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CVS H+P PA prog St Fran Un 2005

endocarditis /predental no problem with penicillian Adults: Amoxicillin 2.0 grams (usually 4 - 500mg capsules), 1 hour before dental appointment.
endocarditis /predental allergic to penicillian Adults: Clindamycin 600 mg (usually 2 - 300mg capsules), 1 hour before dental appointment
Cyanosis hemoglobin level 5g/dl hemoglobin in capillaries what sign?
Cyanotic lips sign of? Central cyanosis
Threshold of Hemoglobin for central cyanosis is 5 g/dl hemoglobin threshold for
Pt. presents with Falling O2 sat, JVD,to auscultaion: S3,gallop, tachycardia whats in your Diff DX? Heart Failure: what sounds to auscutation?
name 4 CVS conditions that have both systolic and diastolic sound 1)Pericardial Friction rub..2) Patent Ductus Arteriosus.3) Venus Hum..4) Mammary souffle
what two Cardiac sounds go away when you push hard on the stethoscope? Venus Hum and mammary souffle...... what auscultation trick can you do?
Persistance of a normal fetal structure between the L pulmonary artery and the decending aorta beyond the 10th day of life is what? PDA Patent Ductus Arteriosus what is it?
Hypertrophic myocardium with out a reason such as HTN is called? HOCM,HCM or IHSS
IHSS stands for Idiopathic Hypertrophic Subaortic Stenosis
IHSS,HCM and HOCM often involve what structure? Ventrical Septum
Is there an S4 sound with HOCM,HCM or IHSS? Yes S4 because of noncomplience
What doe HOCM stand for? Hypertrophic Obstructive Cardiomyopathy
What does HCM stand for? Hypertrophic Cardiomyopathy
Is there an S3 sound with HOCM, HCM or IHSS? No S3! S3 requires excess blood and the Ventrical cavities are tiny. But there is an S4 sound
Whats the best way to auscultate a Venus Hum? With the bell, above the medial aspect of the clavical
what symptoms dos an infant with a moderate sized PDA have? an Infant with : 1) horse cry, cough,lower rep. Infect.,atelectesis or pneumo . what should be in for Diff. Dx?
a constant machine like sound with a papable thrill to auscultation is what? PDA Patent Ductus Arteriosus
HCM,HOCM or ICSS Eitiology? 50% genetic what heart condition can cause Sudden Cardiac Death?
Pts that experience Sudden Cardial Death from IHSS ( HCM HoCM) might have what EKG patterns? tachycardia or fibrillation are likley causes of sudden death ( HCM,IHSS,HOCM) in kids and teens?
An infant has poor weight gain. On physical exam you find: tachycardia, tachypnea, peripheral cyanosis, diapherisis , the mother tells you the baby was premature what's at the top of your differential? Patent Ductus Arteriosus
PDA where auscultate? 2nd ICS
Pathological murmur is it diastolic only? No pathologic murmurs are systolic, diastolic, or continuous
Innocent murmur is it a diastolic mumur? Innocent murmurs are systolic except for venous hum which is continuous
Is there a thrill to an innocent murmur? No thrill with an innocent murmur.
In innocent murmur is grade what? A grade 1 or 2 murmur that can't be heard in the back..... is an innocent murmur
Pericardial impulses at an innocent murmur Normal
Pericardial impulses of pathological murmur May be abnormal
A murmur that varies or disappears when the patient changes position is.( Innocent? or pathological? An innocent murmur varies or disappears with position change
An innocent murmur has what extra hard sounds? None.. there are no extra heart sounds within innocent murmur
Are all systolic murmurs innocent? No what about aortic stenosis!!!
A murmur that is accompanied by a click or a gallop , innocent a pathological? Pathological murmurs may be accompanied by a click were gallop
inverted T waves indicate what 2 things? Ischemia and if anterior inverted T wave consider PE
S1 Q3 T3 a sign of.. Cor pulmonale ( PE, PTX, bronnchospam)
Right ventricle pressure or volume overload cause what on EKGs? In lead III: Q wave..slight ST elevation and inverted T wave
a 3+ Pitting edema is how deep? 6mm pitting edema ..would be rated what?
