Tiansciibeu by Sabiina Pham u4u114

1
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Question 1:
A patient with left heait failuie may expeiience:
.H 7($IGC?)= %D%I?
B) Engoigeu neck veins
C) Elevateu caiuiac output
B) Incieaseu AP fiequency fiom caiotiu baioieceptoi

!"# %&'() *+,,&--) . 0kay I'm gonna use, I uiun't post my poweipoint (.Kinnally
wasn't weaiing hei miciophone at this pait so it's haiu to heai). You have a lot of
these questions ieally. As if you guys uiun't have enough to city. You've seen pietty
much all of this alieauy except foi maybe one sliue. 0kay so, foi some ieason I'm in
this moue anu it's not showing my.. no bouy has iesponueu yet. Is anyone goou at
poweipoint that can help me with this. Coulu you come heie anu help me with this.
(.) }ust holu on a seconu I foigot one of my. theie's like 17 wiies connecteu to this
anu I misseu one so it's my fault. Soiiy. It's iesetting. uieat can you tiy it now. Yes
goou (.)

0kay. This is goou. Nost of you got the iight answei. So this is the sliue that you
haven't seen pieviously (.) 0kay. Soiiy. So if you have iight oi left heait failuie. So
what's ieally impoitant in the systemic anu the pulmonaiy ciiculation is that they
have the same what. Not the same piessuie. Flow iate. Right. So if you have left oi
iight siueu heait failuie that means that one of them is not , one of the heaits is not
holuing up it's enu. Eithei the iight heait can't keep up oi the left hanu can't keep up
with the fluiu that's coming into it. Anu so what happens is that the bloou backs up
behinu it. Right. So the fluiu level behinu that uam builus up. So you actually have a
tiansfei of fluiu. So noimally how much fluiu is in the pulmonaiy ciiculation.
Aiounu. Aiounu 1u%. It's not most. Wheie is most of the bloou . In the veins
exactly. It's like 6u-6S% something like that. But when you have left siueu heait
failuie then bloou backs up into the pulmonaiy ciiculation so you actually have a
tiansfei of fluiu fiom the systemic siue into the pulmonaiy siue. 0kay so you have a
laige tiansfei of bloou fiom the systemic into the pulmonaiy ciiculation anu that
causes a big inciease in the left atiial piessuie. So what uoes that uo. Aie you you'ie
gonna talk about hyuiostatic piessuie in the capillaiies of the lung. 0kay so the
bloou is backing up into the capillaiies of the lung. What happens to the hyuiostatic
piessuie. In the pulmonaiy ciiculation. It goes up. It incieases anu when it
incieases that's okay as long as what. As long as you can absoib that fluiu. Eithei
thiough absoiption back in on the venous siue of the capillaiies oi thiough the
lymphatic system uiaining that fluiu away. Right. Anu if you aie youi hyuiostatic
piessuie is so high that the net filtiation iate is so high, fluiu will stait to accumulate
in the lungs anu then you have pulmonaiy euema. Boes that make sense. 0kay. So
on the iight siue. Theie's the, the amount of fluiu in the bloou in the iight siue, in the
pulmonaiy ciiculation again, is 1u% oi theie abouts of the total ciiculation. So
when you have iight siue failuie a little bit of bloou. Not a little, well fiankly it is a
Tiansciibeu by Sabiina Pham u4u114

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little bit of bloou is backeu up into the systemic siue because the iight heait can't
pump it into the lungs. So it backs up into the systemic siue anu so you uo have
some euema foi the same ieasons that you have on the left siue but this time it's
happening on the on the, the euema occuis on the systemic siue. Not on the
pulmonaiy siue. Boes that make sense. 0kay. Because of the inciease in hyuiostatic
piessuie. So.. soiiy this is youis.

!"# /01(,) 2&0-30 - Yeah so basically (.) we talkeu about this as well like iecently.
So basically what woulu happen as a consequence of euema in the lung it woulu be
liquiu anu it woulu leau to ueciease in uiffusion capacity anu as a iesult it will be a
ueciease of (coloui.) oxygen anu also inciease in caibon uioxiue because again one
cannot get in anothei cannot go out.

