Emergency Medicine–EORE

What’s the best way to ensure proper endotracheal tube placement?
Color change from purple to yellow

Fluids used for shock
*Isotonic crystalloids*
NS or LR

ID the shock
-Pale, cool mottled skin
-Prolonged capillary refill
-*Decreased skin turgor and dry mucous membranes*
-Decreased CO
-Increased PVR
Hypovolemic

What should you avoid in hypovolemic shock?
Pressors

ID the shock
-*Severe respiratory distress*
-Cool clammy skin
-Decreased CO
-Increased PVR
-Increased wedge pressure
Cardiogenic

Cardiogenic Shock Tx
*Pressors*
Dopamine if hypotensive

Dobutamine if normotensive

What type of shock are these examples of?
-Cardiac tamponade
-Tension pneumo
-Massive PE
Obstructive

ID the shock
-*Initially present with warm, flushed extremities and skin, brisk capillary refill, bounding pulse, WIDE pulse pressure*
-Later they’ll have cool, clammy skin
-Increased CO
-Decreased PVR
Septic

MCC septic shock
Bacteremia secondary to gram –

Abx options for septic shock
-Zosyn+ Ceftriaxone or Imipenem
-Intra-abdominal source–> Metronidazole or Clinda
-Asplenic pt–> Ceftriaxone
-MRSA–> Vanc
-Pseudomonas–> Gentamicin

CVP and MAP goals for septic shock pt
MAP >60 mm Hg
CVP= 8

Achieve with norepi or dopamine

ID the shock
*Hypotension without tachycardia*
Neurogenic

ID the shock
*Pruritis, hives, +/- angioedema, +/- throat fullness, hoarseness, wheezing*
Anaphylactic

SIRS Criteria
-WBC <4,000 or >12,000 or >10% bands
-Temp <96.8 or >100.4
-RR >20 or PaCO2 <32 -Pulse >90

Addisonian crisis Tx
Hydrocortisone 100 mg IV

Anaphylactic Shock Tx
Epinephrine 0.3 mg 1:1,000 IM

GCS for eyes
Max Score____
Max Score=4
1= No movement
2= Opens to painful stimuli
3= Opens to voice
4= Opens spontaneously

GCS for speech
Max Score ____
Max Score=5
1= No speech
2= Incomprehensible sounds
3= Inappropriate words
4= Confused conversation but able to answer questions
5= Oriented, converses

GCS for movement
Max Score______
Max Score=6
1= No movement
2= Extends towards pain
3= Flexion from pain
4= Withdraws from pain
5= Localizes to painful stimulus
6= Obeys commands

What is this describing?

-Focal neuro deficit present?
-Midline spinal tenderness present?
-Altered level of consciousness present?
-Intoxication present?
-Distracting injury present?
What is this describing?

-Focal neuro deficit present?
-Midline spinal tenderness present?
-Altered level of consciousness present?
-Intoxication present?
-Distracting injury present?

NEXUS Criteria for c-spine clearance
If no to all of the above, then imaging is not required

Organ MC injured in blunt trauma
Spleen

Organ MC injured in penetrating trauma
Liver if stab wound
Small bowel if gun shot

What’s your Dx? How do you Tx?
*JVD, muffled heart sounds, electrical alternans (alternating QRS amplitude), hypotension*
Cardiac tamponade

Initial tx= Pericardiocentesis
Pericardial window if recurrent

Orientation of objects in esophagus
Frontal

Orientation of objects in trachea
Saggital

Wedge shaped dense consolidated area on pleural surface of chest wall
Hampton Hump associated with PE

Regional area of decreased pulmonary vascularity
Westermark Sign associated with PE

MC EKG findings in PE
Sinus tach and non-specific ST/T changes

Initial screening for PE
Helical CT

Thrombolytic therapy for hemodynamically unstable PE pt
Alteplase (tPA)

What is this the MC presentation of?
*Retrosternal chest discomfort*
MI

MCC myocarditis
Parvovirus according to Hippo, Coxsackie virus according to PANCE prep book

Pericarditis Tx
NSAIDS

Tx of choice for hypertensive emergency
Sodium Nitroprusside

Hypertensive Urgency vs. Emergency
Emergency= SBP >/= 180 and/or DBP >/=120 + signs of organ damage

