BOOK QUESTIONS Flashcards
(132 cards)
1
Q
SBP should be less than what to prevent rebleeding in patients with SAH?
A
<160 - prompt reduction in BP is critical
2
Q
What is a SE of alendronate (Fosamax)
A
esophageal irritation - teach to sit/stand for 30 min after taking
3
Q
What condition is associated with polymyalgia rheumatica?
A
Temporal arteritis
4
Q
What is the blood loss from an unstable pelvic ring fracture? What class of hypovolemic shock is this?
A
3000ml +
Class IV
5
Q
How do we emergently perform a periocardiocentesis?
A
Needle aspiration 1cm left of xiphocostal angle
6
Q
What would indicate that an IO is placed correctly?
A
Red frothy substance (bone marrow)
7
Q
Best way to assess patency of airway in patients with a GCS of 15?
A
Ask to talk - clear speech
8
Q
Best indication that chest tube insertion has been successful in relieving tension PTX?
A
Improvement in hemodynamics
9
Q
How should MAP be lowered for HTN emergency?
A
20-25% in first hour
10
Q
Recommended pulse ox for COPD pt?
A
> 90%
11
Q
This is an inherited sex-linked genetic disorder. Mother is usually carrier and active disease is usually expressed in males..
A
Hemophilia
12
Q
What should never be put on a patient who is actively vomiting?
A
mask / NRB
13
Q
Newborn target SpO2 after 1 minute?
3 minutes?
5 minutes?
10 minutes?
A
1 = 60-65%
3 = 70-75%
5 = 70-85%
10 = 85-95%
14
Q
How do we administer TPA?
A
0.9mg/kg
Max dose 90mg
10% bolus over 1 minute
remainder given over 60 minutes
15
Q
what are some things that may exclude pt from getting TPA?
A
Age >80, hx DM, prior CVA
16
Q
What med should be given for SAH from an aneurysm to decrease vasospasm and possible cerebral infartion?
A
nimodipine
17
Q
Skull fracture with highest risk for intracranial infection?
A
Basilar skull fracture
18
Q
Priority action for ruptured bladder?
A
Give IVF
19
Q
Peds defibrillation dose
A
initial 2 joules/kg, increase to 4, max 10
20
Q
Intervention for snake bite
A
Immobolize area at or below level of heart
mark edges
avoid ice
21
Q
When should critical incident stress management debriefing take place?
A
1-3 days after incident
22
Q
START triage: what would put a patient in the red (immediate) category?
A
-RR >30 (>15, <45)
-cap refill >2 sec or no radial pulse
-unable to follow simple commands
23
Q
What radiation particle can penetrate most objects and is most dangerous to life?
A
Neurons
24
Q
Eye donation preparation
A
Elevate HOB 20 degrees, eyelids taped shut, artificial tears
25
Condition with too much ADH?
Condition with not enough ADH?
SIADH
DI
26
What is Trousseau's sign? What does it indicate?
carpal spasm with BP cuff indicated hypocalcemia
27
What electrolyte abnormality causes hypoactive reflexes? Hyperactive?
Hypo = hypercalcemia
Hyper = hypocalcemia
28
Peds vomiting/diarrhea/gastroenteritis teaching
small amounts or clear liquid at frequent intervals, small amounts of glucose and electrolyte solution
29
Excessive artifact in leads II and III on EKG - change what electrode?
left leg
30
What may cause loss of ventricular capture for a patient with a transcutaneous pacemaker?
Lactic acidosis
31
Priority intervention pt with symptoms of endocarditis
antibiotics
32
What is the most common virus that causes pericarditis?
Coxsackie (hand/foot/mouth)
33
Characteristic sign of COPD
pursed lip breathing
34
C. Diff risk factors
-recent abx
-PPI use
-GI surgery
-long length of stay in healthcare setting
-immunosuppression
35
What is Kehr's sign
LUQ pain radiating to the left shoulder - suggests diaphramatic irritation by peritoneal blood, as seen in splenic injuries
36
What is a side effect of trazodone?
priapism
37
Vent setting initially for ARDS
Pressure-controlled
38
Cor Pulmonale is a complication assoc with what?
COPD
39
Where do we hear bronchial breath sounds?
Bronchovesicular?
Vesicular?
B=over trachea/thorax
BV=over major bronchi
V=peripheral lung fields
40
Consists of the synthesis of revevant research, experience/expertise of practitioner, patient preferences and values
EBP
41
Medical errors esp medication errors are due to what?
inadequate communication
42
Radiation exposure injury with fatal outcome?
CNS syndrome
43
What do we do with a lost tooth?
Try to reimplant within 30 minutes
44
When do S&S of alcohol withdrawal often present?
6-8 hours after last drink was consumed
45
Lumbosacral strain muscle spasm d/c instructions?
