Term
Dx for CP:
Duration: more than 2 sec, less than 10 min
Quality: pressure, tightness, squeezing, heaviness, burning
Location: retrosternal w/ radiation to neck, jaw, shoulders, arms
Associated features: precipitated by exertion, exposure to cold, psych stress. S4 gallop or mitral regurg murmur during pain |
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Definition
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Term
Dx for CP:
Duration: 10-20 min
Quality: severe pressure, tightness, squeezing, burning, heaviness
Location: retrosternal, radiation to arm, jaw, neck, shoulders
Associated features: occurs wtih low levels of activity or at rest |
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Definition
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Term
Dx for CP:
duration: Variable, maybe >30 min
Quality: severe pressure, tightness, squeezing, burning
Location: substernal, radiates to arm, neck, jaw, sohulders
Assocaited features: unrelieved by nitro. may have heart failure or arrhythmias
what tests? |
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Definition
MI
tests: EKG, CK, CKMB, troponins |
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Term
Dx for CP:
Duration: recurrent episodes for 2-10 min
Quality: pressure, tightness, burning, squeezing
Location: retrosternal, radiates to neck, shoulders, arm, jaw
Associated features: late-peaking systolic murmur radiating to carotids |
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Definition
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Term
Dx for CP:
Duration: hours to days, may be episodic
Quality: sharp
Location: retrosternal or toward cardiac apex, may radiate to left shoulder
Features: may be relieved by sitting up and leading forward. may have friction rub |
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Definition
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Term
Dx for CP:
Duration: abrupt onset of unrelenting pain
Quality: tearing, ripping sensation, knifelike
Location: anterior chest, radiating to back or between shoulder blades
Features: HTN, CTDs (Marfan's), murmur of aortic insufficiency, pericardial rub, pericardial tamponade, loss of peripheral pulses
tests? |
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Definition
Aortic dissection
tests: CT w/ contrast, MRI, TEE |
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Term
Dx for CP:
Duration: abrupt onset, several min to few hours
Quality: pleuritic
Location: lateral
Features: dyspnea, tachypnea, tachycardia, hypotension
tests? |
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Definition
PE
tests: CT angiography, lung scan, lower extremity venous US, D-dimer |
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Term
Dx for CP:
Duration: variable
Quality: pressure
Location: substernal
Features: dyspnea, increased venous pressure (edema, JVD) |
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Definition
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Term
Dx for CP:
Duration: variable
Quality: pleuritic
Location: unilateral
Features: cough, dyspnea, fever, rales, rub |
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Definition
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Term
Dx for CP:
Duration: sudden onset, several hours
Quality: pleuritic
Location: lateral
Features: dyspnea, decreased breath sounds |
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Definition
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Term
Dx for CP:
Duration: 10-60 min
Quality: burning
Location: substernal, epigastric
Features: worsened by recumbency
tx? |
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Definition
esophageal reflux
tx: antacids |
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Term
Dx for CP:
Duration: 2-30 min
Quality: pressure, tightness, burning
Location: retrosternal
Features: mimics angina |
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Definition
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Term
Dx for CP:
Duration: prolonged
Quality: burning
Location: epigastric, substernal
Features: relieved w/ food or antacid |
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Definition
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Term
Dx for CP:
Duration: prolonged
Quality: burning, pressure
Location: epigastric, substernal, RUQ
Features: follows a meal |
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Definition
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Term
Dx for CP:
Duration: variable
Quality: aching
Location: variable
Features: aggravated by movement, may be reproduced by localized pressure on exam |
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Definition
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Term
Dx for CP:
Duraiton: variable
Quality: sharp, burning
Location: dermatomal
Features: rash |
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Definition
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Term
Dx for CP:
Duration: variable, fleeting
quality: sharp or burning
Location: variable, retrosternal
Featurs: situational factors precipitate sx, anxiety/depression |
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Definition
| Emotional/psych condition |
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Term
What to do for this murmur?
Grade 1 or II, midsystolic
no sx
Normal EKG and CXR |
|
Definition
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Term
What do you do for this murmur?
