Part 1: Physiology (Heart, Lungs, Kidneys) Flashcards
What vein drains the lumbers into the Superior Vena Cava?
Azygous Vein
What % of blood PASSIVELY flows into the right ventricle?
80% (20% needs atrial contraction)
The P wave starts at __________
SA node
Where is the SA node located?
Christa Terminalis of the Right Atrium
What node has an electrical delay? Why?
AV Node; to allow ventricles to completely fill
The P-R interval is when…
AV node is delaying
At the end of diastole what is the volume of the R. Atrium?
120ml
What valve closing creates the S1 heart sound?
Tricuspid
The QRS complex is when the ________ contract which is known as ___________.
Ventricles; ventricular depolarization
The 2 Pulmonary arteries carry ________________ blood to the lungs.
Deoxygenated
The Umbilical artery in a fetus carries ______________ blood
Deoxygenated
What effect is responsible for blood being oxygenated by the lungs?
Bohr Effect
How many Oxygen are there for each hemoglobin molecule?
Four
What % of hemoglobin is saturated with Oxygen?
97%
How many pulmonary veins carry oxygenated blood to the left atrium?
4
What structures carries the most oxygenated blood in the cardiovascular system?
The pulmonary veins
The umbilical vein in a fetus carries _________ blood.
Oxygenated
What % of blood PASSIVELY flows into the left ventricle? What does the other % need?
80%; 20% needs P wave AV nodal delay
What is the order of events in the left ventricle? (5)
1) Mitral valve closes
2) isovolumetric contraction
3) Midsystole
4) aortic Valve opens
5) aortic valve closes
6) isovolumetric relaxation
When the aortic valve opens how much blood rushes into the Aorta?
70ml
How much blood remains in the ventricles during isovolumetric relaxation?
50ml
Isovolumetric relaxation marks the…
End of Diastole
EKG Readings: P Wave
1) Atrial depolarization
2) Atrium contracts
3) SA Node
EKG Readings: P-R Interval
1) AV nodal delay
2) atrium contracting
EKG Readings: R
1) Isovolumetric contraction
2) Signal released from AV node & travels down Bundle of His into Purkinjie Fibers
What is the Moderator band?
Right Bundle of His in the septomarginal recess of the Right Ventricle
What is the fastest nerve in the body? Why?
Purkinje system in ventricle; intercalated discs & gap junctions
EKG Readings: QRS
1) Ventricular depolarization
2) Ventricle contracts
3) Atrial Repolarization is hidden under the QRS complex
EKG Readings: Q Wave
1) 1st downwards deflection
2) Chordae Tendinae + papillary muscles prevent AV valves from blowing back from vent. Cont.
EKG Readings: T Wave
ventricular Repolarization
EKG Readings: U wave
Repolarization of the papillary muscle (seen sometimes in bigger hearts)
EKG Readings: S-T Segment
Isovolumetric relaxation with 50ml of blood in the ventricles
During the S-T Segment the valves are ________
Closed
Inverted T Wave or an altered S-T segment indicates
Myocardial Infarction
AKA for Long absolute refractory period
Slow Calcium channels
Tetany =
Slow calcium channels
Plateaus means
Impossible for the heart to fire again
AKA for Auto rhythmicity
Automatic conductivity
What does Auto rhymicity mean?
Heart can beat on its own due to leaky sodium channels
What causes auto rhythmicity?
SA node at about 45 bpm
1 degree heart block EKG reading
Elongation of PR interval
2 degree heart block EKG reading
Elongation of PR interval until 2 atrial depolarization show up
What is the Winkebocks Phenomena?
2 degree heart block
Complete heart block EKG reading
No pattern / random
1st heart sound:
- AV valves closed
- Isometric contraction
- Lub
2nd heart sound
Semilunar valves closed
“Dub”
3rd heart sound
Ventricular gallop in CHF (normal in athletes & children)
4th heart sound
- Heard in diastole
- Atrial gallop
What pathologies occur in Diastole?
