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Clinical Prep > CP chief complaint- EMERGENT conditions > Flashcards

CP chief complaint- EMERGENT conditions Flashcards

1
Q

TIMI heart score

A 
age >65
known CAD
>3 risk factors for CAD
EKG abnormal
\+ cardiac markers
recent Aspirin use
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2
Q

lung collapse

A

PNX

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3
Q

PNX

A

air leaks into the space b/w chest wall and lung, making the lung collapse

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4
Q

tall thin men with pleuritic CP, 20-40 years of age

A

Primary spontaneous PNX (lung collapse. idiopathic)

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5
Q

Tension PNX

A

mediastinal structures are shifted to the side

positive air pressure pushes these structures all wonky

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6
Q

Clinical sx:

Pleuritic CP, Unilateral, Non-exertional, Sudden, SOB

A

PNX (collapsed lung)

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7
Q

Hyperresonance
Decreased fremitus
Decreased breath sounds

A

PNX

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8
Q

Test of choice to diagnose PNX

A

CXR- upright view. Expiratory

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9
Q

Tension PNX additional sx

A

Increased JVP
systemic Hypotension
Pulsus paradoxus (exag drop in BP w inspiration)

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10
Q

what does JVP reflect?

Jugular venous pressure

A

Pressure in the Right Atrium

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11
Q

Tension PNX always need

A

Needle aspiration then Chest tube

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12
Q 
Small PSP (primary spon PNX) vs
Large PSP mgmt
A

small: Observe and supp O2
large: needle/cath aspiration vs chest tube or cath thoracostomy

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13
Q

stable, Secondary Spon PNX (d/t underlying dz like COPD or Asthma)

A

Chest tube or catheter thorac

+ Admit

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14
Q

Patient ed after PNX

A

Avoid pressure changes for at least 2 weeks

  • high altitude
  • smoking
  • aircraft
  • scuba diving
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15
Q

Virchow’s triad

A

Risk for PE

  • damage
  • stasis
  • hyper coagulability condition
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16
Q

Classic triad of sudden onset

A

SOB
Pleuritic CP
Cough

signs of PE!!

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17
Q

PE of someone with PE

A

Tachypnea
Tachycardic
Low grade fever (interesting)

often lung exam is normal

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18
Q

PE of someone with MASSIVE PE

A

LOC
Hypotension
Pulseless electrical activity

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19
Q

CXR of someone with PE

A

often normal!!

a normal CXR in the setting of hypoxia is highly suspicious for PE

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20
Q

Most common abnormal finding in someone with PE

A

Atelectasis: partial lung collapse

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21
Q

Most common EKG changes in someone with PE

A

Tachy

Nonspec ST/T changes

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22
Q

Most specific EKG changes indicating PE

A

S1Q3T3

wide and deep S (the down part) in lead I

isolated Q and T wave inversion in lead III

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23
Q

best test to confirm PE, but not diagnose

A

Helical (spiral) CT angiography

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24
Q

When to use VQ scan to detect PE

A

Pregnant pt

increased Creatine

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25
Q

GOLD standard to diagnose PE

A

f sj,/vc22`bh,mmmv

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26
Q

GOLD standard to diagnose PE

A

Pulmonary angiography- BUT rarely performed bc. ordered if high suspicion and negative CT or VQ scan

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27
Q

Tx of PE if pt is hemoD stable

A

Anticoag-1st line

Heparin bridge + Warfarin or novel oral anticoag

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28
Q

Tx of PE if pt is hemoD stable and one of following 3 is present:

A
  • Anticoag is contra-indicated (recent bleed, bleeding disorder)
  • Anticoag doesn’t work
  • Right ventricle dysfx seen on echo (bc even super small clot can be fatal)
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29
Q

Tx of PE if pt is NOT STABLE

A

systolic <90, acute RV dysfx

Thrombolysis (meds) vs. Thrombectomy/ Embolectomy

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30
Q

if PE is unlikely, what do you order?

A

D-dimer, good at ruling OUT PE but not really at confirming presence, need to order more if +

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31
Q

if PE is likely, what do you order?

