Exam 2 Flashcards

1
Q

_____, this valve disease will decrease left ventricular volume

A

Mitral Stenosis

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2
Q

____, this valve disease, causes ventricular enlargement.

A

Aortic Stenosis

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3
Q

More plasma potassium leads to more potassium going into the cell, leading to (depolarization or hyperpolarization), less excitable cells and bradycardia

A

hyperpolarization

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4
Q

3rd Heart Sound most likely occur …

A

during the rapid filling phase

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5
Q

4th heart sound most likely occur…

A

during atrial contraction

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6
Q

2nd heart sound most likely occur…

A

by the closure of aortic and pulmonic valves

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7
Q

1st heart sound most likely occur…

A

by the closure of the mitral and tricuspid valve

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8
Q

____ causes systolic murmur.

A

Mitral regurgitation

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9
Q

____ causes diastolic function disorder

A

Mitral stenosis, Aortic Regurgitation, Restrictive Cardiomyopathy

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10
Q

Afterload is related to ______ (BP=COxTPR)

A

arterial pressure

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11
Q

Preload is related to …

A

volume and venous return

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12
Q

Increase afterload occurs with (increase, decrease) arteriolar resistance, and increased preload occurs with (less, more) venous compliance

A

increase; less

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13
Q

Tension is greatest in ….

A

big vessels with large diameters (aorta)

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14
Q

Tension is smallest in…

A

small vessels with low pressure (capillaries)

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15
Q

Vasculitis disease includes…

A

Raynaud
Buerger
Wegner

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16
Q

Coronary blood flow is controlled mainly by autoregulation, and coronary blood flow is (highest, lowest) at a high heart rate.

A

lowest

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17
Q

Coronary autoregulation is primarily through ____ activation and ___ generation

A

eNOS; NO

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18
Q

Patient with 75% occlusion: What do we expect?

A

Symptoms with exercise

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19
Q

Patient with 95% occlusion: What do we expect?

A

Symptoms at rest and with exercise

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20
Q

Cardiac demand for O2 is increased by …

A

high systolic pressure
increased ventricular volume
increased heart rate of stroke volume

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21
Q

Infarction is…

A

necrosis resulting from irreversible cellular hypoxia.

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22
Q

(1/3 or 2/3) of total CV volume is intracellular volume.

A

2/3

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23
Q

1/3 of total CV volume is extracellular volume and of that, ___% is plasma volume and ___% is interstitial volume

A

20;80

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24
Q

Fluid Flux: Starlings Law – flux occurs (up/down) pressure gradient

A

down (high to low)

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25
Q

Fluid Flux: Normal flux is out on the end of (arterial or venous)

A

arterial

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26
Q

When baroreceptors detect low pressure ….

A

SV increases, TPR increases, Vasoconstriction increases, and CO increases

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27
Q

The baroreflex is great for controlling blood pressure for (long-term or short term)

A

short term

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28
Q

____ + ___ are great for controlling blood pressure long term

A

AVP;RAAS

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29
Q

AVP: High levels of ___ in the body activate aquaporins to increase volume

A

sodium

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30
Q

____ increases sodium retention in the kidney to pull water back in and increase volume

A

RAAS

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31
Q

Match type of Shock

Hemorrhaging due to major car accident

Cardiogenic 
Hypovolemic
Neurogenic
Septic
Anaphylactic
A

Hypovolemic

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32
Q

Match type of Shock

Allergic reaction to lisinopril

Cardiogenic 
Hypovolemic
Neurogenic
Septic
Anaphylactic
A

anaphylactic

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33
Q

Match type of Shock

Bacterial endotoxin

Cardiogenic 
Hypovolemic
Neurogenic
Septic
Anaphylactic
A

Septic

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34
Q

Match type of Shock

Anesthesia

Cardiogenic 
Hypovolemic
Neurogenic
Septic
Anaphylactic
A

Neurogenic

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35
Q

Match type of Shock

Myocardial Infarction

Cardiogenic 
Hypovolemic
Neurogenic
Septic
Anaphylactic
A

Cardiogenic

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36
Q

Normal CK level for a man?

A

38-200 IU/L

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37
Q

Normal CK level for a woman?

