Physiology 1 Flashcards
Which of the following would result in INCREASED oxygen delivery to the tissues?
Oxygen delivery is dependent on cardiac output and arterial oxygen content, but is also affected by factors influencing the P50, the partial pressure of oxygen at which hemoglobin is 50% saturated. A left-shift in the oxygen-hemoglobin desaturation curve results in increased oxygen affinity and decreased oxygen delivery, whereas a right-shift results in decreased oxygen affinity and increased oxygen delivery to tissues.
Which of following MOST likely occurs in the brain after prolonged fasting?
During prolonged fasting the brain uses ketone bodies as an alternate source of energy. The other organs use fatty acids.
TrueLearn Insight : Fasting Period
10-12 hours: Decrease insulin; stimulate glucagon; increase fatty acid oxidation for energy
2-3 days: Increase in ketone bodies for brain to use as alternate energy
3 weeks: Protein breakdown/amino acid utilization for energy
Which of the following factors is MOST LIKELY responsible for the release of arginine vasopressin?
AVP is the main physiologic factor in water resorption. It is released from the pituitary in response to hyperosmolality, reduced effective circulating volume, angiotensin II, stress, pain, nausea, hypoglycemia, pregnancy, and certain drugs.
Which of the following occurs during ventricular diastole?
The cardiac cycle, discussed mainly from the standpoint of the ventricles, consists of diastole and systole. Ventricular diastole starts with isovolumetric relaxation following by rapid filling, diastasis (slow filling), and atrial systole. Ventricular systole starts with isovolumetric contraction followed by ejection of the blood from the ventricles.
Which of the following hormones is cleaved intravascularly during passage through the pulmonary circulation?
Angiotensin I is converted to AII by intravascular ACE in the pulmonary circulation. Circulating norepinephrine is inactivated and degraded within pulmonary endothelium.
Which of the following statements about adult brain metabolism is TRUE?
Under normal circumstances, the brain exclusively utilizes glucose for energy. During periods of fasting, exercise, or starvation, the brain also uses ketone bodies for energy.
An alteration of which of the following parameters MOST significantly stimulates the carotid body chemoreceptors?
The carotid body chemoreceptors are located at the bifurcation of the common carotid arteries bilaterally. The chemoreceptors are stimulated to increase minute ventilation in response to decreases in PaO2 below 60-65 mm Hg.
Which of the following will INCREASE pulmonary vasoconstriction?
Hypercapnia, hypoxia, and acidosis all contribute to pulmonary vasoconstriction. Inhaled nitric oxide is a selective pulmonary vasodilator that can be used to treat severe pulmonary hypertension.
Carbon dioxide is primarily transported in blood in which of the following three forms?
Carbon dioxide is transported in the blood as dissolved CO2, bicarbonate, and carbamino compounds.
Which option below would cause a DECREASE in a patient’s mixed venous oxygen saturation (SvO2)?
The Fick equation states: SvO2 = SaO2 – [VO2 ÷ (CO x Hgb x 1.36)]
Based on the Fick equation, SvO2 is DECREASED in the following settings:
- Increased oxygen consumption (e.g. hyperthermia, shivering, or pain)
- Decreased cardiac output (e.g. myocardial infarction or hypovolemia)
- Decreased hemoglobin concentration
- Decreased arterial oxygen saturation
Mixed venous oxygen saturation levels are INCREASED in the following settings:
- Increasing the hemoglobin concentration via blood transfusions
- Increased SaO2
- Decreased VO2 (e.g. cyanide toxicity, sepsis, carbon monoxide poisoning, methemoglobinemia, hypothermia)
- Increased CO (e.g. sepsis)
A left to right intracardiac shunt, in addition to increasing cardiac output, also shifts oxygenated blood from the left side of the heart to mix with deoxygenated blood on the right side, thereby falsely elevating the SvO2.
A 68-year-old alcoholic male comes in for emergent evacuation of subdural hematoma after a fall while intoxicated 1 hour ago. He is agitated, not following commands, and icteric on exam. The family states he has a history of cirrhosis and is noncompliant with medication therapy. He has no other medical history and is not taking any other medications. Which of the following is MOST likely true regarding his liver disease?
Synthetic liver function is best assessed via the PT/INR, which most closely correlates with factor VIIa levels.
A 60-year-old male is scheduled to undergo laparoscopic cholecystectomy. The patient has a history of type I diabetes mellitus complicated by gastroparesis and peripheral neuropathy. Which of the following is TRUE?
Metoclopramide is a dopamine antagonist that increases lower esophageal sphincter tone, enhances gastric emptying in patients who have slowed gastric emptying, and decreases gastric fluid volume. Unfortunately, its antiemetic properties are weak.
Which lung volume/capacity is defined as the amount of air in a patient’s lungs at end of exhalation during a normal volume breath, when air movement stops?
FRC is the volume of gas left in the lungs at the end of a tidal volume breath. FRC is essential to the effectiveness of preoxygenation.
TrueLearn Insight : Causes of low FRC are PANGOS: Pregnancy, Ascites, Neonates, General anesthesia, Obesity, Supine position.
Factors that increase closing capacity are ACLS-SO: Age, Chronic bronchitis, LV failure, Smoking, Surgery, Obesity.
Which of the following describes the volume of gas remaining in the lungs at passive end expiration?
Functional residual capacity is the volume of gas remaining in the lungs at passive end expiration. Furthermore, FRC is the primary determinant of oxygen reserve in humans when apnea occurs.
Which of the following is NOT a true statement regarding anesthetic uptake and blood:gas solubility?
(FA= fractional concentration of alveolar anesthetic, FI= fractional concentration of inspired anesthetic)
Volatile anesthetic uptake is proportional to blood:gas solubility, whereby those agents with higher blood:gas partition coefficients have a slower rate of rise of FA/FI as compared to less soluble agents. Volatile agent blood:gas solubility in order of least to greatest is: Desflurane < N2O < Sevoflurane < Isoflurane.
A patient presents to the emergency department with an acute ischemic stroke. An angiogram shows occlusion of the left anterior cerebral artery. What is the most likely presenting symptom?
Anterior cerebral artery strokes tend to lead to behavioral abnormalities, aphasia (if dominant cortex is involved), and contralateral lower limb weakness and sensory deficits.
Which of the following decreases the affinity of hemoglobin for oxygen?
Factors that decrease hemoglobin’s affinity for oxygen and therefore increase oxygen unloading to tissues include hyperthermia, acidosis, hypercarbia, and increased 2,3-BPG.
TrueLearn Insight : The Haldane effect describes the relationship between the content of carbon dioxide in the blood and the concentration of oxyhemoglobin. A mnemonic to help remember what shifts the curve to the right is: “CADET, face Right!” for CO2, Acid, 2,3-DPG, Exercise, and Temperature.
Which of the following explains the relationship between the carbon dioxide dissociation curve in blood and oxyhemoglobin?
The Haldane effect illustrates that the oxygenation of hemoglobin lowers the affinity of hemoglobin for carbon dioxide.
A 54-year-old male presents to the emergency department with a lower gastrointestinal bleed. The patient’s blood pressure is 82/51 mm Hg. What is the mechanism of action for renin in this patient?
A decrease in blood pressure stimulates the release of renin into the serum from the renal tubules. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by ACE. Angiotensin II causes an increase in blood pressure by direct vasoconstriction, enhancing the sympathetic nervous system, and causing an increase of aldosterone.
Which of the following is the single best choice in providing an assessment of hepatic protein synthesis?
Hepatic protein synthesis is best assessed by measuring coagulation factors.
In a healthy young adult, plasma volume comprises approximately what percentage of extracellular volume?
The ECV contains one-third of TBW, represents 20% of total body weight and is composed of plasma volume (20-25%) and interstitial fluid volume (75-80%).
Which of the following is the primary determinant of myocardial oxygen consumption?
Heart rate is the primary determinant of myocardial oxygen consumption. The heart maximally extracts arterial oxygen and therefore relies on increased oxygen delivery via metabolically mediated vasodilation, coronary autoregulation, and reactive hyperemia.
Which of the following points represents INCREASED lusitropy on the left ventricular pressure-volume loop below?
Pressure-volume loops can be used to illustrate changes in cardiac work as a result of various changes to ventricular pressure as a function of the ventricular volume. Positive lusitropy is depicted by a rightward and downward shift of diastolic filling, which illustrates a compliant ventricle that is able to accommodate a larger volume at a decreased ventricular pressure.
Which of the following phases contributes the LARGEST volume of blood to the left ventricle during diastole?
Early rapid filling contributes the largest volume of blood during diastole. The phases of diastole are: isovolumetric relaxation, early rapid filling, diastasis, and atrial contraction.
TrueLearn Insight : Atrial contraction normally contributes approximately 15% of the preload. In patients with poor left ventricular filling, as in diastolic dysfunction, the atrial contraction becomes very important.