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Test 2 Flashcards

1
Q

When do you perform rescue PCI?

A
  1. Cardiogenic shock <75
  2. Severe HF, pulmonary edema
  3. Hemodynamically compromising ventricular arrhythmia
  4. Fibrinolytic therapy has failed and a moderate or large area of myocardium is at risk
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2
Q

What are the traditional cardiac risk factors, that are no longer helpful >40?

A
  1. HTN
  2. Diabetes
  3. Tobacco
  4. Fam hx
  5. Hypercholesterolemia
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3
Q

How do you diagnose COPD?

A

Spirometry FEV1: <80%,

FEV1: forced vital capacity:

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4
Q

Legionella presentation?

A

Cigarette smoker, transplant, group of people, sinusitis, pancreatitis, myocarditis, pylenehritis

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5
Q

If you have cancer what might they give you for DVT?

A

Anticoagulant 3-6 months

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6
Q

What is the treatment for acute pericarditis?

A

NSAIDs 7 days to 3 weeks, NO IBUPROFEN FOR DRESSLERS

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7
Q

Common signs and symptoms hypertrophic cardiomyopathy?

A

Chest pain,palpiations, syncope, apical impulse hyperdynamic, s4, systolic ejection murmur

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8
Q

Who gets a V/Q for PE?

A

Pregnant women

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9
Q

What is the MC peripartum cardiomyopathy?

A

Dilated

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10
Q

Hallmark symptoms and physical findings of COPD?

A

Chronic and progressive dyspnea, cough and sputum production. Tachypnea, accessory muscle use, and pursed lip exhalation, skinny w/ gut

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11
Q

Phegmasia cerulea dolens requires what?

A

Rapid action to reduce venous pressure, get cathereter directed thrombodylysis

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12
Q

Respiratory acidosis when?

A

Pco2 >44
35-45

If ph is <7.35 then there is an acute and uncompensated metabolic acidosis present

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13
Q

Long term O2 therapy?

A

PaO2 <=55,
SaO2 <=88%

When PHTN, cor pulmonary, polycythemia

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14
Q

If you think tension pneumo what do you do?

A

Treat w/ needle then tube before radiograph

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15
Q

Mycoplasma pneumonia?

A

Sounds like heart attack, retrosternal chest pain

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16
Q

When is regular steroid treatment recommended for COPD?

A

FEV1 <50%

Severe, very severe

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17
Q

Indications for ICU admission?

A
  1. Severe dyspnea responds inadequately to emergency treatment
  2. Respirate or ventilatory failure despite o2 and non invasive therapy
  3. Decreasing LoC w/ increasing confusion
  4. Hemodynamics instability
  5. End organ failure
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18
Q

What are the risk factors for acute heart failure?

A
  1. HTN
  2. Diabetes
  3. Aortic valve disorder
  4. Male
  5. Old
  6. Obese
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19
Q

What are the hallmarks of tension pneumo?

A

Tracheal deviation away from involved side, hyperresonance on the affected side, hypotension, and significant dyspnea

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20
Q

Unstable angina should not have what?

A

Troponin

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21
Q

What is the hallmark of PE?

A

Dyspnea unexplained by auscultation findings, ECG changes, or clear alternative on CXR

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22
Q

Indication/contraindications for non invasive ventilation?

A

<7.36
PaCO2 >50
PaO2<60
SaO2 <90%

Respiratory arrest, CV instability
Confusion (like you might take it off)
Aspiration risk
Too many secretions 
Recent facial surgery/trauma
Burns, nasopharyngeal abnormalities
Obese
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23
Q

If you are what two things with acute HF do you go to ICU?

A

IV nitro and incubated

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24
Q

What is the treatment of acute exacerbation of COPD in er and what do they leave w/?

A

In hospital:

  1. Albuterol
  2. Iproptropium
  3. Corticosteroids

Go wome w/

  1. Corticosteroids
  2. Z-pack
  3. Making sure they can sat on the home O2
  4. O2
  5. Bronchodilator treatment
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25
Q

4 big signs and symptoms for acute heart failure?

A
  1. DOE (most sens)
  2. Orthopnea, PND, edema (spec)
  3. S3
  4. > 500 BNP
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26
Q

When is observation appropriate?

A

Small, stable pneumo

4 hrs w 02, re CXR, then release and RETuRN in 24 hrs

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27
Q

Patients admitted to the ICU get what meds for pneumonia?

