Exam Flashcards
1
Q
Coronary Artery Disease (CAD)
A
Chest pain, often exertional, improved with rest/Nitroglycerin (NTG)
Test: cardiac catheterization
Greatest factor for MI
2
Q
Myocardial Infarction (MI)
A
Chest pain/pressure, diaphoresis, nausea/vomiting, SOB
Troponin (N-Stemi)
EKG (Stemi)
Stemi patients need to get to cath lab in 90 mins
3
Q
Congestive Heart Failure (CHF)
A
SOB, bilateral extremity edema
Sx: Rales, JVD, pedal edema
Chest X-ray, elevated BNP
4
Q
What other past histories would suggest that a patient has CAD?
A
MI, Angina, CABG, Stent, Angioplasty
5
Q
Does a surgical history of angioplasty mean the patient has CAD?
A
Yes
6
Q
Explain the difference between CAD and an MI
A
CAD is a broad term for heart disease. MI is included in CAD. It’s an active heart attack.
7
Q
If someone has a PMHx of A-Fib or CHF, do they also have CAD
A
No
8
Q
What are the “cardiac risk factors?”
A
HTN, DM, HLD, CAD, Smoking, FHx CAD < 55 y/o
9
Q
How is CAD diagnosed
A
By a cardiologist during a cardiac catheterization. Not done in the ED.
10
Q
Name two ways that an MI can be diagnosed?
A
STEMI- EKG, Non-STEMI- Troponin
11
Q
What are some associated symptoms of an MI other than CP?
A
N/V, SOB, diaphoresis
12
Q
What are some associated symptoms for CHF?
A
SOB (Orthopnea, PND, DOE), pedal edema
13
Q
What 2 studies would diagnose CHF?
A
CXR or elevated BNP
14
Q
What is A-Fib?
A
Electrical abnormality of the heart causing the top of the heart to quiver
15
Q
What might someone feel with A-Fib?
A
Palpitations, fast, pounding, irregular heartbeat
16
Q
How is AFib diagnosed?
A
EKG
17
Q
What could be the CC of someone with a PE?
A
Pleuritic CP or SOB
18
Q
What are the risk factors of PE?
A
Known DVT or PE, FHx of DVT or PE, recent surgery, CA, Afib, immobility, pregnancy, BCP, smoking
19
Q
What study would diagnose a PE?
A
CTA Chest/VQ scan. D-dimer can only rule out
20
Q
What part of the heart does CAD affect. Arteries, Veins, or Nerves?
A
Arteries
21
Q
Can a CT Chest without IV contrast diagnose a PE? Why or why not?
A
No. Contrast in the vessels(IV) helps clearly see a blockage
22
Q
What social history will most COPD patients also have?
A
Smoking
23
Q
What is asthma?
A
Constricting of the airway due to inflammation and muscular contraction of the bronchioles. Also called Reactive Airway Disease
24
Q
What physical exam finding is closely associated with asthma?
A
Wheezes/ing
25
What is PNA?
Pneumonia. Usually a bacterial infection (infiltrates) and inflammation inside the lung
26
What might a person with PNA complain of?
Productive cough and fever
27
How is PNA diagnosed?
CXR
28
Name all 7 areas of the abdomen
Epigastric, RUQ, LUQ, RLQ, LLQ, Suprapubic, Periumbilical (Right/ Left flank)
29
What is the layman’s name for GERD?
“Heartburn” or Acid Reflux
30
What might someone with GERD complain of?
Epigastric pain “burning”
31
For older patients with GERD symptoms, what life-threatening disease may also need to be ruled out?
MI
32
What does bile do? Where is it stored?
Bile emulsifies the fats in foods. It is stored in the gallbladder and made in the liver
33
What is the difference between Cholelithiasis and Cholecystitis?
Cholelithiasis is gallstones. Cholecystitis is acute gallbladder inflammation/infection.
34
What might be the chief complaint of a person with gallstones?
RUQ abdominal pain
35
What physical exam finding is closely associated with Cholecystitis?
Murphy’s Signs
36
How are gallstones diagnosed?
Abdominal Ultrasound of the RUQ
37
Name associated symptoms of appendicitis
Fever, N/V, decreased appetite (anorexia) Note: RLQ pain- gradual, constant, worse w/ movements is the CC (not associated sx)
38
How is appendicitis diagnosed?
CT A/P with PO contrast
39
What might a person with a SBO complain of?
Abd pain/bloating, vomiting, abdominal distention, no BM’s, constipation
40
What is pyelo?
Pyelonephritis, Kidney infection (different and worse than a UTI), usually spread from an UTI
41
What will be the CC of someone with a UTI?
Painful urination (dysuria), frequency, burning, hesitancy, malodorous urine
42
Where would a patient feel pain if they had pyelo?
Flank pain, fever and dysuria
43
How is a UTI diagnosed?
Urine dip or urinalysis (UA) showing white blood cells, bacteria and nitrites
44
What might a person with kidney stones c/o?
Flank pain, sudden onset, radiating to groin
45
How are kidney stones diagnosed?
CT A/P or RBC in UA
46
Name the 2 types of CVA’s (strokes)
Hemorrhagic CVA. Ischemic CVA. (TIA is not a type of a stroke)
47
What sx might a person with a brain bleed c/o?
HA- sudden (“thunderclap”) onset, worst HA of their life, changes in speech, vision, motor (weakness), sensation (numbness), AMS
48
What study would diagnose a brain bleed?
CT Head or Lumbar Puncture
49
What sx might a person with an ischemic CVA c/o?
Focal Neurological Deficit: changes in speech, changes in vision, one-sided motor changes (weakness), one-sided sensation changes (numbness
50
How is an ischemic CVA diagnosed?
Clinically, potentially normal CT head
51
What is a TIA?
Transient Ischemic Attack. Mini-stroke. Temporary loss of blood supply to the brain
52
How does a TIA differ from a CVA?
TIA - mini stroke, symptoms usually resolve in less than a hour. CVA - Stroke, symptoms last longer, and potentially may not go away
53
What is the name of the state after a seizure?
Postictal
54
What are 3 symptoms of meningitis?
Fever, neck pain/stiffness, headache
55
What study would diagnose meningitis?
LP- Lumbar puncture
56
What are 4 important things to document for syncopal episodes?
How they felt before, during, after, and how they currently feel
57
Name 4 causes of altered mental status.
Hypoglycemia, infection, intoxication, neurological
58
How is AMS different from a focal neuro deficit?
AMS is generalized and typically caused by something that can affect the whole brain (drugs, low BS). FND are localized (weakness/ numbness/speech/vision) to one specific area and corresponds with damage to specific spot in the brain
59
What is a DVT?
Deep venous thrombosis
60
What are the risk factors for a DVT?
Known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, CA, immobility, pregnancy, BCP, smoking
61
What are common signs of a DVT?
Extremity pain, swelling (atraumatic)
62
What is an AAA?
Abdominal Aortic Aneurysm
63
What is an aortic dissection?
The separation of the muscular wall from the membrane of the artery, putting the pt at risk for aortic rupture and death
64
Name three important things to document for any trauma patient.
LOC, head injury, neck pain, back pain, numbness, weakness
65
How would you document the GPA for a patient who is currently pregnant, has been pregnant 4 times in the past, and has one child at home?
G:5 P:1 A:3
66
List five body systems found in the ROS and provide two symptoms for each system.
General (fever, chills, weight loss). Cardio (chest pain, palpitations). Resp (cough, SOB, wheezing) Neuro (headache, seizures, numbness). Skin (rashes, itching, redness). Psych (anxiety, hallucinations, depression).
67
What does PERRL stand for?
Pupils are equal round and reactive to light
68
What does AT/NC mean?
Atraumatic/ Normocephalic
69
What does NAD stand for?
No acute distress
70
If a patient has pale conjunctiva, what does that indicate?
Anemia
71
What is scleral icterus, and what does it indicate?
Yellowing of the eyes, indicates liver failure
72
In which body system would you document “TM erythema and bulging”?