A

Helical CT scan

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32
Q

Wells Criteria for PE

A

3 points:

  • clinical signs and sx of DVT
  • PE is #1 dx or equally likely
  1. 5 points:
    - HR >100 bpm
    - have been immobile at least 3d OR surgery in prev 4 wks
    - previous DVT/PE

1 point added:

  • hemoptysis (bloody cough)
  • Cancer
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33
Q

Low prob of PE (Wells)

A

<2 points

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34
Q

High prob of PE (Wells)

A

> 6 points

consider CT Angiography

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35
Q

PERC criteria to rule out PE

A

If pt is low risk and meets all 8, no need to get any testing

If pt is low risk but does not meet all criteria, D-dimer is indicated

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36
Q

PERC Criteria

A 
Younger than 50
HR <100
Ox sat >95%
No hemoptysis
No estrogen use
No prior DVT/PE
No unilateral leg swelling
No surgery/trauma req hosp in recent 4 wks
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37
Q

Pericardial effusion

A

Accum of fluid in pericardial sac

Same cause of Acute pericarditis- viral, idiopathic, cancer

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38
Q

EKG changes assoc with Pericardial Effusion

A

Electrical alternans- alternating amplitudes of QRS complex bc heart is swaying around in all of the fluid

Low QRS voltage

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39
Q

Tx of Pericardial effusion

A

Treat underlying cause- i.e. the pericarditis

Large effusion may need Pericardiocentesis for sx relief (draining)

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40
Q

Cardiac Tamponade

A

an Effusion (fluid) is causing pressure on heart- messing up Filling –> decreased CO and shock

MEDICAL EMERGENCY

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41
Q

What is the more important factor for severity of Tamponade?

A

How quickly the fluid accumulates

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42
Q

Cause of tamponade

A

comp of Pericarditis or TRAUMA- like the ATV accident pt encounter

Most common nontraumatic cause- Cancer

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43
Q

Beck’s triad

A

Tamponade

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44
Q

Low BP (hypotension)
Muffled heart sounds
JVP

A

BECKS TRIAD: a/w Cardiac Tamponade

Other sx:

  • pulsus paradoxus
  • SOB
  • fatigue
  • periph edema
  • shock
  • cool extremities
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45
Q

Diagnosis of Tamponade

A

Echo: shows effusion + diastolic collapse of cardiac chambers

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46
Q

Tx of Tamponade

REMEMBER IT’S a MEDICAL EMERGENCY

A

Immediate Pericardiocentesis to remove pressure

Volume resusc and pressure support if needed , Pericardial window if recurrent

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47
Q

Epigastric pain- constant, boring, radiates to back

A

Pancreatitis

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48
Q

2 most common causes of Pancreatitis

A

Gallstones

Alcohol abuse

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49
Q

Phys Exam signs of Acute Pancreatitis

A

Epigastric pain
Tachycardia
Dec bowel sounds
Dehydration

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50
Q

Necrotizing hemorrhagic Pancreatitis

A

Cullen signs- belly button

Grey turner sign- flank

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51
Q

Diagnostic criteria for Pancreatitis

A

Acute onset epigastric abd pain –> radiating to back
Elevated LIPASE or AMYLASE 3x normal
Imaging

but if first two are present, don’t need the 3rd

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52
Q

Which lab is most specific for Pancreatitis?

A

Lipase!!!

Lipase goes with Pancreatitis

LP

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53
Q

Why might you see Hypocalcemia with Pancreatitis?

A

necrotic fat binds to calcium, lowering the serum levels

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54
Q

Tx of Pancreatitis

A

“Rest the pancreas”

Actually, 90% recover in 3-7 days with only supportive care

NPO, high volume IVF (lactated ringer), Pain meds

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55
Q

Are Abx used in Pancreatitis?

A

Not routinely. Only if severe infected necrosis is seen- then broad spectrum like Imipenem may be used

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56
Q

Chronic Pancreatitis

A

Triad: (but only seen in 1/3 of these pts) hmm..

