all about that bass, no tremble ;)
anterior with LAD occlusion
25 year old with a history of sickle cell disease presents with severe back and bilateral leg pain. Describe and interpret the progression of her CXR’s (attached G and H)
normal at presentation and...
developed acute chest syndrome!
Calculate Hasan's GCS and demonstrate it
insert A0
Patient came in with suicidal attempt using benzo's, what is the most important contraindication that rules out the possibility of flumazenil therapy?
known Seizure disorders!
To interpret an EKG what are the rule of 4's? (hint: taught in kaplan step 1 and easily forgotten very basic)
history/clinical scenario
rate
rhythm
axis
A 41-year-old man presents with one day of central, crushing chest pain, exertional in nature. He has no past medical history. HR 90 reg, BP 157/62, SpO2 100 RA (attached D)
diagnosis?
LVH!
Name the investigation in figure N
lung scintigraphy
Patient comes in with food poisoning after a sea food dinner and says cold bed rails in the emergency department are “burning hot”. What poisoning is it?
Ciguatera poisoning
Hot-cold reversal, better termed cold allodynia, is considered almost pathognomonic of ciguatera poisoning (other dinoflagellate toxins such as palytoxin may mimic ciguatoxin). The phenomenon is probably not a true reversal of temperature sensation, rather pain sensation is altered such that cold is experienced as a burning pain.
Bipolar woman gives birth to a child with a holosystolic murmur worse on inspiration. Name of defect?
Ebstein's Anomaly
Tricuspid insufficiency due to tricuspid valve displacement into Right ventricle
caused by lithium
Patient presents with tachycardia, SOB and the following EKG (attached B). Top diagnosis?
Pulmonary embolism
This is a right bundle branch block, but
may also present on EKG as SI QIII TIII pattern
other common causes of RBBB:
congenital heart disease, cardiomyopathy, recent PCI
Using the EKG (attached C) what is the one intervention that would help immediately?
give K+
hypokalemia!!
Which intervention caused the problem? (attached I)
How do you immediately treat this EKG in the ER with BP 40/35 (attached K)
cardioversion!
if hemodynamically stable vagal maneuver's, adenosine
What is the IV fluid of choice for the treatment of a trauma patient in hypovolemic shock?
Lactated Ringer's solution
Lactated Ringer's solution is the fluid of choice for the pre-hospital treatment of shock patients. It contains many of the electrolytes responsible for homeostasis and normal cardiac functioning that are often lost when the patient loses large amounts of circulating blood volume or becomes dehydrated.
38 year old patient keeps having morning headaches. On echocardiogram you see MVP and coronary artery aneurysm. Name one more investigation that will ascertain nature of the disease. (Note: it is always dominant, never recessive)
ADPKD!
Identify bundle branch block (right or left) and give reasons using EKG (attached A)
This is a Right Left bundle branch block.
'William Marrow'
where
50 year old female presents with fever, pallor, digital clubbing, and the syncope sometimes. Other investigations are normal, spot diagnosis using the following (attached L)
cardiac myxoma
What could this ABG be from (attached J) in a 35 y/o female that is being stabilized on epinephrine and in current shock
P.S ask for hint for organ system if both teams fail for one last attempt
Renal Tubular Acidosis type 1
calculate anion gap, given NAGMA with hypokalemia and hyperchloremia, respiratory acidosis may be from intubation
Patient came in to the ED flushing, tachycardiac, mydriasis on exam. States he took meow meow. Manage by administering, giving supportive care and the following drug:
Benzodiazepines.
meow meow is the street name for mephedrone, which is a stronger version of bath salts.
What is the drug of choice for an adult asthma patient who cannot tolerate nebulized beta-agonist treatments and is experiencing severe dyspnea with wheezing from bronchoconstriction?
A-Albuterol
B-Prednisone
C-Epinephrine
D-Aminophylline
Epinephrine
If a patient is unable to tolerate nebulized medications, subcutaneous or intramuscular epinephrine may be indicated to treat the bronchoconstriction. Epinephrine is effective in causing bronchodilation in times of airway constriction due to bronchospasm.
70 year old patient with seizures and hypotension after overdose and presented to you. At home on >5 medications including anti diabetics, anti hypertensives and anti depressants. Resuscitate the patient in the ER as follows: (at least 2)
(attached F)
Patient has TCA toxicity
In the context of sodium channel blockade:
EKG explained:
In the context of seizures and hypotension, the combination of…
… is highly suggestive of poisoning with a sodium-channel blocking agent — e.g. tricyclic antidepressant.
The sinus tachycardia may be due to the anticholinergic effects of the TCA.
surgery!
What is the best way to transport the patient to prevent the embolus from entering the lungs?
A-Turn the patient on their left side with the head lowered 10 degrees
B-Supine with head of stretcher at 30 degrees
C-Turn patient on right side with head higher than the rest of their body
D-Trendelenburg position
Turn the patient on their left side with the head lowered 10 degrees
If an air embolism is suspected, transport the patient on the left side with about 10 degrees of head-down tilt, in an attempt to trap the embolus in the right ventricle of the heart before it can enter the pulmonary circulation.
Preferable treatment for patient with aortic stenosis and the following:
Age 59
AVA 0.9
transaortic velocity 3.8
BP 165/42
SURGICAL AVR!
TAVR for >80 or those with less than 10 years left to live at least.
Revise AHA classification for aortic stenosis staging!
Female with short stature, webbed neck, primary amenorrhea
What cardiac abnormalities may be seen? Name both possible
Coarctation of aorta
Bicuspid aortic valve