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191 Cards in this Set
- Front
- Back
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Base of the heart
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at the top
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valves heard at the base of the heart are
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aortic and pulmonic
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Precordium
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portion of the body over the heart and lower chest
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pericardium
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double walled sac that contains the heart and the roots of the great vessels, tough, loose fit
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Parietal pericardium
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serous lining , tough outermost layer that sercrets the pericardial fluid
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epicardium
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layer immediately outside of the heart muscle/inner layer of pericardium
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myocardium
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middle and thickest layer of the heart, composed of striated muscle
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endocardium
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endothelial lining membrane of the cavities of the heart
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If it is cardial friction rub it sounds like
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a train
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superior vena cava
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is a large diameter, yet short vein that carries deoxygenated blood from the upper half of the body to the heart's right atrium.
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inferior vena cava
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large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart.
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Pulmonary artery
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carry blood from the heart to the lungs
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pulmonary vein
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large blood vessel of the human circulatory system that carries blood from the lungs to the left atrium of the heart
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aorta
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largest artery in the body, originating from the left ventricle of the heart and extends down to the abdomen....brings oxygenated blood to ALL parts of the body
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Name the 4 valves
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2 atrioventricular valves, two semilunar valves....Pulmonary and Aortic valve, and tricuspid and mitral valve
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Tricuspid valve
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(also known as the right atrioventricular valve) is on the right side of the heart, between the right atrium and the right ventricle....stops deoxygenated blood from flowing back into body
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Mitral valve
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(also known as the bicuspid valve or left atrioventricular valve) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV).....stops oxygenated blood from flowing back to lungs
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Systole....
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heart simultaneously contracts its ventricles and pushes blood to body and lungs
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Diastole
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heart muscle relaxes and blood returns from the body and lungs to the atriums
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Heart sounds are produced by
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valve closures
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S1
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lub; correlates with the closure of the AV valves and beginning of systole; heard best at the apex
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where is the apex of the heart...anatomically
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L MCL, 5th ICS
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S2
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dubb; correlates with closure of the semilunar valves and the beginning of diastole; heard best at the base of the heart
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Systole begins with
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the closure of the AV valves (S1)
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End of systole
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Semilunar valves close (S2) ....after blood pushed into body
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S3
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may be heard in diastole after S2, ventricular gallop, 'Ken-tuc-ky'
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S4
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Maybe heard late in diastole, just before S1
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Conditions that contribute to turbulent blood flow (aka murmurs)...4
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1. Inc blood velocity
2. Structural valve defects 3. Valve malfunction 4. Abnormal chamber openings |
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VSD
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ventricular septal defect
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Sinoatrial node (SA node)
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Impulse generating (pacemaker) tissue...in the right atrium of the heart...generator of sinus rhythm, near the entrance of the superior vena cava.
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Atrioventricular node
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AV node - electrically connects atrial and ventricular chambers.
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Bundle of His
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av bundle; inherent electrical discharge at a rate of 40-60/min....transmit electrical impulss from AV node to the point of apex of the fascicular branches.
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Purkinje fibers
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wrap around heart at the ventricle...influenced by the autonomic nerve system
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Electrocardiogram
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measures the electrical activity of the heart, records depolarization and repolarization
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Cardiac output
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amount of blood pumped by the ventricles during a given period of time (1 minute)
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How to calculate CO
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Stroke volume (typically 70 mm) * HR
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What is a normal adults CO
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5 to 6 L
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What is Cardiac output affected by
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the Autonomic Nervous System....
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Sympathetic impulses
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inc HR (stressed out bc test) increases CO
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parasympathetic impulses
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dec HR (digest food, relax) dec CO
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2 sets of jugular veins...
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internal lie deep and medial to the SCM muscle and external lie superficial and lateral to the SCM above the clavicle
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Assessing the JVD assists in
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determining the function of the RIGHT side of the heart
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Level of the jugular venous pressure reflects
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the Right atrial (central venous) pressure
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Carotid arterial pulse correlates with
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ventrical systolic
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When a pt is lying you should see some
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venous distension...but you shouldnt see it when sitting at angle greater than 45 degree
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External Carotid arteries go
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superficial....supply face & scalp
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Internal carotid arteries go
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deep....to the brain
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what would nocturia suggest?
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increased renal profusion....kidneys work at night
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What does dizziness suggest
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dec blood flow 2ndary to Myocardial damage, inner ear infection, low bp
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What does edema to feet, ankles, legs suggest
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r side heart failur
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what does rheumatic fever history suggest
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can cause rhematicarditis infection of all layers of the heart
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Vein walls are compared to arteries....
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thinner walls and wider
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What are the 3 mechanisms to help blood flow back to heart
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1. Valves
2. Muscle contractions 3. Pressure gradient decreases intrathoracic pressure, inc abdominal press |
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What are the 3 functions of the lymphatic system
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1. drain excess fluid and plasma proteins from bodily tissues and return to venous system
2. filter for the immune system 3. absorb fats from the small intestine into the blood stream |
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Signs of arterial insufficiency
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cold, pale, skin, thin, shiny skin, loss of hair
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Signs of venous insufficiency
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warm skin and brown pigmentation around the ankles
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Arterial disease ulcers
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painful around toes,foot, or lateral ankle
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Venous ulcers
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painless and are on lower leg or medial ankle
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PVD
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Peripheral vascular disease....aortic aneurysms, cerebrovascular disease, deep vein thrombosis, PE, Peripheral arterial occlusive disease and varicose veins
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Lymphedema
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from blocked lymphatic circulation
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Bilateral edema indicates
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systemic problem: congestive heart failure, or local problem
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edema associated with lymphedema
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blockd lymph vessels, non pitting, no ulceration or pigmentations
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edema associated with chronic venous insufficiency
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pitting, pigmentation,and ulceration may be present
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Chordae tendineae
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collagen fibers that anchor the AV valve to papillary muscles in the ventricles
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Presystole, atrial systole
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'atrial kick' final active filling, raises L ventricular pressure
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S1 sound
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closing of AV valves, beginning of systole
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s3 is
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after s2 called ventricular gallop
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s4 is
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before s1 and called atrial gallop
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Conditions contributing to turbulent blood flow
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1. inc blood velocity
2. structural valve defects 3. valve malfunction 4. abnormal chamber openings |
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Right sided heart failure raises
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pressure and volume raising jugular venous pressure
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a wave
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reflects rise in atrial pressure that occurs with atrial contraction
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x descent
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reflects right atrial relaxation and descent of the atrial floor during ventricular systole
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V wave
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reflects right atrial filling inc volume and inc atrial pressure
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Y descent
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reflects right atrial emptying into the right ventricle and dec atrial pressure
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Kussmauls sign
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inspiratory inc in venous pressure may occur in clients with severe constrictive percarditis
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Pulse rate deficit
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if irregular rhythm....compare apical pulse and radial pulse. may indicate a fib, atrial flutter, premature ventricle contraction or heart block
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S1 corresponds with
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carotid pulse and is loudest at apex
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summation gallop
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s3 and s4 sounds together mitral valve stenosis
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aortic regurgitation murmur
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maybe heard when pt sits up, leans forward and exhales at left sternal border
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What is pulse pressure? and a normal?
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Difference btw systolic and diastolic pressures....ave 30-40 mm Hg per person
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Bisferiens pulse
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double systolic peak
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Pulsus alternans
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changes in amplitude (strength) from heart beat to beat....cause by ventricular failure
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Bigeminal pulse
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reg irreg rhythm. one normal beat followed by premature contraction
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Paradoxical pulse
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palpable dec in pulse amplitude on inspiration, pulse stronger on expiration
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When is pt okay for sex
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when pt can walk up 2 flights of stairs or 1 block without dyspnea
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palpitations
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pt can feel heart beating in chest
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fatique
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associated with dec cardiac output
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CAD
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coronary artery disease
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How are women different from men leading to CHD
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Higher body fat, smaller heart, higher resting hr, estrogen, lower iron stores, faster cardiac conduction, higher ejection fraction at rest
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Framingham data
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1. women present with angina
2. men present with mi 3. women present with more 'atypical' angina |
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classic (male pattern) angina
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1. comes on with exertion
2. releived by rest or nitroglycerin 3. mid or substernal location |
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atypical (women) angina
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1. nausea and vomiting
2. fatigue 3. palpitations 4. dyspnea/sob 5. jaw or shoulder pain 6. twice the chance of misdiagnosis of actue MI than men |
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Thallium scans
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diagnostic test for MI, but more difficult to interpret bc of breast tissue
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CV ASSESSMENT AGING CHANGE: apical impulse
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more difficult to locate as the thorax changes
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CV ASSESSMENT AGING CHANGE: Murmurs
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1. most are w/o of CV abnormality (innocent)
2. w/ age inc thickening of aortic cusps - calcification - vibration - aortic stenosis murmur |
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CV ASSESSMENT AGING CHANGE: Blood pressure
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arteriosclerosis and atherosclerosis
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arteriosclerosis
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arteries stiffen
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atherosclerosis
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fat deposits in arteries
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CV ASSESSMENT AGING CHANGE: Blood pressure aorta
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aorta less distensible so greater rise in systolic blood pressure and greater diffence btw systolic and diastolic pressures a 'widdened pulse pressure'
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CV ASSESSMENT AGING CHANGE: diastolic pressure
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diastolic pressure usually stops rising around the 6th decade
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CV ASSESSMENT AGING CHANGE: syncope
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1. postural (orthostatic) hypotension is more common
2. arrythmias (abnormal heart rhythms) are more common 3. can cause syncope |
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JVD shows
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r sided heart failure
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when assessing carotid...you
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auscultate then palpate
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carotid bruits are indicative of
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occlusive heart disease
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palpation of carotid
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changes the strength of the impulse
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inspect pulsations of the precordium ....
