General Paramedicine I Flashcards
___ sounds are the sounds that medical personnel listen for when they are taking blood pressure using a non-invasive procedure. These sounds are most commonly observed while measuring blood pressure with a sphygmomanometer and stethoscope over the ___ artery in the ___ fossa.
- Korotkoff (AKA Korotkov);
- Brachial;
- Antecubital;
Note: Korotkoff sounds are named after Dr. Nikolai Korotkov, a Russian physician who discovered them in 1905.
-https://en.wikipedia.org/wiki/Korotkoff_sounds
The ___ of the cardiovascular system detect blood levels of CO2, O2 and pH. In what two places are these sensors located?
- Chemoreceptors;
- Carotid bodies (in the carotid arteries);
- Aortic bodies (in the aortic arch);
* -https://www.livestrong.com/article/198480-chemoreceptors-in-the-cardiovascular-system/*
The left bundle branch bifurcates into the ___ and ___.
- Left Anterior Fascicles;
- Left Posterior Fascicles;
* -https://en.wikipedia.org/wiki/Bundle_branches*
What is cardiac action potential?
- The cardiac action potential is a brief change in voltage (membrane potential) across the cell membrane of heart cells. This is caused by the movement of charged atoms (called ions) between the inside and outside of the cell, through proteins called ion channels.
-https://en.wikipedia.org/wiki/Cardiac_action_potential
With respect to it’s surroundings, what is the general voltage of a non-pacemaker cardiac myocyte at rest (its resting potential)?
- ~-90 mV;
-https://en.wikipedia.org/wiki/Cardiac_action_potential
What is the general voltage of a non-pacemaker cardiac myocyte’s threshold potential (the point at which it becomes guaranteed to depolarize)?
- ~-70 mV;
-https://en.wikipedia.org/wiki/Cardiac_action_potential
The rapid depolarization of a cardiac myocyte during it’s action potential occurs during which phase?
- Phase 0;
-https://en.wikipedia.org/wiki/Cardiac_action_potential
Upon reaching their threshold potential, ___ channels open on non-pacemaker cardiac myocytes.
- Na+;
- -https://en.wikipedia.org/wiki/Cardiac_action_potential*
- https://www.youtube.com/watch?v=rIVCuC-Etc0*
Upon reaching approximately ___ mV, the Na+ channels of non-pacemaker cardiac myocytes close.
- 20 mV;
-https://en.wikipedia.org/wiki/Cardiac_action_potential
Which phase of the cardiac action potential represents early rapid repolarization?
- Phase 1;
Which phase of the cardiac action potential is the plateau phase, and at approximately what voltage does it plateau?
- Phase 2; 2. 0 mV;
The influx of ___ during phase 2 of the cardiac action potential allows the cardiac muscle cells to prolong contraction, delaying full depolarization.
- Ca++;
Which phase of the cardiac action potential is the rapid repolarization phase?
- Phase 3;
During phase 3 of the cardiac action potential, ___ ion channels are closed and ___ ion channels are opened, allowing these ions to quickly depart.
- Fast Ca++ channels; 2. Fast K+ channels;
Which phase of the cardiac action potential is the period between one potential and another?
- Phase 4;
What is the mechanism which occurs during phase 4 of the cardiac action potential which serves to prime a cell for repolarization?
- The Na+ - K+ pump exchanges ions through the cell membrane (three Na+ ions are pumped out for every two K+ pumped in).
Why does the Na+ - K+ pump require ATP to work?
- Both ions must be transported against their concentration gradients.
During which refractory period can a cardiac cell not respond to any stimulus, no matter how great?
- Absolute Refractory Period;
During which refractory period can a cardiac cell respond to a stimulus, yet isn’t at rest?
- Relative Refractory Period (a larger than normal stimulus is required);
On a bottle of Adenosine, the description “6 mg in 2 mL” represents what? The “3 mg/mL” represents what?
- Dose on Hand; 2. End Concentration;
“Adam’s Apple” is a term for the ___.
- Laryngeal prominence of thyroid cartilage;
At what approximate rate do obese patients desaturate in comparison with non-obese patients?
- Twice as fast;
When assigning a Mallampati Score, what score should be given when the patient’s soft palate, fauces, uvula and both anterior and posterior pillars can be visualized through their open mouth? What score should be given if none of these structures can be seen?
- Class I; 2. Class IV;
When evaluating an airway using direct laryngoscopy with the Cormack-Lehane classification system, what grade should be assigned when a patient’s vocal chords are fully visible? When not even the epiglottis can be seen?
