# Otterbein/Grant CRNA A&p Final Review - No Diagrams

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• 1.

### Fetal hgb is the main O2 transport protein until 6 months of age.  It binds to oxygen with a _______ affinity compared to adult Hgb.

• A.

Greater

• B.

Lesser

A. Greater
Explanation
Fetal hgb has a greater affinity for oxygen compared to adult Hgb. This means that fetal hgb is able to bind to oxygen more strongly, allowing it to efficiently transport oxygen to the developing fetus. As a result, fetal hgb is the main oxygen transport protein until 6 months of age, when adult Hgb takes over this role.

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• 2.

### The metabolic demands of a newborn are __ mL/kg/min, which is double that of an adult.

6
Explanation
The metabolic demands of a newborn are 6 mL/kg/min, which is double that of an adult. This means that for every kilogram of body weight, a newborn requires 6 milliliters of oxygen per minute to meet their metabolic needs. This higher metabolic demand is due to the rapid growth and development that occurs during the neonatal period.

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• 3.

### Newborns have immature contractile proteins, their cardiac output is extremely ___________ dependent.

• A.

Heart rate

• B.

Volume

A. Heart rate
Explanation

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• 4.

### The alveoli are immature until a child is 8-10 years old.  In a newborn, the ratio of alveolar surface to body surface is 1/3 of an adult's, but their minute ventilation is twice that on an adult.  This is due to their increased:

• A.

Respiratory rate

• B.

Tidal volume

A. Respiratory rate
Explanation
The correct answer is respiratory rate. In newborns, their alveoli are immature and their ratio of alveolar surface to body surface is smaller compared to adults. However, to compensate for this, newborns have a higher minute ventilation, which is the amount of air they breathe in one minute. This higher ventilation is achieved through an increased respiratory rate, meaning they take more breaths per minute. This helps them maintain adequate oxygen levels in their body despite their immature alveoli.

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• 5.

### Due to their relying on chemical thermogenesis (brown fat breakdown) instead of shivering, newborns are at a decreased risk of hypothermia intraoperatively.

• A.

True

• B.

False

B. False
Explanation
Newborns are actually at an increased risk of hypothermia intraoperatively because they rely on shivering to generate heat, as they do not have a well-developed brown fat breakdown system like adults. Therefore, the statement given in the question is incorrect.

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• 6.

### Newborns have the _______ total body water compared to weight.

• A.

Highest

• B.

Lowest

A. Highest
Explanation
Newborns have the highest total body water compared to weight because water makes up a larger proportion of their body composition. This is because newborns have a higher percentage of water in their bodies due to their underdeveloped organs and tissues. As they grow and develop, the proportion of water in their bodies decreases. Therefore, newborns have the highest total body water compared to weight.

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• 7.

### Glomerular filtration rate in a newborn is:

• A.

Decreased

• B.

Increased

• C.

A. Decreased
Explanation
Decreased ability to reabsorb Na, bicarb, glucose, aa and phosphates - obligate Na losers

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• 8.

### In a newborn, nerve myelination is incomplete so conduction is slower but the distance impulses have to travel is shorter.

• A.

True

• B.

False

A. True
Explanation
The statement is true because in newborns, the process of nerve myelination, which is the formation of a protective covering around nerve fibers, is not yet complete. This incomplete myelination leads to slower conduction of nerve impulses. However, it is also true that the distance that these impulses have to travel in a newborn is shorter compared to adults. Therefore, while the conduction is slower, the shorter distance compensates for it.

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• 9.

### Newborns are at a decreased risk of brain hemorrhage compared to adults.

• A.

True

• B.

False

B. False
Explanation
Increased

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• 10.

### The release of antidiuretic hormone is stimulate when plasma osmolarity ________, or blood volume ___________.

• A.

Increases, decreases

• B.

Increases, increases

• C.

Decreases, decreases

• D.

Decreases, increases

A. Increases, decreases
Explanation
Also stimulated by stretch receptors in LA and pulmonary veins
Normal osmolality - 285 mOsm/L

And:
Increased Na+ concentration, decreased BP, pain, stress, nausea, Angiotensin II, positive-pressure ventilation, volatile agents, and B-adrenergic stimulation

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• 11.

### Which of the following hormones have a POSITIVE feedback loop?

• A.

Oxytocin

• B.

TSH

• C.

Cortisol

• D.

ACTH

A. Oxytocin
Explanation
Oxytocin is the correct answer because it is involved in a positive feedback loop. During childbirth, oxytocin is released, which stimulates contractions. These contractions then lead to the release of more oxytocin, creating a positive feedback loop. This loop continues until the baby is delivered.

