Physiology Flashcards

1
Q

Pacemaker potential in SAN/AVN(slow depolarisation to threshold) is from ___ to ___ mV
It is due to ___ + ___

A

-60 to -40mV
slow Na+ influx - If and Ib - funny current and background Na current
ICaT - transient Ca2+ influx
decreased Ik - less K+ efflux

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2
Q

The action potential in SAN/AVN(rapid depolarisation) is from ___ to ___ mV
It is due to ___

A

-40 to +10mV

Voltage-gated Ca2+ channels open for rapid influx of Ca2+ - ICaL

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3
Q

Repolarisation in SAN/AVN is from ___ to ___mV

It is due to ____ + ____

A

+10mV to -60mV

K+ channels open (efflux - increase Ik) and Ca2+ channels close

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4
Q

Electrical impulse travels between myocytes through ____

A

gap junctions

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5
Q

3 stages of SAN/AVN electrical activity

A

pacemaker potential - spontaneous slow depolarisation
action potential - rapid depolarisation
Repolarisation

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6
Q

____ and ____ allow rapid conduction of AP to ventricles

A

Bundle of His, its branches and the Purkinje fibres

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7
Q

Resting potential in cardiac myocytes is

A

-90mV

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8
Q

Phase 0 of cardiac myocyte AP is from __ to __mV

Due to ___

A

-90 to +30mV - depolarisation

Fast Na+ influx

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9
Q

Phase 1 of cardiac myocyte AP is due to ___

A

transient K+ efflux (Ito)

closure of Na+ channels

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10
Q

Phase 2 of cardiac myocyte AP =___

Due to ___

A

Plateau phase
Opening of voltage-gated Ca2+ (influx - ICaL)
INaL (late Na influx) w. NCX1 (1Ca in:3Na out)

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11
Q

Phase 3 of cardiac myocyte AP = ___

Due to ___

A

Repolarisation
K+ channels open (efflux) Ik
closure of Ca2+ channels

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12
Q

Phase 4 of cardiac myocyte AP =

A

maintained at -90mV

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13
Q

______ is the dominating ennervation of the SAN at rest

A

Vagal tone (parasympathetic)

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14
Q

Normal HR at rest =

A

60-100bpm

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15
Q

Vagal nerve causes release of __ to ___ receptor in the _____

A

ACh to M2 receptor

SAN and AVN

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16
Q

Parasympathetic effect on pacemaker potential in SAN

A

hyperpolarisation, threshold increases = -ve chronotropic

Increases perm. to K+ and decreases perm. to Na+ & Ca2+

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17
Q

Parasympathetic NS has a chronotropic+/ionotropic effect on the heart

A

-ve chronotropic

NO IONOTROPIC

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18
Q

Sympathetic nerves supply _____ in the heart

A

SAN, AVN and myocardium

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19
Q

Parasympathetic effect on the AVN

A

increases delay

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20
Q

Sympathetic nerves causes release of __ to __ receptors in the heart

A

noradrenaline beta1 adrenoceptor

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21
Q

Effect of sympathetic NS on SAN

A

threshold decreases, decreased perm to K+ increased perm to Na+ and Ca2+ - increases slope of pacemaker potential
=> +ve chronotropic effect

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22
Q

Sympathetic NS has a chronotropic+/ionotropic effect on the heart

A

+ve chronotropic and ionotropic effect

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23
Q

QRS complex =

A

ventricular depol.

masked atrial repol.

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24
Q

T wave =

A

ventricular repol.

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25
Q

PR interval =

A

mainly AVN delay

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26
Q

ST interval =

A

ventricular systole

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27
Q

TP interval =

A

diastole

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28
Q

P wave =

A

atrial depolarisation

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29
Q

Desmosomes are located in ___ and provide ___ allowing ___

A

the intercalated discs
mechanical adhesion
tension development between myocytes

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30
Q

In the heart: Myosin + ___ -> + ___ = ____ formation allowing for binding to _____

A

ATP ; Ca2+ ; cross-bridge ; actin

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31
Q

In the heart: actin + myosin -> ___ + _______ -> ____

A

ADP, Pi + energy released ; powerstroke as myosin bends ; A + M detach

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32
Q

Excitation-contraction coupling in cardiac myocytes

A

systolic Ca2+ influx at Phase 2 stimulates CICR from SR so binding site on actin available for myosin

