Study Guide 3
1. Onset pain after lifting---Straight leg raises for herniated disc
2. Key in hand with eyes closed, assessing for-stereognosis
3. Raise eyebrows, frown, smile and open eyes, assessing –CNS V and VII
4. 52 f with acute rapidly progressive headache, -R/O Subarachnoid hemorrhage
5. Teenage girl admitted with facial trauma secondary to MVA—stroke cornea of each eye with cotton wisp
to check for reflex blinking-what name is this reflex and what CN---Corneal reflex, CN 5 and 7
6. Complaint of breathlessness with activity,---orthopnea
7. 67 f with c/o CP am palpitation, After EKG dx of A-Fib-complications- Peripheral embolization
8. Physical examination of pt with peripheral vascular disease-asses for Size, symmetry and skin color
9. Painful ulcerative lesion near medial malleolus with hyperpigmentation---Venous insufficiency
10. Blood glucose over 360 with extreme thrist, frequent urination and fruity breath---Hyperglycemia
11. State of absolute insulin deficiency, aggravated by hyperglycemia, dehydration and acidosis with positive
ketones---Diabetic ketoacidosis (DKA)
12. Pelvic exam on 23 y/o female, thin, watery frothy, malodorous discharge---Trichomoniasis
13. 27 y.o female, tender warm cystic mass on lower edge of left labia---Bartholin’s gland cyst
14. Right lower quadrant abd pain—examine tender area last
15. 55 y/o male with pain in epigatrum lasting longer than 30 min---All answers are correct
16. Amenorrhea and vaginal spotting, left adnexa tender ---Urine pregnancy test
17. 33 male with 1 week history of fever and pain over left scrotom—Epididymis
18. 26 y/o coach right side pain---acute appendicitis
19. 17 y/o left scrotum, soft movable blood vessels that feel like bag of worms, -- Vericocele
20. 10y/o boy, sudden onset pain -Testicular torsion
21. 72 y/o female sp CABG and POD #3, Tachy at 150, what is the EKG---Atrial Fibrillation
22. 75 y.o male, presents with chest pain, --Cornary Artery disease resulting in STEMI
23. 65 yo female check up, BP in both arms----Subclavin Stenosis
24. Deterioration of frontal lobe of cerebrum,,, it is Boluntary skeletal movement
,25. Turn patients forearm so that palm is up---supination
26. Cause of Acute UTI---E.coli
27. 26 yo DM type 1, caused by pancreatic beta cell destruction predominatly by an autoimmune process
28. Unilateral pain during chewing, ------Tempormanidbular joint syndrome
29. Assessing patient with suspected cholecystitis—Murphy’s sign
30. Cushing’s disease—Glococorticoid excess
31. Back pain associated with constipation and urinary retention---Idopathic low back pain
32. Bronze skin color and darkened gums----Addison’s disease
33. Sudden onset, painful swollen red finger and toe joints----Gout
34. Bluish cervix---Chadwicks sign of cervice and order pregnancy test
35. 44 yo male, right lower extremity edema and discomfort---DVT
36. What type of EKG changes would you expect to find in setting of acute pericarditis---Widespread ST
elevation
37. Auscultation of heart tones, harsh systolic murmur heard best at 2nd intercostal space right midclavicular
line---Aortic stenosis
38. 70 yo male painful left lower extremity---cyanosis of toes---Ischemic foot related to peripherl artery
stenosis
39. Snellen chart evaluating for visual acuity---CN II
40. QRS complex on EKG--- ventricular depolar
41. Pacemaker of heart---SA node
42.
,Week 5 - Cardiovascular and Peripheral Vascular
1. Anatomy and physiology
a. Lies between the lungs in the middle of the mediastinum and enclosed within
the pericardium; behind the body of the sternum, left of the midline, and above the
diaphragm.
b. 4 chambers: left atria, right atria, left ventricle, right ventricle
c. 3 layers of cardiac muscle: epicardium, myocardium, and endocardium
d. Pericardium – fluid filled sac which serves as protective barrier
e. Cardiac Valves
i. Atrioventricular: tricuspid and mitral
ii. Semilunar: pulmonic and aortic
f. Base – superior portion of heart
g. Apex – inferior narrow tip of heart
2. Cardiac Cycle
a. Systole: ventricle contract
i. R ventricle pumps blood into the pulmonary arteries (pulmonic valve is
open); L ventricle pumps blood into the aorta (aortic valve is open)
b. Diastole – ventricle relax
i. Blood flows from R atrium to the R ventricle through the open tricuspid
valve; blood flows from L atrium to the L ventricle through the open
mitral valve
3. Important Concepts:
a. Preload = volume; amount of ventricular stretch at the end of diastole
i. L ventricular end-diastolic pressure, CVP, wedge pressure
b. Afterload = pressure the heart is working against to eject blood during systole
c. Cardiac Output = stroke volume X heart rate
i. Volume of blood being pumped out of the ventricle
d. Blood Pressure = cardiac output X systemic vascular resistance
i. Systolic BP – pressure generated by the LV during systole, when the LV
ejects blood into the aorta and the atrial tree, pressure waves in the
arteries creates pulses
ii. Diastolic BP – pressure generated by blood remaining in the atrial tree
during diastole when the ventricles are relaxed
4. Conduction System:
a. Begins at SA node which is the “pacemaker” – then travels down to the AV node
“gate keeper” – then travels through bundle of his and down to purkinje fibers
b. P wave – SA node to atria
c. PR interval – time between onset of atrial depolarization and ventricular
depolarization
, d. QRS – ventricular depolarization
e. ST – entire ventricle is depolarized
f. T wave – return of ventricle to resting potential
5. History
a. Chief complaint – OLDCARTS
b. Onset
c. Duration
d. Quality
i. What does the chest pain feel like? What makes it better or worse?
e. Severity
f. Aggravating/alleviating factors
g. Associated symptoms
h. Past medical/surgical history
i. HX of CAD, PVD, atherosclerosis, peripheral artery disease, obesity,
hyperlipidemia, DM
i. Family hx
i. Death, sudden death, MI, coronary artery disease
j. Social hx
i. Tobacco use, ETOH use, hobbies, sedentary lifestyle, active
ii. Was there a sudden change in ability to do physical activity?
k. Medications
l. Allergies
m. ROS
6. Common Chief Complaints
a. Chest Pain
i. One of the most important symptoms of cardiac disease
ii. Pain could be secondary to cardiac etiology or stem from pulmonary, GI,
or musculoskeletal origins
iii. Patients may have a “chest pain equivalent”
1. Fatigue, weakness, SOB, referred pain
2. Atypical symptoms more common in women and elderly
iv. Cardiac origin should be ruled out in all patients with c/o chest pain
v. OLDCARTS
vi. Differentials:
1. Angina/ACS
a. True symptom of coronary artery disease
b. Caused by hypoxia to the myocardium which leads to
anaerobic metabolism and the production of lactic acid – the
acid irritates the heart muscles and causes pain
c. Imbalance of oxygen delivery and oxygen demand
d. Levine’s Sign (clutching chest)
e. Classically substernal
f. May be relieved by rest and/or medications
g. May have associated s/s (n/v, diaphoresis, SOB)
1. Onset pain after lifting---Straight leg raises for herniated disc
2. Key in hand with eyes closed, assessing for-stereognosis
3. Raise eyebrows, frown, smile and open eyes, assessing –CNS V and VII
4. 52 f with acute rapidly progressive headache, -R/O Subarachnoid hemorrhage
5. Teenage girl admitted with facial trauma secondary to MVA—stroke cornea of each eye with cotton wisp
to check for reflex blinking-what name is this reflex and what CN---Corneal reflex, CN 5 and 7
6. Complaint of breathlessness with activity,---orthopnea
7. 67 f with c/o CP am palpitation, After EKG dx of A-Fib-complications- Peripheral embolization
8. Physical examination of pt with peripheral vascular disease-asses for Size, symmetry and skin color
9. Painful ulcerative lesion near medial malleolus with hyperpigmentation---Venous insufficiency
10. Blood glucose over 360 with extreme thrist, frequent urination and fruity breath---Hyperglycemia
11. State of absolute insulin deficiency, aggravated by hyperglycemia, dehydration and acidosis with positive
ketones---Diabetic ketoacidosis (DKA)
12. Pelvic exam on 23 y/o female, thin, watery frothy, malodorous discharge---Trichomoniasis
13. 27 y.o female, tender warm cystic mass on lower edge of left labia---Bartholin’s gland cyst
14. Right lower quadrant abd pain—examine tender area last
15. 55 y/o male with pain in epigatrum lasting longer than 30 min---All answers are correct
16. Amenorrhea and vaginal spotting, left adnexa tender ---Urine pregnancy test
17. 33 male with 1 week history of fever and pain over left scrotom—Epididymis
18. 26 y/o coach right side pain---acute appendicitis
19. 17 y/o left scrotum, soft movable blood vessels that feel like bag of worms, -- Vericocele
20. 10y/o boy, sudden onset pain -Testicular torsion
21. 72 y/o female sp CABG and POD #3, Tachy at 150, what is the EKG---Atrial Fibrillation
22. 75 y.o male, presents with chest pain, --Cornary Artery disease resulting in STEMI
23. 65 yo female check up, BP in both arms----Subclavin Stenosis
24. Deterioration of frontal lobe of cerebrum,,, it is Boluntary skeletal movement
,25. Turn patients forearm so that palm is up---supination
26. Cause of Acute UTI---E.coli
27. 26 yo DM type 1, caused by pancreatic beta cell destruction predominatly by an autoimmune process
28. Unilateral pain during chewing, ------Tempormanidbular joint syndrome
29. Assessing patient with suspected cholecystitis—Murphy’s sign
30. Cushing’s disease—Glococorticoid excess
31. Back pain associated with constipation and urinary retention---Idopathic low back pain
32. Bronze skin color and darkened gums----Addison’s disease
33. Sudden onset, painful swollen red finger and toe joints----Gout
34. Bluish cervix---Chadwicks sign of cervice and order pregnancy test
35. 44 yo male, right lower extremity edema and discomfort---DVT
36. What type of EKG changes would you expect to find in setting of acute pericarditis---Widespread ST
elevation
37. Auscultation of heart tones, harsh systolic murmur heard best at 2nd intercostal space right midclavicular
line---Aortic stenosis
38. 70 yo male painful left lower extremity---cyanosis of toes---Ischemic foot related to peripherl artery
stenosis
39. Snellen chart evaluating for visual acuity---CN II
40. QRS complex on EKG--- ventricular depolar
41. Pacemaker of heart---SA node
42.
,Week 5 - Cardiovascular and Peripheral Vascular
1. Anatomy and physiology
a. Lies between the lungs in the middle of the mediastinum and enclosed within
the pericardium; behind the body of the sternum, left of the midline, and above the
diaphragm.
b. 4 chambers: left atria, right atria, left ventricle, right ventricle
c. 3 layers of cardiac muscle: epicardium, myocardium, and endocardium
d. Pericardium – fluid filled sac which serves as protective barrier
e. Cardiac Valves
i. Atrioventricular: tricuspid and mitral
ii. Semilunar: pulmonic and aortic
f. Base – superior portion of heart
g. Apex – inferior narrow tip of heart
2. Cardiac Cycle
a. Systole: ventricle contract
i. R ventricle pumps blood into the pulmonary arteries (pulmonic valve is
open); L ventricle pumps blood into the aorta (aortic valve is open)
b. Diastole – ventricle relax
i. Blood flows from R atrium to the R ventricle through the open tricuspid
valve; blood flows from L atrium to the L ventricle through the open
mitral valve
3. Important Concepts:
a. Preload = volume; amount of ventricular stretch at the end of diastole
i. L ventricular end-diastolic pressure, CVP, wedge pressure
b. Afterload = pressure the heart is working against to eject blood during systole
c. Cardiac Output = stroke volume X heart rate
i. Volume of blood being pumped out of the ventricle
d. Blood Pressure = cardiac output X systemic vascular resistance
i. Systolic BP – pressure generated by the LV during systole, when the LV
ejects blood into the aorta and the atrial tree, pressure waves in the
arteries creates pulses
ii. Diastolic BP – pressure generated by blood remaining in the atrial tree
during diastole when the ventricles are relaxed
4. Conduction System:
a. Begins at SA node which is the “pacemaker” – then travels down to the AV node
“gate keeper” – then travels through bundle of his and down to purkinje fibers
b. P wave – SA node to atria
c. PR interval – time between onset of atrial depolarization and ventricular
depolarization
, d. QRS – ventricular depolarization
e. ST – entire ventricle is depolarized
f. T wave – return of ventricle to resting potential
5. History
a. Chief complaint – OLDCARTS
b. Onset
c. Duration
d. Quality
i. What does the chest pain feel like? What makes it better or worse?
e. Severity
f. Aggravating/alleviating factors
g. Associated symptoms
h. Past medical/surgical history
i. HX of CAD, PVD, atherosclerosis, peripheral artery disease, obesity,
hyperlipidemia, DM
i. Family hx
i. Death, sudden death, MI, coronary artery disease
j. Social hx
i. Tobacco use, ETOH use, hobbies, sedentary lifestyle, active
ii. Was there a sudden change in ability to do physical activity?
k. Medications
l. Allergies
m. ROS
6. Common Chief Complaints
a. Chest Pain
i. One of the most important symptoms of cardiac disease
ii. Pain could be secondary to cardiac etiology or stem from pulmonary, GI,
or musculoskeletal origins
iii. Patients may have a “chest pain equivalent”
1. Fatigue, weakness, SOB, referred pain
2. Atypical symptoms more common in women and elderly
iv. Cardiac origin should be ruled out in all patients with c/o chest pain
v. OLDCARTS
vi. Differentials:
1. Angina/ACS
a. True symptom of coronary artery disease
b. Caused by hypoxia to the myocardium which leads to
anaerobic metabolism and the production of lactic acid – the
acid irritates the heart muscles and causes pain
c. Imbalance of oxygen delivery and oxygen demand
d. Levine’s Sign (clutching chest)
e. Classically substernal
f. May be relieved by rest and/or medications
g. May have associated s/s (n/v, diaphoresis, SOB)
