JenGintheED Posted November 12, 2005 Share Posted November 12, 2005 Guessing--->Head Bub (Sp ?) Nope... something you have the pt do..... Quote Link to comment Share on other sites More sharing options...
andersenpa Posted November 12, 2005 Share Posted November 12, 2005 one thing is an eponymous bedside test.....originally used to help patients open their eustacian tubes..... Quote Link to comment Share on other sites More sharing options...
caldje Posted November 12, 2005 Share Posted November 12, 2005 LA.. all i know to do is have the patient lay in left lateral recumbent and listen with the bell at the mitral area to enhance a mitral stenosis murmur. but i dont see how that would differentiate L v. R? Quote Link to comment Share on other sites More sharing options...
pahopeful Posted November 12, 2005 Author Share Posted November 12, 2005 one thing is an eponymous bedside test.....originally used to help patients open their eustacian tubes..... Is it Valsalva? Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 13, 2005 Share Posted November 13, 2005 Is it Valsalva? Oui... that's half! Since a murmur is turbulent blood flow through the heart & valves, the relative volume of the murmur can be changed by changing the venous return to the heart. Having a pt hold maximal expiration (Valsalva) increases intrathoracic pressure, compressing the vena cavae & decreasing preload. Venous return to the left side of the heart is decreased... right-sided sounds will be softer; left-sided sounds persist (at least initially). So with expiration, left-sided murmurs do not change. Maximal inspiration decreases intrathoracic pressure, allowing increased vr to the right side of the heart... right-sided sounds will be louder, and left-sided sounds don't change. With inspiration, right-sided sounds are amplified. Andersenpa, did I explain that correctly? Quote Link to comment Share on other sites More sharing options...
andersenpa Posted November 15, 2005 Share Posted November 15, 2005 It's a dynamic thing.... Normal inspiration will cause a relatively negative intrathoracic pressure and promote RV filling; this may cause some septal shift and impair LV filling temporarily (interventricular dependence). Passive expiration will not necessarily exaggerate the changes seen with valsalva (forced expiration against a closed glottis)- a decrease in the intensity of most murmurs except MVP (longer duration and earlier click) and hypertrophic cardiomyopathy. MVP is more pronounced due to the lesser LV filling and higher left side atrioventricular gradient. I general, right sided murmurs will return in intensity much more quickly than left side (may take several cardiac cycles to return). There are also particulars to the phases of valsalva- Phases of Valsalva I onset of strain - increased SBP- Increased intrathoracic pressure causes aortic root compression and atrial compression/emptying; results in reflex bradycardia II continued strain - decreased SBP - Increased intrathoracic pressure/compromised venous return, decreased preload, reflex tachycardia III release - decreased SBP - Inspiration increases venous capacitance of pulmonary vasculature, venous pooling and decreased L. heart preload IV recovery - increased SBP- recovery and overshoot resulting from increased vasomotor tone and reflex tachycardia As you can imagine, each of these hemodynamic changes will affect valvular flow and the accentuation of murmurs. OR, you can just get an echo! Quote Link to comment Share on other sites More sharing options...
ScottYoungPA Posted November 21, 2005 Share Posted November 21, 2005 How's about the key features of Gilbert's disease? Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 21, 2005 Share Posted November 21, 2005 increase in unconjugated bilirubin & jaundice, but only occurs occasionally, during stressful situations Quote Link to comment Share on other sites More sharing options...
andersenpa Posted November 21, 2005 Share Posted November 21, 2005 but only occurs occasionally, during stressful situations so, every day?????:p Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 22, 2005 Share Posted November 22, 2005 How do you do it? What is a positive result? What does a positive result mean? Quote Link to comment Share on other sites More sharing options...