HOB slightly elevated and knees flexed when resting in bed
46
How do we know when ready for wound closure after LET admin?
blanching around wound d/t vasoconstriction usually within 20 minutes
47
Symptoms assoc with catecholamine release d/t hypoglycemic episode
-diaphoresis
-anxiety
-dry mouth
-mydriasis
-tremors
48
Peds with sustained RR >___bpm are at risk for resp failure
60
49
What # motor score does a patient get when they localize pain by crossing the midline?
5
(6 = follows commands, 4 = withdraws)
50
What % of EACH SIDE burn BSA are head, chest, abdomen, legs?
Genitals?
Arms?
9%
1%
4.5%
51
What is the Parkland Burn Formula?
4ml LR x %BSA x weight (kg)
52
What electrolyte imbalance do hydroflouric acid burns have?
Hypocalcemia
53
Disaster management phase that includes actions to prevent or reduce cause, impact, consequences of disasters, includes hazard map
Mitigation
54
Disaster management phase that includes planning, training and educational ativities
Prepardness
55
Use of succinycholine in Guillain-Barre patients is contraindicated because it may cause what electrolyte abnormality?
Hyperkalemia
56
Severe aching of the back assoc with tetanus
Opisthotonos
57
What is hypoxia in COPD patients due to?
ventilation/perfusion mismatch
58
What should be performed to r/o urethral injury?
retrograde urethrogram
59
What kind of medications might cause urinary retention?
Antihypertensives
60
How do you describe critical incident stress?
A normal response to an abnormal event
61
Why do we use a LOW tidal volume in ARDS patients on a vent?
To prevent volutrauma
62
What ETCO2 reading during CPR demonstrates adequate compressions/good quality CPR?
>10 (normal ETCO2 is 35-45)
63
During neonatal resus, what provides the most accurate eval of infants resp effectiveness?
cont cardiac monitoring
64
What kind of spider bite is necrotoxic - this may lead to DIC?
Which is neurotoxic - this may also cause abdominal rigidity/cramping?
Brown recluse
Black widow
65
Common symptom of diphtheria?
Findings of diphtheria indicating severe complication of the disease?
thick gray membrane covering throat and tonsils
ST-T wave changes, dysrhythmias may indicate myocarditis and other possible cardiac involvement
66
What can lead to an accelerated juntional rhythm?
Dig toxicity
67
2 assessment findings assoc with compensated shock
Narrowing pulse pressure
Bounding pulse
68
Diagnostic test for PE
Spiral CT
69
What is considered one of the most teratogenic drugs?
Valproic acid / depakote
70
What should we do to a frostbitten area
Protect and immobolize with loose dressing after thawing
do not massage/rub
rewarm with water b/t 99-102 degrees
71
V-fib amiodarone dose
300mg rapid IV bolus initially followed by 150mg rapid IV bolus
72
How is culture defined?
patterns of behaviors and beliefs shared by persons living in a social group
73
Particular spasm of the neck muscles that causes uncontrollable twisting of neck muscles assoc with dystonic reaction.
torticollis
74
what is used to treat a dystonic reaction related to the admin of haldol?
benztropine (cogentin)
75
What lactate level is considered abnormal for exam?
> or = 4
76
2 foods high in K that should be avoided with potassium sparing diuretics (spironolactone)?
bananas
avocados
77
Leukemia most commonly diagnosed in peds
ALL
78
hot potato voice
PTA
79
inflammatory response of the inner ear that can result from recent viral or bacterial infection. Inflammation affects the cochlea, resulting in tinnitus, nystagmus and dizziness.
Labyrinthitis
80
flunitrazepam (Rohypnol) anecdote
flumazenil (Romazicon)
81
What is the goal of wound are?
To maintain function
82
Recommended time to start antibiotics for septic shock? Sepsis without shock?
1 hour if shock, 3 hours if not
83
How do we confirm organophospate poisoning?
plasma pseudocholinesterase level
84
What does cyanide poisoning affect?
Lactate levels
85
Gastritis assoc with n/v expected abnormal lab?
Electrolytes - potassium b/c this is lost in vomit
86
When is pain experienced with a gastric ulcer? Duodenal ulcer?
Gastric = after eating
Duodenal = worse with empty stomach, relieved with eating
87
med class for vaginitis
antimicrobials (most commonly antibiotics for trich/BV and antifungals for yeast)
88
Untreated penile fracture from the rupture of the tunica albuginea may develop what complication?
Erecticle difficulities
Fracture = immediate pain, hematoma, swelling, audible popping sound. Requires surgery.
89
What needs to be used with clindamycin vag cream?
Back up birth control - weakens condoms for 72 hours
90
1st intervention for clear ruptured ectopic?
Emergency surgery
91
Blood glucose levels at 1 minute after birth in neonates below what require treatment with D10?
