BOARD EXAM
Acceleration vs. deceleration (mechanism of injury) Define: blunt trauma, penetrating trauma, coup-contrecoup injuries
*Acceleration* - something falls on your head (immobile head hit by moving object) *Deceleration* - you hit your head into something (mobile head hits immobile object) AKA *blunt trauma* *Penetrating* - wehen injuries are made by foreign bodies (e.g. knives, bullets) *Coup-contrecoup* - blow causes injury on opposite side of brain
Define annulus fibrosis vs. nucleus pulposis
*Annulus fibrosis (disk annulus)* - the outer layers of the cartilage *Nucleus pulposis (disk nucleus)* - soft jelly like interior (the middle space) Components of the disk located between the vertebrae
Which characteristics are specific to anorexia nervosa vs. bulimia nervosa vs. binge eating disorder
*Anorexia nervosa* - perfectionism, sexuality conflicts, maturity fears, ritualistic behaviour, dietary restraint *Bulimia nervosa* - impulsivity, boundary problems, limit setting difficulties, dietary restraint *Binge eating disorder* - negative mood, self-deprecation, social insecurity
Arterial vs. venous ulcers
*Arterial* - painful, sharp/clean edges, pale base *Venous* - achy or heavy sensation, irregular/ragged edges, red healthy base, not as painful when you touch it
Arteries vs. veins
*Arteries* carry oxygenated blood away from the heart and *veins* return blood to the heart
Arteriosclerosis vs. atherosclerosis
*Arteriosclerosis* - peripheral blood vessels lose elasticity and become rigid - increasing BP *Atherosclerosis* - deposit of fatty material in vessels/blockages - causes inflammation
Sexual assault assessment and treatment for victims
*Assessment* is done with a rape kit (also used to collect evidence), lab testing for STI's, urinalysis for drug screening, pregnancy test *Treatment* - prophylactic antibiotics for STIs, emergency contraception, antidepressants, antianxiety, counselling, psychotherapy, exposure therapy, CBT
CNS vs. PNS
*CNS* - made up of the brain and spinal cord (bundle of nerves) *PNS* - all the nerves that lie outside of the brain and spinal cord - includes three parts: motor nerves, sensory nerves, autonomic nerves - has two systems: somatic nervous system and autonomic nervous system
Concussion vs. contusion
*Concussion * - loss of consciousness for 5 minutes with memory loss, injury is reversible *Contusion* - worse, more aggressive hit to the brain, longer than 5 minutes, extensive brain damage with bruising and hemorrhagic areas
Main differences between delirium and dementia
*Delirium* - sudden onset, reversible, most common cause is prescription medication and UTIs, could have *visual hallucinations* *Dementia* - you do not wake up one day with dementia. Chronic and persistent disorder diagnosed in the presence of persistent memory loss and 1 other feature of impaired function (aphasia, apraxia, visuospatial, or executive function)
3 skin layers
*Epidermis* - out layer, can tell you about someones temperature and circulation, protective layer (from bacteria), water insoluble *Dermis* - blood vessels that feed the skin, vascular supply, subcutaneous glands, connective tissue or collagen, elastic tissue *Subcutaneous layer* - fat storage, insulation, protection (cushion)
Define epidural hematoma and subdural hematoma
*Epidural hematoma* - Pockets/buildup of blood between the dura mater and skull *Subdural hematoma* - bleeding in the space between the dura mater and the brain
Which drugs reverse heparin and warfarin?
*Heparin* - protemine sulphite *Warfarin* - vitamin k
Which disease may present similar to the symptoms of psychosis?
