PEARLS

Question 1

high heart rate, low BP

Answer 1

think bleed-dehydration

Question 2

flat jugular veins when supine

Answer 2

think bleed-dehydration or HHNK

Question 3

hot skin in a shock pt

Answer 3

think SEPTIC shock, look for source
- commonly will present with open wound
- can present in nursing home pts
- bacteria in bloodstream via lymph system to be septic
- temp down = late sign in septic shock
- cause is always bacterial

Question 4

female pt on birth control and/or smoking w/ SOB

Answer 4

think PE
- NR classically uses 35 y/o female smoker
- predisposing factors: travel, long period of inactivity, recent surgery, cancer
- PE mimics RSF (blocks blood flow up through the lungs, blood backs up causing edema & JVD)

Question 5

hives, laryngeal edema

Answer 5

think allergic or anaphylaxis
- stridor usually exists with anaphylaxis related throat swelling
- laryngeal edema also caused by trauma/localized infection (Ludwig’s angina)
- hive is a swollen capillary bed
- urticaria = hive related itching
- IgE = antibody responsible for anaphylaxis (histamine from mast cells, IgE attaches, causes them to burst)

Question 6

cool, clammy skin

Answer 6

think shock (sympathetic response)

Question 7

sudden onset of vomiting/diarrhea after eating

Answer 7

think allergic or anaphylactic shock
- food poisoning typically takes ~ 12 hours, allergy/anaphylaxis is quicker

Question 8

cool, clammy skin above & warm, dry skin below w/ low BP & low HR, think…

Answer 8

neurogenic shock (does not have to be trauma)
- spinal shock is temporary (difference between spinal and neurogenic)
- neurogenic shock can come w/ any disruption in blood flow (not just trauma)

Question 8

getting pt to the hospital is not enough…

Answer 8

treat the MI or shock

Question 9

if hives present, think…

Answer 9

allergic or anaphylactic

Question 10

person on ace inhibitor w/ laryngeal edema and stridor, think…

Answer 10

allergic response/anaphylactic shock
- ace inhibitors given for HTN
- most common (lisinopril), any “pril”

Question 11

if it is wet, sticky, and not yours…

Answer 11

don’t touch it!

Question 12

black tarry stools, think…

Answer 12

lower GI bleed
- black tarry stool is the same as melena

Question 13

hematochezia

Answer 13

bright red bleeding, most commonly a hemorrhoid

Question 14

dividing line of the upper and lower GI

Answer 14

ligament of treitz

Question 15

coffee ground emesis

Answer 15

generally due to an ulcer, ulcer is normally caused by bacteria h-pylori

Question 16

pt states “feels like my heart is beating out of my chest,” think…

Answer 16

SVT
- can/will result in LSF, backup blood to lungs
- CHAP = stable or unstable
- Tx stable = adenosine (6mg/12mg, save last 12 for hospital)
- Tx unstable = cardiovert @ 100 J

Question 17

Wolff Parkinson White Syndrome presents with (on 12-lead)…

Answer 17

delta wave on ECG, slurred P wave line into QRS

Question 18

crushing substernal chest pain, think…

Answer 18

MI
- classic sign = crushing substernal chest pain
- other signs = toothache, bellyache
- Tx = MONA (Morphine, Nitro, Oxygen, Aspirin)

Question 19

sudden onset SOB, think…

Answer 19

PE

Question 20

JVD, think…

Answer 20

RSF
- PE, tension pneumo, cardiac tamponade, COPD

Question 21

COPD pts are…

Answer 21

hypercarbic
- can’t blow off CO2
- normal blood gas between 35 - 45, hypercarbic over 45

Question 22

any female of childbearing age with belly pain has an…

Answer 22

ectopic pregnancy
- having tubal ligation increases the risk, but used to throw people off on test
- transport is position of comfort (not LLR)

Question 23

tall, skinny males with SOB, think…

Answer 23

spontaneous pneumo
- closed pneumo, often presents with history of smoking
- can occur in pts with Hx of COPD
- monitor for signs of tension developing (JVD, absent breath sounds on ipsilateral side, narrowing pulse pressure)

Question 24

if the pt has history of hypertension, think…

Answer 24

MI, stroke, aneurism

Question 25

number one cause of pulmonary edema

Answer 25

LSF

Question 26

number one cause of LSF

Answer 26

MI

Question 27

number one cause of RSF

Answer 27

LSF

Question 28

if you hear wet lungs, you must ask yourself this question…

Answer 28

“are they having an MI?”

Question 29

what side failure is seen with COPD patients

Answer 29

RSF

Question 30

what can refer pain to the shoulders?

Answer 30

belly insults - ruptured spleen, liver, ectopic pregnancy
- Kehr’s Sign (pain referred to L shoulder when palpating the abdomen when pt is lying down with legs elevated)

Question 31

never trust a

Answer 31

diabetic

Question 32

the only reason not to disrobe a trauma pt

Answer 32

environmental

Question 32

vaginal bleeding with sharp, sudden, tearing pain, stiff abdomen, massive hemorrhage, third trimester

Answer 32

complete abruption (abruptio placentae)

Question 33

painless, bright red bleeding from vagina during pregnancy

Answer 33

placenta previa

Question 34

s/s of lightheadedness, breathlessness, weakness, headache, nausea, vomiting could indicate what condition

Answer 34

acute mountain sickness
- occurs at 6600 ft, least serious of the altitude related illnesses
- Tx includes remaining where you are and it will subside or go to lower elevation, fluid admin recommended, can be treated with diuretic (acetazolamide)
- high respirations lead to respiratory alkalosis

Question 35

s/s of progressive weakness, fatigue, decreased appetite, weight loss, hyperpigmentation of skin, vomiting, diarrhea could indicate what condition

Answer 35

addison’s disease (hypoadrenalism)
- adrenal disease -> hypoadrenalism -> possibly autoimmune disease (can also be caused by an intense stressor on the system) -> cessation of adrenal gland function
- die from cardiopulmonary collapse

Question 36

s/s of flushed skin, itching, hives, swelling of skin, cyanosis, respiratory difficulty, sneezing, coughing, wheezing, stridor, laryngeal edema, laryngospasm, bronchospasm, etc. could be indicative of what condition

Answer 36

allergies and anaphylaxis
- Tx for allergy run w/o airway compromise = Benadryl
- Tx for anaphylaxis = epi 1:1000 (antibody driver behind this reaction is IgE, which is attached to mast and mobile mast cells, anaphylaxis is type 1 allergic reaction)

Question 37

s/s of problems with short term memory, shuffling gait, stiffness of body muscles, aphasia, psychiatric disturbances, and decorticate (severe) could indicate what condition

Answer 37

alzheimer’s disease