Clinical Correlates Flashcards
What is high altitude pulmonary edema?
When you are in high altitudes, there is lower oxygen concentration in the air, which can trigger a hypoxia response in the body. This will cause vasoconstriction in the pulmonary circulation to redistribute blood to zones of the lung that have higher V/Q ratio (zone 1). Zone 1 is more efficient at ventilation, but it was not designed to do a lot of ventilation (remember, ventilation is efficient but low in zone 1). Thus, redirection of blood flow to this area results in over perfusion and can lead to breakdown of the alveolar capillary basement membrane and cause edema in the alveoli (plasma, blood). Patients will cough up blood. Treated with O2.
Rib Fractures
- What type of pleura directly underlies the ribs?
- What nerve(s) carry innervation from it?
- What type of innervation is carried by the nerves?
- Rib fractures can be subdivided into simple and complex. In general, what distinguishes a simple fx from a complex fx?
- Parietal costal pleura
- Intercostal nerves
- Somatic sensory and motor
- Simple Fx have many ways in which the break can occur (see image) but they only involve a break in one rib. Complex fractures involve disturbance of the pleura and lungs below, can involve multiple ribs, tearing of chest vasculature, or injury to the heart and great vessels.
- What are the preferred sites for a chest tube insertion for a pneumothorax and a hemothorax?
- Where, relative to the ribs, should the tube be inserted?
Where, relative to the ribs, are the intercostal and neurovascular bundles?
Inferior and deep to costal groove
Pulmonary Embolism
- What are the cardinal signs/symptoms of PE?
- What might you hear on ascultation?
- What are the most common sources of the embolus?
- What happens to the PAO2 and PACO2 of the alveoli downstream of a PE?
- Dyspnea and tachycardia
- Could be normal or could hear rales and diminished breath sounds
- See image
- They equilibrate with atmospheric levels of O2 and CO2, namely PAO2 of 150 (reduced from 160 due to humidification in upper airways) and CO2 of 0
If there is airway blockage above the alveoli, they cannot expel CO2 and take in new O2. Over time, the PAO2 and PACO2 will change until they are essentially equal with that of venous blood. At this point, no more gas exchange can occur due to a lack of pressure gradient to drive the exchange.
What’s the relationship between lung tumors and ptosis?
What is cardiac tamponade?
What are some symptoms a person might have if they’re experiencing it?
Fluid build up in the space between the visceral and parietal pericardium.
Pericardium cannot stretch on demand, so if fluid builds up in space then the heart will be compressed. This reduces pumping function (CO) and leads to hypoxia and low BP. These both trigger sympathetic NS activity, which will increase blood in venous system to try and increase CO but the heart can’t pump more with the fluid there so there will be increased venous pressure and decreased arterial pulses due to decreased volume in arterial system. Heart sounds will appear distant due to fluid between point of ascultation and sound production. Neck veins will be distended because of increased volume of blood in venous system. Pt will be in shock b/c low oxygen to tissues.
For each of the following branches of the coronary circulation, explain what part of the heart would be affected.
- LAD
- PDA
- RCA
- SA nodal branch - what would happen to HR?
What is renal tubule acidosis?
Renal tubule acidosis (RTA) refers to conditions in which RNAE is impaired, so NEAP > RNAE –> acidosis results. RTA can be caused by a defect in H+ secretion in the proximal tubule (proximal RTA) or distal tubule (distal RTA) or by inadequate production and excretion of NH4+
