Physio prac theory Flashcards
(243 cards)
1
Q
Volume pump left ventricle, right ventricle
A
Volume pumps left ventricle -> aorta = Volume pumps right ventricle -> arteria pulmonaris
2
Q
Cardiac output
A
SV(ml) * HR(bpm)= CO(mL/min)
3
Q
Regulation Cardiac Output
A
Intrinsic property cardiac muscle
4
Q
Basic regulation cardiac output
A
Length tension diagram
(review on notes)
5
Q
Escalated metabolism compensated by
A
higher CO
by VR (as long as increase less than 2x resting value -> Starling)
6
Q
Effect heart increase stroke volume
A
CO increase b/c
VR (venous load) increase
utilizes diastolic reserve
7
Q
resting EDV
A
120ml
8
Q
resting ESV
A
50ml
9
Q
resting SV
A
70ml
10
Q
VR can be increase up to
A
260-300ml b/c venous pressure increase
11
Q
Effect increase TPR
A
EDV, ESV increase
SV unchanged
12
Q
Effect elevated metabolic demands
A
blood vessels dilate
blood flow increase
TPR decrease
13
Q
Use of ejection fraction
A
monitor effectivity cardiac pumping
14
Q
Formula EF
A
EF=SV/EDV
15
Q
Normal value EF
A
0.55-0.60
16
Q
Heart failure value EF
A
0.4
17
Q
Shock
A
blood volume, capacity blood vessels disproportional -> shock
18
Q
Symptoms shock
A
Decrease blood pressure -> death w/o intervention
19
Q
Arterial blood pressure depends on
A
TPR
CO
20
Q
Shock index
A
HR/Systolic pressure
(SHock -> HR/Systolic Pressure)
21
Q
Value shock index
A
0.5-0.7
22
Q
Abnormal value shock index
A
> 1
23
Q
Effect preload (venous reservoir - blood in v.)
A
increase venous pressure -> increase volume into right ventricle -> CO increase -> S
24
Q
Preload
A
volume blood at end diastolic
25
What affects preload
EDV
increase venous pressure -> increase EDV -> increase ESV -> few strokes -> reestablished balance venous load, stroke volume
26
Effect TPR decrease below certain value
coronary flow insuff -> NO blood perfusion -> heart pumping damaged
27
Effect TPR increase, no change VR
heart forward amount blood venous -> arterial
28
Afterload
resistant to pump to aorta during ejection
29
What affects afterload
TPR
TPR increase -> VR higher than SV -> increase ventricular volume -> EDV,ESV increase until balance reached aka pulse volume reach identical value before change TPR
30
Circulatory shock
decrease TPR -> low arterial blood pressure
31
End point of shock
tissue necrosis
Lack O2, nutrients
32
Types of shock
Hypovolemic
Cardiogenic
Obstructive
Distributive
33
Effect of hypovolemic shock
loss intravascular fluid
hermorrhage
dehydration
trauma
34
Effect cardiogenic shock
impaired heart pump
35
Effect obstructive shock
extrinsic factors
occlusion
36
Effect distributive shock
septic shock (pathogen)
anaphylactic shock (irritants -> loss blood to peripheris -> low TPR)
neurogenic shock
pathological redistribution intravscular fluid -> excess dilation blood vessels
37
Effect CO on systemic shock
CO=SV*HR
MAP=CO*TPR
if decrease SV -> decrease VR -> decrease CO -> decrease MAP below critical closing pressure -> shock
38
Effect of high VR
more volume for circulation -> protection
39
Ach subclass
muscarinic type cholinergic receptor M3
40
Ach stimuates muscle contraction by
binding mACh -> stimulates G protein -> Gq pathway -> increase IP3 -> binds IP3 receptor -> release intracellular Ca2+ -> muscle contraction
41
Relation of Ach to atropine
Atropine inhibits ACH effect on muscarinic receptor
b/c binds to same receptor, NO activates it
(Atropine -> a -> inhibites mAch)
42
Hexamethonium affects on
neuronal type nicotinic acteylcholine receptor (nAch)
43
Location nAch
cell bodies postganglionic autonomic neurons belongs to symp/ parasymp
Chromaffine cells of adrenal medulla
44
Similarity nACH, mAch
stimulated by Ach
45
Function synapse inhibit by
Acetylcholin esterase
drugs that inhibit enzyme need for break down Ach
46
Effect of physostigmine
reversibe inhibition acetylcholine esterase -> greater effect on contraction
(physostigmine -> phy -> inhibit acetylcholine esterase)
47
Stimulator intestinal smooth muscle
Histamine
H1 histamine links to IP3 pathway -> increase intestinal smooth m. motility
48
Atropine
antogonist Ach for mACH
competitive inhibitor -> blocks receptor
increase Ach -> reduce effect atropin as more Ach will bind, unblock mAch but atropine has greater affinity to receptor than Ach
49
Concentration K+ inside, outside
insde > outside
50
Effect increase EC K+
decrease potential gradient K+
51
Effect increase EC K+ to AP
increase K+ -> decrease potential gradient K+ -> after depol -> repol slower -> longer to depol membrane to resting membrane potential -> contraction lasts longer
52
Effect increase EC K+ to AP depol
longer depol -> activates voltage gated Ca2+ -> increase Ca2+ conc IC -> contraction
53
Norepi receptor
binds to a1 receptor
54
Location norepi
smooth m. of blood vessels
55
Effect of Norepi
vasoconstriction
56
How norepi cause VC
Ca2+ release
(Norepi -> VC -> C -> Ca2+ release)
57
Effect of Norepi on both arterial rings
both change with Norepi but w/o intact endothelium shows greater change/value for tension
58
Effect Norepi on intact endo
release NO -> VD -> decrease tension (lower amplitude)
(contact -> release NO -> VD -> decrease tension -> low amp)
59
Effect Norepi w/o endo
No release NO -> strong contraction -> higher amplitude, NO relaxation
60
Types of lead
standard bipolar leads -1,2,3
Wilson's leads- V1-V6
Augumented leads- aVR, aVL, aVF
61
Why use ECG gel/ saline
improves electrical conductance
62
Why no use water
no electrolytes -> increase resistance -> decrease conductance
63
Types rhymthmic
rhythmic
arrhythmic
64
Rhythmic
equal RR distance thru out
steady, constant patterm
65
Arrhythmic
unequal RR distance
66
Basis of arrhythmic
vary thru out ECG rhythm generator via P waves
67
Normal rhythmic
P before NARROW QRS -> SA produce rhythm
(Junc -> (N)O P -> (N)(a)RROW -> AV produce rhythm -> still narrow still above ventricle)
68
Junctional/ Abnormal arrhythmic
NO P before NARROW QRS -> AV produce rhythm
QRS still narrow -> conduction still from above ventricles
(Junc -> NO P - NARROW -> AV produce rhythm - stilll from above ventricles)
69
Intraventricular
NO P before WIDE QRS
70
Cause of intraventricular
block left/right bundle branch
71
Types extra systole
SVES - supra ventricular systole
VES - ventricular systole
72
sves
narrow QRS
above ventricle
(sves
V E S)
73
V E S
wide QRS
in ventricle
(sves
V E S)
74
Whats RR distance
length complete cardiac cycle
75
Formula HR
60/ RR distance*0.04
76
normal heart rate
60-100bpm
77
Bradycardia
<60
78
Tachybradia
>60
79
Rhythmic generating center
P -> R aka from SA
80
ECG component
P wave
PR interval
QRS complex
ST interval
T wave
81
P wave
atrial depolarization
82
PR interval
conduction time
time btw 1st deflection P - 1st deflection QRS
83
QRS complex
ventricular depol
interventricular septum depol -> main mass ventrile -> base
84
ST interval
time btw end QRS complex - start T wave
85
Significant ST interval
0 potential btw ventricular depol, repol
86
T wave
ventricular repol
87
Evaluate ECG
(pad)
(p: polarity: up/pos - down/neg deflcetion)
(amplitude: height wave 0.1mm=0.1mV)
(duration: ????)
88
Evaluate P wave
(pad)
89
Evaluate PR interval
conduction time (begin P to begin Q)
90
Normal conduction time
0.12-0.2s
91
Above normal conduction time
>0.3
1st degree AV block
delay conduction SA
92
Below normal conduction time
<0.11
AV bypassed
93
Evaluate, determine QRS lines
(pad)
Q: 1st down reflection after P
R: 1st up reflecton after Q
S: down reflection after R
94
Normal duration QRS
0.08-0.12s
95
Wide duration QRS
intraventricular conduction b/c bundle branch block
96
Effect of voltage of wide duration QRS
increase voltage (>2cm)
97
Effect of voltage of narrow duration QRS
low voltage (<0.5cm)
98
Evaluate ST segment
isoelectric point
99
ST segment same level as PQ
isoelectric point when ventricles btw depol, repol
100
ST segment below PQ
depol
ischemia (NO O2, nutrients)
101
ST segment above PQ
ST deviation
MI
102
Evaluation T wave
(pad)
103
Measure blood pressure, inflate till what no. and why
>200mmHg
b/c higher than Systolic Pressure -> compress flow blood in peripheral artierioles -> blocks blood -> Pressure external > Pressure artery
104
Measure blood pressure, decrease pressure, effect of pressure
Pressure external < Pressure artery
105
Effect when Pressure external < Pressure artery
Phasic flow - turbulent flow
b/c flow starts again but cross section a. still smaller than normal cond. -> turbulent
106
When is laminar flow
Pressure cuff < Pressure artery
b/c Pressure cuff no longer affect artery
107
When to detect Pressure systolic
1st Korotkoff sound
108
When to detect Pressure diastolic
last Korotkoff sound
109
Pulse qualities for single pulse wave
amplitude
rate rise
compressibility
(car)
110
Amplitude pulse wave
represents force
111
High, low amplitude
High: altus
Low: parvus
112
Rate of rise pulse wave
how fast it reaches peak
113
Fast, slow rate of rise
Fast: celer
Slow: tardus
114
Compressbility
area under curve pulse wave
115
How to measure compressibility
press artery against bone -> judge how much force need to stop pulsation
116
Hard, weak pulse
Hard: durus
Weak: mollis
117
Evaluate whole set pulse wave
Rhythm - time course: regular/irrgularis
Equality - change in amplitude: equalis/inequalis
118
Punctum maximum
chest with heart sound valves loudest
119
Punctum maximum right
2 ICR - aortic
4 ICR - tricuspid
(AT 24)
120
Punctim maximum left
2 ICR - Pulmonary
5 ICR - Bicuspid
6 ICR - Mitral
(Pbimi 256)
121
Systolic sound
deeper
last longer
122
Diastolic sound
higher
shorter
sharper
123
S1
close AV (bicuspid, tricuspid)
124
S2
close semilunar valve (pulmonary, aortic)
125
Systolic period
btw S1-S2
close AV-semilunar
126
Diastolic period
btw S2-S1
Close semilunar-AV
127
S3
abnormal - gallop rhythm
diastolic inflow
128
Charac S3
kids: normal
adults: pathological
129
S4
abnormal - gallop rhythm
sound atrial contraction
130
Charac S4
normal phase but hearing sound is abnormal
Indicates pressure overload -> pathological
131
Murmur stenosis
Semilunar valve: Systsolic murmur
AV valve: diastolic murmur
(sss - stenosis - semilunar - systolic murmur)
132
Murmur insufficient (regurgitation)
Semilunar valve: Diastolic murmur
AV valve: Systolic murmur
133
Evaluate metabolic rate
Minute volume MV
Vital capacity
Inspiratory capacity
FRC?
Total lung capacity
Tiff's index
134
Formula minute volume MV
TV*RF(respiratory freq)
L/min
135
Formula vital capacity VC
IRV+ERV+TV
136
Whats vital capacity
max expiration + max inspiration
137
Formula Inspiratory capacity IC
TV+IRC
138
Whats inspiratory capacity IC
max amount breathe in
139
Whats FRC
amount air remains in lung after normal expiration
Forced Expiration Capacity
140
Formula FEC
ERV + TV???
141
Whats total lung capacity
max volume lungs can expand
142
Formula Tiff's index
FEV1/FEVC *100
FEVC: max expire after max inhale
143
Whats Tiff's index
proportion of patients vital capacity that can expire in force expiration
144
If Tiff's index <80%
obstructive disease (asthma)
145
Hyperthyroidism
increase BMR
normal respiratory freq
146
Pulmonary capacities parameters
Static parameter - volumes (L)
Dynamic parameter - time
147
Diseases of static parameters
Obstructive disease
Restrictive diseases
148
Obstructive disease
Asthma
149
Cause asthma
Bronchoconstriction
delays/ longer respiration
mucosa edema
increase airway resistance
150
Cause of obstructive disease
decrease dynamic parameter (time)
151
Restrictive disease
Fibrosis (accumulation no elastic fibre -> more diff expand lungs)
152
Cause of restrictive disease
decrease in static parameters (volume)
153
Example dynamic parameters
FEV1 - forced exhaled volume
154
Direction VR
goes back to heart
155
SV flow
against TPR
156
Preload
VR increase (70->100) -> EDV increase (150->180) -> 1st few cycles can't adapt-> extra stress-> SV same-> ESV increase (80->110)-> max no. cross bridge-> stronger contraction-> SV increase-> adapt-> SV increase (70->90)
157
Afterload
TPR increase-> SV decrease (70->50) -> ESV increase (80->100) -> EDV increase (150->170) -> increase distention -> max no. cross bridge -> stronger contraction -> SV increase -> adapt to change
158
Significant of afterload
counteracting force - continuous TPR
-> worse results
159
Ejection fraction EF
EF=SV/EDV
160
Normal EF
>40%
161
Effect changing VR
EF NO wide range changes
162
Effect changing TPR
EF changed in wide ranges -> circulation is in unstable cond.
163
Relationship Starling's mechanism
NO effect heart rate
changes b/c nervous/ humeral effects
164
Static parameters example
Minute volume (L/min)
Tidal volume (L)
Respiratory freq RF (1/min)
Inspiratory reserve volume IRV (L)
Expiratory reserve volume ERV (L)
Vital capacity
165
Dynamic parameters example
Forces expiratory vital capacity FVC
Exhale volume during 1st forced expiration FEV1
Forced inspiratory vital capacity FIVC
Inhaled volume during 1st forced inhalation FIV1
166
Conclusion metabolic rate, O2 consumption b4 after exercise
Metabolic rate higher after exercise
O2 consuption higher after exercise
167
Metabolic rate
(Volume O2*60*20)/SA
168
Skeletal muscle sarcomere
resting sarcomere length = optimal sarcomere length -> increase sarc length NO increase tension
169
Cardiac sarcomere
lengthens sarcomere length -> increase tension b/c no. cross bridges, sensitisation of myofilaments to calcium
170
Changes in position ST segment b/c physical load
severe diagnostic signs
contraindicating further tests
171
Pressure in cuff of Riva Rocci method measured by
Mercury/ aneroid manometer
172
When does Pressure External < Pressure Blood
brachial a. re established
lumen blood vessels let blood flow again
173
"Hearing" method
Auscultatory method
174
Position to place "hand piece"
cubital a.
175
What gives rise to characteristic Korotkoff's sound
Turbulent flow, laminar flow
176
When does turbulent flow occur till
untill External Pressure drops below value diastolic blood pressure -> laminar flow
177
Static parameters def
various volumes, capacities
Volumes various lung compartments
Mechanical properties rib cage
Strength respiratory muscle
178
Dynamic parameters def
Airway resistance
179
Characteristic static parameters
Limited information about airway resistance
180
Characteristic dynamic parameters
rate airflow in respiratory tract during inspiration, expiration (Forced expiratory volume, Forced inspiratory volume, peak flow rates
181
Static, dynamic parameters measured by
spirometer
182
Spirometer
determine effectiveness various forces involve in movement lungs, chest wall
Static spirometer: determine volume exhaled
Dynamic spirometer: determine time taken to exhale certain volume
183
Values from spirometer provide
info about presence, degree of obstruction
amount air can be inspired/ expired
184
Spirogram
Volume-time graph
185
Function spirogram
monitors patient's breathing during measurement
186
BMI definition
Body weight/square of height meters
187
Steps dynamic parameters is measure
3 cycle normal breathing -> deep inspiration -> fast expiration -> wait 3s -> fast inspiration
volume, velocity air inhale, exhale important
188
Miller Quadrant
in FVC (forced expiratory vital capacity) measurement
189
Function Miller Quadrant
make lung function diagnoses
190
Vertical axis Miller Quadrant
FVC(%)= FVC actual/ FVC normal *100
191
Horizontal axis Miller Quadrant
FEV(%)= FEV1 actual/ FEV1 normal *100
192
Name of 4 Miller Quadrant
Normal, Restrictive, Obstructive, Combined
193
Cardiac disease def
maintain CO at rest but NOT sufficient during physical exercise
194
Effect of cardiac disease
decrease pump function heart -> systolic pressure NO increase
severe dys left ventricle -> systolic pressure decrease
195
Steps static parameter
3 normal cycle -> complete deep expiration -> complete deep inspiratorion -> return normal -> log in 1 min -> device calc avg respiratory freq
196
Tiff's index calc in what parameter
dynamic parameter
197
Tiff's index important in
diagnostic obstructive, restrictive lungs disease
198
Effect of physical exercise
O2 consumption (metabolic rate) increase
Respiratory freq increase
199
Narrow tub attach to mouth piece to (dynamic)
increase airway resistance
200
