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79 Cards in this Set

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  • 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