PCM Flashcards Exam II.txt

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  1. What is the pathophysiology of pyloric stenosis?
    it is an aquired condition caused by hypertrophy of the pyloric musckle resulting in gastric outlet constriction
  2. Is pyloric stenosis more common in males or females?
  3. Forceful and/or projectile vomit that does not contain bile
    pyloric stenosis
  4. Patient with very forceful vomiting that started at one month old. At first the baby was ravenous after emesis but now is becoming lethargic
    pyloric stenosis
  5. "gastric wave" visible to the naked eye on exam
    pyloric stenosis
  6. palpable "olive" type mass in the left upper quadrant with non bilious vomiting
    pyloric stenosis
  7. What labs do you do for a suspected case of pyloric stenosis?
    electrolyte pannel, BUN and ultrasound of the pyloris
  8. What is the most common clinical laboratory finding in pyloric stenosis?
    hypochloremic metabolic acidosis from excessive vomiting and elevated BUN secondary to dehydration
  9. What is the treatment for pyloric stenosis
    Surgical pyloromyotomy; but first must correct dehydration and hypochloremic acidosis with IV therapy
  10. What is the most common age for foreign body aspiration
    4 years and under
  11. Where in the lung do most foreign bodies lodge themselves?
    right upper lung
  12. what are the most common foreign bodies aspirated?
    food and small toys
  13. Do coins more often lodge themselves in the esophagus or the trachea?
  14. A mother brings a child in from the playground to your office. the child is suffering from cough, localized wheezing unilateral absence of breath sounds in the upper right lobe and slight stridor you suspec the child has...
    Foreign body aspiration
  15. True or false foreign bodys may be lodged in the esophagus and press on the trachea causing respiratory symptoms
  16. What are some symptoms of a foreign body that has been stuck in the system for a long time?
    persistent cough, sputum production, recurrent pneumonia, peristent wheezing that is unresponsive to brochodilation
  17. True or False All foreign bodies will be seen on a chest x-ray
    False, many foreign bodies are not radio-opaque and are thus invisible on x ray
  18. To prevent FB aspiration infants and children should not be given uncooked carrots, nuts, or other food that may be easily broken into small pieces and aspirated until they develope what?
  19. What studies would you order for a suspected foreign body aspiration?
    X-ray, flouroscopy, flexible bronchoscopy, but ridged bronchoscopy for removal
  20. How do you treat uncomplicated foreign body aspiration?
    Removal via ridged broncoscopy
  21. What test do you perform to identify cystic fibrosis?
    sweat cloride
  22. Explain the pathophysiology of cystic fibrosis
    Cystic fibrosis is a genetic disease where a mutation in the gene cystic fibrosis transmembrane regulator causes a defective chloride channel to be made. This chloride channel is located on the apical surface of cells and transports salt and water across the cell membrane. It is crucial in the corect composition of secretions especially secretions of the airway, liver and pancrease, as well as absorbtion in GI and skin sweat.
  23. What is the most common respiratory complication of CF
    respiratory infection and colonization by bacteria (leading to bronchiectasis)
  24. Cystic fibrosis usually presents with __ in infants but __ in older children
    failure to thrive; pulmonary manifestations
  25. What two pathogens typically colonize the repiratory system of CF patients?
    Staphylococcus auresus and pseudomona aeruginosa
  26. You see a 3 year old for persistent/chronic respiratory infections. The mother also complains of peristent strange oily stools. She has a history of a short period of failure to thrive but appears to be doing well now although her BMI is on the low side of normal. What test do you want to order?
