Exam 1 Lecture 1&2 Flashcards
What should be the renal clearance of glucose in mg/dl
0 mg/dl
What hormone is free water clearance governed by
ADH
What is the appropriate value for CVP for a totally healthy 25 year old with no comorbidity?
0- this shit doesn’t exist in real life
What does pulse pressure measure and what is the normal value for a healthy person
Pulse pressure measures how stiff the arteries are and normal is 40 with a BP of 120/80
Do stiff arteries have high or low pulse pressure?
High pulse pressure
As blood leaves the aorta will the overall pulse pressure increase or decrease
Should increase overall because the blood comes into contact with stiffer arteries the farther away from the aorta we get
What does compliance describe
What does it mean to have high compliance
What is the equation for it
Compliance describes how stretchy something is
High compliance= very stretchy
Delta V/ Delta P
Compliance= Delta V/ delta P
A. If we increase volume what will that do to our compliance?
B.If we increase pressure what happens to compliance?
A. Increase in volume will cause an increase in compliance
B. Increase in pressure the vessels will be low compliance and overall more rigid
What is Elastance?
What is Elastance the inverse of
Elastance is the inverse of compliance and describes how rigid a vessel is
What is Elasticity and what is it similar to that we discussed in class
Elasticity is how stretchy something is and is similar to compliance
Do veins have high or low compliance
Do arteries have high or low compliance
Veins= high compliance
Arteries= Low compliance
What is the normal values for:
MPAP-
LAP
PAP
MPAP- 16
LAP- 2
PAP- 25/8
What characteristics does the pulmonary system have in regards to resistance, pressure and compliance
Low resistance
Decreased pressure
High compliance
What is the normal values for left atrial pressure, Left ventricle pressure, Right atrium pressure, and Right ventricle pressure
Left atrium pressure is 2-5
Left ventricle pressure 120-2
Right atrium pressure is 0-4
Right ventricle pressure 0-25
What type of vessels have the thickest walls in comparison to their diameter
Arterioles
What type of vessels have smooth muscle
Arteries, arterioles, veins
All of them BUT capillaries they do not have SM
What properties do veins have in regards to their wall thickness, resistance, and pressure
Thin walls
Low resistance
Low pressure
What type of vessel sits directly upstream of capillaries for our class
Arterioles
What substance did we discuss in class are responsible for dilating arterioles
H protons
CO2
Adenosine
Im sorry about wording of the question it was trash……..
Label the normal values of each listed I the picture
P cap= 30 at beginning and 10 at end average is 17 for our class. This is usually the variable he likes to mess with on Exam
Pie Cap= 28
Pif= 3
Pie isf= “not going to worry about apparently this semester but we are going to say 1” but 6 lectures later says it 8 so for our class its 8
What organ does albumin come from
Liver
What element on the periodic table that we discussed in class is NOT water soluble
Oxygen
Rank in order the importance of Globulins, Fibrinogen and albumin as it pertains to colloid pressure
Albumin-> Globulins->Fibrinogen
What type of vessels do Sympathetic neurons not innervated?
What do these neurons secrete that helps maintain vascular tone
Capillaries
Norepi
What is considered the second circulatory system
Lymphatic System
What is the normal lymphatic flow per day?
What can the lymphatic flow be if we are very active per day?
Normal is 2L/day
Active is 40L/day or 20X normal
What type of muscle squeezes around the lymphatic system and is responsible for keeping the flow
Skeletal Muscle
True or false
The lungs do have a lymphatic system and is equal adapted to remove fluid at the same rate as the rest of circulation
False
The lymphatic system of the lungs does not get rid of fluid as well as the rest of the system
True or false
The lymphatic system does not have one way valves because having one way valves would not allow the skeletal muscle to squeeze with enough force to keep the fluid moving
False
The lymphatic system has one way valves
I was grasping at straws here……….
Will paralytics increase or decrease venous return
Decrease venous return because you are paralyzing SKM
What valve sits next to the Isogravimetric point
Tricuspid valve
How far in millimeters do you have to go below the heart in regards to gravity to increase the pressure by 1mmHg
13.6mm
I don’t know how he is going to get me with this picture but I have a feeling maybe an arrow pointing to one and asking to calculate some pressure idk
But in short you will add the pressure increase to whatever your starting pressure will be. So if he gives a starting pressure of 100 like in the arteries he might ask what is the arterial pressure at the palm of the hand
100 + 35= 135mmHg
Why is the pressure in the left arm +6 and not 0 even though it is on the Isogravimetric point
It should be 0 technically BUT the column of blood sitting on top of it adds pressure and makes it 0
What is interesting about the jugular veins in regards to their pressure
the interesting this is that their pressure is 0 even though it is above the heart which would technically make it negative. But for our class it is 0 because they would collapse under atmospheric pressure if they were negative. Need to add more info to this card he has not explained the reason why yet
Why is it not swell to have a “sucking” head wound beside the obvious
Because the Sagital sinus has a negative pressure so when it is exposed to atmospheric pressure it will cause air emboli to rush in. This is not were the body is most happy
What is the arterial pressure in the foot
190mmHg
Starts at 100 then add 90 for gravity pressure
What is another term for supine
Recumbent
Explain to me in crayon why if you stand extremely still for long periods of time why you might pass out
If we are standing and not moving can cause pooling of blood in leg veins.
What is conductance directly related too
Diameter
Increase in diameter will increase conductance (flow)
What is Distensibility and what is the equation for it
estimate of how expandable something is
What is the equation for Poiseuille law
Are arteries or veins more distensible? and by a factor of how much
systemic veins are 8 X more distensible than systemic arteries
Which type of flow is the most efficient
Laminar flow
In the brain are electrolytes able to move across the junctions as freely as in the systemic capillaries
No the brain has tight junctions and most if not all electrolytes will stay inside of the brain circulation
True or False
A higher Delta P value correlates to a decreased velocity of flow
False
High Delta P= High velocity
Which type of flow can lead to vessel wall weakening overtime
Turbulent flow
In this diagram what portion of the blood will have the slowest velocity
The blood on the wall will have the slowest velocity because it has the most resistance or friction
At what value of Reynolds number can we determine that more than likely there is turbulent flow
Greater than 2000
What is the formula for Reynolds number
What vessel did we discuss in class that always has turbulent flow
Aorta
Crackling or wheezing in the lungs is an example of what kind of air flow
Turbulent air flow
“ I will be wheezing and freaking out if I hit turbulence in an airplane”
When we listen to heart sounds explain the mechanism of action for hearing a Thud and swoosh sound
The thud is from the heart valves closing
The swoosh is from turbulent aorta flow
Please excuse my broken English……..
Which of these slopes correlates to high compliance
High compliance will have a low slope which would be the veins
High slope is low compliance which is the arteries
This graph is showing us what in a nutshell
This is an example of compliance or delta V/ delta P
So veins in picture has large changes in volume but not big changes of pressure so high compliance.
Arteries can’t take much volume without really increasing pressure this is low compliance and a steep slope
Do pulse pressures increase or decrease the further away you get from the “pumping source”
Decrease
If you have aortic valve regurgitation what will happen to your diastolic pressure in the aorta
If we have aortic regurgitation will cause a decreased diastolic pressure because blood will leak back less than the normal 80
Does the aorta or the femoral artery have the wider pulse pressure
Femoral artery has the wider pulse pressure
How does stenosis of arteries effect our pulse pressure
If we have stenosis of the arteries cause increased pulse pressure mostly from an increase in systolic pressure
True or false
As we get older our pulse pressure decreases because our arteries get more worn out?
False our pulse pressure increase as we get older
Possible crappy math question again?
What pressor is best for low BP in spinal anesthesia
Norepi- replace what is gone
What type of nerves innervated all vessels except capillaries. They also run up the ganglia up to the brain for BP control
Sympathetic nerves
(Im not convinced im going to keep this card wording is richy
Do the carotid baroreceptors sit inferior or superior to the carotid bifurcation
Superior
What units is number of signals per second
Hertz
Describe path of nerve signaling from carotid baroreceptors to the brain
Neck baroreceptors connect to herring nerve then to glossopharyngeal nerve CN 9 or IX then to medulla or lower part of brainstem
What does NTS stand for?
How many syllables are in this?
nucleus tractus solitarius important BP control in medulla in brain stem
Haha gotcha I have no idea how many syllables
What is the secondary set of baroreceptors called
Aorta baroreceptors
What is the pressure difference between the aortic and carotid
Aortic pressure is about 20-30 mmHg higher
What nerve does the aortic arch baroreceptors use to communicate back to the NTS
CN X or Vagus
What happens if we constrict carotid bifurcation
If we constrict carotid bifurcation from suture or disease will decrease pressure going to baroceptor and cause brain to think BP is low and will systemically increase BP
What is the pressure cutoff that the baroreceptors won’t kick in and the blood gas mechanisms will kick in to try and compensate
40
How many phases do we have for the cardiac cycle this semester?
What does each phase do
4 phases of cardiac cycle
Phase 1 is filling
Phase 2 isovolumic contraction
Phase 3 ejection
Phase 4 is relaxation
What provides passive tension in the cardiac cycle
Is our preload or diastolic pressure
(Poor wording fix)
Explain what is happening in phase 1
AV valves open to fill ventricle
ventricles filling with blood
during filling we have low ventricular pressure around 2-5 this is are preload
preload determine how full the heart gets by pressure not volume itself
Around 50 ml should be left in heart after ejection and this is our filling starting point this is called ESV or end systolic volume
How much does the heart fill in ml’s
Will fill with 70ml
What is normal EDV
120ml
50ml starting and fill with 70ml
What is happening in phase 2
When Ventricle pressure exceeds atria will close AV valves, and aortic and pulmonic valves must be close
This closed valves leads to same volume in the ventricles throughout or interventricular volume should be same that is why you see straight up and down arrow on right side of this graph. Has same volume but increase pressure. If this line is not straight up in down it means we have leak into the heart probably from regurgitation
What is happening at point C
Point C is ventricle pressure exceeds aortic and causes aortic valve and ejection, start of phase 3, this is afterload point. Phase 3 starts by aortic valve opening
During phase 3 how much blood is ejected
70 ml
What is roughly the peak pressure in phase 3
around 120
At point D why does the aortic valve close
aortic valve closes because pressure in aorta and ventricles drops down to 100 and closes the aortic valve all valves closed at this point too. It also closes because the pressure in the aorta is greater than ventricles
What is happening during the C wave
C wave is from rapid ventricle contraction is from AV valves being hit with that pressure and creates a bowing out
What is happening during the V wave
V wave is from volume building up in atria, blood is still constant and coming into the atria and blood hasn’t been allowed to leave atria and go into ventricles
What is happening in the shaded region? What do we call this?
EW= external work
related to amount of stuff heart is do to CV system
requires energy, volume pressure work is energy used
Work to get blood out of system, entire area in brown, this is a combination of pressures and volume being moved
What causes and increase in “height” on this graph
If ventricular pressure is high from high afterload will cause an increase in the graph up
What happens to the graph when you give WAY to much volume
If we have to much volume will shift graph to right
Why do we have a small blip of pressure at point B
Point B is from atrial contraction that is why you have a small increase in pressure, Atria contraction helps add 10ml to ventricles of total 70, so 60 ml not related to atria contraction
As we increase RAP what happens to our CO
Decrease overall
Decrease venous return= decrease CO
How do we calculate systemic filling pressure
We take our magic purple platypus and they go and stop all blood flow throughout the body. We wait for the blood to go and find equilibrium. Then the Purple Platypus go and take a pressure gauge and measure a “normal” value
Psf=7mmHg
In this picture what would cause an increase in plateau and a shift to the left
Increased contractility
What will cause a decrease in plateau and a shift to the right
Decrease contraction
What kind of heart for our class does the red line depict
A hyper effective heart
What does the black and red line represent
Black line is normal
Red line is strenuous exercise
No question yet just PTSD
What does the red line represent
Heart failure
What does the Mean Circulatory filling pressure take into account that the systemic filling pressure does not
Pulmonary Circuit
if we have increase volume what would we do to keep filling pressure the same
Inhibit sympathetic nervous system
How would an increase in SVR impact arterial pressure. What happens to the resistance
Increase in SVR would increase arterial pressure and make blood flow through arterioles more difficult to get from arteries to veins and back, this would increase our resistance to venous return like green
If we dilate the arterioles what color line would be indicative of that
Blue
What does PE represent on this graph?
Potential energy. Energy that must be used in order to get the heart to where it can produce work. Schmiddy said not to worry too much about this, and for that reason it will definitely be on the exam, have fun.
For this class if we were to increase the after load the heart is pumping against, how would this adjust the shaded area.
We would probably say that this would make pressure loop “taller”
If the frank starling law were in effect due to an increase in venous return to the heart. how would this change the volume pressure loop.
increase in venous return would in turn increase the stroke volume as such for this class we could as the volume pressure loop would get “wider”
What is the cause of the “blip” that occurs just before point B
atrial contraction
At what time period of the cardiac conduction cycle is point C represented
Trick question !!! pressure volume loops don’t account for time, crazy I know!
What is represented by A,C and V
A – atrial contraction
C– Ventricular contraction
V- filling of the atria
if we were to pause our CV system and you know die…. once all the pressure in the CV system were in equilibrium what would the pressure be?
7 mmHg
Will a patient with a high PSF for this example 14 mmHg have a larger or smaller amount of venous return?
for this class probably larger.
If you have lost a massive amount of blood, how will your body respond in order maintain a PSF thats compatible with living?
Sympathetic stimulation
If you are fluid overloaded because someone gives you like 6L of fluid how will you compensate to maintain PSF and by extension a normal cardiac output?
sympathetic inhibition.
