Er Medicine Rotation

Front 1

Presenting complaints of acute asthma attack:

Back 1

Dyspnea, chest tightness, wheezing, and cough

Front 2

Physical exam findings of an acute asthma attack:

Back 2

Wheezing with prolonged expiration
A quiet chest may include severe air flow restriction
Severe attack: pursed-lips exhalation, accessory muscle use, paradoxical respiration, & diaphoresis

Front 3

Tests to diagnose acute asthma attack:

Back 3

1. measure airflow obstruction with peak expiratory flow
2. chest x-ray rule out complications including pneumonia and pneumothorax
3. pulse oximetry
4. arterial blood gas - evaluate for hypercapnia and hypoxia

Front 4

Treatment for acute asthma attack:

Back 4

1. Supplemental Oxygen
2. B-adrenergic agonist are first line - albuterol
3. Steroids - Prednisone

Front 5

Essentials of Diagnosis of Pulmonary Embolism:

Back 5

1. Predisposition for DVTs usually in lower extremities
2. one or more of: dyspnea, chest pain, hemoptysis, syncope
3. Tachypnea and widened alveolar-arterial PO2 difference
4. Characteristic defects on ventilation-perfusion lung scan, helical chest CT scan, or pulmonary arteriogram

Front 6

Components of Virchow's triad

Back 6

venous stasis, injury to vessel wall, and hypercoagulability

Front 7

Lab and imaging findings in pulmonary embolism

Back 7

lab: ECG abnormal; arterial blood gases - acute respiratory alkalosis, profound hypoxia with normal chest x-ray; increased D-dimer levels
Chest x-ray: excludes other lung diseases
Lung scan: diminished blood flow to region of the lungs
CT: sensitive for detection of thrombus in proximal pulmonary arteries

Front 8

Treatment for pulmonary embolism

Back 8

anticoagulation, thrombolytic therapy, IVC filter

Front 9

Diagnosis of pulmonary edema

Back 9

1. acute onset or worsening dyspnea at rest
2. tachycardia
3. diaphoresis
4. cyanosis
5. pulmonary rales, rhonchi, expiratory wheezing
6. x-ray show interstitial and alveolar edema w/ or w/o cardiomegaly
7. arterial hypoxemia

Front 10

Clinical findings of pulmonary edema:

Back 10

severe dyspnea
pink, frothy sputum
diaphoresis
cyanosis

Front 11

Non cardiac causes of pulmonary edema:

Back 11

1. IV opioids
2. increased ICP
3. high altitude sepsis
4. several meds
5. inhaled toxins
6. transfusion reactions
7. shock
8. sepsis

Front 12

Treatment for pulmonary edema:

Back 12

1. place pt in sitting position with legs dangling off the bed
2. Oxygen via mask for arterial PO2 > 60mmHg
3. Morphine for comfort
4. IV diuretic
5. Nitrate - reduces BP & LV filling pressure
6. oral diuretics & ACE inhibitors

Front 13

Clinical features of pneumothorax:

Back 13

1. acute onset of pleuritic pain
2. dyspnea
3. decreased breath sounds on affected side

Front 14

Tools for diagnosis of a pneumothorax:

Back 14

1. chest x-ray ** gold standard
2. clinical signs

Front 15

Treatment of pneumothorax:

Back 15

1. unstable vitals: immediate needle thoractomy followed by tube thoractomy
2. stable pts: oxygen via nasal cannula
3. small pneumothorax: observe and then discharge

Front 16

Clinical features of pneumonia:

Back 16

1. fever
2. dyspnea
3. cough
4. pleuritic chest pain
5. sputum production

Front 17

Treatment of pneumonia:

Back 17

1. oxygen as needed
2. antibiotics: outpt - azithromycin, clarithromycin, cefpodoxime, or amoxicillin/clavulanate; pts > 60 y/o - levofloxacin

Front 18

Possible causes of hemoptysis:

Back 18

1. expectoration of blood from bronchopulmonary tree
2. pneumonia or bronchiectasis
4. pulmonary embolism
5. TB
6. Bronchogenic carcinoma

Front 19

Serum markers for chest pain:

Back 19

1. myoglobin: rises predictably in AMI but also found in muscle
2. creatinine phosphokinase & MB isoenzyme **gold standard
3. Troponin I: sensitive & specific for AMI

Front 20

Possible causes of chest pain:

Back 20

1. Angina pectoris
2. unstable angina
3. variant (prinzmetal) angina: spasms of epicardial vessels in pts
4. AMI
5. Aortic dissection
6. Pericarditis
7. Acute pericardial tamponade
8. Pulmonary embolus
9. Musculoskeletal
10. GERD

Front 21

ECG findings: Anterior wall

Back 21

V2 - V4

Front 22

ECG findings: Inferior wall

Back 22

II, III, aVF, V5, V6

Front 23

ECG findings: Anteroseptal

Back 23

V1 -V3

Front 24

ECG findings: Lateral

Back 24

I, aVL, V4-V6

Front 25

Medication for AMI:

Back 25

1. Aspirin
2. Nitroglycerin
3. B-blockers
4. morphine
5. heparin

Front 26

Treatment for symptomatic sinus bradycardia:

Back 26

1. atropine
2. transcutaneous pacing for those refractory to atropine

Front 27

3 causes of sinus bradycardia:

Back 27

1. physiologic: vagal tone
2. pharmacologic: calcium channel blockers, b-blockers, digoxin
3. pathologic: AMI, increased intracranial pressure, carotid sinus hypersensitivity, hypothyroidism, or sick sinus syndrome

Front 28

Causes of sinus tachycardia:

Back 28

1. physiologic: pain or exertion
2. pharmacologics: sympathomimetrics, caffeine, or bronchodilators
3. pathologic: fever, hypoxia, anemia, hypovolemia, pulmonary embolism, or hyperthyroidism

Front 29

Atrial flutter:

Back 29

250-350 bpm; sawtooth appearance on ECG
Carotid sinus massage or valsalva maneuver - slow ventricular response
anticoagulation should be considered
unstable pts or pts with onset less than 48 hrs can receive cardioversion
rate control with diltiazem

Front 30

Treatment for a fib:

Back 30

diltiazem, verapamil, metoprolol, or digoxin