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Test 2 Flashcards

1
Q

When do you perform rescue PCI?

A
  1. Cardiogenic shock <75
  2. Severe HF, pulmonary edema
  3. Hemodynamically compromising ventricular arrhythmia
  4. Fibrinolytic therapy has failed and a moderate or large area of myocardium is at risk
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2
Q

What are the traditional cardiac risk factors, that are no longer helpful >40?

A
  1. HTN
  2. Diabetes
  3. Tobacco
  4. Fam hx
  5. Hypercholesterolemia
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3
Q

How do you diagnose COPD?

A

Spirometry FEV1: <80%,

FEV1: forced vital capacity:

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4
Q

Legionella presentation?

A

Cigarette smoker, transplant, group of people, sinusitis, pancreatitis, myocarditis, pylenehritis

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5
Q

If you have cancer what might they give you for DVT?

A

Anticoagulant 3-6 months

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6
Q

What is the treatment for acute pericarditis?

A

NSAIDs 7 days to 3 weeks, NO IBUPROFEN FOR DRESSLERS

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7
Q

Common signs and symptoms hypertrophic cardiomyopathy?

A

Chest pain,palpiations, syncope, apical impulse hyperdynamic, s4, systolic ejection murmur

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8
Q

Who gets a V/Q for PE?

A

Pregnant women

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9
Q

What is the MC peripartum cardiomyopathy?

A

Dilated

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10
Q

Hallmark symptoms and physical findings of COPD?

A

Chronic and progressive dyspnea, cough and sputum production. Tachypnea, accessory muscle use, and pursed lip exhalation, skinny w/ gut

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11
Q

Phegmasia cerulea dolens requires what?

A

Rapid action to reduce venous pressure, get cathereter directed thrombodylysis

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12
Q

Respiratory acidosis when?

A

Pco2 >44
35-45

If ph is <7.35 then there is an acute and uncompensated metabolic acidosis present

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13
Q

Long term O2 therapy?

A

PaO2 <=55,
SaO2 <=88%

When PHTN, cor pulmonary, polycythemia

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14
Q

If you think tension pneumo what do you do?

A

Treat w/ needle then tube before radiograph

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15
Q

Mycoplasma pneumonia?

A

Sounds like heart attack, retrosternal chest pain

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16
Q

When is regular steroid treatment recommended for COPD?

A

FEV1 <50%

Severe, very severe

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17
Q

Indications for ICU admission?

A
  1. Severe dyspnea responds inadequately to emergency treatment
  2. Respirate or ventilatory failure despite o2 and non invasive therapy
  3. Decreasing LoC w/ increasing confusion
  4. Hemodynamics instability
  5. End organ failure
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18
Q

What are the risk factors for acute heart failure?

A
  1. HTN
  2. Diabetes
  3. Aortic valve disorder
  4. Male
  5. Old
  6. Obese
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19
Q

What are the hallmarks of tension pneumo?

A

Tracheal deviation away from involved side, hyperresonance on the affected side, hypotension, and significant dyspnea

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20
Q

Unstable angina should not have what?

A

Troponin

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21
Q

What is the hallmark of PE?

A

Dyspnea unexplained by auscultation findings, ECG changes, or clear alternative on CXR

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22
Q

Indication/contraindications for non invasive ventilation?

A

<7.36
PaCO2 >50
PaO2<60
SaO2 <90%

Respiratory arrest, CV instability
Confusion (like you might take it off)
Aspiration risk
Too many secretions 
Recent facial surgery/trauma
Burns, nasopharyngeal abnormalities
Obese
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23
Q

If you are what two things with acute HF do you go to ICU?

A

IV nitro and incubated

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24
Q

What is the treatment of acute exacerbation of COPD in er and what do they leave w/?

