Final Flashcards
What is hepatitis?
Inflammation of the liver, caused by drugs, infection, alcohol. Most common Hep A,B,C.
How is hepatitis A transferred? Cure?
Fecal-oral, close contact, hand to mouth contact with feces.
Two doses of vaccine older than 1 year old people
How is hepatitis B spread? Cure?
Contact with infected blood, seminal fluid, vaginal secretions, mother to newborn, human bite, sex.
Three doses of vaccine any age
How is hepatitis C spread? Cure?
COntact with infected blood, mother to newborn, not easily spread through sex.
No cure or vaccine
What is HIV? Where is it found?
Human immunodeficiency virus. Blood and sexual fluids, like semen, pre-seminal fluid, breast milk, vaginal secretions, rectal fluid. Part virus, part cell mutated cells. Host cell eventually ruptures, destroys the cell, finds new cells. Opportunistic infections take advantage of disabled immune system.
Chlaymida is what?
Most common STD
Ductus arteriosus
What is it and what does it turn into what post birth?
Connects pulmonary artery to aorta to bypass lungs. Become ligamentum arteriosum and it holds/connects the aorta and pulmonary artery.
Ductus venosus
What is it and what does it become post birth?
Connects umbilical vein to inferior vena cava to bypass liver.
Becomes ligamentum venosum and holds portal vein, vena cava, and liver.
Foramen Ovale
What is it and what does it become post birth?
Allows fetal blood flow from the right atrium to the left atrium to bypass lungs. closes after birth to become fossa ovale.
D10 drug card:
Glucagon drug card
Diabetic home medication categories (4)
- Antihyperglycemics
- Biguanides - Decrease glucose production in liver, increase insulin sensativity
- Glucaphage (metformin)
- Alpha glucosidase inhibitors - slow digestion of sugar, block breakdown of starches
- Precose
- Glyset
- TZD’s
- Improve insulin sensitivity to cells, allowing additional uptake of sugar.
- Avandia
- Actose (pioglitazone)
- Sulfonyureas
- Increase insulin release from the beta cells in the pancreas
- Amaryl (Flimepiride tablets)
- Diabeta (Glyburide)
- Diabinese (Chlopropamide)
- Glucotrol (Glipizide)
- Glynase (Micronized glyburide tablets)
- Micronase (glyburide)
- Glyburide (Micronase)
- Biguanides - Decrease glucose production in liver, increase insulin sensativity
What is seroconversion?
Development of antibodies as a result of exposure to an antigen
Myexedema
Advanced Hypothyroidism, causes bradycardia
What is a thyroid storm? s/s?
When the pituitary gland malfunctions (tumor) creates a massive release of T3 and T4.
Hypertensive = hypoglycemic,
A-flutter if you’re hypotensive.
Treatment - beta blockers if hypertensive, cardiovert if hypotensive
High heart rate, high BP, high temp, syncopal, palpations, chest pain, shortness of breath
Best treatment for a thyroid storm and why?
Atenolol (BB)
Usually hypertensive and tachycardic
In pregnancy, what can a cluster headache indicate? Where is the pain?
Around/ behind the eyes, can indicate preeclampsia
Umbilical cord - arteries and veins?
1 vein, 2 arteries
During delivery if umbilical cord is visible, what should you check first?
If it is pulsating.
What happens/ will you see during placental delivery?
Rising and hardening of the fundus
Small vaginal bleeding present
Lengthening of the umbilical cord
What is zollinger ellisons disease?
Increased circulatory gastrin from gastrin secreting in the duodenum or pancrease, causing chronic peptic ulcers.
What are mallory weiss tears?
- Tears in the esophagus
Longitudinal tears, bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia
Upper GI bleeding
Lower GI versus upper GI bleeding
What structure separates the two?
Lower GI
Usually painless, hematochezia (red blood in the stool)
Upper GI
Dark tarry stool (melena), coffee ground emesis
Ligament of Treitz at duodenum (first part of small intestine) seperates them
What do pineal glands excrete?
