Module Quiz Answers Flashcards
What does the term the “master gland” refer to?
The pituitary gland
What is hormone releasing hormone released by?
Hypothalamus
What hormone is released by the heart atriums?
Brain natriurectic hormone and atrial natriurectic hormone
Atrial natriurectic hormone is released by the heart to control what?
Blood pressure
What produces melatonin and what does it control?
Produced by the pineal gland, controls circadian rhythm cycles
What is anabolism?
The building up phase of metabolism
In a negative feedback system, what secretes this hormone when our blood sugar falls?
The pancreas secretes glucagon when our blood sugar falls
When making your diagnosis between HHNK and DKA, what is the biggest difference between the two?
Kussmauls respirations are found with DKA
What is the largest risk factor for developing type 2 diabetes?
Obesity
What type of skin will the unconscious hypoglycemic patient have?
Wet skin
What mechanism controls the regulation of glucose in the blood?
Negative feedback system
True or false? Hypoglycemia can result from a seizure as well as cause a seizure
True
What disease is characterized by a buffalo hump and moon face?
Cushings disease
If discontinued abruptly, steroid therapy can precipitate what?
An addisonian crisis
Excess cortisol production is associated with what?
Cushings disease
What is the other term to describe HHNC?
HHS/HONK
Describe the skin in a patient suffering from DKA
Warm - DKA is a hyperglycemia state. Hypoglycemia is wet skin
The number one cause of diabetes type 1 is thought to be…
Autoimmune disease
Insulin is produced by what cells in the pancreas?
Beta cells in the islets of Langerhans
What does gluconeogenesis mean?
Conversion of fat to form glucose
The catabolism of fatty acids produces…
Ketones
The condition diabetes insipidus causes polyuria due to…
Lack of ADH function
Where is renin produced and what is its main function?
Produced in the kidneys and its main function is to activate angiotensogen to angiotensin 1
What is the function of the parathyroid glands?
The function of the parathyroid glands is to increase levels of calcium in the blood
What is the term used to describe the state of greatly increased urination and dehydration that results when high levels of glucose cannot be re absorbed in the blood from the kidney tubules and the osmotic pressure of the glucose in the tubules prevent water reabsorption?
Osmotic diuresis
What is commonly misdiagnosed as Ketoacidosis?
HHS/HONK because both are states of hyperglycemia
What is the name of the endocrine disorder characterized by excess hormones resulting in body changes associated with increased metabolism?
Graves’ disease (hyperthyroidism)
The symptoms of polydipsia, polyuria, and Polyphagia are found in what?
IDDM (insulin dependent diabetes Mellitus) type 1 where destroyed pancreatic cells can’t produce insulin
The vast majority of endocrine emergencies involve complications of what?
Diabetes Mellitus
Doughy, edematous skin is typical of what disorder?
Myxedema (hypothyroidism)
What disease is caused by adrenocortical insufficiency?
Addison’s disease
What is caused by Graves’ disease? (Hyperthyroidism)
Thyrotoxicosis
How will a patient with myxedema (hypothyroidism) tolerate a cold environment?
They will not, myxedema causes patients to be intolerant of cold environments
What is the condition that reflects prolonged exposure to excess thyroid hormones with resultant changes in body structure and function?
Thyrotoxicosis
What is the classic sign and symptom of a hemorrhagic stroke?
Cephalgia (headache), worst headache of my life
Most occlusive strokes occur during or after what?
Sleep
What is the functional unit of the nervous system called?
Neuron
What is the soma?
Cell body of the neuron
Where do efferent nervous impulses travel?
Away from the brain
Where do afferent nervous impulses travel?
Towards the brain
What is the telltale vital sign in a patient with an isolated insult to the brain/head?
Rising blood pressure
A subarachnoid bleed is a type of what?
Hemorrhagic stroke
When a patient complains of constant twitching in the right eye, this could be what?
Myoclonus
What is cushings triad?
Rising BP, slow/normal pulse, irregular respirations
Chronic alcoholism interferes with the intake, absorption, and use of what and results in an irreversible psychosis known as what?
Vitamin b-1, korsakoff’s psychosis
What type of stroke is a thrombotic stroke?
Occlusive stroke
What is the name of the condition in which stroke like symptoms appear then become asymptomatic within 24 hours?
TIA
What is the name of abnormal electrical conduction along the CN-V?
Tic douloreux
Damage to the brain, brainstem, or spinal cord may result in chronic intense pain often described as a burning, aching, or tingling known as what?
Central pain syndrome
Chronic and progressive motor system disorders characterized by tremor, rigidity, bradykinesia and postural instability known as what?
Parkinson’s disease
What is the name for a group of disorders characterized by muscle contractions that cause twisting, repetitive movements, abnormal postures, or freezing in the middle of actions?
Dystonia
What is the name of the disease that causes inflammation of certain nerve cells followed by demyelination?
Multiple sclerosis
What is another name for Lou Gehrig’s disease?
ALS
When a patient suffers from a seizure from a stimulus that does not cause seizures in the general public is called a what seizure?
Epileptic seizure
What cranial nerve is associated with Bell’s palsy?
VII (7th)
During the tonic phase of a seizure, the patient is often what?
Apneic
What is the name of a seizure that begins as an electrical discharge in a small area of the brain but spread to involve the entire cerebral cortex, causing widespread malfunction?
Simple partial seizure
When there is an abnormal finding in any of the three components of the cincinnati stroke scale, what is the percentage that the patient has suffered a stroke?
82%
What posturing will a lesion above the Brainstem cause?
Decorticate
What is one of the major causes of peripheral neuropathy?
Diabetes
What classification of drug is tegretol?
Anticonvulsant
How are cheyne stokes respirations described?
Apnea followed by increasing depth and frequency of respirations
A patents inability to smile, frown, and wrinkle his forehead indicates an intact cranial nerve…
7
“Day dreaming” in a child could be what kind of seizure?
Absence
Vascular headaches include?
Migraine and cluster headaches
What was first described in 1812 as the “shaking palsy”?
Parkinson’s
What receptors in the stomach are responsible for secretion of acid in the stomach during an anaphylactic reaction?
H2 receptors
True or false, older people are more likely to suffer from an allergic or anaphylactic reaction?
False
What is lisinopril classified as?
ACE antagonist/inhibitor
How many stings are necessary to kill a 165 lb male in other wise good health from the toxic effects of the venom of an insect from Hymenoptera?
1000
What is the most dangerous route of anaphylactic reaction?
Injection
The cells in the immune system that can “morph” into antibody factories are called what?
B-cells
Poison ivy is classified as what type of reaction?
Type IV (4)
Anaphylactic reaction is classified as what type of allergic reaction?
Type 1
The order that includes bee’s, wasps, etc. is known as what?
Hymenoptera
A raised wheal in the skin that itches, usually associated with vasodilation due to histamine release is known as what?
Urticaria
A basophil is what kind of blood cell?
White blood cell
When histamine is released by the mast cells, what 3 things does it cause?
- vasodilation
- bronchoconstriction
- hypotension
What does stimulation of H1 receptor sites cause?
- bronchoconstriction
- peripheral edema
Where are h2 receptor sites found and what do they cause?
Found in the stomach and cause gastric secretion
What is it called when there is an initial exposure of a person to an antigen that results in an immune response?
Primary response
What is the name of the acquired immunity that occurs following exposure to an antigen and results in the production of antibodies specific for that antigen?
Active immunity
IgG antibodies are known for what?
Memory
The ability to detoxify some bacteria endo and exotoxins are properties of what?
Antibodies
If a patient has explosive diarrhea and projectile vomiting immediately after consuming a sea food product, what type of reaction would you expect?
Type 1 allergic reaction
What is the response by the immune system that takes place if the body is exposed to the same antigen again and antibodies for the offending antigen are released?
Secondary response
What is the principle agent of the chemical attack by the body to an invading substance?
Antibodies
What is the initial generalized response to an antigen called?
Primary response
What is another name for innate immunity?
Natural immunity
What is the name of the immunity that begins to develop after birth and is continually enhanced by exposure to new antigens and pathogens throughout life?
Natural acquired immunity
What is the name for the immunity that is achieved through vaccination given to generate an immune response that results of the development of antibodies specific for the injected antigen?
