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pulm 2 Flashcards

1
Q

*** sarcoidosis, amyloidosis, hemochromatosis

A

causes of restrictive cardiomyopathy with preserved ejection HF

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2
Q

*** neuropathy, easy bruising, enlarged tongue, proteinuria, early satiety, edema, subcutaneous nodules

A

amyloidosis

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3
Q

*** what is reflected during inspiratory hold?

A

pulmonary compliance

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4
Q

*** what is reflected during expiratory hold?

A

PEEP

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5
Q

4 types of lung cancer

A

adenocarcinoma
squamous cell
small cell
large cell

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6
Q

two peripherally located lung cancers

A

adenocarcinoma

large cell carcinoma

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7
Q

*** gynecomastia and galactorrhea in lung cancer

A

large cell carcinoma

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8
Q

diastolic murmur, left sternal border, loudest with sitting up, leaning forward and expiration

A

AR

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9
Q

*** healthy woman found to have diastolic murmur, should she get a workup?

A

YES - diastolic murmurs likely pathologic, fo/u with echo

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10
Q

*** what post-MI complications can occur with RCA occlusion

A

RV failure
papillary muscle rupture (new murmur)
interventricular septum rupture (new murmur)

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11
Q

*** post-MI complications with LAD occlusion

A

interventricular septum rupture
free wall rupture
left ventricular aneurysm

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12
Q

pt has new holosystolic murmur after MI and echo reveals new MR - what vessel was occluded?

A

RCA

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13
Q

pleural plaques

A

asbestosis

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14
Q

3 most common causes of cough

A

asthma, GERD, post-nasal drip

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15
Q

rx that increases natriuresis, decreases serum angio II concentration, and decreases aldo production

A

direct renin inhibitor (aliskiren)

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16
Q

*** first line tx of aortic dissection

A

IV BB to reduce HR, SBP, and LV contractility

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17
Q

can vasodilators hydralazine and nitroprusside result in reflex sympathetic stimulation with consequent rise in HR, LV contractility, and aorta wall stress?

A

YES - why we don’t use them in aortic dissection management

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18
Q

*** common causes of cor pulmonale (R HF due to lung disease)

A

COPD
ILD
pulmonary vascular disease
OSA

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19
Q

elevated pulmonary artery systolic pressure, hepatomegaly, chronic COPD, elevated JVD, ascites, pleural effusion, edema

A

Cor Pulmonale

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20
Q

tx of prinzmetal/vasospastic angina

A

CCB for prevention, nitroglycerin for abortive

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21
Q

AD disorder, aortic regurgitation, aortic dissection, pneumothorax, eye abnormalities

A

marfan syndrome

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22
Q

*** how is uremic cause of pericarditis different than others?

A

does not typically cause diffuse ST elevation

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23
Q

4 tx for COPD exacerbation

A

Oxygen
Inhaled bronchodilators
Systemic glucocorticoids
Antibiotics

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24
Q

EKG finding indicative of LVH

A

increased QRS complex voltage

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25
Q

use of ambulatory blood pressure monitoring

A

when you suspect elevated BP based on clinical findings/symptoms (end organ damage - retionopathy, LVH, AMS) but normal BP in office

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26
Q

when holter monitor

A

patients with palpitations, syncope, prescynope

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27
Q

vision changes but no neurological symptoms - focal weakness, facial droop, visual field defects

A

more likely 2/2 HTN, rather than brain ischmia

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28
Q

cardiac manifestation of lyme disease

A

AV block

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29
Q

cough, large-volume mucopurulent sputum production, hemoptysis, dyspnea

A

bronchiectasis

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30
Q

diagnostic test for bronchiestasis

A

high-resolution CT

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31
Q

*** young pt with back pain, worst at night, elevated ESR, improvement with NSAID

A

ankylosing spondylitis

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32
Q

can someone with AS have restrictive pattern on PFTs due to limited chest expansion and spinal mobility

A

YES

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33
Q

what anticoagulants to avoid in someone with impaired kidney function?

A

LMWH (enoxaparin)
Fondaparinux (injection Xa inhibitor)
Rivaroxaban (xa inhibitor)

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34
Q

*** what IS safe for anti-coagulation in kidney disease?

A

UNfractionated heparin = UN-tainted and safe for kidneys

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35
Q

can you monitor anti-coagulation with unfractionated heparin?

A

YES, with aPTT (therapeutic = 1.5-2 times normal)

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36
Q

*** what estimated GFR indicates severe renal insufficiency?

A

< 30

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37
Q

of the obstructive diseases, which have low DLCO?

A

emphysema

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38
Q

can PEs cause pleural effusions?

A

yes - typically small, exudative and bloody

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39
Q

*** restrictive PFTs but normal DLCO

A

chest wall issue

40
Q

*** pre-excitation of the ventricles via an abnormal bypass tract

A

WpW

41
Q

can WPW put pt at risk of re-entrant SVT?

A

yep

42
Q

3 acute complications of cocaine use

A

MI
Aortic dissection
Intracranial hemorrhage

43
Q

*** tx of acute cocaine toxicity and myocardial ischemia

A

O2 and IV benzos

44
Q

bug of CAP

A

s. pneumo

45
Q

bug of HAP

A

p. aeruginosa

46
Q

*** ipratropium MOA

A

anti-muscarinic/anti-cholinergic - mainstay of COPD management

47
Q

how is low tidal volume ventilation lung protective?

A

prevents over-distension of alveoli and resultant baratrauma and IMPROVES mortality in ARDs patients

48
Q

how does inhibition of CYP450 affect warfarin?

A

INCREASES effect by blocking metabolism

49
Q

what rx’s can INCREASE effect of warfarin?

