Shared Flashcard Set

Details

Internal Medicine EOC
End of clerkship exam info
517
Health Care
Graduate
10/08/2009

Additional Health Care Flashcards

 


 

Cards

Term
What should you consider in a pt with profound lactic acidosis and dyspnea?
Definition
Cyanide toxicity
Term
Carbon Monoxide: uses % ________________ to identify toxicity
Definition
carboxyhemoglobin
Term
If you have rapid onset, severe dyspnea in the absence of other clinical features you should think of...
Definition

pneumothorax

pulmonary embolism

inc LVEDP

Term
Spontaneous pneumothorax is usually accompanied by what?
Definition
chest pain
Term
When should you suspect pulmonary embolism in a pt with dyspnea?
Definition

when they report a recent Hx of prolonged immobilization

are on estrogen therapy

have other risk factors for DVT

or when the cause of dyspnea is not apparent

Term
Periodic CP that proceeds the onset of dyspnea is suspicous for what 2 things?
Definition

myocardial ischemia

pulmonary embolism

Term
Most cases of dyspnea associated with wheezing are due to ________________.
Definition
acute bronchitis
Term
When you have dyspnea with wheezing and acute bronchitis is unlikely consider...
Definition

new onset asthma

foreign body

vocal cord dysfunction

Term
What are some noncardiopulmonary causes of prominent dyspnea with mild to no accompanying features?
Definition

anemia

methemoglobinemia

cyanide ingestion

CO

metabolic acidosis

panic attacks

Term
Dyspnea: Main PE components
Definition

Head and neck

Chest

Heart

Lower extremities

 

Term
What are some respiratory patterns suggestive of COPD?
Definition

pursed-lip breathing

use of extrarespiratory mm

barrel-shape chest

Term
What are some respiratory patterns suggestive of pneumothorax?
Definition
asymmetric excursion
Term
What are some respiratory patterns suggestive of metabolic acidosis?
Definition
Kussmaul respirations
Term
What are some respiratory patterns suggestive of impending upper airway obstruction (epiglottis or foreign body), or severe asthma exacerbation?
Definition
tripod positioning
Term

Pulse Ox values <94% almost always represent what?

 

What are the exceptions?

Definition

clinically significant hypoxemia

 

CO toxicity and methemoglobinemia

Term
There is a >90% probability of inc LVEDP when 2+ of the following are present...
Definition

tachycardia

systolic hypotension

JVD

Hepatojugular reflux

crackles, esp bibasilar

3rd Heart sound

LE edema

radiographic pulm vascular redistribution or cardiomegaly

Term
What are the life threatening causes of episodic dyspnea?
Definition

recurrent PE

myocardial ischemia

RAD

Term
Which causes of dyspnea can be Dx by CXR?
Definition

Pneumonia

severe exacerbation of COPD req hospitalization

new-onset CHF

pneumothorax

Term
High-resolution chest CT is useful in evaluating what causes of dyspnea?
Definition

PE

interstitial lung disease

Term
Elevated BNP levels are sensitive and specific for ____________ in symptomatic persons
Definition
inc LVEDP
Term
Patients with hypoxemia should be immediately provided supplemental oxygen unless significant ___________ is present
Definition
hypercapnia
Term
Common causes of acute cough:
Definition

Acute respiratory tract infection

asthma

AR

CHF

Term
Cough due to acute respiratory tract infection resolve with ____ weeks in >90% of pts.
Definition
3
Term
Prevalance of ___________ approaches 20% when cough persists beyond 3 wks
Definition
Pertussis
Term
What should you suspect when cough is accompanied by unexplained wt loss, fevers, and night sweats?
Definition
bronchogenic carcinoma
Term
In a pt with a cough, when should you consider getting a CXR done?
Definition

when the pt shows abnormal vital signs or

has a chest exam suggestive of pneumonia

Term
What are some common causes of persistant cough?
Definition

postnasal drip syndrome

asthma

GERD

Chr bronchitis

Bronchiectasis

TB or other chr infection

interstitial lung diseases

bronchiogenic carcinoma

Term
In a pt with a persistant cough and excessive mucus secretions, you should suspect...
Definition

chronic bronchitis in a smoker or

bronchiectasis in pt with Hx of recurrent or complicated pneumonia

Term
__________ is not commonly reported among pts with persistant cough
Definition
dyspnea
Term
In a pt with persistant cough, a CXR is indicated when what other causes are ruled out?
Definition

ACE inhibitor therapy

post-infectious cough

Term
Which tests confirm Pertussis?
Definition

polymerase chain rxn tests and

Cx from a nasopharnygeal swab

Term

Suspected Condition - Empiric Txt - Dx testing

 

Postnasal drip - __________________ - ENT referral/sinus scan

Definition
therapy for allergy or chronic sinusitis
Term

Suspected Condition - Empiric Txt - Dx testing

 

Asthma - B2 - _______________

Definition
spirometry, consider methacholine challenge if normal
Term

Suspected Condition - Empiric Txt - Dx testing

 

GERD - PPI - __________________

Definition
esophageal pH monitoring
Term
Suspect _________ when an acute cough is accompanied by vital sign abnormalities (tachycardia, tachypnea, fever) or findings suggestive of airspace consolidation (rales, dec breath sounds, fremitus, egophony)
Definition
pneumonia
Term
Definition of hemoptysis
Definition
expectoration of blood that originates below the vocal cords
Term
Massive hemoptysis is defined as...
Definition
>200-600mL in 24 hrs or any amt that is hemodynamically significant or threatens ventilation
Term
If hemoptysis is coming from the airways, it is usually caused by...
Definition

chronic bronchitis

bronchiectasis

bronchogenic carcinoma

Term
If hemoptysis is coming from the pulmonary vasculature, it is usually caused by...
Definition

LVF

Mitral stenosis

pulmonary emboli

AV malformations

Term
If hemoptysis is coming from the pulmonary parenchyma, it is usually caused by...
Definition

Pneumonia

inhalation of crack cocaine

autoimmune dz (Goodpasture's dz, Wegner's granulomatosis)

Term
If hemoptysis is from an iatrogenic hemorrhage, it is usually caused by...
Definition

transbronchial lung biopsies

anticoagulation

pulmonary artery rupture due to distal placement of a balloon-tipped catheter

Term
Which labs/tests should be performed when evaluating hemoptysis?
Definition

CXR

CBC w/ plt ct

renal fxn tests

UA

coagulation studies

flexible bronchoscopy

high-res CT of chest

Term
Flexible bronchoscopy reveals endobronchial cancer in ____% of pts with hemoptysis who have a non-laterizing CXR
Definition
3-6
Term
Uncontrollable hemoptysis hemorrhage warrants:
Definition
rigid bronchoscopy and surgical consultation
Term
Causes of acute bronchitis
Definition

Influenza virus

Mycoplasma Pneumonia

Chlamydia Pneumonia

Bordetella pertussis

Term

Early phase of asthma is ____ mediated

Late phase is associated with ____________ release

Definition

IgE (assc with c histamine release from mast cells)

C cytokine

Term
Status asthmaticus is...
Definition
a severe obstruction lasting for several days
Term
What breath sounds do you hear in mild, moderate and severe asthma?
Definition

mild: expiratory wheezes

Moderate: expiratory and inspiratory wheezing

severe: diminished breath sounds and no wheezing

Term
What are the DDx for asthma?
Definition

CHF

COPD

upper airway obstruction from foreign body

tumor

laryngeal edema

carcinoid tumors (stridor)

Term
Mild intermittent asthma:
Definition

sxs 2 or less times a wk

asymptomatic and norm PEF btwn exacerbations

exacerbations are brief (hrs to days)

intensity may vary

Term
Mild persistent asthma:
Definition

Sxs >2 times/wk but < 1x/d

exacerbations may affect activity

Term
Moderate persistent asthma:
Definition

daily sxs

daily use of inhaled short acting B2 agonist

exacerbations affect activity

exacerbations 2+ times/wk

may last days

Term
Severe persistent asthma:
Definition

continual symptoms

limited physical activity

frequent exacerbations

Term
Essential of Dx for COPD
Definition

Hx of cigarette smoking

Chr cough and sputum production (in chr bronchitis)

dyspnea (in emphysema)

rhonchi, dec intensity of breath sounds

prolonged expiration on physical examination

airflow limitation on PFTs that is not fully reversible and most often progressive

