Hemodynamics

Hemodynamics US Medical PG Question 1: A peripheral artery is found to have 50% stenosis (50% reduction in cross-sectional area). Therefore, compared to a normal artery with no stenosis, by what factor has the flow of blood been decreased?

• A. 8
• B. 2
• C. 32
• D. 16
• E. 4 (Correct Answer)

Hemodynamics Explanation: ***4*** - According to **Poiseuille's Law**, blood flow is proportional to the fourth power of the radius (Flow ∝ r⁴). - If the cross-sectional area is reduced by 50%, the new area is 0.5 times the original. Since Area = πr², we have: πr_new² = 0.5πr_original², which gives r_new = √0.5 × r_original ≈ 0.707 × r_original. - The new flow becomes: Flow_new ∝ (0.707r)⁴ = (0.707)⁴ × r⁴ = 0.25 × r⁴. - Therefore, the flow is reduced to **1/4 of the original**, meaning it has decreased by a factor of **4**. *8* - This would only be correct if flow were proportional to r³ (the cube of radius), which does not apply to laminar blood flow. - Poiseuille's Law establishes a **fourth-power relationship** between radius and flow, not a cubic relationship. *2* - A factor of 2 would imply either a linear relationship between flow and radius, or only a minimal stenosis (~16% area reduction). - This significantly **underestimates** the impact of a 50% area reduction on blood flow through the vessel. *32* - This represents an excessive reduction that would only occur if flow were proportional to r⁵ or higher. - With 50% area stenosis and the r⁴ relationship, the mathematical result is a factor of **4**, not 32. *16* - This would be the correct answer if "50% stenosis" referred to a **50% reduction in diameter** (radius) rather than area. - With 50% diameter reduction: r_new = 0.5r, so Flow_new ∝ (0.5r)⁴ = 0.0625r⁴, giving a decrease by factor of 16. - However, the question specifies **area reduction**, making this option incorrect.

Hemodynamics US Medical PG Question 2: A 28-year-old research assistant is brought to the emergency department for severe chemical burns 30 minutes after accidentally spilling hydrochloric acid on himself. The burns cover both hands and forearms. His temperature is 37°C (98.6°F), pulse is 112/min, respirations are 20/min, and blood pressure is 108/82 mm Hg. Initial stabilization and resuscitation is begun, including respiratory support, fluid resuscitation, and cardiovascular stabilization. The burned skin is irrigated with saline water to remove the chemical agent. Which of the following is the most appropriate method to verify adequate fluid infusion in this patient?

• A. The Parkland formula
• B. Blood pressure
• C. Pulmonary capillary wedge pressure
• D. Heart rate
• E. Urinary output (Correct Answer)

Hemodynamics Explanation: ***Urinary output*** - Maintaining a specific **urinary output** (e.g., adult with major burns: 0.5-1.0 mL/kg/hr or 30-50 mL/hr) is the most reliable clinical indicator of adequate fluid resuscitation in burn patients. - This ensures sufficient end-organ perfusion and avoids both under-resuscitation (leading to shock and organ damage) and over-resuscitation (risk of compartment syndrome and pulmonary edema). *The Parkland formula* - The **Parkland formula** is used to *calculate* the initial fluid volume needed, but it does not *verify* the adequacy of the infusion once started. - This formula provides a starting point for fluid administration, which then needs to be adjusted based on the patient's response. *Blood pressure* - **Blood pressure** can be misleading in burn patients; it may remain deceptively normal due to compensatory mechanisms even with significant fluid deficits. - It is a late indicator of hypovolemic shock, and relying solely on it can lead to under-resuscitation. *Pulmonary capillary wedge pressure* - **Pulmonary capillary wedge pressure (PCWP)** requires invasive monitoring via a pulmonary artery catheter, which is rarely indicated for routine fluid management in burn patients due to its invasiveness and associated risks. - Less invasive and equally effective methods, like urinary output, are preferred for monitoring resuscitation. *Heart rate* - **Heart rate** is a sensitive but non-specific indicator of fluid status; it can be elevated due to pain, anxiety, or infection, not solely hypovolemia. - While a decreasing heart rate can indicate improved fluid status, it is not as reliable or direct an indicator of end-organ perfusion as urinary output.

Hemodynamics US Medical PG Question 3: What is the primary mechanism for maintaining constant cerebral blood flow despite changes in systemic blood pressure?

• A. Endothelial factors
• B. Baroreceptor reflex
• C. Myogenic autoregulation (Correct Answer)
• D. Metabolic control

Hemodynamics Explanation: ***Myogenic autoregulation*** - **Myogenic autoregulation** is the intrinsic ability of vascular smooth muscle to contract when stretched by increased blood pressure, thereby maintaining a constant cerebral blood flow. - This mechanism operates within a specific range of mean arterial pressures (typically **60-150 mmHg**) to prevent both hypoperfusion and hyperperfusion of the brain. *Endothelial factors* - Endothelial cells release various vasoactive substances like **nitric oxide** and **endothelin**, which influence vascular tone. - While important for local blood flow regulation, these factors play a secondary role to myogenic autoregulation in maintaining constant cerebral blood flow against systemic pressure changes. *Baroreceptor reflex* - The **baroreceptor reflex** primarily controls systemic blood pressure by regulating heart rate and peripheral vascular resistance. - It does not directly regulate cerebral blood flow stability in response to systemic pressure changes; its main role is to stabilize the overall systemic arterial pressure. *Metabolic control* - **Metabolic control** regulates cerebral blood flow in response to the brain's metabolic demands, primarily by sensing local concentrations of **CO2**, **pH**, and **oxygen**. - While essential for matching blood supply to neuronal activity, it is not the primary mechanism for maintaining cerebral blood flow despite changes in systemic blood pressure.

Hemodynamics US Medical PG Question 4: A 34-year-old male is brought to the emergency department by fire and rescue following a motor vehicle accident in which the patient was an unrestrained driver. The paramedics report that the patient was struck from behind by a drunk driver. He was mentating well at the scene but complained of pain in his abdomen. The patient has no known past medical history. In the trauma bay, his temperature is 98.9°F (37.2°C), blood pressure is 86/51 mmHg, pulse is 138/min, and respirations are 18/min. The patient is somnolent but arousable to voice and pain. His lungs are clear to auscultation bilaterally. He is diffusely tender to palpation on abdominal exam with bruising over the left upper abdomen. His distal pulses are thready, and capillary refill is delayed bilaterally. Two large-bore peripheral intravenous lines are placed to bolus him with intravenous 0.9% saline. Chest radiograph shows multiple left lower rib fractures. Which of the following parameters is most likely to be seen in this patient?

• A. Increased cardiac output
• B. Increased mixed venous oxygen saturation
• C. Decreased pulmonary capillary wedge pressure (Correct Answer)
• D. Decreased systemic vascular resistance
• E. Increased right atrial pressure

Hemodynamics Explanation: ***Decreased pulmonary capillary wedge pressure*** - The patient presents with classic signs of **hemorrhagic shock** (hypotension, tachycardia, somnolence, abdominal bruising, thready pulses) due to trauma, likely involving the spleen or kidney given the left upper abdominal bruising and rib fractures. - **Decreased pulmonary capillary wedge pressure (PCWP)** is expected in hypovolemic shock because it reflects left atrial and left ventricular end-diastolic pressure, which will be low due to reduced venous return and intravascular volume. *Increased cardiac output* - In **hemorrhagic shock**, the body attempts to compensate by increasing heart rate, but overall **cardiac output is typically decreased** due to profound reduction in preload (venous return) from blood loss. - While heart rate is elevated, the stroke volume is severely diminished, leading to a net decrease in cardiac output despite compensatory efforts. *Increased mixed venous oxygen saturation* - **Mixed venous oxygen saturation (SvO2)** is generally **decreased in hemorrhagic shock** due to increased oxygen extraction by tissues. - Inadequate oxygen delivery to the tissues forces them to extract more oxygen from the blood, leading to a lower SvO2. *Decreased systemic vascular resistance* - In **hemorrhagic shock**, the body activates compensatory mechanisms, including generalized **vasoconstriction**, to maintain blood pressure and prioritize blood flow to vital organs. - This leads to an **increased systemic vascular resistance (SVR)**, not decreased, as reflected by the thready distal pulses and delayed capillary refill. *Increased right atrial pressure* - **Right atrial pressure (RAP)**, representing CVP, is typically **decreased in hemorrhagic shock** due to reduced circulating blood volume. - A lower RAP indicates decreased venous return to the heart, a hallmark of hypovolemia.

