Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine > Pulmonary and Cardio Treatments > Flashcards

Pulmonary and Cardio Treatments Flashcards

1
Q

PE treatment

A

Provoked DVT of calf or upper extremity: 3 months of anticoagulation
Provoked DVT of proximal leg: 6 months of anticoagulation
Unprovoked, malgnancy or antiphospholipid: indefinite
IVC filter: prevents recurrent PE, during active bleeding or other contraindication

Primary: clot dissolution with thrombolysis or surgical removal reserved for those with high risk of adverse outcomes: RHF or hypotension

Secondary: Anticoagulation-unfractionated heparin (must be monitered every 4-6 hrs) right away
subcutaneous LMWH (enoxaprin or tinzaparin) or direct factor Xa inhibitor (fondaparinux)
Warfarin-overlapped with UFH or LMWH for 5 days-INR goal of 2.5 for 2 consecutive days
Duration of treatment relates to risk of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PE imaging choice

A

chest CT with intravenous contrast

CT contraindicated (renal insufficiency or contrast allergy)-use V/Q scan

Both negative but still have a suspicion=lower extremity ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hemodynamically unstable patient in A. Fib

A

Meaning shock or hypotension symptoms
Urgent direct cardioversion
Electrical better than pharmocological

Pharm if electrical failed: procainamide, flecainide, sotalol or amiordarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hemodynamically stable patient in A. fib

A

Ventricular rate control-IV Beta blockers, CCBs or digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Persistently symptomatic A. fib

A

electrical cardioversion with 3 to 4 weeks of anticoagulation prior to and after cardioversion

Goal INR or 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Wolf Parkinson Wright Diagnosis and treatment

A

Diagnosis: narrow complex tachycardia, short PR interval, delta wave

Treatment: procainamide, quinidine or amiordarone
Radiofrequency catheter ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

drugs to avoid in wolf parkinson wright syndrome

A

Beta blockers
Verapamil
Other AV nodal blockers

May paradoxically increase the ventricular rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Best initial test for all forms of chest pain

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of Angina

A

Mild (normal EF,, mild angina, single vessel disease)
Nitrates and B blockers

Moderate (normal EF, moderate angina, two vessel disease)
Try nitrates and B blockers
consider coronary angiography to assess suitability for revascularization-PCI or CABG

Severe (decreased EF, severe angina, and three vessel/LAD)
Coronary angiography and consider CABG-decrease symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of unstable angina

A 
Acute
Aspirin +Clopidogrel-9-12 mos
BB blockers
Enoxaparin (LMWH)-2 days
Nitrates
Oxygen
Abciximab, tirofiban

After acute
Continue aspirin, B blockers, and nitrates
Reduce smoking, weight, diabetes, HTN, hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment of cardiac tamponade

A

relief of pericardial pressure either echocardiographically guided pericardiocentesis or surgical pericardial window

While waiting treat with IV fluids (cardiac tamponade is preload dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of constrictive pericariditis

A

Resection of pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of acute MI

A 
Aspirin/heparin
Beta blockers
Nitrates 
morphine 
supplemental O2

ST segment elevation-thrombolytics within 1-3 hours
PCI perferred within 90 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when to use angioplasty in acute MI

A 
less than 1 hour
Contraindication to lytic therapy-major recent surgery active internal bleeding, or suspected acortic dissection, severe hypertension, or a prior history of hemorrhagic stroke 
Cardiogenic shock
Refractory ventricular arrythmia
large infract size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of COPD

A

Most importantly smoking cessation

B2 agonists for symptomatic relief
Anticholinergic (ipratropium bromide)-longer acting
Both together work better than separate

Inhaled corticosteroids (budesonide, fluticasone)-significant symptoms or repeated exacerbations

Systemic Corticosteroids and antibiotics (azithromycin/levofloxacin) for acute exacerbations, change in sputum, or increased SOB (IV methylpredinsolone)
Possible noninvasive positive pressure ventilation may be necessary

Theophylline if unresponsive to everything else

O2-imporves survival and QOL of those with COPD and chronic hypoxemia (pO2 55%)

Flu vaccine annually
Strep pnemo vaccine every 5-6 yrs if >65 or have severe disease

intubation Acute respiratory acidosis and CO2 retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of asthma

