Family Medicine EOR Complete Review

Atrial flutter

1. Rapid, regular atrial depolarization 300 beats/min

2. INC risk of atrial thrombus -> stroke

3. RF: CAD or HTN

4. Sx: palpitations, dizziness, fatigue, exercise intolerance, mild dyspnea

5. Unstable: altered mental status, chest pain, hypotnesion

6. Dx: EKG sawtooth waves 300 beats/min w/ no P waves and transthoracic echo 

7. Tx: stable = non-di CCB (diltiazem or verapamil) or BB. unstable = direct synch cardioversion with catheter ablation

Atrial fibrillation

1. Multiple irritable atrial foci fire at fast rate, assoc with thrombus formation

2. RF: HTN, DM, alcohol use disorder, abnormal kidney function, stroke

3. Sx: palpitation, dyspnea, prensynccope. If unstable = hypotension, AMS, chest pain

4. EKG: irregularly irregular rhythm with no discrete p waves

5. Stable tx: non di CCB (better for pulm or cocaine-induced MI), BB (better for HF and MI)

6. Unstable tx: TEE to confirm no clots -> direct synch cardioversion

7. If <48 hrs: anticoag for 3 weeks before and 4 weeks after cardioversion

CHADVASC score

1. Congestive heart failure

2. HTN

3. Age >75

4. DM

5. Stroke

6. Vascular disease

7. Age 65-74

8. Sex (female)

   1. Max is 9. If >/2 = moderate-high risk -> oral anticoag (DOAC)

      1. DOAC: direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban)

Paroxysmal Supraventricular Tachycardia (PSVT)

1. Reentry is most common cause of narrow QRS complex tachycardia

2. AVNRT: two pathways located in AV node

3. Narrow QRS complex: rapid activation of ventricles through normal his-perkinje system

4. Widened QRS: below his bundle

5. EKG: orthodromic (most common) - narrow tachycardia -> vagal maneuvers -> IV adenosine

6. Antidromic: wide -> antiarrhtyhmics (class I or III), IV procainamide if WPW

7. Unstable: synch cardioversoin

8. Definitive tx: catheter ablation

Wolff-parkinson-White (WPW) syndrome

1. anterograde conduction through fast pathway outside of V nodule (bundle of kent) bypassing the slower AV node

2. Dx: delta wave, short PR interval, wide QRS

3. Tx: wide qrs or a-fib = procainamide

4. Avoid AV nodal blocking agents (ABCD = adenosine, BB, CCB, digoxin) if wide and afib

5. Narrow qrs: vagal maneuvers -> adenosine

6. Unstable: synchronized cardioversion

7. Long term: catheter ablation

Wandering Atrial Pacemaker (WAP)

Atrial rate <100 BPM and >/ 3 wave morphologies

1. RF for both: pulmonary and CV disease

2. Tx: non-di CCB (diltiazem and verapamil)

   1. Avoid BB if pulm disease

Multifocal atrial tachycardia (MAT)

1. Atrial rate >100 BPM and >/ 3 wave morphologies

2. Assoc with COPD

   1. RF for both: pulmonary and CV disease

   2. Tx: non-di CCB (diltiazem and verapamil)

      1. Avoid BB if pulm disease

Supraventricular Premature Beats

1. Premature activation of atria

2. EKG: p waves earlier than anticipated and has different morphology

3. Tx: no sx = no tx. Symptoms = minimize triggers, education, and reassurance

AV junctional dysrhythmias

P waves absent or inverted, narrow QRS, 40-60 BPM

Premature ventricular complexes (PVC)

1. Wide, bizarre QRS occurs early, t wave in opposite direction of QRS. compensatory pause

2. Tx: low risk for heart disease = no tx

3. Asym PVC = observation and reassurance

4. Sx tx: BB, catheter ablation, class I antiarrhythmics

Ventricular Tachycardia

1. >/3 consecutive PVCs (wide complex) rate >100 BPM, prolonged QT interval, hypomagnesemia 

