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Clin Medicine > Other PCM Final > Flashcards

Other PCM Final Flashcards

1
Q

Sympathetic heart

Parasympathetic heart

A

T1-T5

Vagus

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2
Q

Sympathetic lungs

Parasympathetic lungs

A

T2-7,

Vagus

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3
Q

Sympathies effect heart lungs

A

Causes bronchodilation, decreased secretions, coronary artery vasodilation, increase heart rate

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4
Q

Parasympathetic effect heart and lungs

A

Bronchoconstriction, increased secretions, coronary artery vasoconstriction, decreased heart rate.

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5
Q

Pain tolerance is lowered due to what

A

Hyperactivity of SNS

Normalize sympathetic tone!!!

BE CAREFUL WITH ARRHYTTHMIAS

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6
Q

Myocardium chapman

A

2nd ICS along sternal border

Intertransverse space between T2 and 3

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7
Q

Bronchus chapman

A

2nd ICS along sternal border

Lateral to T2 spinous process

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8
Q

Vacuum

A

Contraindicated in COPD

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9
Q

Heart failure OM

A

Consider fluid status before treating-can the heart tolerate increased fluid return/circulation/stress

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10
Q

Diaphragm

A

S1, S2, AR, MR, friction rub high pitched

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11
Q

Bell

A

S3, S4, MX carotid bruit

Low pitched

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12
Q

S3

A

Dull, low pitched, best heard with bell

Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase

Physiologic in children/young adults

Pathologic >40 Kentucky

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13
Q

S4

A

Dull, low pitch, best heard with bell

Atrial gallop from forceful contraction of atrial against a stiffened (low compliant) ventricle

Can be normal in trained athletes (tennesee)

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14
Q

Systolic murmur

A

AS< PS, MR, TR

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15
Q

Diastolic murmur

A

AR< PR< MS, TS

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16
Q

Weber

A

Lateralization

Sound lateralize to one ear-conduction loss int hat ear of sensorineural loss in opposite

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17
Q

Rinse

A

Compare air and bone conduction

AC.BC normalAC=BC or BC>AC conductive loss to that ear

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18
Q

When do frontal sinus form

A

7 years old

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19
Q

Aphthous ulcers

A

Canker sores

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20
Q

Cheilitis

A

B12 or iron defiency , red cracks at corners of mouth

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21
Q

Gators palatines

A

Benign lump on hard palate

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22
Q

Generalizer hperresonance

A

COPD emphysema

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23
Q

Unilateral hyperresonance

A

Large pneumothorax, large air filled bulla in lung

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24
Q

Decreased breath sounds

A

Decreased air flow (COPD, muscular weakness)

Poor transmission of sound (COPD, pleural effusion, pneumothorax)

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25
Q

Wheeze

A

Narrowed airway COPD bronchitis, asthma

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26
Q

Crackles

A

Fine-Velcro -interstitial pulmonary fibrosis

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27
Q

Ronchi

A

Secretions in airway

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28
Q

Strider

A

Inspiratory wheeze, partial obstruction larynx or trachea

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29
Q

Pleural friction rub

A

Inflamed pleura

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30
Q

Bronchophony

A

Consolidation

Spoken words louder or clearer

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31
Q

Egophony

A

We sound a

Pneumonia

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32
Q

Whisper

A

99 louder

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33
Q

Lung sound normal

A

Vesicular

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34
Q

Lobar pneumonia

A

Whispered sound louder increased fremitis, bronchial sounds

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35
Q

NonTB mycobacteria infection (NT, M kansaii)

A

Fatigue, dyspnea, occasional hemoptysis,

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36
Q

Diagnose NTM

A

Sputum culture and molecular diagnostics

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37
Q

Fungal infection

A

Varies by etiology but can present with pneumonia, nodules, cavitation

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38
Q

Diagnose fungal infection

A

Results, regional exposure

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39
Q

Lung cancer

A

Fever, cough, chest pain, hemoptysis, dyspnea

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40
Q

Diagnose lung cancer

A

Hisopathology

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41
Q

Lymphoma

A

Fever, night swears, weight loss

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42
Q

Diagnose lymphoma

A

Histopathology

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43
Q

Sarcoidosis

A

Hilar lymphadenopathy, can have cavitary lesions

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44
Q

Diagnose sarcoidosis

A

Histopatholog-noncaseating granulomas

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45
Q

Septic emboli

A

Extrapulmonary infection (typically endocarditis) embolizing to lung

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46
Q

Diagnose septic emboli

A

Blood culture, echocardiogram

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47
Q

Lung abscess

A

Fever, cough, sputum production

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48
Q

Lung abscess cxr

A

Air fluid levels in a cavitary lesion, other pulmonary infiltrates

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49
Q

Who is at risk for TB

A

Know someone with TB

Immigrants ( from less than 5 years)

