PANCE High Yield- from Quizlet

CHF

Orthopnea, parxysmal noctural dyspnea, JVD, S3

HOCM

Sudden death in athlete

Atrial Septal Defect

Fixed wide splitting S2, systolic ejection murmur, RV heave

Coaractation of Aorta

Rib notching on X-ray, 3 sign, differences in blood pressure in UE vs LE

PDA

Machine like murmur

Tetralogy of Fallot

Cyanosis with crying or feeding, creshendo-decreshendo at LSB

VSD

Holosystolic murmur, MC of all heart defects, systolic murmur at LLSB

Cardiogenic shock

Hypotensive, cool, clammy skin and MI

Atrial Fibrillation

Irregularly irregular rhythm

Atrial Flutter

Saw tooth pattern

AV block

Long PR interval

Mobitz type 1

Progressively lengthening PR interval until a beat is dropped

Mobitz type 2

Dropped QRS without lengthening PR

Third degree block

Independent P wave and QRS complex

SVT

Narrow complex tachycardia

Stable angina

Chest pain relieved with rest

Prinzmetal angina

Diffuse ST segment elevations, coronary artery spasm

ACS

UA, STEMI, NSTEMI, MONA

Cocaine induced MI

Do NOT give betablockers, give benzodiazepines

Aortic aneurysm

Tobbaco use, screening ultrasound >65

Aortic dissection

Marfan syndrome, ehlers danlos syndrome, tearing chest pain, wide mediastinum

Giant cell arteritis

Jaw claudication, visual disturbance, >50 years, elevated ESR

DVT

Virchow's triad, unilateral LE swelling, pain and erythema, Homan's sign

Murmurs

Squatting/leg raise/handgrip increases the sound of all murmurs except MVP and HOCM

Aortic stenosis

Systolic murmur, 2nd Right ICS, radiates to neck

Mitral regurgitation

Holosystolic murmur, radiates to left axilla

Mitral Valve Prolapse

Mid-systolic click, anxiety, women

Mitral stenosis

Opening snap following S2

Aortic regurgitation

Wide pulse pressure, water hammer pulse

Endocarditis

New murmur, fever, IVDU, strep viridans, Jane Way lesions, Osler nodes, Roth spots

Pericarditis

Pleuritic chest pain. Worse upon laying, improves with sitting up. ST segment elevation, PR depression

Asthma

Wheezing, reversible airway d/o, Samter's triad, Reduced FEV1 to FVC ratio

Acute bronchitis

Usually viral, cough, negative CXR

Bronchiloitis

RSV

Epiglottitis

HIB, Hot potato voice, sniffling position, drooling, Thumb sign on Xray

Croup

Barking cough, Steeple sign on Xray

Pertussis

Inspiratory Whoop

Pneumoniaa

Productive cough, pleuritic chest pain, fever. Lobar consolidation= bacterial. Interstitial infiltrates= viral/pneumocystis

TB

Fever, night sweats, hemoptysis. AFB/culture x3days. RIPE therapy. Screen with TNF inhibitors, Immigration

Carcinoid syndrome

Diarrhea, flushing, bronchospasm

Bronchiectasis

CF, Tram lines, Obstructive pattern

Emphysema

Smoking, alpha 1 antitrypsin deficiency, barrell chest, decreased DLCO and FEV1

Chronic bronchitis

Smoking, decreased FEV1

Cystic Fibrosis

Autosomal recessive, infertility, sweat chloride test

Pulmonary embolism

virchow's triad, sinus tachycardia, pleuritic chest pain, S1Q3T3, Westermark sign, Hamptom hump

Asbestosis

Insulation, ship building

Silicosis

Sandblasting, mines, egg shell calcification

Beryllium

Aerospace, electrical plants

Sarcoidosis

Non caseating granulomas, erythema nodosum, bilateral hilar adenopathy, elevated ACE

Pneumothorax

Smoking, fam hx, males, tall/skinny, pleuritic chest pain

Anterior shoulder dislocation

ABducted, externally rotated, axillary nerve affected

Posterior shoulder dislocation

ADDucted, internally rotated. Electrical injury, seizure

Rotator cuff tear

Empty can test

Mid shaft humerus fracture

Wrist drop, affects radial nerve

Clavicle fracture

middle third most affected, treat with sling

Supracondylar fracture

Children, Median nerve and brachial artery affected. Anterior sail and posterior fat pad sign. Gun stock deformity

