Medical 2 Flashcards
How many people in Canada have symptoms of GERD (gastroesophageal reflux disease)
10-20%
What are some risk factors of GI disorders?
Age
Previous illness
Surgery
Family history
Medications
Cigarettes
Drugs or alcohol
What is role of the portal veins?
Portal veins transport veins transport venous blood from the GI system to the liver for processing of nutrients that have been absorbed.
Name the 3 sections of the small intestine and it’s purpose.
Duodenum, jejunum, and ileum function to absorb 90% of nutrients.
What are the common symptoms of a GI tract disease?
Pain, fluid losses (diarrhea/vomiting), bleeding, and alterations in bowel habits
What is esophageal varices?
Increased pressure in the blood vessels of the distal esophagus due to liver damage or cirrhosis
What is Mallory-Weiss Syndrome?
Tears in the esophageal lining caused by severe vomiting and may lead to hemorrhage.
What causes hemorrhoids?
Swelling and inflammation of the blood vessels surrounding the rectum.
What causes peptic ulcer disease (PUD)? And with are the risk factors?
The protective layer is eroded allowing the acid to eat the mucosal lining of the stomach
Major risk factors are helicobacter pylori infection and NSAID use
What causes cholecystitis?
Obstruction of the cystic duct from the gallbladder to duodenum, usually by a gallstone can cause inflammation of the gallbladder.
Patient may show a positive Murphy sign (rebound tenderness in the right upper quadrant as the diaphragm descends)
What are the Five F risk factors for cholecystitis?
Fat, Fair (White), Female, Fertile, Forty
What causes Diverticulitis?
Feces may become trapped in the diverticula (bulges in the colon wall). Bacteria will grow causing inflammation and infection
Pain from diverticulitis is most common in the left lower quadrant
What causes Ulcerative Colitis?
Generalized inflammation of the colon
What is Crohn disease?
A disease in which the immune system attacks the GI tract, most commonly affecting the ileum
What’s the biggest difference between Ulcerative Colitis and Crohn’s disease?
Ulcerative Colitis affects the colon, Crohn Disease may affect any part of the GI Tract
What is Acute Gastroenteritis and what are it’s symptoms?
Gastroenteritis is caused by several infectious conditions and presents with nausea, diarrhea, vomiting, cramps, and chills.
May run its course in 2-3 days or several weeks
What are the types of Hepatitis, what does hepatitis do, what are the symptoms?
Hep A (fecal-oral)
Hep B (blood-blood)
Hep C (blood-blood)
Hep D (blood-blood)
Hep E (fecal-oral)
Acute Hepatitis causes damage to the liver.
Symptoms: abdominal pain, vomiting, fever, and jaundice
What do you have to do before palpating the abdomen?
Auscultate for bowel sounds
What are Orthostatic vital signs? What can they determine?
When a patient has suffered significant fluid loss, 10-20%, you will note a 20 mmHg systolic and 10 mmHg diastolic change in blood pressure when the patient is sitting vs. standing
What are the 4 types of abdominal pain?
Somatic Pain- localized pain, felt deeply
Rebound Tenderness- felt on rebound of palpation, increases with movement
Visceral Pain- difficult to localize, described as burning cramping or aching
Referred Pain- originates in the abdomen and causes pain in distant locations
What are normal bowel sounds?
Soft gurgles occurring 5-30x per minute
What is the main airway concern for the GI patient?
Potential for aspiration or obstruction of the airway due to vomit or blood
What does shortness of breath with a GI problem indicate?
The patient needs oxygen, GI bleeding may cause significantly decreased hemoglobin. Oxygen saturation may read high but the patient still needs oxygen.
What equipment can be used to protect from bodily fluids?
Gloves, Gowns, Eye pro, Mask
Towels and Wash rags
Extra linens
Absorbent pads
Emesis basin
Disposable basin
How much of the body’s blood flows through the kidneys each minute?
1/4
What are the parts of the kidney?
Hilum- concave medial side
Renal Fascia- dense tissue anchoring the kidney to the abdominal wall
Cortex- light coloured outer region
Medulla- includes cone shaped renal pyramids and inward tissue
Renal pelvis- flat funnel shaped tube that fills the sinus
What is a nephron and how many are there?
