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Step 2 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Characteristic murmur of ASD

A

Wide split S2; left upper and left midsternal border

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2
Q

ASD H&P

A

acyanotic heart defect
children often asymptomatic and discovered inadvertently
large defects cause mild growth failure and exercise intolerance
tolerated well during childhood, but can lead to pulmonary HTN later

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3
Q

Characteristic murmur of VSD

A

harsh, left lower sternal border, holosystolic murmur

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4
Q

VSD H&P

A

most common heart lesion in children
small ones asymptomatic
large ones cause dyspnea, feeding difficulty, growth failure, sweating, recurrent infections, cardiac failure

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5
Q

Characteristic murmur of PDA

A

continous machine like murmur with widened pulse pressure and bounding precordium

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6
Q

PDA H&P

A

usually occurs in preterm infants; closes by 10-15 hours, or max by 48 hours
HF causes tachycardia, dyspnea, hepatomegaly, decreased urine output

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7
Q

Transposition of the great vessels H&P

A

cyanotic CHD begins after PDA closes, 16-48 hours after birth.
decreased blood flow to extremities

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8
Q

Radiologic finding in transposition of great vessels?

A

“Egg on a String” due to small thymic shadow

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9
Q

Treatment for Transposition of great vessels

A

IV Prostaglandin E; followed by septostomy

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10
Q

Characteristic murmur of pulmonary artery stenosis

A

upper left sternal border systolic murmur that radiates to the back and has a systolic click

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11
Q

Dissociative Fugue H&P/Treatment

A

amnesia in which people travel away from home and lose their identity; patient is otherwise normal, brought on by severe trauma
TX: resolves on its own

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12
Q

Dissociative identity disorder

A

presence of 2 or more personalities; where individual has amnesia for personal information, assocaited with severe physical or sexual abuse, 70% of patients have PTSD.
TX: ignore one personality + psychotherapy

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13
Q

depersonalization disorder

A

pervasive sense of detachment or being outside of ones body, feeling of being mechanical or automated

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14
Q

Diagnosis of somatization disorder:

A

multiple medical complaints that are not from a medical illness

1) pain in four different body sites
2) two GI symptoms
3) one sexual symptom
4) one pseudoneurological symptom

symptoms begin before age 30 and last many years
Pts usually have multiple physicians, make frequent office visits, and may seek disability

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15
Q

Treatment of somatization disorder:

A

CBT, antidepressants for comorbid depression

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16
Q

Conversion disorder

A

complaints involving sensory (numbness) and voluntary motor (paralysis) function not caused by neurologic symptoms

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17
Q

Pain Disorder

A

main complain is pain severe enough to disrupt daily life and no physical cause is found

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18
Q

Hypochondriasis

A

preoccupation with having a serious disease based on misintepretation of bodily function and sensation

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19
Q

Adjustment disorder H&P

A

change in emotional state that arises in response to a psychosocial stressor; response is out of proportion to what is expected with normal human experience
occurs within 3 months of the stressor and usually resolves within 6 months unless stressors are chronic

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20
Q

H&P for narcolepsy

A

sleep attacks during the day with rapid eye movement. Sleep intrusions/cataplexy. Daytime naps relieve sleepiness

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21
Q

Treatment for nacrolepsy

A

scheduling of short naps, stimulants mephylphenidate and modafinil, or TCA’s if cataplexy is present

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22
Q

Nightmare disorder

A

repeated episodes of scary dreams that wake a person from sleep; occur during REM sleep

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23
Q

Night Terror disorder

A

repeeated episodes of apparent terror during sleep; d not usually awaken during the attack.

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24
Q

Anorexia Nervosa H&P:

A 
refusal to keep body weight >85% of ideal
intense fear of weight gain
preoccupation with body size and shape
denial of medical risks of low weight
amenorrhea in females
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25
Q

Treatment of Anorexia Nervosa:

A

hospitalization if patient is at risk, meal supervision, weight and electrolyte monitoring, CBT, SSRIs for comorbid depression

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26
Q

Bulimia Nervosa H&P:

A 
bing eating (+/- purging) to avoid weight gain while maintaining body weight
body image issues
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27
Q

Treatment of Bulimia Nervosa:

A

manage medical complications
SSRIs
CBT

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28
Q

What is the number 1 cause of mental retardation, what is the most common heritable cause?

A

downs syndrome #1

fragile X #1 heritable

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29
Q

Treatment of mental retardation?

A

mild: family support and special education
Moderate: train child to perform simple tasks

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30
Q

Autistic Disorder H&P (triad?)

