Associations 2 Flashcards
1
Q
1st degree burn
A
Epidermis Painful Erythema No blisters Blanching (intact cap refill)
2
Q
2nd degree burn, superficial
A
Epidermis + partial dermis Painful Erythema Blisters Blanching (intact cap refill)
3
Q
2nd degree burn, deep
A
Epidermis + partial dermis Painful Erythema Blisters No blanching (non-intact cap refill)
4
Q
3rd degree burn
A
Epidermis + dermis + some fatty tissue
Painless
White/charred/gray
No blanching (non-intact cap refill)
5
Q
Burn complications
A
Infection/Sepsis (pseudomonas) Curling stress ulcers Aspiration/inhalation injury Dehydration/hypovolemia/shock Ileus Renal insufficiency/rhabdomyolysis Compartment syndrome (Electrical): dysrhythmias, RF, bony injury, neuro issues, acidosis
6
Q
Fresh water drowning
A
Decreased electrolyte concentrations
RBC lysis
(hypotonic water drawn into vasculature)
7
Q
Salt water drowning
A
Pulmonary edema
Increased electrolyte concentrations
(hypertonic water draws more water into alveoli)
8
Q
Parkland formula
A
4 mL x body mass (kg) x % surface burned
LR: Give 1/2 in first 8 hrs, 1/2 in next 16 hrs
May also need maintenance fluid
9
Q
J wave (EKG)
A
Small bump after QRS
Hypothermia
(may also see Vtach/Vfib)
10
Q
SCLC associations
A
Lambert-Eaton (muscle weakness improving w/ use)
Ectopic ACTH production
others??
11
Q
Bradycardia in kids
A
R/O BB or CCB toxicity
12
Q
Anticholinergic OD
A
Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter Bloated as a toad Tachycardia
13
Q
Cholinergic (organophosphate) OD
A
DUMBBELSS Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscles/emesis Lacrimation Sweating Salivation Abdominal cramping
14
Q
Carboxyhemoglobinemia causes
A
Usu from smoke inhalation
Ready to intubate quickly (airway edema)
Nitrates C/I (induce methemoglobinemia)
15
Q
Methemoglobinemia causes
A
Familial
Anesthetics such as benzocaine
Benzene
Certain antibiotics (including dapsone and chloroquine)
Nitrites (used as additives to prevent meat from spoiling)
Nitrates (used to treat cyanide poisoning)
16
Q
LAD EKG
A
V1-V3 (septal, IVS)
V2-V4 (anterior wall)
17
Q
L circumflex EKG
A
I, aVL, V5, V6 (lateral wall)
18
Q
R posterior descending EKG
A
II, III, aVF (inferior wall)
19
Q
CO
A
SV x HR
rate of O2 use / (arterial O2 - venous O2)
20
Q
SV determined by
A
Contractility
Preload (venous return)
Afterload (pressure in aorta)
21
Q
SV increases from
A
Catecholamine release Increase in intracellular Ca Decrease in extracellular Na Digoxin Anxiety Exercise
22
Q
SV decreases from
A
BB
Heart failure
Acidosis
Hypoxia
23
Q
Exercise increases CO by
A
Increased SV (initially) Increased HR (later)
24
Q
MAP
A
CO x TPR
2/3 DBP + 1/3 SBP
DBP + 1/3 pulse pressure
25
Increased PR interval
> 0.2 sec
| Heart block
26
Elevated/depressed PR interval
Pericarditis
27
QRS complex, narrow
<0.12 sec is normal
SVT
Signal in AV node or above
Normal His/Purkinje
28
QRS complex, wide
>0.12 sec
Delay in ventricular depolarization
Rhythm starting distal to AV node
Ventricular tachycardias
29
Signs of MI on EKG
Elevated ST segment
| T wave inversion
30
T wave on EKG
Large - hyperkalmia
Flattened - hypokalemia
Inverted - MI
31
ST depression on EKG
Sign of ischemia
| Downsloping/horizontal worse than upsloping
32
Myositis vs Myalgia
Check for muscle inflammation (CPK)
33
CCB
Non-DHP (verapamil, diltiazem) work on heart
| DHP (nifedipine, amlodipine) work on periphery, causing VD, decreasing preload
34
More likely to have atypical or no angina w/ myocardial ischemia
DM (sensory neuropathy)
Elderly
Females