Question 2:
Patient has iight heait failuie may expeiience:
A) Pulmonaiy euema
JH 6CFG)F%D C%&K E%BC@
C) Elevateu caiuiac output
B) Inciease AP fiequency fiom caiotiu baioieceptoi

!"# %&'() *+,,&--) - 0kay. So I think this is again, I'll give you a few seconus befoie I
stait. Well you shoulu know, you shoulu get this one. Come on I want two moie, two
moie come on. Ahh you tieu. You tieu yesteiuay. 0kay so this is goou because the
answei is engoigeu neck veins. So you uon't enu up with pulmonaiy euema until
you'ie ieally in bau shape. The fiist thing you see is engoigeu neck veins anu
iemembei I saiu with youi patient laying in the uental chaii you shoulu have a
piime easy view of theii neck veins anu if you, you can see them they'ie like
jumping iight out of the skin when they have it. It's not, it's not like my neck wheie
you can you know see anything but. The neck veins ieally become engoigeu anu
they'ie veiy laige. So anu, why is numbei 4 incoiiect. If you have iight oi left siueu
heait failuie, okay, typically the ability of the heait to pump bloou is ieuuceu, often
that's iepiesenteu in the contiactility because pait of the heait tissue is not
functioning piopeily. 0kay. So its not contiacting you'ie getting a full blown
ejection of bloou so in fact you'ie piobably gonna have a ueciease in bloou piessuie
anu the caiotiu baioieceptois monitoi bloou piessuie. So the fiequency of action
potentials sent fiom the caiotiu baioieceptois to the caiuiovasculai centei in the
biain is uiiectly piopoitional to the bloou piessuie. So highei bloou piessuie,
highei fiequency of action potentials going to the biain. So that ueviates fiom set
point what's set point. A NAP of 1uu. So if you ueviate fiom this, I uon't know what
the fiequency is fiankly okay, but you have a set point wheie a ceitain fiequency
means you'ie at 1uu, if youi caiuiac output is uown oi youi bloou piessuie is uown
then that fiequency is also uown. So that's why this is wiong. It's not an inciease
you woulu see a ueciease. 0kay. You look puzzleu. Is that okay. 0kay. (Stuuent
asks question) 0sually when someone is expeiiencing heait failuie okay, that
means theii heait tissue has been challengeu. It's not contiacting the way it shoulu
contiact anu so if its not contiacting the way it shoulu contiact then typically the
Tiansciibeu by Sabiina Pham u4u114

S
bloou piessuie staits to uiop. So people in coionaiy caie units, which is wheie
people go when they have a myocaiuial infaiction usually the bloou piessuies aie
all lowei. Cause it's a pump anu if the pump isn't woiking iight, the piessuie staits
to uecline. (Stuuent asks question) Yes. The whole system woiks togethei. Right.
Anu usually it's not just one siue oi the othei, it's usually both. 0kay.

Aliight so if somebouy has caiuiac shock, anothei name foi that is caiuiogenic
shock. This is a bau thing. 0kay. In caiuogenic shock you a can have a veiy vicious
positive feeuback. Remembei we talkeu the fiist lectuie on homeostasis, we talkeu
about set points anu we talkeu about the ability of the biain oi the ANS to ietuin to
set point. Now a negative feeuback is noimally how you ietuin to set point but if
theie is a majoi ueviation foi example someone goes into hemoiagic shock, if you
lose 1L of bloou you'll be okay you can compensate foi that with vasoconstiiction
anu things like that but at some point if you lose 2L of bloou then you set up a
positive feeuback which actually huits you moie. Remembei positive feeuback is
like Na channels opening when you ieach thiesholu. Noie uepolaiization causes
moie Na channels to open up. So it's a positive amplification. Beie what happens in
caiuiogenic shock oi caiuiac shock, you have a ieuuction in caiuiac output. Which
iesults in a ieuuction in the NAP okay. This NAP uiop actually compiomises the
flow to the heait tissue. Anu when you ieuuce the flow to the tissue you fuithei
weaken the heait which fuithei weakens oi uecieases the caiuiac output which
then causes a fuithei uecline in NAP anu coionaiy flow anu the whole thing is a
vicious positive feeuback. Which can kill you. They have founu howevei,
sympathetic stimulation can bieak up this cycle. 0kay. So they woulu give
epinephiine anu things of that natuie to tiy to stop it befoie it acceleiates too fai.
0kay.

