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comp exam > cardiopulm > Flashcards

cardiopulm Flashcards

1
Q

which intercostal muscles elevate the ribs?

A

external intercostals

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2
Q

which accessory muscles help with exhalation?

A

TA and rectus abdominis

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3
Q

how many lobes does each lung have?

A

3 on R, 2 on L

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4
Q

layers of the heart from inside to out

A

endocardium (lining), myocardium (muscle), epicardium

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5
Q

what are the two structural categories of myocardial cells? and function

A

mechanical: for pumping
conductive: self-excitation and transmission of AP

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6
Q

RA receives blood from the

A

body, through inferior and superior vena cava, and coronary sinus

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7
Q

which valve separates the RA and RV?

A

tricuspid valve

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8
Q

LA receives blood from the

A

lungs

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9
Q

which valve separates the LA and LV?

A

mitral valve

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10
Q

normal pressure in the heart by location

A

RA: 0-8
RV: 15-20/0-8
LA: 4-12
LV: 90-140/4-12

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11
Q

left ventricle is about ___ times thicker than the RV

A

left ventricle 7x thicker

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12
Q

conduction system of the heart

A 
SA node
AV node
bundle of his
R and L bundle branches
purkinje fibers
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13
Q

two main branches of the left coronary artery and what they supply

A

Left anterior descending: anterior wall of LV

left circumflex: LA and lateral/post wall of the LV

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14
Q

what does the Right coronary Artery supply?

A

RA, RV, and inferior wall of LV

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15
Q

each molecule of hemoglobin can bind ___ molecules of oxygen

A

4

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16
Q

increased PaO2 leads to _____ hemoglobin binding of oxygen

A

increased (like in the lungs)

about 100 mmHg –> 80-100% binding

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17
Q

what is albumin (plasma protein) important for?

A

fluid movement, keeping fluid inside the vessels

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18
Q

the ____ is the pacemaker of the heart

A

the SA node

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19
Q

what happens if the LAD artery is blocked?

A

no blood pumped out of the heart to the body

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20
Q

if a valve of the heart is stiff, what does it do to CO?

A

it decreases it

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21
Q

what does systole mean?

A

contraction

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22
Q

EF=

A

SV/EDV

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23
Q

what is the norm for EF?

A

55-70%

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24
Q

what is the best predictor of cardiac function?

A

ejection fraction

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25
Q

normal CO

A

4-6 L/min

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26
Q

cardiac index use and norm

A

clinical indicator of pump performance, accounts for body size
norm: 3L/min/m^2

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27
Q

what intrinsic factor affects stroke volume?

A

myocardial cell length

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28
Q

what does the frank-starling mechanism tell us?

A

if the heart muscle can stretch a lot –> the force will be higher

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29
Q

preload

A

clinical concept, effect of myocardial stretch prior to contraction (EDV)

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30
Q

afterload

A

resistance the heart has to overcome to eject the blood

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31
Q

if afterload is too high, what happens?

A

you get hypertrophy of the ventricle

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32
Q

three main cerebral arteries

A

anterior, middle, and posterior cerebral arteries

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33
Q

VO2 is a measure of…

A

the amount of oxygen actually utilized by tissues

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34
Q

how many METs is walking?

A

2

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35
Q

how many METs should a patient be able to tolerate before going home?

A

3-4

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36
Q

abnormal HR responses to exercise

A

rapid increase
decrease in HR
no change in HR
development of arrhythmias

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37
Q

abnormal response of systolic BP during exercise

A

above 200

falls more than 20 most alarming

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38
Q

abnormal diastolic BP response to exercise

A

decrease more then 10

increase more than 10

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39
Q

exertion hypotension

A

decrease in SBP below baseline towards end of exercise test or increase and then falls 20
need to change intensity or duration
requires medical follow-up

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40
Q

rate-pressure product definition and use

A

HR x SBP
good for its with heart disease as indicator of cardiac function
want it to go down

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41
Q

normal SpO2

A

95-100%

stop exercise if below 90% in acutely ill and 85% in chronic lung disease

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42
Q

hypoxemia levels

A

mild: 90-95%
mod: 80-90
severe: 70-80

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43
Q

atherosclerosis

A

low-grade inflammatory state of the inner layer of medium sized arteries, accelerated by high BP, high cholesterol, smoking, diabetes, genetics

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44
Q

angina

A

pain in chest, dyspnea, tightness, pressure in L arm, jaw, back

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45
Q

silent ischemia

A

ischemia without angina

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46
Q

___% occlusion provokes symptoms for myocardial ischemia

A

70

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47
Q

stable angina

A

more than 50% occlusion
exertion
resolves with rest or nitrates
less than 10 minutes

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48
Q

unstable angina

A

more than 7-% occlusion
rest/meds do not resolve, more than 10 min
acute coronary syndrome: may lead to MI

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49
Q

prinzmental/variant angina

A

vasospastic disorder, spontaneous, common at night, more common in females, small increase in troponins

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50
Q

clinical signs of myocardial ischemia for women

A

fatigue, back pain, SOB

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51
Q

myocardial infarction

A

from prolonged myocardial ischemia, sudden onset of chest pain can radiate to arms, neck, throat, back

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52
Q

zones for MI

A

infarction: dead
hypoxic injury: less seriously damaged
ischemia: reversible zone

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53
Q

gold standard for finding coronary blockage

A

coronary angiography

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54
Q

uncomplicated MI is a small infarction with an EF of ____% or better

A

40%

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55
Q

complicated MI has an EF of ____ % or lower for moderate risk

A

30%

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56
Q

acute coronary syndrome defines

A

unstable angina or acute MI (NSTEMI or STEMI)

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57
Q

ACS, when do you see increased enzymes?

A

NSTEMI and STEMI (way more)

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58
Q

difference between STEMI and NSTEMI, which is worse

A

STEMI you see ST elevation, in NSTEMI it actually goes down

STEMI is worse complete occlusion for 2-4 hours

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59
Q

sudden cardiac death

A

death within 1 hour of symptoms for pts. w/ coronary heart disease
Vtach or Vfib

60
Q

abdominal aorta aneurisms are more likely to be ____ the renal arteries

A

BELOW

61
Q

AAA can cause numbness in the LE T/F

A

true,

can also cause decreased distal pulses

62
Q

systolic heart failure

A

less blood pumped out of ventricles, can’t squeeze well

63
Q

diastolic heart failure

A

less blood fills the ventricles, stiff heart can’t relax normally

64
Q

Left sided backward failure

A

pulmonary edema, hypoxemia, dry cough, orthopnea, SOB at night, crackles

65
Q

Right sided backward failure

A

jugular venous distension, ascites, nausea, vomiting, LE edema

66
Q

forward failure

A

cold extremities, pale, clammy

67
Q

NYHA heart failure classification

A

1: normal
2: comfy at rest, slight limitation of PA, ordinary activity causes symptoms
3: comfy at rest, marked limitation of PA, less than ordinary cause symptoms
4: severe limitation, symptoms present at rest

68
Q

compensated HF

A

HF, but controlled on meds, not symptomatic at resst

69
Q

decompensated HF

A

may be on meds, but not controlled, symptomatic at rest

70
Q

classifications of cardiomyopathies

A

dilated
hypertrophic
restrictive (restricts filling)

71
Q

valvular heart disease types

A

stenosis –> doesn’t open

insuffiiciency –> leakage back into heart

72
Q

acute myocarditis

A

inflammation of myocardial walls from infection

73
Q

pericardial effusion –>

A

cardiac tamponade: elevated intracardiac pressure, decreased filling, decreased SV
EMERGENCY

74
Q

Which type of HF leads to HFpEF (preserved ejection fraction)

