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CPSS Exam 1
N/a
91
Medical
Graduate
10/23/2011

Additional Medical Flashcards

 


 

Cards

Term
Dx for CP:
Duration: more than 2 sec, less than 10 min
Quality: pressure, tightness, squeezing, heaviness, burning
Location: retrosternal w/ radiation to neck, jaw, shoulders, arms
Associated features: precipitated by exertion, exposure to cold, psych stress. S4 gallop or mitral regurg murmur during pain
Definition
angina
Term
Dx for CP:
Duration: 10-20 min
Quality: severe pressure, tightness, squeezing, burning, heaviness
Location: retrosternal, radiation to arm, jaw, neck, shoulders
Associated features: occurs wtih low levels of activity or at rest
Definition
unstable angina
Term
Dx for CP:
duration: Variable, maybe >30 min
Quality: severe pressure, tightness, squeezing, burning
Location: substernal, radiates to arm, neck, jaw, sohulders
Assocaited features: unrelieved by nitro. may have heart failure or arrhythmias


what tests?
Definition

MI

tests: EKG, CK, CKMB, troponins

Term
Dx for CP:
Duration: recurrent episodes for 2-10 min
Quality: pressure, tightness, burning, squeezing
Location: retrosternal, radiates to neck, shoulders, arm, jaw
Associated features: late-peaking systolic murmur radiating to carotids
Definition
Aortic stenosis
Term
Dx for CP:
Duration: hours to days, may be episodic
Quality: sharp
Location: retrosternal or toward cardiac apex, may radiate to left shoulder
Features: may be relieved by sitting up and leading forward. may have friction rub
Definition
Pericarditis
Term
Dx for CP:
Duration: abrupt onset of unrelenting pain
Quality: tearing, ripping sensation, knifelike
Location: anterior chest, radiating to back or between shoulder blades
Features: HTN, CTDs (Marfan's), murmur of aortic insufficiency, pericardial rub, pericardial tamponade, loss of peripheral pulses

tests?
Definition

Aortic dissection

 

tests: CT w/ contrast, MRI, TEE

Term
Dx for CP:
Duration: abrupt onset, several min to few hours
Quality: pleuritic
Location: lateral
Features: dyspnea, tachypnea, tachycardia, hypotension

tests?
Definition

PE

 

tests: CT angiography, lung scan, lower extremity venous US, D-dimer

Term
Dx for CP:
Duration: variable
Quality: pressure
Location: substernal
Features: dyspnea, increased venous pressure (edema, JVD)
Definition
pulmonary htn
Term
Dx for CP:
Duration: variable
Quality: pleuritic
Location: unilateral
Features: cough, dyspnea, fever, rales, rub
Definition
Pleuritis or pneumonia
Term
Dx for CP:
Duration: sudden onset, several hours
Quality: pleuritic
Location: lateral
Features: dyspnea, decreased breath sounds
Definition
spontaneous pneumo
Term
Dx for CP:
Duration: 10-60 min
Quality: burning
Location: substernal, epigastric
Features: worsened by recumbency

tx?
Definition

esophageal reflux

 

tx: antacids

Term
Dx for CP:
Duration: 2-30 min
Quality: pressure, tightness, burning
Location: retrosternal
Features: mimics angina
Definition
esophageal spasm
Term
Dx for CP:
Duration: prolonged
Quality: burning
Location: epigastric, substernal
Features: relieved w/ food or antacid
Definition
Peptic ulcer
Term
Dx for CP:
Duration: prolonged
Quality: burning, pressure
Location: epigastric, substernal, RUQ
Features: follows a meal
Definition
gallbladder dz
Term
Dx for CP:
Duration: variable
Quality: aching
Location: variable
Features: aggravated by movement, may be reproduced by localized pressure on exam
Definition
Musculoskeletal
Term
Dx for CP:
Duraiton: variable
Quality: sharp, burning
Location: dermatomal
Features: rash
Definition
zoster
Term
Dx for CP:
Duration: variable, fleeting
quality: sharp or burning
Location: variable, retrosternal
Featurs: situational factors precipitate sx, anxiety/depression
Definition
Emotional/psych condition
Term
What to do for this murmur?

Grade 1 or II, midsystolic
no sx
Normal EKG and CXR
Definition
nothing
Term
What do you do for this murmur?
Grade III or greater, holosystolic, or late systolic
Definition
echo, may need cardio referral
Term
What do you do for this murmur?

Grade I or II and midsystolic
sx of cardiac disease
Definition
echo, may need cardio referral
Term
What do you do for this murmur?

Grade I or II and midsystolic
NO sx but abnormal EKG or CXR
Definition
echo, may need cardio referral
Term
What do you do for this murmur?

Diastolic or continuous murmur
Definition
Echo - may need cardio consult
Term
Management of cough >3 weeks:

If normal CXR and it doesn't get better after stopping smoking/ACE-I and doesn't respond to empirical tx for URI, what do you do?
Definition

treat for asthma

if this doesn't work - treat for eosinophilic bronchitis

if this doesn't work - consider GI disease

Term
Management of cough >3 weeks:

Pt who has cough after having an URI. You treat them for nostnasal drip, but it doesn't go away. What now?

how do you treat them for postnasal drip?
Definition

evaluate for pertussis or hyperreactive airway dz

 

postnasal drip tx: antihistamines, decongestants, nasal glucocorticoids, nasal ipratroprium

Term
Management of cough >3 weeks:

cough w/o a hx of infection and without an obvious cause. What is the first thing to do?
Definition
CXR
Term
When would hemoptysis warrant bronchoscopy and CT?
Definition

recurrent hemoptysis

risk factors for cancer

mass on CXR

parenchymal disease on CXR - CT, then bronchoscopy

Term
First line treatment for HTN

contraindications?
Definition

thiazides (HCTZ)

 

contraindications: DM, dyslipidemia, gout, hypokalemia

Term
Pt w/ HTN + CHF or renal failure. what tx?
Definition
Loop (durosemide, lasix)
Term
pt w/ CHF or primary aldosteronism + HTN, what tx?

contraindications?
Definition

aldosterone antagonist (spironolactone)

 

contraindications: renal fialure, hperkalemia

Term
pt w/ angina + HTN. what tx?

contraindications?
Definition

b-blocker

 

contra: asthma

Term
Pt w/ prostatism + HTN. what tx?
Definition

alpha agonist (prazosin)

 

Term
pt w/ post-MI or CHF + HTN. what tx?
Definition

ACE-I

Verapamil

Term
Pt who can't tolerate ACE-I, give?
Definition
ARB - losartan
Term
Pt w/ angina + HTN, what tx?
Definition
CCB (nifedipine)
Term
Steps in evaluating a CP emergency
Definition

1. assess hemodynamic and resp status

2. Hx: quality, location, duration of pain

3. PE

4. Labs, EKG

 

Term
pt w/ wide, radiating chest pain that has intensified over a period of minutes
Definition
MI
Term
Tests to get when assessing CP
Definition

EKG

MI: enzymes - CK, CK-MB, troponins

Aortic dissection: CT w/ contrast, MRI, TEE

PE: CT angiography, lung scan, lower extremity venous US, D-dimer

Pericarditis/tamponade: echo

Pulm disease: CXR

Term
What hx should you obtain from an anemic pt on first dx
Definition

drugs

alcohol

fm hx

G6PD deficiency

 

sx: bleeding, fatigue, malaise, fever, weight loss, night sweats, systemic sx

Term
PE for pt with anemia
Definition

Look for mechanism of anemia: infection (lymphadenopathy, splenomegaly = lymphoproliferative dz), petechiae - platelet dysfunction, blood in stool

 

other signs:

forceful HB, strong peripheral pulses, systolic flow murmur, pale skin/mucus membranes, Hgb <8-10, pallor in palmar creases

Term
Tests for pt with anemia
Definition

Hgb

Hct

retic count

MCV

MCH

MCHC

RDW

diff

segs

platelet

cell morphology

iron studies - serum iron, TIBC, serum ferritin

Marrow study - aspirate, biopsy

Renal/thyroid fxn - if normocytic

B12 & folate

Term
What does a RBC index <2.5 or >2.5 indicate?
Definition

<2.5 = RBC morphology

>2.5 = hemolysis/hemorrhage

Term
Ddx for normocytic normochromic anemia
Definition

marrow damage - infiltration, fibrosis, aplasia

decreased marrow stimulation

inflammation

metabolic

renal dz

chronic disease

Term
Microcytic anemias
Definition

iron deficiency

thalassemia

sideroblastic

lead poisoning

pyridoxine deficiency

Term
macrocytic anemias
Definition

megaloblastic (B12 and folate deficiency)

spleen and liver dz - target cells, howell jolley bodies

alcoholism

Term
increase in circulating RBCs
Definition

polycythemia

AKA erythrocytosis

Term
What kind of anemia?

microcytic, hypochromic
variation in size (anisocytosis)
variation in shape (poikilocytosis)
Definition
iron deficiency
Term
steps to evaluating polycythemia
Definition

1. recognize increase in Hct (>60% in men, >55% in women)

2. recognize increase in RBC mass (>36 in men, >32 in women)

3. Measure serum EPO

4. If low EPO --> polycythemia vera

5. If high EPO --> depends on other factors

Term
what disease?

sx: ruddy complexion, HA, blurred vision, confusion, stroke
Labs: elevated WBC, increased basophils, thrombocytosis

cause: mutation in JAK-2 gene
Definition
polycythemia vera
Term
What diseases? High EPO + _____:
1. + low O2
2. + high carboxyhemoglobin, in a smoker
3. + abnormal hgb
Definition

1. hypoxia -- look for cause

2. smoker's polycythemia

3. EPO producing tumor

Term
Mucosal bleeding and epistaxis, menorrhagia,
Definition
Von Willebrand's
Term
Spontaneous hemarthrosis occurs in factor ____ & ___ deficiency
Definition
VIII and IX
Term
posttraumatic bleeding + joint hyperextensibility = ____
Definition
ehlers-danlos syndrome
Term
what are some drugs that impair platelet function
Definition

aspirin

NSAIDs

fish oils

Vit E

Term
___ is the major risk factor for arterial thrombosis
Definition
atherosclerosis
Term
tests for thrombosis
Definition

PT/INR

PTT

Coagulation assay

platelet count

mixing studies (after abnormal PT/PTT)

Specific factor assays

Antibodies to phospholipids - ELISA

Term
Honeycombing or cyst formation on CXR
Chronic Purulent sputum or blood
+ rhonchi
Definition
bronchiectasis
Term
symmetric hilar adenopathy on CXR
Definition
Sarcoidosis
Term
purulent or blood-tinged sputum could be what ddx?
Definition
bronchitis, bronchiectasis, pneumonia, lung abscess
Term
> 3% eosinophils on sputum culture w/o asthma = ?
Definition
eosinophilic bronchitis
Term
___ is the procedure of choice for evaluating tumors or for getting tissue samples
Definition
Fiberoptic bronchoscopy
Term
Tests for pts with chronic cough
Definition

CXR

PFT

Sputum test

Bronchoscopy

HRCT

Term
Cough + blood streaked sputum + fever + chills
Definition
pneumonia
Term
putrid smelling sputum
Definition
lung abscess
Term
hemoptysis + chronic cough + pleuritic CP + dyspnea + rub
Definition
PE
Term
Hemoptysis + renal disease
Definition
Goodpasture's or Wegener's
Term
Hemoptysis + AIDS
Definition
kaposis's sarcoma
Term
hemoptysis + crackles
Definition
parenchymal bleed
Term
hemoptysis + airflow obstruction
Definition
chronic bronchitis
Term
what are some ddx for hemoptysis
Definition

GI: esophageal varices

Tracheobroncheal

Pulm parenchyma

primary vascular

rare causes

Term
steps in assessment after dx of HTN
Definition

1. screen for cardiac dz and secondary causes

2. assess lifestyle

3. assess sx: HA, fatigue, dizziness, palpitations, impotence

Term
Proper way to take BP
Definition

1. sit in quiet room for 5 min

2. cuff at heart level

3. width of cuff = 40% arm circumference, length 80%

4. rate of deflation = 2mmHg/s

 

Term
PE for HTN pt
Definition

1. body habitus, weight, height

2. BP in both arms

3. BP sitting, standing, supine

4. if <30 y/o: arterial pressure in lower extremities

5. HR

6. thyroid

7. fundoscopy

8. auscultate carotids, femorals, aorta

9. palpate femorals and pedals

10. auscultate heart

11. feel for PMI

Term
common PE findings in HTN
Definition

- afib

- papilledema, AV nicking, exudates, hemorrhages

- Loud S2,

- S4 gallop

- LVH (displaced PMI)

Term
Labs to get for newly diagnosed HTN, when starting a new med, and then annually
Definition

EKG

renal function - UA, albumin, BUN/Cr

Serum electrolytes - Na, K, Ca, TSH

metabolic function: fasting glucose, total cholesterol, HDL, LDL, trigs

Hct

Term
HTN treatment
Definition

1. lifestyle changes

2. Meds (if >140/90)

1. HCTZ is first line

Term
What meds do you give for these HTN emergencies?

HTN encephalopathy
malignant HTN (<220/110)
Stroke

MI/UA
Aortic Dissection

Preeclampsia
Definition

HTN encephalopathy/maligant/stroke: Nitroprusside, nicardipine, labetalol

 

MI/UA: nitro, nicardepine, labetalol

 

Aortic dissection: nitroprusside, esmolol, labetalol

 

Preeclampsia: hydralazine, labetalol, nicardipine

Term
Stages of htn
Definition

normal: <120/<80

PreHTN: 120-139/80-89 --> and/or

Stage 1: 140-159/90-99

Stage 2: >160/>100

Isolated systolic HTN: >140/<90

 

Term
Secondary causes of HTN
Definition

renal: PCKD, tumors, obstruction

Renal vascular: arteriosclerotic, fibromuscular dysplasia

Aortic coarctation, OSA, preeclampsia

Neurogenic: increased ICP, spinal cord injury, psychogenic

Meds: estrogens, steroids, decongestants, appetite suppressants, cyclosporine, antidepressants, MAOIs, EPO, NSAIDs, Cocaine

Term
Relevant pt hx for HTN evaluation
Definition

1.duration of HTn

2. previous therapies and responses to them

3. fm hx of HTN and CAD
4. dietary and psychosocial hx

5. weight change, dyslipidemia, smoking, DM, physical activity

6. Any evidence of secondary htn

7. evidence of target organ damage - tia, stroke, blindness, angina, MI, sexual dysfunction

8. other diseases

Term
Anion gap
- indications
- increases due to?
- decreases due to?

calculation
Definition

indication: when evaluating acid-base disorder

increase: acidosis, ketoacidosis, ethylene glycol, uremia, aspirin

decrease: hypoalbuminemia (hemorrhage, nephrotic syndrome, cirrhosis)

 

AG = Na - (Cl+HCO3)

 

 

Term
Creatinine clearance

indications
significance
calculation
Definition

indications: used to measure GFR because it is easily measured

Low: renal disease/failure

 

CC (ml/min) = [(140 - age x lean body weight (kg)]/(plasma creatinine x 72)

Term
Indications for acute dialysis
Definition

Acidosis

Electrolyte abn (Hyperkalemia)

Intoxication (lithium)

Overload/oliguria

Uremia

 

Term
complications of acute dialysis
Definition

fever

hypotension

hemolysis

dementia

seziure

bleeding

muscle cramps

Term
pulse pressure calculation & indications
Definition

PP = SBP - DBP

 

PP <25% of SBP - decreased lv stroke volume

trauma - blood loss

 

high/wide PP = exercise

 

>40 mmHg: aortic regurg, atherosclerosis, pregnancy, hyperthyroid, htn drugs

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