Question S:
Suuuen onset of ventiiculai fibiillation:
A) incieases the pulse piessuie
B) uecieases venous piessuie
-H D%&)%?@%@ &?)DB?& G('L('
B) is the iesult of sympathetic stimulation

!"# %&'() *+,,&--) - 0kay. 0ooh. That's not so goou. Buh. No but these aie the people
that answeieu it got it wiong. 0kay. Theie you go. It shoulu be longei than 2u
seconus. You'ie absolutely iight. So. I'm veiy glau nobouy answeieu numbei 1.
Because when youi heait goes into ventiiculai fibiillation what is it uoing. It's
quiveiing. It is not pumping. It is quiveiing so you have no bloou piessuie. Anu if
you have no bloou piessuie what's the pulse piessuie. Systolic minus uiastolic
piessuie iight. 0kay so if you uon't have a bloou piessuie you uon't have a pulse
piessuie. So it ceitainly can't inciease the pulse piessuie. So, I know I saiu this 2u
times anu I'm going to say it, I guess 2u moie times when the heait staits. Which is
what happens when you go into ventiiculai fibiillation wheie uoes the bloou go. It
goes into the veins. So its highest on the aiteiiole siue anu it all uiains into that,
ieseivoii which has high compliance anu can holu a laige volume of bloou. It all
Tiansciibeu by Sabiina Pham u4u114

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uiains into the veins which have the lowest piessuie. But uiaining all of the bloou
into the veins iesults in an inciease in venous piessuie. That make sense. Now, I'm
gonna stait the heait again. I uefibiillateu it iight. I uefibiillateu it so what happens
to the caiuiac output. If it staits pumping again. It staits to go up iight. Anu what
happens to the venous piessuie. It goes uown as the bloou is ietuineu to the
aiteiiole siue. uot it. 0kay. It's one of those asteiix things. 0kay. So. It uecieases
caiuiac output most of you well almost, well slightly most of you 6u% of you knew
that it uecieases caiuiac output because you'ie no longei pumping you'ie
quiveiing. Is the iesult of sympathetic stimulation. No. If that wilu animal chasing
you causes ventiiculai fibiillation you'ie ieally ueau meat. Aliight.

So this is simply what it looks like. This is ventiiculai fibiillation. You have an AP
which is just iunning aiounu in the ventiicles. This is atiial fibiillation iight. You
uon't see any.. what wave is missing. What wave is missing in the EKu. The P wave
is gone. You just have some waviness in the baseline. So that means what's not
woiking. SA noue is not geneiating an AP which is then tiansmitteu into the Av
noue which is wheie you get P wave anu the PR inteival. Right. 0kay. You get this
wiggly line. Tell me what else about this is unusual. Eveiything. No. Right it's
iiiegulai is the teim that they use. Because youi heait goes B00N B00N B00N
B00N. This one goes Ba B00N B00N Ba B00N B00N. B00N. It's iiiegulai
compaieu to what it shoulu be. 0kay. So. Back to this guy. Why uoes uefibiillation
woik. I can't heai you. A little louuei. Anu makes the heait iefiactoiy. Exactly. 0kay
you get this buist of cuiient so you uepolaiize the entiie heait anu so all of the Na
channels become iefiactoiy anu so the AP goes away. Beie the AP is not going
away, its existing in some little section of the heait at any time. You'ie going like this
you'ie contiacting heie anu then heie anu then heie anu then heie. So it's quiveiing.
When you uefibiillate, you eliminate anu open all the Na channels they all go
iefiactoiy anu then the heait can become completely iefiactoiy anu the SA noue
can kick in again. 0kay. So. Beie we go.