A 
Inhaled B2 agonists for acute attacks
Long acting (salmeterol)-nighttime and exercise induced

Inhaled corticosteroids for moderate to severe asthma

Montelukast-prophylaxis of mild exercise induced and moderate persistent asthma

Cromolyn sodium/nedocromil sodium-prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of acute exacerbation of asthma requiring hospital admission

A

Inhaled B2 agonist with ipratropium-first line

Corticosteroids-IV or orally

IV Mg- if not responsive to other therapies

Antiobiotics

Endotracheal intubation if in respiratory failure-hypercapnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment of Bronchiectasis

A

antiobiotics for acute exacerbations

Hydration
Chest physiotherapy-postural drainage, chest percussion

Inhaled bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of CF

A 
pancreatic enzyme replacement
Fat soluble vitamin supplements
Chest physical therapy
Vaccinations-influenza and pneumococcal 
Antibiotics
Inhaled recombinant human deoxyribonuclease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of pleural effusions

A

Transudative (CHF, cirrhosis, nephrotic syndrome)
Diuretics and sodium restriction
Therapeutic thorancentesis if causing dyspnea

Exudative: treat underlying disease
Thorancentesis

Pleural effusion with pneumonia
Antibiotics
Complicated or empyema: chest tube drainage, intrapleural injection of thromboytic agents, surgical lysis of adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment of empyema

A

aggressive drainage of the pleura sometimes repetitive

If severe and persistent rib resection and open drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of pneumothorax

A

Primary spontaneous
small and asymptomatic: observation or one way valve chest tube

Large or patient is symptomatic: supplemental O2
Chest tube

Secondary complicated pneumothoraxx
chest tube drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of tension pneumothorax

A

medical emergency-do not obtain CXR

Chest decompression with large bore needle (2nd or 3rd intercostal space in MCL)
Followed by chest tube placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sarcoidosis treatment

A

Systemic corticosteroids

Methotrexate for those refractory to corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Wegener’s granulomatosis treatment

A

immunosuppressive agents and glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

churg-strauss syndrome treatment

A

glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of berylliosis

A

glucocorticoid therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment of Goodpastures syndrome

A

Plasmapharesis, cyclophosphamide, and corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment of idiopathic pulmonary fibrosis

A

Most do not respond to anything
Supplemental O2
Corticosteroids with or without cyclophosphamide
lung transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hypercarbic respiratory failure treatment

A

High flow venturi mask preferred because one can control oxygenation more precisely

NPPV given to patients in impending respiratory failure in an attempt to avoid intubation and mechanical ventilation -patient should be neurologically intact, awake and cooperative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Treatment of ARDS

A

O2 saturation above 90%-FiO2 levels of 50-60% are desirable
Mechanical ventilation with PEEP

Vasopressors to maintain BP

Tube feedings preferred over parenteral nutrition

32
Q

Treatment of primary pulmonary hypertension

A

IV prostacyclines (epoprostenol) and CCBs
Possible vasodilators ( inhaled NO, IV adenosine, oral CCB)
Anticoagulation with warfarin
Lung transplantation
Bosentan

33
Q

Diagnosis and treatment of MI

A 
Diagnosis:
ECG: peaked T waves-early, 
ST segment elevation: transmural
 q waves-late, T wave inversion, 
ST segment depression (subendocardial injury)

Cardiac enzymes: gold standard for Myocardial injury
Troponins: increases 3-5 hours and returns to nromal in 5-14 days, reaches peak in 24-48 hours
Get on admission and every 8 hours for 24 hrs
Ck-MB: increases within 4-8 horus and retursn to normal in 48-72 hours

Treatment: 
Supplemental O2 
Aspirin-reduces mortality
B-blockers-reduce mortality and remodeling (carvedilol for post MI LV dysfunction) 
ACE inhibs: reduce mortality (ramipril) 
Statins-atorvastatin
Nitrates (IV if persistent pain, hypertension, or HF)
Morphine
IV Heparin-enoxaparin (LMWH)