Resident or employees of high risk area (jail, prison, nursing homes, homeless shelters, healthcare facilities, drug treatment facilities)

Medically underserved, drug treatment facilities

IV drug

HIV AIDS

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50
Q

BCG (bacilli calmetter guerin) vaccine

A

The IFN-y release assay can be used when a patient has a positive TST test with a history of a BCG vaccination

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51
Q

INF-y release assay test TB vs BCG

A
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52
Q

Most people who have had BCG vaccine will have TST reaction

A

3-19 mm (2-3 months after vaccine)

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53
Q

What if TST test over ten years after vaccine

A

TST reaction typically <10 mm

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54
Q

What is BCG and getting repeated TST

A

Reaction can get bigger than 10 mm

Booster phenomenon *healthcare workers, yearly TST in those with history of BCG vaccine)

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55
Q

Interferon gamma release assay (IGRA) are affected by BCG (like quantiferon T GOld)

A

NOOOOOOO

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56
Q

Signs and symptoms of active pulmonary T

A

Fever (can be diurnal), night sweats, cough (>2 weeks) (productive or hemoptysis) weight loss, lymphadenopathy

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57
Q

PPD(purified protein derivative)

TST( tuberculin skin test)

A

Ok

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58
Q

PPD >5 mm induration

A

HIV, close contact with actively infected person, cxr with fibrotic changes consistent with TB, immunosuppression (TNFa inhibitors, chronic glucocorticoids, chemotherapy, organ transplant)

59
Q

PPD>10 mm

A

Persons with clinical conditions that increase risk of reactivationL silicosis, DM, chronic renal failure with dialysis, malignancies, malnourished, IV drug, kids less than 4, from country with high prevalence, residents/employees in high risk setting L jail)

60
Q

> 15 mm

A

Health individual >4 with low likelihood of true TB infection

61
Q

Anergy PPD

A

No rxn secondary to immune unresponsiveness

62
Q

Diagnosis T

A

Sputum culture-MICROBIAL diagnosis

3 separate morning sputum samples are taken for culture on liquid and solid media.

63
Q

How long for sputum culture TB results

A

6-8 days slow grower!

64
Q

Gold standard Tb dianosis

A

Sputum culture

65
Q

Sputum staining TB bc have to ask for it!!

A

Acid fast

Rhodamine-auramine stain-initial screening stain for TB

Ziehl-neelsen or kinyun stain-confirmatory AFB

66
Q

PPD (TST)

A

Utilized to determine if person is currently infected or has been previously infected with M TB.

67
Q

PPD diagnose T

A

Nope. Supports

68
Q

Most widely used screen for Tb

A

PPD

Each, easy, sensitive not specific

69
Q

Interferon gamma release assay ORGA

A

Indicates if there has been a cellular response to BT

70
Q

Who is IGRA used for

A

People who have gotten BCG (as a vaccine or for cancer therapy)

Can be used to test people who have been exposed to ppl with Tb

71
Q

Chest x ray Tb for reactivation T

A

Cavitary lesions typically involve the spices of the lungs

72
Q

NAAT (nuclei acid amplification test) Tb

A

In conjunction with a smear that is positive for AFB while cultures are pending .

73
Q

NAAT-TB

A

Detects TB genetic material

74
Q

NAAT-R

A

Detects INH and rifampin resistance

75
Q

How long do you have to treat Tb with meds

A

6 months

76
Q

Four drugs Tb

A

Rifampin isoniazid athambutol, pyrazinamide

77
Q

Side effect rifampin

A

Red orange fluid, NV rash, hepatitis, Steven johnson

78
Q

Isoniazid AE

A

Hepatitis, NV, peripheral neuropathy (give B6), rash

79
Q

Pyrazinamide AE

A

Urticaria, hyperuricemia/gout, hepatitis, joint aches

80
Q

Ethambutol

A

Optic neuritis color blind

81
Q

What monitor while on B meds

A

Kidney and liver function

AE

82
Q

What should laboratory baseline include before treat T

A

Hepatic enzymes, CBC, serum, creatinine, uric acid

83
Q

What test for before Tb treat

A

Hep B and C in at risk and counseling and test for HIV

84
Q

What test do if ethambutol

A

Visual acuity and red green discrimination

85
Q

Is sputum gotten to monitor efficacy

A

Yup

86
Q

Delay treatment for sputum

A

Don’t delay if clincial diagnosis and awaiting sputum

-start 4 drug tract if active tb

87
Q

Clinical diagnosis active Tb

A

Clincial symptoms, assess risk, order radiography, sputum, don’t delay

88
Q

Latent Tb considerations

A

Clinically silent (no symptoms, but positive IGRA or TST0 but can become active

Get screening PPD or IGRA->positive->check CXR to make sure there is no active TB
Cxr negative->treat as latent TB with 9 months of INH

