CEN Flashcards
The pressure bag for an ART line should be inflated to what pressure?
300 mm/Hg
What is the most common cause of a dampened waveform on an ART line?
Air in the system
What are the papillary muscles?
Connect to the tricuspid and mitral valves via the chordae tendinae and prevent valve prolapse (regurgitation)
What color of stool would you expect with a patient who has a common bile duct blockage?
Gray
What STD often occurs concurrently with gonorrhea?
Chlamydia
What is normal d-dimer?
Less than 0.5
What is normal prothrombin time (PT)?
12-15 seconds
What is considered a positive PPD result (non-HIV patient)
Induration of 10mm
For HIV patients induration of 5mm
Amytriptyline is an antidepressant (tricyclic) that is sometimes prescribed for pain. How long does it take to achieve a therapeutic effect?
Up to 3 weeks
What time of day should TCA’s be taken?
Bedtime
A patient with Addison’s disease experiencing adrenal crisis (insufficient production of adrenal hormones) would experience which electrolyte imbalances?
Hypoglycemia due to reduced cortisol
Hyponatremia due to low aldosterone
Hyperkalemia due to low aldosterone (sodium and water lost, potassium retained)
Hypocalcemia
Symptoms of rubeola:
Koplik’s spots (bluish/white spots to mouth and throat) appear 1-4 days before rash on face and trunk
Rubella symptoms
Red rash starts on the face and spreads to trunk and extremities. Also may have swollen cervical lymph nodes
Donepezil (aricept) is used to treat:
MOI and potential adverse side effect?
Alzheimer’s
Potentially life threatening cholinergic crisis (sludge effects)
Carbidopa/levodopa
- Trade name?
- MOA?
- Primary disease it treats?
- Sinemet
- Converts levodopa to dopamine (inhibits cholinergic activity)
- Parkinson’s
Memantine:
- Trade name
- Primarily used to treat?
- MOI?
- Namenda
- Alzheimer’s
- Decreases the effects of glutamate, the principal excitatory neurotransmitter in the brain
Selegiline:
- Trade name
- Primarily used to treat?
- MOI?
- Eldepryl
- Parkinson’s
- Inhibits the enzyme monoamine oxidase (thereby increasing dopaminergic action)
List 3 cranial nerves involved in eye movement.
3 - Oculomotor
4 - Trochlear
6 - Abducens
Phenytoin:
- Trade name?
- How should it be administered?
- Dilantin
- Mixed with normal saline (1ml/50mg) and a filter should be used due to the likelihood of precipitation
- Administer slowly and monitor for hypotension
What is the difference between subdural hematomas and subarachnoid hemorrhage?
Subdural can take weeks to develop
Subarachnoid can be occur from aneurysm rupture often precipitated by an increase in ICP from straining or heavy lifting.
What type of headache is associated with an aura signaling the start of the headache?
Migraine
What type of headache is associated with dis function of the trigeminal nerve?
Cluster
Edrophonium:
- What type of drug
- Used for?
- Muscle strengthener
2. Used as a diagnostic test for myasthenia Travis
What are symptoms of autonomic dysreflexia in SCI?
Hypertension, bradycardia, severe distress, pupil dilation
Central cord syndrome symptoms.
Loss of function in upper extremities
Lower extremities not affected
Can’t type, but can dance
A patient complains that his new cast is too tight. What will likely be done?
Bi-valving the cast
A boxers fracture is a fracture of the?
Distal 5th metacarpal
What is a Colles’ fracture?
Evaluation of what nerve should be performed with a Colles’ fracture?
- Fracture of the distal third of the radius
2. Radial nerve
Peroneal nerve injury is associated with what injury?
Tib/fib fracture
Patient may have numbness to the top of the foot and be unable to dorsiflex
Median nerve injury is commonly associated with what injury?
Elbow dislocation
Or wrist fracture
Proper fitting of a walker results in elbows bent at?
30 degrees
Describe the drainage commonly associated with gas gangrene infections.
Thin, watery brown, or brown-gray
How would one test sensory function of the radial nerve?
Assessing for feeling on the dorsum of the hand or base of thumb. Or pinch the webbing between the thumb and index finger
Length of time sutures can be left in place for:
- Face, lips, eyelids?
