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CPR Exam 2 > LOs > Flashcards

LOs Flashcards

1
Q

What are the top 5 symptoms that correlate with edema?

A
  1. Leg swelling
  2. Dyspnea
  3. Orthopnea
  4. Paroxysmal Nocturnal Dyspnea
  5. Weight gain
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2
Q

what is edema?

A

abnormally large amounts of fluid in intracellular spaces that can be localized (d/t venous obstruction or lymphatic obstruction) or generalized, d/t systemic causes.

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3
Q

What is edema called in the

  1. - peritoneal cavity
  2. - pleural cavity
  3. - pericardial sac
A
  1. Ascites
  2. Hydrothorax
  3. Hydropericardium
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4
Q

Non-pitting edema is due to?

A
  • 1. Metabolic disease (myxedema)
  • 2. Lymphatic system disease
  • 3. Warm weather
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5
Q

type of imaging for edema

A

1. CXR- PA and lateral

2. EKG

3. Echo

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6
Q

if out of country and patient has lymphedema, what should come to mind as the cause?

A

Filarial infection

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7
Q

What is a fever?

A
  • rise in body temperature in response to endogenous cytokines
  • Above 100.0 F (38.3 C)
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8
Q

involuntary muscle contractions that occur as a result of a sudden lowering of body temperature below a persons set point

A

chills

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9
Q
  1. Describe hyperthermia and its distinction from fever while relating common entities that are associated with its occurrence.
A
  1. Hyperthermia → elevated body temperature inability of body to dissipate heat in response to environmental heat
    1. Anything over 105.8 (41 C) is hyperthermia
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10
Q

What is a fever of unknown origin

A
  • fever that lasts 3 weeks or longer with temperatures above 100.9, with no clear dx, even though there has been 1 week of clinical investigation
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11
Q

How does a fever occur?

A
  1. Lipopolysaccharide (endotoxin) of gram (-) rods, ciruses and other fungi, etx
  2. Endogenous pyrogens (EP) binds to receptors in hypothalamus.
    1. IL1
    2. TNF: like IL1, but does not activate lymphocytes
    3. Interferon-a
  3. Increase in PGE2, monoamines, cations and cAMP
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12
Q
  1. 4 common causes of fever
A
  1. Infection
  2. Autoimmune disease
  3. CNS disease
  4. Malignancy
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13
Q

less common causes of fever

A
  1. CVD
  2. GI Disease
  3. Misc.
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14
Q

most common causes of hyperthermia

A
  1. Heat Stroke
  2. Neuroleptic Malignant Syndrome
  3. Malignant Hyperthermia
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15
Q

Describe the cource of fever in younger adults vs over 65 pts

A
  • younger adults: benign and self-limited.
    • Challenge: ID meniningitis or sepsis
  • older than 65/those with chronic disease and fever: high risk for bad things.
    • 70-90% are hospitalized
    • Infection is the MCC in adults
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16
Q

in older people, what body systems are 80% of the target, which cause fever?

A
  1. Respiratory tract
  2. Urinary tract
  3. Skinn and soft tissue
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17
Q

what alarm systems are assx with a fever?

and what could they imply

A
  1. High fever (above 105.8)
    1. CNS infection, NMS, heat stroke
  2. Rash
    1. ​Meningitis, bacteremia with shock
  3. Changes in mental status
    1. ​Meningitis, encephalitis
  4. Dizziness or lightheadedness
    1. ​Bacterial infection with shock, adrenal insuff, PE
  5. Recent chemo
    1. ​nocosomial infection w neutropenia
  6. SOB or Chest Pain
    1. ​PE, pneumonia and empyema
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18
Q
  • Thermometer with the most variability: ______
  • Subjective report of a fever is usually ______.
  • In patients with a fever, the best predictors of bacteremia are what?
  • Prescence of _________ increases the probability of bacteremia.
  • What is the GREATEST VALUE of fever patterns today?
  • Persistance of a fever means what?
A
  • tympanic fever
  • accurate
  • patients underlying conditions
  • shaking chills
  • they respond to antimicrobial agents
  • superinfection, drug fever, abcess or noninfectious mimic of infectious disease (vasculitis, tumor)
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19
Q
  • MCC of nocosomial infections in hospitilzed pts
  • MCC cause of FUO:
  • Malignancies most assx with FUO:
  • 36% of patients with ____ have fever at presentation
  • 42% of patients with ____ have fever at presentation
  • 42% of patients with ____ have fever, but develops LATER in the course of illness.
A
  • bacterial: pneumo, catheter-related spesis, clostridium difficile diarrhea, wound infections, UTI
  • TB and intra-abdominal abcess
  • Hodkines and non-hodgkins lymphoma
  • SLE
  • Giant cell arteritis
  • IBD
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20
Q
  1. Endocarditis + fever
    1. MCC
    2. Other causes
    3. Diagnose:
A
  • Rheumatic Heart Disease
  • Staph aureus, strep vridans
  • Clinical eval is not enough
    • Blood cultures***
    • Transesophageal echo is the cornerstone
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21
Q

what is used to dx Endocarditis?

