NR 571 Midterm Study Set with solutions
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
noncompressible |vascular |punctures
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
noncompressible |vascular |punctures
