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ACP COPR PREP > AREA 6 > Flashcards

AREA 6 Flashcards

1
Q

(6.1.q) Describe the roles of follicle stimualting hormone (FSH), luteinizing hormone (LH), and progesterone in ovulation and menstruation

A
  • FSH stimulates up to 20 follicles to induce maturation of an oocyte into an ovum per cycle, although only one usually fully matures and is released (the other die via atresia).
  • LH triggers ovulation, wherein a mature ovum is released. The remaining follicular cells form the corpus luteum, which releases…
  • Progesterone triggers the secretory phase of the menstrual cycle, leading to maturation of the endometrium
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2
Q

(6.1.q) List up to 6 functions of the placenta during fetal development

A
  1. Respiratory Gas Exchange
  2. Transport of Nutrients
  3. Excretion of Wastes
  4. Transfer of Heat
  5. Hormone Production (HcG)
  6. Formation of a Barrier (between maternal and fetal circulation)

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3
Q

(6.1.q) At what gestational age is a pregnancy considered “full-term”

A

37-42 weeks

p. 1466

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4
Q

(6.1.q) Which maternal organ undergoes the greatest physiologic change during pregnancy?

A

The uterus
(goes from 2g and 10mL fluid capacity to 1kg and 5L fluid capacity!)

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5
Q

(6.1.q) How can one approximate the appropriate height of the fundus based on gestational age, and what would a low-lying fundus indicate?

A

the top of the fundus should sit the same number of cms above the symphysis pubis as the gestational age (i.e. 32wks = 32cm above the pubis). A low fundus could indicate developmental complications or breech positioning.

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6
Q

(6.1.q) Define the terms “gravid” and “para”

A
  • gravid refers to the total number of pregnancies, of any duration
  • para refers to pregnancies carried to 28 or more weeks gestation (regardless of whether there was a live delivery)

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7
Q

(6.1.q) What is considered typical blood loss during vaginal delivery?

A

up to 500mL

p. 1467

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8
Q

(6.1.q) Describe hematologic and cardiovascular changes during pregnancy

A
  • Blood volume and cardiac output increase by 40-50%
  • Increase in WBC and RBC count (hence the higher risk for anemia during pregnancy)
  • HR increases by 15-20bpm
  • Orthostatic effects on hemodynamics become more pronounced

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9
Q

(6.1.q) Should pregnant patients be intubated with larger, small, or the same size endotracheal tubes as non-pregnant patients?

A

Smaller!
Pregnancy causes edema in the respiratory and oral vasculature.

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10
Q

(6.1.q) A 36YO pregnant patient at 26wks gestation presents with polydypsia, polyuria, and polyphagia. You should be immediately concerned for:

A

GDM (Gestational diabetes Mellitus)

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11
Q

(6.1.q) Blood pressure usually (increases/decreases) during pregnancy

A

Decreases! (especially diastolic)

Blood volume increases, but not pressure during healthy pregnancies

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12
Q

(6.1.q) What are risk factors for preeclampsia

A
  • Maternal Age: either less than 20yrs or advance maternal age
  • Multiple pregnancies
  • Pre-existing HTN, renal disease, and diabetes

p. 1470

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13
Q

(6.1.q) What is the classic triad of findings in preeclampsia? (not including hypertension)

A
  • edema
  • gradual onset of HTN
  • proteinuria

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14
Q

(6.1.q) Describe the pathophysiology of Rh desus of the fetus

A
  • Occurs when Rh-negative mother is pregnant with Rh-positive (inherited from father) fetus
  • RBCs from fetus may stimulate maternal production of anti-Rh antibodies, which go on to attack the fetal RBCs
  • Normally only a problem in subsequent pregnancies, not first ones (mother not yet sensitized)

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15
Q

(6.1.q) What is the preferred agent for treatment of maternal seizures?

A

Magnesium sulfate (bencodiazepines cross the placental barrier and may cause fetal harm)

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16
Q

(6.1.q) A pregnant patient presents with RUQ pain, severe itching of hands and feet, dark urine, and light-colored stools. What is the most likely diagnosis?

A

Cholestasis

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17
Q

(6.1.q) Third-trimester bleeding should (never/sometimes/always) be seen as a dire medical emergency

A

ALWAYS

p. 1474

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18
Q

(6.1.q) What are the three most common causes of third-trimester bleeding?