May have fatigue, exercise intolerance, flu-like symptoms
35
Causes of chest pain
```
Cardiac (Angina, MI), GERD, MSK (MC)
Cocaine/Costochondritis
Hyperventilation/Herpes zoster
Esophagitis/Esophageal spasm
Stenosis of aorta
Trauma
Pulmonary embolism/Pneumonia/Pericarditis/Pancreatitis
Angina/Aortic dissection/Aortic aneurysm
Infarction (myocardial)
Neuropsychiatric (depression)
```
36
Chest pain that occurs w/ exercise, disappears w/ rest
Stable angina
37
Chest pain w/ ST elevation only during brief episodes
Prinzmetal angina (coronary artery vasospasm)
38
Chest pain where patient can localize w/ one finger
MSK
39
Chest pain w/ tenderness to palpation of chest wall
MSK
40
Chest pain w/ rapid onset, sharp, "tearing" that radiates to scapula or back
Aortic dissection
41
Chest pain w/ rapid onset, sharp in young person and associated w/ dyspnea
Spontaneous pneumothorax
42
Chest pain that occurs after heavy meals and is relieved by antacids
GERD, Esophageal spasm
43
Chest pain that is sharp, lasts for hours-days and is somewhat relieved by sitting forward
Pericarditis
44
Chest pain made worse by deep breathing and/or motion
MSK
| Pleuritic pain
45
Chest pain in dermatomal distribution
Herpes zoster
46
MCC noncardiac chest pain
GERD, MSK
47
Chest pain w/ acute onset dyspnea, tachycardia, confusion in hospitalized patient
Pulmonary embolism
48
Chest pain began day after starting exercise program
MSK
49
Chest pain w/ widened mediastinum on CXR
Aortic dissection
50
Electrolytes in cardiac patients
K > 4, Mg > 2
| Decreases potential risk of arrhythmias
51
New onset RBBB
Pulmonary embolism
52
New onset LBBB
MI
53
Difference btwn unstable angina and NSTEMI
-/+ cardiac enzymes
54
Cardiac enzymes (troponin, CK-MB)
Show cardiac muscle damage/cell death
Three sets 8 hrs apart
Troponin I increases faster, more sensitive/specific
CK-MB decreases 24-72 hrs later (troponin I takes 7 days)
55
U wave on EKG
Relative hypokalemia
| Also hypercalcemia, hyperthyroidism
56
Q wave (big) on EKG
Post-MI, usu persists weeks later
57
MCC sudden cardiac death post-MI
Vfib
Vtach
Cardiogenic shock
58
Greatest risk of ventricular wall rupture post-MI
4-8 days later
59
Dressler syndrome
AI pericarditis (fever, +ESR) 2-4 weeks post MI
60
Delta wave on EKG (slurred upstroke of QRS)
Wolff-Parkinson-White syndrome (AV nodal reentry through accessory conduction pathway; PSVT)
61
Medications that can cause heart block arrhythmias (esp Mobitz I and above)
BB
Digoxin
CCB
62
Arrhythmia w/ narrow QRS, rate >100
Supraventricular tachycardia
63
Arrhythmia w/ no relationship between P wave and QRS
3rd degree heart block
64
Arrhythmia w/ 3+ P wave morphologies, rate >100
Multifocal atrial tachycardia
65
Arrhythmia w/ rate <50
Bradycardia
66
Arrhythmia w/ PR interval >0.2 sec
1st degree heart block
67
Arrhythmia w/ early, wide QRS w/o P wave
Premature ventricular contractions
68
Arrhythmia w/ wide QRS, HR 160-240
Ventricular tachycardia
69
Arrhythmia w/ PR interval becomes longer w/ dropped beat
2nd degree heart block, Mobitz type I (Wenckebach)
70
Arrhythmia w/ chaotic pattern, no P wave, no QRS
Ventricular fibrillation
71
Arrhythmia w/ normal PR, occasional dropped beat
2nd degree heart block, Mobitz type II
72
Arrhythmia w/ sawtooth pattern
Atrial flutter
73
Arrhythmia w/ no P waves, narrow QRS, irregularly irregular
Atrial fibrillation
74
Arrhythmia w/ sinusoidal pattern of QRS
Torsades de pointes (VTach)
75
Antiarrhythmic classes
I - Na channel blockers - class IA, IB (lidocaine, tocainide), IC
II - BB - propanolol, esmolol, metoprolol
III - K channel blockers - amiodarone (also type I), sotalol
IV - CCB (NDP) - verapamil, diltiazem
76
PVCs that are concerning
> 3/min
| >3 in a row (VTach)
77
Common causes of AFib
```
PIRATES
Pulmonary disease/pericarditis
Ischemia (CAD)
Rheumatic heart disease
Anemia
**hyperThyroid
Ethanol
Sepsis
Also HTN, valvular disease
```
78
Causes of PEA/Asystole
```
Hs (7) & Ts (7)
Hypovolemia
Hypoxia
H ions (acidosis, common in prolonged code)
Hyperkalemia (common in prolonged code from acidosis)
Hypokalemia
Hypoglycemia
Hypothermia
Tamponade
Tension pneumothorax
Thrombosis (MI)
Thrombosis (PE)
Trauma
Tablets
Toxins
```
79
Organism causing infection in burn victims
Pseudomonas
80
S3 causes
```
Dilated ventricles
HF (most frequent sign of CHF)
Dilated CMP
MR
Acute MI
```
81
S4 causes
Stiff LV
82
Systolic HF causes
```
Decreased contractility
Increased preload (eventually)
Increased afterload
HR abnormalities (brady/tachy)
High output conditions (anemia, hyperthyroid, etc)
```
83
Diastolic HF causes
LVH
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
84
L CHF S/Sx
```
Fatigue
DOE, orthopnea, PND, cough (pulm edema)
Displaced PMI
S3
Rales, crackles
```
85
R CHF S/Sx
JVD
Peripheral edema (especially BLE)
Hepatomegaly, hepatic congestion
86
CC R CHF
```
L CHF (MCC)
Pulmonary HTN, COPD/pulmonary disease (cor pulmonale), valvular disease, congenital
```
87
Normal EF
55-75%
88
Diastolic murmur at L lower sternum that increases with inspiration
TS
89
Late diastolic murmur w/ opening snap, no change with inspiration
MS
90
Systolic murmur heard best in 2nd R interspace
AS
91
Systolic murmur heard best in 2nd L interspace
PS
| ASD (w/ fixed split S2)
92
Late systolic murmur heard best at apex
MVP
93
Diastolic murmur with widened pulse pressure
AR
94
Holosystolic murmur louder w/ inspiration at L lower sternum
TR
| VSD
95
Holosystolic murmur heard at apex, radiates to axilla
MR
96
MCC hypertrophic cardiomyopathy
Congenital (50% autosomal dominant)
97
Systolic murmur louder w/ Valsalva
Hypertrophic cardiomyopathy
98
MC cardiomyopathy
Dilated
99
Causes dilated cardiomyopathy
```
Idiopathic
Alcohol use
Beriberi
Coxsackievirus B (myocarditis)
Cocaine use
Doxorubicin
Hemochromatosis
HIV
Ischemic heart disease
Pregnancy
Chagas disease
```
100
Restrictive cardiomyopathy - causes and dx
Sarcoidosis
Amyloidosis
Hemochromatosis
Dx: biopsy
101
Equal pressure in all chambers on cardiac cath
Chronic constrictive pericarditis
102
Transudative pericardial effusion
Low in protein, spec gravity <1.012, more common
103
Exudative pericardial effusion
High in protein, spec gravity >1.020
| Workup for neoplasm, fibrotic disease, TB
104
Beck triad
Hypotension, distant heart sounds, distended neck veins
| Think cardiac tamponade and perform urgent pericardiocentesis (echo first if patient stable)
105
Low voltage globally on EKG
Cardiac tamponade
106
Global ST elevation, PR depression
Acute pericarditis
107
Kussmaul sign causes
```
JVD w/ inspiration (from decreased RV capacity)
Constrictive pericarditis
Restrictive CMP
RV infarct
Massive PE
Cardiac tamponade (rare)
```
108
Pulsus paradoxus causes
Decreased SBP > pericarditis
109
Heart failure + diabetes + elevated LFTs
Hemochromatosis (usu dilated, can be restrictive CMP)
110
Chagas disease
Trypanosoma cruzi
Cardiomegaly
Mega-esophagus (achalasia)
Megacolon
111
Causes of myocarditis
```
MCC infection: viruses (Coxsackie, adenovirus, echovirus, EBV, CMV, influenza; parvovirus B19, HHV-6), bacteria, rickettsiae, fungi, parasites
