Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adv Physical and Health Assessment > Combined Exam I Decks > Flashcards

Combined Exam I Decks Flashcards

1
Q

What is the (metric) formula for BMI?

A

BMI = kg / m²

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the (imperial) formula for BMI?

A

(703 · BW-lbs) ÷ (inches²)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What mnemonic guides an emergent physical examination?

A

AMPLE
- Allergies
- Medications
- Past medical history
- Last meal
- Events leading up to need for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What factors are worth one point on the Revised Cardiac Risk Index?

A
  • High risk surgery
  • Ischemic heart disease
  • Hx of CHF
  • Hx of CVA
  • DM w/ insulin
  • Creatinine > 2 mg/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Q
What group of surgeries has the highest risk?

A

Vascular (Aortic, major, & peripheral vascular) > 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What sort of risk would be seen on the Revised Cardiac Risk Index with a score of 0?
What about with a score of 3 or greater?

A

0 = 0.4%
3 = 5.4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are METs?
What is one MET equal to?

A
  • Metabolic Equivalent of Tasks (measurement of rate of energy consumption).
  • 1 MET = 3.5 mLO₂ /kg/min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would one assess functional capacity? What is the range of this assessment?

A
  • Through METs
  • 1 MET = eating, working at computer, etc
  • 12 MET = running rapidly for long distances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the three levels of urgency of surgery?

A
  • Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
  • Urgent - Life or limb threatened, sx needed in 6-24 hours.
  • Time-sensitive - delays exceeding 1-6 weeks would adversely affect patient.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What ASA level would an otherwise healthy 22 year old who got in a car wreck with massive trauma necessitating emergent surgery have?

A

ASA V (won’t live without sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What ASA level would a 56 year old male who had an MI 2 months ago have for his follow up TEE today?

A

ASA IV (MI less than 3 months ago)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What ASA level would a 12 year old girl with no hx have coming in for a routine tonscillectomy?

A

ASA I (no hx, healthy, routine sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What ASA level would a 42 year old male with COPD and poorly controlled DM have?

A

ASA III (COPD, poorly controlled DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common anaphylactic drug allergy?
What other two drugs have really common allergies?

A

NMBs
Antibiotics & chlorhexidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What condition makes one more prone to latex allergy?

A

Spina Bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What three things discussed in lecture would prompt you to order coagulation studies?

A
  • Known or suspected coagulopathy
  • Known bleeding disorder, hepatic disease, or anticoagulant use.
  • ASA 3-4; undergoing moderate - major surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What three things discussed in lecture would prompt you to order coagulation studies?

A
  • Known or suspected coagulopathy
  • Known bleeding disorder, hepatic disease, or anticoagulant use.
  • ASA 3-4; undergoing moderate - major surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Is Lidocaine and amide or an ester?
How can you tell?

A
  • Lidocaine = Amide
  • Two “i’s” would indicate and amide (ex. bupivicaine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What cross-reactivity allergies are possible for someone who has a known neuromuscular blocking agent allergy?

A

Neostigmine & Morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What medications need to be discontinued for surgery?

A
  • Aspirin & P2Y12 Inhibitors
  • Topical Medications
  • Diuretics
  • Sildenafil (unless for CHF, then continue)
  • NSAIDs
  • Warfarin
  • Hormone Replacement Therapy
  • Non-insulin DM meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What insulin should a type 1 diabetic take (or not take) the day of their surgery?

A
  • DC short-acting
  • Continue basal rate if using a pump
  • Take 1/3 of normal long-acting if no pump.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What insulin should a type 2 diabetic take (or not take) the day of their surgery?

A
  • DC short-acting
  • Continue basal rate if using a pump
  • 0 - 50% of normal long-acting dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a normal dosing regimen of stress-dose steroid for a major surgery?
Why is this necessary?

A
  • 100mg Hydrocortisone Q8 for 24hrs
  • Stress dose steroid regimen’s replace physiologic cortisol levels. (thus prevent adrenal crisis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the HPA Axis?

A
  • Hypothalamus, Pituitary, & Adrenal glands.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What herbs/supplements carry an increased risk of bleeding?

A
  • Saw Palmetto
  • Garlic
  • Ginger
  • Ginkgo
  • Ginseng
  • Green Tea
    (essentially; saw palmetto & anything starting with a “g”)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which herbs/supplements carry an increased risk of excessive sedation/anxiolysis?

A
  • Kava
  • St. John’s Wort
  • Valerian
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which herbs/supplements carry an increased risk of hypoglycemia?

A

Ginseng

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which herbs/supplements carry a cardiovascular risk (especially intraoperatively)? Why?

A
  • Ephedra (ma huang)
  • Basically ephedrine = ↑ HR & BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which herbs/supplements boost immune system response?

A

Echinacea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If a patient just ate a full, fatty meal, how long until they can have surgery?

A

8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If an infant needs an anesthetic procedure in the morning at 8AM when can their last feeding prior to this occur?

A

4AM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

If a patient has toast with coffee and milk in the morning, how long will it be until they can have surgery?

A

6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If a patient had a gatorade at 6AM when are they clear for their anesthetic procedure?

A

8AM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is Mendelson syndrome?
What two factors increase your risk for this?

A
  • Aspiration Pneumonitis
  • Increased risk of aspiration due to > 25mL of gastric contents and a gastric pH < 2.5.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can be done to prevent aspiration pneumonitis?

A

↓gastric volume and ↑gastric pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What drugs are given to help prevent aspiration pneumonitis?

A
  • Antacids (↑pH)
  • H2 Antagonists (ex. famotidine; ↑pH)
  • PPI’s (ex. omeprazole; ↑pH)
  • D2 Antagonist (ex. metaclopramide; reduces gastric volume)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What scoring tool is used to determine PONV risk?

A

Simplified Apfel Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the four risk factors of a Simplified Apfel Score?

