Exam 2 Review Flashcards
S1 heart tones indicate:
Closure of the Mitral and Tricuspid (AV) Valves
Which of the following is the least accurate cardiac enzyme indicating an MI?
Troponin T
Myoglobin
CPK-MB
BNP
Myoglobin
An elevated BNP indicates:
AMI
Heart Failure
Pulmonary HTN
Unstable Angina
Heart Failure
What sign indicates Chest Pain?
Murphy’s sign
Cullen’s sign
Obturator Sign
Lavine’s sign
Lavine’s sign
(Murphy’s: Cholycystitis, Cullen’s: pancreatitis, Obturator: Appendicitis)
Which of the following is a P2Y12 inhibitor
Amlodipine
Losartan
Hydralazine
Ticagrelor
Ticagrelor
Which of the following is NOT a GP IIb/IIIa inhibitor?
Reopro
Integrilin
Clopidogrel
Aggrastat
Clopidogrel
Which agent is a potent vasodilator that acts equally on venous and arterial smooth muscle?
Nitroprusside
Nitroglycerin
Hydralazine
Labetalol
Nitroprusside
This dihydropyridine calcium channel blocker is commonly used to treat HTN in head bleeds:
Nitroprusside
Nicardipine
Diltiazem
Hydralazine
Nicardipine
Which of the following is NOT an organic nitrate?
Cleviprex
Isordil
Apresaline
Nipride
Cleviprex
(Apresaline: Hydralazine)
Which dyhydropyradine is a potent vasodilator that is metabolized by tissue? (AKA no renal or hepatic dose is required)
Cardene
Apresoline
Clevidipine
Diltiazem
Clevidipine
What class of drug is methyldopa?
Alpha 1 antagonist
Alpha 2 agonist
Organic Nitrate
Phosphodiesterase inhibitor
Alpha 2 agonist
What drug prevents hydrolysis of cAMP and thus prolongs the action of protein kinase?
Methyldopa
Milrinone
Cleviprex
Flolan
Milrinone (Phosphodiesterase inhibitor)
Which inodilator is used in right-sided heart failure?
Dobutamine
Primacor
Nipride
Cleviprex
Primacor (Milrinone)
(Dobutamine is left-sided)
Which of the following is a 5-HT3 Serotonin Receptor Antagonist?
Zofran
Phenergan
Haldol
Inapsine
Zofran
(Phenerhan: H1 antagonist)
In the clotting cascade, which factor is the start of the common pathway?
VII
IV
X
XII
X
(VII start the external pathway)
(XII starts the internal)
Which agent blocks thromboxane A2 (TXA2) synthesis from arachidonic acid in platelets?
ASA
Reopro
Heparin
Plavix
ASA
(Reopro: GP IIb/IIIa inhibitor, Plavix: P2Y12)
GP IIb/IIIa inhibitors:
abciximab (abcixifiban) (ReoPro)
eptifibatide (Integrilin)
tirofiban (Aggrastat)
What drug binds to antithrombin III and accelerates activity, inhibiting thrombin and factor Xa?
ASA
Plavix
Lovenox
Factor X
Lovenox (enoxaprin)
What stage of acetaminophen overdose does death occur?
I
II
III
IV
Stage III
What is the antidote for acetaminophen overdose?
Methyl Blue
Indomathacine
Dexamethasone
N-Acetylcysteine
N-acetylcysteine (Bucamyst)
All of the following are opioid receptors EXCEPT:
Mu
Gamma
Delta
Sigma
Gamma
(Mu, Kappa, Sigma, Delta)
What anticonvulsant is used for prophylactic tx of SAH?
Midazolam
Lorazepam
Phenobarbital
Levetiracetam
Levetiracetam (Keppra)
What drug is used in the tx of GI bleeds?
