Term
Any acute condition within the abdomen that requirs immediate medical or surgical attention.
What is the most common abominal pain diagnosis in the ER? Second most? |
|
Definition
Acute abdomen
1. Non-specific abdominal pain (NSAP)
2. Appendicitis
|
|
|
Term
| Alarm signs with abdominal pain |
|
Definition
| weight loss, GI bleeding, anemia, fever, frequent noctural symptoms, onset of symtoms in pt older than 50 |
|
|
Term
| Best-test question for distinguishing btwn appendicitis and NSAP? |
|
Definition
is pain aggrevated by coughing/movement?
yes --> suggests appendicitis/peritonitis |
|
|
Term
| Where would pain from cholecystitis be? |
|
Definition
| RUQ - may radiate to inf angle of right scapula |
|
|
Term
Rome II criteria: 12 weeks of symtpoms in preceding year, change in frequency or form of stool, bloating, pain that is dull, crampy and recurrent.
What do these suggest? |
|
Definition
|
|
Term
| What are some surgical emergencies in regard to abdominal pain? |
|
Definition
| pelvic inflammatory disease with abscess, ectopic pregnancy, hemorrhage from ovarian cyst, adnexal or ovarian torsion |
|
|
Term
What disease?
Most frequently in alcoholics and pts with gall stones
severe upper abdominal pain that radiates into back
nausea and vomitting
pain is worse when supine |
|
Definition
|
|
Term
| Diseases that present with RUQ pain |
|
Definition
cholecystitis
cholelithiasis
leaking duodenal ulcer
hepatitis,
CHF
MI
hepatic flexure syndrome |
|
|
Term
|
Definition
gastroenteritis
irritable colon |
|
|
Term
|
Definition
muscle strain
appendicitis
salpingitis
diverticulitis |
|
|
Term
| Classic triad of physical findings in a pt with intestinal obstruction |
|
Definition
sudden onset of colicky abdominal pain
vomiting
obstipation (regular passage of stool at 3-5 day intervales)
Also - hyperactive/high pitched bowel sounds |
|
|
Term
Classic triad of _____:
abdominal tenderness
palpable mass in LLQ
fever |
|
Definition
|
|
Term
____: the eructation of gas through the mouth
____: gaseous abdominal distention
____: passage of intestinal gas through rectum |
|
Definition
belching
bloating
flatulence |
|
|
Term
|
Definition
swallowing air (aerophagia)
dyspepsia/GERD |
|
|
Term
| Causes of bloating/flatulence |
|
Definition
gastroparesis (delayed gastric emptying)
malabsorption of sugars and fat
colonic bacterial fermentation
gall bladder disease
colon carcinoma
diverticulitis
diverticulosis
IBS
lactose intolerance |
|
|
Term
____ should be suspected if bloating/flatulence is accompanied by lower abd pain, diarrhea, or constipation
____ should be suspected if flatulence is accompanied by foul-smelling, watery to semi-solid stools and abdominal distension |
|
Definition
diverticulitis
giardiasis |
|
|
Term
| Most common causes of chest pain |
|
Definition
angina pectoris
MI
musculoskeletal chest wall conditions (esp in kids) |
|
|
Term
| Common causes of chest pain in children |
|
Definition
muscoloskeletal, inflammatory process, psychiatric problem
reflux esophagitis, mitral valve prolapse, cocaine |
|
|
Term
| Women are at increased risk for PE if taking ____. They are more likely than men to present with atypical symtpoms such as? |
|
Definition
oral contraceptives
back pain
nausea/vomiting
dyspnea
severe fatigue |
|
|
Term
| Common causes of chest pain in eldery |
|
Definition
| CAD, cervicodoral arthritis, tumors, esophagitis, PE |
|
|
Term
| When taking history of chest pain, note 5 specific things: |
|
Definition
location of pain
quality of pain
duration of pain
factors that precipitate or exacerbate the pain
ameliorating factors
|
|
|
Term
What disease?
Paroxysmal (lasting 30 sec to few min), dull, pressing, squeezing, or aching.
located substernal, may radiate to precordium, upper extremities, neck or jaw.
Described: tightness, pressure, heaviness, (sometimes burning) |
|
Definition
|
|
Term
| What is the angina salute? |
|
Definition
| refers to the way pts hold a clenched fist over the sternum to describe pain |
|
|
Term
Suspect ___, if ____
____ if pain is precordial
___ if pain is substernal ---> VERY common problem
___ if pain is burning sensation
___ if pain is sharp and only lasts a few seconds
___ if pain is exacerbated by respiration |
|
Definition
pericarditis
Esophageal (or biliary)
Peptic esophagitis
Costochondritis, cervicodorsal arthritis, mitral valve prolapse, chest wlal problem
pleuritis |
|
|
Term
What disease?
occurs at rest and lasts few min to several hours
NOT substernal pain
Made better by laying down
arrythmia/lightheadedness/syncope
auscultate mid-systolic "click" |
|
Definition
|
|
Term
| ___ relieves angina pain in 2-4 min |
|
Definition
|
|
Term
| To diagnose chest wall/musculoskeletal pain, what is the maint hing you should do? |
|
Definition
| reproduce pain with palpation |
|
|
Term
| ___: straining iwth BM or BM that occur <3x/week |
|
Definition
|
|
Term
| Common causes of constipation |
|
Definition
laxitive habit
low fiber, high carb diet
change in daily habits/env
drugs
IBS
anorectal problem
|
|
|
Term
____: constipation usually caused by diet or env
___: constipation associated with: idiopathic slow transport (elderly), idiopathic megacolon and megarectum (kids), IBS, diverticular disease
___: constipation due to drug response, chronic laxation, prolonged immobilization, organic disease of rectum anus or colon, (anal fissures, strictures, or carcinoma) |
|
Definition
simple constipation
disordered motility
secondary constipation |
|
|
Term
| make sure to R/O ___ in any pt over 40 who presents with recent constipation or a marked change in bowel habits |
|
Definition
| carcinoma of colon or rectum |
|
|
Term
| Where is carcinoma of the colon most common? |
|
Definition
| r side of descending colon in older adults |
|
|
Term
Suspect ___, if ____
____ if constipation associated with steatorrhea (fat in feces) and foul smelling greenish yellow stools
____ if early mornign rushes, hypogastric cramps, tenesmus (needing to go all the time), and passage of blood
___ if colicky pain, abdominal distention, anemia, decreased laxative effectiveness, weight loss, anorexia, blood, pus, muscus in stool
___ if rectal discomfort, leakage, bleeding, urgency, tenesmus, diarrhea alternating with const, rectal prolapse |
|
Definition
small bowel or pancreatic lesion
colonic origin
colonic tumor
rectosigmoidal tumor |
|
|
Term
What disease?
common in young adults with TMJ, chronic fatigue syndrome, and fibromyalgia
change in stool freq and consistency
mucus in stool
abdominal pain/distension
made worse by stress
alleviated by increasing fiber and descreasing stress
colon tender on palpation
chronic intermittent loss stools, more frequent with onset of pain |
|
Definition
|
|
Term
| If on PE you find hard feces in rectal ampulla, think ____ |
|
Definition
| obstipation/fecal impaction |
|
|
Term
| ____: congenital disease with paralysis of part of the colon, resulting in no soiling and empty rectum on PE |
|
Definition
|
|
Term
Vulnerable populations to diarrhea
Most common cuase of diarrhea |
|
Definition
vulnerable: elderly, travellers, immunosuppressed
cause: gastroenteritis |
|
|
Term
| Common causes of chronic diarrhea |
|
Definition
| IBS, diabetes, lactose intol, continuous drug ingestion, alcoholism |
|
|
Term
If a pt is less than 1 yr with diarrhea, suspect _____
Middle aged women with chronic diarrhea, suspect _____ |
|
Definition
lactose intolerance
functional diarrhea, irritable colon, diabetes |
|
|
Term
| Acute diarrhea vs. chronic (time) |
|
Definition
Acute - abrupt onset, less than one week
may have n/v
Chronic: longer than 2 weeks or recurrent symptoms over months or years
|
|
|
Term
| Acute onset dirrhea in a previously healthy pt without signs or symptoms of other organ involvement suggests.... |
|
Definition
| infection - most commonly viral |
|
|
Term
| Common causes of chronic diarrhea |
|
Definition
IBS, meds, dietary factors, chronic inflammation, bowel disease, colon cancer
|
|
|
Term
| Foul-smelling, watery explosive diarrhea with mucus, suspect ___ |
|
Definition
|
|
Term
| For diarrhea to be "chronic" in children, must last for at least how long? |
|
Definition
|
|
Term
Consistency of stool:
____: postenteritis diarrhea, intestinal infections
____: cystic fibrosis, pancreatic insufficiency
____: shigella, salmonella, dysentery, IBS |
|
Definition
|
|
Term
____: a sensation of burning, warmth, or heat in the retrosternal region between the xiphoid and manubrium that occasionally radiates toward the jaw or rarely the arms. Water brash (regurgitation of fluid) may be present. Has no relation to physical activity.
___: episodic persistent abdominal symptoms related to feeding and thought to result from disorders of the proximal part of the digestive tract. |
|
Definition
|
|
Term
| Most common causes of heartburn and indigestion |
|
Definition
Reflux esophagitis
drugs
gastritis
excess food or alcohol
chronic active gastritis
gallbladder disease
pregnancy
aerophagia
functional GI disorder |
|
|
Term
In adults: heartburn is almost always caused by ____. (NOT by hiatal hernia)
It is most common in what population? |
|
Definition
reflux esophagitis
most common in pregnant women |
|
|
Term
If dyspepsia is continuous, exacerbated by food, and in particular associated with anorexia and weight loss ____ is more likely
Clues to correct diagnosis of ____ is that the pain is not usually brought on by exercise, it frequently occurs in the recumbent position and it is often relieved by antacids. |
|
Definition
gastric cancer
esophagitis |
|
|
Term
| Pain in hip from intermittent claudication is seen in pts with ___ disease |
|
Definition
|
|
Term
| Leg pain that develops during walking occurs in pts with what 4 problems? |
|
Definition
| arterial insufficiency, venous insufficiency, spinal stenosis, thrombophlebitis |
|
|
Term
______: precipitate by walking and relieved by rest.
pain described as a soreness, cramp, burning sensation in calf, OR tightness, heaviness, tiredness, achiness
unilateral or bilateral
rest pain in toes or heels
PE: pallor on elevation, rubor on dependency, loss of hair on toes, diminished arterial pulses |
|
Definition
| arterial insufficiency (intermittent claudication) |
|
|
Term
____:
precipitated by walking, relieved by rest
calf pain
night cramps, edema of legs, statis abnormalities
usually accompanied by varicose veins |
|
Definition
| chronic venous insufficiency |
|
|
Term
| How to determine spinal stenosis from arterial insufficiency? |
|
Definition
|
|
Term
_____:
pain present at rest and is seldom worsened by exercise
unilateral pain and swelling in calf
venography to diagnose |
|
Definition
|
|
Term
____:
diffuse aching in one or both calves with no relaiton to exericise
frequent complain of night cramps
relieved somewhat by elevation |
|
Definition
|
|
Term
| Sudden onset of pain in leg, sometimes associated with paralysis, paresthesia, pallor, or absence of arterial pulsations |
|
Definition
|
|
Term
| ____ are sensations of a skipped heartbeat, irregular heartbeat, a rapid or slow heartbeat, or increased awareness of heartbeat. |
|
Definition
|
|
Term
| When do palpitations occur most frequent? |
|
Definition
|
|
Term
| Common causes of palpitations |
|
Definition
| anxiety, stimulants, drugs, cardiac disease |
|
|
Term
| Most common cause of unilateral leg swelling? |
|
Definition
| chronic venous insufficiency |
|
|
Term
| Most common cause of bilateral leg swelling |
|
Definition
| CHF, nephrotic syndrome, cirrhosis, venous insufficiency, primary lymphedema |
|
|
Term
#1 cause of unilateral leg swelling in children
#1 cause of bilateral leg swelling in children |
|
Definition
unilateral: lymphedema praecox
bilateral: acute glomerulonephritis |
|
|
Term
| In what part of the body does lymphedema start? |
|
Definition
|
|
Term
Chronic alcoholic with leg swelling, think ____
diabetic wiht leg swelling, think ____ |
|
Definition
|
|
Term
When the heart is in diastole:
Period of ventricular _____
Blood flows from ___ to ____ |
|
Definition
relaxation
from atria to ventricles |
|
|
Term
Isovolumetric contraction:
Interval between the start of ____ and the opening of ___ valves
Ventricular volume is ____ |
|
Definition
| systole - aortic and pulmonary valve |
|
|
Term
Rapid ejection phase:
When ventricular pressure exceeds arterial pressure, ___ & ___ open |
|
Definition
|
|
Term
Isovolumentric relaxation:
When ____ pressure exceeds ___ pressure |
|
Definition
| arterial exceeds ventricular |
|
|
Term
S1:
Signals the beginning of _____
Caused by closure of ____ valves
What might cause splitting of S1?
S1 is loudest at the apex, ____ IC space |
|
Definition
ventricular systole
closure of mitral and tricuspid
splitting: two valves don't closue exactly together
left 5th IC space |
|
|
Term
| 3 things that would increase the intensity of S1 |
|
Definition
Mitral stenosis (stiff valves)
Short P-R interval (blood goes through more quickly and mitral valve remains open at onset of isovolumentric contraction)
Left ventricular hypertrophy (secondary to increased left vent contraction) |
|
|
Term
| 2 things that cause Decreased intensity of S1 |
|
Definition
Long P-R interval - mitral valve has time to "float" back to almost closed position prior to left ventricular contraction
Congestive heart failure - reduced left ventricular contraction |
|
|
Term
S2:
Signals end of _____
Caused by closure of ___ valves
Heard at what part of the heart? |
|
Definition
vent systole
aortic and pulmonary valve closure
loudest at the base (top) |
|
|
Term
____ will increase the intensity of S2 due to increased pressure of the valve
____ will decrease the intesity of S2 due to decreased motility of the valves |
|
Definition
HTN
Aortic or pulmonary stenosis |
|
|
Term
| How do you distinguish S1 from S2? |
|
Definition
S2 loudest at base
S1 loudest at apex
S1 synchronous with apical impulse
S1 just precedes the carotid pulse |
|
|
Term
| BP peaks during ____ and troughs during ____. |
|
Definition
peaks during systole
troughs during diastole |
|
|
Term
___ is the difference between systolic and diastolic pressures
____ is the volume of blood ejected wiht each heart beat |
|
Definition
pulse pressure
stroke volume |
|
|
Term
| Factors affecting arterial pressure |
|
Definition
LV stroke volume
Pliability or stiffness of aorta and large arteries
Peripheral vascular resistance
Volume of blood in arterial system (if you eat a high sodium meal, your blood presure will be higher) |
|
|
Term
How will each factor affect pulse pressure?
Decreased stroke volume due to heart failure, hypovolemia (diarrhea), severe aortic stenosis
Increased peripheral resistance due to cold exposure or severe CHF (decreased injection fraction <50%)
Increased stroke volume or decreased peripheral resistance due to fever, anemia, hyperthyroidism, aortic regurgitation, bradycardia, atherosclerosis of aorta |
|
Definition
| decreased stroke volume and increased peripheral resistance decreases PP |
|
|
Term
_____ is an exaggerated (>10 mmHg) decrease in the amplitude of the pulse pressure with inspiration and an increase in pulse pressure with expiraiton
What are 3 conditions in which this occurs? |
|
Definition
pulsus paradoxus
pericardial teamponade
constrictive pericarditis/pericardial effusion
obstructive lung disease |
|
|
Term
| Things to note on inspection during cardio exam |
|
Definition
Shape of chest - pectus excavatum or pectus carinatum
Scars on chest
Percordium - abdnormal motions, lifts, heaves
PMI
Extremities - swelling, cyanosis, ulcers, decreased hair growth, clubbing of nails
Jugular venous pulse and pressure
General and face exam |
|
|
Term
Inspection:
A precordial bulge suggests ____ disease
A midsternal scar suggests _____
A ____ is an erythematous rash including thenar and hypothenar muscles
____ are violet, tender nodules on the phalanges |
|
Definition
long-standing heart disease
Previous open heart surgery
janeway lesion
Osler's nodules |
|
|
Term
Signs of ____ :
xanthoma paimaris
Tendon xanthomatosis |
|
Definition
|
|
Term
Signs of ____:
thyrotoxic heart disesase
heart failure
severe tachycardia
fine tremors
warm, wet hands |
|
Definition
|
|
Term
JVP is the height of the column of blood in the ___ veins
It reflects ___ pressure
Increased JVP suggests what?
Decreased JVP suggests what? |
|
Definition
internal jugular
right atrial pressure
increased JVP suggests right sided Heart failure of possible constrictive pericarditis or tricuspid valve stenosis
decreased JVP suggests hypovolemia |
|
|
Term
|
Definition
When it is >4cm above the sternal angle (>9cm total)
** Normal JVP is 6-8 cm with the 5 cm added ** |
|
|
Term
| Palpation during cardio exam |
|
Definition
Precordium
peripheral pulses
extremities - edema, varicosities
valvular areas apex
epigastrium - AAA, pulsatile mass
note: abdnormal motions, lifts, heaves, thrills & size, location, and force of apical impulse |
|
|
Term
| 5 places to palpate during cardio PE |
|
Definition
pulmonic area (left 2nd IC)
left sternal border
Apex (left 5th IC)
Epigastrium
Aortic area (right 2nd IC) |
|
|
Term
| Increased amplitude of apical impulse may be caused by what 3 things |
|
Definition
hyperthyroidism
Pressure overload of LV (HTN, aortic stenosis)
Volume overload (mitral regurgitation) |
|
|
Term
| How is left ventricular enlargement determined? |
|
Definition
>3cm in diameter
increased force, sustained duration of apical impulse
apical impulse is displaced downward and left |
|
|
Term
| Why would the right ventricular impulse by increased? |
|
Definition
chronic volume overload (atrial septal defect)
pressure overload (pulmonary htn, pulmonary stenosis)
increased pulsations from pulmonary artery dilation |
|
|
Term
Abnormal pulsations in precordium may come from what 2 things?
Thrills may come from what 2 things? |
|
Definition
aneurysms
ventricular enlargement
valvular disease
increased cardiac output due to faster velocity of blood through valves |
|
|
Term
| Why would a pulse be decreased? |
|
Definition
decreased stroke volume (aortic stenosis, hypovolemia)
increased peripheral resistance (cold exposure, severe CHF) |
|
|
Term
| Why would large, bounding pulses be pressent? |
|
Definition
increased stroke volume
decreased peripheral resisitance
Fever, anemia, hyperthyroidism, aortic regurg |
|
|
Term
| ____ is a pulse that alternates in amplitude from beat to beat. indicates left ventricular failure. May also indicate pericarditis. |
|
Definition
|
|
Term
| During cardio exam, inspect and palpate extremities, noting: |
|
Definition
color
skin temp
edema
varicosities
ulcers
decreased hair growth
|
|
|
Term
| Systemic and local causes of edema |
|
Definition
Systemic: CHF, hypoalbuninemia, Na/Water retention
Local: venous stasis, orthostasis, lymphatic obstruction |
|
|
Term
| How to grade edema (not pitting) |
|
Definition
1+ - ankle joint
2+ - below knee
3+ - above knee
4+ - scrotal
Sacral edema can occur in 2+, 3+, or 4+ if pt is confined to bed |
|
|
Term
| Auscultation in cardio exam |
|
Definition
1. carotids - have pt hold breath. note bruits
2. precordium - note rhythm, S1, S2, S3, S4, systole, diastole, murmurs, clicks, rubs, radiation of murmurs, effects of respiration |
|
|
Term
| When do you use the bell & the diaphragm for cardio auscultation |
|
Definition
Bell: low frequency sounds such as S3, S4 and diastolic murmurs (mitral stenosis, tricuspid stenosis)
Diaphrag: high frequency sounds such as S1, S2, and AI or MI murmurs, rubs |
|
|
Term
| ___ is the gold standard for defining a cardiac cause of edema |
|
Definition
|
|
Term
postioning of the heart:
__ forms the right border
__ forms the most anterior border, occupies a majority of anterior cardiac surface
___ lies posterior behind RV
___ lies behind & left of the RV, forms the left lateral margin of the heart |
|
Definition
|
|
Term
Where is the base of the heart located?
Where is the apexl located? |
|
Definition
base: R & L 2nd intercostal space
apex: left 5th ics, 7-9 cm lateral of midsternum |
|
|
Term
| INstead of thinking of arteries and veins as oxygenated and deoxygenated, think of them as what? |
|
Definition
| outgoing (arteries) and incoming (veins) |
|
|
Term
| The ___ returns blood to the RA from the upper body, the ___ returns blood to the RA from the lower body. |
|
Definition
|
|
Term
| Open/closed valves during systole & diastole |
|
Definition
Systole: ventricular contraction
aortic and pulmonary valves are open
mitral and tricuspid are closed
Diastole: ventricular relaxation
aortic and pulmonary valves are closed
mitral and tricuspid are open |
|
|
Term
S1 is closed by closure of the ___ valve
S2 is caused by closure of the ___ valve
The period between S1 and S2 is ____
The period between S2 and S1 is ____ |
|
Definition
mitral, aortic
systole, diastole |
|
|
Term
Mitral valve prolapse:
What's the physiology behind it?
Where in the cardiac cycle is the click heard?
best hear where?
what does a valvsalva/standing move do?
What does a squatting position do?
in what population is it most commonly seen?
What conditions put you at higher risk? |
|
Definition
malfunctioning of a leaflet of the mitral valve - allows backflow of blood into left atrium, causing progressive enlargement
between systole and diastole
left lower sternal border and apex
valvsalva - moves click earlier in systole
Squatting - moves click to later in systole
young women
Marfans syndrome, scoliosis, muscular dystrophy, graves' disease |
|
|
Term
disorder of connective tissue that strengthen's the body's structures. defective gene called fibrillin-1. very tall, deformed chest, long great , long fingers, arm span > height
positive thumb and wrist signs |
|
Definition
|
|
Term
S3 aka ____
where in cardiac cycle does it occur?
pitch?
where is it loudest?
What does it sound like?
what might it suggest? |
|
Definition
ventricular gallop
early in diastole during rapid ventricular filling
dull and low-pitched (bell)
at apex in left lateral position
"KentuckY"
normal in young and late pregnancy, >40 - suggests CHF, contractility, MV regurg |
|
|
Term
S4 aka ____
heard where in cardiac cycle?
pitch?
Loudest where?
Sound like?
What caues it? |
|
Definition
atrial gallop
late in diastole, just before S1
Dull, low-pitched (bell)
loudest at apex in left lateral
TennESSee
due to stiff ventricular wall = increased ventricular resistance to filling
|
|
|
Term
A systolic murmur (between S1 and S2) coincides with the ___ upstroke
Diastolic murmur (between S2 and S1) usually indicates what? |
|
Definition
carotid
diseased heart valve |
|
|
Term
| where does pain from myocardial ischemia typically radiate |
|
Definition
| left shoulder, ulnar aspect of arm, hand, retrosternal, jaw, neck, teeeth, abdomen |
|
|
Term
|
Definition
| pt with myocardial ischemia may have trouble describing symptoms and make fist over chest |
|
|
Term
| 4 E's of chest discomfort |
|
Definition
exertion
Emotional stress
Exposter to cold or hot (constricts/dilates vessels)
Eating a heavy meal |
|
|
Term
| What does it tell you if a pts chest pain is made worse by changing position? |
|
Definition
GI and pericarditis get worse when laying down
myocardidal issues do not |
|
|
Term
| up to __% of MI are "silent" - no pain. what condition does this often occur in? |
|
Definition
25%
DM - bc heart may become neuropathic |
|
|
Term
| People at high risk for having MI or CAD |
|
Definition
diabetics - have some chance of having MI as someone who's already had one once (coronary risk equivalent)
smoking
HTN
high cholesterol
family Hx of CAD
obesity
sedentery lifestyle
hormone replacement therapy
age
recreational drugs
stress |
|
|
Term
| Signs of metabolic syndrome |
|
Definition
Abdominal obesity (women > 88cm, men > 102 cm)
BP > 130/85
Fasting glucose > 110 mg/dL
HDL (men < 40 mg/dL, women < 50)
Triglycerides > 150 mg/dL |
|
|
Term
| examples of some ischemic cardio disorders |
|
Definition
CAD/angina
Unstable angina
aortic stenosis
hypertrophic cardiomyopathy
aortic regurg
mitral regurg
systemic hypertension
pulmonary hypertension
anemia/hypoxia |
|
|
Term
| Non-ischemia cardio disease |
|
Definition
aortic dissection/aneurysm
pericarditis
mitral valve prolapse |
|
|
Term
| stable vs. unstable angina |
|
Definition
stable - relieved with rest or 1 nitro pill
unstable - chest pain wtih rest, won't go away |
|
|
Term
| 3 warning signs of aortic stenosis |
|
Definition
SAD -
syncope, angina, dyspnea |
|
|
Term
| Differentials for chest discomfort |
|
Definition
GI: GERD, IBS, esophageal rupture, hiatal hernia, cholecystis
Pulmonary: PE, Pneumo, Pneumonia, COPD, pleurisy
Musculoskeletal: DJD, chostochondritis, shingles, fibromyalgi
Psychogenic: anxiety, depression, cardiac psychosis, self-gain, drug-seeking
|
|
|
Term
| Conditiosn that cause increaed oxygen demand |
|
Definition
hyperthyroidism
tachycardia
HTN
PE
pregnancy
psychogenic
CNS stimulants
exercise
psychological stress
fever |
|
|
Term
___ is dyspnea when lying down and is described by the number of pillows needed to relieve it
___ wakes a person up 1-2 hours after going to bed and causes them to have to get up |
|
Definition
|
|
Term
|
Definition
arrythmia, valvular disease, cardiomyopathy, ischemia
male gender, CAD/heart disease, event exceeding 5 min duration
Non-cardiac: panic attack, generalized anxiety disorder, somatization, metabolic disorder, high output states, stimulants, medications |
|
|
Term
| What are some signs of cardiac edema |
|
Definition
dependent areas
pitting
worse in evening, better in AM
|
|
|
Term
Deep/superficial veins carry about 90% of venous return from the lower extremities
___ veins connect deep with saphenous (superficial) |
|
Definition
|
|
Term
where does the great saphenous vein drain?
where does the small saphenous vein drain? |
|
Definition
great - to deep femoral vein
small - to vemoral vein at popliteal space |
|
|
Term
What does each lymph node drain?
axillary
epitrochlear
inguinal |
|
Definition
axillary - most of arm
epitrochlear - ulnar surface of forearm and hand, little and ring fingers
inguinal - superficial parts of lower abdoment and external genitalia, anal canal, vagin, perianal, buttock |
|
|
Term
| Blood circulates from arteries to veins through ____ |
|
Definition
|
|
Term
| lymphatic dysfunction or disturbances in hydrostatis osmotic forces can disrupt equilibrium, most commonly resulting in ____ |
|
Definition
|
|
Term
| Risk factors for arterial peripheral vascular disease |
|
Definition
tobacco use!!!!!
HTN
DM
hyperlipidemia
MI, CVA hx
exertional pain relieved by rest (claudication)
change in color of toes/fingers in cold weather |
|
|
Term
| What does the timing of a pt's swelling tell you? |
|
Definition
arterial insufficiency - will be better in morning
DVT - swelling will be there all the time bc the vein is blocked off |
|
|
Term
what condition?
bronzing and ulcerations on ankles just proximal to medial malleolus
dependent swelling |
|
Definition
|
|
Term
| What 2 conditions would cause local inflammation - swelling, tenderness, redness? |
|
Definition
| DVT or superficial thrombosis |
|
|
Term
| what do swollen lymph nodes indicate? |
|
Definition
|
|
Term
|
Definition
0 - absent, unpalpable
1+ - diminished/weak
2+ - brisk, expected
3+ = bounding |
|
|
Term
| Typical arterial insufficiency pt vs venous insufficiency pt |
|
Definition
Arterial - skinny, smoker
venous - fat |
|
|
Term
| In arterial insufficiency, it is most important to palpate which pulses? |
|
Definition
| further down --- if dorsalis pedis pulse is there, posterior tibia pulse will be there |
|
|
Term
| How do you assess pitting edema? |
|
Definition
press in firmly with thumb for at least 5 sec:
over sorsum of foot
behind each malleolus
over the shins
severity graded on 4 point scale (slight to very marked) |
|
|
Term
measuring edema:
a difference bilaterally of >_cm at the ankle or >_cm at the calf suggests edema |
|
Definition
|
|
Term
what's the physiological cause of peripheral arterial disease?
Which arteries are most commonly affected? |
|
Definition
atherosclerosis or clots in arteries
femoral and popliteal
|
|
|
Term
| Classic triad of symptoms in peripheral arterial disease |
|
Definition
vascular claduication
exercise induced calf pain
stopping exercise makes pain go away in 10 min or lses |
|
|
Term
| How do you calculate the ankle-brachial index? |
|
Definition
divide ankle pressure by arm pressure
ABI 0.9-1.3 - normal
0.6-0.89 - mild arterial disease
0.4-0.59 - moderate disease
<0.39 - severe desease with critial stenosis |
|
|
Term
| treatment for peripheral artrial disease |
|
Definition
good foot care, well-fitting shoes
tobacco cessation
hyperlipidemia
control/treatment of DM and HTN
antiplatelet agents
surgical revascularization |
|
|
Term
| what is physiological basis for venous insufficiency? |
|
Definition
| damaged valve allows blood to flow back toward heart |
|
|
Term
|
Definition
3 things that put a pt at risk for DVT:
1. venous stasis - pt is bedridden, not mobile
2. hypercoagulable states - on birth control or cancer drugs
3. injury to vessel wall - truama |
|
|
Term
|
Definition
quick dorsiflex at ankle when supine and leg is raised to 90 deg. pain in calf
suggests DVT but i |
|
|
Term
| Abdominal pain, gas, blaoting, discomfort in female of childbearing age... do what? |
|
Definition
think pregnant
document LNMP
pregnancy test with HCG levels |
|
|
Term
epigastric pain - think what 3 things?
periumbilical pain - think what 4 things? |
|
Definition
epigastric - ulcer, H. Pylori, gastritis
periumbilical - appendicitis, small bowel obstruction, gastritis, colic |
|
|
Term
| What are some other possible causes of abdominal pain, besides abdominal problems |
|
Definition
pneumonia
metabolic disease |
|
|
Term
| Things to note during inspection of abdmoen |
|
Definition
contour: flat, scaphoid, distended
visible peristalsis
visible pulsations
angiomata, ecchymoses, scars
distended abdominal wall veins |
|
|
Term
| 8 F's of a distended abdomen |
|
Definition
fat
fluid
flatus
feces
full bladder
fetal grwoths
fetus
fibroids |
|
|
Term
| normal/expected bowel sounds |
|
Definition
|
|
Term
| Diminished bowel sounds might suggest... |
|
Definition
peritonitis
late obstruction (been going on for a while)
anesthesia (48-72 hours after surgery)
severe pneumonia |
|
|
Term
| Increased bowel sounds might suggest... |
|
Definition
diarrhea
GI bleeding
Early obstruction (body is trying to get rid of obstruction)
laxatives |
|
|
Term
| Runs & Tinkles in bowel sounds suggest... |
|
Definition
intestinal fluid
air undder tension
Classic finding in early obstruction |
|
|
Term
| ____ are prolonged gurgles of hyperperistalsis |
|
Definition
|
|
Term
Bruits from HTN can be heart in what quadrants?
Bruits from arterial insufficiency can be heard where? |
|
Definition
HTN: epigastrium, RUQ, LUQ
arterial insufficiency: aorta (just above umbilicus), renal arteries, iliac arteries, femoral arteries |
|
|
Term
| What does an aortic bruit suggest? |
|
Definition
|
|
Term
| Friction rub indicates what? |
|
Definition
|
|
Term
| venous hum suggests what? where is it heard? |
|
Definition
indicates increased collateral circulation between pulmonary and systemic venous systems (hepatic cirrhosis)
heard over liver |
|
|
Term
| unusual tympany is suggestive of? |
|
Definition
|
|
Term
| Where should the boundaries of the liver be? What is a normal liver span? |
|
Definition
upper: 5th-7th ICS
lower: right costal margin
6-12 cm |
|
|
Term
|
Definition
| something about splenic percussion - in left anterior midaxillary line |
|
|
Term
When palpating the abdomen, palpate towards/away from areas of pain
note? |
|
Definition
toward
note guarding, tenderness, organomegaly, masses |
|
|
Term
|
Definition
palpate the spot with abdominal wall pain while pt tenses abdominal muscles
+ if pain persists or worsens |
|
|
Term
|
Definition
cirrhosis
hepatitis
neoplasm
CHF |
|
|
Term
|
Definition
CHF
leukemia
lymphoma
cirrhosis
subacute bacterial endocarditis |
|
|
Term
| What dose CVA tenderness suggest? |
|
Definition
kidney infection
musculoskeletal problem
renal calculi (kidney stone) |
|
|
Term
| Pain with cough, light percussion, rebound tenderness suggests |
|
Definition
|
|
Term
|
Definition
| cholecystitis - hook thumb under costal margin. have pt take deep breath. if they suddenly stop = + murphy's sign |
|
|
Term
|
Definition
peritoneal inflammation
cirrhosis
metastatic cancer
nephrotic syndrom
CHF |
|
|
Term
| Non-abdominal findings associatd wtih abdominal disease |
|
Definition
clubbing
palmar erythema
icterus
vascular spiders
kayser-fleisher rings
aphtous ulcers
peutz-jegher's syndrome |
|
|
Term
| Vomiting with first feeding of neonate suggests |
|
Definition
|
|
Term
BP:
pre-hypertension
stage 1 hypertension
diabetes and chronic kidney disease target bp |
|
Definition
pre: 120-139/80-89
stage 1: 140-159/90-99
diabetes and chronic kidney: 130/88 target |
|
|
Term
|
Definition
physical inactivity, microalbuminuria, family history of CVD, excessive intake of dietary sodium, insufficient intake of potassium, excessive alcohol consumption
LDL < 70 |
|
|
Term
What does decreased carotid pulse suggest?
What does thready, weak pulse suggest?
what does bounding pulse suggest? |
|
Definition
decreased SV or athersclerotic narrowing
weak: cardiogenic shock
bounding: aortic insufficiency |
|
|
Term
|
Definition
|
|
Term
| 7 things to note from murmurs |
|
Definition
location
timing
shape
radiation
intensity
pitch
quality |
|
|
Term
| How does valsalva affect MVP or aortic stenosis murmurs? |
|
Definition
straining of valsalva: moves MVP click to earlier in systole and thus lengthens the murmur. decreases intensity of aortic stenosis mumur
release of valsalva: delays MVP click and shortens murmur. increases intensity of aortic stensosi murmur |
|
|
Term
| What does pulsus alternans suggest? |
|
Definition
|
|
Term
What does each suggest?
acute, knifelike epigastric pain?
epigastric pain?
colicky, doubled over |
|
Definition
gallstones, pancreatitis
GERD, gastritis
renal stone |
|
|
Term
|
Definition
| GI bleeding, recurrent vomitting, risk factors for gastric cancer, weight loss, dysphagia, odyophagia, anemia |
|
|
Term
|
Definition
melena - tarry/black stool
hematochezia - red/marroon stool |
|
|
Term
____: increased intra-abdominal pressure suggests decreased contractility of urethral sphincter or poor support of bladder neck
____: unable to hold urine. suggests detrusor muscle overactivity.
___: when the bladder cannot be emptied until bladder pressure exceeds urethral pressure, indicates enlarged prostate or neurogenic abnormalities |
|
Definition
stress incontinence
urge incontinence
overflow incontinence |
|
|
Term
| ___: percuss lower left anterior chest between lung resonance and costal marge. this space is called? |
|
Definition
|
|
Term
|
Definition
rovsing's sign
psoas sign
obturator sign
cutaneous hyperesthesia |
|
|
