EM MED Chest

Question 1

What are the 7 components of the TIMI score

Answer 1

Age older than 65

More than 3 risk fxs

Prior stenosis >50%

St segment changes

2 or more anginal events w/in 24 hours

Asprin use w/in 7 days

Elevated Cardiac Markers

Question 2

Components of a HEART score

Answer 2

History
(Slightly sus-0, Mod sus-1, high sus-2)

EKG
(No change-0, Non specific T wave change -, ST depressions-2)

AGE
(<45-0, 45-64-1, >65-2)

Risk fx
(None-0, 1-2-1, <3-2)

Initial Troponin
(NML-0, 1-3x NML-1, >3x ULN-2)

Question 3

When should NSTEMI pts get PCI

Answer 3

refractory angina

hemodynamic or electrical instability

patients at increased risk for clinical events

Question 4

If fibrinolytics fail, rescue PCI is recommended for patients:

Answer 4

in cardiogenic shock who are <75 years old

with severe heart failure or pulmonary edema

with hemodynamically compromising ventricular arrhythmias

in whom fibrinolytic therapy has failed and a moderate or large area of myocardium is at risk

Question 5

STEMI patients who received fibrinolytics should get full-dose anticoagulants for a minimum of

Answer 5

48 hours

Question 6

C/I for ACEI

Answer 6

hypotension

bilateral renal artery stenosis

renal failure

history of cough

angioedema due to prior angiotensin-converting enzyme inhibitor use

Question 7

Verapamil and Diltizem benefit what ACS pts

Answer 7

Verapamil and diltiazem are potentially beneficial in patients
with
- ongoing ischemia
-atrial fibrillation with rapid ventricular response who do not have congestive heart failure
-left ventricular dysfunction
-atrioventricular block
-when β-adrenergic antagonists are contraindicated

Question 8

What is the measurement for Inferior vena cava to Dx Acute HF

Answer 8

An IVC size >2 cm or collapsibility index of <50% is indicative of elevated central venous pressure

Absent pulmonary disease, these are specific for acute HF

Question 9

A pt is in normotensive heart failure

And has never taken diuretics

What is the recommended dose

Answer 9

If the patient is on furosemide 80 mg/PO twice a day, then an initial ED dose is 80 to 200 mg/IV bolus

Loop diuretic naïve? —> start with furosemide 40 mg/IV

Question 10

MC findings in Dilated Cardiomyopathy

Answer 10

LVH and LAE

Question 11

Role of Amioderone or ICD in Acute heart failure

Answer 11

Patients at risk for sudden cardiac death may benefit from amiodarone therapy or an implanted cardioverter-defibrillator

Question 12

ECG findings in HOCM

Answer 12

Resting ECG is nonspecific in most patients with HCM often demonstrating LVH and left atrial enlargement; Deep broad Q waves in septal, lateral or inferior leads

Question 13

Indicators of poor prognosis in acute pericarditis

Answer 13

temperature >38°C (100.4°F)

subacute onset over weeks

immunosuppression

history of oral anticoagulant use

associated myocarditis (elevated cardiac biomarkers, symptoms of CHF)

large pericardial effusion (an echo-free space >20 mm)

Question 14

MC cause of non traumatic pericardial effusion/ Tamp

Answer 14

Cancer

Question 15

What is the triple rule out for Aortic Dissection

Answer 15

Coronary CT angiography,

Question 16

If treating cancer with L-asparaginase

What is the risk

Answer 16

Increased risk of DVTs

Question 17

What is the risk of VTE after intubation

Answer 17

Up to 4 weeks post

Question 18

What metabolic finding difs out syncope vs SZR

Answer 18

Transitory, wide anion gap acidosis follows a generalized seizure but is not present in simple syncope

Question 19

What is the CSRS score

Answer 19

CSRS: predict 30-day serious outcomes not evident during the index ED eval

Applicable to age ≥16 yo, includes following predictors:

• Predisposition to vasovagal syncope
• Heart disease
• Any SBP in ED <90 or >180
• Troponin >99th percentile for normal population
• Abnormal QRS axis (< -30° or > 100°)
• Prolonged corrected QT interval (>480 milliseconds)
• ED diagnosis of cardiac or vasovagal syncope

Question 20

High risk, admit syncope pts

Answer 20

Exertional syncope
Concern for acute coronary syndrome (ACS)
History of ventricular arrhythmia

Implantable cardiac device

Known CHF
(ejection fraction <40%)
Concerning ECG Findings

Question 21

If arterial O2 fails ro raise in response to supplemental o2

Suspect

Answer 21

A Right to left shunt for Hypoxemia

Question 22

Acute PaCO2 elevations over 100 can cause

Answer 22

Cardio collapse

Question 23

What is the rise of HCO3 in acute and chronic hypercapnia

Answer 23

Acute: increases about 1 mEq/L for each increase of 10 mmHg in PaCO2

Chronic: concentration increases about 3.5 mEq/L for each increase of 10 mmHg in PaCO2

Question 24

Can Fluoroquinolones be used in Myasthenia Gravis pts?

Answer 24

NO!

Question 25

Out pt PNA tx

Answer 25

Macrolide-level I recommendation

Respiratory fluoroquinolone

Doxycycline-level III recommendation