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Flashcards in Cardiology (PANCE PEARLS) Deck (259):
1

Heart failure (Systolic/Left) - how do you identify it best?

Echo

2

Heart failure (Systolic/Left) - how do you identify it best?

Echo

3

Heart failure (Systolic/Left) - what will you see? Hear?

Decreased ejection fraction (

4

Heart failure (Systolic/Left) - Buzz

Pink frothy sputum

5

Main goals for HF

6

Every HF patient (unless contraindicated) should be on what?

An ACE and a diuretic

7

MOA of ACE

Decreased aldosterone production degreasing angiotensin II leading to decrease water retention. Bradykinin is also affected and can cause dry coughing and angioedema

8

Does ACE affect mortality?

Yes

9

SE of ACE

Hypotension with first dose. Renal insufficiency (with Cr > 3 or CrCl

10

Heart failure (Systolic/Left) - what will you see? Hear?

Decreased ejection fraction (

11

Heart failure (Systolic/Left) - Buzz

Pink frothy sputum

12

Main goals for HF

13

Every HF patient (unless contraindicated) should be on what?

An ACE and a diuretic

14

MOA of ACE

Decreased aldosterone production degreasing angiotensin II leading to decrease water retention. Bradykinin is also affected and can cause dry coughing and angioedema

15

Does ACE affect mortality?

Yes

16

SE of ACE

Hypotension with first dose. Renal insufficiency (with Cr > 3 or CrCl

17

Why give an ARB instead?

This only blocks the effects of angiotensin II not the creation of it and doesn't affect bradykinin which won't lead to cough.

18

How do you remember ACE drugs?

PRIL (aces (pilots) are PRIcks)

19

How do you remember ARBS?

Sartans (spartans don't eat cARBS)

20

What do you want to be careful of when adding a beta blocker with HF?

It can decrease EF transiently so DON'T give with decompensated HF

21

When do you add a beta blocker?

Usually after an ACE or ARB.

22

What is the MOA of hydralazine?

Vasodilator (decreases afterload)

23

Name 3 loops

Furosemide, Bumetanide, Torsemide.

24

MOA of loops.

They inhibit water transfer across the loop of henle. They get rid of water, chloride, Na, K+

25

What are the two main SE of potassium sparing diuretics?

Hyperkalemia and gynecomastia

26

What are the P's of pericarditis?

Persistent, pleuritic, postural, pain, pericardial friction rub

27

Dresslers syndrome

Post MI pericarditis

28

Becks triad

Associated with tamponade. Becky's tampon. Distant heart sounds, JVP, hypotension.

29

Treatment for pericarditis?

NSAIDS, ASA, Colchicine, corticosteroids if persistent.

30

What two complications of pericarditis?

Effusion (common), tamponade (less common)

31

Kerley B lines

CHF

32

Batwing/Butterfly pattern

CHF

33

What might you see on ECG in pericardial effusion?

Low voltage QRS complexes! You may also electric alternans implying the heart is "swinging in fluid"

34

How will the heart look on CXR with pericardial effusion?

Cardiomegaly.

35

Distant heart sounds with auscultation of suspected pericardial effusion?

Yes. Its in water. Low sound conduction

36

Becks triad

Distant heart sounds, JVP, hypotension.

37

What is Kussmaul's sign

Increased JVD during inspiration due to impaired filling of RV.

38

When do you see Kussmaul's sign?

During constrictive pericarditis as well as restrictive cardiomyopathy.

39

Treatment for constrictive pericarditis?

Pericardiectomy. Gotta remove that crappy pericardium

40

PR elevation and ST depression in AVR

Acute pericarditis. "knuckle sign"

41

What will you see in the V leads with acute pericarditis?

PR depression in V3-V5 and ST elevation in V1-V6

42

Pulsus paradoxis is commonly seen in what?

Tamponade and constrictive pericarditis

43

Most common cause of myocarditis?

Viral

44

Whats the difference between children and adults with myocarditis?

Children often present in florid HF

45

Most common viral cause of myocarditis?

