MDC 4 MAIN EXAMINATION SET QUESTIONS AND
SOLUTIONS RATED A+
✔✔Stroke Initial assessment - ✔✔B-balance
E-Eyes
F-face
A-arms
S-speech
T-time
✔✔Right hemisphere stroke changes - ✔✔poor judgement
lack of awareness
visual deficits and neglect
left sided weakness
✔✔Left hemisphere stroke changes - ✔✔language deficits
anxiety/depression
right sided weakness
✔✔Stroke emerency interventions - ✔✔Rapid ID-hemmy or ischy
CT scan
Glucose stick
Give ateplase if ischy
ICU
frequent vitals
Hemmy-prep for surgery
✔✔When to give ateplase - ✔✔within 3-4.5 hours of initial onset
not a massive stroke over 2/3 of a hemisphere
CT done
glucose stick done/rule out hyperglycemia
BP below 185/110
✔✔Increased ICP symproms - ✔✔decreased LOC
restlessness, irritability and confusion
headache
nausea/vomiting
change in speech
pupillary changes
ataxia
seizuers
cushing triad
posturing
✔✔Cushing triad - ✔✔sign of increased ICP
,-Widening of pulse pressure,
-Slowing HR
-severe HTN
✔✔Increased ICP interventions (6)
Rx? - ✔✔HOB elevate to 30
O2 over 94%
head neutral position
no sudden movements-coughing, sneezing, blowing
no cluster of cares
low stimulation/quiet
Rx- mannitol
✔✔Guillian Barre Syndrome patho - ✔✔acute inflammation of axons or myelin of PNS
✔✔GBS causes - ✔✔infection- viral, GI
vaccine
autoimmune
✔✔GBS physcial assessment - ✔✔parethsesias
muscle weakness
loss of reflexes in arms/legs
low BP/ poor BP control
muscle weakness without muscle atrophy
uncoordinated movements
blurred vision
palpations
decreased respiratory function
✔✔GBS lab diagnosis - ✔✔CSF-increased protein, lymphocytes normal
EMG-normal early changes after 4 weeks
CT/MRI rule out
✔✔GBS interventions - ✔✔Plasmapherisis
IVIG
✔✔Plasmaphersis watch out for - ✔✔monitor for hypocalemia
uticaria
coagulopathy
risk for infections
fluid overload
sensitivity
✔✔IVIG complications - ✔✔myalgia
headaches
, anaphylaxis
asepetic meningitis
✔✔Myasthenia Gravis patho - ✔✔autoimmune disease
muscle weakness
✔✔Types of MG - ✔✔Ocular-eyes
generalized-throughout body
✔✔MG causes - ✔✔distorted acetylcholine receptors
hyperplasia of thymus gland
✔✔MG physcial assessment - ✔✔post infection, pregnancy anesthesia
period of exacerbation
temp weakness after vaccine, menstration, change in temp
worsening of symptoms with repetitive movement
drooping eyelids
dysphagia
voice weakens with use
✔✔Myasthenic crisis - ✔✔lack of meds, give a med and see if it helps
✔✔Cholinergic crisis - ✔✔too much meds
✔✔MG lab diagosis - ✔✔thyroid function
SPEP
AChR antibodies
chest xray/ct
RNS
EMG
Tensilon test
MuSK antibodies
✔✔MG non-surgical interventions - ✔✔respiratory assessment
suctioning
physiotherapy
activity after meds
protect eyes
✔✔MG drug intervention - ✔✔choliesterase inhibitors-pyridostigmine
immunosuppressant-methotrexate, rituximab, steroids
IVIG for acute treatment
✔✔MG surgical intervention - ✔✔thymectomy
SOLUTIONS RATED A+
✔✔Stroke Initial assessment - ✔✔B-balance
E-Eyes
F-face
A-arms
S-speech
T-time
✔✔Right hemisphere stroke changes - ✔✔poor judgement
lack of awareness
visual deficits and neglect
left sided weakness
✔✔Left hemisphere stroke changes - ✔✔language deficits
anxiety/depression
right sided weakness
✔✔Stroke emerency interventions - ✔✔Rapid ID-hemmy or ischy
CT scan
Glucose stick
Give ateplase if ischy
ICU
frequent vitals
Hemmy-prep for surgery
✔✔When to give ateplase - ✔✔within 3-4.5 hours of initial onset
not a massive stroke over 2/3 of a hemisphere
CT done
glucose stick done/rule out hyperglycemia
BP below 185/110
✔✔Increased ICP symproms - ✔✔decreased LOC
restlessness, irritability and confusion
headache
nausea/vomiting
change in speech
pupillary changes
ataxia
seizuers
cushing triad
posturing
✔✔Cushing triad - ✔✔sign of increased ICP
,-Widening of pulse pressure,
-Slowing HR
-severe HTN
✔✔Increased ICP interventions (6)
Rx? - ✔✔HOB elevate to 30
O2 over 94%
head neutral position
no sudden movements-coughing, sneezing, blowing
no cluster of cares
low stimulation/quiet
Rx- mannitol
✔✔Guillian Barre Syndrome patho - ✔✔acute inflammation of axons or myelin of PNS
✔✔GBS causes - ✔✔infection- viral, GI
vaccine
autoimmune
✔✔GBS physcial assessment - ✔✔parethsesias
muscle weakness
loss of reflexes in arms/legs
low BP/ poor BP control
muscle weakness without muscle atrophy
uncoordinated movements
blurred vision
palpations
decreased respiratory function
✔✔GBS lab diagnosis - ✔✔CSF-increased protein, lymphocytes normal
EMG-normal early changes after 4 weeks
CT/MRI rule out
✔✔GBS interventions - ✔✔Plasmapherisis
IVIG
✔✔Plasmaphersis watch out for - ✔✔monitor for hypocalemia
uticaria
coagulopathy
risk for infections
fluid overload
sensitivity
✔✔IVIG complications - ✔✔myalgia
headaches
, anaphylaxis
asepetic meningitis
✔✔Myasthenia Gravis patho - ✔✔autoimmune disease
muscle weakness
✔✔Types of MG - ✔✔Ocular-eyes
generalized-throughout body
✔✔MG causes - ✔✔distorted acetylcholine receptors
hyperplasia of thymus gland
✔✔MG physcial assessment - ✔✔post infection, pregnancy anesthesia
period of exacerbation
temp weakness after vaccine, menstration, change in temp
worsening of symptoms with repetitive movement
drooping eyelids
dysphagia
voice weakens with use
✔✔Myasthenic crisis - ✔✔lack of meds, give a med and see if it helps
✔✔Cholinergic crisis - ✔✔too much meds
✔✔MG lab diagosis - ✔✔thyroid function
SPEP
AChR antibodies
chest xray/ct
RNS
EMG
Tensilon test
MuSK antibodies
✔✔MG non-surgical interventions - ✔✔respiratory assessment
suctioning
physiotherapy
activity after meds
protect eyes
✔✔MG drug intervention - ✔✔choliesterase inhibitors-pyridostigmine
immunosuppressant-methotrexate, rituximab, steroids
IVIG for acute treatment
✔✔MG surgical intervention - ✔✔thymectomy
