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CFD Paramedic Course > Dale's Review Concepts III > Flashcards

Dale's Review Concepts III Flashcards

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1
Q

At what altitude do ppl start getting altitude sickness? What onset?

A

About 6500 ft, 6-10hr onset

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2
Q

What factors determine severity of altitude sickness

A

Rate & height of ascent

Prior Hx AMS & obesity

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3
Q

What height can ppl get acute mountain sickness (AMS)

A

< 6600ft

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4
Q

Pt has throbbing headache on side/back during a mountain ascent. They feel NVD, weak, and are breathing fast. What’s wrong?

What Rx?

A

Acute mountain sickness

Rx = acetazolamide (promotes metabolic acidosis) & descent

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5
Q

During an ascent, pt has SOB at rest, cough, tight chest, congestion, cyanosis w/ adventitious lung sounds. What’s wrong?

What Rx?

A

HAPE (high altitude pulmonary edema)

Rx = Pulmonary vasodilator (ex. Albuterol) , CPAP, & descent

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6
Q

During an ascent, pt has a change in mental status and has become confused. What’s wrong?

What Rx?

A

HACE (high altitude cerebral edema)

Rx = dexamethasone (8mg then 4mg/6hr)

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7
Q

During a dive, pt begins feeling drunk w/ AMS. What’s wrong?

What Rx?

A

Nitrogen narcosis (rapture of the deep) = AMS DT breathing compressed nitro

Rx = ascend & use better air mix next time

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8
Q

Why do pts feel drunk in nitrogen narcosis?

A

Nitrogen binds to the same brain receptors as ETOH

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9
Q

What gas law pertains to the pathophysiology of nitrogen narcosis?

A

Dalton’s law. Divers need to calculate what % of nitro vs O2 mix depending on depth of dive

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10
Q

What is barotrauma?

A

Gas pressure in body vs outside = compression or expansion injury

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11
Q

What parts of the body are very susceptible to barotrauma?

A

Sinuses, GI, lungs, stomach, skin, joints, ear

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12
Q

During ascent from a dive, pt experiences severe CP, sub Q emphysema, dysphagia, crackles in lungs w/ hemoptysis. What’s wrong?

What Rx?

A

Pulmonary Overpressurization syndrome (POPS) = most severe form barotrauma.

Rx = avoid PEEP. Be careful bagging. Give O2 & transport.

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13
Q

What are the complications of POPS

A

POPS result = alveolar rupture = possible pneumo, embolism, arterial gas embolism

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14
Q

Explain Arterial Gas Embolisms

A

Air bubbles from capillaries = MI or CVA

CVA = most common DT head being highest point in body

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15
Q

Any diver that has LOC or AMS following a dive, you must assume … what?

What Rx?

A

Arterial Gas Embolism (AGE)

Rx = L lateral poc, monitor, hyperbaric chamber

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16
Q

Following a dive, pt complains severe abdominal and joint pain, w/ mottled skin. What’s wrong?

What Rx?

A

Decompression sickness (the bends aka cassions disease)

Rx = hyperbaric chamber

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17
Q

How does decompression sickness affect the body? What gas law is it connected to?

A

Nitrogen bubbles out of your blood during an ascent (Henry’s law) and fucks w/ perfusion as well as the body.

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18
Q

What kind of people are at risk for experiencing decompression sickness (the bends)

A

Obese, dehydrated, flying after a dive

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19
Q

What are the 2 main families of snakes in the US?

A
  1. Crotalinae (pit vipers)

2. Elapidae (coral snakes)

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20
Q

What are the different types of pit vipers (crotalinae)?

A

Rattle, cottonmouth, diamondback

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21
Q

How can you differentiate a venomous coral snake from a harmless king snake?

A

“Red on yellow, kill a fellow” “red on black, venom lack”

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22
Q

Pt was bit by a snake, now has swelling, necrosis of wound, systemic bleeding, and coagulopathy. What kind of snake was it?

