Dale's Review Concepts I Flashcards
1
Q
What is Cor Pulmonale
A
R side enlargement/hypertrophy progress to failure DT pulmonary HTN, COPD, massive PE
2
Q
Pt w/ Hx COPD has R side strain, peripheral edema JVD, hepatojugular reflux, & several day onset dyspnea. What’s the problem?
A
Cor Pulmonale
3
Q
How to diagnose Cor Pulmonale
A
S1QT3
4
Q
R vs L side failure
A
1 Cause of R side failure = LSF. # 2 cause = PE/COPD
5
Q
What hormones do the kidneys secrete. What do they do?
A
- Erythropoietin = make RBCs
- Calcitrol = Converted from Vit D = small intestine absorb Ca ++, phosphate for bone growth
- Renin = RAAS for higher BP
6
Q
What hormones does the Anterior Pituitary Gland produce
A
- ACTH = steroids
- FSH
- GH
- LH
- Prolactin = milk
- TSH
7
Q
What hormones does the Posterior Pituitary Gland create
A
- ADH
- Oxytocin
8
Q
What 3 hormones are involved in the RASS system?
A
- Renin
- Angiotensin II
- Aldosterone
9
Q
Explain the RASS system process
A
- Low BP = Renin Release
- Renin turns angiotensinogen (in liver) to angiotensin I
- ACE turns angiotensin I to Angiotenin II (in lungs)
- Angiotensin II = vasoconstriction, Fluid retention, Norepi, Aldosterone, ADH release
- Result = BP/Volume
10
Q
Endocrine vs Nervous System
A
- Endocrine = slow acting, long lasting
- Nervous = Fast acting, long lasting
11
Q
What hormones does the Thyroid Gland make? What do they do?
A
T3, T4, & Calcitonin (lowers blood Ca++)
12
Q
What body parts does the parathyroid gland regulate? What hormone does it release?
A
- Affects bones, intestines, kidneys
- Parathyroid hormone = increase blood Ca++ lvls
13
Q
What two cycles make up the menstrual cycle?
A
Ovarian & Uterine
14
Q
Name the 2 phases of the ovarian cycle and what happens during them?
A
- Follicular phase = FSH & LH helps follicle rupture
- Luteal phase = rupture follicle becomes corpus luteum and releases hormones to facilitate pregnancy
15
Q
Explain the Uterine cycle and its two phases
A
- Proliferative phase = endometrium thickens & perfusion is increased
- Secretion phase = less hormone production & uterine lining shed
16
Q
What separates the three stages of labor
A
- Stage 1 = onset of labor to full cervix dilation
- Stage 2 = crowning to full fetus delivery
- Stage 3 = placenta delivery
17
Q
What happens to the uterus before labor starts
A
Up to 1 wk prior to labor…
- Lightening = Fetus moves from upper ab to lower pelvis
- Bloody show = mucus plug @ cervix + blood expelled
18
Q
A&P: Caudal
A
Going towards tail/feet
19
Q
A&P: cephalic
A
Going towards head
20
Q
Anatomical plane cuts body in top & bottom half
A
Transverse Plane
21
Q
Anatomical Plane cuts body between front & back halves
A
Frontal / Coronal plane
22
Q
Anatomical plane cuts body into L and R halves
A
Sagittal (Lateral) plane
23
Q
Name of Valves separating Atria from Ventricles. Name of the L & R one?
A
The Atrioventricular valves
- L = Bicuspid/Mitral valve
- R = Tricuspid Valve
24
Q
Name of valves separating the ventricles & the lungs/aorta
A
The Semilunar valves (aortic & pulmonary valve)
25
Differentiate the Heart Sounds (in order from first to last)
- S4 (Bla) = Increased Atrial pressure/stiff ventricles
- S1 (Lub) = AV valves close
- S2 (Dub) = semilunar valves close @ end of systole
- S3 (Da) - older adults heart failure/CHF
26
What’s a Bruit
Whooshing sound auscultated over vessel = turbulence = plaque build up
27
What are the 2 main coronary arteries?