A
  • Female
  • Hx of PONV/motion sickness
  • Non-smoker
  • Post-op opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What sort of risk is conferred by an Apfel score of 1-2?
What would be done with this score?

A
  • Moderate-severe risk
  • Prevention with 2-3 antiemetics & limiting opioids.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What sort of risk is conferred by an Apfel score of 3-4?

A
  • Severe risk
  • Avoid volatiles, use propofol. No opioids if possible, use 2-3 antiemetics.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What drugs are useful in prevention/treatment of PONV?

A
  • Scopolamine (necessary well in advance)
  • GABA analogs (lower opioid usage)
  • Ondansetron (5HT3 antagonist)
  • Promethazine (H1 Antagonist)
  • Dexamethasone (may cause perineal burning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What should be known about presurgical antibiotics?

A
  • Prophylactic abx should be given within 1 hour before incision
  • Vanc & fluoroquinolone should be given within 2 hours of incision.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What chance of cross-reactivity exists with cephalosporins and penicillin?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Different ways to physically assess a patient

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
  • Olfaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the grades of pitting edema?

A
  • 0: none
  • +1: trace, 2mm, dissappears rapidly
  • +2: mod., 4 mm, 10-15 sec
  • +3: deep, 6 mm, ≥ 1 min
  • +4: very deep, 8 mm, 2-5 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How deep would one palpate with light palpation technique?
Deep palpation technique?

A
  • 1-2 cm
  • 4-5 cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What would be expected with tympanic, drum-like percussion?

A

Air-containg space (puffed out cheek, gastric air bubble, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What would be expected with resonant, hollow sounding percussion

A

Normal lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What would be an expected finding with assessed hyper-resonant, booming percussive sounds?

A

Emphysematous lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What would be an expected finding with assessed dull, thud-like percussive sounds?

A

Softer organs (ex. Liver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What would be an expected finding with assessed flat percussive sounds?

A

Denser organs (ex. muscle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What temperature does one need to be to go to PACU?

A

96° /35.5 C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Approximately what should the axillary temp be in comparison to a core temperature?

A

1° lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is Anthropometry?

A

Scientific study of the measurements and proportions of the human body (height, weight, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is Mediate or Indirect Percussion?
How is it performed and what is its purpose?

A
  • Plexor (striking finger) & pleximeter (finger being struck).
  • Evaluation of abdomen and thorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is Immediate percussion? What is it utilized for?

A
  • Striking of surface directly with fingers of the hand.
  • Adult sinus or infant thorax evaluation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is Fist percussion? What is it utilized for?

A
  • Flat hand on area to be evaluated being struck with a fist.
  • Used to evaluate the back & kidney for tenderness.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the three forms of percussion?

A
  • Mediate/Indirect percussion
  • Immediate percussion
  • Fist percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When is circumoral cyanosis primarily seen?
How might circumoral cyanosis present on patients with darker skin tones?

A
  • In infants primarily above the upper lip.
  • gray or white rather than blue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are situations that can cause jaundice?

A
  • Acute liver inflammation
  • Inflammation/obstruction of the bile duct
  • Cholestasis
  • Hemolytic anemia
  • Gilbert’s syndrome
  • Crigler-Najjar syndrome
  • Dubin-Johnson syndrome
  • Pseudojaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What causes pseudojaundice? How harmful is it?

A

Harmless condition caused by excess carrots, pumpkins or melon consumption (↑ β-carotene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is Gilbert’s syndrome?

A

Inherited condition where enzymes can’t process bile excretion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is Crigler-Najjar’s syndrome?

A

Inherited condition where enzyme that processes bilirubin is ineffective.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is Dubin-Johnson syndrome?

A

Inherited chronic jaundice where bilirubin can’t be secreted from the hepatic cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What type of cells does vitiligo attack?

A

Melanocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the sign name of periorbital ecchymosis? What does it indicate?

A

Battle’s Sign: indicates basilar skull fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are petechiae indicative of?

A
  • Thrombocytopenia
  • Leukemia
  • Infectious disease
  • Medications
  • Prolonged straining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is koilonychia? What is it often indicative of?

A
  • Spoon-nails where nails become flat or convex. (opposite of clubbing)
  • Iron-deficiency anemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is nail clubbing? What is it often indicative of?

A
  • Increased concavity of nails
  • Heart/lung diseases, also potential osteoarthropathies.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is paronychia?

A

Inflammation of skin around the nail.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are Beau’s lines? What are they indicative of?

A
  • Horizontal striations that develop on the nail.
  • Lots of things. Nail trauma, kidney failure, mumps, thyroid disorders, syphilis, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is hirsutism? What is a common cause?

A

Excessive hair growth often caused by PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the name of notable difference in pupillary size between both eyes called?

A

Anisocoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is ectropion?

A

Eversion of eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is entropion?

A

Inversion of eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is Ptosis?

A

Abnormal drooping of eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is Arcus Senilis?

A

Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What occurs with the eyes during stage 2 of anesthesia?

A
  • Roving eyeball (nystagmus?)
  • Partial pupillary dilation
  • Loss of eyelash reflex
  • No loss of eyelid reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is ocular accomodation?

A

Ability of eye to focus in on objects far away and close.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is most often the most important anesthetic consideration regarding the ears?

A

Padding during surgery to prevent injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Differentiate Weber’s & Rinne’s tests.

A
  • Weber: tuning fork held on the head (assesses left vs right ear hearing)
  • Rinne: tuning fork held to each ear.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are cherry-colored lips most often indicative of?

A

Carbon monoxide poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Differentiate pallor & cyanosis presentations as well as what usually causes each.

A
  • Pallor = pale (usually anemia)
  • Cyanosis = blue (hypoxia or hypoperfusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What would be indicated by the presence of “spongy” gums?

