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midterm Flashcards

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USMLE® Step 1 flashcards
1
Q

subarachnoid hemorrhage: Five grades

A
  1. mild h/a with or w/out meningeal irritation
  2. severe h/a with or w/out pupillary change
  3. mild alteration in neurological exam
  4. depressed level of consciousness
  5. comatose with or w/out posturing
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2
Q

epidural hematoma: increase ICP: Cushing’s Triad

A
  • (patient unresponsive w/imminent death):
    1. systolic hypertension
    2. bradycardia
    3. irregular respiratory pattern
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3
Q

anterior cerebral artery stroke

A
  • altered mental status
  • impaired judgement
  • contralateral weakness more in leg
  • urinary incontinence
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4
Q

posterior cerebral artery stroke

A
  • impaired thought/memory

- visual field deficits

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5
Q

vertebrobasilar artery occlusions

A
  • vertigo
  • syncope
  • ataxia
  • cranial nerve dysfunction- double vision, difficulty swallowing
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6
Q

middle cerebral artery stroke

A

-hemiparesis

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7
Q

subarachnoid hemorrhage

A
  • arteries on brains surface bleed in subarachnoid space
  • may cause mass shift
  • caused by trauma, aneurysm, or arteriovenous malformation ruptures (arteries are directly connected to veins)
  • signs: rapid onset of headache, unconsciousness, stroke symptoms
  • elevate head, IV fluid
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8
Q

subdural hematoma

A
  • may be acute, subacute, or chronic
  • caused by tearing of bridging veins that communicate between the cerebral cortex and the venous sinuses -> blot clots
  • coup-counter coup head injuries
  • headache, unconsciousness, amnesia, hemiparesis
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9
Q

epidural hematoma

A
  • trauma to the arteries in the epidural space
  • high pressure mass effect
  • trauma! -> usually skull fracture
  • surgical decompression
  • can sometimes be venous bleed -> depressed skull fracture
  • dilated, fixed pupils
  • Cushing’s triad- bradycardia, systolic hypertension, irregular respiratory patterns -> imminent death
  • lucid interval- lose consciousness and then wake up
  • do not start IV fluids unless BP is low, administer O2
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10
Q

frontal lobe

A
  • speech
  • motor cortex
  • frontal association center
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11
Q

parietal lobe

A
  • somatosensory cortex
  • speech
  • taste
  • reading
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12
Q

temporal lobe

A
  • hearing
  • auditory association area
  • smell
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13
Q

occipital lobe

A

-visual association area

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14
Q

intracranial hypertension (ICP)

A
  • can compromise brain perfusion
  • May be due to mass effect (hemorrhage or edema) or malfunction of ventriculoperitoneal shunt
  • brain may herniate through foramen magnum (high mortality)
  • unilateral pupil dilation
  • loss of consciousness
  • A ventriculoperitoneal (VP) shunt- relieves pressure on the brain caused by fluid accumulation.
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15
Q

meningitis

A
  • Inflammation of meninges and infection of CSF
  • infectious or non-infectious
  • acute meningitis is usually bacterial infection (life threatening)
  • bacteria colonizes in nasopharynx, spread to CSF
  • Meningitis in infants usually caused by group B streptococcus or E. coli
  • After 1 year old, Streptococcus pneumoniae and Neisseria meningitidis become more common
  • lumbar puncture for CSF testing- diagnosis
  • antibiotics for treatment
  • signs and symptoms: nuchal rigidity, headache, photophobia, seizures, low LOC, death
  • meningismus triad: headache, nuchal rigidity, photophobia
  • kernigs sign- hip is flexed at 90 and legs cant straighten
  • brudzinskis sign- flexing of the legs and hips when the neck is flexed
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16
Q

generalized seizures

A
  • quickly involves both cerebral hemispheres
  • loss of consciousness
  • absence, atonic, tonic, clonic, and tonic-clonic
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17
Q

