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NRS 410A/B EKGs/Pacemakers > 410 Quiz#2 > Flashcards

410 Quiz#2 Flashcards

1
Q

Components of BMP

A
  • sodium, potassium, chloride, bicarbonate/CO2, BUN, creatinine and glucose
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2
Q

Factors Affecting GFR

A
  • Age: GFR decreases with age
  • Gender: GFR is lower in female
  • Race: higher GFR used to be accepted in black patients
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3
Q

Gross Assessment of Urine

A

turbidity, Color, and smell

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4
Q

Urine Dipstick

A
  • specific gravity: urince concentration
  • pH: reflects serum pH
  • RBCs
  • protein: proteinuria = hallmark of renal disease
  • glucose: when blood glucose > 180mg/dL
  • Ketones: not normally in urine; byproduct of fat metabolism, uncontrolled DM
  • bilirubin: conjugated bilirubin, screens for liver or bile duct disease
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5
Q

RBCs on urine Microscopy

A
  • hematuria: >3RBCs per HPF
  • gross color can be misleading
  • transient vs persistent (persistent requires work-up)
  • dysmorphia indicates glomerular disease
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5
Q

RBCs on urine Microscopy

A
  • hematuria: >3RBCs per HPF
  • gross color can be misleading
  • transient vs persistent (persistent requires work-up)
  • dysmorphia indicates glomerular disease
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6
Q

WBCs on urine microscopy

A
  • Pyuria: >5 WBCs per HPF
  • neutrophils: bacteria, renal TB, lithiasis
  • Eosinophils: interstitial nephritis
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7
Q

Epithelial Cells on Urine Microscopy

A
  • shed from genitourinary tract
  • excess of epithelial cells may indicate contamination
  • renal disease/tubular disease: >15 epithelial cells per 10HPF
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8
Q

Nitrates vs Nitrites

A
  • Nitrate: normal constituent of urine; converts to nitrite in presence of certain bacteria
  • Nitrites: abnormal, correlate well with possible infection; >10,000 bacteria count per mL
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9
Q

Leukocyte Esterase

A

enzyme produced by neutrophils, signals pyuria

subject to contaminated specimen, read only after 30-60 secs

nonspecific: TB, tumors, viral, stones, foreign bodies

works with synovial fluid as well to test for septic joint

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10
Q

Accuracy of hematuria, leukocytosis, and nitrites in urinalysis

A
  • hematuria: very sensitive but not specific
  • leukocytosis: very sensitive, not specific
  • Nitries: not sensitive, very specific
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11
Q

Myocardial Cells

A
  • “working cells” of the heart, contractile ability
  • connected by intercalated discs with gap junctions
  • held to by desmosomes
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12
Q

When Heart Cells are injured they release:

A

Troponin and CPK-MB

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13
Q

Anterior Leads

A

V1-V4

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14
Q

Lateral Leads

A

V5-V6, aVL, lead I

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15
Q

Inferior Leads

A

aVF, lead II, and lead III

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16
Q

Normal Intervals

A

PR: 0.12-0.20s

QRS: 0.06-0.11s

QT: 0.36-0.44s

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17
Q

ECG paper

A

small square: 0.04 s in duration, and 0.1mV in amplitude

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18
Q

P wave

A
  • normal duration: 0.06-0.10s; Amplitude: 0.5-2.5mm
  • if amplitude >2.5mm = RAE, P pulmonale
  • if duration > 0.10s (2.5 boxes) = LAE, P mitrale
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19
Q
A

Flutter Waves

  • seen instead of normal P waves when the atria fire rapidly from one site at a rate of 250-350bpm “Saw tooth pattern”
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20
Q
A

Fibrillatory Waves

seen instead of P waves when the atra fire rapidly from many sites at a rate of >350bpm

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21
Q

Short QRS complexes (in amplitude)

A

obesity, hypothyroid patients, pericardial effusion

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22
Q

1st degree AV heart block

A

when the PR interval is lengthened consistently due to a delay in impulse conduction through the AV node

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23
Q

2nd degree AV heart block

A
  • PR intervals get progressively longer until a QRS complex is skipped and the cycle repeats
24
Q

3rd degree AV heart block

A

P wave is completely independent from QRS complex, so PR interval cannot be measured

25
Q

Wandering atrial pacemaker

A
  • pacemaker changes location from site to site producing a slightly irregular rhythm
26
Q

Paroxysmal Tachycardia

A

Normal rate that suddenly accelerates to a rapid rate producing an irregularity in the rhythm

27
Q

Hypertrophy vs. Enlargement

A
  • Hypertrophy:
    • thickening of the wall of the cardiac chamber due to increased pressure that the muscle is having to work against ( high BP, stenotic valve); common in ventricles
  • Enlargement (dilation):
    • not the same as hypertrophy; often occurs due to stretching as a result of fluid overload; common in the atria
28
Q

Clinical conditions associated with r atrial enlargement

A

pulmonic stenosis; tricuspid stenosis; tricuspid regurgitation

29
Q

RAE criteria

A

R atrial enlargement: amplitude >2.5mm

  • if P is biphasic, the initial component is taller than the terminal component
  • leads II and V1 to diagnose atrial enlargement
30
Q

LAE criteria

A

Left Atrial Enlargement: duration >0.10 sec (2.5 boxes)

  • other criteria: terminal portion of P wave in V1 is negative, duration of >0.04 s and depth of >1mm
31
Q

Right Ventricular Hypertrophy Criteria

A

less common, usually d/t pulmonary HTN or pulmonic stenosis, reverse R wave progression

criteria: RAD, R wave > S wave in V1 +/- S wave>R wave in V6

32
Q

Left Ventricular Hypertrophy Criteria

A
  • common causes: HTN and valvular disease, precordial leads more sensitive and helpful in diagnosing LVH
  • Criteria (need ⅔): sum of the deepest S in V1/V2 + tallest R in V5/V5 > 35mm (Sokolov’s rule); R in lead I + S in lead III > 25mm; R in AVL >11mm;
33
Q

Incomplete BBB

A

RR configuration (or “rabbit ears”) with normal QRS

34
Q

RBBB criteria

A
  • Criteria: prolonged QRS, M shaped RR’ (rabbit ears), wide S wave in lead I and V6
  • seen in Coronary artery disease, and pulmonary embolism
35
Q

LBBB Criteria

A
  • Criteria: prolonged QRS, wide R wave in lead I and V6
36
Q

Left Anterior Hemiblock

A

left axis deviation

normal QRS, tall R waves in lead I and deep S waves in aVF

37
Q

Pre-Excitation Syndromes

A
  • Wolf-parkinson-white Syndrome
    • accessory pathway: bundle of kent
    • PR interval <0.12 seconds, wide QRS complex, Delta Wave
  • Lown-Ganong-Levine Syndrome
    • accessory pathway: James Fibers
    • PR interval <0.12seconds, normal QRS complex, absence of delta wave
38
Q

Dissolvable Sutures

A

Vicryl, Dexon, Chromatic, PDS

Very dextrous Chris places dissolvable sutures

sizes, 2.0, 3.0, 4.0 (bigger # → smaller suture)

39
Q

Non-Dissolvable Sutures

A

skin closure, drain anchors, internal suturing (sometime), vascular surgery (leave-in)

nylon, ethilon, silk, prolene

never eliminating stable Paul

size: 3.0, 4.0, 5.0

40
Q

Needle Types

A
  • cutting: skin
  • non-cutting: tissue, bowel, vascular, skin
41
Q

Removal Times of Sutures

A
  • face/neck: 3-5 days
  • scalp & arms: 7-10 days
  • trunk/legs/hands/feet: 10-14 days
  • Palms & soles: 14-21 days
42
Q

Numbing the Wound

A
  • Lidocaine 1% with epi: used on scalp & trunk, lasts longer, controls bleeding
  • Lidocaine 1% without epi: penis, fingers, toes and nose
  • Lidocaine: can be used locally at wound or as a digital block on toes and fingers (use small 25g needle)
43
Q

Post-Suturing Wound Care

A
  • toes/fingers: keep covered for 48-72 hours
  • face/scalp: keep covered for 24-48 hours
  • most wounds: keep covered for 18 hours
44
Q

how late is too late for sutures?

A

face: 24-48 hours

everywhere else: 18 hours?

45
Q

When to contact specialist for suturing?

A

nerve injury, arterial injury, any exposed bone, facial lacerations in children

46
Q

Rouleaux formation

A

stacked RBCs in a linear distribution

47
Q

Howell-Jolly Bodies

A

fragments of nucleus left over in RBCs

usually cleaned out by the spleen

48
Q

Acanthocytes aka Spur Cells

A

irregular projections

caused by changes in lipid metabolism that affect the RBC membrane

49
Q

Echinocytes aka Burr Cells

A

small blunt projections, uniformly spaced over the red cells, cells still have central pallor

caused by: liver disease, uremia

50
Q

Schistocytes

A

helmet or egg shaped fragments

caused by hemolytic anemia

→indicates destruction of RBCs

51
Q

MCH

A

mean corpuscular hgb

average hgb per RBC

52
Q

MCHC

A

mean corpuscular hgb concentration

REDNESS

normochromic, hypochromic, hyperchromic

53
Q

Fishbone for CBC

A
54
Q

Procalcitonin

A

high serum procalcitonin can indicate a systemic bacterial infection and sepsis

55
Q

STEMI or Injury Pattern

A

2 contiguous leads have 1.5-2mm ST elevation

56
Q

NSTEMI or Ischemia (No Injury)

A

2 contiguous leads have 1+mm ST depression

57
Q

unstable angina

A

chest pain at rest

NRS 410A/B EKGs/Pacemakers (7 decks)

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