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Flashcards in Deck 2 Deck (196)
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1

What disease has positive--
1. ANA (anti nuclear antibodies)
2. Anti histone antibodies
3. Anti-dis-DNA antibodies?

1. Sensitive lupus
2. Specific drug induced lupus
3. Specific lupus + renal involvement

2

What disease has positive--
1 anti smooth muscle antibodies
2. Mitochondrial antibodies
3. Centromere antibodies

1. Autoimmune hepatitis
2. PBC
3. Scleroderma

3

Which disease has positive--
1. Anti Ro+La antibodies
2. Anti CCP antibodies
3. Anti RF antibodies

1. Sjogrens
2. RA
3. RA

4

What disease has positive--
1. Anti jo antibodies
2. Topoisomerase antibodies

1. Polymyositis
2. Systemic scleroderma

5

Risk factors for heart disease

DM
Smoking
HTN
Dyslipidemia
Family history
Central obesity
Cocaine use
Sedentary lifestyle

6

What are risk factors for PE

Cancer
Exogenous hormones
Recent surgery
Recent immobility including long travel
Hypercoagulable states (pregnancy, clotting disorders)
History of PE or DVT

7

What is the differential for sharp pleuritic pain?

Pneumothorax
Pulmonary embolism
Pericarditis (also positional)

8

What are the life threatening causes of chest pain that you would want to rule out?

PE
MI
Dissection
Tamponade
CHF
Pneumothorax

9

What is the differential for visceral chest pain (aching, poorly localized)

Myocardial ischemia
--> worrisome features are prolonged pain of more than 20 min and rest pain

Aortic dissection--abrupt, intense pain (often "tearing")

10

What is the pathological change behind stable angina and what is its clinical presentation

Luminal narrowing

Central chest discomfort worsened by exertion, emotion and eating
Relieved by rest and nitro

11

What is the pathological change behind unstable angina and what is the clinical presentation

Plaque rupture or thrombus

Worsening pattern or rest pain
No elevation in troponin, with or without ECG changes of ischemia

12

What is the pathological change behind an NSTEMI and what is the clinical presentation

Partial occlusion

Non ST elevation MI--elevation in troponin with or without ECG changes of ischemia

13

What is the pathological change behind a STEMI and what is the clinical presentation?

Complete occlusion

ST elevation MI--elevation in troponin, with distinct ST segment elevation in more than two continuous leads, new LBBB or posterior wall MI with reciprocal ST depression in pre cordial leads on ECG

14

What is the cardiac Ddx for chest pain

Myocardial--> MI, angina, myocarditis

Valvular--> aortic stenosis--> CHF

Pericardial--> pericarditis, tamponade

Vascular--> aortic dissection

15

What is the pulmonary Ddx for chest pain?

Airway--> obstructive (COPD, asthma)

Parenchyma--> pneumonia

Pleural --> Pleuritis, pneumothorax, pneumomediastinum, pleural effusion

Vascular--> pulmonary embolism

16

What is the GI ddx for chest pain

Esophagitis
Esophageal cancer
Gastritis
PUD
Pyloric stenosis
Cholescystitis
Pancreatitis

17

Other than cardiac, pulm, GI, what is also on the Ddx for chest pain?

MSK -->chostochondritis

Shingles

Anxiety/panic

18

What should you ask for on history for chest pain?

1. Characterize the chest pain--> location, onset, provocation/palliation, radiation, severity, timing
2. Ask about specific patterns of pain for AoD, PE, MI
3. Associated symptoms--> dyspnea, palpitations, diaphoresis, syncope, nausea
4. Infectious symptoms--> fever chills, headache, fatigue, cough, sputum
5. Precipitating factors--> comforting, exertion, trauma
6. Meds
7. Risk factors for CHD and PE
8. ROS--> B symptoms, N/V/D, abdo pain, GU sx

19

What type of process presents typically with mid sternum pain radiating to back, sudden onset, tearing, progressive?

Aortic dissection

20

What type of process presents typically with heavy pressure chest pain, retrosternal, comes on suddenly and lasts hours, radiates to arm/jaw/shoulders, and is relieved by nitro?

MI

21

What type of process presents typically with pleuritic, sudden onset chest pain that is severe and one sided with dyspnea?

PE

22

What signs on physical exam would suggest AoD?

1. Discrepancy in pulse between arms of more than 20 systolic or more than 10 diastolic
2. New aortic regurgitation murmur
3. Absent or reduced pulses

23

What does a pericardial rub suggest?

Pericarditis

24

What does a new aortic regurgitation murmur on exam indicate?

Aortic dissection

25

What does pulsus paradoxus indicate?

More than 10
Asthma or tamponade

26

What does absent or reduced pulses indicate?

Aortic dissection or emboli

27

What might a new mitral regurgitation murmur indicate in the setting of CP?

Papillary muscle dysfunction secondary to ischemia

28

What does Becks triad indicate? What is Becks triad?

Tamponade

Muffled heart sounds
Hypotension
Elevated JVP

29

What might a loud S2 indicate in the setting of chest pain?

Indicates acute elevation in right sided pulmonary pressure

In the setting of chest pain, suggestive of a PE

30

What does decreased air entry to one side on auscultation of the lungs suggest?

Pneumothorax