CEN Flashcards
(341 cards)
1
Q
The pressure bag for an ART line should be inflated to what pressure?
A
300 mm/Hg
2
Q
What is the most common cause of a dampened waveform on an ART line?
A
Air in the system
3
Q
What are the papillary muscles?
A
Connect to the tricuspid and mitral valves via the chordae tendinae and prevent valve prolapse (regurgitation)
4
Q
What color of stool would you expect with a patient who has a common bile duct blockage?
A
Gray
5
Q
What STD often occurs concurrently with gonorrhea?
A
Chlamydia
6
Q
What is normal d-dimer?
A
Less than 0.5
7
Q
What is normal prothrombin time (PT)?
A
12-15 seconds
8
Q
What is considered a positive PPD result (non-HIV patient)
A
Induration of 10mm
For HIV patients induration of 5mm
9
Q
Amytriptyline is an antidepressant (tricyclic) that is sometimes prescribed for pain. How long does it take to achieve a therapeutic effect?
A
Up to 3 weeks
10
Q
What time of day should TCA’s be taken?
A
Bedtime
11
Q
A patient with Addison’s disease experiencing adrenal crisis (insufficient production of adrenal hormones) would experience which electrolyte imbalances?
A
Hypoglycemia due to reduced cortisol
Hyponatremia due to low aldosterone
Hyperkalemia due to low aldosterone (sodium and water lost, potassium retained)
Hypocalcemia
12
Q
Symptoms of rubeola:
A
Koplik’s spots (bluish/white spots to mouth and throat) appear 1-4 days before rash on face and trunk
13
Q
Rubella symptoms
A
Red rash starts on the face and spreads to trunk and extremities. Also may have swollen cervical lymph nodes
14
Q
Donepezil (aricept) is used to treat:
MOI and potential adverse side effect?
A
Alzheimer’s
Potentially life threatening cholinergic crisis (sludge effects)
15
Q
Carbidopa/levodopa
- Trade name?
- MOA?
- Primary disease it treats?
A
- Sinemet
- Converts levodopa to dopamine (inhibits cholinergic activity)
- Parkinson’s
16
Q
Memantine:
- Trade name
- Primarily used to treat?
- MOI?
A
- Namenda
- Alzheimer’s
- Decreases the effects of glutamate, the principal excitatory neurotransmitter in the brain
17
Q
Selegiline:
- Trade name
- Primarily used to treat?
- MOI?
A
- Eldepryl
- Parkinson’s
- Inhibits the enzyme monoamine oxidase (thereby increasing dopaminergic action)
18
Q
List 3 cranial nerves involved in eye movement.
A
3 - Oculomotor
4 - Trochlear
6 - Abducens
19
Q
Phenytoin:
- Trade name?
- How should it be administered?
A
- Dilantin
- Mixed with normal saline (1ml/50mg) and a filter should be used due to the likelihood of precipitation
- Administer slowly and monitor for hypotension
20
Q
What is the difference between subdural hematomas and subarachnoid hemorrhage?
A
Subdural can take weeks to develop
Subarachnoid can be occur from aneurysm rupture often precipitated by an increase in ICP from straining or heavy lifting.
21
Q
What type of headache is associated with an aura signaling the start of the headache?
A
Migraine
22
Q
What type of headache is associated with dis function of the trigeminal nerve?
A
Cluster
23
Q
Edrophonium:
- What type of drug
- Used for?
A
- Muscle strengthener
2. Used as a diagnostic test for myasthenia Travis
24
Q
What are symptoms of autonomic dysreflexia in SCI?
A
Hypertension, bradycardia, severe distress, pupil dilation
25
Central cord syndrome symptoms.
Loss of function in upper extremities
Lower extremities not affected
Can’t type, but can dance
26
A patient complains that his new cast is too tight. What will likely be done?
Bi-valving the cast
27
A boxers fracture is a fracture of the?
Distal 5th metacarpal
28
What is a Colles’ fracture?
| Evaluation of what nerve should be performed with a Colles’ fracture?
1. Fracture of the distal third of the radius
| 2. Radial nerve
29
Peroneal nerve injury is associated with what injury?
Tib/fib fracture
Patient may have numbness to the top of the foot and be unable to dorsiflex
30
Median nerve injury is commonly associated with what injury?
Elbow dislocation
| Or wrist fracture
31
Proper fitting of a walker results in elbows bent at?
30 degrees
32
Describe the drainage commonly associated with gas gangrene infections.
Thin, watery brown, or brown-gray
33
How would one test sensory function of the radial nerve?
Assessing for feeling on the dorsum of the hand or base of thumb. Or pinch the webbing between the thumb and index finger
34
Length of time sutures can be left in place for:
1. Face, lips, eyelids?
2. Eyebrows?
3. Back, chest, arm, hands, thighs?
4. Lower legs, feet?
1. Face, lips, eyelids? 3-5 days
2. Eyebrows? 5-7 days
3. Back, chest, arm, hands, thighs? 7-10
4. Lower legs, feet? 10-14 days
35
What are the symptoms of cyanide poisoning?
Restlessness, dizziness, tachycardia, and the odor of bitter almonds
36
Per HIPPA, a patient can request errors corrected in their medical records within how long?
60 days
37
Symptoms of benzo withdrawal:
Anxiety, confusion, tremors, temp, flu-like symptoms
38
Symptoms of lithium toxicity:
Lethargy, ataxia, nausea, vomiting
39
Normal bicarbonate levels:
22-26
40
How long in-between MDI dose 1 and 2?
1 minute pause
41
What is the antidote for heparin toxicity?
Protamine sulfate
42
Which products necessitate ABO compatibility?
Which do not?
Do: whole blood, PRBC’s, FFP
Don’t: leukocyte poor RBC’s, platelets, albumin
43
What is a grade a recommendation in surviving sepsis?
