EMERGENCY MEDICINE Exam Questions
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Acute/subacute bacterial endocarditis - ✔✔General
-mitral valve MC valve involved (exception: tricuspid valve MC in IV drug users)
-types
• acute bacterial endocarditis: normal valves; S. aureus
• subacute bacterial endocarditis: abnormal valves (S. viridans)
• IV drug-related endocarditis: most commonly due to S. aureus (esp MRSA)
• Prosthetic valve endocarditis: early (within 60 days); Staphylococcus epidermis MC
-organisms:
• Staph. aureus: ACUTE, affects normal valves, IV drug use (esp MRSA)
• Strep. viridans: SUBACUTE, affects damaged valves, poor dentition or dental procedures)
• Staph epidermis: prosthetic valve endocarditis
• Enterococcus: GI or GU procedure
• HACEK organisms: negative blood cultures
Clinical
-persistent fever MC
-new onset of murmur
-Osler nodes
-Janeway lesions: painless macules
-Splinter hemorrhages
-Roth spots
,Dx
-blood cultures (3 sets at least 1 hour apart)
-echocardiogram: transesophageal echocardiogram (TEE) much more sensitive than TTE
-Labs
,• Major: sustained bacteremia positive blood cultures, endocardial involvement (positive
echocardiogram, new valvular regurgitation)
• Minor: fever, vascular & embolic phenomena, immunologic phenomena
Tx
-native valve: anti-staph penicillin (eg. Nafcillin, Oxacillin) plus either Ceftriaxone or Gentamicin
-prosthetic valve: Vancomycin + Gentamicin + Rifampin
-fungal: Amphotericin B
-duration of therapy usu 4-6 wks
Prophylaxis indications
-cardiac conditions: prosthetic (artificial) heart valves, heart repairs using prosthetic material (not
including stents), prior history of endocarditis, congenital heart disease
-procedures: dental, respiratory, procedures involving infected skin/musculoskeletal tissues
-regimens: amoxicillin 2g 30-60mins before, clindamycin 600mg
Angina - ✔✔General
-complication of Coronary artery disease leading to symptoms
Pathophys
-inadequate tissue perfusion due to imbalance between increased demand and decreased coronary
artery blood supply
-Classes:
• I: ***angina only with unusually strenuous activity! No limitations of activity.
• II: ***angina with more prolonged or rigorous activity! Slight limitation of physical activity.
• III: angina with usual daily activity. Marked limitation of physical activity.
• IV: ***angina at rest! Often unable to carry out any physical activity
Clinical
, -chest pain: classic; substernal, poorly localized, exertional, short in duration (<30 mins), relieved with
rest or Nitroglycerin
Dx
-ECG:
• initial test of choice
• ST depression classic finding
• Resting ECG = normal in 50% of cases
-Stress testing: most important noninvasive testing
-Coronary angiography: definitive diagnostic test
Tx
-Medical:
• daily Aspirin + Beta blockers (both decrease mortality), sublingual Nitroglycerin as needed, and daily
Statin
-Revascularization: definitive management
• percutaneous transluminal coronary angioplasty
• coronary artery bypass graft - ***left main coronary artery stenosis, 3 vessel disease
Arrhythmias - ✔✔• Normal sinus: normal rate (60-100) and rhythm; impulse originates in SA node; p
waves upright; regular intervals
• Sinus tach: HR >100; exercise, excitement, illness
• Sinus brady: HR 50-60
• Atrial fibrillation/flutter: irritable sites in atria fire rapidly (400-600bpm); rapid pacemaking à atrial
quivering; ventricles beat
slower bc AV node blocks some atrial impulses
o Sx: Elderly/alcohol use; syncope, dyspnea, palpitations
o Dx: EKG: no discrete p waves; irregularly irregular
o Tx: rate - CCB (diltiazem / verapamil) or beta blocker (metoprolol); rhythm (<48 hrs = cardioversion,
