ICM - Block 1 - Part 2

davidwurbel7's version from 2016-06-09 19:24

Cardiac Disease

(Insert 4-5)
Question Answer
Abnormality of cardiac structure and/or function resulting in clinical symptoms (e.g., dyspnea, fatigue) and signs (e.g., edema, rales), hospitalizations, poor quality of life, and shortened survivalHeart Failure
CHF due to failure of the pump function of the heartSystolic CHF
CHF due to stiffness of the walls and/or mechanical complicationDiastolic CHF
Signs and symptoms of this condition are fatigue, dyspnea orthopnea, paroxysmal nocturnal dyspnea, peripheral edema. Tachycardia ,Jugular venous distention, S3, pulmonary congestion (rales, dullness over pleural effusion), peripheral edema, hepatomegaly, and ascites. S4 is often present in diastolic dysfunctionCHF
This test is used to differentiate cardiac from pulmonary causes of dyspnea BNP


Question Answer
Category of CHF with no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspneaCHF-I
Category of CHF with slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspneaCHF-II
Category of CHF with marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspneaCHF-III
Category of CHF with unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increasesCHF-IV


Question Answer
Congenital unicuspid or bicuspid valve, Rheumatic fever or Degenerative calcific changes with aging could result in this conditionAortic Stenosis
Produces a mid-systolic crescendo - decrescendo murmurAortic Stenosis
(Insert rest of murmurs)
Question Answer
The murmur is best heard with the bell of the in the midclavicular lineMitral Stenosis
The murmur is best heard with the diaphragm at the left sternal boarderAortic Regurgitation
: Mitral Regurgitation
Question Answer
Mid Systolic click followed by Mid to late systolic murmurMitral Valve Prolapse
: Patent Ductus Arteroiosus
; Ventricular Septal Defeat


Question Answer
A continuous whistling sound associated most commonly with expiration due to collapse of intrathoracic airwaysWheeze
Symptoms include wheeze, occur or worsen at night. Symptoms provoked by exposures: either specific allergens or nonspecific irritants. Recurrent or prolonged chest infections (> 2 weeks)Asthma
Allergic rhinosinusitis, Post-infectious cough, Gastroesophageal reflux, COPD, Heart failure, Foreign body, Obstructing lesion and Vocal cord dysfunction can all produce this lung soundWheeze
(Insert 12)
Question Answer
Farmer lung; Hypersensitivity pneumonitis, Ankylosing spondylitis, Sarcoidosis, Tuberculosis, Eosinophilic Granulomatosis, histocytosis and Neurofibromatosis usually present in this part of the lungUpper Lung Lobe
Brronchiactasis (not ILD but appearance), Aspiration (chronic), Drugs/Dermatomyositis, Rheumatoid Arthritis, Asbestosis, Scleroderma, Hamman-Rich syndrome (Idiopathic Pulmonary Fibrosis) usually present in this part of the lungLower Lung Lobe


Question Answer
Presence of alpha wavesStage 1
Presence of beta waves with K complexesStage 2
Presence of delta wavesStage 3/4