A

26-150 IU/L

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38
Q

Troponin is the cardiac specific troponin biomarker with a normal value of …

A

< 1.5 ng/mL

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39
Q

Troponin, Creatinine Kinase, and lactate dehydrogenase are all cardiac markers and markers of ____ damage

A

muscle

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40
Q

Normal ratio of LDH1:LDH2 is (greater or less) than 1

A

less

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41
Q

Increase radius + Decrease resistance= ___ flow

A

increase/more

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42
Q

Arterioles: Decrease radius + increase resistance would decrease flow which means there are more pressure in the upstream (artery) or downstream (capillaries)

A

Less Flow= Less pressure downstream but more pressure upstream

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43
Q

___ valve disease, pressure overload in L. Atrium

A

Mitral Stenosis

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44
Q

____ valve disease, Pressure overload in L. Ventricle

A

Aortic Stenosis

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45
Q

____ valve disease, loud S1, Diastolic sound

A

Mitral Stenosis

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46
Q

____ valve disease, Late (S4) systolic sound

A

Aortic Stenosis

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47
Q

____ valve disease, long S1 sound, Systolic (all)

A

Mitral Regurgitation

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48
Q

_____ valve disease, Volume overload of Atrium, enlargement of atrium and ventricle (S3)

A

Mitral regurgitation

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49
Q

____ valve disease, volume overload of ventricle

A

Aortic regurgitation

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50
Q

_____ valve disease, early diastolic murmur, floppy valve leaflets

A

Aortic regurgitation

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51
Q

Low resistance would (increase or decrease) flow

A

increase

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52
Q

low pressure would (increase or decrease) flow

A

decrease

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53
Q

Increased resistance would increase pressure and flow (upstream or downstream)

A

upstream

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54
Q

Decreased resistance would increase pressure (upstream or downstream)

A

downstream

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55
Q

Sympathetic would (increase or decrease) compliance which results in more pressure (stiffen walls)

A

decrease

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56
Q

Less compliance would result in (more or less) volume and result in increased venous return

A

less

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57
Q

Increase in Sympathetic Tone will (decrease or increase) cardiac output

A

increase

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58
Q

T or F: Parasympathetic NS has little effect on venous tone

A

T

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59
Q

T or F:
Parasympathetic only affects arteriolar resistance in small subset of arterioles and this would not directly alter Cardiac output

A

T

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60
Q

Mitral Stenosis increases left atrial pressure work and would (decrease or increase) L. Ventricle Stroke volume

A

decrease

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61
Q

Aortic Stenosis increases ____ pressure

A

left ventricle

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62
Q

___ heart sound is during atrial contraction, occur with LV enlargement secondary to aortic stenosis

A

4th

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63
Q

___ heart sound is during rapid filling phase

A

3rd

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64
Q

Mitral stenosis causes (ventricular or atrial) enlargement

A

atrial

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65
Q

In a third degree AV block the origin of ventricular wave of depolarization is in:

  • SA
  • AV
  • Purkinje Fibers
  • Cardiomyocytes
A

Purkinje Fibers

66
Q

In Ventricular tachycardia, the origin of the ventricular wave of depolarization is:

  • SA
  • AV
  • Purkinje Fibers
  • Cardiomyocytes
A

Ventricular tachycardia- origin is in ventricle and QRS is different (wide and fast)

Answer: Cardiomyocytes

67
Q

Which causes a disorder of diastolic function?

  • Aortic stenosis
  • Mitral regurgitation
  • Dilated cardiomyopathy
  • Restrictive cardiomyopathy
A

Restrictive Cardiomyopathy

affects the heart’s ability to relax and fill

68
Q

(Restrictive or Dilated) myopathy mainly affect contractility and pumping ability

A

dilated

69
Q

Administration of α1 agonist drug would (increase or decrease) blood pressure, followed by a reflex (increase or decrease) in heart rate

A

increase; decrease

70
Q

Increase parasympathetic nerve activity to the heart would (increase or decrease) blood flow to kidney

A

decrease,

increase PNS to heart will decrease heart rate, decreasing cardiac output and decrease flow to kidney

71
Q

Increased sympathetic nerve activity to the (kidney or heart) would increase blood flow to the kidney

A

heart,

Increase SNS to heart will increase HR, increasing Cardiac output and aortic blood pressure resulting in increased driving pressure to kidney

Increase SNS to kidney would cause renal vasoconstriction= reduce flow to kidney

72
Q

T or F:

Increase parasympathetic nerve activity to the kidney would increase blood flow to the kidney

A

False;

No direct effect of PNS on kidney

73
Q

Adenosine is a (dilator or constrictor)

A

dilator

74
Q

____, ____, ____ act as vasodilators or constrictors that would be affected by endothelial damage.

A

Adenosine, Bradykinin,

Acetylcholine

75
Q

____ acts as vasodilators or constrictors that acts directly on the vascular smooth muscle

A

Ang II, AVP, ANP, Prostaglandins

76
Q

Order of progression of atherosclerosis:

Lipid deposition to complicated injury

A

Monocytes invade intimal layer (through endothelial barrier) then smooth muscle cells migrate into intimal layer and in complicated lesion (not early stage) hemorrhages/ infection occurs

77
Q

Atherosclerosis of coronary arteries would increase your risk of myocardial ischemia because it would reduce ___ supply

A

O2

`

78
Q

Hypertension would increase your risk of myocardial ischemia by (increasing or decreasing) work of heart

A

increasing,

increase work of heart increase workload (O2 demand)

79
Q

Aortic valve insufficiency increases your risk of myocardial ischemia by …

A

increasing work of heart (workload increase Oxygen demand)

80
Q

Would lymphatic disease increase your risk of myocardial ischemia?

A

No, lymphatic disease would cause peripheral edema, would not affect the work of heart

81
Q

Patient with coronary arterial atherosclerosis with 80% occlusion, what would most likely occur?

  • Elevated serum troponin I
  • Elevated ST segments with exercise
  • Angina at rest
  • A fourth heart sound
A

Elevated ST segments with exercise

With exercise, insufficient flow to match higher oxygen demand will result in ischemia and altered ST segment

82
Q

Elevated serum Troponin 1 occur after > ___% occlusion (after cardiac necrosis)

A

90

83
Q

Angina at rest occur (only common) with > __% occlusion

A

90

84
Q

Lymphatic flow is decreased with (increase or decrease) venous pressure

A

increase,

increase venous pressure reduces the gradient of flow from interstitium back to the veins

85
Q

Thromboxane production causes…

A

platelet to aggregate and cause thrombi to form

86
Q

Diseases associated with thrombi includes…

A

Atherosclerosis, Aneurysms, Injection/Inflammation, Cardiac valve disease with calcification or infection (endocarditis)

87
Q

Deep red to blue-purple skin most likely associated with …

  • Arterial thrombosis
  • Venous thrombosis
  • aneurysm
  • endocarditis
A

venous thrombosis

88
Q

Pale skin is associated with (venous or arterial ) thrombosis

A

arterial

89
Q

Complications of thrombosis includes ____ with edema (venous thrombosis) due to higher pressure the swelling press on nerve and cause nerve pain

A

neuralgia

90
Q

Vasculitis disease, ____, cause vasospasm in hand (red, white, blue)

A

Raynaud’s disease

91
Q

Vasculitis disease, _____, occurs in the kidneys and lungs

A

Wegner’s

92
Q

Vasculitis disease, _____, affect blood vessels in the brain (temporal arteritis)

A

giant cell arteritis

93
Q

Vasculitis disease, ____, induce inflammation from smoking, history of smoking alter vascular response cause inflammation of blood vessels long term

A

Buerger’s

94
Q

Vasculitis disease, _____, induce inflammation from cold/stress, induced vasospasm induced by cold exposure or stress

A

Raynaud’s phenomenon

95
Q

Increase in ____ reflects inflammation made by smooth muscle cells, endothelial cells, macrophages, lymphocytes, hepatocytes + adipocytes)

A

C-reactive protein (CRP)

96
Q

Complication of atherosclerosis includes the increase in blood pressure due to (more or less) venous compliance which leads to stiffer vessels and further results in increased pulse pressure (systolic>diastolic)

A

less

97
Q

Problem with peripheral artery atherosclerosis: severe condition includes arteriosclerosis obliterans which is…

A

cannot feel pulse below site

98
Q

_____ affects perfusion and responsiveness.

A

Vasculitis

99
Q

To increase flow- increase pressure in artery and/or increase (resistance or radius) of arteriole

A

radius

100
Q

Ventricles contraction begins to occur when Mitral valves (open or close).

