NR571/ NR 571 Midterm Exam (Latest 2024/ 2025 Update) Complex Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain What is high sensitivity troponin and when to use? - ANSWER first line test for cardiac cell damage used for initial injury What is CKMB - ANSWER CK isoenzyme specific to cardiac muscle tissue (MI) When should CKMB be used? - ANSWER for suspicion of secondary ischemia after an initial infarct normal level for Troponin I - ANSWER <0.04 normal level for CKMB - ANSWER 3-5% of total CK 1 / 4
What is BNP - ANSWER B-type natriuretic peptide Normal BNP levels - ANSWER <100 pg/mL Differential for chest pain - ANSWER Consider: Myocardium- angina, MI, myocarditis, heart failure Pericardium- pericarditis Aorta- dissecting aortic aneurysm Trachea and bronchi- bronchitis Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus Chest wall- costochondritis, herpes zoster Esophagus- reflux, esophageal spasm, esophageal tear Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - ANSWER 90 Initial diagnostics for chest pain - ANSWER 12-lead EKG Troponin q3h x3 at least 2 / 4
BNP - HF
CBC - baseline H&H and Plts PTT, PT/INR - baseline coagulation status BMP - renal function and lytes TSH, Mg, and Phos ECHO Cath Requirements for STEMI dx - ANSWER new ST elevation in 2 contiguous leads of >0.1 mV except V2&V3 elevated troponin STEMI findings in V2-V3 - ANSWER >0.2mV in >40yo M >0.25 mV in <40 yo M >0.15 mV in women Difference between NSTEMI and unstable angina - ANSWER NSTEMI involves Elevated Cardiac Bio markers (cell death) NSTEMI & unstable angina tx - ANSWER Dual antiplatelet therapy Full-dose AC 3 / 4
High-intensity statin BB Nitrates oxygen pain medication Dual antiplatelet therapy - ANSWER DAPT Aspirin (325 x1 = daily 81mg) AND P2Y2 inhibitor clopidogrel or ticagrelor full dose AC - ANSWER SQ lovenox 1mg/kg BID if PCI planned of low GFR use heparin gtt 50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline High-intensity statin - ANSWER atorvastatin 40-80 mg or rosuvastatin 20-40 mg Considerations for BB avoiding BB use - ANSWER HR <60 SBP <100
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