Review: Cardio, Resp, HEENT Flashcards
1
Q
Risk factors for angina pectoris
A
- DM
- hyperlipidemia
- smoking
- HTN
- males
- age over 65
- hx of CAD
- obese
2
Q
How do you dx angina pectoris/CAD
A
- ECG: ST depression w/ exertion, T wave inversion, poor R wave progression +/- normal
- Stress test
- Coronary angiography (gold standard)
3
Q
When are radionuclid MPI stress tests used
A
pts w/ baseline EKG abnormalities, pts unable to exercise can do pharmoacologic
CI: asthmatics
4
Q
Pharmacologic mangement of stable (chronic) angina
A
- Nitrates
- BB
- CCB
- ASA
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
6
Q
Med management of STEMI vs NSTEMI
A
STEMI: BB, NTG, ASA, heparin, ACEI, reperfusion tx**
NSTEMI: BB, NTG, ASA, heparin
7
Q
management of cocaine induced MI
A
ASA, NTG, heparin, Anxiolytics (Benzos_
**AVOID BB due to risk of vasospasm (unopposed A1 constriction)
8
Q
What do you do when you detect sx associated with ischemia or infarct?
A
- perform brief Hx and PE
* *ASK ABOUT phosphodiesterase inhibitors in last 48 hrs - obtain cardiac markers
- O2
- ASA (160-325mg)
- NTG (0.4mg sublingual or spray)
- Morphine IV
- EKG w/in 10 min
9
Q
w/ ___ MI use IV nitrates and morphine w/ caution bc if may cause unsafe drop in BP
A
RV (inferior wall) MI
10
Q
Tx of Prinzmetal angina
A
CCB, nitrates prn
*may give ASA and heparin until atherosclerotic disease is ruled out
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)
- age 65 or older
- 3 or more CAD RF (Fhx, HTN, high Chol, smoker, DM)
- Known CAD (stenosis 50% or over)
- ASA use in past 7 days
- recent severe angina in past 24 hrs
- elevated cardiac markers
- ST elevation 0.5mm
scores of 3 or more are high risk
12
Q
Tx for heart failure
A
at Least ACEI and diuretic
ACEI/ARB + diuretic + BB +/- spironlactone +/- digoxin unless Afib is first line tx
13
Q
P’s of pericarditis
A
persistent, pleuritic, postural pain, and pericardial friction rub
*relieved when witting/leaning forward
14
Q
Most common cause of percarditis
A
- viral (entero, coxsackie and echovirus)
- idiopathic (likely undx viral)
- Dressler’s syndrom (2-5 days s/p MI)
15
Q
Tx of acute pericarditis
A
- NSAIDs or ASA for 7-14 days
- Colchicine 2nd line management - +/- corticosteroids if sx over 48 hrs and refraction
16
Q
EKG of pericardial effusion
A
- low voltage QRS
2. electric alternans (short then tall QRS complexes)
17
Q
What is becks triad
A
for pericardial tamponade
- distant (muffled) heart sounds
- increased JVD
- hypotension
*PT also has pulsus paradoxus
18
Q
tx of pericardial tamponade and effusion
A
pericardiocentesis
19
Q
Causes of aortic stenosis
A
- Degeneration if over 70**
- Congenital if less than 70y/o
- Rheumatic disease
20
Q
Causes of mitral stenosis
A
- Rheumatic heart disease(MOST COMMON by far)
* seen w/ AFib and R-sided HF
21
Q
Causes of aortic regurgitation
A
- Rheumatic dz, HTN
- endcarditis, marfan
- Syphilis
- Ankylosing spondylitis
*seen w L-sided HF
22
Q
Causes of mitral regurgitation
A
- MVP (MOST COMMON)
- RHD, endocarditis
- Ischemia (ruptured papillary muscle/chordae tendinae s/p MI)
23
Q
Causes of MVP
A
- most common in young women
2. Connective tissue dz (Marfan, Ehlers Danlos)
24
Q
Causes of hypovolemic shock
A
- hemorrhage
2. fluid loss (vomiting, diarrhea, pancreatitis, severe burns)
25
Causes of cardiogenic shock
1. MI
2. myocarditis
3. valve dz
4. cardiomyopathy
5. arrhythmias
26
Causes of obstructive shock
1. pericardial tamponade
2. massive PE
3. tension PTX
4. aortic dissection
27
Causes of distributive shock
1. septic
2. neurogenic
3. anaphylaxis
4. hypoadrenal
**CAUSES DECREASED SVR Unlike other shock categories
28
What is the anticoag therapy INR range for someone w. a mechanical heart valve and a mechanical AV replacement?
