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

PPP ROSH- Cards/Pulm Flashcards by brandon lovin

MC form of cardiomyopathy

This MC can be caused by ? chemo agent

IVDA induced endocarditis Tx

Dilated d/t idiopathic/alcohol abuse

Doxorubicin

Vanc w/ Ceftriaxone

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? 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

Strep Bovis

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

BNP- inhibits RAAS, inc Na excretion

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What two conditions can artificially lower BNP

What causes neonatal dilated myopathy

Afib Tx

Obesity, Pericardial constriction

Duchenne/Becker muscular dystrophy

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

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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

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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Categories of TIMI Score

S1 and S2 sounds

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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How is Congenital Long QTc Tx

When is elective repair of AAAs indicated

Stone mason lung Dz

Propranolol

≥5.5cm or expands ≥0.6cm in 6mon

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

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? causes Berylliosis

? causes Siderosis

? causes Stannosis

Aerospace fluorescent bulbs

Arc welding

Tin welding

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Most predictive factor for cardiac ischemia

MOA of B2 agonists in asthma Tx

MOA of anticholinergic agents in asthma Tx

MedHx of CADz

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

Inc bronchodilation by dec cGMP <2hrs from use

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Venous stasis ulcer PE appearance

? level means hypertriglycerides

What meds are used for Tx

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

> 200mg

Fibrates: Fenofibrate, Gemfibrozil

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How is Antidromic AVRT Tx

What is the direction of electricity w/ A-AVRT

How is Orthodromic AVRT Tx

WPW- Procainamide

Anterograde through AV, returns via accessory path

Adenosine

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? causes exudates

? causes transudates

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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Lights Criteria

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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MCC pneumonia in alcoholics

How is the above Tx

MCC of pneumonia overall

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

3rd-G Cephalosporin + Aminoglycoside

Strep pneumo

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EKG findings of pericarditis

Innocent murmur characteristics

? medication is derived from foxglove

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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Wells Score for PE

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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MC inherited RF for thromboembolic Dz

How long are DVTs anticoagulated

How long are Pts anticoagulated after Afib conversion

Factor V Leiden

3mon

4wks

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MV regurg auscultation sound

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

OutPt CAP Tx in Peds

Soft S1 w/ loud holosystolic murmur

Carvedilol, Metoprolol, Bisoprolol

Amoxicillin > Azithromycin

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Characteristics of Venous Hum

How are asthmatic exacerbations Tx

Anti-hypertensives safe for pregnancy

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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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

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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When do post-op DVTs appear

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

? deficiency can cause Prinzmetal Angina

Day 7-10

Medial ankle; Hemosiderin deposits

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Best image for suspected PE

Peripheral S/Sxs of Endocarditis

What criteria is used for Dx

CT pulmonary angiography

FROM JANE:
Fever Roth Osler Murmur Janeway Anemia Nails Emboli

Duke

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MOA and use of Cilostazol

First step Tx for venous stasis ulcer

When are skin grafts indicated for Tx

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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MC dysrhythmia associated w/ sinus node dysfunction

When/How does MAT appear

WAP appearance

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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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

PD5 inhibitors

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

Adenocarcinoma

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MC valves affected by rheuatic fever How does carcinoid tumor present How are they Dx

M > A > T Episodic diarrhea, wheezing, flushing 24hr 5-HIAA urine collection (breakdown of excess serotonin)

Carcinoid tumor MC mets to ? organ Asthma categories and Tx Exacerbations requiring steroids per yer place Pts in ? categories

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

LAMA SAMA LABA SABA Inhaled GCCS

Tiotropium Ipratropium Salm/Formo-terol Albuterol Fluticasone

? is pathognemonic for acute pericarditis but w/ low sensitivity How is uremic pericarditis Tx ? antipyschotic can create this Dx

Friction rub Dialysis Clozipine

CF PTs are susceptible to bronchitis d/t ? microbe How are they Tx Pleural effusions will have ? PE findings

Pseudomonas Inhaled aminoglycosides (-mycin/-micin) Dec tactile fremitus, Dull to percussion (consolidation: inc fremitus, dull percussion)

Initial imaging for chronic venous insufficiency ? anti-hypertensive med is used in Pts w/ osteoporosis Define Pulsus Paradoxus

Duplex US Chlorthalidone- inhibits Na/Cl reabsorption in distal tube SBP dec w/ pulse wave amplitude during inspiration; Dx of Pericarditis Emboli/Thrombus Tamponade

