exam 2 Flashcards
how common is chest pain in PCP
10% of all visits
what is the most common symptoms associated with coronary heart disease
chest pain
classic chest pain sympmtoms
with exertion…
pain, pressure, tightness
atypical symptoms
cramping, grinding, tearing, ripping, jaw/tooth/arm/neck pain
what is a paplitation
awareness of heartbeat
pounding, skipping, racing, fluttering
differential diagnosis for palpitations
anxiety, arrhythmia (afib/pac/pvc) hyperthyroidism
dysnpnea
uncomfortable awareness of breathing that is innaprpriate for level of exertion
orthopnea
dyspnea that occurs when supine and improves with sitting up
paroxysmal noctural dyspnea
sudden dyspnea and orthopnea that awake patient from sleep
differential diagnosis for SOB
anxiety, pulmonary, GI, cardiac
swelling
accumulation of fluid in extravascular interstial space
how many liters of fluid can be absorbed before pitting eema appears
5L
syncope
transient LOC followed by rcovery
what is the most common cause of syncope
neruo cardiogenic
vasovagal reflex
loss of sns tone increases vagal tone which drops BP and heart rate
angina pectoris
temprary myocardial ischemia
associted symptoms wirh angina pectoris
chest pain worse with exertion or stress, diaphoresis, dyspnea, ausea
MI
prolonged ischemia to the heart that results in irreversible muscle damage
symptoms of MI
diaphoresis, nausea, chest pain, fatigue, not revlieaved by rest
CHF
heart failure or ventricular dysfunction
symptoms of right heart failure
edema/leg swelling
symptoms of left heart failure
dyspnea, cough, wheezing
pericarditis
irritation of parietal pleura adjacent to pericardium
location of discomfrot with pericarditis
retrosternal or precordial
characterisitc of pericarditis
pain worse with breatthing, changing positions, coughing, swlaoowing. better when sitting foreward
aortic dissection
splitting within layers of aortic wall
symptoms of aortic dissection
anterior/posterior chets pain radiating to neck/back, ripping or tearing
what might crackles in the lungs indicate
pulmonary edema (left heart failure)
what might congestion of the liver indicate
right heart failure
hepatojugular reflex
push down on the liver and fluid pooled in the hepatic venous system is forced back upward toward the heart causing JVD
what do abdominal bruits indicate
turbulent blood flow in the aorta, renal arteries or splenic artery
0 pulse
absent
1 pulse
weak, thready
2 plulse
normal
3 pulse
full, bounding
allen test
tests patency of ulnar and radial arteries
what is important to check prior to checking abg
allen test
palpable abdominal pulses
aorta
non palpable abdominal pulses
celiac, SMA, IMA
pulsus alternans
regular pulse with alternating strength of pulse
pitting edema
palpable swelling, accumulation of fluid in interstitial space
1+ pitting edema
2 mm
2+ pitting edema
4 mm
3+ pitting edema
6 mm
4+ pitting edema
8 mm
PAD
pain claudications worse with exertion and leg elevation
risk factors for PAD
older than 65, older than 50 woth history of smoking/DM, hx of CAD, black, fam hx of AAA
symptoms of PAD
pain with exertion and non healing wounds
aorto-iliac
butt, hip, thigh
illiac-pudental
ED
common femoral
thigh
superficial femoral
upper calf
politeal
lower calf
tibial or peroneal
foot
celiac or mesenteric
abdominal
what would lead to a strong suspicion of PAD
delayed response and diminished or absent peripheral pulses
what causes varicose veins
incompentancy of valves and weakness of the walls of the veins
causes of varicose veins
pregnancy obesity constipation tumor hereditary
risk factors varicose veins
age, sitting/standing long periods of time, sedentary, obesit, preg, fam hx
venous stasis
chronic permanent skin changes that are associated with chronic venous insufficiency
primary raynauds
no definable cause
secondary raynauds
related to autoimmune disease
arterial ulcerations
diastal location or traumatic
venous ulcerations
around ankles
neuropathic ulcers
pressure points
why is DVT concerning
carrys 90% of blood back to the heheart
symptoms of DVT
pain, swelling, red
hoffmans sign
discomfort in leg with forced dorsiflexion of the foot
superficial thrombophlebitis
inflammation, thrombosis in superficial veins, lower prob of traveling to heart
doppler studies
used to evaluate for competency of veins
abi
less than 0.9 normal
low sens, high spec