Sandostatin
Methylprednisolone
Dexamethasone
Keppra
Sandostatin (octreotide)
Identify a balloon port, CVP, PA, and infusion port:
Balloon port is SHORT and RED, and has a locking mechanism
CVP is BLUE, lumen is PROXIMAL (30cm from tip)
PA port is YELLOW, lumen is DISTAL (at the tip)
Infusion port is WHITE/CLEAR and usually longer, lumen is PROXIMAL (30cm from tip)
Which port is essential to monitor the waveform in case of PAC malposition?
The PA distal port (YELLOW)
Which port is transduced with a normal value of 0-6mmHG?
CVP port (Blue) The most proximal opening (30cm from tip)
Identify different types of aortic dissections:
Type I
Type II
Type III
Type I: Root, Ascending, Arch, Descending
Type II: Ascending Only
Type III: Descending aorta and extends distally
What hemodynamic parameter is equivalent to LVEDP?
CVP
PCWP
PAP
RAP
PCWP
(CVP=RVEDP/RAP)
Which of the following does not factor into oxygen delivery (DO2)?
SaO2
BSI
Cardiac Index (CI)
PaO2
PaO2
(Equation: Cardiac Index: CO/BSI)
The phlebostatic axis aligns to what anatomical structure?
Right Atrium
Left Ventricle
Aortic Arch
Right nipple line
Right Atrium
What are the two transducer points?
Phlebostatic axis (Right Atrium)
Tragus (Formen of Munro)
What does the area under the arterial waveform represent?
SBP
LVEDP
MAP
CO
MAP
Which type of central line has the highest risk for a DVT?
Jugular
Subcarotid
Brachial
Femoral
Femoral
(Subcarotid is MADE UP)
Which of the following is the parameter for a reduced EF?
<40%
<50%
<65%
<25%
Reduced: <40%
(Preserved: >50%, Midrange: 40-50%)
Which hemodynamic parameter reflects left ventricular afterload?
PVR
SVR
MAP
PCWP
SVR
Which of the following will reduce right ventricular afterload?
Nitroglycerin
Nipride
Propofol
Nitric Oxide
Nitric Oxide
Which of the following is best if you want to give a vasopressor?
Dopamine
Milrinone
Epinephrine
Phenylephrine
Phenylephrine (Pure Alpha)
Which of the following will you find a high cardiac output and high SvO2?
Sepsis
HF
Anemia
Hypoxemia
Sepsis
Which of the following is an advantage of IABP therapy?
Increases afterload
Promotes pulsatile flow
Increases myocardial oxygen consumption
Promotes pulsatile flow
Promotes pulsatile flow
(Decreases afterload; Decrease myocardial oxygen demand; Increases coronary artery perfusion)
What trigger should you use with a IABP in cardiac arrest?
Pressure
ECG
Either
Turn the IABP off
Pressure
Be familiar with timing errors and associated waveforms
Early inflation
Late inflation
Early deflation
Late deflation
Should be inflating ON the dicrotic notch
Late deflation is the worst thing an IABP can do
Be familiar with the elements of an IABP waveform:
Unassisted systolic
Unassisted diastolic
Assisted Systolic
Assisted diastolic
Dicrotic notch
You are pacing a patient in VVI mode. What does the second letter represent?
Chamber Sensed
Chamber Paced
Pacemaker response to sensing
Programmed Function
Chamber sensed
(Paced, Sensed, Response)
(VVI is a transvenous setting)
Which of the following would be a pacer setting for a patient with a transvenous pacer?
DDD
DDI
DAI
VVI
VVI
Anything that starts with D is Dual-pacing
Anything sensing the atria is Dual-pacing
MUST be epicardial
What pathogen is the most common cause of community acquired pneumonia?
S. Pneumoniae
S. Aureus
H. Influenza
Klebsiella
S. Pneumoniae
Which of the following is NOT a treatment for community acquired pneumonia?
Cefepime
Ceftriaxone
Levofloxacin
Ampicillin-sulbactam
Cefepime
Which antibiotic is used for treatment of chemical pneumonitis?
Clindamycin
Amoxicillin
Flagyl
No ABX used
No ABX used
What test is used to diagnose TB?
Acid Fast
Gram stain
Sputum Stain
PCR
Acid Fast
Mycobacterium: No cell wall for gram staining
What pathogen is the most common cause of meningitis in adults?
S. Pneumoniae
H. Influenzae
E. Coli
L. Monocytogenes
S. Pneumoniae
What is the IV antiviral that treats severe influenza?
Peramivir
Zanamivir
Oseltamivir
Baloxavir
Peramivir
The rest are PO
Which of the following is not a Human Herpes Virus?
Epstein-Barr
Varicella Zoster
CMV
Noravirus
Noravirus
What type of pathogen causes malaria?
Virus
Bacteria
Protozoa
Amoeba
Protozoa
What is the first line treatment of C. Diff in the intubated ICU Patient?
Vancomycin
Metronidazole
Cefepime
PCN
Metronidazole (Flagyl)
Vancomycin PO can be used, but not for the intubated PT.
You have an afebrile patient with abdominal pain and rice water diarrhea. What is the first line treatment?
Doxycycline
Azithromycin
Ceftriazxone
Vancomycin
Doxycycline
(Cholera)
What type of pathogen causes C. Diff?
Gram positive cocci
Gram negative cocci
Gram negative rod
Gram positive rod
Gram positive anaerobic rod
A CVA pt has a left-sided tongue deviation. What cranial nerve is involved?
XII
X
VII
IX
XII
What dermatome is found at the nipple line?
T4
T10
L1
C8
T4
Which of the following is a sign of meningeal irritation?
Psoas
Kehr’s
Chvosek’s
Brudzinski’s
Brudzinski’s (Hip/Knee flexion 2/2 raising head)
Kernig’s (increased pain/resistance to straightening knee from hip/knee flexion)
(Kehr’s: diaphragmatic irritation , Psoas: Appendicitis , Chvosek’s: Hypocalcemia)
What is the end-goal therapy for SBP in subarachnoid hemorrhage?
140mmHG
180mmHG in ischemic/thrombolytic strokes
What anatomical landmark aligns with the tragus?
Foremen of Munro
Cerebral aqueduct
3rd Ventricle
Hypothalamus
Foramen of Munro
What area of the brain is responsible for word formation?
Wernicke’s
Broca’s
Parietal
Occipital
Broca’s
What is the most common cause of a SAH?
Trauma
Berry’s Aneurysm
Basal artery dissection
Severe HTN
Berry’s aneurysm (Medical)
(2nd most common cause: ADM)
How many nerve roots extend from the cervical vertebrae?
7
6
8
10
8
A patient has a MAP OF 88 AND ICP OF 23. What is the CPP?
MAP - ICP = CCP
CPP is 65
OB patient has 4 living children with 1 born at 32 weeks and no abortions. What is her OB history?
P3104G5
P4004G5
P2114G5
P3104G4
PfpalG
(P: full-term, pre-term, abortions, living children; G: total pregnancies)
P3104G5
The umbilical cord has:
2 arteries and 1 vein
2 veins and 1 artery
2 veins and 2 arteries
1 vein and 1 artery
2 arteries and 1 vein
:)
The uterine fundus of a pregnant pt is at the umbilicus. How many weeks gestation is she?
10 weeks
20 weeks
15 weeks
23 weeks
20 weeks
(McDonald’s rule: fundus leaves the pelvic cavity ~14 weeks)
What condition found in TOCO monitoring requires emergent C-section?
Variable decelerations
Early decelerations
Late decelerations
Atony
Late decelerations
OB patient with severe abdominal pain and dark red vaginal bleeding. you suspect:
Abruptio placenta
Placenta Previa
Uterine rupture
Ectopic pregnancy
Abruptio Placenta (Sever pain, dark red blood)
(Placenta previa: Painless, bright red blood; Uterine rupture: no bleeding; Ectopic pregnancy: appendicitis-like pain, possibly bleeding)
Pre-eclampsia is defined as a SBP >140, plus:
Pulmonary edema
Peripheral edema
Seizures
Proteinuria
Proteinuria
(Peripheral edema is a common finding in OB patients; non-specific)
What calcium channel blocker is used to treat pre-eclampsia?
Labetalol
Hydralazine
Cardene
Nifedipine
Nifedipine (Calcium channel blocker) 1st line
Labetalol is a beta-blocker
Cardene is second line
Hydralazine acts as an organic nitrate
What drug is used to treat post-partum hemorrhage?
Mag sulfate
Terbutaline
Apresaline
Oxytocin
Oxytocin (Pitosin)
Will cause uterine contractions. Do not administer until after delivery of placenta
How to recognize different blocks on ECG
Which drug is a benzodiazepine antagonist?
Phenytoin
Luminal
Romazicon
Levetiracetam
Romazicon (flumazenil)
Localize MIs on 12-lead ECG
I SEE ALL LEADS
Inferior: II, III, aVF
Septal: V1, V2
Anterior: V3, V4
Low-Lateral: V5, V6
High-Lateral: I, aVL
Identify suspect artery through MI localization on ECG
Recognize electrolyte abnormalities on ECG
Strep pneumoniae
Most common cause of CAP (40% of cases)
Gram +
Lobar Pattern on Cxr
Associated w/ rigors and sputum production
Emerging drug resistance
TX: ceftriaxone -or- ampicillin-sulbactam + azithromycin or levofloxacin
(PCN allergy: levofloxacin and aztreonam)
Haemophilus Influenza
2nd most common cause of CAP
Gram -ve coccobacillary
Anaerobe
Nasal flora
Usually lobar
Sputum production
Thx: Ceftriaxone -or- ampicillin-sulbactam + azithromycin or levofloxacin
(PCN allergy: levofloxacin and aztreonam)
Atypical Pneumonia
Mycoplasma Gm +/Chlamidophila Gm -
Walking Pna (often mild, no hypoxia)
Tx: Azithromycin or Levofloxacin
Legionella
Presents as acute pneumonias, but minimal sputum + HA and confusion, Abd on, Nausea, Diarrhea, LFTs
Mortality 15-50%
Tx: Azithromycin
Chemical pneumonitis
Inflammation immediately following aspiration
Tx: O2, removal of aspirate. NO Abx needed
Aspiration Pneumonia
Mostly Gm - anaerobes
Favors RLL on Cxr
Several days from aspiration event to pneumonia
Tx: clindamycin -or- metronidazole + amoxicillin
HAP/VAP
Hospital-acquired Pna/Ventilator-acquired Pna
Watch for development ~48hours after admission or ~2-3 days after intubation
Complex treatment: follow algorithm
HAP/VAP tx algorithm
- Stability
- Previous Abx (w/in 90 days)
- Pseudomonas Risk
- MRSA risk
Treatment of TB
4-drug regimen: INH, rifampin, pyrazinimide, ethambutol
CLABSI
Pulmonary artery catheters- highest infection rate (3.7%)
Remove: Severe Sepisis, endocarditis, thrombophlebitis, bacteremia >72 hours
Salvage: always remove line in S. Aureus, Pseudomonas, fungi, mycobacteria, or polymicrobial infection
Empiric therapy: Vancomycin, add Cefepime for pseudomonas/Gram -ve coverage/neutropenia. Continue for 10 days after 1st negative culture.
CAUTI
Tx: IV imipenem and vancomycin for sepsis/drug resistance
Ceftriaxone, Pipercillin/Tazobactam, or ciprofloxacin for less severe hospitalized PT.
Switch to PO therapy after clinical improvement
Bacterial Meningitis Tx
Varies by age/source, but generally involves vancomycin + 3rd gen cephalosporin.
Cranial nerves
I- Olfactory
II- Optic
III- Oculomotor
IV- Trochlear
V- Trigeminal
VI- Abducens
VII- Facial
VIII- Vestibulocochlear
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
Dermatomes T4 & T10
T4- Nipple line
T10- Umbilicus
