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Med surg > Med-surg test 2 > Flashcards

Med-surg test 2 Flashcards

1
Q

What is a serious of action by the body to protect itself against a pathological organism by the destruction or neutralization of the organism

A

Immunity

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2
Q

What are harmful, different, abnormal substances?

A

Antigens

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3
Q

What are the smallest particle in the body?

A

Haptens

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4
Q

Haptens are not ______ on their own, but if it binds with a _______________ it can cause an allergic reaction

A

ANTIGENS; CARRIER PROTEIN

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5
Q

What are the roles of mononuclear phagocytes?

A

Engulf antigens

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6
Q

What are the lymphocytes that are involved in the immune response and create antibodies? (humoral response)

A

B cells

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7
Q

What are cellular killing cells?

A

Cytotoxic T cells (CD8)

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8
Q

Whar are cells that produce antibidoes?

A

HElper T cells

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9
Q

What is the immunity you are born with?

A

Natural

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10
Q

What immunity exits without formeter contact with antigen?

A

Natural

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11
Q

What is the immunity that produces antibodies?

A

Actibe acquired immunity

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12
Q

What is the immunity that receives antibodies to an antigen?

A

Passive acquired immunity

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13
Q

Vaccines is an example of what immunity?

A

Active acquired

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14
Q

Immunoglobin fed to a baby through breast milk is ________ immunity

A

passive

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15
Q

What immunity is quick and does not last long?

A

PASSIVE

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16
Q

Antivenom is an example of _______ immunity

A

Active

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17
Q

What immunity takes a long time to develop but lasts a long time?

A

Active

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18
Q

What antigen invades and causes B cells to divide and become plama cells- antibodies and to the blood stream?

A

Humoral immunity

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19
Q

What Ig crosses placenta nad is the secondary immune response and takes longer

A

IGG

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20
Q

What Ig lines the mucous membranes and protects body surfaces and is secreted in breast milk

A

IGA

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21
Q

What is the primary immune response and antibodies to ABO blood antigens

A

IGM

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22
Q

Cell mediated incolved what cells

A

CD8 (t cells)

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23
Q

Immune system ______ with age

A

declines

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24
Q

As people get older, there is an increased susceptibility to __________ and ______ incidences?

A

infection and tumor

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25
Q

What occurs in an IgE mediated reaction?

A

Asthma, runny nose, itchiness

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26
Q

Mast cells are where?

A

Everywhere

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27
Q

In an IgE reaction, what is the biggest chemical mediators are released from mast cells

A

HISTAMINE

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28
Q

Anaphylaxis is a ________ emergency

A

medical

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29
Q

The first step of an anaphalytic xn is________ the ______

A

REMOVE the CAUSE

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30
Q

What are the steps of anaphalytic rxn

A

Secure airway
High flow oxygen
IV access
EPI
Albuterol

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31
Q

Cytotoxic reactions involve what Ig’s

A

IgG and IgM

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32
Q

Target cells for a cytotoxic reaction?

A

RBC, WBC, and Platelets

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33
Q

IgG and IgM reactions are normlaly with

A

blood transfucison, Rh factors and drugs

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34
Q

If a patient is transfused with incompatable blood, what should you do?

A

STOP

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35
Q

Delayed Hypersensitive Reactions can be with what material?

A

LATEX

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36
Q

An autoimmune disease is caused when….

A

Immune system cannor decide self from non self

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37
Q

What is the treatment for autoimmunity?

A

Apheresis: blood is separated
Plasmapheresis: plasma is taken

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38
Q

An immunodeficieny occurs when….

A

immune system is not doing its job

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39
Q

What is a primary immunodeficiency disorder?

A

Absent immune cells

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40
Q

Secondary immunodeficiency disorders are caused by?

A

Radiation, chemo, etc.

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41
Q

Unattenuated vaccines are_____

A

dead

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42
Q

Attenutated vaccines are ____

A

alive ; but genetically tweaked

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43
Q

Immunocompromised patient and pregnant cannot get what kind of shot?

A

ATTENUATED

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44
Q

What are the three functions of the immune system?

A

Homeostasis
Defense
Surveillance

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45
Q

What natural killer cells are similar to mononuclear phagocytes and marks for memory?

A

Dendritic cells

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46
Q

What are the cellular communication system?

A

Cytokines

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47
Q

What is the Ig that deals with lymphoyte surfaces and differentiation of B cells?

A

IgD

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48
Q

What is the Ig that is involved in allergic reactions and parasitic infections?

A

IgE

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49
Q

Cell mediated immunity protects primarily against cancer cells, viral infections, and fungal infections?

A

Cell mediated Immunity

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50
Q

What are sympathomimetic/decongestants?

