Medical/AMLS Final review Questions and Answers 100% Solved

Medical/AMLS Final review Questions and Answers 100% Solved Headache, nuchal rigidity, fever/chills and photophobia is a classic sign of: Meningitis Patients who have headache and fever should be assessed for: (which sign(s)?) Kernig's (pain when extension of knee at sitting position; 'K' in Kernigs and knee) and Brudzinsky's signs (involuntary flexing of legs when flexing neck). Positive tests would indicate meningitis. Fluid shifting in lungs is: ARDS (Acute Respiratory Distress Syndrom); occurs during shock or can also happen because of pneumonia, aspiration, pancreatitis or drug overdose. High mortality Epiglottitis VS Croup VS Meningitis Epiglottis: High grade fever (102*F), Sore throat, Drooling, Leaning forward Croup: Seal bark cough at night, Low grade fever(102*F), Stridor Meningitis: Stiff neck, fever/chills, photophobia, Fever with seizures. Dental pain, fever, dysphagia and possible firm red pronounced swelling around throat: Ludwig's Angina Activation of the RAA Pathway is caused by: Dehydration, Drop in Na, or Hemorrhage (which all, essentially, can lead to shock) With regards to RAA: When a drop in BP is sensed by kidneys, they will release ________ which will Renin(think "RENal"/"RENin"; will combine with angiotensinogen (in blood) to make Angiotensin I. There's an enzyme in your lungs called ACE which stands for ________. As Angiotensin-1 is carried from your blood stream to your lungs, it combines with ACE and becomes _________. Angiotensin Converting Enzyme; Angiotensin-2. Angiotensin-2 specifically activates the ________________ to secrete _______________ adrenal cortex; aldosterone aldosterone Causes water and salt retention in blood, thus increasing blood pressure. ADH vs Aldosterone What's the difference between ADH and Aldosterone? ADH Keeps water, and water only; Aldosterone keeps water and salt. ........ If you eat food that's high in salts, you increase the tonicity of your bloodstream when it's absorbed and become hypertonic. That triggers ADH which causes your kidneys to retain water and only water. A drop in blood pressure will also cause ADH release because there's a multiplicity to the body all the time. There's never been a clinical case of somebody overproducing ADH. But there are clinical cases of lower than normal ADH levels (deficiency) which goes by the name of diabetes insipidus. What's diabetes insipidus? If you can't make ADH, you pee a lot because you have no way of not-peeing a lot. The word diabetes means to pee a lot. There's diabetes mellitus. Mellitus means sweet. So this is sweet pee. Insipidus is pee that doesn't taste sweet. These two diabetes were recognized by ancient greeks. When people would pee a lot, they would taste their urine. If it tastes sweet, it was called diabetes mellitus, and if it wasn't sweet it was called diabetes insipidus. Angiotenson, Renin and Aldosterone increase preload and afterload. During compensatory shock renin-angiotensin-aldosterone system is activated to cause: Increase preload afterload and reabsorption of sodium Cullen's vs Murphy's vs Kehr's VS Grey Turner Cullen's: Bruising around umbilicus; acute pancreatitis (the "C" in 'Cullen' wraps around the umbilicus) Murphy's sign: Tenderness in RUQ during inspiration (For Cholecystitis/Gall Bladder infection). Murphy's law- you' gonna get cholecystitis/gall bladder infection) Kehr's Sign: R Shoulder pain; splenic rupture or ectopic pregnancy. K almost looks like an "R" If you draw a line at the top of it. Should is on 'top' of spelee Grey Turner's Sign: Blue discoloration around flanks. Grey's anatomy would see something severe like this. Sympathomimetics: Simulate sympathetic nervous system. Alpha and Beta stimulants; Epinepherine, Dopamine, Albuterol, Levophed AntiCholinergic Opposite of parasympathomimetics effect. So it combats SLUDGE: Salivation, Lacrimation, Urination, Defication, GI problems, Emisis L Pain radiates to R in UQ's? Pancreatitis. Pancreatitis VS Appendicitis VS Gastroenteritis Pancreatitis: mild to severe upper abdominal pain often centered in the mid-epigastric area. The pain often radiates to the back and/or the chest, may be consistent for several hours, and may increase with eating or alcohol use. typically include nausea and vomiting. The patient's abdomen may be swollen and tender. Appendicitis: abdominal pain associated with anorexia, nausea and sometimes vomiting. The pain often begins in the periumbilical area and is described as vague and crampy. As the condition persists, the pain may become steady and sharp, localizing to the right lower quadrant Gastroenteritis: RUQ pain with positive Murphy's Sign. Mallory-Weiss Syndrom Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach COPD'ers will have a Hx of this arrhythmia: AFib AFib causes blood clots which causes: Pulmonary Embolisms Sudden dyspnea, cyanosis and sharp pain in chest; not relieved by O2 therapy: PE Chest Pain, ST Elevation in all leads, Fever Pericarditis What will cause respiratory alkalosis: Fever and Anxiety COPD has a tendency to develop what problem with symptoms of sudden onset, acute SOB and and CP: Pulmonary Embolism (Due to clots formed in the atrium) Initial symptoms of PE: Lung sounds are_____, HR is _______ Clear, Elevated Narcotic overdose would cause respiratory________. Acidosis. Not breathing off CO2 (Acid) If anaphylaxis is severe (bp90) administer IV Epi 1:1,000 .3 If a patient is seizing, regardless of cause (i.e. fever, drugs, etc.) do this: Administer Diazepam/Valium(5-10mg) or Midazolam/Versed (2.5-5) A severe shortness of breath occurring at night after several hours of recumbency, during which fluid pools in the lungs. The patient is forced to sit up to breathe. It is caused by left heart failure. Paroxysmal Nocturnal Dyspnea Septic Pt with fever/ upper respiratory infection and have been peeing/drinking a lot: pick Hyperglycemia High BP, High temp, High RR, High sugar and a history of Graves disease give this type of medication: Beta blockers; will slow everything down Metabolic Acidoses - Ph is down (below 7.35) PcO2 is down, also look for Abnormal bicarb 2nd process in pathway of amls assessment Look for immediate life threats _______ is most important with stroke, determines if they go to a stroke center or not Time Thunder clap in head=_____ subarachnoid Subdural vs Epidural bleed speed Subdural is slow; epidural is fast (artery) Manage an allergic reaction with Epi of___not .5 at a bare minimum they get an .3, not .5; get an IV red rash, fever, chills MRSA. Bad infection after surgery. Abdominal cramping, nausea, vommiting 3 days: gastroenteritis Extreem thirst, diabetes, low bp, drinking a lot=DKA. But, if respirations are 14= HHNS Taking a ton of analgesic w/ abd pain and vomiting, probably: OD on acetomenophin Anyone with Pancreatitis may have _________ develop. Gallstones/cholystitis develop in gallbladder L abd pain and what it could be? Ectopic pregnancy or Diverticulitis If spinal cord surgery , probably : ______ shock neurogenic/spinal Quadraplegic with Fever, difficulty breathing and dark urine in catheter probably has a: UTI which can cause sepsis Back from foreign country, night sweats and cough = = TB Mild Hypothermic VS Critical Hypothermia - S/S & Tx? Mild: shivering and talking ; gets blanket and get them out of the environment and warm fluids if avalable VS Critical : unconscious, avoidrough handling. If they go into V-Fib they get one shock and one round of drugs. Someone stranded on a hot day in woods - cool off and give fluids, intubate on side of mountain, you must do it the whole way down... Foul smelling diharrea, cramping and taking antibiotics for a long time: C-Dif (clostridium difficile). Problem in old people: immuned system is weakend, cant get a fever (an, look for all of the following except...) CHF presentation but BP has now fallen is in ____ shock. Tx? CHF presentation but BP has now fallen - Cardiogenic Shock. Rx is dopamine drip CHF patient w/ osteoperosis, neck broken, how to transport ? KED TKO rate per hour is: ___/hr or ____ dpm 25 cc's per hour = 4 dpm Food from same place and everyone's sick immediately afterwards: Food poisoning (Viruses and Flu have an incubation period) Female after jogging sudden onset of pain and bleeding is: ectopic Sickle cell crisis, how do you know it's getting worse? Makes all symptoms go up (SOB/Pain) and Priapism ; - Metabolic Acidotic ( Vasodiolate) Lukemia destroys white blood cells can't fight infection - don't : start an IV bc it can increase the risk for infection Lock jaw caused by Tetanus Rabies will cause: severe abdominal pain, slurred speech, headache Rattle snake bite needs: Fluids; no constricting band or cold packs Chronic hypertension and blood thinners, risk of : Hemorrhagic stroke Pt tries to kill themselves find out if they ingested anything, you need to find out: what TIME they did it (watch for secondary attempt) Headache when lying down and goes away after work . Pain happening for a week - Possible: Slow head bleed or stroke (check pupils and stroke test)