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    Physio Saq With Answers

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    Ghaidaa Sadeq
    Here is a labeled diagram of a left atrial pressure trace along with a brief description of factors that affect LAP: [DIAGRAM OF LEFT ATRIAL PRESSURE TRACE WITH LABELS FOR A, C, AND V WAVES AND X-Y DESCENT] Factors that affect LAP: - Blood volume - Increased volume leads to higher LAP - Sympathetic tone - Increased tone increases LAP by enhancing LV contractility and heart rate - Posture - Standing increases LAP more than supine due to effects of gravity - LV contractility - Increased contractility augments A wave and decreases X-Y descent - LV compliance - Stiff ventricle decreases compliance, increasing LAP - LV

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    Physio Saq With Answers

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    Ghaidaa Sadeq
    145 views15 pages
    Here is a labeled diagram of a left atrial pressure trace along with a brief description of factors that affect LAP: [DIAGRAM OF LEFT ATRIAL PRESSURE TRACE WITH LABELS FOR A, C, AND V WAVES AND X-Y DESCENT] Factors that affect LAP: - Blood volume - Increased volume leads to higher LAP - Sympathetic tone - Increased tone increases LAP by enhancing LV contractility and heart rate - Posture - Standing increases LAP more than supine due to effects of gravity - LV contractility - Increased contractility augments A wave and decreases X-Y descent - LV compliance - Stiff ventricle decreases compliance, increasing LAP - LV

    Original Description:

    questions about physiology for medical student / first year

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    Here is a labeled diagram of a left atrial pressure trace along with a brief description of factors that affect LAP: [DIAGRAM OF LEFT ATRIAL PRESSURE TRACE WITH LABELS FOR A, C, AND V WAVES AND X-Y DESCENT] Factors that affect LAP: - Blood volume - Increased volume leads to higher LAP - Sympathetic tone - Increased tone increases LAP by enhancing LV contractility and heart rate - Posture - Standing increases LAP more than supine due to effects of gravity - LV contractility - Increased contractility augments A wave and decreases X-Y descent - LV compliance - Stiff ventricle decreases compliance, increasing LAP - LV

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    145 views15 pages

    Physio Saq With Answers

    Uploaded by

    Ghaidaa Sadeq
    Here is a labeled diagram of a left atrial pressure trace along with a brief description of factors that affect LAP: [DIAGRAM OF LEFT ATRIAL PRESSURE TRACE WITH LABELS FOR A, C, AND V WAVES AND X-Y DESCENT] Factors that affect LAP: - Blood volume - Increased volume leads to higher LAP - Sympathetic tone - Increased tone increases LAP by enhancing LV contractility and heart rate - Posture - Standing increases LAP more than supine due to effects of gravity - LV contractility - Increased contractility augments A wave and decreases X-Y descent - LV compliance - Stiff ventricle decreases compliance, increasing LAP - LV

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    © All Rights Reserved
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    of 15

    A young woman requires dialysis for acute renal failure.

    Examine the
    diagram, Describe the principles involved in the system for moving
    solvent and solute across the semi-permeable membrane.
    Blood

    Urea 40 mmol/L
    Osmolarity 320 mosm/L
    Pressure 100 mmHg

    ------------SEMI-PERMEABLE MEMBRANE--------------Dialysate

    Urea 0
    Osmolarity 346 mosm/L
    Pressure 10 mm Hg

    Answer.
    SOLUTE MOVEMENT
    1. Diffusion of Urea down a Concentration gradient.
    2. Hydrostatic Pressure forcing fluid through membrane by a difference of
    hydrostatic pressure - Filtration.
    3. Solvent drag solute molecules move with solvent. convective
    forces

    SOLVENT MOVEMENT
    1. Osmosis from blood into dialysate to equilibrate osmotic pressure

    Outline the physiological effects of acute hypoglycaemia

    Answer
    Define acute hypoglycaemia.
    Time and criteria or level of blood sugar for hypoglycaemia
    Mechanisms for hunger and nausea role of hypothalamus
    State tissues that are dependent totally on glucose as a substrate
    Alternative substrates in tissues not dependent solely on glucose
    Neurohumoral effects
    Metabolic reserves