focal seizure

A
  • involves only one cerebral hemisphere
  • affects only one part of the body
  • wakefulness is usually maintained
  • may be changes in mentation, responsiveness, or behavior
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18
Q

absence: generalized seizure

A
  • ceasing activity
  • no response to stimulation
  • lasts a few seconds
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19
Q

myoclonic generalized seizure

A

-isolated muscle jerking with no loss of consciousness

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20
Q

tonic generalized seizure

A
  • increase in tone

- flexion or extension of the head, trunk, or extremeties

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21
Q

tonic-clonic generalized seizures

A

-vague warning (aura) followed by period of body rigidity (tonus)
-patient jerks rhythmically (clonus)
-can last minute
-frothing at mouth
-

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22
Q

atonic generalized seizures

A

-transient loss of muscle tone resulting in fall to the floor

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23
Q

guillain-barre syndrome

A
  • A group of acute immune-mediated polyneuropathies
  • Demyelinating disorders causing weakness, numbness, or paralysis throughout body
  • Autoimmune response to recent infection
  • Antibodies formed against peripheral nerves
  • starts at legs and goes up -> goes to lung cavity
  • can lead to pneumonia!
  • intubate and ventilate
  • Lack of deep tendon reflexes is strong indicator of Guillain-Barre
  • May have loss of vibratory sense, proprioception and touch
  • degradation of myelin sheath
  • progressive weakness of 2 or more limbs due to neuropathy
  • areflexia
  • disease course < 4 weeks
  • exclusion of other causes (vasculitis, toxins, botulism, diphtheria, porphyria, localized spinal cord or cauda equina syndrome)
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24
Q

5 categories of stimuli

A
    1. insect bites and stings
    1. medications
    1. food
    1. plants
    1. chemicals
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25
Q

leukotrienes

A
  • contractions in smooth muscles lining the bronchioles

- more powerful than histamine

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26
Q

5 classes of antibodies

A
    1. IgG: 80% of all antibodies -> resistance against viruses & bacteria
    1. IgE: attaches to basophil & mast cell surface -> triggers release of histamine, increases inflammation
    1. IgD: on the surface of B cells
    1. IgM: 1st antibody secreted by plasma cells after antigen is encountered -> anti-A & anti-B antibodies of blood typing
    1. IgA: in glandular secretions (saliva, sweat)
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27
Q

4 types of hypersensitivity reactions

A
    1. Type I (acute/immediate) hypersensitivity (IgE)- allergic reaction
    1. Type II (antibody-dependent cytotoxic) hypersensitivity (IgG, IgM)- cytotoxic reactions -> hemolytic rxn and goodpasture syndrome
    1. Type III (Ag-Ab immune complex) hypersensitivity- immune complex deposition -> hypersensitivity pneumonitis, systemic lupus erythematosus, polyarteritis nodosa, serum sickness
    1. Type IV (delayed) hypersensitivity (T cells, cell-mediated)- delayed -> poison ivy, chronic graft rejection, PPD test
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28
Q

histamine

A
  • dilates blood vessels
  • vasodilation
  • hypotension
  • hypovolemic shock
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29
Q

wheels vs urticaria

A
  • wheels -> localized

- urticaria -> systemic

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30
Q

benadryl

A
  • antihistamine
  • diphenhydramine
  • blocks the effects of the naturally occurring chemical histamine in the body
  • helps with urticaria and itching associated with an allergic/anaphylactic reaction
  • emergency dosage- 50mg IV
31
Q

corticosteroids

A
  • anti-inflammatory
  • solu-medrol
  • helps to reduce inflammation over the long term as opposed to other medications such as epinephrine that work immediately
  • long term acting
  • emergency dosage- 125 mg IV
32
Q

epinephrine

A
  • blood vessel constriction
  • reverses vasodilation and hypotension
  • increases cardiac contractility and relieves bronchospasms
  • rapidly reverses the effects of anaphylaxis
  • adult epipen delivers .3 mg of epinephrine
  • the infant-child system delivers .15mg
33
Q

