Patho-Pharm Final Flashcards
1
Q
Pathologic Fractures
A
Fracture resulting from an abnormality, commonly observed in hospitals. That is caused by abnormalities such as cancerous growth or lack of blood supply.
2
Q
Stress Fractures
A
result from repetitive stress, common in athletes or those with excessive physical activity. Rest is crucial.
3
Q
Transchondral Fractures
A
Breaking through cartilage in a joint, leads to potential long-term issues. Separation of a portion of articular cartilage. Lifetime joint problems and limitations affecting daily activities. Breaking through cartilage can lead to irreversible consequences, especially in the wrist.
4
Q
simple fracture
A
Basic break through a bone. Reputation built on anatomically aligning fractures for optimal healing.
5
Q
Comminuted Fracture
A
Bone broken into at least three pieces. (Butterfly Fragment). Central piece resembling the wings of a butterfly.
Expertise crucial in reconstructing comminuted fractures.
6
Q
Open compound fracture
A
Bone breaks through the skin, exposing it to the open air.
High potential for infection, always taken to the operating room.
Thorough examination is crucial to avoid missed open fractures.
7
Q
Green stick fracture
A
Common in young individuals; bone bends but doesn’t fully break.
Often seen in children, where the bone can be easily straightened. One side of the bone typically remains intact.
8
Q
Transverse Fracture
A
Straight-across break; offers some stability.
9
Q
Spiral fracture
A
Twisting break; lacks stability, requires external or internal fixation.
10
Q
Oblique fracture
A
Diagonal break; prone to sliding displacement.
11
Q
Bone Repair Process
A
Periosteum disruption
Clot Formation
Inflammatory response
Vascular Tissue formation
Osteoblasts activation
Collegen and mineralization
Healing
12
Q
Periosteum Significance
A
Outer surface of the bone with rich blood supply.
13
Q
Muscles on the Bone
A
muscles determine the shape of the bone.
14
Q
Muscle effect on fractures
A
Muscles pull fractured bones towards the strongest muscle group.
Shortening and external rotations
15
Q
Shortening
A
seen in the elderly when a fractured hip leads to leg shortening and external rotation.
16
Q
Closed reduction
A
externally
17
Q
Open reduction
A
Internally or externally
18
Q
reduction is used for
A
proper healing and alignment
19
Q
ORIF open reduction internal fixation
A
Surgical procedure involving bone realignment and internal hardware. Used in complex fractures requiring precise realignment and stabilization.
Plates, screws, wires, or pins used for internal fixation. Surgeons cut along the bone, manipulate fragments, and use hardware for stability. Must go under any arteries and muscles.
20
Q
Intramedullary Rods
A
common in fractures of long bones, typically remains in body for entire life.
21
Q
External fixations
A
Pins inserted into the bone and connected to an external device for stabilization. easily removed with a low infection rate.
22
Q
anterior dislocation
A
common, typically in the front
23
Q
posterior dislocation
A
usually in severe trauma cases, often from accidents
24
Q
Subluxations Defined
A
Partial joint movement, typically less than 20 degrees. Usually due to joint degeneration
25
Shoulder Dislocations
True dislocations are challenging to relocate; ease of reduction may indicate a recurrent issue. Must be quick because after 12 hours remodeling occurs.
26
Ligaments
bones to bones and commonly injured sprain
27
Tendons
Connect muscle to bones, prone to tears or strains
28
Rotator cuff tears
often don't ever hear, surrounding muscle just takes over.
29
Achilles tendon tear test
squeeze test to ensure food flexion.
30
Soft tissue healing challenges
Multiple repairs lead to scar tissue formation
31
Bursitis
Inflammation of bursae, fluid-filled sacs near joints. Needle drainage followed by steroid injection for relief.
Common areas Prepatellar, shoulder, elbow, hip.
Bursa not connected to the joint's interior; independent inflammation.
32
Primary arthritis
idiopathic, related to genetics and aging factors
33
Secondary arthritis
results from specific damage, like joint trauma, damage. A known cause
34
Osteoarthritis
The breakdown of cartilage due to bone rubbing on bone.
It never improves, manage discomfort.
35
Indicators for osteoarthritis
1. Erosion of articular cartilage: cartilage loss leads to bone rubbing on bone
2. Subchondral sclerosis: stress on the body prompts extra calcium deposition.
3. Osteophytes (bone Spurs): joint damage due to potential deterioration.
36
Osteoarthritis symptoms:
pain in weight baring joints, stiffness, discomfort, limited range of motion.
37
Treatment for Osteoarthritis
Autoinflammatory, rest, weight loss.
38
Joint effusion
an inflammatory exudate or blood in the synovial cavity caused by osteophyte fragments in the synovial cavity, drainage of cysts from diseased subchondral bone, and acute trauma to a joint structure.
39
Two level prosthesis
A spacer put between the femur and tibia. To prevent the rubbing of bone on bone
40
Chondroitin and Glucosamine
Widely used for potential cartilage regeneration. Two compounds that form cartilage can be found in supplements.
41
Rheumatoid Arthritis
Severe rheumatoid arthritis, is an autoimmune disease that primarily affects hands, causing gradual degeneration.
Inevitable progression, characterized by the body's autoimmune response targeting inflammation of connective tissue and affects synovial membranes.
42
symptoms of rheumatoid arthritis
loss of function in multiple joints, mostly in fingers, toes, feet, and wrists.
Can effect skin and lungs with myocarditis possibilities
43
Treatment for rheumatoid arthritis
focus on controlling inflammation, using steroids for short term relief.
44
Diagnostic tests for rheumatoid arthritis
ESR: erythrocyte sedimentation rate, general inflammation
CRP: C-reactive protein, measures inflammation
RF: rheumatoid factors, testing for positive RH factors
White blood cell count: is elevated in positive RH cases
45
What are the rheumatoid nodules
Solid lumps in affected areas with potential complications if improperly managed.
Removal attempts carry risks of tissue damage. They do not get removed
46
Ankylosing Spondylitis
Chronic inflammatory joint disease is characterized by fusion (ankylosis) of the spine and sacroiliac joints,
Males are more prevalent than females.
HLA B27 genotype associated
Form a classic bamboo spine (hardening of the spine)
47
Gout
Deposition of uric acid: Crystal deposition in joints, especially the big toe, is associated with elevated blood uric acid levels.
Acute attacks, is exquisite pain during attacks; treatment includes NSAIDs, allopurinol, and hydration to prevent crystal formation.
48
Contractures
Resulting from physiological or pathological conditions, often observed in diabetics
49
Osteomyelitis
Infectious bone disease caused by bacteria, viruses, fungi, parasites
Infectious bone disease caused by bacteria, viruses, fungi, parasites
50
Treatment for Osteomyelitis
Intravenous antibiotics, surgical debridement, hyperbaric oxygen therapy for anaerobic infections.
51
Exogenous osteomyelitis
is an infection from outside the body, that spreads from soft tissues to bone (open fractures or surgery)
caused by human bites or fist blows to the mouth, shallow bites can infect soft tissues, and deep bites may infect bone directly. The most common organism for human bites is S. Aureus
52
Endogenous osteomyelitis
is an infection carried in the blood from other sites within the body and spreads from bone to soft tissue.
Staph aureus is the most common bacteria causing osteomyelitis and, the most common source of bacteria (cutaneous, sinus, ear, and dental infection).
53
Osteoporosis
Involves decreased bone density, increasing susceptibility to fractures.
Osteoporosis is present with a BMD of -2.5 SD
Symptoms like back pain, kyphosis hunchback, height loss, improper fit of clothing, protruding abdomen, and negative body image.
54
when is your peak bone mass
mid 20s
55
risk factors for osteoporosis
Age, family history, lack of physical activity, hormonal changes.
56
Prevention for osteoporosis
Weight-bearing exercises, calcium, and vitamin D supplementation, hormonal replacement therapy
57
Secondary care for osteoporosis
HRT: estrogen allows for bone to absorb
Calcitonin: acts as an anti-resorptive agent by acting on osteoclasts
Bisphosphonates: Effects osteoclast apoptosis, clodronate, etidronate alendronate, risedronate
Calcium and vitamin D intake is important
Statins (Lovastatin) have been show to significantly increase bone growth in mice and rats.
The key is bone mineral density testing
58
Osteosarcoma
Aggressive tumor from osteoblasts, often with poor outcomes
59
Chondroma and Chondrosarcoma
Tumors related to cartilage, with chondrosarcoma being more serious.
60
Fibroma and Fibrosarcoma
Benign and malignant tumors originating from fibrous tissues.
61
Giant cell tumor
A tumor affecting the bone's reticular tissue, generally benign.
62
Multiple Myeloma
cancer of plasma cells in bone marrow, leading to weakened bones.
63
Reticulum
blood cell precursors
64
Ewing Sarcoma
Aggressive bone tumor, common in adolescents and young adults, usually affecting long bones.
Can be misdiagnosed initially, leading to delayed treatment.