Initiate prophylactic measures to prevent DVT and stress ulcers
44
Tylenol overdose symptoms
Early (first 24hrs)
Mid (24-48 hrs)
Late (48-96hrs)
May be mild early on, May have mild gastric upset, nausea, vomiting
Mid: abnormal labs
Late signs: vomiting, hypoglycemia, right upper quadrant pain
45
Chlorofluorocarbon trade name?
Signs/symptoms of overdose?
Freon
Loss of consciousness, respiratory depression, thermal burns
46
What effect would narcan have on GHB overdose?
None. GHB has no antidote. Symptoms are similar to opioid overdose.
47
Enlarged liver can be a symptom of what type of heart failure?
Right sided
48
Becks Triad:
1. Hypotension
2. Muffled Heart Tones
3. Distended neck veins
49
A patient has an inferior wall MI. What is the most likely dysthymia to occur?
Bradycardia
50
Bethanechol
1. Trade name
2. Mechanism
3. Uses
1. Urecholine
2. Parasympathomimetic
3a. Urine retention
3b. GERD (stimulates gastric emptying)
51
Patients with IBS should avoid?
Sorbitol - causes gas bubbles in the intestines
52
How frequent/what size meals should the pt with esophigitishave?
Small, frequent
53
Should patients with IBS have water with meals?
No, it can cause distention
54
Discharge instructions for prostratitis should include:
Increase fluid intake to assist in elimination of bacteria.
| No restrictions on sexual activity.
55
Name 3 foods that may cause dark red urine, and one that doesn’t.
Beets, rhubarb, blackberries.
| Strawberries do not.
56
What type of discharge would you expect for trichomoniasis?
Gray or greenish discharge
57
What type of discharge would you expect for gonorrhea?
Yellow discharge
58
What sign (size) is an indication of a viable fetus?
Fundal height 26cm above the pubic symphysis (indicative of 26 weeks gestation which is viable)
59
How many “kicks per hour” are a good indication of fetal well being?
10/hr
60
What might you anticipate the pupil to look like with a globe rupture?
Peaked or teardrop
61
What are some education items for patients with Bell’s palsy?
1. Cold exposure can be a precipitating factor
2. Eye protection should be worn due to loss of normal blink response
3. Artificial tears will need to be used on a regular basis
62
Lyme disease:
1. Caused by?
2. Potential symptoms/complications
3. Treatment
1. Borella burgdorferi, deer ticks
2. Expanding bulls eye circle, flu-like symptoms, AV blocks, meningitis, hepatitis, arthralgia
3. Antibiotics
63
What is myxedema coma?
| Priority treatment?
Severe hypothyroidism
| Supplemental oxygen and airway management
64
Classic symptoms for measles?
Rash on face spreading downward, bluish gray spots on oral mucosa (Koplik’s spots)
65
What would be the difference in leukocytes in Viral vs bacterial meningitis?
Difference in protein?
Viral: less than 1000
Bacterial: greater than 1000
Protein: <200 viral
>200 bacterial
66
In addition to severe headache, what other symptoms are typically present with temporal arteritis?
Red nodules over temples, weight loss, night sweats, aching joints, fever
67
What is a side effect of IV phenytoin?
What is the max dosage rate of phenytoin?
Hypotension and bradycardia
50mg/min (consider 25mg/min for elderly)
68
What are the exclusion criteria for iv administration of tPA?
1. Uncontrolled hypertension 180/110
2. Outside of 180 minute window
3. Under 18 years old
4. Intracranial hemorrhage
69
Fat emboli would typically present with petechiae in what area?
Anterior chest and neck
70
What is the HDVC vaccine for and what site should it always be administered?
Deltoid
Rabies
71
To test radial nerve function, children with an elbow injury are typically asked to perform what sign?
Thumbs up
72
What is the recommendation for the use of echinacea in cancer patients?
Contraindicated you’re give to patients with autoimmune disorders as it can stimulate the immune system.
73
Per EMTALA, the hospital property extends how far from the main building?
250 yards
74
What is the correct dosage for t-PA (alteplase)?
0.9mg/kg up to 90mg
75
Corticosteroids can contribute to what side effect, especially in the geriatric population?
Depression
76
What are the classic symptoms of hypothyroidism?
Confusion, hypotension, bradycardia, and cool/pale skin.
77
What are the characteristics of Cushing’s syndrome?
Hypertension, bradycardia, abnormal respiration’s
78
What is a priority intervention for flail chest?
What is proper positioning?
Pain management to promote adequate ventilation.
Position pt on the injured side in semi-Fowler’s position
79
Indications for a chest tube
Tension pneumo
Hemo-pneumo
Pneumothorax greater than 20%
80
What is the most common cause of acute bronchitis in the non-smoking patient?
Viral
81
What unique findings might you find in the ABG of a pregnant patient?
Decreased PaCO2 due to hyperventilation
Decreased bicarbonate as the kidneys compensate for the decrease in PaCO2
82
The development of coagulopathies after auto transfusion is most likely contributed to what?
Autotransfuaion of 25-50% of total blood volume can lead to dilution of clotting factors
83
What is the indication for Recombinant human activated protein C?
What is an absolute contraindication for this drug?
Indication: sepsis
Contraindication: risk of bleeding
84
What is a common treatment for stingray venom?
Warm to Hot water as it helps to dissipate the venom. Resolution of pain is the indication to stop treatment.
85
Indomethacin is what kind of drug?
What type of pain/diagnosis might it be prescribed for?
NSAID
Pericarditis
86
What is coarction of the aorta?
Narrowing or pinching anywhere in the aorta, most commonly just after the aortic arch, restricting blood flow to the lower part of the body resulting in lower BP in the lower extremities
87
What is intussusception?
What are the symptoms?
When part of the intestine telescopes into the other part.
Most commonly occurs in children.
Symptoms: colicky spasmodic pain and red currant jelly stool.
88
What are the side effects of loperamide?
Indication: anti-diarrhea
Side effects: sedation, dizziness, dry mouth, ileus, constipation
89
What is one of the most serious complications with bowel obstruction?
Peritonitis
90
Name one thing that will increase the odds of getting PID?
Having an intrauterine device.
Also adolescents are at increased risk due to immature immune system and thinner cervical mucus.
91
What type of drug is methotrexate? What are some common indications?
Immunosuppressant and chemo drug.
Treats cancer and may also be prescribed for ectopic pregnancy
92
A FAST exam cannot be used to identify ??
Retroperitoneal injury
93
What is the window for reimplanting an avulsed tooth or teeth?
30 minutes due to the death of periodontal ligament cells.
94
What are the typical symptoms of hypercalcemia?
```
Hyporeflexia
Weakness
Weight loss
Shortened QT and wide T-wave
Polydipsia and polyuria
```
95
What are some classic lab findings of Reye’s Syndrome?
```
Elevated ammonia
Elevated SGOT
Elevated SGPT
Hypoglycemia
Lactic acidosis
```
96
Spinal fluid normal:
Pressure?
WBC’s?
RBC’s?
Glucose?
Pressure? - 50-200
WBC’s? - 0-5
RBC’s? - zero
Glucose? - 50-75
97
Classic symptoms of meningococcemia?
Rapid onset fever, petichial rash, purpura. It is a systemic bacterial infection.
98
Kawasaki disease
Primarily affects 5 and under
Erythematous rash, fever, swelling of hands and feet, cervical lymphadenopathy
99
What type of drug is aminocaproic acid (amicar)?
Promotes clotting
100
How does a hepatitis A infection affect the ability to work?
Most people are out of work at least 4-weeks.
Although it is fecally transmitted, blood banks will often not accept donations for up to one year after exposure.
101
Bluish-gray spots on the oral mucosa (Kopliks spots) are specific to what disease?
Measles
Kopliks spots appear 1-2 days prior to the rash
102
What is propylthiouracil?
Used to treat thyroid storm. It blocks thyroid hormone synthesis.
103
What is the drug edrophonium (tensilon)?
Anticholinesterase (inhibits breakdown of acetylcholine) and is used to assess for presence of myasthenia gravis.
Side effects could be respiratory depression and bradycardia
Reversal agent is atropine
104
What class of drug is nicardipine?
Calcium channel blocker
105
What spinal cord injury is more commonly associated with pediatric patients?
SCIWORA
| Spinal cord injury without radiographic abnormality
106
What is autonomic dysreflexia?
Typically seen with injuries T6 or higher and results in excessively high BP. Foley placement is often necessary in addition to managing the BP.
107
Name 4 animals that are presumed rabid unless otherwise proven negative through testing?
Raccoons, skunks, foxes, bats
108
What is a Colles fracture and what is one identifying characteristic?
Distal radius fracture.
“Silver fork” deformity as the hump deformity resembles the shape of a fork.
109
Which complication is the most likely to occur 12-48hrs post femoral fracture?
Fat embolism
110
What lipid soluble drug can be administered via ET tube during cardiac arrest?
Lidocaine
2 doses of 2-3mg
111
Name 4 herbs that have been shown to affect platelet function and should be avoided by the patient taking aspirin.
Ginger
Garlic
Ginseng
Ginkgo Bilboa
112
This OTC herb is commonly taken for depression, but should be avoided in the post transplant patient due to increased risk of rejection.
St. John’s Wort
113
Digoxin toxicity can have what effect on potassium?
Increase
114
What is the DTaP schedule?
2, 4, 6 months
115
The first dose of Hib should be given when?
2 months
116
What is the MMR schedule?
1st - 12 months
| 2nd - 4-6 years
117
What type of drug is chlorpromazine?
Possible adverse effect?
Antipsychotic
Extrapyramidal symptoms or dystonic reactions
118
What sounds are typically described for a pleural rub?
Low-pitched grating sound.
Heard more on inspiration than expiration.
119
What is the standard pediatric fluid bolus for shock?
20ml/kg
120
Pediatric hypoglycemia dose
2-4ml/kg of d25
Which equals 0.5-1gm/kg
121
How many ml/kg is the best estimate of an infants circulating blood volume?
How does this compare to an adult?
90ml/kg
Adult: 70ml/kg
122
Class 4 shock:
```
HR >140
Hypotension
Confusion
Lethargy
Blood loss > 2000ml
```
123
Signs/symptoms of chlorine gas exposure:
Chest tightness and burning
| Cough, shortness of breath
124
In the case of iron overdose, how long does it take to reach peak iron levels?
3-4 hours
Symptoms may include nausea, vomiting, and bloody diarrhea.
125
Nutmeg can be abused through excessive ingestion and has gained a reputation as a/an?
Hallucinogen
126
Palpating under the right costal margin causing inability to take a deep breath is caused by what? What is this “sign” called?
Cholecystitis
Murphy’s sign
127
Epididymitis is most common at what age?
30-50 years
128
What is boerhaave syndrome?
Spontaneous effort rupture of the esophagus. Often caused by severe straining or vomiting.
129
Hyporeflexia is most commonly associated with what electrolyte imbalance?
Hypokalemia
130
What effect would Addison’s disease have on potassium?
Hyperkalemia
131
Hyperkalemia can lead to peaked t-waves on an EKG. As the hyperkalemia worsens, what are some changes you might notice on the EKG.
Lengthening or absent p-wave
Enlarging QRS
Sine wave
132
What are some ekg changes you might note in a patient with hypokalemia?
St depression
Biphasic t-wave
Prominent u-wave
133
What effect does hypermagnesemia have on deep tendon reflex?
Decreased reflexes
134
What is chovstek’s sign?
In a patient with suspected low magnesium, tap on the side of the face (temporal and zygomatic region) - due to low magnesium causing muscular irritability, they may scrunch that side of the face.
135
What is trousseau’s sign?
Another test for hypomagnesemia. Place a BP cuff on the patients arm and inflate to 20 above the known SBP. Leave it inflated and a positive sign is if the muscles in that extremity begin to contract, have tetany, an May even spasm violently.
136
Name some food that are high in magnesium.
Legumes, chocolate, nuts, grains, leafy greens
137
What is the treatment for hypermagnasemia?
IV fluids, loop diuretics, and in severe cases dialysis.
