Teaching (bedside, ward, & sessions) - Weeks 1 & 2 Flashcards Preview

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Flashcards in Teaching (bedside, ward, & sessions) - Weeks 1 & 2 Deck (155)
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1

What are the 7 features of the JVP?

- Biphasic
- Emerges between the two heads of the SCM
- Nonpalpable
- Obliterated by pressure
- Position/height dependent
- Level lowers on inspiration
- Elevated with increased abdo pressure (AJR)

2

What is the FAILURE mnemonic for heart failure exacerbation?

Forgot meds
Arrythmia, Anemia
Ischemia, Infection
Lifestyle
Upregulation of CO
Renal failure
Embolism

3

What is an initial approach to falls? (2 categories)

Intrinsic
Extrinsic

4

What are the 4 main intrinsic causes of falls?

Syncope/Presyncope
Neuro/Psych Impairment
Sensory impairment
Reduced physical capacity

5

What are the 2 main extrinsic causes of falls?

Drugs
Environment

6

What are the 3 main causes of syncope?

- Cardiac (CHF, aortic stenosis, arrythmias)
- Orthostatic (volume depletion -- can be due to Rx, diarrhea, low intake, hyperglycemia, other)
- Vasovagal / neurocardiogenic (eg with pain, panic, BM or micturition)

7

What neurological and psych issues can cause falls?

Stroke
Parkinsonism
Cognition
Depression (can have physical manifestations, esp in elderly)

8

What sensory causes can lead to falls?

- Bad vision (feet blurry when standing)
- Vestibular issues
- Neuropathy (position sense)

9

How can reduced physical capacity lead to falls?

- Weakness
- Balance & gait abnormaliites
- MSK pain
- Muscle-wasting pro-inflammatory conditions (eg DM, COPD)

10

How do medications lead to falls?

- Polypharmacy (>4 meds)
- Diuretics (worsen orthostatic hypotension)
- Psychotropic meds

11

What are the contributing mechanisms to psychotropic meds causing falls?

- can worsen orthostatic hypotension
- can cause parkinsonism
- can impair cognition and alertness

12

What features of a pt's environment might contribute to falls?

- Rugs
- Stairs (esp w/o handrails)
- bad lighting
- footwear (eg socks, bare feet too)

13

What exam findings should be assessed when a pt presents with falls?

- Orthostatic vitals
- Arrythmia/murmurs
- Neuro/motor deficits
- gait, instability
- vision

14

What are the biggest risk factors for falls?

1. Fall in the last year
2. Impaired vision
3. Impaired gait (weakness, pain)

15

Why should a pt with new fever be Dx with "fever NYD" and not "fever of unknown origin"?

Fever of unknown origin has a specific definition:

- fever higher than 38.3ºC on several occasions
- lasting for at least three (some use two) weeks
- without an established etiology despite intensive evaluation and diagnostic testing (original definition: Uncertain diagnosis after one week of study in the hospital)

16

What is the initial workup before Dx of Fever of unknonwn origin?

- History
- Physical examination
- Complete blood count
- Blood cultures
- Routine blood chemistries, including liver enzymes and bilirubin
- If liver tests are abnormal, hepatitis A, B, and C serologies
- Urinalysis (incl microscopic examination & culture)
- CXR

17

What are the stipulations for blood culture Ix, before Dx Fever of unknown origin?

Three sets drawn from different sites with an interval of at least several hours between each set

In cases in which antibiotics are indicated, all blood cultures should be obtained before administering antibiotics

18

What three general categories of illness account for the majority of "classic" FUO cases?

- Infections
- Malignancies
- Systemic rheumatic diseases (eg, vasculitis, rheumatoid arthritis)

19

What is the TRAP mnemonic for Parkinson's?

Tremor
Rigidity
Akinesia
Postural instability

20

What are the most common presenting findings of Parkinson's?

Tremor
Syncope with orthostatic hypotension
More rarely: dementia

21

What presenting history is common in Parkinson's from the patient?

Pt often complains of difficultly sleeping (because they can't turn in bed) and difficulty with knobs and jars

22

What presenting history is common in Parkinson's from the patient's spouse?

Spouse often reports tremor, and notes that pt is very slow

23

What is more useful in diagnosing Parkinson's, the history or the exam?

History is not as helpful in Parkinsons: exam more helpful

24

If a pt feels faint while you are assessing orthostatic vitals, should you support them to keep them standing?

No: even if you're able to, *brain is hypoperfusing*

(If you do this you can cause GTC in pt!)

25

Why should you not send nursing to do your orthostatic vitals?

Most imp thing is the HR, and nursing generally just takes BP

26

What fevers are typically higher, infectious or malignant?

Infectious: malignant fevers usually low grade

27

What is seen on orthostatic vitals in parkinson's pt?

Pulse stays the same

Parkinsons has central dysautonomia: unable to generate tachycardia

Pulse jump makes parkinson's less likely.

28

What are the features of a parkinsonian tremor?

- resting
- pill-rolling: at wrist, large amplitude, low frequency
- consciously suppressible

29

Describe the gait of a pt with parkinsons

festinating
stooped
shuffling
hesitation at lines on the floor, doors

30

How is the glabellar tap test done?

Tap on the glabella, reaching from behind the head (so pt can't see hand)

Tap 10x

Pt stops blinking after <7 taps: negative
Pt continues to blink for 10 or more taps: positive