A
  1. abruptio placentae
  2. placenta previa (most common)
  3. uterine rupture

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19
Q

(6.1.q) Define the gestational age ranges for each of the three trimesters

A
  • First trimester: 1-13 wks
  • Second Trimester: 14-27 wks
  • Third Trimester: 28-40 wks
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20
Q

(6.1.q) What are common causes of placental abruption?

A
  • Hypertension (most common)
  • Trauma
  • Infection

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21
Q

(6.1.q) What are classic signs/symptoms of placental abruption?

A
  • Sudden-onset severe abdominal pain
  • Signs of shock (often out of proportion to blood loss)
  • Vaginal bleeding may or may not be present

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22
Q

(6.1.q) What is the classic presentation of placenta previa?

A

Painless third-trimester bleeding. Blood is usually bright red. Increased risk with increasing maternal and gestational age. (relatively low risk to mother and fetus if found early)

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23
Q

(6.1.q) Describe the classic presentation of uterine rupture

A
  • Always occurs during labour
  • Intially very strong and painful contractions followed by sudden cessation of contractions, with or without bleeding
  • Signs of shock

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24
Q

(6.1.q) Describe the management of third-trimester bleeding (beyond standard management of hemmhorage or shock)

A
  • Place patient in left-lateral decubitus position
  • Use loosely-placed trauma pads over the vagina to attempt to stop blood flow (do NOT pack the vagina)

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25
Q

(6.1.q) Define hyperemesis gravidarum and describe routine prehospital treatment

A
  • severe nausea/vomiting during pregnancy which continues beyond the first several weeks of pregnancy.
  • May lead to severe dehydration
  • Routine management involves transport, fluid replacement, and dimenhydrinate

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26
Q

(6.1.q) Describe the classic presentation of ectopic pregnancy

A
  • severe abdominal pain and signs of shock in a woman of reproductive age
  • Pt. may or may not be aware of pregnancy

p. 1477

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27
Q

(6.1.q) Distinguish between primigravida, primipara (primip), multigravida, multipara (multip), grand multipara, and nullipara

A
  • primigravida: pregnant for first time
  • primipara (primip): has delivered only one baby
  • multigravida: has had 2+ pregnancies
  • multipara (multip): has delivered 2+ babies
  • grand multipara: has delivered 5+ babies
  • nullipara: has never delivered a baby (a mother who is pregnant for the first time is primigravid and nulliparous)

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28
Q

(6.1.q) What are Braxton Hicks contractions and how are they managed pre-hospitally?

A

Intermittent uterine contractions occuring 10-20 minutes apart, usually in the third month of pregnancy. Previously called “false labour”. Management is transport to hospital for further evaluation, as it’s impossible to know in the pre-hospital environment whether the contractions are benign or not.

p. 1479

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29
Q

(6.1.q) The leading cause of death during pregnancy is:

A

Trauma (be especially suspicious of intimate partner violence)

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30
Q

(6.1.q) You should be (more/less) agressive in fluid resuscitation when managing trauma for pregnant patients

A

More!
Due to increased circulating volume, pregnant patients may not demonstrate classic signs of shock until they’ve lost 40% of their blood volume.

p. 1480

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31
Q

(6.1.q) What is the best indication of fetal status following maternal trauma?

A

fetal heart sounds. A HR below 120 bpm or above 160bpm is a sign of fetal distress

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32
Q

(6.1.q) Why must every maternal trauma patient be transported to hospital for evaluation?

A

maternal circulation is prioritized over fetal, so the mother may present with only mild injuries but fetal circulation may be severely compromised due to vasoconstriction

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33
Q

(6.1.q) What is definitive care for cardiac arrest in pregnant patients?

A

emergency cesarean section

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34
Q

(6.1.q) Someone who has contractions that are 5 to 15 minutes apart, has no crowning, and may or may not have ROM (rupture of membranes) is in which stage of labour?

A

first stage (6-12 hrs. depending on gravida/para)

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35
Q

(6.1.q) What are the characteristics of the third stage of labour?

A

the period after the baby is delivered until the placenta has been fully expelled (5-60 minutes)

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36
Q

(6.1.q) What are signs that someone is in the second stage of labour? How long does this stage usually last?

A
  • contractions are 2 to 3 minutes apart
  • Usually there has been rupture of membranes
  • There will be an urge to bear down with contractions
  • Crowning may be present
  • lasts 1-2 hrs. in nulliparous mother, 30 minutes in primip or multip.

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37
Q

(6.1.q) What are the two most important questions that you need to answer in the pregnant patient who’s called for an ambulance?

A
  • Will you need to deliver the baby (i.e. is birth imminent)
  • Which potential complications should you anticipate

p. 1483

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38
Q

(6.1.q) According to Caroline’s, what 5 questions indicate imminent delivery?

A
  1. Is the patient nullip or primip/multip?
  2. What is the nature of the contractions? (regular, forceful contractions with urge to push indicate true vs. “false” labour)
  3. How frequent are the contractions? (less than 2 minutes between indicates imminent delivery)
  4. Is there an urge to have a bowel movement?
  5. Is there crowning (this ALWAYS indicates imminent delivery)

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39
Q

(6.1.q) What questions should be asked to establish potential complications of pregnancy?

A
  1. Has there been prenatal care
  2. What is the gestational age/due date
  3. Has the water broken? What time, what colour?
  4. History of C-section?
  5. Any previous complications?
  6. How many previous children?
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40
Q

(6.1.q) Are rupture of membranes (ROM) or bloody show signs of imminent delivery?

A

No!
Bloody show typically happens in the prodromal stage (prior to stage 1) meaning delivery could be 12 hours or more away. ROM may occur in stage 1 or stage 2, including following delivery of the baby.

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41
Q

(6.1.q) What does it mean if the fundus is at the level of the umbilicus in a pregnant person? What if it is at the level of the xiphoid?

A

umbilicus: patient is 22+ wks. pregnant
Xiphoid: patient is at or near full term

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42
Q

(6.1.q) A mother wishes to deliver her baby while in a standing position. What do you do?

A

Don’t argue! Facilitate whatever birthing strategy or position is favored by the mother

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43
Q

(6.1.q) Compare and contrast the following positions for birthing: Standing, Kneeling, Semi-Fowler, Sims/Modified Sims, Supine lithotomy

A
  • Standing: allows maximal pelvic opening and assistance of gravity
  • Kneeling: done “on-all-fours”. Provides some advantages of squatting (more optimally aligns pelvis and lower back for baby’s head to clear sacrum)
  • Semi-Fowler: essentially the standard position but may assist with bearing down
  • Sims/Modified sims: Left side-lying position with legs and knees flexed 90 degrees (modified sims leaves the bottom leg straight). May assist with rotation of head/shoulder in occiput posterior presentations
  • Supine Lithotomy: the standard position (supine with legs elevated and knees flexed). most safe to do on stretcher.

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44
Q

(6.1.q) What surfaces should be draped with sterile dressings prior to delivery?

A

everything that isn’t the vagina! Under the buttocks, the thighs, and the anterior abdomen

p. 1486

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45
Q

(6.1.q) What is the USUAL orientation of a baby’s head as it begins to crown and during delivery?

A

usually the baby is occiput-anterior (tum-to-bum) and rotates laterally to permit passing of the shoulders

p. 1486

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46
Q

(6.1.q) Describe standard manual manouvers to aid in delivery of a baby in normal positioning (i.e. what do you do with your hands?)

A
  • Begin with gentle pressure on top of head to control rate of descent
  • As head rotates, gently guide baby downwards for passage of upper shoulder
  • Once upper shoulder passes, gently guide baby upwards for passage of lower shoulder
  • Once both shoulders pass, expect rapid delivery of trunk and legs, be ready to catch!
  • Back, Down, Up, catch!

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47
Q

(6.1.q) While delivering a baby in standard positioning, you notice a nuchal cord. What is nuchal cord and what should your next steps be?

A
  • Nuchal cord is a cord wrapped 360-degrees around baby’s neck
  • Attempt to gently slip cord over baby’s shoulder/head
  • If this is unsuccessful, place clamps 5cm apart and cut the cord between the clamps
  • Prepare for neonatal resuscitation
  • (note that the “flip the baby” technique taught in class is not endorsed by caroline’s)

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48
Q

(6.1.q) When should you assign an APGAR score for a new baby?

A

at 1 and 5 minues after birth

p. 1487

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49
Q

(6.1.q) Where should clamps be placed prior to cutting the umbilical cord?

A

20cm from the baby, 5cm apart

p. 1487

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50
Q

(6.1.q) After clamping and cutting the umbilical cord, you noticed ongoing bleeding from the placental end of the cord. What do you do?

A

apply a second clamp PROXIMAL to the clamp you have already placed

p. 1487

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51
Q

(6.1.q) Describe manual manouvers to facilitate delivery of a breech presentation.