Question Answer
Gastritis or Gastric ulcer, Pancreatitis and Splenic pathology are associated with this quadrantLUQ
Hepatitis, Cholecystitis or Biliary Colic and Duodenal Ulcer are associated with this quadrant RUQ
Diverticulitis, Ectopic pregnancy, Tubo-ovarian abscess, Ruptured ovarian cyst and Nephrolithiasis are associated with this quadrantLLQ
Appendicitis, Diverticulitis, Ectopic pregnancy, Tubo-ovarian abscess, Ruptured ovarian cyst and Nephrolithiasis are associated with this quadrantRLQ
PUD or Gastritis, Pancreatitis, Ruptured aortic aneurysm, MI are associated with this quadrantEpigastric
(Insert 12-14)
Question Answer
Crampy, related to distension of a hollow viscus or stretching of capsule; poorly localizedVisceral Pain
Visceral Pain is transmitted by these fibersC Sympathetic Nerve Fibers
Steady ache, more severe and localized, related to inflammation of peritoneum; aggravated by movement or coughingParietal Pain/Somatic Pain
Parietal Pain/Somatic Pain is transmitted by these fibersA and C Sympathetic Nerve Fibers
Loss of appetite. Inflammatory conditionsAnorexia
Difficulty with Solids only with narrowing of esophagus in Esophageal stricture, both solids and liquids with dysmotility in AchalasiaDysphagia
Spasming of the LESAchalasia
Retrosternal burning usually from acid reflux into esophagus; worse after large meals, specific foods, positions; may have regurgitationHeartburn
Nonspecific - may refer to heartburn, abdominal pain, bloating, gas, nauseaIndigestion
Belching, bloating, flatus from specific foods, lactase deficiency, irritable bowel syndrome, swallowed airExcessive Gas
Forceful, without warning; gastric outlet obstructionProjectile Vomit
Dark green, obstruction distal to Ampulla of VaterBilious Vomit
Bright red/ brown-blackish (“coffee grounds”)Hematemesis
Late small bowel obstructionFecal Odor
Excessive frequency, loose or watery stoolDiarrhea
Fat malabsorption - stools pale, floatSteatorrhea
Inflammation, infectionMucus
Inflammatory Bowel DiseaseChronic
Intense urge to defecate. Relief after defecation – left colon, rectal disordersTenesmus
Difficulty passing stoolsConstipation
Severe constipation in obstructionObstipation
Left sided colonic obstructionPencil stool
Bright red (BRBPR) – bleeding from descending, sigmoid, rectum, anusHematochezia
Black, tarry- bleeding from esophagus through small intestine ( also in ingestion of Peptobismol, iron)Melena
Small amount of blood that is not visible to the naked eye.Occult Blood
Abdominal pain nonspecific - diffuse, crampy, Bloating, nausea, Constipation or diarrhea, Mucus in the stool. Defecation relieves the pain. Sensation of not being able to fully empty bowel after movement. Often aggravated by emotional stress. No demonstrable organic causeIrritable Bowel Syndrome (IBS)
Epigastric pain - burning sensation (heart burn), that is limited to the upper abdomen or chest. Worse after large meals, specific foods, supine position. Relief with antacids. Acid regurgitation and sour taste. Cough (post-prandial, when supine). Endoscopy is needed if dysphagia, weight loss, or signs of anemia present – to rule out malignancyGERD
Complication of GERD isComplication: Barrett’s Esophagus
Erosions in duodenum or stomach. Pain in epigastrium or LUQ. burning, dull, aching. Nausea, vomiting, anorexia, weight loss (gastric ulcer). Food may relieve pain (duodenal ulcer). Diagnosis by urea breath test, endoscopyPeptic Ulcer Disease
Antacids, H2 blockers, PPI’s relieve painPeptic Ulcer Disease
(Insert table 27)
Question Answer
Pain midepigastric to LUQ, often rad. to back. Severe, steady, and boring. Worse supine; prefer knee - chest position (leaning forward or fetal position). Nausea and vomiting. Tachycardia, tachypnea, fever, Mild jaundice. Serum levels ↑amylase & lipase, Ultrasound, CT-ScanAcute Pancreatitis
Bouts of abdominal pain. Pancreatic insufficiency - weight loss, steatorrhea, diabetes. Calcifications in the pancreasChronic Pancreatitis
RUQ pain, right mid-abdomen, right shoulder, Anorexia, Nausea, vomiting, Low grade fever, Positive Murphy’s sign. Investigations: Leucocytosis, ESR, CRP, ↑ AST, ALT,ALK PhosAcute Cholecystitis
Cession of slow inspiration due to pain with compression of the right upper quadrantMurphy's Sign
Esophageal Varices, Hemorrhoids, Caput Medusae, Ascites, SplenomegalyPortal Hypertension
Gynecomastia, spider angiomas (spider nevi), palmar erythema, testicular atrophyEstrogen effects
Jaundice, Portal Hypertension, Bleeding, Malnutrition, Hepatic encephalopathy, coma. Investigations: ↑ Bilirubin, AST, ALT, AP, ultrasound, liver biopsyChronic Liver Disease
Symptoms include Abdominal Pain: visceral periumbilical parietal RLQ, Anorexia, Nausea/Vomiting, Constipation. Signs include Low-grade fever, Tenderness in RLQ (McBurney’s Point), Rebound tenderness, Rovsing: palpate LLQ- pain referred RLQ, Psoas: Extension of leg-pt on left, Obturator: Internal rotation of flexed thigh-pt supine, Dunphy sign: Increase abdominal pain with coughing, Markle sign: Pain when dropping from standing on toes to the heels, Rectal tenderness towards right, Perforation related signs: rigidity, diffuse tender. Investigations: Leucocytosis, ESR, CRP, X-ray, ultrasound, CT-scanAcute Appendicitis
“Probably the most excruciatingly painful event a person can endure”. Due to stones (calculi) in kidney/ureter: nephro/ureterolithiasisAcute Renal Colic
Sudden onset severe flank pain. Radiates anteriorly and inferiorly, to groin. Pain worsens intermittently. Migrates with stone movement. Nausea, vomiting, dysuria, urgency. Patients tend to move constantly, seeking a more comfortable position. Hematuria. Costo-verterbral angle) tendernessAcute Renal Colic
Peak incidence 15 to 40 yo. Affects mucosa of the distal colon and rectum. Continuous areas of involvement. Bloody diarrhea common. Periods of remission and relapse. Areas of hyperplastic inflammatory mucosaUlcerative Colitis
Diarrhea – often bloody. Abdominal cramps, pain. Anorexia, weight loss. Bleeding may be serious, leading to anemia. Arthritis, uveitis; growth delay in childrenUlcerative Colitis
Peak incidence 14-24 yo. Transmural inflammation and ulceration. Most commonly affects ileum and proximal colon (any part can be affected). Skip lesions, patchy involvement. Periods of remission and relapseCrohn's Disease
Pain in the RLQ, Diarrhea (usually without gross blood). Weight loss, anorexia. Partial obstruction, Fistulae. Extraintestinal sx may predominate childhood: Arthritis, anemia, or growth retardationCrohn's Disease
Barium enema shows lead pipe appearance of involved areasUlcerative Colitis
Barium enema shows cobblestone appearance of involved areasCrohn's Disease
A >3cm dilated loops; valvulae coniventes extending across full loop diameter - obstruction.Small Bowel Obstruction
Colon outlined with air; dilation proximal the obstructed segment no air distal to obstructed segmentColonic Obstruction
Indicates perforation; air outlining the hemidiaphragmsFree Air
Abdominal pain - colicky, distention. Vomiting with proximal obstruction; bilious. Diarrhea if early. Constipation if late. Fever, tachycardia suggest strangulation. Previous abdominal or pelvic surgery. History of malignancyBowel Obstruction
Abdominal pain- severe, abrupt in onset worsens steadily over time. Fever. Anorexia, nausea, and vomiting. Altered bowel habits, especially constipation, is common. Distension with diminished bowel sounds. Pain on rectal/pelvic exam. Rebound tenderness due to localized peritonitisDiverticulitis

Abdominal Exam

Question Answer
Distension due to gastric dilatation; enlarged liverU ½ distended
Distension due to pregnancy; uterine tumor, ovarian tumorL ½ distended
Bulging due to obesity, ascitesFlanks
Retroperitoneal hemorrhage - blue, purple flank colorationGrey Turner Sign
Periumbilical skin ecchymosis - Intraabdominal bleedingCullen Sign
Listen with diaphragm in one quadrant for a minute in this quadrant firstRLQ
Normal sounds consist of clicks and gurgles and occur5 to 30 per minute
Abdominal pain radiation to left shoulder when patient’s legs are elevated in lying position due to the presence of blood or other irritant in the peritoneal cavityKehr Sign
Kehr sign can be an indication of thisSpleenic Rupture
Extension of leg-patient on leftPsoas Sign
Psoas sign indicates the appendix is located hereRetrocecal
Internal rotation of flexed thigh-patient supineObturator Sign
Sign indicates the appendix is located herePelvic Appendicitis
Palpate LLQ- pain referred RLQRovsing Sign
Increase abdominal pain with coughingDunphy Sign
Pain when dropping from standing on toes to the heelsMarkle Sign