Artificially acquired immunity
What is the name for any substance that is capable under appropriate conditions of inducing a specific immune response?
Antigen (bad)
What is the name for the immunity that results from a direct attack of a foreign substance by specialized cells of the immune system?
Cellular immunity
What is the name of the immunity resulting from an attack of an invading substance by antibodies?
Humoral immunity
The term antibody means the same as what?
Immunoglobulin
What is the name for an exaggerated response by the immune system to a foreign substance?
Allergic reaction
An unusual or exaggerated allergic reaction to a foreign protein or other substance that often produces life threats is called…
Type 1 allergic response
What potentiates the effects of histamine, especially in the respiratory system?
SRS-A
How do you differentiate DKA from HHNK?
DKA will have kussmaul’s respirations (deep and rapid) and a fever. Both are treated with fluid administration as needed and transport. Both will also present with tachycardia, 3 p’s, and warm dry skin. DKA will also be unique in that it can present with nausea, vomiting, and abdominal pain.
What is thyrotoxicosis?
Another term for hyperthyroidism. If hyperthyroidism is due to an autoimmune disease, it is Graves’ disease.
What is the number 1 treatment for pulmonary edema?
CPAP
What is one of the biggest risk factors for Afib?
Stroke
What does the DOPE acronym stand for?
- displacement of the tube
- obstruction
- pneumothorax
- equipment failure
What is stokes Adam syndrome?
A condition involving sudden fainting which usually lasts less than a minute and may include seizures. Before the attack the patient becomes pale and during the recovery they feel hot and flushed. The fainting occurs due to lack of O2 to the brain due to heart rhythm problems involving slowing of the heart.
- transient heart blocks are the most common cause (blocks that are not permanent)
- digitalis OD could also cause stokes adam
What is the equation for a dopamine drip?
Dose x kg x drip set x volume / drug on hand
What is the 3rd cranial nerve responsible for?
Oculomotor nerve, allows for pupil constriction and eye movements.
- with a head injury and brain swelling you sometimes see constricted pupils. This is because of the pressure on the tentorium, which is the location of the 3rd cranial nerve in the brain.
What is the 5th cranial nerve?
Also called the trigeminal nerve. In tic de leroux, there is trigeminal neuralgia, which is a painful condition of the 5th cranial nerve that is responsible for most facial sensation.
What is the 7th cranial nerve?
Facial nerve affected in Bell’s palsy. There is swelling of the 7th cranial nerve due to immune or viral disorder, causes facial paralysis and is often mistaken for a stroke
What is the 10th cranial nerve?
(Vagus) parasympathetic nerve connection between the brain and numerous organs
What is cushings triad?
3 primary signs that indicate an increase in intracranial pressure…
- high systolic BP
- low pulse
- erratic respirations
What is the difference between wernickes and korsakoff’s?
Both caused by chronic alcoholism. Wernickes syndrome is temporary spats of psychosis that is reversible whereas korsakoff’s psychosis is permanent craziness
What is in the coma cocktail?
Glucose, narcan, and thiamin
What is Addison’s disease?
Hypoadrenalism - patient will present with progressive weakness, fatigue, decreased appetite, weight loss, Hyperpigmentation of the skin, vomiting or diarrhea. It’s possibly an autoimmune disease that can be caused by an intense stressor on the system. Causes a cessation of adrenal gland function. Person will die from cardiopulmonary collapse.
What is sick sinus syndrome?
Encompasses a variety of rhythms that involve a poorly functioning SA node and is common in elderly patients, normally goes back and forth between bradycardia and tachycardia. Some patients experience syncopal or near syncopal episodes, dizziness, and palpitations. Other patients are asymptomatic
What is pericarditis and how will it present?
Inflammation of the pericardial sac as a result of an infection (bacterial, viral, or fungal) or trauma. Patients will present with positional chest pain that is often alleviated by sitting forward, SOB, and recent HX of infection or fever. Characterized by slight ST elevation across all v leads that is nonsensical and a down sloping PR segment. Can lead to pericardial effusion which can develop into pericardial Tamponade. Tx is pericardialcentesis. Will hear a to and fro sound in systole and diastole which is defined as a pericardial friction rub
What is Wolff Parkinson white characterized by?