A

In hospital:

  1. Albuterol
  2. Iproptropium
  3. Corticosteroids

Go wome w/

  1. Corticosteroids
  2. Z-pack
  3. Making sure they can sat on the home O2
  4. O2
  5. Bronchodilator treatment
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25
4 big signs and symptoms for acute heart failure?
1. DOE (most sens) 2. Orthopnea, PND, edema (spec) 3. S3 4. >500 BNP
26
When is observation appropriate?
Small, stable pneumo 4 hrs w 02, re CXR, then release and RETuRN in 24 hrs
27
Patients admitted to the ICU get what meds for pneumonia?
Cover MRSA vancomycin and linezolid
28
What are the signs of dresslers and what is the treatment?
2-10 weeks post MI, chest pain, fever, pleuopericarditis. Aspirin and colchicine
29
Sharp pain, hurts worse when supine, retrosternal, refers to left trapezial ridge?
Acute pericarditis
30
What is the only thing that can reduce rate of decline and morality in COPD?
Smoking cessation
31
What are the 14 day mortality timi score requirements for unstable angina?
1. >=65 2. ST segment deviation 3. Cardiac markers 4. Aspirin in last 7 days 5. Hx 50% coronary artery stenosis 6. >=2 angina events in 24 hrs. 7. >=3 traditional risk factors
32
Goal for o2 therapy?
PaO2 >=60, | SaO2 >=90%
33
What can CT detect for pneumo?
Pulmonary blebs and where the pneumo is
34
What maneuvers increase HOCM?
Vasalva, standing after squatting
35
What is the treatment for massive PE?
Fibrinolytic, and placed in ICU
36
What is the treatment for hypertrophic cardiomyopathy?
Beta blocker
37
Pericardial effusion/ tamponade ECG?
Electrical alternans/ low voltage
38
Haemophilus influenza presentation?
Sickle cell, more in elderly w/ bacteremia
39
Treatment of VTE?
Heparin or MWH
40
What is the MC pneumonia?
Pneumoccus, followed by viruses
41
Limb w/ DVT that has dusky or blue color
Phegmasia cerulea dolens
42
What are the classifications of acute heat failure?
1. Hypertensive 2. Pulmonary edema 3. Cardiogenic shock 4. Acute on chronic 5. High output 6. Right heart failure
43
What does acute pericarditis look like in stage 3?
Inverted t waves I, V5, V6
44
What level of loop diuretic for acute HF?
Total daily dose, may have to give potassium
45
Mvmt and non mvmt signs for pneumo are called what?
Mvmt is beach | No mvmt is barcode
46
Provoking factors for VTE?
Active cancer, infection, estrogen, pregnancy
47
Pseudomonas pneumonia presentation?
Cyanosis, confusion, prolonged hospitalization (steroids or hospital), cystic fibrosis, empyema
48
Swollen, painful, and pale or white limb w/ a proximal venous thrombosis?
Phegmasia abla dolens
49
What is the treatment of ACS?
IV access, aspirin, O2, antiplatelet (aspirin, clopridogrel), antithrombins (unfractionated heparin, enoxaparin), nitrates (nitro sublingual .4 mg q 5 min x 3 prn, IV 10 micro)
50
What are discharge meds for DVT?
LMWH IM, or revoxaban
51
MC physical finding in pneumothorax?
Sinus tachycardia,
52
Management of hypertensive HF?
1. O2 >=95% 2. Severe dyspnea, consider NIV or intubation 3. BP>150/100 add nitro 4. IV loop diuretic (furosemide) 5. ICU 6. Discharge
53
What a is the admission criteria for pericarditis?
1. Temp >100.4 2. Subacute onset 3. Immuno suppressed 4. HX of oral anticoagulant 5. Ass. Myocarditis (elevated biomarkers) 6. Large pericardial effusion
54
Respiratory failure sats?
PaO2 <60 | SaO2 <90
55
PE ecg?
Sinus tachy w/non specific t wave changes, S1Q3T3
56
What is the most life threatening feature of an acute exacerbation of COPD?
Hypoxemia <90%
57
What can occur 1-5 days post infarction?
Free wall rupture, tearing pain
58
What is imaging TOC for DVT?
Venous US, vein doesn’t compress that is a positive
59
