Final Flashcards
(135 cards)
1
Q
elephant on chest pain; crushing, radiating
A
MI
2
Q
substernal chest pain?
- provoked by emotion or ?
- relieved by ? and/or ?
A
angina
eating
rest, nitroglycerin
3
Q
burning, substernal, nocturnal, and worse with lying flat
A
esophageal
4
Q
lasts for hours/days; local tenderness
A
musculoskeletal
5
Q
chest pain- HA aortic dissection angina PE MVP spontaneous pneumothorax acute pericarditis pneumonia esophageal pain costochondritis herpes zoster`
A
mid chest
6
Q
chest pain- HA aortic dissection acute pericarditis esophageal pain spontaneous pneumonia pneumonia
A
back
7
Q
chest pain- HA angina acute pericarditis aortic dissection perforated viscus
A
shoulder
8
Q
chest pain-
HA
angina
A
left arm
9
Q
chest pain-
HA
perforated viscous
A
abdomen
10
Q
SH - don’t forget to ask about ? demands
A
employment
11
Q
pancreatitis, pneumonia, and cervical ? are in the Ddx for ?
A
radiculopathy, chest pain
12
Q
Heart is like plumbing
wiring ?
plumbing ?
walls of house?
A
arrhythmias, electrical activity
ischemia, dissection, clot
endocarditis, pericarditis, amyloidosis
13
Q
equipment for advanced cardiac exam (4)
A
stethoscope
pen light
cm ruler
pencil
14
Q
PE:
apical impulse
heaves/lifts
PULSATIONS
A
inspection
15
Q
PE:
apical impulse
heaves/lifts
THRILLS
A
palpation
16
Q
eye is included in typical cardiac workup- ?
A
optic fundi
17
Q
blue sclera ?
A
congenital heart defect, osteogenesis imperfecta
18
Q
increased arterial pulse:
- observed in ? blood pressure recordings
- fever, anemia, ? weather, exercise, pregnancy, ?thyroidism, atherosclerosis, ? fistulas
- cardiac dz ie ?, ?, and ? and results in a widened pulse pressure
A
typical
hot, hyper, AV
AR, PDA, truncus arteriosus
19
Q
reduced arterial pressure
- ? normally
- from ?, arteriosclerosis, AS, or diabetic ?
A
uncommon
HF, ketoacidosis
20
Q
unequal pulses
- ? difference
- from ? or ?
A
20 mm Hg
AS, subclavian steal
21
Q
pulsus paradoxus
- abnormally large decrease in ? and pulse wave amp during ?
- sign of ?, constrictive pericarditis, restrictive cardiomyopathy, COPD sleep apnea, and ?
A
SBP, inspiration
acute cardiac tamponade, croup
22
Q
pulsus alternans
- found by palpating a peripheral artery, preferably the ?
- ? variation?
- almost always indicative of ? and carries a ?
A
femoral
beat-to-beat (strong-weak)
LV systolic impairment, poor Px
23
Q
AS, ruptured chordae tendinae of mitral valve, and severe AR all have ? detected by ?
A
transmitted murmurs
carotid artery bruits
24
Q
carotid artery bruits occur in obstructive dz in ?
A
cervical arteries (e.g. atherosclerotic carotid arteries, fibromuscular hyperplasia, arteritis
25
most common Sx of orthostatic htn:
dizziness or lightheadedness when sitting up or standing
26
orthostatic htn:
| drop in sys > ? or dis > ? within ? after changing position
20, 10, 3 minutes
27
pressure differs on sides of body in ? or ?
occlusive disease, aortic dissection
28
JVP-
- patient at ?
- place ruler on ? and extend tongue depressor from ? to ruler
- should be ? (if not- RHF, cirrhosis, etc.)
45 degrees
sternal angle, highest point of pulsation
<4 cm
29
hepatojugular/abdominojugular reflux:
- alternate test for JVP pressure
- firm pressure on abdomen by ? for ? seconds
- a rise in JVP = ?
palm of hand, 10-60 sec
| impaired RV function
30
left lateral decubitus accentuates?
