1. SPMP on Acute PULMONARY EDEMA Dr. S. Aswini Kumar. MD Acute onset breathlessness occurring in the background of heart disease is the presentation in this patient IV. 1. A patient complains of sudden onset of dyspnoea. You will now take the following history: Effort intolerance Orthopnoea Paroxysmal nocturnal dyspnoea Angina pectoris All of the above IV. 2. The following illnesses in the Past History are important here EXCEPT: Systemic Hypertension Coronary Artery Heart Disease Aortic Valve Stenosis Chronic Aortic Regurgitation Mitral Valve Stenosis IV. 3. Acute bronchial asthma should be excluded by the following history: Onset in childhood Recurrent dyspnoea with wheeze Seasonal variation History of allergy All of the above. IV. 4. You will now proceed to examine the patient for the following EXCEPT: Tachycardia High or low Blood Pressure Gallop rhythm B/L Basal crepitations Complete neurological examination IV. 5. The following investigations will have to be sent EXCEPT: Random Blood Sugar Renal Function Tests 12 lead ECG Serum Electrolytes Pseudocholinesterase IV. 6. Chest X Ray taken as soon as the patient is better will show all the following EXCEPT: Cardiomegaly Hyper-translucent lung fields Kerly B lines Bilateral hydrothorax Bat wing appearance IV. 7. The following general measure will have to be taken in all patients with LVF: Reassure the patient Explain the prognosis to bystanders Propped up position Oxygen Inhalation All the above IV. 8. Blood pressure <90 mm Hg systolic will be indication for giving: Betamethazone 0.5mg IV Adrenaline 0.5mg IV Pentazocine 50mg IV Dopamine 25 ug/kg All of the above IV. 9. If the Blood Pressure is >90 mm Hg following drugs may be given EXCEPT: Morphine 3mg slow IV Eptoin 100mg IV Frusemide 40mg IV Aminophyllin 250mg IV. Dobutamine 2.5-10ug/kg/min IV IV. 10. Nitroglycerine may be given in the setting of hypertension or angina as: 10-20 ug/kg orally 10-20ug/mt IV infusion 100-200 ug/kg bolus dose 100-200 ug/mt IV infusion None of the above IV. 11. The contraindication for giving intravenous nitroglycerine in Acute LVF is: Mitral stenosis Aortic stenosis BP>150/100 CAHD None IV. 12. IV Sodium Nitroprusside can be administered in the following dose: 20-30 ug/min IV infusion 40-50 ug/min IV infusion 60-70 ug/min IV infusion 20-30 ug/min IV bolus 20-30 ug/min IM injection IV. 13. The indication for digoxin in cardiac failure is the following: Systolic heart failure Diastolic heart failure Acute Myocardial Infarction Atrial Flutter with block Hypertrophic cardiomyopathy IV. 14. Refractory cases of LVF can be managed by the following EXCEPT: Further doses of diuretic Digoxin 5.0mg IV stat Physiological venesection Intra aortic balloon pump Cardiac transplantation IV. 15. Physiological venesection involves the following steps EXCEPT: Using three rubber tourniquet BP Apparatus cuff used alternatively Tied till pulse is absent Three limbs are tied at a time Rotated every 15minutes IV. 16. Surgical venesection in the management of acute LVF means removal of: Up to 050ml venous blood Up to 150ml venous blood Up to 250ml venous blood Up to 350ml venous blood Up to 450ml venous blood V. 17. Indications for continuous positive pressure ventilation in LVF are the following EXCEPT: Patient exhaustion PaO2 < 8 KPa Raising PaCO2 Worsening acidosis pH < 7 All the above