Grade III or greater, holosystolic, or late systolic |
|
Definition
| echo, may need cardio referral |
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Term
What do you do for this murmur?
Grade I or II and midsystolic
sx of cardiac disease |
|
Definition
| echo, may need cardio referral |
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Term
What do you do for this murmur?
Grade I or II and midsystolic
NO sx but abnormal EKG or CXR |
|
Definition
| echo, may need cardio referral |
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Term
What do you do for this murmur?
Diastolic or continuous murmur |
|
Definition
| Echo - may need cardio consult |
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Term
Management of cough >3 weeks:
If normal CXR and it doesn't get better after stopping smoking/ACE-I and doesn't respond to empirical tx for URI, what do you do? |
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Definition
treat for asthma
if this doesn't work - treat for eosinophilic bronchitis
if this doesn't work - consider GI disease |
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Term
Management of cough >3 weeks:
Pt who has cough after having an URI. You treat them for nostnasal drip, but it doesn't go away. What now?
how do you treat them for postnasal drip? |
|
Definition
evaluate for pertussis or hyperreactive airway dz
postnasal drip tx: antihistamines, decongestants, nasal glucocorticoids, nasal ipratroprium |
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Term
Management of cough >3 weeks:
cough w/o a hx of infection and without an obvious cause. What is the first thing to do? |
|
Definition
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Term
| When would hemoptysis warrant bronchoscopy and CT? |
|
Definition
recurrent hemoptysis
risk factors for cancer
mass on CXR
parenchymal disease on CXR - CT, then bronchoscopy |
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Term
First line treatment for HTN
contraindications? |
|
Definition
thiazides (HCTZ)
contraindications: DM, dyslipidemia, gout, hypokalemia |
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Term
| Pt w/ HTN + CHF or renal failure. what tx? |
|
Definition
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|
Term
pt w/ CHF or primary aldosteronism + HTN, what tx?
contraindications? |
|
Definition
aldosterone antagonist (spironolactone)
contraindications: renal fialure, hperkalemia |
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Term
pt w/ angina + HTN. what tx?
contraindications? |
|
Definition
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Term
| Pt w/ prostatism + HTN. what tx? |
|
Definition
|
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Term
| pt w/ post-MI or CHF + HTN. what tx? |
|
Definition
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Term
| Pt who can't tolerate ACE-I, give? |
|
Definition
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Term
| Pt w/ angina + HTN, what tx? |
|
Definition
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Term
| Steps in evaluating a CP emergency |
|
Definition
1. assess hemodynamic and resp status
2. Hx: quality, location, duration of pain
3. PE
4. Labs, EKG
|
|
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Term
| pt w/ wide, radiating chest pain that has intensified over a period of minutes |
|
Definition
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Term
| Tests to get when assessing CP |
|
Definition
EKG
MI: enzymes - CK, CK-MB, troponins
Aortic dissection: CT w/ contrast, MRI, TEE
PE: CT angiography, lung scan, lower extremity venous US, D-dimer
Pericarditis/tamponade: echo
Pulm disease: CXR |
|
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Term
| What hx should you obtain from an anemic pt on first dx |
|
Definition
drugs
alcohol
fm hx
G6PD deficiency
sx: bleeding, fatigue, malaise, fever, weight loss, night sweats, systemic sx |
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Term
|
Definition
Look for mechanism of anemia: infection (lymphadenopathy, splenomegaly = lymphoproliferative dz), petechiae - platelet dysfunction, blood in stool
other signs:
forceful HB, strong peripheral pulses, systolic flow murmur, pale skin/mucus membranes, Hgb <8-10, pallor in palmar creases |
|
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Term
|
Definition
Hgb
Hct
retic count
MCV
MCH
MCHC
RDW
diff
segs
platelet
cell morphology
iron studies - serum iron, TIBC, serum ferritin
Marrow study - aspirate, biopsy
Renal/thyroid fxn - if normocytic
B12 & folate |
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Term
| What does a RBC index <2.5 or >2.5 indicate? |
|
Definition
<2.5 = RBC morphology
>2.5 = hemolysis/hemorrhage |
|
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Term
| Ddx for normocytic normochromic anemia |
|
Definition
marrow damage - infiltration, fibrosis, aplasia
decreased marrow stimulation
inflammation
metabolic
renal dz
chronic disease |
|
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Term
|
Definition
iron deficiency
thalassemia
sideroblastic
lead poisoning
pyridoxine deficiency |
|
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Term
|
Definition
megaloblastic (B12 and folate deficiency)
spleen and liver dz - target cells, howell jolley bodies
alcoholism |
|
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Term
| increase in circulating RBCs |
|
Definition
polycythemia
AKA erythrocytosis |
|
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Term
What kind of anemia?
