PCCN Examination Revision Questions 2023

kidney purpose excretion of metabolic wastes urine formation acid-base balance regulation electrolyte regulation fluid regulation blood pressure regulation (RAAS) erythropoietin secretion and anemia regulation chloride range 96-106 Ischemic stroke and HTN tx HTN only if SBP>220 or DBP >140 unless had tPA then SBP: >185 or DBP >110 Normal BNP level <100 pg/mL positive hepatojugular reflex in setting of edema push and hold on right upper quadrant over liver if the heart is in acute heart failure than the jvd will increase by 3 cm New York Heart Association Classification I: asymptomatic II: sx with ordinary activity III: asymptomatic only at rest IV: sx at rest ACC/AHA evolution of HF Stage A: high risk for heart failure but without structural heart disease or symptoms Stage B: structural heart disease but without symptoms Stage C: structural heart disease with prior or current symptoms Stage D: refractory HF requiring specialized interventions Types of cardiomyopathy 1) Dilated (congestive) WALLS STRETCHED OUT most common --- Ischemic (MI) ---No ischemic (ETOH, viures, myocarditis) ---stress induced (tacosubo) 2) HCM Hypertrophic --thick wall (genetic causes) 3) Restrictive --heart is tight (sarcoid/amloid) Brugada syndrome structurally normal hearts - autosomal dominant, M > W - Resembles RBBB; ST elevation & RSR' in leads V1, V2, and V3. (brugada sign) - can cause fast polymorphic V tach (looks like torsades de pointes). - ICD required Creatinine Kinase females: 40-135 males: 60-170 values higher after exercise elevation indicative of possible brain, myocardial, and skeletal muscle necrosis or injury Anterior lead and coronary artery LAD Inferior lead and coronary artery RCA Lateral lead and coronary artery L circumflex Septal lead and coronary artery RCA Posterior lead and coronary artery RCA and Circumflex (wraps around) Kussmaul sign (inc JVP with inhalation) restrictive cardiomyopathy (JVD with inspiration) Normal pulse pressure 40 mmHg Normal P-R interval time 0.12-0.2 seconds Normal QRS interval 0.04-0.10 Brady Algorithm is it causing symptoms? 1st: Atropine! .5 mg Iv every 3-5 min max of 3 mg 2nd: transcutaneous pacing 3rd: Dopamine or Epi! dopamine: 2-20 mcg/kg/min infuse epi: 2-10 mcg/min infuse retroperitoneal hematoma complaints of back pain or flank pain, distention and abdominal pain, lower quadrant pain, lower extremity pain, hypotension and tachycardia, pallor, drop in hematocrit and hemoglobin