A

Cover MRSA vancomycin and linezolid

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28
Q

What are the signs of dresslers and what is the treatment?

A

2-10 weeks post MI, chest pain, fever, pleuopericarditis. Aspirin and colchicine

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29
Q

Sharp pain, hurts worse when supine, retrosternal, refers to left trapezial ridge?

A

Acute pericarditis

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30
Q

What is the only thing that can reduce rate of decline and morality in COPD?

A

Smoking cessation

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31
Q

What are the 14 day mortality timi score requirements for unstable angina?

A
  1. > =65
  2. ST segment deviation
  3. Cardiac markers
  4. Aspirin in last 7 days
  5. Hx 50% coronary artery stenosis
  6. > =2 angina events in 24 hrs.
  7. > =3 traditional risk factors
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32
Q

Goal for o2 therapy?

A

PaO2 >=60,

SaO2 >=90%

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33
Q

What can CT detect for pneumo?

A

Pulmonary blebs and where the pneumo is

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34
Q

What maneuvers increase HOCM?

A

Vasalva, standing after squatting

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35
Q

What is the treatment for massive PE?

A

Fibrinolytic, and placed in ICU

36
Q

What is the treatment for hypertrophic cardiomyopathy?

A

Beta blocker

37
Q

Pericardial effusion/ tamponade ECG?

A

Electrical alternans/ low voltage

38
Q

Haemophilus influenza presentation?

A

Sickle cell, more in elderly w/ bacteremia

39
Q

Treatment of VTE?

A

Heparin or MWH

40
Q

What is the MC pneumonia?

A

Pneumoccus, followed by viruses

41
Q

Limb w/ DVT that has dusky or blue color

A

Phegmasia cerulea dolens

42
Q

What are the classifications of acute heat failure?

A
  1. Hypertensive
  2. Pulmonary edema
  3. Cardiogenic shock
  4. Acute on chronic
  5. High output
  6. Right heart failure
43
Q

What does acute pericarditis look like in stage 3?

A

Inverted t waves I, V5, V6

44
Q

What level of loop diuretic for acute HF?

A

Total daily dose, may have to give potassium

45
Q

Mvmt and non mvmt signs for pneumo are called what?

A

Mvmt is beach

No mvmt is barcode

46
Q

Provoking factors for VTE?

A

Active cancer, infection, estrogen, pregnancy

47
Q

Pseudomonas pneumonia presentation?

A

Cyanosis, confusion, prolonged hospitalization (steroids or hospital), cystic fibrosis, empyema

48
Q

Swollen, painful, and pale or white limb w/ a proximal venous thrombosis?

A

Phegmasia abla dolens

49
Q

What is the treatment of ACS?

A

IV access, aspirin, O2, antiplatelet (aspirin, clopridogrel), antithrombins (unfractionated heparin, enoxaparin), nitrates (nitro sublingual .4 mg q 5 min x 3 prn, IV 10 micro)

50
Q

What are discharge meds for DVT?

A

LMWH IM, or revoxaban

51
Q

MC physical finding in pneumothorax?

A

Sinus tachycardia,

52
Q

Management of hypertensive HF?

A
  1. O2 >=95%
  2. Severe dyspnea, consider NIV or intubation
  3. BP>150/100 add nitro
  4. IV loop diuretic (furosemide)
  5. ICU
  6. Discharge
53
Q

What a is the admission criteria for pericarditis?

A
  1. Temp >100.4
  2. Subacute onset
  3. Immuno suppressed
  4. HX of oral anticoagulant
  5. Ass. Myocarditis (elevated biomarkers)
  6. Large pericardial effusion
54
Q

Respiratory failure sats?

A

PaO2 <60

SaO2 <90

55
Q

PE ecg?

A

Sinus tachy w/non specific t wave changes, S1Q3T3

56
Q

What is the most life threatening feature of an acute exacerbation of COPD?

A

Hypoxemia <90%

57
Q

What can occur 1-5 days post infarction?

A

Free wall rupture, tearing pain

58
Q

What is imaging TOC for DVT?

A

Venous US, vein doesn’t compress that is a positive

59
Q

What are the absolute contraindications stat fibrinolytic therapy?

A

1 intracranial hemorrhage

  1. Structural cerebral vascular lesion
  2. Intracranial neoplasm
  3. Ischemic stroke 3 months
  4. Active internal bleeding
  5. Aortic dissection or pericarditis
60
Q

How is diagnosis of dilated cardiomyopathy typically made?

