CPR Exam 2 > LOs > Flashcards

LOs Flashcards

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1
Q

What are the top 5 symptoms that correlate with edema?

A
  1. Leg swelling
  2. Dyspnea
  3. Orthopnea
  4. Paroxysmal Nocturnal Dyspnea
  5. Weight gain
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2
Q

what is edema?

A

abnormally large amounts of fluid in intracellular spaces that can be localized (d/t venous obstruction or lymphatic obstruction) or generalized, d/t systemic causes.

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3
Q

What is edema called in the

  1. - peritoneal cavity
  2. - pleural cavity
  3. - pericardial sac
A
  1. Ascites
  2. Hydrothorax
  3. Hydropericardium
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4
Q

Non-pitting edema is due to?

A
  • 1. Metabolic disease (myxedema)
  • 2. Lymphatic system disease
  • 3. Warm weather
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5
Q

type of imaging for edema

A

1. CXR- PA and lateral

2. EKG

3. Echo

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6
Q

if out of country and patient has lymphedema, what should come to mind as the cause?

A

Filarial infection

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7
Q

What is a fever?

A
  • rise in body temperature in response to endogenous cytokines
  • Above 100.0 F (38.3 C)
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8
Q

involuntary muscle contractions that occur as a result of a sudden lowering of body temperature below a persons set point

A

chills

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9
Q
  1. Describe hyperthermia and its distinction from fever while relating common entities that are associated with its occurrence.
A
  1. Hyperthermia → elevated body temperature inability of body to dissipate heat in response to environmental heat
    1. Anything over 105.8 (41 C) is hyperthermia
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10
Q

What is a fever of unknown origin

A
  • fever that lasts 3 weeks or longer with temperatures above 100.9, with no clear dx, even though there has been 1 week of clinical investigation
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11
Q

How does a fever occur?

A
  1. Lipopolysaccharide (endotoxin) of gram (-) rods, ciruses and other fungi, etx
  2. Endogenous pyrogens (EP) binds to receptors in hypothalamus.
    1. IL1
    2. TNF: like IL1, but does not activate lymphocytes
    3. Interferon-a
  3. Increase in PGE2, monoamines, cations and cAMP
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12
Q
  1. 4 common causes of fever
A
  1. Infection
  2. Autoimmune disease
  3. CNS disease
  4. Malignancy
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13
Q

less common causes of fever

A
  1. CVD
  2. GI Disease
  3. Misc.
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14
Q

most common causes of hyperthermia

A
  1. Heat Stroke
  2. Neuroleptic Malignant Syndrome
  3. Malignant Hyperthermia
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15
Q

Describe the cource of fever in younger adults vs over 65 pts

A
  • younger adults: benign and self-limited.
    • Challenge: ID meniningitis or sepsis
  • older than 65/those with chronic disease and fever: high risk for bad things.
    • 70-90% are hospitalized
    • Infection is the MCC in adults
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16
Q

in older people, what body systems are 80% of the target, which cause fever?

A
  1. Respiratory tract
  2. Urinary tract
  3. Skinn and soft tissue
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17
Q

what alarm systems are assx with a fever?

and what could they imply

A
  1. High fever (above 105.8)
    1. CNS infection, NMS, heat stroke
  2. Rash
    1. ​Meningitis, bacteremia with shock
  3. Changes in mental status
    1. ​Meningitis, encephalitis
  4. Dizziness or lightheadedness
    1. ​Bacterial infection with shock, adrenal insuff, PE
  5. Recent chemo
    1. ​nocosomial infection w neutropenia
  6. SOB or Chest Pain
    1. ​PE, pneumonia and empyema
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18
Q
  • Thermometer with the most variability: ______
  • Subjective report of a fever is usually ______.
  • In patients with a fever, the best predictors of bacteremia are what?
  • Prescence of _________ increases the probability of bacteremia.
  • What is the GREATEST VALUE of fever patterns today?
  • Persistance of a fever means what?
A
  • tympanic fever
  • accurate
  • patients underlying conditions
  • shaking chills
  • they respond to antimicrobial agents
  • superinfection, drug fever, abcess or noninfectious mimic of infectious disease (vasculitis, tumor)
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19
Q
  • MCC of nocosomial infections in hospitilzed pts
  • MCC cause of FUO:
  • Malignancies most assx with FUO:
  • 36% of patients with ____ have fever at presentation
  • 42% of patients with ____ have fever at presentation
  • 42% of patients with ____ have fever, but develops LATER in the course of illness.
A
  • bacterial: pneumo, catheter-related spesis, clostridium difficile diarrhea, wound infections, UTI
  • TB and intra-abdominal abcess
  • Hodkines and non-hodgkins lymphoma
  • SLE
  • Giant cell arteritis
  • IBD
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20
Q
  1. Endocarditis + fever
    1. MCC
    2. Other causes
    3. Diagnose:
A
  • Rheumatic Heart Disease
  • Staph aureus, strep vridans
  • Clinical eval is not enough
    • Blood cultures***
    • Transesophageal echo is the cornerstone
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21
Q

what is used to dx Endocarditis?

