Patho Student Questions Flashcards
IV Fluids in Septic Shock Exam
A patient with a 3 day hx of PNM presents with HR of 110, temo 38.3 and WBC of 12,500. You also notice that they have elevated liver enzymes and altered cerebral function. what is you dx for this patient
Severe sepsis
Sepsis is Temp above 38.3 or below 36 Rr over 20 Hr over 90 WBC over 12,000 or under 4000
IV Fluids in Septic Shock Exam Questions
After giving several boluses of lactated ringer’s to a patient with septic shock due to a UTI, you notice that their MAP is 50 mmHg and has remained at this pressure. Your next move is to . . .
Give norepinephrine in addition to continuing their ringer’s infusion
Norepinephrine MOA:allows increase ca in to increase contraction and binds to alpha to vasoconstrict
Epinephrine: binds to beta 2 receptors cause sequestration of Ca from SR so not enough to constrict
Dopamine: increase hr and contraction by binding to adrenergic and dopamine receptors
Phenylephirie: Alpha 1- doesn’t affect the heart only the vessels
IV Fluids in Septic Shock Exam Questions
It is important to know that saline infusion for septic shock can cause
Hyperchlorremia acidosis and Edema
IV Fluids in Septic Shock Exam Questions
A 45 year old female presents with bacteremia and sepsis who has begun to show signs of pulmonary edema. She has a MAP of 58, an irregular heart rhythm with rates from 140-160 bpm, and altered mental status. Which of the following is the most appropriate next treatment for this patient?
Phenylephrine
IV Fluids in Septic Shock Exam Questions
First line treatment for a patient in septic shock on high doses of labetalol is:
0.9% saline, 30 mL/kg mL
IV Fluids in Septic Shock Exam Questions
Beta-adrenergic agents, like norepinephrine, work by:
Increasing calcium conductance in nodal myocytes, increasing calcium storage and potential contractile force
Nausea & Vomiting in the ED Exam Questions
- A 22 yo male patient presents to the ED with a history of excessive alcohol intake and vomiting for the past 2 hours. He appears confused and does not always respond appropriately. He has an unsteady gait, an elevated pulse rate, and complains of nausea.
What is the best test to determine if the patient’s symptoms are due to dehydration or primarily due to the alcohol intake?
BUN/Creatinine ratio
Nausea & Vomiting in the ED Exam Questions
A mother presents with her child to ED, the child is 5 yo and has been vomiting intermittently for the last day with a fever. On exam, the child is responding appropriately and complains of a dry mouth. Pulse rate and respirations are normal. The mother notes that the child hasn’t urinated in the past 5 hours. Based on the clinical presentation, what treatment would you administer for their dehydration status?
Oral Rehydration Solution 50 ml/kg and ongoing losses over 4 hours as tolerated
Nausea & Vomiting in the ED Exam Questions
Hypernatremia can occur following rehydration of patients who are hypovolemic. This occurs due to ___________ and should be treated with ________________.
Fever/dilute diarrhea; 0.9% IV saline`
Nausea & Vomiting in the ED Exam Questions
A 4 year old child presents to the ED with her mother following profuse vomiting for the past 24 hours and failure of ORT. On PE it was noted the child had tachypnea, a rapid and weak pulse, in addition to hypotension. Based on the presentation, the stage of dehydration is best categorized as?
Severe dehydration
Nausea & Vomiting in the ED Exam Questions
A father of a 15 lbs 1 yo called your office with concerns about his child being dehydrated. After obtaining the necessary clinical information from him you determine the child is mildly dehydrated. As the PA you recommend ORT and tell the parent to give how much total ORS every two minutes as tolerated?
75 tsp
Dosage is 5 tsp/ lbs
Questions for Acute Spinal Cord Injury
1.) A 26 yr. old male who was involved in a MVA gets brought into the ED while you are working. You check the Babinski reflex and notice that his hallux dorsiflexes while his other toes fan out. This indicates:
C. Upper motor neuron damage
Questions for Acute Spinal Cord Injury
2.) A 34 yr. old male presents to the ED by ambulance after a 2 story fall from a building. You quickly assess that he has fractured his spine and is now in neurogenic shock. What is your first line treatment?
A. 0.9% Normal Saline
Questions for Acute Spinal Cord Injury
3.) In the treatment of the patient in question #2, what do you want to keep his MAP at/above?
D. 85-90 mmHg
Questions for Acute Spinal Cord Injury
4.) When Spinal Cord Injury occurs, at which level of injury will autonomic dysreflexia be more likely to occur?
above T6
answer is B. C3
Questions for Acute Spinal Cord Injury
T/F A person having a C3 spinal injury is likely to have respiratory complications?
True
Questions for Acute Spinal Cord Injury
You are seeing a 21 yr. old male 2hrs after he was brought into the ED after a motorcycle accident that left him with a spinal cord injury. You are trying to decide if/when to administer Methylprednisolone. What do you decide?
Administer it now
Fever control:
A 75 year old woman presents to the family practice office with chills, body aches, loss of appetite, and claims she just hasn’t been feeling well the last couple days. While reviewing her medical record, you noticed she has a temperature of 98.6ºF.
b. This temperature is concerning because elderly typically run low within the normal range.
Fever control:
Body temperature usually is 0.9ºF higher in the afternoon. Which of the following best explains the reasoning behind this?
Cortisol inhibits phospholipase A, which decreases prostaglandin typically in the early morning and at night.
Fever control:
_____ is the most accurate location to take body temperature while _____ is the least accurate location to take body temperature.
c. Rectal; Forehead
Fever control:
Fevers and hyperthermia both exhibit high body temperatures. Which of the following explains the main difference between a fever and hyperthermia?
d. Fever is caused by a true change in the set point.
Fever control:
You are currently doing a post-operative assessment on a 55 year old man who just had open thoracic surgery. After reviewing his vitals, you realize he has a low-grade fever of 100.5ºF.
This is an expected finding due to the release of inflammatory mediators and cytokines.
Fever control:
Which of the following medications contains anti-inflammatory properties?
Two of the above!
ASA and NSAIDS ( motrin)
Fever control:
A 10 year old boy presented today to the ER with Reye Syndrome where you are currently doing a rotation as a PA student. The boy presented with an altered mental status, vomiting, and a recent history of ASA use. It was determined he had a fast progressing encephalopathy. After beginning to manage the patient, your preceptor asked you what was causing the encephalopathy. Which of the following would be an appropriate response?
The damage to hepatocytes slows the removal of waste products resulting in an increase of ammonia, which crosses the blood brain barrier
Fever control:
Which of the following explains the MOA for Motrin and ASA?
Inhibitors of COX
Fever control:
What is the therapeutic dose of Tylenol in children?
10-15 mg/kg
Fever control:
What is the single toxic dose of Tylenol for a young child?
150 mg/kg
Fever control:
What is the single lethal dose of Tylenol for a child?
338 mg/kg
Fever control:
TRUE OR FALSE. In an extremely compliant patient, Motrin and Tylenol can be alternated every two hours.
ture
Fever control:
TRUE OR FALSE. After a night of heavily drinking alcoholic beverages, it would be appropriate to recommend the patient take Tylenol before bed to avoid a morning hangover
FALSE
Fever control:
You are currently on your ER rotation as a PA student when a mother rushes in her four year old daughter who got into the medicine cabinet and ate multiple grape flavored Tylenol chewable tablets while with the babysitter. The doctor begins to give the little girl oral medication. Due to the rotten eggs smell that takes over the room, you know it was acetylcysteine. How would you best explain how this medication works?
Provides substrate so that the liver can metabolize the toxic metabolite and excrete it.
Fever control:
Tylenol is toxic to _____ while ASA is toxic to _____.
Liver; Kidneys
Fever control:
You are working as PA in a primary care office when you notice that a patient has been taking maximum dose Tylenol every single day for the last 10 years for pain relief. What would be an appropriate lab to order?
CHEM 7 to look at kidney function
Fever control:
What is the single toxic dose for Aspirin?
150 mg/kg
Fever control:
What is the single lethal dose for Aspirin?
400 mg/kg
Fever control:
An 18 year old boy was brought into the ER today where you are currently doing a rotation as a PA student after his girlfriend found him unconscious next to an empty ASA bottle. Among other things, the physician ordered sodium bicarbonate. Which of the following would be the main reason this was ordered?
To neutralize the charge of the ASA to help eliminate it from the body.
Fever control:
An 8 week year old child presents to the ER today where you are currently doing a rotation as a PA student with a 103ºF fever (rectally). What would be included in an appropriate septic work-up?
a. Blood culture
b. UA
c. Spinal Tap
d. CBC
All of the Above
Fever control:
Which of the following explains when it would be most appropriate to get a septic work-up in an adult with a fever?
When the physical exam doesn’t explain the fever
Fever control:
Which of the following are reasons potentially seen in a patient’s past medical history that would trigger the provider to tell a patient NOT take Tylenol?
Hepatitis and G-6-P Deficiency
Fever control:
Currently, you are working as a Physician Assistant at a Grand Rapids Family Practice office. During the weekend you are the on-call provider that patients may contact. At 8 P.M. Saturday, you receive a call from a frantic, crying, first-time mother of a 4 month year old infant who claims her baby has been sick and is experiencing a temperature of 100.8ºF (Axilla). What medication do you recommend?
Tylenol
Fever control:
You are working in Grand Rapids as an OB-GYN Physician Assistant when a mother urgently brings in her 6 week old son who she claims “just hasn’t been acting right.” She took his temperature at home and states it was 101.4ºF (forehead). What is your next step?
send them to the ER for admission
Fever control:
You are a Physician Assistant working in the Emergency Room and a 30-year-old male patient presents with confusion. During your assessment you notice that his skin has a yellow tint to it. You order an ALT/AST, total bilirubin, and a serum acetaminophen level. You diagnose this patient has acetaminophen toxicity, what stage do you think he is currently in?
stage 3
Fever control:
You are evaluating a 42- year- old female patient that admits to taking more than the recommended dose of her Aspirin that morning at 8am. It is now 9:30 am and she is experiencing some nausea, vertigo and diarrhea. What is your next step in managing this patient?
Stabilize the airway, breathing and circulation followed by administering Activated charcoal
Fever control:
Which of the following is not an indication for hemodialysis in a patient who has Aspirin toxicity?
Tinnitus
Stroke:
A 65 year old man presents to the ED with facial paralysis, arm weakness, and speech difficulty, after ruling out other causes you determine a stroke has occurred. What is the next step in treating this patient?
a. Initiate rtPA bolus, followed by IV infusion
b. Initiate aspirin 325 mg
c. Order emergent non contrast head CT
d. Order emergent contrast head CT
c. Order emergent non contrast head CT
Stroke:
A 65 year old man presents to ED two hours after onset of stroke symptoms. He has diabetes, hypertension and hyperlipidemia. He is currently taking metformin 500 mg BID, lisinopril 10 mg, aspirin 81 mg and simvastatin 25 mg. His history was noncontributory. Vitals were taken: HR- 89, RR- 13, BP-198/117, POC glucose was 120 mg/dL, o2 sat – 97%. The CT did not reveal any signs of hemorrhage; what is the next best step in his treatment?
a. Attempt to lower his blood pressure
b. Prep the patient for intra-arterial thrombolysis
c. Initiate rtPA bolus, followed by infusion
d. Initiate heparin and admit for observation
a. Attempt to lower his blood pressure
185/110
Stroke: A patient presents with contralateral homonymous hemianopia and sensory loss. You suspect that this patient has had a stroke, after initiating proper treatment and MRA was preformed. Where was the infarct located? a. Middle cerebral artery b. Anterior cerebral artery c. Basilar artery d. Posterior cerebral artery
d. Posterior cerebral artery
Stroke:
An Anterior Cerebral Artery aneurysm will most likely cause:
a) Contralateral Hemianopsia
b) Ipsilateral CN III Palsy
c) Pressure on the Pituitary Gland leading to hormone imbalance
d) Ipsilateral CN IV Palsy
b) Ipsilateral CN III Palsy
Stroke:
Which of the following is not in the 3hr tPA exclusion criteria?
a) CT showing multilobar infarction.
b) Blood Pressure >185mmHg systolic or >110mmHg diastolic.
c) Venipuncture at a non-compressible site
d) Head trauma in the last 3 months
c) Venipuncture at a non-compressible site
Stroke: Methods of controlling vasospasm after aneurysm coiling include all of the following except: a) Propranolol b) Nefedipime c) Hypervolemia d) All of the above control vasospasm.
a) Propranolol
Monitoring ICP
Which of the following would most likely be an indication for invasively monitoring ICP?
a. Patient that presents to the ED with a severe headache
b. Trauma patient with a Glascow Coma score of 5
c. Patient with an abnormal CT (shows midline shift of 3 mm)
d. A teenager who was just diagnosed with meningitis that is responding to antibiotic treatment
b.Trauma patient with a Glascow Coma score of 5
Monitoring ICP
Your patient in the ICU is suffering from an obstructive, non-communicating hydrocephalus. Which method of ICP monitoring would be the best choice for this patient?
Intraventricular catheter
Monitoring ICP
In which of the following situations would it be most appropriate to intervene with a decompressive craniotomy?
Patient in the hospital recovering from an acute ischeic stroke with ICP of 25 mmHg over the last 10 min
Monitoring ICP
Which of the following regarding non-invasive measures to lower ICP is FALSE?
a. Hyperventilation is effective short-term by causing vasodilation of cerebral blood vessels
b. Head elevation is a quick and easy way to try to decrease ICP
c. Mannitol is an osmotic diuretic that is best used by bolus administration where an acute reduction in ICP is necessary
d. Hyperventilation creates an alkaline environment
a. Hyperventilation is effective short-term by causing vasodilation of cerebral blood vessels
Monitoring ICP
Which of the following is a common manifestation of elevated intracranial pressure due to meningitis?
CN 6 paulsy
Monitoring ICP
A 25 yr old 100kg male presented to the ED via ambulance from the scene of an accident in which he, a motorcycle driver, was struck by an SUV. Luckily, he was wearing a helmet. At the time of presentation, he had a Glasgow Coma score of 9, bilateral papilledema, and numerous distracting injuries (cracked rib, broken right femur to name a few). Conservative ICP treatment was initiated…head elevation, sedation, and a dose of mannitol (20% solution, 1g/kg over 15 minutes). 20 minutes following the mannitol administration, his BMP comes back with the following information: BUN 20 mg/dL, CO2 25 mmol/L, creatinine 1.1 mg/dL, glucose 125 mg/dL, chloride 107 mmol/L, potassium 4.5 mEq/L, and potassium 155mEq/L. Should you repeat mannitol treatment?
No, his serum osmolarity is too high (>320 mmol/L)
Monitoring ICP
In regards to monitoring ICP, what is the main purpose of sedation?
Sedation helps maintain a physiologic basic enviroment leading to cranial vessel vasodilation, maintaing cerebral blood flow
Hemodynamic monitoring in the ICU
A peripheral arterial line should be placed in all of these patients except:
a) 56 y/o with CHF receiving IV dobutamine
b) 2 y/o undergoing a VSD repair
c) 31 y/o admitted with ARDS
d) 47 y/o receiving IV Daptomycin for osteomyelitis
d) 47 y/o receiving IV Daptomycin for osteomyelitis
Hemodynamic monitoring in the ICU
You are a PA working within the hospital and are asked to insert an arterial line on a patient. After successfully gaining access to the radial artery, you suture the catheter and attach the tubing to the transducer and flush system. You remember that the flush solution:
a) keeps the IV site moist
b) prevents clotting
c) is bacteriostatic
d) stops bleedingb) prevents clotting
Hemodynamic monitoring in the ICU
An increased CVP can be caused by an increase in \_\_\_\_\_\_\_\_\_ and/or a decrease in \_\_\_\_\_\_\_\_\_\_.
a) arterial volume; compliance
b) compliance; arterial volume
c) venous volume; compliance
d) compliance; venous volumec) venous volume; compliance
Hemodynamic monitoring in the ICU
The v wave seen within the CVP waveform is indicative of:
a) blood filling the right atrium as the tricuspid valve is closed
b) right atrial contraction
c) blood filling the left atrium as the mitral valve is closed
d) right ventricle contraction
c) blood filling the left atrium as the mitral valve is closed
Hemodynamic monitoring in the ICU
which of the following condictions would result in a decreased PAWP?
Hypovolemic shock
Hemodynamic monitoring in the ICU Patient with refractory heart failure is put on the IABP (Intra-aortic balloon pump). You expect to see all of the following changes as a result of using this device EXCEPT: Increased coronary blood flow Decreased afterload Increased cardiac output Decreased diastolic aortic pressure
Decreased diastolic aortic pressure
Hemodynamic monitoring in the ICU
What is the best way to differentiate between a patient in hypervolemic shock vs. cardiogenic shock? PAP=pulmonary artery pressure PAWP= pulmonary artery wedge pressure
Patient in cardiogenic shock would have increased PAWP, while patient in hypervolemic shock would have decreased PAWP
Patient in cardiogenic shock would have decreased PAWP, while patient in hypervolemic shock would have increased PAWP
Patient in cardiogenic shock would have decreased PAP, while patient in hypervolemic shock would have increased PAP
Patient in cardiogenic shock would have increased
PAWP, while patient in hypervolemic shock would have decreased PAWP
Patient in cardiogenic shock would have increased
PAWP, while patient in hypervolemic shock would have decreased PAWP
Temporary cardiac pacing
- ) Jasmin, a 34 year old female, comes to the ER complaining of chest pain, fatigue, and SOB. She claims that she just got back from a hiking trip and she has a bulls-eye rash on her left leg. What is your main concern in regards to this patient?
a. ) Anaphylactic reaction
b. ) Complete heart block
c. ) Atrial fibrillation
d. ) Second degree heart block
Complete heart block d/t lyme disease
Temporary cardiac pacing
- ) What is the most important reason why is temporary cardiac pacing more beneficial than beta blockers in Jasmin’s father Arinze (67 year old male) after an MI?
a. ) Pacing has fewer side effects than beta blockers
b. ) Pacing helps decrease contractility better
c. ) Pacing keeps cardiac output at a level that can sustain the organs
d. ) Pacing is not more beneficial than beta blockers
c.) Pacing keeps cardiac output at a level that can sustain the organs
Temporary cardiac pacing
- ) Nick, a 43 year old male, presents to the ER with SOB, lightheadedness, and angina for the past hour. A 12-lead ECG is performed, and you have decided to try overdrive pacing. Which arrhythmia was seen on the ECG?
a. ) Complete heart block
b. ) Atrial flutter
c. ) Ventricular fibrillation
d. ) Ventricular tachycardia
Ventricular tachycardia
Temporary cardiac pacing
- ) EMS brings in a 58 year old female who believes that she is having a heart attack. An ECG reveals that she has an anterior wall STEMI, and she must be taken to the cath lab. Once she is in recovery your Cardiology preceptor asks you if he should try transvenous cardiac pacing with this patient to get her heart rhythm under control. What could impede your treatment plan?
a. ) The patient’s use of Coumadin for the past year
b. ) The patient losing consciousness after leaving the cath lab
c. ) Symptomatic bradycardia
d. ) None of the above
The patient’s use of Coumadin for the past year
Temporary cardiac pacing
- ) You are rounding at West Michigan Heart and one of your patients is a 72 year old male who has been hooked up to a transvenous cardiac pacemaker for 2 days. You check the monitor and notice that there is a failure to capture. What should you do first?
a. ) Increase the mA on the pulse generator
b. ) Decrease the mA on the pulse generator
c. ) Increase the mV on the pulse generator
d. ) Decrease the mV on the pulse generator
Increase the mA on the pulse generator
Temporary cardiac pacing
- ) Which of the following is a mode of demand cardiac pacing?
a. ) AAI
b. ) VOO
c. ) AOO
d. ) DOO
AAI
Temporary cardiac pacing
- ) You decide to place a transcutaneous pacemaker on a 50 year old female who was admitted to the hospital for observation after a CABG. You notice that that she is diaphoretic and anxious. You order a 12-lead ECG and notice that she has ventricular tachycardia. You set the pacer at 100 bpm to prevent the development of torsades des pointes. Why?
a. ) This patient has a decreased cardiac output from the CABG which predisposes her to develop torsades
b. ) Overdrive pacing will prolong the QT interval which will maintain a healthy rhythm
c. ) Setting a higher pace rate will prevent early heartbeats
d. ) 2 of the above are true
d.) 2 of the above are true
b. ) Overdrive pacing will prolong the QT interval which will maintain a healthy rhythm
c. ) Setting a higher pace rate will prevent early heartbeats
Stem Cell
- In which of the following disease states would hematopoietic stem cell transplantation not be an appropriate treatment course?
a. Sickle cell anemia
b. Non-Hodgkin lymphoma
c. Acute lymphoblastic leukemia
d. Hepatocellular carcinoma
d. Hepatocellular carcinoma
