Midterm B Flashcards
(296 cards)
1
Q
Pathophysiology of ischemic heart disease
A
Myocardial metabolic oxygen demand that exceeds myocardial oxygen supply
2
Q
Top causes of ischemic heart disease
A
- Thrombosis
- Coronary arterial vasospasm
3
Q
Top risk factors for coronary artery disease
A
- Male
- Increasing age
4
Q
Most reversible risk factor for CAD
A
Smoking
5
Q
What is angina pectoris
A
Chest pain and pressure due to ischemia of myocardium
6
Q
What is chronic stable angina
A
Angina that occurs predictably with exertion
7
Q
Criteria for unstable angina
A
1) Abrupt increase in severity or frequency
2) Angina at rest
3) New onset of angina
8
Q
Angina pectoris is often absent unless the atherosclerotic lesion causes what percentage of coronary occlusion
A
50-75%
9
Q
There is maximal compensatory dilation distal to an atherosclerotic lesion when it has reached __% occlusion
A
70
10
Q
ECG diagnosis of angina
A
ST depression over 1mm with or without T wave inversion
11
Q
Gold standard for angina diagnosis
A
Coronary angiography - determines anatomic extent of CAD and LV function
12
Q
Nearly all MIs are caused by what?
A
Thrombotic occlusion of a coronary artery
13
Q
3 criteria for diagnosing an MI
A
1) Clinical history of angina pectoris
2) Serial ECG changes indicative of MI - ST changes, T wave inversion, bundle branch block
3) Rise and fall of serum cardiac enzymes (troponin)
14
Q
Treatment options for an MI (MONA)
A
- Morphine (to reduce pain/anxiety thus reducing myocardial oxygen demand)
- Oxygen
- Nitrates
- Aspirin (thin blood to get rid of clots)
15
Q
Patient populations at greatest risk of cardiac complications under anesthesia
A
- Extensive CAD
- Recent history of MI
- Ventricular dysfunction
16
Q
Valvular diseases that produce systolic murmurs
A
- Aortic or pulmonary stenosis
- Mitral or tricuspid regurgitation
17
Q
Valvular diseases that produce diastolic murmurs
A
- Mitral or tricuspid stenosis
- Aortic or pulmonary regurgitation
18
Q
Most common dysrhythmia with rheumatic mitral valve disease and left atrial enlargement
A
A-fib
19
Q
Heart valve most often affected by rheumatic disease
A
Mitral valve
20
Q
Effect of mitral stenosis on lungs
A
Could cause pulmonary edema due to high left atrial pressures that cause an increase in pulmonary venous pressure
21
Q
A patient with mitral stenosis becomes symptomatic with a mitral valve area less than…
A
1cm^2
22
Q
A transvalvular pressure gradient over __mmHg is indicative of severe mitral stenosis
A
10
23
Q
Treatment of mitral stenosis
A
- Diuretics
- Rate control for a-fib with digoxin, b-blockers, ca2+ blockers
24
Q
What should be avoided intra-op when managing a patient with mitral stenosis
A
- Tachycardia (b/c it further impairs LV filling)
- Increases in blood volume
- Decreases in SVR (b/c that could cause tachycardia which is not tolerated)
- Hypoxemia/hypercarbia (bc it could exacerbate pulmonary hypertension)
25
Principle pathologic change caused by mitral regurgitation
Left atrial volume overload
26
Severe mitral regurgitation is defined as having a regurgitant fraction over...
0.6
27
Fraction of stroke volume that enters left atrium in a patient with mitral regurgitation depends on what 3 factors
- Size of mitral valve orifice
- Heart rate
- Pressure gradient across mitral valve
28
What should be avoided during anesthetic management of a patient with mitral regurgitation
- Sudden decreases in HR
- Sudden increases in SVR
- Drug induced myocardial depression
29
How can the magnitude of regurgitant flow in a patient with MR be monitored intra-op?
With an echo/pulmonary catheter
30
What is mitral valve prolapse
Prolapse of one or both mitral leaflets into the left atrium during systole - can occur with or without mitral regurg
31
Mitral valve prolapse is associated with what heart sounds?
Mid-systolic click and late systolic murmur (click-murmur syndrome)
32
What is the most common form of valvular heart disease?
Mitral valve prolapse
33
Anesthetic management of a patient with mitral valve prolapse is similar to the management of what other valvular disease?
Mitral regurgitation
34
Aortic stenosis is considered critical when the transvalvular pressure rises above
50mmHg
35
Aortic stenosis is considered critical when the orifice area is below
0.8cm^2
36
Murmur associated with AS and location it is best heard
Systolic ejection murmur that radiates to the neck, best heard at 2nd right ICS
37
Anesthetic considerations for a patient with aortic stenosis
- Maintain normal sinus rhythm (loss of atrial contraction may cause decrease in stroke volume and blood pressure)
- Avoid tachy/bradycardia
- Avoid sudden changes in SVR
- Optimize intravascular fluid volume
38
Murmur associated with aortic regurgitation
Blowing murmur heard along right sternal border
39
During anesthetic management of a patient with AR, it is best to keep their HR under
80
40
What is the most common cause of tricuspid regurgitation?
Pulmonary hypertension which causes dilation of the right ventricle
41
Signs of tricuspid regurgitation
- Jugular vein distension
- Hepatomegaly
- Ascites
- Peripheral edema
42
Anesthetic considerations for a patient with tricuspid regurgitation
- Maintain fluid volume and CVPs high to facilitate adequate preload
- Avoid hypoxemia and hypercarbia because those increase PVR
- Use agents that produce PA vasodilation
43
What is the most common circulatory derangement in adults?
Systemic hypertension
44
Criteria for diagnosis of systemic HTN
Blood pressure over 140/90 on 2 occasions measured 1-2 weeks apart
45
Which type of HTN, essential or secondary, is most common?
Essential HTN - accounts for 95% of HTN cases
46
Most common cause of secondary HTN
Renovascular HTN from renal artery stenosis
47
How is a hypertensive crisis defined
Acute diastolic BP increases over 130mmHg
48
What is the desired decrease in BP during treatment of a hypertensive crisis?
Decrease MAP by 20% in first 2 hours, then additional decreases over next 1-2 days. DON'T decrease to normotensive levels right away.
49
Drug treatments for a hypertensive crisis
- Nitroprusside 0.5-10mcg/kg/min
- Hydralazine
- Nitroglycerin
50
Most common form of heart failure
Left sided heart failure
51
What is the most common cause of right sided heart failure?
Left sided heart failure
52
Systolic heart failure is defined as an ejection fraction below
45%
53
Class I heart failure
Ordinary physical activity does not cause symptoms
54
Class II heart failure
Symptoms occur with ordinary exertion
55
Class III heart failure
Symptoms occur with less than ordinary exertion
56
Class IV heart failure
Symptoms occur at rest
57
Hallmark symptoms of left sided CHF
- Pulmonary systems including dyspnea, tachypnea, orthopnea, PND, S3 heart sounds
- Rales
- Pulmonary edema
58
Hallmark symptoms of right sided CHF
Systemic venous congestion with JVD, organomegaly, RUQ tenderness, elevated liver enzymes, peripheral edema
59
Which lab and values are important in diagnosing CHF
```
Serum BNP (beta naturitic peptide)
Under 100=negative
100-500=intermediate probability
Over 500=indicative of CHF
```
60
Most useful test in the diagnosis of CHF
ECHO
61
What drugs are great to use intraop in a patient with CHF and why?
