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233 Medical Emergencies > Exam 1 > Flashcards

Exam 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

4 lobes of the cerebrum and their functions

A
  • Frontal
    • speech, thinking, voluntary muscle movement, personality
  • Temporal
    • sounds
    • Wernicke’s area
  • Parietal
    • Functions related to speech
    • body positioning
  • Occipital
    • Sight
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2
Q

Temporal lobe epilepsy

A
  • “Partial epilepsy”
    • Odd feelings, such as euphoria, deja vu, fear
  • Focal impaired awareness seizure
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3
Q

Parietal lobe seizure

A
  • sensory disturbances, such as heat, numbness or electrical sensations, weakness, dizziness, hallucinations, distortions of space and other symptoms.
  • Very uncommon
    • Difficult to diagnose, subjective
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4
Q

Phases of capnography

A
  • Phase I – Beginning of exhalation, air from dead space being exhaled w/small to no present CO2.
  • Phase II- CO2 from larger bronchioles resulting in upslope
  • Phase III- Alveolar plateau and end tidal CO2
  • Phase 0 - inhalation
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5
Q

Generalized epileptic seizures

A
  • Grand mal
  • Both brain hemispheres origin
  • Motor and Non Motor (abesnce) seizures
  • Tonic (stiffening) Clonic (jerking)
  • Types
    • Absence
    • Atonic
    • Myoclonic
    • Tonic-clonic
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6
Q

Focal epileptic seizure

A
  • Partial seizure
  • Begins in one hemisphere
  • Types
    • Focal aware
    • Focal impaired awareness seizure (complex partial)
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7
Q

Motor Onset Seizure

A
  • Change in muscle activity
  • One or both sides of body
  • Non- motor onset affect senses
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8
Q

VITAMIN acronym

A

For seizures:

  • Vascular
    • strokes, embolis stroke
  • Infections
    • Meningitis, encephalitis, cerebral malaria
  • Trauma
    • Head injuries
  • AV Malfunction
    • cavernous malformations
  • Metabolic
    • Hypoglycemic, hypoxic, hyponatremia
  • Idiopathic
    • Unknown cause
  • Neoplasms
    • Primary or Secondary
  • OTHERS
    • Sleep deprivation, drug overdose, fever, eclampsia, hydrocephalus, multiple sclerosis
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9
Q

Syncope vs Seizure

A
  • Syncope is a complete LOC
    *
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10
Q

AEIOU-TIPS for altered mental status

A
  • Alcohol/Acidosis
  • Epilepsy/Endocrine/Electrolytes
  • Infection
  • Opiates, Overdose
  • Uremia/Underdose
  • Trauma
  • Insulin
  • Poisoning/Psychosis
  • Stroke/Seizure/Syncope
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11
Q

Causes of Seizures

A
  • Abnormal levels of sodium/glucose
  • Brain infection, meningitis, encephalitis
  • Brain tumor
  • Drug abuse
  • Eclampsia
  • Epilepsy
  • Fever
  • Head injury
  • Heart disease
  • Poisoning
  • Street drugs (PCP, cocaine, amphetamines)
  • Stroke
  • Very high BP
  • Withdrawal from ETOH, some meds
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12
Q

Partial seizures

A
  • Involve only part of the brain
  • 2 types
    • Simple = no LOC
      • sensory/other changes
    • Complex = LOC to varying degrees
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13
Q

Generalized seizure

A
  • Whole brain/both hemisphere involvement
  • 4 types
    • Absence (Petit Mal)
      • Vacant, unresponsive for a short time (30 seconds usually)
      • Slight muscle twitching
      • Several times a day sometimes
      • Common in children
    • Myoclonic
      • Extremely brief (<1 second)
      • Jerky movements, contractions.
    • Clonic
      • Myoclonic that repeat at a rate of 2-3 per second, varies
    • Tonic clonic (Grand mal)
      • Tonic phase = initial contraction of muscles
        • May involve absence of breathing.
      • Clonic phase
        • Rhythmic muscle contractions that follow
    • Atonic
      • Loss of muscle tone, fall to ground
      • “drop attacks”
      • Is NOT Cataplexy (looks very similar)
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14
Q

