CR3 EOYS3 Flashcards

1
Q

Explain three examples that could cause obstructive shock xx [2]

A

PE
Tension pneuomothorax air gets trapped in pleural space: compresses against vena cava and heart: stops blood flow into right side of heart: reduced preload: reduced CO
Cardiac tamponade :accumulation of pericardial fluid: causes increas in intrapericardial pressure which reduceds cardiac filling

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2
Q

Explain 3 examples of distributive shock x

A

Sepsis: dysregulated host response to infection where bacteria in blood release chemicals causing uncontrolled hypotension

Anaphylactic shock: allergic response to antigen: IgE mediated mass degranulation releasing histamines: vasodilation and capillary leaking

Neurogenic shock: loss of sympathetic tone and thus unopposed parasympathetic response driven by the vagus nerve. Consequently, patients suffer from instability in blood pressure,

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3
Q

What is cardiogenic shock?

Name 4 causes of cardiogenic shock xx [4]

A

Failure of the heart to pump blood
Occurs as a result of ventricular dysfunction (esp. LV)

Causes:
* Acute myocardial infarction leading to ventricular dysfunction
* Arrhythmias
* Valvular rupture
* Decompensated heart failure

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4
Q

Explain 4 causes of hypovolaemic shock xx

A
  • Haemorrhage
  • GI losses: severe diarrhoea and vomiting
  • Surgery: exposure of internal structures to heat
  • Burns: fluid shift into extravasuclar space due to inflam response
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5
Q

Explain the compensatory mechanisms for haemorrhagic shock [3]

A

Baroreceptors detect drop in arterial pressure

Activates sympathetic stimulation:
- Constriction of small arterioles increasing total peripheral resistance thereby maintaining BP
- Veins and venous reservoirs constrict, maintaining venous return
- Increased heart rate and contractility to maintain cardiac output

CNS ischaemia results in increased noradrenaline and adrenaline secretion from adrenal medulla

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6
Q

How does RAAS system work to compensate shock? [3]

A
  • Water retention and salt reabsorption
  • Vasomotor centre in the medulla signals to the hypothalamus to release vasopressin (ADH)
  • Urine flow and sodium excretion decrease
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7
Q

Name 3 long term compensatory mechanisms of shock [3]

A
  • There is (by an unknown mechanism) stimulation of albumin and other plasma protein synthesis in the liver.
  • Increased fluid absorption from GI tract
  • Fibroblasts surrounding the kidney tubules are sensitive to hypoxia and release increased amounts of erythropoietin: Red cell production
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8
Q

CO = [] X []?

BP = [] x []?

A

CO = HR X SV

BP = CO x Systemic vascular resistance

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9
Q

Vasodilation is mediated by the activation of which two compounds? [1]

Explain their basic mechanism [1]

A

Nitric oxide and prostacyclin [1]

MoA: Through cGMP and cAMP respectively, secondary messengers cause decrease in calcium and smooth muscle relaxation

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10
Q

Vasoconstriction is predominately activated by which molecule on which receptors? [2]

Name two alternative compounds that can cause vasoconstriction [2]

A

Vasoconstriction is predominately activated by which molecule on which receptors? [2]
Noradrenaline on alpha 2 recptors

Name two alternative compounds that can cause vasoconstriction [2]
Angiotensin
Vasopressin

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11
Q

What are the overall physiological consequences of shock ? [3]

A
  • Increased afterload
  • Reduced systemic vascular resistance (Failure to maintain peripheral vasoconstriction)
  • Decreased CO
    i) reduced preload
    ii) reduced contactility
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12
Q

Name and describe the 4 stages of shock

A
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13
Q

What are the signs of shock?

A
  • Pulse is weak and rapid
  • Pulse pressure reduced - mean arterial pressure (MAP) may be maintained - NOTE; ARTERIAL BP is NOT A GOOD INDICATOR OF SHOCK since it will be maintained until a very large amount of blood loss
  • Reduced urine output
  • Reduced pH
  • Confusion, weakness, collapse and coma
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14
Q

Describe the 4 classes of haemorrhagic shock

A

x

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15
Q

Explain which of HR or BP falls first in major haemorrhage stroke :)

A

Cardiac output can accommodate c. 10% blood loss before change in CO
Between 10-20% fall in blood loss, arterial pressure compensates by vasoconstriction

SO you see a raise in HR to compensate fall in SV BEFORE you see a fall in BP

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16
Q

Whats the A-E of shock management?

A

Airway: probs ok unless they have analphylaxis
Breathing: usually ok, may have compensatory increase in RR to compensate hypoxia in tissues. OR might have tension pneumothorax. Later stages: hypoxic
Circulation: give IV access: increase fluids to increase BP
Disability: Low: cant respond bc of lack of 02
Exposure: look at skin – rash / burns / pale

17
Q

What is chylothorax? [1]

Why may it occur? [1]

A

Chylothorax: leakage of lymph into the pleural cavities

Can cccur due thoracic duct damage

18
Q

What is the path of the testes lymphatic drainage?

What is the path of the scrotum lymphatic drainage?

What is the path of the ovaries lympahtic drainage?

A

What is the path of the testes lymphatic drainage?
Testes –> preaortic aorta

What is the path of the scrotum lymphatic drainage?
Scrotum –> superficical inguinal nodes

What is the path of the ovaries lympahtic drainage?
Ovaries –> preaortic aorta

19
Q

Lymph from the internal and external iliac nodes drains into the [] nodes and then the [] nodes.

Lymph from the GI tract drains into the [] lymph nodes ([], [] and [] nodes)

Intestinal + right and left lumbar trunks drain to []

A

Lymph from the internal and external iliac nodes drains into the common iliac nodes and then the lumbar nodes.

Lymph from the GI tract drains into the pre-aortic lymph nodes (celiac, superior mesenteric and inferior mesenteric nodes)

Intestinal + right and left lumbar trunks drain to cisterna chyli (beginning of thoracic duct)

20
Q

What is waldeyers ring? [4]

A

Waldeyer’s ring consists of four tonsillar structures:
- pharyngeal
- tubal
- palatine
- lingual

As well as small collections of lymphatic tissue disbursed throughout the mucosal lining of the pharynx (mucosa-associated lymphoid tissue, MALT).

21
Q

What are the axillary lymph nodes? [3]

Where do they drain lymph from? [3]

Ddescribe their path to to L / R venous angle [2]

A

Humeral lymph nodes drain from upper limb

Pectoral lymph nodes drain from anterior chest wall (majority drains into here)

Subscapular lymph nodes drain from posterior chest wall (rotator cuffs etc)

Together: go to central –> apical –> supraclavicular –> left / right venous angle

22
Q

Describe the path of deep drainage of the thorax lymphatics

A

Sub pleural plexus –> interlobal lymph vessels –> interpulmnarry lobes –> inferior trachea bronchiol nodes –> superior trachea bronchiole lobes –> bronchomediastinal trunks –> L / R venous angle

23
Q

The thoracic duct enters the thorax through the [] and travels in the [] mediastinum between the [] and the [] vein.

A

The thoracic duct enters the thorax through the aortic hiatus and travels in the posterior mediastinum between the aorta and the azygos vein.

24
Q
A
25
Q

Central lines (also known as a central venous catheter) are catheters that can be place in a large vein to give medication or fluids or to collect blood for medical tests.

Given your anatomical knowledge which veins do you think are used for central lines?

A

Acceptable responses: Internal jugular vein, Internal jugular, Subclavian, Subclavian vein, Femoral, Femoral vein

26
Q

Label 1-3

A

1: LCA
2: LAD
3: Left circumflex

27
Q

Which valves close during S1?
Which valves close during S2?
Where do each of the following correspond to on an ECG?

A

S1: closure of mitral and tricuspid valves: QRS
S2: close of aortic and pulmonary valves: After T wave

28
Q

At what time does ductus arteriosus normally close?

Seconds after birth
1-3 days after birth
2 weeks after birth
6 months after birth

A

At what time does ductus arteriosus normally close?

Seconds after birth
1-3 days after birth
2 weeks after birth
6 months after birth

29
Q

Label the vert. layers of A-D

A
30
Q

The laryngeal prominence occurs at which vertebral level

C3
C4
C5
C6
C7

A

The laryngeal prominence occurs at which vertebral level

C3
C4
C5
C6
C7

31
Q

The carotid bifurication occurs at which vert. level?

C3
C4
C5
C6

A

The carotid bifurication occurs at which vert. level?

C3
C4 : carotid pulse can be palpated either side of thyroid cartilage
C5
C6

32
Q

The cricoid cartilage occurs at which vert. level?

C3
C4
C5
C6

A

The cricoid cartilage occurs at which vert. level?

C3
C4
C5
C6

33
Q

The thyroid gland occurs at which vert. level?

C3
C4
C5
C6

A

The thyroid gland occurs at which vert. level?

C3
C4
C5
C6: overlies cricoid cartilage

34
Q

Thyroid gland overlies which laryngeal cartilage?

Thyroid cartilage
Cricoid cartilage
Epiglottis
Artyenoid cartilages

A

Thyroid gland overlies which laryngeal cartilage?

Thyroid cartilage
Cricoid cartilage
Epiglottis
Artyenoid cartilages

35
Q

What are the 3 components to a definitive airway? [3]

A

1) Tube placed within the trachea with cuff inflated BELOW vocal cords (most important to know)
2) Tube connected to oxygen enriched assisted ventilation
3) Airway secured in place with appropriate stabilizing method

36
Q

How can burns of neck / face cause closure of airways? [1]

A

Direct damage to tissues:
- can cause secondary oedema and swelling of soft tissues
- can be dealyed occlusion of the airway

37
Q

How can trauma to face/neck cause closure of airway?

A

Direct obstruction
- Laryngotracheal fractures

Secondary obstruction
- Displacement of local structures
- Loose teeth, bone fragments etc.
- Post-traumatic complications:
eg. haematoma/swelling