What are the absolute contraindications stat fibrinolytic therapy?
1 intracranial hemorrhage 2. Structural cerebral vascular lesion 3. Intracranial neoplasm 4. Ischemic stroke 3 months 5. Active internal bleeding 6. Aortic dissection or pericarditis
60
How is diagnosis of dilated cardiomyopathy typically made?
Follow up echo w/ additional testing CXR shows cardiomegaly Biventricular enlagement is common
61
When do you admit for pericardial disease?
1. Temp >100.4/38 2. Onset over sev. Weeks 3. Immunosuppressive 4. Hx of ora anticoagulant 5. Ass. Myocarditis (elevated biomarkers) 6. Large pericardial effusion (free space >20)
62
Triad for cardiac tamponade and treatment?
Muffled heart sounds, JVD, hypotension (Pulsus paradoxus) Pericardiocentesis, bolus of fluid, echo, but U/S
63
Dose for sublingual and IV nitro for acute HF?
Sublingual: .4 mg q 5 min IV: .2-.4 mcg/kg/min
64
What are the risk factors for acute heart failure?
1. HTN 2. Diabetes 3. Valvular disorder 4. Old age 5. Male 6. Obesity
65
How long can you not fly for pneumo?
7-14 days
66
Diagnosis of STEMI equivalent LBBB?
1. >1mm ST elevation concordant 2. >1 mm depression V1, V2, V3 3. >5 mm elevation discordant
67
When is an echo indicated?
1. Cause of HF uncertain 2. Exclude known causes of HF that may be correctable 3. EF 4. Rule out potential causes
68
Classic PE pain?
In thorax between clavicles that increases w/ cough or breathing
69
Kllebsiella pneumonia presentation
Alcoholics, brown currant jelly
70
Massive PE is what?
Systolic BP <90 for >15 min,40 % reductionism baseline of systolic BP
71
Presentation of pneumococcal pneumonia?
Sudden onset of disease w/ 1. RIGORS 2. BLOODY SPUTUM 3. HIGH FEVER 4. CHEST PAIN DAY CARE CENTERS
72
When discharging AHF what do you have to make sure?
That their O2 at their home is enough
73
Atypical?
Beta lactam resistant macrolide or fluroquinolone
74
What is the treatment for most pneumonia
Macrolide or fluorquinolone, or doxy -mycin
75
Treatment options for pneumo?
O2 (nitrogen gas pressure gradient), observation, needle, catheter aspiration
76
If you don’t think PE what do you do?
Wells, if - then PERC, if PERC- then d-dimer.
77
What is the criteria for stable pneumo?
1. RR <24 2. No dyspnea at rest 3. Pulse >60 and <120 beats/min 4. Normal BP 5. Room air >90% 6. No hemothorax
78
What are the rules for admission to ICU for pneumonia?
1. Markedly elevated respiratory rate 2. Pp o2 <=250 3. Mulitlobar infiltrates 4. Confusion 5. Uremia w/ BUN >20 6. Leukopenia, thrombocytopenia, hypothermia, hyponatremia, lactic acidosis, and asplenia Septic shock/ mechanical ventilation
79
Murmur that’s associated w/ dilated cardiomyopathy?
Holocystolic mitral/tricuspid regugitant murmur
80
What are common causes of acute pericarditis?
ID, cancer, drug (procainamide, hydralazine), rheumatic, radiation, Dressler’s, uremia
81
What are the COPD severities?
Mild FEV1 >80% Moderate 50-79 Severe 30-49 Very severe <30
82
What does acute pericarditis look like on ECG?
Pr depression, II, aVF, V4-V6 ST elevation I, V5, V6
83
When to admit COPD patient?
1. Increased intensity of symptoms 2. Failure medical treatment 3. Comorbidities 4. HF 5. Frequent relapse 6. Old, 7. Insufficient home support
84
What is the diagnostic hallmark of hyerptrophic cardiomyopathy?
Asymmetric septal hypertrophy
85
S. Aureus pneumonia?
Laryngeal cancer, ASPIRATION RISK PEOPLE W/ STROKE, after viral illness
86
Treatment for right ventricular infarction?
1-2 L saline then dobutamine
87
What is the surgical for pneumo?
Pleurodesis, for recurring, bilateral, recurrent high risk of activities

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