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CardioPulm > Midterm > Flashcards

Midterm Flashcards

1
Q

force that occurs as the result of lungs and body wall (ribs and intercostal muscles) constantly trying to pull away from one another

A

intrapleural pressure - ALWAYS negative

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2
Q

alveolar pressure starts out as equal to atmospheric (0 cm H2) and as the lungs increase in size, what happens to alveolar pressure?

A

decreases (to about -1 cm H2O) allowing air to flow into the lungs

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3
Q

amount of air you inhale and exhale at rest is referred to as what (~500 mL)

A

tidal volume

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4
Q

places where the airway does not contain alveoli (thus blood cannot pick up oxygen here)

A

anatomic dead space

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5
Q

what is the equation for alveolar ventilation

A

VdotA= (Vt-Vds) * f = (tidal volume- dead space) * frequency

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6
Q

how much air is inhaled every minute

A

minute ventilation

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7
Q

what is the name for the protective covering of the lungs

A

pleura (visceral and parietal)

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8
Q

what is the intrapleural pressure of the lungs relative to atmospheric pressure

A

below atmospheric pressure

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9
Q

what is the intrapleural pressure of the lungs relative to atmospheric pressure while the lungs are at rest

A

below atmospheric pressure (about -5 cm H2O)

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10
Q

as the thorax increases in volume during inspiration what happens to intrapleural pressure

A

decreases (to -8 cm H2O)

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11
Q

what muscles are involved in forceful exhalation

A

abdominals, internal intercostals

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12
Q

what muscles do we use to exhale when we are breathing normally

A

NONE- expiration is passive

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13
Q

what muscles do we use to exhale when we are breathing normally

A

NONE- expiration is passive

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14
Q

what happens to alveoli when alveolar pressure drops below atmospheric pressure

A

air flows into the lungs

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15
Q

how do you calculate minute ventilation? (Vdot)

A

Vdot= Vt * freq

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16
Q

When is alveolar pressure equal to atmospheric pressure in the respiratory cycle?

A

In between inhalation and exhalation

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17
Q

When is alveolar pressure at its maximum in the respiratory cycle?

A

Mid-exhalation

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18
Q

When is alveolar pressure at its minimum in the respiratory cycle?

A

Mid-inhalation

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19
Q

When is intrapleural pressure at its minimum in the respiratory cycle?

A

After inhalation

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20
Q

When is intrapleural pressure at its maximum in the respiratory cycle?

A

After exhalation

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21
Q

what are the boundaries of the thorax

A

ribs, vertebra, superior thoracic aperture (thoracic inlet), diaphragm

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22
Q

we can divide the thorax into what 3 compartments

A

2 pulmonary cavities and 1 mediastinum

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23
Q

what are the 3 parts of the sternum

A

manubrium, body of sternum, typhoid process

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24
Q

how many costal notches do you find on the sternum

A

7

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25
Q

what do you ALWAYS find attaching rib to sternum

A

costal cartilage

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26
Q

which rib articulates with the articulation between manubrium and body of sternum

A

rib 2

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27
Q

which rib articulates with the articulation between body of sternum and xiphoid process

A

rib 7

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28
Q

synonym for “true ribs”? Which ribs are “true ribs”?

A

vertebrocostal ribs, (1-7)

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29
Q

synonym for “false ribs”? Which ribs are “false ribs”?

A

vertebrochondral ribs, 8-10

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30
Q

synonym for “floating ribs”? Which ribs are “floating ribs”?

A

vertebral ribs, 11-12

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31
Q

which ribs are atypical

A

1-2, 10-12

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32
Q

what are the components of a typical rib

A

head, neck, tubercle, body

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33
Q

the head of a rib articulates with what? The tubercle of a rib articulates with what?

A

rib head- vertebral body

rib tubercle- transverse process of vertebra

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34
Q

where do ribs tend to break most frequently?

A

near the costal angle

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35
Q

what makes rib 1 atypical?

A

it has 2 grooves (for subclavian vein and subclavian artery) and a tubercle = attachment site for superior scalene muscle

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36
Q

what is the “atypical” feature of rib 2

A

roughened area (tuberosity) on the body where serratus anterior attaches

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37
Q

what makes ribs 10-12 atypical?

A

they meet up with only 1 (instead of 2) vertebra so they only have 1 facet
ribs 11-12 also have no tubercle and no neck

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38
Q

what is a primary cartilaginous joint and examples?

A

synchondrosis (xiphosternal joint, first sternocostal joint)

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39
Q

what is a secondary cartilaginous joint and examples?

A

symphysis (manubriosternal joint)

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40
Q

while the first sternocostal joint is considered synchondrosis, what are the rest classified as?

A

planar synovial joint

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41
Q

what ligaments help to anchor the sternocostal joints

A

anterior radiate sternocostal L

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42
Q

what type of joint is the vertebrocostal

A

planar synovial joint

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43
Q

what ligaments help to anchor the vertebrocostal joints

A

radiate ligament, intra-articular ligament

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44
Q

rib 6 head articulates with which 2 vertebra

A

T5 and T6

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45
Q

the tubercle of rib 6 articulates with what

A

transverse process of T6 vertebra

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46
Q

costotransverse joint is what type of joint

A

planar synovial

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47
Q

what ligaments help to anchor the costotransverse joints

A

superior costotransverse ligament

lateral costotransverse ligament

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48
Q

lateral rib movement increases space in thorax and is classified how

A

bucket handle

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49
Q

anterior rib movement increases space in thorax and is classified how

A

pump handle

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50
Q

costochondral joints are what type of joint

A

synchondrosis

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51
Q

where does rib separation occur

A

between rib and costal cartilage (costochondral joint)

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52
Q

where does rib dislocation occur

A

between costal cartilage and sternum (sternocostal joint)

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53
Q

Except for where ribs 9 and 10 meet, how do we classify the joints of our false ribs

A

planar synovial

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54
Q

how do we classify the joint where ribs 9-10 meet up

A

fibrous joint

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55
Q

how do we classify intervertebral joints

A

symphysis

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56
Q

how do we classify zygopophyseal joints (between superior and inferior articulating facets of vertebra)

A

planar synovial

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57
Q

what are the 3 layers of intercostal mm?

