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
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
What MOI’s could possibly = Myocardial contusion
- Blunt trauma to chest
- Massive deceleration force (i.e. Frontal crash)
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
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)
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
What’s ludwig’s Angina?
Cellulitis of cheek/neck (usually DT tooth infection) = large abscess/mass under jaw = airway compromise risk
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
What kind of ppl are susceptible to spontaneous pneumo thoraces
Tall skinny males, asthmatics, smokers, COPDers
Sudden onset SOB w/ sharp pn after a bunch of coughing. What’s wrong?
Probable spontaneous Pneumothorax.
Rx = monitor VS & transport w/ O2
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.
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
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)
What’s “Inspiratory reserve volume”
Extra air you can inhale after normal breath
Define Expiratory volume
Max air you can exhale
Define Residual volume
Air left in lungs after max exhale
What’s vital capacity
Amount air moved w/ max inhale & exhale
Anatomical vs physiological dead space
Anatomical = parts of lungs where there’s no diffusion (ex. Bronchus & trachea)
Physiological = parts w/ damaged alveoli
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
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)
Name the airway structures from largest to smallest. “Trachea…”
Trachea = main stem bronchus, R/L bronchus, Bronchioles, Alveoli
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
What can wash away/destroy the surfactant in your alveoli, causing atelectasis (collapse)?
Trauma, Water/aspiration, smoking, infection
TIA vs stroke is like ___ vs heart attacks
Angina
TIAs aren’t acutely serious, but they are an ominous sign of what?
Vascular problem in brain. 33% chance CVA will happen in future
Your pt has hx HTN and calls 911 today. 99% chance the issue is __ , __ , or ___.
CVA, MI, Aneurysm
TIA symptoms all resolve within how many hours?
24
Which type of stroke is more common? Ischemic or hemorrhagic
87% are ischemic
13% hemorrhagic
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
Pt states they are having the “worst headache of their life”. What TYPE of stroke is most likely?
Hemorrhagic
Pt tells you they have a headache that feels like “thunder clapping” inside their head. What TYPE of stroke most likely?
Subarachnoid
Pt gets knocked out, regains consciousness, then CRASHES after. Epidural or subdural CVA?
Epidural
Pt gets knocked out, regains consciousness, then gradually deteriorates. Epidural or Subdural CVA?
Subdural
Which artery is mainly responsible to epidural bleeds?
Middle meningeal artery
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.
What are SS of ICP
Cushings reflex: ataxic/Cheyenne stokes respirations, Bradycardia, HTN
Fucked respirations, blown pupils, flaccid paralysis following a head trauma. What level ICP does the pt have (mild, mod, severe)
Severe
Central neurogenic hyperventilation, decerebrate posturing, heavy cushings reflex. What level of ICP does pt have (mild, moderate, severe)
Moderate.
Severe = flaccid w/ blown pupils
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
Localized & intense pn is described as…
- Somatic/parietal or Visceral pn?
Somatic/parietal.
*somatic pn = so DRAmatic pn”
Poorly localized & diffused pn = which?
- Somatic/parietal vs Visceral pn
Visceral.
*ViscerALL = all over pn”
What’s the cut off time for clot buster drugs in a CVA?
3-4.5 hours
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)
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
If you think someone has pericarditis, what ECG signs?
Non sensical ST elevation across all leads w/ J wave (small hump @ end of QRS)
Occipital lobe of brain deals with what function…
Visual stuff
Parietal lobe of brain = what function
Touch/texture/tactile memories
Parietal = top part… TOP = TOUCH
Temporal lobe of brain = what function
hearing, smell, language
- Temporal = ear location… ears HEAR LANGUAGE.*
Front lobe brain = what function
Personality / voluntary muscle control
the limbic system is inside your brain. What does it do?
Basic emotions & reflexes
to play LIMBO, you need emotion and good reflexes
Thalamus vs Hypothalamus
Thalamus = message relay center
Hypothalamus = temp control & hormone control
*Hypo-thalamus.. HIPPO. HIPPOs cool off (temperature) and are aggressive (hormones)
What are the parts of the brain stem and what do they do?
- Midbrain = LOC & sleep
- Pons = resp
- Medulla oblongata = Vitals
- Cerebellum = coordinated movements
What’s a hangman’s fracture?