A
  • Initiate Transport if possible!
  • Place mother in semi-fowler’s with buttocks hanging over edge of stretcher/bed
  • Allow buttocks/legs to be delivered spontaneously. DO NOT Pull
  • Once legs are passed, gently support baby’s back and lower as if baby is “hanging” from vagina. This will faciliate the head passing into the vagina.
  • Once the shoulders are passed and the head is in the vagina, elevate the baby’s body to create neck flexion.
  • If the head does not pass in 3 minutes, place your gloved hand in the vagina in a “V” configuration and grasp baby’s head/shoulders to flex the neck.

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52
Q

(6.1.q) What is standard pre-hospital management for footling or transverse presentations?

A

Rapid Transport! Do not attempt delivery in the field. Position woman supine with hips elevated and encourage her to pant during contractions to delay delivery.

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53
Q

(6.1.q) Describe pre-hospital management of cord prolapse (NOT nuchal cord)

A
  • Do not attempt delivery in the field.
  • Position woman supine with hips elevated and encourage her to pant during contractions to delay delivery.
  • Treat for shock (100% O2, etc.)
  • Place 2-3 fingers in the vagina and gently push the baby’s head (NOT the cord) back into the vagina)
  • Place moist, sterile dressings over the presenting cord
  • Initiate RAPID transport

p. 1490

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54
Q

(6.1.q) Describe signs and managment of shoulder dystocia

A
  • Head passes normally but then retracts folowing each contraction
  • More common with high birth weight (late gestational age, gestational diabetes)
  • Attempt supine positioning, buttocks hanging off bed, legs flexed, firm pressure above symphisis pubis
  • If not successful, attempt “all-fours” positioning or modified sims
  • If not successful, initate transport

p. 1490

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55
Q

(6.1.q) What is the usual timeframe for delivery of multiple babies

A
  • Contractions usually start 5-10 minutes after first delivery
  • Second delivery usually occurs within 30-45 minutes

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56
Q

(6.1.q) Describe the definition and management of postpartum hemorrhage

A
  • Third stage bleeding more than 150-500mL
  • Begin fundal massage
  • Place baby at mother’s breast
  • Consider fluid resuscitation
  • Do NOT pack the vagina
  • Control external (i.e. perineal) bleeding with direct pressure
  • Rapid trtansport

p. 1491

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57
Q

(6.1.q) Under what circumstance is agressive, early suctioning of the neonatal hypopharynx appropriate?

A

meconium-stained amniotic fluid

58
Q

(6.1.q) should you attempt replacing an inverted uterus?

A

YES! (but only once). If this fails, cover tissues in moist, sterile dressings

p. 1493

59
Q

(6.2.a) Describe the primary physiologic changes in the neonate during “transition” (changes after a neonate begins to breath independently)

A
  • Lungs inflate and pulmonary vascular resistance drops substantially
  • The three “shunts” close; the ductus venosus, the ductus arteriosus, and the foramen ovale

p. 1507

60
Q

(6.2.a) Which of the following are NOT considered to be risk factors for requiring neonatal resuscitation?
1. Multiple Gestation
2. Maternal age of 18y
3. Pre-eclampsia
4. Polyhydramnios or oligohydramnios
5. Inadequate prenatal care
6. PROM (premature rupture of membranes)
7. MSAF (meconium-stained amniotic fluid)
8. Maternal multiparity
9. Maternal fever
10. Use of narcotics within 4 hrs. of delivery

A

Maternal age of 18y and Maternal multiparity
Maternal age is not considered a risk factor unless under 16y or over 35y
Multiparity is not considered a risk factor for the neonate, although previous C-sections increase the risk for uterine rupture

p. 1506/1507

61
Q

(6.2.a) Which of the following is NOT considered standard equipment when preparing for neonatal resuscitation?
1. A size 4.5 ETT
2. Oxygen source with flow meter
3. Clean towels/linens
4. Epinephrine 1:10,000

A
  1. A size 4.5 ETT
    typically, the largest size ETT used in NRP is 3.5

p. 1508

62
Q

(6.2.a) Which of the following is considered routine care for the newly-delivered neonate?
1. Suction the oropharynx of any secretions
2. Dry the infant and wrap them in linens or place on mother’s bare skin
3. Obtain an APGAR score at 5 and 10 minutes
4. Apply oxygen to obtain an SpO2 of 100%

A

2, Dry the infant and wrap them in linens or place on mother’s bare skin
routine suctiononing is no longer recommended unless there is MSAF or airway obstruction. APGAR is obtained at 1 and 5 minutes. Oxygen should only be applied as part of NRP and should follow time-specific targets

p. 1510

63
Q

(6.2.a) A baby is born with blue extremities and HR of 80. They appear irritated but do not cry when stimulated and they are limp in the provier’s hands. They are not crying at all. What is their APGAR score?

A

A1P1G1A0R0=3

p.1510

64
Q

(6.2.a) 5 minutes after being born, a baby is centrally and peripherally cyanotic and has a HR of 120. They cry out when stimulated and weakly flex their extremities. Their crying is slow and irregular. What is their APGAR score and what is the significance of this finding? What should your next step be?

A

A0P2G2A1R1=6
Any score less than 7 at 5 minutes is considered poor and requires further monitoring. You should intiate early transport and assign a new APGAR score every 5 minutes until 20 minutes after birth.

p. 1510

65
Q

(6.2.a) What four questions indicate the need to initiate the NRP algorithm?

A
  • Term? (is the baby full term)
  • Tone? (good muscle tone)
  • Color? (of the amniotic fluid) (this is in caroline’s but not NRP)
  • Crying? (or breathing normally)

p. 1514

66
Q

(6.2.a) You have delivered a baby at 31 weeks gestation. What should your first steps be?
1. Vigorously dry and stimulate the baby
2. Assess for breathing and pulse for 10s, start PPV if needed
3. Place the baby in a food-grade plastic bag, without drying
4. Start chest compressions if HR is less than 60 bpm.

A

.3. put the baby in a bag
Do not vigorously dry babies who are less than 32wks gestation. Putting the baby in the bag happens prior to initiation of PPV or consideration of chest compressions

p. 1514

67
Q

(6.2.a) You’ve delivered a baby at 39wks gestation, the mother is an IV drug user and states she used fentanyl 2 hrs. prior to delivery. The baby has poor respiratory effort and tone. After 30s of drying and stimulation, they continue to have poor respirations and are globally cyanotic, what should you do next?

A
  • Assess breathing and circulation
  • If apneic or if HR is less than 100bpm, begin PPV
  • If breathing and HR is greater than 100bpm, give supplemental O2
  • DO NOT GIVE NALOXONE (SERIOUSLY! DON’T DO IT!)

p. 1514

68
Q

(6.2.a) 1 minute after delivering a term baby they remain apneic and cyanotic with a HR of 50. You begin PPV for 15 seconds with no improvement in HR or colour. What should your next step be?
1. Attach the cardiac monitor while continuing PPV
2. Begin chest compressions with PPV at a 3:1 ratio
3. Ensure that the BVM is attached to a 100% O2 source
4. Adjust the mask seal and reposition the baby’s head and neck

A

.4. adjust the mask seal and reposition

If PPV does not immediately correct bradycardia/apnea, proceed via MRSOPA. Attaching the cardiac monitor is not considered essential until corrective ventilatory steps have begun. Term babies should be ventilated at an FiO2 of 21% (room air)

p. 1512, NRP 8th

69
Q

(6.2.a) While attempting to pass a nasogastric tube in a neonate, you notice that the tube coils in the posterior nasopharynx bilaterally. The baby has appeared distressed since birth, with increased respiratory effort and persistent cyanosis. What is the likely cause, and what treatment is available?

A

Bilateral choanal atresia (bony or membranous coverings over the openings at the posterior nasopharynx). May be treated by placing an oral airway

p. 1512

70
Q

(6.2.a) After delivering a baby at 36wks (3000g), you found them to be persistently cyanotic, apneic and bradycardic. Despite PPV and corrective steps, including placement of a 3.5mm ETT, the HR remains below 60BPM. After starting chest compressions, what should your next step be?
1. Administer 0.01mg/kg 1:10,000 epinephrine via IO
2. Administer 3mL of 1:10,000 epinephrine via ETT
3. Administer 0.3mL 1:10,000 epinephrine via UVC
4. Adminiter 0.03mg of 1:10,000 epinephrine via ETT

A

.2. Administer 3mL of 1:10,000 epinephrine via ETT
Recommended dosing is 0.02mg/Kg IV/IO or 0.1mg/kg ETT. This translates to 0.2mL/kg or 1.0mL/kg of 1:10,000 epinephrine, respectively

NRP 8th

71
Q

(6.2.a) A diabetic mother has delivered a SGA (small for gestational age) baby. Although the baby initially looks well, you notice en route that they are repeatedly blinking and making pedalling motions with their legs. What do you think is happening and what should you do next?