Opioids because they inhibit adrenergic activation
62
What is the most common cardiomyopathy
Dilated cardiomyopathy
63
Top cause of secondary cardiomyopathy
Amyloidosis
64
What is cor pulmonale
Chronic right ventricular enlargement
65
Top cause of cor pulmonale
Diseases that induce pulmonary HTN such as COPD
66
EKG manifestation of cor pulmonale
Peaked p waves in leads II, III, and AVF
67
What is pericardial effusion
Abnormal accumulation of fluid in the pericardial cavity
68
What is cardiac tamponade
Pericardial effusion with enough pressure to adversely affect heart function
69
What part of the heart is assessed with standard 6 limb leads
Frontal plane - heart activity moving up, down, right, and left
70
What part of the heart is seen with the 6 precordial leads (V1-V6)
Horizontal plane - view the heart's activity moving anteriorly and posteriorly
71
Inferior heart leads
II, III, aVF
72
Left lateral heart leads
I, aVL, V5, V6
73
Interventricular septum leads
V1, V2
74
Anterior heart leads
V3, V4
75
Which leads should have a biphasic p wave
III, V1
76
Which leads should have a negative P wave
aVR
77
Normal PR interval
0.12-0.2 seconds
78
Which leads should show septal Q waves
I, aVL, V5, V6
79
QT interval duration is proportionate to what other value
Heart rate
80
R wave progression is seen in which leads
Precordial leads V1-V5
81
Most common uses for exercise stress test
Diagnosing CAD and identifying ischemia
82
Sestamibi imaging/technitium scanning is commonly used in tests involving the...
Myocardium or thyroid gland
83
Use of a transthoracic echocardiogram (TTE)
Assessing the overall health of the heart
84
Patients with ejection fractions less than __% tend to have severe disease and increased perioperative morbidity
50%
85
A transesophageal echo (TEE) can image certain parts of the heart better than a TTE and has a high sensitivity for locating what?
A blood clot inside the left atrium
86
What is a myocardial perfusion scan
A type of nuclear medicine test that injects a tracer (Thallium) into a vein and looks at Thallium uptake by the myocardium
87
What is the gold standard in evaluating coronary artery disease
Coronary angiography
88
What is a Holter monitor
Portable device for continuously monitoring various electrical activity of the CV system ofter 2 weeks at a time
89
Diseases commonly diagnosed by chest x-ray
- Pneumonia
| - CHF
90
Pulmonary vessels are seen best on which chest x ray view?
Lateral
91
Grade of 4+ for arterial pulse
Bounding
92
Grade of 3+ for arterial pulse
Increased
93
Grade of 2+ for arterial pulse
Brisk, expected
94
Grade of 1+ for arterial pulse
Diminished, weaker than expected
95
Grade of 0 for arterial pulse
Absent, not palpable
96
What is claudication? What disease is it associated with?
Pain with walking that is relieved with rest. Associated with peripheral artery disease
97
What is pitting edema
Indentation persisting after the release of pressure on the skin
98
Purpose of The Allen's Test
Assess adequacy of circulation to the hand prior to radial/ulnar artery cannulation
99
Clinical manifestations of Acute Arterial Occlusion "Cold Leg" (the 6 P's)
- Pain
- Pallor
- Pulselessness
- Paresthesias
- Paralysis
- Poikilothermia (inability to regulate body temperature)
100
What is Raynaud's phenomenon
Vasospastic disorder causing discoloration of the fingers and toes
101
Methods to diagnose a DVT
- D-dimer
| - Doppler ultrasound
102
Top cause of aortic aneurysms
Hypertension
103
Where must BP be monitored in a patient having an aortic aneurysm surgery
On the right arm b/c the aortic cross clamp is just distal to left subclavian artery
104
When managing aortic aneurysm surgeries, maintain MAPs near ___ mmHg above the cross clamp and above __ mmHg distal to the cross clamp to maintain tissue perfusion
100 above cross clamp, 50 distal to cross clamp
105
What drug is administered before cross-clamping the aorta during aortic aneurysm surgery to improve renal cortical blood flow and GFR?
Mannitol
106
What is a myocardial infarction
When one of the coronary arteries becomes totally occluded and a region of the myocardium dies
107
Cardiac enzymes used to diagnose an MI
- Troponin
- CK-MB
- CK-nonspecific
108
ECG changes with an MI
1) T waves peaking
2) ST elevation
3) Appearance of Q waves
4) T waves eventually inverting
109
How do cardiac enzymes change with an MI?
- CK-MB rises within 6 hours after an MI then level out within 48 hours
- Troponin T and I remain elevated for 5 - 7 days, they are more specific but you can't tell how recent an MI was just by using these
110
True or false - T wave inversion is diagnostic of an MI
False - it can also be seen with other conditions
111
What is a type of ST segment elevation seen in normal hearts?