A

Duke criteria

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22
Q

if pt presents with HF, what is important to note?

A
  • HF is caused by many things.
  • thus, it is important to ID the UNDERLYING cause of HF.
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23
Q

how to dx HF?

A
  • 1. Natriuretic peptide levels
  • 2. 2D echo with doppler
  • 3. CXR
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24
Q

S3 gallop means what?

S4?

A
  • S3: systolic HF
  • S4: diastolic HF
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25
Q
  • Myocarditis
    • ​Follows:
    • Present with:
    • Similar to ____, coming on a few weeks after a febrile illness.
    • May have _________ when auscultated
    • Diagnose
    • Would cardiac enzymes be elevated?
A
  • URI
  • CP or signs of HF
  • PSGN
  • Pericardial friction rub
  • ECG, would see sinus tachycardia
  • COULD be
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26
Q
  1. Granulomatosis with polyangiitis (also called ______)
    1. ____-ANCA
    2. Patient could have a ______
A
  • Wegners
  • c-ANCA
  • Cough
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27
Q

what would have P-ANCA?

A
  • 1. Microscopic polyangitis
  • 2. Polyarteritis nodosa
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28
Q
  1. Pulmonary Embolism (fever)
    1. Elevated levels of _____
    2. Sx:
A
  • D-dimer
  • Appear anxious or ill, hypoxemia, tachypnea
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29
Q

do we hospitlize patients with FUO?

A
  • only if clinical condition requires it, NOT for diagnosis.
  • thus, does NOT need a in-hospital eval
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30
Q

FUO defintion

A
  1. Fever > 101 on at least 2 occasions for 3 or more weeks
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31
Q

Infections cause 1/5 of causes of FUO in Western countries. Next in frequency are what?

A
  • Non-infectious inflammatory diseases (NIIDS)
    • collagen or rheumatic diseases
    • vasculitis
    • granulomatous disoders
    • autoinflammatory syndromes neoplasma
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32
Q
  • If we have a FUO, which DOES NOT ALWAYS MEAN INFECTION, how do we treat?
  • What about if the patient is toxic or septic?
A
  • Withhold ABX
  • If patient is toxic or septic, empirical ABX.
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33
Q
  1. Tick-borne illness that can cause fever?
A
    1. Rickettsial (rocky mountain spotted fever)
    1. Lyme disease
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34
Q

What tick-borne illness is common in SW Missouri?

treat is?

A

HME: Erlichiosis

-empirical ABX

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35
Q

MRC Dyspnea Scale

A
  1. When you have SOB
    • 1 → no trouble except for strenuous exercise
    • 2 → hurrying walking up hill
    • 3 → walking slower than most, stops after a mile or 15 minutes
    • 4 → after 100 yards or a couple of minutes
    • 5 → at rest, can’t leave the house
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36
Q

how do diagnose COPD?

A

GOLD and MRC Dyspnea scale

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37
Q
  1. Describe the 6-minute walk test and its utility in the diagnosis and management of patients with dyspnea and dyspnea on exertion.
A
  • 6 minute walk test is a part of diagnosing COPD + pulmonary HTN.
    • determines function of the right side of the <3
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38
Q

what is best at detecting pulmonary HTN/COPD?

how can we track progression of PAH?

A
  • 6 minute walk test
  • 6 minute walk test + echo
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39
Q

the GOLD criteria is used to diagnose _____

A

COPD

  1. Mild (>80)
    1. SABD prn
  2. Moderate (50-80)
    1. + LABD + pulm rehab
  3. Severe (30-50)
    1. + ICS if repeated exacerbations
  4. Very severe
    1. ​< 30
    2. or <50 + respiratory failure
    3. + add long-term O2 therapy; surgery
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40
Q

what do we see with diffuse parenchymal lung disease on CXR?

other findings?

