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43 Cards in this Set

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  • Back
What is the definition of atrial fibrillation on EKG?
Rapid, irregular, chaotic atrial activity WITHOUT definable p waves on EKG
What is the most common arrhythmia?
Atrial fibrillation
What are the complications of atrial fibrillation?
Hemodynamic instability
Functional impairment
Heart failure
Ischemia
How does a TIA differ from a stroke?
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
What are the risk factors for stroke/TIA?
Age
Smoking
HTN
Hyperlipidemia
What are the screening recommendations for stroke?
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)
How would symptoms of a left MCA stroke present?
Expressive and receptive aphasia
Left facial weakness
How would a stroke affecting the right parietal hemisphere present?
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
What are the diagnostic criteria for post-stroke depression?
>5 of SIGECAPS for at least 2 weeks; syx must interfere with ability to remain independent in ADLs

Can tx w/SSRI
How does number of seconds needed to rise from chair predict mobility? (Provide categories)
<10: freely mobile
<20: Mostly independent
20-29: Variable mobility
>30: Impaired mobility
What is the hallmark sign of a seizure disorder?
Amnesia for event and alteration of consciousness
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%)
What blood tests need to be ordered when stroke is on differential?
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
What does beta-natriuretic peptide indicate?
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
What is the medical management of atrial fibrillation?
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)
Describe the evaluation and management of a patient with stroke.
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
Describe secondary prevention for non-cardioembolic stroke/TIA.
Daily ASA or ticlopidine/clopidogrel if ASA-sensitive
Describe secondary prevention for cardioembolic stroke/TIA.
Warfarin for long-term anticoag

Goal IRN of 2.0-3.5!!!
What activities should a 5 year-old be able to complete?
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
What vaccines are required prior to school entrance?
HBV (series of 3)
Tdap (series of 5)
Polio (series of 4)
MMR (series of 2)
Varicella (series of 2)
What vaccine aren't required for school admission, but decrease mortality/morbidity?
HiB
Pneumococcal
Rotavirus
HAV
Influenza (annual)
What are the criteria for diagnosing ADHD?
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
Diagnose:
Throat irritation
Fever
Non-descript Rash
Rhinorrhea
Viral pharyngitis
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
Diagnose:
Tongue bright red with white coating
Strawberry tongue-->Group A Beta-Hemolytic Strep Pharyngitis
Diagnose:
Punctate, erythematous, sandpaper texture in body folds and creases
Scarlet fever!
What is the medical management of GABHS pharyngitis?
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
What does APGAR stand for? How is it rated?
Appearance (at 1 and 5 minutes postpartum)
Pulse
Grimace
Activity
Respiration

<3 Critically Low
4-6 Fairly Low
7-10 Generally Normal
How does birth weight fluctuate throughout the first 2 weeks after delivery?
Lose 10% birth weight in first several days after delivery

By 2 weeks, return to birth weight
When does significant volume of milk production begin?
48-72 hours following delivery--infants are well designed to tolerate this delay in milk production
What developmental milestones should be expected in a 4 week old infant?
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)
Based on age, how often should an infant cry?
2 weeks: 2 hrs qd
6 weeks: 3 hrs qd
3 months: 1 hr qd
What is the most readily utilized rapid screen for depression?
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?
How is a PHQ-9 scored?
3 = nearly everyday
2 = more than 1/2 the days
1 = several days
0 = not at all

15+ = major depression
20+ = severe major depression
What is the normal heart rate for a newborn?
100-165
What is the Moro reflex?
Allowing head to drop a few centimeters from midline position; should see rapid arm extension with hands open, followed by hands coming back together.
What is the rooting reflex? When does it disappear?
Stroke a newborn's cheek, he will turn head toward stimulus

Present at birth and assists in breastfeeding

Disappears around 4 months of age
Define colic.
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
Diagnose:
Nonbilious vomiting in infants
Pyloric stenosis
Male: female ratio is 4:1

Vomiting may be projectile
When is ultrasound indicated in diagnosis of pyloric stenosis?
When presentation suggests diagnosis but olive mass is not palpated
What is the most common cause of intestinal obstruction in infants?
Intussusception
Under what conditions should an infant undergo full sepsis work up and evaluation?
<2 months of age with fever above 101 degrees (38 degrees Celsius)
Management of colic.
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.