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• 12.

### Glucocorticoid secretion is controlled via a positive feedback loop with ACTH from the anterior pituitary.

• A.

True

• B.

False

B. False
Explanation
Negative feedback loop

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• 13.

### Glucocorticoids _____ glucose production while ________ inflammatory responses.

• A.

Increase, decreasing

• B.

Decrease, decreasing

• C.

Increase, increasing

• D.

Decrease, increasing

A. Increase, decreasing
Explanation
Glucocorticoids are a class of hormones that increase glucose production in the body while simultaneously decreasing inflammatory responses. This means that they promote the synthesis and release of glucose into the bloodstream, helping to raise blood sugar levels. At the same time, they suppress the immune system's inflammatory response, which can be beneficial in managing conditions such as allergies, asthma, and autoimmune diseases.

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• 14.

### Insulin has a circulatory half-life of 5-8 minutes due to the necessity to respond rapidly to changes in blood glucose levels.

• A.

True

• B.

False

A. True
Explanation
Biological half-life = 20 min

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• 15.

### Insulin decreases the uptake of K+, mag, and phos.

• A.

True

• B.

False

B. False
Explanation
Increases

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• 16.

### Over 90% of thyroid hormones released from the thyroid gland epithelial cells is T4, which is converted to the more active form, T3, at the target tissue.  It's 99% protein bound when circulating.

• A.

True

• B.

False

A. True
Explanation
The statement is true because over 90% of thyroid hormones released from the thyroid gland epithelial cells is in the form of T4. T4 is then converted to the more active form, T3, at the target tissue. Additionally, when circulating in the bloodstream, thyroid hormones are highly protein bound, with approximately 99% of them being bound to proteins.

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• 17.

### Cortisol can cause muscle wasting.

• A.

True

• B.

False

A. True
Explanation
Protein catabolism everywhere but the liver.

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• 18.

### The liver receives 50% of cardiac output.

• A.

True

• B.

False

B. False
Explanation
25%

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• 19.

### Positive pressure ventilation, hypoxemia, hypercarbia, sympathetic stimuli, CHF, fluid overload, cirrhosis and anesthesia all _________ hepatic blood flow.

• A.

Decrease

• B.

Increase

A. Decrease
Explanation
Positive pressure ventilation, hypoxemia, hypercarbia, sympathetic stimuli, CHF, fluid overload, cirrhosis, and anesthesia all contribute to a decrease in hepatic blood flow. These factors can lead to increased resistance in the hepatic vasculature, causing a reduction in blood flow to the liver. This can have implications for liver function and metabolism, as well as drug clearance and detoxification processes.

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• 20.

### With a decrease in hepatic venous pressure due to hypovolemia/hemorrhage, blood shifts from the hepatic veins and sinusoids into the central circulation - increasing the circulating blood volume by as much as 500 mL's, close to 10% of TBV.

• A.

True

• B.

False

A. True
Explanation
When there is a decrease in hepatic venous pressure caused by hypovolemia or hemorrhage, blood moves from the hepatic veins and sinusoids into the central circulation. This results in an increase in the circulating blood volume by approximately 500 mL's, which is close to 10% of the total blood volume. Therefore, the statement is true.

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• 21.

### Glucocorticoids, catecholamines, glucagon, and thyroid hormone have this effect on gluconeogenesis, the opposite of insulin's effect on the process.

• A.

Enhance

• B.

Inhibit

A. Enhance
Explanation
Glucocorticoids, catecholamines, glucagon, and thyroid hormone enhance gluconeogenesis, which is the process of synthesizing glucose from non-carbohydrate sources. This is in contrast to insulin, which inhibits gluconeogenesis. These hormones stimulate the production of enzymes involved in gluconeogenesis and promote the breakdown of glycogen and fats to provide substrates for glucose synthesis. As a result, they increase the rate of gluconeogenesis and help maintain blood glucose levels during periods of fasting or stress.

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• 22.

### The SNS stimulation caused by surgical stress stimulates:

• A.

Glycogenolysis

• B.

Gluconeogenesis

• C.

Insulin

A. Glycogenolysis
Explanation
Surgical stress triggers the release of stress hormones such as epinephrine and cortisol, which activate the sympathetic nervous system (SNS). Activation of the SNS leads to an increase in glycogenolysis, the breakdown of glycogen into glucose. This process provides a quick source of energy during times of stress. Gluconeogenesis, the synthesis of glucose from non-carbohydrate sources, may also be stimulated to maintain blood glucose levels. However, the release of insulin, which promotes glucose uptake by cells, is unlikely during surgical stress as it opposes the actions of stress hormones.

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• 23.

### Gastric barrier pressure is calculated as lower esophageal sphincter pressure minus intragastric pressure.

• A.

True

• B.

False

A. True
Explanation
Do not want to lower LES or raise intragastric pressure.
Cricoid pressure LOWERS LES pressure.

LES normally 10-30
Intragastric normally 5-10

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• 24.

### Secretion of hydrochloric acid in the stomach depends on stimulation of receptors in the membrane of the parietal cells.  Histamine, acetylcholine, vagal stimulation, and gastrin all _______ the secretion of hydrochloric acid.

• A.

Increase

• B.

Decrease

A. Increase
Explanation
The secretion of hydrochloric acid in the stomach is stimulated by histamine, acetylcholine, vagal stimulation, and gastrin. These substances increase the secretion of hydrochloric acid, leading to higher levels of acid in the stomach.

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• 25.

### The ____________ is the functional unit of the kidney.

nephron
Explanation
The nephron is the functional unit of the kidney. It is responsible for filtering the blood and producing urine. Each kidney contains millions of nephrons, which consist of a glomerulus, a tubule, and associated blood vessels. The glomerulus filters waste products and excess water from the blood, while the tubule reabsorbs essential nutrients and regulates the concentration of urine. The nephron plays a crucial role in maintaining the body's fluid balance and removing waste products from the bloodstream.

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• 26.

### The acinus or hepatic lobule is the functional unit of the _____.

liver
Explanation
The acinus or hepatic lobule is the functional unit of the liver. This means that it is the smallest structure within the liver that performs all of the essential functions of the organ. The acinus is responsible for processes such as detoxification, metabolism, and the production of bile. It is made up of hepatocytes, which are the main functional cells of the liver. These cells work together to carry out the various tasks required for the liver to maintain its normal function and support overall health.

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• 27.

### The right and left lobes of the liver are divided by the falciform ligament.

• A.

True

• B.

False

A. True
Explanation
• Left lobe segments II , III & IV
• Right lobe segments V,VI,VII & VIII
• Caudate lobe

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• 28.

### Opioids, beta agonists, tricyclic antidepressants, aluminum hydroxide antacids, alcohol, and smoking all _________ gastric emptying.

• A.

Slow

• B.

Hasten

A. Slow
Explanation
TPN causes total gastric stasis.

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• 29.

### The average lifespan of a RBC is ___ days.

120
Explanation
The average lifespan of a red blood cell (RBC) is 120 days. This means that, on average, a red blood cell will live for approximately 120 days before it is removed from circulation and replaced by a new one. This lifespan is important for maintaining a healthy blood supply and ensuring that oxygen and nutrients are efficiently transported throughout the body.

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• 30.

### ________ are formed in the megakaryocytes, a normal count is 150-300,000/mm3, and they have a lifespan of 8-12 days.

Platelets
Explanation
Platelets are small, disc-shaped cell fragments that are formed in the bone marrow by megakaryocytes. They play a crucial role in blood clotting and hemostasis. A normal platelet count ranges from 150-300,000/mm3. Platelets have a relatively short lifespan of 8-12 days before they are removed from circulation.

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• 31.

### The liver is responsible for synthesizing all clotting factors except vWF, tissue factor, and calcium.

• A.

True

• B.

False

A. True
Explanation
The liver is indeed responsible for synthesizing most of the clotting factors in the body. Clotting factors are proteins that play a crucial role in the formation of blood clots to stop bleeding. However, vWF (von Willebrand factor), tissue factor, and calcium are not synthesized in the liver. vWF is produced by endothelial cells and megakaryocytes, tissue factor is released by cells at the site of injury, and calcium is obtained from the diet and is not synthesized by any specific organ. Therefore, the statement is true.

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• 32.

### Autologous transfusions subjects patients to perioperative anemia and increased likelihood of requiring a transfusion.

• A.

True

• B.

False

A. True
Explanation
Autologous transfusions, which involve using a patient's own blood during surgery, can lead to perioperative anemia and an increased chance of needing a transfusion. This is because the process of collecting and reinfusing the blood can result in a decrease in the patient's overall blood volume, leading to anemia. Additionally, there may be unforeseen circumstances during the surgery that require additional blood transfusions. Therefore, it is true that autologous transfusions can subject patients to perioperative anemia and an increased likelihood of requiring a transfusion.

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• Mar 20, 2023
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