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Marcus HA S24 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How is Metric BMI calculated?

A

BMI= kg / m2
[Weight (Kg) / Height (m2)]

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2
Q

Familial history can detect which condition?

A

Malignant Hyperthermia

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3
Q

How is BMI calculated in the inferior Imperial way?

A

703 x lbs / in2 [703 x weight / height (in2)]

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4
Q

BMI Ranges:
Underweight
Normal
Overweight
Obese

A

Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obese >30

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5
Q

2 Anesthesia Hard Stops

A

Unstable Chest Pain
Decompensated Heart Failure

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6
Q

Q
2 Most Important Physical Examination Questions?

Emergent Physical Examination A.M.P.L.E. meaning ?

A

Allergies and Medications

Allergies, Medications, PMH, Last meal eaten, Event leading to surgery.

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7
Q

Which court case established practice of informed consent?

A

Salgo v. Leland Stanford Jr. University Board of Trustees

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8
Q

Common causes of anaphylaxis? (3)

A

Rocuronium (muscle relaxant), antibiotics, chlorhexidine

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9
Q

Do not combine MAOIs with which 2 drugs?

A

Demerol / Meripedem
Ephedrine

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10
Q

Which drug will not work on someone on meth? TEST

A

Ephedrine

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11
Q

Glaucoma/stroke effect of vision? (2) TEST

A

Decreased peripheral vision loss
Glaucoma - tunnel vision

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12
Q

Risks of:
Garlic
Ginger
Gingko
Ginseng
Green Tea

A

bleeding

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13
Q

Risks of:
Ephedra
Kava
Saw Palmetto
St. Johns Wort

A

Ephedra: MI, dec catecholamines
Kava: dec sedation
Saw Palmetto: bleeding
SJW: CYP450

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14
Q

BMI can be used to determine? (4)

A
  • Fluid volume requirement,
  • acceptable blood loss,
  • drug dosage,
  • adequate u/o
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15
Q

What Pre-op intervention can be done for someone with sickle cell?

A

Admit day before to hydrate & possibly pre medicate as it is very hard to control their pain.

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16
Q

What is G6PD deficiency?
What is Factor V Leiden?

A

Enzyme helps red blood cells work properly. A lack of this enzyme can cause hemolytic anemia.
F5: clotting disorder

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17
Q

What should be avoided in Pts with neuromuscular disorders?

A

NMJB

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18
Q

How does anesthesia affect seizure meds?

A

It will reduce half-life of the seizure meds

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19
Q

Why is it important to monitor how long patient has been taking prednisone?

A

High exogenous glucocorticoids suppress cortisol secretion at HPA Axis. This may blunt normal cortisol hypersecretion during surgery.

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20
Q

What should be watched in someone with Raynaud’s?

A

BP sensitive; monitor O2, comfort b/c cold

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21
Q

Blood glucose swings is a sign of what?

A

Poor nutrition

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22
Q

3 Examples of High risk procedures are?

A

Aortic
Major Vascular
Peripheral Vascular

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23
Q

4 Examples of Intermediate risk procedures are?

A

Head/neck surgery
Carotid endarterectomy
Intrathoracic surgery
Intraabdominal surgery

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24
Q

Briefly Describe ASA w/ disease examples:
I
II (4)
III (3)

A

I: healthy Patient
II: mild disease w/o limitations; smoker, pregnant, drinker, well-controlled DM & HTN
III: Moderate disease w/ limitations; COPD, hepatitis, pacemaker, ESRD w/ dialysis

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25
Q

Briefly Describe ASA w/ disease examples:
IV
V (4)
VI

A

IV: Recent (<3months) MI, CVA, TIA, CAD, ARDS, Sepsis, severe CHF
V: Massive Trauma, Intracranial bleed, ischemic bowel, aneurysm
VI: brain dead organ donor

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26
Q

What is scored 1 point in the Revised cardiac Index scale? (6)

A
  • cerebrovascular disease
  • High-risk Sx (intraperitoneal)
  • ischemic heart disease
  • CHF
  • DM requiring insulin
  • Creatinine >2.0mg/dL
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27
Q

Revised Cardiac Risk Index:
Score 0 correlates to?
Score of 3?

A

0 = 0.4%
3 = 5.4% risk of major cardiac events.

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28
Q

What does the MET scale evaluate?
How many are sufficient?

