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A&P > Midterm > Flashcards

Midterm Flashcards

1
Q

Anion gap

A

(Na+K) - (Cl + HCO3)

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2
Q

Osmolarity

A

2(Na) + 0.055(glucose) + 0.36(BUN)

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3
Q

Calculating partial pressure of gas (outside body)

A

multiply % by atmospheric pressure

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4
Q

PiO2

A

(760-47) x FiO2

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5
Q

PAO2

A

[FiO2 x (Pb-47)] - CO2/0.8

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6
Q

Total O2 content

A

(1.37 x Hbg x sat) + PO2(0.003)

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7
Q

Dissolved CO2

A

PaCO2 x 0.067

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8
Q

A-a gradient

A

PAO2- PaO2

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9
Q

Alveolar MV

A

(TV-DS) x RR

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10
Q

Calculating Dead space

A

PaCO2-EtCO2/PaCO2 (apply % to TV) or 2 mL/kg of IBW

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11
Q

Compliance

A

TV/PIP-PEEP

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12
Q

Calculating CO

A

HR x SV (MAP-CVP)/SVR x 80

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13
Q

SV

A

EDV-ESV

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14
Q

EF

A

EDV-ESV/EDV x 100

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15
Q

Which has the LEAST negative threshold- SA node, neuron, or myocyte?

A

SA node

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16
Q

In the SA node, what permeability do we alter to achieve threshold?

A

potassium

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17
Q

What causes the plateau phase of the action potential in the myocyte?

A

influx of calcium

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18
Q

normal aortic valve area

A

2.5-3.5 cm squared

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19
Q

What aortic valve area is severe aortic stenosis?

A

<1 cm squared

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20
Q

Normal PCWP

A

<12 mmHg

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21
Q

Normal LAP

A

4-12 mmHg

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22
Q

normal LV pressure

A

100-140/3-12 mmHg

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23
Q

normal aorta pressure

A

100-140/60-90 mm Hg

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24
Q

normal RAP

A

0-8mmHg

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25
Q

normal RV presure

A

15-28/0-8 mmHg

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26
Q

normal pulmonary arterial pressure

A

15-30/3-12 mmHg

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27
Q

normal CO

A

4-6 L/min

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28
Q

normal CI

A

2.5-4 L/min

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29
Q

Forces that push or pull fluid OUT of vessel

A

capillary hydrostatic, interstitial hydrostatic, interstitial oncotic pressures

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30
Q

Pressures that push/pull fluid INTO vessel

A

plasma oncotic pressure

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31
Q

Net pressures at arterial vs. venous side of capillary

A

Higher net OUT on arterial side, higher net IN on venous side

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32
Q

Valsalva Maneuver

A

-forced expiration against closed glottis -mediated through baroreceptors -SNS inhibited, PNS activated - decreased HR, contractility, BP, vasodilation

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33
Q

Baroreceptor Reflex

A

-response to stimulation/stretch of baroreceptors -afferent signal via Hering’s nerve (glossopharyngeal) or vagus nerve -signal to medulla -efferent response to decrease BP (vagus) -decreased HR and SNS outflow

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34
Q

Occulocardiac Reflex

A

traction of EOM, conjunctiva, or orbital structures cause reflex bradycardia -treatment- remove stimulus, antimuscarinic

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35
Q

Bainbridge/atrial reflex

A

increase in HR due to increase in blood volume (stretch receptors in RA) -prevents sequestration of blood in veins, atria, pulmonary circulation

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36
Q

celiac reflex

A

traction on mesentery/gallbladder/vagus nerve stimulation causes bradycardia, apnea, hypotension -can be elicited by pneumoperitoneum

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37
Q

Cushing reflex

A

physiologic response to CNS ischema from increased ICP -intense vasoconstriction to restore cerebral perfusion -Cushing’s triad- HTN, irregular breathing, bradycardia -may indicate herniation -may be seen after IV norepinephrine

