Board Review Flashcards
S3 suggests
Dilated ventricle in CHF
Risk factors for dilated cardiomyopathy
Men, alcohol, adriomycin (chemo), thyroid, pregnancy, infections
A pregnant woman is short of breath, what is it?
Dilated cardiomyopathy (insidious) or PE (acute)
S4 suggests
Hypertrophic ventricle. Either hypertrophic cardiomyopathy or from hypertension
Who gets hypertrophic obstructive cardiomyopathy (HOCUM)?
Kids playing sports
How to treat HOCUM?
With funnel drugs (chronotropic beta blockers like metop)
How does HOCUM present diagnostically?
Kid passes out. Pathological q waves on wig, large septum on echo. Rate control then surgery
Pericarditis presents how?
Positional chest pain (laying down) and symptoms like restrictive cardiomyopathy. Friction rub. EKG will show diffuse ST elevations without reciprocal changes.
Triad of cardiac tamponade
JVD, muffled heart sounds, hypotension/pulsus paradoxus
Becky triad
Three causes of JVD
Tension pneumothorax, cardiac tamponade, CHF
Systolic murmurs
S-MIAS
Mitral insufficiency or aortic stenosis
Diastolic murmurs
D-AIMS
AOrtic insufficiency, mitral stenosis
What does “blowing” murmur mean?
Insufficiency- either mitral or aortic
Diastolic murmur that radiates inferiorly, maybe pistol shot
Aortic insufficiency
What do prostaglandins do?
Protect mucus membranes, small blood vessels
Baby less than 2 weeks is tanking, sepsis is ruled out, what is the prob and how do you treat it?
VSD or other major congenital defect (TET). Treat initially by opening ductus arteriosis with prostaglandins
When and How do you treat PDA?
Treat it when the kid is ok! Wth indomethacin
Causes of AFib
Stressed heart (HTN, valves CAD), hyper-sympathetic (thyrotoxicosis, Etoh), lung stress to heart (COPD)
How to treat AFib?
Keep rate slow, prevent clots, convert rhythm.
Funnel drugs- beta blockers, calcium channel blockers, dig
Anticoagulation- heparin, Coumadin, lovenox, xarelto
Convert rhythm before anticoagulant of unstable, or have had AFib
CHADS 2 score
Risk of clot after AFib. If score is over 2, keep INR>2. CHF HTN Age > 75 Diabetes Stroke
Treat AFlutter?
Usually transient, going into or coming out of AFib.
Tx is rate control or waiting
Treatments for SVT
Adenosine (d for down) or vagal maneuvers
VTach treatment
Bon Jovi rhythm- is the pt dead ( no pulse) or alive (pulse).
Alive, ok-no funnel drugs because it’s a v rhythm not through AV nose. Use amiodarone.
Unstable but pulse present- cardiovert
Dead- defibrillate
Torsades treatment
Magnesium sulfate
Worst pain types
Ischemic.
Fitting something through where it doesn’t normally go- kidney stone, fall stone child birth.
ACLS step one
“Get an AED”! For adult
For kid- start CPR
Txt for asystole
No shock!
Vasoconstrictor- epi or vasopressin
Epi 1 mg q 4 mins
This is a poor prognosis
PEA causes and management
Drug overdose? K? Or needle?
squeezed heart or lung (tamponade or tension pneumo)… Needle these
others are
HEAD
Hypothermia, electrolytes, acidosis, drugs
Hypothermia won’t be on boards. Acidosis and electrolytes are one and the same because the problem Is K (with exception of aspirin of).
Common causes of hyper K
Lab error, dialysis pt
Narcan reverses which opiate sx
Mental status, respiratory rate, pupils
Blood pressure will stay low
Why do TCAs cause arrhythmias?
Anticholinergic effect of sodium channel blockade has anticholinergic effect
How do you treat hyperkalmia acutely?
Calcium will stabilize the cell membrane- give this if ekg changes, it will give you 30 mins.
Bicarbonate will push potassium into cell by causing metabolic alkalosis. Insulin will do this because k will follow glucose. High dose Proventil (neb) also works.
Kayexalate po or pr- binds in GI tract and excretes it. Dialysis.
Heart block location
1st degree is SA
Wenckebach is AV node
Mobitz II is bundle of hiss
3rd degree is purkinje fibers
Which coronary artery feeds the AV node?
Rca
This is an inferior wall mi if it happens
What has a short PR interval?
Reentry tachycardia from WPW?
Treat a winkebach with
Atropine
Sick sinus syndrome
Tachycardia with pauses (tachy-Brady syndrome)
Most commons cause of CHF?
