Anesthesiology Flashcards

Question

Answer 1

**atrial fibrillation **- fast and irregular stimulation and contractions of individual bundles and fibers of the atrial muscle. It arises most likely as a result of sending excitations through numerous ectopic foci or chaotic circulation of reentry waves over several circuits.

Answer 2

**torsade de pointes** - a rare form of ventricular tachycardia with variable direction and different shapes of QRS complexes.

Answer 3

**ventricular fibrillation** - fast and uncoordinated work of the heart's ventricles (heart stimulation during relative refraction). The ECG of the QRS complex is an irregular sine wave. If the sine wave is regular in shape and the heart rate is 200-300 beats per minute, it is called ventricular flutter.

Answer 4

-peptic ulcer of the stomach and duodenum, ulcer perforation -acute hepatitis -intestinal ischemia -abdominal aortic aneurysm

Answer 5

acute hepatitis abdominal aortic aneurysm bile duct diseases drug-induced mucosal damage of the stomach and duodenum functional dyspepsia gastroesophageal reflux disease (GERD) gastroenteritis intestinal ischemia malignant tumors myocardial infarction peptic ulcer of the stomach and duodenum, ulcer perforation pancreatitis or pancreatic pseudocysts

Answer 6

1. hypoxia 2. hypovolemia 3. hypokalemia or hyperkalemia, metabolic disorders (hypoglycemia, hypocalcaemia, acidosis) 4. hypothermia

Answer 7

1. pneumothorax 2. cardiac tamponade 3. toxic causes of sudden cardiac arrest 4. venous thromboembolism (pulmonary embolism, myocardial infarction)

Answer 8

-have been the mainstay of anticoagulation therapy -VKAs are mainly used for the* prevention of stroke in patients with atrial fibrillation (AF) *and the* treatment* -secondary prevention of *venous thromboembolism*

Answer 9

**bone marrow** - aplasia **gastrointestinal tract** - diarrhea, mucus in the stool, nausea and vomiting, abdominal pain, urgent pressure on the stool, persistent wind and flatulence, bleeding from the lower gastrointestinal tract **skin** - moderate or severe erythema; mottled moist exfoliation, usually limited to folds and folds of the skin **CNS** - although neurons rarely divide, there are many other cells in the brain outside of them. **Radiation causes apoptosis of mature oligodendrocytes**, and also** disrupts the function of astrocytes** and **microglial cells.** Ionizing radiation in cases of strong exposure may also directly affect synaptic conductivity.

Answer 10

- is a *congenital hemorrhagic diathesis* caused by a *decrease in the activity of factor VIII* which causes increased bleeding. - Most often, *hemophilia A occurs as an inherited disease with the X chromosome* but sometimes occurs as a result of de novo mutation. Therefore, most of the patients are males; - In the *majority of cases it is inherited as an X-linked recessive trait*, though there are cases which arise from spontaneous mutations.

Answer 11

- is one of the acute disturbances of water-electrolyte balance and is most *common in people with type II diabetes*, especially in the elderly. -Diagnosis is established on the basis of laboratory values:

Answer 12

-plasma glucose concentration> 600 mg / dl -pH> 7.3 -bicarbonate concentration> 15 mmol / l -sodium concentration> 150 mmol / l (in 50% of patients) -absence of ketone bodies in the urine -serum osmolality> 320 mOsm / kh H2O -disturbances of consciousness, coma

Answer 13

affect the plasma glucose level.

Answer 14

hyperkalemia, hyponatremia, hypoglycemia.

Answer 15

quantitative and qualitative disturbances of consciousness, psychomotor slowness, headaches, visual disturbances, impaired coordination of eye movements, dysarthria, cerebellar ataxia, coarse and fine wave tremors, dystonias, muscle stiffness, seizures

Answer 16

nausea, vomiting, diarrhea, abdominal pain

Answer 17

acute prerenal and renal failure - incl. acute tubular necrosis

Answer 18

arrhythmias, changes in the ECG recording, tachyarrhythmias, bradyarrhythmias, widening of the QRS complexes, disturbances in intraventricular conduction, heart blocks, bundle branch blocks, prolongation of the QTc interval, T wave inversion, non-specific ST-T changes

Answer 19

acute respiratory distress syndrome (ARDS).

Answer 20

alcohols solvents acids and caustics metals (iron and lithium)

Answer 21

hemodialysis

Answer 22

150 µg (0,15 ml)

Answer 23

150 µg (0,15 ml)

Answer 24

300 µg (0,3 ml)

Answer 25

300–500 µg (0,3–0,5 ml)

Answer 26

the tidal volume is **500 ml**

Answer 27

** body weight** and is: **7-9 ml x kg.**

Answer 28

1. breath assessment should take 10 seconds - same as for adult resuscitation, breath assessment is based on 3 senses: hearing (the patient's audible breathing) touch (feeling the patient exhale) eyesight (lifting the chest) 2, while performing CPR on an infant you should compress the chest at a rate of at least 100/min; 3. chest compressions to breaths ratio is 15:2 - true, the altered breathing-to-compression ratio in favor of rescue breaths is due to the fact that in children, respiratory arrest usually precedes cardiac arrest. More specifically, we start with 5 rescue breaths, then continue with chest compressions and breaths at a ratio of 15:2.

Answer 29

- after 2 minutes of CPR - after signs of return to vital signs - when there is a sharp increase in the partial pressure of carbon dioxide in the end expiratory air (ETCO2

Answer 30

**Flumazenil** -> BZD receptor antagonist, is used in BZD poisoning.

Answer 31

opioid overdose.

Answer 32

rectum, esophagus tympanic membrane.

Answer 33

32-35 ° C - *conscious patient* with shivering

Answer 34

28-32 ° C -* impaired consciousness *without shivering

Answer 35

24-28 ° C - *unconscious*, vitals signs present

Answer 36

<24 ° C - no vitals signs

Answer 37

hypoxia, hypokalaemia/hyperkalaemia, hypothermia/hyperthermia, hypovolaemia

Answer 38

tension pneumothorax, tamponade, thrombosis, toxins

Answer 39

acidosis coagulopathy hypothermia

Answer 40

**Adenosine** can *cause bronchospasm*, which is highly undesirable in people with asthma.

Answer 41

N-acetylcysteine

Answer 42

Amyl nitrate

Answer 43

Hydroxocobalamin

Answer 44

Flumazenil

Answer 45

*covers only the epidermis *- the patient feels a burning sensation, redness and a slight swelling appear, healing takes about 1 week, does not leave a scar.

Answer 46

covers the epidermis and part of the dermis - the patient experiences severe pain, redness and swelling appear, blisters filled with light yellow liquid, healing takes about 2 weeks, leaves discoloration.

Answer 47

covers the epidermis and the entire dermis - the skin takes a white color, and as a result of damage to the sensory nerves, the burn does not hurt. Healing takes up to a few weeks and leaves a permanent scar.

Answer 48

covers the entire thickness of the skin - the patient does not feel pain because the sensory receptors are damaged, the skin is hard, dry, white-grayish, the necrosis forms a scab, which, when it falls off, will fill with granulation tissue and large deep wounds will appear.

Answer 49

covers the tissues deeper - muscles, tendons, internal organs - necrosis and charring appear.

Answer 50

Discusses the amount of ***fluids that we have to infuse the patient during the first 24 hours after burns.*** -Fluid quantity = 2-4 ml x patient weight x percent burned body surface area. -50% in 8 hours, 50% in the remaining 16 hours. *Example:* A patient weighing 50 kg has two upper limbs burned. 2-4 x 50 x (9 + 9) = 1800 - 3600 ml. Half of them within the first 8 hours.

Answer 51

1. Assess whether the patient is responding or breathing 2. Call the resuscitation team 3. Perform CPR 30 compressions up to 2 rescue breaths 4. RATE THE RHYTHM 5. Perform CPR for 2 minutes until your next rhythm analysis.

Answer 52

ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)

Answer 53

- **amiodarone** 300 mg in 20 ml 5% glucose and adrenaline 1 mg. -Subsequent doses of drugs - **adrenaline** 1 mg every 3 - 5 minutes, -**amiodarone** after 5 unsuccessful defibrillation 150 mg.

Answer 54

"**time**-dependent", we give it **every 3 - 5 minutes**

Answer 55

"**defibrillator**-dependent", we give it after** 3 and 5 failed defibrillation.**

Answer 56

** lidocaine **3 mg / kg. within an **hour.**

Answer 57

1. Provide intravenous access as soon as possible and give 1 mg of adrenaline. 2. Repeat dose every 3-5 minutes, on average every other CPR cycle. 3. The guidelines for resuscitation state that "survival from an asystole or PEA cardiac arrest is unlikely if a potential cause is not identified and treated." Therefore, actively seek 4H / 4T.

Answer 58

-defibrillate as quickly as possible, -after 3 unsuccessful shock deliveries give **amiodarone and adrenaline**

Answer 59

-cardiac massage, -**adrenaline **administered as quickly as possible,** 3 - 5 minutes apart.**

Answer 60

(polymorphic ventricular tachycardia)

Answer 61

-> use **magnesium** in the form of** magnesium sulphate** -dose of **1-2 g i.v.**, if necessary, -repeat **after 10-15 minutes.**

Answer 62

1. sudden onset, 80% reports dyspnea 2. Pluric chest pain 3. hemoptysis. -In studies: tachycardia, tachypnea, increase in the volume pulmonary component of the 2nd tone and tricuspid regurgitation (right ventricular dilation) murmur.v

Answer 63

a narrowing or closure of the pulmonary artery or its branches by an embolus (embolic material).

Answer 64

1. thrombi - most often from the deep veins of the lower limbs 2. amniotic fluid 3. air 4. adipose tissue - when a long bone is broken 5. tumor masses 6. foreign bodies

Answer 65

1. When the embolic material closes the pulmonary artery, the ventilation to perfusion ratio decreases, and hypoxemia develops. 2. As a result of the embolism, blood from the right side of the heart must overcome more resistance. 3. This leads to right ventricular dilatation and a reduction in the amount of blood that goes to the left heart. 4. The minute capacity decreases and shock develops. 5. In addition, as a result of impaired perfusion, symptoms of myocardial ischemia may appear. 6. The clinical picture depends on the size of the embolus and the general condition of the patient. 7. A young, healthy patient may have only minor symptoms. 8. In an elderly patient with numerous chronic diseases, even a small embolism can lead to shock.

Answer 66

age >40 years old obesity varicose veins of the lower extremities multi-organ injuries fractures of the pelvis and femur operations and associated long-term immobilization long >4 hour flight cancer pregnancy and puerperium (first 6 wks postpartum) HRT and contraception

Answer 67

-**D-dimers **- have a negative predictive value - that is, increased D-dimer levels do not allow the diagnosis of PE, but when they are normal (i.e. <500 in people <50 years of age, 10 for each year of life in people >50 years old) this allows you to exclude PE -**ECG **- right axis deviation, RBBB - right bundle branch block, "SIQIIITIII" syndrome -**-Angio-CT **- remember to include information about suspicion of PE on the referral -**CUS** - compression ultrasound examination of lower limb veins

Answer 68

when the patient points to the source of pain by placing a clenched fist or an open hand on the chest.

Answer 69

**angina pectoris** - retrosternal, can radiate to the left jaw, left shoulder, epigastrium, crushing, burning, intensifying during physical exertion **unstable angina or myocardial infarction** - the same characteristics as above and does not subside after stopping exercise and taking nitroglycerin, lasting> 20/30 minutes **pericarditis -** sharp, stinging, variable intensity, decreases in a sitting position with a forward lean, pericardial friction present **pleural pain -** one-sided, sharp, stinging, it decreases when you lie on your side where the pain occurs **aortic dissection -** sudden, severe, excruciating, covers the anterior chest wall.

Answer 70

**30 ml of a 10% solution of calcium gluconolactobionate** or **10 ml of a 10% solution of calcium chloride** . -This procedure does not cure hyperkalemia itself ! *These drugs are cardioprotective and should always be given if you have heart rhythm*

Answer 71

20-40 ml of 40% glucose solution + 4-8 units of short-acting insulin (1 unit of insulin for 3 g of given glucose).

Answer 72

50 ml of 8.4% NaHCO3 (Sodium bicarbonate) solution.

Answer 73

***loop diuretic** in patients with preserved diuresis , eg *furosemide* 20-40 mg iv, the dose can be repeated after 6-8 h. Loss of fluids due to increased diuresis is compensated with 0.9% NaCl infusion. ***cationic exchangers*** binding potassium in the gastrointestinal tract - polystyrene sulphonate p.o. or p.r. 30 g in 150 ml of water or 10% glucose solution; a 0.5-1.0 mmol / l reduction of kalemia occurs within 4-6 hours **hemodialysis** (rarely peritoneal dialysis) - in the case of life-threatening *hyperkalemia* and in patients with *severe renal insufficiency.*

Answer 74

Hyperglycemia

Answer 75

<135 mmol / L.

Answer 76

mild 130 - 134 mmol / l moderate 125 - 129 mmol / l severe <125 mmol / l, *duration:* *acute* - lasts <48 hours *chronic* - > 48 h and any undocumented hyponatremia.

Answer 77

high loss of fluids and Na, e.g. in diarrhea.

Answer 78

a decrease in Na concentration causes the passage of water into the extracellular space, causing edema. The most common form of hyponatraemia. It occurs in patients with inadequate secretion of vasopressin.

Answer 79

-it occurs when there are a lot of osmolally active substances in the plasma. -They cause fluid to pass from the cells into the blood. Plasma is diluted. -Depending on the concentration of these substances, the plasma osmolality is normal or increased.

Answer 80

may occur when there is an excessive supply of electrolyte-free fluids, with AKI or CKD.

Answer 81

-provide first aid. -This band helps to stop severe bleeding that threatens life by pushing the artery to the bone and completely closing its light . According to the latest guidelines of the European Resuscitation Council, we only use the tourniquet in specific situations: 1. mass accident, 2. amputation, 3. crushing, 4. when the direct compression does not block the bleeding -It is placed about* 5 centimeters above the source of hemorrhage* , but never below the elbow or knee,

Answer 82

jugular subclavian axillary brachial radial ulnar femoral knee-length posterior tibia dorsal foot.

Answer 83

medication

Answer 84

- **stable. ** -the most common symptoms are* atrial fibrillation with an uncontrolled ventricular response* or *atrial flutter with variable AV block. * -We** do not stimulate the vagus nerve in such patients** -We** do** it in patients with **regular tachycardia in order to release the conductivity in the atrioventricular node**.

Answer 85

1. Examine the patient according to the ABCDE scheme 2. Obtain intravenous access, perform an ECG, and administer oxygen when indicated 3. Recognize and treat a reversible cause

Answer 86

4. Assess whether the patient is stable, whether there are any disturbing symptoms such as *shock, fainting, myocardial ischemia or heart failure*

Answer 87

-*If the patient is unstable*, we should perform cardioversion up to 3 attempts, then give amiodarone 300 mg IV. within 20 minutes

Answer 88

*-If the patient is stable,* we need to evaluate the QRS -When they are narrow <120 ms and regular, we should stimulate the vagus nerve and administer adenosine in the 6-12-18 mg regimen -When they are narrow and irregular, it is most likely atrial fibrillation that requires appropriate treatment. -Included here: pharmacological ventricular rhythm control - A with B-blocker or diltiazem. -Moderation with medication - pharmacological cardioversion or electrical cardioversion. -In such patients, treatment to prevent complications should also be started. -When the duration of the arrhythmia is greater than 48 hours or unknown, in order to perform cardioversion, we must administer antiplatelet drugs for 3 weeks before the procedure and 4 weeks after the procedure. -If the patient requires immediate moderation, we must perform a transesophageal ECHO in order to exclude a thrombus in the left atrial appendage.

Answer 89

-uses quick, low-energy shocks to restore a regular heart rhythm. It's a treatment for certain types of irregular heartbeats (arrhythmias), including atrial fibrillation (A-fib). -Sometimes cardioversion is done using medications

Answer 90

cardioversion overdrive electrostimulation amiodarone lidocaine

Answer 91

tachycardia with pulse with narrow and regular QRS.

Answer 92

We use **defibrillation** and **adrenaline** in the case of SCA *-Heart attack* is when blood flow to the heart is blocked. -heart attack is a “circulation” problem -*Sudden cardiac arrest* is when the heart malfunctions and suddenly stops beating. -sudden cardiac arrest is an “electrical” problem.

Answer 93

it should be noted that the patient is** not in cardiac arrest **and therefore we do not perform **CPR.**

Answer 94

-an experienced interventional radiologist places a needle through the skin in the back and into the tumor. -This is done under CT scan or ultrasound guidance. -The ablation machine is then turned on and the tumor is destroyed.

Answer 95

β-blocker or amiodarone therapy

Answer 96

**Bazett formula** is most commonly used.

Answer 97

QT interval (s) / √ RR interval (s)

Answer 98

≥0.45s in males ≥0.46s in females

Answer 99

hypokalemia hypocalcemia hypervagotonia

Answer 100

1. **loop diuretics:** furosemide, torasemide 2. **oxygen** 3. **opioids: ** morphine - this group of drugs is considered, in the case of strong agitation, anxiety, they also reduce the feeling of shortness of breath

Answer 101

4. depending on the systolic pressure a) SBP <85 mmHg - **positive inotropic drugs: **dopamine, dobutamine, milrinone, levosimendan, noradrenaline, adrenaline b) SBP <110 mmHg - vasodilators: nitroglycerin, sodium nitroprusside

Answer 102

-belongs to **positive inotropic drugs** -but we only use it if ? the pulmonary edema was caused by a tachyarrhythmia, (eg atrial fibrillation). -It is not recommended if pulmonary edema was caused by a myocardial infarction - it works arrhythmogenically.

Answer 103

It is an acute respiratory distress syndrome (ARDS).

Answer 104

It is a procedure to restore the normal heart rhythm by simultaneous appearance of the R wave in the ECG and discharge of the short-term current of high voltage, resulting in partial depolarization of the myocardium.

Answer 105

1. Urgent: supraventricular and ventricular tachyarrhythmias inducing hemodynamic disturbances. 2. Elective cardioversion: tachyarrythmiaa (predominantly atrial fibrillation and atrial flutter) that do not cause hemodynamic disturbance, persisting despite pharmacological treatment or when it is not possible to use drugs.

Answer 106

tachycardia tachyarrhythmia

Answer 107

tachyarrythmiaa (predominantly atrial fibrillation and atrial flutter)

Answer 108

-supraventricular tachyarrhythmia, -heart disorder that is an indication for electrical cardioversion.

Answer 109

-cardiac arrhythmias synonymous with cardiac arrest -requiring CPR and defibrillation

Answer 110

VF / pVT are rhythms identical to cardiac arrest, but they do not require defibrillation.

Answer 111

Asystole PEA VF / pVT

Answer 112

1. sodium nitroprusside - onset of action: immediate 2. nicardipine - onset of action: 5-10 min 3. fenoldopam - onset of action: <5 min 4. nitroglycerin - onset of action: 2-5 min 5. enalaprilat - onset of action: 15-30 min 6. dihydralazine - onset of action: 10-20 min

Answer 113

1. labetalol - onset of action: 5-10 min 2. esmolol - onset of action: 1-2 min 3. phentolamine - onset of action: 1-2 min 4. urapidyl - onset of action: 1-5 min

Answer 114

a medical scoring scale that allows you to assess the severity of pneumonia and determine the place of treatment of the patient

Answer 115

-**consciousness disorders** and ( **C **onfusion) -**urea level** ( **U** rea) greater than 7 mmol / l (BUN> 19) -**respiratory rate **( R ) equal to or greater than 30 / minute -**blood pressure** ( B ) equal to or lower than 90/60 mmHg - age over 65. You can get 1 point for each answer 0-1 = outpatient 2 - recommended admission to the hospital 3-5 - obligatory hospitalization, possible treatment in ICU

Answer 116

-water solutions: -**mineral salts** such as sodium chloride, potassium chloride, calcium chloride, magnesium chloride, -**salts of organic acids**, e.g. sodium acetate, sodium lactate, sodium citrate, low molecular weight carbohydrates. They are cheap, easily available, do not cause allergic reactions. Crystalloids after intravenous infusion quickly pass into the extravascular space, only briefly replenishing the plasma volume.

Answer 117

1. 0.9% NaCl 2. Polyelectrolyte fluid 3. Ringer's lactate and lactate-free Ringer

Answer 118

-aqueous solutions of macromolecular substances, most commonly polymers of glucose or derivatives of gelatine. In contrast to crystalloids, **colloids stay longer in the plasma without going quickly to the tissues**. -They better supplement plasma loss. -Colloidal solutions are **more expensive than crystalloids**. -All of them **may cause allergic reaction**s (especially dextranes and to a lesser extent gelatine) with anaphylactic shock, .

Answer 119

1. Hydroxyethylated starch - HES (HAES) 2. modified gelatin 3. dextrans 4. albumin. 5. **Plasma is also a colloid, although it is not a typical infusion fluid**

Answer 120

systolic blood pressure > 220 mm Hg or diastolic> 120 mm Hg

Answer 121

185/110 mm Hg; * Labetalol and urapidil are used to reduce BP

Answer 122

somnolence, double vision abnormal reaction of the pupils to light, optic disc swelling → remember, however, that this is a late symptom,v

Answer 123

bradycardia irregular breathing high blood pressure

Answer 124

1. First, calculate the area of the patient's burn. -According to **Wallace's rule**, we count it as follows: - 2 x lower limb (18%) = 36 - 1 x upper limb (9%) In total, we obtain a result of 45% 2. Then, the demand for crystalloids within 24 hours should be calculated, according to the **Parkland rule**, using the formula: x = 4 ml x body weight x area burns (%) = 4 ml x 80 kg x 45% = 14400 ml 3. The obtained result should be divided in half. 4. We will then get a demand for the first 8 hours, and the other half should be distributed over the remaining 16 hours, i.e. 14440 ml / 2 = 7200 ml - this is the amount to be given within 8 hours and the remaining volume within the next 16 hours

Answer 125

ketoacidosis carbohydrate, lipid, protein, water-electrolyte and acid-base disorders.

Answer 126

-between** 32°C and 36°C for min. 24 h, ** -in addition, in these patients, an **increase in temperature> 37.7°C should be avoided for at least 72 h.**

Answer 127

> 25% > 15% (a <25%)

Answer 128

pH (7.35-7.45) PaO2 (75-100 mmHg) PaCO2 (35-45 mmHg)

Answer 129

metabolic acidosis The correct pH of human blood is: 7.35 - 7.45 Based on this, we can diagnose acidosis in the patient . Now you need to determine which type of acidosis it is. Diarrhea is given in patient history. As a result, the patient loses bicarbonate ions, i.e. anions of an alkaline nature, which meets the definition of metabolic acidosis. In the ABG test we will have a reduced HCO3- concentration.

Answer 130

1. sternum 2. shoulder blade, 3. ribs (especially the back section), 4. spinous processes and vertebral bodies, 5. collarbone, 6. tibia and thigh in infants (shaft), 7. bones of fingers in children who do not walk yet 8. epiphyseal, metaphyseal and intra-articular fractures

Answer 131

the occlusion or narrowing of the pulmonary artery or its branches by embolic material, which may be: thrombus - from deep veins of the lower limbs or pelvis, amniotic fluid, air, adipose tissue, tumor masses, foreign bodie

Answer 132

sudden dyspnoea (in 80% of patients), chest pain of pleural origin, less frequently coronary (in 50% of patients), cough (in 20% of patients), moreover fainting, collapse, hemoptysis.

Answer 133

tachypnoea, tachycardia, sometimes distension of the jugular veins, louder pulmonary compound of the S2 sound, sometimes murmur of tricuspid regurgitation, hypotension and symptoms of shock

Answer 134

12-15 / min.

Answer 135

Kussmaul breathing

Answer 136

metabolic acidosis

Answer 137

1. diabetic ketoacidosis (sudden insulin deficiency), 2. lactic acidosis, 3. acidosis caused by the supply of acid precursors (eg. poisoning with ethanol, methanol, ethylene glycol, salicylates), 4. impaired regeneration of bicarbonates by the kidneys - acidosis in acute or chronic renal failure - it may occur in the case of metformin overdose; 5. loss of the bases by kidneys - proximal and distal tubular acidosis; 6. through the digestive tract - diarrhea, biliary fistulas, pancreatic, intestinal fistulas.

Answer 138

"K" Ketosis "U" Uremia "SS" Salicylate poisoning "M" Methanol poisoning "A" Ethylene poisoning (earlier spelt Aethylene) "U" Uremia "L" Lactic Acidosis

Answer 139

** laryngitis** that occurs more often in children than in adults (usually **from 2 to 6 years of age**) -The most common aetiological factor is **Haemophilus influenzae type B**

Answer 140

The disease begins suddenly with pain in the upper part of the larynx, when swallowing, the pain intensifies to such an extent that the patient avoids it. This results in abundant salivation. From the onset of the disease there is high temperature and rapidly increasing dyspnoea (with stimulation of the sympathetic system and subsequent tachycardia)

Answer 141

- begins suddenly with pain in the upper part of the larynx, when swallowing, the pain intensifies to such an extent that the patient avoids it. --This results in abundant salivation. - From the onset of the disease there is high temperature and rapidly increasing dyspnoea (with stimulation of the sympathetic system and subsequent tachycardia)

Answer 142

-replacement of fluids in burned patients -4-5 ml × mass (kg) × burn area (%) * * calculated on the basis of Wallace rule of nines

Answer 143

is the survival (at least temporarily) of an incident associated with being submerged in water.

Answer 144

is death due to asphyxiation caused by being submerged in water.

Answer 145

is a sudden death caused by immersion in very cold water.

Answer 146

Drowning → hypoxia → laryngospasm → no aspiration of water to the respiratory tract.

Answer 147

where water is aspirated into the lungs.

Answer 148

a decrease in serum potassium **<3.8 mmol / l **.

Answer 149

hyperkalemia.

Answer 150

N-acetylcysteine (NAC) 300 mg/kg m.c. NAC dosing regimen (3 doses in 21h): I dose - 150 mg/kg II dose - 50 mg/kg III dose - 100 mg/kg Summing up all 3 doses, the total dose is 300 mg/kg

Answer 151

-four-level classification used in anaesthesiology, -defining the degree of difficulty of tracheal intubation determined by the anatomical structure of the oral cavity. The classification is as follows: visible soft palate, uvula, fauces and pillars visible soft palate and uvula visible soft palate and the base of uvula one cannot see the soft palate

Answer 152

hyponatremia hypocalcaemia hypomagnesemia hypoglycemia

Answer 153

respiratory tract infections intra-abdominal infections

Answer 154

normal arterial carbon dioxide pressure (32 - 45 mmHg)

Answer 155

-**Temperature control:** constant temperature 32 - 36 ℃ for ≥ 24h; prevent fever for 72 hours. -Keep **normocapnia **(32 - 45 mmHg) and **normoxia** (75 - 100 mmHg); lung-saving ventilation -**Optimalization of hemodynamic parameters** (MAP, lactates, ScvO2, CO / Cl, diuresis) -echocardiography -Maintain normoglycemia -Diagnose / treat convulsions (EEG, sedation, anticonvulsants) -Delay assessment of prognosis for at least 72h

Answer 156

-**impaired renal function** - polyuria, calcinosis and kidney stones -**gastrointestinal disorders** - lack of appetite, nausea, vomiting, constipation, gastric and duodenal ulcer disease, cholecystolithiasis - these conditions usually occur with abdominal pain -**dysfunction of the cardiovascular system **- hypertension, tachycardia, arrhythmia -**neuromuscular symptoms** - muscle weakness, facial muscle paralysis -**neurological symptoms** - headache, depression, drowsiness dehydration note; *metastasis to the bones are very often associated with hypercalcaemia.*

Answer 157

- is a life-threatening condition associated with an increased concentration of thyroid hormones in the blood serum and the inability of the body to adapt to this situation. - It can occur in patients with any form of hyperthyroidism. -Mortality in the course of thyroid storm is up to 30% .

Answer 158

hyperthermia, disturbances of consciousness, tachycardia, arrhythmia (supraventricular arrhythmias, atrial fibrillation)

Answer 159

*Thiamazole* - iv 40-80 mg *Iodine *- over an hour after the administration of thyrostatine - 4-5 drops; possibly Lugol's iodine or iohexol

Answer 160

Propranolol orally 40-80 mg or iv 2 mg very slowly (also inhibits peripheral conversion of T4 to T3) Esmolol iv 0.25 - 0.5 mg / kg very slowly (selective ß1-blocker)

Answer 161

β-blocker , e.g. propranolol Hydrocortisone iv 50-100 mg (also acts as anti-shock)

Answer 162

Cold compresses Paracetamol, less frequently NSAIDs (salicylates, eg acetylsalicylic acid are CONTRAINDICATED! They remove thyroid hormones from complexes with proteins.)

Answer 163

Hydration of the patient iv about 2-3 l / day Electrolyte and 10% glucose supply

Answer 164

is a severe, generalized or systemic hypersensitivity reaction which is potentially life-threatening.

Answer 165

-is an anaphylactic reaction in which there is a life-threatening *reduction in blood pressure*. -It *reduces tissue perfusion and cell damage*.

Answer 166

-supraventricular tachycardia (SVT), -stable ventricular tachycardia -atrial flutter (AFI)

Answer 167

atrial fibrillation (AF), unstable ventricular tachycardia (VT)

Answer 168

- normalize tachyarrhythmias hemodynamically unstable but without circulatory arrest. - It differs from defibrillation in that the electric impulse is synchronized with R-waves.

Answer 169

- electrolyte ions (Na +, K +, Ca ++, Cl-). - These tissues, which are rich in electrolytes, will therefore have the lowest resistance.

Answer 170

impossible to gain access to peripheral veins.

Answer 171

-is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease -also used in the treatment of high blood pressure, low blood potassium that does not improve with supplementation, early puberty in boys, acne and excessive hair growth in women, and as a part of transgender hormone therapy in transfeminine people

Answer 172

( Simple Triage and Rapid Transport ) protocol is one of the protocols enabling the initial selection of the patients according to their condition and priority of providing assistance at the time of a mass event.

Answer 173

BLACK - Victims considered dead . RED - Injured people requiring immediate assistance - the priority of evacuation. YELLOW - Injured, whose condition does not require immediate intervention - evacuated in the second place. GREEN - Victims walking.

Answer 174

The chest compressions in newborns should be started if the heart rate is slower than **60 beats per minute** despite adequate ventilation. - two thumbs on the lower 1/3 of the sternum, with the remaining fingers embracing the chest and back of the child. - compressed to 1/3 of the anterior-posterior dimension of the chest - frequency with which resuscitation should be performed is 120/minute, maintaining the ratio of compressions to breaths 3:1, - Within a minute, therefore, 90 compressions and 30 breaths should be performed - The re-evaluation of heart rate should occur after about 30 seconds, then it should be checked periodically. - Chest compressions should be discontinued if the spontaneous heart rate exceeds 60 beats per minute.

Answer 175

- short assessment that should be performed at the site of the event for the initial assessment of the patient's condition. **A - airway **- it should be managed by tilting the head back and pointing the mandible upwards, or by just jaw-thrust. The oral cavity should also be assessed to reveal items that could potentially cause airway obstruction **B - breathing** - after airway patency is confirmed, breathing is assessed for 10 seconds using three senses - sight, hearing, touch. If breathing occurs, its speed, depth and character are assessed **C - circulation** - indirectly by assessing the breath (in the absence of circulation, the breath will also stop), directly assessing the heart rate of the carotid artery **D - disability** - the AVPU scale is used most often, in which the A - alert - V - verbal response - P - response for pain - U - unconscious. You can also use a more accurate Glasgow scale. **E - expose and examine** - eg a quick trauma assessment.

Answer 176

-occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. -Symptoms: 1. associated with a sudden onset of strong, tearing chest pain radiating to the back, often leading to fainting. 2. You may experience symptoms of shock, neurological symptoms, and heart attack symptoms. The preferred diagnostic method is angio-CT. 3. vomiting, sweating, and lightheadedness may occur 4. Other symptoms may result from decreased blood supply to other organs, such as stroke, lower extremity ischemia, or mesenteric ischemia. - Aortic dissection can quickly lead to death from insufficient blood flow to the heart or complete rupture of the aorta

Answer 177

**Standford classification:** *type A* - dissection includes the ascending aorta regardless of the place of origin *type B* - dissection does not include the ascending aorta **DeBakey classification:** *type I* - dissection starts in the proximal part of the aorta and travels to the descending part *type II* - dissection limited to the ascending aorta *type III *- dissection is located distally to the branching of the left subclavian artery III a) only thoracic aorta III b) Aorta below the diaphragm

Answer 178

20% of the circulating blood in a short time, which is about 1000 ml.

Answer 179

1. Before commencing the transfusion of packed cells, the *patient's blood* should be collected for a *crossmatch*. 2. If there is time for this, the *patient's blood type should be marked and a type -compatible pack should be ordered*. If the patient is in a life-threatening condition, universal packs are transfused, *in the case of packed RBS it will be blood type 0 RhD (-)* 3. *Transfusion speed should be planned* - in the case of massive hemorrhages it is possible that *packed cells *will have to be* transfused at high speed, e.g. 1 unit in 5-10 minutes* 4. The patient's* body temperature, blood pressure and heart rate* should be *measured before connecting the blood componen*t. Measurements should be *repeated 15 minutes after the start of transfusion.*

Answer 180

-is every rhythm with a frequency of> 100 ud / min, which is formed in the bundle of His or above it. -In the ECG record, it will be characterized by narrow QRS complexes.

Answer 181

1. *AV nodal reentrant tachycardia *- AVNRT - arises as a result of the circulation of the excitation wave in the AV node through the fast path with longer refraction and the slow path with shorter refraction. 2. *atrioventricular reentrant tachycardia *- AVRT 3. *atrial tachycardia - AT* - paroxysmal or continual tachycardia that arises in the atrium outside the sinus node

Answer 182

- Symptoms usually include palpitations, fatigue, dizziness, shortness of breath, fainting or loss of consciousness. - Most often it is paroxysmal. - Supraventricular tachycardia usually occurs in patients without any organic heart disease.

Answer 183

1. *treatments that increase the tension of the vagus nerve :* **Valsalva maneuver **- an attempt to make a forced exhalation with a closed epiglottis. The modified Valsalva maneuver ends with a patient lying down with raised legs a. provoking vomiting b. dipping the face in cold water c. cervical sinus massage 2. *Anti-arrhythmic drugs* - depending on the type of SVT: a. adenosine b. Beta-blocker c. Ca-blocker ( Werapamil, Diltiazem ) d. amiodarone 3.*Electrotherapy* - in states of hemodynamic instability - electric cardioversion 4. *Percutaneous and surgical ablation* - in recurrent and persistent tachycardias

Answer 184

- is an anticholinergic drug - used principally to treat bradycardia - selective antagonist of the M1 and M2 cholinergic receptors. - It lowers the effects of acetylcholine - serves as an *antidote for poisoning with organophosphorus compounds, AChE inhibitors and digitalis.*

Answer 185

flumazenil a selective benzodiazepine receptor antagonist

Answer 186

- is a drug from the group of non-benzodiazepine hypnotics. - It is a selective agonist of the GABAa receptor omega-1 subunit, which modulates the chloride channel function. - has a rapid hypnotic effect, thanks to which it facilitates falling asleep - ensures the occurrence of deep sleep phases. - dose of 10 mg just before going to bed. - Treatment: short time due to the high addictive potential - a maximum of 4 weeks. - Discontinuation: gradually with dose reduction.

Answer 187

-gastric lavage should be used, -supply of activated charcoal, -monitoring of vital signs. -When severe *symptoms like respiratory depression occur*, the *supply of flumazenil,* which is a selective benzodiazepine receptor antagonist, may be considered .

Answer 188

cyclic antidepressant drugs

Answer 189

- is used in the case of beta-blockers and Ca-blockers poisoning - - it accelerates heart activity, - increases the strength of myocardial contraction - facilitates conduction in the atrioventricular node by acting on specific receptors for glucagon located in the myocardium.

Answer 190

- is a condition associated with the premature activation of pancreatic proenzymes and their destructive effects on surrounding tissues. - The most common causes: *diseases of the gallbladder* and *bile ducts and alcohol.*

Answer 191

sudden, severe abdominal pain nausea vomiting that do not bring relief fever

Answer 192

- an increase in serum amylase activity - increase in lipase activity - leukocytosis - increase in CRP and procalcitonin

Answer 193

1.* Intensive fluid therapy, alleviation of electrolyte and glycemic disorders* 2. *Combating pain* a. Metamizol ad hoc 1 g b. Tramadol 50 mg every 6 - 8h c. Buprenorphine 0.2 - 0.6 mg every 6 hours d. Pethidine 50 mg every 6 - 8h e. Continuous epidural blocking with bupivacaine 3. *Nutritional treatment* - initially diet "0" 4. *Antibiotic therapy* as a treatment for pancreatic necrosis

Answer 194

-contraction effect on the Oddi sphincter - if the cause of AP is the stones of this area, - morphine may exacerbate symptoms.

Answer 195

1. Symptomatic bradycardia or bradyarrhythmias, resistant to anticholinergic drugs and other treatments 2. Symptomatic type II second degree atrio-ventricular block (Mobitz II) 3. Third degree atrioventricular block (also asymptomatic) 4. Asystole with P waves in the ECG

Answer 196

-opioids -barbiturates -Horner syndrome (unilateral myosis) -damage to the pons

Answer 197

-*Anticholinergic substances:* a. Atropine b. TCAs -cannabinoids - LSD - *sympathomimetics:* a. Amphetamine b. derivatives

Answer 198

Tramadol Morphine Fentanyl Codeine

Answer 199

- fever, tachycardia, anemia

Answer 200

Young Mania Rating Scale (YMRS) - defines the presence and severity of clinical symptoms and manic states occurring in the course of bipolar disorder.

Answer 201

- refers to the classification of pelvic fractures: a. stable fractures (Type A), b. vertically unstable fractures and vertically stable fractures (Type B) c. vertically and rotationally unstable fractures (type C) are distinguished.

Answer 202

- classifies the conditions prevailing in the area of entry to the larynx assessed by means of direct laryngoscopy. There are 4 levels on this scale: Grade I - entry into the glottis completely visible Grade II - visible back of the glottis Grade III - only the epiglottis visible Grade IV - only the soft palate is visible

Answer 203

is a classification of pelvic fractures.

Answer 204

adrenaline -in the *initial dose of 10 μg / kg *. administered intravenously. -Subsequent doses can be *increased up to 30 μg / kg*

Answer 205

pain in the right hypochondrium fever and chills mechanical jaundice This triad refers to *acute cholangitis,*

Answer 206

- or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). - It tends to occur if the bile duct is already partially obstructed by gallstones.

Answer 207

Leukocytosis, high CRP and conjugated bilirubin , possible increase in activity of ALT, AST , GGTP, ALP. In imaging studies - widening of the bile ducts.

Answer 208

-Emergent ERCP -consists of fluid replacement, -supply of diastolic drugs, strict diet - broad-spectrum antibiotics: *ciprofloxacin with metronidazole.*

Answer 209

* Urgent indications ventricular and supraventricular tachyarrhythmia causing haemodynamic disturbances * Scheduled indications ventricular and supraventricular tachyarrhythmias that do not cause hemodynamic disturbances, which do not pass despite pharmacological treatment or when it is not possible to use it

Answer 210

defibrillation

Answer 211

12 to 20 breaths per minute

Answer 212

magnesium sulfate administered intravenously at a dose of 4-6 g .

Answer 213

tachycardia with a pulse, with narrow regular QRS. At a dose of 6mg-12mg-12mg.

Answer 214

**furosemide is a drug used also for pulmonary edema.**

Answer 215

benzodiazepine drug that has anxiolytic, sedative, anticonvulsant, hypnotic and miorelaxant effects. Category D.

Answer 216

diagnosed before pregnancy or before 20 hbd and persisting for more than 6 weeks after delivery

Answer 217

identified after 20 hbd, without proteinuria; we divide them into 1. transient - disappears up to 12 weeks after delivery and 2. chronic - persisting 12 weeks after delivery

Answer 218

increased blood pressure> 140/90 after 20 hbd and proteinuria> 300mg / day; or no proteinuria but there present: thrombocytopenia PLT <100,000 / ul, Alat / Aspt> 2 x upper limit, creatinine> 1.1mg / dl, pulmonary edema , CNS problems, visual impairment

Answer 219

the appearance of tonic-clonic seizures in the course of preeclampsia

Answer 220

rest stress reduction physical activity acetylsalicylic acid 100mg from 16 hbd low molecular weight hepari

Answer 221

Ending pregnancy *before 40 hbd* *Magnesium sulfate iv 4-6 g in 20 minutes, then 1-2g / h for 24h* = Zuspan method. Control reflexes and breathing when administering magnesium! Pressure control - *nifedipine, urapidil, dihydralazine, labotalol Oxygen 8-10l / minute*.

Answer 222

Causal treatment -** LIQUID THERAPY** - 500 ml crystalloids within <15 minutes; within 30 minutes 1000 ml of crystalloids or 300-500 ml of colloids. After the transfusion of 2000 ml, further portions of fluid are administered depending on the patient's condition, 200-500 ml.

Answer 223

Data from the question: abdominal pain, bloody vomiting - bleeding into the upper gastrointestinal tract, tachycardia 130 / minute, tachypnoe, lack of pulse on distal arteries and a weak pulse oximeter signal suggests centralization of circulation, pressure 75/50, Allgover index 1.7 . Patient pale and sweaty. Symptoms suggest hypovolemic shock due to upper gastrointestinal bleeding. Allgover index = heart rate / systolic pressure 0.6 - 1 - norm ~ 1 - developing shock > 1.4 - heavy shock.

Answer 224

1. Examine the patient according to the ABCDE scheme 2. Get intravenous access, do ECG, give oxygen when indicated 3. Diagnose and treat a reversible causes !! 4. Assess whether the patient is stable or has disturbing symptoms such as shock, syncope, myocardial ischaemia or heart failure. 5. If so, we should perform cardioversion up to 3 times, then give amiodarone 300mg iv. within 20 minutes 6. If the patient is stable, we must assess QRS 7. When they are narrow <120 ms and regular (as in our patient's) we should perform vagal maneuver and give adenosine in the 6-12-12 mg approach. 8. When they are narrow and irregular, it is probably atrial fibrillation that requires appropriate treatment.

Answer 225

- It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. - This draws the water out of the body's other organs, including the brain. Risk factors include: A stressful event such as infection, heart attack, stroke, or recent surgery

Answer 226

Hyperosmolar Hyperglycaemic State (HHS) occurs when the blood sugar of a person with diabetes becomes too high (hyperglycemia) for a long time. The extra sugar is passed into the urine, which causes the person to urinate frequently. As a result, he or she loses a lot of fluid, which can lead to severe dehydration (extreme thirst).

Answer 227

*Ketoacidosis* - the most common, especially in patients with type 1 diabetes. *Lactic acidosis *- the least common. *HHS, i.e. Hyperglycemic-Hyperosmolar Syndrome* - common in people with type 2 diabetes. *Drug-induced hypoglycaemia.*

Answer 228

| high hyperglycemia, high plasma osmolality and often prerenal AKI (due t

Answer 229

Glucose> 600mg / dl pH> 7.3 Serum bicarbonate> 15 mmol / l Na serum> 150 mmol / l Plasma osmolality> 320 mOsm / kg h20 Ketone bodies in urine - NONE!

Answer 230

Glucose> 600mg / dl pH> 7.3 Serum bicarbonate> 15 mmol / l Na serum> 150 mmol / l Plasma osmolality> 320 mOsm / kg h20 Ketone bodies in urine - NONE!

Answer 231

- Hydrate 0.45% or 0.9% NaCl Within 1 hour - 1000 ml During the next 4 - 6 hours - 500 ml per hour Until the shortage is compensated - 250 ml per hour. - Reduce hyperglycemia - short-acting insulin Bolus - 0.1j / kg bw Start continuous infusion 2-4j / h - Correct potassium deficiencies - Look for the reason.

Answer 232

*rhabdomyolysis * venous thromboembolism.

Answer 233

-a loop diuretic that has no potassium-sparing effect. -when using such diuretics, i.e.* furosemide, torasemide*, we expect **HYPOkalemia.**

Answer 234

ARB potassium supplements heparin digoxin.

Answer 235

-angiotensin converting enzyme inhibitors - blocking this enzyme prevents the change of angiotensin I to angiotensin II. -Angiotensin II is a potent hormone. It compresses vessels, accelerates the formation of compounds with the same effect, stimulates the formation of aldosterone. In short, aldosterone works to cause HYPERnatremia and HYPOkalemia. -If we use a drug blocking this pathway, we will get the opposite effect, i.e. **HYPERkalemia. ** -Other side effects of ACEi are kidney damage, cough and angioedema.

Answer 236

-NSAIDs - when it comes to potassium, they reduce the concentration of renin and aldosterone. -Thus, the effect of aldosterone is reduced, which can lead to HYPERkalemia.

Answer 237

B-blocker - competitive β1 and β2 adrenoceptor antagonist. -By blocking β2 adrenergic receptors, potassium transport into cells is impaired. -Thus, HYPERkalemia will be a side-effect .

Answer 238

an antibiotic - it works by inhibiting dihydrofolic acid reductase. -It is used in the case of urinary tract infection, upper respiratory tract infection or diarrhea. -Has many side effects: pruritus, gastrointestinal disorders, kidney and bone marrow toxicity, HYPERkalemia.

Answer 239

| compressions in the middle of the chest, in the lower half of the sternu

Answer 240

-Check if the patient responds: "Can you hear me?" -Open the airway and check if the patient is breathing - I look, listen, feel. Take a maximum of 10 seconds ( 1 minute in hypothermia) -Call the Emergency Medical Team -30 chest compressions - in the middle of the chest. in the lower half of the sternum, compression depth 5 cm, not more than 6 cm, with a frequency of 100-120 per minute -2 breaths - open the airway, breathe in normally, surround the patient's mouth, make sure there is no leakage, slowly blow the air for 1 second, checking if the chest rises. ---Repeat. To make 2 breaths, stop compressing the chest for no more than 10 seconds. When available, connect AED.

Answer 241

* assessment of whether the patient is breathing - 10 seconds, hypothermia - 1 minute inhale - 1 second * ventilation pause - 10 seconds * cardiac rhythm assessment - every 2 minutes * Adrenaline supply - every 3-5 minutes t, in hypothermia - extended 2x until reaching over 35 ° C * change of rescuers oppressing KLP - every 2 minutes * recommended time till defibrillation since unconsciousness starts- 3 minutes for children, after 5 rescue breaths, perform CPR for 1 minute before you look for help.

Answer 242

seizures! - check breathing and rule out cardiac arrest!!

Answer 243

1. K + > 5.5 mmol / l. symptoms: weakness flaccid paralysis paraesthesia weakness of deep reflexes bradycardia cardiac arrest.

Answer 244

concentration K> 6.5 mmol / l.

Answer 245

K +> 6.7 mmol / l)** 1st degree block (PQ interval> 200ms) flattening or lack of P wave high, pointed T wave lowering of the ST segment QRS widening> 120ms.

Answer 246

*Calcium resonium 15-30g ion *exchange resin. We give it orally or rectally. It binds potassium ions in the intestine and is removed with the stool.

Answer 247

10 units of short-acting insulin and 25 g of glucose or salbutamol 10-20 mg in

Answer 248

10 ml 10% calcium chloride iv.

Answer 249

-sodium bicarbonate 50 -K +

Answer 250

1. ion exchange resins 2. short-acting insulin 3. salbutamol 4. furosemide / torasemide 5. sodium bicarbonate

Answer 251

-calcium chloride

Answer 252

* Holliday and Segar method * Our patient weighs 35 kg (20 kg +15 kg). 1500 ml + (20 ml x 15 ) = 1800 ml

Answer 253

ETCO2 monitoring allows: Confirmation of the location of the endotracheal tube in the trachea Monitoring the frequency of ventilation during CPR Monitoring the quality of chest compressions - the deeper the greater the cardiac output, so ETCO2 also increases Prognosis during CPR - when we cannot get a value greater than 10mm Hg for 20 minutes, this is associated with poor prognosis for the patient Diagnosis of ROSC - ETCO2 increase.

Answer 254

-positive end-expiratory pressure- this is the pressure that is present in the lungs after normal exhalation. -In a person breathing spontaneously, it is about 2-3 cm H2O. -*During ventilation,* we also set this pressure, but it is higher,* in standard circumstances it is about 5-8 cm H2O.*

Answer 255

-alveoli do not collapse and it is easier to take another breath ("open it and keep them open") -allows reduction of FiO2 in the gas mixture, thanks to which we eliminate the negative effects of oxygen treatment -it also causes the inclusion of dead areas in the gas exchange.

Answer 256

-chest pressure increases, so venous return to the heart and cardiac output decrease -the phenomenon of auto-PEEP - can occur in patients with obstruction, where as a result of an air trap there is air retention and a decrease in cardiac output.

Answer 257

**Naloxone** - a non-selective antagonist of all classes of opioid receptors, is mainly used to improve breathing, not to restore consciousness. pinpoint pupils (like poppy seeds) drowsiness or coma (CNS depression) breathing disorders - shallow, irregular breathing, can lead to apnea (respiratory depression) bradycardia hypotension paralysis of intestinal motility urinary retention nausea, vomiting pallor of the skin dizziness.

Answer 258

Ethanol, Fomepizol, folinic acid

Answer 259

Ethanol, Fomepizol

Answer 260

flumazenil

Answer 261

hydroxocobalamin

Answer 262

Fab fragments of digoxin binding antibodies

Answer 263

N-acetylcysteine

Answer 264

physostigmine

Answer 265

Atropine, Pralidoxime

Answer 266

*Activated charcoal* - 0.5-1.0 g / kg Do not use in case of poisoning with* alcohol, metals, cyanide. *

Answer 267

-poisoning with substances easily soluble in water, weakly binding to proteins. - -Examples of these substances are: *ethanol, methanol, glycol, paracetamol, lithium* (may lead to renal and prerenal/renal AKI), *salicylates*.

Answer 268

-poisoning with substances easily soluble in water, weakly binding to proteins. - -Examples of these substances are: *ethanol, methanol, glycol, paracetamol, lithium* (may lead to renal and prerenal/renal AKI), *salicylates*.

Answer 269

*deep body temperature > 40 ° C* due to increased heat production or impaired heat loss mechanisms.

Answer 270

a set of symptoms that occur after poisoning with a specific substance.

Answer 271

-an *acute state in psychiatry,* it is *caused by a blockage of dopaminergic conduction*, most often as a r*esult of ingesting typical and atypical antipsychotic drugs*, combination of these drugs with e.g. **metoclopramide**, or as a result of *sudden withdrawal of antipsychotic drugs*. -*Symptoms:* muscle stiffness (often the first symptom), "cogwheel" rigidity, muscle tremor, dystonia and dyskinesias, tachycardia, variable blood pressure, tachypnoe, **HYPERthermia**, extensive sweating. -We use **benzodiazepines and dantrolene** for treatment .

Answer 272

> = 2 of the following 4: 1. body temperature > 38 ° C or <36 ° C 2. heart rate > 90 / minute 3. breaths > 20 / minute or PaCO2 <32 mm Hg 4. leukocytes > 12,000 / ul or <4000 / ul, or > 10% of immature forms of neutrophils.

Answer 273

ventricular tachycardia with narrow QRS complexes -fast cardiac rhythms (generally more than 100 beats/min) with a QRS duration of 100 ms or less. -Differential diagnosis of tachycardia with narrow QRS complex (shorter than 0.12 second). -Although rarely life-threatening, these arrhythmias are a common source of morbidity.

Answer 274

-this is the act of making a forced exhalation with the glottis closed. -This leads to increased chest pressure and pressure on the heart along with large blood vessels. -At the moment of exhalation, the baroreceptors are excited and the vagus nerve stimulation increases

Answer 275

1. inhibiting the frequency of sinus node depolarization 2. inhibition of conduction velocity in bundle of His 3. breakdown of the wave of recurrent stimulation that causes tachyarrhythmia

Answer 276

<120 ms 1. Valsalva maneuver 2. carotid sinus massage 3. other methods of stimulating the vagus nerve : (e.g. a sip of cold fluid, provoking vomiting, immersing the face in cold water)

Answer 277

> 3.75 mmol / L. **Hodgkin's disease **

Answer 278

The most common causes of hypercalcaemia (> 3.75 mmol / L) .(90%) are *hyperparathyroidism and cancer. * -Tumors can directly infiltrate bones, leading to the release of calcium (hypercalcaemia) or indirectly lead to an increase in calcium levels in the blood by secreting hormones similar to *PTH.*

Answer 279

assesess the risk of *gastrointestinal bleeding* before performing an endoscopic examination.

Answer 280

-confirm the *position of the endotracheal tube and monitor the frequency of ventilation. * -Capnometry *registers the carbon dioxide content of exhaled air *and allows you to determine the effectiveness of ventilation in a non-invasive way. -It also makes it possible to *recognize the return of spontaneous breathing.*

Answer 281

-benzodiazepine drug with anticonvulsant, hypnotic and sedative effects. -It shows an addictive effect both physically and mentally.

Answer 282

anxiety, panic attacks conditions with increased muscle tone increased agitation insomnia epileptic seizures febrile seizures

Answer 283

-2 to 10mg 2-4x / d should be used -maximum dose of 50 mg.

Answer 284

- brand name *Ambien* - medication primarily used for the *short-term treatment of sleeping problems* - Guidelines recommend that it be used only *after cognitive behavioral therapy for insomnia and behavioral changes, such as sleep hygiene,* have been tried - It decreases the time to sleep onset by about fifteen minutes and at larger doses helps people stay asleep longe - It is taken by mouth and is available in conventional tablets, sublingual tablets, or oral spray

Answer 285

**Flumazenil** a *specific benzodiazepine antagonist,* is useful in *reversing the sedation and respiratory depression* that often occur when benzodiazepines are administered to patients undergoing anesthesia or when patients have taken an intentional benzodiazepine overdose. NOTE: antidote for benzodiazepines, such as *diazepam (Valium®), lorazepam* (Ativan®), and *midazolam (Versed®),* and must be *administered intravenously.*

Answer 286

**S**- sympathomimetics: Amphetamine and derivatives (Adderall, Concerta, Dexedrine, Focalin, Metadate, Methylin, Ritalin) **L**- LSD **A**- Anticholinergic substances Atropine TCAs **C**- cannabinoids

Answer 287

Tramadol Fentanyl Codeine Morphine belong to the group of opioid drugs, hence they will cause narrowed, sometimes pin-like pupils "myosis"

Answer 288

-Reynolds pentad - septic shock and disturbances of consciousness.

Answer 289

pain in the right hypochondrium fever and chills mechanical jaundice

Answer 290

Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to a noxious stressor (infection, trauma, surgery, acute inflammation, ischemia (lack of blood supply to a part of the body) or reperfusion, or malignancy or certain conditions, such as an autoimmune disorder or pancreatitis

Answer 291

is a benzodiazepine drug with anticonvulsant, hypnotic and sedative effects. It shows an addictive effect both physically and mentally. Indications for use of diazepam include anxiety, panic attacks conditions with increased muscle tone increased agitation insomnia epileptic seizures febrile seizures The dosage of the drug depends on the indication. For the treatment of seizures in adults, 2 to 10mg 2-4x / d should be used, doses can be repeated to a maximum dose of 50 mg.

Answer 292

rapid intravenous infusion of *magnesium sulfate * at a dose of *2 g (1 amp. 10 ml MgSO4 20%)*

Answer 293

smell of almonds in the breath.

Answer 294

* hydroxocobalamin* (5 g iv infusion over 15 min).

Answer 295

> 20 mg/dl.. ethanol (antidote) and hemodialysis *Gastric lavage* is not recommended, nor is the use of *activated charcoal.*

Answer 296

Arises from spinal cord injury, intracranial hemorrhage, or brain injury.

Answer 297

vessels dilate, and thus *redness and warming of the skin occurs* and there is a *decrease in vascular resistance*. -This leads to relative *hypovolemia and hyperkinetic circulation* with i*ncreased cardiac output and reduced peripheral blood flow.*

Answer 298

vessels dilate, and thus *redness and warming of the skin occurs* and there is a *decrease in vascular resistance*. -This leads to relative *hypovolemia and hyperkinetic circulation* with i*ncreased cardiac output and reduced peripheral blood flow.*

Answer 299

*supraventricular tachycardia* with a pulse electrical cardioversion, 70-120J

Answer 300

coagulation cascade, which in turn leads to coagulopathy, which is the second element of the death triad

Answer 301

-hemorrhagic diathesis. -In addition, the presence of coagulopathies promotes further blood loss and the development of symptoms of hypovolemia. -Hypovolemia reduces the supply of oxygen to tissues. -This in turn implies a gradual change in metabolism to anaerobic. -Under these conditions, the cells produce lactic acid and ketone bodies, which are responsible for the last element of the death triad, i.e. acidosis.

Answer 302

* reduces myocardial efficiency, it also leads to ↓ peripheral perfusion, which in turn aggravates *hypothermia.*

Answer 303

pain assessment: an effective tool in patients over 85 years with advanced dementia and persistent pain DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).

Answer 304

Multiple doses of *activated charcoal *

Answer 305

- "enteric dialysis"/MDAC (multi-dose activated charcoal). -administering *12.5 g of activated charcoal every hour *or equivalent doses at greater intervals until the patient's clinical condition or toxicological parameters improve.

Answer 306

terlipressin It causes constriction of visceral vessels and a reduction in blood flow to the portal vein - it lowers the portal pressure and causes a decrease in pressure in esophageal varices. Terlipressin is usually used as an adjunct to endoscopic haemostasis.

Answer 307

-a non-selective B-blocker used in the primary and *secondary prophylaxis of bleeding from esophageal varices in patients with cirrhosis of the liver at high risk of bleeding.* -Non-selective B-blockers lower the pressure in the portal vein, which reduces the risk of bleeding. | a non-selective B-blocker used in the primary and secondary prophylaxis

Answer 308

-a drug which strongly and immediately lowers blood pressure. -It is used PRN in emergencies. -Due to the toxicity of the metabolites, sodium nitroprusside is used for a short time, usually up to 48 hours, and one of the contraindications to its administration is liver failure.

Answer 309

α1 adrenergic receptor blocker used PRN to rapidly reduce blood pressure

Answer 310

-according to some reports, glucagon may increase blood flow and pressure in the portal vein, which would be detrimental to bleeding esophageal varices. -*Glucagon is used in hypoglycemia, diagnostics of gastrointestinal motility disorders and intoxication with B-Blockers*

Answer 311

premature newborns → age in weeks / 10 term newborns → 3.5 children 1-2 years of age → 4.0 - 4.5 children> 2 years of age →* age/4 + 4* (knowledge of this formula is most often useful in LEK)

Answer 312

"Pasteurella multocida" -clinical picture corresponds to *pasteurellosis*. -The bacterium that *causes the disease lives in the upper respiratory tract of various animals, both wild and domestic), but most often (about 60-80% of cases) the cause of the disease is caused by cat bites* (long, thin canines → deep penetration of bacteria

Answer 313

1. Head in neutral position (may need to be slightly tilted by placing a rolled up towel under the baby's shoulder blades). 2. In infants, we include (if possible) both the mouth and nose - the so-called mouth-nose ventilation. 3. We make 5 initial rescue inhalations. 4. For infants, the recommended chest compressions technique depends on the number of rescuers: a. with the tips of two fingers - if there is one rescuer, b. two thumbs wrapped around the chest - if there are two rescuers. 5. Compression of the chest to a depth of 1/3 of the chest dimension or to a depth of 4 cm in an infant. 6. When there is one rescuer, he or she should conduct CPR for about 1 minute before seeking help.

Answer 314

- if the patient suffers from coronary artery disease and takes the drug on an emergency basis, he should take 1 dose of nitroglycerin sublingually. - If the pain persists within 5 minutes → call an ambulance. - Possible administration of subsequent doses under the supervision of medical personnel (a total of 3 sl doses of 0.4 mg every 5 minutes, then continuation iv). -Contraindications: systolic blood pressure <90 mmHg, tachycardia> 100 / min, suspected right ventricular infarction, taking a phosphodiesterase inhibitor within 24h or 48h in the case of tadalafil.

Answer 315

we give each patient with symptoms of hypoxia, SpO 2 <90% - our patient does not have dyspnea and hypoxemia.

Answer 316

-the drug of choice for pain management in STEMI. - -We use doses of 4-8 mg iv, subsequent doses of 2 mg every 5-15 minutes until the pain subsides (in some cases the total dose reaches 2 mg / kg and is well tolerated).

Answer 317

-ASA immediately 150-500 mg p.o. (150-300 mg when PCI is planned) or 250 mg IV (80-150 mg IV when PCI is planned) and -Ticagrelor (B) / prasugrel / clopidogrel -GP IIb / IIIa blocker - abciximab / eptifibatide / tirofiban for emergency indications or if there is evidence of no-return of blood flow or a thrombotic complication. Do not administer before the procedure.

Answer 318

-use in patients without contraindications, especially with tachyarrhythmia or elevated blood pressure (metoprolol 50 mg x 2/day, then 100 mg x 2/day) -In case of contraindications, a calcium channel blocker (diltiazem / verapamil) can be used - provided that there is no left ventricular systolic dysfunction or AV block.

Answer 319

- use as early as on day 1 of a heart attack, provided that there are no contraindications, especially LVEF ≤40% or with symptoms of heart failure in the early stage of STEMI. - Use ARB in case of ACEI intolerance.

Answer 320

- we use a statin in all patients, regardless of the concentration of cholesterol in the plasma (unless there are contraindications). - Target LDL cholesterol 1,4 mmol/l (<55 mg/dl) or a decrease of ≥50% from baseline. --Use ezetimibe if patient does not tolerate statins.

Answer 321

- choice and dosage depends on the STEMI treatment method. Independent indications apply when using heparin: a. extensive myocardial infarction, anterior wall infarction, atrial fibrillation, left ventricular thrombus or cardiogenic shock → low molecular weight heparin (D, enoxyparin is a type of LMWH) sc or unfractionated heparin (UFH) (C) iv if we plan CABG in the next 24 h → UFH b. prophylaxis of VTE → heparin in a prophylactic dose until the patient is fully mobilized.

Answer 322

-*metabolic alkalosis* associated with *hypokalaemia *and *increased elimination of hydrogen ions*

Answer 323

*metabolic acidosis* due to the loss of alkalis through the gastrointestinal tract (bile, pancreatic juice and intestinal juices contain HCO3− in high concentration)

Answer 324

**metabolic acidosis associated with the formation of acids and aldehydes during the metabolism of the consumed substances in the liver

Answer 325

- Lactic acidosis associated with overdose of metformin is known as MILA - Metformin- Induced Lactic Acidosis. - The mechanism of this phenomenon is not fully understood, but is probably related to the inhibition of gluconeogenesis by blocking pyruvate carboxylase by the drug

Answer 326

40 beats per minute (to approximate the heart rate at 25mm / s writing speed, divide 300 by the number of 5mm squares between successive R-waves. -In the above case it will be 300 / 7.3 ≈ 41

Answer 327

sinus bradycardia and sinus rhythm

Answer 328

atrial fibrillation

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-the **nodal rhythm** (now more commonly referred to as the **AV junction rhythm**). -It is **characterized by a frequency of about 40-60 / min**, -**no P waves or P waves of extra-sinus origin** (negative P in II, III, aVF, positive in aVR) -and most often morphologically normal QRS waves.

Answer 330

in patients with a high or intermediate clinical probability of pulmonary embolism, it is recommended that *anticoagulant treatment with low molecular weight heparin *should be started immediately during the diagnostic procedure.

Answer 331

** factor Xa inhibitor (api X aban) from the new generation of anticoagulant drugs (NOACs), which is currently the preferred choice for the prevention of recurrence of VTE.**

Answer 332

cerebral cortex brainstem cardiac muscle kidneys liver

Answer 333

adrenaline (epinephrine) amiodarone lidocainre sodium bicarbonate magnesium sulfate calcium chloride alteplaza

Answer 334

flumazenil

Answer 335

ethyl alcohol

Answer 336

ethyl alcohol

Answer 337

N-acetylcysteine

Answer 338

pralidoxime, obidoxime, atropine

Answer 339

-pulse pressure is usually 35-45 mmHg. -A fall in blood pressure suggests *arterial spasm*, which may be caused by cardiogenic, hypovolemic or tachyarrhythmic shock. This is because arterial contraction causes diastolic blood pressure to increase more than systolic blood pressure, resulting in a decrease in the difference between systolic and diastolic pressure.

Answer 340

-parameter used in cardiology to determine the load on the heart muscle. -The formula for calculating it is the product of heart rate and systolic blood pressure (HR x SBP) Thanks to this indicator, we can see how high the heart's need for oxygen is. The parameter is given on a 5-point scale:

Answer 341

-colourless, non-irritating and odourless gas. -Carbon monoxide molecules are lighter than air and have size that allows it easily pass through wall porosity and diffuse throughout the room. -Carbon monoxide binds to hemoglobin 250 times easier than oxygen forming carboxyhaemoglobin (COHb), which is not able to carry oxygen and leads to hypoxia.

Answer 342

-After the seizure patient may develop so-called "postictal sleep", you should put the patient in the recovery position and do not wake him up. -In the postictal phase nervous system is regenerated and the patient should not be woken up.

Answer 343

1. you should stabilize the patient's head and maintain patent airways 2. protect the patient from injuries (e.g. put something soft under the patient’s head) 3. check glucose level, basic parameters - ABCD, provide intravenous catheter 4. measure oxygen saturation and BP 5. diazepam or clonazepam can be given 6. during the seizures you should not put any material objects between patient's teeth or pour water over his face

Answer 344

is a language disorder caused by damage in a specific area of the brain that controls language expression and comprehension

Answer 345

The three most common types of aphasia are: Broca's aphasia. Wernicke's aphasia. Global aphasia1.

Answer 346

-* start to ventilate the patient with oxygen, intubate the patient, administer naloxon*e. -The correct number of respirations in adults is 12-20 per minute, the value of 6/min with 78% saturation indicates acute respiratory failure, which may be caused, among others, by overdosing of certain medications. -Narrow pupils and symptoms of respiratory depression indicate the possibility of poisoning with opiates. -As hypoxia may be one of the causes of sudden cardiac arrest, start oxygen ventilation immediately and intubate the patient. -A specific antidote used in the treatment of opiate intoxication is naloxone at a dose of 0.4-2.0 mg.

Anesthesiology Flashcards

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