Stuff from the Review

Question 1

In what leads do you see atrial flutter best?

Answer 1

II, III, and AVF

Question 2

What are the criteria on ECG for LBBB?

Answer 2

broad, double peaked R in I, AVL, sometimes V5-V6

Dominant S in V1

Question 3

What tx is absolutely contraindicated in NSTE-ACS?

Answer 3

thrombolytics

Question 4

In what cardiac condition are GP IIB/IIIA significantly helpful?

Answer 4

in high risk NSTE-ACS pts

Question 5

What anticoagulants are preferred when treating ACS?

Answer 5

IV heparin first

enoxaparin used 2nd most often

Question 6

What EKG abnormality other than ST elevation indicates a recent STEMI?

Answer 6

new LBBB

Question 7

In what type of MI is sinus bradycardia common?

Answer 7

inferior MI

Question 8

How, in general, do you tx SVT including A fib?

Answer 8

use rate controlling agents like metoprolol or CCBs ASAP
shock if unstable
amiodarone if that doesn’t work

Question 9

In what type of MIs does a complete AV block occur?

Answer 9

more common in inferior MI

worse prognosis if it occurs in anterior MI

Question 10

When would a papillary m rupture occur after MI?

How to tx?

Answer 10

3-7 days afer
need to do emergent echo and intra-aortic balloon pump
Sx is definitive tx

Question 11

How do you treat acute LV failure w/ pulmonary edema?

Answer 11

O2
morphine
diuretics
vasodilators

Question 12

What defines cardiogenic shock?

Answer 12

systolic BP < 90 and signs of decreased perfusion

no response to fluids

Question 13

How do you treat cardiogenic shock?

Answer 13

urgent cath lab and echo
diuretics in less sick
ionotropic support (NE, dobutamine, etc) in more sick

Question 14

In septic shock, what should be your goal for MAP?

Answer 14

keep above 65

Question 15

What is PCWP and what does it represent?

Answer 15

pulmonary capillary wedge pressure

represents L atrial pressure

Question 16

What is CVP and what does it represent?

Answer 16

central venous pressure (often measured as JVP)

represents R atrial Pressure

Question 17

What are the CO, CI, SVR, CVP, and PCWP in cardiogenic shock?

Answer 17

decreased CO and CI

Increased: SVR, CVP, PCWP

Question 18

If you have HAGMA secondary to diabetic ketoacidosis, what is the metabolic alkalosis due to?

Answer 18

volume depletion

contraction alkalosis

Question 19

What are the modified wells criteria for PE risk?

Answer 19

> 4.0 –> PE likely
4.0 or less –> PE unlikely
(then do the diagnostic algorithm)

Question 20

How do you tx an acute PE?

Answer 20

IV fluids
thrombolytic therapy w/ alteplase if hemodynamically unstable
initiation of heparin drip
long term start rivaroxaban

Question 21

How would you tx NAGMA due to diarrhea?

Answer 21

IV fluids
potassium supplementation
avoid anti-diarrheal meds until stool pathogen panel back

Question 22

What is the risk in using anti-diarrheal meds in C diff?

Answer 22

can lead to toxic megacolon

Question 23

What type of acidosis can be caused by toluene toxicity?

How would you tx?

Answer 23

type 1 RTA

Tx: potassium supplementation, sodium bicarb or potassium citrate admin, avoid toluene

Question 24

Obese patients with depression must be screened for what?

Answer 24

obstructive sleep apnea

Question 25

What is pickwickian syndrome?

Answer 25

obesity-hypoventilation syndrome
occurs when obese ppl can’t breath fast or deep enough –> become hypoxic
mimics COPD, but RESTRICTIVE pattern
90% will have OSA

Question 26

What are the goals and tools of management of OSA?

Answer 26

goals: improve daytime sleepiness and cognitive performance; prevent long-term sequelae
tools: lifestyle modifications, CPAP, others

Question 27

What are long term risks of OSA?

Answer 27

4x more likely to die each year than normal person
2.5x more likely to develop cancer
4x more likely to have CVA

Question 28

What is the recommended sleeping position for pts w/ OSA?

Answer 28

lateral decubitus (keeps airway from collapsing)

Question 29

What is an alternative machine to a CPAP?

Answer 29

bi-level PAP

has separate pressures for inspiration and expiration, may improve comfort and adherence

Question 30

Where do you do a needle thoracostomy?

Answer 30

2nd ICS
mid-clavicular line
(correct me if I am wrong, this is what I heard Hubbard say)

Question 31

What is the similarity btw pneumothorax and pleural effusion on exam?

Answer 31

absent or diminished breath sounds on auscultation

Question 32

What are pneumothorax and pleural effusion like on percussion?

Answer 32

pneumo: hyper-resonant
effusion: dull

Question 33

What are pneumothorax and pleural effusion like on auscultation in positional changes of breath sounds?

Answer 33

no change in pneumothorax

may improve in effusion

Question 34

What are requirements for composition of exudate?

Answer 34

if any of the following:
pleural protein/serum protein > 0.5
pleural LDH/serum LDH > 0.6
pleural fluid LDG > 2/3 upper limits of serum LDH

Question 35

What is the normal WBC composition of pleural space?

Answer 35

macrophages 75%

lymphocytes 25%

Question 36

What causes increased eosinophils in pleural fluid?

Answer 36

most often due to air in pleural space
idiopathic
parapneumonic
malignancy

Question 37

What causes increased lymphocytes in pleural fluid?

Answer 37

malignancy or TB

Question 38

How do you manage chronic pleural effusion?

Answer 38

pleurX catheter

pleurodesis - closes potential space btw parietal and visceral pleura