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Knockout at the Needle: Hot Topics in Emergency Medicine

Post Test

1. What are the benefits of Nitroglycerin in ADHF patients?

a. Decreased pulmonary capillary wedge pressure (preload)
b. Improved epicardial coronary blood flow (after load)
c. Good for ischemia (little or no change in heart rate)
d. Low cost, safe to use
e. All of the above

2. The uncertainties associated with the use of PCI relates to arrival in the ER and delivery to the cath lab. Ideal timing of transfer should occur in:

a. >120 minutes
b. <120 minutes
c. >90 minutes
d. 90 to 120 minutes
e. 120 to 180 minutes

3. What are the indications for fibrinolytics in patients being treated at or transferred to a PCI center?

a. Level C = Lytics for high-risk STEMI <6 hours after symptom onset and expected door to balloon
b. Level A = None
c. Level B = Lytics for STEMI ,3 hours after symptom onset and expected D2B exceeding 90 minutes
d. All of the above
e. a and c

4. What are the upstream options for hospital antiplatelet therapies for NSTE ACS diagnosed patients who are to be managed with PCI?

a. Bivalirudin and Clopidogrel
b. GP IIb/IIIa inhibitor, Heparin, and ASA
c. a and b

5. What are the recommended antithrombotic and antiplatelet therapy for acute treatment of STEMI patients?

a. Aspirin
b. Enoxaparin
c. Clopidogrel
d. Unfractionated Heparin
e. All of the above

6. What are the guidelines for Nesiritide in ADHF patients?

a. Consider as an addition to diuretics for improvement in congestion, in the absence of hypotension
b. Superior to nitrates, in the presence of hypotension
c. Certified safety for patients with acute decompensation of heart failure
d. Does not require use of diuretics
e. None of the above

7. ICH data indicates that therapy should be directed at the cerebral perfusion pressure which is MAP minus ICP >70.

a. True
b. False

8. What are the recommended agents in the management of hypertension in acute ischemic stroke patients whose blood pressure is up to the 220/120 level?

a. Nitroprasside
b. Labetalol or nicardipine
c. Diazoxide or Enalaprilat
d. Nitroglycerin

9. Therapy recommendations for an older female patient with hypertension and with an acute rise in pulmonary capillary wedge pressure:

a. Use aggressive vasoactive therapy
b. Use aggressive titration of blood pressure
c. Minimize diuretic use
d. a, b, and c
e. a and b

10. Risk predictors for major bleeding include:

a. renal failure
b. anemia
c. old age
d. a and c
e. all of the above

11. For patients in acute ischemic stroke with hypertension and who are eligible for tpA, which blood pressure requires no antihypertensive therapy?

a. <160/180
b. >220/120
c. <180/105
d. <180/220
e. <150/165

12. Misdiagnosis rate of heart failure in the Emergency Room averages

a. 25%
b. 18%
c. 45%
d. 10%
e. 15%