Dale's Review Concepts I Flashcards
What is Cor Pulmonale
R side enlargement/hypertrophy progress to failure DT pulmonary HTN, COPD, massive PE
Pt w/ Hx COPD has R side strain, peripheral edema JVD, hepatojugular reflux, & several day onset dyspnea. What’s the problem?
Cor Pulmonale
How to diagnose Cor Pulmonale
S1QT3
R vs L side failure
1 Cause of R side failure = LSF. # 2 cause = PE/COPD
What hormones do the kidneys secrete. What do they do?
- Erythropoietin = make RBCs
- Calcitrol = Converted from Vit D = small intestine absorb Ca ++, phosphate for bone growth
- Renin = RAAS for higher BP
What hormones does the Anterior Pituitary Gland produce
- ACTH = steroids
- FSH
- GH
- LH
- Prolactin = milk
- TSH
What hormones does the Posterior Pituitary Gland create
- ADH
- Oxytocin
What 3 hormones are involved in the RASS system?
- Renin
- Angiotensin II
- Aldosterone
Explain the RASS system process
- 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
Endocrine vs Nervous System
- Endocrine = slow acting, long lasting
- Nervous = Fast acting, long lasting
What hormones does the Thyroid Gland make? What do they do?
T3, T4, & Calcitonin (lowers blood Ca++)
What body parts does the parathyroid gland regulate? What hormone does it release?
- Affects bones, intestines, kidneys
- Parathyroid hormone = increase blood Ca++ lvls
What two cycles make up the menstrual cycle?
Ovarian & Uterine
Name the 2 phases of the ovarian cycle and what happens during them?
- Follicular phase = FSH & LH helps follicle rupture
- Luteal phase = rupture follicle becomes corpus luteum and releases hormones to facilitate pregnancy
Explain the Uterine cycle and its two phases
- Proliferative phase = endometrium thickens & perfusion is increased
- Secretion phase = less hormone production & uterine lining shed
What separates the three stages of labor
- Stage 1 = onset of labor to full cervix dilation
- Stage 2 = crowning to full fetus delivery
- Stage 3 = placenta delivery
What happens to the uterus before labor starts
Up to 1 wk prior to labor…
- Lightening = Fetus moves from upper ab to lower pelvis
- Bloody show = mucus plug @ cervix + blood expelled
A&P: Caudal
Going towards tail/feet
A&P: cephalic
Going towards head
Anatomical plane cuts body in top & bottom half
Transverse Plane
Anatomical Plane cuts body between front & back halves
Frontal / Coronal plane
Anatomical plane cuts body into L and R halves
Sagittal (Lateral) plane
Name of Valves separating Atria from Ventricles. Name of the L & R one?
The Atrioventricular valves
- L = Bicuspid/Mitral valve
- R = Tricuspid Valve
Name of valves separating the ventricles & the lungs/aorta
The Semilunar valves (aortic & pulmonary valve)
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
What’s a Bruit
Whooshing sound auscultated over vessel = turbulence = plaque build up
What are the 2 main coronary arteries?
R & L coronary artery
What does the L coronary artery bifurcate into?
- Circumflex (lateral wall L Ventricle)
- L Anterior Descending (Septum & anterior wall LV)
What does the R coronary artery bifurcate into?
- Marginal
- posterior descending artery
Name the reciprocal leads of the following: II, III, aVF
I, aVL
What are the reciprocal leads? I, aVL, V5, V6
II, III, aVF
What are the reciprocal leads of V1, V2
V7, V8, V9
Which ECG correlate w/ the inferior wall of the L ventricle
II, III, aVF
Which ECG leads correlate w/ the septum of the heart
V1 & V2
Which ECG leads correlate to the anterior wall of L ventricle
V3, V4
Which ECG leads correlate w/ High lateral wall of L ventricle
I, aVL
Which ECG leads correlate w/ the low lateral wall of L ventricle
V5, V6
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
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
What is cholecystitis
Gallbladder infection
Pt has pn in RUQ and can’t inhale deeply if you press it. What sign is this?
Murphy’s sign
What is Charcot triad and what is it for?
Fever, RUQ pn, jaundice = common bile duct inflammation/block
What are the 5 F’s for cholecystitis?
Fat, fair, female, Fertile, 40-50s
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
Pt has LLQ pn w/ infection SS (Fever, NVD, Weak). What is wrong & what Rx?
Diverticulitis.
Rx = supportive. Rule out sepsis.
What are the risk factors for diverticulitis?
Old (60+), no fiber/hydration, pn meds (they slow gastric motility)
What is diverticulitis?
Like aneurysm of colon. Pockets form in digestive membrane. bacteria trapped in pouches = inflammation/infection
At what age do people usually get appendicitis? How can you prevent it?
Early 20s. Best prevention = high fiber diet
What are the 3 stages of appendicitis?
Early, ripe, & rupture stage
Pt has periumbilical pn, NV, low grade fever. What’s wrong?
Early stage of appendicitis
Pt has RLQ pn (McBurney’s point) w/ weakness and fever. What might be wrong?
Ripe stage of Appendicitis. Imminent burst.
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.
RLQ pn when palpating LLQ. What sign?
Rovsing’s sign
RLQ pn when coughing. What sign?
Dunphy’s sign
Where do most bowel obstructions occur?
Duodenum of the small intestine
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
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
Pt has NV, ab distention, absent bowel sounds W/ hyperresonance. What’s wrong?
Bowel obstruction (most likely in large intestines)
What is sepsis?
Body’s overreaction to infection/virus = shock. Usually bacterial.
How does sepsis progress to shock?
Immune system gets overwhelmed & fails = Toxins circulate in body = systemic vasodilation & acidosis
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”
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
How does a tension pneumo create narrowing pulse pressure
Pushes lungs against heart = heart twists = inferior vena cava kinks = no preload = narrowing pulse pressure
Classic SS of tension pneumo?
JVD, narrowing pulse pressure, tracheal deviation, unequal breath sounds/chest rise
Where can you need decompress?
- 2-3rd intercostal or 5-6th intercostal
- ABOVE the rib
Flail chest = ___ or more ribs broken in ___ or more places
2, 2
Which way does a flail chest move during inspiration?
It goes inwards, while rest of ribs expand out/up
Flail Chest Rx spectrum?
- Pt self splint w/ hand
- 2nd choice = bulky dressing
- CPAP until resp failure
- finally, Intubate & bag