138
What is the relationship to calcium and phosphate?
They exist in an inverse relationship
139
Normal pressure of spinal fluid?
50-100
139
Normal CSF
WBC’s?
RBC’s?
Glucose?
WBC’s = 0-5
RBC’s - zero
Glucose = 50-75
140
What effect does high or low calcium have on the QT interval?
High calcium = shortened QT
Low calcium = prolonged QT
141
What is the treatment for high phosphate levels?
Aluminum binding agents such as maalox
142
Expected electrolyte abnormalities with renal failure:
```
Potassium:
Sodium:
Phosphorous:
Calcium:
Hydrogen:
```
```
Potassium: high
Sodium: low (kidneys can’t retain)
Phosphorous: high (kidneys can’t excrete)
Calcium: low (inverse to phosphorus)
Hydrogen: high (metabolic acidosis)
```
143
Define azotemia:
Elevated levels of creatinine and BUN
144
What is myxedema coma?
Life threatening low thyroid levels
145
Name 2 drugs that may be used to treat thyroid storm (not practical, only need to know for test)
PROP or Methimazole
- inhibits thyroid hormone synthesis
One hour later give iodine which causes uptake of free thyroid hormone back into tissues.
The PROP or methimazole reduces likelihood of more hormone being produced when the reuptake occurs
146
Hypoglycemia can cause sweating, anxiety, pallor, tachycardia. Why is this?
Hypoglycemia stimulates the release of epinephrine in order to stimulate the release of glycogen stores.
147
What is a possible side effect of glucagon to be aware of?
Vomiting
148
Which has a higher mortality rate?
DKA or HHS?
DKA: 3-10%
HHS: 20-60%
149
What is the treatment for DKA & HHS?
Isotonic fluid:
Adults 1-2L/hr
Ped’s 20ml/kg/hr
IV insulin: bolus 0.1 units/kg then maintain at same dosage per hour
Watch potassium and other electrolytes and correct as needed.
150
What effect does increased aldosterone and cortisol (Cushing’s) have on:
blood sugar?
Potassium?
Sodium?
Elevated blood sugar
Decreases potassium
Increases sodium
Addison’s will be the opposite
151
What is the main cause of Cushing’s?
Chronic steroid usage
If a patient stops taking meds cold turkey they could have addisons symptoms
152
Medical terminology
Elevated red blood cells?
Decreased red blood cells?
Polycythemia
Anemia
153
Medical terminology
Elevated white blood cells?
Decreased white blood cells?
Leukocytosis or leukemia
Leukopenia/pancytopenia
154
Medical terminology
Elevated platelets
Decreased platelets
Thrombocytosis
Thrombocytopenia
155
Sickle cell treatment and discharge instructions
Warm moist heat
NSAIDs or opioids
Hydration
Avoid high altitudes and cold temps
156
Normal platelets?
| Thrombocytopenia is usually asymptomatic above what level?
150-450k
50k
157
What is hemophilia and who does it primarily affect?
Hereditary clotting disorder that primarily affects males.
158
What are the 3 types of hemophilia?
Hemophilia A (deficient factor 8) - most common
Hemophilia B (deficient factor 9)
Hemophilia C (deficient factor 11) - least common in USA, more common in Africa
159
SIRS criteria
2 or more of the following:
```
Temp >38 or <36
HR >90
RR >20 or PaCO2 <32
AMS
WBC’s >12k or <4k
Hyperglycemia >120 (no diabetes)
```
160
What does MODS refer to in regards to the septic pathway?
Multi Organ Dysfunction Syndrome
161
What is the recommended ED sepsis treatment bundle?
Within 3 hours:
1. Measure lactate
2. Blood cultures prior to antibiotics
3. Admin of broad spectrum abx
4. 30ml/kL fluids for hypotension or lactate >4
Within 6 hours
1. Vasopressors if hypotension refractory to fluids
2. Maintain MAP of 65 or greater
162
What is the difference between mild anaphylaxis and severe anaphylaxis?
Mild: normal BP and mild respiratory distress. Treat with IM epi
Severe: hypotension and severe respiratory distress. Treat with IV epi
163
What determines if psychotic behavior is “delirium”?
Positive lab tests that identify what is causing the psychosis
164
What is the only type of psych patient you don’t encourage to talk?
Acute mania
165
Suicide
1. Which demographic is most likely to succeed with an attempt?
2. Which season is most common for attempts?
1. Older Caucasian males
| 2. Spring
166
# Define akasthesia
Treatment?
The constant need to move or inability to hold still
Benadryl or propranolol
167
What is the potentially life threatening reaction to antipsychotics?
Neuroleptic Malignant Syndrome
More common in warm weather
Most common symptoms: AMS and muscle rigidity, sudden fever
168
Symptoms of serotonin syndrome
AMS, tachycardia, diaphoresis, lower extremity rigidity
169
Classic triad of symptoms for shaken baby syndrome
Subdural hemorrhage
Retinal hemorrhage
Decreased LOC
170
What is Munchausen Syndrome
By proxy?
Someone who enjoys receiving medical care
By proxy: passes that need on to someone like a child
- demands extensive work up
- enjoys the hospital setting and staff
- not concerned about subjecting child to to painful tests or treatment
171
The signs of OCD typically begin to appear at what age?
Before 18 years
172
# Define cardiac output
Normal for an adult?
SVxHR = cardiac output
4-8L/min
173
Normal stroke volume
60-130ml
174
How is afterload measured?
MAP
(2x diastolic) + systolic
———————————
3
175
When pacing, once you note capture, how should you check for pulse?
Don’t use carotid.
Use femoral or brachial
176
If a pacemaker is “over sensing”, what is the treatment?
Treat bradycardia per protocol
Consider application of a donut shaped magnet to turn sensing function off
177
What is the difference between hypertensive urgency and hypertensive emergency?
Both are classified as greater than 180/120, however it is an emergency when there are signs of end organ dysfunction.
178
What is the goal for treatment of hypertensive crisis?
