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212 Cards in this Set
- Front
- Back
What are some drugs that are used in the pharmacological management of hypertension?
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Diuretics, ACE inhibitors, angiotensin receptor blockade (ARB), Beta-adrenergic receptor blockade, and calcium channel blockers
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this disease is a narrowing of the small vessels that supply blood and oxygen to the heart
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coronary artery disease (CAD)
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Warning signs of typical angina
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chet pain, pain radiating down the left arm and up to the left jaw, fatigued, weak, syncope
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warning signs of atypical angina
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back pain, upset stomach/nausea
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What are some drugs that are used in the pharmacological management of angina?
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Nitrates, calcium channel blockers, Beta blockers, anti-platelet agents used in prophylaxis
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What are some drugs that are used in the pharmacological management of heart failure?
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Beta blockade, ACE inhibitors, angiotensin receptor blockade, diuretics, cardiac glycosides
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this type of shock is also known as hemorrhagic shock; caused by blood loss and results in decrease in blood pressure
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hypovolemic shock
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this type of shock is when there is inadequate cardiac pumping (power failure of the pump); results in acute cardiac arrest
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cardiogenic shock
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this type of shock results in increased vascular capacity due to loss of vasomotor tone; results also in profound vasodilation
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neurogenic shock
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this type of shock results from a bacterial infection (blood poisoning); can be a result of bowel or appendix perforation, toxid shock syndrome
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septic shock
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this is a reaction that occurs during septic shock in which too many inflammatory cells are activated in a single place; can be potentially fatal if it destroys tissues and cells
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cytokine storm
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What are the two things that produce the major stimulus to redirect vasodilation to the contracting muscle during exercise?
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Nitric Oxide (NO) and local chemical messengers
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What stimulates vasoconstriction to non-working tissues during exercise?
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SNS stimulation through alpha 1 receptors
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what receptors detect an internal bleed?
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baroreceptors
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What is the normal value of hematocrit for males?
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42-52%
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what is the normal value of hematocrit for females?
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37-47%
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What two components make up blood?
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formed elements and plasma
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what is the total blood volume?
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5.5-6 L
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Approximately how much of the blood volume is plasma?
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3-4 L
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About how much of the plasma is water?
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91-93%
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about how much of the plasma is made up of plasma proteins?
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7-9%
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What is the major solute of the plasma?
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sodium
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This is plasma minus the clotting factors and fibrinogen
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serum
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What are the three types of cells in the blood?
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erythrocytes (RBCs), leukocytes (WBCs), and thrombocytes (platelets)
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this is the percentage of blood that is occupied/packed with erythrocytes; they vary depending on age and sex
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hematocrit
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these plasma proteins are made by the liver and play a major role in the maintenance of osmotic pressure in the blood; decreased levels may cause edema and is a frequent complication in patients with liver or kidney disease
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albumin
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these plasma proteins are divided into 3 subtypes (alpha, beta, and gamma); play a key role in transport of vitamins and immunity
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globulins
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these types of globulins are produced by the liver and play a key role in the transport of vitamins
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alpha and beta
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these types of globulins are produced by the lymphocytes and function in immunity
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gamma
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this plasma protein is produced by the liver and is a precursor for fibrin, and is an important component of the blood clotting system
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fibrinogen
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What are all blood cells derived from?
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a pluripotent hematopoietic stem cell
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Where are the pluripotent stem cells found?
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bone marrow
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What are the two major lineages that are derived from pluripotent stem cells?
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myeloid and lymphoid
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these factors represent a collection of proteins that originate outside the bone marrow; they promote the growth of cells or stimulate differentiation of a specific cell type (ex. interleukins and erythropoietin)
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hematopoietic growth factors/growth and differentiation factors
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What is the major role of erythrocytes?
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to transport Hgb which binds and carries oxygen to the peripheral tissues
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What type of protein is Hgb?
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allosteric
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this enzyme that is found in high concentration in the RBCs catalyzes the reaction that allows carbon dioxide to be carried in the blood as bicarbonate
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carbonic anhydrase
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Where are RBCs produced in early embryonic life?
