Final Exam Flashcards
(128 cards)
1
Q
Define stress
A
a state of real or perceived threat to homeostasis
2
Q
Which two body systems control homeostasis?
A
neuro and endocrine
3
Q
What is the major regulator of homeostasis?
A
hypothalamus
4
Q
Why is homeostasis important?
A
maintains optimum cell structure and function
5
Q
Define stressor
A
any external or internal stimulus (variable) that causes a change in the internal homeostatic balance (creates imbalance)
6
Q
What are the two types of stressors? (this will be a question on the exam)
A
Distress– bad stress, ex. genetic, congenital or acquired stress that damages the body
Eustress– good stress, ex. exercising, which energizes and motivates the body
7
Q
What is the difference between signs and symptoms?
A
signs– measurable
symptoms– subjective
8
Q
Define allostasis
A
the process of the body trying to adapt to change– is a compensatory mechanism caused by chronic change to the homeostatic set point of a variable
9
Q
Describe allostatic overload
A
when the body is not able to adapt to stress– from chronic or severe stress
10
Q
Describe General Adaptation Syndrome (GAS)
A
-how our body responds to a stressor
-described by Dr Hans Selye in 1946
-a more thorough version of the fight-or-flight response
2 main factors determine an individual’s response to a specific stressor:
-the specific event or environmental stressor
-the conditioning of the individual experiencing the stress–
including how they cope with the stressor
11
Q
What are the 3 stages of GAS?
A
1) alarm reaction (fight or flight)– norepinephrine was released during a sympathetic NS response
2) resistance reaction– allostasis/adaptation/allostatic load
3) exhaustion stage (allostatic overload)– onset of stress-related issues occurs
12
Q
What are the physiological effects of NE and epi?
A
increase perfusion/mobilize resources (ex. glucose) to organs vital to survival; those deemed non-vital to survival have perfusion decreased
13
Q
What are the categories of stressors?
A
chemical, physical, and psychological
14
Q
What reaction does prolonged stress trigger?
A
the resistance reaction by the HPA
15
Q
What does hypothalamic CRH trigger?
A
anterior pituitary ACTH and then adrenal cortex cortisol
16
Q
Name some stress related diseases
A
HTN, cancer, diabetes, allergies
17
Q
Name some coping strategies
A
meditation, deep breathing, exercise
18
Q
What is the formula for cardiac output?
A
CO=SVxHR
CO is cardiac output (volume of blood pumped per minute)
SV is stroke volume (volume of blood pumped)
HR is heart rate (beats per minute)
19
Q
What affects stroke volume?
A
3 variable: preload, contractility, and afterload
20
Q
Describe preload
A
the “fill”; the volume of blood that fills the ventricle during ventricular diastole (ventricles at rest)– it is related to the rate of venous return and is equal to the end diastolic volume (EDV)
21
Q
Describe contractility
A
the “push”; the force of contraction produced by cardiac muscle cells– Frank-Starling’s Law of the Heart states that contractility is directly affected by preload and thus directly affects SV and CO
22
Q
Describe afterload
A
the “squeeze”; this is the resistance cardiac muscle must overcome to pump blood through the aortic valve->aorta->aortic branches– afterload opposes forward flow of blood and thus inversely affects SV and CO
Increase in afterload is a sign aortic valve disorder or an issue with the aorta itself
23
Q
What is the purpose of the surfactant secreted by type II alveolar cells?
A
to coat the inside of the alveoli as an oil to reduce surface tension so that the cell doesn’t break when it expands during inspiration
24
Q
What is between the inner and outer layers of the capillary?
A
type 4 collagen (egg shaped cell)– this is the collagen that is destroyed during emphysema in COPD patients
25
Explain the V/Q ratio
ventilation (air coming in) divided by perfusion (blood flow)-- should equal to close to 1 for maximum amount of respiratory gas exchange
expresses the effectiveness of gas exchange
26
What is the pH of blood?
between 7.35 and 7.45-- controlled by the amount of bicarbonate in the blood and the amount of carbon dioxide given off by your lungs
27
What happens if blood pH is off?
protein misfolding, enzyme damage, DNA damage, etc.
