IVMS Physiology and Pathophysiology Flash Facts

Physiology & Pathophysiology Flash Facts
Q0001:In a ventricular pacemaker cell; what phase of the action potential is affected by NE?
Phase 4; NE increases the slope of the prepotential; allowing threshold to be reached sooner; and increases the rate of firing.
Q0002:Anatomical and alveolar dead spaces together constitute what space?
Physiologic dead space is the total dead space of the respiratory system.
Q0003:What three organs are necessary for the production of vitamin D3(cholecalciferol)?
Skin; liver; and kidneys
Q0004:What is the effect of LH on the production of adrenal androgens?
LH has no effect on the production of adrenal androgens; ACTH stimulates adrenal androgen production.
Q0005:What four conditions result in secondary hyperaldosteronism?
1. CHF ;2. Vena caval obstruction or constriction ;3. Hepatic cirrhosis ;4. Renal artery stenosis
10
Q0006:What are the five hormones produced by Sertoli cells?
11
1. Inhibin ;2. Estradiol (E2) ;3. Androgen-binding protein ;4. Meiosis inhibiting factor (in fetal tissue) ;5. Antimullerian hormone
12
Q0007:What is the term for the negative resting membrane potential moving toward threshold?
13
Depolarization (i.e; Na+ influx)
14
Q0008:Does the left or right vagus nerve innervate the SA node?
15
Right vagus innervates the SA node and the left vagus innervates the AV node
16
Q0009:How does ventricular repolarization take place; base to apex or vice versa?
17
Repolarization is from base to apex and from epicardium to endocardium.
18
Q0010:What is the term for any region of the respiratory system that is incapable of gas exchange?
19
Anatomical dead space; which ends at the level of the terminal bronchioles.
20
Q0011:What four factors shift the Hgb-O2 dissociation curve to the right? What is the consequence of this shift?
21
Increased CO2; H+; temperature; and 2; 3-BPG levels all shift the curve to the right; thereby making the O2 easier to remove (decreased affinity) from the Hgb molecule.
22
Q0012:What two factors result in the apex of the lung being hypoperfused?
23
Decreased pulmonary arterial pressure (low perfusion) and less-distensible vessels (high resistance) result in decreased blood flow at the apex.
24
Q0013:What is the ratio of pulmonary to systemic blood flow?
25
1:1. Remember; the flow through the pulmonary circuit and the systemic circuit are equal.
26
Q0014:To differentiate central from nephrogenic diabetes insipidus; after an injection of ADH; which will show a decreased urine flow?
27
Central. Remember; there is a deficiency in ADH production in the central form.
28
Q0015:In what area of the GI tract are water-soluble vitamins absorbed?
29
Duodenum
30
Q0016:What wave is the cause of the following venous pulse deflections?;? The rise in right atrial pressure secondary to blood filling and terminating when the tricuspid valves opens
31
V wave
32
Q0017:What wave is the cause of the following venous pulse deflections?;? The bulging of the tricuspid valve into the right atrium
33
C wave
34
Q0018:What wave is the cause of the following venous pulse deflections?;? The contraction of the right atrium
35
A wave
36
Q0019:What are the four functions of saliva?
37
1. Provide antibacterial action ;2. Lubricate ;3. Begin CHO digestion ;4. Begin fat digestion
38
Q0020:When a person goes from supine to standing; what happens to the following?;? Dependent venous pressure
39
Increases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
40
Q0021:When a person goes from supine to standing; what happens to the following?;? Dependent venous blood volume
41
Increases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
42
Q0022:When a person goes from supine to standing; what happens to the following?;? Cardiac output
43
Decreases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate.
44
Q0023:When a person goes from supine to standing; what happens to the following?;? BP
45
Decreases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
46
Q0024:When does the hydrostatic pressure in Bowman's capsule play a role in opposing filtration?
47
It normally does not play a role in filtration but becomes important when there is an obstruction downstream.
48
Q0025:What happens to intrapleural pressure when the diaphragm is ontracted during inspiration?
49
Intrapleural pressure decreases (becomes more negative).
50
Q0026:What is used as an index of cortisol secretion?
51
Urinary 17-OH steroids
52
Q0027:If the pH is low with increased CO2 levels and decreased HCO3- levels; what is the acid-base disturbance?
53
Combined metabolic and respiratory acidosis
54
Q0028:What is the term that refers to the number of channels open in a cell membrane?
55
Membrane conductance (think conductance = channels open)
56
Q0029:What are the five tissues in which glucose uptake is insulin independent?
57
1. CNS ;2. Renal tubules ;3. Beta Islet cells of the pancreas ;4. RBCs ;5. GI mucosa
58
Q0030:Place in order from fastest to slowest the rate of gastric emptying for CHO; fat; liquids; and proteins.
59
Liquids; CHO; protein; fat
60
Q0031:Is most of the coronary artery blood flow during systole or diastole?
61
Diastole. During systole the left ventricle contracts; resulting in intramyocardial vessel compression and therefore very little blood flow in the coronary circulation.
62
Q0032:What modified smooth muscle cells of the kidney monitor BP in the afferent arteriole?
63
The JG cells
64
Q0033:What are the three functions of surfactant?
65
1. Increase compliance ;2. Decrease surface tension ;3. Decrease probability of pulmonary edema formation
66
Q0034:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenolytic; gluconeogenic; lipolytic; glycolytic; and stimulated by hypoglycemia
67
Epinephrine
68
Q0035:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenolytic; gluconeogenic; lipolytic; glycolytic; proteolytic; and stimulated by hypoglycemia and AAs
69
Glucagon
70
Q0036:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenic; gluconeogenic; lipogenic; proteogenic; glycolytic; and stimulated by hyperglycemia; AAs; fatty acids; ketosis; ACh; GH; and Beta-agonist
71
Insulin
72
Q0037:Is the hydrophobic or hydrophilic end of the phospholipids of the cell membrane facing the aqueous environment?
73
Hydrophilic (water-soluble) end faces the aqueous environment and the hydrophobic (water-insoluble) end faces the interior of the cell.
74
Q0038:What type of muscle is characterized by no myoglobin; anaerobic glycolysis; high ATPase activity; and large muscle mass?
75
White muscle; short term too
76
Q0039:What percentage of CO2 is carried in the plasma as HCO3- ?
77
90% as HCO3-; 5% as carbamino compounds; and 5% as dissolved CO2
78
Q0040:What is the most potent male sex hormone?
79
Dihydrotestosterone
80
Q0041:With a decrease in arterial diastolic pressure; what happens to;? Stroke volume?
81
Decreases
82
Q0042:With a decrease in arterial diastolic pressure; what happens to;? TPR?
83
Decreases
84
Q0043:With a decrease in arterial diastolic pressure; what happens to;? Heart rate?
85
Decreases
86
Q0044:What linkage of complex CHOs does pancreatic amylase hydrolyze? What three complexes are formed?
87
Amylase hydrolyzes alpha-1; 4-glucoside linkages; forming alpha-limit dextrins; maltotriose; and maltose.
88
Q0045:Does the heart rate determine the diastolic or systolic interval?
89
Heart rate determines the diastolic interval; and contractility determines the systolic interval.
90
Q0046:On a graphical representation of filtration; reabsorption; and excretion; when does glucose first appear in the urine?
91
At the beginning of splay is when the renal threshold for glucose occurs and the excess begins to spill over into the urine.
92
Q0047:What is the relationship between preload and the passive tension in a muscle?
93
They are directly related; the greater the preload; the greater the passive tension in the muscle and the greater the prestretch of a sarcomere.
94
Q0048:What is the rate-limiting step in the synthetic pathway of NE at the adrenergic nerve terminal?
95
The conversion of tyrosine to dopamine in the cytoplasm
96
Q0049:How many days prior to ovulation does LH surge occur in the menstrual cycle?
97
1 day prior to ovulation
98
Q0050:How are flow through the loop of Henle and concentration of urine related?
99
As flow increases; the urine becomes more dilute because of decreased time for H2O reabsorption.
100
Q0051:What is the PO2 of aortic blood in fetal circulation?
101
60%
102
Q0052:How do elevated blood glucose levels decrease GH secretion? (Hint: what inhibitory hypothalamic hormone is stimulated by IGF-1?)
103
Somatotrophins are stimulated by IGF-1; and they inhibit GH secretion. GHRH stimulates GH secretion.
104
Q0053:What segment of the nephron has the highest concentration of inulin? Lowest concentration of inulin?
105
Terminal collecting duct has the highest concentration and Bowman's capsule has the lowest concentration of inulin.
106
Q0054:What type of resistance system; high or low; is formed when resistors are added in a series?
107
A high-resistance system is formed when resistors are added in a series.
108
Q0055:What hormones; secreted in proportion to the size of the placenta; are an index of fetal well-being?
109
hCS and serum estriol; which are produced by the fetal liver and placenta; respectively; are used as estimates of fetal wellbeing.
110
Q0056:What primary acid-base disturbance is caused by an increase in alveolar ventilation (decreasing CO2 levels) resulting in the reaction shifting to the left and decreasing both H+ and HCO3- levels?
111
Respiratory alkalosis (summary: low CO2; low H+; slightly low HCO3-)
112
Q0057:What respiratory center in the caudal pons is the center for rhythm promoting prolonged inspirations?
113
Apneustic center (deep breathing place)
114
Q0058:What area of the GI tract has the highest activity of brush border enzymes?
115
Jejunum (upper)
116
Q0059:What is the term to describe the increased rate of secretion of adrenal androgens at the onset of puberty?
117
Adrenarche
118
Q0060:What period is described when a larger-than-normal stimulus is needed to produce an action potential?
119
Relative refractory period
120
Q0061:Does T3 or T4 have a greater affinity for its nuclear receptor?
121
T3 has a greater affinity for the nuclear receptor and therefore is considered the active form.
122
Q0062:What are the three main functions of surfactant?
123
1. Lowers surface tension; so it decreases recoil and increases compliance ;2. Reduces capillary filtration ;3. Promotes stability in small alveoli by lowering surface tension
124
Q0063:What is the only important physiological signal regulating the release of PTH?
125
Low interstitial free Ca2+ concentrations
126
Q0064:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH decreased; Ca2+ increased; Pi increased
127
Secondary hypoparathyroidism (vitamin D toxicity)
128
Q0065:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH increased; Ca2+ decreased; Pi decreased
129
Secondary hyperparathyroidism (vitamin D deficiency; renal disease)
130
Q0066:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH decreased; Ca2+ decreased; Pi increased
131
Primary hypoparathyroidism
132
Q0067:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH increased; Ca2+ increased; Pi decreased
133
Primary hyperparathyroidism
134
Q0068:What is the amount in liters and percent body weight for the following compartments? ;? ECF
135
14 L; 33% of body weight
136
Q0069:What is the amount in liters and percent body weight for the following compartments? ;? Interstitial fluid
137
9.3 L; 15% of body weight
138
Q0070:What is the amount in liters and percent body weight for the following compartments? ;? ICF
139
140
Q0071:What is the amount in liters and percent body weight for the following compartments? ;? Vascular fluid
141
4.7 L; 5% of body weight
142
Q0072:What is the amount in liters and percent body weight for the following compartments? ;? Total body water
143
144
Q0073:What hormone is secreted by the placenta late in pregnancy; stimulates mammary growth during pregnancy; mobilizes energy stores from the mother so that the fetus can use them; and has an amino acid sequence like GH?
145
Human chorionic somatomammotropin (hCS) or human placental lactogen (hPL)
146
Q0074:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 increased
147
Graves disease (Increased T4 decreases TRH and TSH through negative feedback.)
148
Q0075:What thyroid abnormality has the following?;? TRH increased; TSH decreased; T4 decreased
149
Secondary hypothyroidism/pituitary (Low TSH results in low T4 and increased TRH because of lack of a negative feedback loop.)
150
Q0076:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 decreased
151
Tertiary hypothyroidism/hypothalamic (Low TRH causes all the rest to be decreased because of decreased stimulation.)
152
Q0077:What thyroid abnormality has the following?;? TRH increased; TSH increased; T4 decreased
153
Primary hypothyroidism (Low T4 has a decreased negative feedback loop; resulting in both the hypothalamus and the anterior pituitary gland to increase TRH and TSH release; respectively.)
154
Q0078:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 increased
155
Secondary hyperthyroidism (Increased TSH results in increased T4 production and increased negative feedback on to hypothalamus and decreased release of TRH.)
156
Q0079:What two stress hormones are under the permissive action of cortisol?
157
Glucagon and epinephrine
158
Q0080:If the radius of a vessel doubles; what happens to resistance?
159
The resistance will decrease one-sixteenth of the original resistance.
160
Q0081:What prevents the down-regulation of the receptors on the gonadotrophs of the anterior pituitary gland?
161
The pulsatile release of GnRH
162
Q0082:True or false? Epinephrine has proteolytic metabolic effects.
163
False. It has glycogenolytic and lipolytic actions but not proteolytic.
164
Q0083:What is the only 17-hydroxysteroid with hormonal activity?
165
Cortisol; a 21-carbon steroid; has a -OH group at position 17.
166
Q0084:Does the oncotic pressure of plasma promote filtration or reabsorption?
167
The oncotic pressure of plasma promotes reabsorption and is directly proportional to the filtration fraction.
168
Q0085:Why is the base of the lung hyperventilated when a person is standing upright?
169
The alveoli at the base are small and very compliant; so there is a large change in their size and volume and therefore a high level of alveolar ventilation.
170
Q0086:By removing Na+ from the renal tubule and pumping it back into the ECF compartment; what does aldosterone do to the body's acid-base stores?
171
The removal of Na+ results in the renal tubule becoming negatively charged. The negative luminal charge attracts both K+ and H+ into the renal tubule and promotes HCO3- to enter the ECF and results in hypokalemic alkalosis.
172
Q0087:What hormone causes contractions of smooth muscle; regulates interdigestive motility; and prepares the intestine for the next meal?
173
Motilin
174
Q0088:What two vessels in fetal circulation have the highest PO2 levels?
175
Umbilical vein and ductus venosus (80%)
176
Q0089:How many days prior to ovulation does estradiol peak in the menstrual cycle?
177
2 days prior to ovulation
178
Q0090:What serves as a marker of endogenous insulin secretion?
179
C-peptide levels
180
Q0091:What is the term for the total volume of air moved in and out of the respiratory system per minute?
181
Total ventilation (minute ventilation or minute volume)
182
Q0092:What is the renal compensation mechanism for alkalosis?
183
Increase in urinary excretion of HCO3-; shifting the reaction to the right and increasing H+
184
Q0093:What is a sign of a Sertoli cell tumor in a man?
185
Excess estradiol in the blood
186
Q0094:In the systemic circulation; what blood vessels have the largest pressure drop? Smallest pressure drop?
187
Arterioles have the largest drop; whereas the vena cava has the smallest pressure drop in systemic circulation.
188
Q0095:What is the major stimulus for cell division in chondroblasts?
189
IGF-1
190
Q0096:What are two causes of diffusion impairment in the lungs?
191
Decrease in surface area and increase in membrane thickness (Palv O2 > PaO2)
192
Q0097:What are the four effects of suckling on the mother?
193
1. Increased synthesis and secretion of oxytocin ;2. Increased release of PIF by the hypothalamus ;3. Inhibition of GnRH (suppressing FSH/LH) ;4. Milk secretion
194
Q0098:A migrating myoelectric complex is a propulsive movement of undigested material of undigested material from the stomach to the small intestine to the colon. During a fast; what is the time interval of its repeats?
195
It repeats every 90 to 120 minutes and correlates with elevated levels of motilin.
196
Q0099:With an increase in arterial systolic pressure; what happens to;? Stroke volume?
197
Increases
198
Q0100:With an increase in arterial systolic pressure; what happens to;? Vessel compliance?
199
Decreases
200
Q0101:With an increase in arterial systolic pressure; what happens to;? Heart rate?
201
Decreases
202
Q0102:What enzyme is needed to activate the following reactions?;? Trypsinogen to trypsin
203
Enterokinase
204
Q0103:What enzyme is needed to activate the following reactions?;? Chymotrypsinogen to chymotrypsin
205
Trypsin
206
Q0104:What enzyme is needed to activate the following reactions?;? Procarboxypeptidase to carboxypeptidase
207
Trypsin
208
Q0105:In a ventricular pacemaker cell; what phase of the action potential is affected by ACh?
209
Phase 4; ACh hyperpolarizes the cell via increasing potassium conductance; taking longer to reach threshold and slowing the rate of firing.
210
Q0106:What is the most potent stimulus for glucagon secretion? Inhibition?
211
Hypoglycemia for secretion and hyperglycemia for inhibition
212
Q0107:What is the term for the summation of mechanical stimuli due to the skeletal muscle contractile unit becoming saturated with calcium?
213
Tetany
214
Q0108:What form of renal tubular reabsorption is characterized by low back leaks; high affinity of a substance; and easy saturation? It is surmised that the entire filtered load is reabsorbed until the carriers are saturated; and then the rest is excreted.
215
A transport maximum (Tm) system
216
Q0109:In an adrenergic nerve terminal; where is dopamine converted to NE? By what enzyme?
217
Dopamine is converted into NE in the vesicle via the enzyme dopamine-Beta-hydroxylase.
218
Q0110:Is the clearance for a substance greater than or less than for inulin if it is freely filtered and secreted? If it is freely filtered and reabsorbed?
219
Filtered and secreted: Cx > Cin (i.e; PAH). Filtered and reabsorbed: Cx < Cin (i.e; glucose); where Cx = clearance of a substance and Cin = clearance of inulin.
220
Q0111:What is the term for the load on a muscle in the relaxed state?
221
Preload. It is the load on a muscle Prior to contraction.
222
Q0112:The surge of what hormone induces ovulation?
223
LH
224
Q0113:What are the two best indices of left ventricular preload?
225
LVEDV and LVEDP (left ventricular end-diastolic volume and end-diastolic pressure; respectively)
226
Q0114:What stage of male development is characterized by the following LH and testosterone levels?;? LH pulsatile amplitude and levels increase; with increased testosterone production.
227
Puberty
228
Q0115:What stage of male development is characterized by the following LH and testosterone levels?;? Both LH and testosterone levels drop and remain low.
229
Childhood
230
Q0116:What stage of male development is characterized by the following LH and testosterone levels?;? LH secretion drives testosterone production; with both levels paralleling each other.
231
Adulthood
232
Q0117:What stage of male development is characterized by the following LH and testosterone levels?;? Decreased testosterone production is accompanied by an increase in LH production.
233
Aged adult
234
Q0118:What primary acid-base disturbance is caused by a loss in fixed acid forcing the reaction to shift to the right; thereby increasing HCO3- levels?
235
Metabolic alkalosis (summary: high pH; low H+ and high HCO3-)
236
Q0119:When referring to a series circuit; what happens to resistance when a resistor is added?
237
Resistance increases as resistors are added to the circuit.
238
Q0120:Why is there an increase in prolactin if the hypothalamic-pituitary axis was severed?
239
Because the chronic inhibition of dopamine (PIF) on the release of prolactin from the anterior pituitary gland is removed; thereby increasing the secretion of prolactin.
240
Q0121:Why is the clearance of creatinine always slightly greater than the clearance of inulin and GFR?
241
Because creatinine is filtered and a small amount is secreted
242
Q0122:What acid form of H+ in the urine cannot be titrated?
243
NH4+(ammonium)
244
Q0123:Regarding the venous system; what happens to blood volume if there is a small change in pressure?
245
Because the venous system is more compliant than the arterial vessels; small changes in pressure result in large changes in blood volume.
246
Q0124:In what stage of sleep is GH secreted?
247
Stages 3 and 4 (NREM)
248
Q0125:Where does the conversion of CO2 into HCO3- take place?
249
In the RBC; remember; you need carbonic anhydrase for the conversion; and plasma does not have this enzyme.
250
Q0126:From the fourth month of fetal life to term; what secretes the progesterone and estrogen to maintains the uterus?
251
The placenta
252
Q0127:What two factors are required for effective exocytosis?
253
Calcium and ATP are required for packaged macromolecules to be extruded from the cell.
254
Q0128:What is the best measure of total body vitamin D if you suspect a deficiency?
255
Serum 25-hydroxy-vitamin D (25-OH-D)
256
Q0129:What hormone is required for 1; 25-dihydroxy-vitamin D (1; 25-diOH-D) to have bone resorbing effects?
257
PTH
258
Q0130:Is bone deposition or resorption due to increased interstitial Ca2+concentrations?
259
Bone deposition increases with increased Ca2+ or PO 4concentrations; whereas resorption (breakdown) is increased when there are low levels of Ca2+ or PO4-.
260
Q0131:The opening of what valve indicates the termination of isovolumetric relaxation phase of the cardiac cycle?
261
Opening of the mitral valve indicates the termination of the isovolumetric relaxation phase and the beginning of the ventricular filling phase.
262
Q0132:Why is there a decrease in the production in epinephrine when the anterior pituitary gland is removed?
263
The enzyme phenyl ethanolamine N-methyltransferase (PNMT); used in the conversion of epinephrine; is regulated by cortisol. Removing the anterior pituitary gland decreases ACTH and therefore cortisol.
264
Q0133:Name the period described by the following statement: no matter how strong a stimulus is; no further action potentials can be stimulated.
265
Absolute refractory period is due to voltage inactivation of sodium channels.
266
Q0134:How many carbons do estrogens have?
267
Estrogens are 18-carbon steroids. (Removal of one carbon from an androgen produces an estrogen.)
268
Q0135:True or false? The alveolar PO2 and PCO2 levels match the pulmonary end capillary blood levels.
269
True. Because of intrapulmonary shunting; there is a slight decrease in PO2 and increase in PCO2 between the pulmonary end capillary blood and the systemic arterial blood.
270
Q0136:In high altitudes; what is the main drive for ventilation?
271
The main drive shifts from central chemoreceptors (CSF H+) to peripheral chemoreceptors monitoring low PO2 levels.
272
Q0137:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; decrease; ICF; no change; body; no change
273
Loss of isotonic fluid (diarrhea; vomiting; hemorrhage)
274
Q0138:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; increase; ICF; increase; body; decrease
275
Gain of hypotonic fluid (water intoxication or hypotonic saline)
276
Q0139:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; decrease; ICF; decrease; body: increase
277
Loss of hypotonic fluid (alcohol; diabetes insipidus; dehydration)
278
Q0140:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF: increase; ICF: no change; body: no change
279
Gain of isotonic fluid (isotonic saline)
280
Q0141:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; increase; ICF; decrease; body; increase
281
Gain of hypertonic fluid (mannitol or hypertonic saline)
282
Q0142:What hormone excess produces adrenal hyperplasia?
283
ACTH
284
Q0143:Is there more circulating T3 or T4 in plasma?
285
T4; because of the greater affinity for the binding protein; T4 has a significantly (nearly fifty times) longer half-life than T3.
286
Q0144:Why is the cell's resting membrane potential negative?
287
The resting membrane potential of the cell is -90 mV because of the intracellular proteins.
288
Q0145:True or false? Thyroid size is a measure of its function.
289
False. Thyroid size is a measure of TSH levels (which are goitrogenic).
290
Q0146:If the radius of a vessel is decreased by half; what happens to the resistance?
291
The resistance increases 16-fold.
292
Q0147:What neurotransmitter is essential for maintaining a normal BP when an individual is standing?
293
NE; via its vasoconstrictive action on blood vessels
294
Q0148:What form of diabetes insipidus is due to an insufficient amount of ADH for the renal collecting ducts?
295
Central/neurogenic diabetes insipidus; in the nephrogenic form there is sufficient ADH available; but the renal collecting ducts are impermeable to its actions.
296
Q0149:Name the three methods of vasodilation via the sympathetic nervous system.
297
1. Decrease alpha-1 activity ;2. Increase Beta-2 activity ;3. Increase ACh levels
298
Q0150:What hormone is characterized by the following renal effects?;? Calcium reabsorption; phosphate excretion
299
PTH
300
Q0151:What hormone is characterized by the following renal effects?;? Calcium excretion; phosphate excretion
301
Calcitriol
302
Q0152:What hormone is characterized by the following renal effects?;? Calcium reabsorption; phosphate reabsorption
303
Vitamin D3
304
Q0153:True or false? Progesterone has thermogenic activities.
305
True. Elevated plasma levels of progesterone can raise the body temperature 0.5 to 1.0F.
306
Q0154:How long is the transit time through the small intestine?
307
2 to 4 hours
308
Q0155:Where is the last conducting zone of the lungs?
309
Terminal bronchioles. (No gas exchange occurs here.)
310
Q0156:True or false? Cortisol inhibits glucose uptake in skeletal muscle.
311
True; cortisol inhibits glucose uptake in most tissue; making it available for neural tissue use.
312
Q0157:What percentage of cardiac output flows through the pulmonary circuit?
313
100%; the percentage of blood flow through the pulmonary and systemic circulations are equal.
314
Q0158:Name the Hgb-O2 binding site based on the following information;? Least affinity for O2; requires the highest PO 2 levels for attachment (approx. 100 mm Hg)
315
Site 4
316
Q0159:Name the Hgb-O2 binding site based on the following information;? Greatest affinity of the three remaining sites for attachment; requires PO2 levels of 26 mm Hg to remain attached
317
Site 2
318
Q0160:Name the Hgb-O2 binding site based on the following information;? Remains attached under most physiologic conditions
319
Site 1
320
Q0161:Name the Hgb-O2 binding site based on the following information;? Requires a PO2 level of 40 mm Hg to remain attached
321
Site 3
322
Q0162:Which three factors cause the release of epinephrine from the adrenal medulla?
323
1. Exercise ;2. Emergencies (stress) ;3. Exposure to cold ;;(The three Es)
324
Q0163:How many ATPs are hydrolyzed every time a skeletal muscle cross-bridge completes a single cycle?
325
One; and it provides the energy for mechanical contraction.
326
Q0164:Why would a puncture to a vein above the heart have the potential to introduce air into the vascular system?
327
Venous pressure above the heart is subatmospheric; so a puncture there has the potential to introduce air into the system.
328
Q0165:What type of saliva is produced under parasympathetic stimulation?
329
High volume; watery solution; sympathetic stimulation results in thick; mucoid saliva.
330
Q0166:In what area of the GI tract does iron get absorbed?
331
Duodenum
332
Q0167:Why is the apex of the lung hypoventilated when a person is standing upright?
333
The alveoli at the apex are almost completely inflated prior to inflation; and although they are large; they receive low levels of alveolar ventilation.
334
Q0168:What pancreatic islet cell secretes glucagons?
335
alpha-Cells; glucagon has stimulatory effects on -cells and inhibitory effects on -cells.
336
Q0169:What are the four characteristics of all proteinmediated transportation?
337
1. Competition for carrier with similar chemical substances ;2. Chemical specificity needed for transportation ;3. Zero-order saturation kinetics (Transportation is maximal when all transporters are saturated.) ;4. Rate of transportation faster than if by simple diffusion
338
Q0170:What is secretin's pancreatic action?
339
Secretin stimulates the pancreas to secrete a HCO3--rich solution to neutralize the acidity of the chyme entering the duodenum.
340
Q0171:Why is there an increase in FF if the GFR is decreased under sympathetic stimulation?
341
Because RPF is markedly decreased; while GFR is only minimally diminished; this results in an increase in FF (remember FF = GFR/RPF).
342
Q0172:What triggers phase 3 of the action potential in a ventricular pacemaker cell?
343
Rapid efflux of potassium
344
Q0173:What is the primary target for the action of glucagon?
345
Liver (hepatocytes)
346
Q0174:What is the renal compensation mechanism for acidosis?
347
Production of HCO3-; shifting the reaction to the left and thereby decreasing H+
348
Q0175:What enzyme found in a cholinergic synapse breaks down ACh? What are the byproducts?
349
Acetylcholinesterase breaks ACh into acetate and choline (which gets resorbed by the presynaptic nerve terminal).
350
Q0176:What hormone; produced by Sertoli cells; if absent would result in the formation of internal female structures?
351
MIF
352
Q0177:What happens to the lung if the intrapleural pressure exceeds lung recoil?
353
The lung will expand; also the opposite is true.
354
Q0178:What two factors determine the clearance of a substance?
355
Plasma concentration and excretion rate
356
Q0179:What type of muscle contraction occurs when the muscle shortens and lifts the load placed on it?
357
Isotonic contraction
358
Q0180:What type of potential is characterized as being an allor-none response; propagated and not summated?
359
Action potential
360
Q0181:What primary acid-base disturbance is caused by a gain in fixed acid forcing the reaction to shift to the left; decreasing HCO3- and slightly increasing CO2?
361
Metabolic acidosis (summary: low pH; high H+; and low HCO3-)
362
Q0182:What two pituitary hormones are produced by acidophils?
363
GH and prolactin are produced by acidophils; all others are by basophils.
364
Q0183:What organ of the body has the smallest AV oxygen difference?
365
The renal circulation has the smallest AV O2 (high venous PO2) difference in the body because of the overperfusion of the kidneys resulting from filtration.
366
Q0184:What is the titratable acid form of H+ in the urine?
367
H2PO4- (dihydrogen phosphate)
368
Q0185:What hypothalamic hormone is synthesized in the preoptic nucleus?
369
GnRH
370
Q0186:What five factors promote turbulent flow?
371
1. Increased tube radius ;2. Increased velocity ;3. Decreased viscosity ;4. Increased number of branches ;5. Narrowing of an orifice
372
Q0187:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona glomerulosa
373
Aldosterone;Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
374
Q0188:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona fasciculata
375
Cortisol;Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
376
Q0189:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona reticularis
377
DHEA (androgens);Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
378
Q0190:Where is most of the body's Ca2+ stored?
379
In bone; nearly 99% of Ca2+ is stored in the bone as hydroxyapatite.
380
Q0191:What is the relationship between ventilation and PCO2 levels?
381
They are inversely related. If ventilation increases; there will be a decrease in PCO2 levels and vice versa.
382
Q0192:Is T3 or T4 responsible for the negative feedback loop on to the hypothalamus and anterior pituitary gland?
383
T4; as long as T4 levels remain constant; TSH will be minimally effected by T3.
384
Q0193:What is the signal to open the voltage-gated transmembrane potassium channels?
385
Membrane depolarization is the stimulus to open these slow channels; and if they are prevented from opening; it will slow down the repolarization phase.
386
Q0194:Increased urinary excretion of what substance is used to detect excess bone demineralization?
387
Hydroxyproline
388
Q0195:What is the term to describe how easily a vessel stretches?
389
Compliance (think of it as distensibility)
390
Q0196:What is the ratio of T4:T3 secretion from the thyroid gland?
391
20:1T4T3. There is an increase in the production of T3 when iodine becomes deficient.
392
Q0197:Do the PO2 peripheral chemoreceptors of the carotid body contribute to the normal drive for ventilation?
393
Under normal resting conditions no; but they are strongly stimulated when PO2 arterial levels decrease to 50 to 60 mm Hg; resulting in increased ventilatory drive.
394
Q0198:What determines the overall force generated by the ventricular muscle during systole?
395
The number of cross-bridges cycling during contraction: the greater the number; the greater the force of contraction.
396
Q0199:Where does most circulating plasma epinephrine originate?
397
From the adrenal medulla; NE is mainly derived from the postsynaptic sympathetic neurons.
398
Q0200:What causes a skeletal muscle contraction to terminate?
399
When calcium is removed from troponin and pumped back into the SR; skeletal muscle contraction stops.
400
Q0201:What happens to intracellular volume when there is an increase in osmolarity?
401
ICF volume decreases when there is an increase in osmolarity and vice versa.
402
Q0202:Which CHO is independently absorbed from the small intestine?
403
Fructose; both glucose and galactose are actively absorbed via secondary active transport.
404
Q0203:When is the surface tension the greatest in the respiratory cycle?
405
Surface tension; the force to collapse the lung; is greatest at the end of inspiration.
406
Q0204:What adrenal enzyme deficiency results in hypertension; hypernatremia; increased ECF volume; and decreased adrenal androgen production?
407
17-alpha-Hydroxylase deficiency
408
Q0205:In reference to membrane potential (Em) and equilibrium potential (Ex); which way do ions diffuse?
409
Ions diffuse in the direction to bring the membrane potential toward the equilibrium potential.
410
Q0206:Under normal conditions; what is the main factor that determines GFR?
411
Hydrostatic pressure of the glomerular capillaries (promotes filtration)
412
Q0207:The closure of what valve indicates the beginning of the isovolumetric relaxation phase of the cardiac cycle?
413
Closure of the aortic valve indicates the termination of the ejection phase and the beginning of the isovolumetric relaxation phase of the cardiac cycle.
414
Q0208:What vessels in the systemic circulation have the greatest and slowest velocity?
415
The aorta has the greatest velocity and the capillaries have the slowest velocity.
416
Q0209:Thin extremities; fat collection on the upper back and abdomen; hypertension; hypokalemic alkalosis; acne; hirsutism; wide purple striae; osteoporosis; hyperlipidemia; hyperglycemia with insulin resistance; and protein depletion are all characteristics of what disorder?
417
Hypercortisolism (Cushing syndrome)
418
Q0210:What enzyme is essential for the conversion of CO2 to HCO3-?
419
Carbonic anhydrase
420
Q0211:True or false? The parasympathetic nervous system has very little effect on arteriolar dilation or constriction.
421
True
422
Q0212:What three lung measurements must be calculated because they cannot be measured by simple spirometry?
423
TLC; FRC; and RV have to be calculated. (Remember; any volume that has RV as a component has be calculated.)
424
Q0213:What is the venous and arterial stretch receptors' function regarding the secretion of ADH?
425
They chronically inhibit ADH secretion; when there is a decrease in the blood volume; the stretch receptors send fewer signals; and ADH is secreted.
426
Q0214:What cell converts androgens to estrogens?
427
Granulosa cell
428
Q0215:What hormone acts on Granulosa cells?
429
FSH
430
Q0216:How long is the transit time through the large intestine?
431
3 to 4 days
432
Q0217:Does subatmospheric pressure act to expand or collapse the lung?
433
Subatmospheric pressure acts to expand the lung; positive pressure acts to collapse the lung.
434
Q0218:What hormone constricts afferent and efferent arterioles (efferent more so) in an effort to preserve glomerular capillary pressure as the renal blood flow decreases?
435
AT II
436
Q0219:Why is there a minimal change in BP during exercise if there is a large drop in TPR?
437
Because the large drop in TPR is accompanied by a large increase in cardiac output; resulting in a minimal change in BP.
438
Q0220:What is the effect of insulin on protein storage?
439
Insulin increases total body stores of protein; fat; and CHOs. When you think insulin; you think storage.
440
Q0221:What is the term for an inhibitory interneuron?
441
Renshaw neuron
442
443
Calcium influx secondary to slow channel opening
444
Q0223:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Percentage of original filtered volume left in the lumen
445
At the end of the PCT 25% of the original volume is left
446
Q0224:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Percentage of Na+; Cl-; K+ left in the lumen
447
At the end of the PCT 25% of Na+; Cl-; K+ is left
448
Q0225:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Osmolarity
449
300 mOsm/L
450
Q0226:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Concentration of CHO; AA; ketones; peptides
451
No CHO; AA; ketones; or peptides are left in the tubular lumen.
452
Q0227:True or false? Enterokinase is a brush border enzyme.
453
False. It is an enzyme secreted by the lining of the small intestine.
454
Q0228:Where does the synthesis of ACh occur?
455
In the cytoplasm of the presynaptic nerve terminal; it is catalyzed by choline acetyltransferase.
456
Q0229:What pancreatic islet cell secretes somatostatin?
457
delta-Cells; somatostatin has an inhibitory effect on alphaand Beta-islet cells.
458
Q0230:Why is O2 content depressed in anemic patients?
459
Anemic patients have a depressed O2 content because of the reduced concentration of Hgb in the blood. As for polycythemic patients; their O2 content is increased because of the excess Hgb concentrations.
460
Q0231:What term describes the volume of plasma from which a substance is removed over time?
461
Clearance
462
Q0232:If capillary hydrostatic pressure is greater than oncotic pressure; is filtration or reabsorption promoted?
463
Filtration; if hydrostatic pressure is less than oncotic pressure; reabsorption is promoted.
464
Q0233:What cells of the parathyroid gland are simulated in response to hypocalcemia?
465
The chief cells of the parathyroid gland release PTH in response to hypocalcemia.
466
Q0234:At the base of the lung; what is the baseline intrapleural pressure; and what force does it exert on the alveoli?
467
Intrapleural pressure at the base is -2.5 cm H2O (more positive than the mean); resulting in a force to collapse the alveoli.
468
Q0235:What hormone is necessary for normal GH secretion?
469
Normal thyroid hormones levels in the plasma are necessary for proper secretion of GH. Hypothyroid patients have decreased GH secretions.
470
Q0236:What is the signal to open the voltage-gated transmembrane sodium channels?
471
Membrane depolarization is the stimulus to open these channels; which are closed in resting conditions.
472
Q0237:What hormones are produced in the median eminence region of the hypothalamus and the posterior pituitary gland?
473
None; they are the storage sites for ADH and oxytocin.
474
Q0238:What is the most energy-demanding phase of the cardiac cycle?
475
Isovolumetric contraction
476
Q0239:What presynaptic receptor does NE use to terminate further neurotransmitter release?
477
alpha2-Receptors
478
Q0240:Are salivary secretions hypertonic; hypotonic; or isotonic?
479
Hypotonic; because NaCl is reabsorbed in the salivary ducts
480
Q0241:What is the effect of T3 on heart rate and cardiac output?
481
T3 increases both heart rate and cardiac output by increasing the number of Beta-receptors and their sensitivity to catecholamines.
482
Q0242:Why will turbulence first appear in the aorta in patients with anemia?
483
Because it is the largest vessel and has the highest velocity in systemic circulation