Drop BP 15-20% over the first hour. Often done with Beta-blockers or calcium channel blockers.
179
What are the emergent treatment goals of dissecting aortic aneurysms?
Reduce HR to 60-80
Reduce systolic to 100-120
2 large bore IV’s
Type & cross
180
If a vasoconstrictor extravasates, what is the correct drug and treatment?
Leave IV in
Administer phentolamine through the IV
Then administer additional phentolamine sub-cutaneously
181
What leads are associates with the LAD coronary artery?
V1,v2,v3,v4
Anterior MI
182
What leads are associated with the Circumflex coronary artery?
1, aVL, V5, V6
| Anterior MI
183
What leads are associates with the Right coronary artery?
II, III, aVF
Inferior MI
184
What leads are associates with the Posterior descending coronary artery?
ST depression in V1, V2
or
R-wave reversal progression
(Tall r-wave in V1 that then progressively gets smaller)
185
What is one possible complication with right sided MI?
Vagal stimulation
Nausea/vomiting
Bradycardia
JVD
Hypotension
186
Classic triad of symptoms for endocarditis
Fever
Heart Murmur
Anemia
187
Define claudication
a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
Intermittent claudication is often a condition that happens in the presence of chronic peripheral vascular disease and is often relieved by rest.
188
What is the difference in activity recommendations for arterial occlusion abs venous occlusion?
Arterial: activity encouraged
Venous: discourage activity
189
What part of the heart is most commonly injured with blunt cardiac injury?
Right side
190
Define pulses paradoxus
Decrease of greater than 10 systolic when holding breath
191
Normal base excess?
-2 to +2
Direct relationship to bicarbonate
High bicarbonate, high base excess
Low bicarbonate, low base excess
192
Pediatric ET tune calculation?
NG/OG or foley size?
ET tune insertion depth?
Chest tube size?
Pediatric ET tune calculation?
(Age/4)+4
NG/OG or foley size?
2x ETT
ET tune insertion depth?
3x ETT
Chest tube size?
4x ETT
193
When are you most likely to see a fat emboli?
24-72hrs after a large bone fracture
194
What symptoms might you see from a pulmonary fat embolism?
Classic PE symptoms
Plus
Petichiae to the chest and axilla
195
What is the treatment for a pulmonary air embolism?
Place the patient on their left side (left lateral decubitus)
196
Define Fremitus
A vibration felt through the body such as when a patient speaks you can hold your hand on their chest and feel the fremitus (vibration)
Fremitus is often INCREASED in lobes with pneumonia due to increased density in the lung parenchyma.
Fremitus can be DECREASED if air or fluid is in the pleural space.
197
What lung sounds would you expect with a pulmonary contusion?
Crackles
198
What different percussive sounds would you anticipate with a pneumothorax vs a hemothorax?
Pneumo: hyperresonance
Hemo: hyporesonance
Both will have decreased fremitus
199
What is egophony and when might you hear it?
Increased resonance of voice sounds when auscultation lungs.
Would be present with fluid in the lungs such as a hemothorax.
200
What happens to PH with massive blood loss?
It decreases - acidosis
201
What happens to pulse pressure with hypovolemia?
Narrowing pulse pressure
202
Difference between
“Paresis”
And
“Plegia”
Paresis = weakness
Plegia = paralysis
203
What are biot’s respiration’s?
Fast, deep respiration’s with long periods of apnea.
204
Normal ICP?
Increased ICP?
Serious/critical ICP?
0-10
>20
>30
205
During a simple partial seizure, what mental status changes would you anticipate?
How is a complex partial different?
None. Cognition should be maintained.
Complex Partial: impaired cognition
206
What discharge instructions are important for concussion?
1. Avoid high risk activity until cleared by a physician to decrease the risk of 2nd impact syndrome
2. Be aware of signs of increased ICP in case a subdural bleed was unrecognized as these can be slow onset.
207
Describe the characteristics of DAI
Mild
Moderate
Severe
Mild: coma 6-24hrs, transient posturing, minimal or no permanent deficits
Moderate: >24hrs coma, transient posturing, amnesia and cognitive deficits
Severe: prolonged coma, persistent posturing, vegetative state or profound deficits
208
How might someone describe the symptoms of a sub-arachnoid bleed?
Worst headache of my life
209
Should O2 be administered with a suspected basilar skull fracture?
If needed, but not via nasal cannula due to risk of pneumocephalus.
210
Anterior cord function?
Descending motor neurons
211
Posterior cord function?
Ascending sensory neurons
1. Soft touch
2. Proprioception
3. Vibration
212
Lateral cord function?
Ascending sensory neurons
1. Pain
2. Temperature
3. Crude touch
213
Nerves from the brain cross over at some point offer control of the contra lateral side. The different parts of the cord cross over at different sections. Where do they cross over?
1. Anterior cord?
2. Posterior cord?
3. Lateral cord?
1. Anterior: at base of brain
2. Posterior: at base of brain
3. Lateral: at entry point of spinal cord
214
The name of the SCI (example T-6 or C7) is indicating what?
The level at which they HAVE function
215
Anterior cord syndrome
Loss of motor function, retention of sensory
216
Posterior cord syndrome
Loss of sensory, but still has motor function
217
Brown adequate syndrome
Often from a penetrating injury.
Can move one side with no sensation
Can’t feel the other side but can still move
218
What is poikelothermy?
Loss of ability to regulate temp and the body becomes the temperature of the environment
219
How might a cluster headache be described?
Intense unilateral pain in the orbital or temporal region lasting 15-180 minutes.
Treatment: high flow O2
220
List some triggers for migraine headaches
Weather/barometric changes
Stress/anxiety, menstruation, pregnancy
Hypoglycemia
Alcohol, aged cheese, chocolate, MSG, caffeine
Tagamet, nifedipine, theophylline
221
Migraine treatment
dihydroergotamine (migranal)
and
Reglan
222
What non-benzo seizure med can be given IM?
Fosphenytoin (cerebyx) - PH of 7
223
Myasthenia gravis
1. Average age of onset
2. Mechanism of disease?
1. 20-30 (more common in females)
2. Reduction in acetylcholine resulting in weakness
3. Airway support, edrophonium to differentiate between MG and cholinergic crisis.
- if no improvement with edrophonium, give atropine to treat cholinergic crisis.
- also may get steroids and plasmapheresis
224
Bell’s palsy symptoms include hemifacial paralysis. What else might the patient complain of?
Intensification if noises in the ear of the affected side
225
What treatment might be used for iritis?
Scopolamine drops
226
A patient is suspected of having mastoiditis. What other finding might help confirm the diagnosis?
The patient recently was diagnosed with otitis media
227
What intervention might be considered to aid the process of foreign body in the nose removal?
Administration of nasal decongestants
228
What is the treatment for trigeminal neuralgia?
What nerve is the trigeminal nerve?
```
Carbamazepine
Phenytoin
Benzo’s
Lamictal
gabapentin
```
(Adjuvant analgesia)
Nerve 5
229
What nerve is involved with Bell’s Palsy?
Symptoms?
Treatment?
Cranial nerve 7 (motor and sensory) (usually caused by herpes simplex virus)
Unilateral paralysis
Cannot close eye on affected side
Inability to purse lips
Ipsilateral loss of taste and hypersensitive hearing
Treated with steroids
230
Tooth fractures are named after?
What are the classes?
Ellis
Ellis 1: through the enamel, chalky white appearance
Ellis 2: into the dentin, yellow appearance
Ellis 3: into the pulp and nerve, bloody or pink appearance
Ellis 3 treatment: application of calcium hydroxide and emergency dental visit
231
Maxillary fractures are classified how?
Lefort 1: maxilla fractures below the nose but above the teeth
Lefort 2: break is above the nose and to the sides of the maxilla in a pyramid shape
Lefort 3: complete craniofacial separation
232
Symptoms of zygomatic fracture?
TIDES
```
Trismus (mouth is locked shut)
Infraorbital anesthesia (numbness)
Diplopia
Epistaxis
Lack of symmetry
```
233
Difference between mydriatic eye drops and miotic eye drops?
Cycloplegic drops?
Mydriatic: dilates
Miotic: constricts
Cycloplegic: dilates and paralyzes eye to stay open
234
What is hyphema?
Eye injury that characteristic by blood accumulation in the front of the eye.
Treatment: bed rest 3-5 days, upright 30-45 degrees, eye rest
235
What is considered increased intraocular pressure?
>20
236
Glaucoma treatment?
Goal is to decrease aqueous humor.
Timolol (topical betablocker)
Mannitol
Miotic eye drops (pilocarpine for constricting the pupil)
237
What type of pain is associated with retinal emergencies?
None
238
How soon must a central retinal artery occlusion be treated?
Treatment?
Irreversible blindness can occur in 1-2 hours
Vasodilation (permissive high CO2)
Nitroglycerin
Timolol
Fibrinolytic therapy
239
Retinal detachment
Symptoms
Treatment
Painless vision loss, sudden bright light followed by floaters or cobwebs, curtain or veil-like vision
Absolute bed rest, bilateral patching, ophthalmology consult
240
Inflammation of the cornea is called?
Keratitis
241
What causes ultraviolet keratitis? Onset?
Welding arc or snow blindness.
6-10 hours after exposure
242
What is iritis?
Inflammation of the iris and ciliary body
Very painful
Treatment: steroids and cycloplegics
243
What is ludwig’s angina?
Cellulitis of the sun-mandibular and sub-lingual region of the face.
Often has an origin of molar infection
Has potential to occlude airway
244
What is Vincent’s angina?
Trench mouth - mouth ulcerations, gingiva, halitosis, lymphadenopathy
245
What causes epiglotitis?
Bacterial infection
Haemophilus B causes 90%
HiB vaccination
246
Average age of croup?
Epiglottitis?
Croup: 6 months - 3 years
Epiglottitis: 2-5 years
247
What is labyrinthitis?
Infection of the inner ear
248
What is the treatment for mastoiditis?
Hospital admission for aggressive IV antibiotics
249
What is Ménière’s disease?
Disease of the inner ear, not an infection.
Fluctuation of fluid in the inner ear usually ages 40-60
Vertigo, hearing loss, N/V, tinnitus
250
Difference between anterior and posterior epistaxis?
Anterior: in front of nasal bones. Most commonly caused by nose picking (digital manipulation). Pinch nose for 10 minutes
Posterior: behind nasal bones (can be heavier bleeding, but much of the blood drips back to the hypopharynx. Has a higher risk of airway obstruction.
251
What complication should be monitored for if topical cocaine is applied to help control a nose-bleed?
Hypertension
252
What nerve runs along the back of the lower leg?
Symptoms?
tiBial nerve
Lack of sensation to Bottom of foot
Unable to point foot down
253
What is the rule of 2’s for tourniquets?
2 inches above the wound
2 inches wide
2nd tourniquet applied 2 inches above 1st one if bleeding not controlled
Turning tourniquets get turned twice
254
Kinetic energy formula
1/2Mass X (velocity squared)
255
What will and will not show up in an X-ray in regards to imbedded objects
Will show: glass, metal
Will not: vegetative matter (splinters, thorns, cactus) and plastic
256
Where should epinephrine not be used to control bleeding due to vasoconstriction risk of hypoxia?
Ears, nose, toes, and hose
257
How many doses of tetanus are recommended?
When treating wounds, what is the recommendation for tetanus booster?
3 doses
Minor wounds - 10 years
All other wounds - 5 years
If tetanus status is unknown and is not minor: Tdap AND TIG
258
What are the P’s of compartment syndrome from early to late
```
Pain
Parathesia (numbness)
Paralysis
Pallor
Pulselessness
```
259
Difference between sprain and strain?
Sprain: injury to ligament
Strain: injury to tendon
260
What is a nursemaids dislocation?
Treatment?
Nursemaid’s elbow
Dislocation of radial head only
Treatment is supination: consider pain control first!
261
What is a nightstick fracture?
Fracture of ulna
262
Where is the scaphoid bone and what is a pain indication that it might be fractured?
It is the carpal bone between the hand and the wrist on the thumb side.
Pain when pressing on the “snuff box” is an indication
263
What is the proper placement of a pelvic binder?
Over the greater trochanters and pubic symphysis
264
Difference in appearance of an anterior vs posterior dislocated hip?
Anterior: externally rotated and abduction
Posterior: internally rotated and adducted
Either way must’ve be reduced <6hrs to prevent femoral head necrosis
265
Which is weight bearing: tibia or fibula?
Tibia = weight bearing
Fibula = non-weight bearing
266
Name 3 antibiotics that can weaken tendons and make more prone to rupture.
Fluoroquinolone’s
Levaquin
Cipro
Avelox
267
Compartment syndrome vs no compartment syndrome
| RICE
Compartment - elevate at the level of the heart
No compartment - above the level of the heart
Also no ice in presence of compartment syndrome
268
```
Blast injuries
Primary
Secondary
Tertiary
Quaternary
```
Primary: gas wave compressing organs
Secondary: flying debris
Tertiary: blunt injuries as body hitting other objects
Quaternary: burns, crushes, toxic inhalation’s, cancer
269
What time of day are gout flare ups more common?
At night
270
Name 2 drugs that should be avoided for gout patients
Thiazide diuretics
| Aspirin
271
Name some foods that can worsen gout
Name some things that can help
Mussels
Sardines, herring, salmon
Veal, bacon, organ meats, yeast
Can help:
Vitamin C, coffee, dairy, exercise
272
What is the goal pH when administering bicarb to a TCA overdose?
Slightly alkaline
| 7.45-7.55
273
Describe how Rocky Mountain Spotted fever typically progresses.
Starts in extremities and spreads to the trunk
274
What type of precautions for pertussis?
Droplet
275
Anti-cholinergic (atropine) overdose symptoms
Similar to sympathomimetic as it’s blocking the parasympathetic system
```
Blind as a bat
Mad as a hatter
Red as a beet
Dry as a bone
Hotter than hell
```
276
Name 3 drugs used in the treatment of cholinergic overdose.
Atropine
2-PAM (pralidoxime)
Benzo’s (for seizure)
277
What is the reversal agent for benzo’s?
Flumazenil (Romazicon)
but monitor for seizures, especially those that dependent on benzo’s, as benzo’s won’t stop the seizure
278
Methanol and ethylene glycol are 2 other types of alcohol. Name 2 examples and what is the common problem/treatment?
Methanol: windshield washer fluid
Ethylene glycol: antifreeze
Both cause metabolic acidosis which can be treated with sodium bicarb and hemodialysis in extreme cases
279
What would be a difference in symptoms between isopropanol (rubbing alcohol) and ethanol (normal alcohol?
Ethanol: hypoglycemia
Isopropanol: hyperglycemia and ketones in urine, fruity breath
280
What is fomepizole given for?
Methanol or ethylene glycol ingestion.
Inhibits toxic metabolites
281
Name 3 plants that can cause digoxin toxicity.
Foxglove
Oleander
Lily of the valley
282
Symptoms of digoxin overdose
Treatment
Bradycardia
Hypokalemia
AMS
Treatment:
* Digibind (Digoxin Immune Fab)
- may cause a drop in potassium
* atropine
* pacing
283
What is the antidote for arsenic, lead, gold, mercury
A chelating agent such as
Dimercaprol
284
Symptoms of iron overdose?
What is the antidote for iron overdose?
Early 0-2 hours: Severe GInsymptoms
Mid (2-48 hours) - temp resolution of symptoms
Late: 48-96 hours - metabolic acidosis, coagulopathies, hemorrhagic shock, hepatic/renal failure.
Antidote: Deferoxamine (Desferal)
- urine may be orangish
285
Metformin overdose will result in?
Surprisingly may not have hypoglycemia
but will have lactic acidosis
Treatment is bicarb
286
Treatment for anti-hyperglycemic overdoses?
Glucose
| Octreitide (50mcg SQ or IV)
287
TCA overdose symptoms?
Treatment?
Anti cholinergic effects (dry skin and mouth, decreased LOC
Adrenergic blocking (hypotension)
Decreased cardiac conduction
Treatment: bicarb
288
Treatment for cyanide overdose?
Discharge instructions for patients who received this drug?
hydroxocobalamin (Cyanokit)
289
Chemical eye exposure treatment priorities
Do not delay treatment for vitals
1. Flush immediately with water until Morgan lens available, then switch to isotonic crystalloid
2. Flush for 30 minutes, then check with litmus paper. Goal pH: 7.4-7.6
3. Recheck after 20 minutes
290
How long do you decontaminate a radiation exposure?
Use tepid water until radiation levels are no higher than 2x background radiation.
291
How does cyanide affect oxygenation?
Cyanide prevents oxygen uptake into the cells resulting in:
1. High venous and arterial oxygen levels
2. Metabolic acidosis
292
What is in a cyanide kit?
1. Amyl nitrate (crush and pt breathes it in.
2. Hydroxycobalamin (converts cyanide to vitamin b12 (do not mix other drugs in same line!!)
3. Sodium nitrite (300mg over 2-4 minutes)
**hydroxocobalamin may turn urine dark brown or red for a few days
293
Modified parkland burn formula
TBSA x 2-4ml x kg
1/2 over 1st 8hrs
1/2 over next 16hrs
Don’t count 1st degree burns
LR is fluid of choice. Also consider D5LR
Adult 2
Pediatric 3
Electrical 4
Regular parkland formula is just 4ml for everyone
294
Goal urine output for electrical burns
1ml/kg/hr
295
Temperature difference between heat stroke and heat exhaustion
Stroke: >41 C
Exhaustion: >37 C
296
When cooling down a heat stroke patient, you want to avoid shivering. What med can help treat shivering?
chlorpromazine (Thorazine)
or
Benzo’s
297
Treatment for frostbite
Handle affected areas gently
IV analgesia
Immerse in circulating water 37-40 C until pink and warm
Once thawed, wrap in loose bulky dressing and monitor for compartment syndrome
298
What is a unique EKG finding that may be present in hypothermic patients?
