Physio Genesis 1 Flashcards by Frankie Aguinot

Q

Most common component

protein
cholesterol

A

protein

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Q

Most important component

protein
cholesterol

A

cholesterol

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Q

tight cellular adhesion

macula adherens (desmosomes)
zonula adherens
zona occludens (tight junctions)
gap junctions

A

macula adherens (desmosomes)

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Q

equivalent in cardiomyocytes is fascia adherens

macula adherens (desmosomes)
zonula adherens
zona occludens (tight junctions)
gap junctions

A

zonula adherens

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Q

barrier to movement of proteins across membranes

macula adherens (desmosomes)
zonula adherens
zona occludens (tight junctions)
gap junctions

A

zona occludens (tight junctions)

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Q

bridge for sharing small molecules between cells

macula adherens (desmosomes)
zonula adherens
zona occludens (tight junctions)
gap junctions

A

gap junctions

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Q

functional unit is connexon

macula adherens (desmosomes)
zonula adherens
zona occludens (tight junctions)
gap junctions

A

gap junctions

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Q

movement across apical and basolateral sides

transcellular transport
paracellular transport

A

transcellular transport

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Q

movement through TJ

transcellular transport
paracellular transport

A

paracellular transport

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Q

3 types of non-carrier mediated transport

A

simple diffusion
endocytosis
exocytosis

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Q

4 types of carrier-mediated transport

A

osmosis
facilitated diffusion
primary active transport
secondary active transport

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Q

Na K ATPase pump transports what?

A

3 Na out
2 K in

“tri-na to-k-en”

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Q

largest contributor to resting membrane potential

A

Na K ATPase pump

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Q

Na K ATPase pump inhibited by what drug?

A

digoxin

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Q

normal value of osmolarity

A

300 mOsm/L

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Q

3 characteristics of all action potentials

A

stereotypical size and shape
propagating
all or none

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Q

most important neurotranmitter

A

acetylcholine

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Q

main inhibitory neurotransmitter of spinal cord

glycine
GABA
glutamate

A

glycine

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Q

main inhibitory neurotransmitter of the brain

glycine
GABA
glutamate

A

GABA

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Q

main excitatory neurotransmitter of the brain

glycine
GABA
glutamate

A

glutamate

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Q

substance P

slow pain
fast pain

A

slow pain

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Q

glutamate

slow pain
fast pain

A

fast pain

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Q

act on their own

multi-unit smooth muscle
single-unit/unitary/syncitial/visceral smooth muscle

A

multi-unit smooth muscle

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Q

no true action potential

multi-unit smooth muscle
single-unit/unitary/syncitial/visceral smooth muscle

A

multi-unit smooth muscle

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junctional potential only - multi-unit smooth muscle - single-unit/unitary/syncitial/visceral smooth muscle

- multi-unit smooth muscle

act together as one - multi-unit smooth muscle - single-unit/unitary/syncitial/visceral smooth muscle

- single-unit/unitary/syncitial/visceral smooth muscle

slow waves, spike potentials and plateau potentials - multi-unit smooth muscle - single-unit/unitary/syncitial/visceral smooth muscle

- single-unit/unitary/syncitial/visceral smooth muscle

PLASMA - parasympathetic mnemonic

``` Para Long pre-ganglionic Ach used Short post-ganglionic Muscaric receptors Ach used ```

Opposite PLASMA - sympathetic mnemonic

``` Sympa Short pre ganglionic Ach used Long post-ganglionic Adrenergic receptors Epi, NE used ```

smooth muscles contraction - alpha 1 receptors - alpha 2 receptors - beta 1 receptors - beta 2 receptors

alpha 1 receptors

smooth muscles relaxation - alpha 1 receptors - alpha 2 receptors - beta 1 receptors - beta 2 receptors

beta 2 receptors

inhibits sympathetic effects - alpha 1 receptors - alpha 2 receptors - beta 1 receptors - beta 2 receptors

- alpha 2 receptors

promotes parasympathetic effects - alpha 1 receptors - alpha 2 receptors - beta 1 receptors - beta 2 receptors

- alpha 2 receptors

relaxing protein that covers actin binding sites at rest - tropomyosin - troponin

- tropomyosin

attaches troponin complex to tropomyosin - troponin T - troponin I - troponin C

troponin T

inhibits actin-myosin binding - troponin T - troponin I - troponin C

troponin I

troponin C - troponin T - troponin I - troponin C

calcium binding protein

borders - Z lines - M lines - A band - H band - Bare zone - I band

Z lines

midline - Z lines - M lines - A band - H band - Bare zone - I band

M lines

entire length of myosin - Z lines - M lines - A band - H band - Bare zone - I band

A band

inside H band - Z lines - M lines - A band - H band - Bare zone - I band

bare zone no myosin heads

purely actin, no myosin interspersed - Z lines - M lines - A band - H band - Bare zone - I band

I band

spreads the ap to all parts of the muscles - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

t-tubules

contains DHPR - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

t tubules

voltage sensitive, activates ryanodines receptors - T tubles - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

DHPR

contains Ca2 needed for muscle contraction - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

sarcoplasmic reticulum

activated by DHPR - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

ryanodine

pumps Ca2 from ICF to the SR - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

SERCA

determines normal stiffness of the ventricular muscle - T tubles - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

titin

binds actin to beta-dystroglycan in the scarcolemma - T tubules - DHPR - sarcoplasmic reticulum - ryanodine - SERCA - titin - dystrophin

dystrophin

blocks release of Ach from the pre-synaptic terminals - botulinus toxin - curare - neostigmine - hemicholinium

botulinus toxin

competes with Ach for receptors on the motor end plate - botulinus toxin - curare - neostigmine - hemicholinium

curare

blocks reuptake of choline into presynaptic terminal - botulinus toxin - curare - neostigmine - hemicholinium

hemicholinium

inhibits acetylcholinesterase - botulinus toxin - curare - neostigmine - hemicholinium

neostrigmine

Vasomotor Center, Respiratory Center (DRG, VRG), Swallowing, Coughing & Vomiting Centers - medulla - pons - hypothalamus - thalamus

medulla

Micturition Center, Pneumotaxic, Apneustic Centers - medulla - pons - hypothalamus - thalamus

pons

Temperature Regulation Thirst, Food Intake - medulla - pons - hypothalamus - thalamus

hypothalamus

Relay Center for almost all sensations, Memory Recall - medulla - pons - hypothalamus - thalamus

thalamus

Motor, Personality, Calculation, Judgment - frontal lobe - parietal lobe - occipital lobe - temporal lobe - limbic lobe

frontal lobe

somatosensory cortex - frontal lobe - parietal lobe - occipital lobe - temporal lobe - limbic lobe

parietal lobe

vision - frontal lobe - parietal lobe - occipital lobe - temporal lobe - limbic lobe