J point elevation
112
What does the appearance of a pathologic Q wave indicate?
Irreversible myocardial death
113
True or False - pathologic Q waves are diagnostic of an MI
True
114
Why do Q waves form after an MI?
The part of the myocardium that dies becomes electrically silent and no longer conducts current, so all electrical forces move away from the area of infarction, causing a negative deflection
115
It is normal to see Q waves in which leads?
- Small Q waves in I, aVL, V5, V6.
- Sometimes II and III.
- Deep waves in aVR
116
What are the characteristics of pathologic Q waves?
- Greater than 0.04 seconds
| - Depth is 1/3 the height of the R wave
117
What is the most common place in the heart to suffer an MI?
Left ventricle
118
Inferior infarcts are caused by occlusion of...
- Right coronary artery OR
| - Descending branch of left coronary artery
119
In which leads are EKG changes seen with an inferior infarct
II, III, aVF
120
Lateral wall infarcts are caused by occlusion of=f...
Left circumflex artery
121
In which leads are EKG changes seen with a lateral wall infarct
I, aVL, V5, V6
122
Anterior wall MIs are caused by occlusion of...
Left anterior descending artery
123
What infarction may occur if the left main artery is occluded?
Anterolateral infarction
124
In which leads are EKG changes seen with an anterior wall MI seen
V2, V3, V4
125
Which infarctions are characterized by poor R wave progression
Anterior wall MIs (poor R wave progression=progressively increasing R wave amplitudes moving through the precordial leads)
126
Posterior wall MIs are caused by occlusion of...
right coronary artery
127
What indicates posterior wall MIs on an EKG?
Reciprocal changes in anterior leads - ST depression and tall R waves
128
EKG changes with angina attacks
- ST depression
| - T wave inversion
129
Which pre-existing conditions make an EKG unreliable when diagnosing an MI?
- WPW syndrome
| - LBBB
130
In which leads are reciprocal changes seen during an inferior infarct?
Anterior or lateral
131
In which leads are reciprocal changes seen during a lateral wall infarct?
Inferior leads
132
In which leads are reciprocal changes seen during an anterior wall MI?
Inferior leads
133
In which leads are reciprocal changes seen during a posterior wall MI?
Anterior leads
134
Virchow's triad of risk factors for a pulmonary embolism
1) Stasis
2) Vessel wall injury
3) Hypercoagulability
135
Clinical manifestations of a pulmonary embolism
- Acute dyspnea
- Tachypnea
- Pleuritic chest pain
- Nonproductive cough
- Cyanosis
- S2 sound
- Tachycardia
136
Treatment options for a pulmonary embolism
- Anticoagulation
- Inotropes (for hypotension caused by low C.O.)
- Airway management
- PA embolectomy
137
Definition of pulmonary hypertension
Mean pulmonary artery pressure greater than 25mmHg at rest, with PCWP, LAP, or LVEDP 15mmHg or less
138
Pre-op considerations for a patient with pulmonary HTN
- Preop sildenafil or L-arginine
- Inhaled NO or prostacyclin
- CAUTION: sedatives (increase PVR), ketamine/etomidate (suppress pulmonary relaxation)
139
Intraop monitoring considerations for a patient with pulmonary HTN
- Central line
| - A-line
140
How should hypotension be treated in patients with pulmonary HTN
Norepi, phenylephrine, or fluids
141
What pulmonary vasodilators should you have ready in patients with pulmonary HTN?
- Milrinone
- NTG
- NO
- Prostacyclin
142
What is COPD
Pulmonary disease characterized by the progressive development of airflow limitation that is not fully reversible
143
COPD encompasses what 2 diseases
- Chronic bronchitis (obstruction of small airways)
| - Emphysema (enlargement of airspaces and destruction of parenchyma)
144
"Pink puffers" have a PaO2 greater than...
