Essential Facts on the Go: Internal Medicine by Lauren Stern, Vijay Lapsia Page A

student or house staff officer who is a visual learner. The visual cues will help you remember the essential facts you need in caring for you patients (and will impress on the wards as well).
    Included in these quick reference cards that you can carry with you in the hospital and the clinic are about 75 different topics ranging from Supraventricular Tachycardia to Venous Thromboembolism to Abdominal Pain to Acute Kidney Injury to Hyperkalemia to Diabetic Ketoacidosis to Opportunistic Infections in HIV to Arthritis to Seizures to Oncologic Emergencies. All topics are presented in ways uniquely suited to learning on the go.
    Lauren Stern, MD
    Vijay Lapsia, MBBS, MD

CARDIOVASCULAR

I_1_a Supraventricular Tachycardia
    Atrial flutter

    Atrial fibrillation

    Multifocal atrial tachycardia (MAT)

    Pattern of atrial and ventricular activation and characteristic relationship of P-wave and QRS complex

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_1_b Supraventricular Tachycardia
    WPW pre-excitation pattern , with triad of short PR, wide QRS, and delta waves. Polarity of the delta waves (slightly positive in leads V 1 and V 2 and most positive in lead II and lateral chest leads) is consistent with a right-sided bypass tract.

    Atrial tachycardia with 2:1 block. P-wave rate is about 150/min, with ventricular (QRS) rate of about 75/min. The nonconducted (“extra”) P waves just after the QRS complex are best seen in lead V 1 . Also, note incomplete RBBB and borderline QT prolongation.

    AV nodal reentrant tachycardia (AVNRT) at a rate of 150/min. Note subtle “pseudo” R waves in lead aVR due to retrograde atrial activation, which occurs nearly simultaneously with ventricles in AVNRT. Left-axis deviation consistent with left anterior fascicular block (hemiblock) is also present.

I_2_a ACLS: Ventricular Tachycardia/Fibrillation

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_2_b ACLS: Bradyarrhythmia/Asystole/Pulseless Electrical Activitiy

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_3_a Bradyarrhythmias
    Sinus slowing and pauses on the ECG

    Mobitz type I SA nodal exit block

    High-grade AV block - Multiple nonconducted P waves with a regular narrow complex QRS escape from the AV junction

    Marked junctional bradycardia (25 beats/min)

    Sinus rhythm at a rate of 64/min (P wave rate) with rhythm probably emanating from third-degree (complete) AV block

    Sinus rhythm (P wave rate about 60/min) with 2:1 (second-degree) AV block

I_3_b Cardiogenic Shock: Initial Management

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_4_a Shock
Physiologic Characteristics of the Various Forms of Shock

Normal Hemodynamic Parameters

Hypovolemic Shock

I_4_b Shock: Approach to Resuscitation

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_5_a Heart Murmurs
    Systolic Murmurs
Ejection Murmurs
• Functional
Still’s murmur and its adult variant
Flow murmur emanating from the root of the pulmonary artery
Murmur associated with high cardiac output states
Flow murmurs associated with aortic or pulmonary valvular insufficiency
• Organic
Valvular aortic stenosis
Aortic sclerosis
Discrete subvalvular aortic stenosis (web or tunnel)
Supravalvular aortic stenosis
Hypertrophic obstructive cardiomyopathy
Pulmonary valvular stenosis
Pulmonary infundibular stenosis
Atrial septal defect
Tetralogy of Fallot
Regurgitant Murmurs
• Functional: None
• Organic
Mitral regurgitation
Rheumatic
Papillary muscle dysfunction
Mitral valve prolapse
Acute
Tricuspid regurgitation
Chronic
Acute
Ventricular septal defect
Roger’s type (small and large)
– Without pulmonary