Cardiopulm - Medical Tests Flashcards
1
Q
What 2 processes maintain homeostasis in the body?
A
- Movement of water
- Exchange of solutes
2
Q
What is regulated by the processes of homeostasis?
A
- Electrolyte concentration
- pH
3
Q
What 2 functions can be interrupted by an imbalance in homeostasis?
A
- Cellular functioning
- Impaired organ function
4
Q
How much of the body is water, and how is this distributed throughout the body?
A
60 % water
- 40 % intracellular
- 20 % extra cellular
- 5 % intravascular
- 15 % interstitial
5
Q
What are 5 sources of our body’s water?
A
- Drink
- Food
- Digestion
- Metabolism
- IV
6
Q
What effect can an imbalance of sodium have on the body?
A
Too much: moves fluid from cell to interstitium
Too little: From interstitium to cells (damages brain)
7
Q
What are 3 methods of passive transport within the body?
A
- Osmosis: solute concentration gradients (water moves to higher)
- Filtration: Hydrostatic concentration
- Diffusion: Solutes move from higher to lower concentration
8
Q
What is active transport, and where does this occur?
A
- Requires energy
- occurs in the heart
9
Q
What are the most typical causes of hypervolemia (fluid overload)?
A
- CHF
- Kidney problems
10
Q
In whome is hypovolemia common?
A
The elderly
11
Q
What are the effects of hypovolemia?
A
- Decreased blood volume
- Decreased preload
- Low blood volume
- High heart rate
12
Q
What are electrolytes? What are 2 types?
A
- Solutes that generate a charge when dissolved in water
- Anions (negative)
- Cations (positive)
13
Q
What are 6 vital functions of electrolytes within the body?
A
- Nerve conduction
- Muscular contraction & relaxation
- Cardiac rhythm & conductin
- Bone health
- Blood coagulation
- Fluid balance
14
Q
What system manages electrolytes and fluid levels during fluid/ solute volume changes?
A
The renal system.
15
Q
What solutes do not have a charge?
A
- O2
- Glucose
- CO2
- Proteins
- Lipids
16
Q
What electrolyte can have a huge effect on heart rhythm?
A
Potassium.
17
Q
What is the major cation in ECF, and what is the major cation in the ICF?
A
ECF: Sodium
ICF: Potassium
18
Q
** See screening profiles slide **
A
** See screening profiles slide **
19
Q
What electrolyte is related to mental status changes?
A
Sodium.
20
Q
What electrolyte is related to heart arrhythmia?
A
Potassium.
21
Q
What electrolyte is related to hydration, and acid/base balance?
A
Chloride.
22
Q
What electrolyte is related to the function of the liver/ kidneys?
A
BUN (blood urea nitrogen)
23
Q
What electrolyte is related to kidney function?
A
Creatinine.
24
Q
What electrolyte is related to blood glucose?
A
Glucose.
25
What electrolyte is related to the level of CO2 in the body, which is regulated by the kidneys?
HCO3
26
What drug increases unrinary Na+ excretion?
Diuretics.
27
What is the most abundant cation in the intracellular compartment?
Potassium.
28
What organ controls long term regulation of potassium?
- The kidneys.
29
How symptoms of potassium deficiency and excess different?
They are very similar.
30
Which electrolyte is the major anion of ECF?
Chloride.
31
What electrolyte's movement is linked to that of chloride?
Sodium.
32
What homeostatic functions does chloride play a role in?
- Fluid balance
| - pH
33
What conditions can lead to a deficiency of chloride?
- Vomiting
- Diarrhea
- Burns
- Acidosis
34
What conditions lead to an excess of chloride?
- Dehydration
- Hyperventilation
- Anemia
35
What 4 processes does calcium play a role in?
- Bone formation
- Cell division/ growth
- Blood coagulation
- Cardiac and smooth muscle contraction
36
What are the 2 roles of phosphate?
- 85 % deposited within skeletal system
| - 15 % used in acid base balance
37
What is an excess of phosphate associated with?