    Sweat chloride test
  27. "meconium ileus"
    Cystic fibrosis
  28. What are some respiratory treatments for cystic fibrosis?
    Chest physiotherapy (airway secretion clearance techniques), Prophylactic antibiotic therapy
  29. What are some treatments for CF patients with exocrine pancreatic insufficency?
    enteric coated pancreatic enzyme capsules with lipase and protease, nutritional supplements, fat soluble vitamins and lipid supplementation but not to excess because that can cause fibrosing colonopathy
  30. What is the treatment for severe meconium ileus?
    surgical intervention, if it cannot be removed by enema
  31. __ leads to infertility in males and sexual dysfunction in females
    Cystic fibrois
  32. All children under the age of 12 with nasal polyps should be screened for what?
    Cystic fibrosis
  33. All children prsenting with failure to thrive, cholestatic jaundice, chronic respiratory symptoms, or electrolyte abnormalities should be tested for what?
    Cystic fibrosis
  34. What are some symptoms of cystic fibrosis?
    Nasal polyps, steatorreah, exocrine pancreatic insufficency, intestinal obstruction, meconium ileus, distal intestinal obstruction syndrome, insulin deficency, hypochloremic metabolic alkalosis, sexual dysfunction, digital clubbing, recurrent upper respiratory infections, bronchiectasis, persistent or recurrent cough productive with sputum, liver disease, cholestatic jaundice, hypoalbuminemia, steatorreah, protein and fat malabsorbtion etc.
  35. What is the most common pathogen associated with otitis externa?
    Pseudomonas aeruginosa
  36. You have a 5 year old presenting in July with symptoms of pain, tenderness and aural discharge with no history of fever. She is particularly tender to manipulation of the pinna and pressure on the tragus. What is your diagnosis?
    Otitis Externa
  37. "ear pain with chewing"
    Otitis Externa, chewing will not cause increased ear pain in otitis media
  38. What are some symptoms of Otitis Externa?
    Pain, tenderness and aural discharge, absense of fever, pain with manipulation of the pinna, pain with manipulation of the tragus, tenderness with pressure on the tragus, inflammation and often occlusion of the auditory canal
  39. How do you treat otitis externa?
    local thearapy with acetic acid preparations to restore pH, Avoid water!, Topical quinolone otic drops (diprofloxacin, ofloxacin), ear wicks, corticosteroids with intense inflammation,
  40. What are some preventative measures for otitis externa?
    the one footed dance, avoid vigorous cleaning of the ear cannal, dry the ear canal after swimming with acetic acid or burrow solution, avoid earplugs and diving equipment
  41. What is the most common pathogen of epiglottitis?
    Group A streptococcal or Staphlococcus aureus
  42. A patient the is sitting with jaw thrust forward in the sniffing position and mouth open with hands on knees most likely has what?
  43. If you see a lateral X-ray of the neck with a thumb sign what diagnosis would you make?
  44. If you performed a laryngoscopy on a patient with trouble breathing and found an inflammed and swollen cherry-red epiglottis and supraepilottic folds what would you diagnose?
  45. If you see a steeple sign on an X-ray what would you diagnose?
  46. Pt presents with a cough that is barking or brassy with hoarsness and inspiratory stridor and a low grade fever. The patient also has some wheezing. What would you diagnose?
  47. What are the most common causes of Croup?
    Parainfluenza viruses 1,2 and 3, respiratory syncytial virus,
  48. Croup is most common in children of what age?
    6 months to 3 years
  49. What is the peak time of year for Croup?
    fall and early winter
  50. Why does croup cause respiratory distress in children and only laryngitis in adults?
    in children the laryngotracheal airway is smaller so any closer of this diameter is dispriportionatly significant in children
  51. You have a patient who you suspect has Croup but they have a high leucocyte count (Leuckocytosis) what does this suggest to you?