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33
Q

location of SR

A

covers myofibrils in muscle cells

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34
Q

effect of increased intracellular Ca2+ in actin myosin binding

A

Ca2+ binds to troponin on tropomyosin and pulls it away from the binding site on actin

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35
Q

Long refractory period in cardiac myocytes is from ___ to ___

A

depolarisation to repolarisation

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36
Q

Stroke volume definition =

A

blood vol ejected from each ventricle per heart beat

EDV-ESV

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37
Q

Intrinsic control of stroke volume =

A

change in diastolic length of myofibrils (EDV/preload determined by venous return)

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38
Q

Staling’s law of the heart

A

increased EDV/venous return => increased stroke volume

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39
Q

stretch in cardiac myocytes ____ troponin affinity for Ca2+

A

Stretch increases troponin affinity for Ca2+

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40
Q

Optimal fibre length in cardiac myocytes =

A

stretched

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41
Q

Starling’s law partially compensates for a decreased SV as ____

A

heart doesn’t eject full volume so EDV increases => SV increases by Starling’s law

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42
Q

Extrinsic control of stroke volume =

A

sympathetic NS to ventricular myocytes

Hormones - adrenaline and noradrenaline

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43
Q

How does the symp. NS cause +ve ionotropic effect on ventricular myocytes?

A

cAMP mediated Ca2+ channels activated = increase force

Shifts Starling curve to the left (contractility at a given EDV is greater)

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44
Q

Aortic area on the chest =

A

2nd intercostal space

R of sternum

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45
Q

Pulmonary area on the chest =

A

2nd intercostal space

L of sternum

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46
Q

Tricuspid area on the chest

A

4th intercostal space

L of sternum

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47
Q

Mitral area on chest

A

5th intercostal space

Mid-clavicular line

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48
Q

a wave in JVP =

A

atrial contraction

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49
Q

c wave in JVP =

A

tricuspid valve bulges into R atrium as ventricles contract

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50
Q

v wave in JVP =

A

atrial filling

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51
Q

The dicrotic notch in aortic pressure occurs at ____ due to ____

A

the end of ventricular systole

closure of the aortic valve

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52
Q

isovolumetric ventricular contraction and relaxation occur when

A

the AV valves and the aortic/pulmonary valves are shut

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53
Q

Ib background Na current in the pacemaker potential is due to ___

A

“leaky cells” = influx of Na

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54
Q

If (funny current) is mediated by _____

A

HCN channels

hyperpolarisation-activated cyclic nucleotide gated channels (influx Na and efflux K)

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55
Q

beta 1 stimulation in AVN causes _____ by increasing ____

A

increased conduction velocity

If and ICa

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56
Q

beta 1 stimulation in SAN causes ____ by ____

A

increased HR
steeper pacemaker potential slope by If+ ICa increase
lowers threshold by increasing ICa

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57
Q

beta 1 stimulation causes +ve ionotropic effect by ____

A

increase Ca2+ influx and sensitise tropomyosin to Ca2+

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58
Q

beta 1 stimulation causes an increase in _____ activity which speeds up ___

A

NaKATPase

repolarisation

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59
Q

Sympathetic enervation of the heart causes the length of systole + diastole to _____

A

Both shorten

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60
Q

ACh to M2 receptors in SAN+AVN cause ____ subunits to open ____ causing ______

A

βγ ; GIRK (K+ channels) hyperpolarisation

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61
Q

Parasympathetic NS increases SAN threshold by ____

A

decreasing ICa

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62
Q

Parasympathetic NS does not supply the _____ in the heart

A

ventricular myocytes

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63
Q

AVN delay is increased by the parasympathetic NS by ___

A

decreased Ca2+ channel activity and GIRK hyperpolarisation

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64
Q

Parasympathetic NS ____ atrial refractory period and may => ____

A

shortens

atrial arrhythmias

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65
Q

HCN channels are activated by

A

hyperpolarisation

cAMP

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66
Q

SERCA =

Its role is to ____

A

SR Ca2+ATPase

sequestration of Ca2+ into the SR so cardiac myocytes relax

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67
Q

CICR is caused by Ca2+ activating ____ receptors

A

ryanodine type 2 (RyR2 receptors)

