Cardiopulmonary II Flashcards
1
Q
Name the 5 sections of the Aorta:
A
Ascending Aortic Arch Descending Thoracic Abdominal
2
Q
What effect dampens pulsatile flow from heart?
A
Windkessel Effect
*due to elastic tissue
3
Q
What are the 3 layers of arteries/veins?
A
Tunica Intima - endothelium
Tunica Media - Elastic/Smooth m.
Tunica Adventitia - CT
4
Q
What is the site of the greatest resistance and largest pressure drop in the circulation?
A
Arterioles
5
Q
Vasoconstriction leads to:
Vasodilation leads to:
A
Decreases Blood flow
Increases
6
Q
Name 2 hormones that affect radius of arteries/arterioles.
A
Angiotensin II
Vasopressin
7
Q
What makes up capillaries structurally?
A
Endothelium - single cell layer
Basal Lamina
8
Q
What % of blood is in the veins at any given time?
A
60%
9
Q
What layer is thinner in veins?
A
Tunica Media
*so not as much smooth muscle
10
Q
What is the largest vein in the body?
What forms it?
A
Inferior Vena Cava
Common Iliac Veins
11
Q
What forms the Superior Vena Cava?
A
Right and Left Brachiocephalic veins
12
Q
What are the 1st three branches off the aortic arch?
excluding coronaries
A
Brachiocephalic trunk
Left common carotid
Left subclavian
13
Q
What does the Brachiocephalic trunk split into?
A
Right common carotid
Right Subclavian
14
Q
The internal carotid arteries are _____ to the externals.
A
Lateral to
15
Q
Five divisions of arteries leading down the arm:
A
Subclavian Axillary Brachial Radial Ulnar
16
Q
What are the 3 branches off the Celiac trunk?
A
Common Hepatic
Splenic
Left gastric
(look at figures)
17
Q
What artery supplies small and large intestine?
Large intestine and rectum?
A
Superior mesenteric
Inferior mesenteric
(look at figures)
18
Q
What supplies the kidney?
A
Left and Right Renal aa. and vv.
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.
20
Q
What drains the liver?
A
Portal hepatic vein
21
Q
The internal jugular vein is ____ to the external.
A
Medial
22
Q
At rest % blood flow to the following areas: Renal: GI: Skeletal: Cerebral: Skin: Coronary:
A
25% 25% 25% 15% 5% 5%
23
Q
Ohm’s Law:
A
Q = P/R
24
Q
Pulmonary pressure originates:
Systemic pressure originates:
A
Right ventricle
Left ventricle
25
Systolic Pressure represents:
| Diastolic Pressure represents:
Peak ejection pressure
| Minimum pressure
26
What is meant by "diastolic runoff"?
The pressure exerted by the aorta that propels blood
27
What is the pressure storing effect of the aorta called?
Wind Kessel effect
28
What blood pressure measurement was invented by Korotkoff?
Auscultatoric
29
What blood pressure measurement uses electronic pressure sensor algorithm?
Oscillometric
30
MAP =
2/3 DP + 1/3 SP
DP + 1/3 PP
*PP = pule pressure (systolic - diastolic)
31
What is the sum of all resistance in the vasculature?
Total Peripheral Resistance (TPR)
or
Systemic Vascular Resistance (SVR)
32
What are the 3 sources of resistance in vasculature?
Viscosity
Length
Diameter
33
R=8 (viscosity) (length) / pi r to the 4th
What law?
What does this suggest?
Poiseuille's Law
Radius is very important to resistance
34
Normal viscosity of blood is 4x thicker than...
Water
35
Anemia:
viscosity?
vascular resistance?
blood flow?
decrease
decrease
increase
36
Polycythemia:
viscosity?
vascular resistance?
blood flow?
increase
increase
decrease
37
Increasing vessels radius x2 increases flow...
| Increasing vessel radius x4 increases flow...
16
256
Poiselle's formula
38
How does vasoconstriction affect blood flow in arteries?
| Why?
decreases blood flow
because elastic, pressure doesn't build enough to increase flow
39
How does vasoconstriction affect blood flow in veins?
Increases flow
* pressure increases because lack of elastic structure
* *veins VERY sensitive to vasoconstriction/dilation
40
Q = P/R, analogous to:
CO = MAP / TPR
41
Short term regulation of Mean Arterial Pressure occurs via...
neural pathways
42
Long term regulation of Mean Arterial Pressure occurs via ____ and targets _____.
endocrine
kidneys and blood vessels
43
Where are the 2 primary baroreceptors that are involved in short-term regulation of the heart?
Carotid sinus
| Aortic arch
44
What cranial nerves innervate the baroreceptors?
| What is the destination in the brain?
Glossopharyngeal (IX) and Vagus (X)
Medullary cardiovascular (cardioregulatory) center of brainstem
45
What is the function of the Medullary Cardiovascular Center of brainstem?
Uses SNS or ParaNS in response to hyper/hypotension
46
Increasing constriction of veins will _____ venous return and ____ Mean systemic pressure.
Increase
| Increase
47
T/F
| Chronic hypertension can alter baroreceptor acuity
True
*allows hypertension to proceed unchecked
48
What do kidneys secrete in response to low BP?
Renin
49
What is the function of Renin?
Angiotensinogen > Angiotensin I
50
What secretes Angiotensinogen?
Liver
51
What enzyme converts Angiotensin I to Angiotensin II?
| Where?
Angiotensin Converting Enzyme (ACE)
Lungs
52
What are the 4 primary effects of Angiotensin II?
Increases Aldosterone
Increases Na+ and H+ exchange
Increases Thirst
Vasoconstricts and Increases TPR
53
How does RAA pathway react to hemorrhage?
Renin > Angiotensinogen > Angiotensin I > Lung > Angiotensin II > 4 things
54
ADH, aka...
Vasopressin
55
What is the most important factor leading to secretion of ADH?
What else stimulates ADH secretion?
Increased Plasma Osmolarity
Hypovolemia
*ADH retains water, balancing (decreasing) osmolarity and increasing volume
56
What are the 2 primary effects of ADH?
| What receptors are involved?
Increase water reabsorption in kidneys
(V2 receptors)
Vasoconstricts
(V1 receptors)
57
Where are V1 receptors?
Arterioles
58
What are two hormonal effects of atrial detection of too much blood volume?
Increased ANP (Atrial Naturetic Peptide)
Decreased ADH
59
Where is Atrial Naturetic Peptide secreted from?
Atria
60
What are ANP's effects at the level of the vasculature?
| At the level of the kidney?
Relaxes smooth muscle (Vasodilation)
| Increased Na+ and water excretion
decreases volume Blood, ECF
61
TPR =
Total Peripheral Resistance
62
What two factors primarily affect Mean Arterial Pressure?
Cardiac Output
| Total Peripheral Resistance
63
Why isn't one data point good enough to diagnose hypertension?
Hypertension is chronic increase of MAP (mean arterial pressure)
64
What does hypertension do at the level of the vessel?
| 2 things
```
Decreases elasticity
Damages Capillaries (eyes and kidneys)
```
65
What does hypertension do to the aorta?
Increases Afterload
* greatly increases workload of LV - hypertrophy
* *Bowling ball heart
66
T/F
| Hypertension is a major risk factor for chronic kidney disease.
True
67
```
What are the ranges for BP:
Normal
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
```
Below 120
120-139
140-159
160 and above
68
What is meant by secondary hypertension?
Secondary to a Primary disease
| like hyperthyroidism, renal failure, etc
69
What is the difference between Atherosclerosis and Arteriosclerosis?
Atherosclerosis - Plaque build-up
| Arteriosclerosis - Thickening and stiffening of walls
70
What layers does Arteriosclerosis preferentially thicken?
Tunica Intima and Media
*This increases rigidity and decreases elasticity
71
T/F
| Arteriosclerosis can cause ischemia
True
*narrows lumen
72
What can weakening of vessel walls cause?
Aneurysm
73
What type of aneurysm, common in the abdominal aorta, constitutes the entire wall "outpouching"?
Circumferential or Fusiform
74
If only one portion of the arterial wall outpouches, it is called?
Where does this often occur?
Saccular (or Berry)
Circle of Willis
75
What type of aneurysm is common in the aortic arch?
| What occurs?
Dissecting
Tunics separate and blood flows in
76
Where does the bulk of lymph come from?
Extra-cellular fluid
77
What are the 2 rare types of capillaries and where are they found?
Sinusoidal - Liver
Continuous - Brain
* sinusoidal very porous for exchange
* *brain continuous to maintain blood brain barrier
78
What is the most common type of capillary?
Fenestrated
79
T/F
| Pinocytosis is a common way to exchange materials at the level of the capillaries.
False
| at least in humans
80
What are the 4 Starling Forces?
Pc - capillary hydrostatic pressure
Pi - interstitial hydrostatic pressure
Pi-c - capillary oncotic
Pi-i - interstitial oncotic
*Pc and Pi-c are most important
81
What creates Oncotic Pressure?
Protein in the blood (while none in the interstitial fluid) creates a gradient IN to the capillary
82
What are the 4 things that don't fit through capillary fenestrations?
Big proteins
RBC's
WBC's
platelets
83
Where does the Pc (capillary hydrostatic pressure) dominate?
| Where does the Pi-c (capillary oncotic pressure) dominate?
Beginning of capillary bed
End of capillary bed
84
When all the pressures (oncotic/hydrostatic and capillary/interstitial) added up, what is the net?
Small amount of fluid is pushed into the interstitium
*this creates Lymph
85
What happens if Pc is too high?
| Pi-c too low?
Both lead to Edema
86
Other than Pc being high or Pi-c being low, what other 2 conditions can cause edema?
Trauma
| Lymphatic blockage
87
What collects lymph on the right and left side?
Which collects more lymph?
Right: rt lymphatic duct
Left: Thoracic duct
Thoracic duct collects most lymph in body
88
Where does the Right Lymphatic Duct drain?
| Thoracic duct?
Right subclavian
| Left subclavian
89
What region of the body is drained by the Right Lymphatic Duct?
Right head, neck, arm and chest
90
T/F
| There are no cells in lymphatic fluid
True
| with the exception of cancer
91
What are the 2 types of edema?
What are they caused by?
Which is more common?
Pitting and non-pitting
Non-pitting caused by excess protein and debris as well as fluid
Pitting more common
92
What are 4 causes of Edema?
increase Pc
decrease Pi-c
increase capillary permeability
blocked lymphatics
93
What are the muscles of inspiration?
Diaphragm
| External Inercostals
94
What are the muscles of expiration?
Internal intercostals
| Abdominal muscles
95
What spinal nerves are required for diaphragm function?
C3-C5
*Phrenic nerve
96
How do the external intercostals move the ribs?
Elevate superolaterally
| Move sternum anteriorly
97
Inhalation is innervated by the _____ nerve and exhalation is generally a ______.
Phrenic
| Passive process
98
Why do emphysema pts have to force air out?
Diaphragm has lost elasticity
99
Lower respiratory structures starting with the trachea:
```
Trachea
Bronchi
Bronchioles
Alveolar Ducts and sacs
Alveoli
```
100
At what branching does the conduction zone turn into the respiratory zone in the lung?
Around 16-17
101
Where does most airway resistance occur in breathing?
Bronchi and Bronchioles
*lots of smooth muscle
102
What receptors induce bronchodilation?
| What receptors induce bronchoconstriction?
Beta-2 (symphathetic)
| Muscarinic (parashympathetic)
103
T/F
| The alveoli have cilia
False
no smooth muscle either
104
What is the structure of respiratory epithelium?
Pseudostratified ciliated columnar epithelium
105
4 paranasal sinuses:
Frontal
Maxillary
Sphenoidal
Ethmoidal
106
3 Tonsils:
Pharyngeal
Palatine
Lingual
107
What are the triangular structures in the posterior Larynx?
| What is on top of them?
Arytenoid
| Corniculate
108
3 types of Bronchi, 3 types of alveolar structures, what's in between?
Primary, Secondary, Tertiary bronchi
Bronchioles
Alveolar ducts, sacs, Alveoli
109
Lobes Left lung and Right lung?
Left - 2
| Right - 3
110
What are the 2 Pleura that line the lung?
| What is in between?
Visceral Pleura
Parietal Pleura
Pleural Cavity - filled with fluid
111
What is the presence of air in the intrapleural space called?
What does it lead to?
Pneumothorax
| Collapse
112
What type of tissue lines the alveolus?
| What secretion lines it?
```
Simple squamous (type I alveolar cell)
Surfactant
```
113
What type of cell secretes surfactant in the alveolus?
Type II alveolar cell (pneumocyte)
114
What constitutes 90% alveolar surface area?
Type I alveolar cell (pneumocyte)
*simple squamous
115
What often contains granules of exogenous material in the alveolus?
Dust cell macrophage
116
What can diagnostic spirometry tell us?
Disease Type and Severity
117
What treatment is often used to reduce the risk of Atelectasis?
Incentive Spirometry
118
What is in/out volume of quiet breathing?
| What is the volume?
Tidal Volume
| 500mL
119
What is the air that does not participate in gas exchange called?
Anatomical Dead Space
120
Alveolar Volume =
(Tidal Volume - Anatomical Dead Space) x Respiratory Rate
*this is a one minute calculation
121
What is the amount of air you can inspire above the normal tidal volume?
Inspiratory reserve
122
What is the amount of air you can expire below normal tidal volume?
Expiratory reserve
123
After forced expiration, what is the amount of air left over?
Residual volume
124
What is the Functional Residual Capacity?
Residual Volume + Expiratory Reserve volume
125
Where does IC (Inspiratory Capacity) begin and end?
Bottom tidal volume to top inspiration
126
T/F
| The Vital Capacity does not include the Residual Volume
True
127
Orthostatic/Postural hypotension (standing up too quickly) can be caused by?
Delay in baroreceptors
128
Anti-hypertensive drugs can often be...
Diuretics
129
Non-selective Beta blockers act where?
Beta-1 Heart
| Beta2 Lungs
130
A selective Beta blocker acts where?
Beta1 Heart
131
Why might cessation of Beta1 blockers lead to sudden death?
Sometimes Beta1 receptors have been increased and sympathetic overcompensates
132
What type of drug prevents Angiotensin I from being converted to Angiotensin II in the lungs?
ACE inhibitor
133
What type of drug prevents the binding of Angiotensin II?
ARB - Angiotensin Receptor blocker
134
What type of drug stops Angiotensin at its source?
DRI - Direct Renin Inhibitor
135
What type of drug decreases force of contraction of the heart as well as decreasing the SA node firing rate?
CCB - Calcium Channel blockers
* this also affects smooth muscle so constipation is a side effect
* *generally dilates BV's, causes headaches
136
What type of drug only effects Calcium channels in Smooth Muscle?
CCB - Calcium Channel blocker (selective)
