Block 2 Flashcards
fundamental purpose of the cardiorespiratory system
to deliver O2 and nutrients to cells and to remove CO2 and other metabolic products from them.
switch from aerobic to anaerobic metabolism
Pasteur effect
The adaptations to hypoxia are mediated, in part, by the upregulation of genes encoding a variety of proteins, including
- glycolytic enzymes, such as phosphoglycerate kinase and phosphofructokinase
- glucose transporters Glut-1 and Glut-2
- growth factors, such as vascular endothelial growth factor (VEGF) and erythropoietin, which enhance erythrocyte production.
The hypoxia-induced increase in expression of these key proteins is governed by this hypoxiasensitive transcription factor?
hypoxia-inducible factor-1 (HIF-1).
During hypoxia, systemic arterioles
During hypoxia, systemic arterioles dilate, at least in part, by opening of K-ATP channels in vascular smooth-muscle cells due to the hypoxia-induced reduction in ATP concentration.
What happens in pulmonary vascular smooth-muscle cells during hypoxia?
By contrast, in pulmonary vascular smooth-muscle cells, inhibition of K+ channels causes depolarization which, in turn, activates voltage-gated Ca2+ channels raising the cytosolic [Ca2+] and causing smooth-muscle cell contraction.
Hypoxia-induced pulmonary arterial constriction shunts blood away from poorly ventilated portions toward better ventilated portions of the lung; however, it also increases pulmonary vascular resistance and right ventricular afterload.
Acute hypoxia causes
impaired judgment, motor incoordination, and a clinical picture resembling acute alcohol intoxication.
High-altitude illness is characterized
by
headache secondary to cerebral vasodilation, gastrointestinal symptoms,
dizziness, insomnia, fatigue, or somnolence.
Pulmonary arterial and sometimes venous constriction causes
capillary leakage and high-altitude pulmonary edema (HAPE), which intensifies hypoxia, further promoting vasoconstriction. Rarely, high-altitude cerebral edema (HACE) develops, which is manifest by severe headache
and papilledema and can cause coma. As hypoxia becomes more severe, the regulatory centers of the brainstem are affected, and death usually results from respiratory failure.
When hypoxia occurs from respiratory
failure, Pao2 ?
declines
when respiratory failure is persistent, the
hemoglobin-oxygen (Hb-O2) dissociation curve?
is displaced to the right, with greater quantities of O2 released at any level of tissue Po2.
TRUE OR FALSE:
Arterial hypoxemia, that is, a reduction of O2 saturation of arterial blood (Sao2), and consequent cyanosis are likely to be more marked when such depression of Pao2 results from pulmonary disease than when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2).
TRUE
What happens when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2)?
In this latter situation, Paco2 falls secondary to anoxia induced hyperventilation and the Hb-O2 dissociation curve is displaced to the left, limiting the decline in Sao2 at any level of Pao2.
The most common cause of respiratory hypoxia is ?
ventilation-perfusion mismatch resulting from perfusion of poorly ventilated alveoli.
Respiratory hypoxemia may also be caused by hypoventilation, in which
case it is associated with ?
an elevation of Paco2
A third cause of respiratory hypoxia is shunting of blood across the lung from the pulmonary arterial to the venous bed (intrapulmonary right-to-left shunting) by perfusion of nonventilated portions of the lung, as in?
pulmonary atelectasis or through pulmonary arteriovenous connections.
The low Pao2 in intrapulmonary right-to-left shunting is corrected by?
The low Pao2 in this situation is only partially corrected by an Fio2 of 100%.
ventilation-perfusion mismatch & hypoventilation can be corrected by?
These two forms of respiratory hypoxia are usually correctable by inspiring 100%
O2 for several minutes.
From a physiologic viewpoint, this cause of hypoxia resembles intrapulmonary right-to-left shunting but is caused by congenital cardiac malformations, such as?
- tetralogy of Fallot
- transposition of the great arteries
- Eisenmenger’s syndrome
Pao2 in anemic hypoxia
normal
the presence of COHb shifts the Hb-O2 dissociation curve to the ?
left
This pathophysiology
leads to an increased arterial-mixed venous O2 difference
(a-v-O2 difference), or gradient.
circulatory hypoxia
Generalized circulatory hypoxia occurs
in ?
heart failure and in most forms of shock
clinical
picture of patients with hypoxia due to an elevated metabolic rate, as
in fever or thyrotoxicosis,
the skin is warm and flushed owing to increased cutaneous
blood flow that dissipates the excessive heat produced, and cyanosis is
usually absent.
Cyanide and several
other similarly acting poisons cause cellular hypoxia. The tissues are
unable to use O2, and, as a consequence, the venous blood tends to have
a high O2 tension. This condition has been termed?
histotoxic hypoxia.
refers to a bluish color of the skin and mucous membranes
resulting from an increased quantity of reduced hemoglobin (i.e., deoxygenated
hemoglobin) or of hemoglobin derivatives (e.g., methemoglobin
or sulfhemoglobin) in the small blood vessels of those tissues.
Cyanosis
Cyanosis is usually most marked in the ?
lips, nail beds, ears, and malar eminences.
A cherry-colored flush, rather than cyanosis,
is caused by ?
COHb
In some instances, central cyanosis can be detected reliably when the
Sao2 has fallen to _____%; in others, particularly in dark-skinned persons,
it may not be detected until it has declined to _____%.
85%
75%.
In general, cyanosis becomes apparent when
the concentration of reduced hemoglobin in capillary blood exceeds?
40 g/L (4 g/dL).
the higher the total hemoglobin content, the (greater or lower) the tendency toward cyanosis?
greater
the Sao2 is reduced or an abnormal hemoglobin derivative
is present, and the mucous membranes and skin are both affected.
central cyanosis
is due to a slowing of blood flow and abnormally
great extraction of O2 from normally saturated arterial blood; it results
from vasoconstriction and diminished peripheral blood flow, such
as occurs in cold exposure, shock, congestive failure, and peripheral
vascular disease.
Peripheral cyanosis
Often in these conditions, the mucous membranes of
the oral cavity or those beneath the tongue may be spared.
Peripheral cyanosis
Decreased Sao2 results from a
marked reduction in the Pao2.
Central Cyanosis
Which of the ff is are correct A. Increase in intravascular colloid osmotic pressure causes absorption B. Decrease in intravascular hydrostatic pressure cause filtration C. Increase in extravascular colloid osmotic pressure causes edema D. A and C
D. A and C
Which of the ff does not cause Edema? A. RAAS B. Natriuretic peptide C. ADH D. Endothelin-1
B. Natriuretic peptide
RAAS, Na and water retention and K excretion is the effect of what hormone A. Angiotensin I B. Angiotensin II C. Aldosterone D. Renin
C. Aldosterone
ACE is an enzyme mainly produced by the
lungs. What is the function of this enzyme?
A. Converts angiotensinogen to angiotensin I
B. Converts angiotensin I to angiotensin II
C. inactivates bradykinin
D. B and C
B. Converts angiotensin I to angiotensin II
Vasopressin/ADH promotes water retention in which of the ff tubules? a. Collecting Tublules b. Proximal c. Distal d. A & C
d. A & C
60y.o male with chief complaint of eyelid
swelling at the morning. Px had a history of
type1 Diabetes Mellitus and Hypertension.
Physical Exam revealed bipedal pitting edema.
Urinalysis revealed 3+ proteins. What is the
cause of edema?
A. Heart failure
B. Nephrotic syndrome
C. Liver cirrhosis
D. Poor protein intake
B. Nephrotic syndrome
S2 is closure of what valve A. Mitral B. Tricuspid C. Semilunar D. A and B
C. Semilunar
Loud with palpable thrill -
Grade 4
10% of the causes of palpitations are due to? a. Cardiac B. Psychiatric C. Miscellaneous D. Unknown
C. Miscellaneous
CD, a 48 year old female, experienced palpitations of greater than 15 minutes A. Cardiac B. Psychiatric C. Miscellaneous D. Unknown
B. Psychiatric
The following are cardiovascular disease that causes dyspnea expect: a. Coronary artery disease b. Restrictive pericarditis c. Pulmonary hypertension d. Cardiomyopathy
a. Coronary artery disease
Type 2 Dypnea
Answer:
walk slowly with same age on level ground
DOB occurring at night is common to what condition? A. Orthopnea B. Asthma C. MI D. Interstitial lung disease
A. Orthopnea
Which of the following order is correct in the examination of the respiratory system? A. IPPA (palpation, percussion) B. IPPA (percussion, palpation) C. IAPP (palpation, percussion) D. IAPP (percussion, palpation)
D. IAPP (percussion, palpation)
High JVP suggests
Answer: Elevated Right Atrial Pressure.
Orthopnea is relieved by:
a. Elevation of both feet
b. Use of bronchidilators
c. Sit upright
d. All of the above
c. Sit upright
Expiratory muscles contract generating
positive intrathoracic pressure as high as
Answer: 300mmHg
Arnold’s nerve is a branch of what cranial
nerve?
Answer: Vagus
Most common origin of hemoptysis?
Answer: Bronchi
Most common cause of hemoptysis
worldwide
Answer: Bronchiectasis
Classic description of hemoptysis of vascular origin A. Blood-tinged B. Massive C. Cherry red D. Pink and frothy
D. Pink and frothy
What is the amount of blood expectorated at one time that is considered massive hemoptysis? A. 500 mL B. 150-200 mL C. 400 mL D. 100-150 mL
D. 100-150 mL
All patients with massive hemoptysis shoud be tested by: A. Chest x-ray B. Culture C. CT scan D. AFB
C. CT scan
During massive hemoptysis, the following should be done except: a. Protect the non-bleeding lung b. Intubate the patient c. Locate the site of bleeding d. Correct the bleeding
d. Correct the bleeding
Preferred treatment for massive hemoptysis: A. Bronchial arterial embolization B. Surgical resection of vessel C. Angiography D. Lobectomy
A. Bronchial arterial embolization
All true about vestibular vertigo except
A. May be paroxysmal or due to fixed unilateral
or bilateral vestibular deficit
B.Vertigo or Imbalance
C. Peripheral disorders that affect the labyrinth
or vestibular D nerves
D. Anterior Unilateral Lesion that causes
imbalance and instability of vision
D. Anterior Unilateral Lesion that causes
imbalance and instability of vision
Assessment of eye, ability to fixate two phases clearly. A. Pursuit B. Oacillopia C. Saccade D. Visual acuity
C. Saccade
Patient presents with maculopapular rash starting from hair line towards down. Palatal petichia was seen. Upon PE post auricular adenopathy. A. B. Rubella C. Rubeola D. Exanthem subitum
B. Rubella
PGE2 has 4 receptor but only _ is important for fever. A. E3 B. E2 C. E4 D. E1
A. E3
What occurs when hypothalamic setpoint is reset downward?
B. Heat loss through vasodilation and
sweating
Situational: patient has breathlessness when walking in her own pace and level ground stop to rest-
Grade 2
Causes of impaired cough except
a. Inc in respiratory muscle contraction
True of Central cyanosis A. Slow blood B. Great oxygen extraction C. Exposure to cold air/h20 D. Abnormal hgb derivatives
D. Abnormal hgb derivatives
Cause of edema in patient with nephrotic
disease.
decrease colloid oncotic pressure
due to loss of protein in urine
True of GI bleeding
A. Melena may indicate that blood in gi bleeding
is <14hrs
B.
C. Hemoptysis is indicative of upper gi bleeding
D. Hematochezia…
*Melena indicates blood has been present in the GI tract for at least 14 hrs and as long as 3 to 5 days.
*The more proximal the bleeding site, the
more likely the melena will occur
*Hematochezia usually presents a lower GI source of bleeding
*Hematemesis indicates an upper GI source of bleeding
PE for abdominal swelling, except
a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node
b. Spider angiomas, palmar erythema, caput
medusae, gynecomastia
c. elevated jvp
d. pericardial knock in heart failure
a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node
Attacks of meniers consists of, except... A. Vertigo B. Loss of balance C. Loss of hearing D. Fullness of affected ear
B. Loss of balance
Hypoxia, when respiratory failure is
persistent
A. Hemoglobin-oxygen dissociation curve
shift to the right
B. Hemoglobin-oxygen dissociation curve no
shift
C. Hemoglobin-oxygen dissociation curve shift to
the left
D. Hemoglobin-oxygen dissociation curve shift
downward
A. Hemoglobin-oxygen dissociation curve
shift to the right
What is the main stimulus of increase renin release? A. Decrease sodium reab B. Diminished renal blood flow C. Decrease O2 in juxtamegulary cells D. Increase plasma oncotic pressure
B. Diminished renal blood flow
Clouding of the eye lens -
B. Cataract
A condition in which eyes are not aligned with each other A.Amblyopia B.Myopia C.Strabismus D.Diplopia
C.Strabismus
Bulging of the eyes between eyelids -
Exopthalmos
Assessment of alignment by the location of corneal light reflex within pupil -
Hirschberg Test