Emphasizes the difficulties in treating certain conditions, such as osteomyelitis in drug abusers and infections in joint replacements.
65
Vomiting
Forceful expulsion of stomach contents
66
Vomiting Reflex
Medulla's vomiting center is influenced by various stimuli.
Labyrinths
Evolutionary theory links vomiting to disorientation and poisoning.
67
Vomiting Process
Retching, gastric content movement; aspiration risk.
Aspiration pneumonia is common in alcoholics.
68
Medications for projectile vomiting
Scopolamine (anticholinergic)
Dimenhydrinate (antihistamines) Ondansetron (seratonin blockers)
69
Psyllium (Metamucil)
Bulk-forming agent; prevents constipation.
Absorbs water, and increases stool size.
Not effective with pre-existing stool plug.
70
Lubricants and Softeners
Emollient
Mineral oil, and lubricants; are effective for stubborn stool plugs.
Colace and similar; milder effect.
71
Hyperosmotic Agents
Polyethylene glycol (PEG), Lactulose.
PEG for thorough bowel evacuation, lactulose for pediatrics.
72
Pediatric Considerations
Lactulose suitable for pediatrics.
Tailor interventions for individual needs.
73
Large Volume Diarrhea
associated with infections; focus on rehydration.
74
Small Volume Diarrhea
Caused by irritation, frequent urges with minimal stool.
Steatorrhea
75
Steatorrhea
Oily/fatty stool
76
Medications for Diarrhea
Adsorbents: coat the walls of the GI tract, and bind to the causative bacteria. Bismuth Subsalicylate (petto-Bismol)
Anticholinergics: decrease intestinal muscle tone and peristalsis of the GI tract, slowing down the movement of fecal matter (atropine)
Opioids, Laxatives.
77
Abdominal Pain
Visceral (organs), parietal (parietal peritoneum), referred pain (gall bladder).
Understanding origin aids in diagnosis.
78
Upper GI bleed
from jejunum, ileum, colin, rectum. Can be caused by polyps, inflammatory disease, cancer, or hemorrhoids.
acute to severe bleeding is life-threatening
79
Lower GI bleed
the esophagus, and stomach, often caused by bleeding ulcers
80
Hematemesis
blood in vomitus
81
Hematochezia
Bright blood from the rectum
82
Melena
dark, tarry stools
83
Occult bleeding
slow chronic blood loss in stool, found by guaiac test, results in iron deficiency anemia. Look for changes in blood pressure and heart rate with acute bleeding.
84
LFT
liver function test
85
BAIT test
B: Bilirubin
A: Albumin
I: INR
T: Total protein
86
Peptic Ulcers
Overview of peptic ulcers: General classification into lower softdel, duodenal, or gastric ulcers.
Factors influencing ulcer occurrence, including acidity levels and pH in the ileum.
Protective mechanisms of the gastrointestinal system against acid, including mucosal barriers.
87
Duodenal Ulcers
The most frequent type of peptic ulcer, the acid and pepsin concentrations penetrate the mucosal barrier and cause ulceration. Rapidly relieved with antacids.
88
Gastric ulcers
Develop adjacent to acid-secreting mucosa, increasing mucosal barrier’s permeability to hydrogen ions.
89
Hiatal Hernia
occurs when the upper part of the stomach bulges through the diaphragm and into the chest.
90
GERD
(gastroesophageal reflux disease), and symptoms like heartburn.
Management strategies for GERD, including lifestyle changes and medications.
91
Treatment Options for Gastrointestinal Disorders
antiacids to neutralize stomach acids
92
types of antacids
aluminum, magnesium, calcium, and sodium bicarbonate.
93
side effects for antiacids
constipation, and kidney issues
94
pH and Medication Absorption
Body pH affects medication absorption.
Changing body pH can impact the effectiveness of certain drugs.
95
H2 blockers
reduces acid secretions, blocks histamine H2 at the receptors
96
Mucus
a protective barrier against HCL
97
Bicarbonate
helps buffer acidic properties of HCL
98
Prostaglandins
event activation of the proton pump.
99
Proton Pump Inhibitors (PPIs)
inhabit gastric production, for GERD and peptic ulcers
'prazole'
100
PPIs are effective for conditions like
GERD and peptic ulcers.
101
H. pylori Treatment
Importance of treating H. pylori bacterial infection with antibiotics.
Challenges of antibiotic therapy, including potential side effects.
102
Nexium
medication that reduces stomach acid
103
Small Bowel Obstruction
Obstruction leads to distress, anorexia, weight loss, and vomiting after eating.
Small bowel obstruction is characterized by mechanical or functional blockage.
Obstruction can lead to ischemia, tissue death, and potentially perforation.
104
Intestinal obstruction
anything that prevents the normal flow of chyme through the intestine.
105
Pyloric obstruction
primarily affects children, causing projectile vomiting. Narrowing of opening between stomach and duodenum
106
Functional Bowel Obstruction (Ileus)
Temporary bowel dysfunction; common after surgery.
Mechanical vs. functional obstruction.
107
Ulcerative Colitis
Ulcerative colitis primarily affects the large bowel and rectum. It involves chronic inflammation and antibody presence.
108
common symptoms of Ulcerative Colitis
low-volume diarrhea with blood and mucus, dehydration, weight loss, and anemia.
109
primary treatment for ulcerative colitis
conservative treatment, surgery is used when medications fails
110
Diagnostic Tools for Colitis
Colonoscopy and sigmoidoscopy play a crucial role in diagnosing colitis.
Endoscopic procedures provide direct visualization of the colon and rectum.
Conservative therapy includes medications, with surgery as a last resort.
111
Appendicitis
Inflammation of the appendix, most common surgery of the abdomen.
May arise from obstruction, or bacterial infection. Right lower quadrant pain is associated with extension of inflammation.
Classic symptoms include central abdominal pain migrating to the right lower quadrant.
112
Crohn's Disease
Inflammatory bowel disease affecting any part of the gastrointestinal tract. Characterized by skip lesions, forming fistulas between hollow organs.
Symptoms include chronic diarrhea, weight loss, and abdominal pain.
113
Medications for Crohn's disease
steroids (during flares), immunosuppressants (e.g., methotrexate), and biologics.
114
IBD medication and treatment
steroids, for treatment of diseases that have chronic inflammation in the digestive tract
115
Dysphagia
(Swallowing Difficulty):
A complex process involving the formation of a bolus and peristalsis. Due to neuromuscular issues often has multifactorial complications.
Aspiration risk arises when food enters the lungs, requiring careful decision-making.
116
Obstructions
Liquids pass through easily, solids feel stuck.
117
Neurological
Difficulty forming a bolus, impacting both liquids and solids.
118
Barium tests
identifying the underlying cause with dysphagia
119
Malabsorption
Failure to absorb broken-down nutrients at the brush border. (enzyme deficiencies)
120
Maldigestion
Inability to break down substances, seen when recognizable food passes through. (impaired breakdown)
121
Anorexia nervosa
involves severe food restriction and distorted body image.
122
Bulimia nervosa
features episodes of overeating followed by compensatory behaviors.
challenges due to recurrent binge-purge cycles, affecting overall health.
123
Viral hepatitis
a common systemic disease that affects the liver, 6 strains known.
Also, look at liver function tests to rule out other concerns. No specific treatment (low-fat, high carbohydrate diet if bile flow is obstructed) Prophylactic immune globulin can prevent HBV.
124
Hep A (HAV)
used to be infectious, the transmission of fecal-oral route, spreads rapidly
125
Hep B
used to be called the serum hep, transmitted through infected blood, body fluids, needles, IgG antibodies rise more slowly.
126
HCV (hep C)
causes most cases of post-transfusion hep, RNA virus, uses a screen for all blood products, incurable.
127
Cholelithiasis
the presence of gallstones in the gallbladder, affects about 20% of the population over 40 years of age.
More prevalent in women.
For unlocalized abdominal discomfort, eructation, and intolerance to certain food, in clients with severe pain, cholecystectomy is recommended.
128
Cholecystitis
acute or chronic inflammation of the gallbladder. Acute is usually caused by gallstones that cannot pass through the cystic duct. There is a QUR pain of the abdomen and N&V, eructation, and flatulence. Diagnosed by ultrasound. Treatments are usually surgery.
129
Gallbladder
Gallbladder attacks are often caused by gallstones. gallbladder removal (cholecystectomy) is preferred for unresolved attacks.
Surgery, preferably laparoscopic, is more successful in women than men. Especially those approaching menopause.
130
Common Bile Duct and Gallbladder
The common bile duct connects to the hepatic ducts and the cystic duct.
Stones passing through the common bile duct lead to gallbladder attacks.
131
Pancreatitis
Pancreatitis involves inflammation of the pancreas.
Most commonly seen in alcoholics; linked with alcoholism and Hepatitis C.
Chronic pancreatitis may lead to scarring and long-term complications. Chronic pancreatitis may contribute to the development of diabetes.
132
Culdoscopy
invasive surgical procedure used to examine and diagnose conditions within the pelvic cavity of the female reproductive system.
133
Vaginitis
infection of the vagina caused by sexually transmitted bacteria and candida albicans.
Symptoms like discharge may prompt treatment.
134
Fibroids (Uterine Leiomyomas)
benign tumors that develop from smooth muscle cells in the myometrium
About a quarter of women develop fibroids.
Most are asymptomatic; symptoms depend on size and location.
135
Fibroids treatment
NSIADS, hormones
Treatment options vary based on age, desire for future pregnancies, and symptoms.
Surgical interventions include hysterectomy or myomectomy
136
Dysfunctional Uterine Bleeding
Characterized by irregular or excessive menstrual bleeding.
Often associated with fibroids or hormonal imbalances.
137
Endometriosis
Tissue growth outside the uterus, influenced by hormonal cycles. causing pain and complications may include fibrosis, leading to adhesions and blockages.
138
Cervical Cancer Staging
Cervical cancer stages progress from mild cell changes to invasive cancer. Stages range from early changes in surface cells to invasive cancer penetrating deeper layers.
Pap smears revolutionized cervical cancer detection.
139
Initial Screening
Positive test requires location biopsies to determine affected areas.
Depth of affected tissue is crucial for treatment decisions.
140
Biopsy Support
Biopsies help identify affected parts and assess depth.
141
Infertility
impaired fertility may warrant evaluation after a year of unsuccessful attempts.
Secondary infertility often stems from untreated STDs affecting the reproductive system.
A year of unprotected sex
142
Female infertility test
include X-ray and laparoscopic exams to identify tract abnormalities.
143
Hysterosalpingogram
x-ray of the womb and fallopian tubes
144
Male infertility test
Testing focuses on sperm activity and quantity
145
Epididymitis
Inflammation of the epididymis, recent UTI, or urethral discharge. (swab and gram stain)
Generally, occurs in young, sexually active men
The most common cause is gonorrhea or chlamydia
complications include: abscess, infarction, infection, infertility
146
UTI antibiotics
Females - 10-12 days
Males - 4-6 weeks
Ciprofloxacin
Doxycycline
Trimethoprim-sulfamethoxazole (Septra)
Nitrofurantoin (Macroid)
147
Testicular Torsion
Testicular torsion is an emergent condition where the testicle loses blood supply.
Prompt diagnosis and manual detorsion within six hours are crucial for salvage.
148
Prostatic hyperplasia
enlargement of the prostate gland
occurs at the age of 40-45, becomes problematic when the urethra is compressed.
80% of men will have this by their 80th year. Urine retention becomes chronic.
149
Acute bacterial prostatitis
Assessing infection of the urinary tract, inflammation of the prostate
low back pain, perineal pain, high fever, chills, dysuria, inability to empty bladder nocturia
Acutely ill and toxic, complications can include bacteremia and septic shock. Same treatment as UTI and epididymitis.
150
Nonbacterial prostatitis
Most common prostatitis syndrome, no bacterial infection
diagnosis by exclusion
151
Testing for STDs
has advanced significantly, moving from cell cultures to PCR-based DNA testing.
Most testing is now urine-based, making it more accessible and efficient.
152
STD
STDs like gonorrhea and chlamydia are common but often asymptomatic.
Testing is crucial, especially for sexually active individuals.
153
Gonorrhea
Caused by gonocci, endocervical canal usual site of original infection in women, urethra in males.
Incubation 3-10 days, females up to 10 days. 50% are asymptomatic
80% infection for women – 30% infection for men
route of transmission (vaginal, oral, anal, mom to baby)
154
treatment for gonorrhea
Ceftriaxone IM
155
Chlamydia tratment
treatment: ABX for affected person and partners (Azithromycin)
156
Chlamydia
Most common STD, puss in the urine, frequency of urinating
asymptomatic, reportable disease, highest in women under 20
obligated, gram-negative intracellular bacteria that cannot reproduce independently
157
Chlamydia and Gonorrhea
often occur together
Chlamydia can lead to Pelvic Inflammatory Disease (PID), causing severe complications like infertility, which may invade any organ.
Dysuria or irregular bleeding may be present.
158
Complications of STDs
Pelvic Inflammatory Disease (PID) can lead to serious long-term sequelae and mortality if not treated promptly.
Delayed treatment can result in irreversible damage and even death, as seen in severe cases.
159
Reportable STDs
Syphilis
Gonorrhea
Chlamydia
160
Genital herpes
Blisters (cold sore) to genital areas, HSV 1 and HSV 2. not curable
Spread through intimate contact from those without signs and symptoms
may occur 5-8 times a year, vaginal discharge, and dysuria, 50% mortality
161
Herpes and Testing
blood tests (positive antigen) and pap smear
162
Herpes Treatment
Antiviral medication
Prophylactic
163
ABC - The primary survey
Airway, Breathing, Circulation
164
Trauma deaths follow a trimodal distribution
immediate deaths
early deaths
deaths from complications that are often weeks later.
165
the focus in trauma care is
treating threats to life first resuscitation and stabilization , then diagnosing the underlying issues.
166
ABCDE
Airway: Ensure patent airway and protect C-spine.
Breathing: Assess oxygenation and ventilation.
Circulation: Evaluate circulation and control bleeding.
Disability: Assess neurological status using the Glasgow Coma Scale (GCS).
Exposure/Environment: Examine for additional injuries and environmental factors.
167
AMPLE history
Allergies, Medications, Past illness, Last meal, Events related to injury.
168
Airway Management
Assess airway patency and protect the cervical spine.
Maintain sufficient air reserve for speech and adequate oxygenation.
Consider potential complications like increased intracranial pressure (ICP) and coning.
169
Nursing Interventions for Closed Head Injury Implement measures to decrease intracranial pressure (ICP)
Elevate the head of the bed to reduce ICP to 45 degrees.
Administer hypertonic saline to draw fluid from the brain.
Consider Mannitol to decrease ICP by drawing fluid from brain tissue.
Hyperventilate to induce vasoconstriction and create more space in the skull.
170
Assessment of Consciousness
1. Who are you?
2. Do you know where you are?
3. Do you know what happened?
171
Elderly Patients special considerations
Increased vulnerability due to pre-existing conditions and reduced functional reserve. Most are on anticoagulants.
172
Anterograde Amnesia
Inability to form new memories after the injury
173
Retrograde Amnesia
Inability to remember events before the injury
174
Pediatric Patients special considerations
Use Braslow Tape for trauma management, which provides size-appropriate equipment. Different mechanism of injury, treatments must be scaled.
175
Trauma in Pregnancy
Monitor two patients, consider medication effects on the fetus, and be aware of physiological changes. Preterm labour. Different normal lab values hemoglobin.
176
Glasgow Coma Scale (GCS)
Used to assess consciousness based on eye, verbal, and motor responses.
Score below 8 requires immediate airway management and potential intubation.
177
Ambulance Transport Criteria
Ambulance services may not transport patients with a GCS score below 8 without airway management (intubate
178
Tension Pneumothorax
Condition where air enters the pleural space but cannot exit, leading to increased pressure and potential life-threatening complications.
Symptoms include shortness of breath, chest pain, decreased blood pressure, and tracheal deviation. Jugular vein distention
179
Hyperresonance lung sounds
percussion notes and decreased breath sounds suggest the presence of air-filled spaces within the lung.
Hyperresonance can indicate conditions like emphysema or pneumothorax and guides diagnostic assessment and management.
180
Treatment for tension pneumothorax
Needle Decompression
Insert a needle into the second intercostal space midclavicular line to release trapped air.
Allows air escape, buys time for chest tube insertion.
Chest tube is standard treatment for pneumothorax; monitors drainage and maintains lung function.
181
Open Pneumothorax
Air build up in the pleural cavity, caused by a hole in the chest wall. Puts pressure eon the lung and can lead for lung to collapse.
sudden chest pain, shortness of breath, rapid shallow breathing, fast heart rate, hypoxia.
Caused by trauma, burnt, penetrating
182
treatment for open pneumothorax
Three way testing, chest tube or surgical repair.
183
Flail Chest
Two consecutive ribs fractured in two places each, causing paradoxical chest movement.
Historically common in car accidents before modern safety features in crs.
184
treatment of flail chest
Requires wiring of ribs; life-threatening if extensive.
Leads to ventilation-perfusion mismatch, potentially fatal if severe.
185
Massive Hemothorax
Accumulation of blood in pleural space, often due to trauma
Chest X-ray, thoracostomy to drain blood.
186
Treatment of a massive hemothorax
Transfusion, drainage, surgical intervention if bleeding persists.
Reduced cardiac output due to pressure on the heart.
187
Cardiac/Pericardial Tamponade
Fluid accumulation around the heart in the pericardium, impairs cardiac function.
Reduced cardiac output due to pressure on the heart.
May lead to Beck's Triad
188
Becks Triad
low blood pressure, distended neck veins, and muffled heart sounds.