occipital

``` Hearing, vestibular processing, recognition of faces, optic pathway (Meyer’s Loop) ``` - frontal lobe - parietal lobe - occipital lobe - temporal lobe - limbic lobe

temporal lobe

Behavior, Emotions, Motivation - frontal lobe - parietal lobe - occipital lobe - temporal lobe - limbic lobe

limbic lobe

large myelinated fibers * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

temporal and spatial fidelity * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

decussates near the medulla * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

vibration * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

sensations that signal movement against the skin * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

position sense and fine pressure * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

two-point discrimination * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* dorsal column-medial lemniscus pathway

smaller myelinated fibers * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

decussates immediately * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

pain * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

temperature sensation * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

light touch and pressure sensation * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

tickles and itch sensation * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

sexual sensation * dorsal column-medial lemniscus pathway * antero-lateral system (spinothalamic tract)

* antero-lateral system (spinothalamic tract)

low-frequency (slow) vibrations - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Meissner corpuscles

Iggo Dome receptors - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Merkel disc

steady-sate signals for continuous touch - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Merkel Disc

determine texture - Meissner Corpuscles - Merkal Disc - Ruffini Corpuscles - Pacinian Corpuscles

Merkel disc

heavy and prolonged touch; sustained steady pressure - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Ruffini corpuscles

degree of join rotation - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Ruffini corpuscles

onion-shaped - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Pacinian corpuscles

high-frequency (fast) vibration tapping - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Pacinian corpuscles

2 point discrimination - Meissner Corpuscles - Merkel Disc - Ruffini Corpuscles - Pacinian Corpuscles

Merkel and Meissner

Has 2/3 of refractive power of eye - cornea - lens

cornea

when ciliary muscles are relaxed; lens is - flat - spherical

flat

when ciliary muscles are contracted; lens is - flat - spherical

spherical

long eyeball - myopia - hyperopia - astigmatism - presbyopia

myopia

biconcave lens - myopia - hyperopia - astigmatism - presbyopia

myopia

short eyeball - myopia - hyperopia - astigmatism - presbyopia

hyperopia

convex lens - myopia - hyperopia - astigmatism - presbyopia

hyperopia

irregular/non-uniform curvature of the cornea - myopia - hyperopia - astigmatism - presbyopia

astigmatism

cylindrical lenses - myopia - hyperopia - astigmatism - presbyopia

astigmatism

inability to contract ciliary body - myopia - hyperopia - astigmatism - presbyopia

presbyopia

most important trans rhodopsin intermediate

metarhodopsin II

dynamic changes - nuclear bag fibers - nuclear chain fibers

- nuclear bag fibers

group Ia afferents - nuclear bag fibers - nuclear chain fibers

- nuclear bag fibers

central "bag" region - nuclear bag fibers - nuclear chain fibers

- nuclear bag fibers

detects static changes - nuclear bag fibers - nuclear chain fibers

- nuclear chain fibers

group II afferents - nuclear bag fibers - nuclear chain fibers

- nuclear chain fibers

in rows - nuclear bag fibers - nuclear chain fibers

- nuclear chain fibers

* Stimulates flexors * Inhibits extensors - Rubrospinal Tract - Pontine Reticulospinal Tract - Medullary Reticulospinal Tract - Lateral Vestibulospinal Tract - Tectospinal Tract

- Rubrospinal Tract

• Stimulates both flexors and extensors (mainly extensors) - Rubrospinal Tract - Pontine Reticulospinal Tract - Medullary Reticulospinal Tract - Lateral Vestibulospinal Tract - Tectospinal Tract

- Pontine Reticulospinal Tract

• Inhibits both flexors and extensors (mainly extensors) - Rubrospinal Tract - Pontine Reticulospinal Tract - Medullary Reticulospinal Tract - Lateral Vestibulospinal Tract - Tectospinal Tract

- Medullary Reticulospinal Tract

• Inhibits Flexors, • Stimulates extensors - Rubrospinal Tract - Pontine Reticulospinal Tract - Medullary Reticulospinal Tract - Lateral Vestibulospinal Tract - Tectospinal Tract

- Lateral Vestibulospinal Tract

• Controls neck muscles - Rubrospinal Tract - Pontine Reticulospinal Tract - Medullary Reticulospinal Tract - Lateral Vestibulospinal Tract - Tectospinal Tract

- Tectospinal Tract

3 major clinical conditions associated with cerebellar dysfunction

- ataxia - intention tremor - absent rebound phenomenon

main neurotransmitter of basal ganglia

GABA

Lesion here causes Parkinson Disease

substantia nigra; continued degeneration of the dopaminergic neurons of the substantia nigra

mnemonic TRAP of Parkinson Disease

Tremors Rigidity Akinesia Postural problems

receptive aphasia - Wernicke Aphasia - Broca Aphasia

Wordy Wernicke

expressive aphasia - Wernicke Aphasia - Broca Aphasia

Broken speach Broca

where memory is mainly stored - temporal lobe - hippocampus - thalamus

temporal lobe

encoding of recent past into long-term memory - temporal lobe - hippocampus - thalamus

hippocampus

helps recall memory - temporal lobe - hippocampus - thalamus

thalamus

parts of BBB

- endothelial cells of cerebral capillaries - astrocyte foot processes - choroid plexus epithelium

body temperature is mediated by

hypothalamus

site of greatest resistance - arterioles - arteries - capillaries - veins - lymphatic vessels

arterioles

contains stressed volume; high pressure - arterioles - arteries - capillaries - veins - lymphatic vessels

arteries

largest total cross-sectional area - arterioles - arteries - capillaries - veins - lymphatic vessels

capillaries

64% of blood found here; capacitance vessels - arterioles - arteries - capillaries - veins - lymphatic vessels

veins

carries chylomicrons and involved in immunity and cancer - arterioles - arteries - capillaries - veins - lymphatic vessels

lymphatic vessels

highest arterial blood pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

systolic pressure

lowest arterial blood pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

diastolic pressure

= systolic pressure - diastolic pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

pulse pressure

= stroke volume / arterial compliance - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

pulse pressure

most important determinant of pulse pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

stroke volume

= 2/3 diastole + 1/3 systole - diastole + 1/3 pulse pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

mean arterial pressure

synonymous with right atrial pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

central venous pressure

estimates left atrial pressure - systolic pressure - diastolic pressure - pulse pressure - stroke volume - MAP (mean arterial pressure) - central venous pressure - pulmonary capillary wedge pressure

pulmonary capillary wedge pressure

atrial depolarization - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

P wave

ventral depolarization - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

QRS complex

vental repolarization - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

T wave

depends on conduction velocity through AV node - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

PR interval

period of ventral depolarization + polarization - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

QT interval

AV node conduction - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

PR segment

correlates with plateau of ventral AP - P wave - QRS complex - T wave - PR interval - QT interval - PR segment - ST segment

ST segment

Stimulates AV Node → ↑ Conduction Velocity → ↓ PR Interval - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- SYMPATHETIC NS

Can decrease AV Node Conduction → ↓ Conduction Velocity → ↑ PR Interval - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- HEART BLOCK

* Flat/inverted T waves, * ↑ amplitude and width of P waves, • with U waves - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- HYPOKALEMIA

Low P waves, Tall T waves - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- HYPERKALEMIA

Prolonged QT Interval - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

HYPOCALCEMIA

Shortened QT Interval - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

HYPERCALCEMIA

ST Segment Elevation - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- Q-WAVE INFARCT / TRANSMURAL INFARCT

ST Segment Depression - SYMPATHETIC NS - HEART BLOCK - HYPOKALEMIA - HYPERKALEMIA - HYPOCALCEMIA - HYPERCALCEMIA - Q-WAVE INFARCT / TRANSMURAL INFARCT - NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

- NON-Q-WAVE INFARCT / SUBENDOCARDIAL INFARCT

Master pacemaker SA Node AV Node

SA node

changes contractility - inotropic effect - lusitropic effect - chronotropic effect - dromotropic effect

inotropic effect

changes in rate of relaxation - inotropic effect - lusitropic effect - chronotropic effect - dromotropic effect

lusitropic effect

changes in heart rate - inotropic effect - lusitropic effect - chronotropic effect - dromotropic effect

chronotropic effect

changes in conduction velocity - inotropic effect - lusitropic effect - chronotropic effect - dromotropic effect

dromotropic effect

inotropes affect - stroke volume - SA node - AV node

stroke volume (ventricular contraction)

chronotipes affect - stroke volume - SA node - AV node

SA node (heart rate)

dromotropes affect - stroke volume - SA node - AV node

AV node (conduction velocity)

dromotropes are affected by

inward calcium current

Beta-1 stimulation of the heart would cause inotrope lusitrope chronotrope

STRONGER (positive inotrope), BRIEFER (positive lusitrope) & MORE FREQUENT (positive chronotrope) CONTRACTIONS

closure of AV valves S1 S2 S3 S4

S1

isovolumic contraction S1 S2 S3 S4

S1

closure of semilunar valves S1 S2 S3 S4

S2

isovolumic relaxation S1 S2 S3 S4

S2

rapid ventricular filling S1 S2 S3 S4

S3

L-sided in patients with CHF indicative of CV morbidity, mortality S1 S2 S3 S4

S3

stiff ventricles S1 S2 S3 S4

S4

atrial contraction/systole S1 S2 S3 S4

S4

acute control of BP - baroreceptor reflex - RAAS

baroreceptor reflex

long-term control of BP - baroreceptor reflex - RAAS

RAAS

responds to increase in blood pressure - carotid baroreceptors - aortic baroreceptors

- carotid baroreceptors | - aortic baroreceptors

responds to decrease in blood pressure - carotid baroreceptors - aortic baroreceptors

- carotid baroreceptors

air from nose to terminal bronchioles - anatomic dead space - alveolar dead space - physiologic dead space

- anatomic dead space

conducting zone - anatomic dead space - alveolar dead space - physiologic dead space

anatomic dead space

air in the respiratory unit of the lung - anatomic dead space - alveolar dead space - physiologic dead space

alveolar dead space

respiratory zone - anatomic dead space - alveolar dead space - physiologic dead space

alveolar dead space

anatomic + alveolar dead space - anatomic dead space - alveolar dead space - physiologic dead space

physiologic dead space

Respiratory bronchiole, alveolar ducts, alveolar sacs - functional anatomic unit of the lung - respiratory unit of the lung

respiratory unit of the lung

Bronchopulmonary Segments - functional anatomic unit of the lung - respiratory unit of the lung

functional anatomic unit of the lung

for gas exchange - type I pneumocyte - type II pneumocyte - goblet cells - club cells - dust cells

Type I pneumocyte

surfactant production - type I pneumocyte - type II pneumocyte - goblet cells - club cells - dust cells

Type II pneumocyte

produces mucus for lubrication in the respiratory system - type I pneumocyte - type II pneumocyte - goblet cells - club cells - dust cells

goblet cells

produces protective GAGs and metabolize air-borne toxins - type I pneumocyte - type II pneumocyte - goblet cells - club cells - dust cells

club cells

alveolar macrophages - type I pneumocyte - type II pneumocyte - goblet cells - club cells - dust cells

dust cells

air inspired over and above the tidal volume - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

IRV

amount of air inhaled or exhaled - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

TV

amount of air exhaled after expiration of tidal volume - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

ERV

remaining air in the lungs after maximal exhalation - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

residual volume

TV + IRV - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

inspiratory capacity

ERV + RV - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

FRC

marker for lung function - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

FRC

IRV + TV + ERV - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

VC

maximum volume of air that can be inhaled or exhaled - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

VC

IRV + TV + ERV + RV - inspiratory reserve volume - tidal volume - expiratory reserve volume - residual volume - inspiratory capacity - functional residual capacity - vital capacity - total lung capacity

TLC

highest compliance - low range of pressure - middle range of pressure - high range of pressure

- middle range

lowest compliance - low range of pressure - middle range of pressure - high range of pressure

- high pressure

cell that produces surfactant

type II pneumocytes

main component of surfactant

water

active component of surfactant

dipalmitoyl-phosphatidylcholine (DPPC)

mechanism for DPPC reducing surface tension

amphipathic nature (hydrophobic and hydrophilic)

effect of surfactant on lung compliance

increase

start of surfactant production

24th week aog

maturation of surfactant

35th week aog

test for surfactant

amniotic L:S ratio

treatment for newborn RDS

steroid, surfactant

3 factors affecting airway resistance

- bronchial smooth muscle - lung volume - viscosity/density of inspired gas

hypoxia from low blood flow - decrease cardiac output - hypoxia - anemia - carbon monoxide poisoning - cyanide poisoning

decrease cardiac output

hypoxia from low PaO2 causes low % saturation of hemoglobin - decrease cardiac output - hypoxia - anemia - carbon monoxide poisoning - cyanide poisoning

hypoxemia

hypoxia from low hemoglobin concentration causes low O2 content of blood - decrease cardiac output - hypoxia - anemia - carbon monoxide poisoning - cyanide poisoning

anemia

hypoxia from low O2 content of blood and left shift of hemoglobin - O2 dissociation curve - decrease cardiac output - hypoxia - anemia - carbon monoxide poisoning - cyanide poisoning

carbon monoxide poisoning

hypoxia from low O2 utilization by tissues - decrease cardiac output - hypoxia - anemia - carbon monoxide poisoning - cyanide poisoning

cyanide poisoning

initiates Hering-Breuer reflex that decreases respiratory rate by prolonging expiratory time - lung stretch receptors - joint and muscle receptors - irritant receptors - j receptors

lung stretch receptors

causes anticipatory increase in respiratory rate during exercise - lung stretch receptors - joint and muscle receptors - irritant receptors - j receptors

joint and muscle receptors

causes bronchoconstriction and increases the respiratory rate - lung stretch receptors - joint and muscle receptors - irritant receptors - j receptors

irritant receptors

causes rapid shallow breathing and responsible for the feeling of dyspnea - lung stretch receptors - joint and muscle receptors - irritant receptors - j receptors

j receptors

60-40-20 rule of body fluid

60% of BW - water 40% of BW - ICF 20% of BW - ECF

25% of nephrons with vasa recta - cortical nephron - juxtamedullary nephron

juxtamedullary nephrons

75% of nephrons with peritubular capillaries - cortical nephron - juxtamedullary nephron

cortical nephrons

main charge barrier in nephron

basement membrane

3 charge and filtration barriers of the glomerulus

- capillary endothelium - basement membrane - podocytes

modified smooth muscles capable of phagocytosis - intraglomerular mesangial cells - extraglomerular mesangial cells - jg cells - macula densa

- intraglomerular mesangial cells

may play a role in renal autoregulation, RAAS, and EPO secretion - intraglomerular mesangial cells - extraglomerular mesangial cells - jg cells - macula densa

- extraglomerular mesangial cells

secrete renin - intraglomerular mesangial cells - extraglomerular mesangial cells - jg cells - macula densa

- jg cells

monitor Na+ concentration in the lumen of distal tubule - intraglomerular mesangial cells - extraglomerular mesangial cells - jg cells - macula densa

- macula densa

creates graded osmolarity - loop of Henle - vasa recta

loop of Henle

preserves graded osmalarity - loop of Henle - vasa recta

vasa recta

high clearance - found in urine - found in blood

urine

low clearance - found in urine - found in blood

blood

highest clearance - PAH - K - insulin - urea - Na - glucose, amino acids, and HCO3 - insulin, creatinine

- PAH

lowest clearance - PAH - K - insulin - urea - Na - glucose, amino acids, and HCO3 - insulin, creatinine

- Na | - glucose, amino acids, and HCO3

4 causes of K+ influx -> hypokalemia

- insulin - beta adrenergic - alkalosis - hypoosmolarity

secrete K - principal cells - intercalated cells

principal cells

reabsorbed K (active in low K diet) - principal cells - intercalated cells

intercalated cells

7 causes of K+ efflux -> hyperkalemia

- insulin deficiency - beta adrenergic antagonist - acidosis - hyper osmolarity - inhibitors of Na K ATPase pump like digitalis - exercise - cell lysis

6 causes of increased distal K secretion

- high K+ diet - hyperaldosteronism - alkalosis - thiazide diuretics - loop diuretics - luminal anions

4 causes of decreased distal K secretion

- low K+ diet - hypoaldosteronism - acidosis - K+ sparing diuretics

arrhythmias - hypercalcemia - hypocalcemia

- hypercalcemia

tetany - hypercalcemia - hypocalcemia

- hypocalcemia

PTH - increases Ca reabsorption - decreases Ca reabsorption

increases CA reabsorption

Thiazides - increases Ca reabsorption - decreases Ca reabsorption

increases Ca reabsorption

loop diuretics - increases Ca reabsorption - decreases Ca reabsorption

decreases Ca reabsorption

hypomagnesemia - hypercalcemia - hypocalcemia

hypercalcemia

hypermagnesemia - hypercalcemia - hypocalcemia

hypocalcemia

respiratory center - controls PCO2 - controls HCO3

controls PCO2

kidneys - controls PCO2 - controls HCO3

controls HCO3

increase H+ RR = plasma CO2 =

increase RR | decrease PCO2

decrease H+ RR = plasma CO2 =

decrease RR | increase PCO2

3 mechanisms for renal regulation of acid-base balance

- secretion of excess H+ - reabsorption of filtered HCO3 if warranted - production of new HCO3 if warranted

increases H+ excretion - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

respiratory acidosis

increase increases HCO3 reabsorption - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

respiratory acidosis

decreases H+ excretion - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

respiratory alkalosis

decreases HCO3 reabsorption - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

respiratory alkalosis

hyperventilation - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

metabolic acidosis

hypoventilation - respiratory acidosis - respiratory alkalosis - metabolic acidosis - metabolic alkalosis

metabolic alkalosis

respiratory acidosis - due to conditions resulting in decreased ventilation (RR) - due to conditions resulting in increased ventilation (RR)

conditions resulting in decreased ventilation (RR)

respiratory alkalosis - due to conditions resulting in decreased ventilation (RR) - due to conditions resulting in increased ventilation (RR)

conditions resulting in increased ventilation (RR)

metabolic acidosis - excess acid or loss of base - loss of acid gain of base

- excess acid or loss of base

metabolic alkalosis - excess acid or loss of base - loss of acid gain of base

- loss of acid gain of base

the 5 official GI hormones

- gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

triggered by phenylalanice (F), tryptophan (W), and methionine (M) - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

gastrin

source is G cells of the antrum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

gastrin

stimulates parietal cells in fundus for HCl secretion, growth of gastric mucosa - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

gastrin

triggered mainly by fatty acids - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

CCK

source is I cells in duodenum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

CCK

triggered by H+ in the duodenum, FA in duodenum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

secretin

source S cells in duodenum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

secretin

trigger is oral glucose - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

GIP

source is K cells in duodenum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

GIP

triggered by fasting - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

motilin

source is M cells in duodenum and jejunum - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

motilin

activates interdigestive/migrating myoelectric complex - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

motilin

acts only on the stomach and small intestines - gastrin - CCK - secretin - GIP (glucose-dependent insulinotropic peptide) - motilin

motilin

GI paracrines

- somatostatin | - histamine

neurocrines

- VIP - enkephalins - GRP

deplorization of circular muscles - decreases diameter of that segment of external anal sphincter - decreases length of that segment of external anal sphincter

- decreases diameter of that segment of external anal sphincter

deplorization of longitudinal muscles - decreases diameter of that segment of external anal sphincter - decreases length of that segment of external anal sphincter

- decreases length of that segment of external anal sphincter

due to subthreshold slow waves - tonic contractions - phasic contractions

tonic contractions

due to spike potentials - tonic contractions - phasic contractions

phasic contractions

swallowing center

medulla

contains mucus neck cells, parietal cells and chief cells - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

oxyntic glands (body)

contains G cells, mucus cells - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

pyloric glands (antrum)

secretes mucus and HCO3 - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

mucus cells, mucus neck cells

secretes HCl and IF - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

parietal cells/oxyntic cells

secretes gastrin - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

g cells

secretes serotonin - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

enterochromaffin cells

secretes histamine - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

ECL

secretes pepsinogen - oxyntic glands (body) - pyloric glands (antrum) - mucus cells, mucus neck cells - parietal cells/oxyntic cells - g cells - enterochromaffin cells - enterochromaffin-like (ECL) cells - chief/peptic cells

chief/peptic cells

secondary active trasport - SGLT 1 - GLUT 5 - GLUT 2

SGLT 1

fructose - SGLT 1 - GLUT 5 - GLUT 2

GLUT 5

all types of monosaccharides - SGLT 1 - GLUT 5 - GLUT 2

GLUT 2

lipids enter intestinal cells via - micelles - chylomicrons

- micelles

lipids leave intestinal cells via - micelles - chylomicrons

- chylomicrons

activates existing intracellular enzymes via phosphorylation - protein hormones (water soluble) - lipid hormone (lipid soluble)

- protein hormones (water soluble)

synthesizes new intracellular enzymes - protein hormones (water soluble) - lipid hormone (lipid soluble)

- lipid hormone (lipid soluble)

direct actions of growth hormone

- increase plasma glucose (diabetogenic) - increase protein deposition and lean body mass - increase lipolysis - increase IGF 1 - anti-againg effects

indirect actions of growth hormone (via IGF 1)

- increase bone length and thickness (pubertal - increase protein synthesis in muscles and other organs and increase lean body mass - increase organ size

symmetrical bone growth - gigantism - acromegaly

gigantism

occurs before closure of epiphyses - gigantism - acromegaly

gigantism

asymmetical bone growth - gigantism - acromegaly

acromegaly

occurs after closure of epyhyses - gigantism - acromegaly

acromegaly

tetraiodothyronine - T4 - T3

T4

93% synthesized - T4 - T3

T4

6 days half life - T4 - T3

T4

10% of the binding to nuclear recpetors - T4 - T3

T4

2 days onset of action (4x slower) - T4 - T3

T4

triiodothyronine - T4 - T3

T3

7% synthesized - T4 - T3

T3

1 day half life - T4 - T3

T3

90% of binding to nuclear receptor - T4 - T3

T3

12 hours (4x faster) onset of action - T4 - T3

T3

aldosterone - zona glomerulosa - zona fasciculata - zona reticularis

- zona glomerulosa

mineralocorticoid - zona glomerulosa - zona fasciculata - zona reticularis

- zona glomerulosa

cortisol, corticosterone - zona glomerulosa - zona fasciculata - zona reticularis

- zona fasciculata

glucocorticoids - zona glomerulosa - zona fasciculata - zona reticularis

- zona fasciculata

DHEA and androstenedione - zona glomerulosa - zona fasciculata - zona reticularis

- zona reticularis

weak androgens - zona glomerulosa - zona fasciculata - zona reticularis

- zona reticularis

insulin amylin - beta cells - alpha cells - delta cells - f cells / pp cell

- beta cells

glucagon - beta cells - alpha cells - delta cells - f cells / pp cell

alpha cells

somatostatin - beta cells - alpha cells - delta cells - f cells / pp cell

delta cells

pancreatic polypeptide - beta cells - alpha cells - delta cells - f cells / pp cell

- f cells / pp cell

main stimulus is low blood glucose - glucagon - pancreatic somatostatin

glucagon

cAMP 2nd messenger - glucagon - insulin

glucagon

main stimulus is high blood glucose - glucagon - insulin

insulin

tyrosine kinase receptor 2nd messenger - glucagon - insulin

insulin

6 minute half-life - glucagon - insulin

insulin

connecting peptide (c peptide) - glucagon - insulin

insulin

stimuli of insulin

- increase plasma glucose - increase plasma aa - increase plasma fa - glucagon - GIP (via oral glucose) - GH - cortisol

effects of insulin

- increase cellular glucose uptake - decrease glycogenolysis,. gluconeogenesis - increase protein synthesis - increase lipogenesis - increase K+ uptake

stimuli of stimuli

- decrease plasma glucose - increase plasma aa - CCK

effects of glucagon

- increase glycogenolysis and gluconeogenesis - increase lipolysis and ketone body formation - NE - epinephrine - ACh

bone deposition - osteoblast - osteoclast

osteoblast

secrete collagen and ground substance where calcium precipitates - osteoblast - osteoclast

osteoblast

bone resorption - osteoblast - osteoclast

osteoclast

lysosomal enzymes, citric acid and lactic acid - osteoblast - osteoclast

osteoclast

secreted chief cells of the parathyroid gland - PTH - calcitonin

PTH

stimulated by low plasma Ca2+ - PTH - calcitonin

PTH

stimulated by hypomagnesemia - PTH - calcitonin

PTH

2nd messenger cAMP - PTH - calcitonin

PTH

secreted by parafollicular cells (C cells) of the thyroid gland - PTH - calcitonin

calcitonin

stimulated by high plasma Ca2+ - PTH - calcitonin

calcitonin

PTH effect on intestine

none

PTH effect on kidney

- increase calcium reabsorption (DT) - decrease phosphate reabsorption (PCT) - increase active Vit D (by increasing 1 alpha hydroxylase)

PTH effect on bone

- calcium and phosphate resorption

PTH effect on net effect on serum levels

- increase serum calcium | - decrease serum phosphate

vitamin D effect on intestines

- increase calcium and phosphate absorption

vitamin D effect on kidney

- increase calcium and phosphate reabsorption | - increase urinary calcium

vitamin D effect on bone

- at normal levels: calcium and phosphate deposition | - at high toxic levels: calcium and phosphate resorption

vitamin D net effect on serum levels

- increase serum calcium | - increase serum phosphate

sperm production - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

seminiferous tubules

full development and function of seminiferous tubules require androgens and FSH - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

seminiferous tubules

sperm maturation, motility - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

epididymis

sperm storage - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

vas deferens

sperm nutrions (contains fructose, prostaglandins) - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

seminal vesicle

for semen alkalinity (using spermine) contains 5-alpha reductase that converts testosterone to DHT - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

prostate gland

supplies mucus for lubrication - seminiferous tubules - epididymis - vas deferens - seminal vesicle - prostate gland - ejaculatory duct - urethra - urethral glads, bulbourethral glands

urethral glands, bulbourethral glands

effects of dihydrotestosterone

* Differentiation of penis, scrotum, and prostate * Male hair pattern * Male pattern baldness * Sebaceous gland activity * Growth of prostate

effects of testosterone

``` • Differentiation of epididymis, • vas deferens, & seminal vesicles • Descent of testes • ↑ bone and muscle mass • ↑ BMR • Pubertal growth spurt • Epiphyseal closure • Growth of penis & seminal vesicles • Deepening of voice • Spermatogenesis • Negative feedback on anterior pituitary • Libido ```

secreted by adrenal cortex and thecal cells - estrone - estradiol - estriol - progesterone - aromatase

estrone

secreted by ovaries - estrone - estradiol - estriol - progesterone - aromatase

estradiol

secreted by placenta - estrone - estradiol - estriol - progesterone - aromatase

estriol

catalyzes conversion of androstenodione -> estrone and testosterone -> estradiol - estrone - estradiol - estriol - progesterone - aromatase

aromatase

secreted by the corpus luteum, placenta, adrenal cortex, testes - estrone - estradiol - estriol - progesterone - aromatase

progesterone

proliferative phase - follicular phase - luteal phase

follicular phase

estrogen predominates - follicular phase - luteal phase

follicular phase

secretory phase - follicular phase - luteal phase

luteal phase

progesterone predominates - follicular phase - luteal phase

luteal phase

days 0-14 - follicular phase - luteal phase

follicular phase

days 14-28 - follicular phase - luteal phase

luteal phase

lowest progesterone - menstruation - follicular phase - ovulation - luteal phase

menstruation

highest estrogen - menstruation - follicular phase - ovulation - luteal phase

follicular phase

highest LH - menstruation - follicular phase - ovulation - luteal phase

ovulation

highest progesterone - menstruation - follicular phase - ovulation - luteal phase

luteal phase

what is difference between plasma and serum

serum is plasma minus clotting proteins and with higher serotonin content

6 components of plasma

- blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

essential component of clotting system - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

blood coagulation proteins

major contributor to osmotic pressure of plasma - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

albumin

includes proteases, transferrin, and transport proteins - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

globulin

major ECF cation: Na+ - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

electrolytes

lipids and aa - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

organic nutrients

carried to sites of breakdown or excretion - blood coagulation proteins - albumin - globulin - electrolytes - organic nutrients - organic wastes

organic wastes

blood cell formation in yolk sac/aortic gonad mesonephrons - 1st trimester - 2nd and 3rd trimester - after birth to puberty - age 20 and above

1st trimester

blood cell formation in liver - 1st trimester - 2nd and 3rd trimester - after birth to puberty - age 20 and above

2nd and 3rd trimester

blood cell formation in bone marrow of all bones - 1st trimester - 2nd and 3rd trimester - after birth to puberty - age 20 and above

after birth to puberty

blood cell formation in bone marrow of "centrally-located" bones - 1st trimester - 2nd and 3rd trimester - after birth to puberty - age 20 and above

age 20 and above

red blood cells are biconcave due to

spectrin

protein inside RBC that binds with O2 - hemoglobin (high/low) - hematocrit (high/low)

hemoglobin

percentage of cells in the whole blood - hemoglobin (high/low) - hematocrit (high/low)

hematocrit

sign of hemorrhagic shock - hemoglobin (high/low) - hematocrit (high/low)

low hematocrit

RBC stages mnemonic PBPORE

- Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

synthesis of hemoglobin starts - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

proerythroblast

nucleoli disappear - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

basophilic erythroblast

hemoglobin appears - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

polychromatic erythroblast

nucleus disappears - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

orthrochromatic erythroblast

formed reticulum, stage that enters blood - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

reticulocytes

final product, reticulum disappears, achieves biconcave shape - Proerythroblast - Basophilic erythroblast - Polychromatic - Orthochromatic erythroblast - Reticulocytes - Erythrocyte

erythrocyte

non-specific - innate immunity - adaptive immunity

- innate immunity

structures shared by a group of microbes - innate immunity - adaptive immunity

- innate immunity

same intensity of action from subsequent exposure - innate immunity - adaptive immunity

