pulm 2 Flashcards by Kelly MacWhorter

*** sarcoidosis, amyloidosis, hemochromatosis

causes of restrictive cardiomyopathy with preserved ejection HF

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*** neuropathy, easy bruising, enlarged tongue, proteinuria, early satiety, edema, subcutaneous nodules

amyloidosis

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*** what is reflected during inspiratory hold?

pulmonary compliance

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*** what is reflected during expiratory hold?

PEEP

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4 types of lung cancer

adenocarcinoma
squamous cell
small cell
large cell

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two peripherally located lung cancers

adenocarcinoma

large cell carcinoma

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*** gynecomastia and galactorrhea in lung cancer

large cell carcinoma

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diastolic murmur, left sternal border, loudest with sitting up, leaning forward and expiration

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*** healthy woman found to have diastolic murmur, should she get a workup?

YES - diastolic murmurs likely pathologic, fo/u with echo

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*** what post-MI complications can occur with RCA occlusion

RV failure
papillary muscle rupture (new murmur)
interventricular septum rupture (new murmur)

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*** post-MI complications with LAD occlusion

interventricular septum rupture
free wall rupture
left ventricular aneurysm

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pt has new holosystolic murmur after MI and echo reveals new MR - what vessel was occluded?

RCA

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pleural plaques

asbestosis

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3 most common causes of cough

asthma, GERD, post-nasal drip

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rx that increases natriuresis, decreases serum angio II concentration, and decreases aldo production

direct renin inhibitor (aliskiren)

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*** first line tx of aortic dissection

IV BB to reduce HR, SBP, and LV contractility

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can vasodilators hydralazine and nitroprusside result in reflex sympathetic stimulation with consequent rise in HR, LV contractility, and aorta wall stress?

YES - why we don’t use them in aortic dissection management

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*** common causes of cor pulmonale (R HF due to lung disease)

COPD
ILD
pulmonary vascular disease
OSA

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elevated pulmonary artery systolic pressure, hepatomegaly, chronic COPD, elevated JVD, ascites, pleural effusion, edema

Cor Pulmonale

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tx of prinzmetal/vasospastic angina

CCB for prevention, nitroglycerin for abortive

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AD disorder, aortic regurgitation, aortic dissection, pneumothorax, eye abnormalities

marfan syndrome

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*** how is uremic cause of pericarditis different than others?

does not typically cause diffuse ST elevation

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4 tx for COPD exacerbation

Oxygen
Inhaled bronchodilators
Systemic glucocorticoids
Antibiotics

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EKG finding indicative of LVH

increased QRS complex voltage

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use of ambulatory blood pressure monitoring

when you suspect elevated BP based on clinical findings/symptoms (end organ damage - retionopathy, LVH, AMS) but normal BP in office

when holter monitor

patients with palpitations, syncope, prescynope

vision changes but no neurological symptoms - focal weakness, facial droop, visual field defects

more likely 2/2 HTN, rather than brain ischmia

cardiac manifestation of lyme disease

AV block

cough, large-volume mucopurulent sputum production, hemoptysis, dyspnea

bronchiectasis

diagnostic test for bronchiestasis

high-resolution CT

*** young pt with back pain, worst at night, elevated ESR, improvement with NSAID

ankylosing spondylitis

can someone with AS have restrictive pattern on PFTs due to limited chest expansion and spinal mobility

YES

what anticoagulants to avoid in someone with impaired kidney function?

LMWH (enoxaparin) Fondaparinux (injection Xa inhibitor) Rivaroxaban (xa inhibitor)

*** what IS safe for anti-coagulation in kidney disease?

UNfractionated heparin = UN-tainted and safe for kidneys

can you monitor anti-coagulation with unfractionated heparin?

YES, with aPTT (therapeutic = 1.5-2 times normal)

*** what estimated GFR indicates severe renal insufficiency?

< 30

of the obstructive diseases, which have low DLCO?

emphysema

can PEs cause pleural effusions?

yes - typically small, exudative and bloody

*** restrictive PFTs but normal DLCO

chest wall issue

*** pre-excitation of the ventricles via an abnormal bypass tract

WpW

can WPW put pt at risk of re-entrant SVT?

yep

3 acute complications of cocaine use

MI Aortic dissection Intracranial hemorrhage

*** tx of acute cocaine toxicity and myocardial ischemia

O2 and IV benzos

bug of CAP

s. pneumo

bug of HAP

p. aeruginosa

*** ipratropium MOA

anti-muscarinic/anti-cholinergic - mainstay of COPD management

how is low tidal volume ventilation lung protective?

prevents over-distension of alveoli and resultant baratrauma and IMPROVES mortality in ARDs patients

how does inhibition of CYP450 affect warfarin?

INCREASES effect by blocking metabolism

what rx's can INCREASE effect of warfarin?

