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HB2 Midterm > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is the hemodynamic version of Ohm’s Law?

A 
P = Q x R
P = pressure, Q = blood flow, R = resistance from organ systems
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2
Q

How do you calculate cardiac output?

A

CO= (MAP - CVP)/R

CO = cardiac output, MAP = mean arterial pressure, CVP = right atrial pressure/central venous pressure, R = resistance)

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3
Q

What does 100% of CO travel through?

A

the pulmonary circulation

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4
Q

How do you calculate the total resistance in series?

In parallel?

A
  • add them all

- take the reciprocal and add, then the reciprocal of the answer

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5
Q

If you add resistors in series, what happens to the total resistance?

A

increase the total resistance

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6
Q

If you add resistors in parallel, what happens to the total resistance?

A

decrease the total resistance

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7
Q

How many action potentials per minute does the SA node produce?
Why is resting HR lower than that?

A
  • about 100

- normal people at rest have a parasympathetic tone on the SA node via the vagus nerve

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8
Q

What is the only pathway that normally connects the chambers of the heart?

A

the AV node

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9
Q

Trace the pathway of electrical conduction through the heart.

A

SA node –> AV node –> bundle of His –> left and right bundle branches –> purkinje fibers –> ventricular myocytes

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10
Q

What is the intrinsic rate of the AV node?

A

40-60

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11
Q

What is the intrinsic rate of the purkinje fibers?

A

30-40

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12
Q

Where in the heart is there a slowing of electrical signal conduction?
Why?

A
  • at the AV node

- allows for full depolarization (and thus contraction) of the atria before stimulating the ventricles

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13
Q

What is the slowest conduction portion of the heart?

The fastest?

A
  • the AV node

- His-Purkinje system

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14
Q

Explain the phases of the cardiac action potential in ventricular myocytes.

A
  • Phase 0: upstroke/depolarization phase. In ventricular myocytes, due to Na influx (fast action potential)
  • Phase 1: rapid repolarization, due to K flowing out
  • Phase 2: plateau, Ca in, K out, little net current or voltage change
  • Phase 3: repolarization, due to K out, and Ca channels closing
  • Phase 4: resting/diastole, Na/Ca exchange, Na/K pump.
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15
Q

Explain the phases of the cardiac action potential in SA/AV node cells.

A
  • Phase 0: upstroke/depolarization phase. In SA/AV node cells, due to Ca influx via L-type Ca channels (slow action potential)
  • Phase 3: repolarization, due to K out, and Ca channels closing
  • Phase 4: resting/diastole/depolarization, Na/Ca exchange, Na/K pump. In nodal cells, funny (Na) channel active, and responsible for most of this phase.
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16
Q

What is the difference between slow and fast action potentials in the heart, and where are they found?

A
  • slow = in SA/AV node cells, due to Ca movement

- fast = in ventricular myocytes, due to Na movement

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17
Q

What is the difference in membrane potential between SA/AV node cells and ventricular myocytes?

A

nodal cell’s resting membrane potential is around -65mV, as opposed to ventricular myocytes whose resting potential is around -80mV

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18
Q

During which phase are ventricular myocytes in their relative refractory period?
What can increased amount of stimuli at this point cause?

A
  • Phase 3

- arrhythmias

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19
Q

What participates in slow Na release?

A

the funny channels

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20
Q

What gives the breast its shape?

Where do they start and end?

A
  • suspensory ligaments

- skin to the deep fascia

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21
Q

What are the 2 main lymphatic drainages of the breast?

A

the axillary nodes and the anterior mediastinal nodes

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22
Q

What border does the cephalic vein create?

A

the border between the deltoid muscle and the pectoralis major

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23
Q

What is the origin of the pectoralis major?
The insertion?
The function?

A

origin- the sternum, clavicle, and ribs
insertion- humerus
function- adduction and medial rotation of the arm

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24
Q

What is the origin of the pectoralis minor?
The insertion?
The function?

A

origin- ribs
insertion- coracoid process of the scapula
function- depressing the shoulder

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25
Q

What does the thoracoacromial artery do?

A

supplies blood to the pectoralis muscles, as well as to the shoulder and overlying skin

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26
Q

Where does the thoroacromial artery come from?

A

the axillary artery

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27
Q

What is the best indicator of left atrial pressure?

A

left capillary wedge pressure

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28
Q

What is pulse pressure an indicator of?

A

stroke volume

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29
Q

What are the ways you can alter the rate of the SA node?

A
  1. alter the steepness of depolarization in phase 4
  2. make the maximum diastolic potential more negative in phase 4 (will take longer to reach the more negative number and slow the HR)
  3. alter the threshold for depolarization
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30
Q

What factors can increase the SA node firing rate?