HASBLED Score for bleeding risk on anticoagulation

``` 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

What imaging/PE results suggest Idiopathic Pulm Fibrosis Define Cor Pulmonale What is the MCC in the USA

Honey combing and digital clubbing Altered structure (hypertrophy and dilation) and function of RV d/t P-HTN COPD

What are the 5 groups of Cor Pulmonale ABX of choice for Tx of Legionella pneumonia

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

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

Ranolazine- selective inhibits late Na channels Prolong Qtc, caution w/ kidney/liver dz 55-60bpm

MC site for mesothelioma to develop Define Choroidal Tubercle Strongest RF for OSA

Pleura Granuloma in choroid of retina d/t TB Obesity

? infectious process can cause a complete heart block Relative c/i to fibrinolytic therapy for STEMI Absolute c/i for therapy

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 ```

CPR lasting longer than ? is a relative c/i to thrombolytic therapy Define Chylothorax EKG findings of Cor Pulmonale

>10min Lymphatic fluid in pleural space RAD, Inc P-wave amplitude in 2, 3, aVF

When are chest tubes (thoracostomy) indicated during pneumonia What lab results will suggest this procedure is needed How does pH guide in decision making

Parapneumonic effusion, Empyema pH <7.2, LDH >700, Glucose <60 Simple/Uncomplicated effusion: normal Complicated/Empyema: pH <7.20

Possible complication arising from aspiration pneumonia and how is it Tx If this complication develops, how are Pts Tx EKG findings for pericarditis

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

MCC of pneumonia and bullous myringitis Gold standard for Dx any pleural effusion Ground glass appearance on infant CXR

Strep pneumo Centesis whenever new effusion develops w/out known cause Hyaline Membrane Dz- RDSyndrome d/t dec surfactant production and birth <34wks

Wide, Fixed split S2 is d/t ? MC type of this defect Croup is AKA and d/t ?

ASD Ostium secundum Laryngotracheitis, Parainfluenza virus (steeple sign, Dexameth, Racemic epi)

Paradoxically split S2 w/ narrow pulse pressure What is the best initial test for DVT Dx What test has the highest sensitvity

Aortic stenosis (valve area <0.8cm2) Duplex US Venography

What are the stages of ST progression during MIs in sequence Different types of ventricular remodeling d/t AS How is inhaled food retrieved

