Mock Exam Part 1, #31-60 Reviewer Flashcards
The air remaining in the chest at the end of exhalation and does not contribute to gas exchange is the ___
Functional Residual Capacity
Dead space and FRC do not contribute to gas exchange
Physiologic dead space - non perfused areas of the lung
functional residual capacity - The air remaining in the chest at the end of exhalation
A mountaineer started his climb at sea level when he experienced dyspnea. The first responder gave him 80% oxygen supplementation. What would be the expected PaO2 that the mountaineer is getting?
400 mmHg
Five times Rule
expected Pao2 from supplemental oxygen can be roughly estimated by multiplying the actual Fio2 by 5
A cyclist who reportedly bike a distance of 130km was brought to the ED due to weakness and fatigue. On diagnostics, the serum phosphate was noted to be 5.5 mg/dL. What could be the possible cause of the cyclist presentation?
There is a shift of phosphate from ICF to ECF possibly due to rhabdomyolysis
Shift of PO4 from ICF to ECF
Hemolysis
Rhabdomyolysis
Tumor lysis syndrome
Respiratory acidosis
Diabetic ketoacidosis
A patient was brought to the ED due to generalized weakness. Upon attaching to the cardiac monitor, there was a note of heart block. Magnesium was also noted to be elevated. What is the best management that can be done for this patient?
Start with 10mL of 10% calcium chloride IV over 2 to 3 minutes
Mg level 12-15 meq/L - Hypotension, heart block, cardiac arrest
TX:
- If renal failure not evident - dilution by IV fluids followed by furosemide
- Severe symptomatic - 10 mL of 10% calcium chloride IV over 2 to 3 minutes
- Renal Failure - Dialysis
Which of the following is an ECG feature of premature ventricular contractions
Abnormally widened QRS complex with different morphology from SA node-initiated QRS complex
Which of the following can be given as pericardioversion anticoagulation for unstable patients with mechanical prosthetic valve or rheumatic mitral stenosis?
Enoxaparin 1mg/kg SC
Nonvalvular atrial fibrillation: Onset >48H or unknown OR Stroke or TIA <6mon OR CHA2DS2VASc score >/= 2
- Dabigatran
- Rivaroxaban
- Apixaban
The following belongs to Class III Vaughan-Williams Classification of antiarrhythmic medication
Amiodarone
Mnemonic: Some Block Potassium Channels
Class I: Na channel blockers (1a, 1b, 1c)
Class II: Beta blockers
Class III: K channel blockers (Sotalol)
Class IV: Calcium channel blockers
Which of the following is a significant adverse effect of dronedarone, a noniodinated, less lipophilic derivative of amiodarone
New-onset or worsening heart failure
Which of the following vasopressor is dose-dependent in increasing the heart rate, blood pressure, cardiac output and systemic vascular resistance
Dopamine
5-10 mcg/kg/min - Inc RENAL blood flow, HR, contractility and CO
>10mcg/kg/min - vasoconstriction and increased blood pressure
1-5 mcg/kg/min - no longer recommended
This inotrope is indicated for the short-term management of patients with acute cardiac decompensation, particularly in patients presenting with cardiogenic shock
Dobutamine
Which of the following is an indication for hyperbaric oxygen therapy
Central Retinal Artery Occlusion
see table 21-2
What is the most common adverse effect of hyperbaric oxygen therapy
Middle ear barotrauma
It is believed that conventional chest compressions can generate approximately how much of physiologic cardiac output
25-30%
CPR generates 1/4 to 1/3 of physiologic cardiac output
maneuver that is NOT RECOMMENDED to relieve foreign body obstruction
Blind finger sweep
Appropriate energy level for synchronized cardioversion of wide irregular rhythms
Not for synchronized cardioversion, needs defibrillation
SYNCHRONIZED CARDIOVERSION
narrow regular rhythm - 50-100J
narrow irregular rhythm - 120-200J
wide regular rhythm - 100J
wide irregular rhythm - FOR DEFIBRILLATION
Appropriate energy level for synchronized cardioversion of ventricular tachycardia in children
1 J/kg
V Tach w/ pulse – 1 J/kg (sync cardioversion)
V Fib – 2-4 J/kg (defib)
Dose of lidocaine for refractory VF/ pulseless VT
1-1.5 mg/kg
1-1.5mg/kg – initial IV bolus
0.5-0.75mg/kg – 2nd IV bolus
1-4mg/min – infusion upon ROSC
In patients who are eligible for therapeutic hypothermia, what is the targeted temperature during the 1st 24 hrs after ROSC
32-36 ⁰C
Which of the following physiologic changes occurs in pregnancy:
a) Decreased central venous pressure
b) Decreased respiratory rate
c) Increased tidal volume and minute ventilation
d) Increased lower esophageal tone and gastric emptying
Increased tidal volume and minute ventilation
a) Decreased central venous pressure - May be increased up to 10mmHG
b) Decreased respiratory rate - No change
d) Increased lower esophageal tone and gastric emptying - DECREASED
Which of the following drugs used in resuscitation is Pregnancy Risk Category D?
