired contractility and overall pump failure

Acute MI

Pulm congestion AMS Tachy Clammy HOTN JVD UOP <20mL

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31
Q

How is Cardiogenic Shock Dx

How is this Tx

Cardiogenic shock d/t free wall ruptures is MC seen after ? type of MI

A

Inc pulmonary capillary wedge pressure >15mmHg

Fluids and Pressor: Dobutamine, NorEpi
Balloon pump

Q-wave transmural
Lateral wall

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32
Q

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

A

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

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33
Q

What VS readings suggest OHTON etiology was hypovolemia

What VS readings suggest a Dx of POTS

How is OHOTN Tx

A

HR >100bpm or an Inc x 30bpm

+Sxs, no HOTN

Inc Na/Fluids, Fludrocortisone, Midodrine

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34
Q

Define NSTEMI

What will be seen on EKGs

What does the “typical” work up include

A

Necrosis w/out ST elevation ror Q-waves

ST depression/inversion d/t incomplete blockage

BNP EKG Troponin CXR CBC/CMP

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35
Q

What biomarkers are evaluated during MIs

A

Myoglobin
1-4h 12hr <24hrs

Troponin:
4-8hr 12-24hr 7-10d

CK-MB:
4-6hr 12-24hr 3-4d

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36
Q

How are NSTEMIs Tx

Define STEMI

What EKG lead indicates location of infarct

A

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

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37
Q

How are STEMIs Tx

EKG time requirement

How often are markers drawn and assessed

A

ASA+Clopidogrel at once
PCI <90min
Thrombolytics <180min

<10min

Three sets q8hrs

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38
Q

Absolute c/is for fibrinolytic therapy for STEMI Tx

A

Suspect dissection

Active bleed/diathesis

Malignant intracranial neoplasm

Ischemic stroke <3mon

Cerebral vascular lesion

Hemorrhage, cranial

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39
Q

Septal MI is d/t blockage in ? vessel

Widow Makers is d/t blockage in ? vessel

? is the MC type of MI

A

SBA, seen in V1-2

LAD: above LCX, Septal and LAD branch

Inferior

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40
Q

? 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

A

ASA

<12hrs
Gold standard= PCI <3hrs of Sx onset

TPA, Streptokinase

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41
Q

Define Stable Angina

Time frame is ?

? PE sign can be seen

A

Pain incraeased w/ exertion/emotion but predictably relieved w/ rest/nitro

<15min

Levine Sign

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42
Q

How is Chronic Angina worked up

How is this form Tx

? is a poor prognostic indicator and ? vessel is MC involved

A

Stress test; definitive w/ angiography

Nitro and BBs

LVEF <50%;
Left main

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43
Q

? 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

A

ACEI

Bisprolol
Metoprolol succinate
Carvedilol

BNP;
Obesity

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44
Q

HF is a syndrome of ? dysfunction

? is the dominant Sx of L-HF

? is the dominant Sxs of R-HF

A

Ventricular

Dyspnea

Fluid retention

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45
Q

Define Systolic Left HF

How is this Tx

How are acute worsenings Tx

A

Dilated, thin LV w/ EF <40%

Loop ACEI BB

O2 ACEI Nitro Doubled diuretic via IV; D/c BB

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46
Q

Define Diastolic left HF

This MC occurs in Pts w/ ?

How is this Tx

A

Thick LV wall w/ impaired relaxation and normal EF

HTN

ACEI and BB/CCB
No diuretics or Digoxin

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47
Q

Define Right HF

What is the gold standard for Dx

Define High Output HF

A

P-HTN induced inability to pump blood

R sided cath

Inc metabolic demand higher than cardiac output

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48
Q

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

A 
BeriBeri/Thiamine deficient
Anemia
Hyperthyroidism
Pregnancy
AV fistula
Paget's Dz

