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PCM III Exam 1 > FINAL Study Guide > Flashcards

FINAL Study Guide Flashcards

1
Q

What is the grading scale for murmurs?

A

Grade 1: very faint, heard only after tune in

Grade 2: quiet, heard w/ in 1-2 beats

Grade 3: moderately loud w/ stethoscope on chest

Grade 4: loud w/ palpable thrill

Grade 5: v loud w/ thrill, heard w/ stethoscope partly off chest

Grade 6: v loud w/ thrill, don’t need stethoscope

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2
Q

What is the triad of sxs of aortic stenosis?

A

Angina
Syncope
Dyspnea

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3
Q

What is murmur of aortic stenosis?

A

harsh systolic murmur @ RUSB that radiates into neck

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4
Q

What are clinical findings assoc w/ aortic stenosis?

A

S4, pulse delay, slow upstroke in carotid A, paradoxical S2 split

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5
Q

What is murmur of MVP?

A

systolic murmur w/ OS or late systolic click @ L mid clavicular line

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6
Q

How to dx MVP?

A

ECHO

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7
Q

What is murmur of TR?

A

holosystolic murmur @ LLSB, increases w/ inspiration w/ increase in venous return to R heart

NO radiation into axilla

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8
Q

What murmur associated w/ large jugular v waves?

A

tricuspid regurgitation

fxnal result of RV dilation or rheumatic heart dz, endocarditis, carcinoid

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9
Q

What is murmur of MR?

A

holosystolic murmur @ L mid clavicular line

best heard w/ bell

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10
Q

What is murmur of VSD?

A

loud harsh holosystolic murmur @ LLSB

increased intensity w/ smaller size

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11
Q

What is murmur of aortic isufficiency?

A

high pitch decrescendo diastolic murmur @ LSB

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12
Q

What are clinical findings of aortic insufficiency?

A

wide pulse pressure
nail pulses
H2O hammer pulse
head bobbing

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13
Q

What murmur is an emergent situation?

A

acute aortic regurgitation

due to aortic dissection (widened mediastinum on CXR) or endocarditis

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14
Q

What is murmur of MS?

A

diastolic murmur w/ OS

almost always due to rheumatic fever

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15
Q

What is murmur of ASD?

A

systolic ejection murmur @ LSB

fixed split S2

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16
Q

What are systolic murmurs?

A

AS (@ RUSB, reduced carotid pulse)

VSD (@ LLSB w/ no change w/ inspiration)

Tricuspid Regurgitation (@ LLSB, increased w/ inspiration)

MVP (L midclavicular line w/ click)

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17
Q

What are diastolic murmurs?

A

Aortic Insufficiency (R upper or L midsternal border w/ bell)

Mitral Stenosis (@ apex when L lat recumb, w/ OS)

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18
Q

What are the normal heart sounds?

A

S1 (start of systole w/ mitral valve closure)

S2 (end of systole, start of diastole w/ aortic valve closure)

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19
Q

What are the abnormal heart sounds?

A

S3 (if in pt>40yo, indicates volume overload & LV fail)

S4 (never normal, indicates atrial contraction against non compliant ventricle due to increased LV end diastolic pressure)

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20
Q

What are the different patterns of split S2 sound?

A

wide physiologic split (delayed closure of pulmonic valve)

fixed split does NOT vary w/ respiration & abnormal (ASD, R vent fail)

paradoxical split w/ P2 before A2 (LBBB b/c abnormal delayed closure of aortic valve)

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21
Q

Describe screening recommendations for carotid artery stenosis

A

NO screening w/ carotid duplex US for asymptomatic

US indicated if sxs or those w/ carotid bruit

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22
Q

What are 3 most predictive findings of acute stroke?

A

facial paresis
arm drift/weakness
abnormal speech

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23
Q

What is defining sx of PAD?

A

claudication (pain w/ walking that eases w/ rest)

severe pallor & ischemia of limbs

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24
Q

What are pearls for CVI?

A 
limb discomfort
edema
ulceration, telangiectasias
stasis dermatitis 
varicose veins
vascular ulcer
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25
Q

What is cor pulmonale?

A

primary right heart failure

setting of pulm HTN, COPD, chronic lung dz

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26
Q

What are 3 main underlying causes of HFpEF?

A

HTN
CAD
DM

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27
Q

What are criteria for HFrEF?

A

LV EF<50%
dilated LV w/ low EF (increased LV filling pressure)

systolic dysfxn

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28
Q

What are the keys to pulmonary edema?

A

sxs: SOB, diaphoresis, wheezing
labs: ECG, cardiac markers, ECHO
dx: w/ PE, CXR
tx: supplemental O2, IV furosemide, mechanical ventilation

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29
Q

What are physical findings of PDA murmur?

A

continuous, machinery like murmur @ LUSB

CXR w/ calcification of ductus arteriosus in adults

30
Q

When would you obtain orthostatic VS?

A

dehydration
blood loss
syncope

31
Q

What are positive orthostatic VS?

A

pulse INCREASE of 10bpm

OR

BP DECREASE of 20mmHg or greater

32
Q

What is the recommended initial testing for PAD?

A

initial test w/ ABI (if ABI<0.9, diagnostic for PAD & moderate arterial dz)

if initial ABI negative but pt w/ sxs of claudication, exercise stress test & re-measure ABI

33
Q

What are urine findings of AKI?

A

low urine output
high serum Cr

need UA+micro, urine albumin:Cr ratio for dx

34
Q

ATN urine findings

A

renal tubular epithelial & transitional epithelial cells, granular or waxy casts

35
Q

AIN or pyelonephritis urine findings

A

WBC, WBC casts, urine eosinophils

36
Q

Vasculitis, glomerulonephritis urine findings

A

dysmorphic RBCs, RBC casts

37
Q

Nephritic syndrome urine findings

A

HEMATURIA, dysmorphic RBCs, RBC casts, some protein

38
Q

Nephrotic syndrome urine findings

A

heavy proteinuria >3.5/day, lipiduria, min hematuria

39
Q

Pre renal azotemia urine findings

A

hyaline cast

40
Q

UTI urine findings

A

WBCs, RBCS, BACTERIA

41
Q

What are common causes of AKI?

A

Pre renal (hypoTN, hypovol, reduced CO, systemic vasodilation, hyperCa2+)

Intra renal (ATN, acute & chronic IN, glomerulonephritis)

Post renal (bladder or ureteral obstruction, renal papillary necrosis)

42
Q

When can FeNa & FeUrea be used?

A

ONLY valid in OLIGURIC PT

used to differentiate btwn pre renal & ATN

43
Q

What is FeNa in pre renal v ATN?

A

pre renal w/ FeNa <1%

ATN w/ FeNa>2%

44
Q

What determines recovery & degree of recovery in AKI?

A

presence of CKD & degree of initial injury are main determinants

no guarantee that kidney recovers fxn or if recovery will return to baseline

45
Q

When does AKI become CKD?

A

if not recovery of renal fxn after 3months?

46
Q

Grade edema

A

1+ is 2mm
2+ is 4mm
3+ is 6mm
4+ is 8mm

pitting edema=CHF

47
Q

What are the cardinal manifestations of HF?

A

dyspnea
fatigue
fluid retention/volume overload

48
Q

What is significant about S3 in pts w/ HF?

A

S3 w/ increased JVP is STRONG predictor of outcome (high risk of death & hospitalization)

49
Q

What is the recommended screening for abdominal aneurysm?

A

any pt>50yo w/ current or past SMOKING hx needs AB US to screen for AAA

50
Q

URI/Acute Bronchitis DX & TX

A

DX: cough for 1-3 weeks, constitutional sxs, PE w/ rhonchi that clear w/ cough (based on HX & PE)

TX: reassurance & symptomatic relief, avoid Abx

51
Q

Chronic Bronchitis DX & TX

A

DX: productive cough w/ sputum for >3mo for 2 consecutive yrs, FEV1/FVC<0.7 on spirometry

TX: pulmonary rehab & pharm tx to improve sxs, exercise capacity, QOL

52
Q

What are CT findings for chronic bronchitis?

A

bronchitis w/ airway luminal narrowing, wall thickening

emphysema w/ multi organ loss of tissue

53
Q

What are work up recs for chronic bronchitis?

A

any pt w/ pulse ox<90%, ABG for complete assessment

any pt w/ pulse ox<88% or PaO2<55 supplied w/ supp O2

54
Q

What are specific tx rec based on chronic bronchitis sxs?

A

intermittent mild sxs: SABA are rescue tx

mild dz: LAMA

more SOB & lung hyperinflate: LAMA w/ LABA

hx of asthma: inhaled GC + LABA (fluticasone + salmeterol)

severe dz: LAMA + LABA + IGC, PDE4i, macrolide, xanthines

55
Q

Asthma DX & TX

A

DX: episodic or chronic sxs of wheezing, SOB, cough worse @ night or early AM; PE w/ prolonged expiration & diffuse wheeze

TX: SABA for quick relief of sxs, ICS

56
Q

What is distinctive of asthma on spirometry?

A

obstructive pattern that is REVERSIBLE w/ bronchodilator tx

57
Q

PNA DX & TX

A

DX: fever, cough, TACHYPNEA, SOB, CXR w/ infiltrates, PE w/ dullness to percussion

TX: CRB65 criteria (new onset confusion, age >65, hypoTN, RR>30), outpt w/ macrolide, inpt w/ resp fluoroquinolone OR macrolide w/ B lactam

58
Q

DX & manage acute abdomen

A

painful abdomen

tense abdomen upon palpation

call surgeon (immediate surgical emergency)

59
Q

What are expected physical findings in COPD?

A

increased AP diameter (barrel chest)

prolonged expiration on auscultation

hyper resonance w/ percussion of chest wall

pursed lip breathing

60
Q

What are causes of DVT?

A

endothelial injury/dysfxn

alteration in blood flow (stasis)

altered blood composition (hyper coaguable state)

61
Q

What are inherited risk factors for DVT?

A

Factor V Leiden mutation
Prothrombin mutation
Protein S/C deficiency
Anti thrombin deficiency

62
Q

What are acquired risk factors for DVT?

A

malignancy
pregnancy/OCPs
surgery/immobile
anti phospholipid syndrome

63
Q

What is Wells criteria?

A

scoring system for likelihood of DVT

higher score=more risk for dx of DVT or PE

64
Q

What is use of D dimer?

A

negative D dimer rules OUT PE

65
Q

What are the components of an asthma action plan?

A

Instructions for pt to take peak flow & adjust meds based on daily peak flow

education on inhaler use

Identify & avoid of triggers

all pts w/ asthma should receive PNA or annual flu vax

66
Q

What are the clinical sxs of pertussis?

A

catarrhal phase (weeks 1-2): malaise, rhinorrhea, mild cough, lacrimation & conjunctivitis

paroxysmal (week 2): severe & vigorous PM cough, post tussive vomiting

convalescent (can last up to 3 months): decreased frequency & severity of cough

67
Q

How to dx pertussis?

A

high index of suspicion w/ cough >2 weeks & 1 of following: paroxysms of cough, inspiratory whoop or post-tussive emesis

Culture w/ in 1st 2 weeks of illness

Nasopharyngeal collection for PCR testing

Serology only post 4 weeks of cough

68
Q

What is tx regimen for pertussis?

A

Abx w/ in 1st 3 weeks of cough

1st line tx: MACROLIDES (azithromycin, clarithromycin)

avoid opioid based cough suppressants

69
Q

What is the 2nd line tx for pertussis?

A

TMP SMX for pts w/ macrolide HSN

70
Q

What is 1st line tx option for pts w/ COPD?

A

NIPPV

pt can blood off excess CO2 (ventilation) & delivered higher FiO2 (oxygenation)

71
Q

What are some indications for tracheal intubation w/ mechanical ventilation?

A

hypoxemia even w/ supp O2

upper airway obstruction

unable clear own secretions

respiratory acidosis

fatigue of accessory ms

apnea

pt w/ trial of NIPPV that did NOT improve w/ in 30-90 min

PCM III Exam 1 (5 decks)

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