Case 7- Confused teenage girl

Question 1

DDx of chest pain in children

Answer 1

s

Question 2

Must not miss diagnoses (x5)

Answer 2

Aortic dissection, pneumothorax, pericardial tamponade, pulmonary embolism, MI

Question 3

Ultrasound technology

Answer 3

s

Question 4

Hx of Ped Patient

Answer 4

family (genetic), surgical, social, past medical hx and description of pain

Question 5

Mid systolic click=

Answer 5

Mitral valve prolapse

Question 6

Chest wall syndrome

Answer 6

painful area of chest wall

Question 7

costochondritis

Answer 7

frequent left 4th sternocostal

Question 8

Teitze

Answer 8

= painful swelling 2/3 rib

Question 9

Precordial catch syndrome

Answer 9

brief sudden sharp pain, increased with inspiration.

Question 10

Slipping rib syndrome

Answer 10

8-10 ribs. Dx: with hooking maneuver

Question 11

Xiphoid pain

Answer 11

tenderness of xiphoid

Question 12

Sickle cell vaso occlusive episode

Answer 12

rib or lung infarction

Question 13

Causes of palpitations (life threatening)

Answer 13

arrhythmia (WPW syndrome, prolonged QT), hypertrophic cardiomyopathy, myocarditis, sick sinus, pacemaker malfunction

Question 14

Causes of palpitations (non life threatening)

Answer 14

premature atrial contraction, premature ventricular contractions, fever, anemia, exercise

Question 15

Pertinent negatives of case:

Answer 15

not pneumonia, endocarditis, pleurisy, congenital heart disease, no chest wall tenderness

Question 16

Mitral valve prolapse sx

Answer 16

dyspnea, exercise intolerance, dizziness/syncope, panic attacks, numbness/tingling, abnormal resting ECGs

Question 17

Most murmurs during valsalva?

Answer 17

decrease in length and intesity

Question 18

Exceptions to decreased length/intensity of murmurs during valsalva. What are murmurs like?

Answer 18

Hypertrophic cardiomyopathy, mitral valve prolapse
Squatting= later click, shorter murmur
Standing/Valsalva= early click and long murmur

Question 19

MVP or Hypertrophic cardiomyopathy?

Answer 19

Mid systolic click= MVP

Hand grip- intensifies MVP but diminishes hypertrophic cardiomyopathy

Question 20

Valsalva maneuver and standing

Answer 20

decreased preload

Question 21

Squatting

Answer 21

increased preload and afterload, rise in pressure

Question 22

Hand grip

Answer 22

increase afterload (TPR) and increase back pressure on mitral valve

Question 23

Ultrasound

Answer 23

no radiation, can see blood flow (doppler ultrasound). Sonar technology with transducer

Question 24

Diagnosis of MGP

Answer 24

systolic mitral leaflet displacement >2mm above annular plane in parasternal or apical long axis

Question 25

MVP associated with

Answer 25

Von willebrand, hypomastia, mesenchymal dysplasia

Question 26

Risk factors for MVP

Answer 26

ehlers danlos, marfan, polycystic diseas, graves disease, pectus excavatum, bipolar, low BMI

Question 27

Sx only in marfan syndrome- not in MVP

Answer 27

Ectopia lentis, aortic involvement, skeletal findings, fam hx

Question 28

Mg deficiency

Answer 28

60% of MVP patients

Question 29

MVP treatment

Answer 29

B-blockers, behavior changes, endocarditis prophylaxis (only if regurgitation is very severe)

Question 30

What tells us an athlete with MVP can participate in sports?

Answer 30

normal sinus rhythm, mild-moderate regurg, normal LV size and function

Question 31

Low activity if pt (with MVP) has

Answer 31

syncope, sudden cardiac death (in fam member with MVP), tachycardia, ventricular tachyarrhythmias, severe mitral valve regurg, prior embolic events, LV systolic dysfunction

Question 32

BMI

Answer 32

25= obese

Question 33

Vit requirements?

Answer 33

calcium, VitD, weight bearing activity, limit cola, no cigarettes

Question 34

You might be a lesbian?

Answer 34

``` BE PATIENT you are not alone you are normal take care of your body (safe sex) be aware of your feelings, find answers from reliable sources ```

Question 35

Bisexuals vs heterosexuals?

Answer 35

Bisexuals have more penile intercourse and have bad contraception use

Question 36

Lesbians have higher rates of?

Answer 36

hx sexual abuse/prostitution

Question 37

Rate of lesbians

Answer 37

1/10 have attraction to other girls

Question 38

bisexual

Answer 38

attraction to both sexes, doesnt have to be equal

Question 39

gender identity

Answer 39

sense of being masculin, feminine etc

Question 40

hermpahrodite

Answer 40

offensive term for intersex

Question 41

intersex

Answer 41

person is born with reproductive anatomy that doesnt fit typical definitions of male/female

Question 42

transsexxual

Answer 42

identification of gender other than the one a person feels at birth

Question 43

sexual identity

Answer 43

how a person identifies as female/male