Scenarios
Dispatch: 67 yo male rear ended another car while traveling at about 30 mph
Pt is sitting in car with air bags deployed some front end damage. Pt complaining of severe headache and is slurring his words. Pt has some facial droop on one side.
VITALS: 168/90, 100 bpm, 97% SPO2, RR 20, warm/pink/dry skin, clear lung sounds, mid-equal and reactive pupils, BGL 118
Severe headache, sharp pain at 10/10, allergic to dust/pollen, uses inhaler, has asthma
Upon examination, pt has unequal grip strength and unable to answer all a&o questions correctly.
Differential: stroke
Treatment: keep patient head elevated, supportive care, drive fast
What is the difference between a stroke and TIA?
Strokes and TIA present similarly, but TIA self resolving within 24 hours, blood flow decreased in the cerebral arteries.
What is the difference between thrombotic and embolic strokes?
Thrombotic: from same place, higher risk with high cholesterol
Embolic: originates from somewhere else and lodges itself in the brain vessels
What is the treatment for hyperglycemia?
in the field: fluids and supportive care
hospital: insulin administration
What is the difference between glycogenolysis, glycogenesis, and gluconeogenesis?
Glycogenolysis: making glucose from glycogen
Glycogenesis: making glycogen from glucose
Gluconeogenesis: making glucose from non-carbohydrates (proteins and fats)
Dispatch: 24 yo male at a single family residence for AMS (0800 am)
Upon arrival family states they found him laying in his bed this morning, which isn't usually like him because he likes to run every morning. You find the patient laying supine in his room and looks like he is working to breathe. He is able to track you around the room, but unable to answer all your questions.
Mom states that he just got over a UTI and has type I diabetes. Mom says the last time he ate was yesterday around 11am and isn't sure if he took his insulin or not.
As you look in the airway you notice it is pale and dry. You notice a slight fruity smell. Breathing is labored and deep. His pulse is rapid. Skin is warm and dry.
Vitals show: 140/91, 125 bpm, RR 36, temp 99.3, BGL 437,
Differential: DKA
Treatment: Isotonic IV fluids
What is Cushing's triad, what does it reflect?
Decreased heart rate, irregular respirations, widened pulse pressure; indicative of increased intracranial pressure
Hormone: chemical messengers that are secreted into the bloodstream by endocrine glands. They circulate throughout the body and target organs to maintain homeostasis.
Neurotransmitter: chemical substance released by a neuron and carries a signal to another cell (including another neuron, muscle cell, or a gland).
What are the main hormones secreted by the posterior pituitary gland? anterior pituitary gland (at least 4-5)?
P: Oxytocin and Antidiuretic Hormone
A: Growth Hormone (GH), Adrenocorticotropic Hormone (ACTH), Thyroid-stimulating hormone (TSH), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Prolactin (PRL)
DM type 1: most common pediatric chronic disease. Strong autoimmune genetic component. No longer able to produce insulin. Thin.
DM type 2: a genetic-environmental interaction is responsible for the disease. Insulin resistant. Obesity. High blood pressure.
Presenting to hospital: 50 yo female c/o progressive weight gain of 20 pounds in the last year, fatigue, dizziness, loss of memory, dry skin, constipation and cold intolerance.
Vitals: 98.6 temp, 58 bpm, 110/60
pt is moderately obese and speaks slowly and has a puffy face, cool/pale/dry skin.
upon examination of the neck you note an enlargement of the thyroid and patient confirms a recent development of difficulty swallowing and a cough lasting a few months.
pt has no medical hx besides a couple surgeries and is allergic to iodine
What are the common causes of seizures (at least 3) and types of seizure (at least 3)?
Causes: endocrine, metabolic, trauma, toxicology, hypoxia
Types: partial (simple and complex), generalized (absence/petite mal and tonic-clonic/grand mal), febrile, and pseudoseizures
What is a synapse and where does it occur?
Why is cortisol important?
it is the primary hormone that responds to stress or danger. increases the body's metabolism of glucose.
What are at least four hormones secreted by the hypothalamus?
Growth Hormone Release Hormone (GHRM), Growth Hormone Inhibiting Hormone (GHIH), Corticotropin Releasing Hormone (CRH), Thyrotropin Releasing Hormone (TRH), Gonadotropin Releasing Hormone (GnRH), Prolactin Releasing Hormone (PRH), Prolactin Inhibiting Hormone (PIH)
Dispatch: 32 yo male unconscious; single family residence; outside
upon arrival pt is lying supine on the ground next to a ladder leaned up against the house. the family is standing around his waving you over.
family states that patient was unconscious for at least 4 minutes after he fell. pt complains of a headache, photophobia, and nausea and does not remember falling
pt is able to open his eyes spontaneously and track you. pt is able to move all extremities normally to command and has a GCS of 15. Pupils are PERRLAC.
upon examination pt has a large hematoma in the occipital area.
vitals show: 140/80, 110 bpm, RR 24, 98% spo2
differential: concussion that could worsen
treatment: c-spine precautions, watch for shock or deterioration (in case of brain bleed)
Parkinson's is a result of a decreased production in what neurotransmitter? Where does it originate?
Dopamine. Midbrain (extrapyramidal tracts)
Name the parts of the brain responsible for the following:
1. judgement
2. visual reception area
3. reading/writing
4. understanding language
5. coordination of movement
6. breathing/heart rate
1. frontal lobe
2. occipital lobe
3. parietal lobe
4. temporal lobe
5. cerebellum
6. brain stem
Multiple Sclerosis
What is Pheochromocytoma and what is the main symptom to identify it?
A tumor on the adrenal medulla that causes an excessive release of norepinephrine. High blood pressure unable to be regulated by medication.
not a scenario lol tricked ya. what are the three different spinal cord lesions and what are the sx?
1. Central cord: paralysis or loss of fine motor control of movements in the arms and hands, with relatively less impairment of leg movements
2. Brown-Sequard: weakness or paralysis on one side of the body and a loss of sensation on the other side
3. Anterior cord: motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion.
What are the 12 cranial nerves? and what are they responsible for?
I: olfactory: (S) nose/smell
II: optic: (S) eye/vision
III: oculomotor:(m) all eye muscles, pupillary response
IV: trochlear: (m) superior oblique muscle
V: trigeminal: (s) all the face, sinuses, teeth (m) lower half of the face (jaws)
VI: abducens: (m) external rectus muscles
VII: facial: (m) facial muscles, expressions
VII: acoustic/vestibulocochlear: (s) sound, inner ear
IX: glossopharyngeal: (m) pharyngeal, musculature (s) posterior part of the tongue, tonsil, pharynx
X: vagus: (m) heart, lungs, bronchi, GI tract (s) heart, lungs, bronchi, trachea, pharynx, GI tract, external ear, gag reflex
XI: spinal accessory: (m) sternocleidomastoid and trapezius muscles (shrugging)
XII: hypoglossal: (m) muscles of the tongue
weakness of the eye muscles, difficulty swallowing, slurred speech
muscles that control eye and eyelid movement, facial expressions, chewing, talking, and swallowing becomes weaker.
the muscles that control breathing and neck and limb movements can also be affected.
What is the difference between hyperparathyroidism and hypoparathyroidism?
Hypo: low production of parathyroid hormone. symptoms including muscle aches/cramps, muscle spasms, fatigue/weakness, brittle nails, dry skin, patchy hair loss
Hyper: excessive secretion of parathyroid hormone that causes HYPERcalcemia and HYPOphosphatemia. symptoms include excessive urination, abdominal pain, kidney stones, bone/joint pain,
Explain the negative feedback loop
Regulation and release of the thyroid hormones occurs as a negative feedback loop. In simple terms, a negative feedback loop means that as something increases, the production of whatever is causing the increase, slows down.