A

Bleeding due to Vit-C deficiency (scurvy?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is Leukoplakia? What causes it?

A

Thick white patches on the gums from smoking and/or alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Where is the apical pulse located?

A

5th Intercostal space, left of sternum, medial to left mid-clavicular line.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

How much assistance should a patient receive when a Mallampati assessment is being done?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Chest pain in sync with respiratory movement could be indicative of what?

A

Musculoskeletal abnormality or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What can cause radial pulses to become unsymmetric?

A

Clavicular fracture or aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

How can Mg⁺⁺ evaluations be done in OB patients?

A

Knee extension/flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What capability is lost with peroneal nerve injury?

A

Dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What anesthetic consideration should one have for a patient with significant lordosis?

A

↑ abdominal pressure could = worse GERD.
Difficult spinal/epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What anesthetic consideration should one have for a patient with significant kyphosis?

A

Airway, ventilation, and positioning issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Patient judgement is relevant to obtaining _______ ________ whilst ________ is pertinent to the patient’s understanding of whats going on.

A

informed consent; insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What test evaluates proprioception?
How is this test performed?

A
  • Romberg Test
  • Standing with eyes closing and palms down; loss of balance is a + test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is a VAN exam?
What does being VAN positive indicate?

A
  • Palms up, checking for downward drift.
  • VAN (+) = ↑ risk for LVO (large vessel occlusion)
  • VAN=Vision Aphasia Neglect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is another name for plantar reflex?

A

Babinski reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

When would a gluteal reflex be performed?

A

Trauma patients in assessing pelvic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What endocrine disorder makes it difficult to manage fluid status?

A

Pituitary tumors (think neurohypophysis ADH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is G6PD deficiency?

A

Lack of enzyme that results in RBCs breaking down faster than they are made.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What are seizure meds effects on anesthesia?

A

Seizure meds make anesthetics work** less effectively.**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Which court case determined how informed consent should be obtained?

A

Salvo vs Leland Stanford Univ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What MET capacity would indicate a patient is good to go for surgery from a cardiovascular fitness standpoint?

A

MET of 5 or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What class of meds commonly given in anesthesia are teratogenic?

A

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What component of “ester” medications are people allergic to?

A

PABA (Para-aminobenzoic acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Which cardiac hypertension meds need to be discontinued prior to surgery? Why?

A

ACEi & ARBs - can lead to severe hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What needs to be checked pre-op with psych patients? Why?

A

EKG for prolonged QT interval. Many psych meds prolong QT interval.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Which meds cannot be given to a patient taking an MAOI?

A

Meperidine & ephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

P2Y12’s inhibitors and aspirin need to be discontinued ______ days prior to surgery.

When is the exception?

A
  • 7 days P2Y12
  • 10-14 days ASA
  • Exception: patient needs to complete 6 months of dual therapy before discontinuation of anything.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Which herb tends to cause an allergic reaction peri-operatively?

A

Echinacea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Which surgery times put one at a greater risk for PONV?

A

Surgeries that are 1 - 4 hours in length. (shorter or longer are lower risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

How is a pack-year calculated?

A

(Cigs per day / 20) x years smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Bedridden, wheelchair-bound patients should not receive what drug?

A

Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What symptoms/signs point to Horner syndrome?
What most often causes it?

A
  • One sided miosis, ptosis, & anhidrosis
  • Interscalene blocks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Pill-rolling tremors are associated with what disorder?

A

Parkinson’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What sign is it when one experiences RUQ pain along with cholecystitis?

A

Murphy’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What vision change accompanies glaucoma?

A

Tunnel vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is the name for chest-clutching that occurs during MI?

A

Levine’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What nerve runs along the breast that we should be aware of?

A

Long thoracic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Where is the apical pulse?

A

5th ICS, left of sternum, mid-clavicular line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the importance of blood in the urine when doing a c-section?

A

Possible severed ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Who is most at-risk for urinary retention post-operatively?

A

BPH patients (old men)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What drug treats preeclampsia?
How can you check for overdose with this drug?

A
  • Magnesium
  • hypermagnesemia will cause patellar reflexes to disappear.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Chipmunk face is associated with what disorder?

A

Bulimia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Leoning face is associated with what disease?

A

Leprosy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Spider angioma is associated with what liver disorder?

A

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Pyloric stenosis is associated with what shape mass?

A

Olive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Hyperthyroidism is associated with what ophthalmic change?

A

Exophthalmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What physical nature is commonly associated with Cushing Syndrom?

A

Buffalo Hump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Rice water stool is commonly found with what illness?

A
  • Cholera
  • NS was invented for this
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Cullen’s sign- bluish periumbilical disoloration is associated with?

A

Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Rebound tenderness at Mcburneys point is associated with?

A

Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Icteric Sclera is associated with?

A

Hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Addison’s disease or adrenal insufficiency is associated with this skin color?

A

Bronze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

This condition results in wheezing on inspiration

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Myasthenia Graves results in this facial condition?

A

Ptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What findings are common in hyperthyroidism?

A

Exophthalamos and tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What Medication should be avoided in adrenal insufficiency?

A

Etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What two signs are common with meningitis?

A

Kernig- from a knee bent at 90 deg, extension causes pain
Brudzinski- neck flexion causes hip/ knee flexion automatically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What signs are commonly associated with hypocalcemia?

A

Trousseau and Chvostek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

With the recent opioid epidemic and advances in pain research, there is a renewed emphasis.

