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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
Treatment of Anorexia Nervosa:
hospitalization if patient is at risk, meal supervision, weight and electrolyte monitoring, CBT, SSRIs for comorbid depression
26
Bulimia Nervosa H&P:
``` bing eating (+/- purging) to avoid weight gain while maintaining body weight body image issues ```
27
Treatment of Bulimia Nervosa:
manage medical complications SSRIs CBT
28
What is the number 1 cause of mental retardation, what is the most common heritable cause?
downs syndrome #1 | fragile X #1 heritable
29
Treatment of mental retardation?
mild: family support and special education Moderate: train child to perform simple tasks
30
Autistic Disorder H&P (triad?)
pervasive developmental disorder of childhood onset | triad: restricted activity and interests, impaired social interactions, impaired ability to communicate
31
Treatment of Autistic Disorder
behavioral management techniques | special education/specialized programs for behavior management
32
Retts Disorder H&P:
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
33
TX of Retts disorder
behavioral techniques, antiseizure/antipsychotic medications
34
Aspergers H&P
impaired social interactions | restrictive, repetitive, sterotyped behaviors and interest, no developmental delays
35
TX of aspergers
educational, behavioral, psychotherapy targeted at maximizing social interaction
36
conduct/Oppositional defiant disorder
``` 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
Paranoid personality disorder H&P:
pts are distrustful, suspicious and anticipate harm and betrayal. not forthcoming about themselves. use projection as a defensive
38
shizoid personality disorders
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
shizotypal personality disorder
pts have odd thoughts, affects, perceptions and beliefs similar to schizophrenia without sustained psychotic symptoms often paranoid and restrict their world
40
antisocial personality disorder
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
Borderline personality disorder
Pts have instability in relationships, self image, affect and impulse control (sex, violence, drug abuse) frequent suicidal defense is splitting
42
histriotronic personality disorder
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
narcissistic personality disorder
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
avoidant personality disorder
Pts experience intense feelings of inadequacy, hypersensitivity to criticism, and consequent social inhibition desire relationships but avoid them because of the anxiety
45
dependent personality disorder
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
obsessive compulsive personality disorder
pts are perfectionists who require order and control | cold and rigid in relationships, devotion to work often replaces intimacy
47
signs of alcohol withdrawal
4-12 hrs --> tremulousness 8-12 --> perceptual disturbances 12-24 hrs --> seizures 72 --> delirium
48
Signs of opiate withdrawal
``` pupillary dilation piloerection sweating tachycardia fever diarrhea insomnia yawning nausea/vomiting ```
49
signs of atypical depression
hypersomnia, increased appetite/weight gain, mood reactivity, long standing rejection sensitivity, leaden paralsysis
50
Panic disorder
characterized by recurrent, unexpected panic attacks occurring with or without agoraphobia panic attacks occur suddenly peak within 10 minutes, lasts 5-30 minutes
51
Tx panic disorder:
high potency/short acting benzodiazepines + CBT
52
Agoraphobia
disabling complication of panic disorder, intense fear of places or situations in which escape might be difficult or embarassing
53
social phobia H&P:
social anxiety, intense fear of being scrutinized in social or public settings, fear induces anxiety response, avoidance of distress
54
Social phobia TX:
beta blockers, SSRIs, alprazolam, gabapentin, CBT ==> flooding and systemic desensitization
55
Generalized anxiety disorder
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
generalized anxiety disorder TX:
benzos, SSRIs, buspirone, SSRIs, gabvapentin, B-blockers
57
PTSD H&P:
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
PTSD TX:
SSRIs used for 6 months psychotherapy propanalol can be given prophylactically after trauma to prevent PTSD
59
Acute Stress disorder
basically PTSD lasting minumum of 2 days and less than 30 days
60
OCD H&P
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
OCD TX:
CBT, clomipramine, SSRs
62
What are the positive symptoms of schizophrenia?
hallucinations delusions disorganized speech bizarre behavior -- aggressive/agitated, odd clothing, odd social behavior
63
What are the negative symptoms of schizophrenia?
affective flattening -- decreased emotional expression, decreased gestures Alogia -- lack of words associality --few friends, activities, interests, hyposexual
64
Schizophrenia H&P:
psychotic symptoms and social/occupational dysfunction lasting > 6 months Pts with schizophrenia at high risk for suicide
65
Schizophrenia TX:
antipsychotic meds and psychosocial treatment
66
Schizoaffective disorder H&P:
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
Schizoaffective TX:
typically a combination of an antipsychotic and mood stabilzer
68
shizophreniform disorder
schizophrenia that lasts <6 months
69
shizophreniform disorder TX
self limited
70
brief psychotic disorder H&P:
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
Major depressive disorder criteria
``` SIG E CAPS sleep interest guilt energy concentration appetite psychmotor retardation suicidal ideation ```
72
Tx major depressive disorder
psychotherapy; CBT, exercise, meditation | TCAs, SSRIs, MAOi's
73
dysthymic disorder
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
dysthymic disorder TX:
same as major depression but with more psychotherapy
75
Bipolar I disorder
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
Bipolar I TX:
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
Bipolar II
characterized by occurrence of hypomania and episodes of major depression in an individual who has no mania, disorder is cyclic
78
Tx;
same as bipolar I
79
Cyclothymic disorder H&P:
recurrent, chronic, mild form of bipolar disorder in which moods oscillate between hypomania and dysthmia
80
Cyclothymic disorder TX:
psychotherapy, mood stabilizers, antidepressants
81
ECG changes in hypokalemia
depression of the ST segment, flattened T waves, increased U wave amplitude
82
ECG changes in hyperkalemia
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
signs of digoxin toxicity
nausea, somnolence, fatigue, visual alterations (yellow green confusion)
84
ECG findings on digoxin toxicity:
scooped ST segments (downward scooping after QRS)

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