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Physiology Flashcards

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1
Q

Why is the pO2 lower in the pulmonary veins than in the pulmonary capillaries?

A

1) Due to deoxygenated blood from the bronchioles is returned to the left heart via the pulmonary veins

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2
Q

Cause of hypoxia that typically results in the blood pO2 not equilibrating with Alveolar pO2

A

Diffusion limitation

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3
Q

What does the bulbus cordis form?

A

1) Forms the beginning of the ventricular outflow tract in the embryonic heart
2) Smooth portions of the left and right ventricles

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4
Q

Describe the fetal circulation

A

1) Oxygenated Blood comes in via the umbilical vein
2) Oxygenated blood bypasses the liver via the ductus venosus and combines with the IVC
3) Right atrium
4) Blood is shunted from the right atrium to the left via the foramen ovale; some blood enters the pulmonary arteries and is transfered to the aorta via the ductus arteriosus
5) Blood from the left atrium enters the aorta
6) Blood goes throughout the body and leaves via the umbilicial arteries attached to the internal iliac

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5
Q

What is important to note about the SVC in the fetal circulation?

A

It does not carry oxygenated blood

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6
Q

What is the most highly oxygenated blood in the fetus?

A

It is found in the umbilical veins

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7
Q

Location of Fetal erythropoiesis

A

Think: Young Liver Synthesizes Blood

1) Yolk sac (3-10 wk)
2) Liver (6 wk to birth)
3) Spleen (15-30 wk)
4) Bone marrow (22 wk to adult)

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8
Q

What is the protein structure of fetal hemoglobin?

A

Alpha2-Gamma2

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9
Q

What is the main organ that is involved with erythropoeisis in fetal development?

A

1) Liver

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10
Q

What causes the ductus arteriosus to close?

A

1) First breath causes increase in O2 which leads to a decreased prostaglandins (E1 and E2 keep PDA open)

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11
Q

Cardiac output equation

A

CO = stroke volume x heart rate = (EDV - ESV) x HR

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12
Q

Mean Arterial pressure (MAP) equation

A

MAP = CO x total peripheral resistance

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13
Q

Pulse pressure

A

PP= systolic - diastolic

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14
Q

Stroke volume

A

SV = End diastolic volume - End systolic volume

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15
Q

What maintains cardiac output in exercise?

A

1) Stroke volume (increased contractility)

2) Heart rate (increased; lasts longer than SV)

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16
Q

What causes an increased stroke volume?

A

1) Increased preload
2) Decreased afterload
3) Increased contractility

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17
Q

What decreases preload? decreases afterload?

A

1) Venodilators (nitroglycerine)
think: prEload = vEnodilators
2) Vasodilators (hydrAlazine)
think: Afterload = vAsodilators

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18
Q

What increases preload?

A

1) Exercise
2) Increased blood volume
3) Excitement

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19
Q

Ejection fraction

A

EF = EDV-ESV/EDV

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20
Q

What does the truncus arteriosus become

A

Ascending aorta and pulmonary trunk

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21
Q

What does the primitive ventricle become

A

Trabeculated left and right ventricles

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22
Q

What does the primitive atria become

A

Trabeculated left and right atrium

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23
Q

What are the main causes for a right to left shunt?

A

1) Tetralogy of Fallot
2) Transposition of the Great Arteries (fatal)
3) Persistent Truncus Arteriosus
4) Tricuspid atresia
5) Total anomalous pulmonary venous connection

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24
Q

What findings make up Tetralogy of Fallot?

A

1) VSD
2) Obstruction of right ventricular outflow
3) Aorta that overrides VSD
4) Right ventricular hypertrophy

