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PANCE Practice > Review: Cardio, Resp, HEENT > Flashcards

Review: Cardio, Resp, HEENT Flashcards

1
Q

Risk factors for angina pectoris

A
  1. DM
  2. hyperlipidemia
  3. smoking
  4. HTN
  5. males
  6. age over 65
  7. hx of CAD
  8. obese
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2
Q

How do you dx angina pectoris/CAD

A
  1. ECG: ST depression w/ exertion, T wave inversion, poor R wave progression +/- normal
  2. Stress test
  3. Coronary angiography (gold standard)
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3
Q

When are radionuclid MPI stress tests used

A

pts w/ baseline EKG abnormalities, pts unable to exercise can do pharmoacologic

CI: asthmatics

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4
Q

Pharmacologic mangement of stable (chronic) angina

A
  1. Nitrates
  2. BB
  3. CCB
  4. ASA
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5
Q

Describe the cardiac markers used to dx AMI

A

CK/CK-MB: appears 4-6 hrs, peaks 12-24, returns to baseline in 3-4 days

troponin I and T: appears 4-8 hrs, peaks 12-24 hrs, returns to baseline 7-10 days ***most sensitive and specific

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6
Q

Med management of STEMI vs NSTEMI

A

STEMI: BB, NTG, ASA, heparin, ACEI, reperfusion tx**

NSTEMI: BB, NTG, ASA, heparin

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7
Q

management of cocaine induced MI

A

ASA, NTG, heparin, Anxiolytics (Benzos_

**AVOID BB due to risk of vasospasm (unopposed A1 constriction)

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8
Q

What do you do when you detect sx associated with ischemia or infarct?

A
  1. perform brief Hx and PE
    * *ASK ABOUT phosphodiesterase inhibitors in last 48 hrs
  2. obtain cardiac markers
  3. O2
  4. ASA (160-325mg)
  5. NTG (0.4mg sublingual or spray)
  6. Morphine IV
  7. EKG w/in 10 min
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9
Q

w/ ___ MI use IV nitrates and morphine w/ caution bc if may cause unsafe drop in BP

A

RV (inferior wall) MI

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10
Q

Tx of Prinzmetal angina

A

CCB, nitrates prn

*may give ASA and heparin until atherosclerotic disease is ruled out

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11
Q

When/How do you use the TIMI score?

A

assess risk of death and ischemic event sin pts w/ U A or NSTEMI (1 point for each)

  1. age 65 or older
  2. 3 or more CAD RF (Fhx, HTN, high Chol, smoker, DM)
  3. Known CAD (stenosis 50% or over)
  4. ASA use in past 7 days
  5. recent severe angina in past 24 hrs
  6. elevated cardiac markers
  7. ST elevation 0.5mm

scores of 3 or more are high risk

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12
Q

Tx for heart failure

A

at Least ACEI and diuretic

ACEI/ARB + diuretic + BB +/- spironlactone +/- digoxin unless Afib is first line tx

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13
Q

P’s of pericarditis

A

persistent, pleuritic, postural pain, and pericardial friction rub

*relieved when witting/leaning forward

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14
Q

Most common cause of percarditis

A
  1. viral (entero, coxsackie and echovirus)
  2. idiopathic (likely undx viral)
  3. Dressler’s syndrom (2-5 days s/p MI)
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15
Q

Tx of acute pericarditis

A
  1. NSAIDs or ASA for 7-14 days
    - Colchicine 2nd line management
  2. +/- corticosteroids if sx over 48 hrs and refraction
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16
Q

EKG of pericardial effusion

A
  1. low voltage QRS

2. electric alternans (short then tall QRS complexes)

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17
Q

What is becks triad

A

for pericardial tamponade

  1. distant (muffled) heart sounds
  2. increased JVD
  3. hypotension

*PT also has pulsus paradoxus

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18
Q

tx of pericardial tamponade and effusion

A

pericardiocentesis

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19
Q

Causes of aortic stenosis

A
  1. Degeneration if over 70**
  2. Congenital if less than 70y/o
  3. Rheumatic disease
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20
Q

Causes of mitral stenosis

A
  1. Rheumatic heart disease(MOST COMMON by far)

* seen w/ AFib and R-sided HF

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21
Q

Causes of aortic regurgitation

A
  1. Rheumatic dz, HTN
  2. endcarditis, marfan
  3. Syphilis
  4. Ankylosing spondylitis

*seen w L-sided HF

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22
Q

Causes of mitral regurgitation

A
  1. MVP (MOST COMMON)
  2. RHD, endocarditis
  3. Ischemia (ruptured papillary muscle/chordae tendinae s/p MI)
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23
Q

