Case Report 1

Question 1

What is the differentiates an NSTEMI to a STEMI?

Answer 1

NSTEMI: occlusion on minor artery leading to partial thickness damage of muscle
STEMI: occlusion of major coronary artery leading to full thickness damage of muscle

Question 2

To be diagnosed with major depression how many symptoms must you have out of the 9 described in SIGECAPS?

Answer 2

5 out of the 9 symptoms

Question 3

What is a major prevention tactic to avoid a GI bleed?

Answer 3

Avoid excess NSAID use

Question 4

What is the pH of a patient who has DKA? What is the pH of blood normally?

Answer 4

<7.3

Blood is normally 7.38-7.42

Question 5

How many classes of thrombolytic drugs are there?

Answer 5

3: Tissue Plasminogen Activator(TPA), Streptokinase (SK), Urokinase (UK)

Question 6

Is warfarin reversible? If so, what is teh agent to reverse it?

Answer 6

Yes, through administration of Vitamin K

Question 7

What is the general MOA of thrombolytic agents?

Answer 7

Plasminogen is converted to plasmin which leads to dissolution of clots through fibrinolysis

Question 8

List 3 symptoms of a PE?

Answer 8

Pink frothy sputum
Low grade fever
Tachycardia

Question 9

The diagnostic test that can detect clotting and exclude PE if the result is negative is?

Answer 9

D-dimer test

Question 10

Define depression

Answer 10

Depressed mood on a daily basis for a minimum of 2 weeks

Question 11

What is the normal range for fasting plasma glucose for people without diabetes?

Answer 11

70-100 mg/dL

Question 12

What drugs are known to cause or put patients at higher risk for developing a PE?

Answer 12

Hormone replacement therapies and oral contraceptives with estrogen

Question 13

What is the enzyme that is important in degrading fibrin clots?

Answer 13

Plasmin

Question 14

What is the main deficiency that leads to pernicious anemia?

Answer 14

Vitamin B12 deficiency

Question 15

Why do paitens experience SOB in anemia

Answer 15

Decreased oxygen carrying capacity of the RBC

Question 16

What is warfarin MOA?

Answer 16

Interferes with the synthesis of Vitamin K depedent clotting factors and anticoagulant protein C and S

Question 17

Name 3 symptoms of DKA

Answer 17

Hyperglycemia >250
Ketones in urine
Acidosis <7.3
Polydipsia, polyuria, fatigue, confusion, n/v, tachycardia
Hypotension

Question 18

Pink frothy sputum is an indication of what condition?

Answer 18

PE

Question 19

What class of drug is Tenecteplace

Answer 19

Thrombolytic

Tissue plasminogen activator

Question 20

What is the first thing that should be done when treating a patient with ketoacidosis

Answer 20

Correct fluid volume

Question 21

What is Warfarin’s onset of action and why does it take this long to reach peak anticoagulation?

Answer 21

An anticoagulation effect generally occurs within 24 hours after warfarin administration. However, peak anticoagulant effect may be delayed 72 to 96 hours; it prevents the creation of new clotting factors but does not get rid of the ones currently in existence

Question 22

Pernicious anemia is caused by impaired absorption of ____________ due to the failure of gastric parietal cells to secrete _________ __________.

Answer 22

Vitamin B12; intrinsic factor

Question 23

When diagnosing community-acquired pneumonia, a sputum culture can be obtained. To be considered an adequate sputum culture, what is required?

Answer 23

> 25 neutrophils and <10 squamous epithelial cells per low power field

Question 24

Define major depression

Answer 24

Depressed mood on a daily basis for a minimum duration of 2 weeks.

Question 25

Venous thromboembolism can lead to pulmonary embolism. What are three risk factors for developing VTE that are also pertinent to our patient?

Answer 25

``` long-haul air travel obesity cigarette smoking eating large amounts of red meat oral contraceptives ```

Question 26

Anticoagulants have 4 principle classes. Name 2.

Answer 26

Direct Factor Xa Direct Thrombin Inhibitors Indirect thrombin inhibitors Vitamin K antagonists

Question 27

Which is a better anticoagulation treatment for patients - Unfractionated Heparin (UFH) vs Low-Molecular-Weight Heparin (LMWH)? Explain your reason.

Answer 27

UFH blocks factors 2a (Thrombin) and 10a, whereas LMWH blocks factor 10a. LMWH is a better treatment for patients as it has a lower risk of bleeding.

Question 28

In GI bleeding, if blood is coming from the rectum or lower colon, _________ _________ blood will coat or mix with your stool. Describe the color of blood.

Answer 28

Bright Red

Question 29

Which anticoagulant is contraindicated in pregnant women?

Answer 29

Warfarin

Question 30

Cardiac enzymes typically are elevated in the blood several hours after the onset of a heart attack. Name one cardiac enzyme that is released into the blood by dying heart muscles

Answer 30

``` Creatine phosphokinase (CPK Troponin ```

Question 31

Anticoagulation can be achieved by antagonizing vitamin K epoxide reductase. A good example of a drug that does this is ___________.

Answer 31

Warfarin

Question 32

List the clotting factors that are the therapeutic targets of warfarin?

Answer 32

VII, X, IX, II | SNOT

Question 33

Signs and symptoms of DKA?

Answer 33

``` Hyperglycemia >250 mg/dL Ketones in the urine or blood Acidosis ph < 7.3; serum bicarbonate <15 Polydipsia, polyuria Fatigue, flushing of the skin N/V, abdominal pain (30% of patients) Difficulty breathing Fruity odor on breath (due to acetones) Confusion, tachycardia (increase HR), tachypnea, hypOtension Weight loss, dehydration ```

Question 34

What are 2 Nonpharmacologic treatments for PE?

Answer 34

Pulmonary embolectomy (high risk patients) Compression stockings and mechanical ventilation Vena cava filter to prevent blood clots from traveling to lungs (IVC filter) Surgery Stent placement Ambulation

Question 35

If the patient PK from our case was placed on a TPA for treatment of PE, the drug would bind to fibrin bound ___________ cleaving it to the active protein: __________.

Answer 35

Plasminogen, plasmin

Question 36

If patient PK from our case had a recent strep infection and the physician decided to use streptokinase to treat the patient for PE, you would recommend the physician to ___________ the dose relative to the standard dosing of 250,000 units over 30 minutes followed by 100,000 units/hr for 24 hours.

Answer 36

Increase

Question 37

Pernicious anemia is due to a lack of ________________ caused by a lack of or decreased production of ___________________ which is produced by ___________________ cells.

Answer 37

Vitamin B12, Intrinsic Factor, parietal

Question 38

What are the major signs/symptoms of a pulmonary embolism?

Answer 38

dyspnea, calf pain/redness/swelling, tachycardia, chest pain, low BP, coughing up blood or bloody mucus, cyanosis, dizziness/lightheadness, feeling anxious

Question 39

What are 3 signs/symptoms of pernicious anemia?

Answer 39

Fatigue, loss of appetite, SOB, dizziness, pale skin, tachycardia, chest pain, confusion, depression, memory loss, dementia, malabsorption, diarrhea, red beefy tongue or pale and smooth tongue, papillaries are absent

Question 40

What is the mechanism of action of Alteplase (Activase®)?

Answer 40

Plasminogen is converted to plasmin which leads to dissolution of clots through fibrinolysis

Question 41

What are the characteristics of diabetic ketoacidosis (DKA)?

Answer 41

Hyperglycemia and ketoacidosis