Family Medicine EOR Keywords/Buzzwords/Quick Cards

Hallmark of Emphysema

Dyspnea

"pink puffers"

Emphysema

Pursed-lip expiration

Emphysema

Gold standard test for emphysema

Pulmonary Function Test

3 Cardinal symptoms of chronic bronchitis

Chronic cough, sputum production, and dyspnea

"Blue Bloaters"

Chronic Bronchitis

Gold standard test for chronic bronchitis

Pulmonary Function Test

Barrel chest

Emphysema

Most important step in management of COPD

Smoking cessation

Examples of macrolides

Azithromycin

Clarithromycin

Erythromycin

Examples of Cephalosporins

- Cefuroxime

-Cefixime

-Cephalexin

-Ceftriaxone

-Cefepime

-Cefotaxime

Gold Criteria

COPD

Example of short acting beta agonist

Albuterol

Example of short acting antimuscarinic (anticholinergic) agent

Ipratropium

Example of long acting beta agonist

Salmeterol

Formoterol

Example of long acting antimuscarinic (anticholinergic) agent

Tiotropium

Initial test of choice for angina pectoris

ECG

Classic finding on ECG for angina pectoris

ST depression (resting ecg normal in 50% of cases)

Most important noninvasive testing for angina pectoris

Stress testing with stress ecg, mycocardial perfusion imaging, or stress echocardiography

Definitive diagnostic test for angina pectoris

Coronary angiography

4 drugs in treatment of angina pectoris

Daily aspirin, beta blockers, and statin and nitroglycerin PRN

M-shaped P wave on Lead II

Left Atrial Enlargement

tall P wave in Lead II > or = 3 mm

Right Atrial Enlargement

1. Wide QRS > 0.12 secs

2. Broad, slurred R in V5,6

3. Deep s wave in V1

4. ST elevations V1-V3

Left BBB

1. Wide QRS > 0.12 secs

2. RsR' in V1,2

3. Wide S wave in V6

Right BBB

First line treatment of sinus tachycardia

Treat the underlying cause

First line treatment of symptomatic or unstable sinus bradycardia

Atropine

Progressive lengthening of the PR interval until an occasional non-conducted atrial impulse (dropped QRS complex)

Mobitz I 2nd degree AV block (Wenckebach)

Constant PR interval before and after the non-conducted atrial beat (dropped QRS complexes)

Mobitz II 2nd degree AV block

Often progresses to 3rd degree AV block

Mobitz II 2nd degree AV block

Regular P-P intervals & regular R-R intervals but they are not related to each other

3rd degree AV block

Prolonged PR interval (>0.20 seconds) + all P waves are followed by QRS complexes

1st degree AV block

"sawtooth" atrial waves with no discernable P waves

Atrial flutter

Definitive management of atrial flutter

Radiofrequency catheter ablation

Examples of beta blockers used to treat atrial flutter/atrial fibrillation

Metoprolol, atenolol, or esmolol

Example of non-dihydropyridine calcium channel blockers used to treat atrial flutter/atrial fibrillation

Diltiazem, verapamil

Irregularly irregular rhythm with fibrillatory waves

Atrial Fibrillation

Direct thrombin inhibitor (binds and inhibits thromin)

Dabigatran

Factor Xa inhibitors

Rivaroxaban

Apixaban

Edoxaban

Bundle of kent

Wolff-Parkinson-White

Wave - delta wave (slurred QRS upstroke)

PR interval that is short

Wide QRS complexes (>0.12 secs)

Wolff-Parkinson-White

Preferred antiartrhymic for Wolff-Parkinson-White

Procainamide

Wide, bizarre QRS occuring earlier than expected

T wave is in the opposite direction of the QRS usually

Premature ventricular complexes (PVC)

Torsades de pointes treatment

IV magnesium

Antibiotic class associated with torsades de pointes

Macrolides

S4 on auscultation

Diastolic heart failure

S3 on auscultation

Systolic heart failure

Diagnostic test of choice in outpatient setting for heart failure

Echocardiogram

Initial test of choice for suspected CHF

Chest radiography and BNP

Most common cause of pleural effusions

CHF

BNP > 100

CHF likely

First line therapy for heart failure (most effective singular medication for mortality benefit)

ACE inhibitors

most effective treatment for symptoms of mild-moderate CHF

Loop Diuretics (furosemide (Lasix), bumetanide, torsemide)

used in the treatment of systolic heart failure to decrease rate of hospitalization but does not decrease mortality