- innate immunity

acts within minutes - innate immunity - adaptive immunity

- innate immunity

less potent - innate immunity - adaptive immunity

- innate immunity

1st line as intrinsically present - innate immunity - adaptive immunity

- innate immunity

not sufficient; those with severe combined immunodeficiency disease suffer from life threatening infections - innate immunity - adaptive immunity

- innate immunity

alternative and lectin pathways - innate immunity - adaptive immunity

- innate immunity

composed of phagocytes, monocytes, macrophages, neutrophils, natural killer cells - innate immunity - adaptive immunity

- innate immunity

complement blood proteins - innate immunity - adaptive immunity

- innate immunity

skin, mucous membranes - innate immunity - adaptive immunity

- innate immunity

extremely specific - innate immunity - adaptive immunity

- adaptive immunity

special antigens of microbial and non-microbial agents - innate immunity - adaptive immunity

- adaptive immunity

long term memory (memory cells) - innate immunity - adaptive immunity

- adaptive immunity

improves after each repeated exposure - innate immunity - adaptive immunity

- adaptive immunity

requires several days before becoming effective - innate immunity - adaptive immunity

- adaptive immunity

more potent - innate immunity - adaptive immunity

- adaptive immunity

develops after exposure - innate immunity - adaptive immunity

- adaptive immunity

it is sufficient - innate immunity - adaptive immunity

- adaptive immunity

activated by classical pathway - innate immunity - adaptive immunity

- adaptive immunity

lymphocytes and antigen presenting cells - innate immunity - adaptive immunity

- adaptive immunity

blood proteins antibodies - innate immunity - adaptive immunity

- adaptive immunity

lymph nodes, spleen, mucosal associated lymphoid tissue - innate immunity - adaptive immunity

- adaptive immunity

main cells are B-lymphocytes - humoral immunity - cell mediated immunity

- humoral immunity

originated and matured in bone marrow - humoral immunity - cell mediated immunity

- humoral immunity

protects against extracellular microbes and their toxins, toxin induced diseases, infections - humoral immunity - cell mediated immunity

- humoral immunity

lymph nodes located in superficial cortex - humoral immunity - cell mediated immunity

- humoral immunity

located in white pulp of spleen - humoral immunity - cell mediated immunity

- humoral immunity

end result of activation by differentiation of B cells into antibody secreting cells called plasma cells - humoral immunity - cell mediated immunity

- humoral immunity

hyper-sensitivity reactions I, II, and III are antibody mediated - humoral immunity - cell mediated immunity

- humoral immunity

rapid onset - humoral immunity - cell mediated immunity

- humoral immunity

antibodies formed - humoral immunity - cell mediated immunity

- humoral immunity

evaluated from plasma level of antibodies - humoral immunity - cell mediated immunity

- humoral immunity

Ab synthesis requires 3 cells: T lymphocytes, B lymphocytes, macrophages - humoral immunity - cell mediated immunity

- humoral immunity

main cells T-lymphocytes - humoral immunity - cell mediated immunity

- cell mediated immunity

originated in bone marrow and complete development in thymus - humoral immunity - cell mediated immunity

- cell mediated immunity

protects against intracellular microbes: virus, parasites (leishmania), bacteria (mycobacteria, listeria), kill tumor cells - humoral immunity - cell mediated immunity

- cell mediated immunity

lymph nodes located in paracortical areas - humoral immunity - cell mediated immunity

- cell mediated immunity

located in paracortical sheaths of spleen - humoral immunity - cell mediated immunity

- cell mediated immunity

end result of activation is secretion of locally acting proteins called cytokines - humoral immunity - cell mediated immunity

- cell mediated immunity

hyper-sensitivity reactions IV is cell mediated - humoral immunity - cell mediated immunity

- cell mediated immunity

delayed type hypersensitivity - humoral immunity - cell mediated immunity

- cell mediated immunity

antibodies not formed - humoral immunity - cell mediated immunity

- cell mediated immunity

evaluation from skin test for development of delayed type of hypersensitivity - humoral immunity - cell mediated immunity

- cell mediated immunity

cell involved are macrophage, helper T cells, natural killer T cells, cytotoxic T cells - humoral immunity - cell mediated immunity

- cell mediated immunity

Antibody synthesis in humoral immunity requires which 3 cells

- T lymphocytes - B lymphocytes - macrophages

highly-lobulated nucleus - neutrophils - eosinophils - basophils - monocytes - platelets

neutrophils

most common type - neutrophils - eosinophils - basophils - monocytes - platelets

neutrophils

involved in bacterial infection and acute inflammation - neutrophils - eosinophils - basophils - monocytes - platelets

neutrophils

bilobed nucleus, stain bright red with eosin dye - neutrophils - eosinophils - basophils - monocytes - platelets

eosinophils

weak phagocytes involved in parasitic infections and allergies - neutrophils - eosinophils - basophils - monocytes - platelets

eosinophils

bilobed/trilobed nucleus, largely densely basophilic (blue) granules - neutrophils - eosinophils - basophils - monocytes - platelets

basophils

least common type - neutrophils - eosinophils - basophils - monocytes - platelets

basophils

produce histamine, heparin, bradykinin, serotonin - neutrophils - eosinophils - basophils - monocytes - platelets

basophils

mast cells: degranulation produces clinical manifestations of allergy to anaphylaxis - neutrophils - eosinophils - basophils - monocytes - platelets

basophils

eccentrically-placed nucleus - neutrophils - eosinophils - basophils - monocytes - platelets

monocytes

largest of WBC - neutrophils - eosinophils - basophils - monocytes - platelets

monocytes

phagocytes, mature to macrophages in tissues - neutrophils - eosinophils - basophils - monocytes - platelets

monocytes

small, non-nucleated cells from megakaryocytes - neutrophils - eosinophils - basophils - monocytes - platelets

platelets

lifespan 7-10 days - neutrophils - eosinophils - basophils - monocytes - platelets

platelets

action of mast cells

degranulation will release histamine causing vasodilation and increased vascular permeability (clinical manifestations of allergy to anaphylaxis)

place in order line of defense - monocytes - neutrophils - tissue macrophages

tissue macrophages > neutrophils > monocytes

responds to lipid and carbohydrate sequences in bacterial cell walls - innate immunity - adaptive immunity

innate immunity

part of body's defense against cancer - innate immunity - adaptive immunity

adaptive immunity

variable portions - determines specificity to antigen - determines other properties of antibodies

- determines specificity to antigen

constant portion - determines specificity to antigen - determines other properties of antibodies

- determines other properties of antibodies

complement activation - IgG - IgA - IgM - IgE - IgD

IgG

localized protection in human body secretions (milk, saliva, tears, respiratory, intestinal, genital tract) - IgG - IgA - IgM - IgE - IgD

IgA

complement activation - IgG - IgA - IgM - IgE - IgD

IgM

regain reactivity; releases histamine from basophils and mast cells - IgG - IgA - IgM - IgE - IgD

IgE

antigen recognition by B cells - IgG - IgA - IgM - IgE - IgD

IgD

smallest, most numerous - IgG - IgA - IgM - IgE - IgD

IgG

secondary immune response - IgG - IgA - IgM - IgE - IgD

IgG

largest - IgG - IgA - IgM - IgE - IgD

IgM

primary immune response - IgG - IgA - IgM - IgE - IgD

IgM

associated with allergies - IgG - IgA - IgM - IgE - IgD

IgD

3 complement the effects of antibodies

opsonization, stimulate inflammation, membrane attack complex

3 pathways of complement

- classic pathway - mannose-binding pathway - alternative/properdin pathway

triggered by immune complex - classic pathway - mannose-binding pathway - alternative/properdin pathway

classic pathway

triggered by lectin binding with mannose groups in bacteria - classic pathway - mannose-binding pathway - alternative/properdin pathway

mannose-binding lectin pathway

triggered by contact with various viruses, bacteria, fungi, and tumor cells - classic pathway - mannose-binding pathway - alternative/properdin pathway

alternative/properdin pathway

C3b - causes opsonization - induces inflammation (anaphylatoxin) - causes WBC chemotaxis - members of the membrane attack complex (MAC)

- causes opsonization

C3a, C4a, C5a - causes opsonization - induces inflammation (anaphylatoxin) - causes WBC chemotaxis - members of the membrane attack complex (MAC)

- induces inflammation (anaphylatoxin)

C5a - causes opsonization - induces inflammation (anaphylatoxin) - causes WBC chemotaxis - members of the membrane attack complex (MAC)

- causes WBC chemotaxis

C5b-C9 - causes opsonization - induces inflammation (anaphylatoxin) - causes WBC chemotaxis - members of the membrane attack complex (MAC)

- members of the membrane attack complex (MAC)

cytotoxic lymphocyte of innate immune system - NK cell - NKT - plasma cell

NK cell

cytotoxic lymphocyte that has features of T-lymphocyte and NK cell - NK cell - NKT - plasma cell

NKT

activated naive b-cell; secrete antibodies - NK cell - NKT - plasma cell

plasma cell

type A - N-acetyl-galactosamine - galactose - both - none

- N-acetyl-galactosamine

type B - N-acetyl-galactosamine - galactose - both - none

galactose

type AB - N-acetyl-galactosamine - galactose - both - none

both

type O - N-acetyl-galactosamine - galactose - both - none

none

4 steps of hemostatsis

- vascular constriction - primary hemostatis/formation of loose platelet plug - secondary hemostasis/blood coagulation - resolution

neutrophils - acute inflammation - chronic inflammation

acute inflammation

macrophages - acute inflammation - chronic inflammation

chronic inflammation

platelet - hemostasis - inflammation - proliferation - remodeling

hemostasis

thrombin formation to stop the bleeding - hemostasis - inflammation - proliferation - remodeling

hemostasis

neutrophils, macrophage - hemostasis - inflammation - proliferation - remodeling

inflammation

releases of bactericidal substances; release of angiogenic substance to promote capillary growth and granulation process - hemostasis - inflammation - proliferation - remodeling

inflammation

fibroblast; epidermal cells - hemostasis - inflammation - proliferation - remodeling

proliferation

secretes glycoproteins and collagen; responsible for reepithelialization - hemostasis - inflammation - proliferation - remodeling

proliferation

fibroblast - hemostasis - inflammation - proliferation - remodeling

remodeling

remodeling of collagen from type III to type I; myofibroblast - hemostasis - inflammation - proliferation - remodeling

remodeling

thrombin formation to stop the bleeding - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

platelet (hemostasis)

release of bactericidal substances - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

neutrophils (inflammation)

release of angiogenic substance to promote capillary growth and granulation process - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

macrophage (inflammation)

secretes glycoproteins and collagen - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

fibroblast (proliferation)

responsible for reepitheliazation - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

epidermal cells (proliferation)

remodeling of collagen from type III to type I; myofibroblast - platelet - neutrophils - macrophage - fibroblast - epidermal cells - fibroblast

fibroblast (remodeling)

cell ATP, cell phosphocreatine - phosphagen energy system - glycogen-lactic acid system - aerobic system

- phosphagen energy system

first 8-10 seconds - phosphagen energy system - glycogen-lactic acid system - aerobic system

- phosphagen energy system

anaerobic - phosphagen energy system - glycogen-lactic acid system - aerobic system

- glycogen-lactic acid system

for 1.3 to 1.6 minutes after phosphagen system used up - phosphagen energy system - glycogen-lactic acid system - aerobic system

- glycogen-lactic acid system

reconstitute ATP and phophocreatine - phosphagen energy system - glycogen-lactic acid system - aerobic system

- phosphagen energy system | - glycogen-lactic acid system

glycogen-lactic acid cycle - phosphagen energy system - glycogen-lactic acid system - aerobic system

- aerobic system

unlimited time as long as with energy supply - phosphagen energy system - glycogen-lactic acid system - aerobic system

- aerobic system

3 causes of bronchodilation

- sympathetic nervous system (adrenergic) - atropine - vasointestinal peptide (VIP)

4 causes of bronchodilation

- parasympathetic nervous system (cholinergic) - cool air, exercise - irritants - leukotrienes, histamine

O2-HGB dissociation curve mnemonics CABET, do the RIGHT thing, LET GO

``` CO2 Acidosis BPG (2, 3 BPG) Exercise Temperature ```

main respiratory center - DRG - VRG - pneumotaxic center - apneustic center

DRG

for forced inspiration and expiration - DRG - VRG - pneumotaxic center - apneustic center

VRG

shortens time for inspiration = increase RR - DRG - VRG - pneumotaxic center - apneustic center

- pneumotaxic center

prolongs time for inspiration = decrease RR - DRG - VRG - pneumotaxic center - apneustic center

- apneustic center

chemoreceptors mnmonic central peripheral

Central chemoreceptors = CSF H+ (comes from plasma CO2) Peripheral chemoreceptors = Pang low oxygen (O2)

renal clearance mnemonic PAHK! CIUNGA (shunga)

PAH > K+ > Creatinine > inulin > urea > Na+ > glucose, amino acid

mnemonic acid-base MUDPILES: HAGMA

High Anion Gap Metabolic Alkalosis ``` Methanol Uremia DKA Paraldehyde Propylene Glycol Iron Isoniazid Idiopathic Acidosis Lactic Acidosis (in Sepsis, Shock) Ethylene Glycol Ethanol Salicylic Acid ```

mnemonic acid-base HARDUP: NAGMA

Non Anion Gap Metabolic Alkalosis ``` Hyperalimentation Acetazolamide RTA Diarrhea Ureteroenteric fistula Pacreaticoduodenal Fistula ```

esophagus to upper large intestines - vagus nerve - pelvic nerve

- vagus nerve

lower large intestines to anus - vagus nerve - pelvic nerve

- pelvic nerve

submucosal plexus - meissner plexus - auerbach plexus

- meissner plexus

between submucosa and inner circular muscle layer - meissner plexus - auerbach plexus

- meissner plexus

contraction of muscularis mucosa for secretion - meissner plexus - auerbach plexus

- meissner plexus

myenteric plexus - meissner plexus - auerbach plexus

- auerbach plexus

between inner circular and outer longitudinal muscle - meissner plexus - auerbach plexus

- auerbach plexus

contraction of inner circular and outer longitudinal muscles for motility - meissner plexus - auerbach plexus

- auerbach plexus

causes gall bladder contraction - CCK - ACh - CCK and ACh

CCK and ACh

causes sphincter of Oddi relaxation - CCK - ACh - CCK and ACh

CCK

FSH, LH, ACTH, TSH, MSH - anterior pituitary - posterier pituitary

- anterior pituitary

GH, prolactin - anterior pituitary - posterier pituitary

- posterier pituitary

derived from oral ectoderm - anterior pituitary - posterier pituitary

anterior pituitary

derived from neural ectoderm - anterior pituitary - posterier pituitary

posterior pituitary

action of vasopressin

increase plasma osmolarity (most potent), decrease blood pressure, decrease blood volume

V1 ADH receptor

vasoconstriction of atertioles

V2 ADH receptor

insertion of AQP-2 in the late distal tubule and collecting ducts

path of semen mnemonic SEVEN UP

``` Seminiferous tubules Epididimys Vas deferens Ejaculatory ducts (Nothing) Urethra Penis ```

mnemonic for semen SSS

FSH Sertoli Cell Sperm

mnemonic for semen LLL

LH Leydig Cell Libido Hormone (testosterone)

forms of estrogen mnemonic

Estradiol: 2 pa lang kayo Main form of estrogen during the reproductive years Estriol: 3 na kayo Main form of estrogen during pregnancy Estrone: 1 ka na lang Main form of estrogen during post-menopausal years

mediated by vWF of ruptured blood vessels walls and Gp1b of platelets - platelet adhesion - platelet activation - platelet aggregation

platelet adhesion

platelets change shape - platelet adhesion - platelet activation - platelet aggregation

platelet activation

mediated by fibronogen and Gp2b-3a of platelets (also by PAF) - platelet adhesion - platelet activation - platelet aggregation

- platelet aggregation

What is 2nd messenger blocked by Sildenafil (Viagra)?

cGMP

What is the most important characteristic of hydrophobic hormones that governs its diffusibility through a cell membrane?

Lipid Solubility

What will increase the diffusive clearance of solutes across the semipermeable dialysis membrane?

Area of the Membrane increases

The increased flow of calcium into the cells is part of the upstroke phase of the action potential of which cell?

Intestinal Smooth muscle

Connexin is an important component of which structure?

Gap Junction

What would cause an immediate reduction in the amount of potassium leaking out of the cell?

Hyperpolarizing the membrane potential

What is the mechanism behind botulinum type A (Botox) smoothing out glabellar lines?

Block the release of synaptic transmitter from alpha motoneurons (specifically acetylcholine)

If concentration of fatty acids on the outside surface of the cell DOUBLE what will happen to rate of diffusion?

Triple | based on Fick’s Law of Diffusion

What activates the NMDA receptor?

Glutamate

What is responsible for relaxation of contracted smooth muscles and the formation of latch bridges?

Dephosphorylation of actomyosin

Basketball player, plays in the hot gym, drinks water a lot (with no electrolytes), suddenly collapse. Why did he collapse?

Increase in Intracellular Volume (ECF becomes hypotonic since water but not water is replaced. Osmosis from ECF to ICF causes swelling of brain which cause the collapse)

What percentage of the body mass is ECF volume?

20% of body mass

What characterizes a molecule whose osmolality is zero

It is diffusible through the membrane as water

What is the basis or the anti- inflammatory effect of exogenous glucocorticoids?

Inhibition of the activation factor-KB (NF-KB)

What is most effective in reducing ICP following a large hemispheric stroke?

50 mmol of mannitol | osmotic diuretic

Why will hypokalemia increase the risk and severity of digitalis toxicity?

Increased inhibition of the Na-K-ATPase pump (because of hyperpolarization of the cardiac membrane)

What contributes to the lipid abnormalities (high LDL, high VLDL, high trigycerides, decreased HDL) in Type 2 DM?