89
Q

Who need to report

A

Ppl confirmed or suspected Tb must be reported to a state or local public health authority promptly (in many states, this period is 24)

90
Q

Are labs required to report diagnostic specimens for Tb

A

Yup to provider and to public health authority

91
Q

The public health authority can provide a link to expert medical consultation for diagnosis or management

A

This may be especially useful in regions with limited local expertise or where Tb is not common

92
Q

CDC

A

Sponsor regional centers where consultatio is available

93
Q

How is TB most likely to be transmitted in health care

A

When health care workers and patients come in contact with persons who have unsuspected TB who are not receiving adequate treatment, and who have not been isolated from others

94
Q

All healthcare setting need an infection control program designed to ensure the following

A

Prompt detection of TB disease

Airborne precautions

Treatment of people who have suspected or confirmed Tb disease

95
Q

A Tb infection control program should be based on ehwta

A

Three level hierarchy of control measures

96
Q

Administrative controls

A

Management measures intended to decrease the risk or exposure to persons with infections TB

Minimize the number of areas where exposure to m Tb may occur

97
Q

Environmental controls (why we admit to negative pressure rooms)

A

To prevent the spread and reduce the concentration of infectious droplet nuclei

Controlling the source of infection by using local exhaust ventilation (hoods) and diluting and removing contaminated air by using general ventilation

Controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation rooms; and cleaning the air by using high efficiency particular air HEPA filtration, or UV germicidal irradiation

Use respiratory protective equipment

98
Q

Respiratory controls

A

Consists of the use of personal protective equipment in situations that pose a high risk of exposure to TB disease

Use of respiratory protection equipment can reduce risk of exposure of health care workers to infectious droplet nuclei that ave been expelled into the air from a patient with infectious T disease
The following measures can be taken to reduce the risk for exposure
-implementing a respiratory protection program
-training health care workers on respiratory hygiene and the importance of cough etiquette procedures

99
Q

Room air

A

FiO2=21%

Fraction if inspiraed oxygen

100
Q

Nasal cannula

A

1-6 liters-FiO2=40-70% (similar to NC. Amount of oxygen adjusted on wall)

101
Q

Venturi mask

A

3-15 liters-aerosol mask-FiO2=34-50% (oxygen amount adjusted by the aperture aka fixed orifice device)

102
Q

Non rebreather

A

15 liters, bag reservoir-FiO2 80-100%

103
Q

What effects the respiratory protection

A

The level os respiratory protection selected

The fit characteristics of the respiratory model

The care in using the respiratory and

The adequacy of training and fit testing program

104
Q

Nonpowered respirators

A

With filters

105
Q

Powered air purifying respiratory

A

With high efficiency filters

106
Q

Fit testing performed

A

During the initial respiratory protection program training and periodically thereafter, in accordance with federal state and local regulations

107
Q

Acute T OMM

A

Contraindicated

Can Spears the bacteria to the lymph nodes causing them to be sore of swollen

Complications from lymph node involvement include sepsis, a dangerous infection of the bloodstream, and fistulas, which are abnormal openings, either between organs or between an organ and the body’s exterior

108
Q

After acute phase

A

Tart

CS, ME, BLT ribs-thoracic cage and diaphragm impediments

Lymph

ST MFR

109
Q

Phrenic nerve tract

A

Increasing air movement and diaphragmatic function

110
Q

Cardiovascular causes of chest pain

A

Acute coronary syndrome -unstable angina, NSTMI, STEMI, pericarditis, pericardial tamponade, aortic dissection, valvular heart disease

111
Q

Pulmonary causes of chest pain

A

PE, pneumothorax, pleurisy, asthma COPD exacerbation, resp infection

112
Q

GI causes of chest pain

A

GERD, esophageal spasm, esophagitis, esophageal rupture (boerhaave SBS), hiatal hernia

