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IPAP > PPP ROSH- Cards/Pulm > Flashcards

PPP ROSH- Cards/Pulm Flashcards

1
Q

MC form of cardiomyopathy

This MC can be caused by ? chemo agent

IVDA induced endocarditis Tx

A

Dilated d/t idiopathic/alcohol abuse

Doxorubicin

Vanc w/ Ceftriaxone

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2
Q

? organism causes infectious endocarditis in PTs w/ colon Ca

CT nodules ? size require no further work up in low risk PTs

Cardiac response to inc volume

A

Strep Bovis

<6cm;
6-8cm- re-CT in 12mon;
>8cm- re-CT at 3mon

BNP- inhibits RAAS, inc Na excretion

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3
Q

What two conditions can artificially lower BNP

What causes neonatal dilated myopathy

Afib Tx

A

Obesity, Pericardial constriction

Duchenne/Becker muscular dystrophy

Stable: rate control w/ Diltiazem/Metoprolol
Unstable: synch’d conversion

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4
Q

What happens when non-invasive pos-pressure ventilation is given during COPD exacerbation

How does this intervention help w/ pulmonary edema d/t decompensated HF

Function of TIMI Score

A

Dec dead space d/t alveolar recruitment,
Inc tidal volume/ventilation

Inc thoracic pressure dec venous return/after load and inc CO and

Estimated mortality for Pts w/ UA/NSTEMIs

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5
Q

Categories of TIMI Score

S1 and S2 sounds

A 
Age ≥65y/o
Marker, elevated/pos
ECG ST depressions
RFs, ≥3 (FamHx, HTN, Cholesterol, DM, Smoker)
Ischmia (≥2 episodes/24hrs)
Coronary stenosis ≥50%
ASA use past 7d

S1: M/T closing, S2: A/P closing

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6
Q

How is Congenital Long QTc Tx

When is elective repair of AAAs indicated

Stone mason lung Dz

A

Propranolol

≥5.5cm or expands ≥0.6cm in 6mon

Silicosis- eggshell calcification of hilar nodes; Inc risk for TB;

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7
Q

? causes Berylliosis

? causes Siderosis

? causes Stannosis

A

Aerospace fluorescent bulbs

Arc welding

Tin welding

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8
Q

Most predictive factor for cardiac ischemia

MOA of B2 agonists in asthma Tx

MOA of anticholinergic agents in asthma Tx

A

MedHx of CADz

Inc bronchodilation d/t inc cAMP <5min from use

Inc bronchodilation by dec cGMP <2hrs from use

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9
Q

Venous stasis ulcer PE appearance

? level means hypertriglycerides

What meds are used for Tx

A

Medial/Lateral ulcer w/ beefy red, granulated wound bed w/ surrounding hyperpigmentation

> 200mg

Fibrates: Fenofibrate, Gemfibrozil

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10
Q

How is Antidromic AVRT Tx

What is the direction of electricity w/ A-AVRT

How is Orthodromic AVRT Tx

A

WPW- Procainamide

Anterograde through AV, returns via accessory path

Adenosine

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11
Q

? causes exudates

? causes transudates

A 
L-side d/t pleural/lung inflammation:
Collagen vascular dz
Chylo/Hemothroax
TB
Esophageal rupture
Malignancy
PE, Pancreatitis, Pneumonia*

PE Cirrhosis Nephrotic Hypothyroid Amyloidosis HF

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12
Q

Lights Criteria

A

Transudate:
Serum Protein ≤0.5
Serum LDH ≤0.6
Pleural <2/3 upper limit

Exudate:
Serum Protein >0.5
Serum LDH >0.6
Pleural >2/3 upper limit

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13
Q

MCC pneumonia in alcoholics

How is the above Tx

MCC of pneumonia overall

A

Klebsiella: Gram-neg encapsulation in R upper lobe w/ currant-jelly sputum

3rd-G Cephalosporin + Aminoglycoside

Strep pneumo

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14
Q

EKG findings of pericarditis

Innocent murmur characteristics

? medication is derived from foxglove

A

ST elevation w/ PR depression in V2-6, 1-3 and aVL/VF

≥2 intensity
Softer w/ sitting
Short systolic duration
Minimal radiation
Muscial/vibratory