CAD
Mnemonic for causes of primary resp symptoms
Don't want to make a horid mistake Heart Obstruction Reactive Infection Dead
Treatment of new or rapidly worsened CHF
Lasix Morphine Nitro Oxygen P biPap
Nitroglycerin is CI
If right ventricle MI
Sx of r and L CHF
Right- roads to heart
Left- lung
Pseudo tumor cerebri
An idiopathic intracranial tumor
HTN
Papilledema
HA
In obese women in their 30s
HTN emergency
End organ damage- high BP with encephalopathy, renal failure, ich, dissection, preeclampsia or eclampsia, CHF, ACS
Lower BP within 1 hour
Thiazide diuretics are risky for
SLUR
problems with:
sugar, lipids, uric acid (gout), renal insufficiency (use a loop)
ACEI side effects
Cough, K+, renal (renal artery stenosis causes inc cr), tongue swelling
Hydralazine can cause what side effect?
Lupus like rash. Don’t use in pregnancy.
Pregnancy induced HTN Med
Methyl dopa
First line for HTN
Thiazide unless CI. Ace if diabetic with proteinuria.
Causes of chest pain
Who's your pappa? Pericarditis Acs Pneumothorax Pulm embolism Thoracic aortic aneurism (or dissection)
Cardiac risk factors
Sad CHF Smoking Age Diabetes- hugest risk factor Cholesterol Hypertension Fam history
Age and Hx are non-modifiable
How do you know if a clot is stable or growing in a pt with unstable angina?
If they continue to have chest pain after giving nitro
Chest pain mnemonic for high incidence of mi
DRIVE diaphoresis Radiation Impending doom (eh) Vomiting Exertion
Absolute contraindications for thrombolytics
Tumor in brain, brain bleed, blood clot or stroke in last year.
GI bleed
Thoracic dissection is suspected (acute tearing pain, radiation to back)
You have 30 mins to administer from pt arrival
RBBB on ekg
V1 right hand, v6 is left hand
Right (v1) is positive and wide
V6 is down- terminal reflection of qrs, not R wave
Lbbb is opposite
What is a new lbbb mean?
You have to treat it like a stemi
Ami EKG
Two up, two down or new Lbbb (terminal deflection is up in v6, down in v1)
First cardiac enzyme
Myoglobin - rises in an hour, peaks in 4. Doubling in 90 mins is highly predictive
Troponin rises when?
3-4 hours, peaks in 12. Stays for 10 days.
Most specific.
Hangmans fracture
C2 fracture/dislocation
Mechanism is hyper extension
Jefferson fracture
C1 burst fracture from axial loading injury (dive in shallow pool)
When to take off collar?
Pain free to palpating, clear radiograph, no neuro defects
Most common injury in rotator cuff tear
Supraspinatous
Hill sacks lesion
H- on humerus
Divet on humerus, suggests soft tissue damage from repeat dislocations
Bankart lesion
Injury to lower labrum from repeat dislocations
On the glenoid
Clavicle fracture management
Unless it is commuted or majorly displaced it doesn’t need surgery. Just sling or figure of 8 for kids,
Adults just get sling
4-8 weeks with periodic rom and no contact sports
Ac joint separation management
Sling, unless open
Check for radial nerve injury
Wrist up, thumb up, sensation at wrist will confirm no radial nerve injury (wrist drop)
Radial head fracture on X-ray
posterior fat pad sign will be visible as very radiolucent.
Anterior fat pad is normally visible. Sail sign is an exaggerated, sail shaped anterior fat pad and suggests fracture of radial head
Lateral epicondylitis will present how?
Tenderness over lateral epicondyle (tennis elbow)
Pt will have pain with wrist extension against resistance. Also pain with supination.
Medial epicondylitis presentaition
Mech is repeated flexion
Pain with wrist flexion against resistance or pronation.
Do you X-ray a radial head dislocation?
Yes (on the pance). Before and after films.
What is a torus or buckle fracture?
Greenstick. Bent but not broken with bulge in periosteum.
Monteggia vs galaiazzi fracture
Letter M can hold “u”- radius can support ulna- monteggia is ulnar fx with superior dislocation
Tx is surgery in adults, splint in kids
Galeazzi - grrrr - radial fracture with inferior displacement
Tx is ORIF for all
Fall onto extended hand - injuries and mngmnt
- Scaphoid (navicular) fx. Tx is thumb spica unless more than 1mm displaced (requires ORIF)
Note that this does not always show up on X-ray check snuffbox
Management of de quervain tenosynovitis? Who gets it?
Diabetics and people >30s.