A

Epinepherine (Adrenalin)
Pseudoephedrine (Sudafed)

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51
Q

What are mast cell stabilizing drugs?

A

Coats the mast cells and prevents inflammatory response
Cromolyn and Nedocromil

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52
Q

What is true about latex allergies?

A

The longer you are exposed the more increased chance of allerfic reactions

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53
Q

What are the two types of latex allergies?

A

Type IV: contact dermatitis (delayed)
Type I: reaction within minutes

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54
Q

What are symptoms of latex allergy:

A

Rash
HIVES
Itching
Flushing
Asthma
Shock

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55
Q

What are examples of autoimmune disease?

A

Lupus
RA
Glomerulonephritis

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56
Q

Where is type I HIV present?

A

US
Canada
Europe

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57
Q

Where is type II HIV present?

A

third world countries

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58
Q

What HIV type responds well to meds>

A

Type 1

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59
Q

What is the mode of transmission for HIV?

A

Sexual contact, blood product, perinatal transmission

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60
Q

HIV is a retrovirus meaning it has ____ but no ___ and needs host to duplicate?

A

RNA no DNA

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61
Q

HIV attaches to ____ receptors

A

CD4

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62
Q

Once HIV is in the body ______ makes the viral _____ with reverse transcriptase

A

RNA; DNA

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63
Q

In HIV enters the body, viral ____ enters the cell’s DNA and alters the cell’s ______

A

DNA; genome

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64
Q

What is the phase of HIV that is when HIV develops specific antibodies and is a short period with active replicating?

A

Acute infection

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65
Q

What are teh s/sx of the acute infection in HIV?

A

Headahce
Body aches
DIarrhea
Pharyngitis
Rash

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66
Q

What stage of HIV infection occurs 1-3 weeks after infection and lasts 1-2 weeks?

A

Acute infection

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67
Q

What levels drop temporarily in the acute phase?

A

CD4; they then return to baseline

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68
Q

What rises quickly in the acute phase of HIV?

A

Viral load

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69
Q

What is the phase in HIV that lasts from a few months to a few years?

A

The asymptomatic infection/ latent phase

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70
Q

What is the viral load of the latent phase?

A

200-500

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71
Q

What is the CD4 count during the latent phase?

A

above 500

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72
Q

What are teh symptoms during the latent phase of HIV?

A

fatigue
headache
diarrhea
low grade fever
night sweats

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73
Q

What is the phase of HIV that lasts for like 8-10 years?

A

Symptomatic

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74
Q

What is the CD4 count during the symptomatic phase?

A

200-500

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75
Q

What are the HIV symptoms during the symptomatic infection?

A

Night sweats
Fever
Chronic diarrhea
HA
Fatigue
increased infection

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76
Q

What are worsening symptoms of HIV?

A

Persistent night sweats and fever, Candidiasis, Kaposi Sarcoma, Oral Hairy Leukoplakia

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77
Q

What part of the chronic HIV infection begins at year 10+ and the CD4 count is below 200

A

AIDS

78
Q

What are some opportunistic infections that occur with AIDS

A

Pneumocystis Jiroveci Pneumonia
Cryptococcal meningitis
Cytomegalovirus retinitis
Opportunistic cancer
Wasting syndrome
Dementia

79
Q

What are the screening for HIV?

A

Orasure testing- gumline
Oraquick- blood drop
These are 20 minute screens for ANITBODIES if a positive then get tested

80
Q

What are the testing for HIV?

A

Risk factors
4th generation testing for antigens and antibodies
Need to wait past 10 day eclipse window period

81
Q

What are normal CD4 cells with no disease?

A

800-1200

82
Q

What is the normal viral load with no disease?

A

0

83
Q

What is the viral load for early chronic phase that is stable?

A

200-500

84
Q

What is the viral load as the disease progresses?

A

5000-10000

85
Q

what is the treatment goal for HIV?

A

Stop replication and stay in the asymptomatic stage

86
Q

What are at risk populations for HIV?

A

Blood transfusion before 1985
Shares needles
Sexual contact with person
Patient with STD

87
Q

What is the diagnosis of HIV?

A

Prevention
Ongoing infection
Dying

88
Q

was are pre-exposure prophylaxis drugs?

A

prescribed to at risk populations
Integration into CD4

89
Q

What are post exposure prophylaxis drugs?

A

Prevents HIV
within 72 hours of exposure
emergency situation
combo of 3 ART for 28 days

90
Q

What are the goals of treating HIV?

A

Keep viral load low
Maintain immune function
Improve QOL
Prevent opportunistic infection
Reduce disability

91
Q

What are the interventions for HIV?

