Exam (elaborations) AACN-CRITICAL CARE (Cardiology, Pulmonary, Neurology)

AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and explanations 1. Question: What are the diagnostic criteria for acute coronary syndrome (ACS), and how do STelevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) differ in presentation and management? o Answer: Diagnostic criteria for ACS include chest pain, elevated cardiac biomarkers (e.g., troponin), and ECG changes. STEMI is characterized by ST-segment elevation on the ECG and requires urgent reperfusion therapy (e.g., PCI or thrombolysis). NSTEMI presents with ST-segment depression or T-wave inversion and is managed with antiplatelet therapy and possibly invasive procedures. o Explanation: STEMI and NSTEMI both involve myocardial infarction but differ in their ECG findings and immediate management strategies, with STEMI requiring rapid reperfusion and NSTEMI often managed with medical therapy and risk assessment. 2. Question: How is heart failure classified according to the New York Heart Association (NYHA) functional classification system, and what are the implications for patient management? o Answer: The NYHA classification system categorizes heart failure into four classes based on functional limitations: Class I (no symptoms), Class II (mild symptoms), Class III (marked symptoms), and Class IV (severe symptoms at rest). Management strategies are tailored to the functional class, with more advanced therapies needed for higher classes. o Explanation: The NYHA classification helps determine the severity of heart failure and guides treatment decisions, including medication adjustments and lifestyle modifications. 3. Question: What are the key features of cardiogenic shock, and how does it differ from other types of shock in terms of treatment approaches? o Answer: Cardiogenic shock is characterized by decreased cardiac output due to severe left ventricular dysfunction, leading to hypotension and organ hypoperfusion. Treatment includes inotropic support, vasopressors, and addressing the underlying cause (e.g., revascularization). It differs from hypovolemic shock, which requires fluid resuscitation, and septic shock, which requires antibiotics and fluid management. o Explanation: Cardiogenic shock results from heart failure, necessitating different management strategies compared to other shock types, which focus on fluid resuscitation or infection control. 4. Question: What are the indications and contraindications for implantable cardioverterdefibrillator (ICD) therapy in patients with heart failure? o Answer: ICD therapy is indicated for patients with symptomatic heart failure and a reduced ejection fraction (EF ≤ 35%) who are at high risk of sudden cardiac death. Contraindications include conditions that limit life expectancy to less than one year or severe comorbidities that may preclude benefit from ICD therapy. AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and explanations o Explanation: ICDs are used to prevent sudden cardiac death in high-risk heart failure patients, with contraindications related to prognosis and overall health status. 5. Question: How is atrial fibrillation (AF) managed in the acute setting, and what are the goals of treatment? o Answer: Acute management of AF involves rate control with beta-blockers or calcium channel blockers, rhythm control (e.g., electrical cardioversion or antiarrhythmic drugs), and anticoagulation to prevent thromboembolism. The goals are to restore normal sinus rhythm, control ventricular rate, and reduce the risk of stroke. o Explanation: The acute management of AF focuses on stabilizing the heart rhythm and preventing complications, with treatment tailored to the patient's clinical presentation and underlying conditions. 6. Question: What are the major side effects of commonly used anticoagulants, such as warfarin and direct oral anticoagulants (DOACs), and how are they managed? o Answer: Major side effects include bleeding risks. For warfarin, management involves monitoring INR levels and reversing with vitamin K or prothrombin complex concentrates if needed. For DOACs, management includes using specific antidotes (e.g., andexanet for factor Xa inhibitors) or supportive care for bleeding complications. o Explanation: Anticoagulants can cause bleeding, requiring careful monitoring and appropriate reversal strategies to manage adverse effects and ensure patient safety. 7. Question: How does the presence of left bundle branch block (LBBB) affect the interpretation of ECGs in patients with suspected myocardial infarction (MI)? o Answer: LBBB can obscure ST-segment changes and T-wave inversions on ECGs, making the diagnosis of MI challenging. In the presence of LBBB, additional diagnostic methods, such as echocardiography or cardiac biomarkers, may be necessary to confirm an MI. o Explanation: LBBB can complicate MI diagnosis due to altered ECG patterns, requiring supplementary diagnostic tools for accurate assessment. 8. Question: What are the key principles in the management of a patient with hypertensive emergency, and how do they differ from hypertensive urgency? o Answer: In hypertensive emergency, blood pressure must be reduced rapidly but cautiously to prevent organ damage, using intravenous medications (e.g., nitroprusside, labetalol). In hypertensive urgency, blood pressure reduction is less immediate, typically achieved with oral medications (e.g., clonidine, captopril) over a period of hours to days. o Explanation: Hypertensive emergencies require urgent blood pressure management to prevent end-organ damage, while urgencies are managed with slower, oral medications. 9. Question: What are the indications for coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI), and how are these decisions made? AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and explanations o Answer: CABG is indicated for multi-vessel disease, left main coronary artery disease, or when PCI is not feasible. PCI is preferred for single or double vessel disease and is suitable for patients with high procedural success rates. Decisions are based on coronary anatomy, patient comorbidities, and clinical outcomes. o Explanation: CABG and PCI are chosen based on the extent of coronary artery disease and patient factors, with CABG generally reserved for more complex cases. 10. Question: What role does BNP (B-type natriuretic peptide) play in the diagnosis and management of heart failure? o Answer: BNP levels are elevated in heart failure and help in diagnosing and assessing the severity of the condition. Elevated levels are used to differentiate heart failure from other causes of dyspnea and to monitor response to therapy. o Explanation: BNP serves as a biomarker for heart failure, aiding in diagnosis and treatment adjustment based on levels reflecting cardiac stress. Pulmonary 11. Question: How is acute respiratory distress syndrome (ARDS) diagnosed, and what are the key components of its management? o Answer: ARDS is diagnosed based on clinical criteria including acute onset of hypoxemia, bilateral pulmonary infiltrates on imaging, and absence of cardiac failure. Management includes mechanical ventilation with low tidal volume strategy, prone positioning, and supportive care. o Explanation: ARDS requires a comprehensive approach including mechanical ventilation strategies and supportive measures to manage the severe hypoxemia and pulmonary inflammation. 12. Question: What are the indications for non-invasive positive pressure ventilation (NIPPV) in patients with respiratory failure, and how does it differ from invasive ventilation? o Answer: NIPPV is indicated for conditions like COPD exacerbations and cardiogenic pulmonary edema to avoid intubation and improve oxygenation and ventilation. It differs from invasive ventilation in that it uses a mask or nasal interface rather than an endotracheal tube, reducing complications associated with intubation. o Explanation: NIPPV provides a less invasive alternative to intubation, benefiting patients with certain respiratory conditions by improving ventilation and reducing the need for mechanical ventilation. 13. Question: What are the key considerations in the management of chronic obstructive pulmonary disease (COPD) exacerbations, and how does it differ from asthma exacerbations? o Answer: Management of COPD exacerbations includes bronchodilators, corticosteroids, and antibiotics if infection is suspected. Differentiating COPD from asthma exacerbations involves assessing patient history, response to treatment, and the presence of AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and explanations underlying comorbidities. Asthma often responds to corticosteroids and bronchodilators more effectively than COPD. o Explanation: COPD exacerbations require tailored management strategies, including potential antibiotic therapy, while asthma exacerbations typically respond well to corticosteroids and bronchodilators. 14. Question: How do you interpret arterial blood gas (ABG) results in the context of acute respiratory acidosis versus metabolic acidosis? o Answer: Acute respiratory acidosis is characterized by elevated pCO2 and a low pH, indicating impaired ventilation. Metabolic acidosis is indicated by a low pH and low HCO3- levels. Analysis of the compensatory response helps differentiate between the two conditions. o Explanation: ABG results help determine the underlying acid-base disturbance and guide appropriate treatment by assessing pCO2 levels and HCO3- concentrations. 15. Question: What are the main goals and strategies for managing a patient with pulmonary embolism (PE)? o Answer: Goals for managing PE include stabilizing the patient, preventing further clot formation, and managing symptoms. Strategies include anticoagulation therapy (e.g., heparin, warfarin), thrombolysis in severe cases, and supportive care. o Explanation: Management of PE focuses on anticoagulation to prevent clot progression and thrombolysis for severe cases, along with supportive care to stabilize the patient. 16. Question: What is the role of corticosteroids in the management of pneumonia, and when should they be considered? o Answer: Corticosteroids can reduce inflammation and improve outcomes in severe pneumonia or patients with severe community-acquired pneumonia (CAP) or COVID-19. They should be used with caution and based on clinical guidelines and patient conditions. o Explanation: Corticosteroids are reserved for severe cases and specific pathogens, with careful consideration of their potential benefits and risks. 17. Question: How does the management of pleural effusion differ based on the underlying cause (e.g., heart failure, malignancy)? o Answer: Management involves treating the underlying condition, such as diuretics for heart failure or chemotherapy for malignancy. Additional interventions include thoracentesis for symptomatic relief and pleurodesis for recurrent effusions related to malignancy. o Explanation: The approach to pleural effusion depends on its cause, focusing on treating the primary condition and providing symptomatic relief as needed. AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and explanations 18. Question: What are the indications for bronchoscopy in the evaluation of lung pathology, and what are the potential complications? o Answer: Indications for bronchoscopy include persistent cough, hemoptysis, and abnormal imaging findings. Potential complications include bleeding, infection, and pneumothorax. Pre-procedural assessment and careful technique help mitigate risks. o Explanation: Bronchoscopy is used for diagnostic and therapeutic purposes, with careful consideration of potential complications to ensure patient safety. 19. Question: How do beta-agonists and anticholinergic agents work in the management of acute asthma attacks, and how are they combined in treatment? o Answer: Beta-agonists relax bronchial smooth muscle and improve airflow, while anticholinergics reduce bronchoconstriction and mucus secretion. They are often combined for synergistic effects, with beta-agonists providing rapid relief and anticholinergics extending bronchodilation. o Explanation: Combining beta-agonists and anticholinergics enhances asthma management by addressing different aspects of bronchoconstriction and airway inflammation. 20. Question: What are the key differences between obstructive sleep apnea (OSA) and central sleep apnea, and how are they managed? o Answer: OSA is caused by upper airway obstruction, while central sleep apnea is due to a lack of respiratory effort. OSA is managed with CPAP therapy, while central sleep apnea may require adaptive servo-ventilation or bilevel positive airway pressure (BiPAP). Identifying the type of apnea guides appropriate treatment. o Explanation: Accurate diagnosis of the type of sleep apnea is crucial for selecting the most effective treatment approach and improving patient outcomes. Neurology 21. Question: What are the primary treatment goals for patients with acute ischemic stroke, and how do thrombolysis and thrombectomy differ in their indications and timing? o Answer: Treatment goals include restoring cerebral blood flow and minimizing neurological damage. Thrombolysis with tissue plasminogen activator (tPA) is indicated within 4.5 hours of symptom onset, while thrombectomy is performed within 6-24 hours for larger vessel occlusions. Timing and patient selection are crucial for maximizing outcomes. o Explanation: Both thrombolysis and thrombectomy are used to treat ischemic stroke, with specific time windows and indications guiding their use to improve patient recover