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Questions and Answers
What is a characteristic feature of unstable angina that distinguishes it from stable angina?
What is a characteristic feature of unstable angina that distinguishes it from stable angina?
Which of the following is NOT considered a symptom of unstable angina?
Which of the following is NOT considered a symptom of unstable angina?
How is an embolus defined in the context of circulatory conditions?
How is an embolus defined in the context of circulatory conditions?
What does the term 'relentless' in the context of unstable angina refer to?
What does the term 'relentless' in the context of unstable angina refer to?
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Which of the following is part of nonpharmacologic treatment for angina?
Which of the following is part of nonpharmacologic treatment for angina?
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Which of the following is characteristic of acute arterial embolism?
Which of the following is characteristic of acute arterial embolism?
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What is the significance of the phrase 'new onset' in terms of unstable angina?
What is the significance of the phrase 'new onset' in terms of unstable angina?
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One of the 4 'UN's of unstable angina is 'Unsurvivable without treatment'. What does this imply?
One of the 4 'UN's of unstable angina is 'Unsurvivable without treatment'. What does this imply?
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What factor can facilitate the development of pneumonia?
What factor can facilitate the development of pneumonia?
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How is infective endocarditis primarily caused?
How is infective endocarditis primarily caused?
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Which condition is characterized by an outer waxy capsule that enhances resistance to destruction?
Which condition is characterized by an outer waxy capsule that enhances resistance to destruction?
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What defines a nosocomial or hospital-acquired infection?
What defines a nosocomial or hospital-acquired infection?
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Which group of individuals is considered at higher risk for developing pneumonia?
Which group of individuals is considered at higher risk for developing pneumonia?
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The development of hypersensitivity in relation to tuberculosis is primarily due to which immune response?
The development of hypersensitivity in relation to tuberculosis is primarily due to which immune response?
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Infective endocarditis typically arises in individuals with which condition?
Infective endocarditis typically arises in individuals with which condition?
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What type of pneumonia is classified as community-acquired?
What type of pneumonia is classified as community-acquired?
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What is the primary mode of transmission for tuberculosis (TB)?
What is the primary mode of transmission for tuberculosis (TB)?
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Which of the following organs can tuberculosis (TB) affect aside from the lungs?
Which of the following organs can tuberculosis (TB) affect aside from the lungs?
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What is a common symptom of peripheral artery disease (PAD)?
What is a common symptom of peripheral artery disease (PAD)?
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Which of the following is a primary risk factor for developing peripheral artery disease (PAD)?
Which of the following is a primary risk factor for developing peripheral artery disease (PAD)?
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What is the purpose of the BCG vaccine?
What is the purpose of the BCG vaccine?
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Which of the following best describes acute rhinosinusitis?
Which of the following best describes acute rhinosinusitis?
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What treatments are typically used for tuberculosis?
What treatments are typically used for tuberculosis?
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In which scenario is the risk of tuberculosis transmission highest?
In which scenario is the risk of tuberculosis transmission highest?
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What is the minimum duration for a condition to be classified as chronic rhinosinusitis?
What is the minimum duration for a condition to be classified as chronic rhinosinusitis?
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Which function is NOT associated with the pericardium?
Which function is NOT associated with the pericardium?
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What occurs in constrictive pericarditis?
What occurs in constrictive pericarditis?
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What is a potential cause of pericarditis?
What is a potential cause of pericarditis?
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Hemothorax primarily involves what type of fluid?
Hemothorax primarily involves what type of fluid?
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In which condition does the pleura become inflamed?
In which condition does the pleura become inflamed?
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Atelectasis refers to a condition affecting the lungs. What does it specifically involve?
Atelectasis refers to a condition affecting the lungs. What does it specifically involve?
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Which statement is true about chylothorax?
Which statement is true about chylothorax?
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What characterizes empyema?
What characterizes empyema?
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Which of the following is a type of pulmonary embolism?
Which of the following is a type of pulmonary embolism?
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Which symptom is NOT typically associated with secondary pulmonary hypertension?
Which symptom is NOT typically associated with secondary pulmonary hypertension?
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What is one common cause of respiratory failure due to impaired ventilation?
What is one common cause of respiratory failure due to impaired ventilation?
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What is the purpose of intubation in the treatment of respiratory failure?
What is the purpose of intubation in the treatment of respiratory failure?
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Which condition can cause respiratory acidosis?
Which condition can cause respiratory acidosis?
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Which treatment is NOT classified under nonpharmacologic treatments of angina?
Which treatment is NOT classified under nonpharmacologic treatments of angina?
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Which factor is likely to increase pulmonary arterial pressure?
Which factor is likely to increase pulmonary arterial pressure?
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Study Notes
Unstable Angina
- Characterized by substernal chest discomfort not relieved by rest or nitroglycerin.
- Often described as an "elephant sitting on my chest".
- Accompanied by symptoms such as pallor, diaphoresis, dyspnea, nausea, and vomiting.
- Remember the 4 Us: Unexpected, Unaltered, Unrelenting, Unsurvivable without treatment.
- Pain is persistent and severe, often lasting more than 20 minutes.
- Pain can occur at rest or with minimal exertion.
- New onset pain is described as frank and sudden.
- Pain patterns can be more severe, prolonged, or frequent than previously experienced.
Chronic Stable Angina
- Associated with a fixed coronary obstruction that limits blood flow to the heart muscle.
Nonpharmacologic Treatment of Angina
- Smoking cessation is crucial.
- Stress reduction techniques are beneficial.
- Regular exercise programs are recommended.
- Dietary modifications include limiting cholesterol and saturated fats.
- Weight reduction is important for obese individuals.
- Avoidance of cold or other vasoconstricting factors is advised.
Embolus
- A freely moving particle, like a blood clot, that travels through the circulatory system until lodging in a smaller vessel.
- Often a complication of heart conditions: ischemic heart disease, atrial fibrillation, or rheumatic heart disease.
- The Seven Ps of Acute Arterial Embolism: Pistol shot, Pallor, Polar, Pulselessness, Pain, Paresthesia, Paralysis.
Endocarditis
- A serious heart infection caused by bacteria or fungi.
- Requires three factors: damaged endocardial surface, a portal of entry for the organism, and an environment conducive to bacterial growth.
- Infective endocarditis is a type of endocarditis caused by infection.
- The presence of valvular disease, prosthetic heart valves, or congenital heart defects increases the risk.
- Infective Endocarditis is a type of endocarditis caused by an infection, involving bacteria or fungi entering the bloodstream and attaching to damaged heart tissue.
### Pneumonia
- Respiratory disorders involving inflammation of the lung structures, including alveoli and bronchioles.
- Infectious agents like bacteria and viruses are common causes.
- Noninfectious agents, such as aspirated gastric secretions, can also cause pneumonia.
Factors Facilitating Pneumonia Development
- Highly virulent organisms.
- Large inoculum (the amount of pathogen introduced to the body).
- Impaired host defenses (weakened immune system).
- Immunocompromised individuals are at increased risk.
Classifications of Pneumonia
- Source of infection:
- Community-acquired: Infection acquired outside the hospital setting.
- Hospital-acquired (nosocomial): Infection acquired within the hospital.
- Immune status of the host:
- Pneumonia in the immunocompromised person: Infection in individuals with weakened immune systems.
- Hospital-acquired infections: Develop within the first 48 hours of hospitalization.
- Community-acquired infections: Occur more than 48 hours after being admitted to the hospital.
Tuberculosis (TB)
- Caused by the Mycobacterium tuberculosis.
- Has an outer waxy capsule that makes it resistant to destruction.
- Can infect any organ, but the lungs are most commonly affected.
- TB bacteria attack and destroy lung tissue through a macrophage-directed immune response.
- Cell-mediated immune response is critical for fighting TB.
- TB is spread through the air when infected individuals cough, sneeze, or spit.
- Crowded living conditions and weakened immune systems increase the risk of transmission.
- TB is highly contagious, and infected individuals can spread it by coughing, speaking, singing, or breathing.
### Key Points about TB
- A potentially severe infectious disease caused by Mycobacterium tuberculosis.
- Primarily affects the lungs but can also affect kidneys, spine, and brain.
- Spread through the air by infected individuals coughing, sneezing, or spitting.
- Crowded places and close living conditions facilitate transmission.
- People with weakened immune systems are at higher risk.
Diagnosis and Treatment of TB
- Diagnosis involves physical examination, skin tests, blood tests, and imaging studies.
- TB is treated with antibiotics, but drug-resistant forms pose a challenge.
- Treatment often requires several months of medication and follow-up care.
TB Prevention
- Bacillus Calmette-Guérin (BCG) vaccine helps prevent TB, particularly in children.
- Prevention includes wearing masks, using separate utensils and rooms, avoiding large gatherings, practicing good hygiene, and maintaining well-ventilated living areas.
PAD (Peripheral Artery Disease)
- Classic symptom is intermittent claudication, causing pain, cramping, or weakness in leg muscles during activity.
Etiology of PAD
- Smoking is the primary risk factor.
- Other risk factors include diabetes, hypertension, hyperlipidemia, obesity, and family history of cardiovascular disease.
Classifications of Rhinosinusitis
-
Acute Rhinosinusitis:
- Caused by viruses, bacteria, or both.
