General

Question 1

most common sx in myocarditis

Answer 1

tachycardia out of proportion to fever -only 50% of patients have viral-related URI/GI symptoms

Question 2

treatment for inferior MI vs non-inferior MI

Answer 2

non-inferior MI->MONABASH inferior (RV MI)–>avoid MONA (morphine, nitrates) bc these are preload dependent MI’s and these drugs will dec preload worsening hypotension

Question 3

pt with an inferior MI is hypotensive, next step…

Answer 3

Give fluid bolus -inferior MIs are preload dependent -avoid pressors unless not fluid reponsive

Question 4

What drug should be added first for aortic dissection BP and HR control

Answer 4

Beta blocker then other afterload reducing agents -BB both dec BP and blocks reflex tachycardia. Other afterload agents cause reflex tachycardia, which is why BB should be given first

Question 5

Goals for aortic dissection

Answer 5

SBP 100-120 HR<60

Question 6

Calculate the rate on EKG

Answer 6

300-150-100-75-60-50-43-37 or Count #QRS in 10sec strip*6

Question 7

which drugs are used in pericarditis

Answer 7

nsaids-dec sx but do not reduce reccurence colchicine-shown to reduce duration of sx AND dec recurrence rate

Question 8

Most common reason for LVAD failure

Answer 8

Suction event -dec preload causes inc negative LV pressure causing the inflow cannula to be sucked down into the LV–>dec CO rx: IVF, screen for arrhythia

Question 9

who gets antibiotic ppx for infective endocarditis?

Answer 9

-hx of endocarditis -hx of cardiac surgery+valve pathology -undergoing dental procedures -prosthetic valve (for 1st 6 months)

Question 10

EPI dosing in -anaphylaxis -cardiac arrest

Answer 10

-anaphylaxis: 0.1 mg -cardiac arrest: 1 mg IV/IM q3-5 min (acls)

Question 11

EKG reading step by step rule of 4s

Answer 11

1. 4 initial features: History, rate, rhythm, axis
2. 4 waves: P, QRS, T, U
3. 4 intervals: PR, QRS, ST, QT

Question 12

1. 4 initial features: History, rate, rhythm, axis details

Answer 12

History-name, CC, history, lead placement

rate- 300/R-R(# large squares)

rhythm-reg or irreg (look at QRS complexes)

axis-normal, LAD, RAD

Question 13

Axis

Answer 13

Question 15

2. 4 waves: P, QRS, T, U

Answer 15

P wave:present, monophasic in II, biphasic in V1. 2.5 mm in II (p pulmonale)

Question 16

2. 4 waves: P, QRS, T, U

Answer 16

QRS complex

• <0.12 sec (3 sm boxes)
• any Q waves? septal q waves are normal (I, AVL, V, VI)
• q waves in V1-V3 are abnormal

Question 17

2. 4 waves: P, QRS, T, U

Answer 17

T wave:

• upright in all leads except AVR and V1
• look for peaked, hyperacute, flattened, biphasic T waves
• Broad, peaked, hyperacute T waves seen in early MI and often precedes STE and Q waves

Question 18

2. 4 waves: P, QRS, T, U

Answer 18

U wave (V2, V3)

• unknown what causes U wave
• should be upright
• inversely proportional to HR, assoc with long QT syndrome
• abnormalities
  
  • prominent U waves: >1-2 mm, seen in bradycardia, severe hypokalemia
  • inverted U waves: very specific for heart disease.
  • U wave + CP–>specific for myocardial ischemia. possibly the earliest sign of UA and MI

Question 19

Categories of fetal tracings

category I

category III

category II

Answer 19

category I: FHR 110-160, +/-accelerations and early decels. NO variable or late decels

category III: absent baseline variability, recurrent variable/late decels, bradycardia

category II: whatever isn’t I or III

Question 20

Options to dec risk of pre-term delivery

Answer 20

Cervical cerclage

hydroxyprogesterone

-progesterone (-)fetal membrane apoptosis,

Question 21

what is the only medication proved to dec risk of preeclampsia

Answer 21

asa

• mech of preeclampsia: inc plt aggregation and inc vasocontriction leading to placental ischemia and infarct. ASA dec both reducing risk
• give to pts with chronic htn, ckd, dm, autoimmune disease, prior preeclampsia, multiparity

Question 22

Syndesmoses joint

Answer 22

joint where two bones areseparated by ligaments or connective tissue (interosseus membrane)–>tibia/fibula and radius/ulna

Question 23

what is the first step in an infertility eval?

Answer 23

Eliminate the man–>semen analysis