Physical Exam & Imaging
What is the indication for ordering a CT with contrast vs without?
CT Without Contrast
- Initial evaluation of acute cerebral hemorrhage
- Trauma where contrast may obscure findings (e.g., skull fractures)
- Renal stones or urinary tract calculi
- Patients with contraindications to contrast
CT With Contrast
- Vascular evaluation (e.g., CT angiography for aneurysms, arterial stenosis)
- Abdominal or pelvic pain evaluation (especially in emergency settings)
- Tumor characterization and staging
- Detection of infection or inflammation, e.g., appendicitis, diverticulitis, abscess
- Assessment of organ perfusion, including liver, pancreas, or kidney
What is the main adverse effect of tPa
This structure shifts leftward on echocardiogram due to right ventricular strain.
interventricular septum
D-dimer is a marker of what degradation product?
Fibrin
Term for the formation of a clot within a vessel
Thrombosis
What physical exam measurement reflects elevated right heart pressure? Name the specific anatomical structure as well
JVP or JVD, IJ
What lab test is used to monitor heparin therapy?
PTT
List the electrical conduction of the heart
SA node > AV node > Bundle of His > L/R Bundle Branches > Moderator Band (RV) + Purkinje fibers (LV)
Is pitting or non-pitting edema associated with PE with DVT and why?
Pitting edema - Characterized by a residual indentation when pressure is applied to swollen tissue. It typically reflects fluid overload or venous insufficiency
Nonpitting edema - More commonly associated with lymphatic obstruction or increased capillary permeability (e.g., myxedema, angioedema).
The term for coughing up blood, as experienced by Ms. Reedy.
What is hemoptysis?
Name the two types of echocardiograms & which one is more common
TTE & TEE
What is the IV anticoagulant of choice in this case and what does it specifically activate in the coagulation cascade?
Heparin
Antithrombin
List the flow of blood in the heart, starting with the three entrances into the RA and ending with the first branch of the Aorta. Make sure to include oxygenation status and valves.
This triad explains the major risk factors for thrombosis
What is Virchow’s Triad?
1. Hypercoaguability
2. Endothelial Damage
3. Venous stasis
Term for clot detachment and migration
Embolization
What is the equation for calculating LVEF and what is considered WNL?
EF = ( EDV - ESV ) / EDV
Normal ≥ 55% or 50 - 70%
What is prophalatically given to all newborns that is a target for the moa of a common anticoagulant?
Name the six factors dependent on this injection for a true daily double.
Vitamin K
Clotting factors II, VII, IX, X, Protein C & S
Name the layers of the heart, starting from the most superficial layer of the pericardium (5 or 6)
Fibrous pericardium
Parietal layer of serous pericardium
Pericardial cavity*
Visceral layer of serious pericardium (epicardium)
Myocardium
Endocardium
What is it called when a thrombus gets infected
Septic thrombophlebitis, IV drug users
What is a pleural effusion and what layers of the pleural cavity does it affect (name 2)?
Pleural effusion is the abnormal accumulation of fluid in the pleural cavity, parietal & visceral layers affected.
The wedge-shaped opacity on chest X-ray in the peripheral lung field is classically associated with this sign of pulmonary infarction. What is the specific name?
What is Hampton's hump
What lab test is used to monitor warfarin and what is the target range for therapy?
PT/INR 2.0 - 3.0
Name the three structures that made up the confluence site of thrombus in this patient
great saphenous vein (GSV), femoral vein (FV), and common femoral vein (CFV) at the saphenofemoral junction (SFJ).
What is a long term complication of recurrent PEs?
Chronic thromboembolic pulmonary hypertension (CTEPH)
What is hypokinesis?
Term describing under-function of a heart chamber, as seen in Ms. Reedy’s RV.