A

pervasive developmental disorder of childhood onset

triad: restricted activity and interests, impaired social interactions, impaired ability to communicate

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31
Q

Treatment of Autistic Disorder

A

behavioral management techniques

special education/specialized programs for behavior management

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32
Q

Retts Disorder H&P:

A

pervasive developmental disorder/MR in young girls

Initially asymptomatic, then pts begin to degenerate:
decreased rate of head growth
loss of acquired hand skills
loss of social engagement
poor gait/trunk movements
severe language impairment and psychomotor retardation

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33
Q

TX of Retts disorder

A

behavioral techniques, antiseizure/antipsychotic medications

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34
Q

Aspergers H&P

A

impaired social interactions

restrictive, repetitive, sterotyped behaviors and interest, no developmental delays

35
Q

TX of aspergers

A

educational, behavioral, psychotherapy targeted at maximizing social interaction

36
Q

conduct/Oppositional defiant disorder

A 
repetitive and persistant pattent of behavior in which basic rights of others are violated
agression towards people/animals
destruction of property
occurs in children under the age of 18
occurs with ADHD
37
Q

Paranoid personality disorder H&P:

A

pts are distrustful, suspicious and anticipate harm and betrayal.
not forthcoming about themselves.
use projection as a defensive

38
Q

shizoid personality disorders

A

pts emotionally detached and prefer to be left alone
pts aloof and detached, trouble experiencing or expressing emotion
do not desire relationships; but maintain one relationship with a close family member sometime

39
Q

shizotypal personality disorder

A

pts have odd thoughts, affects, perceptions and beliefs
similar to schizophrenia without sustained psychotic symptoms
often paranoid and restrict their world

40
Q

antisocial personality disorder

A

pts either flagrant or well concealed, disregard for rules and laws of society
pts exploitative, lie frequently, endager others, impulsive and aggressive, rarely show any remorse
associated with alcoholism

41
Q

Borderline personality disorder

A

Pts have instability in relationships, self image, affect and impulse control (sex, violence, drug abuse)
frequent suicidal
defense is splitting

42
Q

histriotronic personality disorder

A

excessive superficial emotionality and a powerful need for attention
pts exhibit theatrical behavior and lively and dramatic clothing, exxagerated emotional responses, innapropriate and flirtatious behavior, difficulty with intimacy

43
Q

narcissistic personality disorder

A

pts appear arrogant and entitled, a combination of self centerdness and worthlessness.
grandoise sense of self importance/attn seeking
no concern or empathy for others
exploitative
low self esteem and intense envy of those they regard as more desirable

44
Q

avoidant personality disorder

A

Pts experience intense feelings of inadequacy, hypersensitivity to criticism, and consequent social inhibition
desire relationships but avoid them because of the anxiety

45
Q

dependent personality disorder

A

pts extremely needy, relying on others for emotional support and decision making
do not exhibit the impulsive behavior, unstable affect, and poor self image of the borderline patient

46
Q

obsessive compulsive personality disorder

A

pts are perfectionists who require order and control

cold and rigid in relationships, devotion to work often replaces intimacy

47
Q

signs of alcohol withdrawal

A

4-12 hrs –> tremulousness
8-12 –> perceptual disturbances
12-24 hrs –> seizures
72 –> delirium

48
Q

Signs of opiate withdrawal

A 
pupillary dilation
piloerection
sweating
tachycardia
fever
diarrhea
insomnia
yawning
nausea/vomiting
49
Q

signs of atypical depression

A

hypersomnia, increased appetite/weight gain, mood reactivity, long standing rejection sensitivity, leaden paralsysis

50
Q

Panic disorder

A

characterized by recurrent, unexpected panic attacks occurring with or without agoraphobia
panic attacks occur suddenly peak within 10 minutes, lasts 5-30 minutes

51
Q

Tx panic disorder:

A

high potency/short acting benzodiazepines + CBT

52
Q

Agoraphobia

A

disabling complication of panic disorder, intense fear of places or situations in which escape might be difficult or embarassing

53
Q

social phobia H&P:

A

social anxiety, intense fear of being scrutinized in social or public settings, fear induces anxiety response, avoidance of distress

54
Q

Social phobia TX:

A

beta blockers, SSRIs, alprazolam, gabapentin, CBT ==> flooding and systemic desensitization

55
Q

Generalized anxiety disorder

A

characterized by intensive pervasive worry over virtually every aspect of life associated with physical manifestations of anxiety
occurs most days for at least 6 months
3 of the following symptoms: restlesness, easily fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, sleep disturbance

56
Q

generalized anxiety disorder TX:

A

benzos, SSRIs, buspirone, SSRIs, gabvapentin, B-blockers

57
Q

PTSD H&P:

A

persistent re-experience of a trauma, efforts to avoid recollecting the trauma, and hyperarousal.
people wit PTSD endured traumatic event which is relived through repetitive intrusive images, dreams, illusions, hallucinations, flashbacks.
acute PTSD < 3 months
Acute PTSD > 6 months
Delayed onset PTSD; onset after 6 months

58
Q

PTSD TX:

A

SSRIs used for 6 months
psychotherapy
propanalol can be given prophylactically after trauma to prevent PTSD

59
Q

Acute Stress disorder

A

basically PTSD lasting minumum of 2 days and less than 30 days

60
Q

OCD H&P

A

pts have recurrent obsessions (intrusive ideas, thoughts, or images that cause significant anxiety and distress) and compulsions (repetitive, purposeful physical or mental actions that are performed in response to obsessions)

61
Q

OCD TX:

A

CBT, clomipramine, SSRs

62
Q

What are the positive symptoms of schizophrenia?

A

hallucinations
delusions
disorganized speech
bizarre behavior – aggressive/agitated, odd clothing, odd social behavior

63
Q

What are the negative symptoms of schizophrenia?

A

affective flattening – decreased emotional expression, decreased gestures
Alogia – lack of words
associality –few friends, activities, interests, hyposexual

64
Q

Schizophrenia H&P:

A

psychotic symptoms and social/occupational dysfunction lasting > 6 months
Pts with schizophrenia at high risk for suicide

65
Q

Schizophrenia TX:

A

antipsychotic meds and psychosocial treatment

66
Q

Schizoaffective disorder H&P:

A

psychotic episodes that resemble schizophrenia with mood disorders
mood disorders can be any; ie manic or depressive
must have psychotic symptoms present in the abscence of mood swings

67
Q

Schizoaffective TX:

A

typically a combination of an antipsychotic and mood stabilzer

68
Q

shizophreniform disorder

A

schizophrenia that lasts <6 months

69
Q

shizophreniform disorder TX

A

self limited

70
Q

brief psychotic disorder H&P:

A

associated with bipolar disorder and schizotypal disorder
develops psychotic symptoms that last from 1 to 30 days: delusions, hallucinations, disorganized speech, disorganized behavior
TX: hospitalization to protect patient, antipsychotics although condition is self limited

71
Q

Major depressive disorder criteria

A 
SIG E CAPS
sleep
interest
guilt
energy
concentration
appetite
psychmotor retardation
suicidal ideation
72
Q

Tx major depressive disorder

A

psychotherapy; CBT, exercise, meditation

TCAs, SSRIs, MAOi’s

73
Q

dysthymic disorder

A

mild, chronic form of major depressive disorder
requires pt have a minimum of 2 yrs of chronically depressed mood, most of the time
associated w/ changes in appetite, sleep, fatigue, decreased concentration, hopelessness

74
Q

dysthymic disorder TX:

A

same as major depression but with more psychotherapy

75
Q

Bipolar I disorder

A

defined by occurence of one or more manic episodes + depressive episodes
manic episode: 3 to 4 of the following during elevated mood lasting >1wk or requiring hospitalization, self esteem, sleep, speech, thoughts, attention, hedonism

76
Q

Bipolar I TX:

A

antipsychotics + benzos for acute mania
initiation of mood stabilizers (usually lithium)
ECT can be used for immediate responses
psychotherapy to increase medicine compl;iance, help pts come to terms

77
Q

Bipolar II

A

characterized by occurrence of hypomania and episodes of major depression in an individual who has no mania, disorder is cyclic

78
Q

Tx;

A

same as bipolar I

79
Q

Cyclothymic disorder H&P:

A

recurrent, chronic, mild form of bipolar disorder in which moods oscillate between hypomania and dysthmia

80
Q

Cyclothymic disorder TX:

A

psychotherapy, mood stabilizers, antidepressants

81
Q

ECG changes in hypokalemia

A

depression of the ST segment, flattened T waves, increased U wave amplitude

82
Q

ECG changes in hyperkalemia

A

Tall peaked T waves with shortened Qt intervals initially;
progressive lengthening of the PR interval and QRS duration, P wave may disapear, QRS complex widens and becomes a sine pattern with severe hyperkalemia.

83
Q

signs of digoxin toxicity

A

nausea, somnolence, fatigue, visual alterations (yellow green confusion)

84
Q

ECG findings on digoxin toxicity:

A

scooped ST segments (downward scooping after QRS)

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