1 of 3 Flashcards
(203 cards)
0
Q
Diagnosis
Definition
A
The recognition of a disease or condition by its outward signs or symptoms
The analysis of the underlying physiological biochemical causes of a disease or condition
1
Q
HIPPIRONNA
stands for ….
A
History Inspection Palpation Percussion Instrumentation Range of Motion Orthopaedic testing Neurologic Testing Non-Organic Findings Ancillary Studies
2
Q
Prognosis
Definition?
A
prediction
chance of recovery
3
Q
prediction of how a patient’s disease will progress and whether there is a chance of recovery
A
Prognosis
4
Q
The recognition of a disease or condition by its outward signs or symptoms
The analysis of the underlying physiological biochemical causes of a disease or condition
A
Diagnosis
5
Q
Natural History
definition
A
what normally happens during the course of this disease if left untreated
6
Q
Four Pillars
A
Interrogation
Observation /Inspection
Palpation
Olfaction/Listening/Auscilation (tapping and listening/percussion)
7
Q
Western Clinical Reasoning
A
Onset of chief complaint Progression - of Sx/ Palliative or Provocative Factors Quality of Sx Radiation of Sx Severity of Sx Temporal Characteristics
8
Q
What are the 5 Most Prevalent Conditions Associated with Mortality and Morbidity in North America
A
Cancer Myocardial Infarct Hypertension Stroke Diabetes
9
Q
Antalgic Posture
What is it
A
Posture adopted by a patient in an attempt to get away from the source of pain
10
Q
Mesenchyme
What is it?
A
Tissue surrounding other organs, which is not differentiated, and which can become inflamed.
11
Q
AROM
what is it
A
Active Range Of Motion
based on both ability and willingness (ie: When the pain starts)
12
Q
PROM
what is it?
A
Passive Range Of Motion
motion available at a given joint
13
Q
Tests are applied based on:
A
Sensitivity: % true positives
Specificity: % false positives
Relevance: the appropriateness or importance
14
Q
Sensitivity of a test means:
A
% of patients with condition who test positive (evaluates true positives)
15
Q
Specificity of a test means:
A
% of patients without the condition who test positive (evaluates false positives)
16
Q
Relevance of a test means:
A
the appropriateness or importance of a test to formulate a diagnostic impression or hypothesis.
17
Q
Neurology, as it pertains to clinical reasoning:
A
changes in sensation can be the earliest signs of CNS/PNS pathology
sensory or motor deficits within a dermatome or myotome indicate a nerve root or peripheral nerve
general sensory or motor deficits in an extremity with no pain can indicate a spinal cord tract lesion
dissociation of sensory modalities often relates to segmental spinal cord lesions
18
Q
Neurology
objective sensory signs include:
A
Anesthesisa (loss of feeling)
Hypesthesia (diminished sensation)
Hyperpathia (increased pain sensation)
Allodynia (pain from innocuous stimulation)
19
Q
Anesthesisa
definition
A
loss of feeling
20
Q
Hypesthesia
definition
A
diminished sensation
21
Q
Hyperpathia
meaning
A
increased pain sensation
22
Q
Allodynia
meaning
A
pain from innocuous stimulation
23
Q
DDx
meaning
A
Differential Diagnosis
24
WDx
| meaning
Working Diagnosis
25
VINDICATES
| acronym for what?