Revascularization
thrombolytics-up to 24 hours after onset best within 6 hrs (altepase)
PCI-within 90 minutes
CABG: if mechanical complications, cardiogenic shock, life threatening v. fib, after failure of PCI

Stress test before discharge to determine need for CABG

Clopidiogrel-especially after PCI with stent

Cardiac rehab: physician supervised regmien of exercise and risk factor reduction-reduce symptoms and prolong survival

34
Q

Contraindications to thrombolytic therapy

A 
recent head trauma or traumatic CPR
Previous stroke
Recent invasive procedure or surgery
Dissecting aortic aneurysm 
Active bleeding or bleeding diathesis
35
Q

Papillary muscle rupture treatmetn

A

Mitral regurgitation produced
Mitral valve replacement surgery
Afterload reduction: sodium nitroprusside or intraarotic balloon pump

36
Q

Treatment of dressler’s syndrome

A

aspirin and maybe ibuprofen

37
Q

Diagnosis and treatment of CHF

A

Diagnosis:
CXR: Cardiomegaly, Kerley B lines, pleural effusion, prominent interstitial markings

ECHO: Initial test of choice
systolic dysfunction-EF less than 40%, chamber dilation and/or hypertrophy

BNP

ECG: no specific changes

Radionucleotide ventriuclography using technetium-99m:

Cardiac catherization if CAD could be cause of CHF

stress testing

Treatment:
(standard)
Systolic dysfunction: lifestyle modification-sodium restriction, weight loss, smoking cessation, restrict alcohol, exercise, monitor weight, annual flu and pneumoccoal vaccine recommended
Diuretics-(furosemide and spironolactone-reduces mortality in advanced CHF)-symptomatic
ACE inhibs or ARBs-reduce mortality
B-Blockers: reduce mortality post MI-metoprolol, bisoprolol and carvediolol

(additional consdiersations)
Digitalis-EF less than 40% -sypmtomatic for dyspnea
Hydralazine adn isosorbide dinitrates: can’t tolerate ACE inhibs

ICD lowers mortality by preventing sudden cardiac death-40 dyas post MI, EF less than 35%, class II or III
Cardiac resyndchonization therapy-lowers mortality-40 dyas post MI, EF less than 35%, class II or III and lon QRS (>120)
38
Q

Contraindicated medications in CHF

A

Metformin-lactic acidosis
Thiazolidinediones: fluid retention
NSAIDs: increase risk of exacerbation
Anitarrhthmics that have negative inotropic effects

39
Q

Diastolic dysfunction CHF treatment

A

B blockers and diuretics

40
Q

Treatment of acute decompensated heart failure

A

Oxygenation and ventilatory assistance with non-rebreather face mask, NPPV, or event intubation
Diuretics: IMPORTANT
Dietary sodium restriction
Nitrates (IV)
Dobutamine if nothing else works with pulmonary edema

41
Q

Diagnosis and treatment of PACs

A

Diagnosis: early P waves that differ in morphology from other P waves

Treatment: Asymptomatic or B blockers if palpitations

42
Q

Diagnosis and treatment of PVCs

A

wide QRS with P wave not seen

Treatment: asymptomatic: observation
Symptomatic: B blockers

Underlying heart disorder may require ICD

43
Q

Indications for cardioversion vs. defibrillation vs Automatic implantable defibrillator

A

cardioversion: A fib, a flutter, VT with a pulse, SVT
Defib: V Fib, FT without a pulse
AID: V fib and VT not controlled by medical therapy

44
Q

Diagnosis and treatment of A. Fib (A flutter)

A

Diagnosis: EKG-irregularly irregular rhythym with no P waves

treatment:
hemodynamically unstable-cardioversion

Hemodynamically stable:
Rate control-B blockers
Cardioversion-worsening symptoms or first ever (electrical over pharmacological-procainamide, flecainide, sotalol, amiordarone)
Anticoagulation: A fib greater than 48 horus-3 weeks before cardioversion and 4 weeks after or TEE with no thrombus and only 24 hours of IV heparin and 4 weeks after

Chronic A Fib
B blocker
Anticoag: warfarin if over 60 or with other heart abnormalitites