189
Treatment for a cardiac tamponade
Locate the sternal notch.
Insert a large needle into the sternal notch.
Aim towards the left middle VIC (vertebral interspace clavicle).
Verify correct placement using an ECG lead.
Treat until the QRS complex indicates correct positioning.
In severe cases, a cardiac window may be required for further treatment.
190
Hemorrhage Control and Volume Restoration
Identify and clamp bleeding vessels.
Apply pressure and isolate single vessels.
Prevent excessive blood loss to stabilize the patient's condition.
191
Preferred IV sites
Antecubital fossa offers easy access but may restrict movement.
Avoid multiple IVs in different locations to prevent complications.
Large bore IVs (16-18 gauge) are preferred for trauma patients.
192
Intraosseous access
Useful for infants and small children during emergencies.
193
D5W (Dextrose 5% in Water)
End up in cells, not ideal for increasing pressure.
Provides calories during hyperglycemia and intracellular fluid.
Not suitable for patients with head injuries or severe edema.
Not effective for volume deficit or resuscitation.
194
Normal saline (0.9% NaCl)
Most ends up in interstitial space, suitable for increasing intravascular volume and pressure.
Isotonic with the body.
Contains sodium chloride; inexpensive and commonly used.
Used for resuscitation efforts and administering blood products.
Can cause metabolic acidosis
195
Hypertonic saline (3%)
used for increasing intracranial pressure temporarily.
196
Half-normal saline (0.45%)
for hyperosmolar states, requiring close monitoring.
197
Ringers lactate
used mainly only for burns
Contains various components, including lactate as a buffer
Preferred for GI tract issues in some cases.
Commonly used in the US but less so in other regions due to cost.
198
Crystalloids
Used for fluid resuscitation.
Normal saline (0.9% NaCl) and lactated Ringer's are common examples.
Used for hemorrhage, dehydration, and mild hyponatremia.
199
Colloids
Large molecules that hold water in the intravascular space.
Examples include albumin and starches.
Used in situations like ascites drainage to prevent fluid shifts.
200
Albumin
Derived from human donors and can cause allergic reactions.
Used to prevent fluid shifts during ascites drainage.
Cross-matching is not required.
201
Fresh Frozen Plasma (FFP)
Administered to prevent coagulopathy in massive transfusions.
Contains clotting factors and platelets.
Necessary when blood loss exceeds a certain threshold.
202
Massive Transfusion Protocol
Involves blood transfusion to restore intravascular volume.
O-negative blood is universal donor type.
203
severe blood loss is how much
1500 to 2000 ml
204
plasma comes
in a pressurized bag
often given with blood to prevent clotting
205
Platelets are
Derived separately, requiring a large number of donations.
206
Group and Screen
Determines potential need for blood, identifies blood group, and screens for antibodies.
207
Typing cross
Determines the patient's blood type.
208
cross match
Ensures compatibility between donor blood and recipient.
209
Universal donner
O-negative and never requires cross matching
210
FAST
Focused Abdominal Sonography for Trauma
211
Diagnostic Peritoneal Lavage
Quick assessment of peritoneal fluid, helpful for detecting bleeding or infections
212
Gram stain
rapid, specific for current infection, but not very sensitive.
213
culture and sensitivity
Takes days, provides detailed information on bacterial growth and antibiotic sensitivity.
214
Urinalysis
Routine and Microscopic: dipstick and microscopic examination of urine for infection and abnormalities.
215
true or false MRIs are often used in traumas
false
216
Treatment of diabetic ketoacidosis
FASTA: Fluids, Electrolytes, Acidosis, Sugar, Treatable causes, Assessment.
Sequential approach to managing DKA, addressing volume deficits and electrolyte imbalances before addressing hyperglycemia.
217
FASTA
Fluids, Electrolytes, Acidosis, Sugar, Treatable causes, Assessment.
218
Vitamins
Vitamins are organic molecules that serve as cofactors and coenzymes in metabolic reactions.
219
Fat-Soluble Vitamins
Vitamins that dissolve in lipids and can be stored in the body for extended periods.
Includes Vitamin A, Vitamin D, Vitamin E, and Vitamin K.
220
Water-Soluble Vitamins
Vitamins that dissolve in water and are not stored in the body.
Includes B vitamins (B1, B2, B3, B5, B6, B7, B9, B12) and Vitamin C.
221
Vitamin A
Retinol
Important for vision and maintaining healthy skin.
Found in retinol and beta-carotene.
222
Vitamin D
Calciferol (sun vitamin)
Essential for bone health and calcium absorption.
Synthesized by the body through sun exposure.
223
Vitamin E
Tocoferols
Acts as an antioxidant, helps with skin healing, and prevents scarring.
224
Vitamin K
Essential for blood clotting and bone health.
too much can cause toxicity.
225
B Vitamins
Various B vitamins serve different functions including energy metabolism, red blood cell production (B12), and nerve function (B1, B6).
226
Vitamin B1
Thiamine
helps tiredness
severe deficiency leads to beriberi
227
Vitamin B2
Riboflavin
Needed for good vision and healthy skin
228
Vitamin B3
Niacin
cholesterol and nerve function
229
Vitamin B5
Pantothenic Acid
wound healing and healthy skin
230
Vitamin B6
Pyridoxine
formation of red blood cells, cure of anemy
Antiacids and protein metabolism
231
Vitamin B12
Cobalamin
formation of red blood cells
232
Vitamin C
Ascorbic Acid
Collagen, wound healing
233
Low vitamin C causes
Hypovitaminosis - scurvy
234
B12 injections
Necessary for red blood cell formation and can be administered through injections or supplements.
235
Vitamin A toxicity
Overconsumption, especially from sources like polar bear liver, can lead to toxicity due to its fat-soluble nature
236
Recommended Daily Allowance (RDA)
RDA is determined based on the average requirements of a healthy population.
It varies for different vitamins and is used to guide dietary intake.
237
Food and Drug Act (1953)
(all the definitions come from)
Protect consumers from contaminated, adulterated, or unsafe drugs and address drugs with misleading or deceptive labeling.
238
Controlled Drug and Substances Drug Act (1997)
Regulates possession, sale, manufacture, and disposal, of certain drugs. Schedules categorize drugs based on their control level.
239
New drug development
Clinical investigational drug studies (4 phases).
240
Clinical investigational phases
Phase I: Safety. (done on healthy people to see if they can do okay, evaluate pharmacokinetics)
Phase II: Effectiveness. (limited scope on patients who have problems)
Phase III: Long-term impacts. 10 thousand, 60 thousand, and see what happens, recording responsibilities) (can't get rid of the records for 25 years)
Phase IV: Post-marketing studies. ways to get doctors to prescribe for stuff
241
Special access program
If you have a drug people want but have not gone through the phases of the trial yet. But if they are dying anyway, they are annoyed at why they can’t use it.
242
Limited access program
someone with cancer saw a trial work somewhere else, but it can't be prescribed yet.
Provides access to drugs not yet approved, limited to serious or life-threatening illnesses.
243
Euphoria
state of intense happiness, excitement, or well-being.
244
Analgesia
refers to the inability to feel pain or a reduction in pain sensation.
245
Narcotics
Substances binding to opiate receptors in CNS and ANS. Includes morphine, heroin, codeine (natural substances)
246
Narcotic Intoxication
Euphoria
Poor comprehension, memory disturbances
Drowsiness
Miosis/contraction of pupils
247
what do you treat a narcotic over dose with
Narcan
248
what do you treat a narcotic with drawl with
Benzo
249
Narcotic withdrawal
Not life-threatening,
8-12 hours after use
Peak 48-72 hours
Diarrhea, runny nose, yawning, insomnia, irritability, tremors, stomach cramps
250
Morphine is used for what
causes nausea, is the narcotic of choice for chest pain (decreases oxygen demand) (is a good pain relief kick, good for shortness of breath and angina)
251
MONA
M- morphine (decreases workload of the heart and decreases pain)
O- Oxygen (increases Oxygen to the heart)
N- Nitroglycerin (opens up the vessels)
A- Aspirin (prevents platelets from sticking together)
252
Opium
morphine, codeine
very high tolerance
253
Semi-synthetic
Heroine a special version of morphine, no practical use, all you get is high. There is pain relief but that’s it.
254
Dilaudid
super CLEAN, no reaction with other medications (severe pain
255
Percodon and percocets
oxycodone family, not viable IV, or sub-Q. (well tolerated, gives a high)
Percocet is oxycodone with acetaminophen
256
LSD
hard to figure out, no dose, only withdrawals (no predictability)
257
Hallucinogens
CNS stimulant and depressant)
(no evidence of dependency)
Euphoria with transcendent experience
Perceptual alterations
Altered thought process
Distractibility
dilated pupils
tremors
258
Hallucinogens overdose response
Anxiety
Panic
Hypervigilance
Paranoid delusions
259
Psilocybin Mushrooms
Euphoria
Easily distracted
Inc T, P, BP
Involve limb movement
Hallucinations
260
Stimulants cause
weight loss
heart disease
appetite decrease
261
Cocaine
stops blood flow (vasoconstriction)
has a huge cardiac effect
262
Amphetamines
DREM and insanely addictive
263
Dextroamphetamine
dixies
264
Methamphetamines
Addictive, crystal meth
265
Methylphenidates
Adderall, Ritalin.
266
Ritalin
used for the treatment of hyperactivity in children, helps focus attention and filter out extra stimulants, stimulants enhance the reticular activating system.
267
Simulant intoxication
no crazy addiction rate
Euphoria
Inc energy and alertness
Impaired decision-making
psychotic reaction
violent behavior
268
Stimulant withdrawal
Severely depressed mood
Prolonged sleep
Irritability
269
Nicotine
Increased HR and BP
Constricts peripheral blood vessels and lowers the oxygen-carrying capacity of hemoglobin
270
bad side effects of nicotine
coronary artery disease, bronchospasm, and constriction, paralysis of cilia, thickening of mucous, COPD
271
Alcohol is used for
depressant
to relax
to reduce inhibitions
for pleasure
rituals and celebrations
272
alcohol intoxication
affects judgment, motor activity, and sedation. Metabolism by alcohol dehydrogenase; affects the liver leading to fatty liver, hepatitis, and cirrhosis. Withdrawal symptoms range from minor tremors to seizures and delirium tremens.
273
what part does the brain does alcohol have an effect on
Cerebrum: judgment, inhibitions, reasoning
274
Alcohol on the liver
alcohol dehydrogenase, fatty liver, alcohol hepatitis (inflammation of the liver due to alcohol, leads to scaring and sclerosis)
275
Alcohol Withdrawal
often causes seizures
use lorazepam and benzo and anti-seizure medication
276
Alcohol withdrawals peaks
Minor: peaks 24-36hrs Coarse tremor, anxiety
Major: occurs 24hrs, peaks 50hrs fever, disorientation, hallucinations
Extreme: Grand mal seizures (tonic/colonic) (frequently), Delirium Tremors, profound confusion,
277
Wernicke-Korsakoff’s syndrome
a neurological disorder that results from severe deficiency of thiamine (vitamin B1), typically due to chronic alcohol abuse
278
Marijuana
Psychological effects include altered perception, cognitive skills, appetite, tolerance, and psychological dependence.
Withdrawal symptoms include irritability and sleeplessness
279
Marijuana use ethical uses
Glaucoma: reduces intraocular pressure
Nausea and Vomiting
Asthma: a bronchodilator (terrible)
Appetite stimulant
Muscle relaxant: related to paralysis (a little bit)
280
amotivational syndrome
psychological condition characterized by a lack of motivation, particularly in goal-directed behavior and activities. It's often associated with long-term and heavy cannabis (marijuana) use.
281
Psychotherapeutic
Used in the treatment of emotional and mental disorders
Used in small, dispensed amounts to reduce suicide attempts
282
Anxiolytic drugs
Benzodiazepines, SSRI, SNRI, Beta-blockers
283
Mood-stabilizing drugs
lithium, anticonvulsants, atypical antipsychotics
284
Antidepressant drugs
SSRI, SNRI, tricyclic antidepressants, MAIOS, atypical antidepressants
285
Antipsychotic drugs
typical antipsychotics first generation, atypical antipsychotics second generation
286
Anxiety is diagnosed with what
DSM
287
Benzodiazepines
Pure sedatives, muscle relaxants, can be used in seizures, very effective, short-term, or long-term. Depress activity in the brainstem.
288
alprazolam (Xanax®)
fast on set, fast come off, for panic attacks, a poor choice for long-term use, addictive and habit forming. (not great for generalized anxiety)
Most commonly used as an anxiolytic
short-term relief of anxiety symptoms, panic disorder, and anxiety associated
289
diazepam (Valium®)
very effective for seizures, only available in deploy form,
relief of skeletal muscle spasms
Avoid in patients with hepatic dysfunction.
poor interactions with alcohol, oral contraceptives, and others
290
lorazepam (Ativan®)
very common, fantastic, helps with sleep, and anxiety, 30 minutes onset
Very effective, most first choices for seizures, can also be used for seizures, sedation or agitation can be given any route.
Used to treat or prevent alcohol withdrawal
291
Adverse effects of benzodiazepines
Decreased CNS activity, sedation, amnesia
Hypotension
Drowsiness, loss of coordination, dizziness, headaches
Nausea, vomiting, dry mouth, constipation
292
True or false you can overdose on benzos
false there is no overdose on benzos, they are dangerous when taken with alcohol
293
Flumazenil
may reverse the effects of benzos
294
what happens if you mix benzos and alcohol
you will die
295
Anxiolytic drugs
Reduce anxiety by reducing overactivity in the central nervous system (CNS)
296
buspirone (BuSpar®)
Nonsedating and non–habit forming
May have a drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)
Do not administer with monoamine oxidase inhibitors (MAOIs)
297
Affective Disorders
Mood Disorders
Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions)
Some patients may exhibit both mania and depression: bipolar disorder (BPD)
298
Psychosis
out of touch with reality, can't figure out what’s real and not real
Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living.
299
Mood-Stabilizing Drugs
Lithium used for bipolar, nothing for anything but bipolar
300
Lithium
used for bipolar and bipolar only
Frequent drug tests till stable then every three months
Drug of choice for the treatment of mania
Narrow therapeutic range
Can cause cardiac dysrhythmias, Long-term can cause hypothyroidism. Drowsiness, slurred speech, seizures, ataxia and hypotension
301
Antidepressants
Inform patients to take several weeks to see therapeutic effects
Monitor for suicidal attempts
Falls prone in older adults due to postural hypotension
Avoids anesthetics and tricyclics
302
Tricyclic antidepressants
first generation
Inhibition of serotonin and norepinephrine reuptake into nerve endings. Helps regulate the malfunction of neurons, used for neuropathic pain, insomnia, orthostatic hypotension, insomnia, bedwetting, OCD, and anorexia. Overdose is lethal
Largely been replaced by SSRIs as first-line antidepressants
303
amitriptyline (Elavil®)
large dose range, can kill yourself very easily
Oldest and most widely used of all the tricyclic antidepressants
Commonly used to treat insomnia and neuropathic pain (works well)
may cause dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias, erectile dysfunction
304
true or false most antidepressants cause erectile dysfunction
true
305
Overdose of tricyclic antidepressants
Lethal; 70 to 80% die before reaching the hospital.
CNS and cardiovascular systems are
mainly affected. Death results from seizures or dysrhythmias.
Speed elimination by alkalinizing urine. Manage seizures and dysrhythmias.
306
true or false you can mix MAOIs and Tyramine
false, it can cause a life threating reaction.
It can lead to a cerebral hemorrhage, stroke, coma or death.
307
What is Tyramine
aged cheese, smoked foods, yeast extract, red wines, italian broad beans FAVA
308
MAOIs (monoamine oxidase inhibitions)
Prevent the breakdown of serotonin, norepinephrine, and dopamine
Rarely used for depression. Used for Parkinson’s disease
Potential to cause hypertensive crisis when taken with tyramine
309
Second-Generation Antidepressants
Depression, anxiety (will treat one will treat the other), and many others.
may cause insomnia (partly caused by reduced rapid eye movement sleep), weight gain increased appetite, and sexual dysfunction
310
Serotonin Syndrome
too much serotonin
can cause delirium, agitation, tachycardia, sweating, myoclonus (muscle spasms) excess muscle spasms
311
Second generation medications
SSRI
312
SSRI
an antidepressant that inhibits the reuptake of serotonin in the brain, used to treat depression, anxiety, panic disorders, OCD, and PTSD, less severe side effects, more tolerable, less cost-effective
313
fluoxetine (Prozac®)
SSRI
the first one, very effective, mainly used now for pediatric, available in liquid form
314
sertraline (Zoloft®)
very popular, earliest SSRI, fairly wide dose, second choice, generally has very low side effects, with very good results
315
paroxetine (Paxil®)
SSRI
crazy strong, if you go on it you don’t come off it, long tapper with custom pills, works very well, nearly last choice, drugs in the family if the drug works in the family it will work for you, give electric shock from getting off it
316
Celexa and Cipralex
Are the same Celexa lost its patent and made Cipralex
common to start on this unless special indication, lowest side effect with it works well, same drug above, must need double the dose of the one above
317
trazodone (Oleptro®)
elderly patients, used for sleep, rarely for depression by itself, it's too weak and not effective, usually combined
318
bupropion (Wellbutrin®)
an antidepressant that gives you energy, and gives you a boost, only one that doesn’t give you erectile dysfunction
319
what is the only antidepressant that doesn't give you erectile dysfunction
bupropion (Wellbutrin®)
320
SNIR
anti-depressant medicine, which acts on neurotransmitters of the brain that affect the person's mood, inhibits serotonin and norepinephrine. Treats major depressive disorders, anxiety disorders, mood disorders, and ADHD, less tolerant, more cost-effective.
321
Zyban
originally indicated for the treatment of depression, can help in smoking cessation, added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI
322
Duloxetine hydrochloride, Cymbalta
is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI).
Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.
323
Fluoxetine
prototypical SSRI, used in depression, bulimia, OCD, panic disorders, contraindicated in MAOIs, causes dizziness and anxiety, insomnia
324
Mirtazapine (Remeron)
promotes the presynaptic release of serotonin and norepinephrine in the brain, is used in depression and sexual adverse effects, additive CNS depressant effects with alcohol and cytochrome P-450.
Piles on weight like crazy. Causes dry mouth, constipation, and increased appetite
325
Antipsychotics
Drugs used to treat serious mental illness like psychoses, schizophrenia, and autism, extreme mania
Dopamine levels in the CNS are decreased.
tranquilizing effect in psychotic patients
326
What medication has a tranquilizing effect in patients
antipsychotics
327
Positive symptoms of schizophrenia
hallucinations, delusions, and conceptual disorganization
328
Negative symptoms of schizophrenia
apathy, social withdrawal, blunted affect, poverty of speech, catatonia, sitting there won't move
329
Antipsychotics and schizophrenia
often improve positive symptoms but have a lesser effect on negative symptoms
330
Atypical antipsychotics
Help both positive and negative symptoms of schizophrenia
331
Adverse effects of antipsychotics
Agranulocytosis cant make white blood cells and hemolytic anemia, blood isn’t produced properly
332
Extrapyramidal symptoms (EPS)
group of movement disorders that can occur as a side effect of certain medications, particularly antipsychotic medications
333
Tardive dyskinesia
non stop chewing motion
334
Choreoathetosis
Wavelike movements of extremities occurs with long-term use of antipsychotics
335
Haloperidol
settle down anyone, orally, IM, can lower BP.
may cause hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken
Useful in treating patients with schizophrenia who were nonadherent to their drug regimen
336
clozapine (Clozaril®)
only the sickest go on, There huge side effects, big weight gain, regular blood tests, psychotic monitoring, and close monitoring.
Blocks dopamine receptors in the mesolimbic region of the brain. No EPS. Adverse effects- blood dyscrasias.
337
risperidone (Risperdal®)
is atypical in the elderly for sundowning, long-term side effects, negative symptoms of schizophrenia, minimal EPS at a therapeutic dose, oral and injectable
338
olanzapine (Zyprexa®)
atypical in the elderly for sundowning
339
quetiapine (Seroquel®)
helps if you have treatment-resistant depression, and helps sleep, and psychomotor agitation, really good drug, orally) (well tolerated) (massive dose)
340
aripiprazole (Abilify®)
adjacent used with antidepressants, used for adjunct treatment resistance depression) (Massive doses for psychosis
341
Herbal Products
Used for depression, anxiety, sleep disorders, nervousness
May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity
Severe interactions if taken with MAOIs and SSRIs; many other drug interactions
Food–drug interaction with tyramine-containing foods
342
Psychotherapeutic Drugs
Before beginning therapy, assess the physical and emotional status of patients.
Obtain baseline vital signs, including postural blood pressure readings.
Obtain liver and renal function tests.
Check the patient’s mouth to make sure
oral doses are swallowed.
343
Influenzas (flu vaccine)
Recommended vaccine
Inactivated influenza vaccine
It helps prevent the severity of the flu 40-60% success rate on the strain circulating
Rare: Hoarseness wheezing, tachycardia
344
Measles, mumps, rubella (MMR)
Routine vaccine
Live attenuated
Measles, mumps, rubella
Two dose series
78-97% (Often protected for life.)
Rare: febrile seizures, swelling, low platelet count
MMR does not cause autism
345
Inactivated polio Vaccine (IPV)
Routine vaccine
Inactivated vaccine
Prevents 3 types of polio
95% after receiving all 3 doses
Polio is defined as a paralytic disease
346
Hepatitis B Vaccine (hep B)
Routine vaccine
Recombinant
Hepatitis B infection
Common to be administered right after birth
95-100% effectiveness
HepB will be eradicated by 2023, 9 out of 10 who are not vaccinated will get ill
347
Shingles (herpes zoster vaccine) (HZ)
Not routine
New adjunctive, nonlive, recombinant
Herpes Zoster (shingles)
Adults aged 50 and older (especially with a hx of chickenpox)
1 in 3 will develop shingles, the vaccine was approved in Canada in 2017, and 90% of Canadians who have had chicken pox will get shingles
90% effective
348
Yellow fever vaccine (YF-VAX)
Not routine
Live attenuated
Yellow fever
Do not get it if you are allergic to eggs, chicken proteins, gelatin
99% effective (first 10 days 80-100%)
Vaccines have been available for more than 80 years, the name came from victims who became jaundiced from the disease
349
Tuberculosis Vaccine (BCG)
Not routine
Live attenuated
Prevents tuberculosis menial TB
Administered soon after birth, single dose, unless there is a risk of exposure
51% TB, 78% in protecting newborns
¼ of the world is affected by TB
350
COVID-19 mRNA (mRNA-1273)
Not routine
Pfizer, Moderna
Helps prevent Covid-19
Pfizer=90-100%, Moderna 37-100%
Rare: Bell’s Palsy myocarditis
351
Smallpox vaccine
No longer required
Live attenuated
Protect from smallpox
Given at year old and booster every 3 years, typically, a single dose
Administered Via Scarification
The vaccine worked so well it eradicated the disease
352
Hepatitis A (HAV)
Not routine
Inactivated vaccine
Hepatitis A which infects the liver
Travelers, children in high-risk groups, men who have sex with men, people who use injectable drugs, those with chronic liver disease
90-97% after both doses
The first vaccine was used in the US in 1995
353
Typhoid Vaccine
Not routine
Live attenuated (TYPH-o)(Typh-I)
Protects you from typhoid fever and salmonella typhi bacteria
Oral capsule and IM injection
50% effectiveness
10% die if untreated
354
Diphtheria, tetanus, pertussis (DTaP)
Routine vaccine
Combination toxoid
Diphtheria, Tetanus (Lockjaw), Pertussis (Whooping Cough).
2 months old. Oral 4 capsules over 8 days or injectable single dose
50% effective
10% die if untreated, 1% die if treated
355
Meningococcal Vaccine (MEN-C, MEN-B)
Not routine
Inactivated
Meningococcal disease
Everyone over 2 months old
70-85% effective
Only vaccine that protects against bacterial meningitis
356
Respiratory syncytial RSV
Not routine
Lower respiratory tract disease
Embryo and 65+ and older
Single dose
80% effective
357
Tetanus and diphtheria (Td)
Routine vaccine
Inactivated vaccine
Tetanus and diphtheria
Tetanus = 100% and diphtheria = 97%
Diphtheria is transmitted through human contact where whereas tetanus is transmitted through solids and feces.
There are three types of vaccines (localized, generalized, and cephalic)
358
Varicella vaccine aka chickenpox VAR
Not routine
Live attenuated
Risk of getting chicken pox
No during pregnancy or a recent blood transfusion
The first dose was 94% and the second was 98%
359
Human papillomavirus (HPV) (HPV2= protects against 2 types) (HPV 9 protects from 9 types)
Not routine
Not routine
Live attenuated
Protects from human papilloma, genital warts that cause most cases of cervical cancer
2 doses for those before their 15th birthday and 3 doses for those after their 15th birthday
Close to 100%
This vaccine will replace pap smears
360
Haemophilus influenza type b (Hib)
Routine vaccine
Polysaccharide conducted
Haemophilus influenza type b and meningitis
Only a single dose if you are over the age of 5
95-100% effective
1000 children die from Hib every year
361
Dukoral cholera
Not routine
Live attenuated
Protects from cholera (contaminated food and water)
Two doses given at least one week apart. Orally
85% protection
Patients can only drink water an hour after taking the vaccine
362
Rotavirus (RV5) (RV1)
Not routine
Live attenuated
Severe rotavirus infection
2 months old
Orally
Effective 85-96%
363
Pneumococcal conjugate vaccine (PCV)
Routine vaccine
Parents illnesses caused by pneumococcal bacteria
All children younger than 5, adults older than 65, and those at risk
86-97% effective
Spread Via droplets, can host in the nasopharynx
364
Rabies Vaccine (RAB)
Not routine
Inactivated imovax rabavert
Protects you from developing rabies
Safe for all ages, only use (4 doses on days 1, 3, 7, 14)
Rabies can take 2 weeks to a year to appear
365
Japanese encephalitis (JE)
Not routine
Inactivated
2 doses IM
Travellers receive it
60-100% effective
366
The anti-infective drugs
Anti-infective agents are drugs that are designed to act selectively on foreign organisms that have invaded and infected the body.
367
Three mental health disorders
Anxiety
Affective disorders
Psychotic disorders
368
The mechanisms for anti-infective agents are
Inhibition of the biosynthesis of bacterial cell WALL
Inhibition of protein synthesis
Some change the cell membrane permeability.
Some inhibit DNA synthesis
369
Narrow spectrum antibiotics
anti-infectives affect only a few bacterial types because they are selective. The early penicillin drugs are examples.
370
Broad spectrum antibiotics
anti-infectives affect many bacteria. Meropenem is an example.
371
Bacteriostatic
keep the bacteria in status, doesn't fully kill it
372
Bactericidal
Kills the bacteria
373
Gram positive
Blue stain
massive outer cell wall
On the outside of the body
374
The Penicillin's
Bactericidal
beta-lactamase
No side effects because we don't have a cell wall
treats syphilis, tetanus
375
amoxicillin
oral form
376
ampicillin
IV form
377
Cloxacillin used for
for skin infections
378
Piperacillin is used for
Advanced infections
379
Clavulanic acid is used for
enhancing the range of amoxicillin
380
Side effects after stopping penicillin
rashes, pruritus, fever and urticaria
5-10% of those taking penicillin
381
Gram negative
Pink stain
a tiny cell that does not pick up dye
is on the inside of the body
382
Obtain culture and sensitivity when
Before starting any antibiotic
383
amoxicillin is mostly used for what
for a pregnant woman with UTI, because we know most of the penicillin.
384
The Cephalosporins
as you move higher in a generation you get better gram-negative coverage, but you lose gram-positive coverage
The cephalosporins also belong to the beta-lactam group of antibiotics.
385
side effects of cephalosporins
abdominal pain
headache
N&V
rash
dyspepsia
diarrhea
386
First generation cephalosporins
same coverage as penicillin
387
Second generation cephalosporins
Adding effectiveness against Neisseria, and Haemophilus, less effective towards gram-positive
388
Third generation cephalosporins
All of the gram-negative
389
Cefazolin
Iv form, often given before an operation
1st
390
Cephalexin
Oral form
1st
391
Cefprozil
Oral form, same as amoxicilln but only required twice a day
2nd
392
Cefuroxime
IV form
2nd
393
Ceftriaxone
IV form
3rd
394
Cefixime
Oral form often never needed
3rd
395
Cephalosporins and penicillin
10% cross reactivity, if one is allergic to one they are probably allergic to the other.
396
The Aminoglycosides types
no oral form
Gentamycin- IV
Tobramycin- Eye drops (absorbed well)
Amikacin- IV
397
Aminoglycosides
Bactericidal
They inhibit protein synthesis in susceptible strains of gram-negative bacteria ONLY
Having problems with ear problems (pre-existing hearing loss)
Auto-toxic (hearing) and nephron toxic (renal) and hematoxic (bone marrow depression), may lead to immune suppression.
Ensure hydration, to minimize toxicity
398
dethamexazone is used for
inflammatory infections and skin infections
399
The Macrolides
Bacteriostatic
used for strep and listeria
Food does not interfere with the absorption of the macrolides.
Have problems with liver and no pregnant women should take
400
Azithromycin is used for
Used for STDs (treats chlamydia)
Respiratory
401
Clarithromycin
Strongest of macrolides
Extensive uses including skin and resp.
402
Erythromycin
terrible stomach side effects
Long half-life, meaning more resistance.
Erythromycin is destroyed by the gastric juice, which is why slats are added to stabilize the drug.
403
Adverse effects of macrolides
Gi problems
N&V
hepatoxicity
confusion
404
The Tetracyclines
bacteriostatic
major sun effect
can cause weakening of bones and yellowing of teeth, may cause a rash.
405
Doxycycline and minocycline
You'll need it till you grow out of it, they are long acting. used for skin and infections
406
Drug interactions with tetracycline
oral contraceptives decrease the effectiveness, must be given with a meal and try to avoid dairy.
407
The Fluoroquinolones
are broad-spectrum antibiotics.
Bacteriostatic
Can't use under the age of 18, can damage cartilage and stunt growth. Can cause plastic anemia and effect bone marrow.
408
Ciprofloxacin
Fluoroquinolones
gram negative only, oral treatment for pneumonia
409
Levofloxacin
fluoroquinolones
used for respiratory infections
410
Moxifloxacin
strongest and widest used, mostly used for UTI
411
Sulfonamides
Used mostly for urinary tract infections and skin infections
bacteriostatic
Sulfasalazine
Sulfamethoxazole
photosensitivity and rash and hypersensitivity, harmful during pregnancy
412
Vancomycin
Comes IV and oral
Oral is not absorbed at all it is only used for C-diff.
IV works exclusively towards gram-positive and covers MRSA
413
The anti-tubercular
treat all of them at once for a long time, sometimes weeks to months, take all four at once. stop growth of bacteria that causes TB.
they treat mycobacterium tuberculosis
o Isoniazid
o Rifampicin
o Pyrazinamide
o Ethambutol
(all-cause liver problems)
414
responsibilities with taking anti-tubercular
Take as prescribed
check the liver with liver function tests
supplement B6
415
Antifungals
AZOLES
bactericidal
416
Side effects of anti-fungal
Headache and Dizziness
Pruritus
kidney damage
417
Antivirals
VIR
bacteriostatic
418
Antivirals adverse effects
Phlebitis and bone marrow depression and nephrotoxicity
419
Nephrotoxicity
Antibiotics that are metabolized and excreted in the kidney most frequently cause kidney damage.
420
Gastro-intestinal toxicity
Direct toxic effects on the cells of the GI tract can cause nausea, vomiting, stomach pain, and diarrhea.
421
CNS toxicity
When drugs can pass through the brain barrier and accumulate in the nervous tissues, they can interfere with neuronal function. Crosses it can't get back out.
422
Cancer
Uncontrolled cell growth
423
Benign
Non cancerous
Don't grow into other tissue
424
Malignant
Cancerous
Invade tissue or spread
425
Carcinoma
covers external and internal organs and glands
426
Sarcoma
always bad, starts in supporting tissue of the body, bone cartilage, fat
427
Lymphoma
Lymph nodes
428
Leukemia
blood
429
Adeno:
Chondro:
Eythra:
Hengioma:
Hepato:
Lipo:
Lympho:
Melano:
Mylo:
Myo:
Osteo:
Adeno: gland
Chondro: cartilage
Eythra: red blood
Hengioma: blood vessels
Hepato: liver
Lipo: fat
Lympho: lymph nodes
Melano: pigment
Mylo: bone marrow
Myo: muscle
Osteo: bone
430
Lead time bias
Only sometimes finding cancer early helps (it doesn’t change when you die)
431
Cervical cancer is screened with what
pap smear
432
Breast cancer is screened with what
Mammogram
433
Prostate cancer is screened with what
DRA
434
Colon cancer is screened with what
colonoscopy and sigmoidoscopy, FIT test
435
Lung cancer is screened with what
low-intensity CT scan
436
Core biopsy
some of it
437
Incisional biopsy
the whole thing
438
high graded tumors
bad
439
low grade tumors
not so bad
440
well differentiated
means you can tell the cells and where they came from
441
poor differentiated
doesn’t know where those calls came from
442
TNM
(tumor node metastases) T= number of tumors, N= lymph nodes M= metastasis (spread)
443
Stage 1 cancer
In the tissues it is supposed to be in
444
Stage 4 cancer
Spread to distant tissue and organs
445
Gene mutation
no cancer gene (you only have the same genes as the other person who does have cancer)
446
Surgery
is only done for the cure (debulking making a person more comfortable, they will still have the cancer in them).
447
Radiation
burns everything, just happens to also kill the bad stuff (skin changes, swelling, feel sick)
448
Chemo
Nausea and vomiting, hair loss, mouth sores, pain (every cell gets chemo, to kill the cancer)
449
Neo-adjuvant
chemo, radiation, or hormone to shrink a tumor
450
Adjuvant
hemo, chemo, radiation, targeted, biological
451
Target therapy
medications that can very specifically kill some cancers
452
Aggressive hormone therapy
is used in breast cancer and prostate cancer (the more hormones the better ie, estrogen, progesterone, and testosterone)
453
Breast cancer
Cells involved: granular tissue, (ductal or lobular) (also skin ones involved)
Risk factors: age, family history, weight, menopause, radiation
Symptoms: painless lump, discharge in the nipple (inflammatory one), dipping of the skin (tumor is under the skin)
Screening: (non under 50) (screening every 2 years in Canada)
Detection: if you have a breast lump, the test to do is an ultrasound. biopsy, mammogram, MRI, FNAC (fine needle aspiration cytology)
Treatment: surgery, if possible, chemotherapy, hormones almost all receptor sensitive and long term, radiation
Survival: 89% (stage 0 - 2 is nearly 100% and stage 3 is high as well)
454
lung cancer
Cells involved: small cell and non-small cell (4 types)
Risk factors: smoking, environment, genetics, asbestos, other lung disease, prior radiation
Symptoms: cough, shortness of breath, weight loss, chest pain
Screening: age 55-77, with more than 30 pack year history with no symptoms
Detection: Ct scan, biopsy, PET scan (see if it has metastasized), chest X-ray, bronchoscopy (scrape the wall to take a sample)
Treatment: Surgery only if you get rid of the cancer for good, chemotherapy (lung cancer does not respond well to it, small cell cancer does respond to it but the cancer will always come back), radiotherapy, immunotherapy, target therapy
Survival: Overall, 19% over 5 years
455
Colon Cancer
Cells involved: adenocarcinoma
Risk factors: IBD, diet, meat cooked at high temps, low fiber diet
Symptoms: blood in stool, change in bowel habits, weight loss, anemia
Screening: two first-degree relatives with cancer for a colonoscopy, poop test first with average risk
Detection: colonoscopy, CT colonography, biopsy, blood and stool tests
Treatment: primary anastomosis (joining the two cancer-free parts together), osteotomy. Some rectal cancers don’t require radiation. Others get surgery with chemo or radiation
Survival: 67%, very good until stage 4 cancer
456
Prostate cancer
Cells involved: Adenocarcinoma
Risk factors: Gender, age, diet, testosterone levels, family history (male sex main risk)
Symptoms: requinto urination, nocturia
Screening: does work. Not worth it.