A
  • diffuse bilateral reticular lung disease in the upper zones of the lungs
  • dry crackles, parasternal S2
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41
Q

treatment of asthma plan

A
  1. LABA + LAMA (Long acting muscarinic antagonist)
    • Salmeterol/formotorol + tiotropium
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42
Q

a1AT deficiency

  • Which of the following do we give?
    • ICS,
    • O2
    • LABA
A

LABA

  • do not give O2 bc 6 minute walk test is NL
  • no ICS
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43
Q

pt who is hypoxic will describe what symptom

A

SOB

44
Q

COPD d/t infection is caused by

A
  1. Strep. pneumo
  2. M. catarhallis
  3. H. influenzae
45
Q

classic 4 signs of sarcoidosis

A
  1. erythema nodosa
  2. fever
  3. arthralgia
  4. hilar adenopathy (CXR)
46
Q

Which DPLD has HIGH ACE levels

A

sarcoidosis

47
Q
  1. Identify patients at risk for the development of pneumonia.
A
  1. CURB-65 → identify high risk patients + predict complicated course
    1. C → Confusion
    2. U → BUN > 19.6
    3. R –>RR > 30
    4. B → Systolic Blood Pressure LESS 90
    5. 65 → > 65 years old
  2. 2 findings: admit to hospital
  3. 3 findings: admit to ICU
48
Q

if you give a patient therapy for community-acquired pneumo, but they do not respond in 48-72 hours, what should we suspect?

A
  1. Legionnarires
  2. TB
  3. Fungi
  4. Viruses
  5. Pneumocystitis
49
Q
  1. Describe patients at risk for developing active tuberculosis, or harboring latent tuberculosis.
A
  1. Active TB
    1. Born in areas endemic to TB
    2. Around people w/ it
    3. Medically underserved/low income populations
    4. IV Drugs users
  2. Latent TB → Asymptomatic
    1. HIV/AIDS
    2. Immunosuppression in general
    3. Malnutrition
50
Q

Signs of active and latent TB?

A
  • Active: hemoptysis and weight loss
  • Latent: constitiuional sx and asymptomatic
51
Q

In what conditions is tactile fremitis

INCREASED:

DECREASED:

A
  • Increased: pneumonia
  • Decreased: COPD and asthma
52
Q
  1. Plan a directed evaluation of a patient with hypoxia to determine the diagnosis and severity
    of the disorder.
A
  • CXR: PA/lateral view
  • EKG
  • CMP/CBC
  • Lactic acid, blood culture and sputum culture
  • kidney fxtest
53
Q
  1. vicious cycle in COPD pts that are tired and have shoulder pain
A
  • Gave tramadol
  • Cause pleurisy
  • Took more and made it worse
  • Hypoventilates => retain CO2
54
Q

_____ patients retain CO2

______ are CO2 responsive

A
  • Chronic bronchitis (blue bloaters) retain CO2
  • Pink puffers (emphysema) respond to CO2
55
Q

What are signs of infection?

A
  • Increased band count/ increase neutrophil granulation/vacuolization => LEFT shift => INFECTION
56
Q
  1. DDX for Community-Acquired Pneumonia
A
  1. Organizing Pneumonia
    1. Diffuse Parenchymal Lung Disease
  2. Lung Cancer
  3. Eosinophilic Pneumonia
  4. Hypersensitivity Pneumonitis
57
Q

top 4 causes of persistant cough?

A
  • 1. post nasal drip
  • 2. Asthma
  • 3. GERD
  • 4. Pulmonary infection
58
Q
  1. Non-pulmonary causes of cough
A
  1. GERD
  2. PND
  3. HF
  4. Sinusitis
59
Q

Pulmonary infections

  1. Bronchiectasis (produces lots of _______)
  2. Bronchitis (common in ______)
  3. MAC (MC in whom)
  4. Mycoplasma: __________
  5. Clamydia: _________
A
  • mucus
  • smokers
  • older patients, especially with disease
  • # 1 atypical PNA; in military recruits
  • # 2 atypical PNA
60
Q
  • + bronchoprovication test = __________
  • decreased intensity of breath sounds= _________
A
  • asthma
  • COPD
61
Q

which vasculitis of the skin and legs presents with a cough + dyspnea

and has shit ton of eosinphils?

A

churg strauss

62
Q

how do we diagnosis churg straus?

A

fibrinoid necrotizing epitheloid + eosinophillic granulomas

63
Q

Treatment of Churg-Straus?