A

Duke criteria

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22
Q

if pt presents with HF, what is important to note?

A
  • HF is caused by many things.
  • thus, it is important to ID the UNDERLYING cause of HF.
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23
Q

how to dx HF?

A
  • 1. Natriuretic peptide levels
  • 2. 2D echo with doppler
  • 3. CXR
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24
Q

S3 gallop means what?

S4?

A
  • S3: systolic HF
  • S4: diastolic HF
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25
* **Myocarditis** * **​**Follows: * Present with: * Similar to \_\_\_\_, coming on a **few weeks after** a febrile illness. * May have _________ when auscultated * Diagnose * Would cardiac enzymes be elevated?
* **URI** * **CP** or **signs of HF** * **PSGN** * **Pericardial friction rub** * **ECG**, would see **sinus tachycardia** * **COULD** be
26
1. **Granulomatosis with polyangiitis** (also called \_\_\_\_\_\_) 1. \_\_\_\_-ANCA 2. Patient could have a \_\_\_\_\_\_
* **Wegners** * **c-ANCA** * **Cough**
27
what would have **P-ANCA?**
* **1. Microscopic polyangitis** * **2. Polyarteritis nodosa**
28
1. **Pulmonary Embolism (fever)** 1. Elevated levels of \_\_\_\_\_ 2. Sx:
* **D-dimer** * **Appear anxious or ill**, **hypoxemia**, **tachypnea**
29
do we **hospitlize** patients with **FUO**?
* **only if clinical condition requires it,** _NOT_ for diagnosis. * thus, does **NOT need a in-hospital eval**
30
**FUO** defintion
1. Fever **\> 101** on at least **2 occasions** for **3 or more weeks**
31
Infections cause 1/5 of causes of FUO in Western countries. Next in frequency are what?
* **Non-infectious inflammatory diseases (NIIDS)** * collagen or rheumatic diseases * vasculitis * granulomatous disoders * autoinflammatory syndromes neoplasma
32
* If we have a **FUO**, which DOES NOT ALWAYS MEAN INFECTION, how do we treat? * What about if the patient is toxic or septic?
* Withhold ABX * If patient is toxic or septic, empirical ABX.
33
1. **Tick-borne illness** that can cause fever?
* 1. **Rickettsial** (rocky mountain spotted fever) * 2. **Lyme disease**
34
What tick-borne illness is common in **SW Missouri?** treat is?
HME: **_Erlichiosis_** -empirical ABX
35
MRC **Dyspnea** Scale
1. When you have **SOB** * 1 → no trouble except for strenuous exercise * 2 → hurrying walking up hill * 3 → walking slower than most, stops after a mile or 15 minutes * 4 → after 100 yards or a couple of minutes * 5 → at rest, can’t leave the house
36
how do diagnose **COPD**?
**GOLD** and **MRC Dyspnea scale**
37
1. Describe the **6-minute walk test** and its utility in the diagnosis and management of patients with **dyspnea** and **dyspnea on exertion.**
* **6 minute walk test** is a part of diagnosing _COPD_ + _pulmonary HTN._ * determines function of the **right side of the \<3**
38
what is best at detecting **pulmonary HTN**/COPD? how can we track progression of **PAH**?
* **6 minute walk test** * **6 minute walk test + echo**
39
the **GOLD** **criteria** is used to diagnose \_\_\_\_\_
**_COPD_** 1. Mild (\>80) 1. **SABD prn** 2. Moderate (50-80) 1. **+ LABD + pulm rehab** 3. Severe (30-50) 1. **+ ICS if repeated exacerbations** 4. Very severe 1. ​\< 30 2. or \<50 + respiratory failure 3. **+ add long-term O2 therapy; surgery**
40
what do we see with **diffuse parenchymal lung disease** on CXR? other findings?
* **diffuse bilateral reticular lung disease** in the **upper zones** of the lungs * **dry crackles**, **parasternal S2**
41
treatment of **asthma** plan
1. **LABA** + **LAMA** (Long acting muscarinic antagonist) * Salmeterol/formotorol + tiotropium
42
**_a1AT deficiency_** * Which of the following do we give? * ICS, * O2 * LABA
***LABA*** ## Footnote * do not give O2 bc 6 minute walk test is NL * no ICS
43
pt who is **hypoxic** will describe what symptom
**SOB**
44
**COPD** d/t **infection** is caused by
1. **Strep. pneumo** 2. **M. catarhallis** 3. **H. influenzae**
45
classic 4 signs of **sarcoidosis**
1. **erythema nodosa** 2. **fever** 3. **arthralgia** 4. **hilar adenopathy (CXR)**
46
Which DPLD has **HIGH ACE** levels
sarcoidosis
47
1. Identify patients at risk for the development of **pneumonia**.
1. **CURB-65** → identify **high risk patients** + predict **complicated course** 1. C → Confusion 2. U → BUN \> 19.6 3. R --\>RR \> 30 4. B → Systolic Blood Pressure LESS 90 5. 65 → \> 65 years old 2. **2 findings:** admit to hospital 3. **3 findings**: admit to ICU
48
if you give a patient therapy for **community-acquired pneumo**, but they **do not respond in 48-72 hours**, what should we suspect?
1. **Legionnarires** 2. **TB** 3. **Fungi** 4. **Viruses** 5. **Pneumocystitis**
49
1. Describe patients at risk for developing **active tuberculosis,** or harboring **latent tuberculosis.**
1. **_Active TB_** 1. Born in **areas endemic** to TB 2. Around people w/ it 3. **Medically underserved/low income populations** 4. **IV Drugs users** 2. **_Latent TB_** → Asymptomatic 1. **HIV/AIDS** 2. **Immunosuppression** in general 3. **Malnutrition**
50
Signs of **active** and **latent TB?**
* **Active**: hemoptysis and weight loss * **Latent**: constitiuional sx and asymptomatic
51
In what conditions is **_tactile fremitis_** INCREASED: DECREASED:
* **Increased**: pneumonia * **Decreased**: COPD and asthma
52
1. Plan a directed evaluation of a patient with **hypoxia** to determine the diagnosis and severity of the disorder.
* **CXR: PA/lateral view** * **EKG** * **CMP/CBC** * **Lactic acid, blood culture and sputum culture** * **kidney fxtest**
53
1. vicious cycle in **_COPD_** pts that are **tired** and have **shoulder pain**
* Gave tramadol * Cause pleurisy * Took more and made it worse * Hypoventilates =\> retain **CO2**
54
\_\_\_\_\_ patients retain CO2 \_\_\_\_\_\_ are CO2 responsive
* **Chronic bronchitis** (blue bloaters) **retain CO2** * Pink puffers (emphysema) respond to CO2
55
What are signs of **infection**?
* **Increased band count**/ **increase neutrophil granulation/vacuolization** =\> **LEFT shift** =\> **INFECTION**
56
1. DDX for **Community-Acquired Pneumonia**
1. **Organizing Pneumonia** 1. Diffuse Parenchymal Lung Disease 2. **Lung Cancer** 3. **Eosinophilic Pneumonia** 4. **Hypersensitivity Pneumonitis**
57
top 4 causes of **persistant cough?**
* **1. post nasal drip** * **2. Asthma** * **3. GERD** * **4. Pulmonary infection**
58
1. Non-pulmonary causes of cough
1. **GERD** 2. **PND** 3. **HF** 4. **Sinusitis**
59
**_Pulmonary infections_** 1. **Bronchiectasis** (produces lots of \_\_\_\_\_\_\_) 2. **Bronchitis** (common in \_\_\_\_\_\_) 3. **MAC** (MC in whom) 4. **Mycoplasma**: \_\_\_\_\_\_\_\_\_\_ 5. **Clamydia**: \_\_\_\_\_\_\_\_\_
* mucus * smokers * older patients, especially with disease * #1 atypical PNA; in military recruits * #2 atypical PNA
60
* **+ bronchoprovication test** = \_\_\_\_\_\_\_\_\_\_ * **decreased intensity of breath sounds**= \_\_\_\_\_\_\_\_\_
* asthma * COPD
61
which vasculitis of the **skin** and **legs** presents with a **cough + dyspnea** and has shit ton of **_eosinphils_**?
**churg strauss**
62
how do we diagnosis **churg straus?**
**_fibrinoid necrotizing epitheloid_** + **_eosinophillic granulomas_**
63
Treatment of Churg-Straus? How do we maintain therapy?
* **Corticoisteroids (prednisone)** +**cyclophosphamide** until remission then taper off. * Exchange cyclophsophamide with **methotrexate**
64
what clinical CV findings do we see with **Sarcoidosis**?
* **1. Restrictive cardiomyopathy** * **2. Cardiac dysrhythmias** * **3. Conduction disturbances**
65
66
**_Restrictive lung disease_** \_\_\_\_\_ lung volume. \_\_\_\_\_\_\_ TLC or FVC \_\_\_\_\_\_\_ FEV1/FVC ratio
* decreased * alteration in lung parenchyma * disease of pleura, chest wall or NM * Decreased * NL
67
**_Obstruction LD_** * FEV1 * FVC * FEV1/FVC ration * TLC
* decreased * NL * decreased * NL or increase
68
**_idiopathic pulmonary fibrosis_** * Mutation: * Presentation: * Dx:
1. **Surfactant C** and **telomerase/MUC5B** 2. **Gradual onset (\>6) months**; **progressive dyspnea** is the most COM symp 1. basilar inspiritary crackles 2. clubbing
69
what do lung function tests show for **idiopathic pulmopnary fibrosis?** how is it dx?
* **Decreased** diffusing capacity of the lungs for CO (**DLCO**) * **GOLD STANDARD** + **lung biopsy**
70
What is **acute coronary syndrome-NSTEMI**
**NSTEMI (unstable angina)** that presents with substernal **crushing** chest pain that radiates to L arm for more 30 minutes and can be relieved with **nitro**.
71
What is the inital steps in management of **NSTEMI (ACS)?**
* 1. **O2** via nasal canula * 2. **Pain relief with opiate analgenics and nitroglycerin** * MONA: morphine, O2, nitratates and ASP * 3. **Aspirin** * 4. **ECG** * 5. **Labs**: CKMB, tropinin, CMP to check renal fx * High troponin: NSTE * NL troponin: unstable angina
72
What are treatments for **NSTE-ACS?**
1. **Anticoagulation therapy:** IV heparin, Enoxaparin 2. **Class 1 Antiplatelet drugs** (have to do them over and over again for a year) 1. Aspirin 2. P2Y12 inhibitors 1. Clopidogrel and Ticagrelo 3. Glycoprotein 2a3b inhibitors for HIGH risk NSTE-ACS 1. Abciximab, tirofiban +eptifibitide 3. **Opiate analgesia** + **NG** ONLY IF THERE IS PAIN 4. **Bblockers**, **ACE inhibitors**, **statins**
73
What is a **class 3 drug** that you should **NOT** use for **NSTE-ACS?**
**Thrombolytics**
74
When do you give **PCI (percutaneous intervention)** to a patient with NSTE-ACS?
* **High-risk patient,** then send to cath lab
75
How do you treat a low-risk and high-risk patient differently with **NSTEMI-ACS?**
* **Low risk (NL troponin and - ST depression):** stress test * **High risk (high troponin and + ST depression):** PCI and cath lab
76
What are high risk feautures of **NSTEMI-ACS?**
**Elevated troponin + ST depression**
77
How can we tell if patient with **ACS** is experiencing **unstable angina?**
* **NL levels of troponin** unstable angina * **High levels of tropinin:** NSTEMI
78
\_\_\_\_\_\_\_ is dangerous in **NSTE-ACS.** \_\_\_\_\_\_ is the MOST important thing in **STEMI**?
* **thrombolytic/fibrinolytic therapy** * **reperfusion therapy**
79
80
\_\_\_\_ supplies in the inferior of heart: what arteries supplies V1/2? (anterior part of the heart) 1 and aVL? (lateral part of the heart?
* **RCA** * LAD * LCX or diagnonal A from LAD
81
what is the progression of changes in cardiac enzymes in pt with **STEMI**?
1. Initial cardiac enzymes may be normal if early presentation. 2. Become + 4-6 hours later 3. Troponin may stay elevated for 5-7 days after STEM
82
How do you treat **STEMI**?
1. **Aspirin** **2. PG2Y12 inhibitor (clopidrgel/ Ticagrelor)** * If high risk: Gp2a/3b inhibitors 3. **Reperfusion therapy**: via coronary angiography & PCI or thrombolytics (if facility of Primary PCI is not available) d/t ST elevation, * Only give thrombo is cannot do CA or PCI in a cath lab * PCI: door to ballon is 90 minutes * If no cath lab, but you can transfer pt to hospital in 120 minutes, **DO IT**
83
what are **absolute CI** for thrombolytics in **STEMI**?
* **1. Prev hemorrhagic stroke** * **2. Other strokes** * **3. Intracranial neoplasms** * **4. recent head trauma** * **5. Active internal bleeding** (not menstruation) * **6. Suspected aortic dissection** * **7. ANY bleeding**