- Renal failure
| - Chemo
38
What is a deficiency of phophate associated with?
- Too much calcium
| - Diabetes
39
What is the 4th most abundant cation in the body?
Magnesium.
40
Where is magnesium mostly found?
In bone and muscle.
41
What processes does magnesium play a role in?
- Carbohydrate metabolism
- Protein synthesis
- Muscular contraction
42
How is magnesium obtained?
Through diet.
43
What are the effects of a deficiency in magnesium?
- Hyperactive tendon reflexes
| - Cardiac irritability
44
In whom is an excess of magnesium found?
- Elderly
| - Critically ill
45
What specific form of tachycardia is related to low magnesium?
Torsades.
46
What is BMP?
Basal metabolic panel.
47
What are 3 kidney BMP tests?
- Blood Urea Nitrogen
- HCO3
- Creatinine
48
What are 2 blood glucose BMP measures?
- Fasting blood glucose
| - HbA1C or A1C
49
What does HbA1C or A1C measure?
Amount of hemoglobin carrying glucose.
An average of the last few months.
50
If an individual has elevated levels of BUN, what may be their symptoms?
- Low level of endurance
51
Why are typical causes of dehydration in the elderly?
- Not enough preload, or cardiac output.
52
What are 5 symptoms of dehydration?
- Brain uptakes water, making an individual thirsty
- Kidneys are overloaded
- Digestive problems (constipation, acid reflux, etc.)
- Heat shock, fainting, and other body temperature related symptoms
- Heart works harder (increased BP, viscocity, clotting)
53
What is measured in a CBC?
- RBCs
- WBCs
- Hematocrit
- Hemoglobin
54
What is the main function of RBCs?
- Carry O2
55
What is the main function of WBCs?
- Protect against infection
56
What are 5 types of WBCs?
- Neutrophils
- Eosinophils
- Basophils
- Monocytes
- Lymphocytes
57
Where do WBCs originate?
- Bone marrow
| - Spleen
58
What is the hematocrit?
- % red blood cells in blood
59
What is a normal hemtaocrit?
45 %.
60
What is the main function of hemoglobin?
Carries O2 to tissues.
61
What are 3 effects of low RBC?
- Fatigue
- SOB
- Dizziness
62
What are the effects of low WBCs?
- Susceptible to infection
63
Below what level of WBC is exercise contraindicated? when is light exercise indicated? When is infection indicated?
< 5000: With fever, no exercise
> 5000: light exercise
> 11,000: Infection
64
What level hemoglobin contraindicates exercise? light exercise? resistive exercise permitted?
< 8: no exercise
8 - 10: light exercise
> 10: resistive
65
What level hematocrit contraindicates exercise? light exercise? normal exercise?
< 25 %: no exercise
> 25 %: light exercise
30 - 32 %: Exercise as tolerated
66
What is more important than comparison with standard normal values in CBC
Comparison with individualized baseline.
67
What is a normal value for platelets?
150k to 350k/ uL
68
What levels of platelets contraindicate exercise, indicate light exercise, and permit resistive exercise?
< 20,000: No exercise
20,000 - 50,000 --> Light AROM exercise
> 50,000 --> Resistive
69
What the term for low platelet levels, and what are its effects?
Thrombocytopenia leads to bleeding after minor trauma, and increased bleeding post surgery.
70
What are 4 coagulation panels?
- D-dimer
- PT (prothrombin time)
- PTT (partial prothrombin time)
- INR (internationalized normalized ratio)
71
What does an increase in coagulation panels indicate?
- Increased risk of bleeding
72
What does a decrease in coagulation panels indicate?
- Risk of clotting
73
What are 4 blood thinning meds?
Warfarin (coumadin), plavix, heparin, aspirin, and Pradaxa.
74
What are 2 lab tests related to heart failure?
- ANP: a-type natriuretic peptide.; found in atria
- BNP: B-type natriuretic peptide. Found in ventricular tissue
These are both hormones released by the heart to act as diuretics and antihypertensives in repsonse to fluid imbalance.
75
What blood tests are ordered for MI?
Cardiac enzymes:
- CK
- CKMB
- Myoglobin
- Cardiac Troponins
Cholesterols:
- HDL
- LDL
- Total
- Triglycerides
- Ratio
76
What is a halter monitor? When would it be used?
Telemetry device worn continuously to assess arrhythmia during ADLs.
It is worn when the arrhythmia, but do not show up during office visits.
77
What 6 measures are performed with cardiac catheters?
- Heart chamber, and pulmonary pressure
- Blood flow between heart chambers
- Determine valve competency
- Monitor cardiac wall contractility
- Detect intracardiac shunts
- Visualize coronary arteries
78
When would a rt heart catheter be applied?
- Pulmonary hypertension
79
Why may cardiac catheterization not be ultilized?
- Invasive
- Expensive
- Issues with kidney problems
80
What is the purpose of angiography of coronary ateries performed during catheterization?
- Looking for obstructions or aneurysms.
81
How is conventional angiography typically performed?
- Iodine based contrast delivered via catheter though femoral vein to heart
- Image viewed through fluoroscopy
82
How can an echocardiogram assess valve function?
- Stenosis
| - Regurgitation
83
What is an echocardiogram?
- Ultrasound of the heart
84
What motion of the heart wall indicates ischemia?
- Hypokinesis
| - Dyskinesis
85
What motion of the heart wall indicates infract?
- Akinesis
86
What can be used to observe flow rates of the heart?
- A doppler
87
What combination of tests observe changes in the heart with exercise?
Stress test or "Stress - Echo"
88
How is a transesophageal echo (TEE) performed?
- US combined with endoscopy
- Probe (transducer) inserted into esophagus
- Images taken from posterior of heart
89
What is the benefit of images being taken posteriorly in a TEE?
- Less interference from chest wall structures
| - High quality pictures of thoracic aorta
90
What type of patient typically receives a TEE instead of other procedures?
- Obese patients
91
What are some risks associated with TEE?
- More invasion
- Respiration due to sedation/ vagal nerve stimulation
- Aspiration/ perforation of esophagus
92
What is a positron emission test (PET), and what does it measure?
- Radioisotopes given to patient that target blood and glucose.
- Assess myocardial metabolism
- Normal flow/ glucose --> Coronary artery perfusion
- Decreased flow/ glucose met --> Ischemia/ necrosis
- Can also detect tumor in lungs
93
What is a V/Q scan, and what does it measure?
- Ventilation/ Perfusion scan of lungs.
- Measures air flow & blood in lungs
- Typically detects embolisms in pulmonary artery
- Lung function in COPD
- Pre/ post lobectomies
94
How is the V measured in a V/Q scan?
- Patient inhales radioactive Xenon, and pictures are taken to determine which lobes of lung are reached
95
How is Q measured in V/Q scan?
Radioisotope inject through IV, and photos are taken.
96
How are the V/Q used to diagnose PE?
The images are compared and evaluated to determine inconsistencies.
97
What is an older technique alternative to V/Q used to diagnose PEs?
Computer Tomography Pulmonary Angiography: CTPA
- Contract injected into peripheral vein, and plain film taken.
98
What type of technique detects calcium deposits in the heart?
CT cardiac/ angiography
- Contrast dye detects perfusion in pericardium and myocardium
99
What is a nuclear perfusion study?
- Radioisotopes are used together with stress tests to evaluate the coronary arteries
100
How is a nuclear perfusion study performed?
- Radioisotope tracer targeting specific cells of heart muscle is given intravenously.
- HR is increased by exercise or drugs
- Photos taken before, after, and a few hours after
- Check for obstruction of coronary arteries.
101
What are the 4 potential outcomes following a nuclear perfusion study?
- Unobstructed flow
- Normal perfusion at rest, but decreasing during exercise
- Decreased perfusion at rest and during exercise
- Combination of reversible and nonreversible
102
Which result is a reversible defect?
Normal perfusion at rest, decreased during exercise.
103
What result indicates a complete block of the coronary arteries?
Decreased perfusion at rest and during exercise.
104
Which result is common in patients with CVD?
Combination of reversible and nonreversible.
105
What is a MUGA scan?
- Multigated Aquisition
- Isotope injected, and images taken from EDV to ESV
- Determines heart function
106
What does the MUGA scan evaluation?
Function of ventricles
107
What test is MUGA more accurate than?
An echocardiogram
108
What patients would recieve repeated MUGA scans?
Chemo patients to monitor the impact on the heart
109
What is a cardiac MRI?
- High resolution 3 dimensional image of heart done with or without a contrast agent.
110
What is a cardiac MRI used for?
- Creates still and moving pictures of the heart
| - Differentiates various tissues such as: blood, fat, and myocardium
111
What is MRA?
Magnetic resonance angiography
- Describes a group of MRI pulse sequences that generate a signal from flowing blood.
112
What is an MRA used to study?
Cerebrovascular system, aorta, renal arteries, and LEs.
113
What are advantages of MRA?
- Noninvasive
- No contrasts
- No exposure to ionizing radiation
114
What is the disadvantage of the MRA?
- Not as successful as CT angiography
| - High cost
115
What is common stress testing protocol?
Bruce protocol.
Continued until pt becomes symptomatic, and they show signs of intolerance.
116
What sign is used to locate lesions in specific lobes of the heart?
Silhouette sign, in which the border between tissues of 2 similar densities disappears.
117
What are 4 commonly obliterated borders within the lungs?
- Superior mediastinum: lesion in upper lobes
- Border of right heart: Lesion in right middle lobe
- Border of right hemi-diaphragm: lesion at right lower lobe
- Border of left hemi-diaphragm: lesion at left lower lobe
118
What is the cardiothoracic ratio? What is normal in adults?
- Estimates the size of the heart using a plain film
| - In adults: widest portion of heart should be less than half the width of the chest at the diaphragmatic level
119
What are 3 causes of an englarged heart?
- Cardiomyopathy
- CHF
- Incompetent valves
120
What are 4 reasons a heart may appear enlarged, when it is not?
- AP view taken during expiration, not inspiration
- Diaphragm displaced superiorly due to pregnancy
- Abdominal distension
- Pericardial effusion present
121
What are the borders of the mediastinum?
Sternum, spine, lungs
122
What are the contents of the mediastinum?
- Heart
- Vessels
- Trtachea
- Esophagus
123
What are the only borders that can be distinguished in a radiograph of the mediastinum?
The air filled lungs
124
What 3 things can cause a shift of the mediastinum?
- Removal of lung
- Pleural effusion
- Lobular collapse
125
What will cause the mediastinum contents to the opposite side?
Pleural effusion.
126
What will displace the mediastinal contents to the same side?
Lung collapse or volume loss.
127
What type of masses can be detected within the mediastinum?
- Goiter
- Lymphoma
- Esophageal
- Bronchial cancers
- Aortic aneurysms
128
Why can the diaphragm be seen in an x-ray?
It borders the air-filled lungs.
129
What is the white area portion of the diaphragm?
- Liver
- Spleen
- Stomach
- Posterior lungs
- Diaphragm next to x-ray beam
130
Where is the dome of the diaphragm typically aligned?
To the level of the 10th rib.
131
What are 3 reasons for the diaphragm becoming elevated?
- Excessive fluid in peritoneal space
- Later stages of pregnancy
- Splinting after abdominal surgery
132
Why might the diaphragm be flattened?
- Increased lung volume due to:
- Emphysema
- Pleural effusions
- Masses in lung
133
What is the highest point of the diaphragm?
The middle 1/3rd.
134
Which hemi-diaphragm is higher, and why?
Right is higher because of the liver.
135
Which hemi-diaphragm contains the stomach?
The left.