28
What compromises respiratory function?
1. inadequate blood flow to pulmonary capillaries
2. inadequate airflow to the alveoli
3. inadequate exchange of respiratory gases between pulmonary capillaries and alveoli
29
What are the three basic causes of respiratory disease?
1. hypoperfusion
2. hypoventilation
3. inadequate gas exchange
30
Define hypoperfusion
too little blood flow through the lungs-- main causes are heart failure and pulmonary embolism
31
Define hypoventilation
too little gas diffusion in the alveoli-- main causes are airway obstruction and restricted lung expansion
32
What is an acceptable V/Q ratio?
ideal is as close to 1 as possible-- so between 0.8 and1.2
<0.8 means more perfusion than ventilation
>1.2 means more ventilation than perfusion
33
Describe dead-space ventilation
-decreased perfusion (low Q) and normal ventilation
-results in V/Q ration >1
-ventilating a "dead" area where little or no blood is going through
-ex. blockage in pulmonary artery
-builds up CO2
34
What is cor pulmonale?
an abnormal enlargement of the right side of the heart caused by the heart struggling to pump out blood
35
Describe physiological shunting
-normal perfusion and decreased ventilation
-results in a V/Q ratio <1
-something is blocking the airway
-results in mixed blood leaving lung tissue and not just oxygenated blood
-risk of acidosis from lack of CO2
36
Describe silent unit
-decreased perfusion and decreased ventilation
-hypoventilation triggers reflex vasoconstriction and hypoperfusion
-an attempt to maintain V/Q ration = 1
-usually seen in pneumothorax (collapsed lung) and ARDS (acute respiratory distress syndrome)
-not sustainable long term
37
What are the signs and symptoms of respiratory disease?
-cough
-dyspnea
-cyanosis
38
Define dyspnea
-shortness of breath reported by patients
-result of obstruction or reduced lung compliance
-normal during heavy exertion but not normal long term
39
Where is cyanosis visible?
only lighter skin tones it can be visible on the surface of the skin but on darker skin tones check the mucous membranes and whites of the eyes
40
What causes peripheral cyanosis? central cyanosis?
peripheral-- due to peripheral vasoconstriction and reduced blood flow to tissue so it is a perfusion issue
central-- due to failure of the lungs to oxygenate the blood so it is a ventilation/perfusion imbalance
41
What are the two clinical heart failure?
right-sided heart failure and left-sided heart failure
both result in hypoperfusion
42
Describe right-sided heart failure
-weakened right ventricle cannot maintain adequate output so reduced blood flow
-V/Q mismatch
-results in dead-space ventilation and decreased efficiency of gas exchange
43
Describe left-sided heart failure
-weakened left ventricle results in decreased CO
-blood backs up in pulmonary circulation-> pulmonary HTN-> hypoperfusion
44
What is pulmonary edema?
-when plasma and RBCs break through the very thin capillary layers as soon as the pulmonary artery pressure rises too high
-often accompanies heart failure
-abnormal accumulation of fluid in lungs
-patient may cough up pink, frothy fluid and can drown in their edema
-always have dyspnea
45
Describe thromboembolism
-arise in deep calf or thigh veins and lodge in pulmonary vessels, blocking blood flow
-associated with pulmonary HTN upstream from occlusion
-pulmonary HTN results in hypoperfusion
-can lead to right-sided heart failure
46
Clinical examples of hypoperfusion
-heart failure
-pulmonary edema
-thromboembolism
47
Describe bronchial asthma
-obstructive lung disease results in hypoventilation
-result of exposure to inhaled irritant
-mucosal swelling, bronchoconstriction, mucus hypersecretion
-productive cough, dyspnea and wheezing
48
What is the difference between bronchial asthma and chronic bronchitis?