    Leukocytosis is uncommon in croup and suggests epiglotitis or bacterial tracheitis
  52. If you have Croup in a child for more than one week or Stridor in an infant with suspected croup what should you look for?
    direct laryngoscopy for subglottic stenosis or hemangioma
  53. Where should you perform direct observation of the glottis in a child with suspected epiglottitis?
    in the OR with a competent surgeon and anesthesiologist ready to place an endotracheal tube or perform a tracheotomy
  54. What is the treatment for Epiglottitis?
    Endotracheal intubation and antibiotic therapy
  55. What is Bacterial Tracheitis?
    rare but serious infection of the trache that may follow viral croup, and is commonly caused by S. Aureus
  56. Onset of Cough at night that is relieved by cool moist air
  57. What is the pharmacological treatment for Croup?
    Dexamethasone (for mild moderate or severe croup, reduces symptoms); aerosolized racemic mixture of epinephrine (reduces subglotti edema by vasoconstriction)
  58. What is the non pharmacological treatment for Croup?
    keep patient calm, rest, cool humidified air, hospitalization for patients with stridor at rest
  59. What are some complications of Croup?
    Viral pneumonia (1-2%), secondary bacterial pneumonia
  60. What bug causes pertussis?
    Bordatella pertussis a gram negative bacillus that can be acid fast
  61. What is the incubation period for Pertussis?
    6 days
  62. Pertussis patients are most contagious in the ____ stage
    Earliest stage
  63. Children less than what age are likely to have complications of pneumonia and severe infection with pertussis?
    4 months
  64. What are the 3 stages of Pertussis infection?
    Catarrhal stage, Paroxysmal stage, convalescent stage
  65. Catarrhal stage
    stage of pertussis that is marked by nonspecific signs of infection such as increased nasal secretions and low grade fever
  66. Paroxysmal stage
    stage of pertussis that is characterized by coughing that occurs in paroxysms during expiration, forceful inspiration between these paroxysms causes a characteristic whoop, post tussive emesis is common
  67. Post-tussive emesis?
  68. Convalescent stage
    gradual resolution of symptoms over 1 -2 weeks with a residual cough that may persist for months
  69. How does Pertussis present in adolescents and adults?
    prolonged brochitic illness with persistent, nonproductive cough that often begins as a nonspecific upper respiratory infection. They generally do not have the Whoop but may have severe paroxysms that may persist weeks to months
  70. What is the treatment for pertussis in children under 1 month?
    erythromycin, clarithromycin or azythromycin
  71. what antibiotic should not be used in neonates due to its propensity to cause pyloric stenosis?
  72. what can you do to prevent pertussis?
    DTaP and TDaP
  73. what is the most common cause of Bronchiolitis?
    RSV then followed by Human meta-pneumovirus, parainfluenza viruses, influenza firuses, adenoviruses, rhinoviruses, mycoplasma pneumoniae
  74. Who is affeted by bronchiolitis more boys or girls?
  75. What are the 3 characteristics of early stage bronchiolitis?
    Cough, Coryza and rhinorrhea
  76. Your patient presents initially with a Cough, coryza and rhinorrhea which progresses over several days to a noisy raspy breathing and wheezing on auscultation what would you diagnose?
  77. An infant presents with sudden apnea with diffuse hyperresonance, wheezes and crackles on auscultation and hyperinflation with hyperexpansion of the lungs on CXR and some localized atelectasis you suspect
  78. What are some laboratory test you would perform in a child who you suspect has bronchiolitis?
    Pulse oximetry, Antigen tests (ELISA) for diagnosis of pathogen, Or PCR for rapid viral diagnosis
  79. What are the symptoms of full blown bronchiolitis?
    noisy raspy breathing, and audible wheezing, low grade fever, irritability, prolonged expiratory phase of breathing, intercostal retractions of the lower ribs, surpasternal retractions and air trapping with hyperexpansion of the lungs. Hyperresonance with percussion of the lungs and difuse wheezes and crackles upon auscultation
  80. What are three major factors that differentiate asthma from bronchiolitis?
    age of presentation, family history of atopy or asthma, presense or absense of fever
  81. Acute viral infectious causes of pneumonia typically present as what pattern of pneumonia?
    interstitial pneumonitis
  82. True or False in chronic heart failure the lungs may be clear
    True, this is due to the increased lymphatic drainage compensating for the pulmonary edema