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68
Q

greatest p.d. detected when lead is _____ to dipole

A

parallel

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69
Q

Limb lead I goes from ___ to ___

A

R arm (-ve) to L arm (+ve)

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70
Q

Limb lead II goes from ___ to ___

A

R arm (-ve) to L leg (+ve)

71
Q

Limb lead III goes from ___ to ___

A

L arm (-ve) to L leg (+ve)

72
Q

Depolarisation towards a +ve electrode causes

A

upwards deflection in ECG

73
Q

P wave’s normal duration=

A

0.08 - 0.1s

74
Q

normal duration of QRS =

A

less than or equal to 0.12s

75
Q

Q wave = ____ depol of ___

A

L->R depol of intraventricular septum

76
Q

R wave = depol of ____

A

main ventricular mass down towards the apex

77
Q

S wave = depol of ___

A

ventricle from apex upwards

78
Q

T wave = repol of ventricles from ___ to ___

A

epicardium to endocardium towards the apex

79
Q

normal PR interval =

A

0.12 - 0.2s

80
Q

aVR lead electrodes =

A
L arm and L leg (-ve) to 
R arm (+ve)
81
Q

aVL lead electrodes

A
R arm and L leg (-ve) to 
L arm (+ve)
82
Q

aVF lead electrodes

A
R and L arm (-ve) to
L leg (+ve)
83
Q

V1 is placed ____

A

4th intercostal space R of sternum

84
Q

V2 is placed ___

A

4th intercostal space L of sternum

85
Q

V4 is placed ____

A

5th intercostal space L midclavicular line

86
Q

V5 is placed ____

A

5th intercostal space L anterior axillary line

87
Q

V6 is placed ___

A

5th intercostal space L mid axillary line

88
Q

V1 and V2 look at the ____

A

septum

89
Q

V2-4 look at the ____

A

anterior of the heart

90
Q

V5-6 look at the ____

A

lateral border of the heart

91
Q

1st Korotkoff sound =

A

peak systolic pressure

92
Q

5th Korotkoff sound =

A

no sound! diastolic pressure

93
Q

MAP equations

A

2dbp+sbp/3
dbp + 1/3(sbp-dbp)
COxTPR

94
Q

normal MAP =

A

70-105mmHg

95
Q

___ MAP = can’t perfuse heart brain and kidneys

A

less than 60mmHg

96
Q

Short term control of bp is by ___

A

baroreceptor reflex

97
Q

baroreceptor firing increases if ___

A

bp increases

98
Q

baroreceptors are found in ___

and enervated by ___

A
carotid sinus (CN IX)
aortic arch (CN X)
99
Q

Reflex that prevents postural hyypotension

A

baroreceptor reflex

100
Q

Parasympathetics decrease MAP by

A

decreasing HR => decreased CO

101
Q

Sympathetics increase MAP by

A

increase HR and SV => increase CO

increase TPR and venous return

102
Q

Long term regulation of MAP is by ____ adjusting ___

A

hormones

blood volume

103
Q

Hormones involved in MAP regulation =

A

RAAS - Angiotensin II and aldosterone
ANP
ADH/vasopressin

104
Q

Renin is released from ____

A

juxtaglomerular apparatus (macula densa (monitor tubular Na) extraglomerular mesangial cells and granular cells (release renin))

105
Q

Renin is released in response to ___ (3)`

A

renal artery lbp
stim of renal sympathetic nerves
decreased Na concn in renal tubular fluid

106
Q

___ is made up of ___ +___ and controls MAP by __

___ makes up 1/3 of total body fluid

A
extracellular fluid (ECF) = plasma (PV) + interstitial volume
PV controls MAP
ECF =1/3TBF
107
Q

