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64 Cards in this Set
- Front
- Back
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what is a ddx?
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A process used to list possible causes of an ailment and to systematically deduct the unlikely causes to arrive at the most likely diagnosis
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what does the ddx start with?
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chief complaint
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what is the ddx for chest pain?
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Angina
MI Pericarditis Myocarditis Dissecting aortic aneurysm Pulmonary embolus Pleuritis Pneumonia Pneumothorax Esophagitis GERD Musculoskelteal pain Panic attack |
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how should you ask about pain in a focused history?
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Can you show me where the pain is with one finger?
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what is the first question in a focused history?
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where is the pain?
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what other questions should you ask in a focused history?
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when did it start, makes it better, worse, describe it, grade it, radiate, etc
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what is the objective template for a SOAP note
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Vital signs
Gen HEENT (head, eyes, ears, nose, throat) Neck Heart Lungs Abdomen Extremities Skin Rectal Musculo-skeletal Neuro |
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In a focused physical exam for Chest Pain, what should be documented for the extremities?
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Color and temperature
Capillary refill Peripheral pulses Pedal edema |
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in a focused physical exam for chest pain, what should be documented for the skin?
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Erythema, Lesions
Cyanosis, Pallor, Diaphoresis |
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in a focused physical exam for chest pain, what should be documented for the rectal?
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If abdomen is tender
If patient is going to get a full cardiac work-up |
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In a focused physical exam for chest pain what needs to be documented for musculoskeletal/ osteopathic?
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Visual and palpable abnormalities of the thorax
T1 – T5 lesions may suggest cardiac itiology Rib dysfunctions |
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all pts with abdominal pain should get what?
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a rectal exam
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what is an absolute contraindication for thrombolytics?
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any bleeding anywhere
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what does FOBT stand for?
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fecal occult blood test
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what do heart sounds represent?
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closing of valves
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what produces the first heart sound S1?
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closure of AV valves (tricuspid and mitral)
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what produces the second heart sound S2?
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closure of semilunar valves
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what are the abnormal heart sounds?
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S3, S4
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what qualifies a split S1 or S2?
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when the valves close immediately after each other.
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what does S3 represent? caused by?
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ventricular filling caused volume overload
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SLOSH'-ing-in
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S3
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what does S4 represent? caused by?
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represents atrial contraction caused by stiff left ventricle
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a-STIFF'-wall
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S4
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what are the gallop rhythms?
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S3 or S4
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what disease would cause an S3?
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CHF
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what disease would cause an S4?
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cardiomyopathy
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what is an ejection sound (click)?
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opening sound of the aortic or pulmonic valve due to pathology.
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when is a high pitched ejection sound heard best?
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in early systole
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what is a systolic click?
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midsystolic click due to mitral valve prolapse.
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what is an opening snap?
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opening sound of mitral valve (rarely tricuspid) indicating pathology
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when is a high pitched systolic click sound heard best?
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High pitched sound heard with the diaphragm at LLSB, frequently followed by a ejection murmur
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when is a high pitched opening snap sound heard best?
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High pitched sound heard best with the diaphragm in early diastole
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what is a heart murmur?
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sound of turbulent blood flow
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what can cause a heart murmur?
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narrowing (stenosis) or leak (back flow)
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what is a bruit?
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vascular murmur
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what are the seven characteristics that are classifies murmurs?
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Timing, Shape, Location, Radiation, Intensity, Pitch, Quality.
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what are the two systolic murmurs?
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midsystolic and holosystolic
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what are the four possible causes of a midsystolic murmurs?
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innocent, physiologic
pulmonic stenosis aortic stenosis hypertrophic cardiomyopathy |
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what are the three possible causes of holosytolic murmurs?
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Mitral regurgitation
Tricuspid regurgitation Ventricular septal defect |
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what are the two diastolic murmurs?
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early diastolic and mid diastolic
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what are the possible causes of diastolic murmurs?
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early diastolic: aortic regurgitation
mid diastolic: mitral stenosis |
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what is the most common murmur we hear? why is that?
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grade 2 because most physicians miss grade 1
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what grade am I?
moderately loud |
Grade 3
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what grade am I?
loud with palpable thrill |
grade 4
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what grade am I?
very loud with thrill, may be heard when stethoscope is partly off the chest |
grade 5
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what grade am I?
very loud with thrill. May be heard with stethoscope entirely off the chest wall. |
grade 6
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what grade am I?
quiet but heard immediately after placing the stethoscope on the chest |
grade 2
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what is most important in saving lives when it comes to the lungs?
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stethoscope
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what is hyperpnea?
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breathing deep and fast
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what is the differential dx for dyspnea?
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CHF
ACS COPD Bronchitis Asthma Interstitial lung disease Pulmonary embolus Pneumonia Pneumothorax Anaphylaxis Severe anemia FB aspiration Panic attack |
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what are the four things that need to be documented on a focused history for dyspnea?
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onset, provocative/palliative, quality, associate symptoms (cough, fever, chills, nausea/vomiting, chest pain, chest injuries, etc)
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what are the three different types of abnormal lung sounds?
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Absent- pneumothorax
Decreased Adventitious |
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what are the six subcategories of the adventitious lung sound?
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Crackles (Rales)
Wheeze Rhonchi Stridor Pleural Rub Mediastinal Crunch (Hamman’s sign) |
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Continuous whistling sounds heard as air rushes through narrowed airways.
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wheezes
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High pitched- wheezes reflect what?
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air movement through smaller airways or bronchioles.
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Low-pitched wheezes (Rhonchi): reflect what?
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air rushing through narrowed, wider caliber bronchi.
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Discontinuous crackling sounds heard as air bubbles through fluid in the bronchioles or as contracted and fibrotic alveoli snap open late in inspiration.
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crackles (rakes)
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what does a fine or "wet" rale indicate?
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fluid in the alveoli and small airways
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what are coarse "dry" rales and what do they indicate?
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loud, leathery, rasping sounds that reflect scarred alveoli snapping up at the end of inspiration, and are, therefore late inspiratory and are heard in fibrotic lung diseases
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what does a pulse oximeter measure? what is normal?
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oxygen saturation in the blood
95-100% |
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which adventitious sound sounds like a ghost?!
just for fun... |
Wheezes :) OOooooOOOOooooOOO
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what does spirometry measure?
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the amount and rate of air a person breathes in order to diagnose illness or determine progress in tx
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what are the two ways that we can treat kids who have asthma?
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nebulizer and metered dose inhaler
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what is just as efficacious as a nebulizer, but not nearly as expensive?
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spacer
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