Causes of MVP

A
  1. most common in young women

2. Connective tissue dz (Marfan, Ehlers Danlos)

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24
Q

Causes of hypovolemic shock

A
  1. hemorrhage

2. fluid loss (vomiting, diarrhea, pancreatitis, severe burns)

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25
Q

Causes of cardiogenic shock

A
  1. MI
  2. myocarditis
  3. valve dz
  4. cardiomyopathy
  5. arrhythmias
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26
Q

Causes of obstructive shock

A
  1. pericardial tamponade
  2. massive PE
  3. tension PTX
  4. aortic dissection
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27
Q

Causes of distributive shock

A
  1. septic
  2. neurogenic
  3. anaphylaxis
  4. hypoadrenal

**CAUSES DECREASED SVR Unlike other shock categories

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28
Q

What is the anticoag therapy INR range for someone w. a mechanical heart valve and a mechanical AV replacement?

A

Mechanical heart valve replacement: 2.5-3.5

Mechanical AV replacement: 2.0-3.0

29
Q

What are the indications for a AAA repair?

A
  1. sx depites size
  2. larger than 5.5cm in diameter
  3. expansion greater than 0.5cm in 6 months
30
Q

What is the recommended management for someone with a ascending aortic dissection Standford Type A, and Type B

A

Type A: surgical emergency

Type B: if stable, conservative therapy and should be followed every 6 months w/ serial CT.

*Both Type A and B dissections benefit from IV BB and IV nitroprusside

31
Q

Presentation of cor pulmonale

A
  1. Long hx of tobaccos and hx of COPD– dyspnea
  2. Pulmonary arterial HTN
  3. RV overloading/heave
  4. hepatomegaly from bilateral peripheral edema
  5. peaked P waves with RVH
32
Q

What murmur?

Holosystolic heard beast at left sternal border and the intensity increase w/ inspiration

A

tricuspid regurgitation

33
Q 
What leads are involved in the following STEMIs:
Inferior:
Anterior: 
Lateral:
Posterior:
A

Inferior: II, III, aVF

Anterior: V2-V4

Lateral: V5, V6, aVL

Posterior: ST depression in V1-V3 w/ early R wave progression in V1-V3

34
Q

a nonatherosclerotic, inflammatory disease that occurs segmentally in small to medium sized arteries and veins of the extremities
-usualy less than 40y/o and associated w/ smoking

A

Thomboangiitis obliterans or Bruerger’s disease

35
Q

When would you get a transesophageal echo

A

sensitive for detecting valvular vegetations

*presents w/ new on set regurg. + petechiae

36
Q

how can you differentiate SVT and PCC on exam

A

PCC has severe HTN whereas SVT will not

*both have palpitations, diaphorteic, young, female, tachycardia

37
Q

What are the following CXR associated with:

  1. Boot-shaped heart=
  2. Egg-on-a-string=
  3. Snowman heart=
  4. Prominent LV silhouette=
  5. Rib notching=
A
  1. Boot-shaped heart= Tetralogy of Fallot
  2. Egg-on-a-string= Transposition of Great Vessels
  3. Snowman heart= TAPVR
  4. Prominent LV silhouette= Tricupsid atresia
  5. coarctation of the aorta
38
Q

What are the following associated w/

  1. Wide, fixed split S2
  2. Paradoxial split S2
A
  1. Wide, fixed split S2= ASD

2. Paradoxial split S2= LBBB (present on expiration and disappears on inspiration)

39
Q

orthostatic hypotension is defined as a drop in systolic BP of at lease ___ or a drop of diastolic BP of at least ___ within __ mins of standing from sitting position

A

20mmHg

10mmHg

3 min

40
Q

What med is used to control the ventricular rate during an acute event of rapid afib?

A

BB

*digoxin is no longer the drug of choice

41
Q

What drug class is the class of choice to treat life-threatening ventricular tachycardias or fibrillation

A

Class I c (Na+ blocker)

42
Q

What drug class most potently blocks Na channel current in the myocardium

43
Q

What is the mechanism by which cardiac tamponade impedes CO?

A

fluid fills pericardial space and compresses vena cava and decreases inflow of the blood to the ventricles = decreased preload

44
Q

What organism is likely to cause this presentation of pneumonia?

-presents after day sof constitutional sx and nonproductive cough, PE reddened throat and rarely myringitis

A

Mycoplasma pneumoniae

45
Q

How do you dx myocplasma pneumoniae

A

clinical grounds or cold agglutinins for comfirmatory

46
Q

What organism is likely to cause this presentation of pneumonia?

