Overview 3 Flashcards
1
Q
Trigone of the bladder is formed from what? x3
A
Formed from the orifices of the ureters and the urethra
2
Q
Epithelium of the bladder detrusor muscle is?
A
Transitional stratified epithelium
3
Q
Micturition is controlled by what region in the brain?
A
Pontine micturition centre
4
Q
Bladder fills with wee - activates what?
A
Stretch receptors of detrusor muscle
5
Q
Activation of detrusor stretch muscles results in what?
A
Feedback to pontine micturition centre
6
Q
Pontine micturition centre stimulates micturition via what nerve?
A
Pudendal nerve
7
Q
Nerve roots of the pudendal nerve are?
A
S2, 3, 4
8
Q
Action of pudendal nerve on the bladder is?
A
Relaxation of the sphincter of the bladder
9
Q
Micturition pudendal nerve involvement is somatic or autonomic
A
Somatic - conscious relaxation of the sphincter
10
Q
Relaxation of bladder sphincter results in activation of what?
A
Activation of parasympathetic reflex loop from pontine micturition centre
11
Q
Parasympathetic to bladder nerve and nerve roots?
A
Parasympathetic pelvic nerves - S2, 3, 4
12
Q
Detrouser muscle contraction involves what neurotransmitter?
A
Ach
13
Q
Detrouser muscle contraction involves what neurotransmitter receptor?
A
ACh M3
14
Q
Four stages of the bladder cycle are?
A
Bladder filling
First sensation to void
Normal desire to void
Bladder filling
15
Q
Two modes of the bladder cycle are?
A
Storage phase
Emptying phase
16
Q
Bladder spends most of the time in which stage of the bladder cycle?
A
Storage phase
17
Q
Normal outflow of urine per day is?
A
1500ml of urine
18
Q
Potential lower urinary tract symptoms? x4
A
Frequency/urgency/nocturia
Hesitancy/poor flow
Haematuria
Terminal dribbling
19
Q
Main symptoms of overactive bladder syndrome? x3
A
Urgency - with or without incontinence
Frequency
Nocturia
20
Q
Lower urinary tract symptoms are due to problems in which stage of the bladder cycle?
A
Storage phase
21
Q
How can prostate symptoms be measured? (scoring system name)
A
Internation prostate symptom score (IPSS)
22
Q
Score for mild IPSS?
A
0-7
23
Q
Score for moderate IPSS?
A
8-19
24
Q
Score for severe IPSS?
A
20-35
25
Benign prostate hyperplasia has what effect on the anatomy of the bladder?
Detrusor muscle hypertropies to compensate
26
Effect of BHP on the physiology of the bladder?
Hypertrophied detrusor muscle increases pressure - kidney damage
27
Too little fluid consumption has what effect on the bladder?
Too little - toxic concentration of urine irritates the bladder
28
Method to aid fluid management?
Voiding diary
29
Effect of caffeine consumption on bladder contraction?
Increases likelihood of bladder contraction
30
How does calcium act as a diuretic?
Releases calcium stores from the golgi body in the bladder wall
31
What is the effect of acidic drinks on the bladder?
Can irritate the bladder
32
Medical therapy for urinary problems x5
```
alpha blockers
5-alpha reductase inhibitors
PDE5 inhibitors
Antimuscarinincs
Combination
```
33
What would antimuscarinics be used to treat?
OAB
34
Finasteride is a?
5-alpha reductor inhibitor
35
Caffeine causes the release of calcium from which organelle in the cells of the bladder wall?
Golgi apparatus
36
Tamsulosin is a?
Alpha-blocker
37
Doxazosin is a?
Alpha-blocker
38
Dutasteride is a?
5-alpha reductor inhibitor
39
Terazosin is a?
Alpha-blocker
40
How to alpha-blockers treat BHP?
Relaxation of the smooth muscle of the bladder and the prostate to pass urine more easily
41
How to 5-alpha reductase inhibitors treat BHP?
