CHEST PAIN AND SENSORIUM

Question 1

recent onset of pain, pressure, or tightness in the anterior thorax between the xiphoid, suprasternal notch and both midaxillary lines

Answer 1

chest pain

Question 2

________ includes:
Acute myocardial infarction
acute ischemia/unstable angina

Answer 2

acute coronary syndrome

Question 3

type of chest pain

retrosternal left anterior chest crushing, squeezing, tightness or pressure

classic features of ACS
Radiation to the neck, arms or jaw
diaphoresis
dyspnea
nausea and vomiting

Answer 3

classic cardiac pain

Question 4

chest pains lasting for 12-24 hours or more without waxing and waning intensity or pain worsened by specific body movements or positions

Answer 4

non-classic cardiac pain

Question 5

innervates the chest wall from the dermis to the parietal pleura

pain from somatic fibers is usually easily described, precisely located and often experienced as a sharp sensation

Answer 5

somatic pain fibers

Question 6

found in the internal organs such as the heart, esophagus and visceral pleura

patients with visceral pain are more likely to use terms such as discomfort, heaviness, pressure, tightness or aching

visceral pain is often referred to an area of the body corresponding to adjacent somatic nerves

Answer 6

visceral pain fibers

Question 7

angina occurring at rest and that is prolonged usually >20 minutes

Answer 7

rest angina

Question 8

new onset angina that markedly limits ordinary physical activity

Answer 8

new onset angina

Question 9

previously diagnosed angina that has become distinct more frequent has a longer duration or is lower in threshold, limiting ability to walk 1-2 blocks or climb 1 flight of stairs

Answer 9

increasing angina

Question 10

_________ occurs when there is an imbalance of oxygen demand and oxygen supply

Answer 10

ischemia

Question 11

influenced by the oxygen carrying capacity of the blood and the coronary artery blood flow

Answer 11

oxygen supply

Question 12

determined by the amount of hemoglobin present and oxygen saturation

Answer 12

oxygen carrying capacityuni

Question 13

universal sign of ischemic chest pain

defines as an individual holding a clenched fist over the chest that has low sensitivity but is a relatively specific ischemia

Answer 13

levine sign

Question 14

ST segment elevations in V1, V2 and possibly V3

Answer 14

anteroseptal

Question 15

ST segment elevations in V1, V2, V3, and V4

Answer 15

anterior

Question 16

ST segment elevations in V1-V6, I, and aVL

Answer 16

anterolateral

Question 17

ST segment elevations in I and aVL

Answer 17

Lateral

Question 18

ST segment elevations in II, III, and aVF

Answer 18

inferior

Question 19

ST Segment elevations in II, III, aVF, and V5 and V6

Answer 19

inferolateral

Question 20

medications for ST segment elevation or ischemic ECG

A, C, N, beta, anti-

Answer 20

aspirin
clopidogrel
nitroglycerin
beta blockers
antithrombin

Question 21

___________ is indicated for patients with STEMI (as a reperfusion option) if time to treatment is <6 to 12 hours from symptom onset and the ECG has at least 1 mm of ST segment elevation in two or more contiguous leads

Answer 21

fibrinolytic therapy

Question 22

__________ encompass a number of life threatening aortic emergencies

includes:
aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma and aortic aneurysmal leakages

Answer 22

acute aortic syndromes

Question 23

__________ occurs after a violation of the intima, allows blood to enter the media and dissect between the intimal and adventitial layers

Answer 23

aortic dissection

Question 24

stanford classification
involvement of the ascending aorta

Answer 24

type A dissection

Question 25

standford classification restricted only to descending aorta

Answer 25

type B dissection

Question 26

debakey simultaneously involve the ascending aorta, arch and descending aorta

Answer 26

type 1 dissection

Question 27

debakey involves only the ascending aorta

Answer 27

type 2 dissection

Question 28

debakey involve only the descending aorta

Answer 28

type 3 dissection

Question 29

a plain _________- may provide important clues for diagnosis

Answer 29

a plain chest xray

Question 30

imaging modality of choice for diagnosis of dissection can reliably identify a false lumen and can provide additional details such as anatomy of the dissection, the location of the dissection flap, extension of the flap into great vessels, signs of aortic rupture and signs of end organ damage

Answer 30

ct scan

Question 31

sensitive and specific as CT procedure generally has to be performed under moderate sedation or even general anesthesia

Answer 31

transesophageal echocardiography

Question 32

P wave

Answer 32

atrial depolarization

Question 33

distant between the onset of P wave to the onset of QRS

Answer 33

PR interval

Question 34

ventricular depolarization

Answer 34

QRS complex

Question 35

plateau phase, phase 2 of cardiomyocyte action potential

Answer 35

ST segment

Question 36

point where ST segment starts

Answer 36

J point

Question 37

rapid depolarization of contractile sacs

Answer 37

T wave

Question 38

duration of ventricular depolarization and repolarization

Answer 38

QT interval

Question 39

______- are not designed to shock flatline (asystole patterns)

Answer 39

defibrillators

Question 40

the _____ is a test of sensation and if positive may distinguish sensory from motor ataxia

Answer 40

romberg test

Question 41

the _____- response is the toe that moves upward in response to a mildly noxious stimulation applied to the lateral plantar or lateral aspect of the foot

Answer 41

babinski response

Question 42

a ____--- is an episode of abnormal neurologic function caused by inappropriate electrical discharge of neurons

Answer 42

seizure

Question 43

_________ is a clinical condition in which an individual is a subject to recurrent seizures

Answer 43

epilepsy

Question 44

___________ are those in which no evident cause can be identified (type of seizure)

Answer 44

idiopathic seizure

Question 45

______ are seizures that are a consequence of an identifiable neurologic condition such as mass lesion, previous head injury or stroke

Answer 45

symptomatic seizure

Question 46

in a typical attack the patient suddenly becomes rigid (tonic phase), trunk and extremities are extended, and patient falls to the ground

Answer 46

generalized tonic clonic seizures