ACNP Boards > Missing Pieces > Flashcards

Missing Pieces Flashcards

(65 cards)

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1
Q

What valves are open during S1 or systole?

A

Semilunar valves

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2
Q

3 pillow orthopnea is what NYHA class?

A

NYHA class 3

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3
Q

What is a major adverse effect of SGLT-2s?

A

Euglycemic DKA

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4
Q

When are beta blockers started in cardiomyopathies with HF

A

Once euvolemia is achieved to prevent exacerbation

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5
Q

Routine management after stabilization with HF

A

Diuretic, acei/arb, and beta blockers

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6
Q

Where does headache occur with hypertension

A

suboccipital

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7
Q

If diastolic is >80, is that considered HTN?

A

Yes. 80-89 (stage 1), 90+ (stage 2)

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8
Q

How are non-african american HTN patients treated?

A

Thiazide, ACEi/ARB, CCB

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9
Q

How are HTN patients with diabetes treated?

A

ACEi/ARB only

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10
Q

How are HTN patients with CKD treated?

A

ACEi only

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11
Q

How are african american HTN patients treated?

A

thiazide or CCB

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12
Q

What BP is considered HTN urgency?

A

180/110 +

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13
Q

What BP is considered HTN emergency?

A

180/120 + or addition of malignant hyperthemia/AAA/ICH/encephalopathy/unstable angina/acute MI/HF/Eclampsia

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14
Q

What should BP be lowered to in to prevent end-organ damage with the associated conditions?

A

< 140 in the first hour, and <120 for AAA

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15
Q

How quickly should BP be lowered in HTN emergency without those compelling conditions?

A

No more than 25% in first hour then to 160/100 in the next 2-6 hours, then to normal in the next 24-48hrs

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16
Q

Total cholesterol?

A

<200

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17
Q

VLDL?

A

<150

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18
Q

LDL?

A

<100

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19
Q

HDL?

A

40-60, higher is good

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20
Q

Trigs, LDL, HDL with diabetics?

A

<150 trigs, <70 LDL, >40 HDL

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21
Q

Cholesterol absorption inhibitors (Ezetimibe)

A

Used in combo with statin to lower LDL

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22
Q

Which troponin only elevates with true myocardial damage?

A

Troponin I

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23
Q

What medication prevents ventricular remodeling?

A

ACEi

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24
Q

WHat med has mortality benefit?