A

close

stop filling to contract

101
Q

Isovolumetric (contraction or relaxation) is when aortic valve is closed then we close mitral valve and volume of blood in chamber is held constant

A

contraction

102
Q

___ heart sound is in early diastole; can be in normal, large heart

A

S3

103
Q

(stenosis or insufficiency) valve does not completely close which results in backflow

A

insufficiency

104
Q

____ pathway is the SA to AV and to reach from SA to left atrium is the bachmann bundle.

A

internodal

105
Q

Internodal pathway is the SA to AV and to reach from SA to left atrium is the ____bundle.

A

bachmann

106
Q

Sympathetic nerves via ___ activation of HCN increase SA and AV activity

A

beta-1

107
Q

Parasympathetic (Vagus) nerves via ____ inhibition of HCN decreases SA and AV activity

A

M2

108
Q

R-R intervals and P-R intervals are shortened by (SNS or PNS)

A

SNS

shorter –> decrease

109
Q

P-R interval reflects _____

A

AV node delay

110
Q

R-R interval reflects ___

A

heart rate

111
Q

QRS complex reflects the (atrial or ventricular) depolarization

A

ventricular

112
Q

Automaticity of other cells are over-ridden by rate set by ____ because it is faster.

A

SA

113
Q

____ degree nodal block results in more excitation of atria (P wave) than ventricle (QRS)

A

second

114
Q

____ degree nodal block results in longer AV delay, increase P-R interval

A

First

115
Q

____ degree nodal block results in irregular P-QRS interval due to dissociation of atrial and ventricular depolarization (no impulse gets thru AV node)

A

Third

116
Q

Ventricular ectopic focus would produce ___ shaped QRS, with regular p waves

A

abnormal

117
Q

T or F: ischemia can cause reentry and ectopic foci.

A

T

118
Q

Increase plasma (outside) potassium will result in (more or less) negative resting membrane potential

A

less

119
Q

Torsades des pointes have long ___ intervals

A

QT

slow time to repolarize

120
Q

Early triggered beats _____ produces tachycardia which excites cells earlier than we should

A

afterdepolarization

are early action potentials

121
Q

Tachycardia occurs if there is (decrease or increase) plasma K+ which results in a more negative RMP, Na If channels available to open, more excitable, and repolarization period is faster.

A

decrease

122
Q

Tachycardia is (more or less) negative RMP

A

more

123
Q

Contractility increases force of contraction which leads to (more or less) cardiac output

A

more

124
Q

Beta- adrenergic stimulation increases ____ release to cause stronger contraction

A

Ca++ (calcium)

125
Q

_____ cardiomyopathy is thickening of ventricular walls, abnormal diastolic relaxation.

A

Hypertropic

126
Q

In hypertropic cardiomyopathy, Contractility normal (or increase) – (increase or decrease) relaxation– increase diastolic filling pressure– more muscle mass (more oxygen demand)

A

decrease

127
Q

_____ cardiomyopathy is ventricular dilation, Impaired systolic function, impair contractility – reduced stroke volume

A

Dilated

128
Q

_____ cardiomyopathy is the rigidity of ventricular wall, impaired diastolic relaxation

A

Restrictive (constrictive)

129
Q

In restrictive cardiomyopathy, decrease relaxation results in increase diastolic filling pressure and (increase or decrease) venous pressure

A

increase

130
Q

Which cardiomyopathy affects systolic pumping ability?

  • Constrictive
  • Hypertrophic
  • Dilated
A

Dilated

131
Q

____= resistance, regulated by SNS, hormones, and local facors acting on vascular smooth muscle and regulate intracellular calcium

A

Tone

132
Q

Constrictors increase calcium release from SR and they include…

A
Norepinephrine via alpha 1
Angiotensin 
Vasopressin
Prostaglandin PGF2alpha
oxygen
133
Q

Dilators increase calcium storage in SR and/or increase K+ efflux and includes…

A
Adenosine
Bradykinin
Lactic Acid
CO2
NO (nitric oxide)
Prostacyclin 
Epinephrine (low dose) via beta 2
ACh
134
Q

Need ___ release to activate eNOS to produce NO from L-arginine, release of NO goes through soluble guanylate cyclase which activates sGMP and results in vasodilation and increases flow.

A

Calcium

135
Q

Baroreceptors (____ sensors) are stretch receptors in the aortic arch (after heart) and carotid arteries (going toward brain).

A

pressure

136
Q

Increased blood pressure will stretch vessel wall and (increase or decrease) baroreceptors firing rate.

A

increase

137
Q

Efferent neural mechanisms for sympathetic nervous system are…

A
HR
Contractility 
Arteriolar Resistance
Venous Compliance
Renin secretion
138
Q

Baroreceptors are good for (long or short) term adaptation

A

short

139
Q

In the long term the baroreflex adapts to shift slope ; (decreasing or increasing) slope of blood pressure called desensitized reflex: it requires a higher blood pressure for SNS to fire.

A

decreasing

140
Q

Efferent hormonal mechanisms play backup and are important for long term control, they include…

A

RAAS (Renin-Angiotensin-Aldosterone system)
AVP (Vasopressin)
ANP (atrial natriuretic peptide)

141
Q

____ results in vasoconstriction by being released once receptors sense high sodium concentration or dehydration. Released from pituitary gland and low conc. of it acts on kidney which increases water channels (aquaporin) AQP which increases and help us retain or conserve water. High conc. of it will lead to constriction.

A

AVP;

Low conc. –> Increase AQP channels (conserve water)
High conc. –> vasoconstriction

142
Q
RAAS: Angiotensinogen is converted to Angiotensin 1 (inactive) by renin which is then converted into angiotensin II by ACE1. Renin is produced by kidney. 
Angiotensin II (active) will do these three things...
A

stimulate THIRST
VASOCONSTRICTION
Stimulate Adrenal to release Aldosterone (sodium retention)

143
Q

Renin is secreted if Pressure and sodium is (high or low) and SNS is stimulated via beta 1.

A

low

144
Q

ANP is released when filling pressure of heart (decrease or increase).

A

increase

145
Q

Increase flow release (dilators or constrictors)

A

constrictors; to increase resistance (Q=P/R)

146
Q

Normal control of coronary blood flow is by ____ – vessels dilate to meet increased oxygen demands

A

autoregulation

147
Q

Coronary autoregulation is primarily through adenosine-induced eNOS activation and ___ generation–> cause soluble GMP mechanism (dilation)

A

NO

148
Q

Demand for Oxygen is increased by…

A

Increase ventricular volume
high systolic pressure
increase wall thickness (hypertrophy)
increased heart rate or stroke volume

149
Q

Supply for Oxygen is limited by…

A

increase coronary resistance
reduced flow
reduced oxygen availability

150
Q

Microcirculation…

A

arterioles get smaller in size as they branch further into tissue… at point of capillary, a precapillary sphincter controls whether the capillary is open or not

151
Q

Fluid flux occurs between …

A

capillary lumen and interstitium

proportional to net filtration pressure= Hydrostatic pressure (water) - Oncotic pressure (protein)

152
Q

In fluid flux, ____ do not move across capillary (from interstitial to lumen, or from lumen to interstitial)

A

protein (oncotic pressure)

153
Q

(higher or lower) protein concentration in the plasma

A

higher

154
Q

Hydrostatic pressure will flow outside (interstitial) to inside (lumen) if the oncotic pressure is (high or low)

A

HIGH

unbound protein pull water across membrane (net fluid reabsorption)

155
Q

At the arterial end of capillary– Net (outward or inward) flux

A

outward, inc. hydrostatic pressure

156
Q

At the venous end of capillary– Net (inward or outward) flux

A

inward, inc. oncotic pressure

157
Q

Net flux overall in the body tend to be slightly (positive or negative)

A

positive (push out fluid) (hydrostatic pressure tend to be more than oncotic pressure)

158
Q

Inc hydrostatic pressure, more fluid flow out of capillaries, and interstitial fluid pressure increases which (increase or decrease) lymphatic flow.

Lymphatic flow is determined by pressure gradients, there is no pumping action.

A

increase

Pressure would go up (systolic) - pulsation of arteries pushes on lymphatic and cause them to go up to vena cava.

159
Q

______ determines flux of fluids (which could contain the solutes)

A

Fc or filtration coefficient

160
Q

Constriction of arterioles will (increase or decrease) capillary pressure

A

decrease

constrictions of arterioles, or venous obstructions will decrease capillary pressure

161
Q

Edema – fluid lost out of capillaries; caused by increased venous pressure, lymphatic failure, (increase or decrease) oncotic pressure

A

decreased