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Internal Med > OME - Cardio and Pulm > Flashcards

OME - Cardio and Pulm Flashcards

1
Q

What is Beck’s Triad?

What makes the diagnosis?

Indicates what pathology?

Tx?

A

JVD, HoTN, distant heart sounds

Clear lungs, pulsus paradoxus > 10 mmHg

Pericardial tamponade

Pericardiocentesis

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2
Q

When diagnosing a pleural effusion, after you get the CXR, what do you need next? To assess what?

What else can be used?

Then do what?

A

Recumbent Xray to assess if the fluid is free moving (not loculated) and in sufficient quantity (1cm)

CT scan or bedside US

Thoracentesis

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3
Q

Treatment of ARDS?

CXR post ARDS can show what?

A

Intubate, oxygenate, Give PEEP

Pulmonary fibrosis

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4
Q

Severe persistent asthma:
Day time sx?

Nocturnal sx?

PFTs?

Tx?

A

> /= 1 / day

Frequent

< 60%

SABA + High dose ICS + LABA

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5
Q

What is the algorithm for arrhythmia syncope diagnosis?

Presentation?

A

ECG
24-hr Halter
Event recorder

Sudden onset syncope w/NO prodrome

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6
Q

Pt with refractory severe asthma, add what treatment?

A

PO steroids

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7
Q

Pt that has SVT is treated how?

A

IV Adenosine 6mg
Then 12mg more
Then 12mg more

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8
Q

Opening snap followed by a decrescendo murmur in diastole is what?

What symptoms?

Treatment?

A

MS

CHF/SOB and AFib

Balloon valvotomy or valve replacement

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9
Q

What are some causes of exudate in pleural effusion?

Due to what physiologic etiology?

A

Malignancy, PNA, TB

Inflammation —> increased oncotic pressure of interstitium

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11
Q

What determines how severe a PE is?

A

Response of CV system - HoTN, right heart strain, elevated BNP, elevated troponin

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12
Q

What symptoms are common for pleural effusion?

What makes the Dx?

A

SOB, pleuritic chest pain

CXR shows blunting of the CVAs (req. at least 250cc)

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13
Q

What is typical chest pain?

Atypical?

A

Substernal, exertional, relieved w/nitroglycerin

2/3

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14
Q

CHADS2 score stands for what?

A 
CHF
HTN
Age > 75
DM
Stroke
Stroke

1 point for each

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15
Q

What is the goal BP for pts > 60?

Everyone else?

1st line tx?

Who does not Get an ace-I/ARB to start?
Unless what?

A

150/90

140/90

Thiazides, CCB, Ace-I

> 75 or AAs
Unless have CKD, then you do

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16
Q

Main features of bronchitis pts?

A

RHF
JVD
Edema
HSM

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17
Q

What are the hallmarks of vasovagal syncope?

A

Situational, reproducible, anticipated

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18
Q

1st step in w/u of pulmonary nodule?

Stable when?

If unstable do what?

A

Compare old films

No change in 2 years

Follow w/serial CTs or biopsy or CXRs

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18
Q

What defines bronchitis?

What physiologic changes occur?

A

Productive cough for more than 3 months in 2 consecutive years

Inc pulmonary vascular resistance and pulmonary HTN

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20
Q

Mod persistent asthma:
Day time sx?

Nocturnal sx?

PFTs?

Tx?

A

> /= 1 / day

> 1 / week

60-80%

SABA + low dose ICS + LABA

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21
Q

For a pt with new onset AFib, how do you treat?

What classifies as new onset?

A

Cardioversion

< 48 hours

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22
Q

Rumbling Decrescendo murmur is what?

Path?

Tx?

A

AI

ischemia or infarction

replace the valve

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23
Q

Pt w/old (> 48 hours) AFib, how do you treat and work up?

A

1) warfarin 4 weeks
2) then do TEE
3) if no clot, then cardioversion and warfarin 4 more weeks

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24
Q

When are NSAIDs contraindicated in treatment of pericarditis?

A

CKD
Low platelets
Peptic Ulcer Disease

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25
Q

How do you treat CHF exacerbation?

A 
LMNOP
Lasix
Morphine
Nitrates
Oxygen
Position (HOB)
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26
Q

Pt in cardiac arrest, give the algorithm for VT/VF:

A

Epi —> shock —> Amiodarone —> Shock —> repeat

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27
Q

How do you Dx proximal lesions of the lung?

