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, RL 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)