Week 2 Flashcards

Question

Removal of appendix

Answer 1

Appendectomy

Answer 2

Carotid bruit

Answer 3

crescendo decrescendo

Answer 4

Scale 1-6 Stage of cardiac cycle Systolic murmurs can be of ejection type (aortic stenosis), holosystolic (mitral regurgitation -- not closing fully), late systolic (mitral valve prolapse -- not closing properly) Diastolic murmurs can be early type (aortic regurgitation) or mid-late diastole (mitral stenosis)

Answer 5

**S1** Mitrial / Tricuspid valve closing **S2** Aortic / Pulmonary valve closing Splitting because of pulmonary low pressure (inspiration) Heard during expiration during atrial septal block **S3** (diastole) Chordae tendineae relaxing during diastole \* Present in young individuals Pathological in adults (CHF or pregnancy) **S4** (diastole) Caused by noncompliant ventricle

Answer 6

Lipid Panel Beta natriuretic protein (secreted in resposne to excessive streeching) Troponins (released when heart muscle is damaged) Echocardiograms (image e.g. valves) EKG Coronary Angiogram

Answer 7

**Cardiac progenitor** cells lie in epiblast immediately adjacent to the cranial end of the primitive streak They **migrate through** the **streak** and **into** the **splanchnic layer** forming primary heart field (PHF). They are **determined already** before the process starts.

Answer 8

**Angiogenic cells** clusters **form** right and left **endocardial tubes** **Endocardial tubes fuse** by **apoptosis**

Answer 9

**Endocardium** (endothelial cells) **Cardiac jelly** (acellular material made by myocardium) **Myocardium** **Epicardium** (mesothelial migrates in form septum transversum -- the location of diaphgram; forms coronary arteries)

Answer 10

Cranial-caudal folding due to fast nervous system growth

Answer 11

Cardinal [anterior,posterior,common] → Body Vitelline → Yolk Sac Umbilical → Placenta

Answer 12

They are connected **before** any folding Arterial and venous ends anatomically fixed in place

Answer 13

1. Sinus venosus 2. Primitive atrium 3. Primitive ventricle 4. Bulbus cordis / Conus cordis - truncus arteriosus

Answer 14

Normal position of heart chambers Single circuit becomes asymmetrical system

Answer 15

Ventral, lateral, and caudal

Answer 16

**Atrioventricular junction** → Atriventricular canal **Proximal third of bulbus cordis** → Trabeculated right ventricle **Midpoint of bulbus cordis** → Outflow tracks **Distal part of bulbus cordis** → Trunkus arteriosus

Answer 17

Vitelline, Cardinal, and Umbilical Right right vitelline → inferior vena cava right anterior cardinal → superior vena cava left sinus horn → coronary sinus right sinus horn → fuses with atrium

Answer 18

Parts of bulbus cordis develops trabeculae

Answer 19

Sinus venarum IVC, SVC, and coronary sinus crista terminalis (conducting fiber tract SA node to AV node)

Answer 20

Smooth portion in the left atrium

Answer 21

Endocardial cushions Cardiac gelly Splachnic mesoderm + neural crests Septal defects

Answer 22

Formation of **septum primum** (thin **membranous** septum) Programmed cell death forms **ostium secundum** (**superior** aspect) Thick **muscular** **septum secundum** forms to **right** of septum primum contains **foramen** **ovale** on its **inferior** surface.

Answer 23

Right to left shunt During birth when the pressure builds up in right atrium Functional closure occurs at birth and anatomical closure occurs at 3 month Incomplete fusion of septum primum and septum secundum (25% of population, usually no clinical importance)

Answer 24

Growth of pulmonary veins Sinus venarum (sinus venosus) Atrial appendages

Answer 25

they originate from **splachnic mesoderm** from **cardiac jelly** and **neural crest cells** in the conotruncal area Forming **septa** and **valves** **ASD**, **VSD**, **transposition** of great vessels, and **tetralogy of Fallot**

Answer 26

Female 2:1 Osteum segundum Common atrium Problems in athletic individuals and wierd blood cells in a blood smear

Answer 27

By degeneration of trabeculae in ventricles

Answer 28

4 endocardial tissues

Answer 29

Persistent common atriventricular atria Abnormal division

Answer 30

Neural crest cells contribute to swelling (cushions) They form CT and smooth muscle of the aorticopulmonary septum Divided into pulmonary and aortic part

Answer 31

Spiraling lines up the correct outflow tract with the correct ventricle Neural crests cells are required If neural crests are removed, this lead to a persistent truncus arteriosus

Answer 32

Persistent Truncus Arteriosus No formation of septum Cyanosis, blood buildup in lungs and less flow = difficulty to breathe 1/10,000

Answer 33

Aorta/right ventricle and pulmonary trunk/left ventricle Failure of septa to develop in a spiral fashion Strong cyanosis ASD/VSD/ductus arteriossu 2 or 3 per 10,000

Answer 34

Misaligned septum - VSD Large right ventrcile and pressure on pulmonary artery, and lack of blood in lungs -\> acidosis (preventing by squatting) Failure of outflow tract opening to align with ventricles Cyanosis

Answer 35

**muscular** interventricular (IV) septum develops midline **on** the **floor** of primitive ventricle **AV cushions** right and left **bulbar** ridges and inferior AV cushions

Answer 36

Failure of septum to form (most common) VSD are most cardiac congential defect Occurs in 30% of children with congential heart disease 2 to 6 per 1,000

Answer 37

Truncus swelling during end of partitioning

Answer 38

The vitelline system gives rise to the **liver sinusoids** (including the **ductus venous**) The **right umbilical vein disappears** and the left **umbilical vein anastomoses** with the **ductus venous**.

Answer 39

Aortic sac, the most distal part of the truncus arteriosus

Answer 40

6 Aortic sac (distal to trunkus arteriosus) -- right/left dorsal aortae Aortic arch 3, 4, and 6 as well as dorsal aortae arch 1 maxillary artery arch 2 stapedial artery 6 remains on left side and forms pulmonary vessels and the ductus arteriosus

Answer 41

Ductus venosus (constriction) Foramen ovale (closing septa) Ductus arteriosus (constriction)

Answer 42

Left umbilical vein Head, neck, and upper limbs Umbilical arteries

Answer 43

Umbilical arteries → Internal iliac arteries and medial umbilical ligaments Umbilical vein → ligamentum teres of liver Ductus venosus → ligamentum venosum Ductus arteriosus → ligamentum arteriosum Foramen ovale → becomes oliterated

Answer 44

Not closing ductus arteriosus 2 out of 1,000 Female 2:1 Prostaglanding inhibitors such as indomethacin or obuprofen can close small PDAs Enlargement of the heart (future failure) and possible endocarditis (1/8 patients develop) increase mortality by 50%

Answer 45

**Paradoxical splitting** occurs when **splitting** increases during **expiration**. It often be caused by the **setback** of the **aortic valve**. It can be also seen in patients with mechanical delay of LV ejection in **aortic stenosis**.

Answer 46

BNP in an acronym used for B-type natriuretic peptide marker for cardiac overload due to volume expansion and increased ventricular pressure

Answer 47

hydrochlorothiazide or lasix

Answer 48

Increase Na+ by Na+/Ca++ exchanger

Answer 49

Force same Skeletal is faster

Answer 50

Iris Vas deferens

Answer 51

3-6 um 100-500 um 1.5-2.5 um² per every 1 um³

Answer 52

Dense bodies are dense bands found in cytoplasm. Other cells (adherens type), extracellular matrix, actin filaments

Answer 53

70-120 nm pokets 170,000 (increases 70% plasma membrane) 50% (interposed wbetween dense bands) Close to the tubules of the sacroplasmic reticulum Ca-pump ATPase

Answer 54

Gap junctions (low resistance pathway) Connexon 43 made of connexins They penetrate two membranes and they are made of two hemichannels (connexons)

Answer 55

**Myogenic mechanisms** (selft-regulation = spontaneous in absence of signals) *e.g. membrane potential sets Ca²⁺ entry* **Neural regulation** (motor neurons innervate smooth muscle) *e.g.* *alter conductance of Ca²⁺* **Hormonal** *e.g. similar to neurotransmitters* **Humoral or paracrine** (No or prostaglandins) *e.g. NO and prostaglandins* **Inflammatory mediators** (inflamatory agents lead to contraction) *e.g. rlease of cytokines and inflammatory agents*

Answer 56

**Ca²⁺** binds to **calmodulin** and **activates** myosin light chain kinease (**MLCK**). MLCK **phosphorylates** light chain of **myosin**, and facilitates actin binding and cross-bridge cycle. **Myosin phosphatase** (MLCP) reduces cross-bridge cycling leads to relaxation.

Answer 57

ATP pumps K⁺ channels -40mV to -80 mV

Answer 58

Channels that permit calcium into a cell: voltage-dependent, dihydropyridine-sensistive (L-Type) Ca2+ channels (VDCC) ROCs are typically non-selective cation channels (NSCC; allow Na+/Ca2+ entry) IP3 mediated G-protein-coupled receptors (GPCR)

Answer 59

**Primary** sarcoplasmic reticulum Ca²⁺ ATPase (SERCA) plasma membrane Ca²⁺ ATPase Na⁺/K⁺ ATPase **Secondary** Na⁺/Ca²⁺ exchanger (NCX) **Excite** Na⁺/Ca²⁺non-selective cation channels (NSCC) Ca²⁺ VDCC GPCR **SR Ca²⁺ release** IP₃ receptor-operated channels (IP₃) ryanodine-sensitive (RYR)

Answer 60

A major theme in smooth muscle is that **Ca2+ entry** (i.e. **excitation**) tends to be **controlled by K+** channels, **because these** channels set or **regulate membrane potential**, and it is **membrane potential** that **determines** Ca2+ entry via voltage-dependent **Ca2+** **voltage gated** channels.

Answer 61

**Voltage gated channels** (6 transmembrane domains + 1 pore doamin) **Ca2+ activated K+ channels** (six or seven transmembrane segments) **e.g. BK, IK and SK** (two transmembrane channels and one pore doamin) **e.g KATP, KIR, GIRK channels** (has four transmembrane segments and two-pore domains ) **e.g.** **K2P**

Answer 62

voltage-dependent Ca2+ channels, typically L-type Ca2+ channels all smooth muscle express them

Answer 63

**Ca2+ sparks** **activated** large-conductance Ca2+-activated **K+ (BK)** channels in vascular smooth muscle cells Thus, **localized Ca2+** **release** events typically **cause hyperpolarization** and tend to cause **relaxation** in vascular smooth muscle cells.

Answer 64

Neuronal action potentials (**AP**) **promote** the **release** of **ATP** and norepinephrine (**NE**) from perivascular nerve terminals. **Norepinephrine** stimulates **α1** adrenergic receptors (α1R) and **ATP** binds to **P2X** receptors (P2XR) giving rise to [Ca2+]_i. **Inward current** through P2X receptors also **depolarizes** cells and increases Ca2+ entry through **L-type Ca2+ channels**.

Answer 65

Gq (PLC) - PLCb - DAG/IP₃ / G12 - (RhoK) Gs - AC (+) Gi - AC (-) sGC - NO NSCC - +++

Answer 66

DAG -\> PKC -\> CPI-17-(P) that inhibits MLCP G12 -\> Rho-GEF -\> RhoA -\> RhoK (kinease) -\> inactivate MLCP by phosphorylation mediated by cAMP -\> PKA -\> (+) MLCP NO -\> PKG as well both K+ hyperpolarization

Answer 67

o = Pr/n o = wall stress (dynes/cm^2) P = pressure in chamber r = radius n = wall thickness

Answer 68

Top with load Bottom without load

Answer 69

EF (%) = SV/EDV The normal human heart has an EF value ranging from ~ 55-75%

Answer 70

* *heart** is its **ability** to **increase** its **contractility** in response to an * *increase** in **blood volume**

Answer 71

Increases preload increases Pressure and stroke volume

Answer 72

Higher afterload (possibly due to the higher BP) results in lower cardiac output This may lead to first hypertrophy and then heart failure

Answer 73

Sympathetic stimulation decreases EDV (EF up) In heart failure, EDV increases (EF down)

Answer 74

StrokeWork = P x SV ejection pressure is 105 mm Hg and a normal stroke volume is 70 ml 7,000 mm Hg ml or ~ 9.3 x 106 dyne cm

Answer 75

CO = SV \* HR CO = Mean Arterial Pressure / Total Peripheral Resistance 5.6 L/min for male and 4.9 L/min for female

Answer 76

CI = CO / Body surface 3 L/min/m^2

Answer 77

**Increase** Sympathetic stimulation Cardiac hypertrophy **Decrease** (pathological) inhibition of nervous excitation conditions leading to irregular heart rhythms valvular heart disease hypertension congenital heart disease myocarditis cardiac anoxia diphtheria other types of myocardial damage or toxicity.

Answer 78

Pleateau: veins tend to collapse Down slope: downward gradient

Answer 79

A pressure in the right atrium when venous return = 0

Answer 80

The difference between **right atrial pressure** and **mean systemic filling pressure**

Answer 81

Venous Return = (MSFP - RAP)/RVR MSFP = mean systemic filling pressure RAP = the right atrial pressure RVR = resistance to venous return

Answer 82

Left or right shift beacuse of **changes** in **means systemic atrial pressure**

Answer 83

venous return: CO because of preload (Starling's law) & gradient between veins and atrium contractility: more blood pumped and less pressure in atrium

Answer 84

Main mechanism to increase CO during exercise too low: can only pump so much too high: incomplete stroke volume

Answer 85

**Direct** Doppler flow probe **Indirect** Oxygen Fick Method CO = O₂ lung uptake / (aterial O₂ - venous O₂) Indicator dilution method CO = mg of Dye injected / (average dye concentration \* duration of first passage) Thermodiluytion Saline injected in right atrium Temperature changes measured in pulmonary artery

Answer 86

Have **rapid pulsatile blood flow** High pressure

Answer 87

**Most important** in **control blood flow** = hign in number and smooth muscle / diameter ratio Are **major resistance vessels (biggest pressure drop) **of the whole peripheral circulation and regulate blood flow to capillary beds Have thick smooth muscle layer The smooth muscle is partially contracted under normal conditions (**basal tone**)

Answer 88

Degree of **contractile tension** remaining in blood vessels after complete **without externalexcitatory influences** In contrast to skeletal muscle, smooth muscle have basal tone probably **from** **intrinsic** and **local factors** CO₂?

Answer 89

Also **participate in exchange** Only have endothelial layer

Answer 90

**Major capacitance vessels** = major collection and storage site for blood (**major controllable reservoir**) have thin but **muscular walls**

Answer 91

V=Q/A Greater distance = friction Smaller radii = more resistance surface are increases = slower flow

Answer 92

The force exerted by the blood against any unit area of the vessel wall

Answer 93

The **difference** between the peak **systole** and **diastole ** **Dampened** due to **Compliance** of the **arterial vessel** walls **Resistance** to flow as vessel **diameter** become **smaller**

Answer 94

* **hyperthyroidism** * elevated basal metabolism * **arteriolar vasodilation** * **reduced** arteriolar **resistance** * the dampening effect on the pulsatile arteial pressure is diminished * **pulsatile flow** in the **capillaries** is observed in the finger nail beds

Answer 95

Diastole + Systole + 1/3 (Systole - Diastole)

Answer 96

Low High large SV =\> High pulse pressure

Answer 97

**estimated by pulmonary wedge pressure** **catheter**, **inserted** into the smallest branches of the **pulmonary artery**, makes almost direct contact with the pulmonary capillaries. The **measured** pulmonary capillary pressure is **approximately equal** to the left **atrial pressure**.

Answer 98

Q = dP/R Q = blood flow (ml/min) dP = pressure gradient (mm Hg) R = resistance (mm Hg/ml/min)

Answer 99

"distensibility" C = dV / dP C = capacitance or compliance (ml/mm Hg) V = volume (ml) P = pressure (mm Hg)

Answer 100

As a person ages, the arteries become stiffer and less distensible.

Answer 101

R = 8nI / PI r^4 viscosity \* vessel length / radius R - resistance h - blood viscosity (e.g. hematocrit) l - blood vessel length r - radius of the vessel

Answer 102

It is not linear beacuse: Higher pressure gradient Vessels are streched

Answer 103

The complete resistance that blood encounters as it flows from the arterial to the venous side of the circulation.

Answer 104

The resistance that the blood encounters as it flows from the capillaries back to the heart.

Answer 105

**polycytemia vera** (**increased** number of **red blood **cells). The apparent **viscosity** in this condition is **increased** more than **twofold**.

Answer 106

Laminar flow is streamlined (on a straight line), with each layer of blood remaining the same distance from the wall.

Answer 107

**Axial streaming** of red blood cells **lowers** the **apparent viscosity** of blood

Answer 108

defined by the Reynolds number velocity at which the flow becomes turbulent * *decreased blood viscosity** (e.g., reduced hematocrit, anemia) * *increased blood velocity** (e.g., narrowing of a blood vessel followed by a precipitous increase in internal diameter)

Answer 109

is the force that impedes blood through the system.

Answer 110

Ability to strech Veins

Answer 111

Compliance = Distensibility x Volume

Answer 112

Veins have higher compliance

Answer 113

**exposed** to **increased volume** will at **first** exhibit a large **increase** in **pressure**, **but delayed stretch** of the vessel Blood transfusion Hemmorage

Answer 114

When arteries are rigid (**arteriosclerosis**) blood **flow** through the capillaries during **systol**, but **flow ceases** during **diastole**.

Answer 115

Veins more NE is released for the same singal

Answer 116

**Venous pressure** is the average blood pressure within the venous compartment **Peripheral venous pressure** is the average blood pressure within the peripheral venous pool. **Central venous pressure** is the pressure in the thoracic vena cava near the right atrium (CVP = right atrial pressure). the filling pressure of the right heart. = preload

Answer 117

Increased volume Decreased compliance

Answer 118

**Hydrostatic pressure:** the pressure that results from the weight of water **Toricceli law: **in any body of water, the pressure at the surface of the water is equal to the atmospheric pressure, but the pressure rises below the surface.

Answer 119

1-3 seconds

Answer 120

Metarteriole Precapillary sphincter

Answer 121

**Diffsuion**: glocuse, O₂, CO₂, steriod hormones **Water-soluble substances ** Glucose and electrolytes must pass through **filtration pores** **Pinocytosis/Transcytosis**

Answer 122

Hydrostatic capillary pressure always \> IF

Answer 123

85% (16-18L/day) venules and 15% (2-4L/day) lymph

Answer 124

The **contraction-relaxation** cycle o**f lymph bulbs i**s the fundamental process that **removes excess water** and **plasma proteins** from the **interstitial spaces**. **Propells**

Answer 125

Peristalic contractions One way valves Movement of skeletal muscle Respiratory diaphragm (decrease interpleural pressure)

Answer 126

Obstruction of lymph vessel

Answer 127

No (BBB) Channels

Answer 128

Lymphatic anchoring filaments

Answer 129

Right and left bulbar ridges AND inferior AV cushions Endocardial cushions

Week 2 Flashcards

(175 cards)