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boards 4 Flashcards

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1
Q

first EKG change in stemi

A

hyperacute T waves

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2
Q

ventricular aneurysm ekg

A

big q waves, no reciprocal depression, ST elevation

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3
Q

posterior MI ekg changes

A

large R waves with ST depresison v1 v2 R:s>1, upright T waves

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4
Q

EKG inidcations for reperfusion

A

STEMI, posterior MI, sgarbossa LBBB

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5
Q

STE in AVR

A

left main occlusion, triple vesel disease, proximal LAD

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6
Q

wellens

A

biphasic t waves - subacute LAD - urgent cath

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7
Q

what are ekg predictors for refperfusion after lytics

A

early t wave inversions, accelerated idobentrical rhythm- wid ecomplex with rate under 120 (NOT VTACH)

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8
Q

contraindications to nitro

A

viagra, aortic stenosis, RV MI

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9
Q

contraindications for b blocker

A

asthma, CHF, bradycardia, hypotension, RV MI

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10
Q

therapy of AMI

A

heparin, asa, b blockers within 24 hours, morphine, o2, add PLETELET INHIBIORS in high risk patients - clopidogrel, ticagrelor, prasugrel (avoid in TIA/stroke)- indicated if theyre going for invasive therapy

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11
Q

door to ballon time for PCI vs lytics

A

90 minutes

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12
Q

rhythms that you can use atropine vs paced for brady

A

sinus or motiz 1 - atropine mobits 2 or 3rd degree- pacer

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13
Q

early complications of M

A

cardiogenic shock- needs inotrops, IABP, papillary M dysfnx, acute MR, recurrent chest pain, ischemia or reinfaction - CATH NOT EXTRE LYTICS

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14
Q

RV infacrtion

A

hypotensive, clear lungs- associated inferior MI - do R sided chest leads looking for ST elevation, triad of hypotension JVD and CLEAR LUNGS

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15
Q

treatment of RV infarct

A

assn with inferior MI, preload dependent - liberal fluids

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16
Q

late complicaitons MI

A

embolism from mural thrombus- pericarditis, dressler (a few weeks later) -tx nsaids, papillary wall rupture- first week post MI- acute MR and CHF

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17
Q

severe post MI complications + hypotension

A

myocardial rupture - tamponade, hypotension- - papillary m rupture- MR and CHF septal wall rupture- VSD - chf

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18
Q

s3 gallop, JVD , dypsnea, kerley B lines

A

CHF and pulmonary edmea

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19
Q

mcc R sided heart failure

A

L sideed heart failure - JVD peripheral edema, RUQ pain, pulsaile liver

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20
Q

best intervention for CHF

A

BIPAP, then use preload reduction nitrates, diuretics

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21
Q

MCC infectie endocarditis in general IVDA

A

MV; tricuspid- STAPH

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22
Q

bug for subacute IE

A

strep viridans

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23
Q

mcc death IE

A

heart failure, can also get emboli, abscesses

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24
Q

mc bug for IE on prostetic valve

A

first 2 months- staph, late causes - viridans, serratio, psudomonas

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25
tx IE
vanc, gent or ceph, rifampin
26
PPX for IE (or if they have congeital heart disease)
major dental procedure/gum bleeding - tx amox/clinda
27
hypoxia with a normal A-a gradient
hypovenilation (opiods) decc fi02- hgh altitude
28
A-a gadient
150- 1.2 pac02 - pa02
29
elevated A -a gradients
V/q ismatch- pe pna asthma, impaired diffusion - instetial PA PCP -- r to L shunt- CHD
30
pitfalls of pulse ox
CO - false sat - needs co-oximetry - cant use pulse ox or PaO2 ---- methhemoglobin - looks like 85% oxyhb- false sat of 85%
31
factors assn with inc asthma mortalit
poverty, overuse OTC, underuse inhalder steroids peventative
32
structural changes in asthmatics lungs
bronchial constriction and edema, mucou splugging, inc goblet cells, bronchial m hypterophy, airway remodelling
33
complication of timolol eye drops
asthma, copd exacerbations
34
anaphylactoid reaction in patients with nasal polyps
samters tirad- ASANSAID sensitivyt, nasal polyps and asthma
35
1st line tx asthma
b 2 agonists
36
tips for intubating ashtma
MV does not treat obstruction- ahve to continue in line nebs, pulmonary toilet, permissive hypercapnia- allow PC02 to be elevated, p0x> 88%, dec I:E ratio- dec RR, in c flow rate,
37
asthma arrest on ventilator
disconnect, compress chest, bilateral chest tubes, fluid bolus - asthma arrest is a SHOCK STATE - obstrucgive and hypovolemic, consider ECMO
38
lung changes in COPD
hypoexmia and hypercapnia, destruction of pulomary vascular beds, pulm HTN, cor polmonarle (RHF) polycythemia
39
mimics of COPD exacerbation
sudden - PE, PTX, chronic PNA CHF
40
2 inventions to iiimprove mortality in copd
home 02 pa02<55 or cor pulmonale, smoking cessation, also give pneumococcal vaccination
41
ARDS - noncardiogenic pulm edema - features
hypoxia pa02 <60, normal Vent fxn, PCWP <18, diffuse alvolar infiltrates
42
how to ventilate ARDS
o2 sat 85, peep, pressure controlled, low TV, prone position
43
pneumonia mimics
atelectasis, ARDS, cancer, diffuse alvolar hemorrhage, PE, R sided endocarditis (IVDA, indwellign catheter) TB toxigenic
44
septic emboli on CXR
looks like Pna, hx IVDA, indwelling catherer
45
pneumoona with rusty sputum
strep pneumo, CAP
46
lobar patchy pneumonia in copd pts
h flu
47
pna causes pleural effusion abscess, cavitiaion, can be post viral or IVDA
staph
48
lobar, RUL pna, bulging fissure with currnat jelly sputum, alcoholics, DM, copd
klebsiella
49
patchy multilobarl necrotizing mullminate pnz, HCAP
Pseudo entoerbacter, CF patients
50
patchy foul smelling pna, alcoholics, poor dentition
anerboic pna
51
mcc pna w effusoin
strep- also TB (think HIV)
52
cause sof non-infectious pulm effusion
L sided- aortic dissection, boerhaaves, R sided - CHF, pancreatitis, hepattits
53
walking pna, young adults, patchy- with extra pulm GBS, encephalitis, gold agglutinins, Erythema multforme, bullous myringits, hemolysis
mycoplasma pna (atypical PNA wont have naythingon grahm stain)
54
nontxoc kid, staccato cough, patchy, interstitial, outbreaks inyoung adults -
chlamydia pna
55
pna from contaminated water or AC, old sick men, topic pts with bradycardia, unilateral lobar, GI sx NVD, low NA, abnormal LFTsn- no person to person xmission
LEGIONELLA
56
fungal pneumonia- SW, Missippie, SE
SW- coccidio, missis- histo, SW, blasto, CXR hilar adenopathy, diffuse patchy, can also cause CP and Erytema nodosum
57
vets, farers, sheep goats cattle, - hepatitis and endocarditis
Q fever- coxiella nurnetti
58
bird hander pna
psittacosis - chlamydia pssittaci
59
gram positive dipplococci
s pneumo
60
gram positive cocci in chains
grp a strep
61
gram positive cocci in clusters
staph
62
gram positive rods
bacicallus anrhtacis
63
small gram negative rods
h flu
64
gram neg rods
pseudomons, enterobacter,, klebsiella, e coli
65
no orgnaism on gram stain
chlamydiak legionella mycoplacms a

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