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PCM IV > Final Exam > Flashcards

Final Exam Flashcards

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1
Q

medicare hospice-benefit criteria

A

Terminal illness

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2
Q

hospice interdisciplinary team

A 
physician
nurse case manager
dietary counselor
medical social worker
bereavement counselor
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3
Q

double effect

A

primum non nocere

explains permissibility of action that causes harm as side effect of promoting good end

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4
Q

administration of opiods

A

PO preferred

avoid IM

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5
Q

merperidine

A

bad drug
toxic metabolites
avoid

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6
Q

constipation

A 
bulk laxatives NOT recommended
methynaltrexone 
stimulant laxatives
enemas
prevention
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7
Q

methynaltrexone

A

opiate antagonists that cannot x BBB

very $

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8
Q

dyspnea

A

Tx underlying cause
systemic opioids (nebulized may or may not be effective)
basics (position, O2, CPAP, CiPAP)

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9
Q

Nausea types

A

cerebral Cx
vestibular
chemo-trigger zone
GI

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10
Q

cerebral Cx nausea

A

causes: emotional stress, CA, or pain
Tx: Dexamethasone
counseling
anti-anxiety, anti-depressants, and opioids

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11
Q

vestibular nausea

A

cause: infection, motion sickness, CNVIII tumor
Tx: abx, anticholinergics, antihistamines

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12
Q

chemo-trigger nausea

A

causes: drugs, uremia, electrolyte imbalance
Tx: find underlying cause, 5-HT3 antagonists

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13
Q

GI nausea

A

causes: obstructional, gag reflex, irritation/distention
Tx: removing inciting agents, anti-inflammatory agents, anticholinergics, octreotide

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14
Q

Benzos and delerium

A

can have paradoxical exacerbation of terminal delirium

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15
Q

evaluating foreign bodies in wounds

A

x-ray: stones, metal, glass

CT, US, or MRI: organic material

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16
Q

cleansing wounds

A

tap or saline

avoid iodine and hydrogen peroxide

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17
Q

anesthetizing

A

25g or smaller

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18
Q

when should you seek surgical consult

A

deep wounds of hands/feet
full thickness laceration of eyelids, lip, or ear
lacerations involving nn, aa, bones, or joints
penetrating wounds of unknown depth
severe crush injuries
severely contaminated wounds requiring placement of drain
wounds leading to a strong concern about cosmetic outcome

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19
Q

non-absorbable sutures

A 
silk
nylon
polypropylene
cotton
stainless steal
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20
Q

silk sutures

A

lowest tensile strength

rarely used

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21
Q

nylon

A

cheap
high tensile strength
hard to tie

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22
Q

polypropylene

A

high tensile strength
slippery- need extra knots
good for accommodating wound swelling
blue

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23
Q

absorbable sutures

A 
catgut
fast absorbing catgut
polyglactin 910
poliglecaprone
polyglycoic acid
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24
Q

catgut

A

only retains tensile strength for 5-7 days
chormic- delayed absorption time 10-14 dyas
lacerations in oral mucosa

