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SAEM M4 (CURRICULUM 2) EXAM 2024.2025 |GUARANTEED PASS!!, Exams of Nursing

SAEM M4 (CURRICULUM 2) EXAM 2024.2025 |GUARANTEED PASS!!

Typology: Exams

2024/2025

Available from 09/10/2024

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Download SAEM M4 (CURRICULUM 2) EXAM 2024.2025 |GUARANTEED PASS!! and more Exams Nursing in PDF only on Docsity!

SAEM M4 (CURRICULUM 2) EXAM

2024.2025 |GUARANTEED PASS!!

PID cause - ACCURATE ANSWERS✔✔ originates as a cervical infection with Neisseria gonorrhea and/or Chlamydia trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes and ovaries. 3 sx PID - ACCURATE ANSWERS✔✔ -lower abd pain -purulent vag d/c -vag bleed when getPID sx - ACCURATE ANSWERS✔✔ Symptoms begin shortly after the start of the menstrual cycle, when there are fewer defenses by the cervical mucosal barrier to ascending infections. PID with gonnoccal - ACCURATE ANSWERS✔✔ more likely to appear toxic (fever, N/V) dont forget one risk factor pid - ACCURATE ANSWERS✔✔ -recent instrumentation of uterus common exam findings pid - ACCURATE ANSWERS✔✔ -b/l adenexal tenderness -cervical d/c

cervical motion tenderness -uterine tender -lower abd tenderness if pain is u/l think more - ACCURATE ANSWERS✔✔ TOA if RUQ tender think - ACCURATE ANSWERS✔✔ Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule) best test for gonorrohea and chlaymida - ACCURATE ANSWERS✔✔ NAAT with PCR or DNA probes (either urine or cervical secretions) if suspect TOA get - ACCURATE ANSWERS✔✔ US ruptured ovarian cyst shows - ACCURATE ANSWERS✔✔ free fluid in pouch of douglas ovarian torsion shows - ACCURATE ANSWERS✔✔ absence of blood flow to one ovary on pelvic ultrasound with doppler why US>CT - ACCURATE ANSWERS✔✔ CT cannot eval for torsion bc there is no doppler who gets abx for PID - ACCURATE ANSWERS✔✔ -lower abdominal or pelvic pain coupled with adnexal, uterine or cervical motion

tenderness on exam, in a patient at risk for STDs with no other discernible cause for the illness identified complications of pid - ACCURATE ANSWERS✔✔ -chronic pelvic pain -infertility -ectopic -toa -fitz-hiugh curtis toa process - ACCURATE ANSWERS✔✔ walled-off abscess that originates in the infected fallopian tube and extends to involve the ovary how confirm dx of Fitz hugh curtis - ACCURATE ANSWERS✔✔ elevated liver fxn tests inpatient abx pid - ACCURATE ANSWERS✔✔ -cefoxitin + doxy or -cefotentan + doxy or clinda+gentamycin outpatient abx pid? add _____ if 2 - ACCURATE ANSWERS✔✔ - ceftriaxone -doxy

-add metro if severe infection or hx of uterine instrumentation who getsa dmitted - ACCURATE ANSWERS✔✔ -toa -fitz hugh curtis -septic -peritontiis -pre-pubertal kid -iud (which needs to be removed) -pregnant d/c with PID need what testing - ACCURATE ANSWERS✔✔ test for other STD describe whats going on in ovarian torsion - ACCURATE ANSWERS✔✔ ovary, and often the fallopian tube as well (adnexal torsion) become twisted around their vascular pedicle. progression of torsion - ACCURATE ANSWERS✔✔ twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is compromised, leading to ischemia and infarction risk factors for torsion - ACCURATE ANSWERS✔✔ ovary with a mass or cyst is more prone to twisting by virtue of its asymmetry

