Exam 5 Material Flashcards

Question

Laryngeal muscles develop from

Answer 1

mesenchymal myoblasts from the 4th and 6th pharyngeal arches

Answer 2

at cranial end of Laryngotracheal tube

Answer 3

caudal part of hypopharyngeal eminence (from 3rd and 4th pharyngeal arches)

Answer 4

recanalization of the laryngeal lumen

Answer 5

abnormal communication between trachea & esophagus due to defective development of the tracheo-esophageal septum

Answer 6

VACTERL – **V**ertebral anomalies, **A**nal atresia, **C**ardiac defects, **T**EF, **E**sophageal atresia, **R**enal anomalies & **L**imb defects

Answer 7

polyhydramnios [excessive quantity of amniotic fluid]. esophageal atresia inhibits free passage to the intestines of swallowed amniotic fluid.

Answer 8

coughing and choking during feeding, pneumonia, pneumonitis, polyhydramnios.

Answer 9

caudal 4th

Answer 10

2 primary bronchial buds

Answer 11

laterally pericardioperitoneal canals.

Answer 12

bronchopulmonary segments

Answer 13

Pseudo-glandular stage (week 5 - 17) Canalicular period (week 16 - 25) Terminal Sac period ( week 24 to birth) Alveolar period (week 32 (late fetal period) to 8-10 years)

Answer 14

(week 5 - 17) major elements of the lung are formed but no respiratory bronchioles.

Answer 15

(week 16 - 25) terminal bronchiole divides into 2 or more respiratory bronchioles respiratory bronchiole divide into 3-6 alveolar ducts. Type II Alveolar cells appear which produce surfactant. (secretion in week 20)

Answer 16

(week 24 to birth) Terminal sacs formed lined by squamous epithelium; capillaries establish close contact.

Answer 17

(week 32 (late fetal period) to 8-10 years) Primitive alveoli with well developed epithelial – endothelial capillary contacts (blood – air barrier after birth)

Answer 18

after birth as the lungs expand

Answer 19

8-10 years

Answer 20

reduces the surface tension and facilitates expansion of the terminal sacs

Answer 21

Week 20 Week 22-26 (NICU) Week 26-28 (Not NICU)

Answer 22

1. Surfactant deficiency 2. rapid labored breathing shortly after birth. 3. irreversible changes in type II cells rendering them incapable of producing surfactant. 4. underinflated lungs, amorphous deposits in lungs.

Answer 23

accelerates fetal lung movements & surfactant production

Answer 24

1. Thoracic space for growth 2. Fetal breathing movements 3. Amniotic fluid volume

Answer 25

lung is unable to develop normally thoracic space is reduced due to the presence of intestinal content in the thoracic space.

Answer 26

insufficient amount of amniotic fluid may lead to retarded development of lungs (pulmonary hypoplasia)

Answer 27

primordium of future body cavities.

Answer 28

lateral mesoderm, and divides it into 2 layers

Answer 29

- parietal layer of serous pericardium, pleura and peritoneum.

Answer 30

visceral pericardium, pleura and peritoneum

Answer 31

brings heart and pericardium anterior to the foregut. septum transversum forms, and separates pericardial and abdominal cavities.

Answer 32

dorsal mesocardium

Answer 33

apposes paired heart tube primorda and brings dorsal aortae to midline heart primordia fuse to form tubular heart

Answer 34

fuse to form pericardial cavity

Answer 35

lined by visceral and parietal layer continuous with paercardioperitoneal canals

Answer 36

Intraembryonic Coelom (IEC) from Extraembryonic Coelom (EEC)

Answer 37

Bronchial buds grow into pericardioperitoneal canal Membranous ridges develop from lateral wall

Answer 38

separate pleural cavity from pericardial cavity will fuse to form fibrous pericardium

Answer 39

from the Pleuropericardial folds

Answer 40

from the Pleuroperitoneal folds

Answer 41

Closure of pleuroperitoneal openings with septum transversum

Answer 42

project into pleuroperitoneal cavity

Answer 43

final closure of the pleuroperitoneal canal

Answer 44

Anteromedial Central Posterolateral

Answer 45

Rare. Defect b/t costal and sternal musculature

Answer 46

Esophageal hiatus may be abnormally large **congenital hiatal hernia**

Answer 47

Defect of pleuroperitoneal membrane: **congential diaphragmatic hernia** Abdominal contents herniate into thorax More common on left side

Answer 48

Abdomen empty when lying flat. Contents herniate into thorax. Lung compressed & hypoplastic. High mortality rates Requires urgent surgery

Answer 49

defective musculature in one half of diaphragm

Answer 50

failure of the muscle tissue from body wall to extend into the pleuroperitoneal membrane.

Answer 51

The affected side moves up with the contraction of diaphragm during respiration- **paradoxical respiration.**

Answer 52

1. Rib 6 2. Rib 8

Answer 53

1. Rib 8 2. Rib 10

Answer 54

1. Rib 10 2. Rib 12

Answer 55

Absense of lung disease, no prior proviking event, ruptured bleb or bullae

Answer 56

secondary to pleural injury blunt or penetrating trauma

Answer 57

no valve mechanism (unsealed opening) as a result there is no build up pressure.

Answer 58

air filling the pleural cavity can not escape (forming one-way valve). visceral pleura ruptured. pressure builds. mediastinal shift SOB. Needs urgent intervention

Answer 59

Dyspnea Chest pain Tracheal deviation Hypotension Neck vein disension Hyperresonance

Answer 60

Tension pneumothorax-when thoracostomy (chest tube) is not possible in prehospital setting.

Answer 61

2nd intercostal space. Midclavicular line. Affected side.

Answer 62

relieve trappes collections of air or fluid in throax

Answer 63

4th or 5th intercostal space b/t anterior axillary and midaxillary lines.

Answer 64

Moves tongue forward Exposes epiglottis and voal fold

Answer 65

Advance tube b/t vocal folds into trachea Look/Listen for correct placement Be careful! Aspirate to remove excess secretions.

Answer 66

Tumor limited to apical lung region. can metastasize to neighboring structures

Answer 67

Subclavian Vein Compression C8, T1, phrenic nerve, sympathetic chain Compression (Claude-Bernard-Horner syndrome)

Answer 68

Region where mediastinal pleura meets visceral pleura. Structures enter/leave lung here

Answer 69

Attaches lung to mediastinum structures Formed by structures entering/leaving lung.

Answer 70

Bronchi Pulmonary Artery Pulmonary Vein Bronchial Arteries Lymph vessels Nerves

Answer 71

Both Vena Cava Heart Azygous Vein Esophagus

Answer 72

Heart Aortic Arch Thoracic Aorta Esophagus

Answer 73

begin at spinous process of scapula. follow rib VI anteriorly

Answer 74

Follows 4th intercostal Space laterally to meet oblique fissure. Left lung does not have one.

Answer 75

1. To lung 2. To lobe 3. To lobe segment

Answer 76

wider, shorter and more vertical right bronchus and eventually in the right lower lobe

Answer 77

smallest functional unit conical in shape surgically resectable w/o affecting neighbors

Answer 78

branches of pulmonary artery

Answer 79

visceral pleura

Answer 80

intersegmental septa

Answer 81

direct branches of aorta

Answer 82

posterior intercostal

Answer 83

Left: Hemiazygos Right: Azygos

Answer 84

Intrapulmonary Bronchopulmonary (hilar) Tracheobronchial (carinal) Paratracheal Bronchomediastinal trunk Right thoracic trunk/thoracic duct Systemic venous system

Answer 85

normal air-filled spaces of alveoli become filled w/ denser material like fluid/pus

Answer 86

effusion: fluid in cavity edema: fluid in alveoli

Answer 87

no visceral afferents to lung or visceral pleura Visceral afferents innervate bronchi

Answer 88

from vagus nerve. bronchoconstriction, vasodilation, incr. mucus secretion by glands

Answer 89

-from sympathetic trunks via cardiopulmonary nerves. bronchodilation (beta receptors) and vasoconstriction

Answer 90

along bronchial tree and pulmonary vessels

Answer 91

vessels lined up parallel to the airflow→ warms the air. Clinical correlate: nasal congestion

Answer 92

1. Long cilia w/ odor receptors. Axons from olfactory nerve 2. Bipolar neurons

Answer 93

sensory cells

Answer 94

1. Apical Microvilli. Mitochndria heavy, sER/rER. Secretory vesicles→ contain odorant binding protein OBP 2. Mechanical/Metabolic Support. Helps odor perception

Answer 95

regenerate supporting and olfactoy receptor cells

Answer 96

Lamina Propria

Answer 97

odor present olfactory glands secrete secretions trap/dissolve odor particles particles bind to OBP OBP bring odor particles to receptors Glandular secretions wash away particles once sensed.

Answer 98

1. Hyaline Cartilage 2. Air conduction and phonation

Answer 99

Larynx Tumor

Answer 100

1. Mucosa 2. Submucosa 3. Hyaline Cartilage (Continuous) 4. Adventitia 5. Posterior part has small Trachealis muscle

Answer 101

Continuous C-shaped Cartilagenous

Answer 102

Extrapulmonary Intrapulmonary

Answer 103

Respiratory Epithelium

Answer 104

Spirally oriented smooth muscles in in→ regulates the airway diameter

Answer 105

Loose CT with sero-mucus glands (Gl) in larger bronchi

Answer 106

Hyaline cartilage plates

Answer 107

Connective tissue in the extrapulmonary part then surrounded by lung tissue in intrapulmonary bronchi

Answer 108

Respiratory Epithelium

Answer 109

Bronchi. 1st: extrapulmonary 2nd: intrapulmonary

Answer 110

Ciliated columnar Mucus Small Granue/Kulchitsky Basal Brush

Answer 111

1. 250 cilia on surface 2. expel particles trapped in mucus 3. Primary ciliary dyskinesis: Kartegener's Syndrome

Answer 112

1. Short, bunt microvilli 2. mucin granule secretion for protection 3. Incr. in smokers/chronic inflammation

Answer 113

1. most numerous @ primary bifurcation. basal granules 2. Catecholamine/hormone secretion 3. small cell carcinoma affects them

Answer 114

1. Near basement membrane 2. Stem cells pluripotent

Answer 115

1. columnar. extend to apical surface. short microvilli 2. Synapse w/ afferent nerves-\> sensory function

Answer 116

1. smoking, inhalation of toxic fumes and exposure to heavy air pollution 2. Chronic, productive cough. positive history 3. Wheezing, cyanosis (Blue bloater) 4. Chronic irritation → inflammatory changes → metaplasia

Answer 117

Larger: Ciliated pseudostratified columnar with goblet cells Smaller (terminal&respiratory): ciliated cuboidal with secretory (Club) cells

Answer 118

no glands All smooth muscle. Replaces cartilage.