The main structural and functional units of the kidney that form urine, each kidney contains approximately 1.25 million nephrons
What affect does Aldosterone and Antidiuretic hormone (ADH) have on reabsorption?
Aldosterone- increases the rate of sodium and chloride ion reabsorption (water follows salt)
Antidiuretic hormone- Increases water reabsorption when solute concentration in the blood is too high
What is the Micturition Reflex?
Spinal reflex causes contractions of bladder smooth muscle causing the urge to void.
What is Polynephritis?
Inflammation of the kidney linings caused by an upper urinary tract infection. If untreated may lead to sepsis.
What are the risk factors of kidney stones?
Diet, hydration, personal or family history, and hypertension
Types of Kidney stones?
Calcium oxalate (calcium stones account for 80%)
Calcium phosphate
Uric acid/ Cystine
Struvite stones
Define the terms Polyguria, Anuria, Oligura
Polyguria- increased urinary output
Anuria- complete stop of urine production
Oliguria- decreased urinary output
What is an AKI
An Acute Kidney injury is a sudden decrease in the rate of filtration through the glomeruli causing toxins to accumulate in the blood. Classified into 3 types, prerenal, intrarenal, postrenal. (approximately 1/8 will require long term dialysis)
What is CKD?
Chronic Kidney Disease is progressive and irreversible loss of function developed over months or years, more than half caused by diabetes or hypertension. May also be caused by congenital diseases such as pyelonephritis.
What is dialysis? What are the 2 types?
Dialysis is a technique for filtering toxic wastes from blood or removing excess fluids.
There are 2 types:
Peritoneal- large amounts of dialysis fluid are infused into the peritoneal cavity, remain there for 4-6 hours for equilibrium to occur.
Hemodialysis- Blood is circulated through a dialysis machine that functions similarly to normal kidneys
Patients requiring chronic dialysis every 2-3 days
What problems may be associated with dialysis?
Accidental disconnection of the machine
Air embolism
Bleeding from a fistula or shunt
Malfunction of machine
Rapid shift in fluid may cause hypotension, potassium Imbalance, or disequilibrium syndrome
What is Disequilibrium Syndrome and what are it’s signs and symptoms?
Increase of Intracranial pressure from water moving into the CSF through osmosis as a consequence of dialysis.
Patient may experience nausea, vomiting, headache, and confusion
What is Pheochromocytoma?
A tumour in the adrenal gland, usually in the medulla
Fewer than 10% of tumours are malignant (cancerous)
What is the most common presentation of Renal (Kidney) Trauma?
Flank pain and hematuria (blood in the urine)
Why is ongoing assessment of patients with renal and urological emergencies essential?
Electrolyte imbalances caused by renal failure can cause rapid deterioration in the function of organs, specifically the heart.
What are the common symptoms of a UTI?
Painful urination
Difficulty urinating
Hematuria, cloudy, or foul odour in urine
Visceral discomfort or extreme burning
Signs and symptoms of AKI
Fluid retention
Tachycardia
Possible hyperkalemia
Pale, cool, and moist skin
Peripheral edema
Signs and symptoms of CKD?
Altered LOC, Lethargy, Nausea, Headaches, Cramps, Weakness, Vomiting, Anorexia, Increased thirst, Pruritis, and Hypertension
What are the possible routes of absorption of a toxin?
Ingestion
Inhalation
Injection
Dermal Absorption
What’s the difference between and opioid and an opiate?
Opiate- natural product derived from opium
Opioid- synthetic non-opium derived narcotic
What is the definition of drug abuse?
Any use of drugs that causes physical, psychological, economic, legal, or social harm to the user or to others affected by the drug users behaviour
Define the term Habituation?
Psychological or physical dependence on a drug or drugs
Define physical dependence?
A physiological state of adaptation to a drug, usually characterized by tolerance to a drugs affects and by withdrawal syndrome if the drug use is stopped
Define psychological dependence?
