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DNAP 2027 > Spring 25 - AHA Test 2 > Flashcards

Spring 25 - AHA Test 2 Flashcards

1
Q

What items define the thoracic cage?

A
  • Sternum
  • 12 pairs of ribs
  • 12 pairs of thoracic vertebra
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2
Q

Thoracic cage divided into?

A
  • Anterior thorax
  • Posterior thorax
  • RIbs are in the anterior and posterior thorax
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3
Q

What are the True ribs, and how do they attach?

A

1 - 7
Attach directly to the sternum

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4
Q

What are the False ribs, and how do they attach?

A

8 - 10
Attach to the costal cartilage above

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5
Q

what are the Free-floating ribs, and how do they attach?

A

11 & 12
Tips can be palpated

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6
Q

Which joint can be found between the head of the rib and the transverse costal facet of the corresponding vertebra

A

Posterior Costotransvere joint

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7
Q

Which joint can be found Between the head of the rib, the superior costal facet of the corresponding vertebra, and the inferior facet of the vertebra

A

Posterior Costovertebral joint

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8
Q

Which Rib is shorter and wider than the other ribs, with only one facet on its head for articulation with its corresponding vertebra?

A

Rib 1

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9
Q

Which rib is thinner and longer than rib one and has two articular facets on the head?

A

Rib 2

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10
Q

Where does the serratus anterior muscle originate from?

A

The roughened area on the upper surface of Rib 2

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11
Q

Which Rib Only has one facet – for articulation with its
numerically corresponding vertebra?

A

Rib 10

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12
Q

Which ribs have no neck and only contain one facet, which is for articulation with their corresponding vertebra.

A

Rib 11 & 12

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13
Q

What are the Main structures of the Anterior thoracic cage?

A
  • Suprasternal notch
  • Sternum
  • Manubriosternal angle
  • Costal angle
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14
Q

Describe suprasternal notch

A

U-shaped depression just above sternum between clavicles.

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15
Q

Parts of the sternum

A
  • Manubrium
  • Body
  • Xiphoid Process
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16
Q

What is the location of the Manubriosternal angle: “Angle of Louis,” “Sternal Angle”?

A

At articulation of manubrium and sternum, and continuous with
second rib

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17
Q

How is the Manubriosternal angle identified?

A

Palpate lightly to second rib and slide down to second intercostal space

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18
Q

What is the importance of the Manubriosternal angle: “Angle of Louis,” “Sternal Angle”

A
  • Marks site of tracheal bifurcation into right and left main bronchi
  • Corresponds with upper border of atria of the heart, and it lies above fourth thoracic vertebra on back
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19
Q

Where do the right and left costal margins meet?

A

They meet at the xiphoid process.

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20
Q

What are the posterior Thoracic Landmarks?

A
  • Vertebra prominens
  • Spinous processes
  • Inferior border of scapula
  • Twelfth rib
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21
Q

What is the location and function of the Vertebral prominens?

A

Seventh Cervical Vertebra
* Flex your head and feel for most prominent bony spur protruding at base of neck.
* Largest and most inferior vertebra in the neck region.
* “No split at the tip”.

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22
Q

What is the location of the Inferior border of the scapula:

A

Lower tip is usually at the 7th or 8th Rib

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23
Q

What is the location of the 12th rib

A

Palpate midway between spine and a
person’s side to identify its free tip.

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24
Q

What are the reference lines for the Anterior chest:

A
  • midsternal
  • midclavicular line
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25
Q

What are the Reference lines for the Posterior chest?

A
  • Vertebral (midspinal) line
  • Scapular line
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26
Q

Reference lines for lateral chest

A
  • Anterior axillary line
  • Posterior axillary line
  • Midaxillary line
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27
Q

What structures enclose the Thoracic Cavity?

A
  • ribs
  • Sternum
  • vertebral column
  • top of diaphragm
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28
Q

What essential systems are housed/pass through the Thoracic Cavity?

A
  • Respiratory
  • Cardiovascular
  • Nervous
  • Immune
  • Digestive
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29
Q

What is the Content of the mediastinum?

A

Ø esophagus
Ø trachea
Ø heart
Ø great vessels

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30
Q

How many lobes on R lung?

A

3

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31
Q

How many lobes on L lung

A

2

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32
Q

What is the Name and location of the highest point of lung tissue?

A

Apex
Sits 3 to 4 cm above inner 1/3 clavicle

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33
Q

What is the Name and location of the lower border of the lung?

A

Base
Sits arounf 6th rib, midclavicular line

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34
Q

Which lung has no middle lobe?

A

Left one

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35
Q

What form an envelope between the lungs and the chest wall?

A

Pleura

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36
Q

What type of pressure is found in the pleural cavity?

A

Vacuum (Negative pressure) that holds the lung tightly against the chest wall

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37
Q

The Pleural cavity is also known as?

A

Potentional Space
Filled with a few ml of lubricating fluid

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38
Q

Location and description of oblique fissure

A

On anterior chest, oblique fissure crosses fifth rib in midaxillary line and terminates at sixth rib in midclavicular line.

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39
Q

Where would you look for almost all the lateral lobes of the lung?

A

Posterior chest

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40
Q

Where does the trachea lie compared to the Esophagus, and how long is it?

A

The trachea lies anterior to the esophagus and is 10 to 11 cm long in adults.

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41
Q

R vs L main bronchus

A

The right main bronchus is shorter, wider, and more vertical than the left main bronchus

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42
Q

What Cells secrete mucus in the airway

A

Goblet cells

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43
Q

What is the second most dx cancer?

A

Lung cancer

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44
Q

What disease affected more than 1/3 of the world population

A

TB

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45
Q

What is the most chronic disease in childhood

A

Asthma

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46
Q

What are the 5 As of smoking counseling

A
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange
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47
Q

Pediatric Hx red flags

A
  • Frequent colds
  • Hx of allergy
  • Cough/congestion
  • Noisy breathing or wheezing
  • Rule out foreign bodies in airway
  • hx of 2nd hand smoke exposure
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48
Q

What is the appropriate ratio of AP to Transverse diameter

A

0.70 - 0.75

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49
Q

How is Tactile (or vocal) fremitus assessment performed?

A

Using hands to assess for palpable vibrations
* Repetition of phrases by patient (“99” or “blue moon”)
* Be aware of factors that can influence normal intensity.

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50
Q

What is percussion?

A

Determine predominant note over lung fields starting at apices and percuss band of normally resonant tissue across tops of both shoulders

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51
Q

What is auscultation?

A

LISTENING to the passage of air through the tracheobronchial tree creates a characteristic set of noises that are audible through the chest wall.

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52
Q

What are the three types of breath sounds heard in adults?

A
  • Bronchial, sometimes called tracheal or tubular
  • Bronchovesicular
  • Vesicular
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53
Q

Describe Atelectatic crackles

A

(Not pathological) Short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths

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54
Q

Describe Stridor

A

Inspiratory crowing sound, loudest in the neck

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55
Q

What are the discontinuous sounds

A
  • Crackles (fine/coarse)
  • Atelectatic crackles
  • Pleural friction rub
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56
Q

What are the continuous sounds

A
  • Wheeze (sibilant / Sonorous rhonchi)
  • Stridor
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57
Q

How is voice perceived through a stethoscope?

A

Normal voice transmission is soft, muffled, and indistinct; you can hear sound through a stethoscope but cannot distinguish exactly what is being said.

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58
Q

Pathology that increases lung density do what to voice?

A

Enhances transmission of voice sounds.

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59
Q

List abnormal findings of Tactile Fremitus

A

˜ - Increased tactile fremitus
˜ - Decreased tactile fremitus
˜ - Rhonchial fremitus
˜ - Pleural friction fremitus

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60
Q

What would the Percussion finding be in the Right hemithorax?

A

The upper border of liver dullness is located in fifth intercostal space in the right midclavicular line

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61
Q

What would the Percussion finding be in the Left hemithorax

A

Tympany is evident over gastric space.

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62
Q

What is force expiration time

A

Number of seconds it takes to exhale from
total lung capacity to residual volume.

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63
Q

Normal SpO2

64
Q

Every SpO2 result must be evaluated in context of

A

Hgb level, acid-base balance, and ventilatory status.

65
Q

Describe infant thorax

A

Rounded thorax with an equal anteroposterior-to-transverse chest diameter.

66
Q

What changes are expected by age 6 in Child’s thorax?

A

By age 6 years, thorax reaches adult ratio of 1:2

67
Q

What is the Newborn’s first respiratory assessment to measure the successful transition to extrauterine life?

68
Q

What is the newborn’s chest circumference compared to that of their head?

A

Newborn’s chest circumference is 30 to 36 cm. 2 cm smaller than head circumference until 2 years of age

69
Q

The infant is obligate nose breather until what age

A

3 months old

70
Q

In infants, are Brief periods of apnea less than 10 or 15 seconds common?

71
Q

Where would you position the stethoscope on the infant?

A

Try using smaller pediatric diaphragm endpiece, or place bell over infant’s interspaces and not over ribs

72
Q

What are the main Respiratory changes during pregnancy?

A
  • Thoracic cage may appear wider.
  • Deeper respirations and an increase in tidal volume by 40%
73
Q

What are the pulmonary clues to chronic dyspnea?

A

Alveolar, interstitial, obstruction of airflow, restrictive, or vascular

74
Q

What are cardiac clues of chronic dyspnea?

A
  • Dysrhythmia
  • Heart failure
  • Restrictive or constrictive pericardial or valvular disease
75
Q

What are GI clues of chronic dyspnea?

A

Aspiration (Aspiration pneumonitis doesn’t require and abx)

76
Q

What are neuromuscular clues of chronic dyspnea?

A
  • Respiratory muscle weakness
  • MS
  • Muscular distrophy
77
Q

Psychological clues of chronic dyspnea

78
Q

Common Respiratory Conditions

A
  • Atelectasis, lobar pneumonia, or bronchitis
  • Emphysema or asthma (reactive airway disease)
  • Pleural effusion (fluid) or thickening
  • Pneumocystis jiroveci (P. carinii) pneumonia
  • Tuberculosis
  • Pulmonary embolism
  • Acute respiratory distress syndrome (ARDS)
  • Lung cancer
79
Q

What are three requirements for the dx of COPD

A
  • Productive cough for greater than 3 months
  • 2 successive years
  • Not attributed to another cause
80
Q

What are the COPD Gold Classification

81
Q

When would an ABG be helpful for a COPD patient?

A
  • suspected hypoxemia
  • Suspected hypercapnia
  • When post-op ventilator management is likely
82
Q

When would you consider a dx Chest X-ray on a COPD patient?

A
  • changes noted from baseline
  • Com-morbid cardiac and respiratory problems
  • Major intrathoracic or intrabdominal surgeries
83
Q

What are some Post-op pulmonary complications for the COPD patient?

A

Ø atelectasis
Ø respiratory infections exacerbation of underlying pulmonary disease
Ø Hypoxemia

84
Q

What chronic inflammatory disease affects the Airways, causing bronchial hyperresponsiveness and airflow obstruction?

85
Q

What is the pathology of Asthma?

A
  • chronic airway inflammation
  • increased bronchial smooth muscle mass
  • mucus hypersecretion
  • luminal narrowing
86
Q

What are pre- and post-op concerns for patients with asthma?

A
  • Bronchospasm
  • status asthmaticus
87
Q

What is the ARISCAT scoring?

A

It is a prediction tool used to predict the risk of postoperative pulmonary complications (PPCs) in surgical patients.

88
Q

What is the ARISCAT Scoring range?

A

Score < 20 = Low risk
Score 20 - 44 = Intermediate
Score > 44 = high risk

89
Q

What are the grounds for canceling elective surgery on Asthmatic patients?

A
  • active wheezing
  • poorly controlled asthma
  • respiratory infection (in the previous 6 weeks)
90
Q

What is Cystic Fibrosis?

A

Autosomal disorder is found on the epithelial cells and most exocrine glands

91
Q

What does the Cystic Fibrosis mutation cause?

A
  • Abnormal / thickened secretions
  • Abnormalities of other systems
92
Q

What will the Pulmonary Function Tests of a CF patient look like?

A
  • Decreased FEV1
  • Decreased FEV1 to FVC ratio
  • Increased residual volume
93
Q

What will the Lung of a CF patient sound like?

A
  • Wheezing
  • Sounds consistent with upper airway secretions
94
Q

Anesthesia Care Plan patient with Cystic Fibrosis

A
  • Avoid general anesthesia if possible
  • Restrict fluids
  • Optimize pain control
  • Chest Physiology
  • Use of I.S.
95
Q

What is the disease presentation and progression for CF?

A
  • Cough, sputum production wheezing, decreasing exercise tolerance should be investigated
    (Only treatment is lung transplant)
96
Q

What are CF-related co-morbidities?

A
  • Diabetes
  • Liver disease
  • GERD
97
Q

What are the PFT findings on restrictive lung diseases?

A
  • decreased total lung capacity (TLC),
  • Decreased FEV1 and FVC
  • normal or increased FEV1/FVC ratio
98
Q

What is the Intrinsic Cause of Restrictive Lung Disease?

A

Interstitial Lung Disease

99
Q

What are the Extrinsic causes of Restrictive Lung Disease?

A

pleural effusions, ankylosing spondylitis,
kyphoscoliosis, obesity

100
Q

OSA Classification

A

Mild OSA 5 - 14
Moderate OSA 15 - 30
Severe OSA > 30

101
Q

What are the OSA Screening tools

A
  • Stop bang
  • P-Sap
  • Berlin
  • ASA Checklist
102
Q

What is the leading cause of preventable morbidity and mortality

A

Tobacco smoking

103
Q

What are some post-op respiratory complications for a smoker?

A
  • Atelectasis
  • respiratory infections
  • exacerbation of underlying pulmonary diseases
  • Hypoxemia
  • need for noninvasive mechanical ventilation
104
Q

What does the PFT look for?

A

Look for evidence of respiratory disease when patients present with respiratory symptoms (e.g. dyspnea, cough, cyanosis, wheezing, etc.)

105
Q

What is a pulmonary function test?

A

Measures how well the lungs work.

106
Q

ERV definition

A

Expiratory reserve volume: the maximal volume of air that can be exhaled from the end-expiratory position

107
Q

TLC definition

A

Total lung capacity: the volume in the lungs at maximal inflation, the sum of VC and RV

108
Q

VC definition

A

Vital capacity: the volume of air breathed out after the deepest inhalation

109
Q

IC definition

A

Inspiratory capacity: the sum of IRV and TV

110
Q

FVC definition

A

Forced vital capacity: the determination of the vital capacity from a maximally forced expiratory effort

111
Q

Lung volumes and capacities

112
Q

Normal lung volumes

113
Q

What are PFT results for obstructive vs restrictive lung disease?

A
  • FEV1/FVC <80% = Obstructive lung disease
  • Restrictive lung disease has normal or increased FEV1/FVC
114
Q

Normal PFT pattern

115
Q

Acute Asthma pattern

A

Restrictive = Right shift

116
Q

Obstructive emphysema pattern

117
Q

PFT Obstructive pattern

A

Decreased FEV1, normal or decreased FVC, and decreased FEV1/FVC

118
Q

PFT Restrictive pattern

A

Decreased TLC, FEV1, and FVC with a normal FEV1/FVC, and a low DLCO

119
Q

PFT Summary table

120
Q

PFT Practical interpretation

A
  • FEV1 over 70% predicted: MILD
  • FEV1 60-70%predicted: MODERATE
  • FEV1 50-60% predicted: MOD - SEVERE
  • FEV1 35-50% predicted: SEVERE
  • FEV1 <35% predicted: VERY SEVERE
121
Q

What leads read the Right Ventricle?

122
Q

What leads read the Left side of the heart?

A

V5, V6, Lead I and aVL

123
Q

What leads read the inferior territory?

A

Leads II, III and aVF (Feet)

124
Q

What lead reads the Right side of the heart?

125
Q

What leads read the septum of the heart?

126
Q

P wave meaning

A

Atrial contration

127
Q

PR interval meaning

A

Time taken for excitation to spread from the Sinoatrial (SA) node across the atrium and down to the ventricular muscle via the bundle of His

128
Q

QRS meaning

A

Ventricular contraction

129
Q

ST Segment meaning

A

Ventricular relaxation

130
Q

T-Wave meaning

A

Ventricular repolarization

131
Q

What are Two ways to measure the rate on ECG?

A
  • Count the number of QRSs on one line of the ECG and multiply by six.
  • Count the number of large squares between R waves and divide 300
    by this number (if the patient is in atrial fibrillation it is more accurate
    to report a rate range rather than a single value)
132
Q

What are Causes of Left Axis deviation?

A
  • Can be normal if the diaphragms are
    raised e.g. Ascites, pregnancy
  • Left ventricular hypertrophy (LVH)
  • Left anterior hemiblock
  • Inferior myocardial infarction
  • Hyperkalaemia
  • Ventricular tachycardia (VT)
  • Paced rhythm
133
Q

What are Causes of Right Axis Deviation

A
  • Normal in children or young, thin adults.
  • Right ventricular hypertrophy (RVH)
  • Often due to respiratory disease
  • Pulmonary embolism (PE)
  • Anterolateral myocardial infarction
  • Left posterior hemiblock (rare)
  • Septal defect
134
Q

P wave abnormalities

A

In some cases, there can be a notched (or bifid) p-wave known as “p mitral”, indicative of left atrial hypertrophy, which may be caused by mitral stenosis. There may be tall peaked p-waves. This is called “p-pulmonale” and is indicative of right atrial hypertrophy, often secondary to tricuspid stenosis or pulmonary
hypertension.

135
Q

PR interval abnormalitites

A
  • The PR interval may be prolonged in first-degree heart block (described in more detail later).
  • The PR interval may be shortened when there is rapid conduction via an accessory pathway, for example, in Wolff Parkinson White syndrome.
136
Q

Normal Q wave description

A

A q-wave is an initial downward deflection in the QRS complex. These are normal in left-sided chest leads (V5, 6, lead I, aVL) as they
represent septal depolarization from left to right. This is as long as they are <0.04secs long (1 small square) and <2mm deep.

137
Q

What can be the Causes of QRS > 0.12 secs?

A
  • Bundle branch blocks (LBBB or RBBB)
  • Hyperkalemia
  • Paced rhythm
  • Ventricular pre-excitation (e.g. Wolf Parkinson White)
  • Ventricular rhythm
  • Tricyclic antidepressant (TCA) poisoning
138
Q

What is the criteria suggestive of LVH on the ECG?

A

The height of the R wave in V6 + the depth of the S wave in V1. If this value is >35mm this
is suggestive of LVH.

139
Q

What makes a ST segment significant?

A

To be significant, the S-T segment must be depressed or elevated by one or more millimeters in 2 consecutive limb leads or two or more millimeters in 2 consecutive chest leads

140
Q

What can mimic ST Elevation?

A

High-takeoff, AKA benign early repolarization, is where there is widespread concave ST elevation, often with a slurring of the j-point most prominent in leads V2-5.

141
Q

Best leads to read ST segment?

142
Q

What Drugs can prolong QT?

A

*Tricyclic antidepressants (TCAs)
*Terfenadine
*Erythromycin
*Amiodarone
*Phenothiazines
*Quinidine

143
Q

What Metabolic processes can that prolong QT

A

*Hypothermia
*Hypokalaemia
*Hypocalcaemia
*Hypothyroidism

144
Q

What are some Familial predispositions to prolonged QT?

A

*Long QT syndrome
*Brugada syndrome
*Arrhythmogenic RV dysplasia

145
Q

What are some Reasons for inverted T wave?

A
  • Normal variant
  • Normal in aVR and V1 and often in V2 and V3 in people of Afro-Caribbean descent.
  • Ischemia
  • Ventricular hypertrophy
  • LBBB (inversion in the anterolateral leads)
  • Digoxin
  • Hypokalemia (can cause flattened t-waves)
146
Q

What are some Classic changes in Hyperkalemia?

A
  • Small p-wave
  • Tall, tented (peaked) t-wave
  • Wide QRS
  • Widening of the QRS indicates severe cardiac toxicity
147
Q

What is this rhythm?

148
Q

What is this rhythm?

A

ST Elevation in leads II, III, aVF

149
Q

What is this rhythm?

A

Sinus Tach

150
Q

What is this rhythm?

A

Sinus Brady

151
Q

What is this rhythm?

152
Q

What is this rhythm?

A

Complete Heart block

153
Q

What is this rhythm?

A

NSR with hyperK

154
Q

What is this rhythm?

A

Anterior wall MI V3, V4

155
Q

What is this rhythm?

A

Posterior MI (Depression in V1 - V4

DNAP 2027 (7 decks)

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