Coxsackie B. Other causes are adenovirus, parvovirus, herpes simplex 6, EBV, HIV, VZV. think "my oh my you have a pretty coxsackie"

46

What are the bacterial causes of myocarditis?

Lyme disease, Rocky mountain spotted fever, Q fever (Rickettsial). Think "my oh my you have a pretty mouth.

47

What south/central american bacterial cause of myocarditis is common?

Chagas of course. He's "breaking hearts" all over south america.

48

What will you see on CXR with myocarditis?

Cardiomegally.

49

How will a patient with viral myocarditis look?

Fever, myalgias, malaise with on onset of HF symptoms.

50

CKMB and troponin will do what with myocarditis?

Elevate but not due to blockage.

51

What is the GOLD STANDARD for diagnosis myocarditis?

Endomyocardial biopsy

52

How do you want to treat myocarditis?

Same as HF. Diuretics, afterload reducing agents (ACE), increase contractility (dopamine, dobutamine, milrinone)

53

What 3 things will you see on echo of dilated cardiomyopathy?

Left ventricular dilation (thin walls and large chamber), decreased EF, regional or global hypokinesis (shit doesn't work)

54

Treatment for dilated cardiomyopathy?

Same as HF.

55

What the hell is broken heart syndrome?

Tako-Tsubo were two japanese lovers. Tako flew away in a "balloon" when Tsubo started menopause and the surge of catacholamines broke her heart.

56

Most common type of cardiomyopathy?

Dilated (95%), Hypertrophic (4%), Restrictive (1%).

57

What is the most common cause of restrictive cardiomyopathy?

Amyloidosis (Amy restricts the heart). Sarcoidosis too

58

What is the trademark of restrictive cardiomyopathy?

Impaired diastolic function with preserved contractility

59

What if you saw bright speckled myocardium on echo?

Amyloidosis present and likely causing cardiomyopathy

60

Difference on echo between dilated and restrictive?

Dilated ventricle on the first but dilated atria on the other.

61

What part of the heart is most commonly affected with hypertrophic cardiomyopathy.

Septal.

62

What kind of murmur with hypertrophic cardiomyopathy?

Harsh systolic crescendo-decrescendo murmur best heard at left upper sternal border

63

Why does the murmur on hypertrophic cardiomyopathy go quite with squatting or lying down?

Increased blood return which pushes septum out of the way and decreases SAM (systolic anterior motion). Helps the blood go the right direction.

64

How do you measure the ankle brachial index?

Highest ankle pressure over highest arm pressure (both arms). You calculate the index. 1 to 1.4 is normal. 0.5 to 0.8 to 1 the pt has PAD.

65

What two arteries do you use with ankle brachial index?

Dorsalis pedis, posterior tibial (just behind medial maliolus)

66

First line treatment for hypertrophic cardiomyopathy?

Beta blockers.

67

What causes rheumatic fever?

GABHS

68

What valve is most affected?

Mitral then aortic

69

Jones MAJOR criteria for RF. Must have 2 major or 1 major and 2 minor.

Polyarthralgia, carditis, chorea, subcutaneous nodules, erythema marginatam.

70

Jones Minor criteria for RF.

Fever (101 to 104), arthralgias, elevated labs (ESR, CRP, leukocytosis), prolonged PR. Supporting evidence of recent GABHS infection.

71

Where are the nodules seen?

Nodules seen over extensor surfaces.

72

Whats the difference between arthralgias and polyarthragias (minor/major criteria?)

Heat, redness, swelling, severe tenderness MUST be present for polyarthralgias (multiple joints more conclusive)

73

How do you treat the chorea of RF?

Haldol

74

What does the rash look like with RF?

Macular, erythematous, NON pruritic ANNULAR lesions with well defined borders and some possible central clearing. Appears on TRUNK and EXTREMITIES (not the face).

75

How do you treat RF?

PCN G (erythromycin if PCN allergic).

76

What other drug should RF patients possibly get for 2-6 weeks?

ASA with a taper.

77

What can cause a split of S2?

