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Clinical Disciplines > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Addiction

A

Primary, chronic disease of brain reward, motivation, memory and related circuitry
Characterized by inability to abstain, impairment in behavioral control, craving, diminished recognition of significant problems with behaviors and relationships and dysfunctional emotional response

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2
Q

When does addiction start?

A

Peak is about 18 years, but mean is 10-25

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3
Q

Dopamine Pathways

A

Reward/motivation, pleasure, euphoria, motor function (fine-tuning), compulsion, perseveration

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4
Q

Serotonin Pathways

A

Mood, memory processing, sleep, cognition

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5
Q

Dopamine Reward Pathway

A

Dopamine released into synapse, bind to receptors, sends signal topmost-synaptic neuron, transported back to presynaptic neuron
Cocaine blocks removal of dopamine resulting in build-up leading to continuous stimulation>euphoria, over time the receptors become overloaded

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6
Q

Outcomes of continued drug use

A

Sensitization, craving and relapse; loss of control over drug use/compulsive drug seeking behavior
Loss of control of body movement, early learning/memory processing, attention state

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7
Q

Incentive Salience

A

Type of motivation created in brain because its developed an association between stimuli and reward

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8
Q

Risk factor for Substance Abuse Disorder

A

Genes (40-60%), M:F 2:1
Environment (family belief, exposure, peer pressure)
Childhood events (trauma, mental health, etc)
Age of onset (40% if 14 or younger, 10% if 20+)
Psychiatric comorbidities- anxiety, depression, bipolar

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9
Q

What kind of drugs do not have withdrawal symptoms?

A

CPC, hallucinogens, inhalants

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10
Q

Triage

A

Sorting patients according to the urgency of their need for care
Immediate threat to life, limb or vision is treated first

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11
Q

5 level triage system

A 
Takes into account: physical, developmental, psychosocial needs, patient flow, health care access
1-life/limb/vision threat
2-abnormal vitals, 2+ tests
3-2+ tests w/ normal vitals
4-1 test normal vitals
5-no testing needed (healthy)
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12
Q

Decision Point A (triaging)

A

require immediate intervention?-airway, circulation, mental status (unresponsive/only to pain)

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13
Q

Decision Point B (triaging)

A

Abnormal vitals but not life threatening, new mental status changes

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14
Q

Decision Point c (triaging)

A

How many tests are you running?

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15
Q

EMTALA

A

“anti-dumping law”
Any facility that receives government funding must treat any patient until stable or transfer if needs are not available (at least a medical screening exam)
Up to $50,000 fine per violation

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16
Q

250 yard rule

A

Any person within 250 yards of the ED are the responsibility of the ED

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17
Q

Hypoxia

A

Insufficient delivery of oxygen to tissue, taken from finger

SaO2 <94%

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18
Q

Hypoxemia

A

Abnormally low arterial oxygen tension, taken from ABGs

PaO2 <60mmHg

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19
Q

Hypoventilation

A

Causes increased PaCO2 (decreased pH)

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20
Q

Right-to-left Shunt

A

Failure to increase oxygen levels with supplemental oxygen

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21
Q

Causes of Hypoxemia

A

Hypoventilation, right-to-left shunt, VQ mismatch, diffusion, low inspired oxygen (high altitude)

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22
Q

Stridor vs Wheeze

A

S: upper airway, inspiratory (foreign body, epiglottitis, anaphylaxis, croup)
W: lower airway, expiratory (asthma, COPD, cardiogenic palm edema, foreign body)

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23
Q

Rales vs Rhonchi

A

Rales-velcro sound/crackles, CHF

Rhonchi- pneumonia, clears with cough

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24
Q

Hypoxia Symptoms

A

Early: restless, anxiety, tachycardia/tachypnea
Late: Bradycardia, extreme restlessness, dyspnea
Peds: feeding difficulty, stridor, nasal flares expiratory grunting, sternal retractions