Insufficient insulin action in adipose tissue decreases lipoprotein lipase activity

26/M having a bachelor’s party after golf became drunk. Presents to the ER 36 hours later with persistent vomiting and orthostatic hypotension. What metabolic abnormalities are most likely present in the patient?

Hypokalemia, Hypochloremia, metabolic alkalosis (patient has metabolic alkalosis from vomiting, and experienced other manifestations from contraction of vascular volume that led to activation of RAAS)

58/M with impaired breathing and shortness of breath presents with pH=7.35, PaO2 = 60mmHg, PaCO2 = 60mmHg, HCO3-=31mEq/L. What is the most likely diagnosis?

COPD | patient has respiratory acidosis with renal compensation

22/M training for marathon in a place of high altitude. Patient experiences extensive spasms and cramping of calf muscles while running in this high altitude. What is the reason high altitude predisposes to tetany?

Plasma proteins are more ionized under alkalotic conditions, which provide more protein anion to bind with Calcium

64/M with COPD develops jugular venous distention, ascites, peripheral edema, cardiomegaly of the R ventricle. A decrease in ________ is the major cause of cor pulmonale in COPD.

Alveolar PO2

78/F with altered mental status, signs of dehydration, blood glucose=600mg/dL, plasma osmolarity=340mOsm/L. Which is likely increased in this patient?

Urine Volume

21/F after ingesting large dose of ASA was diaphoretic, pH=7.45, PaCO=17mmHg, HCO3-=13mmol/L. Which treatment options would be most DELETERIOUS to this patient?

Decreasing alveolar ventilation (will cause ASA to cross BBB)

Child ingested windshielf wiper fluid and has then had difficulty seeing. ABG results: pH=7.34, PaCO2=29mmHg, HCO3-=15mEq/L, AG=28mEq/L. What is the interpretation?

Compensated metabolic acidosis | HAGMA – due to formic acid accumulation, a metabolite of methanol. Methanol poisoning is seen here

Patient with Guillain-Barre Syndrome develops respiratory muscle parlysis. PaCO increased from 40 to 60mmHg, plasma pH decreased from 7.4 to 7.3 What will then happen?

Central Chemoreceptors would be stimulated (Plasma CO2 converted to CSF H+)

65/M, with profound muscle weakness, plasma glucose=485mg/DL, serum K=8.2mmol/L, diagnosed with DKA and Hyperkalemia. Which lab value would most likely be above normal?

Anion Gap | DKA causes HAGMA

Which of the following conditions causes metabolic alkalosis?

Treatment with loop diuretic | thiazide and LD cause met alk. CAI causes NAGMA

23/F with 3 month history of malaise, generalized muscle cramps has lab results: serum NA=144mmol/L, serum K=2 mmol/L, serum HCO3- = 40mmol/L, arterial pH=7.5 What is the most likely cause of this patient’s hypokalemic alkalemia?

Hyperaldosteronism | remember the effects of aldosterone!

25/M training for 10km race. Most of the volatile acid entering blood is buffered by?

Hemoglobin

64/M with Type 2 DM suffers from weakness and fatigue. Labs: Na=130mEq/L, J=6.3mEq/L, HCO3-=18mEq/L, BUN=43mg/dL, Creatinine=2.9mg/dL, glucose=198mg/dL. Patient is taking 5mg glyburide 2x a day. The Lab results are likely the result of what?

Hypoaldosteronism (Patient has hyporeninemic hypoaldosteronism – type IV RTA. please refer to Pre-Test Physiology for detailed explanation)

60/M presents with Vitamin B12 deficiency and pernicious anemia. What is the underlying problem?

Lack of Intrinsic Factor

Which vitamin is absorbed primarily by diffusion?

Vitamin D

69/M blacks out after drinking beer all afternoon. Which of the following changes in arterial blood gas values are consistent with ethanol- induced coma?

pH: decreased, PaCO2: decreased, AG: increased (patient has compensated HAGMA)

65/M has DM Type , impaired mental status, generalized muscle weakness, plasma glucose=500mg/dL, AG=22mmol/L, HCO3-=14 mmol/L. Which blood value will increase in this patient?

K+ | acidosis cause increase in plasma K and plasma Ca

ECF potassium is decreased by which drug?

Epinephrine (insulin can also do that)

22/F with nausea, abdominal pain and vomiting. Labs: Na=140mEq/L, K=3.2mEq/L, HCO3=37mEq/L. Which PaCO2 and pH values are consistent with these findings?

PaCO2=47 and pH=7.52 | patient has compensated metablic alkalosis due to the vomiting

25/M goes to a place of high altitude. 72 hours after his arrival, what is the expected HCO3- and PaCO2?

HCO3-: decreased, PaCO2: decreased (patient has compensated respiratory alkalosis. Please refer to pre-test physiology for detailed explanation and actual graph)

Which condition can result in hyperkalemia?

Volume Depletion (Cause of HyperK: increased K+ load, decreased K+ excretion, shift of K+ from ICF to ECF. Please refer to Pre-Test Physiology for detailed explanation)

69/M diagnose with small cell lung CA. Patient has hyponatremia (Na=122mEq/L). What is the cause of his hyponatremia?

Arginine Vasopressin (patient has SIADH)

57/M with insulin-depended M was found unresposive in the couch after failing to get his insulin shots. What is the expected ABG results in a diabetic coma patient?

pH-7.10, PaCO2=25mmHg, HCO3-=15mEq/L, AG=30mEq/L | DM presents with HAGMA

27/M with asthmatic bronchitis given bronchodilators. ABG showed NAGMA. This is attributed to what?

A decrease in plasma bicarbonate caused by renal compensation for the respiratory alkalosis that existed before treatment

Medical students climb a mountain, one of them returns disoriented, ataxic, short of breath and vomiting. Diagnotic workup will show decrease in ______________.

PaCO2 (due to hyperventilation)

19/M presents with shortness of breath. There’s a shift to the Left of the O2-HgB dissociation curve. This is consistent with _____________

Recent transfusion with banked blood (banked blood is low in 2,3 BPG)

Measurement of amniotic L/S ratio assesses what?

Fetal Lung Maturity

25/M goes to a place of high altitude. Which value will return to normal after acclimatization?

Cardiac Output

27/F with nausea, vomiting, tachypnea, and following lab results: PaO2=105mmHg, PaCO2=30mmHg, pH=7.47, HCO3-=21mEq/L, Hb=14g/dL. This is consistent with what?

Pregnancy (progesterone stimulates respiratory centers to increase RR)

86/M with thin gown open at the back. Most of the body heat is lost via which mechanism?

Radiation and Conduction

What characterizes the order or recruitment during normal voluntary movement?

Weak muscle fibers are recruited first before strong muscle fibers (remember the “size principle”: that small motor units are recruited first before large motor units)

35/F with anxiety attack collapses. She is hyperventilating with facial and carppedal spasms. What cuases increased excitability of nerves and muscle membranes that can lead to continuous contraction of skeletal muscle fibers?

Depolarization of the nerve and muscle membrane (Take note: opening of the Na channel in response to depolarization is in part related to ECF Ca2+ concentration, they lower the ECF Ca2+ concentration, the easier for Na channels to open and cause depolarization. This is the basis for HYPOCALCEMIC TETANY

32/F undergoing appendectomy had malignant hyperthermia from halothane. What changes occur in the skeletal muscle to increase the body temperature?

Allopurinol

35/F with bilateral drooping eyelids, (+) generalized fatigue and weakness improved by frequent naps. (+) circulating antibodies to nicotinic acetylcholine receptors on the motor endplate. Drug given that increases force of contraction but causes bradycardia. What is the most likely MOA of drug?

Decreases metabolic breakdown of acetylcholine (this is a case of Myasthenia Gravis. Drug is an acetylcholinesterase inhibitor)

What is the most likely cause of muscle weakness in periodic hyperkalemic paralysis

Inactivation of sodium channels in muscle cells (probably due to mutation in gene encoding for sodium inactivation gate. This prevents action potentials from being produced resulting in weakness/ paralysis)

16/M asks pediatrician if he can regularly take in creatine to increase muscle strength before track meet. Why does he want to take creatine?

Creatine is converted to phosphorylcreatine (resulting in increased ATP and therefore enhanced performance)

18 month/M has delayed dentation, short stature, painful walking, bowing of legs. (+) breastfed but no Vit D supplementation. A defect in ________ can explain these findings.

Calcification of bone matrix | patient has rickets

Dystrophin provides structural support to the sarcolemma by binding what?

Actin to Beta-dystroglycan in the sarcolemma

What best describes ankylosing spondylitis?

Its occurrence is correlated with the histocompatibility antigen HLA-B27

24/M medical student is an avid bodybuilder who lifts weights 2-3 hours a day. What best describes the AP of skeletal muscle during his workout?

It spreads inward to all parts of the muscle via the T-Tubules

24/M medical student is an avid bodybuilder who lifts weights 2-3 hours a day. What best describes the AP of skeletal muscle during his workout? what best describes the contractile response of skeletal muscle?

More tension is produced when the muscle contracts isometrically than isotonically

The amount of force produced by a skeletal muscle can be increased by what

Decreasing the interval between contraction (frequency summation causing the Treppe/ Staircase Effect)

McArdle disease restuls from deficiency of what?

Myophosphorylase | also called Muscle Glycogen Phosphorylase

Patients after forearm exercise test has normal rise in venous lactate. What causes exercise intolerance and myoglobinuria?

CPT II defiency | the MCC is recurrent myoglobinuria. Please refer to Pre-Test Physiology for more detailed explanation

87/M with acute pain and swelling of R knee has CPPD (pseudogout). What is expected in CPPD deposition?

The knee is the most commonly affected joint (CPPD: increased production of inorganic pyrophosphate, (+)rhomboid, rod-shaped, rectangular crystals that are weakly positive in birefringence)

28/M takes endurance training to prepare for marathon. Which propery is greater in Type I compares to Type IIb/x skeletal muscle fiber that promotes distance running success?

``` Oxidative Capacity (Type I is Red Muscle Fiber for muscle endurance. Type I has smaller diameter, less fatigability, decreased force of contraction and decreased speed of reaction. Type II is fast twitch and divded into Type IIa and Type IIb/x) ```

What is the major difference in the contractile responses occurring the smooth muscles versus skeletal muscles?

The role of calcium in initiating contraction

What characterizes polymyalgia rheumatica?

Increased Erythrocyte Sedimentation Rate or ESR (Polymyalgia rheumatic: seen in those >50 y.o., CK levels not increased, electromyography and muscle biopsy are normal. Treated with low-dose prednisone)

At which point in the action potential is the membrane closes to the Na equilibrium potential?

At the highest point

Elevations of ECF potassium ion concentration will have which effect on nerve membranes?

Potassium conductance will increase

16/M suffers from concussion. After waking up, able to understand and following commands, including repeating language spoken to him, but has difficulty with spelling, mild word- finding difficulty, and difficulty understanding written language and pictures. What is damaged in this patient?

Angular Gyrus in the categorial hemisphere (Patient has ANOMIC APHASIA: the single MC language disturbance seen in head trauma, met enceph and Alzheimer. Often caused by damaged to angular gyrus without damage to Broca or Wernicke areas.

What is the most important role of gamma- motoneurons

Maintain Ia afferent activity during contraction of muscle

72/M has difficulty holding hand steadily while painting. (+)resting tremor and rigitidy. Sx relieved by levedopa. Where is the lesion?

Substantia Nigra

What illustrated the train of action potentials normally seen in a sensory nerve encoding the velocity of limb movement in response to sudden movement?

The high-frequency burst of action potentials encodes the velocity of the initial movement, whereas the steady firing encodes the position of the limb when the movement is completed. (Type Ia afferents of the muscle spindles are the ones involved.)

The precentral gyrus and the corticospinal and corticobulbar tracts are essential for which of the following?

Voluntary Movement

Which statement correctly describes the cerebrospinal fluid?

It has a lower glucose concentration than plasma (remember: CSF has LOWER GLUCOSE AND PROTEIN concentration than plasma)

78/M after a stroke has dysmetria, ataxia, intention tremor. Where is the lesion?

Cerebellum

What is observed in a patient with REM sleep?

Periods of loss of skeletal muscle tone (REM sleep: irregular heartbeats and respiration and atonia (loss of muscle tone) along with low amplitude, high frequency waves (beta waves) in the EEG. Hypoventilation is seen in both REM and NREM sleep. In narcolepsy, person may pass directly from waking state to REM sleep)

43/F has muscle weakness consistent with pyramidal tract disease. Tapping the patellar tendon causes reflex contraction of the quadriceps muscle. Which occurs during contraction of the quadriceps muscle?

The 1b afferents from the Golgi tendon organ increase their rate of firing

64/F has siblings with recent strokes. She is diagnosed with APAS and placed on warfarin. She still develops thrombotic cerebral infact that lead to spasticity on her L wrist, elbow and knee. The infarct most likely affected which site?

Corticoreticular Fibers

27/M with mild vertigo x 3 months. (+) positional nystagmus (horizontal and vertical) that is bidirectional. (-) tinnitus. What is the most likely etiology of the vertigo?

Lesion of the flocculonodular lobe of the cerebellum

16/F with epilepsy has EEG done. Alpha rhythm on EEG has which characteristic?

It disappears when a patient’s eye is open (Alpha Waves or POSTERIOR DOMINANT RHYTHM: seen in totally relaxed adult with eyes closed, with regular pattern of 8- 12 waves per scond observed over the posterior/occipital brain regions. Replaced by delta waves in deep sleep)

29/F with R sided homonymous hemianospia. The space occupying lesion on CT scan is compressing which area of the brain?

Left Optic Tract

84/F presents with worsening hemiparesis x 3 days. She’s on anticoagulant therapy for AFib. CT Findings reveal: ____________

``` Subdural Hematoma (intracranial hemmorage associated with anticoagulant tx are often lobar or subdural.) ```

84/F presents with worsening hemiparesis x 3 days. She’s on anticoagulant therapy for AFib. CT Findings reveal: ____________ Upon PE of patient in #95, stroking the plantar surface of the foot causes reflex extension of the large toe rather than flexion. This indicates damage to what?

Upper Motoneurons

59/F with neurodegenerative disease has agitation and aggression. 3 years before, (+) irregular, flinging movements. Which area in the brain did the neuronal degeneration result in this presentation?

Striatum | patient has Huntington chorea

22/F with tachycardia and palpitations after taking ephedrine. Activation of the sympathetic NS by Ephedrine causes smooth muscle contraction of which site?

Arterioles

If a patient is unable to hear high-frequency sounds, the damage to the basilar membrane is closest to which structure

``` Oval Window (actually, it should be the base of the cochlea near the oval and round windows. Low-frequency sounds affect basilar membrane near the apex of the cochlea near the helicotrema) ```

Which is responsible for measuring the intensity of a steady pressure on the skin surface?

Ruffini ending | Ruffini is a tonic receptor. Pacinian is rapidly adapting receptor used to encode vibration

The circadian rhythm is controlled by which nuclei?

Suprachiasmatic

Presynaptic inhibition of the CNS affects the firing rate of alpha- motoneurons by which mechanism?

Increasing the chloride permability of the presynaptic nerve ending

62/F has recent loss of initiative, lethargy, memory problems, loss of vision. (+) primary hypothyroidism and enlarged pituitary gland. What is the most likely visual field defect?

Bitemporal Hemianopsia

Narcolepsy is associated with what?

Hypothalamic dysfuction with decreased CSF levels of orexins (note that adenosine induces sleep while serotonin agonists suppresses sleep)

17/M after falling from motorcycle has traumatic brain injury. (+) fever of 39 deg C unrelated to infection or inflammation. Where is the lesion?

``` Anterior Hypothalamus (thermoreceptors are located in the anterior hypothalamus. It also contains neurons for vasodilation and sweating designed to reduce heat temperature) ```

Which sensory receptors are depolarized at rest and hyperpolarized in response to adequate stimulus?

Photoreceptors

34/F immobilized x 4 days due to sprained ankle develops throbbing pain that spreads to entire L leg. (+) OCP use x 15 years. Ischemic pain is associated with what?

Sensory Fibers terminating within the substantia gelatinosa of the dorsal horn of the spinal cord

42/M has increasing difficulty reading a newspaper. Vision problem is due to inability to contract what?

Ciliary Body | Patient has presbyopia

What is the primary function of the middle ear bones?

Amplify sounds

Depolarization of the hair cells in the cochlea is caused primarily by the flow of what?

K+ into the hair cell (stereocilia of hair cells are bathed in endolymph which is rich in K+. Endolymph is positively charged while ICF is negatively charged so K+ flows into the cell)

The otolith organs (utricle and saccule) are responsible for what?