Digoxin- inc contractility w/ inc O2 demand and dec AV conduction

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15
Q

Wells Score for PE

A 
S/Sx of DVT- 3
Alt Dx less likely- 3
HR >100- 1.5
Bed x 3d/post-surg <4wk- 1.5
Prev PE/DVT Dx- 1.5
Hemoptysis- 1
Ca Tx <6mon- 1

Low: <2
Mod: 2-6
High: >6

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16
Q

MC inherited RF for thromboembolic Dz

How long are DVTs anticoagulated

How long are Pts anticoagulated after Afib conversion

A

Factor V Leiden

3mon

4wks

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17
Q

MV regurg auscultation sound

How is rate control achieved w/ rapid ventricular response in setting of compensated systolic HF

OutPt CAP Tx in Peds

A

Soft S1 w/ loud holosystolic murmur

Carvedilol, Metoprolol, Bisoprolol

Amoxicillin > Azithromycin

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18
Q

Characteristics of Venous Hum

How are asthmatic exacerbations Tx

Anti-hypertensives safe for pregnancy

A

Continuous hum heard in subclavicular region louder when sitting, dec w/ laying supine

Albuterol Ipratropium GCCS

Labetalol
Methyldopa/Metroprolol
Nifedipine
Hydralazine/Hydrychlorothatlazone

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19
Q

MOA of Atropine

What other two meds can be used for sinus bradycardia along w/ atropine

How does atelectasis present and how is it Tx

A

Inhibits Ach at AV node from vagus nerve

Dopamine, Epi

Post-op day 2-5 w/ inc work of breathing/hypoxemia; deep breathing exercise/incentive spirometry

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20
Q

When do post-op DVTs appear

Venous ulcers appear more commonly on ? side w/ skin changes ocurring d/t ?

? deficiency can cause Prinzmetal Angina

A

Day 7-10

Medial ankle; Hemosiderin deposits

Mg

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21
Q

Best image for suspected PE

Peripheral S/Sxs of Endocarditis

What criteria is used for Dx

A

CT pulmonary angiography

FROM JANE:
Fever Roth Osler Murmur Janeway Anemia Nails Emboli

Duke

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22
Q

MOA and use of Cilostazol

First step Tx for venous stasis ulcer

When are skin grafts indicated for Tx

A

PD5 inhibitor to improve walking distance for PTs w/ PADz; C/i during HF (most effective therapy for PADz)

Compression therapy

Unhealed x >12mon

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23
Q

MC dysrhythmia associated w/ sinus node dysfunction

When/How does MAT appear

WAP appearance

A

Afib s/ sinus/brady episodes

HR >100 w/ 3 P-wave morphologies in Pts w/ COPD

HR <100 w/ 3 P-wave morphologies

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24
Q

What class of med is used to Tx BPH in Pts w/ Hx of O-HOTN

When are low-dose CT scans done for lung Ca

MC form of lung Ca

A

PD5 inhibitors

50-8y/o w/ 20p/yr Hx or haven’t quit x15yrs

Adenocarcinoma

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25
Q

MC valves affected by rheuatic fever

How does carcinoid tumor present

How are they Dx

A

M > A > T

Episodic diarrhea, wheezing, flushing

24hr 5-HIAA urine collection (breakdown of excess serotonin)

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26
Q

Carcinoid tumor MC mets to ? organ

Asthma categories and Tx

Exacerbations requiring steroids per yer place Pts in ? categories

A

Liver

Sx/SABA/Wake:
I: ≤2 d/wk, ≤2 wake/mon, SABA PRN
Mi: ≥3/wk, ≥3/wk, 3-4/mon, SABA PRN w/ low ICS
Mod: Daily Daily >1/wk, LABA w/ Low ICS
Sev: Throughout, Several, Often/Nightly, High ICS w/ LABA -/+ Omalizumab