upper airway

A
  • nasopharynx
  • oropharynx
  • laryngopharynx
  • epiglottis
  • nasal cavity
  • larynx
34
Q

epiglottitis

A
  • Seen on x-rays and fiber-optic laryngoscopy
  • streptococcus
  • administer oxygen
  • Nebulizers, antibiotics, corticosteroids, epinephrine
  • do not put anything in pt’s mouth -> intubate in field if absolutely necessary -> Endotracheal intubation is best achieved surgically w/ ENT nearby
35
Q

obstructive vs restrictive

A
  • both lower airway conditions
  • obstructive- hard to exhale all the air in lungs
  • restrictive- hard to inhale fully
36
Q

emphysema

A
  • mucus and puss in the alveoli

- not allowing good gas exchange

37
Q

asthma

A
  • tachycardia
  • wheezing
  • obstructive
  • chronic inflammation and constriction of bronchi
  • airway becomes overly sensitive to allergens, viruses, environmental irritants
  • inflammation -> dyspnea, wheezing, coughing
  • bronchoconstriction**
  • Body responds to persistent bronchospasm with edema & mucous secretion, results in bronchial plugging and atelectasis
  • initially hyperventilates -> results in decrease CO2 levels (respiratory alkalosis) -> narrowing -> increase in CO2
  • accessory muscle recruitment
38
Q

asthma treatment

A
  • inhaled beta-2 agonists: albuterol, levalbuterol (Xopenex) used in early wheezing
  • terbutaline or epinephrine: IV or injection added for more severe attacks
  • IV corticosteroids reduce inflammation in bronchi, but may take hours to work (long acting)
  • Beta 2 agonists: smooth muscle relaxation, bronchodilation
    1. inhaled beta-2 agonists:
  • albuterol- 2.5-5 mg every 20 mins for 3 doses or continuously, followed by 2.5-10 mg every 1-4 hours as needed
    1. parenteral beta-2 agonists:
  • terbutaline: 0.25 mg
  • 1:1,000 epinephrine: 0.3 mg
39
Q

COPD

A
  • mainly maintaining oxygenation & ventilation
  • nasal cannula
  • if still hypoxic: nonrebreathing mask
  • CPAP if indicated prior to intubation in alert patient
  • severe cases: endotracheal intubation w/ RSI
  • once airway is secured -> beta-2 agonists early and often
  • anticholinergic agents -> additional 20-40% bronchodilation
  • systemic corticosteroids (injectable) in moderate or severe cases
  • if acute respiratory failure: noninvasive positive pressure ventilation NPPV required or endotracheal intubation w/ invasive ventilation thru a ventilator
  • 3 nebulized doses 20 minutes apart or consecutively in severe cases
40
Q

respiratory syncytial virus (RSV)

A
  • young children
  • infection in lungs and airways
  • premature babies and children with suppressed immune systems
  • can lead to other more serious illnesses that affect heart and lungs
  • can cause bronchiolitis and pneumonia
  • highly contagious
  • dehydration
  • can cause severe upper respiratory infections and asthma symptoms in adults
  • humidified supplemental oxygen for treatment
41
Q

pleural effusion

A
  • caused by fluid collecting between visceral and parietal pleura
  • causes dyspnea
  • may occur in response to any irritation, infection, CHF, or cancer
  • should be considered as a contributing dx in any patients with lungs cancer and shortness of breath
  • with each breath, tissues rub against each other causing inflammation and more fluid to accumulate in the space
  • decreased breath sounds over region where fluid have moved lung away from chest wall
  • patient usually feels better sitting upright
  • if CPAP doesnt work -> fluid can be extracted by needle thoracentesis
  • in rare cases tube thoracostomy
42
Q

