Med surg 1 Final
1. Appendicitis and what will get you worried
If pt is having pain and suddenly the pain goes away it is not good, it now
becomes medical emergency and surgery is required!!
2. Hemodialysis what are s/s Disequilibrium syndrome
Dialysis Disequilibrium Syndrome
Fluid shift in brain
Early: nausea, disorientation, restlessness
Late: confusion
3. Aki? If they develop hyperkalemia what's the tx for it
Sodium polystyrene sulfonate (Kayexalate)
4. Max dose of acetaminophen (APAP)
4 g or 4,000mg
5. Ketorolac
No with NSAIDS & Max 5 days usage (EX: if start on tues stop on Sunday)
6. Opioid toxicity tirade
Pinpoint pupils, ALOC, Resp depression
7. s/s PAD, vs venous insufficency PVD and differences (both could have ulcers and sore
but where?) one feels warm or feels cold SATA for s/s
PVD vs PAD SATA question
PAD - Peripheral Arterial Disease (HANG LEGS)
Cold toes
No pulses
Hairless shiny skin
Dependent rubor
Sores on toes
PVD - Peripheral VENOUS Disease (ELEVATE LEGS)
, Red/ brown color
Pitting edema
Ulcers on medial malleolus
Chronic dermatitis
Varicose veins
8. What is rovsing sign Kehr's sign
rovsing's sign
o push/palpate on left lower quad ( makes right quad hurt)
Kehr’s sign
Left should pain (ruptured spleen)
9. s/s hypothyroidism
Lethargy, cold intolerance, late s/s- wt gain, subnormal temperature,
bradycardia
10. Know Levothyroxine
A/e: s/s of hyperthyroidism
Admin in morning before food
Don't stop abruptly, Hold HR > 110
11. s/s hyperthyroidism
Wt loss, finger clubbing, tremors, intolerance to heat, bulging eyes,
tachycardia, high systolic BP
12. Tx hyperthyroidism and safety considerations
Medical therapy
o PO PIlls PTU and Methimazole (can cause agranulocytosis of pancytopenia)
o Radioactive Iodine therapy
Sub total thyroidectomy- use lugols solution while waiting for sx
o Have trach tray and calcium
o Stridor is bad and could be swelling and tetany
o Support neck while coughing
o Lugol's can stain teeth and take after meals
Equipment for Sub- thyroidectomy:
O2 set up with humidification, Suction tubing, trach tray, IVP Ca
, 13. Iodine 131 therapy radioactive so know precaution in hospital or home
o Delayed response 2-3 months
o Remember time, Distance and Shielding
14. S/S of Hypocalcemia
Chvostek's & Trousseaus, Circumoral tingling, fractures, bleeding, arrythmias
15. S/S SIADH (Too much ADH) (SATA)
Pt wet but the bag is dry (30 ml/hr is normal urine output)
S/S: H/A, weakness, anorexia, muscle cramps, wt gain without edema (Na is not
retained)
Testing: urine( concentrated) and blood tests (Diluted)
16. S/S Diabetes insipidus (Low ADH) (SATA)
Dry but foley is wet (urinate a lot)
S/S: Polyuria, Sunken eyes, Tachycardia, OH, Tenting, Dry mucous membrane, Weak
thready pulse, Aloc/ SZ
Testing: Urine testing (more dilute urine) & blood draw (concentrated)
17. CI of Vasopressin
CI: CAD/ MI/ Angina , monitor ECG
18. s/s insulin
Lipodystrophy (Rotate sites to prevent) , Hypoglycemia, hypokalemia (heart
palpitation, weakness, fatigue, tingling)
19. Type 1 diabetes & 2 if you need to explain to pt
DM I (Autoimmune)
o Caused by genetic factors
DM II
o mainly lifestyle or maybe ethnicity
20. Metabolic syndrome what were the 4 things that contribute
Abdominal obesity, insulin resistance, elevated lipids & triglycerides, HTN
1. Appendicitis and what will get you worried
If pt is having pain and suddenly the pain goes away it is not good, it now
becomes medical emergency and surgery is required!!
2. Hemodialysis what are s/s Disequilibrium syndrome
Dialysis Disequilibrium Syndrome
Fluid shift in brain
Early: nausea, disorientation, restlessness
Late: confusion
3. Aki? If they develop hyperkalemia what's the tx for it
Sodium polystyrene sulfonate (Kayexalate)
4. Max dose of acetaminophen (APAP)
4 g or 4,000mg
5. Ketorolac
No with NSAIDS & Max 5 days usage (EX: if start on tues stop on Sunday)
6. Opioid toxicity tirade
Pinpoint pupils, ALOC, Resp depression
7. s/s PAD, vs venous insufficency PVD and differences (both could have ulcers and sore
but where?) one feels warm or feels cold SATA for s/s
PVD vs PAD SATA question
PAD - Peripheral Arterial Disease (HANG LEGS)
Cold toes
No pulses
Hairless shiny skin
Dependent rubor
Sores on toes
PVD - Peripheral VENOUS Disease (ELEVATE LEGS)
, Red/ brown color
Pitting edema
Ulcers on medial malleolus
Chronic dermatitis
Varicose veins
8. What is rovsing sign Kehr's sign
rovsing's sign
o push/palpate on left lower quad ( makes right quad hurt)
Kehr’s sign
Left should pain (ruptured spleen)
9. s/s hypothyroidism
Lethargy, cold intolerance, late s/s- wt gain, subnormal temperature,
bradycardia
10. Know Levothyroxine
A/e: s/s of hyperthyroidism
Admin in morning before food
Don't stop abruptly, Hold HR > 110
11. s/s hyperthyroidism
Wt loss, finger clubbing, tremors, intolerance to heat, bulging eyes,
tachycardia, high systolic BP
12. Tx hyperthyroidism and safety considerations
Medical therapy
o PO PIlls PTU and Methimazole (can cause agranulocytosis of pancytopenia)
o Radioactive Iodine therapy
Sub total thyroidectomy- use lugols solution while waiting for sx
o Have trach tray and calcium
o Stridor is bad and could be swelling and tetany
o Support neck while coughing
o Lugol's can stain teeth and take after meals
Equipment for Sub- thyroidectomy:
O2 set up with humidification, Suction tubing, trach tray, IVP Ca
, 13. Iodine 131 therapy radioactive so know precaution in hospital or home
o Delayed response 2-3 months
o Remember time, Distance and Shielding
14. S/S of Hypocalcemia
Chvostek's & Trousseaus, Circumoral tingling, fractures, bleeding, arrythmias
15. S/S SIADH (Too much ADH) (SATA)
Pt wet but the bag is dry (30 ml/hr is normal urine output)
S/S: H/A, weakness, anorexia, muscle cramps, wt gain without edema (Na is not
retained)
Testing: urine( concentrated) and blood tests (Diluted)
16. S/S Diabetes insipidus (Low ADH) (SATA)
Dry but foley is wet (urinate a lot)
S/S: Polyuria, Sunken eyes, Tachycardia, OH, Tenting, Dry mucous membrane, Weak
thready pulse, Aloc/ SZ
Testing: Urine testing (more dilute urine) & blood draw (concentrated)
17. CI of Vasopressin
CI: CAD/ MI/ Angina , monitor ECG
18. s/s insulin
Lipodystrophy (Rotate sites to prevent) , Hypoglycemia, hypokalemia (heart
palpitation, weakness, fatigue, tingling)
19. Type 1 diabetes & 2 if you need to explain to pt
DM I (Autoimmune)
o Caused by genetic factors
DM II
o mainly lifestyle or maybe ethnicity
20. Metabolic syndrome what were the 4 things that contribute
Abdominal obesity, insulin resistance, elevated lipids & triglycerides, HTN
