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MD3001 > Week 0 > Flashcards

Week 0 Flashcards

1
Q

Define claudication

A

How far a patient can walk until onset of symptoms
Official definition: a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

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2
Q

Describe the progression of symptoms of each stage of arterial occlusion:

  1. Asymptomatic arterial narrowing
  2. Symptomatic arterial narrowing
  3. Arterial occlusion
A
  1. None (hence asymptomatic)
  2. Predictable and relieved by rest. [Intermittent claudication]
  3. Increasing severe symptoms, onset of symptoms with less exertion, pain at rest. Critical limb ischaemia –>Acute limb ischaemia
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3
Q

What are the non-modifiable risk factors for CV risk? (5)

A 
Age
Gender
Family history
Low birth weight
Ethnicity
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4
Q

What are the modifiable risk factors for CV risk? (6)

A 
Hypertension
Hyperlipidaemia
Diabetes
Obesity
Smoking
Sedentary lifestyle
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5
Q

What are the points to consider when taking a PMH for CVD? (6)

A 
History of vascular disease
Diabetes
Hyperthyroidism
Renal disease
Hypertension
Hypercholesterolaemia
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6
Q

Age at which experiencing symptoms of CVD is considered young

  1. First degree male relative of less than …….. years
  2. First degree female relatives of less than……. years
A
  1. 55

2. 65

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7
Q

What are the common symptoms of CVD? (6)

A
  1. Chest pain
  2. Breatlessness (inc orthopnoea and paraoxysmal nocturnal dyspnoea)
  3. Palpitations
  4. Syncope/dizziness
  5. Oedema
  6. Peripheral vascular symptoms e.g. Intermittent claudication
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8
Q

What is angina?

A

A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase myocardial oxygen demand.
At times patients can present for the first times with severe symptoms/arterial occlusion

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9
Q

Name 3 key features of classical, stable angina

A
  1. Predictable in onset
  2. Reproducible
  3. Relieved by rest or GTN (Glyceryl Trinitrate)
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10
Q

Name 2 of the main acute coronary syndromes

A
  1. Unstable angina

2. Acute MI (including NSTEMI and STEMI)

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11
Q

What does STEMI stand for?

A

ST elevation myocardial infarction

[ST referring to damage to blood vessels]

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12
Q

What does NSTEMI stand for?

A

Non-ST elevation myocardial infarction

[ST referring to damage to blood vessels]

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13
Q

What is pericarditis?

A

Inflammation of the pericardium

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14
Q

What are the symptoms for pericarditis and how are they relieved?

A

Sharp/retrosternal pain

Relieved by sitting forwards

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15
Q

Describe the symptoms of aortic dissection?

A

Sudden and severe.

Radiating to left shoulder/back

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16
Q

What is dyspnoea?

A

Shortness of breath

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17
Q

Name 3 different forms of dyspnoea?

A
  1. Acute
  2. Chronic
  3. Acute-on-chronic
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18
Q

What is orthopnoea?

A

The sensation of breathlessness in the recumbent position, relieved by sitting or standing.)

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19
Q

What is paroxysmal nocturnal dyspnoea? (PND)

A

A sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.

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20
Q

Is the use of diuretics and dyspnoea related?

A

Yes

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21
Q

Associated symptoms of dyspnoea?

A

Cough, sputum, chest pain, palpitations

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22
Q

Name 4 types of arrhythmia and how it feels for patient?

A

Ventricular/atrial extrasystole: Heart misses a beat/heart jumps
Atrial fibrillation: May be unnoticed/ heart racing/associated breathlessness
Supraventricular tachycardia: Heart racing/ associated polyuria
Ventricular tachycardia: Heart racing/associated breathlessness/ Presents as syncope vs palpitations

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23
Q

Potential causes for dizziness and syncope? (5)

A 
Postural hypotension
Neurocardiogenic
Micturiation syncope
Cardiac arrhythmias (either tachy or brady)
Mechanical obstruction to cardiac output
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24
Q

What would unilaterial vs bilateral oedema suggest?

A

Unilateral- DVT, soft tissue infection, trauma, lympathic, obstruction
ateral- CV issue (cardiac failure, chronic venous insufficiency), hepatic/renal pathology, medication side effect, pelvic mass, immobility

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25
Q

Action of pec maj?

A

Shoulder flexion and adduction

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26
Q

Action of pec minor?

A

Stabilises scapula

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27
Q

Action of latissimus dorsi?

A

Shoulder extensions and adduction

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28
Q

Action of serratus anterior?

A

Scapular protraction and rotation in shoulder abduction

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29
Q

What vessels supply breast?

A

Axillary and internal thoracic arteries

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30
Q

What lympathetic nodes drain breast?

A

Axillary and internal thoraxix nodes

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31
Q

What is the main function of a thoracic wall?

A

Respiratory movements

Structures involved: Ribs, costal cartilages, intercostal muscles, diaphragm)

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32
Q

What is the inlet and outlet for the thorax and abdomen?

A 
Thorax
-Inlet: Neck
-Outlet: Diaphragm
Abdomen
-Inlet: Diaphragm
-Outlet: Pelvic diaphragm
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33
Q

What structures make up the thoracic inlet?

A

T1
1st Ribs and CCs
Manubrium

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34
Q

Order structures from ant to post which lie on the first rib:
Subclavian artery, inferior trunk of brachial plexus and subclavian vein
BETWEEN THE THORAX AND UPPER LIMB

A

Subclavian vein, subclavian artery, inferior trunk of brachial plexus

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35
Q

Name 4 structures that pass between the thorax and the neck?

A
  1. Vessels that supply and drain the head and neck
  2. Trachea
  3. Oesophagus
  4. Nerves (R+L Vagus and R+L Phrenic)
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36
Q

Name the 5 structures that surround that close the thoracic outlet

A 
Diaphragm
T12
12th and 11th ribs
Costal cartilages of Ribs 10,9,8,7
Ziphoid cartilage
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37
Q

What is the ziphoid cartilage

A

The cartilaginous section at the lower end of the sternum,

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38
Q

What are the 3 positions of openings of the diaphragm?

A

T8, T10 and T12

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39
Q

What structures pass through the diaphragm at point T8/caval opening?

A

Inferior vena cava

Right phrenic nerve

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40
Q

What structures pass through the diaphragm at point T10/oesophageal opening?

A

Oesophagus
Vagal trunks
Left gastric vessels

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41
Q

What structures pass through the diaphragm at point T12/aortic hiatus?

A

Aorta
Azygos vein
Thoracic duct

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42
Q

What does pleura line?

A

Thorax, lungs and chest wall

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43
Q

What does pericardium line?

A

The heart

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44
Q

What does the peritoneum line?

A

Abdomen and pelvis

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45
Q

What are the 4 sections of pleura?

A

Diaphragmatic, mediastinal, cervical, costal

46
Q

What is the point where the diaphragmatic and costal pleura meet called?

A

Costadiaphragmatic recess

47
Q

What are the positions of the four corners of the heart?

A

2nd Left CC
3rd Rt CC
6th Rt CC
Left 5th Interspace (projects heart beat sound)

48
Q

What is the mediastinum?

A

Structures in the midline of the thorax, between the left and right pleural cavities

49
Q

What is the position of the superior mediastinum?

A

Lies between the inlet and the plane between the sternal angle and T4/5
Behind manubrium

Bifurcation of pulmonary trunk just inferior to sup. mediastinum

50
Q

What is the position of the inferior mediastinum?

A

Lies inferior to the plane between the sternal angle and T4/5 and the thoracic outlet

51
Q

What is the sternal angle?

A

2nd CC- T4/5

52
Q

What is the position of the anterior mediastinum?

A

Lies behind the manubrium and sternum, anterior to the superior mediastinum and the upper part of the inf. mediastinum

53
Q

Which section of the mediastinum contains the thymus?

A

The anterior

Atrophies with age to become a fatty remnant

54
Q

How many subdivisions does the inferior mediastinum have, and what are they called?

A

3
Anterior mediastinum
Middle mediastinum
Posterior mediastinum

55
Q

Which section of the mediastinum contains the

contents of the pericardium (ie heart and great vessels)?

A

Middle mediastinum

56
Q

What are the contents of the posterior mediastinum?

A

Aorta
Oesophagus
Thoracic duct
Azygos veins

57
Q

The pericardium: What is it made up of? Function?

A

Made up of serous (inner) and fibrous (outer) layers

Surrounds the heart so that it can move, expand, contract

58
Q

Apart from the heart what else does the fibrous pericardium surround?

A

The great vessels

59
Q

What are the attachments of the fibrous pericardium?

A

Superiorly: Roots of the great vessels
Inferiorly: Central tendon of the diaphragm

60
Q

Which nerves provide the sensory innervation of the fibrous pericardium?

A

The phrenic nerve

61
Q

What are the two pericardial folds/reflections?

A

Oblique sinus: Lies posterior to the left atrium, potential space
Transverse sinus: Separates the great arteries and veins

62
Q

What vessels are anterior and posterior to the transverse pericardial sinus?

A

Ant- Aorta and pulmonary

Post- Sup. vena cava and left auricular appendage of left atrium

63
Q

What is the base of the heart?

A

The posterior surface

64
Q

What structures make up the anterior, sternocostal surface of the heart?

A

RIGHT VENTRICLE
Right atrium
Left ventricle
Left auricular appendage

65
Q

What structures make up the inferior/diaphragmatic surface of the heart?

A

LEFT VENTRICLE
Right ventricle
Coronary sinus

66
Q

What structures make up the poster/base surface of the heart?

A

LEFT ATRIUM

67
Q

What structures make up the right and left border of the heart?

A

Right border: Right atrium

Left border: Left ventricle and left auricle

68
Q

What is the position of the apex of the heart?

A

5th left intercostal space, mid-clavicular line

69
Q

What structures lay on either side of the heart?

A

Pleura, LUNGS, phrenic nerves

70
Q

What vessels/structure are found on to the right of the mediastinum? (3)

A
  • SVC
  • Arch of the azygos
  • IVC

ALL RELATED TO RA AND VEINS

71
Q

What vessels/structure are found on to the left of the mediastinum? (4)

A
  • Left common carotid artery
  • Left subclavian artery
  • Arch of aorta
  • Thoracic aorta

ALL RELATED TO LV AND ARTERIES

72
Q 
Phrenic nerves:
Passes between which body cavities?
Enters superior mediastinum posterior/anterior to BCV?
Right phrenic: Related to veins/arteres?
Left phrenic: Related to veins/arteries?
A

Passes between the fibrous pericardium and the parietal pleura
Enters the superior mediastinum
posterior to the BCVs.

Right phrenic= Veins
Left phrenic= Arteries

73
Q

What vessel is this:
BCV?
LCC?
LSC?

A

Brachiocephalic Vein
Left Common Carotid
Left Subclavian

74
Q

What nervous supply to the right and left phrenic nerves supply? (4)

A
  1. SOLE MOTOR SUPPLY TO THE DIAPHRAGM
  2. Sensory from the central tendon of the diaphragm and it’s parietal pleura and underlying peritoneum
  3. Sensory from the mediastinal parietal pleura
  4. Sensory from the pericaridum
75
Q

Which nerve supplies the skin over the shoulder?

A

Lateral surpraclavicular

76
Q

Phrenic nerves are branches of which plexus?

A

Cervical

77
Q

In order to produce flow throughout the CVS, what must be maintained?

A

Pressure

78
Q

Functions of the CVS?

A
  • Bulk flow of materials
  • Temperature regulation
  • Homeostasis
  • Host defense
  • Reproduction
79
Q

When it comes to the ANS regulation of the blood vessels, which control is more influential?

A

Sympathetic

80
Q

What is the purpose of the parallel arrangement of the CVS? (2)

A
  1. Allows independent regulation of blood flow to different organs
  2. Adapts to the metabolic demands of the tissues
81
Q

What causes valves to passively open?

A

Pressure differences of either side

82
Q

Are the aortic and pulmonary valves bicuspid or tricuspid?

A

Tricuspid as they are more heavy duty and undergo more stress

83
Q

What structures connect cardiac muscle cells?

A

Desmosomes and gap junctions at the intercalated disks. Intercalated disks allow branching of cells into a network

84
Q

Why is it important to have gap junctions between cardiac muscles cells?

A

As they directly connect the cytoplasm of adjacent cells and permit the easy transfer of ions between cells. This allows synchronized complete contraction of all the cells

85
Q

What is myocardium?

A

The cardiac muscle that allows myogenic contraction .

86
Q

What is endocardium?

A

The endothelium that lines the cambers and valves of the heart

87
Q

What is pericardium?

A

The membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane. The simple squamous epithelium secretes serous fluid

88
Q

What is myogenic contraction?

A

Contraction originated in the muscles not by nerve impulses

89
Q

What 3 vessels provide the inflow to the right atrium?

A

IVC
SVC
Coronary sinus

90
Q

What does trabeculated mean?

A

Characterized by thick wall and hypertrophied muscle bundles

91
Q

What are musculi pectinate?

A

The pectinate muscles (musculi pectinati) are parallel ridges of muscle at pass from the crista terminalis into the auricle

92
Q

What are crista terminalis?

A

The crista terminalis is generally a smooth-surfaced, thick portion of heart muscle in a crescent shape at the opening into the right atrial appendage

93
Q

What is the difference between the anterior and posterior wall of the right atrium in terms of structure?

A

Anterior wall is trabeculated: with musculi pectinate and crista terminalis. It also has an auricle
The posterior wall is smooth, with an interatrial septum dividing the atria. The fossa ovalis and limbus fossa ovalis is found here (where the foramen ovale used to be)

94
Q

Where in the right atrium is the SAN found?

A

Close to the opening of the SVC

95
Q

Where in the right atrium is the AVN found?

A

On septum between the opening of coronary sinus and tricuspid valve

96
Q

What is the limbus fossa ovalis?

A

The limbus of the fossa ovalis is the ridge that surrounds the fossa ovale in the right atrium.

97
Q

What was the purpose of the foramen ovale?

A

An opening between the right and left atrium that allowed oxygenated blood coming from the mother to by-pass the non-functioning foetal lungs

98
Q

What are trabeculae carnae?

A

The trabeculae carneae (columnae carneae, or meaty ridges), are rounded or irregular muscular columns which project from the inner surface of the right and left ventricles of the heart. These are different from the pectinate muscles, which are present in the right atrium and the atrial appendages of the heart.
They give power of contractions and give risk to papillary muscles

99
Q

What 3 structures are present in the right ventricle that cause it to be trabeculated?

A

Trabeculae carneae
3 papillary muscles with chordae tendinae
Septomarginal trabeculae (moderator band)

100
Q

What structures prevent cusp eversion of the tricuspid valve during systole?

A

Papillary muscles
Chordae tendineae

With each papillary muscle sending chordae tenineae to 2 cusps

101
Q

What are names of the 3 cusps of the tricuspid valce? and what are they attached to?

A

Anterior, posterior and septal

Attached to the fibrous ring which is park of the fibrous skeleton

102
Q

What are the names of the 3 cusps of the pulmonary valve?

and what are they attached to?

A

Right, left and anterior.

Attached to the fibrous ring which is park of the fibrous skeleton

103
Q

How does an MI affect papillary muscles?

A

Causes them to become ineffective and valve incompetence

104
Q

Why do the walls of each ventricle become smooth near its outflow?

A

To create laminar flow into the pulmonary trunk and aorta

105
Q

What structure links the the pulmonary trunk and the aorta?

A

Ligamentum arteriosum

106
Q

What 2 structures are present in the right ventricle that cause it to be trabeculated?

A

Trabeculae carneae

2 papillary muscles with chordae tendinae

107
Q

What are the names of the 2 cusps in the mitral valve?

Active/passive competence

A

Anterior and posterior

ACTIVE COMPETENCE

108
Q

Is it during diastole/systole at the aortic valve that blood flows to coronary arteries

A

Diastole

109
Q

What are the functions of the cardiac skeleton?

A

Supports valces and myocardium

Electrically separates atria and ventricles (AV bundle of Hi should be the only conduction between them)

110
Q 
What do these Kardex abbreviations mean:
IV
SL
NG
PV
TOP
IM
SC
PR
INH
A 
IV: Intravenous
SL: Sublingual
NG: Nasogeastric 
PV: Per vagina
TOP: Topical
IM: Intramuscular 
SC: Subcutaneous
PR: Per rectum
INH: Inhalation

MD3001 (12 decks)

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