45
Q

Diagnosis and treatment of MAT

A

Diagnosis: variable P wave morphology and variable PR and RR intervals

Treatmetn: improve oxygenation and ventilation
LV function preserved: CCBs, BBs, digoxin, amiordarone, IV flecainide, IV propafenone,
LV function not preserved: digoxin, diliatizem, or amiordarone

46
Q

Diagnosis, causes and treatment/prevention of paraoxysmal SVT

A

Causes: digoxin toxicity, caffeine and alcohol

Treatment: valsalva maneuver, carotid sinus massage, breath holding, head immersion in cold water

IV adenosine-agent of choice
IV verampil and IV esmolol or digoxin if LV function preserved
DC cardioversion if drugs not effective or if unstable

Prevention:
Digoxin-drug of choice
Vearpamil or B blockers alternative
Radiofrequency catheter ablation if symptomatic or recurrent

47
Q

Diagnosis and treatment of V tach

A

Diagnosis: wide and bizarre QRS complexes

Treatment:
Sustained
Hemodynamically stable and mild symptoms and systolic BP>90=IV amiodarone, IV procanamide, IV Sotalol

Hemodynamically unstable or severe symptoms:
Immediate cardioversion followed with IV amiodarone

All should get ICD unless EF is normal

Nonsustained
No underlying heart disease and asymptomatic: do not treat

Symptomatic, underlying heart disease or inducible: ICD placement
Amiodarone second line

48
Q

Diagnosis and treatment of V Fib

A

Diagnosis: no atrial P waves, No QRS complexes

Treatment:
Immediate defibrillation and CPR are indicated
Cardoversion immediately, CPR in interim

If VF persists:
Continue CPR
Intubation
Epinephrine every 3-5 minutes
Attempt to defibrillate again 30-60 secs after epi
Can also try amiodarone followed by shock

If successful
IV infusion of amiadarone
Implantable Defibrillatiors for chronic therapy

49
Q

Indications ofr cardiac pacemakers

A

Sinus node dysfunction (sick sinus syndrome)
Symptomatic heart block-Mobitz type II and complete heart block
Symptomatic bradyarrhythmias
Tachyarrthymias to interupt rhythm disturbances

50
Q

Causes, diagnosis and treatment of dilated cardiomyopathy

A

Causes: acohol, doxorubicin, adriamycin, CAD, thiamine or selenium deficiency, thryoid, chagas, lyme, SLE, scelroderma, cocaine

Diagnosis: signs of R. and L HF
Cardiomegaly
S3, S4 mitral and tricuspid regurgitation
Atrial or ventricular arrhythmia
EKG, CXR and ECHO consistent with CHF

Treatment:
Similar to CHF: digoxin, diuretics, vasodilators, cardiac transplantation
Anticoagulation

51
Q

Diagnosis and treatment of hypertrophic cardiomyopathy

A

Increased murmur on Valsalva and standing
Decreased murmur on squatting, handgrip, lying down or straight leg raise

ECHO establishes diagnosis

Treatment: None for asymptomatic
Sympotomatic: B Blockers
Diruetics if fluid retention
Possible A fib treatmetn

surgery: myometcomy-excision of part of myocardial septum

Avoid strenuous exercise

52
Q

Diagnosis and treatment of restrictive cardiomyopathy

A

Diagnosis:
ECHO: thickened myocardium and possible systolic ventricular dysfunction
Increased R. atrium and L. atrium size with normal LV and RV size
Amyloidosis has brighter or sparkled appearance
ECG: low voltages or conduction abnormalities, arrhytmias, a Fib
Endomyocardial biopsy may be diagnostic

Treatment:
Treat underlying disease
Give digoxin if systolic dysfunction if present (except in amyloidosis)

53
Q

Diagnosis and treatment of acute pericarditis

A

Diagnosis: EKG-diffuse ST elevation and PR depression
T wave inverts
ECHO if pericardial effusion suspected

Treatment:
Can be self limited within 2-6 weeks
NSAIDs and colcichine
Admit if fever, leukocytosis and worrisome features such as pericardial effusion present

54
Q

Constrictive pericarditis diagnosis and treatment

A

Diagnosis:
Fibrous scarring of the pericardium
JVD-prominent x and y descents
Kussmaul’s sign: JVD fails to decrease during inspiration
Pericardial knock: abrupt cessation of ventricular filling

EKG: low QRS voltages, generalized T wave flattening, left atrial abnormalities (a. fib)
ECHO: increased pericardial thickness, sharp halt in ventricular diastolic filling and atrial enlargement
CT scan and MRI: pericardial thickening and calcificatiotns
Cath: elevated and equal diastolic pressures in all chambers
Ventricular pressure tracer: rapid y descent

Treatment:
Diuretics
Treat underlying condition
Possible pericardiectomy

55
Q

Pericardial effusion diagnosis and treatment

A

Diagnosis:
ECHO-imaging procedure of choice-performed in all patients with acute pericarditis to rule out effusion
CXR-enlargment of cardiac silhouette when >250 mL of fluid has accumulated (an enlarged heart with no pulmonary vascular congestion)
EKG: low QRS voltages, and T wave flattening, electrical alternans
Pericardial fluid analysis

Treatment:
Pericardiocentesis not indicated unless evidence of cardiac tamponade
if small and clinically insignificant repeat echo in 1-2 weeks

56
Q

Cardiac tamponade diagnosis and treatment

A

Diagnosis:
Ventricular filling is impaired during all of diastole
Pressures in RV, LV, RA, LA, pulmonary artery and pericardium equalize during diastole
Beck’s triad: hypotension, JVD, and muffled heart sounds
Prominent x descent with absent y descent
Pulsus paradoxus-decrease in arterial pressure during inspiration (greater than 10 mm Hg drop)

ECHO: diagnosis of choice
CXR: enlargement of cardiac silhouette when >250 mL has accumulated, clear lung fields
EKG: electrical alternans
Cath: equalization of all chamber pressures, increased RAP with loss of y descent

Treatment:
nonhemorrhagic tamponade:
Hemodynamically stable-ECHO, CXR, ECG monitoring
Renal failure-dialysis
Not hemodynamically stable: pericardiocentesis indicated, no change then fluid challenge may improve symptoms
Hemorrhagic tamponade-emergent surgery do not delay with pericardiocentesis

57
Q

Diagnosis and treatment of mitral stenosis

A

Opening snap followed by diastolic rumble
loud s1
Heard best with bell in left lateral decubitus position

Diagnosis:
CXR: left atrial enlargement
ECHO: left atrial enlargement
Thick, calcified mitral valve
Narrow fish mouth shaped orifice

Treatment:
Diuretics-for pulmonary congestion and edema
B-blockers: decrease heart rate and cardiac output
Infective endocarditis prophylaxis
Chronic anticoagulation with warfarin

surgery: percutaneous balloon valvuloplasty

58
Q

Aortic stenosis diagnosis and treatment

A

Diagnosis:
crescendo-decrescendo systolic murmur, heard in right intercostal space, radiates to carotid arteries
soft S2 and maybe single
S4
Parvus et tardus-diminished and delayed carotid upstrokes
Sustained PMI

CXR: calcific aortic valve, enlarged LV/LA
EKG: LVH, LA abnormality
ECHO: diagnostic-thickened, immobile aortic valve and dilated aortic root
Cath: definitive-measures valve area (less than .8 cm indicates severe stenosis) useful before surgery

Treatment: aortic valve replacement if symptomatic

59
Q

Aortic Regurgitation diagnosis and treatment

A

Diagnosis: palpitations worse when lying on left side, head bobbing, uvula bobbing, pistol shot sound heard over femoral arteries
Cyanosis and shock in acute AR
Widened pulse pressure
Diastolic decrescendo murmur best heard at left sternal border
Water hammer pulse-wrist and femoral arteries
Displaced PMI, S3

CXR: LVH, dilated aorta
ECG: LVH
ECHO: assess LV size and function, dilated aortic root and reversal of blood flow in aorta
Cath: to assess severity and degree of LV dysfunction

Treatment
Asymptomatic: salt restrictiotn, diuretics, vasodilators, digoxin, afterload reduction (ACE inhibs, or arterial dilators) and restriction on strenuoues activity
Symptomatic: aortic valve replacement-significant LV dysfunction on ECHO
Endocarditis prophylaxis before dental and GI/genitourinary procedures