A

external, internal, innermost

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58
Q

what is the function of external intercostal mm?

A

elevate ribs

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59
Q

what innervates intercostal mm?

A

intercostal nn

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60
Q

anteriorly, the external intercostal mm become what named structure

A

anterior (external) intercostal membrane

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61
Q

whats the job of internal intercostal mm

A

depress ribs

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62
Q

how many lobes are there in the left lung

A

2

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63
Q

how many lobes are there in the right lung

A

3

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64
Q

what is the term describing distinct lines in between lobes of the lung? What are the 2 types?

A

fissure (can be oblique or horizontal)

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65
Q

what major feature of the lung is found on the mediastinal surface

A

the hilum

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66
Q

what structure of the left lung is homologous to the middle lobe of the right lung

A

lingula of the left lung

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67
Q

what are the 4 parts of parietal pleura surrounding the lungs

A

cervical, costal, diaphragmatic, mediastinal

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68
Q

when you get air into the pleural cavity

A

pneumothorax

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69
Q

when you get blood into the pleural cavity

A

hemothorax

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70
Q

when you get water into the pleural cavity

A

hydrothorax (pleural effusion)

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71
Q

why does a pneumothorax cause lung collapse

A

it breaks the surface tension in the pleura which is normally used to keep the lung expanded

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72
Q

describe the path air takes as it enters the mouth and then travels to the lungs

A

trachea–> main bronchi–> lobar bronchi–> segmental bronchi–> conducting bronchiole–> terminal bronchiole–> respiratory bronchiole–> alveolus

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73
Q

you can find cartilage in which areas of the airway

A

trachea, primary, secondary, and tertiary bronchi

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74
Q

abnormal narrowing of the airway causes difficulty breathing in what pathological condition

A

asthma

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75
Q

1 tertiary bronchus supplies 1 ___ in the lung (there are 10 total)

A

bronchopulmonary segments

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76
Q

what are the two types of smooth muscle and what is the difference in their primary activation?

A

unitary (single unit): hormonal control

multi unit: single nerve ending

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77
Q

smooth muscle composed of separate smooth muscle fibers each operating independently and innervated by a single nerve ending

A

multi-unit smooth muscle

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78
Q

where in the body do we find multi unit smooth muscle

A

ciliary muscle of eye, iris muscle, piloerector muscle cause erection of hairs (sympathetic innervation)

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79
Q

unitary/visceral/syncytial smooth muscle contracts together as a single unit because ions can flow freely through what structures

A

gap junctions

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80
Q

where in the body do we find unitary smooth muscle

A

GI, bile duct, ureters, uterus, blood vessels

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81
Q

smooth muscle does not have the troponin complex so what controls contraction here?

A

calcium binds calmodulin and this complex initiates phosphorylation of myosin and then contraction can occur

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82
Q

these smooth muscle structures are found attached to cell membrane creating intercellular bridges AND dispersed throughout the cell and act like the Z disc acts in skeletal muscle

A

dense bodies

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83
Q

dense bodies in smooth muscle are analogous to what skeletal muscle feature

A

z disc

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84
Q

smooth muscle contraction is initiated by an influx of Ca++ into the cytosol. what mechanisms can control this influx?

A

hormone stimulation, nerve stimulation, stretch of fiber, or random change in chemical environment

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85
Q

what in smooth muscle is analogous to troponin in skeletal muscle

A

calmodulin

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86
Q

describe the 4 steps in smooth muscle contraction

A
  1. Intracellular Ca++ increase (from extracellular fluid or release from SR)
  2. Ca++ binds to calmodulin
  3. Ca/calmodulin complex binds and activates myosin light chain kinase
  4. myosin light chain gets phosphorylated and binds actin and pulls to contract
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87
Q

what structure found in smooth muscle is analogous to T tubules in skeletal muscle (help to conduct action potential along the SR for uniform contraction)

A

caveolae

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88
Q

the force of smooth muscle contraction is highly dependent on what

A

extracellular calcium ion concentration

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89
Q

what happens after calcium/calmodulin is released from the actin/myosin complex (at the end of contraction)

A

myosin phosphatase removes phosphate from myosin light chain so myosin and actin can release to allow relaxation

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90
Q

as skeletal muscle is stretched, what happens to the tension generated ? smooth muscle?

A

decreases in skeletal m

maintains tension when stretched in smooth muscle

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91
Q

is skeletal or smooth muscle more energy efficient?

A

smooth

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92
Q

smooth muscle neural control can be both intrinsic and extrinsic: what does this mean

A

intrinsic control: enteric nervous system (independent of CNS and PNS)
extrinsic control: autonomics

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93
Q

what neurotransmitters help control smooth muscle function

A

acetylcholine (muscarinic receptors: contract OR relax)
norepinephrine (contract vascular, inhibit gut)
NO (inhibit SM via cGMP)

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94
Q

whats the term for: swellings in axon near smooth muscle that releases neurotransmitter

A

varicosities

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95
Q

what type of receptor is required on smooth muscle to bind norepinephrine

A

andrenergic (alpha and beta types)

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96
Q

which neurotransmitter acts on smooth muscle by diffusing through the membrane and acting on cGMP system

A

NO

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97
Q

what structure in the smooth muscle is analogous to NMJ of skeletal muscle

A

varicosities (no motor end plate in smooth muscle)

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98
Q

hormones that can elicit smooth muscle contraction

A

epinephrine, CCK, oxytocin

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99
Q

where does NO come from?

