Every Breath You Take and Some of Your Heartbeats

Question 1

What is the path of the blood through the heart?

Answer 1

1. Blood enters the right atrium from the superior and inferior venae cavae and the coronary sinus.
2. From the right atrium, it goes through the tricuspid valve to the right ventricle.
3. From the right ventricle, it goes through the pulmonary semilunar valves to the pulmonary trunk.
4. From the pulmonary trunk, it moves into the right and left pulmonary arteries to the lungs.
5. From the lungs, oxygenated blood is returned to the heart through the pulmonary veins.
6. From the pulmonary veins, blood flows into the left atrium.
7. From the left atrium, blood flows through the bicuspid (mitral) valve into the left ventricle.
8. From the left ventricle, it goes through the aortic semilunar valves into the ascending aorta.
9. Blood is distributed to the rest of the body (systemic circulation) from the aorta.

Question 2

Lobes of the lung?

Answer 2

Left: 2 lobes, Superior, inferior. Right lung: 3 lobes, Superior, Middle, inferior

Question 3

Key features of thoracic vertebrae

Answer 3

Thick vertebral bodies, inferiorly pointing spinous processes, long transverse processes

Question 4

True ribs?

Answer 4

1-7, directly articulate with the sternum

Question 5

False ribs?

Answer 5

8-10, don’t directly articulate w sternum, 10th rib is the costal margin

Question 6

Floating ribs?

Answer 6

11-12, no contact w sternum

Question 7

Body of sternum?

Answer 7

3-7th rib

Question 8

Degrees of thoracic flexion and limitations?

Answer 8

30-40 degrees, limited by tension in posterior tissues

Question 9

Degrees of thoracic extension and limitations?

Answer 9

20-25 degrees, limited by anterior longitudinal ligament and spinous processes

Question 10

Degrees of thoracic lateral flexion and limitations?

Answer 10

25-30 degrees, limited by ribs

Question 11

Degrees of thoracic rotation?

Answer 11

25-30 degrees

Question 12

IRV?

Answer 12

Inspiratory reserve volume, Breathe in as much air as possible on top of normal inhale IRV=IC-TV

Question 13

IC?

Answer 13

inspiratory capacity, how much inspiration can occur in total, IRV+TV

Question 14

ERV?

Answer 14

expiratory reserve volume, max amount of air exhaled after a normal exhale, FRC-RV

Question 15

RV?

Answer 15

residual volume, air left in the lung after a normal exhale, FRC-ERV

Question 16

TV?

Answer 16

tidal volume, normal inhale and exhale, IRV +TV=IC

Question 17

FRC?

Answer 17

functional residual capacity, erv +rv, equilibrium point for lung at rest

Question 18

TLC?

Answer 18

Total lung capacity, IRV+TV+ ERV+RV OR VC+RV

Question 19

VC?

Answer 19

vital capacity, top of max inhale and bottom max exhale, IRV+TV+ ERV

Question 20

Pressure gradient of inspiration?

Answer 20

Muscle contraction, thoracic volume increases, thoracic pressure decreases, air flows IN to equalize pressure

Question 21

Pressure gradient of quiet exhalation?

Answer 21

muscle relaxation, thoracic volume decreases, thoracic pressure increase, air flows OUT to equalize pressure

Question 22

What nerves innervate the diaphragm?

Answer 22

R and L phrenic nerves (C3-C5)

Question 23

Diaphragm insertion?

Answer 23

costal, sternal, and crural portions insert on central tendon, r hemidiaphragm higher than L

Question 24

Primary muscles responsible for inspiration?

Answer 24

Diaphragm (60%), scalenes, external intercostals, internal intercostals, innermost intercostals

Question 25

What are the accessory muscles of breathing of inspiration?

Answer 25

sternocleidomastoid, pec major, pec minor, serratus anterior, latissimus dorsi, erectors spinae

Question 26

What is the role of the scalenes?

Answer 26

Active during inspiration to elevate and stabilize upper ribs, originate on transverse processes of C3-C7, insert on ribs 1 and 2, insert on ventral rami of C3-C7

Question 27

Direction and location of external intercostals?

Answer 27

Fibers run inferiorly and medially, most prominent on lateral chest wall

Question 28

Direction and location of internal intercostals?

Answer 28

Fibers run inferiorly and laterally, most prominent on anterior chest walls, primarly inspiration for anterior fibers and forced expiration for lateral fibers

Question 29

Direction and location of innermost intercostals?

Answer 29

Fibers run inferiorly and laterally, most prominent in lower thorax

Question 30

Role of abdominals is force expiration?

Answer 30

Active contraction, direct effects: flexes thorax, depresses ribs and sternum, indirect effects: increased abdominal pressure drives diaphragm superiorly. (also lateral fibers of internal intercostals transversus thoracis)

Question 31

Requirements for coughing?

Answer 31

strong inspiratory effort (60% of vital capacity), control of glottis, strong contraction of abs

Question 32

Ventilation in pulmonary fibrosis? Is this restrictive or obstructive?

Answer 32

Restrictive. Lung compliance decreases, increased muscular effort req for ventilation, increased work of breathing

Question 33

What muscles elevate and stabilize the ribs during inspiration?

Answer 33

scalenes | sternocleidomastoid

Question 34

What are the three articulations of the sternum?

Answer 34

chostochondral chostosternal interchondral: 5-10

Question 35

Explain the bucket/pump handle of the thoracic cage?

Answer 35

Elevation of the lateral shaft of the rib with superior and anterior movement of the sternum with inspiration 

Question 36

Does exhalation decrease or increase thoracic pressure? Thoracic volume?

Answer 36

increase pressure | decrease volume

Question 37

Which intercostals are used for inspiration?

Answer 37

external intercostals AND anterior internal (lateral are for forced expiration)

Question 38

What three things are needed for a cough?

Answer 38

strong inspiratory effort control of glottis abdominal contraction

Question 39

What does ECG monitoring reflect?

Answer 39

The electrical activity that immediately precedes mechanical activity Normally: electrical activity and mechanical activity are synchronous, but separate events

Question 40

What is a PEA?

Answer 40

dissociation, pulseless electrical activity in an ECG, electrical activity and mechanical activity has no relationship

Question 41

What are the 4 basic steps of ECG interpretation?

Answer 41

Rate, regularity, intervals/waveforms, rhythm

Question 42

When reading an ECG 1 large box = ____mm and ___ seconds?

Answer 42

1 Large box = 5mm and .2 sec

Question 43

What is the rate of each of Sinus Bradycardia?

Answer 43

<60 bpm

Question 44

What is the rate of Sinus Tachycardia?

Answer 44

>100bpm

Question 45

What are two reasons an Echocardiogram would be used instead of an X-Ray? What can the echocardiogram test for?

Answer 45

Greater detail and 2. less radiation
-Measures chamber dimensions, wall thickness, chamber pressures, estimates EF%.
-Assesses wall motion and valve function

Question 46

Why would you use a transesophageal echocardiogram instead of a regular echo?

Answer 46

The view is critically important and the traditional isn’t clear or enough

Question 47

What method of imaging gives you the best anatomical view of the heart’s anatomy?

Answer 47

MRI, can give better image quality if echo's quality of image isn't good.

Question 48

What test gives you the best view of the coronary arteries?

Answer 48

CT scan