The emotional state of craving a drug to maintain a feeling of well-being
Define the term Tolerance?
Physiologic adaptation to the effects of a drug such that increasingly larger doses of the drug are required to achieve the same effect
Define the term potentiation?
Enhancement of the effect of one drug by another drug
Define the term synergism?
The action of two substances in which the total effect is greater than the sum of the two. (2+2=5)
What are the red flags pointing to alcohol abuse?
Drinking early in the day
Drinking alone or in secret
Periodic binges
Loss of memory/ blackouts
Tremulousness and anxiety
Chronically flushed face and palms
What is Delerium Tremens?
Potentially lethal complication of alcohol withdrawal that usually starts 48-72 hours after the last alcohol intake. Symptoms include confusion, tremors, fever, restlessness, tachycardia, diaphoresis, hallucinations, and hypotension secondary to dehydration.
Drugs such as nasal decongestants and diet pills generally fall into which category?
Amphetamines
What’s the difference between Hemoglobin’s affinity CO vs O2
Hemoglobin’s affinity for CO is 250x greater than it’s affinity for oxygen
What are the symptoms of CO poisoning?
Headache
Nausea
Vomiting
Altered LOC
Cherry red skin (very late symptom)
What does the odour of almonds on a patients breath indicate?
Cyanide poisoning
What is the DUMBELS mnemonic and what is it used to assess
Diaphoresis/ Diarrhea
Urination
Miosis/ Mydriasis (very small pupil/ very large pupil)
Bronchospasm/ Bronchorrhea (watery sputum)/ Bradycardia
Emesis
Lacrimation
Salivation
Symptoms of cholinergic excess
What is considered to be a toxic dose of acetaminophen?
A dose greater than 150-200 mg/kg
What is a caustic substance?
What can the paramedic do for a patient that has ingested a caustic substance?
Give the patient water or milk
What is Lithium used to treat?
Bipolar disorder
What are the functions performed by the blood?
Respiratory function
Nutritional function
Excretory function
Regulatory function
Defensive function
What are the 4 elements of the blood?
Plasma (water with proteins and electrolytes)
Erythrocytes (Red blood cells)
Leukocytes (White blood cells)
Thrombocytes (platelets)
What is the life cycle of white blood cell?
Bone marrow releases granulocytes that circulate in the blood 6-12 hours. If the cells travel to a tissue they will live there for a few days, if not they are recycled by the reticuloendothelial system as red blood cells
Define Thalassemia?
A disorder that causes too little or abnormally shaped hemoglobin
What is Neutropenia?
Abnormally low number of neutrophils, neutrophils make up the majority of circulating white blood cells
What is Leukemia?
Cancer in the lymphoid system. Leukemia can cause anemia, decrease in platelets (thrombocytopenia), and increase in white blood cells (leukocytosis)
What is the difference between Hodgkin Lymphoma and Non-Hodgkin Lymphoma?
Hodgkin Lymphoma
Occurs between 15-35 or age 55-60
Painless
Non-Hodgkin Lymphoma
Occurs at any age
May be slow moving, aggressive, or highly aggressive
What is polycythemia?
An over abundance or over production of red blood cells
What are the 2 stages of DIC (Disseminated Intravascular Coagulopathy)?
Stage 1- thrombin and fibrin deposits in the blood increase and platelets begin to aggregate
Stage 2- uncontrolled hemorrhage results from severe reduction in clotting factors
What is hemophilia?
A bleeding disorder in which clotting cannot occur due to a missing clotting factor
(type A, missing factor 8)
(type B, missing factor 9)
How long will a patient with sickle cell anemia live?
Mortality rate peaks between 1-3 years old
Who is primarily affected by sickle cell anemia?
Most common in African, Puerto Rican, and European populations but may occur in anyone
What is multiple myeloma?
The number of plasma cells in the bone marrow increase abnormally leading to the formation of tumours in the bone
Most common in men over the age of 40
What is an environmental emergency?
A medical condition caused or worsened by the weather, terrain, or unique atmosphere conditions.
Which structure controls thermoregulation in the body?
