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 Tachypnea, tachycardia, hypotension PTX sx - answerPleuritic CP (unilateral), Dyspnea, unequal thoracic expansion PTX tx - answerIf small - observation + O2 If large - Chest tube If Tension - Needle decompression then chest tube (2nd IC space MC line of affected side) Angina dx - answerEKG Stress test Coronary Angiography **** Gold standard Angina tx - answerrest Unstable Angina / NSTEMI management - answer1. Antithrombotic therapy -ASA - prevents platelet aggregation -UFH - prevents fibrin new clots indicated: EKG chg, cardiac markers, hx acute coronary syn -LMWH - (Lovenox, Fragmin) -ADP inhibitors (plavix) - inhibit platelet aggregation - good if asa allergy -GP 2b/3a: inhibit platelet aggregation -Factor Xa: (Xa + prothrombin (factor 2) = Thrombin (2a) activate fibrinogen = Fibrin clot) 2. Adjunctive therapy -BB- contra in cocaine MI -Nitrates - dec sxs not mortality -MS - dec pain, preload -CCB- 3rd line only - 1st choice for Cocaine MI and Prinzmental (coronary spasm) STEMI - answerST elevation myocardial infarction **** a new LBBB is = STEMI STEMI sx - answerCP, Diaphoresis, Left arm and jaw pain, GI upset, dizziness, syncope STEMI dx - answerEKG (w/in 10 mins of arrival) Troponin levels