Internal Medicine Flashcards
What 5 way can CAD present?
- Asymptomatic
- Stable angina pectoris
- Unable angina
- MI-either NSTEMI or STEMI
- Sudden cardiac death
What is the worse risk factor for Stable angina? What is the MC risk factor?
Diabetes mellitus- worst
HTN-MC
What two factors do you look at to determine Prognostic of CAD?
- Left entricular function (ejection fraction): <50%= increase mortality
- Vessel involved: lf. Coronary artery-poor prognosis, two/three vessel w/ CAD= worse prognosis
What finding are present on a stress test of someone w/ stable angina?
—usually a normal ECK before exercising
—ST segment depression; due to subendocardial ischemia
—possible findings; onset of HF or ventricular arrhythmia during exercise or hypotension
(75% sensitive)
What finding a present in a stress echocardiography in a person w/ stable angina?
—evidenced of wall abnormalities (amines is or dyskinesia) determine by injecting radioisotope thallium 201 into body, function cell extract the radioisotope, while ischemic cell don’t
— next, determine if reversible (if yes, PCI or CABG)
What may induce a stress test beside exercise? (Pharmacologic)
- IV adenosine, dipyridamole, or dobutamine
—adenosine and dipyridamole- cause coronary vasodilation=> diseases tissue receives relatively less blood than the rest of the heart
—dobutamine- increases myocardial oxygen demand by increasing heart rate, BP, and cardiac contractility
What are the indications for a Coronary angiography? (5)
- stress test
- Acute MI w/ intent of performing angiogram and PCI
- Angina and 1 of the following: noninvasive test are non diagnostic, continues despite medical treatment, soon after MI
- Severely symptomatic and urgent diagnosis and management is needed
- Evaluation of valvular disease
What is the standard treatment of care for stable angina?
Aspirin ( decreased morbidity-reduces risk of MI)
BBlocker- atenolol and metoprolol
Nitrates for chest pain- symptomatic relief
Use above if the disease is mild (normal EF, moderate angina, single-vessel) If moderate disease try the regime above, consider coronary angiography Sever disease ( decrease EF, severe angina, and 2/3 vessel): coronary syndrome angiography
What are the complication of infective endocarditis for the cardiac, neurologic, renal, MSK?
Cardiac= valvular insufficiency (cause of death), perivalvular abscess, conduction abnormalities, mycotic aneurysms. Neuro= embolic stoke, cerebral hemorrhage, brain abscess acute encephalopathy or meningoencephalitis Renal= renal infarction, glomerulonephritis, drug-induced acute interstitial nephritis from therapy MSK= vertebral osteomyelitis, septic arthritis,,MSK abscess
Describe acute erosive gastropathy?
Acute erosive gastropathy is the development of severe hemorrhagic lesions after the exposure of gastric mucosa to various injuries agents or after a substantial reduction in blood flow.
Aspirin decreases the protective prostaglandin
Cocaine vasoconstriction the vessel=> decrease blood flow
**pt presents with abd discomfort, nausea and bloodily vomits after a night of drinking and cocaine
What are the cause of delirium ( predisposing risk factors-5 and precipitating factors-6)?
Predisposing risk factors: dementia, parkinson Dx, prior stroke, adv. age, sensory impairment
Precipitation factors:
— drugs-narcotics, sedatives, antihistamines, muscle relaxers, poly pharmacy
—infections-pneumonia, UTI, meningitis
—metabolic disturbances-hyponatremia, hypercalcemia
—Systemic illnesses-congestive heart failure, hepatic failure, malignancy
—CNS-seizures, stroke, head injury, subdural hematoma
Treatment for HIV pt with pneumocystis pneumonia?
Trimethoprim-sulfamethoxazole+ corticosteroids **corticosteriods have been shown to decrease mortality in cases of severe PCP
** use when partial pressure of oxygen (PaO2)< 70 mmHg or an alveolar-arterial gradient >35mmHg
How can a PE present in a postop pt?
Pt fall while getting out of bed
Low BP (89/50), increased HR (122), increased RR (24)
decreased bibasilar lung sounds and distended neck veins
ECG: new-onset RBBB w/ non-specific ST-and T-wave changes
What are pt with a PMHx of Hodgkin lymphoma treated with chemo and radiation at an increased risk of developing?
Secondary Malignancies: lung, breast, thyroid, bone and GI
Acute leukemia or non-HL
Describ c. Difficult colitis in adults based on risk factors, clinical presentation, diagnosis, treatment, and infection control.
Risk factors: Recent antibiotics, Hospitalization, PPI
Clinical presentation: profuse diarrhea , fulminant colitis or toxic megacolon
Diagnosis: stool PCR
Treatment: P.O. vancomycin or fidaxomicin
INfection control: hand hygiene with soap and water, content isolation, spermicidal disinfectants
