Clinical Case Studies in Emergency Medicine, Exams of Bioethics

Download Clinical Case Studies in Emergency Medicine and more Exams Bioethics in PDF only on Docsity! FPC-CFRN Review Exam-Version B Exam Questions with Verified Solutions. Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. Hypothyroidism D. Hyperaldosteronism - ANS Hypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. >90% of cases occur in the winter D. Primarily in men - ANS Primarily in men Hypothyroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis - ANS Hypovolemic shock Careful interpretation of the CVP is important! Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Lavished C. Nitride D. Dobutamine - ANS Lavished Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. >30 mmHg - ANS Normal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP D. 2 + DBP × SBP divided by 3 - ANS 2 × DBP + SBP / 3 (Normal 80-100 mmHg) Normal coronary perfusion pressure (CPP) is A. 50-60 mmHg B. 70-90 mmHg C. 80-100 mmHg D. <50 mmHg - ANS Normal 50-60 mmHg Coronary perfusion pressure: (CPP) = DBP-PAWP The patient presents with the following hemodynamic parameters: CVP 1, CI 1.7, PA S/D 12/6, wedge 6, and SVR 300. Vital signs are 78/40, HR 60, RR 16, SaO2 98%. The most likely cause is... A. RVMI B. Neurogenic shock C. Septic shock D. Hypovolemic shock - ANS Neurogenic shock SVR < 800, think distributive shock. Next look at the CI; is it less than 2.5? Hypotension and either a normal heart and/or bradycardia present narrows the type of distributive shock as being neurogenic shock. Severe hypothermic Pt.’s are at highest risk for which of the following rhythm? A. A-Fib B. Systole C. V-Fib D. Sinus Brady - ANS V-Fib Severe: 20-28 (coma, VF common) The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is: A. Anatine B. Sodium bicarbonate C. Dantrolene D. Glucagon - ANS Dantrolene Malignant hyperthermia: Characteristic signs are muscular rigidity, followed by a hyper catabolic state; with increased oxygen consumption, increased carbon dioxide production (hyper apnea, Your patient was struck from behind while driving. The most common area of injury from a rear- end collision is: A. Ankle fracture B. Coup Countercoup injury pattern C. C2 fracture D. T12-L1 injuries - ANS T12-L1 injuries Dry chemicals such as lime should be... A. Brushed off before irrigation B. Neutralized with a special agent before irrigation C. Irrigated immediately with water or physiologic saline D. Wrapped in a dressing and not irrigated - ANS Brushed off before irrigation Chemical burns differ from thermal burns in that the burning process continues until the agent is inactivated by reaction of tissues: neutralized or diluted with water. Dry chemicals, such as lime, should be brushed off before irrigation. Water and physiologic saline are fluids of choice for wound irrigation. Haman’s sign may indicate which of the following? A. Tension pneumothorax B. Tracheobronchial injury C. Aortic rupture D. Cardiac tamponed - ANS Tracheobronchial injury Haman’s sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr. B. 10-20 mL/hr. C. 30-50 mL/hr. D. >100 mL/hr. - ANS 30-50 mL/hr. Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium glucometer B. Osmotic diuretics C. Glucagon D. Pyrimidine - ANS Calcium glucometer Hydrofluoric acid exposure is often treated with calcium glucometer, a source of Ca2+ that sequesters the fluoride ions. HF chemical burns can be treated with a water wash and 2.5% calcium glucometer gel or special rinsing solutions. However, because it is absorbed, Medical treatment is necessary; rinsing off is not enough and in some cases, amputation may be necessary. The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT: A. Serum sodium goal 155 B. Serum osmolality less than 320 C. Hypertonic saline, manifold D. Hyperventilation to maintain EtCO2 at 20-30 mmHg - ANS Hyperventilation to maintain EtCO2 at 20-30 mmHg Routine hyperventilation is no longer recommended in the initial management of the patient with traumatic brain injury. The patient's EtCO2 should be maintained between 35-45 mmHg. Classic picture of neurogenic shock presents with... A. Hypertension B. Absence of tachycardia C. Cool skin D. Pallor - ANS Absence of tachycardia Loss of sympathetic tone below the level of the injury results in loss of auto regulation, a decrease in vascular tone, and inability of the heart to increase its intrinsic rate. The classic picture of neurogenic shock presents with the absence of tachycardia. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing Headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a Foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nitride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. - ANS Insert a Foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: A. Brown-Squared B. Central cord C. Anterior cord syndrome D. Neurogenic shock - ANS Brown-Squared Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown- Squared or incomplete Brown-Squared syndrome, so long as it has characterized by features of a motor loss and numbness to touch and vibration on the same side of the spinal injury and loss of pain and temperature sensation on the opposite side. Most often occurs from a penetrating injury that has damaged one side of the spinal cord. Blood supply to the anterior portion of the spinal cord is interrupted, causing a complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract. Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spin thalamic tract. Retained proprioception and vibratory sensation due to intact dorsal columns. Most often occurs after hyper flexion injury - ANS "Anterior cord" syndrome It is characterized by disproportionately greater motor impairment in upper compared to lower extremities and variable degree of sensory loss below the level of injury. Most often occurs after hyperextension injury. - ANS "Central cord" syndrome Sinusoidal patterns are commonly associated with all of the following, EXCEPT: A. Fetal hypovolemia or anemia B. Accidental tap of the umbilical cord during amniocentesis C. Pregnancy-induced hypertension (PIH) D. Placental abruption - ANS Pregnancy-induced hypertension A uniform sine wave pattern indicates fetal hypovolemia or anemia and may occur in cases of erythroblastosis fetal is, accidental tap of the umbilical cord during amniocentesis, fetomaternal transfusion, placental abruption, or another type of accident. Diving injuries - 1 ATM for every??? Feet descent - ANS 1 ATM for every 33 feet descent You will be transporting a stable twenty-seven-year-old man with no traumatic pneumocephalous secondary to gas producing necrotizing bacteria from rural hospital at 8,500 feet elevation to a local hospital at 1,200 feet sea level. What might be the best transport option? What gas law will most affect this patient negatively? A. Ground; Boyle's law B. Fixed wing transport pressurized to 9,000 AGL; Charles' law C. Rotor transport; Boyle's law D. Rotor transport; Charles' law - ANS Ground; Boyle's law Pneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery or otorhinolaryngology, and rarely, spontaneously. Pneumocephalus can occur in scuba diving, but is very rare in this context. Unpressurized aircraft is not recommended for this patient's condition. When performing a pericardiocentesis, the insertion site is... A. Below the subxyphoid process VT (tidal volume) of 5-8 mL/kg is generally indicated, with the lowest values recommended in the presence of obstructive airway disease and ARDS. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2O. The test most often used to diagnose a pulmonary embolism is: A. Chest x-ray B. V/Q lung scan C. 12-lead ECG D. ABG - ANS V/Q lung scan A ventilation/perfusion lung scan, also known as a V/Q lung scan, is a type of medical imaging that is used to evaluate the circulation of air and blood within the lungs. The ventilation portion of the exam assesses the ability of air to reach all sections of the lungs, and the perfusion portion evaluates how well blood circulates within the lungs. The test is commonly done to evaluate for the presence of blood clots or abnormal blood flow inside the lungs, such as a pulmonary embolism (PE). Acute respiratory failure is defined as: A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 - ANS pO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilator respiratory failure), which is usually accompanied by fall in the pH < 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection - ANS Mask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous - ANS Pulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such as headache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypomania C. Hypothermia D. Increased levels of 2, 3-DPG - ANS Increased levels of 2, 3-DPG The ox hemoglobin dissociation curve describes the relation between the partial pressure of oxygen and the oxygen saturation. The effectiveness of hemoglobin-oxygen binding can be affected by several factors. Situations that involve a RIGHT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypercapnia C. Hyperthermia D. Increased level of 2, 3-DPG - ANS Alkalosis Alkalosis causes a left shift. A scaphoid abdomen, unequal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? A. Tension pneumothorax B. Diaphragmatic hernia C. Aspiration pneumonia D. RDS, formerly known as hyaline membrane disease - ANS Diaphragmatic hernia Diaphragmatic hernia is caused early in gestation when the pleuroperitoneal cavity fails to close. Abdominal contents migrate into the thoracic cavity, compressing developing lungs and causing pulmonary hypoplasia. Because any distention of the bowel further compromises respiratory function, the transport team should insert a large-bore (10 Fry) or gastric tube and initiate suction. Positive-pressure ventilation with a face mask should be avoided. Hypoglycemia in the neonate can be treated with: A. D 25% 2-4 mL/kg B. D 10% 2-4 mL/kg C. D 10% 5-10 mL/kg D. D 5% 2-4 mg/kg - ANS D-10% (2-4 mL/kg) A serum glucose of < 40 mg/ld. represents hypoglycemia in the newborn. The newborn weighing less than 1,000 g should receive 5% dextrose in water because of their intolerance of the higher glucose loads resulting in hyperglycemia. Hypoglycemia should be treated in the neonate presenting with readings of: A. < 70 mg/dl B. < 60 mg/dl C. < 50 mg/dl D. < 40 mg/dl - ANS < 40 mg/dl A serum glucose of < 40 mg/ld. represents hypoglycemia in the newborn. Common cause of seizures = hypoglycemia < 40 mg/ld. and hypoxia Repeated doses of intimidate can cause: A. Increased ICP B. Acute adrenal insufficiency C. AMI D. Pulmonary edema - ANS Acute adrenal insufficiency Intimidate (Amid ate), which is classified as a sedative-hypnotic can block the adrenal gland's production of cortisol and other steroid hormones, possibly resulting in temporary adrenal gland failure. This may cause abnormal salt and water balance, lowered blood pressure, and, ultimately, shock. Patients with known Addison's disease (acute renal insufficiency) should not be given intimidate. Coronary Perfusion Pressure (CPP) is calculated how? PCWP (pulmonary capillary wedge pressure) A. DBP - PCWP B. DBP + PCWP C. SBP - DBP D. SBP - PCWP - ANS CPP = DBP-PCWP (normal 50-60 mmHg) "Cerebral" perfusion pressure which can be calculated by using the following formula: MAP − ICP. Normal range for cerebral perfusion pressure is 70-90 mmHg. Remember that your HEAD is higher than your HEART. Inferior wall MI is caused by an occlusion of which coronary artery? A. LAD B. RCA C. Circumflex D. Inferior vena cava - ANS Right coronary artery (RCA) "Lateral Wall" ST elevation in... - ANS I, Val, V5, V6 D. ST elevation in V1-V4 with abnormally tall R waves - ANS ST Depression in V1-V4 with abnormally tall R waves Acute respiratory failure is defined as: A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 - ANS pO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilator respiratory failure), which is usually accompanied by fall in the pH < 7.3. A sign of hyperventilation and hypocalcaemia is: A. Ker’s B. Grey Turner's C. Trousseau's D. Brzezinski’s - ANS Trousseau's To elicit Trousseau's sign, a blood pressure cuff is placed around the patient's arm and inflated to a pressure greater than the systolic blood pressure and held in place for three minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcaemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metatarsophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. You are transporting a forty-year-old man from a rural ICU. The CXR reveals a ground glass appearance. The patient is on a ventilator with settings at: VT 900 mL, rate of 16, FIO2 0.8 with a PEEP of 5. ABG's reveal: pH 7.34, pO2 76, pCO2 38 and HCO3 of 24. What pulmonary condition do you suspect? A. Pneumothorax B. Pulmonary edema C. ARDS D. Cur pulmonale - ANS ARDS ARDS, also known as respiratory distress syndrome (RDS); lungs are typically irregularly inflamed and highly vulnerable to atelectasis as well as barotrauma and volutrauma, which leads to impaired gas change, resulting in a severe oxygenation defect (hypoxemia). ARDS was defined as the ratio of arterial partial oxygen tension (PaO2) as fraction of inspired oxygen (FIO2) below 200 mmHg in the presence of bilateral alveolar infiltrates on the chest x- ray. Also, the pulmonary capillary wedge pressure is normal (less than 18 mmHg) in ARDS but raised in left ventricular failure. You would manage a Pt. with ARDS by... A. Increasing the rate B. Increasing PEEP C. Performing a rapid needle decompression D. Administering Lasix - ANS Increasing PEEP Positive end-expiratory pressure (PEEP) is used in mechanically ventilated patients with ARDS to improve oxygenation. Hypothermia, low levels of 2, 3-DPG, and hypocarbia can cause the ox hemoglobin dissociation curve shift to go... A. Up B. Down C. Right D. Left - ANS Left A left shift causes