Cardiology
A 64 year old man presents with crushing substernal chest pain. ECG demonstrates ST elevations in leads II, III, and aVF. Which coronary artery is most commonly involved?
What is the right coronary artery?
What oxygen saturation target is commonly used in hospitalized patients with an acute COPD exacerbation who are at risk for hypercapnic respiratory failure?
What is approximately 88-92%?
A hospitalized patient has a positive urine culture but absolutely no urinary symptoms or systemic findings attributable to UTI. Name two classic populations in whom asymptomatic bacteriuria generally should be treated.
Who are pregnant patients and patients undergoing certain invasive endourologic procedures associated with mucosal trauma?
A patient with chronic severe hyponatremia undergoes overly rapid correction. Several days later, they develop dysarthria, dysphagia, quadriparesis, and altered mental status. What complication should you suspect?
What is osmotic demyelination syndrome?
ABG:
pH 7.28
PaCO2 28
HCO3 13
Is respiratory compensation appropriate?
Expected PaCO2 = 1.5 (13) + 8 +/- 2
= 27.5 +/- 2
Measured PaCO2 higher than predicted -->concomitant respiratory acidosis (inadequate compensation)
Measured PaCO2 lower than predicted --> concomitant respiratory alkalosis (overcompensation)
A hospitalized patient develops atrial fibrillation with a ventricular rate of 160 bpm. BP is 72/40 mmHg, and the patient is confused and diaphoretic. What is the immediate treatment?
What is synchronized cardioversion?
COPD exacerbation:
pH 7.27PaCO2 72
HCO3 32
RR 30
The patient is awake and protecting their airway.
What respiratory intervention should be strongly considered before intubation?
What is noninvasive positive-pressure ventilation, typically BiPAP?
After appropriate initial fluid resuscitation, a septic patient remains hypotensive with MAP 55 mmHg. What is the preferred first-line vasopressor? and what initial MAP target is generally recommended
What is norepinephrine?
approximately 65 mmHg
A patient has a potassium 7.1 mEq/L with QRS widening. What medication should be given immediately to stabilize the cardiac membrane?
What is IV calcium?
DOACs are generally avoided in favor of warfarin in patients with this hypercoagulable autoimmune condition.
What is antiphospholipid antibody syndrome?
When PCI cannot be delivered within this timeframe from STEMI diagnosis, fibrinolytic therapy should be given (within 12 hours of symptom onset, no contraindications)
What is 120 minutes?
Pleural fluid protein/serum protein = 0.65 and pleural LDH/serum = 0.70. Is this transudative or exudative?
What is an exudative pleural effusion?
Per the 2026 Surviving Sepsis Campaign, this is the recommended initial crystalloid volume for sepsis-induced hypoperfusion or hypotension.
What is 30 mL/kg?
A hospitalized patient develops:
Na 119
Serum osm 260
Urine osm 600
Urine Na 80
They appear euvolemic
Before diagnosing SIADH, what two endocrine disorders should generally be excluded?
What are adrenal insufficiency and hypothyroidism?
A patient with acute ischemic stroke develops BP 218/`10 and is otherwise potentially eligible for IV thrombolysis. BP must generally be reduced below this threshold before treatment.
What is <185/110 mmHg?
A patient with an acute MI develops sudden pulmonary edema, hypotension, and a new loud holosystolic murmur at the apex. This mechanical complication should be assumed until proven otherwise.
What is acute severe mitral regurgitation from papillary muscle rupture?
In severe ARDS, this positioning intervention performed for more than 12 hours per day carries a strong recommendation for reducing mortality.
What is prone positioning?
In toxic shock-associated group A streptococcal necrotizing infection, this protein-synthesis-inhibiting antibiotic is added to a beta-lactam to suppress exotoxin production, and recent data suggest linezolid is a non-inferior alternative to it.
What is clindamycin?
When fluid restriction fails in SIADH, these two agents are considered the most effective second-line therapies.
What are urea and tolvaptan?
A cirrhotic patient has ascitic protein 3.2 g/dL and SAAG 1.5 g/dL. Rather than typical portal-hypertensive cirrhosis alone, the high SAAG pls high protein should suggest this cardiac process.
What is right-sided heart failure/cardiac ascites
For an ACS patient already on maximally tolerated statin who LDL-C remains at or above this level, a nonstatin agent (ezetimibe, PCSK9 inhibitor, bempedoic acid, or inclisiran) should be added.
What is 70 mg/dL?
An intubated patient with ARDS has a predicted body weight of 70 kg. Approximately what tidal volume should you initially target using lung-protective ventilation?
What is approximately 420 mL?
Teaching pearl: 6 mL/kg predicted body weight x 70 kg = 420 mL. ARDS ventilation is based on predicted rather than actual body weight.
In septic shock with ongoing vasopressor requirement, this "stress-dose" glucocorticoid regimen (200 mg/day, with or without fludrocortisone) shortens shock duration; recent data suggest adding the mineralocorticoid may lower mortality versus the glucocorticoid alone.
What is hydrocortisone (+/- fludrocortisone)
This potassium threshold is a classic absolute indication for urgent renal replacement therapy in AKI,
What is a potassium >6-6.5 mEq/L?
In a septic patient, rather than tight glycemic control, the recommended approach starts insulin once glucose reaches this threshold, targeting roughly 144-180 mg/dL
What is >180 g/dL