Exam 3 Flashcards
(109 cards)
1
Q
Other possible causes of chest pain
A
Pulmonary, GI, musculoskeletal, neurologic, psychogenic, idiopathic
2
Q
Acute chest pain causes other than MI
A
GERD, peptic ulcer, gallstones, ischemic heart disease, pericarditis, pleuritis, pneumonia, pulmonary embolism, lung cancer, aortic aneurysm, aortic stenosis
3
Q
Aggravating factors for angina
A
Eating, physical activity, smoking, cold weather, stress, anger, hunger, lying dow
4
Q
Pericarditis
A
Substernal pain may radiate to neck and/or left arm
Sharp and may be accompanied by friction rub
Aggravated by deep breathing or supine postion
Alleviated by sitting up, leaning forward, anti-inflammatories
5
Q
Dissecting aortic aneurysm
A
Retrosternal, upper abdominal, or epigastric pain
Excruciating and tearing pain
6
Q
Costochondritis
A
Chest wall syndrome
Sharp, continuous or gradual pain; chest tender to touch
Aggravated by movement of palpation
Alleviated by time, analgesics, heat
7
Q
Mitral regurgitation murmur
A
High pitched systolic murmur, heard best at the apex
Radiates to back or clavicle
Prone to CHF
S/S: SOB, pulmonary edema, orthopnea, decreased exercise intolerance, palpitations, A Fib
8
Q
Mitral valve prolapse
A
Mild to late systolic click and late systolic murmur
Gets louder when patient stands up
Harmless in most cases
9
Q
Mitral stenosis
A
Holodiastolic murmur
Low pitched
S/S: may begin with A fib, cough, difficuty breathig, fatigue, ankle edema
10
Q
Aortic regurgitation
A
Diastolic murmur
High pitched
Best heard when sitting forward
S/S: SOB, CHF, palpitations,
11
Q
Aortic stenosis
A
Systolic murmur
Louder with squatting
S/S: SOB with activity, angina, dizziness, palpitations
12
Q
Pulmonic regurgitation
A
Diastolic murmur
S/S: right heart failure
13
Q
Tricuspid regurgitation
A
High pitched systolic murmur
14
Q
Tricuspid stenosis
A
Mid-diastolic murmur
Louder with exercise and inspiration
Softer with standing
15
Q
Pulmonic stenosis
A
Systolic murmur
Sound radiates to neck or back
Deep inspiration will intensify the murmur
16
Q
Inspiration augments which murmurs
A
Right sided sounds due to increased venous return
-Tricuspid and pulmonic stenosis
17
Q
Vasalva maneuver augments which murmurs
A
Mitral stenosis, mitral valve prolapse
18
Q
Squatting augments which murmurs
A
Aortic regurgitation, aortic stenosis, mitral regurgitation, mitral stenosis
19
Q
MSARD
A
Mitral stenosis, aortic regurgitation
DIASTOLIC
20
Q
MRASS
A
Mitral regurgitation, aortic stenosis
SYSTOLIC
21
Q
Cardiac conduction
A
Starts in SA node to the AV node to bundle of His and then out to bundle branches and out to Purkinje fibers
22
Q
Normal PR interval
A
0.12-0.2
23
Q
Normal QRS
A
0.08-0.1
24
Q
Normal QT
A
0.4-0.43
25
Premature Atrial Contraction
Rhythm regular
P wave premature or hidden
PR interval <0.2
QRS <0.12
26
Supraventricular tachycardia
Sudden start and stop
| 170-250 bpm
27
Atrial Flutter
Atrial HR 220-430
Rhythm regular
QRS <0.12
28
A Fib
Atrial HR 350-650
Irregular rhythm
No discernable P waves
29
V Tach
Symptomatic when sustained v tACH
30
1st degree AV block
Regular rhythm
One P wave to each QRS
OR prolonged
QRS normal
31
2nd degree AV block
| Type 1
Rhythm regular
| PR progressively lengthens until P wave occurs without QRS
32
2nd degree AV block
| Type 2
PR interval constant but there is failure to conduct in the bundle of his and purkinje systems
QRS is dropped and wide
Pacemaker needed
33
3rd degree AV block
No impulses conducted from atria to ventricles
P waves marching through rhythm strip
Atrial rate 60-80, ventricle rate of 20-40
Pacemaker needed
34
Cor pulmonale
Enlargement of right ventricle secondary to pulmonary malfunction
35
Tetralogy of fallot
Ventricular septal defect
Pulmonic stenosis
Dextroposition of the aorta
R. Ventricular hypertrophy
36
Acute rheumatic fever
Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection
37
Kawasaki disease
Condition causing inflammation in walls of small and medium arteries throughout the body
38
S/S A fib
Palpitations, lightheadedness, fatigue, poor exercise capacity, angina, dypnea, syncope
39
Labs for MI
Troponin 1 and T increased 3-6 hours after onset and peaks at 12-24 hours, remaining elevated for 2-3 days
Myoglobin is early marker for myocardial necrosis which peaks at 1-4 hours
40
Levine's sign
Clenched fist over center of chest
41
Dx labs for familial hypercholesterolemia
Severely high LDL >330, mildly elevated triglycerides, HDL normal or low
