Final Exam Slides Flashcards
Preload
Is the degree of myocardial distension prior to shortening. The greater the stretch, the stronger the contraction.
Afterload
Pressure in the aorta against which the left ventricle must pump.
Osteoarthritis
Degeneration of a joint surface caused by wear and tear that leads to pain stiffness.
Rheumatoid Arthritis
An inflammation disorder that affects the entire body and leads to degeneration and deformation of joints.
What are the two main layers of the skin?
Epidermis
Dermis
Gangrene
Necrosis of tissue caused by anaerobic, toxin producing bacterium.
Tetanus
Infection with an anaerobic bacterium.
Body produces a potent toxin.
Results in painful muscle contractions and lockjaw.
Necrotizing Fasciitis
Death of tissue from bacterial infection.
Cause by more than one infecting organism.
Crush Syndrome
Body is trapped for longer than 4 hours.
Arterial blood flow is compromised.
Freeing the limb can result in harmful by-products being released.
Causes cardiac arrest.
Compartment Syndrome
Swelling and edema results in increased pressure within soft tissues.
Muscles are confined to an enclosed space.
Leads to compromised circulation.
As pressure develops, delivery of nutrients and oxygen is impaired.
By-products of normal metabolism accumulate.
Tissue necrosis.
If lasts longer than 6 hours:
Serious risk of death of local tissues
Disfiguring would debridement
Sepsis
What are the 5 layers of the skin?
Stratum Corneum: Non living cells continuously shed.
4 inner layers: continuously divide to give rise to the cells of the stratum corneum.
What is the skins function?
Protects underlying tissue from injury.
Aids in temperature regulation.
Prevents excessive loss of water from the body and tissues.
Sense organ, changes in temperature, touch.
Liver
Found in the RUQ
Detoxifies the blood
Produces bile
Gallbladder
Found on lower surface of the liver
Reservoir for bile
Spleen
Found in the LUQ
Clears blood borne bacteria
Pancreas
Found in the retroperitoneal space
Secretes enzymes into the bowel that aid in digestion
Secretes insulin
Stomach
Intraperitoneal organ in LUQ
Secretes acid that aids in digestion
Small and large intestines
Found in the intraperitoneal area
Digest and absorb water and nutrients
First part of the small intestines:
Duodenum
Jejunum
Ileum
Kidneys
Found in the retroperitoneal space
Filter blood and excrete body waste
Bladder
Found in the pelvis
Stores urine
Reproductive Organs
Female:
Uterus
Ovaries
Male:
Penis
Testes
Diaphragm
Separates the thoracic cavity from the abdominal cavity.
Curves from its point of attachment in the flanks at the 12th rib and peaks in the center of at the 4th intercostal space.
Cervical Plexus
Innervates the diaphragm
Brachial Plexus
Controls the upper extremities
Lumbar Plexus
Supplies skin and muscles of the abdominal wall, external genitalia and part of the lower limbs.
Sacral Plexus
Supplies the buttock, perineum, most of the lower limbs.
Afferent and Efferent Nerves
Afferent (sensory) and efferent (motor) nerves are responsible for the somatic functions (voluntary) of the spinal cord.
Upper Thoracic Nerves
Supply muscles of the chest that help with breathing.
Lower Thoracic Nerves
Provide abdominal muscle control and contain nerves nerves of the SNS.
5 Lumbar Nerve Roots
Supply hip flexors and leg muscles.
5 Sacral Nerve Roots
Provide bowel and bladder control, sexual function, sensation in posterior legs and rectum
What are the structural and functional units of the kidney?
Nephrons
What are the two sections of the loop of Henle?
Descending limb: Permeable to water, but impermeable to sodium and chloride.
Ascending limb: Permeable to sodium and chloride ions but impermeable to water.
ADH (Hypothalamus)
Causes water to leave the DCT and collecting ducts and reenter the blood stream.
Aldosterone (Adrenal Glands)
Increases the reabsorption of sodium and chloride in the blood.
