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PCM IV > Final Exam > Flashcards

Final Exam Flashcards

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
Q

fast absorbing catgut

A

good for epidermal suturing, especially facial lacerations

dissolves in 4-6days

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26
Q

polyglactin 910

A

lubricated braided synthetic
significant tensile strength for 3-4wks
complete absorption in 60-90 days
ideal for subQ

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27
Q

poliglecaprone

A

monofilament w/easy handling and less chance of infection
facial lacerations closed w/subcuticular running stiches
tensile strength lost my 21 dyas

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28
Q

polyclycoic acid

A

braided polymer
less reactive then gut sutures
50% of tensile strength left at 25days
high friction coefficient- binding and snagging when wet

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29
Q

polyclycoic acid

A

braided polymer
less reactive then gut sutures
50% of tensile strength left at 25days
high friction coefficient- binding and snagging when wet

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30
Q

interrupted stiches

A

easy

best for wounds that are jagged/irregular

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31
Q

continuous stiched

A

aka baseball stich

better for cosmetic results

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32
Q

subcuticular technique

A

ideal for low-tension, cosmetically important areas

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33
Q

vertical mattress

A

best for everting wound edges in anatomical locations which tend to invert

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34
Q

horizontal mattress

A

best for high yield tension wounds or wounds w/fragile skin

35
Q

tissue adhesive

A

octylcyanoacrylate/dermabond
low tensile strength, cannot be used in high tension areas (joints)
cannot be used in moist areas

36
Q

CI for tissue adhesive

A

higher risk for poor healing
contaminated wound
complex/jagged wounds

37
Q

excisional Bx

A

L 3-4x W

38
Q

face suture removal

A

3-5days

39
Q

scalp suture removal

A

7-10 days

40
Q

arms suture removal

A

7-10days

41
Q

trunk suture removal

A

10-14days

42
Q

legs suture removal

A

10-14days

43
Q

hands/feet suture removal

A

10-14 days

44
Q

palms/soles

A

14-21days

45
Q

MSE

A 
LOL AMEN
level of consciousness
orientation
language
attention
memory
executive fnx
dominant hemisphere
46
Q

attention

A

digit span, speeling, months/days forward/backwards

lack of attention may indicate delirium

47
Q

executive fnx

A 
verbal fluency
similarities
proverbs
estimates
list items in category (normal >20, dementia
48
Q

gerstmann syndrome

A 
apraxia
acalculia
agraphia
cannot determine L/R
cannot distinguish individual fingers
damage to angular gyrus
49
Q

anosognoisa

A

inability to recognize disability

50
Q

CNIII

A

if lesion in CNS will spare pupil

51
Q

CNIV

A

superior oblique

test by having pt look down andin

52
Q

rhomberg

A

better for testing DCML rather then cerebellum

53
Q

functionally illiterate

A

21%

54
Q

moderately illiterate

A

25%
5th-8th grade reading level
cannot use bus schedule

55
Q

literate

A

8th grade reading level

56
Q

erythema toxicum

A

common
small blotchy erythematous areas w/raised yellow/white center
usually first 10days of life (up to 4wks)
harmless, no Tx

57
Q

atopic dermatitis

A

diaper area spared
acute erythema, scaly, itchy
Tx w/topical steroids, antihistmaine, moisturize immediately after shower

58
Q

HSP

A 
systemic vasculitis of small cessels
palpable purpura
may present w/abdominal pain, rash, and arthritis
acute glomerulonephritis
HTN uncommon
59
Q

benign murmurs in kids

A

low-pitched, non-tubulant, low velocity
stills
venous hum

60
Q

stills murmur

A

heard at tricuspid post
best w/bell
decrease or disappear w/valsalva

61
Q

venous hum

A

low pitched continuous murmur made by blood returning from great vv to heart
bell

62
Q

PDA

A

G>B
more common in premies, NRDS, genetic d/o
small usually asymptomatic

63
Q

large PDA

A 
bounding pulse, murmur
tachypnea
poor feeding habits
SOB
sweating when feeding
tiring easily
poor growth
64
Q

Tx of PDA

A

indomethacin or surgery

65
Q

croup

A

steeple sign- subglottic narrowing of trachea
viral
Tx w/oral steroids or nothing if mild
if stridor present at rest add epi inhaler

66
Q

foreign body

A

common cause of chronic cough or u/l nasal discharge

fowl smell

67
Q

labial adhesion

A 
Tx- mechanical seperation w/ointment 
estrogen cream (premarin) if needed
if severe surgery
68
Q

simple febrile seizures

A

last seconds-10min

followed by post-ictal period up to 30min

69
Q

complex febrile seizures

A

longer then 15min
just one part of body
occurs again w/in same illness

70
Q

hand-foot-mouth disease

A

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
Q

erythema infectiosum

A

aka 5th disease
parvovirus B19
slapped cheeks
dangerous for 1st trimester-> hydrops fetalis

72
Q

rocky mountain spotted fever

A

rash begins distally and moves centripetally

73
Q

normal CSF pressure

A

7-30

74
Q

LP

A

below L2

use short bevel

75
Q

xanthochromic

A

slight yellow color of CSF d/t old blood

76
Q

cloudy CSF

A

> 200 WBC/cc
or
400 RBC/cc

77
Q

monocytes in CSF

A

indicates chronic issue

78
Q

glucose in CSF

A

lags behind blood glucose by 1 hr

should never ben

79
Q

protein

A

should be

80
Q

T1

A

white matter brighter then gray
fluid dark
fat bright

81
Q

T2

A

gray matter brighter then white
fluid bright
fat and calcification dark

82
Q

T2

A

gray matter brighter then white
fluid bright
fat and calcification dark

83
Q

MRI

A

not as good as CT for acute stroke

84
Q

CT best for

A

acute cerebral bleeding
abscesses
and ALL fractures

PCM IV (6 decks)

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