Detecting the position of the head in space (provide info about the position of the head with respect to gravity)

27/M with severe epilepsy underwent neurosurgery. This resulted to beneficial effect on his epilepsy but led to devastating memory deficit – normal procedural memory, maintained long- term memory for events prior to surgery, intact short-term memory but could not commit new events to long-term memory (loss of declarative memory). What was bilaterally resected?

``` Temporal Lobe (patient underwent bilateral removal of amyglada, large portions of the hippocamapal formation and portions of the association area of the temporal cortex. Temporal Lobes has critical role in formation of long- term declarative memories) ```

Which reaction in the retinal rods is caused directly by absorption of light energy?

Transformation of 11-cis retinal to all-trans retinal

Which of the following normally happens when a person slowly rotates toward the right?

Both the L and R eyes deviate toward the left (hair cell in the R horizontal canal depolarizesa > stimulates R vestibular nervea > causes eyes to deviate to the left.)

58/F having difficulty threading needles was diagnosed with presbyopia. What is the cause?

Stiffening of the Lens

When light strikes the eye, which normally increases?

The activity of transducin

Cholinergic stimulation of the pupil causes which of the following?

Pupillary contriction (miosis)

20/F has altered taste following wisdom tooth extraction. What is the likely cause of dysgeusia?

Damage to the gustatory afferent nerves

52/M has MVA, head injury and decreased sense of smell. Anosmia after head injury is most likely associated with what?

Shearing of the olfactory fila as they pass through the cribriform plate

6 month/M of Jewish descent. Easily startled by noise, has difficulty swallowing, can no longer hold his head up, (+) seizure. (+) cherry red spots in the eyes. Symptoms are due to accumulation of which substance in the brain?

Ganglioside GM2 | patient has Tay-Sach Disease

24/M medical student with apprehension, restless, tachycardia, tachypnea before licensure exam. Activation of which receptor will decrease his anxiety?

GABAA | major inhibitor NT in the brain

26/F African-American sees flashes of light, moving spots, and has reduced visiaul acuity. (+) myopia, (-) eye pain, (+) scotoma in the peripheral vision field of R eye. (-) cherry red spot. What is the likely cause?

Retinal Detachment

52/F after sitting on one leg crossed under the other for several hours, is unable to walk on the crossed leg and feels tingling and pain. What explains loss of motor function without loss of pain sensation in the peripheral nerves?

Type A-beta fibers are more sensitive to pressure than C fibers (Remember: Type A-beta fibers is for touch, pressure and motor, Type C if for touch, pain and temperature. Type A-beta is most susceptible to pressure, while Type C is least susceptible to pressure)

3 weeks after Campylobacter jejuni GI infection, 60/M has weakness and tingling in his legs. Diagnosed with Guillain-Barré Syndrome. What is the underlying cause of his motor paralysis?

Demyelination of Type A-Beta Fibers

32/F has fatigue, muscular weakness, double vision x 2 months. Gets worse the longer she works at the computer screen. (+) impaired movement of the R eye, (+) bilateral ptosis which worsen with repetitive eye movements. MRI: (+)enlargement of thymus gland. SSx are mostly likely caused by antibodies against what?

Postsynaptic nicotinic acetylcholine receptors on the motor end plate (Patient has Myasthenia Gravis)

Which characteristic of an axon is most dependent on its diameter?

The conduction velocity of its action potential

The conduction velocity of its action potential

Dopamine

62/M with COPD presents to ER with resp distress. Succinylcholine was given to relax skeletal muscles prior to tracheal intubation. (+) severe bradycardia develops. Which drug should be given to counteract the bradycardia without affecting muscle relaxation

Atropine | atropine blocks the parasympathetic binding of Ach to M2 receptors in the SA Node.

Fireman suffers extensive burns leading to fluid and electrolyte imbalance. Which electrolyte imbalance would lead to decrease in magnitude of the nerve membrane action potential?

Hyponatremia (since upstroke of AP is dependent on Na)

Which best explains why increasing the duration of the AP can restore nerve conduction in patients with MS?

The amount of sodium entering the nerve with each action potential increases (in the demyelinating disease MS, too much charge leaks from the membrane. Increasing the duration of AP increases probability that the next patch of excitable membrane will be depolarized to threshold.

The membrane potential will depolarize by the greatest amount if the membrane permeability increases for which ion?

Sodium

65/M presents with fatigue, weakness in the legs, frequent falls x several months. Increased DTRs, decreased vibratory sense in toes. (+) megaloblastic anemia and Vitamin B12 deficiency. What explains the neurologic deficits of vitamin B12 deficiency?

Decreased Myelin Synthesis

52/M with surgery for abscessed tooth. Given a shot of procaine before surgery. Preventing the inactivation of Na channels by local anesthetics will decrease what?

Downstroke velocity of nerve cell action potentials (this will slide down normal repolarization phase, prolong the duration of the AP, and prolong the Relative Refractory Period)

Which best describes the sodium gradient across the nerve cell membrane?

It is used as a source of energy for the transport of other ions

19/F sexually active has lower abdominal pain x 1 week, T=38.33 deg C, tenderness on pelvic exam, (+) mucopurulent vaginal discharge. Synaptic transmission between pain fibers from the pelvis and spinal cord neurons is mediated by what?

Substance P

16/F allergic to bees was stung by a bee. Given epinephrine. | Epinephrine will relieve the effects of the bee sting by decreasing what?

Contraction of the airway smooth muscle

10/F with DM Type 1 develops neuropathy of sensory neurons with free nerve endings. Quatitative sensory testing would reveal higher-than-normal thresholds for detection of which stimuli?

Temperature | remember: free nerve endings are for temperature, pain and crude touch

What would provide definitive diagnosis of Alzheimer Disease?

Neuritic Plaques containing A- beta amyloid bodies

The aortic valve closes during which portion of the ECG?

T wave

Patient admitted for intermittent chest main. ECG: (-) MI but echo: L ventricular muscle thickening and narrowing of aortic valve. Afterload- reducing medication prescribed. Which would provide the best measure of the effectiveness of the medication in reducing L ventricular afterload in aortic stenosis?

L ventricular mean systolic pressure (MAP is also good index of afterload, however in AS, ventricular pressure is higher than aortic pressure that’s why it’s not the answer.

At which point on the ventricular action potential is membrane potential most dependent on calcium permeability?

Plateau phase

What is seen in second- degree AV block?

P wave not always followed by QRS complex 1st degree: “the interval between the beginning of the P wave and the beginning of the QRS complex (the PR interval) is longer than normal (greater than 0.2 seconds) but a QRS complex always follows each P wave.” 3rd degree: “conduction between the atria and ventricles is completely blocked, so the atrial beats (represented by the P waves) and the ventricular beats (represented by the QRS complexes) are completely dissociated.”

During ventricular ejection, the pressure difference smallest in magnitude is between what?

Left Ventricle and Aorta

55/M several episodes of syncope and worsening exercise intolerance. What is the most likely diagnosis?

3rd degree AV block

Rapid ventricular Filling occurs at which point?

When atrial pressure > Ventricular Pressure

``` 82/F has ascited peripheral edema, SOB. Labs: Pulmonary Vein O2 content = 20mL O2/100mL blood Pulmonary Artery O2 content = 12 mL O2/100mL blood Oxygen consumption (VO2) = 280mL/min Stroke Volume = 40mL What is the cardiac output? ```

3.5L/min Fick Equation: CO = VO2/a-vO2 =280mL/min / (20mL/100mL – 12mL/100mL) =280mL/min / 8mL/100mL = 280mL/min x 100mL/8mL = 3500mL/min = 3.5L/min

66/M has diastolic murmur over L sternal border, decreased diastolic pressure, increased pulse pressure. What is the most likely diagnosis?

Aortic Regurgitation | aortic regurg causes increased EDV due to backflow of blood, increasing pulse pressure. It causes diastolic murmur.

What is the average direction traveled by the ventricular muscle action potentials as they propagate through the heart?

Mean Electrical Axis (MEA)

During exercise in cardiac transplant patients, cardiac output increases primariliy due to an increase in what?

``` Stroke Volume (in normal patients, CO increases primarily due to increase in HR. But in cardiac transplant patients, allografts are denervated thus, HR does not increase as much during exercise) ```

Propagation of the action potential through the heart is fastest in which cardiac structure?

Purkinje Fibers | slowest in the AV Node

75/F with fatigue and orthopnea. (+) rales both lung fields. After several days of furosemide, Lisinopril therapy is started. What is responsible for the improvement in her condition with the new drug?

Stabilization of cardiac remodeling | ACE-I stabilizes or reverses cardiac remodeling

37/F with large peritoneal mass. Angiography: abdominal aorta constricted to 1⁄2 its resting diameter. As a result, resistance to blood flow will be ___________.

Increased 16-fold | base on Pouseuille Law

72/M has respiratory distress, fever, fatigue. ECG: ST-segment and T- wave abnormalities. Echo: EF of 30%. Peripheral Edema develops. What is the most likely cause of the peripheral edema?

Increased Central Venous Pressure | which increases capillary hydrostatic pressure leading to edema

The second heart sound occurs at the onset of which phase of the cardiac cycle?

Isovolumetric relaxation

57/M complains of palpitations that are relieved by pressing eyeball. ECG shows atrial fibrillation. An increase in _________ is most likely to accompany this condition?

Left Atrial Pressure (absence of atrial pulse reduces the emptying of the atria during diastole and results in enlarged L atrium and increased L atrial pressure.) Oculocardiac reflex – decrease in HR upon compression of eyball due to connections between V1 and the vagus nerve to the SA node. (similar to carotid sinus massage)

While auscultating for heart sound, patient was told to take in a deep inspiration. Splitting of the second heart sound was noted. What is the mechanism underlying this finding?

Delayed closing of the pulmonic valve (actually it should be earlier closing of aortic valve AND delayed closing of the pulmonic valve)

68/M with S3. What is the most likely cause of his S3?

Heart Failure (S3 normal finding usually in children, young adults and pregnant patient. Left sided S3 in patients with CHF is predictive of cardiovascular morbidity and mortality)

23/F with fatigue, mid- systolic murmur, higher than normal cardiac output. Differential diagnosis should include what?

Anemia (reduced Hctàreduced blood viscosityàincreased blood velocity à(+) turbulent blood flowà systolic murmur. HR and CO increases as compensatatory response to hypoxia)

Antagonism of cholinergic muscraninc receptors causes an increase in which physiologic variable?

Heart Rate | SA Node has M2 receptors

58/F with headache, BP=170/70mmHg. (+) diastolic murmur heard best over the L sternal border. During which phase of the pressure- volume loop does the murmur occur?

``` Ventricular Filling (coincides with diastole. AR has wide pulse pressure and diastolic murmur along with “waterhammer” pulse that result in head bobbing) ```

41/M IV drug user has early systolic murmur. Distance between the height of the blood in the R IJV and sternal angle is 7cm (normal is 3cm). What is most likely responsible for the physical findings?

Triscuspid Regurgitation (increased JVP > increased R atrial pressure. Early systolic murmur + high R atrial pressure is indicative of tricuspid regurgitation which is common in IV drug abusers with IE)

50/F with intermitted chest pain. Given exercise stress test to determine if the angina is a result of myocardial ischemia. The test will be considered positive if which occurs?

Depression of the ST-Segment

64/F postop day 1 after cholecystectomy. Suddenly stands up after being supine since the operation. Which hemodynamic variable is expected to increase?

Heart Rate (0.5L-1L of blood pools in the LE when you sudden stand up > decreases VR,SV,CO, BP > baroreceptor reflex initiated > increased HR, TPR and cardiac contractility)

Newborn baby is cyanotic. Cyanosis not releved by 100% oxygen. Diagnosis of persistent fetal circulation is made based on what?

Pulmonary vasoconstriction and hypertension (persistent fetal circulation is synonymous with persistent pulmonary HPN.)

Digitalis use in a patient with CHF will cause the cardiac function curve to move in which direction?

Shift up and to the left

19/M severs artery in motorcycle accident. Tourniquet applied by bystander. Paramedics noticed patient was slightly hypotensive and pupils are reactive. The greatest percentage of redistributed blood volume came from which vessel?

Venules and Veins | the “reservoir” of blood

Phase 4 of the pacemaker potential of SA nodal cells is caused by what?

Increase in the flow of sodium into the cell

What is a common ECG finding accompanying paradoxical splitting of the second heart sound?

Left bundle branch block (paradoxical splitiing of S2 can also be heart in aortic stenosis. Paradoxical split: - P2 comes before A2 and is caused by any condition that delays the closing of the aortic valve)

The ECG is most effective in detecting a decrease in which?

Coronary Blood Flow (reflected as upward or downward shift in the ST segment. Please refer to Pre- Test Physiology as actual question is different and requires interpretation of picture )

What can lead to increased pulse pressure?

Stiffening of the Arteries (remember: PP = SV/arterial compliance. Stiffening of the arteries will decrease arterial compliance, increasing pulse pressure. An increase in SV would also increase PP. An increase in the speed of ejection of the stroke volume will also increase pulse pressure)

75/F with exertional dyspnea, and episode of syncope while dancing with her husband. (+) systolic ejection murmur that radiates to the carotid arteries. This is most likely due to what?

Aortic Stenosis | meanwhile, AR, MS, PR and TS – all are diastolic murmurs

68/M obese has 4-vessel coronary disease and massive MI. When the paramedics arrive 1 hour later, radial pulse is rapid and 8nterp, pink froth comes out of the mouth, and patient is unresponsive. Increasing _________ would lead to an increased stroke volume in this patient?

``` Ventricular Contractility (patient is in cardiogenic shock. Stroke volume is influenced by preload, afterload and contractility. Increasing contractility in this case would increase SV. Increasing HR or TPR or venous compliance would all decrease SV. Pink frothy sputum is due to pulmonary edema, and reflected by increased pulmonary capillary wedge pressure) ```

What normally occurs during the PR interval

Cardiac action potential passes through the AV node (QRS Complex: ventricular contraction Mitral and Aortic Valve closure: after QRS complex has begun 2nd heart sound: after PR interval Normal duration of PR interval: 120-200ms)

What will predispose an athelete to occurrence of Premature Ventricular Complexes (PVC)?

Bradycardia

Patient no longer able to exercise as long as he used to. (+)crepitant rales, S3, BP normal. Sent to cardio due to suspected heart failure. What is most consistent with diagnosis of CHF?

Increased L ventricular wall tension (sequence: decreased L ventricular contractility > decreased EF > increased L ventricular EDV > increased radius of the dilated ventricle > increased wall tension. Remember Laplace relationship: T = Pr/w where T=tension, P = systolic pressure, r = venricular radius and w= ventricular wall thickness)

Which may compromise stroke volume following myocardial infarction?

Increased heart rate | decreases diastolic filling time and may decrease preload and compromise stroke volume

47/M has chest pain, SOB, fainted at the gym. (+) prominent systolic ejection click and crescendo/decrescendo systolic murmur over the R sternal border. Which is consistent with the patient’s most likely diagnosis?

Decreased Pulse Pressure (Patient has Aortic Stenosis: exertional syncope, angina and dyspnea associated with systolic ejection click and murmur is AS unless proven otherwise. AS: decreased SV, EF, Pulse Pressure. Increased systolic ventricular pressure, blood pressure, cardiac oxygen consumption)

The diagnosis of first- degree AV block is made in which of the following cases?

Prolonged PR interval with every P wave followed by a QRS complex

67/M with RHD presents with difficulty breathing while exercising. (+) holosystolic murmur at the L 5th ICS MCL. Murmur loudest at the apex, radiates to axilla, enhanced during expiration, and when patient is instructed to make a fist. Which finding is most likely to be present?

Increased v wave (mitral regurgitation is present in this patient which causes increased L atrial pressure manifesting as increased v wave in a jugular pressure recording.)

Patient #1 has a ventricular pressure- volume curve to the left of Patient #2. The curves have exactly the same shape and dimensions. Which variable is greater in Patient #1?

``` Cardiac Efficiency (efficiency = work/energy consumption. Energy consumption of the heart is directly related to wall stress. Patient 1 has lower EDV and therefore lower wall stress.) ```

35/M BP of 170/105. (+) episodes of headache with palpitations, diaphoresis, anxiety. What is the best initial pharmacotherapy for this patient’s most likely diagnosis?

Alpha-adrenergic antagonist (patient has Pheochromocytoma – blocking alpha 1 will decrease TPR and BP. Blocking B1 may slow HR but lead to unopposed catecholamine stimulation of alpha 1 receptor, increasing TPR and BP to dangerously high levels.

43/M with exhaustion and SOB. MD suspects pericardial tamponade. What led to the MD’s putative diagnosis?

``` Pulsus paradoxus (Beck Triad of Cardiac Tamponade: hypotension, Jugular venous distention, muffled heart sound. Pulsus paradoxus: >10mmHg drop in systolic pressure during inspiration) ```

When a person is given saline, what happens to cardiac(ventricular) and vascular function curves?

Shift up and to the right

Sympathetic stimulation during exercise has which effect on the heart?

Increase in the activity of sarcoplasmic reticulum calcium pump (sympa also increases SA node firing (increasing HR), decreases duration of both systole and siatole)

37/M brought to the ER in shock. Decision to treat anaphylactic shock rather than hypovolemic schok is based on an increase in which variable?

Cardiac Output (Shock – either hypovolemic, distributive, cardiogenic, or obstructive. Hypovolemic Shock – decreased blood volume > preload, SV, CO decreases > response is increased TPR (vasoconstriction of arterioles) and HR ``` Distributive shock (including anaphylaxis) – (+) dilation of peripheral blood vessels > decreases TPR. Response: increased cardiac output. Both hypovolemic and distributive shock: BRR increases ventricular contractility and HR, blood is shunted from kidney, decreasing GFR and increasing serum creatinine. ``` Cardiogenic school – decrease in cardiac output due to decrease in ventricular contractility. Response: constrict blood vessels > increase TPR

23/M with sedentary lifestyle. Starts regular exercise routine. The cardiovascular response to isotonic exercise includes an increase in what?

Stroke Volume (sympathetic stimulation during exercise causes: increased HR, decreased venous compliance, increased VR, increased Cardiac output (increased CO is due mainly to increase in HR, but SV also modestly increases), increased systolic pressure, decreased diastolic pressure, decreased pulmonary vascular resistance)

Vessel X flows into two divisions – Vessel Y and Vessel Z. Vessel Y has half the resistance of Vessel V. What is the ratio of the flow of Vessel X to Vessel Y?

3:2 (since vessel Y has half the resistance of vessel Z, it will have twice the blood flow. The blood flowing through vessel X is the sum of the blood flowing through vessels Y and Z (2+1 =3). Therfore ratio of flow through Vessels X and Y is 3:2)

Which occurs in response to an increase in intracranial pressure

Blood Pressure increases and Heart Rate decreases (increased ICP causes Cushing Triad – HPN, Bradyacardia, respiratory depression)

75/M with HPN x 25 years. Currently on Losartan. ECG: R wave of >11mm in aVL,SwaveinV1and R wave in V5>35mm . Patient’s L ventricular wall stress will be decreased by an increase in what?

Thickness of the free wall of the left ventricle (Tension or wall stress = Pr/w where P=transmural pressure across the wall of the ventricle, r =radius of the ventricle (determined by EDV) and w=thickness of the ventricular wall. Tension is therefore reduced if wall thickness increases)

During aerobic exercise, blood flow remains relatively constant to which organ?

Brain (take note: during exercise, coronary blood flow increases, blood flow to the gut, kidneys and nonexercising muscles is decreased, and blood flow to the skin increases to prevent overheating)

During which interval on the ECG does the bundle of His depolarize?

``` PR SEGMENT (during the interval between the end of atrial depolarization and the beginning of ventricular depolarization) ```

56/M with fatigue and headaches. (+) wide pulse pressure. What causes his pulse pressure to increase?

