Test 1

Question 1

Meningitis

Answer 1

Contagious= viral/airborne, bacterial/droplet

S/S= photo/phono-phobia, stiff neck, patechiae on chest

Treatment= viral/antiviral, bacterial/antibiotic, fungal/antifungal, IV fluids, phenytoin for seizures

Inflammation of the meniges, occurs from injuries to facial bones

Question 2

Brudzinki sign

Answer 2

Lift head while supine if pt flexes knees = positive

Question 3

Kermigs sign

Answer 3

While supine flex knee at 90degrees and extend knee, if patient feels pain in back = positive

Question 4

Encephalitis

Answer 4

Inflammation of brain via virus(most common), bacteria, or parasite

S/S = confusion, stiff neck

Treat = acyclovir(monitor kidney function)

Avoid opioids(mask neuro symptoms)

Question 5

Myasthenia gravis

Answer 5

Autoimmune disorder that effects neuromuscular junction via acetylcholine receptors

S/S = ocular/facial/throat muscle weakness and if not treated can progress to diaphragm and cause breathing issues

Treatment = initial/pyridostigmine, bromide, mestinon Next/immunosuppressive therapy plasmapheresis IV with thymectomy

Question 6

Cholenergic crisis

Answer 6

Over medication of acetylcholinesterase inhibitors

S/S = may develop decreased swallow/gag reflex, and inadequate cough

may have to intubate

Question 7

Myasthenic crisis

Answer 7

Sudden and temporary onset of MG symptoms

S/S = ptosis, diplopia, respiratory issues, impaired speech/swallowing

may have to initiate tube feeding

Question 8

Guillain-Barré syndrome (GBS)

Answer 8

Autoimmune attack of nerve myelin but spare Schwann cells , commonly caused by a virus

S/S = symptoms ascending diminished muscle/reflexes in lower extremities that can progress to tetraplegia

Treatment = plasmapheresis and IVIG

Interventions = may need to intubate, DVT/PE prevention, Q2 turns, relieve pressure of bony province assit w/ ROM and communication

Question 9

Parkinson’s disease

Answer 9

Results from decrease in dopamine causing increase in excitatory(acetylcholine) neurotransmitters

S/S - TRAP T-tremors R-rigidity A-akinesia P-postural disturbances

Treatment- levodopa, deep brain stimulation, medical marijuana

Question 10

Alzheimer’s disease

Answer 10

Deterioration of the brain

S/S- progressive starting with subtle memory loss escalating to further memory loss w/ decreased ability to understands concepts and consequences of actions and may even cause difficulty speaking/ambulating

Treatment- pharmacological, promoting independence

Question 11

Multiple sclerosis

Answer 11

Autoimmune disorder that does no spare Schwann cells

S/S- unilateral vision loss, orbital pain, diplopia, pain, ataxia, muscle spasticity

Treatment- Disease modifying therapy(requires injections), methylprednisolone, Baclofen(spasticity), encourage walking

Question 12

Bell’s palsy

Answer 12

Unilateral inflammation of the 7th cranial nerve

S/S- facial distortion, possible speech/eating difficulties

Treatment- corticosteroid for inflammation, analgesic/heat and cold for pain

Question 13

Amyotrophic lateral sclerosis

Answer 13

S/S- inc. or dec. muscle tone/spasticity, exaggerated deep tendon reflexes

Treatment- interventions to improve/maintain function= rehab, enteral feedings, Resp. Therapy

Question 14

Increased intracranial pressure (ICP)

Answer 14

Cerebral edema swells, intracellular, extracellular or both

S/S- slows HR, RR is irregular, decreased blood flow(cushings response)

Normal value-15to15mmhg if >20mmhg treatment required

Treatment- fluid restriction, mannitol or hypertonic solution(.3% NS)

cushings response can progress to cushings triad

Question 15

SIADH

Answer 15

Causes fluid overload due to decreased fluid/urine output

S/S- increased urine specific gravity(normal 1.005-1.015), decreased serum osmolality(normal 278-300), low sodium(normal 135-145)

Treatments- fluid restriction or if pt has TBI .3% NS is administered possibly with lasix

Question 16

Neurogenic shock

Answer 16

Bradycardia, hypotension, slow RR, warm/dry skin

Question 17

Spinal cord injury

Answer 17

> th1 tetraplegia, <th1 paraplegia

Cause autonomic dysreflexia (onset of excessively high BP

Treatment- laminectomy

Question 18

Brain tumors

Answer 18

Glioma- most common and aggressive malignant tumor

Meningioma- most common brain tumor and benign/slow growing

Acoustic neuroma- benign tumor of 8th cranial nerve(hearing and balance)

Primary tumors- nonfunctioning(does not secrete), functioning(secretes hormones)

Brain angioma- abnormal blood vessels

Cerebral metastasis- breast/lung cancer

Question 19

Signs of brain tumor

Answer 19

Increased ICP, seizures, headaches, personality changes, papilledema, hemepharesis, Cushing triad(late symptom)

Headaches more common in morning and may not respond to pharmacological treatment

Question 20

Assessment of brain tumors

Answer 20

MRI IS GOLD STANDARD

Question 21

Treatment of brain tumors

Answer 21

Primary- surgery, radiation,chemo, drugs

Metastatic(secondary)- palliative care

Question 22

Spinal cord tumors

Answer 22

Can be primary or metastatic(secondary)

S/S- pain, loss of reflexes above tumor level, loss of sensation or motor function

Treatment- surgery

Question 23

Normal labs

Answer 23

PTT- 21 to 35
PT- 11 to 12.5
INR-1
Na-135 to 145
K- 3 to 5
WBC- 4 to 10
RBC- 4 to 6
Hb- 13 to 18
Hct- 36 to 50
Platelet- 150 to 400

Question 24

Musculoskeletal trauma

Answer 24

Contusion- soft tissue injury via blunt force
Strain- injury to musculotendinous unit via over-use/stretching/stressed
sprain- injury to ligament or supporting muscle that surrounds joint

Question 25

Fracture

Answer 25

A break in the continuity of bone

S/S- deformity, shortening, crepitus, swelling, discoloration

Priorities- stability, immobilization, assessment, infection

Treatment- reduction(restoration of fracture fragments to anatomic alignment and rotation

if wound is sticking out cover with sterile gauze

Question 26

Hypovolemic shock

Answer 26

S/S- thready pulse, decreased urine output and pulse pressure, MAP below 65, RR shallow and rapid

Question 27

Potential complication of fracture

Answer 27

-Fat embolism syndrome(FES)
-Delayed Union, malunion, nonunion
-venous thromboemboli
- necrosis
-reaction to internal or external fixation devices

Question 28

Hip fracture

Answer 28

Very high incidence in older adults

Treatment- hemiarthroplasty(hip replacement)

Question 29

Casts

Answer 29

Made of fiberglass or plaster

Major complication is compartment syndrome

Other complications include pressure ulcers and disuse syndrome

Question 30

Traction

Answer 30

Bucks traction is when weight is applied via cast to pull and keep bones in alignment

Skeletal require pins be placed into leg and then weight is applied to pull and keep bones in alignment

Priorities- ensures traction is aligned properly, maintaining patient in correct position, prevent skin breakdown, provide pin site care(skeletal only)

Question 31

Joint replacement

Answer 31

Surgical replacement of joint with prosthetic

Management- prevent dislocation, monitor complications and wound drainage, prevent DVT and infection

Question 32

Amputation

Answer 32

Performed at most distal point that will heal properly

Complications- hemorrhage, infection, skin breakdown, phantom limb, join contracture

Priorities- promote rehab, minimize altered perception, promote mobility

Question 33

Lupus

Answer 33

Autoimmune inflammatory disease

Look for butterfly/coin shape rash, inflammation especially pericarditis/pleuritis,

Abnormal labs include ANA, CSR, CBC,

Treatment= corticosteroids, NSAIDS, DMARDS, reduce sum exposure

Question 34

Scleroderma

Answer 34

Hardening/stiffness of the skin

May require echo,ANA, skin biopsy to diagnose but has poor prognosis

Management includes meticulous skin care, treat pain, and limit disability

can possibly impair respiratory function

Question 35

Osteoporosis

Answer 35

Reduction in bone density or change in bone structure, due to resorption being greater than osteogenesis

Diagnosed via dexascan

Treatment includes diet high in vitamin c, calcium, increase sunshine, and educating on weight loss

Pharm. treatment includes calcitonin, biophosphates, or or SERMS if post menopause

Question 36

Osteomyelitis

Answer 36

Infection of the bone aka staphylococcus aureus

Can result from tissue infection, direct bone contamination, or blood borne infection

Signs include tachycardia tachypnea, fever, abnormal, WBC, guarding, purulent drainage

Treatment is antibiotic therapy depending on culture

Question 37

Bone tumors

Answer 37

More often benign than malignant

Malignant can come from connective tissue (sarcoma) or bone marrow (multiple myeloma) and are classified as primary

Secondary tumors come from anywhere else

Dishes include weakness, gait abnormalities, brittle bone, loss of control or rententiin of urine

Management includes elimination or surgical removal

SPINAL METASTASIS IS A MEDICAL EMERGENCY