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38
Q

Chemoreceptor reflex

A

sensory receptor that transduces chemical signal into action potential -central- located on medulla, stimulated by increased H -peripheral- carotid arteries, aortic arch, stimulated by decreased O2 -results in increased MV, SNS stim, increased BP

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39
Q

Bezold Jarisch reflex

A
  • C fibers will decrease HR to allow ventricles to fill - see this when sitting patient up during/after anesthesia
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40
Q

Phase 4 of Action potential (myocyte)

A

resting membrane potential -K inside cell (slow leak out) -Na and Cl are outside -remain in this stage until stimulated

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41
Q

Phase 0 of Action Potential (myocyte)

A

rapid depolarization (fast Na channels) -rapid influx of Na into cell (more positive membrane) -gates open between -70 and -65, go up to +20 mV

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42
Q

Phase 1 of Action Potential (myocyte)

A

rapid repolarization -Na gates close -K gates open, K moves out -Cl influx -slow influx of Ca

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43
Q

Phase 0 &1 of action potential make up what part of the EKG?

A

QRS complex

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44
Q

Phase 2 of Action Potential (myocyte)

A

plateau phase -Na channels close (no AP at this time- absolute refractory period) -Ca influx- delays quick repolarization -K efflux

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45
Q

What does phase 2 make up on the EKG?

A

ST segment

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46
Q

Phase 3 of Action Potential (myocyte)

A

rapid repolarization -Ca channels close -K channels still open (efflux) -when Ca close, allow efflux of K to keep moving back to RMP -Na channels reset

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47
Q

What part of the EKG is phase 3 of the action potential?

A

T wave

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48
Q

What phase do LA’s work on?

A

phase 4 (prevent spontaneous depolarization/Na gated channels from opening)

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49
Q

What phase do CCB’s work on?

A

phase 2 (affect Ca channels)

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50
Q

Smooth muscle characteristics

A

spindle shaped, nonstriated, uninucleated, involuntary

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51
Q

Cardiac muscle characteristics

A

striated, branched, uninucleated, involuntary

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52
Q

Skeletal muscle characteristics

A

striated, tubular, multinucleated, voluntary

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53
Q

Contractile proteins of skeletal muscle

A

myosin, actin, tropomyosin, and troponin

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54
Q

What electrolyte disturbances cause skeletal muscle weakness?

A

hypocalcemia, hypermagnesemia

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55
Q

Byproducts of ACh hydrolyzation

A

choline and acetate (choline is repackaged)

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56
Q

NMJ Steps

A

1) synthesis and storage of ACh in presynaptic terminal 2) depolarization of presynaptic terminal and Ca uptake 3) Ca uptake causes ACh release into synaptic cleft 4) diffusion of ACh to postsynaptic membrane and binding of ACh to NICOTINIC receptors 5) end place potential in postsynaptic membrane 6) depolarization of adjacent muscle membrane to threshold 7) degradation of ACh

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57
Q

Intercalated Discs

A

Present in cardiac muscle, helps heart work in unison

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58
Q

Calcium in smooth muscle

A

comes from plasma/blood, not SR

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59
Q

Somatic Nervous System NT

A

ACh- always stimulatory

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60
Q

NT of ANS

A

preganglionic- ACh postganglionic- ACh (PNS) or NE (SNS)

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61
Q

SNS fiber/ganglia characteristics

A

-origin of fibers- thoracolumbar (T1-L2) -short pre, long post -ganglia close to spinal cord

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62
Q

PNS fiber/ganglia characteristics

A

-origin of fibers- craniosacral -long pre, short post -ganglia in visceral effector organs

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63
Q

Accelerator Fibers (SNS)

A

T1-T4

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64
Q

CN of PNS

A

3,5,9,10

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65
Q

Phases of LV Pressure Volume Loop

A

Isovolumetric Contraction Ejection Isovolumetric Relaxation Diastolic Filling

66
Q
A

Aortic Regurgitation

67
Q
A

Aortic stenosis

68
Q
A

Mitral regurgitation

69
Q
A

Mitral stenosis

70
Q

Central Chemoreceptors

A
  • located on medulla
  • respond to changes in H or CO2 (increase stimulates ventilation)
  • surrounded by brain ECF
71
Q