R & L coronary artery
28
What does the L coronary artery bifurcate into?
- Circumflex (lateral wall L Ventricle)
| - L Anterior Descending (Septum & anterior wall LV)
29
What does the R coronary artery bifurcate into?
- Marginal
| - posterior descending artery
30
Name the reciprocal leads of the following: II, III, aVF
I, aVL
31
What are the reciprocal leads? I, aVL, V5, V6
II, III, aVF
32
What are the reciprocal leads of V1, V2
V7, V8, V9
33
Which ECG correlate w/ the inferior wall of the L ventricle
II, III, aVF
34
Which ECG leads correlate w/ the septum of the heart
V1 & V2
35
Which ECG leads correlate to the anterior wall of L ventricle
V3, V4
36
Which ECG leads correlate w/ High lateral wall of L ventricle
I, aVL
37
Which ECG leads correlate w/ the low lateral wall of L ventricle
V5, V6
38
Chronic Bronchitis: what it is, SS, Cause
Chronic smoking = excess Goblet cells = excess mucous
- SS = Sputum all month 3 months/ year x2 years, overweight, bluish, smoker (blue bloater), R side failure SS
39
Emphysema: what is it, SS
AKA pink puffer
- smoking fucks terminal bronchioles = alveoli bunch together
- SS = barrel chest, forward retraction, sniffing/tripod, puffed lips, overdeveloped chest
40
What is cholecystitis
Gallbladder infection
41
Pt has pn in RUQ and can’t inhale deeply if you press it. What sign is this?
Murphy’s sign
42
What is Charcot triad and what is it for?
Fever, RUQ pn, jaundice = common bile duct inflammation/block
43
What are the 5 F’s for cholecystitis?
Fat, fair, female, Fertile, 40-50s
44
Pt has pn at Murphy’s point that gets worse 2-3 hours post meal, Fever, jaundice, Nausea. What’s wrong? What Rx?
Cholecystitis
Rx = N/pn meds, Fluids for vomiting/dehydration
45
Pt has LLQ pn w/ infection SS (Fever, NVD, Weak). What is wrong & what Rx?
Diverticulitis.
Rx = supportive. Rule out sepsis.
46
What are the risk factors for diverticulitis?
Old (60+), no fiber/hydration, pn meds (they slow gastric motility)
47
What is diverticulitis?
Like aneurysm of colon. Pockets form in digestive membrane. bacteria trapped in pouches = inflammation/infection
48
At what age do people usually get appendicitis? How can you prevent it?
Early 20s. Best prevention = high fiber diet
49
What are the 3 stages of appendicitis?
Early, ripe, & rupture stage
50
Pt has periumbilical pn, NV, low grade fever. What’s wrong?
Early stage of appendicitis
51
Pt has RLQ pn (McBurney’s point) w/ weakness and fever. What might be wrong?
Ripe stage of Appendicitis. Imminent burst.
52
Pt was having RLQ pn but now has generalized somatic pn w/ fever. He does have RLQ pn when you touch his LLQ or when he coughs. What’s wrong?
Rupture stage of appendicitis.
53
RLQ pn when palpating LLQ. What sign?
Rovsing’s sign
54
RLQ pn when coughing. What sign?
Dunphy’s sign
55
Where do most bowel obstructions occur?
Duodenum of the small intestine
56
Pt has cramping/intermittent pn w/ NV & poop vomit (feculent). She is hypotensive. What’s wrong and what Rx?
Bowel obstruction (most likely small bowel)
Rx = Supportive w/ sepsis assessment
57
Why can pt’s w/ bowel obstructions be hypotensive?
They’re hypovolemic DT 3rd spacing. Fluids move into colon as it gets more inflamed/swollen
58
Pt has NV, ab distention, absent bowel sounds W/ hyperresonance. What’s wrong?
Bowel obstruction (most likely in large intestines)
59
What is sepsis?
Body’s overreaction to infection/virus = shock. Usually bacterial.
60
How does sepsis progress to shock?
Immune system gets overwhelmed & fails = Toxins circulate in body = systemic vasodilation & acidosis
61
You think pt is septic. What are the SS?
```
Fever/chills
AMS
SBP 100 or less
Tachycardia
Resp 22+
ETCO2 < 25mmHG
Temp really cold or really hot
```
“he’s septic, drive *FASTTER*”
62
Pt has Fever, pn, AMS, tachy w/ vitals: Resp 24, ETCO2 22, BP 95/62. What’s wrong, what Rx?
He’s septic.
Rx = look for source. IV w/ Fluids @ 30ml/kg, monitor
63
How does a tension pneumo create narrowing pulse pressure
Pushes lungs against heart = heart twists = inferior vena cava kinks = no preload = narrowing pulse pressure
64
Classic SS of tension pneumo?
JVD, narrowing pulse pressure, tracheal deviation, unequal breath sounds/chest rise
65
Where can you need decompress?
- 2-3rd intercostal or 5-6th intercostal
| - ABOVE the rib
66
Flail chest = ___ or more ribs broken in ___ or more places
2, 2
67
Which way does a flail chest move during inspiration?
It goes inwards, while rest of ribs expand out/up
68
Flail Chest Rx spectrum?
- Pt self splint w/ hand
- 2nd choice = bulky dressing
- CPAP until resp failure
- finally, Intubate & bag
69
How can a pulmonary contusion be deadly? Finish the progression: “trauma to chest = …”
Trauma to chest = Blood/fluid buildup + WBC activation = edema = surfactant washed away = atelectasis = hypoxia = more mucus = whole section of alveoli becomes useless = pulmonary shunting = more hypoxia & dysrhythmia
70
What MOI’s could possibly = Myocardial contusion
- Blunt trauma to chest
| - Massive deceleration force (i.e. Frontal crash)
71
Explain the pathophysiology of anaphylaxis. Finish the progression: “Body exposed to allergen = Mast cells…
Body exposed to allergen = mast cells release histamine = vasodilation & increased cap permeability = shock & hypoxia
72
Pt has hypotension, urticaria, flushing, swelling, wheeze/bronchospasm. What’s wrong & what Rx?
Anaphylaxis.
Rx = O2, Epi (for low BP), Benadryl (for itching), Albuterol/Ipratropium (for bronchospasm), ETCO2 (look for shark fins)
73
Concentration, Dosage, route & frequency of EPI for anaphylactic pt
- IM = 1:1000. IV = 1:10,000
- 30+ kg = 0.3mg
- 15-30kg = 0.15mg
- give every 5-15 min
74
What’s ludwig’s Angina?
Cellulitis of cheek/neck (usually DT tooth infection) = large abscess/mass under jaw = airway compromise risk
75
Pt has SOB, dysphagia, neck pn/swelling, drooling, fever w/ massive lump under jaw. What’s wrong & what Rx?
Ludwig’s Angina
Rx = aggressive airway mgmt, steroids, rapid transport
76
What kind of ppl are susceptible to spontaneous pneumo thoraces
Tall skinny males, asthmatics, smokers, COPDers
77
Sudden onset SOB w/ sharp pn after a bunch of coughing. What’s wrong?
Probable spontaneous Pneumothorax.
Rx = monitor VS & transport w/ O2
78
How many lobes in the R vs L lung? Which Main bronchus do ET tubes accidentally slip into?
*think “L = less”*
```
L = 2 lobes
R = 3 Lobes
```
- R main stem bronchus is more vertical, so ET tubes usually going into this one.
79
What is Pleurisy? How to assess it?
Pleural space dries inside and visceral + parietal pleura rub against each other. Very painful!
Assess = auscultate area for “leather rubbing” sound
80
Define tidal volume. What is the average number?
Tidal volume = amount air moved in a single breath
Average = 500 ml (150 lost to dead space)
81
What’s “Inspiratory reserve volume”
Extra air you can inhale after normal breath
82
Define Expiratory volume
Max air you can exhale
83
Define Residual volume
Air left in lungs after max exhale
84
What’s vital capacity
Amount air moved w/ max inhale & exhale
85
Anatomical vs physiological dead space
Anatomical = parts of lungs where there’s no diffusion (ex. Bronchus & trachea)
Physiological = parts w/ damaged alveoli
86
What’s minute volume? What’s the formula for it?
Minute volume = amount air breathed in/out in 1 min
Minute vol. = resp rate x tidal volume
87
Which is best way to determine if pt has good ventilations?
- Tidal volume
- Expiratory volume
- vital capacity
- Residual volume
- Minute volume
Minute Volume! (how much air being moved in/out lungs every minute)
88
Name the airway structures from largest to smallest. “Trachea…”
Trachea = main stem bronchus, R/L bronchus, Bronchioles, Alveoli
89
Did you know there are 2 types of alveoli? How are they different?
Type I = normal ones for gas exchange
Type II = Makes surfactant = reduce surface tension = help keeps alveoli from collapsing
90
What can wash away/destroy the surfactant in your alveoli, causing atelectasis (collapse)?
Trauma, Water/aspiration, smoking, infection
91
TIA vs stroke is like ___ vs heart attacks
Angina
92
TIAs aren’t acutely serious, but they are an ominous sign of what?
Vascular problem in brain. 33% chance CVA will happen in future
93
Your pt has hx HTN and calls 911 today. 99% chance the issue is __ , __ , or ___.
CVA, MI, Aneurysm
94
TIA symptoms all resolve within how many hours?
24
95
Which type of stroke is more common? Ischemic or hemorrhagic
87% are ischemic
13% hemorrhagic
96
Pt wakes up from sleep/nap w/ headache & neural deficits (ex. Facial droop, hemiparesis, slurred speech). What TYPE of stroke is it most likely?
Ischemic stroke
97
Pt states they are having the “worst headache of their life”. What TYPE of stroke is most likely?
Hemorrhagic
98
Pt tells you they have a headache that feels like “thunder clapping” inside their head. What TYPE of stroke most likely?
Subarachnoid
99
Pt gets knocked out, regains consciousness, then CRASHES after. Epidural or subdural CVA?
Epidural
100
Pt gets knocked out, regains consciousness, then gradually deteriorates. Epidural or Subdural CVA?
Subdural
101
Which artery is mainly responsible to epidural bleeds?
Middle meningeal artery
102
You notice your pt has A-fib, and that they AREN’T taking their medications. What are they highly at risk of having?
An ischemic stroke. A-fib = main cause of clots that go to the brain. The pt will most likely be on blood thinners.
103
What are SS of ICP
Cushings reflex: ataxic/Cheyenne stokes respirations, Bradycardia, HTN
104
Fucked respirations, blown pupils, flaccid paralysis following a head trauma. What level ICP does the pt have (mild, mod, severe)
Severe
105
Central neurogenic hyperventilation, decerebrate posturing, heavy cushings reflex. What level of ICP does pt have (mild, moderate, severe)
Moderate.
Severe = flaccid w/ blown pupils
106
Pt has Bradycardia, HTN, Cheyenne stokes respirations and vomiting w/out nausea. What level of ICP do they have?
Mild. More severe when they start to posture
107
Localized & intense pn is described as…
- Somatic/parietal or Visceral pn?
Somatic/parietal.
*somatic pn = so DRAmatic pn”
108
Poorly localized & diffused pn = which?
- Somatic/parietal vs Visceral pn
Visceral.
*ViscerALL = all over pn”
109
What’s the cut off time for clot buster drugs in a CVA?
3-4.5 hours
110
You suspect pt has a CVA. What Rx?
“CVA is like a B(rain) STEMI”
- BGL
- Semifowlers (30 degrees)
- Temp (maintain it)
- ETCO2 (hyperventilate till 30-35)
- Monitor (12-lead)
- IV (20g or bigger @ R AC = ideal)
111
Pt had Hx upper resp infection. Today she has CC: CP that lessens when leaning forward. SS: fever, non sensical ST elevation, friction rub auscultated at L sternum. What’s wrong?
Pericarditis
112
If you think someone has pericarditis, what ECG signs?
Non sensical ST elevation across all leads w/ J wave (small hump @ end of QRS)
113
Occipital lobe of brain deals with what function…
Visual stuff
114
Parietal lobe of brain = what function
Touch/texture/tactile memories
*Parietal = top part… TOP = TOUCH*
115
Temporal lobe of brain = what function
hearing, smell, language
* Temporal = ear location… ears HEAR LANGUAGE.*
116
Front lobe brain = what function
Personality / voluntary muscle control
117
the limbic system is inside your brain. What does it do?
Basic emotions & reflexes
*to play LIMBO, you need emotion and good reflexes*
118
Thalamus vs Hypothalamus
Thalamus = message relay center
Hypothalamus = temp control & hormone control
*Hypo-thalamus.. HIPPO. HIPPOs cool off (temperature) and are aggressive (hormones)
119
What are the parts of the brain stem and what do they do?
- Midbrain = LOC & sleep
- Pons = resp
- Medulla oblongata = Vitals
- Cerebellum = coordinated movements
120
What’s a hangman’s fracture?
Head snaps sideways at C1 & C2 (aka the Dens) + quick spinal cord tear
121
What is Don Juan Syndrome?
Don Juan fucked a man’s wife and jumped from a balcony
* pattern of Fractures from a vertical fall = food, hip, T12-L1&L2, Forearm & wrist
122
What’s Claudication
Cramping feeling in low legs DT ischemia & low Potassium lvls
123
Pt feels tightness & weakness/fatigue in calf w/ pn that gets worse when walking/exercising. Goes away w/ rest. What’s wrong? And why is this bad?
It’s called “Claudication”. Indicates peripheral artery disease or a clot
124
Pt has epigastric pn/ CP after bout of forceful vomiting/ dry heaving. What’s wrong?
Possible Mallory-Weiss syndrome or Boerhaave Syndrome
125
What’s the difference between a Mallory-weiss vs Boerhaave syndrome?
* Visualize:Boerhaave = BOARS. Boars have tusks that completely penetrate*
- Both are tears in the esophagus, but a Boerhaave “completely penetrates” & goes through; results in blood in pneumomediastinum
126
Abruptio placenta vs placenta previa
- both are most common 3rd trimester bleeds.
- Previa = placenta over cervix = painless w/ bright red blood
- Abruptio = placenta rips from uterus = painful w/ almost no blood
127
how often should you APGAR a baby?
At 1, 5, 10min post birth
128
What does APGAR stand for?
Appearance, pulse, grimace, activity, respirations
129
If you need to bulb suction a newborn, which to suction first? Mouth or nose?
Mouth first
130
Pt has dull low ab pn that became stabby, has spotting, shoulder pn & a positive pregnancy result. What’s wrong?
Ectopic pregnancy
131
What are risk factors for an ectopic pregnancy?
Anything that scars/inflames pelvis : PID, IUD, previous ectopic, surgery
132
Young girl of child bearing years has ab pn. What must you assume?
Ectopic pregnancy
133
Gallbladder is a hollow or solid organ
Hollow organ. Contains bile made from liver
134
People with gallbladder problems almost always have __ problems, because….
They almost always have PANCREAS problems, because both secrete into duodenum via the same duct
135
Pancreas is a solid or hollow organ
Solid organ
136
Exocrine vs Endocrine functions of the pancreas
Exocrine = digestive enzymes
Endocrine = Alpha/beta/delta cells make glucagon/insulin/somatostatin (respectively)
137
The liver is a solid or hollow organ?
Solid organ
138
What does the liver do?
- Maintain BGL
- Detox of blood
- make plasma protein & clot factors
139
Kidneys are solid or hollow organs?
Solid organs
140
What hormones do the kidneys secrete?
Renin, Erythropoietin, Cholesterol.
141
What are the functions of the kidneys?
- BP maintenance
- Blood/waste filter
- electrolyte water balance (pH)
- makes new glucose
142
What are the three parts of the kidneys?
1. Renal cortex = outer layer
2. Renal medulla = middle layer
3. Renal pelvis = collects urine
143
Normal pH of body is…? What lvl is acidic? Alkalinic?
7.35 - 7.45
- <7.35 = acidic
- >7.45 = alkalinic (basic)
144
When the body gets out of pH balance, it goes through respiratory & metabolic compensation. How are these different?
Respiratory = faster but incomplete (breathing faster)
Metabolic = slower but more effective (bicarbonate)
145
What happens when you HYPOventilate (resp. Acidosis)?
Hypotension
Headache
Flushed skin
Dysrhythmias
146
What happens when you HYPERventilate (resp alkalosis)?
Blurry vision, NV, tingling/numb lips face fingers, light headed, dizzy, toes/finders curl in
147
Why do people get tingly w/ curling fingers/toes when they hyperventilate?
Higher resp = alkalosis
Kidneys compensate = retain H+ = H & Ca++ from blood go into cells = hypocalcemia = muscle contractions
148
What happens to body (SS) when its in Metabolic acidosis?
*think: “When HYPpies (hypotension), do ACID (acidosis), to feel WARM (flushed skin) RHYTHMs (Dysrhythmias) instead of HEADACHES and Depression (CNS depression)”
```
Hypotension
Warm flushed skin
Dysrhythmias
Headaches
CNS depression
```
149
What happens to the body during metabolic alkalosis?
Confusion, muscle tremors/cramps, bradypnea, hypotension
150
What’s #1 cause Gastric Ulcers?
H pylori Bacteria
151
Peptic Ulcer Disease
When protective mucus lining of stomach is eroded & stomach acid eats the tissue
152
What’s gastritis?
Stomach inflamed. No erosion of lining yet… later progresses to peptic ulcer disease (erosion state)
153
What causes erosion of the stomach lining?
chronic NSAIDS, spicy food, smoking, alcohol, high stress
154
Pt has epigastric pain that gets better post meal, but returns 2-3 hours later. What’s wrong? What Rx?
Other SS: Dyspepsia (burp, bloat, fat food intolerance)
Gastritis
Rx = Orthostatic / sepsis assessment, Fluids PRN
155
Pt has sudden onset SOB w/ Chest pn, JVD & cyanosis. What’s wrong?
Pulmonary embolism
156
What is Virchow’s triad?
Factors to causing clotting/embolisms in a person:
- Venous stasis (blood not moving)
- Vein damage
- Activation of blood clotting process
157
What types of ppl are susceptible to getting a pulmonary embolism?
Women on birth control/smoking, post surgery, anything causing long periods of immobility (ex. Plane ride, nursing home, hospital stays)
158
Pt has sudden onset CP w/ SOB & JVD. Pt is purple/cyanotic from nipple line up. What’s wrong?
Saddle embolus = Super big clot at the main pulmonary artery bifurcation.
159
What is a lefort fracture. How can it be serious?
Unstable face Fx. #1 concern = airway mgmt
160
What are the different types of Le Fort Fx.
```
I = Just maxilla
II = pyramid shape (maxilla & nose)
III = all mid facial bones up to upper orbit
```
161
Pt suffered blunt trauma to face and now has severe pn, numb upper lip, & problems seeing. What’s wrong?
Le Fort Fx
162
Pt has shuffle gait, foul discharge, fetal position, fever, alot of pn during her period. What’s wrong?
PID
163
What group of ppl mostly get PIDs
Sexually active girls <25
164
What are the consequences of PID
MODS, sepsis, abscesses, infertility, ectopic pregnancy risk
165
What are some risk factors of PID?
- many sex partners
- douching
- STDs
- IUD
- Abortion
166
Which STD can spread to the anus or throat?
Gonorrhea
167
How are gonorrhea SS different from males & females
Males = pus discharge + dysuria
Females = mild inflammation progresses to PID
168
Pt has lesions on their gonads & face w/ rash, patchy hair loss, swollen lymph glands. What’s wrong?
Syphilis
169
Which STD, if left untreated can spread to your heart, eyes, ears, brain, & make lesions on bones /tissues?
Syphilis
170
Which STD is the leading cause of preventable blindness?
Chlamydia
