Cardiovascular Shoutouts
Heart Murmurs:
When she says… You say…
S3 (early diastolic ventricular gallop) CHF
S4 (late diastolic atrial gallop) Left ventricular hypertropy
Opening snap (OS) Mitral stenosis
Pansystolic murmur (holosystolic) Tricuspid/mitral regurgitation, VSD
Systolic click (mid/late) Mitral valve prolapse
Palpitations Mitral valve prolapse
Ejection type systolic murmur Aortic/pulmonary stenosis
Continuous, machine-like murmur Patent ductus arteriosus (PDA)
Tertiary syphilis, Marfan's syn Aortic regurgitation
Congenital aortic bicuspid Aortic stenosis
Bounding pulses Aortic regurgitation
Slow upstart, 1-2+ (weak) pulse Aortic stenosis
Anemia (low Hct) Turbulent blood flow = MURMUR
Congenital Heart:
When she says… You say…
Rubella PDA
Down's ASD/VSD
Turner's Coarctation of the aorta (rib notching)
Marfan's Aortic dissection, aortic regurg, mitral
valve prolapse
Tertiary syphilis Aortic regurg
Boot-shaped heart Tetralogy of fallot (RV hypertrophy)
EKG Changes:
When she says… You say…
Peaked T wave Hyperkalemia
U wave Hypokalemia
Persistent ↑ ST (diffuse elevations) Pericarditis
Saw tooth EKG Atrial flutter
↑ QT Hypocalcemia
↓ QT Hypercalcemia
Q wave, ST elevation Transmural MI
Quinidine toxicity ↑ QRS
Thallium—cold spots Myocardial ischemia
Technechium—hot spots (bound to Myocardial infarct
pyrophosphate)
TALL QRS Left ventricular hypertrophy (+S4)
Heart sounds:
When she says… You say…
Pulsus paradoxus (large ↓ in systolic P Cardiac tamponade (& asthma
when breathe) hyperinflation)
Irregularly irregular pulse Atrial fibrillation
Regularly irregular pulse Second degree AV block (Mobitz type I or
II)
Syncope, angina, CHF Aortic stenosis
Fixed splitting ASD
Paradoxical splitting Left bundle branch block, aortic stenosis
Wide splitting Right bundle branch block, pulmonic
stenosis
Jump of heart PVB
Multiple jumps of heart A. Fib
Other:
When she says… You say…
Coksackie, echovirus Dilated cardiomyopathy
Young male athlete drops dead Hypertrophic cardiomyopathy
Kussmaul's sign (JVD when you Constrictive pericarditis
inspire)
Hyperkalemia Metabolic acidosis
Hypokalemia Metabolic alkalosis
Frothy white sputum Pulmonary edema
Kerley B lines Pulmonary edema
Straightening of left heart border Dilation of left atrium
Barlow's syndrome Mitral valve prolapse
Renal Shoutouts
When she says… You say…
Foamy Proteinuria
Peaked T wave, sine wave Hyperkalemia
U wave, flat T wave, ST depression Hypokalemia
Shortened QT interval (ST segment)
Hypercalcemia
Prolonged QT (ST segment)
Hypocalcemia, hyperphosphotemia
PR & QT prolongation Hypomagnesium
Fever & flank pain Pyelonephritis (until proven otherwise)
WBC casts Pyelonephritis
Suprapubic pain, blood in urine, NO Cystitis
FEVER
RBC casts Glomerular nephritis
No casts, No fever Cystitis
Eosoniphiluria Acute interstitial nephritis
ANCA Wegener's (RPGN) – nephritic + chronic
sinusitis
Drug induced nephritis Esosinophils
Green urine Pseudomonas
Subepithelial deposits Nephrotic
Subendothelial deposits Nephritic
Hypertension Nephritic
Microalbumenia Diabetic Neuropathy
Orange urine Rifampin
+ nitrites and leukocyte esterase on UA
Bacterial infection
Urine = bad odor
Medulla of nephron Hyperosm urine increase sickling of
RBC in sickle cell patients
1. E. coli
MCC of UTI
2. Staph saprophyticus/albus
Prerenal renal failure OR dehydration
BUN/Cr > 20
(could also be due to high protein diet or
GI bleed b/c these increase BUN)
Proteus mirabilis infection (has urease) VERY alkaline urine (e.g. pH = 9)
1. DM microalbuminemia
MCC of chronic renal failure 2. chronic glomerular ds
3. HTN
4. polycystic kidney
Pulmonary Shoutouts
When she says… You say…
Legionella pneumonia Cough, chest pain, etc PLUS GI
symptoms (diarrhea)
Rigors (one episode) – severe shaking Strep pneumonia
and chills
Rusty (e.g. old lysed blood = Strep pneumonia (but strep not always
hemoglocbin) color (sputum) rusty)
Blood streaked/blood TB (or cancer) pott's ds
tinged/hemoptysis (sputum) with (osteomyelitis), meninges, and scrofula
weight loss (cervical lymph nodes)
Green (bluish-green) sputum Pseudomonas
White frothy (increased protein) Pulmonary edema
When she says… You say…
Pink frothy Pulmonary edema with hemorrhaging (if
immunocomp: think pneumocystis
carinii)
Red currant jelly sputum Klebsiella
Foul smelling sputum Anaerobes
No sputum Viral, atypical bacteria, pneumocystitis
(in normal individual – not
immunocomp)
FEV1/FVC decreases, can't get air out, COPD minimize work by breathing
increased resistance to air flow, slow and deep
increased compliance, decreased
elasticity
FEV1/FVC increases (or normal), can't RLD minimize work by breathing
get air in, increased elasticity/elastic rapid and shallow
resistance
Red/orange urine, tears, etc Rifampin (also causes thrombocytopenia)
Hemoptysis + Hematuria Goodpasteur's
Silver stain with Owl's eye Pneumocystis
Wedge shaped infarct/density on CXR Pulm embolism (with sudden onset of
dyspnea)
Common Clinical Triad
Nasal polyps (small wet grapes inside
nose), Aspirin allergy, asthma (polyps may block sinuses from draining
(bronchospasms), giving sinus headaches)
Sinus tachycardia on EKG Pulmonary embolism (decrease perfusion
increase V/Q ratio)
No perfusion Alveolar dead space (V/Q ratio
approaches infinity): PE, vascular ds
hyperventilation
No ventilation Shunt (ex: atelectasis, pneumonia,
fibrosis, ARDS, pulmonary edema)
hyperventilation
Sudden onset of dyspnea, pleuritic PE feeling of impending doom,
chest pain, and hemoptysis tachypnea, tachycardia Tx: heparin
When she says… You say…
CO, anemia, shock, RL shunt
Tissue hypoxia without hypoxemia
(all lung ds = hypoxemia, thus also
hypoxia)
Resp Alkalosis (pt will hypervent) TB, early asthma, most restrictive lung
ds, pneumonia, pregnancy
Resp Acidosis (pt with breathe slower) COPD, late asthma, neurogenic restrictive
lung ds, chest wall deformities
Chest Xrays
When she says… You say…
Bilateral diffuse interstitial infiltrate Viral
(ground glass haziness) PCP
Mycoplasma
Sarcoidosis (hilar)
Thick walled, round cavity (usu upper TB – fever, night sweats, chills
lung) OR tiny, scattered densities
(miliary dissemination)
Cavity with air-fluid level (usu right Anaerobes/lung abscess foul sputum
middle lobe)
Microabscesses Staph aureus
Multiple, bilateral marble-sized Septic PE (right sided endocarditis, s.
densities aureus)