A

Follow up echo w/ additional testing

CXR shows cardiomegaly

Biventricular enlagement is common

61
Q

When do you admit for pericardial disease?

A
  1. Temp >100.4/38
  2. Onset over sev. Weeks
  3. Immunosuppressive
  4. Hx of ora anticoagulant
  5. Ass. Myocarditis (elevated biomarkers)
  6. Large pericardial effusion (free space >20)
62
Q

Triad for cardiac tamponade and treatment?

A

Muffled heart sounds, JVD, hypotension (Pulsus paradoxus)

Pericardiocentesis, bolus of fluid, echo, but U/S

63
Q

Dose for sublingual and IV nitro for acute HF?

A

Sublingual: .4 mg q 5 min
IV: .2-.4 mcg/kg/min

64
Q

What are the risk factors for acute heart failure?

A
  1. HTN
  2. Diabetes
  3. Valvular disorder
  4. Old age
  5. Male
  6. Obesity
65
Q

How long can you not fly for pneumo?

A

7-14 days

66
Q

Diagnosis of STEMI equivalent LBBB?

A
  1. > 1mm ST elevation concordant
  2. > 1 mm depression V1, V2, V3
  3. > 5 mm elevation discordant
67
Q

When is an echo indicated?

A
  1. Cause of HF uncertain
  2. Exclude known causes of HF that may be correctable
  3. EF
  4. Rule out potential causes
68
Q

Classic PE pain?

A

In thorax between clavicles that increases w/ cough or breathing

69
Q

Kllebsiella pneumonia presentation

A

Alcoholics, brown currant jelly

70
Q

Massive PE is what?

A

Systolic BP <90 for >15 min,40 % reductionism baseline of systolic BP

71
Q

Presentation of pneumococcal pneumonia?

A

Sudden onset of disease w/

  1. RIGORS
  2. BLOODY SPUTUM
  3. HIGH FEVER
  4. CHEST PAIN

DAY CARE CENTERS

72
Q

When discharging AHF what do you have to make sure?

A

That their O2 at their home is enough

73
Q

Atypical?

A

Beta lactam resistant macrolide or fluroquinolone

74
Q

What is the treatment for most pneumonia

A

Macrolide or fluorquinolone, or doxy

-mycin

75
Q

Treatment options for pneumo?

A

O2 (nitrogen gas pressure gradient), observation, needle, catheter aspiration

76
Q

If you don’t think PE what do you do?

A

Wells, if - then PERC, if PERC- then d-dimer.

77
Q

What is the criteria for stable pneumo?

A
  1. RR <24
  2. No dyspnea at rest
  3. Pulse >60 and <120 beats/min
  4. Normal BP
  5. Room air >90%
  6. No hemothorax
78
Q

What are the rules for admission to ICU for pneumonia?

A
  1. Markedly elevated respiratory rate
  2. Pp o2 <=250
  3. Mulitlobar infiltrates
  4. Confusion
  5. Uremia w/ BUN >20
  6. Leukopenia, thrombocytopenia, hypothermia, hyponatremia, lactic acidosis, and asplenia

Septic shock/ mechanical ventilation

79
Q

Murmur that’s associated w/ dilated cardiomyopathy?

A

Holocystolic mitral/tricuspid regugitant murmur

80
Q

What are common causes of acute pericarditis?

A

ID, cancer, drug (procainamide, hydralazine), rheumatic, radiation, Dressler’s, uremia

81
Q

What are the COPD severities?

A

Mild FEV1 >80%
Moderate 50-79
Severe 30-49
Very severe <30

82
Q

What does acute pericarditis look like on ECG?

A

Pr depression, II, aVF, V4-V6

ST elevation I, V5, V6

83
Q

When to admit COPD patient?

A
  1. Increased intensity of symptoms
  2. Failure medical treatment
  3. Comorbidities
  4. HF
  5. Frequent relapse
  6. Old,
  7. Insufficient home support
84
Q

What is the diagnostic hallmark of hyerptrophic cardiomyopathy?

A

Asymmetric septal hypertrophy

85
Q

S. Aureus pneumonia?

A

Laryngeal cancer, ASPIRATION RISK PEOPLE W/ STROKE, after viral illness

86
Q

Treatment for right ventricular infarction?

A

1-2 L saline then dobutamine

87
Q

What is the surgical for pneumo?

A

Pleurodesis, for recurring, bilateral, recurrent high risk of activities

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