*Huntingtons disease* - a neurological disorder that causes degeneration of parts of the brain Individuals with this disease may experience delusions and hallucinations. Not to be confused with psychosis
Differentiate between hyperflexion vs. hyperextension (spinal cord injuries) vs. compression
*Hyperflexion* - whiplash forward (car accident where you smack your head into the steering wheel) - this causes a *tear in the posterior ligament* *Hyperextension* - where your chin hits something and your head is whiplashed backwards - this causes the *anterior ligament to rupture* *Compression* - someone goes head first into the swimming pool
Define hypotension vs. hypertension vs. orthostatic hypotension
*Hypotension* - systolic falls <90mm HG *Hypertension* - >140/90mm HG (heart must continually pump against greater peripheral vascular resistance) *Orthostatic hypotension* - systolic pressure falls more than 15mm HG between sitting and standing
Hypoxia vs. hypoxemia
*Hypoxia* - deficiency in the amount of oxygen reaching the tissues/brain *Hypoxemia* - deficiency in the amount of oxygen in the blood
Define: Jefferson fracture Hangman's fracture
*Jefferson fracture* - shattered/burst ring - causes no pain because there is no pressure thats being put on the nerve *Hangmans fracture* - an actual piece of the spinal process is broken off
Define kyphoplasty vs. arthroplasty
*Kyphoplasty* - inserting a balloon between the vertebrae (functions to expand a collapse vertebrae) *Arthroplasty* - surgical reconstruction or replacement of a joint (usually does with an artificial structure)
Which drugs would be given for increased intracranial pressure?
*Mannitol* (diuretic), anticonvulsants, barbiturates, steroids You also want to reduce a patient's temp - put them in a hypothermic state (because it will slow their metabolism) - Hyperventilate them (blow off Co2, vasoconstriction)
What are the 4 levels that anxiety manifests at?
*Mild* - slight arousal, enhances perception and productivity *Moderate* - tension, nervous, concerned - perception is narrowed, attention is more focussed *Severe* - unable to focus, consuming, requires intervention *Panic* - overpowering, frightening
Normal vital signs
*O2*: 95-100% - generally normal (<92% suggests hypoxemia) *Resp rate*: 12-20 bpm *BP*: 120/80 (ideal), 130/85 (normal) *Heart rate*: 60-100 *Temp*: ~36-37.7 (38.0 indicates fever)
Differentiate between paranoid personality disorder, delusional disorder - persecutory type, and paranoid schizophrenia
*Paranoid personality disorder* - misinterpretation of others but not psychotic. No hallucinations and their delusions are non-bizarre. DO BELIEVE that others are trying to get them, but this is just their baseline thinking. You might be able to reason with them *Delusions of persecution * - Thought form is really tight and organized - they have an answer for everything. Bizarre (e.g. microchip) and non-bizarre delusions, no hallucinations or voices. *Highly resistant to change,* it is almost impossible to reason with them *Paranoid schizophrenia* - preoccupied with delusions and hallucinations, flat or emotionless affect, disorganized thinking and behaviour, fragmented thought form
What are the high blood pressure categories?
*Prehypertension* - 120-139 over 80-89 *Stage 1* - 140-159 over 90-99 *Stage 2* - 160 or higher over 100 or higher *HYPERTENSIVE CRISIS* - higher than 180 over higher than 110
3 levels of prevention
*Primary prevention* - Aim to reduce the possibility of the client's encounter with the stressor or to strengthen the flexible line of defense *prevent it before it happens* *Secondary prevention* - Begins after the stressor has occurred. Functions to ensure the appropriate treatment and decrease the negate impact of the stressor on the system *you have something and you treat it* *Tertiary prevention* - Maintain system stability *long haul maintenance*
What are the 2 types of anorexia?
*Restricting type* - during the current episode of AN, the person *does not* binge-eat or purge *Binge eating/purging type* - during the current episode of AN, the person engages in binge-eating/purging behaviour
Define transference vs. countertransference
*Transference* - The unconscious tendency of a patient to assign to others in the present environment feelings and attitudes associated with significant persons in one's earlier life; especially, the patient's transfer to the therapist of feelings and attitudes associated with a parent or similar person from childhood. The feelings may be positive or negative (e.g. you remind them of their mother) *Countertransference* - Same concept but the other way around (e.g. the client reminds you of your grandfather)
PVD - venous vs. arterial
*Venous* - pulses are present, you elevate the leg above the heart (edema) *Arterial* - pulses are absent, you can't elevate since the problem is at the top (pain) therefore you need to get the arteries open
Vicarious trauma/secondary PTSD Caregiver burden Compassion fatigue
*Vicarious trauma/secondary PTSD* - it didn't happen to you. It happened to someone you know and you pick up some of those symptoms *Caregiver burden* - Taking care of the person (e.g. wife of a war veteran, husband to a rape victim) *Compassion fatigue* - Can happen to anybody. You still have compassion but you're running out of resilience. You're heading to burnout and have less patience to do your job
Which three disorders have paranoia as a primary feature?
- Schizophrenia - paranoid type - Delusional disorder - persecutory type - Paranoid personality disorder
What were the DSM 5 changes re: eating disorders?
-Absence of menstruation for at least 3 months was REMOVED from the DSM 5 (for anorexia nervosa) -Binge eating disorders (BED) were a new addition - For bulimia nervosa, DSM 5 criteria consists of binge eating/purging *once a week* (as opposed to twice a week which was in the DSM 4)
Treatment for sexual offenders
-CBT - Anti-androgren drugs to prevent production of testosterone Sexual offenders who received treatment are less likely to reoffend than offenders who did not receive treatment
Interventions to prevent the formation of ulcers
-Encourage patient to mobilize -Turn Q2H -Use warm, not hot water -Good nutrition -Adequate fluids (2500mL/day) -Keep client clean and dry -Lift, don't drag over sheets to avoid tears -Pat areas dry
Bulimia nervosa treatment
-Focuses on psychological issues (e.g. boundary setting, changing problematic behaviours and dysfunctional thinking) -Intensive psychotherapy -Pharmacologic interventions -Nutrition counselling (helps stabilize and normalize eating) -Support groups *-CBT is very helpful for treating BN - eliminate 'out of control' feelings/setting boundaries and healthy limits/COPING*
Which physical symptoms are associated with bulimia nervosa?
-Loss of dental enamel -Esophageal tears -Menstrual irregularities -Cardiac myopathies
Components of a neurological assessment
-MSE including LOC and orientation -Cranial nerves -Reflexes -Motor function -Sensory function
What are some predisposing/precipitating factors for a sexual assault perpetrator?
-Narcissism -Antisocial behaviours -Stereotypical attitudes towards women -Hostile attitude towards women -Alcohol/substance use -Misperceive the woman's degree of sexual interest
What are the cardinal signs of a basal skull fracture?
-Raccoon eyes (bruising) -Rhinorrhea (fluid discharge from nose) -Otorrhea (fluid discharge from ears) Basal skull fracture - fracture at the base of the skull
What are the comorbidities associated with bulimia nervosa?
-Substance misuse -Depression -OCD
3 types of sexual offenders
1. *Manipulative* (seen with child molesters) 2. *Opportunist* (they have a specific "type", will pry on strangers as well, kidnapping) 3. *Coercive* (typically rapists, stalkers, they might use weapons)
What is the etiology of lower back pain?
1. Biomechanical (disc compression, herniation, torsion injury) 2. Destructive (e.g. infection, tumor, rheumatoid arthritis) 3. Degeneration problems (e.g. osteoporosis, spinal stenosis)
Glasgow coma scale
1. Eye opening - spontaneous, opens eyes in response to speech...etc (/4) 2. Motor response - follows commands, movement (/6) 3. Verbal response - oriented, confusion...etc (/5) /15 The lower the score = the worse they are. Lowest score possible is 3 which pretty much indicates coma/death
What is Cushing's Triad?
1. Irregular resps (e.g. cheyne stokes) (increased systolic?) 2. Bradycardia 3. Widened pulse pressure (the difference between systolic and diastolic pressure) Cushing's Triad is an important, but late *sign of increased intracranial pressure*
What is the most common cause of spinal cord injuries? And who is most at risk?
1. MVA 2. Falls Males 15-39 y/o - risk takers
Most common causes of delirium?
1. Prescription medication 2. UTIs 3. Upper respiratory/chest infections In addition - alcohol/sedative toxicity, withdrawal off alcohol, metabolic disorders (e.g. hypo/hyperthyroidism, hypokalemia), infectious diseases (e.g. pneumonia, fever)
Normal INR range
2-3.5 INR - monitor coumadin/warfarin (anticoagulant)
Normal potassium level
3.5-5
What is normal intracranial pressure (ICP)?
5-15 mm HG 20 mm HG = DANGER
Deep Vein Thrombosis
A blood clot (thrombus) forms in a deep vein in your body, usually in your legs. It can cause leg pain or swelling, but may occur without any symptoms. Serious because the clot can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism) Women > Men Orthopaedic surgery is a red flag for DVT
Define crepitus
A cracking/popping/grating sound produced by friction between bone and cartilage or the fractured parts of a bone
Autonomic dysreflexia (*triad)
A life-threatening syndrome - cluster of clinical manifestations that results when multiple spinal cord autonomic responses discharge simultaneously *TRIAD* - Severe hypertension, pounding headache, bradycardia Other symptoms - diaphoresis, dilated pupils, blurred vision (symptoms happen to try and compensate for the high BP)- rflexes are hyperstimulated Tx - elevate HOB (don't want more venous return coming to the heart), administer antihypertensive, remove noxious stimuli (that is causing injury or distress)
What is binge-eating disorder?
A new category under eating disorders in the DSM 5, where you overeat without the purging but then you feel guilty and go into self-hatred (eating large amounts of food at first to comfort emotions (cope)-> feels guilty for over eating -> uses guilt about eating to avoid other feelings) Individuals with BED eat in the same way as those with BN *but do not compensate* for binges through purging or other behaviours
DSM qualifications for anorexia nervosa
A refusal to maintain a normal body weight -Onset in early adolescence (absence of menstruation for at least 3 months was REMOVED from the DSM 5) -Distorted view of body size, shape and weight
Psychosis (definition and causes)
A serious mental disorder characterize by a loss of contact with reality (delusions, hallucinations) Causes - infections, dementia, delirium, drugs, medications, toxic substances, nutritional deficiencies, vascular disorders, neurological disorders, cerebral hypoxia, stroke
Define the following abbreviations: AC HS PC OD PR QD
AC - before meals HS - at bedtime PC - after meals OD - once a day PR - rectal QD - everyday
Define kussmaul's breathing
Abnormally deep, laboured breathing (very rapid, sighing respirations) - typically a sign of diabetic ketoacidosis
What is hypoxemia?
Abnormally low concentration of oxygen in the blood Assess O2 levels will detect the presence of hypoxemia Factors that effect oxygen saturation include: hemoglobin, problems with circulation, individual is shivering/lots of movement
What are tonic-clonic seizures?
Aura, sudden loss of consciousness *Tonic* - resps stop, cyanosis, rigid body, pupils dilated and fixed (30-60 seconds) *Clonic* - foaming at the mouth, rhythmic jerky movements - can bite their tongue/lips(*injury can occur here*) (2-5 minutes) Postictal phase - amnesia about the event (won't remember anything), complete relaxation, drowsy, confusion, headache
What is the Munro-Kellie hypothesis?
Because the bony skull can not expand, when one of the three components (brain, tissue, blood and CSF) expands, the other two must compensate by decreasing the volume for the total brain volume to remain constant Done through autoregulation
What is more common, AN or BN?
Bulimia is more common than AN The recovery rate is also higher for BN than AN BN is more common in men than AN
Stable angina
Chest pain that occurs when the coronary vascular supply cannot keep up with the metabolic demands of the heart S/S: a squeezing "clenched fist", pain, diaphoresis, dyspnea, nausea, tachycardia MEDS you would likely administer: Aspirin to decrease viscosity of blood, nitroglycerin (vasodilator) PRN if prescribed
Rheumatoid arthritis
Chronic, inflammatory disease that primarily impacts juices but may impact other systems S/S - swelling, redness, heat, pain Idiopathic in nature, may be hereditary
Which enzyme can cause vasodilation in the brain?
Co2 - carbon dioxide Accumulation of Co2 could increase intracranial pressure and can lead to death
Define intermittent claudication
Cramping pain in the leg induced by exercise, typically caused by obstruction of the arteries Occurs when the muscle is engaged but has inadequate blood flow to meet the demands
What is the formula for drug calculations?
D -------------------- x V H Dose (over) what you have (times) the volume
What are some consequences of binge eating?
Diabetes, heart disease, obesity
Define Homan's sign
Discomfort in the upper calf during forced dorsiflexion of the foot (secondary to DVT)
Peripheral Vascular Disease (definition, causes, risk factors, management)
Disorders in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand Primary cause - atherosclerosis (starves tissue of oxygenated blood) Risk factors - surgery, when you are lying around and not moving you are at increased risk for venous problems, smoking Surgical management - balloon angioplasty Prevention - anticoagulants (heparin, warfarin) - THIS ONLY WORKS AS PREVENTION if you don't already have it. Doesn't work once you have it
DSM qualifications for bulimia nervosa
Eating large amounts of food, then ridding the body of the food through self-induced vomiting DSM 5 - binge eating/purging *once* a week DSM 4 - defined as twice a week
What are some advanced (and worrisome) symptoms of hypertension?
Epistaxis, flushing, blurred vision
Define shear
Force exerted parallel to the skin (e.g. transferring a patient and pulling their skin across the bed)
Define cholelithiasis and its causes
Formation of gallstones Causes: bile undergoing a change in composition, gallbladder/bile stasis, infection, genetics Non-surgical eradication of stones - endoscopy, gallstone dissolution Surgical eradication of stones - cholecystectomy
FOIPPA
Freedom of Information and Protection of Privacy Act Dictates how public bodies collects, stores and SHARES information -Continuity of care - we can share information with others if that information is being shared for the same reason it was collected (to offer healthcare)
Which medication helps with sciatic nerve pain?
Gabapentin
What's the function of the discs?
Gelatinous structures that lay between the vertebrae. Function to absorb shock/act as a cushion As you get older the "cushion" gets more compressed and doesn't absorb shock as well
What are the legalities around healthcare professionals disclosing sexual assault information?
Health professionals *are NOT obliged* to disclose to the police or other authorities information related to sexual assault obtained either in the course of treating a patient or found in his or her health record. The exception to this rule is where the patient consents to the disclosure of information or disclosure is authorized by the law
Spinal cord injury/spinal shock
IMMEDIATE RESPONSE to cord transection that occurs 30-60 minutes post injury - at risk for up to 6 weeks -complete loss of bladder, muscular and sympathetic sensation -BP and pulse drop -cardiovascular symptoms because theres no venous return to the heart *At risk for kidney stones because the body absorbs more calcium
Cholecystitis
Inflammation of the gallbladder S/S: severe and persistent pain, tenderness/pain in right upper quadrant, N/V, low grade fever
Acute pancreatitis (definition, symptoms, causes, diagnostics, treatment)
Inflammation of the pancreas. Results in autodigestion of the pancreas by its own enzymes Symptoms - abdominal pain, N/V Diagnostic - (earliest indicator) elevated serum amylase and lipase Causes - drinking and gallstones Treatment - NPO - this will decrease enzymes, pain treatment with demoral, surgical management - whipple procedure (partially removing 1/3 of the stomach)
HYPERTENSION FACTS
Initial S/S - first it is asymptomatic, then headache Commonly forgot about risk factors - use of oral contraceptives Daily sodium intake - <1500/day with hypertensive patients Diagnosed after the BP has been elevated on 3 separate occasions Management - #1 salt restriction, #2 diuretic (e.g. Hydrochlorothiazide) pharmacological treatment, CCB, ACE inhibitors, beta blockers
Define cheyne-stokes breathing
Irregular resps, characterized by *alternating periods of apnea and hyperventilation*. Respiratory cycle begins with slow, shallow breaths that gradually increase to abnormal rate and depth. The pattern reverses, breathing slows and becomes shallow, climaxing in apnea before respiration resumes Usually happens when someone is about to die/comatose patients
Pressure ulcer
It is any lesion (sore) caused by unrelieved pressure (laying down/sitting for too long) and decreased blood supply that results in damage to the underlying tissue Can be found on: shoulders, hips, back, gluteus, heels... anywhere there is pressure Risk factors include friction, immobility, poor nutrition, incontinence, decreased sensorium or sensation, age, health Assess - size, location, colour,exudate, temp, door, pain, swelling, surrounding pain (Use the braden assessment tool - lower score means higher risk)
Which medication would you *NOT GIVE* with ICP?
Morphine - causes vasodilation
How does smoking affect BP?
Nicotine makes arteries smaller and decreases the amount of oxygen brought to all tissues and contributes to HTN
What is status epileptics? (definition, cause, treatment)
Period of continued (30 minutes) seizure activity Rapid succession of seizures with *no regaining of consciousness* - MEDICAL EMERGENCY Often caused by withdrawal of anti epileptic drugs Results in hypoxia, lactic acidosis Tx - oxygen, IV infusion of anti-epileptic medications (e.g. diazepam (valium), ativan, phenytoin (dilantin)
Which medications are used to control (not cure) seizures?
Phenytoin (Dilantin) (S/E- double vision) Carbamazapine (Tegretol) Valproic Acid (Valproate) Lamotragine (Lamictal) Benzos and barbituates
Delirium tremens
Presence of hallucinations/delirium when a chronic alcohol user abstains from alcohol. Usually begins within 3 days of cessation of drinking
Define purging?
Purging is not just inducing vomit. It includes anything you use to get food out of your body (e.g. laxatives, diuretics...etc.)
What is the physiological/cardiac concern with purging? (bulimia nervosa)
Purging removes electrolytes -> low electrolytes cause cardiac arrhythmias -> cardiac arrhythmias can cause death
Purposes of seclusion?
Safety and behavioural management
What are some responses to trauma?
Shock, denial, disbelief, anger, irritability, mood swings, guilt, shame, self-bame, feeling sad/hopeless/disconnected/numb, anxiety, fear, withdrawal Insomnia, nightmares, being startled easily, racing heartbeat, aches and pains, fatigue, difficulty concentrating, agitation, muscle tension
What is meant by the "aura" manifestation of seizures?
Symptoms including: -Ringing in the ears -Strange smells (e.g. burnt toast) -Feeling of being somewhere else + Hallucinations
Pulmonary embolism clinical manifestations
Tachypnea, tachycardia Dyspnea Anxiety Syncope Fever *Chest pain: sudden, severe, exacerbated by breathing* Elevate the HOB for PE treatment/intervention
What could be the biologic cause of binge eating disorder?
The *hypothalamus* (the part of the brain that controls appetite) may not be sending correct messages about hunger and fullness
Sexual assault
The Canadian Criminal Law does not use "rape" but instead criminalizes "sexual assault" Sexual assault - *any form of* sexual contact without both parties' voluntary consent. It is NOT LIMITED to sexual intercourse, but rather also includes non-consensual fondling, touching or kissing
Which areas of the back are most likely to get a herniated disc?
The cervical and lumbar spine are most susceptible (because theres the most movement there)
Which vitamin deficiency can trigger delirium?
Thiamine (vitamin B1)
What is Virchows triad?
Thrombus formation is attributed to: 1) venous stasis 2) hypercoagulability 3) injury to the venous wall At least 2 of the 3 must be present for thrombi to form
What is a ketogenic diet?
Used with children who have not responded to conventional pharmacology tx for seizures High fat/low carb diet that creates a ketosis state in the brain/body (like fasting) which seems to suppress certain types of seizures
Neuman's Systems Model
Views the client as multidimensional and illness as multicausal. Looking at a client holistically through the 5 variables: -Physiological -Psychological -Sociocultural -Developmental -Spiritual