Causing a corresponding increase in water reabsorption.
Organs in the Right Upper Quadrant
Liver
Gallbladder
Duodeum
Head of pancreas
Right adrenal gland
Part of the right kidney
Hepatic flexure of the colon
Parts of the ascending and transverse colon
Organs in the Right Lower Quadrant
Lower pole of the right kidney
Cecum and appendix
Part of the ascending colon
Bladder (if distended)
Ovary and salpinx (female)
Uterus (if enlarged) (female)
Right spermatic cord (male)
Right ureter
Organs in the Left Upper Quadrant
Left lobe of liver
Spleen
Body of pancreas
Left adrenal gland
Portion of left kidney
Splenic flexure of colon
Parts of the transverse and descending colon
Organs in the Left Lower Quadrant
Lower pole of the left kidney
Sigmoid colon
Part of the descending colon
Bladder (if distended)
Ovary and salpinx (female)
Uterus (if enlarged) (female)
Left spermatic cord (male)
Left ureter
Parasympathetic Nervous System
Constricts pupils
Stimulates salvation
Constricts bronchi, decreases heart rate
Stimulates digestive activity
Stimulates gallbladder
Inhibition of adrenaline production
Contracts bladder
Relaxes rectum
Sympathetic Nervous System
Fight or flight response
Dilates pupils
Inhibits salvation
Relaxes bronchi, increases heart rate
Inhibits digestive activity
Stimulates glucose release by liver
Stimulates epinephrin and norepinephrine release
Relaxes bladder
Orgasm, ejaculation, contracts rectum
What does NSAID Stand for?
Non-steroidal anti-inflammatory drugs
Coagulants
Need coagulants to heal so anticoagulant medications delay healing
Hypertrophic Scar
Can form in areas subjected to high stress, usually on the elbows or knees.
Keloid Scar
Grows over wound area and becomes larger than wound. Forms on ears, upper extremities, lower abdomen and sternum.
Closure by Second Intent
Letting a wound heal by itself (will often be done with animal bites)
Tertiary Closure
Delayed primary closure
PRICED Mnemonic
Protect an injured extremity by applying a splint
Rest the injured area
Apply Ice or cold packs
Apply firm Compression
Elevate the injured part to a level above the heart
Administer analgesic Drugs where locally authorized
RICES Mnemonic
Rest
Ice
Compression
Elevation
Splint
Adherent Dressings
Allow exudate from the wound to mesh with the dressing material.
Facilitates clotting and aids in bleeding control.
Removal is painful and may precipitate bleeding.
Non Adherent Dressings
Allow the products of wound repair to pass through the material.
Easy removal but does not aid in clotting.
Applied after wound closure.
Arterial Bleeding
Occurs in spurts
Blood is usually bright red
Venous Bleeding
More likely to be slow and steady.
Darker colored blood.
Capillary Bleeding
Characterized by a slow, even flow of bright or dark red blood.
Present in minor injuries.
Functions of the Musculoskeletal System
Provides support to the soft tissues.
Enables erect posture and body movement.
Also provides protection to critical underlying organs and structures.
Hematopoiesis
Many bones produce new blood cells.
Occurs in the bone marrow.
Produced in bone marrow from stem cells.
How many bones are in the skeleton?
206
Axial Skeleton
Composed of the bones of the central part, or axis of the body.
Skull
Vertebral column (spine)
Ribs (12 pairs)
Appendicular Skeleton
Pectoral girdle, pelvic girdle, upper/lower extremities.
Thorax
Consists of sternum
12 pairs of ribs
True ribs attach to the sternum
False ribs indirectly attach to the sternum
Floating ribs have no anterior attachment
Scapulae
“Shoulder blade”
Flat, triangular bone
Held to rib cage by powerful muscles
Clavicle
“Collar bone”
Slender, s-shaped bone
Articulates with sternum and acromion
Acts as a strut to keep the shoulder propped up and as scaffolding on which other muscles of the thoracic cavity pull.
Because it is slender and very exposed it is vulnerable to injury and is a bleeding risk (subclavian artery).
Any clavicle fracture is a high suspicion for life threatening shock. This is because it’s close to the subclavian artery.
Upper Extremity
Joins shoulder at glenohumeral joint.
Upper arm is formed by humerus.
Distal portion contains radius and ulna: articulation of the two occurs at hinged elbow joint.
Pelvic Girdle
Ischium
Ilium
Pubis
Fused together to form the hip.
Very little movement so the pelvic ring is strong and stable.
Long Bones
Longer than wide.
Ex: Femur, humerus, radius, ulna
Short Bones
Nearly as wide as long
Ex: Phalanges, metacarpals
Flat Bones
Thin, broad
Ex: Sternum, ribs, scapulae
Irregular Bones
Nonspecific shape
Designed for a specific function
Ex: Vertebral column, mandible
Round
Patella
Periosteum
Portion of the bone not covered by cartilage.
Dense, fibrous membrane
Contains capillaries and cells that are important for bone repair and maintenance.
Endosteum
Lines the hollow inner portion of the shaft.
Similar to periosteum, but on the inside.
Contains yellow, fatty marrow in adults
Medullary Canal
Hollow inner portion of the shaft.
Entrance for nutrient artery.
Flexion
Elbow joint when the hand is brought near the shoulder
Extension
Straightening your arm or bending your head back.
Abduction
Movement away from the mid line of the body.
Rotation
Revolves around a single long axis.
Ex: Moving head side to side.
Circumduction
To move a limb in a circular motion
Pronation
Rotation of the forearm, turning the palm inwards towards the body.
Supination
Turning the palm outwards so it faces away.
Fibrous Joints
“Synarthroses” or “fused”
Contain dense, fibrous tissue
Do not allow for motion
Ex: Skull, distal tibiofibular joint
Cartilaginous Joints
“Amphiarthroses”
Allow for minimal motion between bones
Ex: Pubic symphysis, rib-sternum
Synovial Joints
Diathroses
Most mobile joints of the body
Surrounded by joint capsule - extension of periosteum
Bones held in place by strong ligaments
Contain articular cartilage and synovial membrane - synovial membrane secretes synovial fluid into the joint cavity for lubrication
With the flexibility of the synovial joint comes a measure of instability that results in damage to ligaments and disarticulations of bones.
Tendons
Connect muscles to bones.
Flat, cord like bands of connective tissue
Have a glistening, white appearance
Ligaments
Have similar structure to tendons.
Connect bone to bone.
Help maintain stability of joints.
Determine degree of joint motion.
Three Types of Muscles
Smooth
Cardiac
Skeletal
Skeletal muscles include all muscles attached to the skeleton (bulk of the muscles in your arms, legs, spine and buttocks)
Fatigue Fractures
Repetitive stress
Occur in feet after prolonged walking (March fractures)
Pathological Fractures
A force that might not generally cause harm to a normal healthy bone produces a fracture.
A medical condition causes the bone to break. Ex: Elderly patients with osteoporosis
Angulation Fracture
Each end of the fracture is not aligned in a straight line and an angle has formed between them.
Greenstick Fracture
Incomplete fracture
Spiral Fracture
Encircles the bone
Comminuted Fracture
2 fracture fragments located in the same area.
Transverse Fracture
Straight across the bone.
Signs and Symptoms of a Fracture
Pain - hear the snap
Tenderness
Deformity
Shortening - most reliable
Swelling - bleeding/fluid
Guarding/loss of use
Crepitus
Exposed bone ends
Dislocations
A bone is totally displaced from a joint. - Articular surfaces are no longer in contact.
More complaints of pain from dislocations because the muscle is constantly spasming.
Subluxation
Partial joint dislocation
Associated with joint capsule and ligament damage.
May be able to move the joint to some degree.
Diastasis
Occurs when significant damage is done to ligaments that hold two bones together.
The space between the bone increases.
Ex: Injury to the pubic symphysis.
Dislocation Signs and Symptoms
Feeling of pressure over the joint.
Pain
Obvious and significant deformity.
Decrease in range of motion - “frozen” in place
Possible compromised distal PMS
Sprains
Occur when ligaments are stretched or torn.
Sprains result from sudden twisting or overextension at a joint.
Characterized by pain, swelling, discoloration and unwillingness to use limb.
Does not involve deformity and joint mobility is usually limited by pain.
Treat like a fracture because you can’t know for sure that it’s not fractured.
Strains
Least injured
Occur when there is an injury to a muscle and/or tendon
Result from violent muscle contraction, excessive stretching or repeated overuse.
Characterized by minor swelling and pain, increased with movement.
Basically a pulled muscle.
Tendinitis
Inflammation of a tendon
Bursitis
Inflammation of the bursa
Osteoarthritis (OA)
Disease of the joint that occurs as they age and begin to wear. Characterized by pain and stiffness.
Rheumatoid Arthritis (RA)
Systemic inflammatory disease that affects joints and other body systems. Significant bone erosion at affected joints.
Gout
Body has difficulty eliminating uric acid, crystalizes within the joint.
Complications of Musculoskeletal Injuries
Infection
Neurovascular injuries
Compartment syndrome
Thromboembolic disease
Long-term disability
Compartment Syndrome Signs and Symptoms
Burning pain
Numbness/tingling
Firm tissue
Skin pallor
Paralysis of muscle
Loss of distal pulse
Compartment Syndrome Treatment
Elevate the extremity to heart level
Place cold packs over the extremity
Open or loosen tight clothing
Crush Syndrome Treatment
Per direct medical control
Should be done before release of force
High flow Oxygen
Crystalloid bolus
Shoulder Girdle Fractures Treatment
Sling and swath
Immobilize against body
Consider other, more serious injuries (particularly spinal injuries) and treat for these
Mallet Finger
Finger is jammed into an object, resulting in an avulsion fracture of the extended tendon.
C1
The atlas: allow for rotational movement of the skull
C2
The axis: allow for rotational movement of the skull.
Somatic Nervous System (SNS)
Made up of peripheral nerve fibers that send sensory information to the central nervous system and motor nerve fibers that send information to skeletal muscles.
Autonomic Nervous System
Further subdivided into the sympathetic and parasympathetic nervous system.
Babinski Reflex
Only reflex we check.
Normal for toes to move downward (plantar flex) when foot is stimulated. A “positive” Babinski is when toes move upward (dorsiflex).
Intraperitoneal Structures (encased in peritoneum)
Liver
Spleen
Stomach
Small bowel
Colon
Gallbladder
Female reproductive organs
Retroperitoneal Structures (more protected from injuries)
Aorta
Venae cava
Pancreas
Kidneys
Upper part of ureters
Portions of the duodenum and large intestines
Pelvic Structures
Rectum
Lower part of uterus
Pelvic vascular plexus
Infra-aortic and infra-vena-cava vessels
Pelvic skeletal structures
Reproductive organs
Urinary System
Kidneys - filter blood and excretes body waste in form of urine.
Ureters - Carry urine from kidneys to bladder
Bladder - stores urine, hollow organ
Low Velocity Penetrating Trauma
Knife, ice pick or shotgun
Med Velocity Penetrating Trauma
9 mm gun or shotgun
High Velocity Penetrating Trauma
High powered rifle or military weapon
Kehr’s Sign
Presence of shoulder tip pain in association with abdominal pain. (Spleen would radiate to left shoulder, gall bladder would radiate to right shoulder) (it radiates to the same side it’s located).
Portal Vein
Intertwined around the esophagus are veins that drain into an even more complex series of veins.
Ultimately join to form the portal vein.
Transports venous blood from the GI tract directly to the liver for processing of nutrients.
Cardiac Sphincter
At junction of esophagus and stomach. Controls amount of food that moves back up the esophagus.
Hydrochloric Acid and Pepsin
Helps break down food in stomach.
Stomach contracts churning the acid and food together.
Pyloric Sphincter
Opening at the inferior portion of the stomach
Chyme
Material that exits the pyloric sphincter
What’s surrounding and part of the small intestine?
Duodenum
Pancreas
Liver
Bile
Jejunum
Ileum
Duodenum
Where the pancreas, liver and gallbladder connect to digestive system.
Beginning of the small intestines and active stage of absorption.
Cecum
First part of the large intestine
Symptoms of Gastrointestinal Emergencies
Pain
Vomiting and/or diarrhea (fluid loss)
Bleeding
Alterations in bowel habits
Alterations of liver or pancreatic function
Bowel Obstruction
If the patient cannot pass gas you know that they are not constipated and have a bowel obstruction.
Common reason is intestines becoming twisted or entrapped
If the patient is vomiting with a bowel obstruction they are vomiting feces.
Can occur from strictures that narrow the pathway.
Strictures
Scarring that narrows the tube that carries urine out of the body (urethra).
Cirrhosis
Chronic liver failure
Esophageal Varices
Pressure increase within the blood vessels of the distal esophagus.
Can kill you because it’s basically an uncontrolled bleed that you can’t stop (the patient will be spitting up blood constantly).
Mallory-Weiss Syndrome
May lead to severe hemorrhage.
Esophageal lining tears during severe vomiting.
Occurs more in women and is more prevalent in older adults and older children.
Peptic Ulcer Disease
High levels of acidity in the stomach and duodenum.
Protective layer is eroded, allowing the acid to eat into the organ.
Cholecystitis
Obstruction of the cystic duct leading from the gallbladder to the duodenum, usually by gallstones.
Acute Gastroenteritis
Fancy word for stomach flu or stomach ache.
Borborygmi
Growling, indicates strong contractions of the intestines
Hyperperistalsis
Enhanced bowel sounds. Can be early sign of bowel obstruction as bowel tries to overcome the obstruction.
Somatic Pain
Found in skin and deep tissues, well localized. Ex: cut your skin, you experience somatic pain or stretch your muscles too far during exercise.
Visceral Pain
Comes from organs.
First Phase of Hepatitis
Joint aches
Weakness and fatigue
Fever
Nausea and vomiting
Abdominal pain
Anorexia
Second Phase of Hepatitis
Symptoms of liver failure
Acholic (clay colored) stools
Darkening of the urine
Jaundice
Abdominal pain in the right upper quadrant and enlarged liver
Cortex
Kidney : Lighter colored, outer region closest to the capsule
Medulla
Kidney : Middle layer, includes the cone shaped renal pyramids and renal columns
Renal Pelvis
Kidney : Flat, funnel shaped tube that fills the sinus at the level of the hilum
Calyces
Kidney : Branch off the pelvis and connect with the renal pyramids to receive urine draining from the collecting tubules
Pyelonephritis
Inflammation of the kidney linings
Abscesses
Affect kidney function
Kidney Stones
Result when an excess of insoluble salts or uric acid crystalizes in the urine.
Oliguria
Urine output drops to less than 500ml/day
Anuria
Urine production stops completely
Three Types of Acute Renal Failure
Prerenal: Hypoperfusion of the kidneys (shock)
Intrarenal: Damage to kidney often caused by immune mediated disease, toxins, chronic inflammation or medications.
Postrenal: Obstruction of urine flow from the kidneys, prostate enlargement renal calculi or strictures.
Uremia
Increased urea and wastes products in the blood.
Azotemia
Increased nitrogenous wastes in the blood.
Leads to hypertension, anemia and electrolyte imbalances.
What are the two types of dialysis?
Peritoneal and hemodialysis
Peritoneal Dialysis
Large amounts of specially formulated dialysis fluid are infused into the abdominal cavity.
Hemodialysis
Patients blood circulates through a dialysis machine (functions as a normal kidney).
Internal Shunt
Artificial connection between a vein and an artery.
Usually located in the forearm or upper arm.
Testicular Torsion
Is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum.