Term
What two dz grouped together are the 4th leading cause of death in the US?
Definition
COPD and asthma
Term
Clinical Dx of chronic bronchitis is defined by...
Definition

excessive secretion of bronchial mucus

daily productive cough for 3+ mths in at least 2 consecutive yrs

Term
Clinical Dx of emphysema is defined by...
Definition
abnormal permanent enlargement of air spaces distal to the terminal bronchioles, w/ destruction of their walls and w/o obvious fibrosis
Term
____% of smokers will develop progressively disabling sxs in their 40s and 50s
Definition
15
Term
What % of COPD pts have significant exposure to tobacco smoke?
Definition
80
Term
Distinctive features of bronchietasis are:
Definition

recurrent pneumonia and hemoptysis

digital clubbing

radiographic abnormalities

Term
COPD Survival is directly proportional to the # of hrs/day of ____________________
Definition
oxygen administration
Term
What is the most important pharmalogic agent for the management of pts with COPD?
Definition
bronchodilators
Term
What are the 2 most commonly prescribed bronchodilators for the txt of COPD?
Definition

1. Iprotropium bromide (preferred)

2. SAB2 agonist (albuterol, metaproterenol)

 

work better together (at submaximal) then either alone

Term
What are the requirements for lung transplantation?
Definition

severe lung dz

limited ADLs

exhaustion of medical therapy

ambulatory status

potential for pulmonary rehab

limited life expectancy w/o transplant

adequate fxn of other organs

good social support system

Term
Surgical procedures for advanced COPD:
Definition

1. lung transplantation

2. Lung Volume Reduction surgery

3. Bullectomy

Term

What is the median survival of pts with severe COPD

(FEV1 <1 L)?

Definition
~4yrs
Term

Radiographic finding of _________________ are: dilated, thickened airways and scattered, irregular opacities

"tram-tracks" or ring-like markings

Definition
bronchiectasis
Term
_________________ causes 1/2 the cases of bronchiectasis
Definition
Cystic Fibrosis
Term
Which sxs occur in 75% of pts with bronchiectasis?
Definition
dyspnea and wheezing
Term
What is the diagnostic study of choice for bronchiectasis?
Definition
High-resolution CT
Term
What are some complications of bronchiectasis?
Definition

Hemoptysis

Cor pulmonale

amyloidosis

secondary visceral abscesses at distant sites

Term
_______________ is a nonspecific inflammation of terminal bronchioles.
Definition
bronchiolitis
Term
In infants and children _________ is usually caused by RSV or adenovirus
Definition
bronchiolitis
Term
What is the difference btwn bronchiolitis in adults and children?
Definition

in children its usually severe and acute

 

in adults its usually chronic and frequently progressive

Term
What are the 2 pathological variants of bronchiolitis?
Definition

1. constructive (hypertrophy causing obstruction)

 

2. proliferative (polyps partially or completely obstruct bronchioles)

Term
BOOP is also called...
Definition
cryptogenic organizing pneumonitis
Term
How does BOOP usually present?
Definition

Dry cough, dyspnea and flu-like sxs from days to mths

fever and wt loss

 

crackles in most, wheezing in 1/3

 

Term
CXR w/ patchy, bilateral, ground glass or alveolar infiltrates is indicative of...
Definition
BOOP
Term
What may be necessary to Dx COP/BOOP?
Definition
surgical lung Bx
Term
What is used to treat COP/BOOP?
Definition
corticosteroids (in 2/3rds of cases)
Term
What is the most common etiologic agent in pneumonia?
Definition
strep pneumococcus
Term
In _____% of cases of pneumonia the specific cause is unknown.
Definition
40-60
Term
Which forms of pneumonia are assc with a higher mortality risk?
Definition

aspiration

post obstructive

gram neg

staph aureus

Term
Which Abx are used for community acquired pneumonia?
Definition

clarithromycin

doxycyline

levofloxacin

Term
Mycoplasma pneumoniae, Chlamydia pneumoniae, Viruses and Coxiella Burnetii cause ____________ pneumonia
Definition
atypical
Term
S. Pnemo, H. Flu, S. Aureus, Klebisiella, other gram neg bacilli and anaerobes cause ___________ pneumonia
Definition
typical
Term
What will you notice on physical exam in a pt with pleural effusions?
Definition
chest is dull to percussion and breath sounds are decreased
Term
What will you notice on physical exam in a pt with interstitial infiltrates?
Definition
crackles on auscultations
Term
What will you notice on physical exam in a pt with evidence of consolidation?
Definition

dull to percussion

egophony

Term
What are some extrapulmonary findings of pneumonia?
Definition

Altered mental status

altered consciousness

recent seizures (suggest aspiration pneumonia)

periodontal dz (anaerobic inf)

absent gag reflex (bacteriodes species)

encephalitis (legionella)

Term
What is the GOLD STANDARD for Dx of pneumonia?
Definition
CXR
Term
Which meds may cause pneumonia-like sxs?
Definition

Nitrofurantoin

amiodarone

Term
Criteria for Hosp Admission for Pneumonia
Definition

- Inability to take oral meds

-Multilobar involvement

-Severe vital sign abnormality(pulse>125/min, stolic BP <90, resp >30min)

-Acute mental status changes

-Arterial hypoxemia (room air O2 <60)

-Severe acute electrolyte, metabolic, or hematologic abns (Na <130, Hct <30%, Neutrophils <1000, BUN>50, SrCreat>2.5)

-Acute comorbidities

Term
Abx for strep pneumoniae?
Definition

PCN or Amoxicillin

 

unless it has PCN-resistance then, Vanc or ceftriaxone

Term
Abx for H Flu?
Definition
2nd or 3rd gen Cephalosporins or doxy
Term
Abx for Moraxella catarrhalis?
Definition

2nd or 3rd gen cephalosporins or bactrim

 

Term
Abx for anaerobes?
Definition
clindamycin, PCN
Term
Abx for Enterobacteriacease (E. coli, Klebsiella, Proteus, Enterobacter)?
Definition

3rd gen cephalosporin

 

Term
Ab for staph aureus?
Definition

methicillin

vancomycin

Term
Abx for Legionella?
Definition
macrolides w/ or w/o Rifampin
Term
Abx for Mycoplasma or Chlamydia pneumoniae?
Definition
Doxycycline, macrolides, FQs
Term
Abx for Chlamydia psittaci?
Definition
Doxycycline
Term
Abx for Coxiella?
Definition
Tetracycline
Term
Systemic manifestations of pulmonary TB
Definition

fever (50-80%)

malaise

wt loss

night sweats

Term
Which symptom, if present, in TB is an ominous feature seen with widespread advanced disease?
Definition
dyspnea
Term
Fatalies from TB occur from what?
Definition

wasting

hemorrhage

respiratory failure

Term
For Dx of TB, when should sputum be collected?
Definition

in the morning

preferrably 3 consecutive mornings

Term
What is the characteristic lesion in TB?
Definition
granulomatoma - aggregations of inflammatory cells, principally macrophages
Term
Caseation necrosis is a prominent feature of what disease?
Definition
TB
Term
A Mantoux test is used to check for what?
Definition
TB
Term
Combinations of isoniazid, rifampin and pyridoxine are often given to treat ___________
Definition
TB
Term
TB is caused by...
Definition
mycobacterium tuberculosis
Term
What is the TB vaccine?
Definition
BCG (not in this country)
Term
What are some lab abnormalities seen with TB?
Definition

anemia

leukocytosis

Term
Treatment regimens for TB infection? TB disease?
Definition

TB infection - INH qd for 9 mos

 

TB disease - INH, Rifampin, Pyrazinamide and ethambutol or streptomycin, one pill of each, qd, for 6 mos

Term
what percentage of solitary pulmonary nodules, "coin lesions" carry a significant risk of malignancy?
Definition
10-68
Term
Four major cell types of Lung CA
Definition

NSCLC

squamous cell carcinoma, assc w/ cigarettes

adenocarcinoma, most common

large-cell carcinoma

 

SCLC

small-cell lung carcinoma, worst, assc with cigarettes

Term
Lung CA type -- cell of origination
Definition

squamous cell -- epithelium of proximal airway

 

Adenocarcinoma -- goblet cells in major bronchi

 

small cell -- oat cell, intermediate and combined cell types

Term
Txt for NSCLC and SCLC
Definition

NSCLC - surgery, possible radiation

 

SCLC - chemo

Term
Definitions of sarcoidosis
Definition

1. a noncaseous or nonnecrotizing granuloma

2. cause is unknown

3. systemic disease

4. should have clinical consistency

Term
Where can sarcoidosis manifest?
Definition
lymph nodes, lungs, liver, spleen, eyes, bones, salivary and lacrimal glands, CNS, skin and heart
Term
Most pts with PE present with a combo of what sxs?
Definition

dysnpea

pleuritic CP

tachypnea

Term
What is the most common EKG finding in pts with PE?
Definition
sinus tach
Term
What comprises Virchow's triad?
Definition

hypercoagulable state

endothelial injury

local stasis

Term
What is a pneumoconises?
Definition
a lung disease caused by inhalation of inorganic dust. Toxic fumes, gases and heavy metals may also cause inhalation lung injury.
Term
The four major causes of pneumoconiosis are:
Definition

Asbestos

coal dust

silica

beryllium

Term
A reticulonodular pattern seen on CXR is indicative of what?
Definition
coal worker's pneumonconiosis w/ concurrent cigarette smoking
Term
Ferrunginous bodies are associated with...
Definition
asbestos pneumoconioses
Term
In young, otherwise healthy individuals, pleuritis is usually caused by...
Definition
viral resp infections or pneumonia
Term
pleural effusions: 5 possible pathophysiologic processes
Definition

1. inc production of fluid in the setting of normal caps due to inc hydrostatic or dec oncotic pressure (transudates)

2. inc production of fluid to abn cap permeability (exudates)

3. dec lymphatic clearance of fluid from pleural space (exudates)

4. infection in the pleural space (empyema)

5. bleeding into the pleural space (hemothorax)

Term
A pleural friction rub indicates ______________ or _______________
Definition
infarction or pleuritis
Term
what are the 2 most common causes of the exudative effusion?
Definition

bacterial pneumonia

CA

Term
A pH below ______ suggests the need for drainage of the pleural effusions
Definition
7.3
Term
What is a pseudotumor?
Definition
round or oval fluid collections in fissures that resemble intraparenchymal masses
Term
Between ___% and ___%  of exudative pleural effusions are malignant
Definition
40 to 80
Term
The most common underlying disease responsible for secondary pneumothorax is...
Definition
obstructive airway disease
Term
What is catamenial pneumothorax?
Definition
a pneumothorax that recurs at menstrual periods
Term
which type of pneumothorax is life threatening?
Definition

tension

 

usually a complication of mechanical ventilation or other secondary pneumothoraces

Term
Physical signs of pneumothorax:
Definition

hyperresonance on percussion

diminished or absent tactile fremitus and breath sounds

Term
Chest tube drainage is preferred for which types of pneumothorax?
Definition

tension

hydropneumothorax

hemopneumothorax

and pneumothorax with underlying pulmonary dz

Term
Where do you insert needles or catheter for pneumothorax correction?
Definition
the second anterior intercostal space in the midclavicular line
Term
Pts with a pneumothorax usually present with which 3 sxs?
Definition

pleuritic CP

tachypnea

tachycardia

Term
What is the triad of sxs seen in tension pneumothorax?
Definition

dec breath sounds

hypotension

JVD

 

(you may also see tracheal deviation)

Term
What is the best way to Dx a pneumothorax?
Definition
CXR
Term
Hemothorax is usually due to what?
Definition
injury to the chest wall, great vessels or lung
Term
What is recommended for a massive hemothorax?
Definition
Immediate tube thoracostomy
Term
What is Mendelson syndrome?
Definition
acute aspiration of gastric contents
Term
Acute aspiration of gastric contents can cause...
Definition
significant lung injury by acid corrosion, bronchial obstruction or bacterial pneumonia from chemical pneumonitis
Term

Doppler echocardiography is an effective way to estimate pulmonary artery pressure if ___________________is suspected

Definition
Pulmonary HTN
Term
Apnea is defined as the complete cessation of airflow for ________.
Definition
10+ seconds
Term
What is hypopnea?
Definition
a significant decrease in airflow
Term
Apneas and hypopneas can be increased in frequency and duration to the degree that they fragment sleep and produce clinically significant ____________ and _____________.
Definition
hypoxia and hypercapnia
Term
Central Sleep apnea is caused by...
Definition
decreased central respiratory drive
Term
What are some of the consequences of sleep apnea?
Definition

daytime somnolence

increased risk for MVA

Irritability

HA

HTN

increase in sudden death, probably from arrhythmias

Term
What are some abnormal upper airway anatomy that can contribute to obstructive sleep apnea?
Definition

enlarged tonsils

macroglossia

a long soft palate and uvula

micrognathia

Term
During airway occlusion in sleep apnea, there is an increase in sympathetic tone producing __________ and __________.
Definition
vasoconstriction and HTN
Term
Periods of hypoxia, caused by sleep apnea, can lead to _____________ and __________________.
Definition
bradycardia and cardiac arrhythmias
Term
There is an increased incidence of __________ and ________ in pts with obstructive sleep apnea.
Definition
stroke and CAD
Term
How do you establish a Dx of sleep apnea?
Definition

overnight polysomnography

 

airflow, O2 sat, and respiratory, eye, chin and limb mvt are recorded

Term
Which meds should sleep apnea pts be counseled against?
Definition
sedatives, bc they depress ventilatory drive to some degree
Term
Which rare causes of sleep apnea need to be ruled out?
Definition

Hypothyroidism

acromegaly

amyloidosis

Term
What are the 2 major functions of respiration?
Definition
add O2 and remove CO2 from the blood
Term
What is acute respiratory failure?
Definition
the relatively sudden decline in either or both of the functions of respiration
Term

1. Ventilation/perfusion mismatch

2. Alveolar hypoventilation

3. right to left shunt

4. decreased inspired O2 tension

 

These are the 4 causes of ______________

Definition
hypoxia
Term
___________________ is required to correct Hypoxemia
Definition
mechanical ventilation
Term
When mechanical ventilation is used on hypercapnic pts, the goal is to keep the pH between...
Definition
7.32 and 7.38
Term
What kind of CP does angina pectoris normally cause?
Definition
episodic CP or discomfort during exertion or stress
Term
What is Levine's sign?
Definition
when a pt clenches their fist over their chest while describing chest discomfort
Term
Anginal discomfort or CP is classically located where?
Definition
substernally or over the left chest
Term
Anginal discomfort or CP frequently radiates where?
Definition
to the epigastrium, neck, jaw or back and down the ulnar aspect of the left arm
Term
Angina ususally lasts ______ and is relieved by ______  or _________.
Definition

<10 mins

 

rest or NTG

Term
When does angina more frequently occur?
Definition

in the AM

in cold weather

after a large meal

or after exposure to environmental factors

Term
Anginal pain is frequently accompanied by...
Definition
dyspnea, diaphoresis, nausea, palpitations or lightheadness
Term
When does unstable angina occur?
Definition
when a pt reports a significant increase in the frequency or severity of angina or when angina occurs with progressively decreasing exertion or at rest
Term
When anginal pain occurs mainly at rest and results from coronary spasm we call it....
Definition
Prinzmetal's or Variant angina
Term
Since the pain of angina and acute MI may be similar, what features distinguish the two?
Definition
the pain is usually more severe and prolonged, >30 mins, with MI -- and NTG does not relieve it
Term
Dyspnea frequently occurs on exertion, however, in pts with _____________________, it may be present at rest
Definition
severe cardiac disease
Term
In pts with cardiac disease, what causes dyspnea?
Definition

vascular congestion caused by dec LV function

 