Cause Emphysema
loss elasticity lung's tissue
201
Emphysema effect long time
continuous deterioting airway stenosis
202
Symptoms of emphysema
decrease respiratory frequency
decrease IRV (L)
decrease PEF (L/s)
decrease FEV (L/s)
203
Symptoms of asthma bronchiale
breathing difficulty
decrease PIF (L/s)
decrease PEF (L/s)
decrease FEV (L/s)
204
Cond of bathing solution
physiological ionic composition
osmotic pressure
constant temp
reasonable O2, glucose
205
Bathing solution in practice
Tyrode with continuous oxygenation
206
Composition Tyrode
NaCl
KCl
CaCl2
MgCL2
Glucose
Tris-HCl buffer
207
pH Tyrode solution
7.4
208
displacement to voltage converter
output voltage proportional to displacement measuring arm from unloaded position
209
Mode of mechanical, geometrical parameters experiment
isometric
measure strain of muscle while length constant
210
Min-max amplification of slide switch (1X/ 20X)
1-200
211
Unit of amplifier
1V/ full scale deflection
212
Calibration curve aka voltage deflection
straight at 0 point
No point should be high above calibration point
213
Effect of decrease Ca2+
decrease contraction
214
How to increase contraction
increase conc Ca2+
(applied to both cases of Mg2+ and decrease Ca2+)
215
Relationship btw MgCl and Ca2+
Muscle have many Ca2+ binding sites (troponin, myosin, calmodulin,...) -> also bind to Mg2 -> competes with Ca2+ -> relaxation
(M(g) -> good -> relax)
216
Effect of Mg2+
Ca2+ channel blocker -> relaxant -> lowers muscle activity and contraction
(M(g) -> good -> relax)
217
How to counteract effect of Mg2+
increase conc Ca2+
218
Papaverinum hydrochloricum ampoule
have 40mg/ml papaverine
219
Effect of BaCl2
Barium: K+ channel blocker (No repol) -> depol -> open Ca2+ channels -> increase Ca2+ conductance -> EC to IC -> contraction in physiological condition
(Ba-K blocker-contraction)
220
Effect of BaCl2 on contraction
sustained, long contraction (tetanus)
221
Effect of papaverine on contraction
muscle relaxation
(papa-relax)
222
Effect of papaverin
anti plasmic drug aka smooth muscle relaxant
inhibits Na -> relaxation
inhibits phosphodiesterase -> cAMP increase
(Papa -> relax -> (pa)Na -> inihibits Na)
223
Parameters evaluate smooth muscle contraction
Cycle length (delta X)
Max force contraction F (amp)
Time to peak tension TTP
Slope
Integral - area under curve for 1 whole cycle
Half relaxation time
224
Composition Tyrode NaCl
144 mmol/L
225
Composition Tyrode KCl
5.5 mmol/L
226
Composition Tyrode CaCl2
2.5 mmol/L
227
Composition Tyrode MgCl2
1.2 mmol/L
228
Composition Tyrode Glucose
8.3 mmol/L
229
Composition Tyrode Tris-HCl buffer
5.0 mmol/L
230
Tyrode osmolarity
300 mosmol/L
231
Why do uterinal experiment
study effect electrolytes on smooth muscle contraction
232
Component of set up uterinal experiment
Transducer with detector + amplifier
233
When to use transducer
study effect of electrical stimuli
effect of chem agents/ drugs
234
Component of detector
displacement to voltage converter
235
Transducer with amplifier gain
can be adjustable
236
How transducer with amplifier gain can be adjust
Rotatory switch - 5 positions (1,2,5,10,20)
2 position slide switch (1X/10X)
-> final amplification 1 to 200
237
Why need to select gain appropriately
too small gain -> effect invisible
too high gain -> output out of range value -> Can't measure tension
238
What is essential for proportionaity recorded signal
correct baseline of transducer - amplifier system
239
How to determine calibration factor
calibrated using weights
240
How should calibration factor should be
linear
241
Output from amplifier
analog signal -> convert to digital by analog to digital converter and can be track on computer monitor
242
Magnitude seen on computer monitor
proprotion to muscle tension
243