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yolk sac
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Where are RBCs produced in the middle trimester?
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primarily by the liver
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Where are the RBCs produced in late gestation until 5 years of age?
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the bone marrow of all bones
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Where are most of the RBCs produced from ages 5-20?
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the axial skeleton (sternum, vertebrae, ribs, and pelvis)
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What is the first recognizable cell during red blood cell genesis?
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proerythroblast
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What is the product of the proerythroblast dividing many times?
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reticulocyte
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Hgb concentration in the cell is about __% of the total contents.
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34%
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At what stage of development does the "red blood cell" pass from the bone marrow into the circulation?
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reticulocyte
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How long does it take for the RBC to mature in the circulation?
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1-2 days
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What is the average life span of a mature RBC?
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120 days
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Too many RBCs in circulation wil cause an increase in __ of the blood that impedes blood flow.
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viscosity
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Is the total RBC number greater in males or females?
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males
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what hormone is the major regulator for RBC production?
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erythropoietin (EPO)
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Where is EPO synthesized and secreted?
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the kidney
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What vitamins are required for the synthesis of DNA in the RBCs?
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vitamins b12 and folic acid
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this phenomenon occurs when there is a lack of the proper vitamins to synthesize DNA in the RBC
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maturation failure
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What is one of the most common causes for lack of vitamin B12?
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lack of intrinsic factor
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Where is vitamin B12 stored primarily?
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the liver
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how long can you have a deficiency in vitamin B12 before maturation failure occurs?
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3-4 years
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How many Hgb chains are in one Hgb molecule?
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4
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How much of the total body iron is found in Hgb?
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65%
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Where does synthesis of Hgb begin?
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the proerythroblast
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What is the major storage depot for iron?
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the liver
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In what form is iron stored in the liver?
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ferritin
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What is ferritin made of?
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iron bound to apoferritin
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Once iron is absorbed into the circulation, what does it bind with, making what molecule?
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apotransferrin, transferrin
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How is excess iron stored in the cells?
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hemosiderin
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Where is the major site for destruction of old, fragile RBCs?
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the spleen
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Other breakdown products of Hgb are converted by macrophages into this substance, which is secreted into the bile by the liver
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bilirubin
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What can an accumulation of bilirubin in the blood cause?
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jaundice
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Blood type classification is determined by the polysaccharide __ on the surface of the RBC
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antigens (agglutinogens)
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What are the two major agglutinogens that exist in the cell?
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Type A and Type B
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A person with type O blood would have what type of antigens; anti-agglutinins?
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none; anti-A and anti-B
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A person with type A blood would have what type of antigens; anti-agglutinins?
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A; anti-B
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A person with type B blood would have what type of antigens; anti-agglutinins?
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B; anti-A
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A person with type AB blood has what type of antigens; anti-agglutinins?
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A and B; none (universal recipient)
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What type of blood is the universal donor?
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Type O
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what type of blood is the universal recipient?
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Type AB
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This is a deficiency of Hgb which can be due to either a decreased tota number of RBCs or due to a decreased amount of Hgb on the RBCs
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anemia
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This type of anemia results from a lack of vitamin B12 in the body
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pernicious
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This type of anemia allows the person to still have a normal sized cell
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normocytic
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this type of anemia causes the person to have an abnormally large cell
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macrocytic
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this type of anemia causes the person to have an abnormally small cell
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microcytic
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this type of anemia allows the person to have normal amounts of Hgb in the RBC
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normochromic
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this type of anemia causes the person to have abnormally high amounts of Hgb in the RBC
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hyperchromic
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this type of anemia causes the person to have an abnormally low amount of Hgb in the RBC
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hypochromic
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What is the primary effect of anemia on the body?
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It places a greater demand/workload on the heart
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What are common signs of anemia?
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dyspnea, tachycardia, palpitations, and decreased exercise tolerance
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This is a condition where there are too many RBCs, and the result is an increase in the viscoity of the blood and therefore sluggish blood flow
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polycythemia
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This type of polycythemia occurs in situations whenever there is too little oxygen delivery to the tissues; common causes are cardiac failure and altitude
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secondary
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this is a pathological condition in which there are too many blood cells being produced
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polycythemia vera
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Which two cells make up 50-70% of total WBCs in the body?
