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Med/Surg Test 2
spc
| Question | Answer |
|---|---|
| Cerebral blood flow is auto regulated by C02 tension, rising arterial C02 tension will? | Increase cerebral blood flow, where as lowering the C02 has the opposite effect. This is why Pt's with cerebral trauma are often hyperventilated with mech ventilation, to reduce cerebral blood flow and intracerebral pressure |
| In addition to hyperventilation, what other methods may be used to reduce intracerebral pressure? | corticosteroids, and hyper tonic solutions such as mannitol |
| With head trauma auto regulation of cerebral blood flow is often? | lost |
| A spinal cord injury at C3 will cause diaphragmatic paralysis by effecting the? | phrenic nerve, a sniff test can be used to determine |
| Another complication of brain injury (neurological injury) can be? | neurogenic pulmonary edema, secondary to elevated intracranial pressure |
| The exact reason for neurogenic pulmonary edema is unknown, it could possibly be? | from massive adrenergic sympathetic discharge caused by hypothalmic stimulation |
| Abnormal patterns of breathing commonly result from intracranial disorders and are all? | associated with different levels of the brain and brain stem |
| Cheyne stokes breathing? | alternating patterns of hyperventilation followed by either apnea or hypoventilation |
| What is the major cause of cheyne stokes? | severe heart failure |
| Apneustic breathing? | prolonged cessation of breathing in an inspiratory position, this indicates damage to the pons |
| Central neurogenic hyperventilation? | hyperventilation despite arterial oxygen tensions in excess of 75, persistant hyperventilation produces minute ventilation 4 times more than normal. Indicates damage to the midbrain |
| Central neurogenic hypoventilation? | narcotic suppression of respiratory center, associated with co2 retention |
| Lambert eaton myasthenic syndrome is? | disease of myoneural junction, associated with bronchogenic small cell carcinoma |
| Tetanus is a gram positive bacillus that has? | a spore form, when introduced into a wound can multiply and produce toxin. Classic symptoms are tetanic muscle spasm and ridgity |
| Tetanus treatment consists of? | antibiotics, penicillin, in severe tetanus control of the airway requires the pt be paralyzed, sedated, and mechanically ventilated |
| Botulism is? | a severe paralytic disease, common from food poisoning |
| Insecticide poisoning is? | organophosphate poisoning |
| There are several types of muscular dystrophies? | respiratory complications are common, like aspiration pneumonia, ineffective cough, alveolar hypoventilation |
| What is polymyositis? | inflammatory disease of the skeletal system |
| Physical exam of the neuromuscular disease pt? | paradoxical movement of abdomen suggests diaphragm paralysis |
| A cord lesion above C3 will cause? | loss of diaphragm function |
| GBS is a? | autoimmune disease that causes paralysis, often starts as a fever, has an unknown cause |
| The incidence of GBS is equal is males and females, it is? | more common in people over 50, and is 50% to 60% more common in white people |
| The onset of GBS often occurs ? | 1-4 weeks after a febrile episode |
| How many pt's with GBS die? | about 2-3%, was associated with the swine flu vaccine in 1976 |
| Geeral symptoms of GBS pt's? | symmetric muscle weakness in extremities, parasthesia, dysesthesias, pain, numbness, drooling, difficulty speaking |
| About how many GBS cases occur with respiratory muscle paralysis and acute ventilatory failure? | 10-30% |
| About ___% of pt's make a full recovery, this may take as long as 3 years. | 90% |
| Increased protein in cerebral spinal fluid indicates? | GBS |
| The paralysis with GBS is always symmetrical, it does? | not have unilateral ptosis, and has a normal chest x-ray |
| Close respiratory monitoring of GBS pt's includes? | FVC, MIP, MEP, Sa02, ABG's |
| Myasthenia Gravis (MG) is the most common chronic disorder of the? | neuromuscular junction, it interferes with the transmission of acetylcholine (ACH) |
| What is the hallmark clinical feature of MG? | fluctuating skeletal muscle weakness with true muscle fatigue, the fatigue and weakness improves after rest |
| There are two clinical types of MG? | ocular and generalized |
| Ocular MG? | muscle weakness is limited to the eyelids and extraocular muscles |
| Generalized MG? | muscle weakness involves a variable combination of everything |
| The cause of MG appears to be related to? | ACH receptor antibodies that block nerve impulse transmissions, also seems to be associated with the thymus gland, they often have thymic abnormalities |
| Ptosis is? | drooping of one or both eyelids |
| Diplopia? | double vision |
| Opthalmoplegia? | paralysis or weakness of one or both eye muscles |
| All of the eye problems are common in MG pt's, what else is? | dysphagia, facial muscle weakness, difficulty breathing, unstable gait, etc... |
| What is the edrophonium (tensilon) test? | used in pt's with obvious ptosis or opthalmaparesis, it blocks ACH from breaking down, if positive for MG you will see a dramatic improvement after giving the edrophonium |
| ACH inhibitors are the first line of treatment for MG, what are some of these? | pyridostigmine (mestinon) and prostigmine |
| What is plasmapheresis (plasma exchange) | removes the ACHR antibodies from the blood, can be used in a myasthenic crisis |
| A thymectomy may also be? | a form of treatment for MG |
| Certain things can cause MG to exacerbate such as? | pregnancy, stress, illness, trauma, etc..... |
Created by:
juialynn92
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