microcytic, hypochromic
variation in size (anisocytosis)
variation in shape (poikilocytosis) |
|
Definition
|
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Term
| steps to evaluating polycythemia |
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Definition
1. recognize increase in Hct (>60% in men, >55% in women)
2. recognize increase in RBC mass (>36 in men, >32 in women)
3. Measure serum EPO
4. If low EPO --> polycythemia vera
5. If high EPO --> depends on other factors |
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Term
what disease?
sx: ruddy complexion, HA, blurred vision, confusion, stroke
Labs: elevated WBC, increased basophils, thrombocytosis
cause: mutation in JAK-2 gene |
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Definition
|
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Term
What diseases? High EPO + _____:
1. + low O2
2. + high carboxyhemoglobin, in a smoker
3. + abnormal hgb |
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Definition
1. hypoxia -- look for cause
2. smoker's polycythemia
3. EPO producing tumor |
|
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Term
| Mucosal bleeding and epistaxis, menorrhagia, |
|
Definition
|
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Term
| Spontaneous hemarthrosis occurs in factor ____ & ___ deficiency |
|
Definition
|
|
Term
| posttraumatic bleeding + joint hyperextensibility = ____ |
|
Definition
|
|
Term
| what are some drugs that impair platelet function |
|
Definition
aspirin
NSAIDs
fish oils
Vit E |
|
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Term
| ___ is the major risk factor for arterial thrombosis |
|
Definition
|
|
Term
|
Definition
PT/INR
PTT
Coagulation assay
platelet count
mixing studies (after abnormal PT/PTT)
Specific factor assays
Antibodies to phospholipids - ELISA |
|
|
Term
Honeycombing or cyst formation on CXR
Chronic Purulent sputum or blood
+ rhonchi |
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Definition
|
|
Term
| symmetric hilar adenopathy on CXR |
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Definition
|
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Term
| purulent or blood-tinged sputum could be what ddx? |
|
Definition
| bronchitis, bronchiectasis, pneumonia, lung abscess |
|
|
Term
| > 3% eosinophils on sputum culture w/o asthma = ? |
|
Definition
|
|
Term
| ___ is the procedure of choice for evaluating tumors or for getting tissue samples |
|
Definition
|
|
Term
| Tests for pts with chronic cough |
|
Definition
CXR
PFT
Sputum test
Bronchoscopy
HRCT |
|
|
Term
| Cough + blood streaked sputum + fever + chills |
|
Definition
|
|
Term
|
Definition
|
|
Term
| hemoptysis + chronic cough + pleuritic CP + dyspnea + rub |
|
Definition
|
|
Term
| Hemoptysis + renal disease |
|
Definition
| Goodpasture's or Wegener's |
|
|
Term
|
Definition
|
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Term
|
Definition
|
|
Term
| hemoptysis + airflow obstruction |
|
Definition
|
|
Term
| what are some ddx for hemoptysis |
|
Definition
GI: esophageal varices
Tracheobroncheal
Pulm parenchyma
primary vascular
rare causes |
|
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Term
| steps in assessment after dx of HTN |
|
Definition
1. screen for cardiac dz and secondary causes
2. assess lifestyle
3. assess sx: HA, fatigue, dizziness, palpitations, impotence |
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Term
|
Definition
1. sit in quiet room for 5 min
2. cuff at heart level
3. width of cuff = 40% arm circumference, length 80%
