7210 Final Exam Questions with Answers
What are some risk factors for an ectopic pregnancy? - -History of chlamydial or
gonorrheal infection
Exposure to diethylstilbestrol
Intrauterine device use (IUD)
Assisted reproductive technology
History of previous ectopic pregnancy
Maternal age >35
-What are the signs and symptoms of a un-ruptured ectopic pregnancy? - -1. Missed
period or first trimester
2. Abdominal pain
3. Vaginal bleeding (Keep in mind, 25% of pregnant women experience vaginal bleeding
before 12 weeks gestation. Bleeding equal to or heavier than normal menstruation and
accompanied by pain is associated with an increased risk of an abnormal pregnancy.)
-What are the signs and symptoms of a ruptured ectopic pregnancy? - -1. Hypotension
2. Tachycardia
3. Abdominal pain with rebound tenderness and guarding
-What is the method of choice for diagnosing a pregnancy? - -Transvaginal
Ultrasonography: TVUS is the method of choice for visualizing a pregnancy. For gestations
greater than 5.5 weeks, a TVUS examination should identify an IUP with near 100%
accuracy.
Beta-HCG: Serial beta-hCG concentration measurements are used to distinguish normal
from abnormal pregnancies
-Define Shock - -Shock: a complex syndrome characterized by decreased tissue perfusion
and impaired cellular metabolism which results in an imbalance in the supply of, and
demand for, oxygen and nutrients.
-What are the common signs and symptoms of shock - -Tachycardia
Hypotension
Cool clammy extremities
Oliguria
Weak, thready pulses
Altered LOC
Dysglycemia
Elevated lactate
Flattened neck veins (jugular venous distention in cardiogenic shock)
-State the main mechanisms of epinephrine, norepinephrine, dobutamine, dopamine,
isoproterenol and phenylephrine. State appropriate times to use them. - -1. Epinephrine:
Increases both mean arterial BP by vasoconstriction (a1-adrenergic effect) and cardiac
,output ( B1-adrenergic effect), and has bronchodilator effects (B2-adrenergic effect).
Associated with adverse effects like pulmonary HTN, tachyarrhythmias, myocardial
ischemia, lactic acidosis and hyperglycemia. Used primarily during anaphylaxis, cardiac
arrest, and is a last line of defense.
2. Norepinephrine: The primary vasoactive effect of norepinephrine is arterial and venous
vasoconstriction ( ↑ MAP, venous return, preload) and minimal increase of heart rate (a1-
adrenergic effects). Less metabolic adverse effects. Used primarily in sepsis, cardiogenic
shock and traumas.
3. Dobutamine: Dobutamine increases cardiac output and decreases systemic and
pulmonary vascular resistance. (B1) Dobutamine is the preferred vasoactive agent to treat
cardiogenic shock with low output and increased afterload. May be used for cardiogenic
shock or alongside norepi in septic shock.
4. Dopamine: dose dependent, may be more a1 or B1 effective. Dopamine's niche indication
is vasodilatory shock associated with bradycardia.
5. Isoproterenol: Mostly B1 & B2 effects, used to treat bradycardia.
6. Phenylephrine: Short acting a1 effects used to quickly increase MAP.
-What are some geriatric considerations in the Airway/C-spine assessment. - -C:
Osteoporosis/Kyphosis- may pose a challenge to applying the C-collar and also increase
risk of bone breaks due to trauma and falls.
A: False teeth help to maintain structure of airway but can pose a risk if they don't fit well
or during intubation should be removed.
Diminished cough reflex- increased risk for aspiration, difficulty swallowing, increased risk
of choking.
Dry mouth (not normal but due to medications or disease) - also increases risk of infection,
choking, ability to speak etc.
-What are some geriatric considerations in the Breathing assessment. - -Enlargement and
rigidity of chest wall and accessory muscle weakness leads to decreased in chest wall
compliance, shallow breathing, and VQ mismatch.
Supply is often less sensitive to changes in demand- with little exertion, they need more
oxygen and can become SOB easily.
Stretched out alveoli, VQ mismatch, oxygen exchange less efficient.
Altered chemoreceptor function- so not as sensitive to hypoxia and hypercapnia as a
younger person.
Kyphosis/scoliosis and stooped posture as one ages leads to decreased chest expansion so
more DEAD SPACE and decreased expiratory flow
-What are some geriatric considerations in the Circulatory assessment. - -Left ventricle
enlarges by 30% by 80 years of age and consequently there is left atrial enlargement. By
age 65 there is a 35% reduction in coronary blood flow. This can lead to dysrhythmias.
Contraction of the older heart is prolonged, most likely because of slow release of calcium
into the myoplasm during systole. Reduced efficiency and contractile strength of the heart
muscle are reflected in a reduced cardiac output. Sudden demands for more oxygen and
energy result in poor response of heart function attributed to the limited cardiac reserve.