  83. Pleural effusion may be seen in A) Right sided heart failure, B) Left sided heart failure, or C) Both
    C. Both
  84. Name 3 pathological conditions that cause restrictive cardiomyopathy
    Sarcoidosis, amyloidosis, hemachromatosis
  85. Which cardiomyopathy reduces systolic function, dialated? restrictive? hypertrophic?
  86. What are the causes of cardiac dysfunction?
    Hypertension, Ischemia, valvular disease, congenital heart disease, pericardial disease, uncrontrolled tachycardia (as in A fib), cardiomyopathy
  87. What are the 3 main types of cardiomyopathy?
    Dialated, restrictive and hypertrophic
  88. What is BNP and what does it do?
    BNP is a peptide released by the myocardium due to the stretch of the heart, it has vasodilitory effects, mild diuretic properties, antiproliferative activity and offsets the sympathetic nervous system and the Renin angiotensin aldosterone system
  89. What is metabolic syndrome? What are the criteria for metabolic syndrome?
    A group of risk factors that occur together and increase the risk for coronary artery disease, stroke and type 2 diabetes. Metabolic syndrome is defined as having any three of the following characteristics: Abdominal obesity, Triglyceride elevation (above 150), low HDL (below 40 males and below 50 for females), blood pressure above 130/80, fasting glucose of above 110mg/dL (like pneumonics? --> FAT-bh)
  90. Systolic dysfunction
    reduced cardiac contractility
  91. diastolic dysfunction
    impaired relaxation and abnormal ventricular filling
  92. Cardiac output is equal to what?
    Stroke volume X Heart rate
  93. What 3 factors contribute to the overall stroke volume?
    Preload, afterload and contractility
  94. Blood pressure is equal to what?
    Cardiac Output X total peripheral resistance
  95. Preload
    Is the outward force that the blood exerts on the wall of the ventricle at the end of diastole just before systole when the ventricle is at it's most full. This stretch causes increased SV via the frank-starling mechanism
  96. Frank-Starling law of cardiac contraction
    the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume). The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully.
  97. Afterload
    the pressure the ventricle must overcome to eject blood into the aorta, typically equal to the arterial or systolic pressure
  98. An elevated afterload leads to a slight (increase or decrease) in ejection fraction, a (larger or smaller) end systolic volume and a (larger or smaller ) stroke volume
    An elevated afterload leads to a slight Increase, in ejection fraction, a larger end systolic volume and a Smaller stroke volume
  99. Contractility
    intrinsic property of the heart that enables it to contract increased contractivity is caused by an increase in the cycling rate of actin and myosin
  100. Eccentric remodling
    Due to volume overload and becomes dialtation, sarcomeres are added in series
  101. Concentric remodling
    Due to pressure overload heart becomes hypertrophied and sarcomeres are added in parallel
  102. Explain the Neurohormonal activation in response to cardiac output (renin angiotensin system)
    a drop in CO causes a drop in renal blood flow which signals the kidneys to secrete renin which converts angiotensinogen into angiotensin I which is converted to angiotensin II which causes vasoconstriction, water retention and thus increases blood pressure and venous return. In chronic activation this increases afterload with increases cardiac fibrosis and hypertrophy
  103. Name the stages of heart disease
    • Stage A (at high risk of heart failure but without structural heart diseas or HF symptoms; HTN, DM, Obesity, chemotherapy);
    • Stage B (structural heart disease but without heart failure; Prior MI, LVH, valve disease);
    • Stage C ( structural heart disease with prior or current HF symptoms; dyspnea, fatigue);
    • Stage D (Refractory HF requireing special interventions)
  104. What is the number one cause of systolic dysfunction?
    Ichemia (coronary artery disease)
  105. What are the three types of cardiomyopathy
    dialated, hypertrophic, restrictive
  106. What cardiomyopathy reduces systolic function?
    Dialated cardiomyopathy
  107. Which cardiomyopathy intitally preserves systolic function?
  108. What three diseases cause restrictive cardiomyopathy?
    amyloid, sarcoid and hemachromatosis
  109. What are some symptoms of Left sided heart failure?
    rest and exertional dyspnea, orthopena, paroxismal nocturnal dyspnea
  110. What are some symptoms of right sided heart failure
    peripheral edema, RUQ discomfort, liver enlargement, abdominal swelling, anorexia and nausea
  111. What are some clinical finding of left sided heart failure?
    rales, left s3-s4 gallop, mitral regurgitation, pleural effusions
  112. What are some clinical findings of right sided heart failure?
    JVD, hepatomegaly, acites, pedal/presacral edema, right s3 s4 gallop, tricuspid regurgitation
  113. What are some signs of low output heart failure?
    tachycardia, low blood pressure, narrow pulse pressure, cool skin, diaphroetic, dusky color
  114. What is the most common cause of right sided heart failure?
    left sided heart failure
  115. What tests should you order for a patient presenting with heart failure?
    CBC, urinalysis, serum electrolytes, BUN, serum creatinine, fasting blood glucose, lipid profile, liver functioning tests and TSH, 12 lead EKG and a CXR
  116. When would you do a coronary revascularizaiton?
    in patients presenting with heart failure who have angina or significant ischemia unless the patient is not eligible for refascularization of any kind (end stage pancreatic cancer, dementia, renal disease)
  117. when would you perform an endocardial biopsy?
    when you suspedted one of the following diagnoses in a heart failure patient: giant cell myocarditis, infiltrative disease such as amyloid or hemochromatosis
  118. BNP is released in response to __
    cardiac stretch
  119. If an elderly patient has a normal BNP is is safe to rule out heart failure?
    no because elderly people have lower BNP so an elevated BNP for them may appear normal but is actually elevated
  120. Diuretics (indication and important facts)
    used for patients with current or prior symptoms of HF and reduced LVEF with fluid retention, use the lowest does needed to achieve dry weight, NO MORTALITY BENIFIT,
  121. ACE Inhibitors (indication and important facts)
    first line for HF, reduce symptoms, improve exercise capacity, recduce remodling, improve left ventricular function, IMPROVE MORTALITY!, class effect so it doesn't matter which you choose
  122. Side effects of ACE inhibitors
    Renal dysfunction, hypercalcemia, cough, hypotension, angioedma
  123. Beta blockers (indication and important facts)
    Improves systolic function, results in increase in LVEF, reduces symptoms, inhibits renin-angiotensin symptoms, only 3 approved metoprolol, carvedilol, pisprolol, upregulates beta receptors, reduces teh rate of hospital admissions and reduces mortality by 35%-40%
  124. What 3 beta blockers are approved in Heart failure use?
    Metoprolol succinate, Carvedilol, Bisprolol
  125. Which beta blocker do you want to use with asthma?
    Metoprolol because it has no B2 receptor action
  126. What beta blocker would you want to use in HF with HTN?
    Carvedilol- because it is non-specific and blocks alpha 1 causing vasodiliation
  127. When do you use ARBS?
    when the patient is intolerent to ACE inhibitors
  128. Name an aldosterone antagonist
  129. When would you use an aldosterone antagonist?
    in moderatly severe to severe heart failure and reduced LVEF with a patient who has normal potassium levels, and creatinine
  130. When would you use Hydralazine Nitrate (enalapril)?
    in african american patients with moderate to severe symptoms who are already on optimal therapy with ACE inhibitors, beta blockers and diuretics
  131. Does digoxin have an effect on mortality outcome?
  132. When would you use a calcium channel blocker?
    in patients with hypertension + HF
  133. Which two beta blockers are safe for use in heart failure?
    Amlodipine and felodipine
  134. Why wouldn't you use verapamil and diltiazem in heart failure?
    they have negative chronotropic effects weakening an already weak heart
  135. When would you use resynchronization therapy?
    in patients with intraventricular conduction delays and bundle branch blocks, dyssynchronous contraction of the LV or impaired LV emptying, Mitral regurg.