Answer 119

Bronchioles

Answer 120

1. Secretes Surface Active Agent & Proteins 2. Detox 3. Stem Cells

Answer 121

1. Inflammatory Airway Disease 2. Airway Obstruction: incr. mucus, incr. SM, wall inflammation. 3. SOB, wheexing, coughing 4. Albuterol (B2 agonist), anticholinergics. Corticosteroids (antiinflammatory).

Answer 122

Respiratory Bronchiole

Answer 123

alveolar sacs

Answer 124

thin walled sacs where gaseous exchange takes place.

Answer 125

polyhedral

Answer 126

Macrophages Type I Pneumocytes Type II Pneumocytes

Answer 127

Dust Cells phagocytosis of inhaled particles degrade surfactant

Answer 128

Squamous cells which line 95% of alveolar surface Terminal cells not capable of mitosis. Surface is covered by surfactant

Answer 129

Cuboidal cells which secrete surfactant Found at the septal junctions→ AKA septal cells Most numerous but cover only 5% of alveolar surface Apical lamellar bodies→ foamy appearance

Answer 130

regulates synthesis and secretion of surfactant and modulates immune response . regulates airborne allergic response w/ SP-D

Answer 131

regulate surfactant spreading

Answer 132

collagen fibers Elastic fibers continuous capillaries permanent and transient cells

Answer 133

alveolar pores (of Kohn)

Answer 134

collateral airflow → spread of Pneumonia

Answer 135

Surfactant Type I pneumocyte Basal lamina of P1 Capillary endothelium Endothelial cells

Answer 136

Surfactant Type I Pneumocyte w/ basal lamina Connective Tissue Capillary Endothelium Endothelial cells

Answer 137

Thin portion

Answer 138

permanent enlargement of respiratory spaces affecting airways distal to the terminal bronchioles

Answer 139

1. Neutrophils release proteases including elastase→ breaks down elastic fibers 2. Smoking elevates neutrophils activity→ elevated elastase→ destruction of elastic fibers → permanent dilation of airways Treatment: Serum Alpha 1 antitrypsin (AAT) counteracts elastase activity

Answer 140

1. smoking, liver disease etc 2. Cough, dyspnea Dilated

Answer 141

1. elderly, children, immuno-compromised etc. high risk. 2. Fever, chills, cough with sputum, chest pain 3. constricted alveoli. large capillaries

Answer 142

Most common in non-smoking women Peripheral mass

Answer 143

Small Cell Lung Cancer

Answer 144

Squamous Cell Carcinoma

Answer 145

Adenocarcinoma

Answer 146

stratified squamous

Answer 147

End of respiratory tree Gas exchange surface Epithelial layer and an extracellular matrix Surrounded by capillaries

Answer 148

Air flow into/ out of lung heat, hydrate, clean Heat exchange, water vapor pressure equilibriation, remove particulate load Mucociliary clearance

Answer 149

V_gas= D(A/T)(P₁-P₂) V=rate of diffusion D=diffusion coefficient T=diffusion barrier thickness A=surface area available for gas exchange

Answer 150

75m² (300 million alveoli)

Answer 151

Pulmonary Circulation

Answer 152

Gas exchange Acid-Base balance Phonation Pulmonary Defense Metabolism

Answer 153

Angiotensis I --\> Angiotensin II

Answer 154

Bradykinin Serotonin Prostaglandin E1, E2, F2

Answer 155

blood-gas interphase 0.5μm thick

Answer 156

alveolar-capillary membrane of terminal respiratory unit

Answer 157

Thin layer of surface liquid Alveolar epithelium cells (Type 1 Pneumocytes) Associated Basement Membrane Thin layer of interstitial fluid Pulmonry capillary endothelial cells, plus associated basement membrane

Answer 158

Type I pneumocytes Type II pneumocytes

Answer 159

1:, but Type 1 pneumocytes occupy most of the surface area

Answer 160

Stabalizes alveolar size Increases compliance Keeps lung dry

Answer 161

1. Airflow 2. Trachea, Bronchi, Bronchioles 3. Flow Velocity (Ventilation) 4. Asthma, COPD, Bronchitis, Bronchiectasis, cystic fibrosis

Answer 162

1. Gas Exchange 2. Resp. Bronchioles Alveolar Ducts, Alveoli 3. Gas Exchange. Maybe Volume problems 4. Pul. Fibrosis (incl. pneumoconiosis), Hypersensitivity pneumonitis, pneumonia

Answer 163

Beat the mucus covering them away from alveoli, towards pharynx. Function can be inhibited by cigarette smoke.

Answer 164

mucociliary escalator

Answer 165

1. Inflammation of Bronchi 2. Cigarette smoke 3. Goblet cells may incr. in number 4. Cilia movement often impeded 5. Mucus gland incr. secretion and viscosity of mucus. Glands may hypertrophy. Leads to coughing/obstruction.

Answer 166

Cough w/ sputum for at least 3 months a year for 2 consecutive years.

Answer 167

Pressure gradients

Answer 168

@ constant Pressure, Volume is directly proportional to temperature. (V₁/T₁)=(V₂/T₂)

Answer 169

facilitate the movement of air on inspiration and expiration.

Answer 170

When Alveolar pressure is less than atmospheric pressure

Answer 171

When alveolar pressure is higher than atmospheric pressure

Answer 172

Inspiration Expiration

Answer 173

Diaphragm External Intercostals Scalene Sternocleidomastoid Pectoralis Serratus Anterior Latissimus Dorsi

Answer 174

Internal Intercostals Innermost Intercostals Rectus Abdominus Obliques

Answer 175

@ Constant temperature Volume is inversely proportional to Pressure. P₁V₁=P₂V₂

Answer 176

Air particles collide with wall. Each colision applies force. Pressure =Force/Area. Increasing surface area = drop in pressure.

Answer 177

Alveolar Pressure-Intrapleural Pressure

Answer 178

Intrapleural Pressure - Atmospheric Pressure

Answer 179

Incr. Airway Resistance during expiration make for larger pressure gradients that dissipate more slowly.

Answer 180

C=ΔV_L/ΔP_TP C=1/E

Answer 181

1. Airway resistance 2. Frictional forces 3. Inertia of air + tissues 4. Elasticity of lung

Answer 182

hysteresis

Answer 183

hysteresis not present

Answer 184

P=2T/r (4T if 2 surfaces like a bubble)

Answer 185

90% Phospholipids 10% Protein

Answer 186

60% phosphatidycholine 7-15% phosphatidylglycerol Remainder: The rest of the membrane phospholipids

Answer 187

large hydrophilic collagen-like lectin superfamily (collectins) – lung defense

Answer 188

hydrophobic – facilitates surfactant monolayer formation

Answer 189

atelectasis

Answer 190

lung inflates easily and has little elastic recoil Emphysema COPD

Answer 191

lung inflates with difficulty due to large elastic recoil Pulmonary fibrosis Respiratory distress syndrome

Answer 192

Chromosomes 16 and 11.

Answer 193

2 α-globin genes on Chromosome 16. (α1, α2) --making there 4 in total per person. 1 β-globin genes on Chromosome 11--making there 2 in total per person.

Answer 194

Alpha helix. Actually devoid of beta sheet.

Answer 195

* *Four** bonds ro nitrogen in porphyrin ring * *One** bond to amino acid of globin protein **One** bond free to reversibly bond Oxygen

Answer 196

Deep inside. Ensures Oxygen release in the molecular form Oxygen entrance/exit is in a defined path.

Answer 197

pair of identical αβ dimers (α₂β₂tetramer) with widely spaced heme groups.

Answer 198

Hydrophobic Ionic Hydrogen bonds

Answer 199

Basically O₂^-gets released instead of O₂. This leaves Fe³⁺ instead of Fe²⁺. This form of iron cannot bind Oxygen. Also, the other 3 monomers can no longer release oxygen. So this is not an oxygen carrier. Heme binding pocket structured so this can rarely happen, and when it does, it is enzymatically fixed.

Answer 200

out of plane shifts to in pane.

Answer 201

forms taught state of Hb. Decreases Hb O₂ affinity. allows formation of additional salt bridges between αβ / αβ dimers creates driving force for Hb to assume deoxyHb structure (taut).

Answer 202

They reduce the pH of the environment, and they promote O₂release.

Answer 203

promotes formation of carbonic acid from CO₂ H+ ions protonate Hb, forming positive charges Salt bridges form Taut form stabalized. O₂ delivered to tissues.

Answer 204

"α₂γ₂ ~1% "

Answer 205

α₂β₂ ~90%

Answer 206

α₂δ₂ ~2%

Answer 207

α₂β₂ -glycated ~5%

Answer 208

Fetal. α2 γ2

Answer 209

non-enzymatic, spontaneous reaction. does not interfere with normal function of HbA_1C.

Answer 210

monitor blood glucose levels over the previous three months

Answer 211

Qualitative change in Hb Quantitative change in Hb

Answer 212

Glutamic Acid is substituted by Valine at position 6 of the B-globin chain

Answer 213

No HbA exists at all.

Answer 214

5-azacytidine (Decitabine; demethylating agent) Hydroxyurea Butyrate compounds (inhibit histone deacetylation)

Answer 215

alter epigenetic gene regulatory mechanisms may change acetylation of chromatin proteins Alter gene silencing patterns, Derepression of γ-globin gene

Answer 216

point mutation at the 6 th codon position of the β-globin gene missense mutation (Glu→Lys) moves toward anode @ slowest pace. mild hemolysis. tends to crystalize n RBC b/c less soluble than HbA.

Answer 217

episodes of sickling that are similar to sickle cell disease (but milder)

Answer 218

Common in South east Asia, Africa and the Mediterranean deficiency in a-globin chain synthesis

Answer 219

unequal crossing over during homologous recombination

Answer 220

Loss of one gene (aa/a-) is a silent carrier with no clinical problems Loss of two genes (a-/a-) or (aa/- -) results in mild anemia. Loss of three genes (a-/- -) cause β4 tetramers referred to as HbH, which causes moderate hemolytic anemia. Loss of all a globin genes is lethal (- -/- -) and is known as hydrops fetalis

Answer 221

most severe form of α-thalassemia aggregation of γ4 tetramers (as there is absence of a-globin chains) fetal onset of generalized edema, ascites, pleural and pericardial effusions, and severe hypochromic anemia Stillbirth or death as neonate. No HbF or HbA.

Answer 222

infancy or childhood with mild-to-moderate hemolytic anemia and hepatosplenomegaly Mild thalassemia-like bone changes Deletion of 3/4 alleles. HbA low to low normal.

