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122 Cards in this Set
- Front
- Back
What is Cullen's sign?
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bruising around the umbilicus. Indicates bleeding in abdomen and predicts a severe attack of pancreatitis
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What is Grey-Turner's sign?
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bruising of the flanks, indicates kidnesy injury, attack of pancreatitis
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What is included in abdominal exam?
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percussion, palpation, rectal, genital
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What might cause abdominal distention?
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Fluid, full bladder, fat, fibroid, fatal tumor, flatus, feces, fetus, false pregnansy
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What should different organs sound like?
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-Intestines-fluid and air so resonant
-Liver-dull |
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How do you tell where the liver is?
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Percuss over mid-clavicular line from resonance of intestine until hear dullness of the liver. Or scratch test with stethoscope
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Where is the fundus at 20 weeks?
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At umbilicus
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What dx tests might you run for a GI complaint?
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Urine dipstick, CBC, Chem-7, LFTs, H pylori, Hemoccult, fecal occult blood testing, culture and sensitivity, ova and parasites, fecal leukocytes, fecal DNA
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What does a urine dipstick tell you?
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For WBCs in urine, nitrites that bacteria produce, pregnancy, ketone, protein
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What do the WBC differentials tell you?
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-Shift to left means increased neutrophils or bands (with bacterial infection), shift to right means increased lymphocytes (with viral infection possibly)
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What is a BMP?
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basic metabolic profile, this includes BUN and creatinine
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What are LFTs? What is included?
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liver function tests. If ALT, AST are elevated that means there is inflammation somewhere, could be other than the liver. Biliary- ALP elevation could indicate a blockage or a growth spurt, normally higher in adolescence, signifies enzymatic activity going on
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What type of fecal occult blood testing is more sensitive for CA?
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6-sample that pt takes home is more sensitive, single digit rectal exam has low sensitivity
NOTE cannot eat red meat while doing this |
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What does a FIT (fecal immuochemical test) test for?
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tests protein from hemoglobin in blood, no dietary limitations, comes in a kit for pt to use
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What does fecal DNA test for?
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DNA of cancer cells, specific but expensive, must have a complete stool sample and mail it off. ick.
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What is an upper GI series?
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looks at esophagus, stomach, duodenum. Barium can cause constipation
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What will US of gall bladder and liver look for?
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Stones or infection. Must eat a fat free meal and fast
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What does a hepatobilliary (HIDA) scan show?
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gall bladder stones and infections. Must fast and have an injection
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What does an esophagogastroduodenoscopy (EGD) show?
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Light to look into GI, mostly for stomach and duodenum cancers and ulcers
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What is a spiral CT?
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pt moves to increase contrast, this is good to look at appendix.
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Why might a patient have a barium enema?
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to detect differences in lining of the colon
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What could you use for lower GI visualization?
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-barium enema to show on x-ray and lesions
-sigmoidoscopy- see lower colon -colonoscopy- see to secum. Prep with diuretic, sedation. Can see lesions and polyp removal -Virtual- a CT scan but if see anything have to have colonoscopy anyway |
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What are upper GI cancers? What are S&S? How will you dx?
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-include stomach, pancreas, and liver
-S&S- dysphagia (swallowing), odynophagia, early satiety, pain, wt loss, or NONE -dx when advanced and poor prognosis |
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What is colorectal cancer? What do you ask the pt? What are the sx?
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-ask about personal hx of polyps and family hx of different colon cancers. Transition to cancer from plyps increases with age
Sx- dysphagia, hemoptysis, hematuria, rectal bleeding |
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What are sx of ovarian cancer?
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abdominal pain, distension, bloating, urinary urgency and frequency
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What are cancer screening recommendations/
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-CRC- FOBT (false positives), colonoscopy, start at 50 every 10 years or sigmoidoscopy every 5
-Ovarian- if family hx |
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What are GI red flags?
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Acute onset of severe pain 9might be ischemia), bleeding, displaced aortic pulsation, absent bowel sounds, hypovolemia, weight loss (cancer symptom)
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What is parietal pain?
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local irritiation from type A delta pain fibers. such as a muscle spasm
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What is visceral pain?
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autonomic type c pain fibers, poorly localized
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What will ischemic pain feel like?
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HURTS, sudden onset, continuous, progressive
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What are you thinking if a pt has abdominal pain with fever?
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infection, inflammation
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What is psoas sign?
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pt on side with leg extended behind and push against resistance. if abdominal pain might be appendicitis
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What is obturator sign?
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rotation against resistance of the hip, for appendicitis
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What is murphy's sign
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inspiratory arrest and pain when palpating RUQ, or with US pain with tranducer
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**What does sensitivity mean?**
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pts with the dx who test positive
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**What does specificity mean?**
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pts without the dw who test negative
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Describe appendicitis?
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-More common age 10-30, rare under 5 and over 50
-RLQ pain that migrates from umbilical area, pain precedes nausea!! -will not be hungry -abdominal rigidity -could use alvarado score- old but includes exam pts. If over 7 then operate |
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What is choleycystitis?
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-More common in "fair, fat, fertile, forty and flatulent"
-RUQ pain that is worse after meals -estrogen can precipitate gall stones so be aware if post partum or OCPs -rapid weigh loss -murphy's sign |
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What is pancreatitis?
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-Acute, severe, epigastric to back pain
-vomiting -fever -increased amylase, lipase -usually due not to alcohol but to obstruction of sphincter leading to autodigestion -can occur after gall stone |
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What will you see if UTI or pyelonephritis?
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dysuria, flank pain, ask about suprapubic pain
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What will you see in PID?
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usually in younger women who are sexually active with vaginal discharge
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What are the diarrhea definitions?
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greater than 3 times a day. acute if < 2weeks, persistent if 2-4 weeks, chronic if > 4 weeks
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What is gastroenteritis?
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-pain and diarrhea
-contagious -might be as short as 24 hrs -bacterial can be from many different pathogens -passed fecal oral -viral or bacterial |
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What foods might induce foodborne illness?
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seafood, dairy, beef, pork, poultry and raw eggs, veggies, fruit
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What is irritable bowel syndrome?
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-pain and diarrhea
-alternating constipation/diarrhea or one -cramping and urgency -does not wake from sleep |
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What is small intestinal bacterial overgrowth?
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might be a cause of IBS, gas, bloated, diarrhea, only will know if scope and culture
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What is inflammatory bowel disease?
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pain and diarrhea, bloody, wakes from sleep.
Includes Crohn's and ulcerative colitis |
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What is celiac disease?
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-pain and diarrhea
-**NO WHEAT b/c it triggers inflammation **weight loss** -cramping, bloating, might have an itchy rash -more common with RA, thyroid, downs -usually long delay in dx, dx with blood test |
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What will you see in lactose intolerance?
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carmping and diarrhea, try a lactose free trial
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What does HAND stand for?
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in bulimia
-Halitosis -Abrasions on Knuckles -Negative gag -Poor dentition |
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What might a person have if they no longer have a gall bladder?
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diarrhea, might need treatment
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What might C difficile with ab treatment induce?
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extreme diarrhea
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What drugs would you ask about with constipation?
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calcium channel blockers
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Why would a person with peptic ulcer disease vomit? with gall bladder disease?
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-blood into stomach induces vomiting
-if meal was too fattening |
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What will you see with an intestinal obstruction?
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-obstipation- no stool b/c nothing is getting past the blockage
-fecal smell to vomit -might be due to adhesions from past surgery |
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What would a person with dyspepsia present with?
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-indigestion, heartburn, bloating, n/v, regurgitation, anorexia, early satiety
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What must you rule out with upper abdominal or epigastric pain?
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cardiac etiology
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What are the diff dx for epigastric pain?
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-GERD- after meals, burping
-PUD- pain between meals b/c nothing in stomach to counteract acid -dyspepsia -gall bladder- fatty meals, RUQ -hepatitis- exposure, jaundice -pancreatitis- severe pain |
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What are some red flags?
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-cheast pain to L arm, SOB nausea, diaphoresis
-bleeding- hematemesis melena, -dysphagia |
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When is someone low risk for appendicitis?
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no pain migration, bilateral tenderness, no N/V
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What is ischemia bowel?
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When blood shuts off to bowel as a whole or a part, more in older adults
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What is diverticulitis?
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-pooching of bowel
-**LLQ pain** -fever, vomiting** might have blood in stool if no infection it is called diverticulosis |
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What is an abdominal aortic aneurysm?
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will see displaced aortic pulse, aortic bruit. male, older, smoker
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What are some zebras of GI?
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sickle cell crisis, DKA, food allergies, lactose intolerance, ovarian cancer, abuse
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What might cause rectal bleeding?
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hemorrhoids, fissure, diverticulitis, cancer, constipation/ hard stool, inflammatory bowel disease (ulcerative colitis and crohn's)
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**What is the difference between ulcerative colitis and Crohn's?**
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UC- diarrhea with blood, mucous, pus, mild to moderate abdominal pain, fatigue, joint pain, LLQ tenderness
Crohn's- bloody diarrhea, abd cramping, spasm, weight loss, anorexia, fever, joint pain, abd tenderness, mass, perineal/rectal lesions |
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What will you see with jaundice?
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yellos, look at liver size, murphy's sign, get LFTs and hepatitis panel
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When could a C difficile infection happen?
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up to 6 months after antibiotics
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What is claudication?
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vessel pain caused by activity, relieved by rest
"angina of the vessel" chronic ischemia |
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What causes the S1 sound?
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ventricular contraction, systole
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What causes the S2 sound?
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diastole, relaxation and filling
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What are S3 and S4?
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S3- early diastole, resistance and L ventricle is failing as a pump
S4- occurs closer to S1, forcing blood into stiff ventricle |
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What is a click?
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valve that is flapping or prosthetic valve
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What is a rub?
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two enflamed surfaces rubbing against each other
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What do you need to document with murmurs?
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**timing (more in systole), grade, location, radiation (does it go anywhere else)**
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What is included in the vascular exam?
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opthamoscopic exam, bruits, jugular venous pressure, abd aortic pulsations
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What does jugular vein distension tell you?
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back up from heart or pressure from liver
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What is homan's sign?
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dorsifexion of foot --> pain in calf. might mean clot, might dislodge DVT. Evidence says this test doesn't mean anything
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**What is the ankle-brachial index?**
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ABI= highest systolic ankle BP/ highest brachial systolic BP. Normal > .95, PVD < .95
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What are some risks for CVD?
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HTN, DM, obesity, smoking, hyperlipidemia, little exercise, age, sex, family hx of premature cardiac disease (male before 55, female before 65), race
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What hear rate will make you think?
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resting rate >75 or exercise less than 89
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Must have three of these five things for metabolic syndrome?
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waist, HDL, triglycerides, BP, glucose
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Is sleep apnea associated with CV disease?
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yes
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When should you screen for cholesterol levels
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After 35-45 if no risk
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What labs might you draw in a cardiac patient?
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-c-reactive protein- made by liver in inflammation
-homocysteine- amino acid that can cause vasular damage -LpPLA2- biomarker of inflammatory response -Brain NP- from ventricles, released by stretch, high indicate HF EKG! |
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What are some lethal dysrhthmias?
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asystole, ventricular tachycardia, ventricular fibrillation
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**What is ejection fraction?**
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% ejected of total amount of blood in ventricle per systole. Normal is 55%
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Do you test low risk populations?
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no, most are not recomended in low risk
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What are possible origins of chest pain?
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cardiac, circulatory, pulmonary, gastrointestinal, musculoskeletal
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What is acute coronary syndrome?
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ustable angina, may or might not have ST segment elevation
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What is pleuritic chest pain?
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comes and goes with breathing
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the likelihood of an MI decreases with these factors
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Pleuritic chest pain
chest pain reproducible with palpation sharp/stabbing chest pain positional chest pain |
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What will myocardial damage look like on EKG?
