Medical practice test

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Abdominal Emergencies

• Anatomy and physiology of the abdomen:
  • GLASSS-P: Gallbladder, Liver, Appendix, Stomach, Spleen, Pancreas
  • Small intestine: Duodenum, Jejunum, Ileum
  • Large intestine: Ascending colon, Transverse colon, Descending colon, Sigmoid colon, Rectum, Anus
  • Peritoneum: Parietal peritoneum (lining that contains abdominal organs), Visceral peritoneum (lining that covers organs), Peritoneal cavity (space between parietal and visceral peritoneum)
• Communicable disease prevention: PPE (Personal Protective Equipment)
• Identifying and treating a patient with internal abdominal bleeding:
  • Upper GI bleed: melena (dark, tarry stool)
  • Lower GI bleed: hematochezia (bright red blood in stool)
  • Management: fluid resuscitation (1,000 ml of normal saline or lactated ringer solution)
• Preexisting conditions for kidney stones:
  • Struvite stones: more common in women, chronic UTIs, frequent catheterization
  • Uric acid stones: history of gout, more common in dry and arid regions
  • Cystine stones: causes large amounts of amino acids and proteins excreted in urine
• Signs and symptoms of a lower GI bleed:
  • Hematochezia (bright red blood in stool)
• Signs and symptoms of abdominal aneurysms:
  • Pain in abdomen, back, or flank
  • Nausea
  • Pulsating abdominal mass
• Signs and symptoms of an abdominal infection:
  • Peritonitis: diffuse abdominal pain, increase pain with coughing
  • Dunphy sign: rebound pain
  • Febrile, tachycardic, anorexic, nauseous, vomiting, dehydrated, and septic
• Signs and symptoms of an upper GI bleed:
  • Melena (dark, tarry stool)
• Treatment for GI bleeds:
  • IV and fluid resuscitation
  • Pain medications: meperidine hydrochloride (Demerol), morphine, ketorolac (Toradol)

Endocrine Disorders

• Preexisting conditions for Hyperosmolar Hyperglycemic Non-Ketotic (HHNK):
  • Hyperglycemia
  • Diabetic Ketoacidosis (DKA)
  • Hyperosmolar Hyperglycemic Syndrome (HHS)
• Signs and symptoms of a hyperglycemic crisis:
  • Polyuria (increased urine)
  • Polydipsia (increased thirst)
  • Polyphagia (increased hunger)
  • Nausea and vomiting
  • Tachycardia
  • Kussmaul respirations (deep, rapid respirations)
  • Warm, dry skin
  • Fruity odor of ketones (acetone smell) on breath
  • Abdominal pain
  • Sometimes fever
• Signs and symptoms of a thyroid storm:
  • Fever
  • Severe tachycardia
  • Nausea
  • Vomiting
  • Altered mental status
  • Possible heart failure
• Signs and symptoms of diabetic emergencies:
  • Hypoglycemia: loss of consciousness, altered mental status
  • Hyperglycemia: polyuria, polydipsia, polyphagia, nausea, vomiting, Kussmaul respirations, fruity odor of ketones on breath

GU/Renal

• Complications of an acid-base imbalance:
  • Respiratory acidosis: lungs cannot remove excess carbon dioxide, symptoms: systemic or cerebral vasodilation, headache, lightheadedness, warm, flushed skin, CNS depression, bradypnea, nausea, and vomiting
  • Respiratory alkalosis: carbon dioxide levels are too low, symptoms: diminished level of consciousness, lightheadedness, carpopedal spasm, paresthesias of lips and face, chest tightness, confusion, vertigo, blurred vision, nausea, and vomiting
  • Metabolic acidosis: vasodilation, CNS depression, headaches, warm, flushed skin, tachypnea, nausea, and vomiting
  • Metabolic alkalosis: confusion, muscle tremors and cramps, bradypnea, hypotension
• Pathophysiology of respiratory failure: they can’t breathe!
• Physiology of the buffering system: kidneys monitor hydrogen and bicarbonate levels in tubules of nephrons to maintain pH

Hematology

• Treating a patient with sickle cell disease:
  • Supplemental oxygen via NRB
  • Rapid transport
  • IV fluid therapy
  • Warm compresses
  • Position of comfort and cover to maintain body temperature
  • Nitrous oxide for pain

Immunology

• Side effects of an ACE inhibitor:
  • Angioedema (swelling of face and tongue)
• Side effects of IV fluid therapy:
  • Swelling
  • Infection
  • Redness
  • Fever
• Signs and symptoms of anaphylaxis:
  • Extreme allergic reaction involving two or more body systems
  • Key indicators: dyspnea, hypotension, tachycardia
  • Skin: warm, flushed, pruritus, swollen, red eyes, swelling of face and tongue, urticaria
  • Respiratory: dyspnea, tightness in throat and chest, stridor, hoarseness, lump in throat, wheezes, crackles
  • Cardiovascular: dysrhythmias, hypotension
  • GI: abdominal cramping, nausea, bloating, vomiting, abdominal distention
  • Central Nervous: headache, dizziness, confusion, anxiety, restlessness, sense of impending doom, altered mental status
• Treatment for allergic reactions:
  • Oxygen
  • Albuterol/DuoNeb
  • IV
  • Benadryl (25-50mg)
  • EKG
  • Epi (0.3mg)
  • Norepi
  • Transport
• Treatment for anaphylaxis:
  • Epi (0.3mg adult, 0.15mg pediatric)
  • Oxygen
  • IV (2 lines ideally)
  • Benadryl (25-50mg)
  • Albuterol/DuoNeb
  • Norepi
  • EKG
  • Transport

Infectious Diseases

• Medical terminology for contagious childhood diseases:
• Signs and symptoms of an infection (Sepsis):
  • Shivering, fever or feeling very cold
  • Extreme pain or discomfort
  • Clammy or discolored skin
  • Confusion or disorientation
  • Shortness of breath
  • Elevated heart rate
  • Quick Sepsis-related Organ Failure Assessment (qSOFA)
• Signs and symptoms of infectious diseases:
  • Meningitis:
    • Sudden-onset fever
    • Severe headache
    • Stiff neck
    • Kernig Sign
    • Brudzinski sign
    • Photosensitivity
    • Pink rash that becomes purple
    • Changes in mental status
    • Projectile vomiting
  • Seasonal influenza:
    • Systemic fever
    • Shaking chills
    • Headache
    • Muscle pain
    • Malaise
    • Loss of appetite
    • Dry and protracted cough
    • Hoarseness
    • Nasal discharge
• Transmission of communicable diseases:
  • Contact transmission
  • Droplet transmission
  • Airborne transmission

Neurological Emergencies

• Assessing stroke-like symptoms:
  • FAST:
    • Facial droop
    • Arm drift
    • Speech impairment
    • Time is critical
  • Cincinnati Stroke Scale:
    • Facial droop
    • Arm