PP Clues Hrt/Lung Flashcards
How do you calculate SV?
EDV – ESV = SV
How do you calculate CO?
SV * HR = CO
What is normal CO?
5L/minute
How much of this CO goes to the brain, heart, and kidney?
20% = 1L minute or 60L an hour
How do you calculate CPP?
MAP – ICP = CPP
What organs have resistance in series?
placenta
liver
kidney
spleen
Lungs
What organs have resistance in parallel?
All the rest
except:
placenta
liver
kidney
spleen
Lungs
What organ has the highest A-VO2 difference at rest?
Heart
What organ has the highest
A-VO2 difference after exercise?
Muscle
What organ has the highest A-VO2 difference after meal?
Gut
What organ has the highest
A-VO2 difference during a test?
Brain
What organ has the lowest A-VO2 difference?
Kidney
What is A-V 02 tell you
metabolic activity of the organ
how much 02 is extracted from the arterial compare to the veinous end
Where does Type A thoracic aortic dissection occur?
Ascending aorta (occurs in cystic medial necrosis, syphilis)
Where does Type B thoracic aortic dissection occur?
Descending aorta (occurs in trauma, atherosclerosis)
What layers does a true aortic aneurysm occur?
Intima, media, and adventitia
What layers does a
pseudo aortic aneurysm occur?
Intima and media
What is pulse pressure?
Systolic – Diastolic pressure
What vessel has the thickest layer of smooth muscle?
Aorta
What vessels have the most smooth muscle?
Arterioles
What vessels have the largest cross- sectional area?
Capillaries
What vessel has the highest compliance?
Aorta
What vessels have the highest capacitance?
Veins and venules
hold 60% of circulating volume
What are the three causes of HTN?
Increase
1) Volume: SV
2) Rate: HR
3) Resistance: TPR
What is your max heart rate?
220 – age (in years)
What is Stable angina?
Pain with exertion (atherosclerosis)
What is Unstable angina?
Pain at rest (transient clots)
What is Prinzmetal’s angina?
Intermittent pain (coronary artery spasm)
What is Amyloidosis?
Lab?
Deposition of abnormal protein
Stains Congo red, Echo Apple-green birefringence; deposition of proteins
What is Hemochromatosis?
Fe deposit in organs => hyperpigmentation, arthritis, DM
What is Cardiac tamponade?
Pressure equalizes in all 4 chambers, quiet precordium, no pulse or BP, Kussmaul sign, pulsus paradoxicus (↓ >10mm Hg BP w/ insp)
What is a Transudate?
An effusion with mostly water
Too much water:
* Heart failure
Hypothyroidism
* Renal failure
Not enough protein:
* Cirrhosis (can’t make protein)
* Nephrotic syndrome (pee protein out)
What is an Exudate?
An effusion with mostly protein
Too much protein:
* Purulent (bacteria)
* Hemorrhagic (trauma, cancer, PE)
* Fibrinous (collagen vascular dz, uremia, TB)
* Granulomatous (non-bacterial)
What is Systole?
Squish heart, ↓blood flow to coronary aa., more extraction of O2 (Phase 1 Korotkoff)
What is Diastole?
Fill heart, ↑blood flow to coronary aa., less extraction of O2 (Phase 5 Korotkoff)
What are the only arteries w/ deoxygenated blood?
Pulmonary arteries and umbilical arteries
What is the difference between a murmur and a bruit?
A murmur occurs in the heart
A bruit occurs in blood vessels 70%+ occlusion
What murmur has a Waterhammer pulse?
AR
What murmur has Pulsus tardus?
AS
What cardiomyopathy has
Pulsus alternans?
Dilated cardiomyopathy
What disease has Pulsus bisferiens
Idiopathic Hypertrophic Subaortic Stenosis
hcom
What murmur has an irregularly irregular pulse?
A Fib
What murmur has a regulary irregular pulse?
PVC
Premature ventricular contraction
What sound radiates to the neck?
AS/AR
What sound radiates to the axilla?
MR/MS
What sound radiates to the back?
PS
What disease has a boot-shaped x-ray?
Right ventricle hypertrophy
What disease has a banana- shaped x-ray?
IHSS
Idiopathic Hypertrophic Subaortic Stenosis
What disease has an egg-shaped x-ray?
Transposition of the great arteries
What disease has a snowman- shaped x- ray?
figure 8
Total Anomalous Pulmonary Venous Return
What disease has a “3” shaped x- ray?
Coarctation of the aorta
What is Osler-Weber-Rendu?
AVM in lung, gut, CNS => sequester platelets => telangectasias
What is Von Hippel-Lindau?
AVM in brain, retina => renal cell CA risk
When do valves make noise?
When valves close
What valves make noise during systole?
Mitral and tricuspid regurgitation
What are the most common causes of aortic stenosis?
Aging
Dystrophic calcification
What are the most common causes of aortic regurgitation?
Aging
Calcifications causing valve to sag
What are the most common causes of mitral stenosis?
Rheumatic fever
What are the most common causes of mitral regurgitation?
MVP
SBE
Collagen diseases
What are the most common causes of tricuspid stenosis?
Rheumatic fever
Carcinoid syndrome
What are the most common causes of tricuspid regurgitation?
Acute endocarditis (staph aureus secondary to IV drug abuse)
What murmurs occur during systole?
Holosystolic, ejection murmur or click
What are the holosystolic murmurs?
TR, MR, or VSD
What are the systolic ejection murmurs?
AS, PS, or HCM
What valves make noise during diastole?
Aortic and pulmonic
What are the diastolic murmurs?
Blowing and Rumbling
What are the diastolic blowing murmurs?
AR or PR
what are the diastolic rumbling murmurs?
TS or MS
What are the continuous murmurs?
PDA or AVMs
What has a friction rub while breathing?
Pleuritis
What has a friction rub when holding breath?
Pericarditis
What does a mid-systolic click tell you?
Mitral valve prolapse
What does an ejection click tell you?
A/P stenosis
What does an opening snap tell you?
M/T stenosis
What does S2 splitting tell you?
Normal on inspiration (b/c pulmonic valve closes later)
What does wide S2 splitting tell you?
↑O2, ↑RV volume, or delayed pulmonic valve opening
What does fixed wide S2 splitting tell you?
ASD
What does paradoxical S2 splitting tell you?
AS (or left bundle branch block)
What do you see in left sided heart failure?
Pulmonary edema
Orthopnea
Paroxysmal nocturnal dyspnea
What do you see in right sided heart failure?
Hepatomegaly
Peripheral Edema
Jugular venous distension
What is cor pulmonale?
Pulmonary HTN => RV failure
What is Eisenmenger’s?
Pulmonary HTN => reverse L-R to R-L shunt
What is Transposition of the great arteries?
Aorticopulmonary septum did not spiral
What is Tetrology of Fallot?
- Overriding Aorta: aorta sits on IV septum over the VSD; pushes on PA
- Pulmonary Stenosis “Tet spells”
- RV hypertrophy => boot-shaped heart
- VSD (L to R shunt)
What is Total Anomalous Pulmonary Venous Return?
All pulmonary veins to RA, snowman x-ray
What is Truncus Arteriosus?
Spiral membrane not develop => one A/P trunk, mixed blood
What is Ebstein’s Anomaly?
Tricuspid prolapse,
Pregnant woman on Lithium increases risk
What can Lithium do to Mom?
Nephrogenic Diabetes Insipidus
What is Cinchonism?
Hearing loss, tinnitus, thrombocytopenia
List four types of cells in the lungs?
Goblet: Mucus Production
Type I Pneumocyte: Macrophages (95%)
Type II Pneumocyte: Produce Surfactant
Clara/Dust (Macrophages): Ingest dust particles
What is the histology of the trachea?
Top 1/3: Stratified Squamous Epithelium (Protect against abrasion)
Middle 1/3: Mixture
Lower 1/3: Tall Columnar Pseudo-stratified ciliated Epithelium
What are the muscles needed to breathe in?
Innermost intercostals (contralateral chest wall)
External Intercostals (ipsilateral chest wall) Diaphragm
What are the muscles needed to force air in?
Scalenes
SCM -sternocleidomastoid
Trapezius
Pectoralis Major/minor
What are the muscles needed to breathe out?
Passive - recoil
What are the muscles needed to force air out?
Internal/external oblique
Rectus abdominus
Transverse abdominus
Quadratus lumborum
What is the difference between
a carotid body and a carotid sinus
Carotid body: chemoreceptor
Carotid sinus: baroreceptor
What color is air on an x-ray?
Black “radiolucent”
What color is fluid/solid on x-ray?
White “radiopaque”
What disease has a steeple
sign on neck film?
Croup
What disease has a thumb sign on neck film?
Epiglottitis
What is a “blue bloater”?
Bronchitis (chronic)
What is a “pink puffer”?
Emphysema
What diseases have pulmonary eosinophilia?
Aspergillosis, Strongyloides
What drugs cause pulmonary eosinophilia?
Nitrofurantoin, Sulfonamides
What are the risk factors for lung cancer?
Smoking, Radon, 2nd hand smoke, pneumoconiosis (except anthracosis)
What diseases have hemoptysis?
Bronchiectasis, bronchitis, pneumonia, TB, lung cancer
Where is a Bokdalek hernia?
Back of diaphragm
Where is a Morgagni hernia?
Middle of diaphragm
What diseases have respiratory alkalosis?
Restrictive Lung Dz (anxiety, pregnancy, Gram – sepsis, PE)
What diseases have respiratory acidosis?
Obstructive Lung Dz
What diseases have metabolic alkalosis?
Low Volume State (vomiting, diuretics, GI blood loss)
What is the obstructive pattern of blood gases?
↑pCO2 -> ↓pH,
↑RR–>↑pO2
What is the obstructive pattern of blood gasses?
↓ pO2 –> ↑RR –> ↓pCO2 -> ↑pH
What does stridor tell you?
Extrathoracic narrowing => narrows when breathe in => neck x-ray
What does wheezing tell you?
Intrathoracic narrowing => narrows when breathe out => chest x-ray
What does rhonchi tell you?
Mucus in airway => obstructive lung disease
What does grunting tell you?
Blows collapsed alveoli open => restrictive lung disease
What does dull percussion tell you?
Something b/w airspace and chest wall absorbing sound (fluid or solid)
What does hyperresonance tell you?
Lungs hyperinflated with air
What does tracheal deviation tell you?
Away from pneumothorax OR toward atelectasis “air-phobic”
What does fremitus, egophony, and
Consolidation=> pathognomonic for pneumonia
What is Restrictive lung disease?
Small stiff lungs, trouble breathing in
What is Obstructive lung disease?
Big mucus-filled lungs, trouble breathing
out
What is Epiglottitis?
X-ray thumb sign, drooling
What is Croup?
X-ray steeple sign, barking cough
What is Tracheitis?
Look toxic, grey pseudomembrane, leukocytosis
What is Asthma?
Wheeze on expiration, IgE, eosinophils
What is Bronchiolitis?
Asthma in kids <2 y/o
What is Maxillary Sinusitis?
Teeth pain worse with bending forward
What is Bronchiectasis?
Bad breath, purulent sputum, hemoptysis
What is Chronic Bronchitis?
Lots of sputum, “blue bloater”
What is Emphysema?
Restrictive to obstructive pattern, “pink puffer”
What is Laryngomalacia?
Epiglottis roll in from side-to-side
What is Pneumonia?
Consolidation of airway
What is Pneumothorax?
Air outside of lungs; hyperresonnace on same side
How do you detect a Pulomary Embolus?
Tachypnea, increased V/Q scan, EKG: S1Q3T3
What is Tamponade?
Decreased breath sounds/BP; increased JVD; fluid in pericardial sac
What is Tracheomalacia?
Soft cartilage, stridor since birth
What is Cystic Fibrosis?
Meconium ileus, steatorrhea,bronchiectasis
What is Aspergillosis?
Allergy to mold, dead plants, compost piles
Who gets Asbestosis?
Shipyard workers, pipe fitters, brake mechanics, insulation installers
Who gets Silicosis?
Sandblasters, glassblowers
Who gets Byssinosis?
Cotton workers
Who gets Beryliosis?
Radio, TV welders, those working with bulbs
What is Anthracosis?
Coal workers, massive fibrosis
What is Sarcoidosis?
Non-caseating granulomas, eggshell calcification of lymph nodes
What is Carcinoid syndrome?
Flushing, wheezing, diarrhea
What is Small cell CA?
At carina, malignant, Cushing’s, SIADH, SVC syndrome
What is Large cell CA?
Large stuff
What is Squamous cell CA?
Smoker, high PTH, high Ca ++
What is Bronchealveolar CA?
Looks like pneumonia; due to pneumoconiosis
severe aortic stenosis in pt with scattered bleeding angiodysplasia
pathophys
acquire vW factor deficiency
3 action of vW
- bind sites of endothelial injury for platelet aggregation
- promote platelet aggregation at high shearing pressure
- carrier protein for Factor 8
how is vW affected in AS
acquire vWF deficiency
the high shearing site allows ADAMTS 13 to cleave vW multimers causing vWF deficiency