A

Adhere to drug regimen
Promote healthy lifestyle
prevent transmission
Supportive relationships

92
Q

What precautions apply to HIV patients?

A

Standard

93
Q

What is the blood flow through the heart?

A

Vena cava
RA
thru the tricuspid valve
RV
Pulmonic valve
pulmonary arteries
lung
Pulmonary veins
LA
Mitral valve
LV
aortic valve
aorta ——> BODY

94
Q

What are the two semilunar valves of the heart?

A

Pulmonic and aortic

95
Q

What are the two a/v valves of the heart?

A

Tricuspid and mitral

96
Q

What coronary artery supplies the R.A and the R.V and part of the posterior L.V?

A

The right coronary artery

97
Q

What coronary artery branches into the left arterior descending and the left circumflex artery that supplies the LA and LV?

A

L. Coronary Artery

98
Q

What is the part of the conduction system that is a specialized nerve tissue that serves as the pacemaker?

A

SA node

99
Q

What is an electrical impulse that travels trhough the heart and leads to contraction?

A

Action potential

100
Q

Contraction of the heart muscle occurs when ____ flows into cardiac cells after ______________

A

Calcium; depolarization

101
Q

What part of the heart picks up the impulse and spreads it over the ventricles by way of purjunkie fibers?

A

Bundle of His

102
Q

What part of the heart cycle occurs when cells return to former state?

A

Repolarization

103
Q

What is an absolute refractory period?

A

Systole

104
Q

What part of the EKG signifies the depolarization of atria?

A

P wave

105
Q

What part of the EKG signifies the time required for the impulse to travel from the SA node?

A

PR segment

106
Q

What part of the EKG signifies the ventricular depolarization?

A

QRS segment

107
Q

What part of the EKG signifies the repolarization of ventricles?

A

T wave

108
Q

What part of the EKG signifies possible hyperkalemia?

A

U wave

109
Q

Atrial _________ occurs during the QRS complex?

A

Repolarization

110
Q

What determines the rate of an EKG?

A

Number of QRS complexes

111
Q

What does one p wave for every QRS?

A

Sinus versus not sinus

112
Q

What cardiac rhythym has a very high atrial rate (250-400)

A

A flutter

113
Q

What cardiac rhythym looks like “sawtooth”?

A

A flutter

114
Q

A flutter can be summarized by multiple places competing to be the SA node?

A

A flutter

115
Q

The ventricular rhythym is A flutter can be __________ or _____

A

Normal; tachy

116
Q

A flutter is not _____

A

sinus (not one p wave for every QRS)

117
Q

A flutter is _________ irregular; it will either be that or completely ________

A

Regularly; Irregular

118
Q

When you look at at the second lead in A fib you see the ____________ rhythym

A

Ventricular

119
Q

When you look at the first lead in A fib you see ________ rhythym and rate

A

Atrial

120
Q

In A fib, there is no discertation of the ___ wave

A

P

121
Q

Is A fib sinus?

A

No; there are many many p waves for every QRS

122
Q

In A fib, the rate is always __________

A

irregular

123
Q

In A fib. there are ________ of places competing to be the ____ node so there is rapid and irregular p waves and atrial depolarization

A

A TON; SA

124
Q

In V tach, you cannot count the _________ rate

A

Atrial (no p waves)

125
Q

In V tachy, there is a ______ ventricular rate

A

HIGH

126
Q

In V tachy, what are two characteristics that make it stand out?

A

No PR interval
Widened and weird QRS

127
Q

Is the rhthym in V tachy regular?

A

Yes

128
Q

V tachy menas that they are not ________ well and happens during a ____

A

perfusing; MI

129
Q

Is V tachy a shockable rhythm?

A

YES

130
Q

During V-Fib the rate is way too _____ and the rhythm is ________?

A

Fast; irregular

131
Q

____ waves are absent in V-Fib

A

P

132
Q

During V fib, there is no ________, _____, and no ___

A

perfusion
CO
BP

133
Q

Think of V fib as ventricular __________

A

quivering

134
Q

What is the equation for CO?

A

CO = HR x SV

135
Q

What is the volume or the stretch of the heart muscle?

A

Preload

136
Q

What are reasons for increased preload?

A

Hypervolemia, valve regurgitation and congestive heart failure

137
Q

What are reasons for decreased preload?

A

Hypovolemia and bleeding

138
Q

What is the resistance of the heart; going out of the chambers of the heart?

A

Afterload?

139
Q

What are reasons for increased afterload?

A

Vasoconstriction
HTN
Meds

140
Q

What are reasons for decreased afterload?

A

Vasodilation, shock, and hypotension

141
Q

What is how “in shape” the heart is?