an increase in the affinity, making the oxygen easier for the hemoglobin to pick up but harder to release. * L stands for low/holds onto oxygen. * Low temperature (hypothermia) * Low 2, 3-DPG levels, Production decreases with septic shock and hypophosphatemia. * Low pCO2 * There is an "L" in ALKALOSIS In addition to glucose, which electrolyte must be maintained within normal limits when managing a head-injured patient? A. Calcium B. Magnesium C. Potassium D. Sodium - ANS Sodium Maintaining serum sodium levels of 145-155 moll/L is likely to achieve this goal. Low serum sodium levels following traumatic brain injury (TBI) can lead to extracellular volume depletion and cerebral edema. These can all result in dangerous increases in ICP. Hypertonic saline can help avoid the negative effects of hypernatremia by increasing serum sodium levels in the acute phase of head trauma care You are transporting a twenty-year-old male, with penetrating head and facial trauma. During transport, the patient complains of a severe headache, nausea, and vertigo. Your assessment reveals nuchal rigidity, aphasia, dysphasia, along with the patient having episodes of vomiting. What is your diagnosis? A. Pneumothorax B. Pneumocephalus C. Neurogenic shock D. Hypercapnia - ANS Pneumocephalus Pneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery, or with scuba diving (rare). The CT scan of patients with a tension pneumocephalus typically show air that compresses the frontal lobes of the brain, which results in a tented appearance of the brain in the skull known as the Mount Fuji sign. The name is derived from the resemblance of the brain to Mount Fuji in Japan, a volcano known for its symmetrical cone. Calculate the following patient's cerebral perfusion pressure (CPP): BP 180/90, HR 120, RR 24, SpO2 98%, CVP 2, ICP 25. A. 80 B. 120 C. 65 D. 95 - ANS 95 90 × 2 = 180; 180 × 2 = 360 360 divided by 3 = 120 120-25 = 95 Calculate the following patient's cerebral perfusion pressure (CPP): BP 150/75, HR 140, RR 28, and SpO2 100%, CVP 2, ICP 25. A. 98 B. 125 C. 65 D. 75 - ANS 75 MAP = [(75 × 2) + 150] divided by 3 = 100. CPP = 100-25 = 75 mmHg MAP = [(DBP × 2) + SBP] divided by 3 CPP = MAP − ICP Henry's law best describes which of the following patient conditions? A. Bends B. Barotrauma C. Shallow water blackout D. Arterial gas embolism (AGE) - ANS Bends Henry's law states that at a constant temperature, the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid. Aortic rupture with 90% of patients who die at the scene. Chest x-ray findings: widening mediastinum and loss of aortic knob shadow. After administering fluid resuscitation, performing vigorous fundal massage and giving oxytocin, your patient continues with postpartum hemorrhage. Which drug would be indicated to decrease blood loss? A. Apresoline B. Methergine C. Terbutaline D. Magnesium sulfate - ANS Methylergonovine (Methergine) 0.2 mg administered intramuscularly or intravenously, is recommended. Methylergonovine should be used cautiously in patients with PIH because of the presser effects that may result in further elevated blood pressure. Methylergonovine is a blood vessel constrictor and smooth muscle agonist most commonly used to prevent or control excessive bleeding following childbirth and spontaneous or elective abortion. It also causes uterine contractions to aid in expulsion of retained products of conception after a missed abortion and to help deliver the placenta after childbirth. Side effects can include nausea, vomiting, diarrhea, cramping, dizziness, pulmonary hypertension, coronary artery vasoconstriction, and severe systemic hypertension (especially in patients with preeclampsia). Overdue aircraft procedures during flight start after: A. 15 minutes without contact B. 30 minutes without contact C. 45 minutes without contact D. 60 minutes without contact - ANS 45 minutes without contact Time between each communication should not exceed 15 minutes while in flight unless a system of continuous automatic position tracking is utilized or 30 minutes on ground transport. Time between communications should not exceed 45 minutes while on the ground. Who has the ultimate authority to initiate or complete a mission? A. The flight paramedic B. The flight nurse C. The PIC D. The communication specialist - ANS the PIC (Pilot) Platelets are considered low at: A. <600 B. <450 C. <240 D. <150 - ANS <150 In an adult, a normal count is about 150,000-400,000 (150-450) platelets per microliter of blood. If platelet levels fall below 20,000 per microliter, massive bleeding may occur and is considered a life-threatening risk. How should your flight suit fit to provide space of insulation per CAMTS recommendations? A. ½ in. B. 1 in. C. Skin tight so I look really hot for the firefighters on scene D. ¼ in. - ANS 0.25 in. (1/4 in.) The absolute minimum hours required by the Federal Aviation Regulation (FAR) Part 135 with regard to a pilot's "bottle to throttle" rule is... A. 8 B. 12 C. 24 D. 48 - ANS 8 Pilots need to be mindful that the "eight-hour bottle-to-throttle" rule is the absolute minimum. Some individuals may require a longer period between drinking and flying depending on the amount of alcohol consumed and their personal metabolism. You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? A. Grab the fire extinguisher and portable radio. B. Make a call for help on the emergency frequency. C. Exit the helicopter after the aircraft has come to a complete stop and meet at a predestinated position a safe distance from the aircraft. D. Stay in the helicopter as it offers the only available shelter in the area. - ANS Exit the helicopter after the aircraft has come to a complete stop and meet at a predestinated position a safe distance from the aircraft. Usually meeting at the nose of the aircraft, which is twelve o'clock position. The MD has ordered a brain natriuretic peptide (BNP), which would evaluate the patient for... A. Sepsis B. Hypovolemia C. Right ventricular MI D. CHF - ANS CHF BNP is a blood test used to measure the amount of BNP hormone in the blood. BNP is produced by the heart and shows how well the heart is functioning. Normally, only a low amount of BNP is found in the heart. But if the heart has to work harder for a longer period of time, such as in heart failure, the heart releases more BNP, increasing the blood level of BNP. In some cases, this test can diagnose heart failure in a patient who does not have obvious heart failure symptoms. BNP values tend to increase with age and are higher in women than men. Lab findings — Normal BNP level: 0-99 pictograms per milliliter (pg. /mL). Abnormal BNP level: 100 pg. /mL or greater is indicative that heart failure may be present. The ELT takes a minimum of ____________ g's to activate. A. 2 B. 4 C. 6 D. 8 - ANS 4 The ELT is activated by an impact exceeding 4g's and Broadcasts on the universal distress channel 121.5. Preeclampsia is characterized by of the following, EXCEPT: A. Hypertension B. Edema C. Proteinuria D. Seizures - ANS Seizures or Low Platelet Count Preeclampsia is characterized by hypertension, proteinuria, and edema. Hemolytic disease of the newborn can be prevented by the administration of which of the following to a Rhesus negative mother who had a pregnancy with a Rhesus positive infant? A. Albumin B. Rho (D) immune globulin C. Steroids D. Indomethacin - ANS Rho (D) immune globulin The commonly used terms Rh factor, Rh positive, and Rh negative refer to the D antigen only. Rho (D) immune globulin is a medicine solution of Iggy anti-D (anti-Rd.) antibodies used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn). When the disease is mild, the fetus may have mild anemia with reticulocytosis. When the disease is moderate or severe, the fetus can have a more marked anemia and erythroblastosis (erythroblastosis fetal is). When the disease is very severe, it can cause morgues hemolytic us neonatorum, hydro’s fetal is, or stillbirth. Stagnant hypoxia - ANS Occurs when conditions exist that result in Reduced total Cardiac Output, "pooling of the blood" within certain regions of the body, a decreased blood flow to the tissues, or restriction of blood flow. Muscle damage is evidenced by rhabdomyolysis. Elevated creative phosphokinase (CPK) values are a diagnostic hallmark of heatstroke because of the rhabdomyolytic process. The release of destructive lysosome enzymes occurs as a result of extensive muscle damage, which can lead to ARDS, DIC, and ATN. Levine's sign relates to... A. Meningitis; neck pain B. Pancreatitis; per umbilical bruising C. Cardiac; clenched fist over chest D. Splenic injury; left shoulder - ANS Cardiac; clenched fist over chest Pt. clutching their chest, which may indicate that pain may be cardiac in origin. The circulating blood volume in a child is? A. 10-20 mL/kg B. 20-40 mL/kg C. 50-60 mL/kg D. 70-80 mL/kg - ANS 70-80 mL/kg Small amounts of fluid or blood loss can cause serious physiologic effects. The goal in supporting cardiac output in shock is the replacement of lost circulating volume. Circulating blood volume in Newborns? - ANS 80 mL/kg Circulating blood volume in Pediatrics? - ANS 70-80 mg/kg Circulating blood volume in Adults? - ANS 60 mL/kg Pediatric airway anatomy differs from adult anatomy in the following ways, EXCEPT: A. Airway diameter in children is smaller than adults B. The larynx is located more anterior in infants and children C. The epiglottis is long and narrow and angled away from the trachea. D. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. - ANS In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. In children younger than "10 years of age", the narrowest portion of the trachea is at the cricoid process. The vocal cords are attached lower anteriorly and the tongue (especially in infants) is proportionately larger. Pediatric - "10, 11, 12" Rules - ANS Unstuffed tube under 10 Needle cricothyrotomy only under 11 No nasal intubation under 12 Late decelerations may indicate... A. Cord compression B. Acidosis C. Anemia D. Uterine placental insufficiency - ANS Uterine placental insufficiency A late deceleration is one that begins close to the apex of the contraction, gradually decelerates, and gradually returns to the FHR baseline after the contraction is over. Late decelerations always indicate uteroplacental insufficiency; there is inadequate oxygen exchange in the placenta during a contraction. When a contraction is stronger, the insufficiency is greater and the deceleration is proportional. Late decelerations are one of the most ominous fetal heart rate patterns. All of the following are considered stressors of flight, EXCEPT? A. g-forces B. Increased partial pressure of oxygen C. Barometric pressure D. Decreased humidity - ANS Increased partial pressure of oxygen You are transporting a twenty-five-year-old woman with a history of suspected overdose. The following ABGs were obtained prior to your arrival at the sending facility: pH 7.52, pCO2 27, HCO3 24, pO2 110. You would most likely suspect: A. Narcotic overdose B. TCA overdose C. Early salicylate poisoning D. Insulin overdose - ANS Early salicylate poisoning The ABG interpretation of a pH 7.52, pCO2 27 and HCO3 24 is a no compensated respiratory alkalosis, which is present is early salicylate poisoning. The metabolic changes eventually lead to renal depletion of fluids and electrolytes, hypoglycemia, hypokalemia, and a mixed presentation of respiratory and metabolic alkalosis coupled with metabolic acidosis, which may provoke cardiac dysrhythmias, acute pulmonary edema, renal failure or neurological injury. The clinical presentation of salicylate poisoning can also include gastrointestinal bleeding and an unexplained elevated anion gap (metabolic acidosis). Salicylate levels are obtained four to six hours after ingestion. Earlier samples may be unreliable because the pharmacokinetics is not stable before that time. The most important information in assessing severity, however is the patient's clinical condition. If the PIP does not change on a ventilator patient with respiratory acidosis, always... A. Increase VT before rate B. Decrease VT before rate C. Increase rate before VT D. Decrease rate before VT - ANS Decrease VT before rate Elevated peak inspiratory pressures (PIP) can be managed by decreasing the flow rate and tidal volume initially. If necessary, increasing the respiratory rate can be done to correct an underlying respiratory acidosis. Trouble-shooting high-pressure alarms on the ventilator can be caused by all of the following, EXCEPT: A. Secretions B. Obstructions C. ET tube main-stem placement D. Leak in ventilator tubing - ANS Leak in ventilator tubing Leaks and/or loose connections are associated with low ventilator alarms. Normal range for right atrial pressure is: A. 2-6 mmHg B. 8-12 mmHg C. 4-8 mmHg D. 0-5 mmHg - ANS 2-6 mmHg Systemic vascular resistance (SVR) measures? - ANS Afterload for the Left heart The most likely causes of Metabolic Alkalosis can include all of the following, EXCEPT: A. Vomiting B. NG suctioning C. Diarrhea D. Diuretics - ANS Diarrhea Diarrheal dehydration can cause metabolic acidosis, especially in the pediatric patient. Metabolic alkalosis can be caused by loss of hydrogen ions through the kidneys or GI tract. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCL). Renal losses (use of diuretics) of hydrogen ions occur when the distal delivery of sodium increases in the presence of excess aldosterone, resulting in reabsorption of sodium, leading to the secretion of hydrogen ions and potassium ions. The administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause metabolic alkalosis. Shifting of hydrogen ions into the intracellular space can also occur, which is mainly seen with hypokalemia. Digitalis toxicity can easily be exacerbated by... A. Acute MI B. Electrolyte abnormalities C. Undiagnosed diabetes D. Beta-blockers - ANS Beta-blockers