A
  • This is likely a seizure
  • Ensure airway and ventilation are intact
  • Check an immediate blood glucose (should be 2.6mmol/L or greater)

p. 1522

72
Q

6.1a Nancys ch.27
Describe an aneurysm (Intrachranial, aortic)

A

Aneurism is an out-pouching of a vessel.

73
Q

6.1a Nancys ch.27
Describe Arteriosclerosis of the coronary and cerebral arteries, as well as associated patient risk factors.

A

A pathologic condition where arterial walls become thick and inelastic.

Common risk factors include HTN, Smoking, diabetes, obesity, familial hx.

74
Q

6.1a Nancys ch.27
Describe the condition of a DVT, and associated risk factors.

A

DVT: Deep vein thrombosis

Risk factors include recent trauma, inactivity, pregnancy, varicose veins

75
Q

6.1a Nancys ch.27

What is Homans sign?

A

Discomfort behind the knee with dorsiflexion of the foot.

Positive hit for DVT

76
Q

6.1a Nancys ch.27
Describe the criteria for a hypertensive emergency

A

Acute elevation of BP over 200/130 with evidence of end-organ damage.

77
Q

6.1a Nancys ch.27
What are three examples of peripheral vascular disease?

A

Carotid bruits, claudication, phlebitis

78
Q

6.1a Nancys ch.27
When a thoracic aortic dissection occurs, what occurs to the vessel itself?

A

The intima is torn, and blood creates a false channel between the intima and medial layers of the vessel.

79
Q

In 65% of thoracic aortic dissections where does the dissection occur?

A

Just distal to the aortic valve.

80
Q

6.1A Nancys ch.27.4

Describe Endocarditis

A

A rare, but life threatening infection of the internal linings and valves of the heart

81
Q

Porths:

What are four common causes of endocarditis?

A

-Mitral valve prolapse
-Congenital heart disease
-prosthetic heart valves
-implantable devices

82
Q

6.1a Nancys ch.27.4
What is myocarditis, what causes it, and who is it frequently found in?

A

Myocarditis is a less severe infection of myocardial tissues, can be a-symptomatic

-Causes by viral infection
-Frequently seen in patients with AIDS

83
Q

6.1a Nancys ch.27.35

Describe pericarditis

A

Inflammatory/infectious process from too much fluid within the pericardium.

84
Q

6.1a Nancys ch.27.4

Describe common ECG findings in pericarditis

A

-Diffuse ST elevation and PR Depression

85
Q

6.1a Nancys ch.27.25

Describe Acute Coronary syndromes (ACS)

A

-Any group of clinical symptoms consistent with acute MI.

-spectrum–> (stable angina, unstable angina, N-STEMI, STEMI)

86
Q

6.1a Nancys ch.27.25

Describe angina pectoralis

A

ischemic chest pain caused by a supply demand mismatch of oxygen delivery to the heart muscle.

Usually caused by atherosclerotic plaque build up

87
Q

6.1a Nancys ch.27.26

Describe a transmural MI and subendocardial MI

A

-Trasnmural extends through the entire wall of the ventricle

-Subendocardial effects the inner layer only

88
Q

6.1a Nancys ch.27.31

Describe heart failure and recall the associated mortality rate.

A

The heart is not able to pump blood and and it backs up into the systemic or pulmonary system.

Average mortality 10% per year, 50
% 5-year survival rate.

89
Q

6.1a Nancys ch.27.32

Describe Left sided HF

A

RV is operating appropriately, LV cannot pump resulting in blood backing up and causing pulmonary congestion/edema

90
Q

6.1a Nancys ch.27.32

Describe Right sided HF

A

Most common cause of RV disfunction is LV dysfunction. Also caused by PE, COPD.

-Blood backs up into systematic circulation

91
Q

6.1a Nancys ch.27.34

Describe Pericardial tamponade

A

Describe as excessive fluid accumulation within the pericardium, limiting the hearts ability to expand after each contraction (Obstructive shock) resulting in decreased Cardiac output.

92
Q

Porths 835

Describe Atrial septal defect

A

-Hole in the heart dividing the R and L atria resulting in a L-R shunt.

2:1 frequency in females over males

93
Q

Ports 834

Describe a patent ductus arteriosis

A

PDA is defined as open beyond 3 months

Normally for fetus, the ductus Arteriosis diverts blood from the R side of the heart and away from the lungs.

-Normally Closure occurs at birth when spontaneous respiration begins.