42
Giant cell arteritis/temporal arteritis
Headache, painless blindness without any visual changes to the eye, jaw claudication, scalp tenderness
43
Endocarditis
Fever, chills, cough, dyspea, night sweats, weight loss
| May have signs of HF, splinter hemorrhages in nail beds, conjunctival petechiae, splenomegaly, retinal hemorrhage
44
Pericarditis
Pleuritic pain which is reduced by leaning forward and worsened by laying supine; SOB
Pericardial friction rub, S3, cardiac tamponande
45
Wolff-Parkinson White syndrome
Mild chest pain or palpitations, syncope, fatigue, SOB
May have SVT, A fib, A flutter
Check electrolytres
Seen in young patients with episodes of paroxysmal tachycardia; congenital usually
46
Arterial ulcer
Irregular margin, punched out edges, cold and dry, pain present, dimijnished pulses, variable sensation, shiny and taught with no edema
47
Venous ulcer
Irregular margin, pink base, usually exudative, warm, mild to moderate pain, present pulses, sensation present, erythema and edema
48
Diabetic ulcer
Red, often deep and infected; warm and dry; pulse may be present or not; loss of sensation, reflexes and vibration sense, shiny and taut
49
Thrombophlebitis/DVT
Swelling, tenderness, inflammatio nand pain with ambulation
| Dx: doppler ultrasound, D-dimer compression US, contrast venography
50
Aneurysm s/s
Ripping/tearing sensation in chest, pressure on trachea or esophagus, dyspnea, cough, hoarseness, dysphagia
51
Coarctation of aorta
Headaches, lower limb claudication, syncope, chest pain, dyspnea, irritability, poor feeding
52
S/S kawasaki syndrome
Fever, rash, extremely irritabiity, conjunctival injection, red lips, strawberry tongue, rash wirthin 5 days of fever, reddened palms and soles, edema of extremities, tachycardia
53
Intermittent asthma
<2 days per week
FEB >80
SABA as needed
54
Mild asthma
>2 days per week
| FEV >80, Low dose ICS
55
Moderate asthma
Daily
Fev 60-80
Medium dose ICS
56
Severe asthma
Throughout day
FEV <60
Medium dose ICS + LABA
57
When to use oral steroids for asthma
>2 exacerbations in 6 months or >4 wheezing per year
58
Normal respiratory
resonant percussion, trachea midline, breath sounds vesicular, no adventitious sounds, normal tactile fremitus
59
Sounds of chronic bronchitis
Resonant percussion, trachea midline, vesicular breath sounds, scattered coarse crackles or some wheezes, normal tactile fremitus
60
Sounds of LHF
Resonant percussion, midline trachea, vesicular breath sounds, late inspiratory crackles in dependent area of lungs, ormal tactile fremitus
61
Sounds of consolidation
Dull percussion, midline trachea, bronchial breath sounds, late inspiratory cfrackles, increased tactile fremitus
62
Sounds of atelactasis
Dull percussion, trachea shifted toward affected side, breath sounds absent, tactile fremitus absent
63
Sounds of pleural effusion
Dull percussion, trachea shifted toward opposite side, breath sounds decreased, decreased tactile fremitus
64
Sounds of pneumothorax
Hyperresonant percussion, trachea shift toward opposite side, decreased breath sounds, decreased tactile fremitus
65
Sounds of COPD
Hyperresonant percussion diffuse, midline trachea, decreased breath sounds, decreased tactile fremitus
66
Sounds of asthma
Resonant or hyperresonant percussion, midline trachea, wheezes, decreased tactile fremitus
67
X ray colors
Bone--white
Tissue--grey
Air--black
68
Location of gastric bubble
Left side of x ray
69
Diaphragm on X ray
Right hemidiaphrgam slightly higher due to liver
70
Otitis media with effusion
Inflammation of middle ear resulting in collection of purulent fluid when tympanic membrane is intact
Fluid clear and weber is positive to affected ear
Commonly associated with URI or allergic rhinitis
71
Acute otitis media
inflammation of middle ear associated with middle ear effusion that becomes infected by bacteria
Fluid ourulent
72
Otitis externa
Inflammation of auditory canal and external surface of tympanic membrane
Red ear canal, purulent discharge, edema, pain on exam
73
Cholesteatoma
Trapped epithelial tissue behind the tympanic membrane that is often the result of untreated or chronic recurrent otitis media
Noncancerous skin growth in middle ear
74
Hashimoto disease
Autoimmune antibodies against thyroid gland, caused by hypothyroidism
75
Graves disease
Autoimmune antibodies to thryoid stimulating hormone receptor, leading to overactive thyroid
76
Horner syndrome
Ptosis, anhidrosis (loss of sweating), miosis
77
Diabetic retinopathy
Dot hemorrhages or microaneurysms due to development of new vessels as result of anoxic stimulation
78
Lymphatic filariasis
Elephantiasis
| Massive accumulation of lymphedema throughout body
79
Migraine
Pulsating, duration of 72 hours, unilateral, N/V, disabling
Phototobia, phonophobia, lightheadedness, vertigo
Neuro exam normal, negative carotid bruit
80
Tension headaches
Bilateral, pressing, tightening, nonpulsating, mild to moderate, not aggravated by activity, no N/V,
81
When is neuroimaging needed for headache
Onset >40, sudden onset, change in apttern , progressive neuro symptoms, thunderclap headache, double vision
82
Cluster headache
5 attacks of severe unilateral orbital or supraorbital or temporal pain lasting 15-180 minutes; with one of lacrimation, nasal congestion, eyelid edema, forehead and facial sweating, miosis or ptosis
83
Ceremun impaction
Pain, itching, hearing loss, tinnitus
| Medium to dark honey colored cerumen; may see mild erythema and ipsilateral decreased hearing
84
TMJ disorder
Facial or TMJ pain, locking or catching of jaw, decreased ROM, headache, neck pain
85
Allergic rhinitis
Nasal congeston, rhinorrhea, itching of nose, eyes, ears, and palate
Allergic shiners, rhinorrhea clear, pale and boggy blue gray nasal mucosa
Nasal saline helps along with 2nd gen antihistamines
86
Conjunctivitis
```
Conjunctival injection, sensation of foreign body, eyelid sticking or crusting, discharge may be unilateral or bilateal
If herpes--burning
If allergic--constant itching
Dont wear contacts until resolved
Change mascara and all eye make up
```
87
Corneal abrasion
Sudden onset of eye pain, phototobia, sensation of foreign body, blurring vision, conjunctival injection, usually unilateral
Visual acuity affected, conjunctival injection, increased tearing
No contacts until resolved
88
Closed angle glaucoma
Acute, severe eye pain with blurred vision and eye redness, halo around lights, frontal headache, N/V, compromised peripheral vision then central
Fundoscopy shows congestion, cupping, atrophy of optic nerve, pain with eye movement, sluggish pupillary reaction
89
Open angle glaucoma
Painless, slowly progressive, central field loss comes late in disease
90
Cataracts
Decreased visual acuity, blurred vision, distortion or ghosting of images
Lens opacity, nystagmus, strabismus
91
Hordeolum
Localized inflammation of eyelid or surrounding skin; sensation of foreign body; itching
Warm compresses common tx
92
Chalazion
Palpable, non-tender nodule, firm, nonerythemic, nonfluctuant
93
Pharyngitis
Sore throat, painful swallowing, cough, fever
Enlarged tonsils, scarlet fever rash maybe, exudates if bacterial
Usually due to GAS if bacterial
94
Macular degeneration
Distortion of central vision, straight lines look crooked
| Must stop smoking
95
Mono
Fatigue, fever, chest pain, gray white exudate on tonsils, petechiae on soft palate, rash on trunk and upper arms
96
Confluent lesions
Run together
| Hives, urticaria
97
Discrete lesions
Remain separate
| Molluscum
98
Aconthosis nigricans
nonspecific reaction pattern associated with obesity, certain endocrine syndromes or malignancies
99
Alopecia areata
Sudden, rapid, patchy loss of hair
100
Clubbing of nails
Occurs with congenital chronic cyanotic heart disease and COPD
101
Herpes
Burning or tingling sensation prior to vesicles erupting
Recurrent outbreaks
Primary lesions are clustered vesicles
102
Tinea
Itching, pain, fissure, scaly and eczema looking
| Tx lasts 4-6 weeks
103
Scabies
Intense itching that may be worse at night
| Linear, erythemic, small red papules; may form vesicles and can erode or crust
104
Impetigo
Fluid filled lesions show up rapidly, burst and crust over
No fever or lymphadenopathy
Bulae or vesicles/pustules, honey colored custing, weeping, shallow, red ulcers
105
Folliculitis
Red bumps that may itch, usually recent shaving or been in hot tub
Red papules that progress into pustules, erode and crust over
106
Molluscum contagiosum
Burning and itching over the trunk and extremities; often in contact sports
Smooth, pink or flesh colored lesion
Caused by benign virus--very contagious but self limiting
107
Psoriasis
Plaques with overlying silvery scales; salmon colored, well-demarcated
108
Cellulitis
Localized area of edamatous, erythemic, indurated and warm skin
109
5 Is of geriatrics
Intellectual impairment, immobility, instability, incontinence, iatrogenic disorders