- Lasts from 5 to 7 days to up to 4 weeks.
- Symptoms include facial pain, headache, and thick nasal discharge.
- Subacute Rhinosinusitis: Lasts between 4 weeks and less than 12 weeks.
- Chronic Rhinosinusitis: Lasts longer than 12 weeks.
- Rhinitis: Inflammation of the nasal mucosa.
- Sinusitis: Inflammation of the paranasal sinuses.
Definition and Functions of the Pericardium
- A double-layered serous membrane surrounding the heart.
- Functions include isolating the heart, maintaining its position, preventing overfilling, and contributing to ventricular distensibility during diastole.
Pericarditis (Pericardial Disorder 1)
- Acute inflammation of the pericardium, characterized by swelling and irritation of the membrane.
- Caused by factors such as infection and trauma.
- Can be acute, chronic, or constrictive.
Pericardial Effusion (Pericardial Disorder 2)
- Accumulation of fluid in the pericardial cavity.
Cardiac Tamponade (Pericardial Disorder 3)
- Slow or rapid compression of the heart due to fluid, pus, or blood buildup in the pericardial sac.
Constrictive Pericarditis (Pericardial Disorder 4)
- Calcified scar tissue forms between the pericardium's layers.
- Cardiac output and reserve become fixed.
- Symptoms include ascites (fluid build-up in the abdomen), pedal edema (swelling in the feet), dyspnea on exertion (difficulty breathing during activity), fatigue, and Kussmaul sign (abnormal jugular venous distention).
Disorders of the Pleura
- Pleural Effusion: Abnormal fluid collection in the pleural cavity (space between the lung and chest wall).
-
Types of Fluid:
- Transudate: Fluid that leaks from blood vessels.
- Exudate: Inflammatory fluid.
- Purulent drainage (empyema): Pus-filled fluid.
- Chyle: Milky fluid from the digestive tract.
- Blood.
- Hemothorax is a condition where blood collects in the pleural space.
- Pleuritis is a condition where the pleura becomes inflamed.
- Chylothorax is a condition where chyle (a milky fluid from the digestive tract) escapes into the pleural space.
- Atelectasis: Collapse or closure of a lung, resulting in reduced or absent gas exchange.
- Empyema: Accumulation of pus within the pleural space.
Pulmonary Embolism
- Development occurs when a blood-borne substance lodges in a branch of the pulmonary artery, obstructing blood flow.
-
Types:
- Thrombus: Blood clot originating from a deep vein thrombosis (DVT).
- Fat: Released from bone marrow after a fracture or traumatized fat depot.
- Amniotic fluid: Enters the maternal circulation during labor.
Pulmonary Hypertension
- Elevated pressure within the pulmonary circulation.
- Pulmonary arterial hypertension is a specific type of pulmonary hypertension.
Signs and Symptoms of Secondary Pulmonary Hypertension
- Dyspnea (difficulty breathing) and fatigue.
- Peripheral edema (swelling in the legs and feet).
- Ascites (fluid buildup in the abdomen).
- Signs of right heart failure (cor pulmonale).
Causes of Respiratory Failure
-
Impaired ventilation:
- Upper airway obstruction.
- Weakness or paralysis of respiratory muscles.
- Chest wall injury.
- Impaired matching of ventilation (V/Q mismatch): Insufficient oxygen delivery to the lungs.
-
Impaired diffusion: Difficulties in gas exchange between the lungs and blood.
- Pulmonary edema (fluid buildup in the lungs).
- Respiratory distress syndrome (acute lung injury).
Treatment of Respiratory Failure
- Oropharyngeal (OPA) or nasopharyngeal airway: Devices inserted to secure an open airway.
- Intubation: Inserting a tube into the trachea to facilitate breathing support via mechanical ventilation.
- Airway suctioning: Removing secretions from the airway.
ROME (Acid-Base Mnemonic)
-
Respiratory
-
Opposite
-
Metabolic
-
Equal
-
Respiratory Acidosis: High carbon dioxide levels in the blood, typically caused by conditions like COPD and asthma.
-
Respiratory Alkalosis: Low carbon dioxide levels, often due to hyperventilation or anxiety.
Signs & Symptoms of Hypertension:
- Headache (especially in the morning)
- Nosebleeds
- Dizziness
- Fatigue
- Shortness of breath
- Visual disturbances
- Chest pain
- Irregular heartbeat
- Difficulty breathing
Nonpharmacologic Treatment of Angina:
- Smoking cessation.
- Stress reduction.
- Regular exercise program.
- Limiting dietary intake of cholesterol and saturated fats.
- Weight reduction if obesity is present.
- Avoidance of cold or other stresses that produce vasoconstriction.
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