Ears
73
To describe a “runny nose” would the doctor use the word “epistaxis” or “rhinorrhea”
Rhinorrhea
74
What would dry mucous membranes indicate?
Dehydration
75
Why is midline bony tenderness “worse” than paraspinal tenderness?
Bony tenderness (aka vertebral point tenderness) points towards a spinal fracture and therefore concern for spinal cord injury. Paraspinal tenderness points toward a muscle sprain or strain
76
If you saw “RRR” written in the cardiac exam, what do you think it might mean?
Regular Rate and Rhythm
77
Name the rhythm that the physician would hear if the patient was in Afib
Irregularly irregular rhythm
78
If the physician checks the pulse on the right wrist and says “The pulses are fine”
Wrist pulse 5/5, right; Radial pulse OK; Right wrist pulse is fine; Right radial pulse is 2+
79
Name two “Peritoneal signs” in the abdominal exam?
Guarding, rebound, rigidity
80
What abdominal exam sign is indicative of Cholecystitis?
Murphy’s Sign
81
If the doctor takes 1 finger and presses in a specific spot in the RLQ, what is the name of the finding they are investigating?
McBurney’s point tenderness
82
Which of these findings is NOT a peritoneal sign: Guarding, Rebound, Tenderness, Rigidity
Tenderness
83
What is bony tenderness a sign of?
Bone deformity, fracture, or injury
84
What is CVA tenderness?
Flank tenderness (costovertebral angle
tenderness). Tenderness over the kidney(s)
85
What is fluctuance a sign of?
Abscess
86
What does A&Ox4 mean?
Alert and oriented to person, place, time, and situation
87
What section of the neurological exam would you document “Normal Finger-Nose-Finger test” and “Normal Heel-to-Shin”?
Cerebellar/ Coordination
88
Point to the general area of your body that Cranial Nerves (CN) control
Face
89
In the neurological exam, what does “Normal gait” mean
Walking normally
90
What is a normal GCS?
15
91
How do you document normal strength?
On a scale 5/5
92
What would you guess “TTP” means?
Tender to palpation
93
What is the medical term for “Swollen lymph nodes?”
Lymphadenopathy
94
If you document “There is right pronator drift” in the neurological exam, can you also document “No focal neurological deficits”?
No
95
If you documented “NAD” in the constitutional section, would you be contradicting yourself if you wrote “There is mild respiratory distress” in the pulmonary exam?
Yes
96
What organ do the LFTs investigate?
Liver
97
A high potassium is called ________ and this is commonly due to __________
Hyperkalemia, renal failure
98
What are the 3 reasons to consult another physician?
Admit the patient, seek advice from a specialist, gather information from the PCP
99
List 4 CCT qualifying Dx and 4 CCT qualifying procedures.
MI, PE, Severe GI bleed, CVA, Lumbar puncture, Central line, Cardioversion, Chest Tube
100
Hyponatremia is _______ and indicates________.
Low sodium, dehydration.
101
The _______ shows the pH only, while the _______ shows the pH plus HCO3, CO2, and PaO2.
VBG, ABG.
102
Aneurysm
Localized ballooning of a vessel due to a weakened vessel wall
103
Arrhythmia
Irregular heartbeat
104
Bradycardia
Slow heart rate (HR<60)
105
Normal sinus rhythm NSR
Rhythm of a healthy heart
106
Regular rate and rhythm (RRR)
Normal heart sounds with regular rate (60-100 bpm)
107
Stenosis
Narrowing of a body opening or passage
108
Tachycardia
Fast heart rate (HR>100 bpm)
109
Dyspnea on exertion (DOE)
Feeling short of breath during very light exercise
110
Rales
Crackles, wet crackling heard in lungs, typically due to pneumonia or CHF
111
McBurney’s point
RLQ point tenderness indicative of appendicitis
112
Murphy sign
Pain with palpate on of the RUQ during a deep breath, indicative of cholecystitis
113
Peritoneal signs
Signs indicative of acute abdominal inflammation (peritonitis)
114
Cephalgia
Headache
115
Coronary Artery by Pass Graft (CABG)
