Medical 1 Flashcards
1
Q
What are Turbinates?
A
Ridges of tissue in the upper airway covered with mucous with many blood vessels that trap particulates and humidifies air
2
Q
What is Angioedema
A
A type of allergic reaction that may cause severe swelling of the mouth, tongue, or lips
3
Q
Describe the arytenoid cartilages?
A
Appear as two white pearly lumps at the inferior end of each vocal cord
4
Q
Describe the size and placement of the trachea?
A
10-13cm, extending from the 6th cervical vertebrae to the carina at roughly the 5th thoracic vertebrae.
5
Q
What are goblet cells?
A
Goblet cells are found in the lining of the airway, they produce a blanket of mucous that cover the entire lining of the airways
6
Q
Where can the alveoli be found?
A
Alveoli cluster around the terminal bronchioles from level 16-23
7
Q
What is surfactant?
A
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
8
Q
What is retraction?
A
Indrawing of the ribs and intercostals when airflow is restricted by disease processes
9
Q
What is the hering-breuer reflex?
A
Stretch receptors in the lungs are responsible for limiting inspiration and may cause coughing if you take too deep of a breath
10
Q
Why do most people seek a sitting position when they are short of breath?
A
Lying flat may cause abdominal organs to push up against the diaphragm causing Orthopnea (shortness of breath)
11
Q
Describe the classic presentation of a patient with Emphysema? (Pink Puffer)
A
Barrel chest, muscle wasting, pursed lip breathing
12
Q
What is Pulsus Paradoxus?
A
Rare presentation of pulses becoming weak or disappearing on inspiration
13
Q
Rapid onset Dyspnea may be caused by…
A
Bronchospasm, anaphylaxis, pulmonary embolism, or pneumothorax
14
Q
What are some common causes of Tachypnea
A
Anxiety, Diabetes, Or Shock
15
Q
What are adventitious breath sounds?
A
Abnormal breath sounds, extra sounds heard with normal sounds
16
Q
What causes crackles?
A
Crackles are caused by the popping open of air spaces, usually associated with fluid in the lungs
17
Q
What are two common causes of bloody sputum?
A
Tuberculosis or Pulmonary Edema
18
Q
What is the most common cause of upper airway obstruction in the unresponsive patient?
A
The Tongue
19
Q
What are the three most common obstructive airway diseases?
A
Emphysema, Chronic Bronchitis, and Asthma
20
Q
What are 4 symptoms that might alert you to an obstructive airway disease
A
Pursed lip breathing
Increased inspiratory to expiratory ratio
Abdominal muscle use
Jugular venous distension
21
Q
What is hypoxic drive?
A
The primary stimulus to breathe comes from decreased levels of oxygen, not increased levels of carbon dioxide
22
Q
Describe the classic presentation of Tuberculosis
A
Weight loss, night sweats, fever, and cough with bloody sputum
23
Q
What would you likely note about the skin condition of a patient with a pulmonary embolism?
A
Ongoing Cyanosis
24
Q
What is the first step of managing any respiratory problem?
A
Ensure an open and maintainable airway
25
What is an intervention that should be performed on all patients with respiratory problems?
Establish an IV in case of further deterioration
26
How do anticholinergic medications work?
They block the parasympathetic response
27
What are corticosteroids used for?
Reduce bronchial swelling
28
What do Antitussive medications do?
They are designed to stop a cough
29
What are Diuretic medications used for?
Reduce blood pressure and maintain fluid balance in patients who have heart failure or Pulmonary Edema
30
What are vasodilators used for?
They improve chest pain and Pulmonary Edema by reducing cardiac preload
31
How many Canadians are diagnosed and die of heart disease every year?
159 000 newly diagnosed
33 600 die
32
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
33
What is the pericardium?
A tough fibrous sac surrounding the heart containing 30ml of fluid serving as lubricant
34
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
35
What is the coronary sinus?
A large vessel in the posterior part of the coronary sulcus that delivers venous blood to the right atrium
36
What is the coronary sulcus?
The groove in the heart separating the atria from the ventricles
37
Name the 2 atrioventricular valves
Tricuspid valve and mitral valve
38
Name the 2 semilunar valves
Pulmonic valve and aortic valve
39
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
40
What are the 4 layers of a blood vessel?
Tunica adventitia (outermost)
Tunica media
Tunica intima
Epithelium (innermost)
41
What is the cardiac output equation?
Cardiac Output = Stroke Volume x Heart Rate
42
What is normal cardiac output for an adult?
5-6 L/min.
43
What is normal stroke volume?