A
  • Cardiopulmonary fitness & if further testing is necessary.
  • Want >4 METs. Below = cancel Sx to run more tests
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29
Q

Which Labs should be ordered for:

ASA-PS 3 or 4 undergoing intermediate risk? (4)
ASA-PS 2, 3, 4 undergoing major procedures (2)

A

3 or 4: CBC/Hgb/Hct, Renal Function Test, Coagulation, ECG
2, 3, 4: Renal Functioning Test, ECG

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30
Q

How to asses cardiopulmonary function in a bedridden Pt?

A

With a chemical stress test.

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31
Q

When to get pre-op renal panel? (6)
ASA __ & ___ undergoing intermediate
ASA __ & ___ & ___ undergoing major Sx

A
  • DM
  • HTN
  • Cardiac disease
  • N/V/D
  • Renal disease
  • Fluid overload
  • ASA III & IV undergoing intermediate Sx
  • ASA II, III, IV undergoing major Sx
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32
Q

What is considered minimal sedation?

A

Drowsy, able to talk

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33
Q

What is the difference between regional & local anesthesia?

A
  • Regional numbs large area (epidural, nerve block)
  • Local numbs small area (biopsy)
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34
Q

What are the most common allergies? (6)

A
  • Abx
  • Adhesives
  • CHG/Iodine
  • Latex (spina bifida)
  • Rocuronium
  • Opioids
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35
Q

What can be done in someone with an Abx allergy?

A

Give a test dose (1/10th)

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36
Q

In what kind of allergy are PCN/cephalosporin Abx avoided?

A

True IgE-mediated allergy

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37
Q

Which cancer is __ higher in Caucasian A. than African A.?

Which cancer is higher in African Americans than Caucasian Americans?

A

Skin cancer is 20% higher in Caucasian
Americans than African Americans.

Prostate cancer is higher in African Americans than Caucasian Americans.

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38
Q

Burning plastic releases ______ _______.
Person can also have _____ poisoning.
Treatment for poisoning?

A

releases carbon monoxide.
cyanide poisoning
Cyanocobalamin to treat cyanide poisoning

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39
Q

3 Types of Palpation and uses

A

Light palpation - organs
Deep palpation - abd masses
Bimanual palpation - organs

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40
Q

Define:
Strabismus
Leukoplakia

A

S: crossed eyes
L: thick white patches because of smoking and alcohol

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41
Q

How can Mg⁺⁺ evaluations be done in OB patients?

A

Knee extension/flexion

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42
Q

Ectropion
Entropion
Ptosis

A

E: eversion, lid margin turn out
E: inversion, lid margin turns inwards
P: abnormal drooping of lid over pupil

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43
Q

What is a VAN exam?
What does being VAN positive indicate?

A

Palms up, checking for downward drift.
VAN (+) = ↑ risk for LVO (large vessel occlusion)

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44
Q

When would a gluteal reflex be performed?

A

Trauma patients in assessing pelvic injury

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45
Q

How can Amides & Esters be identified?

A
  • Amides have 2 I’s in their name
  • Esters have 1 I in their name.
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46
Q

What 2 anesthetic consideration should one have for a patient with significant lordosis?

A

↑ abdominal pressure could = worse GERD.
Difficult spinal/epidural

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47
Q

Is Lidocaine and amide or an ester?
How can you tell?

A

Lidocaine = Amide
Two “i’s” would indicate and amide (ex. bupivicaine)

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48
Q

What component of “ester” medications are people allergic to?

A

PABA (Para-aminobenzoic acid)

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49
Q

Which antihypertensive medications should be d/c’ed before Sx & why?

A
  • ACEi & ARB’s
  • May cause severe hypotension under anesthesia.
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50
Q

What medication should be d/c’ed 4 weeks prior to Sx & why?

A
  • Oral contraceptives
  • High risk for post-op venous thrombosis
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51
Q

What interaction is there between NMJB’s & anticonvulsants?

A

Anticonvulsants decrease the lifespan of NMJB’s

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52
Q

When should topical medications be discontinued prior to Sx?

A

24hrs

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53
Q

D/c which diuretic before Sx
When should it be d/c-ed?

A

Thiazides
24hrs

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54
Q

When is it not okay to d/c P2Y12 inhibitors?

A

Within the first 6 months of taking drug eluting stents.

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55
Q

When should Post-Menstrual HRT be d/c’ed prior to Sx?

A

4 weeks

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56
Q

What should a type 1 diabetic do with their insulin regimen prior to Sx?

