Medical Assistant Certification Exam Review, Exams of Medicine

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Medical Assistant Certification Exam

What are the 4 parts to a patient's medical history? - chief complaint (CC), history of present illness (HPI), Past, Family and Social History (PFSH), and review of systems (ROS) Vital signs reflect the functions of what three body processes necessary for life? - body temperature, respiration and heart function what are the 4 vital signs of body function? - temperature, pulse, respiration and blood pressure Give the normal temp ranges for the following sites: rectal, oral, axillary and tympanic membrane? - rectal 98.6- oral 97.6-99. axillary 96.6-98. tympanic 9.8. febrile v afebrile - febrile is the presence of fever, afebrile is absence of fever 3 types of fever? - intermittent, remittent and continuous oral temperature is not taken from which patients? - infants and children less than 6 yo, patients who had face, neck nose or mouth surgery, those receiving oxygen, patients w altered mental status and others how long should you wait for patients who just finished eating drinking or smoking to take temp? -

30 minutes What method of taking temp is the least accurate? - axillary (underarm) normal adult pulse range - 60-100 BPM what is the site most commonly used for taking pulse? - radial artery in wrist normal range for adults respiration? - 12-20 per minute what are 3 respiration rate abnormalities? - apnea- temporary complete absence of breathing tachypnea- rate > 40.min bradypnea- decease in number of respirations What are to abnormalities in respiratory rhythm? - Cheyne-Stokes- regular pattern of irregular breathing rate Orthopnea- difficult to breathe unless in upwright position what does depth of respiration refer to? - amount of air that is inspired and expired during respiration what are three abnormalities in depth of respirations? - hypoventilation-reduced amt of air enters lungs hypernea- abnormal inc in depth and rate of breathing

dorsal lithotomy position - used for exam of pelvic orgns prone position - used to examine spine and back Sim's position - used for rectal examination knee-chest position - used for rectal and vaginal exams trendelenburg position - used for surgical procedures of pelvis and abdomen Which organization is responsible for the identification of the various hazards present in the workplace and for the creation of rules and regulation to minimize exposure to hazards? - Occupational Safety and Health Administration (OSHA) What are the 3 categories for safety hazards? - physical hazards, chemical hazards, biological hazards for an external hemorrhage how is bleeding controlled? - elevating the affected part above heart level and applying direct pressure to the wound when does shock occur? - when there is insuffcient return of blood flow to the heart, resulting in inadequate supply of oxygen

what are the common symptoms of shock? - pale, cold clammy skin, rapid weak pulse, increased shallow breathing rate, expressionless face first aid for shcok - maintain an open airway, call for assistance, keep victim lying dow, attempt to control cause of shock what are agents? - infectious microorganisms that can be classified into groups portal of exit and portal of entry - portal of exit is the method by which infectious agent leaves its resevoir; portal of entry allows infectious agent access to suceptible host mode of transmition - specific ways in which microorganisms travel from resevoir to susceptible host. 5 main types: contact, droplet, airborne, common vehicle and vectorborne define medical asepsis - the destruction of pathogenic microorganisms after they leave the body what procedure is used in medical aspesis using various chemicals that can destroy pathogenic microorganisms? - disinfection what is the least expensive and most readily available disenfection? - a 1:10 solution of household beach 4 methods of sterilization - gas sterilization, dry heat sterilization, chemcial and steam (autoclave)

give layers of heart deep to superficial - endocardium, myocardium, pericardium what is the "heart skeleton" made of? - four rings of thick connective tissue what are the layers of fluid separating the parietal pericardium and visceral pericardium? - pericardial sac what structure in the middle of the heart divides the heart into two sides? - septim what kind of blood does the left and right side of the heart pump? - right pumps deoxygenated blood w low pressure from veins into lungs (pulmonary circulation) and left pumps oxygenated blood with high pressure (blood pressure) toward the tissues through the arteries (systemic circulation) What are the four heart chambers? - right atrium, left atrium, right ventricle, left ventricle what are the only arteries in the body that carry oxygenated blood? - pulmonary arteries (efferent) what are the only veins in the body that carry oxygenated blood? - pulmonary veins (afferent) what is the largest artery in the body? - the aorta

