SEM Flashcards
Specify the Heart block that is associated with Wenckebach.
2nd degree Type 1 Mobitz
Provide the formula for Stroke Volume (SV).
SV = EDV-ESV
What is the heart’s natural pacemaker?
SA node
What is the best determinant for intensity of exercises in pulmonary pt’s?
Dyspnea
What heart sound refers to the closure of SL valves?
S2 (dub)
A pt has a low BP and high HR. What is the pt experiencing?
Orthostatic Hypotension
How much mL is in a normal EDV?
120 mL EDV
Termination of exercise. How much increase in mmHg from resting BP to stop exercise?
20-10mmHg
20 sbp - 10 dbp
Termination of exercise. How much decrease in mmHg from resting BP to stop exercise?
10-5 mmHg
10 sbp - 5 dbp
Which side of the body is the cardiac pacemaker placed?
Non-dominant side
What condition refers to “multiple P on P phenomenon”?
3rd Degree Heart Block
What type of population are affected with Ventricular hypertrophy?
Athletes (especially olympians)
What is immediately done in a pt. with Ventricular Fibrillation?
CPR and then Defibrillator
Specify the condition with “double P on P phenomenon”?
2nd degree Type 2 Mobitz
What is the proper mmHg release in taking a pt’s BP?
Deflation is 2-3 mmHg/sec drop in taking BP
What is the greatest treatable risk factor?
Hypertension
What condition is associated with a positive finding of chronic valve murmurs?
Rheumatic Heart Disease RHD
What is the % HR max of pt’s with comorbidities?
40-60% HR max
Provide the formula for Cardio Output CO.
CO = HR x SV
What cardiac condition is associated with Brugada syndrome?
Sudden Unexplained Death Syndrome SUDS
What heart sound automatically corresponds to an abnormal pathology?
S4 heart sound
What kind of shunt is a cyanotic VSD?
L shunt
Enumerate the 4 manifestations of Tetralogy of Fallot TOF.
- Pulmonary artery stenosis
- RV hypertrophy
- Ventricular septal defect (L shunt)
- Overriding of the aorta
What invasive surgery may be done to pt’s with a thrombus?
Coronary Artery Bypass Graft surgery
What do you call the object that maintains the shape of a vessel after deflating a ballon?
Cardiac stent
What are the semilunar valves?
Aortic valve and Pulmonary valve
What heart sound is associated with congestive heart failure CHF?
S3
What technique is used to check the pulmonary arterial pressure?
Swan-Ganz catheter
Hypotension in the midst of tachycardia
Orthostatic Hypotension
Drug of choice given to patients with CHF
Digoxin
Antidote to digitalis toxicity
Digibind
What supplies the 40% of the SA node?
Left Circumflex artery
Provide the formula for Bohr Effect.
Co2 + Hgb –> O2
What are the only veins that carry highly
oxygenated blood?
Pulmonary veins
Where does the Bohr Effect take place?
Peripheral/systemic capillaries
What are the only arteries that carry deoxygenated blood?
R & L pulmonary arteries
What is the systemic pump?
L ventricle
Provide the formula for Haldane Effect.
O2 + Hgb –> CO2
What is the most prone for CAD?
LAD
If there is an impending heart disease or MI or angina pectoris, where will the referred pain be?
Simultaneous B shoulder referred pain
What are the physiologic properties of the heart?
Chronotropic, Bathmotropic, Dromotropic and Inotropic
What artery besides the R coronary artery also supplies the Right ventricle?
LAD
What condition can be seen with Levine’s sign?
Myocardial Infarction
What is the definition of Stroke Volume?
The amount of blood ejected by the heart per second/per cardiac cycle
Provide the formula for Ejection fraction (EF)
SV / LV EDV = x 100
What is the normal value of Stroke Volume?
70 mL
What do you call the structure in an adult heart that was previously called in a fetal heart ‘Foramen ovale’?
Fossa ovalis
What do you call the structure in an adult heart that was previously called in a fetal heart ‘Ductus arteriosus’?
Ligamentum arteriosum
What is the most common cause of blue babies?
Tetralogy of Fallot
What are the mainstays for an MI Myocardial Infarction?
Aspirin, nitroglycerin and O2 (ANO)
What conditions refers to the exchange places aorta becomes RV while pulmonary a.
becomes part of LV?
Transposition of Great vessels
What is the first drug to be given to a pt. with heart attack?
Oxygen
What condition refers to the aorta and pulmonary a. become one in the same trunk without normal separation?
Truncus Arteriosus
What are the 4 defects associated with Tricuspid valve atresia?
Defective tricuspid valve, ASD, VSD and very small RV
R ventricular hypertrophy may lead to ________
R ventricular hypertrophy may lead to cor pulmonale
What position should an irritable blue baby of 10 months?
Supine knee to chest < 1 y.o
What situation is the given pathway referring to VC, RA, RV, pulmo. artery (blocked) goes back to RV?
Pulmonary artery stenosis
What position should an irritable blue baby of 13 months?
Side lying knee to chest > 1 y.o`
A hole in between two atrias of the R atrium and the L atrium
Astrial sepal defect ASD
Enumerate the 4 acyanotic CHD.
Atrial sepal defect (ASD), Patent ductus arteriosus (PDA), Coarctation of the Aorta, VSD (R shunt)
What heart sound can be heard with rapid ventricular filling?
S3
What do you call when the F. ovale is open and the Ductus art. Is closed the blood can still reach the lungs?
Astrial sepal defect ASD
The F. ovale is open and the Ductus art. Is closed the blood can still reach the lungs via ___
L Atrium
What possible conditions with a (+) S4 heart sound?
MI Aortic Stenosis CAD HTN Pulmo Dse. CABG
What heart sound refers to atrial gallop or abnormal atrial systole?
S4 heart sound
In what phase can you hear the S2 heart sound?
Diastole
What BP ranges do you consider normal in a 12 yo.?
SBP: 95-135mmHg
DBP: 53-88 mmHg
What BP ranges do you consider to be preyhypertension?
SBP: 120-139
DBP: 80-89 mmHg
What is the formula for the number of seconds to take a BP?
Pulse pressure divided by 2 mmHg and 3 mmHg
What are the phases of Korotkoff sounds?
Tapping Swishing, murmur Crisp, louder Muffling Disappear
What phase of the cardiac cycle is when all of the AV valves and SL valves are closed?
Phase 2 (Isovolumetric contraction) and Phase 4 (Isovolumetric relaxation)
In the cardiac auscultation where can you hear the murmurs and mitral stenosis?
Erb’s point 3rd ICs on the L
Amount of blood ejected by the ventricle per cycle per second or per beat
Stroke Volume
What is the best determinant for exercise for pulmonary patients like Covid 19?
Dyspnea scale
Provide the formula for BP.
CO x TPR
Where does the conduction of 1st degree Heart Block patients end?
Conducts until the Bundle of HIS
What refers to ventricular repolarization on ECG?
T wave
What basis do you use for termination of exercise?
Blood pressure
What basis do you use for the adjustment of exercise intensity?
Determinants of exercise like dyspnea etc.
What is the pathway for the conduction of the heart?
SA Node → AV Node → AV Bundle of HIS → (R) and (L)
branches of Bundle of HIS → Purkinje Fibers → Ventricles
What refers to atrial depolarization on ECG?
P wave
What is the normal conduction of the heart?
0.12 -0.20 secs
On ECG what determines the conduction of the heart?
PR interval
What heart condition refers to “regularly irregular”?
3rd Degree Heart Block (HB)
What dromotropic incompetence refers to P on P phenomenon – QRS complex is gone
2nd Degree Heart Block (HB) Type 1 Mobitz
Where does physiologic delay happen to allow ventricular filling?
AV Node
What conditions has a flecked sputum?
Pneumoconiosis / Coal Miner’s Disease
What is the most common cause of Bronchiectasis in children?
Cystic Fibrosis
What condition has a purple sputum?
Neoplasm (bronchogenic carcinoma)
What condition has a gray sputum?
Emphysema
What condition has a rusty sputum?
Pneumonia
What is the consistency of a sputum that is “very viscous, white, foul smelling”?
Fetid consistency
What condition has a fetid consistency?
Cystic Fibrosis
Viscous sputum blocks the pathways may cause permanent dilatation of the bronchioles; may lead to what condition?
Bronchiectasis
What adventitious or abnormal lung sound will you hear in a patient with L CHF?
Bibasilar rales
What condition has s/sx such as dyspnea, wheeze, productive cough?
Asthmatic Bronchitis
At what level is Liver?
T7-T10
What type of pneumonia is most commonly seen on the R lung?
Aspiration pneumonia
What bronchus is longer, narrow and oblique?
L bronchus
What cartilage of the larynx represents the Adam’s Apple?
Thyroid cartilage
What is the most effective mechanical way of secretion clearance?
Suctioning
How long should suctioning take?
10-15 secs
Why does the trachea have c-shaped cartilages?
At the posterior part it accommodates the esophagus alimentary upper GIT
What is the bifurcation of the trachea?
Carina
______ lung disease is in a way restrictive also.
Infectious lung disease is in a way restrictive also.
What diseases are commonly seen on the L Bronchus
Bacterial, viral, streptococcal pneumonia, mycoplasma and coronavirus
What is the best position for COVID-19 patients to improve oxygenation?
Prone
How will you position a patient with Aspiration pneumonia?
L side lying
What type of cough does Covid pneumonia have?
Dry cough
What part of the conducting portion marks the transitional zone?
Terminal Bronchioles
What is also known as wet lung disease?
Infant Respiratory Distress (IRD)
What is also known as Pneumocytes?
Alveolar cells
What is the functional unit of the lungs?
Acinus
What is the normal volume of air?
400 mL of AIR
What is the normal volume of blood?
500 mL of BLOOD
What is the normal ventilation perfusion ratio?
0.8
If a pt has a hx of cough for 3 months in a year continuously that could persist 2 consecutive years what could the pt have?
Chronic Bronchitis
What kind of isolation unit ___ pressure room will an airborne patient be in?
Negative pressure room for airborne patients
True of False.
Emphysema could be elevated to Chronic Bronchitis
False
What is the X-ray finding seen in a patient with Emphysema?
Bullae
In a positive pressure room who will be wearing a surgical mask?
Both the patient and the medical staff will be wearing a surgical mask.
In a negative pressure room what who will be wearing an N-95 mask?
Medical staff will only wear N-95 mask
What is another term for a positive pressure room?
Reverse isolation room
What kind of bacteria is seen in a pt. with TB?
Mycobacterium tuberculosis
What do you call the condition that has a blood supply of <75%?
Ischemic Attack
True or False. Two positively charged ions cannot go together
True
In every one cycle of the pump, how many Na+ ions will be pumped outside?
In every one cycle of the pump, 3 Na+ ions will be
pumped outside
In every one cycle of the pump, how many __ K+ ions will be pumped back inside?
2 K+ ions will be pumped back inside
In the nerve/ muscle action potential hyperpolarization phase, there is an influx of what ion?
Influx of Cl-
Why is an Arrythmia considered a Chronotropic Incompetence?
It is considered a Chronotropic incompetence because by definition of Arrythmia there is an abnormality or irregular rhythm of the heart and one of the properties of the heart is chronotropic and under it is rhythmicity.
On ECG there is ST elevation with a down sloping what could be the condition?
SUDS
* If Chronic ST elevation with a down sloping = LV Aneurysm
On ECG you notice there is a saw tooth appearance what could the condition be?
Flutter
What is the flag for atrial fibrillation?
Yellow to red flag
What is Lidocaine indicated for?
Arrythmia
What medication is a cardiac inotrope?
Epinephrine
What drug increases contractility, promoting cardio acceleration so the patient won’t drop to flatline
Epinephrine
What converts Angiotensin 1 to Angiotensin II?
ACE
What alternative drug is used instead of ACE inhibitors to avoid coughing?
Angiotensin receptive blockers ARBs
What is the suffix for ARBs?
“sartan”
Class IV Ca Channel blockers are contraindicated for what patients?
Congestive Heart Failure CHF
What is the normal levels of Albumin in the liver?
3.5-5.5
What happens when a pt has <1.5 Albumin levels?
Malnutrition, edema and ulceration
What kind of edema does R CHF patients have?
Bipedal pitting edema
What anti-arrythmic drugs are usually used for maintenance?
Class II B-blockers and Class IV Ca channel blockers
What could the patient have if there is absent Q wave on the ECG?
Normal
What could the patient have if there is absent P wave on the ECG?
Atrial arrest
Whis has a worse affectation zone of injury or zone of ischemia?
Zone of Injury
on the ECG the pt has a pathologic q wave what zone could be affected?
Zone of Infarction
What has the same normal level of Albumin?
Potassium
What sympathetic receptor is present in the lungs?
Beta-2
What type of cells kill RBCs?
Copper cells
True or False. If there is a decrease in cortisol, there is an decrease in stress.
False. Cortisol hormone must be WNL any inc or dec will still result in stress.
What represents the inferior wall of the heart?
Lead II, Lead III, aVF
In a pt with L ventricular aneurysm what is seen on the ECG?
Chronic ST elevation with down sloping
Enumerate the cardiac isoenzymes.
Myoglobin, CK-MB, AST, LDH, Troponin T and I
If the pt has ST depression between 1mm and <2mm without any complications, what is the flag?
Yellow flag
When a pt experiences an angina pectoris what is seen on the ECG?
ST depression
ST depression with U wave or
Inverted T wave
What is the difference between Cushing Syndrome and Cushing’s disease?
Cushing’s disease: pituitary; Cushing syndrome: problem in adrenal cortex
Where is the direction of the transcellular shift in a pt with an ECG finding of tall T wave?
Transcellular shifting to the R
If a pt has > 5.5 meq/L what is the pt experiencing?
Hyperkalemia
What is the most common cause of sudden death in athletes?
Ventricular hypertrophy
When a pt has an elevated QRS complex what could be the condition?
Ventricular hypertrophy
What type of continuous adventitious sound may be heard on a pt with Laryngospasm?
Ronchi
What do you call the sound usually heard when there is retention of pulmonary secretions?
Crackles/ Rales
What crackling sounds are heard over the pericardium during systole but actually is a pulmonary disease problem?
Crunches
What do you call the structure that filter the air entering the nose?
Vibrissae
What could happen when the larynx or muscles around it become dysfunctional?
Aphonia/ Dysphonia
What condition is related to odorous perspiration?
Cystic fibrosis d/t affectation of sweat glands
How often do CF patients drain secretion?
6x during waking hrs/ once every 2 hrs for 12 hrs
What type of sputum consistency do Asthmatic Bronchitis patients have?
Thick tenacious
What is the structure pierced for tracheostomy of endotracheal tube?
Cricothyroid ligament
How many cartilages compose the trachea?
16 c-shaped cartilages
Where are the two areas that have cilia?
Fallopian tube and tracheobronchial tree
How do you position a patient with mycoplasma streptococcal pneumonia?
R side lying
How many segmental bronchi are there on the R and on the L?
Segmental bronchi: 10 on the R and 8 on the L
At the terminal bronchioles, there is a change to what type of epithelium?
Simple cuboidal epithelium
There is how many generations in the trahceobronchial tree?
23 generations
What is the best way to expectorate?
Huffing or FET
How long is the treatment time per lung segment during postural drainage?
5-10 mins
When do you perform adjuncts like percussion, vibration etc. to postural drainage?
If after 10 mins and still pt reports that the throat is dry even with correct auscultation and positioning.
What cells are responsible for regulating the ABB?
Type 1 Alveolar cells
What do you call the channel that interconnects bronchioles to bronchi?
Martin’s Canal
How long is the maximum treatment time of postural drainage?
45 mins
What do you call the supplemental oxygen given to infants with IRDs?
CPAP
What is the difference between CPAP and IPBB?
CPAP has continuous inflation phase
IPBB has inflation and deflation phase
What do you call the supplemental oxygen given to patients with ARDs?
Intermittent positive pressure breathing IPBB
What cells are responsible for surfactant to decrease surface tension in the lungs?
Type 2 Alveolar cells
Are humans capable of releasing O2? Explain if yes or no
Yes, during CPR the air at the anatomic dead space is what’s used to provide O2 for the pt.
What is the FEF rate of a person with Obstructive lung disease?
FEF ratee: < 25%-75%
What diseases are airborne transmissions?
TB, Measles and Varicella/ Chicken pox
Specify what PPE is used for TB and COVID-19 (Delta variant).
N-95 mask
What kinds of procedures may cause Pneumonia?
Tracheostomy, suctioning and incubation
For pt’s with pneumonia what kind of isolation unit will he be placed at?
Positive pressure room or Reverse isolation room
What condition has bigger droplets that are > 5 mm and can travel for 3ft. or less?
Pneumonia
What PPE should be worn for pt’s with Pneumonia?
Surgical mask and/ or face shield
What diseases have contact precautions that needs gown and gloves for PPE?
Herpes-Zoster, Herpes-Simplex, Open wounds and MRSA
What type of lung disease is Tuberculosis?
Restrictive lung disease
Is there a cure for TB?
Yes, RIPE for 6 mos.
What is the prevention for Tuberculosis?
Bacillus Calmette-Guerin BCG vaccine
What are the medications for TB?
"RIPE" od for 6 months Rifampin Isoniazid Pyrazinamide Ethambutol
*Streptomycin (to increase potency of RIPE)
Arrange the pressures from highest to lowest.
Zone 3
Arterial Pressure > Venous Pressure > Alveolar Pressure
Arrange the pressures from highest to lowest.
Zone 2
Arterial Pressure > Alveolar Pressure > Venous Presure
Arrange the pressures from highest to lowest.
Zone 1
Alveolar Pressure > Arterial Pressure > Venous Pressure
In COVID-19 there is more ___ than ___ which is why you position the pt in prone.
In COVID-19 there is MORE AIR than BLOOD which is why you position the pt in prone.
Pt’s who are intubated are placed in what position?
Prone pos. / SIMS (semi-prone pos.)
What abnormality is when there is an absence of the 12th rib?
None, it’s normal
Why are the first 7 ribs called True ribs?
It is because it’s directly attached to the sternum.
What condition is associated with paradoxical breathing?
Flail chest
How much amount can a chest drain fill up?
2L
True or False. You can start doing amb training for a pt with a chest drain.
True
What kind of pleural effusion refers to Chylothorax?
Lymph drainage
What kind of pleural effusion refers to Pleurisy?
Interstitial fluid
What kind of pleural effusion refers to Pyothorax?
Pus drainage
What kind of pleural effusion refers to Empyema?
Pus drainage
For a pt with chest drain what are the precautions for ROMEs?
Shoulder flexion <80 deg ONLY
Shoulder ER & IR in 90deg of Shoulder abduction ONLY
Horizontal abd and add at 90deg Shoulder abduction ONLY
DO NOT do full Shoulder abduction
What is the primary mm of inspiration?
Diaphragm
What conditions have pectus excavatum?
Marfan syndrome and Arthrogryposis multiplex congenita
What is the innervation of the Diaphragm?
Phrenic Nerve: C3, C4, C5 (keeps the diaphragm alive)
In pregnant women, which trimester can the pt experience gestational orthopnea?
3rd trimester
If a pregnant woman is placed in supine pos. c lightheadedness and edema on B LE what could the pt be experiencing?
Vena-cava compression or Gestational supine hypotension
How should you position a patient with Gestational supine hypotension?
Quarter turn to the left from supine c pillow on R butt to relieve pressure on the R vena cava
In Rib flaring what muscles are considered weak?
External obliques
What is the normal amount of IRV?
3000 mL
How much of the 500 mL of Tidal volume will undergo gas exchange?
350 mL
The 150 mL remaining of the TV will go where?
The remaining 150 mL will go to the Anatomic dead space
Is the Alveolar dead space normal or abnormal?
Abnormal
What is the normal amount of ERV?
1100 mL
What pulmonary lung volume keeps the lungs inflated and preventing it from collapsing? and what it it’s normal amount?
Residual volume = 1200 mL
What condition is present in a pt with crunches breath sounds?
Mediastinal emphysema
What is the generation of the terminal bronchioles?
16th generation
What generation is coughing most effective?
7th generation
For pt’s with status asthmaticus, Ventolin meds do not work what meds should be prescribed?
Epinephrine
What organs are affected with R CHF?
Liver, spleen and lungs
What organs are affected with L CHF?
Kidneys and Brain
