Final Flashcards
elephant on chest pain; crushing, radiating
MI
substernal chest pain?
- provoked by emotion or ?
- relieved by ? and/or ?
angina
eating
rest, nitroglycerin
burning, substernal, nocturnal, and worse with lying flat
esophageal
lasts for hours/days; local tenderness
musculoskeletal
chest pain- HA aortic dissection angina PE MVP spontaneous pneumothorax acute pericarditis pneumonia esophageal pain costochondritis herpes zoster`
mid chest
chest pain- HA aortic dissection acute pericarditis esophageal pain spontaneous pneumonia pneumonia
back
chest pain- HA angina acute pericarditis aortic dissection perforated viscus
shoulder
chest pain-
HA
angina
left arm
chest pain-
HA
perforated viscous
abdomen
SH - don’t forget to ask about ? demands
employment
pancreatitis, pneumonia, and cervical ? are in the Ddx for ?
radiculopathy, chest pain
Heart is like plumbing
wiring ?
plumbing ?
walls of house?
arrhythmias, electrical activity
ischemia, dissection, clot
endocarditis, pericarditis, amyloidosis
equipment for advanced cardiac exam (4)
stethoscope
pen light
cm ruler
pencil
PE:
apical impulse
heaves/lifts
PULSATIONS
inspection
PE:
apical impulse
heaves/lifts
THRILLS
palpation
eye is included in typical cardiac workup- ?
optic fundi
blue sclera ?
congenital heart defect, osteogenesis imperfecta
increased arterial pulse:
- observed in ? blood pressure recordings
- fever, anemia, ? weather, exercise, pregnancy, ?thyroidism, atherosclerosis, ? fistulas
- cardiac dz ie ?, ?, and ? and results in a widened pulse pressure
typical
hot, hyper, AV
AR, PDA, truncus arteriosus
reduced arterial pressure
- ? normally
- from ?, arteriosclerosis, AS, or diabetic ?
uncommon
HF, ketoacidosis
unequal pulses
- ? difference
- from ? or ?
20 mm Hg
AS, subclavian steal
pulsus paradoxus
- abnormally large decrease in ? and pulse wave amp during ?
- sign of ?, constrictive pericarditis, restrictive cardiomyopathy, COPD sleep apnea, and ?
SBP, inspiration
acute cardiac tamponade, croup
pulsus alternans
- found by palpating a peripheral artery, preferably the ?
- ? variation?
- almost always indicative of ? and carries a ?
femoral
beat-to-beat (strong-weak)
LV systolic impairment, poor Px
AS, ruptured chordae tendinae of mitral valve, and severe AR all have ? detected by ?
transmitted murmurs
carotid artery bruits
carotid artery bruits occur in obstructive dz in ?
cervical arteries (e.g. atherosclerotic carotid arteries, fibromuscular hyperplasia, arteritis
most common Sx of orthostatic htn:
dizziness or lightheadedness when sitting up or standing
orthostatic htn:
drop in sys > ? or dis > ? within ? after changing position
20, 10, 3 minutes
pressure differs on sides of body in ? or ?
occlusive disease, aortic dissection
JVP-
- patient at ?
- place ruler on ? and extend tongue depressor from ? to ruler
- should be ? (if not- RHF, cirrhosis, etc.)
45 degrees
sternal angle, highest point of pulsation
<4 cm
hepatojugular/abdominojugular reflux:
- alternate test for JVP pressure
- firm pressure on abdomen by ? for ? seconds
- a rise in JVP = ?
palm of hand, 10-60 sec
impaired RV function
left lateral decubitus accentuates?