(the vascular congestion impairs gas exchange and results in exudation of fluid into the alveolar space)

Term
What is orthopnea?
Definition

an increase in dyspnea upon laying down

 

(augmented venous return that occurs assuming the recumbent position)

Term
What is paroxysmal nocturnal dyspnea?
Definition
when a pt wakes up 2-4 hrs after the onset of sleep with dyspnea
Term
What is the likely cause of paroxysmal nocturnal dyspnea?
Definition
the central redistribution of peripheral edema in the supine position
Term
True paroxysmal nocturnal dyspnea is more specific to ___________ disease
Definition
cardiac
Term
What are the major causes of aortic stenosis?
Definition

bicuspid aortic valve

rheumatic fever

degenerative stenosis

Term
The most common congenital cardiac abnormality affects the...
Definition
bicuspid aortic valve
Term
Over the years, aortic stenosis can cause...
Definition
left ventricular hypertrophy
Term
What are the cardinal symptoms of aortic stenosis?
Definition

angina

syncope

dyspnea

CHF

Term
The mean survival rate, in pts with aortic stenosis, after the onset of symptoms is ____ for those pts with CHF
Definition
~2 years
Term
The mean survival rate, in pts with aortic stenosis, after the onset of symptoms is ____ for those pts with syncope
Definition
~ 3 years
Term
The mean survival rate, in pts with aortic stenosis, after the onset of symptoms is ____ for those pts with angina
Definition
~ 5 years
Term
A harsh, crescendo-decrescendo murmur is associated with what?
Definition
aortic stenosis
Term
The murmur of aortic stenosis is best heard where?
Definition
over the right upper sternal border and often radiates to the neck
Term
What is pulsus parvus et tardus?
Definition
when the carotid pulse is diminished in intensity and delayed because of aortic stenosis
Term
What is the most important diagnostic test to determine the cause of aortic stenosis?
Definition
Echocardiography
Term
What valve area defines critical aortic stenosis?
Definition
<0.7 cm2
Term
A normal aortic valve are measures ______
Definition
3 cm2
Term
What are the major causes of aortic regurgitation?
Definition

bicuspid aortic valve

aortic dissection

endocarditis

rheumatic fever

aortic root dilation

Term
Aortic regurgitation is commonly a consequence of degenerative and ____________________
Definition
bicuspid aortic stenosis
Term
Why does the left ventricle dilate and hypertrophy because of aortic regurgitation?
Definition
bc its trying to maintain normal effective forward flow and minimize wall stress
Term
What symptoms are associated with aortic regurgitation?
Definition

dyspnea on exertion

orthopnea

paroxysmal nocturnal dyspnea

 

chest or head pounding

fatigue or weakness

Term
Why does the pulse pressure widen with aortic regurgitation?
Definition
bc of the runoff of blood back into the left ventricle
Term
What is Corrigan's disease or water-hammer pulse?
Definition
bounding arterial pulse with a rapid upstroke and quick collapse
Term
The murmur of ________________ is a high pitched, decrescendo diastolic murmur best heart at the lower left sternal border with the pt sitting up and leaning forward.
Definition
aortic regurgitation
Term
What is an Austin Flint murmur?
Definition
a low pitched, diastolic murmur
Term
________________ is the primary tool to monitor the progression of aortic regurgitation and optimize the timing of surgery.
Definition
Echocardiography
Term
For moderate to severe aortic regurgitation what medications are recommended?
Definition
Vasodilators, like nifedipine and ACEIs, bc these agents unload the Left ventricle
Term
Acute aortic regurgitation is a ______________ that often requires immediate surgical intervention.
Definition
medical emergency
Term

infective endocarditis,

traumatic rupture of the aortic leaflets,

aortic root dissection and

acute dysfunction of a prosthetic valve

can all cause which type of heart valve dysfunction?

Definition
aortic regurgitation
Term
Why does acute aortic regurgitation occur?
Definition
bc the left ventricle is unable to dilate anymore to accommodate the increased diastolic volume
Term
Pts with acute aortic regurgitation exhibit the symptoms of _______________________.
Definition
cardiogenic shock
Term
The murmur of ___________________ is low pitched and short, and an S3 gallop is often present.
Definition
acute aortic regurgitation
Term
What is the treatment of choice for acute aortic regurgitation?
Definition
urgent valve replacement
Term
What is the major cause of mitral stenosis?
Definition
Rheumatic fever
Term
If mitral stenosis is not corrected, then irreversible changes in the pulmonary vasculature may occur and signs and symptoms of ________ may develop.
Definition
Right ventricular heart failure
Term
At what age do pts with mitral stenosis caused by rheumatic fever usually start to exhibit symptoms?
Definition
in their 30s and 40s
Term
What are the most common symptoms of mitral stenosis caused by rheumatic fever?
Definition

dyspnea

orthopnea

A fib

Term
What is Ortner's syndrome?
Definition
when the left recurrent laryngeal nerve gets compressed from a severely dilated left atrium (from mitral stenosis) and hoarseness results
Term
The characteristic low pitched rumbling murmur of ___________ is best heard at the left ventricular apex with the pt in the left lateral decubitus position.
Definition
mitral stenosis
Term
_________________ is the most useful tool for the pathologic assessment of mitral stenosis
Definition
echocardiography
Term
A hockey stick deformity, or doming, refers to what heart deformity?
Definition
rheumatic deformity of the anterior mitral valve leaflet
Term
Normal mitral valve area is _____
Definition
4-6 cm2
Term
Critical mitral stenosis is defined as a valve area...
Definition
<1 cm2
Term
_____________ control is imperative in the treatment of mitral stenosis
Definition
heart rate
Term
What are the major causes of chronic mitral regurgitation?
Definition

mitral valve prolapse

left ventricular dilation

posterior wall MI

rheumatic fever

endocarditis

Term
What are the major causes of acute mitral regurgitation?
Definition

posterior wall or papillary mm ischemia

papillary mm or chordal rupture

endocarditis

prosthetic valve dysfunction

Term
Mitral regurgitation can result from abnormalities in what aspects of the valve?
Definition

the leaflets

the annulus

the chordae

or the papillary mm

Term
What is the most common leaflet abnormality resulting in chronic mitral regurgitation?
Definition

myxomatous degeneration of the mitral valves

 

which progresses as the chordae become elongated and rupture

Term
_______________ characteristically produces a holosystolic murmur best heard at the apex and radiates to the axilla and back
Definition
mitral regurgitation
Term
If mitral regurgitation is secondary to MVP, the a ______________ may also be heard during the murmur
Definition
midsystolic click
Term
Pts with known mitral regurg should be followed with yearly studies to monitor LV function and size so that surgery can be performed before irreversible ___________ damage and __________________ occur.
Definition
myocyte damage and LV remodeling
Term
If a patient with mitral regurg develops A fib or pulm HTN it may indicated a need for earlier __________________
Definition
surgical intervention
Term
What is an annuloplasty?
Definition
its a prosthetic ring that can be sewn into annulus of a heart valve to reduce the size of the orifice
Term
What is the procedure of choice to repair mitral regurgitation?
Definition
mitral valve repair in all pts in whom it technically feasible.
Term
What are the major causes of tricuspid regurgitation?
Definition

functional annular dilation

tricuspid valve prolapse

endocarditis

Term
In the absence of _____________, tricuspid regurgitation is usually well tolerated
Definition
pulmonary HTN
Term
JVD and a prominent V wave are usually present in which valve disease?
Definition
tricuspid regurgitation
Term
A high pitched, pansystolic murmur best heard along the sternal border is associated with what?
Definition
tricuspid regurgitation
Term
What percentage of the population has mitral valve prolapse?
Definition
1-3%
Term
Which murmur is a midsystolic click, followed by a late systolic murmur?
Definition
Mitral valve prolapse
Term
Dx of mitral valve prolapse is confirmed by ___________________
Definition
echocardiography
Term
Tricuspid stenosis is most often __________ in origin
Definition
rheumatic
Term
Pts with tricuspid stenosis generally exhibit symptoms of right ventricular heart failure such as...
Definition

fatigue

abd bloating

peripheral edema

Term
pulmonic stenosis is often ___________ in origin
Definition
congenital
Term
Pulmonic regurgitation is often secondary to ___________
Definition
pulmonary HTN
Term

The murmur of ____________________ is a high pitched, blowing murmur best heard at the 2nd left intercostal space.

Its also called a _______________ murmur.

Definition

pulmonic regurgitation

 

Graham Steel

Term
prophylaxis for rheumatic fever should be continued for __________ after the primary illness
Definition
5-10 years
Term
Multivalvular disease is common in which type of pts?
Definition
pts with rheumatic heart disease and in the elderly
Term
Acute rheumatic fever is a sequela of __________________________
Definition
group A B-hemolytic strep
Term
In which age group does acute rheumatic fever occur?
Definition
4-9 yrs old
Term
Acute rheumatic fever usually presents as an...
Definition
acute febrile illness 2-4 wks after a strep pharyngitis
Term
What are the major criteria for acute rheumatic fever?
Definition

carditis

polyarthritis

chorea

erythema marginatum

subcutaneous nodules

Term
What are the minor criteria for acute rheumatic fever?
Definition

fever

arthralgia

previous rheumatic fever

or known rheumatic heart disease

Term
Dx of acute rheumatic fever can be made if ____ major criteria are met OR ____ major and ____ minor are present after a recent, documented strep pharyngitis
Definition

2 major

OR

1 major and 2 minor

Term
What can you use for rheumatic fever prophylaxis?
Definition

1.2 million U of benzathine PCN monthly

OR

oral PCN or erythromycin

Term
What do you need to control to prevent further progression of arteriosclerosis?
Definition

Obesity

HTN

DM

lipids

BP

Term
How do statins help hypercholesterolemia?
Definition
they lower LDL with HMG-CoA reductase inhibitors
Term
How does niacin help hypercholesterolemia?
Definition
increases HDL, decreases hepatic LDL and VLDL, decreases hepatic TG esterification
Term
Three of the processes that contribute to the initiation and progression of atherosclerosis are...
Definition

accumulation of lipoproteins

endothelial injury and

inflammation

Term
If the atherosclerotic plaque is covered with a __________________ rupture is less likely, but the plaque can inc in size.
Definition
thick fibrous cap
Term
Temporary myocardial ischemia, "angina", is usually secondary to _______________________
Definition
coronary atherosclerosis
Term
In a pt with angina, the ECG is normal in what percentage of people?
Definition
~25%
Term
Acute coronary syndrome includes: _________, __________ and __________.
Definition

unstable angina

NSTEMI

STEMI

Term
The distinction btwn unstable angina, and NSTEMI can only be made after the results of the _______________ are available
Definition
serum cardiac enzyme analyses
Term
AMI usually begins at _______, worsens __________ and persists for _________.
Definition

rest

gradually

hours

Term
CK-MB levels elevate within _____ hrs
Definition
4-6
Term
CK-MB peaks within _____ hrs
Definition
12-24 hrs
Term
CK-MB returns to baseline in _____ days
Definition
2-3
Term
Troponin sr levels elevate within ______ hrs
Definition
2-6
Term
Troponin sr levels peak at _____ hrs
Definition
12-24
Term
Troponin sr levels return to baseline ____ days
Definition
7-10
Term
Myoglobin elevates in ____ hrs
Definition
1-3
Term
Myoglobin levels peak within ____ hrs
Definition
4-12
Term
Myoglobin levels return to normal in ______ hrs
Definition
12-36
Term
The 2 most current methods for therapy for AMI are:
Definition

thrombolytics and

coronary intervention (stenting is the procedure of choice)

Term
AMI labs include:
Definition

CBC

SrCr, BUN

electrolyte panel

PT, PTT, INR

blood typing, cardiac enzymes

ABG, CRP, homocysteine

fasting lipid panel

Term
What are 3 ways a coronary artery can become obstructed?
Definition

1. artherosclerosis

2. thrombus

3. spasm

Term
AMI associated symptoms:
Definition

dysnpea

weakness

diaphoresis

NVD

confusion

feeling of impending doom

Term
DDx for AMI:
Definition

angina, MVP, dissecting AA

cocaine induced CP, musculoskeletal factors

rib fracture, nerve root compression

bacterial PE, anxiety disorder, esophagitis

spontaneous pneumothorax

cholocystitis, cholelithiasis

Term
How soon after arrival does a pt with AMI have to receive a thrombolytic?
Definition
30-60 mins
Term
When O2 demands increase in the setting of limited myocardial O2 supply, ____________ results.
Definition
ischemia
Term

Prolonged ischemia may produce

_______________,

_______________, or even ______.

Definition

myocardial stunning

hibernation or even MI

Term
What percentage of patients with acute MI have no symptoms or atypical symptoms?
Definition
20%
Term
The initial ECG in a pt with suspected MI is nondiagnostic in what percentage of pts?
Definition
50%
Term
Besides AMI, why else might CKMB be elevated?
Definition

extensive skeletal mm injury or disease

chronic renal disease

hypothyroidism

Term
Which cardiac enzyme is the most sensitive and specific for myocyte necrosis?
Definition
Troponin I
Term
Cardiac arrhythmias result from disorders of what 2 things?
Definition

impulse formation

and/or

impulse conduction

Term
Cardiac arrhythmias: Disorders of impulse formation include...
Definition
enhanced or abnormal automaticity and triggered activity
Term
Cardiac arrhythmias: Disorders of impulse conduction include...
Definition
block with or without re-entry
Term
What are the 3 cateogries that cardiac arrhythmias can be divided into?
Definition

1. premature beats

2. bradyarrhythmias

3. tachyarrhythmias

Term
What are the 3 different types of premature beats?
Definition

atrial premature complexes

junctional premature complexes

ventricular premature complexes

Term
Bradyarrhythmias are usually the result of either ____________________ or ____________________
Definition
sinus node dysfunction or AV block
Term
Tachyarrhythmias are divided into what 3 groups?
Definition

supraventricular

ventricular

pre-excited tachycardias

Term
What are the most common complaints in a person with an arrhythmia?
Definition

palpitations

presyncope, syncope

dizziness

CP

sxs of HF

Term
Skipped beats are likely to be the result of:
Definition
a premature atrial or ventricular beat
Term
Periods of rapid, irregular heart beats may be reflective of...
Definition
paroxysmal A fib
Term
Pts with valvular heart disease or HTN will frequently develop what type of arrhythmia?
Definition
A fib
Term
The S2 may become widely or paradoxically split if a __________ develops during an arrhythmia
Definition
Bundle branch block
Term
What are some diagnostic tests used for arrhythmias?
Definition

Echocardiogram

Recording devices

Head-up tilt table testing

electrophysiologic study

Term
Ventricular Fib occurring in the absence of acute ischemia is likely to ______ and requires _______________
Definition

recur

aggressive therapy

Term
Which prescriptions have been known to cause arrhythmias?
Definition

digoxin

theophylline

anti-arrhythmic agents

certain Abx

Term
Which nonprescription drugs have been known to cause arrhythmias?
Definition

decongestants

cocaine

Term
Which metabolic abnormalities have been known to cause arrhythmias? (4 Hs)
Definition

hypokalemia

hypomagnesemia

hypoxia

hyperthyroidism

Term
What are some nonpharmalogical forms of treatment for arrhythmias?
Definition

pacemakers

direct current cardioversion and defibrillation

radiofrequency catheter ablation and automatic implantable cardioverter-defibrillators

Term
Long QT syndrome is defined as a QT >_____ms
Definition
440
Term
How do genetic mutations cause congenital forms of Long QT syndrome?
Definition
by altering the K and Na channels
Term
Congenital forms of Long QT syndrome may also be associated with ________________.
Definition
deafness
Term
Long QT syndrome is associated with the development of a type of VT called:
Definition
torsades de pointes
Term
How do you treat torsades de pointes?
Definition
with IV magnesium (2-3mg)
Term
Why don't you use typical anti-arrhythmic meds to treat torsades de pointes?
Definition
bc they have a tendency to prolong the QT interval which would exacerbate the arrhythmia
Term
Short QT syndrome is associated with a high incidence of ______________________ and/or _________.
Definition
sudden cardiac death and/or A Fib
Term
How do you Dx short QT syndrome?
Definition
when the pt exhibits syncope and a corrected QT interval <320ms
Term
What is brugada syndrome?
Definition
the presence of ST segment elevation in V1-3 that is unrelated to ischemia, structural heart disease or electrolyte abnormalities.
Term
What are often the first symptoms in a pt with Brugada syndrome?
Definition
syncope and sudden cardiac death
Term
When does the polymorphic VT arrhythmia tend to occur in pts with Brugada syndrome?
Definition
during sleep
Term
Transient loss of consciousness and postural tone due to inadequate cerebral blood flow with prompt recovery without resuscitative measures is called?
Definition
syncope
Term
Syncope is more likely to occur in pts with:
Definition

known heart disease

Older men

younger women who are prone to vasovagal episodes

Term
Vasomotor Syncope may be due to what 2 things?
Definition

excessive vagal tone

or

impaired control of peripheral circulation

Term
Orthostatic hypotension is common in which types of pts?
Definition

the elderly

diabetics, or other pts with autonomic neuropathy

pts with blood loss or hypovolemia

or pts taking vasodilators, diuretics or adrenergic blockers

Term
How much does a pt's BP have to decrease when going from a supine to standing position in order for it to be considered orthostatic?
Definition
20mmHg
Term
What are some mechanical causes of cardiogenic syncope?
Definition

aortic stenosis

pulmonary stenosis

hypertrophic obstructive cardiomyopathy

congenital lesions assc with pulm HTN or L to R shunting

LA myxoma obstructing the mitral valve

Term
What are some arrhythmic causes of cardiogenic syncope?
Definition

disorders of automaticity like sick sinus syndrome

disorders of conduction like an AV block

tachyarrhythmias (esp VT, SVT)

 

Term
What 4 things govern systolic function?
Definition

1. contractile state of the myocardium

2. preload of ventricle

3. afterload applied to the ventricles

4. heart rate

Term
What can cause high output failure?
Definition

thyrotoxicosis

severe anemia

AV shunting

Pagets

Thiamin deficiency

Term
What is the primary feature of Left heart failure?
Definition
dyspnea
Term
Left sided heart failure leads to _____________ as the blood backs up into the lungs.
Definition
pulmonary venous congestions
Term
Left sided heart failure leads to pulmonary venous congestion which leads to pulmonary HTN which leads to what?
Definition
Right sided heart failure
Term
Right sided heart failure leads to what?
Definition
lower extremity edema, tender hepatomegaly and pleural effusions
Term
Diastolic cardiac dysfunction is more frequently caused by...
Definition
Left ventricular hypertrophy
Term
Left ventricular hypertrophy usually results from what?
Definition

HTN

DM2

cardiomyopathies

pericardial dz

Term
What forms of heart failure are there?
Definition

systolic/diastolic

high/low output

L/R sided

acute/chronic

Term
Systolic heart failure refers to the inability of the heart to __________ strongly enough to provide adequate blood flow to the periphery
Definition
contract
Term
What is the primary abnormality in idiopathic cardiomyopathy?
Definition
systolic failure
Term
Diastolic heart dysfunction occurs when there is abnormal ________________ of the myocardium.
Definition
relaxation
Term
Diastolic heart dysfunction is associated with what diseases?
Definition

hypertrophic cardiomyopathy

cardiac amyloidosis

sarcoidosis

Term
High output heart failure occurs when the heart is unable to meet abnormally _____________ metabolic demands of the peripheral tissues
Definition
elevated
Term
Low output heart failure is characterized by insufficient ____________________, both at rest and at times of increased metabolic demand
Definition
forward output
Term
NY heart association classifications of heart failure:
Definition

1. asymptomatic

2. symptomatic with moderate activity

3. symptomatic with slight activity

4. symptomatic at rest

Term
What is the most common heart failure symptom?
Definition
SOA
Term
In a pt with heart failure when does their cough worsen?
Definition
when recumbent
Term
Which symptoms can occur with right sided heart failure?
Definition

RUQ pain

loss of appetite

N

pulmonary edema

Term
A parasternal lift is indicative of...
Definition
pulmonary HTN
Term
A diminished first heart sound is indicative of...
Definition
impaired contractility
Term
What tests are good for diagnosing heart failure?
Definition

ECG

CXR

ECHO

Card Cath

Term
Which meds are known to worsen heart failure?
Definition

CCBs

NSAIDs

Anti-arrhythmic agents

Term
What doses of Lasix are indicated in severe HF?
Definition
500mg
Term
Which meds are used to treat HF?
Definition

Lasix, Spironolactone

ACEI or ARBs

BB

Digitalis glycosides

Vasodilators (nitrates, nesiritide, hydralazine)

CCBs

Anticoagulation

 

Term
What is Acute CHF caused by?
Definition

extensive MI or severe ischemia

volume overload

arrhythmias

mitral stenosis

ventricular septal rupture

Term
What can cause acute CHF secondary to chronic CHF?
Definition

d/c of meds

excessive salt intake

tachyarrhythmias

myocardial ischemia

Term
Myocarditis is usually caused by...
Definition

a viral infection

coxsackievirus B and echovirus being the more common

Term
What may provide the most convient and thorough eval for myocarditis?
Definition
ECHO and serum viral titers
Term
What is the gold standard for Dx myocarditis?
Definition
endomyocardial biopsy
Term
Pericardial friction rub may be heard if what is present?
Definition
myopericarditis
Term
What are the 2 main lipids in the blood?
Definition
cholesterol and trigs
Term
What is familial hypercholestermia?
Definition
a condition in which the body is unable to remove LDL cholesterol from the blood, resulting in unregulated synthesis of LDL
Term
What occurs in pts with a Trig level >1000?
Definition
formation of eruptive xanthomas
Term
Very high LDL levels can result in xanthomas. Where are they located?
Definition
on tendons like the achilles, patellar or back of hand
Term
lipemia retinalis are seen with trig levels great than what?
Definition
2000
Term
LDL goal?
Definition
<70
Term
Which drug is good at lowering LDL levels?
Definition
statins
Term
Soluble fiber, garlic, soy protein, vit C, pecans and plant sterols are all said to lower what?
Definition
LDL
Term
Intensity of drug therapy for high cholesterol should be to lower LDL by what percentage?
Definition
30-40
Term
What was the first lipid lowering drug to be assc with a dec in total mortality?
Definition
niacin
Term
How does niacin effect cholesterol levels?
Definition

dec in VLDL production

secondary dec in LDL and inc in HDL

 

dec TGs by 1/2

Term
What is the main reason pts can't tolerated niacin?
Definition
flushing/pruritis
Term
Niacin can exacerbate what other conditions?
Definition
gout and PUD
Term
Bile acid binding resins decrease LDL levels by what percentage?
Definition
15-25%
Term
which antihyperlipidemic agent can increase TGs?
Definition
Bile-Acid binding resins
Term
Which is the only antilipid that can be used in pregnancy?
Definition
bile acid binding resins
Term
Fibric acid derivatives decrease TG by what percentage?
Definition
40%
Term
pts with very high sr TG levels are at risk for what?
Definition
pancreatitis
Term
At what level of TGs is medication indicated?
Definition
>500
Term
Hypoglycemia can cause what symptoms?
Definition

hypothermia                          HA

confusion                               bizarre behavior

visual distrubances              seizures

lethargy                                  syncope

coma

Term
At what sr glucose level can brain function become impaired?
Definition
~50
Term
at what sr glucose level do symptoms begin to occur?
Definition
< 60
Term
Fasting hypoglycemia occurs in what pts?
Definition

those with hypopituitarism, Addison's dz, myxedema

acute alcoholism, liver failure

renal failure

Term
When fasting hypoglycemia occurs in a pt w/o apparent endocrine or metabolic dz, what are the 2 Dx possibilities?
Definition