```
Vascular
Inflamatory
Neoplasm
Degenerative
Intoxication
Congenital
Auto-Immune
Trauma
Endocrinopathy
Somatic Dysfunction
```
26
Requirements for a good WDx
Coherent
Adequate
Parsimonious
Effective - if not, review your WDx
27
Intensity Grading
Minimal - annoyance but no impairement
Slight - tolerable, but some impairment in performance of activity
Moderate -Sx/Sn cause impairment in activity
Marked - Sx/Sn prevent the activity entirely
28
Frequency Grading
Intermittent <25% of waking hours
Occasional 25%-50% of waking hours
Frequent 50%-75% of waking hours
Constant 75%-100% of waking hours
29
Intermittent
| frequency
<25% of waking hours
30
Occasional
| frequency
25%-50% of waking hours
31
Frequent
| frequency
50%-75% of waking hours
32
Constant
75%-100% of waking hours
33
HIPPIRONA:
| Inspection - what are we looking for?
appearance facial expressions posture (antalgic)
ambulation gait wounds/bruises
weight respiration voice
body habitus edema/swelling eyes
tongue deformity
34
What should you do before palpating painful areas?
Take pulse, so that it's not affected by the sensations of pain from palpations
35
HIPPIRONA:
| Percussion - where is it used?
thoracic cage
abdomen
peripheral structures
36
HIPPIRONA:
| Percussion - what can you use it to find?
Fractures
Swollen Mesenchyme
Outlines of Organs
37
CNS S/Sx of Hypertension?
Severe HA
Visual Changes (cortical, not within the eyes)
Generalized or Focal Weakness and Paresthesias
Disorientation, Seizures, Focal Neuroligic Deficits
38
Retinal Sn/Sx of Hypertension
```
Blurred or Double Vision (Diplopia)
Retinal Hemmorrhage
Retinal Exudates
Retinal Floaters
Papilledema
```
39
Severe HA
Visual Changes (cortical, not within the eyes)
Generalized or Focal Weakness and Paresthesias
Disorientation, Seizures, Focal Neuroligic Deficits
---all Sn/Sx of what?
End Organ Complications of Hypertension
| CNS
40
```
Blurred or Double Vision (Diplopia)
Retinal Hemmorrhage
Retinal Exudates
Retinal Floaters
Papilledema
-----all Sn/x of What?
```
End Organ Complications of Hypertension
| Eyes
41
Pre-Hypertension Parameters
120-139mm HG Systolic
| 120-139 mm HG diastolic
42
Hypertension Parameters
140+ Diastolic
or
90+ Systolic
43
Is Hypertension a Risk Factor or a Disease?
Risk Factor
44
Hypertension Stats
1999 Current
25-55 years of Age
50 million people in USA 72 Million People
32% of African Americans 81% aware
23% Mexican American/Caucasian 73% being treated
45
Cause of Hypertension
No identifiable individual cause. Multifactorial
46
Where does primary arterial pressure get regulated
The arterioles
47
Mean arterial Pressure
96 mm Hg for average BP of 120/80mm Hg
48
Systolic Pressure
| meaning
Pressure of the blood when the heart beats
49
Diastolic
| meaning
When the heart relaxes
50
What keeps the blood moving forward even when the heart relaxes?
The arteries were expanded during Systoly, so during Diastoly they relax
51
Renin-Angiotensin-Aldosterone System
```
If BP falls
Kidney produces Renin
Angiotensin I
Angiotensin II (increases thirst + vasoconstricter --> increase BP)
Aldosterone
Salt Retension
Water Retension ---> increased BP
```
52
What will Sympathetic NS Hyperactivity Elevate?
Blood Pressure
53
Factors that Exacerbate Hypertension
Obesity
Lack of Exercise
Smoking
Alcohol Use
54
Measuring BP
| tool?
Sphygmomanometer plus stethoscope
| occlude the flow of the brachial artery
55
Does acupuncture lower blood pressure?
Yes
56
Factors that can artificially increase BP
Having to Pee
Pain
Stress
White Coat Syndrome
57
Normotension parameters?
<85 Diastolic
| 2 year recheck
58
Mild Hypertension Parameters
| Stage 1
140-159 Systolic
90-99 Diastolic
Refer for Physical Exam
59
Moderate /Severe Hypertension
| Stage 2
160-179 / 180-209 Systolic
100-109/ 110-119 Diastolic
Refer to source of care immediately
60
Very Severe Call 911 Hypertension
Over 210 Systolic
Over 120 Diastolic
Call 911
61
Dx of Primary HTN
Minimum of 2 BP readings on 3 different occasions
Patient must be sitting or lying down for more than 5 minutes
Use more readings if it's all over the place (labile/white coat syndrome)
Normal BP is much lower for kids and infants
62
What is Secondary HTN?
HTN where underlying cause is clearly identified
63
How long does it take for the effects of Cigarettes and Coffee to wear off and get a proper BP reading?
About 20 minutes
64
Common categories of HTN meds?
>Beta Blockers (***)
beta receptors located in heart muscle, so it blocks the ability of the heart to increase it's rate of beating and therefore control cardiac output
>Diuretics
decrease volume of blood therefore decreasing pressure of blood
>ACE inhibitor (**)
Angiotensin Converting Enzyme
Angiotensin I cannot convert to Angiotensin II therefore no aldosterone therefore no additional thirst and no additional vasoconstriction
>Calcium Channel Blockers (*)
>Angiotensin II receptor Blockers
65
What is the difference between primary and secondary HTN?
Primary - multifactorial
| Secondary - cause is clearly identified (aka: it's secondary to another condition)
66
Which HTN tends to occur at younger ages with much higher pressures?
Secondary Hypertension
67
Renal Vascular Hypertension
| what is it?
the most common cause of Secondary HTN
Can also be a symptom of another underlying pathology
From Fibrous dysplasia of the renal arteries (tumour, growth, atherosclerosis)
68
Estrogen Induced HTN
Chronic low doses of estrogen in Oral Contraceptives 5+ years
especially bad with Trifecta of Doom (over 35, Taking Oral Contraceptives for 10+ years, smoker)
69
Hypertension During Pregnancy
Pre-eclampsia
| Eclampsia
70
3 Types of Hypertension
Primary
Secondary
Malignant
71
What is Malignant HTN?
HTN that results in symptomatic damage to the "End Organs"
(brain/heart/kidneys)
160+/110+ mm Hg
Causes damage all the time with no time to repair, so damage builds up faster than body can repair
72
Hypotension
| define
<60 mm Hg Diastolic
can cause blood clotting and stroke because the blood is stagnant
will also cause tissue edema
73
Hypotension
| causes
Anemia
| Anti-HTN meds overdose
74
Orthostatic Hypotension
| causes/what is it
from change in posture,
spells of lightheadedness with paroxysmal headaches, perspiration, palpitations (heart trying to increase cardiac output), panic, anxiety.
75
An intact endothelium favours:
Vasodilation
| vasodialation => inhibits platelet aggregation and vaso-reactivity
76
Vasoconstriction triggers:
platelet aggregation (lack of PGI2 and EDRF)
Platelets release vasocontrictors (serotonin, thromboxane A2, ADP)
Endothelium becomes Hypoxic
Basement membrane thickens, mass produced mitochondria in an effort to recover from hypoxia
endothelium releases vasoconstrictors in an attempt to limit cellular damage
atherosclerosis occurs because the scar tissue is hard, and then plaque accumulates around it... occlusion plus lack of ability to constrict and dilate.
77
Atherosclerotic Agents
Smoking
Cold
Stress/Hyperventilation
Vasoconstrictors (caffein, amphetamine, ephedrine, analogues, etc)
78
Renal S/Sx of Hypertension
```
Nocturia
Oliguria
Hematuria
Flank Pain and Tenderness
Peripheral Edema, Fatigue, Weakness
```
79
Cardiovascular Sn/Sx of HTN
Chest, intrascapular and /or abdominal pain
Palpitations, nausea, vomiting (pressure on heart)
Dyspnoea On Exertion (DOE) and SOB
Murmurs = S3 Gallop
Abdominal Bruits (noises) = venous hum (sound of turbulence as blood flows past obstruction)
80
Four Main Sn/Sx Categories of End-Organ Complications with HGN
("Four organs that are the chief end organ targest of chronic HTN")
CNS Sn/Sx
Retinal Sn/Sx
Renal
Cardivascular
81
Hypertensive Myocardial Hypertorphy
| definition
Left ventricular hypertrophy (LVH) is found in 20-30% of chronic hypertensives
82
Effects of Left Ventricular Hypertrophy
Reduced end ventricular volume within the left ventricle
Reduced ventricular compliance (stretch)
Increased Heart Rate (tachycardia)(Starlings Laws)
83
End results of Myocardial Hypertrophy?
Left Sided Heart Failure
| can result in very healthy athletes who drop dead during exercise
84
Healthy Athletes dropping dead during exercise suffer from:
Hypertrophic Occlusive Cardiomyopathy
(too big, blocking, heart muscle => no blood gets into muscle so it dies)
Eccentric Ventricular Hypertrophy "re-entry"
(not enough blood being pumped out of heart)
Undiagnosed propensity to hemorrhagic strokes
85
What symptom of HTN can destroy the integrity of the blood-brain-barrier?
Diastolic BP exceeding 130mm Hg (it should normally be around 80 though)
86
Hypertensive Encephalopathy
Diastolic >130
destroys BBB
the pressure squeezes your brain down into your spinal column
get Papilledema, flame hemorrhages (visible in eyes), stroke because blood vessels burst
CT scan of the head is the definitive Dx technique
87
Hypertension in Pregnancy
| 2 types?
Pre-Eclampsia
| Eclampsia
88
Pre-Eclampsia
| Dx?
Elevated BP
Proteinuria
Marked Edema
Usually last half of Pregnancy -> 2 weeks post partum
89
Eclampsia
| Dx
Exacerbated Pre-Eclampsia
(**Classic Triad: HTN, Edema, Proteinuria)
to the point of *convulsions* *coma*
90
Dissecting Thoracic Aneurysm
| What is it?
Abdominal Aorta gets a tear, blood flows in, then it starts to dissect the wall of the artery - aka splits the wall of the artery into two layers
91
Symptoms of Dissecting Thoracic Aneurysm
Accute chest or intrascapular pain
shock, diaphoresis, pallor, anxiety, tachypnea, tachycardia
Distension of juular and acute abdomen due to extension of aorta
92
Lab Tests for Dissecting Thoracic Aneurysm
X-Ray (not super reliable)
Ultrasonography (Good)
Computer Tomography with radiopaque dye (better, but radiation)
MRI (good)
93
Renovascular Hypertension:
Acute or chronic elevation of systemic BP caused by partial or complete occlusion of one or more renal arteries or their branches
Causes HTN by inciting the release of Renin from the juxtoglomerular cells of the affected kidney. The Lumen must be decreased by >= 70% before stenosis is hemodynamically significant.
94
Causes of Renovascular HTN
Most Frequent:
- atherosclerosis in men >50 y/o
- younger patients = fibrous dysplasias (usually women)
Renovascular HTN accounts for <2% of cases of HTN
95
Sn/Sx of Renovascular HTN:
55 y/o
Acceleration of previously stable HTN
Trauma of back or flank (kidney damage)with or without hematuria
Systolic-Diastolic bruit in epigastrium, usually transmitted to one or both upper quadrants or sometimes through the back.
96
Conservative Management of HTN
- TCM
| - BE HEALTHY- Qi Gong/Meditation/Breathing/Aerobics/Diet/Alcohol/Weight Reduction
97
"The Silent Killer"
Primary Hypertension
| -no specific Sx
98
Less conservative Tx of Renovascular HTN
```
Revascularization (widening the vessel)
Angioplasty (50% recurrence though)
Stent
Bypass Graft
Removal of Ischemic Kidney (so it's not producing vasoactive chemicals)
Antihypertensinve Drugs
```
99
Sx of Myocardial Hypertrophy
Dyspnea
| Palpitations
100
Large, abrupt increases in BP can lead to what cerebral complication?
