PAEA Internal Medicine EOR: Critical Care 7% Exam Questions With 100% Verified Answers

PAEA Internal Medicine EOR: Critical Care 7% Exam Questions With 100% Verified Answers PE risk factors - answerVirchows triad: stasis, endothelial injury, hyper coagulable state More proximal PEs more at risk for embolization PE sx - answerTRIAD: dyspnea, pleuritic pain, hemoptysis, MASSIVE PE: Syncope, PEA, Hypotension, edema PE -ABGs -CXR -EKG - answerABG: Resp acidosis (early = alkalosis from hyper ventilation), increased A-a gradient (nl: 10-20) CXR: MC is normal, Westermark sign (avascular markings distal to embolism), Hamptons hump, atelectasis, effusions EKG: McGinn-White sign (S1Q3T3): S1 wide deep, Q3- isolated Q in lead 3, T3 - T wave inversion in lead 3 Means cor pulmonale PE dx - answerD dimer: Sensitive but not specific Helical CT *initial* V/Q scan pulmonary angiography ***(gold std)*** Use if highly suspicious but above neg PE tx - answerUnstable BP - IV UFH or SQ LMWH and PO warfarin x 5-7 days and then for 6 mo (Anticoagulation contraindicated with IVC filter) Stable BP - thrombolytics (TP) OR EMBOLECTOMY IF CONTRAINDICATED acute respiratory failure dx - answerPaO2 of 50mmHg with FiO2 60% hypoxemia unresponsive to 100% O2 Low to normal capillary wedge pressures (18mmHg) ARF CXR - answerDiffuse bilteral interstitial and alveolar infiltrates with a normal sized heart Spare costophrenic angle (ceardiogenic pulm edema does not) ARF management - answerBegin ventilations: CPAP/PEEP - FiO2 60 mmHg goal PaO2 55 mm Hg Smaller TV 6cc/kg Treatment of the underlying condition PEEP will keep collapsed alveoli open (essential) Tension PTX - answertrachea and mediastinum push to contralateral side PTX PE - answerHyper resonance Decreased tactile fremitus Decreased breath sounds