Melatonin
What joins the two hemispheres of the brain?
Corpus callosum
Where do involuntary actions in the brain take place?
Like temperature regulation, sleep, water balance, stress response, emotions
Diencephalon (Hypothalamus is here)
What are symptoms of depression?
Sadness, dispair, discouragment
IN SAD CAGES
INterest loss
Sleep disturbances
Appetite change
Depressed mood
Concentration difficulty
Activity level change
Excessive guilt
Loss of energy
SI
Bipolar types (3)
Bipolar 1 = manic episodes lasting 7+days or severe manic requiring hospital
Bipolar 2 = Patern of depressive and hypomanic episodes. Lacks full blown manic of 1
Cyclothymic disorder = 2 years or more periods of depressive symptoms. Not severe enough symptoms to meet hypomanic or depressive episodes.
What are hallucinations?
Senses that are not reality.
Voices most common.
What are delusions?
Are described as false beliefs that are inconsistent with ones knowledge/experience
What is the proper procedure for delivering twins?
Cut cord of first baby first
What is angioedema?
Swelling of the vocal cords usually, also tongue and upper airways
1 in 7 people are diagnosed with what?
Depression
Stung by a scorpion, you’d expect what symptoms?
Muscle twitching, sweating, drowling, slurred speech, restlessness, abdominal pain
Where is an ectopic pregnancy usually found
Fallopian tubes
Symptoms of a snake bite, red on yellow
Convulsions, drooping eyelids, stomach pain, Slurred speech, dilated pupils, dysphagia.
Later signs are flaccid paralysis/death.
22 year old female unresponsive at 22 weeks pregnant. what to check?
BGL
What does flumazenil do?
Its a GABA receptor antaganist, thus it reverses effects of benzodiazepines
What is the microscopic structure in the kidney that produces urine?
Nephrons
25 year old male has difficulty urinating - (dysuria) and maintaining erection. What could be the problem?
Enlarged prostate
Patent foramen ovales can cause strokes - why?
Clots can bypass the lungs (where they would cause a PE) and cause a stroke
- During contraction you see amniotic sac over babies head - what next?
Tear the sac open
What is erythropoetin is responsible for what?
Production of RBC’s
Patient SOB, SPO2 is 88 and Et CO2 is 42. What is likely the problem?
Asthma or something obstructive
Adult patient is having a new onset seizure. What is likely the problem?
Stroke/CVA
Which clotting factor should be replaced when treating hemophilia type A
VIII (8)
What do anticoagulants do?
Take out the clotting factors in the blood, like thrombin, fibrin, vitamin K.
Fibrinolysis
Breakdown of clots
Patient has a vitamin K deficiency - what would you expect to see?
Reduced clotting, so bleeding
Peripheral pitting edema is most commonly seen with what?
Cor pulmonale, aka R Ventricular Failure.
Seen in Emphysema
What does the pancreas secrete?
Glucagon and Insulin
On the pancreas is the islets of Langerhans, the endocrine portion. What does it secrete?
Alpha = glucagon 25%
Beta = insulin 60%
Delta = Somatostatin 10%
F = pancreatic polypeptide 5%
Each hemoglobin can carry how many oxygen molecules
4
- Pregnant patient gives birth and question makes it seem like baby, umbilical and placenta has been delivered - however there is a twist in question that does not clarify everything has been delivered
Give dopamine
Blood type that is universal donor
O-
Sickle cell crisis - what is it?
Sickle shaped cells are fragile, distorted from low oxygen states. Crystallized. Become clogged in tiny blood vessels. Tissues and joints become oxygen starved, causing excruciating pain everywhere.
Basically it’s long term hypoxia
Average hematocrit level?
47% adult male
What is hematocrit?
Percent of blood that is RBC’s
Most appropriate way to restrain a patient
Commercially manufactured padded ones.
If not, roller bandage, blanket roll, small towels, etc.
How long must a TIA be cleared before it can be ruled a TIA?
24 hours
What kind of patient would be prescribed lithium?
Bipolar. Last ditch effort psych medication.