A

its secreted by endothelial cells

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100
Q

to start a new cycle of contraction, a phosphate must be removed from the myosin light chain of smooth muscle. when does this happen?

A

can happen ANY time (high ca++ helps)

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101
Q

what creates active tension in muscle contraction? passive tension?

A

active- cross bridges

passive- stretching

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102
Q

why don’t we get a tension “plateau” in smooth muscle when we stretch it?

A

myosin and actin fibers can rearrange and continue to create active tension

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103
Q

What hangs out in the middle mediastinum and determines where posterior, superior, middle, and anterior medastinums are?

A

heart

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104
Q

From superficial to deep what are all the layers of the heart

A 
fibrous pericardium
parietal serous pericardium
visceral serous pericardium (epicardium)
myocardium
endocardium
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105
Q

What provides a barrier to electrical impulses in the heart so it all doesn’t beat at once ineffectively?

A

fibrous skeleton

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106
Q

If you removed the sternum what surface of the heart are you looking at?

A

sternocostal surface

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107
Q

What surface of the heart makes the cardiac impression?

A

pulmonary surface

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108
Q

What view do you have to look at the heart for the borders to make sense?

A

sternocostal

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109
Q

If I’m looking at the right external surface of the heart what two main features will I see?

A

right AV groove

anterior inter ventricular groove

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110
Q

If I’m looking at the left external surface of the heart what two main features will I see?

A

left AV groove

posterior inter ventricular groove

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111
Q

What does the sulcus terminals on the external surface correspond to inside the heart?

A

crista terminalis

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112
Q

What does the ductus arteriosus become?What runs underneath it?

A

ligamentum arteriosum

left recurrent laryngeal nerve from vagus n

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113
Q

What doe we call the smooth and rough wall in the right atrium?

A

smooth- sinus venarum

rough- pectinate muscle

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114
Q

What separates the smooth and rough walls in the right atrium?

A

crista terminalis

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115
Q

What makes up the interatrial septum? What is the opening in it called?

A 
sinus venarum (smooth wall)
fossa ovalis
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116
Q

Where can yo find the opening to the coronary sinus?

A

right atrium

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117
Q

what is the valve between the right atrium and ventricle? What are the parts of it called?

A

tricuspid valve: septal, anterior, posterior cusps

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118
Q

What connects the cusps to the ___ muscle?

A

chordae tendineae

papillary m

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119
Q

What is the big trabeculae that goes from the anterior ventricular septum to the right margin of the heart?

A

septomarginal trabeculum

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120
Q

dead space that includes anatomic AND alveolar

A

physiologic dead space

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121
Q

What is the valve that the blood must get through to enter the lungs?

A

pulmonary valve

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122
Q

What is the space behind a cusp in the pulmonary valve’?

A

pulmonary sinus

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123
Q

What do we call the valve between the left atrium and ventricle? What are the parts of ti called?

A

bicuspid/mitral

anterior or posterior cusps

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124
Q

What do you call the smooth wall in the left ventricle before it goes into the aorta?

A

aortic vestibule

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125
Q

What do you call the rough wall in the left ventricle?

A

trabecula carnae

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126
Q

what is the space behind an aortic valve cusp?

A

aortic sinus

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127
Q

What node is found in the superior part of the right atrium?

A

sinuatrial node

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128
Q

What node sends the impulse to the ventricles?

A

atrioventricular node

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129
Q

What are other names for purkinje fibers?

A

septomarginal trabecula

moderator band

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130
Q

What do we call it when there’s fluid in the pericardial sack? What does it lead to? How do we treat it?

A

pericardial effusion —> cardiac tamponade

pericardiocentesis

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131
Q

What is the pericardial cavity between?

A

visceral serous (epicardium) and parietal serous pericardium

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132
Q

If we get fluid into the pericardial sack where will it pool?

A

pericardial sinuses: transverse and oblique

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133
Q

What do we call it when there’s fluid in the pericardial sack? What does it lead to? How do we treat it?

A

pericardial effusion —> cardiac tamponade

pericardiocentesis

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134
Q

amount of air inspired in a single breath

A

tidal volume (Vt)

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135
Q

normal resting tidal volume

A

500 mL

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136
Q

volume of air you can breathe in after Vt

A

inspiratory reserve volume (IRV)

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137
Q

volume of air you can breathe out after vt

A

expiratory reserve volume (ERV)

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138
Q

when you blow out your ERV it requires what?

A

activation of expiratory muscles

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139
Q

no matter how hard you try you cannot voluntarily force this air out of the lungs

A

residual volume (RV)

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140
Q

which lung volume cannot be measured using a spirometer

A

residual volume

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141
Q

IRV + VT + ERV

A

VC (vital capacity)

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142
Q

total volume of air you can inhale from a normal resting point

A

inspiratory capacity

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143
Q

IRV + VT

A

IC (inspiratory capacity)

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144
Q

ERV + RV

A

FRC (functional residual capacity)

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145
Q

all the air that remains in your lungs at the end of normal (passive) respiration

A

FRC (functional residual capacity)

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146
Q

If you have an area of lung getting a lot of air flow what chemical will you release to get blood over there? What actually makes it?

A

nitric oxide

endothelium

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147
Q

which capacities CANNOT be measured using spirometry and why

A

TLC and FRC because they include RV which cannot be measured

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148
Q

regions of the lung which receive air but not blood

A

dead space

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149
Q

dead space in conducting airways (where no gas exchange occurs)

A

anatomic dead space

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150
Q

dead space in alveoli that get air but no blood (no gas exchange)

A

alveolar dead space

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151
Q

dead space that includes anatomic AND alveolar

A

physiologic dead space

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152
Q

how can we estimate anatomic dead space in a patient?