A preexcitation disorder that is characterized by short PR interval, widened QRS, and presence of a delta wave
What is a retina arterial occlusion?
Painless loss of vision in one eye
What is cor pulmonale?
Cor pulmonale, or right sided heart failure, is an enlargement of the right ventricle due to high blood pressure in the lungs caused by chronic lung disease
How will a patent describe a detached retina?
Will be described as having a curtain over part of their field of vision. Often occurs due to a blow to the head or shaken baby syndrome
What is delirium?
Rapid onset of widespread, disorganized thought
What is trichotillomania?
Impulse control disorder characterized by pulling out hair, eyebrows, etc.
What is histrionic personality disorder?
Patterns of excessive emotionality and attention seeking needs of behavior. Need for approval, sexually proactive, influenced by others
What is the most common method of suicide?
Bullet wounds
If you see spiders that aren’t there you are experiencing what?
Hallucination
A patient has become blind after a psychological insult with no explanation by any medical issue. What disorder is this person experiencing?
Conversion disorder
Manic depressive is synonymous with what?
Bipolar disorder
When a rape victim is unable to recall any other details of the assault, what occurred?
Psychogenic amnesia
A patient is found 200 miles from home after a significant psychological event. He has no recollection of events that led him there. This is called what?
A fugue state
What is a leFort 1 fracture?
Slight instability involving the maxilla
What is a LeFort 2 fracture?
Fractures of both the maxilla and the nasal bones
What is a LeFort 3 fracture?
Fractures involving the entire facial region below the brow ridge, including the zygoma, nasal bone, and maxilla
What is it called when endometrial tissues grow outside the uterus?
Endometriosis
What is pain upon ovulation called?
Mittleschmertz
Signs and symptoms of ectopic pregnancy usually present how many weeks after fertilization?
6-10 weeks
What hormone does the Graafian follicle produce?
Progesterone
When the egg is released on the ovary it creates a cyst known as what?
The corpus luteum
What hormone is responsible for creating more compliance of the lungs?
Progesterone
What does grand multi para mean?
A woman who has delivered 7 or more babies
When a woman is grand multi para she is more at risk for a precipitous delivery, true or false?
True
What are the signs and symptoms of pre eclampsia?
Hypertension, edema, protein in the urine
PID and tubal litigation are risk factors for developing what?
Ectopic pregnancy
Painless bright red bleeding in the gravid female in the 3rd trimester is what?
Placenta previa. Abrupto placenta is very painful
What are the signs and symptoms of abruptio placentae?
Bleeding or no bleeding, tearing pain, hypotension
When the egg is released on the ovary it creates a cyst known as what?
The corpus luteum
What hormone is responsible for creating more compliance of the lungs?
Progesterone
What does grand multi para mean?
A woman who has delivered 7 or more babies
When a woman is grand multi para she is more at risk for a precipitous delivery, true or false?
True
What are the signs and symptoms of pre eclampsia?
Hypertension, edema, protein in the urine
PID and tubal litigation are risk factors for developing what?
Ectopic pregnancy
Painless bright red bleeding in the gravid female in the 3rd trimester is what?
Placenta previa. Abrupto placenta is very painful
What is it called when endometrial tissues grow outside the uterus?
Endometriosis
What is pain upon ovulation called?
Mittleschmertz
Signs and symptoms of ectopic pregnancy usually present how many weeks after fertilization?
6-10 weeks
What are the signs and symptoms of abruptio placentae?
Bleeding or no bleeding, tearing pain, hypotension
What is a risk factor for a pregnant female who has preeclampsia progress rapidly to eclampsia?
Chronic hypertension
What two things could induce tocolysis?
Oxytocin and fluid bolus
What stage of labor does effacement occur?
1st
When does stage 3 of labor end?
With the delivery of the placenta
What is the most important thing you can do for a newborn?
Keep him warm and dry
What should you do in a breech birth if the head does not deliver?
Place two fingers in vagina to create an airway and transport
What should you do in a limb presentation childbirth?