A
  1. sympathetic stimulation
  2. muscarinic receptor antagonists
  3. B-adrenergic receptor agonists
  4. circulating catecholamines
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31
Q

What factors can decrease the SA node firing rate?

A
  1. parasympathetic stimulation
  2. muscarinic receptor agonists
  3. B-blockers
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32
Q

Where does the sympathetic nervous system arise from?

What does this include?

A
  • the thoracolumbar spinal cord

- T1-12 and the first few L’s

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33
Q

Where does the parasympathetic nervous system arises from?

What does this include?

A
  • the cranial and sacral segments of the spinal cord, aka craniosacral outflow
  • CN III, VII, IX, X and S2-4
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34
Q

How do parasympathetic stimuli travel?

A

either top down or bottom up to meet in the abdomen

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35
Q

What is the basic structure of the neural system in the somatic nervous system?

A

cell body in the anterior horn and lower motor neuron synapses with the target tissue

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36
Q

What is the basic structure of the neural system in the autonomic nervous system?

A

2 nerves are present before you get to the target tissue. You have the 1st order neuron (pre-ganglionic) that leaves the spinal cord, a synapse with a ganglion, and a 2nd order neuron (post-ganglionic) goes to the peripheral tissue

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37
Q

What is located in the lateral horn of the spinal cord?

Where do these leave the spinal cord?

A
  • cell bodies for the para/sympathetic/cranial nerves

- the anterior root

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38
Q

Describe the course of the sympathetic fibers to the anterior ramus.

A
  1. cell bodies in the lateral horn
  2. leaves the spinal cord at the anterior root with the motor nerves
  3. travels through the spinal cord to the anterior ramus
  4. leaves the anterior ramus as a white ramus (myelinated) and goes to the sympathetic chain (ganglion)
  5. leaves the sympathetic chain as a gray ramus (no myelin) to travel to the target tissues
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39
Q

Describe the course of the sympathetic fibers to the posterior ramus.

A
  1. cell bodies in the lateral horn
  2. leaves the spinal cord at the anterior root with the motor nerves
  3. travels through the spinal cord to the anterior ramus
  4. leaves the anterior ramus as a white ramus (myelinated) and goes to the sympathetic chain (ganglion)
  5. leaves the sympathetic chain as a gray ramus and travels to the posterior ramus to innervate the intrinsic muscles of the back
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40
Q

What are the relative lengths of 1st and 2nd order neurons in sympathetic nerves?
Why?

A
  • short 1st order, long 2nd order

- ganglion next to the spinal cord in the sympathetic chain

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41
Q

What are the relative lengths of 1st and 2nd order neurons in parasympathetic nerves?
Why?

A
  • long 1st order, short 2nd order

- ganglion close to target tissues

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42
Q

What is responsible for erection of the penis?

A

parasympathetic S 2, 3, 4 (keeps the penis off the floor)

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43
Q

What neurotransmitter is present between 1st and 2nd order neurons?

A

acetylcholine

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44
Q

In a somatic nerve, what is the neurotransmitter released?

What is the receptor?

A
  • acetylcholine

- N1, aka Nm, the muscle-type nicotinic receptor

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45
Q

What kinds of receptors does acetylcholine bind?

A

cholinergic receptors (nicotinic or muscarinic)

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46
Q

In sympathetic nerves, what is the neurotransmitter released by 1st order neurons?
What is the receptor on the 2nd order neuron?

A
  • acetylcholine

- N2, aka Nn, the neuron-type nicotinic receptor

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47
Q

In sympathetic nerves, what is the neurotransmitter released by 2nd order neurons ?
What is the receptor on the target tissue?
What is the exception?

A
  • norepinephrine
  • a1, a2, B1, or B2 receptors
  • sweat glands, where acetylcholine is released and taken up by muscarinic receptors
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48
Q

What is the exception to the sympathetic neurotransmitter/receptor rule?
What does it use as its neurotransmitter?
What is the receptor?

A
  • sweat glands
  • acetylcholine
  • muscarinic receptors
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49
Q

In what process is the N1/N2 distinction very important?

A

anesthesia, where you want to paralyze the muscles but not the sympathetic nervous system

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50
Q

In parasympathetic nerves, what is the neurotransmitter released by 1st order neurons?
What is the receptor on the 2nd order neuron?

A
  • acetylcholine

- N2, aka Nn, the neuron-type nicotinic receptor

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51
Q

In parasympathetic nerves, what is the neurotransmitter released by 2nd order neurons ?
What is the receptor on the target tissue?

A
  • acetylcholine

- muscarinic receptors

52
Q

What is unique about the innervation of the adrenal medulla?
Why?
What neurotransmitter does the nerve release?
What receptor does the medulla use?
What pathway is it a part of?

