Mixed Deck — All AMLS Topics Flashcards

A septic patient with a lactate of 4.2 mmol/L and hypotension despite 30 mL/kg IV fluids should receive which additional intervention?

Answer: Initiate vasopressors (norepinephrine)

Persistent hypotension after adequate fluid resuscitation in septic shock requires vasopressors, with norepinephrine as first-line.

Which of the following patients is at HIGHEST risk for developing hyperosmolar hyperglycemic state (HHS) rather than DKA?

Answer: A 70-year-old with poorly controlled type 2 diabetes and a respiratory infection

HHS predominantly affects older adults with type 2 diabetes, especially during physiologic stress (e.g., infection) that impairs fluid intake and causes profound dehydration, while their residual insulin prevents ketogenesis.

Which type of shock is characterized by decreased SVR (systemic vascular resistance) and increased cardiac output?

Answer: Distributive shock

Distributive shock (e.g., septic, anaphylactic, neurogenic) causes massive vasodilation, reducing SVR while initially increasing cardiac output.

What is the most common cause of pulmonary embolism (PE)?

Answer: Blood clot (deep vein thrombosis)

The most common cause of a pulmonary embolism (PE) is a blood clot, specifically one that originates in the deep veins of the legs or pelvis, a condition known as deep vein thrombosis (DVT). This clot then breaks off, travels through the bloodstream, and lodges in the pulmonary arteries, blocking blood flow to the lungs. Other types of emboli are far less common.

Which laboratory finding is the hallmark of acetaminophen (Tylenol) toxicity in the delayed phase (24-72 hours)?

Answer: Elevated AST/ALT indicating hepatocellular damage

Acetaminophen overdose causes hepatic necrosis, leading to markedly elevated liver enzymes (AST/ALT) in the delayed phase 24–72 hours post-ingestion.

What is the first step in a patient assessment?

Answer: Performing a scene size-up

In emergency medical care, the very first step in patient assessment is performing a scene size-up. This involves quickly assessing the safety of the scene for both the rescuer and the patient, identifying potential hazards, and determining the nature of the illness or mechanism of injury. Ensuring scene safety is paramount before approaching the patient and initiating direct care.

Cushing's syndrome results from chronic excess of which hormone?

Answer: Cortisol (glucocorticoid excess)

Cushing's syndrome is caused by chronic excess cortisol, whether from endogenous overproduction (e.g., adrenal tumor, pituitary adenoma) or prolonged exogenous corticosteroid use, leading to central obesity, hypertension, hyperglycemia, and skin changes.

Which toxin causes a 'sympathomimetic toxidrome' with hyperthermia, tachycardia, hypertension, and agitation?

Answer: Cocaine or amphetamines

Cocaine and amphetamines cause the sympathomimetic toxidrome by blocking catecholamine reuptake or increasing release, producing excess adrenergic stimulation.

What is the primary goal of early reperfusion therapy in STEMI management?

Answer: Restore coronary blood flow to salvage myocardium

Early reperfusion aims to restore coronary blood flow to limit infarct size and salvage viable myocardium.

A patient presents with sudden-onset tearing chest pain radiating to the back. Which condition should be suspected first?

Answer: Acute aortic dissection

Tearing or ripping chest pain radiating to the back is the classic presentation of acute aortic dissection.

Which treatment reverses the QRS widening caused by TCA overdose?

Answer: Sodium bicarbonate IV bolus

Sodium bicarbonate increases serum pH and sodium load, reversing sodium channel blockade and narrowing the widened QRS in TCA overdose.

Decerebrate posturing in a comatose patient indicates injury at which neurological level?

Answer: At or below the midbrain (diencephalon to brainstem)

Decerebrate posturing (extension of all extremities) indicates injury at the midbrain or below, signaling severe brainstem dysfunction.

A type 2 diabetic on metformin presents with Kussmaul respirations, abdominal pain, and an anion gap metabolic acidosis, but blood glucose is only 130 mg/dL. Which diagnosis should be considered?

Answer: Euglycemic diabetic ketoacidosis

Euglycemic DKA occurs when patients (especially on SGLT-2 inhibitors) develop ketoacidosis with near-normal glucose, making it easy to miss; insulin deficiency and ketone production are present despite minimal hyperglycemia.

Wernicke's encephalopathy is classically caused by a deficiency of which vitamin?

Answer: Thiamine (B1)

Wernicke's encephalopathy results from thiamine (B1) deficiency, commonly seen in alcoholism, and presents with the classic triad of ataxia, ophthalmoplegia, and confusion.

A patient with altered mental status has a blood glucose of 38 mg/dL. IV access cannot be established. What is the most appropriate next intervention?

Answer: Intramuscular glucagon 1 mg

When IV access is unavailable in a hypoglycemic patient with altered mental status (making oral glucose unsafe), IM glucagon stimulates hepatic glycogenolysis to raise blood glucose.

Which of the following is part of the primary survey in patient assessment?

Answer: Checking airway, breathing, and circulation (ABC)

The primary survey in patient assessment focuses on identifying and immediately managing life-threatening conditions. Checking the patient's Airway, Breathing, and Circulation (ABC) is the cornerstone of this survey, as these are the most critical functions for survival. Addressing any issues with ABC takes precedence over other assessments to stabilize the patient.

Beck's triad (hypotension, muffled heart sounds, and JVD) is associated with which cardiac emergency?

Answer: Cardiac tamponade

Beck's triad of hypotension, muffled heart sounds, and jugular venous distension classically indicates cardiac tamponade.

A patient presents with hypotension, JVD, and absent breath sounds on the left. What is the most likely diagnosis?

Answer: Tension pneumothorax

Tension pneumothorax presents with hypotension, JVD, tracheal deviation, and absent breath sounds on the affected side.

What is the Cushing reflex and what does it indicate?

Answer: Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure

The Cushing reflex (hypertension, bradycardia, irregular respirations) is a late sign of severely elevated ICP indicating impending herniation.

Which laboratory finding best differentiates diabetic ketoacidosis (DKA) from hyperosmolar hyperglycemic state (HHS)?

Answer: Presence of significant ketonemia and metabolic acidosis

DKA is characterized by significant ketonemia and anion-gap metabolic acidosis, whereas HHS features extreme hyperglycemia and hyperosmolality without significant ketosis or acidosis.