a) Adenosine
b) Amiodarone
c) Atropine
d) Lidocaine
Amiodarone
a) Adenosine - Class C
c) Atropine - Class C
d) Lidocaine - Class B
A primigravid 36 weeks AOG patient came in the ED with the chief complaint of persistent vomiting for the past 2 days. How much of resuscitative fluid will you give to accommodate the demand in increase in blood and plasma volume for this type of patient?
Give volume of resuscitative fluids by 50% above that is required by the nonpregnant patient
The most common cause of septic shock in pregnancy
Pyelonephritis
Which among the physiologic parameters will not increase during pregnancy that will affect resuscitation process in an Emergent gravid patient?
a) Cardiac output
b) Blood pressure
c) Tidal volume
d) Central venous oxygen saturation
Blood pressure
Peripheral resistace - DECREASE
a) Cardiac output - increased by 30-50%
c) Tidal volume - Increase
d) Central venous oxygen saturation - Increase as high as 80%
A G3P2 was currently managed with resuscitative fluids at the ED en route to the operating room. Patient was already stabilized however hypotensive 15 minutes after spinal anesthesia induction. What medication of choice is appropriate for this patient?
Ephedrine
Hypotension related to spinal anesthesia or unresponsive to fluids
Noninvasive positive-pressure ventilation ( NIPPV ) is most commonly used for patients with
cardiogenic pulmonary edema
An inducting agent during rapid sequence intubation preserving respiratory drive and often used in patients with refractory status asthmaticus
Ketamine
A 39 year old chronic kidney disease patient came in the ED with chief complaint of persistent difficulty of breathing. Initial laboratory result revealed hyperkalemia. What will be the appropriate neuromuscular agent that can be used for this patient
rocuronium
NOTE: succinylcholine -> Do not use in patients with sus
pected preexisting significant hyperkalemia (especially renal failure), myopathies, or myasthenia gravis
The parameter to be used in calculating ideal body weight for patients having acute respiratory distress syndrome
height
Which of the following is appropriate In assessing difficulty establishing a traditional tracheal airway
a) Mallampati score >2
b) hyoid-mental distance of 2 fingerbreadths
c) thyroid-to-mouth distance of 3 fingerbreadths
d) incisor opening distance of 3 fingerbreadths
incisor opening distance of 3 fingerbreadths
LEMON Airway Assesment Method:
L - Look externally (facial trauma, large incisors, beard, large tongue)
E - Evaluate the 3-3-2 rule
* Incisor opening distance: 3 fingerbreadths
* Hyoid-mental distance: 3 fingerbreadths
* Thyroid-to-mouth distance: 2 fingerbreadths
M - Mallampati score ≥3
O - Obstruction
N - Neck mobility (limited neck mobility)
Possible source of bleeding as acute complication in patients undergoing emergency cricothyrotomy
bleeding from the thyroidea ima artery