Intermittent: 0-1/yr, Mild/Mod/Sev: ≥2/yr

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27
Q

LAMA

SAMA

LABA

SABA

Inhaled GCCS

A

Tiotropium

Ipratropium

Salm/Formo-terol

Albuterol

Fluticasone

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28
Q

? is pathognemonic for acute pericarditis but w/ low sensitivity

How is uremic pericarditis Tx

? antipyschotic can create this Dx

A

Friction rub

Dialysis

Clozipine

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29
Q

CF PTs are susceptible to bronchitis d/t ? microbe

How are they Tx

Pleural effusions will have ? PE findings

A

Pseudomonas

Inhaled aminoglycosides (-mycin/-micin)

Dec tactile fremitus, Dull to percussion
(consolidation: inc fremitus, dull percussion)

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30
Q

Initial imaging for chronic venous insufficiency

? anti-hypertensive med is used in Pts w/ osteoporosis

Define Pulsus Paradoxus

A

Duplex US

Chlorthalidone- inhibits Na/Cl reabsorption in distal tube

SBP dec w/ pulse wave amplitude during inspiration; Dx of Pericarditis Emboli/Thrombus Tamponade

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31
Q

HASBLED Score for bleeding risk on anticoagulation

A 
HTN
Abnormal kidney/liver function 1-2pts
Stroke
Bleeding
Labile INR
Elder >65y/o
Drugs/Alcohol 1-2pts

0-1: low 2: mod 3-4: high

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32
Q

What imaging/PE results suggest Idiopathic Pulm Fibrosis

Define Cor Pulmonale

What is the MCC in the USA

A

Honey combing and digital clubbing

Altered structure (hypertrophy and dilation) and function of RV d/t P-HTN

COPD

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33
Q

What are the 5 groups of Cor Pulmonale

ABX of choice for Tx of Legionella pneumonia

A

1: pulm artery HTN
2: left heart dz (MC)
3: lung dz/hypoxemia
4: chronic embolisms
5: unclear/multi-focal

Azithromycin*, Levoflox, Doxy

34
Q

What medication is added to chronic, stable angina but Sx Pts

What are the s/e of this med

What is the desired HR range for Pts w/ chronic stable angina on BB therapy

A

Ranolazine- selective inhibits late Na channels

Prolong Qtc, caution w/ kidney/liver dz

55-60bpm

35
Q

MC site for mesothelioma to develop

Define Choroidal Tubercle

Strongest RF for OSA

A

Pleura

Granuloma in choroid of retina d/t TB

Obesity

36
Q

? infectious process can cause a complete heart block

Relative c/i to fibrinolytic therapy for STEMI

Absolute c/i for therapy

A

Lyme dz

SBP ≥180, DBP ≥110, Anticoagulants, Pregnancy

Intracranial hemorrhage Hx
Trauma (head/face) <3mon
Ischemic stroke <3mon
Suspected aortic dissection
Actively bleeding or bleeding d/o
Intracranial/spinal surgery <2mon
Intracranial neoplasm/malformation
Streptokinase c/i- streptokinase use <6mon
37
Q

CPR lasting longer than ? is a relative c/i to thrombolytic therapy

Define Chylothorax

EKG findings of Cor Pulmonale

A

> 10min

Lymphatic fluid in pleural space

RAD, Inc P-wave amplitude in 2, 3, aVF

38
Q

When are chest tubes (thoracostomy) indicated during pneumonia

What lab results will suggest this procedure is needed

How does pH guide in decision making

A

Parapneumonic effusion, Empyema

pH <7.2, LDH >700, Glucose <60

Simple/Uncomplicated effusion: normal
Complicated/Empyema: pH <7.20

39
Q

Possible complication arising from aspiration pneumonia and how is it Tx

If this complication develops, how are Pts Tx

EKG findings for pericarditis

A

Lung abscess d/t anaerobes; Tx: Amp-Sulbactam, Carbapenems

Amp-Sulbactam, Carbapenem, PO Clinda

PR elevation in aVR
Global PR depression w/ concave ST elevation

40
Q

MCC of pneumonia and bullous myringitis

Gold standard for Dx any pleural effusion

Ground glass appearance on infant CXR

A

Strep pneumo

Centesis whenever new effusion develops w/out known cause

Hyaline Membrane Dz- RDSyndrome d/t dec surfactant production and birth <34wks

41
Q

Wide, Fixed split S2 is d/t ?