Head snaps sideways at C1 & C2 (aka the Dens) + quick spinal cord tear
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
What’s Claudication
Cramping feeling in low legs DT ischemia & low Potassium lvls
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
Pt has epigastric pn/ CP after bout of forceful vomiting/ dry heaving. What’s wrong?
Possible Mallory-Weiss syndrome or Boerhaave Syndrome
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
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
how often should you APGAR a baby?
At 1, 5, 10min post birth
What does APGAR stand for?
Appearance, pulse, grimace, activity, respirations
If you need to bulb suction a newborn, which to suction first? Mouth or nose?
Mouth first
Pt has dull low ab pn that became stabby, has spotting, shoulder pn & a positive pregnancy result. What’s wrong?
Ectopic pregnancy
What are risk factors for an ectopic pregnancy?
Anything that scars/inflames pelvis : PID, IUD, previous ectopic, surgery
Young girl of child bearing years has ab pn. What must you assume?
Ectopic pregnancy
Gallbladder is a hollow or solid organ
Hollow organ. Contains bile made from liver
People with gallbladder problems almost always have __ problems, because….
They almost always have PANCREAS problems, because both secrete into duodenum via the same duct
Pancreas is a solid or hollow organ
Solid organ
Exocrine vs Endocrine functions of the pancreas
Exocrine = digestive enzymes
Endocrine = Alpha/beta/delta cells make glucagon/insulin/somatostatin (respectively)
The liver is a solid or hollow organ?
Solid organ
What does the liver do?
- Maintain BGL
- Detox of blood
- make plasma protein & clot factors
Kidneys are solid or hollow organs?
Solid organs
What hormones do the kidneys secrete?
Renin, Erythropoietin, Cholesterol.
What are the functions of the kidneys?
- BP maintenance
- Blood/waste filter
- electrolyte water balance (pH)
- makes new glucose
What are the three parts of the kidneys?
- Renal cortex = outer layer
- Renal medulla = middle layer
- Renal pelvis = collects urine
Normal pH of body is…? What lvl is acidic? Alkalinic?
7.35 - 7.45
- <7.35 = acidic
- > 7.45 = alkalinic (basic)
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)
What happens when you HYPOventilate (resp. Acidosis)?
Hypotension
Headache
Flushed skin
Dysrhythmias
What happens when you HYPERventilate (resp alkalosis)?
Blurry vision, NV, tingling/numb lips face fingers, light headed, dizzy, toes/finders curl in
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
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
What happens to the body during metabolic alkalosis?
Confusion, muscle tremors/cramps, bradypnea, hypotension
What’s #1 cause Gastric Ulcers?
H pylori Bacteria
Peptic Ulcer Disease
When protective mucus lining of stomach is eroded & stomach acid eats the tissue
What’s gastritis?
Stomach inflamed. No erosion of lining yet… later progresses to peptic ulcer disease (erosion state)
What causes erosion of the stomach lining?
chronic NSAIDS, spicy food, smoking, alcohol, high stress
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
Pt has sudden onset SOB w/ Chest pn, JVD & cyanosis. What’s wrong?
Pulmonary embolism
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
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)
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.
What is a lefort fracture. How can it be serious?
Unstable face Fx. #1 concern = airway mgmt
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
Pt suffered blunt trauma to face and now has severe pn, numb upper lip, & problems seeing. What’s wrong?
Le Fort Fx
Pt has shuffle gait, foul discharge, fetal position, fever, alot of pn during her period. What’s wrong?
PID
What group of ppl mostly get PIDs
Sexually active girls <25
What are the consequences of PID
MODS, sepsis, abscesses, infertility, ectopic pregnancy risk
What are some risk factors of PID?
- many sex partners
- douching
- STDs
- IUD
- Abortion
Which STD can spread to the anus or throat?
Gonorrhea
How are gonorrhea SS different from males & females
Males = pus discharge + dysuria
Females = mild inflammation progresses to PID
Pt has lesions on their gonads & face w/ rash, patchy hair loss, swollen lymph glands. What’s wrong?
Syphilis
Which STD, if left untreated can spread to your heart, eyes, ears, brain, & make lesions on bones /tissues?
Syphilis
Which STD is the leading cause of preventable blindness?
Chlamydia