Prevent further growth of the prostate gland and aim to shrink it
42
5-alpha reductor inhibitors and alpha blockers are both used in the treatment of?
BHP
43
Gold standard surgical treatment for LUTS?
Transurethral resection of the prostate
44
Three types of urinary incontinence are?
Stress UI
Urge UI
Mix of the two
45
What is stress UI?
Leakage on effort or exertion i.e. increased abdominal pressure
46
What is urge UI?
Leakage accompanied by urgency
47
Treatment for stress UI?
Surgery
48
Treatment for urge UI?
Medication
49
Two nerves that can be stimulated for the treatment of UI are?
Posterior tibial
| Sacral
50
Three medications that can be used for UI/OAB?
Anticholinergics
B3 adrenergics
Botox
51
What is the real name of botox?
Botulinum toxin A
52
Vaginal cones can be used in the treatment of what type of UI?
Stress
53
Neurological lesions between which two regions can lead to micturition problems?
Between the micturition centre in the pons and T12
54
What is acromegaly?
Excessive release of GH in the pituitary gland
55
First presentation of acromegaly is?
Enlargement of the hands and feet
56
Most common cause of acromegaly is?
Pituitary adenoma
57
GH is released from where?
Pituitary gland
58
Release of GH is stimulated by what hypothalamic hormone
GHRH
59
Release of GH is inhibited by what hormone?
Somatostatin
60
GH causes the release of what?
Insulin like growth factor
| IGF-1
61
GH causes release of IGF-1 in which three regions?
Liver
Bone
Muscle
62
Negative feedback to GH release is mediated by what?
IGF-1 release from the liver
63
General function of diuretic?
Increase urinary sodium and water loss
64
General mechanism of action of diuretic?
Reduces reabsorption of sodium at different sites of the nephron
65
Five classes of diuretic are?
```
Carbonic anhydrase inhibitor
Loop
Thiazide
Potassium sparing
Osmotic
```
66
Acetazolamide is?
Carbonic anhydrase inhibitor
67
Acetazolamide has function where in the kidney?
Proximal convoluted tubule
68
How commonly are carbonic anhydrase inhibitors used and why?
Weak diuretic - not commonly used anymore
69
Acetazolamide main uses? x3
Glaucoma
Epilepsy
Mountain sickness
70
Side effects of carbonic anhydrase inhibitors? X3
Metabolic acidosis
Sedation
Bone marrow suppression
71
Frusemide is?
Loop diuretic
72
Loop diuretics work at what part of the loop of Henle?
Thick ascending region
73
Loop diuretics work on what transporter?
Na+/Cl-/K+ transporter
74
Three indications for usage of loop diuretics?
Hypertension
Heart failure
Volume overload from CKD
75
Four side effects of loop diuretics?
Hypokalaemia
Dehydration and acute renal failure
Kidney stones
Deafness
76
Bumetanide is?
Loop diuretic
77
Bendroflumethiazide is?
Thiazide diuretic
78
Thiazide diuretic works at which transporter?
Na+/Cl- channel - prevents function
79
Thiazide diuretic at which region of the kidney?
DCT
80
Most potent diuretic is?
Loop diuretic
81
Hydrochlorothiazide is?
Thiazide diuretic
82
Main usage of thiazide diuretics?
Antihypertensives
83
Five s/e of thiazide diuretics
```
Hypokalaemia
Hypercalcaemia
Hyponatraemia
Hyperglycaemia
Hypercholesterolaemia
```
84
Two groups of potassium sparing diuretics are?
Epithelial Na+ channel antagonists
| Aldosterone antagonist
85
Amiloride is?
Potassium sparing diuretic - epithelial Na+ channel antagonist
86
Spironolactone is?
Potassium sparing diuretic - aldosterone antagonist
87
Potassium sparing diuretics work where in the kidney?
Collecting tubule
88
Three indications for amiloride usage?
Heart failure
Hypokalaemia
Cirrhosis
89
Two side effects of amiloride usage?
