Stuff from the Review Flashcards
In what leads do you see atrial flutter best?
II, III, and AVF
What are the criteria on ECG for LBBB?
broad, double peaked R in I, AVL, sometimes V5-V6
Dominant S in V1
What tx is absolutely contraindicated in NSTE-ACS?
thrombolytics
In what cardiac condition are GP IIB/IIIA significantly helpful?
in high risk NSTE-ACS pts
What anticoagulants are preferred when treating ACS?
IV heparin first
enoxaparin used 2nd most often
What EKG abnormality other than ST elevation indicates a recent STEMI?
new LBBB
In what type of MI is sinus bradycardia common?
inferior MI
How, in general, do you tx SVT including A fib?
use rate controlling agents like metoprolol or CCBs ASAP
shock if unstable
amiodarone if that doesn’t work
In what type of MIs does a complete AV block occur?
more common in inferior MI
worse prognosis if it occurs in anterior MI
When would a papillary m rupture occur after MI?
How to tx?
3-7 days afer
need to do emergent echo and intra-aortic balloon pump
Sx is definitive tx
How do you treat acute LV failure w/ pulmonary edema?
O2
morphine
diuretics
vasodilators
What defines cardiogenic shock?
systolic BP < 90 and signs of decreased perfusion
no response to fluids
How do you treat cardiogenic shock?
urgent cath lab and echo
diuretics in less sick
ionotropic support (NE, dobutamine, etc) in more sick
In septic shock, what should be your goal for MAP?
keep above 65
What is PCWP and what does it represent?
pulmonary capillary wedge pressure
represents L atrial pressure
What is CVP and what does it represent?
central venous pressure (often measured as JVP)
represents R atrial Pressure
What are the CO, CI, SVR, CVP, and PCWP in cardiogenic shock?
decreased CO and CI
Increased: SVR, CVP, PCWP
If you have HAGMA secondary to diabetic ketoacidosis, what is the metabolic alkalosis due to?
volume depletion
contraction alkalosis
What are the modified wells criteria for PE risk?
> 4.0 –> PE likely
4.0 or less –> PE unlikely
(then do the diagnostic algorithm)
How do you tx an acute PE?
IV fluids
thrombolytic therapy w/ alteplase if hemodynamically unstable
initiation of heparin drip
long term start rivaroxaban
How would you tx NAGMA due to diarrhea?
IV fluids
potassium supplementation
avoid anti-diarrheal meds until stool pathogen panel back
What is the risk in using anti-diarrheal meds in C diff?
can lead to toxic megacolon
What type of acidosis can be caused by toluene toxicity?
How would you tx?
type 1 RTA
Tx: potassium supplementation, sodium bicarb or potassium citrate admin, avoid toluene
Obese patients with depression must be screened for what?
obstructive sleep apnea
What is pickwickian syndrome?
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
What are the goals and tools of management of OSA?
goals: improve daytime sleepiness and cognitive performance; prevent long-term sequelae
tools: lifestyle modifications, CPAP, others
What are long term risks of OSA?
4x more likely to die each year than normal person
2.5x more likely to develop cancer
4x more likely to have CVA
What is the recommended sleeping position for pts w/ OSA?
lateral decubitus (keeps airway from collapsing)
What is an alternative machine to a CPAP?
bi-level PAP
has separate pressures for inspiration and expiration, may improve comfort and adherence
Where do you do a needle thoracostomy?
2nd ICS
mid-clavicular line
(correct me if I am wrong, this is what I heard Hubbard say)
What is the similarity btw pneumothorax and pleural effusion on exam?
absent or diminished breath sounds on auscultation
What are pneumothorax and pleural effusion like on percussion?
pneumo: hyper-resonant
effusion: dull
What are pneumothorax and pleural effusion like on auscultation in positional changes of breath sounds?
no change in pneumothorax
may improve in effusion
What are requirements for composition of exudate?
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
What is the normal WBC composition of pleural space?
macrophages 75%
lymphocytes 25%
What causes increased eosinophils in pleural fluid?
most often due to air in pleural space
idiopathic
parapneumonic
malignancy
What causes increased lymphocytes in pleural fluid?
malignancy or TB
How do you manage chronic pleural effusion?
pleurX catheter
pleurodesis - closes potential space btw parietal and visceral pleura