-diagnostically similar
-difference in rapidity of the onset and the speed of resolution if treated properly
49
Describe chronic obstructive pulmonary disease (COPD)
-a group of respiratory disorders characterized by chronic and recurrent obstruction of airflow in the pulmonary airways
-progressive but may be partially reversible
-hyperreactive to an irritant, usually smoking
-diagnosed on the basis of 2 consecutive years in which a productive cough is present for at least 3 months
-currently the third leading cause of death in North America and the second leading cause of disability
-encompasses chronic obstructive bronchitis and pulmonary emphysema
50
Describe chronic obstructive bronchitis
-part of COPD
-increased mucus production, obstruction of small airways, and a chronic productive cough
-symptoms similar to bronchial asthma
-swelling of mucosa caused by the irritation from the inhaled particulate matter
51
Describe pulmonary emphysema
-enlargement of air space and destruction of lung tissue
-the continuous activation of neutrophils in the lungs which release an elastase enzyme which destroys type 4 collagen in the alveolar cells walls which causes them to collapse
-barrel-shaped chest, dyspnea, wheezing
52
Describe restrictive lung disease
-diverse category of lung disease causing the same problem of restricted lung expansion
-reduced lung expansion b/c of changes in pulmonary interstitium (support structure of the lungs) and/or respiratory structures external to the lungs
-NOT due to airway obstruction
53
What are the two categories of restrictive lung disease?
1) extrinsic restriction-- caused by changes to respiratory system structures external to the lungs
2) intrinsic restriction-- caused by changes to the lung tissue itself
54
Describe intrinsic restrictive lung disease
disorders that produce alterations in pulmonary interstitium
two forms:
1) acute respiratory distress syndrome
2) pulmonary fibrosis
55
What can be caused by perfusion or ventilation disorders?
- Hypoxia
- Anoxia
- Hypoxemia
- Ischemia
- Infarction
56
What's the difference between a thrombus and a blood clot?
A thrombus is inside the vessel and a blood clot is outside the vessel
57
What are some causes of impaired circulation?
- Endothelial damage
- Abnormal blood flow pattern
- Obstructions
58
What are some causes of inadequate cardiac output?
- Weak ventricular pump
- Structural heart defect
- Dysrhythmias
- Sudden decrease in vascular resistance
59
Which type of blood vessel has elastic fibers?
Elastic arteries--a property called compliance
60
What is the purpose of Arterioles?
regulate blood flow into capillary beds
- Vasoconstriction will decrease perfusion
- Vasodilation will increase perfusion
61
Describe arterial remodeling
When a chronically high arterial BP causes structural changes
62
How does stress effect blood flow?
- Chronic stress leads to increase NE/epi and increase RAAS activity -> chronic systemic vasoconstriction -> chronic increased PR -> chronic endothelial damage
- Chronic stress leads to increased cortisol -> hyperglycemia -> high BG causes chronic irritation of endothelial cells -> cell damage
63
Where is the highest normal capillary BP?
In the Kidneys
64
If you increase capillary BHP what happens to IFHP?
It increases--IFHP manifests as tissue edema
65
Why is slow blood flow rate a potential problem?
Platalets will automatically start clotting
66
What can you do right now to promote YOUR venous return?
- Gravity
- Valves
- Skeletal muscle pumps
- Respiratory pumps
67
What is a common disease in veins?
Varicose veinsssssssssss
68
Define myopathy
A heart muscle disease
69
What 3 aspects make up stroke volume?
- Preload
- Afterload
- Contractility
70
If there is an increase in afterload what does this signal?
A problem with the aorta
71
Which two variables directly affect cardiac workload?
- Contractility
- Heart rate
72
What is orthostatic hypotension?
Hypotension with change of position
73
What causes a change in BP?
A change in blood volume and change in peripheral resistance
74
Define Oliguria
almost no pee
75
What are the patterns of blood flow?
- Normal :)
- Turbulent :(
- Sluggish :(
- Stasis (stopped) :( :(
76
What happens when platelets and collagen interact?