A

BB

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25
First time afib (no comorbidities/risk factors)
Aspirin
26
Afib with comorbities
Warfarin
27
Lab values to monitor for heparin?
PTT, aPTT
28
Risk factors for DVT?
Liver disease, protein S deficiency, female, tamoxifen, smoking, obesity, HTN/diabetes, immobility
29
CI to revasc in dvt
Prior ICH, stroke 3months, Aortic dissection, significant trauma, head/spine surg past 2mo, 185/110+
30
Acute weeping dermatitis
Tap water compresses, hydrocolloid dressings, for mild use hydrocortisone cream
31
When is hospitalization recommended for asthma
If FEV1 or peak Flow <60L/min does not improve after bronchodilators then hospitalization is recommended
32
How do SABAs work? + Examples
Convert ATP in to cAMP (increasing cAMP) to relax bronchial smooth muscles Albuterol (proair) & levalbuterol
33
How do the antimuscarinics work? (SAMA/LAMA) + Examples
Decreasing cGMP; drying secretions SAMA: ipratropium (atrovent) LAMA: Tiotropium or glycopyrrolate or aclidinium
34
LABA/ICS combo examples
Budesonide/formoterol (symbicort) Fluticasone/salmeterol (advair)
35
LABA/LAMA/ICS example
Fluticasone/umeclidinium/vilanterol (trelegy)
36
AP diameter is increased in which COPD?
Emphysema with hyperresonant percussion
37
GOLD 1 & 2 guidelines
GOLD 1 >80% GOLD 2 50-79%
38
GOLD 3 & 4 Guidelines
GOLD 3: 30-49% GOLD 4: <30%
39
GOLD Category A COPD
None or 1 moderate exacerbation per year mMRC 0-1 COPD assessment test (CAT) <10 Treatment: SABA or LABA
40
GOLD Category B COPD
None or 1 moderate exacerbation per year mMRC >2+ COPD assessment test (CAT) >10+ Treatment: LABA + LAMA
41
GOLD Category E COPD
2+ moderate exacerbations or 1+ HOSPITALIZATION Treated with LABA + LAMA and ICS if eosinophils >300 Fluticasone/umeclidinium/vilanterol (trelegy)
42
Inpatient O2 management for COPD
O2 at 1-2LNC or 24-28% venti mask
43
TB treatment regimen
Isoniazid/rifampin/pyrazinamide/ethambutol if isolate is susceptible to INH/RIF then drop ehtambutol Continue these drugs for 2 months and then 4 months of just INH/RIF HIV treated for 9mo
44
How often do tb patients needs sputum smears?
Sputum: 6wks after initiation of therapy then monthly Serum: LFTs, CBC, creatinine
45
CAP: nonsevere inpatient TX
Ceftriaxone + azithromycin OR Fluoroquinolone alone
46
CAP Severe Inpatient
Ceftriaxone + Fluoroquinolone OR azithromycin +pseudomonas risk: do zosyn or meropenem or cefepime + azithromycin
47
Treatment for VAP
MRSA agent + Beta-lactams (Pip/taz, cefepime, aztreonam, carbapenems) Non-beta-lactams (fluoroquinolones, Amikacin/gentamicin, colisitin/polymixin)
48
Moderate-high severity outpatient CAP tx
Augmentin or cefpodoxime + macrolide or doxycycline OR Fluoroquinolone alone
49
Pneumothorax s/sx
Hyperresonance on affected side Diminished breath sounds/fremitus on affected side If tension: mediastinal shift away from affected side
50
Sarcoidosis
Caused by Interstitial lung disease and non-caseating granulomas Class symptoms: Progressive dyspnea, non prod cough, rales (velcro crackles) Treatment: corticosteroids
51
Heparin dose for PE
80u/kg bolus followed by 18u/kg/hr infusion with coumadin at same time
52
Assist control vs SIMV?
Assist control (if RR set at 12 and pt takes a 13th breath, they still get their preset tidal volume) If pt is breathing on their own but vent is giving the preset TV, that puts the pt at risk of developing RESPIRATORY ALKALOSIS. SIMV (if RR set at 12 and pt takes a 13th breath, they make their own tidal volume)
53
Pressure support (Inspiratory)
Inspiratory effort completely unassisted but preset amount of pressure is delivered with each breath (5 --> 10 just like PEEP). No rate.
54
Obstructive PFTs
Reduced airflow rates (
55
Restrictive PFTs
Reduced volumes (
56
Effusion
1. Pleural protein to serum protein >0.5 2. Pleural LDH to serum LDH >0.6 3. Pleural LDH >2/3rds ULN serum LDH
57
Lung Gerontology
Vital capacity decreases because residual volume increases
58
Controlled mandatory ventilation (CMV)
Deeply sedated/paralyzed. Vent does ALL the work
59
Ventilator high pressure alarms
"Paw High" or "Peak Pressure" indicate a restriction in airflow or increased resistance. Common causes include patient coughing, mucus plugs, kinked tubing, biting the tube, bronchospasm, or tension pneumothorax
60
Ventilator low pressure alarms
Indicate a loss of system integrity/air leak. Common causes include accidental circuit disconnection, cuff leaks, ETT displacement, or loose tubing connections
61
Mediastinal deviation in atelectasis/mucus plugging
Toward the side of collapse
62
Mediastinal deviation in pleural effusion
Large volume pleural effusion shifts away from affected side
63
aPTT
28-38s
64
PT
12-16s
65
PTT
60-90s
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