Methylprednisone Sodium (Solumedrol)

A

Class:

  • Steroid

Action:

  • Decreases the inflammatory response

Indications/Dose

  • Refractory
    • Obstructive SOB
    • Allergic Reaction/Anaphalyxis
      • 125mg SIVP

Contraindications

  • None

Side Effects

  • None
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15
Q

Diazepam (Valium)

A

Class: Benzodiazepine

Action: Increases GABA effects, Raises seizure threshold in CNS, Causes amnesia

Indications: Seizures, Procedures, Extreme Anxiety

Dose: 2-10mg SIVP (every 10-15 min PRN) Max: 30mg

Contraindications: Respiratory depression

Side Effects:

  • Respiratory depression
  • Hypotension
  • Ataxia
  • Confusion
  • Psychomotor impairment
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16
Q

Albuterol (Proventil)

A

Class: Sympathomimetic, Selective Beta 2 agonist

Action:

  • Relaxes smooth muscle
  • Bronchodilation
  • Relieves bronchospasms
  • Reduces airway resistance

Indications: Respiratory distress with bronchospasms (Asthma/COPD/Allergic Reaction/Pneumonia)

Dose: 2.5mg in 3mL SVN, repeat as needed

Contraindications: MI, pulmonary edema

Side Effects:

  • Anxiety
  • dizziness
  • tachycardia
  • dysrhythmias
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17
Q

Atrovent (Ipratropium Bromide)

A

Class: Anticholinergic

Action: Blocks acetylcholine at bronchial receptor sites (Bronchodilates)

Indications: Obstructed SOB (Asthma/COPD/Allergic/Pneumonia)

Dose: 0.5mg in 2.5mL SVN, repeat 30-45min

Contraindications:

  • MI/Angina
  • Cardiac Pulmonary edema
  • Glaucoma

Side Effects:

  • Tachycardia
  • Anxiety
  • Anticholinergic toxidrome (Mad/hot/red/dry/blind)
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18
Q

Aspiration

A

Inhalation of foreign contents into lungs

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19
Q

Cerebral Perfusion Pressure

A

CPP

The difference between MAP and ICP

CPP = MAP - ICP

20
Q

Capnometry

A

numeric and graphical representation of CO2 concentration exhaled in each breath

21
Q

Pulsus Paradoxus

A

HR elevates, Systolic BP drops on inhalation

22
Q

Cor Pulmonale

A

Right ventricular hypertrophy (Right sided heart failure) due to emphysema

23
Q

Antigen

A

A toxin/foreign substance which induces an immune response in the body

24
Q

Cushings triad

A

Wide PP, Increase BP, decrease HR, irregular respirations

25
Q

Hypoxemia

A

Low O2 in the blood

26
Q

Syncope

A

Temporary loss of consciousness

27
Q

Mast cells

A

Specialized cells that bind to an antibody to release histamine

28
Q

List 3 causes of SOB besides COPD

A

MI

PE

Pneumonia

Pneumothorax

Anaphalyxis

29
Q

Breathing patterns

A
30
Q

What can be the first sign of altered mentation?

A

Anxiety

31
Q

What is the primary respiratory drive in a normal healthy person?

A

CO2

32
Q

What is amyotrophic lateral sclerosis?

A

Progressive degeneration of muscle specific nerve cell breakdown. Also called Lou Gehrigs Disease

33
Q

Wernicke-Korsakoff syndrome

A

Reduction in intestional absorption and metabolism of thiamine.

34
Q

Wernicke Encephalopathy

A
  • Usually chronic alcoholics
  • Acute neurological condition caused by thiamine deficiency
  • Presents with ophthalmoparesis (weakness/paralysis of eye)
    • Nystagmus
    • ataxia
    • confusion
  • Need Vitamin B1, glucose, fluid.
  • LIFE THREATENING ILLNESS
35
Q

Korsakoff syndrome

A
  • Memory/mental disorder
  • Severe B1 deficiency
  • SLOW onset
36
Q

What does Vitamin B1 do?

