Medical 1 Flashcards
What are Turbinates?
Ridges of tissue in the upper airway covered with mucous with many blood vessels that trap particulates and humidifies air
What is Angioedema
A type of allergic reaction that may cause severe swelling of the mouth, tongue, or lips
Describe the arytenoid cartilages?
Appear as two white pearly lumps at the inferior end of each vocal cord
Describe the size and placement of the trachea?
10-13cm, extending from the 6th cervical vertebrae to the carina at roughly the 5th thoracic vertebrae.
What are goblet cells?
Goblet cells are found in the lining of the airway, they produce a blanket of mucous that cover the entire lining of the airways
Where can the alveoli be found?
Alveoli cluster around the terminal bronchioles from level 16-23
What is surfactant?
Alveoli are lined with surfactant which helps the alveoli expand. If surfactant is decreased or alveoli are not inflated the alveoli will collapse known as atelectasis
What is retraction?
Indrawing of the ribs and intercostals when airflow is restricted by disease processes
What is the hering-breuer reflex?
Stretch receptors in the lungs are responsible for limiting inspiration and may cause coughing if you take too deep of a breath
Why do most people seek a sitting position when they are short of breath?
Lying flat may cause abdominal organs to push up against the diaphragm causing Orthopnea (shortness of breath)
Describe the classic presentation of a patient with Emphysema? (Pink Puffer)
Barrel chest, muscle wasting, pursed lip breathing
What is Pulsus Paradoxus?
Rare presentation of pulses becoming weak or disappearing on inspiration
Rapid onset Dyspnea may be caused by…
Bronchospasm, anaphylaxis, pulmonary embolism, or pneumothorax
What are some common causes of Tachypnea
Anxiety, Diabetes, Or Shock
What are adventitious breath sounds?
Abnormal breath sounds, extra sounds heard with normal sounds
What causes crackles?
Crackles are caused by the popping open of air spaces, usually associated with fluid in the lungs
What are two common causes of bloody sputum?
Tuberculosis or Pulmonary Edema
What is the most common cause of upper airway obstruction in the unresponsive patient?
The Tongue
What are the three most common obstructive airway diseases?
Emphysema, Chronic Bronchitis, and Asthma
What are 4 symptoms that might alert you to an obstructive airway disease
Pursed lip breathing
Increased inspiratory to expiratory ratio
Abdominal muscle use
Jugular venous distension
What is hypoxic drive?
The primary stimulus to breathe comes from decreased levels of oxygen, not increased levels of carbon dioxide
Describe the classic presentation of Tuberculosis
Weight loss, night sweats, fever, and cough with bloody sputum
What would you likely note about the skin condition of a patient with a pulmonary embolism?
Ongoing Cyanosis
What is the first step of managing any respiratory problem?
Ensure an open and maintainable airway
What is an intervention that should be performed on all patients with respiratory problems?
Establish an IV in case of further deterioration
How do anticholinergic medications work?
They block the parasympathetic response
What are corticosteroids used for?
Reduce bronchial swelling
What do Antitussive medications do?
They are designed to stop a cough
What are Diuretic medications used for?
Reduce blood pressure and maintain fluid balance in patients who have heart failure or Pulmonary Edema
What are vasodilators used for?
They improve chest pain and Pulmonary Edema by reducing cardiac preload
How many Canadians are diagnosed and die of heart disease every year?
159 000 newly diagnosed
33 600 die
What are the risk factors for Coronary Heart Disease (14)
Hypertension Physical Inactivity
High Cholesterol Stress
Unhealthy diet Hormonal replacement therapy
Smoking Family History
Diabetes Advanced Age
Excessive Alcohol Use Sex
Obesity Race/ Ethnicity
What is the pericardium?
A tough fibrous sac surrounding the heart containing 30ml of fluid serving as lubricant
What are the 3 layers of the heart wall?
Epicardium- the outermost surface layer
Myocardium- the muscle layer in the middle
Endocardium- the innermost layer of smooth connective tissue
What is the coronary sinus?
A large vessel in the posterior part of the coronary sulcus that delivers venous blood to the right atrium
What is the coronary sulcus?
The groove in the heart separating the atria from the ventricles
Name the 2 atrioventricular valves
Tricuspid valve and mitral valve
Name the 2 semilunar valves
Pulmonic valve and aortic valve
Explain systemic circulation vs pulmonary circulation
Systemic circulation includes all blood vessels from the left ventricle to the right atrium, pulmonary circulation includes all blood vessels from the right ventricle to left atrium
What are the 4 layers of a blood vessel?
Tunica adventitia (outermost)
Tunica media
Tunica intima
Epithelium (innermost)
What is the cardiac output equation?
Cardiac Output = Stroke Volume x Heart Rate
What is normal cardiac output for an adult?
5-6 L/min.
What is normal stroke volume?
60-100ml but can easily increase up to 50%
What is Dromotropic Effect?
The effect on the velocity of conduction.
Explain the difference between the absolute refractory period and relative refractory period?
Absolute: The cell is still highly depolarized and a new action potential cannot be initiated.
Relative: The heart is partially depolarized and a new action potential will be inhibited but not impossible
What are the rates of the intrinsic pacemaker?
SA node 60-100
AV Junction 40-60
Purkinje fibres 20-40
What are the roles of Na, K, Ca, and Mg in cardiac function?
Sodium: flows into the cell to depolarize
Potassium: flows out of the cell to initiate repolarization
Calcium: critical role in pacemaker depolarization and and myocardial contractility
Magnesium: Stabilizes the cell membrane and opposes the actions of calcium
What is the difference between the sympathetic nervous system and the parasympathetic nervous system?
Sympathetic (fight or flight) speeds up heart, constricts blood vessels, dilates bronchi and pupils
Parasympathetic (rest and digest) regulates the body’s vegetative functions, slows heart rate, encourages digestion
What is atropine?
A common medication used for blocking the actions of the parasympathetic nervous system
Explain the role of epinephrine and norepinephrine in the sympathetic nervous system?
Nerves convey their commands through release of norepinephrine, when intense stimulation occurs epinephrine may be mobilized to increase the heart rate
What are the roles of Alpha, Beta 1, and Beta 2 agents?
Alpha agents: arterial constriction and mild bronchoconstriction
Beta 1 agents: increased dromotropy, inotropy, and chronotropy in the heart (conduction, contractility, and heart rate)
Beta 2 agents: arterial dilation and smooth bronchial muscle dilation
What’s the trick to remember the difference between Beta 1 and Beta 2?
Beta 1 acts on the heart, you have 1 heart
Bet 2 acts on the lungs, you have 2 lungs
What is the formula for blood pressure?
BP = Cardiac output X Systemic vascular resistance
What is Paroxysmal Nocturnal Dyspnea?
PND is an acute episode of shortness of breath in which the patient suddenly awakens from sleep with a feeling of suffocation
What are some illnesses that you should ask your patient if they have a past medical history of?
Coronary artery disease
Atherosclerosis, heart disease, angina
MI, hypertension, heart failure
Valvular disease
Aneurysm
Pulmonary disease
Diabetes
Renal disease
Vascular disease
Previous cardiac surgery
How do you verify a midline trachea?
Gently press down with you finger in the patient’s suprasternal notch
How do you estimate a patient’s jugular venous pressure (JVP)?
Place the patient in semi Fowler position (45° angle)
Rotate the head slightly away from the vein you’re examining
Observe the height of the distended fluid column in the vein and note how far up the distension extends above the eternal angle
Normal JVP is ~2-4 cm above the sterna’s angle
What is Atherosclerosis?
Thickening of the artery wall from the accumulation of fatty material and the secondary inflammatory response
What are the 2 ways that Atherosclerosis causes symptomatic disease?
- Chronic gradual narrowing of the arteries can eventually cause ischemia from reduced blood flow (stable angina, leg claudication)
- Acute infarction can be caused by acute plaque rupture and subsequent thrombus formation and occlusion of the artery (MI)
What is coronary heart disease?
CHD is the most common form of heart disease and leading cause of death in Canadian adults.
Blockage of a coronary artery will cause ischemia that will lead to infarction if oxygen supply is not quickly restored
What is Peripheral Artery Disease (PAD)?
Reduced blood flow through the femoral and peripheral arteries that causes a variety of problems
What is a thromboembolism?
A blockage of a blood vessel by a blood clot that has become dislodged from another site in the circulation.
How do stable and unstable angina differ?
Stable angina follows a recurrent pattern. For example: Every time I climb the stairs I get a squeezing pain that goes away in 2-3 minutes
What is Acute Coronary Syndrome (ACS)?
A continuum of cardiac disorders causing myocardial ischemia, infarction, unstable angina, and myocardial infarction.
Besides pain what symptoms might appear with ACS?
Diaphoresis
Dyspnea
Anorexia
Weakness
Dizziness
Dysrhythmias
Feeling of impending doom ( common in MIs)
What is Fibrinolysis?
Fibrinolytic therapy seeks to administer an clot dissolving agent to reperfuse a blocked coronary artery.
Which part of the heart is most commonly damaged during an AMI?
The left ventricle
What are the signs and symptoms of left sided heart failure?
Restlessness and agitation
Confusion
Severe Dyspnea and Tachypnea
Tachycardia and abnormally high or low BP
Crackles, possibly wheezes, and pink frothy sputum
What are the signs and symptoms of right sided heart failure?
Pulmonary Edema
Jugular venous distension JVD
Peripheral Edema
What is cardiac tamponade?
Cardiac Tamponade occurs when excessive fluid accumulates within the pericardium limiting the heart’s ability to fully expand after each contraction.
Signs and symptoms include chest pain, Dyspnea, and weakness
As fluid increases pulse pressure narrows, and tachycardia is common
What is the Beck Triad?
The combination of hypotension, jugular venous distension, and muffled heart sounds
What is the difference between Aortic aneurysm and Aortic dissection?
An aneurysm is a widening or outpouching of a blood vessel
A dissection is a tear in the innermost wall of an artery that causes blood to between the layers, it can block or restrict flow and eventually lead to rupture
What are some causes of cardiac dysrhythmias?
