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boards 4 Flashcards

1
Q

first EKG change in stemi

A

hyperacute T waves

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2
Q

ventricular aneurysm ekg

A

big q waves, no reciprocal depression, ST elevation

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3
Q

posterior MI ekg changes

A

large R waves with ST depresison v1 v2 R:s>1, upright T waves

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4
Q

EKG inidcations for reperfusion

A

STEMI, posterior MI, sgarbossa LBBB

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5
Q

STE in AVR

A

left main occlusion, triple vesel disease, proximal LAD

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6
Q

wellens

A

biphasic t waves - subacute LAD - urgent cath

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7
Q

what are ekg predictors for refperfusion after lytics

A

early t wave inversions, accelerated idobentrical rhythm- wid ecomplex with rate under 120 (NOT VTACH)

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8
Q

contraindications to nitro

A

viagra, aortic stenosis, RV MI

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9
Q

contraindications for b blocker

A

asthma, CHF, bradycardia, hypotension, RV MI

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10
Q

therapy of AMI

A

heparin, asa, b blockers within 24 hours, morphine, o2, add PLETELET INHIBIORS in high risk patients - clopidogrel, ticagrelor, prasugrel (avoid in TIA/stroke)- indicated if theyre going for invasive therapy

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11
Q

door to ballon time for PCI vs lytics

A

90 minutes

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12
Q

rhythms that you can use atropine vs paced for brady

A

sinus or motiz 1 - atropine mobits 2 or 3rd degree- pacer

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13
Q

early complications of M

A

cardiogenic shock- needs inotrops, IABP, papillary M dysfnx, acute MR, recurrent chest pain, ischemia or reinfaction - CATH NOT EXTRE LYTICS

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14
Q

RV infacrtion

A

hypotensive, clear lungs- associated inferior MI - do R sided chest leads looking for ST elevation, triad of hypotension JVD and CLEAR LUNGS

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15
Q

treatment of RV infarct

A

assn with inferior MI, preload dependent - liberal fluids

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16
Q

late complicaitons MI

A

embolism from mural thrombus- pericarditis, dressler (a few weeks later) -tx nsaids, papillary wall rupture- first week post MI- acute MR and CHF

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17
Q

severe post MI complications + hypotension

A

myocardial rupture - tamponade, hypotension- - papillary m rupture- MR and CHF septal wall rupture- VSD - chf

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18
Q

s3 gallop, JVD , dypsnea, kerley B lines

A

CHF and pulmonary edmea

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19
Q

mcc R sided heart failure

A

L sideed heart failure - JVD peripheral edema, RUQ pain, pulsaile liver

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20
Q

best intervention for CHF

A

BIPAP, then use preload reduction nitrates, diuretics

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21
Q

MCC infectie endocarditis in general IVDA

A

MV; tricuspid- STAPH

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22
Q

bug for subacute IE

A

strep viridans

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23
Q

mcc death IE

A

heart failure, can also get emboli, abscesses

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24
Q

mc bug for IE on prostetic valve

A

first 2 months- staph, late causes - viridans, serratio, psudomonas

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25
Q

tx IE

A

vanc, gent or ceph, rifampin

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26
Q

PPX for IE (or if they have congeital heart disease)

A

major dental procedure/gum bleeding - tx amox/clinda

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27
Q

hypoxia with a normal A-a gradient

A

hypovenilation (opiods) decc fi02- hgh altitude

28
Q

A-a gadient

A

150- 1.2 pac02 - pa02

29
Q

elevated A -a gradients

A

V/q ismatch- pe pna asthma, impaired diffusion - instetial PA PCP – r to L shunt- CHD

30
Q

pitfalls of pulse ox

A

CO - false sat - needs co-oximetry - cant use pulse ox or PaO2 —- methhemoglobin - looks like 85% oxyhb- false sat of 85%

31
Q

factors assn with inc asthma mortalit

A

poverty, overuse OTC, underuse inhalder steroids peventative

32
Q

structural changes in asthmatics lungs

A

bronchial constriction and edema, mucou splugging, inc goblet cells, bronchial m hypterophy, airway remodelling

33
Q

complication of timolol eye drops

A

asthma, copd exacerbations

34
Q

anaphylactoid reaction in patients with nasal polyps

A

samters tirad- ASANSAID sensitivyt, nasal polyps and asthma

35
Q

1st line tx asthma

A

b 2 agonists

36
Q

tips for intubating ashtma

A

MV does not treat obstruction- ahve to continue in line nebs, pulmonary toilet, permissive hypercapnia- allow PC02 to be elevated, p0x> 88%, dec I:E ratio- dec RR, in c flow rate,

37
Q

asthma arrest on ventilator

A

disconnect, compress chest, bilateral chest tubes, fluid bolus - asthma arrest is a SHOCK STATE - obstrucgive and hypovolemic, consider ECMO

38
Q

lung changes in COPD

A

hypoexmia and hypercapnia, destruction of pulomary vascular beds, pulm HTN, cor polmonarle (RHF) polycythemia

39
Q

mimics of COPD exacerbation

A

sudden - PE, PTX, chronic PNA CHF

40
Q

2 inventions to iiimprove mortality in copd

A

home 02 pa02<55 or cor pulmonale, smoking cessation, also give pneumococcal vaccination

41
Q

ARDS - noncardiogenic pulm edema - features

A

hypoxia pa02 <60, normal Vent fxn, PCWP <18, diffuse alvolar infiltrates

42
Q

how to ventilate ARDS

A

o2 sat 85, peep, pressure controlled, low TV, prone position

43
Q

pneumonia mimics

A

atelectasis, ARDS, cancer, diffuse alvolar hemorrhage, PE, R sided endocarditis (IVDA, indwellign catheter) TB toxigenic

44
Q

septic emboli on CXR

A

looks like Pna, hx IVDA, indwelling catherer

45
Q

pneumoona with rusty sputum

A

strep pneumo, CAP

46
Q

lobar patchy pneumonia in copd pts

A

h flu

47
Q

pna causes pleural effusion abscess, cavitiaion, can be post viral or IVDA

A

staph

48
Q

lobar, RUL pna, bulging fissure with currnat jelly sputum, alcoholics, DM, copd

A

klebsiella

49
Q

patchy multilobarl necrotizing mullminate pnz, HCAP

A

Pseudo entoerbacter, CF patients

50
Q

patchy foul smelling pna, alcoholics, poor dentition

A

anerboic pna

51
Q

mcc pna w effusoin

A

strep- also TB (think HIV)

52
Q

cause sof non-infectious pulm effusion

A

L sided- aortic dissection, boerhaaves, R sided - CHF, pancreatitis, hepattits

53
Q

walking pna, young adults, patchy- with extra pulm GBS, encephalitis, gold agglutinins, Erythema multforme, bullous myringits, hemolysis

A

mycoplasma pna (atypical PNA wont have naythingon grahm stain)

54
Q

nontxoc kid, staccato cough, patchy, interstitial, outbreaks inyoung adults -

A

chlamydia pna

55
Q

pna from contaminated water or AC, old sick men, topic pts with bradycardia, unilateral lobar, GI sx NVD, low NA, abnormal LFTsn- no person to person xmission

A

LEGIONELLA

56
Q

fungal pneumonia- SW, Missippie, SE

A

SW- coccidio, missis- histo, SW, blasto, CXR hilar adenopathy, diffuse patchy, can also cause CP and Erytema nodosum

57
Q

vets, farers, sheep goats cattle, - hepatitis and endocarditis

A

Q fever- coxiella nurnetti

58
Q

bird hander pna

A

psittacosis - chlamydia pssittaci

59
Q

gram positive dipplococci

A

s pneumo

60
Q

gram positive cocci in chains

A

grp a strep

61
Q

gram positive cocci in clusters

A

staph

62
Q

gram positive rods

A

bacicallus anrhtacis

63
Q

small gram negative rods

A

h flu

64
Q

gram neg rods

A

pseudomons, enterobacter,, klebsiella, e coli

65
Q

no orgnaism on gram stain

A

chlamydiak legionella mycoplacms a

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