stuck Flashcards
what are the 3 nasal muscles
- procures
- nasalis
- levator labii superioris alaeque nasi
what is Daltons Law?
“total pressure (PTotal) of a mixture of gases is the sum of their individual partial pressures (Px)”
what is Henrys Law?
this states that the concentration of O2 dissolved in water is proportional to the partial pressure in the gas phase
where does the trachea extend from?
laryngeal inlet = C3
trachea begins = C6
what are the 2 processes of the arytenoid cartilage?
1- vocal process = attachment for vocal ligament
2- ,muscular process = attachment for the circo-arytenoid muscles
function of the infra hyoid muscles
depress the larynx
- sternohyoid
- thyrohyoid
- sternothyroid
what are the 5 laryngeal elevators?
digastric
mylohyoid
stylohyoid
geniohyoid
thyrohyoid
what 4 muscles are involved in closure of the laryngeal inlet?
- salpingopharyngeus
- palaptopharyngeus
- stylopharyngeus
- stylohyoid
what are the layers of the heart
endocardium
myocardium
serous pericardium
parietal pericardium
fibrous pericardium
exact located on SA node
right atrium
- located at the junction of the crista terminalis in the upper wall of the right atrium and the opening of the SVC.
exact location of the AV node
within the atrioventricular septum
near the opening of the coronary sinus
where are purkinje fibres located?
in the subendocardial surface of the ventricular walls
how does the parasympathetic system have a negative chronotropic effect?
Ach acts on M2 receptors to decrease cAMP production.
= reduces the rate of phase 1 depolarisation.
- it does this by hyperpolarsing the membrane potential which is done by increasing the extent and duration of opening of K channels, therefore increasing K conc.
what is the signal delay in the AV node?
how long does the signal take to reach the AV node from the SA?
0.09 secs
0.03
where is the openings of the right and left coronary artery?
right coronary artery = can be found on the aortic sinus of the right cusp of the aortic valve.
left coronary artery = can be found on the aortic sinus on the left cusp of the aortic valve.
obstruction of the right coronary artery can lead to what type of infarct
inferior infarct
obstruction of the LAD will cause what type of infarct?
anteroseptal infarct
obstruction of the circumflex artery will cause what type of infarct?
lateral infarct
what will anterior infarct cause
loss of left ventricle function, which can cause ventricular fibrillation.
where are chemo sensitive receptors located?
ventral surface of medulla in the BBB
what will the hering-breur reflex do?
it helps to prevent over inflation of the lungs
(it involves slowly adapting pulmonary stretch receptors)
what things cause an abnormal level of respiratory drive?
- hypoxia
- direct stimulation of respiratory centre
- psychogenic
glomus cells
they are the primary site of sensory transduction in aortic and carotid bodies.
what are the 3 ways we classify MI?
- location of infarction
- ECG
- cause of the infarct
cause:
TYPE 1 MI
spontaneous MI related to ischemia due to a primary coronary event.
cause:
TYPE 2 MI
MI secondary to ischemia due to increase in oxygen demand or decreased supply
cause:
TYPE 3 MI
sudden unexpected cardiac death with symptoms suggestive of MI
cause:
TYPE 4 MI
MI associated with percutaneous coronary intervention
cause:
TYPE 5 MI
MI associated with cardiac surgery
how will you diagnose MI?
Clinical History - ECG, STEMI or NSTEMI
Raised cardiomyocyte markers in the blood.
- Troponin T
- Creatine Phosphokinase
- AST
- Myoglobin
3 causes of Ventricular Tachycardia?
1) acute LV damage
2) chronic LV damage
3) long QT interval syndrome
common side effects of ACE inhibitors?
cough
angioneurmtic oedema
NEVER IN PREGANCY
renal dysfunction
common side effects of ARB
renal dysfunction
Never in pregnancy
common side effects of b-blockers
bradycardia/heart block
tired
asthma (try not give to them)
common side effects of CCB
ankle oedema from amlodipine
heart block from diltiziam and verampamil
common side effects of diuretics
hypokalaemia
diabetes
gout
what is brugarda syndrome
this is a channelopathy that that effects the way electrical signals pass through the heart
2 tests that look at the disturbance of cardiac rhythm?
ECG
Holters test
what is the innate immune response characterised by?
- heat
- swelling
- redness
- pain
what are 5 systemic effects of a dysregulated inflammation (SIRS)?
1) systemic vasodilation and reduced blood volume (poor organ perfusion)
2) bad O2 delivery
3) lactic acidosis, cellular dysfunction and organ damage.
4) ATP levels fall
5) mitochondria dysfunction can lead to cell death
what happens to the mitochondria during sepsis?
in this inflammatory disease, higher concentrations of ROS will inhibit mitochondria respiration.
Mitochondria and ATP levels will then drop below a threshold that can trigger cell death.
what explains why people recover rapidly after sepsis?
because instead of all the mitochondria dying, they are able to adopt a low energy state, almost like hibernation during the time of the inflammation.
then once the infection clears up, mitochondria will function normally again.
in sepsis, what happens to the electron transport chain?
what effect does this have?
in disease there will be premature termination of the electron transport chain, this will lead to excess ROS production.
what are the 3 steps involved in the treatment os sepsis?
resuscitation (aggressive fluids targets)
early antibiotics/golden hour (SEPSIS 6)
triage to appropriate place of care.
in the triage of sepsis, what are the 3 different ward levels of care?
L1 - ward = 1 cure to 6-8 patients
L2 = HDU (high dependancy unit) = 1 nurse to 3 patients
L3= ICU= 1 nurse to 1 patient
how many people with downs will have heart defects?
what are the common ones?
50%
AVSD
VSD
ASD
Patent ductus arteriosus
what extra genes are associated with cell migration and cell adhesion causing heart defects in Down syndrome?
DSCAM
COL6A2A
what is locus heterogeneity and what is an example of it?
locus heterogeneity= where mutations in different places can lead to the same phenotype.
Long QT syndrome, mutations in the Na or K channel can lead to the same delayed repolarisation.
what are 3 clinical indications of MI?
- ECG changes (ST elevation)
- chest pain
- raised troponin levels
what is the definition of cardiac rehab
the co-ordinated sum of activities required to influence favourably the underlying cause of the CVD, as well as provide the best possible physical, mental and social condition.
what are the national recommendations for exercise?
- 150 mins of exercise a week
- reduce sedentary
- relaxation
- 2x strength training sessions a week
what are 9 psychological benefits of cardiac rehabilitation?
- improved mood
- increased sex drive
- reduced depressive thoughts
- reduced anxiety
- increased self confidence
- return to work
what are different roadblocks as to why people to quit smoking ?
- negative moods
- other smokers
- triggers and cravings
- time pressures
the health belief model looks at why someone might start changing their behaviour, what 3 things does it include?
1) individual perception
2) modifying factors
3) likelihood of action
what is COM-B?
this is the correct health belief model:
- compatibility (an individuals physical and psychological capacity to engage in the task)
- opportunity (all the factors that lie outwith the individual that make that behaviour possible)
- motivation
what are the 4 prevention measures in disease?
primordial = factors that effects systems that determine the risk factor
primary = detection and management of risk factors for future disease
secondary = screening for asymptomatic patient
Terry = treating the diseased patient
Quality of Life definition
a combination of a person physical, mental and social wellbeing, not merely the absence of disease
what are the 3 stages of gas exchange?
ventilation = moving gas to the site of exchange.
gas exchange = capillary beds at lungs and tissues
cellular respiration = cells use oxygen in processes
what are the features of the lungs that facilitate diffusion
- thin
- permeable
- moist
what will run through Forman caecum
where is it found
- emissary veins
- nasal veins
- superior sagital sinus
- ethmoid bone
what will run through the sphenopalatine Forman
where is it found
- sphenopalatine nerve
- nasopalatine nerve
- superior nasal nerve
- between sphenoid and ethmoid bone
what will run through the incisive canal?
- nasopalatine artery
- greater palatine nerve
what are the 4 arteries that will anastomose at the Kiesselbach area?
- anterior ethmoidal
- sphenopalatine artery
- greater palatine artery
- superior labial artery
3 branches of the ophthalmic nerve?
nasociliary
anterior ethmoidal
lateral and septal nasal branches
maxillary nerve divisions
nasopalatine
greater palatine
what are the 2 muscles of the pharyngeal opening and what happens when they contract ?
salpingopharyngeus
tensor villi palatini
- when either muscle contracts, this will create positive pressure in the oral cavity. so air will open the pharyngotympanic tube and flow into the middle ear cavity.
how do you get mouth breathing?
inflammation and swelling of the pharyngeal tonsils may obstruct the airway and lead to mouth breathing.
it may result in adenoid face which refers to the appearance of the face which appears from persistent adenoid hypertrophy.
what may enlargement of the tubal tonsils cause?
may obstruct the pharyngotymapanic tube and cause middle ear infections.
describe the innervation of the nasal cavity?
V1= ophthalmic (anterior)
V2= maxillary (posterior)
olfactory
what are the intrinsic ligaments of the larynx?
fibro elastic membrane
vocal ligaments
vestibular ligaments
apart from drugs what can be used during end of life care?
pets
music
aroma therapy
gentle touch
what are he borders of the safety triangle?
lateral border = pec major
anterior border = pec minor
apex = axilla
base = nipple
what are the boundaries of the oblique fissure?
posterior y = T3/T4
LATERALLY = mid axillary line
anterior = rib 6
what will pass through the esopogeal hiatus?
oesophagus
right and left vagus trunks
oesophageal branches of left gastric vessels
LYMPAHTICS OF LARYNX
above vocal fold = superior deep cervical
below vocal folds = pre and para trachea
laryngospams
stimulation of internal superior laryngeal fibres, triggering reflex closure of the airway
aspiration pneumonia
compromised swollowing co-ordination often due to a stroke or neurological conditions
what are the principles of care in the last days?
1) informative, timely and sensitive communication
2) descsions about a persons care should be made by a multidisciplinary team
3) each persons physical, psychological, social and spiritual needs should be taken Ito consideration
4) consideration should be given to the well being of the patients.
where would you listen for pulmonary valve stenosis?
and ejection systolic murmur will be heard in the upper left sternal angle.
