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Midterm B Flashcards

1
Q

Pathophysiology of ischemic heart disease

A

Myocardial metabolic oxygen demand that exceeds myocardial oxygen supply

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2
Q

Top causes of ischemic heart disease

A
  • Thrombosis

- Coronary arterial vasospasm

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3
Q

Top risk factors for coronary artery disease

A
  • Male

- Increasing age

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4
Q

Most reversible risk factor for CAD

A

Smoking

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5
Q

What is angina pectoris

A

Chest pain and pressure due to ischemia of myocardium

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6
Q

What is chronic stable angina

A

Angina that occurs predictably with exertion

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7
Q

Criteria for unstable angina

A

1) Abrupt increase in severity or frequency
2) Angina at rest
3) New onset of angina

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8
Q

Angina pectoris is often absent unless the atherosclerotic lesion causes what percentage of coronary occlusion

A

50-75%

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9
Q

There is maximal compensatory dilation distal to an atherosclerotic lesion when it has reached __% occlusion

A

70

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10
Q

ECG diagnosis of angina

A

ST depression over 1mm with or without T wave inversion

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11
Q

Gold standard for angina diagnosis

A

Coronary angiography - determines anatomic extent of CAD and LV function

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12
Q

Nearly all MIs are caused by what?

A

Thrombotic occlusion of a coronary artery

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13
Q

3 criteria for diagnosing an MI

A

1) Clinical history of angina pectoris
2) Serial ECG changes indicative of MI - ST changes, T wave inversion, bundle branch block
3) Rise and fall of serum cardiac enzymes (troponin)

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14
Q

Treatment options for an MI (MONA)

A
  • Morphine (to reduce pain/anxiety thus reducing myocardial oxygen demand)
  • Oxygen
  • Nitrates
  • Aspirin (thin blood to get rid of clots)
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15
Q

Patient populations at greatest risk of cardiac complications under anesthesia

A
  • Extensive CAD
  • Recent history of MI
  • Ventricular dysfunction
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16
Q

Valvular diseases that produce systolic murmurs

A
  • Aortic or pulmonary stenosis

- Mitral or tricuspid regurgitation

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17
Q

Valvular diseases that produce diastolic murmurs

A
  • Mitral or tricuspid stenosis

- Aortic or pulmonary regurgitation

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18
Q

Most common dysrhythmia with rheumatic mitral valve disease and left atrial enlargement

A

A-fib

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19
Q

Heart valve most often affected by rheumatic disease

A

Mitral valve

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20
Q

Effect of mitral stenosis on lungs

A

Could cause pulmonary edema due to high left atrial pressures that cause an increase in pulmonary venous pressure

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21
Q

A patient with mitral stenosis becomes symptomatic with a mitral valve area less than…

A

1cm^2

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22
Q

A transvalvular pressure gradient over __mmHg is indicative of severe mitral stenosis

A

10

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23
Q

Treatment of mitral stenosis

A
  • Diuretics

- Rate control for a-fib with digoxin, b-blockers, ca2+ blockers

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24
Q

What should be avoided intra-op when managing a patient with mitral stenosis

A
  • Tachycardia (b/c it further impairs LV filling)
  • Increases in blood volume
  • Decreases in SVR (b/c that could cause tachycardia which is not tolerated)
  • Hypoxemia/hypercarbia (bc it could exacerbate pulmonary hypertension)
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25
Q

Principle pathologic change caused by mitral regurgitation

A

Left atrial volume overload

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26
Q

Severe mitral regurgitation is defined as having a regurgitant fraction over…

A

0.6

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27
Q

Fraction of stroke volume that enters left atrium in a patient with mitral regurgitation depends on what 3 factors

A
  • Size of mitral valve orifice
  • Heart rate
  • Pressure gradient across mitral valve
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28
Q

What should be avoided during anesthetic management of a patient with mitral regurgitation

A
  • Sudden decreases in HR
  • Sudden increases in SVR
  • Drug induced myocardial depression
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29
Q

How can the magnitude of regurgitant flow in a patient with MR be monitored intra-op?

A

With an echo/pulmonary catheter

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30
Q

What is mitral valve prolapse

A

Prolapse of one or both mitral leaflets into the left atrium during systole - can occur with or without mitral regurg

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31
Q

Mitral valve prolapse is associated with what heart sounds?

A

Mid-systolic click and late systolic murmur (click-murmur syndrome)

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32
Q

What is the most common form of valvular heart disease?

A

Mitral valve prolapse

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33
Q

Anesthetic management of a patient with mitral valve prolapse is similar to the management of what other valvular disease?

A

Mitral regurgitation

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34
Q

Aortic stenosis is considered critical when the transvalvular pressure rises above

A

50mmHg

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35
Q

Aortic stenosis is considered critical when the orifice area is below

A

0.8cm^2

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36
Q

Murmur associated with AS and location it is best heard

A

Systolic ejection murmur that radiates to the neck, best heard at 2nd right ICS

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37
Q

Anesthetic considerations for a patient with aortic stenosis

A
  • Maintain normal sinus rhythm (loss of atrial contraction may cause decrease in stroke volume and blood pressure)
  • Avoid tachy/bradycardia
  • Avoid sudden changes in SVR
  • Optimize intravascular fluid volume
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38
Q

Murmur associated with aortic regurgitation

A

Blowing murmur heard along right sternal border

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39
Q

During anesthetic management of a patient with AR, it is best to keep their HR under

A

80

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40
Q

What is the most common cause of tricuspid regurgitation?

A

Pulmonary hypertension which causes dilation of the right ventricle

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41
Q

Signs of tricuspid regurgitation

A
  • Jugular vein distension
  • Hepatomegaly
  • Ascites
  • Peripheral edema
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42
Q

Anesthetic considerations for a patient with tricuspid regurgitation

A
  • Maintain fluid volume and CVPs high to facilitate adequate preload
  • Avoid hypoxemia and hypercarbia because those increase PVR
  • Use agents that produce PA vasodilation
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43
Q

What is the most common circulatory derangement in adults?

A

Systemic hypertension

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44
Q

Criteria for diagnosis of systemic HTN

A

Blood pressure over 140/90 on 2 occasions measured 1-2 weeks apart

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45
Q

Which type of HTN, essential or secondary, is most common?

A

Essential HTN - accounts for 95% of HTN cases

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46
Q

Most common cause of secondary HTN

A

Renovascular HTN from renal artery stenosis

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47
Q

How is a hypertensive crisis defined

A

Acute diastolic BP increases over 130mmHg

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48
Q

What is the desired decrease in BP during treatment of a hypertensive crisis?

A

Decrease MAP by 20% in first 2 hours, then additional decreases over next 1-2 days. DON’T decrease to normotensive levels right away.

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49
Q

Drug treatments for a hypertensive crisis

A
  • Nitroprusside 0.5-10mcg/kg/min
  • Hydralazine
  • Nitroglycerin
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50
Q

Most common form of heart failure

A

Left sided heart failure

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51
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

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52
Q

Systolic heart failure is defined as an ejection fraction below

A

45%

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53
Q

Class I heart failure

A

Ordinary physical activity does not cause symptoms

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54
Q

Class II heart failure

A

Symptoms occur with ordinary exertion

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55
Q

Class III heart failure

A

Symptoms occur with less than ordinary exertion

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56
Q

Class IV heart failure

A

Symptoms occur at rest

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57
Q

Hallmark symptoms of left sided CHF

A
  • Pulmonary systems including dyspnea, tachypnea, orthopnea, PND, S3 heart sounds
  • Rales
  • Pulmonary edema
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58
Q

Hallmark symptoms of right sided CHF

A

Systemic venous congestion with JVD, organomegaly, RUQ tenderness, elevated liver enzymes, peripheral edema

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59
Q

Which lab and values are important in diagnosing CHF

A 
Serum BNP (beta naturitic peptide)
Under 100=negative
100-500=intermediate probability
Over 500=indicative of CHF
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60
Q

Most useful test in the diagnosis of CHF

A

ECHO

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61
Q

What drugs are great to use intraop in a patient with CHF and why?

A

Opioids because they inhibit adrenergic activation

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62
Q

What is the most common cardiomyopathy

A

Dilated cardiomyopathy

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63
Q

Top cause of secondary cardiomyopathy

A

Amyloidosis

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64
Q

What is cor pulmonale

A

Chronic right ventricular enlargement

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65
Q

Top cause of cor pulmonale

A

Diseases that induce pulmonary HTN such as COPD

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66
Q

EKG manifestation of cor pulmonale

A

Peaked p waves in leads II, III, and AVF

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67
Q

What is pericardial effusion

A

Abnormal accumulation of fluid in the pericardial cavity

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68
Q

What is cardiac tamponade

A

Pericardial effusion with enough pressure to adversely affect heart function

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69
Q

What part of the heart is assessed with standard 6 limb leads

A

Frontal plane - heart activity moving up, down, right, and left

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70
Q

What part of the heart is seen with the 6 precordial leads (V1-V6)