Digoxin

Medication class that can be used in diastolic heart failure but they can worsen systolic heart failure

Calcium channel blockers

Most common cause of primary hypertension

Idopathic Etiology

Most common cause of secondary hypertension

Renovascular (e.g. renal artery stenosis)

Only ARB that does not cause hyperuricemia (gout)

Losartan

prevents kidney Na+/water reabsorption at distal diluting tubule

Hydrochlorothiazide, chlorthalidone

Inhibits water transport across loop of Henle -> increased excretion of water, Cl, Na, and K

Loop diuretics (furosemide, bumetanide)

Strongest class of diuretics

Loop diuretics (furosemide, bumetanide)

Diuretic contraindicated if sulfa allergy

Loop diuretics (furosemide, bumetanide)

Weak diuretic that inhibits aldosterone-mediated Na/H20 absorption

Potassium sparing diuretics (spironolactone, amiloride, eplernone)

Diuretic that is associated with gynecomastia

Spironolactone

nonselective beta blocker

propranolol

Most useful noninvasive test for coronary artery disease

Stress testing

1st line drug for stable angina (reduces mortality)

Cardioselective (beta 1) beta blockers (metoprolol, atenolol)

Most common cause of MI

atherosclerosis

MI location associated with bradycardia or heart blocks. may have S4.

Inferior wall MI

MI location PE finding of increased JVP + clear lungs + positive kussmaul sign

Triad of right ventricular infarction

most sensitive and specific cardiac marker

troponin

Door to PCI time

90 minutes

Door to fibrinolysis (thrombolytics)

30 minutes

No IV morphine or IV nitroglycerin for what MI locations

Inferior or posterior wall STEMI

Treatment of choice for cocaine-induced MI & Prinzmentals

Calcium channel blockers

Avoid what medication in cocaine-induced MI & Prinxmentals

Selective beta-blockers (unopposed alpha constriction)

What medication used in treatment of MI can not be used in patient taking Phosphodiesterase-5 inhibitors (Sildenafil)

Nitroglycerin

post-MI pericarditis + Fever + Pulmonary infiltrates

Dressler syndrome

Inhibits ADP-mediated platelet aggregation

Clopidogrel (Plavix)

Inhibits the finall pathway for platelet aggregation

GP IIb/IIIa inhibitors (eptifibatide, tirofiban, abciximab)

Binds to and potentiates antithrombin III's ability to inactivate Factor Xa, inactivates thrombin (Factor IIa). (Prevents new clot formation but does not dissolve existing clots)

Unfractionated heparin

Example of lower molecular weight heparin

Enoxaparin and dalteparin

Direct factor Xa inhibitor with no direct effect on thrombin

Fondaparinux

First line drug therapy for vasospastic (variant, prinzmental) angina

Calcium channel blockers (e.g. diltiazem, verapamil, amlodipine, and nicardipine)

Most common valve for endocarditis

Mitral valve

Most common valve for endocarditis in IV drug user

Tricuspid

Most common pathogen for IV drug-related endocarditis

S. Aureus (esp. MRSA)

Most common pathogen of early prosthetic valve endocarditis

Staphylococcus epidermis

Most common cause of acute infective endocarditis (affects normal valves)

Staphylococcus aureus

Most common cause of subacute infective endocarditis (affects damaged valves)

Streptococcus viridans

Suspect these organisms in patients with endocarditis and negative blood cultures

HACEK (haemophilus aphrophilus, actinobacillus, cardiobacterium hominis, eikenella corrodens, kingella kingae) - gram negative organims hard to culture

Persistent fever, new onset murmur, Osler nodes, Janeway lesions, splinter hemorrhages, Roth spots

Infective Endocarditis

Native valve infective endocarditis empiric therapy

Anti-staphylococcal penicillin (e.g. nafcillin, oxacillin) + either ceftriaxone or gentamicin

Substitute Vanco for PCN allergy or MRSA suspected

Prosthetic valve infective endocarditis empiric therapy

Vancomycin + Gentamicin + Rifampin

Best meds to lower elevated LDL

Statins, bile acid sequestrants

Best meds to lower elevated triglycerides

Fibrates, Niacin

Best meds to increase HDL

Niacin, Fibrates

Inhibits the rate limiting step in hepatic cholesterol synthesis via inhibition of the enzyme HNG-CoA reductase

Statins

Inhibits triglyceride synthesis, increases the activity of lipoprotein lipase

Fibrates (fenofibrate & gemfibrozil)

Harsh/rumble sounds

Stenosis