Fisdap Medical Emergencies Exam: Reactions, Hypothermia, Neurological, Exams of Medicine

Download Fisdap Medical Emergencies Exam: Reactions, Hypothermia, Neurological and more Exams Medicine in PDF only on Docsity! Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Pyrogenic Reactions - correct answer Two definitions from different sets: - Fever caused by endotoxins and bacteria. The endotoxins may cross over membranes during hemodialysis complications. - "Reaction characterized by an abrupt temperature elevation with severe chills, backache, headache, weakness, nausea, vomiting; a potential complication of IV/IO therapy, complication of hemodialysis." S/G: If the pt is having a blood transfusion and they start to experience the following symptoms: Erythema, urticaria, hypotension (70/40), Tachycardia (P 120), tachypnea (RR 24). The solution is to discontinue the transfusion due to an incompatibility with the donor. Start fluids, benadryl, maybe lasix and possibly epinephrine. Endocrine disease (Such as, but not limited to, thyrotoxicosis) - correct answer Thyrotoxicosis aka "thyroid storm" : Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers "Toxic condition caused by excessive levels of circulating thyroid hormone. Generally caused by Grave's disease, severe under-treated hyperthyroidism, or infection. S&S: Flush, red skin, agitated, angioedema" Graves disease: An autoimmune disease that results in elevated thyroid hormone. Graves disease aka Hyperthyroidism is the main cause of "thyroid storm". Grave's can form a goiter on the neck. S/S: Fever, irritability, delerium, coma, tachycardia, hypotension. Care is mainly supportive. Hashimoto disease: More mild form of hyperthyroidism Addison's disease : Not enough cortisol is produced (hypoadrenalism) Cushing's disease: Too much cortisol (Hyperadrenalism) Moon face Thyrotoxicosis aka "Thyroid storm" - correct answer Visual Aide Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers TB can manifest in many ways. S/S include; Night sweats, hemoptysis, chills, fever, fatigue, and weight loss. Don a N95 mask and mask up the pt. Bleeding Disorders - correct answer - Sickle Cell disease: RBC's are "sickle shaped" and interfere with oxygenation. This causes hypoxia throughout the body and causes excessive pain. Provide supportive measures and GIVE PAIN MEDS (Morphine Sulfate IV). "24 yom w/ hx of sickle cell Lying in the fetal position" - Disseminated Intravascular Coagulation: Found in severe trauma and septic patients. Causes weird clotting AND bleeding throughout the body. Common sign is purpura on the chest and abdomen -Hemophilia: Hereditary disorder with very poor clotting - Thrombocytopenia: Poor clotting due to a low level of platelets - Thrombocytosis: Too many platelets (Asymptomatic) Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Coagulation Processes - correct answer Steps: 1. Vasoconstriction 2. Platelet Plugging 3. Coagulation Clotting cascade: Refers to the process by which clotting factors work together to ultimately form fibrin Coagulopathy: A condition in which the blood's ability to coagulate (form clots) is impaired Physiology Electrical Injuries - correct answer Produce devastating internal injuries with little external evidence may have two injuries sites 1. one at the point where electricity entered the body (entry wound) 2.and where it exited the body (exit wound) Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers as electrical current travels from the contact site into the body, it is converted to heat, which follows the current flow--usually along side blood vessels and nerves-- causing extensive damage to the tissue in its path. respiratory muscle paralysis ventricular fibrillation serious injury because the electricity may have flowed across the chest, potentially injuring the cardiac conduction system "11,000 volts usually fatal, 40,000 volts almost always fatal." Pathophysiology of Angioedema - correct answer "A vascular reaction, that may have am allergic cause and may result in profound swelling of tongue and lips" "Marked edema of the skin and usually involves the head, neck, face, and upper airway. Caused from allergic reactions and anaphylaxis." Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers watch outdoor vfib Management : Passive Rewarming: taking off wet clothes, drying its skin, moving pt into warm ambulance, possible warm fluids External Rewarming: directly warm its skin, heating blankets, direct heat packs to groin, axillary & neck, warm fluids/warm humidified o2 Shock more/withhold meds not dead until warm and dead Treatment of hyperthemia - correct answer Quiz question: 80 yom c/o headache and nausea. He's confused with hot and dry skin. VS: 90/55 P96 RR 18 CBG 88. What should you do? A: Begin active cooling He has s/s of heat stroke. Immediate cooling needs to begin. Active cooling = Cool IV fluids plus ice packs Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Pathophysiology of demylenating disorders: Guillian-Barre Syndrome - correct answer - Guillian-Barré Syndrome: "Unknown cause that involves progressive paralysis that moves from the feet to the head (ascending paralysis) if paralysis reaches the diaphragm, the pt may require respiratory support -- rapid onset signal to axon imparted demyelinating weakess and tingling sensations in the leg moves up to the thorax and arms weakness--->paralysis" "Condition in which the immune system attacks the nerves. Develops very suddenly, within hours to days, and at worst can paralyze the breathing muscle - the diaphragm." Pathophysiology of demylenating disorders: Multiple Sclerosis (Autoimmune) - correct answer - "27 yof c/o general weakness. She feels "Unstable". She's supine and is incontinent. She has a Rx of Methyprednisolone and her script is out." Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers A: She has Multiple sclerosis. MS causes demyelination (nerve degredation) which causes weakness in the limbs, sensory loss and parasthesia" - "An autoimmune condition in which the body attacks the myelin that insulates the brain and the spinal cord causing scarring (demyelinating) "attacks" vary in intensity and remissions" - "Inflammation of certain nerve cells. Disease in which the immune system eats away at the myelin sheath protective covering around nerves brain and spinal cord. S&S: Weakness, sensory loss, changes in vision" Pathophysiology of HHNS - correct answer - "68 yom is confused. Spouse states he has GENERAL MALAISE and loose stools. Pt has a Hx of diabetes and takes METFORMIN. VS: 82/54, P98, RR18, CBG 720, What is it? A: HHNS" Excessive thirst, urination, and hunger. Dehydration, orthostatic hypotension, tachycardia, coma, death. Caused by poorly managed Type 2 diabetes. OFTEN FOUND IN PT'S with STROKES OR INFECTIONS." Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers High pH, low CO2. Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. R. Acidosis: Low pH, High CO2. A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. - How does chemical buffer work to balance pH? Acidosis inactivate h+ ions and increase HCO3 concentration to increase pH Alkalosis chemical buffers generate more h+ ions and decreases HCO3 concentration to decrease pH What are the 3 main buffering systems? Protein Phosphate Carbonic Acids/Bicarbonate Generic and trade names of medications - correct answer These are the medication practice questions on the Practice quiz: Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers - "51 yom is spraying pesticides and feeling light headed with EXCESSIVE SALIVATION PRODUCTION. What do you give? A: Atropine We give Atropine to pt's with organophosphate poisoning. Remember, SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI issues, Emesis" - "Which drug causes pupil constriction? A: Opiates Opiates play on the parasympathetic response which causes pupil constriction." - "If somebody OD's on Atenolol, what would be a predictable symptom? A: Hypotension Atenolol is a selective Beta 1 antagonist which reduces HR and contractility. Hence, hypotension." Pathophysiology of Cranial Nerve inflammation and other commonly seen neurological conditions: Bells Palsy - correct answer First, the quiz question: Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers - "42 yof c/o left sided facial weakness, slurred speech and a LOST SENSE OF TASTE. What's the likely cause? A: Bells Palsy Bells Palsy is the most COMMON FORM of facial weakness. Caused by an inflammatory reaction of the facial nerve (7th cranial nerve). S/S: Facial paralysis, inability to close the eye of the affected side, pain, tearing, drooling, impairment of taste. Some causes are herpes, chickenpox, measles, mumps, and reubella." Pathophysiology of Cranial