Angiontensinogen is produced in the ___ in response to ___

A

liver

renin

108
Q

ACE is produced by ____

A

the lungs - pulmonary vascular endothelium

109
Q

Angiotensin II stimulates ___

A

aldosterone release
systemic vasoconstriction
ADH release and thirst

110
Q

Aldosterone is released from ___

acts on the ___ causing ___

A
adrenal cortex (a steroid hormone)
kidneys - Na and H20 retention
111
Q

RAAS increases MAP by increasing __ + ___

A

plasma volume and TPR

112
Q

ANP is synthesised in ___

A

atrial myocytes

113
Q

ANP is released when ___ and causes ___ and___

A

atrial distension occurs (hypervolaemia)
kidneys excrete more Na and H20
vasodilation

114
Q

ADH is synthesised in ___ and stored in ___

A

hypothalamus

posterior pituitary

115
Q

ADH is released when ___ receptors located ___ sense ___

A

osmoreceptors ; in brain close to hypothalamus ; ^ plasma osmolarity

116
Q

ADH effects:

A

reabsorption of H2O from kidney tubules

vasoconstriction

117
Q

vasodilating substances eg. __

activate ___ on endothelial membrane ->^_->___ activates __ to turn ___ into ___+___

A

bradykinin, ADP, 5-HT

GPCR > ^Ca2+ > eNOS = l-arginine + O2 -> citrulline + NO

118
Q

NO activates ___ and ___

End result = vasodilation

A

Ca2+ dependant K+ channel (K+ efflux)> hyperpolarisation

guanylate cyclase catalyses gTP>cGMP activates protein kinase G

119
Q

Endothelin causes ___ by acting on ___ causing ___

A

vasoconstriction (most potent vasoconstrictor)

ETa receptors on SM => ^Ca2+

120
Q

Increase synth of endothelin

A

adrenaline, angiotensin II, ADH

121
Q

decrease synth of endothelin

A

NO, A/B/CNP, sheer stress

122
Q

pulse pressure =

A

sbp-dbp

123
Q

TPR =

Mainly controlled by

A

blood viscosity x length of vessel/radius^4

arteriolar radius

124
Q

Intrinsic control of vascular SM=

A

metabolic changes (chemical and humoural), temperature, myogenic stretch response

125
Q

main control of brain bp by effect on vascular SM

A

myogenic response to stretch

126
Q

Factors that increase venous return:

A

sympathetic nerves, contraction of skeletal muscle

increased respiratory pump, increased blood volume

127
Q

Exercise causes a ___ pulse pressure by ____

A

wider - increasing sbp and decreasing dbp

128
Q

local metabolic changes that cause vasodilation

A

increased CO2, H+, extracellular K+, osmolarity of ECF, adenosine (from ATP)
decreased O2

129
Q

local vasodilators =

A

histamine, bradykinin, NO (serotonin)

130
Q

local vasoconstrictors =

A

endothelin, leukotrienes, thromboxane A2 (serotonin)

131
Q

hydrophobic core of lipoproteins =

A

cholesteryl ester and triglycerides

132
Q

hydrophilic coat of lipoproteins=

A

monolayer of amphipathic cholesterol
phospholipids
more/=1 apoprotein

133
Q

HDL has apo

A

A1 and A2

134
Q

LDL has apo

A

apoB100

135
Q

VLDL has apo

A

apoB100

136
Q

chylomicrons have apo

A

ApoB48

137
Q

Function of apoB containing lipoproteins

A

deliver tri.s to muscle/adipose tissue

138
Q

ApoB lipoprotein involved in exogenous pathway=
formed in ____
transports ____

A

chylomicrons
intestinal cells
dietary tri.s

139
Q

ApoB lipoprotein involved in endogenous pathway=
formed in ___
transports ___

A

VLDL
liver
tri.s synthed in liver

140
Q

lipidation of ApoB lipoproteins is performed by ___

A

MTP - adds ApoB to lipoprotein

141
Q

Most of the cholesterol in chylomicrons is from __

A

75% bile salts

25% dietary

142
Q

ApoB lipoproteins are activated by

A

apoCII on HDL

allows delivery of tri.s

143
Q

___ allows ApoB lipoproteins to bind to ___ which ___ tri.s allowing them to ___

A

ApoCII ; LPL ; hydrolyses ; enter the tissues

144
Q

LPL is released from ___

A

capillary endothelium in adipose and muscle cells

145
Q

Once LPL dissociates from chylomicrons+VLDL ___ is transferred to HDL in exchange for ___ and they =

A

ApoCII for ApoE

=remnant (cholesteryl ester rich)

146
Q

after chlomicrons+VLDL become remnants they go to the ___ where they are metabolised by ___

A

liver

hepatic lipase

147
Q

Receptor mediated endocytosis in hepatocytes clear __

A

all apoB48 and 50% of apoB100 remnants

148
Q

hepatic lipase remove tri.s from ____ to form ____which then becomes ___ as ___ is lost and only ___ remains

A

50% of apoB100 remnants

IDL>LDL - apoE is lost, apoB100 remains

149
Q

LDL receptors (esp. in hepatocytes) bind to LDL > _____ > ____ where cholesterol is released by ____ >LDL receptor is

A

endocytosed>lysosome>hydrolysis>recycled to the membrane

150
Q

LDL uptake by LDL receptors => (3)

A

inhibits HMG CoA reductase (de novo chol synth)
storage of cholesterol
less LDL receptor expression

151
Q

___ is released when vessel endothelium is damaged. It is oxidised to form ___

A

LDL>atherogenic oxidised LDL (OXLDL)

152
Q

OXLDL is taken up by ___ and converted to ___

A

macrophages> cholesterol laden foam cells

153
Q

inflammatory substances released in vessel damage =>

A

division and proliferation of SM cells into intima and collagen laid down
ie. plaque and fibrous cap form

154
Q

Function of HDL

A

reverse transport of cholesterol

blood->liver

155
Q

HDL is formed in the ___

A

liver

156
Q

cholesterol and cholesteryl ester are taken into hepatocytes when HDL interacts with

A

SRB1 (scavenger receptor)

157
Q

In plasma - ___ mediates the transfer of cholestryl ester from HDL to VLDL+LDL
This =

A

CETP - chol. ester transfer protein

indirect chol. return to liver

158
Q

High tri.s damage the ____

A

pancreas

159
Q

Extra O2 to cardiac tissue is only achieved by ____ as o2 extraction is already at 75% (compared to 25% normal tissues)

A

increasing blood flow

160
Q

Intrinsic control of coronary artery blood flow __

Extrinsic control of coronary artery blood flow ___

A

intrinsic: metabolic hyperaemia causes decreased PO2 -> vasodilation
extrinsic: sympathetics = constriction (overridden by intrinsic) and adrenaline vasodilation

161
Q

Pulmonary bp normally =

A

20-25/6-12mmHg

162
Q

pulmonary capillary pressure =

systemic =

A

8-11mmHg

17-25mmHg

163
Q

hypoxia causes pulmonary vessels to

A

vasoconstrict - to divert blood away from poorly ventilated areas of lung

164
Q

Blood volume _____ in varicose veins to compensate therefore CO ___

A

blood volume increases

CO remains the same

165
Q

Exchangeable proteins pass though capillary endothelial cells by ___

A

vesicular transport

166
Q

forces favouring filtration in capillaries

A

Pc (capillary hydrostatic P)
+
πi (interstitial fluid osmotic P)

167
Q

forces opposing filtration in capillaries

A

πc (capillary osmotic P)
+
Pi (interstitial hydrostatic P)

168
Q

arteriolar end net filtration pressure =

favours ___

A

+10mmHg

filtration

169
Q

venular end net filtration pressure =

favours ___

A

-8mmHg

reabsorption

170
Q

which is greater in a day filtration or reabsorption in capillaries?

A

Filtration by 2-4litres

Excess is returned as lymph

171
Q

Filtration/reabsorption is favoured in pulmonary capillaries as ___ is low and __ is normal

A

reabsorption ( still is a nett filtration movement though)
Pc is low
πc is normal

172
Q

Oedema causes

1) increase capillary P =
2) increase venous P =
3) decreased plasma osmotic P =
4) lymphatic insufficiency =
5) changes in cap. permeability =

A

1) arteriolar dilatation
2) LV failure (pulmonary)
RV failure (peripheral)
prolonged standing (ankles)
3) plasma protein

173
Q

Isoelectric complex =

The axis lies ____ to the isoelectric complex

A

positive and negative deflections are equal in size

at 90degrees