Mock Exam Part 1, #16-30 Reviewer Flashcards
In compartment syndrome, irreversible nerve and muscle damage occurs after _______
4-6 hours
“Pressures >30 mm HG produce muscle ischemia; irreversible muscle damage occurs after 4-6 hours.”
Class A bioterrorism agents
SAFE-BA-Yan-Talaga
Smallpox (Variola major)
Arenavirus
Filovirus
Ebolavirus
Botox (Clostridium botulinum)
Anthrax (Botulinum anthracis)
Yersnia pestis
Tularemia (Francisella tularensis)
Class A agents has the most severe potential to cause harm
Identify the lesion:
Ulcer and eschar of cutaneous anthrax
Prophylaxis for this lesion:
Ciprofloxacin or doxycycline for 60 days is preferred.
In bioterrorism, the following are included in the Class A Biologic agents, EXCEPT:
A. BACILLUS ANTHRACIS
B. RICKETTSIA PROWAZEKII
C. CLOSTRIDIUM BOTULINUM
D. FRANCISELLA TULARENSIS
B. RICKETTSIA PROWAZEKII
Organ system that first to be affected with radiation as little as 2 Gy radiation exposure
Hematopoietic
most readily available marker to grade the extent of radiation injury to the bone marrow cells
Peripheral lymphocyte count
Lymphocytes are preferentially destroyed.
Since granulocytes and platelets are markers of inflammation, their counts initially rise following exposure, but reach a nadir within 30days of injury.
radiation exposure from chest radiograph
0.1 mGy (milligray)
10 mrem
*(table 10-4)
1 rad = 1 rem = 10 mGy = 1000 mrem
radiation exposure to the uterus/fetus with chest radiography with shielding of the maternal abdomen
<0.001 mGy
(table 99-9)
threshold for human teratogenesis
100 mGy
50 mGy - accepted as safe in pregnancy
(table 99-9)
MI and sudden cardiac death most likely happen when?
first few hours after awakening from sleep because of increased sympathetic stimulation
B-blockade provides some protection from sudden cardiac death, particularly in patients with known coronary artery disease who have had myocardial infarction and have a low ejection fraction.
What is the major cause of sudden cardiac death in adults?
Coronary artery disease (80%)
cardiomyopathy: 10-15%
miscellaneous: 5-10%
This valve involvement can trigger syncope and sudden cardiac death
Aortic stenosis
most common cause of aortic stenosis
bicuspid aortic valve
typical finding in hemodynamically significant aortic stenosis
harsh, late-peaking systolic murmur at the upper right sternal border with radiation to the neck
In distributive shock, there is relative intravascular volume depletion due to vasodilatation, which is seen in the following, EXCEPT:
A. Capillary leak from burns
B. Neurogenic shock
C. Sepsis
D. Anaphylaxis
A. Capillary leak from burns
Blood pressure may not drop even in the presence of decreased cardiac output causing decreased perfusion (shock) if the patient is or has:
peripheral vascular disease
For this reason, blood pressure is an insensitive marker for global tissue hypoperfusion
Shock may occur with a normal BP, and hypotension may occur without shock
No single vital sign is diagnostic of shock.
The following may be done to optimize circulation in patients in shock, EXCEPT:
a. place patient in Trendelenburg position
b. careful vasopressor infusion
c. provide PLRS over normal saline
d. central venous access is the preferred route for long-term vasopressors
A. Place patient inTrendelenburg position
The Trendelenburg position does not improve cardiopulmonary performance compared with the supine position.
It may worsen pulmonary gas exchange and predispose to aspiration
Passive leg raising above the level of the heart with the patient supine may be effective.
If passive leg raising results in an increase in BP or cardiac output, fluid resuscitaiton is indicated
The following measures are effective in ensuring adequate oxygen delivery, EXCEPT:
A. pain control
B. muscle relaxation
C. pRBC tranfusion
D. cold treatment rooms
D. cold treatment rooms
it should be warm covering
other measures are:
- anxiolytics
- paralytics when appropriate
Also:
Restore arterial oxygen saturation to ≥91%
In shock states, consider a transfusion of PRBCs to maintain Hgb ≥7 g/dL
Hypotensive resuscitation in trauma is NOT done when?
traumatic brain injury
maintain MAP ≥80 mm Hg in TBI
What is hypotensive resuscitation
used when there’s active bleeding in trauma (but deferred if with concomitant TBI)
In hypotensive resuscitation (permissive hypotension), maintain:
MAP of 60 mm Hg
SBP approx 80-90 mm Hg
(Military Medicine chapter, p2010)
A trauma patient came in due to a stab wound in the abdomen. BP was 90/60, HR of 130. What will NOT be included in your managment
A. perform FAST
B. order of massive tranfusion protocol
C. Surgical hemostasis
D. Low plasma-to-RBC ratio resuscitation
D. Low plasma-to-RBC ratio resuscitation
High plasma-to-PRBC ratio resuscitation appears to also offer survival benefit independent of coagulopathy, and plasma may enhance cell survival by endothelial repair and reducing vascular permeability.
It may also be that plasma is simply a superior fluid for perfusion and tissue oxygenation restoration
1:1:1 ratio pa rin for MTP. It’s just that high plasma-to-PRBC ratio is better than low plasma-to-PRBC ratio, yun napansin nila in the combat setting.
The Assessment of Blood Consumption score uses 4 values to determine need for MTP. These 4 values are:
1.) Penetrating mechanism of injury
2.) Positive FAST
3.) BP <90 mm Hg
4.) PR >120 bpm
The presence of 2 or more variable has a sensitivity for massive transfusion of 76-90%, with a specificity of 67-87%
A patient come in your ED with generalized urticaria with shortness of breath after intake of seafood. What will be your first priority?
A. airway protection
B. decontamination
C. epinephrine
D. IV crystalloids
A. airway protection
In severe anaphylaxis, securing the airway is the first priority
treatment of choice for anaphylaxis
Epinephrine 0.3-0.5 mg IM
(0.3 -0.5 mL of 1:1000 dilution)
Pedia dose for epinephrine in anaphylaxis
0.01 mg/kg IM
or 0.01mL/kg of 1:1000 dilution
TRUE or FALSE
Injections to the deltoid area are more effective at achieving peak blood levels than injections into the thigh area.
FALSE
Injections to the thigh are more effective.
In rabies vaccination, it is not recommended to inject where due to high failure rates?
Gluteal area
The only acceptable site of rabies vaccination for adults and older children
deltoid area
For younger children, the anterolateral aspect of the thigh may be used
Rate of epinephrine for symptomatic bradycardia
2-10 mcg/min