Below 40
92
Why do we give pitocin after delivery of a full term baby?
To reduce PP bleeding
93
Where should rabies vaccine be administered?
In the deltoid furthest from IG administration bc IG may suppress antibody production from the vaccine
94
Sick following camping trip.
Symptoms = single necrotic looking lesion
No rash. Symmetrical, ascending paralysis
Tularemia
Colorado tick fever
95
Firefigher with seizures, hypotension, hypoxia after fighting a house fire - symptoms likely due to what?
What med should we treat with?
Cyanide, hydroxocobalamin (vitamin B12)
96
Clinical manifestation of bronchitis
dry cough that develops into productive cough
97
While transferring a patient with a chest tube, the drainage system falls and breaks. What do you do?
Insert end of chest tube into sterile water
98
What can INH cause?
hepatotoxiity
99
Normal positive reading for PPD? Positive reading for immunocompromised patients?
10mm
5mm
100
Epiglottitis priority intervention
intubation
101
History if cliff diving 90 feet + pink, frothy sputum with cough
pulmonary edema
102
Patient becomes unconscious during scuba diving. What position do we put them in?
left lateral decub, head down
103
What are 3 categories of secondary traumatic stress?
-Intrusion (repeated reliving of disturbing events)
-Avoidance
-Arousal
104
What med for procedural sedation has the shortest duration of action?
Propofol (3-8 minutes)
105
What might someone cleaning out a cat litter box be at risk for?
What is a bacterial infection from animal bites, particularly cats?
Toxoplasmosis
Pasteurellosis
106
Multiple blood transfusion electrolyte abnormality
Hypocalcemia (anticoagulant citrate used in blood products binds to calcium)
107
What med should be avoided in patients with elevated T3 and T4?
aspirin
108
What age patient can experience PTSD?
Any age
109
What is the purpose of the GCS?
To assess level of consciousness in head-injured patients
110
What is true regarding intranasal administration of meds?
Onset of the drug action may be delayed
111
Hypoxia associated with near drowning will cause cerebral edema, leading to what?
An increase in ICP
112
This med is a vasodilator that decreases BP by relaxing vascular smooth muscle and dilating coronary arteries. It must be protected from light during administration.
Nitroprusside
113
Why do we give morphine to patients with an MI?
it decreases catecholamine release, which results in a decrease in HR and afterload
114
Bright red stools associated with lower GI bleeding/hemorrhoids
Hematochezia
115
What is the gold standard for diagnosing a kidney stone?
Noncontrast helical CT scan
116
What is the most common cause of cirrhosis?
Alcohol
117
What chemistry tests are elevated in patients with pancreatitis? (3)
-BUN
-creatinine
-glucose
118
What do we do for a prolapsed cord during an emergency delivery?
Place hand under the head of the fetus, with a gentle lift
119
Med most likely administered to a patient with a dermal burn from hydrofluoric acid
Calcium gluconate
120
What 3 meds are used to treat cyanide poisioning?
-HYDROXOCOALAMIN
-Sodium nitrate
-Sodium thiosulfate
121
What are 2 reasons for failure to capture while externally pacing a patient?
Metabolic Acidosis
Hypoxemia
122
This can occur from blunt trauma, direct blow, strangulation, or clothesline-type injury. Assessment findings include dyspnea, tachypnea, hoarseness, SQ emphysema, hemoptysis, airway obstrution. Tx = HOB 30 degrees, NPO, vocal rest, humidified oxygen.
Tracheobronchial Injury
123
The amount of blood in the left ventricle at the end of diastole
Preload
124
Urine output less than what is an indication of impaired renal function?
30ml/hr
125
Large FB impaled in eye. After visual acuity, what should you do?
Place a rigid eye shield over the affected eye
Should also patch other eye to minimize consensual movement
126
Eye pain, photophobia, purulent d/c and decreased vision that may occur after conjunctivitis; can l/t corneal ulceration and blindness if left untreated
Keratitis
127
Symptoms such as swelling in fat pad at the base of the neck (buffalo hump), moon face, abd swelling that is due to prolonged exposure to cortisone
Cushing's syndrome
128
Complication of hypothyroidism. Rare and serious.
Myxedema Coma
129
What can decreasing a glucose level too quickly in DKA cause?
Cerebral edema (concerning symptom is HA)
130
This is associated with the use of antipsychotic meds. Symptoms include fever, muscle rigidity, altered level of consciousness. Treatment is to remove the offending agent.
Neuroleptic malignant syndrome
131
What are 2 common findings in chronic lymphocytic leukemia?
hepatomegaly, splenomegaly
132
Crutch training for stairs
-Going up: uninjured leg goes first, followed by injured leg and crutches
-Going down: place crutches down a step and step down the the injured leg, followed by the uninjured leg