HypERkalaemia
| Hyponatraemia
90
Four indications for aldosterone inhibitor usage?
Hyperaldosteronism
Heart failure
Hypokalaemia
Cirrhosis
91
Main s/e of aldosterone inhibitor usage
Hyperkalaemia!!!!!!!!!!!!!!
92
What is an osmotic diuretic?
Any osmotically active molecule that is freely filtered in the glomerulus and is not reabsorbed by the tubules
93
Most important osmotic diuretic?
Mannitol
94
Two indications for osmotic diuretic?
Cerebral oedema
| Oliguric acute renal failure
95
Three main contraindications for diuretic usage?
Hypotensive
Dehydrated
Post surgery with poor urine output
96
Three s/e of osmotic diuretic usage
Pulmonary oedema
DKA
Disequilibrium syndrome
97
Mannitol works as a diuretic via what mechanism?
Water drag (osmotic diuretic)
98
Mannitol is absorbed where in the kidney?
Glomerulus
99
What are the three types of hormones?
Steroid
Peptide
Amine
100
Three regions an endocrine hormone may act?
Cell surface
Cytoplasm
Nucleus
101
Three effects of an endocrine hormone?
Increased hormone production
Release of stored hormone
Cell multiplication
102
What factor expression is required for adrenal gland development?
Steroidogenic factor 1
103
Five zones of the adrenal gland are?
```
Adrenal cortex
ZG
ZF
ZR
Adrenal medulla
```
104
Hormones produced by adrenal medulla?
Catecholamines adrenaline and noradrenaline
105
Hormones produced by ZG + eg
Mineralcorticoids e.g. aldosterone
106
Hormones produced by ZF + eg
Glucocorticoids e.g. cortisol
107
Hormones produced by ZR + eg
Androgens e.g. testosteone
108
Right hand adrenal gland shaped?
Pyramidal
109
Left hand adrenal gland shape?
Crescent
110
Adrenal gland blood supply?
Subscapular plexus from adrenal artery
111
ZG, ZF and ZR are found in which part of the adrenal gland?
Adrenal cortex
112
Adrenal gland responds to which three types of stress?
Starvation
Infection
Severe volume loss
113
CYP enzyme expressed at the glomerulosa is?
CYP11B2
114
CYP enzyme expressed at the fasciculata is?
CYP11B1
115
CYP enzyme expressed at the reticulosa is?
CYP17A1
116
Two factors causing release of aldosterone?
Low BP
| High potassium
117
Two hormones that can activate the mineralocorticoid receptor are?
Aldosterone
| Cortisol
118
Which out of aldosterone and cortisol can actually activate the mineralocorticoid receptor and why?
Aldosterone
Cortisol is inactivated to prevent it from binding
119
Aldosterone activates what channel?
Sodium and potassium ATPase - ENAC
120
Primary hyperaldosterone is known as?
Conn's syndrome
121
Three signs of Conn's syndrome
Hypertension
Suppressed plasma renin activity
Increased aldosterone secretion
122
Two causes of Conn's syndrome?
Aldosterone producing adenoma
| Bilateral adrenal hyperplasia
123
What is cortisone?
Inactivated form of cortisol
124
Can cortisone bind to the mineralocorticoid receptor?
No
125
Three signs of Liddle Syndrome
Hypertension
Hypokalaemia
Metabolic alkalosis
126
Cause of Cushing's syndrome? x4
Iatrogenic
ACTH releasing adenoma of pituitary
Cortisol secreting adrenal adenoma
Bilateral adrenal hyperplasia
127
What is the hormone corticotroph?
This is the same as ACTH
128
What is Cushing's syndrome?
Elevated levels of cortisol
129
What is Addison's syndrome?
Reduced levels of cortisol
130
Two causes of Addison's disease?
Autoimmune adrenal failure
| TB
131
Addisonian crisis is?