Coagulation cascade
77
Name the 3 components of a blood clot? (Definitely on the EXAM)
- Fibrin
- Platelets
- Red Blood Cells
78
Define Thrombosis
The formation of a thrombus
79
Define Sepsis
Blood borne infection
80
Define Arteritis and Phlebitis
Arteritis: Inflammation of an artery (most likely due to infection)
Phlebitis: Inflammation of a vein (most likely due to IV)
81
Define Axial streaming
Cells go down the center of the blood vessel (axial zone) -- while plasma surrounds them in the plasmatic zone
82
Where is the highest blood pressure?
Aorta
83
Define Bifurcations
sites of vessel branching -- occurs as blood is forced into a new direction of flow creating turbulence
84
Define Stenosis
The narrowing of a vessel; could be a structural abnormality or cause by trauma
85
Describe the types of arterial remodeling
- T. intima -> Endothelial damage
- T. media -> Vascular smooth muscle hypertrophy
- Vascular Fibrosis -> Fibroblasts make collagen (decreased compliance)
86
Define Hypovolemia
A decrease in blood volume
example: dehydration, hemorrhage, or endocrine disorder
87
What can result from blood stasis?
No blood flow leads to ulcerations and necrosis
88
What is the difference between a Thrombus and an Embolus?
A Thrombus is a blood clot that forms in a vein and an Embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass.
89
Define Atherosclerosis
A progressive inflammatory arterial disorder that only occurs in arteries and arterioles.
2 Major etiologies:
- Hypercholesterolemia
- Inflammation
90
What happens as a result of partial occlusion compared to complete occlusion?
Partial occlusion -> causes ischemia (tissue hypoxia)
Complete occlusion -> Infarction (tissue anoxia / tissue necrosis)
91
Define Collateral Circulation
The addition of extra microvasculature due to chronic hypoxia
- Protective mechanism when arterial occlusion is a slow process
- Helps perfusion
- Not in pulmonary vessels
92
What is Artheroma?
Fatty plaques
- Made of triglycerides, cholresterol, fatty acids and may include calcium
(only in arteries!)
93
What is the chronological order of Atherogenesis? (EXAM)
1. Injury to endothelial cells lining artery wall -> chronic inflammation -> artery wall remodeling
2. Fatty streak formation
3. Fibrous atheromatous plaque formation (Fibrosis)
4. Development of complicated lesions (hard fatty plaque or thrombus)
DECREASES LUMEN SIZE
94
Describe Fatty streak formation
- Migration of WBC's
- Lipid accumulation and oxidation promotes inflammatory response
- Macrophages -> phagocytize lipids -> become LDL laden foam cells
- Fibroblast and smooth muscle cell proliferation
95
Define occlusion
blockage of a vessel-- can be estimated in percentages
96
What serious complications can result from atherosclerosis?
-hypertension
-partial or complete occlusion
-formation of a complicated lesion (stable or unstable plaque)
-aneurysm or ruptured aneurysm weaken the artery wall and thrombosis or hemorrhage can occur at site of lesion
97
Describe Virchow's triad
the triad describes the 3 major causes of thrombosis in arteries, veins or heart chambers
1. endothelial cell injury
2. alterations in blood flow
3. hypercoagulability
98
What are the two methods of classifying thrombi?
1. by location-- occlusive, intrmural or vegetations
2. by vessel type-- arterial or venous
99
Where are (intra)mural thrombi found?
-attached to the lining of the heart wall or aorta
-high embolization rate
-post-cardiac arrest
where are murals found? on walls
100
Where are vegetation thrombi found?
-attached to damaged or infected heart valve or artificial heart valves
-may include bacteria or fibrous scar tissue (a complication of rheumatic heart disease)
101
What is a complicated lesion?
It is a combination of atherosclerotic fatty plaque and thrombus
102
What is Homan's sign?
when there is pain in the calf muscle with dorsiflexion of the foot-- seek immediate medical intervention
103
Where is the risk of embolism for an arterial occlusion? for a venous occlusion?
arterial occlusion has a risk of embolism in the specific tissue that the artery serves
venous occlusion has a risk of embolism in the lungs
104
What are the types of emboli?
-thromboemboli
-air (gaseous)
-neoplasm
-microorganisms (septic)
-amniotic fluid
-fat
-foreign body
NOT ALL EMBOLI ARE BLOOD CLOTS
105
What should you ask yourself when trying to locate a potential embolic site?
1) where did the embolus form?
2) where will the embolus travel to until it reaches a vessel too small to pass through? this is where it will lodge and block blood flow
106
What is the difference between ischemia and infarction?
ischemia is a lack of blood supply to an area and infarction is the process of obstructing blood flow (resulting in death of cells)
107
What are the two categories of infarcts?
based on appearance
1) white or pale infarcts-- arterial occlusion
2) red infarcts-- venous occlusion
108
Define aneurysm
weakened blood vessel or heart wall; outpouchings develop
-if the wall ruptures then it is called a ruptured aneurysm-> sudden hemorrhage
-clinical manifestations depend on the location of the aneurysm
109
Define varicosity
a weakened/distended "tortuous" vein which results in the blood back-flowing and pooling
-can be genetic, congenital or acquired (mechanical compression)
-localized distended purplish veins, edema, skin discoloration, etc.
-can result in varicose veins
-can also be found in the esophagus and rectum/anus
110
What are hemorrhoids?
genetic or acquired varicose veins of the rectum and/or anus; sitting too long "straining a stool", constipation and pregnancy can cause hemorrhoids
111
What are the 4 major etiologies of inadequate CO?
1) impaired ventricular pumping
2) conduction defects that cause arrhythmias/dysrhythmias
3) structural heart defects
4) decreased peripheral (systemic) vascular resistance (decreased PR)
112
Define etiology
the cause of a disease
113
What are the two types of myocardial remodeling?
1) myocardial hypertrophy-- thickening of muscle
2) myocardial dilation-- muscle fibers stretched
the result of the ventricles trying to maintain tissue perfusion
114
What is the difference between stable angina and unstable angina?
stable-- pain due to myocardial ischemia that occurs most commonly during or immediately following exercise/exertion but may occur due to another physiological trigger
unstable-- pain due to myocardial ischemia without any obvious/probably cause
115
What is the time frame difference between an ischemic attack and a myocardial infarction?
ischemic attack-- O2 deficit for less than 20 min
myocardial infarction-- O2 deficit for more than 20 min
116
Why is Acute Coronary Syndrome serious?
-unstable plaque in a coronary artery causing unstable angina (high risk of myocardial infarction)
117
Define myocardial stunning
the period of time when myocardial cells are alive, but injury is severe enough to prevent their normal depolarization and repolarization phases-- the cells should return to normal function
118
Define hibernating myocardium
these cardiac cells are either still feeling some ischemia or have adapted to survive but cannot do their normal function-- they don't contract (sleeping)
119
What are the 3 zones of myocardial damage?
1) zone of infarction and necrosis-- center of damage, where there is no blood flow
2) zone of hypoxic injury-- uncertain the extent of permanent myocardial damage (many cells hibernating)
3) zone of ischemia-- far from damaged area, no permanent deficit
120
What does conduction defects mean in relation to the heart?
-defects in electrical signals (depolarization and repolarization) of cardiac conduction system-- causes uncoordinated mechanical activity of cardiac muscle
-dysrhythmias and arrhythmias
-decrease CO and BP
-can result in cardiac arrest
121
What are the effects of a cardiac dysrhythmia?
sluggish flow, decreased CO and decreased tissue perfusion
FOR ALL TYPES OF CARDIAC DYSRHYTHMIA
122
Define tachycardia
-fast heart rate
-decreased ventricular filling with increased myocardial O2 needs
123
Define bradycardia
-slow HR
-may impair blood flow to vital organs
124
Define flutter
-rapid atrial ectopic tachycardia (240-450bpm)
125
Define fibrillation
-heart chamber(s) vibrate instead of pumping effectively
126
Define coarctation of the aorta
the severe narrowing (stenosis) of the aortic arch-- makes the LV push very hard to pump blood through that highly resistant aorta
-high afterload
127
Define regurgitation of the heart valve
blood leaks backwards
128
Define prolapse of the heart valve
valve cannot close properly which can lead to regurgitation