What medications can cause an anticholinergic reaction?
Phenergan and Benadryl
What regulates temperature, sleep, emotion?
Hypothalamus
What is effacement?
Thinning of the cervix
What is gylcosuria?
Excretion of sugar through urine, NOT NORMAL
Stages of addiction
Habitual
Physiological dependence - physiological need for it
Psychological dependence - the belief that you need it
Tolerance - need more to get what you want.
What is withdrawal?
Components of a toxidrome
Drug overdose
When you take more of a substance than a body can handle
Abuse
Using any substance for anything other than its intended purporse
Cholinergic toxidrome - what gives you it, what are the signs and symptoms
Nerve agents and organophosphates
SLUDGEM
- Salivation
- Lacrimation
- Urinary
- Diaphoresis
- Gastro
- Emesis
- Myosis/spasms
Bradycardia, bronchoconstriction, CNS depressent, confusion, convulsion, seizures, coma, wet skin, pinpoint pupils
Anticholinergic toxidrome, what gives it to you, s/s
Antihistamines, atropine, atrovent, tricyclic, antipsychotics
Red, hot, dry, blind, mad
Sympathimometic Toxidrome, what causes it and s/s
Cocaine, meth
Paranoia, diaphoresis, delusions, HTN, CNS excitability, tachy, dysrhythmias, seizures
Opiate Toxidrome
Fentanyl, Cocaine, Opium
Resp distress, pinpoint pupils, CNS depression, seizures, coma
Hallucinogen sympathomimetic
LSD, marijuana, PCP
Visual illusions, strange behavior, delusions, resp depressant, CNS depressant
Hematopoiesis
Creation of new blood cells and platelets
Oliguria
Low urine output, less than 400mL daily
Exotoxin
Toxin released by a living bacterial cell into its surroundings
Sensitization
Making an organism abnrmally sensitive to a foreign substance
What is the name for hypothyroidism, how does it lead to pituitary enlargement?
S/s?
1 CAUSE IS HASHIMOTOS
Myxedema, an autoimmune thyroid deficiency.
Is a condition resulting from thyroid gland inflammation.
High TSH to compensate for low T3 and T4.
Iodine deficiency can cause it, along with removal, damage, cancer/radiation.
S/s hypoglycemia, weight gain, weakness, bradycardia, depression, hypothermia, slowness
Treatment is levothyroxine, supportive.
If you have a thyroid storm causing hypotension, what is the reason for this?
Hypertension, leads to A-fib/A Flutter, reducing cardiac output, leading to hypotension.
What is graves disease?
Hyperthyroidism
Autoimmune, “thyroid storm”
Overproduction of T3/T4
Neoplasm on pituitary gland that causes decrease in TSH
S/S
Weight loss, tachcardia, hypertension, A FIB or A FLUTTER, sweating, tremors, hyperthermic, protruding eyes, difficulty sleeping, diarrhea
TX = BETA BLOCKERS
What is hashimotos thyroiditis?
Thyroid gland is attacked by a variety of cell and antibody mediated immune processes.
Causes hypothyroidism
What is an acute hypothyroidism event? S/s?
Myxedema crisis
Pituitary glands stop releasing TSH, or trauma to the thyroid directly.
S/s - hypotension, bradycardia, skin swelling, hypoglycemia, shallow respirations, coma.
Chronic complications of diabetes
Blindness
Kidney disease
Peripheral neuropathy
Autonomic neuropathy
Heart disease and stroke
Vascular disease
DKA pathophysiology
- Associated with type 1 diabetes
- Profound low levels of insulin prevents glucose from entering cell.
- Cells are starved, use fat for energy.
- Generates acid and glycerol
- Acid generations ketoacids, thus ACIDOSIS
- Potassium leaves blood to enter vascular space, going to urine
- causes low levels of potassium but body is still HYPERKALEMIC
- Sodium level extracellular decreases, replaced by hydrogen ions, furthering ACIDOSIS
- Osmotic diuresis, plus vomiting and dehydration, cause SHOCK
- Can cause seizures and AMS.