How do we maintain therapy?

A
  • Corticoisteroids (prednisone) +cyclophosphamide until remission then taper off.
  • Exchange cyclophsophamide with methotrexate
64
Q

what clinical CV findings do we see with Sarcoidosis?

A
  • 1. Restrictive cardiomyopathy
  • 2. Cardiac dysrhythmias
  • 3. Conduction disturbances
65
Q
A
66
Q

Restrictive lung disease

_____ lung volume.

_______ TLC or FVC

_______ FEV1/FVC ratio

A
  • decreased
    • alteration in lung parenchyma
    • disease of pleura, chest wall or NM
  • Decreased
  • NL
67
Q

Obstruction LD

  • FEV1
  • FVC
  • FEV1/FVC ration
  • TLC
A
  • decreased
  • NL
  • decreased
  • NL or increase
68
Q

idiopathic pulmonary fibrosis

  • Mutation:
  • Presentation:
  • Dx:
A
  1. Surfactant C and telomerase/MUC5B
  2. Gradual onset (>6) months; progressive dyspnea is the most COM symp
    1. basilar inspiritary crackles
    2. clubbing
69
Q

what do lung function tests show for idiopathic pulmopnary fibrosis?

how is it dx?

A
  • Decreased diffusing capacity of the lungs for CO (DLCO)
  • GOLD STANDARD + lung biopsy
70
Q

What is acute coronary syndrome-NSTEMI

A

NSTEMI (unstable angina) that presents with substernal crushing chest pain that radiates to L arm for more 30 minutes and can be relieved with nitro.

71
Q

What is the inital steps in management of NSTEMI (ACS)?

A
    1. O2 via nasal canula
    1. Pain relief with opiate analgenics and nitroglycerin
      * MONA: morphine, O2, nitratates and ASP
    1. Aspirin
    1. ECG
    1. Labs: CKMB, tropinin, CMP to check renal fx
      * High troponin: NSTE
      * NL troponin: unstable angina
72
Q

What are treatments for NSTE-ACS?

A
  1. Anticoagulation therapy: IV heparin, Enoxaparin
  2. Class 1 Antiplatelet drugs (have to do them over and over again for a year)
    1. Aspirin
    2. P2Y12 inhibitors
      1. Clopidogrel and Ticagrelo
    3. Glycoprotein 2a3b inhibitors for HIGH risk NSTE-ACS
      1. Abciximab, tirofiban +eptifibitide
  3. Opiate analgesia + NG ONLY IF THERE IS PAIN
  4. Bblockers, ACE inhibitors, statins
73
Q

What is a class 3 drug that you should NOT use for NSTE-ACS?

A

Thrombolytics

74
Q

When do you give PCI (percutaneous intervention) to a patient with NSTE-ACS?

A
  • High-risk patient, then send to cath lab
75
Q

How do you treat a low-risk and high-risk patient differently with NSTEMI-ACS?

A
  • Low risk (NL troponin and - ST depression): stress test
  • High risk (high troponin and + ST depression): PCI and cath lab
76
Q

What are high risk feautures of NSTEMI-ACS?

A

Elevated troponin + ST depression

77
Q

How can we tell if patient with ACS is experiencing unstable angina?

A
  • NL levels of troponin unstable angina
  • High levels of tropinin: NSTEMI
78
Q

_______ is dangerous in NSTE-ACS.

______ is the MOST important thing in STEMI?

A
  • thrombolytic/fibrinolytic therapy
  • reperfusion therapy
79
Q
A
80
Q

____ supplies in the inferior of heart:

what arteries supplies V1/2? (anterior part of the heart)

1 and aVL? (lateral part of the heart?

A
  • RCA
  • LAD
  • LCX or diagnonal A from LAD
81
Q

what is the progression of changes in cardiac enzymes in pt with STEMI?

A
  1. Initial cardiac enzymes may be normal if early presentation.
  2. Become + 4-6 hours later
  3. Troponin may stay elevated for 5-7 days after STEM
82
Q

How do you treat STEMI?

A
  1. Aspirin

2. PG2Y12 inhibitor (clopidrgel/ Ticagrelor)

  • If high risk: Gp2a/3b inhibitors
    3. Reperfusion therapy: via coronary angiography & PCI or thrombolytics (if facility of Primary PCI is not available) d/t ST elevation,
  • Only give thrombo is cannot do CA or PCI in a cath lab
  • PCI: door to ballon is 90 minutes
  • If no cath lab, but you can transfer pt to hospital in 120 minutes, DO IT
83
Q

what are absolute CI for thrombolytics in STEMI?

