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Medical Physiology I > Block 3 Exam > Flashcards

Block 3 Exam Flashcards

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USMLE® Step 1 flashcards
1
Q

Implications of Poiseuille’s Law

A

Flow is directly proportional to axial pressure and fourth power of vessel radius
Flow is inversely proportional to length and viscosity

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2
Q

Assumptions of Poiseuille equation

A

Fluid must be incompressible
Tube must be straight, rigid, cylindrical, and unbranched, and have a constant radius
Velocity of thin fluid layer at wall must be zero
Flow must be laminar
Flow must be steady
Viscosity of fluid must be constant

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3
Q

What does mechanical impedance include

A

Compliant impedance
Viscous (or resistive) impedance
Inertial impedance

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4
Q

Compliant impedance

A

Opposes volume change

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5
Q

Viscous (or resistive) impedance

A

Opposes flow

R in dP = FR

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6
Q

Inertial impedance

A

Opposes change of flow

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7
Q

Four factors that generate pressure

A

Gravity
Compliance of the vessels
Viscous resistance
Inertia

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8
Q

Role of circulation

A

Homeostasis

Supply and Demand

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9
Q

What is hemodynamics and why study it?

A

Study of physical aspects of blood circulation
Control of flow and volume
Relationship to other systems

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10
Q

S1 Heart Sound

A

AV valves closing

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11
Q

S2 Heart Sound

A

Semilunar valves closing

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12
Q

S3 Heart Sound

A

Ventricular filling

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13
Q

When is S3 sound normal?

A

Young patients

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14
Q

When is S3 sound pathological?

A

Adults

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15
Q

S4 Heart Sound

A

Atrial kick

Caused by vibration of ventricular wall

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16
Q

Diastole

A

Filling of ventricle

~500ms

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17
Q

Systole

A

Ejection from the ventricle

~300 ms

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18
Q

Increase Preload

A

Increases EDV and SV

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19
Q

Increase afterload

A

Decreases SV

Increases ESV

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20
Q

Resistance in series

A

Greater than any individual resistance

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21
Q

What parts of circulation use resistance in series?

A

Renal portal system
Hepatic portal system
Hypophyseal portal system

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22
Q

Resistance in parallel

A

Far lower resistance than any individual resistance

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23
Q

What causes turbulent flow?

A 
High velocity
Pulsatile flow
Changes in vessel diameter
Larger vessel diameter
Density of blood
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24
Q

What does turbulent flow help diagnosis?

A

Stenosis
Murmurs
Shunts
Valvular problems

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25
Q

Turbulent flow

A

Re is greater than 3000

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26
Q

Laminar flow

A

Re is less than 2000

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27
Q

What is transmural pressure affected by?

A

Physical tissue changes

Wall tension

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28
Q

Noninvasive and indirect measurement of cardiac parameters

A 
Sphygmomanometry
Dilution methods (urine)
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29
Q

Invasive and indirect measurement of cardiac parameters

A

Dilution methods (blood)

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30
Q

Noninvasive and direct measurement of cardiac parameters

A

Ultrasonic flow meters echocardiography & doppler

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31
Q

Invasive and direct measurement of cardiac parameters

A

Angiography cardiac catheterization

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32
Q

1st Korotkoff sound

A

Suprasystolic
No audible sounds
Artery is completely occluded

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33
Q

2nd Korotkoff sound

A

Systolic pressure
First sound
Initial blood slips through with help of ventricular contraction

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34
Q

3rd Korotkoff sound

A 
Diastolic pressure
Last sound (muffled)
Blood flows into artery while heart rests
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35
Q

4th Korotkoff sound

A

True diastolic

Cessation of sound

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36
Q

Compliance

A

Total quantity of blood that can be stored in a given portion of the circulation for a given rise in pressure

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37
Q

Elastance

A

Opposite of compliance

Elastic tension exerted by artery when it is stretched by a volume

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38
Q

Average CO

A

5L/min

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39
Q

Average HR

A

60-100 bpm

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40
Q

Average stroke volume

A

70mL

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41
Q

Average SBP

A

120mmHg

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42
Q

Average DBP

A

80 mmHg

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43
Q

Average MAP

A

95 mmHg

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44
Q

What can lead to a decreased viscosity?

A

Low hematocrit
Anemia
Kidney failure

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45
Q

What can increase viscosity?

A

High hematocrit
High altitude
Polycythemia

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46
Q

Three pressures in circulation

A

Driving pressure
Transmural pressure
Hydrostatic pressure

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47
Q

Driving pressure

A

Difference in pressure along axis of vessel

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48
Q

Transmural pressure

A

Pressure difference across vessel wall

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49
Q

Hydrostatic pressure

A

Change in pressure due to gravity

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50
Q

Arteries

A

Distribution system

High pressure

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51
Q

Veins

A

Collection system

Low pressure

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52
Q

Microcirculation

A

Diffusion and filtration system

Arterioles + capillaries + venules

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53
Q

Aggregate flow

A

Conserved at each level of arborization

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54
Q

Aggregate cross-sectional area

A

Increases with arborization

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55
Q

Where does the steepest drop in pressure occur?

A

Across the arterioles

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56
Q

Vascular resistance

A

Depends on action of smooth muscle cells

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57
Q

What happens to Pc when Rpost increases?

A

Increases

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58
Q

What happens to Pc when Rpre increases?

A

Decreases

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59
Q

High Young’s modulus

A

High elastance

Low compliance

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60
Q

Low Young’s Modulus

A

High compliance

Low elastance

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61
Q

Blood pressure

A

Pressure exerted by the blood against the walls of the blood vessels

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62
Q

Systolic pressure

A

Pressure exerted in the arteries while blood is leaving the heart

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63
Q

Diastolic pressure

A

Pressure exerted in the arteries during the filling of the ventricle

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64
Q

Narrow pulse pressure

A

Commonly indicates decrease in stroke volume

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65
Q

Wide pulse pressure

A

Commonly indicates decrease in compliance of the aorta

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66
Q

Cardiac tamponade

A

Blood fills the pericardial sac surrounding the heart, which decreases the ability of the heart to expand, leading to a decrease in preload and stroke volume

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67
Q

Aortic valve stenosis

A

Narrowing of aortic valve, causing decrease in radius of aortic valve

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68
Q

What does increasing driving pressure lead to?

A 
Increase transmural pressure
Elastic wall distension
Increase radius
Decrease viscous resistance
Increase conductance
Pressure-flow curve steepens
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69
Q

High pressure system

A

Left ventricle in contracted state to systemic arterioles

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70
Q

Low pressure system

A

Systemic capillaries back to the right heart, through the pulmonary circuit, into the left heart in the relaxed state

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71
Q

Three groups of capillaries

A

Continuous
Fenestrated
Discontinuous (Sinusoidal)

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72
Q

Continuous capillary

A

Most common form

Interendothelial junctions

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73
Q

Fenestrated capilary

A

Perforated with fenestrations

Surround epithelia

74
Q

Discontinuous capillary

A

Large gaps
Fenestrae
Found in sinusoids

75
Q

AV valves

A

Inlet valves of ventricles

76
Q

Tricuspid valve

A

Between right atrium and right ventricle

77
Q

Mitral valve

Bicuspid valve

A

Between left atrium and left ventricle

78
Q

Seminlunar valves

A

Outlet valves of ventricles

79
Q

Pulmonary valve

A

Between right ventricle and pulmonary artery

80
Q

Aortic valve

A

Between left ventricle and aorta

81
Q

Cardiac cycle phases

A

Inflow phase
Isovolumetric contraction
Outflow phase
Isovolumetric relaxation

82
Q

Inflow phase

A

Inlet valve is open

Outlet valve is closed

83
Q

Isovolumetric contraction

A

Both valves are closed

84
Q

Outflow phase

A

Outlet valve is open

Inlet valve is closed

85
Q

Isovolumetric relaxation

A

Both valves are closed

86
Q

Protodiastolic gallop

A

Ventricular gallop

S1-S2-S3

87
Q

Presystolic gallop

A

Atrial gallop

S4-S1-S2

88
Q

Maximize rate of O2 uptake

A

Increase HR
Increase SV
Increase Oxygen extraction

89
Q

Microcirculation components

A 
Terminal arteries
Arterioles
Metarterioles
Precapillary sphincters
True capillaries
Venules
90
Q

What components are innervated?

A

Terminal arteries
Arterioles
Venules

91
Q

What components are not innervated?

A

Metarterioles
Precapillary sphincters
True capillaries

92
Q

Parts of true capillaries

A

Basement membrane
Interendothelial junctions/tight junctions/claudins
Coated pits/caveolin-coated vesicles
Glycocalyx

93
Q

Vasoconstriction

A

Increased resistance

94
Q

Vasodilation

A

Decreased resistance

95
Q

Vasomotion

A

Rhythmic oscillations superimposed on a tonic contraction
OR
Spontaneous contractions caused by rhythmic oscillations in Ca2+ and membrane potential

96
Q

Partial pressure of O2 depends on:

A 
Dissolved O2 in blood
O2 content of RBC
Capillary blood flow
Radial diffusion coefficient of O2
Capillary radius
O2 consumption by surrounding tissue cylinder
Axial distance along length of capillary
97
Q

Solute flux

A

Refers to movement of solute X per cm^2 of capillary wall

98
Q

Solute flow for an entire organ

A

Addition or removal of solute X to/from the organ

99
Q

Positive Jv

A

Filtration

Water leaving capillary

100
Q

Negative Jv

A

Absorption

Water entering capillary

101
Q

Jv

A

Volume flux

102
Q

Lp

A

Hydraulic conductivity

103
Q

Pc

A

Hydrostatic pressure in capillary

104
Q

Pif

A

Hydrostatic pressure in interstitial fluid

105
Q

Pi(c)

A

Colloid osmotic pressure in capillary

106
Q

Pi(if)

A

Colloid osmotic pressure in interstitial fluid

107
Q

Sigma

A

Average colloid osmotic reflection coefficient of capillary wall

108
Q

What decreases pi(c)

A

Nephrotic syndrome
Pregnancy
Malnutrition

109
Q

Starling force

A

Mechanical pressure difference

110
Q

Starling hypothesis

A

Overall transendothelial gradients of starling forces, obtained from “bulk solution” measurements of P and pi

111
Q

Endothelial cells of initial lymphatics

A

Oak leaf-shaped
Lack junctions at tip
Anchored on sides by discontinuous button-like junctions

112
Q

Endothelial cells of collecting lymphatics

A

Conventional, continuous, zipper-like junctions also found in endothelial cells of blood vessels

113
Q

Free edges

A

Sites of fluid transit

114
Q

Three convective loops of extracellular water

A

Cardiovascular loop
Transvascular loop
Lymphatic loop

115
Q

Distribution of vessels

A

Conductance vessels

Arteries

116
Q

Diffusion/Filtration vessels

A

Capillaries

117
Q

Resistance vessels

A

Arterioles

Venules

118
Q

Collection vessels

A

Capacitance vessels

Veins

119
Q

Pulse pressure

A

SBP - DBP

120
Q

Perfusion Pressure

A

Pa - Pv

121
Q

Artery makeup

A

Intima
Media
Adventitia

122
Q

Adventitia makeup

A

Collagen
Fibroblasts
Vasa vasorum
Nerves

123
Q

Normal endothelial cell function

A 
Impermeable to large molecules
Anti-inflammatory
Resist leukocyte adhesion
Promote vasodilation
Resist thrombosis
124
Q

Normal smooth muscle cell function

A

Normal contractile function
Maintain extracellular matrix
Contained in medial layer

125
Q

Activated endothelial cell function

A 
Increase permeability
Increase inflammatory cytokines
Increase leukocyte adhesion molecules
Decrease vasodilatory molecules
Decrease antithrombotic molecules
126
Q

Activated smooth muscle cell function

A

Increase inflammatory cytokines
Increase extracellular matrix synthesis
Increase migration and proliferation into subintima

127
Q

Regulation of vascular tone

A

Multi-organ system input

128
Q

Extrinsic regulation of vascular tone

A

Constriction
Neural
Humoral

129
Q

Intrinsic regulation of vascular tone

A 
Dilation
Tissue metabolites
Local hormones
Myogenic
Endothelial factors
130
Q

Nitric oxide

A

Vasodilator

131
Q

EDHF

A

Vasodilator

132
Q

ET-1

A

Vasoconstrictor

133
Q

PGI2

A

Vasodilator

134
Q

P-MLC/t-MLC ratio

A

Molecular signature of smooth muscle cell force production

135
Q

Endothelial cell function

A

Respond to shear and other stimuli

136
Q

Health of endothelium

A

Determines the net effect of signals to endothelial and smooth muscle cells

137
Q

O2 consumption

A

Cardiac work

138
Q

Coronary flow reserve

A

Exercise stress test

139
Q

Chemical stress test

A

Adenosine infusion

140
Q

Vascular disease

A

Endothelial dysfunction, early marker of vascular disease

141
Q

Mechanism of vascular disease

A

Reduced bioactivity of NO
Oxidative stress: NO inactivation
Decreased NO synthase protein

142
Q

Vascular disease featured in:

A

Diabetes
Hypertension
Atherosclerosis

143
Q

Autoregulation

A

Intrinsic ability of an organ to maintain a constant blood flow despite changes in perfusion pressure

144
Q

High autoregulatory ability

A

Cerebral
Coronary
Renal

145
Q

Low autoregulatory ability

A

skin

146
Q

Formed elements of blod

A

RBCs
WBCs
Platelets

147
Q

GM-CSF

A

Stimulates proliferation of a common myeloid progenitor

Promotes production of neutrophils, eosinophils, and monocytes

148
Q

G-CSF and M-CSF

A

Guide ultimate development of granulocytes and monocytes-macrophages/dendritic cells

149
Q

IL-5

A

Sustains terminal differentiation of eosinophilic precursors

150
Q

EPO

A

Homologous to TPO

Supports erythropoiesis

151
Q

Proerythroblasts

A

Lack hemoglobin

152
Q

Major tasks of RBCs

A

Carrying O2 from lungs to systemic tissues
Carrying CO2 from tissues to lungs
Assisting in the buffering of acids and bases

153
Q

Two functions of macrophages

A

Phagocytosis of pathogens or cellular debris

Presentation of antigens to lymphocytes

154
Q

Wigger’s diagram phase 1

A

Filling

Inlet valve is open

155
Q

Wigger’s diagram end of phase 1

A

Atria contraction

Atrial kick

156
Q

Wigger’s diagram phase 2

A

Isovolumetric contraction

157
Q

Wigger’s diagram phase 3

A

Outlet valve opens

Ejection

158
Q

Wigger’s diagram phase 4

A

Isovolumetric relaxation

159
Q

What do smooth muscle lack that both skeletal and cardiac have?

A

Troponin

160
Q

VSMC contraction

A

Increased Ca2+
Decreased cAMP
Decreased cGMP

161
Q

VSMC relaxation

A

Decreased Ca2+
Increased cAMP
Increased cGMP

162
Q

Requirements of vasomotion

A 
Endothelial cells
VSMCs
Cav channels
Cl channels
SR (SERCA + RYR)
Gap junctions
163
Q

What is not required for vasomotion

A

Neuronal input

164
Q

Regulated contraction

A

Central

Local

165
Q

Central control

A

Nervous system

Humoral agonists

166
Q

Local control

A

Myogenic
Metabolic
Endothelial

167
Q

Nervous system control

A

NE
Epi
ATP
Neuropeptide Y

168
Q

Sympathetic vasoconstriction in blood vessels

A

Norepinephrine

169
Q

Adrenal medulla mediated vasodilation of blood vessels

A

Epinephrine

170
Q

Parasympathetic vasodilation of erectile tissue

A

Co-release of ACh, NO, VIP

171
Q

Parasympathetic vasodilation of salivary gland

A

ACh

172
Q

Sympathetic vasodilation of sweat gland

A

Cholinergic ACh

173
Q

Sympathetic vasodilation of blood vessels of muscle

A

Cholinergic ACh

174
Q

Humoral control

A

Angiotensin II
ADH
Serotonin
Neuropeptide Y

175
Q

Endocrine/Paracrine vasoconstriction

A

Angiotensin II
ADH
Serotonin
Neuropeptide Y

176
Q

Endocrine/Paracrine vasodilation

A

Histamine
VIP
ANP

177
Q

Local control

A

Myogenic
Metabolic
Endothelial

178
Q

Endothelin

A

Vasoconstrictor

179
Q

Nitric oxide

A

Vasodilator

180
Q

Autoregulation location

A

Coronary
Cerebral
Renal

181
Q

Systemic capillaries

A

No capillary pulse

182
Q

Pulmonary capillaries

A

Small pulsations

Medical Physiology I (8 decks)

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