  136. Name the different sizes of lipoproteins in the body
    • Chylomicrons
    • VLDL
    • LDL
    • HDL
  137. What are the 5 possible groups of lipid patients?
    • increased LDL
    • Increased TG and decreased HDL
    • Increased LDL and Increased TG
    • decreased HDL
    • Increased Lipoprotein A
  138. What are the major ATP III risk factors for hyperlipidemia?
    • Age males older than 45y.o and females older than 55 y.o.
    • Family history
    • HDL-C less than 40 mg/dL
    • Hypertension
    • Current smoking
  139. What are the CVD risk factors?
    Family history, older age, male gender, smoking, physical inactivity, overweight/obesity, total C/LDL-C/HDL-D/TG, BP, glucose (diabetes)
  140. What are the risk factors for CAD?
    prior coronary artery disease, diabetes mellitus, abdominal aortic anerysm, carotid artery disease, prior CVA, Prior transient ischemic attach (TIA), peripheral artery disease, framingham score greater than 20%
  141. What are 4 approaches to preventing CVD?
    Lipid modification, lowering glucose, lifestyle intervention, lowering BP
  142. With mild hyperlipidemia how long do you maintain diet and exercise as a treatment before adding pharmacotherapy?
    6 months
  143. What is the first line drug for dyslipidema?
  144. What are the major side effects of the statins?
    Myopathy, Rhabdomyolysis, Abnormal AST and ALT
  145. What type of cholesterol are the statins most effective for?
  146. Prior to irrigation what do you ask a patient with a cerumen impaction?
    if they have a history of TM perforation
  147. What is treatment for a cerumen impaction?
    irrigation, instrumental removal
  148. What causes cerumen impaction?
    anatomic deformity, increased number of hairs in the external auditory canal, physical barriers to natural wax extrusion
  149. Subjective tinnitus
    only the patient can hear
  150. Objective tinnitus
    examiner can hear/appreciate
  151. Causes of Objective tinnitus
    stapedial flutter, palatal myoclonus, pulsatile tinnitus, drugs
  152. Treatment for tinnitus includes
    treat menieres, remove vascular loop, cut stapedial tendon, ligate jugular vein, most of the time there is no cure
  153. Causes of Subjective tinnitus
    Noise induced, long standing association with sensoryneural hearing loss, associated with vertigo, unilateral, pt is CRAZY
  154. What are some causes of Conductive hearing loss?
    Cerumen impaction, middle ear effusion, TM perforation, ossicular fixation, otosclerosis, tympanosclerosis, ossicular discontinuity/fracture
  155. What are some causes of senorineural hearing loss?
    Presbyacusis, sudden idiopathic snhl, acoustic swannoma, congenita (TORCHES), hereditary, infectious, meningitis, trauma
  156. How would you evaluate a patient with hearing loss?
    developmental evaluation, pneumatic otsocopy, tuning fork (rinne and weber), finger rubbing, screening pure tone audio
  157. What are some causes of dialated cardiomyopathy?
    • 1.Infections-
    • 1.Viral- adenovirus, coxsacki, echo, CMV
    • 2.Bacterial- group A strep, rickettsial
    • 3.Fungal- spirocheta
    • 4.Protozoa- chagas
    • 2.Toxins- chemotherapy, adriamycin, herceptin, EtOH, cocaine, heavy metals, organic solvents
    • 3.Metabolic- thiamine, niacin deficiency, thyroid disese, diabetes, renal failure
    • 4.Inflammation
    • 1.peripartum- 1/3 recover second pregnancy is contraindicated if they
    • 2.Collagen or vascular (scleroderma or SLE)
    • 3.Sarcoid
    • 4.hypersensitivity (hypereosinophilic cardiomyopathy)
    • 5.Alcohol
    • 6.Familial/ Inherited
    • 7.X- linked: Duchennes and Beckers MD
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PCM Flashcards Exam II.txt

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