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Rosen's Cardinal Presentations > Chapter 9-32 !! > Flashcards

Chapter 9-32 !! Flashcards

1
Q

classification system for AUB

A

PALM-COEIN

structural- PALM
polyps
adenomyosis
leiomyomas
malignancy
nonstructural- COEIN
coagulopathy
ovulatory dysfuction
endocrine
iatrogenic
Not yet specified
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2
Q

most likely diagnoses for vaginal bleeding in prepubescent girls

A 
vaginitis
foreign bodies
sexual abuse
tumors 
trauma
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3
Q

most likely diagnoses for vaignal bleeding in adolescent girls

A

anovulation due to immaturity of HPA axis
bleeding disorders
STIs

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4
Q

most likely diagnoses for vaginal bleeding in reproductive age women

A

structural lesions - polyps, fibroids

PCOS

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5
Q

most likely diagnoses for vaginal bleeding in perimenopausal women

A

anovulatory cycles become common as ovarian function declines

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6
Q

most likely diagnoses for vaginal bleeding in postmenopausal women

A

endometrial atrophy

endometrial cancer

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7
Q

DDX for structural causes of vaginal bleeding in nonpregnant females

A 
polyps
fibroids
malignncy
hyperplasia
endometriosis
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8
Q

DDX for nonstructural causes of AUB in non pregnant fmeales

A

coagulopathies: vWD, factor XI deficiency, thrombocytopenia, ITP
endocrine: PCOS, hypothyroidism, hyperprolactinemia, adrenal hyperplasia, Cushing’s disease
hypothalamic: weight loss, extreme exercise, stress
obesity
trauma / sexual abuse
infections: TOA, vaginitis, STI
systemic disease: liver, kidneys
foreing bodies
medications: anti epileptics, antipsychotics, anticoagulants, hormonal medications, steroids
IUD

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9
Q

DDX for pregnant vaginal bleeding before 20 weeks gestation

A 
ectopic pregnancy
GTD
abortion/miscarriage
implantation bleeding
ruptured corpus luteum cyst
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10
Q

DDX for pregnant vaginal bleeding after 20 weeks

A 
placenta previa
vasa previa
placental abruption
uterine rupture
AVM
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11
Q

risk factors for ectopic pregnancy

A 
smoking
IVF
previous ectopic
use of IUD
prior tubal surgery
PID
endometriosis
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12
Q

important symptoms to clarify on history in patient with vaginal bleeding

A 
amount of bleeding, presence of clots
dizziness, syncope, or weakness 
abdo pain
fever
vaginal discharge or odor
postcoital bleeding
hx of trauma
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13
Q

physical examination in vaginal bleeding

A

determine hemodynamic status
performing complete abdominal and pelvic exam
pelvic exam may reveal source of bleeding because masses, polyps, ulcers, foreign bodies and evidence of trauma or inflammation may be visualized

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14
Q

lab /tests in pt with vaginal bleeding

A

pregnancy test
hemodynamically unstable pts - CBC, type and cross matching, coags, and if pregnant a quantitative B-hCG
bedside US for IUP

hemodynamically stable- as outpt TSH and other hormone levels, complete pelvic US

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15
Q

in pregnant patients over 20 weeks GA, what needs to be done before pelvic

A

US to make sure no placenta previa

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16
Q

treatment of hemodynamically unstable vaginal bleed

A

IV crystalloid bolus
blood transfusions if not response to bolus

high dose IV conjugated estrogen (25mg) is first line, q4-6h for up to 24 hours
if bleeding continues can pack vagina with long continuous gauze, or insert foley into uterus to tamponade bleeding

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17
Q

treatment of stable non pregnant patent with vaginal bleedign

A

NSAIDs
OCP -ie. alesse or other low dose under 35ug of ethanol estradiol, one pill BID for 5 days and then one pill daily for remainder of pack OR if contradicted can use medroxyprogresterne acetate 10mg daily x 10days

OR (not in rosen’s)
TXA 1g PO TID x 5 days

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18
Q

contraindications to use of estrogen

A 
hx of thromboembolic events or stroke
pregnancy
active liver disease
severe uncontrolled htn
women older than 35 who smoke
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19
Q

critical chest pain diagnoses

A

acute MI
acute coronary ischemia
aortic dissection
cardiac tamponade

PE
tension pneumo

esophageal rupture (Boerhaave’s syndrome)

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20
Q

emergent chest pain diagnoses

A

unstable angina
coronary spasm
prinzmetal’s angina
cocaine-induced pericarditis or myocarditis

pneumothorax
mediastinitis

esophageal tear (Mallory-Weiss)
cholecystitis
pancreatitis

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21
Q

nonemergent chest pain diagnoses

A

valvular heart disease
AS
MVP
HCM

pneumonia
pleuritis, tumuour, pneumomediastinum

esophageal spasm
esophageal reflux
peptic ulcer, biliary colic

muscle strain, rib # arthritis, tumor, costochondritits, nonspecific chest wall pain

spinal root compression, thoracic outlet, herpes zoster, PHN

psychological, hyperventilation

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22
Q

risk factors for ACS

A 
past or family hx of CAD
age men > 33, women >40
diabetes mellitus
hypertension
cigarette use or possible passive exposure
elevated cholesterol or triglycerides
sedentary lifestyle
obesity
postmenopausal
LV hypertrophy
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23
Q

