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Emergency Medicine > Cardio > Flashcards

Cardio Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Mid-systolic murmurs:

A

aortic stenosis, pulmonic stenosis

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2
Q

Holo-systolic murmurs

A

mitral regurgitation, tricuspid regurgitation

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3
Q

Late-systolic murmurs

A

MVP (always showing up late)

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4
Q

Early-diastolic murmurs

A

aortic regurgitation, pulmonic regurgitation

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5
Q

Mid/late-diastolic murmurs

A

mitral stenosis, tricuspid stenosis

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6
Q

What maneuvers increase venous return?

A

Squatting, LR, lying down

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7
Q

What maneuvers decrease venous return?

A

Valsalva, standing

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8
Q

S1?

A

AV valve closure

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9
Q

S1 marks the?

A

beginning of systole

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10
Q

S1 is loudest at?

A

Apex

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11
Q

Which valve closes first in S1?

A

mitral, then tricuspid

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12
Q

S2?

A

Semilunar valve closure

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13
Q

S2 marks the?

A

end of systole

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14
Q

S2 loudest at?

A

Base

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15
Q

Which valve closes first in S2?

A

Aortic, then pulmonic

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16
Q

S3?

A

rapid passive ventricular filling

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17
Q

S4?

A

atrial contraction into ventricles

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18
Q

Elevated BP?

A

120/129/ <80

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19
Q

Stage 1 HTN?

A

130-139/ 80-89

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20
Q

Stage 2 HTN?

A

> 140/>90

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21
Q

HTN urgency?

A

> 180/120

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22
Q

Treatment for elevated BP?

A

lifestyle, recheck in 3-6 months

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23
Q

Treatment for stage 1 HTN?

A

10 year risk <10% –> lifestyle; >10% –> 1 med, check in one month

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24
Q

Treatment for stage 2 HTN?

A

2 meds, recheck in one month

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25
Q

Sodium restrictions for HTN?

A

<2.4 g/d

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26
Q

HTN tx: uncomplicated (non-AA)

A

thiazide diuretics, ACE, ARB

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27
Q

HTN tx: a. fib

A

BB, ND CCB

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28
Q

HTN tx: angina

A

BB, CCB

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29
Q

HTN tx: post-MI

A

BB, ACE

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30
Q

HTN tx: systolic HF

A

ACE, ARB, BB, diuretics

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31
Q

HTN tx: DM/CKD

A

ACE, ARB

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32
Q

HTN tx: systolic (isolated) HTN

A

diuretics +/- CCB

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33
Q

HTN tx: osteoporosis

A

thiazides

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34
Q

HTN tx: BPH

A

alpha blockers

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35
Q

HTN tx: AA (non-DM)

A

thiazides, CCB

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36
Q

HTN tx: gout

A

CCB, losartan (only arb that doesn’t cause hyperuricemia)

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37
Q

HTN urgency

A

> 180/>120 + no end organ damage

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38
Q

HTN urgency treatment

A

Decreased BP by 25% over 24-48 hours using oral agents –> goal <160/<100

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39
Q

HTN emergency

A

> 180/>120 + end organ damage

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40
Q

HTN emergency treatment

A

Decrease BP by no more than 25% within first hour, then by an additional 5-15%, over next 23 hours using IV agents

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41
Q

When should you not follow HTN emergency treatment protocol?

A

-Ischemic stroke: not lowered unless >185/110 in thrombo candidates or >220/120 in non-candidates AND in aortic dissection: rapidly reduce to SBP of 100-120 in 20 minutes

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42
Q

Inferior leads:

A

II, III, aVF

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43
Q

II, III, aVF leads?

A

inferior

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44
Q

lateral leads:

A

I, avL, V5, V6

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45
Q

I, avL, V5, V6?

A

lateral

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46
Q

septal leads:

A

V1, V2

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47
Q

V1, V2 leads?

A

septal

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48
Q

V3, V4 leads?

A

anterior

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49
Q

Anterior leads?

A

V3, V4

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50
Q

First degree AV block?

A

long PR interval (>0.20 sec)

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51
Q

First degree AV block treatment?

A

observe

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52
Q

Mobitz Type I (Wenckebach)

A

long, longer, drop

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53
Q

Mobitz Type I treatment

A
  • Symptomatic: atropine, epi, +/- pacemaker

- Asymptomatic: observe +/- cardiac consult

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54
Q

Mobitz Type II

A

PR constant, random drops

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55
Q

Mobitz Type II treatment

A

atropine, temporary pacing; permanent pacemaker = definitive

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56
Q

Third degree AV block:

A

no relationship between P waves and QRS complexes

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57
Q

Third degree AV block treatmnetn

A

temp pacing –> permanent pacing

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58
Q

Pathologic Q wave definition:

A

> 0.04 sec, >2 mm deep, >25% depth of QRS complex

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59
Q

Pathologic Q waves may be normal in what leads?

A

III and aVR

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60
Q

STEMI EKG definition?

A

ST elevations 1+ mm in at least 2 anatomically contiguous leads + reciprocal changes in opposite leads

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61
Q

STEMI EKG progression?

A

hyperacute T waves –> ST elevations/depressions –> T wave inversions –> pathologic Q waves

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62
Q

Describe QT in hypocalcemia?

A

prolonged

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63
Q

Describe QT in hypercalcemia?

A

QT shortened

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64
Q

Sick sinus syndrome?

A

brady-tachy syndrome; sinus arrest with alternating paroxysms of atrial tachy and brady

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65
Q

Treatment of sick sinus syndrome?

A

Permanent pacemaker

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66
Q

MC chronic arrhythmia?

A

a. fib

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67
Q

Describe P waves in a.fib?

A

No discernible P waves

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68
Q

Paroxysmal A. fib?

A

self-terminating within 7 days

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69
Q

Persistent a. fib?

A

fails to self-terminate, lasts > 7 days

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70
Q

Permanent a. fib?

A

> 1 year; refractory to cardioversion or nerve tried

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71
Q

Lone a. fib?

A

paroxysmal, persistent, or permanent without evidence of heart disease

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72
Q

CHADSVASC

A 
CHF or LVEF <40% (1) 
HTN (1) 
Age 75+ (2) 
DM (1) 
Stroke/TIA/thromboembolism (2)
Vascular disease (1) 
Age 65-74 (1) 
Sex: Female (1)
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73
Q

CHADSVASC Score interpretation

A

2+: mod risk; chronic oral anticoags

1: low risk; clinical judgement
0: no anticoag risk

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74
Q

Treatment for unstable a. fib:

A

DC cardioversion

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75
Q

What type of drug is diltiazem?

A

ND-CCB

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76
Q

MCC of atrial flutter

A

HF

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77
Q

Atrial flutter tx: stable

A

vagal, CCB/BB

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78
Q

Atrial flutter tx: unstable

A

DC

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79
Q

Atrial flutter tx:

A

radiofrequency ablation

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80
Q

Long QT can be caused by?

A

macrolides, TCAs, and electrolyte abnormalities

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81
Q

Definitive treatment of long QT?

A

AICD

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82
Q

What type of PSVT is most common?

A

AVNRT

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83
Q

Describe AVNRT?

A

two pathways within the AV node (slow and fast)

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84
Q

Describe QRS of AVNRT?

A

Narrow w/ no discernible P waves

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85
Q

Describe AVRT?

A

1 pathway in the AV node and a second accessory pathway outside of the AV node

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86
Q

Types of AVRT?

A

orthodromic and antidromic

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87
Q

Orthodromic is antegrade via?

A

AV node

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88
Q

Antidromic is antegrade via?

A

accessory

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89
Q

orthodromic is retrograde via?

A

accessory pathway

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90
Q

Antidromic is retrograde via?

A

AV nod

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91
Q

Orthodromic is wide or narrow?

A

Narrow

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92
Q

Antidromic is wide or narrow?

A

wide

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93
Q

Tx of stable orthodromic AVRT?

A

vagal, adenosine, IV verapamil

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94
Q

Tx of unstable orthodromic AVRT?

