Anatomy

L

L

ventricle which then pumps blood through the

d) aortic semi-lunar valve then the blood passes into the

e) aorta (systemic artery)

3) to control the A-V valves during contraction, there are

a) chordae tendonae

b) papillary muscles

4. Electrical Conduction Through the Heart

a. Depolarization b. structures

Polarized (resting state)

Depolarized (action state)

c. ECG - normal

CLASSICAL EKG PATTERN DEVELOPMENT

+

S wave

D. Vascular System (conduit)

1. histology of arteries, arterioles, capillaries, and veins

a. possible vessel tissue layers (tunics)

1) adventitia (external) protective;

2) media (middle) thickest layer, smooth muscle, nerves

3) intima (inner) endothelium selectively permeable

b. vessel types

E. Blood flow: structures

F. systemic vs. pulmonary vasculature

1. pulmonary

a. high compliance

b. low volume

c. low pressure

d. when exposed to low lung O2 conditions,

arterioles & precapillary sphincters

contract (constrict)

2. systemic

a. low compliance

b. high volume

c. high pressure

d. when exposed to low lung O2 conditions, arterioles & precapillary sphincters relax (dilate)

G. Autonomic Nervous System Effects of the Cardiovascular System

stimulation	heart rate	contraction strength	CO	vasomotor tone	BP
sympathetic	(	(	(	(	(
parasympathetic					

H. Myocardial perfusion

1. blood supplied to mycardial tissue by the coronary arteries

2. opening to coronary arteries is near base of aortic valve

and, by this valve, gets partially blocked during systole

3.  myocardial perfusion occurs primarily during diastole

4. deoxygenated blood flows out of the myocardial tissue to

a. coronary sinus in right atrium then to lungs (normal)

b. thebesian veins then in to left ventricle which mixes deoxygenated blood with already oxygenated blood from the lungs (anatomic shunt)

I. Elements of Arterial Blood Pressure (BP)

1. normal systolic values are 120 mmHg or 120 or 120/80

diastolic 80 mmHg 80

2. Total BP = static BP + dynamic BP

a. static BP is due to:

1) total blood volume

2) vasomotor tone

b. dynamic BP is due to:

1) cardiac output

2) vascular resistance

3. Total BP = static BP + dynamic BP

Total BP = (fluid volume x container stretchiness) + (flow rate x resistance)

Total BP = (total blood volume x vasomotor tone) + (C.O. x vascular resistance)

Total BP = (total blood volume x venomotor tone) + (C.O. x SVR)

4. abnormal blood pressure conditions

a. hypertension: BP > 140/90

b. hypotension: BP < 95/60

5. abnormal blood volume conditions

a. low blood volume is hypovolemia

b. high blood volume is hypervolemia

6. NOTE: C.O.  HR  BP  HR

a. normal HR range = 60 to 100 B/min

b. bradycardia if HR < 60 B/min

c. tachycardia if HR > 100 B/min

CARDIOPULMONARY ANATOMY

Pulmonary Anatomy - Upper Airways

1.1.1 Identify the main structures that comprise the upper airways.

1.1.2 Locate and state the purpose for the following components of the nose: nares, nasal septum, choana, vibrissae, vestibule, turbinates, olfactory area, mucus.

1.1.3 Locate and state the purpose for the following components of pharynx: nasopharynx, oropharynx and laryngopharynx.

1.1.4 Locate and state the functions of the larynx.

1.1.5 Locate and state the function of the following components of the larynx: glottis, cartilages (thyroid & cricoid) vocal cords, mucosa, and epiglottis.

1.1.6 List the functions of the upper airways.

Pulmonary Anatomy - Lower Airways

1.2.1 Name the major components and function of the lower airways.

1.2.2 Define "central" airways and tracheobronchial tree.

1.2.3 State the dimension, histology, and components of the trachea.

1.2.4 Name, locate, and state the function of the structures in the tracheobronchial tree beginning with the trachea and ending with the terminal bronchioles.

1.2.5 State the difference between bronchi and bronchioles.

1.2.7 Differentiate between goblet cells and mucous glands; "mucus" and "mucous".

1.2.8 Explain the functions of the mucocilliary escalator

1.2.9 State the three functions and characteristics of the mucous blanket.

1.2.10 Identify the mucus production sites and response to irritation.

1.2.11 State the average mucus production per day for the healthy adult.

1.2.12 Name the components of mucus.

1.2.13 State the relationship between proper hydration and mucus viscosity.

1.2.14 Differentiate the role and location of the gel and sol layers of mucus.

1.2.15 Explain the function of and describe cilia movement through the mucous blanket.

1.2.16 Name the components of sputum.

1.2.17 Locate the airways at which cartilage, goblet cells, cilia, and mucus are no longer present.

Objective for possible essay question:

1.2.18 List, in order, all lower airway components from trachea through alveolar ducts.

Pulmonary Anatomy - Lung parenchyma

1.3.1 Define lung parenchyma.

1.3.2 Give alternate names, locate, and state the function of the components of a "primary lobule."

1.3.3 State the relative amount of gas exchange that takes place in the alveolar sacs and that which takes place prior to the sacs.

1.3.4 Differentiate the function and appearance of Type I, Type II, and Type III alveolar cells.

1.3.5 Describe the components of the alveolar-capillary membrane.

1.3.6 State how tissue oxygen requirements are met in the tracheobronchial tree and respiratory units.

1.3.7 Locate and name the constituents of the lung interstitium (or interstitial space).

1.3.8 State the general function of the lymphatic system in the lung.

1.3.9 State the origin and function of alveolar fluid lining.

1.3.10 State the function and production site of surfactant.

1.3.11 Identify the properties of surfactant.

1.3.12 Name the major functions of the lung parenchyma.

1.3.13 Distinguish "bronchial" from "bronchiole"

1.3.14 Differentiate the function of pulmonary and bronchial arteries.

Thoracic Anatomy

1.4.1 Given an illustration of the lung, locate right and left sides, apex and base.

1.4.2 Given an illustration of the bony thorax, mark the level at which the lung apex can be found.

1.4.3 Differentiate the right and left lungs as to size and number of lobes.

1.4.4 Name and locate the fissures in the right and left lungs.

1.4.5 Define and locate the hilum.

1.4.6 Define and locate the mediastinum.

1.4.7 Name the structures which are contained in the mediastinum.

1.4.8 Describe the effect which trapped blood or air in the mediastinum has on the cardiopulmonary system.

1.4.9 Locate, describe, and explain the function of the parietal and visceral pleurae in the thoracic cavity.

1.4.10 Describe what is found in the pleural space and explain how this allows for movement during inspiration and expiration.

1.4.11 Describe the effect that air or extra fluid (blood, etc.) in the pleural space will have on pulmonary function.

1.4.12 Name the three major components of the bony thorax.

1.4.13 Locate the following components of the sternum: manubrium, body, xiphoid process, sternal angle (angle of Louis), suprasternal notch.

1.4.14 Name the rib which attaches to the manubriosternal articulation (Angle of Louis).

1.4.15 Differentiate between and locate the following: true ribs, false ribs, and floating ribs.

1.4.16 State the number of thoracic vertebrae

1.4.17 Cite the A-P CXR vertebral levels for normal carina and lower lung borders at FRC and TLC.

1.4.18 Name, locate, and state the innervation for the primary muscles of respiration.

1.4.19 Explain how each muscle from the objective above changes intrathoracic gas volumes.

1.4.20 Name and locate the accessory muscles for inspiration and expiration.

1.4.21 Explain how each accessory muscle from the objective above changes intrathoracic gas volumes.

Cardiovascular Anatomy

1.5.1 Name the structures associated with the terms content, cor, and conduit.

1.5.2 List the major functions of the blood.

1.5.3 Name the major formed elements of the blood and describe each cell's major functions.

1.5.4 List and briefly explain the functions of the liquid portion of the blood.

1.5.5 Differentiate between serum and plasma.

Objectives for possible essay questions (in bold):

1.5.6 Name and locate the heart chambers, valves, and muscle layers.

1.5.7 Trace the blood flow through the cardiopulmonary system from the vena cava to the aorta. Name, in writing, the major anatomical structures through which it passes.

1.5.8 List, in writing, the correct sequence of electrical events (depolarization & repolarization) and mechanical events (contraction & relaxations) and structures involved in a normal cardiac contractile cycle.

1.5.9 Identify a P wave, QRS complex, and T wave on a normal electrocardiogram and relate them, in writing, to mechanical events of the heart.

1.5.10 State the electrical event (atrial depolarization, etc.) of the items in 1.5.9.

1.5.11 Describe where the myocardium receives its blood flow, how diastolic blood pressure affects myocardial blood flow, and identify where cardiac veins return their contents.

1.5.12 Differentiate sympathetic vs. parasympathetic effects on heart rate and strength of myocardial contraction.

1.5.13 Identify the basic function of arteries, arterioles, capillaries, venules, and veins.

1.5.14 Differentiate sympathetic vs. parasympathetic effects on systemic vascular tone.

1.5.15 List the major differences between the pulmonary and systemic vascular systems.

1.5.16 Define blood pressure, systolic, and diastolic.

1.5.17 Name the 2 static components of blood pressure.

1.5.18 Name the 2 dynamic components of blood pressure.

1.5.19 Define the following terms: hypotension, hypertension, hypovolemia, and hypervolemia.

TEST TAKING TIPS AND TECHNIQUES

STUDY & PREPARATION

1. DO ALL the OBJECTIVES.

2. Do the objectives as you cover the material, DON'T WAIT until the end of the unit.

3. Get your PREPARATION of study materials done at least 2 days before the exam.

4. Spend the last 2-3 days before an exam REVIEWING your study materials (NOT preparing them).

5. Get a study group together.

6. If you are having problems getting good grades, do not study in a group where EVERYBODY else is having THE SAME PROBLEMS.

7. If you get into a study group, as one of the exercises practice asking each other questions that require:

a. a lot of THINKING to produce (not just "recall" of facts questions)

b. a lot of THINKING to answer (THINKING questions make up about 60-80% of the NBRC CRT exam and 80-90% of the RRT written exam)

**** THIS IS A VEEERY HELPFUL STUDY TECHNIQUE ****

8. Come to the exam:

a. rested,

b. moderately fed (don't forget your corn flakes but don't eat the corn field),

c. with an empty bladder

d. with all your required gear

1) #2 pencils, sharpened

2) erasers

3) Scan-Tron answer sheets

4) calculator

5) watch

6) straight edge/metric ruler

TAKING MACHINE SCORED TESTS

(i.e. Scan-Tron type)

Students this was quoted to one of my former instructors, and then to me!:

“Dear People,

As a representative of ETS (Educational Testing Services), the agency which does the scoring of NBRC exams, please let me inform you that questions which are scribbled, too lightly answered, doodled on, answered in the margin but not on the answer sheet, etcetera, etcetera will become WRONG answers. Period.

Since taking the TMCE and the RRT clinical simulation exam will cost you several hundred dollars, you may want to optimize your chances of not having to pay for re-takes by following these suggestions: (or else!!)

1. Use a #2 soft lead pencil (not a #2H, or a 2.5, just a plain #2)

2. Carefully mark your answer with a solid black mark inside the proper box (not outside or somewhere near the box)

3. Never doodle on your answer sheet, don't draw in the margins, don't write notes to yourself on your answer sheet. Just don't!!!

4. Do not spindle, fold, tear, or otherwise mutilate your answer sheet or else we'll spindle, fold, tear, and mutilate your score!!!!”

TAKING THE TEST

While taking the NBRC type exams (4 or 5 option, multiple and multiple-multiple choice items) the following techniques may help improve your test scores.

1. Analyze complex questions. Ask yourself questions, and record your answers, about the CONDITIONS of a question

a. underline key words

b. clarify the question by:

1) re-writing confusing statements

2) rewording confusing terms ("increased compliance" to "easier to stretch)

c. highlight words of extremes (all, always, none, never)

d. highlight words which indicate a "direction" (increase, decrease, improve, deteriorate, positive, negative, etcetera)

2. Do NOT add unstated information to a question.

3. Always protect the safety of a patient.

4. Consider if "cause & effect" are involved in the question/answer and don't reverse them.

5. On multiple-multiples, a WRONGO is a statement option which you are quite, as in very, sure is a gotcha! When processing (processing is such a neat word) a multiple-multiple choice question:

a. look for WRONGOs in the statement options

b. if you find a WRONGO, immediately eliminate all answer options containing this booger

c. don't look up until all WRONGOs have been dealt with

6. When doing a question about equipment or chest mechanics, a picture is worth a thousand guesses. So draw a diagram already! It will help you visualize the problem (unless you use invisible ink).

7. Sometimes you can, by process of elimination, narrow your choices down to:

a. one that is a close answer, but you really think is wrong

b. one that you don't have the foggiest idea about its' correlation to the correct answer or the question, which is why it wasn't eliminated in the first place.

Go for the fog every time, not the WRONG ANSWER.

8. Process of elimination, ALWAYS. Do this in a written fashion. Use the following marks beside options:

a. Y for yes

b. N for no

c. ? for huh?

The marks will make it easier to keep track of your decision/answering making process. Place the mark just to the right of the letter for that option (NOT someplace out in the margins of the test).

9. Circle the letter of the correct answer ON THE TEST. Do not put any other marks anywhere near, approximate to, somewhere around any of the other option letters. Little marks next to option letters do a neat trick, they turn into circles and jump onto wrong option letters when you do your final transposing of answers onto the Scan-Tron sheet. Neat, but deadly!!!

10. Carefully check that multiple-multiple choice statement options that you chose match the statement options listed in your answer.

33. This is a sample question.

I. Wrong

II. Right

III. Right

IV. Wrong

V. Right

A. I, III, IV

B. I, III, V

C. II, III, IV

D. II, III, V

E. III, IV, V

11. Check that your circled answers match the Scan-Tron answers

TEST TAKING TIPS & TECHNIQUES

*** CLARIFY QUESTIONS ***

1. Underline key words, words which indicate direction (increase, decrease, etc.), and words of extremes (always, never, etc.).

2. Draw pictures/diagrams to visualize equipment/chest function.

3. Re-write confusing statements.

4. Re-word confusing terms.

5. Do NOT add unstated info to a question.

*** PROCESS OF ELIMINATION ***

1. Always use process of elimination. Mark the options: Y for yes, N for no, ? for huh?

2. Eliminate M-MC answer options containing wrong statement options.

*** MISCELLANEOUS ***

1. Never leave a question unanswered.

2. Choose an uncertain option over one that is wrong.

3. Be sure "cause & effect" conditions are appropriate.

4. For math problems, always √ the units, √ decimal points, and SHOW YOUR WORK!

5. Always protect patient safety.

*** MECHANICS OF ANSWERING ***

1. Check that M-MC correct options are in your answer selection.

2. Circle the letter of the answer on your test, transfer to the Scan-Tron sheet later.

3. Check that your circled answers match the Scan-Tron answers.

LABELLING PRACTICE DIAGRAMS

T wave

R wave

P wave

1) arteries (large to small)

thick muscle layer

conduction vessels

some control of blood distribution

2) arterioles

resistance vessels

help control

BP

� EMBED Equation.2 ���distribution

4) veins

thin media layer ( muscle)�stretches easily (( compliance)�capacitance vessels �contains 70% of blood volume

3) capillaries

NO muscle

single cell layer

exchange vessels