Peripheral Chemoreceptors

A
  • Located in carotid bodies (glossopharyngeal) and aortic bodies (vagus)
  • sense decrease in pO2 and pH (increased pCO2) of arterial blood
  • responds intensely to paO2 below 100 mmHg
  • responsible for all increase in ventilation due to arterial hypoxemia (<60mmHg)
72
Q

Intrapleural pressure

A
  • between parietal and visceral pleura
  • normally negative (becomes more negative with inspiration)
  • becomes positive with forced expiration or Valsalva
73
Q

intrapulmonary pressure

A
  • zero (same as atmospheric pressure) at end expiration
  • becomes more negative during inspiration
74
Q

Contributors to Stroke Volume

A
  • proload (tension on ventricle at end of diastole)
  • afterload (wall tension the myocardium needs to overcome to eject SV- pressure within LV during peak systole)
  • mycoardial contractility- state of inotropy independent of preload and afterload
75
Q

What determines coronary artery dominance?

A

Crux (where coronary and posterior interventricular sulcus meet)

majority of population is RCA dominant

76
Q

L main coronary artery

A
  • emerges from behind pulmonary trunk
  • divides into LAD, L CFX, diagonal branch
77
Q

L anterior descending coronary artery

A

multiple branches -anterior 2/3 of interventricular septum, R and L bundle branches, papillary muscles of mitral valve and anterior lateral and apical walls of LV

78
Q

Left circumflex artery

A
  • travels posteriorly around L heart
  • multiple branches, may include sinus node artery
  • supplies LA wall, posterior lateral LV, anterolateral papillary muscle, AV node, SA node
79
Q

Right coronary artery

A
  • supplies SA and AV nodes, RA and RV, posterior 1/3 of interventricular septum, posterior L bundle, interatrial septum
  • in 90% of pop, it travels from R coronary sinus to right AV groove, to crux and onto posterior AV groove
  • multiple branches- sinus node artery, AV node artery, proximal bundle branches, posterior descending artery, LA/LV terminal branches
80
Q

Coronary Sinus

A
  • located in posterior AV groove near crux
  • collects 85% of blood from LV, drains into LA
  • cath for LV studies
  • may be cannulated during bypass to delivery cardioplegia
81
Q

Anterior cardiac veins

A
  • 2-4 veins drain anterior RV wall
  • drain into RV directly or into coronary sinus
82
Q

Thebesian veins

A
  • transverse myocardium and drain into RA, RV, LV
  • may carry 40% of blood returned to RA
83
Q

Nicotinic Receptors

A
  • MUSCLES, all ganglionic neurons
  • effect of ACh is always STIMULATORY
84
Q

Muscarinic Receptors

A
  • found in PNS target organs
  • ACh is either inhibitory (cardiac) or excitatory
85
Q

Beta 1 Receptors

A
  • heart, kidneys
  • NE binding increases HR/strength, stimulates renin release
86
Q

Beta 2 receptors

A
  • lungs, other sympathetic target organs
  • NE binding is inhibitory- dilates BV and bronchioles, relaxes smooth muscle
87
Q

Alpha 1 receptors

A
  • found in blood vessels, sympathetic target organs
  • NE binding constricts vessels, sphincters, pupil dilation
88
Q

Alpha 2 receptors

A
  • found on membrane of adrenergic axon terminals, pancreas, platelets
  • NE binding inhibits NE release- inhibits insulin secretion, promotes blood clotting
89
Q

Increased plasma osmolarity triggers?

A

thirst mechanism

90
Q

Osmosis

A
  • movement of WATER across SPM (solutes do not move)
  • H2O moves from low solute concentration to high solute concentration
91
Q

What are the sensors of the respiratory control system?

A

chemoreceptors, baroreceptors, lung stretch receptors

92
Q

What is the central controller of the respiratory control system?

A

brain (pons, medulla)

93
Q

What are the effectors of the respiratory control system?

