MTB 2

Question 1

Presentation of Heat cramps/exhaustion

Answer 1

Hx: exertion, high temp
Body temp: Nomral
CPK/K+ = Normal
Tx: oral fluids, electrolytes

Question 2

Heatstroke

Answer 2

Hx: exertion, high temp
Body temp: High
CPK/K+ = High
Tx: IVF, evaporation, ice water immersion if no CNS involvement

Question 3

NMS

Answer 3

Hx: APs
Body temp: High
CPK/K+ = High
Tx: Dantrolene or Dopamine Agonists, Bromocriptine, Cabergoline

Question 4

Malignant Hyperthermia

Answer 4

Hx: Anesthetics
Body temp: High
CPK/K+ = High
Tx: Dantrolene

Question 5

MOA of Dantrolene

Answer 5

Muscle relaxant

Works on Ryanodine receptors - Prevents calcium release from SR in skeletal muscle

Question 6

Presentation of Hypothermia

Answer 6

Intoxicated person

Low body temp

Question 7

MCC death hypothermia

Answer 7

Cardiac Arrhythmia

Question 8

Best initial step in hypothermia

Answer 8

EKG

- J Waves - where QRS hits ST segment

Question 9

TX for Frost bite

Answer 9

Rapid rewarming with warm water
Immerse in warm water
If systemic hypothermia - infuse warm fluids

Question 10

Presentation of Salt water Drowning

Answer 10

Acts like CHF

Wet, heavy lungs, pulmonary edema

Question 11

Presentation of Fresh water Drowning

Answer 11

Hemolysis from absorption of hypotonic fluid into vasculature

Question 12

Role of steroids and Abx in drowning

Answer 12

None. They are not useful

Question 13

Management in cardiac arrest

Answer 13

1. Make sure pt is unresponsive
2. Call for help
3. Open airway
4. Give rescue breaths if not breathing
5. Check pulse, start compressions

Question 14

When do we do precordial thump

Answer 14

Very recent onset of arrest
Less than 10 mins
No defibrillator available

Question 15

Causes of pulselessness

Answer 15

Asystole
V Fib
V tach
PEA

Question 16

Best initial management puleslessless

Answer 16

CPR

Question 17

TX for Asystole

Answer 17

1. Epinephrine + Atropine

- Vasopression = alternative for Epi

Question 18

MOA Of epinephrine and vasopressin

Answer 18

Constrict BVs to shunt blood into critical central areas - heart and brain

Question 19

When do we do Unsynchronized Cardioversion

Answer 19

V Fib
Pulseless V tach
Torsades des Pointes

Question 20

Best initial Tx for V fib

Answer 20

1. Immediate Unsynchronized Cardioversion
2. If ineffective -> Resume CPR
3. Shock again
4. Epinephrine/Vasopressin
5. Shock
6. Amiodarone/Lidocaine

Question 21

When is Bretyllium the correct answer

Answer 21

Never

Question 22

Management for Pulseless V tach

Answer 22

1. Immediate Unsynchronized Cardioversion
2. If ineffective -> Resume CPR
3. Shock again
4. Epinephrine/Vasopressin
5. Shock
6. Amiodarone/Lidocaine

Question 23

Management for hemodynamically stable V tach

Answer 23

1. Amiodarone
2. Lidocaine
3. Procainamide
4. Cardiovert

Question 24

Management for hemodynamically unstable V tach

Answer 24

Electrical cardioversion several times

Amiodarone or Lidocaine

Question 25

What makes up hemodynamic instability

Answer 25

Chest Pain SOB HypoTN Confusion

Question 26

What is PEA? | Patient presentation?

Answer 26

Heart is electrically normal No motor contraction Pt with No pulse and normal EKG

Question 27

Causes PEA

Answer 27

``` T's and H's Tamponade Tension Pneumothorax Hypovolemia Hypoglycemia Hypo/Hyper kalemia Hypoxia Hypothermia PE - massive Metabolic Acidosis ```

Question 28

Difference bt A flutter and Fib

Answer 28

``` Flutter = Regular rhythm Fib = Irregular rhythm ```

Question 29

What is A flutter

Answer 29

Reentrant circuit that rotates around Tricuspid Annulus

Question 30

EKG of A fib

Answer 30

Absent P waves | Narrow QRS complexes

Question 31

What is most frequent origin for ectopic foci of A fib

Answer 31

Pulmonary veins

Question 32

When do we do synchronized cardioversion in A fib

Answer 32

Hemodynamically Unstable pts

Question 33

What does synchronization do

Answer 33

Prevents electricity from being delivered during refractory period Helps prevent deterioration into VT or VF

Question 34

Best initial TX for Chronic A fib

Answer 34

1. Rate control - Beta blockers - CCBs - Digoxin 2. Anticoagulate - Warfarin

Question 35

Time length for chronic A fib

Answer 35

2 days

Question 36

Which CCBs used for A fib | MOA

Answer 36

Diltiazem Verapamil Block AV node

Question 37

With A Fib, when is it necessary to use heparin before warfarin

Answer 37

When there is current clot in atrium

Question 38

Benefits of Dabigatran

Answer 38

Does not need monitoring | Prevents stroke

Question 39

What problem can occur in an atrial rhythm problem + Cardiomyopathy

Answer 39

Pulmonary Edema | - loss of atrial contribution

Question 40

How much of atrium contributes to CO

Answer 40

10-15%

Question 41

Criteria for low risk stroke from A fib

Answer 41

``` No Cardiomyopathy/CHF/Atherosclerosis No HTN 75 or younger No DM No past stroke ```

Question 42

Lone A fib - Criteria | Management

Answer 42

No Risk factors | ASA

Question 43

Presentation of SVT

Answer 43

Palpitations | Hemodynamically stable

Question 44

Best initial steps in managing SVT

Answer 44

1. Vagal maneuvers - Carotid massage - Valsalva - Dive reflex - Ice immersion 2. Adenosine 3. Beta blockers, CCBs, Digoxin

Question 45

When is Adenosine used in SVT

Answer 45

Vagal maneuvers are ineffective | Only therapeutically

Question 46

EKG of SVT

Answer 46

Narrow complex Tachycardia No P waves No fibrillatory waves Rate 160-180

Question 47

TX for SVT with unstable Vital signs

Answer 47

DC Cardioversion

Question 48

Presentation of Paroxysmal SVT

Answer 48

Benign and Abrupt attacks HR 160-220 Reentry AV Node

Question 49

Management of Paroxysmal SVT

Answer 49

Increased vagal tone by Valsalva, Carotid massage, cold water immersion to Decrease AV conduction