Failure to respond to stress - low BP, low glucose, low Na, high K
132
Treatment for Addison's disease? x2
Hydrocortisone - glucocorticoid
| Fludrocortisone - mineralocorticoid
133
Treatment for addisonian crisis?
IV fluid resuscitation
| IM hydrocortisone
134
Cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
135
Four consequences of lack of 21-hydroxylase?
Salt-losing
Adrenal insufficiency
Virilisation
Adrenal hyperplasia
136
Noradrenaline is important in what stress response?
Low BP
137
Adrenaline is important in what stress response?
Low blood sugar
138
Adrenaline and noradrenaline are metabolised by what enzyme?
COMT
139
Chromaffin cells are found where?
Adrenal medulla
140
Significance of chromaffin cells?
These are prone to tumour development
141
Alpha-1 receptors are found where?
Smooth muscle
| Endothelium
142
Function of alpha-1 receptor?
Vascular and smooth muscle contraction
143
Beta-1 receptors are found where?
Heart
144
Activation of beta-1 receptors? x2
Increase heart rate and strength of contraction
145
Beta-2 receptors are found where?
At the lungs - bronchioles
| Skeletal muscle
146
Activation of beta-2 receptors?
Relaxation of smooth muscle
147
Symptoms of catecholamine excess? x7
```
Hypertension
Dyspnoea
Headache
Tremor
Nausea and vomiting
Fatigue
Weight loss
```
148
Treatment for catecholamine excess? x2
Phenoxybenzamine
| Propranolol
149
What drugs should be avoided in those with catecholamine excess?
Opiates
150
T3 is called?
Liothyronine/triiodothironine
151
T4 is called?
Levothyroxine
152
Superior thyroid artery originates from?
External carotid artery
153
Inferior thyroid artery originates from?
Thyrocervical trunk from the subclavian artery
154
Superior thyroid vein drains to?
Internal jugular
155
Middle thyroid vein drains to?
Internal jugular
156
Inferior thyroid vein drains to?
Brachiocephalic vein
157
Thyroid follicles contain what substance?
Colloid
158
Cells of the thyroid gland are?
Thyroid follicular cell
159
Where does the thyroid gland originate from?
Branchial pouch
160
Which lobe of the thyroid gland is larger?
Right
161
Which lobe of the thyroid gland is first palpable in goitre?
Right
162
What does thyroglobulin contain and what is it's function?
Contains iodine for T4 production
163
Which thyroid hormone is first produced?
T4
164
Enzyme responsible for T4 conversion to T3?
Deiodinase enzymes
165
Three types of deiodinase enzymes are?
D1, D2, D3
166
Function of D1?
Conversion of T4 to T3 - plasma T3 production
167
Function of D2?
Conversion of T4 to T3 - local T3 production
168
Function of D3?
Can inactivate both T4 and T3 - T3 degredation
169
Where is D1 located? x4
Liver
Kidney
Muscle
Thyroid
170
Where is D2 located? x2
Brain
| Pituitary
171
Where is D3 located? x3
Brain
Placenta
Foetus
172
Which of the deiodinase enzymes are downregulated/upregulated in hypothyroidism?
Upregulate D2
| Downregulate D1 and D3
173
Which of the deiodinase enzymes are downregulated/upregulated in hyperthyroidism?
Down regulate D2
| Upregulate D1 and D3
174
Function of deiodinase enzyme?
Removal of an iodine for conversion of T4 to T3
175
Where is the majority of T4 converted to T3?
Liver
176
In which organ is regulation of T3 levels the most important?
Brain
177
T4/T3 - which is produced by the thyroid gland?
T4
178
T4/T3 - which is the active thyroid hormone?
T3
179
How many more times potent is T3 than T4?
3/4 times
180
Significance of raised thyroid binding globulin?
Signifies reduced levels of free thyroid - more is bound to the globulin
Increased activity fo the thyroid gland to produce T4
181
Physiological cause of raised thyroid binding globulin?
Pregnancy
182
Thyrotoxicosis is?
Too much thyroid hormone
183
Hyperthyroidism is?