    What are the physiological effects of the evaporative loss of 2 litres


    of water in a 60kg man.
    1. Reduction in total body water
    750ml
    from ECF
    1250ml
    from ICF
    2. blood vol decreased VR and atrial filling CO via
    Frank-Starling mechanism
    3. Reduced CO

    BP
    heart rate
    vasoconstriction
    venoconstriction

    4. Baroreceptor stimulated

    both of which tend to restore BP


    5. atrial wall stretch

    ADH
    ANP

    6. Increased osmolarity

    ADH

    7. thirst

    lends to drinking

    8. ADH

    effects on kidney

    Explain the mechanism for the maintenance of oxygen supply to organs


    during isovolaemic haemodilution.
    Haemodilution

    Oxygen flux equation


    =
    cardiac x
    output

    oxygen carrying capacity


    arterial O2
    content

    cardiac output

    [ sat x Hb x 1.34]

    Normally blood loses 25% O2 content so that remaining 75% forms


    reserve supply
    1. ORGAN BLOOD FLOW by
    a) increased cardiac output
    by blood viscosity venous stroke volume
    by afterload
    return
    b) cardiac output via sympathetic drive
    increasing heart rate & stroke volume
    c) regional blood flow by viscosity
    d) vasodilation of organ circulation
    2. O2 EXTRACTION increased
    3. Haematocrit = heart & brain will receive preferential blood supply
    Decreased viscosity-therefore better flow and distribution
    to tissues.

    Briefly describe the functions of proteins in cell membranes.


    Many types of proteins within cell membrane
    Located at (i) outer surface
    (ii) through thickness or integral proteins
    (iii) inner surface
    Hydrophobic part of protein orientated towards cell interior
    Hydrophilic part orientated towards exterior of cell
    May be Lipoproteins (proteins that contain lipids) or Glycoproteins (contain
    carbohydrates)
    Role:
    1. Structural proteins
    2. Active transport mechanisms
    3. Ion channels for passive ion transport
    4. Receptors for transmitters or hormones
    5. G proteins
    6. Surface proteins as receptors eg Glycoprotein receptors
    As antigens eg Rh factor

    Factors that control intra-ocular pressure


    1. Intraocular Blood Volume
    Venous pressure eg coughing and straining, posture
    Carbon dioxide
    Posture improve drainage
    2. Volume of Aqueous humour
    Produced by ciliary body (thickened anterior part of choroid) by
    DIFFUSION
    Role of Carbonic anhydrase intraocular pressure is reduce by CA
    inhibitors e.g acetazolamide
    Drainage of aqueous humour via canal of Schwlem

    Describe the effects of 100ml of 8.4% sodium bicarbonate


    administered intravenously in a 70kg man during CPR at an asystolic
    arrest
    Composition of Sodium bicarbonate
    Na 1 mmo;l per ml
    HCO3 1 mmol per ml
    Tonicity 2 mosmol per ml
    Effects:
    1. Alkali load K+ flux; H+
    2. Na load
    hypertonicity in intravascular volume
    3. CO2 load clue to dissociation of HCO34. Effects on O2 dissociation curve
    5. CO2 diffusion intracellularly leading to intracellular acidosis
    6. Effects on respiratory control

    An elderly lady with bowel obstruction has nasogastric losses >


    1000ml/day for 5 days.
    Explain the mechanism of the development of metabolic alkalosis
    and justify your choice of replacement fluid.
    NG fluid composition
    Na50
    K 10
    H 100
    Mg 2

    (mmol/L)

    Metabolic alkalosis
    loss of H+ ions
    maintained and persist because:
    1) Hypovolaemic
    Na+ reabsorbed in preference to H+ at distal tubule
    2) Hypochloraemia
    HCO3 reabsorbed with Na+ reabsorption
    More K+ and H+ loss at distal tubule
    Choice of fluid
    0.9% NaCl with 30mmol K+

    Define basal metabolic rate. How does the metabolic rate of a child with
    abdominal sepsis in the OR differ from that of a sleeping adult.
    Definition
    BMR = rate of energy utilisation in awake subject 12 hours
    after meal in a comfortable or thermoneutral environment
    Factors affecting BMR of child
    a) Age
    - neonate
    b) Additonal factors
    pain
    sepsis
    pyrexia
    anxiety
    if rigors present
    OR temperature
    ? starvation
    GA
    Sleeping Adult
    Age
    sleep

    Order

    BMR higher
    approx. 2 x adult
    )
    ) metabolic
    )
    rate
    )
    )
    ) metabolic
    )
    rate

    Outline the control of body water by the kidneys.


    1. 180L fluid filtered through the glomeruli/day
    2. Approx. 90% water filtered is reabsorbed
    3. Proximal tubule
    70% passive reabsorption via osmotic forces following (secondary to) active Na
    reabsorption.
    4. Loop of Henle
    passive osmotic reabsorption of water in descending limb because:
    a) descending limb is permeable to H2O
    b) ascending limb is not permeable
    countercurrent multiplier system produces hyperosmotic medullary
    interstitium which enhance H2O reabsorption. Occurs at juxtamedullary
    nephrons.
    5. Distal tubule - passive H2 reabsorption
    Collecting ducts - site of ADH free H2O reabsorption
    Regulated by ECF osmolarity Ant Pit ADH
    6.

    Osmotic diuresis

    Briefly explain how alveolar hypoventilation reduces the systemic arterial partial
    pressure of oxygen (PaO2)
    1. Alveolar hypoventilation
    < 3600ml/min
    2. Alveolar
    Conc of gas + inspired gas conc output / uptake of gas
    alveolar ventilation
    3. With CO2 ; Insp CO2 = O
    PACO2 = K (output)

    VA PAO2

    4. Apply Alveolar Air Equation


    PAO2 = P1O2 - PACO2
    R
    PA P1 in a non-linear manner (i.e. rectangular hyperbola)
    5. O2 cascade

    Pa PA

    6. PAO2 = PIO2 - V. O2
    VA

    Briefly describe the mechanisms that control the distribution of body water
    between the plasma, interstitial and cellular compartments.
    1. Distribution of body H2O
    ICF / ECF
    factors: age, sex, obese
    2. Forces that determine distribution
    membrane permeability
    membrane pumps
    osmotic forces
    Gibb-Donnan effect
    colloid osmotic forces
    3. total body osmolarity
    Na
    Other osmotic forces

    Sugar
    blood urea

    With regard to an invasive arterial blood pressure monitoring, briefly describe


    the role of
    i.
    frequency response
    ii.
    resonant frequency
    iii.
    optimal damping
    of the measuring system (ie cannula, tubing and transducer) in
    achieving an accurate waveform.
    Frequency response: range of frequencies to reproduce the Fourier components
    of the waveform ie without distortion. X10 hormones
    180 beats/m = 3H2 x 10
    Resonant frequency:
    frequency at which the signal is magnified due to
    oscillation and hence distort the signal
    Optimal damping

    df = resist (friction)
    2ms
    damping. coef 0.7 produces the least attenuation of a wide range of
    frequencies and minimum change in frequency response Also calle optimal
    damping.
    Transducer

    f. S/M
    fo = R
    2 TTpl

    mass =

    Connecting tube:
    fo short length, large diameter
    stiff
    air; blood clots
    Cannula:site, size, kinks, etc

    Briefly describe the acid base changes which arise in a hypoxic person,
    including the compensatory processes which may restore the
    status to normal.
    1. Definition:

    Clinical hypoxia
    Decrease PaO2 from capillary (90mmHg) to mitochondria
    ( 1mmHg)

    2. Biochemical Effects:
    Mitochondria:
    stop oxidative phosphorylation
    Glycolytic pathway
    Glucose Pyruvate Lactic Acid + 2 ATP
    2 ATP ADP + AMP - retard Ca ATP pump
    3. Cellular Buffering

    HPO4; Protein

    4. Interstitial buffers
    5. Vascular Buffers:

    PaO2 : Buffers
    HbO2 dissociation shifts
    K+

    6. Acute Compensatory
    s
    Resp: Hyperventilation V/Q
    Sympathetic N. Syst
    Cardiac Output
    7. Long Term Compensatory
    Renal
    EPO

    Draw and label a left atrial pressure trace. Briefly describe the factors that
    affect LAP.
    Diagram A, C and V waves
    X Y descent
    Values on axes
    Factors:
    Blood volume
    Sympathetic tone
    Posture
    LV contractibility (systolic)
    LV compliance (diastolic)
    LV impedance / afterload
    Intrathoracic pressure
    Pericardial pressure
    RV output

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