A

Horizontal plane - view the heart’s activity moving anteriorly and posteriorly

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71
Q

Inferior heart leads

A

II, III, aVF

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72
Q

Left lateral heart leads

A

I, aVL, V5, V6

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73
Q

Interventricular septum leads

A

V1, V2

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74
Q

Anterior heart leads

A

V3, V4

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75
Q

Which leads should have a biphasic p wave

A

III, V1

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76
Q

Which leads should have a negative P wave

A

aVR

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77
Q

Normal PR interval

A

0.12-0.2 seconds

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78
Q

Which leads should show septal Q waves

A

I, aVL, V5, V6

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79
Q

QT interval duration is proportionate to what other value

A

Heart rate

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80
Q

R wave progression is seen in which leads

A

Precordial leads V1-V5

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81
Q

Most common uses for exercise stress test

A

Diagnosing CAD and identifying ischemia

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82
Q

Sestamibi imaging/technitium scanning is commonly used in tests involving the…

A

Myocardium or thyroid gland

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83
Q

Use of a transthoracic echocardiogram (TTE)

A

Assessing the overall health of the heart

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84
Q

Patients with ejection fractions less than __% tend to have severe disease and increased perioperative morbidity

A

50%

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85
Q

A transesophageal echo (TEE) can image certain parts of the heart better than a TTE and has a high sensitivity for locating what?

A

A blood clot inside the left atrium

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86
Q

What is a myocardial perfusion scan

A

A type of nuclear medicine test that injects a tracer (Thallium) into a vein and looks at Thallium uptake by the myocardium

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87
Q

What is the gold standard in evaluating coronary artery disease

A

Coronary angiography

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88
Q

What is a Holter monitor

A

Portable device for continuously monitoring various electrical activity of the CV system ofter 2 weeks at a time

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89
Q

Diseases commonly diagnosed by chest x-ray

A
  • Pneumonia

- CHF

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90
Q

Pulmonary vessels are seen best on which chest x ray view?

A

Lateral

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91
Q

Grade of 4+ for arterial pulse

A

Bounding

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92
Q

Grade of 3+ for arterial pulse

A

Increased

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93
Q

Grade of 2+ for arterial pulse

A

Brisk, expected

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94
Q

Grade of 1+ for arterial pulse

A

Diminished, weaker than expected

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95
Q

Grade of 0 for arterial pulse

A

Absent, not palpable

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96
Q

What is claudication? What disease is it associated with?

A

Pain with walking that is relieved with rest. Associated with peripheral artery disease

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97
Q

What is pitting edema

A

Indentation persisting after the release of pressure on the skin

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98
Q

Purpose of The Allen’s Test

A

Assess adequacy of circulation to the hand prior to radial/ulnar artery cannulation

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99
Q

Clinical manifestations of Acute Arterial Occlusion “Cold Leg” (the 6 P’s)

A
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesias
  • Paralysis
  • Poikilothermia (inability to regulate body temperature)
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100
Q

What is Raynaud’s phenomenon

A

Vasospastic disorder causing discoloration of the fingers and toes

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101
Q

Methods to diagnose a DVT

A
  • D-dimer

- Doppler ultrasound

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102
Q

Top cause of aortic aneurysms

A

Hypertension

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103
Q

Where must BP be monitored in a patient having an aortic aneurysm surgery

A

On the right arm b/c the aortic cross clamp is just distal to left subclavian artery

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104
Q

When managing aortic aneurysm surgeries, maintain MAPs near ___ mmHg above the cross clamp and above __ mmHg distal to the cross clamp to maintain tissue perfusion

A

100 above cross clamp, 50 distal to cross clamp

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105
Q

What drug is administered before cross-clamping the aorta during aortic aneurysm surgery to improve renal cortical blood flow and GFR?

A

Mannitol

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106
Q

What is a myocardial infarction

A

When one of the coronary arteries becomes totally occluded and a region of the myocardium dies

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107
Q

Cardiac enzymes used to diagnose an MI

A
  • Troponin
  • CK-MB
  • CK-nonspecific
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108
Q

ECG changes with an MI

A

1) T waves peaking
2) ST elevation
3) Appearance of Q waves
4) T waves eventually inverting

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109
Q

How do cardiac enzymes change with an MI?

A
  • CK-MB rises within 6 hours after an MI then level out within 48 hours
  • Troponin T and I remain elevated for 5 - 7 days, they are more specific but you can’t tell how recent an MI was just by using these
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110
Q

True or false - T wave inversion is diagnostic of an MI

A

False - it can also be seen with other conditions

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111
Q

What is a type of ST segment elevation seen in normal hearts?

