firecracker 11/28 Flashcards
(132 cards)
1
Q
RHF
A
right ventricle cannot pump blood into lungs
blood accumulates in systemic venous system
2
Q
most common cause of RHF
A
left heart failure
also:
pulmonary HTN, L2R shunt, Tricuspid valve regurg
3
Q
most common cause of RHF if no LSHF
A
COPD
4
Q
cor pulmonale
A
rhf due to chornically elevated pulmonary artery pressures
5
Q
RSHF symptoms
A
HSM
peripheral edema
jugular venous distension
6
Q
hepatomegaly in RSHF
A
venous congestion of hepatic veins of liver
can cause portal htn
7
Q
hepato-jugular reflux
A
pressing on RUQ elcitis distension of right jugular vein
8
Q
peripheral edema cause
A
increase in venous hydrostatic pressure
9
Q
jugular venous distension
A
increased venous pressure in superior venous cava
>4cm abnormal
10
Q
severe pulmonary hypertension ECG
A
P pulmonale
peaked P waves >2.5 in inferior leads II, III, avf
right axis deviation
right ventricular hypertrophy
11
Q
treatment for cor pulmonale
A
adequate oxygenation
correct respiratory acidosis
treat underlying infections
decrease work of breathing using positive pressure or bronchodilators
12
Q
HIT
A
immune mediated reaction after exposure to heparin products
paradoxically pro-thrombotic state
13
Q
pathophysiology of HIT
A
auto-antibodies to platelet factor 4:heparin complex Ab cross react with platelets peripheral activation (thrombosis) and destruction (thrombocytopenia)
14
Q
HIT risk factors
A
unfractionated (vs LMWH)
higher doses
female
recent surgery
15
Q
timing of hit
A
5-10 days after exposure
early onset within 24 hrs if exposed to heparin in past 3 months
16
Q
thrombocytopenia in HIT
A
drop in platelet count >50%
17
Q
thrombosis in HIT
A
venous>arterial
skin necrosis at injection sites
limb gangrene
organ ischemia or infarction
18
Q
4 T score of HIT
A
thrombocytopenia
timing
thrombosis
oTher causes not present
19
Q
HIT diagnosis
A
immunoassay test anti-PF4 antibodies
serotonin release assay
20
Q
management of HIT
A
stop heparin
start direct thrombin inhibitor (argatroban or bivalirudin)
fondaparinux
21
Q
HIT - pts with renal dysfunction
A
argratroban
22
Q
HIT - pts with hepatic dysfunction
A
fondaparinux
23
Q
gout
A
deposition of monosodium urate crystals in joints
24
Q
primary gout
A
hyperuricemia due to nucleic acid metabolism disorders or underexcretion of uric acid
25
secoundary gout
diseases with high metabolic turnover (leukemia, psorasis)
26
gout age groupd
men, 40-60
27
overproduction of uric acid
obesity, cancer, hemoglobinopathies
28
underexcretion of uric acid
renal disease
| diuretic use
29
podagra
first metatarsophalangeal joint
30
gout diagnosis
needle shaped negatively birefringent crystals
| not uric acid
31
tophi
x ray imaging that shows bony erosions and soft tissue crystal deposition
32
gout treatment
nsaids, colchicine, corticosteroids
33
chronic gout treatment
allopurinol (decrease UA production)
| probenecid (inhibit renal UA reabsorption)
34
pleural effusion
collection of fluid between parietal and visceral pleura
35
causes of exudative pleural effusions
lung infections, tb
cancer
pulmonary embolism
impaired pleural lymphatic drainage
36
transudative
increased hydrosatatic pressure or decreased serum oncotic pressure
37
exudate
increased vessel permeability
38
causes of transudative pleural effusion
CHF
nephrosis, cirrhosis
injuries to pleural lining
39
injuries to pleural lining
central venous catheter misplacement
40
pulmonary emobolism - type of pleural effusion
trans or exud
41
chylous effusions
iatrogenic (surgery)
traumatic
malignant
42
pleural effusion symptoms
dyspnea
pleuritic chest pain
worsens with time
associated symptoms (night sweats, wt loss, swelling)
43
pleural effusion physical exam
decreased breath sounds
dullness to percrussion
decreased fremitus
44
pleural effusion cxr
blunting of costophrenic angle
| transudative - bilateral, exudative - unilateral
45
lateral decubitus cxr
most sensitive
46
light's criteria
pleural prot/serum >.5
pleural ldh/serum ldh >.6
pleural ldh greater than 2/3 of normal serum ldh
47
treatment of parapneumonic effusions (around a pneumonia)
antibiotics if uncomplicated
| chest tube drainage if complicated
48
ischemic atn most common cause
pre renal failure
- decreased effective circulating load/preload
- decreased cardiac output
- nsaids
49
DKA potassium levels
low total body levels
| normal/high on labs
50
common cause of nephrotoxic ATN
aminoglycosides, amph b, cisplatinum
| heavy metals, contrast, gram negative sepsis, myoglobinuria
51
meds for pts with coronary interventions
clopidogrel
| gb11a/111b inhibitor
52
decreased effective circulating blood volume
hypovolemia
systemic vasodilation/septic shock
cirrhosis
53
chylous pleural effusion
iatrogenic (surgery)
traumatic
malignant
54
CXR RSHF
right ventricular enelargement
| pulmonary artery dilatation
55
delta gap
AG - 12
/
24 - HCO3
56
ATN - ischemic and nephrotoxic have in common...
disturbances in renal blood flow
| tubular injury
57
RSHF echo
tricuspid regurg
| paradoxical displacement of IV septum into LV during systole
58
agents that cause CAP
```
streptococcus pnemoniae
haemophilus influenzae
klebsiella pneumonia
pseudomonas aeruginosa
staphylococcus aureus
```
59
most common cause of pneumonia
streptococcus pneumoniae
60
risk factors for streptococcus pneumoniae
smoking
copd
immunocompromised
61
H influenzae risk factors
sickle cell dz
copd, smoking
immunocomprimised
alcoholism, diabetes
62
klebsiella risk factors
alcoholics, strokes, elderly, decreased LOC
63
pseudomonas risk factors
structural lung dz: bronchiectasis, cystic fibrosis, copd
hosp or nursing home residents
pts who have received broad spectrum antibiotics or high dose steroid therapy
64
s. aureus risk factors
recent flu or viral illness
skin colonization or staph infection
laryngeal cancer
immunosuppressoin
65
pseudomonas treatment
piperacillin/tazobactam
cefepime
imipenem
meropenem + fluroquinolone
66
symptoms for pneumonia
increased tactile fremtius
dullness to percussion
pleural friction rub
67
atelectasis is
decrease in lung volume secondary to partial collapse of lung tissue
68
atelectasis caused by
operations, impaired inspiratory ability, lack of cough reflex, obstructions/tumors, foreign body in children
69
resorption atelectasis
airway obstructed by foreign object, tumor or thick mucus plug
devoid of lung sounds
70
compression atelectasis
space occupying lesion in pleural caivty (air or fluid) increases pressure
71
atelectasis symptoms
dyspnea, fever
pleuritic chest pain
tachycardia, hypoxia
72
atelectasis physical exam
dullness to percuss
decreased breath sounds
crackles on ausuclation
73
atelectasis CXR
raised diaphram in lower lobe atelectasis
tracheal deviation towards atelectasis in upper lobes
fluffly infiltrates
74
atelectasis treatment
incentive spirometry
deep breathing
ambulation
(bronchoscopy)
75
atelectasis complications
damange to lung parenchyma
pneumonia
resp failure
76
maintaining body ph
bicarbonate buffer in ECF
| proteins and phosphates in ICF
77
phosphate regulation
PTH decreases
insulin lowers
vit D increases
78
signs of pulmonary emoblism - later
resp alkalosis with hypoxia, hypocarbia
loud p2
right heart failure
79
unstable angina
1) chest pain at rest >10 min
2) severe and new onset
3) cresendo pattern
80
most common cause of UA/NSTEMI
rupture of coronary artery plaque --> down stream occlusion
81
unstable angina cause
incomplete stenosis or presence of well-perfused collaterals
82
st depression
subendocardial ischemia
83
NSTEMI vs UA
elevations in cardiac enzymes in NSTEMI
84
pts w/ UA/NSTEMI admit
- telemetry
- serial cardiac enzymes
- possible coronary angiography if indicated
85
Thrombolysis Infarction Risk score
>/= 3 consider LMWH, angiography
Severe angina, coronary artery stensosi >50%, age >65, aspirin use within past 7 days, three or more Risk factors for cad, enzymes elevated, ST segment changes
86
cardiac stress test
- diagnose ischemic heart disease
87
cardiac stress test, how test is performed
exercise --> increase cardiac oxygen demand
| dobutamine -- cardiac INOTROPE
88
stress test with adenosine or dipyridamole
coronary vasodilators
stenotic vessels will dilate less
blood flow through stenotic vessels will be decreased and those tissues will get less oxygen --> "cardiac steal"
89
pre test probability of coronary artery disease
age
sex
typical/definitive AP vs atypical probably AP
nonagnial chest pain
90
high probability patients
more likely to have false negative
91
diagnostic testing for CAD warranted in
pts with symptoms of CAD
asymptomatic pts with high pre test CAD probability
pts with newly diagnosed heart failure
