Physiology Part 2 Flashcards
1
Q
What stimulates Renin?
A
Decreased BP (JGC)
Decreased Na Delivery (MDC)
Increased sympathetic tone (B1R)
2
Q
What are all the 6 effects of AngII?
A
- Acts at AT1 receptors of vascular SM
- Constricts efferent arteriole of glomerulus
- Aldosterone Secretion from Adrenal Gland
- ADH secretion from Post. Pituitary
- Increased PT Na/H activity
- Simulates Hypothalamus
3
Q
What happens when AngII binds AT1 receptors?
A
Vasoconstriction–>
Increased BP
4
Q
What happens when AngII constricts eff. afteriole?
A
Increased FF to preserve GFR in low-volume states and RBF is low
5
Q
Aldosterone enhances ______ and ________ excretion, and creates a favorable gradient for ____ and ____ reabsorption
A
K, H, Na, H2O
6
Q
ADH does what? This leads to what?
A
Increases H2O channel insertion in principal cells leading to water reabsorption
7
Q
Increased PT Na/H activity increases _________ reabsorption
A
Na, HCO3, and H2O
8
Q
Increased PT Na/H activity permits
A
Contraction alkalosis
9
Q
AngII stimulation hypothalamus does what?
A
Increased thirst
10
Q
AngII affects _____, which limits ________
A
Baroreceptor function
Bradycardia
11
Q
AngII maintains what?
A
Blood volume and Blood Pressure
12
Q
Where is ANP released from?
A
Atria
13
Q
What is ANP released in response to?
A
Increased atrial volume
14
Q
What does ANP act as?
A
Check on RAA system
15
Q
ANP _____ vasc. SMC via ______
A
relaxes, cGMP
16
Q
ANP causes _____ GFR and ____ Renin
A
Increased, decreased
17
Q
What are the 2 things ADH regulates?
A
Osmolarity
low blood volume level
18
Q
Which of ADH’s 2 regulating things takes precedent?
A
Low Blood Volume
19
Q
What is Aldosterones primary job?
A
Regulates blood volume
20
Q
In low volume states _____ and ______ protect Blood Volume.
A
ADH, Aldosterone
21
Q
JGA consists of ______ and ______
A
JGC and MDC
22
Q
what are JGC?
A
Modified smooth muscle of afferent arteriole
23
Q
What are MDC?
A
NaCl sensor part of the distal convoluted tubule
24
Q
JGC secrete ______
A
Renin
25
JGC secrete renin in response to what?
Decreased Renal BP
Decreased NaCl delivery to DT
Increased SNS tone (B1R)
26
JGA defends GFR via what system?
RAA
27
B-Blockers have what effect on JGA
Decrease BP by inhibiting B1R of the JGA causing decreased renin release
28
What is Epo released from?
Interstitial cells in the peritubular capillary bed
29
What is Epo released in response to?
Hypoxia
30
PT cells convert ________ to _________ via 1-alpha hydroxylase.
25-OH Vit. D, 1,25-(OH)2 Vit. D
31
What stimulates 1 alpha hydroxylase?
PTH
32
Paracrine secretion of Prostaglandins does what?
Vasodilates afferent arterioles to maintain GFR
33
How do NSAIDS negatively effect the kidney?
Inhibit renal production of prostaglandins
34
ANP causes ______ GFR and ______ Sodium filtration WITH NO compensatory Na reabsorption at the distal nephron.
Increased, increased
35
What is the net effect of ANP?
Na and volume loss
36
PTH is secreted in response to...
Decreased plasma Ca
Increased plasma Phosphate
Decreased plasma Vit. D
37
PTH causes...
Increased Ca reabsorption (DCT)
Decreased Phosphate reabsorption (PCT)
Increased Vitamin D production (PCT)
38
What additional extrarenal effect does PTH have?
Increased calcium and phosphate absorption from the gut
39
ATII is synthesized in response to ____ BP
Decreased
40
When it causes efferent arteriole constriction, it ____GFR and ____ FF WITH compensatory Na reabsorption in the proximal and distal Nephron
Increase, increase
41
Net effect of ATII is...
1. Preserve renal function in low volume states (Increased FF)
2. Simultaneous Na resorption (P and D)
both to decrease volume loss
42
Aldosterone is secreted in response to _______ (via ATII) and _________.
Decreased Blood Volume
| Increased plasma K
43
Aldosterone causes what?
