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ADV. Human Phys > Lab Quiz 2 - 3 > Flashcards

Lab Quiz 2 - 3 Flashcards

1
Q

What instrument measures blood pressure?

A

sphygmomanometer

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2
Q

Normal:

  • Systolic:
  • Diastolic:
A
  • Systolic:
    95 - 135
  • Diastolic:
    50 - 90
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3
Q

Systolic / Diastolic

A

e.g. 120 / 80

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4
Q

What is the name of the method we use to check blood pressure?
Which artery is compressed?

A

Auscultatory method

Brachial artery

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5
Q

Sounds in blood pressure are called?

A

Korotkoff sounds

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6
Q

Five phases of korotkoff sounds:

A 
Silence
K1: Loud tapping (systolic)
K2: Murmur (Swishing)
K3: Loud tapping
K4: Muffled
K5: Silence (diastolic)
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7
Q

What causes the korotkoff sounds:

A

Predominately turbulance.

K1: may be caused by arterial wall slapping back together

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8
Q

Where is the pulse normally taken?

A

Radial artery

temporal, carotid, and facial also used

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9
Q

Heart sounds in healthy adults:

A

S1: lub, closing of the atrioventricular valve (during ventricular systole, shortly after ventricular depolarization, QRS), papillary muscles contract
S2: dub, closing of the semilunar valves, corresponds with dicrotic notch and the repolarization of the ventricles.

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10
Q

Heart beat is also called:

A

heart sound o.O

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11
Q

Heart murmur:

A

Turbulent blood flow (failure of valve to close)

  • Stenosis
  • Valve prolapse
  • Regurgitation
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12
Q

Two types of heart murmurs:

A
  • Physiological (benign):

- Pathological (abnormal):

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13
Q

What is S1 composed of?

  • Which is first?
  • Why?
A

M1: mitral closes
T1: tricuspid closes
The mitral is first.
More pressure in ventricle during contraction

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14
Q

When do the papillary muscles contract?

  • What does it do?
  • What prevents prolapse?
A

During ventricular contraction

  • close the atrioventricular valves
  • Chordae tendinae
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15
Q

What actually causes the S1 sound?

A

The reverberation of blood from sudden reversal of flow in ventricle

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16
Q

What does it mean if T1 occurs more than slightly after M1?

A

Tricuspid valve closed slower, likely a right bundle branch block. Will likely see an extended QRS wave.

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17
Q

What is S2 composed of?

  • Which is first?
  • Why?
A

A2 (aortic semilunar valve) and P2 (pulmonary semilunar valve)
A2
Aorta is under more pressure, fall in left ventricle pressure is more dramatic, drives it to close more quickly

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18
Q

What actually causes the S2 sound?

A

Reversal of blood flow when semilunar valves close

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19
Q

What causes the semilunar valves to close?

A

pocket like cusps in the valves

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20
Q

Splitting of S2:

  • Occurs during:
  • Why?
A
  • Occurs during:
    Inspiration
  • Why?
    Because the fall in intrathoracic pressure increases the time necessary for the pulmonary artery to overcome the right ventricular pressure
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21
Q

Widely split S2 is associated with:

A 
right bundle branch block (just takes longer to contract)
pulmonary stenosis (less effective closure)
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22
Q

S3:

  • Other names:
  • Occurs:
  • Cause:
A
  • Other names:
    protodiastolic gallop
    Ventricular gallop
    Kentucky gallop (ken = s1 tuck = s2, y = s3)
  • Occurs:
    After S2
  • Cause:
    Oscillation of blood inrushing from atria (delayed because ventricles are not filled enough for reverberation earlier)
    It may also be caused by tensing of chordae tendineae during rapid filling and expansion of ventricle
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23
Q

S3 is best heard with?

Why?

A

Bell of the stethoscope

Lower frequency

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24
Q

S3 is indicative of:
- In athletes, youngins, sometimes pregnancy:
- In adults:
Increased blood volume

A
  • In athletes and youngins:
    May be benign
  • In adults:
    Increased blood volume
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25
Q

S4:

  • Other names:
  • Occurs:
  • Cause:
A 
- Other names:
Presystolic gallop
atrial gallop
Tennessee (Ten = S4, nes = S1, See = S2)
- Occurs:
Right before S1
- Cause:
Blood being forces into a stiff/hypertrophic ventricle
26
Q

S4 implication:

A

Pathological
Failing left ventricle
SOmetime restrictive cardiomyopoathy

27
Q

Combined S3, S4:

  • Other names:
  • Occurs:
  • Cause:
A
  • Other names:
    Quadruple gallop
    Hello-goodbye (Hel = S4, lo = S1, Good = S2, Bye = S3)
28
Q

At rapid rates what happens to a quadruple gallop:

A

it merges to produce a summation gallop

somtimes called S7

29
Q

What was used to perform the bleeding time test?

A

Surgicutt device

30
Q

What was used to perform the prothrombin time test and the activated partial thromboplastin time test?

A

A fibrometer

31
Q

What anticoagulant was used on the sheeps blood?

A

Sodium Citrate

32
Q

What may a prolonged bleeding test indicate?

A

Thrombocytopenia
Uremia (blood in urine)
Liver failure (clotting factor loss)
aspirin

33
Q

How is the incision for a bleeding time test standardized?

