Final Review Flashcards
(182 cards)
1
Q
How many chambers does the heart have?
A
4
2
Q
Where along the spine does the heart lie?
A
5th to 8th thoracic vertebrae
3
Q
What are the 4 functions of the heart?
A
- generate blood pressure
- route blood through pulmonary and systemic pathways
- ensure and maintain one-way blood flow
- regulate blood supply to meet metabolic needs
4
Q
What is the pericardial sac?
A
A sac that encloses the heart and anchors it in the thoracic cavity
5
Q
What are the 3 layers of the heart wall?
A
endocardium, myocardium, epicardium
6
Q
What is the endocardium?
A
- innermost layer of the heart
- thinnest layer (1 layer of cells)
- line heart chambers
7
Q
What is the myocardium?
A
- thickest layer
- middle layer of heart wall
- contractile layer
8
Q
What is the epicardium?
A
- outermost layer of the heart
- contains blood vessels to nourish the heart
9
Q
What are the 2 types of heart valves?
A
AV and semilunar
10
Q
What are the 2 AV valves and what side of the heart are they on?
A
bicuspid (mitral) - left
tricuspid - right
11
Q
What are the 2 semilunar valves and what side of the heart are they on?
A
pulmonary - right
aortic semilunar - left
12
Q
Where do the coronary arteries branch off from?
A
aorta
13
Q
What part(s) of the heart does the left circumflex artery supply? (2)
A
left atrium
left ventricle
14
Q
What part(s) of the heart does the left anterior descending artery supply? (3)
A
left ventricle
right ventricle
septum
15
Q
What part(s) of the heart does the left marginal artery supply? (1)
A
left ventricle
16
Q
What part(s) of the heart does the right coronary artery supply? (2)
A
right atrium
right ventricle
17
Q
What part(s) of the heart does the right marginal artery supply? (2)
A
right ventricle
apex
18
Q
Where in the brain is the cardiac center?
A
medulla
19
Q
What notifies the cardiac center of changes of blood pressure? Where are they located?
A
baroreceptors in the aorta and carotid arteries
20
Q
What system is stimulated when blood pressure is low?
A
sympathetic nervous system
21
Q
What happens to heart rate and contractility when the SNS is innervated? How does this happen?
A
HR and contractility increase
epi is released which causes beta receptors to be stimulated thus causing the increase
22
Q
What system is stimulated when blood pressure is high?
A
parasympathetic nervous system
23
Q
What happens to heart rate and contractility when the PNS is innervated? How does this happen?
A
HR and contractility decrease
acetylcholine is secreted which causes HR to slow
24
Q
What are some factors that increase heart rate? (5)
A
- elevated body temp.
- increased environmental temp.
- exercise
- smoking
- stress
25
What are the 5 properties of cardiac cells?
1. contractility
2. automaticity
3. rhythmicity
4. conductivity
5. refractory period
26
What is cardiac output?
the volume of blood ejected by a ventricle in 1 minute
27
What is stroke volume?
the volume of blood pumped from one ventricle in one contraction
28
How do you calculate cardiac output?
CO = HR x SV
29
What is the main function of the electrical conduction system of the heart?
to create an electrical impulse and transmit it to the rest of the myocardium
30
Where is the electrical conduction system of the heart?
inside the heart walls
31
What component of the electrical conduction system acts as the pacemaker? How does it do this?
SA node
using information from the nervous, circulatory, and endocrine systems
32
In what order does an electrical impulse travel through the heart?
1. SA node
2. Internodal pathways
3. AV node
4. Bundle of His
5. Bundle branches (L and R)
6. Purkinje fibers
7. Myocardial cells
33
What are the firing rates of each component of the electrical conduction system?
SA node = 60-100
AV node = 45-60
Bundle of His = 40-45
Bundle branches = 40-45
Purkinje fibers = 35-40
34
What are the phases of normal electrical activity in the heart?
polarization
depolarization
repolarization
35
What is polarization? Where are potassium, sodium, and calcium located?
a state of readiness
potassium inside
sodium outside
calcium outside
36
What is depolarization? Where are potassium, sodium, and calcium located?
contraction
sodium channels open and sodium moves into cell
potassium moves to outside
37
What is repolarization? Where are potassium, sodium, and calcium located?
recovery phase
action potential is terminated
potassium leaves cell
38
What is the refractory period? Absolute vs. relative?
period during which cells resist stimulation
absolute = will not respond to any stimulus
relative = responds to very strong stimuli
39
Where do you place each lead for a 4-lead ECG?
white = right arm
black = left arm
green = right leg
red = left leg
40
What does one little box on an ECG paper represent?
0.04 seconds
41
What do 5 little boxes or 1 big box on an ECG paper represent?
0.2 seconds
42
What does the P wave represent? How long should a P wave be?
atrial depolarization
<120 ms (less than 3 little boxes)
43
What does the PR interval represent? How long should a PR interval be?
movement of impulse down AV node to bundle of his and then to bundle branches
0.12 to 0.20 seconds (3-5 little boxes)
44
What does the QRS complex represent? How long should a QRS complex be?
ventricular depolarization
less than 0.12 seconds (less than 3 little boxes)
45
What does the T wave represent?
ventricular repolarization
46
What are the steps for reading an ECG strip? (6)
1. measure the HR
2. identify P waves (present? regular? inverted, retrograde, absent?)
3. measure the PRI (greater than 0.2 seconds?)
4. determine relationship of P waves to QRS (1:1 ratio?)
5. determine if QRS is wide or narrow (narrow or wide?)
6. determine rhythm regularity
47
What is cardiac stress?
when circumstances force the heart to work harder to maintain cardiac output
48
What are the two categories of cardiac stress?
direct and indirect
49
What are examples of direct stress?
- structural or functional alterations in the heart
- ischemia
- infection
- arrhythmias
- congenital defects
50
What are examples of indirect stress?
- disorders external to the heart that increase workload
- anxiety
- stress from an accident
51
What is ischemia?
a reduction of blood supply to the myocardium caused by degenerative changes to coronary arteries
52
What is arteriosclerosis? What effect does it have on the arteries?
degenerative disorder resulting in vascular obstruction
causes hardening of arteries and thickening of arterial walls
53
What is atherosclerosis? What effect does it have on vasculature?
arteriosclerosis accompanied by accumulation of fatty material
chronic
can be asymptomatic
causes narrowing of vessels and reduction of blood flow through them
54
What are the predisposing factors of arteriosclerosis that cannot be changed?
- age (more than 40)
- gender (men more likely)
- genetics
55
What are the predisposing factors of arteriosclerosis that can be changed?
- obesity
- cigarette smoking
- sedentary lifestyle
- uncontrolled hypertension
56
What causes ischemia?
spastic contraction
- cold weather, caffeine, nicotine, anxiety, exertion
occlusion
57
What is angina?
chest pain caused by deficiency of oxygen for the heart muscle
58
What characterizes stable angina?
predictable pain, same location and severity
lasts 1-5 minutes
59
What characterizes unstable angina? What is it indicative of?
pain is more severe and feels different from normal
not relieved by meds
lasts >15 minutes
indicative of pre-MI angina
60
What are symptoms of angina?
recurrent episodes of chest pain triggered by stress
tightness or pressure in the chest (radiates)
pallor, sweaty, nausea
61
How do you treat angina?
oxygen
ASA, nitro
12 lead
IV therapy
62
How often should you take vitals for angina patients?
every 5 minutes
63
What are symptoms of a STEMI?
sudden, substernal chest pain
gastric discomfort
pallor
sweaty
dizziness, weakness
anxiety, fear
hypotension
rapid weak pulse
dyspnea
64
What are signs of flail chest? How do you treat it?
paradoxical motion
dyspnea
chest pain
treat with internal splinting
65
What is pericardial tamponade?
excess fluid in pericardial sac
66
What are signs of pericardial tamponade?
Beck's triad:
- muffled heart tones
- hypotension
- JVD
67
What are the STEMI mimickers? (7)
LBBB
left ventricular hypertrophy
pericarditis
pacemaker rhythms
hyper and hypokalemia
digitalis effects
benign early repolarization
68
What can LBBBs produce that mimics a STEMI? (3)
ST elevation
ST depression
tall T waves
69
What is pericarditis?
inflammation of the pericardium
70
What are signs and symptoms of pericarditis?
chest pain, sharp and radiating
pain can last hours or days
dyspnea, tachycardia, weakness, chills
71
What does pericarditis look like on an ECG?
ST elevation
concave ST segment in all leads
T wave elevation
PR depression
72
What are the 3 electrolytes?
calcium
potassium
sodium
73
What is the role of calcium in the body? (4)
structural strength for bones and teeth
stability of the nerve membrane (controls permeability)
muscle contractions
metabolic processes and enzyme reactions
74
What is hypokalemia? What causes it?
insufficient potassium
excessive loss of K from diarrhea or diuretic drugs
excessive aldosterone or glucocorticoids
decreased dietary intake
75
What can hypokalemia cause?
cardiac dysrhythmias
neuromuscular function interference
paresthesias (pins and needles)
decreased GI mobility
weak respiratory muscles (shallow inspiration)
renal malfunction
76
What is hyperkalemia? What causes it?
excessive potassium
renal failure
insufficient aldosterone
K sparing diuretics
K leakage out of cells from tissue damage
acidosis
77
What can hyperkalemia cause?
wide, flat P waves
longer PRI
wide, flat QRS
high, wide T wave
muscle weakness
fatigue, nausea, pins and needles
78
What are the 3 layers of blood vessel walls? What layer is each one?
tunica adventitia (outermost)
tunica media (middle)
tunica intima (interior)
79
What are characteristics of tunica adventitia?
strong, flexible connective tissue
prevents tearing
80
What is the thickest layer of the arteries? The veins?
Arteries = tunica media
Veins = tunica adventitia
81
What are characteristics of tunica media?
made of smooth muscle
connected with layers of elastic connective tissue
allows for changes in blood vessel diameter
82
What are characteristics of tunica intima?
made up of endothelial cells
makes up semilunar valves
83
What are characteristics of arteries?
thick walled, muscular vessels
carry blood AWAY from heart
typically carry oxygenated blood EXCEPT in pulmonary arteries (to lungs for oxygenation)
sensitive to stimulation from ANS
regulate BP
84
What are the 2 types of arteries?
elastic and muscular
85
What is the difference between elastic and muscular arteries?
Elastic:
- largest in body
- stretch without injury
Muscular:
- carry blood farther away from heart to specific organs
- smaller in diameter
- thicker walls than elastic
86
What is the main function of arterioles?
to regulate blood flow through the body
87
What are characteristics of veins?
low pressure
thinner walls
less capacity to decrease diameter
more likely to distend
88
What are characteristics of capilliaries?
microscopic
carry blood from arteries to venules
extremely thin walls
transfer nutrients and vital substances between blood and tissues
over 1 billion in body
89
What are characteristics of veins?
carries blood towards heart
become larger as they get closer to heart
great ability to stretch
90
How much blood is in the body?
approximately 5 litres
91
What is anemia? What causes it?
reduction in oxygen transport caused by decreased hemoglobin content
- declining RBC production
- decrease in RBCs
92
What are signs and symptoms of anemia?
fatigue, pallor, dyspnea, tachycardia
dry lips
93
What controls involuntary activity?
autonomic nervous system
94
What controls voluntary activity?
somatic nervous system
95
What structures protect the brain? (3)
the skull
meninges
CSF
96
What are the 3 meninges? What layer is each one? Describe each layer.
dura mater
- outer layer
- tough, fibrous, double layer
arachnoid mater
- middle layer
- loose, web like
pia mater
- inner layer
- delicate connective tissue right on top of brain
97
Where is CSF formed? Where is CSF stored?
made in ventricles of the brain, stored in subarachnoid space
98
What is the purpose of CSF?
provide cushion for the brain and spinal cord
99
How much CSF do we produce each day?
500ml
100
What is the blood brain barrier? What does it do?
protective mechanism made up of impermeable capillaries
controls delicate balance of electrolytes, glucose, and proteins in brain
101
What substances can still pass through the blood brain barrier?
lipid soluble substances
102
How many major lobes are in each hemisphere of the brain? What are they?
4
frontal, parietal, occipital, temporal
103
What is the frontal lobe responsible for?
emotion regulation
planning
reasoning
problem solving
104
What is the parietal lobe responsible for?
sensory information including touch, temp, pressure, pain
105
What is the temporal lobe responsible for?
hearing
visual processing
memory
106
What is the occipital lobe responsible for?
visual processing
107
What are the 2 special areas involved in language?
Brocas's area
Wernicke's area
108
What is Broca's area responsible for? Wernicke's area?
Broca's - motor (words out)
Wernicke's - speech comprehension (words in)
109
What is the limbic system responsible for? What is it linked to?
emotional reactions and feelings
linked to hypothalamus
110
What is the diencephalon? What does it contain?
central portion of the brain
contains thalamus and the hypothalamus
111
What is the thalamus? What does it do?
main nerve bodies
sort and relay incoming sensory information
112
What does the hypothalamus do?
maintains homeostasis in the body
regulates temperature, intake of food and fluid, sleep cycles, and libido
113
What does the cerebellum do?
coordinates movement
maintains posture
maintains balance
114
How is blood supplied to the brain?
internal carotid arteries and vertebral arteries
115
How does blood leave the brain?
it collects in the dural sinuses and drains into right and left jugular veins
116
What is the purpose of Circle of Willis?
to prevent ischemia in the brain by rerouting blood around blockages to maintain continuous supply
117
What are the 12 cranial nerves? What do they do?
Olfactory - smell (sensory)
Optic - vision (sensory)
Oculomotor - eye movements, including eyelids (motor)
Trochlear - eye movement (motor)
Trigeminal - general sensory including eye, nose, face, oral cavity, teeth, and speech muscles (motor + sensory)
Abducens - eye movements (motor)
Facial - taste, muscles of facial expression, scalp muscles (sensory + motor)
Vestibulocochlear - hearing, balance (sensory)
Glossopharyngeal - taste, gag reflex (sensory + motor)
Vagus - external ear, parts of taste, heart and lung smooth muscle, glands of GI system, diaphragm (sensory + motor)
Spinal Accessory - voluntary muscles of pharynx, head movements (motor)
Hypoglossal - muscles of the tongue (motor)
118
What protects the spinal cord?
vertebral column
meninges
CSF
119
Where does the spinal cord start and end? What follows the end of the spinal cord?
starts at medulla oblongata
ends at 1st lumbar vertebra
cauda equina (bundle of nerve roots)
120
What does the spinal cord consist of?
nerves that innervate the skeletal muscles
ascending and descending tracts
121
What do the ascending and descending tracts of the spinal cord do?
ascending - relays information from skeletal muscle to brain
descending - relays information from brain to skeletal muscles for movement
122
How many pairs of spinal nerves are there? What do they do?
31
carry motor and sensory fibers to and from organs and tissues
123
What are neurons?
specialized cells that conduct impulses throughout the CNS and PNS
124
What structures do all neurons have?
dendrite - conducts impulse towards the cell body
cell body - contains nucleus
axon - conducts impulse away from cell body
myelin sheath - insulates fiber, increases rate of conduction
nodes of ranvier - spaces between myelin sheath
125
How are impulses transmitted from cell to cell?
neurotransmitters
126
What are the 4 types of neurotransmitters?
acetylcholine
norepi/epi
dopamine
serotonin
127
What is the chief neurotransmitter in the PNS?
acetylcholine
128
What is the main neurotransmitter in the SNS? What does it do?
norepi/epi
causes vasoconstriction
increases HR
stimulates alpha and beta receptors
129
What does dopamine do? When is it released?
the cycle of motivation, reward, and reinforcement
released when body is expecting a reward
130
What does serotonin impact?
mood, sexual desire and function, appetite, sleep, memory
131
What comprises the autonomic nervous system?
sympathetic nervous system
parasympathetic nervous system
132
What is a primary head injury?
initial damage and direct injuries
result of a force applied to the head
includes tissue and vascular damage
133
What is a secondary head injury?
result of hypoxia and decreased perfusion, cerebral edema, infection, hemorrhage
134
What is the brain's initial response to bruising?
vasodilation and increased blood flow to area of injury
which causes ICP to increase
which causes decreased blood flow
135
What will decreased CO2 levels cause in the brain?
hypoventilation which leads to cerebral vasoconstriction and cerebral ischemia (hypoxia)
136
What will increased CO2 levels cause in the brain?
hyperventilation which leads to vasodilation and edema (hypoxia)
137
What contributes to intracranial pressure? (3)
brain tissues
blood
CSF
138
What is normal intracranial pressure?
5-15 mmHg
139
What is cerebral perfusion pressure (CPP)? What is normal CPP?
pressure needed to maintain blood flow to the brain
normal CPP = 70-80 mmHg (no less than 60 mmHg)
140
What does MAP stand for? What is normal MAP?
Mean Arterial Pressure
normal MAP = 70-100 mmHg
141
How do you calculate CPP?
CPP = MAP - ICP
142
What happens when ICP = MAP?
no more blood flow to the brain
143
What are early signs of increased ICP?
CSF shifts to the spinal cavity
decreased CPP
- leads to hypoxia
hypoxia causes vasodilation to improve blood supply
cycles again
144
What are symptoms of increased ICP?
severe headache
vomiting (projectile)
papilledema (swelling of optic disc)
seizures
145
What triggers the Cushing's Reflex?
cerebral ischemia
146
What does the Cushing's Reflex do? How?
attempts to increase blood supply to the brain
- decreasing pulse
- increasing systolic pressure with a widening pulse pressure
- irregular respirations
147
If increased ICP is not resolved, what is inevitable?
death
148
What is cerebral herniation syndrome? What does it cause?
brain swelling which eventually forces tissues downward through the foramen magnum
causes obstruction of blood flow
places pressure on brain stem
149
What are signs and symptoms of cerebral herniation syndrome?
decreased LOC
coma
dilation of pupil on same side
paralysis of opposite side of body
decerebrate posturing
increased BP
bradycardia
150
How do you treat cerebral herniation syndrome?
hyperventilation to reduce swelling (1:3 seconds)
151
What makes concussions more likely?
history or head trauma or blows to the head
152
What happens during a concussion?
no structural damage to the brain occurs
brief disruption of neural function occurs
- period of unconsciousness or confusion
- return to normal
- short term memory loss
153
What are signs and symptoms of concussion?
headache
dizziness
tinnitus
nausea
154
What is a cerebral contusion? What can it cause?
bruised brain tissue with ruptured small blood vessels, usually caused by a blow to the head
it can cause brain swelling (can be rapid and severe)
155
What are signs and symptoms of a cerebral contusion?
prolonged unconsciousness
altered LOC
personality changes
profound confusion
persistent amnesia
abnormal behaviour
focal neurological signs
156
What usually accompanies basilar fractures?
leaking of CSF through nose and ears
discolouration around the eyes and behind the ears
157
What is a diffuse axonal injury? What can it cause?
severe blunt trauma to the head
can cause stretching, shearing, tearing of nerve fibers
generalized edema
herniation syndrome is possible
permanent vegetative state
158
What are signs and symptoms of a diffuse axonal injury?
seizure activity
coma
vomiting
159
What is an anoxic brain injury? How long does it take until it is irreversible?
lack of oxygen to the brain cells
irreversible after 4-6 minutes
160
What are the 4 classifications of intracranial hemorrhage?
epidural hematoma - between skull and dura
subdural hematoma - between dura and arachnoid
subarachnoid hematoma - between arachnoid and pia
intracerebral hematoma - IN brain tissues
161
What typically causes an epidural hematoma?
a tear in the middle meningeal artery caused by linear fractures to the skull
162
What are signs and symptoms of an epidural hematoma?
head trauma with loss of consciousness
lucid interval followed by signs of increased ICP
rapid death
163
What is typically associated with subdural hematomas?
injury to underlying brain tissues
164
What type of bleed is associated with subdural hematomas?
venous bleeds = slow
165
Who is at a greater risk for subdural hematomas?
elderly people on blood thinners
alcoholics
166
What are the signs and symptoms of subdural hematoma?
headache
change in LOC
slurred speech
167
What is associated with subarachnoid hemorrhage? What occurs?
traumatic bleeding from the blood vessels at the base of the brain
blood mixes with CSF and prevents hematoma formation
168
What are the signs and symptoms of subarachnoid hemorrhage?
sudden, severe headache (worst headache i've ever had in my life)
decreased LOC
pupil changes
posturing
vomiting
seizures
169
What lobes are most commonly affected by intracerebral hemorrhage?
frontal and temporal
170
What are the signs and symptoms of intracerebral hemorrhage?
depends on extent of injury
alterations in LOC
similar pattern to CVA
high mortality rate
171
What does it mean when the oxygen dissociation curve shifts left? Right?
Left = higher hemoglobin oxygen affinity
Right = lower hemoglobin oxygen affinity
172
What causes the oxygen dissociation curve to shift to the left?
lower CO2
higher pH
lower temperature
lower DPG
173
What causes the oxygen dissociation curve to shift to the right?
higher CO2
lower pH
higher temperature
higher DPG
174
What is normal V/Q?
0.8, 1.0 when humidified
175
What does yellow-green, cloudy, thick mucus indicate?
bacterial infection
176
What does rusty/dark sputum indicate?
pneumonia
177
What does blood-tinged sputum indicate?
pulmonary edema
178
What are signs and symptoms of URTIs?
red mucous membranes of nose and pharynx
copious watery discharge
mouth breathing, change in voice tone
cough may develop
179
How do you treat URTIs?
acetaminophen
decongestants
humidifiers
180
What is sinusitis? How do you treat it?
bacterial infection secondary to cold or allergy
decongestants and analgesics
antibiotics
181
What is croup? Who does it typically occur in? How do you treat it?
common viral infection presenting with nasal congestion and cough
ages 1-2
cool, moisturized air
182
What is epiglottitis? Who does it typically occur in? Symptoms? Treatment?
infection from bacterial organism
ages 3-7
swelling of larynx, supraglottic area, epiglottis
child refuses to swallow, mouth open, drooling
treat with O2; DO NOT AGGRAVATE PT.
