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Questions and Answers
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?
How is an embolus defined in the context of circulatory conditions?
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?
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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?
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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?
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How is infective endocarditis primarily caused?
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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?
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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?
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Infective endocarditis typically arises in individuals with which condition?
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What type of pneumonia is classified as community-acquired?
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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?
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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)?
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What is the purpose of the BCG vaccine?
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Which of the following best describes acute rhinosinusitis?
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What treatments are typically used for tuberculosis?
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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?
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Which function is NOT associated with the pericardium?
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What occurs in constrictive pericarditis?
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What is a potential cause of pericarditis?
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Hemothorax primarily involves what type of fluid?
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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?
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Which statement is true about chylothorax?
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What characterizes empyema?
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Which of the following is a type of pulmonary embolism?
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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?
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What is the purpose of intubation in the treatment of respiratory failure?
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Which condition can cause respiratory acidosis?
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Which treatment is NOT classified under nonpharmacologic treatments of angina?
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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.
###Â 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.
###Â 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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