A

The surgicutt makes a 1 mm by 5 mm incision

34
Q

How much pressure is applied prior the bleeding time test first incision?

A

40 mm/hg

35
Q

What does he call the inner elbow crease?

A

Antecubital crease

36
Q

Where is the incision for the bleeding time test?

perpendicular or parallel to the arm?

A

over the lateral aspect, of the volar surface of forearm, 5 cm below the Antecubital crease:
Perpendicular to the arm

37
Q

Normal range for a bleeding time test:

- How much does a gram of aspirin taken orally 4 hours before the test effect this?

A

2 - 8 minutes

Extends by ~3.5 minutes

38
Q

What aids in prediction of the reason for a prolonged bleeding time test?

A

More quantifiable testing (platelet count, platelet aggregation study)
PATIENT HISTORY!

39
Q

What aspect of clotting is platelet time test most testing?

A

Ability of the platelets to form a platelet plug

40
Q

PT test is:

A

Prothrombin Time test

41
Q

Prothrombin Time test:

  • Evaluates:
  • Reagents:
A
  • Evaluates:
    extrinsic pathway and shared (factors VII, X, V, II (prothrombin), and I (fibrinogen).
  • Reagents:
    .1 ml : Blood sample (sheep blood + citrate for us)
    .2 ml : Innovin (purified recombinant tissue factor, synthetic thromboplastin, calcium, buffers and stabilizers)
42
Q

Why is the extrinsic pathway called extrinsic?

A

It is activated by tissue factor III (thromboplastin), which is from outside of the blood vessel (external/extrinsic)

43
Q

Coagulation activators:

A

Released by platelets and damaged tissues to signal that it is time for coagulation

44
Q

Prothrombin activator:

Hint: it’s what activates prothrombin

A

Factor X complexed with factor V. The factor V complex.

45
Q

Complexes and activators require what to work?

A

Calcium (and phospholipids)

46
Q

International Selectivity index:

A

Comparison of how this particular batch of tissue factor compares to an international reference tissue factor

47
Q

International Normalized Ratio:

A 
(patients PT time / normal PT time) ^ ISI
example:
patient time = 10
Normal time = 11.5 (for our lab)
ISI = .88

(10 / 11.5)^.88
10 / 11.5 = .87
.87 ^ .88 = .884

.884 is the international normalized ratio (INR)

48
Q

Prolonged PT test is indicative of:

A

Liver disease
vitamin K deficiency
Taking warfarin (coumadin)
having hereditary or acquired disorder of factors of the extrinsic or common pathway

49
Q

Normal PT test duration:

A

10.6 to 12.4 seconds

50
Q

What is used to measure oral anticoagulant effects (warfarin (coumadin))?
What is the ideal International Normalized Ratio for someone on coumadin?

A

Prothrombin Time test

2 - 3

51
Q

Sodium citrate:

- mechanism:

A

chelates Ca2+, preventing both cascade pathways (necessary for enzyme to run)

52
Q

What is a normal range for the international normalized ratio for a prothrombin test?
High indicates?
Low indicates?

A 
.8 - 1.2
High indicates?
risk of bleeding
Low indicates?
risk of clotting
53
Q

Activated Partial Thromboplastin Time (APTT) test:

  • Evaluates:
  • Reagents:
A 
- Evaluates:
The intrinsic pathway
12 -> 11 -> 9 -> 8 (8, 9 complex to activate factor X)
- Reagents:
0.1 ml sheep plasma (citrate)
0.1 ml liquid rabbit brain cephalin –aka- Actin Activated Cephaloplastin Reagent (acts as a substitute for a substance released by damaged platelets when blood is traumatized). This has ellagic acid which acts as a foreign surface. WAIT 3 MINUTES at 37 degress C after this step!!!
Note: elligic acid with cephalin
.1 ml of preheated Calcium Choride
54
Q

Reason it is called the INTRINSIC pathway?

A

Activated by trauma to the blood itself. Intrinsic to the vessel.

55
Q

Examples of potential activators:

A

Infection, transfussion reactions, injury to platelets, exposure of blood to foreign surfaces:
- Collagen, glass

56
Q

Activated partial thromboplastin test is used to monitor the effectiveness of what anticoagulant?

A

Heparin
Factors in common and intrinsic pathway for disorders
Oral anticoagulants
Hemorrhage and thrombolytic syndromes

57
Q

Normal APTT range:

A

23.4 - 30.6 seconds

58
Q

Which disorders is the APTT prolonged in?

A

Hemophilia (deficiency in factor VIII)
Heparin
intrinsic pathway factor issues
Severe deficiencies in prothrombin, V, X, or fibronigen)
Coumadin (decreases VII, IX and X), note: PT test is more sensitive
Others?

59
Q

Other name for innovin:

A

Lyophilized reagent

Containing tissue factor and synthetic phospholipids (thromboplastin) and Ca2+

60
Q

APTT necessary reagents:

A 
Calcium Chloride (preheated)
Ellagic acid (acts a foreign substance
Cephalin (Actin Activated Cephaloplastin Reagent) (acts as a substitute for a substance released by damaged platelets when blood is traumatized)

ADV. Human Phys (51 decks)

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