Exam 3 - Lecture 3 Flashcards

1
Q

What is the solution?

A

BLOOD

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2
Q

2 forms of oxygen are

A

dissolved and bound

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3
Q

What is dissolved oxygen?

A

How much oxygen is forced into solution

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4
Q

Why does oxygen have a low dissolved content?

A

Not very soluble

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5
Q

The dissolved oxygen PO2 should be the same as

A

environment (? he said this, don’t get it tbh)

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6
Q

What is the force that pushes oxygen into solution?

A

PO2

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7
Q

How is oxygen measured in solution

A

measured in mL O2/mmHg/dL of solution

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8
Q

What is the normal oxygen concentration per dL of solution?

A

.003mL O2/mmHg/dL

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9
Q

What’s the oxygen concentration if you put it in per mL of solution?

A

.00003mL O2/mmHg/mL

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10
Q

Quantity of dissolved oxygen is always measured in

A

volume such as mL/dL/L

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11
Q

Dissolved O2 determines ___, which is what drives O2 _____

A

PO2; on and off hemoglobin

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12
Q

what is the solubility coefficient of oxygen?

A

.003mL O2/mmHg/dL blood

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13
Q

If PO2 = 100 mmHg, then what’s the concentration of dissolved oxygen in the blood?

A

100 x .003 = .3mL O2/dL

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14
Q

Is dissolved oxygen quantity enough to meet metabolic demands?

A

Absolutely fucking not (~250mL/min)

this is why hemoglobin is so crucial

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15
Q

Hemoglobin binding capacity

A

1.34mL O2/g of Hb

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16
Q

Normal Hb is ___, which is how much bound oxygen?

What is this called?

A

15g/dL

15 x 1.34 = 20.1mL O2/dL

Oxygen-carry capacity of hemoglobin

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17
Q

Total oxygen content = __ + ___

A

Dissolved + bound oxygen

0.3 + 20.1 = 20.4mL O2/dL

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18
Q

What is the PVO2?

A

40mmHg (PO2 concentrations in venous blood)

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19
Q

In venous blood, what is the dissolved oxygen content?

A

40 x 0.003 = 0.12mL/O2/dL

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20
Q

What is the amount of bound o2 content in venous blood?

A

15mL/O2/dL

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21
Q

Total oxygen content in venous blood?

A

0.12 + 15 = 15.12mL/O2/dL

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22
Q

Saturation determines what?

A

How much of the carrying capacity is utilized

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23
Q

at 90% O2 sat, what is the bound Hb?

A

90% x 20.1 = 18.09mL O2/dL

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24
Q

What is a normal Hb per this class? how does it differ between populations?

A

15g/dL

Men more, women less

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25
Q

What is HbA and what are the subunits?

A

adult Hb; its a tetramer with 2 alpha and 2 beta subunits

Binds 4 O2 molecules

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26
Q

What is HbF and what are its units?

A

Fetal Hb; 2 alpha and 2 gamma subunits

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27
Q

Which Hb has a higher affinity for O2?

What shift does this mean on the curve?

A

Fetal -> left shift

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28
Q

Why does one Hb have more affinity than the other?

A

HbF has a higher affinity to extract O2 from maternal blood in the placenta. If it had the same affinity, oxygen wouldn’t be motivated to leave HbA for HbF

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29
Q

When is HbF replaced?

A

quickly after birth

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30
Q

EPO is produced by what? What does it do?

A

Erythropoietin is produced by the kidney

Regulates RBC and Hb production

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31
Q

What condition would require synthetic EPO?

A

Renal failure

32
Q

Myoglobin has a similar structure to Hb, but what’s the main difference in structure?

A

only has 1 binding site

33
Q

Explain myoglobins affinity for O2 in comparison to HbA and what kind of shift it creates

A

Higher affinity for O2 than HbA, left shifted.

34
Q

What main 2 things does myoglobin do?

A

Stores O2 in red skeletal muscle

helps unload O2 into working muscle cells

35
Q

What does myoglobin contain and what feature does that result in?

A

Contains iron, this is why red meat is red.

36
Q

How does carbon monoxide (CO) affect O2 carrying capacity?

A

Decreases it by binding to O2 sites with high affinity.

37
Q

How does CO binding affect O2 at the tissue level?

A

CO bound to Hb increases Hb affinity for remaining O2, therefore it DECREASES O2 UNLOADING AT TISSUES

38
Q

How does CO binding affect curve?

A

Left shift with a lower plateau

39
Q

How do you treat CO poisoning?

A

100% O2 to competitively displace CO binding

40
Q

According to oxy-hemoglobin curve, what are normal conditions? (Arterial/venous PO2, Sat, content #’s)

A

Arterial: 100mmHg, 97-100%, 20mL /O2/dL

Venous: 75mmHg, 75%, 15mL O2/dL

41
Q

What are the exceptions in coronary circulation?

What does this indicate?

A

Venous O2 sat drops to 25% because heart extracts 75% of O2

Not much reserve, high vulnerability to ischemia

42
Q

What does a right shift on the oxy-hemoglobin curve mean?

What conditions have a right shift?

A

Decreased affinity for O2, which makes O2 unloading easier

↑ CO2
↓ pH (↑H⁺)
↑ temperature
↑ 2,3-BPG

43
Q

What does a left shift on the oxy-hemoglobin curve mean?

What conditions have a left shift?

A

Increased affinity for O2, makes unloading more difficult.

↓ CO2
↑ pH
↓ temp
↓ 2,3-BPG
- Fetal Hb, myoglobin, CO

44
Q

Increased metabolism will result in what physiologic changes, which results in what? (annoying card, prob have to see answer first to know what im asking, sorry)

A

Increased CO2, H+, Temperature -> Right shift on curve -> Results in the beautiful compensation of more O2 unloading into the tissues

45
Q

What shift would venous blood have? why?

A

Its more acidic, so right shift

46
Q

Sick patients may have a venous saturation of ____ or even lower.

A

60% instead of 75%

47
Q

What is P50?

A

PO2 needed for 50% Hb saturation

48
Q

What is a normal P50?

49
Q

Right shift on the curve does what to the P50?

Left shift?

A

Right shift = increased P50

Left shift = Decreased P50

50
Q

What does an increased/decreased P50 even mean?

A

Increased means you need more O2 to saturate Hb, and a decrease would mean you need less.

51
Q

a right shift means you need more or less O2 to saturate Hb?

A

Right shift = Increased P50 = More O2

opposite is true for left shift.

52
Q

What are the 3 forms of CO2 in the blood?

A

Dissolved, Carbamino compounds, Bicarbonate

53
Q

What are the arterial concentrations of each type of CO2?

A

Dissolved: 5%
Carbamino: 5%
Bicarb: 90%

54
Q

what is the solubility of dissolved CO2 in the arteries?

A

0.06mL CO2/mmHg/dL

at 40mmHg PCO2 -> .06 x 40 = 2.4mL/dL

55
Q

CO2 binds to _____ on proteins, mainly Hb

A

Terminal amine groups

These are the CO2 carbamino compounds

56
Q

CO2 + H2O ⇌ H2CO3 ⇌ ?

A

H⁺ + HCO3⁻

57
Q

? ⇌ H2CO3 ⇌ H⁺ + HCO3⁻

58
Q

What is bicarb catalyzed by?

A

Carbonic anhydrase

59
Q

What is the venous blood composition of CO2?

A

10% dissolved, 30% carbamino, 60% bicarb

52.5mL/dL

60
Q

What is the total CO2 content of arterial blood?

61
Q

How much bicarbonate CO2 is present in 500mL of venous blood under normal conditions?

A

Just take the % composition and multiply total content # to get mL/dL

ex: 0.60 x 52.5 = 31.5 mL/dL

That’s per dL. there are 5 dL in 500mL, so now times that by 5.

Final answer: 157.5mL

62
Q

What’s the Haldane effect?

A

The Haldane effect is when deoxygenated blood can carry more carbon dioxide than oxygenated blood.

Less O2 = More CO2 carried

More O2 = less CO2 carried

63
Q

In the lungs, what promotes CO2 release? (r/t Haldane effect)

A

O2 loading promotes CO2 release

64
Q

CO2 and O2 loading/unloading are ____.

A

Interdependent

65
Q

Final concept integration:

Dissolved O2 sets PO2, which will drive

A

Hb saturation

66
Q

HbF and myoglobin have higher affinity which results in what shift?

67
Q

Carbon monoxide does TWO things to Hgb

A

Decreases O2 capacity AAANNDDDD unloading efficiency

68
Q

P50 gives us insight into _______

A

how willing Hb is to bind to O2

69
Q

O2 unloading helps with

A

CO2 loading

and vice versa

70
Q

What has the lowest venous O2 sat?that

A

Coronary circulation due to extreme demand

25% venous sat

71
Q

A patient’s coronary circulation receives arterial blood at 97% O₂ saturation, and venous blood returns at 24% O₂ saturation.
If the hemoglobin concentration is 15 g/dL, how much O₂ is extracted per dL of coronary blood flow?

(Ignore dissolved O₂ for this calculation.)

A

Hb binding capacity: 1.34mL/O2/g of Hb

1.34 x 15g x 0.97 = 19.497mL O2/dL

then:

1.34 x 15g x 0.24 = 4.824mL O2/dL

subtract them from eachother

final answer: 14.673mL/dL

It’s important to note that he will also probably adjust the Hb level. don’t just assume 15 unless he states under normal conditions

72
Q

A patient’s hemoglobin is 15 g/dL, but 20% of it is bound by carbon monoxide (CO), reducing available sites for O₂.

Arterial O₂ sat = 100%
Venous O₂ sat = 50%

How much O₂ is extracted per dL of blood?

A

real O2 sats = 80% and 30%

1.34 x 15 x 0.8 = 16.08mL/dL

1.34 x 15 x 0.3 = 6.03mL/dL

16.08 - 6.03 = 10.05mL/dL were extracted

73
Q

A patient has:

PO₂ = 100 mmHg
Hb = 15 g/dL
Arterial O₂ sat = 98%
How much O₂ is dissolved in plasma per dL?

A

use dissolved O2 arterial coefficient of .003mL/O2/mmHg/dL

.003 x 100 = 0.3mL O2/dL

the sat has nothing to fucking do with this because dissolved oxygen is independent of Hb saturation, duh!!!

74
Q

A patient has:

-Hb = 10 g/dL

-CO occupies 25% of Hb binding sites

-O₂ saturation is 90%

How much O₂ is bound per dL of blood?

A

Since 25% of sites are bound by CO, that leaves 75% sites remaining for O2

Of those sites, only 90% O2 is bound.

10 (Hb levels) x .75 = 7.5

7.5 x 1.34 x 0.9 = 9.045mL O2/dL

side note to make it relate to real world and help it make sense: patient would be showing a sat of 90% on the monitor. but only 75% of the sites are O2

0.9 x 0.75 = 0.675

0.675 x 10 x 1.34 = 9.045, same answer!