Increased Na reabsorption
Increased K secretion
Increased H secretion
44
ADH is secreted in response to ______ plasma osmolarity and ________ Blood volume
Increased, Decreased
45
ADH binds to receptors on principal cells and _______ water channels and increases _______.
Increase number of
| H2O reabsorption
46
What causes hyperkalemia?
DO Insulin LAB:
```
Digitalis
HyperOsmolarity
Insulin deficiency
Lysis of cells
Acidosis
Beta antagonists
```
47
What causes hypokalemia?
Hypo-osmolarity
Insulin (increases Na/K ATPase)
Alkalosis
Beta agonist
48
Low serum Na concentration leads to...
Nausea
Malaise
Stupor
Coma
49
High serum Na concentration leads to...
Irritability
Stupor
Coma
50
Low serum K concentration leads to what on an ECG?
U waves
| Flattened T waves
51
Low serum K concentration leads to...
Arrhythmias
| Muscle weakness
52
High serum K concentration leads to what on an ECG?
Wide QRS
| Peaked T waves
53
High serum K concentration leads to...
Arrhythmias
| Muscle weakness
54
Low serum Ca concentration leads to...
Tetany
| Seizures
55
High serum Ca concentration leads to...
Stones (renal)
Bones (pain)
Groans (ab pain)
psychiatric Overtones (anxiety, altered mental status)
56
Low serum Mg concentration leads to...
Tetany
| Arrhythmias
57
High serum Mg concentration leads to...
```
Decreased DTR
Lethargy
Bradycardia
Hypotension
Cardiac Arrest
hypocalcemia
```
58
Low serum Phosphate leads to...
Bone loss
| Osteomalacia
59
High serum Phosphate leads to...
Renal stones
Metastatic calcifications
hypocalcemia
60
Metabolic acidosis (pH, Pco2, Hco3)
decreased, decreased, decreased
61
Metabolic alkalosis (pH, Pco2, Hco3)
increased, increased, increased
62
Respiratory acidosis (pH, Pco2, Hco3)
Decreased, Increased, increased
63
Respiratory alkalosis (pH, Pco2, Hco3)
Increased, decreased, decreased
64
What is the compensation for metabolic acidosis?
Hyperventilation (immediate)
65
What is the compensation for metabolic alkalosis?
Hypoventilation (immediate)
66
What is the compensation for respiratory acidosis?
Increased renal HCO3 reabsorption (delayed)
67
What is the compensation for respiratory alkalosis?
Decreased renal HCO3 reabsorption (delayed)
68
What is the henderson-Hasselbach equation?
pH=6.1+log(HCO3 conc.)/0.03PCO2
69
If the measured PCo2 differs significantly from the predicted PCo2, then ________ is likely present
Mixed acid-based disorder
70
What causes hypoventilation?
Airway obstruction
Acute/chronic lung disease
Opioids/sedatives
Weakening of respiratory muscles
71
What causes an increased anion gap?
```
MUDPILES
Methanol (formate)
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tables or INH
Lactic Acidosis
Ethylene glycol (oxalate)
Salicylates (late)
```
72
What causes a normal anion gap?
```
HARD ASS
Hyperalimentation
Addison's disease
Renal tubular acidosis
Diarrhea
Acetozolamide
Spironolactone
Saline infusion
```
73
What causes respiratory alkalosis?
Hyperventilation (eg. early high altitude exposure)
| Salicylates (early)
74
What causes metabolic alkalosis?
Loop diuretics
Vomitting
Antacid use
hyperaldosteronism
75
What is type 1 distal RTA?
Defect in CT ability to excrete H
76
Untreated patients with type 1 distal RTA have a urine pH of _______
>5.5
77
Patients with type 1 distal RTA have a ________ risk for _________ as a result of ________ urine pH and ________.
increased
calcium phosphate kidney stones
increased
bone resorption
78
Type I distal RTA is associated with ________
hypokalemia
79
What is type 2 proximal RTA?
Defect in PT HCO3 resorption
80
type 2 proximal RTA can be seen with _______ syndrome
Fanconi's
81
Untreated patients with type 2 proximal RTA typically have a urine pH of _________
<5.5
82
Type 2 proximal RTA is associated with ________, and patients with this are at increased risk for _______
hypokalemia
| hypophosphatemic rickets
83
What is type 4 hyperkalemic RTA?
Hypoaldosteronism or lack of CT response to aldosterone
84
In type 4 hyperkalemic RTA, the hyperkalemia impairs _____ in the ________, leading to ______ and ______urine pH.
ammoniagenesis
proximal tubule
decreased buffering capacity
decreased
