DM / DNB Cardiology Entrance Mock Test 5
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Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 5.
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Source: Cardiophile MD - January 20, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 4
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Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
Start
Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 4.
You scored %%SCORE%% out of %%TOTAL%%.
Your performan...
Source: Cardiophile MD - January 18, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
CCC Update 014
Updates to the CCC seem to be coming thick and fast these days.
Keep the feedback coming on this free guide to Critical Care encompassing over 1650 pages.
This is what has sprung up since CCC Update 013:
Mitchondrial dysfunction and mitochondrial diseases
About 1.5 billion years ago something extremely odd and extremely pivotal happened in our evolution. One cell enveloped another in an endosymbiotic union. The mitochondria were born, and they continue to be passed along by our mothers today. As the energy powerhouses of our cells, it makes sense that if they don’t work, then we are in big trouble. This manifests as...
Source: Life in the Fast Lane - January 13, 2016 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Education apnoeic oxygenation Delayed Sequence Intubation initial management of severe sepsis and septic shock mitchondrondrial dysfunction neutropaenic sepsis preoxygenation sepsis overview septic cardiomyopathy Source Type: blogs
Would Patients Pay For This?
By HANS DUVEFELT, MD
Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the Government and Corporate America want them to have.
Up until this point, the momentum has been with the payers, Medicare and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash is becoming.
It will come down to this, a kind of “straight face test” for health care: Would patients pay for this?
The Annual Wellness visit, better named “Medicare’s Non-Physical” ...
Source: The Health Care Blog - January 8, 2016 Category: Consumer Health News Authors: John Irvine Tags: Tech Uncategorized Source Type: blogs
Research and Reviews in the Fastlane 114
This article reviews techniques, indications, contraindications and complications of VV and VA ECMO. A literature review of ECMO in poisoned patients is also included.
Recommended by: Meghan Spyres
Critical CareMadhuri S. Kurdi et al. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res 2014; 8(3): 283–290. PMID: 25886322
A nice review article on the use of ketamine in the field of anesthesia, pain, palliative care, intensive care and procedural sedation. Based on at quite extensive literature search this paper highlights Ketamine’s current evidence based use as well as ...
Source: Life in the Fast Lane - December 23, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Neurosurgery Respiratory Resuscitation Trauma Emergency Medicine Intensive Care R&R in the FASTLANE critical care examination LITFL R/V research and reviews recommendations Source Type: blogs
Nocturnal pauses in Holter monitoring : How significant is it ?
Holter monitoring is the Initial test for all those with documented syncope (or Pre syncope ) with suspected cardiac arrhythmia .It is a 24 hour ambulatory ECG monitoring , expected to pick up any electrical abnormality and its correlation with the resultant symptom if any. Though the test looks attractive , the diagnostic yield is far less. (About 10%) .The reason being the episodes can be rare to be missed by 24hr sample time. We have extended Holter (48hr) , Event monitors , Loop recorders and implantable devices that can record ECG for extended periods.(18 Months ,Reveal Plus Medtronic) that improve the yie...
Source: Dr.S.Venkatesan MD - December 11, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Sinus Bradycardia on ECG
Sinus bradycardia is characterised by regular P waves preceding every QRS complex, at a rate below 60 per minute. P wave originating from the sinus node is usually upright in inferior leads (II, III and aVF).
Important causes of sinus bradycardia
Sinus bradycardia can be seen in vagotonic states like athlete’s heart [1] and in raised intracranial tension. Another common cause is suppression of the sinus node by beta blockers. In early stages of inferior wall myocardial infarction, sinus bradycardia is often observed [2]. Sinus bradycardia also occurs during vasovagal syncope. Hypothyroidism is another important cause of...
Source: Cardiophile MD - December 6, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Alcohol induced sinus bradycardia athlete's bradycardia Ictal sinus bradycardia Source Type: blogs
Very Bad Numbers
By ANISH KOKA, MD
The date is July 17th, 2014. It is 10am in the Dirksen Senate building, and the congressional subcommittee on health and aging is about to focus on patient harm. The educating will be done by some of the leaders in the medical field, Ashish Jha and Tejal Gandhi from Harvard, Peter Pronovost from Johns Hopkins. The star of the proceedings is John James, a toxicologist, a PhD from Texas, and the founder of Patient Safety America.
The tone is set from the beginning by none other than Bernie Sanders. In somber tones, he relays that hospitals can make patients worse, and that a recent study suggests medical er...
Source: The Health Care Blog - November 30, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs
Aortic dissection : Its all about flaps, false-lumens . . . and fate !
What are the determinants of dissecting path in Aortic dissection ?