Arteriosclerosis | due to stiffening of the arteries that causes arterial compliance to increase

48/M with chest pain while running. ECG: ST- elevation in leads I, aVL and left precordial leads V3-V6, with reciprocal ST depression in leads II, III, aVF. Diagnosis?

Anterior infaction

63/F with dyspnea, elevated jugular venous pressure, bilateral lower extremity edema. Given captopril. Which best describes the beneficial effect of this drug?

Afterload is decreased (Patient has CHF. ACE-I is mainstay of treatment of CHF and has shown to improve survival as it leads to arteriolar vasodilation and reduced afterload)

During pregnancy, which is true of maternal and fetal circulations?

Majority of the cardiac output goes to the placenta (during pregnancy: 1. Uterine blood flow increases 20x 2. Placenta supplies 40-60% of fetal cardiac output 3. Umbilical vein draining the placenta – highest oxygenation in the fetus, with PO2 of approximately 30mmHg and 80% oxygen saturation 4. Fetal CO2 removed through uterine veins 5. O2-HgB dissociation curve is shifted to the left for fetal hemoglobin

What is a sign of hemorrhagic shock?

``` Low hematocrit (blood loss > decreased capillary hydrostatic pressure and normal oncotic pressure > water moves from Interstitium to vascular bed > decreased hematocrit.) ```

What is the approximate ratio of arterial compliance to venous compliance?

1:20 | Compliance = change in volume / change in pressure.

6 day old girl is tachycardic, (+) wide pulse pressure, (+) thrill and continuous murmur with late systolic accentuation at the upper left sternal edge. Which describes the in utero function of the most likely structure causing the murmur?

It diverts oxygenated blood away from the lungs to the aorta | patient has patent ducturs arteriosus

During treadmill exercise what will happen to the cardiac (ventricular) and vascular function curves?

Cardiac curve shifts up, and vascular function curve shifts to the right and increase its slope

63/F with acute onset of right eye pain. Ophthalmic and neuro exam normal. (+) carotid bruit. Eye pain ceases with carotid endarterectomy. The bruit is most likely caused by what?

High velocity of blood within the carotid artery

In the pressure-volume loop, systole begins at which point?

Start of isovolumic contraction

57/F undergoes femoral popliteal bypass for her peripheral vascular disease. Vascular surgeon wants to induce localized arteriolar constriction to help control hemostasis. An increase in the local concentration of which agent will cause systemic vasoconstriction?

``` Antidiuretic hormone (most potent vasoconstrictor) ```

What best describes the functional closure of the ductus arteriosus?

It is the final event required for conversion of the transitional circulation in the newborn to the adult circulatory pattern

32/M with primary HPN. MD recommends drug for HPN that acts by decreasomg smooth muscle contractile activity without affecting ventricular contractility. What is the most likely site of action of this drug?

Calmodulin

59/M with EF of 15% being treated with meds for heart failure is asked to participate in clinical trial for experimental drug. Drug decreases expression of phospholamban in ventricular muscle cell. What would be increased by increasing phospholamban?

Concentration of calcium within the SR

When is S1 auscultated?

When ventricular pressure starts becoming higher than atrial pressure

62/M with DM and HPN has substernal chest pain for the last hour. Patient given IV nitroglycerin to reduce pain. What is expected with the use of this drug?

Myocardial Oxygen demand is decreased

Patient has normal S1 and S2 with no murmurs. When does the highest coronary blood flow per gram of left ventricular myocardium occur?

At the beginning of diastole (Blood flow to coronary vessels determined by ratio of perfusion pressure to vascular resistance. At the beginning of diastole, aortic pressure is still relatively high and vascular resistance is low due to the fact that the coronary vessels are not being compressed by the contracting myocardium)

Which protein determines the normal stiffness of the ventricular muscle?

Titin | connects Z lines to M lines, thereby providing scaffold for the sarcomere

22/M with (-) hx of congenital heart disease. What is most similar in the systemic and pulmonic circulation of this patient?

Preload (pulmonic circulation has lower resistance, lower afterload, lower stroke work but same heart rate, same stroke volume and cardiac output)

22/F recovering from upper resp infxn with Coxsackie virus. Condition worsens and she becomes dyspneic. Echo: global hypokinesis, EF=25%. What is the underlying process in this patient’s most likely diagnosis?

Ventricular dilation | patient has dilated cardiomyopathy caused by myocarditis

58/M with hx of exertional chest pain x several months. (+) severe arthritis bilaterally and cannot undergo stress test. Chemical stress test with dipyridamole was done to investigate chest pain. After giving drug, (+) severe retrosternal chest pain, ST-segment depression in the anterior leads of the ECG. What is the most likely mechanism of the chest pain?

Coronary blood redistribution (patient has coronary “steal” phenomenon after provocation with a vasodilator dipyridamole) In patients with decreased coronary artery, the vessel is maximally dilated at rest while other disease- free arteries remain at normal diameters. Giving vasodilator will cause ALL coronary arteries to become maximally dilated shunting, stealing blood away from the diseased vascular bed to the newly dilated arteries producing ischemia.)

What happens to the pressure-volume curve of a patient with dilated cardiomyopathy?

Shifted to the right

3/F with unremarkable developmental history and updated immunization. (-) murmurs, rubs, gallops. S1 and S2 heard. S2 is split at fixed interval and does not vary with respiration. What is most likely present in this patient?

Atrial septal defect

58/F with idiopathic pulmonary HPN has RVH and cor pulmonale. ECG: (+) QRS complexes in leads Vi, III, aVF and equiphasic QRS complexes in lead aVR. Wat is her mean QRS vector?

+120 degrees

59/F obese. What happens to her cardiac function curve as she achieves a new steady-state during treadmill exercise?

Upward shift

At 18,000 ft above sea level, barometric pressure is 380mmHg. What would be the resulting PO2 of the dry inspired air?

80 mmHg | based on Dalton Law: 380mmHg x 21% = 80mmHg

28/M has MVA. ABG was ordered while patient breathes room air. While obtaining sample, glass plunger slides back, drawing air bubble into the syringe before it is handed to the blood gas technician. How does exposure to room air affect the measured values of PO2 and PCO2 in arterial blood?

The measured PaO2 will be higher and the measured PaCO2 will be lower than the patient’s actual blood gas values (because room air contains 21% O2 and 0.04% CO2, the measured PaO2 will be inaccurately high will the measured PaCO2 will be inaacurately low.)

68/F with pulmonary fibrosis has increasing dyspnea while performing activities of daily living. Pulmonary fuction test will reveal what?

Decreasing diffusing capacity of the lung (because of the increase in the thickness of the diffusional barrier. In restrictive lung disease, all lung volumes and capacities would also decrease but the FEV1/FVC ratio maybe normal or increased. Airway resistance is normal when corrected for lung volume in contrast to obstructive lung disease wherein increased airway resistance is a hallmark)

What would occur if the blood flow to alveolar units is totally obstructed by pulmonary thromboembolism?

The PO2 of the alveolus will be equal to that in the inspired air (since atmospheric air enters the alveoli, but no gas exchange occurs)

Hospitalized patient has tachypnea and labored respirations requiring mechanical ventilation. If the pressure-volume curve of the lungs shows lower slope than normal which is characteristic of decreased lung compliance, what is the most likely diagnosis?

Pulmonary Edema

What changes in lung function occur as a result of pneumothorax?

The intrapleural pressure in the affected area equals to atmospheric pressure (also: lung on affected size collapses, V/Q ratio decreases, trachea shifts toward affected lung in spontaneous pneumothorax and away from affected lung in tension pneumothorax)

Insulation worker has dyspnea on exertion. Pulmo function test consistent with restrictive impairments. PaO2 is normal at rest but hypoxemic during exercise stress test. What is the most likely explanation for decline in PaO2 during exercise?

An underlying diffusion impairment coupled with a decrease in pulmonary capillary transit time during exercise

26/M training for marathon reaches workload that exceeds anaerobic threshold. Which would increase as a result?

Alveolar Ventilation (Minute ventilation and alveolar ventilation increase linearly with CO2 production up to about 60% of maximal workload during exercise. Above this is the anaerobic threshold where lactic acid causes metabolic acidosis)

Medical student on first patient interview becomes anxious and increases rate of alveolar ventilation . If CO2 production remains constant, what will decrease?

PaCO2

58/M with acute exacerbation of asthma has breathing becoming labored and faster. What changes in airflow is expected?

The pressure gradient required for airflow will increase (increased velocity of airflow > turbulent airflow. Turbulent airflow > increases pressure gradient required for airflow)

Surfactant increases what?

Lung Compliance

If the maximal expiratory flow-volume curve shows decreased expiratory flow rates, but increased lung volume due to air trapping, this is see in which case?

A 75-year old man who has smoked two packs of cigarettes per day for 60 years. His breath sounds are decreased bilaterally and his chest x-ray shows flattening of the diaphgram

14/F with lump in neck. FNAB reveals acinic cell CA of the parotid gland. During parotidectomy, (+)compression injury of the glossopharyngeal nerve. Which respiratory reflex will be impaired?

Carotid Body Chemoreceptor Reflex (afferent pathway of carotid body chemoreceptors include Hering nerve – a branch of CN IX. CN X meanwhile is part of the afferent pathway of the aortic baroreceptors, J receptors, irritant receptors, rapidly adapting lung stretch receptors)

In the upright position, which of the following variables will be lower in the apex compared with the base of the lungs?

Lung compliance (lower hydrostatic pressure in the apex > lower intrapleural pressure > increases resting lung volume > decreased slope of the pressure-volume curve.)

36/M comatose at home. Blood gases: normal PaO2, lower than normal arterial O2 saturation. Which condition is most consistent with this findings?