4. rate of deflation = 2mmHg/s
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|
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Term
|
Definition
1. body habitus, weight, height
2. BP in both arms
3. BP sitting, standing, supine
4. if <30 y/o: arterial pressure in lower extremities
5. HR
6. thyroid
7. fundoscopy
8. auscultate carotids, femorals, aorta
9. palpate femorals and pedals
10. auscultate heart
11. feel for PMI |
|
|
Term
| common PE findings in HTN |
|
Definition
- afib
- papilledema, AV nicking, exudates, hemorrhages
- Loud S2,
- S4 gallop
- LVH (displaced PMI) |
|
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Term
| Labs to get for newly diagnosed HTN, when starting a new med, and then annually |
|
Definition
EKG
renal function - UA, albumin, BUN/Cr
Serum electrolytes - Na, K, Ca, TSH
metabolic function: fasting glucose, total cholesterol, HDL, LDL, trigs
Hct |
|
|
Term
|
Definition
1. lifestyle changes
2. Meds (if >140/90)
1. HCTZ is first line |
|
|
Term
What meds do you give for these HTN emergencies?
HTN encephalopathy
malignant HTN (<220/110)
Stroke
MI/UA
Aortic Dissection
Preeclampsia |
|
Definition
HTN encephalopathy/maligant/stroke: Nitroprusside, nicardipine, labetalol
MI/UA: nitro, nicardepine, labetalol
Aortic dissection: nitroprusside, esmolol, labetalol
Preeclampsia: hydralazine, labetalol, nicardipine |
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|
Term
|
Definition
normal: <120/<80
PreHTN: 120-139/80-89 --> and/or
Stage 1: 140-159/90-99
Stage 2: >160/>100
Isolated systolic HTN: >140/<90
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|
|
Term
|
Definition
renal: PCKD, tumors, obstruction
Renal vascular: arteriosclerotic, fibromuscular dysplasia
Aortic coarctation, OSA, preeclampsia
Neurogenic: increased ICP, spinal cord injury, psychogenic
Meds: estrogens, steroids, decongestants, appetite suppressants, cyclosporine, antidepressants, MAOIs, EPO, NSAIDs, Cocaine |
|
|
Term
| Relevant pt hx for HTN evaluation |
|
Definition
1.duration of HTn
2. previous therapies and responses to them
3. fm hx of HTN and CAD
4. dietary and psychosocial hx
5. weight change, dyslipidemia, smoking, DM, physical activity
6. Any evidence of secondary htn
7. evidence of target organ damage - tia, stroke, blindness, angina, MI, sexual dysfunction
8. other diseases |
|
|
Term
Anion gap
- indications
- increases due to?
- decreases due to?
calculation |
|
Definition
indication: when evaluating acid-base disorder
increase: acidosis, ketoacidosis, ethylene glycol, uremia, aspirin
decrease: hypoalbuminemia (hemorrhage, nephrotic syndrome, cirrhosis)
AG = Na - (Cl+HCO3)
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|
|
Term
Creatinine clearance
indications
significance
calculation |
|
Definition
indications: used to measure GFR because it is easily measured
Low: renal disease/failure
CC (ml/min) = [(140 - age x lean body weight (kg)]/(plasma creatinine x 72) |
|
|
Term
| Indications for acute dialysis |
|
Definition
Acidosis
Electrolyte abn (Hyperkalemia)
Intoxication (lithium)
Overload/oliguria
Uremia
|
|
|
Term
| complications of acute dialysis |
|
Definition
fever
hypotension
hemolysis
dementia
seziure
bleeding
muscle cramps |
|
|
Term
| pulse pressure calculation & indications |
|
Definition
PP = SBP - DBP
PP <25% of SBP - decreased lv stroke volume
trauma - blood loss
high/wide PP = exercise
>40 mmHg: aortic regurg, atherosclerosis, pregnancy, hyperthyroid, htn drugs |
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