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Behavioral Science > Step 2 CK > Flashcards

Step 2 CK Flashcards

(49 cards)

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1
Q

GI disorders associated with chest pain

A

ulcer disease, cholelithiasis, duodenitis, gastritis

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2
Q

Benefit a pt risk of coronary disease

A

Exercise. Increase heart rate shows clear benefit in cardiac outcome

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3
Q

CAD risk factors

A

DM, smoking, HTN (140/90), HL, FMH of premature CAD, men>45, women >55

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4
Q

Tako-Tsubo cardiomyopathy

A

acute myocardial damage most often occur in post menopausal women immediately after an overwhelming event or news (stress). Leads ballooning and left ventricular dyskinesis.Manage with ACE and Beta blockers. Revacularization will not help because coronary arteries (angiography) are normal

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5
Q

Ischemic pain

A

dull or sore; squeezing or pressure

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6
Q

3 features of CP tell whether or not the pain is ischemic in nature

A
  1. changes with respiration (pleuritic)
  2. changes with the position of the body
  3. changes with touch of the chest wall (tenderness)
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7
Q

Costochondritis

A

chest wall tenderness

Test: PE

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8
Q

Pericarditis

A

pain worse with lying flat, better sitting up, young (<40)

Test: ECG with ST elevation everywhere, PR depression

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9
Q

Aortic dissection

A

radiation to the back, unequal bld pressure between arms

Test: Chest Xray with widened mediastinum, chest CT, MRI, TEE confirms disease

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10
Q

Duodenal ulcer

A

epigastric discomfort, better when eating

test: endoscopy

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11
Q

GERD

A

bad taste, cough, hoarseness

Test: response to PPIs or antacids (aluminum hydroxide and magnesium hydroxide)

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12
Q

Pneumonia

A

cough, sputum, hemoptysis

test: CXR

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13
Q

PE

A

sudden onset of SOB, tachycardia, hypoxia

Test: spiral CT, V/Q scan

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14
Q

Pneumothorax

A

sharp, pleuritic chest pain, tracheal deviation

test: CXR

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15
Q

Ischemia EKG

A

ST depressions

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16
Q

best methods for detecting ischemia w/o the use of EKG because of a baseline abnormality

A
  1. nuclear isotope uptake or sestamibi

2. ECG detection of wall motion abnormalities

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17
Q

Reasons for baseline EKG abnormalities

A

left bundle branch block, left ventricular hypertrophy, pacemaker use, or the effect of digoxin

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18
Q

Exercise tolerance

A

determine presence of ischemia

ST segment depression

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19
Q

Exercise thallium

A

normal myocardium will pick up thallium in the same way that potassium is picked up by Na/K ATPase.
ischemia will have decrease uptake of nuclear isotope

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20
Q

ECHO

Study These Flashcards
A

normal myocardium will move on contraction.

abnormalities will be detected by seeing a decreased wall motion (dyskinesis, akinesis, or hypokinesis)

21
Q

Dipyridamole thallium

Study These Flashcards
A

inability to exercise to target heart rate.

dec uptake of nuclear isotope

22
Q

Dobutamine ECHO

Study These Flashcards
A

increase myocardial oxygen consumption and provoke ischemia detected as wall motion abnormalities.
may provoke bronchospasm (no bueno asthmatics)

23
Q

Angiography

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A

detect the anatomic location of coronary artery disease
determines bypass surgery versus angioplasty.
70% intervention

24
Q

Holter monitor

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A

detects rhythm disorders ( Afib, flutter, ectopy (premature beats, v tachy).
does not detect ischemia