The hypothalamus is the thermostat of the body, operates via negative feedback control:
Thermogenesis-heat production
Thermolysis- heat release
What are the 4 ways that the body releases heat?
Radiation
Conduction
Convection
Evaporation
What are heat cramps?
Muscle pain that occurs because of profuse sweating and sodium depletion
What are the symptoms of heat exhaustion?
(Early) nausea, vomiting, headache, weight gain
(Worsened) confusion, agitation, disorientation
(Untreated) cerebral edema, pulmonary edema, respiratory distress, seizures
What are the 2 findings that diagnosis heat stroke?
Core temp > 40°C
Altered LOC
What is frostbite?
An ischemic injury classified as superficial or deep depending on whether tissue loss occurs
What is chilblains?
Itchy red or purple lesions, usually on the face or extremities. Caused by long exposures to temperatures just above freezing
Define Hypothermia?
A decrease in core body temperature below 35°C, owing to inadequate thermogenesis or excessive environmental cold stress.
How may hypothermia cause cardiac disrhythmias?
When the cbt drops below 32.2°C atrial fib and Osborne waves may be seen
When the cbt drops below 28°C the heart is susceptible to ventricular fib
What are the 3 classifications of hypothermia?
Mild 32-35°
Moderate 28-32°
Severe < 28°
What is the definition of drowning?
The process of experiencing respiratory impairment from submersion in liquid
What is Atmospheric Absolute? (ATA)
The weight of air at sea level
1 ATA - 14.7 lbs
Every 33 feet of seawater the pressure increases by 14.7 lbs or 1 ATA
What is Boyle’s law?
At a constant temperature the volume of a gas is inversely proportional to its pressure.
What is Dalton’s law?
Each gas in a mixture exerts the same partial pressure that it would exert if it were alone in the same volume. The total pressure of a mixture of gases is the sum of the partial pressures of all the gases in the mixture.
What is Henry’s law?
The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the liquid.
What is decompression sickness?
Symptoms caused by nitrogen bubbles in the blood and tissues coming out of solution during ascent. Does damage in 2 ways, mechanical interference with tissue perfusion and triggers chemical changes.
At what height does altitude sickness occur?
Typically around 2500 ft, but can occur as low as 2000 ft
What are the 3 types of altitude sickness?
Acute Mountain Sickness (AMS)
High Altitude Pulmonary Edema (HAPE)
High Altitude Cerebral Edema (HACE)
What are the 5 ways a communicable disease may spread?
Airborne transmission
Droplet transmission
Contact transmission
Vehicle transmission
Vector-borne transmission
What are the 4 types of pathogens?
Bacteria
Viruses
Fungi
Parasites
What is Virulence?
The ability of an organism to invade and create disease in a host.
What is host resistance?
The body’s ability to fight off infection.
What is an incubation period?
The time from exposure to symptoms first appearing
What is a communicable period?
The period during which a patient can transmit their illness to someone else.
What is a carrier?
A person who is infected with a disease but does not present any signs or symptoms.
What is the most common cause of blood borne infection in the health care setting?
Needlestick injury
(Report to a supervisor immediately)
What are the 3 protective barriers for the emergency responder?
- Skin/ mucous membranes
- PPE
- Post exposure medical follow up
What are some examples of airborne diseases?
Measles
Rubella
Mumps
Chickenpox/ Shingles
Pertussis (whooping cough)
Meningitis
Tuberculosis
Pneumonia
What are the classic symptoms of meningitis?
Fever
Headache
Neck stiffness
Kernig sign (cannot extend leg at the knee)
Brudzinski sign (passive flexion of the leg on one side)
What are the classic symptoms of TB?
Persistent cough for greater than 3 weeks
Night sweats
Headache
Fever
Fatigue
Weight loss
Hoarseness or chest pain
What are some examples of sexually transmitted diseases?
Gonorrhea
Syphilis
Genital Herpes
Chlamydia
Scabies
Lice
What are some examples of blood borne diseases?
Viral hepatitis
HIV (human immunodeficiency virus)
AIDS (acquired immunodeficiency syndrome)
What are some examples of Vector-borne diseases?
