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M1 Block 3 > Lab Practical > Flashcards

Lab Practical Flashcards

1
Q

What type of tissue comprises the heart valves?

A

Fibroelastic tissue
Dense Connective tissue
Outer is lined by endothelial cells

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2
Q

List 5 characteristics of Myocardium

A
  • Cardiomyocytes with centrally located nuclei
  • Intercalated discs
  • Striations
  • Branching patterns
  • Capillary pattern with simple squamous epithelium
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3
Q

The visceral pericardium is AKA

A

Epicardium

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4
Q

Where is mesothelium found?

A

On the visceral pericardium (epicardium) that secretes lubricants

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5
Q

Describe 3 characteristics of visceral pericardium

A
  • Dense fibrocollagenous tissue
  • Coronary Blood vessels & nerves
  • Adipose tissue
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6
Q

What layer are the heart tissue are Purkinje fibers found?

A

Endocardium

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7
Q

What layer is thickest in the aorta?

A

Tunica media because it has a lot of smooth muscle and multiple layers of elastic laminated organized in a concentric fashion

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8
Q

Where are vasa vasorum found?

A
  • the Tunica Adventitia of blood vessels
  • Vasa vasorum: provide oxygen and nutrients for large vessel walls
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9
Q

Aside from Smooth muscle, what else is found in the tunica media

A
  • Elastic fibers
  • Reticular fibers
  • Proteoglycans
  • Elastic fiber plates: with fenestrations for diffusion of nutrients
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10
Q

Describe the tunica adventitia of blood vessels

A
  • Loose elastic and collagen fibers
  • Fibroblasts & macrophages
  • Vasovasorum
  • Nervivascularis
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11
Q

Describe the layers of the muscular arteries

A

Outermost: Tunica adventitia
External elastic laminate
Tunica media
Internal elastic lamina
Tunica intima

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12
Q

Describe the cellular layers of arterioles

A
  • Tunica adventitia: thin
  • Tunica media: 1-2 smooth muscle layers
  • Tunica intima: absent?
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13
Q

Describe the cellular layers of venules

A

Outermost: Tunica adventitia-thin
Tunica media: little to none
Tunica intima: simple squamous & basal lamina endothelium

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14
Q

What blood vessels are the primary sites involved in inflammatory response?

A

Venules by allowing leukocytes to migrate to affected tissue

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15
Q

What surrounds capillaries?

A

Pericytes

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16
Q

Describe the cellular layers of capillaries

A
  • Single layer of flattened endothelial cells lines the capillary lumen
  • Tunica media and adventitia are often absent
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17
Q

Define silent mutation

A

Occur when a base pair change in a coding region does not affect the amino acid that is encoded
Ex. UCG to UGU is silent because both are codons for cystine
- Can also occur when comparing mutation occurring in a non-coding vs coding region

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18
Q

Define Missense mutation

A

The new codon causes insertion of incorrect amino acid into a protein. Genome length does not change
The protein function depends on the new amino acid

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19
Q

Define nonsense mutation:

A
  • The new codon causes the protein to prematurely terminated
  • Product is shortened and non function
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20
Q

When do nonsense mutations occur?

A
  • When the base pair change in a coding region results in the creation of a stop codon
  • Proteins will be truncated as a result of this type of mutation
  • Ex. UGG to UGA in β thalassemia or GGA to UGA in cystic fibrosis
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21
Q

Give an example of mutation causing transcription factor changes leading to congenital deafness or limb abnormalities

A
  • Mutation in Pax 3 leading to Klein Waardenburg syndrome
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22
Q

What is PAX 3?

A

Gene encodes a transcription factor that regulates the expression of genes that impact cell proliferation, survival, differentiation, and motility
- Directs the activity of other genes that signal neural crest cells to form specialized tissues and cell types

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23
Q

β thalassemia can occur by 2 genetic mutation mechanisms:
1.
2.

A
  1. Nonsense mutation where the STOP codon appears early leading to a truncated protein
  2. Mutation in splice site that causes defects in HBB gene coding for β globulin
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24
Q

Tay-Sach disease is related to problems with _____________________. Its genetic mutation is related to _______________ _____________ involving the HEXA gene

A

Tay-Sachs disease is related to problems with sphingolipids. Its genetic mutation is related to mutation in splice sites involving the HEXA gene

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25
Q

Trinucleotide Repeat Expansion: Mutations occurring ___________________ _______ __________
Fragile X syndrome (FXS):
Myotonic dystrophy (MD):

A
  • Trinucleotide repeat expansion with repeats occurring in untranslated region of gene
  • FXS: mutations occurring in 5’ UTR of FMR1 gene
  • DM: mutations occuring in 3’ UTR of DMPK gene
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26
Q

Expansion of trinucleotide repeats: Mutations occurring __________ _________________
- Huntington’s Disease:
- Spinobulbar muscular atrophy (SBMA):

A
  • Mutations occurring in coding region
  • HD: HTT gene repeats
  • SBMA: AR gene repeats
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27
Q

What is hypomorph?

A
  • Loss of function mutation that causes either reduced activity or decreased stability of the gene product
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28
Q

What is amorph?

A
  • Type of loss of function mutation
  • AKA Null allele
  • Complete loss of gene product
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29
Q

Where are sinusoidal capillaries found?

A
  • Wide leaky capillaries
  • Found in liver, spleen, bone marrow
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30
Q

Where do aneurysms tend to form?

A

Form at branch points

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31
Q

Where do are lipid deposits in atherosclerosis?

A
  • Microphages phagocytose lipids and other material and become bloated and appear as “foam cells”
  • Tunica media pushes tunica intima & creates blockage within the vessel
32
Q

When might AV shunts be activated to keep blood from entering capillaries?

A
  • To pull blood away from the skin, maintain heat from example
33
Q

What changes in blood metabolites will increase blood flow, for example in exercising muscles

A
  • Increase H+, Increased CO2, K+ increase
  • Decrease O2 will cause vasodilation
34
Q

What substances diffuse directly through cell membrane of capillaries?

A

Lipid soluble like CO2 or O2

35
Q

What substances use intercellular clefts of capillaries to cross into interstitial fluid?

A

Lipid insoluble substances such as H2O, Na+, Cl-, glucose

36
Q

When does lymph flow reach a maximum?

A

Lymph flow reaches a maximum when the interstitial pressure (P t ) rises slightly above the atm

37
Q

Microcirculation in the muscles is affected due to:

A

Impaired arteriolar autoregulation

38
Q

How does PAD contribute to ischemia and pain?

A

Atherosclerosis limits blood flow through the larger arteries, and the ability of arterioles to dilate in response to increase metabolic demands is compromised
- Intermittent claudication

39
Q

What is the main protein that contributes to plasma colloid osmotic pressure?

A

Albumin which is made in the liver

40
Q

Which has greater alteration of filtration: changes to venous resistance or arteriolar resistance?

A

Venous resistance has greater effect

41
Q

In persons with nephrotic kidney disease, what filtration mechanism will be changed?

A

Capillary oncotic pressure will be decreased due to decreased circulating plasma proteins

42
Q

In persons with heart failure, what filtration mechanism will be changed?

A

Increased capillary hydrostatic pressure via increased RAAS activation to try and increase cardiac output will increase blood volume

43
Q

Aside from liver failure and kidney nephrosis, what might decrease circulating plasma proteins?

A

Severe burns

44
Q

How does Atrial naturetic peptide exert its effects on fluid balance?

A
  • Regulates fluid, sodium & K+ levels
  • Increases glomerular filtration rate
  • Inhibits ADH
  • Inhibits renin secretion
  • Decreases capillary hydrostatic pressure
45
Q

What is hyperemia?

A

Increased amount of blood in the vessels of an organ or tissue in the body

46
Q

What is active hyperemia?

A

Increased metabolic activity means more metabolites which causes dilation of vessels and more flow

47
Q

What does adenosine do?

A

Causes vasodilation

48
Q

What is reactive hyperemia?

A
  • Found in MI
  • During Transient ischemia metabolites build up. Body responds with excess blood flow requiring to was the metabolites after the occlusion is removed
49
Q

What are the mechanisms that incur reactive hyperemia?

A
  1. Inc. vasodilatory substances: Adenosine, CO2, adenosine phosphate compounds, histamine, potassium ions and H+ ions
  2. By lack of oxygen which could cause opening of more precapillary sphincters in the affected tissue and force blood through the capillary
50
Q

What happens to re-perfusion after a block in coronary blood flow?

A

During coronary artery occlusion, the area of the heart supplied by the artery is deprived of its blood flow
Upon reperfusion there is a dramatic rise in coronary blood flow, far above the baseline flow prior to the occlusion

51
Q

Define autoregulation of blood flow

A

Ability of a tissue to maintain blood flow relatively constantly over a wide range of arterial pressure

52
Q

What are acute responses to heart failure?

A

Increase HR & contractility Increase mean systemic filling pressure and venous return
Maximally activated within 30-60 seconds

53
Q

Describe how Left sided cardiac failure leads to Right sided heart failure

A
  1. L heart failure = decreased CO & increased afterload
  2. The blood starts to back up into the lungs and subsequently increase R atrial pressure
  3. Damming of blood into the R atrium will increase pressure in the R atrium and lead to decreased venous return
54
Q

Which is a stronger indicator of heart failure, ANP or BNP?

A

BNP because it comes from the ventricles
- Both are diuretics

55
Q

Describe how Berberi causes heart failure

A
  • Thymine (B1) deficiency indicates unmet metabolic needs in peripheral tissues, will cause peripheral vasodilation and low TPR.
  • Increased CO despite the weakened heart due to Vit B deficiency further contributing to heart failure
  • Seen in alcoholism and malnutrition
56
Q

What arterio-venous fistula?

A

Opening between a large artery and vein. Blood bypasses resistance beds and results in low TPR. Because TPR is low, CO must increase to maintain blood pressure and meet metabolic demands

57
Q

How does hypoxia vary in blood perfusion of the body vs. the lungs? Why?

A
  • In the body will result in vasodilation
  • In the lungs will incur vasoconstriction
  • This will increase pulmonary vascular resistance to enhance blood flow to areas of the body in need and decrease flow of blood to the lungs
58
Q

What does increased renal blood flow in the afferent arteriole do?

A

Increased RBF will increase the hydrostatic pressure in the glomerular capillaries to increase the glomerular filtration rate and subsequently lowering retention of fluid

59
Q

What does decreased renal blood flow in the afferent arteriole do?

A

Decreased RBF will decrease the hydrostatic pressure in the glomerular capillaries to decrease GFR

60
Q

What does renal efferent arteriole constriction do?

A
  • Increasing constriction will increase the hydrostatic pressure in the glomerular capillaries to increase glomerular filtration and decrease renal blood flow
61
Q

What does renal efferent arteriole dilation do?

A

Decreased hydrostatic pressure in the glomerular capillaries will decrease GFR but increase renal blood flow

62
Q

Where are macula densa cells?

A

In distal tubules of kidneys

63
Q

How might the macula densa cells respond to increased NaCl in the tubules?

A
  • Inc. NaCl means increased GFR
  • Initiates the secretion of adenosine for vasoconstriction in the renal tubules only (everywhere else it causes vasodilatation)
64
Q

What are the parameters of EKG indicating hyperkalemia?

A
  • Prolonged PR internal
  • Widened QRS
  • Flattened P wave
65
Q

Why does hyperkalemia cause slowed heart rate?

A

Increased resting membrane potential BUT this rise in RMP will inactive Na+ channels so that they cannot depolarize the SA node
- Then not able to let Na+ channel inactivation to reactivate and be ready for contraction again

66
Q

What are the drawbacks to CT?

A
  • Poor soft tissue contrast
  • Ionizing radiation
  • Acute contrast nephropathy b/c contrast is viscous
67
Q

How are heart murmurs graded?

A

Scale of 1-6
1. Very faint, only heard after listener has “tuned in” & may not be heard in all positions
2. Quiet but heard immediately
3. Moderately loud
4. Loud with palpable thrill
5. Very loud, with thill & may be heard with stethoscope partly off the chest
6. Very low with thill and can be heard without stethoscope

68
Q

What is pericardial knock?

A
  • High pitched sound, best heard in diastole
  • Caused by thick pericardium limiting expansion of the ventricle
69
Q

What is ejection click?

A

High pitched sound after S1 associated with dilated pulmonary artery or septal defect

70
Q

When listening to heart sounds, what are you assessing?

A
  • Frequency/pitch
  • Intensity
  • Duration
  • Pathology
71
Q

What sound might a S3 make?

A

“Kentucky” as blood falls from atrium to ventricle

72
Q

What sound might S4 make?

A

“Tennessee” due to forceful contraction to compensate for abnormally stiff ventricle

73
Q

How do you document pulses?

A

Rate-BPM
Rhythm: regular/irregular
Symmetry: equal on L & R side
Amplitude: strength of each beat

74
Q

Describe the system of amplitude for documenting pulses

A

0: Absent
1: Weak
2: Normal
3: Increased/Strong
4: Bounding

75
Q

What are janeway lesions?

A
  • Small, non-tender erythematous or hemorrhagic macular or nodular lesions on palms/soles of feet
  • Due to neutrophilic infiltration of capillaries
76
Q

What are Osler nodes?

A
  • Painful red, raised lesions on hands and feet due to microthrombi that lead to localized immune mediated vasculitis
77
Q

What is Xanthelasma?

A
  • Yellow plaques occurring most commonly near the inner canthus of the eye lid
  • Deposits of cholesterol under the skin
  • Can be indicative of plagues in the vessels as well

M1 Block 3 (6 decks)

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