- Osmotic diuresis, plus vomiting and dehydration, cause SHOCK
Treatment for DKA
10 mL/kg (1-2L) of saline, 12 lead.
Too much fluid can cause cerebral edema, a reverse fluid shift into brain
QRS widens? CRITICAL
Consider bicarb, albuterol, calcium (arrests)
Causes and S/s of DKA
Forgot insulin, new type 1, Stress, infection, MI, progression of type 2 to type 1
Warm, dry skin
Diuresis
Tachy, thready pulse
3 P’s Polyuria, dypsia, phagia
ABD pain
Acidosis
N/v
KUSSMAUL respirations to attempt to reduce CO2 level
HHNS pathophysiology
Acute diabetic decompensation IN TYPE 2, but develops over time from sustained hyperglycemia
BGL rises 600+
Still have some insulin so NO KETONES (like DKA)
Less acidity, but still present.
Osmotic diuresis that results in dehydration and electrolyte loss.
Commonly caused by infection or illness
Relative insulin deficiency
Hyperosmalarity of the blood due to high BGL
Early S/S are polyuria and polydipsia
HHNS S/S
Extreme volume depletion, causes orthostatic syncope
Polyuria
Tachycardia
Warm, dry skin
Fever
Confusion
Convulsions
NEED FLUID AND INSULIN
Why do DKA patients lose consciousness?
Hyperosmalarity of the cells cause fluid to escape, crenate.
Sodium and potassium shifts into vasculature, causing hyperkalemia.
Addisons Disease pathophysiology, causes, s/s, treatment
Adrenal deficiency
Adrenal glands fail to produce enough aldosterone and/or cortisol, as well as epi and norepi.
Hypotension, hypoglycemic, (increased sensitivity to insulin so BGL drops)
Weakness, lethargy, abd pain, N/V, hyperpigmentation.
Causes - trauma, tumors, autoimmune diseases, chronic steroid use.
Tx: D10, which usually wont respond, then SOLUMEDROL.
Emphysema pathophysiology
Pink puffers, COPD, caused by chronic lung irritants
Elastin broken down by elastase increase in lungs.
Alveoli damaged, decrease in recoil, loss of structures, narrowing results.
Increased residual volume to compensate and due to damage of walls. Hence long torso
Chronic hypoxia causes polysythemia to compensate, spO2 now abnormally low.
Respiratory acidosis due to air trapping with compensated metabolic alkalosis, now depend on oxygen to breathe instead of CO2.
Pulmonary hyperinflation strains the heart, causes cor pulmonale.
CPAP, 12 lead, IV Albuterol, atrovent, fluid.
Generalized seizures vs partial seizures
Partial = localized part of brain.
- Simple = no LOC. Numbness, tingling, abnormal movements, blank stare
- Complex = LOC in some degree. Blank stare, unable to talk lip smacking
Generalized = all of brain
- Absent aka PETIT MAL
- Vacant and unresponsive for 30 seconds ish. Slight twitching. Daydreaming. Common in kids.
- Tonic clonic GRAND MAL
- Muscle contraction, shaking, incontinent, absent breathing sometimes.
- Postictal after.
Reversible causes of apgar 3
Bradycardia, hypoxia, hypotension
Irreversible causes of apgar 3
Lack of surfactant
Tetrology of fallot
Transposition of great arteries
Hep A, B, C differentials and infection
- Hep A - Symptoms may be flu like, acquired via infected persons stool. May have jaundice; typically clears on its own in a few weeks, Vaccine!
- Hep B - Symptoms may be flu like, acute or chronic, acquired via infected persons bodily fluid like semen or blood; May have jaundice; typically clears on its own in a few weeks, Vaccine!
Hep C – May have no symptoms. Symptoms may be flu like, chronic illness, acquired only via infected persons blood; It can be acute or chronic; May have jaundice, cirrhosis, if untreated can lead to liver and kidney failure; NO vaccine!
phenergan drug card
Thiamine drug card
Valium drug card
Benadryl drug card
