Useful to know

Question 1

Multifocal atrial tachycardia (MAT) is a SVT likely triggered by disturbances such as right atrial enlargement, catecholamine surge (sepsis), or electrolyte imbalance.
MCC seen in elderly (age >70) patients with an acute exacerbation of COPD or Asthma.

ECG should reveal ____.

The best treatment is appropriate management of the acute COPD exacerbation which can lead to resolution of the MAT.

If not, then you may treat with ____

Answer 1

irregular rhythm Tachycardia with distinct P waves of >3 different morphologies and irregular RR intervals

Verapamil (AV nodal blocker)

Question 2

Warfarin can take up to 5-7 days to reach therapeutic levels. It also inhibits proteins C and S (anti-thrombogenic proteins) and can be ___ without a second anticoagulant (heparin) as a “bridge.”

Answer 2

thrombogenic

Question 3

Rivaroxaban is an oral anticoagulant with ___ onset of action.

Contraindicated for patients with severe renal insufficiency!!!!

Answer 3

immediate

(unlike warfarin)

Therefore, no bridging with heparin is indicated.

Question 4

____ is an immunosuppressant drug used for transplant rejection prophylaxis.

Side effects: bone marrow suppression (low plts/ leukocytes/RBCs) , GI sxs (vomiting, diarrhea) & infections.

Answer 4

Mycophenolate mofetil

Cx: lymphoid neoplasia & progressive multifocal leukoencephalopathy (PML)

Question 5

Heart Failure symptoms
plus
elevated BUN & Cr
think of ____

Answer 5

Cardiorenal syndrome

Give Diuretics

Question 6

(BUN)/creatinine ratio > ___

for PRE-Renal AKI

Answer 6

20:1

Question 7

ATN presents with a BUN/creatinine ratio of ___ (consistent with intrinsic renal injury), and ___ casts on urinalysis.

Answer 7

10-15

muddy brown

Question 8

High-output heart failure results from increased cardiac output in response to a low SVR (ex: ___& ___ ).

It involves hyperdynamic circulation (evidenced by ___ & ____)
and
increased cardiac venous return, leading to __ & __

Answer 8

arteriovenous fistula & Hyperthyroidism

widened pulse pressure (>60) & brisk carotid upstroke

peripheral & pulmonary edema

Question 9

Decompensated heart failure typically presents with dyspnea on exertion, ___, and peripheral edema.

Answer 9

jugular venous distension

+/- Pulmonary edema, proteinuria