Dissect and Tell
Lunging for Air
The Ruptured Riddle
Rapid Response Required
Heart of Fire
100
Most common/#1 risk factor for Aortic Dissection.
Risk factors associated with AD include:
Hypertension (76%)
Atherosclerosis (27%)
Aortic aneurysm (16%)
Previous cardiac surgery (16%)
Marfan syndrome (5%)
Iatrogenic injury (4%)
Cocaine use (1.8%)
100
Most is the most common physical exam finding associated with this diagnosis/chest x-ray?
What is Tachycardia. (sinus tachycardia >120 bpm is the most common physical finding)
100
Most common cause of esophageal perforation
The most common etiology of an esophageal perforation is iatrogenic as a result of endoscopic interventions
100
D dimer cutoff for a pregnant patient with signs of dvt?
What is 500.
100
Patient presents with chest pain and shortness. Patient is hypotensive with muffled heart sounds and JVD. Images obtained in ED are below. What is the definitive ED treatment.
What is pericardiocentesis. Pericardiocentesis is performed urgently in cases of obstructive shock due to pericardial tamponade.
200
Name the type of dissection and usual definitive management?
What is Stanford A/Debakey 2. Surgical 
200
You suspect a tension pneumothorax on 25 y/o male that presents with chest pain after an altercation. How will you relieve the tension pneumothorax.
What is needle decompression with tube thoracostomy in 3rd/4th intercostal space midclavicular line or 4th/5th midaxillary line.
200
True or False: Antibiotics are recommended for esophageal perforation?
True. Empiric antimicrobial therapy is recommended
200
Dosage of heparin for pulmonary embolism
What is 80 units/kg intravenous bolus (maximum 10,000 units), followed by 18 units/kg/hour continuous intravenous infusion (maximum 2,000 units/hour).
200
Name the EKG finding and the cause.
What is Electrical alternans. Electrical alternans occurs when a large pericardial effusion is present and the heart swings back and forth, beat-to-beat, inside the distended, fluid-filled pericardial sac.
300
Name one physical exam finding in a patient with aortic dissection
300
Most common cause of this chest x-ray?
What is aspiration pneumonia
300
Imaging modality of choice to diagnose esophageal perforation.
CT esophagram with gastrograffin is the imaging modality of choice in esophageal perforation. Gastrografin helps to avoid the inflammatory reaction seen with barium.
300
The most common complaint in a patient with pulmonary embolism
What is dyspnea.
The most common presenting complaints are dyspnea (81%), chest pain (39%), syncope (22%), hemoptysis (5%), and unilateral leg complaints (38%).
300
What ECG findings help distinguish STEMI from pericarditis?
What is
Reciprocal ST-segment depression (ie, reciprocal changes) in leads other than V1 and aVR (odds ratio for STEMI is 31)
Horizontal or convex upward ST-segment morphology (odds ratio for STEMI is 6)
ST elevation in lead III > lead II (odds ratio for STEMI is 21)
The following are ECG abnormalities that suggest pericarditis
The absence of reciprocal changes
PR-segment abnormalities (depression in multiple leads and elevation in lead aVR).
400
The preferred agent for heart rate control in the setting of aortic dissection and its dose?
What is esmolol 500microgram/kg bolus over 1 minute followed by 50 μg/kg/minute continuous infusion
400
20 y/o female presents with chest pain. Past medical history significant for endometriosis. Chest x-ray show
What is Catamenial pneumothorax. Catamenial pneumothorax is a rare condition that affects the membranes surrounding the lungs.
400
The resuscitation fluid of choice for ruptured AAA is
What is blood products. A 1:1 ratio of packed red blood cells to fresh frozen plasma appears to reduce the risk of mortality.
400
A patient diagnosed with pulmonary embolism goes into cardiac arrest. The drug/treatment of choice is
What is alteplase 100mg IVP or 50mg IVP followed by 50mg IVP 15minutes later. Tenectaplase CPR for 30 minutes
400
Interpret this ekg
Pericarditis
12 Lead ECG shows diffuse ST elevations (most prominent in leads V4-V6, II, aVF) with diffuse PR depressions (most notable in V5-V6) and PR elevation in lead aVR.
500
True or False: A normal exam excludes aortic dissection.
False.
Physical examination may be completely normal upon presentation.
Examination findings classically associated with thoracic AD are present in less than one-third of all cases.
Most clinical findings associated with AD are insensitive in isolation. However, a combination of findings increases the accuracy of the clinical assessment for AD.
500
This ultrasound finding is indicative of what process
What is pneumothorax.
500
Eponym for the crunching sound with heartbeat auscultated over the precordium.
Hamman sign (simultaneous crunching sound with heartbeat auscultated over the precordium, especially in the left lateral decubitus position)
500
65 y/o male presents hypotensive, short of breath, with muffled heart sounds. Ultrasound shows the findings below. Emergent treatment is
US guided pericardiocentesis
500
Gold standard for the diagnosis of myocarditis
What is histology.
No ECG findings are specific to the diagnosis of myocarditis Chest X-ray appears normal in patients without a pericardial effusion or tamponade.