be familiar with heart anatomy - what is the purpose of heart vavles? - to prevent the backflow of blood therby assuring uni-directional flow through the heart what are the subdivisions of the heart valves? - Atrioventricular valves (AV): Tricuspid + Bicuspid Mitral semilunar valves: Pulmonic + Aortic What are the AV cuspid valves characteristcs? - have tough fibrous rings, long and strong leaflets (cuspids), accessory organs (ie papillary muscles, chordae tendinae) give the location of the AV cuspid valves? - tricuspid is btw the right atrium and right ventricle, bicuspid mitral is btw left atrium and left ventricle characteristics of semilunar valves? - three leaflests, shallow in depth, no accessory organs give location of semilunar valves? - pulmonic btq right ventricle and pulmonary trunk, aortic btw left ventricle and aorta where are the coronary arteries located? - on the epidcardium what are the two branches of the left coronary artery? - Left anterior descending (LAD) artery and Left Circumflex (LCX) artery

the heart is under the influence of which nervous system? - the autonomic nervous system which is subdivided into the sypathetic and parasypathetic which division of the ANS has an inhibitory effect via acetylcholine? - parasympathetic (vagus nerve) what division of the ANS has a excitatory effect via norepinephrine? - sypathetic acetylcholine effects in body? - slows SA pacemaker and heart rate, slows conduction of electricity in AV node, decreases strength of atrial and ventricular contraction norepinphrine effects in body? - increase HR, increases force of contraction, increases blood pressure, dopaminergic receptors increase the diameter of visceral blood vessels True or false. the blood volume ejected outside the heart is equal to the blood volume returning back into the heart - TRUE what is stroke volume (preload)? - the blood volume ejected outside the ventricle after each contraction; depends on volume of blood, force of myocardium contraction and vascular resistance what is the Starling Law? - the greater the volume of blood inside the heart during diastole, the stronger the heart contraction force during systole. the lower the resistance in the vessels, the MORE OR LESS easily blood can be ejected outside heart through circulation? -

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what is cardiac output? - the amount of blood ejected outside heart per minute cardiac output equals (X) * (Y) - x- stroke volume y- HRper/min what is peripheral vascular resistance? - the force exerted against the blood flow determined by diameter of the vessel; lower the vascular resistance the less force needed to eject blood define blood pressure - the force exerted by circulating blood volume on the walls of the artery during circulation formula for BP - BP equals (cardiac output) * (vascular resistance) define EKG - graphical presentation of heart electricity over time. electricity created by pacemaker cells how is the electricity created by pacemaker cells? - elecrtical impulses created by passing of ions through the cell membrane What are the 4 properties of cardiac cells? - automaticity excitability conductivity

if the sinus node fails to fire, what is the backup pacemaker, what is its rate and where is it located? - AV node; 40-60 BPM, located at the posterior septal wall of the right atrium just above the tricuspid valve Bundle of His: where is it. intrinsic firing rate? - superior portion of the interventricular septum; 40-60 BPM The bundle of his divides into WHAT to conduct the electrical impulse of WHAT throughout the ventricles? - right and left bundle branches; Purkinje fibers where are purkije fibers located and what is their rate? - within the ventricular endocardium; 20-40BPM conduction system of heart - an EKG is a WHAT that measures what? - galvanometer that measures the heart electricity traveling through the conductive system an EKG is an important tool for what? - monitoring patients HR, evaluating injuries to the heart muscle, evaluating pacemakers and conductive system function, define electrode - a paper, plastic or metal sensor palced on the patient's skin on a specific location define cable and lead -

cable is a wire that connects the electrode to the EKG machine the lead is a recorded tracing of the heart electricity from one or two electrodes that provides a specific view of the heart What are your standard bipolar limb leads? - Lead 1- LA positive, RA negative (LA-RA) Lead 2- LL positive, RA neg (LL-RA) Lead 3- LL positive, LA neg (LL-LA) which electrode is used as a ground electrode for the standard bipolar limb leads? - right leg what do augmented unipolar leads do? - record the heart electricity from one limb and compare it with a zero voltage lead in the center of the heartt what are augmented unipolar leads? - Lead aVR- right arm is positive other limbs are neg Lead aVL- left arm is positive other limbs neg LeadaVF- left leg is positive other limbs neg the standard bipolar limb leads and the augmented unipolar leads record in which plane? - frontal plane the precordial chest unipolar leads record in what plane? - horizontal the electrods for precordial chest unipolar leads are all what sign? - positive