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25
fast absorbing catgut
good for epidermal suturing, especially facial lacerations | dissolves in 4-6days
26
polyglactin 910
lubricated braided synthetic significant tensile strength for 3-4wks complete absorption in 60-90 days ideal for subQ
27
poliglecaprone
monofilament w/easy handling and less chance of infection facial lacerations closed w/subcuticular running stiches tensile strength lost my 21 dyas
28
polyclycoic acid
braided polymer less reactive then gut sutures 50% of tensile strength left at 25days high friction coefficient- binding and snagging when wet
29
polyclycoic acid
braided polymer less reactive then gut sutures 50% of tensile strength left at 25days high friction coefficient- binding and snagging when wet
30
interrupted stiches
easy | best for wounds that are jagged/irregular
31
continuous stiched
aka baseball stich | better for cosmetic results
32
subcuticular technique
ideal for low-tension, cosmetically important areas
33
vertical mattress
best for everting wound edges in anatomical locations which tend to invert
34
horizontal mattress
best for high yield tension wounds or wounds w/fragile skin
35
tissue adhesive
octylcyanoacrylate/dermabond low tensile strength, cannot be used in high tension areas (joints) cannot be used in moist areas
36
CI for tissue adhesive
higher risk for poor healing contaminated wound complex/jagged wounds
37
excisional Bx
L 3-4x W
38
face suture removal
3-5days
39
scalp suture removal
7-10 days
40
arms suture removal
7-10days
41
trunk suture removal
10-14days
42
legs suture removal
10-14days
43
hands/feet suture removal
10-14 days
44
palms/soles
14-21days
45
MSE
``` LOL AMEN level of consciousness orientation language attention memory executive fnx dominant hemisphere ```
46
attention
digit span, speeling, months/days forward/backwards | lack of attention may indicate delirium
47
executive fnx
``` verbal fluency similarities proverbs estimates list items in category (normal >20, dementia ```
48
gerstmann syndrome
``` apraxia acalculia agraphia cannot determine L/R cannot distinguish individual fingers damage to angular gyrus ```
49
anosognoisa
inability to recognize disability
50
CNIII
if lesion in CNS will spare pupil
51
CNIV
superior oblique | test by having pt look down andin
52
rhomberg
better for testing DCML rather then cerebellum
53
functionally illiterate
21%
54
moderately illiterate
25% 5th-8th grade reading level cannot use bus schedule
55
literate
8th grade reading level
56
erythema toxicum
common small blotchy erythematous areas w/raised yellow/white center usually first 10days of life (up to 4wks) harmless, no Tx
57
atopic dermatitis
diaper area spared acute erythema, scaly, itchy Tx w/topical steroids, antihistmaine, moisturize immediately after shower
58
HSP
``` systemic vasculitis of small cessels palpable purpura may present w/abdominal pain, rash, and arthritis acute glomerulonephritis HTN uncommon ```
59
benign murmurs in kids
low-pitched, non-tubulant, low velocity stills venous hum
60
stills murmur
heard at tricuspid post best w/bell decrease or disappear w/valsalva
61
venous hum
low pitched continuous murmur made by blood returning from great vv to heart bell
62
PDA
G>B more common in premies, NRDS, genetic d/o small usually asymptomatic
63
large PDA
``` bounding pulse, murmur tachypnea poor feeding habits SOB sweating when feeding tiring easily poor growth ```
64
Tx of PDA
indomethacin or surgery
65
croup
steeple sign- subglottic narrowing of trachea viral Tx w/oral steroids or nothing if mild if stridor present at rest add epi inhaler
66
foreign body
common cause of chronic cough or u/l nasal discharge | fowl smell
67
labial adhesion
``` Tx- mechanical seperation w/ointment estrogen cream (premarin) if needed if severe surgery ```
68
simple febrile seizures
last seconds-10min | followed by post-ictal period up to 30min
69
complex febrile seizures
longer then 15min just one part of body occurs again w/in same illness
70
hand-foot-mouth disease
coxackie A16 preschoolers highly contangious prodrome 1-2 days before rash painful, shallow, yellow ulcers surrounded by red halos oral lesions only- called herpangina exanthema-rash on palmar, plantal, interdigital hand and foot +/- buttocks
71
erythema infectiosum
aka 5th disease parvovirus B19 slapped cheeks dangerous for 1st trimester-> hydrops fetalis
72
rocky mountain spotted fever
rash begins distally and moves centripetally
73
normal CSF pressure
7-30
74
LP
below L2 | use short bevel
75
xanthochromic
slight yellow color of CSF d/t old blood
76
cloudy CSF
>200 WBC/cc or >400 RBC/cc
77
monocytes in CSF
indicates chronic issue
78
glucose in CSF
lags behind blood glucose by 1 hr | should never ben
79
protein
should be
80
T1
white matter brighter then gray fluid dark fat bright
81
T2
gray matter brighter then white fluid bright fat and calcification dark
82
T2
gray matter brighter then white fluid bright fat and calcification dark
83
MRI
not as good as CT for acute stroke
84
CT best for
acute cerebral bleeding abscesses and ALL fractures

PCM IV (6 decks)

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