60
Q

Diagnosis and treatment of tricuspid regurgitation

A

Diagnosis:
Asymptomatic unless development of RHF/pulmonary HTN
Pulsatile liver
Prominent V waves in jugular venous pulse with rapid y descent
Blowing holosystolic murmur at LLSB
A fib

ECHO: measures pulmonary pressures and extent of TR
ECG: RA and RV enlargement

Treatment:
Diuretics for volume overload and venous congestion/edema
Treat underlying disease
Surgery if there is no pulmonary HTN-native valve repair or valvuloplasty of tricuspid ring

61
Q

Mitral Valve prolapse diagnosis and treatment

A

Diagnosis:
midsystolic or late systolic clicks
Mid to late systolic murmur
Increases with valsalva and standing, decreases with squatting

ECHO

Treatment:
Asymptomatic: reassurance
Chest pain: B blockers
Generally benign

62
Q

Rheumatic heart disease diagnosis and treatment

A 
Diagnosis: JONES
Migratory polyarthrtis
Cardiac involvement-pericarditis, CHF, valve disease
Nodules
Erythema marginatum
Sydenham's chorea

Fever, increased ESR, polyarthralgias, prior history of rheumatic fever, prolonged PR interval, previous strep. infection

Treatment:
treat with strep pharyngitis-penicillin or erythromycin
Acute RF treated with NSAIDs-monitored by CRP
Patient with a history of RF should receive prophylactic erythromycin and amoxicillin for dental/GI/genitourinary procedures

63
Q

Infective endocarditis diagnosis and treatment

A

Diagnosis:
Major:
Sustained bacteremia by organism known to cause endocarditis
Endocardial involvement: TRANSESOPHAGEAL echo-vegetation, abscess, valve perforation, prosthetic dihiscence,
New valvular regurgitation

Minor:
Predisposing condition
Fever
Vascular phenomena-arterial or pulmonary emboli, intracranial hemorrhages, janway lesions
Immune phenomena-osler nodes, Roth spots, glomerulonephritis, RF
Positive blood cultures
Positive echo

Treatment:
parenteral antiobiotics depending on organism for 4-6 weeks
Cultures negative but high suspicision-treat empirically with penicillin (or vanco) plus an aminoglycoside
prophylactic amoxicllin before oral, GI or GU surgery

64
Q

Location of Libman-Sacks endocarditis

A

Aortic valve on both sides

65
Q

Diagnosis and treatment of hypertensive emergency

A

Systolic BP greater than 220 and/or diastolic BP>120 in addition to end-organ damage-immediate treatment indicated
Without end organ damage=urgency

End organ damage
Eyes: papilledema
CNS: altered mental status or intracranial hemorrhage
hypertensive encephalopathy
Kidneys: renal failure, hematuria
Heart: unstable angina, MI, CHF with pulmonary edema, aortic dissection
Lungs: pulmonary edema

Treatment:
Lower BP by 25% in 1-2 hours
Severe (diastolic pressure >130) or hypertensive encephalopathhy-IV hydralzine, esmolol, nitroprusside, labetaolol, or nitroglycerin
Less immediate danger-oral captopril, clonidine, labetalol, nifedipine and diazoxide
Urgency: BP lowered within 24 hours using oral agents
Then perfrom CT to rule out intracranial hemorrhage and then LP if no bleeding
Urgency

66
Q

Long term prophylaxis for COPD

A

Anticholinergic not corticosteroids

67
Q

Diagnosis of ventricular aneurysm

A

5-3 months post no
Persistent ST elevation and deep Q waves
Echo

68
Q

Diagnosis and treatment of aortic dissection

A

Diagnosis: CXR shows widened mediastinum
TEE has high sensitivity and specificity-can be performed acutely at bedside
CT or MRI are both accurate

Treatment: IV B Blockers and IV sodium nitroprusside
Type A: surgical management to prevent MI, aortic regurgitation and cardiac tamponade
Type B: Lower BP with IV B blockers-labetalol, esmolol or propanolol
Pain control with morphine or dilaudid

69
Q

Diagnosis and treatment of abdominal aneurysm

A

Diagnosis
palpable pulsatile abdominal mass on physical exam
Ultrasound-test of choice
CT scan-preoperative planning