Transport immediately with the mother in the knee chest position
A woman is 7 months pregnant and is involved in an MVA into a tree, she complains of a tearing feeling in her belly and is appearing shocky. What should you expect?
Ruptured uterus
What is post-partum hemorrhage treated with?
Fundal massage and pitocin
What is the most common cause of postpartum hemorrhage?
Uterine atony
During childbirth, uterine inversion is usually the result of what?
Pulling on the umbilical cord during delivery
True or false, PE can occur at any time during pregnancy?
True
During childbirth, the ductus arteriosus does what?
Closes and diverts blood to the left ventricle
What does the foramen ovale do?
Connects the umbilical vein to the inferior vena cava and mixes the blood in the right atrium
What does antepartum mean?
Refers to time interval prior to childbirth
During childbirth, CO increases up to…
30%
What are the most common causes of PID?
Chlamydia and neisseria (gonorrhea)
True or false, it is possible to distinguish Braxton hicks contractions from true labor in the field?
False
During delivery you observe turtle sign, this occurs due to what?
Shoulder dystocia
Complications of a precipitous delivery include what?
Maternal and fetal lacerations
What is the difference between petechiae vs. purpura?
Both indicate bleeding under the skin in the capillary bed, usually a liver problem. They are the same thing except that petechiae are under 3mm
What is the difference between a dry drowning and a wet drowning?
A dry drowning is classified as a Laryngospasm, but no water fills the lungs. Wet drowning is when water fills the lungs
What is the difference in a drowning in salt water vs a drowning in fresh water?
In fresh water, the water washes off the surfactant of the alveoli and causes atelectasis. In salt water, the difference in osmolarity causes pulmonary edema in the lungs
As a PE gets more significant, what would your end tidal co2 do?
Decrease below 35
What would a saddle emboli cause blood pressure to do?
Drop
What structures does a saddle emboli block?
The right and left pulmonary vein
A tongue piercing that gets infected could cause what?
Ludwigs angina
Wheezing in an elderly patient could be caused by what?
Weak terminal bronchioles
A defect in the neuromuscular junction in which acetylcholine is disabled is called what?
ALS
Cor pulmonale is a complication of what?
COPD
A common drug used to treat altitude sickness is called what?
Nifidipine
Caissions disease is another name for what?
The bends
A malignant tumor of the lung often produces?
Hemorrhage
Anemia produces shortness of breath because what of the fick principle is affected?
Respiration
What is spirolactone?
Potassium sparring diuretic
The oxygen molecule has?
8 protons, neutrons, and electrons
Hyperoxia is another name for?
O2 toxicity
Non cardiogenic pulmonary edema is known as what?
ARDS
A person suffering from altitude sickness is probably in what acid base disorder?
Respiratory alkalosis
Number one treatment for pulmonary edema secondary to CHF is what?
CPAP
Surfactant is produced by what?
Type 2 cells
Hydrochlorothiazides action in producing diuresis is?
Because it causes the release of chlorine and sodium from the kidneys
A precaution in using ipratropium bromide is that it
Is toxic to the eyes
Why are nitrates used for pulmonary edema?
Dilatory effects on the vessels
Name the 3 chemoreceptors responsible for respirations, their location, and what they respond to.
Carotid bodies- measures co2 (carbon dioxide) in arterial blood, responds to decreases in Pao2.
Aortic arch-measures co2 in arterial blood, responds to decrease in Pao2.
Central chemoreceptors- by respiration centers in the medulla, monitor PH of CSF. An increase in acidity means more co2 in arterial blood. Increase in acidity = decreased PH. Central are primary control of ventilation.
What is pulsus paradoxus and what conditions is it found in?
A decrease in blood pressure by 10 mm Hg or more during inhalation. Found in asthma and pericardial Tamponade.
What is the age range for using a non cuffed ET tube?
Under 8 years old
What drugs can go down an ET tube?
L.E.A.N.
Lidocaine, Epi, atropine, narcan
*double the dose
What is the placement for a Mac blade?
Place in the vallecula
When is blind nasotracheal intubation indicated?
Indicated when c-spine stability is questionable
What is the concentration of O2 delivered by a simple face mask?
55%
What is the O2 percentage delivery of a nasal cannula?
24-44%
What is the O2 percentage delivery of a Venturi mask?
24-40%
What is the good type of cholesterol?
HDL
What is the odonotoid process?
Also known as the dens. Tooth like projection from the second cervical vertebrae on which the first vertebrae pivots. Injury could produce hangmans fracture.
What does s’s in 1, q’s in 3 and inverted t’s in 3 indicate?
Possible PE, right side strain, right side hypertrophy
What does 1 grain equal?
60 mg
What is the normal level of hematocrit?
33-45
Where does referred pain in ectopic pregnancy occur?
Traps
What is the rule of 9’s for adults?
Head-9
Arms-9 (just anterior is 4.5)
Front- 9 for anterior chest, 9 for anterior abdomen
Back- 9 for posterior chest, 9 for lower back
Genetalia- 1
Legs-18 (just anterior or posterior is 9)
What is the rule of 9’s for pediatrics?
Head- 18
Arms- 9 (4.5 for just anterior or posterior)
Front- 18 (9 for thorax, 9 for abdomen)
Back-18 (9 for top, 9 for bottom)
Genitalia- 1
Legs-14 (7 for posterior, 7 for anterior)
What is romazicon (flumazenil) used for?
Reversal of Valium OD in seizures
How much blood loss needs to occur for a drop in pressure?
20%
How much blood loss needs to occur for narrowing pulse pressure?
15%
What are the indications and contraindications of a PASG?
Contra in pulmonary edema
Indicated for stabilizing bilateral femur fractures or pelvic stabilization. Can be used for pregnant patients
What are MAST trousers indicated for?
- bilateral femur fractures
- pelvic fractures
- massive lacerations for lower legs
- AAA
What are idioventricular rhythms usually associated with?
Hypovolemia
Why are nitro and morphine used to treat MI’s?
Decrease preload and pulmonary edema
What is rhabdomyolysis?
Excessive myoglobin release due to the destruction of muscle tissue leading to a release of potassium and myoglobin. Characterized by burgundy pee can be seen as a result of crush injuries.
How will a flail segment move with respirations?
Expiration moves the flail segment outward, inspiration moves the flail segment inward.
What is the name of the injury that presents with a crushing chest injury that produces exothalamus, bloated blue tongue, reddish/purple face and extreme JVD?
Traumatic asphyxia
How do you treat a sodium burn?
Brush it off, rinse with oil. No water!
What are ammonia and bleach?
Alkaline/base poisons
What is the difference between an acid burn and a alkaline burn?
Acid burns are coagulation, alkaline burns are liquification
What are the characteristics of metabolic acidosis?
Co2 stays the same, ph decreases, sodium bicarb decreases. Lactic acid buildup resulting from a change in metabolism to anaerobic metabolism. Seen in ASA OD, DKA, and shock.
What are the characteristics of metabolic alkalosis?
Co2 stays the same, ph increases, sodium bicarb increases. Seen in patients who have been vomiting or has OD’d on bicarb
What are the characteristics of respiratory acidosis?
Co2 increases, ph decreases, NaHCO3 stays the same. Caused by hypoxia and apnea, slowed or stopped breathing. Anything that impedes normal breathing will cause this, COPD, narcotic OD, MI, sleep apnea.
What are the characteristics of respiratory alkalosis?
Co2 decreases, ph increases, NaHCO3 stays the same. Hyperventilation
What is cardiomyopathy?
Chronic disease of the heart muscle, weakening of the vessels
What is the difference between cheyne stokes respirations and biots respirations?
There is no pattern with biots (ataxic). Biots has an irregular pattern, rate, and depth with intermittent periods of apnea. Results from increased intracranial pressure.
Cheyne stokes have a pattern of gradually increasing rate and depth of respirations followed by a gradual decrease with intermittent periods of apnea. Associated with a Brainstem insult.
What is supine hypotensive syndrome?
Characterized by pallor, tachycardia, nausea, hypotension, and dizziness when a pregnant patient lies on her back and resolves when she is turned on her side (left lateral recumbent). Hypotension is due to obstruction by the gravid uterus of the inferior vena cava, resulting in a decreased venous return to the heart.
What is the pediatric fluid bolus dose?
