General Practice Flashcards

Which of the following symptoms does a tension pneumothorax not exhibit?

Answer: Hypertension

A tension pneumothorax results from air accumulating in the pleural space, which compresses the lung and shifts mediastinal structures, impairing venous return to the heart. This leads to a significant decrease in cardiac output and systemic hypotension, not hypertension. Dyspnea, jugular venous distension (JVD), and subcutaneous emphysema are all expected findings due to the compromised respiratory and circulatory function.

Peripheral edema is a sign of heart issues in a patient. What kind of congestion would you expect to see?

Answer: Congestion in the systemic venous circulation

Peripheral edema, especially in the lower extremities, is a classic sign of right-sided heart failure. When the right ventricle fails to pump blood effectively, blood backs up into the systemic venous circulation. This increased pressure in the veins forces fluid out of the capillaries and into the surrounding tissues, causing visible swelling.

What reduces when preload is decreased by hypovolemia?

Answer: Cardiac output

Preload refers to the volume of blood stretching the ventricular muscle fibers at the end of diastole. Hypovolemia, or low blood volume, directly reduces the amount of blood returning to the heart, thereby decreasing preload. According to the Frank-Starling mechanism, a reduced preload leads to a decreased stroke volume, which in turn lowers the overall cardiac output.

If a patient has an 80 ml stroke volume and an 80 bpm heart rate, what is their cardiac output?

Answer: 6400ml

Cardiac output (CO) is calculated by multiplying the stroke volume (SV) by the heart rate (HR). In this case, the stroke volume is 80 mL and the heart rate is 80 bpm. Therefore, CO = 80 mL/beat * 80 beats/minute = 6400 mL/minute.

How long should a child be suctioned for in order to prevent hypoxia?

Answer: 5-10 seconds

Suctioning removes oxygen from the airway along with secretions, which can quickly lead to hypoxia, especially in children who have smaller lung volumes. To minimize the risk of desaturation and adverse effects, each suctioning attempt in a child should be limited to a brief duration, typically 5-10 seconds.

When the early symptoms of cerebral hypoxia are identified, it is possible to treat this dangerous illness. What early signs of cerebral hypoxia are there?

Answer: Restlessness

Early signs of cerebral hypoxia, or insufficient oxygen supply to the brain, often manifest as subtle changes in mental status. Restlessness, agitation, confusion, and irritability are common initial indicators as the brain's higher functions are compromised. Recognizing these early signs is crucial for prompt intervention to prevent more severe neurological damage.

What are the reflections of preload, cardiac contractility, and afterload?

Answer: Stroke volume

Stroke volume is the amount of blood ejected by the ventricle with each heartbeat, and it is a direct reflection of the heart's pumping efficiency. It is determined by three key factors: preload (the stretch on the heart muscle before contraction), cardiac contractility (the force of the contraction), and afterload (the resistance the heart must overcome to eject blood).

Thrombosis, pulmonary thrombosis, tension pneumothorax, and toxins (myocardia)... What is missing?

Answer: Tamponade

This question refers to the 'T's' in the ACLS 'H's and T's' mnemonic for reversible causes of PEA. The listed items are Thrombosis (coronary/pulmonary), Tension pneumothorax, and Toxins. The missing 'T' from this common list is Cardiac Tamponade, a critical condition where fluid accumulation around the heart impairs its ability to fill and pump blood.

What is the most commonly used term to describe myocardial contractions?

Answer: All of the above

The relationship between the stretch of the ventricular muscle (preload) and the force of its subsequent contraction is a fundamental principle of cardiac physiology. This phenomenon is widely known as the Frank-Starling mechanism, or simply Frank-Starling's law of the heart. All the provided options refer to this same physiological principle, which describes how the heart adjusts its stroke volume in response to changes in venous return.

Which of the following lung sounds is/are most likely to be audible while auscultating the lung(s) in areas of a tension pneumothorax?

Answer: Absent or decreased breath sounds.

In a tension pneumothorax, air accumulates in the pleural space, causing the lung on the affected side to collapse and preventing air movement. When auscultating the chest, this lack of air movement results in absent or significantly decreased breath sounds over the affected lung field. While the patient will exhibit labored breathing, the sounds directly from the lung itself will be diminished.

The patient is shocked. Their preload is decreasing, and their pulse pressure is narrow. Which kind of shock is your patient going through?

Answer: Compensatory

A narrow pulse pressure (the difference between systolic and diastolic blood pressure) and decreasing preload are classic indicators of compensatory shock, often seen in hypovolemic states. The body attempts to maintain vital organ perfusion by increasing heart rate and peripheral vasoconstriction, which elevates diastolic pressure and narrows the pulse pressure. This is the body's initial, compensatory response before it progresses to decompensated shock.

When should 50% dextrose be avoided absent a diagnosis of hypoglycemia?

Answer: Both A and B

Administering hypertonic dextrose (D50) to patients with suspected stroke or head trauma, in the absence of confirmed hypoglycemia, can be detrimental. The dextrose can exacerbate cerebral edema and increase intracranial pressure, potentially worsening neurological injury. Therefore, D50 should only be given in these specific situations if hypoglycemia is definitively diagnosed.

What is the cardiac output of a patient with a stroke volume of 80 mL and a heart rate of 60?

Answer: 4800mLs

Cardiac output (CO) is calculated by multiplying the stroke volume (SV) by the heart rate (HR). In this scenario, the stroke volume is 80 mL and the heart rate is 60 bpm. Therefore, CO = 80 mL/beat * 60 beats/minute = 4800 mL/minute.

Which item from the list below can be used to stop poisons from entering the bloodstream?

Answer: Activated charcoal

Activated charcoal is a highly effective adsorbent that can bind to many toxins and drugs in the gastrointestinal tract. By forming a complex with these substances, it prevents their absorption into the bloodstream, thereby reducing systemic toxicity. It is a common and important intervention in the management of oral poisonings.

What exactly restricts the filling of the heart by filling the pericardial sac with fluid?

Answer: Pericardial Tamponade

Pericardial tamponade is a life-threatening condition where fluid accumulates in the pericardial sac, the sac surrounding the heart. This fluid buildup exerts pressure on the heart, physically restricting its ability to fill with blood during diastole. This impaired filling significantly reduces cardiac output and can lead to cardiogenic shock and cardiac arrest.

How long should a patient be suctioned for in order to prevent hypoxia?

Answer: Not more than 15 seconds

Suctioning removes oxygen from the airway along with secretions, which can quickly lead to hypoxia. To minimize the risk of desaturation and adverse effects in an adult patient, each suctioning attempt should be limited to a brief duration, typically no more than 15 seconds. This allows for effective clearing of the airway while preventing significant oxygen deprivation.