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neutrophils and monocytes
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What is the normal Hgb level for males?
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16 g/dL
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What is the normal Hgb level for females?
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14 g/dL
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Where does exchange of carbon dioxide for oxygen on the Hgb molecule occur?
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the lung capillaries
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Where does the exchange of oxygen for carbon dioxide on the hemoglobin molecule occur?
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the body tissues
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Which enzyme catalyzes the reaction that enables CO2 to be carried in the plasma as bicarbonate?
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carbonic anhydrase
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How much iron that is ingested in the diet is actually absorbed into the circulation?
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~10%
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Which two types of blood are the most common?
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Type O and Type A
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What is the term for stoppage of bleeding that involves interplay between blood vessels, platelets, and coagulation factors?
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hemostasis
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In the normal circulation with no injury, are there more anticoagulants or procoagulants?
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anti
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In the circulation WITH injury, are there more anticoagulants or procoagulants?
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pro
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What is the immediate response of the cell to injury?
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vasoconstriction
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Does damage to an artery or damage to a vein generally cause more blood loss?
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artery
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What cell are platelets fragments of?
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megakaryocytes
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What is the average life span of a platelet?
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6-10 days
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What is the normal concentration of platelets in the blood?
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150,000-450,000 cells/mm3
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What factor allows platelets to adhere to collagen?
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von Willebrand factor
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What substance acts to bridge neighboring platelets to form a platelet plug?
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fibrinogen
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What can be caused by defects in platelet aggregation?
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mucosal bleeds, heavy menses
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What is the most dominant hemostatic defense against blood loss?
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clot formation
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What can be caused by disorders of coagulation?
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hematomas, hemarthrosis
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What factor binds to thrombin to activate it to form fibrin?
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prothrombin
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What factor does thrombin create, which goes on to create fibrin?
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fibrinogen
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What are the nutritional requirements for coagulation?
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vitamin K, bile salts, and calcium
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Defects in the anticlotting systems can lead to what state in the blood?
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hypercoaguability
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What messengers are released by endothelial cells to oppose the TXA2 that is produced by the platelets?
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NO and prostacyclin (PGI2)
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What does thrombin bind to, which in turn causes it to activate a plasma protein that inactivates clotting factors?
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thrombomodulin
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This is a plasma protein that inactivates thrombin and several other clotting factors
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antithrombin III
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this is a naturally occurring substance that is on the surface of endothelial cells that activates Antithrombin III
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heparin
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This is the system that dissolves clots after they are formed
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fibrinolytic system
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What is the major type of plasminogen activator?
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t-PA (tissue plasminogen activator)
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What is the molecule that digests the clot during the fibrinolytic system?
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plasmin
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this is a local messenger secreted by platelets that works via the COX pathway, it stimulates further platelet aggregation
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TXA2
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this is the process of forming new blood vessels
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angiogenesis
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what are the two main activator molecules that promote vascular growth?
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vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF)
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From what type of cells is VEGF produced?
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fibroblasts in the ECM
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From what type of cells is bFGF secreted?
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cancerous cells
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what enzyme stimulates NO to cause endothelial cell growth and differentiation in vascular tubes?
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nitric oxide synthase (NOS)
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The activation of endothelial cells leads to secretion of these degradative enzymes that break down the ECM, allowing for migration of endothelial cells into the tissue
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metalloproteinases
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What are the two most important inhibitor molecules that block vessel growth?
