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66 Cards in this Set

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  • Back
Initial IV fluid resuscitation in a hypotensive trauma patient is
rapid infusion of lactated Ringer's solution through two large-bore IVs.
the hallmark of diabetic retinopathy
Neovascularization
2 plus flame-shaped retinal hemorrhages and soft “cotton wool” exudates.
dx?
findings seen in grade 3 hypertensive retinopathy
ophthalmic findings associated with Wilson’s disease
Copper granule deposition in the limbus of the cornea
the primary risk factor for aortic dissection
Systemic hypertension
Auscultation of the heart reveals a single pause in the heart sounds over a 1-minute period. Electrocardiography (ECG) demonstrates two distinct P-wave morphologies and a normal QRS complex.
premature atrial complexes, otherwise known as premature beats.
premature atrial complexes, tx
Observation . Beta blockers could be considered in the symptomatic patient who notices the skipped beats and is disturbed by them.
asystole and evidence of tricyclic antidepressant overdose tx
Bicarbonate
pulseless ventricular tachycardia or ventricular fibrillation, the remaining first-line drug of choice for resuscitation is
vasopressin
the drug of choice for treatmentof torsade de pointes
Magnesium is the drug of choice for treatment and usually is effective in termination of the arrhythmia even when magnesium levels are normal.
The differential diagnosis for this patient with a regular narrow complex tachycardia
paroxysmal supraventricular tachycardia versus an orthodromic circus movement tachycardia, often seen in patients with Wolfe-Parkinson-White syndrome.
The neuroleptics with the highest association with neuroleptic malignant syndrome
chlorpromazine and haloperidol.
Initial treatment for paroxysmal supraventricular tachycardia or an orthodromic circus movement tachycardia, often seen in patients with Wolfe-Parkinson-White syndrome.
adenosine 6-mg intravenous push (followed by adenosine 12-mg intravenous push if necessary) to temporarily block the A-V node.This usually temporarily breaks the circus rhythm or supraventricular rapid conduction, thereby restoring sinus rhythm.
neuroleptic malignant syndrome tx
Immediate medical intervention with the DA receptor agonist bromocriptine and the skeletal muscle relaxant dantrolene is recommended to treat this condition.
patients taking clozapine normal white cell count with persistent fever, tachycardia, and gallop rhythm
his patient is likely suffering from clozapine-induced myocarditis. Myocarditis and cardiomyopathy have been reported in patients taking clozapine.
Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3

which of the following:
inferior myocardial infarction.
left bundle branch block.
acute pulmonary embolism.
anterolateral infarct.
left bundle branch block
left bundle branch block

A. Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3
B. Raised ST segment and Q waves in the Inferior leads (II, III and AVF)
C. S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only
D. ST segment depression and T wave inversion with no Q waves
E. ST segment elevation in leads I, AVL, and V2-V6
Option A (Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3)
Raised ST segment and Q waves in the Inferior leads (II, III and AVF)
which of the following:

inferior myocardial infarction.
left bundle branch block.
acute pulmonary embolism.
anterolateral infarct.
inferior myocardial infarction
inferior myocardial infarction

A. Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3
B. Raised ST segment and Q waves in the Inferior leads (II, III and AVF)
C. S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only
D. ST segment depression and T wave inversion with no Q waves
E. ST segment elevation in leads I, AVL, and V2-V6
Option B (Raised ST segment and Q waves in the Inferior leads (II, III and AVF)) is correct. Complete occlusion of the right coronary artery would most likely show ECG tracings consistent with an inferior myocardial infarction.
S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only
which of the following:

inferior myocardial infarction.
left bundle branch block.
acute pulmonary embolism.
anterolateral infarct.
acute pulmonary embolism.
acute pulmonary embolism.

A. Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3
B. Raised ST segment and Q waves in the Inferior leads (II, III and AVF)
C. S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only
D. ST segment depression and T wave inversion with no Q waves
E. ST segment elevation in leads I, AVL, and V2-V6
Option C (S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only)
ST segment elevation in leads I, AVL, and V2-V6
which of the following:

inferior myocardial infarction.
left bundle branch block.
acute pulmonary embolism.
anterolateral infarct.
anterolateral infarct.
anterolateral infarct.