A

muscles of respiration

94
Q

Major output of central control (respiratory control system) occurs through what nerve?

A

phrenic (C3-5)

95
Q

What are the affector nerves for the respiratory control system?

A

vagus, glossopharyngeal

96
Q

Pneumotaxic Center

A
  • located in pons
  • fine tunes breathing (controls volume and rate)
  • inhibits inspiration
97
Q

Apneustic Center

A
  • located in pons
  • prolonged inspiratory gasps (brain injury)
  • excitatory effect on inspiration
98
Q

Dorsal Respiratory Group (DRG)

A
  • located in medulla
  • intrinsic periodic firing
  • basic rhythm of ventilation
  • can be overriden by pneumotaxic center
99
Q

Ventral respiratory group (VRG)

A
  • located in medulla
  • usually not active during normal breathing
  • more active with forceful breathing
100
Q

Surfactant

A
  • made by alveolar type II cells
  • decreases surface tension
101
Q

Law of Laplace

A

P= 2T/R (for sphere)

102
Q

P50

A

partial pressure where 50% of Hgb is saturated (usually around 27 mmHg)

103
Q

Shifting of Oxyhemoglobin Dissociation Curve

A

Right- O2 affinity for Hgb reduced (O2 unloads easier)

  • caused by increased H, PCO2, temp, 2-3 DPG

Left- increased affinity for Hgb (less unloading)

  • caused by decreased temp, H, PCO2, 2-3 DPG
104
Q

What PO2 is required to achieve a sat of 90% normally?

A

60 mmHg

105
Q

Bohr effect

A
  • change in PCO2 affects O2 dissociation curve
  • curve shifts to the left into lungs (facilitate O2 loading)
106
Q

Haldane Effect

A
  • change in PaO2 affects CO2 dissociation curve
  • at tissue, O2 diffuses into tissues so CO2 affinity increases for loading
  • at lungs, O2 diffuses from alveoli into blood- CO2 curve shifts to R to facilitate unloading
107
Q
A

Hypertonic volume expansion (3% admin)

108
Q
A

Hypotonic volume expansion (SIADH)

109
Q
A

Isotonic volume loss (diarrhea)

110
Q
A

Isotonic volume expansion (0.9 admin)

111
Q

Static Volumes (Lungs)

A

TV, RV, ERV, IRV, CV

112
Q

Dynamic Lung Volumes

A

FEV1, FVC, FEV1/FVC

113
Q

Tidal volume

A
  • normal volume of breathing
  • 6 mL/kg of IBW
114
Q

Residual Volume

A

air left after maximal expiration (1200 mL)

115
Q

Expiratory Reserve Volume

A

maximum air from end of normal inspiration to maximal expiration (1100 ml)

116
Q

Inspiratory Reserve Volume

A

maximum inspired air from rest (3000 mL)

117
Q

Closing Volume

A

volume at which alveoli close at end expiration (normally above residual volume)- absolute voluem of gas in lungs when small airways close

-increases with age, may exceed FRC in supine position

118
Q

FEV1

A

forced expiratory volume in one second

-normal 4L

119
Q

FVC- forced vital capacity

A

volume of gas that can be exhaled forcefully

-normal 5 L

120
Q

FEV1/FVC

A

ratio of parameters that allows distinction of obstructive vs. restrictive lung disease

  • normal is 0.8
  • restrictive lung disease may have normal ratio (both parameters decreased)
121
Q

Zone 1 of Lung

A
  • top
  • minimal blood flow
  • ventilated but not perfused (alveolar dead space)
  • PA>Pa>Pv
122
Q

Zone 2 of Lung

A
  • waterfall zone
  • blood flow determined by difference between arterial and alveolar pressures
  • Pa>PA>Pv
123
Q

Zone 3 of lung

A
  • blood flow determined by arterial-venous gradient
  • continuous blood flow
  • where tip of PA cath should be
  • Pa>Pv>PA
  • greatest compliance
124
Q

Zone 4 of lung

A
  • PATHOLOGICAL
  • present with pulmonary edema
  • low lung volumes, reduced blood flow
  • Pa>Pi>Pv>PA
  • Pi is interstitium pressure
125
Q

What is on the x and y axis of the flow volume loop?