A

Pit viper (crotalinae)

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23
Q

Pt was bit by a snake, now has neuro seizures, paralysis, slurred speech, double vision, NV weakness. What kind of snake was it?

A

Coral snake

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24
Q

What general Rx for a snake bite?

A

IV, monitor, antivenin, clean & immobilize wound below heart level (minimize movement)

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25
Q

Pt was bit by a snake, now has pain, muscle spasms and seizures, paralysis w/ board like abdomen. What spider bit them?

What Rx?

A

Black widow = neuro SS

Rx = calcium gluconate w/ a benzo

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26
Q

Pt has bit by something less than 2 days ago. Now has scabbing and necrosis of wound site. What bit them?

What Rx?

A

Brown recluse spider

Rx = supportive Rx & transport. Definitive Rx = surgical debridement

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27
Q

Pt has hx being outside in hot, humid weather. Now has muscle spasms in legs & abdomen. What’s wrong? What Rx?

A

Heat cramps

Rx = restore salt and fluids (crackers & Gatorade)

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28
Q

Following several hours outside in hot, humid weather, pt CC syncope. What’s wrong?

What Rx?

A

Heat syncope (vessels dilate & BP drops DT heat stress)

Rx = supine position & fluids

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29
Q

Pt has Hx being outside in hot/humid weather now complains weak, NVD, positive orthostatic, mildly elevated temp, sweat skin. What’s wrong?

What Rx?

A

Heat exhaustion

Rx = supine, fluids, passive cooling.

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30
Q

What’s EAH? What Rx?

A

Exercise-associated hyponatremia = heat exhaustion where pt sweats & restores fluids but not sodium.

Rx = hypertonic w/ passive cooling

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31
Q

After a sporting event outside in hot humid weather, pt complains SOB, NVD, weakness w/ pulm edema. What happened?

A

Exercised - associated hyponatremia (EAH). Pt over compensated w/ drinking excessive water = fluid overload = pulmonary edema

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32
Q

What’s the difference between a classic vs exertional heatstroke?

A

Classic = passively overheat (dry red hot skin)

Exertional = actively overheat = pale sweaty skin

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33
Q

Following a hot day, pt has hot skin, AMS, CBT > 104F, bounding pulse. What’s wrong?

What Rx?

A

Heat stroke

Rx = rapid cooling, target 102F or lower temp, fluids, BGL, prep for seizures/rhabdomyolysis

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34
Q

Heat stroke can mimic what other emergencies?

A

Sepsis, fever, infection, anticholinergic OD

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35
Q

How to differentiate anticholinergic OD vs heat stroke

A

Anticholinergic OD = dilated pupils

Heat stroke pupils = pinpoint

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36
Q

What is neuroleptic malignant syndrome?

A

Antipsychotic & antiemetic meds cause heat stroke

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37
Q

What is malignant hyperthermia?

A

Anesthesia meds (Succ) causes heat stroke

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38
Q

What is somatic/parietal pain?

A

Localized & intense pain

*think: somatic = soDRAmatic

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39
Q

What is visceral pain?

A

Poorly localized, diffused

*think: visceral = viscerALL-over pain

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40
Q

You suspect pt has ICP. What SS to look for?

A

Cushings reflex: Bradycardia, HTN, Cheyenne stokes respirations

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41
Q

Pts w/ head injury becomes hypoxic DT lack of…

A

Lack of minute volume

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42
Q

Trauma pt shows Cushings reflex, Cheyenne-stokes, vomit w/ no nausea. What severity of ICP do they have?

A

Mild

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43
Q

Trauma pt shows biot respirations, blown pupils, flaccid paralysis… what severity of ICP do they have

A

Severe

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44
Q

Trauma pt has Cushings reflex, Central neurogenic hyperventilation, decerebrate posturing… what severity of ICP do they have?

A

Moderate

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45
Q

Pt has too much cortisol in their system DT a tumor or gland issue. What endocrine disease do they have?

A

Cushings disease

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46
Q

Pt complains weakness, depression, irritable mood, polydipsia polyuria, high BGL, weight gain, moon face/Buffalo hump, stretch marks. What’s wrong?

