OSCE - DIAGNOSTICS* QUESTIONS AND ANSWERS LATEST
UPDATE A+ GRADED
First degree AV block
prolonged PR interval
Tx:
- asx: no tx
- sx: atropine
2nd degree AV block - Type 1
Wenekebach
PR interval long, longer, drop
the drop is a P wave not followed by a QRS
Tx: pacemaker, may need pacing
2nd degree AV block - Type 2
THERE IS SUDDENLY DROPPED QRS COMPLEX WITHOUT PRIOR PR
LENGTHENING
Tx: pacemaker
3rd degree AV block
atria and ventricles beat independently of each other
(P waves have no relation to QRS waves)
Tx: pacemaker
Torsades
Treat as V-tach, but also consider giving IV Magnesium sulfate
V-tach
If unstable --> defibrillate
If stable --> Adenosine 6mg followed by 12mg (may repeat 12mg dose if needed).
Can control rate with diltiazem or beta blockers
Ventricular fibrillation
Tx: CPR (120-220j on biphasic, 360j on mono) --> Shock --> CPR --> Epinephrine
(repeated every 3-5min) --> CPR --> Amiodarone 300mg IV (then 150mg if needed)
--> CPR --> Shock
Atrial fibrillation
Rate control:
- if slow, pace the patient
- if fast, BB/CCB
Rhythm control:
- Cardioversion w/anti-arrhythmics (amiodarone, sotalol)
Surgery: Ablation, Maze procedure
Atrial Flutter
Saw tooth pattern
Tx: rate control w BB/CCB
Sinus Ventricular Tachycardia
Tx:
, - Stable: vagal maneuvers/carotid sinus massage
- Unstable: cardioversion, BB/CCB
Right BBB
Causes: COPD, HTN, PE, cor pulmonale, cardiomyopathy, MI, congenital
Tx: None if asx, pacemaker in cases where pt has other conduction issues
Left BBB
Causes: dilated cardiomyopathy, acute MI, CAD, Lyme, myocarditis, congenital
defects
Wolff-Parkinson-White
Causes: Congenital, gene defect
Sx: palpitations, dizziness, SOB, fainting, fatigue, anxiety
Tx: vagal, procainamide, cardioversion, ablation
Multifocial atrial tachycardia
Causes: COPD, CAD, CHF, DM, Hypokalemia, HypoMag, PE, PNA, sepsis
Sx: palpitations, SOB, chest pain, syncope
Tx: Tx underlying disorder, BB/CCB for rate control; Amiodarone
*cardioversion is C/I
ARDS
· Causes: Sepsis (MCC), Inhalation of harmful substance, Pneumonia, Head or
chest trauma, pancreatitis, burns, massive blood transfusions
· Risk factors: Infection, alcoholism
· Complications: blood clots, pneumothorax, infections, pulmonary fibrosis
· Tx: Oxygen/ventilator support, Fluid management
Pneumonia
CAP: S. pneumo, H. Flu
Tx: Azithromycin or doxy
- if CHF, CKD = cipro, levo or augmentin or ceftriaxone
HAP: S. aureus, MSSA, MRSA, Kliebsiella, E. Coli
Tx: Vanco until cultures come back
- Ceftriazone or Cefepime and Vanco x 7 days
CHF
Tx: ACE/ARB, BB, Diuretics, Inotropes
Pneumothorax
Causes: spontaneous, iatrogenic, trauma
Tx:
< 20%: O2 + watch, serial CXR
> 20%: chest tube
Tension: needle decompression 2 ICS, MCL
Pleural Effusion
abnormal accumulation of fluid in the pleural space
Pancoast Tumor
Horner's syndrome: miosis, ptosis, anhidrosis
*most are non-small cell lung CA (SCC, adeno)
Tx: surgery if localized, radiation if unresectable
Lung Mass
- MC type of lung cancer is non-small cell (Adeno)
UPDATE A+ GRADED
First degree AV block
prolonged PR interval
Tx:
- asx: no tx
- sx: atropine
2nd degree AV block - Type 1
Wenekebach
PR interval long, longer, drop
the drop is a P wave not followed by a QRS
Tx: pacemaker, may need pacing
2nd degree AV block - Type 2
THERE IS SUDDENLY DROPPED QRS COMPLEX WITHOUT PRIOR PR
LENGTHENING
Tx: pacemaker
3rd degree AV block
atria and ventricles beat independently of each other
(P waves have no relation to QRS waves)
Tx: pacemaker
Torsades
Treat as V-tach, but also consider giving IV Magnesium sulfate
V-tach
If unstable --> defibrillate
If stable --> Adenosine 6mg followed by 12mg (may repeat 12mg dose if needed).
Can control rate with diltiazem or beta blockers
Ventricular fibrillation
Tx: CPR (120-220j on biphasic, 360j on mono) --> Shock --> CPR --> Epinephrine
(repeated every 3-5min) --> CPR --> Amiodarone 300mg IV (then 150mg if needed)
--> CPR --> Shock
Atrial fibrillation
Rate control:
- if slow, pace the patient
- if fast, BB/CCB
Rhythm control:
- Cardioversion w/anti-arrhythmics (amiodarone, sotalol)
Surgery: Ablation, Maze procedure
Atrial Flutter
Saw tooth pattern
Tx: rate control w BB/CCB
Sinus Ventricular Tachycardia
Tx:
, - Stable: vagal maneuvers/carotid sinus massage
- Unstable: cardioversion, BB/CCB
Right BBB
Causes: COPD, HTN, PE, cor pulmonale, cardiomyopathy, MI, congenital
Tx: None if asx, pacemaker in cases where pt has other conduction issues
Left BBB
Causes: dilated cardiomyopathy, acute MI, CAD, Lyme, myocarditis, congenital
defects
Wolff-Parkinson-White
Causes: Congenital, gene defect
Sx: palpitations, dizziness, SOB, fainting, fatigue, anxiety
Tx: vagal, procainamide, cardioversion, ablation
Multifocial atrial tachycardia
Causes: COPD, CAD, CHF, DM, Hypokalemia, HypoMag, PE, PNA, sepsis
Sx: palpitations, SOB, chest pain, syncope
Tx: Tx underlying disorder, BB/CCB for rate control; Amiodarone
*cardioversion is C/I
ARDS
· Causes: Sepsis (MCC), Inhalation of harmful substance, Pneumonia, Head or
chest trauma, pancreatitis, burns, massive blood transfusions
· Risk factors: Infection, alcoholism
· Complications: blood clots, pneumothorax, infections, pulmonary fibrosis
· Tx: Oxygen/ventilator support, Fluid management
Pneumonia
CAP: S. pneumo, H. Flu
Tx: Azithromycin or doxy
- if CHF, CKD = cipro, levo or augmentin or ceftriaxone
HAP: S. aureus, MSSA, MRSA, Kliebsiella, E. Coli
Tx: Vanco until cultures come back
- Ceftriazone or Cefepime and Vanco x 7 days
CHF
Tx: ACE/ARB, BB, Diuretics, Inotropes
Pneumothorax
Causes: spontaneous, iatrogenic, trauma
Tx:
< 20%: O2 + watch, serial CXR
> 20%: chest tube
Tension: needle decompression 2 ICS, MCL
Pleural Effusion
abnormal accumulation of fluid in the pleural space
Pancoast Tumor
Horner's syndrome: miosis, ptosis, anhidrosis
*most are non-small cell lung CA (SCC, adeno)
Tx: surgery if localized, radiation if unresectable
Lung Mass
- MC type of lung cancer is non-small cell (Adeno)