A

on early multimodal pain management, nonpharmacologic options and nonopioid alternatives

142
Q

What 3 factors can influence the patients response to prescribed pain treatment unrelated to actual pharmacological treatments

A
  • Perceived effective communication with physicians and nurses by the patient
  • Perceived responsiveness by the treating team
  • Perceived empathy by the treating team
143
Q

what can affect patients response to painful stimuli

A

age, gender, ethnicity, socioeconomic and psychological factors, catastrophizing, culture/religion, genetics, previous experiences, patient perceptions and expectations

144
Q

how often is depression and pain co-existing

A

30-60% of pain patients report depression

145
Q

what is pain catastrophizing

A

an exaggerated cognitive response to anticipated or actual painful stimulus

146
Q

what are tendencies of people who catastrophize in relation to pain

A

magnification of pain
rumination about their pain
feeling hopeless in managing their pain

147
Q

examples of catastrophizing: magnification

A

“I’m afraid the pain will get worse”

148
Q

examples of catastrophizing: rumination

A

“i cant stop thinking about how much this hurts”

149
Q

examples of catastrophizing: hopelessness

A

“there is nothing I can do to reduce the intensity of my pain”

150
Q

underlying etiology refers to the (pain)

A

source of the experienced pain
nociecpetive
inflammatory
neuropathic

151
Q

Two antatomical locations of pain

A

somatic
visceral

152
Q

temporal nature refers to

A

the duration of pain
acute <3 months
chronic > 3 months
acute on chronic

153
Q

intensity refers to the

A

degree of level of pain
(mild, moderate, severe)

154
Q

example of nociceptive pain

A

bone fractures, surgical incision, acute burn

155
Q

examples of inflammatory pain

A

appendicitis, RA, inflammatory bowel disease, late stage burn

156
Q

examples of neuropathic pain

A

diabetic peripheral neuropathy, post-herpetic neuralgia, chemotherapy-induced pain and radiculopathy

157
Q

difference between somatic and visceral pain

A
  • somatic - musculoskeletal pain (bone, joint, connective tissues and deep tissues)
  • visceral - internal pain from internal organs and tissues
158
Q

which pain is well localized, sharp and worse with movement

A

somatic pain

159
Q

which pain is described as poorly localized and vague deep aches, colicky, and/or cramping

A

visceral pain

160
Q

what is the mechanism of somatic pain

A

a-delta fiber activity located in peripheral tissues

161
Q

what is the mechanism of visceral pain

A

c fiber activity located in deeper tissues

162
Q

name the type of pain and treatment: femur fracture

A
  • nociceptive pain
  • opioids
  • nonopioids
163
Q

name the type of pain and treatment: late stage burn healing

A

inflammatory pain
anti-inflammatory agents

164
Q

name the type of pain and treatment: post-herpetic neuralgia

A

neuropathic pain
tricyclics, SNRTs, GABA analogs or antidepressants

165
Q

name the type of pain and treatment: superficial burn

A

somatic pain
topical/and or local anesthetics, opiates, and non-opiates

166
Q

pain history elements and questions

A

detailed hx of current pain, and for chronic pain - previous pain hx

167
Q

besides the basics of a pain assessment (OPQRST) what else should be assessed

A

functionality
* ADLs impaired
* does the patient work
* how does the patient cope

168
Q

OPQRST

A
  • onset
  • pallative or provacation
  • quality
  • region radiation
  • severity
  • timing
169
Q

pain assessment: physical findings

A

VS- elevated BP or HR
cues - positioning, crying, flushing, diaphoresis

170
Q

what should always be conducted with neuropathic pain

A

a sensory exam

171
Q

pedi tylenol dose

A

15mg/kg PO
PO Q4-6 Hr
max 90 mg/kg/day

172
Q

ketamine MOA

A

Block NMDA receptors, peripheral Na+ channels, and mu-opioid receptors providing sedation, amnesia, and analgesia

173
Q

when should pain level be reassesseed

A

after intervention
consider reassessing pain level 30 minutes after IV and 60 minutes after PO administration of a medication

174
Q

consequences of unrelieved acute pain

A

psychological impacts
chronic pain syndromes
mortality and morbidity

175
Q

Appropriate discharge planning should consider what interventions the patient has received during the visit and transportation home.

A

How will the patient safely arrive home? Consider patient transportation and driving precautions, especially after receiving a sedating medication
Are they ambulating at their baseline without assistance?
Could the treatment or medication still be exerting its effects (i.e. lethargy as a side effect of morphine)?

176
Q

What shows up on a UDS

A
  • codeine
  • amphetamines
  • opioids
  • benzos
  • cocaine
  • marijuana
    Synthetic fentanyl patches do NOT show up
177
Q

What is chronic pain syndrome?

A

Affects
* sleep
* mood
* activity
* energy

178
Q

In what leads should a p-wave be positive?

A

I, II, aVF, V4-V6

179
Q

What should the duration of a p-wave be?

A

< 0.12 seconds

180
Q

What should the duration of a PR interval be?

A

0.1 - 0.2 seconds

181
Q

What should the duration of a QRS complex be?

A

< 0.12 seconds

182
Q

Elevation/depression of an ST segment by __ mm is clinically relevant

A

1

183
Q

T-waves should be positive in which leads?

A

I, II, V3-V6

184
Q

What does Paroxysmal mean?

A

Intermittent

185
Q

Ventricular ectopy is usually indicative of what?

A

K⁺ imbalances

186
Q

What effects do halothane/enflurane have in regards to arrhythmias?

A

Halothane & enflurane sensitize the myocardium

187
Q

What arrhythmia in infants can result from sevoflurane?

A

Bradycardia (via oculo-cardiac reflex?)

188
Q

What can desflurane cause during induction?

A

Prolonged QT

189
Q

What two adverse events can occur from local anesthetic injection into the vasculature?

A
  • Severe bradycardia
  • systole
190
Q

How would excessive intravascular lidocaine be treated?

A

Lipid rescue

191
Q

What is the exhaustive list of conditions that can result in perioperative dysrhythmias?

