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Emergency Medicine EOR Exam

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Emergency Medicine EOR Exam

Dilated Cardiomyopathy: most common cause is ____. Others? << correct answer >>
alcohol; may also be idiopathic, myocarditis, or drugs (doxorubicin) -- 1 in 3 cases of
heart failure are caused by dilated cardiomyopathy

What PE and EKG changes are seen with dilated cardiomyopathy? << correct answer
>> PE: S3, JVD, crackles - possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB

Hypertrophic cardiomyopathy: is due to hypertrophy of the _____. PE reveals mitral
regurgitation, a ____heart sound, and prominent left ventricular impulse. EKG reveals
LVH << correct answer >> cardiac septum; S4

Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post
open-heart surgery. What is the most common first symptom? << correct answer >> --
infiltrative process - amyloidosis, sarcoidosis, and hemochromatosis -- changes in
myocardium
--most common first symptom is exertion intolerance and fluid retention, signs of right
heart failure

Atrial fibrillation - regularly irregular - the most common sustained arrhythmia in adults -
what three treatments are used? << correct answer >> 1. rate control w BB, CCB, or
digoxin
2. Anticoagulation w heparin & warfarin
3. rhythm control w amiodarone or cardioversion

Atrial flutter - sawtooth pattern in II, III, aVF - what three treatments are used? <<
correct answer >> 1. cardioversion if no contraindications
2. acute rate control tx w BB, CCB - amiodarone, sotalol, quinidine, or procainamide
3. If site of reentrant is known, catheter ablation

Multifocal atrial tachycardia - noted in patients with COPD or severe systemic illness -
EKG shows multiple shaped P waves and differing PR intervals. ____are agents of
choice? << correct answer >> CCB

BLOCKS
1. ____=prolonged PR interval
2.____=progressive increase in PR until Pwave is blocked.
3._____=sudden block in P wave w no change in PR
4._____=atrial and ventricular rhythm are independent of each other. << correct answer
>> First degree; Wenckebach Mobitz type I; Mobitz type II, Third degree block

,A _____may develop after acute MI, PE, aortic stenosis and is due to a conduction
delay in the right or left bundles. << correct answer >> Bundle branch block

Paroxysmal supraventricular tachycardia is a reentry tachycardia, commonly noted in
elderly patients with underlying heart disease. What treatment may be helpful before
using adenosine ie. the drug of choice? << correct answer >> vagal maneuvers or
antianxiety medication

What are some drugs associated with Torsades de pointes? << correct answer >>
tricyclic antidepressants, erythromycin, ketoconazole, haloperidol, cisapride,
disopyramide, pentamidine, sotalol, class I anti-arrhythmics

CHF - Systolic dysfunction means a problem with the ____. What drug is
contraindicated? << correct answer >> pump; CCB!

CHF - Diastolic dysfunction means a problem with the ____. << correct answer >>
compliance or relaxation of the heart during ventricular filling

The ________principle means that as preload increases, the ventricle is stretched
during diastole filling and the ejection fraction is increased. << correct answer >> Frank-
Starling principle

_____is released from cardiac ventricles in response to increased wall tension. <<
correct answer >> BNP - B-type natriuretic peptide

What is the pharmacologic therapy for heart failure? << correct answer >> 1. diuretics
for fluid retention
2. ACEi
3. vasodilators (hydralazine & nitrates)
4. BB for LV dysfunction
5. digitalis to increase cardiac contractility

Functional Classification of Heart Failure:
___-No cardiac symptoms with ordinary activity.
___-Cardiac symptoms w MARKED activity but asymptomatic at rest
___-Cardiac symptoms w MILD activity but asymptomatic at rest
___-Cardiac symptoms at rest. << correct answer >> Class I, Class II, Class III, Class
IV

Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined
as greater than ____. << correct answer >> 140/90; 160/100

Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia

,CHF
Previous MI
Chronic Renal Failure
Asthma, COPD << correct answer >> Angina - BB, CCB
Diabetes - ACEi & CCB, avoid diuretics
Hyperlipidemia - ACEi & CCB, avoid diuretics/BB
CHF - diuretics & ACEi, avoid CCB/BB
Previous MI - BB/ACEi
Chronic renal failure - diuretics, CCB
Asthma - diuretics & CCB, avoid BB

Secondary hypertension is HTN due to an ______. << correct answer >> identifiable
cause ie. renovascular disease, coarctation of the aorta, primary aldosteronism,
Cushing's, Pheochromocytoma, OSA, renal parenchymal hypertension

____hypertension is potentially life threatening - HTN plus rentinopathy,
cardiovascular/renal compromise, or encephalopathy. << correct answer >> Malignant

Malignant hypertension bp? What is the rule of thumb for lowering? << correct answer
>> greater than 220/140; 10% in first hour and 15% for the next 3-12 hours, to normal
over next 2 days

What is the agent of choice for BP lowering for patients with hypertensive
encephalopathy, intracranial bleeding, and heart failure? Use with what for dissecting
aneurysm? << correct answer >> nitroprusside; propranolol -- clonidine can also be
used but sedation is common

Hypotension is defined as a systolic blood pressure less than _____mm Hg or a
decrease from baseline by more than 30mmHg. What are the 3 treatments for
improving blood pressure? << correct answer >> 90mmHg;
1. IV Fluids
2. Vasopressors - dopasmine, dobutamine (risk is aggravation of arrhythmias and
increase myocardial oxygen demand)
3. intra-aortic balloon pump

ST Elevations in II, III, aVF << correct answer >> Inferior MI; right coronary artery

ST Elevations in I, aVL, V4, V5, V6 << correct answer >> lateral wall MI, left circumflex
artery

ST Elevations in V1, V2, V3, V4, V5 << correct answer >> Anterioseptal MI, left anterior
descending artery

ST Elevations in V1, V2 << correct answer >> posterior wall MI, posterior descending
artery

, No nitroglycerin in which kind of MI? << correct answer >> inferior

What are the pre hospital treatments for ACS? << correct answer >> MONA; morphine,
oxygen, nitroglycerin (0.4mg SL x3 prn), aspirin (325mg)

What two meds should be given to all ACS patients that do not have contraindications?
<< correct answer >> BB - unless brady or severe COPD - then do NDCCB
(verapamil/diltiazem)
ACEi - if cough, use ARB

What are the adjunctive tx for fibrinolysis or PCI? << correct answer >> 1. antiplatelets
(ASA, clopidogrel)
2. anticoagulants (UFH, LMWH, DTI, direct factor Xai)

How long should Plavix/Clopidogrel be used for bare metal or drug eluting stents? <<
correct answer >> bare metal - 30d-12m
drug eluting - >/=12mon

What meds should a patient go home with after ACS? << correct answer >>
Nitroglycerin
BB
ACEi
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
aldosterone agonist
statin
LIFESTYLE CHANGES

Cardiac Markers: _____is detectable within 1-2 hours after acute MI. Duration <1 day.
Low specificity. << correct answer >> Myoglobin

Cardiac Markers: _____is the test of choice and appears 2-6 hours after MI and stays
elevated for 5-10 days. << correct answer >> Troponin

Cardiac Markers: _____appears 3-6 hours after MI and stays elevated for 2-4 days.
Specific to heart muscle. << correct answer >> Creatine kinase Mb

Timeline:
Reperfusion should take place before ___hours of symptom onset.
Door to needle time for fibrinolysis is ____min.
Door to balloon time for PCI is ___min. << correct answer >> 12; 30min; 90min

Cardiology << correct answer >> is fun!

What are the treatments for bradyarrhythmias? << correct answer >> atropine, pacing,
or epinephrine/dopamine

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