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43 Cards in this Set
- Front
- Back
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What is the definition of atrial fibrillation on EKG?
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Rapid, irregular, chaotic atrial activity WITHOUT definable p waves on EKG
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What is the most common arrhythmia?
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Atrial fibrillation
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What are the complications of atrial fibrillation?
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Hemodynamic instability
Functional impairment Heart failure Ischemia |
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How does a TIA differ from a stroke?
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TIA: brief episode of neurologic dysfn caused by focal brain or retinal ischemia.
Clinical syx lasting less than one hour No e/o acute brain infarction Stroke: focal (or at times global) neurological impairment of sudden onset, and lasting more than 24 hours (or leading to death), and of presumed vascular origin |
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What are the risk factors for stroke/TIA?
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Age
Smoking HTN Hyperlipidemia |
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What are the screening recommendations for stroke?
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All adults >18 for HTN
All adults >20 for hyperChol if at inc'd risk CAD (i.e., DM, HTN, FMH CAD in males <50 or females <60) |
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How would symptoms of a left MCA stroke present?
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Expressive and receptive aphasia
Left facial weakness |
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How would a stroke affecting the right parietal hemisphere present?
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Left hemiplegia
Spatial and perceptual difficulties in misjudgment of distances or attempts to read books upside-down Inattention to people or objects in left visual field Denial of stroke disability |
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What are the diagnostic criteria for post-stroke depression?
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>5 of SIGECAPS for at least 2 weeks; syx must interfere with ability to remain independent in ADLs
Can tx w/SSRI |
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How does number of seconds needed to rise from chair predict mobility? (Provide categories)
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<10: freely mobile
<20: Mostly independent 20-29: Variable mobility >30: Impaired mobility |
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What is the hallmark sign of a seizure disorder?
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Amnesia for event and alteration of consciousness
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What imaging must be performed before treating acute ischemic stroke?
What are the limitations? |
Multimodal CT and MRI of Brain; note that although it can confirm the diagnosis, it cannot elucidate the etiology (thrombotic--85%--vs embolis--15%)
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What blood tests need to be ordered when stroke is on differential?
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Blood glucose (r/o hypoglycemia)
Renal fn/electrolyte disturbances EKG to r/o A fib Cardiac biomarkers (troponins, beta-natriuretic peptide) CBC, PT/PTT O2 Sat to r/o underlying CAD |
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What does beta-natriuretic peptide indicate?
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Secreted by cardiac ventricles in response to ventricular volume expansion and pressure overload. Levels are elevated in pts w/LV dysfn and correlate w/severity of syx and prognosis
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What is the medical management of atrial fibrillation?
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IV Diltiazem, IV beta-blockers or verapamil to slow heart rate
Cardioversion via shock or medications (stroke risk is greatest in patients in AF > 48 hours) |
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Describe the evaluation and management of a patient with stroke.
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Emergency CT scan:
if hemorrhage, contraindication for tPA Checks if tumor Checks for early signs of infarct tPA should be given within 3 hours of syx; administration should not be delayed while awaiting results unless: -clinical suspicion of bleeding abnlty or thrombocytopenia -patient has received heparin or warfarin -use of anticoagulants not known |
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Describe secondary prevention for non-cardioembolic stroke/TIA.
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Daily ASA or ticlopidine/clopidogrel if ASA-sensitive
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Describe secondary prevention for cardioembolic stroke/TIA.
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Warfarin for long-term anticoag
Goal IRN of 2.0-3.5!!! |
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What activities should a 5 year-old be able to complete?
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Dress his/herself
Name colors Draw a person with at least 6 body parts Copy a square and triangle Hold a pencil correctly when writing Skip, hop, and stand on one foot Talk in complete sentences with correct tenses and pronouns Have fully understandable speech |
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What vaccines are required prior to school entrance?
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HBV (series of 3)
Tdap (series of 5) Polio (series of 4) MMR (series of 2) Varicella (series of 2) |
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What vaccine aren't required for school admission, but decrease mortality/morbidity?
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HiB
Pneumococcal Rotavirus HAV Influenza (annual) |
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What are the criteria for diagnosing ADHD?
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Child is usually >6 year old
Syx must be: more frequent or severe compared to other children the same age Present in at least two setting, such as home and school Present at least 6 months |
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Diagnose:
Throat irritation Fever Non-descript Rash Rhinorrhea |
Viral pharyngitis
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Diagnose:
Throat irritation Fever Palatal petechiae Posterior cervical adenopathy |
Mono due to EBV or CMV
May also have faint nonpruritic maculopapular generalized rash that rapidly disappears |
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Diagnose:
Tongue bright red with white coating |
Strawberry tongue-->Group A Beta-Hemolytic Strep Pharyngitis
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Diagnose:
Punctate, erythematous, sandpaper texture in body folds and creases |
Scarlet fever!
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What is the medical management of GABHS pharyngitis?
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Pen VK or Pen G IM if unlikely to finish abx.
Amoxicillin liquid given to children bc it tastes better Can use cephalosporin too if have a PCN allergy, as are macrolides (erythromycin) Pts should stay home from school until has had 24 hrs of abx |
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What does APGAR stand for? How is it rated?
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Appearance (at 1 and 5 minutes postpartum)
Pulse Grimace Activity Respiration <3 Critically Low 4-6 Fairly Low 7-10 Generally Normal |
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How does birth weight fluctuate throughout the first 2 weeks after delivery?
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Lose 10% birth weight in first several days after delivery
By 2 weeks, return to birth weight |
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When does significant volume of milk production begin?
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48-72 hours following delivery--infants are well designed to tolerate this delay in milk production
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What developmental milestones should be expected in a 4 week old infant?
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Bring hands within range of eyes/mouth
Jerky body movements smooth out Listen when you talk to them Focus on you from a distance of 8-12 inches Respond to their mother Move head side to side when lying on stomach Head flops back if unsupported Keep hands in tight fists REcognition of some sounds (mother's voice) |
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Based on age, how often should an infant cry?
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2 weeks: 2 hrs qd
6 weeks: 3 hrs qd 3 months: 1 hr qd |
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What is the most readily utilized rapid screen for depression?
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PHQ-2:
During the past 2 weeks, have you been bothered by feeling down, depressed, or hopeless? During the past two weeks, have you often been bothered by having little interest or pleasure in doing things? Can increase specificity by asking: Is this something you would like help with? |
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How is a PHQ-9 scored?
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3 = nearly everyday
2 = more than 1/2 the days 1 = several days 0 = not at all 15+ = major depression 20+ = severe major depression |
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What is the normal heart rate for a newborn?
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100-165
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What is the Moro reflex?
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Allowing head to drop a few centimeters from midline position; should see rapid arm extension with hands open, followed by hands coming back together.
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What is the rooting reflex? When does it disappear?
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Stroke a newborn's cheek, he will turn head toward stimulus
Present at birth and assists in breastfeeding Disappears around 4 months of age |
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Define colic.
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Unexplained bouts of fussing and crying that last at least three hours a day, at least three times a week, for longer than three weeks
Etiology theories: GI dysregulation Allergies Neurodevelopmental problems |
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Diagnose:
Nonbilious vomiting in infants |
Pyloric stenosis
Male: female ratio is 4:1 Vomiting may be projectile |
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When is ultrasound indicated in diagnosis of pyloric stenosis?
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When presentation suggests diagnosis but olive mass is not palpated
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What is the most common cause of intestinal obstruction in infants?
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Intussusception
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Under what conditions should an infant undergo full sepsis work up and evaluation?
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<2 months of age with fever above 101 degrees (38 degrees Celsius)
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Management of colic.
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Breast milk is by far the most readily digestible, efficient, and healthy food for the baby. Switching to formula does not help.
Note: Simethicone to eliminate gas, or dicyclomine to slow down activity of gut; neither have been proven to work or be safe enough for infants. |
