Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
79 Cards in this Set
- Front
- Back
|
What nerve/nerve root controls dorsiflexion of wrist?
|
radial n, C7
|
|
|
What nerve/nerve root controls quadricep?
|
femoral n, L2/L4
|
|
|
Why do you get neuro problems with B12 def and not folate def?
|
B12 necessary for myelin
|
|
|
fever, no cough or rhinorrhea, nodes swollen at angle of mandible= Likely, _________?
|
strep
|
|
|
poorly controlled DM + diffusely red swollen v. tender auricle= likely ______
|
pseudomonas, otitis externa maligna
|
|
|
tobacco chewer + white painless 1.5cm bump on tongue = likely __________
|
neoplasia, R/O squamous cell (but need biopsy)
|
|
|
ear popping + low grade fever + retracted TM + prominent umbo and diffuse light reflex = likely__________
|
serous otitis media
|
|
|
What nerve root responsible for finger abduction?
|
T1
|
|
|
4+ reflex characterized by?
|
clonus (and crossover?)
|
|
|
pt can abduct shoulder against gravity but not against 2 fingers= what power?
|
3
|
|
|
pruritis rash on extensor surfaces + pitting nails and silvery scales=?
|
psoriasis
|
|
|
inspiratory bulging of neck=?
|
Kussmaul's sign
|
|
|
Kussmaul's sign seen in CONSTRICTIVE PERICARDITIS or CARDIAC TAMPONADE?
|
constrictive pericarditis (tamponade-->whopping pulsus paradoxus)
|
|
|
what 4 heart conditions give you "lots of noise"?
|
1) pericardial friction rub 2) PDA 3) severe AR 4) MR
|
|
|
Pulsus paradoxus of >21 assoc'd with which conditons?
|
cardiac tamponade and status asthmaticus
|
|
|
what might cause pulse deficit? (HR @ wrist<HR @ apex)?
|
Afib
|
|
|
What condition would cause a fixed S2 split?
|
ASD
|
|
|
Pathologic murmur with BRISk ejection?
|
MR
|
|
|
pulsus tardus and parvus associated with?
|
AS
|
|
|
Kussmaul's sign an indication of what?
|
obstruction to R ventricular filling
|
|
|
neck vein findings in cardiac tamponade?
|
prominet X descent but no Y descent
|
|
|
Corrigan/water hammer assoc'ed with?
|
AR (bisferiens pulse), also get Austin Flint murmur
|
|
|
Prominent A wave/ giant V wave seen in?
|
pulmonary HTN
|
|
|
Who is orthopneic?
|
Usually CHF pts, also in pts with massive ascites
|
|
|
Who is platypneic?
|
Pts with R-L shunts (intracardiac--ASD; intrapulmonary--bi-basilar processes ,ike PE, penumonia, large pleural effusion)
|
|
|
Who is trepopneic?
|
Pts with unilateral lung dz (DOWN with the GOOD lung)
|
|
|
What is Kussmaul's respiraton?
|
faster and deeper; DDx includes: LAME PUK--lactic acidosis, aspirin, MetOh, ethylene glycol, paraldehyde, uremia, ketones
|
|
|
Carnett's sign
|
maneuver that uses induced guarding to differentiate ab tenderness due to inflmmation inside vs ab tenderness due to ab wall inflammation (pos (pain increases)--ab wall)
|
|
|
waddling gait + lumbar lordosis +calf pseudohypertrophy =? And assoc'd with what heart probs?
|
Duchenne muscular dystrophy, assoc'd with hypertrophic cardiomyopathy
|
|
|
arterial pulse delays suggestion of?
|
aortic coarctation
|
|
|
dicrotic notch corresponds to what cardiac cycle event?
|
S2, closure of semilunar valves
|
|
|
arterial pulse of HOCM?
|
brisk and rapid upstroke, normal pulse pressure
|
|
|
brisk upstroke + widened pulse pressure=?
|
aortic regurgitation
|
|
|
tetrad of cardiac tamponade (CV PE)
|
1)tachycardia 2) dyspnea/tachypnea 3) distended neck veins 4) clear lungs
|
|
|
Kussmaul's sign seen when? (6)
|
1)SVC syndrome 2) TS 3) R V hypertrophy/infarction 4) constrictive pericarditis 5) PE 6) severe pulmonary HTN; (N.B. all obstruction to R sided venous return!)
|
|
|
Pulsus bisferiens seen when?
|
in severe AR
|
|
|
bifid pulse seen when?
|
HOCM
|
|
|
hypokinetic pulses seen when? (hypokinetic=dec'd amplitude)
|
AS; cardiomyopathy; MS
|
|
|
which jugular vein should be evaluated?
|
right internal, b/c in more direct line with R atrium
|
|
|
A wave assoc'd with?
|
Atrial contraction, coincides with S4 if present
|
|
|
C wave assoc'd with?
|
bulging of tricuspid cusps
|
|
|
early X descent assoc'd with?
|
R atrial relaxation
|
|
|
V wave assoc'd with?
|
early Ventricular diastole
|
|
|
Y descent assoc'd with?
|
produced by opening of tricuspid valve and emptying of R atrium
|
|
|
large A waves seen in which conditions?
|
TS, R atrial myxoma, pulmonary HTN, pulmonic stenosis
|
|
|
absent X descent seen in which condition?
|
Tricuspid regurgitation
|
|
|
absent Y descent seen in which condition?
|
cardiac tamponade
|
|
|
cannon A waves hallmark of what CV problem?
|
atrioventricular dissociation (atrium contracts against a closed tricuspid valve)
|
|
|
Where is Erb's point?
|
3rd L parasternal interspace
|
|
|
Significance of S2 louder than S1 @apex?
|
1) pulmonary/systemic HTN 2) S1 is softer than usual
|
|
|
a BOOMING S1 should make you consider what?
|
MS
|
|
|
Causes of wide (physiologic) splitting of S2?
|
RBBB (delayed PV closure), PS, massive PE, cor pulmonale; severe MR (early AV close), VSD
|
|
|
What causes fixed splitting of S2?
|
ASD (or occasionally VSD)
|
|
|
Causes of paradoxical S2 splitting
|
LBBB, AS, TR, R atrial myxoma
|
|
|
What is a "tambour" S2?
|
loud and ringing S2, usually indicates dilatation of aortic root. If also AR murmur, think Marfan's, syphilis, or dissecting aneurysm
|
|
|
Are S3 and S4 bad?
|
S4 always reflects pathology; S3 usually reflects pathology
|
|
|
How is S3 best detected?
|
hold BELL over APEX, in L lateral decubitus
|
|
|
How is S3 produced?
|
by sudden and abnormal deceleration in L ventricular flow at end of rapid filling
|
|
|
Can a gallop be physiologic?
|
nope
|
|
|
Significance of pathologic S3?
|
reflects either 1)increased ventricular preload or 2) reduced ventricular function
|
|
|
What does S3 in pts with ventricular dysfunction mean (in terms of EF)
|
EF<30%
|
|
|
How is S3 useful in CHF?
|
best predictor for response to digitalis and overall mortality
|
|
|
What disease processes can cause S4? (6)
|
1)HTN, 2) AS, 3) coarctation of aorta, 4) hypertrophic cardiomyopathy 5) CAD 6) prolonged P-R interval
|
|
|
Can you have S4 with Afib?
|
No. need adequate atrial contraction for S4
|
|
|
What is an opening snap?
|
loud, early diastolic extra sound in MS or TS
|
|
|
What is a pericardial knock?
|
loud, early diastolic extra sound usually in chrnic calcific and constrictive pericarditis
|
|
|
Important physical findings that may accompany constrictive pericarditis?
|
(pericardial knock), findings of R heart failure (hepatomegaly, ascites), Kussmaul's sign, pulsus paradoxus (10-20mmHg), systolic retraction of apical impulse
|
|
|
Pathologic processes causing ejection sounds?
|
bicuspid semilunar valve, dilatation of aortic (or pulmonic) root
|
|
|
How distinguish between aortic and pulmonic ejection sounds?
|
aortic ES has constant intensity t/o respiration (pulmonic gets louder in exhalation)
|
|
|
What maneuver enhances pericardial friction rub and why?
|
inspriation b/c the diaphragm stretches the pericardium
|
|
|
What disease processes assoc'd with pericardial friction rubs?
|
pericarditis, acute MI, PE (rarely), metastasis
|
|
|
Does a pericardial friction rub explude pericardial effusion?
|
no b/c of loculation
|
|
|
where do the following radiate to: a) MR b) AS
|
a) radiates to axilla b) radiation to neck
|
|
|
Which murmurs get enhanced by valsalva?
|
HOCM and MVP
|
|
|
What is the most common systolic ejection murmur in elderly?
|
aortic sclerosis
|
|
|
How distinguish valvular AS from HOCM by location, timing and arterial pulse?
|
HOCM is louder over Erb's (AS loudest over aortic area); HOCM usually mid-systole (AS is early); HOCM has brisk and bifid arterial pulse (AS is delayed and reduced)
|
|
|
What is the most common nun-functional murmumr in US?
|
MR
|
|
|
Which leaflet most commonly involved in MVP?
|
posterior
|
|
|
Causes of AR?
|
aortic cusp dz and aortic root dilatation
|