2. Most common cause: ischemic heart disease

3. Unstable sx: hypotension, AMS, chest pain, pulm edema

4. EKG: regular wide complex tachycardia (icicles)

5. Stable tx: antiarrhtymics (class I or III) IV amiodarine or procainamide

6. Unstable tx: synchronized cardioversion

7. Pulseless VT: unsynchronized cardioversion (debrillation) + CPR

8. Chronic therapy: BB

Torsades de Pointes

1. QT prolongation, R to T phenomenon, twisting and oscillations

2. Sx: palpitations, dizziness, syncope

3. Stable tx: IV magnesium sulfate, #2 is isoproternol or overdrive pacing

4. Congenital QT syndrome: BB. avoid isoproterenol in congenital long QT syndrome

5. Unstable: synchronized cardioversion

6. Pulseless: defibrillation (unsynch) cardioversion and CPR

Ventricular Fibrillation

1. Ischemic heart disease most common - pt collapse and turns unconscious

2. EKG: disorganized high frequency erratic pattern

3. Tx: unsynch cardioversion (defib) + CPR

4. If shockable, defib at 120-200 J

5. Admin epi and amiodarone

6. Future: ICD

Pulseless electrical activity (PEA) and asystole

1. Cause: 6 H’s - hypovolemia, hypoxia, hydrogen ions, hyper/hypokalemia, hypothermia and 6 T’s - toxins, tamponade, tension PTX, thrombosis, tachycardia, trauma

   1. Narrow: mechanical issue

      1. Tamponae = pericardiocenteisis

      2. Tension PTX = needle compression and thoracotomy

      3. PE: thrombolysis

      4. Hypovolemia: blood and fluid

   2. Wide: metabolic problem

      1. Hyperkalemia: IV calcium gluconate

      2. Sodium CB overdose: IV sodium bicarb

2. Tx: CPR + IV epi

Burgada Syndrome

1. Congenital syndrome with issues from sodium channels

   1. RBBB pattern, ST elevation V1-V3, t wave inverted in V1 and V2, S waves in lateral leads

2. Tx: ICD

Class I - sodium channel blockers

1. Double Quarter Pounder Lettuce Tomato Fries Please

   1. IA: procainamide, quinidine, disopyramide

      1. Goal: prolong repolerization and action potential

      2. Procainamide and quinidine = lupus-like syndrome

   2. IB: lidocaine, tocainamide

      1. Goal: shortens repolarization, good for post MI

   3. IC: flecainide, propafenone, encainide

      1. CI if abnormal heart structure

Class II - BB

1. Cardioselective: atenolol, metoprolol, esmolol

2. MOA: decrease SA and AV node conduction - controls A flutter and A fib

3. SE: bradycardia, AV blocks, masks hypoglycemia - careful w/ DM

4. Non-selective -> bronchospasm if COPD/asthma

   1. MOA: reduce excessive sympathetic stimulation and mortality

   2. SE: decompensated HF, bradycardia, hypotension, 2nd/3rd heart block

Class III - K+ channel blockers - AIDS

1. Amiodarone, sotalol, ibutilide, dofetilide

   1. Amiodarone: class III but also has class I-IV

   2. SE: pulmonary fibrosis, thyroid disorder, hepatotoxicity

2. Usage: atrial AND ventricular arrhythmia

Class IV - Ca2+ channel blockers

Verapamil and diltiazem

MOA: slows SA node and AV node conduction

SE: peripheral edema

SE of verapamil

antimuscarinic -> constipation

Digoxin -> a-fib or HF

1. Positive inotrope, used for systolic HF and a-fib

2. Causes downsloping of ST segment

3. Digitalis toxicity -> hyperkalemia, GI sx, yellow-green visual changes, bradycardia

antiarrhymics I and III are for ? control, whereas II and IV are for ? control

rhythm

rate

Adenosine

Usage: PSVT and pharm cardiac stress

SE: chest pain, lightheadedness, bronchospasm

Watch for hypotension and AV blocks

Amiodarone

Class III antiarrhythmic with I-IV properties

Usage: stable wide-complex tachy

SE: hypotension, corneal disposition, thyroid disorder, pulm fibrosis, inc LFTs

Must monitor chest radiographs annually, PFTs, TFTs, LFTs

Beta blocker toxicity

1. Most common with high lipid solubility (propranolol)

2. PE: hypotension, bradycardia, heart block, bronchospasm, AMS

3. Dx: hypoglycemia, EKG

4. Tx: support, IV fluid, atropine, dextrose, IV glucagon to INC camp

CCB poisoning

Less likely to cause AMS

Hyperglycemia

Cholinergic drug poisoning

1. Insecticides (organophosphates), meds

2. Increase SLUDD: salivation, sweating, lacrimation, urination, digestion ,defecation, constriction of pupil

3. Others: muscle weakness, paralysis

Lipid Disorders

• Statin therapy if DM I and II 40-75 yo

• Very high risk pt (high LDL): high dose statin

• High risk (pts without cardiovascular disease, high LDL): moderate intensity statin

• Intermediate risk (pre-DM, LDL 100-190): statin therapy

• Low risk: statin not needed

Statins

• High potency: Rosuvastatin -> atorvastatin (best with rhabdo)

• Moderate: pitavastatin, simvastatin

• Low: fluvastatin

• MOA: prevents synthesis of mevalonate (cholesterol precursor), dec LDL, and protect CV

• SE: myopathy, rhabdo, hepatotoxicity (-> reduce dose), renal impairment, hyperglycemia

• CI: pregnancy

Ezetimibe

MOA: inhibits intestinal cholesterol absorption - w/ statin to reduce LDL

SE: INC liver transaminase levels

Bile Acid Sequestrants - Cholestryamine, Colestipol, Colesvelam

1. MOA: binds bile acids in intestine and kicks them out -> body INC LDL receptors so LDL levels drop

2. Safe in pregnancy

3. Reduces pruritus in pts with cholestasis

4. SE: GI, prolonged PT/INR, INC triglyceride

Nicotinic Acid

1. INC HDL, DEC hepatic production of LDL

2. SE: INC prostaglandins (-> flushing, paresthesia, HA), GI sx

PCSK9 inhibitors (Alirocumab and Evolocumab)

DEC LDL and cardiovascular risk, most effective agent at reducing LDL

Fibrates (Gemfibrozil, Fenofibrate) SE

SE: lithogenicity of bile (gallstones), myopathy

Salicylate (acetylsalicylic acid, ASA)

1. Non-selectively and irreversibly inhibits COX 1 and 2 -> reducing prostaglandins

2. SE: GI SE, renal effects, asthma, reye syndrome, INC bleeding

3. CI: renal injury

4. Watch for respiratory alkalosis, ototoxicity, overdose

5. Tx: supportive care and IV hydration for ASA toxicity, avoid intubation

6. IV sodium bicarb to increase salicylate excretion

Ranolazine

1. MOA: late sodium channel blocker, reduces oxygen requirement but no change in HR/BP

2. Usage: add-on for chronic angina episodes

3. CI: QT prolongation

ARNI

1. Usage: superior for ACEI inhibitors, good for HFrEF

2. SE: higher rates of hypotension and angioedema

Mineralocorticoid receptor antagonist (MRA) - eplerenone and spironolactone

1. Usage: reduced and preserved HF

2. SE: hyperkalemia, blocks testosterone and progesterone (gynecomastia), eplerenone has low endocrine risk

ACEI

1. Most effective singular med in HFrEF

2. SE: hyperkalemia, cough, angioedema

3. CI: pregnancy

Loop diuretics + SE

1. Most effective for mild-moderate CHF

2. SE: hyperglycemia and hyperuricemia

HCTZ SE

SE: INC “GLUC” = glucose, lipids, uric acid, calcium

SGLT2 (Dapagliflozin or empagliflozin)

1. MOA: inhibits resorption of sodium, dec mortality and DM CKD

2. SE: hypotension, UTI/yeast infx, GI

3. CI: DM, hypotension, URI, watch for foot ulceration

Chronic Stable Angina Pectoris

• Chest discomfort, myocardial ischemia, exertional, <30 mins, relieved with rest and nitro

• RF: DM

• Dx: EKG ST depression, stress testing. Definitive = coronary angiography

• Tx: BB, sublingual short acting nitro, ASA, statin

• Definitive: revascularization (angioplasty or bypass grafting)

BB MOA

 INC myocardial blood supply and DEC oxygen demand, CI if vasospastic angina (nitro has same MOA)

