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PCM III > FInal > Flashcards

FInal Flashcards

1
Q

When do you hear systolic vs diastolic murmurs

A

Systolic btw S1 and 2; diastolic btw S2 and 1

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2
Q

What is S4

A

Forceful atrial contraction against stiffened low compliant ventricle; atrial Gallop (S3 is ventricular gallop)

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3
Q

What kind of murmur could an atrial myxoma cause

A

Diastolic

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4
Q

What is the murmur heard with MR

A

Systolic - radiates to left axilla, decreased S1

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5
Q

What is ortner syndrome

A

Hoarseness seen with mitral stenosis

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6
Q

What sx does mitral stenosis cause

A

Malar flush, increased S1, opening snap after S2, diastolic murmur use bell

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7
Q

What do you see on PE of aortic stenosis

A

Narrow pulse pressure, decreased SV and systolic pressure; delayed pulses (parvis and tardus), harsh 2nd ICS RSB radiates into Suprasternal notch; gallavardin phenomenon (murmur radiates to apex)

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8
Q

What are causes of chronic aortic regurgitation

A

Syphilis and ankylosing spondylitis

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9
Q

What do you see with aortic regurgitation

A

Wide pulse pressure, de mussel, corigans, quinces, traubes, durozreys, hills, bisferious, diastolic

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10
Q

What is tricuspid regurgitation associated with

A

Pulm HTN, inferior MI - see prominent V wave in JVP; blowing systolic murmur

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11
Q

What do you see with tricupsid stenosis

A

Prominent A wave in JVP, hepatomegaly

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12
Q

What causes most cases of pulmonic regurgitation

A

Pulm HTN; graham steel murmur

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13
Q

What kind of murmur is heard with pulm stenosis

A

Radiates toward left shoulder

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14
Q

what is the difference between EMR and EHR

A

EHR can be shared with other health care providers; contain all info from all caretakers

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15
Q

What are the stages of meaningful use

A

1: data capture and sharing
2: advance clinical process
3: improved outcomes

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16
Q

What is meaningful use

A

Use of EHR to improve health care quality and efficiency; goals: Bring about care that is patient centered, prevention oriented, evidence based, effficient and equitable

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17
Q

What is MIPS

A

Merit based incentive payment system

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18
Q

What must medical students have/do when charting for their preceptor

A
  • have their own username/password
  • contribute meaningful data with inclusion of student note; enter rationale for entering;
  • notes must be reviewed and signed by supervising physician
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19
Q

What kids do you perform a full cardiac exam on

A

Kids with heart murmurs, any child who has historical features suggestive of cardiac dz (feeding intolerance, sweating, head bobbing, failure to thrive, resp sx, cyanosis in infants; chest pain, syncope, exercise intolerance, family hx of sudden death in older children)

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20
Q

What is included in a full cardiac exam

A

Vitals, pulses, cap refill, precordial inspection and palaption, auscultation, murmurs - grade, timing, location, character, changes with position, radiation

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21
Q

Which murmurs have a thrill

A

IV and up

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22
Q

What is fixed split S2 indicative of

A

ASD; only normal when split with inspiration

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23
Q

What can cause S1 to be inaudible

A

VSD, AV regurgitation, patent ductus arteriosus, severe pulm stenosis

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24
Q

What do you use to listen to diastolic murmurs

A

Bell; lower pitched with rumbling character; NEVER normal on its own

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25
Q

When should venous hums disappear

A

When pressure placed on jugular vein, when child’s head is turned, when child is lying supine, *only sound in diastole that doesn’t warrant a referral to cardiology

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26
Q

Which pathologic murmurs change with position

A

Hypertrophic cardiomyopathy: systolic murmur at apex and LSB that increases in intensity when patient stands and with valsalva maneuver *one of the leading causes of death in young athletes - also called IHSS (idiopathic hypertrophic subaortic stenosis)

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27
Q

What are the features of innocent murmurs

A

Sensitive (changes with position), short duration, single, small, soft, sweet, systolic

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28
Q

When do you refer a child to a cardiologist

A

Grade 4 murmur or up, diastolic murmur, increased intensity when patient stands, if sx, Heart sounds obscured, fem pulses weak, clicks, hyperactive precordium, hx of sudden death, ab or extra heart sounds (except S3), conditions predisposing to heart lesions

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29
Q

What is a stills murmur

A

Decreases when standing ; best heard at apex with bell

30
Q

What are the critical congenital heart diseases checked for in the nursery

A

Hypoplastic left heart syndrome, pulm atresia, TOF, total anomalous venous return, transposition, tricuspid atresia, truncus arteriosus

31
Q

What is the study of choice for kids with downs

A

Echo with Doppler

32
Q

What is the most common use of a Doppler

A

Fetal heart sounds

33
Q

What do you use a transesophgeal echo for

A

Endocarditis, mural thrombus

34
Q

What is a FAST exam

A

Focused assessment with sonography in trauma; detects pericardial effusion and Hemo Peritoneum

35
Q

What is beck’s triad

A

JVP, muffled heart sounds, low BP

36
Q

When is transthoracic echo indicate

A

Pericardium, ventricles, atria, septa, valves, ejection fraction evaluation; obscured with pulm dz or body habitus