Cerebral Edema
101
Papilledema, flame hemorrhages, and eventually stroke are signs of what?
Hypertensive Encephalopathy
102
Classic Triad of Eclampsia/Pre-eclampsia?
Hypertension
Edema
Proteinuria
103
biggest cause of Dissecting Thoracic Aneurism?
Hypertension
104
Thickening and stiffening of arterial walls, resulting in reduced arterial compliance is called what?
Arteriosclerosis
105
Arteriosclerosis
| What is it?
Thickening and stiffening of arterial walls, resulting in reduced arterial compliance
106
Difference Between Atherosclerosis and Arteriosclerosis
1. Atherosclerosis is a type of Arteriosclerosis
2. Atherosclerosis is an inflammatory reaction between the intima and media layers
3. Atherosclerosis is generally in larger arteries
4. Atherosclerosis is >90% of heart attacks
107
Most common sites of plaque formation and aneurism?
| Why?
Bifurcations of blood vessels
| Regions of augmentation
108
PAD
| stands for?
Peripheral Artery Disease
109
What happens in PAD
vessel diameter decreases, and tissue becomes hypoxic
110
Why is diabetes a risk factor for PAD?
```
^blood sugar
= ^ osmotic pressure
= ^water into blood
=^Blood Volume
=^ BP
**PAD 4x worse in Diabetics ---> foot ulcerations, neuropathy, and worse
```
111
Why is smoking a risk factor for PAD?
Vasoconstrictor
112
Anasarca
| what is it?
extreme generalized edema
113
CVA
| what is it?
Cerebral Vascular Accident (stroke)
114
Arteriosclerosis can result in which vascular issues?
Arterioles not being able stretch enough to buffer pressure of the blood before it enters the capillaries
---> capillary rupture/anasarca/edema
115
Sx/Sn locations of PAD in order of occurrence:
| pain/sx
a) Femoral-Popliteal occlusion (leg/calf)
b) Popliteal-tibial occlusion (foot/ankle)
c) Aorto-Illiac Occlusion (PSIS- hip/butt)
d) Illiofemoral Occlusion (thigh)
e) Brachio-Ulnar Occlusion (hand/forearm)
116
Pain in the leg/calf could be what?
Femoral-Popliteal Occlusion
117
Pain in the Ankle or Foot could be what ?
Popliteal-Tibial Occlusion
118
Pain in the hip and buttocks could be what?
Aorto-iliac Occlusion
119
Pain in the Thigh could be what?
Illiofemoral Occlusion
120
Pain in the hand and forearm could be what PAD symptom?
Brachio-Ulnar Occlusion
121
What are the 5Ps of Wiles?
```
Paresthesia
Pain
Pallor
Pulselessness
Paralysis
```
122
Paresthesia
| definition
```
Morbid and abnormal sensations
burning
tingling
prickling
formication
```
123
What type of pain is normally associated with PAD?
ISCHEMIC:
muscle cramps while exercising
tingling and burning
way better with rest (but in late stages it's still there at rest)
one of the major causes of restless leg syndrome
124
DDx for PAD?
```
Neurogenic Intermittent Claudation
---from a narrowed spinal canal
---Sx will change depending on the day
---variable threshold distance
---tolerance = 2x threshold distance
---noticeable going DOWN stairs (Neuros hate to go down)
---relieved by knee/lumbrosacral flexion (Neuros like to flex)
(aka - Neurogenic is a chowder head :-)
```
125
Pallor
| early fx:
altered nail bed blanching
| skin is cool to touch
126
Pallor
| chronic fx?