Answer 223

Autosomal recessive disorder Allelic Heterogeneity Excessive a-globin chains precipitate and result in severe hemolytic anemia

Answer 224

‘Cooley's Anemia’ and ‘Mediterranean Anemia’ Very low or absent HbA levels – Absent or very little β globin synthesis High HbA2 and HbF levels (Compensatory)

Answer 225

Mostly homozygotes or compound heterozygotes one severe mutation, second mutation is less severe or two less severe mutations Low HbA levels High HbA2 and HbF levels (Compensatory)

Answer 226

"""β-thalassemia carrier"", ""β-thalassemia trait"" or ""heterozygous β-thalassemia"" Are mostly heterozygotes Almost normal HbA levels "

Answer 227

Frontal bossing, malar prominence – indicative of extramedullary erythropoiesis Bone marrow tries to compensate and expands to perform erythropoiesis and this leads to bone deformity and fractures

Answer 228

**Regular transfusions** **Iron chelation** and **dietary control** **bone marrow transplantation** from an HLA-identical sibling.

Answer 229

A: 40% of cases of severe Factor VIII deficiency arise from a large inversion. Deletions, insertions, and point mutations account for the remaining 50-60% B: Point mutations and deletions in the Factor IX gene

Answer 230

usually asymptomatic some carrier females have increased bleeding tendency from skewed X-inactivation

Answer 231

Recombinant factor VIII (or IX) replacement therapy

Answer 232

Airway pressure everywhere is 0 (no flow) Intrapleural pressure -5 PIP, there is a +5 cm H2O holding airways open.

Answer 233

Chest wall expands, diaphragm flattens. Intrapleura PIP and alveolar pressure PA fall by 2, and air flows into the lungs. at a point further it is -1. +6 holding airway open

Answer 234

Flow is 0. Slightly higher intrapleural pressure PIP. airflow driven by PA and PATM gradient

Answer 235

Intrapleural pressure increases to +30 (diaphragm and thorax).

Answer 236

process that results in effort independence of the flow-volume loop.

Answer 237

dynamic compression results in resistance to air flow as intrapleural pressure increases extra effort not result in increased air flow due to this "valve".

Answer 238

point at which pressure inside the airway equals pressure outside (intrapleural pressure).

Answer 239

after the equal-pressure point (EPP).

Answer 240

the volume of air inhaled or exhaled with each normal breath

Answer 241

the volume of air that can be inhaled at the end of a normal tidal inspiration

Answer 242

the volume of air within the lungs that can be exhaled after the end of a tidal exhalation

Answer 243

the air remaining in the lungs after a maximal expiration (this volume of gas cannot be expelled, and cannot be measured by spirometry)

Answer 244

the total volume of air remaining in the lungs at the end of a tidal exhalation

Answer 245

the volume of air in the lungs at the end of a maximal inspiration

Answer 246

the volume of air exhaled from maximal inspiration to maximal exhalation; maximum expiration. When done with force this volume is termed the forced vital capacity

Answer 247

the volume of air exhaled in the first second of a FVC test

Answer 248

1. 1.9 – 2.5 L 2. 0.4 – 0.5 L 3. 1.1 – 1.5 L 4. 1.5 – 1.9 L 5. 4.9 – 6.4 L 6. 2.3 – 3.0 L 7. 2.6 – 3.4 L 8. 3.4 – 4.5 L

Answer 249

1. (TLC = IRV+VT+ERV+RV) 2. (IC = VT + IRV) 3. (FRC = ERV + RV) 4. (VC = IRV + ERV + VT)

Answer 250

Expiratory flow rate is significantly decreased decreased FEV1 and FVC FEV1/FVC ratio is low.

Answer 251

Lung inflation is decreased decreased FEV1 and FVC FEV1/FVC ratio is normal or increased

Answer 252

Represents the expiratory flow rate over the middle half of the FVC (between 25% and 75%).

Answer 253

FEV1/FVC% is above the lower limit of normal.

Answer 254

1. decr. 2. very decr. 3. \<0.8 4. incr. 5. incr. 6. incr.

Answer 255

1. very decr. 2. decr. 3. \>0.8 4. decr. 5. decr. 6. decr.

Answer 256

Chronic Bronchitis Emphysema Asthma

Answer 257

Pulmonary Fibrosis IRDS Scholiosis

Answer 258

Disintegration of the lung’s elastic framework and destruction of alveolar walls Enlargement of air spaces distal to the terminal bronchioles air trapping – prolonged expiratory phase, barrel chest, flat diaphragm caused by cigarette smoking Genetic risk factor - alpha-1-antitrypsin (AAT) deficiency

Answer 259

Known concentration of helium in a known volume of gas (oxygen) in spirometer Person is asked to breathe until the gas equilibrates between the spirometer & the lungs Useful in healthy individuals with no lung obstruction Helium does not get beyond obstruction, thus yielding a false FRC Body plethysmography can overcome this problem

Answer 260

when pleural pressures = airway pressures

Answer 261

Above EPP, upstream towards mouth, there is dynamic airway compression. - decr. radius, decr. resistance. - Thus restricts airflow - lower lung volumes - Results in effort independent portion of the flow-volume loop

Answer 262

R=8nl/r⁴ V=ΔPπr⁴/8nl V=ΔP/R

Answer 263

sq.root(ΔP)

Answer 264

radial traction forces keep them open Pulled open as alveoli expand their resistance falls as the lung inflates.

Answer 265

Stretching of the alveolar walls leads to stretching and pulls vessels closed

Answer 266

(PA \> Pa \> Pv ) * Flow is limited by compressive force of alveoli along length of pulm. capillary. * No flow & inc in zone 1 may occur with blood loss, positive pressure ventilation (Low Pa or high PA )

Answer 267

(Pa \> PA \> Pv ) * Initial part of the capillary is patent. * As capillary pressure falls below alveolar pressure along the length of the vessel compression occurs and increases capillary resistance.

Answer 268

(Pa \> Pv \> PA) Normal flow, arterial and venous pressure exceed alveolar so no compression along the length of the vessel.

Answer 269

Very base of lung, where the lung structures are subject to small transpulmonary pressure gradient. extra-alveolar vessels have increased resistance and flow is reduced overall.

Answer 270

Medulla Oblongata

Answer 271

Dorsal Root Ganglion and parts of the rostral ventral root ganglion

Answer 272

act as a switch b/t inspiration and expiration

Answer 273

preBötzinger complex

Answer 274

Sends input to Medulla oblongata to control smooth respiratory rhythm.

Answer 275

Cerebrum Mechanoreceptors Chemoreceptors (Both kinds) Proprioceptors

Answer 276

1. Cerebrum, Chemoreceptors, Mechanoreceptors, Proprioceptors 2. Pons/Medulla 3. Spinal Motor Neurons 4. Respiratory Muscles

Answer 277

contains apneuistic and pneumotaxic centers that can modulate the basic pattern of the medulla.

Answer 278

Voluntary control

Answer 279

limbic system and hypothalamus

Answer 280

Pulmonary Stretch Receptors Irritant Receptors J Receptors Proprioceptors

Answer 281

lie in smooth muscle layer of airways fire in proportionate response to transmural pressure

Answer 282

1. in airway epithelium 2. touch, noxious substances (smoke/particle deposition), Inflammatory histamines, serotonins, prostaglandins activated during inflammation 3. Lung edema 4. Coughing/gasping

Answer 283

1. Tendons, joints, muscles. 2. Inform the brain of body position 3. The ones in the chest wall signal the breathing effort.

Answer 284

Juxtapulmonary capillary receptors (C-fiber endings) in Alveolar and bronchial groups Fire in response to lung injury, overinflation, pulmonary edema, pulmonary embolism. Not sensitive to inflammatory mediators Bronchial C-Fibers sensitive to inflammatory mediators Results in rapid, shallow breathing, bronchoconstriction, airway secretion

Answer 285

1. Mechanical/Chemical irritation 2. Upper Airway Irritant receptors 3. Vagus Nerve 4. Bronchoconstriction

Answer 286

1. Mechanical/chemical irritation 2. Nasal irritant receptors 3. Trigeminal, olfactory 4. Sneeze

Answer 287

1. Lung inflation 2. Airway smooth muscle stretch receptor 3. Vagus Nerve 4. Stops Inspiration

Answer 288

1. Lung deflation 2. Possible J, irritant, or stretch receptors 3. Vagus Nerve 4. starts inspiration

Answer 289

1. Stretch of muscle or tendons 2. Proprioceptors 3. Spinal nerve pathways 4. Allows fine control of muscle groups

Answer 290

1. Edema 2. J receptors 3. Vagus nerve 4. Tachypnea, sensation of dyspnea

Answer 291

- Detect changes in PCO₂and pH - Located on ventral surface of medulla oblongata

Answer 292

- Separated from blood by Blood-brain-barier - Has little protein, so very limited buffer capacity - Sensitive to changes in PCO2. Incr. PCO2=decr pH

Answer 293

They are directly proportional in the Respiratory circulation. In Metabolic circulation, there is little effect.

Answer 294

Incr. pH, decr. ventillation.

Answer 295

- Located at carotid bifurcation and along aorta - Detect changes in pH, PCO₂, and PO₂. - Contain Glomus cells

Answer 296

- 2mm sensory organ - afferents feed CNS via glosso-pharyngeal nerve - sense changes in pH and decr. in PO₂

Answer 297

- feed CNS via vagus nerve - sense decr. PO₂

Answer 298

Sites of chemoreception

Answer 299

decr. PO₂ incr. PCO₂ incr. H⁺

Answer 300

Increase in P_ACO₂ increases V_E.

Answer 301

Low P_AO₂increases hypercarbic drive High P_AO₂only slightly decreases hypercarbic drive.

Answer 302

Arterial PCO₂

Answer 303

Central: Primary Peripheral: Quick Response

Answer 304

In chronic disease, when PCO₂ is high, but pH is compensated, then the hypoxic drive becomes more important. This is because PCO₂is only changed due to the change in pH.

Answer 305

"The pressure exerted by a gas in a mixture of known gasses. Expressed in terms of ""dry gas"" concentration "

Answer 306

The percentage or concentration of a known gas in a mixture of known gasses

Answer 307

P_g=P_B x F_g

Answer 308

21% 760 mmHg

Answer 309

V_E = VT × *f*

Answer 310

Amount of air entering the lung in one minute

Answer 311

Volume of air not participating in gas exchange. Volume lost to Conducting airway.

Answer 312

Alveolar dead space. In health, value negligible.

Answer 313

Anatomical dead space + Alveolar dead space

Answer 314

dead space alveoli

Answer 315

V\*_A = (V_T x *f*) - (V_D x *f*) V\*_A = (V_T - V_D) *f* V\*_A = (V_T -V_D) x (breaths/min)

Answer 316

Fowler's Method

Answer 317

Bohr's Method

Answer 318

1ml/pound. so 150lb adult woud have V_D/t = 150mL/breath\*(12breath/min) = 1800mL/min

Answer 319

- Inspire 100% O₂ after tidal expiration - Exhale to maximum (RV) This will enable you to expire also air that was in the dead space as pure O₂. This is exhaled along with alveolar dead space O₂ and N₂. The N₂ volume and concentration in expired air is measured.