MC type of this defect

Croup is AKA and d/t ?

A

ASD

Ostium secundum

Laryngotracheitis, Parainfluenza virus (steeple sign, Dexameth, Racemic epi)

42
Q

Paradoxically split S2 w/ narrow pulse pressure

What is the best initial test for DVT Dx

What test has the highest sensitvity

A

Aortic stenosis (valve area <0.8cm2)

Duplex US

Venography

43
Q

What are the stages of ST progression during MIs in sequence

Different types of ventricular remodeling d/t AS

How is inhaled food retrieved

A 
Hyperacute T-wave
J-point elevation
ST elevation
Q wave formation w/ loss of R-wave
T-wave inversion

Concentric d/t pressure overload- inc wall thickness (eccentric- thinner walls)

Rigid bronchoscopy

44
Q

When are DMT2 screenings indicated

If results are normal, f/u and repeat screening how often?

What breakfast ritual can increase Simvastatin levels

A 
Any adult ≥25k/m w/ one RF or 45 w/ normal BMI/no RFs:
Inactivity/Obesity
CVDz
HDL <35, Tgc >250
A1c ≥5.7
First * relative w/ DM

q3yrs

Grapefruit juice

45
Q

WPW is MC a tachydysrhythmia seen in ? re-entry rhythms

Secondary HTN lab orders

S/e of etomidate for RSI

A

Orthodromic

BMP CBC Lipid UA ECH

Myoclonic jerks, Adrenal suppression

46
Q

S/e of Ketamine for RSI

S/e of succinylcholine for RSI

S3 is best heard w/ ? part of stethascope

A

HTN

HyperK

Bell

47
Q

Presentation of HF w/ preserved EF

How are these Pts managed

Acute Cor Pulmonale is caused by ?

A

Fatigue/Dyspnea w/ EF ≥50%

Exercise training

PE, ARDS

48
Q

Formula for CO

Autosomal recessive d/os

E+ abnormality seen in sarcoidosis

A

CO= SVxHR

Tay sachs, A-1 trypsin, Galactossemia
PKU, CF, Sick cell dz
Hemochromatosis, Wilsons

HyperCa d/t calcitriol production from non-caseating granulomas

49
Q

MOA of Oseltamivir

DM Pts need ? three vaccines

How would congenital heart defects appear first in life

A

Neuraminidase inhibitor

Hep B, Pneumococcal, Annual influenza

Pulm/Peripheral edema

50
Q

Define Aschoff Body

Bicuspid aortas are more likely to be associated w/ ? other finding

Sequence of pneumoccocal vaccines

A

Characteristic histological finding of acute rheumatic fever

Ascending aorta dilation

PCV13 the PPSV23 one year later

51
Q

How does myocarditis present

? valvulopathy is associated w/ Corrigan Pulse and Pts benefit from ? med for Sxs

This is also associated w/ ? other co-existing murmur

A

Prodrome: fever, malaise, myalgia
Heart dysfunction: dyspnea, syncope, tachy/tachy

AR- Nifedipine

Austin flint- low pitch diastolic murmur at apex

52
Q

? PE test can help differ lung issue from consolidation/fluid retention

How is narrow complex WPW tachycardia Tx

How is WPW Tx during pregnancy

A

Egophony

Adenosine

Sotalol, Flecainide

53
Q

MCC of minor hemoptysis in ED

MOA of bile acid sequestrants

What meds are included in this class

A

Acute bronchitis

Binds acids and increases fecal excretion

Chole-styramine/Stipol/Sevelam

54
Q

? antiarrhythmic is c/i in setting of CADz/structural heart dz

Define Carvallo Sign

? valve is least likely to be affected by acquired valvular dz and most likely to be congential

A

Flecainide- inc risk for polymorphic ventricular tachycardia

Murmur increases w/ inspiration= TR

Pulmonic regurg/stenosis

55
Q

Goal to PCI

What med is given enroute to PCI

Tactile fremitus inc w/ ? and dec w/ ?

A

<90min

GP2b/3a inhibitor: Eptifibatide, Tirofiban

Inc: consolidation, Dec: air (Ptx)

56
Q

Pneumonia admission criteria

Three scenarios when PO Pred is used for Tx

Coarctation Tx includes ? med

A

CURB-65:
Confusion BUN >20 RR >30 BP <90/60 Age >65

Asthma exacerbation, RA, Croup

Prostaglandin E1

57
Q

Other Mg Sulfate and defib, how is Torsades Tx

MCC of TS and TR

Pancoast Tumor presentation

A

Overdrive pacing: inc HR to shorten ventricular repolarization

TS: Rheumatic fever, TR: inc R heart pressure

Superior Sulcus Tumor- present w/ shoulder pain and Horner Syndrome and weak/atrophy hand muscles

58
Q

1a, 1b, 1c anti-arrhythmics

Class 2

Class 3

Class 4

A

Na channel blocker:
Double Quarter Pound, Plenty Lettuce Mayo, Fries Please
1: Disopyramide Quinidine Procainamide- inc AP
2: Lidocaine Mexiletine Phenytoin- dec AP
3: Flecainide Propafenone- AP neutral

BBs

Sotalol Amiodarone Ibutilide Dofetilide Dronedarone

CCBs, non-dhp

59
Q

Cavitary lesion post influenza is d/t ?

How is pneumonia during CF Tx

How is pertussis Tx

A

Staph A pneumonia

Piper/Tazo

Whooping cough: Azithromycin, TMP-SMX

60
Q

Constrictive Pericarditis PE finding compared to Acute Pericarditis PE finding

Next step for inhaled foreign object

? med is used for shock-refractory Vfib

A

Constrictive: Kussmaul sign- Inc JVD w/ inspiration
Acute: Friction rub

Rigid bronchoscopy

Amiodarone- inactivates Na channels

61
Q

MCC of dilated myopathy

MC infectious cause

MC metabolic cause

A

Idiopathic

Coxsackie B

B1 deficiency- Thiamine

62
Q

How is mortality reduced during dilated cardiomyopathy

How is Sx control achieved

When is an ICD indicated

A

ACE/ARB, BB, Spironolactone

Diuretics, Digoxin

EF <35%

63
Q

Takotsubo mimicks ? on EKG

Lab results w/ Restrictive Myopathy

How is Restrictive Myopathy Tx by etiology

A

Anterior MI

Apple green birefringence w/ Congo-red stain= amyloidosis

Sarcoid: GCSS, Hemachromatosis: chelation

64
Q

Myocarditis is MC d/t ? and presents as ?

What other issues can Pts present w/

What is the gold standard for Dx although rarely done

A

Coxsackie infection- systolic dysfunction HF

Megacolon, Pericarditis

Biopsy

65
Q

A-Flutter Tx

Direct Thrombin Inhibitor

Factor Xa inhibitors

A

Stable: Vagal, Rate: BB/Non-D CCBs
Unstable; synch’d conversion
Definitive: Ablation

Dabigatran

Edox/Apixa/Rivarox-aban

66
Q

Stable/Narrow PSVT Tx

Stable/Wide PSVT Tx

MAT vs WAP

A

1st: Adenosine 2nd: CCBs/BBs

Amiodarone (Procainamide for WPW)

WAP: HR <100bpm,
MAT: >100bpm w/ COPD (Tx: Verapamil if LV dysfunction)

67
Q

Class 1,3 anti-arhythmics are primarily used for ? while Clas 2,4 are primarily used for ?