-abrupt onset of fever, cough (productive of rusty sputum), pleuritic CP
CXR: lobar consolidation

A

Strep. pneumoniae

47
Q

Tx of bronchitis

A

bronchodilators: albuterol HFA

* bed rest, acetaminophen, fluids for support

48
Q

What pneumonias are common ins alcoholic and in debilitated patients

A

Klebsiella pneumonia

  • gram neg
  • Cavitations seen on CXR
49
Q

What is the drug tx of choice for M. pneumoniae

A

Macrolides (erythromycin or tetracycline)

50
Q

What is the empiricial drug tx of choice for a known cause of CAP

A

Clarithromycin (Marcolide)

51
Q

What organism most commonly causes community aquired pyogenic bacterial pneumonia

A

Pneumococcus

52
Q

peripheral “pruning” of the large pulmonary arteries on CXR is characteristic of __

A

PHTN in severe emphysema

53
Q

What is the current tx of someone who is newly PPD positive

A
  • 6 months of isoniazid (INH) and rifampin (RIF)

- and additional 2 months of pyrazinamide (PZA) and ethambutol (EMB)

54
Q

What is the treatment of choice for immunocompromised pts w/ legionella infection

A

azithromycin or clarithromycin or fluoroquinolon such as levofloxacin

55
Q

What is the gold standard to dx DVT

A

contrast venography

*Doppler US is more commonly used though

56
Q

Describe the physiology with normal neonate cardiac transition

A
  1. Foramen ovale will close with the change of pressures with birth (left side of heart pressure so great, closes Foramen ovale)→ clamping of umbilical cord increases SVR
  2. 48 hours of age (O2 change stimulates closure):
    - PDA will begin to close from pulmonary artery side first (anatomically closing)
  3. 4-7 days of age:
    - PDA will close completely across (loosely, not fully fused/ligament yet)
  4. 4-6 weeks of age:
    - In pulmonary artery, lining thins out and get a decrease in PVR to that of the adult level
    - At this point infants have good pulmonary blood flow
57
Q

CHD w/ associated Genetic syndromes

A
  1. Down’s Syndrome (Trisomy 21): 50% have ASD, VSD, or AVSD
  2. Turner’s Syndrome: 20-40% have coarctation of the aorta
  3. Edward’s Syndrome (Trisomy 18): 99% have VSD
  4. Marfan’s Syndrome: 90% have MVP, aortic root ectasia (results in aortic regurgitation), predisposed to aortic dissection
58
Q

What is Ghent Nosology

A

associated w/ Marfan’s syndrome:

  1. Hypermobile joints
  2. Long upper extremities compared to lower
  3. Height much greater than genetic potential would predict
59
Q

What are the cyanotic heart lesions

A

5T’s and PH

  1. Transposition of great vessels
  2. truncus arteriosus
  3. tricuspid atresia
  4. tetrology of fallot
  5. total anomalous pulmonary venous return
  6. pulmonary atresia
  7. hypoplastic left heart
60
Q

What are acyantoic heart lesions

A
  1. PDA
  2. Critical aortic stenosis
  3. VSD, ASD
  4. Coarctation of the aorta
  5. Hypoplastic left heart
61
Q

What is virchows triad

A
  1. hypercoagulable state
  2. venous stasis
  3. endothelial injury

*prone to clot (PE)

62
Q

What is an aortic dissection

A

blood creates false lumen between intimal and adventital layers

63
Q

Sx and EKG of pericarditis

A

Sx: Worse when supine, relieved when leaning forward

EKG: diffuse, concave upward ST elevation and PR depression

64
Q

What people need Abx for bacterial endocarditis?

A
  1. prosthetic (artifical) valve
  2. heart repairs using prosthetic material
  3. prior hx of endocarditis
  4. CHD
65
Q

People that need Abx for bacterial endocarditis need it for what procedures

A
  1. dental
  2. respiratory: surgery on mucosa or rigid bronchosocpy
  3. procedures involving infected skin, MKS tissue (I and D)

Amoxicillin 2g, 30-60 min before procedure or clindamycin 600mg if pcn allergy

66
Q

Sx:

  1. HA*
  2. jaw claudication w/ mastication*
  3. acute vision disturbance/loss*
  4. constitutional sx (fatigue, wt loss, fever*, night sweats)
  5. thickened temporal artery (may be tender or pulseless)
  6. aortic aneurysm
  7. scalp tenderness*
A

Giant cell arteritis

67
Q

tx of giant cell arteritis

A

HD corticosteroids 40-60mg/d for 6 weeks

68
Q

What are the classes of antiarrhythmic drugs

A 
Class 1- Na+ blocker
Ia- quinidine, procainamide
Ib- lidocaine, phenytoin
Ic- flecainide, propafenone 
Class 2- BB
Class 3- K+ (amiodarone, sotalol)
Class 4- CCB (verapamil, diltiazem)

PANCE Practice (26 decks)

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