484
Q0243:What is the origin of the polyuria if a patient is dehydrated and electrolyte depleted?
485
If the polyuria begins before the collecting ducts; the patient is dehydrated and electrolyte depleted. If the polyuria originates from the collecting ducts; the patient is dehydrated with normal electrolytes.
486
Q0244:What is the physiologically active form of Ca2+?
487
Free ionized Ca2+
488
Q0245:What are the two factors that affect alveolar PCO2 levels?
489
Metabolic rate and alveolar ventilation (main factor)
490
Q0246:Why is spermatogenesis decreased with anabolic steroid therapy?
491
Exogenous steroids suppress LH release and result in Leydig cell atrophy. Testosterone; produced by Leydig cells; is needed for spermatogenesis.
492
Q0247:What type of membrane is characterized as being permeable to water only?
493
Semipermeable membrane; a selectively permeable membrane allows both water and small solutes to pass through its membrane.
494
Q0248:What thyroid enzyme is needed for oxidation of I to I'?
495
Peroxidase; which is also needed for iodination and coupling inside the follicular cell
496
Q0249:What is the most important stimulus for the secretion of insulin?
497
An increase in serum glucose levels
498
Q0250:What term is described as the prestretch on the ventricular muscle at the end of diastole?
499
Preload (the load on the muscle in the relaxed state)
500
Q0251:What peripheral chemoreceptor receives the most blood per gram of weight in the body?
501
The carotid body; which monitors arterial blood directly
502
Q0252:What adrenal enzyme deficiency results in hypertension; hypernatremia; and virilization?
503
11-Beta-Hydroxylase deficiency results in excess production of 11-deoxycorticosterone; a weak mineralocorticoid. It increases BP; Na+; and ECF volume along with production of adrenal androgens.
504
Q0253:What is the term for diffusion of water across a semipermeable or selectively permeable membrane?
505
Osmosis; water will diffuse from higher to lower water concentrations.
506
Q0254:When do hCG concentrations peak in pregnancy?
507
In the first 3 months
508
Q0255:How many milliliters of O2 per milliliter of blood?
509
0.2
510
Q0256:What type of cell is surrounded by mineralized bone?
511
Osteocyte
512
Q0257:What two forces affect movement of ions across a membrane?
513
Concentration force and electrical force
514
Q0258:What happens to the resistance of the system when a resistor is added in a series?
515
Resistance of the system increases. (Remember; when resistors are connected in a series; the total of the resistance is the sum of the individual resistances.)
516
Q0259:What is the greatest component of lung recoil?
517
Surface tension; in the alveoli; it is a force that acts to collapse the lung.
518
Q0260:Where is ADH synthesized?
519
In the supraoptic nuclei of the hypothalamus; it is stored in the posterior pituitary gland.
520
Q0261:How is velocity related to the total cross-sectional area of a blood vessel?
521
Velocity is inversely related to cross-sectional area.
522
Q0262:True or false? Aldosterone has a sodium-conserving action in the distal colon.
523
True. In the distal colon; sweat glands; and salivary ducts; aldosterone has sodium-conserving effects.
524
Q0263:What form of hormone is described as having membrane-bound receptors that are stored in vesicles; using second messengers; and having its activity determined by free hormone levels.
525
Water-soluble hormones are considered fast-acting hormones.
526
Q0264:What forms of fatty acids are absorbed from the small intestine mucosa by simple diffusion?
527
Short-chain fatty acids
528
Q0265:What is the term for the day after the LH surge in the female cycle?
529
Ovulation
530
Q0266:The opening of what valve indicates the beginning of the ejection phase of the cardiac cycle?
531
Opening of the aortic valve terminates the isovolumetric phase and begins the ejection phase of the cardiac cycle.
532
Q0267:What is the region of an axon where no myelin is found?
533
Nodes of Ranvier
534
Q0268:What disorder of aldosterone secretion is characterized by;? Increased total body sodium; ECF volume; plasma volume; BP; and pH; decreased potassium; renin and AT II activity; no edema?
535
Primary hyperaldosteronism (Conn syndrome)
536
Q0269:What disorder of aldosterone secretion is characterized by;? Decreased total body sodium; ECF volume; plasma volume; BP; and pH; increased potassium; renin; and AT II activity; no edema?
537
Primary hypoaldosteronism (Addison's disease)
538
Q0270:What four factors affect diffusion rate?
539
1. Concentration (greater concentration gradient; greater diffusion rate) ;2. Surface area (greater surface area; greater diffusion rate) ;3. Solubility (greater solubility; greater diffusion rate) ;4. Membrane thickness (thicker the membrane; slower the diffusion rate) ;;Molecular weight is clinically unimportant
540
Q0271:How long after ovulation does fertilization occur?
541
8 to 25 hours
542
Q0272:What is the name of the force that develops in the wall of the lungs as they expand?
543
Lung recoil; being a force to collapse the lung; increases as the lung enlarges during inspiration.
544
Q0273:What day of the menstrual cycle does ovulation take place?
545
Day 14
546
Q0274:How does sympathetic stimulation to the skin result in decreased blood flow and decreased blood volume? (Hint: what vessels are stimulated; and how?)
547
A decrease in cutaneous blood flow results from constriction of the arterioles; and decreased cutaneous blood volume results from constriction of the venous plexus.
548
Q0275:What two compensatory mechanisms occur to reverse hypoxia at high altitudes?
549
Increase in erythropoietin and increase in 2; 3-BPG; also called 2; 3-diphosphoglycerate (2; 3-P2Gri) (increase in glycolysis)
550
Q0276:What female follicular cell is under LH stimulation and produces androgens from cholesterol?
551
Theca cell
552
Q0277:What is the main factor determining FF?
553
Renal plasma flow (decrease flow; increase FF)
554
Q0278:Where is the action potential generated on a neuron?
555
Axon hillock
556
Q0279:If free water clearance (CH2O) is positive; what type of urine is formed? And if it is negative?
557
If positive; hypotonic urine (osmolarity <300 mOsm/L); if negative; hypertonic urine (osmolarity > 300 mOsm/L)>>
558
Q0280:What cell in the heart has the highest rate of automaticity?
559
SA node; it is the reason it is the primary pacemaker of the heart.
560
Q0281:What is pumped from the lumen of the ascending loop of Henle to decrease the osmolarity?
561
NaCl is removed from the lumen to dilute the fluid leaving the loop of Henle.
562
Q0282:True or false? In skeletal muscle relaxation is an active event.
563
True. Sarcoplasmic calcium-dependent ATPase supplies the energy to terminate contraction; and therefore it is an active process.
564
Q0283:What three factors increase simple diffusion?
565
1. Increased solubility ;2. Increased concentration gradient ;3. Decreased thickness of the membrane
566
Q0284:What is the pancreatic action of CCK?
567
CCK stimulates the pancreas to release amylase; lipase; and proteases for digestion.
568
Q0285:What is the rate-limiting step in a conduction of a NMJ?
569
The time it takes ACh to diffuse to the postjunctional membrane
570
Q0286:Is excretion greater than or less than filtration for net secretion to occur?
571
Excretion is greater than filtration for net secretion to occur.
572
Q0287:What acid-base disturbance is produced from vomiting?
573
Hypokalemic metabolic alkalosis occurs from vomiting because of the loss of H+; K+; and Cl-.
574
Q0288:What phase of the menstrual cycle is dominated by estrogen? Progesterone?
575
Follicular phase is estrogen-dependent with increased FSH levels; while the luteal phase is progesterone-dependent.
576
Q0289:Name the lung measurement based on the following descriptions;? The amount of air that enters or leaves the lung system in a single breath
577
Tidal volume (VT)
578
Q0290:Name the lung measurement based on the following descriptions;? The maximal volume inspired from FRC
579
Inspiratory capacity
580
Q0291:Name the lung measurement based on the following descriptions;? Additional volume that can be expired after normal expiration
581
Expiratory reserve volume (ERV)
582
Q0292:Name the lung measurement based on the following descriptions;? Maximal volume that can be expired after maximal inspiration
583
Vital capacity (VC)
584
Q0293:Name the lung measurement based on the following descriptions;? Volume in the lungs at the end of passive expiration
585
Functional residual capacity (FRC)
586
Q0294:Name the lung measurement based on the following descriptions;? Additional air that can be taken in after normal inspiration
587
Inspiratory reserve volume (IRV)
588
Q0295:Name the lung measurement based on the following descriptions;? Amount of air in the lungs after maximal expiration
589
Residual volume (RV)
590
Q0296:Name the lung measurement based on the following descriptions;? Amount of air in the lungs after maximal inspiration
591
Total lung capacity (TLC)
592
Q0297:What growth factors are chondrogenic; working on the epiphyseal end plates of bone?
593
Somatomedins (IGF-1)
594
Q0298:What determines the Vmax of skeletal muscle?
595
The muscle's ATPase activity
596
Q0299:True or false? All of the hormones in the hypothalamus and anterior pituitary gland are water soluble.
597
True
598
Q0300:What is the effect of T3 on the glucose absorption in the small intestine?
599
Thyroid hormones increase serum glucose levels by increasing the absorption of glucose from the small intestine.
600
Q0301:Is the bound form or free form of a lipid-soluble hormone responsible for the negative feedback activity?
601
Free form determines hormone activity and is responsible for the negative feedback loop.
602
Q0302:What region or regions of the adrenal cortex are stimulated by ACTH?
603
Zona fasciculata and zona reticularis
604
Q0303:Are the following parameters associated with an obstructive or restrictive lung disorder: decreased FEV1; FVC; peak flow; and FEV1/FVC; increased TLC; FRC; and RV?
605
Obstructive lung disorders. The opposite changes (where you see decrease exchange it for increase and vice versa) are seen in a restrictive pattern.
606
Q0304:What is the respiratory compensation mechanism for metabolic alkalosis?
607
Hypoventilation; which increases CO2; shifting the reaction to the right and increasing H+
608
Q0305:During puberty; what is the main drive for the increased GH secretion?
609
Increased androgen secretion at puberty drives the increased GH secretion.
610
Q0306:What type of potential is characterized as graded; decremental; and exhibiting summation?
611
Subthreshold potential
612
Q0307:What three organs are responsible for peripheral conversion of T4 to T3?
613
Liver; kidneys; and pituitary gland via 5' deiodinase enzyme
614
Q0308:The closure of what valve indicates the beginning of isovolumetric contraction?
615
Mitral valve closure indicates the termination of the ventricular filling phase and beginning of isovolumetric contraction.
616
Q0309:How many carbons do androgens have?
617
Androgens are 19-carbon steroids.
618
Q0310:At the apex of the lung; what is the baseline intrapleural pressure; and what force does it exert on the alveoli?
619
Baseline apical intrapleural pressure is -10 cm H2O (more negative than the mean) resulting in a force to expand the alveoli.
620
Q0311:True or false? Renin secretion is increased in 21-betahydroxylase deficiency.
621
True. Increased renin and AT II levels occur as a result of the decreased production of aldosterone.
622
Q0312:What are the four ways to increase TPR?
623
1. Decrease the radius of the vessel ;2. Increase the length of the vessel ;3. Increase the viscosity ;4. Decrease the number of parallel channels
624
Q0313:What form of estrogen is of placental origin?
625
Estriol
626
Q0314:What term is an index of the effort needed to expand the lungs (i.e; overcomes recoil)?
627
Compliance; the more compliant a lung is; the easier it is to inflate.
628
Q0315:At which three sites in the body is T4 converted to T3?
629
1. Liver ;2. Kidney ;3. Pituitary gland (via 5'-deiodinase enzyme)
630
Q0316:Using Laplace's relationship regarding wall tension; why is the wall tension in an aneurysm greater than in the surrounding normal blood vessel's wall?
631
The wall tension is greater because the aneurysm has a greater radius than the surrounding vessel.
632
Q0317:What percentage of nephrons is cortical?
633
Seven-eighths of nephrons are cortical; with the remainder juxtamedullary.
634
Q0318:To what is the diffusion rate indirectly proportional?
635
Diffusion rate is indirectly proportional to membrane thickness and is directly proportional to membranes surface area.
636
Q0319:ADH is secreted in response to what two stimuli?
637
ADH is secreted in response to increased plasma osmolarity and decreased blood volume.
638
Q0320:What vessels have the largest total cross-sectional area in systemic circulation?
639
Capillaries
640
Q0321:How many days before the first day of menstrual bleeding is ovulation?
641
14 days in most women (Remember; the luteal phase is always constant.)
642
Q0322:What is the major muscle used in the relaxed state of expiration?
643
Under resting conditions expiration is considered a passive process; therefore; no muscles are used. In the active state the abdominal muscles can be considered the major muscle of expiration.
644
Q0323:What subunit of hCG is used to detect whether a patient is pregnant?
645
The beta-subunit; remember; the alpha-subunit is nonspecific.
646
Q0324:What happens to capillary oncotic pressure with dehydration?
647
Oncotic pressure increases because of the removal of water.
648
Q0325:What cells of the kidney are extravascular chemoreceptors for decreased Na+; Cl-; and NaCl?
649
Macula densa
650
Q0326:What is the effect of insulin on intracellular K+ stores?
651
Insulin increases intracellular K+ stores while decreasing serum K+ levels.
652
653
Decreasing potassium conductance; which results in increased excitability
654
Q0328:What is it called when levels of sex steroids increase; LH increases; and FSH increases?
655
GnRH pulsatile infusion
656
Q0329:What parasympathetic neurotransmitter of the GI tract stimulates the release of gastrin?
657
Gastrin-releasing peptide (GRP) stimulates G cells to release Gastrin. (All G's)
658
Q0330:What reflex increases TPR in an attempt to maintain BP during a hemorrhage?
659
The carotid sinus reflex
660
Q0331:What is the name of the regulatory protein that covers the attachment site on actin in resting skeletal muscle?
661
Tropomyosin
662
Q0332:Which way does the Hgb-O2 dissociation curve shift in patients with CO poisoning?
663
The pathologic problem with CO poisoning is that CO has 240 times as much affinity for Hgb molecule as does O2; reducing the carrying capacity and shifting the curve to the left; making it difficult to remove the CO molecule from Hgb.
664
Q0333:What is the main factor determining GFR?
665
Glomerular capillary pressure (increased glomerular capillary pressure; increased GFR and vice versa)
666
Q0334:What is the effect of hypoventilation on cerebral blood flow?
667
Hypoventilation results in an increase in PCO2 levels and therefore an increase in blood flow.
668
Q0335:What cells of the thyroid gland are stimulated in response to hypercalcemia?
669
The parafollicular cells of the thyroid (C cells) release calcitonin in response to hypercalcemia.
670
Q0336:What is the term for the amount of blood in the ventricle after maximal contraction?
671
Residual volume
672
Q0337:What does failure of PaO2 to increase with supplemental O2 indicate?
673
Pulmonary shunt (i.e; pulmonary embolism)
674
Q0338:What two substances stimulate Sertoli cells?
675
FSH and testosterone
676
Q0339:The clearance of what substance is the gold standard of renal plasma flow?
677
Para-aminohippurate (PAH)
678
Q0340:What bile pigment is formed by the metabolism of bilirubin by intestinal bacteria; giving stool its brown color?
679
Stercobilin
680
Q0341:Is ACh associated with bronchoconstriction or bronchodilation?
681
Bronchoconstriction is associated with parasympathetic stimulation (ACh); and catecholamine stimulation is associated with bronchodilation (why epinephrine is used in emergency treatment of bronchial asthma.)
682
Q0342:What are the growth factors released from the liver called?
683
Somatomedins
684
Q0343:Regarding skeletal muscle mechanics; what is the relationship between velocity and afterload?
685
An increase in the afterload decreases velocity; they are inversely related. (V equals 1 divided by afterload.)
686
Q0344:What happens to extracellular volume with a net gain in body fluid?
687
The ECF compartment always enlarges when there is a net gain in total body water and decreases when there is a loss of total body water. Hydration status is named in terms of the ECF compartment.
688
Q0345:What are the six substances that promote the secretion of insulin?
689
1. Glucose ;2. Amino acid (arginine) ;3. Gastrin inhibitory peptide (GIP) ;4. Glucagon ;5. beta-Agonists ;6. ACh
690
Q0346:Does O2 or CO2 have a higher driving force across the alveolar membrane?
691
O2 has a higher driving force but is only one-twenty-fourth as soluble as CO2. CO 2 has a very small partial pressure difference across the alveolar membrane (47-40 = 7 mmHg); but it is extremely soluble and therefore diffuses readily across the membrane.
692
Q0347:What is used as an index for both adrenal and testicular androgens?
693
Urinary 17-ketosteroids
694
Q0348:How are resistance and length related regarding flow?
695
Resistance and vessel length are proportionally related. The greater the length of the vessel; the greater the resistance is on the vessel.
696
Q0349:Is filtration greater than or less than excretion for net reabsorption to occur?
697
Filtration is greater than excretion for net reabsorption to occur.
698
Q0350:What hormone; stimulated by epinephrine; results in an increase in lipolysis?
699
Hormone-sensitive lipase; which breaks down triglyceride into glycerol and free fatty acid
700
Q0351:True or false? Miniature end-plate potentials (MEPPs) generate action potentials.
701
False
702
Q0352:Is GH considered a gluconeogenic hormone?
703
Yes; it decreases fat and muscle uptake of glucose; thereby increasing blood glucose levels.
704
Q0353:True or false? Somatic motor neurons innervate the striated muscle of the bulbospongiosus and ischiocavernous muscles and result in ejaculation of semen.
705
True
706
Q0354:What happens to intraventricular pressure and volume during isovolumetric contraction?
707
As the name indicates; there is no change in volume but there is an increase in pressure.
708
Q0355:Do high levels of estrogen and progesterone block milk synthesis?
709
Yes; they stimulate the growth of mammary tissue but block milk synthesis. At parturition; the decrease in estrogen lifts the block on milk production.
710
Q0356:What two factors lead to the development of the bends (caisson disease)?
711
Breathing high-pressure nitrogen over a long time and sudden decompression result in the bends.
712
Q0357:In what type of circuit is the total resistance always less than that of the individual resistors?
713
Parallel circuit
714
Q0358:What is the term for days 15 to 28 in the female cycle?
715
Luteal phase
716
Q0359:What happens to total and alveolar ventilation with;? Increased rate of breathing?
717
With an increased rate of breathing the total ventilation is greater than the alveolar ventilation. Rapid; shallow breathing increases dead space ventilation with little change in alveolar ventilation. (This is hypoventilation).
718
Q0360:What happens to total and alveolar ventilation with;? Increased depth of breathing?
719
With an increased depth of breathing both the total and alveolar ventilation increase;This concept is always tested on the boards; so remember it.
720
Q0361:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol decreased; ACTH increased
721
Primary hypocortisolism (Addison's disease)
722
Q0362:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol increased; ACTH increased
723
Secondary hypercortisolism (pituitary)
724
Q0363:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol increased; ACTH decreased
725
Primary hypercortisolism
726
Q0364:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol decreased; ACTH decreased
727
Secondary hypocortisolism (pituitary)
728
Q0365:What happens to flow and pressure in capillaries with arteriolar dilation? Arteriolar constriction?
729
Capillary flow and pressure increase with arteriolar dilation and decrease with arteriolar constriction.
730
Q0366:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR increased ; RPF increased ; FF normal; capillary pressure increased
731
Dilation of afferent arteriole
732
Q0367:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR increased ; RPF decreased ; FF increased ; capillary pressure increased
733
Constriction of efferent arteriole
734
Q0368:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR decreased ; RPF increased ; FF decreased ; capillary pressure decreased
735
Dilation of efferent arteriole
736
Q0369:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR decreased ; RPF decreased ; FF normal; capillary pressure decreased
737
Constriction of afferent arteriole
738
Q0370:Which direction is air flowing when the intra-alveolar pressure is zero?
739
When the intra-alveolar pressure equals zero; there is no airflow.
740
Q0371:What phase of the female cycle occurs during days 1 to 15?
741
Follicular phase
742
Q0372:What determines the effective osmolarity of the ICF and the ECF compartments?
743
The concentration of plasma proteins determines effective osmolarity because capillary membranes are freely permeable to all substances except proteins.
744
Q0373:What region of the brain houses the central chemoreceptors responsible for control of ventilation?
745
The surface of the medulla
746
Q0374:What is the site of action of cholera toxin?
747
Cholera toxin irreversibly activates the cAMP-dependent chloride pumps of the small and large intestine; producing a large volume of chloride-rich diarrhea.
748
Q0375:Name the phase of the ventricular muscle action potential based on the following information;? Slow channels open; allowing calcium influx; voltage-gated potassium channels closed; potassium efflux through ungated channels; plateau stage
749
Phase 2
750
Q0376:Name the phase of the ventricular muscle action potential based on the following information;? Slight repolarization secondary to potassium and closure of the sodium channels
751
Phase 1
752
Q0377:Name the phase of the ventricular muscle action potential based on the following information;? Fast channels open; then quickly close; and sodium influx results in depolarization
753
Phase 0
754
Q0378:Name the phase of the ventricular muscle action potential based on the following information;? Slow channels close; voltage-gated potassium channels reopen with a large influx of potassium; and the cell quickly repolarizes
755
Phase 3
756
Q0379:Where in the kidney are the long loops of Henle and the terminal regions of the collecting ducts?
757
In the medulla; all the other structures are cortical.
758
Q0380:What is absorbed in the gallbladder to concentrate bile?
759
Water
760
Q0381:What type of hormone is described as having intracellular receptors; being synthesized as needed; mostly bound to proteins; and having its activity determined by free hormone levels?
761
Lipid-soluble hormones are considered slow-acting hormones.
762
Q0382:What are the three stimuli that result in the reninangiotensin-aldosterone secretion?
763
1. Low pressure in the afferent renal arteriole ;2. Low sodium sensed by the macula densa ;3. Increased beta-1-sympathetic stimulation of the JG cells
764
Q0383:Is there a shift in p50 values with anemia? Polycythemia?
765
The p50 value does not change in either anemia or polycythemia; the main change is the carrying capacity of the blood.
766
Q0384:What hormone level peaks 1 day before the surge of LH and FSH in the female cycle?
767
Estradiol
768
Q0385:True or false? Active protein transport requires a concentration gradient.
769
True; it requires both a concentration gradient and ATP to work.
770
Q0386:Up to how many hours post ejaculation do sperm retain their ability to fertilize the ovum?
771
Up to 72 hours; the ovum losses its ability to be fertilized 8 to 25 hours after release.
772
Q0387:What type of membrane channel opens in response to depolarization?
773
Voltage-gated channel
774
Q0388:What are the five effects of insulin on fat metabolism?
775
1. Increased glucose uptake by fat cells ;2. Increased triglyceride uptake by fat cells ;3. Increased conversion of CHOs into fat ;4. Decreased lipolysis in fat tissue ;5. Decreased ketone body formation
776
Q0389:True or false? In a skeletal muscle fiber; the interior of the T-tubule is extracellular.
777
True. They are evaginations of the surface membranes and therefore extracellular.
778
Q0390:Under resting conditions; what is the main determinant of cerebral blood flow?
779
Arterial PCO2 levels are proportional to cerebral blood flow.
780
Q0391:On the venous pressure curve; what do the following waves represent?;? A wave?
781
Atrial contraction;Atrial; Contraction; Venous
782
Q0392:On the venous pressure curve; what do the following waves represent?;? C wave?
783
Ventricular contraction;Atrial; Contraction; Venous
784
Q0393:On the venous pressure curve; what do the following waves represent?;? V wave?
785
Atrial filling (venous filling);Atrial; Contraction; Venous
786
Q0394:What cell type in the bone is responsible for bone deposition?
787
Osteoblast (Remember; blasts make; clasts take)
788
Q0395:True or false? The blood stored in the systemic veins and the pulmonary circuit are considered part of the cardiac output.
789
False. Cardiac output refers to circulating blood volume. The blood in the systemic veins and the pulmonary circuits are storage reserves and therefore are not considered in cardiac output.
790
Q0396:What hormone disorder is characterized by the following abnormalities in sex steroidsdecreased ; LHdecreased ; and FSHdecreased ?;? Sex steroids ; LH ; FSH
791
Pituitary hypogonadism
792
Q0397:What hormone disorder is characterized by the following abnormalities in sex steroids; LH; and FSH?;? Sex steroids increased ; LH decreased ; FSH decreased ?
793
GnRH constant infusion
794
Q0398:What hormone disorder is characterized by the following abnormalities in sex steroidsdecreased ; LHincreased ; and FSHincreased ?;? Sex steroids ; LH ; FSH ?
795
Primary hypogonadism (postmenopausal women)
796
Q0399:What are the three characteristics of autoregulation?
797
1. Flow independent of BP ;2. Flow proportional to local metabolism ;3. Flow independent of nervous reflexes
798
Q0400:What is the fastest-conducting fiber of the heart? Slowest conduction fiber in the heart?
799
Purkinje cell is the fastest; and the AV node is the slowest.
800
Q0401:What equals the total tension on a muscle minus the preload?
801
Afterload
802
Q0402:What follicular cell possesses FSH receptors and converts androgens into estradiol?
803
Granulosa cells
804
Q0403:What are the primary neurotransmitters at the following sites?;? Postganglionic sympathetic neurons
805
NE
806
Q0404:What are the primary neurotransmitters at the following sites?;? Chromaffin cells of the adrenal medulla
807
Epinephrine
808
Q0405:What are the primary neurotransmitters at the following sites?;? Brainstem cells
809
Serotonin
810
Q0406:What are the primary neurotransmitters at the following sites?;? The hypothalamus
811
Histamine
812
Q0407:What are the primary neurotransmitters at the following sites?;? All motor neurons; postganglionic parasympathetic neurons
813
ACh
814
Q0408:What are the primary neurotransmitters at the following sites?;? Autonomic preganglionic neurons
815
ACh
816
Q0409:What region of the nephron has the highest osmolarity?
817
Tip of the loop of Henle (1200 mOsm/L)
818
Q0410:What pH (acidotic or alkalotic) is needed for pepsinogen to pepsin conversion?
819
Acid is needed for the activation of pepsin and therefore needed for protein digestion.
820
Q0411:What is the term for the amount of blood expelled from the ventricle per beat?
821
Stroke volume
822
Q0412:True or false? Oxytocin initiates rhythmic contractions associated with labor.
823
False. It does increase uterine synthesis of prostaglandins; which increase uterine contractions.
824
Q0413:Why does carbon monoxide diffusion in the lung (DLCO) decrease in emphysema and fibrosis but increase during exercise?
825
DLCO; an index of lung surface area and membrane thickness; is decreased in fibrosis because of increased membrane thickness and decreased in emphysema because of increased surface area without increase in capillary recruitment; in exercise there is an increase in surface area due to capillary recruitment.
826
Q0414:What enzyme converts androgens to estrogens?
827
Aromatase
828
Q0415:The clearance of what substance is the gold standard of GFR?
829
Inulin
830
Q0416:How does myelination affect conduction velocity of an action potential?
831
The greater the myelination; the greater the conduction velocity.
832
Q0417:What are the three end products of amylase digestion?
833
1. Maltose ;2. Maltotetrose ;3. alpha-Limit dextrans (alpha-1; 6 binding)
834
Q0418:Where is most of the airway resistance in the respiratory system?
835
In the first and second bronchi
836
Q0419:What is the respiratory compensation mechanism for metabolic acidosis?
837
Hyperventilation; which decreases CO2; shifting the reaction to the left and decreasing H+
838
Q0420:How are resistance and viscosity related regarding flow?
839
Viscosity and resistance are proportionally related. The greater the viscosity; the greater the resistance is on the vessel.
840
Q0421:T3 increases bone ossification through synergistic effect with what hormone?
841
GH
842
Q0422:Name the ventricular muscle membrane channel;? Closed at rest; depolarization causes channels to open slowly
843
Voltage-gated calcium channel
844
Q0423:Name the ventricular muscle membrane channel;? Always open
845
Ungated potassium channel
846
Q0424:Name the ventricular muscle membrane channel;? Closed at rest; depolarization causes channels to open quickly; will not respond to a second stimulus until cell is repolarized.
847
Voltage-gated sodium channel
848
Q0425:Name the ventricular muscle membrane channel;? Open at rest; depolarization is stimulus to close; begin to reopen during the plateau phase and during repolarization
849
Voltage-gated potassium channels
850
Q0426:What are the three glycogenic organs?
851
Liver; kidney; and GI epithelium
852
Q0427:Is CO2 a perfusion-or diffusion-limited O2 gas?
853
Since CO2 is 24 times as soluble as O2; the rate at which CO2 is brought to the membrane determines its rate of exchange; making it perfusion-limited a gas. For O2 the more time it is in contact with the membrane; the more likely it will diffuse; making it diffusion-limited.
854
Q0428:What is the term for the potential difference across a cell membrane?
855
Transmembrane potential (an absolute number)
856
Q0429:What adrenal enzyme deficiency can be summed up as a mineralocorticoid deficiency; glucocorticoid deficiency; and an excess of adrenal androgens?
857
21-beta-Hydroxylase deficiency leads to hypotension; hyponatremia; and virilization.
858
Q0430:When the ECF osmolarity increases; what happens to cell size?
859
Increase in ECF osmolarity means a decrease in ICF osmolarity; so cells shrink.
860
Q0431:When does cortisol secretion peak?
861
In early-morning sleep; usually between the sixth and eighth hours
862
Q0432:What is the term for ventilation of unperfused alveoli?
863
Alveolar dead space
864
Q0433:What is the bioactive form of thyroid hormone?
865
T3
866
Q0434:What acid-base disturbance occurs in colonic diarrhea
867
Hypokalemic metabolic acidosis occurs in colonic diarrhea because of the net secretion of HCO3- and potassium into the colonic lumen.
868
Q0435:What two AAs act as excitatory transmitters in the CNS; generating EPSPs?
869
Glutamine and aspartate
870
Q0436:What are the three mechanisms of action for atrial natriuretic peptide's diuretic and natriuretic affects?
871
1. Dilation of the afferent arteriole ;2. Constriction of the efferent arteriole ;3. Inhibition of reabsorption of sodium and water in the collecting ducts
872
Q0437:In a parallel circuit; what happens to resistance when a resistor is added in parallel
873
Resistance decreases as resistors are added in parallel.
874
Q0438:What component of the ANS is responsible for movement of semen from the epididymis to the ejaculatory ducts?
875
Sympathetic nervous system
876
Q0439:What happens to O2 affinity with a decrease in p50?
877
O2 affinity increases with a decrease in the p50; making O2 more difficult to remove from the Hgb molecule.
878
Q0440:If the ratio of a substance's filtrate and plasma concentrations are equal; what is that substance's affect on the kidney?
879
If the ratio of the filtrate to plasma concentration of a substance is equal; the substance is freely filtered by the kidney.
880
Q0441:What does a loss of afferent activity from the carotid sinus onto the medulla signal?
881
A loss of afferent activity indicates a decrease in BP; and an increase in afferent activity indicates an increase in BP.
882
Q0442:What are the five F's associated with gallstones?
883
1. Fat ;2. Forty ;3. Female ;4. Familial ;5. Fertile
884
Q0443:True or false? Menstruation is an active process due to increased gonadal sex hormones?
885
False. It is a passive process due to decreased sex hormones.
886
Q0444:What happens to the intrapleural pressure when the diaphragm relaxes?
887
Relaxation of the diaphragm increases the intrapleural pressure (becomes more positive).
888
Q0445:What component of the renin-angiotensin-aldosterone axis increases sodium reabsorption in the proximal convoluted tubules and increases thirst drive?
889
AT II
890
Q0446:What large-diameter vessel has the smallest crosssectional area in systemic circulation?
891
The aorta
892
Q0447:Excess bone demineralization and remodeling can be detected by checking urine levels of what substance?
893
Hydroxyproline (breakdown product of collagen)
894
Q0448:What happens to the following during skeletal muscle contraction?;? A band
895
No change in length
896
Q0449:What happens to the following during skeletal muscle contraction?;? I band
897
Shortens
898
Q0450:What happens to the following during skeletal muscle contraction?;? H zone
899
Shortens
900
Q0451:What happens to the following during skeletal muscle contraction?;? Sarcomere
901
Shortens
902
Q0452:What happens to the following during skeletal muscle contraction?;? Actin and myosin lengths
903
No change in length
904
Q0453:What are the three effects of insulin on protein metabolism?
905
1. Increased amino acid uptake by muscles ;2. Decreased protein breakdown ;3. Increased protein synthesis
906
Q0454:What is the main mechanism for exchange of nutrients and gases across a capillary membrane?
907
Simple diffusion; it does not use protein-mediated transport
908
Q0455:What event signifies the first day of the menstrual cycle?
909
Onset of bleeding
910
Q0456:Name the muscle type based on the histological features;? Actin and myosin in sarcomeres; striated; uninuclear; gap junctions; troponin:calcium binding complex; T tubules and SR forming dyadic contacts; voltage-gated calcium channels
911
Cardiac muscle
912
Q0457:Name the muscle type based on the histological features;? Actin and myosin in sarcomeres; striated; multinuclear; lacks gap junctions; troponin:calcium binding; T tubules and SR forming triadic contacts; highest ATPase activity; no calcium channels
913
Skeletal muscle
914
Q0458:Name the muscle type based on the histological features;? Actin and myosin not in sarcomeres; nonstriated; uninuclear; gap junctions; calmodulin:calcium binding; lacks T tubules; voltage-gated calcium channels
915
Smooth muscle
916
Q0459:Name the valve abnormality based on the following criteria;? Back-filling into the left atrium during systole; increased v-wave; preload; left atrial volume; and left ventricular filling
917
Mitral insufficiency
918
Q0460:Name the valve abnormality based on the following criteria;? Systolic murmur; increased preload and afterload; decreased aortic pulse pressure and coronary blood flow
919
Aortic stenosis
920
Q0461:Name the valve abnormality based on the following criteria;? Diastolic murmur; increased right ventricular pressure; left atrial pressure; and atrial to ventricular pressure gradient; decreased left ventricular filling pressure
921
Mitral stenosis
922
Q0462:Name the valve abnormality based on the following criteria;? Diastolic murmur; increased preload; stroke volume; and aortic pulse pressure; decreased coronary blood flow; no incisura; and peripheral vasodilation
923
Aortic insufficiency
924
Q0463:Circulating levels of what hormone cause the cervical mucus to be thin and watery; allowing sperm an easier entry into the uterus?
925
Estrogen
926
Q0464:What hormone controls relaxation of the lower esophageal sphincter during swallowing?
927
VIP is an inhibitory parasympathetic neurotransmitter that results in relaxation of the lower esophageal sphincter.
928
Q0465:What is the term for the difference between systolic and diastolic pressures?
929
Pulse pressure
930
Q0466:What hormone; produced by the Sertoli cells; is responsible for keeping testosterone levels in the seminiferous tubules nearly 50 times that of the serum?
931
Androgen-binding protein
932
Q0467:True or false? There are no central O2 receptors.
933
True
934
Q0468:What cell type of the bone has PTH receptors?
935
Osteoblasts; which in turn stimulate osteoclasts to break down bone; releasing Ca2+ into the interstitium. (Remember; blasts make; clasts take.)
936
Q0469:What substance is secreted by parietal glands and is required for life?
937
Intrinsic factor (IF)
938
Q0470:What is the only way to increase O2 delivery in the coronary circulation?
939
Increasing blood flow is the only way to increase O2 delivery in the coronary circulation because extraction is nearly maximal during resting conditions.
940
Q0471:What is the term for the load a muscle is trying to move during stimulation?
941
Afterload
942
Q0472:What is the term for days 1 to 7 of the female cycle?
943
Menses
944
Q0473:What is the term for the force the ventricular muscle must generate to expel the blood into the aorta?
945
Afterload
946
Q0474:What happens to the tonicity of the urine with increased ADH secretion?
947
The urine becomes hypertonic because of water reabsorption in the collecting duct.
948
Q0475:What form of renal tubular reabsorption is characterized by high back leak; low affinity for substance; and absence of saturation and is surmised to be a constant percentage of a reabsorbed filtered substance?
949
Gradient-time system
950
Q0476:What type of circuit is described when the total resistance is always greater than the sums of the individual resistors?
951
Series circuit
952
Q0477:What hormone excess brings about abnormal glucose tolerance testing; impaired cardiac function; decreased body fat; increased body protein; prognathism; coarse facial features; and enlargements of the hands and feet?
953
Increased secretion of GH postpuberty leading to acromegaly.
954
Q0478:What happens to V/Q ratio if a thrombus is lodged in the pulmonary artery?
955
The V/Q ratio increases; since the area is ventilated but hypoperfused as a result of the occlusion.
956
Q0479:What hormone has the following effects: chondrogenic in the epiphyseal end plates of bones; increases AA transport for protein synthesis; increases hydroxyproline (collagen); and increases chondroitin sulfate synthesis?
957
GH; especially IGF-1. GH also increases the incorporation of thymidine in DNA synthesis and uridine in RNA synthesis.
958
Q0480:True or false? Bile pigments and bile salts are reabsorbed in the gallbladder.
959
False
960
Q0481:What component of an ECG is associated with the following?;? Conduction delay in the AV node
961
PR interval
962
Q0482:What component of an ECG is associated with the following?;? Ventricular depolarization
963
QRS complex
964
Q0483:What component of an ECG is associated with the following?;? Atrial depolarization
965
P wave
966
Q0484:What component of an ECG is associated with the following?;? Ventricular repolarization
967
T wave
968
Q0485:Where is the greatest venous PO2 in resting tissue?
969
Renal circulation
970
Q0486:Near the end of pregnancy; what hormone's receptors increase in the myometrium because of elevated plasma estrogen levels?
971
Oxytocin
972
Q0487:What respiratory center in the rostral pons has an inhibitory affect on the apneustic center?
973
Pneumotaxic center (short; fast breaths)
974
Q0488:For what hormone do Leydig cells have receptors?
975
LH
976
Q0489:What primary acid-base disturbance is cause by a decrease in alveolar ventilation (increasing CO2 levels) resulting in the reaction shifting to the right and increasing H+ and HCO3- levels?
977
Respiratory acidosis (summary: high CO2; high H+; slightly high HCO3-)
978
Q0490:What lecithin: sphingomyelin ratio indicates lung maturity?
979
2.0 or greater
980
Q0491:What is the term for the negative resting membrane potential becoming more negative?
981
Hyperpolarization (i.e; K+ influx)
982
Q0492:What type of resistance system (i.e; high or low) is formed when resistors are added in parallel?
983
A low-resistance system is formed by resistors added in parallel.
984
Q0493:Why is hypothyroidism associated with night blindness?
985
Thyroid hormones are necessary for conversion of carotene to vitamin A.
986
Q0494:What is the FiO2 of room air?
987
0.21; it is a fancy way of saying 21% of the air is O2.
988
Q0495:Where are the lowest resting PO2 levels in a resting individual?
989
Coronary circulation
990
Q0496:What is the rate-limiting step in the production of steroids?
991
The conversion of CHO to pregnenolone via the enzyme desmolase
992
Q0497:In the water deprivation test; does a patient with reduced urine flow have primary polydipsia or diabetes insipidus?
993
Primary polydipsia; patients with diabetes insipidus will continue to produce large volumes of dilute urine.
994
Q0498:True or false? There is an inverse relationship between fat content and total body water.
995
True; the greater the fat; the less the total body water.
996
Q0499:What is the role of the negative charge on the filtering membrane of the glomerular capillaries?
997
The negative charge inhibits the filtration of protein anions.
998
Q0500:What cardiac reflex is characterized by stretch receptors in the right atrium; afferent and efferent limbs via the vagus nerve; and increased stretch leading to an increase in heart rate via inhibition of parasympathetic stimulation?
999
Bainbridge reflex
1000
Q0501:Where in the GI tract does the reabsorption of bile salts take place?
1001
Bile salts are actively reabsorbed in the distal ileum.
1002
Q0502:What three structures increase the surface area of the GI tract?
1003
1. Plicae circularis (3 times) ;2. Villi (30 times) ;3. Microvilli (600 times)
1004
Q0503:Does physiologic splitting of the first heart sound occur during inspiration or expiration? Why?
1005
Splitting of the first heart sound occurs during inspiration because of the increased output of the right ventricle; delaying the closure of the pulmonic valve.
1006
Q0504:How much dietary iodine is necessary to maintain normal thyroid hormone secretion?
1007
150 mcg/day is the minimal daily intake needed. Most people ingest 500 mcg/day.
1008
Q0505:What is the central chemoreceptor's main drive for ventilation?
1009
CSF H+ levels; with acidosis being the main central drive; resulting in hyperventilation (the opposite being true with alkalosis)
1010
Q0506:What result occurs because of the negative alveolar pressure generated during inspiration?
1011
Air flows into the respiratory system.
1012
Q0507:Corticotropin-releasing hormone promotes the synthesis and release of what prohormone?
1013
Pro-opiomelanocortin (POMC) is cleaved into ACTH and beta-lipotropin.
1014
Q0508:What happens to free hormone levels when the liver decreases production and release of binding proteins?
1015
Free hormone levels remain constant; and the bound hormone level changes with a decrease in binding hormones.
1016
Q0509:What type of estrogen is produced in peripheral tissues from androgens?
1017
Estrone
1018
Q0510:What changes does more negative intrathoracic pressure cause to systemic venous return and to the pulmonary vessels?
1019
Promotes systemic venous return into the chest and increases the caliber and volume of the pulmonary vessels
1020
Q0511:Where is renin produced?
1021
In the JG cells of the kidney
1022
Q0512:True or false? Right-sided valves close before the valves on the left side of the heart.
1023
False. Right-sided valves are the first to open and last to close.
1024
Q0513:What enzyme is associated with osteoblastic activity?
1025
Alkaline phosphatase
1026
Q0514:What is the order of attachment of O2 to Hgb-binding sites in the lung? Order of release from the binding sites in the tissue?
1027
Order of attachment is site 1; 2; 3; 4; and for release is 4; 3; 2; 1.
1028
Q0515:What hormone is secreted into the plasma in response to a meal rich in protein or CHO?
1029
Insulin
1030
Q0516:What happens to blood flow and pressure downstream with local arteriolar constriction?
1031
With arteriolar constriction both the flow and pressure downstream decrease.
1032
Q0517:What occurs when the lower esophageal sphincter fails to relax during swallowing due to abnormalities of the enteric nervous plexus?
1033
Achalasia
1034
Q0518:True or false? Ungated channels are always open.
1035
True. They have no gates; so by definition they are always open.
1036
Q0519:What component of the ANS is responsible for dilation of the blood vessels in the erectile tissue of the penis; resulting in an erection?
1037
Parasympathetics (parasympathetics point; sympathetics shoot)
1038
Q0520:What muscle type is characterized by low ATPase activity; aerobic metabolism; myoglobin; association with endurance; and small muscle mass?
1039
Red muscle
1040
Q0521:What happens to diastolic and systolic intervals with an increase in sympathetic activity?
1041
Systolic interval decreases secondary to increased contractility; diastolic interval decreases secondary to an increase in heart rate.
1042
Q0522:Circulating levels of what hormone in men is responsible for the negative feedback loop to the hypothalamus and the anterior pituitary gland regulating the release of LH?
1043
Testosterone
1044
Q0523:How are pulse pressure and compliance related?
1045
They are inversely proportional to each other; as pulse pressure increases; compliance decreases.
1046
Q0524:What three substances stimulate parietal cells?
1047
ACh; histamine; and gastrin
1048
Q0525:What two factors result in the base of the lung being hyperperfused?
1049
Increased pulmonary arterial pressure (high perfusion) and more distensible vessels (low resistance) result in increased blood flow at the base.
1050
Q0526:True or false? Without ADH the collecting duct would be impermeable to water.
1051
True. Without ADH hypotonic urine would be formed.
1052
Q0527:How does ventricular depolarization take place; base to apex or vice versa?
1053
Depolarization is from apex to base and from endocardium to epicardium.
1054
Q0528:What are effects of PTH in the kidney?
1055
PTH increases Ca2+ reabsorption in the DCT of the kidney and decreases PO4- reabsorption in the PCT.
1056
Q0529:Regarding muscle mechanics; how is passive tension produced?
1057
It is produced by the preload on the muscle prior to contraction.
1058
Q0530:Insulin-induced hypoglycemia is the most reliable (by far not the safest) test for what hormone deficiency?
1059
GH deficiency
1060
Q0531:In regards to solute concentration; how does water flow?
1061
Water flows from a low-solute to high-solute concentrations.
1062
Q0532:Which extravascular chemoreceptor detects low NaCl concentrations?
1063
Macula densa
1064
Q0533:If the AV difference is positive; is the substance extracted or produced by the organ?
1065
A positive AV difference indicates that a substance is extracted by the organ; and a negative difference indicates that it is produced by the organ.
1066
Q0534:What is used as an index of the number of functioning carriers for a substance in active reabsorption in the kidney?
1067
Transport maximum (Tm) occurs when all function carriers are saturated and therefore is an index of the number of functioning carriers.
1068
Q0535:Why is there a transcellular shift in K+ levels in a diabetic patient who becomes acidotic?
1069
The increased H+ moves intracellularly and is buffered by K+ leaving the cells; resulting in intracellular depletion and serum excess. (Intracellular hypokalemia is the reason you supplement potassium in diabetic ketoacidosis; even though the serum levels are elevated.)
1070
Q0536:True or false? Catechol-O-methyl transferase (COMT) is not found in smooth muscle; liver; and the kidneys.
1071
False. That is precisely where COMT is found; it is not found in adrenergic nerve terminals.
1072
Q0537:What somatomedin serves as a 24-hour marker of GH secretion?
1073
IGF-1 (somatomedin C)
1074
Q0538:What receptor is in the smooth muscle cells of the small bronchi; is stimulated during inflation; and inhibits inspiration?
1075
Stretch receptors prevent overdistension of the lungs during inspiration.
1076
Q0539:True or false? Thyroid hormones are necessary for normal menstrual cycles.
1077
True. They are also necessary for normal brain maturation.
1078
Q0540:What component of the cardiovascular system has the largest blood volume? Second largest blood volume?
1079
The systemic veins have the largest blood volume; and the pulmonary veins have the second largest blood volume in the cardiovascular system. They represent the reservoirs of circulation.
1080
Q0541:Serum concentration of what substance is used as a clinical measure of a patient's GFR?
1081
Creatinine
1082
Q0542:Where does CHO digestion begin?
1083
In the mouth with salivary alpha-amylase (ptyalin)
1084
Q0543:How does the sympathetic nervous system affect insulin secretion?
1085
It decreases insulin secretion.
1086
Q0544:How does cell diameter affect the conduction velocity of an action potential?
1087
The greater the cell diameter; the greater the conduction velocity.
1088
Q0545:in a ventricular pacemaker cell; what phase of the action potential is effected by NE
1089
phase 4
1090
Q0546:anatomical and alveolar dead spaces together constitute...
1091
physiologic dead space;= total dead space of resp system
1092
Q0547:what three organs are necessary for the production of vitamin D3 (cholecalciferol)
1093
skin;liver;kidney
1094
Q0548:what is the effect of LH on the production of adrenal androgens
1095
no effect;ACTH stimulates adrenal androgen production
1096
Q0549:what four conditions result in secondary hyperaldosteronism
1097
CHF;vena calval obstruction;hepatic cirrhosis;renal artery stenosis
1098
Q0550:what are the five hormones made by sertoli cells
1099
inhibin;estradiol;androgen-binding protein;meiosis inhibiting factor ;antimullerian hormone
1100
Q0551:does the left or right vagus innervate the SA node
1101
Right vagus innervates SA node (*need the right nerve to control the important node*);Left vagus innervates AV node
1102
Q0552:how does ventricular repolarization take place; base to apex or vice versa
1103
base to apex ;and;epicardium to endocardium
1104
Q0553:what is the term for any region of the respiratory system that is incapable of gas exchange
1105
anatomical dead space (ends at terminal bronchioles)
1106
Q0554:what four factors shift the Hgb-O2 curve to the right?
1107
inc CO2;inc H;inc temp;inc 2;3-BPG;FACILITATE OFFLOADING O2
1108
Q0555:what two factors result in the apex of the lung being hypoperfused
1109
decreased pulmonary arterial pressure and less distensable vessels
1110
Q0556:what is the ratio of pulmonary to systemic blood flow
1111
1:01
1112
Q0557:to differentiate central from nephrogenic diabetes insipidus; after an injection of ADH; which will show decreased urine flow
1113
central
1114
Q0558:in what area of the GI tract are water-soluble vitamins absorbed
1115
duodenum
1116
Q0559:what wave is the cause of the following venous pulse deflection: rise in right atrial pressure secondary to blood filling and terminating when the tricuspid valve opens?;the bulging of the tricuspid valve into the right atrium?;the contraction of the right atrium?
1117
v wave;C wave;A wave
1118
Q0560:what are the four functions of saliva
1119
antibacterial;lubricate;CHO digestion;fat digestion
1120
Q0561:supine to standing..;dependent venous press?;dep venous blood volume?;CO?;BP?
1121
inc;inc;dec;dec;**carotid sinus reflex attempts to COMPENSATE by increasing TPR and heart rate
1122
Q0562:when does the hydrostatic pressure in Bowman's capsule play a role in opposing filtration
1123
when there is an obstruction downstream
1124
Q0563:what happens to intrapleural pressure when the diaphragm is contracted during inspiration
1125
intrapleural pressure decreases
1126
Q0564:what is used as an index of cortisol secretion
1127
urinary 17-OH steroids
1128
Q0565:what is used as an index of cortisol secretion
1129
urinary 17-OH steroids
1130
Q0566:if the pH is low with increased CO2 levels and decreased HCO3 levels; what is the acid-base disturbance
1131
combined respiratory acidosis and metabolic acidosis
1132
Q0567:what is the term that refers to the number of channels open in a cell membrane
1133
conductance
1134
Q0568:what are the five tissues in which glucose uptake is insulin dependent
1135
CNS;renal tubules;beta islet cells;RBCs;GI mucosa
1136
Q0569:place in order from fastest to slowest the rate of gastric emptying for CHO; fat; liquids; proteins
1137
liquids;CHO;protein;fat
1138
Q0570:is most of the coronary artery blood flow during systole or diastole
1139
diastole
1140
Q0571:what modified smooth muscle cell of the kidney monitors BP in the afferent arteriole
1141
juxtaglomerular cells
1142
Q0572:what are the three functions of surfactant
1143
decrease surface tension;increase compliance;decrease probability of pulmonary edema formation
1144
Q0573:glycogenolytic;gluoneogenic;lipolytic;glycolytic;and stimulated by hypoglycemia
1145
epi
1146
Q0574:glycogenolytic;gluconeogenic;lipolytic;glycolytic;prote olytic;and stimulated by hypoglycemia and aa
1147
glucagon
1148
Q0575:glycogenic;gluconeogenic;lipogenic;proteogenic;glycoly tic;and stimulated hy hyperglycemia; aa's; fatty acids; ketosis; ACh; GH; and beta agonists
1149
insulin
1150
Q0576:what type of muscle is characterized by no myoglobin; anaerobic glycolysis; high ATPase activity; and large muscle mass
1151
white muscle; short term too
1152
Q0577:what percentage of CO2 is carried in the plasma as HCO3?;as carbamino compounds?;as dissolved CO2?
1153
90%;5%;5%
1154
Q0578:what is the most potent male sex hormone
1155
dihydrotestosterone
1156
Q0579:with a decreased arterial diastolic pressure; what happens to stroke volume?;TPR?;heart rate?
1157
all decrease
1158
Q0580:what linkage of complex CHOs does pancreatic amylase hydrolyze? What three complexes are formed?
1159
alpha-1;4-glucoside linkages; forming alpha-limit dextrins; maltotriose; and maltose
1160
Q0581:does the heart rate determine the diastolic or systolic interval
1161
diastolic;contractility determines systolic interval
1162
Q0582:on a graphical representation of filtration; reabsorption; and excretion; when does glucose first appear in urine
1163
at the beginning of splay (about 250)
1164
Q0583:what is the relationship between preload and passive tension in a muscle
1165
direct;the greater the preload; the greater the passive tension and the greater the prestretch of a sarcomere
1166
Q0584:what is the rate-limiting step in the synthetic pathway of NE at the adrenergic nerve terminal
1167
conversion of tyrosine to dopamine by tyrosine hydroxylase
1168
Q0585:how many days prior to ovulation does LH surge occur
1169
1 day prior
1170
Q0586:how are flow through the loop of Henle and concentration of urine related
1171
as flow increases; the urine becomes more dilute because of decreased time for H2O reabsorption
1172
Q0587:what is the PO2 of aortic blood in fetal circulation
1173
60%
1174
Q0588:how do elevated blood glucose levels decrease GH secretion
1175
somatotrophins are stimulated by IGF-1 and they inhibit GH secretion;GHRH stimulates GH secretion
1176
Q0589:what segment of the nephron has the highest concentration of inulin?;lowest conc?
1177
terminal collecting duct has highest concentration;Bowman's capsule has lowest?
1178
Q0590:what type of resistance system; high or low; is formed when resistors are added in series
1179
high
1180
Q0591:what hormones; secreted in proportion to the size of the placenta; are an index of fetal well being
1181
hCS and serum estriol; which are produced by the fetal liver and placenta; respectively; are used as estimates of FETAL well being
1182
Q0592:what primary acid-base disturbance is caused by an increase in alveoloar ventilation (decreasing CO2 levels) resulting in the reaction shifting to the left and decreasing both the H and HCO3 levels
1183
respiratory alkalosis;(low CO2;low H;slightly low HCO3)
1184
Q0593:what respiratory center in the caudal pons is the center for rhythm promoting prolonged inspirations
1185
apneustic center (deep breathing place)
1186
Q0594:what area of the GI tract has the highest activity of brush border enzymes
1187
jejunum
1188
Q0595:does T3 or T4 have greater affinity for nuclear receptors
1189
T3
1190
Q0596:what is the only signal regulating release of PTH
1191
low interstitial free Ca
1192
Q0597:1. PTH dec; Ca inc; Pi inc;2. PTH inc; Ca dec; Pi dec;3. PTH dec; Ca dec; Pi inc;4. PTH inc; Ca inc; Pi dec
1193
1. secondary hypo;2. secondary hyper;3. primary hypo;4. primary hyper
1194
Q0598:1. TRH dec; TSH dec; T4 inc;2. TRH inc; TSH dec; T4 dec;3. TRH dec; TSH dec; T4 dec;4. TRH inc; TSH inc; T4 dec;5. TRH dec; TSH inc; T4 inc
1195
1. graves;2. secondary hypo (pituitary);3. tertiary hypo (hypothalamic);4. primary hypo;5. secondary hyper
1196
Q0599:what two stress hormones are under the permissive action of cortisol
1197
glucagon and epi
1198
Q0600:if radius of a vessle doubles; what happens to resistance
1199
dec 1/16
1200
Q0601:what preventgs the down regulation of the recptors on the gonadotrophos of the anterior pituitary
1201
pulatile release of GnRH
1202
Q0602:does epi have proteolytic action
1203
no- only glycogenolytic and lipolytic
1204
Q0603:what is the only 17-hydroxysteroid with hormonal activity
1205
cortisol
1206
Q0604:does the oncotic pressure of plasma promote filtration or reabsorption
1207
reabsorption
1208
Q0605:why is the baes of the lung hyperventialted when a person is standing upright
1209
alveoli are small and very compliant; so there is a large change in their size and volume and therefore a high level of alveolar ventilation
1210
Q0606:by removing Na from the renal tubule and pumping it back into the ECF compartment; what does aldosterone do to the body's acid base stores
1211
removal of Na creates a net negative charge in the renal tubule -> promotes entry of K and H and promotes HCO3 to go to plasma -> produces hypokalemic alkalosis
1212
Q0607:what hormone causes contraction of smooth mucle; regulates interdigestive motility; and prepares intestine for next meal
1213
motilin
1214
Q0608:what two vessels in fetal circulatin have the highest PO2 levles
1215
umbilical vein and ductus venosus
1216
Q0609:how many days prior to ovulation does estradiol peak in the menstrual cycle
1217
2 days prior
1218
Q0610:what serves as a marker of endogenous insulin secretion
1219
C-peptide
1220
Q0611:what is the term for the total volume of air moved in and out of the respiratry system per minute
1221
total ventilation;= minute ventilation;= minute volume
1222
Q0612:what is the renal compensation mechanism for alkalosis
1223
increase urinary excretion of HCO3;shifts reaction to right and increasing H
1224
Q0613:what is a sign of a sertoli cell tumor in a man
1225
excess estradiol in blood
1226
Q0614:in the systemic circulation; what blood vessels have the largest pressure drop?;smallest pressure drop?
1227
arterioles;vena cava
1228
Q0615:what is the major stimulus for cell division in chondroblasts
1229
IGF-1
1230
Q0616:what are two causes of diffusion impairment in the lungs
1231
decrease in surface area and increase in membrane thickness
1232
Q0617:what are four effects of suckling on the mother
1233
increased synthesis and secretion of oxytocin;increased release of PIF from hypothalamus;inhibition of GnRH;milk secretion
1234
Q0618:a MMC is a propulsive mov't of undigested material from the stomach to the small intestine; to the colon. during a fast; what is the time interval of its repeats
1235
90 to 120 minutes;correlates with levels of motilin
1236
Q0619:increasing arterial systolic pressure..;stroke volume?;vessel compliance?;heart rate?
1237
inc;dec;dec
1238
Q0620:what enzyme is needed to activate trypsinogen to trypsin?;chymotrypsinogen to chymotrypsin?;procarboxypeptidase to carboxypeptidase?
1239
enterokinase;trypsin;trypsin
1240
Q0621:in a ventricular pacemaker cell; what phase of the action potential is affected by ACh
1241
phase 4
1242
Q0622:what is the most potent stimulus for glucagon secretion? inhibition?
1243
hypoglycemia -> secretion;hyperglycemia -> inhibition
1244
Q0623:what is the term for the summation of mechanical stimuli due to the skeletal muscle contractile unit becoming saturated with calcium
1245
tetany
1246
Q0624:what form of renal tubular reabsorption is characterized by low back leaks; high affinity of a substance; and easy saturation? It is surmised that the entire filtered load is reabsorbed until the carriers are saturated; and then the rest is excreted
1247
a transport maxium (Tm) system
1248
Q0625:in an adrenergic nerve terminal; where is DA converted to Nepi?
1249
in the vesicle by dopamine-beta-hydroxylase
1250
Q0626:is the clearance for a substance greater than or less than for inulin if it is freely filtered and secreted? if it is freely filtered and reabsorbed?
1251
greater (ex PAH);less (ex glucose)
1252
Q0627:what is the term for the load on a muscle in the relaxed state
1253
preload is load Prior to contraction
1254
Q0628:what are the two best indices of left ventricular preload
1255
LVEDV and LVEDP
1256
Q0629:in males..;1. LH pulsatile amplitude and levels increase; with increased testosterone?;2. both LH and testosterone levels drop and remain low?;3. LH secretion drives testosterone production; with both paralleling eachother?;4. decreased testosterone and increased LH?
1257
1. puberty;2. childhood;3. adulthood;4. aged adult
1258
Q0630:why is the clearance of creatinine always slightly greater than the clearance of inulin and GFR?
1259
because creatinine is freely filtered and slightly secreted
1260
Q0631:what primary acid-base disturbace is caused by a loss in fixed acid forcing the reaction to shift to the left; thereby increasing HCO3 levels
1261
metabolic alkalosis;(high PH; low H; high HCO3)
1262
Q0632:when referring to a series circuit; what happens to resistance when a resistor is added
1263
increases
1264
Q0633:why is there an increase in prolactin if the hypothalamic pituitary axis is severed
1265
the chronic inhibition of dopamine (PIF) on the release of prolactin from the anterior pituitary gland is removed; thereby increasing the release of prolactin
1266
Q0634:what acid form of H in the urine cannot be titrated
1267
NH4
1268
Q0635:regarding the venous system; what happens to blood volume if there is a small change in pressure
1269
venous system is more compliant -> small changes in pressure result in large changes in blood volume
1270
Q0636:in what stage of sleep is GH secreted
1271
3 and 4
1272
Q0637:where does the conversion of CO2 into HCO3 take place
1273
RBC
1274
Q0638:from the fourth month of fetal life to term; what secretes the progesterone and estrogen to maintain the uterus
1275
placenta
1276
Q0639:what two factors are required for exocytosis
1277
Ca and ATP
1278
Q0640:what is the best measure of total body vitamin D if you suspect a deficiency
1279
serum 25-OH-D
1280
Q0641:what hormone is required for 1;25-dihydroxy-D to have bone resorbing effects
1281
PTH
1282
Q0642:is bone deposition or resorption due to increased interstitial Ca concentration
1283
deposition
1284
Q0643:the opening of what valve indicates the terminatino of isovolumetric relaxation of the cardiac cycle
1285
mitral valve
1286
Q0644:why is there a decrease in the production in epi when the anterior pituitary gland is removed
1287
PNMT used in the conversion of epi; is regulated by cortisol; removing the anterior pituitary gland decreases ACTH and therefor cortisol
1288
Q0645:name the period described by the following: no matter how strong a stimulus; no further action potentials can be stimulated
1289
absolute refractory period (voltage inactivation of Na channels)
1290
Q0646:how many carbons do estrogens have
1291
18;(remove one C from an androgen makes an estrogen)
1292
Q0647:T or F? the alveolar PO2 and PCO2 levels match the pumonary end capillary blood levels
1293
true- because of intrapulmonary shunting; there is a slight decrease in PO2 and increase in PCO2 between the pulmonary end capillary blood and the systemic arterial blood
1294
Q0648:in high altitudes; what is the main drive for ventilation
1295
shifts from central chemoreceptors (CSF H) to periopheral chemoreceptors monitoring O2
1296
Q0649:1. ECF dec; ICF no change; body no change;2. ECF inc; ICF inc; body dec;3. ECF dec; ICF dec; body inc;4. ECF inc; ICF no change; body no change;5. ECF inc; ICF dec; body inc
1297
1. loss of isotonic fluid (diarrhea; hemorrhage);2. gain of hypotonic fluid (water intoxication);3. loss of hypotonic fluid (dehydration);4. gain of isotonic saline;5. gain of hypertonic fluid
1298
Q0650:what hormone excess produces adrenal hyperplasia
1299
ACTH
1300
Q0651:is there more circulating T3 or T4
1301
T4- because the greater affinity for the binding protein; T4 has a significantly longer half life than T3 (50x)
1302
Q0652:why is the cells resting membrane potential negative
1303
intracellular proteins
1304
Q0653:is thyroid size a measure of its function
1305
no!;TSH is a measure of its function
1306
Q0654:if the radius of a vessel is decreased by half; what happens to resistance
1307
increased 16x
1308
Q0655:what neurotransmitter is essential for maintaining a normal BP when an individual is standing
1309
NE
1310
Q0656:what form of diabetes insipidus is due to an insufficient amount of ADH
1311
central/neurogenic
1312
Q0657:three methods of vasodilation via the sympathetic nervous system
1313
decreased alpha 1;increased beta 2;increased ACh
1314
Q0658:1. Ca reabsorption and phosphate excretion;2. Ca excretion and phosphate excretion;3. Ca reabsortpion and phosphate reabsorption
1315
1. PTH;2. calcitriol;3. vitamin D3
1316
Q0659:does progesterone have thermogenic activities
1317
yes
1318
Q0660:how long is the transit time through the small intestine
1319
2-4 hours
1320
Q0661:where is the last conducting zone of the lungs
1321
terminal bronchioles (no gas exchange)
1322
Q0662:does cortisol inhibit glucose uptake in skeletal muscle
1323
yes- makes it available for neural tissue
1324
Q0663:what percentage of cardiac output flows through the pulmonary circuit
1325
100%
1326
Q0664:HGb binding site?;1. least affinity for O2; requires highest PO2 (100);2. greatest affinity for attachment; requires PO2 of 26;3. remains attached under most conditions;4. requires a PO2 of 40
1327
1. site 4;2. site 2;3. site 1;4. site 3
1328
Q0665:which three factors cause the release of epi from adrenal medulla
1329
1. exercise;2. emergencies;3. exposure to cold
1330
Q0666:how many ATPs are hydrolyzed every time a skeletal muscle cross-bridge completes a single cycle
1331
one
1332
Q0667:why would a puncture to a vein above the heart have the potential to introduce air into the vascular system
1333
venous pressure above the heart is subatmospheric
1334
Q0668:what type of saliva is produced under parasympathetic stimulation
1335
high volume;watery
1336
Q0669:in what area of the gI tract does iron get absorbed
1337
duodenum
1338
Q0670:why is the apex of the lung hypoventilaged when a person is standing
1339
alveli at apex are almost completely inflated prior to inflation -> they receive low levels of alveolar ventilation
1340
Q0671:what pancreatic islet cell secretes glucagon
1341
alpha;glucagon has stimulatory affects on beta cells and inhibitory effects on delta cells
1342
Q0672:what are the four characteristics of protein mediated transport
1343
1. comp for carrier;2. chemic specificity;3. zero-order saturation;4. rate of transportation faster than if by simple diffusion
1344
Q0673:what is secretin's pancreatic action
1345
stimulates HCO3 rich solution release
1346
Q0674:why is there an increase in FF if the GFR is decreased under sympathetic stimulation
1347
because RPF is markedly decreased; while GFR is only; minimally dec --> inc FF (=GFR/RPF)
1348
Q0675:what triggers phase 3 of action potential in ventricular pace maker cell
1349
efflux of potassium
1350
Q0676:what is the primary target for glucagon
1351
liver
1352
Q0677:what is the renal compensation for acidosis
1353
makes HCO3; shifting reaction to left and decreasing H
1354
Q0678:what enzyme found in a cholinergic synapse breaks down ACh?
1355
acetylcholinesterase;-> acetate and choline
1356
Q0679:what hormone; produced by sertoli cells; if absent would result in the formation of internal female structures
1357
MIF
1358
Q0680:what happens to the lung if the intrapleural pressure exceeds lung recoil
1359
lung will expand
1360
Q0681:what two factors determine the clearance of a substance
1361
plasma concentration and excretio rate;= U/V
1362
Q0682:what type of muscle contraction occurs when the msucle shortens and lifts the load placed on it
1363
isotonic
1364
Q0683:what type of potential is characterized as being an all or none; propagated and not summated
1365
action potential
1366
Q0684:what primary acid-base disturbace is cuased by a gain in fixed acid forcing the reaction to shift to the left; decreasing HCO3 and inc CO2
1367
metabolic acidosis (low pH; high H; low HCO3)
1368
Q0685:pregnant woman in 3rd trimester has normal BP when standing and sitting. When supine BP drops to 90/50;what is the dx?
1369
compression of the IVC
1370
Q0686:35 y/o man has high BP in arms and lowBP in his legs;what is the dx
1371
coarction of teh aorta
1372
Q0687:5 y/o boy presents weith a systolic murmur and a wide fixed split S2. what is the dx
1373
ASD
1374
Q0688:During a game a young football player collapses and dies immediately. What is the most likely type of cardiac dz
1375
hypoertrophic cardiomyopathy
1376
Q0689:pt has a stroke after incurring multiple long bone fractures in trauma stemming from a MVA. What caused the infarct
1377
fat emboli
1378
Q0690:elderly woman presents with a headache and jaw pain. labs show elevated ESR. what is teh dx
1379
temporal arteritis
1380
Q0691:80 y/o man presents w/ systolic crescendodecrescendo murmur. What is the most likely cause?
1381
aortic stenosis
1382
Q0692:Man starts a medication for hyperlipidemia. He then develops a rash; pruritis; and GI upset. What drug was it
1383
Niacin
1384
Q0693:Pt developes a cough and must discontinue captopril. What is a good replacement drug and why doesn't it have the same side effects?
1385
losartan; an angiotensin II receptor antagonist; does not increase bradykinin as captopril does.
1386
Q0694:What are the 3 sx inside the carotid sheath
1387
1) Internal jugular Vein (lateral);2) Common carotid Artery (medial);3) Vagus Nerve (posterior);mneu: VAN
1388
Q0695:In the majority of cases; the SA and AV nodes are supplied by this carotid artery?
1389
Right coronary artery
1390
Q0696:80% of the time the Right coronary artery is "dominant"; suppplying the left ventricle via the _________ branch
1391
Posterior descending artery
1392
Q0697:cardiac output =
1393
SVxHR
1394
Q0698:During exercise; CO increased as a result of an increased in _____. After prolonged exercise; CO increased as a result of an increased in ____
1395
SV;HR
1396
Q0699:cardiac output =
1397
SVxHR
1398
Q0700:During exercise; CO increased initially as a result of an increased in ____. After prolonged exercise; CO increased as a result of an increased in ____.
1399
SV;HR
1400
Q0701:Mean argerial Pressure (MAP)=;give 2 equasions;1) CO; TPR;2) systolic; diastolic
1401
1) CO x TPR;2)1/3 systolic +2/3 diastolic
1402
Q0702:CO=;rate of O2 consumption; aa O2 content; vv O2 content
1403
rate of O2 consumption / (aa O2 content-vv O2 content)
1404
Q0703:Pulse pressure =;systolic; diastolic
1405
systolic-diastolic
1406
Q0704:pulse pressure
1407
stroke volume
1408
Q0705:SV=;(2 equasions);1) CO; HR;2)EDV;ESV
1409
1)=CO/HR;2)=EDV-ESV
1410
Q0706:Coronary Artery Anatomy [pic]
1411
1)Right Coronary aa (RCA);2)Left main coronary aa (LCA);3)Circumflex artery (CFX);4) Left anterior descending aa (LAD;5) Posterior descending aa (PD);6) Acute marginal aa
1412
Q0707:Stroke volume is affected by what 3 things ;mneu: SV CAP
1413
Contractility; Afterload; and Preload;mneu: SV CAP
1414
Q0708:increased Preload __SV
1415
increased
1416
Q0709:increased Afterload __SV
1417
decreased
1418
Q0710:increased contractility __SV
1419
increased
1420
Q0711:SV ___ in anxiety; exercise; & pregnancy
1421
increased
1422
Q0712:a failing heart has a ___ SV
1423
decreased
1424
Q0713:Contractality (and SV); ____ with catecholemines
1425
increased
1426
Q0714:Contractality (and SV); ____ with increased intracellular Ca++
1427
increased
1428
Q0715:Contractality (and SV); ____ with decreased extracellular sodium
1429
increased
1430
Q0716:Contractality (and SV); ____ with digitalis
1431
increased
1432
Q0717:Contractality (and SV); ____ with beta1 blockade
1433
decreased
1434
Q0718:Contractality (and SV); ____ with heart failure
1435
decreased
1436
Q0719:Contractality (and SV); ____ with acidosis
1437
decreased
1438
Q0720:Contractality (and SV); ____ with hypoxia/hypercapnea
1439
decreased
1440
Q0721:Contractality (and SV); ____ with Ca++ channel blockers
1441
decreased
1442
Q0722:Myocardial demand is ___ by increased afterload (diastolic BP)
1443
increased
1444
Q0723:Myocardial demand is ___ by increased contractility
1445
increased
1446
Q0724:Myocardial demand is ___ by increased heart rate
1447
increased
1448
Q0725:Myocardial demand is ___ by increased heart size
1449
increased
1450
Q0726:ventricular EDV
1451
Preload
1452
Q0727:Systolic arterial pressure
1453
afterload
1454
Q0728:proportional to peripheral resistance
1455
afterload
1456
Q0729:venous dialators (e.g. nitroglycerine) decreased _______;(preload or afterload)
1457
preload
1458
Q0730:vaso dialators (e.g. hydralazine) decreased _______;(preload or afterload)
1459
afterload
1460
Q0731:______ increased w/ exercise; increased blood volume; exitement (sympathetics);(preload or afterload)
1461
Preload
1462
Q0732:Starling Curve: Force of _______ is proportional to initial length of cardiac mm fiber (preload)
1463
contraction
1464
Q0733:contraction state of the myocardium is ____ by circulating catecholamines;(+;-)
1465
1466
Q0734:contraction state of the myocardium is ____ by digitalis;(+;-)
1467
1468
Q0735:contraction state of the myocardium is ____ by sympathetic stimulation;(+;-)
1469
1470
Q0736:contraction state of the myocardium is ____ by pharmacologic depressants;(+;-)
1471
1472
Q0737:contraction state of the myocardium is ____ by loss of myocardium (MI);(+;-)
1473
1474
Q0738:EF=;(give 2 equasions);1) SV; EDV;2) EDV; ESV; EDV
1475
1) SV/EDV;2) EDV-ESV/EDV
1476
Q0739:this is an index of ventricular contractility
1477
EF
1478
Q0740:EF is normally > ___%
1479
55
1480
Q0741:Place condition on the Starling curve [pic p.219]
1481
1)exercise;2)CHF + digitalis;3)CHF
1482
Q0742:(driving Pressure)P=;Q (flow) ;R (resistance)
1483
QxR
1484
Q0743:Resisitance (R) =;Give 2 equasions;1)P(driving pressure);flow(Q) ;2)n(viscosity); length(l); radius (r)
1485
1)=P/Q;2)8nxl/r(^4)
1486
Q0744:viscosity depends mostly on _______
1487
hematocrit
1488
Q0745:increased ______ in;1) Polycythemia;2) Hyperproteinemic states (e.g; multiple myeloma);3) hereditary spherocytosis
1489
viscosity
1490
Q0746:resistance is ________ to viscosity ;(proportional or inversely proportional)
1491
proportional
1492
Q0747:resistance is ________ to the radius to the 4th power;(proportional or inversely proportional)
1493
inversely proportional
1494
Q0748:cardiac and vascular fx curves [pic p.219]
1495
1) (+) inotropy;2) (-) inotropy;3) (increased ) blood volume;4) (decreased ) blood volume
1496
Q0749:cardiac cycle image [p. 220]
1497
1)isovolumetric contraction;2) aortic valve opens;3) ejection;4) aortic valve closes;5) isovolumetric relaxation;6) mitral valve opens;7)ventricular filling;8) mitral valve closes
1498
Q0750:Name the phase of the cardiac cycle;period between mitral valve closure and aortic valve opening.
1499
isovolumetric contraction
1500
Q0751:Name the phase of the cardiac cycle: period of highest O2 consumption
1501
isovolumetric contraction
1502
Q0752:Name the phase of the cardiac cycle: period between aortic valve opening and closing
1503
systolic ejection
1504
Q0753:Name the phase of the cardiac cycle: period between aortic valve closing and mitral valve opening
1505
isovolumetric relaxation
1506
Q0754:Name the phase of the cardiac cycle: period just after mitral valve opening
1507
rapid filling
1508
Q0755:Name the phase of the cardiac cycle: period just before mitral valve closure
1509
slow filling
1510
Q0756:name the heart sound: mitral and tricuspid valve closure
1511
S1
1512
Q0757:name the heart sound: aortic and pulmonary valve closure
1513
S2
1514
Q0758:name the heart sound: at the end of rapid ventricular filling
1515
S3
1516
Q0759:name the heart sound: high atrial pressure/stiff ventricle
1517
S4
1518
Q0760:this heart sound is associated w/ dilated CHF
1519
S3
1520
Q0761:this heart sound AKA "atrial kick" is associated with a hypertrophic ventricle
1521
S4
1522
Q0762:Jugular venous pulse waves;a wave
1523
Atrial contraction
1524
Q0763:Jugular venous pulse waves: c wave
1525
RV Contraction (tricuspid valve bulging into atrium)
1526
Q0764:Jugular venous pulse waves: v wave
1527
increaseed atrial pressure due to filling against closed tricuspid Valve
1528
Q0765:jugular venous distention is seen in ___________
1529
right heart failure
1530
Q0766:when the aortic valve closes before the pulmonic this heart sound abnormality results
1531
S2 splitting
1532
Q0767:S2 splitting is increased upon ________
1533
inspiration
1534
Q0768:Paradoxical splitting (S2 split increasd upon expiration is associated with what?
1535
aortic stenosis
1536
Q0769:pressure volume relationship [pic p. 221]
1537
--
1538
Q0770:cardiac mm contraction is dependent on extracellular ________; which enters the cells during plateau of action potential and stimulates ______ release from the cardiac mm sarcoplasm reticulum.
1539
calcium;calcium;calcium induced calcium release
1540
Q0771:In contrast to skeletal mm; cardiac mm action potential has a plateau; which is due to ____ influx.
1541
Ca+
1542
Q0772:In contrast to skeletal mm; cardiac nodal cells ________ depolarize; resulting in automaticity
1543
spontaneously
1544
Q0773:In contrast to skeletal mm; cardiac myocytes are electrically coupled to each other by ________
1545
gap junctions
1546
Q0774:myocardial action potential occurs in atrial and ventricular myocytes and ________
1547
perkinje fibers
1548
Q0775:In a myocardial action potential; this phase is the rapid upstroke; when voltage gated Na+ channels open
1549
phase 0
1550
Q0776:In a myocardial action potential; this phase is the initial repolarization-inactivation of voltage0gated Na+ channels. Voltage gated K+ channels begin to open
1551
Phase 1
1552
Q0777:In a myocardial action potential; this phase is the plateu--Ca++ influx through voltage-gated Ca++ channels balances K+ efflux. Ca++ influx triggers another Ca++ release from sarcoplasmic reticulum and myocyte contraction.
1553
phase 2
1554
Q0778:In a myocardial action potential; this phase is the rapid repolarization--massive K+ efflux due to opening of voltage-gated slow K_ channels and closure of voltage gated Ca++ channels.
1555
Phase 3
1556
Q0779:In a myocardial action potential; this phase is the resting potential--high K+ permeability through K+ channels.
1557
phase 4
1558
Q0780:Pacemaker action potentials occur where
1559
SA & AV nodes
1560
Q0781:In a pacemaker action potential this phase is the upstroke phase--it involves opening of voltage-gated Ca++ channels. These cells lack fast voltage-gated Na+ channels. Results in a slow conduction velocity that is used by the AV node to prolong transmission from the atria to ventricles.
1561
phase 0
1562
Q0782:In a pacemaker action potential this phase; the plateau is absent.
1563
phase 2
1564
Q0783:In a pacemaker action potential this phase; the slow diastolic depololarization results in membrane potential spontaneously depolarizing as Na+ conductance increases. This accounts for automaticity of SA and AV nodes. The slope of this phase in the SA node determines the heart rate. ACh decreases and catecholamines increasee the rate of diastolic depolarization decreasing or increasing heart rate respectively.
1565
phase 4
1566
Q0784:electrocardiogram: atrial depolarization
1567
P wave
1568
Q0785:electrocardiogram: conduction delay through AV node (normally <200 msec)
1569
PR segment
1570
Q0786:electrocardiogram: vetricular depolarization (normally < 120 msec)
1571
QRS complex
1572
Q0787:electrocardiogram: mechanical contraction of the ventricles
1573
QT interval
1574
Q0788:electrocardiogram: ventricular repolarization
1575
T wave
1576