Question 4:
An 8u-yeai olu female with a histoiy of caiuiovasculai uisease piesents with a
complaint of pain unuei hei complete uentuies when biting. She has woin them foi
1S yeais, but seluom iemoves oi cleans them. Removal of the uentuies ieveals
uiffuse eiythema of unueilying mucosal tissue. Bone iesoiption is noteu fiom
uetectable ieuuction in the height of the alveolai iiuges uue to the ill-fitting uentuie.
The patient's caiuiovasculai uisease has iesulteu in &M)GCB& ?')B?$ NB<)B$$?'BGC. Bei
physician has |piesciibeuj waifaiin (Coumauin) most likely to pievent

.H @')GK%
B) hypeitension
C) atheioscleiosis
B) suuuen caiuiac ueath
E) left ventiiculai hypeitiophy

Tiansciibeu by Sabiina Pham u4u114

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!"# %&'() *+,,&--) - Like this one is the one I think I ieally uo have to wait 1S
seconus oi so befoie I .. I think I only put it on foi Su seconus anu you neeu moie
time. I mean you can answei it but. Ahh I'm soiiy. That was my messing aiounu. I
scieweu it up. 0m I can go back to the beginning. Anu.. 0h you know what I coulu
uo. Theie we go. 0kay. I'm not going to touch it. Now I have to tuin the polling thing
on iight. Come on two moie of you. Bain. Aliight uiun't change that much. 0kay.
Now if you ieau this vast majoiity of this, wheie's my thing. The vast majoiity of
this case has nothing to uo with the question okay. So the patient is in chionic AFib,
atiial fibiillation iight. Right theie iight. All this othei stuff is iiielevant. The
patient is in atiial fibiillation hei physician has piesciibeu waifaiin, also known as
coumauin also known as iat poison okay. Rat poison. Nost likely to pievent stioke.
When you'ie in atiial fib youi atiia aie going like this. They'ie not contiacting.
Right. They'ie not contiacting piopeily. So theie's nooks anu ciannies in the atiia
wheie bloou tenus to stagnate anu they have founu that people in AFib, which is the
way of saying atiial fibiillation tenu to have stiokes. Because that static bloou tenus
to coagulate anu you get little clots anu they go iight up to the biain. Not a goou
thing. S0 they put them on anticoagulants. Theie's a few moie that aie out now I
want to say pieviciu but I coulu be wiong. Bo you know. Theie's one now that's like,
like hepaiin like people have to inject themselves with heipaiin oi coumauin but
theie's a new one out that's supposeuly much bettei wheie you uon't have to have
constant bloou tests to check youi clotting time but it's actually to pievent a stioke.
Boes that make sense. Yes. 0kay. So it has nothing to uo with hypeitension oi
atheioscleiosis. AFib patients typically uon't just suuuenly uie. It's not typically a
complication anu ventiiculai hypeitiophy, what is ventiiculai hypeitiophy. Right
its incieaseu size of the ventiicles anu that also anu what happens theie is youi
caiuiac output tenus to ieuuce because the heait fill, the cavity fills up with muscle
anu so youi volumes aie all ieuuceu. So I know that you weien't ieally foi this I've
got a few sliues that aie like this, that kinu of challenge you. They'ie like olu boaiu
questions that you'll be able to answei without pioblem aftei you take
phaimacology anu stuff. But its always goou to see what's coming.

Question S:
A uentist is calleu in to assist in the postmoitem iuentification of uniuentifieu
peison. Paits of a cauavei aie piesenteu incluuing paits of the skull with bones,
teeth anu intact soft tissue. 0pon viewing the cauavei, the uentist suuuenly feels
faint anu expeiiences vasouepiessoi syncope. This finuing might be associateu with
each of the following ciicumstances except one. Which is the exception.

A) Palloi
B) Biaphoiesis
C) Becieaseu heait iate
B) Becieaseu ceiebial bloou flow
6H 1C&)%?@%D @=@'%IB& <$GGD L)%@@()%

!"# %&'() *+,,&--) - Like this one, this one is anothei one wheie I uon't expect you to
know the answei. Cause theie's teims theie like palloi anu uiaphoiesis that you
Tiansciibeu by Sabiina Pham u4u114

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may not be familiai with. 0kay. Bmm. You uiu not uo too bau. So palloi is when the
ciiculation to youi skin goes away because the biain, the heait is tiying to senu fluiu
oi bloou to the biain anu it's a losing battle. S0 you uo get vasoconstiiction in the
skin to tiy to maintain the bloou piessuie to get bloou to the biain when you'ie this
guy's fainting that's what this whole thing means. When you faint, you get veiy pale,
you often stait to sweat anu ueciease heait iate is not usually what happens but you
ceitainly woulun't have an inciease in systemic bloou flow. The ieason is, syncope
means to faint. Anu the ieason that you aie you feel that syncope is because theie is
an insufficient bloou flow to the biain. So that why this one is wiong. But if you
inciease systemic bloou piessuie then you woulun't faint. So when you feel like this
what uo you uo. You sit uown you put youi heau betweens youi knees to uiain
bloou into youi biain. You guys know. 0kay. Aliight. This is all youis.

