CS

• Patient note - part of the medical record where patient's clinical status is recorded

  • include - patient's history, physical exam and test results
  • reflect physician's analysis of pts health status
• What serves to communicate findings between physician and other members of the healthcare team?

  patient note
• When should the patient note be completed?

  as soon as patient encounter
• What should be specifically described in details?

  pertinent negatives
• Full H and P - admission note - contain

  • patient identification
  • complaints
  • full history
  • complete physical exam
  • list of diagnosis
  • plan of management
• SOAP note - progress - contain

  • interview
  • physical exam
  • assessment
  • plan
• SOAP note is used why?

  • patient admitted already
  • follow up consult
• symptoms is subjective - something pt may feel or experience expressed to physician
• sign is objective - something the physician gathered through inspection
• Full H and P has assessment and plan
• In the focus interview only focus on?

  questions relevant to the patient's present symptoms when taking past medical history
• in the focus interview - select questions that are directly relevant to the patient's symptoms and risk assessment
• Diastole - period of ventricular relaxation

  • blood flow from atrium to ventricles
  • initially free flow, but later facilitated by atrial contraction
• During diastole what valves are open vs. closed

  • Open - AV valves - mitral and tricuspid
  • Closed - semilunar - pulmonary and aortic
• Systole - period of ventricular contraction

  • ventricles ejects blood into the aorta
• What valves are open vs. closed during systole?

  • Open - semilunar valves - pulmonary and aortic
  • Close - AV valves - tricuspid and mitral
• S1 - closure of atrio-ventricular valves and opening of semilunar valves
• S2 - closure of semilunar valves and opening of atrio-ventricular valves
• When assessing cardiac symptoms - important to?

  quantify the patient's baseline level of activity
• what is the most common symptom of coronary heart disease?

  chest pain
• Common cause of chest pain?

  • MI
  • pneumonia
  • reflux esophagitis
  • costochondritis
• palpitation - involve unpleasant awareness of heartbeat
• palpations described by the patient as

  • skipping
  • racing
  • fluttering
  • pounding
  • stopping of the heart
• palpations are due to

  • irregular heartbeat
  • rapid acceleration or slowing of the heart
  • increased forcefulness of cardiac contraction
• palpation does not necessarily means heart disease
• Dyspnea - uncomfortable awareness of breathing that is inappropriate to a given level of exertion
• Dyspnea is common in patients with?

  • cardiac
  • pulmonary problem
• orthopnea - dyspnea that occurs when the patient is lying down and improves when the pt sits up
• Orthopnea can be quantified by

  • number of pillow that the patient uses for sleeping
  • patient needs to sleep sitting up
• What do you need to make sure when assessing orthopnea?

  reason for the extra pillow use is for SOB
• Orthopnea is seen in?

  • left ventricular heart failure
  • mitral stenosis
  • obstructive lung disease
• Paroxysmal nocturnal dyspnea (PND) - episodes of sudden dyspnea and orthopnea that awakens the patient from sleep

  • pt needs to sit up or go outside for air
• What condition is associated with paroxysmal nocturnal dyspnea (PND)?

  • wheezing
  • coughing
  • episodes recur same time every night
• Paroxysmal nocturnal dyspnea (PND) - seen in?

  • left ventricular heart failure
  • mitral stenosis
• Paroxysmal nocturnal dyspnea (PND) can mimic?

  nocturnal asthma attacks
• edema - accumulation of excessive fluid in extravascular interstitial space
• pitting edema - appears when interstitial tissues absorbs fluid more than 10% body weight
• dependent edema - appears lowest in the body

  • sitting - feet and lower legs
  • bedridden - sacrum
• syncope - sudden, transient loss of consciousness with complete recovery that is a consequence of transient global cerebral hypoperfusion
• Syncope is caused by?

  • arrythmias
  • hypoglycemia
  • transient ischemic attack