Clinical Assessment Definitions 319 Questions with Verified Answers,100% CORRECT

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Clinical Assessment Definitions 319 Questions with Verified Answers Acid-Fast Bacillus (AFB) Staining (Ziehl - Neelsen) - CORRECT ANSWER Used in diagnosis of Tuberculosis, tuberculous infections ... and leprosy. Organisms will appear red against a blue background when stained by this method. Usually takes 2 -3 weeks to culture tubercle bacilli; results of the AFB stain can indicate the need for the immediate initiation of therapy. Airway Resistance (Raw) - CORRECT ANSWER Estimated by determining the difference between peak airway pressure and plateau pressure. Used to determine the amount of pressure support necessary to overcome airway resistance. Most accurately measured by placing the patient in a body plethysmography in the PFT lab. A measure of the impedance to airflow through the bronchopulmonary system. It is the reciprocal of airway conductance. Raw = Change in Pressure/ Flow = cm H2O/ L/sec Normal: 1.0 - 2.0 cm H2O/L/sec Albumin - CORRECT ANSWER Normal value 3.5-5.0 Important in maintaining osmotic pressure of the blood and has a primary role in lipid metabolism. Decreased levels are seen in protein malnutrition and severe liver disease. Chronic inflammation, severe acute disease and kidney disease lead to low albumin levels. Severe hypoalbuminemia may result in a loss of fluid from the vascular space and contribute to pulmonary edema. Angiogram - CORRECT ANSWER Serial roentgenograms (X-rays) of blood vessels taken in rapid sequence following injection of a radio opaque substance into a vessel. Used to define the size, shape, and patency of veins and arteries. Can evaluate blood flow to the brain, heart, lungs, kidneys or liver. Anion Gap - CORRECT ANSWER Normal range: 8 - 18 mEq/L Formula: (Na+) - (Cl- + HCO3-) Used to identify the cause of metabolic acidosis. Loss of base results in a normal anion while the gain of fixed acids (lactic acidosis) results in an elevated anion gap. Is alos affected by serum albumin levels (rising when albumin does and vice versa) Ascorbic Acid Level - CORRECT ANSWER Determination of the amount of ascorbic acid (vitamin c) in the blood Apgar Score - CORRECT ANSWER System of scoring a newborn's condition at 1 minute and 5 mins after birth. HR, RR, muscle tone, reflex irritability & color are assigned a point value between zero & 2. 7 - 10 score indicate that the infant is stable. 6 - 4 score indicate stimulation, warmth, O2 administration & assist in ventilation. 0 - 3 score require immediate resuscitation. Babinski Reflex - CORRECT ANSWER A neuro test used to evaluate the brainstem and spinal cord function. Performed by stroking the sole of the foot and observing the reaction of the toes. dorsiflexion of the toes in response to this stimulus is be helpful in stable, but unconscious patients. Normal in child, indicated neuro problem in adult Basal Metabolic Rate - CORRECT ANSWER The rate at which energy is produced according to how much is available. Also referred to as (BEE) Basal Energy Expenditure or (MEE) Minimal Energy Expenditure. Determined through direct or indirect calorimetry. A time consuming test, but may be helpful in determining a patient's nutritional needs. Basal Metabolic Panel (BMP) - CORRECT ANSWER Blood test that includes assessment of glucose, electrolytes, fluid levels and kidney function. This panel measures sodium, potassium, calcium, chloride, carbon dioxide, glucose, urea nitrogen and creatinine. BCG vaccine - CORRECT ANSWER A vaccine (bacilli Calmette-Guerin) used against TB. Once a pt receives this vaccine, they will have a positive skin test for TB. An organism of the strain Mycobacterium bovis is in the vaccine. Bilirubin Level - CORRECT ANSWER Bilirubin is the orange-yellow pigment of bile, formed by the breakdown of hemoglobin. Used as an indication of liver function. pt appears jaundice. Norma level: 0.1 to 1.0 mg/dL Blood Alcohol Level - CORRECT ANSWER Measurement of the amt of alcohol present in the pt's blood. Blood alcohol isn't always actually measured; it may also be estimated from the amt present in expired air (breathalyzer). 50 mg/dL = sedation or tranquility < 80 mg/dL = legal driving level 50 - 150 mg/dL = lack of coordination 140 - 200 mg/dL = unconsciousness > 400 mg/dL = may be fatal Blood Digoxin Level - CORRECT ANSWER Digoxin is an inotropic agent used to increase cardiac contractility in pts with CHF.Toxicity may result in diarrhea, nausea, arrhythmias (PVC) and ECg changes in T waves. 0.9 - 2.0 ng/mL = Therapeutic blood level > 3.0 ng/mL = potentially toxic blood level Blood Glucose Level - CORRECT ANSWER A blood test important in the evaluation of stable infants and patients with suspected diabetes. Normal levels: Preterm = 20 - 30 mg/100 mL Term = > 30 mg/100 mL Adults = 80 -120 mg/ 100 mL Blood Magnesium Level - CORRECT ANSWER Normal level: 1.5 - 2.5 mEq/L Deficiency may be present in pts with chronic diarrhea or diseases that interfere with food absorption Blood Natriuretic Peptide (BNP) - CORRECT ANSWER Secreted by the cardiac muscle when heart failure or worsens. BNP levels useful to determine if the patient's symptoms are the result of CHP or another condition, such as COPD Blood Type and Crossmatch - CORRECT ANSWER Blood typing refers to genetically determined antigens on the surface of the red blood cell used to determine blood groups (A, B, O). Crossmatching is a procedure used to determine compatibility of a donor's blood with that of the recipient. Both tests are performed prior to blood transfusion. Blood Urea Nitrogen (BUN) - CORRECT ANSWER Normal: 7 - 20 mg/dL Elevated BUN may indicate in the presence of renal disease Bone Marrow Transplant - CORRECT ANSWER Bone marrow cells from a donor whose tissue and blood cells closely match those of the recipient are infused into a patient with aplastic anemia, leukemia, or immune deficiency syndromes. Borg Scale - CORRECT ANSWER A numerical scale for assessing dyspnea, from 0 representing no dyspnea to 10 as maximal dyspnea. Bowel Sounds - CORRECT ANSWER Auscultation over the abdomen. May be helpful to detect the presence of congenital diaphragmatic hernia in a newborn or the location of nasogastric (NG) in adult patients. Bronchoalveolar Lavage (BAL) - CORRECT ANSWER Instillation and aspiration of the lungs using saline solution. This procedure may be performed during bronchoscopy to diagnose nosocomial pneumonia and VAP. Bronchogram - CORRECT ANSWER X-ray examination of the bronchi after instillation of radiopaque contrast medium. Useful in diagnosing bronchiectasis or the presence of obstructing airway lesions. Calcium Chloride - CORRECT ANSWER A salt used to raise the calcium content of the blood in disorders such as hypocalcemic tetany, or beta blocker and calcium channel blocker overdose. Administered IV in solution & compatible with epinephrine Caloric Stimulation - CORRECT ANSWER Iced saline is injected into the external auditory canal to test for the presence of cranial reflexes, usually as part of the determination of brain death. If the reflex is present, it results in nystagmus and deviation of the eyes in which the ice saline is injected. Calorimetry - CORRECT ANSWER Measurement of a pt's daily energy expenditure (calories) and is used to assess & manage the pt's nutritional status. Direct measurement is not feasible so an indirect method is utilized. Capillary Blood Gas - CORRECT ANSWER Analysis of blood sample obtained by puncturing the skin of the infant's warmed heel. The blood sample is used to evaluate the infant's PCO2 and pH. However, capillary PO2 values should not be relied upon to monitor the appropriateness of oxygen therapy. Capillary Refill - CORRECT ANSWER Assessed by pressing firmly for a brief period on the pt's fingernail and noting the speed at which the blood flow (color) returns.Excellent non-invasive way to evaluate circulation and perfusion. Normal capillary refill time: < 2 seconds Carboxyhemoglobin Level - CORRECT ANSWER Direct measurement of the amt of CO bound to hemoglobin in the RBC. Measured using co-oximetry or hemoximetry. Should be performed for any pt who may have been exposed to CO (victim of house fire, outdoor burning, car exhaust, etc) Normal values: 1 - 3% in non-smokers 5 - 10% in smokers > 20% indicates CO poisoning Cardiac Catherizarion - CORRECT ANSWER Passing a catheter into the heart. The catheter may be inserted into the atria and ventricles to measure pressure and oxygen saturation, or through the coronary arteries to identify and treat blockages. Cardiac Enzymes/ CPK Isoenzymes - CORRECT ANSWER Measurement of the MB isoenzyme of creatine phosphokinase (CPK-MB) and troponin in order to detect myocardial damage. May be used to assess the degree of muscle damage in pt's who have had myocardial infarction. Carotid Massage - CORRECT ANSWER Performed by rubbing the skin over the carotid artery in order to decrease the HR. May be used in the treatment of atrial TACHYCARDIA Cerebral Perfusion Pressure (CPP) - CORRECT ANSWER The pressure gradient between the mean arterial pressure and the intracranial pressure (MAP - ICP) Normal: 70 - 90 mm Hg < 70 mm Hg result in reduction of blood flow to the brain and increase the risk of ischemia Cerebrovascular accident (CVA) Stroke/ Apoplexy - CORRECT ANSWER The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. The sudden onset of weakness, numbness, paralysis, slurred speech, aphasia, problems with vision and other manifestations of a sudden interruption of blood flow to a particular area of the brain. Cerebrospinal Fluid (CSF) - CORRECT ANSWER Watery , clear and colorless fluid that flows through and protects the brain, subarachnoid space and spinal canal. Normal CSF in adults: 100 - 140 mL The pressure exerted by the CSF is determined by a lumbar puncture (spinal tap) and the initial pressure is = 10 - 15 cmH2O Chaddock Reflex - CORRECT ANSWER Extension of great toe resulting from irritation around external malleolus. Flexion of wrist and fanning fingers when forearm is irritated above and near wrist. Chest Fluoroscopy (Cardiac fluoroscopy) - CORRECT ANSWER Projection of serial x-ray images directly onto a screen for visual examination. Has limited diagnostic value and requires a relatively large dose of radiation. Has limited diagnostic value and requires a relatively large dose of radiation. May be worthwhile in initial assessment of patients with congenital heart disease or valvular disease. Chest Radiogram Chest X-ray Chest Roentgenogram - CORRECT ANSWER Routine radiologic assessment of the chest. Indicated as one of the Basic Lab Tests in a stable pt Coagulation Studies - CORRECT ANSWER Evaluation of the ability of the blood to form a clot. The Activated Partial Thromboplastin (APTT) is used to monitor is used to monitor heparin therapy. Normal value: 24 - 32 sec The Prothrombin Time (PT) is used to monitor Warfarin (Coumadin) therapy. Normal value: 12 - 15 sec Coarctation of the Aorta (CoA) - CORRECT ANSWER The aorta is narrowed or constricted. This obstructs blood flow to the lower part of the body and increases blood pressure above the constriction. Usually there are no symptoms at birth, but they can develop as early as the first week of life. If severe symptoms of high blood pressure and congestive heart failure develop, surgery may be considered. Hypertension in upper extremities, hypotension in lower, cyanotic despite FIO2 Colloid Osmotic (ONCOTIC) Pressure Plasma Oncotic Pressure - CORRECT ANSWER Pressure created by serum albumin & globulin particles, which are large molecules which cannot diffuse through normal endothelium. May be used to determine the cause of pulmonary edema. Colloid Infusion - CORRECT ANSWER Administration of an intravenous solution containing proteins such as albumin. Should not be administered to patients with leaky pulmonary capillaries such as ARDS Computed Tomography Scan (CT Scan) - CORRECT ANSWER An X-ray technique that produces an image representing a detailed cross-section of tissue structure. Expensive but useful for the diagnosis of pulmonary embolism or bronchiectasis Coomb's Test (Antiglobulin Test) (preNATAL and neoNATAL) - CORRECT ANSWER Testing for the presence of antibodies that coat and damage RBCs. Can detect Rh antibodies in maternal blood and is used to anticipate hemolytic disease in NEWBORNS. Also used to determine the compatibility of blood types Used to determine anemia and transfusablility Complete Blood Count (CBC) - CORRECT ANSWER Measurement of the major components of the blood, including RBC, hemoglobin, hematocrit, erythrocyte index, WBC, differential of WBC and platelets. Indicated as one of the Basic Lab Test in a stable pt. Cord pH - CORRECT ANSWER Measurement of the pH of the blood in the umbilical cord of a newborn. May be useful if arterial or capillary blood is not available. Cromolyn Sodium - CORRECT ANSWER Preventative ONLY. Contraindicated in the presence of wheezing. Deep Tendon Reflexes - CORRECT ANSWER A brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertion of the muscle. Absence of the reflec may be caused by damage to the muscle, peripheral nerve, nerve roots, or spinal cord at that level Example:Rubber hammer on the knee cap. Dubowitz Score - CORRECT ANSWER A method of estimating the gestational age of a Neonate based on 21 defined clinical signs. This method provides the correct gestational age +/- 2 weeks in 95% of infants. A score of 40 indicates a gestational age of 40 weeks. Dysphagia - CORRECT ANSWER "difficulty swallowing." It is the inability of food or liquids to pass easily from the mouth, into the throat, and down into the esophagus to the stomach during the process of swallowing. Tests to diagnose include: Oral-pharyngeal video swallow, Barium swallow/upper GI series, Endoscopy, Esophageal manometry, Laryngoscopy. ELISA Test - CORRECT ANSWER Enzyme-Linked Immunosorbent Assay Test commonly used to detect the presence of antibodies to specific infectious agents such as HIV test Hering Breuer Inflation Reflex - CORRECT ANSWER Parasympathetic inflation reflex mediated by the lung's stretch receptors. Appears to influence the duration of the expiratory pause between spontaneous breaths. The inflation reflex stops inspiration and stimulates expiration, the deflation reflex inhibits expiration and initiates inspiration. Treatment for Myasthenia Gravis - CORRECT ANSWER - Mestinon - Neostigmine Manitol (Osmitol) - CORRECT ANSWER ICP Pentamadine - CORRECT ANSWER AIDS (600 mg monthly) Aminophylline / Theophylline (xanthine) IV bronchodilator - CORRECT ANSWER 10-20 mcg in blood Rifampin & Isoniazid INH - CORRECT ANSWER Tuberculosis Survanta - CORRECT ANSWER 100 mL/kg, divide 4 doses, instill dose, vigorously ventilate for 30 sec, change position and repeat Tine test - CORRECT ANSWER For ALLERGIES HLTV-III Test - CORRECT ANSWER HIV testing Methacholine Challenge Test (Bronchial Provocation) - CORRECT ANSWER Performed by having the patient inhale methacholine followed by spirometry. The test is positive for airway hyperreactivity when there is a 20% decrease in the FEV1 Complete PFT Rooting reflex - CORRECT ANSWER infant turns head toward anything that strokes its face Reticulogranular - CORRECT ANSWER IRDS Ground glass - CORRECT ANSWER ARDS Transposition of Great Arteries (TGA) - CORRECT ANSWER "Egg-shaped" heart "blue-baby syndrome" A congenital (present at birth) heart defect. Due to abnormal development of the fetal heart during the first eight weeks of pregnancy, the large vessels that take blood away from the heart to the lungs, or to the body, are improperly connected. In TGA, the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle—the opposite of a normal heart's anatomy. Tetralogy of Fallot (TOF / TET) - CORRECT ANSWER "Boot-shaped heart", right ventricular hypertrophy (SURGERY - confirm by ECG) Is a condition of several related congenital (present at birth) defects that occur due to abnormal development of the fetal heart during the first eight weeks of pregnancy. These problems include the following: VSD, Pulmonary (or right ventricular outflow tract) obstruction, Overriding aorta, and right ventricle becomes enlarged as it tries to pump blood past the obstruction into the pulmonary artery. Transposition of Great Vessels - CORRECT ANSWER Egg-shaped heart, aorta on right/pul. Artery on left (SURGERY) Patent Ductus Arteriosis - CORRECT ANSWER > 15 mmHg difference of PO2 in pre-DA and post-DA arteries (SURGERY) Meconium Aspiration - CORRECT ANSWER Meconium aspiration occurs when a baby breathes in amniotic fluid containing meconium (the baby's first stools). It usually occurs in babies born at term (37 to 41 weeks) or post-term (after 42 weeks). Suction mouth, THEN nose ASAP. Repeated, vigorous suction. INTUBATE tube may need to be replaced at least once. IRDS Type II (TTN) Transient Tachypnea of the Newborn - CORRECT ANSWER Late onset (~2 days) Is a term for a mild respiratory problem of babies that begins after birth and lasts about three days. This is due to the slow absorption of the fluid in the fetal lungs causes TTN. This fluid makes taking in oxygen harder and the baby breathes faster to compensate. Treatments include: O2, CPAP Diaphragmatic Hernia - CORRECT ANSWER Is a birth defect, which is an abnormality that occurs before birth as a fetus is forming in the mother's uterus. An opening is present in the diaphragm (the muscle that separates the chest cavity from the abdominal cavity). With this type of birth defect, some of the organs that are normally found in the abdomen move up into the chest cavity through this abnormal opening. Nasogastric tube is key intervention. Bowel or bowel sounds in chest, mediastinal shift, barrel chest and scaphoid abdomen are all indicators. Smoke/fire/burn - CORRECT ANSWER Intubate immediately Tube position - CORRECT ANSWER 2 cm (1 in) past vocal cords Myocardial infarction - CORRECT ANSWER Chest pain, cold and clammy skin, diaphoresis V-fib - CORRECT ANSWER Defibrillate! Pulseless v-tach - CORRECT ANSWER CPR Laryngeal mask intubation - CORRECT ANSWER Temporary, non-emergent, as in surgery Pickwickian syndrome - CORRECT ANSWER Obesity Hypoventialtion Sydrome, often accompanies OSA BARKING cough - CORRECT ANSWER CROUP!! (laryngotracheobronchitis) AVOID weaning if PIP is too high! - CORRECT ANSWER > 39 mmHg Normal rise/fall of pul. artery catheter - CORRECT ANSWER Between 25 and 10 mmHg WITH a dicrotic notch. No dicrotic notch - CORRECT ANSWER Pressure dampening. Either flush, rotate or inflate balloon and "sail" back into position Rales - CORRECT ANSWER Diurese! Choanal Atresia - CORRECT ANSWER Is a narrowing