20 ml/kg
What is the adult fluid bolus dose?
500-1000 mL
What is peripheral neuropathy?
A group of conditions in which the nerves leaving the spinal cord are damaged. The signals moving to or from the brain become distorted. Can be caused by metabolic disorders, trauma, toxins, tumors and autoimmune disorders. Patient will have sensory and motor impairment, loss of sensation, numbness, burning pain, and will eventually lose the ability to feel their feet in some areas. Caused by high blood glucose.
What is glucopenia?
A shortage of glucose in the brain (hypoglycemia)
What are the three primary buffer systems for the body to maintain ph?
Circulating bicarbonate buffer system
Respiratory system
Renal system
What value do you need in order to say someone is in a metabolic disorder vs. a respiratory acid-base disorder?
Must have a bicarbonate value to determine if it is metabolic acidosis vs metabolic alkalosis. Normal bicarb is 23 to 30. If bicarb is above 30, the patient is in metabolic acidosis. If bicarb is below 23, the patient is in metabolic alkalosis.
What is pectoriloquy?
The sound of words heard through the chest wall with auscultation. Indicates a cavity or consolidation of lung tissue.
What is cystitis?
Inflammation of the urinary bladder. Often caused by infection and is usually accompanied by frequent, painful urination. Will present with possible blood in the urine, cloudy or strong smelling urine.
How do you determine branch bundle blocks in an ECG?
Look at 1 and AVF. 1 is for a left, AVF is for a right. Whichever one points up is where the block is.
What medication would you give for a dialysis patient with cardiac toxicity from hyperkalemia?
Calcium gluconate
What is the number one site for a thoracic aneurysm?
Ascending aorta at the ligamentum arteriosum
How would you confirm a posterior STEMI?
Look for ST depression in v1 and v2, confirm with reciprocal changes in v7, v8, v9 (would show ST elevation)
What is scarbossa’s criteria?
Set of findings used to identify an MI in the presence of LBBB or ventricular paced rhythm.
- concordant ST elevation greater than 1 mm in leads with a positive QRS complex (score 5)
- concordant ST depression greater than 1 mm in v1-v3 (score 3)
- excessively discordant ST elevation greater than 5 mm in leads with a -ve QRS complex (score 2)
- a total score greater than or equal to 3 is 90% accurate for diagnosing MI
What is the difference between libel and slander?
Libel and slander are both considered defamation, which is when someone’s words end up causing harm to your reputation or your livelihood.
Libel - written or published defamation
Slander- spoken defamation
What is virchow’s triad?
Virchow’s triad describes the three broad categories of factors that are thought to contribute to a thrombosis…
- ) hypercoagulability
- ) hemodynamic changes like stasis or turbulence
- ) endothelial injury or dysfunction
What is otorrhea?
Any kind of flow or discharge from the ear
What is venous stasis?
Venous stasis is a risk factor for forming blood clots in veins (venous thrombosis) that occurs after long periods of rest such as driving, flying, bed rest, or having an orthopedic cast. Can lead to DVT
What is the oxygen percentage delivered for a nasal cannula?
24-44%
What is the oxygen percentage delivered for a non rebreather?
90-100%
What is the oxygen percentage delivered with a BVM with attached o2?
Nearly 100%
What is the oxygen percentage delivered with a mouth to mask device?
Nearly 55%
What is the oxygen percentage delivery for a Venturi mask?
24-40%
What is an NSTEMI?
Symptomatic patient with possible ST depression and T wave inversion but no ST elevation. Essentially a pre STEMI
What should each intubation attempt be limited to?
30 seconds
What is autonomic dysreflexia?
A potentially dangerous complication of a spinal cord injury where an individual’s blood pressure will spike to dangerous levels in an undetermined period of time after the initial injury because of a minor insult or stimulation. Also called spinal hyperreflexia
What cells release glucagon in the pancreas?
Alpha cells
What cells release insulin in the pancreas?
Beta cells
What do the delta cells in the pancreas release?
Somatostatin
A hypoglycemic patient needs?
Glucagon or glucose. Glucagon converts glycogen to glucose
A hyperglycemic patient needs?
Insulin
What is the most narrow portion of the airway in a child?