S3, S4, tricuspid and mitral murmurs
inspect- 4 S in advanced peripheral vascular exam?
size
symmetry
swelling
skin changes
palpate- 2 T in advanced peripheral vascular exam
temperature
tenderness
advanced peripheral vascular exam- don’t forget to asses ? response
motor, sensory, and reflex
pitting- wait 30 seconds slight? more pronounced, resolves ? more severe, takes a while to ? very ?, takes a long time to resolve
1
quickly, 2
resolve, 3
severe, 4
chronic arterial insufficiency: pain when ? pale or ? cool temp no ? thin, ? skin loss of ? painful ulcerations/trauma gangrene*** decreased ?
walking dusky red edema shiny hair pulses
5 Ps of arterial insufficiency?
pallor paresthesia pain paralysis pulselessness
chronic venous insufficiency: No ? cyanotic or ? pigmentation ? temp pitting edema*** ? of skin ulcerations around ? NO ? ? pulses
pain brownish normal thickening ankles (stasis dermatitis) gangrene normal
assess varicosities while patient is ?
standing
calf pain elicited upon acute passive ? of the foot
low ?
called?
be careful not to precipitate ?
DVT dorsiflexion sensitivity Homan's sign PE
assess patency of radial and ulnar artery
ask patient to clench fist for ?
ask patient to open fist and release ?
watch for filling of hand to assess ulnar artery patency
repeat and assess ?
called ?
30s
ulnar artery
radial artery
Allen Test
always evaluate ? and auscultate ?
pulmonary system, lungs
always ask about ? complaints
GI complaints over ? or strong hx should have an ? to r/o ? ; especially ?
GI
40 yo, EKG, ACS, women
a form of PREVENTIVE medicine evaluation
wellness exam
Wellness HPI has two parts:
- explore past ? and ?
- develop an HPI based on the ?
exams, results
complaint
Wellness:
focus on confirming data already?
update info as appropriate
in chart
FH should have a minimum of ? generations
in diagrammatic or outline form
concludes with a ? for common genetic dz
3
negative statement
when a ? elicited, further details asked to put in the ROS
positive response
Wellness- all positive response MUST be ?
thoroughly explained
DOCUMENT AS “NO” or “DENIES”
ROS in wellness exam- ? is explored
EVERY category
wellness- not a ? ROS but complete
focused
ROS can be used to assess patient’s compliance with ?
screening tests i.e. cardiac- last EKG?
wellness- F- include ? and ? exams
M?
breast, pelvic
rectal, prostate
thorough exam is most basic “screening test” for ? (4)
breast
HYPERTENSION
skin
vision/hearing
cholesterol testing for men > ? and women > ?
35, 45
check cholesterol at ? to ? if increased risk
20-35
ACA
mammogram at ? every ?
clinical breast exam (CBE) every ? for women in 20s and 30s
before 40 & increased risk = ? and ? yearly
40, year (annually)
3 years
MRI, mammogram
*moderate risk - 15-20% should talk with their provider about the benefits and limits of adding MRI screening
breast cancer risk factors... a bunch race? age? relative? menarche? therapy? (2) alcohol, obesity
caucasian >55 1st degree before 12 chest radiation, HRT
USPSTF: breast cancer screening
- mammogram between ? every ?
- decision to start before 50 is individual
- against teaching ?
50-74, two years
SBE - self-breast exams
Colon cancer
- many modifiable factors including high ? diet, obesity, inactivity, smoking, heavy ? use, D type 2
- non-modifiable- Hx ? or ?, age, FH ? cancer, genetics
red meat, alcohol
polyps/IBD, colorectal
colonoscopy at ? every ? years
OR ? every 5 years
OR ? every 5 years
OR ? every 5 years
50, 10
sigmoidoscopy
barium enema
CT colonography (virtual colonscopy)
tests that mainly find cancer:
fecal occult blood test (FOBT) every ?
fecal immunochemical test (FIT) every ?
stool DNA test (sDNA)– interval ?
year
year
uncertain
UPSTF:
screen for cervical cancer in ages ? with cytology (Pap Smear) every ?
women ages ? can have a Pap with ? every ?
21-65, 3 years
30-65, HPV, 5 years
UPSTF recommends against:
- screening women over ?