A

Cushings disease

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47
Q

Pediatric pt is in sniffing position, CC SOB: stridor, drooling, high work of breathing. Pt has previous Hx upper Resp infection. What’s wrong?

What Rx?

A

Epiglottitis

Rx = humidified O2, keep them calm, nothing in mouth, ask about Hib vaccine

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48
Q

Your epiglottis pt is rapidly decompensating and you anticipate intubation. How would you prepare?

A

Drop 1-2 sizes BELOW recommended size

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49
Q

What age kids typically get epiglottitis?

A

2-7Yrs

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50
Q

What’s the fancy medical name for croup

A

Laryngotracheobronchitis

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51
Q

Pt has stridor, seal bark cough, cold SS, low grade fever, work of breathing (worse at night). What’s wrong?

What Rx?

A

Croup (laryngotracheobronchitis)

Rx = expose to extreme air, no humidified O2, racemic epi, steroids, prepare BVM & ETT

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52
Q

During labor, mom suddenly feels a sharp tearing pain in her pubic area. You are now able to see an outline of the fetus through mom’s belly. What happened?

What Rx?

A

Ruptured Uterus

Rx = treat for shock and transport

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53
Q

Female pt complains severe pn during & after period, fetal position, shuffle gait, smelly discharge. What’s wrong?

What Rx

A

PID

Rx = transport

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54
Q

What is PID and who gets it usually?

A

Infection of women’s reproductive organs. Mostly sexually active girls <25 yrs

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55
Q

What are the risk factors for PID?

A

STDs, IUD, douching, abortion, multiple sex partners

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56
Q

What are the complications of PID?

A

MODS, sepsis, abscesses, infertility, ectopic pregnancy

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57
Q

Pt is anxious w/ NV thirst, SOB, weak rapid pulse, cool clammy skin. Compensated or decompensated shock?

A

Compensated. Pt will be altered not anxious.

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58
Q

How are skin signs different between compensated vs decompensated shock?

A

Compensated = cool clammy

Decompensated = ashen/mottled, cyanotic

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59
Q

Pt has no urine production, dilated pupils, thready pulse, hypotension. Compensated vs decompensated shock?

A

Decompensated shock

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60
Q

Pericardial tamponade, aortic dissection, PE, tension pneumo… all are what singular type of shock are they in?

A

Obstructive shock

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61
Q

What are the three types of distributive shock?

A

Anaphylaxis, neurogenic, septic

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62
Q

Distributive shock = ____ failure

A

Pipe failure

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63
Q

What is the medical word for a bladder infection

A

Cystitis

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64
Q

How do people usually get cystitis?

A

Bacteria from taint travel up urethra

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65
Q

Untreated cystitis can eventually spread upwards to the kidneys. What is this called?

A

Pyelonephritis

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66
Q

What is pyelonephritis and why is it serious?

A

A kidney infection secondary to an untreated bladder infection. Pt risks losing their kidney

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67
Q

Pt complains cloudy, painful urine. Pt has hematuria & polyuria, w/ Hx fever. What’s wrong?

A

Cystitis

68
Q

What defines a 1st degree heart block?

A

No dropped QRS complexes, but prolonged PRI (normal = 0.12-0.20s)

69
Q

Second degree type I vs Type II heart blocks?

A

Type I (wenchbach) = progressively longer PRI then dropped QRS

Type II = consistent PRI then dropped beat

70
Q

2nd degree heart blocks are commonly caused by what location of MI?

A

Anterior/anteroseptal wall MI because it supplies the AV node

71
Q

Geriatric pt has CC: dizziness, syncope, palpitations, w/ ECG that alternates between Bradycardia & tachycardia. What’s wrong?

What Rx?

A

Sick sinus syndrome

Rx = pacemaker

72
Q

How can you tell if someone has a 3rd degree heart block?

A

QRS complexes are regular, P waves are also regular but neither of them sync up

73
Q

What is Prinzmetals angina? What is another name for it?

