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1
Q

Flu like complaints in a 22yo followed by tachycardia and fever, I think? What lab marker helps to diagnose?

A

Myocarditis, troponin is elevated

2
Q

Troponin level timeline

A

Rise within 3 to 6 hours of pain onset, peek at 12 to 24 hours, remain elevated for 7 to 10 days

3
Q

Myoglobin timeline

A

Rises within 1 to 2 hours, peaks in 4 to 6 hours, returns to baseline in 24 hours

4
Q

Absolute contraindications to TPA

A

Previous hemorrhagic stroke, Active known intracranial neoplasm, active internal bleeding, suspected aortic dissection or pericarditis

5
Q

Relative contraindication to tPA

A

SBP greater than 180, anticoagulation, major surgery less than three weeks prior, active PUD

6
Q

How to manage patient with food bolus stuck in esophagus but no respiratory distress

A

A minister 1 mg glucagon IV and plan for endoscopy

Glucagon causes relaxation of esophageal smooth muscle, It does not work endoscopy is definitive

7
Q

When is TPA used in PE patients

A

In massive PE- embolus with sustained hypertension or hypotension requiring Inotropic support
or hemodynamic collapse
Still unclear for use in sub massive PE: RVD, no persistent hypertension –traditional anticoagulation

8
Q

Congenital long QT syndromes

A

Romano Ward
Jervell
Lang-Nielsen
Beta blockers are the treatment of choice, ICDs are most definitive for high-risk patients

9
Q

Management of small primary spontaneous pneumothorax impatience without underlying lung disease

A

Get initial chest x-ray, observe for six hours and repeat chest x-ray, discharge with follow up in 24 hours

10
Q

Ace inhibitor angioedema

A

Can occur at any point in the course of taking the medication, unlike a true type one hypersensitivity reaction – occurs immediately after exposure
Mechanism of action: inhibition of bradykinin production

11
Q

Treatment for HCAP pneumonia

A

Vancomycin, cefepime, Azithromycin

Covers Pseudomonas and MRSA

12
Q

EKG findings in PE

A

Right heart strain: large R waves and inverted T-waves in leads V1-3

13
Q

When to give steroids in PJP pneumonia

A

PA 02 less than 70, or A-a gradient greater than 35

14
Q

abx for SBP

A

third generation cephs, i.e. cefotaxime