Carbon Monoxide Poisoning

22/M has nonproductive cough, wheezing, dyspnea. Patient was given aerosolized medication. There was greater flow rates measured. This is attributed to an increase in what?

``` Airway radius (case of asthma, Beta-2 agonist given) ```

Which is likely to have a lower value in the preterm infant compared to the term infant?

Pulmonary Blood Flow (in the preterm infant, the pulmonary vascular resistance, pulmonary artery pressure (PAP), pulmonary capillary hydrostatic pressure, pressure gradient from pulmonary artery to the aorta, are all increased)

Pulmonary edema in CHF is promoted by what?

Increased pulmonary capillary hydrostatic pressure

As a result of alveolar septal departitioning in emphysema, there is a decrease in what?

Diffusing Capacity (destruction of alveolar septa > loss of pulmonary capillaries > decreased surface area for diffusion > decreased rate of diffusion)

54/M with severe asbestosis and worsening dyspnea. PFTs were ordered and Maximal Expiratory Flow volume (MEFV) curve was obtained. His Lung compliance is decreased, lung elastic recoil is increased, and all lung volumes and capacities are lower than normal. This is consistent with which set of labs?

FVC: 3.1L, FVC(%predicted): 48 FEV1:2.8L FE1(%predicted):50 FEV1/FVC:90

25/F with GDM has HPN and preeclampsia requiring delivery of fetus at 30 weeks AOG. Patient was given betamethasone, 12mg, IM, 24h apart. What is the purpose of prenatal steroid therapy?

Increase the Lecithin/Spingomyelin ratio in the amniotic fluid

Person with CHF and SOB admitted for cardiac transplant. Hemodynamic recording: Mean Pulmonary Artery Pressure (PAP): 35mmHg, Mean Left Atrial Pressure (LAP): 20mmHg, Pulmonary Artery Wedge Pressure (PAWP): 25mmHg, Cardiac Output: 3L/min. On previous admission, LAP:15mmHg, Cardiac Output:4L/min. What can be deduced?

Cardiac contractility is lower than on the previous admission

68/M with COPD has SOB. RR=35, productive cough and rales over all lung fields. Patient has ashen complexion and cyanosis. ABG and CXR ordered. Patient placed on O2 mask delivering 40% O2. 30 minutes later, patient was unreponsive. His complexion has changed to flushed pink with (-) cyanosis. R=6, TV=300mL. ABG: PCO2 had increased from 55mmHg to 70mmHg, PaO2 increased from 55mmHg to 70mmHg. The oxygen therapy most likely result in what?

Alveolar Hypoventilation (Remember: Hypercapnic drive in COPD patients is attenuated due to compensated respiratory acidosis eliminating direct stimulus to central chemoreceptors. The low PaO2 stimulating the peripheral chemoreceptors (hypoxic drive) become the primary drive to breath in chronic hypercapnia. Supplemental O2 is the only pharma therapy that decreases mortality in COPD, aside from extending life, improving IQ, exercise tolerance and cor pulmonale)

Scientist exposed to sodium cyanide experiences headache, dizziness, clumsiness, decreased visual acuity, naurea. Labs: Hb=16g/dL, PaO2=102mmHg, PaCO2=27mmHg, pH=7.57, HCO3-=23mEq/L, SaO2=97.5%, PVO2=65mmHg, Cardiac Output=5.6L/min. The patient’s hypoxia is most likely the result of what?

Impaired oxygen utilization | remember: cyanide is an inhibitor of the ETC

42 week AOG infant delivered by CS. What will occur with the baby’s first diaphgramatic respiration?

PaO2 increases (causing pulmonary vascular resistance to decrease, systemic vascular resistance to increase. Ductus arteriosus normally remains open for 48 hours)

29/F has dyspnea and swelling on both feet. (+) severe pectus excavatum with only 2cm of space between vertebral bodies and sternum. FVC is 15% of predicted. FEV1/FVC 100% of predicted. What lab measurement would be below normal in this patient?

Arterial pH (patient has restrictive lung disease due to the pectus excavatum. Her condition would cause hypoventilation and consequent respiratory acidosis which would decrease the arterial pH)

The pacemaker neurons responsible for respiratory rhythmogenesis are located in which area of the brain?

Pre-Botzinger complex in the VRG

45/M suffers from severe back pain due to herniated disk from operating a jackhammer. (+)60 pack years. During forced expiration, patient has intrapleural pressure of 20mmHg. The patient’s equal pressure point will move closer to the mouth and FEV will increase if there is an increase in what?

Inspired lung volume (equal pressure point: point at which pressure inside the airways equals the intrapleural pressure. Increasing lung volume expands alveoli, making recoil force greater and intrapleural ressure less (more negative). This moves the equal pressure toward the mouth.

Which pulmonary function test is consistent with allergic bronchospasm?

Decreased FEV1/FVC | obstructive lung disease causes air trapping and is associated with decrased FEV1/FVC, and increased RV, FRC and TLC.

5 month infant with repeat episodes of sleep apnea. Ventilator response test: ventilation did not increase when PaCO2 was increased, but decreased during hyperoxia. What is the most likely cause of the infant’s apnea?

Dysfunctional central chemoreceptors (remember: plasma CO2 becomes CSF H+ that triggers central chemoreceptors. In this case, no increase in RR with increased PaCO2, but decreased RR during hyperoxia means the central chemoreceptors are not working, while the peripheral chemoreceptors are working.)

V/Q abnormalities occurring in patient with lobar pneumonia will generally cause a decrease in ___________.

Arterial PO2

72/M with CHF, PND, orthopnea. PFT in the supine and upright positions done. What is higher at the apex than the base when person is upright?

V/Q Ratio

Flow of fluid through the lymphatic vessels will be decreased if there is an increase in _________________.

Capillary oncotic pressure | lymph flow is proportional to the amount of fluid filtered out of the capillaries

24/M suffering from sleep apnea underwent ventilator responsiveness test. His alveolar ventilation increased as predicted in response to breathing 5% CO2 but his ventilator response to breathing 16% O2 was depressed. Whas is consistent with these findings?

Decreased Peripheral Chemoreceptor Sensitivity (peripheral chemoreceptors respond to hypoxemia and hypercarbia, central chemoreceptors respond to hypercarbia that is converted to CSF H+, but not directly to hypoxemia)

Which will decrease the oxygen consumption of the respiratory muscles?

A decrease in airway resistance (respiratory muscles consume O2 in proportion to the work of breathing. Work of breathing Is equal to the product of the change in volume for each breath and the change in pressure necessary to overcome resistive work of breathing (tissue and airway resistance) and the elastic work of breathing (lung compliance)

18/M thrown from motorcycle. (+) brain transection above the pons. How will this lesion affect the control of breathing in the patient?

The limbic system will no longer be able to exert any control over ventilation (breathing continues because of intact pons, medulla. Hering- Breuer Reflex is also still intact)

Normally, intrapleural pressure is negative throughout a tidal inspiration and expiration because of which of the following?

The lungs and chest wall recoil away from each other throughout a tidal breath (inward elastic recoil of lungs opposing outward elastic recoil of chest wall results in subatmospheric (negative) pressure in the pleural space

47/M with fever, productive cough, SOB x 7 days. CXR: consolidation in the R lower lobe, sputum (+) for Klebsiella pneumoniae. ABG: (+) hypoxemia, no CO2 retention. What would be increased in this patient?

Alveolar-arterial PO2 difference | synonymous with A-a gradient. A-a gradient is increased because of decreased V/Q ratio due to the pneumonia.

37/F with severe kyphoscoliosis and respiratory muscle weakness. Which of the following physiologic variables is most likely decreased in the patient?

Chest Wall Compliance (kypohoscoliosis leads to decreased chest wall compliance > inadequate alveolar ventilation > respiratory acidosis, decreased lung volumes and capacities, but normal or increased FEV1/FVC ratio.

83/F unresponsive 3 hours after gallbladder surgery. Nurse reported patient asked for pain meds. ABG: hypercapnia, hypoxemia. What is the most likely cause of the high arterial PCO2?

Hypoventilation

Which of the following conditions will cause a decrease in pulmonary vascular resistance?

Increased Cardiac Output

Normally, during moderate aerobic exercise, which occurs?

Alveolar ventilation increases (along with increase in O2 consumption and CO2 production. PaCO2 does not change. Arterial pH and blood lactate are also normal during moderate aerobic exercise but not during anaerobic exercise – whenever workloads exceeed 60% of the maximal workload (anaerobic threshold))

56/F with fatigue, headache, dyspnea on exertion. Sometimes gets blue lips and fingers during exercise. PFT: increase rather than decrease in diffusing capacity of the lungs. What is the explanation for the increase in diffusing capacity?

Polycythemia

49/M farmer has headache and becomes dizzy after working in his barn. Wife suspects CO poisoning. Patient is red, does not appear in respiratory distress and denies dyspnea. Blood levels of carboxyHgB are elevated. What best explains the absence of respiratory signs and symptoms associated with carbon monoxide poisoning?

Arterial oxygen tension is normal (remember: CO decreases arterial oxygen SATURATION by decreasing oxyhmoglobin and total arterial O2 content BUT it does not reduce the amount of O2 dissolved in plasma which determines the arterial oxygen TENSION. CO is colorless and odoless – dyspnea and respiratory distress are late signs.

What best characterizes lung compliance?

It is inversely related to the elastic recoil properties of the lung

The activites of the central chemoreceptors is stimulated by what?

An increase in the PCO2 of blood flowing through the brain

What will increase as a result of stimulating cholinergic receptors on the bronchial smooth muscles?

Resistive work of breathing | remember – parasympathetic stimulation causes bronchoconstriction

During normal inspiration, why does more air go to the alveoli at the base of the lungs than to the alveoli at the apex of the lungs?

The alveoli at the base of the lung are more compliant

21/F presents with cough and SOB. PFT done. Maximum flow-volume curve shows increased elastic recoil and decreased lung compliance with a shift of the normal MEFV curve down and to the right. These findings are consistent with what?

Sarcoidosis

Aerobic exercise causes which of the following changes in pulmonary physiology?

Diffusing capacity of the lungs increases

49/M coal miner has dyspnea, nonproductive cough, decreased exercise tolerance. TLC = 3.34L(56% of predicted), RV=0.88L(54% of predicted), FVC=1.38L (30% of predicted). PaO2=68mmHg. Which value will be normal?

FEV1/FVC ratio (because this is a restrictive lung disease. All lung volumes and capacities are decerased, and there is increase in thickness in the diffusion barrier.)

43/F with asthma. Airway resistance is greater at ___________.

Low lung volumes compared with high lung volumes (as lung volume decreases, intrapleural pressure increases. This will cause decrease radial traction in the airways, decreasing airway diameter and increasing airway resistance)

A spirometer can be used to directly measure: __________.

VC | It cannot measure RV, FRC, TLC. It also cannot measure peak flow rate which requires a pnemotach or peak flow meter

Which will be greater than normal in a patient with low V/Q ratio?

A-a gradient for O2

At which point on the flow- volume loop will airflow remain constant despite an increased respiratory effort?

At midpoint of expiration | during the “effort-independent portion of the MEFV curve”.

15/F more tired than usual, (+) muscle cramps in her calves, legs get weak and sore after soccer. BP 160/100mmHg, ECG: prolonged QT interval, U waves. Labs: hypokalemia, metabolic alkalosis, decreased plasma renin and aldosterone. SSx improved with diuretic amiloride. Based on this finding, which major transport process is the major defect causing her metabolic disoder?

Greater than normal sodium reabsorption by the cortical collecting ducts (patient has Liddle syndrome which is marked by mutated genes that increases ENaC activity and sodium retention despite low levels of renin and aldosterone. This causes her metabolic alkalosis, hypokalemia and HPN – due to increased sodium and water reabsorption. Amiloride – a potassium sparing diuretic blocks sodium channels in the principal cells of the collecting ducts, limiting sodium reabsorption and improving her condition.)

A stimulus for increasing renal renin secretion is an increase in what?

Sympathetic nerve activity | via B1 receptors in the JGA

Patient with uncontrolled HPN placed on new diuretic targeting Na+ reabsorption site from basolateral surface of renal epithelial cells. What transport process is this new drug affecting?

Na-K pump (note that Na-H exchange pump and Na-Glucose symport are located on the apical surface of the epithelial cells. Na is transported from peritubular spaces to the capillaries by solvent drag)

What will most likely produce an increase in GFR in patients with acute renal failure?

Vasodilation of afferent arterioles

83/F with HPN presents with oligura. Elevated BUN and Creatinine, CT: hypoplastic L kidney. Substance X was injected in arterial line. All of substance X appears in the urine and none is detected in the renal vein. What do these findings indicated about the renal handling of substance X?

Its clearance is equal to the renal plasma flow (RPF) | Substance X was filtered, secreted, but not reabsorbed similar to PAH

PTH increases Ca2+ reabsorption at which point along the nephron?

Medullary thick ascending limb and the distal convoluted tubule (note that PTH inhibits phosphate reabsorption in the PCT)

In patients with SIADH, which will increase?

Intracellular Volume (due to decreased ECF osmolarity, osmosis will happen from ECF to ICF, increasing ICF volume. At the end of the day, ECF and ICF volume will increase, ECF and ICF osmolarity will decrease)

46/M with frontal headaches x 12 weeks. Brain CT: mass in posterior pituitary, with absent posterior pituitary “bright spot” on MRI. (+) increased thirst and waking up frequently during the night. What best describes his urine?

Higher-than-normal flow of hypotonic urine (Patient has Central Diabetes Insipidus. Central DI will present with polyuria, polydipsia, dehydration, hypernatremia, hyperosmolarity)

28/F with SLE develops hypokalemic paralysis. ABG: PaO2 = 102mmHg, pH=7.1 Dx:RTATypeI, cause dby autoimmune response that damages the H+-ATPase on the distal nephron. Which lab value will most likely be normal in this patient?

Anion Gap | remember causes of NAGMA: HARD-UP. R is RTA.

24/M with Hx of renal insufficiency admitted to ER after ingesting large dose of ibuprofen. BUN = 150mg/dL. Patient’s high serum urea nitrogen most likely caused by what?

Decreased GFR | in renal insufficiency, less urea filtered, less urea excreted. This results in increased plasma concentration of urea

Aldosterone secretion is increased when there is a decrease in the plasma concetration of which substance?

Sodium

92/M with dehydration after 4 days of diarrhea. Hypotonic fluid would be expected at which part of the nephron

Ascending Limb of the Loop of Henle (the “diluting segment”. 1st part of the distal tubule or the “cortical diluting segment” can also be the correct answer)

Which part of the kidney is responsible for majority of amino acid reabsorption?

PCT

Which best describes the action or secretion of renin?

It converts angiotensinogen to angiotensin I

What structural features distinguides the epithelial cells of the proximal tubule from those of the distal tubule?

The proximal tubule has a more extensive brush border (it has microvilli!)

Most of the glucose that is filtered through the glomerulus undergoes reabsorption in which area of the nephron?

Proximal Tubule

The effective RPF, determine from the clearance of PAH, is less than the true RPF because of which of the following?

The plasma entering the renal vein contains a small amount of PAH. (CPAH underestimates true RPF by 10% due to shunting)

What neurotransmitter is responsible for initiating bladder (destrusor muscle) contraction?

Acetylcholine | remember: urination is parasympathetic

Both the GFR and RBF would increase if which of the following occurred?

The efferent and afferent arterioles are both dilated

The amount of potassium excreted by the kidney will decrease if which of the following occurs?

Na+ reabsorption by the distal nephron decreases

Which substance is more concentrated at the end of the proximal tubule than at the beginning of the proximal tubule?

Creatinine (because creatinine is filtered, not reabsorbed, not secreted, its amount is not changed throughout the PCT. But water is reabsorbed throughout the PCT, therefore CONCENTRATION of Creatinine will INCREASE along the PCT)

The effect of decreasing the resistance of the afferent arteriole in the glomerulus of the kidney is to decrease which of the following aspects of renal function?

Renin release from juxtaglomerular cells (Decreasing resistance in the afferent arteriole (vasodilation of Afferent arteriole) will DECREASE and not increase, renin production. RPF, Filtration Fraction, Oncotic pressure, GFR all increase when there is afferent arteriole vasodilation)

Electrically neutral active transport of sodium and chloride occurs in which area of the nephron?

Distal Tubule (DT reabsorbs 5% of filtered NaCl via electrically neutral thiazide-sensitive Na+/Cl- constransporter on the apical membrane.)

Renin release from the juxtaglomerular apparatus is normally inhibited by which?

Increased pressure within the afferent arterioles

The ability of the kidney to excrete concentrated urine will increase if ___________ occurs.

The activity of the Na+-K+ pump in the loop of Henle increases

What best characterizes the actions of aldosterone on the kidney?

It increases the number of active epithelial sodium channels (ENaCs) in the collecting ducts

What effect does angiotensin II have on the glomerular filtration rate (GFR)?

Increases GFR because of constriction of the efferent arteriole

In the absence of ADH or when the kidney lacks responsiveness to ADH, the luminal Na+ concentration will be lowest at which part of the tubules?

Collecting Duct

What is the effect of vasopressin on the kidney?

Increases permeability of the collecting ducts to water

How does the distal nephron differ functionally from the proximal tubule?

The distal nephron has a more negative intraluminal potential than the proximal tubule.

In which condition is increased free water clearance a hallmark of the disease?

Diabetes insipidus

58/M had MI. several days later, 24h UO is lower than normal. An increase in __________ contributes to a reduced urine flow in a patient with CHF and reduced effective circulating volume.

Renal sympathetic nerve activity (“Patients with CHF have paradoxical increase in NaCl and water retention despite increase in ECF volume. Increased sympathetic nerve activity promotes correction by decreasing GFR, increasing renin secretion and increasing renal tubular NaCl reabsorption. ANP, urodilatin, renal perfusion pressure, sodium delivery to macula densa would all increase NaCl and water excretion”)

A decrease in GFR is seen in _____________.

Compression of the renal capsule | due to decrease net capillary filtration pressure

Patient with persistent diarrhea x 7 days. Which will decrease in this patient?

Filtered load of HCO3- | persistent diarrhea > NAGMA > decrease plasma concentration of HCO3- > decreased filtered load of HCO3-

27/M from China for TB screening. Quantiferon testing (+), PE: cough, cachexiam mild respiratory distress. CXR: cavitary lesion in the R upper lobe. Labs: serum Na = 118mg/dL, increased ADH concetrnation. As a result, permeability of the collecting duct will be increased to what?

Urea | via UT-1 transporters in the CD. Water is also reabsorbed in the CD because of ADH

Filtration fraction may be increased in patients with heart failure due to an increase in what?

Efferent arteriolar resistance | since FF = GFR/RPF. Efferent arteriole vasoconstriction increases GFR while decreasing RPF

Carbonic anhydrase inhibitor exert their diuretic effect by inhibiting the reabsorption of Na+ in which part of the nephron?

The proximal tubule

Which endogenous substance causes RBF to decrease?

Angiotensin II

19/M football player for annual PE. Asymptomatic but UA reveals macroscopic hematuria. (+)deformed erythrocytes and RBC casts. Where in the renal-urinary system is the most likely origin of the blood in his urine?

Glomerulus (patient has nephritic syndrome, most probably due to IgA nephropathy – which is seen in young men after viral infection, trauma or exercise)

55/M with HPN placed on K-sparing diuretic. What is the MOA?

Inhibition of Na+ reabsorption via Na channels in the collecting tubules

Which best describes renal ammonia (NH3)?

Renal NH3 synthesis is decreased in hyperkalemia

In Type IV RTA, excretion of which urinary electrolyte iI increased?

Na+ | “Type IV RTA is caused by aldosterone resistance or deficiency, and is also called hyporeninemic hypoaldosteronism.”

Patient with renal failure has increasing fatigue x 1 month. Based on tests, symptoms caused by loss of hormone produced by the kidney. What is the most likely diagnosis?

Anemia | due to decreased EPO due to renal failure

ANP increases Na+ excretion by which mechanism?

Decreasing sodium reabsorption by the inner medullary collecting duct

Elderly woman has spiking fever, shaking chills, nausea and CVA tenderness. Urine culture (+) and hospitalized for pyelonephritis. Decreased GFR with increase in concentration of NaCl delivered in the intraluminal fluid to the TAL of LH. Macula densa will increase formation and release of which substance?

Adenosine | which constricts the afferent arteriole

Aldosterone increases Na+ reabsorption at which part of the nephron?

Cotical and medullary collecting ducts

The renal clearance of phosphate is increased by which hormone?

PTH

What will produce the greatest increase in potassium secretion?

An increase in distal nephron sodium concentration

36/M with 3rd degree burns over 70% of BSA. Effective circulating volume and renal perfusion pressure decreases, concentration of NaCl in the intraluminal fluid in the kidney decreases. These conditions cause JGA to release which hormone?

Renin

In adults, which is greater in the pulmonary circulation compared to the renal circulation?

Blood Flow (because lungs are in series with the heart, pulmonary blood flow is 100% of cardiac output, compared to renal blood flow which has 22-25% of cardiac output)

The transport of H+ into the proximal tubule is primarily associated with what?

Reabsorption of bicarbonate ion

In the presence of ADH, the filtrate will be isotonic to plasma in which part of the kidney?

Cortical collecting tubule

What is associated with chronic renal failure?

A decrease in the excretion of creatinine

Furosemide increases sodium reabsorption in the thick ascending limb of the loop of Henle via which mechanism?

Na-K-2Cl cotransport

What causes relaxation of the LES in response to swallowing?

Release of vasointestinal peptide and nitric oxide from inhibitory ganglionic neurons

What best describes the function of gastric emptying?

Hyperosmolality of of duodenal contents initiates a decrease in gastric emptying (gastroparesis – delayed gastric emptying – common cause of GERD – is common in DM because hyperosmolality of the duodenum initiates a decrease in gastric emptying. This is neural in origin and sensed by duodenal osmoreceptors)

What best describes small intestinal cell motility?

Contractile activity is initiated in response to bowel wall distention (intestinal motility has 3 tupes of smooth muscle contractions – peristalsis, segmental contraction, tonic contraction. Peristaltic rushes occur in intestinal obstruction. Interstitial Cells of Cajal are responsible for production of slow waves (also called the Basal Electrical Rhythm or BER that coordinate the various types of contractile activity but rarely causes muscle contraction. Cycles of motor activities called Migrating Motor Complex also occurs between periods of digestion)

