Afib and Hyponatremia

Question 1

Hyponatremia diagnostic approach

Answer 1

Question 2

Hyponatremia workup and management

Answer 2

Question 3

Management and symptom control of Afib

Answer 3

Question 4

When controlling heart rate for Afib. . .

Answer 4

. . . 110 is a decent target – you don’t need to fully normalize HR, you probably won’t be able to

Question 5

Risk calculators in Afib management

Answer 5

CHADS-VASc (for stroke risk)

HAS-BLED (for major bleed risk)

Question 6

In which patients are direct oral anticoagulants contraindicated?

Answer 6

Patients with some form of hemophilic disorder

Patients with prosthetic heart valves

Obese patients

Question 7

In order to perform an elective cardioversion for someone, they need to be . . .

Answer 7

. . . anticoagulated for at least 3 weeks, OR have evidence showing there is no intracardiac clotting.

Question 8

When deciding what treatment to use for atrial fibrillation, it is important to take into account whether or not the patient is in, . .

Answer 8

. . . congestive heart failure

Rate control agents like metoprolol or diltiazem may make CHF worse at high doses. Rhythm agents may be a better choice in these cases, however we don’t like to keep patients on them long-term if avoidable because of side effects.

Question 9

Major side effects of amiodarone

Answer 9

Amiodarone can cause end-organ damage to multiple organs, but most importantly:

Lung

Liver

Thyroid

Question 10

Nociceptive pain circuit

Answer 10

Question 11

Neuropathic pain circuit

Answer 11

Question 12

Drugs for nociceptive pain don’t work for. . .

Answer 12

. . . neuropathic pain

Question 13

WHO Pain STEP diagram (nociceptive)

Answer 13

Question 14

Ketoralac

Answer 14

Particularly strong NSAID for nociceptive pain.

Only available IV. Great for acute moderate pain, but due to effects on kidneys only safe for 3-5 days.

Question 15

Adverse effects and contraindications of NSAIDs

Answer 15

Question 16

Neuropathic pain step diagram

Answer 16

Question 17

Only approved COX-2 selective inhibitor

Answer 17

Celecoxib aka celebrex

Contraindicated in patients with cardiac conditions.

Question 18

Opioid receptors

Answer 18

Question 19

Opioid analgesic mechanism of action

Answer 19

Question 20

“Morphine equivalency”

Answer 20

Potency of opioids and other analgesics relative to morphine

Used to compare pain medications when switching for one reason or another.

Question 21

Daily limit of tylenol

Answer 21

4000 mg

Question 22

Anesthetic vs analgesic

Answer 22

Analgesics selectively deactivate pain pathways

Anasthetics deactivate all sensory and motor pathways (they usually target basic nerve depolarization pathways, like Na channels, think lidocaine)

Question 23

Indications for pharmacoligically treatment of delirium

Answer 23

Patient is a threat to self or others

Patient is removing IVs or other medical equipment necessary to their treatment and immediate health or causing traumatic injury in the process

Question 24

Delirium treatment algorithm

Answer 24

Question 25

Haloperidol for delirium

Answer 25

1st line for delirium

Question 26

2nd generation antipsychotics for delirium

Answer 26

Question 27

Lorazepam for delirium

Answer 27

Question 28

Trazodone for delirium

Answer 28

Question 29

Adverse effects/contraindications of SSRIs

Answer 29

Question 30

Classic appearance of a fractured femoral neck on X-ray

Answer 30

"Ice cream scoop that has slipped off its cone" It is often hard to see the fracture line, but you can see some sclerosis. In comparison to a normal femoral neck, which is very clean and continuous, fractures look a little burrier and more granular.

Question 31

If a patient presenting with acute fracture presents with afebrile leukocytosis, you should. . .

Answer 31

. . . **not be surprised.** Trauma alone can cause afebrile leukocytosis -- there are a lot of DAMPs being released and white cells are being recruited to sterilize and occupy the injured site.

Question 32

Fracture risk in patients with osteopoenia

Answer 32

Is normal! They are not at increased risk. But, there is evidence of lower BMD, and so they may progress to osteoporosis. At that point, they would be at increased risk for fractures.

Question 33

Bisphosphonate adverse effects

Answer 33

Question 34

Why is it so important to distinguish between Afib and atrial flutter?

Answer 34

Because classic flutter has a defined circuit in the RA that can be ablated, effectively curing the patient, where as Afib is often a chronic condition. LA flutter can also be seen and appears less "clean" than the RA version due to the more circuitous route it must take to complete a circle. Clockwise vs counterclockwise can also be determined by reading ECG.

Question 35

Other name for AV reentrant tachycardia

Answer 35

Wolf-Parkinson-White syndrome! They are the same thing.

Question 36

For someone not on anticoagulation, past what timepoint of being in afib are you worried about there being a thrombus in the heart?

Answer 36

48 hours