A

DC

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95
Q

Tx of stable antidromic AVRT?

A

flecainidine, procainamide, amiodarone

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96
Q

What drugs must be avoided in WPW?

A

digoxin, verapamil, BB

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97
Q

Tx for multifocal atrial tachycardia?

A

CCB, BB

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98
Q

Describe EKG of premature ventricular complexes?

A

T wave opposite direction of QRS

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99
Q

Tx of PVCs?

A

no treatment needed; BB if symptomatic; if frequent, w/u for heart disease

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100
Q

Describe ventricular tachycardia?

A

3+ consecutive PVC at a rate of >100 bpm

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101
Q

Where does ventricular tachycardia originate?

A

Bundle of His

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102
Q

MCC of ventricular tachycardia

A

CAD with prior MI

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103
Q

Describe sustained v-tach?

A

> 30 seconds; almost always symptomatic; life threatening; can progress to v. fib

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104
Q

Describe non-sustained v-tach?

A

brief, limited, usually asymptomatic

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105
Q

Two types of ventricular tachycardia

A

monomorphic or polymorphic

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106
Q

Tx: sustained, stable v-tach?

A

amiodarone, procainamide, sotolol (does not respond to vagal or adenosine)

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107
Q

Tx: unstable v-tach?

A

DC, followed by amiodarone

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108
Q

Tx: no pulse v-tach?

A

defib + CPR

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109
Q

Name two non-D ccb?

A

diltiazem, verapamil

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110
Q

What rhythm do most ventricular fibrillations start with?

A

VT

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111
Q

MCC of ventricular fibrillation?

A

ischemic heart disease

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112
Q

Chronic treatment of f. fib?

A

amiodarone or ICD (unless within 48 hours of acute MI, then recurrence rate is low; no LT tx needed)

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113
Q

What lumen reduction becomes symptomatic?

A

70%

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114
Q

Worst RF for CAD?

A

DM

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115
Q

Most important modifiable RF for CAD?

A

cigarette

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116
Q

MC RF for CAD?

A

HTN

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117
Q

Angina classifications?

A

I: only with strenuous activities; no limitations
II: with more prolonged or rigorous activities; slight limitations
III: with usual activity; marked limitations
IV: at rest; often unable to carry out any physical activity

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118
Q

Most useful non-invasive test for CAD?

A

stress test

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119
Q

If a stress test is positive for CAD, what test should be undergone?

A

cardiac cath

120
Q

Definitive test for CAD?

A

cardiac cath

121
Q

Tx for CAD?

A

nitro, BB (CCB), ASA, statin

122
Q

Definitive tx for CAD

A

PTCA vs. CABG

123
Q

When is PTCA preferred?

A

1 or 2 vessel without left main

124
Q

When is CABG preferred?

A

L main, 3 vessel or critical (70%), LVEF <40

125
Q

When does pain at rest occur with ACS?

A

90% occlusion

126
Q

What signs indicate an inferior wall MI is likely?

A

chest pain + bradycardia

127
Q

First cardiac marker detected?

A

myoglobin

128
Q

Most specific/sensitive cardiac marker?

A

Troponin I/T

129
Q

What conditions cause falsely elevated troponins?

A

renal failure, advanced HF, acute PE, CVA

130
Q

What is the exception to the benign upsloping rule?

A

de Winter’s sign (upsloping ST depression with prominent T-waves) –> likely LAD proximal occlusion

131
Q

What types of ST depressions are likely ischemic?

A

horizontal and down (upsloping benign)

132
Q

What types of ST elevations are likely ischemic?

A

convex or straight (concave can be non-ischemic)

133
Q

UA and NSTEMI treatment?

A

ASA + clopidogrel + BB + LMWH

134
Q

STEMI treatment?

A

immediate and prompt with PCI within 90 minutes of presentation or thrombolysis within 12 hours of symptom onset
-ASA + prasugrel/ticagrelor/clopidogrel + UF heparin + BB + statins + ACE

135
Q

PCI must occur within how long of symptom onset?

A

12 hours

136
Q

Absolute CI to thrombolytics?