Overproduction of thyroid hormone - leads to thyrotoxicosis
184
Hyperthyroidism cardiac effect?
AF
185
Hyperthyroidism effect on metabolism? x6
```
Increased BMR
Increased appetite
Heat intolerance
Protein and lipid degredation
Weight loss and myopathy
Hyperglycaemia
```
186
Hyperthyroidism effect on nervous system? x2
Nervousness
| Seizures
187
Hyperthyroidism effect on the eyes? x3
Lid lag
Proptosis
Widening eyes
188
Hyperthyroidism effect on skin? x4
Plumber's nails
Warm and moist skin
Vitiligo
Pretibial myxodoedema
189
Hyperthyroidism effect on bone? x3
Accelerated osteoclast activity
Hypercalcaemia
Osteoporosis
190
Hyperthyroidism - haematological effect?
Pernicious anaemia
| B12 deficiency
191
Hyperthyroidism effect on reproduction? x2
Oligomenorrhoea
| Erectile dysfunction
192
What is Graves disease?
Overactive thyroid gland - leads to thyrotoxicosis
193
Four risk factors for Graves' disease?
HLA status
Infection
Stress
Female sex
194
Three treatments used in management of Graves?
Thionamide drugs
Radioactive Iodine
Thyroidectomy
195
Name two thionamide drugs
Propylthiouracil
| Carbimazole
196
Signs of hypothyroidism?
```
Reduced sweat and sebum
Hair loss and wispy
Brittle nails
Bradycardia
Reduced appetite
Constipation
Slow relaxing reflexes
Growth retardation
Reduced BMR
Reduced GFR
Reduced libido
Erectile dysfunction
Hypoglycaemia
```
197
Which GLUT expression is reduced in hypothyroidism?
GLUT4
198
Causes of hypothyroidism x4
Hashimoto's disease
Endemic goitre
Lithium
Hypopituitarism
199
Histological feature of Hashimoto's thyroditis?
Lymphocytic infiltration
200
AST/ALT ratio of what signifies liver cirrhosis?
AST/ALT ratio >1
201
When does cirrhosis occur?
This is the end stage to any liver disease
202
Wavelength of x-rays are?
0.01-10 nanometres
203
Effect of x-rays on DNA?
Damage to DNA
204
Why is ultrasound used more than x-rays in urology?
X-rays for hard materials
| Ultrasound - soft materials - liquid urine
205
What is the main role of MRI in urology?
Prostate imaging
206
Two advantages of nuclear imaging?
Can give function and obstruction information rather than just static information
Can also give static information
207
Two routes of endoscopy?
Natural hole
| Laparoscopy - use a new hole
208
Glomerulus afferent and efferent arteriole - which is under the greatest pressure?
Afferent
209
What volume of plasma is filtered per day?
180L
210
Normal volume of urine per day?
1-2L
211
Five factors that determine the filtrate through glomerulus?
```
Net filtration pressure
Podocyte slit pores
Size of the molecule
Charge of the molecule
Negative charge of the GBM glycoproteins
```
212
Molecular weight of proteins that are cut off from passing through glomerulus?
>52,000 daltons
213
What is the molecular weight of albumin?
69,000 daltons
214
GFR value per minute?
120mL
215
Three stages to measuring clearance of a substance?
Measure concentration of creatinine in plasma
Collect urine for fixed time period - urine flow
Measure concentration of creatinine in collected urine
216
Gold standard for measurement of GFR is?
Nuclear medicine scan
217
Four variables of the MDMR equation?
Creatinine
Age
Sex
Race
218
Creatine is produced by what?
Muscle
219
Effect of creatinine levels in muscular individuals?
They will have raised creatinine levels
220
Effect of trimethoprin drug on creatinine?
Inhibits tubular secretion of creatinine
221
Anatomy of PCT differs to that of DCT how?
PCT has apical brush border - microvilli
222
Glucose exceeding the glucose threshold results in what change in the urine?
