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SPE Flashcards

1
Q

general inspection for

A

acute distress, ill appearing, AMS

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2
Q

duration includes

A

constant vs intermittent

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3
Q

character includes

A

quality, severity

sitting, supine, breathing, eating

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4
Q

radiation includes

A

jaw, arm, back, shoulders

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5
Q

timing includes

A

time of day/ recurring circumstances

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6
Q

also ask what with OLDCAARTS

A

previous episodes

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7
Q

pertinent ROS (21)

A 
1- dyspnea/ DOE
2- syncope
3- orthopnea (# of pillows)
4- PND
5- palpitations
6- edema
7- claudication
8- cough
9- wheezing
10- HAs
11- abd pain
12- indigestion/ heartburn/ reflux
13- difficulty swallowing
14- pain w swallowing
15- appetite change
16- food intolerance
17- N/V
18- constipation
19- hematemesis
20- melena
21- anxiety/ nervousness
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8
Q

pertinent hx (11)

A 
1- recent viral illness
2- recent MI/ heart disease or illness
3- trauma
4- HTN
5- hyperlipidemia
6- heart disease
7- lung disease
8- HF
9- DM
10- prior CXR/ EKG/ addl studies
11- recent life changes/ stressors
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9
Q

other ROS (14)

A 
1- fever
2- chills
3- fatigue
4- malaise
5- sweats
6- sleep interruptions
7- unintentional weight changes
8- rash/ skin changes
9- dizziness
10- numbness
11- ST
12- hoarseness
13- diarrhea
14- changes in urinary habits/ sxs
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10
Q

PMH (7)

A 
1- medical illnesses
2- medications/ OTC supps
3- medication allergies (also seasonal/ latex)
4- surgeries/ hospitalizations
5- accidents/ injuries
6- immunizations
7- LMP (if female)
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11
Q

FH

A

first degree- heart disease, HTN, DM, CA

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12
Q

SH

A

tobacco, alcohol, drugs, exercise, occupation

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13
Q

PE skin

A

socks off

diaphoresis, turgor, rash

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14
Q

PE neck

A

JVD, Kussmaul’s sign (increase in JVP with inspiration), palpate carotid pulse

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15
Q

what to do in PE before lungs

A

draping

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16
Q

PE lungs inspect

A

body habitus & chest wall, breathing pattern/ chest symmetry/ chest expansion

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17
Q

PE lungs palpate

A

increased/ decreased tactile fremitus

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18
Q

PE lungs auscultate

A

decreased breath sounds, crackles, rhonchi, wheezing

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19
Q

PE CV inspect/ palpate

A

PMI, tenderness, crepitus

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20
Q

PE CV auscultate

A

seated and supine aortic, pulmonic, tricuspid, mitral with diaphragm and bell

for: pericardial friction rub, murmurs, gallops, S3/ S4

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21
Q

PE abd inspect

A

distension, pulsatile masses, periumbilical or flank bruising

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22
Q

PE abd auscultate

A

hyper/hypoactive bowel sounds, abdominal bruits

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23
Q

PE abd percuss

A

hyperresonance, tympany, dullness

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24
Q

PE abd palpate

A

liver, spleen, kidneys, abdominal aorta size, tenderness (mostly epigastric), masses

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25
Q

PE MSK

A

edema, peripheral pulses

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26
Q

labs

A

CBC, CMP, troponin, BNP

+/- CK-MB, myoglobin, UDS

others to consider: PT/ INR, ESR

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27
Q

imaging

A

EKG, CXR

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28
Q

additional studies

A

D-dimer, CT chest, CTA, PHQ, GAD

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29
Q

things not to forget

A 
vitals
secondary diagnoses
disposition
ER precautions
follow up
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30
Q

pleuritic, positional CP
friction rub
diffuse ST elevations in V1-V6 with associated PR depressions

A

pericarditis

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31
Q

pericarditis tx

A

Ibuprofen OR Aspirin
**both until symptom free for 24 hours (usually 7-14 days) → then taper weekly for 2-4 weeks

PLUS

Colchicine (prevents recurrence)

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32
Q

pericarditis tx if Dressler syndrome (fever & pulmonary infiltrates)

A

aspirin or colchicine, avoid NSAIDs

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33
Q

pericarditis pt edu

A

sxs resolve w/i 1-2 days of treatment
good long-term prognosis
avoid strenuous activity until symptoms resolved

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34
Q

hx of viral prodrome
young adult
S3 gallop
cardiomegaly on CXR

A

myocarditis

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35
Q

myocarditis tx

A

supportive - ACE inhibitors, diuretics, BBs

36
Q

substernal, poorly localized, exertional, short in duration CP relieved w/ rest or nitro
+ dyspnea, N/V, diaphoresis, numbness, fatigue
EKG → ST depression

A

stable angina

37
Q

stable angina outpt tx

A

daily Aspirin & BBs (both decrease mortality)
+ daily statin
sublingual nitro prn
(use CCBs if BBs c/i’d)

38
Q

stable angina definitive tx

A

revascularization (percutaneous transluminal coronary angiography) vs CABG (L main coronary artery or 3 vessel involvement)

39
Q

stable angina pt edu

A

HTN/ DM control, exercise, diet, smoking cessation

40
Q

retrosternal CP not relieved with rest or nitro
pain at rest
≥ 30 min
radiation (lower jaw/ teeth, L arm, epigastrium, back, shoulders)
+/- anxiety, diaphoresis, tachy, palpitations, N/V, dizziness

A

ACS

unstable angina vs NSTEMI vs STEMI

41
Q

caution for silent MI in who

A

women, elderly, diabetics, obese

42
Q

atypical MI sxs

A

abd pain, jaw pain, dyspnea w/o CP

43
Q

how to distinguish between unstable angina vs NSTEMI/ STEMI

A

cardiac enzymes

44
Q

ACS tx if normal EKG

A

MONA + serial enzymes/ EKG’s

45
Q

UA or NSTEMI tx

A

MONA BASH

46
Q

STEMI tx

A

MONA BASH + reperfusion

47
Q

arrhythmias, ventricular aneurysm/ rupture, cardiogenic shock, papillary muscle dysfunction, heart failure, L ventricular wall rupture are complications of

A

NSTEMI/ STEMI

48
Q

post-MI pericarditis + fever + pulmonary infiltrates

A

Dressler syndrome

49
Q

CP at rest, midnight to early morning
not exertional
not relieved with rest
transient ST elevations

A

vasospastic (variant, Prinzmetal) angina

50
Q

vasospastic angina tx

A

CCB’s at night
nitro
BB’s avoided (lead to unopposed vasospasm)

51
Q

triggers for vasospastic angina tx

A

cold weather, exercise, alpha-agonists, hyperventilation

52
Q

retrosternal, postprandial, increased with supine, relieved with antacids CP
water brash, sour taste in mouth
cough, ST

A

GERD

53
Q

GERD alarm sxs

A

dysphagia, odynophagia, weight loss, bleeding

→ endoscopy

54
Q

GERD dx gold standard

A

24 hr ambulatory pH monitoring

55
Q

intermittent/ mild GERD and tx

A

< 2 episodes per week

prn antacids and H2 receptor antagonists

56
Q

severe GERD and tx (drug class)

A

≥ 2 episodes/ week

PPI’s

57
Q

GERD tx (specific)

A

Famotidine
if no relief → Omeprazole
+ lifestyle mod

58
Q

GERD complications

A

esophagitis, stricture, Barrett’s esophagus, esophageal adenocarcinoma

59
Q

GERD pt edu

A

elevate head of bed 6-8 inches, avoid lying down for 3 hrs after eating
avoid food that delays gastric emptying (fatty, spicy, chocolate, peppermint, caffeine)
smoking cessation
decreased alcohol intake
weight loss

60
Q

constant, boring chest/ epigastric pain that radiates to the back
exacerbated supine, eating
relieved leaning forward, sitting, fetal position
N/V/fever
epigastric tenderness
tachycardia
periumbilical/ flank bruising

A

pancreatitis

61
Q

best lab for pancreatitis

A

lipase (3x uln)

62
Q

pancreatitis tx

A

supportive - NPO, high-volume IV fluid resuscitation, analgesia

*antibiotics NOT routinely used

63
Q

pancreatitis pt edu

A

90% recover without complications in 3-7 days with supportive care

64
Q

dyspnea, pleuritic CP, cough
dullness to percussion
decreased tactile fremitus
decreased breath sounds

A

pleural effusion

65
Q

transudative causes of pleural effusion

A

CHF > nephrotic syndrome, cirrhosis

66
Q

exudative causes of pleural effusion

A

any condition a/w infection/ inflammation, PE, malignancy

67
Q

pleural effusion initial test of choice vs gold standard

A

CXR

thoracentesis

68
Q

pleural effusion tx

A

treat underlying disease
thoracentesis
chest tube fluid drainage if empyema

69
Q

tall, thin man 20-40 yo, smoker OR underlying lung disease
pleuritic, unilateral, non-exertional, sudden CP
dyspnea
unilateral hyperresonace to percussion
decreased fremitus
decreased/absent breath sounds

A

pneumothorax

70
Q

tall, thin man 20-40 yo, smoker OR underlying lung disease
pleuritic, unilateral, non-exertional, sudden CP
dyspnea
unilateral hyperresonace to percussion
decreased fremitus
decreased/absent breath sounds

PLUS

increased JVP
systemic hypotension
tracheal deviation
\+/- chest flail 
tachypnea
A

tension pneumothorax

71
Q

pneumothorax tx if small PSP < 3 cm from chest wall at apex

A

observation + supplemental O2

72
Q

pneumothorax tx if large PSP > 3 cm from chest wall at apex

A

needle or catheter aspiration vs chest tube/ catheter thoracostomy

73
Q

pneumothorax tx if stable, SSP

A

chest tube or catheter thoracostomy + hospitalization

74
Q

pneumothorax tx if tension

A

needle aspiration followed by chest tube thoracostomy

75
Q

pneumothorax pt edu

A

avoid pressure changes for a min of 2 weeks

high altitudes, smoking, unpressurized aircrafts, scuba diving

76
Q

hypercoagulable state, venous stasis, vascular inflammation or injury
hx of recent surgery, long travel, estrogen use
dyspnea
pleuritic chest pain
cough
wheezing
orthopnea
+/- hemoptysis
hypoxemia
EKG with S1Q3T3 pattern, right ventricular strain, new incomplete right bundle branch block
+/- homan’s sign

A

PE

77
Q

PE diagnostics if stable

A

D-dimer testing, spiral CTA chest. V/Q scan (esp if pregnant)

78
Q

PE diagnostics if unstable

A

bedside echocardiography or venous compression ultrasound

79
Q

PE tx

A

heparin w/ factor Xa inhibitors and oral direct thrombin inhibitors thereafter
3+ months of anticoagulation

80
Q

when to use warfarin in tx of PE

A

factor Xa or direct thrombin inhibitors are not available and for patients with severe renal insufficiency

81
Q

warfarin target INR range

A

2.0-3.0

82
Q

when to tx PE with embolectomy

A

hemodynamically unstable PE in whom thrombolytic therapy is contraindicated

83
Q

when to tx PE with vena cava filter

A

patients at high risk of recurrence who are unable to tolerate anticoagulants

84
Q

Hx:

  • CP
  • SOB
  • LE swelling
  • Weight gain
  • Orthopnea

PE:

  • LE edema
  • JVD
  • Systolic: S3
  • Diastolic: S4

Labs:

  • CXR: Kerley B Lines
  • Echo
  • BNP >
A

CHF (exacerbation)

85
Q

CHF tx

A
  • Lasix

Systolic:
- Ace Inhibitor + β-blocker + Loop Diuretic

Diastolic:
- Ace inhibitor + β-blocker or CCB (do not use diuretics in stable chronic diastolic failure)

86
Q

CHF pt edu

A

Low salt diet

Med compliance

EYE (1 decks)

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