Q0789:electrocardiogram;atrial repolarization is masked by _______
1577
QRS complex
1578
Q0790:electrocardiogram: isoelectric; ventricles depolarized
1579
ST segment
1580
Q0791:electrocardiogram: These waves caused by hypokalemia
1581
U wave
1582
Q0792:this syndrome is caused by an accessory conduction pathway from atria to vetricle (bundle of kent); bypassing AV node. As a result; ventricles begin to partially depolarize earlier; giving rise to characteristic delta wave on ECG. May result in reentry current leading to supraventricular tachycardia [image p.223]
1583
Wolff-Parkinson-White syndrome
1584
Q0793:This ECG tracing has a chaotic and erratic baseline (irregularly irregular) with no discrete P waves in between irregularly spaced QRS complexes (pic. p 224)
1585
Atrial fibrillation
1586
Q0794:This ECG tracing has a rapid succession of identical; back to back atrial depolarization waves. The identical appearance accounts for the "sawtooth" appearance of the flutter waves. (pic. p 224)
1587
Atrial flutter
1588
Q0795:In this condition PR interval is prolonged (>200 msec). Asymptomatic;(pic. p 224)
1589
1st degree AV block.
1590
Q0796:Progressive lenthening of the PR interval until a beat is "dropped" (a P wave not followed by a QRS complex). Usually asymptomatic. (pic. p 224)
1591
2nd degree AV block;Mobitz type I (Wenckebach)
1592
Q0797:On ECG shows dropped beats that are not preceded by a change in the length of the PR interval. These abrupt; nonconducted P waves result in a pathologic condition. It is often found as a 2:1 block; where there are 2 P waves to 1 QRS response. May progress to 3rd degree block.(pic. p 225)
1593
Mobitz type II AV block
1594
Q0798:In this condition; the atria and ventricles beat independently of each other. Both P waves and QRS complexes are present; although the P waves bear no relation to the QRS complexes. The atrial rate is faster than the ventricular rate. Usually treat with pacemaker.
1595
3rd degree AV block (complete)
1596
Q0799:completely erratic rhythm with no identifiable waves. Fatal arrhythmia without immediate CPR and defibrillation. (pic. p 225)
1597
Ventricular Fibrillation
1598
Q0800:________receptor transmits via vagus nn to medulla (responds only to increase blood pressure)
1599
aortic arch receptor
1600
Q0801:________ receptor transmits via glossopharyngeal nn to medulla
1601
carotid sinus
1602
Q0802:decreased firing by aroreceptors during hypotension results in an increase in efferent ________ firing
1603
sympathetic
1604
Q0803:In a carotid massage; the increased pressure on carotid aa results in increased stretch and ____ in heart rate
1605
decrease
1606
Q0804:Peripheral chemoreceptors in the carotid and aortic bodies respond to (3 things)
1607
decreased PO2 (<60mmHg); increased PCO2 and decreased pH of blood
1608
Q0805:Central chemoreceptors respond to what changes (2)
1609
changes in pH and Pco2 (not Po2)
1610
Q0806:This chemoreceptor is responsible for Cushing reaction; response to cerebral ischemia; response to increase intracranial pressure leads to hypertension (sympathetic response) and bradycardia (parasympathetic response)
1611
Central chemoreceptor
1612
Q0807:This orgen gets the largest share of systemic cardiac output
1613
liver
1614
Q0808:this organ gets the highest blood flow per gram of tissue
1615
kidney
1616
Q0809:this orgen has a large arteriovenous O2 differnece. Increased O2 demand is met by increased coronary blood flow; not by increased extraction of O2.
1617
heart
1618
Q0810:this is a good approximation of L atrial pressure and measured with a Swan-Ganz catheter
1619
Pulmonary capillary wedge pressure
1620
Q0811:blood flow is altered to meet demands of tissue
1621
autoregulation
1622
Q0812:Name the organ regulated by the local metabolites;O2 adenosine; NO
1623
heart
1624
Q0813:Name the organ regulated by the local metabolites;CO2 (pH)
1625
brain
1626
Q0814:Name the organ regulated by the local metabolites: Myogenic and tubuloglomerular feedback
1627
kidneys
1628
Q0815:Name the organ regulated by the local metabolites: hypoxia causes vasoconstriction
1629
lungs
1630
Q0816:_______ vasculature is unique in that hypoxia causes vasoconstriction (in other organs hypoxia causes vasodilation)
1631
pulmonary
1632
Q0817:Name the organ regulated by the local metabolites: lactate; adenosine; K+
1633
skeletal mm
1634
Q0818:Name the organ regulated by the local metabolites: sympathetic stimulation most important mechanism--temp control
1635
skin
1636
Q0819:______ forces determine fluid movement by osmosis throug capillary membranes
1637
starling
1638
Q0820:moves fluid out of capillary
1639
P(c) capillary pressure
1640
Q0821:moves fluid into capillary
1641
P(i) interstitial fluid pressue
1642
Q0822:moves fluid into capillary
1643
(c) plasma colloid osmotic pressure
1644
Q0823:moves fluid out of capillary
1645
(i) interstitial fluid colloid osmotic pressure
1646
Q0824:net filtration pressure=Pnet=
1647
[Pc-Pi)-(c-i)];capillary pressure -interstitial pressure ;;plasma colloid osmotic presure - interstitual fluid colloid osmotic pressures
1648
Q0825:Kf=
1649
filtration constant (capillary permeability)
1650
Q0826:excess fluid outflow into interstitium
1651
edema
1652
Q0827:edema is commonly caued by ___ capillary pressure (give example)
1653
increased P(c);Heart failure
1654
Q0828:edema is commonly caued by ___ plasma protiens(give example)
1655
decreased (c) plasma proteins ;(nephrotic syndrome; liver failure)
1656
Q0829:edema is commonly caused by ___ capillary permeability (give example)
1657
increased Kf;infections; burns
1658
Q0830:edema is commonly caued by ___ interstitial fluid colloid osmotic pressure;(give example)
1659
increased i;lymphatic blockage
1660
Q0831:right-to-left shunts (early cyanoisis) "blue babies"
1661
3 Ts;Tetrology;Transposition;Truncus
1662
Q0832:Children with this type of shunt may squat to increase venous return
1663
right to left shunts
1664
Q0833:Right-to Left shunts (early cyanosis) - "blue babies"
1665
1) Tetrology of fallot;2) Transposition of great vessels;3) Truncus arteriosis;The 3 Ts
1666
Q0834:children with this type of shunt may squat to increase venous return.
1667
right to left shunt
1668
Q0835:Left to right shunts (late cyanosis) - "blue kids"
1669
1) VSD;2) ASD;3) PDA
1670
Q0836:this is the most common cause of early cyanosis
1671
tetralogy of fallot
1672
Q0837:this is the most common congenital cardiac anomaly
1673
VSD
1674
Q0838:this congenital heart dz manifests itself with a loud S1 and a wide; fixed split S2
1675
ASD
1676
Q0839:this congenital heart defect is closed with indomethacin
1677
PDA
1678
Q0840:give the frequency of occurance with;PDA;VSD;ASD
1679
VSD>ASD>PDA
1680
Q0841:Uncorrected VSD; ASD or PDA leads to progressive pulmonary hypertension. As pulmonary resistance increases; the shunt reverses from L to R to R to L; which causes late cyanosis (clubbing & polycythemia). [pic p. 228]
1681
eisenmenger's syndrome
1682
Q0842:Tetrology of Fallot [pic. p 228]
1683
1) Pulmonary stenosis ;2)RVH;3) Overiding aorta (overides VSD);4) VSD;mneu: PROVe
1684
Q0843:most important determinant for prognosis of tetrology of fallot
1685
pulmonary stenosis
1686
Q0844:ON x-ray TOF looks ________
1687
boot shaped
1688
Q0845:give the frequency of occurance with;PDA;VSD;ASD
1689
VSD>ASD>PDA
1690
Q0846:Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)leading to separation of systemic and pulmonary circulations.
1691
Transposition of great vessels
1692
Q0847:Transposition is not compatable with life unless a _____is present to allow adequate mixing of blood;[pic p. 229]
1693
shunt (e.g. VSD; PDA or patent foramen ovale)
1694
Q0848:transposition of great vessels is due to failure of the _________ septum to spiral
1695
aorticopulmonary
1696
Q0849:this type of coarction of aorta is aortic stenosis proximal to insertion of ductus arteriosus (preductal)
1697
infantile;INfantile: IN close to the heart
1698
Q0850:this type of coarction of aorta is aortic stenosis is distal to ductus arteriosus (postductal) it is associated with notching of the ribs; hypertension in upper extremities; weak pulses in lower extremities.
1699
adult type;aDult: Distal to Ductus
1700
Q0851:Coarction of aorta has a male: female ratio of ____
1701
3:01
1702
Q0852:what is best way to diagnose coartation of aorta
1703
femoral pulses on pysical exam
1704
Q0853:In fetal period; shunt is right to left. In neonatal period; lung resistance decreases and shunt becomes L to R w/ subsequent RVH and failure. [pic p. 229]
1705
patent ductus arteriosis
1706
Q0854:______ is used to closed a PDA
1707
indomethacin
1708
Q0855:______ is used to keep a PDA open; which may be necessary to sustain life in conditions such as transposition of the great vessels
1709
PGE
1710
Q0856:Congenital cardiac defect associations;22q11
1711
truncus arteriosus; tetralogy of Fallot
1712
Q0857:Congenital cardiac defect associations;Down syndrome
1713
ASD; VSD
1714
Q0858:Congenital cardiac defect associations;Congenital rubella
1715
septal defects; PDA
1716
Q0859:Congenital cardiac defect associations;Turners syndrome
1717
coarctation of aorta
1718
Q0860:Congenital cardiac defect associations;Marfan's syndrome
1719
aortic insufficiency
1720
Q0861:Congenital cardiac defect associations: Offspring of diabetic mother
1721
transposition of great vessels
1722
Q0862:Hypertension
1723
BP >140/90
1724
Q0863:HTN risk factors
1725
increase age; obesity; diabetes; smoing; genetics; blck>white>asians
1726
Q0864:90% of hypertension is this kind
1727
essential
1728
Q0865:essentail hypertention is related to either one of these two factors
1729
increased CO or TPR
1730
Q0866:10% of HTN is mostly secondary to ______ dz
1731
renal
1732
Q0867:this type of HTN is severe and rapidly progressing
1733
malignant
1734
Q0868:HTN predisposes pts to (give 3)
1735
athrosclerosis; stroke; CHF; renal failure; retinopathy; & aortic dissection
1736
Q0869:Hyperlipidemia signs;Plaques in blood vessel walls
1737
Atheromata
1738
Q0870:Hyperlipidemia signs;plaques or nodules composed of lipid-laden histocytes in the skin; especially the eyelids
1739
Xanthoma
1740
Q0871:Hyperlipidemia signs: lipid deposits in the tendon; esp. the achilles
1741
Tendinous xanthoma
1742
Q0872:Hyperlipidemia signs: lipid deposit in cornea; nonspecific (arcus senilis)
1743
corneal arcus
1744
Q0873:This type of arteriosclerosis is in the media of the arteries; esp radial or ulnar. Usually benign.
1745
Monckeberg
1746
Q0874:This type of arteriosclerosis is hyalin thickening of small arteries in essential hypertension. Hyperplastic "onion skinning" in malignant hypertension.
1747
Arteriolosclerosis
1748
Q0875:This type of arteriosclerosis is when fibrous plaques and atheromas form in intima of arteries
1749
atherosclerosis
1750
Q0876:risk factors for atherosclerosis
1751
smoking; hypertension; dbts; hyperlipidemia; family hx
1752
Q0877:progression of atherosclerosis;complex atheromas; fatty streaks; proliferative plaque
1753
fatty streaks to proliferative plaque to complex atheromas
1754
Q0878:complications of atherosclerosis (give 3)
1755
aneurisms; ischemia; infarcts; peripheral vascular dz; thrombus; emboli
1756
Q0879:most common location of atherosclerosis
1757
abdominal aorta> coronary artery>popliteal artery>carotid artery
1758
Q0880:symptoms of atherosclerosis
1759
angina; claudication; but can be asymptomatic
1760
Q0881:CAD narrowing >75%
1761
angina
1762
Q0882:retrosternal chest pain with exertion ; mostly secondary to atherosclerosis
1763
stable angina
1764
Q0883:chest pain occurring at rest secondary to corony artery spasm
1765
prinzmetal's variant (unstable angina)
1766
Q0884:worsening of chest paiin due to thrombosis but no necrosis
1767
unstable/crescendo angina
1768
Q0885:most often acute thrombosis due to coronary artery atherosclerosis. Results in myocyte necrosis
1769
myocardial infarction
1770
Q0886:death from cardiac causes within 1 hour of onset of symptoms; most commonly due to a lethal arrythmia
1771
sudden cardiac death
1772
Q0887:progressive onset of CHF over many years due to chronic ischemic myocardial damage
1773
chronic ischemic heart dz
1774
Q0888:infarcts occuring in loose tissues with collaterals; such as lungs; intestine; or follwing reperfusion
1775
red (hemorrhagic) infarcts;REd=REperfusion
1776
Q0889:infarcts occur in solid tissues with single blood supply; such as brain; heart; kidney and spleen.
1777
pale infacts
1778
Q0890:give order of highest frequency of coronary artery occlusion ;CFX; LAD; RCA
1779
LAD>RCA>CFX
1780
Q0891:symptoms of MI (give 4)
1781
diaphoresis; nausea; vomiting; severe retrosternal pain; pain in left arm or jaw; shortness of breath; fatigue; adrenergic symptoms.
1782
Q0892:How long ago did the MI occur?;Occluded artery but no visable change by light microscopy
1783
2-4 hours
1784
Q0893:How long ago did the MI occur?;Gross: dark mottling; pale with tetrazolium stain;Micro: coagulative nocrosis. coagulation bands visable. release of contents of necrotic cells into bloodstream and the begining of neutrophil emigration.
1785
after 4 hrs. 1st day
1786
Q0894:How long ago did the MI occur?;Gross: hyperemic border; central yellow-brown softening;Micro: outer zone (ingrowth of granulation tissue); macrophages; & neutrophils
1787
5-10 D
1788
Q0895:How long ago did the MI occur?;Gross: greywhite;Micro: scar complete
1789
7 weeks
1790
Q0896:dx of MI what is gold standard in the 1st 6 hrs
1791
ECG
1792
Q0897:This lab test rises after 4 hours and is elevated for 710D.
1793
troponin I
1794
Q0898:this lab test is more specific than other protein markers
1795
troponin I
1796
Q0899:This is predominantly found in myocardium but can also be relased from skeletal mm
1797
CK-MB
1798
Q0900:This is nonspecific and can be found in cardiac; liver and skeletal mm cells
1799
AST
1800
Q0901:ECG changes include ST elevation which indicates
1801
transmural infarct
1802
Q0902:ECG changes include ST depression which indicates
1803
subendocardial infarct
1804
Q0903:ECG changes include pathological Q waves
1805
transmural infact
1806
Q0904:This MI complication is the most important cause of death before reaching hosptial; it is common in the 1st few days
1807
cardiac arrhythmia
1808
Q0905:This MI complication results in pulmonary edema
1809
LV failure
1810
Q0906:This MI complication has a high risk of mortanilty and occurs when there is a large infarct
1811
cardiogenic shock
1812
Q0907:Rupture of ventricular free wall; interventricular septum; or paillary mm; usually occurs _____ post MI
1813
4-10D
1814
Q0908:This MI complication of an MI results in decreased CO; a risk of arrythmia; and embolus from mural thrombus
1815
aneurism formation
1816
Q0909:this MI complication is also known as a friction rub and occurs 3-5 D post MI
1817
fibrinous pericarditis
1818
Q0910:This MI complication is an autoimmune phenomenon resulting in fibrinous pericarditis; several weeks post-MI
1819
dresslers syndrome
1820
Q0911:This is the most common cardiomyopathy (90%)
1821
dialated (congestive) cardiomyopathy
1822
Q0912:In dialated (congestive) cardiomyopathy ________ dysfunction ensues
1823
systolic
1824
Q0913:In this type of cardiomyopathy; the heart looks like a baloon on chest x-ray
1825
dialated (congestive) cardiomyopathy
1826
Q0914:etiology of dialated (congestive) cardiomyopathy
1827
Alcohol ;Beriberi;Coxsackie B;Cocaine;Chagas dz;Doxorubicin;peripartum;hemochromatosis
1828
Q0915:this type of cardiomyopathy often involves an asymetric enlargement of the intraventricular septum
1829
hypertrophic cardiomyopathy
1830
Q0916:In hypertrophic cardiomyopathy ______ disfunction occurs
1831
diastolic
1832
Q0917:hypertrophic cardiomyopathy is a __________ trait; and 50% are familial
1833
autosomal dominant
1834
Q0918:This is a very common cause of sudden death in young athletes.
1835
hypertrophic cardiomyopathy
1836
Q0919:What are the heart sound findings with hypertrophic cardiomyopathy
1837
loud S4; apical impulses; systolic murmur
1838
Q0920:How do you tx hypertrophic cardiomyopathy
1839
Beta blocker
1840
Q0921:major causes of this type of cardiomyopathy include sarcoidosis; amyloidoss; postratdiation fibrosis; endocarrdial fibroelastosis; and endomyocardial fibrosis (Loffler's)
1841
restrictive/obliterative cardiomyopathy
1842
Q0922:Heart Murmurs;holostolic; high piched "blowing murmur" loudest at apex
1843
mitral regurgitation
1844
Q0923:Heart Murmurs: crecendo-decrescendo systolic ejection murmur following ejection click. radiates to carotids/apesx. "pulsus parvus et tardus" pulses weak compared to heart sounds
1845
aortic stenosis
1846
Q0924:Heart Murmurs;holosystolic murmur
1847
VSD
1848
Q0925:Heart Murmurs;Late systolic murmur with midsystolic click. Most frequent valvular lesion
1849
mitral prolapse
1850
Q0926:Heart Murmurs;immediate high-pitched "blowing" diastolic murmur. Wide puse pressure
1851
aortic regurgitation
1852
Q0927:Heart Murmurs: follows opening snap. delayed rumbling late diastolic murmur.
1853
mitral stenosis
1854
Q0928:Heart Murmurs: Continuous machine like murmur. Loudest at time of S2
1855
PDA
1856
Q0929:most common primary cardiac tumor in adults. Usually described as a "ball-valve" obstruction in the LA
1857
myxomas.
1858
Q0930:90% of myxomas occur in the _____
1859
atria (mostly LA)
1860
Q0931:Most frequent primary cardiac tumor in children; associated with tuberous sclerosis
1861
rhabdomyomas
1862
Q0932:Most common heat tumor (see color image 88)
1863
metasteses
1864
Q0933:Given the pathophysiology tell me the symptom of CHF;failure of LV output to increase during exercise
1865
dyspnea on exertion
1866
Q0934:Given the pathophysiology tell me the symptom of CHF: greater ventricular end-diastolic volume
1867
cardiac dilation
1868
Q0935:Given the pathophysiology tell me the symptom of CHF;Lv ventrical failure leads to increased pulmonary venous pressure which leads to pulmonary venous distention and transudation of fluid.
1869
pulmonary edema (paroxysmal nocturnal dyspnea)
1870
Q0936:this CHF abnormality is associated with presence of hemosiderin-laden macrophages
1871
pulmonary edema
1872
Q0937:Given the pathophysiology tell me the symptom of CHF: increase venous return in supine position exacerbates pulmonary vascular congestion
1873
orthopnea (shortness of breath when supine)
1874
Q0938:Given the pathophysiology tell me the symptom of CHF: increased central venous pressure leading to increased resistance to portal flow.
1875
hepatomegaly (nutmeg liver)
1876
Q0939:Given the pathophysiology tell me the symptom of CHF: RV failure leads to increased venous pressure which leads to fluid transudation
1877
ankle ; sacral edema
1878
Q0940:embolus types
1879
Fat; Air; Thrombus; Bacteria; Amniotic fluid; Tumor;mneu: an embolus moves like a a FAT BAT
1880
Q0941:this type of emboli are associated with long bone fractures and liposuction.
1881
fat
1882
Q0942:approximately 95% of pulmonary emboli arise from where?
1883
deep leg veins
1884
Q0943:this type of emboli can lead to DIC; especially postpartum
1885
amniotic fluid
1886
Q0944:this type of embolus is associated with chest pain; tachypnea; and dyspnea
1887
pulmoary embolus
1888
Q0945:compression of heart by fluid (i.e;blood) in pericardium; leading to decreased cardiac output and equilibration of pressures in all four chambers.
1889
cardiac tamponade
1890
Q0946:youre pt presents with hypotension; JVD; and distant heart sounds. He shows pulsus paradoxus and ECG shows electrical alternans
1891
cardiac tampanad
1892
Q0947:pulsus paradoxus
1893
(exaggeration of nml variation in the systemic arterial pulse volume with respiration-- becoming weaker with inspiration and stronger with expiration)
1894
Q0948:electrical alternans
1895
(beat to beat alterations in QRS complex height)
1896
Q0949:Symptoms of bacterial endocarditis
1897
Fever;Roth spots;osler nodes;Murmur (new);Janeway lesions;Anemia;Nail-bed hemorrhage;Emboli;;mneu: bacteria FROM JANE
1898
Q0950:osler nodes
1899
tender raised lesions on finger or toe pads
1900
Q0951:Roth's spots
1901
round white spotss on retina surrounded by hemorrhage
1902
Q0952:Janeway lesions
1903
small erythematous lesions on palm or sole
1904
Q0953:What is the most frequently involved valve in bacterial endocarditis
1905
mitral valve
1906
Q0954:What valve is associated with endocarditis associated with IV drug abuse
1907
tricuspid valce
1908
Q0955:what are some of the complications associated with bacterial endocartitis (give 2)
1909
chordae rupture;glomerulonephritis;supportive pericarditis;emboli
1910
Q0956:acute endocarditis has a rapid onset. It results from large vegetations on previously normal valves. It is most often caused by this bug.
1911
S. aureus (high virulence)
1912
Q0957:Subacute bacterial endocarditis has a more insidious onset. It consists of smaller vegetations on congentitally abnormal or diseased valves. It can be a sequela of dental procedures. Often caused by this bug
1913
viridans streptococcus (low virulence)
1914
Q0958:endocarditis may also be nonbacterial and secondary to these 2 conditions
1915
metastasis or renal failure (marantic/ thrombotic endocarditis)
1916
Q0959:In this condition; associated with lupus; vegetations develop on both sides of valve leading to mitral valve stenosis but do not embolize
1917
libman-sacks endocarditis;mneu: SLE causes LSE
1918
Q0960:Rhematic heart dz is a late consequence of pharyngeal infection with this organism
1919
a beta hemolytic streptococci
1920
Q0961:rhematic heart dz affects heart valves in this order
1921
mitral>aortic>>tricuspid;mneu: high pressure valves associated most.
1922
Q0962:Give the symptoms of rheumatic heart dz
1923
Fever;Erythema marginatum;Valvular damage;ESR (high);Redhot joints (polyartheritis);Subcutaneous nodules;St. Vitus' dance (chorea);mneu: FEVERSS
1924
Q0963:This is associated with Aschoff bodies; migratory polyarthritis; erythema marginatum; elevated ASO titers.
1925
Rheumatic heart dz
1926
Q0964:is rheumatic heart dz immune mediated or the direct effect of bacteria
1927
immune mediated
1928
Q0965:Associated ith Aschoff bodies and Anitschkow's cells
1929
rheumatic heart dz;mneu: think of 2 RHussians with RHeumatic heart dz (Aschoff & Anischkow)
1930
Q0966:Aschoff bodies
1931
granuloma with giant cell
1932
Q0967:Anitschkow's cells
1933
activated histiocytes
1934
Q0968:This condition presents with pericardial pain; friction rub; ECG changes (diffuse ST elevation in all leads) pulsus paradoxus; distant heart sounds
1935
pericarditis
1936
Q0969:pericarditis can resolve without scarring however; scarring can lead to this
1937
chronic adhesive or chronic constrictive pericarditis
1938
Q0970:this type of pericarditis is caused by SLE; rheumatoid arthritis; infection; or uremia
1939
serous pericarditis
1940
Q0971:this type of pericarditis is caused by uremia; MI; rheumatic fever
1941
fibrinous pericarditis
1942
Q0972:this type of pericarditis is caused by TB or malignancy (e.g; melanoma)
1943
hemorrhagic
1944
Q0973:this dz disrupts the vasa vasora of the aorta with consequent dilation of the aorta and valve ring. It often effects the aortic root and results in calcification of ascending arch of the aorta
1945
syphalitic heart dz (tertiary syphalis)
1946
Q0974:This dz can result in aneurism of the ascending aorta or aortic arch and aortic valve incompetence.
1947
syphalitic heart dz (tertiary syphalis)
1948
Q0975:This Rx used for HTN has the adverse effect of HYPOKALEMIA; slight hyperlipidemia; hyperuricemia; lassitude; hypercalcemia; hyperglycemia
1949
hydrochlorothiazide (diuretic)
1950
Q0976:This Rx used for HTN has the adverse effect of potassium wasting; metabolic alkalosis; hypotension; ototoxicity
1951
loop diuretics
1952
Q0977:This sympathoplegic used in the tx of HTN has the adverse effect of dry mouth; sedation; severe rebound HTN
1953
clonidine
1954
Q0978:This sympathoplegic used in the tx of HTN has the adverse effect of sedation; positive Coomb's test
1955
methyldopa
1956
Q0979:This sympathoplegic used in the tx of HTN has the adverse effect of severe orthostatic hypotension; blurred vision; constipation; sexual disfunction
1957
hexamethonium
1958
Q0980:This sympathoplegic used in the tx of HTN has the adverse effect of sedation; depression; nasal stuffiness; diarrhea
1959
reserpine
1960
Q0981:This sympathoplegic used in the tx of HTN has the adverse effect of orthostatic and exercise hypotension; sexual dysfunction; diarrhea
1961
Guanethidie
1962
Q0982:This sympathoplegic used in the tx of HTN has the adverse effect of 1st dose orthostatic hypotension; dizziness; headache
1963
Prazosin
1964
Q0983:This sympathoplegic used in the tx of HTN has the adverse effect of impotence; asthma; bradycardia; CHF; AV block; sedation & sleep alterations
1965
B blockers
1966
Q0984:This vasodialator used in the tx of HTN has the adverse effect of nausea; headache; lupus-like syndrome; reflex tachycardia; angina; salt retension
1967
hydralazine
1968
Q0985:This vasodialator used in the tx of HTN has the adverse effect of hypertrichosis; pericardial effusion; reflex tachycardia; angina; salt retension
1969
minoxidil
1970
Q0986:This vasodialator used in the tx of HTN has the adverse effect of dizziness; flushing; constipation; nausea
1971
nifidipine; veripamil (constipation)
1972
Q0987:This vasodialator used in the tx of HTN has the adverse effect of cyaide toxicity (releases CN)
1973
nitroprusside
1974
Q0988:This ACE inhibitor used in the tx of HTN has the adverse effect of;Hyperkalemia; Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1975
Captopril;mneu:CAPTOPRIL-Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1976
Q0989:This angiotensin II receptor inhibitor has theadverse effect of fetal renal toxicity; hyperkalemia
1977
Losartan
1978
Q0990:This vasodialator used in the tx of HTN has the adverse effect of hypertrichosis; pericardial effusion; reflex tachycardia; angina; salt retension
1979
minoxidil
1980
Q0991:This vasodialator used in the tx of HTN has the adverse effect of dizziness; flushing; constipation; nausea
1981
nifidipine; veripamil (constipation)
1982
Q0992:This vasodialator used in the tx of HTN has the adverse effect of cyaide toxicity (releases CN)
1983
nitroprusside
1984
Q0993:This ACE inhibitor used in the tx of HTN has the adverse effect of;Hyperkalemia; Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1985
Captopril;mneu:CAPTOPRIL-Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1986
Q0994:The MOA of this drug used for severe HTN & CHF is that it increases cGMP leading to smooth mm relaxation. It vasodilates arterioles > veins resulting in a reduction of afterload
1987
hydralazine
1988
Q0995:Toxicity of this drug for severe HTN & CHF include compensitory tachycardia; fluid retension; & lupus like syndrome
1989
hydralazine
1990
Q0996:The druges Nifedipine; verapamil & diltiazem belong to this category
1991
calcium channel blockers
1992
Q0997:The MOA of these drugs is that they block voltagedependent L-type calcium channels of cardiac and smooth muscle and thereby reduce mm contractilty
1993
calcium channel blockers
1994
Q0998:give the order of potency of the 3 CCBs (nifedipine; verapamil; diltiazem) in;1) the heart;2)vascular smooth mm
1995
heart-verapamil>diltiazem>nifedipine;vascular sm mm-;nifedipine>diltiazem>verapamil
1996
Q0999:CCBs are used in hypertension but also in these 2 conditions
1997
angina; arrythymias (not nifedipine)
1998
Q1000:These drugs produce a toxicity of cardiac depression; peripheral edema; flushing; dizziness; & constipation
1999
CCBs
2000
Q1001:These 2 drugs used for angina; pulmonary edema; and as an erection enhancer have a MOA of vasodilating by releasing NO in smooth mm; causing an increase in cGMP and smooth mm relaxation. They dialate vv>>arteries resulting in a decrease in preload
2001
nitroglycerine; isosorbide dinitrate
2002
Q1002:toxicity of these drugs include tachycardia; hypotension; headache; "Monday dz" in industrial exposure; development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend; resulting intahycardia; dizziness; and headache.
2003
nitroglycerin; isosorbide dinitrate
2004
Q1003:What are the 2 major Rxs used in the tx of antianginal therapy
2005
nitrates & B blockers
2006
Q1004:In antianginal therapy the goal is to do what?
2007
reduce myocardial O2 consumption.
2008
Q1005:In order to reduce myocardial O2 consumption you need to decrease 1 or more of the determinants of MVO2 which are give 2(5)
2009
1)EDV;2)BP;3)HR;4) contractility;5) ejection time
2010
Q1006:Used for antianginal therapy Nitrates reduce _______ (preload or afterload)
2011
preload
2012
Q1007:Used for antianginal therapy B-blockers reduce _______ (preload or afterload)
2013
afterload
2014
Q1008:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;EDV
2015
N (preload):decreased ;BB (afternoad):increased ;C: no effect or decreased
2016
Q1009:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;BP
2017
N (preload):decreased ;BB (afternoad):decreased ;C:decreased
2018
Q1010:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;Contractility
2019
N (preload):increased (reflex response);BB (afternoad):decreased ;C:little or no effect
2020
Q1011:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;HR
2021
N (preload):increased reflex response;BB (afternoad):decreased ;C:decreased
2022
Q1012:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;Ejection time
2023
N (preload):decreased ;BB (afternoad):increased ;C:little or no effect
2024
Q1013:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;MVO2
2025
N (preload): decreased ;BB (afternoad): decreased ;C: decreased decreased
2026
Q1014:CCBs: Nifedipine is similar to ________ (nitrates or B blockers); Verapamil is similar to ________nitrates or B blockers)
2027
Nitrates ;B blockers
2028
Q1015:Cardiac drugs: sites of action
2029
1) Digitalis (-);2) CCB (-);3) B blockers;4) Ryanodine (+);5) Ca++ sensitizers
2030
Q1016:This cardiac drug inhibits Na+/K+ ATP ase
2031
digitalis
2032
Q1017:These 2 cardiac drugs inhibit on voltage gated Ca++ channels
2033
CCBs;B blockers
2034
Q1018:This cardiac drug sensitizes Ca++ release channel in the SR
2035
Ryanodine
2036
Q1019:These cardiac drug is a site of Ca+ interaction with troponin-tropomyosin system
2037
Ca++ sensitizers
2038
Q1020:This cardiac glycoside has 75% bioavalibility; is 2040% protein bound; has a half life of 40 hours and is excreted in the urine
2039
digoxin
2040
Q1021:the MOA of this drug is that it inhibits the Na+/K+ ATPase of the cardiac sarcomere; causing an increase in intracellular Na+. Na+-Ca++antiport does not function as efficiently; casing an increase in intracellular Ca++; leading to positive inotropy.
2041
digoxin
2042
Q1022:this drug may cause an elevated PR; a depressed QT; a scooping of ST segment; and a T-wave inversion on ECG
2043
digoxin
2044
Q1023:The clinical uses for this drug include 1) ________ due to increased contractility 2) _______ due to decreased conduction at AV node
2045
1) CHF;3) atrial fibrillation
2046
Q1024:toxicity of this drug includes N/V/D. Blurry yellow vision. Arrhythmia.
2047
digoxin
2048
Q1025:Digoxins toxicities are increased by _________(decreased excretion); _______(potentiates drug's effects) ; and _________ (decreases digoxin clearance and displaces dignoxin from tissue binding sites
2049
renal failure ;hypokalemia ;quinidine
2050
Q1026:What is the treatment for digoxin toxicity
2051
slowly normalize K+;lidocaine;cardiac pacer;anti-dig Fab fragments
2052
Q1027:antiarrythmics (Class I) are _____ channel blockers
2053
Na+
2054
Q1028:antiarrythmics (Class II) are _____ blockers
2055
Beta
2056
Q1029:antiarrythmics (Class III) are _____ channel blockers
2057
K+
2058
Q1030:Thhs class of antiarrhthmics are local anesthetics. They act by slow or decreasd conduction. They decrese the slope of phase 4 ddepolarization and increase threshhold for firing in abnormal pacemaker cells.
2059
antiarrhythmics-Na+ channel blockers (class I)
2060
Q1031:antiarrhythmics-Na+ channel blockers (class I) are state dependent meaning what
2061
they selectively depress tissue that is frequently depolarized (e.g; tachycardia
2062
Q1032:this class of antiarrhythmics has 3 subcategories A; B; &C
2063
antiarrhythmics-Na+channel blockers (class I)
2064
Q1033:this class of antiarrythmics includes Quinidine; Amiodarone; Procainamide; Disopyramide.
2065
Class IA;mneu: Queen Amy Proclaims Diso's PYRAMID
2066
Q1034:This class of antiarrhytmics has an increased AP duration; increased effective refractory period (EERP; increased QT interval. It can affect both atrial and ventricular arrhythmias
2067
IA
2068
Q1035:This member of class IA antiarrhytmics has toxicities that include (cinchonism-headache; tinnitis; thrombocytopenia; torsades de pointes due to prolonged QT interva)
2069
quinidine
2070
Q1036:This member of class IA antiarrhytmics has toxicities that include reverible SLE-like syndrome
2071
procainamide
2072
Q1037:This class of antiarrythmics include lidocaine mexiletine; tocainide
2073
IB (Na+ channel blockers)
2074
Q1038:this class of antiarrythmics acts to decrease AP duration. It effects ischemic or depolarized purkinje and ventricular tussue. It is useful in acute ventricular arrhytmias (especially post-MI) and i digitalis-induced arrhythmias.
2075
2076
Q1039:This class of antiarrhytmics has toxicities that include local anesthetic effects; CNS stimulation/depression; cardiovascular depression
2077
2078
Q1040:This class of antiarrhythmics includes flecainide; encainide; propafenone.
2079
class IC (Na+ channel blockers.
2080
Q1041:This class of antiarrhythmics has no effect on AP duration. It is useful in V-tachs that progress to VF and intractable SVT. Usually used only as last result in refractory tachyarrythmias.
2081
2082
Q1042:Toxicities of this class of antiarrhythmics includes arrythmias; especially post MI (CONTRAINDICATED)
2083
2084
Q1043:picture p. 242 Class I antiarrythmics (Na+ channel blockers)
2085
1) IA;2) IB;3) IC
2086
Q1044:This clas of antiarrythmics includes propanolol; esmolol; metroprolol; atenolol; timool.
2087
Beta Blockers (Class II)
2088
Q1045:This class of antiarrythmics acts by decreased cAMP; decreased Ca+ currents; and by supressing abnormal pacemakers by decreased slope of phase 4. The AV node is particularly sensitive resulting in increaed PR interval
2089
B-blockers (Class II antiarrythmics)
2090
Q1046:this is the shortest acting B blocker
2091
esmolol
2092
Q1047:Toxicities of this class of antiarrythmics include impotence; exacerbation of asthma; CV effects (bradycardia; AV block; CHF); CNS effects (sedation; sleep alterations). It may mask signs of hypoglycemia.
2093
B-blockers (Class II antiarrythmics)
2094
Q1048:This class of antiarrythmics includes Sotalol; ibutilide; bretylium; & amiodarone
2095
K+ channel blockers (class III)
2096
Q1049:This class of antiarrythmics acts by increased AP duration; increased ERP. It thends to increased QT interval. It is used when other antiarrhythmics fail.
2097
K+ channel blockers (class III)
2098
Q1050:This class III antiarrythmic has toxicities which include torsades de pointes and excessive beta block
2099
sotalol
2100
Q1051:This class III antiarrythmic has toxicities which include new arrhytmias& hypotension
2101
bretylium
2102
Q1052:This class III antiarrythmic has toxicities which include PULMONARY FIBROSIS; HEPATOTOXICITY; HYPOTHYROIDSIM/HYPERTHYROIDISM; corneal deposits; skin depsits resulting in photodermatiitis; neurologic effects; constipation; CV effects (bradycardia; heart block; CHF
2103
amiodarone;mneu: remember to check PFTs; LFTs; and TFTs when using amiodarone.
2104
Q1053:This class of antiarrythmics include the drugs verapamil; and diltiazem.
2105
Ca++ channel blockers (class IV)
2106
Q1054:The MOA of this class of antiarrythmics is primarily on AV nodal cells. They decreased conduction velocity; increased ERP; increased PR interval.
2107
2108
Q1055:this class of antiarrythmics is used in prevention of nodal arrhythmias (e.g; SVT)
2109
2110
Q1056:Toxicity of this class of antiarrythmics can include constipation; flushing; edema; CV effects (CHF; AV block; sinus node depression; & torsades de pointes.
2111
2112
Q1057:Other antiarrythmics: this antiarrhythmic is the drug of choice in diagnosing/abolishing AV nodal arrhythmias
2113
adenosine
2114
Q1058:Other antiarrythmics: this antiarrhythmic depresses ectopic pacemakers; especially in digoxin doxicity
2115
K+
2116
Q1059:Other antiarrythmics: this antiarrhythmic is effective in torsades de pointes and digoxin toxiciity
2117
Mg+
2118
Q1060:cardiac output(CO) formula
2119
rate of O2 consumption/;(arterial O2 content - venous)
2120
Q1061:mean arterial pressure (MAP) formula
2121
MAP = CO - TPR;MAP also = 1/3 systolic + 2/3 diastolic
2122
Q1062:stroke volume (SV) formula
2123
SV = CO/ HR;SV also = EDV-ESV
2124
Q1063:cardiac output variables
2125
SV CAP ;->SV is affected by Contractility; Afterload and Preload
2126
Q1064:contractility/SV increases due to
2127
increased catecholamines (high activity of Ca pump in SR);increased [Ca]i;decreased [Na]e;digitalis admin (increases intracellular Na which leads to increased [Ca]i)
2128
Q1065:contractility/SV decreases due to
2129
B1 blockers;heart failure;acidosis;hypoxia/hypercapnea;Ca channel blockers
2130
Q1066:force of contraction [starling curve
2131
is proportional to the initial length of cardiac muscle fiber [PRELOAD]
2132
Q1067:ejection fraction (EF) formula
2133
EF = SV/EDV = (EDV-ESV)/EDV;EF is an index of ventricular contractility;EF should be >/= 55%
2134
Q1068:resistance/pressure/flow formula
2135
change in P = Q x R;Q = flow; R = resistance;R= 8 x viscosity x length/;pi radius ^4;*viscostity increased in;polycythemia; high protein and hereditary spherocytosis
2136
Q1069:JVP waves
2137
a: atrial contraction;c: RV contraction(when tricuspid bulges back into RA);v: increased atrial pressure due to atrial filling against closed tricuspid valve
2138
Q1070:cardiac myocyte vs skeletal myocytes
2139
cardiac muscle;-> AP has a plateau ;-> nodal cells SPONTANEOUSLY depolarize [automaticity];-> myocytes are electrically coupled via gap jxns;**contraction is due to extracellular Ca
2140
Q1071:AP in atrial/ventricular myocytes and purkinje fibers
2141
phase O: rapid upstroke (Na);1: intial repol (inactivation of Na channels);2: plateau (Ca influx balances slowly increasing K efflux);3: rapid repol (massive K efflux due to slow K channels and closure of Ca channels);4: resting potential (K and Ca leak currents + Na/K ATPase and Na/Ca exchanger)
2142
Q1072:AP in pacemaker cells
2143
phase 0: upstroke due to Ca channels; NO fast Na channels;2: no plateau (pointy);4: slow diastolic depol (I-f accounts for automaticity of SA/AV nodes);**slope of phase 4 in SA node determines heart rate**
2144
Q1073:wolf parkinson white syndrome
2145
accessory conduction pathway from atria to ventricle;bypasses the AV node;**see a DELTA WAVE before QRS complex;can lead to SVTs
2146
Q1074:1st degree AV block
2147
PR interval prolonged (>200 msec);is asymptomatic
2148
Q1075:2nd degree AV block
2149
mobitz type 1;->progressive lengthening of PR until a beat is dropped. asymptomatic;mobitz type 2;->dropped beats not proceeded by change in PR length. is symptomatic: 2 P waves to 1 QRS
2150
Q1076:3rd degree AV block [complete heart block]
2151
atria and ventricles beat independantly;P waves have no relation to QRS;atrial rate > ventricular;*Tx = pacemaker;rate of ventricular beat: 30-45;stroke volume is increased (high pulse pressure)
2152
Q1077:O2 demand in heart
2153
high O2 demand drives increased blood flow; NOT increased extraction of O2
2154
Q1078:fluid pressure [hydrostatic] starling forces
2155
Pc = capillary fluid pressure;-> fluid out of capillary;Pi = interstitial fluid pressure;-> fluid into capillary
2156
Q1079:colloid pressure starling forces
2157
pi-c: plasma colloid osmotic p;-> moves fluid into capillary;pi-i: interstitial colloid p;-> moves fluid out of capillary
2158
Q1080:right to left shunts
2159
=early cyanosis (blue babies);Teratology of Fallot;Transposition of great arteries;Truncus arteriosus
2160
Q1081:left to right shunts
2161
VSD (#1 congenital anomaly);ASD (loud S1; fixed split S2);PDA (close w/indomethacin)
2162
Q1082:teratology of Fallot
2163
PROVe;Pulmonary a. stenosis (Px feature);RVH;Overriding aorta (overrides VSD);VSD;*pts suffer 'cyanotic spells';caused by anteriosuperior displacement of aorta
2164
Q1083:transposition of great vessels
2165
aorta leavse RV and pulm trunk leaves LV (posterior);not compatible with life unless shunt is present to mix systemic and pulm circulations (VSD; pDA or pFO)
2166
Q1084:coarctation of aorta
2167
infants: aortic stenosis proximal to insertion of DA;adults: distal to DA;-> notching of ribs; HTN in upper extremities; weak pulses in lower extremities;-> 3:1 male to female ratio;**ass'd with Turner Syndrome
2168
Q1085:patent DA
2169
in fetal pd; shunt R to L (bypasses pulmonary circulation);birth = lung resistance drops and shut becomes L to R which causes RVH and R heart failure;*continuous machine like murmur;patency = low O2 tension; PGE
2170