, Conductivity is altered, more ectopic beats, more risk for arrhythmias and possibly
decreased cardiac output.
Vessels are less elastic, decreasing ability to respond in changes in BP.
Decrease in blood flow, glomeruli, renin, and filtration; loss of ability to concentrate urine
and conserve water; poor response to stress
-What are some geriatric considerations in the Disability assessment. - -Ocular changes in
cornea, iris, pupil, lens lead to impaired ability to see, needing more light, more risk for
falls. Also hearing and sensory losses.
Brain shrinks- bridging vessels can tear more easily as they are more atherosclerotic and
stretched out to reach the shrunken brain. So smaller amount of trauma can have more
devastating effects.
Loss of sensitivity to insulin, blood glucose does not return to normal as quickly.
Decreased perception of pain.
-What are some geriatric considerations in the Expose assessment. - -Temperature-
change in the distribution of body fat leads to a change in thermoregulation; usually their
resting body temperature is quite cool. What is considered a "low grade" fever in adults
could be actually a high fever in the geriatric population.
Loss of subcutaneous tissue and thinning of dermis, underlying tissue more fragile;
inability to respond to heat or cold quickly; proneness to heat stroke; loss of moisture;
wrinkling.
-What are the main induction agents used (and what do they do), and when would you use
them? - -Induction Agents: producing immediate unresponsiveness
1. Etomidate: Risky for patients who are immunocompromised, sepsis, transplant. May
cause hypotension.
2. Ketamine: Good for hemodynamically unstable pts. Avoid with MIs, increased ICP or
significantly high BP. May cause increase of BP/HR
3. Propofol: (general anesthesia) avoid if allergies to eggs, soybeans or peanuts. Good for
epileptic pts. Will cause hypotension, therefore not good for unstable pts.
-What are the main neuromuscular blocking agents used (and what do they do), and when
would you use them? - -Neuromuscular blocking agents: producing immediate muscular
relaxation
1. Succinylcholine: depolarizing muscle relaxant
Avoid if renal insufficiency, burns >10 hours old, crush injuries, eye disease, hyperkalemia,
history of hyperthermia, rhabdomyolysis. Used mainly for neurological issues where a
neuro assessment must be done post intubation (duration is 5-10 minutes).
2. Rocuronium (nondepolarizing) has less contraindications but has a longer duration (35-
45 mins)
-Name and describe the 7 P's of RSI - -1. Preparation & Plan
Assess for airway difficulties
Monitor vitals (including end-tidal CO2)
Functional IV access
What are some risk factors for an ectopic pregnancy? - -History of chlamydial or
gonorrheal infection
Exposure to diethylstilbestrol
Intrauterine device use (IUD)
Assisted reproductive technology
History of previous ectopic pregnancy
Maternal age >35
-What are the signs and symptoms of a un-ruptured ectopic pregnancy? - -1. Missed
period or first trimester
2. Abdominal pain
3. Vaginal bleeding (Keep in mind, 25% of pregnant women experience vaginal bleeding
before 12 weeks gestation. Bleeding equal to or heavier than normal menstruation and
accompanied by pain is associated with an increased risk of an abnormal pregnancy.)
-What are the signs and symptoms of a ruptured ectopic pregnancy? - -1. Hypotension
2. Tachycardia
3. Abdominal pain with rebound tenderness and guarding
-What is the method of choice for diagnosing a pregnancy? - -Transvaginal
Ultrasonography: TVUS is the method of choice for visualizing a pregnancy. For gestations
greater than 5.5 weeks, a TVUS examination should identify an IUP with near 100%
accuracy.
Beta-HCG: Serial beta-hCG concentration measurements are used to distinguish normal
from abnormal pregnancies
-Define Shock - -Shock: a complex syndrome characterized by decreased tissue perfusion
and impaired cellular metabolism which results in an imbalance in the supply of, and
demand for, oxygen and nutrients.
-What are the common signs and symptoms of shock - -Tachycardia
Hypotension
Cool clammy extremities
Oliguria
Weak, thready pulses
Altered LOC
Dysglycemia
Elevated lactate
Flattened neck veins (jugular venous distention in cardiogenic shock)
-State the main mechanisms of epinephrine, norepinephrine, dobutamine, dopamine,
isoproterenol and phenylephrine. State appropriate times to use them. - -1. Epinephrine:
Increases both mean arterial BP by vasoconstriction (a1-adrenergic effect) and cardiac
,output ( B1-adrenergic effect), and has bronchodilator effects (B2-adrenergic effect).
Associated with adverse effects like pulmonary HTN, tachyarrhythmias, myocardial
ischemia, lactic acidosis and hyperglycemia. Used primarily during anaphylaxis, cardiac
arrest, and is a last line of defense.
2. Norepinephrine: The primary vasoactive effect of norepinephrine is arterial and venous
vasoconstriction ( ↑ MAP, venous return, preload) and minimal increase of heart rate (a1-
adrenergic effects). Less metabolic adverse effects. Used primarily in sepsis, cardiogenic
shock and traumas.
3. Dobutamine: Dobutamine increases cardiac output and decreases systemic and
pulmonary vascular resistance. (B1) Dobutamine is the preferred vasoactive agent to treat
cardiogenic shock with low output and increased afterload. May be used for cardiogenic
shock or alongside norepi in septic shock.
4. Dopamine: dose dependent, may be more a1 or B1 effective. Dopamine's niche indication
is vasodilatory shock associated with bradycardia.
5. Isoproterenol: Mostly B1 & B2 effects, used to treat bradycardia.
6. Phenylephrine: Short acting a1 effects used to quickly increase MAP.
-What are some geriatric considerations in the Airway/C-spine assessment. - -C:
Osteoporosis/Kyphosis- may pose a challenge to applying the C-collar and also increase
risk of bone breaks due to trauma and falls.
A: False teeth help to maintain structure of airway but can pose a risk if they don't fit well
or during intubation should be removed.
Diminished cough reflex- increased risk for aspiration, difficulty swallowing, increased risk
of choking.
Dry mouth (not normal but due to medications or disease) - also increases risk of infection,
choking, ability to speak etc.
-What are some geriatric considerations in the Breathing assessment. - -Enlargement and
rigidity of chest wall and accessory muscle weakness leads to decreased in chest wall
compliance, shallow breathing, and VQ mismatch.
Supply is often less sensitive to changes in demand- with little exertion, they need more
oxygen and can become SOB easily.
Stretched out alveoli, VQ mismatch, oxygen exchange less efficient.
Altered chemoreceptor function- so not as sensitive to hypoxia and hypercapnia as a
younger person.
Kyphosis/scoliosis and stooped posture as one ages leads to decreased chest expansion so
more DEAD SPACE and decreased expiratory flow
-What are some geriatric considerations in the Circulatory assessment. - -Left ventricle
enlarges by 30% by 80 years of age and consequently there is left atrial enlargement. By
age 65 there is a 35% reduction in coronary blood flow. This can lead to dysrhythmias.
Contraction of the older heart is prolonged, most likely because of slow release of calcium
into the myoplasm during systole. Reduced efficiency and contractile strength of the heart
muscle are reflected in a reduced cardiac output. Sudden demands for more oxygen and
energy result in poor response of heart function attributed to the limited cardiac reserve.
, Conductivity is altered, more ectopic beats, more risk for arrhythmias and possibly
decreased cardiac output.
Vessels are less elastic, decreasing ability to respond in changes in BP.
Decrease in blood flow, glomeruli, renin, and filtration; loss of ability to concentrate urine
and conserve water; poor response to stress
-What are some geriatric considerations in the Disability assessment. - -Ocular changes in
cornea, iris, pupil, lens lead to impaired ability to see, needing more light, more risk for
falls. Also hearing and sensory losses.
Brain shrinks- bridging vessels can tear more easily as they are more atherosclerotic and
stretched out to reach the shrunken brain. So smaller amount of trauma can have more
devastating effects.
Loss of sensitivity to insulin, blood glucose does not return to normal as quickly.
Decreased perception of pain.
-What are some geriatric considerations in the Expose assessment. - -Temperature-
change in the distribution of body fat leads to a change in thermoregulation; usually their
resting body temperature is quite cool. What is considered a "low grade" fever in adults
could be actually a high fever in the geriatric population.
Loss of subcutaneous tissue and thinning of dermis, underlying tissue more fragile;
inability to respond to heat or cold quickly; proneness to heat stroke; loss of moisture;
wrinkling.
-What are the main induction agents used (and what do they do), and when would you use
them? - -Induction Agents: producing immediate unresponsiveness
1. Etomidate: Risky for patients who are immunocompromised, sepsis, transplant. May
cause hypotension.
2. Ketamine: Good for hemodynamically unstable pts. Avoid with MIs, increased ICP or
significantly high BP. May cause increase of BP/HR
3. Propofol: (general anesthesia) avoid if allergies to eggs, soybeans or peanuts. Good for
epileptic pts. Will cause hypotension, therefore not good for unstable pts.
-What are the main neuromuscular blocking agents used (and what do they do), and when
would you use them? - -Neuromuscular blocking agents: producing immediate muscular
relaxation
1. Succinylcholine: depolarizing muscle relaxant
Avoid if renal insufficiency, burns >10 hours old, crush injuries, eye disease, hyperkalemia,
history of hyperthermia, rhabdomyolysis. Used mainly for neurological issues where a
neuro assessment must be done post intubation (duration is 5-10 minutes).
2. Rocuronium (nondepolarizing) has less contraindications but has a longer duration (35-
45 mins)
-Name and describe the 7 P's of RSI - -1. Preparation & Plan
Assess for airway difficulties
Monitor vitals (including end-tidal CO2)
Functional IV access