113
Q

Mak causes of chest pain

A

Costochondritis, rib fracture, spasm

114
Q

Endocrine cause of chest pain

A

Hyperthyroidism

115
Q

Psychiatric chest pain

A

Severe anxiety, panic attacks, cocain induced vasospasm

116
Q

Other causes of chest pain

A

Sickle cell, rheumatic diseases, sarcoidosis, herpes zoster

117
Q

Chest pain of acute coronary syndrome

A

Pressure, squeezing, sharp, burning

118
Q

Radiation acute coronary syndrome presentation

A

Back, jaw, shoulders, arms, upper abdomen

119
Q

Palpitations acute coronary syndrome

A

Possible

120
Q

Nausea acute coronary syndrome

A

Secondary to vagal stimulation

121
Q

Diaphoresis acute coronary syndrome

A

Secondary to sympathetic discharge

122
Q

Dyspnea acute coronary syndrome

A

May/may not improve with Ian or rest

123
Q

Other possible findings of acute coronary syndrome

A

Hypotension, HTN, diaphoresis with cool, clams skin, JVD , S3, S4, rales

124
Q

How does acute coronary syndrome present

A

Pressure-type retrosternal chest paint hat typically occurs at rest or with minimal exertion lasting >10 min

Can radiate to either or both arms, the neck or the jaw
-pain ma also occur in these areas independent of chest pain

Unexplained new onset or increased exertional dyspnea is the most common angina equivalent

Older patients (>75 years old) and women usually present with typical symptoms of acs, the freque cy of atypical presentations is increased int hese groups as well as in patients with DM, impaired renal function and dementia**
-atypical symptoms, including epigastric pain, indigestion, stabbing or pleuritic pain,and increasing dyspnea in the absence of chest pain should raise concern
125
Q

What do when come in

A

Thorough cardiovascular exam

Also look at hepatojugular reflux, rales in the lung bases or egophony (sign of heart failure) and/or dependent edema

126
Q

Risk cvd

A

Aging, men, family history, cigarettes or have quit less than 6 months ago, or env smoke

Sedentary lifestyle

Obesity

Stres

HTN >140/90

Dyslipidemia LDL>130 HDL<40, or meds, or TC>200

Pre diabetes IFG>100 or OGTT>140 and ,199 done in 2 dif measurements

127
Q

Negative risk factor cvs

A

HDL>60

128
Q

Nonmodifiable risk factors

A

Factors that increase the risk of developing a condition that cant be changed: age, gender, family

129
Q

Stable angina

A

Intermittent chest paint hat can be brought on by exertion or duress. Improves with rest and/or nitroglycerin. Episodes tend to be similar in nature. Episodes generally 2-5 minutes

130
Q

Unstable angina

A

Chest pain that can occur at rest, pain tends to escalate over time, episodes last 10 minutes, does not respond to rest of nitroglycerine, high risk of ae: NSTEMI, STEMI
noonspecific ekg findings (may have inverted t wave)-ekg changes are typically transientnormal cardiac enxymes

131
Q

NSTEMI (least common)

A

Complete occlusion of minor coronary artery or partial occlusion of major coronary artery that causes ischemia, tissue damage, and possible myocyte damage/necrosis.

**ekg findings are variable-normal or may have St depression, t wave inversion **elevated cardiac enzymes

132
Q

Stemi(most common

A

Complete vascular occlusion of major coronary artery leading to ischemia and myocardial damage/necrosis **ST segment elevations affiliated with area of heart where blood flow is affected. May also have new lbbb **elevated cardiac enzymes, severe symptoms

133
Q

Immediate treatment for ACS

A

MONA-B

134
Q

MONA-B

A

Morphine, O2, nitroglycerina, asprin (Asa), beta blocker

135
Q

Still give O2 if O2 looks ok

A

Year..heart is distressed and demanding more

136
Q

Labs acs

A

CBC(anemia) CMP(electrolyte imbalance, liver of kidney prob)

137
Q

Cardiac markers

A

Troponin I or T immediately upon patient presentation and q6hx3

138
Q

Ekg

A

Immediately on presentation, then ekg q8hx3

139
Q

Cxr

A

Evaluate potential causes for cp

140
Q

Lipid panel

A

Fasting in am (is there HDL? Has patient responded to HDL to) this is not an immediate assessment during the acs evaluation, but rather information to be used for prevention/risk management once the patient is stabilized

141
Q

Urine drug screen

A

Consider-are there substances that indicated presentation

142
Q

Uncontrollable chest pain, new LBBB or stemi

A

Stat cath lab

143
Q

Nitroglycerin and hposphodiesterase inhibitors (sildenafil-viagara)

A

Absolute contraindication secondary to hypotensive effects secondary to systemic vasodilation. Can result in severe hypotension or even death. Use PDE inhibitors within 24 hours of presentation is contraindication to use ntg

144
Q

Contraindication ntg

A

PDE inhibitor within 24 hours

Clin Medicine (28 decks)

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