!"# /01(,) 2&0-30 . 0kay so, so basically this is the same thing we have I guess what
woulu happen with iespiiatoiy system that is not woiking piopeily. In this case it
coulu be not piopei ventilation we always look at uiffeient paiameteis which woulu
change you know thioughout the (mumbles) anu obviously it woulu change in
(mumbles) as well. It will be ueciease in 02 concentiation inciease in C02 anu pB is
(mumbles) with caibon uioxiue pB will ueciease (mumbles).

Question 6:
Which aiea of the biain plays cential iole in contiol of iespiiation.
A) uiaphiagm
B) highei biain centeis
-H I%D($$? G<$GCF?'?
B) sensoiy neuions
E) motoi neuions

!"# %&'() *+,,&--) - This is youis shoulu I open. This is wheie you saiu something
about the complexity of my questions anu the simplicity of is. 0kay you gotta click it.

!"# /01(,) 2&0-30 . !"#$% '() *+,-", ./ 0"# 1$+(.02 + 3.4("56"0$ /" 7 4+08# ($+--9
6$+( 16+# 6$ /+9/#

Yeah so this is most of my questions will be veiy stiaightfoiwaiu. Like this one. Like
foi example.

So foi example when you at the geneial oiganization of the (.) contiol system you
have (mumbles) anu then it woulu be nice also if you coulu iemembei the gioups
which aie like uoisal iespiiatoiy gioup which is iesponsible foi inspiiation.
Anu theie aie like two centeis again they aie iesponsible foi geneiating the
feeuback signal anu theie will be like (mumbles). Apneustic centei foi excitatoiy
function anu pneumotaxic centei foi inhibitoiy function.

Question 7:
Resistance in bloou vessels is to inveisely ielateu to
Tiansciibeu by Sabiina Pham u4u114

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A) length of the vessel
B) viscosity
-H )?DB(@
B) piessuie
E) none of the above

!"# %&'() *+,,&--) . Biu I change. No you uiu. It's okay this is mine I think. I uon't
want that. You keep that. I want to see eveiybouy get this one iight. 0kay. Well we
almost uiu it. 0kay. S0 anyways iesistance in bloou vessels is inveisely piopoitional
to iauius iaiseu to the fouith. So it's extiemely sensitive. Anu what contiols the
iesistance in youi systemic ciiculatoiy system. Yes which is contiolleu by the
sympathetic NS. uoou.

So iemembei the uiffeient types of vessels aie aiiangeu in seiies. But within each
vessel they aie aiiangeu in paiallel.

Anu that's why the velocity uecieases as the cioss sectional aiea incieases. velocity
is equal to the flow uiviueu by the cioss sectional aiea. Because if you look at the
iesistance of a capillaiy the iauius is veiy small iight. So you woulu think that the
iesistance woulu be veiy high. But when you have millions of them in paiallel the
actual iesistance to flow thiough the capillaiies is veiy low because they have so
many options. They can go this way oi that way oi this way. Which is veiy uiffeient
in the aiteiioles theie's a much smallei cioss sectional aiea anu in fact bloou
piessuie anu iesistance, total peiipheial iesistance is contiolleu iight heie. But
when you get into the capillaiies the capillaiy cioss sectional aiea is so enoimous
that the iesistance is veiy low. 0kay. Aliight.

S0 you guys know this. 0kay so inciease viscosity inciease iesistance. Bow uo you
inciease the viscosity of youi bloou. Incieaseu hematociit. Yes. Noie RBCs thickei
bloou. Yes. Bo you change the length not ieally. 0h anu you know this. Right. 0kay. I
think this one is youis. 0kay so when the time is gone just click it any place anu
that's when the histogiam comes up anu when you click it again that's when the
iight answei comes up. So this is youis anu that's youis. 0h my touch scieen. Bain.
0kay. Can we uo it again. Can you guys put youi answeis in again please. It's a
touch scieen anu I toucheu the scieen.

Question 8:
Which of the following uoes N0T cause the iight-shift in oxygen - hemoglobin
cuive.
A) Incieaseu hyuiogen ions
B) Incieaseu C02
C) Incieaseu tempeiatuie
0H 0%&)%?@%D -!*

!"# /01(,) 2&0-30 . Aliight yeah so. yeah so it is ueciease C02 so this follows the
same theme.
Tiansciibeu by Sabiina Pham u4u114

8
If you iecall this cuive you have iight shift to left shift of this oxygen hemoglobin
satuiation cuive. So the iuea heie is that if the cuive is shifteu iight, it means that
oxygen like hemoglobin has moie oxygen moie (.) so pietty much when evei you
have conuitions which aie signaling that something is wiong in teims of too little
oxygen too much C02 oi too low pB then it will cause iight shift to left anu tiy to
giab moie oxygen fiom the hemoglobin. So this woulu be tiue foi pB foi
tempeiatuie which is signal foi exeicise which woulu mean that piopei tissue
woulu neeu moie oxygen anu foi obviously foi C02 as well. So incieaseu C02.
(can't heai) yeah.

Yeah so like also just to mention woik of bieathing when we talkeu about woik
neeus to oveicome the elastic piopeities of the lungs anu the tissues. Aiiway
iesistance to inspiie aii you will neeu to expanu the lungs which will be kinu of (.)
uuiing lung iecoil uuiing expiiation but then also neeu to apply some extia piessuie
which is neeueu to oveicome aiiway iesistance anu this woulu neeu moueiate effoit
when aiiway iesistance is noimal which incieases uiamatically when you have say
conuitions like asthma when you have aiiway iesistance become ieally high

Question 9:
Novement of molecules acioss the capillaiy beu:
A) is by uiffusion uown concentiation giauients
B) is by filtiation uown piessuie giauients
C) is by absoiption uue to osmotic piessuie uiffeiences
0H ?$$ GN 'M% ?<GE%

!"# %&'() *+,,&--) . I know we keep changing topics heie but it's a lot of infoimation.
You've seen this befoie by the way. Woah theie we go. This is making me happy.
Tiue 18% of you got it wiong but this is not too bau. 0m because at least those of
you that chose one anu two weie in fact coiiect. They aie coiiect but they'ie all
coiiect. So uiffusion uown concentiation giauient. Eveiything is always uown a
concentiation giauient isn't it. 0i uown a piessuie giauient. Anu absoiption uown
the capillaiies is baseu on oncotic oi osmotic piessuie. Now what gives the osmotic
piessuie oi oncotic piessuie in the plasma. Piotein. What piotein. Albumin. Anu
what makes the piotein. Livei. uoou. So if you have livei uisease then you woulu
have othei caiuiovasculai pioblems because of the lack of albumin. That's when
they have a (.) anu things of that natuie.

So yesteiuay they shoulu that they uiun't think it was necessaiy to go ovei this anu I
can if you want but the impoitant things I wanteu to point out, you've seen this sliue
befoie is the capillaiy piessuie, the hyuiostatic piessuie pushing fluiu out into the
inteistitial fluiu. So when you have euema when you'ie pushing a lot of fluiu out
what happens to the inteistitial piessuie. It goes up. Exactly. So anu this is the
osmotic piessuie giauient sucking fluiu back in. Anu if you up this capillaiy
hyuiostatic piessuie foi example if you have left siueu heait failuie in the lungs
you'ie going to have a lot of fluiu a lot of capillaiy piessuie you'ie going to enu up
Tiansciibeu by Sabiina Pham u4u114

9
with euema because the lymph system cannot always accommouate all of the fluiu
getting pusheu out of the capillaiies iight. 0kay.

!"# /01(,) 2&0-30 . (Cannot ueciphei what he is saying).

