Term
| You are a student in the vascular surgery rotation. You are examining a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination? |
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Definition
| Lower extremity size, symmetry, and skin color |
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Term
| A 51-year-old housekeeper reports pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system? |
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Definition
Intermittent claudication:
Intermittent claudicating is leg pain that occurs with walking and is relieved by rest. It is a key symptom of peripheral vascular disease. This symptom is present in only about one third of patients with significant arterial disease and, if found, calls for more aggressive management of cardiovascular risk factors. Screening with ankle brachial index can help detect this problem. |
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Term
| LLQ abdominal pain is most characteristic of which of the following |
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Definition
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Term
| The most commonly fractured tarsal bone is the: |
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Definition
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Term
| A high school soccer player injured her wrist in a game. She is complaining of joint pain. She is tender between the two tendons at the base of the thumb. Which of the following is likely: |
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Definition
Scaphoid fracture:
The “anatomic snuffbox” is found between the extensor and abductor tendons at the base of the thumb. Tenderness should make one think of a scaphoid fracture. Not only is this the most common carpal bone injury, but the poor blood supply puts the bone at risk for avascular necrosis when injured. This fracture is commonly missed on x-ray, so this is an important physical finding to support further or repeated studies. As for soccer players having an epidemic of joint pain, see The Widening Circle by Polly Murray [ the discoverer of Lyme Disease] |
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Term
| Absent [none] bowel sounds is most characteristic of which of the following : |
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Definition
| a total bowel obstruction |
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Term
| The significance of a hot, tender, swollen calf (mid tibial area) is that the patient is at risk of developing |
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Definition
| a risk of pulmonary embolism |
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Term
| Which of the following is NOT associated with deep venous thrombosis (DVT) occlusion |
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Definition
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Term
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Definition
| Pain, erythema/redness, hot, tenderness |
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Term
| What is the vessel located just anterior to the medial malleolus of the ankle |
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Definition
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Term
| Which of the following signs is most compatible with the diagnosis of partial small bowel obstruction (due to prior surgery |
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Definition
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Term
| A patient reporting a sudden onset of cold, blue, painful foot would most likely have the following rhythm: |
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Definition
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Term
| Which of the following is NOT associated with an acute arterial occlusion |
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Definition
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Term
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Definition
| Atrial fibrillation, pain, cold extremity, tenderness |
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Term
| Signs of a partial small bowel obstruction (PMH + for previous abd. surgery) |
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Definition
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Term
| From the following, which condition would most likely be associated with LUQ (left upper quadrant) abdominal pain |
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Definition
| infectious mononucleosis(spleen) |
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Term
| John G, is a 79 y.o. male with sudden onset of severe abdominal pain. He has a past history of a hernia. His exam reveals an elderly male in moderate distress, with active vomiting. Vital signs are: BP: 172/98; HR: 128; RR: 22; T [in ED] : 104.2; oxygen saturation: 92%. His exam reveals no bowel sounds and a distended, rigid, diffusely tender abdomen with a tense scrotal bulge. The most likely explanation for these findings is |
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Definition
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Term
| Which of the following best describes a disorder most the risk for tenosynovitis and for a disabling infection as a consequence |
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Definition
a red, hot, swollen palm (thenar area),
human bite on fist that gets bacterial infection |
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Term
| Regarding the anatomy of the groin which of the following is accurate: |
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Definition
the femoral vein is found medial to the artery,
Lateral.........to.......Medial
Nerve-Artery-Vein |
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Term
| In a ruptured ectopic pregnancy, an acute intra-abdominal emergency, the paramedic would be most likely to find |
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Definition
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Term
| Which of the following is NOT associated with an acute ruptured abdominal viscous |
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Definition
| intermittent waves of colicy pain |
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Term
| When assessing temperature of the skin, which portion of your hand should be used [this is not effective through gloved hands – but illustrates a point |
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Definition
Backs of fingers
The backs of the fingers are thought to be the most temperature sensitive, perhaps because the skin is thinnest there. You may have difficulty detecting subtle differences if you do not use the backs of the fingers |
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Term
| When a hernia cannot be returned to the abdominal cavity, it is called |
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Definition
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Term
| Susan S, is a 22 y.o. female with a gradual onset of severe abdominal pain, nausea, and anorexia.. She has no past history of a similar pain or other health problems, or trauma (recent or remote). Her exam reveals a moderately uncomfortable female. Vital signs are: BP: 112/68; HR: 110; RR: 22; skin temp.: hot; oxygen saturation: 98%. Her abdominal exam reveals hypoactive bowel sounds. Upon moving the gurney, the patient is jostled - at this she reports considerable pain. The most worrisome condition that would explain these findings is |
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Definition
| rebound and percussion indicating peritoneal irritation |
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Term
| As the internal diameter of a blood vessel changes, the resistance changes as well. Which of the following descriptions depicts this relationship? |
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Definition
| Resistance varies proportionally(inversely) to the 4th power of the diameter
(inversly??) |
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Term
| A 15 YO skateboarder has fallen on his outstretched right hand. He was in so much pain that his mother brought him to your attention. But he now does not think that he needs evaluation. He has no obvious deformity. You ask |
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Definition
| if he will let you examine the base of his 1st metacarpal ("anatomic snuffbox") |
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Term
| Falling on the outstreched hand with wrist injury is significant because it can result in |
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Definition
| non union arthritis of the navicular bone |
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Term
| Droplets of fat [looking like oil dropletss in the blood] coming from an anterior knee puncture injury would suggest to the paramedic that the patient: |
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Definition
| is at risk for injury to the deep structures within the knee capsule |
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Term
| What is the vessel located just behind of the medial malleolus of the ankle |
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Definition
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Term
| RUQ abdominal pain is most characteristic of which of the following |
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Definition
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Term
| A patient with a cold, painful foot would most likely have an associated |
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Definition
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Term
| In a patient with the leg section of MAST troussers and an umbilical bluish discoloration , with positive peritoneal signs, and with a systolic BP of 136/- , would suggest to the paramedic that s/he should first try to |
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Definition
| slowly decrease the afterload |
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Term
| Pain in the epigastrium may be due to |
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Definition
| MI, Ulceration of stomach, Aneurysm |
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Term
| Let's say, you are on a respiratory rotation and you are assisting obtaining an arterial blood gas in the radial artery on a retired paramedic who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you will: |
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Definition
Check for patency of the ulnar artery
The Allen test is for determining patency of the ulnar artery before puncturing the radial artery. In the event of an occlusion in the radial artery system, the ulnar artery can provide adequate blood flow. |
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Term
| A 62 yr old paramedic instructor develops back pain associated with constipation and urinary retention. Which of the following is most worrisome? |
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Definition
| Cauda equina syndrome
The presence of bowel and bladder symptoms associated with back pain is worrisome for Cauda equina syndrome and should suggest impingement of nerve roots S2,3, and 4. [CYA and CPA--> consider a Neurosurg. Emerg.]
Simple de novo, brand new, idiopathic low back pain is unlikely. Epidural abscess may present with midline pain which can be increased with percussion over the spinous processes. Sciatica is associated with pain which radiates into the buttocks and/or down the posterior leg in the S1 distribution. |
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Term
| The difference between an incarcerated hernia and a strangulated hernia is that |
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Definition
| a strangulated hernia involves torsion of the large bowel |
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Term
| A bluish discoloration in the periumbilical area in a patient with abnormally positive peritoneal signs is called: |
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Definition
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Term
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Definition
| Increased Afterload, harder to empty |
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Term
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Definition
| Resistance: the pressure against which LV works to empty |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Preload, Afterload, Myocardial contractility |
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Term
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Definition
| Volume: vol of blood in the RV at end of diastole |
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Term
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Definition
Increased preload:
Vol expansion, Inhalation(neg pressure), Inc SV, CV Hormones(ADH, ANP, Renin-Angiotensin-Aldosterone) |
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Term
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Definition
Decreased preload:
vol depletion, valsalva, exhalation/pos pressure, dec SV, Vasodilator drugs |
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Term
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Definition
| Decreased Afterload, easier to empty |
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Term
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Definition
| Fran-Starling recoil propertional to stretch, Adrenergic receptor activation: Symp B1, Circulating catecholamines B1, Cardiac drugs: +Inotrope(harder: Dig, Isoproternl, Pure Beta), -Inotrope(softer: TCA, Ca blockers-verapamil, nefedapine) |
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Term
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Definition
Dehydration: -dec veous return, dec preload, dec CO, shock
CHF: -vol overload, inc venous ret, preload, myocardial work, declining myocardial efficienc, dec CO |
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Term
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Definition
Septic shock: dec PVR, afterload, shock
MAST: inc PVR, afterload, myocardial work, declining myo eff. dec CO |
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Term
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Definition
IV Fluid: inc ven ret, preload, CO
Diuretic: Lasix, vol elimination, dec ven ret, dec preload, inc myo eff, inc CO
Venodilators: Dec preload, Lasix, Nitro, Morphine, Mg++, B2 agentsinc albuterol
Phlebotomy-leches |
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Term
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Definition
Arteriolar dilators: Nitro, Morphine, Mg++, B2 agents
Decrease PVR
Decrease Pul VR |
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Term
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Definition
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Term
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Definition
| Dec preload-Lasix, lower afterload-Ntro |
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Term
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Definition
| inc preload vol-fluids IV, Raise PVR/afterload-pressor agents:dopamine |
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Term
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Definition
| 1-LV stroke vol 2-blood vol 3-distensibility of aorta 4-large arteries 5-distensibility of small arteries/arterioles (PVR) |
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Term
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Definition
| RV receptivity, distensibility of lungs/pul vasculature, intrathoracic pressure, blood vol |
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Term
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Definition
| 5-10 cm H2O, measured from Rt atrium |
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Term
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Definition
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Term
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Definition
| Mild elevation-mild CHF, DOE, bibasilar rales, NVD mild |
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Term
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Definition
| Moderate- moderate CHF, Compensated, halfway up neck, SOB at rest, cough, diffuse rales, NVD midneck |
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Term
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Definition
| Angle of Jaw, Severe (severe CHF), decompensated, wet cough, wheezing, pink frothy sputum, NVD to jaw/ear |
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Term
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Definition
| shock, low BP, cyanosis, cardiogenic shock |
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Term
| 3 principal functions of the heart |
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Definition
| rec blood from veins, send it to lungs, pump to the body |
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Term
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Definition
| disruption of one or more of the 3 prin fx of the heart, secondary to a loss of normal contractile ability |
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Term
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Definition
| loss of heart muscle b/c infarct, loss of nourishment b/c ischemia, loss of effieiency |
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Term
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Definition
| 1- MI or ischemia chronic is most common 2-HTN 3-Valvular dysfunction aortic, mitral 4-Acquired cardiomyopathy: a) toxic-alcohol or cocaine b) metabolic- thyroid hyper or hypo 5-Misc: anemia, cx arrythmias-AF |
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Term
| Most HF is associated with_____. |
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Definition
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Term
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Definition
peripheral edema, RUQ pain, JVD, hepatomegaly, hepatojugular reflex, presacral edema
Pul embolus, severe COPD, RV MI |
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Term
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Definition
| Dyspnea, Cheyne-Stokes, orthopnea, paroxysmal nocturnal dyspnea, fatigue, ALOC, BP changes, diaphoresis, tachycardia, tachypnea, wet rales, wheezing, S3 gallop |
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Term
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Definition
-hold vol in periphery: NTG, morph, mg
-eliminate vol: diuretics
-vasodilators: ntg, morph, Mg
-positioning |
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Term
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Definition
Physical: infections, injuries due to lifting, nutrition
Emotional: death/dying, stress, fear |
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Term
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Definition
| strength, flexibility, endurance, body composition, stress reduction |
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Term
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Definition
| Vigorous-20 min, Moderate-40 min 3/week |
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Term
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Definition
Use 60-70% of cardiac reserve
Max HR=220-age
x by .6 for lowest target HR=lowest HR in aerobic range |
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Term
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Definition
1: resting HR
2: max HR=220-age
3: Max+resting=reserve
4:reservexdesired(.6-.7)
5: Add # 4 to Resting HR for Min target HR |
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Term
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Definition
Cleaning:washing
Disinfecting: removing microbes from surface, abrasion
Sterilizing: killing all microbes on an object- boiling water |
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Term
| Positive Peritoneal findings |
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Definition
| Distended, hypOactive bowel sounds, rigid, guarding, diffuse tenderness, percussion (rebound) tenderness |
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Term
| Significance of Pos peritoneal signs |
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Definition
| intraabdominal emergency, inflammation-appendicitis, bleeding-ectopic, AAA, Ruptured viscus-perforated ulcer, uterus, colon |
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Term
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Definition
Classic s/s in only 60%
HX: n/v, anorexia, fever, inc pain over 6 hr, periumbilical initially then to RLQ, pain: vague dull (visceral) at first, later will be pinpoint, tachycardia, tachypnea, distension, hypoactive or absent bowel sounds, rigid, tnder, guarding, pain with cough or bump, Rosving's, hypersensative skin, Psoas or Obturator sign |
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Term
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Definition
| pain in RLQ w/ palpation of LLQ, radiating all across abd |
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Term
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Definition
| inc tenderness on palpation while abd muscles are contracting-ask to sit up |
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Term
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Definition
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Term
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Definition
| Spleen/mono, sickle cell hemoglobin (HbSS) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| *MI/Angina, ulcer, pancreatitis, gallbladder |
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Term
| Periumbilical or Generalized |
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Definition
| mesenteric ischemia or infarct-sudden onset, vague abd signs |
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Term
| Preferred order for abd exam |
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Definition
1:Inspect
2:Auscultate
3:Percussion
4: Palpation |
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Term
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Definition
| for rectal bleeding, hemmorides, fissure |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Posterior tibial artery location |
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Definition
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Term
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Definition
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Term
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Definition
| Diastolic, decrescendo, wide pulse pressure |
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Term
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Definition
| Mid-late systolic, decrescendo, MI: mortality up 7 fold, dull, cooing, heard at apex |
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Term
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Definition
| Pulmonic & aortic valve open, vent contract |
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Term
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Definition
| Mitral & tricuspid open, vent relax |
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Term
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Definition
| Stomach, spleen, pancreas, transverse and decending colon, small portion of liver |
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Term
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Definition
| Mainly liver, gallbladder, accending and part transverse colon, |
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Term
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Definition
| Accending colon, appendix, |
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Term
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Definition
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Term
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Definition
| Hollow organs, stomach, etc |
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Term
| % of pts with sig intraabdominal pathoogy, that have normal exam |
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Definition
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Term
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Definition
| Discoloration in the umbilical/naval area-intraperitoneal bleed |
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Term
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Definition
| Over 1 or other kidney in the back , retroperitoneal bleed |
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Term
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Definition
| Appendicitis: flex knee, rotate in external direction, results in internal rotation of femur stretching the obt muscle |
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Term
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Definition
| Pain with thigh extension, flex thigh against resistance-tenderness upon muscle contraction |
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Term
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Definition
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