Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPAP > EMED 2 Cram > Flashcards

EMED 2 Cram Flashcards

1
Q

What gender is more likely to present to ER w/ vague Sxs of stroke?

What is the first lab drawn during suspected stroke or AMS work up?

A

Women- weak, light headed, fatigue

Glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of seizure mimics a stroke w/ transient focal unilateral deficits that is normally self resolving after 48hrs?

What vessel is MC affected in strokes?

A

Todd’s paralysis

Middle cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of stroke has complete muscle paralysis, no communication or movement except for ability to do upward gaze and blinking?

PT presents w/ acute onset of HA, stroke type Sxs, partial Horner’s and hears ‘whooshing’ noises?

A

Basilar artery infarction

Carotid artery dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What image modality is not used for posterior infarcts/hemorrhages?

If PT is allergic to bees, are they allergic to wasps?

A

NCHCT- can’t see through bone window

Yes, w/ common Sx of swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the first line of Tx for Hymenoptera stings and/or anaphylaxis?

What is the MC manifestation of a Loxosceles bite?

A

Epi IM, repeat q5-10min

Red White and Blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PT presents w/ Crotalinae bite to extremities, what needs to be monitored for development?

What are the 3 P’s of DKA?

A

Compartment syndrome

Poly-dipsia, uria, phagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the sequence of Tx DKA

What are the 5 things needed for DKA Dx

A

Fluids then check K+

Widened gap
Acidosis
Low bicarb
Ketones 
DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the criteria for DKA Tx

Define Dementia

A

Glucose under 200 and two of:
Bicarb >18
pH >7.3
Normal gap

Failure of content portion of consciousness w/ preserved alertness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 MC causes of AMS in elderly PTs beside strokes?

What are the 3 meds and dosages contained within a B52?

A

Hypoglycemia
Infection- PUSS
Meds

Benadryl 50mg
Ativan 2mg
Haloperidol 5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are alcoholics going through withdrawals Tx?

Why would a PT w/ dementia suddenly have declining mental status?

A

Diazepam

CHF
UTI
Hypothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of syncope presents w/ flushed, warm and nauseous?

What type of syncope has a fast/slow onset

A

Vasovagal

Fast- cardiac
Slow- vasovagal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PT passes out while decorating Christmas tree, what is a DDx?

MC cause of death in young adults/teens?

A

Sub-clavian steal syndrome

HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anaphylaxis presenting w/ ? needs immediate intubation

What is the MOA of Epi used during these cases?

A

Angioedema

A1 activation= dec edema, corrects HOTN
B1 activation= inc HR/strength
B2 activation= bronchodilation, dec mediator responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are PTs w/ anaphylaxis but on BBs Tx?

What is the s/e of this Tx step?

A

Glucagon reverses BB
Epi IM
Refractory= IV Epi

N/V from glucagon administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anaphylaxis is ? type of shock, meaning ? is used during Tx?

What meds are used for second-line therapy?

A

Distributive
IV crystalloids 20mg/kg

CCS
Antihistamines
B2 bronchodilator
Glucagon
Vasopressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the disposition for anaphylactic PTs

Which ones need to be observed for longer times?

A

Healthy PT ASx x 1-6hrs post Tx= d/c

Hx of severe reactions
Use of BBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PTs that are d/c after severe allergic reactions or anaphylaxis are given ? on the way out?

Hymenoptera venom contains ? components?

A

Antihistamines
CCSs
Epi auto injectors x 2

Histamine
Melittin- baso/mast degranulation
Phospholipase
Hyaluronidase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the MC response to a Hymenoptera sting?

How are these stings Tx?

A

Transient local reaction w/ spontaneous resolution

Stinger removal
Cold compress
PO CCS Antihistamine NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is Hymenoptera anaphylaxis Tx?

