obinno59's version from 2015-12-08 17:49


Question Answer
A 65-year-old male has been in the CCU for the last three days following an anteroseptal myocardial infarction. On Day #4 of this admission, his chest pain returns. On exam, he is found to have a third heart sound (S3) and bibasilar rails. Labs demonstrate an elevated CK-MB and a LDH1/LDH2 flipMI vs Angina, PE, aortic disection, pneumothorax, pericarditis, PUD, GERD, cholecystitis, esophageal spasm, aortic dissection
Patient presents with unstable angina like characterisitics ____ is alone is not enough for PCI vs What are?Positive cardiac biomarker vs The indications are persistent chest pain and electrical or hemodynamic instability.
Right ventricular infarction complicates up to 40% of inferior STEMIs and thus_____ should be avoided nitrates
A 63-year-old male presents with severe chest pain that is alleviated by leaning forward. Physical exam reveals CVP and a friction rub best heard when the patient leans forward. ECG shows ST elevation in all leads and PR depression in the precordial leads.Pericarditis vs Cardiac tamponade, hemopericardium, heart failure, MI, pneumonia, pneumothorax
Classic pericarditis vs ConstrictiveClassic: STEMI in all leads
Constrictive: Low voltage
Uremic pericarditis MC sxFever
A 61-year-old male with a history of CAD and HTN is found to have a pulsatile abdominal mass on palpation. A bruit is heard on ausculation.AAA vs Pancreatitis, pseudocyst, appendicitis, gallbladder disease, aortic dissection
What is the best definitive management for ruptured abdominal aortic aneurysm?Emergency operative repair(>>>open repair) is required and endovascular aneurysm repair is preferred and has a better survival rate than open repair...(>>>> blood products)
1. Chronic obstructive pulmonary disease
2. Gout
4. Congestive heart failure
and there CONTRA
Answer 1: This is a relative contraindication in beta-blockers.
Answer 2: This is a relative contraindication in thiazide diuretics.
Answer 4: This is a relative contraindication in alpha-blockers.
_____ has the greatest results for reducing BP(lifestyle change)Weight loss
A 68-year-old male presents to his primary care physiciaDilated cardiomyopathy with dyspnea on exertion and swollen ankles. He has a long history of CAD and alcohol abuse.CHF vs Deconditioning, chronic lung disease, MI, angina, pericarditis, renal failure, cirrhosis, or other causes of lower-extremity edema (venous insufficiency, hypoproteinemia, nephrosis, etc)
CHF affect on Cardiac index = CI; Systemic vascular resistance = SVR; Left ventricular end diastolic pressure = LVEDPDecreased CI, increased SVR, increased LVEDP
This patient with known heart failure with reduced ejection fraction (HFrEF) presents in acute decompensated heart failure would first be tx withIV loops
-PO diuretics have poor systemic absorption in patients with heart failure due to GI system edema; therefore, IV diuretics are more routinely used.
Tx for severe MS 2/2 to RHDPercutaneous mitral balloon valvotomy >>>>>Closed mitral commissurotomy
Severity in MR between two patients is usually due to____________ not ___________1.Chronicity of valvular pathology
2. Size of valvular pathology
When AS becomes symptomaticThe aortic valve must be replaced by a cardiac surgeon.
most common cause of aortic stenosis in a young patient is______________Bicuspid aortic valve
A 32-year-old man with eunuchoid proportions and arachnodactyly presents to the ER complaining of sudden onset of severe substernal chest pain with pain radiating down his back. CXR shows a widened mediastinum.AD vs MI, PE, angina, thoracic aortic aneurysm, esophageal rupture, pancreatits, pancreatic pseudocyst, neoplasms, orthopaedic causes of back pain, appendicitis, and gallbladder disease
Interscapular back pain is more common with_____ dissection while anterior chest pain is more common with _____dissection.
1. Distal
RF for ADRisk factors for aortic dissection include longstanding hypertension, trauma, connective tissue diseases (Marfan's Ehlers-Danlos, Turner syndrome), bicuspid aortic valve, and coarctation of the aorta.
If patient is suffering from hemorrhagic shock, likely secondary to intraperitoneal bleeding from blunt abdominal trauma experienced during the accident. After checking the _____, in a hemodynamically unstable patient, _______ is needed to evaluate for intraperitoneal hemorrhage vs ____1. ABC's
2. Abdominal ultrasound
3. CT abdomen/pelvis is indicated if the patient is determined to be stable after assessing their ABC's. Avoid sending an unstable patient to the CT scanner due to the risk of further deterioration while away from the trauma bay.
Approach to hemorrhagic shock(primary)Primary survey (ABC)
establish airway (A)
if patient can speak airway is fine
methods used in order of urgency from least to most includes oropharyngeal airway, intubation, cricothyroidotomy
assess for breathing (B)
assess for bilateral breath sounds and chest rise
do not miss a hemo/pneumothorax or single lung intubation
place two large bore IVs (C)
replace fluid (3 liters to every liter of blood lost)
prepare for transfusion if patient does not respond to 2 L IV fluids
Approach to hemorrhagic shock(secondary)Secondary survey (DE)
check neurologic function - disability (D)
calculate with Glasgow Coma Scale (GCS)
identify source of bleeding and other injuries - exposure (E)
remove patient's clothes
perform complete examination
stomach - gastric tube
abdomen - US / CT / Digital rectal exam
diagnostic peritoneal lavage no longer used
retroperitoneal - US / CT
bleeding into the abdomen should be treated with exploratory laparotomy
bleeding into the pelvis should be treated with angiographic embolization
place foley-most accurate indicator of fluid resusitation.
blood at urethral meatus
high riding, mobile, nonpalpable prostate
Pt found in the alley, bleeding, then brought to ER then becomes asystolic what is the first step to txEndotracheal intubation>>>chest compressions
Pt US shows DVT. no order comorbidities. Best approach to tx? When should labs be done?Discharge home with LMWH therapy and coumadin and follow up in 3 days~
Regarding therapy choice, coumadin takes roughly 5 days to have full therapeutic effect, and therefore she will need to be "bridged" with weight-based LMW heparin
Given the risk for heparin-induced thrombocytopenia (HIT), albeit lower with LMWH than with unfractionated heparin (UFH), the patient should be evaluated on day 3 of treatment for a platelet check and INR check

