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Advanced Anatomy, Physiology & Pathophysiology II > Exam 1 - Lecture I (Renal Re-Cap, Vascular Properties & CV Cycle) > Flashcards

Exam 1 - Lecture I (Renal Re-Cap, Vascular Properties & CV Cycle) Flashcards

1
Q

Fluid that is completely cleared of a substance is describing what?

A

Clearance.
(Usually referring to plasma.)
Slide 2

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2
Q

Clearance is measured in what units?

A

Volume/Time (mL/min)
Slide 2

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3
Q

What is Free Water clearance?

A

It is a # that tells you how much pure water is being removed from the blood.
Slide 2

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4
Q

What hormone governs Free Water clearance?

A

ADH
Slide 2

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5
Q

Your patient is hyponatremic. Do you expect her Free Water clearance to be high or low?

A

High!
The kidney will get rid of free water to increase her osmolarity.
(You would expect low FWC if she were hypernatremic)
Slide 2

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6
Q

Do we typically reabsorb ALL of the glucose we initially filter?

A

YES!
Slide 2

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7
Q

Identify each formula.

A

Notice the pattern -
most equations are (UxV / P)

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8
Q

The term that describes how elastic or stretchy something is? (Usually talking about vasculature)

A

Compliance!
Slide 3

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9
Q

What is the formula for compliance?

A

Change in volume / Change in pressure

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10
Q

Arteries are more compliant than veins. True or False?

A

False!
Veins are overall more compliant - the reason they serve as a large blood reservoir. 🩸🩸

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11
Q

What is the most compliant artery?
Why?

A

The aorta - it has to be able to absorb the differing pressures.
This also helps keeps the load down on the left ventricle.
Slide 3

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12
Q

The difference between SBP and DBP is? What are the normal, healthy values of each?

A

Pulse pressure (40) - 120/80
Slide 3

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13
Q

This term describes how rigid something is.

A

Elastance.
Slide 3.

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14
Q

What is the relationship between compliance and elastance?

A

Elastance is inversely proportional to compliance.
(The higher the compliance, the lower the elastance & vica versa)
Slide 3

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15
Q

What two things, from lecture, does the aorta serve as?

A
  1. Pressure reservoir
  2. Secondary pump - keeps blood flowing between heart beats.
    Slide 3
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16
Q

What can pulse pressure tell you?

A

How stiff your arteries are.
Slide 3

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17
Q

What is a normal CVP seen in a healthy patient?

A

0mmHg
Pressure should dramatically decrease as blood returns to the heart.
Slide 3

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18
Q

What is the Delta P of the systemic circulation?

A

100-0
Slide 3

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19
Q

What are 3 reasons the pulmonary circulation is more compliant vs. the systemic?

A
  1. Closer to heart (shorter pathway)
  2. More vessels to choose from
  3. Less resistance vessels compiled with smooth muscle

Slide 3

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20
Q

The large arteries have higher elastance than than the aorta. True or False?

A

True!
The larger arteries are more rigid (elastance) thus experiencing higher pressures than the aorta.

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21
Q

What is the Delta P of the pulmonary circulation?

A

16-2 mmHg
Slide 3

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22
Q

List the pressures each of these chamber’s experience: LA, LV, RA, RV.

A

LA: ~2-5 (should always be low)
LV: 0-120 (lots of variability)
RA: 0-4
RV: 0-25 (variable as well)
Slide 4

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23
Q

You give epinephrine. Would you expect your patients capillaries to constrict? Why or why not?

A

No!
Capillaries have no smooth muscle & cannot respond to pressers.
Slide 5

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24
Q

Which vessels in the body make up most of the total cross-sectional area? What is the numerical value?

A

Capillaries!
4500 cm^2 (Lange)
2500 cm^2 (Guyton)

Slide 5

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25
Q

According to lecture, which vessels accept volume the best? Why?

A

Veins
The walls are thin, giving them lower vascular resistance.

Slide 5

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26
Q

Why is the velocity (V) of blood slower in the venae cavae vs the aorta?

A

Because the venae cavae make up a larger cross-sectional area.
(remember there are 2 vessels = CSA 8cm^2

V= Q/A

Slide 5

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27
Q

What is the formula for velocity?
How do calculate velocity for the circulatory system?

A

V = F/A
Flow rate / Cross-sectional Area
Slide 5 & 6

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28
Q

What is the cross-sectional area for the Aorta and the Venea Cavae?

A

Aorta: 2.5 cm^2
Venae cavae: 8 cm^2

Slide 6 (This is the Guyton table, the Lange table on Slide 5 has slightly different #s)

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29
Q

What is normal cardiac output/ flow rate of the circulatory system?

A

5 L/min

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30
Q

Why do veins have smooth muscle?