Calcifications
Steatorrhea
DM

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57
Q

Other sx of Chronic Pancreatiits

A

Weight loss
Epigastric pain
Then the triad: Calcifications, steatorrhea, DM

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58
Q

Imaging of Chronic Pancreatitis

A

Calcification seen on CT and X Ray

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59
Q

Pancreatic function testing

A

Fecal elastase (most sensitive and specific)

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60
Q

Tx of Chronic Panceatitis

A 
Stop drinking, Pain meds
Low fat diet
Vit supp
Oral enzyme replacement
Remove only if pain doesn't stop despite meds
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61
Q

Pancreatic CA

A

Very bad prognosis

Usually head of pancreas involved
Adencarcinoma

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62
Q

sx of Pancreatic CA

A 
Painless jaundice
Weight loss
PRURITIS
Anorexia
Dark urine
Courvoiser's sign
Trousseaus malignancy sign
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63
Q

Trousseaus malignancy sign

A

Migratory vein inflammation (phlebitis) associated with malignancy

(d/t pro-coag factors formed by CA cells)

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64
Q

Courvoiser’s sign

A

Palpable, NON tender, distended gallbladder (RUQ)

d/t common bile duct obstruction

65
Q

Tx of Pancreatic CA

A

Whipple procedure (remove pancreas and duodenum) if CA is confined to the head or duodenal area

66
Q

GI complaints that may cause CP and are CRITICAL

A

Esophageal rupture
Perf ulcer
Acute cholecystitis
Acute pancreatitis

67
Q

Becks triad

Tamponade

A

Muffled heart sounds
JVD
Hypotension

68
Q

Esoph rupture

A

Vomiting or straining prior to this happening

Excruciating retrosternal CP

69
Q

CP d/t cocaine use

A
  • promotes clots
  • increases heart’s oxygen demand
  • constricts hearts blood vessels
70
Q

How long does CP last with Unstable Angina or MI?

A

greater than 15 minutes

71
Q

CP lasts for days/weeks/months

A

probably NOT ischemic

72
Q

Pleuritic CP

A

Pulmonary
Chest wall
Cardiac Tamponade

73
Q

tearing, ripping, searing CP

A

Aortic dissection

74
Q

Dull, heavy, tight, pressure, ache, squeezing CP

A

Ischemia !!!

75
Q

Worse lying down, better with sitting up and leaning forward

A

Pericarditis

76
Q

Relief with Nitro

A

Ischemic CP

Esophageal spasm

77
Q

CP relieved with rest

A

Stable angina

78
Q

Women
Diabetics
>65 YO

A

often have atypical presentations of CP

poorly localized

79
Q

C/o Fatigue and SOB

A

can be indicative of ischemia for Women, Diabetic, or >65 YO

80
Q

Anterior wall MI

A

V2-4

81
Q

Lateral wall MI

A

I, avL, v5-6

82
Q

Inferior wall MI

A

II, III, avF

83
Q

Person has stemi, now what?

A

Anticoags
B-blockers
IV Nitro

Start PCI therapy OR Thrombolysis

84
Q

Mgmt of STEMI

“SNAB”

A

B blocker
Nitrates
Antiplatelet: (ASA + Clopidogrel)
Statin

85
Q

EKG changes if someone has Hyperkalemia

A

peaked T waves

86
Q

CONTRA to using Thiazide diuretics

A

allergy to Sulfa

87
Q

CONTRA to Nitro

A 
Systolic <90
Tachy >100
Brady <50
Use of Viagra within 24 hrs
Hypertrophic cardiac myopathy
Severe aortic stenosis?
88
Q

ACE-I and ARBs ultimately result in

A

Vasodilation

89
Q

Amlodipine is what category of CCB?

A

Dihydro

good for HTN and Angina

90
Q

Verapamil

Diltiazem are what type of CCB

A

Non-Dihydro

Rate control
Angina

91
Q

Diff b/w unstable angina and NSTEMI/STEMI

A

unstable angina: reversible ischemia and NO INJURY

NSTEMI/STEMI: injury from ischemia has occured

92
Q

Anterior MI means what coronary vessel is likely affected?

A

Left Anterior Descending

LAD

93
Q

Lateral MI means what coronary vessel is likely affected?

A

Left Coronary Artery
LCA

“left goes with lateral”

94
Q

Inferior MI means what coronary vessel is likely affected?

A

Right coronary artery

RCA

95
Q

Acute tx for Unstable Angina and NSTEMI

A

Early invasive OR meds

96
Q

Acute tx for STEMI

A

START REPERFUSION is priority

97
Q

Meds for STEMI

A

Anticoags: ASA + plavix
B-blocker: Atenolol
IV Nitro
Statin: Atorvastatin

and REPERFUSION

98
Q

Meds for UA/NSTEMI

A

Anticoags: ASA + plavix
B-blocker: Atenolol or Metoprolol
IV Nitro
Statin: Atorvastatin

maybe ACE-I if high risk for another event

99
Q

4 things in mgmt of UA, STEMI, NSTEMI

add reperfusion if STEMI

A

B-blocker
Nitro
Anticoag
Statin

100
Q

Commonly used b-blockers in ACS

A

Atenolol

Metoprolol

101
Q

Commonly used ACE-I in HTN, Diabetic nephropathy, and CKD

A

Lisinopril

102
Q

Non-dihydro CCBs affect

A

the HEART more
used for rate
(Verapamil, Diltiazem)

103
Q

Dihydro CCBs affect

A

the vessels more
used for HTN
(Amlodipine)

104
Q

both types of CCB can be used for

A

Angina

105
Q

When should you NOT use Dihydro (affecting the periph vessels) i.e. Amlodipine, Felodipine, or Nifedipine

A

in ACUTE MI

heart attack!! Don’t use CCB

106
Q

Tx of HTN in pregnancy

A

Nifedipine (a dihydro CCB)

Methyldopa

107
Q

Initial therapy for ACS

A

Nitrates

B-blockers

108
Q

Left Heart Failure

A

Congestion of pulmonary system

  • SOB
  • fatigue
  • hypoxia
  • cough w frothy
  • orthopnea
109
Q

Right Heart Failure

A

Congestion of peripheral tissues

  • weight gain (d/t dependent edema)
  • ascites
  • increased JVD
  • anorexia, GI distress, weight loss
  • hepatomegaly
  • impaired liver fx
110
Q

SOB, sweaty, tachypnea, tachycardic, rales, crackles, S3 or S4

A

Left Heart Failure

111
Q

Periph edema
RUQ pain/discomfort
JVD
Ascited

A

Right Heart Failure

112
Q

With Systolic HF, will likely see an Ejection Fraction

A

<40%

113
Q

Normal Ejection Fraction

A

> 50-55 %

114
Q

Dilated Left ventricle means

A

Systolic dysfx

115
Q

Left ventricle hypertrophy

A

Diastolic dysfx

116
Q

CXR shows:

  • Cardiomegaly
  • Cephalization of vessels
  • Kerley B lines
  • Pleural effusions
A

HEART FAILURE, dawg

117
Q

Stress EKG is contra-indicated when

A

ANY ACUTE EVENT

something that’s already stressing out the heart

118
Q

Labs to order

A 
Cardiac enzymes- trop and CK-MB
CBC
CMP
Glucose
LFT
BNP
119
Q

BNP is very useful in:

A

ruling OUT Heart Failure

<100

120
Q

Treatment order for HF

A

Diuretic
ACE-I

Then, if tolerating, add B-blocker

121
Q

ARDS

A

Acute Respiratory Distress Syndrome

potentially fatal complication of HF

122
Q

Workup for Acute Decomp Heart Failure

A 
EKG
CXR
Pulse ox
Arterial blood gas
CBC
Electrolytes
Renal/liver
Cardiac markers
BNP
Echo
123
Q

Hypertrophic cardiomyopathy

A

Sudden death
Young athletes
Diastolic
Thick L ventricle wall

124
Q

Dilated cardiomyopathy

A

MOST COMMON TYPE

Enlargement of all chambers
Systolic dysfx

125
Q

Restrictive cardiomyopathy

A

Rigid vent walls
Diastolic

(least common type)

126
Q

Cardiomyopathy

definition

A

Heart is not working well but NOT DUE TO: cad, htn, valve dz, chd

But, its Structurally or Functionally jacked up still

127
Q

Dilated cardiomyopathy

A

SOB, fatigue, CP
Abd pain
Periph edema

PE:
S3 gallop
Mitral/tricuspid REGURGITATION murmur
JVP
Crackles
128
Q

What causes Dilated cardiomyopathy?

A

Idiopathic usually

+ a bunch of possible others (genetic, infection, alc, drugs, endocrine, diet)

129
Q

If Dilated Cardiomyopathy is infectious, most likely

A

VIRAL if in the US

130
Q

Gold standard for dx of Infectious Dilated Cardiomyopathy

A

Endomyocardial biopsy

131
Q

Tx for Dilated Cardiomyopathy

A

ACE-I
Diuretics
B-blockers
Digoxin maybe

Anti-arrhythmics
Anticoags

Implantable defibrillator

Cardiac transplant

132
Q

1st line tx for Symptomatic Dilated Cardiomyopathy

A

ACE-I

133
Q

Leading cause of Sudden Cardiac Death in young people

A

Hypertrophic Cardiomyopathy

a DIASTOLIC filling abnormality

134
Q

What causes Hypertrophic Cardiomyopathy?

