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PANCE > Board Review > Flashcards

Board Review Flashcards

1
Q

S3 suggests

A

Dilated ventricle in CHF

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2
Q

Risk factors for dilated cardiomyopathy

A

Men, alcohol, adriomycin (chemo), thyroid, pregnancy, infections

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3
Q

A pregnant woman is short of breath, what is it?

A

Dilated cardiomyopathy (insidious) or PE (acute)

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4
Q

S4 suggests

A

Hypertrophic ventricle. Either hypertrophic cardiomyopathy or from hypertension

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5
Q

Who gets hypertrophic obstructive cardiomyopathy (HOCUM)?

A

Kids playing sports

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6
Q

How to treat HOCUM?

A

With funnel drugs (chronotropic beta blockers like metop)

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7
Q

How does HOCUM present diagnostically?

A

Kid passes out. Pathological q waves on wig, large septum on echo. Rate control then surgery

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8
Q

Pericarditis presents how?

A

Positional chest pain (laying down) and symptoms like restrictive cardiomyopathy. Friction rub. EKG will show diffuse ST elevations without reciprocal changes.

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9
Q

Triad of cardiac tamponade

A

JVD, muffled heart sounds, hypotension/pulsus paradoxus

Becky triad

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10
Q

Three causes of JVD

A

Tension pneumothorax, cardiac tamponade, CHF

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11
Q

Systolic murmurs

A

S-MIAS

Mitral insufficiency or aortic stenosis

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12
Q

Diastolic murmurs

A

D-AIMS

AOrtic insufficiency, mitral stenosis

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13
Q

What does “blowing” murmur mean?

A

Insufficiency- either mitral or aortic

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14
Q

Diastolic murmur that radiates inferiorly, maybe pistol shot

A

Aortic insufficiency

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15
Q

What do prostaglandins do?

A

Protect mucus membranes, small blood vessels

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16
Q

Baby less than 2 weeks is tanking, sepsis is ruled out, what is the prob and how do you treat it?

A

VSD or other major congenital defect (TET). Treat initially by opening ductus arteriosis with prostaglandins

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17
Q

When and How do you treat PDA?

A

Treat it when the kid is ok! Wth indomethacin

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18
Q

Causes of AFib

A

Stressed heart (HTN, valves CAD), hyper-sympathetic (thyrotoxicosis, Etoh), lung stress to heart (COPD)

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19
Q

How to treat AFib?

A

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

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20
Q

CHADS 2 score

A 
Risk of clot after AFib. If score is over 2, keep INR>2. 
CHF
HTN
Age > 75
Diabetes
Stroke
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21
Q

Treat AFlutter?

A

Usually transient, going into or coming out of AFib.

Tx is rate control or waiting

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22
Q

Treatments for SVT

A

Adenosine (d for down) or vagal maneuvers

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23
Q

VTach treatment

A

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

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24
Q

Torsades treatment

A

Magnesium sulfate

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25
Q

Worst pain types

A

Ischemic.

Fitting something through where it doesn’t normally go- kidney stone, fall stone child birth.

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26
Q

ACLS step one

A

“Get an AED”! For adult

For kid- start CPR

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27
Q

Txt for asystole

A

No shock!
Vasoconstrictor- epi or vasopressin
Epi 1 mg q 4 mins

This is a poor prognosis

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28
Q

PEA causes and management

A

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).

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29
Q

Common causes of hyper K

A

Lab error, dialysis pt

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30
Q

Narcan reverses which opiate sx

A

Mental status, respiratory rate, pupils

Blood pressure will stay low

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31
Q

Why do TCAs cause arrhythmias?

A

Anticholinergic effect of sodium channel blockade has anticholinergic effect

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32
Q

How do you treat hyperkalmia acutely?

A

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.

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33
Q

Heart block location

A

1st degree is SA
Wenckebach is AV node
Mobitz II is bundle of hiss
3rd degree is purkinje fibers

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34
Q

Which coronary artery feeds the AV node?

A

Rca

This is an inferior wall mi if it happens

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35
Q

What has a short PR interval?

A

Reentry tachycardia from WPW?

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36
Q

Treat a winkebach with

A

Atropine

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37
Q

Sick sinus syndrome

A

Tachycardia with pauses (tachy-Brady syndrome)

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38
Q

Most commons cause of CHF?

A

CAD

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39
Q

Mnemonic for causes of primary resp symptoms

A 
Don't want to make a horid mistake
Heart
Obstruction
Reactive
Infection 
Dead
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40
Q

Treatment of new or rapidly worsened CHF

A 
Lasix 
Morphine
Nitro
Oxygen
P biPap
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41
Q

Nitroglycerin is CI

A

If right ventricle MI

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42
Q

Sx of r and L CHF

A

Right- roads to heart

Left- lung

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43
Q

Pseudo tumor cerebri

A

An idiopathic intracranial tumor
HTN
Papilledema
HA

In obese women in their 30s

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44
Q

HTN emergency

A

End organ damage- high BP with encephalopathy, renal failure, ich, dissection, preeclampsia or eclampsia, CHF, ACS

Lower BP within 1 hour

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45
Q

Thiazide diuretics are risky for

A

SLUR
problems with:
sugar, lipids, uric acid (gout), renal insufficiency (use a loop)

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46
Q

ACEI side effects

A

Cough, K+, renal (renal artery stenosis causes inc cr), tongue swelling

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47
Q

Hydralazine can cause what side effect?

A

Lupus like rash. Don’t use in pregnancy.

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48
Q

Pregnancy induced HTN Med

A

Methyl dopa

49
Q

First line for HTN

A

Thiazide unless CI. Ace if diabetic with proteinuria.

50
Q

Causes of chest pain

A 
Who's your pappa?
Pericarditis
Acs
Pneumothorax
Pulm embolism
Thoracic aortic aneurism (or dissection)
51
Q

Cardiac risk factors

A 
Sad CHF
Smoking
Age
Diabetes- hugest risk factor
Cholesterol
Hypertension
Fam history

Age and Hx are non-modifiable

52
Q

How do you know if a clot is stable or growing in a pt with unstable angina?

A

If they continue to have chest pain after giving nitro

53
Q

Chest pain mnemonic for high incidence of mi

A 
DRIVE
diaphoresis
Radiation
Impending doom (eh)
Vomiting 
Exertion
54
Q

Absolute contraindications for thrombolytics

A

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

55
Q

RBBB on ekg

A

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

56
Q

What is a new lbbb mean?

A

You have to treat it like a stemi

57
Q

Ami EKG

A

Two up, two down or new Lbbb (terminal deflection is up in v6, down in v1)

58
Q

First cardiac enzyme

A

Myoglobin - rises in an hour, peaks in 4. Doubling in 90 mins is highly predictive

59
Q

Troponin rises when?

A

3-4 hours, peaks in 12. Stays for 10 days.

Most specific.

60
Q

Hangmans fracture

A

C2 fracture/dislocation

Mechanism is hyper extension

61
Q

Jefferson fracture

A

C1 burst fracture from axial loading injury (dive in shallow pool)

62
Q

When to take off collar?

A

Pain free to palpating, clear radiograph, no neuro defects

63
Q

Most common injury in rotator cuff tear

A

Supraspinatous

64
Q

Hill sacks lesion

A

H- on humerus

Divet on humerus, suggests soft tissue damage from repeat dislocations

65
Q

Bankart lesion

A

Injury to lower labrum from repeat dislocations

On the glenoid

66
Q

Clavicle fracture management

A

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

67
Q

Ac joint separation management

A

Sling, unless open

68
Q

Check for radial nerve injury

A

Wrist up, thumb up, sensation at wrist will confirm no radial nerve injury (wrist drop)

69
Q

Radial head fracture on X-ray

A

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

70
Q

Lateral epicondylitis will present how?

A

Tenderness over lateral epicondyle (tennis elbow)

Pt will have pain with wrist extension against resistance. Also pain with supination.

71
Q

Medial epicondylitis presentaition

A

Mech is repeated flexion

Pain with wrist flexion against resistance or pronation.

72
Q

Do you X-ray a radial head dislocation?

A

Yes (on the pance). Before and after films.

73
Q

What is a torus or buckle fracture?

A

Greenstick. Bent but not broken with bulge in periosteum.

74
Q

Monteggia vs galaiazzi fracture

A

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

75
Q

Fall onto extended hand - injuries and mngmnt

A
  1. 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

76
Q

Management of de quervain tenosynovitis? Who gets it?

A

Diabetics and people >30s.

Tx with RICE, steroid injections

77
Q

Boutonnière vs swan neck deformity

A

They are opposites. Swan neck is hyper extension of pip and hyper flexion of dip. Boutonnière is flexion of pip, extension of dip.

78
Q

Bouchards nodes vs heberden’s nodes?

A

HBO
heberden’s =dip
Bouchards = pip
O= occurs in OA

79
Q

Tx for carpel tunnel syndrome

A

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

80
Q

Management of boxer fx

A

Reduce closed if >30 degrees. ORIF if communated.

If abrasion that could be caused by teeth? Augmentin

81
Q

What gets fractured in a Colles’?

A

Distal radius (dorsal). Half also fx styloid. Always check for damage to median nerve.

82
Q

What gets damaged in a smith’s?

A

Distal radius (volar). May cause median nerve injury.

83
Q

Gamekeepers thumb

A

Hyperextension of thumb

84
Q

Patellar reflex tests which nerve root?

A

L3

85
Q

Where does sciatica radiate?

A

Back all the way down to lateral maleolus. If it doesn’t go past the knee, it’s not sciatica.

86
Q

Herniated nucleus pulpus..sx and tx

A

Sx include sciatica. Test with straight leg raise. Txt with NSAIDs, prednisone

87
Q

Spondylilysis

A

Fracture through pars

Scottie dog

88
Q

Spondylolisthesis

A

Slipped vertebra

89
Q

Spinal stenosis

A

Neural claudication, relieved by leaning forward. Get CT or MRI. Tx with steroids or surgery

90
Q

Who gets a brace for scoliosis?

A

> 60 degrees

91
Q

HLA B27 is associated with

A

Ankylosing Spondylilysis

92
Q

Old is down, externally rotated and short leg

A

Hip fx

93
Q

Old is down, leg is long and externally rotated

A

Hip dislocation

94
Q

Legg-calve-perthes disease

A

In kids, limping

A vascular necrosis of femoral head

95
Q

Scfe is what

A

Slipped capital femoral epiphysis. Sx with X-ray frog leg view.
Fat kids.

96
Q

Knee injury, check what

A

Popliteal artery. Check for cold leg.

97
Q

Osgood-schlatter

A

Avulsion injury of proximal tibia

98
Q

Maissoneuve fracture

A

Excessive external rotation of knee. Fx of proximal fibula. Tx is surgery

99
Q

Lisfranc fracture

A

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

100
Q

Types of proximal 5th metatarsal fx

A

Avulsion-
Jones
Stress

101
Q

Jones fx treatment

A

Hard boot, refer to ortho

102
Q

Plantar fasciitis

A

Pain at insertion of calcaneous
Worst in AM or walking
To is NSAIDs

103
Q

What do sickle cell patients get in ID?

A

Acute or chronic osteomyelitis from staph or salmonella

104
Q

Pain in bone at night? What do you think?

A

Cancer. Most common primary bone ca is multiple myeloma.
Chondosarcoma is for 60 yo plus
Ewing’s sarcoma I 15 yo
Osteosarcoma in 15yo

105
Q

Lab and clinical presentation of multiple myeloma

A

Lytic bone lesions, high calcium, Benz jones proteins monoclonal gamma globulinemia.

106
Q

Joint fluid wbc counts

A

Wbc- >50000 is septic
Less is rheumatoid.
OA is will have a few hundred

107
Q

Sjogren’s

A

Can occur alone or with Ra, SLE, poly myosotis,

Sholman test is filter paper in eye

Anti-Ro
Anti-La

108
Q

Poly arthritis nodosa

A

F 50yo

30% associated with hep B

109
Q

Lupus

A

Must have positive ANA. Lupus will give false positive for RPR (also Lyme)

Antibodies to smith and double stranded DNA

110
Q

Drugs that cause SLE

A

Check photos for slide

111
Q

Polymyalgia rheumatica

A

Older F.
Girdle pain (shoulder and pelvis)
Associated with temporal arteritis

112
Q

Scleroderma

A

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

113
Q

RA

A

Symmetric, Swan neck and boutonnière deformities.

114
Q

Reiter syndrome

A

Reactive arthritis. Chlamydia, conjunctivitis, arthritis in one joint.

HLA b27 positive

115
Q

Gout

A

Podagra- first mtp pain
Negatively bifringent

Tx is NSAIDs, colchicine, steroids

Colchicine causes GI effects

116
Q

Pseudogout

A

Rhomboid positively bifringent crystals. Calcium

117
Q

Compartment syndrome

A

Pain, parasthesia, pallor, paralysis, pulselessness

To is fasciotomy

118
Q

Osteoporosis

A

Risk factors are steroids, smoking, Etoh.

Prevent calcium vit D and phosphorus

Bisphosphonates - take with full glass of water sitting upright

PANCE (3 decks)

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