65mmHg
145
How is PaCO2 changed in pink puffers
Normal to slightly decreased
146
Blue bloaters have a PaO2 less than__mmHg and a PaCO2 over __mmHg
PaO2 under 65, PaCO2 over 45
147
Drug therapy options for patients with COPD
- Bronchodilator
- Anticholinergics
- Inhaled corticosteroids
- Antibiotics
148
What is bronchiectasis
Chronic suppurative disease of the airways of infective ideology causing destruction of airways and recurrent infections
149
What is cystic fibrosis
Mutation in chloride ion transport resulting in viscous secretions resulting in luminal airway obstruction
150
What is Primary Ciliary Dyskinesia
Congenital impairment of ciliary activity in respiratory tract epithelial cells and sperm tails (chronic sinusitis, OM, productive cough & infertility)
151
Asthma is characterized by what airway changes
- Chronic airway inflammation
- Reversible expiratory obstruction
- Airway hyperreactivity
152
Clinical manifestations of asthma
Wheezing, cough, dyspnea
153
Drug therapy options for asthma
- Anti-inflammatory drugs (corticosteroids, cromolyn, leukotriene modifiers)
- Bronchodilators
- Theophylline
154
What pre-op/pain medications should be avoided in patients with asthma
NSAIDs
155
What is restrictive lung disease
Lung diseases characterized by decreases in total lung capacity, usually caused by intrinsic disease process that alters the elastic properties of the lungs and stiffens them
156
Causes of acute intrinsic RLDs
ARDS, aspiration, upper airway obstruction, CHF
157
Causes of chronic intrinsic RLDs
Sarcoidosis, hypersensitivity pneumonitis, drug-induced pulmonary fibrosis
158
Causes of chronic extrinsic RLDs
Obesity, pregnancy, ascites, skeletal deformities
159
Clinical manifestations of RLD
- Decreased vital capacity (FEV1/FVC)
- Dyspnea
- Hypercarbia leads to vasoconstrictive pulmonary HTN and cor pulmonale
- Recurring of atelectasis and pneumonia
160
Patients with RLD usually have a total lung capacity less than __% of normal
80
161
What is acute respiratory failure
Inability of patient's lungs to provide adequate arterial oxygenation, with or without acceptable elimination of CO2
162
Criteria for acute respiratory failure diagnosis
- PaO2 less than 60mmHg
| - PaCO2 over 50
163
How is acute respiratory failure is distinguished from chronic respiratory failure
Patients with chronic failure have a normal pH, patients with acute failure have a decreased pH
164
Is hypertrophy caused by a volume overload or a pressure overload?
Pressure overload, when the ventricle pumps against increased resistance or a stenotic valve
165
Is enlargement caused by a volume overload or a pressure overload?
Volume overload - chambers dilate to accommodate increased amount of blood
166
What portion of the EKG do we look at to assess atrial enlargement?
P wave
167
What portion of the EKG do we look at to assess ventricular hypertrophy?
QRS complex
168
3 ways an EKG wave can change when a chamber enlarges or hypertrophies
1) EKG wave increases in duration since chamber takes longer to depolarize
2) Wave may increase in amplitude since chamber can generate more current
3) Electric axis may shift
169
Normal QRS vector lies between...
-30 and +90 degrees
170
The QRS axis must be normal if the QRS is positive in which 2 leads?
I and aVR
171
Right axis deviation lies between which axis points
90-180 degrees
172
Left axis deviation lies between which axis points
0 and -90 degrees
173
Extreme right axis deviation lies between which axis points
-90 and -180 degrees
174
Atrial enlargement is assessed in which leads
II and V1
175
Which lead is oriented parallel to the flow of current through the atria?
Lead II
176
Which lead is oriented perpendicular to the flow of current through the atria?
V1
177
Right atrial enlargement is often referred to as what?
P pulmonale - because it is often caused by severe lung disease
178
Right atrial enlargement often causes what axis deviation?
Right axis deviation
179
The enlargement of which atria causes a prominent increase in duration of the p wave?
Left atrium
180
Left atrial enlargement is often referred to as what?
P mitrale - because mitral valve disease is a common cause of left atrial enlargement
181
The diagnosis of left atrial enlargement requires what EKG change?
