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Cardiopulmonary Midterm > Diseases/Clinical > Flashcards

Diseases/Clinical Flashcards

1
Q

Which ribs are most commonly fractured?

What may occur if lower ribs are fractured?

What is the hallmark of severe blunt trauma for rib fxs and what else can be injured?

A

Ribs 4-10 most commonly fractured

lower rib fxs may tear diaphragm (diaphragmatic hernia)

1st rib fx = hallmark of severe blunt trauma (can also injury brachial plexus and subclavian vessels)

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2
Q

Difference between primary and secondary atelectasis

A 
primary = failure of lungs to inflate at birth
secondary = collapse of previously inflated lungs
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3
Q

Define pneumothorax, hydrothorax, hemothorax, and hemopneumothroax

A 
pneumothorax = entry of air into pleural cavity
hydrothorax = accumulation of fluid in pleural cavity (pleural effusion)
hemothorax = blood in pleural cavity
hemopneumothroax = accumulation of both blood and air
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4
Q

Where should a needle be inserted during a thoracentesis?

A

into 9th intercostal space in midaxillary line during expiration; should be inserted superior to rib to avoid neuromuscular bundles and angled upward

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5
Q

Where should a chest tube be inserted?

A

5th or 6th intercostal space in midaxillary line (approximately nipple line)

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6
Q

What are the signs and sx of pleurisy (inflammation of pleura)?

A

sharp stabbing pain, especially on exertion; will hear sounds like clumps of hair being rubbed between fingers

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7
Q

What are common sites of metastases for bronchogenic carcinoma? What are the first lymph nodes to enlarge? What nerves may be involved by metastases?

A

brain; bone, and suprarenal glands

Mediastinal lymph nodes

Phrenic N may cause paralysis of hemidiaphragm; recurrent laryngeal N. may result in hoarseness/paralysis of vocal cord

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8
Q

Define pericarditis, pericardial rub, and pericardial effusion

A

pericarditis - inflammation of pericardium
pericardial rub - friction caused by pericarditis (smooth wall becomes rough) - sounds like rustle of silk
pericardial effusion - passage of fluid from pericardial capillaries into pericardial cavity or pus

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9
Q

Where would you insert a needle for a pericardiocentesis?

A

through left 5th or 6th intercostal space near sternum

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10
Q

In what arteries do the majority of MIs occur?

A

anterior interventricular A. (50%); RCA (30-40%) and circumflex branch of LCA (15-20%)

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11
Q

What causes angina pectoris? How does it differ from an MI?

A

results from ischemia of heart that falls short of cellular necrosis (narrowed arteries); pain will be transient where as MI pain isn’t

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12
Q

What causes cardiac referred pain?

A

visceral sensory fibers of heart share spinal ganglion w/ somatic sensory fibers of upper limb and later chest wall; may feel pain in area innervated by left medial brachial cutaneous N.

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13
Q

What part of the lung can be punctured without going through the rib cage?

A

Apex of lung - located in root of neck above superior thoracic aperture

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14
Q

What is the costovertebral angle? What injury can occur at that angle?

A

angle between 12th rib and spine; parietal pleura present and can be punctured (causing pneumothorax) if needle inserted into pt’s back

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15
Q

What 2 clinical problems can the ligamentum arteriosum cause?

A

weak spot in atrial wall can create aneurysm; if it bulges out, it can hit left recurrent laryngeal N. and cause hoarseness/paralysis of lymph nodes

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16
Q

What are 5 areas to listen to heart valves?

A

Aortic - right 2nd intercostal space
Pulmonary - left 2nd intercostal space
Erb’s point - (S1, S2) - left 3rd intercostal space
Tricuspid - lower left sternal border (4th intercostal space)
Mitral - left 5th intercostal space, medial to midclavicular line

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17
Q

Difference between spontaneous and tension pneumothorax

A 
Spontaneous = rupture of alveoli through visceral pleura spontaneously (no injury)
Tension = air enters thorax and cannot exit due to trauma and positive pressure ventilation (during resuscitation)
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18
Q

What is a meniscus sign?

A

due to surface tension between 2 different fluids in pleural cavity (normally serous fluid and pleural effusion)

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19
Q

What is a coin sign?

A

solitary, round shadows on Xray that may be calcified; caused by TB, neoplasms, cysts, and vascular anomalies

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20
Q

What are kerley lines?