classic present torsion - ACCURATE ANSWERS✔✔ sudden onset of unilateral lower abdominal pain which is initially visceral in character (ie, vague and poorly localized) and may be accompanied by nausea and vomiting. It may radiate to the groin or flank. intermittent torsion - ACCURATE ANSWERS✔✔ several episodes of pain over the course of hours, days, or even weeks, why does current pregnancy inc risk of torsion - ACCURATE ANSWERS✔✔ corpus lutem cyst on ovary tests for torsion - ACCURATE ANSWERS✔✔ There are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion best way to dx torsion - ACCURATE ANSWERS✔✔ US careful with US: - ACCURATE ANSWERS✔✔ important to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion signs of torsion on US - ACCURATE ANSWERS✔✔ -enlargement/edema of ovary -ovrian mass or cyst -free pelvic fluid

what does CT torsion show - ACCURATE ANSWERS✔✔ finding an enlarged ovary or ovarian mass -assocaited free fluid -thick fallopian tube -deviation of uterus to the affected side definitively dx torsion - ACCURATE ANSWERS✔✔ OR tx torsion - ACCURATE ANSWERS✔✔ or (try and salvage ovary but testicle just gets removed) torsion sotry often sounds like - ACCURATE ANSWERS✔✔ kidney story testicular torsion is - ACCURATE ANSWERS✔✔ twisting of the testis and spermatic cord within the scrotum, with resulting in occlusion of venous return and and edema which can progress to arterial occlusion and ischemia normal testicle anatomy and issue with torsion - ACCURATE ANSWERS✔✔ anchored within the scrotum by the tunica vaginalis, which surrounds the testicle and attaches posteriorly to the scrotal wall and epididymis. The tunica vaginalis consists of a visceral and parietal layer with an interposed potential space. This potential space allows the testicle to rotate about the spermatic cord within the tunica vaginalis if a firm posterior scrotal attachment is lacking.

bell clapper deformity - ACCURATE ANSWERS✔✔ When the tunica vaginalis attaches higher up on the spermatic cord, the testicle can move and twist within the scrotum. inc risk of torsion 2 most common ages get torsion - ACCURATE ANSWERS✔✔ 1st year of life and in puberty hx of testicular torsion - ACCURATE ANSWERS✔✔ airly sudden, severe unilateral testicular pain, sometimes radiating into the abdomen, associated with nausea and vomiting -may have urgency, freuqency, dysuria which testicle most common - ACCURATE ANSWERS✔✔ left weird cause of torsion - ACCURATE ANSWERS✔✔ trauma exam - ACCURATE ANSWERS✔✔ -testicle is tender and swollen -sits higher in sac -sits in transverse lie -loss of cremasteric reflex (rise hihgerthan .5cm) labs in torsion - ACCURATE ANSWERS✔✔ usually not helpful

best way to dx testicle torsion? what show2 - ACCURATE ANSWERS✔✔ US: painful testicle is enlarged and hypeochoic as ocmpread to good side. can show absence of flow but this is alte finding torsion v. epididymitis - ACCURATE ANSWERS✔✔ usually associated with increased blood flow to the testicle and the epididymis, as part of the body's inflammatory response. torsion of testicular appendage -age of pop -where is pain -timeline of paiin -creamsteric reflex -us shows -tx -outcome - ACCURATE ANSWERS✔✔ -7-14yrs -upper pole of testicle -hrs-day -reflex is present -Body of testis similar to asymptomatic side with focal hypoechoic area -supportive -Infarction and resorption of appendage, no effect on fertility epididymis

-timeline -2 sx -cremasteric reflex -exam shows -2 labs -US shows -tx -outcome - ACCURATE ANSWERS✔✔ -over days -fever, dysuria -present -Epididymal tenderness with or without testicular tenderness -wbc and nitrites -Body of testis similar to asymptomatic side with hypoechoic epididymis -abx -Possible scarring, possible impaired fertility definitive dx testicle torsion - ACCURATE ANSWERS✔✔ OR if delay in getting to OR what do - ACCURATE ANSWERS✔✔ manual detorsion (rotat eit way from midline at least 360) -know it owrked if dec pain within minutes how know twist right way - ACCURATE ANSWERS✔✔ -if hard to untwist, try twisting the other way

when susepct trauma is cause of torsion - ACCURATE ANSWERS✔✔ testicular trauma who still has pain 1-2 hours after an injury. to US for torsion must - ACCURATE ANSWERS✔✔ compare side to side when managing torsion - ACCURATE ANSWERS✔✔ do not delay OR trip to use US as torison is mostly a clinical dx 4 types of intracranial hemorrhages - ACCURATE ANSWERS✔✔ - epidural -subdural -subarachnoid -intracerebral sx of all intracrnial hemorrhages 4 - ACCURATE ANSWERS✔✔ - headache -N/v -altered -seizure who is at risk for big bleed even with minor trauma - ACCURATE ANSWERS✔✔ -old -alcohol