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25
Signs of Respiratory Failure
Nasal flaring, head bobbing, see saw breathing, retractions, altered mental status, hypoxia
26
What pathogen is Rust Colored Sputum?
Strep pneumoniae | Also most common cause of pneumonia
27
What pathogen is is green colored sputum?
Pseudomonas or H flu
28
What pathogen is red currant jelly?
Klebseilla | Common in alcoholics and nursing home pts
29
What pathogen causes foul smelling/bad tasting sputum?
Anaerobes
30
What pathogen is associated with bradycardia and hyponatremia?
Legionella
31
What pathogen is associated with bullous myringitis?
Mycoplasma pneumoniae
32
Symptoms of pneumonia
sudden onset of fever, rigors, productive cough, dyspnea | Lobar infiltrate
33
Left heart border not visible due to what?
Left upper lobe pneumonia (in the lingula)
34
HCAP Treatment
Cefepime or ceftazidime or piperacillin-tazobactam Cipro Q8H or levo QD vancomycin Q12H
35
Pneumonia Mortality Predictor
CURB-65 confusion, uremia, resp rate >30, BP <90/60, over 65YO 3-5 points=ICU, 2=admit
36
High Altitude Sickness
>5000 feet, most commonly 8,000-14,000: hypoxic environment | Sleep and rate of ascent are most critical to consider
37
Altitude Acclimatization
Hypoxic ventilatory response-lessened by respiratory depressants Increased erythropoietin Peripheral venoconstriction ^central blood volume, ADH and aldosterone suppressed>diuresis Increased HR, contracted pulmonary vessels Cheyne-stokes breathing above 9,000 ft Acetazolamide causes bicarb diuresis
38
Acute Mountain Sickness Signs/Symptoms
Lightheaded/dizzy, headache increased with bending/valsalva, anorexia, nausea, weak, irritable, breathless w/ activity Localized rales, postural hypotension, retinal heme, FLUID RETENTION
39
Acute Mountain Sickness Treatment
``` Decrease elevation 0.5-1L O2/min Acetazolamide Aspirin Dexamethasone Prevent with slow ascent, acetazolamide 24hrs before, dex, high carb meals, avoid exertion, alcohol and respiratory depressants ```
40
High Altitude Cerebral Edema
Altered mental status w/ neuropathy symptoms, ataxia, stupor, coma Cranial nerve palsy 3-6
41
High Altitude Cerebral Edema Treatment
Oxygen, descent, dexamethasone, loop diuretics (furosemide, bumetanide)
42
High Altitude Pulmonary Edema
Most lethal altitude sickness | Dry>productive cough, decreased exercise performance, rales, increasing dyspnea, coma, death
43
High Altitude Pulmonary Edema Treatment
Recognition, immediate descent, Oxygen, nifedipine
44
Congestive Heart Failure
MC reason for medicare admission | Most common cause is LV dysfunction (hypertension, aortic stenosis-syncope, chest pain, dyspnea on exertion)
45
CHF Signs and Symptoms
Hypoxemia, hypertension, tachycardia, dyspnea, weight gain, rales, wide QRS complex, "fluffy" infiltrates on X-ray, B-lines on lung ultrasound* L: fatigue, cough, orthopnea R: edema, JVD
46
CHF Treatment
Oxygen/ventilation, nitroglycerin, morphine sulfate, diuretic (furosemide), dobutamine
47
CHF Treatment to Avoid
CCB, NSAIDs, Anti-arrhythmics
48
Pulmonary Embolism
Most common cause of nonsurgical maternal postpartum death | Virchows Triad
49
Virchows Triad
Venous stasis, vessel wall inflammation, hypercoagulability
50
Pulmonary Embolism Signs/Symptoms
*Pleuritic chest pain, shortness of breath, hemoptysis* | dyspnea, syncope, leg swelling, confusion, hypoxemia
51
Pulmonary Embolism Risk Assessments
``` Wells score (2-6 mod, >6 high) Geneva score (>3) PERC Criteria ```
52
Pulmonary Embolism Testing
Xray: Hampton's hump (triangle infiltrate), westermark's sign (dilated pulmonary vessels), Fleischner sign (distended palm artery) CT is test of choice EKG: "classic sign" S1Q3T3, sinus tach is most common
53
PE Treatment (anticoags)
Heparin, Coumadin, lovenox, rivaroxaban
54
PE treatment (Thrombolysis)
Streptokinase, urokinase, alteplase (tPA) | Embolectomy, catheter directed (tPA/heparin)
55
Asthma
Chronic but reversible inflammatory disorder | "airway inflammation, obstruction to airflow, bronchial hyper-responsiveness" with dyspnea, cough and wheezing
56
COPD
Chronic irreversible disorder *Smokers, alpha-1-antitrypsan Cough worse in the morning, SOB, wheezing, dyspnea, cyanosis
57
Chronic Bronchitis
Chronic productive cough for 3 months in 2 years
58
Emphysema
Destruction of bronchioles and alveoli
59
COPD Treatment
``` B-agonist (albuterol) Epi IM-bronchodilator Ipatropium bromide with B agonist Corticosteroids (dei, methylpred, pred) Magnesium Sulfate-exacerbations only Heliox (peds) No theophylline BiPAP ```
60
BiPAP
Bilevel positive airway pressure, more similar to natural breathing than CPAP Inspiratory higher pressure than expiratory start at 10/5, don't go lower than 8/4 or higher than 25/15 IPAP increased for hyprcapnia EPAP increased for hypoxemia Goal is SaO2>94%
61
Foreign Body Aspiration
1-3 or >85 (MC <1 and >75) Unilateral wheezing with symptoms that do not respond to bronchodilators CT or laryngoscopy/bronchoscopy
62
Most common site of foreign body aspiration?
Thoracic inlet (level of clavicles on X-ray)-where muscle changes from skeletal to smooth

Clinical Disciplines (4 decks)

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