Peripheral lesion?

Centrally located in lung lesions?

A

Bronchoscopy / EBUS

Percutaneous CT guided

VATS

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28
Q

What is HTN urgency?

Emergency? Treated how?

A

> 180/110

W/End organ damage
IV nitrates or CCBs to get MAP down 25% w/in first 2-6 hours, then normal w/PO meds in 24 hours

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28
Q

Pt that has restrictive lung pattern w/B/L symmetrical Arthralgia may have what?

Work up how?

A

Caplan syndrome

Rheumatoid Arthritis —> anti-CCP Ab

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30
Q

When do cardiac enzymes peak?

When can a test be considered Negative?

A

18 hours

2 sets are negative when separated by 6 hours

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31
Q

Light’s criteria used for what?

What are the 3 criteria?

A

Transudate v Exudate

LDH > 2/3 upper limit normal (200)
LDH effusion / LDH serum > 0.6
Total protein effusion / total protein serum > 0.5

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32
Q

Pt with an arrhythmia, what constitutes as “unstable symptoms”?

Treat how?

A

SYS BP < 90
Chest pain
SOB
AMS

Electricity

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33
Q

What baselines values should you get before starting a statin?

A

Lipids
A1c
LFT
CK

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33
Q

INR < 5, do what??

5-9?

> 9?

Any bleeding ?

A

Hold dose

Hold dose, give Vit K

Hold dose, give Vit K, LOWER dose

FFP, Vit K

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34
Q

What ECG changes may show in bronchitis pts?

What sx?

A

RV strain (RVH), RAD

Hypoxia (blue, cyanosis)
Pulm HTN, edema

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35
Q

What is a symptom that indicates lung cancer may be incurable due to METS?

A

Hoarseness

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35
Q

What are the main SEs of corticosteroids?

A

Hyperglycemia
HTN
Osteopenia

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36
Q

Massive PE that causes HoTN, treatment?

Otherwise?

A

tPA

Heparin to warfarin bridge

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37
Q

What is a normal rhythm w/a constantly prolonging PR interval until a QRS complex is dropped?

Tx?

A

2nd degree Wemckebach

Atropine, PACE

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38
Q

What has AV node dissociation where the Ps march out and the QRSs march out resulting in a dropped P wave?

A

3 degree AV block

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38
Q

What is the pt presentation of someone w/ARDS?

Sx?

Imaging?

A

Septic shock, Burns, TRALI, near-drowning

SOB, cough, crackles

B/L white out

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40
Q

Dilated cardiomyopathy causes what major path?

Tx?

A

Systolic HF

BB, ACEI, diuretics

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41
Q

Pt that has AFib and CHF exacerbation what is contraindicated?

Why?

Give what instead?

A

CCBs

Drop the EF

Digoxin or Amiodarone

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42
Q

What PCWP means it is noncardiogenic origin?

Find out this info how?

A

< 12

Right heart CATH

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43
Q

What are the acute causes of AI?

Chronic?

A

Cardiogenic shock, pulmonary edema

Dilated HF, CHF

43
Q

Doubling the TV of a pt on a vent can cause what?

ARDS has what PaO2/FiO2 ratio?

A

Tension pneumothorax

< 200

44
Q

Class IV NYHA is treated with what additionally?

Class III and EF < 35%?

A

Dobutamine

AICD

44
Q

ABG in COPD pt shows what?

CBC?

A

Hypoxic hypercapnic respiratory acidosis

Erythrocytosis

45
Q

What types of pathology causes demand ischemia?

A

Stable angina
Unstable angina
NSTEMI

46
Q

When is a pulmonary nodule suspicious for cancer?

A

> 2cm
Spiculated
30 yr pack history
70 y/o

49
Q

How do you increase venous return?

Does this increase or decrease the intensity of the 4 MC murmurs?

A

Squatting, leg lift

INCREASE

50
Q

What causes Dilated cardiomyopathy?

A 
Ischemia
Valve disease
Infectious
Alcoholic
Autoimmune
Idiopathic
51
Q

How to diagnose CHF?

What kinds are there?

A

Echo

Diastolic —> restrictive type
Systolic —> EF < 55%

51
Q

Mild persistent asthma:
Day time sx?

Nocturnal sx?

PFTs?

Tx?

A

< 1 / day

> 2 / month

> /= 80%

SABA + Low dose ICS

52
Q

ST changes in leads II, III, aVF mean what?