60-100ml but can easily increase up to 50%
44
What is Dromotropic Effect?
The effect on the velocity of conduction.
45
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
46
What are the rates of the intrinsic pacemaker?
SA node 60-100
AV Junction 40-60
Purkinje fibres 20-40
47
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
48
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
49
What is atropine?
A common medication used for blocking the actions of the parasympathetic nervous system
50
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
51
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
52
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
53
What is the formula for blood pressure?
BP = Cardiac output X Systemic vascular resistance
54
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
55
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
56
How do you verify a midline trachea?
Gently press down with you finger in the patient’s suprasternal notch
57
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
58
What is Atherosclerosis?
Thickening of the artery wall from the accumulation of fatty material and the secondary inflammatory response
59
What are the 2 ways that Atherosclerosis causes symptomatic disease?
1. Chronic gradual narrowing of the arteries can eventually cause ischemia from reduced blood flow (stable angina, leg claudication)
2. Acute infarction can be caused by acute plaque rupture and subsequent thrombus formation and occlusion of the artery (MI)
60
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
61
What is Peripheral Artery Disease (PAD)?
Reduced blood flow through the femoral and peripheral arteries that causes a variety of problems
62
What is a thromboembolism?
A blockage of a blood vessel by a blood clot that has become dislodged from another site in the circulation.
63
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
64
What is Acute Coronary Syndrome (ACS)?
A continuum of cardiac disorders causing myocardial ischemia, infarction, unstable angina, and myocardial infarction.
65
Besides pain what symptoms might appear with ACS?
Diaphoresis
Dyspnea
Anorexia
Weakness
Dizziness
Dysrhythmias
Feeling of impending doom ( common in MIs)
66
What is Fibrinolysis?
Fibrinolytic therapy seeks to administer an clot dissolving agent to reperfuse a blocked coronary artery.
67
Which part of the heart is most commonly damaged during an AMI?
The left ventricle
68
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
69
What are the signs and symptoms of right sided heart failure?
Pulmonary Edema
Jugular venous distension JVD
Peripheral Edema
70
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
71
When does cardiogenic shock occur?
When 40% or more of the left ventricle has been infarcted
72
What is the Beck Triad?
The combination of hypotension, jugular venous distension, and muffled heart sounds
73
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
74
What are some causes of cardiac dysrhythmias?
Acid-Base disturbance Hypoxia
Automatic nervous system imbalance Increased vagal tone
Central nervous system imbalance Myocardial ischemia or infarction
Poisons Rheumatic heart disease
Cor pulmonale (RV failure) Trauma
Dissection of cardiac chambers
Drug effects
Electrolyte disturbance
Endocrine disorders
Hypothermia
75
How do nitrate medications work?
Relieve angina by causing vasodilation and decreasing the work of the heart
76
What do Beta blockers do?
Decrease hypertension by decreasing the rate and strength of cardiac contractions
77
What do calcium channel blockers do?
Calcium channel blockers prevent arterial spasm and decrease the force of cardiac contraction by blocking the influx of calcium into the cardiac muscle
78
How do Diuretics work?
Diuretics or water pills trick the kidneys into excreting more sodium and water than usual
79
What are the 2 categories of the nervous system?
Central nervous system: Brain and Spinal cord
Peripheral nervous system: Spinal nerves and Peripheral nerves
80
What are the 4 lobes of the brain?
Frontal
Parietal
Temporal
Occipital
81
What are the roles of the Thalamus and Hypothalamus?
Thalamus: relays sensory information and interprets sensory messages such as pain, temp., and pressure
Hypothalamus: controls homeostatic function such as body temp., respiration, and heartbeat. Also directs hormone secretions of the pituitary gland
82
What is a neoplasm and how are they categorized?
Neoplasm is the medical term for cancer and they are caused by abnormal and unregulated growth of cells in the body
Categorized as either benign (non-cancerous) or malignant (cancerous)
83
What is the name for cancer cells moving from their site of origin?
Metastasis
84
What are the 3 factors that explain why many people get diseases?
How well the body system was developed as a fetus
How effective the body’s defence and repair mechanisms are
How severe or prolonged the factors trying to damage the body are
85
What are the 2 possible problems caused by ICP?
Ischemia due to lack of blood supply
Herniate
86
Explain decorticate vs decerebrate posturing?
Decorticate: abnormal flexion, the patient flexes the arms and curls them toward the chest, at the same time they point the toes.
Decerebrate: abnormal extension, the patient extends arms outward and rotates the lower arms palms down, the wrists are flexed, again the toes are pointed
Decerebrate posturing is a more severe finding than decorticate posturing
87
What is trismus?
Involuntarily closed clenching of the teeth
88
What is Ptosis and what might it suggest?
Ptosis is drooping eyelids and may indicate bell palsy or a stroke
89
What do Agnosia and Apraxia mean?
Agnosia: patients will be unable to name common objects because connections between visual interpretation and the words have become damaged
Apraxia: Refers to the inability to know how to use a common object
90
What are the 3 types of Aphasia (altered speech)?
Receptive aphasia: patient cannot understand speech but is able to speak clearly
Expressive aphasia: the patient cannot speak clearly but is able to understand speech
Global aphasia: this form of aphasia is a combination of expressive and receptive, patient will not follow commands and cannot answer questions
91
What does Nystagmus mean?
Eye twitching
92
What is Bradykinesia?
Routine motions will slow dramatically, a person asked to turn in a circle or walk in a straight line may take very small steps
93
If a person has had a stroke in what way is their arm most likely to droop from an arms out/ palms up position?
One arm will drift down and turn toward the body
94
Define Myoclonus and Dystonia?
Myoclonus: rapid and jerky involuntary contraction of muscles
Dystonia: a part of the body contracts and remains contracted
95
What are the two types of movements that patients can perform while seizing?
Tonic activity: rigid and contracted body posture with shaking
Clonic activity: rhythmic contraction and relaxation of muscle groups, arms and legs may flail and the torso may move wildly
96
What are the hallmark symptoms of ICP? (Cushing reflex)
Bradycardia
Bradypnea
WIDENED PULSE PRESSURE
97
What are the 2 different types of strokes or CVAs (cerebrovascular accidents)?
Ischemic stroke
Hemorrhagic stroke
4/5 strokes are ischemic strokes due to a blocked blood vessel
98
What are the signs and symptoms of a stroke?
Language effects (aphasia, agnosia, apraxia)
Movement effects (hemiparesis, hemiplegia, arm drifting)
Facial droop, Ptosis, and ataxia may be observed as well.
99
What is a TIA?
A transient ischemic attack (TIA) is an episode of cerebrovascular ischemia that does not inflict any permanent damage. Typical presentation of a CVA can occur with a TIA but the symptoms resolve within hours.
More than 1/3 of patients with a TIA will experience a stroke soon afterward.
100
What are some common causes of seizures?
Abscess
Alcohol
Birth defects
Brain infections (meningitis) Uremia (kidney failure)
Brain trauma Tumour
Diabetes Systemic infection
Fever Stroke or TIA
Hypertension during pregnancy (eclampsia) Recreational drug use
Inappropriate medication dosage
101
What are the 5 types of seizures?
Tonic Clonic: full body, violent jerking movements
Absence: freezing or staring
Pseudoseizures: Tonic Clonic but caused by a psychiatric mechanism
Simple partial: shaking or sensation in one area of the body
Complex partial: subtle alterations in LOC
102
What is Status Epilepticus?
A seizure that lasts longer than 4-5 minutes or consecutive seizures that occur without consciousness returning between episodes.
103
What is Multiple Sclerosis (MS)?
An autoimmune condition where the body attacks the myelin sheaths of the neurons in the brain and spinal cord
Symptoms include: double or blurred vision, weakness, impairment of pain temp. and touch senses, pain, tremors, speech disturbance, bladder bowel or sexual dysfunction
104
What is Parkinson’s Disease?
Damage occurs to the part of the brain that produces dopamine.
Symptoms include: gradual onset starting with tremors, postural instability, rigidity, bradykinesia, depression, trouble swallowing, fatigue
105
What is Bell Palsy?
Temporary paralysis of the facial nerve (seventh cranial nerve), easy to confuse with a stroke.
Often resolves within 2 weeks.
Symptoms include: Ptosis (facial droop) and loss of ability to taste
106
What is Amyotrophic Lateral Sclerosis (ALS)?
ALS involves death of voluntary motor neurons for unclear reasons, most common middle aged men.
Symptoms include: (early) fatigue, weakness, difficulty speaking (advanced) lose ability to walk, eat, and speak
107
What is Guillain-Barré Syndrome?
Rare condition that leads to paralysis within 2 weeks.
108
What is Cerebral Palsy
A developmental condition affecting the frontal lobe
Symptoms include muscles in a near constant state of contraction, slow uncontrolled writhing movements, tremors
109
What is Myasthenia Gravis
The body creates antibodies against acetylcholine receptors causing muscle weakness in the eyes, mouth, and throat
110
What is Muscular Dystrophy?
Origin marked by the degeneration of muscle tissue. Usually diagnosed between ages 2-5 and only in men. Life span is shortened to rarely over 20 years.
111
What are the main functions of the endocrine system?
Maintain homeostasis and promote permanent structural changes
112
What are the 2 classifications of glands in the body?
Exocrine Glands: excrete chemicals for elimination, they have ducts that carry secretions to the surface of the skin or into a body cavity
Endocrine Glands: secrete chemicals that are used inside the body, they lack ducts and release hormones directly into surrounding blood and tissue
113
What is the difference between an Agonist and an Antagonist?
Agonists are molecules that bind to a cell’s receptor and trigger a response. Antagonists are molecules that bind to a cell’s receptor to block the action of an agonist.
114
What is the role of the hypothalamus?
The hypothalamus is the primary link between the endocrine system and the nervous system
115
Which hormones are released by the anterior pituitary lobe?
Growth Hormone
Thyroid stimulating hormone
Adrenocorticotropic hormone
Follicle stimulating hormone
Luteinizing hormone
Prolactin
116
What hormones are secreted by the posterior lobe of the pituitary gland?
(ADH) antidiuretic hormone
Oxytocin
117
What hormone is secreted by the thyroid gland?
Thyroxine
118
What are the 2 parts of adrenal glands?
Adrenal Cortex (outer part)
Adrenal Medulla (inner part)
119
Which hormones are produced by the Adrenal Glands?
Adrenal Cortex: corticosteroids, mineralocorticoids
Adrenal Medulla: catecholamines (epinephrine and norepinephrine)
120
What is the endocrine component of the pancreas?
The Islet of Langerhans
Secrets glucagon and insulin
121
What hormones are produced by the gonads?
Estrogen
Progesterone
Testosterone
122
What is Diabetic Ketoacidosis (DKA)?
Untreated hyperglycaemia will lead to DKA, a life threatening condition cause by acids accumulating in the body because insulin is not available.
123
What are signs and symptoms of DKA?
Polyuria (increased urination)
Polydipsia (excessive thirst)
Polyphagia (excessive eating)
Nausea and vomiting
Tachycardia
Kussmaul respirations (deep and rapid)
Fruity door of breath
124
Explain primary vs. secondary adrenal insufficiency?
Primary: caused by atrophy or destruction of both adrenal glands (Addison disease)
Secondary: caused by a lack of ACTH secretion from the pituitary gland
125
What is what is Myxedema coma?
Myxedema coma is an extreme manifestation of untreated hypothyroidism accompanied by physiological decompensation
126
What are the symptoms of hypothyroidism?
Fatigue
Feeling cold
Weight gain
Dry skin
Sleepiness
127
What is thyrotoxicosis and what are it’s signs and symptoms?
Thyrotoxicosis is a toxic condition caused by excessive levels of circulating thyroid hormone.
Presents with fever,tachycardia, nausea and vomiting, altered mental status, possible heart failure.
128
What’s the difference between cellular immunity and humoral immunity?
Cellular immunity: the body produces white blood cells called T cells that attack and destroy invaders.
Humoral immunity: the B cells produce antibodies (also called immunoglobulins) in response to antigens to fight of infection.
129
What are the 5 types of Immunoglobulins?
IgA- provides protection to mucous membranes
IgD- Stimulate antibody producing cells
IgE- Responds in allergic reactions
IgG- Provides protection against bacteria and viruses
IgM- One of the first to appear, causes agglutination and lysis of microbes
130
What are the effects of histamine?
-Increases vascular permeability leading to capillary leakage into the extra vascular space, leading to swelling of the skin and angioedema potentially compromising the airway
-Bronchoconstriction and increased mucous production
-Pruritic (itchy) rash on the skin
-Increase heart rate, dysrhythmia, hypotension, and shock
-Nausea, abdominal pain, vomiting, and diarrhea
131
What are the 6 important topics of patient education regarding an allergy?
How to avoid the antigen
Notify all health personnel of the allergy
Wear identification tags or medical alert bracelets
Carry an anaphylaxis kit/ Epi Pen
Report symptoms early
Biphasic Reactions (monitor up to 8 hours after the reaction)
132
What is the definition of diabetes?
The term diabetes mellitus refers to a metabolic disorder in which the body’s ability to metabolize simple carbohydrates (glucose) is impaired
133
What are the potential causes for Type 1 Diabetes?
Hereditary predisposition
Environmental factors- Ex. infection that triggers an autoimmune disorder destroying the Islet of Langerhans