Nerve inflammation and other commonly seen neurological conditions: Dementia - correct answer Dementia: A group of different neurological disorders characterized by the chronic deterioration of memory, personality, language skills, perception, reasoning, judgement, with no loss of consciousness Pathophysiology of Cranial Nerve inflammation and other commonly seen neurological conditions: Alzheimer's Disease - correct answer A progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers repetitive questioning, Improvement of symptoms with time Moderate: Axon disruption with cerebral contusion, LOC, Photophobia, N/V? CONCUSSIONS = REPETITVE QUESTIONING Differentiate between types if intracranial hemorrhages: Cerebral Contusion - correct answer Look for focal injuries the bruising of brain tissue as the result of a head injury that causes the brain to bounce against the rigid bone of the skull Differentiate between types if intracranial hemorrhages: Subdural Hematoma - correct answer Venous bleed Collection of blood under the dura mater. Slower than a epidural bleed. An injury can occur and a subdural hematoma will be present days later. Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Differentiate between types if intracranial hemorrhages: Epidural Hematoma - correct answer LOC followed by another LOC due to Increased ICP Arterial bleed Approx. 1% of hematomas Most likely caused by a meningeal artery bleed. This happens fast. You will typically see focal deficits. Temporal hematomas often occur due to a blow to the side of the head. Evaluate the effects of untreated infections: Sepsis and Septic Shock - correct answer A complex type of distributive shock that usually begins as a bacterial or fungal infection & progresses to a dangerous condition over a period of days. Recognize an antidepressant overdose - correct answer Tricyclic Antidepressants: Amyltripiline, Doxepine Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Dry Mouth, ALOC, confused, slurred speech, drowsiness, dysrhythmias (sinus tachycardia/SVT), dilated pupils, pulmonary edema, hypotension, seizures, respiratory depression, QT prolongation. - Treatment with Sodium Bicarb Monoamine Oxidase Inhibitors (MAOIs): Psychiatric medication used primarily to rest atypical depression by increasing norepinephrine and serotonin levels in the central nervous system 6-24 laters onset, hyperactivity,dysrhytmias, hyperventilation, chest pain, palpitations, hypertension, diaphoresis, agitated or combative behavior, hyperthermia, hallucinations severe: bradycardia, hypotension, seizures, coma, pulmonary edema, cardiac arrest, hyperthermia Differentiate between types and phases of seizures: Tonic/Clonic - correct answer Involves a larger area or entire hemisphere Tonic-Rigidity (Body Wide) Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers "Type 1 diabetics who are in a state of DKA have built up ketones and the body is trying to regulate pH by hyperventilating and blowing off CO2" Management of seizures and the following postictal state - correct answer Quiz question: 20 yof is postictal after a 10 minute seizure. Family reports a hx of TBI 8 months ago. BP 144/82 P92 R16 02 90% CBG 66. How do you treat? A: Apply supplemental O2 Postictal pt's need O2 to increase sats. Clear space for pt to protect themselves Protect airway and neck removes any restrictive jewelry or clothes Airway Management -02 (blow by possible bvm) -suction (blood from possible tongue bite) Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers -nasal adjuncts BGL admin dextrose if needed Temp. Mangement ---> rectal acetaminophen peds supportive/emotional care especially for postictal phase Versed 2.5-5mg IM/IV Evaluate Respiratory efforts on blood pH levels - correct answer ... See above for other info on this. RR up = pH up (Alkalosis) RR down = pH down (Acidosis) Provide pharmacological interventions for a seizure patient - correct answer ... See above for this but typically it's airway management, ABC's, O2, IV, Benzos, and possibly tylenol for peds in a febrile seizure Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Treat and communicate with a psychiatric patient - correct answer Quiz question: The mother of a 17 yom calls for her son who is depressed. A: Inquire about his suicidal ideations Depression needs to be treated with professional psychological help Dialysis and the