Resp Case 2

Question 1

what is GTPAT?

Answer 1

part of obstetrical history taking. 
G (gravidity) = # of total pregnancies
T (term) = full term deliveries
P (preterm) = # of preterm deliveries
A (abortion/miscarriage) 
L  (Living children )

Question 2

Taking the uterus and ovaries and sometimes cervix is a procedure known as _

Answer 2

Total hysterectomy

Question 3

what are causes of S2 splitting during a cardiac exam

Answer 3

• physiologic spliting is normal
• persistent spliting during inspiration and expiration = heart disease in adults most likely RBBB; and RV pressure overload such as acute massive PE

Question 4

what can be heard on pulm exam with a PE, 53% of the time

Answer 4

rales

Question 5

what is an invasive but highly accurate way of measuring blood pressure constantly?

Answer 5

arterial line (excellent in pts with any type of shock)

Question 6

What labs can be checked for inherited thrombophilia?

Answer 6

• activated protein C/Factor V Leiden, homocysteine level, functional assays of antithrombin III/protein C/ Protein S, antiphospholipid antibodies

Question 7

what is the most common finding on a EKG in a pt with a PE?

Answer 7

nonspecific ST-T wave abnormalities and sinus tachycardia

Question 8

what is the gold standard imaging choice for PE?

Answer 8

CT angiogram (CTA) of chest (PE protocol) - need to consider stability of pt before taking them to radiology

Question 9

what can be seen on EKG that is indicative of PE?

Answer 9

s1 Q3 T3 (S in lead I, Q in lead III, and an inverted T wave in lead III)

Question 10

What is tPA?

Answer 10

recombinant tissue type plasminogen activator (tPA, alteplase) clot buster

Question 11

what hormones are pro-thrombotic?

Answer 11

• Hormone replacement therapy (HRT) of premarin (estrogen)

Question 12

what is factor V leiden?

Answer 12

• mutant form of coagulation factor V –> insensitive to action of activated protein C, a natural anticoagulant –> increased risk of venous thromboembolism

Question 13

what is Virchows triad?

Answer 13

Theory of pathogenesis of venous thromboembolism: 1)alteration in blood flow, 2) vascular endothelial injury; 3) alterations in constituents of blood

Question 14

what is well’s criterdia?

Answer 14

Assessment for PE:

• clinical symptoms = 3pt
• other diagnosis less likely than PE = 3pt
• HR>100 = 1.5pt
• immobilization >3 days = 1.5pts
• Previous DVT/PE = 1.5
• Hemoptysis and malignancy= 1.0pt each

High = > 6pts
Moderate risk = 2-6 pts
low <2 pts

Question 15

what are the contraindications for fibrinolytic therapy?

Answer 15

Absolute: prior intracranial hemorhage; known structural vascular lesion, malignant intracranial neoplasm; ischemic stroke with 3 months; aortic dissection; active bleeding; significant bclosed-head trauma

Question 16

what are the types of shock?

Answer 16

hypovolemic = >65% (early) or <65 (late) tissue perfusion
Cardiogenic shock <65% tissue perfusion
Distributive (dec systemic vascular reisstance) > 65% tissue perfusion

Question 17

what are the considerations/ algorithm to management of inherited thrombophilia?

Answer 17

Active VTE –> anticoagulation for at least 3-6 months
Family hx of VTE –> if homozygous/compound OR more than one thrombophilia OR antithrobin def OR additional risk factor –> prophylactic anticoagulation post-op, pregnancy, postpartum

No personal or family history of VTE, but with antithrobin def -> prophylactic anticoagulation postoperatively, during pregnancy, and postpartum. All other thrombophilias –> routine care, education

Question 18

what is Mean arterial pressure (MAP)

Answer 18

diastolic BP + (systolic BP-diastolic BP) / 3

> 65 = good perfusion
< 65 = hypotension/hypoperfusion