ED Final Exam

Question 1

6 Risk Factors for MI

Answer 1

1. Smoking
2. DM
3. HTN
4. HLD
5. Fm hx early CAD
6. AGE

Question 2

Holosystolic murmur, heard in apex, radiating to axilla

If new in the setting of MI, think?

Answer 2

Papillary muscle rupture

Ischemic dysfunction

Question 3

What makes AS severe?

Answer 3

Parvus et tardus

Late peak in intensity

Question 4

Concave ST elevation

Answer 4

Smile, you might not have MI

Question 5

What are reciprocal leads for II, III, F?

Answer 5

1 and AVL

Question 6

What is an anterior wall MI?

Answer 6

V1-V4 ST elevation

Question 7

What is a lateral wall MI?

Answer 7

I, L and maybe V5-V6

Question 8

How can you spot a posterior wall MI?

Answer 8

ST depression in V1-V3

Question 9

Acute MI Therapy:

Answer 9

Aspirin - 4x81mg chewable
Sublingual IV nitroglycerin
IV morphine 4mg
Heparin bolus
Rapid cards consult

Question 10

What murmur develops in aortic dissection?

Answer 10

Aortic Regurg/insuff in proximal dissections

- diastolic decrescendo murmur at RSB

Question 11

Four risk factors for Aortic Dissection?

Answer 11

1. HTN
2. Bicuspic aortic valve
3. Preggers
4. Marfan/Ehlers-Danlos

Question 12

Treatment for aortic dissection?

Answer 12

Esmolol (beta-blocker) to lower BP

maybe nitroprusside 2nd

Question 13

What is virchow’s triad?

- why do we care?

Answer 13

Venous stasis
Hypercoagulability
Endothelial injury
increased risk for PE

Question 14

PE Risk Factors?

Answer 14

Prior DVT, PE
Lupus anticoagulant, protein C/S AT III deficiency
Central lines
Cancers (ovarian, colon)
Pregnancy / high dose estrogen
IBD (Crohn's)

Question 15

In what do you see wide split S2?

Answer 15

PE
Pulmonary HTN
RBBB

Question 16

What is one thing you should listen for in PE?

Answer 16

Wide split S2

Question 17

Two drugs you might use in PE?

Answer 17

IV heparin bolus
TPA
- if pt is in shock

Question 18

Treatment for tension pneumo?

Answer 18

Needle decompression at 2nd intercostal space at mid-clavicular line

Question 19

What finding clinically in boerhaave’s?

Answer 19

Crunching sound on thoracic exam
Early may be subtle rub
Subcutaneous air

Question 20

26yo AA male w/ 24hours sharp CP

• worse when supine
• better when sitting forward

Answer 20

Cardiac Tamponade

• pleuritic CP
• Dyspnea

Question 21

What is Beck’s triad?

- why do we care?

Answer 21

Hypotension
JVD
Small and quiet heart
Cardiac Tamponade

Question 22

What is a major finding in tamponade?

Answer 22

Pulsus paradoxus
- decrease in BP > 10mmHg on inspiration

Diffuse ST elevations

Electrical alternans

Question 23

Classic presentation of pneumonia?

Answer 23

Cough
Fever
Chills

Earliest sign is focal rales

Question 24

Finish this…alcoholics…RUL pneumonia…

Answer 24

Klebsiella

Question 25

Two drugs for outpatient treatment of pneumonia?

Answer 25

Moxifloxacin 400mg 7-10 days | Azithromycin (Z-pack)

Question 26

Two drugs for inpatient CAP treatment?

Answer 26

Moxifloxacin 400mg IV --- if allergy to PEN 1g Ceftriaxone + Azithromycin 500mg (both IV

Question 27

How treat HCP?

Answer 27

Pip/tazo Ciprofloxacin 500mg +/- vancomycin + macrolide

Question 28

Five signs of Pneumothorax?

Answer 28

``` Hypotension Ipsilateral deceased BS Tympany JVD Contralateral tracheal deviation ```

Question 29

Progressive dyspnea and orthopnea are hallmarks of? | - also?

Answer 29

Pulmonary edema - also paroxysmal nocturnal dyspnea (due to resorption of interstitial fluid during recumbency) Everything causes orthopnea...but think CHF

Question 30

Kerley B lines | Bronchial cuffing

Answer 30

Think pulmonary edema

Question 31

Tx for Pulmonary Edema?

Answer 31

O2, bipap IV dopamine / dobutamine / nitroglycerine (tons of it) (w/ hypotension) (borderline BP) (hypertension)

Question 32

PERC Criteria

Answer 32

``` Age > 50 HR > 100 O2 sat < 95% Recent trauma/surgery Hemoptysis Exogenous estrogens Unilateral leg swelling ```

Question 33

Wheezes and prolonged expiratory phase?

Answer 33

Asthma/COPD

Question 34

Signs of impending respiratory failure?

Answer 34

``` One word answers Accessory muscle use RR > 40 Diaphoresis Lethargy Acute CO2 retention ```

Question 35

Tx for Asthma?

Answer 35

Nebulized albuterol/ipratropium PO prednisone BIPAP if severe ABX in COPD

Question 36

Decreased breath sounds | Dullness to percussion?

Answer 36

Pleural effusion - tumor - infection - chylothorax (ruptured thoracic duct) - Hemorrhage

Question 37

What assoc w/ second degree type 2 AV block?

Answer 37

This is the worse one: fixed long PR interval with drops - CAD - MI - dig toxicity - beta blockers