symptoms associated with renal failure - correct answer Quiz question: What is the potential risk for delinquent dialysis pts? A: Hyperkalemia In renal failure, the body retains fluids, waste products, and especially potassium. Signs and symptoms of hyperkalemia: Paralysis, irregular heart rhythm, numbness & tingling, dyspnea, N/V. Symptoms can range from nothing to cardiac compromise Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers prolonged dive. A symptom of decompression sickness is "the bends" or deep pain in the muscles and joints. Alcoholic Hepatitis - correct answer Quiz question: "48 yom c/o RUQ pain. He is malnourished with GENERAL MALAISE and a hx of alcoholism and poverty. VS: 112/66, P112, RR24, CBG55 What's the condition? A: Hepatitis Injured hepatocytes causes inflammation & liver disease. Other symptoms include hepatic hypertrophy, "fatty changes" (lipid retention in the liver), lesions and spontaneous hemorrhages. Other symptoms can include anorexia due to the liver not properly converting glucose to glycogen and possibly hypoglycemia." Alcoholic hepatitis is inflammation of the liver caused by drinking alcohol. Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Alcoholic hepatitis is most likely to occur in people who drink heavily over many years. However, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately. More on pt's with hepatic issues - correct answer Quiz question: 46 yof c/o SOB, CRACKLES and hx of alcohol abuse and presents with ascites. VS: BP142/84, P102, RR24 What do you suspect? A: Liver Failure Pt's suffering from alcohol abuse and has probably developed hepatitis. The ascites causes peritoneal pressure which pushes on her diaphragm and causes SOB Managing pt's with appendicitis - correct answer Quiz question: 54 yof c/o N/V with pain around her UMBILICUS, abdominal tenderness with increased pain with palpation. VS: 80/40 P130, what do you suspect? Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers A: Ruptured appendix Pt's with rebound tenderness who are febrile and with hypotension with these complaints and VS are likely in hypovolemic shock due to a ruptured appendix Last tips and subtle cues to finding the right answer. - correct answer Remember... Pain around UMBILICUS = Appendix Watery eyes, eyelid edema = Benadryl Weakness and "UNSTABLE feelings = MS LOSS OF TASTE = Bells Palsy Goiter = Thyrotoxic Crisis Hot, dry pt + Confusion = Heat Stroke Flank pain + Dark urine = kidney stones Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers Heat related injuries INHIBIT vasodilation BP is primarily regulated by changes in cardiac output and peripheral vascular resistance Levopoda = Medication to treat Parkinsons The meninges are part of the CNS Thiamine (Vitamin B1) = Helps the brain break down glucose. Deficiencies of B1 are common in alcoholics Petit mal seizure = Absence seizure Complex partial seizure = Full seizure Inflammatory bowel disorder with "occult" (not visible) GI bleed obstruction Hematemesis = May also be a result of peptic ulcers. Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers When a pt is "vomiting blood" and has a hx of alcoholism, think esophageal varicies Possible DVT = Limit the movement of the extremity Trousseau's sign = Hands drawing inward due to carpopedal spasms RUQ pain that radiates to the shoulder = Cholecystitis Arteriosclerosis = Thickened or hardened veins "Sighing" deep breaths = Possible atelectasis Cranial nerve 1 = Olfactory Cranial nerve 2 = Optic You may encounter this on a unit exam or test: Mid-epigastric pain that subsides with eating? - correct answer Peptic Ulcers Fisdap Medical Emergencies Unit Exam S.G. Questions And Answers You may encounter this on a unit exam or test: The thing you should be MOST concerned with in a hypertensive pt withdrawing from alcohol that also has a headache? - correct answer Seizure, not stroke. Always seizure! You may encounter this on a unit exam or test: If the pt is complaining of seeing "Yellow Halos" - correct answer This is due to the improper excretion Digoxin You may encounter this on a unit exam or test: Treating a pt after a "Spice party"? What medication do you give? - correct answer Midazolam (Versed) You may encounter this on a unit exam or test: Has your pt been taking "K2" aka Spice? What's that about! Why are they acting this way? - correct answer Acidosis