A

J point elevation

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112
Q

What does the appearance of a pathologic Q wave indicate?

A

Irreversible myocardial death

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113
Q

True or False - pathologic Q waves are diagnostic of an MI

A

True

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114
Q

Why do Q waves form after an MI?

A

The part of the myocardium that dies becomes electrically silent and no longer conducts current, so all electrical forces move away from the area of infarction, causing a negative deflection

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115
Q

It is normal to see Q waves in which leads?

A
  • Small Q waves in I, aVL, V5, V6.
  • Sometimes II and III.
  • Deep waves in aVR
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116
Q

What are the characteristics of pathologic Q waves?

A
  • Greater than 0.04 seconds

- Depth is 1/3 the height of the R wave

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117
Q

What is the most common place in the heart to suffer an MI?

A

Left ventricle

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118
Q

Inferior infarcts are caused by occlusion of…

A
  • Right coronary artery OR

- Descending branch of left coronary artery

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119
Q

In which leads are EKG changes seen with an inferior infarct

A

II, III, aVF

120
Q

Lateral wall infarcts are caused by occlusion of=f…

A

Left circumflex artery

121
Q

In which leads are EKG changes seen with a lateral wall infarct

A

I, aVL, V5, V6

122
Q

Anterior wall MIs are caused by occlusion of…

A

Left anterior descending artery

123
Q

What infarction may occur if the left main artery is occluded?

A

Anterolateral infarction

124
Q

In which leads are EKG changes seen with an anterior wall MI seen

A

V2, V3, V4

125
Q

Which infarctions are characterized by poor R wave progression

A

Anterior wall MIs (poor R wave progression=progressively increasing R wave amplitudes moving through the precordial leads)

126
Q

Posterior wall MIs are caused by occlusion of…

A

right coronary artery

127
Q

What indicates posterior wall MIs on an EKG?

A

Reciprocal changes in anterior leads - ST depression and tall R waves

128
Q

EKG changes with angina attacks

A
  • ST depression

- T wave inversion

129
Q

Which pre-existing conditions make an EKG unreliable when diagnosing an MI?

A
  • WPW syndrome

- LBBB

130
Q

In which leads are reciprocal changes seen during an inferior infarct?

A

Anterior or lateral

131
Q

In which leads are reciprocal changes seen during a lateral wall infarct?

A

Inferior leads

132
Q

In which leads are reciprocal changes seen during an anterior wall MI?

A

Inferior leads

133
Q

In which leads are reciprocal changes seen during a posterior wall MI?

A

Anterior leads

134
Q

Virchow’s triad of risk factors for a pulmonary embolism

A

1) Stasis
2) Vessel wall injury
3) Hypercoagulability

135
Q

Clinical manifestations of a pulmonary embolism

A
  • Acute dyspnea
  • Tachypnea
  • Pleuritic chest pain
  • Nonproductive cough
  • Cyanosis
  • S2 sound
  • Tachycardia
136
Q

Treatment options for a pulmonary embolism

A
  • Anticoagulation
  • Inotropes (for hypotension caused by low C.O.)
  • Airway management
  • PA embolectomy
137
Q

Definition of pulmonary hypertension

A

Mean pulmonary artery pressure greater than 25mmHg at rest, with PCWP, LAP, or LVEDP 15mmHg or less

138
Q

Pre-op considerations for a patient with pulmonary HTN

A
  • Preop sildenafil or L-arginine
  • Inhaled NO or prostacyclin
  • CAUTION: sedatives (increase PVR), ketamine/etomidate (suppress pulmonary relaxation)
139
Q

Intraop monitoring considerations for a patient with pulmonary HTN

A
  • Central line

- A-line

140
Q

How should hypotension be treated in patients with pulmonary HTN

A

Norepi, phenylephrine, or fluids

141
Q

What pulmonary vasodilators should you have ready in patients with pulmonary HTN?