-anticoagulated subarachnoid hemorrhage classic - ACCURATE ANSWERS✔✔ - thunderclap ha -reach max intensity within sec sah sx - ACCURATE ANSWERS✔✔ -loc -vomit -neck stiff sentinel ha - ACCURATE ANSWERS✔✔ -small headache=small bleed before a much larger bleed grading system for sah - ACCURATE ANSWERS✔✔ hunt and hess most common cause sah - ACCURATE ANSWERS✔✔ saccular aneurysms interestng risk factor for sah - ACCURATE ANSWERS✔✔ recent exertion epidural hematoma patho - ACCURATE ANSWERS✔✔ -trauma causes fracture of temporal bone to rupture middlemeningeal artery

classic story of epidural. but really - ACCURATE ANSWERS✔✔ -brief LOC after blow to head then lucid period than loc again -but most either dont hve loc or if they do, they dont get better subdural hematomas patho - ACCURATE ANSWERS✔✔ bridging eins are sheared during acceler-decel of head timeline of subdural/ esp what pop, why - ACCURATE ANSWERS✔✔ -can present late because the hematoma gros slow -esp delayed in those with brain atrophy bc there is more space in head for blood subdural in kid - ACCURATE ANSWERS✔✔ think childabuse shaken baby syndrome 3 - ACCURATE ANSWERS✔✔ -subdural -retinal hemorrhages -long bone fractures chronic subdural in 2 pops? 2 reasons why - ACCURATE ANSWERS✔✔ -old and alcoolic bc most prone to atrophy and coaugloapthy cushings triad= - ACCURATE ANSWERS✔✔ htn -brady -abnormal resp patterns

signifcance of cushings - ACCURATE ANSWERS✔✔ physiologic response to rapidly increasing intracranial pressure and imminent brain herniation colors of blood on ct by time - ACCURATE ANSWERS✔✔ -white if acute -3-14d then same color as brain -after 2 weeks=hypodense diagnostic pathway of sah - ACCURATE ANSWERS✔✔ -CT -then LP if after 6hrs of start of sx subdural on ct - ACCURATE ANSWERS✔✔ crescent sah on ct - ACCURATE ANSWERS✔✔ starfish. fillls sulci epidural on ct - ACCURATE ANSWERS✔✔ lens CSF of Sah - ACCURATE ANSWERS✔✔ -absence or clearing of blood -xanthocromia blood in csf ddx 3 - ACCURATE ANSWERS✔✔ -sah -infection

-traumatic tap how know its traumatic tap - ACCURATE ANSWERS✔✔ if fourth tube has almost no lbood in it if CT or LP pos in CAH next step - ACCURATE ANSWERS✔✔ angiogprahy if unsure if should get head ct - ACCURATE ANSWERS✔✔ -canadian ct rules what consider in hemorrhages - ACCURATE ANSWERS✔✔ seizure prophylaxis control inc ICP 5 - ACCURATE ANSWERS✔✔ -lower BP -elevate head of bed 30degrees -provide adequate sedation and analgesia -consider mannitol -or higer ventilation (goal CO2 around 30) 3 ways to have to stroke - ACCURATE ANSWERS✔✔ -embolus -thrombosis -bleed (under 15%)