Tx with RICE, steroid injections
Boutonnière vs swan neck deformity
They are opposites. Swan neck is hyper extension of pip and hyper flexion of dip. Boutonnière is flexion of pip, extension of dip.
Bouchards nodes vs heberden’s nodes?
HBO
heberden’s =dip
Bouchards = pip
O= occurs in OA
Tx for carpel tunnel syndrome
Conservative, NSAIDs and steroids, volatile wrist splint, surgery. Can do nerve conduction study to confirm.
Note that phalens needs to be held for a minute to see if it causes parasthesia
Management of boxer fx
Reduce closed if >30 degrees. ORIF if communated.
If abrasion that could be caused by teeth? Augmentin
What gets fractured in a Colles’?
Distal radius (dorsal). Half also fx styloid. Always check for damage to median nerve.
What gets damaged in a smith’s?
Distal radius (volar). May cause median nerve injury.
Gamekeepers thumb
Hyperextension of thumb
Patellar reflex tests which nerve root?
L3
Where does sciatica radiate?
Back all the way down to lateral maleolus. If it doesn’t go past the knee, it’s not sciatica.
Herniated nucleus pulpus..sx and tx
Sx include sciatica. Test with straight leg raise. Txt with NSAIDs, prednisone
Spondylilysis
Fracture through pars
Scottie dog
Spondylolisthesis
Slipped vertebra
Spinal stenosis
Neural claudication, relieved by leaning forward. Get CT or MRI. Tx with steroids or surgery
Who gets a brace for scoliosis?
> 60 degrees
HLA B27 is associated with
Ankylosing Spondylilysis
Old is down, externally rotated and short leg
Hip fx
Old is down, leg is long and externally rotated
Hip dislocation
Legg-calve-perthes disease
In kids, limping
A vascular necrosis of femoral head
Scfe is what
Slipped capital femoral epiphysis. Sx with X-ray frog leg view.
Fat kids.
Knee injury, check what
Popliteal artery. Check for cold leg.
Osgood-schlatter
Avulsion injury of proximal tibia
Maissoneuve fracture
Excessive external rotation of knee. Fx of proximal fibula. Tx is surgery
Lisfranc fracture
Falling off horse with foot stuck In stirrup. Can’t put any pressure on foot.
If u can’t see on X-ray, get ct
Tax is ORIF
Types of proximal 5th metatarsal fx
Avulsion-
Jones
Stress
Jones fx treatment
Hard boot, refer to ortho
Plantar fasciitis
Pain at insertion of calcaneous
Worst in AM or walking
To is NSAIDs
What do sickle cell patients get in ID?
Acute or chronic osteomyelitis from staph or salmonella
Pain in bone at night? What do you think?
Cancer. Most common primary bone ca is multiple myeloma.
Chondosarcoma is for 60 yo plus
Ewing’s sarcoma I 15 yo
Osteosarcoma in 15yo
Lab and clinical presentation of multiple myeloma
Lytic bone lesions, high calcium, Benz jones proteins monoclonal gamma globulinemia.
Joint fluid wbc counts
Wbc- >50000 is septic
Less is rheumatoid.
OA is will have a few hundred
Sjogren’s
Can occur alone or with Ra, SLE, poly myosotis,
Sholman test is filter paper in eye
Anti-Ro
Anti-La
Poly arthritis nodosa
F 50yo
30% associated with hep B
Lupus
Must have positive ANA. Lupus will give false positive for RPR (also Lyme)
Antibodies to smith and double stranded DNA
Drugs that cause SLE
Check photos for slide
Polymyalgia rheumatica
Older F.
Girdle pain (shoulder and pelvis)
Associated with temporal arteritis
Scleroderma
F 40yo
Starts with reynaud’s
SCL-70 is associated with diffuse type
Anti-centromere antibody is good indicator of limited type
CRESt syndrome
Calcinosis, reynaud’s, esophageal, scleroderma, telangiecasis
RA
Symmetric, Swan neck and boutonnière deformities.
Reiter syndrome
Reactive arthritis. Chlamydia, conjunctivitis, arthritis in one joint.
HLA b27 positive
Gout
Podagra- first mtp pain
Negatively bifringent
Tx is NSAIDs, colchicine, steroids
Colchicine causes GI effects
Pseudogout
Rhomboid positively bifringent crystals. Calcium
Compartment syndrome
Pain, parasthesia, pallor, paralysis, pulselessness
To is fasciotomy
Osteoporosis
Risk factors are steroids, smoking, Etoh.
Prevent calcium vit D and phosphorus
Bisphosphonates - take with full glass of water sitting upright
