NR571 MidTerm Study Set- UPDATED ACTUAL Questions and
CORRECT Answers
What is high sensitivity troponin and when to use? first line test for cardiac cell damage
used for initial injury
What is CKMB CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? for suspicion of secondary ischemia after an initial infarct
normal level for Troponin I <0.04
normal level for CKMB 3-5% of total CK
What is BNP B-type natriuretic peptide
Normal BNP levels <100 pg/mL
Differential for chest pain Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion,
pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under __ minutes 90
, Initial diagnostics for chest pain 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
Requirements for STEMI dx new ST elevation in 2 contiguous leads of >0.1 mV except V2&V3
elevated troponin
STEMI findings in V2-V3 >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina NSTEMI involves Elevated Cardiac Bio markers (cell death)
NSTEMI & unstable angina tx Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
When is NGT contraindicated? RV infarct b/c it reduces preload
CORRECT Answers
What is high sensitivity troponin and when to use? first line test for cardiac cell damage
used for initial injury
What is CKMB CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? for suspicion of secondary ischemia after an initial infarct
normal level for Troponin I <0.04
normal level for CKMB 3-5% of total CK
What is BNP B-type natriuretic peptide
Normal BNP levels <100 pg/mL
Differential for chest pain Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion,
pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under __ minutes 90
, Initial diagnostics for chest pain 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
Requirements for STEMI dx new ST elevation in 2 contiguous leads of >0.1 mV except V2&V3
elevated troponin
STEMI findings in V2-V3 >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina NSTEMI involves Elevated Cardiac Bio markers (cell death)
NSTEMI & unstable angina tx Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
When is NGT contraindicated? RV infarct b/c it reduces preload