or blockage of the nasal airway by tissue. It is a congenital condition, meaning it is present at birth. Nasal tissue blockage, cyanotic, resp distress while feeding, fine the next Exosurf dosing - CORRECT ANSWER 2.5 mL/kg divided into two doses Place on one side, instill one dose, ventilate Place on other side, instill other dose, ventilate Pulmonary angiogram - CORRECT ANSWER Suspicion of Pulmonary Emboli, esp if V/Q scan is inconclusive Potassium - CORRECT ANSWER For PVCs, Increased urine output, metabolic alkalosis CSF protein test (spinal tap) - CORRECT ANSWER Tests for Guillain-Barre Ribavirin dosing (for RSV) - CORRECT ANSWER 20 mg/mL, diluted in sterile water, via SPAG Steeple sign Xray - CORRECT ANSWER Croup Thumb sign Xray - CORRECT ANSWER Epiglottitis Dobutamine - CORRECT ANSWER For heart failure and cardiogenic shock Butterfly pattern Xray or fluffy infiltrates - CORRECT ANSWER Pulmonary edema Wedge-shaped Xray - CORRECT ANSWER Pulmonary embolus Hochsinger's Sign, Doll's eyes - CORRECT ANSWER Test for tetanus (NOT DONE) MRSA infection control - CORRECT ANSWER Strict isolation Contact precautions Decadron (Dexamethasone) - CORRECT ANSWER Corticosteroid, PO or IV For croup! Plasmapheresis - CORRECT ANSWER Separate elements from the plasma. Maybe beneficial in treating Myasthenia Gravis and Guillain-Barre Syndrome Verapamil - CORRECT ANSWER Controls HR Electromyography (EMG) - CORRECT ANSWER Recording muscle activity induced by inserting needle electrodes into the muscles and passing electrical signals through them. - Can use used to test for impending neurological muscle weakness Eosinophils - CORRECT ANSWER Type of white blood cells. Increased levels in blood or sputum indicate allergic reaction, and perhaps Asthma. Level may decrease with steroid therapy. Normally 1- 3% of WBC. Extracorporeal Membrane Oxygenation (ECMO) - CORRECT ANSWER Procedure that supports the heart and lungs. Blood is removed from the body, passes though a membrane oxygenator which adds O2 and removes CO2, reheated, and returned to the patient. A roller pump provides support and control of circulation and perfusion. Used during open heart surgery and in an intensive care unit to provide temporary support to pts with severe cardiac and/or pulmonary pathologies, such as ARDS/ IRDS, PPHN, cardiomyopathy, or ventricular failure. Corneal Reflex - CORRECT ANSWER Closure of eyelids resulting from direct corneal irritation. Coronary Angiogram (Angiography) - CORRECT ANSWER Serial X-rays of the coronary arteries taken in rapid sequence following injection of a radiopaque substance. Used to define the size, shape and patency of the blood vessels. May be useful in evaluating coronary blood flow following acute myocardial infarction. Creatinine - CORRECT ANSWER Substance formed from the metabolism of creatine and found in the blood, urine, and muscle tissue. Measure in the blood as an indicator or renal function and may be a more accurate indicator than BUN. Normal: 0.60 - 1.5 mg/dL Creatinine Clearance - CORRECT ANSWER Measurement of the amt of creatinine present in a 24 hr urine collection. Useful indicator of renal function. Normal: 90 - 120 mL/min Culture and Sensitivity (C&S) - CORRECT ANSWER Sputum or blood samples are cultures in an appropriate medium for 24 hours, and then organisms present are identified. The organisms are then exposed to different antibiotics to evaluate their effectiveness. The results of these tests re generally not available for at least 48 hours. D-Dimer - CORRECT ANSWER One of the fibrin degradation products (FDP) measurable in the blood after a clot has formed and is in the process of breaking down. May be indicated to determine the presence of a pulmonary embolus Delee Suction Device - CORRECT ANSWER A suction device designed to remove meconium from the upper airway of a neonate. The operator provides negative pressure using his or her mouth. Deep Pain Response - CORRECT ANSWER The pt's response to a painful stimulation, such as a sternal rub, pinching of the skin, insertion of a needle or catheter, etc. Lack of this response indicates a deep level of unconsciousness, anesthesia, or a neurologic deficit. Dextrostix - CORRECT ANSWER A cellulose strip impregnated with enzyme reagents that gives approximate results for glucose concentration with one drop of whole or capillary blood. The strip changes color and is then compared to a reference color chart provided on the side of the bottle. Provides a rapid means of identifying hypo- or hyperglycemia but is not accurate enough for quantitative determination of glucose. Drug Toxicology Screen - CORRECT ANSWER A blood test to identify the presence and amount of commonly abused drugs. Indicated during assessment of a pt with suspected drug overdose or ingestion of a toxic substance. Echocardiogram Echocardiography - CORRECT ANSWER A non-invasive diagnostic method of evaluating the structure and function of the heart using sound waves (ultrasound). May be indicated in neonates and children to determine the presence of a congenital heart defect. Also helpful in adults to determine the severity of valve pathologies (prolapse or stenosis), pericardial effusion, or acquired heart disease Electroencephalography (EEG) - CORRECT ANSWER A recording of brain-wave activity obtained by placing electrodes on the head. The test is used to evaluate seizure disorders, brain stem disorders, and the presence of focal lesions. Also used during sleep studies (polysomnogram) to determine stages of sleep Electrolytes Serum Electrolytes - CORRECT ANSWER Measurement of the level of K+, Na, Cl-, Mg, Ca, HCO3-, in the blood. Indicated as a Basic Lab test in a stable patient End Tidal CO2 Level (ETCO2 Level) - CORRECT ANSWER The partial pressure (or percent) of CO2 at the end of exhalation. Measured with a capnograph or capnometer and is a valuable, non-invasive way to monitor ventilation. Normal: 25 - 35 torr 3 - 5 % Esophageal pH Monitoring - CORRECT ANSWER Performed during esophageal manometry to determine gastroesophageal reflux Gag Reflex Pharyngeal Reflex - CORRECT ANSWER Stimulated by touching the soft palate or posterior pharynx. Tests the integrity of the vagus and glossopharyngeal nerves. One of the first reflexes to disappear in anesthetized pts or those suffering from myasthenia gravis or a drug overdose. Should not be evaluated in pts without an artificial airway bec the pt may aspirate. Gastroesophageal Reflux Disease (GERD) - CORRECT ANSWER Backflow of stomach contents into the esophagus. The acidity of the gastric juices causes burning pain in the esophagus (heartburn). Aspiration of the gastric contents into the lungs may cause asthma-like symptoms. Glucose Tolerance Test - CORRECT ANSWER A test of the body's ability to metabolize carbohydrates by administering a standard dose of glucose and measuring the blood and urine for glucose at regular intervals. Useful in diagnosis of diabetes. Glasgow Coma Scale (GCS) Glasgow Coma Score - CORRECT ANSWER The Glasgow Coma Scale is an assessment tool used in cases of traumatic brain injury. A scoring system for evaluating the severity of CNS involvement in head injury, which measures 3 parameters—motor response, verbal response and eye opening response—from 0 (brain death) to a maximum score of 15 for normal cerebral function. The Glasgow Coma Scale is used to estimate and categorise the probable outcomes of patients with brain injury based on overall social capability or dependence on others. 13-15 - Mild 9-12 - Moderate Disability 3-8 - Severe Disability (Coma) Gram Stain - CORRECT ANSWER Microorganisms present in a sputum or blood sample are stained with a violet stain, followed by an iodine solution, decolorizing with alcohol or acetone, and then counterstained with safranin. Gram positive organism retain the violet stain while gram negative organisms appear pink. The results may be available in approximately one hour. Gram staining may be followed by C&S to identify the specific bacteria present and appropriate antibiotic therapy. Grimace Reflex Irritability - CORRECT ANSWER One of the components evaluated as part of the APGAR score in a neonate. Elicited by tactile stimulation or insertion of a catheter into the nares. Heel Stick - CORRECT ANSWER Method of obtaining a blood sample from a neonate. Also called capillary sample or astrup Holter Monitor - CORRECT ANSWER Portable recording device for electrocardiographic data while pt conducts normal daily activities. Useful for obtaining a record of cardiac electrical activity that would not be discovered by means of a static ECG. Hyperbaric Oxygen Therapy (HBO Therapy) - CORRECT ANSWER O2 therapy administered at greater than normal atmospheric pressure. Useful in treating decompression sickness (bends), CO poisoning, anaerobic infections, and to facilitate wound healing. Treatment is usually conducted at 2 - 3 atmospheres. Slow for decompression, 2 ATM Rapid for CO poisoning or infection, 3 ATM, 90 min TID/BID Indirect Calorimetry - CORRECT ANSWER Uses measurements of O2 consumption (VO2), CO2 production (VCO2) and urinary N2 (UN) to calculate: RER, REE, RQ and Kcal. Used to assess the nutritional status of the patient. Induce Vomiting - CORRECT ANSWER Causing the patient to vomit by administering syrup of ipecac. May be used to treat ingestion of certain types of poison or drug overdose. Induced (Therapeutic) Hypothermia - CORRECT ANSWER A medical treatment that lowers a pt's body temp in order to help reduce the risk of ischemic injury to tissue following an episode of insufficient blood flow. These episodes may be due to cardiac arrest or stroke. Therapeutic hypothermia may be induced by invasive means, in which a catheter is placed int he inferior vena cava via the femoral vein, or by non-invasive means, usually involving a chilled water blanket or torso vest and leg wraps in direct contact with the pt's skin. Inductive Plethysmography - CORRECT ANSWER A series of elastic bands placed around the chest to measure chest movement and breathing frequency. Used in sleep studies to monitor chest motion. IgE Levels - CORRECT ANSWER IgE is an immunoglobulin (antibody) that attaches to the mast cell in the respiratory and intestinal tracts and has a major role in allergic reactions. About 50% of pts with allergies have elevated IgE levels. Inotropic Agents - CORRECT ANSWER Drugs that increase the strength or force of contraction of the myocardium. I.e: Digitalis and Digoxin Intraocular Pressure - CORRECT ANSWER The internal pressure of the eye. It increases with physical stress and neurologic factors. It is time-consuming and generally not necessary for evaluating pts with respiratory or cardiac disease. Intracranial Pressure (ICP) - CORRECT ANSWER Normal is 5-10 mm Hg Pressure inside the head. ICP monitoring is useful for pts with neurological diseases or trauma to the head. Usually want to keep them hyperventilated with PCO2 of about 25 - 30 mm Hg Intravenous Pyelogram (IVP) - CORRECT ANSWER An x-ray examinations of the kidneys, ureters and urinary bladder that uses contrast material injected into a vein Jugular Vein Distention (JVD) - CORRECT ANSWER Enlargement of the jugular veins. It is normally present when the pt is in the supine position, but is considered abnormal when present with the patient in an upright position. May be a result of CHF, pneumothorax, or cardiac tamponade Lactate Dehydrogenase (LDH) - CORRECT ANSWER An enzyme found int he cytoplasm of most body tissues. It is monitored as an indicator of anaerobic carbohydrate metabolism and as a serum indicator of myocardial infarction and muscular dystrophies. Serum levels generally rise 1 - 18 hours following myocardial infarction. Lactate Levels - CORRECT ANSWER Generally increase in the presence of anaerobic metabolism. Can rise during intense exercise, shock, heart failure, and lung disease. Normal: 4.5 - 19.8 mg/dL Lactated Ringer's Solution - CORRECT ANSWER A solution for IV administration which contains glucose, electrolytes and other nutrients. USed interchangeably with normal saline for fluid administration during resuscitation Lecithin/ Sphingomyelin (L/S) Ratio - CORRECT ANSWER Calculated by measurement of the amount of lecithin and sphingomyelin in amniotic fluid. Used to predict the degree of lung maturity of a fetus. An L/S ratio of 2:1 or greater indicates the lungs are mature enough to sustain life outside of the uterus Liver Enzymes - CORRECT ANSWER Elevated levels of the following enzymes may indicate liver disease: AST, ALT, LDH Lumbar Puncture (Spinal Tap) - CORRECT ANSWER Introduction of a needle into the subarachnoid space of the lumbar portion of the spinal column. The pressure of the CSF is measured and the CSF is sent to the lab for analysis. May be useful in diagnosing Guillain-Barre syndrome, which is characterized by elevated levels of protein in the CSF. Lung Fluoroscopy - CORRECT ANSWER Projection of serial X-ray images of the lung directly onto a screen for visual examination. Has limited diagnostic value and requires a relatively large dose of radiation M-Mode Echocardiography - CORRECT ANSWER Early echocardiography technique which uses a single scan line. Its high frequency response makes it excellent to measure valve operation and chamber motion Magnetic Resonance Imaging (MRI) - CORRECT ANSWER Medical imaging that uses radiofrequency radiation as its source. Has limited application in diagnosing lung disease, but may be useful in identifying hilar lymph node enlargement and invasion of the chest wall by tumores. May be helpful in detecting edema and tumors in the brain. Maxillomandibular - CORRECT ANSWER Concerning the maxilla & mandible Mantoux Test - CORRECT ANSWER A tuberculin skin test that consists of intradermal injection of a purified protein derivative (PPD) of mycobacterium tuberculosis. Most reliable test for TB sensitivity. A positive test is determined when a hardened, raised red area appears 24 to 72 hours after injection. Medroxyprogesterone (Provera) - CORRECT ANSWER A form of progesterone, which is a female hormone that helps regulate ovulation and menstrual periods. It is used to test abnormal menstruation, irregular vaginal bleeding, and also to prevent overgrowth of the lining of the uterus to possibly decrease the risk of cancer of the uterus in pts who are taking estrogen Methemoglobin Level - CORRECT ANSWER Amt of hemoglobin in which the ferrous ion has been oxidized to the ferric state. There is almost always some methemoglobin present int he body; however the enzyme methemoglobin reductase keeps the level below 1%. The level may be increased by nitric oxide (NO) therapy or by ingestion of compounds containing nitrites. Military Anti-Shock Trousers (MAST) - CORRECT ANSWER A garment designed to put external pressure on the lower extremities, keeping the blood volume in the pts abdomen and thorax. May be indicated in situation in which blood pressure is very low, such as in severe blood loss or high spinal cord injury. Moro Reflex - CORRECT ANSWER Also called startle reflex, this is present in newborns in response t o any surprise, such as a loud noise. The normal response consists of flexion of the legs, drawing of the arms across the chest, and usually a brief cry. Muller's Maneuver - CORRECT ANSWER A forced inspiratory effort against a closed glottis. Opposite of a valsalva maneuver Myocardial Infarction (MI) Heart Attack - CORRECT ANSWER A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn't get enough blood or oxygen, causing cells in that area of the heart to die (called an infarct). A heart attack is a medical emergency. Most heart attacks are caused by blood clots, which are in turn caused by atherosclerosis (stiffening and narrowing of the arteries) Neuromuscular Blockade - CORRECT ANSWER The use of drugs which cause paralysis of the skeletal muscles. I.e: pancuronium, vecuronium, cisatracurium Nitric Oxide (NO) Therapy - CORRECT ANSWER Administration of NO gas to a pt receiving mechanical ventilation. when treatment does work, it decreases pulm art pressure, increased pulm blood flow, and increased o2 Ocular Pressure - CORRECT ANSWER Pressure inside the eye, may be elevated in pts with glaucoma Oral-pharyngeal video swallow - CORRECT ANSWER Pt is given small amounts of a liquid containing barium to drink with a bottle, spoon, or cup, or spoon fed a solid food containing barium. Barium shows up well on an X-ray. A series of X-rays are taken to evaluate what happens as your child swallows the liquid. P50 - CORRECT ANSWER The value for PaO2 at which blood is 50% saturated with oxygen giving an indication of shifts in the oxygen-dissociation curve. Hemoglobin affinity for O2, Oxygen Dissociation Curve Normal: 26 - 28 torr Pancreatic Enzymes - CORRECT ANSWER Any of the enzymes secreted by the pancreas as part of the digestive process. The more important enzymes are trypsin, chymotrypsin, steapsin, and amylopsin Paradoxical Pulse Pulsus Paradoxus - CORRECT ANSWER A variance in the pulse strength or rate during respiration. I.e. a systolic pressure change of 10 mm Hg or more during inspiration. Occurs with pts with asthma or cardiac tamponade. The presence of paradoxical pulse indicates a severe degree of airway obstruction or compression of the myocardium Peak Expiratory Flow Rate (PEFR) - CORRECT ANSWER The maximum flow rate measured during a forced expiratory maneuver. In PFT, it gives an indication of pt effort. Most commonly ised to regularly monitor changes in lung function in pts with asthma, such as daily variations and response to bronchodilator therapy. Normal: 600 L/min or 10 L/sec Pedal Edema Pitting Edema - CORRECT ANSWER Soft tissue swelling of the ankles cause by abnormal accumulation of fluid. Associated with disease of the kidneys, liver, heart, and lungs. Evaluated using a scale from 1+ to 4+, with 4+ being the most severe/ Should be assessed in any pt with a history of COPD, CHF, MI r pulmonary edema and/or renal failure Measured Percent Shunt (Qs/Qt) - CORRECT ANSWER Qs/ Qt = (A-aDO2 x 0.003)/ [(A-aDO2 x 0.003) + C(a-v)O2] The portion of the cardiac output that does not participate in gas exchange. Increased level of shunting results in hypoxemia that refractory to oxygen therapy. Increased in pts with atelectasis, ARDS, pneumonia, etc Normal: 5% Peripheral Reflexes - CORRECT ANSWER A part of the neurologic examination that tests the integrity of the peripheral nerves Permissive Hypercapnia - CORRECT ANSWER An approach to mechanical ventilation in which the PaCO2 is maintained at a higher than normal level (>45 mm Hg). This technique utilizes subnormal tidal volume to protect the lungs against baro/volutrauma. May be indicated for pts with ARDS or status asthmaticus. Sodium bicarbonate may be administered to treat the acidosis which results from the elevated PaCO2. Phrenic Nerve Pacing - CORRECT ANSWER The placement of an electrical stimulating device around the phrenic nerve. When an electric current is applied to this device, an impulse is sent through the phrenic nerve, causing the diaphragm to contract, and inspiration occur. Phrenic pacing is used to treat hypoventilation syndrome caused by lack of stimulation from the respiratory center of the brain. Platelet Count - CORRECT ANSWER Estimation of the number of platelets present int he blood. Platelets are small blood cells that play an important role in coagulation, hemostasis. Normal: 150,000 - 400,000/mm^3 Pleural Biopsy - CORRECT ANSWER Removal of a small piece of pleural tissue for microscopic examination. May be indicated when evaluation of thoracentesis fluid alone does not yield a specific diagnosis Purified Protein Derivative (PPD) Tuberculin Test - CORRECT ANSWER Tuberculosis sensitivity test. Same as Mantoux test Pupillary Reflex Light Reflex - CORRECT ANSWER The mechanism by which the pupil of the eye constricts in response to light. May be helpful in stable, unconscious pts. Radioisotope Implantation - CORRECT ANSWER Insertion into the body of a chemical element that has been made radioactive by bombardment with neutrons in an atomic pile or cyclotron. By giving off radiation, it provides a valuable treatment for some types of cancer Rapid Shallow Breathing Index (RSBI) - CORRECT ANSWER RSBI = f / Vt in L Used to predict the success of weaning a pt from mechanical ventilation. A RSBI <100 indicates the pt should do well off the ventilator and is ready for weaning. Range of Motion - CORRECT ANSWER Range of Movement of a joint Respiratory Exchange Ratio (RER) Respiratory Quotient (RQ) - CORRECT ANSWER Ratio of the amount of CO2 entering the alveoli per minute to the amt of O2 leaving the alveoli/ min. Used to evaluate the degree of exertion during an exercise test Reyes Syndrome - CORRECT ANSWER A combination of acute encephalopathy (brain dysfunction) and fatty infiltration of the internal organs that often follows an acute viral illness. it occurs more often in people younger than 18 yrs & may be associated with the administration of aspirin Rh Factor Rh Blood Group - CORRECT ANSWER A system of antigens on the surface of RBCs. When the Rh factor is present, an individual's blood type is designated Rh+. When the Rh antigen is absent, the blood type is Rh-. If an individual with Rh- blood receives a transfusion of Rh+ blood, it causes the formation of anti-Rh agglutinin. Subsequent transfusions of Rh+ blood may result in serious transfusion reactions (hemolysis of RBCs). A pregnant woman who is Rh- may become sensitized by blood on an Rh+ fetus. In subsequent pregnancies, if the fetus is Rh+, Rh antibodies produced in maternal blood may cross the placenta and destroy fetal cells, causing erythroblastosis fetalis. The Rh factor of the mother should be evaluated as part of prenatal assessment Right Ventricular Stroke Work Index (RVSWI) - CORRECT ANSWER RVSWI = [(PA mean - CVP) x SVI x 1.36]/ 100 Normal: 4.5 - 8.0 gm m/m2/beat A measurement of the pumping function of the right ventricle Rubella Titer - CORRECT ANSWER Serology test to determine immune status to rubella Serological Evaluation - CORRECT ANSWER Serum is obtained by taking plasma and removing the substances responsible for the clotting mechanism. The remaining substance is called serum and the following analyses can be performed: electrolytes, BUN, creatinine, enzymes, glucose and protein Serum Amylase - CORRECT ANSWER Amylase is an enzyme that catalyzes the hydrolysis of starch into smaller carb molecules. Elevated in acute pancreatitis, salivary gland dysfunction and tumors that secrete amylase. Serum Immunoglobulins - CORRECT ANSWER The amount of antibodies present in the serum. Levels may be elevated in pts with allergic disease and/or asthma Serum Magnesium - CORRECT ANSWER Amt of Mg in the serum. Increased in pts with renal disease. Decreased in pts with diarrhea, malabsorption, uncontrollable diabetes, hypercalcemia, & those taking diuretics & antibiotics. Normal: 1.7 - 2.1 mg/dL Silverman-Anderson score - CORRECT ANSWER Evaluates the degree of respiratory distress in neonates. The score includes assessment of nasal flaring, grunting, retractions of the upper and lower chest and xiphoid margin. Total scores ranges from 0 - 10. 10 is severe respiratory distress Specific Airway Conductance (SGAW) - CORRECT ANSWER Similar to airway conductance (Gaw) except it's measured per L of lung volume (L/s/cmH2O/L) with a body box. Complete PFT Normal: 0.42 - 1.67 L/s/cmH2O/L Specific Gravity of Pleural Fluid - CORRECT ANSWER Measurement of the specific gravity of pleural fluid may be useful in determining whether the fluid is a transudate or exudate because it closely correlates with the protein content. A pleural fluid protein level that is less than 50% of the serum protein level indicates transudative fluid Specific Gravity of Urine - CORRECT ANSWER Indicator of how concentrated the urine is. Decreased n diabetes insipidus, renal disease, excess fluid intake, and diabetes mellitus. Increased in dehydration, adrenal insufficiency, nephrosis, CHF, and liver disease. Normal: 1.003 -1.030 g/mL Surfactant Replacement Therapy - CORRECT ANSWER Instillation of exogenous surfactant solutions directly into the trachea to prevent and treat hyaline membrane disease/ IRDS. I.e: Survanta, Surfacten, Alveofact, Exosurf, Surfaxin, & Survanta Sweat Chloride Test - CORRECT ANSWER Measurement of the chloride concentration is a sample of sweat collected from the skin. Recommend to establish a diagnosis of CF. > 60 mEq/L = positive for CF T-Cell Count - CORRECT ANSWER A measurement of the number if T-type lymphocytes. T-cells are lymphocytes that form in the bone marrow and then migrate to the thymus where they mature. Essential for immune response. Reduced in HIV-positive pts. Tensilon Test - CORRECT ANSWER Edrophonium chloride, a rapid-acting, short-lasting cholinesterase inhibitor. TEST for Myasthenia Gravis Thallium Stress Test - CORRECT ANSWER Nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity. Theophylline Level - CORRECT ANSWER Measurement of the emt of theophylline in the pts blood. For bronchodilation, 10-20 mg/L For neonates with Apnea of Prematurity, level is 5-10 mg/L Thoracic Cage (Chest) Configuration - CORRECT ANSWER Inspection of the chest should be performed as part of bedside pt assessment and include detection of any abnormality such as barrel chest, kyphosis, scoliosis, pectus carinatum (pigeon breast) or pectus excavatum (funnel breast) Throat Culture - CORRECT ANSWER The mucosal surface of the throat is swabbed and then evaluated for the presence of microorganisms. The procedure should not be performed in children with suspected epiglottitis. Thrombolytic Therapy - CORRECT ANSWER Thrombolytic drugs like urokinase, streptokinase, or tissue plasminogen activator (t-PA) are administered to break up or dissolve a blood thrombus. Indicated for the treatment of pulmonary emboli and may also be used for the treatment of acute myocardial infarction and thrombotic cerebrovascular accident (stroke) Tomograms Tomography - CORRECT ANSWER An X-ray technique that demonstrates organs or tissues at a particular depth. Also CT Transient Ischemic Attack (TIA) - CORRECT ANSWER Similar to a stroke, but the interruption of blood flow is temporary. The clot resolves sporadically. The symptoms are relatively the same as a stroke but last less than 24 hours, whereas stroke symptoms persist for greater than 24 hours. Tracheal/ Carinal Reflex - CORRECT ANSWER Spontaneous coughing in response to stimulation of the trachea with a catheter. A protective reflex to prevent aspiration of foreign matter into the lungs. Troponin Test - CORRECT ANSWER Used to identify different heart disorders, including MI. Elevated cardiac troponin level in pts who had MI. Cardiac troponins are a marker of ALL heart muscle damage, not just MI. Transillumination Of Chest - CORRECT ANSWER Placement of a bright fiber optic light on the chest of a neonate to determine th presence of a pneumothorax or congenital diaphragmatic hernia. Should be reommend prior to CXR whenever pneumothorax is suspected in a newborn "Halo" is normal. If chest "lights up", there is a PNEUMOTHORAX Transtracheal Aspiration - CORRECT ANSWER Procedure used to obtain a sputum specimen in which a needle is inserted through the skin into the trachea through the cricothyroid membrane. Used to identify anaerobic bacteria bec this method bypasess the oropharynx. Two-Dimensional Echocardiography - CORRECT ANSWER An echocardiographic technique that scans the ultrasound beam rapidly across the heart to produce 2-D tomographic images. Used for evaluating pts with coronary artery disease, exercise testing and evaluating ventricular function. Can measure cardiac chamber volumes very accurately and can alos determine ejection fractions. Tympanic Temperature - CORRECT ANSWER Measurement of temperature in the outer ear in order to monitor body temperature Upper & Lower GastroIntestinal (GI) Series - CORRECT ANSWER Radiographic and fluoroscopic examinations of the stomach and duodenum. Urinalysis - CORRECT ANSWER Physical, microscopic, and chemical examination of urine. Some of the factors evaluated include color, pH, protein, glucose, specific gravity, blood cells, ketone bodies, casts, pus, bilirubin and phenylketonuria (PKU) Uvulopalatopharyngoplasty (UPPP) - CORRECT ANSWER Surgical procedure in which redundant soft palate, uvula, tonsils, adenoids, and sometimes posterior pharyngeal wall mucosa are removed. This procedure indicated to correct intractable snoring or sleep apnea Ventilation-Perfusion (V/Q) Scan - CORRECT ANSWER Suspicion of Pulmonary Emboli (aka deadspace disease) test only ONCE Ventilation is evaluated by inhalation of radioisotope gas (133-Xenon) followed by scanning of the chest to determine the distribution of gas throughout the lungs. Perfusion is evaluated by injection of albumin tagged in radioactive iodine (99m-Technetium) into a peripheral vein, followed by scanning of the chest to determine the distribution and volume of perfusion. Pulmonary embolus is confirmed if the result indicate a normal ventilation scan but abnormal perfusion scan. Vestibular Nystagmus - CORRECT ANSWER Constant, involuntary, cyclical movement of the eyeball, resulting from physiological stimuli to the labyrinth of the ear movement may be any direction. (Caloric Stimulation) Wilson Mikity Syndrome Pulmonary Dysmaturity Syndrome - CORRECT ANSWER A chronic disease occurring in low-birthweight infants that resembles bronchopulmonary dysplasia (BPD). The infants do well initially and then develop tachypnea, cyanosis and retractions during the first week of life. Treatment is primarily supportive, mechanical ventilation to treat apnea and hypercarbia, oxygen, and keep O2 and MV to a minimum because it can cause air leak syndromes. Barium Swallow/ Upper GI series - CORRECT ANSWER Pt is given a liquid containing barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) to drink, and a series of X-rays are taken. The doctor can watch what happens as pt swallows the fluid, and note any problems that may occur in the throat, the esophagus, or the stomach. Endoscopy - CORRECT ANSWER A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Under anesthesia, an endoscopy is performed. Pictures are taken of the inside of the throat, the esophagus, and the stomach to look for abnormalities. Small tissue samples, called biopsies, can also be taken to look for problems. Esophageal manometry - CORRECT ANSWER Under sedation, a small tube containing a pressure gauge is guided through pt's mouth and into the esophagus. The pressure inside the esophagus is then measured to evaluate esophageal motility or how well food moves through the esophagus. Laryngoscopy - CORRECT ANSWER Direct visual examination of the larynx with a laryngoscope. Under anesthesia, a doctor places a tube into your pt's throat and looks through it for narrowed areas and other problems. Diphtheria - CORRECT ANSWER Diphtheria is an acute bacterial disease that can infect the body in two areas: -The throat (respiratory diphtheria) -The skin (skin or cutaneous diphtheria) The diphtheria bacterium can enter the body through the nose and mouth. However, it can also enter through a break in the skin. It is transmitted from person-to-person by respiratory secretions or droplets in the air. After being exposed to the bacteria, it usually takes two to four days for symptoms to develop. It can lead to breathing problems, paralysis, heart failure, and even death. Tetanus (Lockjaw) - CORRECT ANSWER Tetanus (lockjaw) is an acute, sometimes fatal, disease of the central nervous system, caused by the toxin of the tetanus bacterium, which usually enters the body through an open wound. Tetanus causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the person cannot open his or her mouth or swallow. Tetanus is not a contagious illness. It occurs in individuals who have had a skin or deep tissue wound or puncture. It is also seen in the umbilical stump of infants in underdeveloped countries. This occurs in places where immunization to tetanus is not widespread and women may not know proper care of the umbilical stump after the baby is born. After being exposed to tetanus, it may take between two days to two months to develop any symptoms. In infants, symptoms may take between five days to two weeks to develop. Pertussis (Whooping Cough) - CORRECT ANSWER Pertussis (whooping cough) mainly affects infants and young children. Caused by a bacterium called Bordetella pertussis, it is characterized by paroxysms (intense fits or spells) of coughing that end with the characteristic whoop as air is inhaled. Whooping cough causes coughing spells so bad that it is hard for infants and children to eat, drink, or breathe. These spells can last for weeks. It is spread through children from exposure to infected persons through droplets in the air (coughing and sneezing), and is highly contagious. Once the bacteria is in the child's airways, swelling of the airways and mucus production begins. It can lead to pneumonia, seizures, brain damage, and death. DTaP Vaccine - CORRECT ANSWER - Protects against diphtheria, tetanus, and pertussis - Newer form of the vaccine, in which the pertussis component is "acellular," thus less likely to cause reactions than former types DT or Td Boosters - CORRECT ANSWER - Protects against diphtheria and tetanus - For people seven years of age and older - Recommended every 10 years for adults Tdap vaccine - CORRECT ANSWER - Protects against tetanus, diphtheria, and pertussis - Recommended as a booster shot for adolescents ages 11 to 18 years who have completed the recommended DTP/DTaP series and as a one-time booster for adults in place of their next every-ten-year booster shot. Total Anomalous Pulmonary Venous Return (TAPVR) - CORRECT ANSWER TAPVR is a congenital (present at birth) heart defect. Due to abnormal development of the fetal heart during the first eight weeks of pregnancy, the vessels that bring oxygen-rich (red) blood back to the heart from the lungs are improperly connected. Babies with this heart defect cannot supply oxygen-rich (red) blood to the body after birth. Without an additional heart defect that allows mixing of oxygen-poor (blue) and oxygen-rich (red) blood, such as an atrial septal defect, infants with TAPVR will have a mixture of oxygen-rich (red) and oxygen-poor (blue) blood circulating through the right heart and back to the lungs—a situation that is fatal. Biochemical Genetic Testing - CORRECT ANSWER Involves the study of enzymes in the body that may be abnormal in some way. The enzymes may be deficient, absent, or unstable, or they may have altered activity which can lead to clinical manifestations in a child (for example, birth defects). These types of disorders are usually called "inborn errors of metabolism" since they are present at birth and affect how the body's metabolism works. Metabolism is a term that describes how the body converts food to energy and then gets rid of the waste products. Lower GI (Gastrointestinal) series Barium Enema - CORRECT ANSWER procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. Magnetic resonance cholangiopancreatography (MRCP) - CORRECT ANSWER A special type of magnetic resonance imaging (MRI) that uses radio waves and magnets to obtain pictures of the bile ducts and internal organs. Ultrasound - CORRECT ANSWER A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video tape of the test is also made so it can be reviewed in the future. Prenatal History - CORRECT ANSWER Certain factors during pregnancy can affect the development of the baby. To assess these, various information is looked at, including the following: - Family medical history - Results of any prenatal testing - Personal medical history of the mother (her general health and any health condition she may have) - Any medications used during the pregnancy - Histories of past pregnancies - Vaccination status - Infection screening - Diet - Vitamin use - Smoking or other recreational drug use - Exposure to other harmful substances Neonatal History - CORRECT ANSWER Assessments for newborn babies. Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. These include the following: - Apgar scoring (scores heart and respiratory rates, muscle tone, reflexes and color) - Birthweight - Measurements, such as head circumference, abdominal circumference and length - Full physical examination - Hearing screening - State newborn screening - Gestational assessment (determining whether a baby was born premature by looking at both physical maturity, neuromuscular maturity) Patent Ductus Arteriosus (PDA) - CORRECT ANSWER This defect occurs when the normal closure of the patent ductus arteriosus, which is present in all fetuses, does not occur. Extra blood goes from the aorta into the lungs and may lead to "flooding" of the lungs, rapid breathing, and poor weight gain. PDA is often seen in premature infants. Atrial Septal Defect (ASD) - CORRECT ANSWER In this condition, there is an abnormal opening between the two upper chambers of the heart—the right and left atria. This causes an abnormal blood flow through the heart. Some children may have no symptoms and appear healthy. However, if the ASD is large, permitting a large amount of blood to pass through the right side, symptoms will be noted. Pulmonary Atresia - CORRECT ANSWER A congenital defect in which there is underdevelopment of the pulmonary valve. Normally, the pulmonary valve is found between the right ventricle and the pulmonary artery. It has three leaflets that function like a one-way door, allowing blood to flow forward into the pulmonary artery, but not backward into the right ventricle. With pulmonary atresia, problems with valve development prevent the leaflets from opening, therefore, blood cannot flow forward from the right ventricle to the lungs. Aortic stenosis (AS) - CORRECT ANSWER In AS, the aortic valve between the left ventricle and the aorta did not form properly and is narrowed. This makes it difficult for the heart to pump blood to the body. A normal valve has three leaflets or cusps, but a stenotic valve may have only one cusp (unicuspid) or two cusps (bicuspid). Although aortic stenosis may not cause symptoms, it may worsen over time. Surgery or a catheterization procedure may be needed to correct the blockage, or the valve may need to be replaced with an artificial one. Croup - CORRECT ANSWER Croup is a disease caused by a virus, bacteria, allergies, and inhaled irritants that leads to swelling in the airways and problems breathing. A child may have stridor, which is a high-pitched sound usually heard when the child breathes in (inspiration). The most common virus is the parainfluenza virus. Other viruses may include: Respiratory syncytial virus (RSV), Influenza virus, Measles, Adenovirus, Enteroviruses. Croup is most commonly seen in children 3 months old to 5 years. The peak time for croup to occur is 2 years old. Croup is seen more often in the winter. Symptoms of Croup - CORRECT ANSWER - A runny nose, congestion, and slight cough - A cough develops into a "seal's bark" - Laryngitis - Fever - Stridor. A high-pitched sound that is usually noted as the child breathes in (inspiration), although it can also be heard as the child breathes out (expiration). Bronchiolitis - CORRECT ANSWER Bronchiolitis is an infection of the lower respiratory tract that usually affects infants. There is swelling in the smaller airways or bronchioles of the lung, which causes obstruction of air in the smaller airways. The most common cause of bronchiolitis is a virus, most frequently the respiratory syncytial virus (RSV). However, many other viruses have been involved, including: Parainfluenza virus, Adenovirus, Influenza, Human metapneumovirus. It is rarely caused by bacteria, usually mycoplasma pneumoniae. Initially, the virus causes an infection in the upper respiratory tract, and then spreads downward into the lower tract. The virus causes inflammation and even death of the cells inside the respiratory tract. This leads to obstruction of airflow in and out of the child's lungs. Bronchiolitis usually occurs in the winter and early spring. The most common age group affected by bronchiolitis is 3 to 6 months of age. The medication is called palivizumab (Synagis) and recommended only for high-risk infants, including premature infants (age at birth less than 35 weeks) and infants with chronic lung disease during RSV season. Nasopharyngeal Swab - CORRECT ANSWER This is done for respiratory syncytial virus (RSV) and other respiratory viruses. These tests yield rapid results for presence of RSV or other viruses. Epiglottitis - CORRECT ANSWER Epiglottitis is an acute life-threatening bacterial or viral infection that results in swelling and inflammation of the epiglottis. The epiglottis is an elastic cartilage structure at the root of the tongue that prevents food from entering the windpipe (trachea) when swallowing. This causes breathing problems, including stridor, that can progressively worsen and may, ultimately, lead to airway obstruction. There is so much swelling that air cannot get in or out of the lungs resulting in a medical emergency. The primary cause of epiglottitis is a bacterial infection which is spread through the upper respiratory tract. The bacteria usually is Haemophilus influenzae type B (HIB). The HIB vaccine protects against this bacteria, therefore decreasing the chance of developing epiglottitis. The disease usually occurs in children 2 to 6 years of age, but has also occurred in adults. The disease can occur at any time; there is no one season that it is more prevalent. Intraventricular Hemorrhage (IVH) - CORRECT ANSWER Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, the spaces in the brain containing the cerebral spinal fluid. - Intraventricular means within the ventricles - Hemorrhage means excessive bleeding Intraventricular hemorrhage is most common in premature babies, especially very low birthweight babies weighing less than 1,500 grams. VH is often described in four grades: Grade 1. Bleeding occurs just in a small area of the ventricles. Grade 2. Bleeding also occurs inside the ventricles. Grade 3. Ventricles are enlarged by the blood. Grade 4. Bleeding into the brain tissues around the ventricles. Grades 1 and 2 are most common, and often there are no further complications. Grades 3 and 4 are the most serious and may result in long-term brain injury to the baby. Hydrocephalus (too much cerebral spinal fluid in the brain) may develop after severe IVH. Valsalva Maneuver - CORRECT ANSWER Patient forcibly exhales against a closed nose and mouth while bearing down, as if having a bowel movement, specific changes occur in blood pressure and the rate and volume of blood returning to the heart. It is used as a diagnostic tool to evaluate the condition of the heart and is sometimes done as a treatment to correct abnormal heart rhythms or relieve chest pain. When performed formally, the patient is asked to blow against an aneroid pressure measuring device (manometer) and maintain a pressure of 40 millimeters of mercury (mm Hg) for 30 seconds. Or, less formally, the patient may be asked to bear down, as if having a bowel movement. During this 30 second period, a recording is made of the changes in blood pressure and murmurs of the heart. Pneumogram - CORRECT ANSWER ... Pulmonary Stress Test - CORRECT ANSWER ... CO2 response test - CORRECT ANSWER ; Mixed venous oxygen saturation - CORRECT ANSWER ... Transesophageal echocargiograph - CORRECT ANSWER .. O2 consumption - CORRECT ANSWER , Fiberoptic bronchcospy - CORRECT ANSWER . Vital signs (TPR) and blood pressure - CORRECT ANSWER An excellent bedside clinical indicator of the patient's physiologic and psychologic health, including body temperature (T), pulse (P), respiratory rate (R), and blood pressure (BP). Vital Capacity - CORRECT ANSWER The maximum volume of air that can be expelled at the normal rate of exhalation after a maximum inspiration, representing the greatest possible breathing capacity CO2 production - CORRECT ANSWER q P(A-a)O2 - CORRECT ANSWER a Identification of pathogen - CORRECT ANSWER Gram stain, simplest and most common •• Gram positive (stain purple) •• Gram negative (stain pink) Acid--fast stain Enzyme-linked immunosorbent assay (ELISA) Latex agglutination Abscess - CORRECT ANSWER Localized collection of pus that results from disintegration or displacement of tissue in any part of the body Accessory muscles of Expiration - CORRECT ANSWER The accessory muscles of exhalation are often recruited when airway resistance becomes significantly elevated. When these muscles actively contract, intrapleural pressure increases and offsets the increased airway resistance. The major accessory muscles of exhalation are as follows: rectus abdominis, external oblique, internal oblique, transversus abdominis. Accessory muscles of Inspiration - CORRECT ANSWER During advanced stages of chronic obstructive pulmonary disease, the accessory muscles of inspiration are activated when the diaphragm becomes significantly depressed by the increased residual volume and functional residual capacity. The accessory muscles assist or largely replace the diaphragm in creating subatmospheric pressure in the pleural space during inspiration. The major accessory muscles of inspiration are as follows: scalene, sternocleidomastoid, pectoralis major, trapezius. Acetylcholine (ACh) - CORRECT ANSWER A direct-acting cholinergic neurotransmitter agent widely distributed in body tissues, with a primary function of mediating synaptic activity of the nervous system and skeletal muscles. Its half-life and duration of activity are short because it is rapidly destroyed by acetylcholinesterase. Its activity can also be blocked by atropine at junction of nerve fibers with glands and smooth muscle tissue. It is a stimulant of the vagus and parasympathetic nervous system and functions as a VASODILATOR and CARDIAC DEPRESSANT. Acidemia - CORRECT ANSWER Decreased pH or an increased hydrogen ion concentration of the blood. Acidosis - CORRECT ANSWER Pathologic condition resulting from accumulation of acid or loss of base from the body. Acinus - CORRECT ANSWER Smallest division of a gland, a group of secretory cells surrounding a cavity; the functional part of an organ. The respiratory acinus includes terminal bronchioles, alveolar ducts, alveoli, and ll the other structures therein. Acquired Bronchiectasis - CORRECT ANSWER Destruction and widening of the large airways. If the condition is present at birth, it is called CONGENITAL BRONCHIECTASIS. If it develops later in life, it is called ACQUIRED BRONCHIECTASIS. Acute Alveolar Hyperventilation - CORRECT ANSWER A condition marked by low levels of carbon dioxide, and a high pH in the blood, due to breathing excessively. Also called ACUTE RESPIRATORY ALKALOSIS. Acute Alveolar Hyperventilation with Partial Renal Compensation - CORRECT ANSWER A condition marked by low levels of carbon dioxide and a high pH in the blood due to hyperventilation, which is partly corrected by the excretion of HCO3- via the renal system. Acute Epiglottitis - CORRECT ANSWER A very rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death. Acute Respiratory Acidosis - CORRECT ANSWER A condition marked by high levels of carbon dioxide, and a low pH in the blood, due to hypoventilation. Also called ACUTE VENTILATORY FAILURE Acute Ventilatory Failure with Partial Renal Compensation - CORRECT ANSWER A condition marked by high levels of carbon dioxide and a low pH in the blood resulting from hypoventilation, which is partly corrected by the retention of HCO3- via the renal system and/or the administration of HCO3- Acute - CORRECT ANSWER - Sharp, severe - Of rapid onset and characterized by severe symptoms and a short course - not chronic Adenocarcinoma - CORRECT ANSWER Any one of the large group of malignant epithelial cell tumors of the glandular tissue. Specific tumors are diagnosed and named by cytologic identification of the tissue affected; For example, adenocarcinoma of the uterine cervix is characterized by tumor cells resembling the glandular epithelium of the cervix Adenovirus - CORRECT ANSWER Any one of the 49 medium-sized viruses of the Adenoviridae family, pathogenic to humans, that cause conjunctivitis, upper respiratory tract infection, cystitis, or GI infection. After the acute and symptomatic period of illness, the virus may persist in a latent stage in the tonsils, adenoids, and other lymphoid tissue. Adrenergic - CORRECT ANSWER Term applied to nerve fibers that, when stimulated, release epinephrine at their endings. Includes nearly all sympathetic postganglionic fibers except those innervating sweat glands Adventitious Breath Sounds - CORRECT ANSWER - Abnormal breath sounds - Additional or different sounds that are NOT normally heard over a particular area of the thorax Aerosol - CORRECT ANSWER Gaseous suspension of fine solid or liquid particles Afebrile - CORRECT ANSWER Without fever Afterload Reduction - CORRECT ANSWER The load, or resistance, against which the left ventricle must eject its volume of blood during contraction. The resistance is produced by the volume of blood already in the vascular system and by the constriction of the vessel walls. Air Bronchogram - CORRECT ANSWER When air can be visualized in the more peripheral intrapulmonary bronchi, this is known as "AIR-BRONCHOGRAM SIGN." This abnormality is usually caused by an infiltrate/ consolidation that surrounds the bronchi. Air Cyst - CORRECT ANSWER Nonspecific term usually used to describe the presence in the lung of a thin-walled, well-define and well-circumscribed lesion, greater than 1 cm in diameter. Cysts may contain either air or fluid, but this term is usually used to refer to an air-containing lesion, or air-filled cyst. Air Trapping - CORRECT ANSWER Trapping of alveolar gas during exhalation Alkalemia - CORRECT ANSWER Increased pH or decreased hydrogen ion concentration of the blood Allergen - CORRECT ANSWER Any substance that causes manifestations of allergy. It may or may not be a protein Allergy - CORRECT ANSWER Acquired hypersensitivity to a substance (allergen) that normally does not cause a reaction. An allergic reaction is essentially an antibody-antigen reaction, but in some cases the antibody cannot be demonstrated. The reaction is caused by the release of histamine or histamine-like substances from injured cells α1-antitrypsin - CORRECT ANSWER Inhibitor of trypsin that may be deficient in persons with emphysema Alpha1-antitrypsin Deficiency - CORRECT ANSWER Blood test useful for individuals with a family history of emphysema, since a familial tendency to have a deficiency of alpha1-antitrypsin antienzyme exists. A similar deficiency also exists in children with liver disease α-receptor - CORRECT ANSWER Site in the autonomic nerve pathways where excitatory responses occur when adrenergic agents such as norepinephrine and epinephrine are released Alpha Waves - CORRECT ANSWER - One of the 4 brain waves, characterized by a relatively high voltage or amplitude and a frequency of 8-13 Hz. - "Relaxed waves" of the brain - Commonly seen during Stage N1 sleep. maybe seen during REM sleep Alteplase - CORRECT ANSWER A tissue plasminogen activator Alveolar Hypoplasia - CORRECT ANSWER Underdevelopment of the alveolar tissue Anaerobic - CORRECT ANSWER Metabolic pathway that does not require oxygen; such processed usually produce lactic acid Anaphylaxis - CORRECT ANSWER Allergic hypersensitivity reaction og the body to a foreign protein or drug Anemia - CORRECT ANSWER A condition in which there is a reduction in the number of circulating red blood cells per cubic millimeter Anemic Hypoxia - CORRECT ANSWER The PaO2 is normal , but the oxygen-carrying capacity of the hemoglobin is inadequate. Aneurysm - CORRECT ANSWER Localized dilation of a blood vessel, usually an artery Anoxia - CORRECT ANSWER Absence of oxygen Anterior Axillary Line - CORRECT ANSWER An imaginary vertical line on the body wall continuing the line of the anterior axillary fold with the upper arm Anterolateral - CORRECT ANSWER In front and to one side Anteroposterior radiograph - CORRECT ANSWER Chest x-ray from the front to the back of the body Antibody - CORRECT ANSWER Protein substance produced by plasma cells in the lymphoid tissue, that develops in response to add interacts with an antigen. Antibodies may be present because of previous infection, vaccination, or transfer from the mother to the fetus in utero or may occur without known antigenic stimulus, usually as a result of unknown, accidental exposure. Antidysrhythmic Agents - CORRECT ANSWER Drugs used to treat irregularity or loss of heart rhythm Antigen Assay Tests - CORRECT ANSWER A laboratory assessment of the amounts of components in multimolecular antigen-antibody complexes. The assay is used in various diagnostic tests for collagen-vascular disorders, glomerulonephritis, vasculitis, hepatitis, and neoplastic diseases. Antigen - CORRECT ANSWER Substance that induces the formation of antibodies that interact specifically with it. An antigen may be introduced tot eh body or may be formed within the body. Aperture - CORRECT ANSWER Opening or orifice Apex - CORRECT ANSWER Top, end, or tip of a structure Apical Pulse - CORRECT ANSWER The heartbeat is heard with a stethoscope placed on the chest wall adjacent to the apex cordi Apnea - CORRECT ANSWER Complete absence of spontaneous ventilation, or the cessation of airflow, for at least 10 seconds, with a simultaneous 2% or 4% decrease in the patient's SaO2 Apnea-Hypopnea Index (AHI) - CORRECT ANSWER At many sleep lab centers, the diagnosis of OSA is commonly based on the apnea-hypopnea index. It is the average number of apneas and hypopneas the patient has per hour of sleep. Hypopnea - CORRECT ANSWER The reduction of airflow of 30% to 50% with a concomitant drop in the patient's SaO2. Aponeurosis - CORRECT ANSWER Flat, fibrous sheet of connective tissue that attaches muscle to bone or other tissues. May sometimes serve as a fascia. Arrhythmia - CORRECT ANSWER Irregularity or loss of heart rhythm Arterial Catheter - CORRECT ANSWER A tubular instrument that can be inserted into an artery either to draw blood or to measure blood pressure directly Arthralgia - CORRECT ANSWER Any pain that affects a joint Ascending paralysis - CORRECT ANSWER A condition in which theres is successive flaccid paralysis of the legs, then the trunk and arms, and finally the muscles of respiration. Causes include poliomyelitis, Guillain-Barre syndrome, and exposure to toxic chemicals, for example botulinum toxin Asepsis - CORRECT ANSWER The absence of germs Asphyxia - CORRECT ANSWER Condition caused by an insufficient uptake of oxygen Aspiration - CORRECT ANSWER Inhalation of pharyngeal contents into the pulmonary tree Asymmetric - CORRECT ANSWER Unequal correspondence in shape, size, and relative position of parts on opposite sides of the midline Asystole (Cardiac Standstill) - CORRECT ANSWER Absence of contractions of the heart Atelectasis - CORRECT ANSWER Collapsed of airless lung. May be caused by the obstruction of the airways by foreign bodies, mucous plugs, or excessive secretions or by compression from without, as by tumors, aneurysms, or enlarged lymph nodes Atopic - CORRECT ANSWER Of or pertaining to a hereditary tendency to develop immediate allergic reactions because of the presence of an antibody in the skin and sometimes the bloodstream Atrial Fibrillation - CORRECT ANSWER Irregular and rapid randomized contractions of the atria working independently of the ventricles Atrial Flutter - CORRECT ANSWER Extremely rapid (200 to 400/min) contractions of the atrium. In pure fluter a regular rhythm is maintained, in impure flutter the rhythm is irregular. Atrophy - CORRECT ANSWER A wasting or decrease in size of an organ or tissue Atropine - CORRECT ANSWER An alkaloid obtained from belladonna. It is a parasympatholytic agent. For Bradycardia Auscultation - CORRECT ANSWER ... [Show More]

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