Drug toxicity (chemo, penicillins, sulfonamides, cocaine, radiation), toxins, endocrine abnl
```
112
Acute rheumatic fever cause
Untreated GAS -> autoantibodies
113
Rheumatic heart disease diagnosis
```
Recent strep + 2 major or 1 major, 2 minor
JONES (major)
Joints (polyarthritis, hot and swollen joints)
Heart (carditis, valve damage M>A>T)
Nodules (SQ, extensor)
Erythema marginatum (painless)
Sydenham chorea
PEACE (minor)
Previous rheumatic fever
EKG w/ PR prolongation
Arthralgias
CRP/ESR
Elevated temp
```
114
Libman-Sacks endocarditis
SLE, noninfective endocarditis
115
At risk patients for endocarditis
Congenital heart defects
IVDU
Prosthetic valves
116
Negative-culture endocarditis bacteria
```
HACEK
Haemophilus
Actinobacilus
Cardiobacterium
Eikenella
Kingella
```
117
Acute endocarditis bacteria
Staph aureus (esp prosthetic valves)
Strep pneumo
Strep pyogenes
Neisseria gonorrhoea
118
Subacute endocarditis bacteria
Viridans strep (esp dental)
Enterococcus
Fungi
Staph epidermidis (coag neg) (esp prosthetic valves)
119
Infective endocarditis diagnosis
```
Direct histologic evidence OR
Positive gram stain from surgical debridement/autopsy OR
2 major Duke criteria OR
1 major + 3 minor OR
5 minor
```
120
Major Duke criteria
Infective endocarditis (2 major or 1+3 or 5)
Serial blood cultures + for organisms associated
Blood culture + for Coxiella burnetii
Presence of vegetations or cardiac abscess seen on echo
Evidence of new onset valvular regurgitation
121
MC valve involved in infective endocarditis
Mitral valve (regurgitation)
122
Valve involved in IVDU + infective endocarditis
Tricuspid regurgitation
123
Minor Duke criteria
Infective endocarditis (2 or 1+3 or 5 minor)
Predisposing heart condition or IVDU
Fever >38C
Vascular phenomenon (emboli, infarcts, aneurysm, hemorrhage, Janeway lesions)
Immunologic phenomenon (glomerulonephritis, Osler nodes, Roth spots, +RF)
Positive cultures not meeting major requirements or serologic evidence of infection w/ neg culture
124
Osler nodes
Painful nodules on fingertip or toe pads
125
Janeway lesions
Painless petechiae on palms/soles
126
Roth spots
Retinal hemorrhages
127
Reasons for prophylaxis for endocarditis
```
Prosthetic cardiac valves
Previous history IE
Congenital heart disease (unrepaired cyanotic, repaired w/ prosthetic, not fully repaired)
Cardiac transplant w/ valve problems
Not before GI/GU procedures
Not rheumatic heart disease anymore
```
128
Dx HTN
>140 or >90 at 3 separate readings
129
HTN urgency
BP >180/120
130
HTN emergency
BP >180/120 + end-organ damage (renal failure, pulmonary edema, aortic dissection, unstable angina, MI, AMS, papilledema, retinal vascular changes)
131
HTN in UE but low BP in LE
Aortic coarctation (assoc w/ Turner's, AV pathology, PDA)
132
HTN + proteinuria
Renal disease
133
MCC secondary HTN
Renal disease
134
HTN + hypokalemia
```
Primary hyperaldosteronism (Conn)
Secondary hyperaldosteronism (renal artery stenosis)
```
135
HTN + tachycardia, diarrhea, heat intolerance
Hyperthyroidism
136
HTN + hyperkalemia
Renal failure
137
HTN + episodic sweating, tachycardia
Pheochromocytoma
138
ACE/ARB AE
Dry cough, angioedema (ACE)
Azotemia (monitor)
Hyperkalemia (C/I)
Teratogen (affects fetal kidneys)
139
Thiazide diuretic AE
```
Increased serum glucose (mild)
Increased serum cholesterol, TG
Hypokalemia
Hyponatremia
Increased serum Ca (decreased excretion)
```
140
Loop diuretic AE
```
Increased serum glucose (mild)
Increased serum cholesterol, TG
Hypokalemia
Hyponatremia
Decreased serum Ca (increased excretion)
```
141
Swan Ganz catheter measures?