(this card sucks)

A
  • General anesthetics
  • Local anesthetics
  • Abnormal ABG or electrolytes
  • Endotracheal intubation
  • Autonomic reflexes
  • CVP cannulation
  • Surgical stimulation of heart/lungs
  • Location of surgery
  • Hypoxemia
  • Cardiac Ischemia
  • Catecholamine excess
192
Q

What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?

A

Pulmonary arteries

193
Q

What example was given of a surgical location where stimulation results in dysrhythmias?

A
  • Eyes (due to oculo-cardiac reflexes)
  • Heart/lungs
194
Q

Where does lead V1 go? V2?

A
  • V1 - 4th ICS, right of sternum
  • V2 - 4th ICS, left of sternum
195
Q

Where does lead V3 go?
V4?

A
  • V3 - between V2 and V4
  • V4 - 5th ICS, left of sternum, midclavicular
196
Q

Where does lead V5 go?
V6?

A
  • V5 - 5th ICS, left of sternum
  • V6 - 5th ICS, left of sternum, mid axillary
197
Q

What wave is the first negative deflection after the p-wave on any lead?

A

Q-wave

198
Q

What wave is the first positive deflection after a p-wave?

A

R-wave

199
Q

Describe an s-wave.

A

Negative deflection below baseline after an R or Q wave.

200
Q

1 small box on an EKG strip equals _____.

A

1mm or 0.04s

201
Q

1 large box on an EKG strip equals ______.

A

5mm or 0.2s

202
Q

If healthy, both the QRS complex and T-wave should be ______ in leads I, II, & III.

A

positive.

203
Q

What is the mean electrical axis of the heart?

A

59°

204
Q

A clockwise shift of the mean electrical axis shift of the heart is indicative of what?

A

Right-axis deviation

205
Q

A counter-clockwise shift of the mean electrical axis shift of the heart is indicative of what?

A

Left-axis deviation

206
Q

Regarding Lead I, where is the negative terminal connected? How about the positive terminal?

A

Negative terminal = Right arm
Positive terminal = Left arm

207
Q

Regarding Lead II, where is the negative terminal connected? How about he positive terminal?

A

Negative terminal = Right arm
Positive terminal = Left leg

208
Q

Regarding Lead III, where is the negative terminal connected? How about the positive terminal?

A

Negative terminal = Left arm
Positive terminal = Left leg

209
Q

Which lead can be used as the determinant of posterior vs anterior injury?

A

V2

210
Q

In which precordial lead does the QRS complex have the most magnitude?

A

V4

211
Q

What mV is denoted by a small box on an EKG strip?

A

0.1mV

212
Q

What mV is denoted by a large box on an EKG strip?

A

0.5mV

213
Q

What angle is viewed utilizing aVF?

A

90°

214
Q

What angle is viewed utilizing aVL?

A

-30°

215
Q

What angle is viewed utilizing aVR?
How does this compare to lead II?

A
  • -150°
  • aVR is essentially opposite lead II. (not exactly though, Lead II’s negative terminal is -120°)
216
Q

What are the positive & negative terminals for lead aVR?

A

Negative = left arm + left leg (+30°)
Positive = right arm (-150°)

217
Q

What are the positive & negative terminals for lead aVF?

A

Negative = left arm + right arm
Positive = left leg

218
Q

What are the positive & negative terminals for lead aVL?

A

Negative = left leg + right arm
Positive = left arm

219
Q

What cardiac EKG lead is the least useful in practice but most unique in its position? (this one has a lot of test questions about it)

A

aVR

220
Q

What is the axis of Lead I?

A

0°

221
Q

What is the axis of Lead III?

A

120°

222
Q

What degree change would characterize an extreme axis deviation?

A

-90° to 180°

223
Q

A positive current of injury noted on V2 would be indicative of what?

A

Posterior MI

224
Q

A negative current of injury noted on V2 would be indicative of what?

A

Anterior MI

225
Q

What axis would be expected with a negative QS deflection in leads I and II and a positive R deflection in Lead III?

A

Right Axis deviation

226
Q

What axis would be expected with a negative QS deflection in leads II and III and a positive R deflection in Lead I?

A

Left Axis Deviation

227
Q

A positive V1 QRS with negative QRS in leads I, II, and III would the resulting axis be?

A

Extreme Right Axis (ERAD)

228
Q

What block would you expect to present with a right axis deviation?

A

Posterior Hemiblock

229
Q

What block would you expect to present with a left axis deviation?

A

Anterior Hemiblock

230
Q

What is an MCL1 lead?
How is it placed?

A
  • Modified V1 lead
  • Negative on left arm, positive in 4th ICS right of sternum.
231
Q

What would leads I, III, and III look like with normal axis?

A

All + QRS

232
Q

Differentiate physiologic left axis and pathologic left axis deviation.

A
  • Physiologic = (+ Lead I, + or isoelectric Lead II, -lead III; 0 to -40
  • Pathologic = (+ Lead I) & (- Lead II & III); -40 to -90
233
Q

What is the most common cause of right ventricular hypertrophy?

A

Lung disease, pulmonary embolus, and pulmonary valve disease.

234
Q

In what situations would you find physiologic left axis deviation?

A

Obesity & athleticism

235
Q

Bundle Branch Block diagnosis is dependent on ______.
Hemiblock diagnosis is based on _______________.

A
  • time
  • axis deviation
236
Q

What pertinent anatomical features of the heart are fed via the RCA?

A
  • Inferior & posterior wall
  • Right ventricle
  • SA & AV node
  • Posterior fascicle of LBB
237
Q

What pertinent anatomical features of the heart are fed via the LAD?

A
  • Anterior wall of LV
  • Septal wall
  • Bundle of His & BB
238
Q

What severe outcome should you worry about with septal infarct?

A

Septal rupture

239
Q

What pertinent anatomical features of the heart are fed via the circumflex artery?