84
#1 treatment for **STEMI**?
1. **SEND TO CATH LAB**
85
1. **Post MI complications (5)**
1. Post infarct ischemia 2. Arrhythmia 3. Right ventricular infarction 4. Mechanical complications 5. Myocardial dysfunction
86
**Post MI Ischemia** can occur when? Tx?
* 1. After **thrombolytic** therapy for **STEMI** * 2. **After medically treating a NSTEMI.** Treat with vigorous medical therapy. If refractory, undergo early aniography and revascularization
87
What **arrythmias** can occur after a **MI**?
1. Sinus bradycardia (MCC in inferior MI) 2. Supraventricular tachycardia, including a-fib 3. Conduction disturbances 4. Ventricular arrhythmias
88
1. **AV node** supplied by \_\_\_\_\_\_\_
**RCA**
89
**Post-M**I, patient has * 1st degree AV block * 2nd degree AV block * Complete AV block describe them
* **1st degree AV block:** most common and no treatment * **2nd degree AV block**: only treat if symptom * **Complete AV block:** most common in an inferior MI. * If occurs with an anterior MI =\> worse.
90
**complete AV block** is most common in an ____ MI and worse with an _____ MI? What is the treatment?
* **inferior** * **anterior** = worse bc sign of BAD infarction * Permenant pacing
91
What is the most comon conduction abnormality in the **first few hours** after MI and how is it treated?
**Ventricular arrythmia (VT/VF)** * if hemodynamically signifiant: defibrillate * Stable: antiarrhythmic meds + amiodrone
92
how do you treat **RV infarction,** which occurs in 1**/3 of all inferior MIs.**
**_IV fluids_** * - AVOID VASODILATORS (NG) * - DO NOT REDUCE PRELOAD
93
**Right ventricular infarcts (RV infarcts)** presents with what sx?
**1. Hypotension** **2. Normal LV function** **3. High JVP** **4. Clear lungs**
94
How are **LV/RV infarcts** different?
* **RV infarcts** * RV infarcts will have clear lungs * Dx by: ST elevation in the right sided anterior leads * **LV infarcts** * LV infarcts do NOT have clear lungs * Dx: ST elevation in the left sided anterior leads
95
**_NAME THAT SHOCK!_** * **Systolic BP \< 90mmhg** and **diminished perfusion** (cold clammy extremities, decreased urine output, confusion), however the patient **does not respond to fluid resuctiation.**
**Cardiogenic shock**
96
**NAME THAT SHOCK** should be considered for urgent _coronary angiography_, _revascularization_ and possible _placement of intra-aortic balloon pump._
**cardiogenic shock**
97
**_NAME THAT SHOCK_** **Echocardiagram** should be taken and will show function of the **LV is moderately - severely reduced.**
**Cardiogenic shock**
98
**_NAME THAT SHOCK!_** what type of shock has a 3**0 day mortality** of **40-80%**
99
• Essentials of Diagnosis in a patient with **shock** (4)
1. **Hypotension** 2. **Tachycardia** 3. **Oliguria** 4. **Altered mental status**
100
**_Name that shock_** **Blood loss** or **dehydration** causes decreased intravascular volume. To **treat**, we **replete** the intravascular volume
**hypovolemic shock**
101
**_NAME THAT SHOCK!_** Shock caused by [**cardiac tamponade**, **tension pneumothorax** and **massive PE]** that is treated by _treating underlying cause_
**Obstructive shock**
102
**_NAME THAT SHOCK_** A category of shocks, where the most common in **septic shock!**
**distributive shock**
103
**_NAME THAT SHOCK!_** Shock most commonly caused by gram (-/+) organism where hypotension does NOT respond to fluid. Systolic BP are \< 100mmHg, serum lactate levels are high (\> 2mmol/L) and requires vasopressors to keep MAP above 65mmHg.
**SEPTIC SHOCK**
104
**_NAME THAT SHOCK!_** Type of shock treated by fluids + ABX + hope for the best!
**Septic shock**
105
CPR Exam 2
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