A

Previous ICH, non-hemorrhagic stroke within 6 months or closed head/facial trauma within 3 months, intracranial neoplasm/aneurysm/AVM, active internal bleeding, suspected aortic dissection

137
Q

What drugs require caution in RV (inferior wall) MI?

A

nitrates and morphine

138
Q

Tx for cocaine induced MI?

A

ASA, NTG, heparin, benzos, CCB (! no BB!)

139
Q

Dressler’s syndrome:

A

post-MI pericarditis + fever + pulmonary infiltrates

140
Q

What score is used to estimate mortality in unstable angina and NSTEMI?

A

TIMI score

141
Q

TIMI score

A
  • Age 65+ (1)
  • 3+ CAD RF (1)
  • Known CAD (stenosis 50+%) (1)
  • ASA use in past 7 days (1)
  • Severe angina (2+ episodes in 24 hours) (1)
  • EKG ST changes 0/5+ mm (1)
  • positive cardiac markers (1)
142
Q

What is a worrisome TIMI score?

A

3+

143
Q

What does the TIMI score show?

A

% risk at 14 d of all-cause mortality, new or recurrent MI, severe ischemia requiring urgent revascularization

144
Q

When do you use the HEART score?

A

Use in 21+ y/o presenting with symptoms of ACS; do not use of ST segment elevation 1+ mm

145
Q

HEART score

A

-history: slightly suspicious (0), moderately (1), highly (2)
-EKG: normal (0), non-specific repolarization disturbances (1), significant ST deviation (2)
-Age: less than 45 (0), 45-64 (1), 65+ (2)
-RF: none (0), 1-2 RF (1), 3+ (2)
Troponin: less than normal (o), 1-3x normal (1), >3x normal (2)

146
Q

HEART score interpretation

A

0-3: discharged
4-6: admitted
7+: early invasive measures

147
Q

Definitive test for variant (prinzmetal) angina?

A

coronary angiography (coronary vasospasm when given IV ergonovine or acetylcholine)

148
Q

Tx of variant (prinzmetal) angina?

A

CCB, nitrates, +/- ASA, heparin, benzos (no BB!)

149
Q

MCC of HF?

A

CAD

150
Q

Systolic or diastolic MC HF?

A

systolic

151
Q

Is EF increased or decreased in systolic HF?

A

decreased

152
Q

Is EF increased or decreased in diastolic HF?

A

Normal or increased

153
Q

Left HF MCC?

A

CAD

154
Q

Right HF MCC?

A

left-sided heart failure

155
Q

pink frothy sputum is associated with?

A

hF

156
Q

MCC of transudative pleural effusion?

A

CHF

157
Q

What breathing pattern is associated with HF?

A

Cheyne-Strokes: deeper, faster breathing with gradual decrease and periods of apnea

158
Q

HF initial test?

A

echo

159
Q

Tx HF?

A

ACE (1)/ARb (2) +/- BB + diuretics (symptoms)

160
Q

Tx of HF + a. fib?

A

digoxin

161
Q

What drugs are CI in HF?

A

metformin and NSAIDs

162
Q

MCC of pericarditis?

A

viral and idiopathic

163
Q

Mneumonic for pericarditis?

A

pleuritic, persistent, postural (relieved with leaning forward)

164
Q

What is heard on auscultation with pericarditis?

A

pericardial friction rub

165
Q

EKG of pericarditis?

A

ST elevation –> pseudo-normalization –> T wave inversion –> resolution (no reciprocal changes)

166
Q

What EKG sign is seen with pericarditis?

A

knuckle sign: ST elevation with PR depression in same lead

167
Q

Treatment of pericarditis?

A

ASA or NSAIDs x 7-14 days; second line colchicine

168
Q

Cause of constrictive pericarditis?

A

chronic pericarditis; idiopathic/viral

169
Q

MC symptom of constrictive pericarditis

A

dyspnea

170
Q

Sign seen with constrictive pericarditis?

A

Kusmmaul’s sign: increased JVD during inspiration

171
Q

What is heard on auscultation with pericarditis?

A

pericardial knock

172
Q

What condition shows a square root sign on cardiac cath?