A
  • a neuron from the spinal cord directly innervates it
  • allows medulla to secrete catecholamines quickly
  • acetylcholine
  • N2 receptors
  • sympathetic
53
Q

What are the 1st messengers in the autonomic nervous system?

A

acetylcholine, epineprhine, and norepinephrine

54
Q

What effector is Galpha-s associated with?

A

adenylyl cyclase

55
Q

What effector is Galpha-i associated with?

A

adenylyl cyclase

56
Q

What effector is Galpha-q associated with?

A

phospholipase C

57
Q

What G’s do beta receptors use?

A

Gs

58
Q

What G’s do alpha receptors use?

A

Gq

59
Q

What are common agonists for muscarinic receptors?

Antagonists?

A

agonist: acetylcholine and muscarine
antagonist: atropine

60
Q

What is the typical signalling pathway for M1/M3 receptors?

A

Gq

61
Q

What is the typical signalling pathway for M2 receptors?

A

Gi

62
Q

What are the common agonists for a1-adrenergic receptors?

Antagonists?

A

agnoists: norepinephrine and phenylephrine
antagonists: phentolamine and prazosin

63
Q

What are the common agonists for a2-adrenergic receptors?

Antagonists?

A

agonists: norepinephrine and clonidine
antagonists: phentolamine

64
Q

What is the typical signalling pathway for a1-adrenergic receptors?

A

Gq

65
Q

What is the typical signalling pathway for a2-adrenergic receptors?

A

Gi

66
Q

What are the common agonists for B1-adrenergic receptors?

Antagonists?

A

agonists: epinephrine, norepinephrine, and isoproterenol
antagonists: propranolol and atenolol

67
Q

What are common agonists for B2-adrenergic receptors?

Antagonists?

A

agonists: epinephrine, isoproterenol, and albuterol
antagonists: propranolol

68
Q

What is the typical signalling pathway for B1-adrenergic receptors?

A

Gs

69
Q

What is the typical signalling pathway for B2-adrenergic receptors?

A

Gs

70
Q

In the pulmonary system, what receptors are used in the para/sympathetic system?
What do they do?

A
  • sympathetic: B2, increase airway radius

- parasympathetic: M, decrease airway radius, increase secretions

71
Q

In the heart, what receptors are used in the para/sympathetic system?
What do they do?

A
  • sympathetic: B1, increase HR, increase myocyte contractility, and increase nodal conductance
  • parasympathetic: M, decrease HR and decrease nodal cocnductance
72
Q

In the blood vessels, what receptors are used in the para/sympathetic system?
What do they do?

A
  • sympathetic: mostly a1, but also a2, B2, decrease blood vessel radius (M3 increase radius)
  • parasympathetic: n/a
73
Q

In the sweat glands, what receptors are used in the para/sympathetic system?
What do they do?

A
  • sympathetic: M, stimulates sweat secretion

- parasympathetic: n/a

74
Q

What are the functions of skin?

A
  1. protection
  2. sensory
  3. heat and water regulation
  4. immune function
  5. metabolic
  6. endocrine
  7. excretion
  8. sexuality
75
Q

In what layer of the skin are blood vessels located?

A

dermis

76
Q

What are the layers of the epidermis from top to bottom?

A
  1. stratum corneum (horny cell layer)
  2. stratum granulosum
  3. stratum spinosump
  4. stratum basalis
77
Q

Which layer of the epidermis consists of proliferating cells that are responsible for maintenance of cell populations of the dermis?

A

stratum basalis

78
Q

Where is most of skin’s keratin synthesized?

A

stratum granulosum

79
Q

What are the components of the basal lamina?

A

the lamina lucida and lamina densa

80
Q

How are basal keratinocytes attached to the basil lamina?

A
  1. intracellular tonofilaments are attached to the desmosome plaque
  2. desmosomal plaque is attached to lamina densa anchoring filaments
  3. lamina densa attached to underlying reticular, collagen, and elastic fibers via anchoring fibrils (collagen VII)
81
Q

What are the specialized cell types located in the skin?

Which layer are they located in?

A
  • melanocytes, Merkel cells, and Langerhans cells

- the epidermis

82
Q

What do Langerhans cells do?

A

-they are derived from bone marrow and are part of the immune system of the skin; participate in phagocytosis

83
Q

What do Merkel cells do?

Where are they located?

A
  • act as mechanoreceptors

- the basal layer of the epidermis

84
Q

Where are melanocytes located?

A

the basal layer of the epidermis

85
Q

What are the layers of the dermis?

What are they comprised of?

A
  • papillary dermis: loose CT

- reticular dermis: dense irregular CT

86
Q

Where are most skin appendages located?

A

in the reticular dermis

87
Q

What are the skin appendages?

A

nail, hair follicles, sebaceous glands, and eccrine and apocrine sweat glands

88
Q

What do sebaceous glands secrete?

Where does their duct open into?

A
  • lipids/oils

- the hair follicles

89
Q

What do eccrine glands secrete?

Where does their duct open into?

A
  • sweat

- the surface of the skin

90
Q

What do apocrine glands secrete?
Where does their duct open into?
Where are they located?

A
  • viscous, odorless sex secretion
  • hair follicles
  • axilla and genital skin
91
Q

Where is the main arterial blood supply to the skin located?

A

the subcutis

92
Q

Which layer of the pericardium restricts expansion?

A

the fibrous pericardium

93
Q

On an EKG, how much time does a small horizontal block represent?

A

0.04 seconds

94
Q

On an EKG, how much time does a big horizontal block represent?

A

0.2 seconds (0.04 x 5)

95
Q

Explain the +/- of the standard 3 lead system

A

lead I- negative right arm, positive left arm
lead II- negative right arm, positive left leg
lead III- negative left arm, positive left leg

96
Q

In what directions do the unipolar limb leads run?

A

aVR- body center towards positive right arm
aVF- body center towards positive left leg
aVL- body center towards left arm

97
Q

What does the P wave represent?

A

atrial depolarization

98
Q

What does the QRS complex represent?

A

ventricular depolarization

99
Q

What does the T wave represent?

A

ventricular myocyte repolarization

100
Q

Where can atrial repolarization be found in the PQRST system?

A

hidden in the QRS complex

101
Q

On an EKG, when does conduction from the AV node, bundle of His, bundle branches, and Purkinje fibers occur?

A

between the P and Q wave

102
Q

How do you measure the PR interval?

What does this give you information about?

A
  • the start of the P wave to the first deflection of the Q wave
  • conduction through the AV node
103
Q

On an EKG, what difference would you expect to see if you had hypertrophy of the myocardium?

A

prolonged QRS complex

104
Q

How do you calculate HR from an EKG strip?

A

60/R-R interval

105
Q

What are normal values for the Mean Electrical Axis (MEA)?

A

-30 to +90

106
Q

What is perpendicular to lead I?

A

aVF

107
Q

What is perpendicular to lead II?

A

aVL

108
Q

What is perpendicular to lead III?

A

aVR

109
Q

What are the “rules of EKG”?

A
  1. de/repolarization perpendicular to the axis of an electrode has no net deflection
  2. Depolarization towards a + end gives upward deflection; repolarization towards a + end gives a downward deflection
  3. larger tissue mass causes larger deflection (ventricles more than atria)
  4. all EKG leads are recording the same information, just from different angles
110
Q

What value does the lead perpendicular to the MEA have?

A

NET 0

111
Q

What is the mitral valve aka?

A

bicuspid valve

112
Q

What designates when end diastolic volume occurs?

A

when the tricuspid/bicuspid valve closes

113
Q

What represents the maximal pressure that can be generated by the heart for any given volume?

A

the End Systolic Pressure Volume Relationship (ESPVR)

114
Q

How do you calculate stroke volume?

A

end systolic pressure - end diastolic pressure

115
Q

What designates when end systolic volume occurs?

A

when the tricuspid/bicuspid valve opens

116
Q

How do you calculate the ejection fraction?

A

EF = (EDV-ESV)/EDV

117
Q

What happens to the PV loop if you increase preload?

A
  • end diastolic volume (EDV) increased

- stroke volume increases

118
Q

What happens to the PV loop if you increase afterload?

A
  • prolong the time it takes for the aortic valve to open (isovolumetric contraction)
  • decreases the stroke volume
119
Q

What happens to the PV loop if you increase contractility?

A
  • increase slope of ESPVR

- increases stroke volume

120
Q

Which takes more time of the cardiac cycle- systole or diastole?
Why?

A
  • diastole

- diastole is when ventricles fill, and you want sufficient time for this to happen before contraction

121
Q

If you increase the HR, which decreases more- systole or diastole?

A

diastole

122
Q

What does diastole include?

A
  • ventricular relaxation
  • ventricular filling
  • atrial contraction
123
Q

What does systole include?

A
  • ventricular contraction

- ventricular ejection

124
Q

Which pleura cannot sense pain?

Why?

A
  • visceral pleura

- it has no sensory innervation

125
Q

What are the “divisions” of the pleura?

A
  1. costal
  2. cervical
  3. mediastinal
  4. diaphragmatic
126
Q

What are the contents of the superior mediastinum?

A
  1. thymus
  2. trachea
  3. esophagus
  4. aortic arch
  5. brachiocephalic veins
  6. superior vena cava
  7. vagus nerves
  8. phrenic nerves

HB2 Midterm (5 decks)

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