- Grade I;
- Grade IV;
* - https://en.wikipedia.org/wiki/Cormack-Lehane_classification_system*
The pediatric airway is ___ shaped, with the widest part being at the ___, and the narrowest at the ___.
- Funnel; 2. Vocal cords; 3. Cricoid cartilage;
When preparing to intubate a pediatric patient, it is recommended to open how many ET tubes?
- Three (one below and one above the expected size);
Toward the head or anterior end of the body.
- Cephalad;
Infants and young children rely more upon the ___ to breathe than adults do.
- Diaphragm;
When possible, in what position should patients who suffer from respiratory conditions be intubated?
- Upright (laying them flat may worsen their condition);
- Name two varieties of external laryngeal manipulation.
- Sellick Maneuver (cricoid pressure); 2. BURP;
What is the Sellick Maneuver?
- External pressure applied over the cricoid cartilage to occlude the esophagus and prevent aspiration/regurgitation;
Once an action potential is initiated, there is a period of time that a new action potential cannot be initiated. This is termed the ___ of the tissue. This period is approximately equal to the absolute refractory period (ARP), and occurs because the ___ channels remain closed until the cell fully repolarizes.
- Effective Refractory Period; 2. Fast Na+;
Patients near an SPO2 of ___% are at risk for precipitous desaturation.
- 90%;
What does FiO2 stand for?
- Fraction of Inspired Oxygen (the percentage of oxygen a patient is inhaling);
What size ET tube should be used if a nasal intubation is attempted? Correct placement will typically result in measurements of 26 cm at the nose for women and 28 cm at the nose for men.
- As large as will be tolerated;
- 26 cm;
- 28 cm;
* - https://litfl.com/nasal-intubation/*
In what position should a supine patient’s head be positioned to intubate with an i-Gel? With a King LTS-D ?
- Sniffing;
- Sniffing;
How deep should the King LTS-D airway be inserted? The i-Gel?
- Connector to teeth, then backed out until ventilations are easy to deliver; 2. Until a definitive resistance is felt;
How much air should be used to inflate the bulbs of the King LTS-D?
- The entire volume of the syringe provided (can be adjusted up or down afterwards);
Name one (of three listed) techniques for keeping the tongue out of the way while inserting a King LTS-D. After insertion, be sure to inflate the cuffs before releasing the ___.
- Tongue-jaw lift (thumb fully in the patient’s mouth to capture the tongue); 2. OPA left in mouth during intubation; 3. Shoehorn technique with laryngoscope (fully inserted to lift tongue forward); 4. Tongue;
What does the “S” in “King LTS-D” stand for?
- Suction;
King LTS-D airways are sized according to patient ___. I-Gel airways are sized according to patient ___.
- Height; 2. Weight;
When inserting an i-Gel, how should the jaw be manipulated?
- The chin should be gently pushed inferiorly, toward the feet (no tongue-jaw lift or fingers inserted into the mouth);
How should the i-Gel be taped down?
- Maxilla to maxilla;
The contraction of cardiac myocytes is initiated by electrical impulses known as ___.
- Action potentials;
An ___ is essentially a brief reversal of electric polarity across a cell’s membrane, and is produced by ___ ion channels.
- Action potential; 2. Voltage-gated;
___ cells do not have a true resting potential.
- Pacemaker cells;
Which cardiac cells exhibit funny channels (aka funny current)?
- Pacemaker cells;
Classification of drugs ending in -pril.
- Ace Inhibitors;
Classification of drugs ending in -olol.
- Beta-Blockers;
Classification of drugs ending in -ipine.
- Dihydropyridine Ca++ Channel Blockers;
Classification of drugs ending in -xetine.
- Selective Serotonin Reuptake Inhibitors (SSRIs);
Which scheduled drugs must be kept locked in a secured container?
- Schedule II-V;
In which schedule classification do drugs with a high abuse potential and with no recognized medical purpose fall?
- Schedule I;
In what safe temperature range must medications be stored?
- 55-86 degrees F;
Into which Pregnancy Classification do drugs which controlled studies showed no risk to the fetus belong?
- Class A;
Into which Pregnancy Classification do drugs which cause fetal abnormalities (risks clearly outweigh any benefits) belong?
- Class X;
Lusitropy is the rate of myocardial ___.
- Relaxation;
Hypothermia ___ the efficacy of medications.
- Reduces;
Blow (air, gas or powder) into a cavity of the body.
- Insuflate;
Malignant hyperthermia is a rare side effect of which paralytic medication?
