N CLEX - RN Te st
TABLE OF CONTENTS
N CLEX TEST RESOURCES... 4
I N TROD UCTI ON TO TH I S GUI D E... 5
TESTI N G AN D AN ALYSI S... 7
I N TROD UCTI ON TO TH E N CLEX... 9
TH E N CLEX SCORI N G SCALE... 10
GEN ERAL STRATEGI ES... 11
STRATEGY 1: UNDERSTANDI NG THE INTI MI DATI ON... 11
STRATEGY 2: FI NDI NG YOUR OPTI MAL PACE... 13
STRATEGY 3: DON’T BE A PERFECTI ONI ST... 15
STRATEGY 4: FACTUALLY CORRECT, BUT ACTUALLY WRONG... 16
STRATEGY 5: EXTRANEOUS INFORMATI ON... 16
STRATEGY 6: AVOI DI NG DEFI NI TES... 18
STRATEGY 7: USI NG COMMON SENSE... 18
STRATEGY 8: INSTI NCTS ARE RI GHT... 19
STRATEGY 9: NO FEAR... 19
STRATEGY 10: DON’T GET THROWN OFF BY NEW INFORMATI ON... 20
STRATEGY 11: NARROWI NG THE SEARCH... 20
STRATEGY 12: YOU’RE NOT EXPECTED TO BE EI NSTEI N... 21
RESPI RATORY CON D I TI ON S... 21
CI RCULATORY SYSTEM... 35
COURSE OF CI RCULATI ON... 36
THE HEART... 37
CARDI OVASCULAR CONDI TI ONS... 40
ARRHYTHMI AS REVI EW... 53
CARD I AC FAI LURE REV I EW... 55
EN D OCRI N E REV I EW ... 57
M I CROBI OLOGY REV I EW ... 68
CHARACTERI STI CS OF BACTERI A TYPES... 68
IMMUNOGLOBULI N I SOTYPES... 74
CYTOKI NES REVI EW... 74
PH ARM ACOLOGY... 78
M EASUREM EN T EQUI V ALEN TS... 87
D RUG D I STRI BUTI ON... 90
BI OTRAN SFORM ATI ON OF D RUGS... 93
DRUG ELI MI NATI ON... 94
GEN ERAL PH ARM ACOKI N ETI CS REV I EW... 96
PHARMACODYNAMI C TERMS... 98
AUTONOMI C NERVOUS SYSTEM RECEPTORS... 98
SPECI FI C PED I ATRI C CON D I TI ON S... 99
TUM OR REV I EW... 108
GI REV I EW... 110
EYE, EAR, AN D M OUTH REV I EW... 118
DI SORDERS OF THE EYE... 118
DI SORDERS OF THE MOUTH... 121
DI SORDERS OF THE EAR... 123
OBSTETRI CS/ GYN ECOLOGY... 125
D ERM ATOLOGY REVI EW... 133
AX I AL SKELETON... 139
APPEN D I CULAR SKELETON... 140
M USCULOSKELETAL CON D I TI ON S... 146
V ALUABLE N CLEX RESOURCE LI N KS... 182
SPECI AL REPORT– QUI CK REFEREN CE LESI ON REV I EW ... 183
SPECI AL REPORT- H I GH FREQUEN CY TERM S... 186
D EFI N I TI ON OF ROOT W ORD S... 192
PREFI X ES... 196
SUFFI X ES... 198
N CLEX Te st Re sou r ce s
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St u dy Tips a n d I n for m a t ion
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I n t r odu ct ion t o t h is Gu ide
Your NCLEX score is one of t he m ost crit ical elem ent s t o your
qualificat ion t o becom e a nurse, so it is nat urally m uch t oo im port ant for you t o t ake t his t est unprepared. The higher your NCLEX score, t he bet t er your chances of passing t he boards.
Careful preparat ion, as described in t his expert guide, along w it h hard w ork, w ill dram at ically enhance your probabilit y of success. I n fact , it is w ise t o apply t his philosophy not only t o your board’s exam , but t o ot her elem ent s of your life as w ell, t o raise you above t he com pet it ion. Your NCLEX score is one of t he areas in t he licensure process over w hich you have a subst ant ial am ount of cont rol; t his opport unit y should not be t aken light ly. Hence, a rat ional, prepared approach t o your NCLEX t est as well as t he rest of t he licensure process w ill cont ribut e considerably t o t he likelihood of success.
Keep in m ind, t hat alt hough it is possible t o t ake t he NCLEX m ore t han once, you should never t ake t he t est as an “ experim ent ” j ust t o see how well you do. I t is of ext rem e im port ance t hat you always be prepared t o do your best w hen t aking t he NCLEX. For one t hing, it is ext rem ely challenging t o surm ount a poor perform ance. I f you ar e looking t o t ake a “ pract ice” run, look int o review course, professionally developed m ock NCLEX exam inat ions, and, of course, t his guide.
and know ledge you need for m axim izing your perform ance on your NCLEX t est .
Te st in g a n d An a lysis
I t w on’t t ake you long t o discover t hat t he NCLEX is unlike any t est you’ve t aken before, and it is probably unlike any t est you w ill ever t ake again in your academ ic career. The t ypical high school or college t est is a know ledge- based t est . The NCLEX, how ever, is applicat ion-based.
What does t his m ean t o you? I t m eans t hat you’ll have t o prepare yourself in a com plet ely different w ay! You w on’t sim ply be recit ing m em orized fact s as t hey w ere phrased in som e t ext book, and you w on’t be applying any learned form ulas t o specific problem s t hat w ill be laid out .
The NCLEX requires you t o t hink in a t horough, quick and st rat egic m anner…and st ill be accurat e, logical and w ise. This t est is designed t o j udge your abilit ies in t he w ays t hat t he licensure boards feel is vit al t o t he success of first year nursing graduat e.
To som e ext ent , you have already gradually obt ained t hese abilit ies over t he lengt h of your academ ic career. However, what you probably have not yet becom e fam iliar w it h is t he capabilit y t o use t hese
abilit ies for t he purpose of m axim izing perform ance w it hin t he com plex and profound environm ent of a st andardized, skills- based exam inat ion.
There are different st rat egies, m indset s and perspect ives t hat you w ill be required t o apply t hroughout t he NCLEX. You’ll need t o be
som et hing you can learn from t aking a course or reading a book, but it is som et hing you can develop t hrough pract ice and concent rat ion.
The follow ing chapt ers in t his guidebook w ill lay out t he form at and st yle of t he NCLEX as well as give you sam ple quest ions and exam ples of t he fram e of m ind you’ll be expect ed t o t ake. I f t here is one skill t hat you t ake w it h you from your preparat ion for t he NCLEX, t his should be it .
I n t r odu ct ion t o t h e N CLEX
The purpose of t he NCLEX is t o est ablish a st andard m et hod of
m easurem ent for t he skills t hat have been acquired by nursing school graduat es. These skills are considered crit ical t o t he healt hcare
profession. The principle behind t he NCLEX is sim ilar t o t he SAT’s t hat are required for applicat ion t o Am erican colleges. Alt hough t hese t est s are sim ilar experiences in som e respect s, t he NCLEX is a m uch m ore challenging and com plex.
Fort unat ely, t he NCLEX does not change very dram at ically from year t o year. What t his m eans t o you, is t hat it has becom e possible for qualit y pract ice t est s t o be produced, and if you should t ake enough of t hese t est s, in addit ion t o learning t he correct st rat egies, you w ill be able t o prepare for t he t est in an effect ive m anner.
The NCLEX is not j ust a m ult iple- choice t est . Fill in t he blank
quest ions and m ult iple right answ er quest ions have been added t o t he t est . Alt hough t hese t ypes of quest ions are not t he m aj orit y of
Th e N CLEX Scor in g Sca le
The m inim um num ber of quest ions asked on t he NCLEX- RN exam is 75. The m axim um num ber of quest ions is 265. The exam is offered in CAT form at w hich m eans t he difficult ly of t he quest ions varies
significant ly. I f you m iss a quest ion, t he com put er w ill give you an easier quest ion. I f you get it right , t hen you w ill get harder quest ions.
Many NCLEX t est t akers freak out if com put er shut s off aft er 75
quest ions, or if t hey have t o t ake t he m axim um num ber of quest ions. The m ain point is t o be prepared t o go t he dist ance. Don’t be sprint er and concent rat e for 100 quest ions and t hen let your concent rat ion begin t o fade. Likew ise, don’t st ress on how m any quest ions you have t o t ake. You w on’t know t he out com e unt il you get your scores, so don’t st ress out .
Take som e t im e for yourself and do som et hing fun follow ing t he exam .
N CLEX Tips
1. Arrive early t o t he t est ing cent er. 2. Bring m ult iple form s of idea. 3. Wear layered clot hing.
4. Get a good night ’s sleep before t he t est . ( Don’t cram ) 5. Use a st udy part ner w hen preparing for t he exam . 6. Be fam iliar w it h t he form at of t he exam .
7. Know your m edical t erm inology.
8. Lim it your dist ract ions preparing for t he exam .
9. Take t im e t o unw ind and reduce st ress as you prepare.
10. Rem em ber if you don’t pass, you can ret ake t he exam .
Ge n e r a l St r a t e gie s
St r a t e gy 1 : Un de r st a n din g t h e I n t im ida t ion
The t est writ ers w ill generally choose som e m at erial on t he exam t hat w ill be com plet ely foreign t o m ost t est t akers. You can’t expect all of t he m edical t opics t o be a t opic w it h w hich you have a fair am ount of fam iliarit y. I f you do happen t o com e across a high num ber of
t opics/ cases t hat you are ext rem ely fam iliar w it h, consider yourself lucky, but don’t plan on t hat happening.
Each case and scenario w ill be slight ly different . Try and underst and all of t he m at erial, w hile w eeding out t he dist ract er inform at ion. The cases will also frequent ly be draw n from real w orld experiences.
Therefore, t he passage t hat you w ill face on t he t est m ay alm ost seem out of cont ext and as t hough it begins in t he m iddle of a m edical
process. You w on’t have a nice t it le overhead explaining t he general t opic being covered but w ill im m ediat ely be t hrow n int o t he m iddle of a st range form at t hat you don’t recognize.
St r a t e gy 2 : Fin din g you r Opt im a l Pa ce
Everyone reads and t est s at a different rat e. I t w ill t ake pract ice t o det erm ine w hat is t he opt im al rat e at w hich you can read fast and yet absorb and com prehend t he inform at ion. This is t rue for bot h t he flyover t hat you should init ially conduct and t hen t he subsequent reading you w ill have t o do as you go t hrough and begin focusing on a specific quest ion. How ever, on t he flyover, you are looking for only a surface level know ledge and are not t rying t o com prehend t he m inut ia of det ails t hat w ill be cont ained in t he quest ion. Basically, skim t he quest ion and t hen read t he quest ion slow ly.
Wit h pract ice, you w ill find t he pace t hat you should m aint ain on t he t est w hile answ ering t he quest ions. I t should be a com fort able rat e. This is not a speed- reading t est . I f you have a good pace, and don’t spend t oo m uch t im e on any quest ion, you should have a sufficient am ount of t im e t o read t he quest ions at a com fort able rat e. The t w o ext rem es you w ant t o avoid are t he dum bfounded m ode, in w hich you are lip reading every w ord individually and m out hing each w ord as t hough in a st upor, and t he overw helm ed m ode, w here you are panicked and are buzzing back and fort h t hrough t he quest ion in a frenzy and not com prehending anyt hing.
how m uch t im e you spend reading each quest ion. Pract ice w ill allow you t o det erm ine t hat opt im al rat e.
St r a t e gy 3 : D on ’t be a Pe r fe ct ion ist
I f you’re a perfect ionist , t his m ay be one of t he hardest st rat egies, and yet one of t he m ost im port ant . The t est you are t aking is t im ed, and you cannot afford t o spend t oo m uch t im e on any one quest ion.
I f you are w orking on a quest ion and you’ve got your answ er split bet ween t wo possible answer choices, and you’re going back t hrough t he quest ion and reading it over and over again in order t o decide bet ween t he t wo answer choices, you can be in one of t he m ost
frust rat ing sit uat ions possible. You feel t hat if you j ust spent one m ore m inut e on t he problem , t hat you w ould be able t o figure t he right
answ er out and decide bet w een t he t w o. Wat ch out ! You can easily get so absorbed in t hat problem t hat you loose t rack of t im e, get off t rack and end up spending t he rest of t he t est playing cat ch up
because of all t he w ast ed t im e, w hich m ay leave you rat t led and cause you t o m iss even m ore quest ions t hat you w ould have ot herw ise.
St r a t e gy 4 : Fa ct u a lly Cor r e ct , bu t Act u a lly W r on g
A favorit e ploy of quest ion writ ers is t o writ e answer choices t hat are fact ually correct on t heir own, but fail t o answ er t he quest ion, and so are act ually wrong.
When you are going t hrough t he answer choices and one j um ps out for being fact ually correct , w at ch out . Before you m ark it as your answ er choice, first m ake sure t hat you go back t o t he quest ion and confirm t hat t he answ er choice answ ers t he quest ion being asked.
St r a t e gy 5 : Ex t r a n e ou s I n for m a t ion
Som e answ er choices w ill seem t o fit in and answ er t he quest ion being asked. They m ight even be fact ually correct . Everyt hing seem s t o check out , so w hat could possibly be w rong?
Does t he answer choice act ually m at ch t he quest ion, or is it based on ext raneous inform at ion cont ained in t he quest ion. Just because an answer choice seem s right , don’t assum e t hat you overlooked inform at ion w hile reading t he quest ion. Your m ind can easily play t ricks on you and m ake you t hink t hat you read som et hing or t hat you overlooked a phrase.
Unless you are behind on t im e, alw ays go back t o t he quest ion and m ake sure t hat t he answ er choice “ checks out .”
St r a t e gy 6 : Avoidin g D e fin it e s
Answ er choices t hat m ake definit e st at em ent s w it h no “ w iggle room ” are oft en wrong. Try t o choose answ er choices t hat m ake less definit e and m ore general st at em ent s t hat w ould likely be correct in a w ider range of sit uat ions and aren’t exclusive.
Exam ple:
A. The nurse should follow universal cont act precaut ions at all t im es in every case.
B. The nursing assist ant com plet ely dem onst rat ed poor aw areness of t ransfer safet y.
C. Never allow new m edicat ions t o be accessible on t he unit . D. Som et im es, t he act ion t aken by t he aide w as not w ell planned.
Wit hout know ing anyt hing about t he quest ion, answ er choice D uses t he t erm “ som et im es,” w hich has w iggle room , m eaning t here could have been a few st rong point s and w eak point s about t he aide’s perform ance. All of t he ot her answer choices have a m ore definit e sense about t hem , im plying a m ore precise answ er choice w it hout w iggle room t hat is oft en w r ong.
St r a t e gy 7 : Usin g Com m on Se n se
The quest ions on t he t est are not int ended t o be t rick quest ions. Therefore, m ost of t he answer choices w ill have a sense of norm alcy about t hem t hat m ay be fairly obvious and could be answered sim ply by using com m on sense.
While m any of t he t opics w ill be ones t hat you are som ew hat unfam iliar w it h, t here w ill likely be num erous t opics t hat you have som e prior indirect knowledge about t hat w ill help you answ er t he quest ions.
St r a t e gy 8 : I n st in ct s a r e Righ t
When in doubt , go w it h your first inst inct . This is an old t est - t aking t rick t hat st ill w orks t oday. Oft ent im es if som et hing feels right
inst inct ively, it is right . Unfort unat ely, over analyt ical t est t akers w ill oft en convince t hem selves ot herw ise. Don’t fall for t hat t rap and t ry not t o get t oo nit picky about an answ er choice. You shouldn’t have t o t w ist t he fact s and creat e hypot het ical scenarios for an answer choice t o be correct .
St r a t e gy 9 : N o Fe a r
The dept h and breadt h of t he NCLEX t est can be a bit int im idat ing t o a lot of people as it can deal w it h t opics t hat have never been
St r a t e gy 1 0 : D on ’t Ge t Th r ow n Off by N e w
I n for m a t ion
Som et im es t est w rit ers w ill include com plet ely new inform at ion in answer choices t hat are wrong. Test t akers will get t hrown off by t he new inform at ion and if it seem s like it m ight be relat ed, t hey could choose t hat answer choice incorrect ly. Make sure t hat you don’t get dist ract ed by answ er choices cont aining new inform at ion t hat doesn’t answ er t he quest ion.
Exam ple: Which conclusion is best support ed?
A: Hyponat rem ia can cause t he anxiet y present ed in t his case.
Was anxiet y even discussed in t he quest ion? I f t he answ er is NO – t hen don’t consider t his answ er choice, it is w rong.
St r a t e gy 1 1 : N a r r ow in g t h e Se a r ch
Whenever t wo answ er choices are direct opposit es, t he correct answ er choice is usually one of t he t wo. I t is hard for t est writ ers t o resist m aking one of t he w rong answ er choices w it h t he sam e w ording, but changing one word t o m ake it t he direct opposit e in m eaning. This can usually cue a t est t aker in t hat one of t he t wo choices is correct .
Exam ple:
A. Calcium is t he prim ary m ineral linked t o ost eoporosis t reat m ent . B. Pot assium is t he prim ary m ineral linked t o ost eoporosis
t reat m ent .
These answer choices are direct opposit es, m eaning one of t hem is likely correct . You can t ypically rule out t he ot her t wo answ er choices.
St r a t e gy 1 2 : You ’r e n ot Ex pe ct e d t o be Ein st e in
The quest ions w ill cont ain t he inform at ion t hat you need t o know in order t o answ er t hem . You aren’t expect ed t o be Einst ein or t o know all relat ed know ledge t o t he t opic being discussed. Rem em ber, t hese quest ions m ay be about obscure t opics t hat you’ve never heard of. I f you w ould need t o know a lot of out side know ledge about a t opic in order t o choose a cert ain answ er choice – it ’s usually w rong.
Re spir a t or y Con dit ion s
Pulm onary Valve St enosis
Causes:
Congenit al Endocardit is Rheum at ic Fever
Sym pt om s:
Faint ing SOB
Palpit at ions Cyanosis
Test s:
Cardiac cat het erizat ion ECG
Chest - Xray Echocardiogram
Treat m ent :
Blood t hinners Valvuloplast y
ARDS- low oxygen levels caused by a build up of fluid in t he lungs and inflam m at ion of lung t issue.
Causes:
Traum a
Chem ical inhalat ion Pneum onia
Sept ic shock
Sym pt om s:
Low BP
Rapid breat hing SOB
Test s:
ABG CBC Cult ures Treat m ent : Echocardiogram Auscult at ion
Cyanosis Chest X- ray
Mechanical Vent ilat ion
Treat t he underlying condit ion
Monit or t he Pat ient for:
Pulm onary fibrosis
Mult iple syst em organ failure Vent ilat or associat ed pneum onia Acidosis
Respirat ory failure
Respirat ory Acidosis- Build- up of Carbon Dioxide in t he lungs t hat causes acid- base im balances and t he body becom es acidic.
Causes:
COPD
Airw ay obst ruct ion
Hypovent ilat ion syndrom e Severe scoliosis
Severe ast hm a
Sym pt om s:
Chronic cough Wheezing SOB
Confusion Fat igue
Test s:
CAT Scan ABG
Pulm onary Funct ion Test .
Treat m ent :
Respirat ory Alkalosis: CO2 levels are reduced and pH is high.
Causes:
Anxiet y Fever
Hypervent ilat ion
Sym t pom s:
Dizziness Num bness
Test s:
ABG
Chest X- ray
Pulm onary funct ion t est s
Treat m ent :
Paper bag t echnique
I ncrease carbon dioxide levels
RSV ( Respirat ory synct ial virus) - spread by cont act , virus can survive for various t im e periods on different surfaces.
Sym pt om s:
Fever SOB Cyanosis Wheezing
Nasal congest ion Croupy cough
Test s:
ABG
Chest X- ray
Treat m ent :
Ribvirin
Vent ilat or in severe cases I V fluids
Bronchodilat ors
Monit or t he pat ient for:
Pneum onia
Respirat ory failure Ot it is Media
Hypervent ilat ion Causes:
COPD
Panic At t acks St ress
Ket oacidosis Aspirin overdose Anxiet y
Apnea: no spont aneous breat hing.
Causes:
Obst ruct ive sleep apnea Seizures
Cardiac Arrhyt hm ias Brain inj ury
Nervous syst em dysfunct ion
Drug overdose Prem at urit y Bronchospasm Encephalit is Choking
Lung surgery
Causes: Cancer
Lung abscesses At elect asis
Em physem a Pneum ot horax Tum ors
Bronchiect asis
Pneum onia: viruses t he prim ary cause in young children, bact eria t he prim ary cause in adult s. Bact eria: St rept ococcus pneum oniae,
Mycoplasm a pneum oniae
Types of pneum onia:
Viral pneum onia Walking pneum onia Legionella pneum onia CMV pneum onia Aspirat ion pneum onia At ypical pneum onia Legionella pneum onia
Sym pt om s:
Fever Headache Ribvirin SOB Cough
Chest pain Test s:
Chest X- ray
Pulm onary perfusion scan CBC
Cult ures of sput um Presence of crackles
Treat m ent :
Ant ibiot ics if caused by a bact erial infect ion
Respirat ory t reat m ent s St eroids
I V fluids
Vaccine t reat m ent s
Pulm onary act inom ycosis –bact eria infect ion of t he lungs caused by ( propionibact eria or act inom yces)
Causes:
Microorganism s
Sym pt om s:
Pleural effusions Facial lesions Chest pain Cough Weight loss
Monit or pat ient for:
Em physem a
Meningit is Ost eom yelit is
Alveolar prot einosis: A build- up of a phospholipid in t he lungs w ere carbon dioxide and oxygen are t ransferred.
Causes:
May be associat ed w it h infect ion Genet ic disorder 30- 50 yrs. Old
Sym pt om s:
Weight loss Fat igue Cough Fever SOB
Test s:
Chest X- ray
Presence of crackles CT scan
Bronchoscopy ABG- low O2 levels
Pulm onary Funct ion t est s
Treat m ent :
Lung t ransplant at ion
Special lavage of t he lungs
Pulm onary hypert ension: elevat ed BP in t he lung art eries
Causes:
May be genet ically linked More predom inant in w om en
Sym pt om s:
Fat igue Chest Pain
SOB w it h act ivit y LE edem a
Test s:
Pulm onary art eriogram Chest X- ray
ECG
Pulm onary funct ion t est s CT scan
Cardiac cat het erizat ion
Treat m ent :
Manage sym pt om s Diuret ics
Calcium channel blockers Heart / Lung Transplant if necessary
Pulm onary art eriovenous fist ulas: a congenit al defect w ere lung art eries and veins form im properly, and a fist ula is form ed creat ing poor oxygenat ion of blood.
Sym pt om s:
SOB w it h act ivit y Presence of a m urm ur Cyanosis
Clubbing
Paradoxical em bolism
Test s:
CT Scan
Pulm onary art eriogram Low O2 Sat urat ion levels Elevat ed RBC’s
Treat m ent :
Surgery Em bolizat ion
Pulm onary aspergillom a: fungal infect ion of t he lung cavit ies causing abscesses.
Cause:
Fungus Aspergillus
Sym pt om s:
Wheezing
SOB
Chest pain Fever Cough
Test s:
CT scan
Sput um cult ure Serum precipit ans Chest X- ray
Bronchoscopy
Treat m ent :
Surgery
Ant ifungal m edicat ions
Pulm onary edem a: m ost com m only caused by Heart Failure, but m ay be due t o lung disorders.
Sym pt om s:
Rest less behavior Anxiet y
Wheezing Poor speech SOB
Sweat ing Pale skin
Drow ning sensat ion
Test s:
Murm urs m ay be present Echocardiogram
Presence of crackles Low O2 Sat urat ion levels
Treat m ent :
Diuret ics Oxygen
Treat t he underlying cause
Causes:
Response t o an inflam m at ory agent
Found in people ages 50- 70. Linked t o sm oking
Sym pt om s:
Cough SOB
Chest pain Cyanosis Clubbing Cyanosis
Test s:
Pulm onary funct ion t est s Lung biopsy
Rule out ot her connect ive t issue diseases
CT scan Chest X- ray
Treat m ent :
Lung t ransplant at ion Cort icost eroids
Ant i- inflam m at ory drugs
Monit or t he pat ient for:
Polycyt hem ia Pulm onary Ht n. Respirat ory failure Cor pulm onarle
Pulm onary em boli: Blood clot of t he pulm onary vessels or blockage due t o fat droplet s, t um ors or parasit es.
Causes:
DVT- m ost com m on
Sym pt om s:
SOB ( rapid onset )
Chest pain Decreased BP Skin color changes LE and pelvic pain Sweat ing
Dizziness Anxiet y Tachycardia
Labored breat hing Cough
Test s:
Doppler US Chest X- ray
Pulm onary angiogram
Pulm onary perfusion t est Plet hysm ography
ABG
Check O2 sat urat ion
Treat m ent :
Placem ent of an I VC filt er Adm inist er Oxygen
Surgery
Throm bolyt ic Therapy if clot det ect ed
Monit or t he pat ient for:
Shock
Pulm onary hypert ension Hem orrhage
Palpit at ions Heart failure
Tuberculosis- infect ion caused by Mycobat erium t uberculosis.
Causes:
Due t o airborne exposure
Sym pt om s:
Fever Chest pain SOB
Fat igue Wheezing
Phlegm product ion
Test s:
TB skin t est Chest X- ray Bronchoscopy
Treat m ent :
Generally about 6 m ont hs Rifam pin
Pyrazinam ide I soniazid
Cyt om egalovirus – can cause lung infect ions and is a herpes- t ype virus.
Causes:
More com m on in im m unocom prom ised pat ient s Oft en associat ed w it h organ t ransplant at ion
Sym pt om s:
Fever SOB Fat igue
Loss of appet it e Cough
Joint pain
Test s:
CMV serology t est s ABG
Blood cult ures
Bronchoscopy
Treat m ent :
Ant iviral m edicat ions Oxygen t herapy
Monit or t he pat ient for:
Kidney dysfunct ion I nfect ion
Decreased WBC levels Relapses
Viral pneum onia – inflam m at ion of t he lungs caused by viral infect ion.
Causes:
Rhinovirus
Herpes sim plex virus I nfluenza
Adenovirus Hant avirus CMV
RSV
Sym pt om s:
Fat igue Sore Throat s Nausea Joint pain Headaches Muscular pain Cough
SOB
Test s:
Bronchoscopy Open Lung biopsy Sput um cult ures Viral blood t est s
Treat m ent :
Ant iviral m edicat ions I V fluids
Monit or t he pat ient for:
Liver failure Heart failure Respirat ory failure
Pneum ot horax: a build- up of a gas in t he pleural cavit ies.
Types:
Traum at ic pneum ot horax Tension pneum ot horax Spont aneous pneum ot horax Secondary spont aneous
Sym pt om s:
SOB
Cyanosis
Chest pain- sharp Fat igue
Test s:
ABG
Chest X- ray
Poor breat h sounds
Treat m ent :
Chest t ube insert ion Adm inist rat ion of oxygen
Cir cu la t or y Syst e m
Fu n ct ion s
The circulat ory syst em serves:
( 1) t o conduct nut rient s and oxygen t o t he t issues; ( 2) t o rem ove w ast e m at erials by t ransport ing
nit rogenous com pounds t o t he kidneys and carbon dioxide t o t he lungs;
( 3) t o t ransport chem ical m essengers ( horm ones) t o t arget organs and m odulat e and int egrat e t he int ernal m ilieu of t he body;
( 4) t o t ransport agent s w hich serve t he body in allergic, im m une, and infect ious responses;
( 5) t o init iat e clot t ing and t hereby prevent blood loss; ( 6) t o m aint ain body t em perat ure;
( 7) t o produce, carry and cont ain blood;
( 8) t o t ransfer body reserves, specifically m ineral salt s, t o areas of need.
Ge n e r a l Com pon e n t s a n d St r u ct u r e
t o capillaries ( essent ially endot helial t ubes) , and venules, event ually becom ing veins, ret urn blood from t he capillary bed t o t he heart .
Cou r se of Cir cu la t ion
Syst e m ic Rou t e :
a. Art erial syst em. Blood is delivered by t he pulm onary veins ( t w o from each lung) t o t he left at rium , passes t hrough t he bicuspid ( m it ral) valve int o t he left vent ricle and t hen is pum ped int o t he ascending aort a; backflow here is prevent ed by t he aort ic sem ilunar valves. The aort ic arch t ow ard t he right side gives rise t o t he brachiocephalic ( innom inat e) art ery w hich divides int o t he right subclavian and right com m on carot id art eries. Next , arising from t he arch is t he com m on carot id art ery, t hen t he left subclavian art ery.
The subclavians supply t he upper lim bs. As t he subclavian art eries leave t he axilla ( arm pit ) and ent er t he arm ( brachium ) , t hey are called brachial art eries. Below t he elbow t hese m ain t runk lines divide int o ulnar and radial art eries, w hich supply t he forearm and event ually form a set of art erial arches in t he hand w hich give rise t o com m on and proper digit al art eries. The descending ( dorsal) aort a cont inues along t he post erior aspect of t he t horax giving rise t o t he segm ent al int ercost als art eries. Aft er passage “ t hrough” ( behind) t he diaphragm it is called t he abdom inal aort a.
At t he pelvic rim t he abdom inal aort a divides int o t he right and left com m on iliac art eries. These divide int o t he int ernal iliacs, w hich
supply t he pelvic organs, and t he ext ernal iliacs, w hich supply t he low er lim b.
b. Venous syst em. Veins are frequent ly m ult iple and variat ions are com m on. They ret urn blood originat ing in t he capillaries of peripheral and dist al body part s t o t he heart .
H e pa t ic Por t a l Sy st e m : Blood draining t he alim ent ary t ract
( int est ines) , pancreas, spleen and gall bladder does not ret urn direct ly t o t he syst em ic circulat ion, but is relayed by t he hepat ic port al syst em of veins t o and t hrough t he liver. I n t he liver, absorbed foodst uffs and wast es are processed. Aft er processing, t he liver ret urns t he blood via hepat ic veins t o t he inferior vena cava and from t here t o t he heart .
Pu lm on a r y Cir cu it : Blood is oxygenat ed and deplet ed of m et abolic product s such as carbon dioxide in t he lungs.
Lym ph a t ic D r a in a ge : A net w ork of lym phat ic capillaries perm eat es t he body t issues. Lym ph is a fluid sim ilar in com posit ion t o blood plasm a, and t issue fluids not reabsorbed int o blood capillaries are t ransport ed via t he lym phat ic syst em event ually t o j oin t he venous syst em at t he j unct ion of t he left int ernal j ugular and subclavian veins.
Th e H e a r t
Myocardium ( m iddle coat ; cardiac m uscle)
Epicardium ( ext ernal coat or visceral layer of pericardium ; epit helium and m ost ly connect ive t issue)
I m pulse conduct ing syst em
Ca r dia c N e r ve s: Modificat ion of t he int rinsic rhyt hm icit y of t he heart m uscle is produced by cardiac nerves of t he sym pat het ic and
parasym pat het ic nervous syst em . St im ulat ion of t he sym pat het ic syst em increases t he rat e and force of t he heart beat and dilat es t he coronary art eries. St im ulat ion of t he parasym pat het ic ( vagus nerve) reduces t he rat e and force of t he heart beat and const rict s t he coronary circulat ion. Visceral afferent ( sensory) fibers from t he heart end alm ost w holly in t he first four segm ent s of t he t horacic spinal cord.
Ca r dia c Cycle : Alt ernat ing cont ract ion and relaxat ion is repeat ed about 75 t im es per m inut e; t he durat ion of one cycle is about 0.8 second. Three phases succeed one anot her during t he cycle:
a) at rial syst ole: 0.1 second, b) vent ricular syst ole: 0.3 second, c) diast ole: 0.4 second
The act ual period of rest for each cham ber is 0.7 second for t he at ria and 0.5 second for t he vent ricles, so in spit e of it s act ivit y, t he heart is at rest longer t han at work.
Blood
Blood is com posed of cells ( corpuscles) and a liquid int ercellular ground subst ance called plasm a. The average blood volum e is 5 or 6
lit ers ( 7% of body w eight ) . Plasm a const it ut es about 55% of blood volum e, cellular elem ent s about 45% .
Pla sm a : Over 90% of plasm a is wat er; t he balance is m ade up of plasm a prot eins and dissolved elect rolyt es, horm ones, ant ibodies, nut rient s, and w ast e product s. Plasm a is isot onic ( 0.85% sodium chloride) . Plasm a plays a vit al role in respirat ion, circulat ion,
Ca r diova scu la r Con dit ion s
Cardiogenic Shock: heart is unable t o m eet t he dem ands of t he body. This can be caused by conduct ion syst em failure or heart m uscle
dysfunct ion.
Sym pt om s of Shock:
Rapid breat hing Rapid pulse Anxiet y Nervousness Thready pulse Mot t led skin color Profuse sw eat ing Poor capilary refill
Test s:
Nuclear Scans Elect rocar diogram Echocardiogram Elect rocar diogram
ABG Chem - 7 Chem - 20 Elect rolyt es Cardiac Enzym es
Treat m ent :
Am rinone
Norepinephrine Dobut am ine I V fluids PTCA
Ext rem e cases- pacem aker, I ABP
Aort ic insufficiency: Heart valve disease t hat prevent s t he aort ic valve from closing com plet ely. Backflow of blood int o t he left vent ricle.
Causes:
Rheum at ic fever
Congenit al abnorm alit ies
Endocardit is
Marfan’s syndrom e Ankylosing spondylit is
Reit er’s syndrom e
Sym pt om s:
Faint ing Weakness Bounding pulse
Chest pain on occasion SOB
Fat igue
Test s:
Palpat ion
I ncreased pulse pressure and diast olic pressure
Pulm onary edem a present
Auscult at ion
Left heart cat heret erizat ion Aort ica angiography
Dopper US Echocardiogram Treat m ent : Digoxin Dieuret ics
Surgical aort a valve repair
Monit or pat ient for:
PE
Left - sided heart failure Endocardit is
Aort ic aneurysm : Expansion of t he blood vessel w all oft en ident ified in t he t horacic region.
Causes:
Ht n
Marfan’s syndrom e Syphilis
At herosclerosis ( m ost com m on) Traum a
Possible back pain m ay be t he only indicat or
Test s:
Varies depending on locat ion St ent
Circulat ory arrest Surgery
Monit or pat ient for:
Bleeding St roke
Graft infect ion
I rregular Heart beat s Heart At t ack
Hypovolem ic shock: Poor blood volum e prevent s t he heart fr om pum ping enough blood t o t he body.
Causes:
Traum a Diarrhea Burns
GI Bleeding
Cardiogenic shock: Enough blood is available, however t he heart is unable t o m ove t he blood in an effect ive m anner.
Sym pt om s:
Anxiet y Weakness Sweat ing Rapid pulse Confusion Clam m y skin
Test s:
CBC
Echocardiogram CT scan
Endoscopy w it h GI bleeding Sw an- Ganz cat het erizat ion
Treat m ent :
I ncrease fluids via I V Avoid Hypot herm ia Epinephrine
Norepinephrine Dobut am ine
Myocardit is: inflam m at ion of t he heart m uscle.
Causes:
Bact erial or Viral I nfect ions Polio, adenovirus, coxsackie virus
Sym pt om s:
Leg edem a SOB
Viral sym pt om s Joint Pain
Syncope
Heart at t ack ( Pain) Fever
Unable t o lie flat I rregular heart beat s
Test s:
Chest X- ray Echocardiogram ECG
WBC and RBC count Blood cult ures
Treat m ent :
Diuret ics Pacem aker Ant ibiot ics St eroids
Monit or t he pat ient for:
Pericardit is Cardiom yopat hy
Heart valve infect ion: endocardit is ( inflam m at ion) , probable valvular heart disease. Can be caused by fungi or bact eria.
Sym pt om s:
Weakness Fever Murm ur SOB
Night sw eat s
Janeway lesions Joint pain
Test s:
CBC ESR
ECG
Blood cult ures Enlarged speen Presence of splint er hem orrhages
Treat m ent :
I V ant ibiot ics
Surgery m ay be indicat ed
Monit or t he pat ient for:
Jaundice Arrhyt hm ias CHF
Glom erulonephrit is Em boli
Pericardit is: I nflam m at ion of t he pericardium .
Causes:
Viral- coxsackie, adenovirus, influenza, rubella viruses Bact erial ( various m icroorganism s)
Fungi
Oft en associat ed w it h TB, Kidney failure, AI DS, and aut oim m une disorders.
Surgery
Sym pt om s:
Dry cough Pleurit is Fever Anxiet y Crackles
Pleural effusion LE sw elling
Unable t o lie dow n flat
Test s:
Auscult at ion MRI scan CT scan
Blood cult ures CBC
Treat m ent :
NSAI DS
Pericardiocent esis Analgesics
Pericardiect om y
Monit or t he pat ient for:
Const rict ive pericardit is A fib.
Supravent ricular t achycardia ( SVT)
Arrhyt hm ias: I rregular heart beat s and rhyt hm s disorder
Types:
Bradycardia Tachycardia
Vent ricular fibrillat ion Ect opic heart beat Vent ricular t achycardia
Wolff- Parkinson- w hit e syndrom e At rial fib.
Sick sinus syndrom e Sinus Tachycardia Sinus Bradycardia
Sym pt om s:
SOB Faint ing Palpit at ions Dizziness Chest pain
I rregular pulse
Test s:
Coronary angiography ECG
Echocardiogram Holt er m onit or
Treat m ent :
Defibrillat ion Pacem aker Medicat ions
Monit or t he pat ient for:
Heart failure St roke
Heart at t ack I schem ia
Art eriosclerosis: hardening of t he art eries. Causes: Sm oking Ht n Kidney disease CAD St roke
Sym pt om s:
Claudicat ion pain Cold feet
Muscle acheness and pain in t he legs
Hair loss on t he legs
Num bness in t he ext rem it ies Weak dist al pulse
Test s: Doppler US Angiography
I VSU MRI t est
Poor ABI ( Ankle brachial index) reading
Treat m ent :
Analgesics
Vasodilat ion m edicat ions Surgery if severe
Ballon surgery St ent placem ent
Monit or t he pat ient for:
Art erial em boli Ulcers
I m pot ence Gas gangreene
I nfect ion of t he low er ext rem it ies
Cardiom yopat hy- poor hear pum ping and w eakness of t he m yocardium .
Causes:
Ht n
Heart at t acks Viral infect ions
Types:
Alcoholic cardiom yopat hy- due t o alcohol consum pt ion Dilat ed cardiom yopat hy- left vent ricle enlargem ent
Hypert rophic cardiom yopat hy- abnorm al growt h left vent ricle
I schem ic cardiom yopat hy- w eakness of t he m yocardium due t o heart at t acks.
Peripart um cardiom yopat hy- found in lat e pregnancy
Rest rict ive cardiom yopat hy- lim it ed filling of t he heart due t o inabilit y t o relax heart t issue.
Sym pt om s:
Chest pain SOB
Fat igue Ascit es LE sw elling Faint ing Poor Appet it e Ht n
Palpit at ions
Test s:
ECG CBC
I soenzym e t est s Coronary Angigraphy Chest X- ray
MRI
Auscult at ion
Treat m ent :
Ace inhibit ors Dieuret ics Blood t hinners
LVAD – Left Vent ricular Assist Device
Digoxin Vasodilat ors
Class I describes a pat ient w ho is not lim it ed w it h norm al physical act ivit y by sym pt om s.
Class I I occurs w hen ordinary physical act ivit y result s in fat igue, dyspnea, or ot her sym pt om s.
Class I I I is charact erized by a m arked lim it at ion in norm al physical act ivit y.
Class I V is defined by sym pt om s at rest or w it h any physical act ivit y.
Causes:
CAD
Valvular heart disease Cardiom yopat hies Endocardit is
Ext racardiac infect ion Pulm onary em bolus
Sym pt om s:
Skin cold or cyanot ic Wheezing
Mit ral valvular deficit s Low er ext rem it y edem a Pulsus alt ernans
Hypert ension Tachypnea
Heart Sounds:
S1- t ricuspid and m it ral valve close S2- pulm onary and aort ic valve close S3- vent ricular filling com plet e
S4- elevat ed at rial pressure ( at rial kick)
Wave Review
ST segm ent : vent ricles depolarized P w ave: at rial depolarizat ion
PR segm ent : AV node conduct ion QRS com plex: vent ricular depolarizat ion U wave: hypokalem ia creat es a U wave T wave: vent ricular repolarizat ion
Wave Review I ndept h:
1. P WAVE - sm all upw ard w ave; indicat es at rial depolarizat ion 2. QRS COMPLEX - init ial dow nw ard deflect ion follow ed by large
upright wave followed by sm all downward wave; represent s vent ricular depolarizat ion; m asks at rial repolarizat ion; enlarged R port ion -
enlarged vent ricles; enlarged Q port ion - probable heart at t ack.
3. T WAVE - dom e shaped w ave; indicat es vent ricular repolarizat ion; flat w hen insufficient oxygen; elevat ed w it h increased K levels
5. S- T SEGMENT - t im e from end of S t o beginning t o T w ave;
represent s t im e bet ween end of spreading im pulse t hrough vent ricles and vent ricular repolarizat ion; elevat ed w it h heart at t ack; depressed w hen insufficient oxygen.
6. Q- T I NTERVAL - t im e for singular depolarizat ion and repolarizat ion of t he vent ricles. Conduct ion problem s, m yocardial dam age or
congenit al heart defect s can prolong t his.
Ar r h yt h m ia s Re vie w
Supravent ricular Tachyarrhyt hm ias
At rial fibrillat ion – Abnorm al QRS rhyt hm and poor P w ave appearance. ( > 300bpm .)
Sinus Tachycardia- Elevat ed vent ricular rhyt hum / rat e.
Paroxysm al at rial t achycardia- Abnorm al P w ave, Norm al QRS com plex
At rial flut t er- I rregular P Wave developm ent . ( 250- 350 bpm .)
Paroxysm al supravent ricular t achycardia- Elevat ed bpm ( 160- 250)
Mult ifocal at rial t achycardia- bpm ( > 105) . Various P w ave appearances.
Vent ricular Tachyarrhyt hm ias
Vent ricular Tachycardia- Presence of 3 or great er PVC’s (
150-200bpm ) , possible abrupt onset . Possibly due t o an ischem ic vent ricle. No P w aves present .
Vent ricular fibrillat ion- Com plet ely abnorm al vent ricular rat e and rhyt hum requiring em ergency innervent ion. No effect ive cardiac out put .
Bradyarrhyt hm ias
AV block ( prim ary, secondary ( I ,I I ) Tert iary Prim ary- > .02 PR int erval
Secondary ( Mobit z I ) – PR int erval I ncrease Secondary ( Mobit z I I ) – PR int erval ( no change)
Tert iary- m ost severe, No signal bet w een vent ricles and at ria not ed on ECG. Probable use of At rophine indicat ed. Pacem aker required.
Right Bundle Branch Block ( RBBB) / Left Bundle Branch Block ( LBBB)
Sinus Bradycardia- < 60 bpm , w it h presence of a st andard P w ave.
Ca r dia c Fa ilu r e Re vie w
Right Sided Heart Failure A. Right Upper Quadrant Pain B. Right Vent ricular heave C. Tricuspid Murm ur
D. Weight gain E. Nausea
F. Elevat ed Right At rial pressure
G. Elevat ed Cent ral Venous pressure
H. Peripheral edem a I . Ascit es
J. Anorexia
K. Hepat om egaly
Left Sided Heart Failure A. Left Vent ricular Heave B. Confusion
C. Paroxysm al not urnal dyspnea D. DOE
E. Fat igue F. S3 gallop
G. Crackles H. Tachycardia I . Cough
J. Mit ral Murm ur K. Diaphoresis L. Ort hopnea
ECG Changes w it h MI
T Wave inversion ST Segm ent Elevat ion Abnorm al Q waves
ECG Changes w it h Digit alis
Depresses ST segm ent
ECG Changes w it h Quinidine I nvert s T wave
QT segm ent longer QRS segm ent longer
ECG Changes w it h Pot assium
Hyperkalem ia- Low ers P w ave, I ncreases w idt h of QRS com plex Hypokalem ia- Low ers T w ave, causes a U w ave
ECG Changes w it h Calcium
Hypercalcem ia- Makes a longer QRS segm ent Hypocalcem ia- I ncreases t im e of QT int erval
En docr in e Re vie w
Hypot hyroidism : Poor product ion of t hyroid hor m one:
Prim ary- Thyroid cannot m eet t he dem ands of t he pit uit ary gland. Secondary- No st im ulat ion of t he t hyroid by t he pit uit ary gland.
Causes:
Surgical t hyroid rem oval I rradiat ion
Congenit al defect s
Hashim ot o’s t hyroidit is ( key)
Sym pt om s:
Const ipat ion Weight gain Weakness Fat igue Poor t ast e
Hoarse vocal sounds Joint pain
Muscle weakness Poor speech Color changes Depression
Test s:
Decreased BP and HR Chest X- ray
Elevat ed liver enzym es, prolact in, and cholest erol
Decreased T4 levels and serum sodium levels
Presence of anem ia Low t em perat ure Poor r eflexes
Treat m ent :
I ncrease t hyroid horm one levels Levot hyroxine
Monit or t he pat ient for:
Hypert hyroidism sym pt om s following t reat m ent
Heart disease Miscarriage
Hypert hyroidism : excessive product ion of t hyroid horm one.
Causes:
I odine overdose
Thyroid horm one overdose Graves’ disease ( key) Tum ors affect ing t he reproduct ive syst em
Sym pt om s:
Skin color changes Weight loss
Anxiet y
Possible goit er Nausea
Exopht halm os Diarrhea
Hair loss Elevat ed BP Fat igue Sweat ing
Test s:
Elevat ed Syst olic pressure not ed T3/ T4 ( free) levels increased TSH levels reduced
Treat m ent :
Radioact ive iodine Surgery
Bet a- blockers Ant it hyroid drugs
Congenit al adrenal hyperplasia: Excessive product ion of androgen and low levels of aldost erone and cort isol. ( Genet icially inherit ed disorder) . Different form s of t his disorder t hat affect m ales and fem ales
different ly.
Causes: Adrenal gland enzym e deficit causes cort isol and aldost erone t o not be produced. Causing m ale sex charact erist ics t o be expressed prem at urely in boys and found in girls.
Sym pt om s:
Boys:
Sm all t est es developm ent Enlarged penis developm ent St rong m usculat ure appearance
Girls:
Abnorm al hair grow t h Low t oned voice
Abnorm al genit alia Lack of m enst ruat ion
Test s:
Salt levels
Low levels of cot isol Low levels of aldost erone
I ncreased 17- OH progest erone I ncreased 17- ket ost eroids in urine
Treat m ent :
Reconst ruct ive surgery Hydrocorist one
Dexam et hasone
Prim ary/ Secondary Hyperaldost eronism
Prim ary Hyperaldost eronism : problem w it hin t he adrenal gland causing excessive product ion of aldost erone.
Secondary Hyperaldost eronism : problem found elsew here causing excessive product ion of aldost erone.
Causes:
Prim ary:
Tum or affect ing t he adrenal gland
Possibly due t o HBP Secondary:
Nephrot ic syndrom e Heart failure
Cirrhosis
Sym pt om s:
Paralysis Fat igue
Num bness sensat ions Ht n
Weakness
Abnorm al ECG readings Decreased pot assium levels Decreased renin levels
Treat m ent :
Prim ary: Surgery
Secondary: Diet / Drugs
Cushing’s syndrom e: Abnorm al product ion of ACTH w hich in t urn causes elevat ed cort isol levels.
Causes:
Cort icost eroids prolonged use Tum ors
Sym pt om s:
Muscle weakness
Cent ral obesit y dist ribut ion Back pain
Thirst
Skin color changes Bone and j oint pain Ht n
Headaches
Frequent urinat ion Moon face
Weight gain Acne
Test s:
Dexam et hasone suppression t est
Cort isol level check MRI - check for t um ors
Treat m ent :
Surgery t o rem ove t um or Monit or cort icost eroid levels
Monit or t he pat ient for:
Kidney st ones Ht n
Bone fract ures DM
I nfect ions
Diabet ic ket oacidosis: increased levels of ket ones due t o a lack of glucose.
Causes: I nsufficient insulin causing ket one product ion w hich end up in t he urine. More com m on in t ype I vs. t ype 2 DM.
Sym pt om s:
Low BP
Abdom inal pain Headaches Rapid breat hing Loss of appet it e Nausea
Fruit breat h sm ell Ment al deficit s
Test s:
Elevat ed glucose levels
I ncreased am ylase and pot assium levels
Ket ones in urine Check BP
Treat m ent :
I nsulin I V fluids
Monit or t he pat ient for:
Renal failure MI
Com a
T3/ T4 Review
Bot h are st im ulat ed by TSH release from t he Pit uit ary gland T4 cont rol basal m et abolic rat e
T4 becom es T3 wit hin cells. ( T3) Act ive form . T3 radioim m unoassay- Check T3 levels
Hypert hyroidism - T3 increased, T4 norm al- ( in m any cases)
Medicat ions t hat increase levels of T4:
Met hadone
Cloffibrat e
Medicat ions t hat decrease levels of T4:
Lit hium Propranolol I nt erferon alpha Anabolic st eroids Met hiam azole
Lym phocyt ic t hyroidit is: Hypert hyroidism leading t o hypot hyroidism and t hen norm al levels.
Causes: Lym phocyt es perm eat e t he t hyroid gland causing hypert hyroidism init ially.
Sym pt om s:
Fat igue
Menst rual changes Weight loss
Poor t em perat ure t olerance Muscle weakness
Hypert hyroidism sym pt om s
Test s:
T3/ T4 increased I ncreased HR
Lym phocyt e concent rat ion not ed w it h biopsy
Treat m ent :
Varies depending on sym pt om s. ( Bet a blockers m ay be used.)
Monit or t he pat ient for:
Aut oim m une t hyrodit is Hashim ot o’s t hyroidit is Goit er
St um a lym phom at osom a
Graves’ disease: m ost com m only linked t o hypert hyroidism , and is an aut oim m une disease. Exopht halm os m ay be not ed ( prot ruding
eyeballs) . Excessive product ion of t hyr oid horm ones.
Sym pt om s:
Elevat ed appet it e Anxiet y
Menst rual changes Fat igue
Poor t em perat ure t olerance Diplopia
Exopht halm os
Test s:
Elevat ed HR
I ncreased T3/ T4 levels
Serum TSH levels are decreased Goit er
Treat m ent :
Bet a- blockers Surgery
Prednisone
Radioact ive iodine
Monit or t he pat ient for:
Fat igue CHF
Depression
Hypot hyroidism ( over-correct ion)
Type I diabet es ( Juvenile onset diabet es)
Causes: Poor insulin product ion from t he bet a cells of t he pancreas. Excessive levels of glucose in t he blood st ream t hat cannot be used due t o t he lack of insulin. Moreover, t he pat ient cont inues t o
experience hunger, due t o t he cells not get t ing t he fuel t hat t hey need. Aft er 7- 10 years t he bet a cells are com plet ely dest royed in m any
Sym pt om s:
Weight loss Vom it ing Nausea
Abdom inal pain Frequent urinat ion Elevat ed t hirst
Test s:
Fast ing glucose t est I nsulin t est
Urine analysis
Treat m ent :
I nsulin
Relieve t he diabet ic ket oacidosis sym pt om s
Foot ulcer prevent ion
Monit or for infect ion:
Monit or for hypoglycem ia condit ions if t ype I is over-correct ed.
Glucagon m ay need t o be adm inist ered if hypoglycem ia condit ions are severe.
Monit or t he pat ient for ket one build- up if t ype I unt reat ed. Get t he eyes checked- once a year
Type I I diabet es
The body does not respond appropriat ely t o t he insulin t hat is present . I nsulin resist ance is present in Type I I diabet es. Result s in
hyperglycem ia.
Risk fact ors for Type I I
Diabet es:
Obesit y
Lim it ed exercise individuals Race- Minorit ies have a higher dist ribut ion
Elevat ed Cholest erol levels Ht n
Sym pt om s:
Blurred vision Fat igue
Elevat ed appet it e Frequent urinat ion Thirst
Not e: A person m ay have Type I I and be sym pt om free.
Test s:
Random blood glucose t est . Oral glucose t olerance t est
Fast ing glucose t est .
Treat m ent :
Tlazam ide Glim epiride Cont rol diet
I ncrease exercise levels Repaglidine/ Nat eglinide Glycosylat ed hem oglobin BUN/ ECG
Frequent blood sugar t est ing Acarbose
Diabet ic Ulcer prevent ion
Monit or t he pat ient for: Neuropat hy
CAD
I ncreased cholest erol Ret inopat hy
Diabet es Risk Fact ors:
Bad diet Ht n
Weight dist ribut ion around t he w aist / overw eight . Cert ain m inorit y groups
Hist ory of diabet es in your fam ily Poor exer cise progr am
M icr obiology Re vie w
Ch a r a ct e r ist ics of Ba ct e r ia Type s
Ricket t sias- gram - negat ive bact eria, sm all
Ricket t sia ricket t sii
Spirochet es- spiral shape, no flagella, slender
Lym e disease, Treponem a pallidum - syphilis
Gram posit ive cocci- Hold color w it h Gram st ain, ovoid or spherical shape
St aphlyococcus aureus, St rept ococcus pneum oniae
Gram negat ive cocci- Loose color w it h Gram st ain, spherical or oval shape
Neisseria m eningidis ( m eningococcus) , Neisseria gonorrhoeae ( gonococcus)
Mycoplasm as- Mycoplasm a pneum oniae
Acid- fast bacilli- Hold color w it h st aining even w hen st ained w it h acid in m ost
cases. Mycobact erium leprae, Mycobact erium t uberculosis
Acit inom ycet es- St ained posit ive w it h a gram st ain, narrow filam ent s Nocardia, Act inom yces israelii
Gram posit ive- Rod shaped, hold color w it h gram st ain
Clost ridium t et ani, Bacillus ant hracis
Gram negat ive- Do not hold color w it h gram st ain, also rod shaped. Pseudom onas aeruginosa, Escherichia coli, Klebsiella pneum oniae
D ise a se s a n d Acid Fa st Ba cilli Re v ie w
Disease Bact eria Prim ary Medicat ion
Tuberculosis, renal and m eningeal infect ions
Mycobact erium
t uberculosis
I soniazid + rifam pin + pyrazinam ide
Leprosy Mycobact erium leprae Dapsone + rifam pin
D ise a se s a n d Spir och e t e s Re vie w
Disease Bact eria Prim ary Medicat ion
Lym e Disease Borrelia burgdorferi Tet racycline
Meningit is Lept ospira Penicillin G
Syphilis Treponem a pallidum Penicillin G
D ise a se s a n d Act in om yce t e s Re vie w
Disease Bact eria Prim ary Medicat ion
Cervicofacial, and ot her lesions
D ise a se s a n d Gr a m - N e ga t ive Ba cilli Re vie w
Disease Bact eria Prim ary Medicat ion
Meningit is Flavobact erium m eningosept icum
Vancom ycin
UTI ’s Bact erem ia Escherichia coli Am picillin+ / -am inoglycoside Gingivit is, Genit al
infect ions, ulcerat ive pharyngit is
Fusobact erium
nucleat um
Penicillin G
Abscesses Bact eroides species Clindam ycin/ Penicillin G
Hospit al acquired infect ions
Acinet obact er Am inoglycoside
Abscesses, Endocardit is
Bact eroides fragilis Clindam ycin, m et ronidazole Legionnaires’ Disease Legionella
pneum onphila
Eryt hrom ycin
UTI ’s Prot eus m irabilis Am picillin/ Am oxicillin Pneum onia, UTI ’s,
Bact erem ia
Pseudom onas
aeruginosa
Penicillin- Broad
Bact erem ia, Endocardit is
St rept obacillus
m oniliform is
Penicillin G
Pneum onia, UTI Klebsiella pneum oniae Cephalosporin Bact erem ia, Wound
infect ions
Past eurella m ult ocida Penicillin G
D ise a se s a n d Gr a m - Posit ive Ba cilli Re vie w
Disease Bact eria Prim ary Medicat ion
Gas Gangrene Clost ridium Penicillin G
Tet anus Clost ridium t et ani Penicillin G Pharyngit is Corynebact erium
dipht heriae
Penicillin G
Meningit is, Bact erem ia
List eria
m onocyt ogenes
Am picillin
Ant hrax / pneum onia Bacillus ant hracis Penicillin G Endocardit is Corynebact erium
species
Penicillin
G/ Vancom ycin
D ise a se s a n d Cocci Re vie w
Disease Bact eria Prim ary Medicat ion
Genit al infect ions, art hrit is- derm at it is syndrom e
Neisseria gonorrhoeae Am picillin, Am oxicillin
Meningit is, Bact erem ia
Neisseria m eningit idis Penicillin G
Endocardit is, Bact erem ia
St rept ococcus
( viridans group)
Gent am icin
Bact erem ia, brain and ot her absesses
St rept ococcus
( anaerobic species)
Penicillin G
Endocardit is, Bact erem ia
St rept ococcus
agalact iae
Am picillin
abscesses
UTI ’s, Endocardit is St rept ococcus faecalis Am picillin, Penicillin G Pneum onia, sinusit is,
ot it is, Art hrit is
St rept ococcus
pneum oniae
Penicillin G or V
Cellulit is, Scarlet fever, bact erem ia
St rept ococcus
pyogenes
Penicillin G or V
Bact erem ia, endocardit is
St rept ococcus bovis Penicillin G
D N A V ir u s Re vie w
DNA Virus I nfect ion
Adenovirus Eye and Respirat ory infect ions Hepat it is B Hepat it is B
Cyt om egalovirus Cyt om egalic inclusion disease Epst ein- Barr I nfect ious m ononucleosis
Herpes Types 1 and 2 Local infect ions oral and genit al Varicella- zost er Chickenpox, herpes zost er Sm allpox Sm allpox
RN A V ir u s Re vie w
RNA Virus I nfect ion
Hum an respirat ory virus Respirat ory t ract infect ion Hepat it is A virus Hepat it is A
I nfluenza virus A- C I nfluenza
Measles virus Measles
Mum ps virus Mum ps
Respirat ory syncyt ial virus Respirat ory t ract infect ion in children
Poliovirus Poliom yelit is Rhinovirus t ypes 1- 89 Cold
Hum an im m unodeficiency virus
AI DS
Rabies virus Rabies
Alphavirus Encephalit is
I m m u n oglobu lin isot ype s
I gA– can be locat ed in secret ions and prevent s viral and bact erial at t achm ent t o m em branes.
I gD- can be locat ed on B cells
I gE- m ain m ediat or of m ast cells w it h allergen exposure.
I gG- prim arily found in secondary responses. Does cross placent a and dest roys viruses/ bact eria.
I gM- prim arily found in first response. Locat ed on B cells
Cyt ok in e s Re vie w
I L- 1 Prim arily st im ulat e of fever response. Helps act ivat e B and T cells. Produced by m acrophages.
I L- 2 Aids in t he developm ent of Cyt ot oxic T cells and helper cells. Produced by helper T cells.
I L- 3 Aids in t he developm ent of bone m arrow st em cells. Produced by T- cells.
I L- 4 Aids in t he growt h of B cells. Produced by helper T- cells. Aids in t he product ion of I gG and I gE
I L- 5 Prom ot es t he grow t h of eosinophils. Produced by helper T- cells. Also prom ot es I gA product ion.
I L- 8 Neut rophil fact or
TNF-α Prom ot es t he act ivat ion of neut rophils and is produced by m acrophages.
TNF-β Produced by T lym phocyt es and encourages t he act ivat ion of neut rophils
γ- int erferon ( Act ivat es m acrophages and is produced by helper T cells.)
Con t r olle d Su bst a n ce Ca t e gor ie s
Schedule I Highest pot ent ial abuse, used
m ost ly for research. ( heroin, peyot e, m arij uana)
Schedule I I High pot ent ial abuse, but used for t herapeut ic purposes ( opioids, am phet am ines and barbit urat es) Schedule I I I Mild t o m oderat e physical
dependence or st rong
psychological dependence on bot h. ( opioids such as codeine, hydrocodone t hat are com bined w it h ot her non- opoid drugs) Schedule I V Lim it ed pot ent ial for abuse and
physical and/ or psychological dependence ( benzodiazepines, and som e low pot ency opioids)
Schedule V Low est abuse pot ent ial of
cont rolled subst ances. Used in cough m edicat ions and ant i-diarrheal preps.
Dose Response- t he relat ionship bet ween dose and t he body’s response is called a dose- response curve ( DRC) .
Pot ency- relat es t o t he dosage required t o produce a cert ain response. A m ore pot ent drug requires a low er dosage t han does a less pot ent drug t o produce a given effect .
Efficacy- usually refers t o m axim um efficacy. Maxim um efficacy is plat eau ( or m axim um response) , but m ay not be achievable clinically due t o undesirable side effect s. I n general, t he st eepness of t he curve dict at es t he range of doses t hat are useful t herapeut ically.
LD50/ ED50 - - Quant al dose response curve is t he relat ionship bet w een
t he dose of t he drug and t he occurrence of a cert ain response.
Therapeut ic index ( TI ) - t he rat io of t he m edian effect ive dose ( ED50)
and t he t oxic dose ( TD50) is a predict or of t he safet y of a drug. This
Ph a r m a cology
Drug Suffix Exam ple Act ion
- azepam Diazepam Benzodiazepine
- azine Chlorprom azine Phenot hiazine
- azole Ket oconazole Ant i- fungal
- barbit al Secobarbit al Barbit urat e
- cillin Met hicillin Penicillin
- cycline Tet racycline Ant ibiot ic
- ipram ine Am it ript yline Tricyclic Ant
i-depressant
- navir Saquinavir Prot ease I nhibit or
- olol Tim olol Bet a Ant agonist
- oxin Digoxin Cardiac glycoside
- phylline Theophylline Met hylxant hine
- pril Enalapril ACE I nhibit or
- t erol Albut erol Bet a 2 Agonist
- t idine Ranit idine H2 Ant agonist
- t rophin Som at ot rophin Pit uit ary Horm one
- zosin Doxazosin Alpha 1 Ant agonist
Ca r diova scu la r Ph a r m a cology
Ant iarrhyt hm ics- Na+ channel blockers ( Class I )
Class I A Procainam ide Disopyram ide Am iodarone Quinidine
Class I B Mexilet ine Lidocaine Tocainide
Class I C Flecainide Encainide Propafenone
Ant iarrhyt hm ics ( Bet a blockers) ( Class I I ) Met roprolol
At enolol Propranolol Tim olol Esm olol
Ant iarrhyt hm ics ( K+ Channel blockers) ( ClassI I I ) Sot aolol
Am iodarone Bret ylium I but ilide
Ant iarrhyt hm ics ( Ca2+ channel blockers) ( Class I V) Dilt iazem
Minoxidil Hydralazine
Calcium Channel Blockers: Verapam il
Dilt iazem Nifedipine
Sym pat hoplegics: Bet a blockers Clonidine Reserpine Guanet hidine Prazosin
ACE I nhibit ors: Lisinopril
Enalapril Capt opril
Cardiac glycosides: Digoxin
Dieuret ics: Loop Dieuret ics
Hydrocholorot hiazide
K+ Sparing Dieuret ics Spironolact one
Triam t erene Am iloride
CN S Ph a r m a cology
Sym pat hom im et ics: Dopam ine
Dobut am ine Epinephrine Norephinephrine I soprot erenol
Cholinom im et ics: Carbachol
Neost igm ine Pyridost igm ine Echot hiophat e Bet hanechol
Cholinorecept or blockers: Hexam et honium - Nicot inic blocker
At ropine- Muscarinic blocker
Bet a blockers: At enolol Nadolol Propranolol Met oprolol Pindolol Labet alol
Tricyclic Ant idepressant s: Doxepine
I m ipram ine Am it ript yline Nort ript yline Am it ript yline
Parkinson’s Treat m ent : L- dopa
Am ant adine Brom ocript ine
Benzodiazepindes: I orazepam Triazolam Oxazepam Diazepam Opiod Analgesics: Heroin Met hadone Morphine Codeine
Tranylcyprom ine Phenelzine
Serot on specific Re- upt ake inhibit ors:
Paroxet ine Sert raline Fluoxet ine Cit alopram
Epilepsy Tre
