mostly cardio

Question 1

Sepsis-Presence of pathogenic organisms or their toxins in the blood and tissues with a resulting systemic inflammatory response consider obtaining serum sepsis markers (lactate, procalcitonin, others) to help stratify the sickest children.TestPossible findingsCBC with WBC differentialBacterial or viral shiftBlood cultureBacteremia (presence of bacteria in the blood) usually sustained in sepsisUrinalysis (UA) and urine culture and sensitivity via transurethral catheter or suprapubic tapIn UTI, pyelonephritis‒ WBC, bacteria, urine culture positive for the offending organisms LP for CSF analysis and culturePleocytosis (WBC in CSF) and other findings consistent with bacterial or viral meningitisChest x-ray (CXR)To assist in diagnosis of pneumoniaStool culture, fecal WBC count, if diarrhea presentTo assist in the diagnosis of shigella or other forms of infectious diarrhea

Answer 1

Presence of pathogenic organisms or their toxins in the blood and tissues with a resulting systemic inflammatory response
Consider obtaining serum sepsis markers (lactate, procalcitonin, others) to help stratify the sickest children.
Tests
Possible findingsCBC with WBC differentialBacterial or viral shiftBlood cultureBacteremia (presence of bacteria in the blood) usually sustained in sepsis

Urinalysis (UA) and urine culture and sensitivity via transurethral catheter or suprapubic tapIn UTI, pyelonephritis‒ WBC, bacteria, urine culture positive for the offending organisms

Not for everyone
LP for CSF analysis and culturePleocytosis (WBC in CSF) and other findings consistent with bacterial or viral meningitis(neutrophils for bacterial, lymphocytes viral)
Chest x-ray (CXR)To assist in diagnosis of pneumonia

Stool culture, fecal WBC count, if diarrhea presentTo assist in the diagnosis of shigella or other forms of infectious diarrhea

Question 2

1. A 78 Year-old Woman…• With a 30-year history of hypertension and dyslipidemia and a 10-year history of type 2 diabetes presents with suspected acute coronary syndrome. She is most likely to report a recent onset of
   A. Retrosternal chest pain with radiation to the left arm. B. Syncope. C. Unusual fatigue. D. Nausea and vomiting

Answer 2

unusual fatigue (70% of women)
she is an older woman
with a high 
cardiovascular risk 
nausea and vomiting is not specific to cardiac disease

Question 3

If unable to palpate the PMI?

Answer 3

position in the left lateral decubitus position

Question 4

S1

Answer 4

Lubdub” Heard nearly simultaneous with the carotid upstroke

Question 5

S2

Answer 5

Marks the end of systole. Produced by events surrounding the closure of the aortic and pulmonic valves

Question 6

Physiologic split S2

Answer 6

Split increases on patient inspiration. Found in the majority of adults

Question 7

Pathologic S3 heart sound

Answer 7

Marker of ventricular overload and/or systolic dysfunction

Low pitch, best heard with bell, might miss with diaphragm

S1 S2 S3 For diagnosis of heart failure, correlate with additional findings such as dyspnea, tachycardia, crackles. Finding can resolve with treatment of underlying condition

Question 8

Systolic Murmurs
•Mitral
•Regurgitation
•Physiologic (innocent, functional)
•Aortic 
•Stenosis
•Systolic

Answer 8

can be benign or pathologic

Question 9

DIalstolic murmurs are:

Answer 9

always pathologic

Question 10

Systolic murmur is likely benign:

Answer 10

• Consider benign only if all noted– 
Negative hx– 
Lower grade (<=Gr III/VI)–
No radiation beyond the precordium–
S1, S2 intact– 
No heave or thrill–
PMI WNL– 
Softens or disappears with supine to stand position change

Question 11

Pathologic • Consider pathologic (echocardiogram usual next step in evaluation) until proven otherwise if

Answer 11

=>1 of the following present–
Abnormal hx–
Higher grade (=>Gr IV/VI)– Radiation beyond the precordium to neck, axilla, other locations–
S1, S2 obliterated– w/ thrill or heave–
PMI displaced–
Increases in intensity with supine to stand position change