Normal would be inspiration. This would be transient only during inspiration. Abnormal would be fixed. Commonly seen with ASD or VSD or pulmonary HTN or MS. Delayed closure of pulmonary valve. Paradoxical split (during exhalation) you will see it with delayed emptying of ventricle where aortic portion is later than pulmonic. Seen with LBBB or severe aortic stenosis.

78

When would you hear an ejection click?

Mitral valve prolapse where the chordae tendonae pull the valve shut rapidly.

79

S3.

Lub de bub. Rapid filling of ventricle. You hear S1 then S2 then S3

80

S4.

Belup dub. Atria contracting into stiff ventricle. S4 then S1 then S2.

81

Stenosis leads to what?

Pressure overload

82

Regurgitation leads to what?

Volume overload

83

Harsh murmurs are usually ____

Stenotic (forward flow)

84

Blowing murmurs are usually ____

Regurgitation (back flow)

85

Systolic murmurs

Mitral and tricuspid regurgitation AND Aortic and pulmonic stenosis

86

Diastolic murmurs

Mitral and tricuspid stenosis AND Aortic and pulmonic regurgitation

87

Where does aortic stenosis radiate to?

Carotid

88

Where does mitral regurgitation radiate to?

Axilla

89

Where does aortic regurgitation radiate to?

L upper sternal border

90

In was pt position can you best hear a mitral murmur?

Decubitus (lying left side)

91

In was pt position can you best hear an aortic murmur?

Pt seated up leaning forward

92

With the exception of hypertrophic cardiomyopathy, increasing venous return does what to murmurs?

Makes them louder

93

What is the classic triad of transposition of the great vessels?

It's a right to left shunt (which causes what in newborns? CYANOSIS!!!) CXR will show 1) Egg on a string sign. 2) Pulmonary vascular congestion. 3) Mild cardiomegaly

94

Most common type of cardiac defect?

VSD - V=Very common

95

When would you see cyanosis? What kind of shunting?

Right to left (no oxygenation of blood)

96

Murmur. Harsh holosystolic murmur at left sternal border. Management?

VSD. 35% close. Surgery possible. Give diuretic and digoxin early if necessary.

97

Pulmonary stenosis. What disease of the young causes it?

Congenital RUBELLA syndrome

98

Murmur. Harsh midsystolic crescendo-decrescendo murmur at upper left sternal border radiating into the neck.

Pulmonary stenosis. May have WIDE split of S2 as blood can't get out for the pulmonary valve to close.

99

Mid systolic click is virtually diagnostic for what?

Mitral valve prolapse

100

Early diastolic murmur with decrescendo shape?

Aortic regurgitation

101

Opening diastolic snap with mid mid diastolic rumble with presystolic accentuation.

Mitral stenosis

102

Volume overload can cause what sound?

S3. During rapid filling phase of diastole

103

Pressure overload can cause what sound?

S4. It's the atrial kick against a bad ventricular wall.

104

A pt has a lower BP in his legs than in his arms and delayed weak femoral pulses

Coarctation of the Aorta

105

What sign might you see with coarctation of the aorta?

3 sign or backward E sign.

106

Infantile coarctation is ____ ductal

Pre

107

Adult coarctation is ____ ductal

Post

108

What is rib notching? Another name for it?

Roesler sign. Dilated, tortuous vessels erode the rib walls as collateral vasculature forms to feed the aorta downstream from stenosis

109

How do you test for coarctation of the aorta?

Angiogram

110

How do you treat coarctation of the aorta?

Balloon angioplasty

111

Cyanotic or not? PDA

Not. Left to right shunt

112

Cyanotic or not? Tetrology of fallot

Cyanotic. Right to left shunt

113

The production of what continues to keep a PDA patent?

PG E2

114

What will you hear with PDA

Continual "machine murmur" over pulmonic area. You will also see WIDE PULSE PRESSURE and bounding peripheral pulses. This is because blood is running off from the aorta into the pulmonic valve

115

What syndrome can occur with PDA

Eisenmenger syndrome. Pulm HTN causes shunt from L to R to R to L. Bad.

116

What is the treatment for PDA in a preterm infant?

Indomethacin (it closes the duct). Surgery if not preterm.