A
  • Milrinone
  • NTG
  • NO
  • Prostacyclin
142
Q

What is COPD

A

Pulmonary disease characterized by the progressive development of airflow limitation that is not fully reversible

143
Q

COPD encompasses what 2 diseases

A
  • Chronic bronchitis (obstruction of small airways)

- Emphysema (enlargement of airspaces and destruction of parenchyma)

144
Q

“Pink puffers” have a PaO2 greater than…

145
Q

How is PaCO2 changed in pink puffers

A

Normal to slightly decreased

146
Q

Blue bloaters have a PaO2 less than__mmHg and a PaCO2 over __mmHg

A

PaO2 under 65, PaCO2 over 45

147
Q

Drug therapy options for patients with COPD

A
  • Bronchodilator
  • Anticholinergics
  • Inhaled corticosteroids
  • Antibiotics
148
Q

What is bronchiectasis

A

Chronic suppurative disease of the airways of infective ideology causing destruction of airways and recurrent infections

149
Q

What is cystic fibrosis

A

Mutation in chloride ion transport resulting in viscous secretions resulting in luminal airway obstruction

150
Q

What is Primary Ciliary Dyskinesia

A

Congenital impairment of ciliary activity in respiratory tract epithelial cells and sperm tails (chronic sinusitis, OM, productive cough & infertility)

151
Q

Asthma is characterized by what airway changes

A
  • Chronic airway inflammation
  • Reversible expiratory obstruction
  • Airway hyperreactivity
152
Q

Clinical manifestations of asthma

A

Wheezing, cough, dyspnea

153
Q

Drug therapy options for asthma

A
  • Anti-inflammatory drugs (corticosteroids, cromolyn, leukotriene modifiers)
  • Bronchodilators
  • Theophylline
154
Q

What pre-op/pain medications should be avoided in patients with asthma

155
Q

What is restrictive lung disease

A

Lung diseases characterized by decreases in total lung capacity, usually caused by intrinsic disease process that alters the elastic properties of the lungs and stiffens them

156
Q

Causes of acute intrinsic RLDs

A

ARDS, aspiration, upper airway obstruction, CHF

157
Q

Causes of chronic intrinsic RLDs

A

Sarcoidosis, hypersensitivity pneumonitis, drug-induced pulmonary fibrosis

158
Q

Causes of chronic extrinsic RLDs

A

Obesity, pregnancy, ascites, skeletal deformities

159
Q

Clinical manifestations of RLD

A
  • Decreased vital capacity (FEV1/FVC)
  • Dyspnea
  • Hypercarbia leads to vasoconstrictive pulmonary HTN and cor pulmonale
  • Recurring of atelectasis and pneumonia
160
Q

Patients with RLD usually have a total lung capacity less than __% of normal

161
Q

What is acute respiratory failure

A

Inability of patient’s lungs to provide adequate arterial oxygenation, with or without acceptable elimination of CO2

162
Q

Criteria for acute respiratory failure diagnosis

A
  • PaO2 less than 60mmHg

- PaCO2 over 50

163
Q

How is acute respiratory failure is distinguished from chronic respiratory failure

A

Patients with chronic failure have a normal pH, patients with acute failure have a decreased pH

164
Q

Is hypertrophy caused by a volume overload or a pressure overload?

A

Pressure overload, when the ventricle pumps against increased resistance or a stenotic valve

165
Q

Is enlargement caused by a volume overload or a pressure overload?

A

Volume overload - chambers dilate to accommodate increased amount of blood

166
Q

What portion of the EKG do we look at to assess atrial enlargement?

167
Q

What portion of the EKG do we look at to assess ventricular hypertrophy?

A

QRS complex

168
Q

3 ways an EKG wave can change when a chamber enlarges or hypertrophies

A

1) EKG wave increases in duration since chamber takes longer to depolarize
2) Wave may increase in amplitude since chamber can generate more current
3) Electric axis may shift

169
Q

Normal QRS vector lies between…

A

-30 and +90 degrees

170
Q

The QRS axis must be normal if the QRS is positive in which 2 leads?

171
Q

Right axis deviation lies between which axis points

A

90-180 degrees

172
Q

Left axis deviation lies between which axis points

A

0 and -90 degrees

173
Q

Extreme right axis deviation lies between which axis points

A

-90 and -180 degrees

174
Q

Atrial enlargement is assessed in which leads

175
Q

Which lead is oriented parallel to the flow of current through the atria?

176
Q

Which lead is oriented perpendicular to the flow of current through the atria?

177
Q

Right atrial enlargement is often referred to as what?

A

P pulmonale - because it is often caused by severe lung disease

178
Q

Right atrial enlargement often causes what axis deviation?

A

Right axis deviation

179
Q

The enlargement of which atria causes a prominent increase in duration of the p wave?

A

Left atrium

180
Q

Left atrial enlargement is often referred to as what?

A

P mitrale - because mitral valve disease is a common cause of left atrial enlargement

181
Q

The diagnosis of left atrial enlargement requires what EKG change?

A

The terminal (left) portion of the p wave should drop at least 1 mm below the isoelectric line in V1

182
Q

The diagnosis of right atrial enlargement requires what EKG change?

A

P waves with an amplitude exceeding 2.5mm in inferior leads

183
Q

What axis deviation is seen with left atrial enlargement?

A

None because the left atrium is normally electrically dominant

184
Q

Axis deviation associated with right ventricular hypertrophy

A

Right axis deviation

185
Q

Most common causes of right ventricular hypertrophy

A

Pulmonary disease and congenital heart disease

186
Q

Most accurate precordial lead criteria for diagnosing left ventricular hypertrophy

A

R wave amplitude in lead V5 or V6 plus the S wave amplitude in V1 or V2 exceeds 35mm

187
Q

Most accurate limb lead criteria for diagnosing left ventricular hypertrophy

A

R wave amplitude in aVL exceeds 13mm

188
Q

Most accurate precordial lead change for diagnosing right ventricular hypertrophy

A

R wave larger than S wave in V1, S wave larger than R wave in V6 (R wave progression is disrupted)

189
Q

Surgical infection guidelines state that prophylactic antibiotics should be given within __ hour(s) of surgery and stopped after __ hour(s) post op

A

Given within 1 hour, stopped within 24 hours (or 48 for cardiac surgery)

190
Q

Prophylactic antibiotics given for many commonly performed procedures in the OR

A
  • Cephalosporin

- Vancomycin

191
Q

Why should vancomycin be administered slowly

A

To avoid Red man syndrome - a drug induced histamine release

192
Q

Preventative measures against infection

A
  • Increase FiO2
  • Avoid hypothermia
  • Analgesia
  • Avoid hypocapnea
  • Avoid hypoglycemia
193
Q

Major cause of blood stream infections

A

Central venous catheters

194
Q

CVC location most at risk for infection

195
Q

What is sepsis

A

Infection with systemic inflammatory response syndrome

196
Q

What is severe sepsis

A

Sepsis plus organ dysfunction

197
Q

What is septic shock

A

Severe sepsis plus hypotension (systolic BP under 90)

198
Q

Anesthetic management of a patient with sepsis/septic shock

A
  • Keep MAP over 65
  • CVP 8-12mmhg
  • Adequate urine output
  • MvO2 over 70%
199
Q

Effects of sepsis on pulmonary system

A
  • Increased minute ventilation and airway resistance
  • Decreased compliance and skeletal muscle efficiency
  • Tachypnea
  • Arterial hypoxemia
200
Q

Effects of septic shock on cardiovascular system

A
  • Systolic BP under 90 and unresponsive to fluids

- Low cardiac filling pressures and output

201
Q

Effects of sepsis on kidneys

A

Transient oliguria related to hypotension

202
Q

Effects of sepsis on GI system

A
  • “Shock liver”
  • Ileus
  • Malnutrition
203
Q

Effects of sepsis on coagulation system

A
  • Vitamin K deficiency
  • Effects on factors 2, 7, 9, 10
  • Thrombocytopenia
  • DIC (formation of blood clots in small vessels throughout the body)
204
Q

What infection is defined as an anaerobic, gram positive spore forming organism causing antibiotic assoc. diarrhea and pseudomembranous colitis

205
Q

Risk factors for C. diff infection

A
  • Chronic antibiotics
  • Depressed immune system
  • Old day
  • GI surgery
  • NG tube
  • ICU stay
206
Q

Signs and symptoms of C. diff infection

A
  • Diarrhea

- Abdominal pain

207
Q

Examples of necrotizing soft tissue infections

A
  • Gas gangrene
  • Fournier’s gangrene
  • Severe cellulitis
  • “Flesh eating infections”
208
Q

Types of pneumonia

A
  • Community acquired
  • Aspiration
  • Post-operative
  • Lung abscess
  • Ventilator associated
209
Q

Treatment for pneumonia

A

Antibiotics 10-14 days

210
Q

Most cases of TB occur in what populations?

A
  • Racial/ethnic minorities
  • IV drug abusers
  • AIDS patients
211
Q

How is TB transmitted

A

Inhaled aerosolized droplets

212
Q

What antibiotic is used to treat TB?

213
Q

Safety precautions for a patient with TB

A
  • Universal precautions
  • Postpone elective procedures
  • If not elective - negative pressure room, patient wears mask, HEPA filter on circuit, personnel wear N95
214
Q

Symptoms of influenza

A

Myalgias, malaise, headache

215
Q

Treatments for influenza

A
  • Amantadine
  • Rimantidine
  • Zanamivir
216
Q

Route of transmission for herpes type 1

217
Q

Route of transmission for herpes type 2

218
Q

Varicella-zoster is common in what patients

A

Immunocompromised

219
Q

Side effects of Epstein-Barr virus

A

Fever, LAD, splenomegaly

220
Q

AIDS is initiated by which virus?