MC innocent murmur

MC location for Coarctations

A

1,3: rhythm 2,4: rate

1st: Still- musical/vibratory mid-systolic that dec w/ standing/valsalva, inc w/ supine
2nd: Venous- MC continuous benign murmur; turbulant return of blood between JV/SVC, inc w/ sitting/dec w/ supine and head rotation

Insertion of ductus arteriosus distal to L-subclavian origin

68
Q

Define Harlequin Sign

PPIs can interact w/ ? CADz drug

Post-surgical corrected Tetrology criteria to return to sports

A

Horner syndrome w/ contralateral face sweating, flushing

Clopidogrel

RV pressure <50mmHg

69
Q

High out put HF etiolgoies

Low out put HF etiologies

Normal EF

A

Beriberi AV fistula Hyperthyroidism Pagets Anemia Pregnancy

Dilated cardiomyopathy HTN Valvular heart dz

≥55%

70
Q

Gold standard to Dx Aortic Dissection

Define Lofgren Syndrome

How is this syndrome Tx

A

CT angiogram

Sarcoidosis w/ hilar adenopathy, erythema nadosum and polyarthralgia

NSAIDs

71
Q

MC etiology of V-Fib

Most specific stress test finding to indicate ischemia

Define Hamman Sign

A

Myocardial ischemia

2mm down sloping ST segment depression

Crunching sound heard on auscultation d/t pneumomediastinum

72
Q

Gold standard image for spontaneous pneumomediastinum

What meds are used for Sx control of Carcinoid Tumors

? meds are avoided in Mobitz 2/2 blocks

A

CT scan

Somatostatins: -eotide

Anything that slows AV conduction: Adenosine BB CCBs Digoxin

73
Q

MOA of Digoxin

Best test for PE

What does the D-wave of WPW mean

A

Inc PNS activity of AV node and inhibits Na/K/ATP pump to inc contractility

CT angiography

Conduction through accessory tract

74
Q

Gold standard image for PEs

S/e of using Ethambutol for TB Tx

MOA of Heparin

A

Spiral CT w/ contrast

Red-Green blindness, Optic neuritis

Potentiates anti-thrombin 3, inhibiting thrombin/coagulation

75
Q

Most specific PE finding for DVTs

When is a Trousseau Sign seen

MCC is ? but the condition is Tx how

A

Calf swelling >3cm

Migratory thrombophlebitis associated w/ Ca (palpable cord)

Factor 5 laden;
Support: NSAID, Elevation, Warm compress
Phlebectoy
PCN w/ Aminoglycoside if febrile

76
Q

? two steroid sparing/refractory meds are used in the Tx for GCA

? is the MC primary cardiac tumor

How is this MC Dx

A

Methotrexate, Azathioprine

Atrial myxoma in LA near fossa ovalis (mimics MS)

TEE

77
Q

Define Leriche Syndrome

What causes this Triad

PADz is Dx w/ ABI below ? and ? measurement indicates calcified vascular walls

A

Dec femoral pulses Impotence Claudication

Aortic bifurcation/common iliac occlusion

<0.90; >1.2

78
Q

Aortography w/ cork screw collateral suggests ? Dx

? is the cornerstone of management of this condition

? med is used during this cornerstone

A

Buerger’s Dz: Thromboangitis Obliterans

Tobacco cessation

Iloprost

79
Q

MCC of MR in the USA

6 D’s of Dilated Cardiomyopathy

Main PE finding

A

MVP

Don't know (idiopathic)
Drinking
Drug- cocaine
Dz- Coxsackie
Doxorubicin
Deficiency (B1)

S3 gallop: blood splashing against overly compliant, baggy ventricles

80
Q

Dec mortality for Pts w/ HF using ? meds

What meds are used for Sx relief

When are ICDs considered

A

BASH the heart to pump harder:
BBs ACEI/ARB Spirinolactone Hydralazine-nitrate

Fuorsemide- dec fluid burden
Digoxin- inc contractility

EF <30%

81
Q

Restrictive Cardiomyopathy MC has ? sided HF

? lab result indicates the MCC as the etiology

? class of medication should be given initially to Tx acute pulmonary edema during HF

A

R > L

Apple-green w/ Congo red stain= Amyloidosis

Nitrates

82
Q

? meds are used for HOCM Tx

A

Non-DHP: Verapamil, Diltiazem (Dec Velocity of AV node)

IPAP (212 decks)

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