37
Q

What is an endocrine cause of chest pain

A

Hyperthyroidism

38
Q

What are the emergent causes of chest pain

A

NSTEMI, STEMI, pericardial tamponade, aortic dissection, boorhaves, PE, pneumothorax

39
Q

Where does pain in acute coronary syndrome radiate

A

Back, jaw, shoulders, arms, upper abdomen

40
Q

What is the most common anginal equivalent

A

Unexplained new onset or increased exertional dyspnea

41
Q

Who tends to have atypical presentation of ACS

A

People over 75, diabetics, impaired renal function and dementia; sx include epigastric pain, indigestion, stabbing or pleuritic pain, dyspnea in absence of chest pain

42
Q

Besides a full cardiac exam what else should you do for someone presenting with cardiac sx

A

Hepatojugular reflux, rales in lungs or egophany (sign of heart failure), edema

43
Q

What is the age risk factor for CV dz

A

Men > 45; women >55

44
Q

What is the family hx risk for CV dz

A

Heart attack, bypass surgery or sudden death < 55 in father/brother or <65 for mother/sister

45
Q

What is considered a sedentary lifestyle

A

Not participating in moderate physical activity at least 3 days a week for 3 months

46
Q

What are the obesity and HTN risk factors for CV dz

A

BMI>30, BP >140/90 or taking medication

47
Q

What are the lipid risks for CV dz

A

LDL >130, HDL <40 or taking meds

48
Q

What is considered pre diabetes

A

IFG >100; OGTT >140 but <199 by 2 measurements

49
Q

What is a protective factor for CV dz.

A

HDL > 60

50
Q

Does unstable angina respond to nitroglycerin

A

No

51
Q

What is the treatment for ACS

A

MONA-B

  • morphine
  • O2: even if O2 sat is good
  • nitroglycerin
  • aspirin: PO chewable
  • beta blocker
52
Q

When do you order cardiac markers

A

Immediately and then repeat q6hx3

53
Q

When do you order EKG

A

Immediately and then q8hx3

54
Q

When do you order a lipid panel for a cardiac case

A

In the am; fasting; NOT immediate

55
Q

When will you send someone straight to the cath lab

A

Uncontrollable chest pain, new LBBB, or STEMI

56
Q

How do you diagnose nontuberculosis mycobacterial infection

A

Sputum culture and molecular diagnostics

57
Q

How do you diagnose fungal infection in the lung

A

Sputum culture and regional exposure

58
Q

How do you diagnose a septic embolus to the lung

A

Blood culture and echo

59
Q

What do you do to test for TB if someone has had a BCG vaccine

A

Use a gamma release assay

60
Q

What are the sx of an active TB infection

A

Fever, night sweats, cough (productive or hemoptysis), weight loss, LAD

61
Q

What kind of hypersensitivity reaction is the PPD test

A

IV

62
Q

When is a PPD considered positive

A
  • > 5mm in people with HIV, close contact with active infectious persons, CXR with fibrotic changes consistent with TB, immunosuppressed
  • > 10mm in ppl with silicosis, DM, chronic renal ialure with dialysis, malignancies, malnourished, IV drug abuse, kids <4, rom country with high prevalence, residence in jails, nursing homes, homlesss shelters
  • > 15 mm in healthy individual
63
Q

What is the work up for TB

A
  • Morning Sputum culture x3 - gold standard: stain for rhodamine-auramine for screening and Ziehl-Nielsen or Kinyun for confirmatory
  • PPD: not used for diagnosis
  • IFN gamma release assay
  • chest XR: cavitary lesions typically in apices
  • NAAT (nucleic acid amplification test): NAAT-TB tests TB genetic material and NAAT-R detects INH and rifampin resistance
64
Q

What are the side effects of the RIPE drugs

A

rifampin: orange, hepatitis, Steven Johnson syndrome
Isoniazid: hepatitis peripheral neuropathy
Pyrazinamide: urticaria, hyperuricemia, gout, hepatitis
Ethambutol: colorblind

65
Q

What monitoring should you do to patients on RIPE treatment

A
  • hepatic enzymes, CBC, serum creatinine and Uric aid
  • testing for hep B and C with risk factors and HIV on all patients
  • visual acuity
  • sputum is collected to monitor treatment efficacy
66
Q

How do you diagnose latent TB infection

A

Positive PPD or IGRA -> check chest CXR to make sure no active infection; if negative treat as latent TB with 9 months of INH

67
Q

What are the TB infection control measures

A
  • administrative controls: decrease the risk or exposure to persons with TB
  • environmental controls: admit to negative pressure room
  • respiratory controls: use or protective equipment
68
Q

What is the FiO2 for the diff kinds of oxygen administration

A
  • room air: 21%
  • Nasal cannula: 24-44%
  • simple face mask: 40-70%
  • Venturi mask: 24-50%
  • non-rebreather (NRB):: 80-100%
69
Q

Is OMT indicated in acute TB

A

No

70
Q

What are the posterior lung Chapman’s points

A

Myocardium: intertransverse btw T2-3
Bronchus: lateral to T2 spinous
Upper lung: intertransverse btw T-3 and 3-4
Lower lung: 4-5

PCM III (2 decks)

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