A

Contractability

142
Q

What are reasons for increased contractability?

A

SNS, ionatropes, and digoxins

143
Q

What are reasons for decreased contractability?

A

Age and heart failure

144
Q

What is the law that states the more the fibers are stretched the greater the force of contractability?

A

Starling’s law

145
Q

During the SNS response, the HR and contractability ________

A

INCREASE

146
Q

During the PNS response, the HR and contractability ________

A

DECREASE

147
Q

What is the normal systolic BP?

A

120

148
Q

What is the normal diastolic BP?

A

80

149
Q

What is the systolic BP- diastolic BP?

A

Pulse pressure

150
Q

What does a narrowing pulse pressure mean?

A

Hypovolemia and bleeding

151
Q

What does a widening pulse pressure mean?

A

ISH, ICP, and neuro issues

152
Q

What is the equation for MAP?

A

SBP + (2 x DBP) / 3

153
Q

MAP is a meaure of __________

A

PERFUSION

154
Q

What are the four cardiovascular effects on the elderly?

A

Increased collagen
Valves require lipid and collagen
Decrease response of the heart to exercise
Decrease in number of pacemaker cells and beta receptors

155
Q

What are diagnostic test of the regulation of the CV system?

A

Chest X ray
EKG
ECHO
Nuclear cardiology
CT scoring and CT scan
Cardiac Cath

156
Q

What is a cardiac marker that is an inflammatory marker in the body and is released when an MI occurs?

A

CRP (should be less than 1.0)

157
Q

What is the gold standard cardiac marker?

A

Troponin

158
Q

What is the normal levels for troponin?

A

less than 0.4

159
Q

If troponin is greater than 0.4, it is likely that what has occured?

A

MI

160
Q

Troponin is ____________

A

highly specific

161
Q

Troponin levels rise in _______ hours after the MI

A

4-6

162
Q

Troponin levels peak ________ hours

A

10-24

163
Q

Troponin levels return to normal ________ days after the MI?

A

4

164
Q

Total cholesterol should be less than _____ mg/dL

A

200

165
Q

What is the ideal LDL levels?

A

less than 100

166
Q

What is the ideal HDL for women?

A

greater than 50

167
Q

What is the ideal HDL for men?

A

Greater than 40

168
Q

What are the most common meds for hyperlipidemia

A

Statins
Niacin
Fibric acid derivities

169
Q

What is the cardiac cath that goes through the venous right side of the heart?

A

Right cardiac cath

170
Q

A right cardiac cath is done on what kind of patients?

A

Pulmonary

171
Q

What does a right cardiac cath measure?

A

pressure and volume

172
Q

What is the cardiac cath that goes thru the artery to the LV?

A

Left sided cardiac cath

173
Q

What does a left cardiac cath measure?

A

evaluates chamber pressure and 02 content

174
Q

What is the procedure that injects dye into the vessel to visualize arteries on screen during cath?

A

Coronary angiography

175
Q

What are Pre-Cath considerations?

A

Takes 2-3 hours
Permission and consent
NPO for 6-12 hours before

176
Q

What are Post-Cath considerations?

A

Peripheral pulses
Warmth
Color
Q 15 vitals then every hours
Assess for bleeding, RR, signs of PE, and arrthymias

177
Q

What are the 4 phases of CAD?

A

Early/endothelial stage
Fatty streaks
Raised fibrous plaque
Complicated lesion

178
Q

What age can the fatty streaks stage start?

A

age 15

179
Q

What stage of CAD is reversible?

A

Fatty streak

180
Q

What age can the raised fibrous plaque stage start?

A

age 30

181
Q

What stage of CAD can lipids become calcified?

A

Raised fibrous plaque

182
Q

What stage of CAD leads to dangerous hemorhage?

A

Complicated lesions.

183
Q

What is the demand for O2 is greater than the supply and is bc of artherosclerosis?

A

Angina Pectoris

184
Q

What is a stable angina?

A

Classic

185
Q

What is an unstable angina?

A

Progressive

186
Q

What is the vasospams angina?

A

Prinzmetal Variant

187
Q

What are other considerations for Prinzmetal Variant Angina?

A

Rare
Migraines and Reynaud’s
W/O CAD
After period of physical demand
Happens at rest
May follow stress, EPI, and histamine

188
Q

What are the signs and symptoms of angina?

A

Chest pain
Vague pressure
Indigestion and burning

189
Q

What are complications of Angina?

A

Arythmias and MI

190
Q

What are diagnostics of angina?

A

History
Lipid panel
Treadmill and nuclear imaging
Angiography

191
Q

What is teh management of CAD?

A

Nitro
Antiplatelts
Betablockers
CCB

Med surg (2 decks)

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