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FINAL Flashcards

1
Q

Cardiac Output using Ohm’s law

A

(MAP-CVP/SVR) x 80

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2
Q

Partial pressure of substance (outside body)

A

Patm x % of molecules

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3
Q

Partial pressure of inspired gas (PiO2)

A

% x (Patm-PH20) partial pressure of H20 is 47

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4
Q

Pressure of oxygen in alveoli (PAO2)

A

[FiO2 x (Patm - PH20)] - PaCO2/0.8

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5
Q

How do you calculate A-a gradient and what is the normal?

A

PAO2- PaO2 (5-15 mmHg)

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6
Q

Law of Laplace (sphere/alveoli)

A

P= 2T/R

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7
Q

Compliance

A

Delta V/Delta P or (TV/PIP-PEEP)

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8
Q

Boyle’s Law/Ideal gas law

A

PV=nRT (as pressure drops, volume increases)

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9
Q

Alveolar Ventilation

A

(TV-DV) x RR

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10
Q

How do you calculate dead space (DV)?

A

2 ml/kg of IBW or PaCO2-PeCO2/PaCO2 (take % and apply to TV)

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11
Q

Total O2 Content

A

(1.39 x Hgb x %sat) + 0.003 PO2

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12
Q

Dissolved CO2

A

PaCO2 x 0.067

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13
Q

IBW

A

Women 105 + 5 lbs for every in over 5’ Men 106 + 6 for every in over 5’

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14
Q

Calculating Stroke Volume

A

EDV-ESV

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15
Q

Calculating EF

A

(EDV-ESV)/EDV x 100

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16
Q

Calculating MAP

A

1) SBP-DBP 2) divide by 3 3) add that to diastolic

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17
Q

Pulse Pressure

A

SBP-DBP

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18
Q

Coronary Perfusion Pressure

A

DBP- LVEDP

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19
Q

What % of CO does the liver get?

A

25%

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20
Q

What are the functional units of the liver?

A

hepatic lobule or acinus

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21
Q

Normal hepatic blood flow

A

1500 mL/min

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22
Q

How much blood flow comes from the hepatic artery?

A

25-30%

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23
Q

How much blood flow comes from the portal vein?

A

70-75%

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24
Q

O2 sat of blood from portal vein

A

60-85%

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25
Q

How much oxygen does the hepatic artery supply?

A

45-50% of requirements

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26
Q

How much oxygen does the portal vein supply?

A

50-55% of requirements

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27
Q

Mean BP of hepatic artery

A

40-70

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28
Q

Mean BP of portal vein

A

5-10

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29
Q

Why is the dual supply to the liver important?

A

makes it resistant to hypoxia

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30
Q

Hepatic arterial flow is dependent on…

A

autoregulation

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31
Q

Portal vein flow is dependent on…

A

blood flow to GI tract and spleen

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32
Q

What happens to liver blood flow after meals?

A

increases

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33
Q

What vessels converge to form the hepatic portal vein?

A

superior mesenteric, inferior mesenteric, and splenic veins

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34
Q

Receptors in Hepatic artery vs portal vein

A

artery- alpha and beta vein- only alpha

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35
Q

Kupffer cells

A

remove bacteria and endotoxin entering the blood stream from the portal circulation- part of reticuloendothelial system

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36
Q

Metabolic functions of the liver

A

carbs, fats, proteins, drugs

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37
Q

Final products of carb digestion

A

glucose, fructose, galactose

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38
Q

Hepatic conversion of fructose and galactose into ? makes ? metabolism the final common pathway for most carbs

A

glucose

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39
Q

Cells use ? to produce ? either aerobically via the citric acid cycle or anaerobically via glycolysis

A

glucose; ATP

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40
Q

Anion gap

A

(Na+K)-(Cl+HCO3)

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41
Q

plasma osmolarity

A

2(Na+K)+0.055(glucose)+0.36(BUN)

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42
Q

Aortic root pressure

A

1/3(LVP-aortic root P)

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43
Q

Coronary perfusion pressure

A

DBP-CVP

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44
Q

Cerebral perfusion pressure

A

MAP-ICP or MAP-CVP

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45
Q

Filtration fraction

A

GFR/RBF

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46
Q

Glomerular filtration pressure

A

MAP-(colloidal P+glomerular P)

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47
Q

Glucose is stored in hepatocytes as ?

