Mock Exam Part 1, #1-15 Reviewer

Question 1

primary indication for temporary transcutaneous pacing

Answer 1

bradycardia with hemodynamic compromise
until a more definitive pacing method can be established

Question 2

indication for temporary transvenous pacemaker placement (not transcutaneous)

Answer 2

asystole
overdrive pacing in unresponsive VTach
Unresponsive recurrent sinus pauses (>3 s)

alternating bundle branch block
consider in RBBB with anterior or posterior hemiblock

Question 3

when performing synchronized cardioversion, at which phase of the QRS complex should the shock be delivered?

Answer 3

on the R wave
“peak of the QRS complex”, “highest point of the R-wave”

Question 4

synchronized cardioversion for atrial flutter

Answer 4

may require as little as 25-50 J

Question 5

synchronized cardioversion for atrial fibrillation

Answer 5

150-200 J
(or 120-200 J)

A fib is narrow-complex, irregular.
But if narrow-complex, regular (SVT): 50-100 J

Question 6

MOA of adenosine

Answer 6

inhibition of the conduction through the AV node, interrupting the reentry circuit responsible for SVT

6 mg - 12 mg - 12 mg

Question 7

other drugs that block AV nodal conduction

Answer 7

verapamil, diltiazem
esmolol, metoprolol, propranolol
(table 18-2)

Question 8

antiarrhythmic of choice for the stable wide-complex tachycardia

Answer 8

procainamide

if unstable –> electrical cardioversion, start at 100 J

Question 9

preferred acute pain management for the patient with severe abdominal pain due to suspected kidney stones

Answer 9

ketorolac
“Agents such as NSAIDs should be considered for mild to moderate pain or when targeting severe pain originating from smooth muscle spasm such as renal or biliary colic

In specific instances such as renal and biliary colic, although parenteral NSAIDs may control severe pain, combination therapy with an opioid is usually superior.

Question 10

before administering procedural sedation, what is the most important aspect to assess in the patient

Answer 10

allergies to medications

Question 11

TRUE or FALSE
don’t give propofol in those with soy allergies

Answer 11

FALSE
“Propofol’s only TRUE immunologic contraindication is an allergy to the drug itself.”

Question 12

A pediatric patient requires procedural sedation. What medicaiton is preferred for procedural sedation in children due to its safety profile and rapid onset

Answer 12

ketamine
- also the combination of anesthesia, analgesia, and amnesia is suitable for kids

Question 13

almost universally preferred anxiolytic for minor procedures in children

Answer 13

midazolam, because of its rapid onset and short duration of action

Question 14

sedative that can cause hallucinations and dissociation

Answer 14

ketamine
- derivative of the drug phencyclidine and is an NMDA glutamate receptor antagonist

Question 15

critical dosing threshold of ketamine, above which characteristic dissociative state appears

Answer 15

1.0 to 1.5 mg/kg IV
or 3 to 4 mg/kg IM
no observable increased levels of depth beyond threshold, just increased duration of dissociative state

Question 16

recommended immediate treatment for individuals exposed to a nerve agent in a chemica lwarfare incident

Answer 16

administer atropine and pralidoxime
nerve agents are organophosphates
never give succinylcholine

Question 17

type of chemical warfare agent primarily affecting the skin and mucous membranes, causing blistering and tissue damage

Answer 17

vesicants
also known as blister agents
examples: sulfur mustard, phosgene oxime, lewisite

Question 18

treatment for vesicant exposure

Answer 18

irrigate with water, supportive care

Question 19

vesicant that can cause bone marrow supression

Answer 19

mustard agents

Question 20

agents that interfere with O2 utilization in mitochondria

Answer 20

cyanide
hydrogen sulfide
phosphine
sodium azide
carbon monoxide

treatment: hydroxocobalamin

(table 8-4)

Question 21

agents that interrupt delivery of oxygen to tissues

Answer 21

carbon monoxide
methylene chloride
nitrites
benzocaine
phenazopyridine

treatment: O2, methylene blue

(table 8-4)

Question 22

examples of simple asphyxiants

Answer 22

carbon monoxide
hydrogen
nitrogen
butane
propane

asphyxiants displace O2 from the air

treatment: remove from source, give O2

(table 8-4)

Question 23

what is sarin?

Answer 23

a nerve agent
= sarin is aka “GB”
= an organophosphate

Question 24

may be seen in the recovery phase of trauma

Answer 24

trauma (also seen in acute phase)
communicable disease
soft tissue infections
vectorborne disease
infectious complications of trauma (also seen in immediate postevent phase)
exacerbation of chronic disease (also seen in immediate postevent phase)
PTSD

(table 6-1)

Question 25

the only natural disaster where more injury and death occur during the recovery phase than in the acute phase

Answer 25

hurricanes

Question 26

type of blast injury that results from the **patient being propelled** through the air and striking stationary objects

Answer 26

***T***ertiary blast injury "Flying ***T***ao"

Question 27

blast injury due to collateral damage from flying objects

Answer 27

***S***econdary blast injury "Flying ***S***hrapnels"

Question 28

most common fatal primary blast injury

Answer 28

pulmonary barotrauma primary blast injuries most commonly affect **gas-filled** structures, such as **lungs**, stomach, middle-ear

Question 29

most common serious complication of crush syndrome

Answer 29

**renal failure** cause is multifactorial: - systemic hypoperfusion - renal vasoconstriction - nephrotoxicity from **myoglobin** (via formation of ferriheximate, free hydroxyl radicals) - **uric acid and phosphate** precipitation in the **distal tubules**

Question 30

primary cause of delayed death in compartment syndrome

Answer 30

renal failure

Question 31

fluid hydration in compartment syndrome

Answer 31

PNSS 1000 mL/hour for 2 hours, then 500cc/hour thereafter to maintain UO 200-300 mL/hour (5-7 L every 24 hours