nitro SE and CI

SE: vasodilation and tolerance

CI: hypotension, PDE-5, right ventricular infarction

ASA SE

INC risk of bleeding, renal injury, GI upset-if can’t take ASA -> clopidogrel,

gold standard dx for CAD

Coronary Angiography

Acute Coronary Syndrome

1. Most common cause of MI: atherosclerosis

   1. Other: coronary artery vasospasm from cocaine or variant angina

2. Chest pain NOT relieved w/ rest or nitro, >30 mins

3. PE: inferior wall MI = S4 gallop. Right ventricular infarction = INC JVP + clear lungs + positive kussmaul sign

4. Dx and tx: get EKG, ASA, nitro, oxygen, morphine

   1. UA/NSTEMI: ASA, nitro, anticoag (unfrac heparin), BB, dual antiplt (ASA + clopidogrel), NO fibrinolytics

      1. Plaque rupture, change in angina pattern, negative CK and troponin in UA whereas NSTEMI has troponin INC

   2. STEMI: ASA, nitro, anticoag, BB, dual antiplt therapy, reperfusion (PCI or CABG). Long term = ACEI

   3. Inferior/posterior STEMI: ASA, fluids, anticoag, dual antiplt therapy, reperfusion. No nitro, morphine, CCB

   4. Cocaine-related: benzodiazeipines, NO BB

anterior leads vs. arteries

1. Anterior: V1-V4 ST elevation, LAD or V1 and V2 elevation, proximal LAD

2. Lateral: I, aVL, V5-6: circumflex

3. Anterolateral: I, aVL, V4-v6: mid LAD, CFX, or L main

4. Inferior wall: II, III, avF - RCA

5. Posterior wall: St depression V1 and V2 - RCA or CFX

LHF

1. Most common cause: Coronary artery disease, HTN, valvular disease

2. Sx: pulmonary sx, dyspnea (most common), cough (rales)

RHF

1. LHF most common cause, pulmonary disease

2. Sx: systemic sx, peripheral edema, JVD, GI/hepatic congestion

HFrEF

1. Thin walls, big LV chamber

2. Tx: reduce sodium and fluids - ACEI, BB, MRA (spironolactone), SGLT2 (dapagliflozin or empagliflozin). #2 = isosorbide dinitrate plus hydralazine and ivabradine. ICD

3. Avoid thiazolidinediones, CCB, and NSAIDs

4. Chronic: angiotensin blocker, BB (if stable HF), MRA, SGLT2 inhibitors

5. Acute: IV loops, IV vasodilators, natriuretic peptide

HFpEF

1. diastolic dysfunction - HTN, S4 gallop 

   1. normal/INC EF, thick walls, small LV chamber

   2. Tx: SGLT2, MRA, tx of underlying condition, diuretics

heart failure PE and DOC

1. PE: crackles, cheyne-stokes breathing, lower edema

2. DOC: echo

Congestive Herat Failure (ADHF)

1. L: dyspnea, L for L side and Lungs

2. Right: R for R sided and 3 roads to heart (IVC, SVC, portal vessels)

3. PE: crackles, edema, S3

4. Dx: chest radiograph, kerley b lines, cardiomegaly, butterfly appearance, cephalization of flow. High BNP

5. Tx: loop diuretic, oxygen, nitrates

Dilated Cardiomyopathy

1. Systolic dysfunction and dilation of ventricles, most common

2. Idiopathic, infx (most common cause), PP, toxic, thiamine def, anthracylines

3. L: dyspnea on exertion 

4. R: peripheral edema, JVD

5. PE: S3 gallop, lateral displacement of PMI, positive fluid test,

6. Dx: echo and chest radiograph

7. Tx: angiotensin blocker, BB, MRA, diuretics

8. Avoid NSAID, CCB, and alcohol

Myocarditis

1. Cause: idiopathic, viral (enteroviruses), clozapine, doxorubicin. Most common in young previously health adults

2. Sx: viral sickness, worsening HF, chest pain, pericarditis, life threatening, megacolon

3. Dx: EKG (sinus tachycardia), positive troponin

4. Definitive dx: endomyocardial biopsy

5. Tx: supportive, if heart failure -> angiotensin blocker, BB, and diuretics

6. No NSAID, heart heavy meds, alcohol, digoxin, exercise

Restrictive Cardiomyopathy

1. Diastolic Dysfunction

2. Cause: infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis)

3. PE: kussmauls sign (INC JVD with inspiration)

4. Dx: echo = diastolic dysfx, biatrial enlargement, criterion standard

Hypertrophic cardiomyopathy

1. Diastolic dysfunction, harsh systolic murmur, decrease in murmur intensity when INC venous return (ie squatting), INC murmur intensity (ie valsava, standing)