What is contraindicated?

1st step is to give what?

A

Inferior MI/Right sided infarct

Morphine, Nitro

IVF

53
Q

Pt that has CAD or CHF, give what 1st line meds?

A

BB + Ace-I

54
Q

How do you know there is VTac?

Treat how?

A

No P Waves
Wide QRS complexes

Amiodarone or lidocaine

55
Q

What are the acute sx of MR?

Chronic?

A

Cardiogenic shock, pulmonary edema

CHF, AFib

55
Q

Head bobbing and, hyper dynamic pulse, and WIDE pulse pressure = ?

Described how?

A

AI/AR

Blowing diastolic decrescendo murmur

57
Q

What are the 3 main causes of vasovagal syncope?

Diagnose how?

A

Visceral organ stim - cough/defecation, etc
Overactive carotid sinus
Psychotropic

Tilt-table

58
Q

When is the only time you use an IVC filter in setting of PE?

A

DVT and they have an ACTIVE bleed (GI)

59
Q

What rhythm only has the ventricles contracting and will not show any p waves?

A

Idioventricular rhythm

59
Q

PEA/Asystole cardiac arrest what do you do?

A

Epi —> Nothing —> repeat

59
Q

COPD exacerbation w/out signs of infection treated with what?

What can you check?
Will look how?

A

Doxycycline

Procalcitonin levels
Decreased if viral

60
Q

What does hand grip due to to SVR?

How does affect the intensity of HCOM and AS?
MVP?

A

Increases Afterload

Decreases
later onset in MVP

64
Q

What diseases qualify pts for a statin?

A

StarCraft on your PC

Stroke
CAD
PVD
Carotid Stenosis

65
Q

Pt has a pericardial KNOCK, means what?

Dx?

Tx?

A

Constrictive pericarditis —> diastolic CHF

Echo

Pericardiectomy

65
Q

Intermittent asthma:
Day time sx?

Nocturnal sx?

PFTs?

Tx?

A

= 2 / wk

< 2 / month

> /= 80%

SABA

66
Q

Sx of pericarditis?

Treatment of pericarditis?

A

Pleuritic and positional chest pain w/multiphasic friction rub

NSAID + colchicine

67
Q

Sinus bradycardia that is stable treat how?

If unstable?

A

Atropine

Pace

68
Q

What indicates Orthostatic HoTN?

A

DEC systolic BP of 20
DEC diastolic BP of 10
INC HR of 10

Or symptoms going from laying to standing

68
Q

What qualifies a pt to get a statin no matter what?

A

LDL > 190

73
Q

What does the MVP murmur sound like?

A

Holosystolic murmur

74
Q

What is the PATH behind ortho HoTN?

A 
Volume down (Diarrhea, dehydrated, diuresis, hemorrhage)
OR
Dysfunctional ANS - DM, Parkinson’s, advanced age
74
Q

What is the screening recommendation for lung cancer?

A

Annual low dose CT scan of chest

30 yr pack hx, quit < 15 yr ago, bw 55-80 yrs old

75
Q

What sx seen in hemochromatosis HF?

Dx how?

A

Cirrhosis, DM

Ferritin, genetic testing, cardiac MRI

76
Q

Pt w/LDL 70-189 gets statin if they have what else?

A

Age 40-75 + DM
Or
Age + Calculated risk (DM, HTN, smoke, Dyslipidemia)

76
Q

What levels can be increased in sarcoidosis?

Treat how?

A

ACE, calcium, Vit D

Methotrexate and cyclophosphamide

78
Q

Holosystolic murmur radiating to the axilla heard at apex is what?

Pathology?

Tx?

A

MR

Ruptured papillary m. Or chordae tendinae (d/t MI) acutely
Ischemia or MVP chronically

BB/CCB

78
Q

HCOM and MVP, what makes the murmur LOUDER?

Quieter?

A

Dec venous return —> Valsalva

Inc venous return —> squat

78
Q

What sx seen in sarcoidosis HF?

Dx how?

A

Pulm disease

Cardiac MRI 1st, then endomyocardial biopsy

79
Q

What is the path behind restrictive cardiomyopathy?

Is also what?

Tx?

A

Sarcoidosis, amyloid, hemochrom, cancer, fibrosis

Diastolic HF

Diuresis and RATE control

80
Q

Confirmed STEMI goes where? Dx how?

NSTEMI?

+ stress test?

