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ABA ITE > Physiology > Flashcards

Physiology Flashcards

1
Q

What corresponds with the electrical R wave on an ECG?

A

Mitral valve closure

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2
Q

What happens to the FRC when you age? With height changes?

A

It increases. This is due to the elastic recoil of the lung decreasing. FRC will increase with height

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3
Q

What effect does propofol have on SSEPs?

A

Decreases amplitude and increases latency (not to the extent that volatiles or barbiturates will)

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4
Q

What is the standard FRC in a standard adult patient? What is the oxygen consumption?

A

FRC: 30 ml/kg

O2 consumption: 3-4 ml/kg/min

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5
Q

Name 3 hormones that are metabolized in the pulmonary circulation

A
  1. NE
  2. Serotonin (>95% of serotonin is removed from circulation in one pass through the lungs)
  3. bradykinin
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6
Q

What is the posterior pituitary gland called?

A

The neurohypophysis (this releases oxytocin and ADH)

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7
Q

Which is more active? T3 or T4? Why? How is T3 formed?

A

T3 due to decreased protein binding. It is formed by the peripheral conversion of T4 to T3 by 5-iodinase

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8
Q

What neuro monitoring system is MOST affected by volatiles?

A

Visual: VERY #1
Motor: most
Somatosensory: somewhat
Brainstem auditory: barely

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9
Q

What ratio of urine osmolarity to plasma osmolarity indicates a pre-renal cause of oliguria?

A

Uosm: Posm > 1.5

Urine osmolarity > 440 and Plasma osmolarity > 285

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10
Q

What effects do a L to R shunt and a R to L shunt have on inhalational induction and IV induction?

A
  1. Inhalational: L to R shunt has no effect, but a R to L shunt SLOWS induction
  2. Intravenous: L to R shunt MINIMALLY slows induction (due to recirculation of drugs through the lungs) and a R to L shunt speeds induction
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11
Q

What are the three main ways that CO2 is carried in the blood?

A
  1. Dissolved CO2
  2. Bicarbonate
  3. Carbamino compounds (CO2 bound to proteins)
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12
Q

Name 6 factors that increase MAC

A

Things that increase cerebral metabolic rate:

  1. Hyperthermia
  2. Hypernatremia
  3. Chronic alcohol use
  4. Increase in central neurotransmitters (seen with MAOIs, levodopa, ephedrine, cocaine, and amphetamines)
  5. Red hair
  6. Peak at 6 months of age
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13
Q

Which vertebral segments house the SNS?

A

T1-L3

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14
Q

What ganglia are part of the UE SNS?

A

upper cervical, middle cervical, and stellate ganglia (stellate is the fusion of the lower cervical and first thoracic ganglia)

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15
Q

What is the reticular activating system?

A

The part of the brain that alters consciousness. Signals are transported from the RAS via the thalamus to the cerebral cortex. Most anesthetics (except Ketamine) directly depress the RAS. Ketamine works on the Thalamus

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16
Q

Explain the changes seen with pregnancy that occur with spirometry

A
  1. There is minimal to no decrease in TLC or VC

2. There is a decrease in RV and ERV, meaning that IRV will increase

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17
Q

Name the sleep stages, in order, of awake to asleep

A 
BATS Drink Blood
Beta (awake)
Alpha (drowsy)
Theta (stage 1)
Spindles and K complexes (stages 3/4)
Blood (awake)

Higher frequency waves start at the top and decrease in frequency as you progress

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18
Q

What determines movement of fluids across the BBB? What common molecule crosses the BBB freely?

A

Intravascular osmolarity and oncotic forces.

Water crosses the BBB freely

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19
Q

What techniques can be used as an ancillary modem of confirming brain death? What defines electro cerebral silence?

A
  1. EEG and evoked responses

2. EEG < 2uV/mm activity

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20
Q

What is the volume left at the end of normal tidal volume breathing?

A

FRC (ERV + RV)

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21
Q

Describe the changes seen with altitude sickness. What are the complications? How can you prevent it?

A
  1. Low PaO2 stimulates the carotid body to tell the brain to breathe
  2. Increased ventilation means a resp. alkalosis ( though the alkalosis normalizes, MV remains increased)
  3. The CSF then decreases it’s concentration of Bicarb prior to plasma via excretion
  4. Body equilibrates in 2-3 days
  5. Complications include HAPE (more likely if pre-existing pulmonary HTN), and HACE due to hyperemia in the setting of hypoxia
  6. Acetazolamide is the prophylaxis
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22
Q

What is the equation for CPP? What does the body do to acutely compensate for increases in ICP?

A

MAP - (ICP or CVP: depends on which is highest)

  • Movement of intracranial venous blood to extra cranial veins or intracranial CSF to spinal CSF
  • CBF will NOT decrease. It will INCREASE because it will try to maintain CPP, and this is what explains Cushing’s triad
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23
Q

Describe the ABG of a pregnant woman

A
  1. Increased MV leads to a respiratory ALKALOSIS with an incomplete metabolic acidosis for compensation
  2. Early in pregnancy, you will see an increase in PaO2 to 105-107 that will then decrease as the pregnancy progresses
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24
Q

Describe the formation and metabolism of Ach

A
  1. Ach is synthesized in neuron terminals by choline acetyltransferase
  2. Ach is broken down in the synaptic cleft by acetylcholinesterase (not to be confused with butyrlycholinesterase aka pseudocholinesterase)
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25
Q

Describe the phases of the pacemaker action potential. How does sympathetic activation change this waveform?

A

Phase 0: influx of Calcium via L-type calcium channels
Phase 3: efflux of K
Phase 4: Influx of Na and Ca via T-type calcium channels

-Sympathetics increase the slope of phase 4, meaning that the myocytes reach their threshold faster

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26
Q

Describe the Renin-Angiotensin-Aldosterone System. Describe the role of Angiotensin II

A
  1. the kidneys sense poor perfusion and release renin
  2. The renin then cleaves angiotensinogen to angiotensin 1
  3. Angiotensin 1 is converted to Angiotensin II by the lungs (primarily) and the kidney
  4. Angiotensin II causes the production of aldosterone
  5. Angiotensin II and Aldosterone increase systemic blood pressure, renal perfusion, and increase intravascular volume
  6. Angiotensin II: increases SVR by vasoconstriction, increases GFR by constriction of efferent glomerular arterioles, stimulates release of ADH to increase volume, and stimulates production of Aldosterone
  7. Aldosterone causes re-absorption of Na and therefore water
27
Q

What is another term for transpulmonary lung pressure?

A

Elastic recoil of the lung

28
Q

What will an ABG show in a patient with diarrhea?

A
  1. Acidosis, diarrhea goes down the tube and so does the pH
    (as opposed to vomiting, which goes up and so does the pH)
  2. Hyperchloremic metabolic acidosis
  3. Hypokalemia
29
Q

What is Winter’s formula? When do you use it?

A
  1. used for metabolic acidosis, to determine change in Co2
  2. = (1.5*HCO2) + 8 +/-2
  3. If CO2 is different, suspect a mixed disorder!
30
Q

Where are catecholamines made? What amino acid are they made from?

A
  1. Chromaffin cells of the adrenal medulla

2. Tyrosine

31
Q

What did the ARDSnet trial show in regards to lung protective strategies?

A

TVs of 6ml/kg lead to decreased hemodynamic changes as well as decreased coagulopathic and renal issues

32
Q

What is the function of a Type 1 pneumocyte vs. Type 2?

A
  1. Type 1: forms the cells that participate in alveolar gas exchange
  2. Type 2: makes surfactant
33
Q

What causes an increase in A-a gradient?

A

Dead space, shunt, perfusion abnormalities

A-a > 15 abnormal (A-a is 5-10 in healthy adults)

34
Q

What is the equation for coronary perfusion pressure?

A

Coronary PP: AoDiastolic pressure - LVEDP

35
Q

What molecule does the Juxtaglomerular apparatus in the kidney sense?

A

Chloride

36
Q

What drug should be given to pregnant patients upon reversal with neostigmine to prevent fetal bradycardia?

A

Atropine (this is a tertiary amine as opposed to glyco which is a quaternary amine)

37
Q

Up until what post conceptual age should neonates be monitored overnight following GA? Why?

A
  1. 60 post conceptual weeks

2. to prevent bradycardia and apnea

38
Q

What respiratory changes are seen in pregnant women on spirometry?

A
  1. Decreased FRC, which means that IRV increases
  2. TV increases
  3. VC and TLC remain unchanged
39
Q

What is the incidence of paraparesis following LP?

A

1.5%

40
Q

Describe the Bohr effect

A

Increased H+ or CO2 decreases the affinity of Hgb for 02. This is the rightward shift of the o2 dissociation curve. This provides the body ability to deliver O2 to metabolically active tissues

41
Q

Describe the effects of sodium bicarbonate on the body

A
  1. Increase in pre-load: NaHCO3 is very hyperosmolar. This will pull fluid into the intravascular space
  2. Decrease in LV Contractility. This is because it will bind out the ionized calcium momentarily
  3. Increases affinity of Hgb and O2
  4. Can cause intracerebral hemorrhage in neonates due to increased volume as well as increased CBF due to conversion of bicarb to CO2
42
Q

Describe the Haldane effect

A

This provides the body ability to deliver CO2 to the lungs. De-oxygenated hemoglobin binds to CO2 with more affinity than oxygenated hgb. This is the opposite of the Bohr effect and explains how we are able to offload CO2 in the lungs

43
Q

What type of acid base disorder would you see with fast administration of NS?

A

Non anion gap hyperchloremic metabolic acidosis, strong anion difference of 0

44
Q

What are the components of NS vs LR?

A
  1. NS: 154 Na, 154 Cl –> Hypertonic
    2: LR: 130 Na, 4 K, 28 bicarb, 28 lactate —> hypotonic, lactate is metabolized to Bicarb which there is a question of whether or not this can cause an alkalosis
45
Q

In what scenario are anesthetics used to create burst suppression (EEG)? And why?

A
  1. Used in Status epilepticus
  2. Decreases CMRO2 by 50%
  3. Can use propofol, gasses, or barbiturates
    * * phenobarb coma**
46
Q

How would you describe the coronary perfusion of the RV?

A

Continuous through the cardiac cycle because the RVP is low enough to allow minimal compression of the RCA

47
Q

Describe the change that you would see on a pressure volume loop with increased lusitropy

A

Increased lusitropy: ability to increase volume of the ventricle at lower pressures, which means a downward and rightward movement of the End diastolic pressure volume slope

48
Q

What contributes most to evaporative heat loss in the OR?

A

Exposed body tissue

49
Q

Describe secondary adrenal insufficiency

A

Loss of ACTH production due to exogenous steroid administration

50
Q

Describe the zones of the adrenal cortex

A

Cortex: secretion of glucocorticoids and mineralocorticoids
Reticularis: androgens
Medulla: catecholamines

51
Q

Why do you see fade with NDMB?

A

There are nAChr on the pre and post junctional membranes. The ones on the PRE junctional membrane are activated during continuous nerve stimulation to create a positive feedback loop, which leads to release of Ach . With NDMB, you block these PRE synaptic nAchR, which leads to decreased release of Ach and therefore decreased muscle twitches.

52
Q

What is the thermoneutral zone for a fully naked newborn?

A

32-35 degrees

53
Q

Describe the physiology of a transplanted heart

A
  1. Unopposed sympathetics leads to increased intrinsic heart rate
  2. The atrial remnant from the patient remains in place but dose not stimulate the heart
  3. The heart rate is driven by the transplanted heart’s atrium
54
Q

What is the brand name for sodium polystyrene sulfonate?

A

Kayexalate

55
Q

What is the cause of bronchospasm?

A

Direct stimulation of airway, or direct irritation. It is not a result of the autonomic nervous system

56
Q

True or False: dilution anemia causes a reduction of 02 delivery to tissues

A

TRUE

57
Q

Define mixed venous oxygen saturation

A

The percentage of Hgb-O2 molecules returning to the R side of the heart

58
Q

Write out the Fick equation

A

Mixed venous oxygen concentration = The amount of oxygen in the blood minus the amount of oxygen consumed in the body/ (Hemoblobin x Cardiac output x 1.36)

59
Q

Define the Bowditch effect

A

This is the link in increase in HR leading to an increase in contractility

60
Q

What is the most common cause of hypotension following initiation of CPB?

A
  1. Hemodilution. The crystalloid makes the blood more thin, which leads to increased blood flow and decreased SVR
61
Q

Describe the effects of general anesthesia on renal perfusion

A

Transient decrease in renal function, leading to decreased GFR, renal blood flow, UOP, and UNa

62
Q

Where is CSF produced?

A

Choroid plexus and lateral ventricles

63
Q

Which amino acid partakes in producing glucose during stressed states?

A

Alanine (in the alanine-pyruvate cycle)

64
Q

What is the trend of TBW as you progress from neonate to teen to adult to elderly?

A

Neonate: highest proportion
Stabilizes as a teen
Then it decreases in relation to weight but stays relatively normal due to an increase in fat in the elderly

ABA ITE (16 decks)

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