aca stroke sx - ACCURATE ANSWERS✔✔ -LE>UE (weak and sensory loss) mca stroke sx - ACCURATE ANSWERS✔✔ -weak and sneosry loss of face and upper extremitiy with aphasia or neglect pca stroke sx - ACCURATE ANSWERS✔✔ homonomynous hemianopsia vertebrobasilar syndromes - ACCURATE ANSWERS✔✔ -c/l sensory and weakness -ipsilateral cn palsies -D signs: diplopia, dysarthria, dysphagia, droopy face, dysequelibrium, dusmetria, dec level fo conciosuness -N/V what is lacunar infarct - ACCURATE ANSWERS✔✔ cclusion of one of the deep perforating arteries which supplies the subcortical structures and brainstem. 5 diff presentations of lacunar syndromes - ACCURATE ANSWERS✔✔ -pure motor hemipareiss -sensorimotor troke -ataxic hemiparesis -pure sensory

-dysathria-clumsy hand syndrome most commmon ct findign in ishcmeic stroke= - ACCURATE ANSWERS✔✔ normal bc cant see findigns for several hours earliest stroke finding on CT - ACCURATE ANSWERS✔✔ hyperdensity representing acute thrombus or embolus in a major intracranial vessel. frank hypodensity on CT - ACCURATE ANSWERS✔✔ indicative of completed stroke and may be a contraindication to thrombolytic therapy whst must rule out in all stroke people - ACCURATE ANSWERS✔✔ hypoglycemia tpa - ACCURATE ANSWERS✔✔ fibrinolytic agent that catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown tpa timeline - ACCURATE ANSWERS✔✔ -best outcomes: witihn 90mi -max: 3-4.5h complication of TPA - ACCURATE ANSWERS✔✔ intracranial hemorrhage

tpa dispo - ACCURATE ANSWERS✔✔ icu reasons to stop tpa and get head ct - ACCURATE ANSWERS✔✔ -acute severe ha -acute sever ehtn -intractable n/v -ams -neuro deficits after TPA what must do - ACCURATE ANSWERS✔✔ stricktly keep b p under 180/105 to prevent hemorrhage if not on TPA tx stroke BP control - ACCURATE ANSWERS✔✔ under 220/ why aspirin within 48h of stroke - ACCURATE ANSWERS✔✔ reduce the rate of early reucrrent stroke (dont give for at least 24hr after give tpa) exclusion criteria of tpa - ACCURATE ANSWERS✔✔ -signficant head trauma or stroke in last 3 mo -sx suggest hemorrhage -hx of previous intracrnail hemorrhage -structural issues in brain -recent surgery

-BP>185/

-platelet under 100k -elevated PTT -INR>1. -PT? -CT shows multilobular infarction how get meningitis - ACCURATE ANSWERS✔✔ pathogens often invade the host through the upper airway by infecting the mucosa, bloodstream, and ultimately crossing the blood-brain barrier 3 causes of meningitis - ACCURATE ANSWERS✔✔ trauma, surgery, or a contiguous infection such as sinusitis or otitis media. 2 most common bacteria - ACCURATE ANSWERS✔✔ -strep pneumo -n menigitis listeria - ACCURATE ANSWERS✔✔ -over 50 -under 3 mo -immunocomproised -pregnany most commmon cause of encephalitis - ACCURATE ANSWERS✔✔ virus

when suspect encephalitis - ACCURATE ANSWERS✔✔ -suspected CNS infxn with ams or FND triad meningitis - ACCURATE ANSWERS✔✔ -fever -neck stiffness -ams common sx meningitis - ACCURATE ANSWERS✔✔ seizure kernig - ACCURATE ANSWERS✔✔ flexing the hip and extending knee to elicit pain in back and legs brudzinski - ACCURATE ANSWERS✔✔ passive flexion of neck causes flexion oh hip when ct before lp 5 - ACCURATE ANSWERS✔✔ -new seizures -immnocomrpsed -ams -fnd -papilledema try and do ____and ______ b4 abx - ACCURATE ANSWERS✔✔ -lp -blood cultures

CSF of bacterial meniningits -glucose -protein -wbc -percent neutrophils -opening pressure - ACCURATE ANSWERS✔✔ -under 40 -over 200 -wbc over 1000 -80% or more -increased encephalitis csf - ACCURATE ANSWERS✔✔ -inc wbc with llymhpcoccytic predominace -inc rbc why blood in csf 3 - ACCURATE ANSWERS✔✔ -edema -hemorrhage -necrosis empiric abx under 1 mo-3mo - ACCURATE ANSWERS✔✔ -amp and cefotaxime

empiric abx over 3 mo-adult under 50 - ACCURATE ANSWERS✔✔ - dexxamaethasone (maybe fore abx) -cefotaxime/ceftriazone -and vanco adult over 50 - ACCURATE ANSWERS✔✔ -dexxamaethasone (maybe fore abx) -cefotaxime/ceftriazone -and vanco -and ampicillin tx hsv encephalitis - ACCURATE ANSWERS✔✔ acyclovir tx other bugs that cause enhceplaitis - ACCURATE ANSWERS✔✔ just supporive care why steroid - ACCURATE ANSWERS✔✔ tarted before or concurrently with the first dose of antibiotics may decrease mortality and neurologic sequelae for some subsets of patients with bacterial meningitis. menigntiis triad prevlanece - ACCURATE ANSWERS✔✔ only there under 50% of time order of tx and tests - ACCURATE ANSWERS✔✔ Empiric antibiotics should not be delayed while waiting for a CT scan prior to an LP if

meningitis is a likely diagnosis. When a CT scan is necessary, draw blood cultures and administer steroids and appropriate antibiotics before the LP. CSF results if inconclusive - ACCURATE ANSWERS✔✔ tx empriicall anyway,csf often doesnt yeild classic results types of seizures - ACCURATE ANSWERS✔✔ simple v. complex focal. veneralized focal with secondary generalizaton most seizures last - ACCURATE ANSWERS✔✔ 1-2min clues its seizure - ACCURATE ANSWERS✔✔ -tongue trauma -urinary or bowel incontenince todds paralysis - ACCURATE ANSWERS✔✔ fnd post seiure what 4 sx raise suspicion for what 3 causes of seizures - ACCURATE ANSWERS✔✔ -tachy/diaphoresis/tremors/anixety -withdrawal -drug use -hypoglycemia

3 when do epileptics ahve breathru seizures - ACCURATE ANSWERS✔✔ -med noncomplaince -sleep deprivation -emotional or physical stress causes of seizure - ACCURATE ANSWERS✔✔ GAINCUCOHMW -low glucose -anatomic -infection -low or high Na -low calcuim -uremia -cocaine -low o2 -hepatic fail -low mag -withdrawal new onset first time seizure what tests - ACCURATE ANSWERS✔✔ - chemistry panel -pregnacy test people with epilepsy test - ACCURATE ANSWERS✔✔ get level of their drug

when get CT - ACCURATE ANSWERS✔✔ new onset seizure -chance in seizure pattern -more seizures latlet -trauma -new neuro defitic -anyone in status when dc a seizure patient what need - ACCURATE ANSWERS✔✔ mri as outpatient when get continuous eeg - ACCURATE ANSWERS✔✔ in status alcohol withdraw sx - ACCURATE ANSWERS✔✔ -anxiety -tremors -ams -tachy everything and htn does elevated alcohol blood level rule out withdrawal - ACCURATE ANSWERS✔✔ no chrnoic alcoholics can seizre at any point worry about preg + seizure - ACCURATE ANSWERS✔✔ eclampsia

4 when suspect ecalmpsia - ACCURATE ANSWERS✔✔ -vision complaints -edema of face hands and feet -rpoteinuria on UA -htn tb med that can cause siezures - ACCURATE ANSWERS✔✔ isonaidzid 2 trauma issues that can cause sieuzre - ACCURATE ANSWERS✔✔ - intracraial hemorrhage -brain injury clues to pseudoseizure - ACCURATE ANSWERS✔✔ -rhthymic, controlled shaking activity -ability to talk or follow commands during seizure -lack of postical status - ACCURATE ANSWERS✔✔ continuous seizure or do not return to baselie in between seizures 1st line tx seizure secnd third - ACCURATE ANSWERS✔✔ -benzo (lorazepam) -fosphenyton/phenobarbital/valproate