94
Q

Porths 838

Describe transposition

A

aorta comes from the RV and pulmonary arteries from the LV

-1/4000 births, presents with cyanosis

95
Q

Porths 835

Describe Ventricular septal defect

A

-Opening between ventricles causing a L to R shunt.

-28-42% equal distribution between male and female.

96
Q

6.1b provide care to patients experiencing neurological S/S

Describe Seizures, list 6 types and define status epilepticus

A

Seizure(s) is a sudden, erratic firing of neurons-Nanys p.1113

Defined as…
-Generalized (tonic-clonic)
-Absence
-Pseudoseizures (psychogenic non-epileptic)
-partial/focal
-Febrile
-Status seizures (4-5 min long in duration, or consecutive seizures without return of consciousness.

97
Q

Describe meningitis

A

Inflammation of the meninges of the brain and spinal cord secondary to infection.

-Most commonly bacterial/viral

S/S consist of fever, chills, stiff neck, headache, photophobia, seizures, petechial rash, kerning or brudzinski sign.

98
Q

Describe Encephalitis

A

Inflammation of the parenchyma of the brain or spinal cord typically due to infection (viral).

-S/S similar to meningitis. Should not produce kerning or brudzinskis sign.

99
Q

Define and differentiate vascular vs organic headaches.

A

Vascular: Cluster headaches or migraines

-migraines: last minutes-several days, unilateral, may be associated with an aura

-Cluster: series of one-sided headaches, sudden and intense lasting 15min to 4 hours.

Organic: less common, occurs in people with tumours, infection, diseases of the eye or brain.
-Sinus Headache: Due to inflammation/infection of the sinus cavities, pain over upper portion of the face worse when pt bends over.

100
Q

Define a Stroke/CVA

A

Damage/destruction of brain tissue caused by ischemic or hemorrhagic lesions to a portion of the brain.

101
Q

Define an ischemic stroke/occlusive CVA

A

Thrombotic or embolic, occurs when clot or other material occlude blood flow from regions of the brain.

S/S include FAST-VAN symptoms.

102
Q

Define hemorrhagic stroke

A

Most commonly arteriovenous, malformations, and aneurysms but may also be traumatic.

S/S include, thunderclap headache, nausea/vomiting, DLOC, signs of increased ICP, seizures. Badness

103
Q

Nancys p. 1110

Describe the 2 sections of Altered mental status and its subsections

A
  1. TOX/METABOLIC
    -anoxia
    -DKA
    -Hepatic failure
    -Hypoglycaemia
    -Renal failure
    -Thiamine deficiency
    -Toxic exposure
  2. Structural
    -Neoplasm
    -Degenerative disease
    -Inter-cranial hemorrhage
    -Parasites
    -Trauma
104
Q

Define
AEIOUTIPS

A

A-alcohol, acidosis
E-epilepsy, endocrine, electrolytes
I-Insulin
O-opiates, other drugs
U-uremia (kidney failure)
T-Trauma, temperature
I-Infection
P-poisoning, psychogenic
S-Shock,stroke,syncope, space-occupying lesion, subarachnoid hem.

105
Q

Define Syncope

A

sudden and temporary loss of consciousness with accompanying loss of tone.

-occurs when cerebral perfusion is disrupted

Causes can be arrythmogenic, cardiac, non-cardiac

106
Q

Define Alzheimers

A

A degenerative brain disorder, and is the most common cause of dementia in elderly people

107
Q

Define Amyotropic lateral sclerosis (ALS) (Lou Gehrigs)

A

ALS is a degenerative disease affecting voluntary motor neurons.

108
Q

Which cranial nerve is inflamed in bells palsy cases?

A

Cranial nerve 7, the facial nerve

109
Q

How is Levodopa is used to treat Parkinson’s disease?

A

Dopamine is needed for smooth muscle contraction, Levodopa helps to restore dopamine levels

110
Q

6.1e
What are two typical ominous signs for fluid loss?

A

Cullens sign-Bruising around the periumbilical area

Grey Turners sign-Bruising to the flanks

111
Q

6.1e

List the three types of GI pain.

A
  1. Visceral pain-originates in the walls of hallow organs
  2. Somatic-Sharp localized pain within the wall of the muscles
  3. Refereed pain originates in a region other than where it is felt.
112
Q

Esophageal varicies is usually caused by…

A
  1. ETOH
  2. Caustic substance ingestion
  3. Cirrhotic liver disease
113
Q

6.1e
What are the 6 identifiable causes of upper GI bleeding.

