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Physiology I > Lab Final > Flashcards

Lab Final Flashcards

1
Q

Where is the auscultatory position for the aortic valve?

A

2nd intercostal space to the immediate right of the sternum

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2
Q

Where is the auscultatory position for the pulmonary valve?

A

2nd intercostal space to the immediate left of the sternum

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3
Q

Where is the auscultatory position for the tricuspid valve?

A

5th intercostal space to the immediate left of the sternum

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4
Q

Where is the auscultatory position for the mitral valve?

A

5th intercostal space on the mid clavicuar line (over apex of heart)

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5
Q

S1 and the mitral valve may sound louder if the patient:

A

leans forward and left while twisting a bit to their right.

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6
Q

What is the S1 heart sound and what produces it?

A

“lub” is produced by the closing of atrioventricular valves at the beginning of ventricular systole (contraction/emptying)

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7
Q

What is the S2 heart sound and what produces it?

A

“dub” is produced by the closing of semilunar valves at the beginning of ventricular diastole (relaxation/filling)

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8
Q

IF you hear odd “swishing,” “clicking,” or “blowing sounds” between S1 and S2 you may be hearing :

A

Murmur

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9
Q

What is the suggested sweep pattern for auscultation of the heart?

A

A P T M

I.e. aortic valve -> pulmonary valve -> tricuspid valve -> mitral valve

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10
Q

arterial blood pressure is a consequence of two parameters:

A

1) cardiac output, and 2) peripheral resistance.

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11
Q

What is the typical systolic blood pressure (SBP)?

A

120 mmHg

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12
Q

What is the typical diastole blood pressure (DBP)?

A

80 mmHg

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13
Q

The cyclical nature of the cardiac pumping action produces a pulse pressure, with is high systolic and low diastolic. What is the typical pulse pressure?

A

SBP-DBP which is 120-80= 40 mmHg

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14
Q

Why is simple screening for high BP so important?

A

It is a way to catch many dangerous cardiovascular diseases before they actually develop

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15
Q

In addition to assessing BP as part of routine 1st time patient screenings, when might chiropractors also record BP?

A
  • if a patient has chest pain
  • for a pre-sports or pre-employment physical
  • for a geriatric patient (where hypertension is common)
  • in patients where symptoms may indicate a heart problem (such as edema in the legs)
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16
Q

What is the indirect way of measuring arterial blood pressure?

A

Sphygmomanometry which increases pressure on a tourniquet over the brachial artery while placing a stethoscope immediately downstream of the site of occlusion.

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17
Q

What are Korotkov sounds?

A

“Thumping” sounds heard during sphygmomanometry due to turbulence in the vessel

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18
Q

there are many potentially confounding factors that can seriously alter an accurate reading of arterial blood pressure. What are some of the most common ones?

A
  • missed auscultatory gap
  • cuff too narrow
  • cuff over clothing
  • patient arm unsupported
  • “white coat” reaction
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19
Q

The white coat reaction can alter systolic blood pressure by how much?

A

11-28 mmHg

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20
Q

The white coat reaction can alter diastolic blood pressure by how much?

A

3-15 mmHg

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21
Q

excessively high pressure is termed:

A

hypertension (HTN)

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22
Q

What is the SBP range for pre hypertension?

A

120-139 mmHg

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23
Q

What is the DBP range for prehypertension?

A

80-89 mmHg

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24
Q

What is the SBP range for stage 1 hypertension?

A

140-159 mmHg

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25
Q

What is the DBP range for stage 1 hypertension?

A

90-99

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26
Q

What is the SBP for stage 2 hypertension?

A

160 mmHg or more

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27
Q

What is the DBP for stage 2 hypertension?

A

100 mmHg or more

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28
Q

What is an auscultatory gap?

A

When lowering the pressure in the cuff, there is a period when the sounds may lessen a bit and in some people the sound may temporarily disappear, termed a auscultatory gap. This would cause the examiner to mistakenly record SBP lower than it actually is

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29
Q

What procedure can be done to avoid inadvertently missing an auscultatory gap?

A

Palpatory systolic BP

30
Q

How would you take a palpatory systolic BP?

A

palpate the radial pulse and rapidly inflate the cuff to the point at which the pulse disappears. This represents the approximate SBP.

31
Q

When pumping up the blood pressure cuff, it should be inflated to a pressure that is ________ above the palpatory systolic pressure

A

20-30 mmHg

31
Q

While checking blood pressure, the sphygmomanometer exhaust valve should be opened so that the pressure falls at what rate?

A

about 3-5 mmHg per sec

32
Q

How are blood pressure values recorded?

A

As a fraction (DBP/ SBP i.e 120/80) and with even numbers

32
Q

How do you calculate mean arterial pressure?

A

MAP = (SBP-DBP)/3 + DBP

NOTE: it is usually around 93

34
Q

Where should the stethoscope head be placed what checking blood pressure with a sphygmomanometer?

A

Slightly medial, just above the ante-cubital fossa

35
Q

What should be the placement of the blood pressure cuff?

A

The bottom of the blood pressure cuff should be about 1” above the ante-cubital fossa and the “artery arrow” should be aligned with brachial artery

also make sure you have a properly fitting cuff for patient size

36
Q

The effect of ______ and ______ can play a profound role in measured BP

A

gravity and vascular resistance

37
Q

What is VO2

A

Oxygen consumption measured in liters per minute

39
Q

What is aerobic capacity?

A

The typically linear relationship between work load (of skeletal muscle) and oxygen consumption - as work load increases, so does oxygen consumption

40
Q

There is a limit to aerobic capacity and it is represented by:

A

Max VO2

41
Q

max VO2 is affected by a variety of conditions. What are they?

A
  • body size
  • gender
  • age
  • heredity
  • training
42
Q

How does body size affect maxVO2?

A

larger people have a higher maxVO2

43
Q

How does gender affect max VO2?

A

males typically have a higher maxVO2 than females (may simply be due to body size)

44
Q

How does age affect max VO2?

A

maxVO2 declines with years

45
Q

How does training affect max VO2?

A

aerobic fitness increases ones maxVO2

46
Q

Oxygen utilization (VO2) is a function of three cardiovascular parameters :

A

VO2 = Heart Rate X Stroke Volume X A-V O2 Difference

Remember that heart rate x stroke volume is simply cardiac output, therefore by knowing A-V O2 and cardiac output, you can calculate VO2

47
Q

What is A-V O2 Difference?

A

arterio-venous oxygen difference. It identifies the difference between oxygen content of the systemic arterial system and the systemic venous system - essentially a measure of oxygen extraction or consumption from metabolizing tissues

48
Q

Who would have a higher stroke volume? A trained or untrained person?

A

Trained

Therefore VO2 is also higher in trained people

49
Q

In graphs of exercise physiology, the linear relationship between cardiac output and VO2 is due to the ______, and the difference in end-point is due to ________.

A
  • heart rate
  • stroke volume

This leads to two lines with different slopes

50
Q

What is the rate-limiting agent when it comes to aerobic work?

A

The heart

51
Q

Because work load is linearly related to VO2, and VO2 is linearly related to heart rate, then:

A

work load should be linearly related to heart rate

52
Q

Submaximal tests measure VO2 and heart rate to at submaximal levels and then graphically estimate max VO2. Why are submaximal tests used to determine fitness?

A

Because of the linear relationship between oxygen consumption and heart rate, the slope of the heart rate/work load line should make it possible to determine how well-conditioned a person is at any point during some exercising activity. This eliminates the need to special equipment and potentially hazardous conditions required to measure max VO2 directly

53
Q

What is the training effect (or training sensitive zone) for cardiovascular conditioning?

A

EXERCISE 3-5 times/week @ 50-85% of maxVO2 for 15-60 minutes

54
Q

What is the pulse rate differential?

A

Exercise HR (aka pulse rate differential) = Resting HR + %maxVO2(Maximum HR – Resting HR)

A ratio of ones exercising heart rate to their normal range used to approximately estimate whether or not an individual is performing at their training threshold.

55
Q

What is ones maximum theoretical heart rate?

A

220 minus ones age in years although some believe that 206 minus ½ your age is a better method.

56
Q

%maxVO2 represents:

A

the percent of ones maxVO2 (with 0.6 as the training threshold to obtain fitness)

57
Q

With this example, calculate the target HR for the “training effect”:

A 25 year old with a resting heart rate of 70 bpm

A

Using:
Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR)

Resting HR = 70
Max HR = (220-30) = 195
%maxVO2 for training effect = 0.6

70 + 0.60(195 – 70) = 145 bpm TARGET PULSE

58
Q

With this example, calculate the percentage of the persons max VO2 being utilized during aerobic exercise:

A 38 year old with a resting heart rate of 55 bpm and a peak heart rate during the exercise of 128 bpm.

A

Using:
Exercise HR = Resting HR + %maxVO2(Maximum HR – Resting HR)

Resting HR = 55
Max HR = 220-38 = 182
Exercise HR = 128

128 = 55 + X(182 – 55) → X or %maxVO2 = 0.57 (just under training sensitive zone)

59
Q

The science of measuring ventilation is termed:

A

spirometry

60
Q

A spirometer records:

A

both the amount of air as well as the amount over time.

61
Q

The routine amount of air moved by the lungs during breathing?

A

Tidal volume (TV) which is normally 500ml at rest but can rise to more than 3 liters during exercise!

62
Q

The “spare” air than can be inhaled?

A

Inspiration reserve volume (IRV) and is normally around 3 liters

63
Q

The “spare” air than can be exhaled?

A

Exploratory reserve volume (ERV) which is normal about 1 L

64
Q

The total amount of air that can be moved by the lungs in a given ventilation cycle

A

Vital capacity (VC) which is the sum of tidal volume, IRV and ERV and normally about 4.5 liters

65
Q

The total amount of air that can be forced out of the lungs (from a fully inhaled state) in a specified amount of time

A

Forced expiratory volume (FEV), usually measured over 1 second (sometimes 3 seconds), thus FEV1.0 (or FEV3.0).

66
Q

What is the percentage of forced expiratory volume per forced vital capacity over 1 second (FEV1.0/FVC) for a normal adult?

A

65-85%

67
Q

What is the percentage of forced expiratory volume per forced vital capacity over 3 second (FEV3.0/FVC) for a normal adult?

A

80-100%

68
Q

The total amount of air that can be forced in and out over a specified amount of time

A

Maximum voluntary ventilation

It is usually measure for about 10 seconds and then extrapolated to the total amount of air that could be moved in 1 minute

69
Q

In a breath holding experiment, rank from shortest to longest duration: the expected breath holding times at rest, after hyperventilation and after hypoventilation

A
  • after hypoventilation breath holding time would be shortest
  • at rest breath holding time would be intermediate
  • after hyperventilation breath holding time would be longest
70
Q

the feeling of wanting to breathe, “breathing hunger”

A

Dyspnea

71
Q

Target HR (straight up equation)

A

RHR + %maxVO@ (MHR - RHR)

72
Q

%MaxVO2 (straight up equation)

A

(EHR - RHR) / (MHR - RHR)

Physiology I (15 decks)

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