PreTest Medicine: Hospital-Based Medicine

Question 1

You are called to an elderly patient in the ICU’s room. She is unresponsive and has sinus tach on tele but no palpable pulses. What should you do?

Answer 1

Administer saline

This is pulseless electrical activity (PEA), which is often caused by hypovolemia. Tamponade can also be a cause.

Question 2

List the five most important features of perioperative cardiovascular risk calculation.

Answer 2

• Ischemic heart disease
• CHF
• IDDM
• Creatinine > 2
• CVA

Question 3

tPA can be given to those with ischemic stroke up to _________ hours after the onset of symptoms.

Answer 3

4.5

Though some sources still say 3.

Question 4

Give the CHF caveats on these drugs:

• ACEi
• Spironolactone
• Digoxin

Answer 4

• ACEi: reduces mortality in all-comers
• Spironolactone: should be given in NYHA III or IV (less than 30% EF) to improve mortality
• Digoxin: reduces hospitalizations but not mortality

Question 5

What is the recommended treatment for community-acquired pneumonia?

Answer 5

• Third-generation cephalosporin or fluoroquinolone (for S. pneumo)
• Macrolide (atypicals)

Question 6

List the four things that may be seen on an EKG in hyperkalemia.

Answer 6

• Peaked T waves
• Widened QRS
• PR prolongation
• Loss of P waves

Question 7

List four things that can decrease the risk of ventilator-associated pneumonia.

Answer 7

• Sedation holidays
• Oropharyngeal intubation
• Subglottic suctioning
• Elevating the head of the bed

Question 8

Remember that ____________ can present with single P waves before each QRS with a sharp upslope.

Answer 8

atrial flutter

Look for the classic rate of 150 BPM.