A

FAMILIAL

aut dominant

135
Q

Sx of Hypertrophic Cardiomyopathy

A

often NOTHING, sudden death

if sx: exertional SOB, fatigue, pre-syncope, palpitations

136
Q

S4 associated with

A

Hypertrophic Cardiomyopathy

sudden death

137
Q

Tx for Hypertrophic Cardiomyop

A

If A-sx: nothing, just monitor

If Sx: B-blockers or (non-dihydro) CCBs, i.e. Verapamil or Diltiazem

May need Surgery if refractory to meds

138
Q

Dihydro CCBs (act more on VESSELS)

A

Amlodipine

Nifedipine

139
Q

Non-Dihydro CCBs

act more on HEART

A

Verapamil

Diltiazem

140
Q

Rigid Cardiomyopathy

A

Diastolic dysfx bc the walls are rigid and can’t fill properly

141
Q

Most common cause of RESTRICTIVE CARDIOLMYOPATHY

A

Amyloidosis protein infiltrating the heart

142
Q

Restrictive Cardiomyopathy can sometimes be confused with Constrictive Pericarditis.

How should we tell them apart?

A

Pericarditis: hx of prev pericarditis, trauma, cardiac surgery, CA, etc

Restrictive CM: rare, often underlying dz progress slowly until sx show, then rapid decline
S3 GALLOP!!!

143
Q

S3 gallop should prompt you to think about

A

Restrictive Cardiomyopathy

and this is not seen in Constrictive Pericarditis

144
Q

Other sx of Restrictive Cardiomyopathy

A 
Edema
Abd disc
Ascites
Syncope
CP
SOB

S3 gallop
JVP
Kussmaul
Possible Regurgitation murmur

145
Q

Periorbital Purpura (w/ heart failure) is pathgnomic

“racoon eyes”
“panda eyes”

A

a late finding for Cardiac Amyloidosis (a cause of Restrictive CM)

146
Q

What will be enlarged in Restrictive CM?

A

Both Atria

147
Q

Tx for Restrictive CM

A

Underlying cause
Low dose LOOP DIURETICS

Heart transplant

Poor prog :(

148
Q

1st line tx for Symptomatic Restrictive CM

A

Loop diuretics

149
Q

Takubostu CM

Presents just like an MI, so treat just like an MI

A

Stabilize pt
Cath lab

at d/c: ASA, beta blocker, ACE-I until heart recovers

150
Q

Takubostu CM

A

Trop and BNP will be elevated

EKG shows STE

151
Q

What is Takubsto?

“broken heart syndrome”

A

TEMPORARY systolic and diastolic dysfx but in the ABSENCE of CAD

trigger: emotional or physical stress, often post-menopausal WOMEN

152
Q

Cardiac Ausc exam

Firm pressure
Light pressure

A

Firm:

Light:

153
Q

Pulses to check on cardiac exam:

A

Ausc AND palpate:

  • Carotid
  • Abd Aorta
  • Renal (just listen)

Just palpate:

  • Brachial
  • Radial
  • Iliac
  • Femoral
  • Post tib
  • Dorsalis pedis
154
Q

JVD

atrial pressure

A

indic of volume overload

esp in right side of heart

155
Q

Hepatojug reflux

check for R side fluid overload

A

apply pressure to LIVER in RUQ, and observe the JVP.

If it increased with this, suggests VOLUME overload

156
Q

Leaning fwd heart exam

A

good for Aortic or Pulmonic REGURGITATION murmurs

bringing base closer to chest wall

157
Q

Homans sign

A

pt sitting on table, pull toes up in dorsiflexion

is it painful in the calf?

testing for phlebitis (inf of veins)

158
Q

Allen test

A

occlude Radial and ulnar arteries

pt make tight fist

then open hand

release pressure of ULNAR artery (pinky)

does BF return?

159
Q

When to perform Allen test

A

prior to radial artery puncture

want to make sure ULNAR ARTERY is patent and can take over when the radial artery is punctured

Clinical Prep (41 decks)

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