risk factors for PE

A 
prolonged immobilzation
surgery > 30 min in last 3 mos
prior DVT or PE
pregnancy or recent pregnancy
pelvic or lower extremity trauma
oral contraceptives + smoking
CHF
obestiy
PMHx or famhx of hypercoagulability
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24
Q

risk factors for aortic dissection

A 
htn
congenital dz. of aorta or aortic valve
inflammatory aortic dz.
CTD
pregnancy
arteriosclerosis
cigarette use
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25
Q

risk factors for pericarditis or myocarditis

A 
infection
autoimmune dz. (lupus)
acute rheumatic fever
recent MI or cardiac surgery
malignanct
radiation therapy to mediastinum
uremia
drugs
prior pericarditis
26
Q

risk factors for pneumothorax

A

prior pneumothorax
Valsalva’s maneuver
chronic lung disease
smoking

27
Q

chest pain described as crushing pressure, substernal, exertion, radiation to jaw, neck, shoulder, arm

A

acute MI, coronary ischemia, unstable angina, coronary spasm

28
Q

chest pain described as tearing, severe, radiating to or located in back, maximum at onset, may migrate to upper back or neck

A

aortic dissection

29
Q

chest pain that is pleuritic

A

esophageal rupture, pneumothorax, cholecystitis, pericarditis, myocarditis

30
Q

chest pain described as indigestion or burning

A

acute MI, coronary ichemia, esophageal rupture, UA, coronary spasm, esophageal tear, cholecystitis

31
Q

chest pain associated with syncope or near-syncope

A

aortic dissection, PE, acute MI, pericarditis, myocarditis

32
Q

chest pain associated with dyspnea (SOB, DOE, PND, orthopnea)

A

acute MI, coronary schema, PE, tension pneumothorax, pneumothorax, UA, pericarditis

33
Q

chest pain associated with hemoptysis

A

PE

34
Q

chest pain associated with nausea, vomitting

A

esophageal rupture, acute MI, coronary schema, UA, coronary spasm, esophageal tear, cholecystitis

35
Q

chest pain + acute respiratory distress

A

PE, tension pneumothorax, acute MI, pneumothorax

36
Q

chest pain + diaphoresis

A

acute MI, aortic dissection, coronary ischemia, PE, esophageal rupture, UA, cholecystitis, perforated peptic ulcer

37
Q

chest pain + hypotension

A

tension pneumothorax, PE, acute MI, aortic dissection, coronary schema, esophageal rupture, pericarditis, myocarditis

38
Q

chest pain + tachycardia

A

acute MI, PE, aortic dissection, coronary ischemia, tension pneumothorax, esophageal rupture, coronary spasm, pericarditis, myocarditis, mediastinitis, cholecystitis, esophageal tear

39
Q

chest pain + bradycardia

A

acute MI, coronary schema, UA

40
Q

chest pain + hypertension

A

acute MI, coronary ischemia, aortic dissection

41
Q

chest pain + fever

A

PE, esophageal rupture, pericarditis, myocarditis, mediastnitis, cholecystitis

42
Q

chest pain + hypoxemia

A

PE, tension pneumothorax, pneumothorax

43
Q

chest apin + diffrence in UP BPs

A

aortic dissection

44
Q

chest pain + narrow pulse pressure

A

pericarditis with effusion

45
Q

chest pain + new murmur

A

acute MI, aortic dissection, coronary ischemia

46
Q

chest pain + S3,S4 gallop

A

acute MI, coronary ischemia

47
Q

chest pain + pericardial rub

A

pericarditis

48
Q

chest pain + audible systolic “crunch” on cardiac auscultation

A

esophageal rupture, mediastinitis

49
Q

chest pain + JVD

A

acute MI, coronary ischemia, tension pneumothorax, PE, pericarditis

50
Q

chest pain + unilateral diminished or absent breath sounds

A

tension pneumo, pneumo

51
Q

chest pain + pleural rub

A

PE

52
Q

chest pain+ subQ emphysema

A

tension pneumo, esophageal rupture, pneumo, mediastnitis

53
Q

chest pain + rales

A

acute MI, coronary ischemia, UA

54
Q

chest pain + epigastric tenderness

A

esophageal rupture, esophageal tear, cholecystitis, pancreatitis

55
Q

chest pain + LUQ tenderness

A

pancreatitis

56
Q

chest pain + RUQ tenderness

A

cholecystitis

57
Q

chest pain + unilateral leg swelling, warmth, pain, tenderness, erythema

A

PE

58
Q

chest pain + focal neuro findings

A

aortic dissection

59
Q

chest pain + stroke

A

acute MI

60
Q

nonneurologic causes of weakness

A

alterations in plasma volume (dehydration)
alterations in plasma composition (glucose, lytes)
derangement in circulating RBCs (anemia or polycythemia)
decrease in cardiac pump function (MI)
decrease in SVR (vasodilator shock from any cause)
increased metabolic demand (local or systemic infection, endocrinopathy, toxin)
mitochondrial dysfunction (severe sepsis or toxin-mediated)
global depression of CNS (stimulant withdrawal, sedatives)

Rosen's Cardinal Presentations (2 decks)

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