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230 Cards in this Set

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What occurs with alcoholic cerebellar degeneration?
This involves degeneration of just the cerebellar vermis with sparing of the cerebellar hemispheres. This continues after the pt has stopped drinking (chronic alcoholism)
What are the S/S of alcoholic cerebellar degeneration?
The vermis mainly deals with the leg proprioception, so these pts are unable to do the heel to shin maneuver (equivalent to the finger to nose movement)
What is Friedreich’s ataxia?
An autosomal recessive idiopathic cerebellar degeneration caused by a tri-nucleotide repeat on Chromosome 9.
What is the inheritance pattern for ataxia-telangiectasia? Chromosome?
Autosomal recessive disorder resulting from a trinucleotide repeat in Chromosome 11 (idiopathic cerebellar degeneration)
What activates the classic complement pathway? Alternate pathway?
Classic pathway: IgG and IgM

Alternate: molecules on the surface of microbes (especially endotoxin)
What secretes IL-1? Function?
secreted by macrophages

Stimulates T cells, B cells, Neutrophils, fibroblasts, and epithelial cells to grow, differentiate, or synthesize specific products.

Causes FEVER
What surface proteins are found on Helper T cells?
CD4, TCR, CD3, CD28, CD40L
What surface proteins are found on Cytotoxic T cells?
CD8, TCR, CD3
What secretes IL-2? Function?
Secreted by Th cells (undifferentiated).

Stimulates growth of helper and cytotoxic T cells
What secretes IL-4? Function?
Secreted by Th2 cells

Promotes growth of B cells
Enhances class switching of IgE and IgG
What secretes IL-5? Function?
Secreted by Th2 cells

*Promotes differentiation of B cells
* Enhances class switching of IgA
* Stimulates production and activation of eosinophils
What does IL-8 do?
It is the major chemotactic factor for neutrophils
What secretes IL-10? Function?
Secreted by Th2 cells

Stimulates Th2 while inhibiting Th1 cells
What secretes IL-12? Function?
Secreted by B cells and Macrophages.

Activates NK and Th1 cells
What secretes IFN-gamma? Function?
Th1 cells secrete it

activates macrophages
What secretes TNF-alpha? Function?
Secreted by Macrophages

* Increases IL-2 receptor synthesis by Th cells
* Increases B-cell proliferation
* Attracts and activates Neutrophils
* Stimulates dendritic cell migration to lymph nodes
What surface proteins do B cells have?
IgM, B7, CD19, CD20, CD40, MHC II
What surface proteins do macrophages have?
MHC II, CD14, Receptors for Fc and C3b
What surface proteins are found on NK cells?
Receptors for MHC I, CD16, CD56
What surface protein is found on all cells except mature red cells?
MHC I
Where does Myocardial ischemia typically refer to?
left axillary region
Where does gall bladder pain refer to?
the area beneath the shoulder blade
Where does the pain from the distention of the ureter due to a kidney stone often refer to?
the loin and groin regions
What is the usual cause of incongruent contralateral homonymous hemianopia with macular sparing?
Usually a unilateral lesion of the visual cortex (contralateral); may be due to obstruction of the posterior cerebral artery
Pt complains that he has a hard time getting out of his chair. He says that he has been taking daily walks lately and that getting started is tough, but once he gets going his legs start feeling better (stronger). What diagnosis is likely? Tests to be done? Expected findings?
Eaton-Lambert Myasthenic Syndrome; EMG: incremental response; Blood: voltage gated calcium channel antibodies
Pt comes in complaining that they can’t go as far as they used to on their daily walks because their legs get really tired. On exam, you note diminished patellar and Achilles reflexes bilaterally and weakness in the legs (3/5 b/l). Everything else is normal. What motor neuron disease is likely?
Progressive spinal muscular atrophy
Pt complains that ‘her hands aren’t working right’. On exam, you note hyperreflexia (3/4) in both biceps and brachioradialis reflexes bilaterally. Increased tone is also noted in both arms. There are no other significant findings. What motor neuron disease is likely?
Primary lateral sclerosis
28y/o complains that she ‘sees double at the end of the day’. She works at a computer all day and she says that when she gets home she experiences double vision that is relieved by taking a nap. She also says that she recently has been having trouble climbing the last flight of stairs in her office building (her office is on the 5th floor and she gets tired when she hits the 4th floor). After she sits at her desk for a while, though, she feels fine. What is the likely diagnosis? What tests should be ordered? Expected findings?
Myasthenia Gravis; order blood work for acetylcholine receptor antibodies; possibly order EMG (look for decremental response); and do a Tensilon test
What type of motor neuron disorder would be characterized by inability to shrug their shoulders, inability to flex the head and turn to the side, and inability to protrude the tongue?
Progressive bulbar palsy
Pt with weakness in their legs. EMG shows incremental response. What is the likely diagnosis?
Eaton-Lambert Myasthenic Syndrome
Pt states that they can’t finish a game of basketball anymore because they get really tired before the second half. Your nurse notes that he has lost 10 pounds since the last visit, but pt denies being on a diet. On exam, you note weakness in both legs (3/5 bilaterally) and hyperreflexia of the Left patellar and Achilles reflexes. CN are WNL. What is the likely disorder? What tests could you do to diagnose this?
ALS – Amyotrophic Lateral Sclerosis; do an EMG (expect widespread denervation) and blood test (elevated CPK)
Pt complains of a sore throat and blurry vision that started 2 hours ago. While she is in the ER she develops nausea and vomiting and complains that her mouth is really dry. When you question her about her diet, she says that she had the normal food for dinner: baked chicken, a can of green beans that a friend made her, a baked potato from her garden, etc. As time passes, she shows external ophthalmoplegia and upper arm paralysis. What is the likely diagnosis? Tx?
Botulism; tx with ICU monitoring (resp) and the antitoxin and possibly guanidine hydrochloride
Pt with weakness in their legs. Blood shows Acetylcholine receptor antibodies. What do you expect to see on the EMG?
Decremental response
Comatose pt is taking very long breaths (inspiration) followed by no breathing for a period of time. What respiratory pattern is this? Area of lesion?
Apneustic breathing; mid/low pons lesion
Comatose pt exhibiting hyperpnia regularly alternating with apnea. What respiratory pattern is this? Level of lesion?
Cheynes-Stokes pattern – seen in bilateral hemisphere or diencephalon damage
Comatose pt showing irregular breathing. What pattern of breathing is this? Level of lesion?
Ataxic respiratory pattern – medullary lesion
Comatose pt shows hyperventilation. What respiratory pattern is this? Level of lesion?
Central Neurogenic Hyperventilation – midbrain lesion
What determines the size of the pupils?
Sympathetic/parasympathetic balance
Comatose pt shows tonic conjugate gaze to the right. What could this mean?
Destructive hemispheric lesion on the right; irritative hemispheric lesion on the left; or brainstem destructive lesion on the left.
What occurs in the oculocephalic maneuver?
Doll’s Eyes maneuver – roll the head to one side and the eyes should lag (move to the side with the head) and then move back to midline
What is the Doll’s Eyes maneuver testing?
The extraocular muscles and CN III, IV, and VI (mid pons)
What should you look at before performing the caloric (oculovestibular) reflex?
Be sure the TM are intact
What occurs in the caloric reflex? Expected findings?
Irrigate the ear canal with warm or cold water. With cold water, the eyes should deviate toward the irrigated side. Warm water: eyes deviate away from irrigated side
Pt becomes comatose after having a seizure at home. Family said he has been confused for a couple days and it seemed to be getting worse when he finally had the seizure. On exam, the motor signs are symmetrical and pupillary reactions are normal. What is the likely cause of the coma?
Metabolic – commonly see seizures, pupillary reactions are usually preserved and motor signs are usually symmetrical; can also see asterixis, myoclonus and tremor
What is the definition of brain death?
Cessation of brain function (unresponsiveness and absent brainstem reflexes); irreversibility of brain function
Pt experiences loss of lower leg function and periods of unconsciousness while mowing the grass. He has a history of atherosclerosis. What is the likely diagnosis?
Subclavian Steal Syndrome
What occurs in Subclavian Steal Syndrome?
blockage of the subclavian artery proximal to the vertebral artery. During exercise, blood is shunted around the subclavian artery to ipsilateral limb, resulting in hypoperfusion of the vertebral artery and brainstem, resulting in transient unconsciousness
What artery supplies the paracentral lobule?
Anterior cerebral artery
Pt experiences sudden loss of lower leg function on the Right. Diagnosis?
Infarct of anterior cerebral artery that supplies the paracentral lobule on the left (anterior portion - primary motor cortex portion)
What artery supplies the primary motor cortex?
Middle cerebral artery
What artery supplies the primary visual cortex?
posterior cerebral artery
What artery supplies the frontal lobe?
Anterior cerebral artery
Where is the watershed area?
the area b/w the ACA and MCA / MCA and PCA distribution where terminal branches of both arteries are needed to maintain the oxygen need of the brain tissue
What artery supplies the posterior 1/2 of the spinal cord?
posterior spinal artery
What artery supplies the central region of the spinal cord?
anterior spinal artery
What occurs in Central Cord Syndrome?
abrupt symptoms resulting from insufficiency of anterior spinal artery
How does CCS differ from Syringomyelia?
Syringomyelia has a progressive onset (from slow growth of the cyst) where CCS has abrupt onset (from ischemia of the central cord)
Occlusion of what artery results in Broca's aphasia?
Middle cerebral artery
What artery supplies the middle ear?
Labyrinthine artery
What results form thrombosis of the labyrinthine artery?
disturbances in equilibrium and/or hearing
What are the S/S of unilateral lesion of the LSTT?
contralateral loss of pain and temp sensations 2 sensory dermatomes below the level of the lesion
S/S of a unilateral lesion of the spinal lemniscus?
contralateral hemianalgesia and thermal hemianesthesia
Pt says that she keeps having episodes where she passes out and wakes up ‘in a heap on the floor’. Her sister said that she just suddenly drops to the floor. She says that she is very tired after the event. What type of seizures is this? Expected finding on the EEG?
Atonic seizure; expect to find bilateral involvement of the hemispheres on EEG
Pt complains of having seizures. When you talk to her husband, he says that they last a couple minutes during which she loses consciousness and just stares at the wall. The pt tells you that she sees a bright light before they start and that she feels exhausted afterwards. EEG shows involvement of only the Left hemisphere. What type of seizure is this?
Complex partial seizure
Pt complains that they keep passing out and when they wake up they’re on the floor in a pool of sweat. She says that she feels lightheaded before she passes out and her mom says she gets really pale. What is the probable diagnosis?
Syncope
Mother brings her 11y/o son in because her teacher says he is having ‘funny inattentive spells in class.’ She says that he just stares at the blackboard and then when she asks him a question he has no idea what’s going on. You order an EEG and it shows bilateral involvement of the hemispheres. What is occurring here?
Absence (petit mal) seizures
Pregnant woman is determined to have epilepsy. What drug should be avoided?
Valproic acid
Pt’s husband says that her wife keeps having brief episodes where her extremities start jerking and she loses consciousness for a few seconds. She says that she doesn’t really feel tired after the event. What is the likely diagnosis? Expected findings on EEG?
Myoclonic seizures – bilateral hemispheric involvement on EEG
You determine that a pt has absence (petit mal) seizures. What drugs can you use to treat them?
Ethosuxamide or valproic acid
Pt complains of having seizures that last a couple minutes. His wife says his whole body stiffens up and he looses consciousness. The pt says that afterwards he is very sleepy and will sometimes sleep for 12hrs. EEG shows involvement of only the Right hemisphere. What type of seizure is this?
Secondarily generalized
Pt complains of having seizures. Her husband says that she stiffens up like a board, loses consciousness and then starts jerking her extremities. He says it usually lasts a couple minutes and she says that she feels exhausted after the episode. What seizure disorder do you suspect? What would you expect on the EEG?
Tonic-clonic seizures; expect bilateral involvement
Pt comes into the ER having seizures. The husband says that she has had 3 back-to-back seizures without resting in between. What should be done initially? What drug can be given acutely?
ABC’s and establish IV; labs (glucose, CBC, Chem) and a non-contrast CT head; give benzodiazepine
When performing the Doll’s eyes maneuver on a comatose pt, you move the head to the Right and the Right eye moves to the left, but the left eye remains in place. What does this indicate?
Left VI palsy
When testing cardinal signs of gaze, a pt can look laterally to the L normally, but cannot look to the Right (the right eye looks to the right, but the left eye does not). What is the disorder and where is the lesion?
Left INO; lesion of the MLF
What are the expected findings with the Doll’s eye maneuver and the oculocaloric test?
Doll’s eye maneuver: eyes move in the opposite direction from the movement of the head;
oculocaloric test: eyes move toward the side of the noxious stimuli (water in ear)
While you’re talking to your pt, you notice that they passively look to the left. When testing cardinal signs of gaze, your pt cannot look to the Right with either eye. Where is the lesion likely located?
Right PPRF (paramedian pontine reticular formation)
When performing the Doll’s eyes maneuver on a comatose pt, you move the head to the Left and neither eye moves. What does this indicate?
Midbrain damage
Pt complains of dizziness. As you’re talking to them they tend to turn their body to the right and when you question them about the vertigo, they say everything is spinning to the Left. When you have them perform the Rhomberg test, they fall to the Right. Upon examination of the eyes, they exhibit nystagums to the R. Where is the lesion?
The R vestibular system
When performing the oculocarloric test on a comatose pt, you inject water into the L ear and the Left eye looks to the left while the right eye does not move. What does this indicate?
R III palsy
When testing cardinal signs of gaze, a pt can look laterally to the R normally, but cannot look to the left (the left eye looks to the left, but the right eye does not). What is the disorder and where is the lesion?
Right INO; lesion of the MLF
What are the most common causes of Internuclear ophthalmoplegia?
MS in young adult pts with bilateral INO and vascular disease in older pts with unilateral INO
What results from a lesion of the Left Paramedian Pontine Reticular Formation?
Inability to move both eyes in conjugate horizontal gaze to the Left; their gaze preference would be to the Right
When performing the Doll’s eyes maneuver on a comatose pt, you move the head to the Right and the Left eye moves to the left, but the right eye remains in place. What does this indicate?
Right III palsy
When performing the oculocaloric test on a comatose pt, you inject cold water into the R ear and neither eye moves. What does this indicate?
R VIII nerve palsy of midbrain damage (deep coma state)
What is Brodmann area 3, 1, 2?
Primary somesthetic cortex
What is Brodmann area 41, 42?
Primary auditory cortex
What is Brodmann area 17?
Primary visual cortex
What is Brodmann area 44, 45?
Broca’s speech area
What is Brodmann area 22?
Wernicke’s area
What is Brodmann area 17?
Occipital eye field
What is Brodmann area 8?
Frontal eye field
What is Brodman area 4?
Primary motor cortex
What is Brodman area 6, 8?
Premotor area
What are some systemic disorders that can cause neuropathies?
Pregnancy, hypothyroidism or diabetes
What is included in the full neurological exam?
Muscle strength, DTRs, Sensory dermatomes, and CN
What nerve root is tested when you have a pt abduct their arm?
C5/6 - deltoid
What nerve root is tested when the pt flexes his arm against resistance?
C5/6 - biceps brachii
What nerve root is tested when you have a pt pronate their arm?
C6 - pronator teres
What nerve root is tested when you have a pt supinate their arm?
C6 - supinator
What nerve root is tested when you have a pt extend their hand at the wrist?
C6 - extensor carpi radialis (longus and brevis)
What nerve root is tested when you have a pt extend their arm?
C7 - triceps brachii
What nerve root is tested when you have a pt flex their hand at the wrist?
C7 - flexor carpi radialis
What nerve root is tested when you have a pt abduct their fingers?
C8 - T1 - Dorsal interosseous muscles
What nerve root is tested when you have a pt adduct their fingers?
C8-T1 - Palmar interosseous muscles
What nerve is tested when you have a pt shrug their shoulders?
Spinal Accessory nerve - trapezius m.
What nerve root is tested when you have a pt flex their thigh against resistance?
L1-3 - Iliopsoas m
What nerve root is tested when you have a pt extend their leg against resistance?
L2-4 - Quadriceps (rectus femoris, vastus medialis, intermedius and lateralis)
What nerve root is tested when you have a pt adduct their thigh against resistance?
L2-4 - Adductor longus
What nerve root is tested when you have a pt invert their foot against resistance?
L4 - Tibialis Anterior
What nerve root is tested when you have a pt dorsiflex their foot against resistance?
L5 - extensor digitorum longus
What nerve root is tested when you have a pt abduct their thigh against resistance?
L5 - gluteus medius
What nerve root is tested when you have a pt flex their leg against resistance?
S1 - gluteus maximus and hamstring m (biceps femoris, semitendinosus and semimembranosus)
What nerve root is tested when you have a pt evert their foot against resistance?
S1 - fibularis longus/brevis
What nerve root is tested when you have a pt plantarflex their foot against resistance?
S1-2 - gastrocnemius and soleus
Describe what the numbers of the muscle strength testing mean (results).
5 (normal) - complete ROM against gravity with full resistance

4 (good) - complete ROM against gravity with some resistance

3 (fair) - complete ROM against gravity

2 (poor) - complete ROM with gravity eliminated

1 (trace) - evidence of slight contractility. No joint motion

0 (zero) - no evidence of contractility
What lab work would you order for a pt with neurological symptoms?
CBC, PT, PTT, CMP, Accucheck, drug screen?
What radiological studies would you order for a pt with neurological symptoms?
CXR, CT (first line), MRI, MRA head; possibly Echo, EKG, Carotid doppler
What are 5 possible treatments for neurological symptoms?
Lifestyle modifications
NSAIDs
OMT
Steroid injections
Surgery
What are the non-avoidable risk factors for Osteoporosis?
Age (older)
Gender (women)
Frame size (smaller)
Race (caucasian)
Estrogen
Previous breast cancer
Long-term corticosteroid use
What are some absolute contraindications to HVLA?
*Osteoporosis
*Osteomyelitis
*Fracture
*RA
*Down's syndrome
*If the pt experiences neurological symptoms when setting pt up for tx
*if pt refuses tx
*metastatic bone cancer
What are the 5 major axes of psychiatric diagnosis?
I: Clinical disorders
II: Personality disorders and Mental Retardation
III: Physical conditions adn disorders (General medical conditions)
IV: Psychosocial and env. problems
V: Global assessment of Functioning (GAF)
What is mild mental retardation? Describe it.
70-50 IQ:
*Self-supporting w/some guidance
*85% of retarded persons
*2x as many are male
*Usually diag. in 1st yr of school
What is moderate mental retardation? Describe it.
49 - 35 IQ
* 'Trainable'
*Benefit from vocational training, but need supervision
*Sheltered workshops
What is severe mental retardation? Describe it.
34 - 20 IQ
*Training not helpful
*Can learn to communicate
*Basic habits
What is profund mental retardation? Describe it.
Below 20 IQ
*Need highly structured environment, constant nursing care supervision
When is autism usually diagnosed? What gender is M/C?
Usually diagnosed at age 2

M:F ratio - 4:1
What is the usual IQ of autistic individuals?
80% have IQs below 70
What are some clinical signs of Autism?
* problems w/reciprocal social interactions
* abnormal/delayed language dev., impaired verbal and nonverbal communication
*No separation anxiety
*Oblivious to external world
*Fails to assume anticipatory posture, shrinks from touch
*Preference for inanimate objects
*Stereotyped behavior; decreased repertoire of activities and interests
What gender more commonly has ADHD?
M:F ratio - 10:1
What are the clinical signs of ADHD?
Difficulty sustaining attention; Hyperactivity; Impulsivity
How is ADHD treated?
Behavior therapy
Drugs: Methylphenidate, dextroamphetamine, atomoxetine
What is the typical onset age of Schizophrenia?
Males: 15-24y/o
Females: 25 - 34y/o
What is the prevalence of schizophrenia?
1% of population cross-culturally; More often in low social economic status
How often do pts with schizophrenia attempt suicide? Succed?
50% of pts attempt suicide; 10% succeed
What is the hypothesized cause of schizophrenia?
"Dopamine hypothesis of schizopohrenia"

*Symptoms arise b/c of an excess of dopamine activity in teh CNS (mesolimbic/mesocortical pathways)
What are the subtypes of schizophrenia?
5: Paranoid, catatonic, disorganized, undifferentiated, and residual
How is Neuroleptic malignant syndrome caused by antipsychotic drugs treated?
Dantrolene and dopamine agonists
What antipsychotic drug can cause agranulocytosis?
Clozapine
Describe obsessions and compulsions (associated with OCD).
Obsessions - focusing on one thought, usually to avoid another

Compulsion - repetitive action shields person from thoughts, action 'fixes' bad thought
What region of the brain is involved in OCD?
There is increased frontal lobe metabolism and increased activity in the caudate nucleus
What is the tx for OCD?
Fluoxetine, fluvoxamine, or other SSRI, clomipramine
Describe panic disorder.
3 attacks in a 3-week period with no clear circumscribed stimulus; abrupt onset of symptoms that peak w/in 10 minutes
What are the clinical signs of panic disorder?
*Great apprehension and fear
*Palpitations, trembling, sweat
*Fear of dying or going crazy
*Hyperventilation, 'air hunger'
*Sense of unreality
How are panic disorders treated?
alprazolam, clonazepam, imipramine
What gender more commonly experiences eating disorders?
Females - for both AN and BN
What does a pt with anorexia nervosa typically weigh? Bulimia nervosa?
AN: >15% ideal body weight loss

BN: varies, usually normal or > normal
What NT are involved in AN and BN?
possibly Serotonin and Norepinephrine
What are possible medical complications of anorexia nervosa?
Amenorrhea, lanugo, high mortality, dental cavities, electrolyte imbalances, cardiac abnormalities
What are the possible medical complications of bulimia nervosa?
Dental cavities, calluses on hands/fingers, enlarged parotid glands, electrolyte imbalances, cardiac abnormalities.
What is agoraphobia?
Fear of open spaces wiht a sense of helplessness or humiliation
What is generalized anxiety disorder? Symptoms?
Symptoms exhibited more days than not for longer than a 6-month period;
*Motor tension
*Autonomic hyperactivity
*Apprehension
*Vigilance and scanning
*Fatigue and sleep disturbances common, esp. insomnia and restlessness
What are specific phobias? Symptoms?
Fear of specific objects - spiders, snakes, etc.;

Anxiety when faced w/ID object, phobic object avoided, persistent and disabling fear
What is the MOA of benzodiazepines?
They bind GABA-A receptors and increase frequency of Cl ion channel opening
At birth, what normally happens to the ductus arteriosis?
It closes w/in a few hours via smooth muscle contraction to form the ligamentum arteriosum.
What can be used to sustain the patency of teh ductus arteriosus?
Prostaglandin E and intrauterine or neonatal asphyxia
What can be used to promote closure of the patent ductus arteriosus?
Prostaglandin inhibitors (indomethacin), acetylcholine, histamine, and catecholamines
What does the superior mediastinum contain?
Superior to the sternal angle - Thymic remnants, SVC and its brachiocephalic tributaries, arotic arch and its branches, trachea, esophagus, thoracic duct, and the vagus and phrenic nerves
What is the inferior mediasinum divided into?
Anterior, middle and posterior mediastina
What is the landmark dividing the superior and inferior mediastina?
The sternal angle
What does the anterior mediasinum contain?
Anterior to the heart - contains remnants of the thymus.
What does the middle mediastinum contain?
The heart and great vessels
What does the posterior mediastinum contain?
thoracic aorta, esophagus, thoracic duct, azygos veins, and the vagus nerve.
Where do structures pass through the diaphragm?
Inferior Vena Cava - T8
Esophagus - T10
Aorta - T12
What two arteries supply the heart? Branches of...?
Right and left coronary arteries - branches of the aorta
What does the right coronary artery supply?
The right atrium, right ventricle, sinoatrial and atrioventricular nodes, and parts of teh left atrium and left ventricle.
What is the distal branch of teh right coronary artery?
In 70% of subjects = Posterior interventricular artery
What does the left coronary artery supply?
most of the left ventricle, left atrium and the anterior part of the interventricular septum.
What are the two main branches off the left coronary artery?
Anterior interventricular artery (LAD) and the circumflex artery
Where do most MI's occur? Next M/C? Next?
50% occur in the LAD;
30% in the right coronary artery;
20% in the circumflex artery
What is the trabeculae carneae?
The ridges of myocardium in the ventricular wall
What are the papillary muscles?
These project into the cavity of the ventricle and attach to the cusps of the AV valve by the strands of the chordae tendineae.
What is the infundibulum?
The smooth area of the right ventricle leading to the pulmonary valve.
What forms the anterior surface of the heart?
The right ventricle
What forms the posterior surface of the heart?
Left atrium
What forms the diaphragmatic surface of the heart?
The left ventricle
What are the common systolic valvular defects?
Mitral insufficiency and aortic stenosis
What should be open and closed during ventricular systole?
Aortic and pulmonic valves should be open; mitral and tricuspid should be closed.
What should be open and closed during ventricular diastole?
Tricuspid and mitral should be open; aortic and pulmonic should be closed.
What are the common diastolic valvular defects?
Mitral stenosis and aortic insufficiency
What forms the right border of the heart?
The right atrium
What forms the left border of the heart?
Left ventricle
What forms the base of the heart?
The two atria
What forms the apex of the heart?
The left ventricle
Describe the conduction system of the heart.
Sinoatrial node initiates impulse --> Atrioventricular node receives impulse --> transmits impulse to the ventriles through the bundle of His --> Divides into R and L bundle branches and Purkinje fibers to the two ventricles
What innervation increases the HR?
Sympathetic innervation from the T1-T5 spinal cord segments
What innervation decreases the HR?
Parasympathetics by way of the Vagus nerve
What occurs in phase 4 of the ventricles/atria action potential?
Resting potential:
*high gK via iK1 channels
What occurs in phase 1 of the ventricles/atria action potential?
Upstroke:
*increased gNa via typical fast Na channels
*decreased gK as iK1 channels close
What occurs in phase 2 of the ventricles/atria action potential?
Plateau:
*increased gCa via slow (L-type) channels
*at end of phase see increased gK via iK channels
What occurs in phase 3 of the ventricles/atria action potential?
Repolarization:
*Decreased gCa as L-type channels close
*increased gK via iK; then iK1 opens
At what period of the cardiac action potential is the heart most susceptible to arrhythmia?
During the relative refractory period
What is the normal length of the PR interval? What occurs during this time?
0.12-0.20 seconds; measures AV conduction time
What is the normal length of the QRS complex? What occurs during this time?
<0.12 seconds; Measures ventricular conduction time
What is the normal length of the QT interval? What occurs during this time?
0.35 - 0.45 seconds; total time of ventricular depolarization and repolarization (varies with heart rate and age)
What is the normal resting heart rate?
60-100 beats/min
What is bradycardia? Tachycardia?
Bradicarcia: <60 beats/min

Tachycardia: >100 beats/min
What are the standard limb leads on an EKG?
I, II, III:

I: - R arm; + L arm
II: - R arm; + L leg
III: - L arm; + L leg
What are the augmented limb leads?
aVR, aVL, aVF
What are the precordial leads?
V1-V6
What occurs at the beginning of the P wave (in the heart)?
Sinoatrial node depolarizes - primary pacemaker
What occurs during the P wave (in the heart)?
Conduction of depolarization through atrial muscle
What occurs between the P wave and the QRS complex (PR interval)?
Conduction through the atrioventricular node
What occurs at the beginning of the QRS complex?
Conduction through His-Purkinje system and ventricular septum
What occurs during the QRS complex?
Ventricular depolarization apex to base; septum to lateral wall; endocardial to epicardial
What occurs during the ST segment?
Ventricles are int eh plateau phase of depolarization
What occurs during the T wave?
Repolarization of ventricles in reverse sequence
What occurs in a first degree AV conduction block?
PR interval increases (>0.20 seconds); 1:1 correspondence; P wave:R wave
What occurs in a second degree AV conduction block, Mobitz I (wenckebach)?
Progressively increase PR interval; then dropped (missing) QRS and then repeat of sequence
What occurs in a second degree AV conduction block, Mobitz II?
Regular but prolonged PR interval; unexpected dropped QRS; may be a regular pattern, such as e:1 = 2 P waves: 1 QRS complex or 3:1, etc.
What occurs in Third degree AV conduction block?
Complete block:
No correlation of P waves and QRS complexes; usually high atrial rate and lower ventricular rate
What occurs in premature ventricular contraction (PVC)?
Large, wide QRS complex originates in ectopic focus of irritability in ventricle
What may PVC's indicate?
Premature ventricular contraction - may indicate hypoxia
What occurs in Ventricular tachycardia?
Repeated large, wide QRS complexes like PVCs; rate 150 - 250/min; acts like prolonged sequence of PVCs
What occurs in ventricular fibrillation?
Total loss of rhythmic contraction; totally erratic shape
What changes will be seen in an acute MI?
ST segment elevation/depression; inverted T waves; prominent Q waves
What will be seen in a resolving infarction (weeks to months later)?
Inverted T waves and prominent Q waves
What will be seen in an old (stable) MI (months to years later)?
Prominent Q waves as result of MI persist for rest of life
What can maternal rubella cause in the fetal heart?
Exposure at 5-10th week can lead to PDA, ASDs and VSDs
What can Fetal alcohol syndrome cause to the heart?
CV defects, including VSD
What are examples of Left-to-Right shunts?
VSD, ASD, complete endocardial cushion defect, sinus venosus, patent foramen ovale, PDA
What are examples of R-to-L shunts?
Tetralogy of Fallot, Transposition of the great vessels; perisstent truncus arteriosus
What will eventually happen in a Left-to-right shunt?
Eisenmenger syndrome - reversal of shunt flow with late onset cyanosis
What occurs with a VSD (location)? What is a VSD often associated with?
Usually in the membranous interventricular septum; often associated with Trisomy 21
What occurs in complete endocardial cushion defect? Typically seen in...?
Combination of ASD, VSD, and a common atrioventricular valve; common in Down's syndrome pt.
What is the big risk with patent foramen ovales?
paradoxical emboli
What is the most common cyanotic congenital heart disease in older children and adults?
Tetralogy of Fallot
What is tetralogy of Fallot commonly associated with?
Trisomy 21
What occurs in Tetralogy of Fallot?
1) VSD
2) overriding aorta that receives blood from both ventricles
3) R ventricular hypertrophy
4) Pulmonic stenosis (right ventricular outflow obstruction)
What causes transposition of the great vessels?
Failure of the truncoconal septum to spiral
What must occur in order for Transposition of the great vessels to not be fatal?
There must also be a shunt (PDA, VSD, ASD, patent foramen ovale) to mix the venous and systemic blood