A. Broad notched R waves with ST depression in leads I, AVL, and V6, and broad QS waves in V1-V3
B. Raised ST segment and Q waves in the Inferior leads (II, III and AVF)
C. S wave in lead I, a Q wave in lead III and an inverted T wave in lead III only
D. ST segment depression and T wave inversion with no Q waves
E. ST segment elevation in leads I, AVL, and V2-V
Option E (ST segment elevation in leads I, AVL, and V2-V6)
ASD can be diagnosed using findings on the electrocardiogram (ECG). Both primum and secundum present with a right bundle branch block and axis deviation. In primum, the axis deviation is
leftward as a result of hypoplastic changes in the left anterior fascicle.
ASD can be diagnosed using findings on the electrocardiogram (ECG). Both primum and secundum present with a right bundle branch block and axis deviation. In secundum, the axis deviation is
rightward as a result of right ventricular enlargement.
Ostium (primum OR secundum) type ASD is also associated with first-degree arteriovenous (AV) block.
Ostium primum type ASD
Hypokalemia: Clinically Important ECG Abnormalities (3)
ST-segment depression, decreased amplitude of the T wave (or inverted T waves), prominent U waves
Hyperkalemia: Clinically Important ECG Abnormalities (4)
tall, narrow, or tent-shaped T waves, decreased or absent P waves, short QT intervals, widening of QRS complex.
Hypocalcemia: Clinically Important ECG Abnormalities
QT interval prolongation , flat or inverted T waves.
Hypercalcemia:Clinically Important ECG Abnormalities
short or absent ST segment, decreased QTc interval.
Hypomagnesemia: Clinically Important ECG Abnormalities (5)
prolonged QT interval, T-wave flattening, prolonged PR interval, atrial fibrillation, torsade de pointes.
Hypermagnesemia: Clinically Important ECG Abnormalities (4)
shortened PR interval, heart block, peaked T waves, increased QRS duration.
ST-segment depression, decreased amplitude of the T wave (or inverted T waves), prominent U waves

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hypokalemia
tall, narrow, or tent-shaped T waves (see Fig. 1-12), decreased or absent P waves, short QT intervals, widening of QRS complex.

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hyperkalemia
QT interval prolongation, flat or inverted T waves.

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hypocalcemia
short or absent ST segment , decreased QTc interval

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hypercalcemia
prolonged QT interval, T-wave flattening, prolonged PR interval, atrial fibrillation, torsade de pointes.

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hypomagnesemia
shortened PR interval, heart block, peaked T waves, increased QRS duration.

Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hypermagnesemia
Hypermagnesemia
difference in P waves b/t atrial fibrillation and multifocal atrial tachycardia
There are no identifiable “P” waves.(Atrial fibrillation)