Below the glottis at the level of the cricoid cartilage
What is the most narrow portion of the adult airway?
Level of vocal cords
What is a late sign of septic shock?
Low temp
Is neurogenic shock only trauma related?
No, comes with any disruption of blood flow
Describe a black widow spider bite presentation and tx
Immediate localized bite from a spider with a red hour glass on the thorax.
Progressive muscle spasms of all large muscle groups is the key sign, usually stomach muscles and thigh. Other signs and symptoms are nausea and vomiting, decreased LOC, seizures, and paralysis.
Tx= IV muscle relaxants for muscle spasms, Valium, calcium gluconate @ 0.1-0.2 mg/kg of 10% solution, antivenom if available.
Describe a brown recluse spider bite presentation and tx
Painless, small erythematosus macule surrounded by a white ring around site
Patient will present with chills, fever, nausea, vomiting, joint pain, localized redness and swelling and pain around 8 hours after bite. Tissue necrosis will begin days to weeks after bite.
Venom causes tissue necrosis so tx is surgical debridement
Describe the presentation and tx of a coral snake bite
Patient will present with localized numbness and weakness, drowsiness, ataxia (impaired balance), slurred speech, salvation, paralysis of tongue, drooping of eyelids, double vision, DILATED PUPILS, abdominal pain, nausea, vomiting, loss of consciousness, seizures, hypotension, respiratory failure.
Venom is a neurotoxin
*tx is DO NOT let the patient move. The more you move, the faster the venom spreads. Put a light constricting band (lymphatic constriction only) proximal to the bite and tx associated ABC needs
What is the presentation and tx for a jellyfish sting?
Intense local pain and swelling, weakness, nausea and vomiting, dyspnea, tachycardia, hypotension or severe shock
Tx= establish and maintain airway, apply light constricting band for lymphatic flow only, apply heat or hot water, remove any stingers
*venom is designed to interact with other marine animals/ oceans are cold so the venom is designed to operate at a cooler temp. Heat the area to disable the venom
What nerve controls the diaphragm?
Phrenic nerve
Describe electrical alternans and what it is associated with
Electrical alternans occurs because there is an effusion of fluid around the pericardium that blankets the electrical activity of the heart.
The electrical amplitude therefor alternates between strong/weak/strong/weak etc on an ECG
associated with pericarditis and may be accompanied by atrial arrhythmias
Describe the renin/angiotensin system in its entirety
This system is designed to keep blood pressure up ultimately.
Kidneys secrete renin = angiotensinogen now converts to angiotensin 1 = lungs secrete ACE (angiotensin converting enzyme) which converts angiotensin 1 to 2 = angiotensin 2 causes vasoconstriction and secretion of aldosterone from adrenals = causes body to retain water, thus increasing BP
What type of bleed is a subdural hematoma?
Venous bleed
What type of bleed is an epidural hematoma?
Arterial bleed
What is key to remember when deciding if a person is in a metabolic acid/base disorder?
Need a sodium bicarb value to diagnose metabolic acidosis or alkalosis. Bicarb will follow ph up or down.
What releases follicle stimulating hormone?
Pituitary gland
What releases LH?
Pituitary gland
What is the Graafian follicle?
Sac that the egg is in, secretes estrogen
What secretes progesterone?
Corpus luteum
Describe the entire sequence of blood flow through the heart and body
- ) blood that has circulated through the body, which has lost all its oxygen and has picked up carbon dioxide, enters through the vena cava to the right atrium.
- ) right atrium pumps blood through tricuspid valve into right ventricle.
- ) right ventricle pumps blood through the pulmonary artery to the lungs to be oxygenated.
- ) oxygenated blood returns via pulmonary vein into the left atrium
- ) oxygenated blood pumps through the mitral valve and into the left ventricle
- ) the left side of the heart contracts and pumps blood through the aortic arch on its way to all parts of the body. At this point, there are a few options for where blood flow can be pumped…
- carotid artery to the brain
- auxiliary arteries to the arms
- through the aorta and into the torso and legs - ) blood will then move through the arteries, then through the capillaries, and then return through the veins.
- ) deoxygenated blood returns to the heart and the cycle repeats