``` 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

When are DMT2 screenings indicated If results are normal, f/u and repeat screening how often? What breakfast ritual can increase Simvastatin levels

``` 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

WPW is MC a tachydysrhythmia seen in ? re-entry rhythms Secondary HTN lab orders S/e of etomidate for RSI

Orthodromic BMP CBC Lipid UA ECH Myoclonic jerks, Adrenal suppression

S/e of Ketamine for RSI S/e of succinylcholine for RSI S3 is best heard w/ ? part of stethascope

HTN HyperK Bell

Presentation of HF w/ preserved EF How are these Pts managed Acute Cor Pulmonale is caused by ?

Fatigue/Dyspnea w/ EF ≥50% Exercise training PE, ARDS

Formula for CO Autosomal recessive d/os E+ abnormality seen in sarcoidosis

CO= SVxHR Tay sachs, A-1 trypsin, Galactossemia PKU, CF, Sick cell dz Hemochromatosis, Wilsons HyperCa d/t calcitriol production from non-caseating granulomas

MOA of Oseltamivir DM Pts need ? three vaccines How would congenital heart defects appear first in life

Neuraminidase inhibitor Hep B, Pneumococcal, Annual influenza Pulm/Peripheral edema

# Define Aschoff Body Bicuspid aortas are more likely to be associated w/ ? other finding Sequence of pneumoccocal vaccines

Characteristic histological finding of acute rheumatic fever Ascending aorta dilation PCV13 the PPSV23 one year later

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

Prodrome: fever, malaise, myalgia Heart dysfunction: dyspnea, syncope, tachy/tachy AR- Nifedipine Austin flint- low pitch diastolic murmur at apex

? PE test can help differ lung issue from consolidation/fluid retention How is narrow complex WPW tachycardia Tx How is WPW Tx during pregnancy

Egophony Adenosine Sotalol, Flecainide

MCC of minor hemoptysis in ED MOA of bile acid sequestrants What meds are included in this class

Acute bronchitis Binds acids and increases fecal excretion Chole-styramine/Stipol/Sevelam

? 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

Flecainide- inc risk for polymorphic ventricular tachycardia Murmur increases w/ inspiration= TR Pulmonic regurg/stenosis

Goal to PCI What med is given enroute to PCI Tactile fremitus inc w/ ? and dec w/ ?

<90min GP2b/3a inhibitor: Eptifibatide, Tirofiban Inc: consolidation, Dec: air (Ptx)

Pneumonia admission criteria Three scenarios when PO Pred is used for Tx Coarctation Tx includes ? med

CURB-65: Confusion BUN >20 RR >30 BP <90/60 Age >65 Asthma exacerbation, RA, Croup Prostaglandin E1

Other Mg Sulfate and defib, how is Torsades Tx MCC of TS and TR Pancoast Tumor presentation

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

1a, 1b, 1c anti-arrhythmics Class 2 Class 3 Class 4

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

Cavitary lesion post influenza is d/t ? How is pneumonia during CF Tx How is pertussis Tx

Staph A pneumonia Piper/Tazo Whooping cough: Azithromycin, TMP-SMX

Constrictive Pericarditis PE finding compared to Acute Pericarditis PE finding Next step for inhaled foreign object ? med is used for shock-refractory Vfib

Constrictive: Kussmaul sign- Inc JVD w/ inspiration Acute: Friction rub Rigid bronchoscopy Amiodarone- inactivates Na channels

MCC of dilated myopathy MC infectious cause MC metabolic cause

Idiopathic Coxsackie B B1 deficiency- Thiamine

How is mortality reduced during dilated cardiomyopathy How is Sx control achieved When is an ICD indicated

ACE/ARB, BB, Spironolactone Diuretics, Digoxin EF <35%

Takotsubo mimicks ? on EKG Lab results w/ Restrictive Myopathy How is Restrictive Myopathy Tx by etiology

Anterior MI Apple green birefringence w/ Congo-red stain= amyloidosis Sarcoid: GCSS, Hemachromatosis: chelation

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

Coxsackie infection- systolic dysfunction HF Megacolon, Pericarditis Biopsy

A-Flutter Tx Direct Thrombin Inhibitor Factor Xa inhibitors

Stable: Vagal, Rate: BB/Non-D CCBs Unstable; synch'd conversion Definitive: Ablation Dabigatran Edox/Apixa/Rivarox-aban

Stable/Narrow PSVT Tx Stable/Wide PSVT Tx MAT vs WAP

1st: Adenosine 2nd: CCBs/BBs Amiodarone (Procainamide for WPW) WAP: HR <100bpm, MAT: >100bpm w/ COPD (Tx: Verapamil if LV dysfunction)

Class 1,3 anti-arhythmics are primarily used for ? while Clas 2,4 are primarily used for ? MC innocent murmur MC location for Coarctations

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

# Define Harlequin Sign PPIs can interact w/ ? CADz drug Post-surgical corrected Tetrology criteria to return to sports

Horner syndrome w/ contralateral face sweating, flushing Clopidogrel RV pressure <50mmHg

High out put HF etiolgoies Low out put HF etiologies Normal EF

Beriberi AV fistula Hyperthyroidism Pagets Anemia Pregnancy Dilated cardiomyopathy HTN Valvular heart dz ≥55%

Gold standard to Dx Aortic Dissection Define Lofgren Syndrome How is this syndrome Tx

CT angiogram Sarcoidosis w/ hilar adenopathy, erythema nadosum and polyarthralgia NSAIDs

MC etiology of V-Fib Most specific stress test finding to indicate ischemia Define Hamman Sign

Myocardial ischemia 2mm down sloping ST segment depression Crunching sound heard on auscultation d/t pneumomediastinum

Gold standard image for spontaneous pneumomediastinum What meds are used for Sx control of Carcinoid Tumors ? meds are avoided in Mobitz 2/2 blocks

CT scan Somatostatins: -eotide Anything that slows AV conduction: Adenosine BB CCBs Digoxin

MOA of Digoxin Best test for PE What does the D-wave of WPW mean

Inc PNS activity of AV node and inhibits Na/K/ATP pump to inc contractility CT angiography Conduction through accessory tract

Gold standard image for PEs S/e of using Ethambutol for TB Tx MOA of Heparin

Spiral CT w/ contrast Red-Green blindness, Optic neuritis Potentiates anti-thrombin 3, inhibiting thrombin/coagulation

Most specific PE finding for DVTs When is a Trousseau Sign seen MCC is ? but the condition is Tx how

Calf swelling >3cm Migratory thrombophlebitis associated w/ Ca (palpable cord) Factor 5 laden; Support: NSAID, Elevation, Warm compress Phlebectoy PCN w/ Aminoglycoside if febrile

? two steroid sparing/refractory meds are used in the Tx for GCA ? is the MC primary cardiac tumor How is this MC Dx

Methotrexate, Azathioprine Atrial myxoma in LA near fossa ovalis (mimics MS) TEE

# Define Leriche Syndrome What causes this Triad PADz is Dx w/ ABI below ? and ? measurement indicates calcified vascular walls

Dec femoral pulses Impotence Claudication Aortic bifurcation/common iliac occlusion <0.90; >1.2

Aortography w/ cork screw collateral suggests ? Dx ? is the cornerstone of management of this condition ? med is used during this cornerstone

Buerger's Dz: Thromboangitis Obliterans Tobacco cessation Iloprost

MCC of MR in the USA 6 D's of Dilated Cardiomyopathy Main PE finding

MVP ``` Don't know (idiopathic) Drinking Drug- cocaine Dz- Coxsackie Doxorubicin Deficiency (B1) ``` S3 gallop: blood splashing against overly compliant, baggy ventricles

Dec mortality for Pts w/ HF using ? meds What meds are used for Sx relief When are ICDs considered

BASH the heart to pump harder: BBs ACEI/ARB Spirinolactone Hydralazine-nitrate Fuorsemide- dec fluid burden Digoxin- inc contractility EF <30%

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

R > L Apple-green w/ Congo red stain= Amyloidosis Nitrates

? meds are used for HOCM Tx

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