A

constrictive pericarditis

173
Q

Definitive treatment of constrictive pericarditis?

A

pericardiectomy

174
Q

MCC of myocarditis?

A

Viral specifically enteroviruses (coxsackie)

175
Q

What may be seen on x-ray with myocarditis?

A

cardiomegaly

176
Q

What may be seen on EKG with myocarditis?

A

sinus tachy (MC)

177
Q

Gold standard for dx myocarditis?

A

biopsy

178
Q

Tx of myocarditis?

A

diuretics, ACE, IVIG

179
Q

What rash is seen with Lyme disease?

A

erythema migrans

180
Q

Mneumonic for rheumatic fever (just say the menumonic)

A

JONES CAFE PAL

181
Q

JONES CAFE PAL: major criteria

A 
Joint involvement: polyarthritis 2+ joints; lower to upper; medium large joints MC
O looks like a heart: myocarditis
Nodules
Erythema marginatum (MC on trunk)
Sydenham chorea
182
Q

JONES CAFE PAL: minor criteria

A

CRP
Arthralgias
Fever 101.3 +
ESR

Prolonged PR interval
Anamnesis of rheumatism
Leukocytosis

183
Q

Diagnostic criteria for rheumatic fever

A

throat cultures growing GABHS or ASO pos + 2 major OR

1 major and 2 minior

184
Q

Rheumatic fever is assoc with what valve dz?

A

mitral stenosis

185
Q

Tx of rheumatic fever?

A

ASA 2-6 weeks with taper +/- corticosteroids; pen G in acute phase

186
Q

MC site of PAD?

A

superficial femoral artery (hunter canal)

187
Q

MC RF for PAD

A

smoking

188
Q

Leriche’s syndrome:

A

claudication (buttocks, thigh), impotence, decreased femoral pulses

189
Q

Dependent rubor is seen with?

A

PAD

190
Q

Hanging foot over bed helps with pain?

A

PAD

191
Q

Painful ulcers at LM with clean margins?

A

PAD

192
Q

Test for PAD?

A

ABI

193
Q

Gold standard test for PAD?

A

arteriography

194
Q

ABI is + for PAD at?

A

<0.90

195
Q

Tx for PAD?

A

Cilostazol is mainstay

196
Q

Acute arterial occlusion MC location?

A

common femoral artery

197
Q

MCC of acute arterial occlusion?

A

a. fib

198
Q

Skeletal muscule can tolerate x of ischemia?

A

6 hours

199
Q

Tx of acute arterial occlusion?

A

IV heparin, emergency embolectomy

200
Q

Chronic venous insufficiency MC occurs after?

A

superficial thrombophlebitis, after DVT, or trauma to leg

201
Q

Which type of LE deficiency has edema?

A

chronic venous insufficiency

202
Q

Which type of LE deficiency has decreased pulses?

A

PAD

203
Q

Improves with walking/elevation; worse with sitting/standing?

A

chronic venous insufficiency

204
Q

Uneven, medial mallelolus, less painful ulcers?

A

chronic venous insufficiency

205
Q

Stasis dermatitis is seen with?

A

chronic venous insufficiency

206
Q

Atrophic skin changes are seen with?

A

PAD

207
Q

Atrophie blanch is seen with?

A

chronic venous insufficiency

208
Q

Dx of chronic venous insufficiency

A

trendelenburg test

209
Q

Tx of chronic venous insufficiency

A

stockings, leg elevation

210
Q

AAA: focal dilation of aortic diameter at least x diameter at level of renal arteries; typically >

A

1-1.5 x

>3 cm (normal 2 cm)

211
Q

MC location of AAA

A

infra-renal (between renal arteries and iliac bifurcation)

212
Q

AAA tx: 3-4 cm

A

US every year

213
Q

AAA tx: 4-4.5

A

US every 6 months

214
Q

AAA tx: 4.5-5.5

A

vascular surgery referral

215
Q

AAA tx: 5.5+ or >0.5 growth in 6 months

A

immediate surgery

216
Q

AAA criteria for: US every year

A

3-4 cm

217
Q

AAA criteria for: US every 6 months

A

4-4.5 cm

218
Q

AAA criteria for: vascular surgery referral

A

4.5-5.5 cm

219
Q

AAA criteria for: immediate surgery

A

5.5+ or >0.5 growth in 6 months

220
Q

AAA I:

A

l. subclavian to renal

221
Q

AAA II:

A

L. subclavian to aortic bifurcation

222
Q

AAA III:

A

mid-descending to aortic bifurcation

223
Q

AAA IV:

A

upper abdominal aorta and all or none of infrarenal

224
Q

CM of AAA:

A

fullness, throbbing pain in hypogastrium and lower back

225
Q

Symptoms of impending rupture AAA?

A

sudden onset of severe pain in back and lower abdomen, radiating to groin, buttocks, legs; grey-turner and cullen sign

226
Q

Acute leakage/rupture AAA?

A

1) severe back pain/abdominal pain
2) syncope or hypotension
3) tender, pulsatile mass
+/- flank ecchymosis
*** no further testing –> emergent lapartomy

227
Q

Acute GI bleed in patients who underwent prior aortic grafting?

A

-Aortoenteric fistula

228
Q

Initial test in suspected AAA?

A

US

229
Q

Test for pre-op planning in AAA?

A

CT scan

230
Q

Gold standard AAA?

A

angiography

231
Q

MC site for aortic dissection?

A

ascending

232
Q

Stanford A:

A

proximal AD

233
Q

Stanford B:

A

distal AD (not involving ascending)

234
Q

DeBakey I:

A

ascending + descending

235
Q

DeBakey II:

A

confined to ascending

236
Q

DeBakey III:

A

not involving ascending

237
Q

Most important predisposing RF to aortic dissection?

A

HTN

238
Q

CM of ascending AD?

A

anterior chest pain

239
Q

CM of aortic arch AD?

A

neck/jaw pain

240
Q

CM of descending AD?

A

interscapular pain

241
Q

Describe vascular symptoms of AD?

A

decreased peripheral pulses; variation in pulse/BP

242
Q

Dx of aortic dissection?

A

CT with contrast

243
Q

Gold standard aortic dissection?

A

MRI angio

244
Q

Type A AD tx?

A

surgical emergency; open!

245
Q

Type B AD tx?

A

medical management; lower BP as quickly as possible with IV BB –> SBP 100-120

246
Q

Stanford A CM?

A

new onset aortic regurgitation

247
Q

Stanford B CM?

A

HTN

248
Q

Most specific sign for DVT?

A

> 3 cm calf difference

249
Q

Initial test for DVT?

A

US

250
Q

gold standard for DVT?

A

venography

251
Q

Wells Criteria for DVT?

A

active cancer (1)
bedridden >3 days or major sx in 4 weeks (1)
calf swelling >3 cm (1)
collateral superficial veins (1)
Entire leg swollen (1)
Localized tenderness to deep venous system (1)
Pitting edema, one leg (1)
Paralysis, paresis, or recent plaster immobilization (1)
Previously documented DVT (1)
alt. diagnosis as likely or more likely (-2)

252
Q

wells criteria dvt: (-2) to 0:

A

d-dimmer

  • If + –> US (if negative r/o)
  • If (-) –> r/0
253
Q

wells criteria DVT: 1-2

A 
d-dimer
-If - --> r/o 
-If + US -----> 
If (-) r.o 
If non-diagnostic, repeat US q 2-3 d for 2 weeks 
if (+) anticoag
254
Q

Wells criteria DVT 3

A 
All get US; d-dimer to risk stratify 
(-) us and dimer --> r/o 
(+) d-dimer: 
     (+): US anticoag 
       (-) US repeat in one week
255
Q

If patient has DVT with coagulation problems? tx?

A

lifetime anti-coag

256
Q

1st DVT with reversible RF?

A

3 months

257
Q

1st DVT with idiopathic cause: proximal

A

LT

258
Q

1st DVT with idiopathic cause; distal

A

3 months if severely symptomatic; US surveillance if asymptomatic

259
Q

Anticoag used in pregnancy?