[ARMS & PRTS]
Aortic Regurgitation
Mitral Stenosis
Pulmonic Regurgitation
Tricuspid Stenosis
MC cause of CHF
Essential hypertension
2nd MC cause of CHF
Aortic stenosis
Essential hypertension age range
35-55
Ventricular Hypertrophy is seen in
CHF
What causes Exertional Dyspnea and Orthopnea?
Blood being backed up into the L. Atrium into the lungs (early sign of CHF)
What is Orthopnea?
Can’t lay down because of fluid in lungs
In CHF, blood backs up into the L. Atrium and lungs via
The pulmonary vein
Blood backing up into the L. Atrium to the lungs creates
1) pulmonary edema
2) pulmonary hypertension
In right sided heart failure..
Blood backs up into right ventricle
MC cause of right sided heart failure
Left sided heart failure
If right sided heart failure is isolated to the right side…
Cor Pulmonale problem; lung problem such as pneumonia or emphysema
If the R. Atrium backs up into the SVC…
Pulsation of jugular veins
If the R. Atrium backs up into the IVC…
It will back up to the liver and the legs (pitting edema)
What is the longest vein in the body?
Great saphenous vein
“Bag of worms” appearance of veins =
Varicocele
What vein is used for coronary bypass?
Great saphenous
Th Portal vein =
Superior mesenteric vein + Splenic/Lineal Vein
Portal hypertension creates
Ascites
MC cause of liver failure
Alcoholism
Alcoholism can cause
Ascites
Mallory Weiss Syndrome is caused by what steps?
1) alcoholism
2) liver failure
3) esophageal varices
4) hematemesis (vomit blood)
What is found in the liver with Mallory Weiss Syndrome
Mallory bodies
B1 (Thiamin deficiency) can lead to
Wernicke-Korsakoff psychosis
What are the layers of the blood vessels?
1) Tunica intimate (inside)
2) Tunica Muscularis (middle)
3) Tunica Adventitia (outside)
Blood vessels that irrigate blood vessels are called
Vaso Vasorum
The greatest pressure is found in what arteries?
The largest arteries
Resistance to pressure is found in what vessels?
Arterioles
Coronary arteries _________ & _________ due to ____________ _________.
Dilate & constrict; metabolic demand
Coronary arteries dilating & contricting due to metabolic demand…..
After load in heart is determined by aortic pressure
Normal blood pH
7.35-7.45
What blood type is the universal donor?
Type O-
What blood type is the universal recipient?
AB+
Characteristics of Tetralogy of Fallot: (4)
1) Dextroposition of aorta
2) R. Ventricular Hypertrophy
3) Interventricular septal defect
4) Pulmonary stenosis
Characteristics of Marfan’s syndrome: (4)
1) Dissecting aneurysm
2) Eye lens subluxation
3) tall stature
4) long spider-like fingers (arachnodactaly)
Characteristics of Valve defect:
1) destroyed by rheumatic fever
2) Strep Pyogenes
3) makes Aschoff bodies
Group A vs. Group B valve pathology:
A: Lancefield
B: Hemolytic Strep
MC benign tumor of the heart
Myxoma
Sign of Heart inflammation
C-reactive protein (CRP)
Laws of physiology: Bell Magende
Anterior spinal roots are motor / Posterior are Sensory
Laws of physiology: Hering Breuer
Limits respiratory excursion via the Vagus nerve
Laws of physiology: LaPlace’s Law for arteries
The tension in an artery is proportional to the radius of the vessel
Laws of physiology: LaPlace’s Law for the heart
ventricular pressure depends on muscular tension, size & shape of the heart
Laws of physiology: Starling’s Law
Cardiac output is equal to venous return
If venous return exceeds cardiac output…
Congestive Heart Failure
What is the Haldane effect?
Hemoglobin becomes more acidic binding with oxygen
The Haldane effect causes
Carbon dioxide and H+ protons to be expelled into the alveoli upon expiration
Carbon Dioxide and H+:
Always move together
What is the Bohr’s effect on the lungs?
[Shift to the Left = Shift to the Lung]
- Hemoglobin binds 4 O2’s
- Hemoglobin releases CO2, H+ & DPG
- Decreases temperature
What is Bohr’s effect at the Tissues?
- Hemoglobin releases O2
- Hemoglobin binds CO2, H+ & DPG
- Increases temperature
Normal Tidal volume
500 ml
Tidal volume is controlled by the
Pneumotaxic center and limits inspiration when lung is full
Tidal volume AKA
Normal breathing
What reflex is fired in tidal volume?
Herring Breuer reflex
Inspiration Reserve volume AKA
Forced Inspiration
Normal Inspiration Reserve volume
3000ml
Inspiration Reserve volume shuts of the
- Herring Breuer Reflex
- & Pneumotaxic reflex via the apneustic center in the pons
What lung volume allows for deep breath and is the largest part of individual breathing?
Inspiration Reserve volume
Expiratory Reserve Volume AKA
Forced expiration
Normal Expiratory Reserve Volume
1100ml
What controls Expiratory Reserve Volume
Rectus abdominals
What lung volume keeps the lungs from collapsing?
Residual volume
Normal Residual volume
1200ml
What is the calculation for Normal Inspiratory capacity?
Inspiratory Reserve Volume + Tidal Volume = 3500ml
What is the calculation for normal Functional Residual capacity?
ERV + RV = 2300ml
What is the calculation for normal Vital capacity?
IRV + TV + ERV = IC + ERV = 4600ml
What is the calculation for normal Total lung volume?
IRV + TV + ERV +RV = 5800ml
What is “dead space” in the lungs
Air in the pulmonary tree not involved with gas exchange (like air in bronchi)
Respiration is controlled by 1) what nerve & 2) what CN’s?
1) Dorsal Motor nucleus of Vagus nerve
2) Nucleus Ambiguous CN 9, 10 & 11
Alveolar pressure is
Slightl negative due to surfactant
Atmospheric pressure
Opposes alveolar pressure
Pleural pressure
Is negative and keeps the lungs open to their resting level
Trans pulmonary pressure
Is the difference between alveolar pressure and pleural pressure measuring elastic forces in the lungs
Lack of surfactant at birth usually in premature babies (disease name)
Acute Respiratoy Distress Syndrome (ARDS)
AKA Neonatal Hyaline Membrane Disease
Apex of the lung is called the
Cupola
What type of cell is the entire lung made up of?
(PCCE) Pseudostratified Ciliated Columnar Epithelium
The alveolar sacs are made of what type of cell?
Simple Squamous Epithelium
Type 1 Pneumocytes are responsible for:
Gas exchange
Type 2 Pneumocytes are responsible for:
Decrease surface tension (Surfactant)
What are the macrophages of the lung called
Dust cells
Fluid in the lungs collects in the
Diaphragmatic recess
J cells are for
Mucous
Water is 20x more absorbable to. ____ than ____
CO2; O2
Central chemoreceptors in the brain are most sensitive to
Increases in CO2 (Decrease in O2 is second)
Peripheral chemoreceptors in the carotid and aortic body are most sensitive to
Decrease in O2 & Increase in CO2
Chloride shift does what?
Keeps the blood pH constant
%’s of CO2 in the blood (3)
70% is bicarbonate
23% is carbamino Hemoglobin
7% freely diffused in blood
AKA for Carboxyhemoglobin
Carbon Monoxide
Carbonic Anhydrase converts what?
H20 + CO2 <-> H + HCO3
Carbonic Anhydrase is a ____________ ___________.
Reversible enzyme
What is the mineral for carbonic Anhydrase?