- Eyebrows?
- Back, chest, arm, hands, thighs?
- Lower legs, feet?
- Face, lips, eyelids? 3-5 days
- Eyebrows? 5-7 days
- Back, chest, arm, hands, thighs? 7-10
- Lower legs, feet? 10-14 days
What are the symptoms of cyanide poisoning?
Restlessness, dizziness, tachycardia, and the odor of bitter almonds
Per HIPPA, a patient can request errors corrected in their medical records within how long?
60 days
Symptoms of benzo withdrawal:
Anxiety, confusion, tremors, temp, flu-like symptoms
Symptoms of lithium toxicity:
Lethargy, ataxia, nausea, vomiting
Normal bicarbonate levels:
22-26
How long in-between MDI dose 1 and 2?
1 minute pause
What is the antidote for heparin toxicity?
Protamine sulfate
Which products necessitate ABO compatibility?
Which do not?
Do: whole blood, PRBC’s, FFP
Don’t: leukocyte poor RBC’s, platelets, albumin
What is a grade a recommendation in surviving sepsis?
Initiate prophylactic measures to prevent DVT and stress ulcers
Tylenol overdose symptoms
Early (first 24hrs)
Mid (24-48 hrs)
Late (48-96hrs)
May be mild early on, May have mild gastric upset, nausea, vomiting
Mid: abnormal labs
Late signs: vomiting, hypoglycemia, right upper quadrant pain
Chlorofluorocarbon trade name?
Signs/symptoms of overdose?
Freon
Loss of consciousness, respiratory depression, thermal burns
What effect would narcan have on GHB overdose?
None. GHB has no antidote. Symptoms are similar to opioid overdose.
Enlarged liver can be a symptom of what type of heart failure?
Right sided
Becks Triad:
- Hypotension
- Muffled Heart Tones
- Distended neck veins
A patient has an inferior wall MI. What is the most likely dysthymia to occur?
Bradycardia
Bethanechol
- Trade name
- Mechanism
- Uses
- Urecholine
- Parasympathomimetic
3a. Urine retention
3b. GERD (stimulates gastric emptying)
Patients with IBS should avoid?
Sorbitol - causes gas bubbles in the intestines
How frequent/what size meals should the pt with esophigitishave?
Small, frequent
Should patients with IBS have water with meals?
No, it can cause distention
Discharge instructions for prostratitis should include:
Increase fluid intake to assist in elimination of bacteria.
No restrictions on sexual activity.
Name 3 foods that may cause dark red urine, and one that doesn’t.
Beets, rhubarb, blackberries.
Strawberries do not.
What type of discharge would you expect for trichomoniasis?
Gray or greenish discharge
What type of discharge would you expect for gonorrhea?
Yellow discharge
What sign (size) is an indication of a viable fetus?
Fundal height 26cm above the pubic symphysis (indicative of 26 weeks gestation which is viable)
How many “kicks per hour” are a good indication of fetal well being?
10/hr
What might you anticipate the pupil to look like with a globe rupture?
Peaked or teardrop
What are some education items for patients with Bell’s palsy?
- Cold exposure can be a precipitating factor
- Eye protection should be worn due to loss of normal blink response
- Artificial tears will need to be used on a regular basis
Lyme disease:
- Caused by?
- Potential symptoms/complications
- Treatment
- Borella burgdorferi, deer ticks
- Expanding bulls eye circle, flu-like symptoms, AV blocks, meningitis, hepatitis, arthralgia
- Antibiotics
What is myxedema coma?
Priority treatment?
Severe hypothyroidism
Supplemental oxygen and airway management
Classic symptoms for measles?
Rash on face spreading downward, bluish gray spots on oral mucosa (Koplik’s spots)
What would be the difference in leukocytes in Viral vs bacterial meningitis?
Difference in protein?
Viral: less than 1000
Bacterial: greater than 1000
Protein: <200 viral
>200 bacterial
In addition to severe headache, what other symptoms are typically present with temporal arteritis?
Red nodules over temples, weight loss, night sweats, aching joints, fever
What is a side effect of IV phenytoin?
What is the max dosage rate of phenytoin?
Hypotension and bradycardia
50mg/min (consider 25mg/min for elderly)
What are the exclusion criteria for iv administration of tPA?
- Uncontrolled hypertension 180/110
- Outside of 180 minute window
- Under 18 years old
- Intracranial hemorrhage
Fat emboli would typically present with petechiae in what area?
Anterior chest and neck
What is the HDVC vaccine for and what site should it always be administered?
Deltoid
Rabies
To test radial nerve function, children with an elbow injury are typically asked to perform what sign?
Thumbs up
What is the recommendation for the use of echinacea in cancer patients?
Contraindicated you’re give to patients with autoimmune disorders as it can stimulate the immune system.
Per EMTALA, the hospital property extends how far from the main building?
250 yards
What is the correct dosage for t-PA (alteplase)?
0.9mg/kg up to 90mg
Corticosteroids can contribute to what side effect, especially in the geriatric population?
Depression
What are the classic symptoms of hypothyroidism?
Confusion, hypotension, bradycardia, and cool/pale skin.
What are the characteristics of Cushing’s syndrome?
Hypertension, bradycardia, abnormal respiration’s
What is a priority intervention for flail chest?
What is proper positioning?
Pain management to promote adequate ventilation.
Position pt on the injured side in semi-Fowler’s position
Indications for a chest tube
Tension pneumo
Hemo-pneumo
Pneumothorax greater than 20%
What is the most common cause of acute bronchitis in the non-smoking patient?
Viral
What unique findings might you find in the ABG of a pregnant patient?
Decreased PaCO2 due to hyperventilation
Decreased bicarbonate as the kidneys compensate for the decrease in PaCO2
The development of coagulopathies after auto transfusion is most likely contributed to what?
Autotransfuaion of 25-50% of total blood volume can lead to dilution of clotting factors
What is the indication for Recombinant human activated protein C?
What is an absolute contraindication for this drug?
Indication: sepsis
Contraindication: risk of bleeding
What is a common treatment for stingray venom?
Warm to Hot water as it helps to dissipate the venom. Resolution of pain is the indication to stop treatment.
Indomethacin is what kind of drug?
What type of pain/diagnosis might it be prescribed for?
NSAID
Pericarditis
What is coarction of the aorta?
Narrowing or pinching anywhere in the aorta, most commonly just after the aortic arch, restricting blood flow to the lower part of the body resulting in lower BP in the lower extremities
What is intussusception?
What are the symptoms?
When part of the intestine telescopes into the other part.
Most commonly occurs in children.
Symptoms: colicky spasmodic pain and red currant jelly stool.
What are the side effects of loperamide?
Indication: anti-diarrhea
Side effects: sedation, dizziness, dry mouth, ileus, constipation
What is one of the most serious complications with bowel obstruction?
Peritonitis
Name one thing that will increase the odds of getting PID?
Having an intrauterine device.
Also adolescents are at increased risk due to immature immune system and thinner cervical mucus.
What type of drug is methotrexate? What are some common indications?
Immunosuppressant and chemo drug.
Treats cancer and may also be prescribed for ectopic pregnancy
A FAST exam cannot be used to identify ??
Retroperitoneal injury
What is the window for reimplanting an avulsed tooth or teeth?
30 minutes due to the death of periodontal ligament cells.
What are the typical symptoms of hypercalcemia?
Hyporeflexia Weakness Weight loss Shortened QT and wide T-wave Polydipsia and polyuria
What are some classic lab findings of Reye’s Syndrome?
Elevated ammonia Elevated SGOT Elevated SGPT Hypoglycemia Lactic acidosis
Spinal fluid normal:
Pressure?
WBC’s?
RBC’s?
Glucose?
Pressure? - 50-200
WBC’s? - 0-5
RBC’s? - zero
Glucose? - 50-75
Classic symptoms of meningococcemia?
Rapid onset fever, petichial rash, purpura. It is a systemic bacterial infection.
Kawasaki disease
Primarily affects 5 and under
Erythematous rash, fever, swelling of hands and feet, cervical lymphadenopathy
What type of drug is aminocaproic acid (amicar)?
Promotes clotting
How does a hepatitis A infection affect the ability to work?
Most people are out of work at least 4-weeks.
Although it is fecally transmitted, blood banks will often not accept donations for up to one year after exposure.
Bluish-gray spots on the oral mucosa (Kopliks spots) are specific to what disease?
Measles
Kopliks spots appear 1-2 days prior to the rash
What is propylthiouracil?
Used to treat thyroid storm. It blocks thyroid hormone synthesis.
What is the drug edrophonium (tensilon)?
Anticholinesterase (inhibits breakdown of acetylcholine) and is used to assess for presence of myasthenia gravis.
Side effects could be respiratory depression and bradycardia
Reversal agent is atropine
What class of drug is nicardipine?
Calcium channel blocker
What spinal cord injury is more commonly associated with pediatric patients?
SCIWORA
Spinal cord injury without radiographic abnormality
What is autonomic dysreflexia?
Typically seen with injuries T6 or higher and results in excessively high BP. Foley placement is often necessary in addition to managing the BP.
Name 4 animals that are presumed rabid unless otherwise proven negative through testing?
Raccoons, skunks, foxes, bats
What is a Colles fracture and what is one identifying characteristic?
Distal radius fracture.
“Silver fork” deformity as the hump deformity resembles the shape of a fork.
Which complication is the most likely to occur 12-48hrs post femoral fracture?
Fat embolism
What lipid soluble drug can be administered via ET tube during cardiac arrest?
Lidocaine
2 doses of 2-3mg
Name 4 herbs that have been shown to affect platelet function and should be avoided by the patient taking aspirin.
Ginger
Garlic
Ginseng
Ginkgo Bilboa
This OTC herb is commonly taken for depression, but should be avoided in the post transplant patient due to increased risk of rejection.
St. John’s Wort
Digoxin toxicity can have what effect on potassium?
Increase
What is the DTaP schedule?
2, 4, 6 months
The first dose of Hib should be given when?
2 months
What is the MMR schedule?
1st - 12 months
2nd - 4-6 years
What type of drug is chlorpromazine?
Possible adverse effect?
Antipsychotic
Extrapyramidal symptoms or dystonic reactions
What sounds are typically described for a pleural rub?
Low-pitched grating sound.
Heard more on inspiration than expiration.
What is the standard pediatric fluid bolus for shock?
20ml/kg
Pediatric hypoglycemia dose
2-4ml/kg of d25
Which equals 0.5-1gm/kg
How many ml/kg is the best estimate of an infants circulating blood volume?
How does this compare to an adult?
90ml/kg
Adult: 70ml/kg
Class 4 shock:
HR >140 Hypotension Confusion Lethargy Blood loss > 2000ml
Signs/symptoms of chlorine gas exposure:
Chest tightness and burning
Cough, shortness of breath
In the case of iron overdose, how long does it take to reach peak iron levels?
3-4 hours
Symptoms may include nausea, vomiting, and bloody diarrhea.
Nutmeg can be abused through excessive ingestion and has gained a reputation as a/an?
Hallucinogen
Palpating under the right costal margin causing inability to take a deep breath is caused by what? What is this “sign” called?
Cholecystitis
Murphy’s sign
Epididymitis is most common at what age?
30-50 years
What is boerhaave syndrome?
Spontaneous effort rupture of the esophagus. Often caused by severe straining or vomiting.
Hyporeflexia is most commonly associated with what electrolyte imbalance?
Hypokalemia
What effect would Addison’s disease have on potassium?
Hyperkalemia
Hyperkalemia can lead to peaked t-waves on an EKG. As the hyperkalemia worsens, what are some changes you might notice on the EKG.
Lengthening or absent p-wave
Enlarging QRS
Sine wave
What are some ekg changes you might note in a patient with hypokalemia?
St depression
Biphasic t-wave
Prominent u-wave
What effect does hypermagnesemia have on deep tendon reflex?
Decreased reflexes
What is chovstek’s sign?
In a patient with suspected low magnesium, tap on the side of the face (temporal and zygomatic region) - due to low magnesium causing muscular irritability, they may scrunch that side of the face.
What is trousseau’s sign?
Another test for hypomagnesemia. Place a BP cuff on the patients arm and inflate to 20 above the known SBP. Leave it inflated and a positive sign is if the muscles in that extremity begin to contract, have tetany, an May even spasm violently.
Name some food that are high in magnesium.
Legumes, chocolate, nuts, grains, leafy greens
