Book Review Chapters 11-14

Book ReviewChapters 11-14 Jim Mlejnek MD, PGY-2 November 8, 2019

Question 1 • A 32 y.o. healthy male presents to the ED for evaluation of multiple episodes of syncope. The following is his EKG. What does this EKG demonstrate?

Answer 1 • A. Myocardial Ischemia • B. Wolf Parkinson White • C. Brugada Syndrome • D. Hyperkalemia • E. Right Bundle Branch Block • F. Benign Early Repolarization

Question 2 • What is the pathognomonic EKG pattern seen in Brugada Syndrome?

Answer 2 • A. Downsloping ST segment elevation in leads V1-3 and RBBB pattern • B. ST Elevation in V2-6, notched J point, and upward deflection of the T wave • C. Deep S wave in lead I, Q wave in lead III and inverted T wave in lead III • D. Normal EKG Findings

Question 3 True or False: Cardiac arrest during AMI is associated with a significantly improved outcome compared to cases not occurring in the setting of AMI.

Answer 3 • A. True • B. False

Question 4 • Which of the following is a cause of sudden cardiac arrest?

Answer 4 • A. Ventricular Tachycardia • B. Ventricular Fibrillation • C. Brady-asystole • D. Pulseless Electrical Activity • E. All of the above

Question 5 • Which of the following antiarrhythmic medications may have some protective value in patients at high SCD risk?

Answer 5 A. Amiodarone B. Flecainide C. Moricizine D. Encainide E. Sotolol F. Both A and E

Question 6 Treatment with which of the following is most effective at reducing mortality in patients at high risk for SCD?

Answer 6 • Amiodarone • Beta Blockers • Internal Cardiac Defibrillators’s • Coumadin

Question 7 Each minute that a patient remains in VF, the odds of survival decrease by what percentage?

Answer 7 • 1-2% • 7-10% • 15-20% • 25-30%

Question 8 Both SCD and AMI are most likely to occur when?

Answer 8 • Summer • Within the first few hours of awakening • Winter • Within a few hours of eating dinner • Both B and C

Question 9 In patients in the EP lab that develop VT or VF, prompt defibrillation (typically within 20 to 30 s of dysrhythmia onset) results in what percentage of patient survival?

Answer 9 • 25% • 50% • 75% • Nearly 100%

Question 10 Upon discovery of a collapsed individual, what is the first action that should be performed?

Answer 10 • Pre-cordial Thump • Secure the scene and establish that the patient is unresponsive • Head Tilt, Chin Lift, and check for breathing • Check for a pulse

Question 11 In a patient found unresponsive, you first position the airway and then assess for breathing. If the patient is not breathing, you should immediately do what next?

Answer 11 • Reposition the airway • Give 2 slow breaths • Insert a nasal or oral airway and reassess • Give 30 compressions immediately

Question 12 What is the FiO2 of expired air in each breath given by a rescuer during CPR?

Answer 12 • 1-2% • 16-17% • 21-22% • 27-28%

Question 13 Which of the following are acceptable ways of providing ventilations during CPR?

Answer 13 • Mouth to Mouth • Mouth to Nose • Mouth to Stoma • Mouth to Mask • Mouth to snout • All of the above

Question 14 A 4 y.o. female is brought in by parents after she was chewing on an orange peel. The parents say she started coughing and hasn’t stopped since. On exam you notice severe facial petechiae and a coughing child. Pulse ox is 89%. What is the next step in management of this patient?

Answer 14 • Perform abdominal thrusts until the obstruction is relieved • Establish IV, O2, Monitor and then intubate • Leave the child alone and call ENT for emergent bronchoscopy • Leave the child alone as obstruction is unlikely at this point

Question 15 What is the most frequent reason for resuscitation of a newborn?

Answer 15 • Prematurity • Aspiration • Nuchal Cord • Congenital Defect

Question 16 Which of the following is the definition of neonatal asphyxia?

Answer 16 • Umbilical artery acidemia (pH <7.00) • 5-min Apgar score of 0 to 3 • neonatal neurologic sequelae • multiorgan dysfunction • All of the above

Question 17 An infant born at 35 weeks in noted to have a heart rate of 130, a weak cry, good flexion, some motion to noxious stimuli, and is cyanotic all over. What is the patients Apgar score?

Answer 17 • 4 • 5 • 6 • 7 • 8

Question 18 An 18 y.o. female presents to the emergency department at 40 weeks gestation for evaluation of leakage of fluid. The patient is having intermittent abdominal pain every five minutes. When questioned she says the fluid was green. On exam you find the baby crowning. Your sphincter tightens and you call for stat OB and Neonatal consult. The baby is suctioned after the head is delivered. The infant has a HR < 100 and a weak cry. What is the next step in resuscitation of this infant?

Answer 18 • Administer O2 and re-suction the nose and posterior pharynx • Administer O2 and suction the posterior pharynx with an ET Tube • Administer O2, intubate, and initiate positive pressure ventilations • Administer O2 and suction the trachea with an ET Tube

Question 19 What percentage of births have meconium staining of the amniotic fluid?

Answer 19 • 2.5% • 5% • 10% • 20% • 40%

Question 20 The infant above is reassessed after suctioning and is noted to be bradycardic. The patient was intubated. At what HR would you begin cardicac massage on this patient and how fast should you do compressions?

Answer 20 • < 60 bpm, 120 compression/min • < 60 bpm, 100 compression/min • < 80 bpm, 120 compression/min • < 80 bpm, 100 compression/min

Question 21 During resuscitation of a newborn you find that the blood glucose is 40 mg/dL. How do you correct the hypoglycemia?

Answer 21 • 2 ml/kg of D15W at 2 ml per min • 4 ml/kg of D15W at 4 ml per min • 2 ml/kg of D25W rapid IV push • 4ml/kg of D10W rapid IV push

Question 22 The glucose is now 110mg/dL however the patient’s HR is < 60 bpm and you are performing cardiac massage. What medication can you use to increase the patient’s HR?

Answer 22 • Atropine 0.1 mg/kg IVP • Atropine 0.2 mg/kg down the ETT • Epi 0.1 to 0.3 mL/kg of a 1:10,000 solution may be given IV • Epi 0.2 to 0.75 ml/kg of a 1:10,000 solution down the ETT • Both C and D • All of the above

Question 23 The infant is resuscitated and transferred to the NICU. The nurse calls you because you are now doing a NICU rotation. She says that the child is experiencing periods of apnea lasting 10-15 sec and the heart rate is 70-75 during these episodes. True or False: you can tell her not to worry. This is normal periodic breathing in this infant.

Answer 23 • True • False

Question 24 You respond to a code at Harrison 4 Main. When you arrive your find an 18 hour old male infant seizing. You support the airway, breathing, and have an IV established. What medication should you give? What should you consider if the seizure doesn’t stop?

Answer 24 • Ativan 0.5 mg/kg, hypoglycemia • Phenytoin 0.5 mg/kg, hypoglycemia • Phenobarb 0.5 mg/kg, hypoglycemia • Ativan 0.05 mg/kg, hypoglycemia

Question 25 A woman with no prenatal care delivers in the ED. The infant is having respiratory distress. The chest is large, the abdomen is scaphoid, and there are bowel sounds in the left chest. What is the diagnosis?

Book Review Chapters 11-14