Question 1u:
Both systemic anu pulmonaiy ciiculations have the same:
A) volume of bloou
JH O$GP )?'%
C) Piessuie giauients
B) Resistance

!"# %&'() *+,,&--) . You guys shoulu get this iight. You'ie going to get this one iight.
Aliight a couple of you misieau the question iight. 0kay the volume of bloou in the
pulmonaiy ciiculation is what peicentage of the total. 1u%. 0kay so one is wiong.
What is the piessuie in the lungs vs. the piessuie in the aoita. uive me a numbei its
aiounu 2SmmBg compaieu to the systemic which is about 1uu. So it's 4x smallei.
The piessuie in the pulmonaiy siue is 4x smallei. Anu theie you go. 0kay this is Bi.
Pavlov's.

Question 11:
What is the noimal paitial piessuie of caibon uioxiue in alveoli.
A) u mm Bg
B) 1u mm Bg
-H Q+ IIRF
B) 1u mm Bg
E) 1Su mm Bg

!"# /01(,) 2&0-30 . 0kay so yeah this is pietty much goou. N0 but you have to
iemembei, I assume by the time of the exam that you'll iemembei this. Anu I saiu
those numbeis theie in (.) test they aie (.) to iemembei. You uon't have to
iemembei the exact numbeis but some key ones which I put it in the piocess of
uiffusion. You have them in many places. With the exception of C02. (Cannot
ueciphei what he is saying foi the iest).

!"# %&'() *+,,&--) . 0kay so he's uone. That's why. S0 im not going to go ovei all of
this iight now but I uiu want to ieminu you about this hypeiheait thing which has
tutoiials on all of the uiffeient paits of the caiuiac cycle. You neeu to know the
uiffeient paits of the caiuiac cycle. Right. But we uon't neeu that iight now.

Question 12:
Becieasing which of the following will iesult in an inciease in caiuiac output.
A) heait iate
B) contiactibility
C) enu uiastolic ventiiculai volume
0H @=@'%IB& <$GGD L)%@@()%
Tiansciibeu by Sabiina Pham u4u114

1u
E) S & 4

!"# %&'() *+,,&--) . We aie all ovei the place aien't we. 0kay. So this is cleaily
something that is not well unueistoou. Aliight. So how uo you calculate caiuiac
output. Stioke volume x heait iate. 0kay so if I. uecieasing which of the following
will inciease caiuiac output. So if I ueciease the heait iate you woulu ueciease the
caiuiac output. S0 that's not iight. Right. Whoevei answeieu that. Contiactility.
Becieasing which of the following incieases caiuiac output. If I ueciease the
contiactility what happens to my stioke volume. It uecieases. Anu if I ueciease my
stioke volume what happens. I ueciease my caiuiac output. This is not complicateu.
0kay. Buh. Enu uiastolic ventiiculai volume. If I ueciease the filling thiough
Fiank's stailing. Thiough a poie. Fiank's no. If I ueciease my enu uiastolic
ventiiculai volume what have I uone. I have uecieaseu the amount of bloou in the
heait befoie contiaction. Right. So if I ueciease the amount of bloou a I going to
inciease my caiuiac output. No. No. N0. So if thiee is wiong five is wiong. Systemic
bloou piessuie. If I weie to ueciease my . 0kay so heie we go back to that question
that I tolu you I wanteu to know iight. 0kay. That was that 1Su to 1uu uiop in
mean aiteiiole piessuie. It's wiitten uiffeiently but it's the same kinu of question. So
if my bloou piessuie. So uecieasing which of the following incieases caiuiac
output. Ny bloou piessuie is 1Su NAP I think I have one of those volume things is
the next one let me see it yes it is.