2. S4 gallop, pulses bisferiens (biphasic pulse)

3. Echo: diastolic dysfunction, asymmetric wall thickness

4. Tx: BB

BP ranges

1. Normal: <120/<80

2. Elevated: 120-129/<80: lifestyle

3. Stage I: 130-139/80-89: 1 med

4. Stage 2: 140+/90+: 2 drugs

drugs for HTN

1. Thiazides

2. ACEI

3. CCB

4. Angiotensin II receptor blockers

drugs for comorbid disease with HTN

1. Angina = BB or CCB

2. Post MI: ACEI or BB

3. HFrEF: ACEI, ARB, BB

4. DM: ACEI, ARB

5. BPH: A1 blocker

6. Blacks: thiazides, CCB

7. Gout: CCB 

8. Atrial fib/flutter: BB, CCB

Hypertensive Urgency

1. >180/>120 with no end organ damage

2. Tx: no sx = no tx, gradual reduction of MAP with oral meds (clonidine or captopril)

Hypertensive emergency

1. >180/>120 with end organ damage

2. Tx: IV BP meds 

   1. HTN encephalopathy, stroke: nicardipine or labetolol

   2. Aortic dissection = BB

   3. ACS: nitro, BB

   4. AHF: nitro, furosemide

Orthostatic Hypotension

1. Hypotension of >/20 fall in systolic or >/10 in diastolic when standing

2. Dx: blood pressure measurement, tilt table test

3. Tx: INC salt and fluid volume,

   1. Add-on if fail: fludocortisone and midodrine

harsh/rumble murmur is

stenosis

blowing murmurs are

regurgitation

the only one where INC venous return does NOT inc intensity and vice versa is _ and ?

HOCM and MVP

Aortic stenosis

1. Cause: degenerative, congenital, biscupid valve

2. Sx: exertional dyspnea*

3. Harsh, low pitched mid late systolic crescendo decrecendo murmur R upper border, radiates to carotids

4. TOC: aortic valve replacement

aortic regurg

1. Chronic: non-emergent. Acute: emergent (cause: endocarditis and aortic dissection)

2. High pitched blowing decrescendo diastolic murmur heard left sternal borer at erb’s point

3. Tx: afterload reduction, emergency aortic valve repair

Mitral stenosis

1. Cause: rheumatic heart disease

2. PE: dyspnea (most common), a-fib, opening snap, low-pitched rumbling diastolic murmur, heard at mitral area/apex

3. Dx: echo and EKG

4. Tx: balloon valvuloplasty

Mitral regurg

1. Cause: MVP

2. PE: a-fib, high-pitched blowing holosystolic murmur at apex, radiates to axilla

3. Tx: tx HTN and surgery

Mitral valve prolapse (MVP)

1. Most common in young women

2. Cause: degeneration of mitral valve leaflets, asymptomatic

3. Midsystolic click at apex (earlier = valsava, later = squatting, supine)

4. Tx: no sx = reassurance. Sx = BB

Pulmonary Regurg

1. Cause: congenital

2. PE: graham steel murmur: brief high pitched decrescendo early diastolic blowing murmur at left sternal border

Tricuspid stenosis

1. Inc in intensity with inspiration

2. Opening snap

Tricuspid regurgitation

1. High pitched holosystolic soft blowing murmur

2. Carvallo’s sign: INC murmur intensity with inspiration

Pericarditis

1. Cause: idiopathic*, viral (coxsackie and echovirus), dressler syndrome (post MI pericarditis + pleural effusion)

2. Sx: chest pain, pericardial friction rub, better leaning forward, worse with inspiration, distant heart sounds

3. EKG: precordial leads have diffuse, lead aVR = ST depression nad PR elevation

4. Tx: high dose NSAID and ASA w/ colchicine. Refractory = glucocorticoids

5. Dressler syndrome tx: ASA and colchicine. Avoid NSAID

Pericardial Effusion

• Muffled heart sounds

• TOC: echo (inc fluid in pericardial space)

Cardiac Tamponade

• Beck’s triad: muffled heart sounds, distended neck veins, decreased BP

• Dx: EKG, radiograph, echo (diastolic collapse of cardiac chambers)

• Tx: pericardiocentesis, tx underlying cause

Constrictive Pericarditis

• Thickening, fibrosis, and calcification -> RHF and pericardial knock

• Echo: “square root sign” - CT/MRI = pericardial thickening

Aortic Dissection

1. RF: HTN

2. Most common site of intimal tear is first few cm of ascneding aorta

3. Sx: chest or back pain that is sharp or tearing

4. PE: unequal blood pressure, aortic regurgitation

5. Dx: EKG, chest radiograph (widened mediastinum), CT angiography (if stable), if unstable = TEE

6. Tx: surgery. IV BB only if acute descending dissection w/ no complications

Peripheral artery disease

1. Claudication = most common sx

2. Sx: lower extremity pain, relieved with rest, DEC weak absent pulses, skin shiny with hair loss, non-healing wound ulcer (lateral malleolus), dependent rubot