A
  • Helps brain produce energy from sugar
  • Without it, brain cannot generate energy to function properly
  • Mostly alcoholics need it but defeciency can come from AIDS, Cancers, infections, poor nutrition.
37
Q

Oxy Hemoglobin Dissociation Curve (photo)

A
38
Q

Oxy hemoglobin dissociation curve: what happens as temperature increases?

A
  • Increases
    • pH decreases, need more O2 to get a good pulse ox.
    • O2 affinity lower to hemoglobin
      • Lets oxygen go when in hot working muscles for fast use
    • Hotter = O2 doesn’t retain on hemoglobin as well
39
Q

Oxy hemoglobin dissociation curve: what happens when temperature decreases?

A
  • pH increases
    • need less O2 for good pulse ox, higher affinity for O2.
  • O2 delivery to tissues is bad, won’t let go of O2.
  • moves curve to left
40
Q

Bohr effect

A
  • Shifts to the right
  • High affinity for O2, assists with perfusion at tissues
41
Q

Haldane effect

A
  • Shifts left
  • Helps dissociate CO2 to be released at the lungs
42
Q

What do shark waves in capnography mean?

A
  • Prolongation of the expiratory phase 3 (bronchoconstriction like emphysema)
  • Angle between 2 and 3 is lost, resulting in fin shape
  • Constant increase in the amount of exhaled CO2
43
Q

Pathophysiology of allergic reaction/anaphalyxis

A
  • Antigen (allergen) enters body
  • B cells release IgE antibodies
  • IgE bind to mast cells to create rapid response for next allergen exposure
  • Allergen enters the body again later
  • Allergen combines with IgE on Mast cells triggering release of histamine from mast cells
  • Histamine stimulates vasodilation causing fluid leak, mucus production, and bronchoconstriction
  • BP drops and widens. Will be tachycardic
  • S/S: Upper airway swelling, stridor, wheezes, dyspnea, edema, hives/rash, chest tightness, anxiety
44
Q

Emphysema pathophysiology

A
  • Emphysema (Pink Puffer)
    • Thin, barrel chest presentation
    • Nonproductive cough
    • Wheezing and Rhonchi
    • Pink Complexion
    • Extreme dyspnea on exertion
    • Prolonged expiration (pursed-lip breathing)
45
Q

Bronchitis pathophysiology

A
  • Bronchitis (Blue Bloater)
    • Typically overweight in chronic patients
    • Productive cough with sputum
    • Coarse rhonchi
    • Cyanosis
    • Mild dyspnea
    • Resistance on inspiration and expiration
46
Q

Chronic Bronchitis pathophysiology ALS level

A
  • Overproduction of mucus in the lungs
  • Caused by irritants in lungs like smoke
  • Lungs irritated and produce mucus to get rid of irritants
  • Over growth of mucus glands – permanent tissue change due to continuous production of mucus. Body makes more glands to get rid of more irritants
47
Q

Emphysema ALS level

A
  • Loss of lung elasticity, enlargement of air spaces distal to small bronchioles, destruction of alveolar walls
  • Air trapping. Expiration extended, increased residual volume
  • Elastase breaks down elastin due to smoking
  • Chronic hypoxia due to polyscythemia side effect, low SPO2
  • CO2 elevates, respiratory acidosis with compensatory metabolic alkalosis. Now you depend on o2 to breathe instead of CO2
  • Cor pulmonale = right ventricular hypertrophy
    • impaired left ventricular filling and reduced left ventricular stroke volume and cardiac output. This is due to pulmonary hyperinflation putting pressure/strain on the heart
  • Treatment:
    • CPAP, IV, 12 lead, albuterol, atrovent, fluid

233 Medical Emergencies (4 decks)

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