Inservice Deck 1 - CV and ENT Flashcards
Immediate tx for unstable patient with pulses?
synchronized cardioversion @ 100J
procainamide - 2 main indications
4 stopping points
WPW and VTach
Hypotension
Resolution of arrhythmia
QRS widening > 50% original
Max dose reached (17 mg/kg)
Hepatojugular reflux indicates?
right sided heart failure
What do you think of with electrical alternans?
cardiac tamponade (pericardial effusion)
Best way to visualize the vegetations in endocarditis?
TEE
gold std - tissue biopsy
most useful test for endocarditis?
blood cxs x 3, taken 1 hour apart
Number 1 complication of endocarditis?
CHF
Most sensitive CXR finding in aortic dissection?
widened mediastinum
Sudden onset of sharp chest pain and back pain, syncope, or stroke-like symptoms think?
aortic dissection
initial treatment for hemodynamically stable patient with prolonged qt who develops tachyarrhythmia
mg
normally functioning pacemaker fails to pace, most likely cause
oversensing
- pacemaker senses external stimuli as atria/vent contraction
ekg in pericarditis will most commonly show ST elevations and what else?
PR depression
tx for patient with ST elevations in II, III, and aVF who develop hypotension?
IV fluid bolus
- inferior MI think right ventricle involved
most common sign in patient with myocarditis?
tachycardia
most specific sign in acute CHF?
S3
Patient had MI 2 months ago and has EKG with persistent ST elevation. What is the diagnosis?
ventricular aneurysm
tx for asymptomatic patient with PVCs?
observe / DC if incidental finding
10 year old has signs and symptoms of CHF as well as HTN and unequal pulses. Most likely cause?
coarctation of the aorta
dialysis patient presents with dyspnea. You press on his AV gract and the pulse drops from 130-90. What does this indicate?
high output failure
Branham sign - may occur when > 20% of cardiac output is diverted through the access
Disposition for patient with abd pain and 7 cm pulsatile mass?
operating room
- no CT, ruptured AAA
What are the contraindications to thrombolytics in patients with ACS?
TPA IS BAD
T - trauma P - pericarditis A - active internal bleeding I - intracranial pathology/tumor S - stroke - hemorrhagic or recent ischemic (6 months) B - BP uncontrolled, 180 or above SBP or 11 DBP A - allergic to med D - dissection (suspected)
what ST/T ratio can distinguish benign early repolarization from pericarditis?
ST/T < 0.25 in benign early repol
Female with palpitations and mid systolic click has what diagnosis?
mitral valve prolapse
most common cause of dysr4hythmia in cardiac transplant patient?
rejection
patient s/p cardiac transplant has bradycardia. WHat med will not be effective? why not?
atropine - denervated vagal nerve
Next test to order on 65 year old male with HTN, left flank/back pain, and trace hematuria?
abd ultrasound - r/o AAA
What tx is indicated for patient with unstable angina allergic to ASA?
clopidogrel
patient with transvenous pacer has pacer spikes with LBBB pattern on EKG. WHat does this signify?
functioning normally
a magnet placed over a pacemaker has what effect?
causes it to fire at a fixed rate
30 year old male presents after syncopal event with EKG showing ST elevatioin in V1-V3 with a RBBB without reciprocal depressions. Most likely diagnosis?
brugada syndrome
tx - refer for EPS study
What is the best tooth transplant medium? what if not available?
Hank’s balanced salt solution
- milk
- saline
- intraoral
hanks - isotonic calcium containing cell culture medium
bad breath and bad gums?
ANUG
acute necrotizing ulcerative gingivitis
What is the diagnosis and inital source that caused an abnl swelling in submandibular region with tongue deviated upward?
ludwig’s angina
odontogenic - caused from an abscess of the mandibular molars
Organism that causes malignant otitis externa?
pseudomonas - classically in diabetics
Common source of posterior epistaxis?
sphenopalatine artery
patients most at risk for posterior bleeds?
elderly with coag
diabetic presents with facial pain, unilateral facial swelling over the mandible, fever, trismus, purulent discharge from stetson’s duct has what?
suppurative parotitis
Cause - bact = staph viral = mumps
tx - abx, sialogogues
patient has acute onset of tinnitus hearing loss and vertigo, N/V, and nystagmus that is fatigable. No recent URI and has had multiple previous episodes. Diagnosis?
meniere’s disease
child has been coughing since playing with legos. What test is needed?
bronchoscopy after CXR
Diagnosis and tx for baby with infection of lacrimal sac?
dacryocystitis
tx - topical and systemic abx, ophtho consult, warm compresses
3 year old immigrant with multipe episodes of paroxysms of coughing. Dx and tx?
pertussis
tx - erythromycin or other macrolide
are systemic abx indicated for most patients with dry socket
NO!
tx - nerve block, irrigate, eugenol, +/- gelfoam
What infection is of concern in diabetic febrile who develops black sputum?
mucormycosis
what is the disposition and tx for a febrile patient who presents with posterior auricular pain and tenderness to touch
mastoiditis
tx - admit with IV abx
most common organism in otitis media?
strep pneumo
most common complication of AOM?
tympanic membrane perforation