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angiostatin and endostatin
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this is a molecule that is a fragment of plasminogen; it causes endothelial cells to lyse/go through apoptosis
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angiostatin
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this is a molecule that is a product of ocllagen breakdown from dissolving the ECM; it stimulates apoptosis
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endostatin
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This is the normal level of arterial oxygen
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98-100 mm Hg
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this is the normal level of arterial carbon dioxide
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40 mm Hg
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this is a condition that results from decreased ability to expire CO2
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respiratory acidosis
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this is a phenomenon that occurs when air flow causes vibration of the vocal cords
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phonation
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this is the mechanical movement of air between the atmosphere and the lung alveoli
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ventilation
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This is the area from the mouth/nose to the end of the terminal bronchiole; it can hold about 150 mL of air; the function includes air flow, phonation, warming the air, saturating the air with water and trapping foreign inhaled particles
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conducting zone
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this is the zone that runs from the respiratory bronchi, alveolar ducts, to the alveoli; it functions in gas exchange by diffusion
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respiratory zone
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this type of muscle lines the airways from the trachea to the respiratory bronchii; it functions to contract or relax the radius of the airways for airway resistance
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smooth muscle
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What type of ANS stimulation causes airway constriction?
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parasympathetic (ACh)
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What type of ANS stimulation causes airway dilation?
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sympathetic (Epi, Norepi, B2)
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these cells line the epithelium of the airway and secrete mucus
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glandular cells
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a genetic defect in the chloride channels that secrete water fluid (surfactant)
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cystic fibrosis
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These cells secrete this liquid which forms a layer between the interface of air and water in the alveoli
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pneumocytes (specifically type II)
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this type of pneumocyte is elongated and covers a large surface area
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type I
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this type of pneumocyte is round, numerous, and produces the surfactant
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Type II
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This is a mixture of phospholipids and proteins that form a monolayer between the interfact of air and water in the alveoli; it functions to lower the surface tension at the air water interface, thereby increasing the compliance of the lung
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surfactant
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When is surfactant produced?
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late in the third trimester of pregnancy
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This syndrome occurs in premature infants if they are born before the production of surfactant; can also occur in adults in advanced disease states
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respiratory distress syndrome
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This is the pressure surrounding the body and in the nose and mouth
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Patm (atmospheric)
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this is the pressure of air in the alveolus
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Palv (alveolar)
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this is the pressure of air in the intrapleural space (between the lung and the chest wall)
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Pip (intrapleural)
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this is Palv-Pip; the pressure that acts to expand the lungs
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transpulmonary pressure
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This is the equation for the pressure that determines the movement of air in and out of the lungs
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Patm-Palv
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This law states that the pressure of a fixed amount of gas is inversely related to the volume of the container (decrease in volume, increase in pressure, vice versa)
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Boyle's law
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The diaphragm is innervated mainly by what nerve?
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the phrenic nerve
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What are the accessory muscles of inspiration?
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the external intercostals and the anterior neck muscles
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What are the accessory muscles of expiration?
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the internal intercostals, and the abdominals (primarily the obliques)
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During inspiration, does the Pip become more positive or more negative?
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negative
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During inspiration, there is an increase in transpulmonary pressure. Is the atmospheric pressure greater or less than the alveolar pressure?
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greater
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During expiration, does the Pip become more positive or negative?
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positive
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During expiration, there is a decrease in transpulmonary pressure. Is the atmospheric pressure greater or less than the alveolar pressure?
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less than
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this is the volume of air that comes in with breath
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tidal volume (~500 mL)
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How do you determine minute ventilation?
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tidal volume x respiratory rate (mL/min)
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How do you determine alveolar ventilation?
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tidal volume-dead space x respiratory rate (mL/min)
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What is the average lung capacity?
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6 L
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What is the vital capacity of the lungs
|
4.8 L
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this is the amount of air that you can actually move in and out of the lungs (amount of air exhaled after a maximum inspiration)
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vital capacity
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this is the volume of air that is trapped in the lungs
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residual volume
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this is the measure of the maximum amount of air that can be inhaled an exhaled for one minute (measured for 15 seconds and then extrapolated)
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maximum voluntary ventilation
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This is the volume of the vital capaicty that can be exhaled in 1 second
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Forced Expiratory Volume (FEV1)
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this ratio represents the proportion of forced vital capacity that is exhaled in 1 second
|
FEV1/FVC
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These lung diseases are thoe that destroy the lung parenchyma and cause a resistance to air flow
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obstructive lung diseases
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these lung diseases are those that don't actually have a resistance to air flow, but there is a structural block that makes it difficult to fully expand the chest/thorax
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restrictive lung disease
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this is the point of maximum airflow where an increase in effort cannot cause a greater flow rate
|
maximum expiratory effort
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this is caused when extra fluid is fluxing out of the lung capillaries and there is no subsequent lymph drainage; the fluid fluxes easily in the alveoli, causing extra fluid in the interstitial spcae
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pulmonary congestion
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this is caused when there is extra fluid in the alveoli, which causes there to be a harder barrier for gas diffusion
|
pulmonary edema
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Each breath replaces about how much alveolar air?