J-wave or Osborn wave (follows QRS) maybe looks like BERS
299
What type of fluids should be used when warming hypothermic patients
NS with D5 if needed
Don’t use LR
300
What’s different about defibrillation in the hypothermic patient?
Cardiac meds?
If initial shock is unsuccessful, warm to 30-32 before shocking again
Same with meds
301
Treatment for envenomation from jellyfish, fire coral, man of war?
1. Rinse with NS or salt water
2. Remove tentacle if applicable
3. Apply isopropyl alcohol, meat tenderizer, or vinegar
4. Corticosteroids
302
Pit vipers (rattle snakes) symptoms and treatment
Pain, swelling, ecchymosis, edema, blisters
Weakness, N/V, metallic taste, hypotension
45% of bites are “dry” and only require tetanus
Remove jewelry, clothing
Oxygen, IV’s, fluids
Antivenin, anaphylaxis treatment
303
Symptoms/treatment for coral snakes (Elapidae)?
More neuro effects, less local effects
*diplopia, pros is, difficulty swallowing, respiratory distress, pharyngeal spasm, cyanosis, trismus
“Red on yellow kill a fellow, red on black venom lack”
Treatment: antivenin and supportive therapy
304
Brown recluse bite symptoms
Immediate: painless bluish ring
8hrs-4days: erythema, necrosis
Weeks to months: eschar
Treatment - wound care, dapsone
305
Black widow bite symptoms
Neurotoxic
Pinprick pain and local swelling
Localized cramping that spreads to the entire body
Treatment: ice, benzos, antivenin
306
Treatment for Rocky Mountain spotted fever?
Doxycycline
307
Treatment for rabies
1. Scrub with viricidal agent
2. Human rabies immunoglobulin
3. Human diploid cell vaccine on days 0,3,7,14
308
What causes scabies?
Symptoms
Treatment
Round mites (can live off body for up to 24hrs)
Red, pruritic rash
Treatment: lindane or permethrin
309
Treatment for giardia?
Metronidazole
albendazole
310
What diseases require airborne precautions?
My (measles)
Chicken (pox)
Hez (Herpes Zoster - shingles)
TB (tuberculosis)
311
What type of precautions for RSV?
Contact
312
Transmission period for measles?
5 days before and after rash
Incubation: 8-12 days
313
Pertussis incubation period
7-10 days
314
Pertussis treatment
It is bacterial
Treat with macrolide abx
315
Most serious complication of diptheria?
Incubation
Treatment
Airway compromise due to membrane growing over pharynx or edema causing compromise
Incubation: 1-8 days
Can treat with antibiotics and/or antitoxin
316
Chicken pox precautions
Contact
317
Average age difference for duodenal vs gastric ulcers?
Duodenal: 30-55 - increased pain with empty stomach
Gastric: 55-70 - increased pain with full stomach
318
What are 2 things the liver does with protein?
Protein is broken down into ammonia and the liver converts the ammonia into urea.
Protein is converted into albumin
319
What causes urine to become cola colored in liver failure patients?
Bilirubin doesn’t pass into digestive tract and then will be excreted in the urine.
320
A patient with duodenal trauma may have referred pain where?
Testicle
321
Diverticulitis and ulcerative colitis most commonly present with pain in what region?
LLQ
322
What lab changes would you expect with pancreatitis?
Elevated amylase 24-72 hours then returns to normal
Elevated lipase
Hypocalcemia
323
A common precursor to epididymitis is?
UTI
324
What positioning can reduce the pain associated with epididymitis?
Scrotal elevation (Prehn’s sign)
325
Discharge instructions for flagyl
No alcohol while taking and for 7 days after last dose.
Can cause severe vomiting
326
Gonorrhea discharge instructions
Avoid sex for 7 days after completing antibiotics
327
Syphilis 3 stages
Treatment
Primary: firm, round, painless sore on penis that may last 3-6 weeks
Secondary: rough red or brown spots on palms and bottom of feet. May have flu like symptoms
Tertiary: incoordination, paralysis, blindness, dementia
Treatment: penicillin, doxycycline, tetracycline
328
Genital herpes education
Always use protection even when asymptomatic
Keep lesions clean and dry (no creams)
No intercourse during outbreaks
Sitz baths and cool compresses for pain relief
Wear loose clothing and cotton underwear
Increased risk of cervical cancer: frequent pap-smears
329
Testicular torsion treatment time frame?
<6 hours 80-100% salvage rate
>12hours orchiotomy likely
330
Normal menstrual blood loss
25-60ml per day for 4-5 days
Average pad or tampon holds 20-30ml
331
Missed abortion
Prolonged retention of dead products of conception. Cervical os remains closed
332
An ectopic pregnancy in the Fallopian tube may go as long as?
12 weeks
333
Treatment for ectopic pregnancy
Hemodynamically stable: methotrexate
RhoGAM for RH negative mother
334
What is HELLP syndrome
Found in pregnant patients, often pre-eclamptic, but not always
Hemolysis (elevated bilirubin)
Elevated Liver enzymes
Low Platelets
Symptoms can include N/V, RUQ pain, jaundice
Treatment can range from observation to immediate c-section
335
Normal fetal heart tones
110-160
336
Treatment for prolapsed cord
Position mother head down, butt high.
Don sterile gloves and insert fingers into vaginal canal to reduce pressure on cord. May need to maintain this position until delivery.
337
Where do you clamp the umbilical cord?
4 centimeters from each attachment.
Wait for pulsating to stop, then cut
338
APGAR
```
Appearance
Pulse
Grimace (muscle tone)
Activity
Respiratory effort
```
339
Normal HR, RR, and temp of newborn
100-160
40-60
97.7 (36.5)
340
What should the uterus feel like after birth?
Firm like a grapefruit and centrally located.
