Dale's Review Concepts III Flashcards
(165 cards)
1
Q
At what altitude do ppl start getting altitude sickness? What onset?
A
About 6500 ft, 6-10hr onset
2
Q
What factors determine severity of altitude sickness
A
Rate & height of ascent
Prior Hx AMS & obesity
3
Q
What height can ppl get acute mountain sickness (AMS)
A
< 6600ft
4
Q
Pt has throbbing headache on side/back during a mountain ascent. They feel NVD, weak, and are breathing fast. What’s wrong?
What Rx?
A
Acute mountain sickness
Rx = acetazolamide (promotes metabolic acidosis) & descent
5
Q
During an ascent, pt has SOB at rest, cough, tight chest, congestion, cyanosis w/ adventitious lung sounds. What’s wrong?
What Rx?
A
HAPE (high altitude pulmonary edema)
Rx = Pulmonary vasodilator (ex. Albuterol) , CPAP, & descent
6
Q
During an ascent, pt has a change in mental status and has become confused. What’s wrong?
What Rx?
A
HACE (high altitude cerebral edema)
Rx = dexamethasone (8mg then 4mg/6hr)
7
Q
During a dive, pt begins feeling drunk w/ AMS. What’s wrong?
What Rx?
A
Nitrogen narcosis (rapture of the deep) = AMS DT breathing compressed nitro
Rx = ascend & use better air mix next time
8
Q
Why do pts feel drunk in nitrogen narcosis?
A
Nitrogen binds to the same brain receptors as ETOH
9
Q
What gas law pertains to the pathophysiology of nitrogen narcosis?
A
Dalton’s law. Divers need to calculate what % of nitro vs O2 mix depending on depth of dive
10
Q
What is barotrauma?
A
Gas pressure in body vs outside = compression or expansion injury
11
Q
What parts of the body are very susceptible to barotrauma?
A
Sinuses, GI, lungs, stomach, skin, joints, ear
12
Q
During ascent from a dive, pt experiences severe CP, sub Q emphysema, dysphagia, crackles in lungs w/ hemoptysis. What’s wrong?
What Rx?
A
Pulmonary Overpressurization syndrome (POPS) = most severe form barotrauma.
Rx = avoid PEEP. Be careful bagging. Give O2 & transport.
13
Q
What are the complications of POPS
A
POPS result = alveolar rupture = possible pneumo, embolism, arterial gas embolism
14
Q
Explain Arterial Gas Embolisms
A
Air bubbles from capillaries = MI or CVA
CVA = most common DT head being highest point in body
15
Q
Any diver that has LOC or AMS following a dive, you must assume … what?
What Rx?
A
Arterial Gas Embolism (AGE)
Rx = L lateral poc, monitor, hyperbaric chamber
16
Q
Following a dive, pt complains severe abdominal and joint pain, w/ mottled skin. What’s wrong?
What Rx?
A
Decompression sickness (the bends aka cassions disease)
Rx = hyperbaric chamber
17
Q
How does decompression sickness affect the body? What gas law is it connected to?
A
Nitrogen bubbles out of your blood during an ascent (Henry’s law) and fucks w/ perfusion as well as the body.
18
Q
What kind of people are at risk for experiencing decompression sickness (the bends)
A
Obese, dehydrated, flying after a dive
19
Q
What are the 2 main families of snakes in the US?
A
- Crotalinae (pit vipers)
2. Elapidae (coral snakes)
20
Q
What are the different types of pit vipers (crotalinae)?
A
Rattle, cottonmouth, diamondback
21
Q
How can you differentiate a venomous coral snake from a harmless king snake?
A
“Red on yellow, kill a fellow” “red on black, venom lack”
22
Q
Pt was bit by a snake, now has swelling, necrosis of wound, systemic bleeding, and coagulopathy. What kind of snake was it?
A
Pit viper (crotalinae)
23
Q
Pt was bit by a snake, now has neuro seizures, paralysis, slurred speech, double vision, NV weakness. What kind of snake was it?
A
Coral snake
24
Q
What general Rx for a snake bite?
A
IV, monitor, antivenin, clean & immobilize wound below heart level (minimize movement)
25
Pt was bit by a snake, now has pain, muscle spasms and seizures, paralysis w/ board like abdomen. What spider bit them?
What Rx?
Black widow = neuro SS
Rx = calcium gluconate w/ a benzo
26
Pt has bit by something less than 2 days ago. Now has scabbing and necrosis of wound site. What bit them?