Difference between A and B lines

A

seen when interlobular septa in pulmonary interstitium becomes prominent (enlarged lymphatics)
A = diagonal lines running from hila to periphery
B = short parallel lines at periphery

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21
Q

Define Cardiac Tamponade and what it would look like on Xray

A

fluid buildup within pericardial cavity; obstructs blood flow; would see a globular heart silhouette in Xray

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22
Q

What is Beck’s triad and what is it associated with?

A

associated w/ cardiac tamponade -> distant heart sounds, jugular dissension, and hypotension

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23
Q

What region of the rib is most likely to fracture?

A

rib angle located more posteriorly

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24
Q

Difference between rib dislocation and separated rib?

A

Dislocation - displacement of costal cartilage from sternum; occurs at sternocostal joint (usually ribs 8-10)
Separation - occurs at costochondral joint; rib pops out of cartilage attaching it to sternum (usually ribs 3-10)

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25
Q

What is gastroschisis? How does it differ from an umbilical hernia?

A

failure of lateral folds to fuse at midline (protrusion of viscera at right side of umbilical cord); differs from umbilical hernia in that the bowel is not covered by mesentery and is floating in amniotic fluid

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26
Q

Where would a congenital epigastric hernia be located?

A

midline bulge of ABD wall between umbilicus and xiphoid process

27
Q

Where are you most likely to find a congenital diaphragmatic hernia (CDH)?

A

visceral bulge into pleural cavity on left side (left is larger and has more surface area to close)

28
Q

What causes laryngeal atresia and what does it lead to?

A

failure of recanalization of larynx; leads to CHAOS syndrome (obstruction of upper fetal airway)

29
Q

What is a tracheoesophageal fistula? Describe the complications of it

A

Failure of endoderm to proliferate enough to create tracheoesophageal septum and divide trachea and esophagus

Milk will be swallowed into blind esophagus and regurgitated into the trachea; can then drain into attached esophagus or be aspirated; also leads to polyhydramnios

30
Q

Complications of oligohydramnios

A

can impair lung development (lack of fetal breathing movements); leads to pulmonary hypoplasia where fluid is pulled into larger lung and not the smaller

31
Q

What is the main cause of respiratory distress syndrome (RDS) and what are the sx?

A

surfactant deficiency (type II pneumocytes); sx include tachypnea, nasal flaring, grunting, and cyanosis

32
Q

Causes and sx of congenital lung cysts

A

cysts filled w/ fluid or air due to dilation of terminal bronchi; may cause wheezing, cyanosis, or difficulty breathing (may also be asymptomatic)

33
Q

Difference between capillary and cavernous hemangiomas

A 
capillary = excessive capillary formation
cavernous = excessive venous sinus formation
34
Q

Describe the different types of heterotaxia: ventricular inversion; situs inverses; situs ambiguous (visceroatrial heterotaxia)

A

ventricular inversion - reverse cardiac looping causes a right-sided left ventricle
situs inverses - total heart reversal of heart and GI organs
situs ambiguous (visceroatrial heterotaxia) - partial reversal (right-sided heart, normal GI)

35
Q

What does failure of AV septum fusion cause and what disease is it linked to?

A

creates ASD and VSD as cushion tissue from AV septum forms fibrous septa; linked to Down’s Syndrome

36
Q

What is a complication of ASDs?

A

can raise pressure of rt side of heart and cause hypertrophy as well as mixing of oxygenated and deoxygenated blood

37
Q

How might cyanosis also manifest besides blue skin tone?

A

clubbing of fingers, bluish fingertips, fatigue

38
Q

What is a double outlet right ventricle?

A

insufficient shifting of AV septum or cardiac looping leads to both aorta and pulmonary A exiting RV

39
Q

Complications of VSDs

A

LV hypertrophy and pulmonary congestion (too much blood going through pulmonary circuit)

40
Q

What is persistent truncus arteriosus?

A

lack of separation between pulmonary A and aorta

41
Q

What is the most common cause of cyanosis upon birth and what causes it?

A

Tetralogy of Fallot - o Outflow tract not divided evenly by conotrunchal ridge; aorta is large and pulmonary trunk is small (pulmonary stenosis)

42
Q

What 4 things are associated w/ Tetralogy of Fallot?

A

pulmonary stenosis, overriding aorta, VSD, and RV hypertrophy

43
Q

What defect causes 2 circuits where deoxygenated keeps going around the body and oxygenated keeps going back to the lungs? How?

A

Transposition of Great Vessels - Conotrunchal ridge forms but does not spiral -> pulmonary A hooked up to left ventricle and aorta hooked up to right

44
Q

Difference between aortic valvular atresia and stenosis

A 
Stenosis = very small aortic valve = doesn't let blood into aorta very well (LV hypertrophy)
Atresia = no outlet at all for LV (RV hypertrophy)
45
Q

How does blood move through heart w/ tricuspid atresia?

A

no tricuspid valve; blood in RA goes through patent foramen ovale to go anywhere

46
Q

Complications of hypoplastic LV

A

mitral valve and aortic valves not formed; works as univertricular heart w/ RV doing all the work

47
Q

What causes the ductus arteriosus to close after birth? Complications of leaving it open?

A

Changes in O2 tension (first breath) and blood flow decrease prostaglandin levels (no more from mother); Lung endothelial cells release endothelin which contributes to closure

Consequences = LV hypertrophy w/ pulmonary congestion and CHF

48
Q

Preductal vs Postductal Coarctation

What condition is is mostly associated with?

A 
Preductal = constriction before ductus arteriorsus
Postductal = constriction after ductus arteriorsus (preferred b/c vessels can be remodeled around constriction)

Most common in Turner’s Syndrome

49
Q

What is aberrant origin of Rt Subclavian?

A

rt 4th aortic arch disappears so rt subclavian A. comes off descending aorta further down than left; often passes behind esophagus

50
Q

What causes an interrupted aortic arch? What disorder is it most associated with?

A

both 4th aortic arches disappear as well as part of dorsal aorta; pulmonary A. carrying deoxygenated blood will go out to descending aorta

51
Q

What could cause a left superior vena cava?

A

when left sinus horn is retained (drains head and neck into coronary sinus)

52
Q

What is asthma?

A

recurrent obstruction of airflow due to bronchiole inflammation and smooth muscle contraction; infiltration by eosinophils, lymphocytes, and mast cells

53
Q

What is emphysema?

A

chronic obstruction of airflow due to narrowing of bronchioles and accompanied by destruction of alveolar wall; significant area for gas exchange is lost; increased compliance

54
Q

What is pulmonary fibrosis?

A

collagen deposition within interstitial spaces -> increases diffusion difference and decreases diffusion of gases; lower compliance

55
Q

What is the cause of coughing for pts who take ACE inhibitors?

A

increased amount of bradykinin - usually inactivated by ACE (angiotensin converting enzyme)

56
Q

What is air trapping and in what type of lung disease does it occur?

A

abnormal retention of air in lungs (unable to expel it); occurs with obstructive lung diseases; may increase TLC and will significantly increase RV

57
Q

Hypoxic hypoxia and disease associated w/ it?

A

PaO2 is below normal b/c PAO2 is reduced or blood is unable to equilibrate w/ alveolar air -> COPD/emphysema

58
Q

Anemic hypoxia and disease associated w/ it?

A

low O2 levels due to low amounts of RBCs -> carbon monoxide (binds to Hb and reduces O2 carrying capacity of RBCs)

59
Q

Circulatory hypoxia and disease associated w/ it?

A

tissues not receiving sufficient O2 b/c heart can’t pump blood to tissue (or arteries blocked by clots) -> sickle cell anemia

60
Q

Histotoxic hypoxia and disease associated w/ it?

A

cells have been poisoned (tissues unable to use oxygen) -> cyanide (poisons systems that use O2 to create energy)

61
Q

What is apneusis and what causes it?

A

maintained inspiration (fails to expire) - pontine damage

62
Q

What is apnea and what causes it?

A

absence of inspiration (caused by medullary or spinal cord damage)

63
Q

What is Primary Alveolar Hypoventilation Syndrome (Ondine’s Curse)? Where is it seen?

A

long periods of apnea while sleeping; can occur while awake as well; seen in chronic poliomyelitis and stroke

64
Q

Congenital central hypoventilation syndrome and cause?

A

apnea and hypoventilation during sleeping due to mutation in PHOX2B gene

Cardiopulmonary Midterm (3 decks)

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