A

HIV 1 and 2 which destroys T cells

221
Q

Which antiviral medication greatly reduces risk of AIDs transmission?

A

Zidovudine (AZT)

222
Q

Which lab value is used to diagnose AIDs

A

CD4 T cell count below 200

223
Q

Safety precautions used for patients with AIDs

A

Universal precautions

224
Q

How are hepatitis A and E transmitted

A

Fecal-oral

225
Q

What is infective endocarditis

A

Microbial infection that implants on heart valves

226
Q

Predisposing factors for infective endocarditis

A

1) Prosthetic heart valves
2) History of endocarditis
3) Congenital heart disease

227
Q

Signs/symptoms of infective endocarditis

A
  • Heart murmur
  • Anemia
  • Fever
228
Q

Most frequent cardiac complication associated with infective endocarditis

229
Q

Standard antibiotic used for general endocarditis prophylaxis

A

Amoxicillin 2g PO

230
Q

Antibiotic available for endocarditis prophylaxis for patients unable to take oral amoxicillin

A

2 g Ampicillin

231
Q

Antibiotics available for endocarditis prophylaxis for patients who are allergic to PCN

A
  • 600mg clindamycin PO

- Cephalexin

232
Q

Antibiotics available for endocarditis prophylaxis for patients who cannot take oral medications and are allergic to PCN

A

600mg clindamycin IV

233
Q

Infection characterized by inflammation of sinus epithelium

A

Acute sinusitis

234
Q

Infection characterized by ear infection from nasopharynx to middle ear

A

Acute otitis media

235
Q

Infection characterized by inflammation of pharynx

A

Pharyngitis

236
Q

A URI that is a complication of strep tonsilitis

A

Peritonsillar abscess

237
Q

URI that is characterized by soft tissue swelling and forward displacement of the larynx

A

Retropharyngeal infections

238
Q

What is Ludwig’s angina

A

Cellulitis of submandibular, sublingual, and submental regions (caused by strep and causes fever and rapidly progressive edema)

239
Q

What infection epidemic is due to lack of vaccination against Haemophiuls influenzae

A

Acute epiglottitis

240
Q

What intra-abdominal infection is suspected in patients who have undergone abdominal surgery who have unexplained fever

A

Subphrenic abscess

241
Q

What is the most common of all bacterial infections affecting humans

A

Urinary tract infections

242
Q

UTIs are most common in which population?

A

Females under 50

243
Q

What is osteomyelitis

A

Progressive inflammatory destruction of bone caused by staph aureus

244
Q

3 main types of conduction blocks

A
  • Sinus node block
  • AV block
  • Bundle branch block
245
Q

What is a fascicular block?

A

A block of only one part of one of the bundle branches

246
Q

How is an AV block diagnose?

A

Examining the relationship of P waves to QRS complexes

247
Q

First degree AV block is characterized by what EKG change

A

PR interval greater than 0.2 seconds

248
Q

What EKG changes characterize a 2nd degree AV block Mobitz I

A
  • Successively longer PR intervals until one QRS fails

- Irregular ventricular rhythm

249
Q

What EKG changes characterize a 2nd degree AV block Mobitz II

A

PR intervals are similar and don’t increase in length, but a QRS is suddenly dropped

250
Q

What is a 3rd degree AV block

A

When there is no association between atria and ventricles, they are depolarizing independently

251
Q

EKG criteria to diagnose a right bundle branch block

A
  • R/R’ waves in V1 and V2

- Slurred S wave in V5, V6, lead I

252
Q

EKG criteria to diagnose a left bundle branch block

A
  • “Blunted” positive QRS and inverted T wave in V5, V6, lead I
  • Predominately negative QRS in V1-V3
253
Q

What is a hemiblock?

A

A conduction block of just one of the fascicles of the left bundle branch

254
Q

What is the major effects that hemiblocks have on EKG?

A

Axis deviation

255
Q

What is a left anterior hemiblock?

A

Conduction down the left anterior fascicle is blocked, so current rushed down left posterior fascicle to inferior surface of the heart - depolarizing goes from inferior –> posterior and right –> left

256
Q

Axis of depolarization with a left anterior hemiblock

A

Upward and slightly left

257
Q

EKG changes with left anterior hemiblock

A
  • Tall R waves in left lateral leads

- Deep S waves in inferior leads

258
Q

What is a left posterior hemiblock?

