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Flashcards in Stuff from the Review Deck (38)
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1
Q

In what leads do you see atrial flutter best?

A

II, III, and AVF

2
Q

What are the criteria on ECG for LBBB?

A

broad, double peaked R in I, AVL, sometimes V5-V6

Dominant S in V1

3
Q

What tx is absolutely contraindicated in NSTE-ACS?

A

thrombolytics

4
Q

In what cardiac condition are GP IIB/IIIA significantly helpful?

A

in high risk NSTE-ACS pts

5
Q

What anticoagulants are preferred when treating ACS?

A

IV heparin first

enoxaparin used 2nd most often

6
Q

What EKG abnormality other than ST elevation indicates a recent STEMI?

A

new LBBB

7
Q

In what type of MI is sinus bradycardia common?

A

inferior MI

8
Q

How, in general, do you tx SVT including A fib?

A

use rate controlling agents like metoprolol or CCBs ASAP
shock if unstable
amiodarone if that doesn’t work

9
Q

In what type of MIs does a complete AV block occur?

A

more common in inferior MI

worse prognosis if it occurs in anterior MI

10
Q

When would a papillary m rupture occur after MI?

How to tx?

A

3-7 days afer
need to do emergent echo and intra-aortic balloon pump
Sx is definitive tx

11
Q

How do you treat acute LV failure w/ pulmonary edema?

A

O2
morphine
diuretics
vasodilators

12
Q

What defines cardiogenic shock?

A

systolic BP < 90 and signs of decreased perfusion

no response to fluids

13
Q

How do you treat cardiogenic shock?

A

urgent cath lab and echo
diuretics in less sick
ionotropic support (NE, dobutamine, etc) in more sick

14
Q

In septic shock, what should be your goal for MAP?

A

keep above 65

15
Q

What is PCWP and what does it represent?

A

pulmonary capillary wedge pressure

represents L atrial pressure

16
Q

What is CVP and what does it represent?

A

central venous pressure (often measured as JVP)

represents R atrial Pressure

17
Q

What are the CO, CI, SVR, CVP, and PCWP in cardiogenic shock?

A

decreased CO and CI

Increased: SVR, CVP, PCWP

18
Q

If you have HAGMA secondary to diabetic ketoacidosis, what is the metabolic alkalosis due to?

A

volume depletion

contraction alkalosis

19
Q

What are the modified wells criteria for PE risk?

A

> 4.0 –> PE likely
4.0 or less –> PE unlikely
(then do the diagnostic algorithm)

20
Q

How do you tx an acute PE?

A

IV fluids
thrombolytic therapy w/ alteplase if hemodynamically unstable
initiation of heparin drip
long term start rivaroxaban

21
Q

How would you tx NAGMA due to diarrhea?

A

IV fluids
potassium supplementation
avoid anti-diarrheal meds until stool pathogen panel back

22
Q

What is the risk in using anti-diarrheal meds in C diff?

A

can lead to toxic megacolon

23
Q

What type of acidosis can be caused by toluene toxicity?

How would you tx?

A

type 1 RTA

Tx: potassium supplementation, sodium bicarb or potassium citrate admin, avoid toluene

24
Q

Obese patients with depression must be screened for what?

A

obstructive sleep apnea

25
Q

What is pickwickian syndrome?

A

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

26
Q

What are the goals and tools of management of OSA?

A

goals: improve daytime sleepiness and cognitive performance; prevent long-term sequelae
tools: lifestyle modifications, CPAP, others

27
Q

What are long term risks of OSA?

A

4x more likely to die each year than normal person
2.5x more likely to develop cancer
4x more likely to have CVA

28
Q

What is the recommended sleeping position for pts w/ OSA?

A

lateral decubitus (keeps airway from collapsing)

29
Q

What is an alternative machine to a CPAP?

A

bi-level PAP

has separate pressures for inspiration and expiration, may improve comfort and adherence

30
Q

Where do you do a needle thoracostomy?

A

2nd ICS
mid-clavicular line
(correct me if I am wrong, this is what I heard Hubbard say)

31
Q

What is the similarity btw pneumothorax and pleural effusion on exam?

A

absent or diminished breath sounds on auscultation

32
Q

What are pneumothorax and pleural effusion like on percussion?

A

pneumo: hyper-resonant
effusion: dull

33
Q

What are pneumothorax and pleural effusion like on auscultation in positional changes of breath sounds?

A

no change in pneumothorax

may improve in effusion

34
Q

What are requirements for composition of exudate?

A

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

35
Q

What is the normal WBC composition of pleural space?

A

macrophages 75%

lymphocytes 25%

36
Q

What causes increased eosinophils in pleural fluid?

A

most often due to air in pleural space
idiopathic
parapneumonic
malignancy

37
Q

What causes increased lymphocytes in pleural fluid?

A

malignancy or TB

38
Q

How do you manage chronic pleural effusion?

A

pleurX catheter

pleurodesis - closes potential space btw parietal and visceral pleura