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EMRG 1230 > Final Review > Flashcards

Final Review Flashcards

1
Q

How many chambers does the heart have?

A

4

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2
Q

Where along the spine does the heart lie?

A

5th to 8th thoracic vertebrae

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3
Q

What are the 4 functions of the heart?

A
  • generate blood pressure
  • route blood through pulmonary and systemic pathways
  • ensure and maintain one-way blood flow
  • regulate blood supply to meet metabolic needs
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4
Q

What is the pericardial sac?

A

A sac that encloses the heart and anchors it in the thoracic cavity

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5
Q

What are the 3 layers of the heart wall?

A

endocardium, myocardium, epicardium

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6
Q

What is the endocardium?

A
  • innermost layer of the heart
  • thinnest layer (1 layer of cells)
  • line heart chambers
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7
Q

What is the myocardium?

A
  • thickest layer
  • middle layer of heart wall
  • contractile layer
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8
Q

What is the epicardium?

A
  • outermost layer of the heart
  • contains blood vessels to nourish the heart
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9
Q

What are the 2 types of heart valves?

A

AV and semilunar

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10
Q

What are the 2 AV valves and what side of the heart are they on?

A

bicuspid (mitral) - left
tricuspid - right

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11
Q

What are the 2 semilunar valves and what side of the heart are they on?

A

pulmonary - right
aortic semilunar - left

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12
Q

Where do the coronary arteries branch off from?

A

aorta

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13
Q

What part(s) of the heart does the left circumflex artery supply? (2)

A

left atrium
left ventricle

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14
Q

What part(s) of the heart does the left anterior descending artery supply? (3)

A

left ventricle
right ventricle
septum

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15
Q

What part(s) of the heart does the left marginal artery supply? (1)

A

left ventricle

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16
Q

What part(s) of the heart does the right coronary artery supply? (2)

A

right atrium
right ventricle

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17
Q

What part(s) of the heart does the right marginal artery supply? (2)

A

right ventricle
apex

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18
Q

Where in the brain is the cardiac center?

A

medulla

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19
Q

What notifies the cardiac center of changes of blood pressure? Where are they located?

A

baroreceptors in the aorta and carotid arteries

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20
Q

What system is stimulated when blood pressure is low?

A

sympathetic nervous system

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21
Q

What happens to heart rate and contractility when the SNS is innervated? How does this happen?

A

HR and contractility increase
epi is released which causes beta receptors to be stimulated thus causing the increase

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22
Q

What system is stimulated when blood pressure is high?

A

parasympathetic nervous system

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23
Q

What happens to heart rate and contractility when the PNS is innervated? How does this happen?

A

HR and contractility decrease
acetylcholine is secreted which causes HR to slow

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24
Q

What are some factors that increase heart rate? (5)

A
  • elevated body temp.
  • increased environmental temp.
  • exercise
  • smoking
  • stress
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25
Q

What are the 5 properties of cardiac cells?

A
  1. contractility
  2. automaticity
  3. rhythmicity
  4. conductivity
  5. refractory period
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26
Q

What is cardiac output?

A

the volume of blood ejected by a ventricle in 1 minute

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27
Q

What is stroke volume?

A

the volume of blood pumped from one ventricle in one contraction

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28
Q

How do you calculate cardiac output?

A

CO = HR x SV

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29
Q

What is the main function of the electrical conduction system of the heart?

A

to create an electrical impulse and transmit it to the rest of the myocardium

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30
Q

Where is the electrical conduction system of the heart?

A

inside the heart walls

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31
Q

What component of the electrical conduction system acts as the pacemaker? How does it do this?

A

SA node
using information from the nervous, circulatory, and endocrine systems

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32
Q

In what order does an electrical impulse travel through the heart?

A
  1. SA node
  2. Internodal pathways
  3. AV node
  4. Bundle of His
  5. Bundle branches (L and R)
  6. Purkinje fibers
  7. Myocardial cells
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33
Q

What are the firing rates of each component of the electrical conduction system?

A

SA node = 60-100
AV node = 45-60
Bundle of His = 40-45
Bundle branches = 40-45
Purkinje fibers = 35-40

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34
Q

What are the phases of normal electrical activity in the heart?

A

polarization
depolarization
repolarization

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35
Q

What is polarization? Where are potassium, sodium, and calcium located?

A

a state of readiness
potassium inside
sodium outside
calcium outside

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36
Q

What is depolarization? Where are potassium, sodium, and calcium located?

A

contraction
sodium channels open and sodium moves into cell
potassium moves to outside

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37
Q

What is repolarization? Where are potassium, sodium, and calcium located?

A

recovery phase
action potential is terminated
potassium leaves cell

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38
Q

What is the refractory period? Absolute vs. relative?

A

period during which cells resist stimulation
absolute = will not respond to any stimulus
relative = responds to very strong stimuli

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39
Q

Where do you place each lead for a 4-lead ECG?

A

white = right arm
black = left arm
green = right leg
red = left leg

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40
Q

What does one little box on an ECG paper represent?

A

0.04 seconds

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41
Q

What do 5 little boxes or 1 big box on an ECG paper represent?

A

0.2 seconds

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42
Q

What does the P wave represent? How long should a P wave be?

A

atrial depolarization
<120 ms (less than 3 little boxes)

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43
Q

What does the PR interval represent? How long should a PR interval be?

A

movement of impulse down AV node to bundle of his and then to bundle branches
0.12 to 0.20 seconds (3-5 little boxes)

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44
Q

What does the QRS complex represent? How long should a QRS complex be?

A

ventricular depolarization
less than 0.12 seconds (less than 3 little boxes)

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45
Q

What does the T wave represent?

A

ventricular repolarization

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46
Q

What are the steps for reading an ECG strip? (6)

A
  1. measure the HR
  2. identify P waves (present? regular? inverted, retrograde, absent?)
  3. measure the PRI (greater than 0.2 seconds?)
  4. determine relationship of P waves to QRS (1:1 ratio?)
  5. determine if QRS is wide or narrow (narrow or wide?)
  6. determine rhythm regularity
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47
Q

What is cardiac stress?

A

when circumstances force the heart to work harder to maintain cardiac output

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48
Q

What are the two categories of cardiac stress?

A

direct and indirect

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49
Q

What are examples of direct stress?

A
  • structural or functional alterations in the heart
  • ischemia
  • infection
  • arrhythmias
  • congenital defects
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50
Q

What are examples of indirect stress?

A
  • disorders external to the heart that increase workload
  • anxiety
  • stress from an accident
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51
Q

What is ischemia?

A

a reduction of blood supply to the myocardium caused by degenerative changes to coronary arteries

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52
Q

What is arteriosclerosis? What effect does it have on the arteries?

A

degenerative disorder resulting in vascular obstruction
causes hardening of arteries and thickening of arterial walls

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53
Q

What is atherosclerosis? What effect does it have on vasculature?

A

arteriosclerosis accompanied by accumulation of fatty material
chronic
can be asymptomatic
causes narrowing of vessels and reduction of blood flow through them

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54
Q

What are the predisposing factors of arteriosclerosis that cannot be changed?

A
  • age (more than 40)
  • gender (men more likely)
  • genetics
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55
Q

What are the predisposing factors of arteriosclerosis that can be changed?

A
  • obesity
  • cigarette smoking
  • sedentary lifestyle
  • uncontrolled hypertension
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56
Q

What causes ischemia?

A

spastic contraction
- cold weather, caffeine, nicotine, anxiety, exertion
occlusion

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57
Q

What is angina?

A

chest pain caused by deficiency of oxygen for the heart muscle

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58
Q

What characterizes stable angina?

A

predictable pain, same location and severity
lasts 1-5 minutes

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59
Q

What characterizes unstable angina? What is it indicative of?

A

pain is more severe and feels different from normal
not relieved by meds
lasts >15 minutes
indicative of pre-MI angina

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60
Q

What are symptoms of angina?

A

recurrent episodes of chest pain triggered by stress
tightness or pressure in the chest (radiates)
pallor, sweaty, nausea

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61
Q

How do you treat angina?

A

oxygen
ASA, nitro
12 lead
IV therapy

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62
Q

How often should you take vitals for angina patients?

A

every 5 minutes

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63
Q

What are symptoms of a STEMI?