pulmonary embolism

A
  • sudden blockage of lung artery with a blood clot
  • DVT (deep vein thrombosis) is most common cause- blood clot travels to lungs from leg
  • risk post surgery or trauma or with catheters
  • chest pain, dyspnea, tachycardia, syncope, hemoptysis (coughing blood), new onset wheezing, new cardiac arrhythmia, thoracic pain
  • may evolve quickly and lead to cardiac arrest
  • treatment: anticoagulants, TPA
43
Q

pulmonary final thoughts

A
    1. should be last option for asthmatic patients (difficult to ventilate, prone to pneumothorax)
    1. be proactive- intubate/ventilate before cardiac arrest occurs (conscious patients in respiratory arrest may need sedation/RSI)
    1. lack of gag reflex in stroke or intoxicated patients makes them prone to vomiting (consider intubation to protect airway)
    1. if med administered to diabetic or OD patient, use bag mask first and monitor for changes
44
Q

two parts to secondary assessment

A
  • obtaining vital signs

- head to toe survey

45
Q

glasgow coma scale

A
    1. eye opening- spontaneous (4), to verbal command (3), to pain (2), no response (1)
    1. verbal response- oriented and converses (5), disoriented conversation (4), speaking but nonsensical (3), moans or makes unintelligible sounds (2), no response (1)
    1. motor response- follows commands (6), localized pain (5), withdraws to pain (4) decorticate flexion (3), decerebrate extension (2), no response (1)
  • higher GCS (15)- no neurologic disability
  • 13-14- mild dysfunction
  • 9-12- moderate to severe dysfunction
  • 8 or less- severe dysfunction (lowest possible is 3)
46
Q

aortic aneurysm

A
  • may be seen pulsating in the upper midline
  • do not palpate an obvious pulsatile mass -> could burst
  • dilates -> aneurysm
  • wall of aorta burst or starts to expand
  • bursts -> dissection (once it starts penetrating the wall
47
Q

larynx

A
  • extrinsic muscles connect larynx and elevate it during swallowing
  • intrinsic muscles control vocal cords
  • keeps food and drink out of airway
  • marks where the upper airway ends and the lower airway begins
  • epiglottis
  • cartilage
  • hypoid bone
  • ligaments
48
Q

kussmals respirations

A
  • deep and fast gasping respirations
  • lacking any apneic periods
  • associated with metabolic/toxic disorders (diabetes mellitus)
49
Q

biots respirations

A
  • breathing normally and then dropping or raising
  • irregular pattern
  • may follow serious head injury
50
Q

nonrebreather mask

A
  • moderate respiratory distress patients
  • 10-15 L/min
  • delivers oxygen at 60-95%
  • preferred way to give oxygen in prehospital setting
51
Q

nasal cannulas

A
  • 24-44% oxygen delivered
  • 1-6 L/min
  • used for chronic illnesses
  • mild respiratory distress
  • calms patients with minimal oxygen levels
52
Q

bag mask device

A
  • most common method used to ventilate patients in EMS and during initial respiratory failure in ER
  • 10-15 L/min
  • severe respiratory distress
  • 75-100%
53
Q

CPAP

A
  • use with caution for people with low BP -> can cause pneumothorax
  • increases intrathoracic pressure -> aspiration
54
Q

cranial nerves

A
  • olfactory- smell
  • ocular- sight
  • oculomotor- movement of eyes, size, shape and symmetry of pupils
  • trochlear- downward eye movement
  • trigeminal- cheek, jaw, chewing
  • abducens- lateral eye movement
  • facial- facial muscles, taste, saliva
  • auditory/vestibular- hearing and balance
  • glossopharyngeal- tongue and pharynx sensation, taste, swallowing
  • vagus- throat and trachea, taste, voice, heart rate
  • accessory- shoulder movement, ability to turn head
  • hypoglossal- speech and tongue
55
Q

decorticate posturing

A
  • arm at chest and angled in
  • fists are clenched
  • dysfunction of the cerebral cortex
  • 3 on the glasgow scale
56
Q

decerebrate posturing

A
  • significant brain injury
  • rigidity
  • arms and legs are extended
  • toes point downward
  • head and neck are arched
  • 2 on the glasgow
57
Q

common types of vertebral injury

A
  • C-1/C-2: delicate vertebrae
  • C-7: transition from flexible cervical spine to thorax
  • T-12/L-1: different flexibility between thoracic and lumbar regions
58
Q

pedicles

A

Thick, bony structures that connect the vertebral body to the
spinous and transverse processes

59
Q

Vertebral Ligaments: Anterior Longitudinal

A
  • Anterior surface of vertebral bodies
  • Provides major stability of the spinal column
  • Resists hyperextension
60
Q

vertebral ligaments: Posterior Longitudinal

A
  • Posterior surface of vertebral bodies in spinal canal

* Prevents hyperflexion

61
Q

sacral spine

A
  • 5 fused vertebrae
    – Form posterior plate of pelvis
    – Help protect urinary and reproductive organs
    – Attach pelvis and lower extremities to axial
    skeleton
62
Q

growth of spinal cord

A
  • Fetus- Entire cord fills entire spinal foramen
  • Adult- Base of brain to L-1 or L-2 level
  • adult Peripheral nerve roots pulled into spinal foramen at the distal end (cauda equina)
63
Q

dermatomes

A
  • Topographical region of the body surface innervated by one nerve root
  • umbilical- T-10
  • nipple line- T-4
64
Q

myotomes

A

-Muscle and tissue of the body innervated by spinal nerve roots

65
Q

parasympathetic / sympathetic

A
  • parasympathetic- sacral and cranial peripheral nerve roots
  • sympathetic- lumbar and thoracic peripheral nerve roots -> vasoconstriction
66
Q

axial stress / loading

A

-Compression* common between T-12 and L-2
• Distraction
• Combination
-Distraction/rotation or compression/flexion
-pressure to the length of the spine
-you land feet first (or head) -> squish the spine

67
Q

complete transient cord injury

A

-Cervical Spine damage:
-Quadriplegia
-Incontinence
-Respiratory paralysis
–> Below T-1:
» Incontinence
» Paraplegia

68
Q

incomplete transection cord injury: anterior cord syndrome

A
  • Anterior vascular disruption
  • Loss of motor function and sensation of pain, light touch, and temperature below injury site
  • Retain motor, positional, and vibration sensation
69
Q

incomplete transection cord injury: central cord syndrome

A
  • Hyperextension of cervical spine
  • Motor weakness affecting upper extremities
  • Bladder dysfunction
70
Q

incomplete transection cord injury: brown-sequard’s syndrome

A
  • Penetrating injury that affects one side of the cord
  • Ipsilateral (same side) sensory and motor loss
  • Contralateral pain and temperature sensation loss
71
Q

spinal shock

A

-Temporary insult to the cord
-Affects body below the level of injury
-Affected area:
• Flaccid
• Without feeling
• Loss of movement (flaccid paralysis)
• Frequent loss of bowel and bladder control
• Priapism
• Hypotension secondary to vasodilation

72
Q

neurogenic shock

A

-Occurs when injury to the spinal cord disrupts the brain’s ability to control the body
-Loss of sympathetic tone:
-Dilation of arteries and veins -> Expands vascular space and results in relative hypotension
-Reduced cardiac preload
-Reduction of the strength of contraction -> Frank-Starling reflex
-ANS loses sympathetic control over adrenal medulla
-Unable to control release of epinephrine and norepinephrine -> Loss of positive inotropic and chronotropic effects
• Bradycardia
• Hypotension
• Cool, moist, and pale skin above the injury
• Warm, dry, and flushed skin below the injury
• Male: priapism

73
Q

Autonomic Hyperreflexia Syndrome

A

-Associated with the body’s resolution of the effects of
spinal shock
-Commonly associated with injuries at or above T-6
-Presentation
• Sudden hypertension
• Bradycardia
• Pounding headache
• Blurred vision
• Sweating and flushing of skin above the point of injury

Medical Emergencies (16 decks)

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