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1/16-1/20
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this is the ratio of CO2 produced to O2 consumed
|
respiratory quotient
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What is the normal respiratory quotient on a mixed diet?
|
0.8
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this is increased ventilation that is not matched with an increase in the metabolic need for O2 (elevated PaO2 and decreased PaCO2)
|
hyperventilation
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this is a decreased ventilation that is not matched with a decrease in metabolic need for O2 (elevated PaCO2 and decreased PaO2)
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hypoventilation
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this is when increased ventilation matches increased O2 consumption (normal PaO2 and PaCO2)
|
hyperpnea
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when there is decreased alveolar oxygen, what do you normally see?
|
hypoxic vasoconstriction
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when there is decreased alveolar carbon dioxide, what do you normally see?
|
airway constriction
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when there is increased alveolar carbon dioxide, what do you normally see?
|
airway dilation
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this ocurs when there is a ventilated alvoli with no blood perfusion, and V/Q ratios approach infinity
|
physiologic dead space
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this occurs when there is capillary perfusion to areas with no ventilation, and V/Q ratios approach zero
|
shunt
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The different between arterial and alveolar CO2 should be less than __-__ mm Hg
|
10-15
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__% of oxygen is carried bound to hemoglobin
|
98
|
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__% of carbon dioxide is carried physically dissolved
|
10
|
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__% of carbon dioxide is carried as carbamino compound
|
30
|
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__% of carbon dioxide is carried as plasma bicarbonate
|
60
|
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this ion maintains the electroneutrality when bicarbonate moves out of the red blood cell into the plasma
|
chloride
|
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where is the respiratory rhythm generator located in the brain?
|
the medulla
|
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this respiratory group of cells are activated only during inspiration
|
dorsal
|
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this respiratory group of cells are activated during both inspiration and expiration
|
ventral
|
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these chemoreceptors are located in the aortic and carotid bodies and are stimulated primarily by a decrease in PaO2 or an increase in H, CO2; they stimulate an increase in ventilation
|
peripheral
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these chemoreceptors are located in the medulla, and are bathed by the interstitial fluid of the medulla and respond to changes in H concentration
|
central
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this reflex in the lungs act as a stretch receptor to prevent overinflation of the lungs
|
Hering-Breuer reflex
|
|
this is a deficiency of oxygen at the tissue/cell level
|
hypoxia
|
|
this is a decrease in arterial oxygen levels
|
hypoxemia
|
|
this occurs when there is not enough red blood cells or Hgb, but the arterial oxygen concentration is normal
|
Anemic hypoxia
|
|
this type of hypoxia occurs when there is a blood flow problem
|
ischemic
|
|
this occurs when something at the level of the cell is blocking cell respiration
|
histotoxic hypoxia
|
|
progressive decline in VO2 max occurs at a rate of __% every 1000 meters of altitude
|
10
|
|
What is the immediate response to altitude?
|
to increase ventilation
|
|
If the difference between arterial and alveolar oxygen concentration is greater than 15, what does this signal?
|
a diffusion problem
|
|
this law states that the concentration of a dissolved gas in a liquid is diretly proportional to the partial pressure of the gas in the atmosphere to which that liquid is exposed
|
Henry's Law
|
|
which airway generations constitute the conducting zone?
|
1-17
|
|
which airway generations constitute the respiratory zone?
|
18-25
|
|
About how many airway generations are there in the body?
|
23-25
|
|
this is the difference in the blood from the arteries to the veins after going through the systemic capillaries
|
AVO2 difference
|