Test 39- IM

Question 1

What EKG finding is specific for a pericardial effusion?

Answer 1

Electrical alternans - QRS complexes whose amplitudes vary from beat to beat. Caused by heart swinging back and forth in an increased amount of pericardial fluid.

Question 2

What causes Wolf-Parkinson-White?

Answer 2

An accessory pathway conducts depolarization from the atria to the ventricle without going through the AV node first. This causes episodes of SVT.

Question 3

Why would you not use Digoxin, b-blockers, ca channel blockers or adenosine on a WPW patient that was in AFib.

Answer 3

These drugs all act to modify the signaling through the AV node. WPW patients have an accessory pathway that bypasses the AV node anyway, so the medications woulf not have the desired effect.

Question 4

What would you use on a WPW patient to convert them from Afib to sinus rhythm?

Answer 4

electric cardioversion or an an antiarrhythmic medication like procainamide

Question 5

What is Trihexyphenidyl? What is it used to treat and what side effects do you have to watch out for?

Answer 5

Anticholinergic used to treat parkinsons

Side effects: anticholinergic 
red as a beet - flushing
dry as a bone - dry mouth and eyes
hot as a hare - hyperthermia
blind as a bat - mydraisis/ vision changes/ glaucoma
mad as a hatter - delerium/ confusion
full as a flask - urinary retention

Question 6

A patient with pneumonia develops a pleural effusion secondary to the pneumonia (parapneumonic effusion). Under what conditions would that fluid need to be drained by thorocastomy and what lab test would indicate that?

Answer 6

Effusion needs to be drained if there is puss in the fluid (empyema). This is best indicated by a pH of less than 7.2.

Question 7

A healthy young man has a solid testicular mass. Do you biopsy or remove and why?

Answer 7

You proceed with radical orchiectomy. Biopsy is contraindicated for risk of spread through lymphatics and other blood vessels.