The terminal (left) portion of the p wave should drop at least 1 mm below the isoelectric line in V1
182
The diagnosis of right atrial enlargement requires what EKG change?
P waves with an amplitude exceeding 2.5mm in inferior leads
183
What axis deviation is seen with left atrial enlargement?
None because the left atrium is normally electrically dominant
184
Axis deviation associated with right ventricular hypertrophy
Right axis deviation
185
Most common causes of right ventricular hypertrophy
Pulmonary disease and congenital heart disease
186
Most accurate precordial lead criteria for diagnosing left ventricular hypertrophy
R wave amplitude in lead V5 or V6 plus the S wave amplitude in V1 or V2 exceeds 35mm
187
Most accurate limb lead criteria for diagnosing left ventricular hypertrophy
R wave amplitude in aVL exceeds 13mm
188
Most accurate precordial lead change for diagnosing right ventricular hypertrophy
R wave larger than S wave in V1, S wave larger than R wave in V6 (R wave progression is disrupted)
189
Surgical infection guidelines state that prophylactic antibiotics should be given within __ hour(s) of surgery and stopped after __ hour(s) post op
Given within 1 hour, stopped within 24 hours (or 48 for cardiac surgery)
190
Prophylactic antibiotics given for many commonly performed procedures in the OR
- Cephalosporin
| - Vancomycin
191
Why should vancomycin be administered slowly
To avoid Red man syndrome - a drug induced histamine release
192
Preventative measures against infection
- Increase FiO2
- Avoid hypothermia
- Analgesia
- Avoid hypocapnea
- Avoid hypoglycemia
193
Major cause of blood stream infections
Central venous catheters
194
CVC location most at risk for infection
Femoral
195
What is sepsis
Infection with systemic inflammatory response syndrome
196
What is severe sepsis
Sepsis plus organ dysfunction
197
What is septic shock
Severe sepsis plus hypotension (systolic BP under 90)
198
Anesthetic management of a patient with sepsis/septic shock
- Keep MAP over 65
- CVP 8-12mmhg
- Adequate urine output
- MvO2 over 70%
199
Effects of sepsis on pulmonary system
- Increased minute ventilation and airway resistance
- Decreased compliance and skeletal muscle efficiency
- Tachypnea
- Arterial hypoxemia
200
Effects of septic shock on cardiovascular system
- Systolic BP under 90 and unresponsive to fluids
| - Low cardiac filling pressures and output
201
Effects of sepsis on kidneys
Transient oliguria related to hypotension
202
Effects of sepsis on GI system
- "Shock liver"
- Ileus
- Malnutrition
203
Effects of sepsis on coagulation system
- Vitamin K deficiency
- Effects on factors 2, 7, 9, 10
- Thrombocytopenia
- DIC (formation of blood clots in small vessels throughout the body)
204
What infection is defined as an anaerobic, gram positive spore forming organism causing antibiotic assoc. diarrhea and pseudomembranous colitis
C. diff
205
Risk factors for C. diff infection
- Chronic antibiotics
- Depressed immune system
- Old day
- GI surgery
- NG tube
- ICU stay
206
Signs and symptoms of C. diff infection
- Diarrhea
| - Abdominal pain
207
Examples of necrotizing soft tissue infections
- Gas gangrene
- Fournier's gangrene
- Severe cellulitis
- "Flesh eating infections"
208
Types of pneumonia
- Community acquired
- Aspiration
- Post-operative
- Lung abscess
- Ventilator associated
209
Treatment for pneumonia
Antibiotics 10-14 days
210
Most cases of TB occur in what populations?
- Racial/ethnic minorities
- IV drug abusers
- AIDS patients
211
How is TB transmitted
Inhaled aerosolized droplets
212
What antibiotic is used to treat TB?