In patients with bleeding risk or comorbidities, inpatient hospitalization for DVT may be warranted
Duration of Warfarin therapyThe duration of warfarin therapy for DVT depends on the patient's risk of developing a subsequent DVT. If this is the patient's first DVT and the DVT was associated with a reversible risk factor (i.e. surgery, OCPs), the patient should be anticoagulated for at least 3 months.

If the patient's first DVT is idiopathic or proximal, or if the patient has a PE, inherited thrombophilia, or previous DVT, indefinite anticoagulation should be considered. If a DVT is associated with malignancy, the patient should be anticoagulated until remission or indefinitely.
patients present with range of symptoms that may include
high fever that can last for weeks
systemic symptoms (weakness, fever, malaise)
Endocarditis vs Osteomyellits, abscess, pneumonia, rheumatic fever, prostatitis in males, STDs in females, other causes of FUO
Tx indicated in endocarditis involving prosthetic valves.IV gentamycin and PO rifampin,
Endocarditis tx in pt with hx of IV drug useIV vancomycin and IV ceftriaxone in this situation should target MRSA, streptococci, and enterococci.
Hx of ____makes enterococci the most likely organism in BEHis recent cystoscopyin the setting of recurrent UTIs
Patients with subacute bacterial endocarditis (SBE) with Streptococcus viridans highly susceptible to penicillin should be treated with ______or ______IV penicillin G or IV ceftriaxone
A 55-year-old African American male presents to the emergency department with complaints of blurry vision and a mild headache for the past 2-3 hours. He states that he has experienced these symptoms once before, but they resolved spontaneously within one hour. His past medical history is significant for hypertension, for which he takes hydrochlorothiazide and lisinopril. He states he has been taking his blood pressure medications as scheduled and has not missed a dose. He denies any focal neurologic deficits, chest pain, shortness of breath, or changes in bladder habits. Vital signs are as follows: BP 210/100, HR 95, RR 16, and SaO2 98%. What is the most appropriate next step in the management of this patient?Fundoscopic exam
-Must evaluate for all possible end organ damage before tx
Heart block congen form a/w congenital
with SS-A (Ro) and SS-B (La)
complete HB