A

ABCs
IM Epi
IV crystalloids, antihistamine, steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Brown Recluse bites

A

Loxosceles

Venom contains:
Hyaluronidase
Sphingomyelinase D- necrosis

Painless bite
Red White Blue sign

ABX
Dapsone- leukocyte inhibitor
Serial wound f/u w/ PCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Latrodectus

A

Black Widow

Painful bite
Venom= A-latrotoxin- release Ach/NorEpi (muscle/cardiac)

Abdominal cramping/pain
HTN/Tachy

Tx- IV Ca Opioid Benzo Anti-V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Centruroides Sculpturatus

A

Bark Scorpion

Opens Na channels= seizure like movements d/t prolonged depolarization

CV toxicity= Tachy HTN Pulm edema, cardiogenic shock

Peripheral NS toxicity-
Abnormal eye, pharyngeal, tongue control (Hyper salivation- CN 5 7 9)

Systemic/CN Sxs= admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Crotaline

A

Rattlesnake

Tissue/hematology destruction
Early Sxs: N/V PO numbness
Systemic= Tachy Tachy HOTN

Dry bite Dz= ASx x 8-12hrs

Tx mainstay= IV/IO FabAV
Isotonic fluid/vasopressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Elapid

A

Red on yellow, kill fellow
Red on black, venom lack

Tx- 3-5 vials IM/IO Antivenin (M Fulvius)
Observe x 12hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What lab result is used as prognostic for PTs w/ sepsis

What body process creates this lab result for tracking?

A

Serum lactate

Anaerobic metabolism secondary to tissue hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are two independent predictors of mortality during sepsis?

How does one of these predictors response to Tx determine mortality?

A

Lactate elevation
HOTN

Failure to dec lactate by 10% in first few hrs= inc mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes Sepsis

What two events occur

A

Immune response fails to control/over reacts to pathogen

Abnormal inflammatory response
Imbalanced pro/anticoagulant function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PTs suffering from septic shock are at increased risk of developing ?

What Sxs indicate an underlying sepsis issue?

A

DIC- clots, impaired perfusion, thrombosis

Fever
HOTN
Tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What type of shock does sepsis create?

What areas of the body can be injured by the sepsis inflammation process?

A

Distributive

Cholestatic jaundice
Thrombocytopenia
AKI
Ileus
Lungs- ARDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What 3 parts of the body are examined for suspected sepsis?

What is needed to Dx sepsis?

A

Skin (erysipelas) Urine CXR

SBP <90 after fluids
Evidence of hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the only reliable method to obtain temps in PTs that are septic?

What is a late Sx of sepsis on Peds?

A

Rectal temps

HOTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What two extra labs are drawn in septic PTs that are HOTN/anemic?

What labs are drawn if they have DIC?

A

Type/screen

Fibrinogen aPTT PTT D-dimer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the goals of resuscitation when Tx sepsis?

If PT is not improving after 20cc/kg fluid push, what is added to Tx in order?

A

Improvement of:
Preload O2 delivery Perfusion

NorEpi Vasopressin Epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the ABX delivery time frame recommended for septic PTs?

What are 4 examples of cardiac syncope etiology?

A

1hr of recognition
3hrs from triage

Aortic stenosis
HCM- MC cause of death
PE
MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are three forms of dysrhythmias that can cause cardiac syncope?

How do these types of syncope present?

A

Brugada
Long/short Qtc
Catecholamine PVTachy

Sudden w/out prodome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why do vasovagal/neuro reflex syncopes occur?

What are the preceding Sxs?

What is different/unique about this type of syncope?

A

Inappropriate dilation/brady

Light headed
Nausea
Pallor
Sweat/warmth

Slow/progressive onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What type of syncope is a situational syncope?

What causes this type?

A

Vasovagal/neuro reflex

Post cough, micturition, defecation or swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does carotid sinus hypersensitivity cause V/N reflex syncope?

When is this form of syncope a possible Dx?

A

Abnormal vagal response leads to brady and asystole >3sec
Sometimes BP dec x 50mm

Older PT w/ recurrent syncope and negative cardiac exams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What causes OHOTN sycope

What are the two MC underlying psych issues in PTs who have psych syncope?

A

Dec volume
Poor tone d/t a-receptor d/o or meds

GAD, MDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why is neurological syncope no a true syncope?

The LoC is usually preceded by ? Sxs?

A

LoC w/ persistent neuro deficit/AMS

Diplopia
Vertigo
Focal neuro deficit
Nausea

41
Q

What type of syncope is Sublclavian Steal syndrome?

What causes this?

How is it ID’d on PE?

