CPR Test 1 Flashcards
Which are the most commonly fractured ribs?
middle ribs, anterior to costal angle
supernumerary ribs
extra ribs in cervical or lumbar region
TOS/ issues w brachial plexus and subclavian A or asymptomatic
Dislocation of ribs
dislocation at the Sternocostal joint
sternum and costocartliage
separation of ribs
separation at the Costochondral joint
rib and costocartilage
Thoracentesis
Bw what ribs?
pleural cavity fluid sample taken w hypodermic needle in between intercoastal nv bundle and collateral branches
ribs 9 and 10, midaxillary
Where do you insert a chest tub?
bw 5 and 6th rib
removes large amt of air, fluid, blood or pus from pleural cavity with collapsed lung/ emergency
thoroscopy
visualization/biopsy with thoracoscope inside pleural cavity
intercostal spaces 1-3
gastroschisis
protrusion of viscera to right of umbilical cord
amniotic fluid (saltly) = bad for GI
bowel is uncovered and floating in ^^
failure of lateral folds to pull gut in
congenital epigastric hernia
midline bulge covered w skin and subcut. tissue
bw xiphoid process and umbilicus
congenital diaphragmatic hernia
posterolateral defect
viscera bulge into pleural cavity that delay lung growth
on left side
failure for myoblast to partially or fully infiltrate pericardiopertioneal canal
Lung cancer can involve what nerves due to proximity?
Phrenic N., Vagus N. and Recurrent Laryngeal N.
treatment for lung cancer?
removal of a Lung (Pneumonectomy), a lobe of a lung (Lobectomy) or a specific Bronchopulmonary Segment (Segmentectomy) through a procedure called Lung Resection
Pleuritis
inflammation of the Pleura producing a roughness on the lungs making breathing difficult.
friction! sometimes can adhere parietal and visceral
sharp pain (ie w walking upstairs), deeper and increased breathing
pulmonary collapse
enough air enters the Pleural Cavity to break the surface tension between the two layers of Pleura
lung elasticity causes them to collapse
Pneumothorax
thoracic wall wound or rupture of pulmonary lesion of PC
causes entry/build up of air/pressure into the Pleural Cavity, results in a collapse of the lung
Hydrothorax
excess fluid in the Pleural Cavity, usually the result of fluid escape into the Pleural Cavity, or Pleural Effusion.
Hemothorax
blood in pleural cavity
cut of intercostal vessel/internal thoracic vessel
bronchial asthma
widespread narrowing of the airways produced by contraction of smooth muscle, edema of the mucosa and mucus in the lumen of the Bronchi and Bronchioles
Bronchoscopy
insertion of a Bronchoscope into the trachea to visualize the Main Bronchi.
laryngeal atresia
failure of recanalization of larynx
CHAOS syndrome (obstruction of upper fetal airway)
airways dilated, lung enlarged, filled w fluid
diaphragm flattened/inverted, fetal ascites/hydrops
tracheoesophageal fistual
connection bw trachea and esophagus (most common LRT)
failed foregut endoderm to proliferate rapidly
cant swallow, drools, regurgitation, GI reflux
polyhydramnios
associated with esophageal atresia
pulmonary agenesis
unilateral agenesis (lack lung, lobe, bronchi) resp bud fail to split into bronchial buds
oligohydramnios
insufficient amniotic fluid production, severe retards lung devlp
assoc w renal agenesis/failure
pulmonary hypoplasia
restriction of fetal thorax (uterine pressure)
affects stretch recpt and lung growth
decreased hydraulic pressure on lungs
higher risk of oligohydramnios <26 weeks
resp distress syndrome
rapid labored breaking surfactant deficiency (lung underinflated) tachy/nasal flaring, suprasternal/intercostal/subcostal retractions, grunts/cyanosis
congenital lung cysts
fluid or air filled
bronchial develp. disturbance
wheezing, cyanosis, diff breathing
bronchospasm
constriction of smooth m in bronchioles
emphysema
perm enlargement of air spaces distal to term bronchiole, narrowing of bronchioles, destruction of alveolar walls
loss of gas exchange bc decrease SA
dyspnea, cough, wt loss
PNA
inflamed lung tissue, filled w WBC (neutrophils), rbc, fibrin
big capillaries w lots rbcs
looks red/firm/heavy
fever chills, cough, decreased breath sounds, crackles in lungs
What is abnormal bv/lymphatic capillary growth via vasculogenesis called?
Angiomas
ex: capillary hemangioma (lots caps), cavernous hemangioma (lots venous sinuses)
form from mesenchyme, regress on their own
common in head and neck
What is called to have a right sided L ventricle?
ventricular inversion
ventricle folds to the right, outflow tract is on L
What is the name of a total heart reversal? Partial? Right heart, normal GI?
heterotaxia
situs inversus - total, every body organ if filled to opposite side, no consequence
situs ambiguous - partial, some organs, issue w/ venous return
r heart, norm gi - visceroatrial heterotaxia (inflow, outflow problems)
What happens when the AV septum fails to fuse?
persistent AV canal (agnesis of av valves)
pulmonary hypertension, hard to exercise, SOB, cardiac congestion, endocarditis risk, linked down syndrome
What color does the skin changed to due to low o2 in the blood? symptoms?
blue - cyanosis
clubbed fingers, blue fingernail beds/lips, tired, fatigue
from mixing of blood
What is it when you have insufficient shifting of AV septum or cardiac looping? symptoms?
Double outlet right ventricle
pulmonary a and aorta exit R ventricle, with VSD
symptoms: cyanosis, breathlessness, murmur, and poor weight gain
Tetralogy of fallot
conotruncal ridges off center formation = aorta/pulm trunk are unequal
pulmonary stenosis, aorta overrides where pulmonary a should be, VSD, RV hypertrophies (r to l shunt, cyanosis)
pulmonary valvular atresia
pulmonary a is closed off (semilunar valves closed)
patent foramen ovale and ductus arteriosus
Rv hypoplasia
aortic valvular stenosis
L ventricular hypertrophy = cardiac fail and pulm hypertension
narrowing of aortic valve
male dom, congenital, degenerative, infection (RF)
aortic valvular atresia
fused valves, hypoplastic LV,
big ductus arteriosus, hypertrophy RV
What can start as asymptotic and lead to L ventricular hypertrophy over time from less cusps?
bicuspid aortic valve (2 instead of 3)
associated w aortic aneurysms
regurgitation, stenosis
tricuspid atresia
r AV orfice destroyed
patent foramen ovale, VSD, patent ductus arteriosis, atresia of valve cusps
hypoplastic RV, hypertrophy LV
What is underdeveloped/not formed in hypoplastic L ventricle?
LV, mitral valve, aortic valve, ascending portion of aorta
acts as univentricular, only using RV (univent)
patent ductus arteriosus and patent foramen ovale (ASD)
What can you use for coronary a bypass graft?
great saphenous v bc easy dissection from LE, lengthy w no branching or valves, same size
or radial a
What is coronary angioplasty do?
small ballon catheter flattens plaque against the wall of coronary a to increase the size of lumen for better blood flow
What can cause pulmonary embolism? track it runs?
blood clot, fat globule, air bubble embolus
a vein on R side of heart to pulmonary A
what fills bronchiolar walls during asthma
eosinophils, lymphocytes, mast cells
atrial septal defect
L to R shunting from increased blood to lungs and decreased pulm resistantce after lungs expand
this increased blood to lung, pulm resistance, R vent hypertrophy, CHF, then r to l shunt, cyanosis
90% ostium II (secundum, high atrial septal defect)
left to right blood shunt causes?
increased work load for R ventricle = hypertrophies, which causes right to left shunts, then cyanosis
failure of contruncal ridge formation and fusion is called? caused what else to happen?
persistent truncus arteriosus
VSD, mix of blood, pulm congestion, RV hypertrophy, R vent pressure increase, cyanotic cond
failed conotruncal ridges to spiral? consequences?
transposition of great vessels
pulm a connected to LV, aorta to RV
survives w vsd, asd, patent ductus arteriosus
how can pt live with pulmonary valvular atresia?
patent ductus arteriosis used to flow of blood from aorta into pulmonary a
patent foramen ovale
transplant if hypoplasia too bad, vsd rv to left and out aorta = univentricular heart (mix of blood)
Which lymph nodes are most associated with breast cancer?
Axillary Lymph Nodes (include the Pectoral, Interpectoral, Deltopectoral, Supraclavicular and Inferior Deep Cervical Lymph Nodes
also parasternal
what is down syndrome (trisomy 21) associated with?
failure of atrioventricular septa to form
lack of blood to myocardium is caused by? And can lead to?
block of coronary A
myocardial infarction
building up of lipids on the internal walls of the coronary arteries does what? leading to increase likelihood?
decrease the size of the lumen of vessel, can cause embolus and plugging the vessel fully.
coronary atherosclerosis
What produces a strangling pain in the chest?
angina pectoris
narrow or obstructed coronary arteries that produces ischemia of myocardium
cardiac catheterization
insert catheter in femoral v
into inferior vena cava
to look at RA, RV, PT, Pulm a
what ccan you do if you AV or SA node isnt working?
artificial cardiac pacemaker
reg electrical impulse to ventricles via electrodes in large vein to superior vena cava into RA past valve in endocardium of trabecula carnae of RV
irregular twitching of atrial cardiac m fibers
atrial fibillation
irregular twitching of ventricle cardiac m fibers - not able to pump blood
ventricular fibillation
what can you do for ventricular fibrilliation
defibrillation - electric shock by electrodes to cease movement in hopes it starts back up again
Cardiac Referred Pain
Ischemia stimulates visceral pain sensory fibers in the heart of the Autonomic Nervous system. These visceral sensory fibers often share a spinal ganglion with the somatic sensory fibers of areas such as the upper limb and superior lateral chest wall.
Anginal pain is typically referred to the area innervated by
Left Medial Brachial Cutaneous nerve, the left substernal area, left pectoral area and medial aspect of the left upper limb are often involved in this variety of referred pain.
What is used to treat heart failure? and what is the mechanism?
Cardiac glycosides
inhibit Na/K atpase K binding site, increase Na, decrease Ca out (increase of ca inside to SERCA), positive inotropic effect
Cardiac Failure causes what to happen first in the heart? And then follows with?
negative inotropic effect
decreased inotropy and vas compliance, increase of Blood Volume and SVR/TPR
first decreases cardiac output, then increases volume to compensate
Inflammation of the pericardium? Causes?
Pericarditis
causes friction on the heart and if not treated, can calcify
can also lead to pericardial effusion
Pericardial Effusion leads to?
cardiac tamponade (heart compression) makes it beat harder accumulation of fluid or pus in the pericardial sac which can compress the heart
Used to treat pericardial effusion/cardiac tamponade?
Pericardiocentesis
Drainage of blood, fluid or pus from the pericardial sac.
where do surgeons clamp/insert tubes of a bypass machine?
transverse pericardial sinus
accesses area posterior to aorta and pulmonary trunk
oligohydramnios (potters) sequence
still born childern
oligohydramnios -> fetal compression -> pulm hypoplasia, altered facies (nasal flaring, bridge wide, potter facies, limb hypoplasia, renal fail, club foot, breech presentation)
in a rib fracture, what is most likely seen in an X-Ray?
hematoma at site of fracture, actually frac is hard to see
CT more sensitive
Can puncture kidney, liver (right side), and spleen (left side)
air leaking in cavity with no outside intervention happens from?
spont pneumothorax
spon rupture of alveoli through vicseral pleura so air leaks into cavity
risks - smoke, copd, cystic fibrosis, inherited apical bleb
lung collapse, compress of mediastinal structure/vessel
air entering thorax but can’t exit is?
tension pneumothorax
from trauma where injury fails to seal, + pressure ventilation during resuscitation
collapsed lung, impaired venous return -> cardiac arrest
pulmonary meniscus sign
on surface of fluid seen with pleural effusion
due to surface tension between 2 diff fluids in pleural cavity (norm serous fluid and pleural effusion)
in costophrenic angles and substernal region
coin sign
solitary round, circumscribed shadows on xray
can be calcified
symptomatic
causes: tuberculosis, neoplasms, cysts, vasc anomalies
kerley lines
interlobular septa in pulmonary interstitium are prominent
lymph swelling makes them seen, pressing into CT making them dense
kerley a vs b
a - diagonal lines from hila to periphery
b - short parallel lines at periphery perp to pleura
causes of kerley lines
pulm edema, lymphoma, cancer, pna
causes of cardiac tomponade
neoplasms, pericarditis, effusion due to renal fail, trauma
fiberous pericardium prevents overflow, and create issues when there is a build up of fluid because it can cause friction and decrease hr
becks triad
for cardiac tamponade distant heart sounds muffled jugular distention - restricted venous return hypotension signs of shock, decreased co treat with pericardiocentsis
cardiac tamponade can show up as what on xray
water bottle heart
globular heart silhouette in xray
what do you use echocardiography for?
good in utero, child
adult - probe is on ant skin, red blood flow toward, blue away
color change = turbulence and can indicate mixing of blood
can indicate blood regurgitation
What keeps the PDA open during development?
prostaglandins
regulated by o2 tension and blood flow -> regulates smooth m contraction
consequences of pda?
lv hypertrophy, pulmonary congestion, congestive HF
treated with indomethacin or surgery
bad if mom has rubella
aortic lumen narrowed due to abnormal thickening of the wall is? Types?
coarctation of aorta
aka turner’s syndrome
postductal (after da) - not noticed bc collateral circulation through intercostal arteries and internal thoracic a
preductal - collaterals not devlp, after birth little body goes to LE, pda, death often unless repaired
aberrant origin of R subclavian
distal of right dorsal aorta and 7th intercostal a (intersegmental)
r AA IV, prox part of R dorsal aorta obliterated
dysphagia and dyspnea (dorsal aorta cross esophagus to reach r ue
double aortic arch leads to?
esophageal dysfunction and strangulation of trachea
vascular ring around trachea and esophagus, looks like a heart shape
right aortic arch
left AA IV and left dorsal aorta obliterated, replaced by vessels on r
dysphagia and dyspnea happens in r aortic arch because?
l subclavian A pass behind esophagus and ligamentum arteriosum in front of trachea to reach R side
interrupted aortic arch
left and right AA IV obliterated, as well as prox part of r dorsal aorta
pda, descending aorta and subclav A supplied by blood of low 02
aortic trunk supplies 2 common carotids
what is seen in DiGeorge syndrome? dangerous?
interrupted aortic arch
life threatening
