Flashcards in Teaching (bedside, ward, & sessions) - Weeks 1 & 2 Deck (155)
What are the 7 features of the JVP?
- Emerges between the two heads of the SCM
- Obliterated by pressure
- Position/height dependent
- Level lowers on inspiration
- Elevated with increased abdo pressure (AJR)
What is the FAILURE mnemonic for heart failure exacerbation?
Upregulation of CO
What is an initial approach to falls? (2 categories)
What are the 4 main intrinsic causes of falls?
Reduced physical capacity
What are the 2 main extrinsic causes of falls?
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)
What neurological and psych issues can cause falls?
Depression (can have physical manifestations, esp in elderly)
What sensory causes can lead to falls?
- Bad vision (feet blurry when standing)
- Vestibular issues
- Neuropathy (position sense)
How can reduced physical capacity lead to falls?
- Balance & gait abnormaliites
- MSK pain
- Muscle-wasting pro-inflammatory conditions (eg DM, COPD)
How do medications lead to falls?
- Polypharmacy (>4 meds)
- Diuretics (worsen orthostatic hypotension)
- Psychotropic meds
What are the contributing mechanisms to psychotropic meds causing falls?
- can worsen orthostatic hypotension
- can cause parkinsonism
- can impair cognition and alertness
What features of a pt's environment might contribute to falls?
- Stairs (esp w/o handrails)
- bad lighting
- footwear (eg socks, bare feet too)
What exam findings should be assessed when a pt presents with falls?
- Orthostatic vitals
- Neuro/motor deficits
- gait, instability
What are the biggest risk factors for falls?
1. Fall in the last year
2. Impaired vision
3. Impaired gait (weakness, pain)
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)
What is the initial workup before Dx of Fever of unknonwn origin?
- 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)
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
What three general categories of illness account for the majority of "classic" FUO cases?
- Systemic rheumatic diseases (eg, vasculitis, rheumatoid arthritis)
What is the TRAP mnemonic for Parkinson's?
What are the most common presenting findings of Parkinson's?
Syncope with orthostatic hypotension
More rarely: dementia
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
What presenting history is common in Parkinson's from the patient's spouse?
Spouse often reports tremor, and notes that pt is very slow
What is more useful in diagnosing Parkinson's, the history or the exam?
History is not as helpful in Parkinsons: exam more helpful
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!)
Why should you not send nursing to do your orthostatic vitals?
Most imp thing is the HR, and nursing generally just takes BP
What fevers are typically higher, infectious or malignant?
Infectious: malignant fevers usually low grade
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.
What are the features of a parkinsonian tremor?
- pill-rolling: at wrist, large amplitude, low frequency
- consciously suppressible
Describe the gait of a pt with parkinsons
hesitation at lines on the floor, doors