A

Neuro

Blood stolen from vertebrobasilar to subclavian artery, usually on L side

Dec pulse/BP on affected arm

42
Q

What medications can lead to syncope?

Sudden events w/out warning and events associated w/ exertion raises suspicion for ? Dxs

A

BB/CCBs- blunts HR after orthostatic stress
Diuretics- depleted volume
Laxatives

Cardiac dysrhythmia
Cardiopulmonary lesion

43
Q

What 4 precipitating issues cause concern for immediate life threatening Dxs after syncope?

PT w/ more than 5 syncope episodes w/in 1 yr are likely to have ? Dx

A

Chest pain
HA
Abdominal pain
Palpitations

Vasovagal
Psych dx

44
Q

What is the MC Dx mistaken for syncope?

What physical appearance may present with any form of syncope?

A

Seizure

Convulsive syncope

45
Q

Post-syncope PE needs to be focused on what two system?

What is the criteria for OHOTN?

A

Cardiovascular
Neurological

Dec >20mm w/ Sxs
SBP <90mm

46
Q

What is the most important part of Dx syncope?

What EKG findings post-syncope are linked with higher morbidity

A

Hx

LBBB
Non-sinus rhythms

47
Q

What post-syncope lab result would indicate PT is at risk for morbidity?

When are head CTs/MRIs not needed for syncope work ups?

A

Inc BNP

ASx PT
Isolated event
Atraumatic event

48
Q

What type of syncope means PT is admitted?

If pregnant PT has syncope, first two Dxs are ?

A

Cardiac
Neurologic

Ectopic pregnancy
PE

49
Q

What PTs usually suffer from DKA?

What PT population does DKA have higher mortality?

A

DMT-1
Newly Dx DMT-2, esp AfAm/Hispanic

Elderly- Renal dz Infection Coma HOTN

50
Q

What catabolic hormones are released during DKA?

DKA occurs in response to ?

A

Glucagon GH
Catecholamine Cortisol

Cellular starvation

51
Q

During DKA, the lack of insulin and presence of catabolic hormones results in what 5 issues?

Why do DKA PTs experience N/V?

Why does their breath smell fruity?

A 
Pre-renal azotemia
Osmotic diuresis
Wide gap acidosis
Hyperglycemia
Ketone formation

Prostaglandin release

Acetone production

52
Q

Clinical manifestations of DKA are directly related to what 3 things?

Why can DKA PTs develop AMS?

A

Hyperglycemia
Acidosis
Depleted volume

Dec K= inc acidosis
Hyperosmolarity*
Low ECF volume
Poor hyemodynamics

53
Q

What odd VS may be seen in DKA?

How is DKA Dx

A

Hypothermia from peripheral dilation

Glucose >250
Anion gap >10
pH <7.3
BiCarb <15
Ketonuria/emia
54
Q

What are the DDx for DKA?

What type of fluid is used during DKA Tx

A

Renal failure
Alcohol/starvation ketoacidosis
Ingestion- MES
Lactic acidosis

NS 25mg/kg
Once glucose reaches 250mg, switch to D5W and .45NS

55
Q

What is the most life threatening adverse reaction DKA PTs can have during Tx?

What K+ ranges dictate holding/giving K or insulin?

A

HypoK

Norm range- give FKI
<3.3- give FK, no I
>5.2- give FI, no K

56
Q

How are DKA PTs w/ insulin pump malfunctions Tx?

What is the leading cause of fetal loss during pregnancy?

What Sxs may precede a DKA episode?

A

D/c and turn off pump
Tx like normal PT

DKA

Vomit/UTI
DKA will be triggered at lower glucose level

57
Q

What is the MC cause of seizures?

What PE findings suggest an unwitnessed/unrecognized seizure?

A

Missed Rx dose in young adult/teens

Unexplained injury
Nocturnal tongue bite/enuresis

58
Q

What is suspected in post-seizure PT w/ persistent/severe HA?

What are 3 common sequelaes of seizures?

A

Intracranial pathology

Tongue lacs
Aspiraiton
Dental Fx

59
Q

What are the first 4 things checked in suspected seizure PT?

What needs to be done after the PT assessment?

A

VS
Glucose
Head/C-spine
Shoulders

Monitor LoC/mentation

60
Q

What type of seizures don’t have postictal state?

