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Tim's Cards > Cardiopulmonary II > Flashcards

Cardiopulmonary II Flashcards

1
Q

Name the 5 sections of the Aorta:

A 
Ascending
Aortic Arch
Descending
Thoracic
Abdominal
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2
Q

What effect dampens pulsatile flow from heart?

A

Windkessel Effect

*due to elastic tissue

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3
Q

What are the 3 layers of arteries/veins?

A

Tunica Intima - endothelium
Tunica Media - Elastic/Smooth m.
Tunica Adventitia - CT

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4
Q

What is the site of the greatest resistance and largest pressure drop in the circulation?

A

Arterioles

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5
Q

Vasoconstriction leads to:

Vasodilation leads to:

A

Decreases Blood flow

Increases

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6
Q

Name 2 hormones that affect radius of arteries/arterioles.

A

Angiotensin II

Vasopressin

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7
Q

What makes up capillaries structurally?

A

Endothelium - single cell layer

Basal Lamina

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8
Q

What % of blood is in the veins at any given time?

A

60%

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9
Q

What layer is thinner in veins?

A

Tunica Media

*so not as much smooth muscle

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10
Q

What is the largest vein in the body?

What forms it?

A

Inferior Vena Cava

Common Iliac Veins

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11
Q

What forms the Superior Vena Cava?

A

Right and Left Brachiocephalic veins

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12
Q

What are the 1st three branches off the aortic arch?

excluding coronaries

A

Brachiocephalic trunk
Left common carotid
Left subclavian

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13
Q

What does the Brachiocephalic trunk split into?

A

Right common carotid

Right Subclavian

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14
Q

The internal carotid arteries are _____ to the externals.

A

Lateral to

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15
Q

Five divisions of arteries leading down the arm:

A 
Subclavian
Axillary
Brachial
Radial 
Ulnar
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16
Q

What are the 3 branches off the Celiac trunk?

A

Common Hepatic
Splenic
Left gastric

(look at figures)

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17
Q

What artery supplies small and large intestine?

Large intestine and rectum?

A

Superior mesenteric
Inferior mesenteric

(look at figures)

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18
Q

What supplies the kidney?

A

Left and Right Renal aa. and vv.

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19
Q

What does the Inferior vena cava split into as it descends?

A

L/R Common Iliac
L/R Internal Iliac
L/R External Iliac
L/R Femoral

*all aa. and vv.

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20
Q

What drains the liver?

A

Portal hepatic vein

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21
Q

The internal jugular vein is ____ to the external.

A

Medial

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22
Q 
At rest % blood flow to the following areas:
Renal:
GI:
Skeletal:
Cerebral:
Skin:
Coronary:
A 
25%
25%
25%
15%
5%
5%
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23
Q

Ohm’s Law:

A

Q = P/R

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24
Q

Pulmonary pressure originates:

Systemic pressure originates:

A

Right ventricle

Left ventricle

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25
Q

Systolic Pressure represents:

Diastolic Pressure represents:

A

Peak ejection pressure

Minimum pressure

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26
Q

What is meant by “diastolic runoff”?

A

The pressure exerted by the aorta that propels blood

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27
Q

What is the pressure storing effect of the aorta called?

A

Wind Kessel effect

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28
Q

What blood pressure measurement was invented by Korotkoff?

A

Auscultatoric

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29
Q

What blood pressure measurement uses electronic pressure sensor algorithm?

A

Oscillometric

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30
Q

MAP =

A

2/3 DP + 1/3 SP

DP + 1/3 PP

*PP = pule pressure (systolic - diastolic)

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31
Q

What is the sum of all resistance in the vasculature?

A

Total Peripheral Resistance (TPR)
or
Systemic Vascular Resistance (SVR)

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32
Q

What are the 3 sources of resistance in vasculature?

A

Viscosity
Length
Diameter

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33
Q

R=8 (viscosity) (length) / pi r to the 4th

What law?
What does this suggest?

A

Poiseuille’s Law

Radius is very important to resistance

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34
Q

Normal viscosity of blood is 4x thicker than…

A

Water

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35
Q

Anemia:
viscosity?
vascular resistance?
blood flow?

A

decrease
decrease
increase

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36
Q

Polycythemia:
viscosity?
vascular resistance?
blood flow?

A

increase
increase
decrease

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37
Q

Increasing vessels radius x2 increases flow…

Increasing vessel radius x4 increases flow…

A

16
256

Poiselle’s formula

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38
Q

How does vasoconstriction affect blood flow in arteries?

Why?

A

decreases blood flow

because elastic, pressure doesn’t build enough to increase flow

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39
Q

How does vasoconstriction affect blood flow in veins?

A

Increases flow

  • pressure increases because lack of elastic structure
  • *veins VERY sensitive to vasoconstriction/dilation
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40
Q

Q = P/R, analogous to:

A

CO = MAP / TPR

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41
Q

Short term regulation of Mean Arterial Pressure occurs via…

A

neural pathways

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42
Q

Long term regulation of Mean Arterial Pressure occurs via ____ and targets _____.

A

endocrine

kidneys and blood vessels

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43
Q

Where are the 2 primary baroreceptors that are involved in short-term regulation of the heart?

A

Carotid sinus

Aortic arch

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44
Q

What cranial nerves innervate the baroreceptors?

What is the destination in the brain?

A

Glossopharyngeal (IX) and Vagus (X)

Medullary cardiovascular (cardioregulatory) center of brainstem

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45
Q

What is the function of the Medullary Cardiovascular Center of brainstem?

A

Uses SNS or ParaNS in response to hyper/hypotension

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46
Q

Increasing constriction of veins will _____ venous return and ____ Mean systemic pressure.

A

Increase

Increase

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47
Q

T/F

Chronic hypertension can alter baroreceptor acuity

A

True

*allows hypertension to proceed unchecked

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48
Q

What do kidneys secrete in response to low BP?

A

Renin

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49
Q

What is the function of Renin?

A

Angiotensinogen > Angiotensin I

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50
Q

What secretes Angiotensinogen?

A

Liver

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51
Q

What enzyme converts Angiotensin I to Angiotensin II?

Where?

A

Angiotensin Converting Enzyme (ACE)

Lungs

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52
Q

What are the 4 primary effects of Angiotensin II?

A

Increases Aldosterone
Increases Na+ and H+ exchange
Increases Thirst
Vasoconstricts and Increases TPR

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53
Q

How does RAA pathway react to hemorrhage?

A

Renin > Angiotensinogen > Angiotensin I > Lung > Angiotensin II > 4 things

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54
Q

ADH, aka…

A

Vasopressin

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55
Q

What is the most important factor leading to secretion of ADH?
What else stimulates ADH secretion?

A

Increased Plasma Osmolarity

Hypovolemia

*ADH retains water, balancing (decreasing) osmolarity and increasing volume

56
Q

What are the 2 primary effects of ADH?

What receptors are involved?

A

Increase water reabsorption in kidneys
(V2 receptors)

Vasoconstricts
(V1 receptors)

57
Q

Where are V1 receptors?

A

Arterioles

58
Q

What are two hormonal effects of atrial detection of too much blood volume?

A

Increased ANP (Atrial Naturetic Peptide)

Decreased ADH

59
Q

Where is Atrial Naturetic Peptide secreted from?

A

Atria

60
Q

What are ANP’s effects at the level of the vasculature?

At the level of the kidney?

A

Relaxes smooth muscle (Vasodilation)

Increased Na+ and water excretion
decreases volume Blood, ECF

61
Q

TPR =

A

Total Peripheral Resistance

62
Q

What two factors primarily affect Mean Arterial Pressure?

A

Cardiac Output

Total Peripheral Resistance

63
Q

Why isn’t one data point good enough to diagnose hypertension?

A

Hypertension is chronic increase of MAP (mean arterial pressure)

64
Q

What does hypertension do at the level of the vessel?

2 things

A 
Decreases elasticity
Damages Capillaries (eyes and kidneys)
65
Q

What does hypertension do to the aorta?

A

Increases Afterload

  • greatly increases workload of LV - hypertrophy
  • *Bowling ball heart
66
Q

T/F

Hypertension is a major risk factor for chronic kidney disease.

A

True

67
Q 
What are the ranges for BP:
Normal 
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
A

Below 120
120-139
140-159
160 and above

68
Q

What is meant by secondary hypertension?

A

Secondary to a Primary disease

like hyperthyroidism, renal failure, etc

69
Q

What is the difference between Atherosclerosis and Arteriosclerosis?

A

Atherosclerosis - Plaque build-up

Arteriosclerosis - Thickening and stiffening of walls

70
Q

What layers does Arteriosclerosis preferentially thicken?

A

Tunica Intima and Media

*This increases rigidity and decreases elasticity

71
Q

T/F

Arteriosclerosis can cause ischemia

A

True

*narrows lumen

72
Q

What can weakening of vessel walls cause?

A

Aneurysm

73
Q

What type of aneurysm, common in the abdominal aorta, constitutes the entire wall “outpouching”?

A

Circumferential or Fusiform

74
Q

If only one portion of the arterial wall outpouches, it is called?
Where does this often occur?

A

Saccular (or Berry)

Circle of Willis

75
Q

What type of aneurysm is common in the aortic arch?

What occurs?

A

Dissecting

Tunics separate and blood flows in

76
Q

Where does the bulk of lymph come from?

A

Extra-cellular fluid

77
Q

What are the 2 rare types of capillaries and where are they found?

A

Sinusoidal - Liver
Continuous - Brain

  • sinusoidal very porous for exchange
  • *brain continuous to maintain blood brain barrier
78
Q

What is the most common type of capillary?

A

Fenestrated

79
Q

T/F

Pinocytosis is a common way to exchange materials at the level of the capillaries.

A

False

at least in humans

80
Q

What are the 4 Starling Forces?

A

Pc - capillary hydrostatic pressure
Pi - interstitial hydrostatic pressure
Pi-c - capillary oncotic
Pi-i - interstitial oncotic

*Pc and Pi-c are most important

81
Q

What creates Oncotic Pressure?

A

Protein in the blood (while none in the interstitial fluid) creates a gradient IN to the capillary

82
Q

What are the 4 things that don’t fit through capillary fenestrations?

A

Big proteins
RBC’s
WBC’s
platelets

83
Q

Where does the Pc (capillary hydrostatic pressure) dominate?

Where does the Pi-c (capillary oncotic pressure) dominate?

A

Beginning of capillary bed

End of capillary bed

84
Q

When all the pressures (oncotic/hydrostatic and capillary/interstitial) added up, what is the net?

A

Small amount of fluid is pushed into the interstitium

*this creates Lymph

85
Q

What happens if Pc is too high?

Pi-c too low?

A

Both lead to Edema

86
Q

Other than Pc being high or Pi-c being low, what other 2 conditions can cause edema?

A

Trauma

Lymphatic blockage

87
Q

What collects lymph on the right and left side?

Which collects more lymph?

A

Right: rt lymphatic duct
Left: Thoracic duct

Thoracic duct collects most lymph in body

88
Q

Where does the Right Lymphatic Duct drain?

Thoracic duct?

A

Right subclavian

Left subclavian

89
Q

What region of the body is drained by the Right Lymphatic Duct?

A

Right head, neck, arm and chest

90
Q

T/F

There are no cells in lymphatic fluid

A

True

with the exception of cancer

91
Q

What are the 2 types of edema?
What are they caused by?
Which is more common?

A

Pitting and non-pitting

Non-pitting caused by excess protein and debris as well as fluid

Pitting more common

92
Q

What are 4 causes of Edema?

A

increase Pc
decrease Pi-c
increase capillary permeability
blocked lymphatics

93
Q

What are the muscles of inspiration?

A

Diaphragm

External Inercostals

94
Q

What are the muscles of expiration?

A

Internal intercostals

Abdominal muscles

95
Q

What spinal nerves are required for diaphragm function?

A

C3-C5

*Phrenic nerve

96
Q

How do the external intercostals move the ribs?

A

Elevate superolaterally

Move sternum anteriorly

97
Q

Inhalation is innervated by the _____ nerve and exhalation is generally a ______.

A

Phrenic

Passive process

98
Q

Why do emphysema pts have to force air out?

A

Diaphragm has lost elasticity

99
Q

Lower respiratory structures starting with the trachea:

A 
Trachea
Bronchi
Bronchioles
Alveolar Ducts and sacs
Alveoli
100
Q

At what branching does the conduction zone turn into the respiratory zone in the lung?

A

Around 16-17

101
Q

Where does most airway resistance occur in breathing?

A

Bronchi and Bronchioles

*lots of smooth muscle

102
Q

What receptors induce bronchodilation?

What receptors induce bronchoconstriction?

A

Beta-2 (symphathetic)

Muscarinic (parashympathetic)

103
Q

T/F

The alveoli have cilia

A

False

no smooth muscle either

104
Q

What is the structure of respiratory epithelium?

A

Pseudostratified ciliated columnar epithelium

105
Q

4 paranasal sinuses:

A

Frontal
Maxillary
Sphenoidal
Ethmoidal

106
Q

3 Tonsils:

A

Pharyngeal
Palatine
Lingual

107
Q

What are the triangular structures in the posterior Larynx?

What is on top of them?

A

Arytenoid

Corniculate

108
Q

3 types of Bronchi, 3 types of alveolar structures, what’s in between?

A

Primary, Secondary, Tertiary bronchi

Bronchioles

Alveolar ducts, sacs, Alveoli

109
Q

Lobes Left lung and Right lung?

A

Left - 2

Right - 3

110
Q

What are the 2 Pleura that line the lung?

What is in between?

A

Visceral Pleura
Parietal Pleura

Pleural Cavity - filled with fluid

111
Q

What is the presence of air in the intrapleural space called?
What does it lead to?

A

Pneumothorax

Collapse

112
Q

What type of tissue lines the alveolus?

What secretion lines it?

A 
Simple squamous  (type I alveolar cell) 
Surfactant
113
Q

What type of cell secretes surfactant in the alveolus?

A

Type II alveolar cell (pneumocyte)

114
Q

What constitutes 90% alveolar surface area?

A

Type I alveolar cell (pneumocyte)

*simple squamous

115
Q

What often contains granules of exogenous material in the alveolus?

A

Dust cell macrophage

116
Q

What can diagnostic spirometry tell us?

A

Disease Type and Severity

117
Q

What treatment is often used to reduce the risk of Atelectasis?

A

Incentive Spirometry

118
Q

What is in/out volume of quiet breathing?

What is the volume?

A

Tidal Volume

500mL

119
Q

What is the air that does not participate in gas exchange called?

A

Anatomical Dead Space

120
Q

Alveolar Volume =

A

(Tidal Volume - Anatomical Dead Space) x Respiratory Rate

*this is a one minute calculation

121
Q

What is the amount of air you can inspire above the normal tidal volume?

A

Inspiratory reserve

122
Q

What is the amount of air you can expire below normal tidal volume?

A

Expiratory reserve

123
Q

After forced expiration, what is the amount of air left over?

A

Residual volume

124
Q

What is the Functional Residual Capacity?

A

Residual Volume + Expiratory Reserve volume

125
Q

Where does IC (Inspiratory Capacity) begin and end?

A

Bottom tidal volume to top inspiration

126
Q

T/F

The Vital Capacity does not include the Residual Volume

A

True

127
Q

Orthostatic/Postural hypotension (standing up too quickly) can be caused by?

A

Delay in baroreceptors

128
Q

Anti-hypertensive drugs can often be…

A

Diuretics

129
Q

Non-selective Beta blockers act where?

A

Beta-1 Heart

Beta2 Lungs

130
Q

A selective Beta blocker acts where?

A

Beta1 Heart

131
Q

Why might cessation of Beta1 blockers lead to sudden death?

A

Sometimes Beta1 receptors have been increased and sympathetic overcompensates

132
Q

What type of drug prevents Angiotensin I from being converted to Angiotensin II in the lungs?

A

ACE inhibitor

133
Q

What type of drug prevents the binding of Angiotensin II?

A

ARB - Angiotensin Receptor blocker

134
Q

What type of drug stops Angiotensin at its source?

A

DRI - Direct Renin Inhibitor

135
Q

What type of drug decreases force of contraction of the heart as well as decreasing the SA node firing rate?

A

CCB - Calcium Channel blockers

  • this also affects smooth muscle so constipation is a side effect
  • *generally dilates BV’s, causes headaches
136
Q

What type of drug only effects Calcium channels in Smooth Muscle?

A

CCB - Calcium Channel blocker (selective)

Tim's Cards (140 decks)

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