- screening for cervical cancer with HPV (alone or in combo with cytology in women ?
- screening women with ? (unless for cervical cancer)
65
less than 30
hysterectomy
when getting a PAP smear- check for ? and ? if at risk
chlamydia
gonorrhea
prostate cancer
- both PSA (prostate-specific Ag) blood and digital rectal exam (DRE) were recommended in the past to be offered to men beginning at age ?
- high risk- start at age ? race at risk? FH?
- higher risk- FH? start testing at ?
50
45, AA, 1st degree relative Dx before 65
40, more than one 1st degree affected early
- USPSTF recommends against ? for prostate ca
- task force doesn’t think AA have diff balance of benefits/harms from PSA screening than whites
- high risk- talk to patient about ?
- many risks i.e. AA, genetics, diet, exercise, VASECTOMY, age?
PSA screening
PSA/DRE screening risk/benefit
>65
bone scan for women ages ? or younger if risk; men at risk
> /= 65
ECG - USPSTF against screening w/ resting OR exercise ECG for prediction of ? in ? adults at low risk for CHD; screen those with FH, condition or risk factors
CHD, asymptomatic
ALL men who ? should have and u/s to screen for ? at age ? ; ONE time screening
smoked, AAA, 65
aspirin 81 mg daily
- men over ?
- postmen women or age ?
- pts at risk for ?
- USPSTF recommends aspirin for men at age ? if the benefit of preventing ? outweighs risk for ?
45
55
CVD
45-79, MI, GI hemorrhage
exercise- 30 min ? d/week
5
alcohol- F? M?
1 drink, 2 drinks
oral case presentations- present in an ? and ? manner
oral, brief
OCP- a ? story; never a ?
simple, surprise
OCP- emphasize ? and ?&?
HPI, assessment & plan
? sees if there is a successful intro sentence and you can say no to “do any surprises appear after this sentence?”
litmus test
OCP- only ? in P.E.
key findings
OCP- <1m, on rounds or in hallways; very brief?
bullet or capsule
OCP- 2-3 min, rounds, consultations, more thorough than bullet/capsule
formal
OCP- 5-10 min, grand rounds, presentations, consults, oral form of written record
complete
OCP- org exactly as ?
written report
OCP- describe all Sx ?
- keep info chronological
- pertinent ? and ?
fully
positives, negatives
OCP- all ? precede all ? elements
positive, negative
OCP- Intro statement includes? (4)
age
gender
pertinent PMH
CC
OCP- PMH and surgical Hx is ? but ?
-no need to include ? unless pertinent
comprehensive, brief
dates
OCP- ALWAYS include ? and ?
only include pertinent parts of ? and ?
ROS- only mention ?
allergies, meds
FH, SH
pertinent positives
OCP- P.E.
- begin with ?
- followed by ?
- present PERTINENT findings in ?
- describe ? in detail
vitals
general survey
head-to-toe fashion
abnormal findings
OCP- labs/Dx tests
- if tests normal, state ?
- in ? presentation state results of all values
WNL
comprehensive
OCP- assessment
- 1 or 2 sentences summarizing patient case
- transition from findings to ?
- summarize highlights of case
critical thinking process
OCP- DDX
-try to have ? differentials
3 or more
OCP- Delivery
- use ? statements rather than ? statements
- DO NOT ? or ? as you present; just tell the ‘facts’ as they were obtained by you (you’re telling your patient’s story not yours)
positive, negative
editorialize, rationalize
patients with underlying ? may be very Sx of severe anemia but with a ? up to ?
CAD, high Hg- 10gm/dL
cardiac adjustment to anemia = ? at rest
high CO
anemia causes cerebral hypoxia and ? in ear or ? in head
roaring, humming sound
B12 deficiency
- degeneration of DORSAL columns of s.c.: unsteadiness of ?
- degen of LATERAL columns: ? weakness
- peripheral neuropathy- ? sensation in hand, feet
gait (ataxia), falling
motor
pins & needles
general Sx of anemia:
? of blood away from splanchnic bed, loss of ?, abdominal discomfort, indigestion, nausea
shunting, appetite
thalassemia major
sickle cell dz
spherocytosis
all are ?
hereditary anemias
? may be Dx later in life i.e. thalassemia trait (alpha or beta thalassemia minor)
hetero hereditary anemias
hereditary hemolytic anemia that has acute episodes of hemolysis; occur within hours to few days after exposure to oxidant stressor i.e. medications
glucose-6-phosphate dehydrogenase deficiency
life threatening, hemolytic, schistocytes?
TTP (thrombotic thrombocytopenic purpura)
hemolytic & schistocytes also, increased aTPP and dimers?
DIC (disseminated intravascular coagulation)
painful crisis in hours to days upon exposure to heat or cold exertion, dehydration, infection, etc.
SC disease
sulfonamides and antimalarial drugs i.e. primaquine or nitrofurantoin can trigger an acute hemolytic crisis in ?
glucose-6-phosphate dehydrogenase deficiency
sulfonamides, cephalosporins, penicillin can cause ?
AI hemolytic
NSAIDS can cause gastritis or PUD (GI bleeding)»_space; ?
iron def anemia
isoniazid Tx can cause ?
sideroblastic anemia
methotrexate, phenytoin, and trimethroprim can cause ?
folate def anemia
cytotoxic cancer chemo, anti-seizure meds, i.e. valproic acid, phenytoin, and a/b i.e. sulfonamides; CHLORAMPHENICOL can lead to ?
aplastic anemia
AA predisposed to ? and ?
SC anemia, G6PD def (more males)
African, mediterranean, indian, SE asian predisposed to ? and ?
G6PD def, thalassemias
northern europeans ?
hereditary spherocytosis
alc toxicity can cause ? anemia
mildly macrocytic
chronic liver failure (cirrhosis) can lead to ?
iron def anemia
tea and toast diet in elderly ?
folate def
strict vegetarians and preggos who are ‘moderate’ vegetarians are at increased risk for ?
B12 def
long distance runners - chronic GI blood loss?
iron def anemia
travel - tropical countries- endemic for ?
malaria - hemolytic anemia
smoking causes ? due to increased binding of carbon monoxide to Hgb; which stim EPO release
‘relative tissue hypoxia’
complications of hereditary hemolytic anemias?
jaundice, bilirubin gallstones
colon cancer will have unintentional ? and ? stool; abdominal pain
weight loss, ‘pencil-like’
GI bleeding can be of ? origin- difficult to detect and treat; people exposed to this ? (3)» can cause significant chronic disabling anemia
obscure
CRF, vW dz, elderly
hypothyroidism may cause ? anemia; ask about difficulty concentrating, constipation, hoarseness
macrocytic
chronic renal disease can be a cause of anemia of renal failure due to ?
decreased EPO production
iron def
- heavy menses at least ?; clots of blood
- vaginal bleeding b/w periods
- post meno bleeding may be ?
4 days
uterine cancer
RA?
SLE?
anemia of chronic dz
hemolytic anemia
TB can result in ?
anemia of chronic dz
nail changes = ? anemia
chronic iron deficiency i.e. brittleness, longitudinal ridging, flattening, spooning (koilonychia)
chronic ankle ulcers in ?
SC dz
petechiae, purpura in ? from acute leukemia or aplastic anemia
thrombocytopenia
cheilosis in ?
vit b12 and folate def, iron def
chipmunk facies in ?
thal major
frontal bossing ?
SC dz
severe anemia- ? murmur in ? area
sys ejection, pulmonic
sternal tenderness due to ? of b.m. w/ ? cells or ? plasma cells
infiltration, leukemic, multiple myeloma
malignancies of WBC will have ? and the leukemic cells replace ? and cause anemia
splenomegaly, bone marrow