NSAIDS, acetaminophen, omeprazole, SSRIs, amiodarone, and more

pt comes in with CP and you suspect MI but cardiac enzymes are not yet positive, while waiting to repeat pt becomes unresponsive and develops arrhythmia - most likely arrhythmia? what do you do?

v fib, defibrillate

what two rhythms should be defibrillated?

V fib or pulseless v tachy

when is mag sulfate used for heart stuff

Torsades

what to do for pt with hemodynamic instability and narrow or wide QRS complex tachyarrhthmia

synchronized cardio-version

what are some narrow or wide QRS complex tachyarrhythmias?

a fib, a flutter, VT with a pulse

can addition of amiodarone, verapamil, quinidine, or propafenone increase serum level of digoxin and contribute to digoxin toxicity?

yep

are anorexia, N/V, abdominal pain, weakness, and color vision changes signs of digoxin toxicity?

yep

*** sick sinus syndrome

inability of SA node to generate adequate HR; age-related degeneration of cardiac conduction system , fibrosis of SA node

*** what to do for sick sinus syndrome?

pacemaker

aberrant conduction pathway

WpW

3 EKG changes seen in WpW

short PR interval widened QRS interval slurred upstroke of QRS

how to manage HOCM

avoid volume depletion BBs/CCBs sx if persistent

*** initial monotherapy for HOCM

metoprolol or atenolol

causes of constrictive pericarditis

``` idiopathic pericarditis viral pericarditis cardiac sx radiation tx TB pericarditis ```

hx of cancer tx and new heart failure

constrictive pericarditis 2/2 radiation tx

pt has CP and lightheadedness and EKG shows narrow complex tachycardia consistent with SVT - how do we determine type?

need to slow HR to reveal morphology of rhythm, vagal maneuver or give adenosine

list 3 vagal maneuvres

eyeball pressure, carotid sinus massage, valsalva

3 general types of tachy

sinus narrow complex (<120 msec) wide complex

*** can hypokalemia result of beta agonist like albuterol?

yes

can anaphylaxis result in hypotension, poor organ perfusion, upper airway edema?

yes

what is fourth heart sound due to?

blood hitting a stiff ventricle

is a fourth heart sound normal in older adults?

yes, stiffening of heart muscle is normal

when is S4 abnormal?

younger, ventricular hypertrophy, acute MI

what causes S3?

lots of blood volume filling ventricles

what sound is associated with HF?

what sound is associated with acute MI?

*** smoking induced emphysema results in destruction of ________

upper lobes = centriacinar emphysem of smoking

*** lower lobe destruction is seen in panacinar emphysema of _______

AAT deficiency = lower lobes = panacinar emphysema

latin america, protozoal disease, megacolon, megaesophagus, cardiac disease

Chagas with Trypanosoma

how can supplemental oxygen increase hypercapnia in COPD?

increased dead space perfusion causing CQ mismatch decreased affinity of oxyhemoglobin for CO2 reduced alveolar ventilation

*** how do cerebral vessels respond to high levels of CO2?

with increase of CO2, cerebral vessels vasodilate - risk of SEIZURES

should you use a CXR to rule out PE?

Nope - nonspecific

*** what is long-term tx for asthma

ICS

long-term tx for COPD

LAMA (anti-muscarinin/anti-cholinergic - ipratropium)

complication of infective endocarditis which can result in conduction abnormalities

perivalvular abscess

drug user with new murmur and heart block

perivalvular abscess

murmur associated with TV endocarditis

holosystolic murmur of TR that becomes accentuated with inspriation

common causes of aortic regurgitation

congenital bicuspid aortic valve post inflammatory (rheumatic, endocarditis) aortic root dilation (marfaan, syphillis)

diastolic decrescendo murmur, left sternal border, louder with leaning forward, widened pulse pressure, warter-hammer pulsation, pistol shot femoral pulses

*** 3 things that can cause pulsus paradoxus ( > 10 change in SBP with inspiration)

asthma COPD tamponade

fibromuscular dysplasia results in stenosis of the ___ and ___ arteries

fibromuscular dysplasia = renal artery and internal carotid artery stenosis

*** internal carotid artery stenosis manifestation in fibromuscular dysplasia

recurrent HA pulsatile tinnitus transient ischemic attack stroke

*** renal artery stenosis manifestation in fibromuscular dysplasia:

secondary HTN | flank pain

Two bruits heard on exam of patient with fibromuscular dysplasia

subauricular systolic bruit | abdominal bruit

*** secondary hypertension, hypokalmeia, metabolic alkalosis

primary hyperaldosteronism

*** what are the markers of empyema and complicated pleural effusion

effusion with low ph (<7.2) and glucose (<60)

how to manage empyema and complicated pleural effusion

drainage + abx