```
local hair loss
waxy skin
dry chalky skin
thick, irregular, brittle, opaque nails
ulcerations on webbing
gangrene
```
127
Pulselessness
| when does it happen with PAD?
exercise
| elevation of affected limb
128
Why does Paralysis happen with PAD?
late stage
arterial occlusion becomes complete
muscle atrophy if loss of motor fx
129
Acute Ischemia
| cause?
arterial occlusion
heart embolism
plaque
aneurysm
130
Sx of Acute Ischemia?
```
Severe Pain
Coldness
Numbness
Pallor
Pulses are absent/nearly absent distal to occlusion
```
131
Risk Factors for PAD
```
Atherosclerosis
Lower Extremity
Elderly
Male
Diabetes Mellitus
```
132
Classic Presentation of PAD?
Occlusion of the Femoral-Popliteal segment
| Sx = calf pain during excercise
133
Buerger's Test**
a) elevate suspect extremity 1-3 minutes (Pallor?)
b) quickly put it back down
- ---reactive hyperemia longer than 10 seconds?
- ---rubor of cyanosis/dependant rubor (30+ seconds)?
134
Allen's Test is.....
not reliable
135
Dewiest Test
excecise to point of pulslessness - BAD IDEA if CAD!!!!!!!!
136
Types of Intermittent Claudication
Arterial
| Neurogenic
137
Arterial Intermittent Claudication
| Sx/Sn?
Fixed Threshold Distance
Short Tolerance Distance
Brief Refractory Period
Shows up when walking up hill/up stairs
138
Classic PAD Sx Progression
Paresthesia and pain with exercise
- -> at rest
- -> Ischemic ulcerations
- -> Digital Gangrene
139
Types of Aneurysms?
```
Arteriosclerotic
Dissecting
Berry
Traumatic
Syphilitic
```
140
Arteriosclerotic Aneurysm
| what is it?
secondary to effects of arteriosclerosis, as that causes eddies and waves in the blood that increase and make more pressure and then you get an aneurysm
141
Dissecting Aneurysm
| what is it
tear in the intima that allows blood to get in between the layers but that blood flow change makes more eddies and currents and stuff and it increases pressure and rips it wide open making a bigger and bigger separation between the layers and eventually the whole thing bursts wide open
142
Berry Aneurysm
| what is it
at a place where the vessels split off, and it makes a bulge, then makes a Jawa looking thing, then the Jawa's head explodes.
143
Traumatic Aneurysm
| what is it
2% of aneurisms
| from stuff like bike helmet straps
144
Syphilitic Aneurysm
| What is it?
Infants born with Syphilis get them
145
Most aneurisms are asymptomatic until they.....
Dissect
Occlude Blood Flow through the Aorta
Explode and kill people
146
Hematoma of the Thoracic Aorta is also known as a....
Dissecting Thoracic Aneurysm
147
Risk factors for Dissecting Thoracic Aneurism?
```
Male
40-70 y/o
Hx HTN
Preggers if female
Cardiopulmonary surgery
HTN
```
148
Sx/Sn of Dissecting Thoracic Aneurysm?
Severe, Acute chest pain that is stabbing/ripping/unbearable
Anterior (chest) pain if ASCENDING off the aortic arch
Intra-scapular pain if DESCENDING down the aorta
HTN Sx
acute congestive heart failure
TIA Sx (hemiplegia, paraplegia, anuria)
33% mortality within 24hrs
149
Thoracic Aortic Aneurysm
(non-dissecting)
Causes?
Atherosclerosis
Congenital issues (syphilis, etc)
Whiplash
150
Sx/Sn of Thoracic Aortic Aneurysm?
Dyspnea/Stridor/Cough (from Pressure on the trachea)
Dysphagia (from pressure on the esophagus)
Hoarsness (from pressure on the pharyngeal nerve)
Edema in upper extremities (pressure on superior vena cava)
151
AAA
| what is it?
Abdominal Aortic Aneurysm
152
How are AAA's normally found?
Palpation
153
Where are 95% of Abdominal Aortic Aneurysms (AAAs) found?