Isoniazid
213
Safety precautions for a patient with TB
- Universal precautions
- Postpone elective procedures
- If not elective - negative pressure room, patient wears mask, HEPA filter on circuit, personnel wear N95
214
Symptoms of influenza
Myalgias, malaise, headache
215
Treatments for influenza
- Amantadine
- Rimantidine
- Zanamivir
216
Route of transmission for herpes type 1
Oral
217
Route of transmission for herpes type 2
Genital
218
Varicella-zoster is common in what patients
Immunocompromised
219
Side effects of Epstein-Barr virus
Fever, LAD, splenomegaly
220
AIDS is initiated by which virus?
HIV 1 and 2 which destroys T cells
221
Which antiviral medication greatly reduces risk of AIDs transmission?
Zidovudine (AZT)
222
Which lab value is used to diagnose AIDs
CD4 T cell count below 200
223
Safety precautions used for patients with AIDs
Universal precautions
224
How are hepatitis A and E transmitted
Fecal-oral
225
What is infective endocarditis
Microbial infection that implants on heart valves
226
Predisposing factors for infective endocarditis
1) Prosthetic heart valves
2) History of endocarditis
3) Congenital heart disease
227
Signs/symptoms of infective endocarditis
- Heart murmur
- Anemia
- Fever
228
Most frequent cardiac complication associated with infective endocarditis
CHF
229
Standard antibiotic used for general endocarditis prophylaxis
Amoxicillin 2g PO
230
Antibiotic available for endocarditis prophylaxis for patients unable to take oral amoxicillin
2 g Ampicillin
231
Antibiotics available for endocarditis prophylaxis for patients who are allergic to PCN
- 600mg clindamycin PO
| - Cephalexin
232
Antibiotics available for endocarditis prophylaxis for patients who cannot take oral medications and are allergic to PCN
600mg clindamycin IV
233
Infection characterized by inflammation of sinus epithelium
Acute sinusitis
234
Infection characterized by ear infection from nasopharynx to middle ear
Acute otitis media
235
Infection characterized by inflammation of pharynx
Pharyngitis
236
A URI that is a complication of strep tonsilitis
Peritonsillar abscess
237
URI that is characterized by soft tissue swelling and forward displacement of the larynx
Retropharyngeal infections
238
What is Ludwig's angina
Cellulitis of submandibular, sublingual, and submental regions (caused by strep and causes fever and rapidly progressive edema)
239
What infection epidemic is due to lack of vaccination against Haemophiuls influenzae
Acute epiglottitis
240
What intra-abdominal infection is suspected in patients who have undergone abdominal surgery who have unexplained fever
Subphrenic abscess
241
What is the most common of all bacterial infections affecting humans
Urinary tract infections
242
UTIs are most common in which population?
Females under 50
243
What is osteomyelitis
Progressive inflammatory destruction of bone caused by staph aureus
244
3 main types of conduction blocks
- Sinus node block
- AV block
- Bundle branch block
245
What is a fascicular block?
A block of only one part of one of the bundle branches
246
How is an AV block diagnose?
Examining the relationship of P waves to QRS complexes
247
First degree AV block is characterized by what EKG change
PR interval greater than 0.2 seconds
248
What EKG changes characterize a 2nd degree AV block Mobitz I
- Successively longer PR intervals until one QRS fails
| - Irregular ventricular rhythm
249
What EKG changes characterize a 2nd degree AV block Mobitz II
PR intervals are similar and don't increase in length, but a QRS is suddenly dropped
250
What is a 3rd degree AV block
When there is no association between atria and ventricles, they are depolarizing independently
251
EKG criteria to diagnose a right bundle branch block
- R/R' waves in V1 and V2
| - Slurred S wave in V5, V6, lead I
252
EKG criteria to diagnose a left bundle branch block
- "Blunted" positive QRS and inverted T wave in V5, V6, lead I
- Predominately negative QRS in V1-V3
253
What is a hemiblock?
A conduction block of just one of the fascicles of the left bundle branch
254
What is the major effects that hemiblocks have on EKG?
Axis deviation
255
What is a left anterior hemiblock?
Conduction down the left anterior fascicle is blocked, so current rushed down left posterior fascicle to inferior surface of the heart - depolarizing goes from inferior --> posterior and right --> left
256
Axis of depolarization with a left anterior hemiblock
Upward and slightly left
257
EKG changes with left anterior hemiblock
- Tall R waves in left lateral leads
| - Deep S waves in inferior leads
258
What is a left posterior hemiblock?
All of the current rushes down the left anterior fascicle and ventricle myocardial depolarization ensues superior to inferior and left to right in direction
259
Axis of depolarization with a left posterior hemiblock
Downward and to the right
260
EKG changes with left posterior hemiblock
- Tall R waves in inferior leads
| - Deep S waves in left lateral leads
261
How are hemiblocks eventually diagnosed?
By seeing left or right axis deviation with no other causes found
262
Top cause of right sided heart failure
Left sided heart failure
263
Cardiac condition that elevated BNP levels are associated with
CHF
264
Best test to diagnose CHF
Echo
265
Claudication is a sign of what
Peripheral artery disease
266
Risk factors for developing a PE
Virchow's triad
1) Stasis
2) Vessel wall injury
3) Hypercoagulability
267
Pathology of pulmonary HTN
Develops as result of pulmonary vasoconstriction, vascular wall remodeling, and thrombosis. Causes increased RV wall stress
268
Criteria for pulmonary HTN
PAP over 25mmHg with PCWP, LAP, or LVEDP less than 15mmHg
269
In right axis deviation, lead I is ______ (+/-) and avF is ______ (+/-)
Lead I negative, aVF positive
270
In left axis deviation, lead I is ______ (+/-) and avF is ______ (+/-)
Lead I positive, aVR negative
271
Tests used to diagnose AIDS
- ELISA
- Positive western blot test
- CD4 T cell count below 200
272
Aortic stenosis murmur
Mid-systolic murmur, crescendo/decrescendo, radiates to neck
273
Mitral valve prolapse murmur
Mid-systolic click
274
Mitral regurgitation murmur
Pansystolic/holosystolic apical murmur, radiates to axilla
275
Tricuspid regurgitation murmur
Pansystolic
276
2 main diastolic murmurs
- Aortic regurgitation
| - Mitral stenosis
277
Mitral stenosis murmur
Opening snap
278
Aortic regurgitation murmur
Blowing
279
Signs and symptoms of left ventricular heart failure
Symptoms - dyspnea, tachypnea, orthopnea, PND, S3
| Signs - rales
280
Presentation of cardiac tamponade
- Dyspnea, hypotension, distant heart sounds
| - "Water bottle heart" on chest X ray
281
Risk factors for clostridium difficile colitis
- Antibiotics
- Depressed immune system
- Old age
- GI surgery
- NG tube
- Antiulcer meds
- Long hospital stay
282
Risk factors for ischemic heart disease
- Male gender
- Increasing age
- HTN
- Smoking
- Hypercholesterolemia
- DIabetes
- Obesity
283
Fastest AMI treatment for re-perfusion of coronary arteries
Thrombolytic therapy within 30-60 minutes of hospital arrival
284
Effects of obstructive lung disease on lung volume
- Can increase lung volumes due to air trapping
- Decreased FEV1/FVC
- Normal to increased FRC/TLC
- Increased residual volume
285
Components of universal precautions
- Handwashing
- Decontaminate equipment
- Use and dispose of needles, AVOID RECAPPING
- Wear protective items
286
Artery that is blocked when EKG changes are seen in I, V5, V6, aVL
Left circumflex
287
Definition of bruit
Turbulent flow with aneurysm or thrombosis
288
Drugs to stop the morning of surgery for CHF
- Diuretics
- ACE inhibitors (usually)
- ARBs
289
Describe vesicular breath sounds
"Gentle sighing" - soft, low pitched. Heart on inspiration at base of lung
290
What diseases will prevent diagnosing an MI from EKG
- WPW
| - LBBB
291
Barrel chest is associated with what disease
Emphysema
292
Candidiasis can be caused by what
Steroid inhaler
293
Physical exam finding of carotid stenosis
Carotid bruits
294
Atrial enlargement is assessed with which leads
II and V1
295
Normal angle for neck extension
30 degrees
296
Views available from chest X ray
- Anterior posterior
- Lateral
- Oblique