A

Emergent CATH, ST elevation or NEW LBBB

Urgent CATH

Elective CATH

81
Q

What presents w/worsening dyspnea (on exertion), orthopnea, PND?

Dx how?

Treat?

A

Pericardial effusion

Echo

Pericardial window

82
Q

What is the treatment for acute presentation of chest pain?

A 
MONA BASH
Morphine 
Oxygen
Nitrates
ASA

BB
ACEI
Statin
Heparin

85
Q

What has a normal PR interval but drops QRSs randomly?

Treatment?

A

Type II Mobitz AV block

PACE

86
Q

How do you decrease venous return?

Does this increase or decrease the intensity of the 4 MC murmurs?

A

Valsalva

Decrease

87
Q

Treatment for HIT?

A

Draw HIT panel
Stop heparin
Give Argatroban

88
Q

What kind of lung cancer do NON-smokers get?

Located where?

A

Adenocarcinoma

Periphery

90
Q

How do you know there is SVT?

Treat how?

A

Narrow, fast, HR > 150
No P waves

Adenosine

91
Q

WOMAN PE mnemonic = what?

A 
Syncope Diff Dx
W --> Vasovagal 
O —> Ortho HoTN
M —> Mechanical valve
A —> Arrhythmia 
N —> Neuro
P —> PE
E —> Electrolyes (glucose, TSH)
92
Q

What has a regularly prolonged PR interval?

Treat how?

A

1st degree AV block

Atropine, Pace

92
Q

Pt w/suspected ILD 1st step in w/u?
Will show what?

Do what next?
Will show what?

What to continue to w/u?

A

CXR
Patchy infiltrates

High Res CT
Ground glass opacities

Serology or Bx

93
Q

What sx most often present in amlyloid HF?

Dx how?

What random disease can cause it?

A

Neuropathy

Fat pad biopsy

Multiple myeloma

95
Q

Pt with COPD what inhalers do you give them in order?

A 
SABA
\+ LAMA (tiotropium)
\+ LABA
\+ ICS
\+ PDE4-i
\+ Steroids
96
Q

MC causes of pericarditis?

Dx how?

Best test?

A

Viral (coxsackie) and uremia

ECG —> PR depression and Diffuse ST elevation

MRI

96
Q

CHADS2 score of 0 do what?

1?

2?

A

ASA

ASA or anticoagulation

ONLY anticoagulate

97
Q

What murmurs require a workup?

How do you start working it up?

A

3 or higher
Any diastolic murmur

1st: TTE, then TEE

101
Q

What is a wide QRS? Means what?

Narrow? Means what?

A

> .12 ms, ventricular rhythm

< .12 ms, atrial rhythm

103
Q

What are the SEs of BBs?

A

Bradycardia

Maybe syncope

107
Q

Excessive ventilation in an intubated COPD pt can cause what?

A

Hypoventilation

108
Q

Neurogenic syncope is d/t what?

Presents how?

Dx?

A

Dec blood flow to posterior circulation —> vertebrobasilar insuff.

Post-octal state, FND

CTA

109
Q

Crescendo-decrescendo systolic murmur is what?

Sx?

Tx?

A

AS

SAD

Preload reduction (BB/CCB)
Valve replacement which leads to Ostia being lost —> CABG
111
Q

ARDS is a _____ that results from ______?

Results in what?

A

Noncardiogenic pulmonary edema

Increased permeability of the capillaries

Hypoxemia

112
Q

When can you start home O2 in a COPD pt?

A

PO2 < 55 on ABG
OR
SpO2 < 88% on a pulse ox at rest

119
Q

How do small emboli cause dyspnea?

Mechanism?

A

Platelet-derived mediators —> inflammation

RR increases, CO2 blown off and O2 canNOT get in

129
Q

What is the treatment for a loculated effusion?

What can parapneumonic effusions form? Treatment?

Repeat effusions treated with what?

A

Thoracostomy (chest tube)

Empyema, Thoracotomy

Pleurodesis

132
Q

Staging of lung cancer is done with what?

Before making a treatment plan, must do what?

A

PET-CT

PFTs

140
Q

What is the best test to detect a PE?

What if there is CKD or AKI? What also must be present?

A

CT Angio / Spiral CT

V/Q scan, Clear lungs

146
Q

PE causes what physiologically? (2 things)

A

1 - limitation of gas exchange

2 - INC in pulmonary vascular resistance, causes Right heart strain

Internal Med (7 decks)

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