A T wave represents what? - the first wave after the QRS complex is produced by ventricular repolarization; slightly asymmetric U wave - deflection seen following T wave but preceding the diastole; represents repolarization of Purkinje fibers How is the PR segment measured and what does it represent? - measured from the end of the P wave to the beginning of the QRS complex; represents depolarization of the AV node and its dely and depolarization of the Bundle of His and Bundle branches How is ST segment measured and what does it represent? - represents time of ventricular contraction and beginning of repolarization of both ventricles; measured from the end of QRS to beginning of the T wave what is a normal PR interval? - 0.12 - 0.2 seconds what does the QT interval represent? - total ventricular activity what are the 4 methods to calculate heart rate (EKG)? - 6 second method large boxes method small boxes method sequence method "memorization" how do you perfrom the 6 second method? -

count number of QRS complexes btw 6 sec marks and multiply by 10 **used for estimating slow and irregular rhythyms how to perform the large boxes method? - count number of large boxes btw 2 RR intervals and divide into 300 for ventricular rate; count large boxes s btw P waves for artrial rate; used for regular rhythms how to perform little box method? - count number of small boxes between an RR inteval and divide into 1500 **regular rhythms only sequence method (memorization method) - select the R that falls on a dark vertical line; number next dark line as 300,150,75,60,50. note where next R wave falls in relation to dark lines, that is the HR Analyzing the EKG strip involves what 6 steps? -

1. assess the HR
2. assess rhythm/regularity
3. identify and examine P wabes
4. asses intervals (PR, QRS, QT)
5. Evauluate ST segments and T waves
6. General evaluation and conclusion cardiac arrythmias are due to what 4 mechanisms? -
7. arrythmias of sinus origin
8. ectopic rhythms
9. conduction blocks
10. pre-excitation syndromes what are ectopic rhythms? - electrical impulses originate from somewhere other than sinus node

b. diastolic pause is small or nonexistent c. tachycardia reduces the blood supply to the cardiac muscle sinus arrhythmia - (SINUS RHYTHM) notice that PQRST waves are equal and normal in size, but diastolic periods are different after each heart systole a. HR 60- b. different diastolic pause after each systole supraventricular tachycardia - (ATRIAL RHYTHM) Atrial Tachycardia (AT) is caused by an irritable focus in the atria that fires electrical impulses after normal firing of SA node pacemaker HR btw 100- 150 AV Reentry Tachcardia is caused when the electrical impulse passes a passage other than AV node. cardiac rhythm regular but up to 250 BPM **EMERGENCY NOTIFY DOCTOR atrial flutter - (atrial rhythm) notie that there are no more "p waves" only saw-tooth-like wave called F wave a. characterized by rapid depolarization of a single atrial focus at a rate of 250-350 BPM b.typically a slower ventricular rate **EMERGENCY NOTIFY DOCTOR atrial fibrillation - (atrial rhythm) no more p waves, instead they are substituted by small trembling waves, while QRST complex are almost normal a. caused by multiple irritable sites all over the atria firing at rate > b. no identifiable P waves, fibrillatory eratic "f" waves **EMERGENCY NOTIFY DOCTOR Premature Ventricular Complex (PVC) -

(ventricular rhythm) observe difference btw the normal QRS complexes and the wide inverted abnormal QRS of the PVC and full compensatory pause a. QRS and PVC greater than .12 s because ventricular depolarization is abnormal b. T waves usu in opposite direction of QRS ventricular tachycardia (VT) - (ventricular rhythm) notice there are no more p waves but wide, bizarre QRS complexes at a rate

a. 3 or more PVCs in a row b. regular fast rhythm c. no P waves ** EMERGENCY ND ventricular fibrillation (VF) - notice the quivering eratic waves that do not resemble any of the normal waves or QRS complexes a. chaotic deflection of different waves that vary in size shape and duration b. no visible waves EMERGENCY requires defibrillationa nd CPR Asystole (Cardiac Arrest) - just an isoelectric line, no waves are seen patient is clinically dead EMERGENCY!! What are the 4 types of Atrio-ventricular blocks (AV blocks) -

1. Type I First Degree AV block
2. Type I Second Degree (Wenckebach, Mobitz I)
3. Type II Second Degree AV block (Mobits II)
4. Third Degree AV block