Answer 320

V_D/V_T = 1-(P_ECO₂/P_aCO₂)

Answer 321

high in PO₂ and low in PCO₂

Answer 322

Depth and Rate of breathing

Answer 323

V_A = (V_ECO₂ X 0.863)/ P_ACO₂

Answer 324

expired volume of CO₂ in 1 minute

Answer 325

P_AO₂ = PIO₂- (P_ACO₂/R) Healthy person @ sea level: P_AO₂ = 150- (P_ACO₂/R) R=Resp. Quotient=0.8 (usually)

Answer 326

P_B FIO₂ Metabolic Activity Ventilation

Answer 327

FIO2 – is 21% in ambient air

Answer 328

difference between the alveolar oxygen gas tension and the arterial oxygen tension

Answer 329

[PIO₂ − (P_ACO₂/R)] − P_aO₂

Answer 330

pnea = metabolic changes ventilation = respiratory pressure changes

Answer 331

ATP Investment 6C -\> 3C sugar ATP Generation

Answer 332

hexokinase PFK-1 pyruvate kinase

Answer 333

1. Phosphoglycerate Kinase 2. Pyeuvate Kinase

Answer 334

Hexokinase PFK-1

Answer 335

Glucose-3-Phosphate Dehydrogenase

Answer 336

Facilitated diffusion

Answer 337

GLUT 1: Neurons, Brain, Erythrocytes GLUT 2: Liver GLUT 3: Neurons/Brain GLUT 4: Muscle/adipose

Answer 338

PFK-1 allosteric regulation.

Answer 339

a drop in pH cramps

Answer 340

Inhibits G3PD in glycolysis

Answer 341

Inhibits Enolase. Used in lab to test glucose levels.

Answer 342

Takes lactate, and transports from blood to liver. Used for Gluconeogenesis

Answer 343

Most cancer cells use glycolysis as main source of ATP.

Answer 344

in liver has a high Km for glucose (more active when the blood glucose is elevated). It is also present in B-cells of the pancreas.

Answer 345

Relates to Cardiac Output. 5L/min

Answer 346

venous admixture

Answer 347

low O₂tension in blood. (hypoxemia)

Answer 348

Physiological shunt

Answer 349

50% comes from anatomic shunt (right-to-left shunt) 50% from low V_A/Q at base of lung

Answer 350

All of the blood entering the lung is not fully oxygenated, leading to some “wasted blood.”- physiologic shunt.

Answer 351

Anatomic + low V_A/Q = Physiological Shunt (Wasted blood)

Answer 352

Anatomic + Alveolar = Physiological Dead Space (Wasted air)

Answer 353

high low low

Answer 354

against more

Answer 355

1. Apex: P \< V 2. Base: P \> V

Answer 356

causes the blood coming into the area to be directed to other parts of the lung.

Answer 357

bronchi constrict slightly. resistance incr. and ventilation decr. in area w/ not enough perfusion limits alveolar dead space

Answer 358

1. Normal 2. N/A 3. N/A

Answer 359

1. Abnormal 2. Not effective 3. N/A

Answer 360

1. Abnormal 2. Effective 3. Normal

Answer 361

1. Abnormal 2. Effective 3. Abnormal

Answer 362

perfusion of an area with no ventilation i.e. a shunt

Answer 363

dead space – ventilation with no perfusion

Answer 364

Dissolved in Plasma Bound to Hemoglobin

Answer 365

0.003mL O₂/ dL Plasma

Answer 366

Dissolved O₂ = PO₂ x solubility. =100 x 0.003 = 0.3mL/dL

Answer 367

Hemoglobin. Because in the soluble state, we would need to pump 83L/min to supply our body's need of 250mL/min.

Answer 368

- Plateau portion of the curve is also known as loading phase - Steep portion of the curve known as unloading phase

Answer 369

O2 content & O2 saturation remain fairly constant over a wide range of partial pressures – occurs in lungs

Answer 370

allows release of O2 at tissue level where there is low PO2

Answer 371

The effect of pH & PCO2 on Hb’s affinity to bind O2 high PCO2 and low pH = low binding affinity

Answer 372

normal. normal. fewer.

Answer 373

↑in the concentration of RBC’s more Hb per 100 ml blood Increased oxygen carrying capacity of blood No change in the affinity – just more binding sites for O2

Answer 374

Has 210 x the affinity of O2 to Hb - PaO2 is normal but O2 content low No physical signs to indicate O2 content is low, when CO binds Hb – blood is cherry red & not cyanotic

Answer 375

slowed reaction time blurred vision coma

Answer 376

Bulk Flow Diffusion

Answer 377

all molecules move as one unit

Answer 378

pressure gradient b/t P_atm(at the mouth) - P_A

Answer 379

Movement from alveoli -\> blood or blood -\> tissues

Answer 380

pressure gradient membrane thickness surface area diffusion coefficient

Answer 381

V_gas= D(A/T)(P₁-P₂) V=rate of diffusion D=diffusion coefficient T=diffusion barrier thickness A=surface area available for gas exchange

Answer 382

Diffusion coefficient (D) = solubility/√Mol wt

Answer 383

R = VCO2 / VO2 = 0.8

Answer 384

pulmonary capillary blood flow

Answer 385

0. 1 sec 0. 25 sec does not equilibriate

Answer 386

0.75 seconds

Answer 387

increase barrier thickness - Pulmonary edema - Pulmonary fibrosis

Answer 388

single breath test with carbon monoxide (CO)

Answer 389

PCO is diffusion limited only none in venous blood avidity to binding Hb maintains P_aCO near zero

Answer 390

P2 = PaCO which is near 0 therefore DL = V_CO/P_ACO

Answer 391

Bicarbonate Dissolved Carbamino Compounds

Answer 392

↑ PCO2 in tissues drives CO2 into blood only small portion dissolves the bulk of it diffuses into RBC’s

Answer 393

HCO3 - + H+ carbonic anhydrase (CA)

Answer 394

free amine groups NH2

Answer 395

40mmHg 24 mM

Answer 396

45mmHg 25.6 mM

Answer 397

Carbamino Bicarbonate Free CO2

Answer 398

The inverse relationship between CO2 & PO2

Answer 399

Shift in curve in either direction 2^o to PCO2 changes

Answer 400

more CO2 to load in tissues unload more CO2 load in lungs

Answer 401

perfusion limited. 0.25 secs to equilibrate which same as O2, even though it is more soluble P is only 5-6 mmHg

Answer 402

Can still equilibrate due to 0.5 reserve time.

Answer 403

hepatorenal recess

Answer 404

Renal Vein Renal Artery Renal Plevis

Answer 405

renal capsule

Answer 406

perirenal (perinephric) fat renal fascia (Gerota’s fascia) pararenal (paranephric) fat

Answer 407

Liver (superior) Adrenal Gland (superior) Descending Duodnum (Medially) Colic/hepatic flexure (Inferior)

Answer 408

Diaphragm (Superior) Rib 12 (Superior) Post. abdomen muscles (inferior)

Answer 409

Stomach(superior) Adrenal Gland (superior) Spleen (Superior) Pancreas tail (Medially) Peritoneum covering small intestine (Inferior)

Answer 410

Diaphragm (Superior) Rib 11 & 12 (Superior) Post. abdomen muscles (inferior)

Answer 411

glomeruli and convoluted tubules.

Answer 412

renal pyramids with straight tubules

Answer 413

demarcate the renal cortex from the renal medulla

Answer 414

Glomerulus -\> tubular system -\> collecting ducts -\> minor calyces -\> mjor calyces -\> renal pelvis -\> ureter -\> bladder -\> urethra -\> toilet

Answer 415

Renal Corpuscle Tubular System

Answer 416

* Glomerulus * Bowman’s capsule

Answer 417

P. Convoluted Loop of Henle D. Cnvoluted

Answer 418

Uriniferous Tubule

Answer 419

Left kidney Left suprarenal gland Left gonads (testicular/ovarian)

Answer 420

Right kidney

Answer 421

directly into the IVC

Answer 422

stasis of blood in the Lt. testicle

Answer 423

varicocele

Answer 424

a condition where veins in the scrotum become dilated, incompetent and cause retention of blood in the testicle. dilated veins can be felt as a ‘bag of worms’ on physical examination

Answer 425

Left/Right lumbar (aortic/caval)

Answer 426

Kidney lymphatics or lumbar lymph nodes

Answer 427

common iliac

Answer 428

common, external, internal iliac

Answer 429

internal iliac

Answer 430

smooth area of the bladder in the non-distended state, bounded by 2 Ureteral orifices and Urethra

Answer 431

open into the posterolateral aspect of the bladder

Answer 432

commences at the neck of the bladder as the internal urethral orifice

Answer 433

Neural crest cells -\> coelomic cavity wall. NCC also called chromaffin (chromaphil) cells due to their staining (yellow) with chromium salts

Answer 434

1. celomic epithelium (mesothelium) cells proliferate. Initially form buds that separate from epithelium 2. small buds are now mesenchymal cells that form the fetal cortex.

Answer 435

superior suprarenal (inf. phrenic) middle suprarenal (aorta) inferior suprarenal (renal)

Answer 436

One suprarenal vein on each side. Left: drains to left renal vein Right: drains into IVC

Answer 437

Lumbar lymph nodes

Answer 438

chromaffin cells in the adrenal medulla

Answer 439

Intermediate mesoderm & Urogenital sinus

Answer 440

between paraxial and lateral mesoderm; extends along dorsal body wall of the embryo

Answer 441

genital system

Answer 442

nephrogenic cord: urinary system gonadal ridge: genital system

Answer 443

**Pronephros**-rutimentary/nonfunctional **Mesonephros**-brief function in early fetal period **Metanephros**-will form permanent kidney

Answer 444

Begin week 4 7-10 cell groups in cervical region forms vestigial excretory units: nephrotomes Regress before the next system is formed more caudally disappears by end of week 4.

Answer 445

Starts week 4 w/ pronephros Excretory tubules appear Degenerates by end of 1st trimester

Answer 446

lengthen gradually. Form S-shaped loop Acquires tuft of blood forming primitive glomerulus Tubules elongate laterally. Join w/ mesonephric duct mesonephric duct opens into cloaca

Answer 447

longitudinal collecting duct

Answer 448

ductus deferens, duct of epididymis and efferent ductules

Answer 449

Appears in 5th week Excretory ducts develop from the metanephric mesoderm Ureteric bud grows Ureteric bud penetrates the metanephric tissue

Answer 450

outgrowth from mesonephric duct close to cloaca attachment

Answer 451

molded over by a cap from the surrounding mesoderm (metanephric blastema)

Answer 452

bud dilates to form the primitive renal pelvis splits into a caudal stalk (ureter)and cranial portion (collecting tubules) The metanephric diverticulum (ureteric bud) in its cranial part undergoes successive branching First divides into two to form the major calyces Continues to divide to form the minor calyces and collecting tubules The end of each collecting tubule divides and become arched

Answer 453

" The collecting tubules induce clusters of mesenchymal cells from **Metanephric Blastema** to form small **Metanephric Vesicles**. "

Answer 454

metanephric (renal) tubules

Answer 455

glomeruli( tuft of capillaries)

Answer 456

at birth 1-2 million

Answer 457

Excretory part Bowman’s capsule, Proximal Convoluted Tubules (PCT), Loop of Henle Distal Convoluted Tubules (DCT)

Answer 458

Conducting part - Collecting tubules, minor calyces, major calyces, pelvis ureter

Answer 459

functional uriniferous tubules

Answer 460

ventrally common iliac arteries

Answer 461

caudal final renal

Answer 462

Arise from Aorta above or below main artery

Answer 463

cross over the ureter and can cause obstruction (leading to hydronephrosis)

Answer 464

ischemia of the segment of the kidney supplied

Answer 465

More common in boys Usually left absent Asymptomatic if other kidney is normal (compensatory hypertrophy)

Answer 466

can result in: Oligohydramnios Pulmonary hypoplasia POTTER sequence Incompatible with post-natal life

Answer 467

urethra, vagina or vestibule

Answer 468

2 separate ureteric buds developed on that side

Answer 469

One ureteric bud divide and induce the formation of an extra kidney Due to early, incomplete division of the ureteric bud

Answer 470

Fusion of lower poles while still in pelvis Ascent interrupted by the inferior mesenteric artery

Answer 471

Renal Capsule (lines inside too) Perirenal Fat (Extraperitoneal fat) Renal Fascia (lines adrenal too) Pararenal Fat

Answer 472

Superior to right kidney posterior to liver

Answer 473

Fluid in the abdomen will accumulate in this space when the body is supine

Answer 474

pouch of Morrison

Answer 475

lesser and least thoracic splanchnics and lumbar splanchnic nerves segmentally

Answer 476

* The celiac ganglion and plexus * The aorticorenal ganglion * The lower (least) thoracic splanchnic nerves * The 1st lumbar splanchnic nerve

Answer 477

ureteric and gonadal plexuses

Answer 478

thoracic splanchnic nerves

Answer 479

flanks inguinal groin genitals upper thigh basically: loin-\>groin

Answer 480

ureteropelvic junction (UPJ) ureterovesical junction (UVJ)

Answer 481

(skin over upper medial thigh, upper scrotal and labial areas)

Answer 482

(skin over the anterior abdominal muscles, pubic symphysis)

Answer 483

subcostal nerves

Answer 484

"Water under the bridge" ureter being crossed over by the uterine vessels or ductus deferens

Answer 485

Just posterior to pubic symphyses area

Answer 486

median umbilical fold (remnant of the urachus)

Answer 487

shaped like an inverted triangle and faces posteroinferiorly.

Answer 488

upper corners of the base lower corner of the base

Answer 489

smooth triangular area on the internal surface between the openings of the ureters and the urethra

Answer 490

superior and inferior vesicle artery

Answer 491

external iliac nodes

Answer 492

urachal cyst urachal sinus urachal fistula (if it remains completely patent)

Answer 493

- Pubovesical (♀) or puboprostatic (♂) - Rectovesical/cardinal(transverse cervical) - Perineal membrane, and muscles of the pelvic floor

Answer 494

hold the neck of the bladder in place and help support/suspend the bladder

Answer 495

Urorectal septum

Answer 496

Upper Middle Phallic

Answer 497

Vesical part. Largest portion Forms bladder.

Answer 498

connect the developing bladder to the yolk sac through the umbilicus. soon constricts to form the urachus, which eventually obliterates and becomes the median umbilical ligament

Answer 499

thin pelvic part give rise to the urethra at the neck of bladder

Answer 500

males: prostatic and membranous portions of urethra females: entire urethra

Answer 501

forms most of the penile urethra in males

Answer 502

wall of the urinary bladder trigone

Answer 503

the ureters enter the bladder

Answer 504

They move superiorly and posteriorly due to the migration of the kidneys

Answer 505

Increases when standing over supine. Abdominal contents push into thoracic cavity when lying, but are suspended and pull down on diaphragm when standing. change in shape of lung compliance curve and increase in FRC.

Answer 506

The pull on the alveoli. more pull=more diameter=more tension

Answer 507

diminishing stretch of lung as you exhale

Answer 508

sign of lung hyperextension. Flat diaphragm especially evident in lateral view.

Answer 509

loss of lung tissue = loss of vascular tissue = poor ventillation = sm contract hypoxic vasoconstriction = vsm hypertrophy = incr. afterload on right heart

Answer 510

pure respiratory acidosis.

Answer 511

respiratory acidosis with metabolic compensatory alkalosis and increased bicarbonate reabsorption.

Answer 512

increased renal proton secretion

Answer 513

1. S2-4 (Pelvic Splanchnic) through inf. hypogastric to bladder 2. T10-12 (lesser and least splanchnics), L1&2 (lumbar splanchnics) reach the bladder through the Hypogastric plexuses

Answer 514

sympathetic/Parasympathetic nerves

Answer 515

Pudendal (S2- S4)

Answer 516

an increase in urinary frequency due to increased urinary urge

Answer 517

- Short urethra - Proximity to vagina and anus - Intercourse

Answer 518

located within the deep perineal pouch

Answer 519

– its proximal portion contains openings for the bulbourethral glands

Answer 520

men • Age range 20-60 years

Answer 521

Aggregates of calcium, phosphate, oxalate, urate and other soluble salts

Answer 522

Urine becomes saturated and a small change in pH can cause precipitation of these salts

Answer 523

Pain usually radiates from the infrascapular region into the groin or scrotum hematuria

Answer 524

bacteria, maybe

Answer 525

infection urinary obstruction renal failure

Answer 526

Inherited disorder that can be AD or AR

Answer 527

super rare. cycts on all nephron segments renal failure usually only until adulthood

Answer 528

cysts progressively form from collecting duct kidneys become large. renal failure in infancy or childhood

Answer 529

1. Skin 2. Subcutaneous tissue 3. Latissimus dorsi 4. Serratus posterior inferior 5. Thoracolumbar fascia posterior layer 6.Sacrospinalis 7. Thoracolumbar fascia middle layer 8.Quadratus lumborum 9. Thoracolumbar fascia anterior layer 10.Pararenal fat 11. Renal Fascia 12. Gerota’s fascia (Perirenal fat)

Answer 530

placed and attached in the region of the iliac fossa

Answer 531

inserted through the skin about 1 inch above the symphysis pubis.

Answer 532

1. general or local anesthesia 2. closed drainage. may be left in place for a time, sutured to the abdominal skin.

Answer 533

Lower incidence of urinary tract infection ease of voiding naturally when the catheter is clamped ease of ambulation

Answer 534

A physician has to insert it. Cleaning is a pain in the butt at home. Cleaning needs to be sterine in hospital

Answer 535

first bend is in the spongy urethra and can easily be manipulated second bend is located at the membranous urethra and is fixed

Answer 536

damage to bulb of penis -just deep to the first bend

Answer 537

Stres (like from laughing or coughing) increases intra-abdominal pressure/ Sphincters become weak, so they do not close, and urine leaks.

Answer 538

Prolapse of the bladder into the vaginal canal

Answer 539

repetitive straining of bowel movements constipation chronic or violent coughing heavy lifting being overweight or obese

Answer 540

Regulate acid-base balance Maintain extracellular fluid volume Excretion BP Regulation Endocrine

Answer 541

Space around hilar structures, filled w/ loose conn. tissue

Answer 542

Granular in appearence consists most of nephron components\ extends b/t medulary pyramids as renal columns (bertin)

Answer 543

Pyramid arrangement Apical portion of pyramid: renal papilla. Projects into minor calyx Striated appearence: straight portions of tubules and straight blood vessels.

Answer 544

Cortical: Short LOH Intermediate: mid cortical Juxtamedullary: long loops of Henle, these are crucial for concentrating urine

Answer 545

Medulla and associated cortex

Answer 546

straight tubules

Answer 547

renal corpuscle and convoluted tubules

Answer 548

Med. Ray in middle w/ areas of cort. laby on either side collecting duct and the nephrons it drains bounded by interlobular arteries

Answer 549

Medullary Rays. Pars Recta

Answer 550

arcuate arteries

Answer 551

Podocytes modified squamous cells invests glomerular capillaries

Answer 552

outer layer simple squamous epithelium contin. w/ PCT

Answer 553

Bowman's space lies b/t 2 layers collects ultrafiltrate

Answer 554

– covers pedicles of visceral layer of BC – zipper like thin sheet with a dense center containing nephrin – Anchored to actin filaments within pedicels of podocytes

Answer 555

- numerous fenstrations - no diaphragms - produces NO and PGE₂ - Abundant aquaporin-1 receptors

Answer 556

Thick Fused basal lamina of endothelial cells and podocytes Type IV collagen Heparan Sulfate

Answer 557

Lamina Rara Interna (of capillary) Lamina Densa: Type IV collagen - physical barrier Lamina Rara Externa (of podocyte): haparan sulphate to repel negatively charged molecules

Answer 558

charge size shape

Answer 559

IgG against Type IV collagen of basement membrane -\> glomerulonephritis: hematuria and proteinuria

Answer 560

Mesangial cells (contain actin filaments) Matrix

Answer 561

At vascular pole (Lacis cells, extraglomerular mesangial cells) Within the corpuscle enclosed by the GBM

Answer 562

Phagocytosis of residue along the GBM Structural support: Secrete ECM Secretion of inflammatory substances – interleukin-1, prostaglandin E2, PDGF Contractile cells

Answer 563

reabsorption secretion reduce urine volume hyperosmotic fluid

Answer 564

Proximal Convoluted Tubule

Answer 565

simple cuboidal epithelium -\> absorption Large cells -\> large spaces b/t adjacent nuclei

Answer 566

receive ultra-filtrate from glomerulus. Reabsorbs 65% of it. 100% glucose 98% amino acids, small polypeptides Some protein and large peptides are returned to the blood via endocytosis

Answer 567

microvilli form brush border

Answer 568

Tight junctions and Zona Adherens Pilcae Basal interdigitations Basal striations associated with elongated mitochondria

Answer 569

folds in lateral PCT which interdigitate with adjacent cellular processes

Answer 570

Na + / K+ pumps : on lateral folds, creates osmotic gradient

Answer 571

apical tubular pits b/t microvilli, endocytotic vesicles, endosomes, lysosomes -\> protein absorption and recycling (image A)

Answer 572

Contains enzymes for absorption of glucose, peptides, etc. -\> stain w/ PAS Extensive Brush Border

Answer 573

Reabsorption Secretion Reducing Urine Volume Create Hyperosmotic Fluid

Answer 574

Thick descending Loop of Henle

Answer 575

Short cells. Poorly developed brush border. Less complex basolateral/lateral interdigitations than PCT Fewer/smaller mitochondria

Answer 576

Proximal Straight Tubule

Answer 577

Longer in juxtamedullary nephrons and are found in the medulla

Answer 578

shape of cells, their content of organelles, the depth of their tight junctions, and their water permeability

Answer 579

thin simple squamous in both ascending and descending limbs in short nephrons Squamous cells –modified in various parts of loop of Henle

Answer 580

Thin Segment of Loop of Henle

Answer 581

Help maintain osmotic gradient in the interstitium

Answer 582

causes loss of water from the arterioles as they descend into medulla Movement of water into the venules as they ascend

Answer 583

Vasa Recta

Answer 584

Found in the medullary ray of the cortex. Also found in outer medulla.

Answer 585

Short cells Blunted Brush Border Less complex basolateral/lateral interdigitations Smaller cells w/ less mitochondria in cytoplasm

Answer 586

Thick Ascending Limb

Answer 587

medullary rays

Answer 588

Transport ions from lumen of tubule to interstitium via. active transport. Reabsorption of other ions: Ca²⁺and Mg²⁺

Answer 589

Top line: Straight descending Yellow Circle: Straight ascending

Answer 590

Simple Cuboidal

Answer 591

Smaller cells therefore more nuclei visible

Answer 592

less acidophilic

Answer 593

Arrows: Distal Convoluted Tubule

Answer 594

Reabsorb Na+, Bicarbonate, Ca2+ (PTH) Secrete K+, H+, Ammonium Na/K-ATPase activity Water impermeable

Answer 595

PCT: more microvilli DCT: more basal folds

Answer 596

Modified cells of the distal straight tubule

Answer 597

vascular pole

Answer 598

Narrow and taller

Answer 599

Senses changes in Na+ concentration within the lumen of the distal tubule sends signals to the juxtaglomerular cells in afferent arteriole

Answer 600

modified smooth muscle cells

Answer 601

Macula Densa

Answer 602

Produce renin → cleaves angiotensinogen to angiotensin I

Answer 603

stimulates reabsorption of Na+ and secretion of K+ by connecting tubules and collecting ducts

Answer 604

Connects DCT to cortical collecting duct

Answer 605

Gradual transition of epithelium from DCT to collecting duct

Answer 606

Secretes of K+ into lumen→ partly regulated by aldosterone.

Answer 607

medullary ray of the cortex.

Answer 608

Lined by simple cuboidal epithelium with prominent cell boundaries

Answer 609

simple cuboidal transitions to simple columnar epithelium

Answer 610

- Most abundant: Pale staining - Single primary cilium: short scattered microvilli - Abundant ADH regulated Aquaporins (AQP- 2) channels - true basal infoldings

Answer 611

- Fewer - Not present in the inner medulla - Microvilli and microplicae at apical cytoplasm - Secretion of H+ or bicarbonate - Only found in outer medulla

Answer 612

- 200 to 300 µm in diameter. - Empties at the area cribrosa at the apex of a renal papilla.

Answer 613

fibroblasts mononuclear cells

Answer 614

resemble myofibroblasts present along the descending vasa recta

Answer 615

transit and storage of urine

Answer 616

minor and major calices renal pelvis ureter urinary bladder urethra

Answer 617

a) mucosa b) muscularis c) adventitia

Answer 618

on the apical surface of urothelium contains crystalline uroplakin which contributes to the permeability barrier

Answer 619

Flattened also called fusiform vesicles

Answer 620

Urothelium + lamina propria

Answer 621

inner longitudinal middle circular outer longitudinal (only present in distal end)

Answer 622

peristaltic waves

Answer 623

Mucosa Muscularis Adventitia/serosa

Answer 624

Epithelium + fibroelastic CT

Answer 625

thick and consists of smooth muscle arranged in an inner longitudinal, middle circular and outer longitudinal layer oblique orientation of muscles

Answer 626

Urinary Bladder. Arrow: ureter entering bladder

Answer 627

preserve the osmolar gradient of the interstitium keeps the pO2 of the medulla lower than that in the cortex

Answer 628

proximal tubule into the peritubular capillaries entering into the renal vein

Answer 629

specialized chemoreceptors cells in the walls of the distal convoluted tubule, which respond to changes in solute concentration (especially Na)

Answer 630

modified smooth muscle cells located in the walls of the afferent arteriole immediately proximal to the glomeruli

Answer 631

1. Entothelium of glomerular capillaries 2. Glomerular basement embrane 3. Podocyte layer

Answer 632

numerous fenstrations no diaphragm

Answer 633

Fused basal lamina of the endothelial cells and podocytes Rich in heparin sulphate to repel negatively charged molecules

Answer 634

visceral layer of the Bowman ’s capsule Modified highly ramified epithelial called podocytes Primary processes Secondary processes Teritary processes Filtration slits between pedicels (~40 nm)

Answer 635

Water Sodium Glucose Inulin Myoglobin Albumin

Answer 636

That's why Ablumin isn't well filtered, even though it's small enough for the membrane pores. negative charge and the electrostatic repulsion exerted by negative charges on the glomerular capillary wall proteoglycans.

Answer 637

∆P= (P_GC + π_BS) – (P_BS + π_GC)

Answer 638

product of hydraulic conductivity and surface area of the glomerular capillaries directly proportional to GFR Not primary mechanism for impacting GFR

Answer 639

increasing thickness of the glomerular capillary basement membrane and eventually by damaging capillaries

Answer 640

kidney disorder that causes your body to excrete too much protein in your urine. Increase in onocotic pressure in the bowman’s space. Favors filtration

Answer 641

Kidney stone causing obstruction and dilation of urinary system. Increase in hydrostatic pressure within the bowman space Opposes filtration

Answer 642

glomerular plasma proteins that are not filtered get concentrated.

Answer 643

The 1/5 of protein-free fluid that filters into the Bowman’s capsule

Answer 644

The greater the FF, the higher the oncotic pressure in the peritubular capillaries.

Answer 645

Oncotic pressure

Answer 646

120/600 = 0.2 = 20%

Answer 647

1. Flow decreases 2. Pressure upstream increases 3. Pressure downstream decreases

Answer 648

1. Flow increases 2. Pressure upstream decreases 3. Pressure downstream increases

Answer 649

maintain a relatively constant GFR allow for precise control of renal excretion of water and solutes.

Answer 650

Needed substances cannot be reabsorbed quickly enough and is lost in the urine

Answer 651

Too much reabsorption occurs inclusive of waste products such as Urea

Answer 652

changes in the resistance of the afferent arteriole

Answer 653

Myogenic Responses Tubuloglomerular feedback (TGF)

Answer 654

intrinsic property of smooth muscle is to contract when stretched

Answer 655

increase in RBF and GFR

Answer 656

dilates the arteriole increase in renal blood flow and GFR

Answer 657

Triggers adenosine and ATP secretion Leads to vasoconstriction of the afferent arteriole decrease renal blood flow and GFR

Answer 658

Nephron starts in corpuscle (glomerulus and Bowman's) Ultrafiltrate enters capsule Passed through tubules to collecting ducts, gets filtered. Forms urine

Answer 659

starling forces

Answer 660

process by which solutes and water are removed from tubular fluid, and moved into blood.

Answer 661

Transfer of materials from peritubular capillaries to renal tubular lumen

Answer 662

Substances not filtered and not completely reabsorbed are excreted in urine Substance that is filtered and then secreted is excreted in large amounts in the urine b/c it comes from 2 places in nephron

Answer 663

Filtered Load = Excretion rate Amount filtered and amount excreted per unit time are always the same. There is no net tubular modification.

Answer 664

Filtered Load = GFR x P_x Amount/time = (volume/time) x (amount/volume)

Answer 665

Excretion = U_xx V Amount/time = (amount/volume) x (volume/time)

Answer 666

Filtered Load \> Excretion. always. glucose, sodium, urea

Answer 667

" If a substance is completely reabsorbed in the nephron, the rate of filtration and the rate of reabsorption are **equal**, and the excretion rate is **zero**. "

Answer 668

excretion is less than filtration

Answer 669

Filtered Load \< Secretion. always. PAH, creatinine

Answer 670

freely filtered. very small amount secreted.

Answer 671

Filtered Load - Excretion (GFR x P_x) - (U_xx V) (K_f x ∆P x P_x) - (U_xx V)

Answer 672

percent of plasma being filtered

Answer 673

FF= GFR/RPF

Answer 674

volume of plasma that enters the kidney in a minute

Answer 675

FF=120/600 FF= 0.2

Answer 676

RBF= RPF/(1-HCT)

Answer 677

RPF= RBF x (1-HCT)

Answer 678

Simple diffusion Facilitated diffusion Active Transport

Answer 679

"2/3 gets reabsorbed Na/K-ATPase, stimulated by **Catecholamines** and **angiotensin II**. facilitates **reabsorption** "

Answer 680

2/3 of the filtered water, potassium and almost 2/3 of the filtered chloride follow the sodium (leaky system to these substances) of the large percentage of bicarbonate reabsorbed here

Answer 681

"As water is reabsorbed from tubule, urea concentration in the tubular lumen **increases** This increase creates **a concentration gradient favoring the reabsorption of urea**. "

Answer 682

"1. 2^o Active Transport linked to sodium 2. 2^o Active Transport 3. Metabolite concentration should be **zero** in tubular fluid "

Answer 683

Combines with Free H+ in lumen and is converted to CO₂ and H₂O H+ is pumped into lumen. Exchange with Na+. (H+ ATPase) CO2 crosses luminal membrane. Combines w/ H₂O. Reforms H+ and Bicarbonate H+ pumped back into the lumen while bicarbonate pumped through basolateral membrane

Answer 684

H+ secretion and the activity of CA

Answer 685

Angiotensin II

Answer 686

medications designed to increase the amount of water and salt expelled from the body as urine.

Answer 687

Proximal Convoluted Tubule

Answer 688

reduces bicarbonate reabsorption and the activity of the Na+/H+ antiport. Sodium remains in the lumen and therefore water remains in the lumen. They get excreted by urine

Answer 689

PCT recaptures 2/3 of filtered sodium

Answer 690

helps protect extracellular volume despite any GFR changes

Answer 691

Permeable to water (20% of filtered water) Impermeable to solute

Answer 692

Impermeable to water

Answer 693

Impermeable to water solutes transported out (25% of the filtered load of sodium, potassium and chloride absorbed here)

Answer 694

Na/k+- ATPase pump creates a relative sodium deficiency intracellular, which provides a favorable gradient for the movement of sodium across the luminal surface into the cell via Na/Cl/K+ cotransporter and drives the Na/H+ antiport, which allows more H+ secretion, which leads to more bicarbonate absorption

Answer 695

K+ channel in lumen membrane. Allows for diffusion of ino back to lumen. Positive lumen potential promotes sodium, calcium, and magnesium reabsorption via a paracellular pathway

Answer 696

blocking Na/CL/K+ co-transporter in the luminal membrane = increase urine output of sodium, chloride, potassium and other electrolytes as well as water

Answer 697

1. incr. soulte quantity. decr. osmotic gradient. prevent water reabsorption 2. Disrupt countercurrent multipler system. decr. ion absorption, which impair ability of kidney to concentrate or dilute urine

Answer 698

Reabsorbs Na Cl Ca Na/K+-ATPase creates a low intracellular concentration allowing NaCl to cross apical membrane via Na/Cl- symporter impermeable to water. osmolality decreases. Lowest of the whole nephron.

Answer 699

Enters cell from luminal fluid passively through Ca channels. PTH regulated Actively extruded into the peritubular fluid via Ca2+-ATPase or 3Na/Ca2+ antiporter Cells have calcium binding protein calbindin. Facilitates reabsorption. Incr. by Vit.D. Enhance PTH action on DCT.

Answer 700

block NaCl symporter in DCT. this enhances Ca reabsorptionin DCT, and can lead to hypercalcemia.

Answer 701

Macula densa cellssense tubular flow and GFR. Send signals back to afferent/efferent arteriole to constrict/dilate to keep GFR normal.

Answer 702

Luminal Membrne contains eNaC. Influx of Na down concentration gradient (created by Na/k+-ATPase) Some chloride does not follow sodium, creating a negative luminal potential causing potassium secretion Aldosterone activates the mineralcorticoid receptor on these cells

Answer 703

1. Increasing luminal ENaC channels 2. Increase ENaC opening time 3. Stimulates/Augments Na/K+-ATPase

Answer 704

aquaporins ADH

Answer 705

1. pumps H+ into the lumen. 2. buffers, phosphate and ammonia 3. poorly reabsorbed and is thus excreted 4. bicarbonate is added to the body (new bicarbonate) 5. excess aldosterone causes Metabolic Alkalosis

Answer 706

1. Blocking ENaC channels 2. Blocking aldosterone receptors 3. Blocking the production of aldosterone e

Answer 707

it could result in dehydration or overhydration

Answer 708

reabsorption or secretion through the tubules This occurs under the influence of hormonal control: ADH & aldosterone.

Answer 709

Blood Volume (BV) = PV/(1 – Hct)

Answer 710

1/3rds TBW OR Interstitial fluid (ISF)+ Plasma volume(PV)

Answer 711

2/3rds TBW OR TBW - ECF

Answer 712

60% weight in kg

Answer 713

55% weight in kg

Answer 714

2.2 lbs 1L of water

Answer 715

dilution technique

Answer 716

Distributes across all body compartments Useful for measuring TBW

Answer 717

Remain in plasma Too large to cross capillary walls Useful for measuring plasma volume(PV)

Answer 718

Remain in ECF & can’t cross cell membranes Useful for measuring ECF ECF=amount of mannitol in plasma/Plasma [mannitol].

Answer 719

- millimoles(mmol) - milligrams(mg) - units of radioactivity-millicuries(mCi)

Answer 720

known quantity dye is injected & allowed to equilibrate. Then the concentration of dye is measured in plasma Then the volumes are calculated

Answer 721

(amount injected - amount excreted)/concentration in plasma V = Q/C

Answer 722

assess compartmental fluid balance

Answer 723

the ECF volume. may or may not alter ICF

Answer 724

changes in ECF osmolarity

Answer 725

Isosmotic Isotonic NaCl

Answer 726

Hyperosmotic High intake of NaCl

Answer 727

Hyposmotic SIADH

Answer 728

Isosmotic Diarrhea

Answer 729

Hyperosmotic Water depravation

Answer 730

Hyposmotic Adrenal Insufficiency

Answer 731

non-cellular liquid layer of the blood obtained by sedimentation and centrifugation.

Answer 732

Prepared in laborotory whole blood coagulates, is centrifuged, and coagulation factors removed. the serum is plasma minus coagulation factors.

Answer 733

Charge (Serum Protein Electrophoresis) Density (Densitometry)

Answer 734

alpha beta gamma

Answer 735

a1: Antitrypsin, a Fetoprotein, Transcortin, Retinol binding protein a2: Macroglobulin, Ceruloplasmin, Hepatoglobin

Answer 736

Transferrin Hemopexin LDL

Answer 737

Immunoglobulins. IgG, IgM, IgA, IgD, IgE

Answer 738

maintains osmotic pressure

Answer 739

Calcium ions Free Fatty Acids Bilirubin hormones drugs

Answer 740

Enzymes Transport Inhibitor Proteins

Answer 741

Immune response (Immunoglobulins)

Answer 742

3.5-5 g/dL

Answer 743

Maintain osmotic pressure Prevent edema Transport of lipids Bind and transport Calcium ions

Answer 744

appear normal. do not show edema. Other serum proteins regulate the osmotic pressure early on.

Answer 745

Decreased albumin synthesis Increased albumin loss

Answer 746

Dietary deficiency of proteins. Frequent Infections. Decreased albumin synthesis

Answer 747

Severe liver damage impairs albumin synthesis

Answer 748

Glomerulus Basement Membrane gets damaged Albumin gets lost in urine.

Answer 749

Blood vessels get damaged There is a huge serum loss. There is increased albumin loss (because albumin is in serum)

Answer 750

a₁ antitrypsin: \>90%

Answer 751

serum protein released by liver inhibits neutrophil elastase in lung alveoli

Answer 752

pulmonary and liver disease

Answer 753

Neutrophils activated Release neutrophil elastase Reactive Oxygen Species modify the structure of a₁-AT reduce binding to neutrophil elastase Elavated neutrophil elastase destroys alveoli elastin

Answer 754

a1 globulin. abundant in fetal plasma. low albumin levels. Functions similar to albumin later in fetal life.

Answer 755

marker for possible fetal abnormalities.

Answer 756

amniotic fluid

Answer 757

A small amount of amnoitic fluid can cross the placenta, allowing AFP to be measured in maternal serum.

Answer 758

neural tube defects

Answer 759

Down Syndrome

Answer 760

transports 75% of cortisol in blood.

Answer 761

Transports retinol from liver to peripheral tissues

Answer 762

inhibits plasmin and thrombin

Answer 763

damage to GBM yields a greater than 10 fold increase in a2 Macroglobulin (A2M) A2M excess can't get lost in urine because it is too big. Albumin is tiny, so that one gets lost in this disease.

Answer 764

Copper Transport in blood Ferroxidase activity

Answer 765

very low blood levels of ceruloplasmin hepatic copper binding is deficient Apoceruloplasmin (without copper) is released into the blood where it is degraded.

Answer 766

Ferric Iron

Answer 767

Macrohages degrade heme, release ferrous iron. Ferrous iron can cause free radicals. Ceruloplasmin oxidizes ferrous iron, forming ferric iron. Ferric iron bound to transferrin and transported in blood.

Answer 768

binds to free hemoglobin dimers in the blood and prevents loss of Hb in urine.

Answer 769

Haptoglobin-hemoglobin complex is taken up by macrophages.

Answer 770

b-globulin which transports ferric iron in blood especially between: intestine, liver, bone marrow and spleen.

Answer 771

found in patients with iron deficiency as fewer sites of transferrin are filled.

Answer 772

found in patients with iron overload (High serum iron leads to increased binding).

Answer 773

B-globulin that binds to free heme in the blood Prevents the loss of heme-iron

Answer 774

A. Heme-induced damage of plasma membranes B. Heme usage by microbes

Answer 775

b-globulins

Answer 776

plasma cells (Activated B-lymphocytes)

Answer 777

found in blood and lymph first antibody to be produced in response to an antigen (infection).

Answer 778

(smallest and most common) found in all body fluids produced by repeated exposure to the same antigen cross the placenta giving passive immunity to the fetus and newborn

Answer 779

found in the lung, skin, mucous membranes secreted in allergic reactions.

Answer 780

found in body secretions protects body surfaces. main antibody found in human milk.

Answer 781

role in serum is uncertain.

Answer 782

tumor of the plasma cells example of monoclonal gammopathy

Answer 783

presence of high amounts of a single type of immunoglobulin produced by a malignant clone of the cell.

Answer 784

changes in the synthesis of serum proteins.

Answer 785

overall positive response to prevent damage following an injury

Answer 786

Serum proteins that are synthesized in larger amount as they reduce inflammation and deprive microbes of iron.

Answer 787

a1 -Antitrypsin Ceruloplasmin Haptoglobin Hemopexin

Answer 788

Serum proteins that are synthesized in smaller amount in order to preserve amino acids for the increased synthesis of positive acute phase reactants.

Answer 789

Albumin Transcortin Retinol-binding protein Transferrin

Answer 790

acute phase reactant does not lead to a peak in SPEP

Answer 791

kidneys can either retain or excrete water by osmoregulation

Answer 792

30 – 1200mOsm/L

Answer 793

Solute wastes – 600mOsm/day must be excreted in urine.

Answer 794

minimum urine volume that needs to be excreted /day

Answer 795

1. Countercurrent multiplication 2. Urea recycling 3. Slow rates flow

Answer 796

Ascendng limb of loop of henle.

Answer 797

The loop of Henle deposits more salt than water in the intersitium

Answer 798

Medullary interstitium becomes hypertonic – potential for urine concentration! Tubular fluid becomes hypotonic – potential for urine dilution!

Answer 799

- Descending LH is water permeable - Ascending LH is impermeable to water, & also transports Na+ & Cl actively into the interstitium

Answer 800

- ATP dependent solute transport - Increase in medullary osmolarity - Slow tubular fluid flow

Answer 801

- Urea is necessary for increasing osmolarity of Inner medulla - Urea Contributes to half the hyperosmotic gradient - Urea is passively reabsorbed from the tubule( MCD) - Requires ADH

Answer 802

urea is by product of protein metabolism

Answer 803

In presence of ADH As H2O is reabsorbed from Collecting Duct, Urea concentration rises ADH upregulates transporters (UTA1 and UTA3) Urea diffuses passively via transporters into the interstitium Some of it is secreted into both thin & thick LoH

Answer 804

50 % is absorbed in proximal tubule. Of the 50% in the lumen after recycling 20% is excreted

Answer 805

Collecting duct is impermeable to water No Urea reabsorption Medulla slightly hyperosmotic

Answer 806

Collecting duct permeable to water (AQP2) Urea reabsorption (MCD) Medulla highly hyperosmotic

Answer 807

V₂ receptor mutations, AQP2 mutations acquired eg. Lithium therapy

Answer 808

congenital lack of ADH production acquired e.g. Head trauma

Answer 809

osmolar clearance (C_osm ).