A

y- flow (L/sec)

x- volume

126
Q
A

Normal flow volume loop

127
Q
A

Fixed upper airway (kinked ETT)

128
Q
A

Obstructive lung disease

129
Q
A

Restrictive Lung Disease

130
Q

Semilunar valves

A

aortic and pulmonic (each have 3 cusps)

131
Q

AV valves

A

tricuspid (R side, 3 leaflets)

mitral (L side, 2 leadflets)

132
Q

Inferior EKG leads

A

II, III, aVF

RCA

133
Q

Anteroapical EKG leads

A

V3 and V4

distal LAD

134
Q

Anteroseptal EKG Leads

A

V1, V2

LAD

135
Q

Anterolateral EKG Leads

A

I, aVL, V5, V6

Circumflex artery

136
Q

Extensive Anterior EKG Leads

A

I, aVL, V2-V6

proximal LCA

137
Q

True Posterior EKG leads

A

Tall R in V1

RCA

138
Q

Average Total Blood Volume

A

5 L

139
Q

What % of blood volume is RBCs?

A

40% or 2 L

140
Q

What % of blood volume is water?

A

60% or 3 L

141
Q

Variations in age with water content

A

babies- more water

elderly- less water (less muscle mass)

142
Q
A

Norepinephrine synthesis

143
Q

How is NE removed from the synpase?

A

reuptake or metabolized by MAO and COMT

144
Q

NE metabolites

A

DOMA, NMN, MOPEG, VMA

145
Q

Where is NE synthesized?

A

nerve terminal

146
Q

Which has a longer effect, NE or ACh?

A

NE- takes longer to metabolize

reuptake is how its action is stopped

147
Q

Limb placements for Einthoven’s triangle

A

RA (-/-)

LA (+/-)

LL (+/+)

148
Q

Lead Directions

A
149
Q

Which lead follows the electrical direction of the heart?

A

Lead II

150
Q

Layers of Pericardium

A

visceral- covers outer surface of heart

parietal- outer layer

normally 10-25 mL of serous fluid of between

151
Q

Layers of Cardiac Musculature

A

epicardium- outermost layer

myocardium- middle/muscle layer- pumping action

endocardium- thin, innermost layer

152
Q

Simple Diffusion

A
  • passive transport
  • nonpolar lipid soluble substances diffuse directly through phospholipid bilayer (gradient)
153
Q

Facilitated Diffusion

A
  • passive process
  • certain lipophobic molecules (glucose, amino acids, ions) use carrier proteins or channel proteins
  • proteins are selective, saturable, and can be regulated in terms of activity/quantity
154
Q

Is coronary blood flow continuous or noncontinuous?

A

Non-continuous

155
Q

Functional Residual Capacity (FRC)

A

air left after normal expiration

RV+ERV

2300 mL

reservoir for O2

156
Q

Vital Capacity

A

maximal inspiration followed by maximal expiration

(IRV+TV+ERV)

4500 mL

157
Q

Inspiratory Capacity

A

IRV+TV

3500 mL

158
Q

Total Lung Capacity (TLC)

A

volume in lungs after maximal inspiration

IRV+TV+ERV+RV

5800 mL

159
Q

Hypoxic Pulmonary Vasocontriction

A

determined by ALVEOLAR PO2

inhibition of nitric oxide pathway

shunts blood away from hypoxic areas

160
Q

Nitric Oxide effects on pulmonary vasculature

A
  • relaxing factor
  • increases cGMP- smooth muscle relaxation
  • disruption can lead to pulmonary HTN
161
Q

Prostacyclin effects on pulmonary vasculature

A
  • vasodilator
  • activates adenyl cyclase
  • inhibits platelet aggregation
162
Q

Pulmonary vasoconstrictors

A
  • endothelin 1
  • thromboxane 2

A&P (11 decks)

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