EM No. 1 Flashcards
what is the dx: pt has swollen red and tender right calf. dorsiflexion of the right foot induces pain in calf. venous ultrasonography reveals failure of venous compression with passive dilatation.
DVT
sign associated with passive dorsiflexion of the foot inducing pain in the calf - also, what is the dx once the sign is positive?
homan sign; dvt
once dvt is dx what is the immediate treatment regimen?
anticoagulant - heparin for the first 5-7 days followed by oral anticoagulants with interlacing in the 3 or 5th days
during pregnancy when treating a DVT, what is the preferred anticoagulant?
heparin b/c warfarin is associated with congenital anomalies
with pleural effusion, the trachea is displaced to the which side?
the side opposite the fluid
what is the dx - increasing dyspnea, mild temp elevation; dull percussion note of posterior chest, distant bronchovesicular breath sounds, increased whispered voice sounds, and diminished voice sounds below 6th ITS.
pleural effusion - dullness in area of effusion; distant sounds due to fluid presence; whispers increase in area of fluid, and spoken are diminished in areas of fluid.
what is the formula for the anion gap? what is the normal range?
sodium minus chloride plus bicarb; 3 to 12
in cardiac arrest involving ventricular fibrillation, what is the highest priority in terms of next step management?
DEFIBRILLATION - immediately - DO NOT do anything else before you DEFIB!
what is the first line treatment of management of asystole and PEA?
DO NOT DEFIB!! continue CPR and give epinephrine.
what are the 4 rhythms that can produce pulse cardiac arrest?
vfib, pea, rapid vtach, asystole
an increase in stroke volume leads to what type of pulse pressure and eventual systolic pressure?
increase in pulse pressure and increase in systolic pressure
what eventually happens to stroke volume with chronic aortic regurgitation?
increases
what is the definitive treatment of AR?
valve replacement
what is the MCC of CHF? and the 2nd MCC?
CAD; dilated cardiomyopathy
pts with protein c and s deficiencies are more prone to a hyper-coagulable state which predisposes them to what condition?
DVT and PE
what is known as enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs (pulmonary hypertension).
cor pulmonale
which heart sound is associated with pulmonary embolism that has progressed to acute cor pulmonale?
s3 gallop
as the RV suffers from acute pressure overload it will increase RV wall tension , dilatation and failure. RV dilatation shifts the ITV septum towards the LV reducing its capacity and increasing resistance of LV - what is the phenomenon called?
ventricular interdependence
what are the two signs you are looking for on the echo to dx PE?
right ventricular dilatation and asynergy except in the apex (McConnell’s sign) *Remember that pts with RV abnormalities are at higher risk than those without
what are the two ways you can differentiate a right ventricular infarction from a PE?
on the EKG look for signs of inferior infarction and also look for ST elevations
what are the two ways you can differentiate PE from pneumonia?
in pneumonia the cough is typically productive and also the dyspnea is typically NOT of sudden onset
in terms of the primary treatment for PE what are your top 3?
oxygen, NSAID, and dobutamine (positive inotropic and pulmonary vasodilator)
why is it IV fluids is NOT advised in PE?
b/c ventricular interdependence may lead to left sided heart failure
what is the major cause for concern with thrombolytic therapy?
intracranial bleeding (1% risk)
pt with peptic ulcer disease presents with PE and is need of therapy - what line of treatment is an absolute contraindication?
thrombolytics due to pts active peptic ulcer disease
an atypical antipsychotic medication used in the treatment of schizophrenia, and is also sometimes used off-label for the treatment of bipolar disorder. this drug also has a very high risk of aggranulocytosis
clozapine
what are the 4 components of tetralogy of fallot?
pulmonary stenosis, RVH, overriding aorta, ventricular septal defect.
i say “boot shaped hear” you say …
TOF - associated with right atrial enlargement and decreased pulmonary vasculature
pt presents with hearing loss in the R ear - what are the expected test results if the pt has conductive hearing loss? (Weber and Rinne)
lateralization to the R ear (affected) and BC > AC in the R (affected) ear.
pt presents with hearing loss in the R ear - what are the expected test results if the pt has sensorineural hearing loss? (Weber and Rinne)
Weber would lateralize to the GOOD ear (left unaffected ear) and AC > BC in BOTH ears.
what are the pressure drop requirements for orthostatic hypotension?
drop in standing systolic of at least 20mmHg and 10 mmHg diastolic
what is the cornerstone treatment of HCM?
beta blockers - they reduce the amount of obstruction by decreasing the HR and therefore also increase LV filling.
what is a common occurrence after CABG?
pericardial effusions –> remember that an effusion can become tamponade
i say child pt with fever that subsides followed by a rash - you say?
roseola (HHV6)
childhood rash - begins in the face, spreading to the entire body and disappearing by 4th day - what is it?
rubella
childhood rash - spreads down from the face and hairline to the TRUNK over 3 days - other signs of the illness include fever, cough, conjunctivitis and coryza.
rubeola (aka measles)
i say erythema infectiosum you say …
slapped cheek
i say Erythema migrans you say ?
rash often (though not always) seen in the early stage of Lyme disease
i say Erythema marginatum you say ?
RF
i say verrucous endocarditis, you say?
Libman Sacks endocarditis - associated with SLE patients
what are the three types of cardiomyopathies?
dilated; obstructive and restrictive
MCC of mitral stenosis
rheumatic heart disease
what is the relationship between MVP and MR?
MVP can lead to/because/cause MR
diastolic rumbling murmur heard best at the apex in the LL position?
MS
diastolic rumbling murmur heard best along the left sternal border accompanied by a thrill?
TS
soft early diastolic murmur, high pitched and heard best when sitting and leaning forward?
AR
i say opiod overdose - you say? (for treatment)
naloxone NOT naltrexone (don’t be tricked! trix are for kids silly rabbit!)
DOC of acetaminophen OD?
N-acetylcysteine
T or F: beta blockers are contraindicated in patients who suffer from hyperkalemia.
true
which htn medication is contraindicate in patients with gout?
loop diuretics due to causation of hyperuricemia
T or F: secondary HTN is more common in children than in adults.
TRUE
what is the relationship between feeling of satiety/appetite suppression and serotonin
serotonin levels (high) will cause feeling of satiety - appetite suppressing drugs will raise serotonin levels!
HTN is what case is associated with BP difference btwn arms and legs?
coarctation of the aorta
HTN is what condition is associated with central obesity ,hirsutism, pigmented striae, buffalo hump and moon face?
Cushing’s syndrome
HTN associated with what will be likely to present with palpitation, anxiety, moodiness, weight loss, and heat intolerance?
hyperthyroidism
HTN associated with decreased K+ levels indicates what?
primary aldosteronism
T or F: pain of MI is unrelieved with nitroglycerin
TRUE
i say pericardial friction rub (is heard on auscultation) you say ?
pericarditis
i say steamy cornea, you say?
acute angle closure glaucoma
i say systolic ejection CLICK! you say ?
Aortic Stenosis (AS)
tall, peaked T waves say what about serum potassium levels?
increased
inverted t wave on EKG indicates what about potassium serum levels?
low!
what is the most common chronic arrhythmia is pts with hyperthyroidism?
AFIB
the initial step in the management of atrial fibrillation is to control what rate?
ventricular response
