fliipped_PANCE Word Associations for Medical Diagnoses

Subdural hematoma

Bridging veins

Coup-Contra coup

Elderly

Peds

ETOH

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

CHF

S3

CHF, dilated cardiomyopathy, Preg

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

Hypertrophic CM or fatal arrhythmia. Get EKG or ECHO

Alcoholic with palpitations, arrhythmia

Atrial fibrillation (Holiday heart)

Irregular irregular

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

Atrial fibrillation or prosthetic valve

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

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

Do exercise stress test

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

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

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

Pericarditis

JVD, Hypotension, muffled heart sounds

Pericardial effusion/tamponade (Beck's triad)

Sudden onset ripping, tearing chest pain, diminished pulses

Aortic dissection

Flank pain, hypotension, pulsatile abdominal mass

AAA

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

Digoxin toxicity (Hypokalemia will make worse)

HTN Tx w/ meds, cough or angioedema

ACEI is cause

DM & HTN

ACE is best choice

Post MI

Beta-blockers

HTN not responsive to basic meds

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

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

Bacterial endocarditis (strep. Viridians) prevention

IVDA w/ new murmur

Bacterial endocarditis (staph aureus, strep. Viridians) prevention

Elderly w/ systolic murmur

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

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

Aortic stenosis

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

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

Diastolic murmur best heard at apex without radiation

Mitral stenosis (ARMS are BAD)

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

Mitral valve prolapse

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

Mitral regurgitation

New murmur after MI (esp. if apical systolic)

Mitral regurgitation (caused by papillary muscle rupture)

Continuous harsh, machine-like murmur

PDA

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

VSD

Pulseless electrical activity

Hs&Ts

Hypovolemia

Hypoxemia

Hypothermia

Hydrogen ion (acidosis)

Hyper- Hypo kalemia

Hypoglycemia

Tamponade cardiac

Tension pneumo

Thrombosis -- PE or cardio

Toxins

Trauma

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

Coarctation of aorta

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)

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

Tx is arterial bypass

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

Varicose veins. Tx with compression stockings

Murmur that causes weak carotid pulse

AS

Side effect of statin drugs

Liver toxicity

Illegal substance that causes MI secondary to acute coronary artery vasospasm

Cocaine

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

Wenckebach; Second 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

Complete third degree AV block

Types of second degree AV blocks

Mobitz and Wenckebach

Asystole

Confirm in a second lead

Rapid, deep labored breathing

Kussmaul breathing -- DKA, Metabolic acidosis

Deep breathing alternating w/ apnea

Cheyne-Stokes breathing -- heart failure, brain damage

Crackles or rales

Pneumonia, heart failure, etc...

Apical infiltrates, F, C, dry cough

TB

Eggshell pattern on CXR

Silicosis (Sandblasters)

Ground glass appearance on CXR

Asbestosis -- shipbuilders, building demolition

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

DVT/PE

Venous stasis, vessel wall injury, hypercoagulability

DVT/PE (Virchow's triad)

Pediatric with baking cough, stridor

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

Drooling, sniffing position, tripod, toxic

Epiglottitis

Inspiratory stridor

FB, viral croup (laryngotracheobronchitis)

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

Bronchitis (COPD)

Smoker, DOE, cough

COPD

Hyperinflation on CXR, tear drop heart

Emphysema

Airway edema with eosinophils, neutrophils, lymphocytes

Asthma

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

Pneumonia

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

Strep. Pneumonia

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

Mycoplasma pneumonia

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

Klebsiella

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

Legionella

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

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

Sweat chloride test

Cystic fibrosis

< 2 days post-op with fever

Atelectasis

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

Pneumothorax

Stab wound, dullness to percussion, decreased breath sounds.

Hemothorax

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

Spontaneous PTX

Stab wound to chest. Hypotension, tracheal shift

Tension PTX

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

Obstructive sleep apnea

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

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

Horner's syndrome

Ptosis, miosis, anhidrosis

Pancoast tumor -- apex of lung

EKG S1Q3T3

Pulmonary embolism

FEV1 less than 80% suggests

Obstructive lung disease

Types of pleural effusions

Exudative verses transudative

Neoplastic, infection

Exudative pleural effusion

Transudative pleural effusion

CHF, cirrhosis

Funnel chest

Pectus excavatum

Hypotension, JVD, tracheal shift to the Right

Left Tension Pneumothorax

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

TB

Emboli seen following long bone fracture

Fat emboli

Fat, forty, female, fertile w/ RUQ pain

Cholelithiasis or Cholecystitis

Fever, RUQ pain, radiation to back

Cholecystitis

Chronic cough, bitter taste in mouth or throat, dyspepsia

GERD

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

Acute pancreatitis

Peri-umbilical or flank ecchymosis

Acute pancreatitis (Cullen & Grey Turner's Sign)

Urologic emergencies

Testicular torsion and paraphimosis

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

SBO

Air fluid levels on upright abd plain film

SBO

Air under diaphragm, rigid board-like abdomen

Perforated viscus, perforated ulcer

>60yo F, LLQ pain

Diverticulitis. IV Abx, fluids, NPO

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

Crohn's disease

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

Mesenteric ischemia