A

NSAIDS, acetaminophen, omeprazole, SSRIs, amiodarone, and more

50
Q

pt comes in with CP and you suspect MI but cardiac enzymes are not yet positive, while waiting to repeat pt becomes unresponsive and develops arrhythmia - most likely arrhythmia? what do you do?

A

v fib, defibrillate

51
Q

what two rhythms should be defibrillated?

A

V fib or pulseless v tachy

52
Q

when is mag sulfate used for heart stuff

A

Torsades

53
Q

what to do for pt with hemodynamic instability and narrow or wide QRS complex tachyarrhthmia

A

synchronized cardio-version

54
Q

what are some narrow or wide QRS complex tachyarrhythmias?

A

a fib, a flutter, VT with a pulse

55
Q

can addition of amiodarone, verapamil, quinidine, or propafenone increase serum level of digoxin and contribute to digoxin toxicity?

A

yep

56
Q

are anorexia, N/V, abdominal pain, weakness, and color vision changes signs of digoxin toxicity?

A

yep

57
Q

*** sick sinus syndrome

A

inability of SA node to generate adequate HR; age-related degeneration of cardiac conduction system , fibrosis of SA node

58
Q

*** what to do for sick sinus syndrome?

A

pacemaker

59
Q

aberrant conduction pathway

A

WpW

60
Q

3 EKG changes seen in WpW

A

short PR interval
widened QRS interval
slurred upstroke of QRS

61
Q

how to manage HOCM

A

avoid volume depletion
BBs/CCBs
sx if persistent

62
Q

*** initial monotherapy for HOCM

A

metoprolol or atenolol

63
Q

causes of constrictive pericarditis

A 
idiopathic pericarditis
viral pericarditis 
cardiac sx
radiation tx
TB pericarditis
64
Q

hx of cancer tx and new heart failure

A

constrictive pericarditis 2/2 radiation tx

65
Q

pt has CP and lightheadedness and EKG shows narrow complex tachycardia consistent with SVT - how do we determine type?

A

need to slow HR to reveal morphology of rhythm, vagal maneuver or give adenosine

66
Q

list 3 vagal maneuvres

A

eyeball pressure, carotid sinus massage, valsalva

67
Q

3 general types of tachy

A

sinus
narrow complex (<120 msec)
wide complex

68
Q

*** can hypokalemia result of beta agonist like albuterol?

A

yes

69
Q

can anaphylaxis result in hypotension, poor organ perfusion, upper airway edema?

A

yes

70
Q

what is fourth heart sound due to?

A

blood hitting a stiff ventricle

71
Q

is a fourth heart sound normal in older adults?

A

yes, stiffening of heart muscle is normal

72
Q

when is S4 abnormal?

A

younger, ventricular hypertrophy, acute MI

73
Q

what causes S3?

A

lots of blood volume filling ventricles

74
Q

what sound is associated with HF?

A

S3

75
Q

what sound is associated with acute MI?

A

S4

76
Q

*** smoking induced emphysema results in destruction of ________

A

upper lobes = centriacinar emphysem of smoking

77
Q

*** lower lobe destruction is seen in panacinar emphysema of _______

A

AAT deficiency = lower lobes = panacinar emphysema

78
Q

latin america, protozoal disease, megacolon, megaesophagus, cardiac disease

A

Chagas with Trypanosoma

79
Q

how can supplemental oxygen increase hypercapnia in COPD?

A

increased dead space perfusion causing CQ mismatch
decreased affinity of oxyhemoglobin for CO2
reduced alveolar ventilation

80
Q

*** how do cerebral vessels respond to high levels of CO2?

A

with increase of CO2, cerebral vessels vasodilate - risk of SEIZURES

81
Q

should you use a CXR to rule out PE?

A

Nope - nonspecific

82
Q

*** what is long-term tx for asthma

A

ICS

83
Q

long-term tx for COPD

A

LAMA (anti-muscarinin/anti-cholinergic - ipratropium)

84
Q

complication of infective endocarditis which can result in conduction abnormalities

A

perivalvular abscess

85
Q

drug user with new murmur and heart block

A

perivalvular abscess

86
Q

murmur associated with TV endocarditis

A

holosystolic murmur of TR that becomes accentuated with inspriation

87
Q

common causes of aortic regurgitation

A

congenital bicuspid aortic valve
post inflammatory (rheumatic, endocarditis)
aortic root dilation (marfaan, syphillis)

88
Q

diastolic decrescendo murmur, left sternal border, louder with leaning forward, widened pulse pressure, warter-hammer pulsation, pistol shot femoral pulses

A

AR

89
Q

*** 3 things that can cause pulsus paradoxus ( > 10 change in SBP with inspiration)

A

asthma
COPD
tamponade

90
Q

fibromuscular dysplasia results in stenosis of the ___ and ___ arteries

A

fibromuscular dysplasia = renal artery and internal carotid artery stenosis

91
Q

*** internal carotid artery stenosis manifestation in fibromuscular dysplasia

A

recurrent HA
pulsatile tinnitus
transient ischemic attack
stroke

92
Q

*** renal artery stenosis manifestation in fibromuscular dysplasia:

A

secondary HTN

flank pain

93
Q

Two bruits heard on exam of patient with fibromuscular dysplasia

A

subauricular systolic bruit

abdominal bruit

94
Q

*** secondary hypertension, hypokalmeia, metabolic alkalosis

A

primary hyperaldosteronism

95
Q

*** what are the markers of empyema and complicated pleural effusion

A

effusion with low ph (<7.2) and glucose (<60)

96
Q

how to manage empyema and complicated pleural effusion

A

drainage + abx

IM (17 decks)

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