A

glycogen

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48
Q

gluconeogenesis

A

liver produces glucose from lactate, pyruvate and amino acids (maintains normal glucose)

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49
Q

What stimulates and what inhibits gluconeogensis?

A

stimulates- glucocorticoids, catecholamines, glucagon, thyroid hormones inhibits- insulin

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50
Q

Glycogenolysis

A

release of glucose back into circulation

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51
Q

What stimulates glycogenolysis?

A

surgical stress, SNS stimulation

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52
Q

Liver makes plasma proteins except?

A

immunoglobulins

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53
Q

What coagulation factors does the liver NOT make?

A

VIII, vWF

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54
Q

What is produced by the liver that is important in regards to succinylcholine?

A

pseudocholinesterase

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55
Q

The liver combines 2 ammonia with CO2 to produce?

A

urea- excreted by kidneys

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56
Q

What are excess carbs and proteins converted into?

A

fatty acids

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57
Q

Fatty acids are oxidized into…

A

acetyl CoA

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58
Q

Acetyl CoA is used…

A

in cirtic acid cycle to produce ATP

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59
Q

Where is Acetyl CoA stored?

A

liver and adipose tissue

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60
Q

Obstructive vs. parenchymal disorders of the liver

A

obstructive- affect biliary excretion parenchymal- generalized hepatocellular dysfunction

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61
Q

What liver test is considered a true test of function?

A

serum bilirubin- reflects liver’s ability to take up, proess, and secrete bilirubin

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62
Q

Normal serum bilirubin

A

less than 1.2-1.5 mg/dL

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63
Q

van den Bergh reaction

A

indirect positive- unconjugated bilirubin biphasic- both unconjugated/conjugated direct positive- conjugated

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64
Q

What does high unconjugated bilirubin mean?

A

hemoglobin is being broken down too fast or the liver can’t process it fast enough (neurotoxic –> encephalopathy)

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65
Q

What does high conjugated bilirubin mean?

A

bilirubin is backing up in the liver

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66
Q

normal albumin

A

3.5-5.3 g/dL

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67
Q

What does low albumin indicate?

A

liver disease, nephrotic syndrome- half life is 14 days, so values are normal in acute liver disease

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68
Q

Prothrombin time (PT)- what is it and normal range?

A

measures how long it takes for clot to form (activity of fibrinogen, prothrombin, and factors V, VII, X)- 10-14 seconds

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69
Q

Normal platelet count

A

150,000-450,000 mm3

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70
Q

What does a prolonged PT mean?

A

severe liver disease (unless Vit K deficiency is present)

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71
Q

Transaminases

A

enzymes released into circulation as result of hepatocellular injury/death (AST and ALT)

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72
Q

AST

A

associated with cell necrosis (liver, brain, heart tissues)

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73
Q

ALT

A

LIVER CELLS ONLY- indicate cell inflammation

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74
Q

Blood ammonia is cleared by the liver and converted into?

A

urea

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75
Q

Normal ammonia levels

A

47-65 mmol/L

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76
Q

What does an elevation in ammonia indicate?

A

disruption of urea synthesis, severe hepatocellular damage, can cause encephalopathy

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77
Q

What do inhalation agents do to hepatic blood flow?

A

DECREASE- halothane is the worst *(isoflurane is the least- causes arterial dilation that can actually increase hepatic BF)

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78
Q

What does regional anesthesia do to hepatic blood flow?

A

decrease by lowering arterial BP

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79
Q

What does general anesthesia do to hepatic blood flow?

A

decreases by lowering arterial BP and CO

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80
Q

Which nervous system enhances gastric fluid secretion and motility?

A

PNS

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81
Q

Emptying of liquids from stomach begins within ? of ingestion- solids begin after ?

A

1 minute; 15-137 minutes

82
Q

What is responsible for facilitating the emptying of liquids from the stomach?

A

contraction of gastric fundus

83
Q

What is responsible for controlling the emptying of solids from the stomach?

A

antral contractions

84
Q

What substances are ABSORBED in the stomach?

A

highly lipid soluble substances (ETOH, ASA)

85
Q

What empties faster from the stomach, isoosmolar or hyperosmolar fluids?

A

iso-osmolar (could drink up to 150 ml of water right before induction)

86
Q

What condition causes delayed gastric emptying that is not related to fluid type or volume?

A

diabetic gastroparesis

87
Q

What medications delay gastric emptying?

A

opioids, beta agonists, TCA’s, aluminum hydroxide antacid, ETOH, smoking

88
Q

What causes complete gastric stasis?

89
Q

ASA Fasting Guidelines

90
Q

What is the most abundant lymphocyte?

A

neutrophils

91
Q

What do neutrophils do?

A

seek out, ingest, and kill bacteria- first line of defense (increase in number during infection)

92
Q

What do eosinophils do?

A

weak phagocyte- released with foreign proteins like parasites

93
Q

What do basophils do?

A

similar to mast cells- contain histamine and heparin- usually active with allergic reactions

94
Q

What do monocytes do?

A

precursor to macrophages- contain lysosomes and peroxides, breakdown dead tissue

95
Q

What cells are in the second line of defense vs third line of defense?

A

Second- phagocytic WBCs Third- lymphocytes, antibodies

96
Q

Humoral immunity

A

production of antibodies by B cells

97
Q

What do macrophages do?

A

phagocytosis, destruction- present antigen to helper T cells and secrete cytokines

98
Q

What do NK cells do?

A

destruction of virus infected “self” cells and tumor cells, secrete cytokines - do not require antigen stimulation

99
Q

What do helper T cells do?

A

secrete cytokines that stimulate helper T cell proliferation and activation of B lymphocytes, cytotoxic T lymphocytes, macrophages

100
Q

What do cytotoxic T cells do?

A

engage antigen and secrete perforins into foreign cell, secrete granzymes that destroy target cell

101
Q

B cells are to ? immunity as T cells are to ? immunity

A

humoral; cell mediated

102
Q

Summary of the Immune Response

103
Q

ABO Blood Groups

104
Q

Factor I

A

fibrinogen- forms clot

105
Q

Factor II

A

prothrombin

106
Q

Factor III

A

tissue factor/thromboplastin

107
Q

Factor IV

108
Q

vWF

A

von Willebrand- mediates adhesion

109
Q

Factor IX

A

Christmas Factor

110
Q

Factor XI

A

fibrin stabilizing factor- crosslinks fibrin

111
Q

Which factors depend on the presence of Vitamin K for synthesis in the liver?

A

prothrombin, Factors VII, IX, X

112
Q

The clotting cascade

113
Q

which lab value monitors the extrinsic pathway?

114
Q

Which lab value evaluates the intrinsic pathway?

A

PTT and ACT

115
Q

Extrinsic pathway mnemonic

A

for 37 cents you can purchase the extrinsic pathway

116
Q

Intrinsic pathway mnemonic

A

If you can’t buy the intrinsic pathway for 12, you can get it for 11.98

117
Q

FCP mnemonic

A

The FCP can be purchased at the 5 and dime for 1 or 2 dollars on the 13th of the month

118
Q

normal aPTT

A

25-32 seconds

119
Q

Normal INR

120
Q

Mediators responsible for procoag, anticoag, and fibrinolytic activities

121
Q

What is FFP

A

fluid portion of whole blood that contains clotting factors and inhibitors, source of antithrombin III

122
Q

What is FFP given for?

A

dilutional coagulopathy (factors consumed or diluted)- microvascular bleeding, MTP, warfarin reversal, vWF disease, antithrombin III deficiency

123
Q

Should FFP be cross matched?

A

whenever possible

124
Q

What is cryo?

A

precipitate collected off the top of FFP as it is thawed- contains I, VIII, XIII, vWF, Protein C

125
Q

What is cryo given for?

A

microvascular bleeding, vWF disease

126
Q

What are PRBCs given for?

A

bleeding, to increase O2 carrying capacity

127
Q

What blood product can be given unmatched?

128
Q

What are platelets used for?

A

MTP, active bleeding

129
Q

What is a condition characterized by widespread thrombosis and spontaneous hemorrhage that can be caused by sepsis, incompatible blood transfusion, cancer, or pregnancy?

130
Q

What happens in the proximal convoluted tubule?

A

major reabsorption of nutrients (2/3)

131
Q

What happens in the loop of Henle?

A

establishment of osmotic gradient- promotes water reabsorption

132
Q

Difference between thin descending and thick ascending limbs of the loop of Henle

A

thin- very permeable to water thick- not very permeable to water- pumps to move solutes

133
Q

What happens in the DCT?

A

further adjustments in composition of tubular fluid- combination of secretion and reabsorption

134
Q

What happens in the collecting duct?

A

carries tubular fluid through the osmotic gradient in the renal medulla (more fine tuning)

135
Q

Na in the nephron

A

reabsorbed along the entire nephron (2/3 within the PCT)

136
Q

What do the principal cells of the DCT/CD do?

A

reabsorb Na and H20, excrete K- normally impermeable to water unless acted upon by ADH

137
Q

What do the alpha intercalated cells of the DCT/CD do?

A

secrete H (stimulated by aldosterone)- reabsorb K by H-K-ATPase

138
Q

K in the nephron

A

2/3 reabsorbed in the PCT, 20% in ascending thick limb, either reabsorbed or secreted in the DCT and CD depending on dietary K intake (fine tuning)

139
Q

Path of CSF

A

lateral ventricles -> foramen of Monro -> 3rd ventricle -> aqueduct of Sylvius -> 4th ventricle -> Luschka and Magende -> subarachnoid space -> arachnoid villi and venous drainage

140
Q

Average cerebral blood flow

A

50-60 mL/100 g of brain tissue/minute, or 740-900 ml/min

141
Q

What % of CO does the brain receive?

142
Q

Regulation of cerebral blood flow

143
Q

Affect of CBF in response to CO2

A

increased CO2 leads to increased CBF (CO2+H20–> carbonic acid –> H ions, which lead to vasodilation of cerebral vessels)

144
Q

Substances that increase the acidity of the brain will do what?

A

increase H ion concentration, which will increase CBF

145
Q

What does increased H concentration do to neuronal activity?

A

depresses it- “CO2 is a great anesthetic”

146
Q

Affect of oxygen deficiency on CBF

A

a decrease in cerebral tissue PO2 below 30 mmHg increases cerebral blood flow

147
Q

CBF is autoregulated between arterial pressure limits of?

A

around 60-160 (CBF is severely decreased below 50 mmHg)

148
Q

What happens to the CBF autoregulation curve in patients with chronic HTN?

A

shifts to the right

149
Q

CBF Autoregulation

150
Q

Role of SNS on CBF

A

when MAP rises quickly, SNS constricts brain arteries to prevent high pressure from reaching small vessels (prevents vascular hemorrhage)

151
Q

What has a higher metabolic rate, gray or white matter?

A

gray matter

152
Q

What is normal CPP (cerebral)?

A

80-100 mmHg <50= slowing on EEG 25-40= flat EEG sustained <25= irreversible brain damage

153
Q

Decreases in CPP results in?

A

cerebral vasodilation (and vice versa)

154
Q

What does hypothermia do to CMR and CBF?

A

decreases both

155
Q

How quickly is CSF formed?

156
Q

What produces CSF?

A

choroid plexus

157
Q

What absorbs CSF?

A

arachnoid villi

158
Q

C3-5

A

diagphragm

159
Q

thumb dermatome

160
Q

pinky/ulnar dermatome

161
Q

nipple line dermatome

A

T4- think cardiac accelerator fibers

162
Q

groin dermatome

163
Q

belly button dermatome

164
Q

knee dermatome

165
Q

xiphoid dermatome

166
Q

What concentrations are higher in CSF than plasma?

A

sodium, chloride, magnesium

167
Q

What concentrations are lower in the CSF than plasma?