95% are found between renal arteries and umbilicus (iliac crest)
154
What do AAAs feel like? Where would you feel them?
- anything over 4 cm (normal range is 2.5-4cm)
- normal pulse is brief and succinct
- between iliac crests
- readily palpable expanding pulsing mass (80%)
155
Can AAAs be asymptomatic?
Yes - 50% are found by accident, unless they rupture
156
Sx of Abdominal Aortic Aneurism (AAA)?
- feels like herniated disk or cramping
- could feel like biliary colic, appendicitis, or pancreatitis
* having these Sx indicates impending rupture*
157
What are the complications of Abdominal Aortic Aneurism?
Lower extremity Vascular Intermittent Claudication
Emboli that lodge in the distal arteries
Rupture (SHOCK)
158
Are there any AAAs that aren't likely to rupture?
anything less than 5cm rarely ruptures
| *but they do produce emboli that lodge in the distal arteries!
159
Risk associated with Abdominal Aortic Aneurysms that are >6cm?
DEATH (50% <2yr)
160
How big are the AAAs that cary the greatest risk of rupture?
7cm +
161
What's a DVT?
Deep Vein Thrombosis
162
What's a Deep Vein Thrombosis?
formation of a thrombus/clot in a deep vein
| often due to slower blood
163
What are the types of DVT?
Ileofemoral Deep Vein Thrombosis
| Popliteal Deep Vein Thrombosis
164
What kind of Sx for DVT?
mostly just vague and ambiguous Sx
165
What's an Ileofemoral DVT?
Deep Vein Thrombosis at the ileofemoral vein
166
What's a Popliteal DVT?
Deep Vein Thrombosis at the Popliteal Vein
167
What are the Sx for an Ileofemoral DVT?
- leg
- pain or soreness on walking or standing
- congestion or numbness @ rest
- dilation of superficial veins of femoral triangle/lower abdomen
- edema (thigh/leg)
- skin discolouration (thigh/leg)
- tissue turgor (thigh/leg)
- femoral triangle is tender
- hard, palpable cord where vein is occluded
168
What are the Sx of Popliteal DVT?
- Popliteal space ( knee pit )
- **DDx** - extending the knee causes a muscle-like leg pain
- pain or soreness on walking or standing
- congestion or numbness @ rest
- dilation of superficial veins (leg)
- edema (ankle/leg)
- skin discolouration (ankle/leg)
- tissue turgor (ankle/leg)
- femoral triangle is tender
- hard, palpable cord where vein is occluded
169
2 main causes of DVTs?
```
Sedentary Postures (couch potato/standing all day)
Trauma (superficial or deep leg trauma)
```
170
What lifestyle or injury factors increase the risk of DVTs occurring?
Lifestyle - female smoker on OCAs (less circulation)
| Trauma - hip or proximal tibia fractures
171
Most serious complication of DVTs?
Pulmonary Embolism
172
Sx of Pulmonary Embolism?
Leg pain with quick accute SOB
173
Long term consequences of DVT?
Chronic Venous Insufficiency
174
What does Chronic Venous Insufficiency cause?
Edema
Stasis Pigmentation
Stasis Dermatitis
Stasis Ulceration (gangrene)
175
DDx for Sudden Onset Leg Pain?***
PAD
Osteoarthritis at hip or knee (chronic, but suddenly got worse)
Peripheral Neuritis
Nerve Root Compression
176
Other Vascular Conditions
Raynaud's
Phlebitis
Varicosities
177
Top 6 Risk Factors for CHD ***
| Coronary Heart Disease
```
Age
Family Hx
HTN
Smoking
Diabetes
Low HDLs
Waist Girth/BMI
```
178
Female Specific Heart Disease influences?
OCA Hypertension
Pre-eclampsia
Toxaemia
Peri partum cardiomyopathy
179
What's the leading cause of death in American (not Canadian) women?
Coronary Heart Disease
180
Types of Chest Pain (2 main types)?
Episodic / Recurrent Chest Pain
| Acute/ Severe Chest Pain
181
Types of Episodic / Recurrent Chest Pain
Angina Pectoris
Non-Anginal Chest Pain
Compatible Chest Pain
182
Types of Acute/ Severe Chest Pain
Acute Pleuritic Chest Pain
| Myocardial Infarction
183
What is Angina Pectoris?
Chest pain from
Transient Myocardial Ischemia
No heart tissue necrosis (at beginning)
184
What is Levine's Sign? ***
clenched fist over sternum
185
Pain Sx of Angina Pectoris
```
Crushing/gripping
Diffuse /poorly localized
Levine's Sign ***
neck/chest/jaw/shoulders/arms/back/epigastrium
abrupt
2-3 minutes but feels longer
```
186
Why is Angina Pectoris predictable?
Exercise or stress induced
relieved by nitro tablets
Hx makes Dx easy
187
Conservative Management of Angina Pectoris?
```
Stop Smoking
No Sudden Cold
No Emo
No hyperventilation
No Vasoconstrictors (amphetamines/ephedrine/cocaine/etc)
```
188
Differentiated types of Angina?
```
Atypical
Equivalent
Mixed
Unstable
Silent
```
189
How to Rule Out Angina?
```
constant pain
greater than an hour
comes and goes in a second
caused by bending forward, esp after food
reproduced by pressing on chest
comes with moving trunk/arm
relieved by lying down
```
190
Neuro Muscular Sx Chest Pain
| DDx Sx?
Constant
Comes and Goes in a Second
Reproducible by pressing on chest
Reproduced by moving arm/trunk
191
```
Plueritic Pain (Non-Angina Chest Pain)
DDx Sx?
```
Influenced by respiration
192
```
GERD Pain (Non Angina Chest Pain)
DDx Sx?
```
Caused by bending forward, esp after meal
193
Mitral Valve Prolapse Syndrome
| what is it?
Congenital
Connective Tissue of Mitral Valve issue
Causes atypical chest pain, palpitations, lightheadedness
194
Compatible Chest Pain
define it
examples
```
can't say it is or isn't Angina without further tests
GERD
Plueritis
Psychogenic
Cardiopulmonary Dz
```
195
Plueritis
| what is it?
inflammation of the pleura
196
Sx of Plueritis?
Well localized stabbing pain over lung field (Angina not localized)
^ Pain w/ coughing/breathing
So shallow, rapid breathing
Crackling sound (crepitations) over pain
No tactile fremitus (vibrations from voice)
No breath sounds
197
What is Pleural Effusion?
fluid in intra-pleural space
198
Types of Non-Inflammatory Pleural Effusion?***
Hydrothorax
Chylothorax (lymph)
Pyothorax (pus)
Hemothorax
199
What's the DDx b/w Spontaneous Pneumothorax and Secondary Spontaneous Pneumothorax?
Secondary is a complication of other lung Dz, not in otherwise healthy folks
200
What's a Tension Pneumothorax?
air gets into intra pleural space due to a little nick or weak spot, but the flap keeps letting air in and never out so the pressure eventually changes
201
Myocardial Infarction
| what is it?
Myocardial Ischemia with irreversible tissue necrosis
202
Sx of MI?
*"I just don't feel well"
*Anxiety and mental confusion
*Palpitations
*Excessive Sweating
*Nausea
*Pallor and possible cyanosis
*Paroxysmal Nocturnal Dyspnea (can't breath right at night)
**Pulsus Alternans
Decreased peripheral pulses
Heart murmers
irregular tachycardia
sometimes prodrome
Hx of Angina that was hard to resolve
SOB
DOE (Dyspnea on Exertion)
Palpitations
(pre) Syncope
Sx of TIAs
Unexplained profuse sweating (diaphoresis)