Tachycardia fading to systolic failure

Echo- most important for prognosis

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49
Q

What is normal EF

EF under ? is associated w/ increased mortality

What can be seen on CXR

A

55-60

<35, place defib

Kerley B lines in bat wing pattern

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50
Q

Why do ventricles release BNP

BNP levels over ? suggest CHF is likely

What are the four NYHA classifications of HF

A

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

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51
Q

AR

MS

PR

TS

AS

PS

HOCM

MVP

MR

TR

VSD

A

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

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52
Q

Triad of AS

What type of murmur is heard

What makes the murmur louder/softer

A

Syncope Angina Dyspnea

Systolic cres/decres at aortic area w/ radiation to neck/apex w/ split S2

Inc: lean forward/squat
Dec: grips

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53
Q

What PE finding suggest AS is a congenital cause

What type of cells may be reported w/ lab results

MCC of AR

A

Aortic ejection sound

Helmet- schistocytes

Age

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54
Q

AR can present w/ ? unique c/c

What finding on PE helps w/ Dx

What finding suggests a large regurgitation flow is present

A

Pt aware of heart when laying down

Water hammer pulse

Austin Flint- diastolic murmur from blood hitting anterior mitral leaflet

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55
Q

What causes MS

Pts can present w/ ? c/c

What is heard on PE

A

Rheumatic heart dz

Paroxysmal nocturnal dyspnea

Opening snap after S2

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56
Q

MR can present w/ ? issues

What may be heard on PE

What causes MVP

A

SOB w/ activity/laying down
Inc urination at night

Apical S3

Mitral valve balloons into LA

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57
Q

What is the MC Sxs of MVP

How is this Dx

How are Sxs managed

A

Palpitations from arrhythmia

TTE/TEE

BB is palpitations present

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58
Q

What is the MCC of TS

What is the MCC of TR

How is the JVP wave different for TR

A

Rheumatic heart Dz

RV failure and dilation

Large V-waves

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59
Q

How is TR differed from MR

PS is MC found in ? population

What will be heard on PE

A

Radiates to LLSB and inc w/ inspiration

Peds

Wide split S2 w/ dec P2

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60
Q

What is the MC Sx of PR

What type of murmur is heard

Define Afib

A

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

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61
Q

Tx AFib aims to keep HR below ?

How is this accomplished

How is rhythm control accomplished

A

110

Diltiazem Metoprolol Verapamil

<48hr: TEE prior to conversion w/ amiodarone
>48hr: anticoag x 21days then convert
Unstable: synch’d conversion

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62
Q

How is the need for anticoagulation in Afib calculated

A

CA2DS2VASc:

CHF/LVEF

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63
Q

What DOAC meds are used to anticoagulate Pts w/ Afib

When is Warfarin needed

What is the goal INR for warfarin w/ these Pts

A

Dabigatran Edoxaban Apixaban Rivaroxaban

Mechanical valves
MS
EGFR <30
Pheyntoin/Antiretroviral meds

2.5

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64
Q

What DOAC has the best balance of safety vs efficacy

What DOAC is best for once daily dosing

What DOAC is reversible

A

Apixaban

Rivaroxaban

Dabigatran

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65
Q

Define PSVT

These rhythms can be caused by ?

What is the hallmark EKG for one of these

A

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

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66
Q

WPW can AKA ?

How are PSVTs Dx

How are these Tx

A

AV reciprocating tachycardia

Holter monitor

Stable: Vagal Carotid massage Valsalva
Sxs: adenosine
Definitive: ablation

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67
Q

What two meds need to be avoided in WPW

What are the three types of premature beats

How are these Dx

A

Adenosine, CCBs

PAC: abnormal P-wave
PJC: narrow QRS
PVC: bizarre/wide QRS

EKG or Holter monitor

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68
Q

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 ?

A

Abnormally shaped P-waves

Can occur in normal hearts w/out precipitating factors

COPD

PSVT, Afib/flutter

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69
Q

How do PVCs appear on EKG

What can cause these to develop

Pts that are Sx will complain of ?

A

Early, wide QRS w/out P-waves

Hypoxemia, E+ imbalance

Palpitations felt in throat

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70
Q

How do PJCs appear on EKG

What causes these to develop

How are premature beats Tx

A

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

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71
Q

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

A

≥3 consecutive premature ventricular beats

Acute MI, Dilated myopathy

In order:
Amiodarone Lidocaine Procainamide

Synch’d direct conversion starting at 100j

Defib

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72
Q

Define V-Fib

How is this Tx

What is the MCC of AV blocks

A

Uncoordinated quivering of ventricles w/out useful contractions

CPR
Defib (non-cynch’d conversion) 120, 150, 180
Amiodarone x 2

Idiopathic fibrosis/sclerosis, Ischemia

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73
Q

Define SSS

What are the 4 categories

What is the MCC

A

Dyfunction in automaticity and impulse generation

Brady, Pause, Arrest, Tachy/Brady

SA node fibrosis

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74
Q

How is SSS Tachy-Brady Syndrome Tx

Criteria for arrest

What 3 nodal agents need to be avoided

A

Pacemaker

Absent of P-waves x 3sec

BB, CCB, Digoxin

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75
Q

Infective endocarditis is MCC by ? microbes

Define Acute endocarditis

Define Subacute endocarditis

IVDA endocarditis is MCC by ?

Prosthetic valve endocarditis is MCC by ?

A

Strep V**, Staph, Fungi

HACEK infected normal valves w/ Staph A

Infected abnormal valves w/ Strep viridians

Staph A

Staph epidermis

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76
Q

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 ?

A

Contaminated lines leading to slow growing but large vegetation

Amphotericin B

Step Viridians w/ small, slow growing vegetation post valve replacement w/ embolization

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77
Q

What are the peripheral S/Sxs of infective endocarditis

What is the gold standard for Dx

A 
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

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78
Q

What criteria is used for Dx endocarditis

What are the major criteris

What are the minor criteria

A

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

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79
Q

How is IE in native valves w/out IVDA Tx

How is prosthetic valve IE Tx

How is IVDA IE Tx

A

Naficillin Ampicillin Genta

Vanc Genta Rifampin

Nafcillin (Rosh said Cefepime and Vanc)

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80
Q

What is used for IE prophylaxis to prevent recurrent episodes

Rheumatic fever MC affects ? valve

This follows an infection w/ ?

A

2g Amox 30-60min prior

Mitral

Step throat d/t antistreptolysin Abs reacting to heart proteins

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81
Q

First episode of acute rheumatic fever is Dx w/ ?

What are the minors of this criteria

A 
Jones Criteria:
Joints- polyarthritis
Oh no, carditis
Nodules, SQ
Erythema marginatum
Sydenhams chorea

Fever Arthralgia Prolonged PR Elevated ESR/CRP

82
Q

How is Rheumatic Fever Tx

When is ABX prophylaxis indicated

A 
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
Q

Acute pericarditis can often progress into developing ? issue

? type of pericarditis appears 2-5d post-MI

What is the MCC of pericarditis

A

Pericardial effusion

Dresslers

Coxsackie

84
Q

How is pericarditis Dx

What type of JVD abnormality would be seen

How is this Tx

A

EKG: diffuse, precordial ST elevation w/ PR depression- 2, aVF, V4-6

Kussmaul- inc CVP w/ inspiration

NSAIDs/ASA
CCS if Sxs >48hrs

85
Q

Myocarditis is MC associated w/ ? cause

How is a Dx definitively made

How does a pericardial effusion present

A

Viral infection: Coxsackie B

Endomyocardial biopsy

Low voltage QRS
Alternans
Distant sounds

86
Q

How is pericaridal effusion Dx

How is it Tx

? triad is seen in Cardiac Effusion w/ Tamponades

A

EKG: low voltage w/ alternans
Echo: swinging heart
CXR: water bottle

Centesis; Window if recurrent

Becks:
HOTN Inc JVD Muffles

87
Q

? is a classic PE finding for a cardiac tamponade

? is the gold standard for Dx

How does an effusion look differently from a tamponade

A

Pulsus paradoxus- SBP drops x 10mmHG w/ narrow pulse pressure

Echo showing diastolic collapse of RV

Effusion doesn’t have RV collapse

88
Q

How are Cardiac Tamponades Tx

What is the triad of a AAA presentation

When does USPSTF recommend screenings

A

Inc preload prevents RV collapse; Centesis- therapeutic

Back pain
Pulsatile mass
HOTN

65-75y/o w/ +smoke Hx

89
Q

How/When are AAAs screened for

When is surgical repair indicated

When is monitoring indicated

A

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
Q

What is used for Pts w/ Dx AAA prior to surgical repair

How are AAAs different from dissections

What PE finding suggest aortic dissection

A

BBs

AAA- three layers
Dissection- intima

Different BPs in arms

91
Q

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

A

MRI angiography**

US then CT then Angiography

6 Ps- Pain Paralysis Pallow Paresthesia Polar Pulseless;
LE > UP d/t Afib or MS

92
Q

What is the gold standard for Dx of an arterial embolism

How are these Tx

Half of AV malformations inthe brain initially present w/ ?