117

Amiloride, epleronone

Potassium sparing diuretics with spironolactone (inhibit aldosterone mediated water/Na absorption). These cause gynecomastia in addition to hyperkalemia.

118

If pt has HTN and it is refractory to antihypertesives...

Think 2ndary cause.

119

Abdominal bruit?

Renal artery stenosis

120

What finding on PE signifies advanced stage of malignant HTN?

Papilledema

121

What are 3 diuretics commonly used as first line in HTN?

HCTZ, chlorthalidone, metolazone

122

Where do thiazides work?

Distal tubule. Prevents sodium and thus water reabsorption there.

123

Loop diuretics get rid of water, Na, Cl, and K

True

124

What diuretics are contraindicated in sulfa allergy?

Loops. Furosemide and bumetanide

125

HTN emergency is what? How would you treat it?

220/120 + with signs of organ damage. Eyes, brain, kidneys, heart damage. You want 10% reduction in MAP within first hour and an additional 15% reduction over next 2-3 hours. using IV agents.

126

ARBS are contraindicated in what?

Pregnancy

127

When do you use dyhydroperidine CCB's and non-dyhydroperidine CCB's? And what are the?

Dyhydroperidines (dipine) are good for HTN alone. Non-dyhydroperidines (verapamil, diltiazem) good for HTN and A-fib. (they work on contractility and conduction AND vasodilation (the dipines only work on vasodilation).

128

Should beta blockers be used as first line mono therapy in HTN?

NO

129

What does a beta blocker do?

Blocks adrenergic renin release.

130

When would you use an alpha blocker? What is the first SE?

On a dude who wants to be the alpha male but has HTN and BPH. He will probably faint the first time he takes it.

131

Zosin drugs

Alpha 1 blockers. A=Zosin

132

HTN emergency is what? How would you treat it?

220/120 + with signs of organ damage. Eyes, brain, kidneys, heart damage. You want 10% reduction in BP within first hour and an additional 15% reduction over next 2-3 hours. using IV agents.

133

HTN urgency is what? How would you treat it?

Elevated BP without signs of organ damage. You want to decrease MAP by 25% in first 24-48 hours using PO agents

134

What are the 4 main oral drugs used for HTN urgency and their side effects?

Clonidine (Alpha 2 agonist - dry mouth, headache, tachycardia, N/V, sedation, fatigue). Captopril (ACE - andioedema, renal failure). Labetalol (Alpha 1/Beta 1/2 blocker - COPD, heart block, heart failure exacerbation). Nicardipine (CCB - reflex tachycardia, HA, N/V, flushing)

135

What class of medication do you NOT want to give to an asthmatic?

Beta blocker. Lebetalol for example.

136

What is the DRUG OF CHOICE for HTN emergency?

Sodium nitroprusside

137

Is sodium nitroprusside ok for pregnancy?

NO

138

What should you give a pregnant patient in a HTN emergency? What class drug is it?

Methyldopa. Alpha 2 agonist.

139

What would you give a pt who is in HTN emergency and is having an aortic dissection due to it?

Labetalol, NTP + esmolol

140

Patients over 60 BP goals?

150/90

141

Pt with CKD and HTN goals?

140/90

142

A non-african american with uncomplicated HTN can have which drugs?

Thiazide type diuretic, ACE, ARB, BB, or CCB

143

Main causes of hypercholesterolemia?

Hypothyroid, pregnancy, kidney failure

144

Main causes of hypertriglyceridemia

DM, obesity, steroids, ETOH, estrogen

145

What is one finding that is common with hypercholesterolemia

Xanthomas (around eyelids, achilles tendon)

146

What abdominal issue does hypertriglyceridemia sometimes cause?

Pancreatitis

147

Common bacteria with IV drug abuse endocarditis?

MRSA, pseudomonas, candida (fungal)

148

Common cause of acute bacterial endocarditis?

Staph. A

149

Common cause of prosthetic valve endocarditis?

Staph epidermis

150

What is the infection of normal valves?

Acute bacterial endocarditis.

151

Common cause of subacute bacterial endocarditis (abnormal valves)

Strep viridans

152

What are the 5 organisms responsible for large endocarditis vegetations?