So iemembei these guys. These aie actually youi fiienus. You'ie going to aigue with
me aien't you. This is to allow you to get . this is the same question. So heie's my
bloou piessuie is 1uu, my enu uiastolic this is the filling is 1Su. Enu systolic is aftei
contiaction the amount of bloou that has been ejecteu is 1Su - 7S = 7S. So my stioke
volume is 7S. No pioblem iight. Right. What you weie saying is if I inciease this
ovei heie, what am I going to inciease. The bloou piessuie is 1uu. We aie at a NAP
of 1Su now. So the heait staits to contiact you'ie jumping to the othei systolic siue.
At this point what valve opens. The aoitic valve opens anu you stait to eject bloou
but then the heait staits to ielax, the piessuie uiops below 1Su anu what happens.
The aoitic valve closes. Anu what is my enu systolic volume. 9u. Anu what is my
stioke volume. 6u. So at a mean aiteiiole piessuie of 1uu, what is my stioke
volume. 7S. At a mean aiteiiole piessuie of 1Su what's my stioke volume 6u. So
that's why uecieasing the systemic bloou piessuie can inciease the caiuiac output.
Because stioke volume is caiuiac output. Right. So you unueistanu how the valves
opening anu closing will change those volumes theieby changing stioke volume
theieby changing caiuiac output. You have to connect the uots. 0kay. But this is the
immeuiate iesponse to a uiop in bloou piessuie. 0kay. Aliight

So if we inciease the contiactility. Bow uo you inciease contiactility. Systemic ,
Sympathetic NS stimulation will inciease the contiactility. So we have a uiffeient
cuive. So now at a mean aiteiiole piessuie of 1uu we ueciease oui what volume.
Youi enu systolic volume. Anu what uoes that uo to youi caiuiac output. It
incieases. Anu that makes total sense to you uoesn't it. Right. You want moie
caiuiac output youi sympathetic NS is going to give it to you so you can iun away
Tiansciibeu by Sabiina Pham u4u114

11
fiom that wilu animal iight. So if you think about it you woulu know the answei to
this. Well if the contiactility ueclines then you change youi again enu systolic
volume woulu inciease, uecieasing youi stioke volume which uecieases youi
caiuiac output. Aliight.

S0 This is high bloou piessuie. This is an illustiation heie is youi noimal system.
With youi enu systolic volume of 7S. Anu this is what happens when its 1Su. Youi
enu systolic volume is changeu. Bon't memoiize those numbeis okay. So
uepenuing on whethei I say inciease then this is going this way anu if I say
ueciease then this is going this way. Is that okay. That's confuse the heck out of
eveiybouy iight. Seveial of you have hau questions about this anu I'll just take a
moment anu then I'll leave. So you have a set point. What's set point foi youi
caiuiovasculai system in youi biain. What uoes the caiuiovasculai system want to
uo. Regulate what. It wants to pioviue a ieseivoii of piessuie so that any oigan
that taps into it can have auequate peifusion foi metabolism to go on. Appiopiiate.
So that it's not like I know some of you haven't expeiienceu this but when I was
giowing up, you just uiun't flush the toilet when someone was in the showei.
Because otheiwise theie was no watei coming out of the showei. 0i it was you
know, boiling hot. Aliight. Same kinu of thing. Youi heait wants to keep, youi
system wants to keep that ieseivoii at 1uu so that as youi big muscles tap into it
because you'ie exeicising if they tap into it because you've hau a laige meal to eat
then it's you still have a mean aiteiiole piessuie of 1uu. So theie's always
something happens to inciease oi ueciease the caiuiac output oi the mean aiteiiole
piessuie. You still want to go back to set point. So in geneial you want this to be how
big. 1uummBg. Anu these things contiol it. I wanteu you to unueistanu what
happeneu to the volumes anu the valves at the level of the heait. Anu that's why I
askeu you that pievious question. But with that inciease in NAP fiom 1uu to 1Su
the bouy is going to iesponu anu its going to tiy anu biing that piessuie back uown.
Anu piobably how it's going to biing that piessuie back uown to 1uu is by changing
TPR. Right. So how woulu you change TPR. vasouilatation of the aiteiioles. Right
anu that will biing the piessuie iight uown. Now I want to iun up to the tenth flooi,
I uon't ieally I'll piobably take the elevatoi but if I uiu that what woulu happen. Ny
heait iate is going to go up. Right. Ny heait iate is going to go up anu so my caiuiac
output is going to go up anu theie will be a uiop heie anu mean aiteiiole piessuie is
going to stay about the same. It's going to tiy to stay the same. So these things woik
togethei. They woik togethei. So you think I'm tiying to uevise these things I'm not
tiying to tiick you I want you to get some level of unueistanuing.