92
asymptomatic pts who should undergo stress testing
>20% 10-year CAD risk
| exercise ECG
93
symptomatic pts with low or intermediate pre-test probability
if able to exercise and have interpretable ECG --> undergo stress exercise testing
94
test of choice for symptomatic pts unable to exericse or uninterpretable ECG
stress radionuclide imaging or echo
95
stress cardiac mri
symptomatic high pre test
96
symptomatic pt with high pre test probability should receive
stress radionucleide imaging, stress echo, stress MRI, or coronary angiography
not exercise ecg
97
newly diagnosed CHF pts
evaluated similarity to symptomatic with high pre test probability
98
exercise stress test that diagnose coronary artery stenosis show
greater than 2mm ST segment depression
| greather than 10mmhg drop in systolic blood pressure
99
drugs that should be held before exercise stress test
beta blockers, non-dihydropyridine calicum channel blockers
certain antiarrhthm - amiodaraone, sotalol
digoxin, nitrates
100
exercise stress testing contraindicated in
unstable patients
patients who cannot exercise
patients with uninterpreable EKGs
101
nuclear stress testing
thallium
accumulates in well-perfused heart tissue
approriate in pts with baseline EKG abnormalities
102
coronary angiography
most sensitive and specific for CAD
| allows immediate intervention (stent placement)
103
A fib
signal from SA node is overwhelmed by disorganized signals from other areas
myocytes contracting at different times
104
most important risk factor for A fibrillation
mitral valve stenosis
105
A fib incidence increases with
age
106
atrial rate vs ventricular rate
500bpm vs 120-180
107
A fib symptoms
palpitations
exercise intolerance
venous statsis --> SOB, edema
108
A fib EKG/PE
>100 bmp
irregularly regular rhythm with ventricular rate >100 bmp
absence of p waves
narrow QRS complexes
109
lab tests for A fib
renal function
electrolytes
TSH
CBC
110
complications of a fib arise from
reduced CO
increased cardiac oxygen demand
thromboembolism
111
A fib - blood remains
in atrium, may lead to clot --> emoblic event --> stroke
112
increased cardiac oxygen demand
can lead to MI
113
reduced cardiac output can lead to
CHF symptoms like pulmonary or lower leg edema
114
treatment of a fib - ventricular rate
beta blocker, calcium channel blocker
115
chemical cardioversion of a fib
```
class IC (propafenone, flecainide)
class III (ibutilide, dofetilide > amiodarone, sotalol)
```
116
electric cardioversion in afib
delivery of DC synchronized with QRS complex
117
CHADS
CHF, HTN, Age > 75 (2 pts)
DM
Previous stroke or TIA (2)
118
VASC
vascular dz
age >65 but less than 75
sex cateogry - female
119
anticoagulation with a fib
warfarin
| dabigatran
120
warfarin causes prolongation of
PT/INR, aPTT
121
a fib rate control
```
class II (BB)
class IV (CCBs)
```
122
ventricular rate ontrol
slows conduction from fibrilating atria to ventricles
| pts >65
123
rhythm control
propafenone, dofetilide, amiodarone
| alter cardiac potential
124
CHADSVASC of 1
aspirin
125
CHADSVASC of 2
anticoagulation
126
TTP and HUS characterized by
microangiopathic hemolytic anemia
+
thrombocytopenia
127
TTP vs HUS
neuro symptoms - TTP
| renal symptoms - HUS
128
TTP/HUS pentad
```
F - fever
A - micoangiopathic anemia
T - thrombocytopenia
R - acute kidney injury
N - neuro abnormalities (AMS)
```
129
MAHA
non-immune hemolysis
| RBC fragmentation = schitocytes
130
TTP/HUS associated symptoms
bloody diarrhea ( e coli 0157h7)
pregnancy
meds - mitomycin C, cyclosporine, gemcitabine
131
lab studies for TTP/HUS
schistocytes
elevated LDH
decreased haptoglobin
<10% ADAMTS13
132
TTP/HUS treatment
plasma exchange
| normalize platelet count, LDH level
