Cardiovascular

Front 1

Which is the most common transfusion reaction?

Back 1

Febrile transfusion reaction is the most common and least serious. It is characterized by fever, chills, and malaise, and is related to antileukocyte and antiplatelet antibodies, seen in the multiply transfused patient. Treatment is symptomatic with analgesic and antipyretics and an antihistamine.

Front 2

Tx for hemolytic transfusion rxn

Back 2

IV fluids thru new tubing,
diuretics,
low dose dopamine

Front 3

packed RBCs can be stored for

Back 3

25-45 days

Front 4

most likely acute complication of multiple unit red blood cell transfusion?

Back 4

hypothermia

Front 5

transfusion indication - hgb = ?
1 unit prbc raise hgb by ?

Back 5

<6
1

Front 6

Variant (Prinzmetal's) angina
x6 sewrva

Back 6

Variant (Prinzmetal's) angina
-due to spasm of the coronary arteries.
- ST segment elevation
- usually responds to coronary vasodilators.
- predilection for women under age 50
-tends to occur during sleep or while the patient is at rest.
~ 33% have normal coronary vessels at angiography.

Front 7

Chest pain that is maximally severe at onset, later radiating to the interscapular area and then the upper abdomen, is most characteristic of __.

Back 7

aortic dissection

Front 8

*Peaked T waves, widened QRS, and loss of P waves indicates __.

Back 8

severe acute hyperkalemia

Front 9

What can cause an audible mediastinal crunch with cardiac systole (Hamman's sign) and mediastinal emphysema?

Back 9

Spontaneous pneumomediastinum is usually benign, but esophageal perforation progresses rapidly to fatal mediastinitis if not promptly recognized and treated. Mediastinal emphysema due to asthma, trauma, cocaine, or smoking marijuana may also result in the above clinical findings. Esophageal perforation may be spontaneous or traumatic and is associated with dysphagia, mediastinal widening, fever, and leukocytosis.

Front 10

Which cardiac marker is most sensitive for myocardial infarction (MI)?

Back 10

MYOGLOBIN
sens. not specific

Front 11

sharp, stabbing, pleuritic chest pain that does not change with non-respiratory chest movements. Pain is worse supine, but improves with sitting up. What is the most likely diagnosis?

Back 11

Patients with pericarditis often complain of a sharp, stabbing, and pleuritic-type pain that does not change with chest wall motion. Pain may be severe and is not relieved with nitroglycerin. Pain is often worse when supine, but improves with sitting up. It is often preceded by a viral illness or underlying disease (SLE or uremia).

Front 12

Non-coronary causes of anginal-type pain probably attributable to insufficient blood supply to a straining hypertrophied heart include:

Back 12

IHSS & aortic stenosis

Front 13

4 Causes of chest pain in children include:
Which is most common?

Back 13

MI (history of Kawasaki's syndrome), IHSS, MVP, myocarditis, SVT: 4%

ulcers, esophageal FB, esophagitis: 3% (aggravated by acid foods)

sickle cell crisis: 3% (positive history; abnormal CBC and retic count)

idiopathic/psychogenic: 45% (most common category; more likely after age 12; often subacute or chronic; doesn't interfere with sleep)

Front 14

Characteristics of pericarditis include:
e/i, fr, rp, 3pp

Back 14

diffuse ST elevation or T-wave inversion (x AVR)

intermittent pericardial friction rub sometimes noted

steady severe retrosternal pain that may radiate similar to angina pain

worsening pain with chest movement (positional pain) or respiration (pleuritic pain); pain can be pulsatile, varying with the heartbeat

Front 15

Are pts w/ PE more likely to have physical signs or risk factors?

Back 15

risk factors

Front 16

Thoracic aortic dissection causes what kind of CXR abnormalities?

Back 16

The CXR shows abnormalities in 90% of patients with an acute aortic dissection. Findings include widened mediastinum, an abnormal aortic contour, pleural effusions, or a deviation of the trachea, mainstem bronchi, or the esophagus.

Front 17

give the cause of these exam changes:
1)New diastolic M of AI = rare but ominous sign of__.

Back 17

1) thoracic dissecting aneurysms

Front 18

Sudden recurrence of chest pain with dyspnea and a new holosystolic murmur about 1-5 days after the MI is indicative of__. LV wall MI is assoc'd w/ __ ___ ___.
Anterior MI is assoc'd w/ ___ ___ .

Back 18

rupture
LV MI -->free wall rupture

Antr MI --> septal rupture

Front 19

Post-MI pericarditis that presents with chest pain and a friction rub is most likely due to the sequelae of __.

Back 19

-inferior and right ventricular wall MIs because the right ventricle lies immediately adjacent to the chest wall.

Front 20

Which type of pericarditis is rare, but has more risk of cardiac tamponade requiring surgery?
What is the usual cause?

Back 20

Constrictive (think boa constrictor)
- caused by virulent bacteria such as H. influenzae and E. coli

Front 21

Infants with _______ ___may not be diagnosed until after pulmonary hypertension develops and the resulting shunt reversal presents as CHF.

Back 21

left-to-right shunting

Front 22

Any neonate in shock who does not respond to fluids or pressors has __ __ __ __ until proven otherwise. PGE1 administration can be life saving.

Back 22

left ventricular outflow obstruction

Front 23

The hypercyanotic deterioration, which is initially managed with knee-chest positioning in the infant or squatting in the older child is caused by what condition.

Back 23

Tetralogy of Fallot

Front 24

two voltage criteria for LVH:

Back 24

RV5 + RV6 + (SV1 or 2) > 35 mm (or SV2 + RV6 >= 35 mm, the modified Index of Sokolow)
R dominant in both V5 & V6 and RV6 > RV5

Front 25

Paroxysmal nocturnal dyspnea is most common in which condition?

Back 25

Left heart failure

Front 26

Pulse oximetry is based on light absorption at two different wavelengths, red and infrared, which are then canceled out and calculated. What will falsely elevate the pulse oximeter reading.

Back 26

Carboxyhemoglobin is considered by the pulse oximeter to be mostly oxyhemoglobin

Front 27

What will result in a falsely low pulse ox reading? 5

Back 27

Severe vasoconstriction,
excessive movement,
nail polish,
severe anemia
abnormal hemoglobin

Front 28

indications for intra-arterial BP monitoring x4

Back 28

frequent ABGs
rapid prog. shock
syst BP>250mm
anatomic difficulties