What Rx?
Brown recluse spider
Rx = supportive Rx & transport. Definitive Rx = surgical debridement
27
Pt has hx being outside in hot, humid weather. Now has muscle spasms in legs & abdomen. What’s wrong? What Rx?
Heat cramps
Rx = restore salt and fluids (crackers & Gatorade)
28
Following several hours outside in hot, humid weather, pt CC syncope. What’s wrong?
What Rx?
Heat syncope (vessels dilate & BP drops DT heat stress)
Rx = supine position & fluids
29
Pt has Hx being outside in hot/humid weather now complains weak, NVD, positive orthostatic, mildly elevated temp, sweat skin. What’s wrong?
What Rx?
Heat exhaustion
Rx = supine, fluids, passive cooling.
30
What’s EAH? What Rx?
Exercise-associated hyponatremia = heat exhaustion where pt sweats & restores fluids but not sodium.
Rx = hypertonic w/ passive cooling
31
After a sporting event outside in hot humid weather, pt complains SOB, NVD, weakness w/ pulm edema. What happened?
Exercised - associated hyponatremia (EAH). Pt over compensated w/ drinking excessive water = fluid overload = pulmonary edema
32
What’s the difference between a classic vs exertional heatstroke?
Classic = passively overheat (dry red hot skin)
Exertional = actively overheat = pale sweaty skin
33
Following a hot day, pt has hot skin, AMS, CBT > 104F, bounding pulse. What’s wrong?
What Rx?
Heat stroke
Rx = rapid cooling, target 102F or lower temp, fluids, BGL, prep for seizures/rhabdomyolysis
34
Heat stroke can mimic what other emergencies?
Sepsis, fever, infection, anticholinergic OD
35
How to differentiate anticholinergic OD vs heat stroke
Anticholinergic OD = dilated pupils
Heat stroke pupils = pinpoint
36
What is neuroleptic malignant syndrome?
Antipsychotic & antiemetic meds cause heat stroke
37
What is malignant hyperthermia?
Anesthesia meds (Succ) causes heat stroke
38
What is somatic/parietal pain?
Localized & intense pain
*think: somatic = soDRAmatic
39
What is visceral pain?
Poorly localized, diffused
*think: visceral = viscerALL-over pain
40
You suspect pt has ICP. What SS to look for?
Cushings reflex: Bradycardia, HTN, Cheyenne stokes respirations
41
Pts w/ head injury becomes hypoxic DT lack of…
Lack of minute volume
42
Trauma pt shows Cushings reflex, Cheyenne-stokes, vomit w/ no nausea. What severity of ICP do they have?
Mild
43
Trauma pt shows biot respirations, blown pupils, flaccid paralysis… what severity of ICP do they have
Severe
44
Trauma pt has Cushings reflex, Central neurogenic hyperventilation, decerebrate posturing… what severity of ICP do they have?
Moderate
45
Pt has too much cortisol in their system DT a tumor or gland issue. What endocrine disease do they have?
Cushings disease
46
Pt complains weakness, depression, irritable mood, polydipsia polyuria, high BGL, weight gain, moon face/Buffalo hump, stretch marks. What’s wrong?
Cushings disease
47
Pediatric pt is in sniffing position, CC SOB: stridor, drooling, high work of breathing. Pt has previous Hx upper Resp infection. What’s wrong?
What Rx?
Epiglottitis
Rx = humidified O2, keep them calm, nothing in mouth, ask about Hib vaccine
48
Your epiglottis pt is rapidly decompensating and you anticipate intubation. How would you prepare?
Drop 1-2 sizes BELOW recommended size
49
What age kids typically get epiglottitis?
2-7Yrs
50
What’s the fancy medical name for croup
Laryngotracheobronchitis
51
Pt has stridor, seal bark cough, cold SS, low grade fever, work of breathing (worse at night). What’s wrong?
What Rx?
Croup (laryngotracheobronchitis)
Rx = expose to extreme air, no humidified O2, racemic epi, steroids, prepare BVM & ETT
52
During labor, mom suddenly feels a sharp tearing pain in her pubic area. You are now able to see an outline of the fetus through mom’s belly. What happened?
What Rx?
Ruptured Uterus
Rx = treat for shock and transport
53
Female pt complains severe pn during & after period, fetal position, shuffle gait, smelly discharge. What’s wrong?
What Rx
PID
Rx = transport
54
What is PID and who gets it usually?
Infection of women’s reproductive organs. Mostly sexually active girls <25 yrs
55
What are the risk factors for PID?
STDs, IUD, douching, abortion, multiple sex partners
56
What are the complications of PID?
MODS, sepsis, abscesses, infertility, ectopic pregnancy
57
Pt is anxious w/ NV thirst, SOB, weak rapid pulse, cool clammy skin. Compensated or decompensated shock?
Compensated. Pt will be altered not anxious.
58
How are skin signs different between compensated vs decompensated shock?
Compensated = cool clammy
Decompensated = ashen/mottled, cyanotic
59
Pt has no urine production, dilated pupils, thready pulse, hypotension. Compensated vs decompensated shock?
Decompensated shock
60
Pericardial tamponade, aortic dissection, PE, tension pneumo… all are what singular type of shock are they in?
Obstructive shock
61
What are the three types of distributive shock?
Anaphylaxis, neurogenic, septic
62
Distributive shock = ____ failure
Pipe failure
63
What is the medical word for a bladder infection
Cystitis
64
How do people usually get cystitis?
Bacteria from taint travel up urethra
65
Untreated cystitis can eventually spread upwards to the kidneys. What is this called?
Pyelonephritis
66
What is pyelonephritis and why is it serious?
A kidney infection secondary to an untreated bladder infection. Pt risks losing their kidney
67
Pt complains cloudy, painful urine. Pt has hematuria & polyuria, w/ Hx fever. What’s wrong?
Cystitis
68
What defines a 1st degree heart block?
No dropped QRS complexes, but prolonged PRI (normal = 0.12-0.20s)
69
Second degree type I vs Type II heart blocks?
Type I (wenchbach) = progressively longer PRI then dropped QRS
Type II = consistent PRI then dropped beat
70
2nd degree heart blocks are commonly caused by what location of MI?
Anterior/anteroseptal wall MI because it supplies the AV node
71
Geriatric pt has CC: dizziness, syncope, palpitations, w/ ECG that alternates between Bradycardia & tachycardia. What’s wrong?
What Rx?
Sick sinus syndrome
Rx = pacemaker
72
How can you tell if someone has a 3rd degree heart block?
QRS complexes are regular, P waves are also regular but neither of them sync up
73
What is Prinzmetals angina? What is another name for it?
AKA vasospastic angina = angina/CP DT coronary arteries spasming
74
How can you assess for L side hypertrophy on a 12-lead?
V1 or V2 (biggest S depth) + V5 or V6 (biggest R height) = >7 boxes
75
How can you assess for R side strain on a 12-lead ECG?
S1QT3
Also, V1 = R wave > S wave
76
How does ICP present on a 12-lead?
ICP = cerebral T waves = deep inverted symmetrical T waves on V-leads & prolonged QT interval
77
What do alpha 1 receptors do?
Vasoconstriction of arteries & veins
78
What do alpha 2 receptors do?
Less insulin/norepi
More glucagon
79
What do Beta 1 receptors do?
More Heart stuff (ino/chromo/dromotropic)
Renin
80
What do beta 2 receptors do?
Bronchiole relaxation/dilation
More insulin
Uterine relax
Arterial dilation of some organs
81
What’s Brugatta syndrome
Rare genetic heart disease w/ sodium channel issue = syncope or Cardiac arrest occurs in their 40-50s
82
You suspect your geriatric syncope pt to have brugatta syndrome. How to assess?
Incomplete RBBB (rSR pattern in V1, QRS
83
What’s babinski’s sign?
Fanning toes when heel is stroked w/ pen = upper motor neuron damage
84
What’s brudinski’s sign?
flex the neck = knees flex up
Sign of meningitis
*think: Brudinski sounds Russian. Russians do sit ups
85
What’s kernig’s sign
Cant straighten & pull leg up = meningitis
*think: kernig… Kermit the frog is a puppet, cant lift His leg up
86
What’s eyelash sign
No movement when stoke eyelash = no gag reflex
87
What’s joffroy’s sign
No forehead wrinkles when eye brows raise DT fluid buildup under forehead = Graves’ disease
88
Cullens vs grey turners sign
Grey turners = flank bruising = kidney injury
Cullens = belly button bruising = ab internal bleeding
*think: grey TURN to your SIDE
89
What’s Rovsing’s sign
Pn on RLQ when pushing on LLQ = appendicitis
90
What’s hamman’s sign
Crunching sound in heart when auscultation = pneumopericardium or mediastinum
91
What’s kussmaul’s sign
Bilateral or paradoxical increase in JVD during inhalation = COPD
92
What’s Levine’s sign
Levine’s sign = clutch chest = MI
93
What’s trousseaus sign
When BP on arm squeezes, wrists spasm DT hypocalcemia
94
What’s exophthalmos
Bulging eyeballs = Graves’ disease
95
What’s kehrs sign
Pn in L shoulder (& ab pn) = ruptured spleen
96
What’s another term for false labor contractions
Braxton hicks contractions
97
What’s Lloyds sign?
Pn when tap over kidneys = possible kidney stone or pyelonephritis
98
What’s McMurray’s sign
Rotate ankle internally & hear clicking sound in knee = meniscus tear
*think Murray .. MurrANKLE
99
What’s the Romberg’s test
When you stand up & close your eyes = lose balance = neuro proprioception deficit
*Think Romberg. Ron burgandy cant keep his balance
100
What’s Homan’s sign
If possible DVT, Dorisflex foot = calf hurts where Thrombus is
101
Which endocrine disease has the moon face and the buffalo hump? Why is that?
Cushings. Excess stress hormone = excess fat storage in back hump and face
102
What’s Bell’s palsy
Lesion on cranial nerve VII (facial) = face droop
103
Pt has brown/dark red lines going up their finger nails. What condition do they have? What is this called?
Splinter hemorrhage = endocarditis
104
Pt has clubbed finger nails. What does this tell you?
COPD (chronic hypoxia)
105
If a pt has white finger nails, what does this mean?
Anemia
106
Pt has a thick black/purple vertical streak up their finger nail. What’s wrong?
Nail bed cancer
107
What skin disease/condition is associated with aids?
Kaposi sarcoma
108
What’s Dahls sign?
discolored/thick skin at elbow & knees DT chronic tripod position from COPD.
*think: strippers get on their knees for DAHLERS $
109
What’s Thompson’s sign
Grab the calf & squeeze = foot will move. No foot movement = Achilles’ tendon rupture
110
Pt has an “atrogenic” injury. What does this mean?
It was caused by the doctor/hospital
111
What’s the principle source of hydration in the body?
Food
112
What does the cation Calcium do?
Stabilizes cell membrane for impulses & muscle contractions
113
Oropharynx + Nasopharynx = ?
Laryngopharynx
114
What’s spasmatic croup
Quick onset croup that dissipates <2 hours w/ no fever
115
You can’t tell if your pt has anaphylaxis vs asthma. Would benedryl help or hurt the pt?
Benedryl exacerbates asthma by drying out membranes & increasing overall mucous
116
Classic signs of shaking baby syndrome
Detached retina & brain trauma
117
What is sinus dysrhythmia? (HR?)
Exhale = slower HR, inhale = faster HR DT intrathoracic pressure
HR = 60-100
118
Wandering Atrial Pacemaker (HR, rhythm, P wave, PRI)
HR <100, irregularly irregular w/ @ least 3 P wave Morphologies
Common in kids, old people & athletes
119
What is MAT (HR, Rhythm, Pwave)
Multifocal atrial tachycardia = 100+, irregularly irregular w/ @ least 3 P wave morphologies.
Common in terminal COPD/lung disease pts
120
How do you know a rhythm is SVT? What about in kids and infants?
Fast narrow, regular
```
Adult = +150bpm
Kid = +180bpm
Infant = +220bpm
```
121
How do you know a rhythm is atrial flutter?
Usually Regular w/ a ratio (atrial = 300, ventricle = variable) and Saw teeth (F waves)
122
How do you know if a rhythm is A-fib
It’s irregularly irregular; can’t tap your feet to it
123
PVC vs PAC vs PJC
*all occur earlier
PVC = wide QRS w/ no p wave
PAC = narrow QRS w/ different shaped p wave
PJC = inverted or no p wave w/ narrow QRS
124
What’s a Junctional escape rhythm
Beat occurs longer than normal rhythm w/ no p wave
125
Junctional rhythm vs accelerated junctional vs junctional tachycardia
They all look the same (inverted or no p wave / narrow QRS). except HR…
Junctional = 40-60
Accelerated junctional = 60-100
Junctional tachy = >100
126
Sinus block vs sinus Arrest vs sinus pause
Sinus block = no pwave or beat but unbroken P-P interval
Sinus pause = no pwave/beat w/ broken P-P interval
Sinus arrest = longer sinus pause
127
How can you tell if a rhythm is Idioventricular?
Regular rate of 20-40Bpm w/ wide QRS no pwave
128
How can you tell if a rhythm is Ventricular Tachycardia?
Rate 110-250 regular w/ wide QRS (often > .16s) and no Pwave
129
What constitutes a STEMI?
ST elevation in 2+ contiguous leads or new/suspected LBBB
130
How to diagnose a LBBB
Both BBB Look at I, V1, V6
LBBB
- QRS > 0.12s
- I & V6, wide monomorphic R wave
- V1 wide monomorphic S wave
131
How to diagnose RBBB
Both BBBs Look at I, V1, V6
RBBB=
- QRS >0.12s
- I & V6 = slurred S wave
- V1 = RSR pattern
132
How to determine axis deviation in a 12-lead
Look @ QRS in Lead I & avF
R hand = I, L hand = avF
Pos. = thumb up, Neg = thumb down
Both ++ = normal
Both neg = extreme right
Turn towards thumb = R or L deviation
133
What conditions can mimic a STEMI
```
LBBB
Percarditis
Brain bleed
Brugada syndrome
Paced rhythm
```
134
What’s the average cardiac output? Average minute volume?
CO = 4.9-5L blood
Minute vol = 5-6L
135
How big are the capillaries?
Only 1 cell thick
136
Fluids from the lymphatic system empty into the…
Subclavian vein
137
Average tidal volume is 500ml. How much of that actually reaches the alveoli?
350mL. 150mL is dead space
138
Where is the base vs apex of the heart?
Base = top
Apex = bottom
139
What’s it called when there’s fluid in the pleural space of the lungs?
Pleural effusion
140
The endocardium (inner heart layer) secretes chemicals that do what?
Chemicals to increase contractility
141
What’s starling’s law?
Muscle contracts more powerfully when pre-stretched
142
What is the foramen ovale?
Hole between atriums to bypass lungs. Found in fetus
143
What is the “cardiac skeleton”?
Dense connective tissue in heart that the valves attach to
144
Coronary sinus vs coronary sulcus?
Sinus = large coronary vein drains blood from coronary arteries back into R atrium
Sulcus = separates atrium vs ventricles
145
Pulmonary edema = Number one sign of…
L ventricular failure
146
What do S3 & S4 indicate?
S3 = CHF or high school kids
S4 = MI or failure
147
What is rheumatic fever? How does it affect the heart?
Rheumatic fever = scarlet fever
Autoimmune response = inflammation of heart = most common cause of valve problems
148
Coronary arteries fill during what contraction phase?
Diastole
149
What is anastomosis
Aka collateral circulation.
Interconnections between coronary arteries that help bypass a clot
150
The membrane of a cardiocyte is always positive or negative?
Positive
151
Intrinsic rates of SA node, AV node, Purkinje fibers
SA = 60-100
AV = 40-60
Ventricles = 20-40
152
Where is the cardiac plexus located at?
Next to aorta
153
Muscarinic type II receptors are located where and do what?
Located in SA node for parasympathetic stimulation
154
Sympathetic NS is AKA …
Adrenergic system
155
Parasympathetic NS is AKA …
Cholinergic system
156
Prinzmetals angina is often caused by what defect? How do we Rx?
Defect in Calcium channels
Rx = calcium channel blocker
157
What’s the significance of a pathological Q wave?
Yes Q wave = transmural (full thickness MI)
No Q wave = MI normally in subendocardial tissue
158
What’s wellens syndrome
Predicts imminent MI:
Deeply inverted T waves in V2 & V3 (LAD stenosis)
159
What’s the cardiac notch?
Pocket in the L lung where the heart sits
160
What’s the muscle cell of the heart called?
Cardiomyocyte
161
What’s the fossa ovalis?
Depression in interatrial septum where the foramen ovale used to be
162
What is the pulmonary trunk?
Large arterial vessel carries blood from R ventricle
163
What is the polarity of aVF (positive vs negative end)
Looks straight down
Positive = L foot
Neg = between R & L arms
164
What is the polarity of aVL? (Positive vs negative lead placement)
Looks up towards L hand
```
Positive = L hand
Negative = between R hand & L foot
```
165
What is the polarity of aVR? (Positive vs negative lead placement)
Looks towards R hand
Positive = R hand
Negative = between L hand & L foot
