EM M4 SAEM EXAM 2023 QUESTIONS AND ANSWERS
treatment of PE - Answer- Anticoagulation may be started before imaging confirmation in patients with a high pre-test probability of the disease. Either unfractionated heparin or low-molecular weight heparins (e.g. enoxaparin) may be used in most cases. Warfarin (Coumadin) has a transient hypercoagulable effect; therefore, patients starting warfarin are placed on heparin until warfarin reaches a therapeutic level (INR 2-3).
DOAC (rivaroxaban, apixaban, dibigatran) ideal for outpatient treatment of DVT/PE because they require no additional monitoring and have a quick onset of action, providing anti-coagulation much sooner than warfarin therapy.
contraindications to anticoagulation - Answer- - Active pathological bleed
- Coagulation disorder
- Hepatic dysfunction w/ hi PT or INR
- Severe thrombocytopenia
- Malignant HTN
- Hypersensitivity to meds
what are massive and submassive PE - Answer- ICU admission is warranted for patients with "massive" PE and should be considered in patients with "submassive" PE. Massive PE is defined as causing persistent hypotension (including relative hypotension
in patients with a history of hypertension) and does not refer to the size of the thrombus itself. Submassive PE is defined as normotensive but with increased work of breathing, hypoxia <90%, new altered mental status, and evidence of right heart strain: elevated troponin or BNP, new RBBB, or evidence of RVs train on echocardiography.
NYHA CHF Classification - Answer- Class I - Ordinary activity not limited by symptoms
Class II - Ordinary activity leads to dyspnea, fatigue, etc
Class III - Marked limitation of ordinary activity
Class IV - Symptoms at rest or with any physical activity
In high output heart failure the cardiac output is____. High output HF can be caused by - Answer- high or normal, but remains insufficient to supply oxygen demands.
hyperthyroidism, pregnancy, anemia, AV fistulas, beriberi, or Paget's disease.
treatment of PE - Answer- Anticoagulation may be started before imaging confirmation in patients with a high pre-test probability of the disease. Either unfractionated heparin or low-molecular weight heparins (e.g. enoxaparin) may be used in most cases. Warfarin (Coumadin) has a transient hypercoagulable effect; therefore, patients starting warfarin are placed on heparin until warfarin reaches a therapeutic level (INR 2-3).
DOAC (rivaroxaban, apixaban, dibigatran) ideal for outpatient treatment of DVT/PE because they require no additional monitoring and have a quick onset of action, providing anti-coagulation much sooner than warfarin therapy.
contraindications to anticoagulation - Answer- - Active pathological bleed
- Coagulation disorder
- Hepatic dysfunction w/ hi PT or INR
- Severe thrombocytopenia
- Malignant HTN
- Hypersensitivity to meds
what are massive and submassive PE - Answer- ICU admission is warranted for patients with "massive" PE and should be considered in patients with "submassive" PE. Massive PE is defined as causing persistent hypotension (including relative hypotension
in patients with a history of hypertension) and does not refer to the size of the thrombus itself. Submassive PE is defined as normotensive but with increased work of breathing, hypoxia <90%, new altered mental status, and evidence of right heart strain: elevated troponin or BNP, new RBBB, or evidence of RVs train on echocardiography.
NYHA CHF Classification - Answer- Class I - Ordinary activity not limited by symptoms
Class II - Ordinary activity leads to dyspnea, fatigue, etc
Class III - Marked limitation of ordinary activity
Class IV - Symptoms at rest or with any physical activity
In high output heart failure the cardiac output is____. High output HF can be caused by - Answer- high or normal, but remains insufficient to supply oxygen demands.
hyperthyroidism, pregnancy, anemia, AV fistulas, beriberi, or Paget's disease.