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25
What is the cause of a Tetralogy of Fallot?
Displacement of anterior superior infundibular septum
26
Boot heart appearance
Tetralogy of Fallot
27
Causes of Left to right shunt
1) Atrial septal defect 2) Ventricular septal defect 3) Patent foramen ovale 4) Patent ductus arteriousus
28
What can chronic left to right shunt lead to?
1) Right ventricular hypertrophy which eventually becomes stronger than left side 2) Eisenmenger syndrome
29
Eisenmenger syndrome
1) Conversion of a left to right shunt to a right to left shunt due to hypertrophy of the right ventricle
30
What do the following become: 1) Umbilical vein 2) Umbilical arteries 3) Ductus arteriosus 4) Ductus venosus 5) Notochord 6) Allantosis
1) Falciform ligament 2) Medial umbilical ligament 3) Ligamentum arteriosum 4) Ligamentum venosum 5) Nucleus pulposus of intervertebral disc 6) Median umbilical ligmanet
31
What supplies blood to both the SA and AV node?
Right coronary artery
32
When do coronary arteries fill?
During diastole
33
What is the most posterior part of the heart? Anterior?
1) Left atrium 2) Enlargement can cause dysphagia and hoarseness 3) Right ventricle
34
What increases contractility of the heart?
1) Increase Calicium
35
What is the ejection fraction in a normal healthy individual?
>55%
36
What are findings of a right to left shunt?
1) Hypoxia 2) Clubbing of fingers 3) Cyanosis
37
What are findings of a left to right shunt?
1) Pulmonary hypertension | 2) Right ventricular hypertrophy
38
What is the calculation for resistance?
Resistance = 8(viscosity)(length) divided by r^4
39
Resistance in parallel
= 1/R1 + 1/R2 + 1/R3 ...
40
Resistance in series
= R1 + R2 + R3
41
What is the relationship between Resistance and viscosity? Length? Radius?
1) Directly proportional 2) Directly proportional 3) Inversely proportional to the 4th power
42
What accounts for the greatest amount of total peripheral resistance?
Arterioles
43
What is the cause of normal S2 splitting?
1) Inspiration 2) Inspiration causes decreased intrathoracic pressure which causes increased venous return 3) Increased venous return leads to Increased right SV 4) Increased SV leads to delayed ejection time, causing delayed closure of the pulmonic valve
44
What are causes of wide spitting of S2?
1) Conditions that cause RV emptying delay | 2) Pulmonary fibrosis, right bundle branch block
45
What causes fixed splitting of S2?
1) Atrial septal defect
46
What causes paradoxical splitting of S2?
1) Aortic stenosis | 2) Left bundle branch block
47
Causes of systolic murmur?
think: SASMR 1) Aortic stenosis 2) Mitral regurgitation (insuffiency)
48
Causes of diastolic murmur?
think: DARMS 1) Aortic regurgitation (insufficiency) 2) Mitral stenosis
49
What increases the intensity of right heart sounds?
1) Inspiration
50
What increases the intensity of left heart sounds?
2) Expiration
51
What does a hand grip maneuver do and what murmurs does it increase?
1) Increases systemic vascular resistance (increase afterload) 2) Increases intensity of MR, AR, VSD, Mitral valve prolapse
52
What does a valsalva maneuver do and what murmurs does it increase?
1) Increases venous return | 2) Decreases most murmurs; increases MVP and hypertrophic cardiomyopathy
53
Holosytolic, high pitched "blowing murmur"; heard loudest at the apex; enhanced by hand grip or squatting
Mitral regurgitation
54
Crescendo-decrescendo systolic murmur following ejection click; LV pressure greater than aortic pressure during systole; radiates to carotids (Pulsus parvus et tardus"
Aortic stenosis
55
Holosystolic harsh sounding murmur; loudest at tricuspid area
Ventricular septal defect
56
What is the location to listen to the aortic valve? Mitral valve? Tricuspid? Pulmonic?
1) Right 2nd intercostal 2) 5th intercostal midclavicular line 3) 5th intercostal lateral to sternum 4) Left 2nd intercostal
57
What enhances a ventricular septal defect murmur?
Hand grip (increases afterload)
58
Late systolic crescendo murmur with a midsystolic click; best heard over apex; loudest at S2
Mitral valve prolapse
59
Immediate high pitched "blowing" diastolic crescendo; wide pulse pressure; may have bounding pulses and head bobbing
Aortic regurgitation
60
What increases an aortic regurgitation murmur
Hand grip (increases afterload)
61
What murmur is associated with bounding pulses and head bobbing; increased pulse pressure
Aortic regurgitation
62
Continuous machine like murmur; loudest at S2
Patent ductus arteriosus
63
Harsh midsystolic murmur at left sternal border; found in younger pt. Increased with standing and valsalva
Hypertrophic obstructive cardiomyopathy
64
What occures in the following phases of the ventricular action potential: 1) Phase 0 2) Phase 1 3) Phase 2 4) Phase 3 5) Phase 4
1) Influx of Na 2) Efflux of K and inactivation of Na channels 3) Influx of Ca and Efflux of K (Ca influx leads to contraction) 4) Massive K efflux due to opening of slow K channels 5) Resting potential
65
What are the two main transporters within a cardio muscle cell that allows for an action potential to occur?
1) Na-K ATPase (3Na in, 2 K out) | 2) Na-Ca Exchanger (3 Na in , 2 Ca out)
66
How are cardiac myocytes electrically coupled?
1) Gap junctions
67
What area of the heart has the slowest electrical conduction? fastest?
1) AV node | 2) Purkinje
68
How do the aortic arch baroreceptors transmit information
1) Vagus nerve (CN X) to the solitary nucleus | 2) Only responds to increase BP
69
How do the carotid baroreceptors transmit information
1) Glossopharyngeal (CNIX) to the solitary nucleus
70
What results when a baroreceptor is stretched (via increased pressure)?
1) Leads to increased afferent baroreceptor firing | 2) Results in inhibition of sympathetic firing
71
How is cerebral perfusion regulated?
1) Regulated by chemo and baroreceptors 2) Chemo receptors recognize change in PCO2 3) Perfusion directly related to PCO2
72
What is the normal pulmonary capillary wedge pressure?
1) <12 mmHg | 2) Good approximation of Left arterial pressure
73
Define CO in equation
CO = HR (SV) CO = Oxygen consumption divided by arteriovenous O2 difference
74
What is located posterior to the esophagus?
Descending aorta
75
How do the following affect the action potential in pacemaker cells: 1) Adenosine 2) Norepinephrine 3) Acetylcholine
1) Reduces the rate of depolarization by activating K channels and prolonging K flow and inhibits L type Ca channels from opening 2) Facilitates opening of L type Ca channels in phase 4; decreases time for depolarization 3) Acts similarly to adenosine
76
What are the phases for a pacemaker action potential?
1) Phase 0 - opening of L-type Ca channels; slow influx of Ca 2) Phase 3 - opening of K channels and efflux of K ions with Ca L-type Ca channel closing 3) Phase 4 - slow influx of Na after repolarization; slow decrease in K efflux
77
At what point do Ca L-type channels of pacemaker cells open causing an action potential?
1) At -50 mV T-type Ca channels open 2) At -40 mV L-type Ca channels open and cause depolarization to action potential threshold 3) Action potential occurs at -40 to -30 mV)
78
Where does the conoary sinus empty in to?
1) Right atrium | 2) Takes deoxygenated blood back to heart
79
What intrinsic factors are important in influencing coronary blood flow?
1) Nitric Oxide (NO) | 2) Adenosine (vasodilates)
80
What triggers NO release?
1) Released in response to neurotransmitters (ACh and NE) 2) Released in response to platelet products (Serotonin and Adenosine diphosphate) 3) Thrombin 4) Histamine 5) Bradykinin 6) Endothelin 7) Pulsatile stretch and flow shear stress
81
What is the affect of Atrial natriuretic peptide (ANP)
1) Activates guanylate cyclase increasing GMP 2) Dilates afferent arterioles and inhibits renin secretion 3) Restricts aldosterone secretion 4) Relaxes vascular smooth muscle in arterioles and venules
82
What is the systolic pressure for the right atrium? Right ventricle? Pulmonary artery?
1) 8 mmHg 2) 25 mmHg 3) 25 mmHg
83
What is the equation for flow including pressure, visocisity, and radius of vessel?
Flow (Q) = P1 - P2 (r^4) divided by viscosity (L)
84
What causes the production of ANP and BNP? Where are these produced? What is there function?
1) Volume overload or hypertrophy of the heart 2) ANP = atrium; BNP = Ventricle 3) Cause natriuresis and diuresis

Cardiovascular (2 decks)

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