HACEK. Haemophilus, actinobacillus, cardiobacterium, eikenella, klingella

153

How might a person with infective endocarditis present?

Fever, weight loss, fatigue, EKG abnormalities.

154

What might you find on skin exam?

Janeway lesions (painless palms), Osler nodes (painful pads), Roth spots (retinal hemorrhage with pale center), petechiae (palate, conjunctiva), Splinter hemorrhages, clubbing, hepatosplenomegally, septic emboli.

155

What do you want to do if you suspect it?

Blood culture (before ABX), EKG, echo (TTE before TEE), CBC,

156

What criteria is used for infective endocarditis?

DUKE

157

What are the major Duke criteria?

Bactermia (2 cultures positive), Endocardial involvement (either positive echo or new MR or AR murmur)

158

Empiric treatment for NATIVE VALVE ACUTE infective endocarditis?

Nafcillin + gentamicin 4-6 weeks. If PCN allergy or if you suspect MRSA use Vancomycin and gentamicin

159

Empiric treatment for NATIVE VALVE SUBACUTE infective endocarditis?

PCN/Ampicillin + gentamicin. If IVDA use Vancomycin with gentamicin

160

Empiric treatment for PROSTHETIC VALVE infective endocarditis?

Vancomycin + gentamicin + rifampin (for staph A)

161

Empiric treatment for fungal infective endocarditis?

Amphotericin B or Capsofungin if severe

162

Prophy treatment is what before procedures for pts with what?

Amoxicillin 2g 30-60minute before surgery OR clindamycin 600mg (if PCN allergy). Dental work, respiratory surgery, or procedures involving skin (includes I&D)

163

Whats the most common presentation of PAD?

Intermittent claudication. Pain with activity relieved by rest.

164

Most common arteries involved with PAD claudication

Femoral and branches and popliteal

165

What if there is resting leg pain with PAD?

Advanced disease

166

What are the s/s of acute arteriole emboli?

6 P's. Parathesias, pain, pallor, pulselessness, paralysis, poikilothermia

167

If there is arterial occlusion, what can happen?

Gangrene (wet and dry) Wet is gross and dry is mummy

168

What skin findings will you have with PAD?

Atrophic changes. muscle atrophy, thin/shiny skin, hair loss, nail thickening, cool limbs, possible necrotic areas.

169

What color will the skin be?

Dependent rub or with paleness on elevation.

170

Where are some common ulcers of PAD?

Lateral maleolar ulcers.

171

How do you screen/dx PAD?

Ankle brachial index (ABI).

172

Normal value for ABI?

1-1.2

173

PAD dx with an ABI of what?

174

Severe PAD with ABI of what?

175

What ABI would you need to heal diabetic ulcers?

At least 0.85

176

What is the GOLD standard for PAD testing?

Arteriography

177

How would you treat PAD?

Cilostazol is the mainstay as it's a vasodilator and ADP inhibitor.

178

What other drugs would you use for PAD?

ASA and clopidogrel (plavix).

179

An aneurysm greater than what is considered aneurysmal?

3.0cm

180

Where do AAA usually occur?

Infrarenally.

181

Give me the picture of an AAA candidate?

Atherosclerosis (#1 cause) >60 MALE SMOKER who is WHITE

182

What law says that wall tension = pressure x radiates and as the wall dilates the force on the wall increases causing more dilation making larger aneurysms expand more rapidly than small ones.

Laplace's law

183

Ripping chest pain is indicative of what?

Thoracic dissection

184

Dx of AAA

Abdominal US

185

DX of thoracic aneurysms

CT scan

186

What is the gold standard for AAA dx

Angiography

187

When do you operate on an AAA?

> or equal to 5cm or 0.5cm expansion in 6 months (remember Laplace's law!!!)

188

When do you refer?

> 4.5cm

189

AAA 4.0 to 4.5cm

US monitoring every 6 months

190

AAA 3.0 to 4.0cm

US monitoring every year

191

What drug helps reduce sheering forces?

Beta blockers!!! Non selective (labetalol) and add nitroprusside if needed.

192

Where does an aortic dissector most commonly occur and in what layer of the aorta?

Ascending aorta (60%) and in the INTIMA layer

193

What is the most common predisposing factor to aortic dissection?

HTN

194

What syndrome predisposes people to AAA and aortic dissection while young?

Marfan syndrome

195

What is the aortic dissection pain like?

Severe, tearing, knife like ripping chest/upper back pain

196

Where do the ascending aorta, aortic arch, descending aorta dissections pain radiate to?

Anterior chest, neck/jaw, intrascapular

197

What pulse changes might you see with aortic dissection?

Variation of pulses between arms of more than 20mm/hg

198

If pt is hemodynamically stable, how might you diagnose this?

Angiography (gold standard) or TEE

199

How is this dx urgently?

CXR showing widening mediastinum and CT scan with contrast (CT 3-D is happening now too)

200

A pt presents with new onset localized headache and scalp tenderness and fevers. He has noticed some pain after chewing and some jaw muscle spasms (truisms) as well. While in clinic he suddenly has feels as though a shade came down and covered one of his eyes causing monocular blindness or amaurosis fugax. What is it? How will you know? What will you do?

Temporal arteritis. Clinical diagnosis though ESR and CRP will likely be elevated. Treat with high dose corticosteroids 40-60mg/day for 6 weeks with tapering. You can try methotrexate or azathioprine if refractory to steroids.

201

Temporal arteritis is generally a ____ disease?

Autoimmune sparked by a virus

202

Another name for temporal arteritis

Giant cell arteritis

203

A pt presents with very tender nodules following venous distribution. There is claudication and even some ulcers forming on the distal extremities. What are you thinking? What else might you see?

Thromboantiitis obliterans (buerger disease). I think the fingers, toes, ears, nose, and tongue could worsen with cold, SMOKING, or emotional stress (Raynaud's phenomenon).

204

How would you know it's Buerger disease and how would you treat it?

You would not see atherosclerosis

205

Young smoker with numb digits going from pale, to blue, to red in the vasospasm tricolor classic presentation of what?

Buerger disease

206

What test may be abnormal with Buerger disease?

Allen test

207

What is the only definitive management of buerger disease?

Smoking cessation

208

What is the medication treatment for buerger disease?

Dyhydroperidine CCB. "DIPINE" Nifedipine, nicardipine, amlodipine

209

What is the triad for clot development?

Virchow's triad. 1) Damage (trauma, infection, inflammation 2) Stasis (sitting, surgery) 3) Hypercoagulability (factor V leiden, oral contraception)

210

What is migratory thrombophlebitis?

Trousseau's sign. Associated mostly with malignancy or vasculitis.

211

A pt presents with tenderness, pain, induration, edema, and erythema along a palpable cord of superficial vein. How will you confirm what you suspect and how will you treat it?

Confirm by venous duplex US. You will see a non compressible vein with a clot. Do a hypercoag workup (factor 5, protein C, S, lupus, factor 7, homocysteine). Treatment is supportive. Elevation, warm compresses, NSAIDS, compression stockings.

212

When would you consider heparin and warfarin with superficial thrombophlebitis?

If in saphenofemoral junction (may throw clot)

213

What if the superficial thrombophlebitis is septic?

If they have fever or it's purulent. Treat with PCN + aminoglycoside.

214

Pt presents with unilateral leg swelling, calf pain, and noticeable phlebitis. What are you thinking? How will you know? How will you treat?

DVT. Venous duplex US. Also a D-dimer may be helpful. But the GOLD STANDARD is venography. The main goal is to prevent PE. Heparin/LMWH then Warfarin for 3-6 months is the mainstay of treatment.

215

Where do most DVT clots that throw to a PE originate?

Calf

216

When would you consider lifelong warfarin treatment?

Pts with protein C, S or antithrombin III deficiency or factor 5 leiden.

217

How does heparin work?

Potentiates antithrombin III and coagulation factors of the INTRINSIC pathway.

218

How would you treat heparin toxicity?

Protamine sulfate.

219

What should the PTT goal be for a pt on heparin?

1.5-2 x the normal value

220

What is the trade name for LMWH and what is the advantage of it? How is it given and when should it be avoided.

Enoxaparin. No need to monitor PTT. Given SQ and lasts 12 hours so patients can go home. Don't give in renal disease (Cr > 2.0) or in thrombocytopenia.

221

How does warfarin (coumadin work)?

Inhibits vitamin K dependent coagulation in EXTRINSIC pathway.

222

What coagulation factors are affected by coumadin?

2, 7, 9, 10, and protein C and S.

223

Should coumadin be overlapped with heparin?

YES. For at least 5 days.

224

What is the goal INR for warfarin patients?

2.0-3.0

225

What is the antidote for warfarin overload?

Vitamin K

226

Talk through unlikely DVT workup

Low clinical probability? D-dimer. If negative then DVT is excluded. If positive then do venous US. If negative, then DVT is excluded. . If positive then DVT is dx.

227

Talk through likely DVT workup

Intermediate or high probability? Venous US. If positive then DVT is dx. If negative then do D-dimer. If negative then DVT is excluded. If positive then do serial US. If positive then DVT is dx. If negative then DVT is excluded.

228

What are the features of the DVT ____ Criteria?

Wells criteria. 1) Cancer 2) Paralysis, paresis, or immobilization of lower extremity 3) Bedridden for more than 3 days 4) Localized tenderness along deep vein distribution 5) Entire leg swollen 6) Unilateral calf swelling > 3cm 7) Unilateral pitting edema 8) Collateral superficial veins 8) Alternative diagnosis as likely or more likely than DVT (-2)

229

What has the higher risk of heparin induced thrombocytopenia?

Unfractionated heparin

230

Redness with dependency (PVD/PAD)

PAD

231

Pain worse with dependency (PVD/PAD)

PVD

232

Pain better with walking (PVD/PAD)

PVD

233

Pain better with dependency (PVD/PAD)

PAD

234

Pain worse with walking (PVD/PAD)

PAD

235

Lateral Malleolus ulcers (PVD/PAD)

PAD

236

Medial Malleolus ulcers (PVD/PAD)

PVD

237

Unclear margins of ulcers (PVD/PAD)

PVD

238

Clear margins of ulcers (PVD/PAD)

PAD

239

Cyanosis with dependency

PVD

240

Stasis dermatitis with thickening of skin and brown pigmentation (PVD/PAD)

PVD

241

Limited edema (PVD/PAD)

PAD

242

Lots of edema (PVD/PAD)

PVD

243

Thin shiny skin with loss of hair and muscle, pallor, thickened nails (PVD/PAD)

PAD

244

Livedo reticularis (PVD/PAD)

PAD. This is that mottled appearance

245

Pulses and temp in lower extremities normal (PVD/PAD)

PVD

246

Pulses and temp in lower extremities cool and diminshed (PVD/PAD)

PAD

247

Who gets varicose veins?

People with increased estrogen, OCP's pregnancy, obesity, prolonged standing. Treat with stockings and elevation.

248

What kind of shock is this? Pt is in severe respiratory distress and appears cool and clammy. Pt has decreased CO and increased PCWP and increased systemic vascular resistance

This could be cardiogenic or obstructive

249

What are the common causes of cardiogenic shock?

MI, myocarditis, valvular disease, cardiomyopathy, arrhythmias

250

What are the common causes of obstructive shock?

Tamponade, PE, tension pneumo, aortic dissection

251

What kind of shot is this? Increased cardiac output

Septic shock (distributive)

252

In what shock might you see hypotension without tachycardia?

Neurogenic (distributive)

253

What are the causes of distributive shock?

Sepsis, neurogenic, anaphylactic, hypoadrenal

254

Treatment for adrenal insufficiency shock

Hydrocortisone 100mg.

255

Sepsis treatment initial?

Zosyn + rocephin or imipenem

256

What if you suspect pseudomonas for your sepsis?

Gentamicin

257

What if you suspect MRSA for your sepsis?

Vancomycin

258

What if it's an intrabdominal source for your sepsis?

Clindamycin or metronidazole.

259

What if the patient has not spleen and they are septic?

Rocephin to cover N meningitides and H. Flu.