A

All of the current rushes down the left anterior fascicle and ventricle myocardial depolarization ensues superior to inferior and left to right in direction

259
Q

Axis of depolarization with a left posterior hemiblock

A

Downward and to the right

260
Q

EKG changes with left posterior hemiblock

A
  • Tall R waves in inferior leads

- Deep S waves in left lateral leads

261
Q

How are hemiblocks eventually diagnosed?

A

By seeing left or right axis deviation with no other causes found

262
Q

Top cause of right sided heart failure

A

Left sided heart failure

263
Q

Cardiac condition that elevated BNP levels are associated with

264
Q

Best test to diagnose CHF

265
Q

Claudication is a sign of what

A

Peripheral artery disease

266
Q

Risk factors for developing a PE

A

Virchow’s triad

1) Stasis
2) Vessel wall injury
3) Hypercoagulability

267
Q

Pathology of pulmonary HTN

A

Develops as result of pulmonary vasoconstriction, vascular wall remodeling, and thrombosis. Causes increased RV wall stress

268
Q

Criteria for pulmonary HTN

A

PAP over 25mmHg with PCWP, LAP, or LVEDP less than 15mmHg

269
Q

In right axis deviation, lead I is ______ (+/-) and avF is ______ (+/-)

A

Lead I negative, aVF positive

270
Q

In left axis deviation, lead I is ______ (+/-) and avF is ______ (+/-)

A

Lead I positive, aVR negative

271
Q

Tests used to diagnose AIDS

A
  • ELISA
  • Positive western blot test
  • CD4 T cell count below 200
272
Q

Aortic stenosis murmur

A

Mid-systolic murmur, crescendo/decrescendo, radiates to neck

273
Q

Mitral valve prolapse murmur

A

Mid-systolic click

274
Q

Mitral regurgitation murmur

A

Pansystolic/holosystolic apical murmur, radiates to axilla

275
Q

Tricuspid regurgitation murmur

A

Pansystolic

276
Q

2 main diastolic murmurs

A
  • Aortic regurgitation

- Mitral stenosis

277
Q

Mitral stenosis murmur

A

Opening snap

278
Q

Aortic regurgitation murmur

279
Q

Signs and symptoms of left ventricular heart failure

A

Symptoms - dyspnea, tachypnea, orthopnea, PND, S3

Signs - rales

280
Q

Presentation of cardiac tamponade

A
  • Dyspnea, hypotension, distant heart sounds

- “Water bottle heart” on chest X ray

281
Q

Risk factors for clostridium difficile colitis

A
  • Antibiotics
  • Depressed immune system
  • Old age
  • GI surgery
  • NG tube
  • Antiulcer meds
  • Long hospital stay
282
Q

Risk factors for ischemic heart disease

A
  • Male gender
  • Increasing age
  • HTN
  • Smoking
  • Hypercholesterolemia
  • DIabetes
  • Obesity
283
Q

Fastest AMI treatment for re-perfusion of coronary arteries

A

Thrombolytic therapy within 30-60 minutes of hospital arrival

284
Q

Effects of obstructive lung disease on lung volume

A
  • Can increase lung volumes due to air trapping
  • Decreased FEV1/FVC
  • Normal to increased FRC/TLC
  • Increased residual volume
285
Q

Components of universal precautions

A
  • Handwashing
  • Decontaminate equipment
  • Use and dispose of needles, AVOID RECAPPING
  • Wear protective items
286
Q

Artery that is blocked when EKG changes are seen in I, V5, V6, aVL

A

Left circumflex

287
Q

Definition of bruit

A

Turbulent flow with aneurysm or thrombosis

288
Q

Drugs to stop the morning of surgery for CHF

A
  • Diuretics
  • ACE inhibitors (usually)
  • ARBs
289
Q

Describe vesicular breath sounds

A

“Gentle sighing” - soft, low pitched. Heart on inspiration at base of lung

290
Q

What diseases will prevent diagnosing an MI from EKG

A
  • WPW

- LBBB

291
Q

Barrel chest is associated with what disease

292
Q

Candidiasis can be caused by what

A

Steroid inhaler

293
Q

Physical exam finding of carotid stenosis

A

Carotid bruits

294
Q

Atrial enlargement is assessed with which leads

295
Q

Normal angle for neck extension

A

30 degrees

296
Q

Views available from chest X ray

A
  • Anterior posterior
  • Lateral
  • Oblique

Clinical Methods (4 decks)

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