A
  • Lateral wall of LV
  • *SA & AV nodes (?)
  • Posterior wall of LV
    should be RCA, no?
240
Q

Why is morphine now avoided in MI’s?

A

Morphine causes histamine release

241
Q

What percentage occlusion would be assumed with chest pain on exertion?

A

70 - 85% occlusion

242
Q

What percentage occlusion would be assumed with chest pain at rest?

A

90% occlusion

243
Q

What percentage occlusion would be assumed with chest pain unrelieved by nitroglycerin?

A

100% occlusion

244
Q

What should be administered before nitroglycerin with an acute right-sided MI?

A

fluid bolus

245
Q

Are EKGs better in regards to sensitivity or specificity?

A

Specificity (If MI is shown on EKG then its likely an MI) but sensitivity is 50% for EKGs so a negative EKG result doesn’t rule out MI.

246
Q

What sign would indicate ischemia?

A

Symmetrical inverted T-waves in two or more related leads.

247
Q

What sign would indicate an injury pattern?

A
  • ST segment elevation of more than 1mm in two or more related leads
  • Reciprocal changes in related leads
248
Q

What sign would indicate infarction?

A

Pathologic Q waves ( >40ms wide or ⅓ the depth of r-wave height) coupled with ST elevation.

249
Q

Which leads indicate a true lateral MI?
Which would indicate a high lateral?

A
  • True lateral = V5 & V6
  • High lateral = I, aVL
250
Q

What is the most commonly seen MI?
What is commonly seen with this type of MI?
Do you use nitrates?

A
  • Inferior
  • Bradycardia, hypotension, 1st degree or Mobitz 1 blocks, and nausea.
  • Caution with nitrates due to RV’s being preload dependent w/ inferior MI’s
251
Q

What is the most lethal MI?
What dysrhythmias are commonly seen with this type of MI?
Do you use nitrates?

A
  • Anterior Wall (LAD)
  • CHB and VF/Vtach
  • Yes to nitrates.
252
Q

What would cause one to prepare defibrillation pads for a patient undergoing an anterior MI? (other than vfib/vtach)

A

Presence of BBB or hemiblock whilst undergoing an anterior MI

253
Q

What condition presents with ST elevation on all leads?
How is it diagnosed?

A
  • Pericarditis
  • Patient feels better when they lean forward and there won’t be reciprocal ST depression.
  • Diagnosed via fever, WBCs, hx of IVDU, etc.
254
Q

What condition looks like myocardial infarction on an EKG but can be fatal if thrombolytics are administered?

A

Dissecting thoracic aorta aneurysm.

255
Q

What four conditions mimic myocardial infarction in their EKG presentation?

A
  • LBBB
  • LV hypertrophy
  • Pericarditis
  • Thoracic aortic dissection
256
Q

Inferior MI Leads

A
  • II, III, aVF
  • Recipricated: I, aVL
257
Q

Septal MI Leads

A
  • V1, V2
  • no recipricals
258
Q

Anterior MI Leads

A
  • V3, V4
  • Recpricated: II, III, aVF
259
Q

Lateral MI leads

A
  • V5, V6, I, aVL
  • II, III, aVF
260
Q

Posterior (RCA) MI Leads

A

Right EKG:
* V8, V9, R>S in V1
* V1-4

261
Q

RV MI Leads (RCA)

A
  • V4R
  • Recpricated: NONE
262
Q

ISAL

A
  • Inferior- II, III, aVF
  • Septal- V1, V2
  • Anterior- V3, V4
  • Lateral- V5, V6, I, aVL
263
Q

LV Hypertrophy is most commonly cause by

A
  • hypertension
    less common:
  • hypertrophic cardiomyopathy
  • extreme exercise
  • aortic disease
264
Q

Hyperkalemia EKG changes

A
  • P-waves are widened, low amplitude
  • QRS widening/ fusion with T
  • loss of ST
  • Tall tented T
265
Q

Hypokalemia EKG changes

A
  • ST depression/ T flattening
  • Negative T
  • possible U-wave
266
Q

Hypercalcemia EKG changes

A

Mild
* tall peaking T-waves
Severe
* Extremely wide QRS, Low R
* disappearnce of P waves
* tall peaking T-waves

267
Q

Hypocalcemia EKG changes

A
  • Narrowing QRS
  • reduced PR-interval
  • T wave flat or inverted
  • Prolongation of QT-interval
  • Prominent U-wave
  • Prolong and depressed ST-segment
268
Q

What is the Osborne “J” wave and what is it associated with?

A
  • Positive deflection seen at the J-point in precordial and true limb leads
  • Recipricol, negative deflection in aVR and V1
  • Hypothermia and possible in hypercalcemia
269
Q

What is a Delta wave and what is it associated with?

A
  • slurred upstroke in the QRS, relates to pre-excitation of the ventricles, shortens PR-interval
  • Wolff Parkinson White
270
Q

What HR would be considered bradyarrhythmia?

A

Less than 50 bpm

271
Q

What is the leading cause of bradycardia?

What are other causes of bradycardia?

A

Hypoxia

MI/infarction
Drugs/toxicities (CCB, BB, Dig)
Hyperkalemia

272
Q

What can persistent bradyarrhythmia cause?

A
  • Hypotension
  • Acutely altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute HF
273
Q

What do you do if someone is bradycardic but clinically stable?

A

Monitor and observe

274
Q

What is the treatment for bradycardia?

A

1 mg Atropine every 3 to 5 minutes.
Max: 3 mg

275
Q

What to do if atropine is ineffective for bradycardia?

A

Transcutaneous pacing and/or dopamine infusion or epinephrine infusion.

Dopamine infusion: 5-20 mcg/kg/min TTE
Epinephrine infusion: 2-10 mcg/min TTE

276
Q

Why do you have to be cautious about when giving atropine for adult bradycardia?

A

A very low dose (0.1 mg) can actually worsen bradycardia. Make sure you give 1 mg.

277
Q

How do you treat bradycardia secondary to calcium channel blockers?

A

Give Calcium

278
Q

How do you treat bradycardia secondary to beta blockers?

A

Glucagon and give something for rate support while the glucagon kicks in

279
Q

How do you treat bradycardia secondary to digoxin?

A

Digibind or Digifab

280
Q

What is the rate for CPR?

A

100-120 compressions/min

281
Q

Features of quality CPR?

A

Push hard (2 in) and fast (100-120/min)
Minimize interruptions in compressions
Avoid Excess ventilation
Change Compressors every 2 minutes or fatigued
30:2 compression: ventilation ratio if no airway
ETCO2 > 35-45 mmHg (normal)

282
Q

ETCO2 of what level indicates perfusion.

A

15 mmHg

283
Q

Shock Energy for Defibrillation
Biphasic:
Monophasic:

Shockable rhythms:
Non-shockable rhythms:

A

Biphasic: Manufacturer recommendation (120 to 200J)
Monophasic: 360J

Shockable rhythms: V-fib/ pulseless V-tach
Non-shockable rhythms: PEA/Asystole

284
Q

Drug Therapy for Cardiac Arrest

A

Epinephrine IV/IO: 1mg every 3 to 5 minutes

Amiodarone IV/IO: first dose 300mg bolus, second dose 150mg

Lidocaine IV/IO: First dose 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

285
Q

Should you stop CPR to place an advanced airway?

A

No, oftentimes a supraglottic airway (LMA) will be placed during the code. Once the patient is stabilized, they will be intubated.

286
Q

What is used to confirm and monitor ET tube placement?

A

Waveform capnography or capnometry

287
Q

With an advanced airway, one breath will be delivered every ______ seconds.

A

6 seconds/ 1 breath

288
Q

What are indications of Return of Spontaneous Circulation (ROSC).

A

Palpable Pulse
Blood Pressure, spontaneous atrial pressure wave
Abrupt sustained increase in ETCO2 (15 mmHg to 40 or 50 mmHg)

289
Q

What are your reversible causes of cardiac arrest (H’s and T’s )

A

Hypovolemia - give blood, fluids
Hypoxia - oxygen and airway
Hydrogen Ion (acidosis)- bicarb and ventilation
Hypo/Hyperkalemia
Hypothermia- cold hearts are irritable

Tension Pneumothorax - can result in PEA, decompress chest
Tamponade, Cardiac- Pericardiocentesis
Toxins- use antidotes
Thrombosis (PE) -cannulation/ECMO/thrombectomy
Thrombosis (Coronary)-cannulation/ECMO/thrombectomy

290
Q

How often do you defibrillate a shockable rhythm?

A

2 min.

291
Q

What HR is considered tachyarrhythmia?

A

HR greater than 150 bpm

292
Q

What can persistent tachyarrhythmias cause?

A

Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF

293
Q

Treatment for unstable tachycardia:

A

Synchronized Cardioversion
-consider sedation

294
Q

Difference between wide and narrow complexes in tachycardia.

A

Narrow complexes are supraventricular (consider adenosine)

Wide complexes are ventricular (consider ventricular antiarrhythmics )

295
Q

What is the dose for adenosine for SVT?

A

First dose: 6 mg rapid IV push; follow with NS flush
Second dose: 12 mg

296
Q

IV Amiodarone dosing for stable wide complex tachycardia.

A

Amiodarone: First dose 150 mg over 10 minutes followed up by 1 mg/min infusion for first 6 hours, 0.5 mg/min for the next 18 hours.

297
Q

What is the IV dosing for Procainamide for stable wide tachycardia?

A

20 to 50 mg/min until arrhythmia suppression,
Hypotension ensues, QRS duration >50%, or max dose of 17 mg/kg.

Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.

298
Q

What is the IV dosing for Sotalol for stable wide tachycardia?

A

100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.

299
Q

Treatment for patients with stable narrow tachycardia.

A

Vagal maneuvers
Adenosine
Beta-blockers (esmolol)
Calcium channel blockers
Carotid sinus massage (young person)
Expert consultation

300
Q

What is the first thing to do after ROSC has been obtained?

A

Manage the airway, with the early placement of an endotracheal tube.

Manage respiration: 10 breaths/min, SpO2 >92%, PaCO2: 35-45 mmHg

Manage hemodynamic parameters: > 90/65, MAP>65

Obtain 12 Lead

301
Q

When to consider emergency cardiac intervention post ROSC?

A

STEMI present
Unstable cardiogenic shock
Mechanical circulatory support required (ECMO, balloon pump)

302
Q

Interventions if the patient is unable to follow commands post ROSC?

A

Targeted temperature management
Head CT
EEG monitoring

303
Q

What is the antidote for Magnesium overdose?

A

Calcium chloride or gluconate

This can happen in a pregnant patient receiving Magnesium for PIH

304
Q

Why do you want IV access to the upper extremities for pregnant patients undergoing cardiac arrest?

A

The patient has uteroplacental displacement. Medication to IVs on the lower extremity might not reach the heart.

305
Q

If no ROSC within _________ minutes, consider immediate perimortem c-section.

A

5 minutes

306
Q

What are the potential etiology of maternal cardiac arrest?

A

Anesthetic complication - spinal
Bleeding - C-section, maternal hemorrhage-DIC
Cardiovascular - underlying issue
Drugs - meth
Embolic -amniotic fluid embolism
Fever
General (H’s and T’s)
Hypertension - Mag overdose for PIH

307
Q

What meds do you give to treat amniotic fluid embolism?

A

Atropine
Ondansetron
Ketolorac (Tordal)

AOK

308
Q

What are the biggest causes of asystole and PEA in pediatrics?

A
  1. Hypoxia
  2. Hypotension
309
Q

How far do you compress during CPR for pediatrics?

A

one-third of the anteroposterior diameter of the chest.

310
Q

Drug therapy during pediatric cardiac arrest.

A

Epinephrine: 0.01 mg/kg every 3 minutes up to a max of 1 mg.

Amiodarone: 5mg/kg bolus up to 3 doses for v-fib/pVT

Lidocaine: 1mg/kg loading dose

311
Q

For pediatric patients when do you start CPR?

A

Start CPR if the patient is symptomatic and HR is less than 60 bpm despite oxygenation and ventilation

312
Q

Meds for pediatric bradycardia.

A

Start with Epinephrine 0.01 mg/kg every 3-5 mins

Atropine 0.02 mg/kg, repeat once.
Minimal Atropine dose 0.1 mg
Max atropine Single dose 0.5 mg

313
Q

Other interventions for pediatric bradycardia?

A

Transthoracic/ Transvenous pacing
ID causes (hypothermia, hypoxia, meds)

314
Q

What is the most common cause of pediatric tachycardia?

A

Pre-existing cardiac disease rather than ischemic events.

315
Q

What HR is considered tachyarrhythmia for a child and infant?

A

Child >180 bpm
Infant >220 bpm

316
Q

What is the intervention for an unstable tachycardiac pediatric patient?

A

Synchronized Cardioversion
Begin with 0.5 - 1.0 J/kg; if not effective increase to 2 J/kg.
Sedate if needed, but don’t delay cardioversion

317
Q

What is the medication of choice for pediatric SVT?

A

Adenosine
First dose 0.1 mg/kg rapid bolus (max of 6 mg)
Second dose 0.2 mg/kg rapid bolus (max of 12 mg)

318
Q

When do you give adenosine for ventricular tachycardia?

A

If the rhythm is regular and monomorphic

319
Q

What are ways to treat stable SVT in children?

A

Vagal maneuvers (blow up a ballon)

320
Q

What is the scoring system for neonates?

A

APGAR score (0-2 points per category)
Score greater than 7, baby is in good health.

Activity
Pulse
Grimace
Appearance
Respiration

321
Q

What to do with neonates if they are not a term gestation, do not provide good tone, and not breathing/crying immediately after birth?

A

Within the first minute:
Warm and maintain a normal temperature
Position Airway
Clear Secretion
Dry
Stimulate

322
Q

What happens if the neonate is showing apnea or gasping after initial intervention?

A

Positive Pressure Ventilation
SpO2 monitor
EKG monitor

323
Q

What happens if the neonate is labored breathing or presents persistent cyanosis after initial intervention?

A

Position and clear airway
SpO2 monitor
Supplementary O2 as needed
Consider CPAP

324
Q

What happens if the neonate is bradycardic (<100 bpm) after initial intervention?

A

Check chest movements
Check for adequate ventilation
ETT or laryngeal mask (know where pediatric equipment is located)

325
Q

What happens if neonate’s HR drops below 60 bpm?

Medications?

A

Intubate if not already done
CPR
Coordinate with PPV
100% O2
EKG Monitor
Consider emergency UVC (In reality, just cannulated the umbilical vein like an IV externally)

IV epinephrine (0.01 mg/kg) every 3-5 minutes

326
Q

Considerations for neonate bradycardia after epinephrine and other interventions?

A

Consider hypovolemia
Consider pneumothorax
Check blood sugar (hypoglycemia)
Narcan

327
Q

What treatment is most important to convert v-fib?

A

Defibrillation

328
Q

What is the initial dose of lidocaine to treat v-fib?

A

1 to 1.5 mg/kg

329
Q

Most common cause of anaphylaxis in abx

A

PCN and Cephalosporins

330
Q

Cefazolin dose

A

Most commonly administered abx for sx
Administered over 30 min.
* 2g (3g if >120)
* 30 mg/kg in peds

331
Q

Clindamycin Dose

A

Over 30-60 min
gram - & gram + or MRSA infection
* 900 mg
* 10 mg/kg in peds

332
Q

Vancomycin dose

A

Infuse 15 mg/ min
gram + or MRSA infection
* 15 mg/kg in adults/ peds

333
Q

Ketamine Dosing

A
  • Procedural: 0.5-1.0 mg/ kg; 4-5 mg/kg IM
    -1-2 mg/ kg (peds)
  • Sub-dissociative analgesia 0.1-0.3 mg/ kg; 0.5-1.0 mg/ kg IM or inh
  • Excited Delirium Syndrom: 1 mg/kg; IM 4-5 mg/ kg
334
Q

Sensory dermatome S2-S4

A

perineum

335
Q

Sensory dermatome S1

A

lateral foot

336
Q

Sensory dermatome L3-L4

A

knee and distal thigh

337
Q

Sensory dermatome T12

A

inguinal ligament

338
Q

Sensory dermatome T10

A

umbilicus

339
Q

Sensory dermatome T4

A

Nipple

340
Q

Sensory dermatome T1-T2

A

inner aspect of forearm

341
Q

Sensory dermatome T6

A

Tip of xyphoid process

342
Q

Sensory dermatome C6-7

A

thumb and index finger

343
Q

Sensory dermatome C5-C4

A

shoulder clavicle

344
Q

bracioradialis tendon action

A

elbow flexion and/or forearm pronation

345
Q

triceps tendon action

A

elbow extension or contraction of the triceps muscle

346
Q

patellar tendon action

A

knee extension

347
Q

Tibialis posterior tendon action

A

plantar flexion/inversion of the foot

348
Q

achiles tendon action

A

plantar flexion of the foot

349
Q

Be cautious with Toradol because

A

risk for bleeding
alters platelet function

350
Q

Side effect of high dose Ketamine and how do you solve it

A
  • increased secretions
  • glyocopyrrolate or benadryl

Adv Physical and Health Assessment (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions