FISDAP Study Guide: Paramedic Exam Prep Answers (Bonus Episode)

PhysDAP Medical Study Guide with Answers. Reference: Bledsoe's Paramedic Care: Principles and Practice, Volumes 1 and 2. Revise for comprehensive studying with detailed answers to all questions. Respiratory Pulmonology. Q. Review the differences between upper and lower airway. A. Upper airway: Extends from the nose and mouth through the larynx. Includes nasal cavity, pharynx, and larynx. Lower airway: Extends from the trachea through the alveoli. Includes trachea, bronchi, and lungs. Upper airway functions in air conduction and filtering. Lower airway is where gas exchange occurs. Q. What are the differences between upper and lower respiratory conditions? A. Upper respiratory conditions: Typically cause stridor, hoarseness, cough, croup, epiglottitis, foreign body obstruction. Lower respiratory conditions: cause wheeze, crackles, raunchy, decreased breath sounds. Pneumonia, asthma, COPD, pulmonary edema. Q. What is laryngeal edema? A. Swelling of the tissues surrounding the larynx causing airway narrowing. Can be life-threatening if severe, presenting with stridor and potential for complete airway obstruction. Common causes: anaphylaxis, burns, infection, angioedema. Requires rapid intervention. Q. What are the different types of lung sounds and where do they occur? A. Vesicular (normal). Heard over peripheral lung tissue, soft, low-pitched. Bronchial, heard over trachea, mainstem bronchi. Louder, hollow. Crackles. Fine, coarse popping sounds in alveoli. Pneumonia, pulmonary edema. Raunchy. Coarse rattling sounds in larger airways. COPD, secretions. Wheeze. Musical, high-pitched. Bronchospasm, asthma. Q. What respiratory conditions present with fevers? A. Pneumonia, tuberculosis, bronchitis, acute respiratory infections, Legionella, atypical pneumonias, respiratory syncytial virus (RSV), influenza, aspiration pneumonia, and other infectious inflammatory airway diseases. Q. How will the patient present with signs and symptoms of chronic infection of lung tissue? A. Productive cough (may have blood), fever (low-grade and chronic), Weight loss, fatigue, dyspnea, night sweats, chills. Long-standing history: typical in tuberculosis, chronic bronchitis, bronchiectasis. Q. How will the patient present with signs and symptoms of pleural effusion? A. Dyspnea, chest pain, worse with breathing, decreased breath sounds on affected side, dullness to percussion, weight on affected side, recent illness or cardiac disease history. Q. How will the patient present with signs and symptoms of chronic inhalation of irritants? A. Chronic cough, dyspnea, wheezing, decreased exercise tolerance, crackles on auscultation, history of occupational or environmental exposure, progressive worsening over years. Q. How will the patient present with signs and symptoms of bronchoconstriction? A. Wheezing, primarily expiratory, dyspnea, prolonged expiration, Tachypnea. Retractions, anxiety. Use of accessory muscles. Recent URI trigger or allergen exposure. May have history of asthma or COPD. Q. How will the patient present with signs and symptoms of tuberculosis? A. Chronic productive cough, often with hemoptysis. Fever, especially afternoon or evening. Night sweats, weight loss, fatigue, chills, malaise, dyspnea. Symptoms develop insidiously over weeks to months. Risk factors: homeless, immunocompromised, close exposure. Ayu, how do you treat an asthma attack? A. Position upright. Oxygen to maintain SpO2 should be 94% or greater. Albuterol/salbutamol via nebulizer or MDI. If severe or not responding, consider ipratropium, magnesium sulfate v. Corticosteroids (systemic). If critical, prepare for intubation. Establish a V-access. Consider transport to facility with advanced respiratory support. Q: What medications can be given for an asthma attack not responding to albuterol or MDI? A: ipratropium (anticholinergic), magnesium sulfate (IV), systemic corticosteroids, methylprednisolone (prednisone), and in severe cases, epinephrine. I am. Continuous albuterol nebulization may also be beneficial. Q. What precautions are required for a patient with tuberculosis? A. Use respiratory protection (N95 or higher mask). Isolate patient (separate compartment if possible). Limit transport unless necessary. Notify receiving facility of suspected TB. Minimize personnel exposure and follow CDC local infection control guidelines. Patient should wear surgical mask. Q. What are the signs of a pulmonary embolism? A. Acute dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxia, syncope (if massive), hemoptysis (if infarction occurs), anxiety, low-grade fever. May present with signs of DVT (leg swelling, pain). Symptoms depend on size of clot and cardiac status. Toxicology. Q: How would overdoses present in opioid medication types? List some examples. A: Presentation. CNS depression, respiratory depression, miosis, pinpoint pupils, hypotension, bradycardia, altered mental status, coma, death. Examples: heroin, morphine, codeine, hydrocodone, oxycodone, fentanyl, methadone, tramadol. Treatment. Naloxone (Narcan) reversal. Q. How would overdoses present in analgesic medication types? List some examples. A. Presentation varies by type. Acetaminophen: early GI symptoms, then hepatotoxicity, delayed. Aspirin: tinnitus, altered mental status, respiratory alkalosis, then metabolic acidosis, pulmonary edema. NSAIDs: GI bleeding, renal failure. Treatment: Supportive, activated charcoal if early, specific antidotes vary. Q: How would overdoses present in NSAID medication types? List some examples. A: Presentation: GI upset, nausea, vomiting, bleeding, renal dysfunction, metabolic acidosis in severe overdose. Examples: Ibuprofen, Naproxen, Indomethacin, Ketorolac. Chronic overdose causes GI bleeding and renal failure. Treatment: Supportive care, GI decontamination if recent ingestion. Q. What medications would a patient in renal failure be prescribed who has congestive heart failure? A. ACE inhibitors: lisinopril, enalapril. ARBs: losartan. Beta-blockers: carvedilol, metoprolol. Aldosterone antagonists: spironolactone. Loop diuretics: careful dosing in renal failure. Avoid NSAIDs and nephrotoxic agents. Dialysis may be needed. Q: What is digoxin toxicity? A: Toxic effects from excessive digoxin levels causing arrhythmias and systemic effects. Therapeutic index is narrow. Risk factors: renal impairment, hypokalemia, dehydration, drug interactions, overdose. Q: What are the signs and symptoms of digoxin toxicity? A. GI: nausea, vomiting, anorexia, abdominal pain. Cardiac: multiple PVCs, PSEs, heart blocks, atrial fibrillation with slow ventricular response. Visual: blurred vision, yellow-green halos. Neuro: weakness, confusion, hallucinations, delirium. Q. Are there common arrhythmias associated with digoxin toxicity? A. Yes. Paroxysmal atrial tachycardia with AV block. Classic. PVCs. Often bigeminal. Slow atrial fibrillation. Junctional rhythms. Heart blocks. The combination of atrial tachycardia with AV block is pathognomonic for digoxin toxicity. Q. What is a toxidrome? A. A syndrome of toxic symptoms/signs caused by a specific class of drugs or poisons. Groups of symptoms that help identify the type of substance ingested: anticholinergic, cholinergic, opioid, sympathomimetic, hallucinogenic, depressant, etc. Q: How do heroin affect pupil dilation? A: Heroin causes miosis (pinpoint pupils), constriction. Mediated by opioid receptors in the brainstem. Q: How do morphine affect pupil dilation? A: Morphine causes miosis (pinpoint pupils), constriction. A. Same mechanism as heroin. Both are opioids. Q. How do amphetamines affect pupil dilation? A. Amphetamines cause mydriasis (dilated pupils). Sympathomimetic effect stimulates adrenergic receptors. Q. How does marijuana affect pupil dilation? A. Marijuana typically does not cause significant pupil changes, though may cause mild mydriasis (slight dilation) in some cases. Q. How does nerve agent affect pupil dilation? A. Nerve agents cause severe miosis (pinpoint pupils) due to cholinergic overstimulation (anticholinesterase effect). Part of the cholinergic toxidrome. Q. How could you protect yourself from a patient who has been exposed to radiation? A. Time, distance, shielding. Minimize time near patient. Maximize distance from source. Use appropriate shielding. Wear protective equipment. Decontaminate if necessary, remove outer clothing. Document exposure time. Don't let contamination concern delay necessary treatment. Q. Why are patients with hepatitis more likely to suffer from drug toxicity? A. The liver metabolizes most medications. Hepatitis impairs liver function, reducing drug metabolism and clearance, leading to drug accumulation and toxicity at lower doses. This is especially true for hepatotoxic drugs. Q. What is the therapeutic index of a medication? A. The ratio between the toxic dose and the therapeutic dose (TDED). A narrow therapeutic index means small differences between therapeutic and toxic levels. Examples: digoxin, phenytoin, lithium, warfarin. Drugs with narrow indices require careful dosing and monitoring. Psychiatric. Q. What is postpartum depression? A. A major depressive episode occurring within 1 year of childbirth, usually within first 4 weeks. Presents with sadness, anhedonia, guilt, worthlessness, fatigue, sleep disturbance, hopelessness, and in severe cases, suicidal ideation or psychotic features. Distinct from postpartum blues, milder, self-limited. Q: How should you handle patients who took a bunch of pills in an attempt to self-harm and refuse care? A: Treat as a mental health crisis. Do not force treatment but encourage transport for evaluation. Consult medical direction. If patient is competent and alert: explain risks, obtain refusal, document carefully, consider police presence if danger to self or others. If altered mental status or danger: may transport against will depending on local law. Maintain calm, nonjudgmental demeanor. Q. What is an acute dystonic reaction that can occur with antipsychotic medication? A. Muscle rigidity, involuntary muscle contractions, abnormal posturing, spasm of face, jaw, taut neck, neck, back muscles. Oculogyric crisis—eyes rolling upward. Caused by anticholinergic effects. Treated with IV/IM anticholinergic, benztropine or diphenhydramine. GI—goo. Q: What are the signs and symptoms of pancreatitis? A: Acute severe epigastric pain radiating to the back, nausea, vomiting, fever, tachycardia, elevated amylase, lipase. A. Can progress to shock, ARDS, organ failure. Causes: Alcohol, gallstones, medications, trauma. Chronic: Malabsorption, steatorrhea, weight loss, diabetes. Q. What are the signs and symptoms of cholecystitis? A. Right upper quadrant pain (colicky), Murphy's sign positive, nausea, cough, vomiting, fever, tenderness over gallbladder. Pain may radiate to right shoulder. Elevated WBC. Often triggered by fatty meal. Q. What are the signs and symptoms of ulcerative colitis? A. Bloody diarrhea, abdominal cramping, urgency, tenesmus, fever, weight loss. Inflammation limited to colon and rectum mucosa. Extraintestinal manifestations: arthritis, uveitis, erythema nodosum. Q. What are the signs and symptoms of viral gastroenteritis? A. Watery diarrhea, vomiting, abdominal cramping, low-grade fever, myalgias. Usually self-limited (24-72 hours). Supportive care and fluid/electrolyte replacement. Many different viral causes. Q. What are the signs and symptoms of appendicitis? A. Periumbilical pain migrating to RLQ. McBurney's point tenderness, rebound guarding, fever, nausea, vomiting, positive Rovsing's sign, risk of perforation and peritonitis if untreated. Q. What are the signs and symptoms of diverticulitis? A. Left lower quadrant pain (TLOQ) tenderness or RLQ if right-sided diverticula, fever, elevated WBC, constipation or diarrhea. Complications: perforation, abscess, peritonitis, fistula. Q. What are the signs and symptoms of bowel obstruction? A. Abdominal pain. Colicky initially, then constant. Vomiting. Abdominal distension. Constipation. Visible peristaltic waves. Auscultation. Hyperactive, early, or absent, late bowel sounds. Causes. Adhesions. Hernia. Tumor. Volvulus. Intussusception. Q. What are the signs and symptoms of esophageal varices? A. Hematemesis. Often massive, bright red. Melena. Signs of GI bleed. Hypotension. Tachycardia. Pale, clammy. Caused by portal hypertension. High mortality. Often in alcoholic cirrhosis patients. Q. What are the signs and symptoms of cirrhosis of the liver? A. Jaundice. Acetes. Hepatomegaly. Spider angiomas. Palmar erythema. Asterixis. Encephalopathy. Easy bruising. Coagulopathy. Gynecomastia. Testicular atrophy. Portal hypertension leads to varices. Splenomegaly. Q: What are the signs and symptoms of gastritis? A: Epigastric pain burning, nausea, vomiting, may contain blood, loss of appetite, feeling of fullness. Causes: alcohol, NSAIDs, H. pylori, stress, bile reflux. Q: How should you treat a patient presenting with abdominal pain? A. Assess severity and location. Keep NPO. Establish IV access. Pain management per protocol. Oxygen if hypoxic. Monitor vital signs and glucose. Transport to hospital. Do not give strong narcotics initially, may mask surgical abdomen. Reassess frequently. Provide fluids if severely dehydrated and no contraindications. Q. Can the following cause bleeding in the stool? A. Yes. Esophageal varices. Ulcerative colitis, appendicitis (late), diverticulitis, if bleeding, gastritis, peptic ulcer disease, Crohn's disease, hemorrhoids, anal fissures, bowel cancer, mesenteric ischemia. Q. How do esophageal varices develop? A. Portal hypertension, from cirrhosis, portal vein thrombosis, etc., backs up blood into esophageal veins, causing them to dilate and become fragile. Risk of rupture increases with increased pressure. Rupture causes massive, often fatal hemorrhage. Q: What causes ascites and jaundice? A: Ascites: Caused by cirrhosis, portal hypertension, decreased albumin synthesis, sodium fluid retention, peritoneal inflammation, malignancy. Jaundice: Caused by elevated bilirubin from liver dysfunction, biliary obstruction, hemolysis. Both common in cirrhosis. Neurology. Q. What are the signs and symptoms of a stroke? A. Sudden onset neurological deficit. Use fast. Face drooping, arm weakness, speech difficulty. Additional signs: sudden severe headache, dizziness, ataxia, numbness, vision loss, confusion, loss of consciousness. Symptoms depend on location and size of stroke. Q. What are different types of stroke? A. Ischemic. Due to arterial occlusion. Thrombotic or embolic. Accounts for 85% of strokes. Hemorrhagic. Due to bleeding into brain parenchyma or subarachnoid space. Accounts for 15%. Transient ischemic attack (TIA). Symptoms resolve within 24 hours, no permanent damage. Q. How will each of the strokes present? A. Ischemic. Sudden onset focal neurological deficit, alert initially, may worsen over hours. Hemorrhagic: often more severe, headache prominent, vomiting, hypertension, rapid deterioration, may lose consciousness. TIA: symptoms identical to stroke but resolve completely and rapidly, minutes to hours. Study this. Q: What cranial nerve controls pupillary dilation? A: Cranial nerve III (oculomotor nerve) carries parasympathetic fibers that control pupillary constriction. Sympathetic fibers from T1 spinal level via cervical sympathetic chain control dilation. Damage to CN3—dilated pupil. Q. Identify myoclonic seizures. A. Brief, shock-like jerks of muscles or muscle groups, often occurring in clusters. Can occur throughout the day. Associated with certain epilepsy syndromes and other conditions. Q. Identify clonic seizures. A. Rhythmic jerking movements of limbs or body. Repetitive muscle contractions and relaxations. May be generalized or focal. Q. Identify status epilepticus. A. Continuous seizure activity or seizures occurring in rapid succession without return to consciousness between events. Medical emergency with risk of death. Hypoxia, hyperthermia, rhabdomyolysis, acidosis. Q. Identify absent seizures. A. Brief loss of consciousness without motor activity or minimal automatism. Staring spell lasting seconds. EEG shows characteristic 3 Hz spike and wave pattern, common in childhood absence epilepsy. Q. What are the different stages of a seizure? A. Prodrome: warning symptoms hours before seizure. Aura: subjective experience right before seizure, altered sensation, emotion, etc. Actal phase: the seizure itself. Seconds to minutes. Postictal phase: confusion, fatigue, headache, muscle soreness may last hours. Recovery: return to baseline function. Endocrinology. Q: What is the first-line treatment for anaphylaxis? A: Epinephrine (adrenaline). 0.3 mg IM immediately. Can repeat every 5-15 minutes as needed. Also, establish airway, Oxygen, IV access, antihistamines, corticosteroids. Consider second-line vasopressors if hypotensive. Q. What medication would benefit a hypotensive patient while in anaphylaxis? A. Epinephrine, first line. Second line: IV fluids, large-bore, rapid infusion, vasopressors, dopamine, norepinephrine. If refractory hypotension, treat underlying cause while supporting blood pressure. Q. How should you treat a semi-conscious hypoglycemic patient with snoring Aspirations. A. Do not give oral glucose. Aspiration risk. Establish IV access and give D50W (50% dextrose), IV or IM glucagon. Position in recovery position. Oxygen. Monitor for aspiration. May need airway protection, IAS intubation if no gag reflex. Q. What should you administer if you cannot establish IV access to raise blood glucose? A. Glucagon IM sqwon mengwu. May repeat in 15 minutes. Works by stimulating hepatic glycogenolysis. Takes 5-20 minutes to work. Alternative: oral glucose if patient can swallow safely. Q. What type of diabetes is associated with DKA? What about HHNS? A. DKA (diabetic ketoacidosis). Primarily type 1 diabetes, but can occur in type 2 with severe stress. HHNS: Hyperosmolar Hyperglycemic Non-Ketotic State. Primarily Type 2 diabetes, rarely in Type 1. Q: What diabetes causes Kussmaul respirations? A: Type 1 diabetes in DKA causes Kussmaul respirations—deep, rapid, labored breathing. Metabolic acidosis from ketone production triggers respiratory compensation. Q: What type of acid-base balance is Kussmaul respirations? A. Metabolic acidosis with respiratory compensation. The primary problem is metabolic acidosis, from DKA. Kussmaul respirations are the respiratory system's attempt to blow off CO2 and raise pH. Q. What conditions are associated with hypothyroidism? A. Hashimoto's thyroiditis (autoimmune). Iodine deficiency. Thyroid surgery, ablation. Medications. Lithium, amiodarone. Pituitary/hypothalamic disease. Leads to myxedema if severe, untreated. Q. Signs and symptoms of Addisonian crisis. A. Acute onset: Severe hypotension, tachycardia, hypoglycemia, confusion, shock. Chronic: Weakness, fatigue, hypotension, hyperpigmentation, especially in skin creases or scars, Weight loss, GI symptoms. Caused by acute adrenal insufficiency. Q: What will low cortisol cause? A: Weakness, fatigue, hypotension, hypoglycemia, hyponatremia, increased ACTH feedback, poor stress response, depression, confusion, shock, and Addisonian crisis. Q: What will high cortisol cause? A: Hypertension, hyperglycemia, weakness from hypokalemia, Weight gain, central obesity, purple stretch marks, easy bruising, osteoporosis, moon faces, buffalo hump. Seen in Cushing's syndrome. Q: What is metformin prescribed for? A: Type 2 diabetes. Works by reducing hepatic glucose production and improving insulin sensitivity. Does not increase insulin secretion, so low risk of hypoglycemia. Weight neutral. First-line agent. Q. What are the differences between Graves' disease, Cushing disease, and myxedema coma? A. Graves' disease: hyperthyroidism with antibodies against TSH receptor, exophthalmos, tremor, anxiety, tachycardia, weight loss. Cushing disease: excessive cortisol from pituitary ACTH, moon faces, buffalo hump, purple striae, HTN, hyperglycemia. Myxedema coma: severe hypothyroidism with altered mental status, hyperventilation, bradycardia, hypothermia, shock. Nephrology. Q: What would happen to the body if a patient misses renal dialysis? A: Accumulation of uremic toxins, hyperkalemia, risk of cardiac arrhythmia, death. Hyperphosphatemia, metabolic acidosis, fluid overload, pulmonary edema, hypertension, hypercalcemia, anemia, uremia. Can be life-threatening. Infectious diseases and septic conditions. Q. What are the signs and symptoms of septic shock? A. Fever or hypothermia, tachycardia, tachypnea, hypotension, altered mental status, elevated lactate, signs of infection source. May progress rapidly. Requires immediate aggressive treatment. Q. What are the signs and symptoms of gastroenteritis? A. Diarrhea, vomiting, abdominal cramping, fever, malaise. Usually viral, self-limited. Risk: dehydration, electrolyte loss. Treatment: supportive care, fluid, electrolyte replacement. Q: What are the signs and symptoms of hantavirus? A: Fever, headache, muscle pain, myalgias, then respiratory symptoms, dyspnea, cough, and potential progression to pulmonary edema and shock. Transmitted via rodent droppings, urine. High mortality. Q. What are the signs and symptoms of meningitis? A. Fever, severe headache, neck stiffness, nuchal rigidity, photophobia, altered mental status, rash, petechial, purpuric in meningococcemia. Koernig's sign positive, Brudzinski's sign positive. Viral versus bacterial may vary. Q. What are the signs and symptoms of tetanus? A. Trismus, lockjaw. Rises sardonicus, facial grimacing. Rigidity of trunk, do— limbs, arching of back, opus thetonus. Respiratory muscle rigidity, dysphagia. Caused by Clostridium tetani toxin. Preventable by vaccination. Q. What are the signs and symptoms of folliculitis? A. Pustules, are— papules around hair follicles, erythema, tenderness. Usually superficial caused by bacteria, S. aureus, or fungi. May progress to deeper infection. Q. What are the signs and symptoms of MRSA? A. Depends on site. Skin: erythema, pustules, abscess, folliculitis. Respiratory: pneumonia with severe symptoms. Bloodstream: sepsis signs. Wound: cellulitis, abscess. Resistant to beta-lactam antibiotics. Q. What are the signs and symptoms of boils? A. Painful nodule with surrounding erythema, chasseus, Edema. May rupture draining pus. Fever if systemic infection. Usually caused by S. aureus. May require drainage, antibiotics if large. Q. What are the signs and symptoms of ringworm? A. Circular patches with raised edges. Central clearing. Classic appearance. Pruritus. Scaling. Fungal infection, not a worm. Can affect skin, nails, hair. Contagious. Q. What are the signs and symptoms of hepatitis C? A. Often asymptomatic initially. If symptomatic: jaundice, fatigue, abdominal pain, nausea, dark urine. Chronic infection common. Risk of cirrhosis. Transmitted via blood/body fluids. Q: What are the signs and symptoms of hepatitis? A: Jaundice, fatigue, weakness, anorexia, nausea, right upper quadrant pain, dark urine, pale stool, fever, hepatomegaly. Can progress to liver failure in severe cases. Q. What are the signs and symptoms of pneumonia? A. Fever. Cough, productive or dry. Dyspnea. Pleuritic chest pain. Wheezing, hot crackles on exam. Tachypnea. Tachycardia. Malaise. Can be bacterial, viral, or atypical. Severity ranges from mild to severe. Q. What are the signs and symptoms of peritonitis? A. Severe abdominal pain. Rigid abdomen. Guarding, rebound, fever, nausea, vomiting, tachycardia, hypotension, shock. May follow perforation or occur spontaneously. Medical: Jhāsāi. Surgical emergency. Q. What are the signs and symptoms of Neisseria gonorrhoeae STD? A. Men: Dysuria. Purulent urethral discharge. Women: Often asymptomatic or mild cervicitis. Dysuria. Vaginal discharge. Q. Complications: prostatitis, PID, disseminated infection. Q. What are the signs and symptoms of chlamydia STD? A. Often asymptomatic. If symptomatic: dysuria, vaginal or urethral discharge, PID in women. More subtle than gonorrhea. Complications: infertility, chronic pelvic pain. Q. What are the signs and symptoms of syphilis STD? A. Primary. Chonker: painless ulcer at inoculation site. Secondary: rash, including palms, soles, fever, lymphadenopathy, systemic symptoms. Tertiary: gummas, neurosyphilis, cardiovascular complications. Congenital: multiple manifestations. Q. What are the signs and symptoms of herpes simplex virus STD? A. Vesicles, pustules, shallow ulcers, painful, fever, systemic symptoms. Especially primary infection. Recurrence common. HSV-1 oral, HSV-2 genital, though either can affect either site. Contagious even without lesions. Q. Why should someone who cuts themself need an updated tetanus shot? A. Risk of Clostridium tetani contamination from dirty, rusty objects. Tetanus spores are ubiquitous in environment. Vaccination provides immunity. Booster needed every 10 years, or 5 years if dirty wound and greater than 5 years since last dose. Q. What is the normal fluid bolus administration dose? A. For adults: Typically 20 mL/kg IV fluid (normal saline or lactated ringers) over 15-30 minutes. Reassess and repeat as needed. Example: 70 kg patient equals approximately 1,400 mL bolus. For pediatrics: Weight-based dosing. Usually 20 mL/kg as well. Titrate to response. Hematology. Q: What is sickle cell anemia? A: Genetic hemoglobinopathy caused by substitution of valine for glutamic acid in beta-globin chain, resulting in sickle-shaped RBCs when deoxygenated. Leads to hemolysis, vascular occlusion, chronic anemia, pain crises, organ damage. Autosomal recessive, homozygous condition (SS). Q: What is a sickle cell crisis and what is the pathophysiology behind it? A. Sudden acute event. Vaso-occlusive crisis. Due to sickling of