3. Dx: Ankle-brachial index <0.90

4. Tx: supportive = risk reduction, platelet inhibitors, statins, cilostazol most helpful w/ claudication

Acute Limb Ischemia

1. Decrease in limb perfusion - 6 P: pain, pallor, pulselessness, poikothermia, paralysis. Absent pulse, cool temp

2. Dx: bedside arterial doppler, duplex imaging, angiography

3. Tx: supportive. If threatened, IV heparin, revascularization

Abdominal Aortic Aneurysm (AAA)

1.  RF: smoking*, atherosclerosis, age >60

2. Sx: asymptomatic, back pain, bruit, palpable mass, hypotension

3. Dx: CT With IV contrast (stable), if unstable = focused bedside ultrasound

4. Tx: immediate surgical repair

Atrial Septal Defect

1. Hole in atrial septum*

2. Sx: ostium secundum MC, asymptomatic

3. PE: systolic ejection crescendo-decrescendo flow murmur @ pulmonic area, widely split S2 (does not vary)

4. Dx: CXR = cardiomegaly, crochetage sign, incomplete RBB, echo = GS

Patent Ductus Arteriosus

1. Eisenmenger syndrome: left to right shunt switches -> R to L (cyanotic)

2. Continuous machinery murmur, wide pulse pressure (bounding peripheral pulse)

3. CXR, EKG = LVH, echo = GS

4. Tx: IV indomethacin

Coarctation of Aota

1. Many have biscupid aortic valve*

2. Sx: secondary HTN, bilateral claudication, systolic murmur that radiates to back/chest, higher BP inUE, delayed femoral pulses

3. Dx: rib notching on echo, GS = angiogram

4. Tx: balloon angioplasty, prostagalandin, surgery

Tetralogy of Fallot

1. R to L (cyanotic)

2. Etiology: RV outflow obstruction, RV hypertrophy, VSD, overriding aorta

3. Tet-spells (older children relieve spells by squatting)

4. Harsh holosystolic murmur in left upper border (pulmonary stenosis)

5. “Boot shaped heart” and RVH (Big heart)

Transportation of great arteries (2 vessels switched)

1. Dextro-TGA most common

2. Severe cyanosis and tachypnea within first 30 days of life (neonatal), single S2

3. Echo: diagnosis, “egg on a string” appearance, cardiomegaly

4. Tx: oxygenation (prostaglandin) and corrective surgery

Tetralog of fallot

1. Right ventriuclar outflow obstruction

2. Right ventricular hypertrophy

3. Overriding aorta

4. Ventricular septal defect

Ventral Septal Defect

1. Most common type of congenital heart disease in childhood

2. Membranous: most common type, hole in the LV outflow tract

3. High pitched harsh holosystolic murmur, handgrip maneuver inc intensity of VSD murmur

4. Echo: preferred over catheterization

5. Tx: observation, if sx then patch closure

Deep Vein Thrombosis

1. Virchow’s triad: venous stasis, vascular epithelial damage, hypercoagulability

2. Homan’s sign

3. Cause: surgery, genetics

locations of AV node, bundle of his, purkinje fibers, etc

1. Bundle of his is located @ inferior interatrial septum

2. AV node is at interatrial septum

3. Purkinje fibers: interventricular septum

4. Left anterior ventricular wall: LAD (widowmaker)

5. SA node is located at right atrial wall (sick sinus syndrome)

Macular Degeneration

• distortion or waviness in the central visual field

• drusen

• Prevention - most common cause of blindness in older Americans

Amaurosis Fugax (GCA)

1. Assoc with giant cell arteritis (>50 yo), assoc with polymyalgia rheumatica

2. Temporal headache, jaw claudication, dilated tortuous tender temporal artery

3. Concerned about vision loss d/t anterior optic neuropathy

4. Tx: corticosteroids

Corneal Abrasion

1. Foreign body feeling, excessive tearing, conjunctival injection

2. Dx: slit lamp then if nothing - > fluorescein staining

3. Tx: test visual acuity first and then give erythromycin ointment

Orbital Cellulitis

• Limitation with eye movement, bulging of eye, eye pain, loss of vision

• Tx: IV abx

Squamous Cell Carcinoma RF

tobacco

Otitis Media tx

Tx: amoxicillin/augmentin, 2nd line = cefdinir

Bullous Myringitis

1. Cause: strep pneumoniae

2. Sx: painful fluid filled vesicles, URI -> otitis media, severe unilateral ear pain