Physician Assistant Exam For Dummies Cheat Sheet

Tricks for NSTEMI treatment

When you’re treating a non-ST elevation myocardial infarction (an NSTEMI), keep OH BATMAN in mind. The mnemonic works for treating unstable angina, too.

• O = oxygen: Ischemia implies oxygen deprivation, which leads to increased myocardial oxygen demand and increased myocardial work. The goal of treatment is to reduce the workload of the heart. Every person admitted to the hospital with acute coronary syndrome (ACS) is given oxygen via nasal cannula.

• H = heparin: This blood thinner works by potentiating antithrombin III. Its purpose is to prevent clotting and to thin the blood during an ACS. Heparin can be given for unstable angina, but it’s almost always given to a person with an NSTEMI.

• B = beta blocker: This is a standard of care for anyone with ACS, both an NSTEMI and a STEMI. It decreases the workload of the heart and should improve morbidity and mortality. The most common beta blockers used are metoprolol (Lopressor) and atenolol (Tenormin).

• A = aspirin: Anyone with an MI needs to chew an aspirin right away. It’s an antiplatelet agent that has saved countless lives.

• T = thrombolysis: Use thrombolysis in the setting of a STEMI if and only if cardiac catheterization can’t be done within a few hours of the ischemic event.

• M = morphine: Morphine is for managing the pain associated with an MI. You can also use it in treating CHF/pulmonary edema.

• A = ACE inhibitors: ACE inhibitors can help preserve myocardium in the setting of an MI. They’re usually given in the first 24 hours unless acute kidney failure is present.

• N = nitroglycerin: This coronary artery vasodilator helps in the management of ACS. In the setting of an NSTEMI, nitroglycerin is usually given as a continuous infusion along with heparin. It can also be given as a pill (isosorbide mononitrate, brand name Imdur) or as a topical nitropaste applied across the chest.

The person with ACS is going to be on multiple treatments at one time. For example, the person with an NSTEMI will be on IV heparin and nitroglycerin, on oxygen via nasal cannula, and on oral metoprolol.

Just because someone comes into the hospital on warfarin (Coumadin) doesn’t mean that he or she can’t have an MI. Coumadin isn’t an antiplatelet drug. It works on the extrinsic clotting pathway. Coumadin won’t inhibit platelet aggregation/clumping, which is why aspirin and clopidrogel (Plavix) are used in treating ACS.

Classifying anemia by MCV — Mean Corpuscular Volume

In anemia, the body has a reduced quantity of red blood cells. One of the best ways to classify anemia is by the MCV, or mean corpuscular volume, which is expressed in femtoliters (fL). The MCV helps you think about the cause of the anemia and how to evaluate for it:

• Microcytic anemias (low MVC, < 79 fL): Think TAIL: thalassemia, anemia of chronic disease, iron deficiency anemia, lead poisoning.

• Macrocytic anemias (high MCV, > 100 fL): Think BILL: B₁₂ deficiency, impaired liver function, low folate levels, low thyroid levels.

• Normocytic anemias (normal MCV, 80–99 fL): Think RAM: renal dysfunction, anemia of chronic disease (also can cause a low MCV), malignancy or myelopthisic anemia.

Using the alphabet to identify malignant melanoma

You can use the alphabetic classification system to evaluate melanoma, the most aggressive form of skin cancer. This guide helps you determine whether a skin lesion is malignant. The mnemonic is the first five letters of the English alphabet — A, B, C, D, and E. Here are the warning signs:

• A = asymmetry: If one side of the lesion differs from the other, the lesion is more likely to be malignant.

• B = borders: Are the borders of the skin lesion regular or irregular? Are they smooth or spiculated? The more irregular the borders, the greater the likelihood that you’re dealing with a malignancy.

• C = colors: The melanoma may have more than one color.

• D = diameter: The larger the lesion, the greater the risk that it’s melanoma. A skin lesion of more than 9–10 mm is more suspicious for melanoma.

• E = evolution: How is the lesion changing over time, in terms of appearance and size? Melanoma is more likely to change.

If you suspect melanoma, the next step is a skin biopsy.

Knowing what the APGAR score evaluates

An APGAR score measures how well a newborn is doing at 1 and 5 minutes after birth. The five factors you evaluate just happen to line up with the last name of the doctor, Dr. Virginia Apgar, who created the scoring system. Here are the APGAR factors:

• A = appearance: The skin color should be pinkish.

• P = pulse: The pulse should be 140–160 beats per minute.

• G = grimace: After stimulation, the newborn should pull away or maybe give a good cry.

• A = activity: The arms and legs should be flexed and resist extension.

• R = respiration: There should be a good, loud cry (from the baby, not you).

Each factor gets a score of 0, 1, or 2, and you perform the test twice. A total score of 7 or greater means that the newborn is in good shape. A score of less than 7 means that the newborn’s in trouble. Check your textbooks for details on designating a specific score for each factor.