A

potassium, calcium, bicarbonate, glucose

168
Q

specific gravity and pH of CSF

A

1.002-1.009; 7.32

169
Q

Growth hormone releasing hormone (GHRH)

A

-released from hypothalamus -targets anterior pituitary -causes increased growth hormone secretion

170
Q

Growth hormone inhibiting hormone (GHIH)

A

-released from hypothalamus -targets anterior pituitary -causes decreased GH secretion

171
Q

Thyrotropin releasing hormone (TRH)

A

-released by hypothalamus -targets anterior pituitary -increases TSH secretion

172
Q

Corticotoprin releasing hormone (CRH)

A

-released by hypothalmus -targets anterior pituitary -increases ACTH secretion

173
Q

gonadotropin-releasing hormone (GnRH)

A

-released by hypothalamus -targets anterior pituitary -increased secretion of LH and FSH

174
Q

Prolactin-releasing hormone (PRH)

A

-released by hypothalamus -targets anterior pituitary -increased prolactin secretion

175
Q

Prolactin-inhibiting hormone (PIH)

A

-released by hypothalamus -targets anterior pituitary -decreases prolactin secretion

176
Q

Antidiuretic hormone (ADH)

A

-released by posterior pituitary -targets kidneys -increases water reabsorption

177
Q

Oxytocin

A

-released by posterior pituitary -targets uterus and mammary glands -increases uterine conractions, increased milk expulsions

178
Q

Growth hormone/somatotropin

A

-released by anterior pituitary -targets most tissues -increases growth, amino acid uptake and protein synthesis, glycogen synthesis, blood glucose levels

179
Q

Thyroid stimulating hormone (TSH)

A

-released by anterior pituitary -targets thyroid -increases TH secretion

180
Q

Adrenocorticotropic hormone (ACTH)

A

-released by anterior pituitary -targets adrenal cortex -increases glucocorticoid hormone secretion

181
Q

Luteinizing hormone

A

-released by anterior pituitary -targets ovaries and testes -ovulation and progesterone production in ovaries, testosterone synthesis

182
Q

Follicle stimulating hormone (FSH)

A

-released by anterior pituitary -targets follicles in ovaries, seminiferous tubules -follicle maturation and estrogen secretion, sperm cell production

183
Q

prolactin

A

-released by anterior pituitary -targets ovaries and mammary glands -milk production, increased response of follicle to LH and FSH

184
Q

epinephrine

A

-released by adrenal medulla -targets heart, BV, liver, adipose -increases CO, blood flow to muscles, constriction of BV, increased release of glucose and FA

185
Q

Mineralcorticoids (aldosterone)

A

-released by cortex (glomerulosa) -targets kidney -increased Na reabsorption and K/H excretion; enhanced water reabsorption

186
Q

Glucocorticoids (cortisol)

A

-released by cortex (fasciculata) -15-30 mg/day (up to 100 in stress) -targets most tissues -increased protein and fat breakdown, increased glucose production, inhibition of immune response and decreased inflammation

187
Q

Androgens

A

-released by cortex (reticularis) -targets many tissues -development of secondary sex characteristics

188
Q

thyroxine (T4) and triidothyronine (T3)

A

-stimulates oxygen and energy consumption, increases basal metabolic rate -stimulate protein synthesis -t4 is more abundant, T3 is active

189
Q

calcitonin

A

-released by thyroid -stimulates osteoblasts, inhibits Ca release from bone -“tones” down calcium

190
Q

Parathyroid hormone (PTH)

A

regulates serum calcium, phosphate, and vitamin D synthesis

191
Q

Glucagon

A

-released by alpha cells -breakdown of glycogen in liver and muscles -increases glucose level in blood

192
Q

insulin

A

-released by beta cells -increases membrane permeability for glucose, lowers glucose level, stimulates synthesis of glycogen in liver and muscles

193
Q

somatostatin

A

-released by delta cells -inhibits release of GI hormones

194
Q

pancreatic polypeptide

A

self regulate the pancreas secretion activities and affect glycogen levels

195
Q

What are hormones?

A

chemical messengers- either proteins, amino acid derivatives, steroids

196
Q

How are hormones stimulated to be released?

A

-low blood concentrations -SNS fibers stimulate -hypothalamus secrete stimulating hormones

197
Q

4 main stimulants for aldosterone release

A

-hyperkalemia -angiotensin II -hyponatremia -ACTH

198
Q

Where is cortisol metabolized?

199
Q

metabolism of epi and NE

A

metabolized by COMT in the liver and kidney

200
Q

Metabolism of insulin

A

can be metabolized by almost all tissues but mostly by liver and kidneys

A&P (11 decks)

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