Hemodynamics US Medical PG Question 5: A 71-year-old man is admitted to the hospital one hour after he was found unconscious. His pulse is 80/min and systolic blood pressure is 98 mm Hg; diastolic blood pressure cannot be measured. He is intubated and mechanically ventilated with supplemental oxygen at a tidal volume of 450 mL and a respiratory rate of 10/min. Arterial blood gas analysis shows: PCO2 43 mm Hg O2 saturation 94% O2 content 169 mL/L Pulmonary artery catheterization shows a pulmonary artery pressure of 15 mm Hg and a pulmonary capillary wedge pressure of 7 mm Hg. Bedside indirect calorimetry shows a rate of O2 tissue consumption of 325 mL/min. Given this information, which of the following additional values is sufficient to calculate the cardiac output in this patient?

• A. Left ventricular end-diastolic volume
• B. Partial pressure of inspired oxygen
• C. End-tidal carbon dioxide pressure
• D. Pulmonary artery oxygen content (Correct Answer)
• E. Total peripheral resistance

Hemodynamics Explanation: ***Pulmonary artery oxygen content*** - Cardiac output can be calculated using the **Fick principle**, which states that **Cardiac Output = (Oxygen Consumption) / (Arteriovenous Oxygen Difference)**. - We are provided with **O2 tissue consumption (325 mL/min)** and **arterial O2 content (169 mL/L)**. To complete the Fick equation, we need the **mixed venous oxygen content**, which is represented by the **pulmonary artery oxygen content**. *Left ventricular end-diastolic volume* - While **left ventricular end-diastolic volume** is a determinant of stroke volume (and thus cardiac output), it alone is not sufficient to calculate cardiac output without knowing heart rate and ejection fraction. - This value is more relevant for assessing **preload** and ventricular function. *Partial pressure of inspired oxygen* - The **partial pressure of inspired oxygen** is used to calculate the **alveolar oxygen partial pressure** and is important for assessing oxygenation and respiratory function. - It is not directly used in the Fick principle for calculating cardiac output. *End-tidal carbon dioxide pressure* - **End-tidal carbon dioxide (ETCO2)** is a measure of the partial pressure of CO2 at the end of exhalation and reflects ventilation and pulmonary perfusion. - While it can be correlated with cardiac output in certain clinical contexts, it is not a direct input for the **Fick principle** calculation of cardiac output. *Total peripheral resistance* - **Total peripheral resistance (TPR)** can be calculated from cardiac output and mean arterial pressure using the formula: **(MAP - CVP) / CO**, but it cannot be used to calculate cardiac output directly without knowing the other variables. - TPR is a measure of the **resistance to blood flow** in the systemic circulation.

Hemodynamics US Medical PG Question 6: A 29-year-old man is brought to the emergency room 6 hours after the onset of severe epigastric pain and vomiting. His heart rate is 110/min and blood pressure is 98/72 mm Hg. He is diagnosed with acute pancreatitis, and fluid resuscitation with normal saline is initiated. Which of the following is the most likely immediate effect of fluid resuscitation in this patient?

• A. Increase in plasma oncotic pressure
• B. Increase in glomerular filtration fraction
• C. Increase in volume of distribution
• D. Increase in cardiac afterload
• E. Increase in myocardial oxygen demand (Correct Answer)

Hemodynamics Explanation: ***Increase in myocardial oxygen demand*** - Fluid resuscitation in a hypotensive patient with tachycardia increases **cardiac preload** and **stroke volume**, leading to higher cardiac output. - This increased workload on the heart, especially when the patient is already tachycardic, directly translates to an **increased demand for oxygen** by the myocardium. *Increase in plasma oncotic pressure* - Fluid resuscitation with **normal saline** (crystalloid solution) primarily increases intravascular volume but does not significantly increase plasma proteins, which are responsible for oncotic pressure. - In fact, large volumes of crystalloids can sometimes **slightly decrease oncotic pressure** due to hemodilution. *Increase in glomerular filtration fraction* - Fluid resuscitation improves **renal perfusion** and **glomerular filtration rate (GFR)** by restoring blood pressure and intravascular volume. - However, the glomerular filtration fraction, which is the ratio of GFR to renal plasma flow, does not necessarily increase; it might even decrease as renal plasma flow improves. *Increase in volume of distribution* - Volume of distribution refers to the apparent volume into which a drug distributes in the body. Fluid resuscitation **increases the intravascular fluid volume**, which is part of the total body water, but this is a change in actual volume, not a change in a pharmacokinetic parameter for drug distribution. - It would more accurately be described as increasing the **effective circulating volume**, not the **volume of distribution** in a pharmacological sense. *Increase in cardiac afterload* - Cardiac afterload refers to the resistance the heart must overcome to eject blood. While fluid resuscitation increases **intravascular volume**, it primarily affects **preload**. - Although indirectly, by improving cardiac output and maintaining blood pressure, there might be a slight increase in afterload, an **increase in myocardial oxygen demand** is a more direct and immediate consequence of the increased workload.

Hemodynamics US Medical PG Question 7: A 27-year-old man is running on the treadmill at his gym. His blood pressure prior to beginning his workout was 110/72. Which of the following changes in his cardiovascular system may be seen in this man now that he is exercising?

• A. Decreased blood pressure
• B. Decreased systemic vascular resistance (Correct Answer)
• C. Increased systemic vascular resistance
• D. Decreased stroke volume
• E. Decreased heart rate

Hemodynamics Explanation: ***Decreased systemic vascular resistance*** - During dynamic exercise, metabolic vasodilation in exercising muscles leads to a substantial **decrease in systemic vascular resistance (SVR)** to accommodate increased blood flow. - This vasodilation overrides the systemic vasoconstriction driven by the sympathetic nervous system, resulting in a net decrease in overall SVR. *Decreased blood pressure* - While SVR decreases, **systolic blood pressure typically increases** during exercise due to increased cardiac output. - **Diastolic blood pressure** usually remains stable or may slightly decrease, but overall blood pressure, specifically the mean arterial pressure, is generally maintained or elevated. *Increased systemic vascular resistance* - This is incorrect as **vasodilation in active muscles** causes a significant decrease in overall systemic vascular resistance. - An increase in SVR would typically hinder blood flow to working muscles and is not a characteristic cardiovascular response to dynamic exercise. *Decreased stroke volume* - Stroke volume generally **increases significantly** during exercise due to enhanced venous return, increased contractility, and reduced afterload (from decreased SVR). - A decreased stroke volume would limit cardiac output and exercise performance. *Decreased heart rate* - Heart rate **increases proportionally with exercise intensity** to boost cardiac output and oxygen delivery to active muscles. - A decreased heart rate would counteract the body's physiological demand for increased blood flow during physical activity.

Hemodynamics US Medical PG Question 8: A 27-year-old man is brought to the emergency department by emergency medical services. The patient was an unrestrained passenger in a head-on collision that occurred 15 minutes ago and is currently unresponsive. His temperature is 99.5°F (37.5°C), blood pressure is 60/33 mmHg, pulse is 180/min, respirations are 17/min, and oxygen saturation is 95% on room air. A FAST exam demonstrates fluid in Morrison’s pouch. Laboratory values are drawn upon presentation to the ED and sent off. The patient is started on IV fluids and an initial trauma survey is started. Twenty minutes later, his blood pressure is 95/65 mmHg, and his pulse is 110/min. The patient is further stabilized and is scheduled for emergency surgery. Which of the following best represents this patient’s most likely initial laboratory values?

• A. Hemoglobin: 10 g/dL, Hematocrit: 30%, MCV: 110 µm^3
• B. Hemoglobin: 19 g/dL, Hematocrit: 55%, MCV: 95 µm^3
• C. Hemoglobin: 7 g/dL, Hematocrit: 21%, MCV: 75 µm^3
• D. Hemoglobin: 11 g/dL, Hematocrit: 33%, MCV: 88 µm^3 (Correct Answer)
• E. Hemoglobin: 15 g/dL, Hematocrit: 45%, MCV: 90 µm^3

Hemodynamics Explanation: ***Hemoglobin: 11 g/dL, Hematocrit: 33%, MCV: 88 µm^3*** - The patient experienced significant trauma and is experiencing **hemorrhagic shock**, as evidenced by his initial **hypotension** (BP 60/33 mmHg), **tachycardia** (pulse 180/min), and positive **FAST exam** for fluid in Morrison's pouch, indicating intra-abdominal bleeding. - The initial hemoglobin and hematocrit could be mildly decreased due to acute blood loss, but significant drops are often *not immediately apparent* as plasma volume has not yet moved into the intravascular compartment to dilute the remaining red blood cells. A hemoglobin of 11 g/dL and hematocrit of 33% are consistent with **acute blood loss** before significant hemodilution occurs. MCV of 88 µm^3 is within the normal range for **normocytic anemia** seen in acute hemorrhage. *Hemoglobin: 10 g/dL, Hematocrit: 30%, MCV: 110 µm^3* - While a hemoglobin of 10 g/dL and hematocrit of 30% are consistent with anemia due to blood loss, an **MCV of 110 µm^3** (macrocytic) is not typically seen in acute hemorrhage. - Macrocytic anemia usually results from conditions like **B12 or folate deficiency**, alcoholism, or liver disease, which are not suggested by the acute traumatic scenario. *Hemoglobin: 19 g/dL, Hematocrit: 55%, MCV: 95 µm^3* - This indicates **polycythemia** (abnormally high red blood cell count), which is the opposite of what would be expected in a patient experiencing acute hemorrhagic shock. - These values would suggest conditions like **polycythemia vera** or severe dehydration, which are not relevant in this acute trauma setting. *Hemoglobin: 7 g/dL, Hematocrit: 21%, MCV: 75 µm^3* - While a hemoglobin of 7 g/dL and hematocrit of 21% represent significant anemia consistent with major blood loss, these values are typically seen *later* as **hemodilution** occurs, or in cases of chronic blood loss. - An **MCV of 75 µm^3** (microcytic) is generally indicative of **iron deficiency anemia** or thalassemia, which develops over time and is not characteristic of acute traumatic blood loss. *Hemoglobin: 15 g/dL, Hematocrit: 45%, MCV: 90 µm^3* - These values are within the **normal range** for hemoglobin and hematocrit, which would not be expected in a patient presenting with signs of **hemorrhagic shock** and a positive FAST exam indicating significant internal bleeding. - This would suggest either very minor blood loss or that the values were taken before any bleeding had occurred or before hemodilution had a chance to manifest.

Hemodynamics US Medical PG Question 9: An 83-year-old male presents with dyspnea, orthopnea, and a chest radiograph demonstrating pulmonary edema. A diagnosis of congestive heart failure is considered. The following clinical measurements are obtained: 100 bpm heart rate, 0.2 mL O2/mL systemic blood arterial oxygen content, 0.1 mL O2/mL pulmonary arterial oxygen content, and 400 mL O2/min oxygen consumption. Using the above information, which of the following values represents this patient's cardiac stroke volume?

• A. 30 mL/beat
• B. 70 mL/beat
• C. 40 mL/beat (Correct Answer)
• D. 60 mL/beat
• E. 50 mL/beat

Hemodynamics Explanation: ***40 mL/beat*** - First, calculate cardiac output (CO) using the **Fick principle**: CO = Oxygen Consumption / (Arterial O2 content - Venous O2 content). Here, CO = 400 mL O2/min / (0.2 mL O2/mL - 0.1 mL O2/mL) = 400 mL O2/min / 0.1 mL O2/mL = **4000 mL/min**. - Next, calculate stroke volume (SV) using the formula: SV = CO / Heart Rate. Given a heart rate of 100 bpm, SV = 4000 mL/min / 100 beats/min = **40 mL/beat**. *30 mL/beat* - This answer would result if there was an error in calculating either the **cardiac output** or if the **arteriovenous oxygen difference** was overestimated. - A stroke volume of 30 mL/beat with a heart rate of 100 bpm would yield a cardiac output of 3 L/min, which is sub-physiologic for an oxygen consumption of 400 mL/min given the provided oxygen content values. *70 mL/beat* - This stroke volume is higher than calculated and would imply either a significantly **lower heart rate** or a much **higher cardiac output** than derived from the Fick principle with the given values. - A stroke volume of 70 mL/beat at a heart rate of 100 bpm would mean a cardiac output of 7 L/min, which is inconsistent with the provided oxygen consumption and arteriovenous oxygen difference. *60 mL/beat* - This value is higher than the correct calculation, suggesting an error in the initial calculation of **cardiac output** or the **avO2 difference**. - To get 60 mL/beat, the cardiac output would need to be 6000 mL/min, which would mean an avO2 difference of 0.067 mL O2/mL, not 0.1 mL O2/mL. *50 mL/beat* - This stroke volume would result from an incorrect calculation of the **cardiac output**, potentially from a slight miscalculation of the **arteriovenous oxygen difference**. - A stroke volume of 50 mL/beat at 100 bpm would mean a cardiac output of 5 L/min, requiring an avO2 difference of 0.08 mL O2/mL, which is not consistent with the given values.

Hemodynamics US Medical PG Question 10: A 69-year-old woman is admitted to the hospital with substernal, crushing chest pain. She is emergently moved to the cardiac catheterization lab where she undergoes cardiac angiography. Angiography reveals that the diameter of her left anterior descending artery (LAD) is 50% of normal. If her blood pressure, LAD length, and blood viscosity have not changed, which of the following represents the most likely change in LAD flow from baseline?

• A. Decreased by 93.75% (Correct Answer)
• B. Increased by 6.25%
• C. Decreased by 25%
• D. Decreased by 87.5%
• E. Increased by 25%

Hemodynamics Explanation: ***Decreased by 93.75%*** - This option is correct based on Poiseuille's Law, which states that flow is proportional to the **fourth power of the radius (r^4)**. A 50% decrease in diameter means a 50% decrease in radius (0.5r). - The new flow would be (0.5)^4 = 0.0625 times the original flow. Therefore, the decrease in flow is 1 - 0.0625 = 0.9375, or **93.75%**. *Increased by 6.25%* - This answer incorrectly suggests an **increase** in flow, which is contrary to the effect of a narrowed artery. - While 6.25% represents the new flow as a percentage of baseline (since 0.0625 = 6.25%), the vessel stenosis causes a **decrease**, not an increase in flow. *Decreased by 25%* - This calculation might arise from considering a linear relationship (e.g., radius decreases by 50%, so flow decreases by 50% of 50%, which is incorrect). - It does not account for the **fourth power relationship** between radius and flow according to Poiseuille's Law. *Decreased by 87.5%* - This percentage represents a calculation error, likely from misapplying the fourth power relationship or confusing the calculation steps. - It does not accurately reflect the dramatic reduction in flow caused by a 50% reduction in vessel diameter. *Increased by 25%* - This option implies a significant increase in blood flow, which would not happen with a **stenosed artery**. - It completely contradicts the physiological response to a **narrowed vessel**.

Hemodynamics Flashcard 1 of 10

Question: The _____ is a fast, neurally mediated mechanism of regulating arterial pressure

Answer: baroreceptor reflex

Hemodynamics Flashcard 2 of 10

Question: Cerebral perfusion pressure is decreased with _____ ICP

Answer: increased

Hemodynamics Flashcard 3 of 10

Question: Vasodilation (e.g. following hypertensive therapy) reduces _____-load

Answer: after

Hemodynamics Flashcard 4 of 10

Question: What equation may be used to calculate mean arteriole pressure given a patient's blood pressure?_____

Answer: MAP = 2/3 diastolic pressure + 1/3 systolic pressure

Hemodynamics Flashcard 5 of 10

Question: Ideally, blood flow in the cardiovascular system is _____, or streamlined

Answer: laminar

Hemodynamics Flashcard 6 of 10

Question: How do SVR and afterload change during hypovolemic shock?_____

Answer: Increased

Hemodynamics Flashcard 7 of 10

Question: Which type of blood vessel causes the greatest decrease in pressure in a vascular system arranged in series? _____

Answer: Arterioles

Hemodynamics Flashcard 8 of 10

Question: What equation is used to calculate mean arterial pressure using a patient's cardiac output?_____

Answer: MAP = CO x TPR

Hemodynamics Flashcard 9 of 10

Question: The rate at which blood is pumped from either ventricle is called the _____

Answer: cardiac output

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/cardiology/videos/cardiac-parameters-of-physiologic-function?index=10] https://onlinemeded.org/spa/cardiac/anatomy-of-the-heart/acquire?ref=anki 

Hemodynamics Flashcard 10 of 10

Question: Both ADH and oxytocin are neuropeptides, synthesized in hypothalamic neurons and secreted from nerve terminals in the _____

Answer: posterior pituitary

Extra Information:   Watch Hypothalamic & Pituitary Dysfunction Etiologies [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-endocrine/videos/medical-pathophysiology-endocrine-hypothalamic-and-pituitary-disorders-hypothalamic-and-pituitary-dysfunction-etiologies?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/histology/videos/endocrine-system?index=23] https://onlinemeded.org/spa/endocrinology?ref=anki