A

sudden, substernal chest pain
gastric discomfort
pallor
sweaty
dizziness, weakness
anxiety, fear
hypotension
rapid weak pulse
dyspnea

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64
Q

What are signs of flail chest? How do you treat it?

A

paradoxical motion
dyspnea
chest pain
treat with internal splinting

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65
Q

What is pericardial tamponade?

A

excess fluid in pericardial sac

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66
Q

What are signs of pericardial tamponade?

A

Beck’s triad:
- muffled heart tones
- hypotension
- JVD

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67
Q

What are the STEMI mimickers? (7)

A

LBBB
left ventricular hypertrophy
pericarditis
pacemaker rhythms
hyper and hypokalemia
digitalis effects
benign early repolarization

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68
Q

What can LBBBs produce that mimics a STEMI? (3)

A

ST elevation
ST depression
tall T waves

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69
Q

What is pericarditis?

A

inflammation of the pericardium

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70
Q

What are signs and symptoms of pericarditis?

A

chest pain, sharp and radiating
pain can last hours or days
dyspnea, tachycardia, weakness, chills

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71
Q

What does pericarditis look like on an ECG?

A

ST elevation
concave ST segment in all leads
T wave elevation
PR depression

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72
Q

What are the 3 electrolytes?

A

calcium
potassium
sodium

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73
Q

What is the role of calcium in the body? (4)

A

structural strength for bones and teeth
stability of the nerve membrane (controls permeability)
muscle contractions
metabolic processes and enzyme reactions

74
Q

What is hypokalemia? What causes it?

A

insufficient potassium
excessive loss of K from diarrhea or diuretic drugs
excessive aldosterone or glucocorticoids
decreased dietary intake

75
Q

What can hypokalemia cause?

A

cardiac dysrhythmias
neuromuscular function interference
paresthesias (pins and needles)
decreased GI mobility
weak respiratory muscles (shallow inspiration)
renal malfunction

76
Q

What is hyperkalemia? What causes it?

A

excessive potassium
renal failure
insufficient aldosterone
K sparing diuretics
K leakage out of cells from tissue damage
acidosis

77
Q

What can hyperkalemia cause?

A

wide, flat P waves
longer PRI
wide, flat QRS
high, wide T wave
muscle weakness
fatigue, nausea, pins and needles

78
Q

What are the 3 layers of blood vessel walls? What layer is each one?

A

tunica adventitia (outermost)
tunica media (middle)
tunica intima (interior)

79
Q

What are characteristics of tunica adventitia?

A

strong, flexible connective tissue
prevents tearing

80
Q

What is the thickest layer of the arteries? The veins?

A

Arteries = tunica media
Veins = tunica adventitia

81
Q

What are characteristics of tunica media?

A

made of smooth muscle
connected with layers of elastic connective tissue
allows for changes in blood vessel diameter

82
Q

What are characteristics of tunica intima?

A

made up of endothelial cells
makes up semilunar valves

83
Q

What are characteristics of arteries?

A

thick walled, muscular vessels
carry blood AWAY from heart
typically carry oxygenated blood EXCEPT in pulmonary arteries (to lungs for oxygenation)
sensitive to stimulation from ANS
regulate BP

84
Q

What are the 2 types of arteries?

A

elastic and muscular

85
Q

What is the difference between elastic and muscular arteries?

A

Elastic:
- largest in body
- stretch without injury
Muscular:
- carry blood farther away from heart to specific organs
- smaller in diameter
- thicker walls than elastic

86
Q

What is the main function of arterioles?

A

to regulate blood flow through the body

87
Q

What are characteristics of veins?

A

low pressure
thinner walls
less capacity to decrease diameter
more likely to distend

88
Q

What are characteristics of capilliaries?

A

microscopic
carry blood from arteries to venules
extremely thin walls
transfer nutrients and vital substances between blood and tissues
over 1 billion in body

89
Q

What are characteristics of veins?

A

carries blood towards heart
become larger as they get closer to heart
great ability to stretch

90
Q

How much blood is in the body?

A

approximately 5 litres

91
Q

What is anemia? What causes it?

A

reduction in oxygen transport caused by decreased hemoglobin content
- declining RBC production
- decrease in RBCs

92
Q

What are signs and symptoms of anemia?

A

fatigue, pallor, dyspnea, tachycardia
dry lips

93
Q

What controls involuntary activity?

A

autonomic nervous system

94
Q

What controls voluntary activity?

A

somatic nervous system

95
Q

What structures protect the brain? (3)

A

the skull
meninges
CSF

96
Q

What are the 3 meninges? What layer is each one? Describe each layer.

A

dura mater
- outer layer
- tough, fibrous, double layer
arachnoid mater
- middle layer
- loose, web like
pia mater
- inner layer
- delicate connective tissue right on top of brain

97
Q

Where is CSF formed? Where is CSF stored?

A

made in ventricles of the brain, stored in subarachnoid space

98
Q

What is the purpose of CSF?

A

provide cushion for the brain and spinal cord

99
Q

How much CSF do we produce each day?

A

500ml

100
Q

What is the blood brain barrier? What does it do?

A

protective mechanism made up of impermeable capillaries
controls delicate balance of electrolytes, glucose, and proteins in brain

101
Q

What substances can still pass through the blood brain barrier?

A

lipid soluble substances

102
Q

How many major lobes are in each hemisphere of the brain? What are they?

A

4
frontal, parietal, occipital, temporal

103
Q

What is the frontal lobe responsible for?

A

emotion regulation
planning
reasoning
problem solving

104
Q

What is the parietal lobe responsible for?

A

sensory information including touch, temp, pressure, pain

105
Q

What is the temporal lobe responsible for?

A

hearing
visual processing
memory

106
Q

What is the occipital lobe responsible for?

A

visual processing

107
Q

What are the 2 special areas involved in language?

A

Brocas’s area
Wernicke’s area

108
Q

What is Broca’s area responsible for? Wernicke’s area?

A

Broca’s - motor (words out)
Wernicke’s - speech comprehension (words in)

109
Q

What is the limbic system responsible for? What is it linked to?

A

emotional reactions and feelings
linked to hypothalamus

110
Q

What is the diencephalon? What does it contain?

A

central portion of the brain
contains thalamus and the hypothalamus

111
Q

What is the thalamus? What does it do?

A

main nerve bodies
sort and relay incoming sensory information

112
Q

What does the hypothalamus do?

A

maintains homeostasis in the body
regulates temperature, intake of food and fluid, sleep cycles, and libido

113
Q

What does the cerebellum do?

A

coordinates movement
maintains posture
maintains balance

114
Q

How is blood supplied to the brain?

A

internal carotid arteries and vertebral arteries

115
Q

How does blood leave the brain?

A

it collects in the dural sinuses and drains into right and left jugular veins

116
Q

What is the purpose of Circle of Willis?

A

to prevent ischemia in the brain by rerouting blood around blockages to maintain continuous supply

117
Q

What are the 12 cranial nerves? What do they do?

A

Olfactory - smell (sensory)
Optic - vision (sensory)
Oculomotor - eye movements, including eyelids (motor)
Trochlear - eye movement (motor)
Trigeminal - general sensory including eye, nose, face, oral cavity, teeth, and speech muscles (motor + sensory)
Abducens - eye movements (motor)
Facial - taste, muscles of facial expression, scalp muscles (sensory + motor)
Vestibulocochlear - hearing, balance (sensory)
Glossopharyngeal - taste, gag reflex (sensory + motor)
Vagus - external ear, parts of taste, heart and lung smooth muscle, glands of GI system, diaphragm (sensory + motor)
Spinal Accessory - voluntary muscles of pharynx, head movements (motor)
Hypoglossal - muscles of the tongue (motor)

118
Q

What protects the spinal cord?

A

vertebral column
meninges
CSF

119
Q

Where does the spinal cord start and end? What follows the end of the spinal cord?

A

starts at medulla oblongata
ends at 1st lumbar vertebra
cauda equina (bundle of nerve roots)

120
Q

What does the spinal cord consist of?

A

nerves that innervate the skeletal muscles
ascending and descending tracts

121
Q

What do the ascending and descending tracts of the spinal cord do?

A

ascending - relays information from skeletal muscle to brain
descending - relays information from brain to skeletal muscles for movement

122
Q

How many pairs of spinal nerves are there? What do they do?

A

31
carry motor and sensory fibers to and from organs and tissues

123
Q

What are neurons?

A

specialized cells that conduct impulses throughout the CNS and PNS

124
Q

What structures do all neurons have?

A

dendrite - conducts impulse towards the cell body
cell body - contains nucleus
axon - conducts impulse away from cell body
myelin sheath - insulates fiber, increases rate of conduction
nodes of ranvier - spaces between myelin sheath

125
Q

How are impulses transmitted from cell to cell?

A

neurotransmitters

126
Q

What are the 4 types of neurotransmitters?

A

acetylcholine
norepi/epi
dopamine
serotonin

127
Q

What is the chief neurotransmitter in the PNS?

A

acetylcholine

128
Q

What is the main neurotransmitter in the SNS? What does it do?

A

norepi/epi
causes vasoconstriction
increases HR
stimulates alpha and beta receptors

129
Q

What does dopamine do? When is it released?

A

the cycle of motivation, reward, and reinforcement
released when body is expecting a reward

130
Q

What does serotonin impact?

A

mood, sexual desire and function, appetite, sleep, memory

131
Q

What comprises the autonomic nervous system?

A

sympathetic nervous system
parasympathetic nervous system

132
Q

What is a primary head injury?

A

initial damage and direct injuries
result of a force applied to the head
includes tissue and vascular damage

133
Q

What is a secondary head injury?

A

result of hypoxia and decreased perfusion, cerebral edema, infection, hemorrhage

134
Q

What is the brain’s initial response to bruising?

A

vasodilation and increased blood flow to area of injury
which causes ICP to increase
which causes decreased blood flow

135
Q

What will decreased CO2 levels cause in the brain?

A

hypoventilation which leads to cerebral vasoconstriction and cerebral ischemia (hypoxia)

136
Q

What will increased CO2 levels cause in the brain?

A

hyperventilation which leads to vasodilation and edema (hypoxia)

137
Q

What contributes to intracranial pressure? (3)

A

brain tissues
blood
CSF

138
Q

What is normal intracranial pressure?

A

5-15 mmHg

139
Q

What is cerebral perfusion pressure (CPP)? What is normal CPP?

A

pressure needed to maintain blood flow to the brain
normal CPP = 70-80 mmHg (no less than 60 mmHg)

140
Q

What does MAP stand for? What is normal MAP?

A

Mean Arterial Pressure
normal MAP = 70-100 mmHg

141
Q

How do you calculate CPP?

A

CPP = MAP - ICP

142
Q

What happens when ICP = MAP?

A

no more blood flow to the brain

143
Q

What are early signs of increased ICP?

A

CSF shifts to the spinal cavity
decreased CPP
- leads to hypoxia
hypoxia causes vasodilation to improve blood supply
cycles again

144
Q

What are symptoms of increased ICP?

A

severe headache
vomiting (projectile)
papilledema (swelling of optic disc)
seizures

145
Q

What triggers the Cushing’s Reflex?

A

cerebral ischemia

146
Q

What does the Cushing’s Reflex do? How?

A

attempts to increase blood supply to the brain
- decreasing pulse
- increasing systolic pressure with a widening pulse pressure
- irregular respirations

147
Q

If increased ICP is not resolved, what is inevitable?

A

death

148
Q

What is cerebral herniation syndrome? What does it cause?

A

brain swelling which eventually forces tissues downward through the foramen magnum
causes obstruction of blood flow
places pressure on brain stem

149
Q

What are signs and symptoms of cerebral herniation syndrome?

A

decreased LOC
coma
dilation of pupil on same side
paralysis of opposite side of body
decerebrate posturing
increased BP
bradycardia

150
Q

How do you treat cerebral herniation syndrome?

A

hyperventilation to reduce swelling (1:3 seconds)

151
Q

What makes concussions more likely?

A

history or head trauma or blows to the head

152
Q

What happens during a concussion?

A

no structural damage to the brain occurs
brief disruption of neural function occurs
- period of unconsciousness or confusion
- return to normal
- short term memory loss

153
Q

What are signs and symptoms of concussion?

A

headache
dizziness
tinnitus
nausea

154
Q

What is a cerebral contusion? What can it cause?

A

bruised brain tissue with ruptured small blood vessels, usually caused by a blow to the head
it can cause brain swelling (can be rapid and severe)

155
Q

What are signs and symptoms of a cerebral contusion?

A

prolonged unconsciousness
altered LOC
personality changes
profound confusion
persistent amnesia
abnormal behaviour
focal neurological signs

156
Q

What usually accompanies basilar fractures?

A

leaking of CSF through nose and ears
discolouration around the eyes and behind the ears

157
Q

What is a diffuse axonal injury? What can it cause?

A

severe blunt trauma to the head
can cause stretching, shearing, tearing of nerve fibers
generalized edema
herniation syndrome is possible
permanent vegetative state

158
Q

What are signs and symptoms of a diffuse axonal injury?

A

seizure activity
coma
vomiting

159
Q

What is an anoxic brain injury? How long does it take until it is irreversible?

A

lack of oxygen to the brain cells
irreversible after 4-6 minutes

160
Q

What are the 4 classifications of intracranial hemorrhage?

A

epidural hematoma - between skull and dura
subdural hematoma - between dura and arachnoid
subarachnoid hematoma - between arachnoid and pia
intracerebral hematoma - IN brain tissues

161
Q

What typically causes an epidural hematoma?

A

a tear in the middle meningeal artery caused by linear fractures to the skull

162
Q

What are signs and symptoms of an epidural hematoma?

A

head trauma with loss of consciousness
lucid interval followed by signs of increased ICP
rapid death

163
Q

What is typically associated with subdural hematomas?

A

injury to underlying brain tissues

164
Q

What type of bleed is associated with subdural hematomas?

A

venous bleeds = slow

165
Q

Who is at a greater risk for subdural hematomas?

A

elderly people on blood thinners
alcoholics

166
Q

What are the signs and symptoms of subdural hematoma?

A

headache
change in LOC
slurred speech

167
Q

What is associated with subarachnoid hemorrhage? What occurs?

A

traumatic bleeding from the blood vessels at the base of the brain
blood mixes with CSF and prevents hematoma formation

168
Q

What are the signs and symptoms of subarachnoid hemorrhage?

A

sudden, severe headache (worst headache i’ve ever had in my life)
decreased LOC
pupil changes
posturing
vomiting
seizures

169
Q

What lobes are most commonly affected by intracerebral hemorrhage?

A

frontal and temporal

170
Q

What are the signs and symptoms of intracerebral hemorrhage?

A

depends on extent of injury
alterations in LOC
similar pattern to CVA
high mortality rate

171
Q

What does it mean when the oxygen dissociation curve shifts left? Right?

A

Left = higher hemoglobin oxygen affinity
Right = lower hemoglobin oxygen affinity

172
Q

What causes the oxygen dissociation curve to shift to the left?

A

lower CO2
higher pH
lower temperature
lower DPG

173
Q

What causes the oxygen dissociation curve to shift to the right?

A

higher CO2
lower pH
higher temperature
higher DPG

174
Q

What is normal V/Q?

A

0.8, 1.0 when humidified

175
Q

What does yellow-green, cloudy, thick mucus indicate?

A

bacterial infection

176
Q

What does rusty/dark sputum indicate?

A

pneumonia

177
Q

What does blood-tinged sputum indicate?

A

pulmonary edema

178
Q

What are signs and symptoms of URTIs?

A

red mucous membranes of nose and pharynx
copious watery discharge
mouth breathing, change in voice tone
cough may develop

179
Q

How do you treat URTIs?

A

acetaminophen
decongestants
humidifiers

180
Q

What is sinusitis? How do you treat it?

A

bacterial infection secondary to cold or allergy
decongestants and analgesics
antibiotics

181
Q

What is croup? Who does it typically occur in? How do you treat it?

A

common viral infection presenting with nasal congestion and cough
ages 1-2
cool, moisturized air

182
Q

What is epiglottitis? Who does it typically occur in? Symptoms? Treatment?

A

infection from bacterial organism
ages 3-7
swelling of larynx, supraglottic area, epiglottis
child refuses to swallow, mouth open, drooling
treat with O2; DO NOT AGGRAVATE PT.

EMRG 1230 (1 decks)

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