Skin Temperature is cheked how in PE? Use the back of your hands and go proximal to distal
On PE what do you check with your thumbs distal to proximal? How do you check pitting edema?
Calf size do you check the unaffected side first? No.. in PE of calf size check affected side first
You want to get ABG s on a Pt what do you do first? Allen's Test is done befor...
Pt with orthostatic BP rises from a horizontal position to standing. What happens to systolic pressure? An increase in systolic pressure by 20mmHg with in 3 min.s from when standing indicates what?
Pt with orthostatic BP rises from a horizontal position to standing what happens to the diastolic pressure? A decrease in diastolic pressure by 20mmHg with in 3 min.s when a pt stands ...indicates what?
A pt has syncope on rising, that is relieved by lying down.. whats the problem? Orthoatatic BP ... a pt stands quickly how do the feel?
the patient rises from a siting or horizontal position to stand you are checks there pulse . If they have orthostatic BP what do you expect On rising a Pt develop an increased heart rate...what can this indicate?
There is a strong correlation between PVD of LE and what? CAD has a strong correlation with what?
Chronic Arterial Insufficiency.... pulses do what? Pulses decrease in what Insufficiency ...
Chronic Arterial Insufficiency.... color is? Pale color in what chronic insuffiiency?
Chronic Arterial Insufficiency.... are there ulcers ? Ulcer are at pressure points in what Insufficiency?.....
Chronic Arterial Insufficiency.... decribe skin? Shiny ,hairless and thick nails with ridges in.... what isuffiency?
Are there Ulcers in Chronic Venous Insufficiency? The Ulcers at the medial maleolus ( not at a presure point ) indicates what insuffucuency?
A pt presents with legs that have thick brown skin with scaring and ulcers but fortuantly no gangren what your DX? Chronic Venous Insufficiency what are the skin signs?
Chronic Venous Insufficiency ....Pulses are? Normal pulses in what insuffucuency??
2 couses of Chronic Venous Insufficiency? Venous Valve leakage and partial vein blockage can cause what ? Hint Tortuous
How do you cure Chronic Venous Insufficiency ? You cant .. No cure but you can treat ..
Is Chronic Arterial Insuffucuency painful? Yes ! with exertion
what is " angina of the legs?" Chronic Arterial Insufficiency
What chronic insufficiency has edema? Chronic Venous Insufficiency has edema ... no way out for the blood
Is there edema in Chronic Arterial insufficiency? No edema .. the veins are fine
Erectile dysfunction an be caused by what chronic insufficiency ? ..and were?? Chronic Arterial Insufficiency in the Iliac can lead to what condition???
How do you measure claudication? Measure by distance.. "how many blocks did you walk last year?"..
Acute Arterial Emboli 80-90% originate were? .. do to what? A fib in the heart can cause Acute Arterial Emboli
Acute Arterial Emboli lodge 40% of the time in bifurcations of what three arteries? Aortic, Femoral and popliteal artery bifurcations are were most Emboli lodge
How many CABG procedures were done in 2004? 160,185 coronary artery bypass graft (CABG) procedures were performed in the United States in 2004
Dosage of nitroglycerin 0.3-0.4 mg sl q 5 min prn chest pain Max three pills
two criteria for defining angina length of time of attack, and does nitroglycerin shorten attack?
Unstable angina: chest discomfort that's not brought on by exertion.
Prinzmetal's angina is what? caused by focal spasm of angiographically normal coronary arteries
Prinzmetal's angina s/s 1)chest painchest pain 2 dyspnoea 3) palpitations
Prinzmetal's angina EKG: ST segment elevated
Prinzmetal's angina TX RX Nifedipine and nitrates,2)Coronary stenting 3)CABG
Q wave > then 2 small blocks means Infarction...(but take a few hours to show up) see non EKG as?
What's the cut off for thrombolytics to treat stroke? three hours
What’s the cut off for thrombolytics into heart is? six hours
MI TX start IV,Morphine,Oxygen,Nito, Aspirin
MI Lab you think of first... what how often? Cardiac enzymes: now q eight hours x 24
MI Other labs electrolyte panel(potassium sodium glucose, calcium), 2)CBC 3)chest x-ray AP for cardio megaly Liver, Pt/Ptt/INR, echocardiogram
T wave inversion Ischemia
ST elevation or the “tomb stone like in a cemetery” Injury
Q wave ( more the 2 small block Infarction:
what are the inferior leads in EKG II,III AF is for inferior by apex
Costro chondritis what do you seeon PE? No physical manifestation to inspection
Tietze Syndrome what do you see erythematous and edematous around area of rib cartilage
To auscultate Aortic sounds better...? Pt Sit up and lean forward
To here Mitral sounds and S3 S4 Have Pt roll to LLD while auscultaing to sse if they increase
To increase venous blood to heart what 2 techn.? Pt sqauts or lift legs 60degrees for 60 sec
Reducing blood to the heart what 2 ways? Bear down (Valsalva) and stand.
Straight back murmur Vibration of normal blood flow in young F with thin AP
Straight back murmur Echo normal
Becks triad Cardiac Tampoaid: decress HTN , muffeled heartsounds disteneded JVP
Cardiac Tamponaide the heart is restrained by fluid accumulation in pericardial sack
cardaic tamponaide what treatment? pericardial centisis is to treat what?
Diastolic murmurs almost always indicate: Heart disease
Mitral regurgitation Diastolic. or Systolic? Pansystolic murmur, Mitral valve cant close, the ventricles contract and blood squirts back to the left atrium.
Tricuspid Regurgitation Diastolic or Systolic? Pansystolic: The Tricuspid valve fails to close. when thr right ventricle contracts the murmur is caused by the blood squirtng back in to the right atrium.
To tell the differrence between Tricuspid Regurgitaion and Mitral Regurgitation On inspriration which on becomes louder??? n On Inspiration Tricuspid regurgitation becomes loader ( Bates tbl 7-7)
Aortic Regurgitation Diastolic or sysytolic? Diastolic: the aortic valve does not close well and blood goes backward from the Aorta to the left ventrical
what 4 conditions mimic Aortic stenosis? 1)Aortic sclerosis 2) bicuspid aortic valve 3) dilated aorta 4) Pathalogic increased flow
Aortic Stenosis is it Diastolic or Systolic? Aortic Stenosis is a Midsystolic Murmurs due to impaired blood flow
Mitral Stenosis Diastolic or Systolic? Diastolic ..Mitral valve thickens and does not open well during diastole
a condition where a clot forms in one of the veins that run close to the surface of the body. visable through the skin? Thrombophlebitis what is it?
Venous stasis, vessel wall injury, hypercoagulable state is called: Virchow triad
2-6 y/o most commen ( can go to early adolecents) with thin AP diameter, loudest supine LSB what is it called____ Murmur Stills Murmur is systolic.. who gets it? and were best heard?
10-14 y/o F with thin A-P you hear a systolic murmurecho shows: normal blood through normal structures what is it? Straightback systolic murmur is innocent discribe
Pericardiocentesis Tx for what? Cardiac Tamponade
Most common cause of Cardiac Tamponade? Malignancy is the most common cause of what Hint "the big squeeze
Pt presensts with chest pain and cant breath well they apear anxious on inspect.: distended neck Veins, PE Hypotensive,muffled heart sounds,tachycardic whats the problem? Cardiac Tomponade
whats Becks Triad? 1)Hypotensive 2) Distended neckVeins 3) Muffled heart sounds
Becks Triad indicates what? Cardiac Tamponade
Can TB cause Cardiac Tamponade? Yes Cardiac Tamponade canbe caused by infection
name 4general etiologie of Cardiac tamponade 1) malingnancy 2) Infection, 3)Trauma 4) surgery ( nicking veins) can be the cause of what condition with Becks triad?
What infectious agents can cause Cardiac Tamponade? Virus, bacteria, Fungal, and TB can in fect the pericardium and ......may cause what?
What sound Atrial systole? S 4 ..caused by contraction of
S3 normal in .. Peds,, pregnant
S3 at what age do you worry? Over age 40 .. you worry becuase this sound indicates voulume overload of the heart...
what condition pops in your mind FIRST whith an S3 cardiac sound? Heart Failure . or CHF old school
Opening snap.. what valve? Mital valve sound when it opens
Opening snap..OS... diastolic or systolic? Diastolic blood flows from the atrium to the ventricle so what sound you hear?
Ejection sound diastolic or systolic? Systolic is when blood is injected into the aorta ... what is the sound?
Ejection sound what valve? Aortic valve with sound occurs by opening?
• Syncope:Normal EKG and echocardiogram what 2 condutions aortic valve stenosis or carotid artery stenosis could they get Syncope?
pt gets periodic runs of arrhythmias what do you do? holter monitor to find possible arrhythmias ...control with pace maker...ablate renegaid pacercell
Do pts who get  Percutaneous transluminal coronary angioplasty have symptoms return?  1/3 of pts with PTCA have a return of sx in 6 mos
PTCA whats it stand for?  Percutaneous transluminal coronary angioplasty
Your Pt. has angina form athersclerosis and refuses bypass sugery. what other procedure might help  Percutaneous transluminal coronary angioplastyo PTCA
What is the best artery to use for a CABG? long term • Left internal mammary artery (lima)
Can LIMAs be harvested endoscopically? Yes EVH ( endoscopic Vein Harvesting ) of the LITA ( or LIMA) is the standard in most CABG
BT or Bridging technique was started to avoid wound healing morbidities assocated with open saphenectomies describe the incisions: four to six 4cm insicion starting at the ankle with 7-8cm subcutaneous tunnels.... what am I describing?
What are 3 advantages of EVH over open saphenectomy? 1) reduced morbidity 2) better cosmetic outcome 3) lower treatment cost
What three`vessels can be harvested endoscopically for a CABG? Radial artery, Saphenous vein and ITA (LIMA) (LITA)
CABG .. postoperatively What do you monitor Atelectasis can be a complication after what cardiac procedure
Pericarditis puts the etiology ?(3).. Idiopathic, 2) infections ( viral or bac.) 3 status/ post MI
A patient presents sharp sometimes still achy chest discomfort, worse with inspiration swallowing top of your differential list? Pericarditis what does the patient complained of?
Pt presents substernal pain after eating worse with reclining what two things could it be ( though MIs in the Back your mind) GERD and pericarditis both positional symptoms ... listen for PFR to differentiate but dont forget Acute Arterial emboli of the mesentary maybe more abdominal
50 year old patient, with uncontrolled HTN , a congenital bicuspid aortic valve, and PMHX connective tissue disease, complains of a tearing inter-scapula pain what... diagnostic test ? in what do you expect to find? chest Xray signs of Aortic aneurysm
Named two conditions that respond to nitroglycerin: Esophageal spasm in angina what do they have in common? Besides chest pain
Herpes zoster true or false the pain occurs after the rash False ! .. the pain of herpes zoster(shingles) occurs before the rash !!!
How many patients present with Virchows's triad before a pulmonary embolism? 20% of pulmonary emboli patients present with hypercoaguability, venous stasis or inflammation/injury to vessel
What three interventions for pulmonary embolism? 1) thrombolytics 2) anticoagulant 3) surgery to retrieve emboli
Pulmonary angiography is the gold standard for diagnosing what? Pulmonary embolism.... what's the gold standard to diagnose??
what is the Greenfield filter? A filter sewn into the inferior vena cava to prevent emboli from reaching the pulmonary arteries but called?
PE prevention what three things: 1) ambulate the patient 2) TED hose 3)  Prophylactic anticoagulation
an abnormal sound on auscultation caused by alterd blood flow into a chamber or through a valve. Murmur...give a general definition
Murmurs classifiy 1) Dia or Sys?or both? 2) shape 3) quality (harsh musical) 4)Intensity( grade1-6) 5) body position heard best: 6) Radiate to
a heart murmur Loud with palpable thrill what grade? Grade 4 murmur discribe....
Murror Sound radiates: In the direction of blood flow
Murmur caused by High blood flow throuh normal valves usually innocent uusually diastolic
High blood flow Hyper thyroid, pregnant, anemia Murmurs due to Lots of blood , sound of murmer even ifvalves normal
Most Diastolic murmurs are pathalogic? Yes remeber this
a pt has a moderately loaud murmur what do you grade it? Grade 3 murmur what didiyou hear or feel?
MVP when? Dia or sys? sytole
Mitral Valve stenosis how , and were to listen were to radiate? Apex ,,Bell .. Little radiation
aortic sclerosis what is it? calcium accumulates on the aortic valve
DVT s/s red hot swollen andtender
DVT s/s test Homan's sign
DVT dx in clinic most common duplex ultrasonography
DVT Dx diffinative test is Veinography the diffinative test for___??
Superficial veinous thrombus does it"throw clots?" superfiecial clots raerly break off
What veins alllow blood to pass from the superficial veins into the deep vein system? Perforating veins... whats their purpose??
Valvular incompentence in one or more perforating veins results in what? Varicise veins ... what happens to one or more perforating veins??
Varicise veins and telangiectasia are normal veins that have dilated becuse ..? Increased venous presssure causes normal veins to become.. ??
telagiectasias are also called? spider veins are also called?
What may induce AAA formation? Atrerosclerosis
Retroperitoneal expansion and pressure on a femoral nerve can cause Isolated groin pain
Isolated groin pain is a insidious presentation of ...? AAA ...is putting pressure on a femoral nerve ...s/s?
AAA D/DX name 10!! ( not 9 asked befor Dec 12) 1) acute appendicitis, 2) cholelithiasis 3) Diverticular Dis. 4) Gastrirtis and PUD 5) MI 6) obstruction LB 7) obstrutionSB 8) pansreatitis 9) UTI 10) Renal Calculi
AAA to detect 100% use what?? CT .. 100% detecting AAA
Tests for AAA ..name 5? 1) plain radiography, 2) US 3) CT 4) MRI 5) angiography
Can Ultrasonography detect free peritoneal blood? Yes free peritoneal blood can be dected by...what bedside test?
You think a pt who is obease and recently ate 5 bean burritos is having an AAA. What test wont work well? Ulrasonography's imaging ability is reduced with bowel gas or obesity.
You want to follow up a AAA pt with a surgery at what size? 4-6 cm
What is the leading cause of Heary Failure the first month of life?? Coarctation of the Aorta .... Leading cause of heart failure in who?
Increased incidence of Coarctation of the Aorta in what 2 groups? Males and Females with Turner's .. are at increased risck of what disease of the Aorta?
On PE on infant is hypertensive in UE and hypotensive in LE whats this a classic finding for? Coarctation of the Aorta a classic PE finding in..?
AA mom brings her little girl in to the office saying shes lazy , Test results come back showing she is missing an X chromosome and has colateral circulation just distal to the Lsubclavian vein. You DX?? Coarctation of Aorta .... name a genetic assoc. and compinsating mechanisim.
This test is limited in detecting leakage involving an AAA? Ultrasonography .. can it detect leakagein an AAA?
This test is limited in detecting branch artery or suprarenal involvement in a AAA? Ultrasosgraphy can not detect branch artery or suprarenal involvment in ab AAA?
Acute arterial insufficiency what s/s are the 5 P's? Pain..Pallor.. Pulselessness.. paraestetias..paralysis
Lymphatic system.. the Thoracic duct drains in to.... The left subclavian vein .... recieves lympatic fluid from what duct?
What is WNL in width for an aortic aneurysm? ( cm) 2 cm for an aorit aneurysm is considered.....?
Most AAA occur associated with ___? Atherosclerosis is associated with what ?
An other wise healthy child can have palpable lymph nodes in what 3 area ? submandibular...axilliary.... ingunal lymph nodes are palpable .. are they always pathalogic???
list in alphabetical order the names of the 600 lymph nodes.. Just kiding! just know there are 600 lymph node in the body?
A breast cancer pt has swollen lymph nodes which 4 make you worie the most? Infra and supra clavicular, posterior and central axillary lymph nodes are a bad sign with what cancer?
whats the clasic triad with AAA? 1) pulsatile mas in the abdomen, 2) hyPOtension 3) Abdominal pain is the traid of what?
I say Reed Sternberg cell you say..? Hodgkin's lymphoma ( or disease) ... what cell comes to mind?
Infectious Mononucleosis ... what adenopathy on PE?? PCC and maybe inguinal adenopathy ( palpable nodes) are associated with what? Hint (kissing)
a number of STD'd are associated with what adenopathy? Inguinal adenopathy is associated with what type of diseases? ...Hint ( more then kissing)
discribing lymphadenopahty : what 4 charateristics? 1) size 2) matting 3) painfull 4) Generalized or localized ..what are these used to discribe?
True of False most of the lymph nodes in a body are generalized.?... NO ..No.. NO!!! Most lymph nodes are localized inthe headand neck followed by generalized,inguinal axillary and finally Supraclavicular
Inflammatory condition of 1 or more lymphatic VESSELs usually resulting from an acute streptococcal infection of an extermity... whats it called? LymphANGitis... what is it??
If I have LymphANGITIS what constitutional symptoms might I have? Tachycardia, HA, malais,Fever Chills are the constitution s/s of what disorder of the lymph system? ( Hint red streak)
Can lymphedema or impaitment of the lymph system be congenital? Yes!!! Lymphedema can be acquired AND congenital
Lympedema after an event like breast CA whwn are you nolonger at risk? Most people get lymphedema within 3 yrs of an event but ... will always be suspeptible .
What percent of breast CA pts get Lymphedema? 10-15% get lyphedema ...Who?
One funtion of the lymphatic system is to conserve..... Plasma protiens and fluids that leak out of cappillaries are conserved where...?
What does the lymphatic system absorb from the intestinal tract? Lipids end up in the lyphatic system by being absorbed FROM the intestines
Lymph drainage is high in what substances?(3) protein, Lipids and water are in the L----System
Hodgkin's Lymphoma what 2 age groups?? give me the ages.. 15-34 y/o AND > 55 y/o get Hodgkins ( Reed Sternbeg cells remeber?
Etiology of MVP: Kyphosis..Scoliosis Genetic,,Marfan's.. are the etiology of what Mitral Valve problem?
Clasic triad of Aortic Stenosis: 1) Chest pain 2) HF 3) sycope ..classic triad of what heart valve?
Most commonly replaced heart valve? Aortic Valve supplies blood to the coranary arteries.. if it goes bad you die pretty fast
Atherosclerosis :Modifiable Risk Factor (6) 1.Obesity 2.Physical inactivity 3 Cigarrette smoking >10 cigs/day. 4) HDL <40M <50F 5) HTN 6) DM Modifiable.... risk of what?
Abdominal obesity ,Atherogenic dyslipidemia ,HTN, Insulin resistance ,Prothrombotic state,Proinflammatory state what syndrome? Metabolic syndrom name 6 characteristics
Metabolic syndrome be identified as the presence of three or more of these component: 1.)Elevated waist circumference,2.)Elevated triglycerides,3) Reduced HDL (“good”) cholesterol,4)Elevated Blood pressure:5)Elevated fasting glucose
A Female PT with fasting glucose of 102mg/dl, BP 132/85, HDL 48 mg/dl, triglycerides, 152 mg/dl, and a 37 inch waist . what do you say ? You have Metabolic syndrome wich puts you at risk for developing CAD,other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes ....what symptoms ??
Created by: pnelson