amiodarone; >48
with 100% Correct Answers Latest Updated
2025 Top Rated A+
Acute/subacute bacterial endocarditis - ✔✔General
-mitral valve MC valve involved (exception: tricuspid valve MC in IV drug users)
-types
• acute bacterial endocarditis: normal valves; S. aureus
• subacute bacterial endocarditis: abnormal valves (S. viridans)
• IV drug-related endocarditis: most commonly due to S. aureus (esp MRSA)
• Prosthetic valve endocarditis: early (within 60 days); Staphylococcus epidermis MC
-organisms:
• Staph. aureus: ACUTE, affects normal valves, IV drug use (esp MRSA)
• Strep. viridans: SUBACUTE, affects damaged valves, poor dentition or dental procedures)
• Staph epidermis: prosthetic valve endocarditis
• Enterococcus: GI or GU procedure
• HACEK organisms: negative blood cultures
Clinical
-persistent fever MC
-new onset of murmur
-Osler nodes
-Janeway lesions: painless macules
-Splinter hemorrhages
-Roth spots
,Dx
-blood cultures (3 sets at least 1 hour apart)
-echocardiogram: transesophageal echocardiogram (TEE) much more sensitive than TTE
-Labs
,• Major: sustained bacteremia positive blood cultures, endocardial involvement (positive
echocardiogram, new valvular regurgitation)
• Minor: fever, vascular & embolic phenomena, immunologic phenomena
Tx
-native valve: anti-staph penicillin (eg. Nafcillin, Oxacillin) plus either Ceftriaxone or Gentamicin
-prosthetic valve: Vancomycin + Gentamicin + Rifampin
-fungal: Amphotericin B
-duration of therapy usu 4-6 wks
Prophylaxis indications
-cardiac conditions: prosthetic (artificial) heart valves, heart repairs using prosthetic material (not
including stents), prior history of endocarditis, congenital heart disease
-procedures: dental, respiratory, procedures involving infected skin/musculoskeletal tissues
-regimens: amoxicillin 2g 30-60mins before, clindamycin 600mg
Angina - ✔✔General
-complication of Coronary artery disease leading to symptoms
Pathophys
-inadequate tissue perfusion due to imbalance between increased demand and decreased coronary
artery blood supply
-Classes:
• I: ***angina only with unusually strenuous activity! No limitations of activity.
• II: ***angina with more prolonged or rigorous activity! Slight limitation of physical activity.
• III: angina with usual daily activity. Marked limitation of physical activity.
• IV: ***angina at rest! Often unable to carry out any physical activity
Clinical
, -chest pain: classic; substernal, poorly localized, exertional, short in duration (<30 mins), relieved with
rest or Nitroglycerin
Dx
-ECG:
• initial test of choice
• ST depression classic finding
• Resting ECG = normal in 50% of cases
-Stress testing: most important noninvasive testing
-Coronary angiography: definitive diagnostic test
Tx
-Medical:
• daily Aspirin + Beta blockers (both decrease mortality), sublingual Nitroglycerin as needed, and daily
Statin
-Revascularization: definitive management
• percutaneous transluminal coronary angioplasty
• coronary artery bypass graft - ***left main coronary artery stenosis, 3 vessel disease
Arrhythmias - ✔✔• Normal sinus: normal rate (60-100) and rhythm; impulse originates in SA node; p
waves upright; regular intervals
• Sinus tach: HR >100; exercise, excitement, illness
• Sinus brady: HR 50-60
• Atrial fibrillation/flutter: irritable sites in atria fire rapidly (400-600bpm); rapid pacemaking à atrial
quivering; ventricles beat
slower bc AV node blocks some atrial impulses
o Sx: Elderly/alcohol use; syncope, dyspnea, palpitations
o Dx: EKG: no discrete p waves; irregularly irregular
o Tx: rate - CCB (diltiazem / verapamil) or beta blocker (metoprolol); rhythm (<48 hrs = cardioversion,
amiodarone; >48