West Nile virus
Lyme disease
Hantavirus
Rabies
Tetanus
What are the 4 categories of abnormal behaviour causes?
Biological/ organic causes
Environmental causes
Acute injury or illness causes
Substance related causes
What is Boyle’s law?
At a constant temperature, the volume of a gas is inversely proportional to it’s pressure
What is Dalton’s law?
Each gas in a mixture exerts the same partial pressure that it would exert if it were alone in the same volume and the total pressure of a mixed gas is the sum of all the partial pressures.
What is Henry’s law?
The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the liquid.
What is decompression sickness?
Nitrogen bubbles accumulate in the blood and tissues during ascent. Cause damage by interfering mechanically with tissue perfusion and triggers chemical changes within the body.
At what height might you start experiencing altitude sickness?
Typically around 2500 ft, can occur as low as 2000 ft
What are the 3 types of altitude sickness?
Acute mountain sickness (AMS)
High Altitude Pulmonary Edema (HAPE)
High Altitude Cerebral Edema (HACE)
What are the 5 ways that communicable diseases may be transmitted?
Airborne Transmission
Droplet Transmission
Contact Transmission
Vehicle Transmission
Vector-borne Transmission
What are the 4 types of pathogens?
Bacteria- grow and reproduce outside the cell
Viruses- smaller than bacteria, grow rapidly
Fungi- similar to bacteria
Parasites- live in or on another living creature and feeds off its host
What is virulence?
The ability of an organism to invade and create disease in a host, also encompasses its ability to survive outside the host.
What is host resistance?
The ability of the body to fight off infection.
How do delerium and dementia differ?
Delirium- Rapid onset impairment of consciousness and cognitive function, usually caused by a medical condition
Dementia- Chronic onset of deficits in memory, abstract thinking, and judgement
What is stereotyped activity?
Repetition of movements that do not seem to serve any useful purpose.
What are compulsions?
Repetitive actions carried out to relieve the anxiety of obsessive thoughts
Define these 3 terms?
Neologism
Echolalia
Mutism
Neologisms- words that the patient invents
Echolalia- the patient echos the words of the examiner
Mutism- the patient does not speak at all
Explain thought broadcasting and thought control
Broadcasting- the patient believes that others can hear their thoughts
Control- the patient believes that outside forces are controlling their thoughts
What is thought perseveration?
Repetition of the same idea over and over again.
What’s the difference between mood and affect?
Mood- a persons sustained and pervasive emotional state
Affect- the outward expression of a persons mood
What are the 4 parts of memory?
Registration- the ability to add new things
Retention- the ability to store information in an accessible place
Recall- the ability to retrieve stored information on demand
Recognition- the ability to identify things that have happened before
What is agoraphobia?
The fear of public places
What are the diagnostic features of depression remembered by the mnemonic GAS PIPES
Guilt
Appetite
Sleep disturbance
Paying attention
Interest
Psychomotor abnormalities
Energy
Suicide
What are the 4 levels of substance disorder?
Substance use- moderate consumption
Substance intoxication- use that impairs thinking and motor function
Substance abuse- when use disrupts daily living
Substance dependence- an addiction to a substance
What are the most common causes of psychosis?
Mental illness or drug abuse
Other causes include, intense stress, delusional disorders and schizophrenia
What are positive, negative, and disorganized symptoms of schizophrenia?
Positive symptoms include delusions or hallucinations
Negative symptoms include apathy, mutism, flat affect, and lack of interest in pleasure
Disorganized symptoms include erratic speech, emotional responses, and motor behaviour
What steps should you take when there is a potential for violence in any situation?
Call for backup
Assess the situation
Observe your surroundings
Maintain a safe distance
Try verbal interventions first
Why should you never hogtie or place a patient face down on a stretcher?
Can be dangerous and lead to asphyxia or aspiration, or death
What is required to restrain a patient?
Overwhelming force, which means a minimum of 5 trained and able bodied people.
What are the symptoms of a lithium overdose?
Nausea
Vomiting
Tremors
Excessive thirst
Slurred speech
Muscle weakness
Blurred vision
Seizures (eventually)