S3, S4, tricuspid and mitral murmurs
31
inspect- 4 S in advanced peripheral vascular exam?
size
symmetry
swelling
skin changes
32
palpate- 2 T in advanced peripheral vascular exam
temperature
| tenderness
33
advanced peripheral vascular exam- don't forget to asses ? response
motor, sensory, and reflex
34
```
pitting- wait 30 seconds
slight?
more pronounced, resolves ?
more severe, takes a while to ?
very ?, takes a long time to resolve
```
1
quickly, 2
resolve, 3
severe, 4
35
```
chronic arterial insufficiency:
pain when ?
pale or ?
cool temp
no ?
thin, ? skin
loss of ?
painful ulcerations/trauma
gangrene***
decreased ?
```
```
walking
dusky red
edema
shiny
hair
pulses
```
36
5 Ps of arterial insufficiency?
```
pallor
paresthesia
pain
paralysis
pulselessness
```
37
```
chronic venous insufficiency:
No ?
cyanotic or ? pigmentation
? temp
pitting edema***
? of skin
ulcerations around ?
NO ?
? pulses
```
```
pain
brownish
normal
thickening
ankles (stasis dermatitis)
gangrene
normal
```
38
assess varicosities while patient is ?
standing
39
calf pain elicited upon acute passive ? of the foot
low ?
called?
be careful not to precipitate ?
```
DVT
dorsiflexion
sensitivity
Homan's sign
PE
```
40
assess patency of radial and ulnar artery
ask patient to clench fist for ?
ask patient to open fist and release ?
watch for filling of hand to assess ulnar artery patency
repeat and assess ?
called ?
30s
ulnar artery
radial artery
Allen Test
41
always evaluate ? and auscultate ?
pulmonary system, lungs
42
always ask about ? complaints
| GI complaints over ? or strong hx should have an ? to r/o ? ; especially ?
GI
| 40 yo, EKG, ACS, women
43
a form of PREVENTIVE medicine evaluation
wellness exam
44
Wellness HPI has two parts:
1. explore past ? and ?
2. develop an HPI based on the ?
exams, results
| complaint
45
Wellness:
focus on confirming data already?
update info as appropriate
in chart
46
FH should have a minimum of ? generations
in diagrammatic or outline form
concludes with a ? for common genetic dz
3
| negative statement
47
when a ? elicited, further details asked to put in the ROS
positive response
48
Wellness- all positive response MUST be ?
thoroughly explained
| DOCUMENT AS "NO" or "DENIES"
49
ROS in wellness exam- ? is explored
EVERY category
50
wellness- not a ? ROS but complete
focused
51
ROS can be used to assess patient's compliance with ?
screening tests i.e. cardiac- last EKG?
52
wellness- F- include ? and ? exams
| M?
breast, pelvic
| rectal, prostate
53
thorough exam is most basic "screening test" for ? (4)
breast
HYPERTENSION
skin
vision/hearing
54
cholesterol testing for men > ? and women > ?
35, 45
55
check cholesterol at ? to ? if increased risk
20-35
56
ACA
mammogram at ? every ?
clinical breast exam (CBE) every ? for women in 20s and 30s
before 40 & increased risk = ? and ? yearly
40, year (annually)
3 years
MRI, mammogram
*moderate risk - 15-20% should talk with their provider about the benefits and limits of adding MRI screening
57
```
breast cancer risk factors... a bunch
race?
age?
relative?
menarche?
therapy? (2)
alcohol, obesity
```
```
caucasian
>55
1st degree
before 12
chest radiation, HRT
```
58
USPSTF: breast cancer screening
- mammogram between ? every ?
- decision to start before 50 is individual
- against teaching ?
50-74, two years
| SBE - self-breast exams
59
Colon cancer
- many modifiable factors including high ? diet, obesity, inactivity, smoking, heavy ? use, D type 2
- non-modifiable- Hx ? or ?, age, FH ? cancer, genetics
red meat, alcohol
| polyps/IBD, colorectal
60
colonoscopy at ? every ? years
OR ? every 5 years
OR ? every 5 years
OR ? every 5 years
50, 10
sigmoidoscopy
barium enema
CT colonography (virtual colonscopy)
61
tests that mainly find cancer:
fecal occult blood test (FOBT) every ?
fecal immunochemical test (FIT) every ?
stool DNA test (sDNA)-- interval ?
year
year
uncertain
62
UPSTF:
screen for cervical cancer in ages ? with cytology (Pap Smear) every ?
women ages ? can have a Pap with ? every ?
21-65, 3 years
| 30-65, HPV, 5 years
63
UPSTF recommends against:
- screening women over ?
- screening for cervical cancer with HPV (alone or in combo with cytology in women ?
- screening women with ? (unless for cervical cancer)
65
less than 30
hysterectomy
64
when getting a PAP smear- check for ? and ? if at risk
chlamydia
| gonorrhea
65
prostate cancer
- both PSA (prostate-specific Ag) blood and digital rectal exam (DRE) were recommended in the past to be offered to men beginning at age ?
- high risk- start at age ? race at risk? FH?
- higher risk- FH? start testing at ?
50
45, AA, 1st degree relative Dx before 65
40, more than one 1st degree affected early
66
- USPSTF recommends against ? for prostate ca
- task force doesn't think AA have diff balance of benefits/harms from PSA screening than whites
- high risk- talk to patient about ?
- many risks i.e. AA, genetics, diet, exercise, VASECTOMY, age?
PSA screening
PSA/DRE screening risk/benefit
>65
67
bone scan for women ages ? or younger if risk; men at risk
>/= 65
68
ECG - USPSTF against screening w/ resting OR exercise ECG for prediction of ? in ? adults at low risk for CHD; screen those with FH, condition or risk factors
CHD, asymptomatic
69
ALL men who ? should have and u/s to screen for ? at age ? ; ONE time screening
smoked, AAA, 65
70
aspirin 81 mg daily
- men over ?
- postmen women or age ?
- pts at risk for ?
- USPSTF recommends aspirin for men at age ? if the benefit of preventing ? outweighs risk for ?
45
55
CVD
45-79, MI, GI hemorrhage
71
exercise- 30 min ? d/week
5
72
alcohol- F? M?
1 drink, 2 drinks
73
oral case presentations- present in an ? and ? manner
oral, brief
74
OCP- a ? story; never a ?
simple, surprise
75
OCP- emphasize ? and ?&?
HPI, assessment & plan
76
? sees if there is a successful intro sentence and you can say no to "do any surprises appear after this sentence?"
litmus test
77
OCP- only ? in P.E.
key findings
78
OCP- <1m, on rounds or in hallways; very brief?
bullet or capsule
79
OCP- 2-3 min, rounds, consultations, more thorough than bullet/capsule
formal
80
OCP- 5-10 min, grand rounds, presentations, consults, oral form of written record
complete
81
OCP- org exactly as ?
written report
82
OCP- describe all Sx ?
- keep info chronological
- pertinent ? and ?
fully
| positives, negatives
83
OCP- all ? precede all ? elements
positive, negative
84
OCP- Intro statement includes? (4)
age
gender
pertinent PMH
CC
85
OCP- PMH and surgical Hx is ? but ?
| -no need to include ? unless pertinent
comprehensive, brief
| dates
86
OCP- ALWAYS include ? and ?
only include pertinent parts of ? and ?
ROS- only mention ?
allergies, meds
FH, SH
pertinent positives
87
OCP- P.E.
- begin with ?
- followed by ?
- present PERTINENT findings in ?
- describe ? in detail
vitals
general survey
head-to-toe fashion
abnormal findings
88
OCP- labs/Dx tests
- if tests normal, state ?
- in ? presentation state results of all values
WNL
| comprehensive
89
OCP- assessment
- 1 or 2 sentences summarizing patient case
- transition from findings to ?
- summarize highlights of case
critical thinking process
90
OCP- DDX
| -try to have ? differentials
3 or more
91
OCP- Delivery
- use ? statements rather than ? statements
- DO NOT ? or ? as you present; just tell the 'facts' as they were obtained by you (you're telling your patient's story not yours)
positive, negative
| editorialize, rationalize
92
patients with underlying ? may be very Sx of severe anemia but with a ? up to ?
CAD, high Hg- 10gm/dL
93
cardiac adjustment to anemia = ? at rest
high CO
94
anemia causes cerebral hypoxia and ? in ear or ? in head
roaring, humming sound
95
B12 deficiency
- degeneration of DORSAL columns of s.c.: unsteadiness of ?
- degen of LATERAL columns: ? weakness
- peripheral neuropathy- ? sensation in hand, feet
gait (ataxia), falling
motor
pins & needles
96
general Sx of anemia:
| ? of blood away from splanchnic bed, loss of ?, abdominal discomfort, indigestion, nausea
shunting, appetite
97
thalassemia major
sickle cell dz
spherocytosis
all are ?
hereditary anemias
98
? may be Dx later in life i.e. thalassemia trait (alpha or beta thalassemia minor)
hetero hereditary anemias
99
hereditary hemolytic anemia that has acute episodes of hemolysis; occur within hours to few days after exposure to oxidant stressor i.e. medications
glucose-6-phosphate dehydrogenase deficiency
100
life threatening, hemolytic, schistocytes?
TTP (thrombotic thrombocytopenic purpura)
101
hemolytic & schistocytes also, increased aTPP and dimers?
DIC (disseminated intravascular coagulation)
102
painful crisis in hours to days upon exposure to heat or cold exertion, dehydration, infection, etc.
SC disease
103
sulfonamides and antimalarial drugs i.e. primaquine or nitrofurantoin can trigger an acute hemolytic crisis in ?
glucose-6-phosphate dehydrogenase deficiency
104
sulfonamides, cephalosporins, penicillin can cause ?
AI hemolytic
105
NSAIDS can cause gastritis or PUD (GI bleeding) >> ?
iron def anemia
106
isoniazid Tx can cause ?
sideroblastic anemia
107
methotrexate, phenytoin, and trimethroprim can cause ?
folate def anemia
108
cytotoxic cancer chemo, anti-seizure meds, i.e. valproic acid, phenytoin, and a/b i.e. sulfonamides; CHLORAMPHENICOL can lead to ?
aplastic anemia
109
AA predisposed to ? and ?
SC anemia, G6PD def (more males)
110
African, mediterranean, indian, SE asian predisposed to ? and ?
G6PD def, thalassemias
111
northern europeans ?
hereditary spherocytosis
112
alc toxicity can cause ? anemia
mildly macrocytic
113
chronic liver failure (cirrhosis) can lead to ?
iron def anemia
114
tea and toast diet in elderly ?
folate def
115
strict vegetarians and preggos who are 'moderate' vegetarians are at increased risk for ?
B12 def
116
long distance runners - chronic GI blood loss?
iron def anemia
117
travel - tropical countries- endemic for ?
malaria - hemolytic anemia
118
smoking causes ? due to increased binding of carbon monoxide to Hgb; which stim EPO release
'relative tissue hypoxia'
119
complications of hereditary hemolytic anemias?
jaundice, bilirubin gallstones
120
colon cancer will have unintentional ? and ? stool; abdominal pain
weight loss, 'pencil-like'
121
GI bleeding can be of ? origin- difficult to detect and treat; people exposed to this ? (3)>> can cause significant chronic disabling anemia
obscure
| CRF, vW dz, elderly
122
hypothyroidism may cause ? anemia; ask about difficulty concentrating, constipation, hoarseness
macrocytic
123
chronic renal disease can be a cause of anemia of renal failure due to ?
decreased EPO production
124
iron def
- heavy menses at least ?; clots of blood
- vaginal bleeding b/w periods
- post meno bleeding may be ?
4 days
| uterine cancer
125
RA?
| SLE?
anemia of chronic dz
| hemolytic anemia
126
TB can result in ?
anemia of chronic dz
127
nail changes = ? anemia
chronic iron deficiency i.e. brittleness, longitudinal ridging, flattening, spooning (koilonychia)
128
chronic ankle ulcers in ?
SC dz
129
petechiae, purpura in ? from acute leukemia or aplastic anemia
thrombocytopenia
130
cheilosis in ?
vit b12 and folate def, iron def
131
chipmunk facies in ?
thal major
132
frontal bossing ?
SC dz
133
severe anemia- ? murmur in ? area
sys ejection, pulmonic
134
sternal tenderness due to ? of b.m. w/ ? cells or ? plasma cells
infiltration, leukemic, multiple myeloma
135
malignancies of WBC will have ? and the leukemic cells replace ? and cause anemia
splenomegaly, bone marrow
