Med/surg Exam 1

Front 1

VIP score numbering

Back 1

0-5. Resite on stage 2.

Front 2

size of blue needle

Back 2

22

Front 3

size of pink needle

Back 3

20

Front 4

size of green needle

Back 4

18

Front 5

Size of gray needle

Back 5

16

Front 6

size of orange needle

Back 6

14

Front 7

size of yellow needle

Back 7

24 (too small for anything!)

Front 8

regular osmolarity of blood

Back 8

275-295 mOsm/L

Front 9

daily replacement needed of Na

Back 9

100 mEq

Front 10

Daily replacement needed of K

Back 10

40-80 mEq

Front 11

fluid loss during surgery by evaporation per hour

Back 11

500-1000 mL/ hr

Front 12

What is in 1 L of LR

Back 12

130 Na, 109 Cl, 4 KCl, 3 Ca, 28 HCO3. 273 total.

Front 13

osmotic pressure from 1 g dextrose

Back 13

5 mOsm

Front 14

Fever within 24 hours of admit

Back 14

atelectasis, wound cellulitis, drug fever (NOT likely CAUTI)

Front 15

Fever on day 2

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pneumonia or CAUTI

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Fever on day 3 or 4

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Thrombophlebitis, DVT, wound infection, tissue/organ inflammation

Front 17

Fever after day 5-7

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"not good!" deep infection, DVT, Cdiff, neoplasm, leaking anastmosis

Front 18

when would wound dehiscence occur

Back 18

5-12 days after surgery

Front 19

Lymphocytes are up with

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viral infection (often mono) or leukemia

Front 20

How to diagnose COPD

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Test FEV1 <70% AFTER giving short acting bronchodilator

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3 most common symptoms of COPD

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dyspnea, cough, sputum

Front 22

CAT assessment criteria (7)

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Cough, sputum, tightness, stairs/breathless, limits on home activities, confident leaving home, sleep soundly, energy

Front 23

MMRC dyspnea scale

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1 - slight hill, 2- slower than everyone else on flat ground, 3 - stop after 100 yards, 4- too breathless to leave house

Front 24

Gold scale

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1 (mild) FEV more than 80%, 2 (moderate) 50

Front 25

how to combine assessment of COPD (GOLD standard)

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mMRC or CAT (low or high) and then number of exacerbations/year (0-1 vs 2 or more)

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COPD combined assessment categories (4)

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A: less symptoms, less risk. B: more symptoms, less risk. C: Less symptoms, high risk. D: More symptoms, high risk.

Front 27

COPD comorbidiities (6)

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CVD, Osteoporosis, RI, Anxiety/depresion, DM, Lung cancer

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5 med categories for COPD

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Beta 2 agonists, Anticholinergics, Methylxanthines, Corticosteroids, Phosphodiesterase 4 inhibitors.

Front 29

Inhaled Corticosteroids indicated when

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when FEV1 is less than 60%

Front 30

Phosphodiesterase-4 inhibitors indicated when

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GOLD 3 or 4 (less than 50% FEV1), AND Hx of exacerbations and chronic bronchitis.

Front 31

roflumilast

Back 31

phosphodiesterase-4 inhibitor (for severe COPD)

Front 32

When is flu vaccine indicated r/t COPD

Back 32

when FEV1 is less than 40%, or pt. is over 65

Front 33

Can O2 therapy increase survival rates? With whom?

Back 33

pts with severe resting hypoxemia

Front 34

when is lung volume reduction surgery indicated

Back 34

pts with upper-lobe emphysema and low exercise capacity

Front 35

use of corticosteroids with COPD

Back 35

recommended short term and/or in combination with others long term. Not LT monotherapy!

Front 36

what is an exacerbation of COPD

Back 36

worse symptoms beyond normal day-to-day variations AND leads to Cx. In medication

Front 37

most common cause of COPD exacerbation

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URI or infective trachea/bronchitis

Front 38

normal Rx for exacerbation

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Short acting bronchodilators with or without anthicholinergics, corticosteroids and antibiotics, noninvasive ventilation

Front 39

ideal pulse ox reading for COPD patient

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88-92% to keep from getting O2 dependent

Front 40

3 cardinal symptoms indicating use of antibiotics in COPD

Back 40

increased dyspnea, increased sputum, and increased sputum purulence. AND/or mechanical ventilation.

Front 41

why does smoking increase pneumonia risk?

Back 41

disrupts ciliary and macrophage activity

Front 42

Why does NPO increase pneumonia risk?

Back 42

colonization of bacteria in pharynx

Front 43

why does ETOH increase pneumonia risk?

Back 43

decreases ciliary mvmt and immunosuppression

Front 44

classical symptoms of pneumonia

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PaO2 <80%, shaking chills, stabbing chest pain, fever, and increased HR 10 BPM for every degree Celsius, increased WBC (with bacterial) or lymphocyte (Viral)

Front 45

normal WBC count

Back 45

5-10,000

Front 46

why would monocytes be high?

Back 46

chronic infection/ end of infection (become macrophages)

Front 47

why would eosinophil count be high?

Back 47

inflammatory or allegic reaction

Front 48

Never let momma eat beans

Back 48

order of multiplicity in blood. Neutrophils, lymphocytes, monocytes, eosinophils, basophils

Front 49

what does WBC "shift to the left" mean?

Back 49

high neutrophil and band (immature neutrophils) count. Indicates acute bacterial infection.

Front 50

HAP timing

Back 50

48 hours or more after admission

Front 51

VAP timing

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24 hours to 4 days after intubation

Front 52

HCAP timing

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within 2 days of admission in a pt who is in a LTCF, was hospitalized within past 30 days, or received blood dialysis

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CAP timing

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pneumonia present upon admission

Front 54

parenchyma

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function tissue of an organ (ex. Lung or liver), as opposed to support structure (such as pleura)

Front 55

does asthma increase mucus production

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Why yes, it does!

Front 56

AG->AB response

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antigen to antibody

Front 57

viral illnesses often lead to…

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sinusitis (treat with amoxicillin)

Front 58

can cold precipate asthma?

Back 58

yes, it can! And also sinus infection.

Front 59

3 Rx for acute asthma

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O2, SABA, high dose systemic corticosteroid

Front 60

Asthma treatment steps (6)

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1) SABA, 2) ICS or LTRA or AntiCh or Methylxanthine. 3) medium ICS or low ICS and LABA. 4) Medium IC and LABA. 5) High ICS and LABA. 6) High ICS, LABA and PO CS.

Front 61

ICS

Back 61

inhaled corticosteroid

Front 62

LTRA

Back 62

leukotrine receptor antagonist (for bronchodilation)

Front 63

osmotic pressure from 1 g dextrose

Back 63

5 mOsm

Front 64

Isoetharine (bronkosol)

Back 64

SABA

Front 65

Albuterol med type

Back 65

SABA

Front 66

Epinepherine med type r/t asthma

Back 66

SABA

Front 67

Atrovent

Back 67

anticholinergic (block parasympathetic NS)

Front 68

Aminophylline

Back 68

xanthine group (methylxanthine). Decrease bronchospasm, longer than SABAs.

Front 69

Theophylline

Back 69

xanthine group (methylxanthine). Decrease bronchospasm, longer than SABAs.

Front 70

Xanthine levels

Back 70

5-15 mcg/mL

Front 71

cromolyn sodium (nasalcrom)

Back 71

prophylaxis decreae airway inflammation and edema. Start 2-3 wk beore allergy season

Front 72

Nedocromil (Tilade)

Back 72

inhibits release of inflammatory mediators

Front 73

Intal

Back 73

prevent mast cells from opening for allergen

Front 74

Zafirlukast (accolate)

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prevent leukotreine synthesis

Front 75

montelukast (singulair)

Back 75

prevent leukotreine synthesis

Front 76

zileuton (zyflow) type and concern

Back 76

prevent leukotreine synthesis. Inhibits P450.

Front 77

Mg as a med

Back 77

vaso and bronchodilator

Front 78

how to do peak flow measurement

Back 78

fill lungs completely, bite and close lips, blow out hard and fast as possible, record. Repeat 3 times. Take "personal best"

Front 79

when should PRN SABA move to scheduled dose

Back 79

when used more than 3X week

Front 80

when should more powerful dose of bronchodilator be used

Back 80

when you need more than 6 puffs/day

Front 81

how much K lost per L of urine

Back 81

20 mEq

Front 82

Ampicillin-sulbactam treatment for what type of Pneumonia

Back 82

early onset simple pneumonia

Front 83

Ceftriaxone for pneumonia

Back 83

early onset simple pneumonia

Front 84

levofloxacin or moxifloxacin for pneumonia

Back 84

early onset simple pneumonia

Front 85

ciprofloxacin for pneumonia

Back 85

early onset simple pneumonia

Front 86

ertapenem for pneumonia

Back 86

early onset simple pneumonia

Front 87

cefepime for pneumonia

Back 87

late onset or multidrug resistant pneumonia

Front 88

ceftazidime for pneumonia

Back 88

late onset or multidrug resistant pneumonia

Front 89

imipenem or meropenem for pneumonia

Back 89

late onset or multidrug resistant pneumonia

Front 90

piperacillin-tazobactam and cipro or levofloxacin for pneumonia

Back 90

late onset or multidrug resistant pneumonia

Front 91

amikacin, gentamycin, or trobramycin AND linezolid or vancomycin for pneumonia

Back 91

late onset or multidrug resistant pneumonia

Front 92

minimum treatment time for CAP

Back 92

5 days

Front 93

minimum treatment time for HCAP HAP or VAP

Back 93

7 to 10 days

Front 94

POX

Back 94

pulse oximeter reading

Front 95

PaO2

Back 95

partial pressure of oxygen in blood Usually over 80

Front 96

SPO2

Back 96

pulse oximeter reading

Front 97

hypoxemia definition

Back 97

PaO2 of less than 60 mmHg or POX of less than 90%

Front 98

what flow rate of O2 to start humidifying

Back 98

when more than 6 L/min

Front 99

what are the conditions for oxygen toxicity?

Back 99

more than 60% O2 for more than 48 hours

Front 100

five drugs for TB

Back 100

isonazid, rifampin, pyrazinmide, streptomycin, ethambutal

Front 101

virchows triangle for PE

Back 101

stasis, vessel wall injury, hypercoagulability

Front 102

PERC for PE criteria (8)

Back 102

over 50, HR over 100, POX under 95, Hx of DVT, recent trauma, hemoptysis, Estrogen, Unilateral leg swelling