Detection: rectal exam, PSA testing (only for those who have cancer), ultrasound, MRI, PCA3 RNA test, random 12-core biopsy
Treatment: surgery (very rare), hormone therapy, radiation, immunotherapy, target therapy
Survival: 97.1% (only treat aggressively if you have bone Mets)
457
Pancreatic Cancer
Cells involved: pancreatic ductal adenocarcinoma
Risk factors: age, obesity, pancreatitis (alcohol abuse and high cholesterol), smoking, diabetes, family hx
Symptoms: stomach pain, back pain, starts in the middle and goes straight through you, weight loss, jaundice if obstructed, changes in stool.
Screening: screening tests imagine testing, staging, laparoscopy, blood tests
Treatment: The Whipple procedure is the only procedure, putting the pancreas into the side of a bowel. Surgery, radiation, chemo, target therapy
Survival: 10% over 5 years
458
Brain Cancer
Cells involved: glioblastoma, astrocytoma (very bad ones) and meningioma, pituitary
Risk factors: alcohol, radiation, age, smoking, family history
Symptoms: headache, seizures (very common), cognition, vision, and speech
Screening: no screening tests
Detection: MRI, CT, lumbar puncture, hormone blood test, biopsy
Treatment: surgery, radiation (works very well because neurons don’t divide), chemotherapy, target therapy (gamma ray tumor)
Survival: depends on what type of cancer, glioblastoma is the most survivable
459
Ovarian Cancer
Cells involved: epithelial cells, stromal cells, germ cell
Risk factors: family history, ovarian and breast cancer, genetic variation, age, more pregnancy, breastfeeding and contraceptives have less chance
Symptoms: bloating, pelvic pain, urinary frequency, shortness of breath (most common means it’s bad)
Screening: ultrasound
Detection: pelvic exam, blood test, imagining testing, biopsy, genetic testing
Treatment: surgery, debulk or removal, chemo, radiation
Survival: 45% over 5 years
460
Renal cancer
Cells involved: sporadic, clear cell carcinoma
Risk factors: obesity, age, smoking, high blood pressure, kidney dialysis, exposure to asbestos
Symptoms: back pain, blood in the urine (microscopic will only show up in a urine dipstick), loss of appetite, weight loss, tiredness, fever
Screening: there is no screening
Detection: ultrasound or urine test, CT scan
Treatment: Surgery, chemo, radiation
Survival: survivals good if it's inside the kidney capsule
461
Macule
a flat circumscribed area that is a change in the color of the skin (freckles or small birth marks)
462
Patch
flat, non-palpable irregularly shaped macule more than 1cm diameter (big macule, large birth marks)
463
Papule
elevated, firm circumscribed area less than 1 cm (acne and moles)
464
Plaque
elevated, firm and rough lesion with flat top surface area greater than 1 cm (large moles and sist, sclerosis)
465
Circumscribed
you can tell exactly where it is
466
Seborrheic keratosis
benign, obvious edge, no problems ever, skin off this type of tumour with a blade
467
Actinic Keratosis
benign, sun damage, squamous cell carcinoma
468
Nevi
benign, moles, overgrowth of normal tissue, as long as they don’t change its fine
469
basal cell carcinoma
malignant, local cancer, never mastitis in the basal cell, red tissue with a pearly colour to it, never metastasis but it will keep growing.
470
squamous cell carcinoma
malignant, not serious, nonhealing lesion, makes ulcers, usually doesn’t metastatic
471
malignant melanoma
malignant, all you can do is cut it out and do a biopsy
472
Burns
Alterations in skin integrity resulting in tissue loss or injury caused by thermal, chemical, electrical or radiation
473
Thermal
dry heat (flame), moist heat (steam or liquid), cold (frostbite)
474
Chemical
acidic or alkaline agents
475
Electrical
dependent on voltage, duration, current
476
Radioactive
sunburn, cancer treatment
477
1st degree burn
Superficial thickness injury (sun burn), Only involves epidermis
Maintains water vapor and bacterial barrier functions
Local pain and erythema, no blisters for 24 hours
No treatment
Heal in 3-5 days
478
Types of 2nd degree burns
Superficial partial thickness
and deep partial thickness
479
Superficial partial thickness
fluid-filled blisters appear immediately, pain dt exposures of nerve endings to air if blisters break open, heal in 3-4 weeks, usually no scar. Drain with a needle and leave the skin on and put a dressing on it.
480
deep partial thickness
usually involves entire dermis but hair follicles are preserved, looks waxy white surrounded by superficial partial thickness injury, can’t distinguish between this and 3rd degree until day 7 which skin buds appear, weeks to heal, treated with autograft, potential infection. Lots of scarring.
481
3rd degree burn
Full thickness
Destruction of the entire epidermis, dermis, and subcutaneous, muscle or bone
Destroyed elasticity of dermis
Edema will shut off the circulation you need escharotomies to relieve pressure are painless due to destroyed nerve endings and allow more blood clow.
482
rule of 9s draw it
doesn't include first degree burns
99%
483
body surface burns depends on
extent of body surface area involved
on depth of cutaneous injury
Burns exceeding 20% are considered major, massive
484
How do bruns effect the body
by age, medical history, extent and depth of injury, involved body area
dramatic changes to the body in the first few minutes
within several hours, capillary integrity is lost dt release of several mediators of inflammation (histamine or prostaglandin) that cause vasodilation
485
Burn shock
both a hypovolemic cardiovascular component and a cellular component
486
Fluid resuscitation
administration of IV (lactated Ringers) -> restore circulating blood in time of inc. capillary permeability
Most reliable indicator of success = urine output
487
Three main areas of burn
cardiovascular and systemic response
cellular response: metabolic and immunologic
evaporative water loss
488
Fluid replacement
Basal fluid replacements per day
Total hourly maintenance fluids
basal fluid requirements per day / 24 hours + evaporated water loss per hour = ml/hr
Can cause edema in lungs and non burned areas due to fluid shifting in massive amounts
489
End point of burn shock
when individual has adequate urine output for 2 hours + (30 ml/hr)
490
Capillary integrity
usually restored within 24 hours (hallmark sign that burn shock is over) is termed capillary sealed
491
whathappens at a cellular level during burns
altered cell membrane permeability, loss of normal electrolyte homeostasis - contributes to shock
492
Transmembrane
changes also occur in undamaged cells
493
Metabolic response
to injury involves SNS, and other homeostatic regulators (all the sress hormones release at once)
increase catecholamines, cortisol, glucagon, and insulin levels -> inc. gluconeogenesis, lipolysis, proteolysis
494
Cells cannot maintain adequate electrolyte shifts and results in the following
excess Na
excess K
Which eventually can lead to cardiac dysrhythmias and altered central nervous system function
Produce a hypermetabolic state
495
Chemical mediators
cause peripheral vasodilation, pulmonary vasoconstriction, inc. capillary permeability and local tissue ischemia
496
Burn shock
can induce changes in integrity of intestinal wall
WBC are also altered, when needed to inhibit sepsis
Persons with pre burn altered immune status are at increased risk - elderly, malnutrition, cardiac disease, hx of alcohol or drug abuse
Ability of skin to serve as a barrier to evaporative water loss is lost
497
Estimated evaporative water loss for burns is
20X normal. Replacement is mandatory to prevent volume deficit
498
Burns recovery
Goal is wound closure that promotes survival
Scar formation
Three elements of survival
o meticulous wound management
o adequate fluids and nutrition
o earlier surgical excision and grafting
499
Diagnosis and treatment for burns
Rule of Nines
BUN, creatinine clearance
urine output
CBC, electrolytes
Narcotics for pain relief
Remove rings and jewellery ASAP
O2 administration
Hydration