Urgency= Elevated BP (SBP >/= 180 or DBP >/=110) without signs of organ damage

ID the site of infarct if ST elevation is seen in the following:
*I, aVL, V5, V6*
Lateral MI due to *Circumflex* infarct

ID the site of infarct if ST elevation is seen in the following:
*II, III, aVF*
Inferior MI due to *RCA* infarct

ID the site of infarct if ST elevation is seen in the following:
*V1-V4*
Anterioseptal MI due to *LAD* infarct

ID the site of infarct if ST elevation is seen in the following:
*V3, V4, I, aVL, V5, V6*
Anteriolateral MI due to *LCA* infarct

Sequence of Tx for Thyroid Storm
Propanolol then PTU then potassium iodide (wait 1 h after giving PTU before giving iodide as iodide can interfere with the activity of PTU)

Thyroid storm pt present with *A fib, fever and delirium*

MC type of shoulder dislocation
Mechanism of this dislocation
Anterior
Abduction, external rotation and extension

PEA/Asystole Tx
Epi 1 mg 1:10,000 IV

Parkland Formula for Burns
4 x pt weight in kg x %BSA

Give 50% over first 8 h
Remaining over the next 16 h

ID the burn
*Epidermis only is involved*
-Area is painful and erythematous
1st degree

ID the burn
*Epidermis and partial thickness of dermis*
-Blisters are present
2nd degree

ID the burn
*Epidermis + full thickness of dermis and potentially deeper tissues*
-Painless
-White or charred appearance
3rd degree

What should you do if a burn pt has evidence of inhalation injury?
Intubate and transfer to burn center

Criteria for transferring pt to burn center
-Partial and full thickness >10% in pt <10 or >50
-Partial and full thickness >20% in all other age groups
-Any full or partial over face, hands, feet, genitals, perineum, major joints
-Circumferential burns
-Chemical, electrical or lightning injury
-Inhalation injury

Cough produces pain in RLQ
Dunfy sign associated with appendicitis

MCC fat emboli causing pulmonary embolism
Femur fracture

Gold standard for imaging of suspected PE
Pulmonary angiography

Tx for pt in respiratory distress with facial trauma
Cricothyroidotomy

Tension PTX tx
Decompression with 18 g needle in 2nd ICS

Trachea deviates AWAY from side of PTX

DKA Tx
NS + Insulin + K if hypokalemic

Unstable A. fib Tx
Synchronized cardioversion at 120-200 J

Stable A. fib Tx
Control rate with Diltiazem or BB
Anti-coagulate if duration >48 h

LP contraindications
-*Papilledema*
-Increased ICP
-New onset seizure
-Overlying skin infection

At what GCS is intubation indicated?
8 or less

Paroxysmal SVT Tx
Adenosine 6 mg rapid IV push

VT Tx
Lidocaine

Imaging of choice for suspected appendicitis
Contrast CT

MC site of esophageal rupture/Boerhaave
Distal esophagus
Usually seen in middle aged men after over indulging in food and alcohol

Wernicke Encephalopathy
Pathophys
Tx
Due to decreased Thiamine/B1
Can also be caused by giving glucose before B1 (e.g. in alcoholic pt)
Tx= Thiamine 100 mg IV

Vasculitis involving the temporal and external carotid artery
Temporal arteritis
Tx= Steroids

SAH Tx
Nimodipine

Hip flexion with passive neck flexion
Brudzinksi
Suggest meningitis

Tx of choice for status epilepticus
Lorazepam or Diazepam

These are the MCC meningitis in which age group?
-GBS
-Listeria
-E. coli
0-4 weeks old

These are the MCC meningitis in which age group?
-GBS
-E. coli
-Listeria
-H. flu
-S. pneumo
4-12 weeks old

These are the MCC meningitis in which age group?
-S. pneumo
-N. meningitidis
3 m-17 y/o

These are the MCC meningitis in which age group?
-S. pneumo
-N. meningitidis
-Listeria
>/= 18 y/o

MC site of CVA
Middle cerebral artery

ID the site of brain infarct
-Inability to move muscles, but lateral gaze is intact
-Quadriplegia
Basilar

ID the site of brain infarct
-H/A
-Neck pain
-Vomiting
-*Sudden inability to walk or stand*
Cerebellar

What’s your Dx? How do you tx?
*Elevated ammonia levels and AMS in cirrhotic pt*
Hepatic encephalopathy
Tx= Lactulose

What sign is positive in a pt with a meniscal tear?
McMurrary’s

MC type of radial head dislocation
Posterior

Test to assess for suspected *MCL* injury
Valgus

Test to assess for suspected *LCL* injury
Varus

MC nerve injured in humeral shaft fx
Radial

Wrist droop indicates radial nerve injury

Humeral Fx Tx
Sugar tong splint + ortho follow up in 24-48 h

ID the Fx. How do you tx?
*Swelling and tenderness at elbow with prominent olecranon and anterior fat pad*
Supracondylar
Non-displaced–> Sling
Displaced–> ORIF

ID the Fx. How do you tx?
*Pt presents with pain after sustaining a pulling injury while her elbow was extended*
Subluxation of radial head/nursemaid’s elbow
Tx= *Reduce* by applying pressure to radial head and then flex and supinate

MC site of clavicle fx
How do you tx?
Mid 1/3
Arm sling x 4-6 weeks
Consult ortho if fx is in proximal 1/3

ID the Fx. How do you tx?
Ulnar fx with radial head dislocation
Monteggia
Tx= Ortho can do closed reduction, posterior splint

ID the Fx. How do you tx?
Distal radial fragment tilted dorsally +/- ulnar fracture
*Dinner fork deformity*
Colles

Tx= Sugar Tong Splint

ID the Fx. How do you tx?
Radius fx with disruption of radioulnar joint
Galeazzi
Tx= ORIF and posterior splint

ID the Fx. How do you tx?
-Anterior sail sign
-Posterior fat pad
-Pain with rotation and flexion of arm
Radial head fracture
Tx= Sling or posterior splint + sling

ID the ortho condition. How do you tx?
-+ Tinel’s
-+ Phalen’s
-Pain is worse at night
CTS due to median nerve entrapment
Tx= Volar splint + NSAIDS

ID the Fx. How do you tx?
*5th metacarpal fx*
Boxer’s Fx
Tx= Ulnar gutter splint with flexion of digits

ID the ortho condition. How do you tx?
-Due to rupture or avulsion of the insertion of the extensor tendon
-Results in a flexion deformity of the DIP
Mallet Finger
Tx= Splint DIP in extension x 6-8 weeks

What nerve should you assess in a tibia fx pt?
Peroneal

What nerve and artery should you assess in a femur fx pt?
Peroneal nerve
Popliteal artery

MC injured knee ligament
ACL

*Positive Thompson Test*
What does this mean? How do you treat?
Achilles tendon rupture

Ankle does not plantar flex when calf is squeezed

Tx= Surgery then splint in plantar flexion

Ankle ligament injured by *inversion*
ATFL

Ankle ligament injured by *eversion*
Deltiod

ID the Salter-Harris Fx
*Growth plate fx*
I

ID the Salter-Harris Fx
*Growth plate + metaphysis*
MC type
II

ID the Salter-Harris Fx
*Growth plate + epiphysis*
III

ID the Salter-Harris Fx
*Extends across metaphysis, growth plate and epiphysis*
IV

Salter-Harris IV Fx require reduction

ID the Salter-Harris Fx
*Growth plate compression injury*
V

ID the fx. How do you tx?
*Incomplete fracture involving the cortex of only 1 side (tension side) of the bone*
Greenstick (bowing fx)
Tx= Reduction with casting and repeat films in 10-14 d

What type of injury can occur in a pt with a proximal humerus fx?
Brachial plexus injury
Evaluate for this by assessing deltoid sensation

ID the cord syndrome
*Due to flexion injury*
-Paralysis distal to lesion
-Loss of pain and temp sensation
-Maintenance of posterior cord functions like proprioception and vibration
Anterior Cord

ID the cord syndrome
*Due to EXTENSION injury*
-Weak upper extremities
-Clumsy hands
Central Cord

What’s a common mechanism for PCL tear?
How do you assess?
Dashboard injury

+ Pivot Shift Test
+ Posterior Drawer

MOA AC separation
Direct blow to ADDucted shoulder

Grade the AC Separation
*Normal CXR, ligamentous sprain only*
I

Grade the AC Separation
*AC ligament rupture + coracoclavicular ligament sprain*
II

Grade the AC Separation
*Both AC and coracoclavicular ligaments ruptured*
III

ID the ortho condition. How do you tx?
*Chronic hyperABduction injury of thumb*
Gamekeeper’s thumb
Tx= Thumb Spica + Hand surgeon referral

Patellar Fx Tx
Non-displaced Tx= Leg cast x 6 weeks

Surgery if displaced

MCC patellar dislocation
What sign will be present with this injury?
How do you tx?
Valgus stress
Apprehension sign–> Pt contracts quads when examiner pushes laterally
Tx= Closed reduction

Patella alta
Patellar tendon rupture

Patella baja
Quadriceps tendon rupture

ID the fx. How do you tx?
*Transverse fx through diaphysis of 5th metatarsal*
Jone’s

Tx= NWB x 6-8 weeks

ID the fx. How do you tx?
Incomplete fracture where one side of bone buckles upon itself without disrupting the other side
Torus Fx
Tx= Immobilization, usually heals within 3 weeks

What grade ankle sprain is a complete sprain?
Grade III

Signs of Basilar Skull Fx
-CSF rhinorrhea
-Racoon eyes
-Battle’s sign
-CN deficits
-Bloody TM

ID the LeForte Fx
*Maxilla at level of nasal bones*
I

ID the LeForte Fx
*Maxilla, nasal bones and medial aspect of orbits*
II

ID the LeForte Fx
*Maxilla, zygoma, nasal bones, ethmoids, vomer and lesser bones of cranial base*
III aka Craniofacial dysfunction

What’s your Dx? How do you tx?
*11-13 y/o obese male presents with referred pain to medial knee and thigh with an associated limp, loss of abduction and internal rotation of hip*
Slipped Capital Femoral Epiphysis

Tx= ORIF

ID the fx
*Avulsion fx of inferior portion of anterior vertebral body*
MC site= C2
Extension teardrop

ID the fx
*Unstable hyperextension fx through the pedicles of C2*
Hangman

ID the fx
*C1 fx*
Jefferson

ID the fx
*only STABLE neck fracture*
-Avulsion fx of the spinous process of the lower cervical vertebrae
MC site= C7
Clay Shoveler’s

What pressures would you expect in a pt with compartment syndrome?
>/= 30 mm Hg

Etiology of Cauda equina
Delayed or inadequate tx of disc herniation

What alleviates the pain in spinal stenosis?
Lumbar flexion and rest

What nerve and artery can be injured in a supracondylar fracture?
Median nerve
Brachial artery

-Due to untreated supracondylar fracture
-*Claw like deformity* from ischemia with flexion/contracture of wrist
Volkmann’s ischemic contracture

Osteomyelitis Tx
Parenteral Abx x 4-6 weeks

MCC Erythema Multiforme
SOAP
S= Sulfa
O= Oral hypoglycemics
A= Anticonvulsants
P= Penicillin

Etiology of lateral epicondylitis/tennis elbow
Wrist extension

Etiology of medial epicondylitis/golfers elbow
Wrist flexion

ID the fx. How do you tx?
*Pain with palpation of anatomical snuffbox*
Scaphoid fracture
-Thumb spica splint then repeat imaging in 2-3 weeks
-Proximal fx more likely to result in AVN because blood supply is distal

MC mechanism of ankle injury
Forced inversion with ankle in plantar flexion

-Inflammation of the long head of the biceps tendon and tendon sheath
-Causes anterior shoulder pain
-Positive Yergason test (shoulder pain with supination and flexion of forearm against resistance)
Bicipital/biceps tendinitis

ID the fx. How do you tx?
-Radial fx with volar angulation
-Reverse dinner fork deformity
Smith’s

Tx= Sugar Tong Splint

-Idiopathic osteonecrosis of the femoral head
-MC in 4-8 y/o
-MC in males
-Presents as a limp that worsens with activity and is more noticeable at the end of the day
-Aching the groin or proximal thigh
Legg-Calve-Perthes

Tx= Observation, *ABduction bracing*, osteotomy

Painless nodule in flexor tendon of palm near metacarpal head
Audbile snap when finger is extended
Trigger finger

ID the ortho condition. How do you tx?
-Tensynovitis of abductor pollicis longs and extensor pollicis brevis
-+ Finklestein
DeQuervain Tendonitis
Tx= Thumb spica splint and NSAIDs

ID the ortho condition. How do you tx?
-MC between third and fourth toes
-Described as *walking on a pebble*
Morton’s Neuroma
Initial Tx= Get better shoes
Can be surgically excised if they recur

MC type of hip dislocation
Posterior

ID the hip dislocation
-Usually secondary to dashboard injury
-Shortened, adducted and internally rotated
Posterior

ID the hip dislocation
*Flexed, abducted and externally rotated*
Anterior

Femoral neck fx presentation
Tx
Leg will be shortened and EXTERNALLY rotated
Tx= ORIF

Posterior epistaxis tx
Epistat + Admit

Painless
Slow onset vision loss
Blood and thunder fundus
CRVO

Sudden painless unilateral vision loss
Marcus Gunn pupil (direct light reflex absent, indirect present)
Cherry red spot
CRAO

CRAO Tx
-Acetazolamide
-Digital massage
-Cycloplegics
-Optho consult

Normal intraocular pressure
10-21 mm Hg

“Lowering of a curtain over the eyes”
Retinal detachment

MC in pt with myopia (near sighted) and Marfan’s

Corneal Ulcer
MCC
How do you tx?
Association?
MCC= Pseudomonas
Tx= Cipro
Association= Contact lens wearers

Blood in anterior chamber
Pain
Photophobia
Decreased vision
Hyphema

MCC peritonsillar abscess
B-hemolytic strep

Swollen cyanotic leg from venous engorgement secondary to massive ileofemoral thrombosis
Can lead to gangrene
Phlegmasia cerulea dolens

-Milk leg due to massive ileofemoral thrombosis
-Diminished/absent dorsalis pedis or posterior pulses
-White leg due to arterial spasm
Phlegmasia alba dolens

What dermatome is at the nipple line?
T4

BB overdose Tx
Glucagon

TCA overdose Tx
Bicarbonate

ID the nerve root responsible for the following
-Patellar reflexes
-Medial foot sensation
-Knee extension
L4

ID the nerve root responsible for the following
-Middle finger sensation
-*Triceps reflex*
-Thumb extension
C7

ID the nerve root responsible for the following
-Cremasteric reflex
-Sensation in groin
-Hip flexion
L1

ID the nerve root responsible for the following
-Sensation in lateral dorsal and plantar foot
-*Achilles reflex*
-*Plantar flexion*
-Tiptoe walking
S1

ID the nerve root responsible for the following
-Anal reflex
-Perineal sensation
-Pelvic floor control
S4

ID the nerve root responsible for the following
-Dorsal foot sensation
-*Dorsiflexion*
L5

ID the nerve root responsible for the following
*Biceps reflex*
C5

MC vessel injured in acute blunt trauma
Thoracic aorta

Sinusitis associated with orbital/periorbital cellulitis
Ethmoid

How do you differentiate orbital from periorbital cellulitis?
Orbital cellulitis presents with ocular pain and decreased eye movement

Dental Abscess Tx
-Oral Abx (*Pen VK*)
-Analgesics (NSAIDs)
-I if large

ID the type of PNA
-Hypoxia
-Confusion
-Fever
-Sepsis
-Lower lobe infiltrates on CXR
Pseudomonas

Tx= High dose aminoglycoside e.g. *Gentamicin*

ID the type of PNA
-Older children, young adults, elders
-*Bullous myringitis*
-Erytehma multiforme rash
-Neuro symptoms
-Arthritis
-Arthralgia
Mycoplasma

Tx= Azithromycin

DMARD of choice for RA
MTX

Persistent flexion of PIP with hyperextension of DIP
Boutonneire Deformity

-Fixed flexion of DIP with hyperextension of PIP
-Seen in RA pt
Swan Neck Deformity

MCC CAP
S. pneumo

What’s your Dx?
-Fever
-Unilateral sore throat
-Odynophagia
-Drooling
-Deviation of uvula
Peritonsillar abscess

What’s your Dx?
-Fever
-Sore throat
-*Muffled voice (hot potato voice)*
-Dysphagia
-Respiratory distress
-Drooling
-*Inspiratory stridor*
-*Tripod position*
-*Toxic looking*
Epiglottitis

MCC= H. flu

Get ready to intubate

What’s your Dx?
-Swelling beneath chin
-Tongue displaced up and posterior
-Trismus
Ludwig’s Angina

Gout or Pseudogout?
-MC in ankle, wrist and metatrasophalangeal joint
-*Calcium pyrophosphate crystals*
-POSITIVELY birefrengent
-*Rod-shaped* crystals
Pseudogout

*P*seudogout=*P*ositive

Gout or Pseudogout?
-*Sodium urate crystals*
-NEGATIVELY birefrengent
-*Needle-shaped* crystals
Gout

Definitive Tx= Allopurinol which inhibits xanthine oxidase leading to decreased serum urate levels

NSAIDS are good for flares
Alcohol increases gout attacks
Dairy DECREASES gout attacks

ID the overdose, how do you tx?
-Delirium
-Dilated pupils
-Tachycardia
-Urinary retention
-Hyperthermia
-Red skin
-Hallucinations
Anticholinergics

Tx= Physostigmine

What’s your Dx?
-Paradoxical bradycardia
-Malaise
-H/A
-Fever
-Abdominal distention
-Thick green stools
Salmonellosis

ID the overdose, how do you tx?
-AMS
-High anion gap acidosis
-*Calcium oxalate crystals in urine*
-Hyperkalemia
Ethylene glycol (e.g. Antifreeze)

Tx= Ethanol or Fomepizole

ID the overdose
-Abnormal anion gap
-*High serum and urine ketones*
Isopropyl alcohol

ID the overdose, how do you tx?
-Delayed presentation of toxic-related symptoms
-*Severe lactic acidosis*
-*Ocular toxicity and blindness*
-NO ketosis
Methanol

Tx= Ethanol or Fomepizole

Study of choice for suspected UGI bleed
Endoscopy

Shallow-to-deep ulcers in esophagus
CMV esophagitis

ID the esophagitis etiology, how do you tx?
-Odynophagia
-Large number shallow ulcers in lower 1/3 of esophagus
HSV esophagitis

Tx= Acyclovir po

ID the esophagitis etiology, how do you tx?
-HIV pt
-No oral lesions
-Odynophagia
-Unintentional weight loss
Candida esophagitis

Tx= Fluconazole po

Benzo overdose Tx
Flumazenil

Acetaminophen Overdose Tx
NAC (N-acetylcysteine) 140 mg/kg then 70 mg/kg q. 4 h

MOA= Inhibits the binding of toxic metabolite to hepatic products

What marker is most sensitive for Dx of Rhabdomyolysis?
Creatinine Phosphokinase (CK or CPK)

What’s your Dx? Tx?
*10 y/o overweight male presents with a limb with no mechanism of injury. XR reveals posteromedial angulation of femoral epiphysis. Limited hip ROM on PE*
SCFE

Tx= Surgical pinning

What’s your Dx? Tx?
Child presents 2 weeks post viral URI with a painful limp and pain in anterior thigh
Transient synovitis

Tx= Supportive

MCC restrictive cardiomyopathy
Amyloidosis

Restrictive CM presents with R HF symptoms (edema, JVD, hepatomegaly)

ID the site of brain hemorrhage
-*Pinpoint, reactive* pupils
-Coma
-Decreased lateral ocular motility
-*Quadriplegia with decerebrate posturing*
Pontine

ID the site of brain hemorrhage
-Impaired consciousness
-Contralateral motor and sensory loss
-*Gaze preference towards side of hemorrhage*
Thalamic

ID the site of brain hemorrhage
-*Impaired gait*
-CN palsies
-*Vertigo*
-*Limb ataxia*
Cerebellar

ID the site of brain hemorrhage
-*Severe onset H/A*
-Varying degrees of neuro deficits
SAH

ID the site of brain hemorrhage
-H/A
-N/V
-AMS
-Visual disturbances
-Seizures
-Coma
Lobar

Study of choice for suspected TIA
Carotid doppler

Sharp, stabbing chest pain
Pericarditis

Best marker to assess for reinfarction in pt with recent MI
CK-MB because it returns to normal within 24-48 h of infraction unlike Troponin which takes several days

MC type of cardiomyopathy
Dilated

What is a good test to perform in someone with a syncopal episode suspected to be due to vasovagal?
Tilt table test

Do this before invasive testing
MCC syncope= Vasovagal

MCC infective endocarditis in IV drug users
S. aureus

MCC infective endocarditis in non-drug users
Strep viridans

T/F Hemiplegia is absent in posterior artery occlusion
True

Most reliable EKG finding of cardiac *ischemia*
Depression of ST segment >1 mm

Lifestyle modification associated with *5-20 mm Hg* reduction in SBP
Weight loss

Lifestyle modification associated with *4-9 mm Hg* reduction in SBP
30 min exercise most days per week

Lifestyle modification associated with *8-14 mm Hg* reduction in SBP
DASH diet

Lifestyle modification associated with *2-4 mm Hg* reduction in SBP
Decreasing alcohol intake

What interventions most significantly improve outcomes in cardiac arrest pt?
Defibrillation and CPR

3 distinctly different p waves with varying PR, RR, PP intervals
MAT (wondering atrial pacemaker with rate >100)

MAT is associated with:
-COPD
-Theophylline toxicity
-Beta agonist

-Irregularly irregular rhythm
-Best seen in leads V1, V2, V3, aVF
Associated with:
-Ischemic heart disease
-Valvular heart disease
-*Alcohol excess or withdrawal*
-Pericarditis
-Hyperthyroidism
A. fib

-Sawtooth pattern
Associated with:
-*COPD*
-Atherosclerotic heart disease
-MI
-Thyrotoxicosis
-PE
-Mitral valve disease
-CHF
-Metabolic derangements
A. flutter

MI associated with Wenckebach
Inferior

MI associated with 2nd degree heart block type 2
Anterior

Type of acidosis associated with *renal tubular acidosis*
NORMAL anion gap

MUDPILES for acidosis with anion gap

Cluster H/A tx
Oxygen

Tension H/A tx
NSAIDS

CK-MB and Troponin I begin to elevate ____ h post MI
3-12

Myoglobin elevates ___ h post MI
1-4
*first to elevate*

Most specific marker for detecting myocardial necrosis
Troponin I

MCC non-traumatic cardiac tamponade
Metastatic malignancy

Will present with dyspnea and profound exercise intolerance
MC cancer to metastasize to heart is melanoma

Double vision with lateral gaze
MS

What drug is CI in acute ischemia?
Verapamil

Orthostatic hypotension definition
SBP reduction of 20
DBP reduction of 10

Thrombolytic CI
-Suspected aortic dissection
-BP >185/110

Which thrombolytic can not be given to a pt that received it in the past?
Streptokinase

Samter Triad
-Polyps
-Asthma
-Aspirin sensitivity

What type of aortic dissections require immediate surgery?
Ascending

Stanford A
DeBakey I and II

What’s your Dx?
-Angina at rest in pt without PMH angina
-ST elevation on EKG
-Female
-Smoker
Prinzmetal Angina

Due to transient coronary vasospasm

Imaging study to evaluate infective endocarditis
TEE

MCC bacterial myocarditis
Diphtheria

Bacterial myocarditis is very rare

ID the arrhythmia
-Bursts of tachycardia and pre syncopal episodes
-Hypokalemia can predispose pt to this
V Tach

ID the arrhythmia
Abrupt syncopal episodes
Sinus brady

HR are slow, normal and fast secondary to pauses
Sick sinus syndrome

MCC pardoxical S2 split
LBBB

What *sodium channel* blocker is indicated for VT, VF and refractory SVT?
Flecainide

Class Ic anti arrhythmic

How does diastolic dysfunction affect stroke volume?
SV is decreased in pt with diastolic dysfunction

What can these cause?
-HYPERkalemia
-Lyme disease
-MI
-Lithium
AV block

First line tx for symptomatic PACs
BB

*JVP rise with inspiration*
-This sign is present in RV infarct
Kussmaul

Medication for VT conversion
IV Lidocaine

Med to prevent recurrent VT
Sotalol or *Amiodarone*

Indications for echo after discovering a new murmur in a pt
-Diastolic murmur
-Continuous murmur
-Systolic murmur > grade II

Med used to tx PVD claudication
Cilostazol (phosphodiesterase inhibitor)

Harsh holosystolic murmur best heard at LSB with a wide fixed split S2
VSD

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