1. hyperinsulinism

2. non-insulin-producing extrapancreatic tumor

Term
Early postprandial hypoglycemia is seen after what type of procedure?
Definition
GI surgery
Term
which drugs can cause hypoglycemia?
Definition

sulfonylureas

insulins

quinine, quinidine

disopyramide

salicylates

ACEIs

gatifloxacin, pentamidine

Term
What blood pH level will a pt with lactic acidosis have?
Definition
<7.3
Term
Accumulation of excess lactic acid in the blood can lead to ________.
Definition
coma
Term
The main feature of lactic acidosis is marked _________________
Definition
hyperventilation
Term
A serum bicarb level in a pt with lactic acidosis is below what?
Definition
15
Term
Low bicarb and pH indicate the presence of severe metabolic ____________
Definition
acidosis
Term
Dx of lactic acidosis is confirmed by a plasma lactic acid concentration of what?
Definition
greater than or equal to 5
Term

What are the levels of the following in a pt with DKA?

glucose

sr bicarb

blood pH

 

Definition

glucose >250

bicarb <15

pH <7.3

 

Term
DKA is the production of ketones during fat metabolism due to a lack of ____________ needed for glucose uptake
Definition
insulin
Term
DKA can occur during times of increased insulin requirements. What are some examples?
Definition

infection

surgery

trauma

MI

Term
Symptoms of DKA
Definition

1+ dys of polydipsia/polyuria

marked fatigue

NV

mental stupor progressing to coma

Term
What are the 3 categories of cardiomyopathies?
Definition

dilated

hypertrophic

restrictive

Term
What is dilated cardiomyopathy characterized by?
Definition

chamber enlargement and impaired systolic function (contractile) of one or both ventricles

 

 

etiology is unknown

Term
what is the most common type of cardiomyopathy?
Definition
dilated
Term
Hypertrophic cardiomyopathy is autosomal dominant in ____% of pts.
Definition
50
Term
Hypertrophic cardiomyopathy is characterized by __________ hypertrophy, involving the Left ________________________.
Definition

ventricular

ventricular septum

Term
Hypertrophic cardiomyopathy results in...
Definition
elevated diastolic pressures
Term
Arrhythmias are an important problem that can lead to sudden cardiac death in what type of cardiomyopathy?
Definition
hypertrophic
Term
____________ cardiomyopathy may progress to ______________ cardiomyopathy
Definition

hypertrophic

to

dilated

Term
What are some possible causes of hypertrophic cardiomyopathy?
Definition

HTN

familial

renal disease

Term
Pts with hypertrophic cardiomyopathy often present with...
Definition
dyspnea, CP, syncope and increased outflow obstruction
Term
A loud S4 is seen in which cardiomyopathy?
Definition
hypertrophic cardiomyopathy
Term
Which drug improves diastolic function and reduce outflow obstruction by vasodilation?
Definition
CCBs
Term
________________ cardiomyopathy is characterized by impaired diastolic filling but distinct in that early diastolic filling is accentuated rather than impaired.
Definition
restrictive
Term
With restrictive cardiomyopathy which sided heart failure dominates?
Definition
right over left
Term
Is contractility increased or decreased in dilated cardiomyopathy?
Definition
decreased
Term
Pulmonary HTN is present with which type of cardiomyopathy?
Definition
restrictive
Term
What is the most common cause of restrictive cardiomyopathy?
Definition
amyloidosis
Term
which cardiomyopathy has a large ventricular cavity and which has a small one?
Definition

Dilated -- large

 

hypertrophic, restrictive -- small

Term
How much serous fluid is normally btwn the inner visceral layer attached to teh epicardium and the parietal layer?
Definition
~50ml
Term
Pericarditis CP may radiate where?
Definition
to the tip of the shoulder and to the neck
Term
What positions decrease CP caused by pericarditis?
Definition
sitting or leaning forward
Term
What are some of the assc symptoms of pericarditis?
Definition
fever, tachycardia, pulsus paradoxus, tamponade, ESR, leukocytosis, elevated ST, PR depression
Term
What drugs can increase the risk for pericarditis?
Definition

procainamide

hydralazine

isoniazid

Term
What are the most common viral causes of pericarditis?
Definition

HIV

Hepatitis

mumps

influenza

EBV

Echoviruses

coxsackie

Term
How does tuberculous pericarditis occur?
Definition
from direct lymphatic or hematogenous spread
Term
Name some forms of non-infectious pericarditis.
Definition

uremic in RF w/ dialysis

Neoplastic - due to spread of lung CA

Post-MI

Radiation

RA, lupus, and drug-induced

myxedema

Term
Which areas of the body inc or dec catecholamines to produce vasodilation or vasoconstriction?
Definition
baroreceptors and adrenal glands
Term
When is it appropriate to treat HTN based on just one BP reading?
Definition
if there is evidence of acute target-organ damage (hypertensive crisis)
Term
what is pseudohypertension?
Definition
elderly pts with stiff, noncompliant, atheromatous arteries who appear to have HTN
Term
What percentage wt loss can decrease BP?
Definition
3-9%
Term
In what position is BP the lowest? highest?
Definition

lowest - lateral decubitus

highest - standing

Term
Pregnancy induced HTN has a ______% incidence in multiple gestations and a ____% in pregnancies that proceed beyond the first trimester.
Definition

30

 

5-10

Term
HTN in pregnancy is assc with...
Definition
abruptio placentae, hepatic rupture and preeclampsia,eclampsia
Term
What is preeclampsia?
Definition
the dev of HTN w/ proteinuria and/or edema induced by pregnancy
Term
Eclampsia is preeclampsia with the presence of ___________
Definition
convulsions
Term
What do you give pts with worsening preeclampsia or severe preeclampsia or eclampsia?
Definition

Mg Sulfate (to prevent convulsions)

Hydralazine first choice antihypertensive

Delivery

Term
For pregnant pts with chronic HTN, when do you give antiHTN therapy?
Definition
when the DBP >110
Term
Which antihypertensive medication is a good choice during pregnancy?
Definition
Methyldopa
Term
Hyponatremia is defined as < _____ meq/L
Definition
130
Term
What is the most common electrolyte abnormality in hospitalized pts?
Definition
hyponatremia
Term
Which 2 diseases can cause pseudohyponatremia?
Definition

hyperlipidemia

hyperproteinemia

Term
What are some extra renal causes of salt loss?
Definition

dehydration

diarrhea

vomiting

Term
Hypernatremia is a sr Na > ____ meq/L
Definition
145
Term
Over how long a period of time you should admin fluids in a pt with hypernatremia?
Definition
over 48 hrs
Term
Hypokalemia is a sr K < ___ mEq/L
Definition
3.5
Term
What is the total content of K in the body?
Definition
50 mEq/kg
Term
What is the most common cause of hypokalemia?
Definition
GI loss due to infectious Diarrhea
Term
What is the most important regulator of body K content?
Definition
Aldosterone
Term
______________ is an important cofactor for K uptake and for maintenance of intracellular K levels.
Definition
Magnesium
Term
What are some signs and symptoms of hypokalemia?
Definition

mm weakness

fatigue

mm cramps

constipation

ileus

Term
What are some signs and symptoms of hypokalemia?
Definition

flaccid paralysis

hyporeflexia

hypercapnia

tetany

rhabdomyolysis

Term
When you give IV K you are not to exceed ____ mEq/L an hour.
Definition
40
Term
In a pt with severe hypokalemia you need to check serum levels how often?
Definition
4-6 hrs
Term
Hyperkalemia - a serum K > ____ mEq/L
Definition
5.2
Term
Severe hyperkalemia is defined as > ____ mEq/L
Definition
6.5
Term
which drugs inhibit K excretion?
Definition

spironolactone

ACEIs

ARBs

NSAIDs

Trimethoprim

Cyclosporine

Term
Burns, rhabdomyolysis, hemolysis, severe infection, internal bleeding and vigorous exercise can cause an increase in which electrolyte?
Definition
K
Term
Serum K conc rises ___ mEq/L for every decrease of 0.1 pH during acidosis.
Definition
0.7
Term
What meds can you use to distribute K into cells?
Definition
IV Sodium Bicarb, insulin, albuterol
Term
Hypocalcemia is defined as ionized sr Ca <___ mg/dL
Definition
4.7
Term
What is the most common cause of hypocalcemia?
Definition
renal failure
Term
What are some signs and symptoms of hypocalcemia?
Definition

mm cramps, tetany, laryngospasm w/ stridor, convulsions, parasthesia, abd pain

Chvostek's sign

Trousseau's sign

Vent arrhythmias

cataracts

Term
What is Chvostek's sign?
Definition
contraction of facial mm when you tap on facial nn anterior to the ear
Term
What is Trousseau's sign?
Definition
Carpal spasm occurring after occlusion of brachial artery with BP cuff for 3 mins
Term
Hypomagnesia leads to low PTH which leads to low ____
Definition
Ca2+
Term
What do you use to treat severe hypocalcemia?
Definition

Calcium gluconate 10%

infusion of 10-15 Ca2

 

Term

Mild hypercalcemia is defined as ___ - ___ mg/dL

Severe hypercalcemia >___ mg/dL

Definition

mild 10.3-11

severe >14

Term
Hypercalcemia usually becomes symptomatic when sr Ca levels reach what?
Definition
>12
Term
Signs and symptoms of hypercalcemia
Definition

Constipation, polyuria

N, V

anorexia, PUD

renal colic, hematuria

mild drowsiness, weakness

depression, lethargy, stupor, coma

Term
hypercalcemia can cause nephrogenic __________
Definition
diabetes insipidus
Term
hypophosphatemia is defined as < ___ mg/dL for severe, and ___ to ___ mg/dL for moderate
Definition

<1.0

 

1.0-2.5

Term
Do you want to make sure that you measure serum or plasma phosphorus?
Definition

plasma

 

bc imbalances can occur with low, normal or high concentrations of phosphorus in serum

Term
Parental admin of phosphate can cause _________ so oral replacement is better
Definition
hypocalcemia
Term
In DKA hypophosphatemia is usually correct with normal __________ _________
Definition
dietary intake
Term
______________ deficiency often coexists with hypophosphatemia
Definition
Mg
Term
Phosphate salts can not be used in pts with what illnesses?
Definition

hypoparathyroidism

renal insufficiency

tissue damage/necrosis

hypercalcemia

Term
Hyperphosphatemia is defined by a sr phosphorus level > _____
Definition
4.1
Term
What is the main cause of hyperphosphatemia?
Definition
Chronic renal insufficiency
Term
What are some exogenous phosphate sources?
Definition

excessive Vit D

laxatives or enemas containing phosphate

IV phosphate

Term
What are some endogenous sources of excessive phosphate?
Definition

rhabdomyolysis

cell destruction by chemo

metabolic acidosis (lactic acidosis, ketoacidosis)

respiratory acidosis

Term
What conditions can cause pseudohyperphosphatemia?
Definition

multiple myeloma

high Trigs

cell lysis

Term
Hypomagnesemia is defined as < ____ mEq/L
Definition
1.5
Term
The excretion of magnesium is related by what organ?
Definition
the kidney
Term
Magnesium has physiologic effects on the ___________ resembling those of Calcium
Definition
nervous system
Term
Severe and prolonged Mg depletion impairs PTH secretion with consequent hypo___________
Definition
calcemia
Term
What are symptoms that hypokalemia, hypocalcemia and hypomagnesemia have in common?
Definition
mm weakness and cramps
Term
What change can you see on an EKG in a pt with hypomagnesemia?
Definition
prolonged ST segment
Term
If a pt has normal _______ function they shouldn't develop hypermagnesemia bc the __________ will dump the excess
Definition

renal

 

kidneys

Term
Hypermagnesemia is defined as > ____ mEq/L
Definition
2.5
Term
What are the characteristic S/Sx of hypermagnesemia?
Definition
mm weakness, dec DTRs, mental obtundation, confusion
Term
What is a EKG finding seen in a pt with hypermagnesemia?
Definition
inc PR interval, broad QRS complex, peaked T wave
Term
Respiratory acid base disorders affect blood pH causing changes in _______
Definition
pCO2
Term
Metabolic acid-base disorders affect blood pH by causing changes in ______
Definition
HCO3
Term

Metabolic acidosis has an arterial pH < ____

and an arterial HCO3 < ___ mEq/L

Definition

7.3

 

22

Term
Hyperkalemia is associated with which type of acid-base disorder?
Definition
metabolic acidosis
Term
Alcoholic ketoacidosis, Salicylate intox and methanol intoxication can cause which acid-base disorder?
Definition
metabolic acidosis
Term
Metabolic acidosis has an arterial pH > ____ and a serum HCO3 > _____
Definition

7.45

 

26

Term
Severe metabolic acidosis requires _____________
Definition
urgent treatment
Term
Respiratory acidosis is also known as _______________
Definition
hypercapnia
Term

Respiratory acidosis has an arterial pH < ____

a sr PCO2 > _____ and

a sr HCO3 > _____

Definition

7.36

45

26

Term
What can cause respiratory acidosis?
Definition

opiod-induce CNS depression

acute respiratory failure

underying lung disease - COPD

Term
Respiratory alkalosis is also called _____________
Definition
hypocapnia
Term
Respiratory alkalosis is a pH > ___, and a sr pCO2 < ___
Definition

7.45

 

35

Term
What is the most common cause of respiratory alkalosis?
Definition
hyperventilation syndrome
Term
what is the best indicator of water balance?
Definition
weight loss or gain
Term
What are the two types of gynecomastia?
Definition

fatty

and

glandular

Term
how does fatty gynecomastia differ from glandular gynecomastia?
Definition

fatty is typically diffuse and nontender

 

glandular is lumpy and may be tender

Term
You need to make sure you distinguish gynecomastia from what 2 other conditions?
Definition
tumors or mastitis
Term
Gynecomastia can be the first sign of which serious disorder?
Definition
Peutz-Jeghers syndrome -- prone to dev gynecomastia secondary to testicular tumors
Term
Why would you order a CXR in a pt with gynecomastia?
Definition
to R/O lung CA or mets
Term
How long does it usually take pubertal gynecomastia to resolve?
Definition
1-2 yrs
Term
What do you treat persistent or painful gynecomastia with?
Definition
estrogen receptor modulators -- raloxifene or tamoxifen
Term
Adults with a deficiency in GH experience what?
Definition

asthenia

obesity and

Inc cardiac mortality

Term
Deficiency in LH and FSH causes...
Definition
hypogonadism and infertility in men and women
Term
About ___% of survivors of Subarachnoid hemorrhage develop at least 1 pituitary hormone deficiency
Definition
55
Term
Kallmann's syndrome is the most common cause of congenital isolated ___________ deficiency
Definition
gonadotropin
Term
hypo________ often occurs after the removal of pituitary tumors
Definition
hyponatremia
Term
ADH deficiency or resistance causes central ___________
Definition
diabetes insipidus
Term
What is the treatment of choice for diabetes insipidus?
Definition
desmospressin acetate
Term
Diabetes incs risk of heart disease by ____times and that of stroke by ____ times
Definition

2 - 6 times

 

2 - 4 times

Term
DM2 goes undiagnosed on average for ______ yrs
Definition
5-10
Term
______________, a complication of DM, is the leading cause of blindness in middle-aged adults
Definition
retinopathy
Term
What is the leading cause of ESRD?
Definition
Diabetic nephropathy
Term
What is the leading cause of non-traumatic amputation?
Definition
diabetes
Term
What are 2 subtypes of DM2?
Definition

Gestational DM

Maturity Onset Diabetes of Youth

Term
What are the 4 main characteristics of MODY?
Definition

1. diabetes usually presents at a young age, <25

2. autosomal dominant inheritance

3. do not always need insulin

4. do not produce enough insulin

Term
What are the microvascular complication of diabetes?
Definition

retinopathy

nephropathy

neuropathy

DKA

Term
What are the macrovascular complications of diabetes?
Definition

cardiovascular disease

coronary artery disease

dyslipidemia

Term
how do you Dx diabetes?
Definition
fast plasma glucose >126 on two separate occasions
Term
Which drugs mask hypoglycemia sxs?
Definition
BBs
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