PANCE Word Associations for Medical Diagnoses

CHF

DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis

S3

CHF, dilated cardiomyopathy, Preg

Hypertrophic CM or fatal arrhythmia. Get EKG or ECHO

Young athlete with syncope during athletic event or practice. No physical exam abnormalities

Atrial fibrillation (Holiday heart)

Alcoholic with palpitations, arrhythmia

Atrial fibrillation; (if > 48 or chronic - anticoagulate)

irregular irregular

Warfarin (2 - 3 for Afib; 2.5 - 3.5 for valve); Tx Warfarin OD is vitamin K

Atrial fibrillation or prosthetic valve

Do Exercise stress test

Hx angina but no acute sx. EKG no acute changes.

Angina (if lasts minutes), AMI if lasts > 30 minutes. Acute Ischemia -- ST elevation; Injury -- T wave depression; Infarction -- Q wave

Crushing CP, dyspnea, palpitations, radiation to neck or left arm

Pericarditis

Constant, sharp CP worse lying down, better sitting up and leaning forward

Pericardial effusion/tamponade (Beck's triad)

JVD, Hypotension, muffled heart sounds

Aortic dissection

Sudden onset ripping, tearing chest pain, diminished pulses

AAA

Flank pain, hypotension, pulsatile abdominal mass

Digoxin toxicity (Hypokalemia will make worse)

EKG changes, N, V, yellow-green visual disturbances

ACEI is cause

HTN Tx w/ meds, cough or angioedema

ACE is best choice

DM & HTN

Beta Blockers

Post MI

Think secondary HTN most likely Renal artery stenosis (infrarenal artery)

HTN not responsive to basic meds

Bacterial endocarditis (strep. Viridians) prevention

mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis

Bacterial endocarditis (staph aureus, strep. Viridians) prevention

IVDA w/ new murmur

Aortic stenosis (due to calcifications -- age related (or bicuspid valve -- congenital)

Elderly w/ systolic murmur

Aortic stenosis

Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF

Aortic Regurgitation/Insufficiency: Quincke's pulse (subungual capillary pulsation), Corrigan (rapid rise and fall), Austin flint (low pitch middiastolic murmur at apex)

Lateral displaced PMI, Canon "a" waves, Quincke's pulse, Corrigan's pulse, Austin flint murmur, deMusset's sign, water

Mitral stenosis (ARMS are BAD)

Diastolic murmur best heard at apex without radiation

Mitral valve prolapse

Female or Post MI, systolic murmur best @ apex preceded by click without radiation

Mitral regurgitation

Systolic murmur heard best at apex with radiation to left axilla (apical systolic)

Mitral regurgitation (caused by papillary muscle rupture)

New murmur after MI (esp. if apical systolic)

PDA

Continuous harsh, machine-like murmur

VSD

Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3rd ICS. LVH & RVH

Hs&Ts

Hypovolemia

Hypoxemia

Hypothermia

Hydrogen ion (acidosis)

Hyper- Hypo kalemia

Hypoglycemia

Tamponade cardiac

Tension pneumo

Thrombosis -- PE or cardio

Toxins

Trauma

Pulseless electrical activity

Coarctation of aorta

Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses

Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, arteriogram gold standard)

Tx is arterial bypass

LE rubor, no hair, brittle nails, pallor on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM

Claudication with rest pain, (ABI < 0.4)

Varicose veins. Tx with compression stockings

LE pain after long periods of standing. Dilated, tortuous, veins

AS

Murmur that causes weak carotid pulse

Liver toxicity

Side effect of statin drugs

Cocaine

Illegal substance that causes MI secondary to acute coronary artery vasospasm

Janeway lesions

Infective endocarditis; Scaly plaques on palms and soles

Osler nodes

Infective endocarditis; Tender nodules on tips of fingers and toes

Pre-load

Volume of blood in ventricles at the end of diastole

Ejection fraction

Amount of blood being pumped out of the L ventricle during contraction

Tearing, ripping pain between scapula

Aortic dissection

CXR with aortic dissection

Widened mediastinum

BP higher in arms than the legs

Coarctation of the aorta

EKG - Rate assessment

300-150-100-75-60-50

PR interval greater than 0.2 sec consistently in every cycle

First degree AV block

PR interval gradually lengthens in successive cycles, last P wave fails to conduct ventricles

Wenchebach;

Second degree AV block

Complete third degree AV block

AV block in which there is a total block of conduction to the ventricles so no atrial depolarizations are conducted to ventricles

Types of second degree AV blocks

Mobitz and Wenchebach

Asystole

Confirm in a second lead

Kussmaul breathing -- DKA, Metabolic acidosis

Rapid, deep labored breathing

Cheyne-Stokes breathing -- heart failure, brain damage

Deep breathing alternating w/ apnea

Crackles or rales

Pneumonia, heart failure, etc...

TB

Apical infiltrates, F, C, dry cough

Silicosis (Sandblasters)

Eggshell pattern on CXR

Asbestosis -- shipbuilders, building demolition

Ground glass appearance on CXR

DVT/PE

Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also

DVT/PE (Virchow's triad)

Venous stasis, vessel wall injury, hypercoagulability

Pediatric with barking cough, stridor

viral croup (Laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.

Epiglottitis

Drooling, sniffing position, tripod, toxic

Inspiratory stridor

FB, viral croup (laryngotracheobronchitis)

Bronchitis (COPD)

Smoker, chronic productive cough. NO hemoptysis, wt. loss.

COPD

Smoker, DOE, cough

Emphysema

Hyperinflation on CXR, tear drop heart

Asthma

Airway edema with eosinophils, neutrophils, lymphocytes

Pneumonia

Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR - infiltrates or consolidation

Strep. Pneumonia

>35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C

Mycoplasma pneumonia

<35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches

Klebsiella

PNA w/ DM, immunocompromised, EtOH. Currant color sputum.

Legionella

PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking

Cystic fibrosis (Staph & Pseudomonal infections usually cause of death)

Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT

Sweat chloride test

Cystic fibrosis

< 2 days post-op with fever

Atelectasis

Pneumothorax

Stab wound, hyperresonance to percussion, decreased breath sounds, tympany

Hemothorax

Stab wound, dullness to percussion, decreased breath sounds.

Spontaneous PTX

Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea

Tension PTX

Stab wound to chest. Hypotension, tracheal shift

Obstructive sleep apnea

Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening

Flail chest (pain control, incentive spirometry, pulmonary toilet, intubation)

s/p thoracic trauma. Multiple rib fractures. Chest wall moves in with inspiration, out with expiration.

Horner's syndrome

Ptosis, miosis, anhidrosis

Pancoast tumor -- apex of lung

EKG S1Q3T3

Pulmonary emboli

FEV1 less than 80%

Suggests obstructive lung disease

Types of pleural effusions

Exudative verses transudative

Exudative pleural effusion

Neoplastic, infection

Transudative pleural effusion

CHF, cirrhosis

Funnel chest

Pectus excavatum

Left Tension Pneumothorax

Hypotension, JVD, tracheal shift to the Right

TB

Fever, night sweats, wt loss with cough, pleuritic chest pain, hemoptysis

Fat emboli

Emboli seen following long bone fracture

Cholelithiasis or Cholecystitis

Fat, forty, female, fertile w/ RUQ pain

Cholecystitis

Fever, RUQ pain, radiation to back

GERD

Chronic cough, bitter taste in mouth or throat, dyspepsia

Acute pancreatitis

N/V, epigastric abdominal pain, radiates to the back, worse supine, caused by alcohol ingestion, or following fatty meals

Acute pancreatitis (Cullen & Grey Turner's Sign)

Peri-umbilical or flank ecchymosis

Urologic emergencies

Testicular torsion and paraphimosis

SBO

Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles

SBO

Air fluid levels on upright abd plain film

Perforated viscus, perforated ulcer

Air under diaphragm, rigid board-like abdomen

Diverticulitis. IV Abx, fluids, NPO

>60yo F, LLQ pain

Crohn's disease

Transmural granulomatous disease, affecting any part of GI tract - mouth to anus

Mesenteric ischemia

Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial

Pyloric stenosis

Neonate w/ projectile vomiting. Olive sized mass.