A

AKA vasospastic angina = angina/CP DT coronary arteries spasming

74
Q

How can you assess for L side hypertrophy on a 12-lead?

A

V1 or V2 (biggest S depth) + V5 or V6 (biggest R height) = >7 boxes

75
Q

How can you assess for R side strain on a 12-lead ECG?

A

S1QT3

Also, V1 = R wave > S wave

76
Q

How does ICP present on a 12-lead?

A

ICP = cerebral T waves = deep inverted symmetrical T waves on V-leads & prolonged QT interval

77
Q

What do alpha 1 receptors do?

A

Vasoconstriction of arteries & veins

78
Q

What do alpha 2 receptors do?

A

Less insulin/norepi

More glucagon

79
Q

What do Beta 1 receptors do?

A

More Heart stuff (ino/chromo/dromotropic)

Renin

80
Q

What do beta 2 receptors do?

A

Bronchiole relaxation/dilation

More insulin

Uterine relax

Arterial dilation of some organs

81
Q

What’s Brugatta syndrome

A

Rare genetic heart disease w/ sodium channel issue = syncope or Cardiac arrest occurs in their 40-50s

82
Q

You suspect your geriatric syncope pt to have brugatta syndrome. How to assess?

A

Incomplete RBBB (rSR pattern in V1, QRS

83
Q

What’s babinski’s sign?

A

Fanning toes when heel is stroked w/ pen = upper motor neuron damage

84
Q

What’s brudinski’s sign?

A

flex the neck = knees flex up

Sign of meningitis

*think: Brudinski sounds Russian. Russians do sit ups

85
Q

What’s kernig’s sign

A

Cant straighten & pull leg up = meningitis

*think: kernig… Kermit the frog is a puppet, cant lift His leg up

86
Q

What’s eyelash sign

A

No movement when stoke eyelash = no gag reflex

87
Q

What’s joffroy’s sign

A

No forehead wrinkles when eye brows raise DT fluid buildup under forehead = Graves’ disease

88
Q

Cullens vs grey turners sign

A

Grey turners = flank bruising = kidney injury

Cullens = belly button bruising = ab internal bleeding

*think: grey TURN to your SIDE

89
Q

What’s Rovsing’s sign

A

Pn on RLQ when pushing on LLQ = appendicitis

90
Q

What’s hamman’s sign

A

Crunching sound in heart when auscultation = pneumopericardium or mediastinum

91
Q

What’s kussmaul’s sign

A

Bilateral or paradoxical increase in JVD during inhalation = COPD

92
Q

What’s Levine’s sign

A

Levine’s sign = clutch chest = MI

93
Q

What’s trousseaus sign

A

When BP on arm squeezes, wrists spasm DT hypocalcemia

94
Q

What’s exophthalmos

A

Bulging eyeballs = Graves’ disease

95
Q

What’s kehrs sign

A

Pn in L shoulder (& ab pn) = ruptured spleen

96
Q

What’s another term for false labor contractions

A

Braxton hicks contractions

97
Q

What’s Lloyds sign?

A

Pn when tap over kidneys = possible kidney stone or pyelonephritis

98
Q

What’s McMurray’s sign

A

Rotate ankle internally & hear clicking sound in knee = meniscus tear

*think Murray .. MurrANKLE

99
Q

What’s the Romberg’s test

A

When you stand up & close your eyes = lose balance = neuro proprioception deficit

*Think Romberg. Ron burgandy cant keep his balance

100
Q

What’s Homan’s sign

A

If possible DVT, Dorisflex foot = calf hurts where Thrombus is

101
Q

Which endocrine disease has the moon face and the buffalo hump? Why is that?

A

Cushings. Excess stress hormone = excess fat storage in back hump and face

102
Q

What’s Bell’s palsy

A

Lesion on cranial nerve VII (facial) = face droop

103
Q

Pt has brown/dark red lines going up their finger nails. What condition do they have? What is this called?

A

Splinter hemorrhage = endocarditis

104
Q

Pt has clubbed finger nails. What does this tell you?