Aortic dissection is taught to us as a dramatic cardiac emergency where the blood enters one of the planes of aortic wall and travels in a random way . The wrong way blood instead of flowing within the lumen invades the vessel wall .(Vascular Tsunami ?) It may (or may not) leave the aorta at a distance resulting in various combinations of true and false lumen. Much like a tsumani its also triggered by an energy releasing blood pressure spikes hitting on the weakened aortic wall rupturing the Intima. While acute dissection are o...
Source: Dr.S.Venkatesan MD - November 29, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions aortic dissection plane of aortic dissection tracking arch dissection Source Type: blogs
Exercise induced ventricular tachycardia
Illustrated Review
Exercise induced ventricular tachycardia
(Click on the image for an enlarged view)
ECG showing ventricular tachycardia occurring during a treadmill exercise test. The initiating beat is a ventricular ectopic beat with R on T phenomenon. It is a monomorphic tachycardia with negative QRS in V1 and positive QRS in leads II and V5. This could be a tachycardia originating from the right ventricular outflow tract (RVOT) as it has an LBBB pattern and an inferior axis. RVOT tachycardias are known to be induced by exercise [1, 2]. They can respond to beta blocker therapy and are also amenable for radiofrequency c...
Source: Cardiophile MD - November 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology ECG Library Catecholaminergic polymorphic ventricular tachycardia CPVT monomorphic tachycardia R on T phenomenon right ventricular outflow tract tachycardia Source Type: blogs
Prosthetic valve associated hemolysis
Brief Review
Prosthetic valve associated hemolysis is more with paravalvular leak, endocarditis and structural failure in bioprosthetic valve. Prosthetic valve dehiscence is an important cause for prosthetic valve associated hemolysis [1].
Control of hypertension with beta blockers can reduce hemolysis as the shear stress reduced. One of the earlier studies used propranolol to reduce hemolysis in patients with aortic prosthetic valve [2]. Three of the five patients given propranolol in their study had a clear decrease in hemolysis. One of their patients developed congestive heart failure with propranolol therapy at 6 mont...
Source: Cardiophile MD - November 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery paravalvar leak Prosthetic valve dehiscence Source Type: blogs
Digoxin may not improve prognosis in AF
In this study, about 44 thousand received beta blockers while over 18 thousand received calcium channel blockers and about 39 thousand received digoxin. No rate reducing agents were received by about 169 thousand patients, which incidentally constituted the majority of this study population.
Use of beta blockers and calcium channel blockers were found to confer a lower risk of mortality compared to no treatment while use of digoxin was associated with a poor prognosis. Authors while calling for a prospective study endorsed the current guideline recommendation to use beta blockers and calcium channel blockers for rate contr...
Source: Cardiophile MD - October 31, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
Hyponatremia, he fell, the answer
To recap:
78-year-old man admitted after a fall – no fractures.
His labs on admission
125
89
33
128
5.2
22
2.1
He has a history of B-cell lymphoma.
His serum osm are 273 and urine osm 263.
Clinically he is euvolemic (i.e., not orthostatic). He is bradycardic (we stopped his beta blocker given for previous CABG).
He is new to our hospital, we do not know his previous renal function.
Your question – what further tests do you want? Can you speculate on his diagnosis?
Cory had the proper instincts. The patient had a random cortisol of ~4 (normal 8 or greater). His stimulation test had a peak cortis...
Source: DB's Medical Rants - October 13, 2015 Category: Internal Medicine Authors: rcentor Tags: Acid-Base & Lytes Source Type: blogs
Hyponatremia and he fell
78-year-old man admitted after a fall – no fractures.
His labs on admission
125
89
33
128
5.2
22
2.1
He has a history of B-cell lymphoma.
His serum osm are 273 and urine osm 263.
Clinically he is euvolemic (i.e., not orthostatic). He is bradycardic (we stopped his beta blocker given for previous CABG).
He is new to our hospital, we do not know his previous renal function.
Your question – what further tests do you want? Can you speculate on his diagnosis?
(Source: DB's Medical Rants)
Source: DB's Medical Rants - October 8, 2015 Category: Internal Medicine Authors: rcentor Tags: Acid-Base & Lytes Source Type: blogs
Research & Reviews in the Fastlane 103
This study is quite limited as it doesn’t include potential recommendations for these over the counter medications but is a good reminder to prescribe stool softeners/laxatives with opioids.
Recommended by Lauren Westafer
Emergency medicineRodrigo GJ et al. Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant? Am J Emerg Med 2015. PMID 26233619
The authors of this paper want to tell us that vitals signs aren’t helpful in asthma, but I think their conclusions are entirely backwards.
This is a retrospective look at data that was collected prospectively as part of 7 other asth...
Source: Life in the Fast Lane - October 7, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs