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ischemia- inverted T waves
injury- ST segment changes Infarct- Q waves |
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What ar ethe differences in chest pain between MI and angina?
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MI- pressure, substernal to L arm and neck, lasts more than 5 min, unrelieved by nitroglycerin or rest, accompanied by nausea, SOB, diaphoresis
Angina- pressure, substernal to l arm and neck. lasts less than 5 minutes, relieved by nitro |
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What are the symptoms women might have with an MI?
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atypical- SOB, fatigue, jaw/ back pain, CP at rest, epigastric pain
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Why is a woman who had breast CA more likely to have an MI?
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meds are cardiotoxic
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What is the reynolds risk score?
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For women, quantifies the risk of MI
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Who is likely to have atypical presentation/
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women, elderly, AA's
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What is mitral valve prolapse?
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might hear a click, turbulence, worsens with standing or squatting, can cause blood to back up
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What is pericarditis?
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inflammation of the pericardium, lean forward and pain should improve, friction rub
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What are some circulatory causes of chest pain?
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aortic dissection, AAA (back pain), DVT, sickle cell crisis
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What is an abdominal aortic aneurysm?
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dilation of 3 cm or more in wall of adbominal aorta, screen if have ever smoked
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What are some pulmonary causes of chest pain?
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pneumonia (fever, cough), pleuritis (inc pain with breathing, friction rub), pneumothorax (sudden onset dyspnea)
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What are some GI causes of chest pain?
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GERD, PUD, gallbladder, pancreatitis
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What are the red flags in chest pain?
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*Pneumothorax- pleuritic CP, decreased BS, dyspnea
*PE- acute dyspnea, tachycardia, tachypnea, hemoptysis *Aortic dissection- back pain, pulse asymmetry, murmur *Pericarditis- pericardial rub, pleuritic/ positional sx |
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What are the zebras of chest pain?
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herpes zoster, cocaine, pericardial tamponade
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What are premature ventricular contractions (PVCs)?
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compensatory pause and then back to the same rhythm, can be unifocal or multifocal, feel like heart stopping and feel compensatory pause, CP, SOB related to exertion
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What is heart failure?
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inability of the heart to maintain adequate vital organ perfusion. First two stages will have no symptoms!
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What is syncope?
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sudden transient loss of consciousness with loss of postural tone, followed by spontaneous recovery. REturn to baseline without confusion. caused by interruption of blood flow and cerebral cellular perfusion
-can be neuro, neurocardiogenic (vasovagul), vascular, metabolic, psychogenic |
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What is a CVA?
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decreased blood flow to brain --> ischemia
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how do you test for initial signs of a stroke?
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smile, talk, raise arms
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What family hx of breast cancer is significant?
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-dx <50?
-*2 or more with breast or ovarian CA *1 with breast AND ovarian cancer |
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how often CBE?
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q3yrs until 40, then yearly
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What breast skin changes might you see with Paget's disease?
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-peau d'orange, erythema, scaling, nipple excoriation, tissue thickening
-poss bloody discharge |
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What is inflammatory breast disease?
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rapid increase in size, pain, tenderness
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What are the lab tests for syphilis?
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RPR/ VDRL
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What is normal vaginal pH/
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3.8-4.5
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What are the bethesda criteria?
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adequacy of specimen, negative for intraepithelial lesion/malignancy, positive findings (squamous or glandular cells)
-tells you if you don't have the right cells in the sample |
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What is the normal number of WBCs in a high powered slide?
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up to 4
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What is a clue cell?
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has bacteria in and on cell, membrane is not distinct, indicative of bacterial vaginosis
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What is pelvic inflammatory disease?
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infection in pelvis, in ovaries, in tubes. Positive cervical motion tenderness, caused by STIs but other infections too, diffuse tenderness all over abdomen
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What are symptoms of ovarian cancer?
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acute onset abd pain, inc abd size, bloating, urinary frequency/urgency
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