A

COPD (chronic hypoxia)

105
Q

If a pt has white finger nails, what does this mean?

A

Anemia

106
Q

Pt has a thick black/purple vertical streak up their finger nail. What’s wrong?

A

Nail bed cancer

107
Q

What skin disease/condition is associated with aids?

A

Kaposi sarcoma

108
Q

What’s Dahls sign?

A

discolored/thick skin at elbow & knees DT chronic tripod position from COPD.

*think: strippers get on their knees for DAHLERS $

109
Q

What’s Thompson’s sign

A

Grab the calf & squeeze = foot will move. No foot movement = Achilles’ tendon rupture

110
Q

Pt has an “atrogenic” injury. What does this mean?

A

It was caused by the doctor/hospital

111
Q

What’s the principle source of hydration in the body?

A

Food

112
Q

What does the cation Calcium do?

A

Stabilizes cell membrane for impulses & muscle contractions

113
Q

Oropharynx + Nasopharynx = ?

A

Laryngopharynx

114
Q

What’s spasmatic croup

A

Quick onset croup that dissipates <2 hours w/ no fever

115
Q

You can’t tell if your pt has anaphylaxis vs asthma. Would benedryl help or hurt the pt?

A

Benedryl exacerbates asthma by drying out membranes & increasing overall mucous

116
Q

Classic signs of shaking baby syndrome

A

Detached retina & brain trauma

117
Q

What is sinus dysrhythmia? (HR?)

A

Exhale = slower HR, inhale = faster HR DT intrathoracic pressure

HR = 60-100

118
Q

Wandering Atrial Pacemaker (HR, rhythm, P wave, PRI)

A

HR <100, irregularly irregular w/ @ least 3 P wave Morphologies

Common in kids, old people & athletes

119
Q

What is MAT (HR, Rhythm, Pwave)

A

Multifocal atrial tachycardia = 100+, irregularly irregular w/ @ least 3 P wave morphologies.

Common in terminal COPD/lung disease pts

120
Q

How do you know a rhythm is SVT? What about in kids and infants?

A

Fast narrow, regular

Adult = +150bpm
Kid = +180bpm
Infant = +220bpm
121
Q

How do you know a rhythm is atrial flutter?

A

Usually Regular w/ a ratio (atrial = 300, ventricle = variable) and Saw teeth (F waves)

122
Q

How do you know if a rhythm is A-fib

A

It’s irregularly irregular; can’t tap your feet to it

123
Q

PVC vs PAC vs PJC

A

*all occur earlier

PVC = wide QRS w/ no p wave

PAC = narrow QRS w/ different shaped p wave

PJC = inverted or no p wave w/ narrow QRS

124
Q

What’s a Junctional escape rhythm

A

Beat occurs longer than normal rhythm w/ no p wave

125
Q

Junctional rhythm vs accelerated junctional vs junctional tachycardia

A

They all look the same (inverted or no p wave / narrow QRS). except HR…

Junctional = 40-60
Accelerated junctional = 60-100
Junctional tachy = >100

126
Q

Sinus block vs sinus Arrest vs sinus pause

A

Sinus block = no pwave or beat but unbroken P-P interval

Sinus pause = no pwave/beat w/ broken P-P interval

Sinus arrest = longer sinus pause

127
Q

How can you tell if a rhythm is Idioventricular?

A

Regular rate of 20-40Bpm w/ wide QRS no pwave

128
Q

How can you tell if a rhythm is Ventricular Tachycardia?

A

Rate 110-250 regular w/ wide QRS (often > .16s) and no Pwave

129
Q

What constitutes a STEMI?

A

ST elevation in 2+ contiguous leads or new/suspected LBBB

130
Q

How to diagnose a LBBB

A

Both BBB Look at I, V1, V6

LBBB

  • QRS > 0.12s
  • I & V6, wide monomorphic R wave
  • V1 wide monomorphic S wave
131
Q

How to diagnose RBBB

A

Both BBBs Look at I, V1, V6

RBBB=

  • QRS >0.12s
  • I & V6 = slurred S wave
  • V1 = RSR pattern
132
Q

How to determine axis deviation in a 12-lead

A

Look @ QRS in Lead I & avF

R hand = I, L hand = avF
Pos. = thumb up, Neg = thumb down

Both ++ = normal

Both neg = extreme right

Turn towards thumb = R or L deviation

133
Q

What conditions can mimic a STEMI

A 
LBBB
Percarditis
Brain bleed
Brugada syndrome
Paced rhythm
134
Q

What’s the average cardiac output? Average minute volume?

A

CO = 4.9-5L blood

Minute vol = 5-6L

135
Q

How big are the capillaries?

A

Only 1 cell thick

136
Q

Fluids from the lymphatic system empty into the…

A

Subclavian vein

137
Q

Average tidal volume is 500ml. How much of that actually reaches the alveoli?

A

350mL. 150mL is dead space

138
Q

Where is the base vs apex of the heart?

A

Base = top

Apex = bottom

139
Q

What’s it called when there’s fluid in the pleural space of the lungs?

A

Pleural effusion

140
Q

The endocardium (inner heart layer) secretes chemicals that do what?

A

Chemicals to increase contractility

141
Q

What’s starling’s law?

A

Muscle contracts more powerfully when pre-stretched

142
Q

What is the foramen ovale?

A

Hole between atriums to bypass lungs. Found in fetus

143
Q

What is the “cardiac skeleton”?

A

Dense connective tissue in heart that the valves attach to

144
Q

Coronary sinus vs coronary sulcus?

A

Sinus = large coronary vein drains blood from coronary arteries back into R atrium

Sulcus = separates atrium vs ventricles

145
Q

Pulmonary edema = Number one sign of…

A

L ventricular failure

146
Q

What do S3 & S4 indicate?

A

S3 = CHF or high school kids

S4 = MI or failure

147
Q

What is rheumatic fever? How does it affect the heart?

A

Rheumatic fever = scarlet fever

Autoimmune response = inflammation of heart = most common cause of valve problems

148
Q

Coronary arteries fill during what contraction phase?

A

Diastole

149
Q

What is anastomosis

A

Aka collateral circulation.

Interconnections between coronary arteries that help bypass a clot

150
Q

The membrane of a cardiocyte is always positive or negative?

A

Positive

151
Q

Intrinsic rates of SA node, AV node, Purkinje fibers

A

SA = 60-100

AV = 40-60

Ventricles = 20-40

152
Q

Where is the cardiac plexus located at?

A

Next to aorta

153
Q

Muscarinic type II receptors are located where and do what?

A

Located in SA node for parasympathetic stimulation

154
Q

Sympathetic NS is AKA …

A

Adrenergic system

155
Q

Parasympathetic NS is AKA …

A

Cholinergic system

156
Q

Prinzmetals angina is often caused by what defect? How do we Rx?

A

Defect in Calcium channels

Rx = calcium channel blocker

157
Q

What’s the significance of a pathological Q wave?

A

Yes Q wave = transmural (full thickness MI)

No Q wave = MI normally in subendocardial tissue

158
Q

What’s wellens syndrome

A

Predicts imminent MI:

Deeply inverted T waves in V2 & V3 (LAD stenosis)

159
Q

What’s the cardiac notch?

A

Pocket in the L lung where the heart sits

160
Q

What’s the muscle cell of the heart called?

A

Cardiomyocyte

161
Q

What’s the fossa ovalis?

A

Depression in interatrial septum where the foramen ovale used to be

162
Q

What is the pulmonary trunk?

A

Large arterial vessel carries blood from R ventricle

163
Q

What is the polarity of aVF (positive vs negative end)

A

Looks straight down

Positive = L foot

Neg = between R & L arms

164
Q

What is the polarity of aVL? (Positive vs negative lead placement)

A

Looks up towards L hand

Positive = L hand
Negative = between R hand & L foot
165
Q

What is the polarity of aVR? (Positive vs negative lead placement)

A

Looks towards R hand

Positive = R hand

Negative = between L hand & L foot

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