A

Angiography

Heparin bolus then infusion

Bleeding > Epilepsy

93
Q

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

A

Angiography

Connected artery and veins bypassing capillaries; most dangerous of vascular malformations

Supratentorial

94
Q

What are the two RFs for cerebral AVMs

How are these Tx

How does Venous Insufficiency appear on PE

A

Male, FamHx

Surgical excision- mainstay
Radiosurgery- high risk
Endovascular embolization- adjunct

Hyperpigmentation
Atrophic shiny skin
Stasis dermatitis

95
Q

Where do ulcers appear in Pts w/ venous insufficiency

Define Postphlebotic Syndrome

How is insufficiency Tx

A

Medial malleolus

Sx chronic venous insufficiency after DVTs

Wound management
Elevation/exercise
Topical derm agents

96
Q

What is first line imaging for suspected DVT

What is the gold standard image

How are these Tx

A

Duplex US

Venography

LMWH/Fondaparinux/Xa inhibitors

97
Q

How can varicose veins present if Sxs

How are these Tx

How does Peripheral Arterial Dz present

A

Pain w/ exertion or hyperesthesia

Compression Elevate Wound care Sclerotherapy Surgery

Painful ulcers MC d/t atherosclerosis

98
Q

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

A

Intermittent claudication relieved w/ rest

Angiography

Elevated homocysteine

99
Q

S/e of Nitro

Where is the location of Type 2 blocks

What is the first drug of choice for mild/mod HTN pregnancy

A

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
Q

Define Inotropic, Chronotropic, and Drootropic

Drug Tx of choice for HTN Urgency

Drug Tx of choice for HTN Emergency

A

I: Alters force of myocardial contraction
C: Alters HR
D: Alters conduction

Clonidine

Sodium Nitroprusside

101
Q

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

A

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
Q

Hypertriglyceridemia screenings begin at ? age

What level is considered normal

What are the ranges for mild, mod and severe

A

20y/o then q5yrs

<150

Mild: 150-499
Mod: 500-886
Sev: >886

103
Q

How is hypertriglyceridemia Tx

What is the goal of Tx

What benefit comes from managing the flushing s/e of meds used for Tx

A

Fibrates- Gemfibrozil, Fenofibrate
Niacin

Prevent pancreatitis

Inc HDL

104
Q

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

A

Hyperglycemia, DM

Daily ASA

Coronary artery spasm causing ST elevations

105
Q

What is the MC and another common RF seen in prinzmetal angina Pts

How is this Tx

What is the MC type of ASD

A

Smoking- MC; Cocaine

Long acting nitrates w/ Amlodipine

Ostium secundum: incomplete adhesion between foramen ovale flap and septum secundum

106
Q

? are the MC forms of ASD in order

MOA of ASA

What can cause acquired cases of aortic coarctation

A

O. Secundum, mid-septum
O. Primum- low septum
Sinus Venosus- upper septum

Irreversible inhibition of cyclooxygenase- catalyzes thromboxane enzymes

Inflammatory Dz: Takayasu arteritis

107
Q

Characteristics of Venous Hum

What inc/dec hum

What antiarrhythmic med is c/i during CADz/structural heart dz

A

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
Q

Class 1a antiarrhythmics

Class 1b antiarrhythmics

Class 1c antiarrhythmics

A

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
Q

Class 2 antiarrhythmics

Class 3 antiarrhythmics

Class 4 antiarrhythmics

A

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
Q

How are stable Pts w/ CHF Tx outpatient

How is PSVT Tx in stable Pt

What side effects are expected

A

BB ACEI Diuretic +ionotropic

Vagal
Adenosine 6mg, 12mg

Facial flushing
Dysrhythmia
Seizure
Hyper/Hypo-tension

111
Q

How does Acute Hypertensive HF present

How is this condition managed

What condition develops if too much medication is given

A

Pulm edema

Nitro O2 Furosemide

Methemoglobinemia

112
Q

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

A

Warfarin

IVDA secondary to tricuspid valve endocarditis

Paradoxical rise in JVP w/ inspiration during restrictive cardiomyopathy/pericarditis

113
Q

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

A

Amyloidosis

Tropical Endomyocardial Fibrosis- world
Amyloidosis- MC

GCA; Polymyalgia rheumatica

114
Q

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

A

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
Q

? is the MCC of HF w/ dec EF

MCC of pericarditis in USA and world

What form of pericarditis is afebrile

A

Ischemic cardiomyopathy

US: Viral (Coxsackie)
World: TB

Uremic

116
Q

Indications to admit pericarditis Pt

What antipsychotic med can cause peri/myocarditis

Rosh question

A 
Fever
PO anticoagulation
Out Pt failure
Myopericarditis
ImmSupp
Trauma
Effusion

Clozapine

Cards #26

117
Q

MCC of COPD

Why does this MC lead to so many issues

COPD is an umbrella term encompassing ?

A

Smoking

Vasoconstriction

Chronic bronchitis Emphysema

118
Q

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

A

Productive cough 3mon/yr x 2yrs w/out fever (fever= pneumonia Dx)

Blue bloaters: hypoxia

Hx 40 pack/year smoker

119
Q

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

A

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
Q

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

A

Inc H/H
Inc CO2/Dec O2
Respiratory acidosis- PCO2 >45, BiCarb >30

Cessation

SaO2 <89% or,
PaO2 <55mmHg

121
Q

What vaccinations doe Chronic Bronchitis Pts need

How are exacerbations managed

What complication can arise from this Dz process

A

Influenza, Pneumococcal

Pred 40mg/day x 5d
ABX: Azith/Cefur/Doxy

Cor pulmonale d/t hypoxic vasoconstriction

122
Q

COPD Gold Categories

A

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
Q

What causes structural changes seen in emphysema

Emphysema almost always co-exists w/ ? Dx

What type of breathing habit do these Pts develop

A

Destroyed alveolar septae d/t elastin loss

Chronic bronchitis

Purse lip, keeps airway from collapsing

124
Q

What CXR findings are seen w/ emphysema

What lab result will be different compared to chronic bronchitis Pts

What will emphysema PFT results show

A

Barrel chest
Hyperinflated lungs w/ bullae
Flat diaphragm

Normal Hct

Dec FEV1/FVC ratio
Inc TLC

125
Q

What causes acute sinusitis

What is the ‘little brother’ to HFlu

What is the gold standard for Dx

A

Acute: Strep Pneumo
Chronic: Staph A

Moraxella

CT

126
Q

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

A

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
Q

How is chronic rhinosinusitis Tx

What is used for Peds

What is used if they are allergic to PCN containing ABX

A

Augmentin
Allergic: Clinda

Augmentin

3rd Gen: Cefpod/Cefdinir

128
Q

? is the MC type of pneumonia

Typical pathogens typically present w/ ?

Atypical and viral pathogens present how?

A

Strep pneumo >40y/o;
Mycoplasma <40y/o

F/C/Tachy/Tachy w/ rusty sputum- lobar pneumonia

Fever w/ dry cough- interstitial infiltrate

129
Q

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

A

Strep pneumo HFlu Moraxella and more sick

Legionella Mycoplasma Chlamydial and not as sick

Legionella

130
Q

What microbe causes pneumonia after an influenza infection

What microbe infects CF, COPD, malignancy or ventilated Pts

? are the MC nosocomial infections

A

Staph A

Pseudomonas

UTI w/ catheter
Pneumonia w/ Strep pneumo

131
Q

What vaccination reduces risk for pneumococcal pneumonia

What populations should receive this

How is lobar pneumonia Tx in sequential order

A

23-PPSV

Chronic liver dz/Alcoholics
DM
Cigarette smokers
Asplenic/Sickle cell
Native American/Eskimo

Azith/Clarith-romycin
Doxy
Autmentin
Levofloxacin

132
Q

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

A

HFlu w/ patchy alveolar infiltrates

Kids <5y/o in daycare
COPD, HIV

Augmentin
Cefur/Cefdinir/Cefixime
Azithromycin
Levo- unless COPD, then first

133
Q

? is the MCC of pneumonia in Pts <40y/o

What other PE findings suggest this microbes etiology

What does this look like on CXR

A

Mycoplasma w/ late summer/early fall outbreaks

Bullous myringitis
Erythema multiforme

Patchy infiltrates that are more extensive than Pt appears on PE

134
Q

How is Mycoplasma pneumonia Tx in order

What form of Legionairres is most dangerous

What doe they require for replication

A

Azith/Clarith-romycin
Doxy
Levofloxacin

Serogroup 1

Amoebas in water

135
Q

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

A

Bradycardia

Pontiac fever, Pneumonia

Lower lobe patch w/ pleural effusion (inc LDH)

136
Q

How is Legionairres pneumonia Dx

How is this Tx in order

What causes pneumonia in HIV/AIDS/Ca Pts

A

Immunofluorescent Ab and ELISA
Direct fluorescent of sputum
UA

Azith, Levo, Doxy

P. jiroveci, unicellular fungi

137
Q

How does pneumonia d/t Jiroveci present

What does this look like on CXR

How is it Dx

A

F/C, dyspnea w/ dry cough x weeks

Interstitial pneumonia w/ inflamed/infected alveolar epithelial cells= bilateral, perihilar infiltrates

Bronchial lavage and biopsy

138
Q

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

A

Inc LDH levels

1st: TMP/SMX x 21days
2nd/PCN Allergy: Pentadmie (s/e- Qtc prolongation)
TMP + Dapsone

CD4 <200

139
Q

How is C Pistacci transmitted

How is this Tx

What are the 3 MCC of viral pneumonia

A

Inhalation through dried bird droppings

1st: Doxy; 2nd: Azith

Para/Influenza Adenovirus

140
Q

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/ ?

A

1st: Ribavirin; 2nd: Palivizumab

Decadron

<3mon w/ Levofloxacin

141
Q

How are Peds w/ CAP Tx

First line ABXs for CAP outpatient Tx

What is the risk when prescribing Levofloxacin

A

<5y/o: Amoxicillin
>5y/o: Azithromycin

Azith/Erythromycin
Clarithro/Doxy

Prolonged QTc

142
Q

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

A

Rust colored, Splenectomy

Salmon colored sputum after influenza infection

Bat/bird droppings from Ohio River valley; Sarcoidosis

143
Q

What three PE findings are common in pneumonia Pts

How does fungal pneumonia d/t Coccidioides present

? etiology of pneumonia is detected via CSF

A

Tactile fremitus
Egophony
Dull to percussion

Non-remitting cough unresponsive to ABX

Cryptococcus

144
Q

How is Crytpococcus and Histoplasma pneumonia Tx

How is Coccidioides and Aspergillus pneumonia Tx

What are the classic findings of TB on PE

A

Amphotericin B

Flu/Itra-conazole

Fever Anorexia Weight loss Night sweats

145
Q

What are the PPD rules for TB

A 
>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
Q

How is TB Dx

What is seen on CXR

What is seen on biopsy results

A

Acid fast bacilli smears and cultures

Apical Ghon complexes

Caseating granulomas

147
Q

What are the two forms of miliary TB

How is TB Tx

A

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
Q

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

A

Hepatotoxic; baseline labs

R: orange fluids
I: neuropaty
P: hyperuricemia
E: red-green blindness

Isoniazid x 12mon

149
Q

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

A

Two negative AFBs and cultures

P/E- 3 x/wk

Raltegravir, double dose when used w/ Rifampin

150
Q

What are the 4 indications to test for TB w/ NAAT

? is the traditional test for latent TB

Define Ranke Complex

A

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
Q

How are pregnant Pts w/ TB Tx and w/ ? educational piece

Define Asthma

Absence of ? Sx on PE indicates medical emergency

A

R/I/E x 4-8wks
R/I x 7months
Breast feeding not c/i

Chronic, reversible inflammatory airway dz

Lack of wheeze

152
Q

Define FEV1

Define FEV

Define FVC

How is asthma Dx and what result is Dx

A

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
Q

Define Intermittent Asthma

Define Mild

Define Moderate

Define Severe

A

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
Q

Step 1 Asthma Tx

Step 2 Asthma Tx

Step 3 Asthma Tx

Step 4 Asthma Tx

Step 5 Asthma Tx

Step 6 Asthma Tx

A

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
Q

What is used for acute Tx of asthma exacerbation

? is the MC of all interstitial lung dzs

How is this MC Dx

A

PO CCS
Ipratropium bromide
Nebulized SABA
O2

Idiopathic pulmonary fibrosis

CXR w/ diffuse, patchy fibrosis and pleural base honeycomb

156
Q

What type of PFT results are seen in Idiopathic Pulmonary Fibrosis

How is this Tx

Define Pneumoconiosis

A

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
Q

Asbestosis CXR findings

Coal Workers CXR findings

Sillicosis CXR findings

A

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
Q

Berylliosis CXR findings

? restrictive lung dz makes Pts at increased risk for TB

? restrictive lung dz needs tobacco cessation more than others

A

Difuse infiltrates w/ hilar adenopathy

Sillicosis- need serial TST/CXRs

Asbestosis

159
Q

? tissue finding indicates significant exposure to asbestos

? size lung mass is a nodule or a mass

How are incidental findings of pulmonary nodules managed

A

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
Q

Define Carcinoid Tumor

These are primarily found ? and MC mets to ?

What is the MCC of the mets

A

Neuroendocrine cells w/ excess secretion of serotonin, histamine and bradykinin

GI; Liver then to lungs

Appendix carcinoid tumor

161
Q

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

A

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
Q

How is carcinoid syndrome Dx

What would be seen on CXR

What would be seen on bronchoscopy

A

CT located tumors
Octreoscan
UA: Inc 5-HIAA, metabolite of serotonin

Pedunculated sessile growth in central bronchi

Pink/Purple lesion w/ vascularization

163
Q

How is carcinoid syndrome Tx

What are the two categories of lung cancer

What are the 4 subtypes of one of these categories

A

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
Q

? 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

A

Non-small cell adenocarcinoma

HypoNa, HyperCa

Lambert Eaton myasthenic syndrome- limb muscle weakness

165
Q

How are lung Ca Dx

Pancoast tumors are more likely to be ? types

What two syndromes can pancoast tumors cause

A

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
Q

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

A

Stage 1-2: surgery
Stage 3: chemo then surgery
Stage 4: palliative

Chemo, no surgery option

≥2yrs and <1.cm diameter

167
Q

Pulmonary nodule w/ calcification/central location suggests ? etiology

? measurement is indicative of a Dx of PHTN

What is the MCC

A

Benign, Tuberculoma, Histoplasmona

> 25mmHg at rest

Mitral stenosis

168
Q

What are the 5 WHO groups of P-HTN etiologies

What is the first Dx test

What is the gold standard for Dx

A

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
Q

What EKG findings suggest P-HTN

How is P-HTN Tx depending on the cause

A

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
Q

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

A

Progestin only

Fist: Venous US
Gold: venography

D-dimer

171
Q

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

A

LMWH
Fondaparinux
Factor 10a inhibitors

Cancer OCPs Pregnancy Surgery

Hypoxemia
Neuro abnormals
Petechial rash

172
Q

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

A

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
Q

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

A

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
Q

? triad is used for DVTs/PE

What two findings may be seen on CXR

? is the gold standard or imaging modalities for Dx

A

Virchows:
Trauma Stasis Hypercoag

Westermark, Hampton Hump

Pulm angiography

175
Q

OSA usually presents d/t obstruction at ? level

What are the 5 RFs for OSA

For a Dx, ? sleep study results are needed

A

Oropharynx

Obesity
Anatomical
FamHx
ETOH/Sedative
Hypothyroidism

5/> events/hr w/ Tired/Waking/Snoring/HTN
15/> events/hr regardless of other Sxs

176
Q

How is mild/mod OSA Tx

How is severe OSA Tx

Obesity Hypoventilation Syndrome is AKA ? and includes ? criteris

A

CPAP; PO appliance

CPAP
Uvulo-plasty
Tracheostomy- if life threat

Pickwickian-
BMI >30, Sleep d/o breathing, Chronic hypercapnia >45mmHg

177
Q

Define Central Sleep Apnea

What causes transudative pleural effusions

What is the MCC

A

Ventilatory effort absent for duration of apneic period

Thin watery ooze d/t back pressure in circulation and loss of osmotic pressure

CHF

178
Q

What are some causes of transudative pleural effusions

What are some causes of exudative effusions

Pleural effusions present w/ ? PE findings

A

HF
Cirrhosis/Ascites
Nephrotic induced hypoalbuminemia

Fluid d/t infection/Ca:
Pneumonia Ca PE TB

Dec breath sounds and tactile fremitus

179
Q

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 ?

A 
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
Q

How are pleural effusions Tx

Define ARDS

What is the MCC and possible causes

A

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
Q

How is ARDS Dx

What would be seen on CXR

How is ARDS Tx

A

Bilateral Sxs, CXR and PAO2/FIO2 ration <300

Air bronchograms w/ bilateral, fluffy infiltrates

Mechanical PEEP maintaining PaO2 >60/SaO2 >90

182
Q

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

A

Inc permeability of alveolar cap membrane

qSOFA:
New/worse mentation
RR >22/min
SBP 100/<

Lactate

183
Q

? is the MCC of sepsis and ? is the MC manifestation

Gram-Pos shock is d/t ? microbes

Gram-Neg shock is d/t ? microbes

A

Pneumonia; Fever

Staph/Strep exotoxin

EColi, Klebsiella, Proteus, Pseudomonas endotoxins

184
Q

? are the sepsis biomarkers

How are septic Pts Tx

A

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
Q

What ABG results are seen w/ sepsis

MCC of anaphylaxis

? type of reaction is the usually

A

Resp alk, Metabolic acid

Ingested foods

MC a Type 1 IgE mediated reaction

186
Q

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

A

Cutaneous pruritus/urticaria/angioedema

IM Epi

BBs

187
Q

Define Cystic Fibrosis

How is this Dx

What would be seen on CXR

A

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
Q

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

A

Staph A, HFlu the Pseudomonas

Hypertonic saline cleanings
ADEK supplementation

Cheyne Stokes- fast/shallow breathing followed by slow/heavy breathing
Pulsus alternans

189
Q

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 ?

A

BNP- establish prognosis/severity

Cardiac MRI

Transplant rejection

190
Q

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

A

ACEI, BB

Add aldosterone antagonist- Spironolactone, Eplerone
Switch ACEI/ARB for ARNI- Sacubitril/Valsartan

CCBs; Afib/flutter ventricular control

191
Q

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?

A

Mineralcorticoid antagonist- Spironolactone, Eplerone;
<40%

Resting HR >70
LVEF <35%
Chronic and stable

Digoxin;
Dec hospitalization

192
Q

? 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

A

Hydralazine-Nitrate

Significant MR and,
QRS >150msec

ASx ischemic cardiomyopathy w/ LVEF <35% on appropriate medical therapy and >40d post-MI

193
Q

Dilated Cardiomyopathy w/ Afib should be anticoagulated w/ ? unless ?

What are four reversible causes of Dilated Cardiomyopathy

When is the obstruction of HOCM increased

A

DOAC; Mitral stenosis

Hypothyroid
Alcohol
Toxins
Sarcoidosis

Systole w/ anterior motion of MVs anterior leaflet

194
Q

What is the end consequence of HOCMs hypertrophy

How is this condition inherited

How is this condition differed from athletic heart

A

Inc LV diastolic pressure

Autosomal dominant sarcomere defect: myosin heavy chains/Ca regulating proteins

Athletes- no diastolic dysfunction

195
Q

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 ?

A

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
Q

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

A

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
Q

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

A

MR

LVH

Septal Q-wave (2, 3, aVF)
High voltage precordium

198
Q

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

A

Ventricular noncompaction- trabeculation causing incomplete ventricular filling

Dual biventricular pacing

Malignat ventricular arrhythmia
Unexplained syncope w/ +FamHx sudden death

199
Q

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/ ?

A

Myotomy myomectomy w/ Alfieri

Alcohol ablation into LCA

Outflow gradient >50mmHg;
BBs

200
Q

? 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

A

Tech-pyrophosphate bone scan

Cardiac MRI

Rectal Adipose Gingival biopsies;
Endomyocardial biopsy

IPAP (212 decks)

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