- Succinylcholine chloride;
The ___ is central to the transport and modification of proteins in eukaryotic cells.
- Golgi apparatus;
A ___ is an organelle in the cytoplasm of eukaryotic cells containing degradative enzymes enclosed in a membrane.
- Lysosome;
The most abundant tissue type in the body.
- Connective tissue;
What type of tissue is blood?
- Connective tissue;
Which type of glands secrete their products through tubes, endocrine or exocrine?
- Exocrine;
___ is a process of programmed cell death that occurs in multicellular organisms.
- Apoptosis;
The most prevalent ion in extracellular fluid.
- Sodium (Na+);
A high sodium ion level in the blood.
- Hypernatremia;
A high potassium ion level in the blood.
- Hyperkalemia;
The most prevalent ion in intracellular fluid.
- Potassium (K+);
The principle chemical buffer of the human body.
- Bicarbonate (HCO3-);
Oncotic pressure is also called ___.
- Colloid osmotic pressure (osmotic pressure exerted by large protein particles);
Which law/hypothesis relates the passage of fluid out of a capillary to the hydrostatic and osmotic pressures of the blood and tissue fluid, and states that the net effect of the opposing pressures determines the direction and rate of flow?
- Starling’s Hypothesis;
Name the principle components of blood and the percentage they make up.
- Plasma (54%); 2. Red blood cells (45%); 3. White cells/platelets (1%);
RBCs are rendered ___ from a hypertonic solution.
- Crenated;
RBCs can ultimately be rendered ___ from a hypotonic solution.
- Lysed;
Normal range of the body’s pH.
- 7.35-7.45;
Chemical formula of carbonic acid.
- H2CO3;
Increased ventilations lead to a(n) ___ in CO2 and a(n) in pH.
- Decrease; 2. Increase;
Decreased ventilations lead to a(n) ___ in CO2 and a(n) ___ in pH.
- Increase; 2. Decrease;
What does DNA stand for?
- Deoxyribonucleic acid;
The most prevalent endocrine disorder.
- Diabetes mellitus;
The amount of blood ejected from the left ventricle in one contraction.
- Stroke volume;
The ___ law of the heart states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant.
- Frank-Starling;
Stroke Volume x Heart Rate = ___
- Cardiac output;
cardiac output x peripheral vascular resistance = ___
- Blood pressure;
The signs and symptoms of anaphylactic shock most often present within _(time period)_.
- One minute;
What does MODS stand for?
- Multiple Organ Dysfunction Syndrome;
The ___ is a membrane-bound structure found within muscle cells which stores and releases calcium ions.
- Sarcoplasmic reticulum (SR);
With the addition of energy from an ATP molecule, the sodium potassium pump moves ___ sodium ions out of the cell and moves ___ potassium ions into the cell with each turn. The goal of this process is to return, or keep, the cell at a resting state, or resting potential.
- Three; 2. Two;
Cardiac pacemaker cells exhibit ___ response action potential.
- Slow;
In general medicine, ___ drug administration is drug administration by the digestion process in the gastrointestinal tract.
- Enteral;
A ___ reaction is an inflammatory reaction to IV contaminants, and takes approximately ___ minutes to present.
- Pyrogenic; 2. 30;
The upper and lower airways are separated by the ___.
- Glottis;
The part of the larynx consisting of the vocal cords and the slit-like opening between them.
- Glottis;
Calculation for a patient’s ideal weight in kilograms.
- 50 + [(# inches > 5’) x 2.3];
When intubating with a bougie (with a partner available to assist with ET tube placement after bougie insertion), how far should the introducer be inserted into the trachea?
Advance until you encounter “holdup,” indicating the bougie has struck the carina or a branch in the bronchial tree, then retract to 25 cm (per EMCrit; if the bougie has entered the esophagus, it would often be possible to insert the entire stylet);
The suffix ___ signifies an inflammatory process, while ___ signifies a degenerative process.
- Itis;
- Osis;
* http://atpplusct.com/itis-vs-osis/*
The term edema refers to a discernible excess of _(location)_ fluid. ___ edema gives way on palpation, leaving persistent impressions in the skin; ___ edema offers resistance and leaves no impressions.
- Intersititial;
- Pitting;
- Brawny;
* https://www.ncbi.nlm.nih.gov/books/NBK348/*
___, the anion that results from dissociation of lactic acid, is a product of ___ metabolism; specifically it is the end product of _(metabolic process)_.
- Lactate;
- Glucose;
- Anaerobic glycolysis;
* https://acutecaretesting.org/en/articles/lactate-and-lactic-acidosis*