Zinc
Acidosis has increased:
[H+] & [CO2]
Acidosis has decreased
[O2]
Alkalosis has decreased
[H+] & [CO2]
Alkalosis has increased
[O2]
Cause of Respiratory Acidosis
Decreased ventilation
Examples of Respiratory Acidosis (3)
- Holding breath
- consolidation
- pneumonia
Treatment for Respiratory Acidosis
Urinate NH4+ out and Breathing
Cause of Respiratory Alkalosis
Increased ventilation
Example of Respiratory Alkalosis
Hyperventilation
Treatment for Respiratory Alkalosis
Bag over head and/or excrete Bicarbonate (NaCO3)
Cause of Metabolic Acidosis
Non-Lung Acidosis
Examples of Metabolic Acidosis (3)
- Diarrhea
- Diabetes
- Ketoacidosis
Treatment for Metabolic Acidosis
Hyperventilation to blow off CO2
(If DM -> smell ketones)
Cause of Metabolic Alkalosis
Non-lung alkalosis
Examples of Metabolic Alkalosis (2)
1) Bulimia (loss of HCL)
2) Diuretics ( loss of H+)
Treatment for Metabolic Alkalosis
Slow Breathing
Kidneys filter ____ liters of fluid per day
180
The macula densa is located in the ____________
Distal convoluted tubule
The macula densa is sensitive to
Sodium concentration
When the macula densa detects decreased sodium …….
It interprets it as decreased blood pressure
The macula densa acts on the ________ ___________ causing _____________.
Afferent arteriole; Vasodilation
After the macula densa causes vasodilation of the afferent arteriole, what cells are stimulated and what do they do?
Juxtaglomerular cells; release Renin into the blood
Renin combines with _____________ to form _____________.
Angiotensinogen; angiotensin I
After Angiotensin is formed where does it travel? And what is it converted to?
Lung; Angiotensin II
What is the most powerful vasoconstricter known to humankind?
Angiotensin II
Where does Angiotensin II have its greatest effect and what does it do?
The Efferent Arteriole; Vasoconstriction
Angiotensin II ultimately produces what result?
Increases pressure in the Glomerulus
Increased pressure in the glomerulus…
Forces fluid out into the Bowman’s Capsule for filtration
Angiotensin II goes to the _____ __________ of the ___________ __________ to secrete _____________.
Zona Glomerulosa; Adrenal Cortex; Aldosterone
Once Angiotensin produces secretion of Aldosterone the affect is on the ____________________ which retains ________ and excretes __________.
Distal convoluted tubules; Sodium; Potassium
When sodium levels rise in the blood, what are they picked up by and what is the result?
Osmoreceptors of the supraoptic nucleus of the hypothalamus & Release ADH/Vasopressin
What is the greatest effect of ADH
Makes the COLLECTING DUCTS permeable to water
Once water leaks out of the collecting ducts, the __________ __________ of the _____________ ______________ return it to the blood
Oncotic pressure; peritubular capillaries
Where does angiotensinogen come from?
Liver
What is the first segment of the male urethra?
Preprostatic urethra
What is the second segment of the male urethra?
Prostatic urethra
What is the third segment of the male urethra?
Membranous urethra passing through the urogenital diaphragm in the deep perineal pouch
What is the forth segment of the male urethra?
Penile Urethra; corpus spongiosum
If the penile urethra comes out on the top of the penis it is called
Epispadias
If the penile urethra comes out of the bottom of the penicillin it is called
Hypospadias
What structure is responsible for Male erection?
Corpus Cavernosa
What does Micturitian mean?
Going pee
Whaat is the muscle that avoids the bladder in the urinary system?
Detrusor
What triggers the release of Aldosterone?
Angiotensin II
Where does Aldosterone act?
Distal convoluted tubules
What is the action of Aldosterone
Retain Sodium & Excrete Potassium
What triggers the release of ADH?
Increased Sodium osmolarity
Where does ADH act?
Collecting duct
What is the action of ADH?
Allows reabsorption of water by making collecting ducts permeable to water
The distal convoluted tubules absorbs ______ under the influence of _____________.
Sodium; Aldosterone
Everything except for sodiu is absorbed through the…
Proximal convoluted tubules
What is the best test for GFR?
Insulin
The Loop of Henle prevents
Excess Ion excretion
The kidney cortex includes (3)
1) Nephron
2) PCT
3) DCT
The kidney Medulla consists of: (2)
1) Loop of Henle
2) collecting ducts
Order of where fluid flows in the urinary system: (5)
Minor Caylx
Major Caylx
Renal Sinus
Renal Pelvis
Ureter
