deck 39

Question 1

impt complication of implantable pacemakers or cardioverter-defribillator placement

Answer 1

transvenous lead placement through the tricuspid valve can cause severe tricuspid regurg due to direct valve leaflet damage or inadequate leaflet coaptation

Question 2

cause of SOB in pt with ascending aortic aneurysm

Answer 2

aortic regurg (can propagate proximally from site of intimal tear to involve the aortic valve)

Question 3

other lab to order for new-onset AF

Answer 3

TSH + T4 to screen for occult hyperthyroidism

Question 4

most common bugs for brain abscesses

Answer 4

viridans streptococci
staph aureus
gram-negative organisms

Question 5

PE algorithm to remember

Answer 5

In patients with likely probability of acute PE, especially those in moderate to severe distress, need to anticoagulant BEFORE diagnostic testing (has been shown to decrease mortality risk)

Question 6

peak airway pressure

Answer 6

• max pressure measured as tidal volume is being delivered

- = resistive pressure + plateau pressure

Question 7

how to calculate PEEP

Answer 7

end-expiratory hold maneuver

Question 8

plateau pressure

Answer 8

sum of elastic pressure and PEEP

Question 9

elastic pressure

Answer 9

lung’s elastane X volume of gas delivered

Question 10

aspiration pneumonitis

Answer 10

acute lung injury due to aspiration of acidic and sterile stomach contents (gastric acid induces a chemical burn and consequent inflammatory response)

Question 11

presentation of aspiration pnuemonitis

Answer 11

• presents hours after aspiration event
• ranges from no symptoms to nonproductive cough, hypoxia, respiratory distress
• CXR infiltrates (one or both lower lobes)

Question 12

radiograph of pseudogout

Answer 12

chondrocalcinosis (calcified articular cartilage) (the arthritis is caused by release of calcium pyrophosphate dehydrate crystals from calcification of articular cartilage into the joint space)

Question 13

how to tell if you’ve overdiuresed someone

Answer 13

look at k (hypokalemia)

also see hypomagnesemia

Question 14

timeline of amiodarone toxicity

Answer 14

can occur months to years after therapy

Question 15

pulmonary presentation of amiodarone toxicity

Answer 15

interstitial pneumonitis – dyspnea + nonproductive cough + new reticular or ground glass opacities on CXR

Question 16

acute optho complaint commonly seen in poorly controlled diabetes

Answer 16

ischemic oculomotor (CN III) palsy, presenting with “down and out” gaze + diplopia + normal pupillary response

Question 17

CSF with guillain bairre

Answer 17

elevated protein + normal cell count (albuminocytologic dissociation)

Question 18

complete heart block on ECG

Answer 18

• P waves unassociated with QRS complexes

- R-R interval constant and independent of P-wave occurrence

Question 19

management of symptomatic third-degree AV block

Answer 19

• temporary pacemaker insertion while undergoing further evaluation to identify and correct reversible causes

Question 20

painless thyroiditis presentation

Answer 20

acute thyrotoxicosis + mild thyroid enlargement + contender + suppressed TSH + decreased RAI uptake

Question 21

pathophys of hypertensive heart disease

Answer 21

vascular remodeling –> impaired myocardial relaxation + increased LV wall stiffness –> increase in LV end-diastolic pressure

Question 22

cardiac auscultation with AS

Answer 22

• soft second heart sound (thickening and calcification of the aortic leaflets leads to reduced mobility) (as a result of reduced mobility, A2 is delayed and occurs simultaneously with pulmonic valve closure leading to a single S2)
• mid to late systolic murmur with maximal intensity at the 2nd right intercostal space

Question 23

cause of S2

Answer 23

aortic valve closure

Question 24

why modify FiO2 on ventilator + what FiO2 should ideally be

Answer 24

Once patient is stable, need to reduce FiO2 ASAP below levels that predispose to yxgen toxicity (i.e. below 60%).