BKAT Study Questions and Answers 2023 solved correctly
What to do first if patient has chest pain.
Rest!
ECG changes in an acute MI
ST elevation in 2 or more contiguous leads. Ischemia d/t full thickness loss of muscle.
EMERGENCY.
Inferior leads
II, III, aVF. RCA occlusion.
Septal leads
V1 & V2.
Anterior leads
V1 - V4. LAD lesion.
Lateral leads
V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes
Troponins, CK-MB, and CK
Changes in CK
Rise: 3-6 hours
Peak: 24 hours
Normal: 3-4 days
Changes in CK-MB
Released after myocardial necrosis. Specific for myocardial damage.
Rise: 3-12 hours
Peak: 24 hours
Normal: 2-3 days
Troponin I
Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 24 hours
Normal: 5-10 days
Troponin T
Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 12-48 hours
Normal: 5-14 days
Common conditions that cause a murmur
Aortic dissection, aortic regurgitation (both acute & chronic), mitral valve regurgitation
(both acute & chronic), mitral valve stenosis
Drugs to decrease afterload/SVR/PVR
(Arterial Dilators) Nitroprusside, nitroglycerin, amrinone, alpha (Regitine) & Ca channel
blockers
Drugs to increased afterload/SVR/PVR
(Vasopressors) Epinepherine, norepinepherine, dopamine, neosynephrine
Drugs to decrease contractility/SVI
, Beta blockers (atenolol, metoprolol, propranolol, labetolol, esmolol) and Ca channel
blockers
Drugs to increase contractility/SVI
Positive inotropes, dobutamine, dopamine, milrinone, and digoxin
Drugs to decrease preload/CVP/PAWP
Venous Dilators - Nitroglycerin, nitroprusside, amrinone, alpha & Ca channel blockers
Diuretics - Furosemide, bumex, mannitol
Drugs to increase preload/CVP/PAWP
Volume - Colloid, crystalloids, blood, hetastarch
Dysrhythmia control - antirhythmics, pacemaker, AICD
Complications when using thrombolytics
Allergic reaction, bleeding/hemorrhage, stroke
Failure to capture
Pacer delivers a stimulus at the appropriate time but no depolarization occurs. No P or
QRS wave after pacer spike.
Failure to fire/pace
No pacer spikes seen
Failure to sense
Pacemaker does not detects heart's intrinsic activity or interprets noncardiac activity as
intrinsic activity. Spikes in inappropriate times.
Normal PR
0.12 - 0.20
Normal QRS
0.04-0.10
Normal QT
Less than 0.48. Varies by age, HR, and gender.
Vasopressors
Epinepherine, norepinepherine, dopamine, phenylephrine/neosynephrine,
vasopressin/pitressin, milrinone/Primacor, dobutamine/Dobutrex
Indication for dopamine/Intropin
Acts on SNS to increased HR and BP. Indicated for hypotension, low CO, decreased
renal blood flow. Use if patient is bradycardic.
Doses of dopamine
Low: 0.5-2 mcg/kg/min (dopaminergic)
Intermediate: 2-10 mcg/kg/min (beta receptors, increases CO)
High: over 10 mcg/kg/min (alpha receptors, vasoconstrict)
SE of dopamine
Watch volume and starting BP. Use central line. Inactivated by sodium bicarb. Can
cause acidosis. SE: ectopic beats, tachycardia, tissue necrosis d/t extravasation
Treatment of dopamine extravasation
Phentaolmine 5-10 mg and possibly nitropaste to vasodilate
Indication for norepinepherine/Levophed
Indicated for diastolic hypotension (specifically decreased SVR) and septic shock.
Stimulates alpha & beta receptors. Increased contractility, HR, and vasoconstriction.
Doses of norepinepherine
2-12 mcg/min. Immediate onset.
What to do first if patient has chest pain.
Rest!
ECG changes in an acute MI
ST elevation in 2 or more contiguous leads. Ischemia d/t full thickness loss of muscle.
EMERGENCY.
Inferior leads
II, III, aVF. RCA occlusion.
Septal leads
V1 & V2.
Anterior leads
V1 - V4. LAD lesion.
Lateral leads
V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes
Troponins, CK-MB, and CK
Changes in CK
Rise: 3-6 hours
Peak: 24 hours
Normal: 3-4 days
Changes in CK-MB
Released after myocardial necrosis. Specific for myocardial damage.
Rise: 3-12 hours
Peak: 24 hours
Normal: 2-3 days
Troponin I
Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 24 hours
Normal: 5-10 days
Troponin T
Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 12-48 hours
Normal: 5-14 days
Common conditions that cause a murmur
Aortic dissection, aortic regurgitation (both acute & chronic), mitral valve regurgitation
(both acute & chronic), mitral valve stenosis
Drugs to decrease afterload/SVR/PVR
(Arterial Dilators) Nitroprusside, nitroglycerin, amrinone, alpha (Regitine) & Ca channel
blockers
Drugs to increased afterload/SVR/PVR
(Vasopressors) Epinepherine, norepinepherine, dopamine, neosynephrine
Drugs to decrease contractility/SVI
, Beta blockers (atenolol, metoprolol, propranolol, labetolol, esmolol) and Ca channel
blockers
Drugs to increase contractility/SVI
Positive inotropes, dobutamine, dopamine, milrinone, and digoxin
Drugs to decrease preload/CVP/PAWP
Venous Dilators - Nitroglycerin, nitroprusside, amrinone, alpha & Ca channel blockers
Diuretics - Furosemide, bumex, mannitol
Drugs to increase preload/CVP/PAWP
Volume - Colloid, crystalloids, blood, hetastarch
Dysrhythmia control - antirhythmics, pacemaker, AICD
Complications when using thrombolytics
Allergic reaction, bleeding/hemorrhage, stroke
Failure to capture
Pacer delivers a stimulus at the appropriate time but no depolarization occurs. No P or
QRS wave after pacer spike.
Failure to fire/pace
No pacer spikes seen
Failure to sense
Pacemaker does not detects heart's intrinsic activity or interprets noncardiac activity as
intrinsic activity. Spikes in inappropriate times.
Normal PR
0.12 - 0.20
Normal QRS
0.04-0.10
Normal QT
Less than 0.48. Varies by age, HR, and gender.
Vasopressors
Epinepherine, norepinepherine, dopamine, phenylephrine/neosynephrine,
vasopressin/pitressin, milrinone/Primacor, dobutamine/Dobutrex
Indication for dopamine/Intropin
Acts on SNS to increased HR and BP. Indicated for hypotension, low CO, decreased
renal blood flow. Use if patient is bradycardic.
Doses of dopamine
Low: 0.5-2 mcg/kg/min (dopaminergic)
Intermediate: 2-10 mcg/kg/min (beta receptors, increases CO)
High: over 10 mcg/kg/min (alpha receptors, vasoconstrict)
SE of dopamine
Watch volume and starting BP. Use central line. Inactivated by sodium bicarb. Can
cause acidosis. SE: ectopic beats, tachycardia, tissue necrosis d/t extravasation
Treatment of dopamine extravasation
Phentaolmine 5-10 mg and possibly nitropaste to vasodilate
Indication for norepinepherine/Levophed
Indicated for diastolic hypotension (specifically decreased SVR) and septic shock.
Stimulates alpha & beta receptors. Increased contractility, HR, and vasoconstriction.
Doses of norepinepherine
2-12 mcg/min. Immediate onset.