A

weight in pounds in mL

50 lb patient has ~ 50 mL of anatomic dead space

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153
Q

how do you calculate alveolar ventilation

A

VdotA= (tidal volume-dead space)*frequency

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154
Q

how do you calculate minute ventilation

A

Vdot= tidal volume*frequency

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155
Q

Autonomic nervous system is activated by centers located where

A

Spinal cord, brain stem, hypothalamus

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156
Q

Sympathetic nerve fibers originate in the spinal cord with spinal nerves between cord segments T1-L2 but must pass through what before reaching the organs that they innervate

A

They synapse in the Sympathetic chain (paravertebral)

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157
Q

The cell body of each preganglionic sympathetic neuron lies where within the spinal cord

A

Intermediolateral horn

158
Q

What type of postganglionic sympathetic fiber passes back from sympathetic chain through gray rami to spinal nerves

A

Small type C fibers (to blood vessels, sweat glands, piloerector hair muscle)

159
Q

Sympathetic fiber pattern: from cord segment T1 usually terminate where

A

Head

160
Q

Sympathetic fiber pattern: from cord segment T2 usually terminate where

A

Neck

161
Q

Sympathetic fiber pattern: from cord segment T3-6 usually terminate where

A

Thorax

162
Q

Sympathetic fiber pattern: from cord segment T7-11 usually terminate where

A

Abdomen

163
Q

Sympathetic fiber pattern: from cord segment T12-L2 usually terminate where

A

Legs

164
Q

Preganglionic sympathetic fiber can pass without synapsing through sympathetic chain, through splanchnic nerves, and into adrenal medullae where they end on what kind of modified neuronal cells

A

Chromaffin cell (secretes norepinephrine)

165
Q

Which cranial nerves have parasympathetic fibers

A

3, 7, 9, 10

166
Q

75% of all parasympathetic fibers travel in what named nerve

A

Vagus (CN X)

167
Q

Vagus nerve supplies what structures

A

Heart, lung, esophagus, stomach, small intestine, proximal half of colon, liver, gallbladder, pancreas, kidney, upper ureter

168
Q

Parasympathetics from CN III go where

A

Pupillary sphincter, ciliary muscle of eye

169
Q

Parasympathetics from CN VII go where

A

Lacrimal, nasal, submandibular glands

170
Q

Parasympathetics from CN IX go where

A

Parotid gland

171
Q

Where do parasympathetics arise that supply descending colon, rectum, urinary bladder, lower ureter? (They also cause erection)

A

S2-3

172
Q

Which autonomic division has a long presynaptic neuron and a short postsynaptic neuron (often located within the wall of the organ being innervated)

A

Parasympathetics

173
Q

Which autonomic division has a short presynaptic neuron and a long postsynaptic neuron

A

Sympathetics

174
Q

All autonomic preganglionic neurons are what

A

Cholinergic (release Ach)

175
Q

Nearly all postganglionic neurons of the parasympathetic system are ___ compared to ___ for most postganglionic in the sympathetic system

A

Para- Cholinergic

Symp- Andrenergic (release norepinephrine)

176
Q

There are a few cholinergic postganglionic sympathetic fibers which go to what structures

A

Sweat glands (and maybe a few blood vessels)

177
Q

Autonomic neurotransmitter release at target tissue occurs at varicosities which are rich in what two things that are necessary to synthesize and store NT

A

Mitochondria, ATP

178
Q

What is the process for making norepinephrine?

A

Tyrosine –> dopa –> dopamine –> into a vesicle –> norepinephrine –> (only in adrenal medulla) methylation to epinephrine

179
Q

3 ways norepinephrine can be removed form secretory site

A
  1. Reuptake via active transport
  2. Diffusion into surrounding fluids
  3. Destruction by tissue enzymes
180
Q

Because norepinephrine binds this kind of receptor it can have. Different functions. On different cells

A

GPCR

181
Q

What type of receptor is a muscarinic Ach receptor? Nicotinic?

A

Muscarinic- GPCR (excitatory or inhibitory)

Nicotinic- ligand gated ion channel (excitatory only)

182
Q

Contraction of the left ventricles closes what valves and opens what valves?

A

closes mitral

opens aortic

183
Q

Even though they do so at different pressures, the left and right ventricles do what?!?!

A

pump the same volume of blood over the course of a minute

184
Q

What is the blood pressure in the right ventricle forcing blood to the lungs?

A

25/15

185
Q

Where do extra-alveolar capillaries arise from? What are their functions?

A

left ventricle

deliver o2 and co2 to the tissues the lungs

186
Q

How do extra alveolar capillaries return to the heart?What do they cause?

A

pulmonary veins

venous admixture

187
Q

Compare blood gases between alveolar capillary and extra-alveolar capillary

A

alveolar- high O2 low CO2

extra- low O2 high CO2

188
Q

What is cardiac output comparable to in the lungs?

A

minute ventilation

189
Q

What is the equation for blood pressure?

A

CoxTPR

cardiac output x total peripheral resistance

190
Q

How can the right ventricle have such smaller pressure compared to left ventricle yet move the same amount of blood?

A

pulmonary vascular resistance is 1/4 of systemic

191
Q

What causes pulmonary vascular resistance to be so low?

A

high number of capillaries

less sympathetic tone

192
Q

Why does PVR drop during exercise?

A

more pulmonary capillaries open up to accommodate increased CO

193
Q

What’s going on as far as size and blood flow in the apex (zone I) of the lungs? Why is blood flow the way it is?

A

alveoli are expanded
less blood flow
above level of heart- low BP

194
Q

What’s going on in zone II of the lungs for blood flow and alveoli size?

A

both are average

195
Q

What is the alveolar size and blood flow in zone III of lungs? Why?

A

alveoli-small

blood flow- high, below heart

196
Q

So when we go from the top of the lungs to the base of the lungs what happens to alveolar pressure?

A

high to low

197
Q

What does NO do?

A

smooth muscle relaxation and vasodilation

198
Q

What can be used to constrict blood vessels so we don’t send blood to plays with low oxygenation? Where is it made and when do we see it?

A

endothelin 1 made in lungs

pathologic conditions

199
Q

What is another vasoconstrictor in lungs that is found in conditions following injury

A

thromboxane

200
Q

Why must we keep the alveoli dry?

A

oxygen is not water soluble so it wouldn’t be able to cross over to blood

201
Q

What do we call the pressure generated from fluid pushing against the tissue or walls of the capillary?

A

hydrostatic pressure

202
Q

the sympathetic “fight or flight” system functions when our body is under what conditions

A

needs oxygen, O2 to muscle, heart pumps fast and hard, no digestion

203
Q

Where is tissue hydrostatic pressure trying to push fluid? How do we write it?

A

into capillary

Pt

204
Q

Where is the plasma (capillary) oncotic pressure pull fluid? How do we write it?

A

pull water into capillary

pi c

205
Q

sympathetic innervation to the ciliary muscle of the lens leads to what

A

relaxation (flattening) increasing far sight

206
Q

So what are the two forces moving water into alveolus?

A

Pc and pi tissue

capillary hydrostatic and tissue oncotic pressure

207
Q

What are forces trying to move water into capillary?

A

Ptissue and pi c

tissue hydrostatic pressure and capillary hydrostatic pressure

208
Q

What its the greatest single starling force in the lungs?

A

Pc

hydrostatic pressure in capillary

209
Q

The forces that cause a negative intrapleural pressure also cause what?

A

NEGATIVE hydrostatic pressure in the tissue

210
Q

Even though the starling forces favor net filtration of fluid into the alveoli what do we do?

A

lymphatics remove filters fluid from alveoli

211
Q

Where is angiotensinogen converted to angiotensin 1 and by what enzyme?

A

liver

renin

212
Q

bronchial smooth muscle has what type of andrenergic receptor

A

beta 2 (makes sense because albuterol is a beta 2 agonist)

213
Q

sympathetic innervation to the bronchial smooth muscle leads to what

A

bronchodilation (get more air in)

214
Q

what type of andrenergic receptors do we have in bronchial glands? what do they do?

A

alpha1 - decrease secretion

beta2 - increase secretion (humidify dat air)

215
Q

What are produced by immune system activation in the lungs?

A

leukotrienes and prostaglandins/thromboxane A2`

216
Q

what type of sensory receptor activates a withdrawal reflex arc

A

nociceptor (pain)

217
Q

unlike the withdrawal reflex, most autonomic reflexes occur where?

A

brain (lower levels than cortex like brainstem/hypothalamus)

218
Q

the withdrawal reflex stimulates an alpha motor neuron to produce motion whereas visceral reflexes activate what

A

autonomic neurons

219
Q

the parasympathetic “rest and digest” system functions when our body is under what conditions

A

plenty of oxygen, heart beat slow, BP low, blood to intestine for digestion

220
Q

the sympathetic “fight or flight” system functions when our body is under what conditions

A

needs oxygen, O2 to muscle, heart pumps fast and hard, no digestion

221
Q

whats the rule of thumb for andrenergic receptors in vasculature

A

alpha receptors : vasoconstrict

beta receptors : vasodilate

222
Q

sympathetic innervation to the radial m. of the iris leads to what

A

alpha receptor : contraction (dilation, light comes in)

223
Q

sympathetic innervation to the ciliary muscle of the lens leads to what

A

relaxation (flattening) increasing far sight

224
Q

what class of andrenergic receptor do we find in radial m of iris

A

alpha

225
Q

what class of andrenergic receptor do we find in ciliary m of lens

A

beta 2

226
Q

what class of andrenergic receptor do we find in heart

A

beta 1 and beta 2

227
Q

sympathetic innervation to the heart leads to what

A

increased HR and contraction strength

228
Q

what type of andrenergic receptor do we find in vessels

A

BOTH! (alpha constricts, beta dilates)

229
Q

what is the purpose of andrenergic receptors in vessels

A

direct blood flow to skeletal muscle mostly (also to heart, lung, abdominal organs, kidney)

230
Q

bronchial smooth muscle has what type of andrenergic receptor

A

beta 2 (makes sense because albuterol is a beta 2 agonist)

231
Q

sympathetic innervation to the bronchial smooth muscle leads to what

A

bronchodilation

232
Q

what type of andrenergic receptors do we have in bronchial glands? what do they do?

A

alpha1 - decrease secretion

beta2 - increase secretion

233
Q

what type of andrenergic receptors do we have in GI? what do they do?

A

alpha1 - decrease motility AND contract sphincter
alpha2 - decrease secretion
beta - decrease motility

234
Q

what type of andrenergic receptors do we have in liver? what do they do?

A

alpha1 and beta2 (release glycogen)

235
Q

what type of andrenergic receptors do we have in adipose? what do they do?

A

alpha1, beta1, beta3 (increase lipolysis)

236
Q

What are the three layers of the endocardium starting at most proximal to lumen to distal

A

endothelium
sub endothelium
subendocardium

237
Q

The endothelium of endocardium is continuous with what?

A

endothelium of blood vessels

238
Q

What does the sub endothelium in endocardium contain?

A

collagen, elastin, some smooth muscle fibers

239
Q

What does the subendocardium of endocardium contain?

A

thicker layer of CT

small blood vessels and subendocardial branches

240
Q

What is thicker in the atrium and what is thicker in the ventricles?

A

atrium- endocardium

ventricles- myocardium

241
Q

What do subendocardial branches (purkinje) stain like and why?

A

pale central area due to having a lot of glycogen

242
Q

What are subendochardial branches modified versions of? How are they different?

A

cardiocytes
larger
fewer myofibrils

243
Q

Overall what is the thickest layer of the heart?

A

myocardium

244
Q

What does the myocardium consist of?

A 
striated cardiac muscle fibers (contractile)
specialized cardiocytes (nodal)
myoendocrine cardiocytes (hormonal)
245
Q

What are the two types of granules found in myocardium?

A 
lipofuscin
atrial (myoendocrine)
246
Q

What cause striations in cardiocytes?

A

sarcomeres lined up

247
Q

What two things are found in the transverse region of an intercalated disc?

A 
fasciae adherentes (zonula adherents)
macula adherentes (desmosomes)
248
Q

What is the function of the zonula adherents?

A

anchoring site for actin filaments of terminal sarcomeres to the plasma membrane

249
Q

What is the function of the maculae adherentes?

A

hold contractile cardiocytes tightly together

250
Q

What is found in the lateral region? What is its relationship to myofibrils?

A

gap junctions
parallel
less mechanical stress

251
Q

What is the t-tubule system in the cardiac cells? What makes up the system?

A

did

one t-tubule and one SR cisterna

252
Q

Where is the diad t-tubule system found?

A

z-lines (AI junction in skeleton muscle)

253
Q

What exactly is a transverse tubule?

A

fingerlike invaginations of the sarcolemma (plasma membrane)

254
Q

What make up lipofuscin granules and in what cells do we find them?

A

contain material derived from residual bodies after lysosomal digestion
accumulate with age in stable non-dividing cells

255
Q

What do we find in atrial granules? Where in the heart do we mostly find them?

A

precursor to atrial natriuretic factor (ANF)

right atrium

256
Q

What does the epicardium consist of?

A

mesothelium

subepicardium

257
Q

What makes the mesothelium in epicardium?

A

lining of simple squamous cells (visceral layer of pericardium)

258
Q

What makes up the subepicardium?

A

layer of loose CT

collagen, elastin, adipocytes, nerves, coronary vessels

259
Q

What is thefunctio of the epicardium?

A

protect the coronary arteries

260
Q

What is also known as the heart’s pacemaker?

A

sinoatrial node

261
Q

What is the path of an electrical impulse starting at SA node?

A 
SA node
internal atrial pathways
AV node
AV bundle (of His)
R/L bundle branch
subendocardial branches  to ventricular contractile cardiocytes
262
Q

where does the atrioventricular bundle (of His) travel?

A

in inter ventricular septum

263
Q

Where is the SA node located?

A

along sulcus terminals at junction of the superior vena cava with right atrium

264
Q

What are the cardiocytes of the SA node centered around?

A

sinoatrial nodal artery

265
Q

What are the cells of the SA node connected by? What are they connected by? How do they stain?

A

pale
connected by gap junctions and desmosomes
NOT intercalated discs

266
Q

where is the atrioventricular node located?

A

base of intertribal septum at the junction of the right atrium and ventricle

267
Q

What are the atrioventricular node cardiocytes situated around?

A

atrioventricular nodal artery

268
Q

How do the sells of the AV node look different from the cells of the SA node?

A

irregularly arranged

269
Q

What are three functions of the fibrous skeleton?

A
  • structural framework
  • attachment for valves and myocardium
  • electrical insulation
270
Q

What are the three layers of the heart valves?

A

central- fibrosa
spongiosa sandwiches fibrous
outermost is endothelium

271
Q

What is the cartilage that makes up heart valves continuous with?

A

annuli fibrous of the fibrocollagenous skeleton

272
Q

What is the myocardium doing in relation to the heart valves?

A

myocardium extends into the valve, but stops before end of valve

273
Q

If we’re piercing a blood vessel what are the layers we will encounter as we go deep?

A 
tunica adventitia
external elastic lamina
tunica media
internal elastic lamina
tunica intima
274
Q

What are the parts of the tunica intima from closest to the lumen to farther away?

A

endothelium
sub endothelium
basal lamina

275
Q

What makes up the tunica media?

A

smooth muscle (CT)

276
Q

What makes up the tunica adventitia?

A

fibroblasts
collagen
vasovasorum
nerves

277
Q

In what layer do you find the vasovasorum?

A

tunica adventitia

278
Q

What is the internal elastic lamina indistinguishable from?

A

basal lamina of tunica intimate

279
Q

What kind of collagen is found in the basal lamina of the tunica intima?

A

type 4

280
Q

In what layer of a blood vessel do you find the sensory fibers and motor innervation?

A

tunica media

281
Q

What kind of sense is picked up in the tunica media? Who innervates it?

A

baroreceptors

autonomic nervous- sympathetic

282
Q

What is the functions of the tunica adventitia?

A

anchors to surrounding connective tissue

283
Q

What type of fibers are found in the tunica adventitia?

A

longitudinal type I and elastic

284
Q

What is unique about the layers of arteries?

A

tunica adventitia is not that thick

tunica media is very thick

285
Q

What is unique about the layers of capillaries?

A

there is only endothelium layer of tunica intima

286
Q

What is unique about the layers of veins?

A

thin tunica media

thick tunica adventitia

287
Q

What type of artery is the aorta?

A

elastic

288
Q

How can we differentiate between muscular artery and elastic artery under a slide?

A

muscular- tiny tunica adventitia

elastic- big adventitia with lots of elastic fibers

289
Q

What type of artery has vasovasorum?

A

elastic

290
Q

What is another name for muscular arteries? What are some examples?

A

distributing

femoral, subclavian, etc

291
Q

What is noteworthy of muscular arteries?

A

big tunica media

292
Q

What makes up a capillary?

A

thin tube of endothelium surrounded by basal lamina

293
Q

What are the three types of capillaries?

A

continuous
fenestrated
discontinuous

294
Q

Where do you find continuous capillaries? What’s another name for these capillaries?

A

muscle, brain, peripheral nerves, exocrine glands

somatic

295
Q

Why is a continuous capillary continuous?

A

endothelium bound tightly

zonula occludens

296
Q

What’s another name for fenestrated capillaries? Where do you find them?

A

visceral

kidneys, intestine, exocrine glands (rapid exchange between tissue and blood)

297
Q

How big are the pores in fenestrated capillaries?

A

size of a macromolecule

298
Q

Where do you find discontinuous capillaries? What cells are usually interspersed along the walls?

A

hematopoietic organs

phagocytic cells

299
Q

What is another name for discontinuous capillaries?

A

sinusoidal capillaries

300
Q

What are the three types of veins?

A

large veins
medium-sized veins
venules

301
Q

What type of collagen is found in the tunica media of large veins?

A

2

302
Q

In large veins what is difficult to distinguish?

A

tunica adventitia from tunica media

303
Q

What is sparse in tunica adventitia of large veins?

A

elastin

304
Q

In what type of veins do we usually see valves?

A

medium-sized veins

305
Q

What is the best developed tunic in medium-sized veins?

A

adventitia

306
Q

What are valves projections of? What are they lined by? What supports them?

A

tunica intima
endothelial cells
elastic and collagen fibers

307
Q

What is the best developed tunic in venules?

A

tunica adventitia

308
Q

How does the lymphatic system terminate?

A

dumps into venous circulation via right lymphatic and thoracic ducts

309
Q

What are the 3 parts of the aorta

A

Ascending, aortic arch, descending

310
Q

What are the branches that come off of the ascending aorta

A

Left and right coronary artery

311
Q

What are the anterior branches of the. Right coronary artery

A 
Sinuatrial nodal
Conus branch
Atrial branch
Right coronary
Posterior interventricular a
Right marginal a
312
Q

What are the posterior branches of the right coronary artery?

A

Atrioventricular nodal a
Right posterolateral a
Posterior interventricular a

313
Q

Normal range for arterial CO2

A

35- 45 mmHg

314
Q

Normal range for arterial bicarb

A

22-26 mEq/L

315
Q

What does the left vagus nerve become super low on the esophagus before it goes through diaphragm?

A

anterior vagal trunk

316
Q

What does the right vagus nerve become super low on esophagus before it goes through diaphragm?

A

posterior vagal trunk

317
Q

What are the roots for the vagus nerve

A

C3,4,5

318
Q

What does the phrenic nerve travel through?

A

mediastinal parietal pleura and fibrous pericardium

319
Q

What innervates all the muscles of the thoracic cage?

A

muscular branches from intercostal nerves

320
Q

What are the three branches of the intercostal nerve?

A

lateral cutaneous
muscular
anterior cutaneous

321
Q

Which intercostal nerves are typical?

A

3-6

322
Q

Which intercostal nerves are atypical?

A

1-2

7-11

323
Q

What is the anterior rams of the 1st thoracic spinal nerve doing?

A

joining brachial plexus

324
Q

What makes 2nd thoracic spinal nerve atypical?

A

branch can go to brachial plexus

lateral cutaneous branch goes to skin and body wall

325
Q

Why are intercostal nerves 7-11 atypical?

A

start thoracic
end abdomen
thoracoabdominal nerves

326
Q

What do we call the sympathetic division of the ANS according to location?

A

thoracolumbar

327
Q

What are the two divisions of the ANS?

A

sympathetic

parasympathetic

328
Q

Which division of the ANS is limited?

A

parasympathetic

329
Q

What division of ANS is in charge of vasoconstriction? glandular production?

A

sympathetic

parasympathetic

330
Q

Where is the presynaptic cell of the sympathetic division?

A

lateral horn

331
Q

What part of the spinal cord do you see the lateral horn?

A

thoracic and lumbar

332
Q

What are the guys called that connect us from paravertebral to pre vertebral?

A

greater, lesser, least splanchnic nerves

333
Q

what are the synaptic options for sympathetic division?

A
  • synapse in same level paravertebral ganglion
  • synapse in different level paravertebral ganglion
  • synapse in pre vertebral ganglion
334
Q

Why do we have a sympathetic trunk

A

to let the little presynaptics travel to different levels of ganglion

335
Q

What are the four pre vertebral ganglion?

A

celiac
superior mesenteric
inferior mesenteric
aorticorenal

336
Q

What are the guys called that connect us from paravertebral to pre vertebral?

A

splanchnic nerves

337
Q

What makes up all the cardiopulmonary splanchnic nerves? Why?

A

post synaptic fibers

synapse in paravertebral ganglion (either same or different level)

338
Q

What makes up all the abdomenpelvic splanchnic nerves?

A

pre synaptic fibers

synapse in prevertebral

339
Q

Who is the parasympathetic guy from the cranium that we care about at this point?

A

vagus (CNX)

340
Q

Where do we find the sacral part of the spinal cord?

A

up by conus medullaris so L1-2

341
Q

Where is the postsynaptic cell body of parasympathetic division

A

in the cell body

342
Q

What do we call the presynaptic fibers in the sacral part of parasympathetic?

A

`pelvic splanchnic nerves

343
Q

What do we find in the autonomic plexus?

A

sympathetic and parasympathetic POSTsynaptic fibers

344
Q

What contributes to the pulmonary autonomic plexus?

A 
pulmonary splanchnic (sympathetic)
pulmonary branches of vagus (parasympathetic)
345
Q

What contributes to the superficial cardiac plexus?

A 
cardiac splanchnic (sympathetic)
superior, middle, inferior cardiac branches of vagus n (parasympathetic)
346
Q

What contributes to deep cardiac plexus?

A

cardiac splanchnic nerves

so strictly sympathetic

347
Q

What contributes to the aortic plexus?

A

continuation of superficial cardiac plexus

348
Q

What contributes to the esophageal plexus?

A 
great splanchnic (presynaptic, sympathetic)
esophageal branches of vagus n (parasympathetic)
349
Q

the left coronary artery splits into what two branches

A

circumflex a

anterior interventricular a (LAD)

350
Q

the circumflex artery (after coming off of left coronary a) gives off what major branch inferiorly

A

left marginal a

351
Q

what is the major branch from the anterior inter ventricular artery (LAD)

A

AV nodal a

AV bundle branches

352
Q

where do they place the new vessel during coronary artery bypass

A

one end on aorta, other end on the occluded artery distal to occlusion

353
Q

what branch of subclavian a is the major arterial supply to the anterior thorax

A

internal thoracic a

gives off anterior intercostal aa and pericardiacophrenic a and musculophrenic a

354
Q

if we see a branch coming off the internal thoracic a and diving medially what do we call them

A

medial mammary a

355
Q

where does lateral mammary a come from?

A

off of lateral thoracic a (which comes from axillary a)

OR from lateral cutaneous branch of posterior intercostal a

356
Q

what are the unpaired visceral branches of the thoracic aorta

A

mediastinal
esophageal
pericardial

357
Q

what are the paired lateral visceral branches of the thoracic aorta

A

bronchial a

358
Q

what are the paired segmental parietal branches of the thoracic aorta

A

posterior intercostal a

subcostal a

359
Q

what are the 2 possible branches that can come from posterior intercostal aa

A

lateral cutaneous a

collateral branch

360
Q

what are the blood supplies to the diaphragm

A 
musculophrenic (from internal thoracic)
pericardiacophrenic (from internal thoracic)
superior phrenic (from descending thoracic aorta)
361
Q

how can we distinguish arteries and veins that supply/ drain the alveoli

A

arteries follow the airway and veins are intersegmental running between airways

362
Q

whats it called if a blood clot travels to the lungs and causes major issues

A

pulmonary embolism

363
Q

how many pulmonary veins drain into the posterior heart

A

4 (L superior pulmonary, L inferior pulmonary, R superior pulmonary, R inferior Pulmonary)

364
Q

which cardiac veins empty directly into atrium

A

anterior cardiac veins

365
Q

great cardiac vein, small cardiac v, and middle cardiac v all drain into what structure

A

coronary sinus

366
Q

what v runs with right marginal a

A

small cardiac v

367
Q

what a runs with great cardiac v

A

anterior interventricular a

368
Q

what a runs with middle cardiac v

A

posterior interventricular a

369
Q

what do posterior intercostal vv drain into on the left side? right side?

A

right- azygos v

left- hemiazygos or accessory hemiazygos v

370
Q

behind the esophagus we see a vessel running superiorly without any branches. what is it?

A

thoracic duct

371
Q

what are the 2 ways oxygen travels in the blood

A

bound to hemoglobin or dissolved

372
Q

who has greater solubility in water: oxygen or CO2?

A

CO2 (6 mL / dL blood / 100 mmHg)– 20x more soluble

O2 (0.3 mL / dL blood / 100 mmHg)

373
Q

when we refer to PaO2 levels (partial pressure of O2 in arterial blood) we are referring to what population of oxygen?

A

dissolved!!!

374
Q

what is the range of O2 partial pressures in the blood that allow hemoglobin to be “fully” (>85%) saturated?

A

60-100 mmHg

375
Q

what is the normal oxygen content of blood that is 85% Hb saturated

A

17 mL O2 / dL blood

376
Q

an increase in Hb’s affinity for O2 would shift the Hb/PO2 curve to which direction? What can cause this?

A

left shift!

low CO2, high pH,

377
Q

a decrease in Hb’s affinity for O2 would shift the Hb/PO2 curve to which direction? What can cause this?

A

right shift

High CO2, low pH, increase temperature, 23BPG

378
Q

where in the body do we see increase in CO2, H+, temp, and 23BPG? Why is this a good thing

A

in the TISSUE

it shifts Hb/O2 dissociation RIGHT and we release O2 at the tissue

379
Q

normal venous PO2

A

40 mmHg (=75% saturation = 15.2 mL O2/ dL blood)

380
Q

what is the difference in arterial and venous O2

A

4.6 mL O2 / dL blood

this is how much O2 is USED by tissue being perfused

381
Q

there is a consistent ratio of O2 used to CO2 produced in the tissue: what is that ratio if the fuel is carbs? fats? mixed fuels?

A

carb- 1:1 ratio
fat- 7 CO2 produced: 10 O2 consumed
mix: 8 CO2 produced: 10 O2 consumed

382
Q

what is respiratory quotient? How do we find it?

A

its the ratio between volume of CO2 produced and O2 consumed

RQ= V(dot)CO2/V(dot)O2

383
Q

whats the RQ if we are metabolizing mixed fuels?

A

RQ= V CO2 produced / V O2 consumed = 8/10 = 0.8

384
Q

what are the 3 ways we transport CO2 in the blood

A 
dissolved
carbamino compounds (bound nonspecifically to proteins)
as HCO3 (bicarb-- this accounts for MOST CO2 transport)
385
Q

what is the haldane shift

A

presence of O2 bound to heme reduces heme affinity for CO2

386
Q

what enzyme helps CO2 and water become H+ and bicarb

A

carbonic anhydrase – in RBCs

387
Q

we pump bicarb out of RBCs by bringing in what ion? (an electroneutral exchange)

A

Cl-

this is why we have lower chloride in venous blood: The Chloride Effect

388
Q

how do we calculate [O2] in the alveoli? (alveolar gas equation)

A

PAO2= PIO2 - (PaCO2/R)

PIO2: inspired PO2 (account for water vapor: PiO2=(760-47)*O2% at sea level)
PaCO2: arterial CO2
R: 0.8 for mixed fuel, 1 for carbs

389
Q

A-a O2 gradient is normally what?

an increase in A-a O2 gradient means what?

A

less than 20 mmHg

diffusion impairment of alveoli

390
Q

When anion gap is calculated to be greater than 12, what must be present and unmeasured (contributing to the metabolic acidosis)

A

MUDPILES

Methanol, uremia, diabetic (or starvation or alcoholic) ketoacidosis, paraldehyde, isoniazid, iron, lactic acidosis, ethanol or ethylene glycol, salicylate

CardioPulm (6 decks)

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