A
  • 1. Prev hemorrhagic stroke
  • 2. Other strokes
  • 3. Intracranial neoplasms
  • 4. recent head trauma
  • 5. Active internal bleeding (not menstruation)
  • 6. Suspected aortic dissection
  • 7. ANY bleeding
84
Q

1 treatment for STEMI?

A
  1. SEND TO CATH LAB
85
Q
  1. Post MI complications (5)
A
  1. Post infarct ischemia
  2. Arrhythmia
  3. Right ventricular infarction
  4. Mechanical complications
  5. Myocardial dysfunction
86
Q

Post MI Ischemia can occur when?

Tx?

A
    1. After thrombolytic therapy for STEMI
    1. After medically treating a NSTEMI.

Treat with vigorous medical therapy. If refractory, undergo early aniography and revascularization

87
Q

What arrythmias can occur after a MI?

A
  1. Sinus bradycardia (MCC in inferior MI)
  2. Supraventricular tachycardia, including a-fib
  3. Conduction disturbances
  4. Ventricular arrhythmias
88
Q
  1. AV node supplied by _______
A

RCA

89
Q

Post-MI, patient has

  • 1st degree AV block
  • 2nd degree AV block
  • Complete AV block

describe them

A
  • 1st degree AV block: most common and no treatment
  • 2nd degree AV block: only treat if symptom
  • Complete AV block: most common in an inferior MI.
    • If occurs with an anterior MI => worse.
90
Q

complete AV block is most common in an ____ MI and worse with an _____ MI? What is the treatment?

A
  • inferior
  • anterior = worse bc sign of BAD infarction
    • Permenant pacing
91
Q

What is the most comon conduction abnormality in the first few hours after MI and how is it treated?

A

Ventricular arrythmia (VT/VF)

  • if hemodynamically signifiant: defibrillate
  • Stable: antiarrhythmic meds + amiodrone
92
Q

how do you treat RV infarction, which occurs in 1/3 of all inferior MIs.

A

IV fluids

    • AVOID VASODILATORS (NG)
    • DO NOT REDUCE PRELOAD
93
Q

Right ventricular infarcts (RV infarcts) presents with what sx?

A

1. Hypotension

2. Normal LV function

3. High JVP

4. Clear lungs

94
Q

How are LV/RV infarcts different?

A
  • RV infarcts
    • RV infarcts will have clear lungs
    • Dx by: ST elevation in the right sided anterior leads
  • LV infarcts
    • LV infarcts do NOT have clear lungs
    • Dx: ST elevation in the left sided anterior leads
95
Q

NAME THAT SHOCK!

  • Systolic BP < 90mmhg and diminished perfusion (cold clammy extremities, decreased urine output, confusion), however the patient does not respond to fluid resuctiation.
A

Cardiogenic shock

96
Q

NAME THAT SHOCK

should be considered for urgent coronary angiography, revascularization and possible placement of intra-aortic balloon pump.

A

cardiogenic shock

97
Q

NAME THAT SHOCK

Echocardiagram should be taken and will show function of the LV is moderately - severely reduced.

A

Cardiogenic shock

98
Q

NAME THAT SHOCK!

what type of shock has a 30 day mortality of 40-80%

A
99
Q

• Essentials of Diagnosis in a patient with shock (4)

A
  1. Hypotension
  2. Tachycardia
  3. Oliguria
  4. Altered mental status
100
Q

Name that shock

Blood loss or dehydration causes decreased intravascular volume. To treat, we replete the intravascular volume

A

hypovolemic shock

101
Q

NAME THAT SHOCK!

Shock caused by [cardiac tamponade, tension pneumothorax and massive PE] that is treated by treating underlying cause

A

Obstructive shock

102
Q

NAME THAT SHOCK

A category of shocks, where the most common in septic shock!

A

distributive shock

103
Q

NAME THAT SHOCK!

Shock most commonly caused by gram (-/+) organism where hypotension does NOT respond to fluid. Systolic BP are < 100mmHg, serum lactate levels are high (> 2mmol/L) and requires vasopressors to keep MAP above 65mmHg.

A

SEPTIC SHOCK

104
Q

NAME THAT SHOCK!

Type of shock treated by fluids + ABX + hope for the best!

A

Septic shock

105
Q
A

CPR Exam 2 (29 decks)

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