A
  1. peptic ulcer disease
    2.Gastritis
    3.Varix Rupture
  2. Mallore-Weis tear
  3. Esophagitis
  4. Duodenitis
114
Q

6.1e
List the four major causes of lower GI bleeding

A

1.diverticulosis
2. colon lesions
3. rectal lesions
4. inflammatory bowel disorder

115
Q

Nancys 29.24
Addisons disease is described as

A

-Primary Adrenal insufficiency

Decreased adrenal cortex function. Lacking of cortisol and aldosterone function.

-results in low BP, low stress hormone, slows inflammatory response.

116
Q

Nancys 29.16
Describe Cushing Disease

A

Excess cortisol production by adrenal glands

117
Q

Nancys 29.8

Describe Diabetes mellitus

A

T1 (Can lead to DKA) , T2. (Lead to HHNK)

A metabolic disorder where the body ability to metabolize glucose is impaired.

118
Q

What are the two most common electrolytes involved in electrolyte imbalances?

A

Potassium and calcium

K+ 3.5-5.0meq/L
Ca++ 8.2-10.2 mg/dL

119
Q

Where is sodium primarily found and what role does it play?

A

Within the blood and fluid outside of the cells, plays a role in regulating fluid balance, total fluid volume, and BP

120
Q

What is a common electrolyte involved in flaccid paralyisis

A

K+

Hypok.

121
Q

In myxoedema coma, will these patients be typically male or female?

A

4-8x more likely in women.

122
Q

What is hyphema?

A

A condition where blood enters the anterior chamber of the eye between the iris and cornea. Caused by trauma

S/S:
-visual blood IFO eye
-photophobia
-Pain
-Blurred vision

123
Q

What is glaucoma?

A

A group of conditions that lead to increased intraocular pressure.

124
Q

What is retinal detachment?

A

Commonly caused by trauma and aging, retinal detachment can be rhegmatogenous (aging), tractional (diabetes), or exudative (trauma, tumour, inflammation)

125
Q

What is retinal detachment?

A

Commonly caused by trauma and aging, retinal detachment can be rhegmatogenous (aging), tractional (diabetes), or exudative (trauma, tumour, inflammation)

126
Q

6.1K
Define pharmacokinetics

A

Activity of drugs in the body (what the body does to a drug)

127
Q

6.1k
Define pharmacodynamics

A

The mechanism of action of a drug within the body

128
Q

6.1k
Define Bioavailability

A

The percentage of unchanged substance that is present within systemic circulation

129
Q

6.1k
Define the half-life of a drug

A

the amount of time it takes the average person to metabolize or eliminate 50% of a drug within the plasma

130
Q

6.1K
Define potentiation

A

The enhancement of the effect of one drug by another drug

131
Q

List the four routes of entry to the body.

A

Inhalation
Ingestion
injection
absorption

132
Q

What are the five major classes of toxidrome.

A

Narcotics
Sympathomimetics
Cholinergics
Anti-cholinergics
Sedative hypnotics

133
Q

What type (s) of toxidrome classes cause mydriasis (dilated pupils)

A

Sympathomimetics
Anticholinergics

134
Q

Which types of toxidrome classes cause miosis (constriction of pupils?)

A

Narcotics
Cholinergics

135
Q

What is the mechanism of action for TCA medications?

A

TCA’s are norepinephrine and serotonin reuptake inhibitors, causing sympathomimetic and seritonergic effects, muscarinic and histamine blockade

136
Q

SSRI mechanism of action

A

Inhibits the breakdown of serotonins and enhance serotonergic neurotransmission

137
Q

Describe Serotonin syndrome

A

When multiple medications such as SSRI, TCA, MAOI’S, Lithium, stimulants and opcodes are ingested.

S/S include tachycardia, delirium, HTN, Diaphoresis, diarrhea, muscle rigidity, myoclonus, hyperreflexia, trismus.

138
Q

Describe delirium tremens

A

Serious and life-threatening complications from alcohol withdrawal starting 48-72 hours after having last drink.

139
Q

Describe Korsakovs psychosis

A

Psychosis characterized by memory disorder, disorientating, muttering delirium, insomnia, delusions, hallucinations. Caused by ETOH and thiamine deficiency.

Possibly irreversible

140
Q

Define wernickes encephalopathy

A

Acute but reversible encephalopathy due to thiamine deficiency from chronic ETOH. Results in loss of memory, and disorientation.

141
Q
A

ACP COPR PREP (12 decks)

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