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IPPA > FPA- Cardiorespiratory > Flashcards

FPA- Cardiorespiratory Flashcards

1
Q

At what level do the IVC, oesophagus and descending aorta pierce the diaphragm, where do they pierce and why is the location relevant?

A

IVC T8, pierces central tendon, tension holds it open to aid venous return
Oesophagus T10, below muscle part, tension causes blockage so no acid goes upward due to the change in pressure
Descending aorta T12, behind diaphragm as blood flow cannot be interrupted

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2
Q

Name the heart valves and their cusp number

A

3- Tricuspid between RA/V,
Pulmonary between RV and lungs
Aortic between LV and circulation
2- Mitral valve between LA/V

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3
Q

The the three structures that help shut the valves in the RV, LA/V. What is different in the RA?

A

Chordae tendinae
Papillary muscles
Trabeculae carnae

Pectinate muscles, Crista terminalis is the border

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4
Q

What are the layers of the pericardium?

A

Fibrous
Serous (Parietal and Visceral)

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5
Q

What are the three intercostal muscles, their function and orientation?

A

External intercostal- inspiration inferomedially
Internal intercostal- expiration inferolaterally
Innermost intercostal- expiration discontinuous

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6
Q

What are some differences in the right and left lung?

A

Left- 2 lobes, heart descending aorta indents
Right- 3 lobes, azygous SVC indents

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7
Q

What nerves supply the lungs?

A

Sympathetic T1-4 bronchodilate
Vagus Parasympathetic bronchoconstrict

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8
Q

What is the difference between intercalated discs, desmosomes and gap junctions

A

Intercalated discs contain gap junctions and desmosomes
GJ- tunnels allowing signal to transduct
D- hold myocytes together during contraction

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9
Q

How is skeletal and cardiac muscle contraction different?

A

Skeletal, voltage sensor
Cardiac, Ca influx by voltage gated channel

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10
Q

How fast does depolarization spread in the heart?

A

0.5m/s

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11
Q

Generally what does PQRST represent?

A

PQR- Atrial systole SA AV
QRS- Ventricular systole
ST- Ventricular plateau

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12
Q

What are the phases of conduction?

A

0- Rapid rising phase, Na+
1- Early repolarization, Na+ close K+ open
2- Plateau, sustained depolarization, open Ca2+
3- Repolarization, Ca2+ close K+ stay open
4- Resting membrane phase

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13
Q

What are If (funny) channels?

A

Opened by hyperpolarization, allowing Na+ to leak in.

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14
Q

Describe vessels and their different physiology

A

Veins- highly compliant, little recoil, large lumen, less smooth muscle
Muscular artery- high smooth muscle
Elastic artery- more elastin, near heart, compliant
Arterioles- resistance vessels
Capillaries- small lumen, thin walled
Venules- b/n veins and capillaries

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15
Q

What are the three types of capillaries?

A

Continuous- endothelial cells joined by leaky gap junctions
Fenestrated- gaps in endothelial membrane e.g. kidney
Sinusoid- large fenestrations and intracellular clefts e.g. liver

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16
Q

What are intercellular clefts?

A

Gaps in the membrane of vessels

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17
Q

How does a large change in volume affect vein pressure?

A

Only small change as they are compliant

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18
Q

Which vessels has the highest fall in hydrostatic pressure and which has the slowest rate of blood flow?

A

Arterioles as they are resistance vessels
Capillaries as they have the smallest lumen

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19
Q

What are the largest vessels with the smallest cross-sectional area?

A

Elastic arteries and vena cava

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20
Q

What is the relationship between blood pressure and vessels?

A

Further from the heart, lower the blood pressure
Arteries > Capillaries > Veins

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21
Q

What factors increase and decrease blood flow?

A

I- Diameter of Vessel (most effect), Pressure,
D- Distance, Fluid Viscosity

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22
Q

What is laminar and turbulent flow?

A

Straight, unidirectional and jumbled, hitting wall
Laminar is low pressure, turbulent increases pressure

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23
Q

What do capillaries exchange?

A

Water, gases, nutrients and waste

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24
Q

What is transcytosis and pinocytosis?

A

Pino- fluid endocytosis
Transcytosis is both ways

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25
Q

What are the pressures involved in filtration and reabsorption?

A

F- hydrostatic pressure
R- oncotic pressure

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26
Q

As you go towards the venular end, how does capillary hydrostatic and oncotic pressure change?

A

Hydrostatic decreases, oncotic is constant.
Hydrostatic pressure in capillary is high so it goes to low interstitial pressure
Due to proteins in vessel known as albumin, this draws water back in. This occurs when hydrostatic pressure falls below oncotic pressure.

27
Q

How does the autonomic nervous system affect vessels?

A

Sympathetic directly, PS indirectly through heart

28
Q

What are endothelin?

A

Strong vasoconstrictors that begin as initially cause vasodilation by nitrate production

29
Q

What is pulse pressure?

A

Difference between systolic and diastolic BP

30
Q

What is systolic pressure?

A

Pressure measured in arteries

31
Q

What is end-diastolic volume?

A

Amount of blood in the ventricle on the onset of ventricular systole

32
Q

What is the Frank-Starling Mechanism?

A

Increase stretch on cardiac muscle increases stroke volume

33
Q

What makes the lub-dub sound?

A

Lub, mitral/tricuspid valve closing
Dub, semilunar valves closing

34
Q

What is isovolumetric contraction and relaxation?

A

C- Both valves closed before ventricular pressure can exceed aortic pressure
R- Both valves closed before ventricular pressure can fall under atrial pressure

35
Q

How to calculate stroke volume?

A

Subtract end systolic volume from end diastolic volume

36
Q

When does Korotkoff sounds occur?

A

As pump pressure equals systolic blood pressure

37
Q

What two things does inspiration have to overcome and what is energy expended to overcome called?

A

Resistive- friction of airflow in bronchi
Elastic- expansion of lungs and chest wall
WOB

38
Q

What does surfactant do?

A

Prevents collapse of alveoli and thus increases lung compliance

39
Q

What is TLC, VC, RV, TV, FEV1 and FRC?

A

Total lung capacity- air in lungs at maximum inhalation
Residual volume - air in lungs at maximum exhalation
Vital Capacity- air exhaled from TLC to RV
Tidal Volume- volume of any breath
Forced expiratory volume in 1 second
Functional residual capacity, volume remaining after passive exhalation

40
Q

What is the relationship between intrapleural and intra-alveolar pressure?

A

Intrapleural always less than intra-alveolar because of elastic recoil of lungs and chest wall

41
Q

What are consequences to increased WOB?

A

Recruitment of accessory muscles scalene and SCM
Increased O2 consumption by muscles
Risk of respiratory fatigue

42
Q

What factors increases and decreases diffusion of gas?

A

I- surface area, difference in partial pressure
D- thickness of membrane

43
Q

What is ventilation and perfusion and what ratio are they most optimal for gas exchange?

A

P- blood flow V- O2 transfer
V/Q = 1
Analogy too many buses with no passengers
too many passengers with not enough buses to take them all

44
Q

What happens when V/Q is low and its compensation?

A

Not all hemoglobin filled with O2, some of blood returning to left atrium will not be fully oxygenated.
Vasoconstriction occurs in areas of low ventilation to reduce hypoxaemia

45
Q

When is PaO2 low?

A

Low PiO2, low ventilation, abnormal gas exchange (low V/Q, shunt, diffusion impairment)

46
Q

When is PaCO2 high

A

Low ventilation

47
Q

What is a shunt?

A

Shunt is extreme low V/Q, V/Q =0.
Doesn’t respond to supplemental oxygen

48
Q

What ensures ventilation and perfusion is equal?

A

Fractal structure, tree

49
Q

What is the difference between hypoxaemia and hypoxia?

A

Hypoxaemia- reduced PaO2 and SaO2 in systemic arterial blood
Hypoxia- reduced oxygen supply to tissues

50
Q

Where is the steep curve of O2?

A

60 mmHg

51
Q

What are the 4 causes of Hypoxia?

A

Hypoxia- gas exchange abnormality, altitude or hypoventialtion
Anaemic- low or abnormal Hb
Stagnant- insufficient cardiac output
Histotoxic- substance blocking the use of O2 in tissues e.g. CN

52
Q

Where are the baroreceptors?

A

Aortic bodies and carotid bodies

53
Q

What causes hypoventilation?

A

Reduced drive (low CO2), suppression (drug), paralysis

54
Q

What is hypercapnoea?

A

Too much CO2

55
Q

What is normal pH, PaCO2 and HCO3?

A

pH- 7.38-7.42
PaCO2- 35-45
HCO3- 22-28
Respiratory acidosis will see low pH and high PaCO2, compensation is to increase HCO3

56
Q

What are the layers of the pleura?

A

Parietal and visceral

57
Q

What are the innervations of the diaphragm, lungs and pleura?

A

Phrenic
Sympathetic
Sympathetic for visceral pleura, intercostal and phrenic for parietal

58
Q

What factors increase and decrease resistance

A

I- viscosity and distance
D- Diameter of vessel (most effect)

59
Q

What does Ventilation (Ve) = ?

A

Ventilation = Tidal Volume x frequency

60
Q

How does breathing change from rest to exercise?

A

Initial, rapid rise than slow rise to steady-state

61
Q

How does ventilation and VO2 change during incremental exercise?

A

Ventilation linear and then exponential rise, coincides with CO2 production which is major driver of ventilation
VO2 linear then plateaus

62
Q

Why does plasma lactate increase ventilation?

A

Lactic acid production by anaerobic glycolysis, produces H+ which can produce CO2 through buffer, both are drivers of ventilation

63
Q

What are the three phases after exercise and describe what happens in them?

A

Fast phase- replenish O2, ATP/CP
Slow phase- lactate removal, glycogen resynthesis, increase temp
Ultra slow phase- protein turnover

64
Q
A

IPPA (7 decks)

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