Presence of glucose in the urine
223
What is Gitelman's defect?
Problem at the DCT
224
What is Bartter type 1 defect?
Problem at the thick ascending loop of Henle
225
Superior rectal vein drains to where?
Inferior mesenteric vein
226
Inferior rectal vein drains to where?
Internal iliac vein
227
Two veins that form the hepatic portal vein are?
SMV
| Splenic vein
228
Inferior mesenteric vein joins onto what vein?
Splenic vein
229
Pancreatoduodenal artery is a branch of what artery?
Gastroduodenal artery
230
Vertebral level of kidneys?
T12-L3
231
Which renal vein can you see extending in a CT?
Left renal vein crosses anterior to the aorta
232
Visceral layer of Bowman's capsule composed of?
Podocytes
233
Parietal layer of Bowman's capsule composed of?
Simple squamous epithelium
234
Graves; disease is hypo or hyperthyroidism?
Hyperthyroidism
235
How to tell apart collecting duct from loop of Henle histology?
Cells of the loop of Henle more spaced out and cells of collecting duct much closer together
236
Cause of nutmeg liver?
Right sided heart failure
237
Cirrhosis causes what in the liver?
Fibrosis of the liver
238
Fibrotic tissue of the liver composed of what component?
Type 1 collagen
239
Cirrhotic live contains what collagen type?
Type 1
240
Renal artery branches off of the aorta at what level?
L1
241
Aorta bifurcates into common iliac arteries at what level?`
L4/L5
242
Gonadal artery (vaginal/testicular) leaves aorta at what level?
L2
243
Catechalamines are produced from teh adrenal medulla or the adrenal cortex?
Medulla
244
GFR zones are part of teh adrenal medulla or teh adrenal cortex?
Cortex
245
Right gonadal vein drains into?
IVC
246
Left gonadal vein drains into?
Left renal vein
247
Three hormones secerted by the thyroid gland are?
T3
T4
Calcitonin
248
Cells that secrete hormone calcitonin are?
Parafollicular cells in the thyroid
249
Acinar cells are located in which organ?
Pancreas
250
Source of middle rectal artery?
Internal iliac artery
251
Source of inferior rectal artery?
Internal pudendal artery
252
Epithelium of renal papilla?
Transitional
253
Tissue that composes a cirrhotic nodule is?
Dense irregular fibrocollagenous tissue
254
Location of follicular cells vs. parafollicular cells
Both in thyroid gland
Follicular cells - within thyroid follicle
Parafollicular cells - around thyroid follicles
255
Parafollicular cells of thyroid secrete?
Calcitonin hormone
256
Follicular cells of thyroid secrete?
Hormones T3/T3
257
Papillae form in the thyroid gland in which condition?
Grave's disease
258
Left suprarenal veins drain to?
Left renal vein
259
Parafollicular cells are also known as?
C cells
| secretion of Calcitonin
260
Six structures found in the cavernous sinus are?
```
CNIII
CNIV
CNV - V1
CNV - V2
CNVI
```
+ Internal carotid artery
261
Acinar cells are located in which organ?
Pancreas
262
What is the renal papilla?
Region where renal medullary pyramids empty into the minor calyx
263
What empties into minor calyx from renal medullary pyramid?
Urine
264
Tissue that composes a cirrhotic nodule is?
Dense irregular fibrocollagenous tissue
265
Central veins of the liver are found where?
At the centre of hepatic lobules
266
Origin of uterine artery?
Internal iliac artery
267
Internal iliac artery - two terminal branches?
Inferior gluteal artery
| Internal pudendal artery
268
Origin of vaginal artery?
Internal iliac artery
269
What are gallstones made from?
Cholesterol
270
Function of bile is?
Transportation to aid fat digestion
271
Obstruction where in the biliary tree would cause jaundice?
Common bile duct
272
Passage of bile is?
From the liver to the duodenum (half from the liver is stored in the gallbladder)
273
Two ketogenic amino acids are?
Leucine
| Lysine
