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212 Cards in this Set

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