Answer 810

C_osm= (U_osm x V)/P_osm U_osm - urine osmolarity P_osm - plasma osmolarity V - flow rate

Answer 811

The volume of free water cleared from plasma, & excreted in urine per unit time

Answer 812

concentrate or dilute urine

Answer 813

C_H2O=V - ((U_osm x V)/P_osm)

Answer 814

that rate at which solute free water is being excreted

Answer 815

urine is iso-osmotic to plasma

Answer 816

hypo-osmotic urine produced

Answer 817

hyperosmotic urine produced

Answer 818

sodium intake & excretion

Answer 819

- Renin Angiotensin Aldosterone System (RAAS) - Sympathetic NS - Starlings forces - Atrial Natriuretic Peptide (ANP)

Answer 820

Baroreceptors Renin Release Starlings Forces Macula Densa

Answer 821

Promotes ADH release Evokes thirst Promotes vasoconstriction: systemic arterioles, intrarenal afferent & efferent arterioles incr. Proximal tubule Na+ reabsorption incr. Distal tubule Na+ reabsorption via Aldosterone

Answer 822

Efferent. Incr. Filtration Fraction

Answer 823

incr: - afferent arteriole resistance - renin release - proximal tubule Na+ reabsorption

Answer 824

"Atrial Natriuretic Peptide ANP Starlings Forces ![]() "

Answer 825

Released by cardiac Atrial myocytes Receptors located in the venous system

Answer 826

Atrial stretch from excess blood volume (BV or PV)

Answer 827

Vasodilate afferent arterioles & constricts efferent arterioles thereby ↑ GFR Inhibits Na+ reabsorption directly at the medullary CD

Answer 828

bone ECF intracellular

Answer 829

cardiovascular, gastrointestinal & neuromuscular function Reduces PTH effectiveness leading to hypocalcemia.

Answer 830

25% is reabsorbed in proximal tubule 65% is reabsorbed around loop of Henle A small amount in distal tubule through magnesium ion channel on the luminal side

Answer 831

extracellular calcium sensing receptor (CaR).

Answer 832

Ca2+ ATPase pump or Na+ -Ca2+ exchanger

Answer 833

proximal tubule ThALH via para cellular route distal tubule PTH

Answer 834

Insulin accelerates K+ uptake into cells Insulin/glucose used clinically in treatment of hyperkalemia

Answer 835

Intense exercise releases K+ . High levels of epinephrine is also released during exercise which promotes K + entry into cells

Answer 836

70% is reabsorbed in PCT 20% Is reabsorbed in ThALH Rest is regulated in DCT & CCD & is secreted into the lumen

Answer 837

" 1: Homozygous Normal MM 2: Heterozygous MZ 3: Compound Heterozygous SZ 4: Homozygous ZZ ![]()"

Answer 838

AAT is synthesized into ER through secretory pathway Released into circulation

Answer 839

AAT is Synthesized into ER Sometimes leads to formation of AAT polymers ER retention causes cellular stress Chronic hepatocellular injury

Answer 840

‒Advise patients not to smoke ‒Avoidance of second-hand smoke Intravenous administration of A1AT protein Slows progression of COPD

Answer 841

Gain of Function

Answer 842

Loss of Function

Answer 843

Acute Inflammation

Answer 844

Prolonged Inflammation

Answer 845

No Disease. Normal Serum Protein Electrophoresis

Answer 846

Multiple Myeloma (Monoclonal Gammopathy)

Answer 847

Nephrotic Syndrome

Answer 848

Hypogammaglobulinemia

Answer 849

a1-Antitrypsin deficiency

Answer 850

1. Albumin peak is reduced due to less hepatic synthesis 2. a1-peak is elevated due to positive acute phase reactant: a1-antitrypsin. 3. a2-peak is elevated due to positive acute phase reactants: haptoglobin, ceruloplasmin and a2- macroglobulin. 4. b-globulin peak: although hemopexin (positive acute phase reactant) is released, it does not lead to an elevated b-peak because at the same time there is less transferrin released by the liver (transferrin is a negative phase reactant). ? SOM.1

Answer 851

1. Albumin peak reduced to a much greater degree than acute inflammation 2. a1-peak is elevated due to positive acute phase reactant: a1-antitrypsin 3. a 2-peak is elevated due to positive acute phase reactants: haptoglobin, ceruloplasmin, a2-macroglobulin 4. . b-globulin peak is elevated due to even more hemopexin release than in acute inflammation 5. g-globulin peak is strongly increased, all immunoglobulins but mainly IgG.

Answer 852

1. Reduced Albumin Peak 2. a1 peak not elevated 3. a2 peak reduced 4. B-globulins and gamma globulins form B-g bridge All immunoglobulins elevated. Incr. IgA found in a specific liver disease

Answer 853

All peaks normal except elevated gamma due to presence of a high amount of one single immunoglobulin.

Answer 854

1. Albumin peak reduced due to urine loss 2. a1 peak reduced 3. a2 sharp increase due to 10 fold incr. of macroglobulin 4. B globulin peak decreased

Answer 855

loss of proteins with exceptions of a2-macroglobulin.

Answer 856

All peaks normak. Gamma peak absent.

Answer 857

All peaks normal. a1 peak absent

Answer 858

1. Severe dehydration. 2. : Liver damage, Nephrotic syndrome, severe protein malnutrition and Acute phase response.

Answer 859

1. Acute and chronic inflammatory diseases, liver cancer (AFP). 2. a1-AT deficiency, Nephrotic syndrome.

Answer 860

1. Acute and chronic inflammatory diseases, Nephrotic syndrome (macroglobulin). 2. Wilson disease (ceruloplasmin)

Answer 861

1. Hypercholesterolemia (LDL), Prolonged inflammation (hemopexin). 2. Nephrotic syndrome.

Answer 862

1. acute and chronic inflammatory diseases, acute infections, liver cirrhosis, multiple myeloma, and lymphoma 2. Hypogammaglobulinemia

Answer 863

remains at 1.0 because equal amount of sodium and water reabsorbed here.

Answer 864

Completely reabsorbed. therefore there TF/P approaches zero.

Answer 865

more avidly reabsorbed compared to water but the reabsorption is not complete

Answer 866

first 1/2 of tubule: sodium is reabsorbed with co-transport with amino acids, glucose and other solutes second 1/2 of tubule: little glucose and amino acids . Therefore sodium is not reabsorbed with chloride ions first half Cl conc around 105 mEq/L vs the second half conc around 140 mEq/L

Answer 867

it is reabsorbed from the tubule but to a much lesser extent than chloride ions, therefore the concentration increases ore greatly

Answer 868

it is filtered into the proximal tubule, NOT reabsorbed and is SECRETED. Hence the rapid rise in TF/P of Creatinine.

Answer 869

Descending: Water permeable Ascending: Solute Permeable

Answer 870

reabsorb Sodium and water, but secrete potassium. TF/P curve more steep than Na and Cl in the Distal Convoluted Tubule

Answer 871

Secrete Hydrogen into tubular lumen. Hydrogen combines w/ bicarbonate to form CO2 CO2 diffuses across luminal membrane CO2 dissociates and forms H+ and HCO3. H+ gets secreted and HCO3 gets reabsorbed.

Answer 872

mainly concerned with water reabsorption All solutes except Bicarbonate increase conc. Also has capacity for urea reabsorption

Answer 873

Freely filtered not secreted or reabsorbed TF/P increases moving along nephron

Answer 874

Freely filtered not reabsorbed. very little secreted. TF/P increases moving along nephron, close to inulin but slightly more.

Answer 875

Very step curve. Filtered Highly secreted.

Answer 876

Measure GFR & RPF determine renal handling of different substances

Answer 877

Volume of plasma cleared of a substance per unit time

Answer 878

C_x = (U_x x V)/P_x U_x= Urine Concentration P_x=Plasma Concentration V = urine flow rate (mL/min)

Answer 879

GFR like inulin

Answer 880

less than that of inulin ex.(Na+, Urea, Cl- )

Answer 881

greater than that of inulin ex.(PAH)

Answer 882

excretion \< filtered load

Answer 883

excretion \> filtered load

Answer 884

Endogenous (by-product of muscle metabolism) Released into blood at relatively constant rate plasma concentration is fairly stable; therefore only need one blood sample * Freely filtered ✓ * Not reabsorbed ✓ * Is secreted in small amounts (true Ccr normally overestimates GFR by ~10-20%)

Answer 885

it is also secreted & this ⁭incr urinary excretion by 20%, in the numerator of the clearance formula the colorimetric method measures other substances such as glucose leading to ⁭ 20% incr in the denominator in the clearance formula But since they cancel each other, no biggie.

Answer 886

Proportion of the filtered load that was excreted

Answer 887

Fractional excretion of Z (FEZ ) = rate of excretion of Z/rate of filtration of Z Clearance/GFR

Answer 888

Acidic drug pKa = 3.5

Answer 889

Basic Drug pK 7.9

Answer 890

– Buffers (First line) – Respiratory system (Second line) – Regulates PCO2 – Renal system (Third line) – Regulates HCO3 levels

Answer 891

Volatile acid major metabolic acid handled by lungs

Answer 892

Handled by the kidneys

Answer 893

"Buffering systems of body fluids (ECFand ICF) immediately combine with **acid/base** to prevent large changes in **[H+]**."

Answer 894

Within minutes to eliminate CO2 (H2CO3 ) from body

Answer 895

Slowest - hours/days to eliminate excess acid/base Most powerful

Answer 896

22-25 mEq/L (24mEq/L)

Answer 897

38-42mmHg (40 mmHg)

Answer 898

plasma [HCO3 -]

Answer 899

H+ ATPase K + -H+ ATPase secreted protons are buffered by HPO4 - and NH3 to form Acid Phosphate (NaH2PO4 - ) and NH4 + Cl

Answer 900

Aldosterone stimulates reabsorption of Na+ Stimulates K+ excretion in urine Stimulates renal tubular H+ ATPase--alkalosis

Answer 901

1. low 2. high 3. normal (Acute) high (Chronic)

Answer 902

1. high 2. very low 3. almost normal (acute) low (chronic)

Answer 903

1. low 2. low 3. low

Answer 904

Na-Cl-HCO3 8-16

Answer 905

Serum K+ is increased Plasma glucose: 500mg/dL Insulin deficiency in type I diabetes mellitus prevents K+ entry into ICF (K+ levels in ECF increase) – Remember, Insulin activates the Na-K ATPase

Answer 906

1. high 2. high 3. high

Answer 907

Renal system compensates, if it is functioning normally, by excreting more HCO3

Answer 908

Acute salicylate poisoning → stimulation of respiratory center Chronic salicylate poisoning results in metabolic acidosis – as a result of formation of weak acids

Answer 909

Patient has more than one acid-base disorder PCO2 and HCO3 move in opposite directions If the pH is normal and HCO3 and PCO2 are abnormal

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