Clin Med Exam 4 Guessing Game

"Often asymptomatic,

Long term target organ signs (LVH, CKD)

Headache if severe"

Primary HTN

"abdominal bruit

signs related to underlying cause:

flank pain

episodic headaches/sweating

hypokalemia "

Secondary HTN

"Severe BP numbers > 180/120 with minimal to no

focal neuro/cardiac/renal signs "

Hypertensive Urgency

"Symptoms/signs of end‑organ damage:

encephalopathy, focal neuro deficits, chest pain/MI,

pulmonary edema, oliguria/AKI, retinal hemorrhages"

Hypertensive emergency

"Usually asymptomatic

may present with signs of lipid deposition or ASCVD

Xanthomas (eruptive, tendinous),

Xanthelasma,

Lipemia retinalis,

NAFLD, Pancreatitis (TG > 1000),

ASCVD signs: carotid stenosis, MI, PAD"

Lipid DIsorders

Pale, diaphoretic, anxious; hypotension or pulmonary rales if LV dysfunction

Severe chest pressure, diaphoresis, nausea, syncope; often at rest; prolonged >20 min

STEMI

May show signs of ischemia or mild heart failure depending on size/location

Chest pain similar to NSTEMI/UA but may be less classic in elderly/diabetics

nSTEMI

Predictable exertional chest pressure; relieved by rest or nitroglycerin; short duration (

Stable angina/ Chronic Coronary Disease

New, worsening, or rest chest pain; more prolonged or recurrent

May be normal; can have diaphoresis, tachycardia, mild distress

Unstable angina

"Brawny Edema

Telangictasias

hyperpigmentation

Stasis Derm

Burning

Swelling (edema)

Throbbing

Cramping

Aching

Heaviness

Restless legs

Leg Fatigue

WORSE: prolonged standing and in heat

BETTER: leg elevation, walking"

Chronic Venous Insufficiency

"In the gaiter area

above the medial malleolus

shallow, irregular borders, granulation tissue

and fibrin

pain varies and is less severe than in arterial ulcers"

Venous Ulcer

"Dilated, tortuous veins of thigh and calf

Asymptomatic → aching discomfort or pain

Hereditary

Pregnancy

Dull, achy heaviness

Feeling of fatigue in legs when standing

Itching

Dilated tortuous veins of thighs and calves"

Varicose Veins

"Unilateral leg swelling, pain, tenderness, warmth,

erythema, dilated superficial collateral veins

Homan's sign -> pain with dorsiflexion

superficial thrombophlebitis

RED FLAGS:

- Phlegmasia cerulea dolens

(massive swelling, cyanosis, pain, and

threatened limb viability). This is the

main indicator for urgent removal

- Dyspnea, pleuritic chest pain,

or syncope suggests PE"

Deep Vein Thrombosis (DVT)

dyspnea on exertion (DOE), fatigue, orthopnea, paroxysmal nocturnal dyspnea (PND), weight gain, edema

S3 gallop (sounds like the cadence for Kentucky), crackles, displaced apical impulse, JVD, peripheral edema (if RV involved), hepatomegaly

Heart Failure with Reduced Ejection Fraction (HFrEF)

typical HF symptoms/signs; congestion may be pulmonary and/or systemic

Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)

DOE (dyspnea on exertion), fatigue, orthopnea, PND; exercise intolerance

S4 gallop (can be sound as the cadence of Tennessine) may be present; pulmonary or systemic congestion depending on ventricular involvement

HF with Preserved Ejection Fracture (HFpEF)

pulmonary congestion → DOE, cough, crackles, PND, frothy sputum

Left Sided HF

systemic venous congestion → JVD, peripheral edema, hepatomegaly, ascites

Right Sided HF

Intermittent claudication (reproducible exertional limb pain relieved by rest); rest pain and ischemic ulcers in advanced/critical limb ischemia; acute severe ischemia → 6 P's (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia)

Diminished/absent distal pulses, cool/cyanotic limb, delayed capillary refill; trophic skin/nail changes; ischemic (necrotic) ulcers on toes/pressure points; abnormal ABI (

Peripheral Artery Disease (PAD)

Sudden collapse

no pulse

unconsciousness

Cardiac Arrest

No measurable BP or pulse

Ventricle Fibrillation

Syncope, palpations, sudden cardiac arrest

Torsades de Pointes

Palpitations, dizziness, syncope, CP

Rapid, regular wide-complex rhythm; may cause hypotension

Ventricular Tachycardia

Often asymptomatic, palpitations, fatigue, dyspnea, dizziness, exercise intolerance

irregularly irregular pulse, variable HR

Atrial Fibrillation

Palpations, fatigue, dyspnea, dizziness, may cause HF symptoms

Often regular tachycardia near 150 bpm with 2:1 AV conduction

Atrial Flutter

Palpations, lightheadedness, fatigue

Rapid atrial rate (150-250 bpm), variable ventricular response

Atrial Tachycardia

sudden palpitations, dyspnea, dizziness, diaphoresis, mild chest pain; syncope uncommon

Rapid regular rhythm, usually between 150-250 bpm

Paroxysmal Supraventricular Tachycardia (PSVT)

usually asymptomatic

regular rhythm with prolonged PR intervals

AV Block - Type I

(First Degree AV Block)

Dizziness, fatigue, syncope

Irregular rhythm with dropped QRS (Mobitz I: grouped beats; Mobitz II: sudden drop)

AV Block - Type II

(Second Degree AV block)

Fatigue, syncope, near sudden death

Bradycardia, cannon A waves, variable pulse

AV Block - Type III (Third Degree (complete) AV Block)

Often asymptomatic; may cause palpitations

Wide split S2;

Right Bundle Branch Block:

Often asymptomatic; may cause exertional dyspnea

Wide QRS, broad/notched R waves in I/V6

Left Bundle Branch Block

Often asymptomatic; may cause dizziness

Wide QRS, slow rate (

Idioventricular Rhythm

Often asymptomatic; may cause fatigue or palpitation

Regular rhythm, narrow QRS, inverted/absent P waves

Junctional Rhythms

Often asymptomatic; may feel skipped beat or palpitations

Irregular rhythm; early beat with compensatory pause

Premature contractions

Fatigue, dizziness, syncope, palpitations

Bradycardia, pauses, alternating tachy-brady episodes

Sick Sinus Syndrome

None; may notice HR variation with breathing

HR increases with inspiration, decreases with expiration

Sinus Arrhythmia