Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Phase II Lecture > Panoptos for Mental Probe 2 > Flashcards

Panoptos for Mental Probe 2 Flashcards

1
Q

___ of patients in ER for a chest problem will have acute coronary syndrome

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

___ of patients with symptoms of acute cardiac ischemia will have an MI

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is acute coronary syndrome

A

patients with an acute MI (heart attack) and/or unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

___ of patients in a primary care medical office have uynstable heart disease and need to have ____ _____

A

1.5%, emergency referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MEMORIZE
Cardiac chest pain, Ischemic
What are three diagnosis?

A

Stable angina, unstable angina (ACS), MI (ACS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MEMORIZE
Cardiac chest pain, non-ischemic
What are four diagnosis?

A

Pericarditis, Aortic dissection, Valvular heart disease, Arrythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MEMORIZE
Non-cardiac chest pain, gastro-esophageal
What are three diagnosis?

A

GERD, peptic ulcer disease, esophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MEMORIZE
Non-cardiac chest pain, non-gastro-esophageal
What are four diagnosis?

A

Pneumothorax, pulmonary embolism, musculoskeletal, panic attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does ischemic heart disease mean in layman’s terms

A

Heart is not getting enough oxygen and cells are dying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GERD can closely mimic what?

A

heart attack, ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who should I call an ambulance for?

A

Chest pain and respiratory problems or abnormal vitals (eg. low BP)
may have an acutely unstable heart problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common to least common causes of heart pain

A 
Musculoskeletal conditions
non-specific chest pain
GI disease
Stable CAD
psychosocial or psychiatric disease
Pulmonary disease
Other CV disease (pulmonary embolus/heart failure)
Unstable CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MS conditions in patients in primary care office

A

29-36%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GI disease causing chest pain in patients in primary care office

A

10-19%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stable CAD causing chest pain in patients in primary care office

A

8-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

psychosocial or psychiatric disease in patients in primary care office

A

8-17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Three procedures to investigate the heart

A

BP, pulse, auscultate heart (mitral valve while performing Valsalva)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Procedures to investigate the Upper GI track

A

palpate or percuss upper quadrants with knees flexed

Assess epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Procedures to investigate spine and body wall

A

Static and motion palpation of the cervical, thoracic spine (TLJ)
Palpate posterior ribs and back muscles
Palpate the chest wall (CS junctions, pectoralis, intercostals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Frequency of causes of chest pain in 204 non-acute patients

A 
pericarditis - 9%
pleuritis - 2% 
pulmonary embolism - 2% 
lung cancer - 1.5%
aortic aneurysm - 1% 
aortic stenosis - 0.5%
herpes zoster - 0.5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Procedures to investigate the lungs

A

Observe respiratory rate
Observe breathing, use of accessory muscles
Palpate for fremitus
Auscultate the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What four signs indicate a patient who should be evaluated for myocardial infarction?

A

Chest pain, shortness of breath, dizziness/weakness/syncope, abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Of those who die of heart complications how early do they die?

A

within 2 hours of symptoms which is why new onset chest pain is so concerning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are four clues indicating high risk for Acute Coronary Syndrome?

A

Exertional chest pain
Pain radiating to one or both arms
Pain similar or greater than prior cardiac pain
Associated with nausea, vomiting, diaphoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are three clues that lower the likelihood of Acute Coronary Syndrome?

A

Pain that is pleuritic (breath)/positional/reproducible with palpation(BEST)/stabbing-knife

Pain that is non-exertional
Pain in a small inframammary part of the chest

26
Q

Location of chest pain is likely NOT

A

Above C3 or below T10

27
Q

Clinical Pearl for angina

A

suspect angina in any patient who describes discomfort above the waist that is provoked by exercise and relieved by rest

28
Q

MEMORIZE

Associated symptoms that make me worried about the heart

A 
Dyspnea
Dizziness
Diaphoresis (shocky looking)
Nausea (poor prognosis)
Weakness
(near) syncope
Palpitations
29
Q

Modifiable risk factors for CVD

A 
Overweight or obese - 65%
LDL cholesterol >130mg/dl - 46%
Physically inactive - 38%
Hypertension - 26%
Tobacco use - 25%
Metabolic syndrome - 24%
Pre-hypertension - 22%
DM - 8%
30
Q

Factors that are non-modifiable for CVD

A

Male
Family history
Increased hsCRP (high pro-inflammatory levels)
Hormone Replacement Therapy
Increased coronary artery calcium (uses a specific CT scan)

31
Q

Ancillary studies for CAD risk factors

A

Lipid profile
Glucose/HgB A1C/ 2 hour post load
hsCRP
Coronary artery calcium (CAC) (CAT scan. not a blood test)

none of these tests diagnose HD, they are RISK factors

32
Q

Definition of stable angina

A

brief ischemic episodes without permanent heart damage

33
Q

Main criteria for diagnosing angina

A

Typical angina:
Substernal chest discomfort with a characteristic quality and duration
Provoked by exertion or emotional stress
Relieved by rest or nitroglycerin

Atypical angina:
Meets 2 of the above criteria

Noncardiac chest pain:
Meets 1 of the above or none

34
Q

Ancillary studies for suspected angina

A 
12 lead resting EKG (often normal)
Stress tests (EKG, echocardiogram, myocardial perfusion scintigraphy) - stress--
Chest radiograph (optional)

Angiogram (GOLD STANDARD)

35
Q

Qualities of unstable angina

A 
Occurs at rest
>10 minutes in length
Nitro usually helps
ST depression or elevation on EKG
Unstable due to complicated atherosclerosis
Prinzmetal type is due to vasospasm
36
Q

Qualities of stable angina

A 
Exertion related
<10 minutes in length
Rest and nitro help
ST depression on EKG
Negative enzymes
Due to atherosclerosis
37
Q

LR of nausea predicting acute MI

A

10

38
Q

LR of pain in both arms predicting acute MI

A

9.7

39
Q

LR of right arm pain predicting acute MI

A

7.3

40
Q

Cardiac red flags

A

Chest pain that completely stops a patient from activity

41
Q

PE features of MI

A

Third heart sound
Hypotension (SBP <80)
Pulmonary crackles
Diaphoresis

42
Q

Clinical prediction rule to rule out CAD in chest pain patients

A 
Women > 64, Men > 54
Known CAD, cerebrovascular disease, peripheral vascular disease
Pain is worse with exercise 
Pain is not reproducible with palpation 
Patient assumes pain is cardiac

Each of the above is worth one point
98% with less than or equal to two will not have CAD, 23% with 3 or higher points will have CAD

43
Q

Ancillary tests for MI

A 
12 lead EKG (is likely changed) permanent change
Troponins (breakdown protein from heart muscle) disappears in 24 hours
Cardiac enzymes (CPK-MB, AST)
44
Q

Gold standard test for acute MI

A

angiography

45
Q

Causes of chest pain from heart that are not MI

A

Mitral valve prolapse

Pericarditis

46
Q

Mitral valve prolapse ancillary and big clue

A

Test with echocardiogram

Mid-systolic murmur or closing click

47
Q

Pericarditis big clues

A

non-pleuritic friction rub
pre-cordial pain radiates to trapezius ridge
*** aggravated by lying supine and relieved by bending forward
characteristic Electrocardiogram changes

48
Q

Arrythmias that begin in the atrium or at the gateway to the lower chambers are ____ ____

A

supraventricular arrhythmias

49
Q

Types of supraventricular arrhythmias

A

atrial fibrillation
atrial flutter
paroxysmal supraventricular tachycardia (PSVT)

50
Q

Arrhythmias in the ___ ___ typically require urgent medical care and include ___ ___ and ___ ___.

A

lower chamber, ventricular tachycardia, ventricular fibrillation

51
Q

Patients with atrial fibrillation have a __ greater risk for stroke or peripheral embolism.

A

5X

52
Q

Oral anticoagulation is recommended in patients with ___ ___ who have had a ___ ___ _ ___ ___ ___. Currently approved anticoagulants include ___ ___ ___ ___.

A

atrial fibrillation, prior stroke or transient ischemic attack
warfarin, dabigatran, rivaroxaban, and apixaban.

53
Q

Atrial fibrillation is more common in

A

Men than women and whites than blacks

54
Q

Atrial fibrillation can be associated with ___, ___, ___, and ___

A

hemodynamic dysfunction, tachycardia-induced cardiomyopathy, and systemic thromboembolism.

55
Q

Pericarditis ancillary tests

A

chest radiograph, CBC, blood chemistry, ESR

56
Q

causes of pleuritis

A

Viral, bacterial, secondary to pneumonia, systemic lupus

57
Q

If lupus is suspected test with

A

ANA

Anti-Nuclear Antibody

58
Q

Pleuritis clues and ancillary tests

A

Pleuritic pain, respiratory friction rub, fever/malaise

Ancillary: Chest radiograph, CBC, blood chemistry, ESR

59
Q

Tests for GERD

A

Acid suppression approach

Give a lot of PPI for a few weeks and if pain goes away then it is GERD. 40mg 2X a day

60
Q

Three questions for panic disorder

A

When you are nervous, how often do you think, “I am going to pass out”?
During the last 7 days, including today, how much have you been bothered by pains in the chest?
To what degree is your chest pain tiring or exhausting?

61
Q

In Cervicothoracic Angina (CTA) what is effective?

A

HVLA and STM

Clin Phase II Lecture (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions