shoutouts-2

8/6/2019 Shoutouts-2

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Cardiovascular Shoutouts

Heart Murmurs:

When she says… You say…S3 (early diastolic ventricular gallop) CHF

S4 (late diastolic atrial gallop) Left ventricular hypertropy Opening snap (OS) Mitral stenosis

Pansystolic murmur (holosystolic) Tricuspid/mitral regurgitation, VSDSystolic click (mid/late) Mitral valve prolapse

Palpitations Mitral valve prolapseEjection type systolic murmur Aortic/pulmonary stenosis

Continuous, machine-like murmur Patent ductus arteriosus (PDA)Tertiary syphilis, Marfan's syn Aortic regurgitationCongenital aortic bicuspid Aortic stenosisBounding pulses Aortic regurgitationSlow upstart, 1-2+ (weak) pulse Aortic stenosis Anemia (low Hct) Turbulent blood flow = MURMUR

Congenital Heart:

When she says… You say…

Rubella PDA Down's ASD/VSDTurner's Coarctation of the aorta (rib notching)Marfan's Aortic dissection, aortic regurg, mitral

valve prolapseTertiary syphilis Aortic regurgBoot-shaped heart Tetralogy of fallot (RV hypertrophy)

EKG Changes:

When she says… You say…Peaked T wave HyperkalemiaU wave Hypokalemia

Persistent ↑ ST (diffuse elevations) Pericarditis

Saw tooth EKG Atrial flutter↑ QT Hypocalcemia

↓ QT Hypercalcemia

Q wave, ST elevation Transmural MIQuinidine toxicity ↑ QRSThallium—cold spots Myocardial ischemia

Technechium—hot spots (bound topyrophosphate)

Myocardial infarct

TALL QRS Left ventricular hypertrophy (+S4)



Heart sounds:


Pulsus paradoxus (large ↓ in systolic P when breathe)

Cardiac tamponade (& asthmahyperinflation)

Irregularly irregular pulse Atrial fibrillationRegularly irregular pulse Second degree AV block (Mobitz type I or

II)Syncope, angina, CHF Aortic stenosisFixed splitting ASDParadoxical splitting Left bundle branch block, aortic stenosis Wide splitting Right bundle branch block, pulmonic

stenosisJump of heart PVBMultiple jumps of heart A. Fib

Other:

When she says… You say…Coksackie, echovirus Dilated cardiomyopathy Young male athlete drops dead Hypertrophic cardiomyopathy Kussmaul's sign (JVD when youinspire)

Constrictive pericarditis

Hyperkalemia Metabolic acidosisHypokalemia Metabolic alkalosisFrothy white sputum Pulmonary edemaKerley B lines Pulmonary edemaStraightening of left heart border Dilation of left atrium

Barlow's syndrome Mitral valve prolapse



Renal Shoutouts

When she says… You say…Foamy ProteinuriaPeaked T wave, sine wave HyperkalemiaU wave, flat T wave, ST depression HypokalemiaShortened QT interval (ST segment)

HypercalcemiaProlonged QT (ST segment)

Hypocalcemia, hyperphosphotemiaPR & QT prolongation HypomagnesiumFever & flank pain Pyelonephritis (until proven otherwise) WBC casts PyelonephritisSuprapubic pain, blood in urine, NOFEVER

Cystitis

RBC casts Glomerular nephritis

No casts, No fever CystitisEosoniphiluria Acute interstitial nephritis ANCA Wegener's (RPGN) – nephritic + chronic

sinusitisDrug induced nephritis EsosinophilsGreen urine PseudomonasSubepithelial deposits NephroticSubendothelial deposits Nephritic

Hypertension NephriticMicroalbumenia Diabetic Neuropathy

Orange urine Rifampin+ nitrites and leukocyte esterase on UA

Urine = bad odor

Bacterial infection

Medulla of nephron Hyperosm urine increase sickling of RBC in sickle cell patients

MCC of UTI 1. E. coli

2. Staph saprophyticus/albusBUN/Cr > 20 Prerenal renal failure OR dehydration

(could also be due to high protein diet orGI bleed b/c these increase BUN)

Proteus mirabilis infection (has urease) VERY alkaline urine (e.g. pH = 9)MCC of chronic renal failure 1. DMmicroalbuminemia

2. chronic glomerular ds 3. HTN

4. polycystic kidney



Pulmonary Shoutouts

When she says… You say…Legionella pneumonia Cough, chest pain, etc PLUS GI

symptoms (diarrhea)Rigors (one episode) – severe shakingand chills

Strep pneumonia

Rusty (e.g. old lysed blood =hemoglocbin) color (sputum)

Strep pneumonia (but strep not alwaysrusty)

Blood streaked/bloodtinged/hemoptysis (sputum) with weight loss

TB (or cancer) pott's ds(osteomyelitis), meninges, and scrofula(cervical lymph nodes)

Green (bluish-green) sputum Pseudomonas

White frothy (increased protein) Pulmonary edemaPink frothy Pulmonary edema with hemorrhaging (if

immunocomp: think pneumocystis

carinii)Red currant jelly sputum KlebsiellaFoul smelling sputum Anaerobes

No sputum Viral, atypical bacteria, pneumocystitis(in normal individual – notimmunocomp)

FEV1/FVC decreases, can't get air out,increased resistance to air flow,increased compliance, decreasedelasticity

COPDminimize work by breathingslow and deep

FEV1/FVC increases (or normal), can't

get air in, increased elasticity/elasticresistance

RLDminimize work by breathing

rapid and shallow

Red/orange urine, tears, etc Rifampin (also causes thrombocytopenia)Hemoptysis + Hematuria Goodpasteur'sSilver stain with Owl's eye Pneumocystis Wedge shaped infarct/density on CXR Pulm embolism (with sudden onset of

dyspnea)Nasal polyps (small wet grapes insidenose), Aspirin allergy, asthma(bronchospasms),

Common Clinical Triad

(polyps may block sinuses from draining

giving sinus headaches)

Sinus tachycardia on EKG Pulmonary embolism (decrease perfusion increase V/Q ratio)

No perfusion Alveolar dead space (V/Q ratio

approaches infinity): PE, vascular dshyperventilation

No ventilation Shunt (ex: atelectasis, pneumonia,

fibrosis, ARDS, pulmonary edema)hyperventilation

Sudden onset of dyspnea, pleuriticchest pain, and hemoptysis

PE feeling of impending doom,

tachypnea, tachycardia Tx: heparin




Tissue hypoxia without hypoxemia CO, anemia, shock, R L shunt

(all lung ds = hypoxemia, thus alsohypoxia)

Resp Alkalosis (pt will hypervent) TB, early asthma, most restrictive lungds, pneumonia, pregnancy

Resp Acidosis (pt with breathe slower) COPD, late asthma, neurogenic restrictivelung ds, chest wall deformities

Chest Xrays

When she says… You say…Bilateral diffuse interstitial infiltrate

(ground glass haziness)

Viral

PCP

Mycoplasma

Sarcoidosis (hilar)Thick walled, round cavity (usu upperlung) OR tiny, scattered densities(miliary dissemination)

TB – fever, night sweats, chills

Cavity with air-fluid level (usu rightmiddle lobe) Anaerobes/lung abscess

foul sputum

Microabscesses Staph aureusMultiple, bilateral marble-sizeddensities

Septic PE (right sided endocarditis, s.aureus)

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