NR 571 MidTerm Study Set
What is high sensitivity troponin and when to use? - Correct Answer - first line test for cardiac cell
damage
used for initial injury
What is CKMB - Correct Answer - CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? - Correct Answer - for suspicion of secondary ischemia after an initial
infarct
normal level for Troponin I - Correct Answer - <0.04
normal level for CKMB - Correct Answer - 3-5% of total CK
What is BNP - Correct Answer - B-type natriuretic peptide
Normal BNP levels - Correct Answer - <100 pg/mL
Differential for chest pain - Correct Answer - Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
,Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - Correct Answer - 90
Initial diagnostics for chest pain - Correct Answer - 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
Requirements for STEMI dx - Correct Answer - new ST elevation in 2 contiguous leads of >0.1 mV
except V2&V3
elevated troponin
STEMI findings in V2-V3 - Correct Answer - >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina - Correct Answer - NSTEMI involves Elevated
Cardiac Bio markers (cell death)
,NSTEMI & unstable angina tx - Correct Answer - Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy - Correct Answer - DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC - Correct Answer - SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin - Correct Answer - atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use - Correct Answer - HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
, COPD
Cocaine use
When is NGT contraindicated? - Correct Answer - RV infarct b/c it reduces preload
Absolute contraindications for fibrinolytic therapy - Correct Answer - Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy)
Identification of LBBB - Correct Answer - QRS is negatively deflected in V1
Identification of RBBB - Correct Answer - QRS is positively deflected in V1
Relative contraindications for fibrinolytic therapy - Correct Answer - Hx of chronic, severe, poorly
controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
What is high sensitivity troponin and when to use? - Correct Answer - first line test for cardiac cell
damage
used for initial injury
What is CKMB - Correct Answer - CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? - Correct Answer - for suspicion of secondary ischemia after an initial
infarct
normal level for Troponin I - Correct Answer - <0.04
normal level for CKMB - Correct Answer - 3-5% of total CK
What is BNP - Correct Answer - B-type natriuretic peptide
Normal BNP levels - Correct Answer - <100 pg/mL
Differential for chest pain - Correct Answer - Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
,Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - Correct Answer - 90
Initial diagnostics for chest pain - Correct Answer - 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
Requirements for STEMI dx - Correct Answer - new ST elevation in 2 contiguous leads of >0.1 mV
except V2&V3
elevated troponin
STEMI findings in V2-V3 - Correct Answer - >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina - Correct Answer - NSTEMI involves Elevated
Cardiac Bio markers (cell death)
,NSTEMI & unstable angina tx - Correct Answer - Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy - Correct Answer - DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC - Correct Answer - SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin - Correct Answer - atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use - Correct Answer - HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
, COPD
Cocaine use
When is NGT contraindicated? - Correct Answer - RV infarct b/c it reduces preload
Absolute contraindications for fibrinolytic therapy - Correct Answer - Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy)
Identification of LBBB - Correct Answer - QRS is negatively deflected in V1
Identification of RBBB - Correct Answer - QRS is positively deflected in V1
Relative contraindications for fibrinolytic therapy - Correct Answer - Hx of chronic, severe, poorly
controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