Monica Posted November 26, 2005 Share Posted November 26, 2005 How do you do it?What is a positive result? What does a positive result mean? I want to know the answer...anyone? Bueller? Quote Link to comment Share on other sites More sharing options...
merseur Posted November 26, 2005 Share Posted November 26, 2005 I heard it before but i dont remember that much. I think it has something to do with checking trauma to the eye (scleral or corneal penetrating injury)by using flourecine staining to detect aqueous humor leak. Flourecine dyes usually stains abrasions/ulcers. I think the positive result is when there is a constant streaming of the dye from eye. Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 26, 2005 Share Posted November 26, 2005 I heard it before but i dont remember that much. I think it has something to do with checking trauma to the eye (scleral or corneal penetrating injury)by using flourecine staining to detect aqueous humor leak. Flourecine dyes usually stains abrasions/ulcers. I think the positive result is when there is a constant streaming of the dye from eye. That would be it! Under a cobalt blue light, you see a moving stream of flourescein-stained aquaeous humor. Good job, as usual, Merseur!! Quote Link to comment Share on other sites More sharing options...
andersenpa Posted November 27, 2005 Share Posted November 27, 2005 new question- what are the criteria for ARDS and ALI (acute lung injury)? LA- you just took FCCS so you are not excused for not knowing! Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 28, 2005 Share Posted November 28, 2005 new question- what are the criteria for ARDS and ALI (acute lung injury)? LA- you just took FCCS so you are not excused for not knowing! It's too recent to have forgetten yet... but I'll bet some others know as well :D Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted December 1, 2005 Share Posted December 1, 2005 new question- what are the criteria for ARDS and ALI (acute lung injury)? Hint... it's the acute onset of three things... Quote Link to comment Share on other sites More sharing options...
melcal Posted December 1, 2005 Share Posted December 1, 2005 1. PaO2/FiO2 is < or =300 mmHg (regardless of PEEP) for ALI; < or =200 mmHg (regardless of PEEP) for ARDS 2. bilat infiltrates on CXR 3. < or = 18 mmHg PCWP (no clinical evidence of left heart failure) Quote Link to comment Share on other sites More sharing options...
melcal Posted December 1, 2005 Share Posted December 1, 2005 ok, new question. <flipping thru cardiology rotation notes> wolff-parkinson white (wpw) syndrome: 1. what do you see on ekg 2. other arrhythmias associated with it 3. how can you treat it Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted December 1, 2005 Share Posted December 1, 2005 a delta wave. sick sinus syndrome treat it with CCB (NOT) Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 1, 2005 Moderator Share Posted December 1, 2005 This was a new one for me also: what is dandy-walker syndrome? had a pt with this yesterday..... Quote Link to comment Share on other sites More sharing options...
Monica Posted December 1, 2005 Share Posted December 1, 2005 This was a new one for me also:what is dandy-walker syndrome? had a pt with this yesterday..... WOW! Dandy-Walker? All I can remember right now is inc. ICP associated w/ hydrocephalus. Once the full answer is out, tell us about the presentation, etc. I'm going to have to go read up on that one. Quote Link to comment Share on other sites More sharing options...
melcal Posted December 2, 2005 Share Posted December 2, 2005 a delta wave.sick sinus syndrome treat it with CCB (NOT) yup, ekg shows delta wave w/ wide QRS and short PR interval can also be assoc w/ afib & reentry tachy treatment... depends: if w/ reentry tachy & stable =adenosine; if w/ afib =cardioversion Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted December 2, 2005 Share Posted December 2, 2005 ok not to skip over Eric but let me throw a baby lamb into the lion's den... what would the MCV, MCHC,Fe, TIBC, Fe Sat% be in iron def anemia... all of these other questions are cool but this is one that you NEED to know Quote Link to comment Share on other sites More sharing options...
melcal Posted December 2, 2005 Share Posted December 2, 2005 ok not to skip over Eric but let me throw a baby lamb into the lion's den... what would the MCV, MCHC,Fe, TIBC, Fe Sat% be in iron def anemia... all of these other questions are cool but this is one that you NEED to know MCV = dec (microcytic), MCHC = nl-dec (hypochromic), Fe = dec, TIBC =inc, Fe Sat% =dec i knew my med tech degree & 5yrs in lab would help somewhere :p Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted December 2, 2005 Share Posted December 2, 2005 good job that is one that you will see daily, or at least have to know how to work up Quote Link to comment Share on other sites More sharing options...
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