25
Chronic Angina tx
Beta blockers, aspirin, nitroglycerin [oral (sub-lingual, IV and paste= acute) or transdermal] (B.A.N) best mortality benefit is aspirin and beta blo
26
Clopidegrel
``` aspirin intolerance (allergy) recent angioplasty with stenting ```
27
Prasugrel
antiplatelet medication pt who are undergoing angioplasty and stenting dangerous in pt 75 or older b/c inc risk of hemorrhagic stroke
28
Ticlopidine
inhib plt pt who are intolerant to both aspirin and clopidogrel causes neutropenia and TTP
29
ACEI
SE: cough, hyperkalemia
30
Hydralazine
direct acting arterial vasodilator | dec afterload, clear benefit in pt with systolic dysfunction
31
National Cholesterol Ed Program
CAD and LDL above 100 to 130=statin | goal to get LDL <100
32
CAD equivalents
PAD, carotid disease (not stroke), Aortic disease, DM
33
STATINS
- antioxidant effect on the endothelial lining of the coronary arteries in addition to lowering LDL. - elevations of transaminases (check ALT and AST at intiation, before dosage inc and periodically. an in >3x reduce or w/draw meds) - also causes myositis, elevation of CPK, and rhado
34
Niacin
- inc HDL - ass with glu intolerance (inc glucose), elevation of uric acid level, and an uncomfortable itchiness from transient release of histamine
35
Gemfibrozil
- lower triglycerides | - inc risk of myositis when used with statins
36
Cholestyramine
- bile sequestrate also has significant interactions with other medications in the gut (block absorption) - GI discomfort, bad taste, cramping, flatus
37
When to use CCBs (verapamil/diltiazem) in CAD only.....
severe asthma precluding the use of beta blockers, prinzmetal variant angina, cocaine induced chest pain (BB are CI), inability to control pain with maximum therapy
38
Coronary artery bypass grafting
lowers mortality in - 3 vessels with at least 70% stenosis in each vessel - left main coronary artery occlusion - 2 vessel disease in a pt with DM - persistent sx despite maximal medical therapy * **internal mammary artery grafts last 10yrs before occluding, saphenous veins 5yrs
39
Percutaneous coronary intervention (angioplasty)
-best in acute coronary syndromes (ST segment elevations)
40
S4 gallop
-sound of atrial systole as bld is being ejected from the atrium into a stiff ventricle associated with ACS because of ischemia leading to noncompliance of the left ventricle
41
Pulsus paradoxus
dec of bld pressure of greater than 10mmHg on inspiration. | ass with cardiac tamponade
42
Kussmaul sign
inc in jugulovenous press on inhalation
43
displaced point of maximal impulse
-characteristic of left ventricular hypertrophy, dilated cardiomyopathy
44
LEADS
- V2 to V4=anterior wall of the LV. ST elevation signifies acute MI. untx 20-40% mortality - II, III, avF ST elevation =acute MI of the inferior wall. untx <5% mortality - V1 and V2=ST depressions are suggestive of posterior wall MI. very low mortality.
45
ACS
-aspirin (chew) within 1hr, call cath lab (PCI w/in 90min), transfer to ICU -angioplasty (PCI) is superior to thrombolytics in terms of survival and mortality benefit, fewer hemorrhagic complications MONA (morphine, O2, nitroglycerine, and aspirin). beta blockers at some point during admission
46
most common cause of death s/p MI
ventricular arrhythmia (Vtach, Vfib)
47
complications of PCI
rupture, restenosis-throbosis of the vessel, hematoma at the site of entry prevent restenosis with placement of drug eluting stent (paclitaxel, sirolimus) which inhib the local T cell response . Heparin is used at the time of the procedure. Warfarin doesn't help because its not a venous problem
48
CI to thrombolytics
``` major bleeding into the bowel or brain recent surgery (w/in 2wks) severe HTN (180/110) nonhemorragic stroke w/in 6mo ```
49
Pulmonary capillary wedge pressure
- indirect measure of the left atrial pressure, indirect indicator of left ventricular filling pressure or preload. When the balloon of the PA catheter is inflated, a branch of the pulmonary artery is occluded. The pressure that is transmitted by the pulmonary vein is approximately the same as the lead atrial pressure because there are no valves is the lung vasculature that would create a change in pressure between the left ventricle and the pulmonary vein. - Normal: 8-12mmHg - Increase in PCWP: Intravascular Volume Overload, Mitral Valve Stenosis, Left Ventricular Failure, Cardiogenic Shock, High PEEP (to estimate PCWP when pt. is on PEEP: PCWP - 1/2PEEP = corrected PCWP), pulmonary edema - Decrease in PCWP: Hypovolemia, Right Ventricular Infarction

Behavioral Science (2 decks)

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