irregular but has identifiable P waves.(Multifocal atrial tachycardia)
this artery does not exiest
A. Diffuse collateral arteries
B. Left anterior descending artery
C. Left circumflex artery
D. Right circumflex artery
E. Right coronary artery
there is no right circumflex artery.
Left circumflex artery blocked.
___ wall MI.
posterior wall MI
ST depression in V1toV4 as well as an increase in R wave amplitude and widening instead of Q waves.
___ wall MI.
posterior wall MI
Left anterior descending artery blocked.
___ wall MI.
anterior wall MI
ST segment elevation in I, AVL, and V1 to V6 along with Q waves in V1-V4.
___ wall MI.
anterior wall MI
Right coronary artery blocked.
___ wall MI.
inferior wall MI
ECG changes involve leads II, III, and AVF.
___ wall MI
inferior wall MI
suitable outpatient monotherapy options for deep vein thrombosis (DVT).
Enoxaparin sodium (Lovenox) or dalteparin sodium (Fragmin) (both low-molecular-weight heparins)
Treatment with warfarin alone results in a ___ day period of subtherapeutic anticoagulation.
3 to 6
Post DVT, anticoagulation will be continued for ____ months depending on the etiology of the DVT.
3 to 6
Pediatric patient is suspected of having TB. Consequently, to obtain a sample for culture...
hildren usually do not produce sputum because they swallow it. Consequently, sputum remnants can be obtained by early morning gastric aspiration. Direct visualization with smear is not entirely useful, but it is useful for culture.
congenital long QT syndrome, the cornerstone of therapy
Beta blockers are the cornerstone of therapy because they reduce syncope and risk of sudden cardiac death.
Congeital cardiac diagnosis should be suspected in patients who have syncope, sensorineural deafness, and a family history of sudden cardiac death.
congenital long QT syndrome, Jervell-Lange-Nielsen syndrome subtype
Mitral stenosis
quality, location, timing, maneuver
ow-pitched, apical, early-to-mid-diastolic murmur that is best heard with the patient in the left lateral decubitus position.
Aortic regurgitation
quality, shape, location, maneuers
ortic regurgitation produces a blowing, high-pitched, decrescendo murmur along the left sternal edge toward the apex. Typically, it is heard best at the fourth intercostal space to the left of the sternum with the patient leaning forward and in full expiration.
aortic stenosis ejection murmur
shape, location, radiation
diamond-shaped, usually best heard in the second intercostal space to the right of the sternum. The sound radiates toward the right clavicle and both sides of the neck and may be associated with a systolic thrill.
Pulmonic valve regurgitation
quality, shape, location, radiation,
superficial-sounding, high-pitched diastolic decrescendo murmur that radiates toward the mid-right sternal edge and is loudest over the second left intercostal space at the sternal edge.
tricuspid regurgitation
location, timing, qulatiy, maneuver
best heard at the lower left sternal edge, over the xiphoid and sometimes over the middle lobe of the liver. The murmur is holosystolic, softer than that of mitral regurgitation, and, in contrast to the latter, increases with right ventricular filling volume during inspiration.
supraventricular tachycardia with a regular rate, shortened P-R interval, and a delta wave at the onset of a slurred QRS complex.
A. Hyperkalemia
B. Hyperthyroidism
C. Hypovolemia
D. Sinus nodal reentrant tachycardia
E. Wolff-Parkinson-White syndrome
Option E (Wolff-Parkinson-White syndrome) is correct. Wolff-Parkinson-White syndrome is caused by an accessory pathway between the atria and ventricles, which predisposes to reentry tachycardias. The ECG description is classic for this syndrome.

Option A (Hyperkalemia) is incorrect. Tachycardia would most likely not be present; bradycardia is more likely. ECG changes seen include peaked T waves and a prolonged, not shortened, P-R interval.

Option B (Hyperthyroidism) is incorrect. There are no findings other than tachycardia consistent with hyperthyroidism, nor are the specific ECG findings in this case seen in tachycardia associated with hyperthyroidism.

Option C (Hypovolemia) is incorrect. The patient has no clinical signs or symptoms of hypovolemia, and the ECG changes present here would not be seen in tachycardia associated with volume depletion.

Option D (Sinus nodal reentrant tachycardia) is incorrect. Sinus nodal reentrant tachycardia shows normal P wave morphology and QRS complexes.
Cotton wool spots and hemorrhages are seen in both diabetic retinopathy and hypertensive retinopathy.Key distinguishing features?
“copper wiring” (increased retinal arteriole light reflex), and arteriovenous (AV) nicking (arteriolar-venular crossing defects).

Diabetic retinopathy typically presents with hard lipid exudates, microaneurysms, macular edema, and dot and blot hemorrhages.
peaked T waves, prolonged P-R interval, QRS widening, and loss of P waves.
electrolyte imbalance?
hyperkalemia
hyeprkalemia tx that does not lower potassium, but decreases myocadial excitability, protecting against arrhythmia
calcium gluconate 10%, preferably through a central venous catheter as the calcium may cause phlebitis
Prerenal causes of oliguria usually show urine sodium >/< than 20 mmol/dL.
<
Prerenal causes of oliguria usually show fractional excretion of sodium >/< 1%.
< 1%
Serum blood urea nitrogen/creatinine >/< than 20 to 1 is typical for prerenal causes of oliguria.
> 20 to 1
Prerenal oliguria usually results from decreased renal perfusion. Urine smolality is usually....
A concentrated urine is an expected physiological response. Urine osmolality is usually more than 500 MOsm/kg.
Acute ventricular septal rupture is often seen xxx days following an acute anteroseptal infarction
4 to 7