Q1086:congenital cardiac defects
2171
22q11: truncus arteriosus; teratology of fallot;Ts21: ASD or VSD;rubella: septal defects; pDA;turner's: coarctation of aorta;marfan's: aortic insufficiency;mom w/DM: transposition of great vessels
2172
Q1087:monckeburg arteriosclerosis
2173
calcification of arteries; especially radial or ulnar;usually benign
2174
Q1088:arteriolosclerosis
2175
hyaline thickening of small arteries due to essential hypertension;ONION SKINNING in malignant HTN
2176
Q1089:cardiovascular system is derived from which cell layer?
2177
mesoderm;paired endocardial heart tubes from in cephalic region
2178
Q1090:primitive embryonic heard dilates into five areas (starting at weeks 5-8):
2179
from cranial to caudal;-truncus arteriosus: proximal aorta and proximal pulm artery;-bulbus cordis: smooth parts of right ventricle and LV;-primitive ventricle: RV; LV;-primitive atrium: RA and LA;-sinus venosus (R and L): smooth part of RA; coronary sinus; oblique vein
2180
Q1091:pathophysiology of teratology of Fallot
2181
aberrant development of aortico-pulmonary septum [which should normally divide aorta and pulmonary trunk]
2182
Q1092:development of aortic arches
2183
6 paired aortic arches at 1st;->arch 3: common carotids;->4: aorta and proximal subclavian artery;->6: DA and pulmonary trunk
2184
Q1093:developent of veins
2185
vitelline veins: ductus venosus carries O2 blood from placenta to fetus;L umbilical vein: ligamentum teres hepatis;R umbilical vein: regresses
2186
Q1094:paradoxical emboli
2187
originate in the venous circulation and pass through pFO or ASD to produce symptoms on arterial side
2188
Q1095:situs inversus
2189
all body's organs are transposed ;associated with Kartagener's syndrome [immotile cilia]
2190
Q1096:Eisenmerger's syndrome
2191
change of L to R to R to L shunt secondary to increasing pulmonary HTN;often result of chronic response to VSD
2192
Q1097:acquired arteriovenous fistula
2193
decreased TPR leads to increased CO (increased HR and SV);diastolic bp falls b/c blood rapidly exits arterial system;but mean bp is relatively normal b/c regulating mechanisms are normal
2194
Q1098:change in pulse pressure with arteriosclerosis
2195
increases (b/c arteries have hardened; need to push harder [higher systolic bp] to get the blood out)
2196
Q1099:type of endocarditis in pts with SLE
2197
Libman-Sacks;->small granular vegetations consisting of fibrin develop on mitral and aortic valves;->leads to aortic stenosis
2198
Q1100:premortum thrombus
2199
look for Lines of Zahn (composed of platelets);->b/c has formed over a period of time;often due to atrial fibrillation
2200
Q1101:pathology of repeated episodes of stable angina
2201
gradual loss of myocytes;->small patches of fibrosis and vacuolization;->usually in subendocardial area (poorly perfused)
2202
Q1102:thoracic outlet syndrome with the presence of a cervical rib
2203
subclavian artery compressed btwn scalenus anterior and the rib;=pain and tingling on affected side
2204
Q1103:effect of severe anemia
2205
wide pulse pressure;->resting CO is increased due to increased SV and HR;also see tachycardia
2206
Q1104:causes of decreased pulse pressure
2207
aortic valve obstruction;cardiac tamponade;heart failure;mitral valve obstruction
2208
Q1105:effect of malignant hypertension on arteriole structure
2209
arteriolar rarefaction;=dissolution and loss of arterioles;-due to long term over-perfusion of tissues;also; arteriolar wall to lumen ratio INCREASES (thicker wall)
2210
Q1106:syphilitic aneurysm
2211
massive dilation of aortic root with absence of atherosclerosis;histo = plasma cell lesion in vasa vasorum that supply the aorta [eventually obliterate it and cause aneurysm]
2212
Q1107:cyanosis
2213
only from R-L shunt
2214
Q1108:signs of cardiac tamponade
2215
decreased arterial pressure;small; quiet heart;hypotension; tachypnea; tachycardia; increased JVP;*pulsus paradoxus
2216
Q1109:signs of pericarditis
2217
sharp; knife like pain;->usually related to breathing;diffuse STEs and upright T waves;pericardial rub MAY be present
2218
Q1110:location of femoral vein on CT
2219
medial to femoral artery;('venous toward the penis')
2220
Q1111:typical bp of someone with aortic regurgitation
2221
wide pulse pressure (160/80);systemic pressure drops during diastole b/c blood flows back thru aorta into LV
2222
Q1112:most common cause of sudden cardiac death (SCD)
2223
ischemic heart disease;*in younger patients; the nonatherosclerotic causes are more common;->hypertrophy; MVP; myocarditis; dilated cardiomyopathy; etc
2224
Q1113:Kawasaki disease
2225
'mucocutaneous lymph node syndrome';leading cause of acquired heart disease in kids in the US;all sizes of arteries affected;*risk of coronary artery aneurysm
2226
Q1114:positive result in starling equation
2227
=net fluid leaving capillaries;(Pc-Pi) - (pi c - pi i)
2228
Q1115:Dressler's syndrome
2229
autoimmune phenomenon several weeks post-MI;->fibrinous pericarditis
2230
Q1116:dilated cardiomopathy
2231
90% of all cardiomyopathies;Alcohol; Beriberi; Coxsackie B; Cocaine; Chagas'; Doxorubicin toxicity [chemo]; peripartum; hemochromatosis;-> SYSTOLIC dysfunction
2232
Q1117:hypertrophic cardiomyopathy
2233
often asymmetric; involves intraventricular septum;50% familial (AD);sudden death in young athletes;loud S4**; strong apical impulse; systolic murmur;treat with B-blockers;> DIASTOLIC dysfunction
2234
Q1118:restrictive/obliterative cardiomyopathy
2235
sarcoidosis; amyloidosis; postradiation; Loffler's
2236
Q1119:MR
2237
holosystolic;high pitched; 'blowing';loudest at apex
2238
Q1120:AS
2239
crescendo-decrescendo systolic; following an ejection click;LV >> aortic pressure in systole;radiates to carotids; apex;*pulsus parvus et tardus*
2240
Q1121:VSD
2241
holosystolic
2242
Q1122:MVP
2243
late systolic murmur;midsystolic click;#1 valvular lesion
2244
Q1123:AR
2245
high pitched blowing diastolic;associated with wide pulse pressure
2246
Q1124:MS
2247
delayed rumbling late diastolic;follows opening snap;LA >> LV during diastole (takes a lot to open the stenotic MV);**tricuspid stenosis murmur gets louder with INSPIRATION** (b/c more blood to lungs)
2248
Q1125:pDA murmur
2249
continuous; machine like;throughout systole and diastole;loudest at S2 (aortic/pulmonic close)
2250
Q1126:'heart failure cells'
2251
hemosiderin laded macrophages
2252
Q1127:cause of orthopnea in CHF
2253
increased venous return in supine position;exacerbates pulmonary vascular congestion (= SOB)
2254
Q1128:virchow's triad
2255
stasis;hypercoagulability;endothelial damage;leads to DVTs
2256
Q1129:features of cardiac tamponade
2257
compression of heart by fluid leads to low CO;equilibration of pressures in all 4 chambers**;hypotension; high JVP; pulsus paradoxus
2258
Q1130:Aschoff bodies
2259
=granulomas with giant cells;found in rheumatic heart disease;also see Anitschkow's cells (activated histiocytes)
2260
Q1131:hydralazine
2261
increases cGMP: sm musc relaxation;vasodilates arterioles > veins;REDUCED AFTERLOAD;SEs: tachycardia; fluid retention; lupus like syndrome
2262
Q1132:CCBs
2263
block L-type Ca channels;->reduced cardiac contractility;nifedipine better vascular sm muscle;verapamil better heart muscle;SEs: cardiac depression; edema; flushing; constipation
2264
Q1133:nitroglycerine; isosoribde dinitrate
2265
release NO in smooth muscle: increased cGMP ;veins >> arteries;REDUCED PRELOAD;for angina; pulmonary edema
2266
Q1134:digoxin
2267
inhibits Na/K/ATPase;->increased Na-i leads to increased Ca-i (b/c Na won't come in using Na/Ca antiport);EKG changes;>low QT; scooping of ST; T wave inversion*;used for CHF; a-fib (low AV);SEs;-> n/v; van gogh vision; arrhymthmias
2268
Q1135:Digoxin drug interaction
2269
increased [ ] with renal failure;hypokaleima potentiates effects (low K = more K out; Na in);quinidine decreases clearance;*treat Dig toxicity with K+ admin (or Mg+)
2270
Q1136:beta blockers with intrinsic sympathomimetic activity
2271
acebutolol and pindolol;not recommended for pts with angina (can exacerbate)
2272
Q1137:CCBs to avoid in those with CHF
2273
verapamil;->1st gen CCB that has strong negative inotropic effect;dilitiazem;->mild to mod negative inotrope;*amlodipine and felodipine are used in CHF pts (can actually increase contractility)
2274
Q1138:treatment of WPW
2275
don't use an agent that slows AV node conduction (will increase propensity to go to bypass tract);DO use ibutilide (K channel blocker);->disrupts reentry circuits and increases refractory period of the bypass tract
2276
Q1139:acute treatment of atrial fibrillation
2277
dilitiazem (IV);-inhibits Ca into vascular sm muscle and myocardium;-AV node blocker;*amiodarine takes 1-3 weeks to work properly
2278
Q1140:most common cardiac anomaly in Ts21
2279
endocardial cushion defect (??);or maybe ASD/VSD;20% have congenital cardiac abnormalities
2280
Q1141:mean linear velocity of a RBC is lowest in what vessels?
2281
capillaries (have the largest cross-sectional area);velocity from highest to lowest;aorta > vena cavae > large veins > small arteries > arterioles > small veins > venules > capillaries
2282
Q1142:Churg-Strauss syndrome
2283
aka allergic granulomatosis and angiitis;variant of PAN--> ass'd with asthma and eosinophilia;vascular lesions; granulomas; GI vasculitis
2284
Q1143:polyarteritis nodosa (PAN)
2285
affects small/med arteries;->esp GI tract and kidneys;fibrinoid necrosis of vessels w/ polys; eos; monos;often young adult males;Tx: steroids; cyclophosphamide
2286
Q1144:severe anemia's affects on vessels
2287
hypoxia causes dilation of small arterioles and arteries;also: low blood viscosity; decreased PVR; low splanchnic blood flow
2288
Q1145:most common primary cardiac tumor in children
2289
rhabdomyoma;composed of cells that resemble skeletal muscle;**common in kids with tuberous sclerosis
2290
Q1146:mechanism of cocaine-induced hypertension
2291
blocks re-uptake of NE
2292
Q1147:arterioles account for ___% of total peripheral resistance
2293
50% (greatest fall in bp occurs as blood goes thru arterioles);highest ratio of wall to cross-sectional area to lumen crosssectional area
2294
Q1148:leukocytoclastic angiitis
2295
=microscopic PAN;smaller affected vessels;vasculitis w/hemorrhage to skin (palpable purpura);many fragmented neutrophils;*penicillin is a common trigger
2296
Q1149:vascular structures that contain the greatest % of total blood volume
2297
venules and veins (64%)
2298
Q1150:week of gestation when heart forms
2299
4th week;(heart forms and starts beating almost immediately);6th week = heart is fully formed (so difficult to prevent congenital malformations b/c heart forms so early)
2300
Q1151:alpha1 agonists act on;
2301
smooth muscle cells in media of arterioles;leads to increase in intracellular Ca [smooth muscle contraction]
2302
Q1152:ASD found in Down's syndrome
2303
ostium primum (most common type in general is the ostium secundum);can also be associated with tricuspid and mitral valve abnormalities;*L-R shunts with late cyanosis (when reversal occurs)
2304
Q1153:mean systemic filling pressure (MSFP)
2305
pressure that exists when heart has been stopped and blood has been redistribuited equally;as MSFP increases; there is more venous return to heart;**venous system is important blood reservoir (normal fxn can be resored w/20% of blood loss)
2306
Q1154:when O2 consumption of the heart increases; this builds up in heart muscle
2307
adenosine;(ATP degrades to adenosine);adenosine then dilates vessels allowing increased coronary blood flow
2308
Q1155:graft vascular disease (aka graft arteriosclerosis)
2309
develops years after transplant;intimal thickening of coronary arteries w/out atheroma formation or inflammation;leads to progressive stenosis;chest pain DOES NOT accompany the ischemia--> sudden death;**can't be prevented with current immunosuppresive Tx
2310
Q1156:this decreases in old age and causes widened pulse pressure
2311
arterial compliance (usually due to hardening by arteriosclerosis)
2312
Q1157:cardiac complications of fragile X syndrome
2313
mitral valve prolapse and aortic root dilatation ;[occur late in adolescence or adulthood]
2314
Q1158:___% of those with ischemic heart disease will present with death
2315
25%
2316
Q1159:Beta-1 selective beta blockers
2317
A BEAM;atenolol; betaxolol; esmolol; acebutalol; metroprolol;non-selective: labetalol (also adds alpha 1); timolol; nadolol
2318
Q1160:individual cardiac muscles are joined together at
2319
intercalated disks (that contain gap jxns)
2320
Q1161:fetal umbilical arteries arise from
2321
the fetal iliac arteries (supply unoxygenated blood to the placenta);umbilical vein takes newly oxygenated blood from placenta to fetal liver then to IVC via the ductus venosus
2322
Q1162:fibrinous and serofibrionous pericarditis
2323
= Dresseler's syndrome (when following an acute MI)
2324
Q1163:why is atenolol contra-indicated in DM pts?
2325
b/c it can block the 'warning signs' of hypoglycemia
2326
Q1164:what is a cystic hygroma??
2327
lymphatic malformations resembling hemangiomas;-->a feature of Turner syndrome that contributes to the 'webbed neck';(and remember; Turner is associated with coarctation of the aorta)
2328
Q1165:side effect of metroprolol
2329
dyslipidemia
2330
Q1166:ovary drainage
2331
R ovary = ovarian vein to IVC;L ovary = ovarian vein to RENAL VEIN to IVC
2332
Q1167:best drug for initial treatment of hypertrophic cardiomyopathy
2333
beta blocker (metoprolol);Sx: sustained apical impulse; loud S4; systolic ejection murmur;echo = systolic anterior motion of mitral valve; assymetic LVH; early closing of aortic valve
2334
Q1168:appearance of amyloidosis
2335
waxy texture of affected organs;histo = positive Congo red staining
2336
Q1169:TPR
2337
(MAP-RAP) / CO;pressure = flow x resistance;(P = Q x R)
2338
Q1170:removing an organ will ___ the TPR
2339
INCREASE;(organs are in parallel; and adding parallel resistances = lower total)
2340
Q1171:fully compensated aortic coarctation
2341
blood flow normal in upper and lower body ;but there is increased arterial pressure in upper body;->lower vascular resistance in lower body (b/c resistance = pressure / flow)
2342
Q1172:possible finding at autopsy of a SIDS baby
2343
RVH
2344
Q1173:endocardial fibroelastosis
2345
probably related to intrauterine viral infection (mumps);thickened endocardium w/fibrous and elastic tissue;LV is most commonly involved;other findings = mural thrombi; flattened trabeculae and stenosed valves;*infantile and adolescent forms
2346
Q1174:artery commonly damaged in knee dislocations
2347
popliteal artery;-divides into anterior tibial; posterior tibial and peroneal;-emerges from superficial femoral artery
2348
Q1175:classical findings in ASD
2349
prominent RV impulse;systolic ejection murmur heard in pulmonic area;fixed split S2;*due to abnormal L-R shunt [creates volume overload on R side]
2350
Q1176:massive PE affects which part of the heart first?
2351
RV ;[a saddle PE causes acute cor pulmonale with abrupt RV dilation];*acute cor pulmonale is a surgical emergency
2352
Q1177:cardiac tamponade causes build up of fluid in which space?
2353
between the epicardium [visceral pericardium] and parietal pericardium;(aka the pericardial space)
2354
Q1178:PO agent similar to lidocaine
2355
mexiletine;(class IB anti-arrhythmic for treatment of VT);Na channel blocker and shortens AP duration
2356
Q1179:Which hormone increases HCl secretion by parietal cells; pepsinogen secretion by chief cells?
2357
Gastrin
2358
Q1180:What are the actions of CCK?
2359
Stimulates gall bladder contraction and relaxes sphincter of Oddi to allow pancreatic enzyme secretion.
2360
Q1181:Which hormone increases blood flow to the intestines?
2361
CCK
2362
Q1182:Which hormone is stimulated by low pH to increase pancreatic bicarb secretion and increase bile production (and decrease gastric H production?)
2363
Secretin
2364
Q1183:Which hormone increases insulin release and decreases gastric H+ secretion?
2365
GIP
2366
Q1184:Which hormone is turned on in the fasting state to initiate the MMC?
2367
Motolin
2368
Q1185:Which hormone is turned on when the acid in the stomach is below pH3 to inhibit basically everything?
2369
Somatostatin
2370
Q1186:Which other two hormones in the pituitary does somatostatin inhibit?
2371
TSH and GH
2372
Q1187:Action of Histamin?
2373
increase gastric acid secretion.
2374
Q1188:Tumor of non alpha and non beta islet cells of the pancrease that causes watery diarrhea secretes this:
2375
VIP (VIPoma)
2376
Q1189:Which hormone relaxes intestinal sm mm; increases pancreatic bicarb secretion; and stimulates intestinal secretion of electrolytes and water?
2377
VIP
2378
Q1190:This hormone is released from vagal nerve endings to mediate the release of gastrin.
2379
GRP
2380
Q1191:Somatostatin is released from these cells in the GI tract.
2381
Delta (D) cells
2382
Q1192:CCK is released from these cells in the duodenum and jejunum.
2383
I cells
2384
Q1193:Secretin does what to the rate of stomach emptying?
2385
decreases it.
2386
Q1194:What is the effect of GIP on pancreatic beta cells?
2387
stimulates the release of insulin
2388
Q1195:Region of stomach parietal and chief cells are located
2389
body/corpus
2390
Q1196:region of stomach G cells are located?
2391
antrum (G cells secrete gastrin)
2392
Q1197:Which gland produces 70% of total salivary secretions?
2393
submandibular
2394
Q1198:Which hormone is the primary regulator of bicarb secretion from the pancreas?
2395
secret
2396
Q1199:Which pancreatic cells secrete somatostatin
2397
alpha
2398
Q1200:actions of gastrin?
2399
(G cells of antrum) inc'd gastric H+; stim growth of gastric mucosa
2400
Q1201:what stimulates release of gastrin?
2401
sm peptides; amino acids in stomach lumen; stomach distention; vagus (via GRP)
2402
Q1202:where is CCK from?
2403
I cells of duodenum
2404
Q1203:5 actions of CCK
2405
1. stim gallbladder contraction and Oddi relaxation; 2) stim pancreatic enzyme secretion; 3) potentiates secretin-induced stim of pancreatic bicarb secretion; 4) stim growth of exocrine pancrease; 5) inhibits gastric empyting
2406
Q1204:what stimulates release of CCK from duodenum?
2407
small peptides; amino acids; fatty acids and monoglycerides (not TGs b/c can't cross intestinal membrane)
2408
Q1205:actions of secretin?
2409
1. stim pancreatic bicarb (potentiated by CCK) and inc'd growth of exocrine pancrease; 2) stim bicarb and H2O secretion by liver and inc'd bile production; 3) inhibits H+ by gastric parietal cells
2410
Q1206:what stimulates release of secretin from S cells of duodenum?
2411
H+ and fatty acids in duodenum
2412
Q1207:actions of GIP (gastric inhibitory peptide)
2413
1. stimulates insulin release (this is why oral glucose better!) 2. inhibits H+ secretion
2414
Q1208:what stimulates release of GIP from K cells?
2415
fatty acids; amino acids; oral glucose (only GI hormone that responds to fat; protein; and carbs!)
2416
Q1209:what inhibits release of somatostatin?
2417
vagal stimulation
2418
Q1210:effect of His on GI
2419
increased H+ secretion directly and indirectly by potentiating effects of gastrin and vagal stim
2420
Q1211:actions of VIP?
2421
relaxation of GI smooth mm (LES!); stimulate pancreatic bicarb; inhibits H+
2422
Q1212:basal electric rhythm of a) stomach b) duodenum c) ileum
2423
a) 3 Hz; b) 12 Hz; c) 8-9 Hz
2424
Q1213:gastroileal reflex?
2425
food in stomach--> increased peristalsis in ileum and relaxation of ileocecal sphincter
2426
Q1214:gastrocolic reflex?
2427
food in stomach--> increased colon motility and frequency of mass movements
2428
Q1215:composition of saliva
2429
high K+; HCO3-; low NaCl (hypotonic; unless made rapidly); alpha amylase; lingual lipase; kallikrein
2430
Q1216:parasympathetic regulation of saliva production?
2431
CN VII; IX (via muscarinic R IP3 or Ca); inc'd production
2432
Q1217:sympathetic regulation of saliva production
2433
increased production; via beta adrenergic stim (cAMP)
2434
Q1218:composition of aq part of pancreatic secretions?
2435
always ISOTONIC; more bicarb than in plasma; if low flow rate--high Na Cl; if high flow rate--high Na HCO3-
2436
Q1219:what does sucrase do?
2437
degrades sucrose to glucose and fructose
2438
Q1220:what does SLGT 1 in intestine do?
2439
transports glucose and galactose into cells; Na+-dependent
2440
Q1221:how is fructose transported into intestinal cells?
2441
facilitated diffusion
2442
Q1222:optimum pH for pepsin activity?
2443
1-3 (in pH>5; denatures)
2444
Q1223:(hypothetical) deficiency of enterokinase--> ?
2445
no activation of pancreatic proteases b/c it converts tyrpsinogen into trypsin and tryspin then cleaves all the others
2446
Q1224:why might hypersecretion of gastrin cause steatorrhea?
2447
low duodenal pH inactivates pancreatic lipase
2448
Q1225:what would a lack of apoprotein B do in intestine?
2449
cause steatorrhea b/c apo B necessary for transporting chylomicrons out of intestinal cells
2450
Q1226:what happens to K+ in GI?
2451
dietary K+ absorbed paracellularly; activly secreted in colon (similar to in kidney)
2452
Q1227:how does Vibrio Cholerae cause diarrhea?
2453
toxin binds R in luminal membrane; activates AC which causes increase cAMP--> lumenal Cl- channels open. Na and H2O follow Cl--> secretory diarrhea!!
2454
Q1228:Effect of sympathetic stimulation in the GI tract
2455
decreased motility; decreased secretions; increased contraction of sphincters
2456
Q1229:Effect of parasympathetic stimulation in GI tract
2457
increased motility; increased secretions; increased relaxation of sphincters (except LES which contracts); increased gastrin release
2458
Q1230:Hormones of the GI system
2459
Gastrin; CCK; secretin; GIP
2460
Q1231:Stimulus for gastrin secretion
2461
Stomach distension. Stomach acid in the duodenum inhibits gastrin release
2462
Q1232:Sources of gastrin
2463
G cells of the stomach anthrum; duodenum
2464
Q1233:Actions of gastrin
2465
Stimulates acid secretion by parietal cells; increases motility and secretions.
2466
Q1234:Source of secretin
2467
S cells of the duodenum
2468
Q1235:Stimulus for secretin release
2469
Acid entering the duodenum
2470
Q1236:Actions of secretin
2471
Stimulates HCO3 secretion by pancreas to neutralize acid entering duodenum
2472
Q1237:Source of CCK
2473
Cells lining the duodenum
2474
Q1238:Stimulus for CCK secretion
2475
Fat and amino acids entering duodenum
2476
Q1239:Actions of CCK
2477
Inhibits gastric emptying; stimulates pancreatic enzyme secretion; stimulates contraction of the gallbladder and relaxation of sphincter of Oddi.
2478
Q1240:Source of GIP
2479
Duodenum
2480
Q1241:Stimulus for GIP secretion
2481
Fat; carbs and amino acids
2482
Q1242:Actions of GIP
2483
Inhibits stomach motility and secretion
2484
Q1243:Properties of GI smooth muscle
2485
Stretch stimulates contraction; electrical syncytium with gap junctions; pacemaker activity
2486
Q1244:Factors that inhibit gastric motility
2487
Acid in the duodenum (secretin); fat in the duodenum (CCK); hypoerosmolarity in duodenum; distension of duodenum
2488
Q1245:Factors that stimulate gastric motility
2489
Distension of the stomach and ACh
2490
Q1246:What are the different contractions of the intestines?
2491
Segmentation contractions (mixing); peristaltic movements (propulsive).
2492
Q1247:What factors control the ileocecal sphincter?
2493
Distension of the ileum relaxes; distension of the colon contracts
2494
Q1248:What are the different contractions of the colon
2495
Segmentation contractions (haustrations); peristalsis and mass movements
2496
Q1249:Composition of salivary secretions
2497
Low in NaCl because of reabsorption; High in K and HCO3 because of secretion; alpha-amylase begins digestion of carbs; fluid is hypotonic due to NaCl reabsorption and impermeability of ducts to water
2498
Q1250:Parietal cells
2499
Located in the middle part of the gastric glands. Secrete HCl and intrinsic factor.
2500
Q1251:Chief cells
2501
Located in the deep part of the gastric glands. Secrete pepsinogen which is converted to pepsin by acid medium. Pepsin begins digestion of proteins to peptides
2502
Q1252:Mucous cells of the stomach
2503
Located in the superficial part if the gastric glands (gastric pits). Secrete mucus and HCO3. Secretion is stimulated by PGE2
2504
Q1253:Ionic composition of gastric secretions
2505
High in H+; K+ and Cl-; low in Na+. Vomiting produces metabolic alkalosis and hypokalemia.
2506
Q1254:Control of acid secretion
2507
Acetylcholine; histamine and gastrin stimulate parietal cells to secrete acid.
2508
Q1255:Secretion of acid by parietal cells
2509
CO2 is extracted from the blood and combined into H2CO3 by carbonic anhydrase. H+ ions are exchanged by the proton pump for K+ ions (active antitransport)
2510
Q1256:Pancreatic amylase
2511
Hydrolyzes alpha-1;4-glucoside bonds forming alpha-limit dextrins; maltotriose and maltose
2512
Q1257:Pancreatic lipase
2513
Needs colipase which displaces bile from surface of micelles. Lipase digests triglycerides to two free fatty acids and one 2monoglyceride
2514
Q1258:Cholesterol esterase
2515
Hydrolizes cholesterol esters to yield cholesterol and free fatty acids
2516
Q1259:Pancreatic proteases
2517
Trypsinogen is converted to trypsin by enterokinase --> chymotrypsinogen is converted to chymotrypsin by trypsin -> procarboxypeptidase is converted to carboxypeptidase by trypsin
2518
Q1260:Ionic composition of pancreatic secretions
2519
Isotonic due to permeability of ducts to water and high in HCO3. Stimulated by CCK and secretin.
2520
Q1261:What are the primary bile acids?
2521
Cholic acid and chenodeoxycolic acid. Synthesized in the liver from cholesterol.
2522
Q1262:How are bile salts formed?
2523
Bile acids (cholic and deoxycholic) are conjugated with glycine and taurine which mix with cations to form salts.
2524
Q1263:What are the secondary bile acids?
2525
Formed by deconjugation of bile salts by enteric bacteria deoxycholic acid (from cholic acid) and lithocolic acid (from chenodeoxycholic acid). Lithocholic acid is hepatotoxic and is excreted.
2526
Q1264:Enterohepatic circulation
2527
Bile acids are reabsorbed only in the distal ileum. Resection or malabsoption syndromes lead to steatorrhea and cholesterol gallstones.
2528
Q1265:What are the components of bile?
2529
Conjugated bile acids (cholic and chenodeoxycholic); billirubin; lecithin and cholesterol.
2530
Q1266:How are carbohydrates absorbed?
2531
Glucose and galactose via active secondary Na cotransporter. Fructose is absorbed independently
2532
Q1267:How are amino acids absorbed?
2533
Secondary active transport linked to Na and receptormediated endocytosis.
2534
Q1268:How are lipids absorbed?
2535
Micelles diffuse to the brush border then digested lipids (2monoglycerides; fatty acids; cholesterol and ADEK vitamins) diffuse into enterocytes. Triglycerides are resynthesized and packaged as chylomicrons with apoB48. Leave the intestine via lymphatics to thoracic duct.
2536
Q1269:source of gastrin
2537
G cells in antrum of stomach
2538
Q1270:source of CCK
2539
I cells in duo and jejunum
2540
Q1271:source of secretin
2541
s cells; duodenum
2542
Q1272:action of gastrin
2543
increased H+ in stomach ;increased growth of gatric mucosa ;increased gastric motility
2544
Q1273:action of CCK
2545
increases pancreatic secretions ;increases gallbladder contraction ;slows gastric emptying
2546
Q1274:action of secretin
2547
release of HCO3-;decreased gastric acid secretion
2548
Q1275:regulation of gastrin
2549
decreased when stomach pH <1.5;increased when stomach is distended; presence of AA and peptides;increased in vagal stimulation
2550
Q1276:regulation of CCK
2551
decreased if stomach pH<1.5;decreased by secretin ;increased by fatty acids and AA
2552
Q1277:regulation of secretin
2553
increased by acid; FA in lumen of duo
2554
Q1278:source of somatostatin
2555
D cells of pancreatic islets and GI mucosa
2556
Q1279:what regulates somatostatin
2557
increased by acid ;decreased by vagal stimulation
2558
Q1280:what is somatostatin used to treat
2559
VIPoma ;carcinoid tumors
2560
Q1281:what releases GIP?
2561
K cells in duo and jejunum
2562
Q1282:what does GIP do?
2563
exocrine fxn of decreasing H secretion ;endocrine fxn of increasing insulin release
2564
Q1283:regulation of GIP
2565
increased by fatty acids; AA; oral glucose
2566
Q1284:which is used more rapidly: oral or IV glucose?
2567
oral
2568
Q1285:source of VIP
2569
parasympathetic ganglia in sphincters; gallbladder and small intestines
2570
Q1286:action of VIP
2571
increases intestinal water absorption ;relaxation of intestinal smooth muscle and sphincters
2572
Q1287:regulation of VIP
2573
increased by distention and vagal stimulation ;decreased by adrenergic imput
2574
Q1288:what is VIPoma
2575
non-alpha; non-beta islet cell pancreatic tumor that secrete VIP --> copious watery diarrhea
2576
Q1289:action of NO on GI tract
2577
increased smooth muscle relaxation; (NB: lower P in LES)
2578
Q1290:what is implicated in decreased NO secretion
2579
accounts for incresed LES tone seen in achalasia
2580
Q1291:where is HCO3- released from?
2581
mucosal cells;stomach;duo
2582
Q1292:where is pepsin released from?
2583
chief cells of stomach
2584
Q1293:what controls gastric acid release
2585
increased by histamine and ACh;decreased by somatostatin; GIP; PG; secretin
2586
Q1294:fxn of salivary amylase
2587
hydrolyzes alpha-1;4 linkages --> disaccharides
2588
Q1295:fxn of pancreatic amylase
2589
hydrolyzes starch to oligosaccharides and disaccharides
2590
Q1296:where is pancreatic amylase found
2591
highest [] in duo lumen
2592
Q1297:fxn of oligosaccharide hydrolase
2593
hydrolyzes oligosaccharidses --> monosaccharides ;RL step in carb digestion
2594
Q1298:What cells are the source of GASTRIN?
2595
G cells (antrum)
2596
Q1299:What cells are the source of CCK?
2597
I cells (duodenum; jejunum)
2598
Q1300:What cells are the source of SECRETIN?
2599
S cells (duodenum)
2600
Q1301:What cells are the source of SOMATOSTATIN?
2601
D cells (pancreatic islets; GI mucosa)
2602
Q1302:What cells are the source of GIP?
2603
K cells (duodenum; jejunum)
2604
Q1303:What cells are the source of INTRINSIC FACTOR?
2605
Parietal cells (body; fundus)
2606
Q1304:What cells are the source of HCL?
2607
Parietal cells (body; fundus)
2608
Q1305:What cells are the source of PEPSIN?
2609
Chief cells (stomach)
2610
Q1306:What cells are the source of HCO3-?
2611
Mucosal cells (stomach; duodenum)
2612
Q1307:What is the function of GASTRIN?
2613
increased gastric H+ secretion;increased gastric mucosa
2614
Q1308:What is the function of CCK?
2615
increased pancreatic secretions;Stimulates gallbladder contraction;Inhibits gastric emptying
2616
Q1309:What is the function of SECRETIN?
2617
increased pancreatic HCO3- secretion ;Inhibits HCl secretion
2618
Q1310:What is the function of SOMATOSTATIN?
2619
Inhibits everything;Inhibits gallbladder contraction;Inhibits release of both insulin and glucagon
2620
Q1311:What is the function of GIP?
2621
Exocrine: decreased gastric H+ secretion;Endocrine: increased insulin release
2622
Q1312:What is the function of INTRINSIC FACTOR
2623
Binds B12
2624
Q1313:What is the function of HCL?
2625
decreased stomach pH
2626
Q1314:What is the function of PEPSIN?
2627
Protein digestion at pH of 1.0-3.0
2628
Q1315:What is the function of HCO3-?
2629
Neutralizes acid;Prevents autodigestion
2630
Q1316:What stimulates gastrin release?
2631
Stomach distention;Amino acids;Vagal stimulation
2632
Q1317:What inhibits gastrin release?
2633
H+ secretion;pH < 1.5
2634
Q1318:What stimulates CCK release?
2635
Fatty acids;Amino acids
2636
Q1319:What inhibits CCK release?
2637
Secretin;pH < 1.5
2638
Q1320:What stimulates secretin release?
2639
Low duodenal pH;Fatty acids in lumen of duodenum
2640
Q1321:What stimulates somatostatin release?
2641
Low pH
2642
Q1322:What inhibits somatostatin release?
2643
Vagal input
2644
Q1323:What stimulates HCl secretion?
2645
Histamine;ACh;Gastrin
2646
Q1324:What inhibits HCl secretion?
2647
Somatostatin;GIP;Prostaglandins
2648
Q1325:What stimulates pepsin secretion?
2649
Vagal input;Local acid
2650
Q1326:What stimulates HCO3- secretion?
2651
Secretin
2652
Q1327:What is the function of VIP?
2653
Relaxes intestinal smooth muscle;Stimulates pancreatic HCO3- secretion;Inhibits gastric H+ secretion
2654
Q1328:What is the source of VIP?
2655
Smooth muscle and nerves of intestines
2656
Q1329:Where does TRYPSIN cleave?
2657
Carboxy side of ARG and LYS
2658
Q1330:Where does CHYMOTRYPSIN cleave?
2659
Carboxy side of aromatic amino acids (PHE; TYR; TRP)
2660
Q1331:Where does ELASTASE cleave?
2661
Carboxy side of ALA; GLY; and SER
2662
Q1332:What is the function of SALIVARY AMYLASE?
2663
Starts digestion;Hydrolyzes alpha-1;4 linkages to give maltose; maltotriose; and alpha-limit dextrans
2664
Q1333:What is the function of PANCREATIC AMYLASE?
2665
Hydrolyzes starch to oligosaccharides; maltose; and maltotriose
2666
Q1334:Where is the highest concentration of PANCREATIC AMYLASE?
2667
Duodenal lumen
2668
Q1335:Where are lipids digested?
2669
Duodenum
2670
Q1336:Where are lipids absorbed?
2671
Jejunum
2672
Q1337:major cations/anions of ICF?
2673
cations--K+; Mg2+; anions--protein; organic phosphates (eg ATP)
2674
Q1338:markers for measuring TBW
2675
D2O; tritiated H2O
2676
Q1339:markers for measuring ECF?
2677
mannitol; sulfate; inulin
2678
Q1340:markers for measuring plasma?
2679
RISA; Evan's blue
2680
Q1341:markers for measuring interstitial fluid?
2681
indirect: ECF - plasma (mannitol - Evan's blue)
2682
Q1342:markers for measuring ICF?
2683
do indirectly: TBW - ECF (D2O - mannitol)
2684
Q1343:What happens if isotonic NaCl is infused?
2685
isosmotic volume expansion
2686
Q1344:What happens to fluid volumes if you have diarrhea?
2687
loss of isotonic fluid-->isometric volume contraction
2688
Q1345:what happens to fluid volumes if excessive NaCl intake?
2689
hyperosmotic vol expansion
2690
Q1346:what happens to fluid volumes if you get lost in a desert? (dehydration)
2691
hyperosmotic vol contractino
2692
Q1347:what happens to fluid volumes in SIADH?
2693
hyposmotic volume expansion
2694
Q1348:what happens to fluid volumes if adrenocortical insufficiency?
2695
hyposmotic volume contraction
2696
Q1349:treatment of SIADH?
2697
demeclocyclene; water restriction
2698
Q1350:renal blood flow is what % of CO?
2699
~25%
2700
Q1351:at low [ang II]; what effect on renal arterioles?
2701
preferential dilation of efferent arteriole--> protects GFR
2702
Q1352:over what range of pressures does renal blood flow remain constant (autoregulation)
2703
80-200mmHg (thanks to myogenic mech and tubuloglomerular feedback)
2704
Q1353:How measure renal plasma flow?
2705
use PAH; which is both filtered and secreted by renal tubules (so that~none in renal veins); this is the effective RPF
2706
Q1354:filtration fraction?
2707
GFR/RPF (normal~0.20)
2708
Q1355:where does acetozolamide work in kidney?
2709
(carbonic anhydrase inhibitor) works in PCT to inhibit resorption of HCO3- (w/o bicarb; don't have H+ needed for Na-H antiport) (N.B. can also tx acute mountain sickness)
2710
Q1356:middle/late PCT vs. early PCT?
2711
early PCT--Na resorb.coupled with glucose; aa; phosphate; etc; mid/late PCT--Na resorb.w/ Cl-
2712
Q1357:where do K+sparing diuretics work?
2713
in CCD
2714
Q1358:role of alpha intercalated cells?
2715
secrete H+ and resorb. K+ if hypokalemic (or acidic?)
2716
Q1359:what cell is responsible for excreting K+ in hyperkalemia?
2717
principal cell (via Na-K ATPase and K channels)
2718
Q1360:where is phosphate resorbed?
2719
only in PCT. ~15% of filtered phosphate excreted (imp for buffering later on)
2720
Q1361:effect of PTH on phosphate in kidney?
2721
PTH inhibits phosphate resorb. in PCt via inc'd AC->cAMP. (get phosphaturia and inc'd urinary cAMP)
2722
Q1362:which diuretics can be used to treat hypercalcemia?
2723
loop diuretics
2724
Q1363:which diuretics can be used to treat hypercalciURIA
2725
thiazides (increase Ca resorb.)
2726
Q1364:relationship of K+ and NH3?
2727
hyperkalemia inhibits NH3 synthesis (RTA type 4); dec'd H+ excretion; hyPOkalemia--stim NH3 synthesis
2728
Q1365:ECF volume contraction and acid/base balance?
2729
ECF volume contraction-->HCO3- resorb; contraction alkalosis (N.B. in vomiting; met alk made worse if ECF vol contracts!)
2730
Q1366:why might you get tingling; numbness; muscle spasms in respiratory alkalosis?
2731
signs/symptoms of hypocalcemia; b/c H+ and Ca2+ compete for protein binding sites and dec'd H+ means more bound Ca and less free Ca (~hypocalc.)
2732
Q1367:effect of insulin on K+?
2733
insulin deficiency--> shift of K+ out of cells; hyperkalemia; insulin-->shift of K+ into cells; hypokalemia
2734
Q1368:what happens to osmolarity of ECF if person is infused with isotonic saline solution?
2735
stays the same
2736
Q1369:what happens to osmolarity of ECF if person has loss of isotonic fluid? (example)
2737
diarrhea;stays the same
2738
Q1370:what happens to osmolarity of ECF if person has high NaCl intake?
2739
incresaes
2740
Q1371:what happens to ECF osmolarity if person is sweating in the desert?
2741
increases (sweat is hyposmotic; more water than salt is lost)
2742
Q1372:what happens to ECF osmolarity in SIADH?
2743
decreases
2744
Q1373:what happens to ECF osmolarity in adrenocortical insufficiency (NaCl loss)?
2745
decreases (lack of aldosterone); kidneys excrete more NaCl than water
2746
Q1374:what happens to plasma protein [] and hematocrit in infusion of isotonic NaCl?
2747
decreases (overall increase in fluid)
2748
Q1375:what happens to plasma protein [] and hct in diarrhea?
2749
increases (from volume contraction)
2750
Q1376:what happens to plasma protein [] and hct in high NaCl consumption?
2751
decrease (ICF shrinks to accomodate the increased osmolarity in ECF; this dilutes out the plasma protein)
2752
Q1377:what happens to plasma protein [] and hct when swaeting in desert?
2753
protein increases;hct stays same b/c fluid leaves rbcs to offset fuid loss
2754
Q1378:what happens to plasma protein [ ] and hct in siadh
2755
decreases;stays same
2756
Q1379:what happens to plasma protein [] and hct in adrenal insuff?
2757
plasma protein increases;hct increases (from decreased ECF volume and rbc swelling from water entry)
2758
Q1380:how does vasoconstriction of renal arterioles affect RBF? how is this achieved?
2759
decreases RBF;SNS
2760
Q1381:how does AII affect renal arterioles
2761
preferentially constricts efferent arterioles unless it is a situation where there is a massive hemorrhage. then; so much AII is released that it constricts both efferent and afferent arterioles
2762
Q1382:how does ACE affect renal arterioles
2763
preferentially constricts efferent arterioles
2764
Q1383:what effects does AII have on GFR?
2765
increases it
2766
Q1384:what effect do ACE-I have on GFR
2767
decreass it by dilating efferent arterioles
2768
Q1385:what does afferent arteriole constriction do to RPF?
2769
decreases
2770
Q1386:what does efferent artiorole constriction do to GFR?
2771
increases (by increasing Pgc)
2772
Q1387:what does increased plasma protein do to GFR?
2773
decreases it by increasing osmotic pressure in GC
2774
Q1388:what does decreased plasma protein do to GFR?
2775
increases it by decreasing osmotic pressure in GC
2776
Q1389:what does increased plasma protein do to RBF?
2777
nothing
2778
Q1390:what does decreased plasma protein [] do to RBF?
2779
nothing
2780
Q1391:what does efferent arteriole constriction do to RBF?
2781
decreases it
2782
Q1392:what happens to the filtration fraction in afferent arteriole constriction?
2783
(GFR/RBF);GFR decreases; RBF decreases;FF no change
2784
Q1393:what happens to FF in efferent arteriole constriction
2785
GFR/RBF;GFR increases; RBF decreases ;FF increases
2786
Q1394:what happens to FF in increased plasma protein concentraton
2787
GFR/RBF;GFR decreases; RBF no change;FF decreases
2788
Q1395:what happens to FF in decreased plasma protein []
2789
GFR/RBF;GFR increases; RBF no change;FF increases
2790
Q1396:what happens to FF when ureter is constricted?
2791
GFR/RBF ;GFR decreases; RBF no change;FF decreases
2792
Q1397:what things are reabsorbed in the PCT?
2793
glucose;AA's;most of the HCO3
2794
Q1398:describe how HCO3 is handled in PCT
2795
HCO3 is in the lumen and combines with H that is secreted into the lumen --> H2CO3;Carbonic anhydrase --> H20 + CO2 ;which re-enters the tubule and reforms as H2CO3 with CA ;the H is then secreted into the lumen and the HCO3 is reabsorbed
2796
Q1399:what happens in the TAL?
2797
NKCC pump (blocked by furosemide): aids in reabsorbing Na; Cl; K ;K flows back out into lumen and the gradient drives the absorption of Mg and Ca ;also aids in the running of the NKCC pump
2798
Q1400:is the TAL permeable to water
2799
no
2800
Q1401:what is the thin descending loop permeable to?
2801
water; but not Na
2802
Q1402:what is happens in the early distal convaluted tubule
2803
actively reabsorbs Na; Cl ;Ca absorption is controlled by PTH receptors found here
2804
Q1403:what happens in the collecting tubules
2805
Na is reabsorbed in exchange for K/H (regulated by ALDOSTERONE!!!) ;reabsorption of water regulated by ADH (aquaporins)
2806
Q1404:which part of the nephron is impermeable to water?
2807
TAL (and collecting tubule if there is no ADH)
2808
Q1405:where in kidney is EPO released from
2809
endo cells of peritubular capillaries
2810
Q1406:what enzyme converts 25-OH vitamin D to its active form?
2811
1-alpha hydroxylase
2812
Q1407:what do JG cells do?
2813
secrete renin in response to low renal blood pressure
2814
Q1408:what does the macula densa do?
2815
senses the amt of Na
2816
Q1409:where is the macula densa
2817
part of the DCT
2818
Q1410:what do PGs do to the kidney
2819
vasodilate the afferent arterioles (that's why NSAIDS can --> ARF by inhibiting PG)
2820
Q1411:what effect does aldosterone have on H
2821
more H is secreted
2822
Q1412:where does aldosterone work in kidney?
2823
DCT
2824
Q1413:where does PTH work?
2825
PCT to decrease PO4 reabsorption ;DCT to increase Ca reabsorption ;stimulates 1-alpha hydroxylase in PCT
2826
Q1414:where is ACE released from?
2827
lung
2828
Q1415:increased glomerular pressure; decreased peritulbuar pressure; decreased RPF
2829
Efferent arteriole constriction
2830
Q1416:decreased glomerular pressure; increased peritubular pressure; increased RPF
2831
Efferent arteriole dilation
2832
Q1417:decreased glomerular pressure; decreased peritulbuar pressure; decreased RPF
2833
Afferent arteriole constriction
2834
Q1418:increased glomerular pressure; increased peritulbuar pressure; increased RPF
2835
Afferent arteriole dilation
2836
Q1419:Afferent arteriole dilation
2837
increased glomerular pressure; increased peritulbuar pressure; increased RPF; increased GFR
2838
Q1420:Afferent arteriole constriction
2839
decreased glomerular pressure; decreased peritulbuar pressure; decreased RPF; decreased GFR
2840
Q1421:Efferent arteriole dilation
2841
decreased glomerular pressure; increased peritubular pressure; increased RPF; decreased GFR
2842
Q1422:Efferent arteriole constriction
2843
increased glomerular pressure; decreased peritulbuar pressure; decreased RPF; increased GFR; increased FF
2844
Q1423:Plasma oncotic pressure changes as blood flows through the nephron
2845
Oncotic pressure increases because filtered fluid increases protein concentration. Oncotic pressure is resposible for peritubular reabsorption
2846
Q1424:Normal capillary hydrostatic pressure of the glomerulus
2847
45 mmHg
2848
Q1425:Normal capillary oncotic pressure of the glomerulus
2849
27 mmHg
2850
Q1426:Normal hydrostatic pressure of bowman's capsule
2851
10 mmHg
2852
Q1427:Normal GFR value
2853
120 ml/min
2854
Q1428:Normal RPF value
2855
600 ml/min
2856
Q1429:Normal filtration fraction value
2857
FF = GFR/RPF = 120mi/min / 600ml/min = 0.20
2858
Q1430:Effect of sympathetic stimulation in the nephron
2859
decreased GFR; increased FF; increased peritubular reabsoption
2860
Q1431:Effect of angiotensin II in the kidney
2861
Vasoconstriction of the efferent arteriole more than afferent -> maintains GFR
2862
Q1432:Filtered load
2863
Rate at which a substance filters into Bowman's capsule = FL = GFR x Free plasma concentration
2864
Q1433:Excretion of a substance in the urine
2865
Excretion = filtered load + (amount secreted - amount reabsorbed) = filtered load + transport OR urine concentration X urine flow rate
2866
Q1434:Characteristics of a Tm system
2867
Carriers become saturated; carriers have high affinity; low back leak. The filtered load is reabsorbed until carriers are saturated - the excess is excreted.
2868
Q1435:Renal treshold for glucose
2869
180 mg/dl or 1.8 mg/ml. Represents the beginning of splay.
2870
Q1436:Tm rate of reabsorption of glucose
2871
375 mg/min. Represents the maximum filtered load that can be reabsorbed when all carriers in the kidney are saturated (end of splay region).
2872
Q1437:Glucose reabsorption graph
2873
At normal glucose levels; the amount filtered is the same as the amount reabsorbed. At threshold (beginning of splay); the excretion curve starts to ascend and the amount filtered exceeds the amount reabsorbed.
2874
Q1438:Substances that are reabsorbed using a Tm system
2875
Glucose; amino acids; small peptides; myoglobin; ketones; calcium; phosphate.
2876
Q1439:Characteristics of a gradient-time system
2877
Carriers are not saturated; carriers have low affinity; high back leak
2878
Q1440:Substances that are reabsorbed using a gradient-time system
2879
Sodium; potassium; chloride and water
2880
Q1441:Substances secreted using a Tm system
2881
PAH. 20% filtered; 80% secreted.
2882
Q1442:Graph for PAH secretion
2883
At low plasma concentration secretion is 4 times the filtered load. When carriers become saturated; secretion reaches a plateau and the amount excreted is proportional to the amount filtered.
2884
Q1443:How is the net transport rate for a substance calculated?
2885
Net transport rate = filtered load - excretion rate = (GFR X Px) - (Ux X V)
2886
Q1444:Effects of blood pressure changes in the kidney
2887
GFR and RBF are maintained constant within the autoregulatory range. Urine flow is directly proportional to blood pressure due to pressure natriuresis and pressure diuresis.
2888
Q1445:What is clearance and how is it calculated?
2889
It's the volume of plasma cleared of a substance over time. Clearance = excretion / Px = Ux X V / Px
2890
Q1446:Characteristics of glucose clearance
2891
At normal glucose levels; clearance is zero. Above treshold levels; clearance increases as plasma concentration increases but never reaches GFR as there's always glucose reabsorption.
2892
Q1447:Characteristics of inulin clearance
2893
A constant amount of inulin is cleared regardless of plasma concentration (parallel line to x axis). Inulin clearance is equal to GFR because it's not secreted nor reabsorbed. If GFR increases; clearance increases (line shifts upward); and vice versa.
2894
Q1448:Characteristics of creatinine clearance
2895
A constant amount of creatinine is cleared regardless of plasma concentration; but creatinine clearance is more than GFR because some is always secreted.
2896
Q1449:Characterisics of PAH clearance
2897
As plasma concentration increases; clearance decreases because carriers that mediate active secretion become saturated. At normal levels; PAH clearance = RPF because all is excreted.
2898
Q1450:How is GFR calculated using inulin?
2899
GFR is equal to inulin clearance because it's only filtered and none is secreted nor reabsorbed. Cin = GFR = Uin X V / Pin
2900
Q1451:How is creatinine production calculated?
2901
Creatinine production = creatinine excretion = filtered load of creatinine = [Cr]p X GFR. Creatinine is filtered and secreted; not reabsorbed.
2902
Q1452:How does inulin concentration change as it passes through the nephron?
2903
Inulin becomes more concentrated as it passes through the tubules because water is being reabsorbed and not inulin.
2904
Q1453:Gold standard to measure GFR
2905
Inulin clearance because it's filtered but not secreted nor reabsorbed.
2906
Q1454:Gold standard to measure RPF
2907
PAH clearance because some is filtered and the remaining is all secreted.
2908
Q1455:How is effective RPF calculated?
2909
PAH clearance = RPF = Upah X V / Ppah
2910
Q1456:How is renal blood flow calculated?
2911
ERPF / 1-Hct; ERPF = Upah X V / Ppah
2912
Q1457:What does positive free water clearance mean?
2913
Water is being eliminated. Hypotonic urine is being formed to increase plasma osmolarity.
2914
Q1458:What does negative free water clearance mean?
2915
Water is being conserved. Hypertonic urine is being formed to lower plasma osmolarity.
2916
Q1459:How is free water clearance calculated?
2917
V - (Uosm(V) / Posm)
2918
Q1460:Which substance is cleared the most: PAH; inulin; glucose; creatinine
2919
PAH
2920
Q1461:Which substances are cleared more than glucose?
2921
Sodium; inulin; creatinine; PAH
2922
Q1462:Which substance is cleared the least: PAH; inulin; glucose; creatinine
2923
Glucose
2924
Q1463:Which substances are cleared more than inulin?
2925
Creatinine; PAH
2926
Q1464:Which substances are cleared less than creatinine?
2927
Inulin; glucose; sodium
2928
Q1465:Transporters in the luminal membrane of the proximal tubule
2929
Secondary Na/glucose cotransporter; secondary Na/amino acid cotransporter; secondary Na/H countertransporter
2930
Q1466:What substances are reabsorbed in the proximal tubule and how much?
2931
Na (2/3 of filtered load); glucose (100%); amino acids (100%); HCO3 (indirectly; 80%); H20 (2/3); K (2/3); Cl (2/3)
2932
Q1467:Tubular osmolarity at beginning and end of proximal tubule
2933
At the beginning and end is isotonic with plasma but only 1/3 of the filtered load.
2934
Q1468:Transporters in the basal membrane of proximal tubule
2935
Na/K ATPase - luminal membrane secondary Na transporters depend on this.
2936
Q1469:Transporters in the basolateral membrane of proximal tubule
2937
Na/K ATPase - luminal membrane secondary Na transporters depend on this.
2938
Q1470:Most energy-dependant process in the nephron
2939
Active reabsorption of Na by the basal and basolateral Na/K ATPase
2940
Q1471:Characteristics of the loop of henle
2941
Descending limb is permeable to water so water difuses out and intraluminal osmolarity increases to 1;200mOsm Ascending limb is impermeable to water and Na is actively pumped out by Na/K/2Cl pump so fluid becomes hypotonic. Flow is slow; anything that increases flow; decreases capacity to concentrate urine.
2942
Q1472:Characteristics of the collecting duct
2943
Impermeable to water unless ADH is present. ADH increases permeability to H20 and urea to concentrate urine. Tight junctions with little back-leak.
2944
Q1473:Specialized cells of the distal tubule and collecting duct
2945
Principal cells (aldosterone) and intercalated cells (create HCO3)
2946
Q1474:Actions of principal cells of the distal tubule and collecting duct
2947
Aldosterone increases Na receptors in the membrane and increases primary transport by Na/K ATPase. Secondary transport of Na and secretion of K.
2948
Q1475:Actions of intercalated cells of the distal tubule and collecting duct
2949
Acidify the urine and produce new bicarbonate
2950
Q1476:Actions of the distal tubule and collecting duct
2951
Reabsorption of Na and secretion of K (stimulated by aldosterone); acidification of the urine (secretion of H and creation of HCO3)
2952
Q1477:Urine buffer systems
2953
H2PO4- (dihydrogen phosphate) (tritratable acid) buffers 33% of secreted H. NH4+ (amonium) (nontritratable acid) buffers the remaining secreted H.
2954
Q1478:How is potassium affected by acidosis?
2955
High concentration of ECF H --> H diffuses to ICF --> K diffuses to ECF --> hyperkalemia
2956
Q1479:How is potassium affected by alkalosis?
2957
Low concentration of ECF H --> H diffuses to ECF --> K diffuses to ICF --> hypokalemia
2958
Q1480:Potassium dynamics in acute alkalosis
2959
Hypokalemia; increased intracellular K; increased renal K excretion; negative K balance
2960
Q1481:Potassium dynamics in chronic alkalosis
2961
Hypokalemia; decreased intrecellular K; increased renal K excretion; negative K balance
2962
Q1482:Potassium dynamics in acute acidosis
2963
Hyperkalemia; decreased intracellular K; decreased renal K excretion; positive K balance
2964
Q1483:Potassium dynamics in chronic acidosis
2965
Hyperkalemia; decreased intracellular K; increased renal K excretion; negative K balance
2966
Q1484:How is potassium balance in acute acidosis?
2967
Positive (potassium is reabsorbed)
2968
Q1485:How is potassium balance in acute alkalosis?
2969
Negative (potassium is excreted)
2970
Q1486:How is potassium balance in chronic alkalosis?
2971
2972
Q1487:How is potassium balance in chronic acidosis?
2973
2974
Q1488:How is plasma potassium concentration in alkalosis?
2975
Hypokalemia
2976
Q1489:How is plasma potassium concentration in acidosis?
2977
Hyperkalemia
2978
Q1490:What is the difference in potassium dynamics between acute and chronic alkalosis?
2979
Acute alkalosis --> increased intracellular K; Chronic alkalosis --> decreased intracellular K
2980
Q1491:What is the difference in potassium dynamics between acute and chronic acidosis?
2981
Acute acidosis --> decreased renal K excretion; positive K balance; Chronic acidosis --> increased renal K excretion; negative K balance
2982
Q1492:Changes in respiratory acidosis
2983
Hypoventilation --> increased PaCO2 --> increased H and slight increased in HCO3 --> decreased pH
2984
Q1493:Changes in respiratory alkalosis
2985
Hyperventilation --> decreased PaCO2 --> decreased H and HCO3 --> increased pH
2986
Q1494:Changes in metabolic acidosis
2987
Gain of H or loss of HCO3 --> decreased HCO3 --> decreased pH. To see if gain of H or loss of HCO3 check anion gap.
2988
Q1495:Changes in metabolic alkalosis
2989
Loss of H or gain in HCO3 --> increased HCO3 --> increased pH. To see if gain of H or loss of HCO3 check anion gap.
2990
Q1496:Normal values of PCO2; HCO3 and pH
2991
pH = 7.4; PCO2 = 40mmHg; HCO3 = 24mmol/L
2992
Q1497:increased pH; increased HCO3; increased PCO2; decreased PO2; alkaline urine
2993
Partially compensated metabolic alkalosis
2994
Q1498:decreased pH; increased PCO2; increased HCO3; decreased PO2; acid urine
2995
Partially compensated respiratory acidosis
2996
Q1499:increased pH; decreased PCO2; decreased HCO3; normal PO2; alkaline urine
2997
Partially compensated respiratory alkalosis
2998
Q1500:decreased pH; decreased PCO2; decreased HCO3; normal PO2; acid urine
2999
Partially compensated metabolic acidosis
3000
Q1501:Normal plasma anion gap value
3001
PAG = 12
3002
Q1502:Conditions that increase plasma anion gap
3003
Lactic acidosis; ketoacidosis; ingestion of salicylate
3004
Q1503:Hyperchloremic non-anion gap metabolic acidosis
3005
Loss of HCO3 (as in diarrhea) causes increases absorption of solutes and water; increasing Cl. Therefore decreased HCO3 and increased Cl with a plasma anion gap of 12.
3006
Q1504:Equation to measure body fluid volumes
3007
V= Q/C;V= body fluid volume;Q= indicator administered;C=concentration of indicator
3008
Q1505:TBW indicators
3009
D20; H20; antipyrine
3010
Q1506:ECF indicators
3011
Na; inulin; mannitol
3012
Q1507:PV indicators
3013
Albumin; Evans blue; Cr red blood cells
3014
Q1508:100 mM glucose =
3015
100 osm
3016
Q1509:100 nM NACL
3017
200 mOsm/L
3018
Q1510:Filtered Load =
3019
GFR * Solute (plasma)
3020
Q1511:Excretion:
3021
Volume Urine Flow * Urine concentration
3022
Q1512:Clearance Concept
3023
Related the excretion of a substance to its concentration in plasma
3024
Q1513:Clearance Calculation
3025
C= U*V/Ps;Cs: Clearance of substance;U: urine concetration of substance;V: Urine flow;P: Plasma concentration
3026
Q1514:Applying Clearance to GFR
3027
Inulin Clearance used to measure GFR
3028
Q1515:Best clinical measure of GFR
3029
Creatinine
3030
Q1516:Clearance to Renal Plasma Flow and RBF
3031
PAH clearance = RBF ;PAH measures PLASMA FLOW ONLY
3032
Q1517:RBF using REnal plasma flow =
3033
RBF=RPF (1- hematocrit);*Hct: 0.40
3034
Q1518:Specialized portion of capillaries that perfuse medilla
3035
vasa recta
3036
Q1519:Filtration fraction
3037
GFR/RBF
3038
Q1520:Filtration
3039
GFR= KF (Pgc-Pbc) - ;(TT gc-TTbc)
3040
Q1521:Myogenic autoregulation
3041
Increase in arterial pressure; stretches vessel wall leading to an icnrease in calcium movement and contraction
3042
Q1522:Tubuloglomerular feedback
3043
decrease in arterial pressure causes decrease in GFR; decreasing NACL to macula densa; Therefore efferent arteriolar resistnace Increases in response to HIGH angiotensin II.
3044
Q1523:Regulation of filtration of AFFERENT Arteriole; CONSTRICTION (Dilation is opposite)
3045
Pcap: D;GFR: D;RBF: D
3046
Q1524:Regulation of filtration of EFFERENT Arteriole;CONSTRICTION ;(Dilation is opposite)
3047
Pcap: U;GFR: U;RBF: D
3048
Q1525:T Max or GLucose is
3049
300 mg/min reabsorption
3050
Q1526:REABSORPTION AND SECRETION
3051
REABSORPTION AND SECRETION
3052
Q1527:Proximal Tubule
3053
NAHCO3 reabsoprtion;NACL ;Water;Glucose
3054
Q1528:How are ions absorbed
3055
Na/H antiport;Cl/Anion antiport ;Na/K Atpase;*Water follows non Cl reabsorption and icnreases tubular fluid of Cl.
3056
Q1529:H= in proximal tubule is
3057
Secreted
3058
Q1530:Descending Thin Limb
3059
Reabsorbs 15% GFR;Tbublular fluid volume DECREASES ;Tubular fluid osmolarity INCREASES
3060
Q1531:Thick Ascending Loop of Henle
3061
break
3062
Q1532:Reabsorption of Na
3063
Symport with Cl/ K;Antiport with H
3064
Q1533:Reabsorption of K
3065
Symport with Na and Cl-
3066
Q1534:Reabsorption of Ca
3067
Ca Atpase; Na/Ca exchange;2G/Ca Atpase antiport;PTH stimulates
3068
Q1535:Reabsorption of MG
3069
active and electrical force
3070
Q1536:SECRETION of H
3071
Na/H exchange/ NH4+
3072
Q1537:Early Distal tubulue
3073
REabsorbs NACL via Na-Cl symoporter;REabsorbs Ca via PTH
3074
Q1538:What inhibits NA/CL symporter and PTH
3075
Thiazide diuretics
3076
Q1539:LAte Tubule
3077
H20 reabsorbed by ADH;NACL REab by Aldosterone;HCO# reab vy aldosterone;SECRETION Of K= Aldosterone
3078
Q1540:Secretion of K determines
3079
total excretion
3080
Q1541:Collecting Duct
3081
Reabsorbs H20 by ADH;Reab. UREA via ADH
3082
Q1542:PTH acts on ? for Ca reabsorption
3083
DCT
3084
Q1543:ADH receptor complex activates
3085
adenylate cyclase. CAMP activates a kinase and phosphorylates proteins
3086
Q1544:In Normal system; Urine flow and osmolarity are
3087
inversely related
3088
Q1545:In the presence of ADH
3089
Water is reabsorbed;Urine volume is Small;Urine concentration is same in MEdulla = HYPEROSMOTIC
3090
Q1546:In the absence of ADH
3091
No Water reabsorbed;Urine flow is high/dilute;Medullary osmoloarty if low.
3092
Q1547:REgulation of Plama osmoloarity by ADH
3093
see page 300
3094
Q1548:ADH secretion is increased my
3095
elevated plasma sodium or osmolarity
3096
Q1549:ADH secretion is decresed by
3097
High blood volume or pressure
3098
Q1550:Glucose in a DM patietn causes
3099
opsmotic diuresis
3100
Q1551:ANP will
3101
Increase GFR;Decrease REnin; angio II; aldosterone; NACL and H2o reapbsortopn; ADH secretion
3102
Q1552:ADH will
3103
Increase H20 reabsorption; decrease urine flow and Increase urine osmolarity
3104
Q1553:Henderson Hasselbach equation
3105
ph=6.1 log (HCO3) / 0.03 PCO2
3106
Q1554:Increase in ventilation will
3107
decrease PCO@ (Alkalosis)
3108
Q1555:Decrease in Ventilation
3109
Increases PCO2 (acidosis)
3110
Q1556:Cahnge in renal acid excretion and HCO3 production is
3111
Metabolic response
3112
Q1557:Standard Values of ;HCO3 = 24 mEq/L;PCO2= 40 mm HG
3113
Just know
3114
Q1558:Acidosis due to loss of HCO3 or DIARRHEA
3115
Hyperchloremic Acidosis (because kdineys reabosrb CL since no HCO3)
3116
Q1559:Conducting zone ;Consists of
3117
nose; pharynx; trachea; bronchi; bronchioles; and terminal bronchioles.
3118
Q1560:Respiratory zone ;Consists of
3119
respiratory bronchioles; alveolar ducts; and alveoli.
3120
Q1561:Pneumocytes;Pseudocolumnar ciliated cells extend to the
3121
respiratory bronchioles;
3122
Q1562:Pneumocytes;extend to the respiratory bronchioles
3123
Pseudocolumnar ciliated cells
3124
Q1563:Pneumocytes;goblet cells extend to the
3125
terminal bronchioles.
3126
Q1564:Pneumocytes;extend to the terminal bronchioles.
3127
goblet cells
3128
Q1565:Pneumocytes;%'s
3129
Type I cells (97% of alveolar surfaces);Type II cells (3%)
3130
Q1566:role of;Type I cells
3131
line the alveoli.
3132
Q1567:role of;Type II cells
3133
-secrete pulmonary surfactant;-serve as precursors to type I cells and other type II cells. Type II cells
3134
Q1568:role of;clara cells
3135
secrete a component of surfactant - degrade toxins - act as reserve cells
3136
Q1569:ratio of in amniotic ;?uid is indicative of fetal ;lung maturity.
3137
A lecithin-to-sphingomyelin ;ratio of > 2.0
3138
Q1570:bronchopulmonary segment ;structure
3139
3(segmental) bronchus ;- 2 arteries (bronchial ;and pulmonary) in the center - veins and lymphatics drain along the borders.
3140
Q1571:what is described by RALS
3141
the heart. The relation of the ;pulmonary artery to the ;bronchus at each lung hilus ;is described by RALS ;Right Anterior; Left ;Superior.
3142
Q1572:Structures perforating diaphragm;what and levels
3143
-T8: IVC;-T10: esophagus; vagus (2 trunks);-At T12: aorta (red); thoracic duct (white); azygous vein (blue).
3144
Q1573:Pain from the diaphragm can be referred to
3145
the shoulder.
3146
Q1574:Muscles of respiration;in exercise
3147
Inspirationexternal intercostals; scalene muscles; sternomastoids;Expirationrectus abdominis; internal and external obliques; transversus abdominis;internal intercostals.
3148
Q1575:5 Important lung products
3149
-Surfactant;-ACE;-Prostaglandins;-histamine;-Kallikrein
3150
Q1576:Surfactant;aka
3151
dipalmitoyl phosphatidylcholine ;or ;lecithin
3152
Q1577:Collapsing pressure =
3153
2T/R;T=tension;R= radius
3154
Q1578:what activates bradykinin
3155
Kallikrein
3156
Q1579:role of Kallikrein
3157
activates bradykinin
3158
Q1580:role of ACE in lung
3159
angiotensin I angiotensin II; inactivates bradykinin
3160
Q1581:lung effects of ACE inhibitors and other effect
3161
ACE inhibitors increased bradykinin and ;cause cough; angioedema)
3162
Q1582:role of surfactant/mech
3163
decreased alveolar surface tension;increased compliance
3164
Q1583:TLC =
3165
IRV + TV + ERV + RV
3166
Q1584:VC =
3167
TV + IRV + ERV
3168
Q1585:TV + IRV + ERV
3169
VC
3170
Q1586:IRV + TV + ERV + RV
3171
TLC
3172
Q1587:what causes a shift of the curve ;to the right.
3173
An increased in all factors (except pH)
3174
Q1588:what causes a shift of the curve to the left.
3175
A decreased in all factors (except pH)
3176
Q1589:Pulmonary circulation;;normal resistnace and compliance
3177
Normally a low-resistance; high-compliance system.
3178
Q1590:Pulmonary circulation;;A decreased in PaO2 causes
3179
a hypoxic vasoconstriction that shifts blood away from ;poorly ventilated regions of lung to well-ventilated regions of lung.
3180
Q1591:Pulmonary circulation;;Perfusion limited;what molecules / when / describe / how to change
3181
O2 (normal health);-CO2;-N2O;Gas equilibrates early along the length of the capillary. Diffusion can be increased only if blood ?ow increased .
3182
Q1592:Pulmonary circulation;;Diffusion limited;what molecules / when / describe
3183
O2 (exercise; emphysema;?brosis);-CO;-Gas does not equilibrate by the time blood reaches the end of the capillary.
3184
Q1593:Normal pulmonary artery pressure =;and when is it changes
3185
Normal pulmonary artery pressure = 1014 mm Hg; or >35 mm Hg during exercise;-pulmonary HTN25 mm Hg
3186
Q1594:Pulmonary hypertension;primary vs secondary
3187
Primaryunknown etiology; poor prognosis;;Secondary usually caused by COPD; also can be caused by L R shunt.
3188
Q1595:O2 content =
3189
(O2 binding capacity % saturation) + dissolved O2.
3190
Q1596:O2 changes as Hb falls
3191
O2 content of arterial blood decreased as [Hgb] falls;but O2 saturation and arterial PO2 do not.
3192
Q1597:Arterial PO2 decreased with
3193
chronic lung disease; physiologic shunt decreased O2 extraction ratio;not decrease in Hb
3194
Q1598:-Normally 1 g Hgb can bind;-normal Hgb amount in blood;-Normal O2 binding capacity
3195
-1 g Hgb can bind 1.34 mL O2;-Hgb amount in blood is 15 g/dL;-O2 binding capacity 20.1 mL O2 / dL.
3196
Q1599:increased A-a gradient may occur in
3197
-hypoxemia; causes include ;shunting; high V/Q mismatch; ?brosis (diffusion block)
3198
Q1600:CO2 transport forms
3199
1. Bicarbonate (90%);2. Bound to hemoglobin as carbaminohemoglobin (5%);3. Dissolved CO2 (5%)
3200
Q1601:Haldane effect
3201
In lungs; oxygenation of hemoglobin promotes dissociation of CO2 from hemoglobin
3202
Q1602:Bohr effect
3203
In peripheral tissue; increased H+ shifts curve to right; unloading O2
3204
Q1603:7 Response to high altitude
3205
1. Acute increased in ventilation;2. Chronic increased in ventilation;3. increased erythropoietin ;4. increased 2;3-DPG ;5. Cellular changes (increased mitochondria);6. increased renal excretion of bicarbonate to ;compensate for the respiratory alkalosis;7. Chronic hypoxic pulmonary vasoconstriction results in RVH
3206
Q1604:Emphysema ;types with causes
3207
Centriacinar: caused by smoking;Panacinar: alpha 1antitrypsin de?ciency
3208
Q1605:alpha 1-antitrypsin de?ciency leads to
3209
Panacinar Emphysema and liver cirrhosis
3210
Q1606:Paraseptal emphysema: what and who
3211
associated with bullae can rupture pneumothorax;often in young; otherwise healthy males.
3212
Q1607:associated with bullae can rupture pneumothorax;often in young; otherwise healthy males.
3213
Paraseptal emphysema
3214
Q1608:Emphysema ;pathology
3215
increased elastase activity;Enlargement of air spaces and decreased recoil resulting from destruction of alveolar ;walls.
3216
Q1609:Chronic Bronchitis ;pathology
3217
Hypertrophy of mucus glands in the bronchioles Reid index = gland depth / total thickness of bronchial wall; in COPD; Reid index > 50%.
3218
Q1610:Reid index
3219
gland depth / total thickness of bronchial wall; in COPD; Reid index > 50%.
3220
Q1611:Bronchiectasis ;pathology
3221
Chronic necrotizing infection of ;bronchipermanently dilated airways;
3222
Q1612:Bronchiectasis ;complications
3223
purulent sputum; recurrent infections; hemoptysis.
3224
Q1613:causes of Bronchiectasis
3225
Associated with bronchial obstruction; CF; poor ciliary motility; Kartageners ;syndrome.
3226
Q1614:Asthma triggers
3227
Can be triggered by viral URIs; allergens; and stress.
3228
Q1615:Restrictive lung;disease causes ;Poor breathing mechanics (extrapulmonary):
3229
a. Poor muscular effortpolio; myasthenia gravis;b. Poor structural apparatusscoliosis; morbid obesity
3230
Q1616:Restrictive lung;disease 8 types;Interstitial lung diseases (pulmonary):
3231
1. (ARDS) 2. Neonatal RDS ;3. Pneumoconioses ;4. Sarcoidosis;5. Idiopathic pulmonary ?brosis;6. Goodpastures syndrome;7. Wegeners granulomatosis;8. Eosinophilic granuloma
3232
Q1617:Pneumoconioses ;name some
3233
coal miners silicosis; asbestosis
3234
Q1618:Neonatal respiratory distress ;syndrome;Tx
3235
maternal steroids before birth;arti?cial surfactant for infant.
3236
Q1619:Adult acute respiratory distress syndrome (ARDS);pathophys
3237
Diffuse alveolar damageincreased alveolar capillary permeability protein-rich leakage into alveoli. Results in formation of intra-alveolar hyaline membrane.
3238
Q1620:Adult acute respiratory distress syndrome (ARDS);initial damage due to
3239
-neutrophilic substances toxic to alveolar wall;-activation of coagulation cascade;-oxygen-derived free radicals.
3240
Q1621:Sleep apnea;types
3241
Central sleep apneano respiratory effort;Obstructive sleep apnearespiratory effort ;against airway obstruction.
3242
Q1622:Sleep apnea;define
3243
Person stops breathing for at least 10 seconds ;repeatedly during sleep.
3244
Q1623:Sleep apnea;complications
3245
- systemic/pulmonary hypertension;-arrhythmias;-possibly sudden death;-chronic fatigue
3246
Q1624:Asbestosis;mech
3247
Diffuse pulmonary interstitial ?brosis caused by inhaled asbestos ?bers.
3248
Q1625:asbestos;wrt malignancy
3249
increased risk of;pleural mesothelioma ;bronchogenic carcinoma.
3250
Q1626:pneumoconioses ;where in lungs
3251
Asbestosis Mainly affects lower lobes. Other pneumoconioses ;affect upper lobes (e.g; coal worker's lung).
3252
Q1627:Asbestos and smoking
3253
Asbestosis and smoking greatly;increased risk of bronchogenic cancer (smoking not additive with mesothelioma).
3254
Q1628:Asbestosis;histo
3255
Ferruginous bodies in lung (asbestos ?bers coated with hemosiderin). Ivory-white pleural plaques
3256
Q1629:Bronchial obstruction ;-Breath Sounds ;-Resonance ;Fremitus ;-Tracheal Deviation
3257
-Absent/decreased over affected area ;-decreased ;-decreased ;-Toward side of lesion
3258
Q1630:Pleural effusion;-Breath Sounds ;-Resonance ;Fremitus ;-Tracheal Deviation
3259
-decreased over effusion ;-Dullness ;-decreased ;- NC
3260
Q1631:Pneumonia (lobar) ;-Breath Sounds ;-Resonance ;Fremitus ;-Tracheal Deviation
3261
-May have bronchial ;breath sounds over lesion;-Dullness ;increased ;-NC
3262
Q1632:Pneumothorax;-Breath Sounds ;-Resonance ;-Fremitus ;-Tracheal Deviation
3263
-decreased ;-Hyperresonant ;-Absent ;-Away from side of lesion
3264
Q1633:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-Absent/decreased over affected area ;-decreased ;decreased ;-Toward side of lesion
3265
Bronchial obstruction
3266
Q1634:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-decreased over effusion ;-Dullness ;-decreased ;NC
3267
Pleural effusion
3268
Q1635:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-May have bronchial ;breath sounds over lesion;Dullness ;-increased ;-NC
3269
Pneumonia (lobar)
3270
Q1636:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-decreased ;-Hyperresonant ;-Absent ;-Away from side of lesion
3271
Pneumothorax
3272
Q1637:Lung cancer;complications
3273
SPHERE of complications;-Superior vena cava syndrome;Pancoasts tumor;-Horners syndrome;-Endocrine (paraneoplastic);-Recurrent laryngeal symptoms;(hoarseness);-Effusions (pleural or ;pericardial)
3274
Q1638:Lung cancer;which types are central
3275
-Squamous cell carcinoma;-Small-cell
3276
Q1639:Lung cancer;which types are peripheral
3277
Adenocarcinoma;Bronchial ;Bronchoalveolar ;Large cell carcinoma
3278
Q1640:Lung cancer;describe Squamous cell ;carcinoma (gross)
3279
Hilar mass arising from bronchus; Cavitation;
3280
Q1641:Lung cancer;which have strong smoking association
3281
-Squamous cell carcinoma;-Small-cell
3282
Q1642:Lung cancer;Undifferentiated very aggressive
3283
Small-cell (oat-cell) carcinoma
3284
Q1643:Lung cancer;ectopic production of ACTH or ADH
3285
3286
Q1644:Lung cancer;Lambert-Eaton syndrome.
3287
3288
Q1645:Lung cancer histology;Small-cell (oat-cell) carcinoma
3289
Neoplasm of neuroendocrine ;Kulchitsky cells small dark ;blue cells.
3290
Q1646:Lung cancer histology;Squamous cell carcinoma
3291
Keratin pearls and intercellular ;bridges.
3292
Q1647:Lung cancer histology;Neoplasm of neuroendocrine ;Kulchitsky cells small dark ;blue cells
3293
3294
Q1648:Lung cancer histology;Keratin pearls and intercellular bridges
3295
Squamous cell carcinoma
3296
Q1649:Lung cancer histology;Clara cells type II pneumocytes multiple densities on x-ray of chest.
3297
both types of Adenocarcinoma;Bronchial ;and;Bronchoalveolar
3298
Q1650:Lung cancer histology;Pleomorphic giant cells with ;leukocyte fragments in ;cytoplasm.
3299
Large cell carcinoma
3300
Q1651:Lung cancer histology;Adenocarcinoma
3301
Both Types: Clara cells type II pneumocytes multiple densities on x-ray of chest.
3302
Q1652:Lung cancer histology;Large cell carcinoma
3303
Pleomorphic giant cells with ;leukocyte fragments in ;cytoplasm.
3304
Q1653:Lung cancer characteristics;Adenocarcinoma: Bronchial
3305
Develops in site of prior pulmonary in?ammation or injury
3306
Q1654:Lung cancer characteristics;most common lung CA in non-smokers
3307
Adenocarcinoma: Bronchial
3308
Q1655:Lung cancer characteristics;Develops in site of prior pulmonary in?ammation or injury
3309
Adenocarcinoma: Bronchial
3310
Q1656:Lung cancer characteristics;Not linked to smoking.
3311
Adenocarcinoma: Bronchoalveolar
3312
Q1657:Lung cancer characteristics;parathyroid-like activity PTHrP
3313
3314
Q1658:Lung cancer characteristics;Hilar mass arising from bronchus; Cavitation
3315
3316
Q1659:Lung cancer characteristics;Highly anaplastic undifferentiated tumor; poor prognosis.
3317
Large cell carcinoma
3318
Q1660:Lung cancer characteristics;Large cell carcinoma
3319
Highly anaplastic undifferentiated tumor; poor prognosis.
3320
Q1661:Lung cancer characteristics;Carcinoid tumor
3321
Secretes serotonin; can cause carcinoid ;syndrome (?ushing; diarrhea; wheezing;salivation).
3322
Q1662:Lung cancer characteristics;?ushing; diarrhea; wheezing;salivation
3323
Carcinoid tumor
3324
Q1663:Lung cancer characteristics;most common. Brain (epilepsy); bone (pathologic fracture); and liver (jaundice;hepatomegaly).
3325
Metastases
3326
Q1664:Lung cancer common presentation features
3327
cough; hemoptysis; bronchial ;obstruction; wheezing; pneumonic coin lesion on x-ray ?lm.
3328
Q1665:cough; hemoptysis; bronchial ;obstruction; wheezing; pneumonic coin lesion on x-ray ?lm.
3329
Lung cancer
3330
Q1666:Pancoasts tumor;where and findings
3331
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus; causing ;Horners syndrome.
3332
Q1667:Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus; causing ;Horners syndrome.
3333
Pancoasts tumor
3334
Q1668:Kulchitsky cells
3335
Enterochromaffin (EC) cells (Kulchitsky cells) are a type of enteroendocrine cell[1] occurring in the epithelia lining the lumen of the gastrointestinal tract. also implicated in the origin of small cell lung cancer.
3336
Q1669:Lambert-Eaton syndrome;findings
3337
progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles; the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
3338
Q1670:Lambert-Eaton syndrome;causes
3339
small-cell lung cancer; lymphoma; non-Hodgkin's lymphoma
3340
Q1671:progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles; the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
3341
Lambert-Eaton syndrome
3342
Q1672:Small-cell carcinoma ;aka
3343
oat-cell carcinoma
3344
Q1673:oat-cell carcinoma ;aka
3345
Small-cell carcinoma
3346
Q1674:Pneumonia types with different organism causes
3347
Lobar - Pneumococcus usually;Bronchopneumonia - S. aureus; H. ?u; Klebsiella; S. pyogenes;Interstitial (atypical) pneumonia - viruses (RSV; adenoviruses); Mycoplasma;Legionella; Chlamydia
3348
Q1675:Lobar pneumonia Characteristics
3349
Intra-alveolar exudate consolidation; may involve entire lung
3350
Q1676:Bronchopneumonia Characteristics
3351
Acute in?ammatory in?ltrates ;from bronchioles into ;adjacent alveoli; patchy ;distribution involving 1 ;lobes
3352
Q1677:Interstitial (atypical) ;pneumonia Characteristics
3353
Diffuse patchy in?ammation ;localized to interstitial areas ;at alveolar walls; distribution involving 1 lobes
3354
Q1678:Which type of pneumona;Intra-alveolar exudate consolidation; may involve entire lung
3355
Lobar
3356
Q1679:Which type of pneumona;Acute in?ammatory in?ltrates ;from bronchioles into ;adjacent alveoli; patchy ;distribution involving 1 ;lobes
3357
Bronchopneumonia
3358
Q1680:Which type of pneumona;Diffuse patchy in?ammation ;localized to interstitial areas at alveolar walls; distribution involving 1 lobes
3359
Interstitial (atypical);pneumonia
3360
Q1681:Which type of pneumona;Pneumococcus most frequently
3361
Lobar
3362
Q1682:Which type of pneumona;S. aureus
3363
Bronchopneumonia
3364
Q1683:Which type of pneumona;Viruses (RSV; adenoviruses)
3365
Interstitial (atypical) ;pneumonia
3366
Q1684:Which type of pneumona;Mycoplasma; Chlamydia
3367
3368
Q1685:Which type of pneumona;Legionella
3369
3370
Q1686:Interstitial pneumonia;aka
3371
atypical pneumonia
3372
Q1687:atypical pneumonia;aka
3373
Interstitial ;pneumonia
3374
Q1688:Which type of pneumona;S. aureus
3375
Bronchopneumonia
3376
Q1689:Which type of pneumona;H. ?u
3377
Bronchopneumonia
3378
Q1690:Which type of pneumona;Klebsiella
3379
Bronchopneumonia
3380
Q1691:Which type of pneumona;S. pyogenes
3381
Bronchopneumonia
3382
Q1692:what are Lung abscess and who gets them
3383
Localized collection of pus within parenchyma; usually resulting from bronchial ;obstruction (e.g; cancer) or aspiration of gastric contents (especially in patients ;predisposed to loss of consciousness; e.g; alcoholics or epileptics).
3384
Q1693:Pleural effusions what and causes of;Transudate
3385
decreased protein content;Due to CHF; nephrotic syndrome; or hepatic cirrhosis.
3386
Q1694:Pleural effusions what and causes of;Exudate
3387
increased protein content; cloudy. Due to malignancy; pneumonia; collagen vascular disease;trauma.
3388
Q1695:Which type of Pleural effusion;decreased protein content
3389
Transudate
3390
Q1696:Which type of Pleural effusion;CHF
3391
Transudate
3392
Q1697:Which type of Pleural effusion;nephrotic syndrome
3393
Transudate
3394
Q1698:Which type of Pleural effusion;hepatic cirrhosis
3395
Transudate
3396
Q1699:Which type of Pleural effusion;increased protein content; cloudy
3397
Exudate
3398
Q1700:Which type of Pleural effusion;malignancy
3399
Exudate
3400
Q1701:Which type of Pleural effusion;pneumonia;
3401
Exudate
3402
Q1702:Which type of Pleural effusion;collagen vascular disease
3403
Exudate
3404
Q1703:Which type of Pleural effusion;increased protein content
3405
Exudate
3406
Q1704:Which type of Pleural effusion;cloudy
3407
Exudate
3408
Q1705:Which type of Pleural effusion;trauma
3409
Exudate
3410
Q1706:1st generation H1 blockers;names
3411
Diphenhydramine; dimenhydrinate; chlorpheniramine.
3412
Q1707:1st generation H1 blockers;Clinical uses
3413
Allergy; motion sickness; sleep aid.
3414
Q1708:1st generation H1 blockers;Toxicity
3415
Sedation; antimuscarinic; anti-alpha -adrenergic.
3416
Q1709:1st generation H1 blockers;mech
3417
Reversible inhibitors of H1 histamine receptors.
3418
Q1710:2nd generation H1 blockers;mech
3419
Reversible inhibitors of H1 histamine receptors.
3420
Q1711:2nd generation H1 blockers;names
3421
Loratadine; fexofenadine; desloratadine.
3422
3423
Allergy.
3424
3425
Far less sedating than 1st generation.
3426
Q1714:Asthma drugs;name the Nonspeci?c beta -agonists
3427
Isoproterenol
3428
Q1715:Asthma drugs;Isoproterenol;mech and uses
3429
Nonspeci?c beta -agonists relaxes bronchial smooth muscle (beta 2).
3430
Q1716:Asthma drugs;Isoproterenol;toxicity
3431
Nonspeci?c beta -agonists Adverse effect is tachycardia (beta 1).
3432
Q1717:Asthma drugs;name the beta 2 agonists
3433
Albuterol and Salmeterol
3434
Q1718:Asthma drugs;Albuterol;mech and uses
3435
beta 2 agonist relaxes bronchial smooth muscle (beta 2). Use during acute exacerbation.
3436
Q1719:Asthma drugs;Salmeterol;mech and uses
3437
beta 2 agonist long-acting agent for prophylaxis.
3438
Q1720:Asthma drugs;Salmeterol;toxicity
3439
Adverse effects are tremor and arrhythmia.
3440
Q1721:asthma drug;Adverse effects are tremor and arrhythmia.
3441
Salmeterol
3442
Q1722:Asthma drugs;;name the Methylxanthines
3443
Theophylline
3444
Q1723:Asthma drugs;Theophylline;mech and uses
3445
Methylxanthine - likely causes bronchodilation by inhibiting phosphodiesterase; thereby decreased ;cAMP hydrolysis.
3446
Q1724:Asthma drugs;Theophylline;tioxicity
3447
Usage is limited because ;of narrow therapeutic index (cardiotoxicity;neurotoxicity).
3448
Q1725:Asthma drugs;Usage is limited because ;of narrow therapeutic index (cardio and neuro toxicity).
3449
Methylxanthines: Theophylline
3450
Q1726:Asthma drugs;name the muscarinic antagonists
3451
Ipratropium
3452
Q1727:Asthma drugs;Ipratropium;mech and uses
3453
competitive block of muscarinic ;receptors; preventing bronchoconstriction.
3454
Q1728:Cromolyn ;mech and uses
3455
Prevents release of mediators from mast cells. Effective;only for the prophylaxis of asthma. Not effective ;during an acute asthmatic attack.
3456
Q1729:Asthma drugs;7 different Tx drug classes
3457
1. Nonspeci?c beta -agonists ;2.beta 2 agonists ;3. Methylxanthines;4. Muscarinic antagonists ;5. Cromolyn ;6. Corticosteroids;7. Antileukotrienes
3458
Q1730:Cromolyn ;toxicity
3459
Toxicity is rare.
3460
Q1731:Asthma drugs;name the corticosteroids
3461
Beclomethasone; prednisone
3462
Q1732:Asthma drugs;Beclomethasone; prednisone;mech
3463
inhibit the synthesis ;of virtually all cytokines. Inactivate NFB; the ;transcription factor that induces the production of ;TNF-alpha ; among other in?ammatory agents.
3464
Q1733:1st-line therapy for chronic asthma.
3465
Beclomethasone; prednisone
3466
Q1734:name the Antileukotrienes
3467
Zileuton;Za?rlukast; montelukast
3468
Q1735:Zileuton;mech and uses
3469
A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes;asthma
3470
Q1736:A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.
3471
Zileuton
3472
Q1737:Za?rlukast; montelukast;mech and uses
3473
Za?rlukast; montelukastblock leukotriene receptors;Especially good for aspirin induced asthma.
3474
Q1738:block leukotriene receptors.
3475
Za?rlukast; montelukast
3476
Q1739:Especially good for aspirin induced asthma.
3477
Za?rlukast; montelukast
3478
Q1740:Expectorants;names
3479
-Guaifenesin (Robitussin);;-N-acetylcystine
3480
Q1741:Guaifenesin;aka
3481
Robitussin
3482
Q1742:Robitussin;aka
3483
Guaifenesin
3484
Q1743:Guaifenesin ;mech and uses
3485
Removes excess sputum but large doses necessary; does not suppress cough re?ex;Expectorants
3486
Q1744:Removes excess sputum but large doses necessary
3487
Guaifenesin
3488
Q1745:Mucolytic can loosen mucus plugs in CF patients.
3489
N-acetylcystine
3490
Q1746:N-acetylcystine ;mech and uses
3491
Mucolytic can loosen mucus plugs in CF patients;also used as an antidote for acetaminophen overdose
3492
Q1747:antidote for acetaminophen overdose
3493
N-acetylcystine
3494
Q1748:What is the epithelium of the bronchi? What are some causes of ciliary dyskinesia?
3495
Pseudostratisfied ciliated columnar cells with goblet (mucus secreting) cells;Primary ciliary dyskinesia: AR disorder that renders cilia unable to beat;Secondary ciliary dyskinesia: cigarette smoking.
3496
Q1749:Describe the differences between bronchi and conducting bronchioles.
3497
Bronchi: many layers of SMCs; cartilage is present; pseudostratified columnar; densely ciliated; diameter is independent on lung volume;Bronchioles: 1-3 layers of SMCs; no cartilage; simple columnar with few ciliated cells; diameter depends on lung volume.
3498
Q1750:Where is resistance the greatest in the lung airways?
3499
Conducting bronchioles because they are arranged in series. Small airways are aligned in parallel; which reduces resistance greatly (1/= 1/R1+ 1/R2;).
3500
Q1751:What are the layers of the pulmonary membrane?
3501
Surfactant; alveolar epithelium (mostly type I pneumocytes); BM; and capillary epithelium.
3502
Q1752:What vertebral level does the trachea begin? What vertebral level does the trachea bifurcate?
3503
The trachea begins just inferior to the cricoid cartilage; C6; and ends at the sternal angle (T4) level where it bifurcates.
3504
Q1753:What equation is used to calculate physiological dead space?
3505
Vd = Vt * ((PACO2 - PECO2)/PACO2) ;Vt = tidal volume;PACO2 = PCO2 of alveolar gas;PECO2 = PCO2 of expired air
3506
Q1754:How is alveolar ventilation calculated?
3507
Alveolar ventilation = (tidal volume - dead space) * breaths/min
3508
Q1755:Which of the following can be measured by spirometry?;Tidal volume; total lung capacity; functional residual capacity; residual volume; vital capacity?
3509
Tidal volume and vital capacity. All other volumes listed contain residual volume which cannot be measured.
3510
Q1756:Use boyles law to explain inspiration of air?
3511
PV= k. Increasing lung volume decreases the pressure which allows atmospheric air to flow in the lungs (down a pressure gradient).
3512
Q1757:What muscles are used in inspiration? Expiration?
3513
Inspiration: diaphragm and during exercise or respiratory distress: external intercostals; scalenes; sternocleidomastoids;Expiration: normally expiration is passive; but during exercise: internal intercostal; innermost intercostal; and abdominal muscles
3514
Q1758:What are the sources of resistance during inspiration?
3515
Airway resistance: air molecules colliding with wall = friction;Compliance resistance: expansion of alveolar and paranchyma tissue;Tissue resistance: parietal and visceral pleura friction
3516
Q1759:What are the sources of resistance during expiration?
3517
Intrathoracic pressure increases which compresses airways and reduces airway diameter. Reduced airway diameter is the primary source of resistance.
3518
Q1760:Compliance work (resistance) is the energy required to overcome the intrinsic elastic recoil of the lungs. It accounts for 75% of the total work in breathing. Is compliance work increased or decreased in emphysema?
3519
Emphysema destroys lung paranchyma. Compliance work is decreases and inspiration is easy. Expiration is difficult.
3520
Q1761:Does elastance increase or decreased in restrictive lung disease?
3521
Elastance will increase in restrictive lung diseases. Elastance = resist deformation. Is is inversely proportional to compliance. E = change in P/change in V.
3522
Q1762:Explain how emphysema changes the functional residual capacity.
3523
Lung compliance (distensibility) is increased in emphysema and the tendency of the lungs to collapse decreases. The lungchest wall system will seek a higher FRC until the two opposing forces (tendency of the chest wall to expand and collapsing force of lung) reach a new equilibrium.
3524
Q1763:What is LaPlace's law? What decreases the collapsing force on alveoli?
3525
P = 2T/r;P = collapsing pressure on alveolus;T = surface tension;r = radius of alveolus;Surfactant.
3526
Q1764:Describe surfactant and its function.
3527
Phophatidylcholine (phospholipid) synthesized by type II alveolar cells and reduces surface tension by disrupting the intermolecular forces between liquid molecules. Lecithin:sphingomyelin ratio greater than 2:1 reflects mature levels of surfactant in the fetus.
3528
Q1765:What is Dalton's law of partial pressure? What is the partial pressure of oxygen in dry air; inspired air; alveolar air; systemic arterial blood; and venous blood?
3529
Partial pressure = total pressure * concentration of gas;O2: 160; 150; 100; 100; 40;CO2: 0; 0; 40; 40; 46
3530
Q1766:What is Fick's law of diffusion?
3531
D = change in P * A * S / T;A = surface area;S = solubility coeff. of oxygen;T = distant oxygen must diffuse across pulmonary membrane
3532
Q1767:How is V/Q optimized for the most efficient gas exchange (ventilation matches perfusion)?
3533
Hypoxia-induced vasoconstriction. Paradoxical vasoconstriction in response to hypoxia.
3534
Q1768:How does V/Q ratio change in exercise?
3535
V/Q at rest is 0.8. During exercise; V/Q approaches 1.0 and is more efficient. Under perfused areas become more perfused due to increased PA blood pressures and under ventilated areas become more ventilated (apices).
3536
Q1769:In terms of V/Q; whats the difference between a shunt and dead space?
3537
In a shunt V/Q approaches 0; e.g. airway obstructions;In dead space V/Q approaches infinity; e.g. pulmonary embolism occluding a pulmonary artery.
3538
Q1770:An A-a gradient greater than ____ mmHg indicates a pathological condition. How are both PAO2 and PaO2 calculated?
3539
30 mmHg;PAO2 = PiO2 - PACO2/R;PaO2 is measured with arterial blood gas labs.
3540
Q1771:What is the oxygen saturation in arterial blood? Venous blood?
3541
Arterial partial pressure of oxygen in arterial blood is approximately 100 mmHg. At this PP; Hb is 100% bound. In venous blood; the PP of oxygen is 40 mmHg. At this PP; Hb is 75% bound to hemoglobin.
3542
Q1772:What are some causes of hypoxia with an increase in A-a gradient? Normal A-a gradient?
3543
Increased A-a: ventillation; perfusion; or diffusion defects; RL shunts;Normal A-a: CNS depression; phrenic nerve lesion; upper airway obstruction (?)
3544
Q1773:How come the pH of venous blood only drops to 7.26 (from 7.4) despite the large offloading of H+ (via CO2 + H20 yielding H + HCO3)? (In other words; who is buffering the H+ so efficiently)
3545
Deoxyhemoglobin buffers H+ inside the RBCs.
3546
Q1774:What is the chloride shift?
3547
Cl ions are taken up by RBCs in exchange for HCO3. HCO3 is transported to the lungs via plasma. This is how CO2 is transported to the lungs.
3548
Q1775:20% of CO2 is transported in the blood by Hb. What is the Bohr effect?
3549
Binding of CO2 to Hb decreases the O2 affinity of Hb (facilitates offloading of oxygen).
3550
Q1776:Where in the medulla is the respiratory center located? What part controls inspiration? Expiration?
3551
Reticular formation. Inspiration and the basic rhythm for breathing is controlled by the dorsal respiratory group. Expiration (not active in normal breathing) is controlled by the ventral respiratory group.
3552
Q1777:What two centers in the pons help to control breathing?
3553
Apneustic center: lower pons; stimulates deep and prolonged inspiratory gasp;Pneumotaxic center: upper pons; inhibits inspiration; thus; regulating volume and rate
3554
Q1778:What do central chemoreceptors in the medulla respond to?
3555
Central chemoreceptors respond to acidosis (high CO2 levels) in the CSF and in response they increase ventilation (breathing rate).
3556
Q1779:What do peripheral chemoreceptors in the carotid (via CNIX) and aortic (via CNX) bodies respond to?
3557
Decreased PaO2 ( < 60 mmHg); decrease pH; and increase PaCO2.
3558
Q1780:What is Ondine's curse?
3559
Impaired autonomic control of breathing.
3560
Q1781:What receptors are responsible for Hering-Breuer reflex?
3561
Lung stretch receptors. When stimulated by distention of the lungs they produce a reflex decrease in breathing frequency.
3562
Q1782:Explain why climbers must ascend mountains slowly.
3563
Initially; decrease PaO2 stimulates hyperventilation via peripheral chemoreceptors. This causes respiratory alkalosis. The increase pH inhibits the central chemoreceptor induction of hyperventilation. Meanwhile; the kidney excretes HCO3 in response to resp. alkalosis (1-3 days). When pH returns to normal; peripheral chemoreceptors can again stimulate hyperventilation.
3564
Q1783:What stimulates the J receptors?
3565
Engorgement of the pulmonary capillaries stimulate the J receptors which then cause rapid; shallow breathing.
3566
Q1784:A claustrophobic girl is stuck in an elevator. Her vision becomes blurry and she feels dizzy; why?
3567
Hyperventilation decreases PaCO2. PaCO2 is a potent vasodilator for cerebral arteries. The decrease in oxygen delivery to the brain causes these symptoms.
3568
Q1785:Where are irritant receptors located?
3569
Large-diameter airways. Mediate cough; sneeze and bronchoconstriction in response to noxious substances.
3570
Q1786:What is histotoxic hypoxia? Does supplemental oxygen alleviate symptoms?
3571
Inability of cells to us O2 effectively (cyanide poisoning). No.
3572
Q1787:What are some physiological responses to high altitude (4)?
3573
1) Hyperventilation;2) Renal hypoxia induces EPO = polycythmemia;3) Increased anaerobic metabolism increases 2;3-BPG production = right shift of Hb dissociation curve;4) Pulmonary hypoxic vasoconstriction = pulmonary hypertension
3574
Q1788:What is and what causes Biot's breathing?
3575
Is: abnormal pattern of breathing characterized by groups of quick; shallow inspirations followed by regular or irregular periods of apnea;Cause: damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla due to uncal or tentorial herniation. Or opioid use.
3576
Q1789:What is and what causes Cheyne-Stokes breathing?
3577
Is: periodic breathing amid higher PaCO2 to stimulate breathing. Characterized by oscillation of ventilation between apnea and tachypnea;Causes: head trauma.
3578
Q1790:What is Kussmaul's breathing?
3579
Bodies response to metabolic acidosis. Rapid; deep breathing to expire CO2. Often occurs in type I diabetic patients experiencing ketoacidosis.
3580
Q1791:How is FEV1; FVC; and FEV1/FVC affected in asthma and COPD? How about in fibrosis?
3581
FEV1 is greatly reduced. FVC is reduced. FEV1/FVC is reduced;Fibrosis: FEV1 is reduced. FVC is greatly reduced. FEV1/FVC is either normal or increased.
3582
Q1792:What are Clara cells?
3583
Clara cells are located in the bronchioles and they secrete a component of surfactant; metabolize toxins; and release Cl ions into the lumen (cGMP-guanylate cyclase ion channel).
3584
Q1793:What are type I pneumocytes? Type II pneumocytes?
3585
Type I pneumocytes are simple squamous epithelium joined by tight junctions (zonula occludens) that line alveoli and have no mitotic capacity;Type II pneumocytes are large and cuboidal shaped cells. They secrete surfactant (stored in lamellar bodies). They are stem cells that regenerate type I and type II pneumocytes.
3586
Q1794:What is the function of the pores of Kohn?
3587
These alveolar pores are found within interalveolar septae and equalize pressure within alveoli.
3588
Q1795:Name some bronchoconstrictors;Name some bronchodilators:
3589
BCs: LTC4; LTD4; PGF; TxA2; and parasympathetic stimulation;BDs: PGE2; sympathetic stimulation (Beta-2 agonists).
3590
Q1796:Describe the clinical features of pink puffers (emphysema).
3591
Thin; barrel-shaped chest; tachypneic; mild hypoxemia; hypocapnia or normocapnia.
3592
Q1797:Describe the clinical features of blue bloaters (chronic bronchitis).
3593
Muscular; barrel-shaped chest; severe hypoxemia with cyanosis; hypercapnia leading to respiratory acidosis; RV failure; and systemic edema.
3594
Q1798:Tidal volume
3595
Volume of air that enters and leaves the lung in a single cycle. 500ml
3596
Q1799:Functional residual capacity
3597
Amount of air in the lungs after passive expiration. 2;700ml
3598
Q1800:Inspiratory capacity
3599
Maximal volume of gas inspired from FRC. 4;000ml
3600
Q1801:Inspiratory reserve volume
3601
Air that can be inhaled after normal inspiration. 3;500ml
3602
Q1802:Expiratory reserve volume
3603
Air that can be expired after a normal expiration. 1;500ml
3604
Q1803:Residual volume
3605
Air in the lungs after maximal expiration. 1;200ml
3606
Q1804:Vital capacity
3607
Maximal air that can expired after maximal inspiration. 5;500ml
3608
Q1805:Total lung capacity
3609
Air in the lungs after maximal inspiration. 6;700ml
3610
Q1806:Total ventilation
3611
Total ventilation = Tidal volume X respiratory rate.
3612
Q1807:Dead space
3613
Regions that contain air but do not exchange O2 and CO2
3614
Q1808:Anatomic dead space
3615
Conducting zones. Approximately equal to person't weight in pounds.
3616
Q1809:Alveolar dead space
3617
Alveoli with air but without blood flow
3618
Q1810:Physiologic dead space
3619
Anatomic dead space plus alveolar dead space
3620
Q1811:Alveolar ventilation
3621
Tidal volume - anatomic dead space X respiratory rate.
3622
Q1812:Lung recoil
3623
Force that collapses the lung. As the lung enlarges; recoil increases and vice versa.
3624
Q1813:Intrapleural pressure
3625
Normally -5 cmH2O. Force that expands the lung. The more negative; the more lung expansion.
3626
Q1814:Lung mechanics before inspiration
3627
Glotis is open but no air is flowing - alveolar pressure = 0. Intrapleural pressure and lung recoil are equal but opposite. Gravity decreases intrapleural pressure at the apex and increases it at the bases. Apex alveoli are more distended.
3628
Q1815:Lung mechanics during inspiration
3629
Diaphragm contracts; intrapleural pressure becomes more negative. Expansion of alveoli makes alveolar pressure negative causing air to flow into the lungs.
3630
Q1816:Lung mechanics at the end of inspiration
3631
Intrapleural pressure and recoil are the same but opposite. Alveolar pressure returns to zero and air stops flowing in.
3632
Q1817:Lung mechanics during expiration
3633
Diaphragm relaxes; intrapleural pressure increases; lung recoil collpases the lung. Alveoli compress tha air and alveolar pressure becomes positive and air flows out of the lungs until alveolar pressure is back to zero. Lung recoil and intrapleural pressure become equal but opposite.
3634
Q1818:Assisted control mode ventilation
3635
Inspiration is initiated by the patient or the machine if no signal is detected.
3636
Q1819:Positive end-expiratory pressure
3637
Does not allow intraalveolar pressure to return to zero at the end of expiration. The larger lung volume prevents atelectasis.
3638
Q1820:What is lung compliacnce?
3639
It's the change in volume with a change in pressure. Increased compliance means more air flows in with a given change in pressure. Decreased compliance means the opposite. The steeper the slope of the lung inflation curve; the greater the compliance. Emphysema = very compliant; fibrosis = not compliant.
3640
Q1821:Components of lung recoil
3641
1) the tissue's collagen and elastin fibers and 2) the surface tension (greatest component)
3642
Q1822:Functions of surfactant
3643
Lowers lung recoil and increases compliance (decreased surface tension) more in small alveoli than large alveoli; reduces capillary filtration forces reducing tendency to develop edema.
3644
Q1823:Pathophysiology of respiratory distress syndrome
3645
Low surfactant --> increased recoil; decreased compliance (a greater change in intrapleural pressure is necessary to inflate the lungs); alveoli collapse (atelectasis); more negative intrapleural pressures promote capillary filtration (pulmonary edema)
3646
Q1824:Airway resistance
3647
R = 1/r4; first and second bronchi have less radius than alveoli; therefore more resistance. Ach increases resistance (bronchoconstriction); catecholamines decrease resistance (bronchodilation)
3648
Q1825:Effect of lung volume on airway resistance
3649
increased lung volume --> increased radius --> decreased resistance. The more negative the intrapleural pressure; the less resistance
3650
Q1826:Lung volumes in obstructive disease
3651
increased TLC; increased RV; increased FRC; decreased FEV1; decreased FVC; decreased FEV1/FVC
3652
Q1827:Lung volumes in restrictive disease
3653
decreased TLC; decreased RV; decreased FRC; decreased FEV1; decreased FEV; increased FEV1/FVC
3654
Q1828:Pressure of alveolar O2 and CO2
3655
PAO2 = 100mmHg; PACO2 = 40mmHg
3656
Q1829:Pressure of venous pulmonary capillary O2 and CO2
3657
PvO2 = 40mmHg; PvCO2 = 47mmHg
3658
Q1830:Pressure of arterial pulmonary capillary O2 and CO2
3659
PO2 = 100mmHg; PCO2 = 40mmHg
3660
Q1831:Which factors affect PCO2?
3661
Metabolic CO2 production and alveolar ventilation
3662
Q1832:Relationship between alveolar ventilation and PACO2
3663
Inversely proportional. Hyperventilation decreases PACO2; hypoventilation increases PACO2.
3664
Q1833:Relationship between PAO2 and PACO2
3665
decreased PACO2 --> increased PAO2 (hyperventilation); increased PACO2 --> decreased PAO2 (hypoventilation)
3666
Q1834:Which factors affect PAO2?
3667
Atmospheric pressure; oxygen concentration of inspired air and PACO2
3668
Q1835:What determines oxygen content?
3669
Hemoglobin concentration. 1.34ml O2 combines with each gram of hemoglobin.
3670
Q1836:Amount of dissolved oxygen in the blood
3671
0.3 volumes %; 0.3ml per 100ml of blood. Determines PO2 which acts to keep oxygen bound to Hb
3672
Q1837:What determines oxygen attachment to hemoglobin?
3673
PO2 and the affinity of the individual attachment sites. The higher the affinity; the less PO2 is needed to keep it attached
3674
Q1838:What determines PO2?
3675
Amount of oxygen dissolved in plasma. Normally 0.3 volumes %.
3676
Q1839:Site 4 of hemoglobin
3677
Oxygen is attached at 100mmHg. Least affinity; last site to be saturated.
3678
3679
Oxygen is attached at 40mmHg. More affinity than site 4; less affinity than site 2.
3680
3681
Oxygen is attached at 26mmHg which is p50. More affinity; second site to be saturated.
3682
3683
Oxygen remains attached under physiologic conditions. Highest affinity; first site to be saturated.
3684
Q1843:Factors that shift oxygen dissociation curve to the right
3685
increased CO2; increased 2;3BPG; fever; acidosis
3686
Q1844:Factors that shift oxygen dissociation curve to the left
3687
decreased CO2; decreased 2;3BPG; hypothermia; alkalosis; HbF; methemoglobin; carbon monoxide; stored blood
3688
Q1845:How is CO2 carried in the blood?
3689
5% dissolved; 5% attached to Hb (carbamino compounds); 90% as bicarbonate.
3690
Q1846:Main drive for ventilation
3691
H+ ions from dissociated H2CO3 which stimulate central chemoreceptors. H2CO3 is proportional to PCO2 of CSF
3692
Q1847:Central chemoreceptors
3693
Sense [H+] which is proportional to PCO2 and H2CO3 of the CSF (not systemic)
3694
Q1848:Peripheral chemoreceptors
3695
Carotid bodies (afferents via IX); aortic bodies (afferents via X). Monitor PO2 and [H+/CO2]
3696
Q1849:Main drive for ventilation in severe hypoxemia
3697
Peripheral chemoreceptors sense PaO2 (dissolved oxygen) once PaO2 falls to 50-60mmHg.
3698
Q1850:Ventilatory response to chronic hypoventilation
3699
Peripheral chemoreceptors are the main drive for ventilation eventhough PaCO2 is increased.
3700
Q1851:Ventilatory response to anemia
3701
PaO2 and PACO2 are normal; therefore neither peripheral nor central chemoreceptors respond.
3702
Q1852:Central control of ventilation
3703
Apneustic center in the caudal pons promotes prolonged inspiration. Pneumotaxic center in the rostral pons inhibits apneustic center. Efferents are from the medulla to the phrenic nerve (C1-C3) to the diaphragm
3704
Q1853:Differences in ventilation between the base and the apex of the lung
3705
Base intrapleural pressure is -2.5; alveoli are compliant and small with a small volume of air but are underventilated due to too much blood flow; Apex pressure is -10; alveoli are large and stiff and contain a large volume of air but are overventilated due to limited blood flow
3706
Q1854:Differences in blood flow between the base and the apex of the lung
3707
Blood vessels of the apex are less distended; have more resistance and receive less blood flow. Blood vessels of the base are more distended; have less resistance and receive more blood flow
3708
Q1855:Ventilation/perfussion relationship at the base of the lungs
3709
Blood flow is higher than ventilation; the relationship is less than 0.8; the bases are underventilated; increased shunts
3710
Q1856:Ventilation/perfussion relationship at the apex of the lungs
3711
Blood flow is lower than ventilation; the relationship is more than 0.8; the apex are overventilated; increased dead space
3712
Q1857:What does a ventilation/perfussion relationship under and over 0.8 mean?
3713
Under 0.8 (at the bases) lungs are underventilated and less gas exchange takes place; therefore PACO2 and end-capillary PCO2 will be higher and PAO2 and end-capillary PO2 will be lower.
3714
Q1858:What is hypoxic vasoconstriction?
3715
A decrease in PAO2 causes vasoconstriction and shunting of blood through that segment.
3716
Q1859:What is the effect of a thrombus in a pulmonary artery?
3717
Blood flow decreases; therefore increased Va/Q --> decreased PACO2; increased PAO2
3718
Q1860:What is the effect of a foreign object occluding a terminal bronchi?
3719
Ventilation decreases; therefore decreased Va/Q --> increased PACO2; decreased PAO2
3720
Q1861:What constitutes a pulmonary shunt?
3721
Regions of the lung where blood is not ventilated. Low Va/Q relationship.
3722
Q1862:What constitutes alveolar dead space?
3723
Regions of the lung where there's no blood flow in spite of ventilation. High Va/Q relantionship
3724
Q1863:Va/Q > 0.8
3725
Represents alveolar dead space. Can be reversed with supplemental O2
3726
Q1864:Va/Q < 0.8
3727
Represents a pulmonary shunt. Cannot be reversed with supplemental O2
3728
Q1865:What is the normal A-a gradient?
3729
5-10 mmHg
3730
Q1866:Hypoventilation
3731
decreased PAO2 but diffusion and A-a gradient are normal. Perfusion-limited defect.
3732
Q1867:What is a perfussion-limited defect?
3733
There's a lung problem but A-a gradient is normal
3734
Q1868:What is a diffusion-limited defect?
3735
There's a lung problem where A-a gradient is below normal; therefore diffusion isn't normal
3736
Q1869:Diffusion impairment lung defect
3737
Due to structural problem (increased thickness or decreased surface area). A-a gradient is more than normal. Supplemental oxygen compensates structural deficit but increased A-a gradient remains. Fibrosis; emphysema.
3738
Q1870:Diffusion capacity of the lung
3739
Its measured with CO because it's a diffusion-limited gas. Structural problems decrease CO uptake. It's an index of surface area and membrane thickness.
3740
Q1871:Pulmonary right-left shunt
3741
decreased Va/Q. Ther is an increased A-a gradient that is unresponsive to supplemental O2. Atelectasis or ARDS.
3742
Q1872:PO2 in atrial septal defect
3743
increased Right atrial PO2; increased right ventricular PO2; increased pulmonary artery PO2; increased pulmonary blood flow and pressure
3744
Q1873:PO2 in ventricular septal defect
3745
No change in right atrial PO2; increased right ventricular PO2; increased pulmonary artery PO2; increased pulmonary flow and pressure
3746
Q1874:PO2 in patent ductus arteriosus
3747
No change in right atrial PO2 nor right ventricular PO2; increased pulmonary artery PO2; increased pulmonary flow and pressure
3748
Q1875:Factor XII;Intrinsic; extrinsic or common?
3749
intrinsic
3750
Q1876:Factor XII;PTT or PT?
3751
PTT
3752
Q1877:Factor XII;activates?
3753
XI
3754
Q1878:Factor XI;Intrinsic; extrinsic; or common?
3755
Intrinsic
3756
Q1879:Factor XI;PTT or PT?
3757
PTT
3758
Q1880:Factor XI;activates?
3759
IX;***requires Ca++ and platelet phospholipid
3760
Q1881:Factor IX;Intrinsic; extrinsic; or common?
3761
intrinsic
3762
Q1882:Factor IX;PTT or PT
3763
PTT
3764
Q1883:Factor IX;activates?
3765
X;**requires Ca++ and platelet phospholipid
3766
Q1884:Factor VII;intrinsic; extrinsic; or common?
3767
extrinsic
3768
Q1885:Factor VII;PTT or PT?
3769
PT
3770
Q1886:Factor VIIa;Activates?
3771
X;**requires Ca++ and platelet phospholipid
3772
Q1887:Tissue factor;activates?
3773
VII;**requires Ca++ and platelet phospholipid
3774
Q1888:Xa and Va;Activate?
3775
Prothrombin;**requires Ca++ and platelet phospholipid
3776
Q1889:factor X;intrinsic; extrinsic; or common?
3777
common
3778
Q1890:Thrombin;activates?
3779
Fibrinogen
3780
Q1891:Factor which crosslinks fibrin
3781
XIIIa
3782
Q1892:inactivate Va and VIIIa
3783
Protein C;Protein S;**Vitamin K dependent
3784
Q1893:inactivates;thrombin;IXa;Xa;XIa
3785
Antithrombin III
3786
Q1894:activated by heparin
3787
Antithrombin III
3788
Q1895:generates plasmin; which cleaves fibrin
3789
tPA
3790
Q1896:fibrinolytic system link to complement cascade?
3791
plasminogen activates C3
3792
Q1897:Clotting link to kallikrein-kinin system
3793
XIIa activates Prekallikrein ;->kallikrein
3794
Q1898:Kallikrein link to kinin system?
3795
kallikrein activates HMWK;-->Bradykinin
3796
Q1899:Kinin link to Clotting system
3797
HMWK activates Factor XII
3798
Q1900:Kallikrein link to fibrinolytic system
3799
Kallikrein activates Plasminogen;-->Plasmin
3800
Q1901:Microcytic anemias: Definition
3801
Mean Corpuscular Volume less than 80 cubic micrometers
3802
Q1902:Macrocytic anemias: Definition
3803
Mean Corpuscular Volume more than 100 cubic micrometers
3804
Q1903:Normocytic anemias: Definition
3805
Mean Corpuscular Volume between 80 and 100 cubic micrometers
3806
Q1904:Corrected reticulocyte count less than 3%: Bone marrow status
3807
Ineffective erythropoiesis
3808
Q1905:Corrected reticulocyte count greater than or equal to 3%: Bone marrow status
3809
Effective erythropoiesis
3810
Q1906:Regular hematocrit level
3811
45%
3812
Q1907:Stimuli for erythropoietin
3813
-hypoxemia;-left-shifted oxygen binding curve;-high altitude
3814
Q1908:Where is erythropoietin made?
3815
Endothelial cells of peritubular capillaries
3816
Q1909:Corrected reticulocyte count: Definition
3817
(Actual hematocrit/45) * reticulocyte count;If polychromasia; divide by 2.
3818
Q1910:Reticulocyte count: What does it measure?
3819
-Effective erythropoiesis;-Must be corrected for degree of anemia
3820
Q1911:How long does it take for reticulocyte count to increase after blood loss?
3821
5-7 days.
3822
Q1912:Microcytic (less than 80 cubic micrometers) anemias: List
3823
-Iron deficiency;-Anemia of chronic disease;-Thalassemia (alpha and beta);-Sideroblastic anemia
3824
Q1913:Sideroblastic anemias: List
3825
-Chronic alcoholism (most common);-Pyridoxine (B6) deficiency;-Lead poisoning
3826
Q1914:Anemias of chronic disease: List
3827
-Chronic inflammation (eg rheumatoid arthritis; TB);Alcoholism;-Malignancy
3828
Q1915:Type of anemia: Iron deficiency
3829
Early-stage: Normocytic with a low reticulocyte count;Laterstage: Microcytic
3830
Q1916:Type of anemia: Anemia of chronic disease
3831
Early-stage: Normocytic with a low reticulocyte count;Laterstage: Microcytic
3832
Q1917:Type of anemia: Thalassemia
3833
Microcytic
3834
Q1918:Sign: Dark blue iron granules around the nucleus of developing normoblasts
3835
Ringed sideroblasts; indicating sideroblastic anemia
3836
Q1919:Type of anemia: Sideroblastic
3837
Microcytic
3838
Q1920:Type of anemia: Pyridoxine deficiency
3839
Sideroblastic; so Microcytic
3840
Q1921:Type of anemia: Lead poisoning
3841
Sideroblastic; so microcytic
3842
Q1922:Type of anemia: Alcoholism
3843
Either sideroblastic; or anemia of chronic disease. Either way; microcytic.
3844
Q1923:Type of anemia: Rheumatoid arthritis
3845
Chronic inflammation; so anemia of chronic disease; so microcytic
3846
Q1924:Type of anemia: TB
3847
Chronic inflammation; so anemia of chronic disease; so;Early: Normocytic with low reticulocyte count;Later: Microcytic
3848
Q1925:Type of anemia: Malignancy
3849
Anemia of chronic disease; so microcytic
3850
Q1926:Type of anemia: Vitamin B12 deficiency
3851
B12 deficiency or metabolism defect means megaloblastic macrocytic
3852
Q1927:Type of anemia: Vitamin B12 metabolism defect
3853
B12 deficiency or metabolism defect means megaloblastic macrocytic
3854
Q1928:Type of anemia: Folate deficiency
3855
Folate deficiency or metabolism defect means megaloblastic macrocytic
3856
Q1929:Type of anemia: Folate metabolism defect
3857
Folate deficiency or metabolism defect means megaloblastic macrocytic
3858
Q1930:Type of anemia: DNA synthesis defect
3859
Macrocytic megaloblastic
3860
Q1931:Type of anemia: Liver disease
3861
non-megaloblastic macrocytic;or ;normocytic with a normal reticulocyte count and an extrinsic RBC defect
3862
Q1932:Type of anemia: Cytotoxic drugs
3863
Macrocytic non-megaloblastic
3864
Q1933:Type of anemia: Hypothyroidism
3865
3866
Q1934:Type of anemia: Stress erythropoiesis
3867
3868
Q1935:Type of anemia: Blood loss
3869
Normocytic;Reticulocyte count;-Less than one week: low;More than one week: normal
3870
Q1936:Type of anemia: Aplastic anemia
3871
Normocytic with a low reticulocyte count
3872
Q1937:Type of anemia: Renal disease
3873
Normocytic;Reticulocyte count;-low;-normal: extrinsic defect hemolytic anemia
3874
Q1938:Type of anemia: Absence of erythropoietin
3875
3876
Q1939:Type of anemia: Replacement of bone marrow
3877
3878
Q1940:Type of anemia: Hereditary spherocytosis
3879
Membrane defect; so;Normocytic hemolytic anemia with normal reticulocyte count
3880
Q1941:Type of anemia: Hereditary elliptocytosis
3881
Membrane defect; so;Normocytic with normal reticulocyte count
3882
Q1942:Type of anemia: South-East Asian Ovalocytosis
3883
3884
Q1943:Type of anemia: Paroxysmal Nocturnal Hemoglobinuria
3885
3886
Q1944:Type of anemia: G6PD deficiency
3887
Metabolism defect so;Normocytic hemolytic anemia with normal reticulocyte count
3888
Q1945:Type of anemia: Glutathione deficiency
3889
3890
Q1946:Type of anemia: Pyruvate kinase deficiency
3891
3892
Q1947:Type of anemia: Sickle cell disease
3893
Hemoglobin defect so;Normocytic hemolytic anemia with normal reticulocyte count
3894
Q1948:Type of anemia: Drugs
3895
Normocytic hemolytic anemia with normal reticulocyte count
3896
Q1949:Type of anemia: Chemical/Physical agents
3897
3898
Q1950:Type of anemia: Snake bite venom
3899
Toxin so;Normocytic hemolytic anemia with normal reticulocyte count
3900
Q1951:Type of anemia: Clostridial toxin
3901
Toxin so;Normocytic hemolytic anemia with normal reticulocyte count
3902
Q1952:Type of anemia: Burns
3903
Injury so;Normocytic hemolytic anemia with normal reticulocyte count
3904
Q1953:Type of anemia: Fresh water drowning
3905
Injury so;Normocytic hemolytic anemia with normal reticulocyte count
3906
Q1954:Type of anemia: Hypersplenism
3907
3908
Q1955:Type of anemia: Cold antibody type
3909
Autoimmune so;Normocytic hemolytic anemia with normal reticulocyte count
3910
Q1956:Type of anemia: Warm antibody type
3911
Autoimmune so;Normocytic hemolytic anemia with normal reticulocyte count
3912
Q1957:Type of anemia: Alloimmune
3913
Immune so;Normocytic hemolytic anemia with normal reticulocyte count
3914
Q1958:Type of anemia: Drug induced immune hemolytic anemia
3915
Drug-induced and/or immune so;Normocytic hemolytic anemia with normal reticulocyte count
3916
Q1959:Type of anemia: Vasculitis
3917
Red cell fragmentation syndrome so;Normocytic hemolytic anemia with normal reticulocyte count
3918
Q1960:Type of anemia: Mechanical devices
3919
3920
Q1961:Type of anemia: Microangiopathic hemolytic anemia
3921
3922
Q1962:Type of anemia: Macroangiopathic hemolytic anemia
3923
3924
Q1963:Type of anemia: March hemoglobinuria
3925
3926
Q1964:How do you identify a reticulocyte?
3927
-Supravital stain (new methylene blue);-RNA filaments
3928
Q1965:How do you get hemoglobin from hematocrit?
3929
hb = (1/3)hct
3930
Q1966:For every unit of packed red blood cells; you increase:
3931
hemoblobin by 1;hematocrit by 3
3932
Q1967:Most common cause of anemia in the world
3933
iron deficiency
3934
Q1968:Most common cause of iron deficiency
3935
GI bleed
3936
Q1969:RDW: Definition
3937
RBC Distribution Width;Checks uniformity of size.
3938
Q1970:Low MCV with Increased RDW
3939
-Increases variation in size: Mixture of normocytic and microcytic RBCs;-Iron deficiency
3940
Q1971:Spherocyte: membrane defect
3941
Too little membrane
3942
Q1972:Target cell: membrane defect
3943
Too much membrane so more hemoglobin can collect in the middle
3944
Q1973:Target cell: markers for what?
3945
-Alcoholism;-Hemoglobinopathy
3946
Q1974:How to identify a microcytic cell
3947
Too much central pallor
3948
Q1975:How to identify a spherocyte
3949
-No central pallor;-Small and red
3950
Q1976:Spoon nails: Sign of?
3951
Iron deficiency
3952
Q1977:Cheilosis: Sign of?
3953
-Iron deficiency;-Riboflavin deficiency
3954
Q1978:Pale conjunctiva: Sign of?
3955
Low hemoglobin
3956
Q1979:No red in palmar creases: Sign of?
3957
Iron deficiency
3958
Q1980:Discoloration of gum margin: Sign of?
3959
Known as "lead lines". A sign of lead poisoning.
3960
Q1981:Normal serum iron
3961
About a 100 (like the alveolar oxygen)
3962
Q1982:Serum ferritin: what is it?
3963
Soluble circulating form of iron storage
3964
Q1983:Serum ferritin: what does it represent?
3965
Amount of iron in bone marrow;-Best overall screening test
3966
Q1984:Carrying protein for iron
3967
Transferrin (Carries iron)
3968
Q1985:TIBC: What does it measure?
3969
Transferrin
3970
Q1986:What does increased TIBC indicate?
3971
Increased transferrin synthesis by liver; so decreased iron stores in the bone marrow.
3972
Q1987:What does decreased TIBC indicate?
3973
Decreased transferrin synthesis by liver; so increased iron stores in the bone marrow.
3974
Q1988:Define: % iron saturation
3975
Serum iron/TIBC
3976
Q1989:Normal TIBC
3977
300
3978
Q1990:Normal % iron saturation
3979
33%;=normal serum iron/ normal TIBC = 100/300
3980
Q1991:Hemoglobin type: 2 alpha chains and 2 beta chains
3981
HbA
3982
Q1992:Hemoglobin type: 2 alpha chains and 2 delta chains
3983
HbA2
3984
Q1993:Hemoglobin type: 2 alpha chains and 2 gamma chains
3985
HbF
3986
Q1994:Mechanism of pathogenesis in Anemia of Chronic Disease
3987
Bugs increase reproduction with iron; so body assumes there is a bacterial infection; and keeps iron away from bacteria;Iron is normally stored in macrophages in bone marrow. It's kept away from RBCs.
3988
Q1995:Where does Hemoglobin synthesis begin?
3989
Mitochondria of RBC
3990
Q1996:First reaction of Hemoglobin synthesis
3991
Succinyl CoA + Glycine (catalyzed by ALA synthetase) yields delta-ALA;all in the mitochondria
3992
Q1997:What kind of neurotransmitter: Glycine
3993
Inhibitor of muscle.
3994
Q1998:What toxin blocks glycine?
3995
Tetanus
3996
Q1999:Rate limiting step in Heme synthesis
3997
delta-ALA synthesis
3998
Q2000:What enzyme does heme inhibit?
3999
ALA synthase
4000
Q2001:Why does alcoholism cause sideroblastic anemia?
4001
Alcohol is a mitochondrial toxin.
4002
Q2002:What are sideroblasts?
4003
Overloaded mitochondria
4004
Q2003:Why does B6 deficiency cause sideroblastic anemia?
4005
Can't form CoA; so can't form succinyl CoA; so can't do first reaction of heme synthesis.
4006
Q2004:Mechanism of lead poisoning
4007
Lead denatures ferrochelatase --> Can't form heme
4008
Q2005:Test for lead poisoning
4009
Blood lead levels
4010
Q2006:What are the main groups that we see alphathalassemia?
4011
-Southeast asians;-Black Americans
4012
Q2007:What are the main populations we see betathalassemia in?
4013
-black Americans;-Greeks;-Italians
4014
Q2008:% of Hb that is: HbA
4015
95%
4016
Q2009:% of Hb that is: HbA2
4017
2%
4018
Q2010:% of Hb that is: HbF
4019
1%
4020
Q2011:alpha-thalassemia: mode of inheritance
4021
Autosomal recessive
4022
Q2012:alpha-thalassemia: pathogenesis
4023
problem making alpha chains
4024
Q2013:alpha-thalassemia: electropheresis results
4025
all normal proportions (all Hbs decreased)
4026
Q2014:alpha-thalassemia: one gene deletion
4027
Silent carrier
4028
Q2015:alpha-thalassemia: two gene deletions
4029
alpha-thalassemia minor;-mild anemia (microcytic because globin is decreased)
4030
Q2016:alpha-thalassemia: three gene deletions
4031
Four beta chains form making HbH. Found in electropheresis;Called HbH disease
4032
Q2017:alpha-thalassemia: four gene deletions
4033
Four gamma chains form making Hb Bart. Found in electropheresis. Called hydrops fetalis.
4034
Q2018:Why is choriocarcinoma increased in far east?
4035
1. Increased alpha thalassemia rates;2. Increased spontaneous abortions due to Hb Bart;3. Increased choriocarcinoma
4036
Q2019:alpha-thalassemia: treatment
4037
4038
Q2020:beta-thalassemia: permutations of problems
4039
beta by itself: normal number of beta chains;beta with a + sign: not making enough; but are making;beta with a 0: not making it at all
4040
Q2021:beta-thalassemia: mode of inheritance
4041
autosomal recessive
4042
Q2022:beta-thalassemia: what is the genetic association with severe anemia?
4043
Nonsense mutation with formation of a stop codon
4044
Q2023:beta-thalassemia: what hemoglobin will decrease
4045
HbA
4046
Q2024:beta-thalassemia: what hemoglobins will increase
4047
HbA2 and HbF
4048
Q2025:beta-thalassemia: electropheresis results
4049
Will show increased HbA2 and HbF with decreased HbA
4050
Q2026:beta-thalassemia: treatment
4051
none
4052
Q2027:Cooley's anemia: disease type
4053
Not making any beta chains (beta 0)
4054
Q2028:Cooley's anemia: Prognosis
4055
Will not live past 30
4056
Q2029:Main way to tell Anemia of chronic disease from Iron deficiency
4057
Ferritin levels;Low: Iron deficiency;High: Anemia of chronic disease
4058
Q2030:Stain used to find Ringed Sideroblasts
4059
Prussian Blue
4060
Q2031:Histologic sign associated with Lead poisoning
4061
Coarse basophilic stippling
4062
Q2032:Where does stippling come from?
4063
Inability to break down ribosomes.
4064
Q2033:Classic presentation of lead poisoning in children
4065
-Severe abdominal colic;-Cerebral edema (convulsions; etc);Severe microcytic anemia;-Failure to thrive
4066
Q2034:What is seen on a flat plate?
4067
-Iron (if kid took iron tablets);-Lead (from intestine);Mercury
4068
Q2035:Mechanism of lead poisoning
4069
Buildup of delta-ALA; leading to neuronal toxicity
4070
Q2036:Presentation of lead poisoning in adults
4071
-Workers from automobile factory or moonshine makers or pottery painters;-Abdominal colic;-Diarrhea;-Neuropathy (slapping gait; drops (radial; ulnar palsies); claw hand
4072
Q2037:What is the disease: Serum Iron (low); TIBC (high); % iron saturation (low); Serum ferritin (low)
4073
Iron deficiency
4074
Q2038:What is the disease: Serum Iron (low); TIBC (low); % iron saturation (low); Serum ferritin (high)
4075
Anemia of Chronic Disease
4076
Q2039:What is the disease: Serum Iron (normal); TIBC (normal); % iron saturation (normal); Serum ferritin (normal)
4077
Thalassemia
4078
Q2040:Sideroblastic anemias: Iron status
4079
Iron overload
4080
Q2041:Hemochromatosis: Iron status
4081
Iron overload
4082
Q2042:Hemosiderosis: Iron status
4083
Iron overload
4084
Q2043:What is the disease: Serum Iron (high); TIBC (low); % iron saturation (high); Serum ferritin (high)
4085
Iron overload (Sideroblastic anemia; hemochromatosis; hemosiderosis)
4086
Q2044:What do B12 and folate deficiencies most immediately not allow production of?
4087
dTMP (using Thymidylate synthase) leading to lack of DNA production
4088
Q2045:What is the size of immature nuclei?
4089
Nucleus gets smaller and more condensed due to increased DNA?
4090
Q2046:What are cells called with immature nuclei?
4091
Megaloblasts
4092
Q2047:Why is B12 called Cobalamin?
4093
It has cobalt in it.
4094
Q2048:What is the circulating form of Folate?
4095
N5-methyl-Tetrahydrofolate
4096
Q2049:What does B12 do in folate metabolism?
4097
B12 removes methyl group from N5-methyl-THF to make THF
4098
Q2050:What happens when you add a methyl group to homocysteine?
4099
Methionine
4100
Q2051:Which amino acid is used for one-carbon transfers?
4101
Methionine
4102
Q2052:What are serum homocysteine levels in B12 or THF deficiency?
4103
High
4104
Q2053:Why do high homocysteine levels produce thromboses?
4105
It damages endothelial cells predisposing them to thrombosis.
4106
Q2054:What is the most common cause of high homocysteine levels?
4107
Folate deficiency
4108
Q2055:Drugs which inhibit folate metabolism
4109
5-fluorouracil (which inhibits thymidylate synthase);Methotrexate and TMP-SMX (which both inhibit DHF reductase); Phenytoin (which inhibits intestinal conjugase); Oral contraceptives and alcohol (which both inhibit of uptake of monoglutamate in jejunum; but alcohol also inhibits the release of folate from the liver)
4110
Q2056:What happens if B12 is missing to MethylmalonylCoA?
4111
It builds up; because it cannot form succinyl-coA
4112
Q2057:Sensitive test for B12 deficiency
4113
Methylmalonic acid
4114
Q2058:What is methylmalonic acid level a test for?
4115
B12 deficiency
4116
Q2059:What is the mechanism of B12 deficiency leading to neurologic deficiencies?
4117
Propionyl CoA builds up; and myelin production is deficient.
4118
Q2060:What are the neurologic effects of B12 deficiency?
4119
Dementia; demyelination of posterior columns (proprioception and vibratory sensation) and lateral corticospinal tract (upper motor neuron problems)
4120
Q2061:Serum levels to order in dementia
4121
TSH to rule out hypothyroidism and B12 to rule out B12 deficiency
4122
Q2062:Where is B12 gotten from?
4123
Animal products
4124
Q2063:What is the first factor B12 binds to?
4125
R factor
4126
Q2064:What does R factor do?
4127
It protects B12 from being destroyed?
4128
Q2065:Where does intrinsic factor come from?
4129
Parietal cells in the gastric body and fundus.
4130
Q2066:Where is vitamin B12 absorbed?
4131
Terminal ileum
4132
Q2067:What deficiencies are found in Crohn's disease?
4133
Bile salts and vitamin B12 (both due to reabsorption problems in terminal ileum)
4134
Q2068:Most common cause of B12 deficiency
4135
Pernicious anemia
4136
Q2069:What is the mechanism in pernicious anemia?
4137
Autoimmune destruction of parietal cells and intrinsic factor
4138
Q2070:What is achlorhydria?
4139
Atrophic gastritis of the body and fundus leading to ;lack of acid which leads to gastric adenocarcinoma;AND;bacterial overgrowth from stasis
4140
Q2071:Causes for achlorhydria
4141
Tapeworms; pernicious anemia; folate deficiency
4142
Q2072:Eaten form of folate
4143
Polyglutamate
4144
Q2073:What converts polyglutamate to monoglutamate?
4145
Intestinal conjugase
4146
Q2074:What drug blocks intestinal conjugase?
4147
Phenytoin
4148
Q2075:What is the mechanism of Phenytoin?
4149
Blocks intestinal conjugase
4150
Q2076:What blocks absorption of monoglutamate from jejunum?
4151
Alcohol and oral contraceptives
4152
Q2077:What are hypersegmented neutrophils with neurologic deficiency diagnostic for?
4153
Vitamin B12 deficiency
4154
Q2078:What are hypersegmented neutrophils without neurologic deficiency diagnostic for?
4155
Folate deficiency
4156
Q2079:What is a characteristic CBC finding in macrocytic anemia?
4157
Pancytopenia
4158
Q2080:Schilling's test
4159
1. Give radioactive B12 by mouth;2. 24 hour urine collection;3. If nothing comes out; can't reabsorb B12;4. Then give radioactive B12 and intrinsic factor together by mouth;5. 24 hour urine collection. If something comes out; it's pernicious anemia. If not; go to step 6;6. Give broad-spectrum anti-biotic. If you see B12 in the urine; you have bacterial overgrowth. If not; go to step 7;7. Take pancreatic extract with radioactive B12. If you get B12 in the urine; they have chronic pancreatitis. If not; it could be Crohn's disease; a worm; or some other cause. 4160
Q2081:Stages of iron deficiency
4161
1. Ferritin goes down;2. Iron decreases; TIBC increases; % iron sat decreases;3. Mild normocytic anemia;4. Microcytic anemia
4162
Q2082:What test must be ordered to confirm aplastic anemia?
4163
Bone marrow study
4164
Q2083:Most common cause of aplastic anemia
4165
Idiopathic
4166
Q2084:Most common known cause of aplastic anemia
4167
Drugs (Indomethacin; Phenylbutazone; Thyroid-related drugs; Chloramphenicol)
4168
Q2085:Second most common known cause of aplastic anemia
4169
Hepatitis C
4170
Q2086:Most common infective cause of pure RBC aplasia
4171
Parvovirus
4172
Q2087:Mechanisms of hemolysis
4173
1) Intravascular hemolysis;2) Extravascular hemolysis which is more common
4174
Q2088:What is the mechanism of extravascular hemolysis?
4175
Macrophages kill them at the Cords of Bilroth
4176
Q2089:What are some causes of RBCs being phagocytosed at the cords of Bilroth?
4177
IgG or c3b on the surface;or Howell-Jolly bodies inside; or an abnormal shape (such as spherical or sickle cell)
4178
Q2090:End product of phagocytosing an RBC
4179
Unconjugated bilirubin
4180
Q2091:Clinical finding in extravascular hemolysis
4181
Jaundice; which is due to unconjugated bilirubin due to macrophages phagocytosing red blood cells.
4182
Q2092:Causes of intravascular hemolysis
4183
1) Congenital bicuspid aortic valve;2) IgM binding to surface and activating complement system
4184
Q2093:End product of intravascular hemolysis
4185
Hemoglobin
4186
Q2094:Name of protein which binds free hemoglobin in blood
4187
Haptoglobin
4188
Q2095:Clinical findings in intravascular hemolysis
4189
1) Hemoglobinuria;2) Low haptoglobin levels
4190
Q2096:general steps in hormone synthesis
4191
1. preprohormone synthesized in rER; 2. signal peptides cleaved--> prohormone transported to Golgi; 3. more cleavage in golgi and HORMONE then packaged in secretory granules
4192
Q2097:amine hormones
4193
derivates of TYROSINE; include thyroid hormone; Epi; NE
4194
Q2098:active form of G protein?
4195
ATP-bound to alpha subunit
4196
Q2099:how does caffeine work?
4197
inhibits phosphodiesterase which degrades cAMP (get more cAMP)
4198
Q2100:IP3 signalling mech
4199
hormone + R--> Gq --> PLC --> DAG and IP3 --> PKC
4200
Q2101:which hormones of anterior pituitary most homologous to TSH?
4201
FSH; LH (identical alpah subunits)
4202
Q2102:"children" of POMC
4203
ACTH; MSH; beta-lipotropin; beta-endorphin
4204
Q2103:which hormone of anterior pituitary most related to GH?
4205
prolactin
4206
Q2104:what increases the pulsatile secretion of GH?
4207
sleep; stress; puberty; starvation; exercise; hypoglycemia
4208
Q2105:what decreases GH secretion?
4209
somatostatin; somatomedins; obesity; hyperglycemia; preggers
4210
Q2106:what does GH do in liver?
4211
causes production of somatomedins (insulin-life growth factors)
4212
Q2107:4 direct actions of GH
4213
1. dec'd glucose uptake into cells; 2. inc'd lipolysis; 3. inc'd protein synthesis in mm; 4. inc'd production of IGF
4214
Q2108:actions of GH via IGF
4215
inc'd protein synthesis! In chondrocytes--> growth spurt; in mm-->inc'd lean body mass; inc'd organ size
4216
Q2109:how is prolactin secretion regulated?
4217
tonic inhibition by dopamine (which is stimulated by PRL); TRH increases PRL secretion
4218
Q2110:4 actions of PRL
4219
1. stim milk production; 2. stim breast development (w/estrogen); 3. inhibits ovulation via GnRH inhibition; 4. inhibits spermatogenesis
4220
Q2111:how treat PRL excess?
4221
bromocriptine (DA agonists)
4222
Q2112:hormones of the posterior pituitary?
4223
ADH (supraoptic hypothal); oxytocin (paraventricular hypothal)
4224
Q2113:what inhibits the iodide pump/trap in thyroid follicular epithelial cells?
4225
thiocyanate and perchlorate anions
4226
Q2114:Wolff-Chaikoff effect?
4227
high levels of I- inhibit I- pump
4228
Q2115:significance of propylthiouracil?
4229
inhibits peroxidase enzyme (which first catalyzes oxidation of I- to I2;and then other steps); used for treatment of hyperthyroidism
4230
Q2116:what happens when TSh stimulates thyroid?
4231
iodinated thyroglobulin is taken back into follicular cells; digested and T3; T4 released into circulation. Leftover MIT; DIT deiodinated by thyroid deiodinase
4232
Q2117:what happens to T3; T4 in circulation?
4233
mostly bound to TBG (inc'd in preggers); peripherally; T4->T3 or rT3
4234
Q2118:bone manifestation of thyroid deficiency?
4235
bone age < chronologic age; b/c TH stimulates bone maturations
4236
Q2119:effect of TH on heart?
4237
upregulates beta 1 R
4238
Q2120:effect of TH on O2 consumption?
4239
increases b/c of upregulation of Na-K ATPase (which uses ATP;which comes from O2;kinda)
4240
Q2121:which part of adrenal cortex makes mineralocorticoids?
4241
(outermost) zona glomerulosa (works on kidneys;which have glomeruli)
4242
Q2122:which part of adrenal cortex makes glucocorticoids?
4243
(middle) zona fasciculata
4244
Q2123:which part of adrenal cortex makes androgens (DHEA; androstenedione)
4245
(innermost) zona reticularis (b/c you should be really particularis of your sex partners)
4246
Q2124:effect of ACTH on adrenal cortex?
4247
stimulates cholesterol desmolase thereby increasing steroid synthesis; also upregulates own R
4248
Q2125:control of aldosterone secretion?
4249
tonically--ACTH; also Ang II stimulates aldosterone synthase (corticosterone--> aldosterone)
4250
Q2126:4 actions of glucocorticoids
4251
1. stim gluconeogenesis; 2. anti inflamm; 3. immunosuppressive; 4. upregulate alpha 1 R on arterioles
4252
Q2127:how do glucocorticoids stimulate gluconeogenesis?
4253
1. increase protein catabolism in mm (more aa available); 2)decrease glucose utilization and insulin sensitivty of fat; 3) increase lipolysis (more glycerol available)
4254
Q2128:how are glucocorticoids anti-inflammatory?
4255
induce synthesis of lipocortin (inhibits PLA2); inhibit production of IL-2; thereby inhibit proliferation of T cells; inhibit relase of His and serotonin from mast cells; platelets
4256
Q2129:Name the dz: Increased ACTH; hypoglycemia; hyperpigmentation; ECF volume contraction
4257
Addison's disease
4258
Q2130:how is secondary adrenocortical insufficiency different from Addison's?
4259
no hyperpigmentation; no volume contraxn ;hyperKalemia; metab acidosis
4260
Q2131:Conn's syndrome leads to?
4261
HTN; hypokalemia; metab alkalosis; dec'd renin
4262
Q2132:name the dz: decreased cortisol and aldosterone; increased adrenal androgens; virilization; suppression of gonad function
4263
21 hydroxylase deficiency
4264
Q2133:name the dz: decreased androgen and glucocorticoid levels; increased aldosterone; hypoglycemia; lack of pubes
4265
17 hydroxylase deficiency
4266
Q2134:3 major cell types and their main export in islets of Langerhans?
4267
alpha--glucagon; beta--insulin; delta--somatostatin; gastrin
4268
Q2135:what do delta cells islets of Langerhans secrete?
4269
somatostatin; gastrin
4270
Q2136:what stimulates glucagon release from alpha cells?
4271
decreased blood glucose
4272
Q2137:3 actions of glucagon
4273
1. increase blood glucose; 2. increase blood FA; ketoacids; 3. increase urea production
4274
Q2138:mechanism of insulin secretion?
4275
glucose binds GLUT 2 on beta cell membrane--> depolarization of membrane--> Ca channel opens; influx --> insulin secretion
4276
Q2139:why get hyPOtension in uncontrolled DM?
4277
high [glucose] exceeds Tm in kidney so urine is very sugary->osmotic diuretic
4278
Q2140:what stimulates secretion of PTH?
4279
dec'd Ca; mildly dec'd Mg (severe hypoMg inhibits PTH secretion!)
4280
Q2141:"goal" of PTH
4281
increase calcium; decrease phosphate
4282
Q2142:4 actions of PTH
4283
1. increase bone reabsorp; 2 inhibit renal phosphate reabsorp.(PCT); 3. increase renal Ca reabsorp; 4. stimulate production of active vit D
4284
Q2143:Albright's hereditary osteodystrophy
4285
pseudohypoparathyroidism cause by defective Gs in kideny and bone-->end organ resistance to PTH
4286
Q2144:how does chronic renal failure lead to hypocalcemia?
4287
increased GFR--> increased sr phosphate which complexes with Calcium; thereby decreasing free Ca; also decreased vit D
4288
Q2145:"goal" of vit D
4289
increase calcium and phosphate in ECF for bone mineralization
4290
Q2146:Calcitonin: a) where b)stim'd by c)action
4291
a)parafollicular thyroid cells; b) increased sr Ca; c) inhibit bone reabsorp.
4292
Q2147:what do Leydig cells make?
4293
testosterone
4294
Q2148:why can't Leydig cells make glucocorticoids and mineralocorticoids?
4295
no 21 beta hydroxylase or 11 beta hydroxylase
4296
Q2149:significance of 5 alpha reductase?
4297
enzyme that converts testosterone to DHT; found in accessory sex organs like the prostate
4298
Q2150:significance of finasteride?
4299
inhibits 5alpha reductase (can tx BPH)
4300
Q2151:FSH acts on Sertoli cells to?
4301
stimulate production of inhibin which has negative feedback effect on FSH
4302
Q2152:what do theca cells make?
4303
androgens which are converted to estrogens by aromatase in granulosa cells
4304
Q2153:2 causes of end organ ADH resistance
4305
1. drugs (Li!!! Inhibits Gs); 2. severe hypercalcemia (inhibits AC)
4306
Q2154:which diuretics can also be used for treatment of acute mountain sickness?
4307
carbonic anhydrase inhibitors like acetazolamide (metabolic acidosis to combat respiratory alkalosis)
4308
Q2155:why get HTN in 11beta hydroxylase deficiency?
4309
the precursor that the enzyme would act on is a weak mineralocorticoid
4310
Q2156:Factors that affect hormone binding protein synthesis
4311
Estrogen increases binding proteins; androgens decrease binding proteins. In pregnancy there's increased total hormones with normal levels of free hormone.
4312
Q2157:Site of synthesis of CRH
4313
Paraventricular nucleus
4314
Q2158:Site of synthesis of TRH
4315
Paraventricular nucleus
4316
Q2159:Site of synthesis of PIF
4317
Arcuate nucleus
4318
Q2160:Site of synthesis of GHRH
4319
Arcuate nucleus
4320
Q2161:Site of synthesis of GnRH
4321
Preoptic region
4322
Q2162:Site of synthesis of ADH
4323
Supraoptic and paraventricular nuclei
4324
Q2163:How do hypothalamic hormones reach the anterior pituitary?
4325
Hormones are released in the hypophyseal-portal system
4326
Q2164:Hypothalamic hormones
4327
GHRH; GnRH; PIF (dopamine); TRH; CRH; Somatostatin; ADH; prolactin
4328
Q2165:Anterior pituitary hormones
4329
ACTH; TSH; LH; FSH; GH; prolactin
4330
Q2166:Sheehan syndrome
4331
Ischemic necrosis of the pituitary due to severe blood loss during delivery. Causes hypopituitarism.
4332
Q2167:Obstruction of pituitary stalk
4333
Adenoma compresses pituitary stalk and decreases secretion of anterior pituitary hormones except prolactin.
4334
Q2168:What prevents downregulation of pituitary receptors?
4335
Pulsatile release of hypothalamic hormones.
4336
Q2169:Hyperprolactinemia
4337
Results from dopamine antagonists or pituitary adenomas that compress the pituitary stalk. Amenorrhea; galactorrhea; decreased libido; impotence; hypogonadism
4338
Q2170:What hormone controls release of cortisol and adrenal androgens?
4339
ACTH
4340
Q2171:What hormone regulates release of aldosterone?
4341
Angiotensin II and also potassium in hyperkalemia
4342
Q2172:Layers of the adrenal cortex
4343
From external to internal: glomerulosa (aldosterone); fasciculata (cortisol); reticularis (androgens)
4344
Q2173:Consequences of loss of zona glomerulosa
4345
No aldosterone: loss of Na; decreased ECF; decreased blood pressure; circulatory shock; death
4346
Q2174:Consequences of loss of zona fasciculata
4347
No cortisol: circulatory failure (cortisol is permissive for cathecolamine vasoconstriction); can't mobilize energy stores during exercise or cold (hypoglycemia)
4348
Q2175:Consequences of loss of adrenal medulla
4349
No epinephrine: decreased capacity to mobilize fat and glycogen during stress. Not necessary for survival.
4350
Q2176:What are the 17-OH steroids?
4351
17OHpregnenolone; 17OHprogesterone; 11-deoxycortisol; cortisol. Urinary 17OH steroids are an index of cortisol secretion.
4352
Q2177:What is the rate-limiting enzyme for steroid hormone synthesis?
4353
Desmolase - converts cholesterol into pregnenolone
4354
Q2178:What are the 17-ketosteroids?
4355
DHEA and androstenidione
4356
Q2179:DHEA
4357
Weak androgen 17-ketosteroid conjugated with sulfateto make it water-soluble
4358
Q2180:What is measured as an index of androgen production?
4359
Urinary 17-ketosteroids. In females and prepubertal males is an index of adrenal 17-ketosteroids. In postpubertal males is an index of 2/3 adrenal androgens and 1/3 testicular androgens.
4360
Q2181:Stimulus for the zona glomerulosa
4361
Angiotensin II and potassium in hyperkalemia stimulate production of aldosterone
4362
Q2182:Hormone responsible for negative feedback for ACTH release
4363
Cortisol
4364
Q2183:Enzyme deficiencies that produce congenital adrenal hyperplasia and low cortisol levels
4365
21beta -OH; 11beta -OH and 17alpha -OH all result in low cortisol levels.
4366
Q2184:21beta -OH deficiency
4367
No aldosterone: loss of Na; decreased ECF; decreased blood pressure in spite of high renin and angiotensin II; circulatory shock; death. No cortisol (low 17OH steroids): skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; hypotension (persmissive for catecholamines); fasting hypoglycemia. Excess androgens (17-ketosteroids): female pseudohermaphrodite; hirsutism
4368
Q2185:11beta -OH deficiency
4369
Excess 11-deoxycorticosterone: Na and water retention; lowrenin hypertension. No cortisol (low 17OH steroids): skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; fasting hypoglycemia. Excess androgens (17ketosteroids): female pseudohermaphrodite; hirsutism
4370
Q2186:17alpha -OH deficiency
4371
Excess 11-deoxycorticosterone and low aldosterone (no AII): Na and water retention; low-renin hypertension. No cortisol: skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; corticosterone partially compensates low cortisol levels. No 17-ketosteroids: male pseudohermaphrodite; no testosterone; no estrogen.
4372
Q2187:decreased 17OH-steroids increased ACTH; decreased blood pressure; decreased mineralocorticoids; increased 17ketosteroids
4373
21beta -OH deficiency
4374
Q2188:decreased 17OH-steroids increased ACTH; increased blood pressure; decreased aldosterone; increased 11deoxycorticosterone; increased 17-ketosteroids
4375
11beta -OH deficiency
4376
Q2189:decreased 17OH-steroids increased ACTH; increased blood pressure; decreased aldosterone; increased 11deoxycorticosterone; decreased 17-ketosteroids
4377
17alpha -OH deficiency
4378
Q2190:Stress hormones
4379
GH; Glucagon; cortisol; epinephrine
4380
Q2191:Actions of GH in stress situations
4381
Mobilizes fatty acids by increasing lipolysis in adipose tissue
4382
Q2192:Actions of glucagon in stress situations
4383
Mobilizes glucose by increasing liver glycogenolysis
4384
Q2193:Actions of cortisol in stress situations
4385
Mobilizes fat; carbs and proteins
4386
Q2194:Actions of epinephrine in stress
4387
Mobilizes glucose via glycogenolysis and fat via lipolysis.
4388
Q2195:Metabolic actions of cortisol
4389
1) Protein catabolism and delivery of amino acids; 2) lipolysis and delivery of fatty acids and glycerol 3) gluconeogenesis raises glycemia; also inhibits glucose uptake.
4390
Q2196:Permissive actions of cortisol
4391
Enhances glucagon (without cortisol --> fasting hypoglycemia); enhances epinephrine (without cortisol ->hypotension)
4392
Q2197:alpha -MSH
4393
Stimulates melanocytes and causes darkening of skin. Synthesized along with ACTH from pro-opiomelanocortin.
4394
Q2198:increased cortisol; decreased CRH; decreased ACTH; no hyperpigmentation
4395
Primary hypercortisolism
4396
Q2199:decreased cortisol; increased CRH; increased ACTH; hyperpigmentation
4397
Addison disease - primary hypocortisolism
4398
Q2200:increased cortisol; decreased CRH; increased ACTH; hyperpigmentation
4399
Secondary hypercortisolism
4400
Q2201:decreased cortisol; increased CRH; decreased ACTH; no hyperpigmentation
4401
Secondary hypocortisolism
4402
Q2202:decreased cortisol; decreased CRH; decreased ACTH; no hyperpigmentation; symptoms of excess cortisol
4403
Steroid administration
4404
Q2203:Cushing syndrome
4405
Protein depletion; weak inflammatory response; poor wound healing; hyperglycemia; hyperinsulinemia; insulin resistance; hyperlipidemia; osteoporosis; purple striae; hirsutism; hypertension; hypokalemic alkalosis; buffalo hump
4406
Q2204:Actions of aldosterone
4407
increased Na channels in lumen of principal cells; increased activity of Na/K ATPase of principal cells --> increases Na reabsorption. Also increased secretion of K and H leading to hypokalemic metabolic alkalosis.
4408
Q2205:Addison disease
4409
increased ACTH; hyperpigmentation; hypotension (no aldosterone; no cortisol); hyperkalemic metabolic acidosis (no aldosterone); loss of body hair (no androgens); hypoglycemia; increased ADH secretion
4410
Q2206:Causes of secondary hyperaldosteronism
4411
CHF; vena cava constriction; cirrhosis; renal artery stenosis
4412
Q2207:Primary hyperaldosteronism
4413
Na and water retention; hypertension; hypokalemic metabolic alkalosis; decreased renin and angiotensin; no edema due to pressure diuresis and natriuresis.
4414
Q2208:Primary hypoaldosteronism
4415
Na and water loss; hypotension; hyperkalemic metabolic acidosis; increased renin and angiotensin II; no edema
4416
Q2209:Secondary hyperaldosteronism
4417
increased renin and angiotensin II; increased Na and water retention in venous circulation; edema
4418
Q2210:Factors that influence ADH secretion
4419
increased osmolarity --> increased ADH secretion; decreased blood volume --> baroreceptors --> medulla --> increased ADH secretion
4420
Q2211:Actions of ADH
4421
Inserts water channels in luminal membrane of collecting ducts; increases reabsorption of water.
4422
Q2212:Central diabetes insipidus
4423
Not enough ADH secreted. Dilute urine is formed in spite of water deprivation. Responds to injected ADH.
4424
Q2213:Nephrogenic diabetes insipidus
4425
ADH is secreted but ducts are unresponsive to it. Dilute urine is formed in spite of water deprivation or injected ADH.
4426
Q2214:SIADH
4427
Excessive secretion of ADH in spite of low osmolarity. Concentrated urine is formed.
4428
Q2215:decreased permeability of collecting ducts; increased urine; decreased urine osmolarity; decreased ECF; increased osmolarity
4429
Diabetes insipidus
4430
Q2216:increased permeability of collecting ducts; decreased urine; increased urine osmolarity; decreased ECF; increased osmolarity
4431
Dehydration
4432
Q2217:increased permeability of collecting ducts; decreased urine; increased urine osmolarity; increased ECF; decreased osmolarity
4433
SIADH
4434
Q2218:decreased permeability of collecting ducts; increased urine; decreased urine osmolarity; increased ECF; decreased osmolarity
4435
Primary polydipsia
4436
Q2219:Actions of ANP
4437
Atrial stretch or increased osmolarity --> ANP secretion --> dilation of afferent; constriction of efferent --> increased GFR --> natriuresis; also decreases permeability of collecting ducts to water.
4438
Q2220:Delta cells of the pancreas
4439
Between alpha and beta cells; represent 5% of islets. Secrete somatostatin.
4440
Q2221:Alpha cells of the pancreas
4441
Near the periphery of the islets; represent 20%. Secrete glucagon.
4442
Q2222:Beta cells of the pancreas
4443
In the center of the islets; represent 60-75%. Secrete insulin and C peptide.
4444
Q2223:Insulin receptor
4445
Has intrinsic tyrosine kinasae activity. Insulin receptor substrate binds tyrosine kinase; activates SH2 domain proteins: PI-3 kinase (translocation of GLUT-4); p21RAS.
4446
Q2224:Tissues that require insulin for glucose uptake
4447
Resting skeletal muscle and adipose tissue
4448
Q2225:Tissues independent of insulin for glucose uptake
4449
Brain; kidneys; intestinal mucosa; red blood cells; beta cells of the pancreas.
4450
Q2226:Anabolic hormones
4451
Insulin; GH/IGF-1; androgens; T3/T4; IGF-1 (somatomedin C)
4452
Q2227:Effects of insulin on potassium
4453
Increases Na/K ATPase uptake of K. Insulin + glucose used to treat hyperkalemia.
4454
Q2228:Mechanism of insulin release
4455
Glucose enters beta cells and is metabolized --> increased ATP --> closes K channels --> increased depolarization --> increased Ca influx --> exocytosis of insulin.
4456
Q2229:Factors that stimulate secretion of insulin
4457
Glucose; arginine; GIP; glucagon
4458
Q2230:Factors that inhibit insulin release
4459
Somatostatin; norepinephrine via alpha 1 receptors
4460
Q2231:increased glucose; increased insulin; increased C peptide
4461
Type 2 diabetes
4462
Q2232:increased glucose; decreased insulin; decreased C peptide
4463
Type 1 diabetes
4464
Q2233:decreased glucose; increased insulin; increased C peptide
4465
Insulinoma
4466
Q2234:decreased glucose; increased insulin; decreased C peptide
4467
Factitious hypoglycemia (insulin injection)
4468
Q2235:Actions of somatomedin C
4469
Increases cartilage synthesis at epiphyseal plates (increased bone length). Also increased lean body mass. Protein-bound and long half-life correlates with GH secretion. Also called IGF-1.
4470
Q2236:Secretion of GH
4471
Pulsatile during non-REM sleep; more frequent in puberty due to increased androgens; requires thyroid hormones; decreases in the elderly.
4472
Q2237:Factors that stimulate GH secretion
4473
Deep sleep; hypoglycemia; exercise; arginine; GHRH; low somatostatin
4474
Q2238:Factors that inhibit GH secretion
4475
Negative feedback by GH on GHRH; positive feedback on somatostatin by IGF-1
4476
Q2239:Dwarfism
4477
Due to GH insensitivity during prepuberty
4478
Q2240:Acromegaly
4479
Due to excess GH in postpuberty. Enlargement of hands; feet and lower jaw; increased proteins; decreased fat; visceromegaly; cardiac insuficiency.
4480
Q2241:Composition of bone
4481
Phosphate and calcium precipitate forming hydroxyapatite in osteoid matrix.
4482
Q2242:Actions of PTH
4483
Rapid actions: increases Ca reabsorption in distal tubules and decreases phosphate reabsorption in proximal tubules; thus lowering blood phosphate and lowering solubility product which leads to bone resorption and raises plasma Ca. Slow actions: increases number and activity of osteoclasts (via osteoclast activating factor released by osteoblasts); increases activity of alpha-1 hydroxylase in the proximal tubules which increases active vitamin D and absorption of Ca and phosphate in the instetines.
4484
Q2243:Clinical features of primary hyperparathyroidism
4485
increased plasma Ca and decreased plasma phosphate; phosphaturia; polyuria; calciuria (filtered load of Ca exceeds Tm); increased serum alkaline phosphatase; increased urinary hydroxyproline; muscle weakness; easy fatigability.
4486
Q2244:Clinical features of primary hypoparathyroidism
4487
decreased plasma Ca and increased plasma phosphate; hypocalcemic tetany due to increased excitability of motor neurons.
4488
Q2245:increased PTH; increased Ca; decreased phosphate
4489
Primary hyperparathyroidism. Causes: parathyroid adenoma (MEN I and II); ectopic PTH tumor (lung squamous CA)
4490
Q2246:decreased PTH; decreased Ca; increased phosphate
4491
Primary hypoparathyroidism. Cause: surgical removal of parathyroid.
4492
Q2247:increased PTH; decreased Ca; increased phosphate
4493
Secondary hyperparathyroidism due to renal failure (no active vitamin D; decreased GFR)
4494
Q2248:increased PTH; decreased Ca; decreased phosphate
4495
Secondary hyperparathyroidism. Causes: deficiency of vitamin D due to bad diet or fat malabsorption.
4496
Q2249:decreased PTH; increased Ca; increased phosphate
4497
Secondary hypoparathyroidism due to excess vitamin D.
4498
Q2250:Vitamin D synthesis
4499
Dietary and skin cholecalciferol is hydroxylated by 25hydroxylase in the liver and activated to 1;25 di-OH cholecalciferol by 1-alpha hydroxylase in the proximal tubules.
4500
Q2251:Actions of 1;25 di-OH cholecalciferol
4501
Increases Ca binding proteins by intestinal cells which increases intestinal reabsorption of Ca and phosphate. Also increases reabsorption of Ca in the distal tubules. Increased serum Ca promotes bone deposition.
4502
Q2252:Osteomalacia
4503
Underminerilized bone in adults due to vitamin D deficiency leads to bone deformation and fractures. Low calcium leads to secondary hyperparathyroidism.
4504
Q2253:Rickets
4505
Underminerilized bone in children due to vitamin D deficiency leads to bone deformation and fractures. Low calcium leads to secondary hyperparathyroidism.
4506
Q2254:Excess vitamin D
4507
Leads to bone reosprtion and demineralization
4508
Q2255:Synthesis of thyroid hormones
4509
1) Iodine is actively transported into follicle cell; 2) thyroglobulin is synthesized in the RER; glycosylated in the SER and packaged in the GA; 3) Peroxidase is found in the luminal membrane and catalizes oxidation of I-; iodination of thyroglobulin and coupling to form MITs and DITs; 4) iodinated thyroglobulin is stored in the follicle lumen.
4510
Q2256:Structure of thyroid hormones
4511
T4 has iodine attached to carbons 3 and 5 of both fenol rings; T3 has iodide attached to carbons 3 and 5 of the amino terminal fenol ring and the 3 prime carbon of the hydroxyl end fenol ring; reverse T3 has iodide in carbon 3 of the amino terminal fenol ring but not carbon 5.
4512
Q2257:Secretion of thyroid hormones
4513
Iodinated thyroglobulin is endocytosed from the lumen of the follicles into lysosomes. Thyroglobulin is degraded into amino acids; T3; T4; DITs and MITs. T4 and T3 are secreted in a 20:1 ratio. DITs and MITs are deiodinated and iodine is recycled.
4514
Q2258:Transport of thyroid hormones
4515
99% is bound to TBG; 1% is free. T4 has greater affinity for TBG and a half-life of 6 days. T3 has greater affinity for nuclear receptor and is the active form with a 1 day half-life. 50:1 T4/T3 ratio in periphery.
4516
Q2259:Activation and degradation of thyroid hormones
4517
5' monodeiodinase activates T4 into T3. 5-monodeiodinase inactivates T4 into reverse T3.
4518
Q2260:Actions of thyroid hormones
4519
increased metabolic rate by increased Na/K ATPase except in brain; uterus and testes; essential for brain maturation and menstrual cycle; permissive for bone growth; permissive for GH synthesis and secretion; increased clearance of cholesterol; required for activation of carotene; increased intestinal glucose absorption; increased affinity and number of beta 1 receptros in the heart.
4520
Q2261:Effects of hypothyroidism in newborns
4521
decreased dendritic branching and myelination lead to mental retardation.
4522
Q2262:Effects of hypothyroidism in juveniles
4523
Cretinism results in decreased bone growth and ossification -> dwarfism. Due to lack of permissive action on GH.
4524
Q2263:Control of thyroid hormone secretion
4525
Circulating T4 is responsible for negative feedback of TSH by decreasing sensitivity to TRH. T4 is converted to T3 in the thyrotroph to induce negative feedback.
4526
Q2264:Effects of TSH
4527
Rapid actions: increased iodide trapping; increased synthesis of thyroglobulin; increased reuptake of iodinated thyroglobulin; increased secretion of T4; late effects: increased blood flow to thyroid gland; increased hypertrophy of follicles and goiter.
4528
Q2265:decreased T4; increased TSH; increased TRH
4529
Primary hypothyroidism; increased TSH is the more sensible index
4530
Q2266:decreased T4; decreased TSH; increased TRH
4531
Pituitary (secondary) hypothyroidism
4532
Q2267:decreased T4; decreased TSH; decreased TRH
4533
Hypothalamic (tertiary) hypothyroidism
4534
Q2268:increased T4; increased TSH; decreased TRH
4535
Pituitary (secondary) hyperthyroidism
4536
Q2269:increased T4; decreased TSH; decreased TRH
4537
Graves disease
4538
Q2270:Pathophysiology of iodine deficiency
4539
Thyroid makes less T4 and more T3 so actions of T3 may be normal but low levels of T4 stimulate TSH secretion with development of goiter. Thus euthyroid with goiter.
4540
Q2271:Clinical features of hypothyroidism
4541
decreased basal metabolic rate with cold intolerance; decreased cognition; hyperlipidemia; nonpitting myxedema (mucopolysacchride accumulation around eyes retains water); physiologic jaundice (increased carotene); hoarse voice; constipation; anemia; lethargy
4542
Q2272:Clinical features of hyperthyroidism
4543
increased metabolic rate with heat intolerance and sweating; increased apetite with weight loss; muscle weakness; tremor; irritability; tachycardia; exophthalmos.
4544
Q2273:Leydig cells
4545
Stimulated by LH; produce testosterone for peripheral tissues and Sertoli cells. Testosterone provides negative feedback for LH secretion by pituitary.
4546
Q2274:Sertoli cells
4547
Stimulated by FSH; produce inhibins (inhibits secretion of FSH); estradiol (testosterone is converted by aromatase); androgen binding proteins and growth factors for sperm. Responsible for development of sperm in males. Also MIH in male fetus.
4548
Q2275:decreased sex steroids; increased LH; increased FSH
4549
Primary hypogonadism or postmenopause.
4550
Q2276:decreased sex steroids; decreased LH; decreased FSH
4551
Pituitary hypogonadism or constant GnRH infusion (downregulates GnRH receptors of pituitary.
4552
Q2277:increased sex steroids; decreased LH; decreased FSH
4553
Anabolic steroid therapy. LH supression causes Leydig cell atrophy with decreased Leydig testosterone which suppresses spermatogenesis.
4554
Q2278:increased sex steroids; increased LH; increased FSH
4555
Pulsatile infusion of GnRH
4556
Q2279:Fetal development of male structures
4557
LH --> Leydig cells --> testosterone --> Wolffian ducts (internal male structures: epididymis; vasa deferentia and seminal vesicles). Testosterone + 5-alpha reductase --> dihydrotestosterone --> urogenital sinus and external organs. MIH by Sertoli cells --> regression of Mullerian ducts and female structures.
4558
Q2280:Characteristics of sub-threshold potentials
4559
Proportional to stimulus strength; not propagated; decremental with distance; summation
4560
Q2281:Characteristics of action potentials
4561
Independent of stimulus strength; propagated unchanged in magnitude; summation not possible
4562
Q2282:Factors that affect conduction velocity of the action potential
4563
Cell diameter and amount of myelination are directly proportional to conduction velocity
4564
Q2283:Absolute refractory period
4565
No stimulus can depolarize the cell
4566
Q2284:Relative refractory period
4567
A large stimulus can depolarize the cell
4568
Q2285:Neuromuscular transmission
4569
Action potential travels down axon and opens pre-synaptic Ca channels --> calcium influx --> release Ach vesicles --> Ach diffuses and attaches to nicotinic ion channels --> increased gNa --> end-plate depolarization (local) spreads to areas with voltage-gated Na channels --> depolarization of muscle fiber
4570
Q2286:Excitatory postsynaptic potentials
4571
Transient subtreshold depolarizations due to increased gNa -> summation reaches axon hillock at the junction of cell body and axon --> voltage-gated Na channels depolarize the axon
4572
Q2287:Inhibitory postsynaptic potentials
4573
increased gCl or increased gK hyperpolarize the cell and lower threshold for depolarization
4574
Q2288:Electrical synapse
4575
Action potential transmitted from one cell to the next via gap junctions; without synaptic delay and in both directions. Cardiac muscle; smooth muscle.
4576
Q2289:Sarcomere A band
4577
Contains overlapping actin and myosin. Does not shorten during contraction.
4578
Q2290:Sarcomere H zone
4579
Contains thick myosin filaments. Shortens during contraction.
4580
Q2291:Sarcomere I band
4581
Contains thin actin filaments. Shortens during contraction.
4582
Q2292:Sarcomere Z line
4583
Within the I band.
4584
Q2293:Sarcomere M line
4585
Within the H zone.
4586
Q2294:Actin
4587
Structural protein of the thin filaments; contains attachment sites for myosin cross-bridges.
4588
Q2295:Myosin
4589
Structural protein of the thick filaments; contains crossbridges that attach to actin. Has ATPase activity to terminate actin-myosin cross-bridges. ATP decreases actin-myosin affinity.
4590
Q2296:Tropomyosin
4591
Part of thin filaments. Covers the actin attachment sites for the myosin cross-bridges
4592
Q2297:Troponin
4593
Part of thin filaments; binds calcium; which moves tropomyosin out of the way exposing actin binding sites for cross-bridges.
4594
Q2298:What happens if calcium is removed to the sarcoplasmic reticulum?
4595
Muscle goes back to resting state. Removal of calcium requires ATP.
4596
Q2299:Rigor mortis
4597
Depletion of ATP - cycling stops with myosin attached to actin - (muscle contracted).
4598
Q2300:Muscle contraction steps
4599
Action potential travels down T-tubules --> activates dihydropiridine voltage sensors --> foot processes are pulled aways from ryanodine calcium release channels of sarcoplasmic reticulum --> calcium is released --> calcium attaches to troponin --> tropomyosin moves exposing actin binding sites for myosin cross-bridges --> myosin binds actin --> myosin ATPase breaks down cross bridges producing active tension and shortening --> contraction terminated by active pumping of Ca into the sarcoplasmic reticulum.
4600
Q2301:Myosin ATPase
4601
Hydrolizes ATP to supply energy for active tension and shortening. ATP decreases myosin-actin affinity
4602
Q2302:Sarcoplasmic calcium-dependent ATPase
4603
Supplies energy to terminate contraction and pump Ca back into sarcoplasmic reticulum.
4604
Q2303:Source of calcium for skeletal muscle contraction
4605
Sarcoplasmic reticulum. No extracellular calcium is involved because it doesnt have voltage-gated Ca channels.
4606
Q2304:Source of calcium for heart and smooth muscle contraction
4607
Sarcoplasmic reticulum and extracellular. Cardiac and smooth muscle have voltage-gated calcium channels.
4608
Q2305:Tetanus
4609
Multiple action potentials increase release of calcium thus increasing contraction. Muscle cells have a short refractory period.
4610
Q2306:Preload
4611
Stretch prior to contraction. increased preload --> increased prestretch of the sarcomere --> increased passive tension
4612
Q2307:Afterload
4613
The load the muscle is working against. increased afterload -> increased cross-bridge cycling --> increased active tension
4614
Q2308:What is the best measure of preload?
4615
Sarcomere length
4616
Q2309:Preload-length tension curve
4617
Its a function of the legth of the relaxed muscle. A positive parabola.
4618
Q2310:Isomertric contraction
4619
Active tension is produced but length stays the same. Afterload is greater than active tension; load not moved.
4620
Q2311:How is active tension produced?
4621
Calcium binds troponin --> tropomysion exposes actin sites -> myosin cross-bridges bond to actin --> myosin ATPase generates energy to break cross-bridge link --> cycle repeats -> active tension. The more cross-bridges that cycle; the greater the active tension.
4622
Q2312:Total tension
4623
Passive (preload) tension + active (afterload) tension
4624
Q2313:Active tension curve
4625
It's a function of the number of cross-bridges capable of crosslinking with actin. Negative parabola.
4626
Q2314:What is L0?
4627
The optimum length to produce maximum active tension. Beyond L0; muscle is overstretched; below L0; it's understretched.
4628
Q2315:Isotonic contraction
4629
Muscle contracts and shortens to move the load. Occurs when total tension equals the load.
4630
Q2316:Most energy demanding phase of cardiac cycle
4631
Isovolumetric contraction. Active tension is generated. Equivalent to isometric contraction of skeletal muscle.
4632
Q2317:Relationship between load; muscle force and muscle velocity
4633
increased ATPase activity --> increased velocity; increased muscle mass --> increased force generated; increased afterload --> decreased velocity
4634
Q2318:Regulation of skeletal muscle force and work
4635
increased frequency of action potentials; increased recruitment; increased preload and increased afterload --> increased force and work
4636
Q2319:Regulation of cardiac and smooth muscle force and work
4637
Factors that regulate force and work are preload; afterload and contractility (which is altered by hormones). No summation nor recruitment.
4638
Q2320:Characteristics of white muscle
4639
Large mass; high ATPase activity (fast muscle); anaerobic glycolysis; low myoglobin
4640
Q2321:Characteristics of red muscle
4641
Small mass; low ATPase activity (slower muscle); aerobic metabolism (mitochondria); high myoglobin.
4642
Q2322:Characteristics of skeletal muscle
4643
Actin and myosin form sarcomeres; sarcolema lacks junctional complexes; each fiber innervated; troponin binds calcium; high ATPase activity; triadic contacts by T-tubules at A-I junctions; no calcium channels on membrane
4644
Q2323:Characteristics of cardiac muscle
4645
Actin and myosin form sarcomeres; gap junctions; electrical syncytium; troponin binds calcium; intermediate ATPase activity; dyadic contacts by T-tubules near Z-lines; voltagegate calcium channels.
4646
Q2324:Characteristics of smooth muscle
4647
Actin and myosin not organized in sarcomeres; gap junctions; electrical syncytium; calmodulin binds calcium; low ATPase activity; lacks T-tubules; voltage-gated calcium channels.
4648

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Physiology & Pathophysiology Flash Facts

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Q0002:Anatomical and alveolar dead spaces together constitute what space?

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Skin; liver; and kidneys

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Q0004:What is the effect of LH on the production of adrenal androgens?

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Q0005:What four conditions result in secondary hyperaldosteronism?

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Physiology & Pathophysiology Flash Facts

Q0006:What are the five hormones produced by Sertoli cells?

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Depolarization (i.e; Na+ influx)

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Q0008:Does the left or right vagus nerve innervate the SA node?

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Repolarization is from base to apex and from epicardium to endocardium.

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Q0013:What is the ratio of pulmonary to systemic blood flow?

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Central. Remember; there is a deficiency in ADH production in the central form.

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Q0015:In what area of the GI tract are water-soluble vitamins absorbed?

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Q0019:What are the four functions of saliva?

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Intrapleural pressure decreases (becomes more negative).

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Q0026:What is used as an index of cortisol secretion?

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Urinary 17-OH steroids