Mechanical heart valve replacement: 2.5-3.5
Mechanical AV replacement: 2.0-3.0
29
What are the indications for a AAA repair?
1. sx depites size
2. larger than 5.5cm in diameter
3. expansion greater than 0.5cm in 6 months
30
What is the recommended management for someone with a ascending aortic dissection Standford Type A, and Type B
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
Presentation of cor pulmonale
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
What murmur?
| Holosystolic heard beast at left sternal border and the intensity increase w/ inspiration
tricuspid regurgitation
33
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What leads are involved in the following STEMIs:
Inferior:
Anterior:
Lateral:
Posterior:
```
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
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
Thomboangiitis obliterans or Bruerger's disease
35
When would you get a transesophageal echo
sensitive for detecting valvular vegetations
| *presents w/ new on set regurg. + petechiae
36
how can you differentiate SVT and PCC on exam
PCC has severe HTN whereas SVT will not
*both have palpitations, diaphorteic, young, female, tachycardia
37
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=
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
What are the following associated w/
1. Wide, fixed split S2
2. Paradoxial split S2
1. Wide, fixed split S2= ASD
| 2. Paradoxial split S2= LBBB (present on expiration and disappears on inspiration)
39
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
20mmHg
10mmHg
3 min
40
What med is used to control the ventricular rate during an acute event of rapid afib?
BB
*digoxin is no longer the drug of choice
41
What drug class is the class of choice to treat life-threatening ventricular tachycardias or fibrillation
Class I c (Na+ blocker)
42
What drug class most potently blocks Na channel current in the myocardium
Class Ic
43
What is the mechanism by which cardiac tamponade impedes CO?
fluid fills pericardial space and compresses vena cava and decreases inflow of the blood to the ventricles = decreased preload
44
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
Mycoplasma pneumoniae
45
How do you dx myocplasma pneumoniae
clinical grounds or cold agglutinins for comfirmatory
46
What organism is likely to cause this presentation of pneumonia?
-abrupt onset of fever, cough (productive of rusty sputum), pleuritic CP
CXR: lobar consolidation
Strep. pneumoniae
47
Tx of bronchitis
bronchodilators: albuterol HFA
| * bed rest, acetaminophen, fluids for support
48
What pneumonias are common ins alcoholic and in debilitated patients
Klebsiella pneumonia
* gram neg
* Cavitations seen on CXR
49
What is the drug tx of choice for M. pneumoniae
Macrolides (erythromycin or tetracycline)
50
What is the empiricial drug tx of choice for a known cause of CAP
Clarithromycin (Marcolide)
51
What organism most commonly causes community aquired pyogenic bacterial pneumonia
Pneumococcus
52
peripheral "pruning" of the large pulmonary arteries on CXR is characteristic of __
PHTN in severe emphysema
53
What is the current tx of someone who is newly PPD positive
- 6 months of isoniazid (INH) and rifampin (RIF)
| - and additional 2 months of pyrazinamide (PZA) and ethambutol (EMB)
54
What is the treatment of choice for immunocompromised pts w/ legionella infection
azithromycin or clarithromycin or fluoroquinolon such as levofloxacin
55
What is the gold standard to dx DVT
contrast venography
*Doppler US is more commonly used though
56
Describe the physiology with normal neonate cardiac transition
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
CHD w/ associated Genetic syndromes
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
What is Ghent Nosology
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
What are the cyanotic heart lesions
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
What are acyantoic heart lesions
1. PDA
2. Critical aortic stenosis
3. VSD, ASD
4. Coarctation of the aorta
5. Hypoplastic left heart
61
What is virchows triad
1. hypercoagulable state
2. venous stasis
3. endothelial injury
*prone to clot (PE)
62
What is an aortic dissection
blood creates false lumen between intimal and adventital layers
63
Sx and EKG of pericarditis
Sx: Worse when supine, relieved when leaning forward
EKG: diffuse, concave upward ST elevation and PR depression
64
What people need Abx for bacterial endocarditis?
1. prosthetic (artifical) valve
2. heart repairs using prosthetic material
3. prior hx of endocarditis
4. CHD
65
People that need Abx for bacterial endocarditis need it for what procedures
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
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*
Giant cell arteritis
67
tx of giant cell arteritis
HD corticosteroids 40-60mg/d for 6 weeks
68
What are the classes of antiarrhythmic drugs
```
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)
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