A

Helps maintain tone.
Slide 5

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31
Q

The circulatory system is mainly made up of ______ pathways that gives blood many options of flow.

A

Parallel

Slide 7

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32
Q

What are the two ways of flow, as discussed in lecture?

A
  1. Mechanical (the heart pump)
  2. Diffusion (the capillaries)
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33
Q

________ govern blood flow through a tissue by responding to capillary secretion of byproducts such as ____, ____, & ____.

A

Arterioles
Protons (H+), CO2 & Adenosine. (These increase blood flow by causing vasodilation, btw)
Slide 9

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34
Q

Fill in the normal capillary Starling Forces.

A

A. 30
B. 10
C. 17
D. 28
E. -3
F. Irrelevant ‘some low #’ according to Schmidt.
Slide 10

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35
Q

What are the three main colloids that make up our colloid pressure in order from most abundant to least?

A
  1. Albumin
  2. Globulins
  3. Fibrinogen
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36
Q

Your patient has an albumin level of 2.6. Is this high or low? What is normal?
What would you expect in your patient?

A

Albumin level of 2.6 is low.
Normal is 4.5 g/dL
Assuming other colloids and pressures remained normal, you would expect fluid to start leaking out of the vascular space potentially causing edema & hypotension bc your total colloid capillary pressure has dropped.
Slide 11

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37
Q

Why is it so danger-some to have leaky capillaries in the pulmonary circulation?

A

Because oxygen is not very water soluble and you will start to see gas exchange problems.
Slide 11

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38
Q

This helps create tone in the vasculature and is released by the nervous system.

A

Norepinephrine!
Slide 15

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39
Q

All vessels have ANS innervation. True or False?

A

False.
The capillaries do not have innervation or smooth muscle.
Slide 15

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40
Q

“To squeeze or not to squeeze?” That is up to norepi, but what determines how hard to squeeze?

A

The pressure! Depending on what our pressures are will determine the strength of the squeeze.
Slide 15

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41
Q

This second circulatory system runs parallel with our blood vessels and helps rid our blood of toxins and excess fluid.

A

Lymphatic System :D
Slide 16

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42
Q

Two-way valves are crucial in preventing backflow in the venous and lymphatic systems. True or False?

A

False!
“One-Way valves” silly goose.
Slide 16 & 19

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43
Q

What must we consider when giving a paralytic or general sedation and the lymphatic system?

A

Taking away skeletal muscle contraction - it acts as a pump to drive the lymphatic system.
Slide 16 & 17

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44
Q

Normal lymph flow is __ /day. In healthy specimens, it can increase by how much?

A

2L/day
20-fold!!!

(Last semester - lymph 120ml/hr = 2-3L day)
Slide 17

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45
Q

Normally, where does the lymphatic system dump?

A

Subclavian vein.
Slide 16

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46
Q

The lung lymphatic system is not as capable ridding as much fluid as the systemic lymphatic system. True or False?

A

True!
Slide 16

47
Q

Pertaining to gravity, for each _____ cm beneath the heart, we must add ___mmHg of pressure.

A

1.36cm (or 13.6mm)
1 mmHg

48
Q

Where is the isogravimetric point located? What is another name for it?

A

Next to the Tricuspid valve.
“Phlebostatic point”
Slide 19 & 20

49
Q

When standing, what is the normal venous pressure in the lower leg/foot?

A

+ 90mmHg

Slide 19

50
Q

Assuming you are standing, why do your venous and arterial pressures increase as you move inferior to your heart?

A

Gravity, baby!
The higher the column of blood, the higher the pressure - so you should see the highest pressures in your feet.

51
Q

When standing, what is the normal arterial pressure in the lower leg/foot?

A

+190 mmHg
(Affects both SBP and DBP)

Slide 19

52
Q

If this point beneath the subclavian vein is even with the isogravimetric point, why is it +6mmHg and not 0?

A

Slide 19, Guyton pg. 189

53
Q

Why are the jugular veins 0 and not negative?

A

They remain at 0mmHg bc they are collapsed on themselves in the standing person d/t atmospheric pressure. (If cut, they would fall below 0 & collapse even more)
Slide 19, Guyton pg. 189-190

54
Q

What factors are unique about the sagittal sinuses/veins?

A

They are rigid (don’t collapse) & have NO one-way valves - this allows the pressure to be negative (especially when we are standing or upright)
Slide 19

55
Q

Your patient comes in with a hefty skull fracture. What are you worried about as far as pressures in his head?

A

Because the sagittal sinus is rigid, it wont collapse on itself d/t its negative pressure like the jugular veins would. Instead, there is risk it will create a sucking head wound if exposed to atmospheric pressure and possible air emboli. :(

Slide 19

56
Q

Why do people pass out after standing still for a long period of time?

A

When standing still, blood can/will pool in your lower legs/feet because of gravity and no skeletal muscle movement helping return blood to your heart - this eventually decreases your CO and you collapse.
Slide 20

57
Q

Why is patient positioning so important after you give a paralytic?

A

We wouldn’t want to pinch any nerves, cause blood pooling/clots, or pressure ulcers in our paralyzed patient.
Slide 20

58
Q

Describing how much flow blood or air may have is called?

A

Conductance
Slide 21

59
Q

What is the formula for conductance and what is it directly proportionate to?

A

Conductance is proportional to diameter^4.

Slide 21

60
Q

This is the formula for what?

A

Distensibility.
Slide 21

61
Q

Differentiate vascular compliance vs. vascular distensibility.

A

Distensibility - how compliant or EXPANDABLE something is; takes into account the STARTING volume of the system.

Compliance - the change in volume / change in pressure.

Slide 21

62
Q

Systemic veins are ___ times more distensible vs. systemic arteries.

A

8 times!
Slide 21

63
Q

Capillaries are made of ______ cells and allow ____ based substances, water and _____ through but typically not ______.

A

Endothelial, lipid, small compounds (glucose, electrolytes), & proteins/colloids.
Slide 22

64
Q

What is different about the capillaries in the brain vs the systemic circulation?

A

Less porous, the junctions are tighter and more selective.
(Electrolytes typically are confined in the capillary)
Slide 22

65
Q

Flow through a tube depends on what?

A

The pressure gradient.
Slide 23

66
Q

What is the relationship between Delta P and flow through a capillary?

A

The higher the Delta P, the faster the flow!
Slide 23

67
Q

Name and describe the three types of flow discussed in class?

A
  1. Turbulent - disorderly, tolerated okay in the healthy.
  2. Laminar - desired, orderly.
  3. No flow - lolz.

Slide 24

68
Q

Laminar flow has differing speeds in the vessel. Explain this further and why.

A

Laminar flow has a faster flow in the middle of the tube vs a slower speed on the outer bc the blood is hitting the walls of the tube.

Slide 24

69
Q

What does Reynold’s number describe and what is the formula?

A

Predicts turbulent flow.
Slide 24

70
Q

You calculate Reynold’s number for your patient and you get 2000. Does this predict turbulent flow?

A

YES! >2000 = turbulent

Slide 24

71
Q

Low velocity with a small diameter creates an opportunity for a lot of turbulent flow. True or False?

A

False!
HIGH velocity with a LARGE diameter would do this.
Slide 24

72
Q

What vessel most likely experiences a lot of turbulent flow?

A

The aorta
Slide 24

73
Q

Can you have turbulence in your lungs?

A

Yes! This is what causes increased breath sounds like wheezing or crackles.
Slide 24

74
Q

You can hear your patients pulse - this is because of what?

A

Increased turbulence in the vessel.
Slide 24

75
Q

Why are the slopes different between arterial and venous? What do the slopes equate to?

A

The slopes are different because each system responds to pressure and volume changes differently.

Slope = compliance
(lower the slope, the more compliant)

Slide 25

76
Q

Would it be harder to inject saline into a vein or an artery? Why?

A

An artery, because it is less compliant and has higher pressures.
Slide 25

77
Q

If we kept the arterial volume constant (700cc) but lost all sympathetic tone, what would happen to the pressure?

A

It would drop very low. (~40mmHg)
Slide 25

78
Q

As we move further from the heart, pulse pressure gets higher. True or False?

A

False!
As we move further from the source of the pressure (heart) we LOSE our pulse pressure.
Slide 31

79
Q

The _____artery waveform can give us a clean picture of our pulse pressure.

A

Radial.
Slide 31

80
Q

As we age, you can expect pulse pressure to _____ because our arteries ______.

A

Widen, harden.

Slide 31

81
Q

Does arteriosclerosis tend to affect SBP or DBP more? Does it increase or decrease it?

A

Hardened arteries tend to increase SBP.

Slide 31

82
Q

Your patient is diagnosed with aortic regurgitation (leaky valve).
What changes to the DBP would you expect?
And what’s a normal DBP?

A

You would expect a lower DBP, typically ~40mmHg, bc you are losing volume.
Normal is ~80mmHg.

Slide 31

83
Q

You’re preparing for a deep spinal anesthesia on your next case. What should you consider and why?

What medication(s) should you have prepped to react to this possible issue?

A

Hypotension - Losing your sympathetic innervation.
“It shouldn’t go lower than 50mmHg” -Schmidt

You should have Norepinephrine, or some pressor, but it’s best to replace whats missing.
(Remember, nervous system releases NE & NE also helps both your heart & vessels!)

Slide 35

84
Q

The main controller(s) of BP and what keep it consistent throughout the day.

A

Baroreceptors!
Slide 36

85
Q

For baroreceptors, which operate at higher pressures (~20-30mmHg higher) & can act as a ‘backup system’ if pressures get too high?
Aortic or Carotid?

A

Aortic! They are lower thus gravity creates a higher pressure.
(Notice the aortic curve is shifted to the right)

Slide 36

86
Q

What part of the “s” wave is most sensitive to changes in pressure?

A

The middle/steepest incline.
(Pressure increases - firing increases & vic versa.)

Slide 36

87
Q

What does NTS stand for, where is it located and what does it do?

A

Nucleus Tractus Solitarius
It’s in the medulla of the brainstem & is the BP control site! 😁

Slide 36

88
Q

Where on the “s” curve is it least sensitive to changes?

A

The beginning/bottom & end/top.

Slide 36

89
Q

The aortic baroreceptors use the ____ nerve & the carotid use _______ & _______ nerves to send impulses to the NTS.

A

Vagus, Hering’s & Glossopharyngeal

Slide 36

90
Q

What nerve is the glossopharyngeal?

A

CN 9 (IX)

Slide 36

91
Q

What would you expect in your patient if the surgeon clamped both common carotid arteries? Why?

A

Hypertension!
Your carotid baroreceptors would see lower pressures thus signaled to fire faster increasing your arterial pressures. :O

Slide 37

92
Q

If your baroreceptors become denervated, what would you expect?

A

Wide swings in your arterial pressures. :(

Slide 37

93
Q

List the 4 phases of the cardiac cycle (for this semester).

A
  1. Ventricular filling
  2. Isovolumetric contraction
  3. Ejection
  4. Isovolumetric Relaxation

Slide 39 & 40

94
Q

What does the pressure/volume loop tell us?

A

Cardiac function/contractility.

Slide 39

95
Q

Diastolic pressure is also referred to as?

A

Preload or filling pressure.

Slide 39

96
Q

Systolic pressure is also referred to as?

A

Cardiac contractility / function.

Slide 39

97
Q

What is open during phase I of the cardiac cycle and why?

A

AV valves bc the pressure in atria is higher than in the ventricle (~2-5).

Slide 40

98
Q

In the left heart, when the ____ valve closes, Phase II of the cardiac cycle begins and it ends when the _____ valve opens.

A

Mitral, Aortic

Slide 40

99
Q

During ejection, or Phase III of the cardiac cycle, approximately how much blood is ejected?

A

70cc (this is the stroke volume)

Slide 40

100
Q

What is the normal ESV (end systolic volume)?
EDV (end diastolic volume)?
Passive filling volume?

A

ESV - 50cc
EDV - 120cc
PFV - 70cc

Slide 40

101
Q

Which phases in the cardiac cycle are all valves closed?

A

Phase II and IV.
Isovolumetric contraction and isovolumetric relaxation.

Slide 40

102
Q

At the end of phase III going into phase IV, how does ejection continue if the pressure is falling?

A

The ventricles are done squeezing but there is still blood moving through the aorta.

Slide 40

103
Q

If Phase II weren’t a vertical line but deviated, what would this indicate?

A

That you are losing or gaining volume from somewhere in the heart.

Slide 40

104
Q

The pressure outside of the aorta that the ventricle must overcome is referred to as?
What phase of the cardiac cycle begins at this point?

A

Afterload!
Phase III

Slide 40

105
Q

In the left heart, at what pressure does the aortic valve close?
Why does it close?

A

~100mmHg
Aortic pressure > ventricular pressure

Slide 40

106
Q

What is the BP of the pulmonary circulatory system?

A

25/8 mmHg

Slide 3

107
Q

What is a phonocardiogram?

A

Recording of heart sounds ❤️

Slide 38

108
Q

What 4 waveforms are on the Carl Wiggers diagram and what is its overall purpose?

A

Chamber/ aortic pressures, ventricular volume, ECG and phonocardiogram.

This diagram is used to demonstrate the varying pressures in the atria, ventricles and artery during one cardiac cycle.

Slide 38

109
Q

What is the velocity through the venae cavae?
CSA = 8cm^2
Flow rate = 5L/min

A

10.4 cm/sec
(*remember to convert to ml and convert mins to secs)

Slide 6 (Guyton Table used for CSA)

110
Q

What is the formula for resistance?

A

Change in pressure / flow rate

111
Q

What is the PRU of the systemic circulation? (Last semester)

A

1 PRU = (100mmHg - 0mmHg / 100ml/sec)

112
Q

What is PRU? What is the formula for it? (Last semester)

A

Peripheral Resistance Unit

Resistance = change in pressure / flow rate

113
Q

What factors does Poiseuille’s Law include when it comes to flow (Q) through something?

A

Viscosity (n)
Pressure gradient (Delta P)
Length of vessel (l)
Diameter (r)

Slide 21

Advanced Anatomy, Physiology & Pathophysiology II (9 decks)

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