Final Review Flashcards
S/sx’s:
Dyspnea, anxiety, pleuritic chest pain, cough, hemoptysis. Low pulse ox and arterial gasses
Pulmonary Embolism:
S/sx’s:
Sx onset is usually gradual over minutes and chest pain is the mc sx. Sensation of tightness, squeezing, pressure.
Myocardial Infarction:
S/sx’s:
Crackles (rales), Chest pain but with fever, cough, and dyspnea
Pneumonia:
S/sx’s:
Discomfort induced by exertion and relieved with rest or nitroglycerin.
Angina Pectoris:
S/sx’s:
Sx’s occur with the same degree of exertion and resolves with the same decree of rest and same dosage and strength of nitroglycerine.
Stable Angina:
S/sx’s:
Angina that occurs with more frequent occurrence of angina episodes, longer lived ones, or more easily proved not relieved by nitroglycerine
Unstable Angina:
S/sx’s:
Angina at rest not relieved by Nitroglycerine
Prientz Metal/ Atypical:
S/sx’s:
Pressure/squeezing quality, pain similar to prior mi or angina, radiation to neck, shoulders, jaw or left arm, associated dyspnea and could have nausea and sweating.
Acute Coronary Syndrome:
S/sx’s:
Inc. heart rate, rapid breathing and displacement of windpipe away from affected side
Pneumothorax:
S/sx’s:
Unequal pulses, radiating pain to the back, new onset murmur
Aortic Dissection:
S/sx’s:
Cardiac Tamponade:
“Beck’s triad”
Becks Triad= Low BP, JVD, Decreased Heart Sounds
S/sx’s:
Pain radiating to the mid back, hoarse voice and left due to left recurrent laryngeal nerve being stretched *Matching of where pain goes
Aortic Aneurysm:
Beck’s triad
Low BP, JVD, Decreased Heart Sounds
Wells DVT score:
- Active cancer (treatment within last 6 months or palliative): +1
- Calf swelling ≥ 3cm compared to asymptomatic calf (measured 10cm below tibial tuberosity): +1
- Swollen unilateral superficial veins (non-varicose, in symptomatic leg): +1
- Unilateral pitting edema (in symptomatic leg): +1
- Previous documented DVT: +1
- Swelling of entire leg: +1
- Localized tenderness along deep venous system: +1
- Paralysis, paresis or recent cast immobilization of lower extremities: +1
- Recently bedridden ≥ 3days, or major surgery requiring regional or general anesthetic in
the past 12 weeks: +1 - Alternative diagnosis at least as likely as a diagnosis of DVT: -2
Wells PE score:
Clinically suspected DVT: +3
Alternative diagnosis is less likely than PE: +3
Tachycardia (HR > 100): +1.5
Immobilization (≥ 3d)/surgery in previous four weeks: +1.5
History of DVT or PE: +1.5
Hemoptysis: +1
Malignancy (with treatment within 6 months) or palliative treatment: +1
(possible score -2 to +9)
Wells PE score:
Traditional interpretation
Score of > 6.0 = High probability of PE (probability 59% based on pooled data)
Score of 2.0 to 6.0 = Moderate probability of PE (probability 29% based on pooled data])
Score of
Wells PE score:
Alternative interpretation
Score > 4 means that a PE is likely. Consider diagnostic imaging.
Score 4 or less means that a PE is unlikely. Consider D-dimer testing.
Know the different stages used in assessing the severity of an asthmatic attack.
- Mild asthma - Adequate air exchange, mild dyspnea, diffuse wheezes. FEV1 50 to 80% of normal.
- Moderate asthma - Respiratory distress at rest, hyperpnoea, marked wheezes, and air exchange is normal to decreased. FEV1 is 50% of normal or less.
- Severe - Marked respiratory distress, marked wheezes or absent breath sounds, check for pulsus paradoxus - drop of systolic blood pressure >10 mm. with inspiration. SCM retraction is commonly noted. FEV1 is 25% to 11% of normal.
- Respiratory failure - Severe respiratory distress, lethargy, confusion, prominent pulsus paradoxus, SCM retraction. FEV1 is generally 10% of normal or less.
Review the presentations of different causes of GI bleeding.
- Approximately 50% of upper GI bleeds are due to peptic ulcer disease.
- Esophagitis and erosive disease of the esophagus causing bleeding are the next most common causes.
- About 75% of patients presenting to the emergency room with GI bleeding have an upper source.
- Patients with upper GI bleed due to peptic ulcer disease often present with hematemesis, coffee ground vomiting, melena, or hematochezia (maroon colored stool if the hemorrhage is severe).
- The anatomic cut-off for upper GI bleeding is the ligament of Treitz & pharynx.
- Patients may also present with complications of anemia, including fatigue, chest pain, syncope and shortness of breath.
Metabolic:
S/sx’s & Cancer-
Hypercalcemia of malignancy
All cancers, esp. lung, breast, and prostate as well as multiple myeloma
Fatigue, anorexia, nausea, vomiting, constipation, mental decline, renal failure, coma, myalgia, headache, altered mental status
Metabolic:
S/sx’s & Cancer-
Syndrome of inappropriate antidiuretic hormone
Bronchogenic carcinoma
Anorexia, nausea, vomiting, constipation, muscle weakness, myalgia, polyuria, polydipsia, seizures, coma
Metabolic:
S/sx’s & Cancer-
Tumor lysis syndrome
Hematologic malignancies, cancers with rapidly growing tumors,
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, acidosis, acute renal failure particularly acute leukemias and high-grade lymphomas
Hematologic:
S/sx’s & Cancer-
Febrile neutropenia
Chemotherapy-associated bacterial or fungal infections
Temp. greater than 101º F (38.3º C), absolute neutrophil Hematologic count less than 500 per mm3
Hematologic:
S/sx’s & Cancer-
Hyperviscosity syndrome
Waldenström’s macroglobulinemia, multiple myeloma, leukemia
Spontaneous bleeding, hemorrhagic retinal veins, neurologic defects,
Structural:
S/sx’s & Cancer-
Epidural spinal cord compression
Breast, lung, renal, and prostate cancers and myeloma
New back pain that worsens when lying down, late paraplegia, late incontinence, and loss of sensory function
Structural:
S/sx’s & Cancer-
Malignant pericardial effusion
Metastatic lung and breast cancer, melanoma, leukemia, lymphoma,
Dyspnea, fatigue, distended neck veins, distant heart sounds, tachycardia, orthopnea, narrow pulse pressure, pulsus paradoxus,
Structural:
S/sx’s & Cancer-
Superior vena cava syndrome
Lung cancer, metastatic mediastinal tumors, lymphoma, indwelling venous catheters
Edema, discoloration of head, neck or upper extremity swelling or discoloration; development of collateral venous circulation
Shocks:
fluid is lost from the circulatory system.
Hypovolemic –
Shocks:
heart fails to pump enough blood, heart is injured or damaged, CAD, CHF, VF.
Cardiogenic –
Shocks:
blood vessels dilate or constrict causing blood to pool away from vital areas.
Peripheral vascular –
Hemorrhages: class 1-4
Class I – up to 15%
Class II – 15% - 30%
Class III – 30% - 40%
Class IV – over 40%
Samter’s triad
asthma, aspirin and NSAID sensitivity, and nasal / ethmoidal polyps.
Compare and contrast ischemic stroke and hemorrhagic stroke.
Ischemic=> A clot blocks blood flow to an area the brain.
Hemorrhagic=> Bleeding occurs inside or around brain tissue.
- Nausea, vomiting, headache and change in the level of consciousness are symptoms that are more common in hemorrhagic strokes.
- Morbidity is more severe and mortality rates are higher for hemorrhagic stroke
- Morbidity is more severe and mortality rates are higher for hemorrhagic stroke
- 80% of strokes are ischemic.
- The 30 day mortality rate for hemorrhagic stroke ranges from 40 to 80%.
- Approximately 50% of all stroke deaths occur within the first 48 hours.
- Ischemic stroke can be reduced by using aspirin or related compounds which inhibit platelets from aggregating and forming obstructive clots.
- However this same treatment intervention may increase the likelihood and effects of hemorrhagic stroke.
Review signs and symptoms of meningitis..
The classic triad Dx
The classic triad Dx=> nuchal rigidity, sudden high fever, and altered mental status.
Young children often exhibit only nonspecific symptoms such as irritability, drowsiness, or lack of appetite.
In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness).
Toxic syndromes due to drug use or overdose:
Dry skin and dry mucous membranes, dry skin, hyperthermia, thirst, constipation, tachycardia, urinary retention, delirium, mydriasis**
Anticholinergic drugs
(i.e. Benadryl)
- *A common mnemonic for the main features of anticholinergic syndrome is: Hot as a hare (hyperthermia), blind as a bat (dilated pupils), dry as a bone (dry skin), red as a beet (vasodilation) and mad as a hatter (deliurm/hallucinations/agitation) and the bowel and bladder lose their tone while the heart goes on alone (ileus, urinary retention and tachycardia).
Toxic syndromes due to drug use or overdose:
(SLUDGE)
Salivation, lacrimation, increased urination, increased defecation, diarrhea, emesis, bradycardia, confusion, miosis
Cholinergic drugs
i.e. Organophosphate poisoning
Toxic syndromes due to drug use or overdose:
Miosis, depressed level of consciousness, respiratory depression, hypotension, hypothermia, hyporeflexia
Narcotics
(i.e. Oxycontin)
Toxic syndromes due to drug use or overdose:
Depressed level of consciousness, respiratory depression, hypotension, hypothermia, hyporeflexia
Sedatives/hypnotics
(i.e. Ambien)
Toxic syndromes due to drug use or overdose:
Tachycardia, hypertension, mydriasis, diaphoresis, seizures
Sympathomimetic
(i.e. Cocaine)
Antidotes and interventions:
Acetaminophen
N-acetyl cysteine (NAC)
Antidotes and interventions:
Amphetamines, cocaine
Benzodiazepines
Antidotes and interventions:
Aspirin
alkalinization of urine with IV sodium bicarb, hemodialysis
Antidotes and interventions:
Benzodiazepines
Flumazenil
Antidotes and interventions:
Beta-blockers
Glucagon, IV calcium, ventricular pacing
Antidotes and interventions:
Calcium channel blockers
Glucagon, IV calcium, ventricular pacing
Antidotes and interventions:
Carbon monoxide
100% oxygen, hyperbaric oxygen
Antidotes and interventions: Ethylene glycol (anti-freeze)
Ethanol, hemodialysis
Antidotes and interventions:
Warfarin (Coumadin)
Vitamin K
Antidotes and interventions:
Heparin
Protamine sulfate
Antidotes and interventions:
Insulin, oral hypoglycemic agents
Glucagon, IV glucose (D5W)
Antidotes and interventions:
Narcotics
Naloxone*
*Naloxone should not be confused with Naltrexone. Naloxone is used in emergency cases of opioid overdose whereas Naltrexone (full strength dosing) is used primarily in the management of alcohol dependence and opioid dependence. Using Naloxone in place of Naltrexone can cause acute opioid withdrawal symptoms. Conversely, using Naltrexone in place of Naloxone in an overdose situation can lead to insufficient opioid antagonism and fail to reverse the overdose.
Antidotes and interventions:
Organophosphates (cholinergic)
Atropine
Glasgow-Blatchford bleeding score (GBS) is a screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have urgent medical intervention such as a blood transfusion or endoscopic examination.
Blood Urea Hemoglobin (g/L) for men Hemoglobin (g/L) for women Systolic blood pressure (mm Hg) Pulse Melena Syncope Hepatic cardiac failure
Glasgow-Blatchford bleeding scoring (GBS)
Scores of 6 points or more on the Glasgow-Blatchford scoring system are associated with a greater than 50% risk of signifigant bleeding that requires urgent/ emergent intervention.
- A G-B score can be zero if all of the following findings are present:
- Hemoglobin level: >12.9 g/dL (men) or >11.9 g/dL (women)
- Systolic blood pressure: >109mm Hg, Pulse:
Rockall scoring system:
This system attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding.
The scoring system uses clinical criteria (increasing age, co-morbidity, shock) as well as endoscopic finding (diagnosis, signs of acute bleeding).
ABCDE - Age, Blood pressure fall (shock), Co-morbidity, Diagnosis and Evidence of bleeding.
Advantages of the GBS over the Rockall score:
Assesses the risk of mortality in patients with UGIB, include a lack of subjective variables such as the severity of systemic diseases and the lack of a need for upper endoscopy to complete the score, a feature unique to the GBS.
(STEMI)
MI=> ST elevation