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with pt supine HOB 30-45 degree. will be in the mitral area (L MCL 4th-5th ics)
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PMI=
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old apical impulse
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thrill at apical pulse equals
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grade IV murmur
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Aortic area on chest
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2nd ICS RSB
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Pulmonic area on chest
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2nd ICS LSB
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ERB's point area on chest
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3rd ICS LSB
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Tricuspid area on chest
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4th ICS LSB
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Mitral area on chest
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5th ICS MCL
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What veins use for cabg?
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saphenous veins
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PVD
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peripheral vascular disease
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5 vascular disorders of PVD
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1. Aortic aneurysms
2. cerbrovascular disease 3. deep vein thrombosis and pulmonary embolism 4. varicose veins 5. periphearl arterial occlusive disease |
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Peripheral vascular history?
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Leg pain or cramps? walking distance? skin changes on legs or arms? swelling in legs or arms
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Where are epitrochlear lymph nodes?
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located 3 cm above elbow
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HOMAN's sign
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sl bend in the knee and dorsiflex foot....positive is a pain in the calf
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arterial insufficiency
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Pain is intermittent claudation to sharp unrelenting, pulses are deminished, reddish/purple color to knee down
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venous insufficiency
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aching, cramping, pulse is difficult to palpate through edema
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ankle/brachial index AKA: ABI
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assess circulation to feet. identify early signs of peripheral vascular insufficiency.
ankle/brachial pressure....ABI = 1.25 ...want a higher number |
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Which CN are responsible for gag reflex
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CN IX and X
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area of the brain that receive sounds
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temporal
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Nerves and ganglia
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- sensory nerves carry incoming signals from the sense receptrs, motor signals carry outgoing signals to the muscles and gland
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Somatic system
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Conscious awareness, voluntary control. Governs most general senses and skeletal muscle control
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Autonomic system
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visceral awareness, involuntary control, sympathetic pathways 'flight or fight', parasympathetic pathways for resting or digesting
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Pia
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think protective cover
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Arachnoid
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vascular, where CSF is absorbed and *blood stops the reabsorption*
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sulci
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crevices
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gyri
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folds
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Circle of Willis
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Arterial circuit to supply the brain. Common site of aneurysms and strokes
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Where is circle of willis
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lies over brainstem connects carotid to brain
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dura matter
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hard leather
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Medulla controls
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respiration rhythm, vomit, sneeze, cough
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Pons controls
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rate, length of respiration CN 5-8
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Midbrain controls
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CN 3-4, visual stimuli, auditory
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Diencephalon
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hypothalamus, thalamus
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Frontal
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contains motor cortex, voluntary skeletal movements, fine repetivie motor movements, brocas area in dominant hemisphere
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Brocas area
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expressive speech center....back of frontal lobe
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Parietal
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processes sensory data, interpretation of tactile, visual, gustatory, olfactory and auditory sensations, recognition of body partss
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temporal
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perception and interpretion of sounds, integration of taste, smell, and balance, wernickes area
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wernickes area
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receptive speech....back of temporal
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occipital
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vision center, interpret visual data
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limbic system
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mediates primitive behavior, visceral responses to emotion and biological rhythms
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global aphasia
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when both brocas and wernickes damaged
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Hypothalamus
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temp, water balance, sex, sleep, gi
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thalamus
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relay center, feelings of well being, pain, touch
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pineal gland
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sleep cycles, response to light, puberty
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limbic
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learning, emotion, memory
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Hippocampus
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medial on temp. process info from short to long term memory
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Corpus callosum
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band of axons connecting the R and l hemispheres
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Cranial nerves are
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peripheral nerves that arise from the brain...not spinal cord
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CN I
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olfactory, sensory smell reception and interpretation
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CN II
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Optic, sensory, visual acuity and visual fields
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CN III
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oculomotor, motor (raise eyelids, EOM) parasympathetic (pupillary constriction, change lens shape)
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CN IV
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Trochlear; Motor downward, inward eye movements
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CN V
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Trigeminal; Motor (jaw opening, and clenching, chewing and mastication) Sensory (sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose
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CN VI
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Abducens; motor, lateral eye movement
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CN VII
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Facial; Motor (movement of facial expression muscles except jaw....close eyes, labial speech sounds B, M, W) Sensory (taste, anterior 2/3 of tongue, sensation to pharanyx) Parasympathetic (Secretion of saliva and tears)
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CN VIII
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Vestibulocochlear/Acoustic; Sensory (hearing and equilibrium)
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CN IV
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Glossopharyngeal; motor (Voluntary muscles for sqallowing and phonation); sensory (sensation of nasopharynx, gag, taste posterior 1/3 of tongue) Parasympathetic (secretion of salivary glands, carotid reflex)
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CN X
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Vagus; Motor (voluntary muscles of phonation, and swallowing) Sensory (sensation behind ear and part of external ear canal) Parasympathetic (secrection of digestive enzymes, peristalic carotid reflex, involuntary action of heart, lungs and GI)
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CN XI
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Spinal accessory; Motor (turn head, shrug shoulder,
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CN XII
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Hypoglossal; motory (tongue movement for speech and sound articulation and swallowing
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Spinal cord begins
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at foramen magnum...where medulla stops
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Cauda equina
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horse tail....end of spinal cord
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White matter
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myelindated sheath grows as older....allows greater control of movents
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Ascending tracts
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sensory axons
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Descending tracts
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motor axons
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Pyramidal tract
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Corticospinal; voluntary movements of great skill
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Extrapyramidal tract
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more primative function, walking
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Dorsal column
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(posterior) for fine touch, localized, deep pressure, vibration, position, stereognosis, 2 pt discrimination
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Spinothalamic tract
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for light and crude touch, temp, pain
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Upper Motor neurons
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Located in CNS, convey impulse from motor areas to LMN in anterior horn cells
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Types of upper motor neuron diseases
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CVA, CP, MS
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Lower motor neurons
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in the PNS, direct contact btw spinal cord and muscle, translate movement into action, spinal and CN
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TYpes of lower motor neuron diseases
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ALS, spinal cord lesions, poliomyelitis
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How many pairs of nerves?
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31. 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
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Motor fibers of the ventral root carry impulses
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from the spinal cord to the muscles and glands
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Sensory fibers of the dorsal root carry impulses
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from the sensory receptors of the body to the spinal cord to the brain for interpretation
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The impulse may synapse immediately with the motor fiber at
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the level of the spinal cord (reflex arc)
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5 reflex arc components
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1. intact sensory (afferent) nerve
2. functional synapse in cord 3. intact motor (efferent) nerve 4. neuromuscular junction 5. competent muscle |
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In newborns motor activity is controlled by
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spinal cord and medulla....sensory and motor development occurs with gradual acquisition of myelin
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In older adults...
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general atrophy with steady loss of neurons...velocity of nerve conduction decreases. General slowing down of movement, dec in cerebral blood flow and oxygen consumption
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Cerebellar function
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balance & coordination
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Romberg
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balance on 1 foot
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Primary Sensory Functions test
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1. superficial touch, pain, temp, vibration, position of joints
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Cortical sensory functions test
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stereognosis, 2 pt discrimination, extinction phenomenon, graphesthesia, pt location
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Babinski
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abnormal....dorsiflexion in adults
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proprioception
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ability to sense the position and location and oreientation of movement of the body and its parts
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