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Flashcards in IM Platinum stuff Deck (51):
1

cardiac output formula

CO = HR x SV

2

mean arterial pressure formula

MAP = (SBP/3) + (2DBP/3)

3

systemic vascular resistance formula

SVR = [(MAP - CVP) x 79.9] / CO

4

ejection fraction formula

EF = SV / EDV

5

most useful index of LV function

ejection fraction

6

estimates risks of ischemic stroke in patients with non rheumatic / non valvular atrial fibrillation (AF may induce thrombus formation)
risk is expressed in numberof events per 100 persons per year
oral anticoagulation is advised with a score of ___

CHADS2 score
>2

7

What does CHADS2 mean?

CHF (1pt)
Hypertension (1pt)
Age >75 years old (1pt)
Diabetes mellitus (1pt)
previous Stroke (2pts)

Oral anticoagulation is advised with a score of >2

8

Estimates the 10 year risk of coronary disease, cerebrovascular disease, peripheral vascular disease, and heart failure based on the following criteria ___
(clue: "Framingham STASHeD BiG for 10 years")

"Framingham STASHeD BiG for 10 years"
S---Systolic blood pressure
T---Total cholesterol
A---Age
S---Smoking status
H---High density lipoprotein
D---Diabetes mellitus
B---BP treatment
G---Gender

9

Prognostication scheme which categorizes a UA/STEMI patient based on risk of all-cause mortality, new or recurrent MI, or severe ischemia requiring urgent revascularization
What are its criteria? (clue: 3A 3C ST)

TIMI score

3A 3C ST (1pt each)
AGE >65 years
ASPIRIN use in the past 7 days
severe ANGINA in last 24 hours
>3 CAD risk factors
known CAD (>50%) stenosis
elevated CARDIAC MARKERS
ST DEVIATION >0.5mm

score of 1 5%
score of 7 50%
5-8-13-20-26-41-50

10

Are you through reading your IM Platinum book?!

Yes! ;)

11

(more severe type of) heaviness, tightness, squeezing, pressure
unrelieved by nitroglycerin
>30 min
may be associated with heart failure or arrhythmia

AMI (STEMI/NSTEMI)

12

sharp pain
retrosternal or toward apex
may radiate to left shoulder
may be associated with a pericardial friction rub
relieved by sitting up and leaning forward

Pericarditis

13

heaviness, tightness, squeezing, pressure
may be associated with systolic murmur radiating to carotids

Aortic stenosis

14

tearing or ripping, knife like pain
abrupt onset
radiates to back, between shoulder blades
may be associated with murmur of aortic insufficiency, pericardial rub, pericardial tamponade, loss of peripheral pulses

Aortic dissection

15

pleuritic pain, on side of affected area
dyspnea, tachypnea, tachycardia, hypotension

Pulmonary Embolism

16

pleuritic pain, unilateral, often localized
dyspnea, cough, fever, rales, occasional rub

Pneumonia or Pleuritis

17

CHADS SCORE versus STROKE RATE
1 ------ ?
2 ------ ?
3 ------ ?
4 ------ ?
5 ------ ?
6 ------ ?``

2.8%
4.0%
5.9%
8.5%
12.5%
18.2%

18

TIMI SCORE versus RISK
1 ------ ?
2 ------ ?
3 ------ ?
4 ------ ?
5 ------ ?
6 ------ ?
7 ------ ?

5%
8%
13%
20%
26%
41%
50%

19

Cardinal Symptoms of Cardiovascular Disease
(enumerate)

Chest pain or discomfort
Dyspnea
Orthopnea
PND
Wheezing
Palpitations
Dizziness
Syncope
Cough
Hemoptysis
Fatigue
Weakness
Pain in extremities with exertion (claudication)

20

heaviness, tightness, squeezing, pressure
2 to 10 minutes
retrosternal in location
radiation to shoulders, jaw, neck, or arms (usually left)
precipitating factor: exertion, exposure to cold, stress

Stable Angina (CSAP)

21

(more severe type of) heaviness, tightness, squeezing, pressure
10 to 20 minutes
precipitating factor: lower levels of exertion or even at rest

Unstable Angina

22

pleuritic pain
abrupt onset
dyspnea, decreased breath sounds

Spontaneous Pneumothorax

23

substernal or epigastric burning pain
relieved with food or antacids

Peptic Ulcer

24

aching
reproduced by localized pressure (pinpoint tenderness)

Costochondritis

25

Other causes of chest pain --- give 3

gallbladder disease
herpes zoster
emotional stress

26

GRADING OF HEART MURMURS
Grade 1 ---?
Grade 2 ---?
Grade 3 ---?
Grade 4 ---?
Grade 5 ---?
Grade 6 ---?

Grade 1 ---very faint
Grade 2 ---faint, can be heard readily by an experienced observer
Grade 3 ---moderately loud
Grade 4 ---loud; associated with a thrill
Grade 5 ---very loud, heard with stethoscope lightly pressed on the skin
Grade 6 ---very loud, heard with a stethoscope slightly above the chest wall

27

HEART SOUNDS: coincides with the closure of mitral valve and tricuspid valve (systolic phase); best heard in the apex

S1

28

S1 is best heard in the ___

apex

29

HEART SOUNDS: coincides with the closure of the aortic and pulmonic valves (diastolic phase)

S2

30

S2 is best heard in the ___

base

31

HEART SOUNDS: best heard in the base

S2

32

HEART SOUNDS: indicates end of systole (or beginning of diastole)

S2

33

HEART SOUNDS: splitting is normally heard

S2

34

HEART SOUNDS: S2
Variations: Widened interval in ___, ___

RBBB
severe MR

35

HEART SOUNDS: S2
Variations: Narrowly split or singular S2 in ___

pulmonary artery HPN

36

HEART SOUNDS: S2
Variations: Fixed splitting in ___

ASD (secundum type)

37

HEART SOUNDS: S2
Variations: Paradoxical splitting in ___, ___, ___, ___, ___

LBBB
RV apical pacing
severe AS
HOCM
MI

38

HEART SOUNDS: coincides with early diastole or rapid ventricular filling

S3

39

HEART SOUNDS: caused by the flow of blood during rapid ventricular filling

S3

40

HEART SOUNDS: best heart after S2

S3

41

HEART SOUNDS: coincides with late diastole or atrial systole (slow ventricular filling)

S4

42

HEART SOUNDS: occurs when diminished ventricular compliance increases the resistance to ventricular filling

S4

43

HEART SOUNDS: usually heard in LVH or MI

S4

44

Cyanosis due to RIGHT TO LEFT shunting, as seen in congenital heart diseases (deoxygenated blood reaches systemic circulation)

Central Cyanosis

45

Cyanosis due to decreased extremity blood flow, as seen in exposure to cold (due to small vessel vasoconstriction)

Peripheral Cyanosis

46

Cyanosis affecting the lower extremities BUT not the upper, as seen in large PDA

Differential Cyanosis

47

Posterior calf pain on active dorsiflexion of the foot against resistance; suggestive of DVT

Homan's sign

48

Rise or a lack of fall of the JVP with inspiration; associated with constrictive pericarditis; normally, venous pressure should fall at least 3mmHg with inspiration

Kussmaul's sign

49

Pressure over the upper abdomen/RUQ for at least 10 seconds --- a positive response = sustained rise of >3cm in JVP for at least 15 seconds after release of the hand

Abdominojugular reflex

50

High pitched and occurs after a very short interval after S2; heard in mitral stenosis

Opening snap

51

Heard in patients with constrictive pericarditis

Pericardial knock