RBCs causing ischemia. Infarction. Triggered by infection, hypoxia, dehydration, cold, stress. Results in severe pain, fever, organomegaly, stroke risk, splenic sequestration. Life-threatening. Q. What do sickle cell patients normally require as a treatment? A. IV fluids. Large volume hydration. IV opioids for severe pain. Oxygen, to reduce sickling. Blood transfusion, if severe anemia crisis. Antibiotics, if infection. Exchange transfusion for stroke, shock, acute chest syndrome. Q. What balances pH in the body? A. Buffer systems. Bicarbonate buffer system is primary in blood, phosphate buffer system in cells, protein buffers. Respiratory system, CO2 elimination, respiratory compensation. Renal system, bicarbonate and H+ excretion, metabolic renal compensation. Q: How do you treat an allergic reaction to a blood transfusion? A: Stop transfusion immediately. Establish, maintain IV access. Oxygen, monitor vitals. Antihistamines, diphenhydramine, for urticaria, jashi, itching. Corticosteroids, methylprednisolone, for severe reaction. Epinephrine, IM, if anaphylaxis. Acetaminophen for fever. Return blood product to blood bank for testing. Q. What are the signs and symptoms of lymphoma? A. Lymphadenopathy, painless. Fever. Night sweats. Weight loss. B symptoms. Fatigue. Splenomegaly. Hepatomegaly. Can present insidiously. Hodgkin versus non-Hodgkin lymphomas have different presentations/prognosis. Miscellaneous conditions. Q: What facility would be appropriate for a patient who ascended too quickly during a dive, presenting with extreme pain? A: Hyperbaric oxygen chamber facility. Condition is decompression sickness, the bends. Requires immediate recompression therapy to reduce nitrogen bubble size and increase oxygen gradient. May also need transport to dive medicine specialist center. Q: What are the signs and symptoms of neuropathy? A: Numbness, tingling, paresthesias, usually distal, arsh, symmetrical. Weakness, balance problems, pain (burning or sharp), reduced reflexes, muscle atrophy. Caused by diabetes, chemotherapy, infections, toxins, autoimmune, B12 deficiency, etc. Q: What are the signs and symptoms of amyotrophic lateral sclerosis? A: Progressive muscle weakness and atrophy, upper/lower motor neurons fasciculations, spasticity, hyperreflexia, Eventual paralysis including respiratory muscles. Cognitive function usually preserved until late. Leads to death, usually respiratory failure. No cure. Q: What are the signs and symptoms of biliary obstruction? A: Jaundice, pale stool, dark urine, right upper quadrant pain, nausea, vomiting, fever (if infection). Caused by gallstones, tumor, stricture. Risk of pancreatitis, cholangitis. Q. What are the signs and symptoms of pancreatic cancer? A. Usually presents late. Jaundice, painless. Abdominal pain, weight loss, nausea, backache, depression. Often head of pancreas, bile duct obstruction. High mortality, poor prognosis. Q. What are the signs and symptoms of alcohol-related liver disease? A. Fatty liver. Mild abdominal pain, hepatomegaly. Alcoholic hepatitis. A) Fever, jaundice, hepatomegaly, right upper quadrant pain. Cirrhosis, ascites, portal hypertension, varices, coagulopathy, encephalopathy. History of heavy alcohol use. Q: What are the signs and symptoms of H5N1 (avian influenza)? a) High fever, severe pneumonia, respiratory distress, cough, gastrointestinal symptoms, encephalitis, organ failure, shock. High mortality rate. A. Transmitted from birds/poultry. Rare human-to-human transmission. Q. What are the signs and symptoms of Zika? A. Fever, headache, muscle/joint pain, rash, conjunctivitis (without exudate), malaise. Usually mild and self-limited. Teratogenic—causes congenital abnormalities, especially microcephaly if contracted during pregnancy. Q. What are the signs and symptoms of diabetic coma? A. Altered mental status progressing to coma. May have Kussmaul respirations in DKA, or more subtle presentation in HHNS. Preceded by hyperglycemia signs: polydipsia, polyuria, polyphagia. Q. What are the signs and symptoms of cardiogenic shock? A. Hypotension, altered mental status, poor perfusion, cool, clammy skin, oliguria, pulmonary edema signs. Crackles, dyspnea, tachycardia. Caused by: acute MI, heart failure, arrhythmia, valvular disease, tamponade, PE. End of study guide.