Treatment:
Aneurysm is >5 cm diameter or symptomatic: surgical resection wiht synthetic graft placement
Aneurysm less than 5 cm than periodic imaging is indicated
Ruptured AAA: emergency surgical repair

70
Q

Peripheral Vascular disease diagnosis and treatment

A 
Diagnosis: ankle to brachial index
Normal ABI=.9-1.3
ABI > 1.3=noncompressible vessels and indicates severe disease
Claudication=ABI less than .7 
Rest pain =ABI is less than .4

pulse volume recordings:
Excellent assessment of segmental limb perfusion

Arteriography: gold standard (arteriogram)

Treatment:
Stop smoking 
Graduated exercise program
Atherosclerotic risk factor reduction
Avoid temperature extremes
Aspirin with ticlopidine/clopidogrel 
Cilostazol

Surgery:
indications: rest pain, ischemic ulcerations, severe symptoms refractory to conservative treatment
Angioplasty-first
Surgical bypass grafting

71
Q

Diagnosis and treatment of acute arterial occlusion

A

Pain, pallor, polar, paralysis, paresthesias, pulselessness
Diagnosis
Arteriogram,
ECG to look for MI, Afib
Echo-to look for clots, evaluate valves, MI

Treatment:
Assess viability of tissues to salvage the limb
Skeletal muscle can tolerate 6 hrs. of ischemia
Immediately anticoagulate with IV heparin
Emergent surgical embolectomy
Thrombolytics are possible

72
Q

Diagnosis and treatment of DVT

A

Diagnosis:
Doppler ultrasound
Venography-most accurate for calf veins
D-dimer has high sensitivity but low specificity

High/Intermediate pretest probability of DVT:
Doppler ultrasound +=begin antigcoagulation
Non diagnositic=repeat US every 2-3 days for up to 2 weeks

Low/intermeidated pretest probability
Doppler ultrasound negative-no need for anticoagulation
Repeat ultrasound in 2 days

Treatment
Anticoagulation: heparin bolus and titrated to maintain PTT at 1.5-2x the aPTT
Start warfarin and continue for 3-6 months once INR is 2-3 for 48 hours

Thrombolytics
indicated with massive PE, hemodynamically unstable, evidence of RHF, no contraindcations

Prophylactic IVC filter-high risk

73
Q

Diagnosis and treatment of cardiogenic shock

A 
Diagnosis
right atrial pressure: increased
O2 saturation: decreased
CO: decreased
SVR: increased
PCWP: increased
EKG: St elevation indicating MI or arrhytmia
ECHO: estimates EF
Hemodynamic monitoring: swan Ganz catheter 
Treatment:
MI treatment if indicated
Dopamine-initial drug used
dobutamine-further increases CO
NO fluids instead use diuretics 
intraaortic balloon pump possibly
74
Q

Diagnosis and treatment of hypovolemic shock

A 
Diagnosis:
Right atrial pressure: decreased
O2 saturation: decreased
CO: decreased
SVR: increased
PCWP: decreased
decreased central venous pressure
Central venous line or pulmonary artery catheter can help monitor

Treatment:
probably requires intuation and mechanical ventilation
IV hydartion
Crystalloid with appropriate electrolytes for hemorrhage

75
Q

Diagnosis and treatment of septic shock

A 
Diagnosis:
Right atrial pressure: decreased
O2 saturation: increased
CO: increased
SVR: decreased
PCWP: decreased
Blood cultures 
warm extremities 
EF decreased

Treatment:
broad spectrum antibiotics at max doses
Surgical drainage
Fluid adminstartion to increase mean BP-may not respond
Dopamine (first line) and NE (second line)

76
Q

Neurogenic shock diagnosis and treatment

A 
Diagnosis
Decreased CO
Decreased SVR
Decreased PCWP 
Warm extremities
Bradycardia
Treatment
IV fluids
Vasoconstrictors=cautiously
Supine or tranelenburg position
Maintain body temp
77
Q

SIRS criteria

A

fever >38 or hypothermia less than 36
Hyperventlation: rate >20 or PaCO2 less than 32
tachycardia >90
increased WBC count

Internal Medicine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions