1.
Compare acute vs. chronic cholecystitis?: acute = gallstone
chronic = trouble eating greasy food
2.
Compare ischemic vs. non-ischemic chest pain.: Ischemic - constricting, squeezing, heavy
NonIschemic - dull or sharp pain
3.
Compare ischemic vs. non-ischemic precipitating factors.: Ischemic - exercise, stress, meals, excited
NonIschemic - after exercise & provoked by specific body movements or deep breaths
4.
List fixed risks for IHD (Ischemic Heart Dz).: Males
FHx of IHD
Age
Social Class Y
Race
5.
List Modifiable risks for IHD.: Smoking
High LDL, TGs, low HDL
HTN
Obesity
Western diet
DM
Sedentary
Birth control pills
High plasma fibrinogen
Unemployment
Stress
Personality
6.
What are ddx for non-emergent chest pain?: Stable angina, myocarditis, pericarditis, pneumonia, pleuritis, esophagitis/reflux, chest trauma, costochondritis, herpes zoster, PUD, cholecystitis, acute pancreatitis, lung tumors, cocaine use
7.
What are ddx of emerget chest pain?: AMI, Acute coronary artery insufficiency, pneumothorax, congenital cornary anomalies, dysrhythmias, PE, aortic dissection
8.
What are other causes of chest pain that are not IHD.: Esophageal/gallbladder/peptic ulcer
PE
MVP/pericarditis/dissecting aneurysm
Teitze syndrome
Anxiety
9.
What are other causes of myocarditis?: Radiation, lead, alcohol, emetine, chloroquine
10.
What are PE findings for stable angina? Dx studies?: Normal exam
EKG during episode
11.
What are PE findings of cholecystitis?: + Murphy's sign
Palpable GB
12.
What are PE findings of dysrhythmias?: Irregular pulse
13.
What are PE findings w/myocarditis? Dx studies?: Heart murmur, friction rub, fever.
EKG, CXR
14.
What are PE findings with congenital coronary anomalies?: Murmurs
Clicks
Decreased lower extremity pulses
Irregular pulse
BP
Squatting -esp w/cyanotic congenital HD/ToF
May be associated with other abnormalities
15.
What are the grades of heart dz?: Grade 1 - no limitation of activities, no symps.
Grade 2 - no limitation under rest, but symptoms appear under severe activity
Grade 3 - limitation of activities on mild active
Grade 4 - limitation of activities at rest, restricting pt to bed or chair
16.
What bacteria cause myocarditis?: Corynebacterium diptheriae, Chlamydia, Rickettsia, Coxiella burnetii
17.
What conditions are worse after meals?: Ischemic heart dz
Esophagitis/reflux
cholecystitis (chronic)
18.
What does stable angina EKG look like?: May have NL EKG at rest, but abnormal on exertion.
19.
What dx studies are done for a PE?: VQ scan (perfusion problem)
Helical CT arteriography
CXR
ABG's
EKG
Sinus tachy & nonspecific ST & T wave changes
D-dimer (breakdown product of fibrin) elevated in presence of thrombus
20.
What dx studies are done for a pneumothorax?: CKR, ABGs
21.
What dx studies are done for an AMI?: Serial EKGs & cardiac enzymes, nuclear scan
22.
What dx studies are done for dysrhythmias?: EKG (during episode)
Holter monitoring
24h EKG
23.
What dx studies are done with acute coronary artery insufficiency?: EKGs, cardiac enzymes
24.
What dx studies are done with aortic dissection?: Echo, angiography, CT/MRI
25.
What dx studies are used for congenital coronary anomalies?: EKG, echo
26.
What Dx studies for pneumonia?: CXR, sputum cultures, ABGs
27.
What Hx accompanie costochondritis (Teitz sydrome)?: Pain along sternal border.
Worse w/deep breaths.
Hx of exercise,or URI
28.
What Hx accompanies a PE?: Acute onset
Sense of doom
Pleuritic pain
Restlessness
Mild-severe pain
Hemoptoysis
History of DVT
Recent trauma to lower extremity
Recent OR
OCP's
29.
What Hx accompanies acute coronary artery insufficiency?: History
Severe, constricting retrosternal chest pain
>30 min.
Anxiety
Diaphoresis
Dyspnea
History of angina or MI
30.
What Hx accompanies acute pancreatitis?: Severe LUQ/epigastric abdominal pain
Radiate - L chest
Worse in supine position
N/V
Fever
Sit & rock, cry
31.
What Hx accompanies aortic dissection?: Sudden tearing pain anterior or posterior chest, radiation to arms/ab/legs/back
32.
What Hx accompanies cholecystitis?: RUQ abdominal pain
Radiate to right chest
Worse after fatty meal
N/V
5 F's (Female, fat, 40, fair, fertile)
33.
What Hx accompanies congenital coronary anomalies?: Children, adolescents
Moderate-severe cp with or after exercise
Family history - sudden death
34.
What Hx accompanies dysrhythmias?: Palpitations
Dizzy
Forceful heartbeats
CHD history
Fever
Meds
Sympathomimetics (give tachycardia)
Beta-adrenergic agents
History cocaine use
35.
What Hx accompanies esophagitis/reflux?: Substernal pain worse after eating & lying down. Sour taste in mouth.
36.
What Hx accompanies herpes zoster?: Unilateral chest pain
Painful rash
37.
What Hx accompanies myocarditis?: Chest pain, fever Hx, mc is viral
38.
What Hx accompanies pericarditis?: Sharp stabbing pain
Radiate to left shoulder or trapezius ridge
Worse during coughing or deep breathing
May be relieved with sitting forward
History of viral or bacterial infection
Autoimmune disease
39.
What Hx accompanies pleuritis?: Mild, localized chest pain, worse with deep breathing
Recent URI
40.
What Hx accompanies pneumonia?: Productive cough (yellow/green/rust)
Dyspnea
Pleuritic pain
41.
What Hx accompanies PUD?: Epigastric pain 1-2 hours after eating
May be relieved by antacids
Hematemesi (vomit blood) & melena...black stools
Risk factors: smoking/alcohol
42.
What Hx is with a pneumothorax?: Sharp, tearing pain, may radiate to ipsilateral shoulder
Dyspnea
Child w/ asthma, CF, or Marfan's
43.
What is Hx for cocaine use?: CP
SOB
Diaphoresis
Nausea
History of cocaine use
44.
What is Hx for lung tumors?: CP
SOB
Hemoptysis
Smoker
History pneumonia
Weight loss
45.
What is IHD (aka coronary heart dz) caused by?: CAD
46.
What is the mc form of congenital heart dz?: VSD (holosystolic sound....MR & TR also have holosystolic sound)
47.
What kind of Hx is with AMI?: History
Severe oppressive constricting substernal pain with radiation to left or right arm, neck, &/or jaw
> 30 min. (15 minutes!)
Diaphoresis
Dyspnea
Nausea
History of CAD
Smoker
Family history
hyperlipidemia
48.
What PE accompanies pneumonia?: Fever
Tachycardia
Tachypnea
Crackles
Vocal fremitus
Percussion dull or flat (consolidation)
Bronchophony
Egophony
49.
What PE finding is with reflux? Dx studies?: Epigastric pain w/palpation.
Endoscopy, esophgeal pH.
50.
What PE findings accompany a pneumothorax?: Hyperresonance, diminished BS, decreased tactile fremitus, tracheal shift, tachycardia.
51.
What PE findings accompany acute coronary artery insufficiency?: Restlessness, cool/clammy skin, tachycardia
52.
What PE findings accompany AMI?: HTN, htn, cardiac arrhythmia
53.
What PE findings accompany aortic dissection?: Pulse deficits
HTN
Possible neuro changes in legs
Aortic diastolic murmur
Widened aorta
54.
What PE findings accompany PE?: Fever
Dyspnea
Cough
Tachycardia
Tachypnea
Diminished breath sounds
Crackles
Wheezing
55.
What PE findings accompany pericarditis? Dx studies?: Fever before pain, tachycardia, friction rub.
WBC, ESR, EKG, CKR
56.
What PE findings are with costochondritis?: Pain w/palpation over costochondral joints.
NL BSs
57.
What PE findings are with pleuritis?: Shallow respirations
Local tenderness (can point directly to pain)
Friction rub
58.
What PE findings w/PUD?: Epigastric tenderness, hypovolemia
59.
What PE findings with acute pancreatitis? Dx studies?: LUQ/epigastric abdominal pain w/palpation
htn
Grey Turner's sign (bruising in lower ab) in acute pancreatitis
Results from tracking of blood from pancreatic area of retroperitoneum
Dx: serum amylase & lipase
60.
What presents w/ stable angina?: Substernal chest pressure (after exercise, relieved by rest or NTG)
Nausea
Diaphoresis
<15min
61.
What protozoa cause myocarditis?: Trypanosoma cruzi, Taxoplasma gondii
62.
What triggers gallbladder inflammation?: Greasy foods.
63.
What viruses cause myocarditis?: Coxsaxie, Influenza, Adenovirus, Echovirus, Rubella