PCWP (estimates LA pressure)
142
Transfusion rxn w/ fevers, chills, rigors, malaise 1-6 hrs after transfusion
Nonhemolytic febrile (Abs to HLA antigens)
143
Transfusion rxn w/ fever, chills, nausea, flushing, tachycardia, tachypnea, hypotension during transfusion
Acute hemolytic (ABO incompatibility)
144
Transfusion rxn w/ slight fever, falling H/H, mild increase in unconjugated bili 2-10 days after transfusion
Delayed hemolytic (Abs to Kidd/Rh antigens)
145
Transfusion rxn w/ rapid onset of shock and hypotension, maybe angioedema and resp distress
Anaphylactic (maybe anti IgA Abs in IgA deficiency)
146
Transfusion rxn w/ urticaria
Minor allergic rxn (plasma present in donor blood)
147
Transfusion rxn w/ thrombocytopenia developing 5-10 days after transfusion
Post-transfusion purpura (usu women sensitized by pregnancy)
148
Biggest risk factors for AAA
Tobacco use, age >55
| atherosclerosis, HTN, fam hx
149
Screening for AAA
Men 65-75 w/ smoking hx, one time abd US
150
Indications to surgically repair AAA
>5.5 cm (men) or 5 cm (women)
Increase in diameter by >0.5 cm in 6 months
Symptomatic
151
Risk factors aortic dissection
HTN
Trauma, aortic coarctation
Syphilis, Ehlers-Danlos, Marfan
152
Widened mediastinum on CXR
Think aortic dissection (get CT w/ contrast) or aortic rupture
153
Intermittent claudication
Think PVD
154
PVD severity
```
Pain
Pallor
Poikilothermia (can't regulate temperature)
Pulsenessness
Paresthesia
Paralysis
```
155
Virchow's triad
Blood stasis
Hypercoagulability
Vascular damage
156
Dx criteria for PVD
ABI <0.4 severe disease
157
Palpable purpura
Think vasculitis
158
Vasculitis + hepatitis B or C
Polyarteritis nodosa
159
Vasculitis + kidneys, GI, but spares lungs, w/ neg p-ANCA
Polyarteritis nodosa
160
Vasculitis + women >50
Temporal (giant cell) arteritis
161
Vasculitis + polymyalgia rheumatica
Temporal (giant cell) arteritis
162
Vasculitis + headache, blindness
Temporal (giant cell) arteritis
163
Vasculitis + Asian woman age 10-40
Takayasu arteritis
164
Vasculitis + decreased UE pulses
Takayasu arteritis
165
Vasculitis + asthmatic symptoms
Allergic granulomatosis w/ angiitis (Churg-Strauss)
166
Vasculitis + p-ANCA
Allergic granulomatosis w/ angiitis (Churg-Strauss)
167
Vasculitis + eosinophilia
Allergic granulomatosis w/ angiitis (Churg-Strauss)
168
Vasculitis + LE palpable purpura
Henoch-Schonlein purpura
169
Vasculitis + recent upper respiratory infection
Henoch-Schonlein purpura
170
Vasculitis + IgA nephropathy
Henoch-Schonlein purpura
171
Vasculitis + lung disease + renal disease
Goodpasture (anti-GBM)
Granulomatosis w/ polyangiitis (Wegener) (upper airway involvement, + c-ANCA)
Henoch-Schonlein purpura (recent URI, IgA immune complexes, palpable LE purpura, usu kids)
172
Vasculitis (focal necrotizing) + granulomas in lungs and upper airway + glomerulonephritis
Granulomatosis w/ polyangiitis (Wegener)
173
Vasculitis + c-ANCA
Granulomatosis w/ polyangiitis (Wegener)
174
Vasculitis + young male smokers
Thromboangiitis obliterans (Buerger disease)
175
Non-cyanotic congenital heart defects
VSD
ASD
PDA
176
Cyanotic congenital heart defects
```
5Ts
Tetralogy of Fallot
Transposition of the great vessels
Truncus arteriosus
Total anomalous pulmonary venous return
Tricuspid atresia
```
177
MC congenital heart defect
VSD (30%)
178
MC cyanotic congenital heart defect
Tetralogy of Fallot
179
Medication to close PDA
Indomethacin
180
Medication to keep PDA open
Prostaglandin E
181
Eisenmenger syndrome
L to R shunt -> pulmonary HTN -> RVH -> reverses into R to L shunt (becomes cyanotic)
182
Continuous "machinery" murmur at L 2nd IC space
PDA
183
Pathognomonic injuries for child abuse
```
Multiple simultaneous facial injuries
Bruises in shapes of objects
Bruises over trunk and abdomen
Multiple burns (esp in shape of objects)
Rib or skull fractures
Long bone fractures in non-ambulatory kids
```
184
Physician obligated to report
```
Child abuse
Elder abuse (>60)
```