A
  • Take 1/3 of their usual dose the morning of Sx
  • Continue basal rate if infusion pump present
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57
Q

What should a type 2 diabetic do with their insulin regimen prior to Sx?

A

Take none or up to half of a long-acting the day of Sx.

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58
Q

What & how much stress dose medication is given?

A

100mg hydrocortisone q8hr for up to 24-48hrs.

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59
Q

What are the NPO times for full meal, light meal, breast milk, & clear liquids?

A

8hrs, 6hrs, 4hrs, & 2hrs

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60
Q

Kahoot
Leoning Face associated with infectious disease?
Chipmunk face associated with which eating disorder?
Spider Angioma associated with which liver disease?
Pyloric Stenosis associated with mass shaped as?

A

Leoning Face associated with Leprosy.
Chipmunk face associated with Bulimia Nervosa
Spider Angioma associated with Cirrhosis.
Pyloric Stenosis associated with olive shaped mass.

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61
Q

Kahoot
Hyperthyroidism is associated with what ophthalmic change
Physical feature for Cushing’s disease
Rice water stool is commonly found in what illness?

A

Hyperthyroidism ; Exophthalmos.
Cushing’s disease ; Buffalo hump
Rice water stool ; Cholera

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62
Q

Stimulating the peroneal nerve causes? TEST

A

Foot drop; plantar reflex

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63
Q

When can tube feeds be continued?

A

With a Dobhoff unless it is a abdominal case.

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64
Q

What is Mendelson syndrome?
What two factors increase your risk for this?

A

Aspiration Pneumonitis is a chemical injury caused by inhaled gastric contents.

Increased risk of aspiration due to > 25mL of gastric contents and a gastric pH < 2.5.

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65
Q

What are some aspiration prophylactic measures?

A
  • Decrease gastric volume
  • Increase gastric pH (sodium citrate),
  • H-2 receptor antagonist
  • PPI’s
  • Dopamine-2 antagonist.
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66
Q

H-2 receptor antagonists like Pepcid & PPI’s do what?

A

Increase gastric pH & decrease gastric acid secretion

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67
Q

Who is at risk for pulmonary aspiration?

A
  • Pregnancy
  • DM
  • Significant opioid users
  • BMI >40
  • Emergent Sx
  • Any esophagus or abdominal issue Pt
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68
Q

What is PONV?
What are risk factors for it? (4)

A

Premedication Nausea and Vomiting Prevention
Female, History of PONV, Nonsmoker, PostOp Opioids

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69
Q

For someone with an Apfel score of 3-4 should receive what considerations? (4)

A
  • Avoid general anesthesia
  • Propofol
  • Minimize opioids
  • Prevent 3 drugs from different classes.
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70
Q

For a Pre-op Pt currently on Vanc or fluoroquinolone should receive their Abx when?

A

2hrs before incision

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71
Q

What chance of cross-reactivity exists with cephalosporins and penicillin?

A

10%

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72
Q

What 2 anesthesia considerations are made in someone taking Echinacea?

A

-Reduces effectiveness of immunosuppressants.
-Can cause perioperative allergic reaction

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73
Q

What anesthesia considerations are made in someone taking Ephedra? (3)

D/c when?

A
  • Risk of MI
  • Arrhythmia
  • Hemodynamic instability
  • D/C 24hrs pre-op
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74
Q

What anesthesia considerations are made in someone taking garlic (ajo)?

D/c when

A

Inhibits plt aggregation. D/c 7 days prior to Sx

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75
Q

What anesthesia considerations are made in someone taking ginger?

A

Increased risk of bleeding

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76
Q

What anesthesia considerations are made in someone taking Ginko?

A

Increased risk of bleeding. D/C 36hrs before Sx.

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77
Q

What anesthesia considerations are made in someone taking Ginseng? (3)

A
  • Hypoglycemia
  • Inhibit Plt aggregation ->
  • Decrease effect of Warfarin. D/c 7days prior to Sx.
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78
Q

What anesthesia considerations are made in someone taking Green tea?

A

Inhibit plt aggregation

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79
Q

What anesthesia considerations are made in someone taking Kava?

A

Increase sedative effects of anesthetics

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80
Q

What anesthesia considerations are made in someone taking Saw palmetto?

A

Increased risk of bleeding.

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81
Q

What anesthesia considerations are made in someone taking St John’s? (3)

A
  • Induction of CYP450
  • Affects benzos, CCB’s
  • Delayed emergence.
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82
Q

What anesthesia considerations are made in someone taking Valerian?

A
  • Increased sedation effects
  • Increased anesthetic use with long-term use.
  • Acute benzo withdrawal
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83
Q

Scopolamine patch should NOT be used in what kind of Pt? (2)
Confused because they can’t see?

A

Narrow-angle glaucoma, confused Pts

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84
Q

What N/V medication is given after induction & what can it cause?

A

Dexamethasone. Can cause increased blood glucose

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85
Q

When are Abx re-dosed in the OR?

A

When the Sx lasts >4hrs

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86
Q

RUQ pain with cholecystitis is called? TEST

A

Murphy’s sign

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87
Q

Kahoot
Bluish discoloration associated w/ pancreatitis?
Rebound tenderness associated w/ appendicitis?
Icteric Sclera associated with _______.
Addison’s disease associated with this skin color?
Condition w/ inspiratory wheezes?

A

Blue & Pan: Cullen sign
Rebound: McBurney’s point
Icteric S: Hepatitis.
Addison’s D: Bronze
Wheeze: Asthma.

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88
Q

What is the name for chest-clutching that occurs during MI? TEST

A

Levine’s sign

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89
Q

1 sign of hypoexmia in children? TEST

A

Bradycardia

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90
Q

Kahoot!
Myasthenia Gravis results in facial condition?
Two common findings in hyperthyroidism?
Which medication should be avoided in adrenal insufficiency & why?
Which two signs are common with Meningitis?
Which two are associated with hypocalcemia?

A

MG: Ptosis
HyperThy: Exophthalmos & Tachycardia
Adrenal: Etomidate causes adrenal suppression
Meningitis: Kernig and Brudzinski
Hypocalcemia: Chvostek and Trousseau

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91
Q

WEBER’S TEST
RINNES TEST

Purpose of test

A

Rinne’s test. + when air conduction is better than bone conduction.
Weber’s is heard in the midline is equal

Tests for hearing loss

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92
Q

Vibration travels faster through bone than air?

A

True, vibration travels fastest thru bone.

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93
Q

Rank the following from most to least reflective; bone, air, muscle, liver?

A

Air, bone, liver, muscle

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94
Q

In what leads will the P wave be positive?

P wave duration

A

Leads I, II, aVF, V4-V6
D: < 012s

95
Q

Right MI causes death of?
Expected HR?
Lead Elevation?

A

pacemaker cells.
HR: 40-60
Lead: II & III

96
Q

Bachman’s bundle

A

Conduction pathway traveling from SA node to L atrium

97
Q

Baseline HR of Purkinje Fibers
What is an idioventricular rhythm?

A

20-40 bpm
ID: rate <50, absent P waves, wide QRS

98
Q

AV node inherent HR
Junctional Rhythm conducted where? HR?

A

40-60bpm
JR from AV junction. HR still 40-60

99
Q

A retrograde P-wave means what?

A

A junctional rhythm with the signal coming from the AV node

100
Q

PR interval represents:
Length of PR Interval:

A

AV conduction
0.1-0.2

101
Q

QRS Complex
Big QRS Complex =

A

0.08-0.12 seconds
Big QRS Complex = small heart size

102
Q

ST elevation in all the leads

A

PERICARDITIS

103
Q

The T-wave will positive in what leads?

A

Leads I, II, V3-V6

104
Q

PVCs are problematic because

A

it’s 75% of SV in ventricles
need to check if pt perfusing

105
Q

Common cause of:
PVCs
Bifocal PVCs (2)

A

Hypoxia
Electrolyte imbalances, electrical injuries

106
Q

What can induce A flutter (2)

A

Caffeine and cocaine

107
Q

Which electrolyte imbalance do V fib patients usually have?

A

Hyperkalemia

108
Q

First MEDICATION after NO PULSE is _____? Next try _____; how many units in bottle?

A

1 mg of Epi
Next try Vasopressin 20-unit dose

109
Q

Halothane & enflurane can cause what?

A

Sensitive myocardium leading to arrhythmias

110
Q

Sevoflurane can cause _____ in infants?

A

Bradycardia

111
Q

Desflurane may cause ____ during induction?

A

Prolonged QT

112
Q

Concentrated intravascular local anesthetic can cause ____ & is treated with____?

A

Asystole & lipid rescue

113
Q

Lidocaine’s effect on ventricles

A

Lidocaine: knocks out ventricular component

114
Q

What is sometimes masked intra-op & presents post-op with HTN, tachycardia or both?

A

Catecholamine excess

115
Q

Pt’s using cocaine are more likely to what intra-op?

A

Bleed

116
Q

Pt’s using meth are likely to what intra-op?

A

Go hypotensive. They are chronically hypertensive.

117
Q

What does a Pt’s temp have to be to go to PACU?

A

96 degrees

118
Q

What is anthropometry?

A

Study of measurements & proportions of the human body

119
Q

What is micrognathia?

A

Undersized lower jaw.

120
Q

Compare axillary vs core temp.

A

Axillary will read 1 degree Fahrenheit less

121
Q

Which NMJB should not be given to bedridden Pt’s?

A

Succinylcholine

122
Q

When is mediated or indirect percussion used?
How is it performed?

A

To evaluate the abdomen or thorax. Strike fingers of one hand with other.

123
Q

How to do Immediate Percussion?
What does it evaluate?

A

Striking the surface directly with the fingers of the hand.
Evaluate the sinus or an infant thorax.

124
Q

When is fist percussion used?

A

To evaluate the back and kidneys for tenderness.

125
Q

A high pitched, drum-like sound during percussion is indicative of?

A

Air containing space, enclosed area, gastric air bubble

126
Q

A long, hollow, low pitched sound during percussion is indicative of?
Sound name?

A

Resonance
Normal lungs

127
Q

Name of a very loud & low booming sound during percussion.
Indicative of?
TEST

A

Hyperresonance
Emphysematous lungs

128
Q

A thud-like, high pitched percussion is indicative of which organ?

A

Liver

129
Q

A short, high pitched, flat sound percussion is indicative of which organ?

A

Muscle

130
Q

What is Gilbert’s syndrome?

A

Inherited condition that impairs the ability of enzymes to process the excretion of bile.

131
Q

What is Cholestasis?

A

This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted.

132
Q

What is Hemolytic anemia?

A

The production of bilirubin increases when large quantities of red blood cells are broken down.

133
Q

What happens in inflammation of the bile duct?

A

This can prevent the secretion of bile and removal of bilirubin, causing jaundice.

134
Q

What happens in acute inflammation of the liver?
Results in?

A

Impair liver’s ability to conjugate and secrete bilirubin
Resulting in a buildup.

135
Q

What is Vitiligo?

A

An autoimmune disorder in which the systems in the body that fight off infection begin to fight off the healthy cells (melanocytes). Black & white skin)

136
Q

Ecchymosis can be caused by what? (4)

A
  • cocaine use
  • Sinus infection
  • spontaneous bleeding
  • skull fx
137
Q

Koilonychia can be a sign of

other name

A

Sign of hypochromic anemia, especially iron-deficiency anemia.
Spoon nails. Abnormally thin nails that lost their convexity.

138
Q

What is Paronychia?
Caused by which bacteria or fungus?

A
  • Inflammation of the skin around the nail
  • due to the bacterium Staphylococcus aureus
  • Gradually caused by the fungus Candida albicans.
139
Q

Someone with a shampoo allergy might also be allergic to?

A

CHG, chloraprep, etc.

140
Q

What is anisocoria?

A

A notable difference in pupil size between the two eyes.

141
Q

What is Arcus Senilis?

A

Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)

142
Q

What is Horner’s syndrome? (TEST)
Cause (2)

A
  • Constellation of clinical signs, the triad of ptosis, miosis, & anhidrosis.
    -Interscalene blocks
  • Results from a lesion to the sympathetic pathway that supply the head and neck region.
143
Q

What is the treatment for a sty?

A

Warm moist towel, helps increase perfusion and unclog the duct.

144
Q

How does Narcan affect the pupils?

A

Narcan can make pupils slow to react. Even unevenly.

145
Q

PEA is also know as

A

EMD: Electromechanical Dissociation: Rhythm but no squeeze

146
Q

Defibrillation Jules:
Biphasic
Monophasic

A

Biphasic: 120-200J
Monophasic: 360J

147
Q

PEDI Defibrillation Joules
First shock:
Second Shock:

A

First: 2J/kg
Second: 4J/kg

148
Q

What are the 6 H’s of ACLS?

A

Hypoxia
Hypovolemia
Hyper-/hypokalemia
Hydrogen ion (acidosis)
Hypoglycemia
Hypothermia

149
Q

What are the 5 T’s of ACLS

A

Toxins
Tamponade(cardiac)
Tension pneumothorax
Thrombosis (coronary and pulmonary) Trauma.

150
Q

What is the dose & interval for atropine in adult bradycardia?

A

1mg q3-5mins max 3mg

151
Q

What is the treatment for beta blocker induced bradycardia?

A

Glucagon

152
Q

What is the treatment for CCB induced bradycardia?

A

Calcium

153
Q

At what ETCO2 reading does a cardiac arrest pt perfuse adequately?

A

> 15 mmHg

154
Q

What are the lidocaine doses for an adult cardiac arrest?

A
  • First dose: 1 -1.5 mg/kg.
  • 2nd dose: 0.5 – 0.75 mg/kg
155
Q

3 Meds for Stable Wide Complex Tachycardia
-include dose

A
  • Amio: bolus 150mg over 10mins then infusion.
  • Procainamide: 20-15 mg/min (start w/ 20 mg/min & titrate until
    arrhythmia is suppressed or hypotension occurs or QRS widens
    >50%).
  • Sotalol: 100 mg over 5mins (avoid in long QT).
156
Q

What is the treatment for magnesium OD in PIH?

A

Calcium or gluconate

157
Q

What are the causes for cardiac arrest in pregnancy?
ABCDEFGH

A
  • (A)nesthetic
  • (B)leeding (prone to DIC)
  • (C)ardiovascular
  • (D)rugs
  • (E)mbolic
  • (F)ever
  • (G)eneral
  • (H)TN
158
Q

What is the Epi dose in pediatric cardiac arrest (IV & ETT)?

A
  • IV: 0.01 mg/kg
  • ETT: 0.1 mg/kg
159
Q

Pediatric patients usually have VF or Asystole/PEA?
What causes Vf? (2)

A

Kid’s usually have H*T’s so Asystole/PEA.
Vf: electrocution and drowning

160
Q

What is the Amio dose for pediatric cardiac arrest?

A

5mg/kg up to 3 doses

161
Q

What is the lidocaine dose for pediatric cardiac arrest?

A

1mg/kg loading

162
Q

What is the atropine dose & frequency in pediatric bradycardia?

A

0.02 mg/kg q3-5mins

163
Q

What is the adenosine dose for pediatric tachycardia?

A

0.1 mg/kg

164
Q

What are the neonatal target SpO2 1min & 5mins post birth?

A
  • 1min= 60-65%
  • 5mins= 80-85%
165
Q

When should Epi be given in neonatal resuscitation?

A

If HR <60 persists.

166
Q

When is neonatal resuscitation started?

A

If apneic or HR <100.

167
Q

How are Celsius convert to Fahrenheit & vice versa?

A
  • Take Celsius temp multiply it by 1.8 & add 32.
  • Take Fahrenheit temp, subtract 32 and multiply by 5/9th.
168
Q

EKG Changes:
Hyperkalemia
Hypokalemia (2)

A

HyperK: peaked T waves
Hypok: U wave & ST depression

169
Q

EKG Changes:
Hypercalcemia (4)
Hypocalcemia

A

HyperC: P wave disappears, WIDE QRS*, Peaked T & J wave
HypoC: Prominent U wave

170
Q

What is a Delta wave?
Which patients get it?
What are problematic medications? (2)

A

D: Slurred upstroke of QRS
P: WPW
Avoid CCB and Adenosine in WPW pts

171
Q

What position is recommended for EKG lead placement?

A

Supine

172
Q

Precordial Lead Placement: V1-V6

A

V1 4th intercostal, right sternum
V2 4th intercostal, left sternum
V3 between V2 & V4
V4 5th intercostal, left mid clavicular
V5 5th inter; more left than V4
V6 5th inter; more left than V5

173
Q

Briefly Describe:
Q Wave
R wave
S
J Point

A

Q: first negative deflection after P wave
R: first POSITIVE deflection after P wave
S: negative deflection after Q/R
J: Juncture point for QRS ends, ST begins

174
Q

What is axis deviation used for?

A
  • To diagnose hemiblocks
  • Calling VT
  • Identify possible complications
175
Q

Physiologic Left Axis Degrees?
Lead I, II, III +/- ?

A

Degrees: 0 to -40
I: +, II: +/-, III: -

176
Q

What axis would result from an anterior hemiblock?

A

Pathological Left axis (-40 to -90degrees)

177
Q

What axis would result from a posterior hemiblock?

A

Right axis (90 to 180degrees)

178
Q

What axis would result from a ventricular origin rhythm?

A

Extreme right axis (>180)

179
Q

What will the QRS, in Leads I, II, III look like in an extreme right axis?

A

Negative like a V in all 3.

180
Q

What Lead is used for BBB (Turn Signal) & what other criteria is important?

A
  • V1 (MCL-1)
  • QRS must be at least .12sec wide
    -Down = left; Up = right
181
Q

What will the QRS, in Leads I, II, III look like in a pathological left axis?

A
  • Lead I= ^
  • Lead II & III= negative V
182
Q

What meds are not given to someone with a RBBB + anterior hemiblock (bifasicular)?
Why?

A

Lidocaine & procainamide
They’ll lose all ventricle function

183
Q

Which 2 block is at high risk for LAD occlusion?

A

RBBB + posterior hemiblock

184
Q

RCA supplies blood to (5)

A

SA & AV node
Right Ventricle
LV Inferior & Posterior wall
Posterior Fascicle of LBB

185
Q

What part of the heart is the best seen on a 3 lead EKG?

A

LV inferior wall

186
Q

The LAD supplies which structures? (4)
Also called the?

A
  • LV anterior wall
  • septal wall
  • Bundle of His
  • BB
    Called the Widow Maker
187
Q

Someone with an occlusion in the LAD is at risk for?(3)

A
  • Decreased systemic perfusion
  • myocardial rupture
  • hypotension
188
Q

The Circumflex supplies which structures? (4)

A
  • LV lateral & posterior walls
  • SA (40%) & AV (10%) nodes
189
Q

Chest Pain Relation to Occlusion:
CP on exertion
CP at rest
CP on nitro

A

Exertion: 70 – 85% occlusion
Rest: 90%
Nitro: 100%

190
Q

What is ischemia & at what time does it start?

A
  • Transient reduction in blood flow to the myocardium
  • Begins to form in 30mins
191
Q

Ischemia primary effect on T waves?

A

Inverted T waves in 2+ leads

192
Q

Reciprocal changes of an Inferior MI causes ST depression in which leads?

A
  • ST depression in Lead I & aVL
193
Q

ST depression can indicate what else besides infarcts? (2)

A
  • Subendocardial injury
  • Drug or electrolyte problems
194
Q

At what size is a Q wave pathological & what does it mean?

A
  • > 40 ms wide or 1/3 depth of R wave
  • Means necrotic tissue is present
195
Q

Leads I & aVL refer to what part of the heart?

A

High lateral

196
Q

The circumflex correlates to which leads & where would reciprocal changes be?

A
  • V5, V6, Lead I
  • Reciprocal in aVL Leads II, III, aVF
197
Q

The LAD correlates to which leads & where would reciprocal changes be?

A
  • V1 – V4
  • Reciprocal in II, III, aVF
198
Q

The RCA correlates to which leads in a normal EKG

A
  • Normal EKG= inferior II, III, aVF
199
Q

What reciprocal changes would be seen with a posterior AMI?

A

ST depression in V1 – V4

200
Q

Inferior MI’s may present with what kind of symptoms? (4)

A
  • Nausea
  • Abd referred pain
  • Bradycardia
  • Hypotension
201
Q

An anterior wall MI can lead:
-3 heart rhythms
-heart conduction problem
-spread to create MIs in 2 places

A
  • CHB, VT, or VF
  • Hemiblocks
  • Anterorseptal or anterolateral MI’s
202
Q

Besides PCI, what is the treatment for anterior wall MI’s? (2)

A
  • Nitrates IV
  • No fluid bolus, use fluids cautiously
203
Q

What reciprocal changes will be seen with LV hypertrophy?

A

None

204
Q

What position will someone with pericarditis feel best in?

A

Leaning forward

205
Q

What can inhaled nitrous lead to in nasal procedures?

A

Air trapping

206
Q

Besides the eyes & skin what is a good site to check for jaundice?

A

Buccal mucosa

207
Q

A bright red tongue is an indication for what? TEST

A

Vitamin B12 or niacin deficiency

208
Q

What is an indication of cherry-colored lips?

A

Carbon-monoxide poisoning

209
Q

What are spongy gums indicative of?

A

Vitamin C deficiency

210
Q

What is Leukoplakia?

A

Thick white patches on gums due to smoking & EtOH

211
Q

What does the Romberg’s test assess?

A

Perception

212
Q

How do you assess arm flexion at the elbow?

A
  • Identify biceps tendon by flexing against resistance
  • Then place arm @ 90 degrees
  • Place finger on tendon & strike it.
213
Q

How do you assess extension at elbow?

A

1) Flex arm at elbow,
2) Hold arm across chest or hold upper arm horizontally
3) Strike tendon just above elbow

214
Q

What herbs/supplements carry increased risks for bleeding?

A

Saw Palmetto & anything starts with a G.

215
Q

Who population is 90% fast acetylators

A

Asians are ultra-rapid metabolizers

216
Q

Temporal nature refers to the __________ of the pain.
Underlying etiology refers to the _______ of the experienced pain

A

Temporal: duration; acute vs chronic
Etiology: source; nociceptive vs inflammatory

217
Q

What are the four ways to classify pain?

A

Underlying etiology
Anatomic location
Temporal nature
Intensity.

218
Q

Pain Underlying Etiology:
Describe Nociceptive Pain

A

Result of direct tissue injury from a noxious stimulus.

219
Q

Pain Anatomic Location:
Describe Somatic vs Visceral Pain

A

S: superficial like muscle, bone
V: internal organ pain like appendicitis

220
Q

Which opioid does not show up on a UDS?

A

Fentanyl

221
Q

OPQRST Pain History Mnemonic

A

Onset
Provocation of symptoms
Quality
Region
Severity
Timing

222
Q

Pain Pharm Tx for Etiologies:
Nociceptive (2)
Inflammatory
Neuropathic (3)
Idiopathic

A

N: Both opiate & non-opiate
I: Anti-inflammatory
N: SNRI, Gabapentin, Antidepressant
I: difficult to address

223
Q

Pain Pharm Tx for Anatomy:
Somatic (4)
Visceral

A

S: Topical & local anesthetics, opiates & non-opiates
V: Opiates

224
Q

Pain Scale for Pediatrics:
Birth-6mo
Infant & older
3y and older
8y and older

A

B-6: Neonatal Infant Pain Scale (NIPS)
Infant: Faces, Legs, Activity, Cry, Console (FLACC)
3: Wong Baker FACES
8: Numeric Pain Scale (NPS)

225
Q

PO Pediatric Dose of Acetaminophen:
PO (dose, frequency, max)

A

PO: 15mg/kg, q 4-6h
Max 90mg/kg/d

226
Q

IV Pediatric Dose of Acetaminophen:
(2 dose & frequency; max)

A

Dose: 15mg/kg q6 or 12.5mg/kg q 4;
Max: 75mg/kg/d

227
Q

Ketamine Procedural Dosing:
Adult
Pediatric
IM

A

A: 0.5-1.0 mg/kg
P: 1-2mg/kg
IM: 4-5mg/kg

228
Q

Ketamine Sub-dissociative Dosing:
Adult IV
IM
IN

A

Adult IV: 0.1 - 0.3mg/kg
IM: 0.5-1.0 mg/kg
IN: 0.5-1.0 mg/kg

229
Q

Ketamine Delirium Dosing:
Adult
IM

A

IV: 1mg/kg
IM: 4-5mg/kg

230
Q

Intranasal Doses and Max:
Fentanyl
Midazolam

A

F: 1.5-2mcg/kg q1-2h; max 3mcg/kg
M: 0.3mg/kg; max: 10mg per nostril

231
Q

Intranasal CONCENTRATIONS of:
Ketamine
Fentanyl
Midazolam

A

K: 50mg/ml
F: 50mcg/ml
M: 5mg/ml

232
Q

Ketamine MOA

A

Block NMDA receptors, peripheral Na channels and μ-opioid receptors

233
Q

Dermatomes:
Shoulder & Clavicle
Thumb & Index Finger
Forearm
Nipple
Xiphoid Process Tip

A

Shoulder & Clavicle C4-C5
Thumb & Index Finger C6-C7
Forearm T1-T2
Nipple T4
Xiphoid Process Tip T6

234
Q

Dermatomes:
Umbilicus
Inguinal Ligament
Knee & Distal Thigh
Lateral Foot
Perineum

A

Umbilicus T10
Inguinal Ligament T12
Knee & Distal Thigh L3-L4
Lateral Foot S1
Perineum S2-S4

Marcus HA S24 (11 decks)

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