Vitamin B12 is absorbed primarily in which portion of the GI tract?

Ileum

27/F with profuse watery diarrhea x 2 days. Dx: acute secretory diarrhea and dehydration due to E. coli. Which sodium reabsorptive pathway is inhibited by the enterotoxin?

Electroneutral NaCl transport | toxins augment diarrhea also by increasing salt and water secretion by intestinal crypt cells

37/M with dehydration, hypokalemic metabolic acidosis. This is associated with excess fluid loss from which GI organ?

Colon (fluid loss from pancreas, liver, ileaum and colon can lead to metabolic acidosis because they secrete bicarbonate, but because colon secretes potassium, fluid loss from colon will also have hypokalemia)

Normally, basal acid output is increased by what?

Alkalinization of antrum (releases gastrin-releasing cells from inhibitory influence of somatostatin. Acidification of antrum promotes release of somatostatin)

42/M with gastric CA in the proximal third of the stomach. Patient scheduled for partial gastrectomy of the affected region. Which process will be most affected by surgery?

Receptive relaxation (also call “accommodation reflex”, this is a poperty of the orad stomach only and not other stomach parts. Caudad stomach causes peristalsis, trituration(grinding) and retropulsion(mixing))

37/M with AIDS has fever, anorexia, weight loss, GI bleeding. (+) proximal small-bowel malignancy requiring surgical resection. Removal of proximal segment of the small intestine would likely result in a ↓ in?

Pancreatic enzyme secretion

63/F with intractable duodenal ulcer. Laparoscopic vagotomy performed. Patient experiences nausea and vomiting after ingestion of mixed meal. What best explains her sx?

Decreased gastric emptying of solids (Section of vagus nerve fibers to antral regions of the stomach will decrase strength of contraction causing decrease in gastric emptying of solids. Gastric emptying of liquies are unaffected since it normally bypasses the pyloric sphincter)

17/M treated with macrolide erythromycin has nausea, intestinal cramping, diarrhea. The side effects are the results of the antibiotic binding to receptors in the GIT that recognize which hormone?

Motilin (erythromycin shows ability to excite motilin-like receptors on enteric nerves and smooth muscles)

23/F (+) abdominal cramps and bloating relieved by defecation. (+) maximal acid output, decreased serum calcium and iron, microcytic anemia. Inflammation in which area of the GIT best explains this findings?

Duodenum ``` (Inflammation of duodenum causes: 1. increased acid output via reduced inhibitor feedback (reduced effect of enterogastrone and enterogastric reflex) 2. Hypocalcemia since Ca2+ is primarily absorbed in the duodenum 3. Microcytic anemia since Fe2+ is primarity absorbed in the duodenum ```

Removal of terminal ileum woud most likely result in what?

Increased excretion of fatty acids (since bile salt is absorbed in the terminal ileum. Removal of terminal ileuam wil also cause diarrhea since fat and bile salts in the colon promote water secretion in the feces)

67/M alcoholic has severe epigastric pain, hypotension, abdominal distention, diarrhea with steatorrhea. (+) increased serum amylase and lipase. Dx: pancreatitits. Steatorrhea can be accounted for by a decrease in the luminal concentration of which pancreatic enzyme?

Lipase | also known as carboxylic esterase

Which best describes the salivary glands?

Starch digestion begins in the mouth via salivary alpha amylase (NOTE: Pre-Test Physiology made an error – citing B (salivary alpha amylase preferentially hydrolyzes 1:6alpha over 1:4alpha linkages, as the correct answer)

Which transport protein is responsible for entry of glucose intro the intestinal enterocyte?

SGLT-1

43/F with dysphagia to solids and liquids, bland regurgitation, diffuse chest pain x 2 months. (+) 20 lbs weight loss. Esophagogram: dilated esophagus with distal stenosis. Manometry tracing during wes swallow: high LES opening pressure and uncoordinated peristalsis. These findings are consistent with which diagnosis?

Achalasia

42/M with intermitted midepigastric pain that is relieved by antacids or eating. Basal and maximal acid outputs exceed normal values. Gastric hypersecretion can be explained by an increase in the plasma concentration of which substance?

Gastrin

Which best describes colonic function?

Absorption of Na+ in the colon is under hormonal control by aldosterone (remember that aldosterone has effects on sweat glands, salivary glands, kidneys and colon)

Which is expected with contraction of the gallbladder following a meal?

It occurs in response to cholecystokinin

42/M with midepigastric pain that is relieved by antacids or eating. Endoscope: (+) duodenal ulcer. Based on the diagnosis, which is expected?

Increased maximal acid output

43/F with bulky and frequent diarrhea and weight loss. (+) recurrent episodes of abdominal distension terminated by passage of stools. Labs: (+) microcytic anemia, decreased serum calcium, decreased serum albumin. Her generalized decrease in intestinal absorption can be attributed to what?

Decreased intestinal surface area | Patient has gluten-sensitivity enteropathy of celiac sprue. (+) antibodies to gliadin and tissure transglutaminase

Which best describes the pharmacologic blockade of H2 receptors in the gastric mucosa?

It inhibits both gastrin- and acetylcholine-mediated secretion of acid

37/M with exacerbation of Crohn disease with severe inflammation of the ileum. What will be seen?

Deceased bile acid pool size | resulting in reduced absorption of fat and fat-soluble vitamins including Vit K

47/M uses esomeprazole for “acid indigestion.” Which best describes the use of substituted benzimidazole derivatives?

They inhibit H-K-ATPase in parietal cells

57/M undergoes resection of distal 100cm of terminal ileum for Crohn disease. Patient likely will have malabsorption of what?

Bile Salts

62/F prescribed prostablanding E agonist, misoprostol and NSAID for severe bilateral osteoarthritis of the knees. What is the misoprostol for?

Prevent NSAID-induced gastric ulcers (misoprostol maintains gastric mucosal barrier, enhances bicarbonate secretion in the gastric mucous gel. Misoprostol may cause diarrhea BTW)

18/F severe abdominal bloating and diarrhea within 1 hour of consuming dairy products. (+) abnormal hydrogen breath test. Diarrhea and bloating can best be explained by what?

Deficiency in the brush border enzyme lactase

32/F with abdominal pain, diarrhea, steatorrhea. (+) basal acid output of 12 mmol/hour (normal: <5mmol/hour). The steatorrhea is most likely due to what?

Inactivation of pancreatic lipase due to low duodenal pH

What is the primary physiologic stimulus of gallbladder contraction in the digestive period?

Fat-induced release of cholecystokin from the small intestines

The metabolic effect of insulin include what?

Decreased lipolysis | insulin promotes anabolic reaction – increases glucose utilization, lipogenesis, proteogenesis

31/M has heartburn and difficulty swallowing. Esophageal manometry: inflamed esophageal mucosa, hypotensive LES. Dx: GERD. Patient given PPI. Normally which is most likely regarding reflux of gastric acid into the esophagus?

It initiates secondary esophageal peristalsis (characterized by enteric nerve- initiated peristalsis beginning at the site of irritation and LES relaxation. In GERD, esophageal motility is decreased, gastric emptying is delayed)

What best describes bile acid function?

The amount lost in the stool each day represents the daily loss of cholesterol (since the only way to remove cholesterol from the human body is via the bile salt)

26/M with diarrhea and steatorrhea x 48h. What best accounts for the appearance of excess fat in the stool?

Decreased bile acid pool size

14/F ballerina has chronic diarrhea. Frequently drinks skim milk, does not use laxatives, condition improves during fasts for religious observances. In contrast to secretory diarrhea, what is most likely seen in osmotic diarrhea?

t is characterized by an increase in the stool osmotic gap (>50mOsm due to unmeasured solute contributing to the fecal electrolyte content. MCC of osmotic diarrhea: lactase deficiency, ingestion of magnesium- containing antacids or laxatives, ingestion of nonabsorbable sugars. Secretory diarrhea is caused by overproduction of water by SI and LI. Secretory diarrhea has normal stool osmotic gap and is not remedied by fasting)

Short-Chain Fatty Acid (SCFAs) absorption occurs almost exclusively from which segment of the GI tract?

Colon

42/F with epigastric abdominal pain, nausea, vomiting. (+) binge drinking. Dx: acute pancreatitis. Which of the following best describes pancreatic function in this patient?

Phospholipase A2 maybe prematurely activated by trypsin (“Phospholipase A2 cleaves a fatty acid off phosphatidylcholine (PC) to form lyso-PC, which damages cell membranes. Premature activation of phospholipase A2 by trypsin is hypothesized to cause acute pancreatitis”)

Which best describes iron digestion and absorption?

Iron transported in the blood bound to transferrin (transferrin is a beta-globulin. Excess iron stored in ferritin of the liver. Rate of iron absorption is extremely slow and primariy absorbed in the ferrous form)

Patient with alcoholic cirrhosis has hematemesis. After IV fluids, MD administers analog of which agent to inhibit gastric acid secretion and visceral blood flow?

Somatostatin (this is the principal GI PARACRINE secretion involved in the inhibitory feedback of gastric acid secretion by the parietal cells. Its drug analogs can be used to decrease visceral blood flow in patients with bleeding esophageal varices secondary to portal hypertension)

Patient with vomiting and severe diarrhea after eating spoiled shellfish. (+) Vibrio cholera. Which statement best describes water and electrolyte absorption in the GI tract?

The majority of water and electrolyte absorption happends in the jejunum

Trypsinogen is converted to its active form trypsin by which substance?

Enteropeptidase | also called Enterokinase

18/F gets tattoo. 2 months later, (+) fever, RUQ pain, nausea, vomiting, jaundice. What is most likely found in a patient with infectious hepatitis?

An increase in both direct and indirect bilirubin

Gas within the colon is primarily derived from which of the following sources?

Fermentation of undigested oligosaccharides

With respect to cobalamin-intrinsic factor binding in a normal individual, nearly all binding of cobalamin to intrinsic factor occurs in which organ?

Duodenum | but absorption happens in the terminal ileum

The rate of gastric emptying increases with an increase in what?

Intragastric volume (note: increasing the volume, fat content, acidity or osmolarity at the lumen of the SMALL INTESTINES inhibit gastric emptying)

53/M with chronic cough. No postnasal drip, asthma, pulmonary disease. (+) substernal burning pain most pronounced after ingestion of coffee, chocolate, French fries, alcohol. What is the most likely cause of the symptoms in this patient?

Decreased LES tone (Patient has GERD. Other causes of GERD: decreased gastric emptying, hiatal hernia, decreased esophageal motility)

What is the cause of normal bowel movements in newborns?

Gastrocolic Reflex

10/M with below- average body weight and height, Vit K deficiency signs, steatorrhea, bloating. (+) MHC Class II antigen HLA-DQ2. Which is the most appropriate dietary treatment of malabsorption in this condition?

Gluten-Free Diet | Patient has celiac sprue/gluten enteropathy

47/F with jaundice, elevated direct bilirubin. What is the most likely diagnosis?

Obstruction of the common bile duct

Dietary fat, after being processed, is extruded from the mucosal cells of the GI tract into the lymphatic ducts in which form?

Chylomicrons | note – short chain fatty acids are extruded as free fatty acids into the portal blood

After workout, 3rd year medical students drinks electrolyte- containing sports drink. What is the major mechanism for absorption of sodium from the small intestines?

Neutral NaCl absorption

42/M takes multivitamin supplement. What is required for absorption of fat- soluble vitamins contained in the supplement?

Pancreatic Lipase | if this is low, decreased Vit ADEK absorption

After gastric bypass surgery, patients presents with crampy abdominal discomfort 15-30 mins after meals, with nausea, diarrhea, belching, tachycardia, palpitations, diaphoresis, light- headedness. These symptoms most likely arise from which?

Release of VIP and motilin (patient has dumping syndrome.)

Surgical resection of the terminal ileum would most likely result in which?

Orad stomach accommodation | since receptive relaxation (orad stomach accommodation) is dependent on intact vago-vagal reflex

What is the major factor that protects the duodenal mucosa from damage by gastric acid?

Pancreatic bicarbonate secretion

49/F vomiting shortly after eating has normal rate of liquid emptying but prolonged time for emptying of solids. What best explains these findings?

Pyloric Stenosis (remember that emptying of solids is determined by strength of antral peristaltic contractions and resistance offered by pyloric sphincter)

Full-term newborn infant with abdominal distension. (-)BM x 5 days. AXR: narrowed colon, bowel obstruction, dilated intestine. Patho report: absence of ganglion cells , presence of nonmyelinated nerves in the biopsy segment. What is the underlying cause of the bowel obstruction in this patient?

Impaired endothelin B receptor function | Patient has Hirschsprung disease or aganglionic megacolon.

Chief Cells of the stomach produce what?

Pepsinogen

In a woman with menstrual cycle of 28-30 days, ovulation occurs during which day?

Days 14 to 16

Which best describes spermatogenesis?

Spermatogenesis requires temperature lower than internal body temperature

Decreased production of which hormone leads to amenorrhea in anorexia nervosa?

Gonatropin-releasing hormone (GnRH) | GnRH is decreased due to decreased leptin associated with decreased mass of adipose tissue

What is true about prolactin?

Prolactin inhibits GnRH secretion by the hypothalamus

Biologic actions of estrogens include a decrease in ___________.

Serum cholesterol levels (estrogen also stimulate growth of female genital tract, increases libido in humans and protective against osteoporosis (inhibits osteoclasts))

Start-peak-decline of B- hCG during pregnancy?

6-8 days ovulation – 7-9 weeks – 20 weeks

What is the function of Sertoli cells in the seminiferous tubules?

Maintenance of blood-testis barrier

Ovulation is caused by sudden increase in the secretion of which hormone?

LH

What best describes the implantation of the zygote in the uterine wall?

Involves infiltration of the endometrium by the syncitiotrophoblast

What is the source of estrogen and progesterone in the first 2 months of pregnancy?

Corpus luteum

What is the source of estrogen and progesterone in the last 7 months of pregnancy?

Placenta

Which hormone is involved in the ejection of milk from the lactating mammary gland

Oxytocin

Progesterone is the main hormone during which part phase of the menstrual cycle?

Secretory Phase/Luteal Phase

Administration of estrogens in women will do what?

Produce cyclic changes in the vagina and endometrium (estrogen: cervical mucus becomes thinner, more alkaline and exhibit fernlike pattern upon drying. It stimulates growth of ovarian follicle, stimulates glandular epithelium of endometrium, smooth muscle of uterus and uterine vascular system. It also stimulates ductal elements of the breast (progesterone stimulates growth of glandular elements o the breasts). Estrogen also maintains bone density)

What best describes progesterone?

Progesterone is secreted by the corpus luteum

Which hormone is responsible for transforming undifferentiated external genitalia in the fetus into male external genitalia?

Dihydrotestosterone

What best describes a patient with Turner syndrome?

Ovarian dysgenesis (streak ovary) is characteristic

What are the effects of postmenopausal HRT?

Reduces the incidence of hot flashes (but may increase risk of coronary artery disease, endometrial CA, breast CA, venous thromboembolism, gallbladder disease)

Prolactin secretion is tonicaly suppressed in nonpregnant women by which hormone?

Dopamine

Once conception takes place, what must occur in order for the pregnancy to proceed uneventfully?

Once conception takes place, what must occur in order for the pregnancy to proceed uneventfully?

Physiologic changes that occur during pregnancy include what?

Reduced circulating gonadotrophin levels

What is an indication that ovulation has taken place?

An increase in serum progesterone levels

What takes place a day after the peak of estrogen secretion during the menstrual cycle?

LH Surge and Ovulation

Ovariectomy before the 6th week of pregnancy leads to abortion but has no effect on pregnancy thereafter because the placenta secretes adequate amounts of which hormones?

Estrogens and progesterone

54/M prescribed finasteride. Why is the pregnant wife instructed not to even handle the medication?

Blocking the production of DHT will interfere with normal sexual differentiation of the penis, scrotum, and prostate in male fetuses

What is expected with normal thyroid function?

TSH secretion is regulated primarily by the pituitary level of T3

43/M with brain tumor that impinges on Supraoptic nucleus in the hypothalamus. Which hormone is affected?

Antidiuretic Hormone (ADH)

What best describes parathyroid hormone?

It acts directly on bone cells to increase Ca2+ resorption and mobilize Ca2+ (PTH stimulates osteoclasts after binding with PTH receptor in the osteoblasts)

39/M with enlarged head, hands, feet. (+) osteoarthritic vertebral changes, hirsutism, gynecomastia and lactation. Patient has tumor located where?

Anterior pituitary

What best describes human growth hormone?

It stimulates production of somatomedins (IGF-I and II) by the liver, cartilage and other tissues

28/F with vision changes, frequent pressure-like headaches, polyuria, polydipsia. MRI: tumor at the posterior pituitary stalk. Which hormone abnormality is expected?

Decreased ADH leading to diabetes insipidus (craniopharyngioma at the posterior pituitary stalk that causes the diabetes insipidus)

What is the principal steroid secreted by the fetal adrenal cortex?

Dehydroepiandrosterone

Which aspect of glucose transport is enhanced by insulin?

Transport into adipocytes

Iodides are stored in the thyroid follicles mainly in the form of which of the following?

Thyroglobulin

Physiologically active thyroxine exists in which form?

Unbound

Plasma levels of calcium can be increased most rapidly by the direct action of PTH on what?

Bones

The physiologic secretion of growth hormone is increased by what?

Hypoglycemia

50/M alcoholic with cirrhotic liver disease and chronic pancreatitis. (+) nausea x several days, with no eating. As a result of high glucagon levels, what will occur?

Stimulation of gluconeogenesis

The actions of insulin include what?

Enhancing potassium entry into cells

The endogenous secretion of ACTH is correctly describe by which statement?

Shows circadian rhythm in humans

Patient with TB confused, with muscle cramp and nausea. Labs: Plama Na = 125mEq/L Serum osmolarity = 200 mOsm/kg Urine Na = 400mEq/d Normal blood volume These findings are consistent with what?

Increased secretion of ADH

65/F with metastatic small cell lung CA with nausea, vomiting, tachycardia. Dx: Addison disease. What is most consistent with a patient in this condition?

Serum Na = decreased Serum K = increased Blood Glucose = decreased Blood Pressure = decreased (Addison – all adrenocortical hormone levels are decreased)

Abdominal CT in 50/M with Conn syndrome shows multiple small adrenocortical masses. Which clinical finding is most likely present?

Hypertension

75/F with primary hyperparathyroidism has dehydration and malaise. Plasma level of _________is most likely to be decreased.

Phosphate

29/M with weight gain, decreased energy, dry skin, brittle hair x 6 months. Dx: hypothyroidism and started on synthetic thyroid hormone. A decrease in which lab value is expected as a result of starting treatment?

Plasma Cholesterol

37/F with exophthalmos and enlarged thyroid gland. Free thyroxine levels are elevated. Other clinical findings of Graves disease include what?

Increased basal metaolic rate

Insulin-independent glucose uptake occurs in which site?

Brain

Which is associated with a hypothyroid state?

Sleepiness

What is the most appropriate treatment for exaggerated hyperthyroidism (Thyroid storm)

β-Adrenergic anatagonist therapy to block sympathomimetic symptoms

13/M with short stature. Patient smaller than friends, did not notice pubertal changes like enlargement of testes or development of axillary or pubic hair. What lab test would you expect to see?

Decreased IGF-1

What best describes the islets of Langerhans?

They secrete insulin and glucagon

59/M is weak, nauseated, urinate frequently. Urine (+) for ketones and fingerstick glucose is high. Presumptive Dx of diabetes. As a result of insulin deficiency, what will most likely occur?

59/M is weak, nauseated, urinate frequently. Urine (+) for ketones and fingerstick glucose is high. Presumptive Dx of diabetes. As a result of insulin deficiency, what will most likely occur?

Radiation treatment for pituitary tumor in 8/M causes complete loss of pituitary function. Child is most likely to experience which symptom?

Hyporeflexia | panhypopituitarism caused by radiationàdecreased thyroid hormoneàdecreased reflexes

36/M programmer experiences tachycardia, palpitations, irregular heartbeat especially at night. Plasma catecholamine levels are increased, which result from what?

Increase in plasma cortisol | “Circumstances that increase sympathetic nerve input to the adrenal medulla increase catecholamine secretion”

Cortisol administration to a patient with adrenal insufficiency will result in what?

Increased gluconeogenesis

What is the hallmark of Pheochromocytoma?

Hypertension

What is the mechanism for citrate’s antocoagulative action?

Chelating Calcium | decreases free Ca2+ required in the coagulation pathway

44/F with excessive menstrual bleeing, menstrual cycles last >7 days has increasing fatigue and cold extremities. Hemoglobin concentration of 6 g/dL. In this patient which is reduced?

Total Arterial Oxygen Content (Patient has anemic from chronic blood loss – manifesting as iron deficiency anemia which would reduce her total arterial O2 content)

Majority of CO2 in the blood is transported in which form?

Bicarbonate

67/M with history of thromboembolism was placed on warfarin (Coumadin). Bleeding occurs. What will be the treatment?

Vitamin K

65/M slightly cyanotic, with pruritus and nose bleeds has Hct of 62%. Diagnosed with Polycthemia Vera. Treatment includes ASA to reduce the Hct. Why is the reduction in Hct beneficial?

Reduces blood viscosity (polythemia vera: abnormally high number of RBCs. Reduction of blood viscosity decreases severity of symptoms. Primary treatment is phlebotomy BTW)

61/M frequent diarrhea with weight loss. (+) easy bruisability, PT of 19 seconds (normal: 11-14 seconds). Easy bruisability and prolonged PT is explained by decrease in which vitamin?

Vitamin K

52/M brought to ER for severe chest pain. (+) severe coronary occlusion. Thrombolytic agent given to establish perfusion. What does this agent activate?

Plasminogen

32/F with SOB and right sided chest pain that increases during inspiration. (-) cough, colds, asthma, respiratory diseases. (+) history of OCP use x 8 years. (+) history of pulmonary embolism in her mom. Normal CXR, but V/Q scan reveals possible pulmonary embolism. Which blood disorder is associated with the hypercoagulable state?

Activated Protein C Resistance | most common inherited hypercoagulable state. Please refer to Pre-Test Physiology for more detailed explanation

What is the primary mechanism for the change in RBC shape during a sickle cell crisis?

Polymerization of HbS as it deoxygenated

67/M with chronic bronchitis has labored breathing and cyanosis. The cyanosis is due to what?

Increased concentration of deoxygenated Hb