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Clinical Disciplines > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Addiction

A

Primary, chronic disease of brain reward, motivation, memory and related circuitry
Characterized by inability to abstain, impairment in behavioral control, craving, diminished recognition of significant problems with behaviors and relationships and dysfunctional emotional response

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2
Q

When does addiction start?

A

Peak is about 18 years, but mean is 10-25

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3
Q

Dopamine Pathways

A

Reward/motivation, pleasure, euphoria, motor function (fine-tuning), compulsion, perseveration

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4
Q

Serotonin Pathways

A

Mood, memory processing, sleep, cognition

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5
Q

Dopamine Reward Pathway

A

Dopamine released into synapse, bind to receptors, sends signal topmost-synaptic neuron, transported back to presynaptic neuron
Cocaine blocks removal of dopamine resulting in build-up leading to continuous stimulation>euphoria, over time the receptors become overloaded

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6
Q

Outcomes of continued drug use

A

Sensitization, craving and relapse; loss of control over drug use/compulsive drug seeking behavior
Loss of control of body movement, early learning/memory processing, attention state

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7
Q

Incentive Salience

A

Type of motivation created in brain because its developed an association between stimuli and reward

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8
Q

Risk factor for Substance Abuse Disorder

A

Genes (40-60%), M:F 2:1
Environment (family belief, exposure, peer pressure)
Childhood events (trauma, mental health, etc)
Age of onset (40% if 14 or younger, 10% if 20+)
Psychiatric comorbidities- anxiety, depression, bipolar

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9
Q

What kind of drugs do not have withdrawal symptoms?

A

CPC, hallucinogens, inhalants

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10
Q

Triage

A

Sorting patients according to the urgency of their need for care
Immediate threat to life, limb or vision is treated first

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11
Q

5 level triage system

A 
Takes into account: physical, developmental, psychosocial needs, patient flow, health care access
1-life/limb/vision threat
2-abnormal vitals, 2+ tests
3-2+ tests w/ normal vitals
4-1 test normal vitals
5-no testing needed (healthy)
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12
Q

Decision Point A (triaging)

A

require immediate intervention?-airway, circulation, mental status (unresponsive/only to pain)

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13
Q

Decision Point B (triaging)

A

Abnormal vitals but not life threatening, new mental status changes

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14
Q

Decision Point c (triaging)

A

How many tests are you running?

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15
Q

EMTALA

A

“anti-dumping law”
Any facility that receives government funding must treat any patient until stable or transfer if needs are not available (at least a medical screening exam)
Up to $50,000 fine per violation

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16
Q

250 yard rule

A

Any person within 250 yards of the ED are the responsibility of the ED

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17
Q

Hypoxia

A

Insufficient delivery of oxygen to tissue, taken from finger

SaO2 <94%

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18
Q

Hypoxemia

A

Abnormally low arterial oxygen tension, taken from ABGs

PaO2 <60mmHg

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19
Q

Hypoventilation

A

Causes increased PaCO2 (decreased pH)

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20
Q

Right-to-left Shunt

A

Failure to increase oxygen levels with supplemental oxygen

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21
Q

Causes of Hypoxemia

A

Hypoventilation, right-to-left shunt, VQ mismatch, diffusion, low inspired oxygen (high altitude)

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22
Q

Stridor vs Wheeze

A

S: upper airway, inspiratory (foreign body, epiglottitis, anaphylaxis, croup)
W: lower airway, expiratory (asthma, COPD, cardiogenic palm edema, foreign body)

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23
Q

Rales vs Rhonchi

A

Rales-velcro sound/crackles, CHF

Rhonchi- pneumonia, clears with cough

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24
Q

Hypoxia Symptoms

A

Early: restless, anxiety, tachycardia/tachypnea
Late: Bradycardia, extreme restlessness, dyspnea
Peds: feeding difficulty, stridor, nasal flares expiratory grunting, sternal retractions

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25
Q

Signs of Respiratory Failure

A

Nasal flaring, head bobbing, see saw breathing, retractions, altered mental status, hypoxia

26
Q

What pathogen is Rust Colored Sputum?

A

Strep pneumoniae

Also most common cause of pneumonia

27
Q

What pathogen is is green colored sputum?

A

Pseudomonas or H flu

28
Q

What pathogen is red currant jelly?

A

Klebseilla

Common in alcoholics and nursing home pts

29
Q

What pathogen causes foul smelling/bad tasting sputum?

30
Q

What pathogen is associated with bradycardia and hyponatremia?

A

Legionella

31
Q

What pathogen is associated with bullous myringitis?

A

Mycoplasma pneumoniae

32
Q

Symptoms of pneumonia

A

sudden onset of fever, rigors, productive cough, dyspnea

Lobar infiltrate

33
Q

Left heart border not visible due to what?

A

Left upper lobe pneumonia (in the lingula)

34
Q

HCAP Treatment

A

Cefepime or ceftazidime or piperacillin-tazobactam
Cipro Q8H or levo QD
vancomycin Q12H

35
Q

Pneumonia Mortality Predictor

A

CURB-65
confusion, uremia, resp rate >30, BP <90/60, over 65YO
3-5 points=ICU, 2=admit

36
Q

High Altitude Sickness

A

> 5000 feet, most commonly 8,000-14,000: hypoxic environment

Sleep and rate of ascent are most critical to consider

37
Q

Altitude Acclimatization

A

Hypoxic ventilatory response-lessened by respiratory depressants
Increased erythropoietin
Peripheral venoconstriction ^central blood volume, ADH and aldosterone suppressed>diuresis
Increased HR, contracted pulmonary vessels
Cheyne-stokes breathing above 9,000 ft
Acetazolamide causes bicarb diuresis

38
Q

Acute Mountain Sickness Signs/Symptoms

A

Lightheaded/dizzy, headache increased with bending/valsalva, anorexia, nausea, weak, irritable, breathless w/ activity
Localized rales, postural hypotension, retinal heme, FLUID RETENTION

39
Q

Acute Mountain Sickness Treatment

A 
Decrease elevation
0.5-1L O2/min
Acetazolamide
Aspirin
Dexamethasone
Prevent with slow ascent, acetazolamide 24hrs before, dex, high carb meals, avoid exertion, alcohol and respiratory depressants
40
Q

High Altitude Cerebral Edema

A

Altered mental status w/ neuropathy symptoms, ataxia, stupor, coma
Cranial nerve palsy 3-6

41
Q

High Altitude Cerebral Edema Treatment

A

Oxygen, descent, dexamethasone, loop diuretics (furosemide, bumetanide)

42
Q

High Altitude Pulmonary Edema

A

Most lethal altitude sickness

Dry>productive cough, decreased exercise performance, rales, increasing dyspnea, coma, death

43
Q

High Altitude Pulmonary Edema Treatment

A

Recognition, immediate descent, Oxygen, nifedipine

44
Q

Congestive Heart Failure

A

MC reason for medicare admission

Most common cause is LV dysfunction (hypertension, aortic stenosis-syncope, chest pain, dyspnea on exertion)

45
Q

CHF Signs and Symptoms

A

Hypoxemia, hypertension, tachycardia, dyspnea, weight gain, rales, wide QRS complex, “fluffy” infiltrates on X-ray, B-lines on lung ultrasound*
L: fatigue, cough, orthopnea
R: edema, JVD

46
Q

CHF Treatment

A

Oxygen/ventilation, nitroglycerin, morphine sulfate, diuretic (furosemide), dobutamine

47
Q

CHF Treatment to Avoid

A

CCB, NSAIDs, Anti-arrhythmics

48
Q

Pulmonary Embolism

A

Most common cause of nonsurgical maternal postpartum death

Virchows Triad

49
Q

Virchows Triad

A

Venous stasis, vessel wall inflammation, hypercoagulability

50
Q

Pulmonary Embolism Signs/Symptoms

A

Pleuritic chest pain, shortness of breath, hemoptysis

dyspnea, syncope, leg swelling, confusion, hypoxemia

51
Q

Pulmonary Embolism Risk Assessments

A 
Wells score (2-6 mod, >6 high)
Geneva score (>3)
PERC Criteria
52
Q

Pulmonary Embolism Testing

A

Xray: Hampton’s hump (triangle infiltrate), westermark’s sign (dilated pulmonary vessels), Fleischner sign (distended palm artery)
CT is test of choice
EKG: “classic sign” S1Q3T3, sinus tach is most common

53
Q

PE Treatment (anticoags)

A

Heparin, Coumadin, lovenox, rivaroxaban

54
Q

PE treatment (Thrombolysis)

A

Streptokinase, urokinase, alteplase (tPA)

Embolectomy, catheter directed (tPA/heparin)

55
Q

Asthma

A

Chronic but reversible inflammatory disorder

“airway inflammation, obstruction to airflow, bronchial hyper-responsiveness” with dyspnea, cough and wheezing

56
Q

COPD

A

Chronic irreversible disorder
*Smokers, alpha-1-antitrypsan
Cough worse in the morning, SOB, wheezing, dyspnea, cyanosis

57
Q

Chronic Bronchitis

A

Chronic productive cough for 3 months in 2 years

58
Q

Emphysema

A

Destruction of bronchioles and alveoli

59
Q

COPD Treatment

A 
B-agonist (albuterol) 
Epi IM-bronchodilator
Ipatropium bromide with B agonist
Corticosteroids (dei, methylpred, pred)
Magnesium Sulfate-exacerbations only
Heliox (peds)
No theophylline
BiPAP
60
Q

BiPAP

A

Bilevel positive airway pressure, more similar to natural breathing than CPAP
Inspiratory higher pressure than expiratory
start at 10/5, don’t go lower than 8/4 or higher than 25/15
IPAP increased for hyprcapnia
EPAP increased for hypoxemia
Goal is SaO2>94%

61
Q

Foreign Body Aspiration

A

1-3 or >85 (MC <1 and >75)
Unilateral wheezing with symptoms that do not respond to bronchodilators
CT or laryngoscopy/bronchoscopy

62
Q

Most common site of foreign body aspiration?

A

Thoracic inlet (level of clavicles on X-ray)-where muscle changes from skeletal to smooth

Clinical Disciplines (4 decks)

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