How do pseudoseizures present

A

Simple absence/partial

Head side to side
Pelvic thrusts
Extremity cogwheel

61
Q

How are movement d/os different from seizures?

What is an inconsistent d/o associated w/ seizures?

A

Consciousness always preserved
Temp suppressible on command

Active movement d/os

62
Q

What are the only two labs needed for seizure Hx PTs w/ repeat seizures?

What are two lab results that can prove seizure was fake?

A

Medication levels
Glucose

Lactate
Prolactin

63
Q

What is the image ordered for first time seizure or change in baseline seizure Hx?

What are the 3 indications to do LP in setting of an acute seizure?

A

CT

Febrile
ImmComp
Suspected SAH w/ normal NCHCT

64
Q

Seizures lasting longer than 5min are considered ?

How are first time/unprovoked seizures Tx?

How are PTs w/ provoked/secondary seizures Tx?

A

Status epilepticus- more than 5min or two seizures w/out regaining consciousness

Return to baseline
Do not admit/medicate

Admit/medicate

65
Q

What are the criteria for eclampsia Dx?

How are these seizures Tx?

A

> 20wks w/ seizure and:
HTN Edema Proteinuria

MgSO4

66
Q

Criteria for non-convulsive status epilepticus?

What Tx step is take for status epilepticus immediately after paralytic agents are given?

What drugs are used for Tx?

A

Fluctuating mental status
Long postictal after general seizure
Unexplained stupor/confusion
Subtle motor signs

Continuous EEG monitoring

Loraz*/Diazepam
Fospheny- IM loading dose if PT doesn’t have IV
Phenytoin

67
Q

What is the criteria for refractory status epilepticus?

What meds are used for this type?

A

> 60min after two anti-epileptic drugs

Propofol*
Midazolam
Ketamine/Barbituates-Pento/Phenobarbital

68
Q

What causes a syncope

How is consciousness restored?

A

10sec of complete blockage of blood/substrates
Reduced perfusion x 35-50%

Supine
Autonomic autoregulators
Perfusing cardiac rhythms

69
Q

What is the MC type of syncope

What type of syncope has no increased risk of death when compared to GenPop?

A

Vasovagal

Vasovagal

70
Q

Define Stroke

What are the two categories of stroke and the types within each category

A

Dz that interrupts blood flow
Injury related to loss of oxygen/glucose
Injury d/t mediators of injury

Ischemic- thrombotic hypoperfusion embolic

Hemorrhagic- intracerebral subarachnoid

71
Q

How do thrombotic strokes develop?

How do the Sxs present?

These are the MC cause of ?

A

Narrowing of damaged lumen by clot formation

Gradual onset/wax and wane

TIAs

72
Q

How do embolic strokes develop?

How do the Sxs present?

A

Obstruction of normal lumen by material from remote source

Sudden, account for 20% of ischemic strokes

73
Q

How do the Sxs of hypoperfusion strokes present?

How do intracerebral hemorrhages develop?

Who is more likely to have this type

A

Diffuse injury in water shed areas w/ wax/waning sxs

Parenchymal hemorrhage from weakened arterioles

Asian/AfAm

74
Q

What can cause non-traumatic subarachnoid strokes?

How does these get foreshadowed?

A

Berry aneurysm
Vascular malformation rupture

Warning leak (sentinal HA)

75
Q

What are the general Sxs of strokes?

What are the subtle Sxs?

A

Face Arm Speech

Weak Light Vague sensory AMS

76
Q

Traditional stroke Sx for women?

Non-traditional stroke Sx for women?

A

AMS

Weakness

77
Q

Hemorrhage/embolic strokes have ? onset

Hypo/thrombotic strokes have ? onset

A

Sudden

Wax/wane

78
Q

How could a cerebral aneurysm rupture be provoked during PE?

RFs and distribution for thrombotic strokes

A

Valsalva worsens it

HTN Atherosclerosis DM
Transient neuro deficits in same vascular distribution

79
Q

Epidural bleed

Subdural bleed

Subarachnoid hemorrhage

A

E: blood out of dura, concave shape

S: blood under dura, crescent shape

SAH: blood in brain, compressing ventricles

80
Q

rtPA inclusion criteria

rtPA exclusion criteria

A

Measurable Dx
Onset <3hrs
>18y/o

Platelets <100K
Heparin <48hrs
aPTT elevated
Direct thrombin/Xa inhibitors
Glucose <50
INR >1.7
Multi-lobe infarct
PTT >15s
81
Q

What is the MC vessel involved in ischemic strokes

How does this type present

A

MCA

Hemiparesis
Facial plegia
Contralateral sensory loss

82
Q

How does MCA infarct on dominant side present?

How does it present if it’s on the non-dominant side?

A

Dom= aphasia

Non-dom= DIANE
Dysarthria
Inattention
Apraxia- 2D/3D
Neglect
Extinction on double stime
83
Q

What eye clue develops during MCA infarcts?

What are the presenting issues w/ PCA infarct?

A

Homo Hemi
Gaze preference to infarcted side

Ipsi CN
Contra motor
V7 GULS:
Vision CN7 Gait Unilateral weak/ataxia Lethargy Sensory

84
Q

What PE finding is specific for a PCA infarct?

What other PE findings may be seen?

A

Hemi Homo and Unilateral blindness

CN3 palsy
Hemiballismus, chorea type
No reading/naming colors

85
Q

How does a BA infarct present

A 
CN7 signs
Babinski
Locked in syndrome
Unilateral limb weakness
Dysarthria
86
Q

Define Lacunar infarction

RFs for Carotid/vertebral artery dissection

A

Pure motor/sensory loss d/t HTN/age

Chiro/Chop/CT dz
Migraine Hx
Vessel arteriopathies
HTN

87
Q

What is the first presenting Sx of Carotid/Vertebral artery dissection?

What other unique PE finding may be seen?

What is the first image ordered?

A

Unialteral HA in frontoremporal region

Partial Horner’s

CTA then MRA

88
Q

How does Vertebral Artery Dissection present

What is the first and second image ordered for cerebellar hemorrhages?

A

Occipital HA and neck pain

1st- NCHCT
2nd: MRI diffusion weighted images

89
Q

Stoke evaluation and Tx decision needs to occur w/in ?mins?

They need to be imaged w/in ?min

A

60min of arrival at ED

20min of arrival at ED, read w/in 45min/ASAP

90
Q

What is the only image needed prior to giving rtPA?

What is the only lab result needed prior to administration?

A

NCHCT

Glucose

91
Q

Ischemic Tx gaols

A 
SPO2 >94%
Glucose 140-180
IV Acetaminophen
Only lower BP if:
>220/120, condition reqs
Reduce x 20% over 24hrs
w/ Labetalol/Nicardipine
Reperfusion candidate: <185/110
92
Q

What metabolic condition is common during acute strokes?

NIHSS score commonly indicates rtPA use

A

Hyperglycemia d/t cortisol/NEpi release

4-22

93
Q

Stroked due to ? vessel involvement are not candidates for rtPA therapy?

What is c/i during hemorrhagic strokes?

A

MCA

Thrombolytics

94
Q

How are TIAs scored?

How are these Tx

A 
ABCD2, 0-7pts
Age >60
BP >140/90
Clinical
Duration
DM

ASA/ASA + Dipyridamole
Warfarin for non-vascular Afib/TIAs

95
Q

When are pregnant PTs at highest risk for any type of stroke?

It’s recommended to give ASA w/in ?hrs of stroke onset?

A

6wks post partum

24-48hrs

96
Q

What are the 3 locations stimulation w/ valsalva appears?

What causes RCVS?

A

Brain tumor
Intracranial abnormality
Cerebral aneurysm rupture

Uppers causing constriction of smooth muscles- ischemia

97
Q

What is an important PE finding that indicates underlying bleeding or infection in the CNS?

What f/u exam is needed?

A

Meningismus

ENT for OM/sinusitis

98
Q

What two issues can cause asymmetric pupil/ptosis issues?

Define meningitis

A

CN3 compression d/t PCS aneurysm or brain stem herniation

HA + Triad (fever Neck stiffness AMS)

99
Q

? + ? is a cerebellar hemorrhage until proven otherwise?

A

Acute HA + vestibular Sxs (vertigo, ataxia)

IPAP (212 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions