Firecracker 10/27 Flashcards
1
Q
STEMI - EKG
A
hyperacute T waves
T wave inversions
ST segement elevation
Q waves
2
Q
ST segment elevation =
A
transmural ischemia
3
Q
Leads II, III, aVF
A
inferior
posterior descending artery or marginal branch.
4
Q
Leads I, aVL, V4-V6
A
Lateral infarct of the left anterior descending artery or circumflex.
5
Q
Leads V1, V2, V3
A
septal infarct of LAD
6
Q
Leads V4, V5, V6
A
anterior infarct of LAD
7
Q
serum cardiac enzymes for STEMI
A
cardiac-specific troponin T (cTnT),
cardiac-specific troponin I (cTnI),
creatine kinase MB-isoenzyme (CKMB)
8
Q
troponins for STEMI
A
more specific and sensitive
elevated for 7-10 days after
9
Q
CKMB for STEMI
A
rises within 8 hours
returns to normal after 72
10
Q
AV block
A
impaired conduction between the sinoatrial (SA) pacemaker and the ventricles.
11
Q
First Degree AV Block
A
PR > 0.2
normal 1:1 P:QRS ratio
12
Q
First Degree AV Block Cause
A
increased vagal tone
AV nodal dz
electrolyte disturbance
med side effect
13
Q
Second Degree AV Block - Mobitz Type I
A
progressive PR lengething until QRS is dropped
Group Beating
14
Q
Group Beating
A
lumping of P-QRS-T elements leading up to the dropped QRS complex.
15
Q
Second Degree AV Block - Mobitz Type II
A
random dropped QRS
discernible ratio of P:QRS
16
Q
Mobitz Type I Causes
A
intranodal or HIS bundle conduction defects that result from medications (e.g., beta blockers, digoxin, calcium channel blockers),
increased vagal tone, or
right coronary artery mediated ischemia.
17
Q
Mobitz Type II Causes
A
infranodal conduction abnormality in either the bundle of His or Purkinje fibers.
18
Q
Mobitz Type I Treatment
A
adjusting medications or pacing if associated with symptomatic bradycardia
19
Q
Mobitz Type II Treatment
A
always treated with a pacemaker due to the increased risk of progressing to high grade or third degree AV block.
20
Q
Third Degree AV BLock
A
P waves separate from QRS
supra-ventricular impulses completely fail to conduct impulses to the ventricles, and ventricular depolarization is initiated by pacemaker cells distal to the block
21
Q
Third Degree AV Block causes
A
coronary ischemia
also congenital AV block, lupus, or Lyme disease
22
Q
Third Degree AV Block symptoms
A
hypotension, dizziness, syncope
23
Q
Third Degree AV Block treatment
A
pacemaker
24
Q
VF most commonly associated with
A
coronary artery dz
25
VF risk factors
MI, decreased left EF, electrolyte disturbance
| long QT syndrome, A fib
26
most common cause of mortality following MI
V fib
27
Patients with VF
sudden LOC or comatose
| symptoms of MI prior to collapse
28
VF results in
insufficient forward cardiac output -->
| CNS ischemic injury, MI, sudden cardiac death
29
initial therapy for VF
defibrillation followed by 2 minutes of CPR
30
VF - after 2 rounds of defibrillation
epinephrine (1mg bolus, then every 3-5 minutes) should be administered followed by another shock.
31
medicines to consider with VF refractory to defibrillation
magnesium and amiodarone
32
asystole or pulseless electrical activity
immediate high-quality chest compressions.
| not shockable arrhythmias
33
mildly elevated LFTs
chronic hepatitis
alcohol induced hepatitis
NAFLD
34
LFTs 100s or 1000s
acute viral hepatitis
35
LFTs 10,000
toxin-related hepatitis
| liver ischemia
36
location of AST
liver, cardiac muscle, skeletal muscle
37
hepatic pattern of liver disease
markedly elevated AST and ALt
| minimal to no elevation in alk phos
38
half life of albumin
20 days
39
albumin in patients with advanced liver cirrhosis
low
40
severe liver damage labs
increased PT/INR
41
PHT value
greater/equal to 12
| increased resistance to portal blood flow
42
Prehepatic PHT
portal vein thrombosis
| schistosomiasis
43
Intrahepatic PHT
cirrhosis
hep B/c
PBC
44
posthepatic PHT
right sided heart failure
Budd-Chiari syndrome
severe TR
45
hepatic venous pressure gradient
balloon catheter to monitor gradient pressure btwn portal vein and IVC
46
PHT complications
variceal bleedings
SBP
ascites
pleural effusion
47
PHT management
screening for GE varices, beta blockers, diuretics, sodium restriction
48
transjugular intrahepatic portosystemic shunt
shunt between portal and hepatic vein (allowing portal vein to drain properly)
49
metabolic acidosis
ph <7.37
| decrease in HCO3- levels
50
metabolic acidosis lab values
low pH, high H+
very low HCO3-
low pCO2
compensation - hyperventilation
51
normal anion gap values
10-15
52
causes of anion gap metabolic acidosis
methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethylene glycol, salicylates
53
increased osmolol gap
suggesitive of toxic alcohol ingestion
54
OG =
Osm - (2Na + glucose/18 + BUN/2.6)
55
normal OG
<10
56
normal anion gap metabolic acidosis (hyperchloremic metabolic acidosis)
GI HCO3- loss
renal acidosis
drug induced hyperkalemia with renal insuff
other
57
metabolic acidosis/ GI HCO3 loss
diarrhea
external pancratic or small bowel drainage
jejunal and ileal loops
58
Normal anion gap hypokalemic renal acidosis
Type 1 and 2 RTA
| acetazolamide, topiramate, amph b
59
normal anion gap hyperkalemic renal acidosis
Type 4 RTA (hypoaldosteronism)
60
Drug-induced hyperkalemia with renal insufficiency leading to normal anion gap metabolic acidosis is seen in
potassium sparing diuretics
trimethoprim
ACEI/ARB
NSAIDs, cyclosporine
61
other causes of normal anion gap metbaolic acidosis
```
acid loads (ammonium chloride)
expansion acidosis from rapid saline adminstration
hippurate
```
62
urine anion gap
Na(urine) + K - Cl
63
negative UAG
high levels of NH4 excretion
| suggests normal renal function
64
positive UAG
low NH4 excretion
| suggests renal tubular dysfunction
65
Compensation for metabolic acidosis
hyperventilation
| cause reduction in pco2
66
expected PCO2 range with metabolic acidosis
Winter's formula
| 1.5 (measured HCO3) + 8 +/- 2
67
acute and severe metabolic acidosis treatment
administration of NaHCo3
68
absolute iron def
decreased iron levels in body stores
- poor nutriion
- impaired absorption
- blood loss
69
Functional iron def
insuff availability of iron to incorporate into precursors
- anemia of chronic dz
- treatment with erythropoiesis-stimulating agents
70
anemia of chornic dz
hepcidin-induced block on iron release from stores
71
etiology of iron def anemia
menorrhagia
gi bleed (colon polyp or cancer)
meckel's diverticulum in child
72
breast milk contains low
iron
73
iron absorbed in
duodenum
74
stages of iron def
loss of iron stores -> decreased ferritin --> decreased serum iron --> increased TIBC --> decreased iron sat --> normocytic anemia -- > microcytic anemia
75
symptoms of iron def anemia
pallor, fatigue
exertional dyspnea, orthostatic hypotension
tachycardia
koilonychia (spoon nails)
76
plummer-vinson syndrome
anemia + glossitis + esophageal webs
77
ferritin
intracellular protein that stores iron
78
transferrin
decreased in total iron --> upregulation of transferritin synthesis
79
iron def anemia gold standard
bone marrow biopsy - hardly ever performed
80
treatment of iron def anemia
trial or oral iron to menstruating women
| work up
81
oral iron, don't take with
tea, coffee, calcium (decreased absorption)
| acidity (increase absorption)
82
oral iron side effects
n/v, constipation, black stool
83
dextran
parenteral iron
| can cause life-threatening anaphylaxis
84
blood transfusion for iron anemia
```
unstable patients (hypotensive, hypoxic)
hemoglobin of 7 for healthy patients, 10 for patients with CAD
```
85
acute mesenteric ischemia causes
arterial thrombus (atherosclerosis)
venous thrombus (hypercoaguable)
arterial occlusion from emboli
hypoperfusion - blood loss, CHF
86
CMI cause
ischemia due to long standing atherosclerotic dz or 2 or more mesenteric vessels
also, vasculitidies
87
CMI - age
over 60
| females > males
88
CMI - vessels
celiac trunk
superior mesenteric artery
inferior mesenteric artery
89
AMI symptoms
diffuse non localized pain
N/v
bloody diarrhea
90
CMI symptoms
postprandial pain
weight loss
n,v,diarrhea
91
AMI pe findings
hyperactive/absent bowel sounds
positive occult blood
tachycardia
92
CMI PE findings
malnutrition
abdominal bruit
signs of peripheral vascular dz
93
diagnosis of mesenteric ischemia
CT angiography
94
mesenteric ischemia - plan films
can be used to exclude perforated viscus and free air under diaphragm
95
AMI complications
bowel necrosis, perforation, peritonitis, sepsis, death
96
CMI complications
acute thrombosis/embolism
| prolonged hospitalization due to chronic malnutrition
97
AMI treatment
fluid resuscitation, ng tube, IV antibodies
| embolectomy + thrombolytic influsion via angiography catheter
98
CMI treatment
open or endovascular revasc
| warfarin
99
CMI with bowel necrosis
laparotmy to remove tissue
100
systolic dysfunction due to
decreased ventricular contraction
101
diastolic dysfunction due to
noncompliant ventricle
102
causes of systolic dysfuncton
ischemia/CAD
| anemia, myocarditis, dilated CM, fluid overload
103
causes of diastolic dysfunction
```
HTN
increased afterload (Aortic stenosis)
restrictive processes
```
104
LSHF symptoms
pulmonary congestion - DOE, orthopnea, paroxysmal noctural dyspnea
105
LSHF - DOE
caused by interstitial fluid in lung stimulating juxtacapillary receptors
106
LSHF - orthopnea
because of increased venous return to right side of heart, worsen pulmonary congestion
107
paroxysmal nocturnal dyspnea
gradual reabsorption of fluid from interstitium into vascular compartment that leads to increase in venous return, worses PCongestion
108
LSHF - fluid overload
decreased CO
activates RAAS
retention of salt, water
109
hemoptysis in LSHF
rupture of engored bronchial veins
110
brick red sputum in LSHF
increased pressure in alevolar capillareis --> alevolar macrophages inget RBC --> hemosiderin laden macrophages
111
systolic HF ausculation
S3 gallop - kentucky
112
diastolic HF ausculation
S4 gallop - tennessee
113
BNP cutoff
400
114
Chest x ray findings HF
Kerley B lines – thin pulmonary opacities caused by fluid in the interstitium of the lung
Enlarged cardiac silhouette
Peribronchial cuffing – excess fluid in the small airway passages of the lung causes localized patches of atelectasis.
Cephalization of the pulmonary vasculature – antigravitational redistribution of the pulmonary blood flow due in part to increased pulmonary vascular resistance and pulmonary HTN.
115
LSHF acute treatment
```
Lasix (furosemide)
morphine
nitroglycerin
oxygen
positioning
```
116
LSHF morphine
decreases anxiety and preload through venodilation
117
Nitroglycern in LSHF
titrate IV SBP no less than 80
118
long term treatment of LSHF
beta blockers
spironolactone
ACE inhibitors
119
CCB and LSHF
not recommended
120
physical findings of atypical pneumonia
slower onset, insidious
| no signs of consolidation
121
maintaining K balance
excreted in distal nephron
excretion enhanced with reabsorption of Na+
secretion increased by aldosterone
GI tract absorbs 90%
122
pleurisy
any condition that causes an irritation of the parietal pleura.
123
diastolic HF - echo
normal/high EF
decreased EDV
increased EDP
124
digoxin in HF
symptoms relief, reduce hospitalization
| no effect on mortality
125
tetanus management
benzos
immune globulin
metronidzale or penicllin g
126
lifestyle modifications for CHF
exercise, sodium restriction
127
Mobitz Type I pathophysiology
intranodal or HIS bundle conduction defects that result from medications (e.g., beta blockers, digoxin, calcium channel blockers), increased vagal tone, or right coronary artery mediated ischemi
128
Mobitz Type II pathophysiology
infranodal conduction abnormality in either the bundle of His or Purkinje fibers.
129
LS CHF x ray findings
cardiomegaly
kerley b lines
peribronchial cuffing
cephalization of pulm vasculature
130
clinical features of pleurisy
sharp knife like pain worse on inspiration
| after preceded by URI symptoms
131
emphysema
lung condition highlighted by pathological enlargement of distal airways due to airway destruction.
132
chronic bronchitis
productive cough of at least 3 months per year for 2 consecutive years.
133
COPD risk factors
smoking!!
| pulmonary irritants, alpha-1 antitrypase, asthma
134
protease-antiprotease hypothesis
Nicotine and smoke derived free radicals cause accumulation of PMNs and macrophages in the alveoli.
Activated PMNs → release proteases which result in tissue damage.
Smoking also enhances macrophage elastase activity, which is not susceptible to cleavage by α1-antitrypsin.
135
functional alpha1-antritrypsin def
smoking derived free radicals can disrupt the balance between proteases and anti-proteases by inactivating α1-antitrypsin → "functional" α1-antitrypsin deficiency.
136
COPD patient presents with
combination of cough (productive or non-productive) and dyspnea of insidious onset and chronic duration.
137
COPD PE findings
Hyperinflation or “barrel chest” (increased AP diameter)
Diminished breath sounds
Hyperresonance to percussion
Prolonged expiration with “pursed lips” breathing → sudden expiration may cause atelectasis due to rapidly decreased alveolar pressure.
138
obstructive pattern COPD symtpoms
tachypnea, tachycardia, and cyanosis.
139
wheezes
expiratory, obstruction
140
crackles
inspiratory, opening of collapsed alveoli
141
COPD diagnosis
hyperinflation with an obstructive pattern, and systemic findings of hypoxemia and hypercapnia
142
COPD PFTS
```
Decreased FEV1
Decreased FEV1/FVC ratio
Decreased VC
Decreased DLCO
Increased TLC, RV, FRC (from trapped air)
```
143
COPD ABGs
Chronic respiratory acidosis, leading to chronic metabolic alkalosis → elevated PCO2 and bicarbonate.
Polycythemia may occur in response to chronic hypoxemia.
144
COPD CXR
hyperlucent lung fields. Air trapping can lead to flattening of the diaphragm. In severe disease the heart can also become elongated and tubular shaped as a result of the increased air in the thorax.
145
COPD death
```
Respiratory acidosis and hypercapnic respiratory failure
Cor pulmonale (rare)
Massive spontaneous secondary pneumothorax
```
146
cor pulmonale occurs as result of
hypoxia
147
increased afterload can cause
RV failure
148
COPD treatment goals
reduce obstruction by dilating the airways and reducing mucus secretion, and prevention of disease progression.
149
COPD treatment
1) smoking cessation 2) antitussives/expectoants 3) inhaled b2 agonists 4) anticholinergics 5) inhaled corticosteroids
150
antitussives
dextromethophran
| codeine-guaifenesin
151
inhaled b2 agonists
bronchodilators
| salmeterol
152
inhaled anticholinergics
bronchodilator
ipratropium bromide
slower onset, longer duration
153
inhaled corticosteroids
budesonide, fluticasone
