PPP ROSH- Cards/Pulm Flashcards
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
? 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
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
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
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
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;
? causes Berylliosis
? causes Siderosis
? causes Stannosis
Aerospace fluorescent bulbs
Arc welding
Tin welding
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
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
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
? 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
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
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
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
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
MC inherited RF for thromboembolic Dz
How long are DVTs anticoagulated
How long are Pts anticoagulated after Afib conversion
Factor V Leiden
3mon
4wks
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
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
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
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
Mg
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
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
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
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
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)