A

LMWH

260
Q

MC predisposing condition for PE?

A

Factor V Leiden

261
Q

MC symptom of PE

A

Dyspnea

262
Q

MC sign of PE

A

tachy

263
Q

PERC criteria:

A

-Age 50+
-HR 100+
SaO2 <95
-Unilateral leg swelling
-Hemoptysisi
-Recent surgery, trauma (4 weeks)
-Prior PE/DVT
-Hormone use

264
Q

Wells criteria: PE

A

Signs/symptoms of DVT (3)
PE # diagnosis (3)
HR >100 (1.5)
Immobilization at least 3 days or surgery in 4 weeks (1.5)
Previous DVT/ PE (1.5)
Hemoptysis (1)
Malignancy with treatment in 6 months (1)

265
Q

Wells Criteria: <2 (PE)

A

d-dimer

266
Q

Wells criteria: 2-6 (PE)

A

high sensitivity d- dimer

267
Q

Wells criteria: >6 (PE)

A

CT angio

268
Q

Best initial test for PE

A

Helical CT

269
Q

Gold standard test for PE

A

pulmonary angio

270
Q

CXR: PE

A

westermark’s sign; hamptom’s hump

271
Q

Westermark:

A

avascular markings distal to embolus

272
Q

Hamptoms hump

A

wedge shaped infiltrate

273
Q

EKG finding in PE

A

S1Q3T3

274
Q

S1Q3T3

A

PE

275
Q

Describe S1Q3T3

A

wide deep S in lead I, isolated Q and T wave inversion in lead III

276
Q

ABG PE

A

resp alk –> resp acidosis

277
Q

Tx PE

A

heparin –> warfarin

278
Q

MC valve affected in non-IVDA in endocarditis?

A

Mitral valve

279
Q

MC valve affected in IVDA in endocarditis?

A

Tricuspid

280
Q

MCC of sub-acute endocarditis?

A

strep viridans

281
Q

MCC of acute endocarditis?

A

staph aureus

282
Q

MCC of endocarditis in IVDA?

A

staph aureus

283
Q

MCC of endocarditis in men 50 y/o with a history of GI/GU procedures?

A

enterococcus

284
Q

MCC of endocarditis in prosthetic valve within 60 days of surgery?

A

staph epidermis

285
Q

MCC of endocarditis in prosthetic valve >60 d of surgery?

A

strep viridans

286
Q

Painless lesions on soles/palms seen in endocarditis?

A

Janeway

287
Q

Retinal hemorrhages seen in endocarditis?

A

Roth

288
Q

Tender spots on pads of digits seen in endocarditis?

A

Osler’s nodes

289
Q

Dx of endocarditis

A

Blood cultures x 3;

Echo: TTE, then if non-diagnostic TEE (if prosthetic valve, do TEE first)

290
Q

Endocarditis prophylaxis is required for those who have:

A
  • prosthetic heart valve
  • Heart repairs using prosthetic cardiac valve
  • Prior hx of endocarditis
  • Congenital heart disease (unrepaired cyanotic, repaired congential heart dz with prosthetic material during first 6 months)
  • Cardiac valvulopathy in transplanted heart
291
Q

Endocarditis prophylaxis is required for these procedures?

A
  • dental: manipulation of gums, root of teeth, oral mucosa perforation
  • respiratory: surgery on respiratory mucosa, rigid bronchoscopy
  • Procedures involving infected skin/MSK (including I&D)
  • Not needed for GI/GU
292
Q

Endocarditis prophylaxis

A

amox 2 g 30-60 minutes prior

-Clinda 600 mg if PCN allergic

293
Q

Endocarditis (acute; native)

A

nafcillin + gent x 4-6 weeks

or vanco + gent

294
Q

Endocarditis (subactue, native)

A

PCN or amp + gent

-Vanco in IVDA

295
Q

Fungal endocarditis

A

amphotericin B x 6-8 weeks

296
Q

Prosthetic endocarditis

A

Vanc + gent + rifampin

Emergency Medicine (7 decks)

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