Elbow dislocation

Posterior dislocation MC

Scaphoid fracture

FOOSH, Snuffbox tenderness, Thumb spica splint

Carpal Tunnel Syndrome

Median nerve, Phalen sign, Tinel sign. Compression test. Thenar eminence atrophy

Boxer fracture

5th metacarpal fracture, ulnar gutter splint

Dequervain tenosynovitis

Finklestein test, common in pregnancy

Ankylosing spondylitis

Young male, HLA B27, Bamboo spine

Cauda Equina

Bowel/bladder incontinence, saddle paresthesia

Spinal stenosis

Shopping cart sign (pain relieved with forward bending)

Avascular necrosis

Femoral neck fracture, limp, frog leg lateral xray

Legg-Calve-Perthes

Knee pain, avascular necrosis of hip

SCFE

Obese, athlete. Xray: posterior displacement of the femoral epiphysis

Developmental hip dysplasia

Positive Ortalani and Barlow test. Palpable clunk, Pavlick harness. Difference in skin folds on legs

Hip fx

External rotation and shortening

ACL

Deceleration, hyperextension, audible pop and swelling. Positive Lachman or anterior drawer test

Meniscal tear

Mechanical symptoms. Baker cyst. Positive McMurray and Apley tests

Osgood-Schlatter Disease

Knee pain worse with exercise. Children. Tenderness over tibial tuberosity

Achilles tear

Positive Thompson test

Osteomyelitis

MCC Staph aureus

Ewing Sarcoma

Moth eaten patten and onion peel appearance

Osteoarthritis

MC joint- Knee, Bouchard (PIP) and Heberden (DIP) nodes

Osteoporosis

Risk factors: spoking, glucocorticoids, amenorrhea

Osteosarcoma

Sunburst pattern

Compartment syndrome

Pain out of proportion. 6 Ps: pain, pressure, paresthesias, pulselessness, pallor and paralysis

Rheumatoid Arthritis

Bilateral symmetric and progressive. Boutonniere, swan neck deformities. Splenomegaly, neutropenia

Fibromyalgia

MC in women, depression with unexplainable pain, treat with TCA

Psuedogout

Calcium pyrophosphate. Positive bifringent rhomboid crystals

Juvenile RA

Polyarthritis, spiking fevers, salmon colored rash. Risk of uveitis

Polyarteritis Nodosa

Hep B, Livedo reticularis, mononeuritis multiplex

Polymyositis

Progressive proximal muscle weakness, dysphagia

Dermatomyositis

Heliotrope rash, guttron papules, shawl sign, Risk of malignancy. Anti-jo-1 and Mi-2 antibodies

Polymyalgia Rheumatica

>50 years old. Giant cell arteritis

Reactive arthristis

MCC GI/GU infection, urethritis, conjunctivitis

SLE

Malar rash, positive ANA, discoid rash. Double stranded DNA and anti-smooth antibodies

Scleroderma

Fibrosis. Calcinosis, Raynaud phenomenon, GERD, sclerodactyly, telangiectasis. Anticentromere antibodies and SCL-70 antibodies

Sjogren Syndrome

Dry eyes. Positive Shirmer test. Positive anti-ro (SSA) and anti-la (SSB) antibodies. Oral candidiasis and non-hodgkin lymphoma association.

Gout

Monoarticular. Podagra, needle shaped negatively bifringent crystals. Uric acid

GERD

Relaxed LES, chronic cough. Aggravated by caffeine, obesity, ETOH, tobacco. PPI for tx

Esophagitis

HIV= Candida

Zenker Diverticulum

Undigested food

Achlasia

"Bird's beak" on xray

Plummer Vinson syndrome

Iron def anemia, chelitis, glossitis, difficultly swallowing. Treat with iron therapy

Mallory Weis Tear

Forceful cough/vomiting= blood, not full tear

Boerhaave Syndrome

Esophageal rupture

Esophageal varices

Acute bleed: tx with octreotide/fluoroquinolone followed by TIPS. Beta blockers used to prevent bleeding