A

diastolic because less filling and less pumping

75
Q

hypertension

A

elevated: 120-29/less than 80

stage 1: 130-39/80-89
stage 2: 140+/90+
hypertensive crisis: 180+/120+

76
Q

obstructive diseases cause

A

difficulty exhaling

77
Q

restrictive diseases cause

A

difficulty inhaling

78
Q

conditions that make up COPD

A

emphysema, chronic bronchitis, asthma

79
Q

what causes COPD

A

long-term exposure to particles and gasses

genetics

80
Q

emphysema

A

destruction of terminal bronchioles, alveolar ducts, and walls resulting in enlarged air spaces

81
Q

chronic bronchitis

A

productive cough for 3 months 2 years in a row

82
Q

bronchiectasis

A

dilation of 1 or more bronchi w/ chronic inflammation and infection (cough w/ sputum or blood, chronic lung infection, dyspnea and tiredness)

83
Q

cor pulmonale

A

right sided HF

response to alveolar hypoxia is vasoconstriction (pulmonary HTN)

84
Q

cystic fibrosis

A

mucus stasis affecting epithelial cells

85
Q

asthma

A

chronic inflammatory disorder –> hypertrophy of bronchial wall

86
Q

symptoms of asthma

A

wheezing, SOB, chest tightness

87
Q

signs of restrictive lung disease

A 
increased RR
hypoxemia
decreased lung volume
cyanosis
clubbing
decreased chest wall expansion
wasting
88
Q

idiopathic pulmonary fibrosis

A

scarring and destruction of lung architecture, unknown cause, older adults, lethal

89
Q

sarcoidosis

A

alveoli’s, round or oval granulomas, pulmonary fibrosis
young adults
can affect many organ systems

90
Q

infectious causes of restrictive lung disease

A

pneumonia (inflammation of parenchyma)

empyema (pus in pleural space)

91
Q

pneumothorax

A

presence of air in the pleural cavity

92
Q

atelectasis

A

incomplete expansion results in lung parenchyma collapse

93
Q

acute respiratory distress syndrome (ARDS)

A

inflammatory disease leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated tissue

94
Q

what does increased BUN mean

A

heart or renal failure

95
Q

what does decreased BUN mean

A

dehydration, liver

96
Q

blood sugar norms

A

70-100

97
Q

normal blood pH

A

7.35-7.45

98
Q

normal PaCO2

A

35-45

99
Q

normal HCO3

A

22-26

100
Q

5 lead EKG neumonic

A

snow over grass
smoke over fire
chocolate on the stomach

101
Q

what is gold standard measurement of HR?

A

EKG

needs to be regular heart rhythm

102
Q

normal size of QRS waves?

A

less than 3 small squares

103
Q

normal size of P-R interval

A

3-5 small squares, 0.2 seconds

104
Q

SA node spontaneously depolarizes at ____-____ bpm

A

60-100 bpm

105
Q

ectopic focus

A

an area within the myocardium that can spontaneously depolarize

106
Q

PAC

A

premature atrial contractions

can be isolated, bigeminal, trigeminal, paired

107
Q

causes and treatment for PAC

A

causes: emotional stress, nicotine, caffeine, alcohol, hypoxemia, benign arrhythmias
traeatment: none needed if frequency is low

108
Q

atrial flutter

A

one ectopic focus firing repeatedly and rapidly, AV node can’t keep up
on EKG: multiple P waves to every QRS complex

109
Q

difference of atrial flutter vs. fibrillation on EKG

A

flutter the P waves look consistent

fibrillation you see “chaos” because of multiple ectopic foci

110
Q

atrial fibrillation

A

multiple ectopic foci, all firing at random

no real P waves, weird T waves

111
Q

how should new a-fib be treated immediately?

A

anticoagulation because there is an increased risk for embolism

112
Q

junctional rhythms

A

SA node is silent, so AV takes over, no P wave
AV node rate is 40-60 bpm
only concerned for PT if HR is too low

113
Q

premature ventricular contraction

A

ectopic focus in ventricle

most commonly due to MI (more worried), more likely to cause decreased SV

114
Q

ventricular tachycardia

A

more than three PVCs in a row faster than 100 bpm
NO EXERCISE, CALL FOR HELP
defibrillation

115
Q

ventricular fibrillation

A

Vtach can become Vfib
no organization of EKG waveform
CALL CODE AND START CPR

116
Q

heart blocks

A

problem with initiation or flow of depolarization through the conduction system

117
Q

which type of heart block requires a pacemaker?

A

3rd degree because the AV and SA are acting separately

118
Q

which surgical approach is used for bilateral lung transplant?

A

anterolateral thoracotomy

119
Q

atelectasis:

A

collapsed lung, can be from anesthesia

120
Q

what is likely to happen if there is afib?

A

embolism, happens in a lot of bypass patients

121
Q

how soon after acute coronary syndrome should treatment be performed?

A

90 minutes

122
Q

Three types of percutaneous coronary interventions

A

angioplasty: balloon
atherectomy: removing the clot
stenting

123
Q

why bypass graft instead of PCI?

A

more than 3 vessels are obstructed

124
Q

pacemaker placement precautions

A

no lifting of 10 lbs, no raising UE on side above shoulder

125
Q

leading causes of death for heart transplant

A
  1. infection

2. rejection

126
Q

what does an A line do and what is an important clinical note

A

it monitors BP, the monitor needs to be at heart level to be accurate

127
Q

normal RR in adults

A

12-20 bpm

128
Q

normal breath sounds

A

vesicular: periphery, low pitch
bronchial: sternum, high pitched
bronchovesicular: between scapulae, blowing sound

129
Q

cardiac auscultation

A 
All PTs Move
A: aortic
P: pulmonic
T: tricuspid
M: mitral
130
Q

normal heart sounds

A

S1 and S2

131
Q

S3 heart sound

A

kentucky

normal in kids, athletes, and pregnant women

132
Q

S4 heart sound

A 
Tennessee
late diastole (right before S1)
133
Q

precautions for postural drainage

A 
pulmonary edema
hemoptysis
massive obesity
large pleural effusion
massive ascites
134
Q

relative contraindications for postural drainage

A 
increased intracranial pressure
hemodynamically unstable
recent esophageal anastomosis
recent spinal fusion or injury
recent head trauma
diaphragmatic hernia
recent eye surgery
135
Q

how do drugs reduce BP

A

diuretics: decrease blood volume
beta blockers: decrease cardiac stimulation
alpha blockers: decrease vasoconstriction
ACE inhibitors: decrease angiotensin 1 –> 2
angiotensin 2 receptor blockers: dont let it bind
ca channel blockers: weakened smooth muscle contraction
vasodilators: act directly on smooth muscle or vascular endothelium

136
Q

which drugs help with hyperlipidemia

A

statins

137
Q

what are nitrates used for?

A

to help vasodilation in the coronary arteries, to improve O2 delivery

138
Q

what does digitalis do?

A

increases strength of heart contraction, used for HF, causes slow HR

139
Q

normal INR

A

0.8-1.2 (bleeding risk: 3.6+)

140
Q

normal prothrombin time

A

11-13 seconds

141
Q

normal partial thromboplastin time (PTT)

A

21-34 seconds, spontaneous bleeding is 70+

142
Q

expectorants

A

increase secretion of thin, watery sputum in the upper respiratory tract, so you can cough it up

143
Q

methylxanthines

A

found in coffee, causes bronchodilator and increased force of diaphragm

144
Q

why does pregnancy cause decreased BP

A

elevated NO production –> vasodilation

relaxin –> reduced peripheral resistance

145
Q

preeclampsia

A

increased Bp 140+/90+

comp exam (18 decks)

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