Physiology & Pathophysiology - 2000

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
Q0006:What are the five hormones produced by Sertoli cells?
1. Inhibin ;2. Estradiol (E2) ;3. Androgen-binding protein ;4.
Meiosis inhibiting factor (in fetal tissue) ;5. Antimüullerian
hormone
Q0007:What is the term for the negative resting membrane
potential moving toward threshold?
Depolarization (i.e; Na+ influx)
Q0008:Does the left or right vagus nerve innervate the SA
node?
Right vagus innervates the SA node and the left vagus
innervates the AV node
Q0009:How does ventricular repolarization take place; base
to apex or vice versa?
Repolarization is from base to apex and from epicardium to
endocardium.
Q0010:What is the term for any region of the respiratory
system that is incapable of gas exchange?
Anatomical dead space; which ends at the level of the terminal
bronchioles.
Q0011:What four factors shift the Hgb-O2 dissociation curve
to the right? What is the consequence of this shift?
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.
Q0012:What two factors result in the apex of the lung being
hypoperfused?
Decreased pulmonary arterial pressure (low perfusion) and
less-distensible vessels (high resistance) result in decreased
blood flow at the apex.
Q0013:What is the ratio of pulmonary to systemic blood
flow?
1:1. Remember; the flow through the pulmonary circuit and
the systemic circuit are equal.
Q0014:To differentiate central from nephrogenic diabetes
insipidus; after an injection of ADH; which will show a
decreased urine flow?
Central. Remember; there is a deficiency in ADH production
in the central form.
Q0015:In what area of the GI tract are water-soluble vitamins
absorbed?
Duodenum
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
V wave
deflections?;? The bulging of the tricuspid valve into the right
atrium
C wave
deflections?;? The contraction of the right atrium
A wave
Q0019:What are the four functions of saliva?
1. Provide antibacterial action ;2. Lubricate ;3. Begin CHO
digestion ;4. Begin fat digestion
Q0020:When a person goes from supine to standing; what
happens to the following?;? Dependent venous pressure
Increases;Remember; the carotid sinus reflex attempts to
compensate by increasing both TPR and heart rate;;------------
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happens to the following?;? Dependent venous blood volume
Increases;Remember; the carotid sinus reflex attempts to
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happens to the following?;? Cardiac output
Decreases;Remember; the carotid sinus reflex attempts to
compensate by increasing both TPR and heart rate.
happens to the following?;? BP
Decreases;Remember; the carotid sinus reflex attempts to
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Q0024:When does the hydrostatic pressure in Bowman's
capsule play a role in opposing filtration?
It normally does not play a role in filtration but becomes
important when there is an obstruction downstream.
Q0025:What happens to intrapleural pressure when the
diaphragm is ontracted during inspiration?
Intrapleural pressure decreases (becomes more negative).
Q0026:What is used as an index of cortisol secretion?
Urinary 17-OH steroids
Q0027:If the pH is low with increased CO2 levels and
decreased HCO3- levels; what is the acid-base disturbance?
Combined metabolic and respiratory acidosis
Q0028:What is the term that refers to the number of channels
open in a cell membrane?
Membrane conductance (think conductance = channels open)
Q0029:What are the five tissues in which glucose uptake is
insulin independent?
1. CNS ;2. Renal tubules ;3. Beta Islet cells of the pancreas ;4.
RBCs ;5. GI mucosa
Q0030:Place in order from fastest to slowest the rate of
gastric emptying for CHO; fat; liquids; and proteins.
Liquids; CHO; protein; fat
Q0031:Is most of the coronary artery blood flow during
systole or diastole?
Diastole. During systole the left ventricle contracts; resulting
in intramyocardial vessel compression and therefore very little
blood flow in the coronary circulation.
Q0032:What modified smooth muscle cells of the kidney
monitor BP in the afferent arteriole?
The JG cells
Q0033:What are the three functions of surfactant?
1. Increase compliance ;2. Decrease surface tension ;3.
Decrease probability of pulmonary edema formation
Q0034:Name the hormone—glucagon; insulin; or
epinephrine;? Glycogenolytic; gluconeogenic; lipolytic;
glycolytic; and stimulated by hypoglycemia
Epinephrine
epinephrine;? Glycogenolytic; gluconeogenic; lipolytic;
glycolytic; proteolytic; and stimulated by hypoglycemia and
AAs
Glucagon
epinephrine;? Glycogenic; gluconeogenic; lipogenic;
proteogenic; glycolytic; and stimulated by hyperglycemia;
AAs; fatty acids; ketosis; ACh; GH; and Beta-agonist
Insulin
Q0037:Is the hydrophobic or hydrophilic end of the
phospholipids of the cell membrane facing the aqueous
environment?
Hydrophilic (water-soluble) end faces the aqueous
environment and the hydrophobic (water-insoluble) end faces
the interior of the cell.
Q0038:What type of muscle is characterized by no
myoglobin; anaerobic glycolysis; high ATPase activity; and
large muscle mass?
White muscle; short term too
Q0039:What percentage of CO2 is carried in the plasma as
HCO3- ?
90% as HCO3-; 5% as carbamino compounds; and 5% as
dissolved CO2
Q0040:What is the most potent male sex hormone?
Dihydrotestosterone
Q0041:With a decrease in arterial diastolic pressure; what
happens to;? Stroke volume?
Decreases
happens to;? TPR?
Decreases
happens to;? Heart rate?
Decreases
Q0044:What linkage of complex CHOs does pancreatic
amylase hydrolyze? What three complexes are formed?
Amylase hydrolyzes alpha-1; 4-glucoside linkages; forming
alpha-limit dextrins; maltotriose; and maltose.
Q0045:Does the heart rate determine the diastolic or systolic
interval?
Heart rate determines the diastolic interval; and contractility
determines the systolic interval.
Q0046:On a graphical representation of filtration;
reabsorption; and excretion; when does glucose first appear in
the urine?
At the beginning of splay is when the renal threshold for
glucose occurs and the excess begins to spill over into the
urine.
Q0047:What is the relationship between preload and the
passive tension in a muscle?
They are directly related; the greater the preload; the greater
the passive tension in the muscle and the greater the
prestretch of a sarcomere.
Q0048:What is the rate-limiting step in the synthetic
pathway of NE at the adrenergic nerve terminal?
The conversion of tyrosine to dopamine in the cytoplasm
Q0049:How many days prior to ovulation does LH surge
occur in the menstrual cycle?
1 day prior to ovulation
Q0050:How are flow through the loop of Henle and
concentration of urine related?
As flow increases; the urine becomes more dilute because of
decreased time for H2O reabsorption.
Q0051:What is the PO2 of aortic blood in fetal circulation?
60%
Q0052:How do elevated blood glucose levels decrease GH
secretion? (Hint: what inhibitory hypothalamic hormone is
stimulated by IGF-1?)
Somatotrophins are stimulated by IGF-1; and they inhibit GH
secretion. GHRH stimulates GH secretion.
Q0053:What segment of the nephron has the highest
concentration of inulin? Lowest concentration of inulin?
Terminal collecting duct has the highest concentration and
Bowman's capsule has the lowest concentration of inulin.
Q0054:What type of resistance system; high or low; is
formed when resistors are added in a series?
A high-resistance system is formed when resistors are added
in a series.
Q0055:What hormones; secreted in proportion to the size of
the placenta; are an index of fetal well-being?
hCS and serum estriol; which are produced by the fetal liver
and placenta; respectively; are used as estimates of fetal well-
being.
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?
Respiratory alkalosis (summary: low CO2; low H+; slightly
low HCO3-)
Q0057:What respiratory center in the caudal pons is the
center for rhythm promoting prolonged inspirations?
Apneustic center (deep breathing place)
Q0058:What area of the GI tract has the highest activity of
brush border enzymes?
Jejunum (upper)
Q0059:What is the term to describe the increased rate of
secretion of adrenal androgens at the onset of puberty?
Adrenarche
Q0060:What period is described when a larger-than-normal
stimulus is needed to produce an action potential?
Relative refractory period
Q0061:Does T3 or T4 have a greater affinity for its nuclear
receptor?
T3 has a greater affinity for the nuclear receptor and therefore
is considered the active form.
Q0062:What are the three main functions of surfactant?
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
Q0063:What is the only important physiological signal
regulating the release of PTH?
Low interstitial free Ca2+ concentrations
Q0064:What endocrine abnormality is characterized by the
following changes in PTH; Ca2+; and inorganic phosphate
(Pi)? ;? PTH decreased; Ca2+ increased; Pi increased
Secondary hypoparathyroidism (vitamin D toxicity)
(Pi)? ;? PTH increased; Ca2+ decreased; Pi decreased
Secondary hyperparathyroidism (vitamin D deficiency; renal
disease)
(Pi)? ;? PTH decreased; Ca2+ decreased; Pi increased
Primary hypoparathyroidism
(Pi)? ;? PTH increased; Ca2+ increased; Pi decreased
Primary hyperparathyroidism
Q0068:What is the amount in liters and percent body weight
for the following compartments? ;? ECF
14 L; 33% of body weight
for the following compartments? ;? Interstitial fluid
9.3 L; 15% of body weight
for the following compartments? ;? ICF
for the following compartments? ;? Vascular fluid
4.7 L; 5% of body weight
for the following compartments? ;? Total body water
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?
Human chorionic somatomammotropin (hCS) or human
placental lactogen (hPL)
Q0074:What thyroid abnormality has the following?;? TRH
decreased; TSH decreased; T4 increased
Graves disease (Increased T4 decreases TRH and TSH
through negative feedback.)
increased; TSH decreased; T4 decreased
Secondary hypothyroidism/pituitary (Low TSH results in
low T4 and increased TRH because of lack of a negative
feedback loop.)
decreased; TSH decreased; T4 decreased
Tertiary hypothyroidism/hypothalamic (Low TRH causes all
the rest to be decreased because of decreased stimulation.)
increased; TSH increased; T4 decreased
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.)
decreased; TSH decreased; T4 increased
Secondary hyperthyroidism (Increased TSH results in
increased T4 production and increased negative feedback on to
hypothalamus and decreased release of TRH.)
Q0079:What two stress hormones are under the permissive
action of cortisol?
Glucagon and epinephrine
Q0080:If the radius of a vessel doubles; what happens to
resistance?
The resistance will decrease one-sixteenth of the original
resistance.
Q0081:What prevents the down-regulation of the receptors
on the gonadotrophs of the anterior pituitary gland?
The pulsatile release of GnRH
Q0082:True or false? Epinephrine has proteolytic metabolic
effects.
False. It has glycogenolytic and lipolytic actions but not
proteolytic.
Q0083:What is the only 17-hydroxysteroid with hormonal
activity?
Cortisol; a 21-carbon steroid; has a -OH group at position 17.
Q0084:Does the oncotic pressure of plasma promote
filtration or reabsorption?
The oncotic pressure of plasma promotes reabsorption and is
directly proportional to the filtration fraction.
Q0085:Why is the base of the lung hyperventilated when a
person is standing upright?
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.
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?
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.
Q0087:What hormone causes contractions of smooth muscle;
regulates interdigestive motility; and prepares the intestine for
the next meal?
Motilin
Q0088:What two vessels in fetal circulation have the highest
PO2 levels?
Umbilical vein and ductus venosus (80%)
Q0089:How many days prior to ovulation does estradiol peak
in the menstrual cycle?
2 days prior to ovulation
Q0090:What serves as a marker of endogenous insulin
secretion?
C-peptide levels
Q0091:What is the term for the total volume of air moved in
and out of the respiratory system per minute?
Total ventilation (minute ventilation or minute volume)
Q0092:What is the renal compensation mechanism for
alkalosis?
Increase in urinary excretion of HCO3-; shifting the reaction
to the right and increasing H+
Q0093:What is a sign of a Sertoli cell tumor in a man?
Excess estradiol in the blood
Q0094:In the systemic circulation; what blood vessels have
the largest pressure drop? Smallest pressure drop?
Arterioles have the largest drop; whereas the vena cava has
the smallest pressure drop in systemic circulation.
Q0095:What is the major stimulus for cell division in
chondroblasts?
IGF-1
Q0096:What are two causes of diffusion impairment in the
lungs?
Decrease in surface area and increase in membrane thickness
(Palv O2 > PaO2)
Q0097:What are the four effects of suckling on the mother?
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
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?
It repeats every 90 to 120 minutes and correlates with
elevated levels of motilin.
Q0099:With an increase in arterial systolic pressure; what
happens to;? Stroke volume?
Increases
happens to;? Vessel compliance?
Decreases
happens to;? Heart rate?
Decreases
Q0102:What enzyme is needed to activate the following
reactions?;? Trypsinogen to trypsin
Enterokinase
reactions?;? Chymotrypsinogen to chymotrypsin
Trypsin
reactions?;? Procarboxypeptidase to carboxypeptidase
Trypsin
Q0105:In a ventricular pacemaker cell; what phase of the
action potential is affected by ACh?
Phase 4; ACh hyperpolarizes the cell via increasing potassium
conductance; taking longer to reach threshold and slowing the
rate of firing.
Q0106:What is the most potent stimulus for glucagon
secretion? Inhibition?
Hypoglycemia for secretion and hyperglycemia for inhibition
Q0107:What is the term for the summation of mechanical
stimuli due to the skeletal muscle contractile unit becoming
saturated with calcium?
Tetany
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.
A transport maximum (Tm) system
Q0109:In an adrenergic nerve terminal; where is dopamine
converted to NE? By what enzyme?
Dopamine is converted into NE in the vesicle via the enzyme
dopamine-Beta-hydroxylase.
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?
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.
Q0111:What is the term for the load on a muscle in the relaxed
state?
Preload. It is the load on a muscle Prior to contraction.
Q0112:The surge of what hormone induces ovulation?
LH
Q0113:What are the two best indices of left ventricular
preload?
LVEDV and LVEDP (left ventricular end-diastolic volume and
end-diastolic pressure; respectively)
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.
Puberty
the following LH and testosterone levels?;? Both LH and
testosterone levels drop and remain low.
Childhood
the following LH and testosterone levels?;? LH secretion
drives testosterone production; with both levels paralleling
each other.
Adulthood
the following LH and testosterone levels?;? Decreased
testosterone production is accompanied by an increase in LH
production.
Aged adult
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?
Metabolic alkalosis (summary: high pH; low H+ and high
HCO3-)
Q0119:When referring to a series circuit; what happens to
resistance when a resistor is added?
Resistance increases as resistors are added to the circuit.
Q0120:Why is there an increase in prolactin if the
hypothalamic-pituitary axis was severed?
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.
Q0121:Why is the clearance of creatinine always slightly
greater than the clearance of inulin and GFR?
Because creatinine is filtered and a small amount is secreted
Q0122:What acid form of H+ in the urine cannot be titrated?
NH4+(ammonium)
Q0123:Regarding the venous system; what happens to blood
volume if there is a small change in pressure?
Because the venous system is more compliant than the arterial
vessels; small changes in pressure result in large changes in
blood volume.
Q0124:In what stage of sleep is GH secreted?
Stages 3 and 4 (NREM)
Q0125:Where does the conversion of CO2 into HCO3- take
place?
In the RBC; remember; you need carbonic anhydrase for the
conversion; and plasma does not have this enzyme.
Q0126:From the fourth month of fetal life to term; what
secretes the progesterone and estrogen to maintains the
uterus?
The placenta
Q0127:What two factors are required for effective exocytosis?
Calcium and ATP are required for packaged macromolecules
to be extruded from the cell.
Q0128:What is the best measure of total body vitamin D if
you suspect a deficiency?
Serum 25-hydroxy-vitamin D (25-OH-D)
Q0129:What hormone is required for 1; 25-dihydroxy-vitamin
D (1; 25-diOH-D) to have bone resorbing effects?
PTH
Q0130:Is bone deposition or resorption due to increased
interstitial Ca2+concentrations?
Bone deposition increases with increased Ca2+ or PO 4-
concentrations; whereas resorption (breakdown) is increased
when there are low levels of Ca2+ or PO4-.
Q0131:The opening of what valve indicates the termination of
isovolumetric relaxation phase of the cardiac cycle?
Opening of the mitral valve indicates the termination of the
isovolumetric relaxation phase and the beginning of the
ventricular filling phase.
Q0132:Why is there a decrease in the production in
epinephrine when the anterior pituitary gland is removed?
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.
Q0133:Name the period described by the following statement:
no matter how strong a stimulus is; no further action
potentials can be stimulated.
Absolute refractory period is due to voltage inactivation of
sodium channels.
Q0134:How many carbons do estrogens have?
Estrogens are 18-carbon steroids. (Removal of one carbon
from an androgen produces an estrogen.)
Q0135:True or false? The alveolar PO2 and PCO2 levels
match the pulmonary end capillary blood levels.
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.
Q0136:In high altitudes; what is the main drive for
ventilation?
The main drive shifts from central chemoreceptors (CSF H+)
to peripheral chemoreceptors monitoring low PO2 levels.
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
Loss of isotonic fluid (diarrhea; vomiting; hemorrhage)
ECF; increase; ICF; increase; body; decrease
Gain of hypotonic fluid (water intoxication or hypotonic
saline)
ECF; decrease; ICF; decrease; body: increase
Loss of hypotonic fluid (alcohol; diabetes insipidus;
dehydration)
ECF: increase; ICF: no change; body: no change
Gain of isotonic fluid (isotonic saline)
ECF; increase; ICF; decrease; body; increase
Gain of hypertonic fluid (mannitol or hypertonic saline)
Q0142:What hormone excess produces adrenal hyperplasia?
ACTH
Q0143:Is there more circulating T3 or T4 in plasma?
T4; because of the greater affinity for the binding protein; T4
has a significantly (nearly fifty times) longer half-life than T3.
Q0144:Why is the cell's resting membrane potential negative?
The resting membrane potential of the cell is -90 mV because
of the intracellular proteins.
Q0145:True or false? Thyroid size is a measure of its
function.
False. Thyroid size is a measure of TSH levels (which are
goitrogenic).
Q0146:If the radius of a vessel is decreased by half; what
happens to the resistance?
The resistance increases 16-fold.
Q0147:What neurotransmitter is essential for maintaining a
normal BP when an individual is standing?
NE; via its vasoconstrictive action on blood vessels
Q0148:What form of diabetes insipidus is due to an
insufficient amount of ADH for the renal collecting ducts?
Central/neurogenic diabetes insipidus; in the nephrogenic form
there is sufficient ADH available; but the renal collecting
ducts are impermeable to its actions.
Q0149:Name the three methods of vasodilation via the
sympathetic nervous system.
1. Decrease alpha-1 activity ;2. Increase Beta-2 activity ;3.
Increase ACh levels
Q0150:What hormone is characterized by the following renal
effects?;? Calcium reabsorption; phosphate excretion
PTH
effects?;? Calcium excretion; phosphate excretion
Calcitriol
effects?;? Calcium reabsorption; phosphate reabsorption
Vitamin D3
Q0153:True or false? Progesterone has thermogenic activities.
True. Elevated plasma levels of progesterone can raise the
body temperature 0.5° to 1.0°F.
Q0154:How long is the transit time through the small
intestine?
2 to 4 hours
Q0155:Where is the last conducting zone of the lungs?
Terminal bronchioles. (No gas exchange occurs here.)
Q0156:True or false? Cortisol inhibits glucose uptake in
skeletal muscle.
True; cortisol inhibits glucose uptake in most tissue; making it
available for neural tissue use.
Q0157:What percentage of cardiac output flows through the
pulmonary circuit?
100%; the percentage of blood flow through the pulmonary
and systemic circulations are equal.
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)
Site 4
information;? Greatest affinity of the three remaining sites for
attachment; requires PO2 levels of 26 mm Hg to remain
attached
Site 2
information;? Remains attached under most physiologic
conditions
Site 1
information;? Requires a PO2 level of 40 mm Hg to remain
attached
Site 3
Q0162:Which three factors cause the release of epinephrine
from the adrenal medulla?
1. Exercise ;2. Emergencies (stress) ;3. Exposure to cold ;;(The
three Es)
Q0163:How many ATPs are hydrolyzed every time a skeletal
muscle cross-bridge completes a single cycle?
One; and it provides the energy for mechanical contraction.
Q0164:Why would a puncture to a vein above the heart have
the potential to introduce air into the vascular system?
Venous pressure above the heart is subatmospheric; so a
puncture there has the potential to introduce air into the
system.
Q0165:What type of saliva is produced under
parasympathetic stimulation?
High volume; watery solution; sympathetic stimulation
results in thick; mucoid saliva.
Q0166:In what area of the GI tract does iron get absorbed?
Duodenum
Q0167:Why is the apex of the lung hypoventilated when a
person is standing upright?
The alveoli at the apex are almost completely inflated prior to
inflation; and although they are large; they receive low levels
of alveolar ventilation.
Q0168:What pancreatic islet cell secretes glucagons?
alpha-Cells; glucagon has stimulatory effects on -cells and
inhibitory effects on -cells.
Q0169:What are the four characteristics of all protein-
mediated transportation?
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
Q0170:What is secretin's pancreatic action?
Secretin stimulates the pancreas to secrete a HCO3--rich
solution to neutralize the acidity of the chyme entering the
duodenum.
Q0171:Why is there an increase in FF if the GFR is decreased
under sympathetic stimulation?
Because RPF is markedly decreased; while GFR is only
minimally diminished; this results in an increase in FF
(remember FF = GFR/RPF).
Q0172:What triggers phase 3 of the action potential in a
ventricular pacemaker cell?
Rapid efflux of potassium
Q0173:What is the primary target for the action of glucagon?
Liver (hepatocytes)
Q0174:What is the renal compensation mechanism for
acidosis?
Production of HCO3-; shifting the reaction to the left and
thereby decreasing H+
Q0175:What enzyme found in a cholinergic synapse breaks
down ACh? What are the byproducts?
Acetylcholinesterase breaks ACh into acetate and choline
(which gets resorbed by the presynaptic nerve terminal).
Q0176:What hormone; produced by Sertoli cells; if absent
would result in the formation of internal female structures?
MIF
Q0177:What happens to the lung if the intrapleural pressure
exceeds lung recoil?
The lung will expand; also the opposite is true.
Q0178:What two factors determine the clearance of a
substance?
Plasma concentration and excretion rate
Q0179:What type of muscle contraction occurs when the
muscle shortens and lifts the load placed on it?
Isotonic contraction
Q0180:What type of potential is characterized as being an all-
or-none response; propagated and not summated?
Action potential
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?
Metabolic acidosis (summary: low pH; high H+; and low
HCO3-)
Q0182:What two pituitary hormones are produced by
acidophils?
GH and prolactin are produced by acidophils; all others are
by basophils.
Q0183:What organ of the body has the smallest AV oxygen
difference?
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.
Q0184:What is the titratable acid form of H+ in the urine?
H2PO4- (dihydrogen phosphate)
Q0185:What hypothalamic hormone is synthesized in the
preoptic nucleus?
GnRH
Q0186:What five factors promote turbulent flow?
1. Increased tube radius ;2. Increased velocity ;3. Decreased
viscosity ;4. Increased number of branches ;5. Narrowing of
an orifice
Q0187:What is the major hormone produced in the following
areas of the adrenal cortex?;? Zona glomerulosa
Aldosterone;Remember; from the outer cortex to the inner
layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you
go deeper.
areas of the adrenal cortex?;? Zona fasciculata
Cortisol;Remember; from the outer cortex to the inner layer;
Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go
deeper.
areas of the adrenal cortex?;? Zona reticularis
DHEA (androgens);Remember; from the outer cortex to the
inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as
you go deeper.
Q0190:Where is most of the body's Ca2+ stored?
In bone; nearly 99% of Ca2+ is stored in the bone as
hydroxyapatite.
Q0191:What is the relationship between ventilation and
PCO2 levels?
They are inversely related. If ventilation increases; there will
be a decrease in PCO2 levels and vice versa.
Q0192:Is T3 or T4 responsible for the negative feedback loop
on to the hypothalamus and anterior pituitary gland?
T4; as long as T4 levels remain constant; TSH will be
minimally effected by T3.
Q0193:What is the signal to open the voltage-gated
transmembrane potassium channels?
Membrane depolarization is the stimulus to open these slow
channels; and if they are prevented from opening; it will slow
down the repolarization phase.
Q0194:Increased urinary excretion of what substance is used
to detect excess bone demineralization?
Hydroxyproline
Q0195:What is the term to describe how easily a vessel
stretches?
Compliance (think of it as distensibility)
Q0196:What is the ratio of T4:T3 secretion from the thyroid
gland?
20:1T4T3. There is an increase in the production of T3 when
iodine becomes deficient.
Q0197:Do the PO2 peripheral chemoreceptors of the carotid
body contribute to the normal drive for ventilation?
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.
Q0198:What determines the overall force generated by the
ventricular muscle during systole?
The number of cross-bridges cycling during contraction: the
greater the number; the greater the force of contraction.
Q0199:Where does most circulating plasma epinephrine
originate?
From the adrenal medulla; NE is mainly derived from the
postsynaptic sympathetic neurons.
Q0200:What causes a skeletal muscle contraction to
terminate?
When calcium is removed from troponin and pumped back
into the SR; skeletal muscle contraction stops.
Q0201:What happens to intracellular volume when there is an
increase in osmolarity?
ICF volume decreases when there is an increase in osmolarity
and vice versa.
Q0202:Which CHO is independently absorbed from the small
intestine?
Fructose; both glucose and galactose are actively absorbed via
secondary active transport.
Q0203:When is the surface tension the greatest in the
respiratory cycle?
Surface tension; the force to collapse the lung; is greatest at
the end of inspiration.
Q0204:What adrenal enzyme deficiency results in
hypertension; hypernatremia; increased ECF volume; and
decreased adrenal androgen production?
17-alpha-Hydroxylase deficiency
Q0205:In reference to membrane potential (Em) and
equilibrium potential (Ex); which way do ions diffuse?
Ions diffuse in the direction to bring the membrane potential
toward the equilibrium potential.
Q0206:Under normal conditions; what is the main factor that
determines GFR?
Hydrostatic pressure of the glomerular capillaries (promotes
filtration)
Q0207:The closure of what valve indicates the beginning of
the isovolumetric relaxation phase of the cardiac cycle?
Closure of the aortic valve indicates the termination of the
ejection phase and the beginning of the isovolumetric
relaxation phase of the cardiac cycle.
Q0208:What vessels in the systemic circulation have the
greatest and slowest velocity?
The aorta has the greatest velocity and the capillaries have the
slowest velocity.
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?
Hypercortisolism (Cushing syndrome)
Q0210:What enzyme is essential for the conversion of CO2
to HCO3-?
Carbonic anhydrase
Q0211:True or false? The parasympathetic nervous system
has very little effect on arteriolar dilation or constriction.
True
Q0212:What three lung measurements must be calculated
because they cannot be measured by simple spirometry?
TLC; FRC; and RV have to be calculated. (Remember; any
volume that has RV as a component has be calculated.)
Q0213:What is the venous and arterial stretch receptors'
function regarding the secretion of ADH?
They chronically inhibit ADH secretion; when there is a
decrease in the blood volume; the stretch receptors send fewer
signals; and ADH is secreted.
Q0214:What cell converts androgens to estrogens?
Granulosa cell
Q0215:What hormone acts on Granulosa cells?
FSH
Q0216:How long is the transit time through the large
intestine?
3 to 4 days
Q0217:Does subatmospheric pressure act to expand or
collapse the lung?
Subatmospheric pressure acts to expand the lung; positive
pressure acts to collapse the lung.
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?
AT II
Q0219:Why is there a minimal change in BP during exercise if
there is a large drop in TPR?
Because the large drop in TPR is accompanied by a large
increase in cardiac output; resulting in a minimal change in BP.
Q0220:What is the effect of insulin on protein storage?
Insulin increases total body stores of protein; fat; and CHOs.
When you think insulin; you think storage.
Q0221:What is the term for an inhibitory interneuron?
Renshaw neuron
Calcium influx secondary to slow channel opening
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
At the end of the PCT 25% of the original volume is left
Percentage of Na+; Cl-; K+ left in the lumen
At the end of the PCT 25% of Na+; Cl-; K+ is left
Osmolarity
300 mOsm/L
Concentration of CHO; AA; ketones; peptides
No CHO; AA; ketones; or peptides are left in the tubular
lumen.
Q0227:True or false? Enterokinase is a brush border enzyme.
False. It is an enzyme secreted by the lining of the small
intestine.
Q0228:Where does the synthesis of ACh occur?
In the cytoplasm of the presynaptic nerve terminal; it is
catalyzed by choline acetyltransferase.
Q0229:What pancreatic islet cell secretes somatostatin?
delta-Cells; somatostatin has an inhibitory effect on alpha-
and Beta-islet cells.
Q0230:Why is O2 content depressed in anemic patients?
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.
Q0231:What term describes the volume of plasma from which
a substance is removed over time?
Clearance
Q0232:If capillary hydrostatic pressure is greater than oncotic
pressure; is filtration or reabsorption promoted?
Filtration; if hydrostatic pressure is less than oncotic
pressure; reabsorption is promoted.
Q0233:What cells of the parathyroid gland are simulated in
response to hypocalcemia?
The chief cells of the parathyroid gland release PTH in
response to hypocalcemia.
Q0234:At the base of the lung; what is the baseline
intrapleural pressure; and what force does it exert on the
alveoli?
Intrapleural pressure at the base is -2.5 cm H2O (more
positive than the mean); resulting in a force to collapse the
alveoli.
Q0235:What hormone is necessary for normal GH secretion?
Normal thyroid hormones levels in the plasma are necessary
for proper secretion of GH. Hypothyroid patients have
decreased GH secretions.
Q0236:What is the signal to open the voltage-gated
transmembrane sodium channels?
Membrane depolarization is the stimulus to open these
channels; which are closed in resting conditions.
Q0237:What hormones are produced in the median eminence
region of the hypothalamus and the posterior pituitary gland?
None; they are the storage sites for ADH and oxytocin.
Q0238:What is the most energy-demanding phase of the
cardiac cycle?
Isovolumetric contraction
Q0239:What presynaptic receptor does NE use to terminate
further neurotransmitter release?
alpha2-Receptors
Q0240:Are salivary secretions hypertonic; hypotonic; or
isotonic?
Hypotonic; because NaCl is reabsorbed in the salivary ducts
Q0241:What is the effect of T3 on heart rate and cardiac
output?
T3 increases both heart rate and cardiac output by increasing
the number of Beta-receptors and their sensitivity to
catecholamines.
Q0242:Why will turbulence first appear in the aorta in
patients with anemia?
Because it is the largest vessel and has the highest velocity in
systemic circulation
Q0243:What is the origin of the polyuria if a patient is
dehydrated and electrolyte depleted?
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.
Q0244:What is the physiologically active form of Ca2+?
Free ionized Ca2+
Q0245:What are the two factors that affect alveolar PCO2
levels?
Metabolic rate and alveolar ventilation (main factor)
Q0246:Why is spermatogenesis decreased with anabolic
steroid therapy?
Exogenous steroids suppress LH release and result in Leydig
cell atrophy. Testosterone; produced by Leydig cells; is
needed for spermatogenesis.
Q0247:What type of membrane is characterized as being
permeable to water only?
Semipermeable membrane; a selectively permeable membrane
allows both water and small solutes to pass through its
membrane.
Q0248:What thyroid enzyme is needed for oxidation of I– to
I'?
Peroxidase; which is also needed for iodination and coupling
inside the follicular cell
Q0249:What is the most important stimulus for the secretion
of insulin?
An increase in serum glucose levels
Q0250:What term is described as the prestretch on the
ventricular muscle at the end of diastole?
Preload (the load on the muscle in the relaxed state)
Q0251:What peripheral chemoreceptor receives the most
blood per gram of weight in the body?
The carotid body; which monitors arterial blood directly
Q0252:What adrenal enzyme deficiency results in
hypertension; hypernatremia; and virilization?
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.
Q0253:What is the term for diffusion of water across a
semipermeable or selectively permeable membrane?
Osmosis; water will diffuse from higher to lower water
concentrations.
Q0254:When do hCG concentrations peak in pregnancy?
In the first 3 months
Q0255:How many milliliters of O2 per milliliter of blood?
0.2
Q0256:What type of cell is surrounded by mineralized bone?
Osteocyte
Q0257:What two forces affect movement of ions across a
membrane?
Concentration force and electrical force
Q0258:What happens to the resistance of the system when a
resistor is added in a series?
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.)
Q0259:What is the greatest component of lung recoil?
Surface tension; in the alveoli; it is a force that acts to collapse
the lung.
Q0260:Where is ADH synthesized?
In the supraoptic nuclei of the hypothalamus; it is stored in
the posterior pituitary gland.
Q0261:How is velocity related to the total cross-sectional
area of a blood vessel?
Velocity is inversely related to cross-sectional area.
Q0262:True or false? Aldosterone has a sodium-conserving
action in the distal colon.
True. In the distal colon; sweat glands; and salivary ducts;
aldosterone has sodium-conserving effects.
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.
Water-soluble hormones are considered fast-acting hormones.
Q0264:What forms of fatty acids are absorbed from the small
intestine mucosa by simple diffusion?
Short-chain fatty acids
Q0265:What is the term for the day after the LH surge in the
female cycle?
Ovulation
Q0266:The opening of what valve indicates the beginning of
the ejection phase of the cardiac cycle?
Opening of the aortic valve terminates the isovolumetric
phase and begins the ejection phase of the cardiac cycle.
Q0267:What is the region of an axon where no myelin is
found?
Nodes of Ranvier
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?
Primary hyperaldosteronism (Conn syndrome)
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?
Primary hypoaldosteronism (Addison's disease)
Q0270:What four factors affect diffusion rate?
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
Q0271:How long after ovulation does fertilization occur?
8 to 25 hours
Q0272:What is the name of the force that develops in the wall
of the lungs as they expand?
Lung recoil; being a force to collapse the lung; increases as the
lung enlarges during inspiration.
Q0273:What day of the menstrual cycle does ovulation take
place?
Day 14
Q0274:How does sympathetic stimulation to the skin result
in decreased blood flow and decreased blood volume? (Hint:
what vessels are stimulated; and how?)
A decrease in cutaneous blood flow results from constriction
of the arterioles; and decreased cutaneous blood volume
results from constriction of the venous plexus.
Q0275:What two compensatory mechanisms occur to reverse
hypoxia at high altitudes?
Increase in erythropoietin and increase in 2; 3-BPG; also
called 2; 3-diphosphoglycerate (2; 3-P2Gri) (increase in
glycolysis)
Q0276:What female follicular cell is under LH stimulation and
produces androgens from cholesterol?
Theca cell
Q0277:What is the main factor determining FF?
Renal plasma flow (decrease flow; increase FF)
Q0278:Where is the action potential generated on a neuron?
Axon hillock
Q0279:If free water clearance (CH2O) is positive; what type
of urine is formed? And if it is negative?
If positive; hypotonic urine (osmolarity <300 mOsm/L); if
negative; hypertonic urine (osmolarity > 300 mOsm/L)>>
Q0280:What cell in the heart has the highest rate of
automaticity?
SA node; it is the reason it is the primary pacemaker of the
heart.
Q0281:What is pumped from the lumen of the ascending loop
of Henle to decrease the osmolarity?
NaCl is removed from the lumen to dilute the fluid leaving the
loop of Henle.
Q0282:True or false? In skeletal muscle relaxation is an active
event.
True. Sarcoplasmic calcium-dependent ATPase supplies the
energy to terminate contraction; and therefore it is an active
process.
Q0283:What three factors increase simple diffusion?
1. Increased solubility ;2. Increased concentration gradient ;3.
Decreased thickness of the membrane
Q0284:What is the pancreatic action of CCK?
CCK stimulates the pancreas to release amylase; lipase; and
proteases for digestion.
Q0285:What is the rate-limiting step in a conduction of a
NMJ?
The time it takes ACh to diffuse to the postjunctional
membrane
Q0286:Is excretion greater than or less than filtration for net
secretion to occur?
Excretion is greater than filtration for net secretion to occur.
Q0287:What acid-base disturbance is produced from
vomiting?
Hypokalemic metabolic alkalosis occurs from vomiting
because of the loss of H+; K+; and Cl-.
Q0288:What phase of the menstrual cycle is dominated by
estrogen? Progesterone?
Follicular phase is estrogen-dependent with increased FSH
levels; while the luteal phase is progesterone-dependent.
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
Tidal volume (VT)
descriptions;? The maximal volume inspired from FRC
Inspiratory capacity
descriptions;? Additional volume that can be expired after
normal expiration
Expiratory reserve volume (ERV)
descriptions;? Maximal volume that can be expired after
maximal inspiration
Vital capacity (VC)
descriptions;? Volume in the lungs at the end of passive
expiration
Functional residual capacity (FRC)
descriptions;? Additional air that can be taken in after normal
inspiration
Inspiratory reserve volume (IRV)
descriptions;? Amount of air in the lungs after maximal
expiration
Residual volume (RV)
descriptions;? Amount of air in the lungs after maximal
inspiration
Total lung capacity (TLC)
Q0297:What growth factors are chondrogenic; working on the
epiphyseal end plates of bone?
Somatomedins (IGF-1)
Q0298:What determines the Vmax of skeletal muscle?
The muscle's ATPase activity
Q0299:True or false? All of the hormones in the
hypothalamus and anterior pituitary gland are water soluble.
True
Q0300:What is the effect of T3 on the glucose absorption in
the small intestine?
Thyroid hormones increase serum glucose levels by increasing
the absorption of glucose from the small intestine.
Q0301:Is the bound form or free form of a lipid-soluble
hormone responsible for the negative feedback activity?
Free form determines hormone activity and is responsible for
the negative feedback loop.
Q0302:What region or regions of the adrenal cortex are
stimulated by ACTH?
Zona fasciculata and zona reticularis
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?
Obstructive lung disorders. The opposite changes (where you
see decrease exchange it for increase and vice versa) are seen in
a restrictive pattern.
Q0304:What is the respiratory compensation mechanism for
metabolic alkalosis?
Hypoventilation; which increases CO2; shifting the reaction
to the right and increasing H+
Q0305:During puberty; what is the main drive for the
increased GH secretion?
Increased androgen secretion at puberty drives the increased
GH secretion.
Q0306:What type of potential is characterized as graded;
decremental; and exhibiting summation?
Subthreshold potential
Q0307:What three organs are responsible for peripheral
conversion of T4 to T3?
Liver; kidneys; and pituitary gland via 5' deiodinase enzyme
Q0308:The closure of what valve indicates the beginning of
isovolumetric contraction?
Mitral valve closure indicates the termination of the
ventricular filling phase and beginning of isovolumetric
contraction.
Q0309:How many carbons do androgens have?
Androgens are 19-carbon steroids.
Q0310:At the apex of the lung; what is the baseline
intrapleural pressure; and what force does it exert on the
alveoli?
Baseline apical intrapleural pressure is -10 cm H2O (more
negative than the mean) resulting in a force to expand the
alveoli.
Q0311:True or false? Renin secretion is increased in 21-beta-
hydroxylase deficiency.
True. Increased renin and AT II levels occur as a result of the
decreased production of aldosterone.
Q0312:What are the four ways to increase TPR?
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
Q0313:What form of estrogen is of placental origin?
Estriol
Q0314:What term is an index of the effort needed to expand
the lungs (i.e; overcomes recoil)?
Compliance; the more compliant a lung is; the easier it is to
inflate.
Q0315:At which three sites in the body is T4 converted to
T3?
1. Liver ;2. Kidney ;3. Pituitary gland (via 5'-deiodinase
enzyme)
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?
The wall tension is greater because the aneurysm has a greater
radius than the surrounding vessel.
Q0317:What percentage of nephrons is cortical?
Seven-eighths of nephrons are cortical; with the remainder
juxtamedullary.
Q0318:To what is the diffusion rate indirectly proportional?
Diffusion rate is indirectly proportional to membrane
thickness and is directly proportional to membranes surface
area.
Q0319:ADH is secreted in response to what two stimuli?
ADH is secreted in response to increased plasma osmolarity
and decreased blood volume.
Q0320:What vessels have the largest total cross-sectional area
in systemic circulation?
Capillaries
Q0321:How many days before the first day of menstrual
bleeding is ovulation?
14 days in most women (Remember; the luteal phase is
always constant.)
Q0322:What is the major muscle used in the relaxed state of
expiration?
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.
Q0323:What subunit of hCG is used to detect whether a
patient is pregnant?
The beta-subunit; remember; the alpha-subunit is nonspecific.
Q0324:What happens to capillary oncotic pressure with
dehydration?
Oncotic pressure increases because of the removal of water.
Q0325:What cells of the kidney are extravascular
chemoreceptors for decreased Na+; Cl-; and NaCl?
Macula densa
Q0326:What is the effect of insulin on intracellular K+ stores?
Insulin increases intracellular K+ stores while decreasing
serum K+ levels.
Decreasing potassium conductance; which results in increased
excitability
Q0328:What is it called when levels of sex steroids increase;
LH increases; and FSH increases?
GnRH pulsatile infusion
Q0329:What parasympathetic neurotransmitter of the GI
tract stimulates the release of gastrin?
Gastrin-releasing peptide (GRP) stimulates G cells to release
Gastrin. (All G's)
Q0330:What reflex increases TPR in an attempt to maintain
BP during a hemorrhage?
The carotid sinus reflex
Q0331:What is the name of the regulatory protein that covers
the attachment site on actin in resting skeletal muscle?
Tropomyosin
Q0332:Which way does the Hgb-O2 dissociation curve shift
in patients with CO poisoning?
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.
Q0333:What is the main factor determining GFR?
Glomerular capillary pressure (increased glomerular capillary
pressure; increased GFR and vice versa)
Q0334:What is the effect of hypoventilation on cerebral blood
flow?
Hypoventilation results in an increase in PCO2 levels and
therefore an increase in blood flow.
Q0335:What cells of the thyroid gland are stimulated in
response to hypercalcemia?
The parafollicular cells of the thyroid (C cells) release
calcitonin in response to hypercalcemia.
Q0336:What is the term for the amount of blood in the
ventricle after maximal contraction?
Residual volume
Q0337:What does failure of PaO2 to increase with
supplemental O2 indicate?
Pulmonary shunt (i.e; pulmonary embolism)
Q0338:What two substances stimulate Sertoli cells?
FSH and testosterone
Q0339:The clearance of what substance is the gold standard
of renal plasma flow?
Para-aminohippurate (PAH)
Q0340:What bile pigment is formed by the metabolism of
bilirubin by intestinal bacteria; giving stool its brown color?
Stercobilin
Q0341:Is ACh associated with bronchoconstriction or
bronchodilation?
Bronchoconstriction is associated with parasympathetic
stimulation (ACh); and catecholamine stimulation is
associated with bronchodilation (why epinephrine is used in
emergency treatment of bronchial asthma.)
Q0342:What are the growth factors released from the liver
called?
Somatomedins
Q0343:Regarding skeletal muscle mechanics; what is the
relationship between velocity and afterload?
An increase in the afterload decreases velocity; they are
inversely related. (V equals 1 divided by afterload.)
Q0344:What happens to extracellular volume with a net gain
in body fluid?
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.
Q0345:What are the six substances that promote the secretion
of insulin?
1. Glucose ;2. Amino acid (arginine) ;3. Gastrin inhibitory
peptide (GIP) ;4. Glucagon ;5. beta-Agonists ;6. ACh
Q0346:Does O2 or CO2 have a higher driving force across the
alveolar membrane?
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.
Q0347:What is used as an index for both adrenal and testicular
androgens?
Urinary 17-ketosteroids
Q0348:How are resistance and length related regarding flow?
Resistance and vessel length are proportionally related. The
greater the length of the vessel; the greater the resistance is on
the vessel.
Q0349:Is filtration greater than or less than excretion for net
reabsorption to occur?
Filtration is greater than excretion for net reabsorption to
occur.
Q0350:What hormone; stimulated by epinephrine; results in
an increase in lipolysis?
Hormone-sensitive lipase; which breaks down triglyceride
into glycerol and free fatty acid
Q0351:True or false? Miniature end-plate potentials
(MEPPs) generate action potentials.
False
Q0352:Is GH considered a gluconeogenic hormone?
Yes; it decreases fat and muscle uptake of glucose; thereby
increasing blood glucose levels.
Q0353:True or false? Somatic motor neurons innervate the
striated muscle of the bulbospongiosus and ischiocavernous
muscles and result in ejaculation of semen.
True
Q0354:What happens to intraventricular pressure and volume
during isovolumetric contraction?
As the name indicates; there is no change in volume but there
is an increase in pressure.
Q0355:Do high levels of estrogen and progesterone block milk
synthesis?
Yes; they stimulate the growth of mammary tissue but block
milk synthesis. At parturition; the decrease in estrogen lifts
the block on milk production.
Q0356:What two factors lead to the development of the
bends (caisson disease)?
Breathing high-pressure nitrogen over a long time and sudden
decompression result in the bends.
Q0357:In what type of circuit is the total resistance always
less than that of the individual resistors?
Parallel circuit
Q0358:What is the term for days 15 to 28 in the female cycle?
Luteal phase
Q0359:What happens to total and alveolar ventilation with;?
Increased rate of breathing?
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).
Q0360:What happens to total and alveolar ventilation with;?
Increased depth of breathing?
With an increased depth of breathing both the total and
alveolar ventilation increase;This concept is always tested on
the boards; so remember it.
Q0361:What pathophysiologic disorder is characterized by
the following changes in cortisol and ACTH?;? Cortisol
decreased; ACTH increased
Primary hypocortisolism (Addison's disease)
increased; ACTH increased
Secondary hypercortisolism (pituitary)
increased; ACTH decreased
Primary hypercortisolism
decreased; ACTH decreased
Secondary hypocortisolism (pituitary)
Q0365:What happens to flow and pressure in capillaries with
arteriolar dilation? Arteriolar constriction?
Capillary flow and pressure increase with arteriolar dilation
and decrease with arteriolar constriction.
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
Dilation of afferent arteriole
capillary pressure?;? GFR increased ; RPF decreased ; FF
increased ; capillary pressure increased
Constriction of efferent arteriole
capillary pressure?;? GFR decreased ; RPF increased ; FF
decreased ; capillary pressure decreased
Dilation of efferent arteriole
capillary pressure?;? GFR decreased ; RPF decreased ; FF
normal; capillary pressure decreased
Constriction of afferent arteriole
Q0370:Which direction is air flowing when the intra-alveolar
pressure is zero?
When the intra-alveolar pressure equals zero; there is no
airflow.
Q0371:What phase of the female cycle occurs during days 1
to 15?
Follicular phase
Q0372:What determines the effective osmolarity of the ICF
and the ECF compartments?
The concentration of plasma proteins determines effective
osmolarity because capillary membranes are freely permeable
to all substances except proteins.
Q0373:What region of the brain houses the central
chemoreceptors responsible for control of ventilation?
The surface of the medulla
Q0374:What is the site of action of cholera toxin?
Cholera toxin irreversibly activates the cAMP-dependent
chloride pumps of the small and large intestine; producing a
large volume of chloride-rich diarrhea.
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
Phase 2
potential based on the following information;? Slight
repolarization secondary to potassium and closure of the
sodium channels
Phase 1
potential based on the following information;? Fast channels
open; then quickly close; and sodium influx results in
depolarization
Phase 0
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
Phase 3
Q0379:Where in the kidney are the long loops of Henle and
the terminal regions of the collecting ducts?
In the medulla; all the other structures are cortical.
Q0380:What is absorbed in the gallbladder to concentrate bile?
Water
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?
Lipid-soluble hormones are considered slow-acting hormones.
Q0382:What are the three stimuli that result in the
reninangiotensin-aldosterone secretion?
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
Q0383:Is there a shift in p50 values with anemia?
Polycythemia?
The p50 value does not change in either anemia or
polycythemia; the main change is the carrying capacity of the
blood.
Q0384:What hormone level peaks 1 day before the surge of
LH and FSH in the female cycle?
Estradiol
Q0385:True or false? Active protein transport requires a
concentration gradient.
True; it requires both a concentration gradient and ATP to
work.
Q0386:Up to how many hours post ejaculation do sperm
retain their ability to fertilize the ovum?
Up to 72 hours; the ovum losses its ability to be fertilized 8
to 25 hours after release.
Q0387:What type of membrane channel opens in response to
depolarization?
Voltage-gated channel
Q0388:What are the five effects of insulin on fat metabolism?
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
Q0389:True or false? In a skeletal muscle fiber; the interior of
the T-tubule is extracellular.
True. They are evaginations of the surface membranes and
therefore extracellular.
Q0390:Under resting conditions; what is the main determinant
of cerebral blood flow?
Arterial PCO2 levels are proportional to cerebral blood flow.
Q0391:On the venous pressure curve; what do the following
waves represent?;? A wave?
Atrial contraction;Atrial; Contraction; Venous
waves represent?;? C wave?
Ventricular contraction;Atrial; Contraction; Venous
waves represent?;? V wave?
Atrial filling (venous filling);Atrial; Contraction; Venous
Q0394:What cell type in the bone is responsible for bone
deposition?
Osteoblast (Remember; blasts make; clasts take)
Q0395:True or false? The blood stored in the systemic veins
and the pulmonary circuit are considered part of the cardiac
output.
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.
Q0396:What hormone disorder is characterized by the
following abnormalities in sex steroidsdecreased ;
LHdecreased ; and FSHdecreased ?;? Sex steroids ; LH ; FSH
Pituitary hypogonadism
following abnormalities in sex steroids; LH; and FSH?;? Sex
steroids increased ; LH decreased ; FSH decreased ?
GnRH constant infusion
following abnormalities in sex steroidsdecreased ; LHincreased
; and FSHincreased ?;? Sex steroids ; LH ; FSH ?
Primary hypogonadism (postmenopausal women)
Q0399:What are the three characteristics of autoregulation?
1. Flow independent of BP ;2. Flow proportional to local
metabolism ;3. Flow independent of nervous reflexes
Q0400:What is the fastest-conducting fiber of the heart?
Slowest conduction fiber in the heart?
Purkinje cell is the fastest; and the AV node is the slowest.
Q0401:What equals the total tension on a muscle minus the
preload?
Afterload
Q0402:What follicular cell possesses FSH receptors and
converts androgens into estradiol?
Granulosa cells
Q0403:What are the primary neurotransmitters at the
following sites?;? Postganglionic sympathetic neurons
NE
following sites?;? Chromaffin cells of the adrenal medulla
Epinephrine
following sites?;? Brainstem cells
Serotonin
following sites?;? The hypothalamus
Histamine
following sites?;? All motor neurons; postganglionic
parasympathetic neurons
ACh
following sites?;? Autonomic preganglionic neurons
ACh
Q0409:What region of the nephron has the highest
osmolarity?
Tip of the loop of Henle (1200 mOsm/L)
Q0410:What pH (acidotic or alkalotic) is needed for
pepsinogen to pepsin conversion?
Acid is needed for the activation of pepsin and therefore
needed for protein digestion.
Q0411:What is the term for the amount of blood expelled
from the ventricle per beat?
Stroke volume
Q0412:True or false? Oxytocin initiates rhythmic
contractions associated with labor.
False. It does increase uterine synthesis of prostaglandins;
which increase uterine contractions.
Q0413:Why does carbon monoxide diffusion in the lung
(DLCO) decrease in emphysema and fibrosis but increase
during exercise?
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.
Q0414:What enzyme converts androgens to estrogens?
Aromatase
Q0415:The clearance of what substance is the gold standard
of GFR?
Inulin
Q0416:How does myelination affect conduction velocity of
an action potential?
The greater the myelination; the greater the conduction
velocity.
Q0417:What are the three end products of amylase digestion?
1. Maltose ;2. Maltotetrose ;3. alpha-Limit dextrans (alpha-1;
6 binding)
Q0418:Where is most of the airway resistance in the
respiratory system?
In the first and second bronchi
Q0419:What is the respiratory compensation mechanism for
metabolic acidosis?
Hyperventilation; which decreases CO2; shifting the reaction
to the left and decreasing H+
Q0420:How are resistance and viscosity related regarding
flow?
Viscosity and resistance are proportionally related. The
greater the viscosity; the greater the resistance is on the
vessel.
Q0421:T3 increases bone ossification through synergistic
effect with what hormone?
GH
Q0422:Name the ventricular muscle membrane channel;?
Closed at rest; depolarization causes channels to open slowly
Voltage-gated calcium channel
Always open
Ungated potassium channel
Closed at rest; depolarization causes channels to open
quickly; will not respond to a second stimulus until cell is
repolarized.
Voltage-gated sodium channel
Open at rest; depolarization is stimulus to close; begin to
reopen during the plateau phase and during repolarization
Voltage-gated potassium channels
Q0426:What are the three glycogenic organs?
Liver; kidney; and GI epithelium
Q0427:Is CO2 a perfusion-or diffusion-limited O2 gas?
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.
Q0428:What is the term for the potential difference across a
cell membrane?
Transmembrane potential (an absolute number)
Q0429:What adrenal enzyme deficiency can be summed up as
a mineralocorticoid deficiency; glucocorticoid deficiency; and
an excess of adrenal androgens?
21-beta-Hydroxylase deficiency leads to hypotension;
hyponatremia; and virilization.
Q0430:When the ECF osmolarity increases; what happens to
cell size?
Increase in ECF osmolarity means a decrease in ICF
osmolarity; so cells shrink.
Q0431:When does cortisol secretion peak?
In early-morning sleep; usually between the sixth and eighth
hours
Q0432:What is the term for ventilation of unperfused alveoli?
Alveolar dead space
Q0433:What is the bioactive form of thyroid hormone?
T3
Q0434:What acid-base disturbance occurs in colonic diarrhea
Hypokalemic metabolic acidosis occurs in colonic diarrhea
because of the net secretion of HCO3- and potassium into the
colonic lumen.
Q0435:What two AAs act as excitatory transmitters in the
CNS; generating EPSPs?
Glutamine and aspartate
Q0436:What are the three mechanisms of action for atrial
natriuretic peptide's diuretic and natriuretic affects?
1. Dilation of the afferent arteriole ;2. Constriction of the
efferent arteriole ;3. Inhibition of reabsorption of sodium and
water in the collecting ducts
Q0437:In a parallel circuit; what happens to resistance when a
resistor is added in parallel
Resistance decreases as resistors are added in parallel.
Q0438:What component of the ANS is responsible for
movement of semen from the epididymis to the ejaculatory
ducts?
Sympathetic nervous system
Q0439:What happens to O2 affinity with a decrease in p50?
O2 affinity increases with a decrease in the p50; making O2
more difficult to remove from the Hgb molecule.
Q0440:If the ratio of a substance's filtrate and plasma
concentrations are equal; what is that substance's affect on the
kidney?
If the ratio of the filtrate to plasma concentration of a
substance is equal; the substance is freely filtered by the
kidney.
Q0441:What does a loss of afferent activity from the carotid
sinus onto the medulla signal?
A loss of afferent activity indicates a decrease in BP; and an
increase in afferent activity indicates an increase in BP.
Q0442:What are the five F's associated with gallstones?
1. Fat ;2. Forty ;3. Female ;4. Familial ;5. Fertile
Q0443:True or false? Menstruation is an active process due
to increased gonadal sex hormones?
False. It is a passive process due to decreased sex hormones.
Q0444:What happens to the intrapleural pressure when the
diaphragm relaxes?
Relaxation of the diaphragm increases the intrapleural
pressure (becomes more positive).
Q0445:What component of the renin-angiotensin-aldosterone
axis increases sodium reabsorption in the proximal convoluted
tubules and increases thirst drive?
AT II
Q0446:What large-diameter vessel has the smallest cross-
sectional area in systemic circulation?
The aorta
Q0447:Excess bone demineralization and remodeling can be
detected by checking urine levels of what substance?
Hydroxyproline (breakdown product of collagen)
Q0448:What happens to the following during skeletal muscle
contraction?;? A band
No change in length
contraction?;? I band
Shortens
contraction?;? H zone
Shortens
contraction?;? Sarcomere
Shortens
contraction?;? Actin and myosin lengths
No change in length
Q0453:What are the three effects of insulin on protein
metabolism?
1. Increased amino acid uptake by muscles ;2. Decreased
protein breakdown ;3. Increased protein synthesis
Q0454:What is the main mechanism for exchange of nutrients
and gases across a capillary membrane?
Simple diffusion; it does not use protein-mediated transport
Q0455:What event signifies the first day of the menstrual
cycle?
Onset of bleeding
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
Cardiac muscle
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
Skeletal muscle
features;? Actin and myosin not in sarcomeres; nonstriated;
uninuclear; gap junctions; calmodulin:calcium binding; lacks T
tubules; voltage-gated calcium channels
Smooth muscle
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
Mitral insufficiency
criteria;? Systolic murmur; increased preload and afterload;
decreased aortic pulse pressure and coronary blood flow
Aortic stenosis
criteria;? Diastolic murmur; increased right ventricular
pressure; left atrial pressure; and atrial to ventricular pressure
gradient; decreased left ventricular filling pressure
Mitral stenosis
criteria;? Diastolic murmur; increased preload; stroke volume;
and aortic pulse pressure; decreased coronary blood flow; no
incisura; and peripheral vasodilation
Aortic insufficiency
Q0463:Circulating levels of what hormone cause the cervical
mucus to be thin and watery; allowing sperm an easier entry
into the uterus?
Estrogen
Q0464:What hormone controls relaxation of the lower
esophageal sphincter during swallowing?
VIP is an inhibitory parasympathetic neurotransmitter that
results in relaxation of the lower esophageal sphincter.
Q0465:What is the term for the difference between systolic
and diastolic pressures?
Pulse pressure
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?
Androgen-binding protein
Q0467:True or false? There are no central O2 receptors.
True
Q0468:What cell type of the bone has PTH receptors?
Osteoblasts; which in turn stimulate osteoclasts to break
down bone; releasing Ca2+ into the interstitium. (Remember;
blasts make; clasts take.)
Q0469:What substance is secreted by parietal glands and is
required for life?
Intrinsic factor (IF)
Q0470:What is the only way to increase O2 delivery in the
coronary circulation?
Increasing blood flow is the only way to increase O2 delivery
in the coronary circulation because extraction is nearly
maximal during resting conditions.
Q0471:What is the term for the load a muscle is trying to
move during stimulation?
Afterload
Q0472:What is the term for days 1 to 7 of the female cycle?
Menses
Q0473:What is the term for the force the ventricular muscle
must generate to expel the blood into the aorta?
Afterload
Q0474:What happens to the tonicity of the urine with
increased ADH secretion?
The urine becomes hypertonic because of water reabsorption
in the collecting duct.
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?
Gradient-time system
Q0476:What type of circuit is described when the total
resistance is always greater than the sums of the individual
resistors?
Series circuit
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?
Increased secretion of GH postpuberty leading to acromegaly.
Q0478:What happens to V/Q ratio if a thrombus is lodged in
the pulmonary artery?
The V/Q ratio increases; since the area is ventilated but
hypoperfused as a result of the occlusion.
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?
GH; especially IGF-1. GH also increases the incorporation of
thymidine in DNA synthesis and uridine in RNA synthesis.
Q0480:True or false? Bile pigments and bile salts are
reabsorbed in the gallbladder.
False
Q0481:What component of an ECG is associated with the
following?;? Conduction delay in the AV node
PR interval
following?;? Ventricular depolarization
QRS complex
following?;? Atrial depolarization
P wave
following?;? Ventricular repolarization
T wave
Q0485:Where is the greatest venous PO2 in resting tissue?
Renal circulation
Q0486:Near the end of pregnancy; what hormone's receptors
increase in the myometrium because of elevated plasma
estrogen levels?
Oxytocin
Q0487:What respiratory center in the rostral pons has an
inhibitory affect on the apneustic center?
Pneumotaxic center (short; fast breaths)
Q0488:For what hormone do Leydig cells have receptors?
LH
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?
Respiratory acidosis (summary: high CO2; high H+; slightly
high HCO3-)
Q0490:What lecithin: sphingomyelin ratio indicates lung
maturity?
2.0 or greater
Q0491:What is the term for the negative resting membrane
potential becoming more negative?
Hyperpolarization (i.e; K+ influx)
Q0492:What type of resistance system (i.e; high or low) is
formed when resistors are added in parallel?
A low-resistance system is formed by resistors added in
parallel.
Q0493:Why is hypothyroidism associated with night
blindness?
Thyroid hormones are necessary for conversion of carotene to
vitamin A.
Q0494:What is the FiO2 of room air?
0.21; it is a fancy way of saying 21% of the air is O2.
Q0495:Where are the lowest resting PO2 levels in a resting
individual?
Coronary circulation
Q0496:What is the rate-limiting step in the production of
steroids?
The conversion of CHO to pregnenolone via the enzyme
desmolase
Q0497:In the water deprivation test; does a patient with
reduced urine flow have primary polydipsia or diabetes
insipidus?
Primary polydipsia; patients with diabetes insipidus will
continue to produce large volumes of dilute urine.
Q0498:True or false? There is an inverse relationship between
fat content and total body water.
True; the greater the fat; the less the total body water.
Q0499:What is the role of the negative charge on the filtering
membrane of the glomerular capillaries?
The negative charge inhibits the filtration of protein anions.
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?
Bainbridge reflex
Q0501:Where in the GI tract does the reabsorption of bile
salts take place?
Bile salts are actively reabsorbed in the distal ileum.
Q0502:What three structures increase the surface area of the
GI tract?
1. Plicae circularis (3 times) ;2. Villi (30 times) ;3. Microvilli
(600 times)
Q0503:Does physiologic splitting of the first heart sound
occur during inspiration or expiration? Why?
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.
Q0504:How much dietary iodine is necessary to maintain
normal thyroid hormone secretion?
150 mcg/day is the minimal daily intake needed. Most people
ingest 500 mcg/day.
Q0505:What is the central chemoreceptor's main drive for
ventilation?
CSF H+ levels; with acidosis being the main central drive;
resulting in hyperventilation (the opposite being true with
alkalosis)
Q0506:What result occurs because of the negative alveolar
pressure generated during inspiration?
Air flows into the respiratory system.
Q0507:Corticotropin-releasing hormone promotes the
synthesis and release of what prohormone?
Pro-opiomelanocortin (POMC) is cleaved into ACTH and
beta-lipotropin.
Q0508:What happens to free hormone levels when the liver
decreases production and release of binding proteins?
Free hormone levels remain constant; and the bound hormone
level changes with a decrease in binding hormones.
Q0509:What type of estrogen is produced in peripheral
tissues from androgens?
Estrone
Q0510:What changes does more negative intrathoracic
pressure cause to systemic venous return and to the
pulmonary vessels?
Promotes systemic venous return into the chest and increases
the caliber and volume of the pulmonary vessels
Q0511:Where is renin produced?
In the JG cells of the kidney
Q0512:True or false? Right-sided valves close before the
valves on the left side of the heart.
False. Right-sided valves are the first to open and last to
close.
Q0513:What enzyme is associated with osteoblastic activity?
Alkaline phosphatase
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?
Order of attachment is site 1; 2; 3; 4; and for release is 4; 3; 2;
1.
Q0515:What hormone is secreted into the plasma in response
to a meal rich in protein or CHO?
Insulin
Q0516:What happens to blood flow and pressure
downstream with local arteriolar constriction?
With arteriolar constriction both the flow and pressure
downstream decrease.
Q0517:What occurs when the lower esophageal sphincter fails
to relax during swallowing due to abnormalities of the enteric
nervous plexus?
Achalasia
Q0518:True or false? Ungated channels are always open.
True. They have no gates; so by definition they are always
open.
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?
Parasympathetics (parasympathetics point; sympathetics
shoot)
Q0520:What muscle type is characterized by low ATPase
activity; aerobic metabolism; myoglobin; association with
endurance; and small muscle mass?
Red muscle
Q0521:What happens to diastolic and systolic intervals with
an increase in sympathetic activity?
Systolic interval decreases secondary to increased
contractility; diastolic interval decreases secondary to an
increase in heart rate.
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?
Testosterone
Q0523:How are pulse pressure and compliance related?
They are inversely proportional to each other; as pulse
pressure increases; compliance decreases.
Q0524:What three substances stimulate parietal cells?
ACh; histamine; and gastrin
Q0525:What two factors result in the base of the lung being
hyperperfused?
Increased pulmonary arterial pressure (high perfusion) and
more distensible vessels (low resistance) result in increased
blood flow at the base.
Q0526:True or false? Without ADH the collecting duct would
be impermeable to water.
True. Without ADH hypotonic urine would be formed.
Q0527:How does ventricular depolarization take place; base
to apex or vice versa?
Depolarization is from apex to base and from endocardium to
epicardium.
Q0528:What are effects of PTH in the kidney?
PTH increases Ca2+ reabsorption in the DCT of the kidney
and decreases PO4- reabsorption in the PCT.
Q0529:Regarding muscle mechanics; how is passive tension
produced?
It is produced by the preload on the muscle prior to
contraction.
Q0530:Insulin-induced hypoglycemia is the most reliable (by
far not the safest) test for what hormone deficiency?
GH deficiency
Q0531:In regards to solute concentration; how does water
flow?
Water flows from a low-solute to high-solute concentrations.
Q0532:Which extravascular chemoreceptor detects low NaCl
concentrations?
Macula densa
Q0533:If the AV difference is positive; is the substance
extracted or produced by the organ?
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.
Q0534:What is used as an index of the number of functioning
carriers for a substance in active reabsorption in the kidney?
Transport maximum (Tm) occurs when all function carriers
are saturated and therefore is an index of the number of
functioning carriers.
Q0535:Why is there a transcellular shift in K+ levels in a
diabetic patient who becomes acidotic?
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.)
Q0536:True or false? Catechol-O-methyl transferase
(COMT) is not found in smooth muscle; liver; and the
kidneys.
False. That is precisely where COMT is found; it is not
found in adrenergic nerve terminals.
Q0537:What somatomedin serves as a 24-hour marker of GH
secretion?
IGF-1 (somatomedin C)
Q0538:What receptor is in the smooth muscle cells of the
small bronchi; is stimulated during inflation; and inhibits
inspiration?
Stretch receptors prevent overdistension of the lungs during
inspiration.
Q0539:True or false? Thyroid hormones are necessary for
normal menstrual cycles.
True. They are also necessary for normal brain maturation.
Q0540:What component of the cardiovascular system has the
largest blood volume? Second largest blood volume?
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.
Q0541:Serum concentration of what substance is used as a
clinical measure of a patient's GFR?
Creatinine
Q0542:Where does CHO digestion begin?
In the mouth with salivary alpha-amylase (ptyalin)
Q0543:How does the sympathetic nervous system affect
insulin secretion?
It decreases insulin secretion.
Q0544:How does cell diameter affect the conduction velocity
of an action potential?
The greater the cell diameter; the greater the conduction
velocity.
Q0545:in a ventricular pacemaker cell; what phase of the
action potential is effected by NE
phase 4
Q0546:anatomical and alveolar dead spaces together
constitute...
physiologic dead space;= total dead space of resp system
Q0547:what three organs are necessary for the production of
vitamin D3 (cholecalciferol)
skin;liver;kidney
Q0548:what is the effect of LH on the production of adrenal
androgens
no effect;ACTH stimulates adrenal androgen production
Q0549:what four conditions result in secondary
hyperaldosteronism
CHF;vena calval obstruction;hepatic cirrhosis;renal artery
stenosis
Q0550:what are the five hormones made by sertoli cells
inhibin;estradiol;androgen-binding protein;meiosis inhibiting
factor ;antimullerian hormone
Q0551:does the left or right vagus innervate the SA node
Right vagus innervates SA node (*need the right nerve to
control the important node*);Left vagus innervates AV node
Q0552:how does ventricular repolarization take place; base to
apex or vice versa
base to apex ;and;epicardium to endocardium
Q0553:what is the term for any region of the respiratory
system that is incapable of gas exchange
anatomical dead space (ends at terminal bronchioles)
Q0554:what four factors shift the Hgb-O2 curve to the right?
inc CO2;inc H;inc temp;inc 2;3-BPG;FACILITATE
OFFLOADING O2
Q0555:what two factors result in the apex of the lung being
hypoperfused
decreased pulmonary arterial pressure and less distensable
vessels
Q0556:what is the ratio of pulmonary to systemic blood flow
1:01
Q0557:to differentiate central from nephrogenic diabetes
insipidus; after an injection of ADH; which will show
decreased urine flow
central
Q0558:in what area of the GI tract are water-soluble vitamins
absorbed
duodenum
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?
v wave;C wave;A wave
Q0560:what are the four functions of saliva
antibacterial;lubricate;CHO digestion;fat digestion
Q0561:supine to standing..;dependent venous press?;dep
venous blood volume?;CO?;BP?
inc;inc;dec;dec;**carotid sinus reflex attempts to
COMPENSATE by increasing TPR and heart rate
Q0562:when does the hydrostatic pressure in Bowman's
capsule play a role in opposing filtration
when there is an obstruction downstream
Q0563:what happens to intrapleural pressure when the
diaphragm is contracted during inspiration
intrapleural pressure decreases
Q0564:what is used as an index of cortisol secretion
urinary 17-OH steroids
Q0565:what is used as an index of cortisol secretion
urinary 17-OH steroids
Q0566:if the pH is low with increased CO2 levels and
decreased HCO3 levels; what is the acid-base disturbance
combined respiratory acidosis and metabolic acidosis
Q0567:what is the term that refers to the number of channels
open in a cell membrane
conductance
Q0568:what are the five tissues in which glucose uptake is
insulin dependent
CNS;renal tubules;beta islet cells;RBCs;GI mucosa
Q0569:place in order from fastest to slowest the rate of
gastric emptying for CHO; fat; liquids; proteins
liquids;CHO;protein;fat
Q0570:is most of the coronary artery blood flow during
systole or diastole
diastole
Q0571:what modified smooth muscle cell of the kidney
monitors BP in the afferent arteriole
juxtaglomerular cells
Q0572:what are the three functions of surfactant
decrease surface tension;increase compliance;decrease
probability of pulmonary edema formation
Q0573:glycogenolytic;gluoneogenic;lipolytic;glycolytic;and
stimulated by hypoglycemia
epi
Q0574:glycogenolytic;gluconeogenic;lipolytic;glycolytic;prote
olytic;and stimulated by hypoglycemia and aa
glucagon
Q0575:glycogenic;gluconeogenic;lipogenic;proteogenic;glycoly
tic;and stimulated hy hyperglycemia; aa's; fatty acids; ketosis;
ACh; GH; and beta agonists
insulin
Q0576:what type of muscle is characterized by no
myoglobin; anaerobic glycolysis; high ATPase activity; and
large muscle mass
white muscle; short term too
Q0577:what percentage of CO2 is carried in the plasma as
HCO3?;as carbamino compounds?;as dissolved CO2?
90%;5%;5%
Q0578:what is the most potent male sex hormone
dihydrotestosterone
Q0579:with a decreased arterial diastolic pressure; what
happens to stroke volume?;TPR?;heart rate?
all decrease
Q0580:what linkage of complex CHOs does pancreatic
amylase hydrolyze? What three complexes are formed?
alpha-1;4-glucoside linkages; forming alpha-limit dextrins;
maltotriose; and maltose
Q0581:does the heart rate determine the diastolic or systolic
interval
diastolic;contractility determines systolic interval
Q0582:on a graphical representation of filtration;
reabsorption; and excretion; when does glucose first appear in
urine
at the beginning of splay (about 250)
Q0583:what is the relationship between preload and passive
tension in a muscle
direct;the greater the preload; the greater the passive tension
and the greater the prestretch of a sarcomere
Q0584:what is the rate-limiting step in the synthetic pathway
of NE at the adrenergic nerve terminal
conversion of tyrosine to dopamine by tyrosine hydroxylase
Q0585:how many days prior to ovulation does LH surge
occur
1 day prior
Q0586:how are flow through the loop of Henle and
concentration of urine related
as flow increases; the urine becomes more dilute because of
decreased time for H2O reabsorption
Q0587:what is the PO2 of aortic blood in fetal circulation
60%
Q0588:how do elevated blood glucose levels decrease GH
secretion
somatotrophins are stimulated by IGF-1 and they inhibit GH
secretion;GHRH stimulates GH secretion
Q0589:what segment of the nephron has the highest
concentration of inulin?;lowest conc?
terminal collecting duct has highest concentration;Bowman's
capsule has lowest?
Q0590:what type of resistance system; high or low; is formed
when resistors are added in series
high
Q0591:what hormones; secreted in proportion to the size of
the placenta; are an index of fetal well being
hCS and serum estriol; which are produced by the fetal liver
and placenta; respectively; are used as estimates of FETAL
well being
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
respiratory alkalosis;(low CO2;low H;slightly low HCO3)
Q0593:what respiratory center in the caudal pons is the
center for rhythm promoting prolonged inspirations
apneustic center (deep breathing place)
Q0594:what area of the GI tract has the highest activity of
brush border enzymes
jejunum
Q0595:does T3 or T4 have greater affinity for nuclear
receptors
T3
Q0596:what is the only signal regulating release of PTH
low interstitial free Ca
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
1. secondary hypo;2. secondary hyper;3. primary hypo;4.
primary hyper
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
1. graves;2. secondary hypo (pituitary);3. tertiary hypo
(hypothalamic);4. primary hypo;5. secondary hyper
Q0599:what two stress hormones are under the permissive
action of cortisol
glucagon and epi
Q0600:if radius of a vessle doubles; what happens to
resistance
dec 1/16
Q0601:what preventgs the down regulation of the recptors on
the gonadotrophos of the anterior pituitary
pulatile release of GnRH
Q0602:does epi have proteolytic action
no- only glycogenolytic and lipolytic
Q0603:what is the only 17-hydroxysteroid with hormonal
activity
cortisol
Q0604:does the oncotic pressure of plasma promote filtration
or reabsorption
reabsorption
Q0605:why is the baes of the lung hyperventialted when a
person is standing upright
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
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
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
Q0607:what hormone causes contraction of smooth mucle;
regulates interdigestive motility; and prepares intestine for
next meal
motilin
Q0608:what two vessels in fetal circulatin have the highest
PO2 levles
umbilical vein and ductus venosus
Q0609:how many days prior to ovulation does estradiol peak
in the menstrual cycle
2 days prior
Q0610:what serves as a marker of endogenous insulin
secretion
C-peptide
Q0611:what is the term for the total volume of air moved in
and out of the respiratry system per minute
total ventilation;= minute ventilation;= minute volume
Q0612:what is the renal compensation mechanism for
alkalosis
increase urinary excretion of HCO3;shifts reaction to right and
increasing H
Q0613:what is a sign of a sertoli cell tumor in a man
excess estradiol in blood
Q0614:in the systemic circulation; what blood vessels have
the largest pressure drop?;smallest pressure drop?
arterioles;vena cava
Q0615:what is the major stimulus for cell division in
chondroblasts
IGF-1
Q0616:what are two causes of diffusion impairment in the
lungs
decrease in surface area and increase in membrane thickness
Q0617:what are four effects of suckling on the mother
increased synthesis and secretion of oxytocin;increased release
of PIF from hypothalamus;inhibition of GnRH;milk secretion
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
90 to 120 minutes;correlates with levels of motilin
Q0619:increasing arterial systolic pressure..;stroke
volume?;vessel compliance?;heart rate?
inc;dec;dec
Q0620:what enzyme is needed to activate trypsinogen to
trypsin?;chymotrypsinogen to
chymotrypsin?;procarboxypeptidase to carboxypeptidase?
enterokinase;trypsin;trypsin
Q0621:in a ventricular pacemaker cell; what phase of the
action potential is affected by ACh
phase 4
Q0622:what is the most potent stimulus for glucagon
secretion? inhibition?
hypoglycemia -> secretion;hyperglycemia -> inhibition
Q0623:what is the term for the summation of mechanical
stimuli due to the skeletal muscle contractile unit becoming
saturated with calcium
tetany
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
a transport maxium (Tm) system
Q0625:in an adrenergic nerve terminal; where is DA converted
to Nepi?
in the vesicle by dopamine-beta-hydroxylase
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?
greater (ex PAH);less (ex glucose)
Q0627:what is the term for the load on a muscle in the relaxed
state
preload is load Prior to contraction
Q0628:what are the two best indices of left ventricular
preload
LVEDV and LVEDP
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?
1. puberty;2. childhood;3. adulthood;4. aged adult
Q0630:why is the clearance of creatinine always slightly
greater than the clearance of inulin and GFR?
because creatinine is freely filtered and slightly secreted
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
metabolic alkalosis;(high PH; low H; high HCO3)
Q0632:when referring to a series circuit; what happens to
resistance when a resistor is added
increases
Q0633:why is there an increase in prolactin if the
hypothalamic pituitary axis is severed
the chronic inhibition of dopamine (PIF) on the release of
prolactin from the anterior pituitary gland is removed; thereby
increasing the release of prolactin
Q0634:what acid form of H in the urine cannot be titrated
NH4
Q0635:regarding the venous system; what happens to blood
volume if there is a small change in pressure
venous system is more compliant -> small changes in pressure
result in large changes in blood volume
Q0636:in what stage of sleep is GH secreted
3 and 4
Q0637:where does the conversion of CO2 into HCO3 take
place
RBC
Q0638:from the fourth month of fetal life to term; what
secretes the progesterone and estrogen to maintain the uterus
placenta
Q0639:what two factors are required for exocytosis
Ca and ATP
Q0640:what is the best measure of total body vitamin D if
you suspect a deficiency
serum 25-OH-D
Q0641:what hormone is required for 1;25-dihydroxy-D to
have bone resorbing effects
PTH
Q0642:is bone deposition or resorption due to increased
interstitial Ca concentration
deposition
Q0643:the opening of what valve indicates the terminatino of
isovolumetric relaxation of the cardiac cycle
mitral valve
Q0644:why is there a decrease in the production in epi when
the anterior pituitary gland is removed
PNMT used in the conversion of epi; is regulated by cortisol;
removing the anterior pituitary gland decreases ACTH and
therefor cortisol
Q0645:name the period described by the following: no matter
how strong a stimulus; no further action potentials can be
stimulated
absolute refractory period (voltage inactivation of Na
channels)
Q0646:how many carbons do estrogens have
18;(remove one C from an androgen makes an estrogen)
Q0647:T or F? the alveolar PO2 and PCO2 levels match the
pumonary end capillary blood levels
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
Q0648:in high altitudes; what is the main drive for ventilation
shifts from central chemoreceptors (CSF H) to periopheral
chemoreceptors monitoring O2
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
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
Q0650:what hormone excess produces adrenal hyperplasia
ACTH
Q0651:is there more circulating T3 or T4
T4- because the greater affinity for the binding protein; T4
has a significantly longer half life than T3 (50x)
Q0652:why is the cells resting membrane potential negative
intracellular proteins
Q0653:is thyroid size a measure of its function
no!;TSH is a measure of its function
Q0654:if the radius of a vessel is decreased by half; what
happens to resistance
increased 16x
Q0655:what neurotransmitter is essential for maintaining a
normal BP when an individual is standing
NE
Q0656:what form of diabetes insipidus is due to an
insufficient amount of ADH
central/neurogenic
Q0657:three methods of vasodilation via the sympathetic
nervous system
decreased alpha 1;increased beta 2;increased ACh
Q0658:1. Ca reabsorption and phosphate excretion;2. Ca
excretion and phosphate excretion;3. Ca reabsortpion and
phosphate reabsorption
1. PTH;2. calcitriol;3. vitamin D3
Q0659:does progesterone have thermogenic activities
yes
Q0660:how long is the transit time through the small intestine
2-4 hours
Q0661:where is the last conducting zone of the lungs
terminal bronchioles (no gas exchange)
Q0662:does cortisol inhibit glucose uptake in skeletal muscle
yes- makes it available for neural tissue
Q0663:what percentage of cardiac output flows through the
pulmonary circuit
100%
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
1. site 4;2. site 2;3. site 1;4. site 3
Q0665:which three factors cause the release of epi from
adrenal medulla
1. exercise;2. emergencies;3. exposure to cold
Q0666:how many ATPs are hydrolyzed every time a skeletal
muscle cross-bridge completes a single cycle
one
Q0667:why would a puncture to a vein above the heart have
the potential to introduce air into the vascular system
venous pressure above the heart is subatmospheric
Q0668:what type of saliva is produced under
parasympathetic stimulation
high volume;watery
Q0669:in what area of the gI tract does iron get absorbed
duodenum
Q0670:why is the apex of the lung hypoventilaged when a
person is standing
alveli at apex are almost completely inflated prior to inflation
-> they receive low levels of alveolar ventilation
Q0671:what pancreatic islet cell secretes glucagon
alpha;glucagon has stimulatory affects on beta cells and
inhibitory effects on delta cells
Q0672:what are the four characteristics of protein mediated
transport
1. comp for carrier;2. chemic specificity;3. zero-order
saturation;4. rate of transportation faster than if by simple
diffusion
Q0673:what is secretin's pancreatic action
stimulates HCO3 rich solution release
Q0674:why is there an increase in FF if the GFR is decreased
under sympathetic stimulation
because RPF is markedly decreased; while GFR is only;
minimally dec --> inc FF (=GFR/RPF)
Q0675:what triggers phase 3 of action potential in ventricular
pace maker cell
efflux of potassium
Q0676:what is the primary target for glucagon
liver
Q0677:what is the renal compensation for acidosis
makes HCO3; shifting reaction to left and decreasing H
Q0678:what enzyme found in a cholinergic synapse breaks
down ACh?
acetylcholinesterase;-> acetate and choline
Q0679:what hormone; produced by sertoli cells; if absent
would result in the formation of internal female structures
MIF
Q0680:what happens to the lung if the intrapleural pressure
exceeds lung recoil
lung will expand
Q0681:what two factors determine the clearance of a
substance
plasma concentration and excretio rate;= U/V
Q0682:what type of muscle contraction occurs when the
msucle shortens and lifts the load placed on it
isotonic
Q0683:what type of potential is characterized as being an all
or none; propagated and not summated
action potential
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
metabolic acidosis (low pH; high H; low HCO3)
Q0685:pregnant woman in 3rd trimester has normal BP when
standing and sitting. When supine BP drops to 90/50;what is
the dx?
compression of the IVC
Q0686:35 y/o man has high BP in arms and lowBP in his
legs;what is the dx
coarction of teh aorta
Q0687:5 y/o boy presents weith a systolic murmur and a
wide fixed split S2. what is the dx
ASD
Q0688:During a game a young football player collapses and
dies immediately. What is the most likely type of cardiac dz
hypoertrophic cardiomyopathy
Q0689:pt has a stroke after incurring multiple long bone
fractures in trauma stemming from a MVA. What caused the
infarct
fat emboli
Q0690:elderly woman presents with a headache and jaw pain.
labs show elevated ESR. what is teh dx
temporal arteritis
Q0691:80 y/o man presents w/ systolic crescendo-
decrescendo murmur. What is the most likely cause?
aortic stenosis
Q0692:Man starts a medication for hyperlipidemia. He then
develops a rash; pruritis; and GI upset. What drug was it
Niacin
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?
losartan; an angiotensin II receptor antagonist; does not
increase bradykinin as captopril does.
Q0694:What are the 3 sx inside the carotid sheath
1) Internal jugular Vein (lateral);2) Common carotid Artery
(medial);3) Vagus Nerve (posterior);mneu: VAN
Q0695:In the majority of cases; the SA and AV nodes are
supplied by this carotid artery?
Right coronary artery
Q0696:80% of the time the Right coronary artery is
"dominant"; suppplying the left ventricle via the _________
branch
Posterior descending artery
Q0697:cardiac output =
SVxHR
Q0698:During exercise; CO increased as a result of an
increased in _____. After prolonged exercise; CO increased
as a result of an increased in ____
SV;HR
Q0699:cardiac output =
SVxHR
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 ____.
SV;HR
Q0701:Mean argerial Pressure (MAP)=;give 2 equasions;1)
CO; TPR;2) systolic; diastolic
1) CO x TPR;2)1/3 systolic +2/3 diastolic
Q0702:CO=;rate of O2 consumption; aa O2 content; vv O2
content
rate of O2 consumption / (aa O2 content-vv O2 content)
Q0703:Pulse pressure =;systolic; diastolic
systolic-diastolic
Q0704:pulse pressure ≈
stroke volume
Q0705:SV=;(2 equasions);1) CO; HR;2)EDV;ESV
1)=CO/HR;2)=EDV-ESV
Q0706:Coronary Artery Anatomy [pic]
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
Q0707:Stroke volume is affected by what 3 things ;mneu: SV
CAP
Contractility; Afterload; and Preload;mneu: SV CAP
Q0708:increased Preload →__SV
increased
Q0709:increased Afterload→ __SV
decreased
Q0710:increased contractility→ __SV
increased
Q0711:SV ___ in anxiety; exercise; & pregnancy
increased
Q0712:a failing heart has a ___ SV
decreased
Q0713:Contractality (and SV); ____ with catecholemines
increased
Q0714:Contractality (and SV); ____ with increased
intracellular Ca++
increased
Q0715:Contractality (and SV); ____ with decreased
extracellular sodium
increased
Q0716:Contractality (and SV); ____ with digitalis
increased
Q0717:Contractality (and SV); ____ with beta1 blockade
decreased
Q0718:Contractality (and SV); ____ with heart failure
decreased
Q0719:Contractality (and SV); ____ with acidosis
decreased
Q0720:Contractality (and SV); ____ with
hypoxia/hypercapnea
decreased
Q0721:Contractality (and SV); ____ with Ca++ channel
blockers
decreased
Q0722:Myocardial demand is ___ by increased afterload
(diastolic BP)
increased
Q0723:Myocardial demand is ___ by increased contractility
increased
Q0724:Myocardial demand is ___ by increased heart rate
increased
Q0725:Myocardial demand is ___ by increased heart size
increased
Q0726:ventricular EDV
Preload
Q0727:Systolic arterial pressure
afterload
Q0728:proportional to peripheral resistance
afterload
Q0729:venous dialators (e.g. nitroglycerine) decreased
_______;(preload or afterload)
preload
Q0730:vaso dialators (e.g. hydralazine) decreased
_______;(preload or afterload)
afterload
Q0731:______ increased w/ exercise; increased blood
volume; exitement (sympathetics);(preload or afterload)
Preload
Q0732:Starling Curve: Force of _______ is proportional to
initial length of cardiac mm fiber (preload)
contraction
Q0733:contraction state of the myocardium is ____ by
circulating catecholamines;(+;-)
+
digitalis;(+;-)
+
sympathetic stimulation;(+;-)
+
pharmacologic depressants;(+;-)
-
Q0737:contraction state of the myocardium is ____ by loss of
myocardium (MI);(+;-)
-
Q0738:EF=;(give 2 equasions);1) SV; EDV;2) EDV; ESV;
EDV
1) SV/EDV;2) EDV-ESV/EDV
Q0739:this is an index of ventricular contractility
EF
Q0740:EF is normally > ___%
55
Q0741:Place condition on the Starling curve [pic p.219]
1)exercise;2)CHF + digitalis;3)CHF
Q0742:(driving Pressure)ΔP=;Q (flow) ;R (resistance)
QxR
Q0743:Resisitance (R) =;Give 2 equasions;1)ΔP(driving
pressure);flow(Q) ;2)n(viscosity); length(l); radius (r)
1)=ΔP/Q;2)8nxl/Πr(^4)
Q0744:viscosity depends mostly on _______
hematocrit
Q0745:increased ______ in;1) Polycythemia;2)
Hyperproteinemic states (e.g; multiple myeloma);3)
hereditary spherocytosis
viscosity
Q0746:resistance is ________ to viscosity ;(proportional or
inversely proportional)
proportional
Q0747:resistance is ________ to the radius to the 4th
power;(proportional or inversely proportional)
inversely proportional
Q0748:cardiac and vascular fx curves [pic p.219]
1) (+) inotropy;2) (-) inotropy;3) (increased ) blood
volume;4) (decreased ) blood volume
Q0749:cardiac cycle image [p. 220]
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
Q0750:Name the phase of the cardiac cycle;period between
mitral valve closure and aortic valve opening.
isovolumetric contraction
Q0751:Name the phase of the cardiac cycle: period of highest
O2 consumption
isovolumetric contraction
Q0752:Name the phase of the cardiac cycle: period between
aortic valve opening and closing
systolic ejection
Q0753:Name the phase of the cardiac cycle: period between
aortic valve closing and mitral valve opening
isovolumetric relaxation
Q0754:Name the phase of the cardiac cycle: period just after
mitral valve opening
rapid filling
Q0755:Name the phase of the cardiac cycle: period just before
mitral valve closure
slow filling
Q0756:name the heart sound: mitral and tricuspid valve
closure
S1
Q0757:name the heart sound: aortic and pulmonary valve
closure
S2
Q0758:name the heart sound: at the end of rapid ventricular
filling
S3
Q0759:name the heart sound: high atrial pressure/stiff
ventricle
S4
Q0760:this heart sound is associated w/ dilated CHF
S3
Q0761:this heart sound AKA "atrial kick" is associated with a
hypertrophic ventricle
S4
Q0762:Jugular venous pulse waves;a wave
Atrial contraction
Q0763:Jugular venous pulse waves: c wave
RV Contraction (tricuspid valve bulging into atrium)
Q0764:Jugular venous pulse waves: v wave
increaseed atrial pressure due to filling against closed tricuspid
Valve
Q0765:jugular venous distention is seen in ___________
right heart failure
Q0766:when the aortic valve closes before the pulmonic this
heart sound abnormality results
S2 splitting
Q0767:S2 splitting is increased upon ________
inspiration
Q0768:Paradoxical splitting (S2 split increasd upon expiration
is associated with what?
aortic stenosis
Q0769:pressure volume relationship [pic p. 221]
--
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.
calcium;calcium;calcium induced calcium release
Q0771:In contrast to skeletal mm; cardiac mm action potential
has a plateau; which is due to ____ influx.
Ca+
Q0772:In contrast to skeletal mm; cardiac nodal cells
________ depolarize; resulting in automaticity
spontaneously
Q0773:In contrast to skeletal mm; cardiac myocytes are
electrically coupled to each other by ________
gap junctions
Q0774:myocardial action potential occurs in atrial and
ventricular myocytes and ________
perkinje fibers
Q0775:In a myocardial action potential; this phase is the
rapid upstroke; when voltage gated Na+ channels open
phase 0
initial repolarization-inactivation of voltage0gated Na+
channels. Voltage gated K+ channels begin to open
Phase 1
plateu--Ca++ influx through voltage-gated Ca++ channels
balances K+ efflux. Ca++ influx triggers another Ca++ release
from sarcoplasmic reticulum and myocyte contraction.
phase 2
rapid repolarization--massive K+ efflux due to opening of
voltage-gated slow K_ channels and closure of voltage gated
Ca++ channels.
Phase 3
resting potential--high K+ permeability through K+ channels.
phase 4
Q0780:Pacemaker action potentials occur where
SA & AV nodes
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.
phase 0
Q0782:In a pacemaker action potential this phase; the plateau
is absent.
phase 2
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.
phase 4
Q0784:electrocardiogram: atrial depolarization
P wave
Q0785:electrocardiogram: conduction delay through AV node
(normally <200 msec)
PR segment
Q0786:electrocardiogram: vetricular depolarization (normally
< 120 msec)
QRS complex
Q0787:electrocardiogram: mechanical contraction of the
ventricles
QT interval
Q0788:electrocardiogram: ventricular repolarization
T wave
Q0789:electrocardiogram;atrial repolarization is masked by
_______
QRS complex
Q0790:electrocardiogram: isoelectric; ventricles depolarized
ST segment
Q0791:electrocardiogram: These waves caused by
hypokalemia
U wave
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]
Wolff-Parkinson-White syndrome
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)
Atrial fibrillation
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)
Atrial flutter
Q0795:In this condition PR interval is prolonged (>200
msec). Asymptomatic;(pic. p 224)
1st degree AV block.
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)
2nd degree AV block;Mobitz type I (Wenckebach)
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)
Mobitz type II AV block
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.
3rd degree AV block (complete)
Q0799:completely erratic rhythm with no identifiable waves.
Fatal arrhythmia without immediate CPR and defibrillation.
(pic. p 225)
Ventricular Fibrillation
Q0800:________receptor transmits via vagus nn to medulla
(responds only to increase blood pressure)
aortic arch receptor
Q0801:________ receptor transmits via glossopharyngeal nn
to medulla
carotid sinus
Q0802:decreased firing by aroreceptors during hypotension
results in an increase in efferent ________ firing
sympathetic
Q0803:In a carotid massage; the increased pressure on carotid
aa results in increased stretch and ____ in heart rate
decrease
Q0804:Peripheral chemoreceptors in the carotid and aortic
bodies respond to (3 things)
decreased PO2 (<60mmHg); increased PCO2 and decreased
pH of blood
Q0805:Central chemoreceptors respond to what changes (2)
changes in pH and Pco2 (not Po2)
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)
Central chemoreceptor
Q0807:This orgen gets the largest share of systemic cardiac
output
liver
Q0808:this organ gets the highest blood flow per gram of
tissue
kidney
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.
heart
Q0810:this is a good approximation of L atrial pressure and
measured with a Swan-Ganz catheter
Pulmonary capillary wedge pressure
Q0811:blood flow is altered to meet demands of tissue
autoregulation
Q0812:Name the organ regulated by the local metabolites;O2
adenosine; NO
heart
Q0813:Name the organ regulated by the local
metabolites;CO2 (pH)
brain
Q0814:Name the organ regulated by the local metabolites:
Myogenic and tubuloglomerular feedback
kidneys
hypoxia causes vasoconstriction
lungs
Q0816:_______ vasculature is unique in that hypoxia causes
vasoconstriction (in other organs hypoxia causes vasodilation)
pulmonary
lactate; adenosine; K+
skeletal mm
sympathetic stimulation most important mechanism--temp
control
skin
Q0819:______ forces determine fluid movement by osmosis
throug capillary membranes
starling
Q0820:moves fluid out of capillary
P(c) capillary pressure
Q0821:moves fluid into capillary
P(i) interstitial fluid pressue
Q0822:moves fluid into capillary
π(c) plasma colloid osmotic pressure
Q0823:moves fluid out of capillary
π(i) interstitial fluid colloid osmotic pressure
Q0824:net filtration pressure=Pnet=
[Pc-Pi)-(πc-πi)];capillary pressure -interstitial pressure ;-
;plasma colloid osmotic presure - interstitual fluid colloid
osmotic pressures
Q0825:Kf=
filtration constant (capillary permeability)
Q0826:excess fluid outflow into interstitium
edema
Q0827:edema is commonly caued by ___ capillary pressure
(give example)
increased P(c);Heart failure
Q0828:edema is commonly caued by ___ plasma
protiens(give example)
decreased π(c) plasma proteins ;(nephrotic syndrome; liver
failure)
Q0829:edema is commonly caused by ___ capillary
permeability (give example)
increased Kf;infections; burns
Q0830:edema is commonly caued by ___ interstitial fluid
colloid osmotic pressure;(give example)
increased πi;lymphatic blockage
Q0831:right-to-left shunts (early cyanoisis) "blue babies"
3 Ts;Tetrology;Transposition;Truncus
Q0832:Children with this type of shunt may squat to increase
venous return
right to left shunts
Q0833:Right-to Left shunts (early cyanosis) - "blue babies"
1) Tetrology of fallot;2) Transposition of great vessels;3)
Truncus arteriosis;The 3 Ts
Q0834:children with this type of shunt may squat to increase
venous return.
right to left shunt
Q0835:Left to right shunts (late cyanosis) - "blue kids"
1) VSD;2) ASD;3) PDA
Q0836:this is the most common cause of early cyanosis
tetralogy of fallot
Q0837:this is the most common congenital cardiac anomaly
VSD
Q0838:this congenital heart dz manifests itself with a loud S1
and a wide; fixed split S2
ASD
Q0839:this congenital heart defect is closed with
indomethacin
PDA
Q0840:give the frequency of occurance with;PDA;VSD;ASD
VSD>ASD>PDA
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]
eisenmenger's syndrome
Q0842:Tetrology of Fallot [pic. p 228]
1) Pulmonary stenosis ;2)RVH;3) Overiding aorta (overides
VSD);4) VSD;mneu: PROVe
Q0843:most important determinant for prognosis of tetrology
of fallot
pulmonary stenosis
Q0844:ON x-ray TOF looks ________
boot shaped
Q0845:give the frequency of occurance with;PDA;VSD;ASD
VSD>ASD>PDA
Q0846:Aorta leaves RV (anterior) and pulmonary trunk
leaves LV (posterior)leading to separation of systemic and
pulmonary circulations.
Transposition of great vessels
Q0847:Transposition is not compatable with life unless a
_____is present to allow adequate mixing of blood;[pic p.
229]
shunt (e.g. VSD; PDA or patent foramen ovale)
Q0848:transposition of great vessels is due to failure of the
_________ septum to spiral
aorticopulmonary
Q0849:this type of coarction of aorta is aortic stenosis
proximal to insertion of ductus arteriosus (preductal)
infantile;INfantile: IN close to the heart
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.
adult type;aDult: Distal to Ductus
Q0851:Coarction of aorta has a male: female ratio of ____
3:01
Q0852:what is best way to diagnose coartation of aorta
femoral pulses on pysical exam
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]
patent ductus arteriosis
Q0854:______ is used to closed a PDA
indomethacin
Q0855:______ is used to keep a PDA open; which may be
necessary to sustain life in conditions such as transposition of
the great vessels
PGE
Q0856:Congenital cardiac defect associations;22q11
truncus arteriosus; tetralogy of Fallot
Q0857:Congenital cardiac defect associations;Down
syndrome
ASD; VSD
Q0858:Congenital cardiac defect associations;Congenital
rubella
septal defects; PDA
Q0859:Congenital cardiac defect associations;Turners
syndrome
coarctation of aorta
Q0860:Congenital cardiac defect associations;Marfan's
syndrome
aortic insufficiency
Q0861:Congenital cardiac defect associations: Offspring of
diabetic mother
transposition of great vessels
Q0862:Hypertension
BP >140/90
Q0863:HTN risk factors
increase age; obesity; diabetes; smoing; genetics;
blck>white>asians
Q0864:90% of hypertension is this kind
essential
Q0865:essentail hypertention is related to either one of these
two factors
increased CO or TPR
Q0866:10% of HTN is mostly secondary to ______ dz
renal
Q0867:this type of HTN is severe and rapidly progressing
malignant
Q0868:HTN predisposes pts to (give 3)
athrosclerosis; stroke; CHF; renal failure; retinopathy; &
aortic dissection
Q0869:Hyperlipidemia signs;Plaques in blood vessel walls
Atheromata
Q0870:Hyperlipidemia signs;plaques or nodules composed of
lipid-laden histocytes in the skin; especially the eyelids
Xanthoma
Q0871:Hyperlipidemia signs: lipid deposits in the tendon;
esp. the achilles
Tendinous xanthoma
Q0872:Hyperlipidemia signs: lipid deposit in cornea;
nonspecific (arcus senilis)
corneal arcus
Q0873:This type of arteriosclerosis is in the media of the
arteries; esp radial or ulnar. Usually benign.
Monckeberg
Q0874:This type of arteriosclerosis is hyalin thickening of
small arteries in essential hypertension. Hyperplastic "onion
skinning" in malignant hypertension.
Arteriolosclerosis
Q0875:This type of arteriosclerosis is when fibrous plaques
and atheromas form in intima of arteries
atherosclerosis
Q0876:risk factors for atherosclerosis
smoking; hypertension; dbts; hyperlipidemia; family hx
Q0877:progression of atherosclerosis;complex atheromas;
fatty streaks; proliferative plaque
fatty streaks to proliferative plaque to complex atheromas
Q0878:complications of atherosclerosis (give 3)
aneurisms; ischemia; infarcts; peripheral vascular dz;
thrombus; emboli
Q0879:most common location of atherosclerosis
abdominal aorta> coronary artery>popliteal artery>carotid
artery
Q0880:symptoms of atherosclerosis
angina; claudication; but can be asymptomatic
Q0881:CAD narrowing >75%
angina
Q0882:retrosternal chest pain with exertion ; mostly
secondary to atherosclerosis
stable angina
Q0883:chest pain occurring at rest secondary to corony artery
spasm
prinzmetal's variant (unstable angina)
Q0884:worsening of chest paiin due to thrombosis but no
necrosis
unstable/crescendo angina
Q0885:most often acute thrombosis due to coronary artery
atherosclerosis. Results in myocyte necrosis
myocardial infarction
Q0886:death from cardiac causes within 1 hour of onset of
symptoms; most commonly due to a lethal arrythmia
sudden cardiac death
Q0887:progressive onset of CHF over many years due to
chronic ischemic myocardial damage
chronic ischemic heart dz
Q0888:infarcts occuring in loose tissues with collaterals; such
as lungs; intestine; or follwing reperfusion
red (hemorrhagic) infarcts;REd=REperfusion
Q0889:infarcts occur in solid tissues with single blood
supply; such as brain; heart; kidney and spleen.
pale infacts
Q0890:give order of highest frequency of coronary artery
occlusion ;CFX; LAD; RCA
LAD>RCA>CFX
Q0891:symptoms of MI (give 4)
diaphoresis; nausea; vomiting; severe retrosternal pain; pain in
left arm or jaw; shortness of breath; fatigue; adrenergic
symptoms.
Q0892:How long ago did the MI occur?;Occluded artery but
no visable change by light microscopy
2-4 hours
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.
after 4 hrs. 1st day
Q0894:How long ago did the MI occur?;Gross: hyperemic
border; central yellow-brown softening;Micro: outer zone
(ingrowth of granulation tissue); macrophages; & neutrophils
5-10 D
Q0895:How long ago did the MI occur?;Gross: grey-
white;Micro: scar complete
7 weeks
Q0896:dx of MI what is gold standard in the 1st 6 hrs
ECG
Q0897:This lab test rises after 4 hours and is elevated for 7-
10D.
troponin I
Q0898:this lab test is more specific than other protein
markers
troponin I
Q0899:This is predominantly found in myocardium but can
also be relased from skeletal mm
CK-MB
Q0900:This is nonspecific and can be found in cardiac; liver
and skeletal mm cells
AST
Q0901:ECG changes include ST elevation which indicates
transmural infarct
Q0902:ECG changes include ST depression which indicates
subendocardial infarct
Q0903:ECG changes include pathological Q waves
transmural infact
Q0904:This MI complication is the most important cause of
death before reaching hosptial; it is common in the 1st few
days
cardiac arrhythmia
Q0905:This MI complication results in pulmonary edema
LV failure
Q0906:This MI complication has a high risk of mortanilty
and occurs when there is a large infarct
cardiogenic shock
Q0907:Rupture of ventricular free wall; interventricular
septum; or paillary mm; usually occurs _____ post MI
4-10D
Q0908:This MI complication of an MI results in decreased
CO; a risk of arrythmia; and embolus from mural thrombus
aneurism formation
Q0909:this MI complication is also known as a friction rub
and occurs 3-5 D post MI
fibrinous pericarditis
Q0910:This MI complication is an autoimmune phenomenon
resulting in fibrinous pericarditis; several weeks post-MI
dresslers syndrome
Q0911:This is the most common cardiomyopathy (90%)
dialated (congestive) cardiomyopathy
Q0912:In dialated (congestive) cardiomyopathy ________
dysfunction ensues
systolic
Q0913:In this type of cardiomyopathy; the heart looks like a
baloon on chest x-ray
dialated (congestive) cardiomyopathy
Q0914:etiology of dialated (congestive) cardiomyopathy
Alcohol ;Beriberi;Coxsackie B;Cocaine;Chagas
dz;Doxorubicin;peripartum;hemochromatosis
Q0915:this type of cardiomyopathy often involves an
asymetric enlargement of the intraventricular septum
hypertrophic cardiomyopathy
Q0916:In hypertrophic cardiomyopathy ______ disfunction
occurs
diastolic
Q0917:hypertrophic cardiomyopathy is a __________ trait;
and 50% are familial
autosomal dominant
Q0918:This is a very common cause of sudden death in young
athletes.
hypertrophic cardiomyopathy
Q0919:What are the heart sound findings with hypertrophic
cardiomyopathy
loud S4; apical impulses; systolic murmur
Q0920:How do you tx hypertrophic cardiomyopathy
Beta blocker
Q0921:major causes of this type of cardiomyopathy include
sarcoidosis; amyloidoss; postratdiation fibrosis; endocarrdial
fibroelastosis; and endomyocardial fibrosis (Loffler's)
restrictive/obliterative cardiomyopathy
Q0922:Heart Murmurs;holostolic; high piched "blowing
murmur" loudest at apex
mitral regurgitation
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
aortic stenosis
Q0924:Heart Murmurs;holosystolic murmur
VSD
Q0925:Heart Murmurs;Late systolic murmur with
midsystolic click. Most frequent valvular lesion
mitral prolapse
Q0926:Heart Murmurs;immediate high-pitched "blowing"
diastolic murmur. Wide puse pressure
aortic regurgitation
Q0927:Heart Murmurs: follows opening snap. delayed
rumbling late diastolic murmur.
mitral stenosis
Q0928:Heart Murmurs: Continuous machine like murmur.
Loudest at time of S2
PDA
Q0929:most common primary cardiac tumor in adults.
Usually described as a "ball-valve" obstruction in the LA
myxomas.
Q0930:90% of myxomas occur in the _____
atria (mostly LA)
Q0931:Most frequent primary cardiac tumor in children;
associated with tuberous sclerosis
rhabdomyomas
Q0932:Most common heat tumor (see color image 88)
metasteses
Q0933:Given the pathophysiology tell me the symptom of
CHF;failure of LV output to increase during exercise
dyspnea on exertion
CHF: greater ventricular end-diastolic volume
cardiac dilation
CHF;Lv ventrical failure leads to increased pulmonary venous
pressure which leads to pulmonary venous distention and
transudation of fluid.
pulmonary edema (paroxysmal nocturnal dyspnea)
Q0936:this CHF abnormality is associated with presence of
hemosiderin-laden macrophages
pulmonary edema
CHF: increase venous return in supine position exacerbates
pulmonary vascular congestion
orthopnea (shortness of breath when supine)
CHF: increased central venous pressure leading to increased
resistance to portal flow.
hepatomegaly (nutmeg liver)
CHF: RV failure leads to increased venous pressure which
leads to fluid transudation
ankle ; sacral edema
Q0940:embolus types
Fat; Air; Thrombus; Bacteria; Amniotic fluid; Tumor;mneu:
an embolus moves like a a FAT BAT
Q0941:this type of emboli are associated with long bone
fractures and liposuction.
fat
Q0942:approximately 95% of pulmonary emboli arise from
where?
deep leg veins
Q0943:this type of emboli can lead to DIC; especially
postpartum
amniotic fluid
Q0944:this type of embolus is associated with chest pain;
tachypnea; and dyspnea
pulmoary embolus
Q0945:compression of heart by fluid (i.e;blood) in
pericardium; leading to decreased cardiac output and
equilibration of pressures in all four chambers.
cardiac tamponade
Q0946:youre pt presents with hypotension; JVD; and distant
heart sounds. He shows pulsus paradoxus and ECG shows
electrical alternans
cardiac tampanad
Q0947:pulsus paradoxus
(exaggeration of nml variation in the systemic arterial pulse
volume with respiration-- becoming weaker with inspiration
and stronger with expiration)
Q0948:electrical alternans
(beat to beat alterations in QRS complex height)
Q0949:Symptoms of bacterial endocarditis
Fever;Roth spots;osler nodes;Murmur (new);Janeway
lesions;Anemia;Nail-bed hemorrhage;Emboli;;mneu: bacteria
FROM JANE
Q0950:osler nodes
tender raised lesions on finger or toe pads
Q0951:Roth's spots
round white spotss on retina surrounded by hemorrhage
Q0952:Janeway lesions
small erythematous lesions on palm or sole
Q0953:What is the most frequently involved valve in bacterial
endocarditis
mitral valve
Q0954:What valve is associated with endocarditis associated
with IV drug abuse
tricuspid valce
Q0955:what are some of the complications associated with
bacterial endocartitis (give 2)
chordae rupture;glomerulonephritis;supportive
pericarditis;emboli
Q0956:acute endocarditis has a rapid onset. It results from
large vegetations on previously normal valves. It is most often
caused by this bug.
S. aureus (high virulence)
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
viridans streptococcus (low virulence)
Q0958:endocarditis may also be nonbacterial and secondary
to these 2 conditions
metastasis or renal failure (marantic/ thrombotic endocarditis)
Q0959:In this condition; associated with lupus; vegetations
develop on both sides of valve leading to mitral valve stenosis
but do not embolize
libman-sacks endocarditis;mneu: SLE causes LSE
Q0960:Rhematic heart dz is a late consequence of pharyngeal
infection with this organism
a beta hemolytic streptococci
Q0961:rhematic heart dz affects heart valves in this order
mitral>aortic>>tricuspid;mneu: high pressure valves
associated most.
Q0962:Give the symptoms of rheumatic heart dz
Fever;Erythema marginatum;Valvular damage;ESR (high);Red-
hot joints (polyartheritis);Subcutaneous nodules;St. Vitus'
dance (chorea);mneu: FEVERSS
Q0963:This is associated with Aschoff bodies; migratory
polyarthritis; erythema marginatum; elevated ASO titers.
Rheumatic heart dz
Q0964:is rheumatic heart dz immune mediated or the direct
effect of bacteria
immune mediated
Q0965:Associated ith Aschoff bodies and Anitschkow's cells
rheumatic heart dz;mneu: think of 2 RHussians with
RHeumatic heart dz (Aschoff & Anischkow)
Q0966:Aschoff bodies
granuloma with giant cell
Q0967:Anitschkow's cells
activated histiocytes
Q0968:This condition presents with pericardial pain; friction
rub; ECG changes (diffuse ST elevation in all leads) pulsus
paradoxus; distant heart sounds
pericarditis
Q0969:pericarditis can resolve without scarring however;
scarring can lead to this
chronic adhesive or chronic constrictive pericarditis
Q0970:this type of pericarditis is caused by SLE; rheumatoid
arthritis; infection; or uremia
serous pericarditis
Q0971:this type of pericarditis is caused by uremia; MI;
rheumatic fever
fibrinous pericarditis
Q0972:this type of pericarditis is caused by TB or
malignancy (e.g; melanoma)
hemorrhagic
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
syphalitic heart dz (tertiary syphalis)
Q0974:This dz can result in aneurism of the ascending aorta
or aortic arch and aortic valve incompetence.
syphalitic heart dz (tertiary syphalis)
Q0975:This Rx used for HTN has the adverse effect of
HYPOKALEMIA; slight hyperlipidemia; hyperuricemia;
lassitude; hypercalcemia; hyperglycemia
hydrochlorothiazide (diuretic)
Q0976:This Rx used for HTN has the adverse effect of
potassium wasting; metabolic alkalosis; hypotension;
ototoxicity
loop diuretics
Q0977:This sympathoplegic used in the tx of HTN has the
adverse effect of dry mouth; sedation; severe rebound HTN
clonidine
adverse effect of sedation; positive Coomb's test
methyldopa
adverse effect of severe orthostatic hypotension; blurred
vision; constipation; sexual disfunction
hexamethonium
adverse effect of sedation; depression; nasal stuffiness;
diarrhea
reserpine
adverse effect of orthostatic and exercise hypotension; sexual
dysfunction; diarrhea
Guanethidie
adverse effect of 1st dose orthostatic hypotension; dizziness;
headache
Prazosin
adverse effect of impotence; asthma; bradycardia; CHF; AV
block; sedation & sleep alterations
B blockers
Q0984:This vasodialator used in the tx of HTN has the
adverse effect of nausea; headache; lupus-like syndrome;
reflex tachycardia; angina; salt retension
hydralazine
adverse effect of hypertrichosis; pericardial effusion; reflex
tachycardia; angina; salt retension
minoxidil
adverse effect of dizziness; flushing; constipation; nausea
nifidipine; veripamil (constipation)
adverse effect of cyaide toxicity (releases CN)
nitroprusside
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
Captopril;mneu:CAPTOPRIL-Cough; Angioedema;
angiotensin II
Q0989:This angiotensin II receptor inhibitor has theadverse
effect of fetal renal toxicity; hyperkalemia
Losartan
adverse effect of hypertrichosis; pericardial effusion; reflex
tachycardia; angina; salt retension
minoxidil
adverse effect of dizziness; flushing; constipation; nausea
nifidipine; veripamil (constipation)
adverse effect of cyaide toxicity (releases CN)
nitroprusside
Q0993:This ACE inhibitor used in the tx of HTN has the
adverse effect of;Hyperkalemia; Cough; Angioedema;
angiotensin II
Captopril;mneu:CAPTOPRIL-Cough; Angioedema;
angiotensin II
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
hydralazine
Q0995:Toxicity of this drug for severe HTN & CHF include
compensitory tachycardia; fluid retension; & lupus like
syndrome
hydralazine
Q0996:The druges Nifedipine; verapamil & diltiazem belong
to this category
calcium channel blockers
Q0997:The MOA of these drugs is that they block voltage-
dependent L-type calcium channels of cardiac and smooth
muscle and thereby reduce mm contractilty
calcium channel blockers
Q0998:give the order of potency of the 3 CCBs (nifedipine;
verapamil; diltiazem) in;1) the heart;2)vascular smooth mm
heart-verapamil>diltiazem>nifedipine;vascular sm mm--
;nifedipine>diltiazem>verapamil
Q0999:CCBs are used in hypertension but also in these 2
conditions
angina; arrythymias (not nifedipine)
Q1000:These drugs produce a toxicity of cardiac depression;
peripheral edema; flushing; dizziness; & constipation
CCBs
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
nitroglycerine; isosorbide dinitrate
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.
nitroglycerin; isosorbide dinitrate
Q1003:What are the 2 major Rxs used in the tx of antianginal
therapy
nitrates & B blockers
Q1004:In antianginal therapy the goal is to do what?
reduce myocardial O2 consumption.
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)
1)EDV;2)BP;3)HR;4) contractility;5) ejection time
Q1006:Used for antianginal therapy Nitrates reduce _______
(preload or afterload)
preload
Q1007:Used for antianginal therapy B-blockers reduce
_______ (preload or afterload)
afterload
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
N (preload):decreased ;BB (afternoad):increased ;C: no effect
or decreased
have;BP
N (preload):decreased ;BB (afternoad):decreased ;C:decreased
have;Contractility
N (preload):increased (reflex response);BB
(afternoad):decreased ;C:little or no effect
have;HR
N (preload):increased reflex response;BB
(afternoad):decreased ;C:decreased
have;Ejection time
N (preload):decreased ;BB (afternoad):increased ;C:little or no
effect
have;MVO2
N (preload): decreased ;BB (afternoad): decreased ;C:
decreased decreased
Q1014:CCBs: Nifedipine is similar to ________ (nitrates or B
blockers); Verapamil is similar to ________nitrates or B
blockers)
Nitrates ;B blockers
Q1015:Cardiac drugs: sites of action
1) Digitalis (-);2) CCB (-);3) B blockers;4) Ryanodine (+);5)
Ca++ sensitizers
Q1016:This cardiac drug inhibits Na+/K+ ATP ase
digitalis
Q1017:These 2 cardiac drugs inhibit on voltage gated Ca++
channels
CCBs;B blockers
Q1018:This cardiac drug sensitizes Ca++ release channel in
the SR
Ryanodine
Q1019:These cardiac drug is a site of Ca+ interaction with
troponin-tropomyosin system
Ca++ sensitizers
Q1020:This cardiac glycoside has 75% bioavalibility; is 20-
40% protein bound; has a half life of 40 hours and is excreted
in the urine
digoxin
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.
digoxin
Q1022:this drug may cause an elevated PR; a depressed QT; a
scooping of ST segment; and a T-wave inversion on ECG
digoxin
Q1023:The clinical uses for this drug include 1) ________ due
to increased contractility 2) _______ due to decreased
conduction at AV node
1) CHF;3) atrial fibrillation
Q1024:toxicity of this drug includes N/V/D. Blurry yellow
vision. Arrhythmia.
digoxin
Q1025:Digoxins toxicities are increased by
_________(decreased excretion); _______(potentiates drug's
effects) ; and _________ (decreases digoxin clearance and
displaces dignoxin from tissue binding sites
renal failure ;hypokalemia ;quinidine
Q1026:What is the treatment for digoxin toxicity
slowly normalize K+;lidocaine;cardiac pacer;anti-dig Fab
fragments
Q1027:antiarrythmics (Class I) are _____ channel blockers
Na+
Q1028:antiarrythmics (Class II) are _____ blockers
Beta
Q1029:antiarrythmics (Class III) are _____ channel blockers
K+
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.
antiarrhythmics-Na+ channel blockers (class I)
Q1031:antiarrhythmics-Na+ channel blockers (class I) are
state dependent meaning what
they selectively depress tissue that is frequently depolarized
(e.g; tachycardia
Q1032:this class of antiarrhythmics has 3 subcategories A; B;
&C
antiarrhythmics-Na+channel blockers (class I)
Q1033:this class of antiarrythmics includes Quinidine;
Amiodarone; Procainamide; Disopyramide.
Class IA;mneu: Queen Amy Proclaims Diso's PYRAMID
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
IA
Q1035:This member of class IA antiarrhytmics has toxicities
that include (cinchonism-headache; tinnitis;
thrombocytopenia; torsades de pointes due to prolonged QT
interva)
quinidine
Q1036:This member of class IA antiarrhytmics has toxicities
that include reverible SLE-like syndrome
procainamide
Q1037:This class of antiarrythmics include lidocaine
mexiletine; tocainide
IB (Na+ channel blockers)
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.
Q1039:This class of antiarrhytmics has toxicities that include
local anesthetic effects; CNS stimulation/depression;
cardiovascular depression
Q1040:This class of antiarrhythmics includes flecainide;
encainide; propafenone.
class IC (Na+ channel blockers.
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.
Q1042:Toxicities of this class of antiarrhythmics includes
arrythmias; especially post MI (CONTRAINDICATED)
Q1043:picture p. 242 Class I antiarrythmics (Na+ channel
blockers)
1) IA;2) IB;3) IC
Q1044:This clas of antiarrythmics includes propanolol;
esmolol; metroprolol; atenolol; timool.
Beta Blockers (Class II)
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
B-blockers (Class II antiarrythmics)
Q1046:this is the shortest acting B blocker
esmolol
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.
B-blockers (Class II antiarrythmics)
Q1048:This class of antiarrythmics includes Sotalol; ibutilide;
bretylium; & amiodarone
K+ channel blockers (class III)
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.
K+ channel blockers (class III)
Q1050:This class III antiarrythmic has toxicities which
include torsades de pointes and excessive beta block
sotalol
include new arrhytmias& hypotension
bretylium
include PULMONARY FIBROSIS; HEPATOTOXICITY;
HYPOTHYROIDSIM/HYPERTHYROIDISM; corneal
deposits; skin depsits resulting in photodermatiitis; neurologic
effects; constipation; CV effects (bradycardia; heart block;
CHF
amiodarone;mneu: remember to check PFTs; LFTs; and TFTs
when using amiodarone.
Q1053:This class of antiarrythmics include the drugs
verapamil; and diltiazem.
Ca++ channel blockers (class IV)
Q1054:The MOA of this class of antiarrythmics is primarily
on AV nodal cells. They decreased conduction velocity;
increased ERP; increased PR interval.
Q1055:this class of antiarrythmics is used in prevention of
nodal arrhythmias (e.g; SVT)
Q1056:Toxicity of this class of antiarrythmics can include
constipation; flushing; edema; CV effects (CHF; AV block;
sinus node depression; & torsades de pointes.
Q1057:Other antiarrythmics: this antiarrhythmic is the drug
of choice in diagnosing/abolishing AV nodal arrhythmias
adenosine
Q1058:Other antiarrythmics: this antiarrhythmic depresses
ectopic pacemakers; especially in digoxin doxicity
K+
Q1059:Other antiarrythmics: this antiarrhythmic is effective
in torsades de pointes and digoxin toxiciity
Mg+
Q1060:cardiac output(CO) formula
rate of O2 consumption/;(arterial O2 content - venous)
Q1061:mean arterial pressure (MAP) formula
MAP = CO - TPR;MAP also = 1/3 systolic + 2/3 diastolic
Q1062:stroke volume (SV) formula
SV = CO/ HR;SV also = EDV-ESV
Q1063:cardiac output variables
SV CAP ;->SV is affected by Contractility; Afterload and
Preload
Q1064:contractility/SV increases due to
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)
Q1065:contractility/SV decreases due to
B1 blockers;heart failure;acidosis;hypoxia/hypercapnea;Ca
channel blockers
Q1066:force of contraction [starling curve
is proportional to the initial length of cardiac muscle fiber
[PRELOAD]
Q1067:ejection fraction (EF) formula
EF = SV/EDV = (EDV-ESV)/EDV;EF is an index of
ventricular contractility;EF should be >/= 55%
Q1068:resistance/pressure/flow formula
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
Q1069:JVP waves
a: atrial contraction;c: RV contraction(when tricuspid bulges
back into RA);v: increased atrial pressure due to atrial filling
against closed tricuspid valve
Q1070:cardiac myocyte vs skeletal myocytes
cardiac muscle;-> AP has a plateau ;-> nodal cells
SPONTANEOUSLY depolarize [automaticity];-> myocytes
are electrically coupled via gap jxns;**contraction is due to
extracellular Ca
Q1071:AP in atrial/ventricular myocytes and purkinje fibers
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)
Q1072:AP in pacemaker cells
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**
Q1073:wolf parkinson white syndrome
accessory conduction pathway from atria to
ventricle;bypasses the AV node;**see a DELTA WAVE
before QRS complex;can lead to SVTs
Q1074:1st degree AV block
PR interval prolonged (>200 msec);is asymptomatic
Q1075:2nd degree AV block
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
Q1076:3rd degree AV block [complete heart block]
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)
Q1077:O2 demand in heart
high O2 demand drives increased blood flow; NOT increased
extraction of O2
Q1078:fluid pressure [hydrostatic] starling forces
Pc = capillary fluid pressure;-> fluid out of capillary;Pi =
interstitial fluid pressure;-> fluid into capillary
Q1079:colloid pressure starling forces
pi-c: plasma colloid osmotic p;-> moves fluid into
capillary;pi-i: interstitial colloid p;-> moves fluid out of
capillary
Q1080:right to left shunts
=early cyanosis (blue babies);Teratology of
Fallot;Transposition of great arteries;Truncus arteriosus
Q1081:left to right shunts
VSD (#1 congenital anomaly);ASD (loud S1; fixed split
S2);PDA (close w/indomethacin)
Q1082:teratology of Fallot
PROVe;Pulmonary a. stenosis (Px feature);RVH;Overriding
aorta (overrides VSD);VSD;*pts suffer 'cyanotic
spells';caused by anteriosuperior displacement of aorta
Q1083:transposition of great vessels
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)
Q1084:coarctation of aorta
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
Q1085:patent DA
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
Q1086:congenital cardiac defects
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
Q1087:monckeburg arteriosclerosis
calcification of arteries; especially radial or ulnar;usually
benign
Q1088:arteriolosclerosis
hyaline thickening of small arteries due to essential
hypertension;ONION SKINNING in malignant HTN
Q1089:cardiovascular system is derived from which cell
layer?
mesoderm;paired endocardial heart tubes from in cephalic
region
Q1090:primitive embryonic heard dilates into five areas
(starting at weeks 5-8):
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
Q1091:pathophysiology of teratology of Fallot
aberrant development of aortico-pulmonary septum [which
should normally divide aorta and pulmonary trunk]
Q1092:development of aortic arches
6 paired aortic arches at 1st;->arch 3: common carotids;->4:
aorta and proximal subclavian artery;->6: DA and pulmonary
trunk
Q1093:developent of veins
vitelline veins: ductus venosus carries O2 blood from placenta
to fetus;L umbilical vein: ligamentum teres hepatis;R umbilical
vein: regresses
Q1094:paradoxical emboli
originate in the venous circulation and pass through pFO or
ASD to produce symptoms on arterial side
Q1095:situs inversus
all body's organs are transposed ;associated with Kartagener's
syndrome [immotile cilia]
Q1096:Eisenmerger's syndrome
change of L to R to R to L shunt secondary to increasing
pulmonary HTN;often result of chronic response to VSD
Q1097:acquired arteriovenous fistula
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
Q1098:change in pulse pressure with arteriosclerosis
increases (b/c arteries have hardened; need to push harder
[higher systolic bp] to get the blood out)
Q1099:type of endocarditis in pts with SLE
Libman-Sacks;->small granular vegetations consisting of fibrin
develop on mitral and aortic valves;->leads to aortic stenosis
Q1100:premortum thrombus
look for Lines of Zahn (composed of platelets);->b/c has
formed over a period of time;often due to atrial fibrillation
Q1101:pathology of repeated episodes of stable angina
gradual loss of myocytes;->small patches of fibrosis and
vacuolization;->usually in subendocardial area (poorly
perfused)
Q1102:thoracic outlet syndrome with the presence of a
cervical rib
subclavian artery compressed btwn scalenus anterior and the
rib;=pain and tingling on affected side
Q1103:effect of severe anemia
wide pulse pressure;->resting CO is increased due to
increased SV and HR;also see tachycardia
Q1104:causes of decreased pulse pressure
aortic valve obstruction;cardiac tamponade;heart failure;mitral
valve obstruction
Q1105:effect of malignant hypertension on arteriole structure
arteriolar rarefaction;=dissolution and loss of arterioles;-due to
long term over-perfusion of tissues;also; arteriolar wall to
lumen ratio INCREASES (thicker wall)
Q1106:syphilitic aneurysm
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]
Q1107:cyanosis
only from R-L shunt
Q1108:signs of cardiac tamponade
decreased arterial pressure;small; quiet heart;hypotension;
tachypnea; tachycardia; increased JVP;*pulsus paradoxus
Q1109:signs of pericarditis
sharp; knife like pain;->usually related to breathing;diffuse
STEs and upright T waves;pericardial rub MAY be present
Q1110:location of femoral vein on CT
medial to femoral artery;('venous toward the penis')
Q1111:typical bp of someone with aortic regurgitation
wide pulse pressure (160/80);systemic pressure drops during
diastole b/c blood flows back thru aorta into LV
Q1112:most common cause of sudden cardiac death (SCD)
ischemic heart disease;*in younger patients; the non-
atherosclerotic causes are more common;->hypertrophy;
MVP; myocarditis; dilated cardiomyopathy; etc
Q1113:Kawasaki disease
'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
Q1114:positive result in starling equation
=net fluid leaving capillaries;(Pc-Pi) - (pi c - pi i)
Q1115:Dressler's syndrome
autoimmune phenomenon several weeks post-MI;->fibrinous
pericarditis
Q1116:dilated cardiomopathy
90% of all cardiomyopathies;Alcohol; Beriberi; Coxsackie B;
Cocaine; Chagas'; Doxorubicin toxicity [chemo]; peripartum;
hemochromatosis;-> SYSTOLIC dysfunction
Q1117:hypertrophic cardiomyopathy
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
Q1118:restrictive/obliterative cardiomyopathy
sarcoidosis; amyloidosis; postradiation; Loffler's
Q1119:MR
holosystolic;high pitched; 'blowing';loudest at apex
Q1120:AS
crescendo-decrescendo systolic; following an ejection click;LV
>> aortic pressure in systole;radiates to carotids;
apex;*pulsus parvus et tardus*
Q1121:VSD
holosystolic
Q1122:MVP
late systolic murmur;midsystolic click;#1 valvular lesion
Q1123:AR
high pitched blowing diastolic;associated with wide pulse
pressure
Q1124:MS
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)
Q1125:pDA murmur
continuous; machine like;throughout systole and
diastole;loudest at S2 (aortic/pulmonic close)
Q1126:'heart failure cells'
hemosiderin laded macrophages
Q1127:cause of orthopnea in CHF
increased venous return in supine position;exacerbates
pulmonary vascular congestion (= SOB)
Q1128:virchow's triad
stasis;hypercoagulability;endothelial damage;leads to DVTs
Q1129:features of cardiac tamponade
compression of heart by fluid leads to low CO;equilibration of
pressures in all 4 chambers**;hypotension; high JVP; pulsus
paradoxus
Q1130:Aschoff bodies
=granulomas with giant cells;found in rheumatic heart
disease;also see Anitschkow's cells (activated histiocytes)
Q1131:hydralazine
increases cGMP: sm musc relaxation;vasodilates arterioles >
veins;REDUCED AFTERLOAD;SEs: tachycardia; fluid
retention; lupus like syndrome
Q1132:CCBs
block L-type Ca channels;->reduced cardiac
contractility;nifedipine better vascular sm muscle;verapamil
better heart muscle;SEs: cardiac depression; edema; flushing;
constipation
Q1133:nitroglycerine; isosoribde dinitrate
release NO in smooth muscle: increased cGMP ;veins >>
arteries;REDUCED PRELOAD;for angina; pulmonary edema
Q1134:digoxin
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
Q1135:Digoxin drug interaction
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+)
Q1136:beta blockers with intrinsic sympathomimetic activity
acebutolol and pindolol;not recommended for pts with angina
(can exacerbate)
Q1137:CCBs to avoid in those with CHF
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)
Q1138:treatment of WPW
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
Q1139:acute treatment of atrial fibrillation
dilitiazem (IV);-inhibits Ca into vascular sm muscle and
myocardium;-AV node blocker;*amiodarine takes 1-3 weeks
to work properly
Q1140:most common cardiac anomaly in Ts21
endocardial cushion defect (??);or maybe ASD/VSD;20% have
congenital cardiac abnormalities
Q1141:mean linear velocity of a RBC is lowest in what
vessels?
capillaries (have the largest cross-sectional area);velocity from
highest to lowest;aorta > vena cavae > large veins > small
arteries > arterioles > small veins > venules > capillaries
Q1142:Churg-Strauss syndrome
aka allergic granulomatosis and angiitis;variant of PAN-->
ass'd with asthma and eosinophilia;vascular lesions;
granulomas; GI vasculitis
Q1143:polyarteritis nodosa (PAN)
affects small/med arteries;->esp GI tract and kidneys;fibrinoid
necrosis of vessels w/ polys; eos; monos;often young adult
males;Tx: steroids; cyclophosphamide
Q1144:severe anemia's affects on vessels
hypoxia causes dilation of small arterioles and arteries;also:
low blood viscosity; decreased PVR; low splanchnic blood
flow
Q1145:most common primary cardiac tumor in children
rhabdomyoma;composed of cells that resemble skeletal
muscle;**common in kids with tuberous sclerosis
Q1146:mechanism of cocaine-induced hypertension
blocks re-uptake of NE
Q1147:arterioles account for ___% of total peripheral
resistance
50% (greatest fall in bp occurs as blood goes thru arterioles);-
highest ratio of wall to cross-sectional area to lumen cross-
sectional area
Q1148:leukocytoclastic angiitis
=microscopic PAN;smaller affected vessels;vasculitis
w/hemorrhage to skin (palpable purpura);many fragmented
neutrophils;*penicillin is a common trigger
Q1149:vascular structures that contain the greatest % of total
blood volume
venules and veins (64%)
Q1150:week of gestation when heart forms
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)
Q1151:alpha1 agonists act on;
smooth muscle cells in media of arterioles;leads to increase in
intracellular Ca [smooth muscle contraction]
Q1152:ASD found in Down's syndrome
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)
Q1153:mean systemic filling pressure (MSFP)
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)
Q1154:when O2 consumption of the heart increases; this
builds up in heart muscle
adenosine;(ATP degrades to adenosine);adenosine then dilates
vessels allowing increased coronary blood flow
Q1155:graft vascular disease (aka graft arteriosclerosis)
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
Q1156:this decreases in old age and causes widened pulse
pressure
arterial compliance (usually due to hardening by
arteriosclerosis)
Q1157:cardiac complications of fragile X syndrome
mitral valve prolapse and aortic root dilatation ;[occur late in
adolescence or adulthood]
Q1158:___% of those with ischemic heart disease will present
with death
25%
Q1159:Beta-1 selective beta blockers
A BEAM;atenolol; betaxolol; esmolol; acebutalol;
metroprolol;non-selective: labetalol (also adds alpha 1);
timolol; nadolol
Q1160:individual cardiac muscles are joined together at
intercalated disks (that contain gap jxns)
Q1161:fetal umbilical arteries arise from
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
Q1162:fibrinous and serofibrionous pericarditis
= Dresseler's syndrome (when following an acute MI)
Q1163:why is atenolol contra-indicated in DM pts?
b/c it can block the 'warning signs' of hypoglycemia
Q1164:what is a cystic hygroma??
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)
Q1165:side effect of metroprolol
dyslipidemia
Q1166:ovary drainage
R ovary = ovarian vein to IVC;L ovary = ovarian vein to
RENAL VEIN to IVC
Q1167:best drug for initial treatment of hypertrophic
cardiomyopathy
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
Q1168:appearance of amyloidosis
waxy texture of affected organs;histo = positive Congo red
staining
Q1169:TPR
(MAP-RAP) / CO;pressure = flow x resistance;(P = Q x R)
Q1170:removing an organ will ___ the TPR
INCREASE;(organs are in parallel; and adding parallel
resistances = lower total)
Q1171:fully compensated aortic coarctation
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)
Q1172:possible finding at autopsy of a SIDS baby
RVH
Q1173:endocardial fibroelastosis
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
Q1174:artery commonly damaged in knee dislocations
popliteal artery;-divides into anterior tibial; posterior tibial
and peroneal;-emerges from superficial femoral artery
Q1175:classical findings in ASD
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]
Q1176:massive PE affects which part of the heart first?
RV ;[a saddle PE causes acute cor pulmonale with abrupt RV
dilation];*acute cor pulmonale is a surgical emergency
Q1177:cardiac tamponade causes build up of fluid in which
space?
between the epicardium [visceral pericardium] and parietal
pericardium;(aka the pericardial space)
Q1178:PO agent similar to lidocaine
mexiletine;(class IB anti-arrhythmic for treatment of VT);Na
channel blocker and shortens AP duration
Q1179:Which hormone increases HCl secretion by parietal
cells; pepsinogen secretion by chief cells?
Gastrin
Q1180:What are the actions of CCK?
Stimulates gall bladder contraction and relaxes sphincter of
Oddi to allow pancreatic enzyme secretion.
Q1181:Which hormone increases blood flow to the intestines?
CCK
Q1182:Which hormone is stimulated by low pH to increase
pancreatic bicarb secretion and increase bile production (and
decrease gastric H production?)
Secretin
Q1183:Which hormone increases insulin release and decreases
gastric H+ secretion?
GIP
Q1184:Which hormone is turned on in the fasting state to
initiate the MMC?
Motolin
Q1185:Which hormone is turned on when the acid in the
stomach is below pH3 to inhibit basically everything?
Somatostatin
Q1186:Which other two hormones in the pituitary does
somatostatin inhibit?
TSH and GH
Q1187:Action of Histamin?
increase gastric acid secretion.
Q1188:Tumor of non alpha and non beta islet cells of the
pancrease that causes watery diarrhea secretes this:
VIP (VIPoma)
Q1189:Which hormone relaxes intestinal sm mm; increases
pancreatic bicarb secretion; and stimulates intestinal secretion
of electrolytes and water?
VIP
Q1190:This hormone is released from vagal nerve endings to
mediate the release of gastrin.
GRP
Q1191:Somatostatin is released from these cells in the GI
tract.
Delta (D) cells
Q1192:CCK is released from these cells in the duodenum and
jejunum.
I cells
Q1193:Secretin does what to the rate of stomach emptying?
decreases it.
Q1194:What is the effect of GIP on pancreatic beta cells?
stimulates the release of insulin
Q1195:Region of stomach parietal and chief cells are located
body/corpus
Q1196:region of stomach G cells are located?
antrum (G cells secrete gastrin)
Q1197:Which gland produces 70% of total salivary
secretions?
submandibular
Q1198:Which hormone is the primary regulator of bicarb
secretion from the pancreas?
secret
Q1199:Which pancreatic cells secrete somatostatin
alpha
Q1200:actions of gastrin?
(G cells of antrum) inc'd gastric H+; stim growth of gastric
mucosa
Q1201:what stimulates release of gastrin?
sm peptides; amino acids in stomach lumen; stomach
distention; vagus (via GRP)
Q1202:where is CCK from?
I cells of duodenum
Q1203:5 actions of CCK
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
Q1204:what stimulates release of CCK from duodenum?
small peptides; amino acids; fatty acids and monoglycerides
(not TGs b/c can't cross intestinal membrane)
Q1205:actions of secretin?
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
Q1206:what stimulates release of secretin from S cells of
duodenum?
H+ and fatty acids in duodenum
Q1207:actions of GIP (gastric inhibitory peptide)
1. stimulates insulin release (this is why oral glucose better!)
2. inhibits H+ secretion
Q1208:what stimulates release of GIP from K cells?
fatty acids; amino acids; oral glucose (only GI hormone that
responds to fat; protein; and carbs!)
Q1209:what inhibits release of somatostatin?
vagal stimulation
Q1210:effect of His on GI
increased H+ secretion directly and indirectly by potentiating
effects of gastrin and vagal stim
Q1211:actions of VIP?
relaxation of GI smooth mm (LES!); stimulate pancreatic
bicarb; inhibits H+
Q1212:basal electric rhythm of a) stomach b) duodenum c)
ileum
a) 3 Hz; b) 12 Hz; c) 8-9 Hz
Q1213:gastroileal reflex?
food in stomach--> increased peristalsis in ileum and
relaxation of ileocecal sphincter
Q1214:gastrocolic reflex?
food in stomach--> increased colon motility and frequency of
mass movements
Q1215:composition of saliva
high K+; HCO3-; low NaCl (hypotonic; unless made rapidly);
alpha amylase; lingual lipase; kallikrein
Q1216:parasympathetic regulation of saliva production?
CN VII; IX (via muscarinic R IP3 or Ca); inc'd production
Q1217:sympathetic regulation of saliva production
increased production; via beta adrenergic stim (cAMP)
Q1218:composition of aq part of pancreatic secretions?
always ISOTONIC; more bicarb than in plasma; if low flow
rate--high Na Cl; if high flow rate--high Na HCO3-
Q1219:what does sucrase do?
degrades sucrose to glucose and fructose
Q1220:what does SLGT 1 in intestine do?
transports glucose and galactose into cells; Na+-dependent
Q1221:how is fructose transported into intestinal cells?
facilitated diffusion
Q1222:optimum pH for pepsin activity?
1-3 (in pH>5; denatures)
Q1223:(hypothetical) deficiency of enterokinase--> ?
no activation of pancreatic proteases b/c it converts
tyrpsinogen into trypsin and tryspin then cleaves all the
others
Q1224:why might hypersecretion of gastrin cause
steatorrhea?
low duodenal pH inactivates pancreatic lipase
Q1225:what would a lack of apoprotein B do in intestine?
cause steatorrhea b/c apo B necessary for transporting
chylomicrons out of intestinal cells
Q1226:what happens to K+ in GI?
dietary K+ absorbed paracellularly; activly secreted in colon
(similar to in kidney)
Q1227:how does Vibrio Cholerae cause diarrhea?
toxin binds R in luminal membrane; activates AC which
causes increase cAMP--> lumenal Cl- channels open. Na and
H2O follow Cl--> secretory diarrhea!!
Q1228:Effect of sympathetic stimulation in the GI tract
decreased motility; decreased secretions; increased
contraction of sphincters
Q1229:Effect of parasympathetic stimulation in GI tract
increased motility; increased secretions; increased relaxation
of sphincters (except LES which contracts); increased gastrin
release
Q1230:Hormones of the GI system
Gastrin; CCK; secretin; GIP
Q1231:Stimulus for gastrin secretion
Stomach distension. Stomach acid in the duodenum inhibits
gastrin release
Q1232:Sources of gastrin
G cells of the stomach anthrum; duodenum
Q1233:Actions of gastrin
Stimulates acid secretion by parietal cells; increases motility
and secretions.
Q1234:Source of secretin
S cells of the duodenum
Q1235:Stimulus for secretin release
Acid entering the duodenum
Q1236:Actions of secretin
Stimulates HCO3 secretion by pancreas to neutralize acid
entering duodenum
Q1237:Source of CCK
Cells lining the duodenum
Q1238:Stimulus for CCK secretion
Fat and amino acids entering duodenum
Q1239:Actions of CCK
Inhibits gastric emptying; stimulates pancreatic enzyme
secretion; stimulates contraction of the gallbladder and
relaxation of sphincter of Oddi.
Q1240:Source of GIP
Duodenum
Q1241:Stimulus for GIP secretion
Fat; carbs and amino acids
Q1242:Actions of GIP
Inhibits stomach motility and secretion
Q1243:Properties of GI smooth muscle
Stretch stimulates contraction; electrical syncytium with gap
junctions; pacemaker activity
Q1244:Factors that inhibit gastric motility
Acid in the duodenum (secretin); fat in the duodenum (CCK);
hypoerosmolarity in duodenum; distension of duodenum
Q1245:Factors that stimulate gastric motility
Distension of the stomach and ACh
Q1246:What are the different contractions of the intestines?
Segmentation contractions (mixing); peristaltic movements
(propulsive).
Q1247:What factors control the ileocecal sphincter?
Distension of the ileum relaxes; distension of the colon
contracts
Q1248:What are the different contractions of the colon
Segmentation contractions (haustrations); peristalsis and mass
movements
Q1249:Composition of salivary secretions
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
Q1250:Parietal cells
Located in the middle part of the gastric glands. Secrete HCl
and intrinsic factor.
Q1251:Chief cells
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
Q1252:Mucous cells of the stomach
Located in the superficial part if the gastric glands (gastric
pits). Secrete mucus and HCO3. Secretion is stimulated by
PGE2
Q1253:Ionic composition of gastric secretions
High in H+; K+ and Cl-; low in Na+. Vomiting produces
metabolic alkalosis and hypokalemia.
Q1254:Control of acid secretion
Acetylcholine; histamine and gastrin stimulate parietal cells to
secrete acid.
Q1255:Secretion of acid by parietal cells
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)
Q1256:Pancreatic amylase
Hydrolyzes alpha-1;4-glucoside bonds forming alpha-limit
dextrins; maltotriose and maltose
Q1257:Pancreatic lipase
Needs colipase which displaces bile from surface of micelles.
Lipase digests triglycerides to two free fatty acids and one 2-
monoglyceride
Q1258:Cholesterol esterase
Hydrolizes cholesterol esters to yield cholesterol and free
fatty acids
Q1259:Pancreatic proteases
Trypsinogen is converted to trypsin by enterokinase -->
chymotrypsinogen is converted to chymotrypsin by trypsin -
-> procarboxypeptidase is converted to carboxypeptidase by
trypsin
Q1260:Ionic composition of pancreatic secretions
Isotonic due to permeability of ducts to water and high in
HCO3. Stimulated by CCK and secretin.
Q1261:What are the primary bile acids?
Cholic acid and chenodeoxycolic acid. Synthesized in the liver
from cholesterol.
Q1262:How are bile salts formed?
Bile acids (cholic and deoxycholic) are conjugated with glycine
and taurine which mix with cations to form salts.
Q1263:What are the secondary bile acids?
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.
Q1264:Enterohepatic circulation
Bile acids are reabsorbed only in the distal ileum. Resection or
malabsoption syndromes lead to steatorrhea and cholesterol
gallstones.
Q1265:What are the components of bile?
Conjugated bile acids (cholic and chenodeoxycholic);
billirubin; lecithin and cholesterol.
Q1266:How are carbohydrates absorbed?
Glucose and galactose via active secondary Na cotransporter.
Fructose is absorbed independently
Q1267:How are amino acids absorbed?
Secondary active transport linked to Na and receptor-
mediated endocytosis.
Q1268:How are lipids absorbed?
Micelles diffuse to the brush border then digested lipids (2-
monoglycerides; 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.
Q1269:source of gastrin
G cells in antrum of stomach
Q1270:source of CCK
I cells in duo and jejunum
Q1271:source of secretin
s cells; duodenum
Q1272:action of gastrin
increased H+ in stomach ;increased growth of gatric mucosa
;increased gastric motility
Q1273:action of CCK
increases pancreatic secretions ;increases gallbladder
contraction ;slows gastric emptying
Q1274:action of secretin
release of HCO3-;decreased gastric acid secretion
Q1275:regulation of gastrin
decreased when stomach pH <1.5;increased when stomach is
distended; presence of AA and peptides;increased in vagal
stimulation
Q1276:regulation of CCK
decreased if stomach pH<1.5;decreased by secretin ;increased
by fatty acids and AA
Q1277:regulation of secretin
increased by acid; FA in lumen of duo
Q1278:source of somatostatin
D cells of pancreatic islets and GI mucosa
Q1279:what regulates somatostatin
increased by acid ;decreased by vagal stimulation
Q1280:what is somatostatin used to treat
VIPoma ;carcinoid tumors
Q1281:what releases GIP?
K cells in duo and jejunum
Q1282:what does GIP do?
exocrine fxn of decreasing H secretion ;endocrine fxn of
increasing insulin release
Q1283:regulation of GIP
increased by fatty acids; AA; oral glucose
Q1284:which is used more rapidly: oral or IV glucose?
oral
Q1285:source of VIP
parasympathetic ganglia in sphincters; gallbladder and small
intestines
Q1286:action of VIP
increases intestinal water absorption ;relaxation of intestinal
smooth muscle and sphincters
Q1287:regulation of VIP
increased by distention and vagal stimulation ;decreased by
adrenergic imput
Q1288:what is VIPoma
non-alpha; non-beta islet cell pancreatic tumor that secrete
VIP --> copious watery diarrhea
Q1289:action of NO on GI tract
increased smooth muscle relaxation; (NB: lower P in LES)
Q1290:what is implicated in decreased NO secretion
accounts for incresed LES tone seen in achalasia
Q1291:where is HCO3- released from?
mucosal cells;stomach;duo
Q1292:where is pepsin released from?
chief cells of stomach
Q1293:what controls gastric acid release
increased by histamine and ACh;decreased by somatostatin;
GIP; PG; secretin
Q1294:fxn of salivary amylase
hydrolyzes alpha-1;4 linkages --> disaccharides
Q1295:fxn of pancreatic amylase
hydrolyzes starch to oligosaccharides and disaccharides
Q1296:where is pancreatic amylase found
highest [] in duo lumen
Q1297:fxn of oligosaccharide hydrolase
hydrolyzes oligosaccharidses --> monosaccharides ;RL step in
carb digestion
Q1298:What cells are the source of GASTRIN?
G cells (antrum)
Q1299:What cells are the source of CCK?
I cells (duodenum; jejunum)
Q1300:What cells are the source of SECRETIN?
S cells (duodenum)
Q1301:What cells are the source of SOMATOSTATIN?
D cells (pancreatic islets; GI mucosa)
Q1302:What cells are the source of GIP?
K cells (duodenum; jejunum)
Q1303:What cells are the source of INTRINSIC FACTOR?
Parietal cells (body; fundus)
Q1304:What cells are the source of HCL?
Parietal cells (body; fundus)
Q1305:What cells are the source of PEPSIN?
Chief cells (stomach)
Q1306:What cells are the source of HCO3-?
Mucosal cells (stomach; duodenum)
Q1307:What is the function of GASTRIN?
increased gastric H+ secretion;increased gastric mucosa
Q1308:What is the function of CCK?
increased pancreatic secretions;Stimulates gallbladder
contraction;Inhibits gastric emptying
Q1309:What is the function of SECRETIN?
increased pancreatic HCO3- secretion ;Inhibits HCl secretion
Q1310:What is the function of SOMATOSTATIN?
Inhibits everything;Inhibits gallbladder contraction;Inhibits
release of both insulin and glucagon
Q1311:What is the function of GIP?
Exocrine: decreased gastric H+ secretion;Endocrine: increased
insulin release
Q1312:What is the function of INTRINSIC FACTOR
Binds B12
Q1313:What is the function of HCL?
decreased stomach pH
Q1314:What is the function of PEPSIN?
Protein digestion at pH of 1.0-3.0
Q1315:What is the function of HCO3-?
Neutralizes acid;Prevents autodigestion
Q1316:What stimulates gastrin release?
Stomach distention;Amino acids;Vagal stimulation
Q1317:What inhibits gastrin release?
H+ secretion;pH < 1.5
Q1318:What stimulates CCK release?
Fatty acids;Amino acids
Q1319:What inhibits CCK release?
Secretin;pH < 1.5
Q1320:What stimulates secretin release?
Low duodenal pH;Fatty acids in lumen of duodenum
Q1321:What stimulates somatostatin release?
Low pH
Q1322:What inhibits somatostatin release?
Vagal input
Q1323:What stimulates HCl secretion?
Histamine;ACh;Gastrin
Q1324:What inhibits HCl secretion?
Somatostatin;GIP;Prostaglandins
Q1325:What stimulates pepsin secretion?
Vagal input;Local acid
Q1326:What stimulates HCO3- secretion?
Secretin
Q1327:What is the function of VIP?
Relaxes intestinal smooth muscle;Stimulates pancreatic
HCO3- secretion;Inhibits gastric H+ secretion
Q1328:What is the source of VIP?
Smooth muscle and nerves of intestines
Q1329:Where does TRYPSIN cleave?
Carboxy side of ARG and LYS
Q1330:Where does CHYMOTRYPSIN cleave?
Carboxy side of aromatic amino acids (PHE; TYR; TRP)
Q1331:Where does ELASTASE cleave?
Carboxy side of ALA; GLY; and SER
Q1332:What is the function of SALIVARY AMYLASE?
Starts digestion;Hydrolyzes alpha-1;4 linkages to give
maltose; maltotriose; and alpha-limit dextrans
Q1333:What is the function of PANCREATIC AMYLASE?
Hydrolyzes starch to oligosaccharides; maltose; and
maltotriose
Q1334:Where is the highest concentration of PANCREATIC
AMYLASE?
Duodenal lumen
Q1335:Where are lipids digested?
Duodenum
Q1336:Where are lipids absorbed?
Jejunum
Q1337:major cations/anions of ICF?
cations--K+; Mg2+; anions--protein; organic phosphates (eg
ATP)
Q1338:markers for measuring TBW
D2O; tritiated H2O
Q1339:markers for measuring ECF?
mannitol; sulfate; inulin
Q1340:markers for measuring plasma?
RISA; Evan's blue
Q1341:markers for measuring interstitial fluid?
indirect: ECF - plasma (mannitol - Evan's blue)
Q1342:markers for measuring ICF?
do indirectly: TBW - ECF (D2O - mannitol)
Q1343:What happens if isotonic NaCl is infused?
isosmotic volume expansion
Q1344:What happens to fluid volumes if you have diarrhea?
loss of isotonic fluid-->isometric volume contraction
Q1345:what happens to fluid volumes if excessive NaCl
intake?
hyperosmotic vol expansion
Q1346:what happens to fluid volumes if you get lost in a
desert? (dehydration)
hyperosmotic vol contractino
Q1347:what happens to fluid volumes in SIADH?
hyposmotic volume expansion
Q1348:what happens to fluid volumes if adrenocortical
insufficiency?
hyposmotic volume contraction
Q1349:treatment of SIADH?
demeclocyclene; water restriction
Q1350:renal blood flow is what % of CO?
~25%
Q1351:at low [ang II]; what effect on renal arterioles?
preferential dilation of efferent arteriole--> protects GFR
Q1352:over what range of pressures does renal blood flow
remain constant (autoregulation)
80-200mmHg (thanks to myogenic mech and tubuloglomerular
feedback)
Q1353:How measure renal plasma flow?
use PAH; which is both filtered and secreted by renal tubules
(so that~none in renal veins); this is the effective RPF
Q1354:filtration fraction?
GFR/RPF (normal~0.20)
Q1355:where does acetozolamide work in kidney?
(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)
Q1356:middle/late PCT vs. early PCT?
early PCT--Na resorb.coupled with glucose; aa; phosphate;
etc; mid/late PCT--Na resorb.w/ Cl-
Q1357:where do K+sparing diuretics work?
in CCD
Q1358:role of alpha intercalated cells?
secrete H+ and resorb. K+ if hypokalemic (or acidic?)
Q1359:what cell is responsible for excreting K+ in
hyperkalemia?
principal cell (via Na-K ATPase and K channels)
Q1360:where is phosphate resorbed?
only in PCT. ~15% of filtered phosphate excreted (imp for
buffering later on)
Q1361:effect of PTH on phosphate in kidney?
PTH inhibits phosphate resorb. in PCt via inc'd AC--
>cAMP. (get phosphaturia and inc'd urinary cAMP)
Q1362:which diuretics can be used to treat hypercalcemia?
loop diuretics
Q1363:which diuretics can be used to treat hypercalciURIA
thiazides (increase Ca resorb.)
Q1364:relationship of K+ and NH3?
hyperkalemia inhibits NH3 synthesis (RTA type 4); dec'd
H+ excretion; hyPOkalemia--stim NH3 synthesis
Q1365:ECF volume contraction and acid/base balance?
ECF volume contraction-->HCO3- resorb; contraction
alkalosis (N.B. in vomiting; met alk made worse if ECF vol
contracts!)
Q1366:why might you get tingling; numbness; muscle spasms
in respiratory alkalosis?
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.)
Q1367:effect of insulin on K+?
insulin deficiency--> shift of K+ out of cells; hyperkalemia;
insulin-->shift of K+ into cells; hypokalemia
Q1368:what happens to osmolarity of ECF if person is
infused with isotonic saline solution?
stays the same
Q1369:what happens to osmolarity of ECF if person has loss
of isotonic fluid? (example)
diarrhea;stays the same
Q1370:what happens to osmolarity of ECF if person has high
NaCl intake?
incresaes
Q1371:what happens to ECF osmolarity if person is sweating
in the desert?
increases (sweat is hyposmotic; more water than salt is lost)
Q1372:what happens to ECF osmolarity in SIADH?
decreases
Q1373:what happens to ECF osmolarity in adrenocortical
insufficiency (NaCl loss)?
decreases (lack of aldosterone); kidneys excrete more NaCl
than water
Q1374:what happens to plasma protein [] and hematocrit in
infusion of isotonic NaCl?
decreases (overall increase in fluid)
Q1375:what happens to plasma protein [] and hct in diarrhea?
increases (from volume contraction)
Q1376:what happens to plasma protein [] and hct in high
NaCl consumption?
decrease (ICF shrinks to accomodate the increased osmolarity
in ECF; this dilutes out the plasma protein)
Q1377:what happens to plasma protein [] and hct when
swaeting in desert?
protein increases;hct stays same b/c fluid leaves rbcs to offset
fuid loss
Q1378:what happens to plasma protein [ ] and hct in siadh
decreases;stays same
Q1379:what happens to plasma protein [] and hct in adrenal
insuff?
plasma protein increases;hct increases (from decreased ECF
volume and rbc swelling from water entry)
Q1380:how does vasoconstriction of renal arterioles affect
RBF? how is this achieved?
decreases RBF;SNS
Q1381:how does AII affect renal arterioles
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
Q1382:how does ACE affect renal arterioles
preferentially constricts efferent arterioles
Q1383:what effects does AII have on GFR?
increases it
Q1384:what effect do ACE-I have on GFR
decreass it by dilating efferent arterioles
Q1385:what does afferent arteriole constriction do to RPF?
decreases
Q1386:what does efferent artiorole constriction do to GFR?
increases (by increasing Pgc)
Q1387:what does increased plasma protein do to GFR?
decreases it by increasing osmotic pressure in GC
Q1388:what does decreased plasma protein do to GFR?
increases it by decreasing osmotic pressure in GC
Q1389:what does increased plasma protein do to RBF?
nothing
Q1390:what does decreased plasma protein [] do to RBF?
nothing
Q1391:what does efferent arteriole constriction do to RBF?
decreases it
Q1392:what happens to the filtration fraction in afferent
arteriole constriction?
(GFR/RBF);GFR decreases; RBF decreases;FF no change
Q1393:what happens to FF in efferent arteriole constriction
GFR/RBF;GFR increases; RBF decreases ;FF increases
Q1394:what happens to FF in increased plasma protein
concentraton
GFR/RBF;GFR decreases; RBF no change;FF decreases
Q1395:what happens to FF in decreased plasma protein []
GFR/RBF;GFR increases; RBF no change;FF increases
Q1396:what happens to FF when ureter is constricted?
GFR/RBF ;GFR decreases; RBF no change;FF decreases
Q1397:what things are reabsorbed in the PCT?
glucose;AA's;most of the HCO3
Q1398:describe how HCO3 is handled in PCT
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
Q1399:what happens in the TAL?
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
Q1400:is the TAL permeable to water
no
Q1401:what is the thin descending loop permeable to?
water; but not Na
Q1402:what is happens in the early distal convaluted tubule
actively reabsorbs Na; Cl ;Ca absorption is controlled by
PTH receptors found here
Q1403:what happens in the collecting tubules
Na is reabsorbed in exchange for K/H (regulated by
ALDOSTERONE!!!) ;reabsorption of water regulated by
ADH (aquaporins)
Q1404:which part of the nephron is impermeable to water?
TAL (and collecting tubule if there is no ADH)
Q1405:where in kidney is EPO released from
endo cells of peritubular capillaries
Q1406:what enzyme converts 25-OH vitamin D to its active
form?
1-alpha hydroxylase
Q1407:what do JG cells do?
secrete renin in response to low renal blood pressure
Q1408:what does the macula densa do?
senses the amt of Na
Q1409:where is the macula densa
part of the DCT
Q1410:what do PGs do to the kidney
vasodilate the afferent arterioles (that's why NSAIDS can -->
ARF by inhibiting PG)
Q1411:what effect does aldosterone have on H
more H is secreted
Q1412:where does aldosterone work in kidney?
DCT
Q1413:where does PTH work?
PCT to decrease PO4 reabsorption ;DCT to increase Ca
reabsorption ;stimulates 1-alpha hydroxylase in PCT
Q1414:where is ACE released from?
lung
Q1415:increased glomerular pressure; decreased peritulbuar
pressure; decreased RPF
Efferent arteriole constriction
Q1416:decreased glomerular pressure; increased peritubular
pressure; increased RPF
Efferent arteriole dilation
Q1417:decreased glomerular pressure; decreased peritulbuar
pressure; decreased RPF
Afferent arteriole constriction
Q1418:increased glomerular pressure; increased peritulbuar
pressure; increased RPF
Afferent arteriole dilation
Q1419:Afferent arteriole dilation
increased glomerular pressure; increased peritulbuar
pressure; increased RPF; increased GFR
Q1420:Afferent arteriole constriction
decreased glomerular pressure; decreased peritulbuar
pressure; decreased RPF; decreased GFR
Q1421:Efferent arteriole dilation
decreased glomerular pressure; increased peritubular
pressure; increased RPF; decreased GFR
Q1422:Efferent arteriole constriction
increased glomerular pressure; decreased peritulbuar
pressure; decreased RPF; increased GFR; increased FF
Q1423:Plasma oncotic pressure changes as blood flows
through the nephron
Oncotic pressure increases because filtered fluid increases
protein concentration. Oncotic pressure is resposible for
peritubular reabsorption
Q1424:Normal capillary hydrostatic pressure of the
glomerulus
45 mmHg
Q1425:Normal capillary oncotic pressure of the glomerulus
27 mmHg
Q1426:Normal hydrostatic pressure of bowman's capsule
10 mmHg
Q1427:Normal GFR value
120 ml/min
Q1428:Normal RPF value
600 ml/min
Q1429:Normal filtration fraction value
FF = GFR/RPF = 120mi/min / 600ml/min = 0.20
Q1430:Effect of sympathetic stimulation in the nephron
decreased GFR; increased FF; increased peritubular
reabsoption
Q1431:Effect of angiotensin II in the kidney
Vasoconstriction of the efferent arteriole more than afferent --
> maintains GFR
Q1432:Filtered load
Rate at which a substance filters into Bowman's capsule = FL
= GFR x Free plasma concentration
Q1433:Excretion of a substance in the urine
Excretion = filtered load + (amount secreted - amount
reabsorbed) = filtered load + transport OR urine concentration
X urine flow rate
Q1434:Characteristics of a Tm system
Carriers become saturated; carriers have high affinity; low
back leak. The filtered load is reabsorbed until carriers are
saturated - the excess is excreted.
Q1435:Renal treshold for glucose
180 mg/dl or 1.8 mg/ml. Represents the beginning of splay.
Q1436:Tm rate of reabsorption of glucose
375 mg/min. Represents the maximum filtered load that can be
reabsorbed when all carriers in the kidney are saturated (end
of splay region).
Q1437:Glucose reabsorption graph
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.
Q1438:Substances that are reabsorbed using a Tm system
Glucose; amino acids; small peptides; myoglobin; ketones;
calcium; phosphate.
Q1439:Characteristics of a gradient-time system
Carriers are not saturated; carriers have low affinity; high back
leak
Q1440:Substances that are reabsorbed using a gradient-time
system
Sodium; potassium; chloride and water
Q1441:Substances secreted using a Tm system
PAH. 20% filtered; 80% secreted.
Q1442:Graph for PAH secretion
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.
Q1443:How is the net transport rate for a substance
calculated?
Net transport rate = filtered load - excretion rate = (GFR X
Px) - (Ux X V)
Q1444:Effects of blood pressure changes in the kidney
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.
Q1445:What is clearance and how is it calculated?
It's the volume of plasma cleared of a substance over time.
Clearance = excretion / Px = Ux X V / Px
Q1446:Characteristics of glucose clearance
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.
Q1447:Characteristics of inulin clearance
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.
Q1448:Characteristics of creatinine clearance
A constant amount of creatinine is cleared regardless of
plasma concentration; but creatinine clearance is more than
GFR because some is always secreted.
Q1449:Characterisics of PAH clearance
As plasma concentration increases; clearance decreases
because carriers that mediate active secretion become
saturated. At normal levels; PAH clearance = RPF because all
is excreted.
Q1450:How is GFR calculated using inulin?
GFR is equal to inulin clearance because it's only filtered and
none is secreted nor reabsorbed. Cin = GFR = Uin X V / Pin
Q1451:How is creatinine production calculated?
Creatinine production = creatinine excretion = filtered load of
creatinine = [Cr]p X GFR. Creatinine is filtered and secreted;
not reabsorbed.
Q1452:How does inulin concentration change as it passes
through the nephron?
Inulin becomes more concentrated as it passes through the
tubules because water is being reabsorbed and not inulin.
Q1453:Gold standard to measure GFR
Inulin clearance because it's filtered but not secreted nor
reabsorbed.
Q1454:Gold standard to measure RPF
PAH clearance because some is filtered and the remaining is all
secreted.
Q1455:How is effective RPF calculated?
PAH clearance = RPF = Upah X V / Ppah
Q1456:How is renal blood flow calculated?
ERPF / 1-Hct; ERPF = Upah X V / Ppah
Q1457:What does positive free water clearance mean?
Water is being eliminated. Hypotonic urine is being formed to
increase plasma osmolarity.
Q1458:What does negative free water clearance mean?
Water is being conserved. Hypertonic urine is being formed to
lower plasma osmolarity.
Q1459:How is free water clearance calculated?
V - (Uosm(V) / Posm)
Q1460:Which substance is cleared the most: PAH; inulin;
glucose; creatinine
PAH
Q1461:Which substances are cleared more than glucose?
Sodium; inulin; creatinine; PAH
Q1462:Which substance is cleared the least: PAH; inulin;
glucose; creatinine
Glucose
Q1463:Which substances are cleared more than inulin?
Creatinine; PAH
Q1464:Which substances are cleared less than creatinine?
Inulin; glucose; sodium
Q1465:Transporters in the luminal membrane of the proximal
tubule
Secondary Na/glucose cotransporter; secondary Na/amino acid
cotransporter; secondary Na/H countertransporter
Q1466:What substances are reabsorbed in the proximal tubule
and how much?
Na (2/3 of filtered load); glucose (100%); amino acids (100%);
HCO3 (indirectly; 80%); H20 (2/3); K (2/3); Cl (2/3)
Q1467:Tubular osmolarity at beginning and end of proximal
tubule
At the beginning and end is isotonic with plasma but only 1/3
of the filtered load.
Q1468:Transporters in the basal membrane of proximal tubule
Na/K ATPase - luminal membrane secondary Na transporters
depend on this.
Q1469:Transporters in the basolateral membrane of proximal
tubule
Na/K ATPase - luminal membrane secondary Na transporters
depend on this.
Q1470:Most energy-dependant process in the nephron
Active reabsorption of Na by the basal and basolateral Na/K
ATPase
Q1471:Characteristics of the loop of henle
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.
Q1472:Characteristics of the collecting duct
Impermeable to water unless ADH is present. ADH increases
permeability to H20 and urea to concentrate urine. Tight
junctions with little back-leak.
Q1473:Specialized cells of the distal tubule and collecting duct
Principal cells (aldosterone) and intercalated cells (create
HCO3)
Q1474:Actions of principal cells of the distal tubule and
collecting duct
Aldosterone increases Na receptors in the membrane and
increases primary transport by Na/K ATPase. Secondary
transport of Na and secretion of K.
Q1475:Actions of intercalated cells of the distal tubule and
collecting duct
Acidify the urine and produce new bicarbonate
Q1476:Actions of the distal tubule and collecting duct
Reabsorption of Na and secretion of K (stimulated by
aldosterone); acidification of the urine (secretion of H and
creation of HCO3)
Q1477:Urine buffer systems
H2PO4- (dihydrogen phosphate) (tritratable acid) buffers
33% of secreted H. NH4+ (amonium) (nontritratable acid)
buffers the remaining secreted H.
Q1478:How is potassium affected by acidosis?
High concentration of ECF H --> H diffuses to ICF --> K
diffuses to ECF --> hyperkalemia
Q1479:How is potassium affected by alkalosis?
Low concentration of ECF H --> H diffuses to ECF --> K
diffuses to ICF --> hypokalemia
Q1480:Potassium dynamics in acute alkalosis
Hypokalemia; increased intracellular K; increased renal K
excretion; negative K balance
Q1481:Potassium dynamics in chronic alkalosis
Hypokalemia; decreased intrecellular K; increased renal K
Q1482:Potassium dynamics in acute acidosis
Hyperkalemia; decreased intracellular K; decreased renal K
excretion; positive K balance
Q1483:Potassium dynamics in chronic acidosis
Hyperkalemia; decreased intracellular K; increased renal K
Q1484:How is potassium balance in acute acidosis?
Positive (potassium is reabsorbed)
Q1485:How is potassium balance in acute alkalosis?
Negative (potassium is excreted)
Q1486:How is potassium balance in chronic alkalosis?
Q1487:How is potassium balance in chronic acidosis?
Q1488:How is plasma potassium concentration in alkalosis?
Hypokalemia
Q1489:How is plasma potassium concentration in acidosis?
Hyperkalemia
Q1490:What is the difference in potassium dynamics between
acute and chronic alkalosis?
Acute alkalosis --> increased intracellular K; Chronic
alkalosis --> decreased intracellular K
Q1491:What is the difference in potassium dynamics between
acute and chronic acidosis?
Acute acidosis --> decreased renal K excretion; positive K
balance; Chronic acidosis --> increased renal K excretion;
negative K balance
Q1492:Changes in respiratory acidosis
Hypoventilation --> increased PaCO2 --> increased H and
slight increased in HCO3 --> decreased pH
Q1493:Changes in respiratory alkalosis
Hyperventilation --> decreased PaCO2 --> decreased H and
HCO3 --> increased pH
Q1494:Changes in metabolic acidosis
Gain of H or loss of HCO3 --> decreased HCO3 -->
decreased pH. To see if gain of H or loss of HCO3 check
anion gap.
Q1495:Changes in metabolic alkalosis
Loss of H or gain in HCO3 --> increased HCO3 --> increased
pH. To see if gain of H or loss of HCO3 check anion gap.
Q1496:Normal values of PCO2; HCO3 and pH
pH = 7.4; PCO2 = 40mmHg; HCO3 = 24mmol/L
Q1497:increased pH; increased HCO3; increased PCO2;
decreased PO2; alkaline urine
Partially compensated metabolic alkalosis
Q1498:decreased pH; increased PCO2; increased HCO3;
decreased PO2; acid urine
Partially compensated respiratory acidosis
Q1499:increased pH; decreased PCO2; decreased HCO3;
normal PO2; alkaline urine
Partially compensated respiratory alkalosis
Q1500:decreased pH; decreased PCO2; decreased HCO3;
normal PO2; acid urine
Partially compensated metabolic acidosis
Q1501:Normal plasma anion gap value
PAG = 12
Q1502:Conditions that increase plasma anion gap
Lactic acidosis; ketoacidosis; ingestion of salicylate
Q1503:Hyperchloremic non-anion gap metabolic acidosis
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.
Q1504:Equation to measure body fluid volumes
V= Q/C;V= body fluid volume;Q= indicator
administered;C=concentration of indicator
Q1505:TBW indicators
D20; H20; antipyrine
Q1506:ECF indicators
Na; inulin; mannitol
Q1507:PV indicators
Albumin; Evans blue; Cr red blood cells
Q1508:100 mM glucose =
100 osm
Q1509:100 nM NACL
200 mOsm/L
Q1510:Filtered Load =
GFR * Solute (plasma)
Q1511:Excretion:
Volume Urine Flow * Urine concentration
Q1512:Clearance Concept
Related the excretion of a substance to its concentration in
plasma
Q1513:Clearance Calculation
C= U*V/Ps;Cs: Clearance of substance;U: urine concetration
of substance;V: Urine flow;P: Plasma concentration
Q1514:Applying Clearance to GFR
Inulin Clearance used to measure GFR
Q1515:Best clinical measure of GFR
Creatinine
Q1516:Clearance to Renal Plasma Flow and RBF
PAH clearance = RBF ;PAH measures PLASMA FLOW
ONLY
Q1517:RBF using REnal plasma flow =
RBF=RPF (1- hematocrit);*Hct: 0.40
Q1518:Specialized portion of capillaries that perfuse medilla
vasa recta
Q1519:Filtration fraction
GFR/RBF
Q1520:Filtration
GFR= KF (Pgc-Pbc) - ;(TT gc-TTbc)
Q1521:Myogenic autoregulation
Increase in arterial pressure; stretches vessel wall leading to an
icnrease in calcium movement and contraction
Q1522:Tubuloglomerular feedback
decrease in arterial pressure causes decrease in GFR;
decreasing NACL to macula densa; Therefore efferent
arteriolar resistnace Increases in response to HIGH
angiotensin II.
Q1523:Regulation of filtration of AFFERENT Arteriole;
CONSTRICTION (Dilation is opposite)
Pcap: D;GFR: D;RBF: D
Q1524:Regulation of filtration of EFFERENT
Arteriole;CONSTRICTION ;(Dilation is opposite)
Pcap: U;GFR: U;RBF: D
Q1525:T Max or GLucose is
300 mg/min reabsorption
Q1526:REABSORPTION AND SECRETION
REABSORPTION AND SECRETION
Q1527:Proximal Tubule
NAHCO3 reabsoprtion;NACL ;Water;Glucose
Q1528:How are ions absorbed
Na/H antiport;Cl/Anion antiport ;Na/K Atpase;*Water
follows non Cl reabsorption and icnreases tubular fluid of Cl.
Q1529:H= in proximal tubule is
Secreted
Q1530:Descending Thin Limb
Reabsorbs 15% GFR;Tbublular fluid volume DECREASES
;Tubular fluid osmolarity INCREASES
Q1531:Thick Ascending Loop of Henle
break
Q1532:Reabsorption of Na
Symport with Cl/ K;Antiport with H
Q1533:Reabsorption of K
Symport with Na and Cl-
Q1534:Reabsorption of Ca
Ca Atpase; Na/Ca exchange;2G/Ca Atpase antiport;PTH
stimulates
Q1535:Reabsorption of MG
active and electrical force
Q1536:SECRETION of H
Na/H exchange/ NH4+
Q1537:Early Distal tubulue
REabsorbs NACL via Na-Cl symoporter;REabsorbs Ca via
PTH
Q1538:What inhibits NA/CL symporter and PTH
Thiazide diuretics
Q1539:LAte Tubule
H20 reabsorbed by ADH;NACL REab by
Aldosterone;HCO# reab vy aldosterone;SECRETION Of K=
Aldosterone
Q1540:Secretion of K determines
total excretion
Q1541:Collecting Duct
Reabsorbs H20 by ADH;Reab. UREA via ADH
Q1542:PTH acts on ? for Ca reabsorption
DCT
Q1543:ADH receptor complex activates
adenylate cyclase. CAMP activates a kinase and
phosphorylates proteins
Q1544:In Normal system; Urine flow and osmolarity are
inversely related
Q1545:In the presence of ADH
Water is reabsorbed;Urine volume is Small;Urine
concentration is same in MEdulla = HYPEROSMOTIC
Q1546:In the absence of ADH
No Water reabsorbed;Urine flow is high/dilute;Medullary
osmoloarty if low.
Q1547:REgulation of Plama osmoloarity by ADH
see page 300
Q1548:ADH secretion is increased my
elevated plasma sodium or osmolarity
Q1549:ADH secretion is decresed by
High blood volume or pressure
Q1550:Glucose in a DM patietn causes
opsmotic diuresis
Q1551:ANP will
Increase GFR;Decrease REnin; angio II; aldosterone; NACL
and H2o reapbsortopn; ADH secretion
Q1552:ADH will
Increase H20 reabsorption; decrease urine flow and Increase
urine osmolarity
Q1553:Henderson Hasselbach equation
ph=6.1 log (HCO3) / 0.03 PCO2
Q1554:Increase in ventilation will
decrease PCO@ (Alkalosis)
Q1555:Decrease in Ventilation
Increases PCO2 (acidosis)
Q1556:Cahnge in renal acid excretion and HCO3 production is
Metabolic response
Q1557:Standard Values of ;HCO3 = 24 mEq/L;PCO2= 40
mm HG
Just know
Q1558:Acidosis due to loss of HCO3 or DIARRHEA
Hyperchloremic Acidosis (because kdineys reabosrb CL since
no HCO3)
Q1559:Conducting zone ;Consists of
nose; pharynx; trachea; bronchi; bronchioles; and terminal
bronchioles.
Q1560:Respiratory zone ;Consists of
respiratory bronchioles; alveolar ducts; and alveoli.
Q1561:Pneumocytes;Pseudocolumnar ciliated cells extend to
the
respiratory bronchioles;
Q1562:Pneumocytes;extend to the respiratory bronchioles
Pseudocolumnar ciliated cells
Q1563:Pneumocytes;goblet cells extend to the
terminal bronchioles.
Q1564:Pneumocytes;extend to the terminal bronchioles.
goblet cells
Q1565:Pneumocytes;%'s
Type I cells (97% of alveolar surfaces);Type II cells (3%)
Q1566:role of;Type I cells
line the alveoli.
Q1567:role of;Type II cells
-secrete pulmonary surfactant;-serve as precursors to type I
cells and other type II cells. Type II cells
Q1568:role of;clara cells
secrete a component of surfactant - degrade toxins - act as
reserve cells
Q1569:ratio of in amniotic ;?uid is indicative of fetal ;lung
maturity.
A lecithin-to-sphingomyelin ;ratio of > 2.0
Q1570:bronchopulmonary segment ;structure
3°(segmental) bronchus ;- 2 arteries (bronchial ;and
pulmonary) in the center - veins and lymphatics drain along
the borders.
Q1571:what is described by RALS––
the heart. The relation of the ;pulmonary artery to the
;bronchus at each lung hilus ;is described by RALS–– ;Right
Anterior; Left ;Superior.
Q1572:Structures perforating diaphragm;what and levels
-T8: IVC;-T10: esophagus; vagus (2 trunks);-At T12: aorta
(red); thoracic duct (white); azygous vein (blue).
Q1573:Pain from the diaphragm can be referred to
the shoulder.
Q1574:Muscles of respiration;in exercise
Inspiration––external intercostals; scalene muscles;
sternomastoids;Expiration––rectus abdominis; internal and
external obliques; transversus abdominis;internal intercostals.
Q1575:5 Important lung products
-Surfactant;-ACE;-Prostaglandins;-histamine;-Kallikrein
Q1576:Surfactant;aka
dipalmitoyl phosphatidylcholine ;or ;lecithin
Q1577:Collapsing pressure =
2T/R;T=tension;R= radius
Q1578:what activates bradykinin
Kallikrein
Q1579:role of Kallikrein
activates bradykinin
Q1580:role of ACE in lung
angiotensin I → angiotensin II; inactivates bradykinin
Q1581:lung effects of ACE inhibitors and other effect
ACE inhibitors increased bradykinin and ;cause cough;
angioedema)
Q1582:role of surfactant/mech
decreased alveolar surface tension;increased compliance
Q1583:TLC =
IRV + TV + ERV + RV
Q1584:VC =
TV + IRV + ERV
Q1585:TV + IRV + ERV
VC
Q1586:IRV + TV + ERV + RV
TLC
Q1587:what causes a shift of the curve ;to the right.
An increased in all factors (except pH)
Q1588:what causes a shift of the curve to the left.
A decreased in all factors (except pH)
Q1589:Pulmonary circulation;;normal resistnace and
compliance
Normally a low-resistance; high-compliance system.
Q1590:Pulmonary circulation;;A decreased in PaO2 causes
a hypoxic vasoconstriction that shifts blood away from
;poorly ventilated regions of lung to well-ventilated regions of
lung.
Q1591:Pulmonary circulation;;Perfusion limited;what
molecules / when / describe / how to change
O2 (normal health);-CO2;-N2O;Gas equilibrates early along
the length of the capillary. Diffusion can be increased only if
blood ?ow increased .
Q1592:Pulmonary circulation;;Diffusion limited;what
molecules / when / describe
–O2 (exercise; emphysema;?brosis);-CO;-Gas does not
equilibrate by the time blood reaches the end of the capillary.
Q1593:Normal pulmonary artery pressure =;and when is it
changes
Normal pulmonary artery pressure = 10–14 mm Hg; or >35
mm Hg during exercise;-pulmonary HTN≥25 mm Hg
Q1594:Pulmonary hypertension;primary vs secondary
Primary––unknown etiology; poor prognosis;;Secondary––
usually caused by COPD; also can be caused by L → R
shunt.
Q1595:O2 content =
(O2 binding capacity × % saturation) + dissolved O2.
Q1596:O2 changes as Hb falls
O2 content of arterial blood decreased as [Hgb] falls;but O2
saturation and arterial PO2 do not.
Q1597:Arterial PO2 decreased with
chronic lung disease; physiologic shunt decreased O2
extraction ratio;not decrease in Hb
Q1598:-Normally 1 g Hgb can bind;-normal Hgb amount in
blood;-Normal O2 binding capacity
-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.
Q1599:increased A-a gradient may occur in
-hypoxemia; causes include ;shunting; high V/Q mismatch;
?brosis (diffusion block)
Q1600:CO2 transport forms
1. Bicarbonate (90%);2. Bound to hemoglobin as
carbaminohemoglobin (5%);3. Dissolved CO2 (5%)
Q1601:Haldane effect
In lungs; oxygenation of hemoglobin promotes dissociation of
CO2 from hemoglobin
Q1602:Bohr effect
In peripheral tissue; increased H+ shifts curve to right;
unloading O2
Q1603:7 Response to high altitude
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
Q1604:Emphysema ;types with causes
Centriacinar: caused by smoking;Panacinar: alpha 1-
antitrypsin de?ciency
Q1605:alpha 1-antitrypsin de?ciency leads to
Panacinar Emphysema and liver cirrhosis
Q1606:Paraseptal emphysema: what and who
associated with bullae →can rupture →pneumothorax;often in
young; otherwise healthy males.
Q1607:associated with bullae →can rupture →
pneumothorax;often in young; otherwise healthy males.
Paraseptal emphysema
Q1608:Emphysema ;pathology
increased elastase activity;Enlargement of air spaces and
decreased recoil resulting from destruction of alveolar ;walls.
Q1609:Chronic Bronchitis ;pathology
Hypertrophy of mucus glands in the bronchioles →Reid index
= gland depth / total thickness of bronchial wall; in COPD;
Reid index > 50%.
Q1610:Reid index
gland depth / total thickness of bronchial wall; in COPD; Reid
index > 50%.
Q1611:Bronchiectasis ;pathology
Chronic necrotizing infection of ;bronchi→permanently
dilated airways;
Q1612:Bronchiectasis ;complications
purulent sputum; recurrent infections; hemoptysis.
Q1613:causes of Bronchiectasis
Associated with bronchial obstruction; CF; poor ciliary
motility; Kartagener’s ;syndrome.
Q1614:Asthma triggers
Can be triggered by viral URIs; allergens; and stress.
Q1615:Restrictive lung;disease causes ;Poor breathing
mechanics (extrapulmonary):
a. Poor muscular effort––polio; myasthenia gravis;b. Poor
structural apparatus––scoliosis; morbid obesity
Q1616:Restrictive lung;disease 8 types;Interstitial lung
diseases (pulmonary):
1. (ARDS) 2. Neonatal RDS ;3. Pneumoconioses ;4.
Sarcoidosis;5. Idiopathic pulmonary ?brosis;6. Goodpasture’s
syndrome;7. Wegener’s granulomatosis;8. Eosinophilic
granuloma
Q1617:Pneumoconioses ;name some
coal miner’s silicosis; asbestosis
Q1618:Neonatal respiratory distress ;syndrome;Tx
maternal steroids before birth;arti?cial surfactant for infant.
Q1619:Adult acute respiratory distress syndrome
(ARDS);pathophys
Diffuse alveolar damage→increased alveolar capillary
permeability →protein-rich leakage into alveoli. Results in
formation of intra-alveolar hyaline membrane.
Q1620:Adult acute respiratory distress syndrome
(ARDS);initial damage due to
-neutrophilic substances toxic to alveolar wall;-activation of
coagulation cascade;-oxygen-derived free radicals.
Q1621:Sleep apnea;types
Central sleep apnea––no respiratory effort;Obstructive sleep
apnea––respiratory effort ;against airway obstruction.
Q1622:Sleep apnea;define
Person stops breathing for at least 10 seconds ;repeatedly
during sleep.
Q1623:Sleep apnea;complications
- systemic/pulmonary hypertension;-arrhythmias;-possibly
sudden death;-chronic fatigue
Q1624:Asbestosis;mech
Diffuse pulmonary interstitial ?brosis caused by inhaled
asbestos ?bers.
Q1625:asbestos;wrt malignancy
increased risk of;pleural mesothelioma ;bronchogenic
carcinoma.
Q1626:pneumoconioses ;where in lungs
Asbestosis Mainly affects lower lobes. Other
pneumoconioses ;affect upper lobes (e.g; coal worker's lung).
Q1627:Asbestos and smoking
Asbestosis and smoking greatly;increased risk of
bronchogenic cancer (smoking not additive with
mesothelioma).
Q1628:Asbestosis;histo
Ferruginous bodies in lung (asbestos ?bers coated with
hemosiderin). Ivory-white pleural plaques
Q1629:Bronchial obstruction ;-Breath Sounds ;-Resonance ;-
Fremitus ;-Tracheal Deviation
-Absent/decreased over affected area ;-decreased ;-decreased
;-Toward side of lesion
Q1630:Pleural effusion;-Breath Sounds ;-Resonance ;-
-decreased over effusion ;-Dullness ;-decreased ;- NC
Q1631:Pneumonia (lobar) ;-Breath Sounds ;-Resonance ;-
-May have bronchial ;breath sounds over lesion;-Dullness ;-
increased ;-NC
Q1632:Pneumothorax;-Breath Sounds ;-Resonance ;-Fremitus
;-Tracheal Deviation
-decreased ;-Hyperresonant ;-Absent ;-Away from side of
lesion
Q1633:Breath Sounds; Resonance; Fremitus; Tracheal
Deviation;-Absent/decreased over affected area ;-decreased ;-
decreased ;-Toward side of lesion
Bronchial obstruction
Deviation;-decreased over effusion ;-Dullness ;-decreased ;-
NC
Pleural effusion
Deviation;-May have bronchial ;breath sounds over lesion;-
Dullness ;-increased ;-NC
Pneumonia (lobar)
Deviation;-decreased ;-Hyperresonant ;-Absent ;-Away from
side of lesion
Pneumothorax
Q1637:Lung cancer;complications
SPHERE of complications;-Superior vena cava syndrome;-
Pancoast’s tumor;-Horner’s syndrome;-Endocrine
(paraneoplastic);-Recurrent laryngeal
symptoms;(hoarseness);-Effusions (pleural or ;pericardial)
Q1638:Lung cancer;which types are central
-Squamous cell carcinoma;-Small-cell
Q1639:Lung cancer;which types are peripheral
Adenocarcinoma;Bronchial ;Bronchoalveolar ;Large cell
carcinoma
Q1640:Lung cancer;describe Squamous cell ;carcinoma (gross)
Hilar mass arising from bronchus; Cavitation;
Q1641:Lung cancer;which have strong smoking association
-Squamous cell carcinoma;-Small-cell
Q1642:Lung cancer;Undifferentiated→ very aggressive
Small-cell (oat-cell) carcinoma
Q1643:Lung cancer;ectopic production of ACTH or ADH
Q1644:Lung cancer;Lambert-Eaton syndrome.
Q1645:Lung cancer histology;Small-cell (oat-cell) carcinoma
Neoplasm of neuroendocrine ;Kulchitsky cells → small dark
;blue cells.
Q1646:Lung cancer histology;Squamous cell carcinoma
Keratin pearls and intercellular ;bridges.
Q1647:Lung cancer histology;Neoplasm of neuroendocrine
;Kulchitsky cells → small dark ;blue cells
Q1648:Lung cancer histology;Keratin pearls and intercellular
bridges
Squamous cell carcinoma
Q1649:Lung cancer histology;Clara cells→ type II
pneumocytes multiple densities on x-ray of chest.
both types of Adenocarcinoma;Bronchial
;and;Bronchoalveolar
Q1650:Lung cancer histology;Pleomorphic giant cells with
;leukocyte fragments in ;cytoplasm.
Large cell carcinoma
Q1651:Lung cancer histology;Adenocarcinoma
Both Types: Clara cells → type II pneumocytes multiple
densities on x-ray of chest.
Q1652:Lung cancer histology;Large cell carcinoma
Pleomorphic giant cells with ;leukocyte fragments in
;cytoplasm.
Q1653:Lung cancer characteristics;Adenocarcinoma: Bronchial
Develops in site of prior pulmonary in?ammation or injury
Q1654:Lung cancer characteristics;most common lung CA in
non-smokers
Adenocarcinoma: Bronchial
Q1655:Lung cancer characteristics;Develops in site of prior
pulmonary in?ammation or injury
Adenocarcinoma: Bronchial
Q1656:Lung cancer characteristics;Not linked to smoking.
Adenocarcinoma: Bronchoalveolar
Q1657:Lung cancer characteristics;parathyroid-like activity
→ PTHrP
Q1658:Lung cancer characteristics;Hilar mass arising from
bronchus; Cavitation
Q1659:Lung cancer characteristics;Highly anaplastic
undifferentiated tumor; poor prognosis.
Large cell carcinoma
Q1660:Lung cancer characteristics;Large cell carcinoma
Highly anaplastic undifferentiated tumor; poor prognosis.
Q1661:Lung cancer characteristics;Carcinoid tumor
Secretes serotonin; can cause carcinoid ;syndrome (?ushing;
diarrhea; wheezing;salivation).
Q1662:Lung cancer characteristics;?ushing; diarrhea;
wheezing;salivation
Carcinoid tumor
Q1663:Lung cancer characteristics;most common. Brain
(epilepsy); bone (pathologic fracture); and liver
(jaundice;hepatomegaly).
Metastases
Q1664:Lung cancer common presentation features
cough; hemoptysis; bronchial ;obstruction; wheezing;
pneumonic “coin” lesion on x-ray ?lm.
Q1665:cough; hemoptysis; bronchial ;obstruction; wheezing;
pneumonic “coin” lesion on x-ray ?lm.
Lung cancer
Q1666:Pancoast’s tumor;where and findings
Carcinoma that occurs in apex of lung and may affect cervical
sympathetic plexus; causing ;Horner’s syndrome.
Q1667:Carcinoma that occurs in apex of lung and may affect
cervical sympathetic plexus; causing ;Horner’s syndrome.
Pancoast’s tumor
Q1668:Kulchitsky cells
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.
Q1669:Lambert-Eaton syndrome;findings
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.
Q1670:Lambert-Eaton syndrome;causes
small-cell lung cancer; lymphoma; non-Hodgkin's lymphoma
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.
Lambert-Eaton syndrome
Q1672:Small-cell carcinoma ;aka
oat-cell carcinoma
Q1673:oat-cell carcinoma ;aka
Small-cell carcinoma
Q1674:Pneumonia types with different organism causes
Lobar - Pneumococcus usually;Bronchopneumonia - S.
aureus; H. ?u; Klebsiella; S. pyogenes;Interstitial (atypical)
pneumonia - viruses (RSV; adenoviruses);
Mycoplasma;Legionella; Chlamydia
Q1675:Lobar pneumonia Characteristics
Intra-alveolar exudate → consolidation; may involve entire
lung
Q1676:Bronchopneumonia Characteristics
Acute in?ammatory in?ltrates ;from bronchioles into ;adjacent
alveoli; patchy ;distribution involving ≥ 1 ;lobes
Q1677:Interstitial (atypical) ;pneumonia Characteristics
Diffuse patchy in?ammation ;localized to interstitial areas ;at
alveolar walls; distribution involving≥ 1 lobes
Q1678:Which type of pneumona;Intra-alveolar exudate →
consolidation; may involve entire lung
Lobar
Q1679:Which type of pneumona;Acute in?ammatory
in?ltrates ;from bronchioles into ;adjacent alveoli; patchy
;distribution involving ≥ 1 ;lobes
Bronchopneumonia
Q1680:Which type of pneumona;Diffuse patchy in?ammation
;localized to interstitial areas at alveolar walls; distribution
involving ≥ 1 lobes
Interstitial (atypical);pneumonia
Q1681:Which type of pneumona;Pneumococcus most
frequently
Lobar
Q1682:Which type of pneumona;S. aureus
Bronchopneumonia
Q1683:Which type of pneumona;Viruses (RSV; adenoviruses)
Interstitial (atypical) ;pneumonia
Q1684:Which type of pneumona;Mycoplasma; Chlamydia
Q1685:Which type of pneumona;Legionella
Q1686:Interstitial pneumonia;aka
atypical pneumonia
Q1687:atypical pneumonia;aka
Interstitial ;pneumonia
Q1688:Which type of pneumona;S. aureus
Bronchopneumonia
Q1689:Which type of pneumona;H. ?u
Bronchopneumonia
Q1690:Which type of pneumona;Klebsiella
Bronchopneumonia
Q1691:Which type of pneumona;S. pyogenes
Bronchopneumonia
Q1692:what are Lung abscess and who gets them
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).
Q1693:Pleural effusions what and causes of;Transudate
decreased protein content;Due to CHF; nephrotic syndrome;
or hepatic cirrhosis.
Q1694:Pleural effusions what and causes of;Exudate
increased protein content; cloudy. Due to malignancy;
pneumonia; collagen vascular disease;trauma.
Q1695:Which type of Pleural effusion;decreased protein
content
Transudate
Q1696:Which type of Pleural effusion;CHF
Transudate
Q1697:Which type of Pleural effusion;nephrotic syndrome
Transudate
Q1698:Which type of Pleural effusion;hepatic cirrhosis
Transudate
Q1699:Which type of Pleural effusion;increased protein
content; cloudy
Exudate
Q1700:Which type of Pleural effusion;malignancy
Exudate
Q1701:Which type of Pleural effusion;pneumonia;
Exudate
Q1702:Which type of Pleural effusion;collagen vascular
disease
Exudate
Q1703:Which type of Pleural effusion;increased protein
content
Exudate
Q1704:Which type of Pleural effusion;cloudy
Exudate
Q1705:Which type of Pleural effusion;trauma
Exudate
Q1706:1st generation H1 blockers;names
Diphenhydramine; dimenhydrinate; chlorpheniramine.
Q1707:1st generation H1 blockers;Clinical uses
Allergy; motion sickness; sleep aid.
Q1708:1st generation H1 blockers;Toxicity
Sedation; antimuscarinic; anti-alpha -adrenergic.
Q1709:1st generation H1 blockers;mech
Reversible inhibitors of H1 histamine receptors.
Q1710:2nd generation H1 blockers;mech
Reversible inhibitors of H1 histamine receptors.
Q1711:2nd generation H1 blockers;names
Loratadine; fexofenadine; desloratadine.
Allergy.
Far less sedating than 1st generation.
Q1714:Asthma drugs;name the Nonspeci?c beta -agonists
Isoproterenol
Q1715:Asthma drugs;Isoproterenol;mech and uses
Nonspeci?c beta -agonists relaxes bronchial smooth muscle
(beta 2).
Q1716:Asthma drugs;Isoproterenol;toxicity
Nonspeci?c beta -agonists Adverse effect is tachycardia (beta
1).
Q1717:Asthma drugs;name the beta 2 agonists
Albuterol and Salmeterol
Q1718:Asthma drugs;Albuterol;mech and uses
beta 2 agonist relaxes bronchial smooth muscle (beta 2). Use
during acute exacerbation.
Q1719:Asthma drugs;Salmeterol;mech and uses
beta 2 agonist long-acting agent for prophylaxis.
Q1720:Asthma drugs;Salmeterol;toxicity
Adverse effects are tremor and arrhythmia.
Q1721:asthma drug;Adverse effects are tremor and
arrhythmia.
Salmeterol
Q1722:Asthma drugs;;name the Methylxanthines
Theophylline
Q1723:Asthma drugs;Theophylline;mech and uses
Methylxanthine - likely causes bronchodilation by inhibiting
phosphodiesterase; thereby decreased ;cAMP hydrolysis.
Q1724:Asthma drugs;Theophylline;tioxicity
Usage is limited because ;of narrow therapeutic index
(cardiotoxicity;neurotoxicity).
Q1725:Asthma drugs;Usage is limited because ;of narrow
therapeutic index (cardio and neuro toxicity).
Methylxanthines: Theophylline
Q1726:Asthma drugs;name the muscarinic antagonists
Ipratropium
Q1727:Asthma drugs;Ipratropium;mech and uses
competitive block of muscarinic ;receptors; preventing
bronchoconstriction.
Q1728:Cromolyn ;mech and uses
Prevents release of mediators from mast cells. Effective;only
for the prophylaxis of asthma. Not effective ;during an acute
asthmatic attack.
Q1729:Asthma drugs;7 different Tx drug classes
1. Nonspeci?c beta -agonists ;2.beta 2 agonists ;3.
Methylxanthines;4. Muscarinic antagonists ;5. Cromolyn ;6.
Corticosteroids;7. Antileukotrienes
Q1730:Cromolyn ;toxicity
Toxicity is rare.
Q1731:Asthma drugs;name the corticosteroids
Beclomethasone; prednisone
Q1732:Asthma drugs;Beclomethasone; prednisone;mech
inhibit the synthesis ;of virtually all cytokines. Inactivate NF-
κB; the ;transcription factor that induces the production of
;TNF-alpha ; among other in?ammatory agents.
Q1733:1st-line therapy for chronic asthma.
Beclomethasone; prednisone
Q1734:name the Antileukotrienes
Zileuton;Za?rlukast; montelukast
Q1735:Zileuton;mech and uses
A 5-lipoxygenase pathway inhibitor. Blocks conversion of
arachidonic acid to leukotrienes;asthma
Q1736:A 5-lipoxygenase pathway inhibitor. Blocks
conversion of arachidonic acid to leukotrienes.
Zileuton
Q1737:Za?rlukast; montelukast;mech and uses
Za?rlukast; montelukast––block leukotriene
receptors;Especially good for aspirin induced asthma.
Q1738:block leukotriene receptors.
Za?rlukast; montelukast
Q1739:Especially good for aspirin induced asthma.
Za?rlukast; montelukast
Q1740:Expectorants;names
-Guaifenesin (Robitussin);;-N-acetylcystine
Q1741:Guaifenesin;aka
Robitussin
Q1742:Robitussin;aka
Guaifenesin
Q1743:Guaifenesin ;mech and uses
Removes excess sputum but large doses necessary; does not
suppress cough re?ex;Expectorants
Q1744:Removes excess sputum but large doses necessary
Guaifenesin
Q1745:Mucolytic → can loosen mucus plugs in CF patients.
N-acetylcystine
Q1746:N-acetylcystine ;mech and uses
Mucolytic → can loosen mucus plugs in CF patients;also
used as an antidote for acetaminophen overdose
Q1747:antidote for acetaminophen overdose
N-acetylcystine
Q1748:What is the epithelium of the bronchi? What are some
causes of ciliary dyskinesia?
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.
Q1749:Describe the differences between bronchi and
conducting bronchioles.
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.
Q1750:Where is resistance the greatest in the lung airways?
Conducting bronchioles because they are arranged in series.
Small airways are aligned in parallel; which reduces resistance
greatly (1/= 1/R1+ 1/R2;).
Q1751:What are the layers of the pulmonary membrane?
Surfactant; alveolar epithelium (mostly type I pneumocytes);
BM; and capillary epithelium.
Q1752:What vertebral level does the trachea begin? What
vertebral level does the trachea bifurcate?
The trachea begins just inferior to the cricoid cartilage; C6; and
ends at the sternal angle (T4) level where it bifurcates.
Q1753:What equation is used to calculate physiological dead
space?
Vd = Vt * ((PACO2 - PECO2)/PACO2) ;Vt = tidal
volume;PACO2 = PCO2 of alveolar gas;PECO2 = PCO2 of
expired air
Q1754:How is alveolar ventilation calculated?
Alveolar ventilation = (tidal volume - dead space) *
breaths/min
Q1755:Which of the following can be measured by
spirometry?;Tidal volume; total lung capacity; functional
residual capacity; residual volume; vital capacity?
Tidal volume and vital capacity. All other volumes listed
contain residual volume which cannot be measured.
Q1756:Use boyles law to explain inspiration of air?
PV= k. Increasing lung volume decreases the pressure which
allows atmospheric air to flow in the lungs (down a pressure
gradient).
Q1757:What muscles are used in inspiration? Expiration?
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
Q1758:What are the sources of resistance during inspiration?
Airway resistance: air molecules colliding with wall =
friction;Compliance resistance: expansion of alveolar and
paranchyma tissue;Tissue resistance: parietal and visceral
pleura friction
Q1759:What are the sources of resistance during expiration?
Intrathoracic pressure increases which compresses airways
and reduces airway diameter. Reduced airway diameter is the
primary source of resistance.
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?
Emphysema destroys lung paranchyma. Compliance work is
decreases and inspiration is easy. Expiration is difficult.
Q1761:Does elastance increase or decreased in restrictive lung
disease?
Elastance will increase in restrictive lung diseases. Elastance =
resist deformation. Is is inversely proportional to compliance.
E = change in P/change in V.
Q1762:Explain how emphysema changes the functional
residual capacity.
Lung compliance (distensibility) is increased in emphysema
and the tendency of the lungs to collapse decreases. The lung-
chest 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.
Q1763:What is LaPlace's law? What decreases the collapsing
force on alveoli?
P = 2T/r;P = collapsing pressure on alveolus;T = surface
tension;r = radius of alveolus;Surfactant.
Q1764:Describe surfactant and its function.
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.
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?
Partial pressure = total pressure * concentration of gas;O2:
160; 150; 100; 100; 40;CO2: 0; 0; 40; 40; 46
Q1766:What is Fick's law of diffusion?
D = change in P * A * S / T;A = surface area;S = solubility
coeff. of oxygen;T = distant oxygen must diffuse across
pulmonary membrane
Q1767:How is V/Q optimized for the most efficient gas
exchange (ventilation matches perfusion)?
Hypoxia-induced vasoconstriction. Paradoxical
vasoconstriction in response to hypoxia.
Q1768:How does V/Q ratio change in exercise?
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).
Q1769:In terms of V/Q; whats the difference between a shunt
and dead space?
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.
Q1770:An A-a gradient greater than ____ mmHg indicates a
pathological condition. How are both PAO2 and PaO2
calculated?
30 mmHg;PAO2 = PiO2 - PACO2/R;PaO2 is measured with
arterial blood gas labs.
Q1771:What is the oxygen saturation in arterial blood?
Venous blood?
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.
Q1772:What are some causes of hypoxia with an increase in
A-a gradient? Normal A-a gradient?
Increased A-a: ventillation; perfusion; or diffusion defects; R-
L shunts;Normal A-a: CNS depression; phrenic nerve lesion;
upper airway obstruction (?)
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)
Deoxyhemoglobin buffers H+ inside the RBCs.
Q1774:What is the chloride shift?
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.
Q1775:20% of CO2 is transported in the blood by Hb. What
is the Bohr effect?
Binding of CO2 to Hb decreases the O2 affinity of Hb
(facilitates offloading of oxygen).
Q1776:Where in the medulla is the respiratory center located?
What part controls inspiration? Expiration?
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.
Q1777:What two centers in the pons help to control
breathing?
Apneustic center: lower pons; stimulates deep and prolonged
inspiratory gasp;Pneumotaxic center: upper pons; inhibits
inspiration; thus; regulating volume and rate
Q1778:What do central chemoreceptors in the medulla
respond to?
Central chemoreceptors respond to acidosis (high CO2 levels)
in the CSF and in response they increase ventilation
(breathing rate).
Q1779:What do peripheral chemoreceptors in the carotid (via
CNIX) and aortic (via CNX) bodies respond to?
Decreased PaO2 ( < 60 mmHg); decrease pH; and increase
PaCO2.
Q1780:What is Ondine's curse?
Impaired autonomic control of breathing.
Q1781:What receptors are responsible for Hering-Breuer
reflex?
Lung stretch receptors. When stimulated by distention of the
lungs they produce a reflex decrease in breathing frequency.
Q1782:Explain why climbers must ascend mountains slowly.
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.
Q1783:What stimulates the J receptors?
Engorgement of the pulmonary capillaries stimulate the J
receptors which then cause rapid; shallow breathing.
Q1784:A claustrophobic girl is stuck in an elevator. Her
vision becomes blurry and she feels dizzy; why?
Hyperventilation decreases PaCO2. PaCO2 is a potent
vasodilator for cerebral arteries. The decrease in oxygen
delivery to the brain causes these symptoms.
Q1785:Where are irritant receptors located?
Large-diameter airways. Mediate cough; sneeze and
bronchoconstriction in response to noxious substances.
Q1786:What is histotoxic hypoxia? Does supplemental
oxygen alleviate symptoms?
Inability of cells to us O2 effectively (cyanide poisoning). No.
Q1787:What are some physiological responses to high
altitude (4)?
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
Q1788:What is and what causes Biot's breathing?
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.
Q1789:What is and what causes Cheyne-Stokes breathing?
Is: periodic breathing amid higher PaCO2 to stimulate
breathing. Characterized by oscillation of ventilation between
apnea and tachypnea;Causes: head trauma.
Q1790:What is Kussmaul's breathing?
Bodies response to metabolic acidosis. Rapid; deep breathing
to expire CO2. Often occurs in type I diabetic patients
experiencing ketoacidosis.
Q1791:How is FEV1; FVC; and FEV1/FVC affected in
asthma and COPD? How about in fibrosis?
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.
Q1792:What are Clara cells?
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).
Q1793:What are type I pneumocytes? Type II pneumocytes?
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.
Q1794:What is the function of the pores of Kohn?
These alveolar pores are found within interalveolar septae and
equalize pressure within alveoli.
Q1795:Name some bronchoconstrictors;Name some
bronchodilators:
BCs: LTC4; LTD4; PGF; TxA2; and parasympathetic
stimulation;BDs: PGE2; sympathetic stimulation (Beta-2
agonists).
Q1796:Describe the clinical features of pink puffers
(emphysema).
Thin; barrel-shaped chest; tachypneic; mild hypoxemia;
hypocapnia or normocapnia.
Q1797:Describe the clinical features of blue bloaters (chronic
bronchitis).
Muscular; barrel-shaped chest; severe hypoxemia with
cyanosis; hypercapnia leading to respiratory acidosis; RV
failure; and systemic edema.
Q1798:Tidal volume
Volume of air that enters and leaves the lung in a single cycle.
500ml
Q1799:Functional residual capacity
Amount of air in the lungs after passive expiration. 2;700ml
Q1800:Inspiratory capacity
Maximal volume of gas inspired from FRC. 4;000ml
Q1801:Inspiratory reserve volume
Air that can be inhaled after normal inspiration. 3;500ml
Q1802:Expiratory reserve volume
Air that can be expired after a normal expiration. 1;500ml
Q1803:Residual volume
Air in the lungs after maximal expiration. 1;200ml
Q1804:Vital capacity
Maximal air that can expired after maximal inspiration.
5;500ml
Q1805:Total lung capacity
Air in the lungs after maximal inspiration. 6;700ml
Q1806:Total ventilation
Total ventilation = Tidal volume X respiratory rate.
Q1807:Dead space
Regions that contain air but do not exchange O2 and CO2
Q1808:Anatomic dead space
Conducting zones. Approximately equal to person't weight in
pounds.
Q1809:Alveolar dead space
Alveoli with air but without blood flow
Q1810:Physiologic dead space
Anatomic dead space plus alveolar dead space
Q1811:Alveolar ventilation
Tidal volume - anatomic dead space X respiratory rate.
Q1812:Lung recoil
Force that collapses the lung. As the lung enlarges; recoil
increases and vice versa.
Q1813:Intrapleural pressure
Normally -5 cmH2O. Force that expands the lung. The more
negative; the more lung expansion.
Q1814:Lung mechanics before inspiration
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.
Q1815:Lung mechanics during inspiration
Diaphragm contracts; intrapleural pressure becomes more
negative. Expansion of alveoli makes alveolar pressure
negative causing air to flow into the lungs.
Q1816:Lung mechanics at the end of inspiration
Intrapleural pressure and recoil are the same but opposite.
Alveolar pressure returns to zero and air stops flowing in.
Q1817:Lung mechanics during expiration
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.
Q1818:Assisted control mode ventilation
Inspiration is initiated by the patient or the machine if no
signal is detected.
Q1819:Positive end-expiratory pressure
Does not allow intraalveolar pressure to return to zero at the
end of expiration. The larger lung volume prevents atelectasis.
Q1820:What is lung compliacnce?
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.
Q1821:Components of lung recoil
1) the tissue's collagen and elastin fibers and 2) the surface
tension (greatest component)
Q1822:Functions of surfactant
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.
Q1823:Pathophysiology of respiratory distress syndrome
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)
Q1824:Airway resistance
R = 1/r4; first and second bronchi have less radius than
alveoli; therefore more resistance. Ach increases resistance
(bronchoconstriction); catecholamines decrease resistance
(bronchodilation)
Q1825:Effect of lung volume on airway resistance
increased lung volume --> increased radius --> decreased
resistance. The more negative the intrapleural pressure; the
less resistance
Q1826:Lung volumes in obstructive disease
increased TLC; increased RV; increased FRC; decreased
FEV1; decreased FVC; decreased FEV1/FVC
Q1827:Lung volumes in restrictive disease
decreased TLC; decreased RV; decreased FRC; decreased
FEV1; decreased FEV; increased FEV1/FVC
Q1828:Pressure of alveolar O2 and CO2
PAO2 = 100mmHg; PACO2 = 40mmHg
Q1829:Pressure of venous pulmonary capillary O2 and CO2
PvO2 = 40mmHg; PvCO2 = 47mmHg
Q1830:Pressure of arterial pulmonary capillary O2 and CO2
PO2 = 100mmHg; PCO2 = 40mmHg
Q1831:Which factors affect PCO2?
Metabolic CO2 production and alveolar ventilation
Q1832:Relationship between alveolar ventilation and PACO2
Inversely proportional. Hyperventilation decreases PACO2;
hypoventilation increases PACO2.
Q1833:Relationship between PAO2 and PACO2
decreased PACO2 --> increased PAO2 (hyperventilation);
increased PACO2 --> decreased PAO2 (hypoventilation)
Q1834:Which factors affect PAO2?
Atmospheric pressure; oxygen concentration of inspired air
and PACO2
Q1835:What determines oxygen content?
Hemoglobin concentration. 1.34ml O2 combines with each
gram of hemoglobin.
Q1836:Amount of dissolved oxygen in the blood
0.3 volumes %; 0.3ml per 100ml of blood. Determines PO2
which acts to keep oxygen bound to Hb
Q1837:What determines oxygen attachment to hemoglobin?
PO2 and the affinity of the individual attachment sites. The
higher the affinity; the less PO2 is needed to keep it attached
Q1838:What determines PO2?
Amount of oxygen dissolved in plasma. Normally 0.3
volumes %.
Q1839:Site 4 of hemoglobin
Oxygen is attached at 100mmHg. Least affinity; last site to be
saturated.
Oxygen is attached at 40mmHg. More affinity than site 4; less
affinity than site 2.
Oxygen is attached at 26mmHg which is p50. More affinity;
second site to be saturated.
Oxygen remains attached under physiologic conditions.
Highest affinity; first site to be saturated.
Q1843:Factors that shift oxygen dissociation curve to the
right
increased CO2; increased 2;3BPG; fever; acidosis
Q1844:Factors that shift oxygen dissociation curve to the left
decreased CO2; decreased 2;3BPG; hypothermia; alkalosis;
HbF; methemoglobin; carbon monoxide; stored blood
Q1845:How is CO2 carried in the blood?
5% dissolved; 5% attached to Hb (carbamino compounds);
90% as bicarbonate.
Q1846:Main drive for ventilation
H+ ions from dissociated H2CO3 which stimulate central
chemoreceptors. H2CO3 is proportional to PCO2 of CSF
Q1847:Central chemoreceptors
Sense [H+] which is proportional to PCO2 and H2CO3 of the
CSF (not systemic)
Q1848:Peripheral chemoreceptors
Carotid bodies (afferents via IX); aortic bodies (afferents via
X). Monitor PO2 and [H+/CO2]
Q1849:Main drive for ventilation in severe hypoxemia
Peripheral chemoreceptors sense PaO2 (dissolved oxygen)
once PaO2 falls to 50-60mmHg.
Q1850:Ventilatory response to chronic hypoventilation
Peripheral chemoreceptors are the main drive for ventilation
eventhough PaCO2 is increased.
Q1851:Ventilatory response to anemia
PaO2 and PACO2 are normal; therefore neither peripheral nor
central chemoreceptors respond.
Q1852:Central control of ventilation
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
Q1853:Differences in ventilation between the base and the
apex of the lung
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
Q1854:Differences in blood flow between the base and the
apex of the lung
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
Q1855:Ventilation/perfussion relationship at the base of the
lungs
Blood flow is higher than ventilation; the relationship is less
than 0.8; the bases are underventilated; increased shunts
Q1856:Ventilation/perfussion relationship at the apex of the
lungs
Blood flow is lower than ventilation; the relationship is more
than 0.8; the apex are overventilated; increased dead space
Q1857:What does a ventilation/perfussion relationship under
and over 0.8 mean?
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.
Q1858:What is hypoxic vasoconstriction?
A decrease in PAO2 causes vasoconstriction and shunting of
blood through that segment.
Q1859:What is the effect of a thrombus in a pulmonary
artery?
Blood flow decreases; therefore increased Va/Q --> decreased
PACO2; increased PAO2
Q1860:What is the effect of a foreign object occluding a
terminal bronchi?
Ventilation decreases; therefore decreased Va/Q --> increased
PACO2; decreased PAO2
Q1861:What constitutes a pulmonary shunt?
Regions of the lung where blood is not ventilated. Low Va/Q
relationship.
Q1862:What constitutes alveolar dead space?
Regions of the lung where there's no blood flow in spite of
ventilation. High Va/Q relantionship
Q1863:Va/Q > 0.8
Represents alveolar dead space. Can be reversed with
supplemental O2
Q1864:Va/Q < 0.8
Represents a pulmonary shunt. Cannot be reversed with
supplemental O2
Q1865:What is the normal A-a gradient?
5-10 mmHg
Q1866:Hypoventilation
decreased PAO2 but diffusion and A-a gradient are normal.
Perfusion-limited defect.
Q1867:What is a perfussion-limited defect?
There's a lung problem but A-a gradient is normal
Q1868:What is a diffusion-limited defect?
There's a lung problem where A-a gradient is below normal;
therefore diffusion isn't normal
Q1869:Diffusion impairment lung defect
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.
Q1870:Diffusion capacity of the lung
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.
Q1871:Pulmonary right-left shunt
decreased Va/Q. Ther is an increased A-a gradient that is
unresponsive to supplemental O2. Atelectasis or ARDS.
Q1872:PO2 in atrial septal defect
increased Right atrial PO2; increased right ventricular PO2;
increased pulmonary artery PO2; increased pulmonary blood
flow and pressure
Q1873:PO2 in ventricular septal defect
No change in right atrial PO2; increased right ventricular PO2;
increased pulmonary artery PO2; increased pulmonary flow
and pressure
Q1874:PO2 in patent ductus arteriosus
No change in right atrial PO2 nor right ventricular PO2;
increased pulmonary artery PO2; increased pulmonary flow
and pressure
Q1875:Factor XII;Intrinsic; extrinsic or common?
intrinsic
Q1876:Factor XII;PTT or PT?
PTT
Q1877:Factor XII;activates?
XI
Q1878:Factor XI;Intrinsic; extrinsic; or common?
Intrinsic
Q1879:Factor XI;PTT or PT?
PTT
Q1880:Factor XI;activates?
IX;***requires Ca++ and platelet phospholipid
Q1881:Factor IX;Intrinsic; extrinsic; or common?
intrinsic
Q1882:Factor IX;PTT or PT
PTT
Q1883:Factor IX;activates?
X;**requires Ca++ and platelet phospholipid
Q1884:Factor VII;intrinsic; extrinsic; or common?
extrinsic
Q1885:Factor VII;PTT or PT?
PT
Q1886:Factor VIIa;Activates?
X;**requires Ca++ and platelet phospholipid
Q1887:Tissue factor;activates?
VII;**requires Ca++ and platelet phospholipid
Q1888:Xa and Va;Activate?
Prothrombin;**requires Ca++ and platelet phospholipid
Q1889:factor X;intrinsic; extrinsic; or common?
common
Q1890:Thrombin;activates?
Fibrinogen
Q1891:Factor which crosslinks fibrin
XIIIa
Q1892:inactivate Va and VIIIa
Protein C;Protein S;**Vitamin K dependent
Q1893:inactivates;thrombin;IXa;Xa;XIa
Antithrombin III
Q1894:activated by heparin
Antithrombin III
Q1895:generates plasmin; which cleaves fibrin
tPA
Q1896:fibrinolytic system link to complement cascade?
plasminogen activates C3
Q1897:Clotting link to kallikrein-kinin system
XIIa activates Prekallikrein ;->kallikrein
Q1898:Kallikrein link to kinin system?
kallikrein activates HMWK;-->Bradykinin
Q1899:Kinin link to Clotting system
HMWK activates Factor XII
Q1900:Kallikrein link to fibrinolytic system
Kallikrein activates Plasminogen;-->Plasmin
Q1901:Microcytic anemias: Definition
Mean Corpuscular Volume less than 80 cubic micrometers
Q1902:Macrocytic anemias: Definition
Mean Corpuscular Volume more than 100 cubic micrometers
Q1903:Normocytic anemias: Definition
Mean Corpuscular Volume between 80 and 100 cubic
micrometers
Q1904:Corrected reticulocyte count less than 3%: Bone
marrow status
Ineffective erythropoiesis
Q1905:Corrected reticulocyte count greater than or equal to
3%: Bone marrow status
Effective erythropoiesis
Q1906:Regular hematocrit level
45%
Q1907:Stimuli for erythropoietin
-hypoxemia;-left-shifted oxygen binding curve;-high altitude
Q1908:Where is erythropoietin made?
Endothelial cells of peritubular capillaries
Q1909:Corrected reticulocyte count: Definition
(Actual hematocrit/45) * reticulocyte count;If polychromasia;
divide by 2.
Q1910:Reticulocyte count: What does it measure?
-Effective erythropoiesis;-Must be corrected for degree of
anemia
Q1911:How long does it take for reticulocyte count to
increase after blood loss?
5-7 days.
Q1912:Microcytic (less than 80 cubic micrometers) anemias:
List
-Iron deficiency;-Anemia of chronic disease;-Thalassemia
(alpha and beta);-Sideroblastic anemia
Q1913:Sideroblastic anemias: List
-Chronic alcoholism (most common);-Pyridoxine (B6)
deficiency;-Lead poisoning
Q1914:Anemias of chronic disease: List
-Chronic inflammation (eg rheumatoid arthritis; TB);-
Alcoholism;-Malignancy
Q1915:Type of anemia: Iron deficiency
Early-stage: Normocytic with a low reticulocyte count;Later-
stage: Microcytic
Q1916:Type of anemia: Anemia of chronic disease
Early-stage: Normocytic with a low reticulocyte count;Later-
stage: Microcytic
Q1917:Type of anemia: Thalassemia
Microcytic
Q1918:Sign: Dark blue iron granules around the nucleus of
developing normoblasts
Ringed sideroblasts; indicating sideroblastic anemia
Q1919:Type of anemia: Sideroblastic
Microcytic
Q1920:Type of anemia: Pyridoxine deficiency
Sideroblastic; so Microcytic
Q1921:Type of anemia: Lead poisoning
Sideroblastic; so microcytic
Q1922:Type of anemia: Alcoholism
Either sideroblastic; or anemia of chronic disease. Either way;
microcytic.
Q1923:Type of anemia: Rheumatoid arthritis
Chronic inflammation; so anemia of chronic disease; so
microcytic
Q1924:Type of anemia: TB
Chronic inflammation; so anemia of chronic disease; so;Early:
Normocytic with low reticulocyte count;Later: Microcytic
Q1925:Type of anemia: Malignancy
Anemia of chronic disease; so microcytic
Q1926:Type of anemia: Vitamin B12 deficiency
B12 deficiency or metabolism defect means megaloblastic
macrocytic
Q1927:Type of anemia: Vitamin B12 metabolism defect
B12 deficiency or metabolism defect means megaloblastic
macrocytic
Q1928:Type of anemia: Folate deficiency
Folate deficiency or metabolism defect means megaloblastic
macrocytic
Q1929:Type of anemia: Folate metabolism defect
Folate deficiency or metabolism defect means megaloblastic
macrocytic
Q1930:Type of anemia: DNA synthesis defect
Macrocytic megaloblastic
Q1931:Type of anemia: Liver disease
non-megaloblastic macrocytic;or ;normocytic with a normal
reticulocyte count and an extrinsic RBC defect
Q1932:Type of anemia: Cytotoxic drugs
Macrocytic non-megaloblastic
Q1933:Type of anemia: Hypothyroidism
Q1934:Type of anemia: Stress erythropoiesis
Q1935:Type of anemia: Blood loss
Normocytic;Reticulocyte count;-Less than one week: low;-
More than one week: normal
Q1936:Type of anemia: Aplastic anemia
Normocytic with a low reticulocyte count
Q1937:Type of anemia: Renal disease
Normocytic;Reticulocyte count;-low;-normal: extrinsic defect
hemolytic anemia
Q1938:Type of anemia: Absence of erythropoietin
Q1939:Type of anemia: Replacement of bone marrow
Q1940:Type of anemia: Hereditary spherocytosis
Membrane defect; so;Normocytic hemolytic anemia with
normal reticulocyte count
Q1941:Type of anemia: Hereditary elliptocytosis
Membrane defect; so;Normocytic with normal reticulocyte
count
Q1942:Type of anemia: South-East Asian Ovalocytosis
count
Q1943:Type of anemia: Paroxysmal Nocturnal
Hemoglobinuria
count
Q1944:Type of anemia: G6PD deficiency
Metabolism defect so;Normocytic hemolytic anemia with
Q1945:Type of anemia: Glutathione deficiency
Q1946:Type of anemia: Pyruvate kinase deficiency
Q1947:Type of anemia: Sickle cell disease
Hemoglobin defect so;Normocytic hemolytic anemia with
Q1948:Type of anemia: Drugs
Normocytic hemolytic anemia with normal reticulocyte count
Q1949:Type of anemia: Chemical/Physical agents
Q1950:Type of anemia: Snake bite venom
Toxin so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1951:Type of anemia: Clostridial toxin
Toxin so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1952:Type of anemia: Burns
Injury so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1953:Type of anemia: Fresh water drowning
Injury so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1954:Type of anemia: Hypersplenism
Q1955:Type of anemia: Cold antibody type
Autoimmune so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1956:Type of anemia: Warm antibody type
Autoimmune so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1957:Type of anemia: Alloimmune
Immune so;Normocytic hemolytic anemia with normal
reticulocyte count
Q1958:Type of anemia: Drug induced immune hemolytic
anemia
Drug-induced and/or immune so;Normocytic hemolytic
anemia with normal reticulocyte count
Q1959:Type of anemia: Vasculitis
Red cell fragmentation syndrome so;Normocytic hemolytic
Q1960:Type of anemia: Mechanical devices
Q1961:Type of anemia: Microangiopathic hemolytic anemia
Q1962:Type of anemia: Macroangiopathic hemolytic anemia
Q1963:Type of anemia: March hemoglobinuria
Q1964:How do you identify a reticulocyte?
-Supravital stain (new methylene blue);-RNA filaments
Q1965:How do you get hemoglobin from hematocrit?
hb = (1/3)hct
Q1966:For every unit of packed red blood cells; you increase:
hemoblobin by 1;hematocrit by 3
Q1967:Most common cause of anemia in the world
iron deficiency
Q1968:Most common cause of iron deficiency
GI bleed
Q1969:RDW: Definition
RBC Distribution Width;Checks uniformity of size.
Q1970:Low MCV with Increased RDW
-Increases variation in size: Mixture of normocytic and
microcytic RBCs;-Iron deficiency
Q1971:Spherocyte: membrane defect
Too little membrane
Q1972:Target cell: membrane defect
Too much membrane so more hemoglobin can collect in the
middle
Q1973:Target cell: markers for what?
-Alcoholism;-Hemoglobinopathy
Q1974:How to identify a microcytic cell
Too much central pallor
Q1975:How to identify a spherocyte
-No central pallor;-Small and red
Q1976:Spoon nails: Sign of?
Iron deficiency
Q1977:Cheilosis: Sign of?
-Iron deficiency;-Riboflavin deficiency
Q1978:Pale conjunctiva: Sign of?
Low hemoglobin
Q1979:No red in palmar creases: Sign of?
Iron deficiency
Q1980:Discoloration of gum margin: Sign of?
Known as "lead lines". A sign of lead poisoning.
Q1981:Normal serum iron
About a 100 (like the alveolar oxygen)
Q1982:Serum ferritin: what is it?
Soluble circulating form of iron storage
Q1983:Serum ferritin: what does it represent?
Amount of iron in bone marrow;-Best overall screening test
Q1984:Carrying protein for iron
Transferrin (Carries iron)
Q1985:TIBC: What does it measure?
Transferrin
Q1986:What does increased TIBC indicate?
Increased transferrin synthesis by liver; so decreased iron
stores in the bone marrow.
Q1987:What does decreased TIBC indicate?
Decreased transferrin synthesis by liver; so increased iron
stores in the bone marrow.
Q1988:Define: % iron saturation
Serum iron/TIBC
Q1989:Normal TIBC
300
Q1990:Normal % iron saturation
33%;=normal serum iron/ normal TIBC = 100/300
Q1991:Hemoglobin type: 2 alpha chains and 2 beta chains
HbA
Q1992:Hemoglobin type: 2 alpha chains and 2 delta chains
HbA2
Q1993:Hemoglobin type: 2 alpha chains and 2 gamma chains
HbF
Q1994:Mechanism of pathogenesis in Anemia of Chronic
Disease
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.
Q1995:Where does Hemoglobin synthesis begin?
Mitochondria of RBC
Q1996:First reaction of Hemoglobin synthesis
Succinyl CoA + Glycine (catalyzed by ALA synthetase)
yields delta-ALA;all in the mitochondria
Q1997:What kind of neurotransmitter: Glycine
Inhibitor of muscle.
Q1998:What toxin blocks glycine?
Tetanus
Q1999:Rate limiting step in Heme synthesis
delta-ALA synthesis
Q2000:What enzyme does heme inhibit?
ALA synthase
Q2001:Why does alcoholism cause sideroblastic anemia?
Alcohol is a mitochondrial toxin.
Q2002:What are sideroblasts?
Overloaded mitochondria
Q2003:Why does B6 deficiency cause sideroblastic anemia?
Can't form CoA; so can't form succinyl CoA; so can't do first
reaction of heme synthesis.
Q2004:Mechanism of lead poisoning
Lead denatures ferrochelatase --> Can't form heme
Q2005:Test for lead poisoning
Blood lead levels
Q2006:What are the main groups that we see alpha-
thalassemia?
-Southeast asians;-Black Americans
Q2007:What are the main populations we see beta-
thalassemia in?
-black Americans;-Greeks;-Italians
Q2008:% of Hb that is: HbA
95%
Q2009:% of Hb that is: HbA2
2%
Q2010:% of Hb that is: HbF
1%
Q2011:alpha-thalassemia: mode of inheritance
Autosomal recessive
Q2012:alpha-thalassemia: pathogenesis
problem making alpha chains
Q2013:alpha-thalassemia: electropheresis results
all normal proportions (all Hbs decreased)
Q2014:alpha-thalassemia: one gene deletion
Silent carrier
Q2015:alpha-thalassemia: two gene deletions
alpha-thalassemia minor;-mild anemia (microcytic because
globin is decreased)
Q2016:alpha-thalassemia: three gene deletions
Four beta chains form making HbH. Found in
electropheresis;Called HbH disease
Q2017:alpha-thalassemia: four gene deletions
Four gamma chains form making Hb Bart. Found in
electropheresis. Called hydrops fetalis.
Q2018:Why is choriocarcinoma increased in far east?
1. Increased alpha thalassemia rates;2. Increased spontaneous
abortions due to Hb Bart;3. Increased choriocarcinoma
Q2019:alpha-thalassemia: treatment
Q2020:beta-thalassemia: permutations of problems
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
Q2021:beta-thalassemia: mode of inheritance
autosomal recessive
Q2022:beta-thalassemia: what is the genetic association with
severe anemia?
Nonsense mutation with formation of a stop codon
Q2023:beta-thalassemia: what hemoglobin will decrease
HbA
Q2024:beta-thalassemia: what hemoglobins will increase
HbA2 and HbF
Q2025:beta-thalassemia: electropheresis results
Will show increased HbA2 and HbF with decreased HbA
Q2026:beta-thalassemia: treatment
none
Q2027:Cooley's anemia: disease type
Not making any beta chains (beta 0)
Q2028:Cooley's anemia: Prognosis
Will not live past 30
Q2029:Main way to tell Anemia of chronic disease from Iron
deficiency
Ferritin levels;Low: Iron deficiency;High: Anemia of chronic
disease
Q2030:Stain used to find Ringed Sideroblasts
Prussian Blue
Q2031:Histologic sign associated with Lead poisoning
Coarse basophilic stippling
Q2032:Where does stippling come from?
Inability to break down ribosomes.
Q2033:Classic presentation of lead poisoning in children
-Severe abdominal colic;-Cerebral edema (convulsions; etc);-
Severe microcytic anemia;-Failure to thrive
Q2034:What is seen on a flat plate?
-Iron (if kid took iron tablets);-Lead (from intestine);-
Mercury
Q2035:Mechanism of lead poisoning
Buildup of delta-ALA; leading to neuronal toxicity
Q2036:Presentation of lead poisoning in adults
-Workers from automobile factory or moonshine makers or
pottery painters;-Abdominal colic;-Diarrhea;-Neuropathy
(slapping gait; drops (radial; ulnar palsies); claw hand
Q2037:What is the disease: Serum Iron (low); TIBC (high); %
iron saturation (low); Serum ferritin (low)
Iron deficiency
Q2038:What is the disease: Serum Iron (low); TIBC (low); %
iron saturation (low); Serum ferritin (high)
Anemia of Chronic Disease
Q2039:What is the disease: Serum Iron (normal); TIBC
(normal); % iron saturation (normal); Serum ferritin (normal)
Thalassemia
Q2040:Sideroblastic anemias: Iron status
Iron overload
Q2041:Hemochromatosis: Iron status
Iron overload
Q2042:Hemosiderosis: Iron status
Iron overload
Q2043:What is the disease: Serum Iron (high); TIBC (low); %
iron saturation (high); Serum ferritin (high)
Iron overload (Sideroblastic anemia; hemochromatosis;
hemosiderosis)
Q2044:What do B12 and folate deficiencies most immediately
not allow production of?
dTMP (using Thymidylate synthase) leading to lack of DNA
production
Q2045:What is the size of immature nuclei?
Nucleus gets smaller and more condensed due to increased
DNA?
Q2046:What are cells called with immature nuclei?
Megaloblasts
Q2047:Why is B12 called Cobalamin?
It has cobalt in it.
Q2048:What is the circulating form of Folate?
N5-methyl-Tetrahydrofolate
Q2049:What does B12 do in folate metabolism?
B12 removes methyl group from N5-methyl-THF to make
THF
Q2050:What happens when you add a methyl group to
homocysteine?
Methionine
Q2051:Which amino acid is used for one-carbon transfers?
Methionine
Q2052:What are serum homocysteine levels in B12 or THF
deficiency?
High
Q2053:Why do high homocysteine levels produce
thromboses?
It damages endothelial cells predisposing them to thrombosis.
Q2054:What is the most common cause of high homocysteine
levels?
Folate deficiency
Q2055:Drugs which inhibit folate metabolism
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)
Q2056:What happens if B12 is missing to Methylmalonyl-
CoA?
It builds up; because it cannot form succinyl-coA
Q2057:Sensitive test for B12 deficiency
Methylmalonic acid
Q2058:What is methylmalonic acid level a test for?
B12 deficiency
Q2059:What is the mechanism of B12 deficiency leading to
neurologic deficiencies?
Propionyl CoA builds up; and myelin production is deficient.
Q2060:What are the neurologic effects of B12 deficiency?
Dementia; demyelination of posterior columns
(proprioception and vibratory sensation) and lateral
corticospinal tract (upper motor neuron problems)
Q2061:Serum levels to order in dementia
TSH to rule out hypothyroidism and B12 to rule out B12
deficiency
Q2062:Where is B12 gotten from?
Animal products
Q2063:What is the first factor B12 binds to?
R factor
Q2064:What does R factor do?
It protects B12 from being destroyed?
Q2065:Where does intrinsic factor come from?
Parietal cells in the gastric body and fundus.
Q2066:Where is vitamin B12 absorbed?
Terminal ileum
Q2067:What deficiencies are found in Crohn's disease?
Bile salts and vitamin B12 (both due to reabsorption
problems in terminal ileum)
Q2068:Most common cause of B12 deficiency
Pernicious anemia
Q2069:What is the mechanism in pernicious anemia?
Autoimmune destruction of parietal cells and intrinsic factor
Q2070:What is achlorhydria?
Atrophic gastritis of the body and fundus leading to ;lack of
acid which leads to gastric adenocarcinoma;AND;bacterial
overgrowth from stasis
Q2071:Causes for achlorhydria
Tapeworms; pernicious anemia; folate deficiency
Q2072:Eaten form of folate
Polyglutamate
Q2073:What converts polyglutamate to monoglutamate?
Intestinal conjugase
Q2074:What drug blocks intestinal conjugase?
Phenytoin
Q2075:What is the mechanism of Phenytoin?
Blocks intestinal conjugase
Q2076:What blocks absorption of monoglutamate from
jejunum?
Alcohol and oral contraceptives
Q2077:What are hypersegmented neutrophils with neurologic
deficiency diagnostic for?
Vitamin B12 deficiency
Q2078:What are hypersegmented neutrophils without
neurologic deficiency diagnostic for?
Folate deficiency
Q2079:What is a characteristic CBC finding in macrocytic
anemia?
Pancytopenia
Q2080:Schilling's test
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.
Q2081:Stages of iron deficiency
1. Ferritin goes down;2. Iron decreases; TIBC increases; %
iron sat decreases;3. Mild normocytic anemia;4. Microcytic
anemia
Q2082:What test must be ordered to confirm aplastic anemia?
Bone marrow study
Q2083:Most common cause of aplastic anemia
Idiopathic
Q2084:Most common known cause of aplastic anemia
Drugs (Indomethacin; Phenylbutazone; Thyroid-related drugs;
Chloramphenicol)
Q2085:Second most common known cause of aplastic anemia
Hepatitis C
Q2086:Most common infective cause of pure RBC aplasia
Parvovirus
Q2087:Mechanisms of hemolysis
1) Intravascular hemolysis;2) Extravascular hemolysis which
is more common
Q2088:What is the mechanism of extravascular hemolysis?
Macrophages kill them at the Cords of Bilroth
Q2089:What are some causes of RBCs being phagocytosed at
the cords of Bilroth?
IgG or c3b on the surface;or Howell-Jolly bodies inside; or an
abnormal shape (such as spherical or sickle cell)
Q2090:End product of phagocytosing an RBC
Unconjugated bilirubin
Q2091:Clinical finding in extravascular hemolysis
Jaundice; which is due to unconjugated bilirubin due to
macrophages phagocytosing red blood cells.
Q2092:Causes of intravascular hemolysis
1) Congenital bicuspid aortic valve;2) IgM binding to surface
and activating complement system
Q2093:End product of intravascular hemolysis
Hemoglobin
Q2094:Name of protein which binds free hemoglobin in blood
Haptoglobin
Q2095:Clinical findings in intravascular hemolysis
1) Hemoglobinuria;2) Low haptoglobin levels
Q2096:general steps in hormone synthesis
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
Q2097:amine hormones
derivates of TYROSINE; include thyroid hormone; Epi; NE
Q2098:active form of G protein?
ATP-bound to alpha subunit
Q2099:how does caffeine work?
inhibits phosphodiesterase which degrades cAMP (get more
cAMP)
Q2100:IP3 signalling mech
hormone + R--> Gq --> PLC --> DAG and IP3 --> PKC
Q2101:which hormones of anterior pituitary most
homologous to TSH?
FSH; LH (identical alpah subunits)
Q2102:"children" of POMC
ACTH; MSH; beta-lipotropin; beta-endorphin
Q2103:which hormone of anterior pituitary most related to
GH?
prolactin
Q2104:what increases the pulsatile secretion of GH?
sleep; stress; puberty; starvation; exercise; hypoglycemia
Q2105:what decreases GH secretion?
somatostatin; somatomedins; obesity; hyperglycemia;
preggers
Q2106:what does GH do in liver?
causes production of somatomedins (insulin-life growth
factors)
Q2107:4 direct actions of GH
1. dec'd glucose uptake into cells; 2. inc'd lipolysis; 3. inc'd
protein synthesis in mm; 4. inc'd production of IGF
Q2108:actions of GH via IGF
inc'd protein synthesis! In chondrocytes--> growth spurt; in
mm-->inc'd lean body mass; inc'd organ size
Q2109:how is prolactin secretion regulated?
tonic inhibition by dopamine (which is stimulated by PRL);
TRH increases PRL secretion
Q2110:4 actions of PRL
1. stim milk production; 2. stim breast development
(w/estrogen); 3. inhibits ovulation via GnRH inhibition; 4.
inhibits spermatogenesis
Q2111:how treat PRL excess?
bromocriptine (DA agonists)
Q2112:hormones of the posterior pituitary?
ADH (supraoptic hypothal); oxytocin (paraventricular
hypothal)
Q2113:what inhibits the iodide pump/trap in thyroid
follicular epithelial cells?
thiocyanate and perchlorate anions
Q2114:Wolff-Chaikoff effect?
high levels of I- inhibit I- pump
Q2115:significance of propylthiouracil?
inhibits peroxidase enzyme (which first catalyzes oxidation of
I- to I2;and then other steps); used for treatment of
hyperthyroidism
Q2116:what happens when TSh stimulates thyroid?
iodinated thyroglobulin is taken back into follicular cells;
digested and T3; T4 released into circulation. Leftover MIT;
DIT deiodinated by thyroid deiodinase
Q2117:what happens to T3; T4 in circulation?
mostly bound to TBG (inc'd in preggers); peripherally; T4--
>T3 or rT3
Q2118:bone manifestation of thyroid deficiency?
bone age < chronologic age; b/c TH stimulates bone
maturations
Q2119:effect of TH on heart?
upregulates beta 1 R
Q2120:effect of TH on O2 consumption?
increases b/c of upregulation of Na-K ATPase (which uses
ATP;which comes from O2;kinda)
Q2121:which part of adrenal cortex makes mineralocorticoids?
(outermost) zona glomerulosa (works on kidneys;which have
glomeruli)
Q2122:which part of adrenal cortex makes glucocorticoids?
(middle) zona fasciculata
Q2123:which part of adrenal cortex makes androgens (DHEA;
androstenedione)
(innermost) zona reticularis (b/c you should be really
particularis of your sex partners)
Q2124:effect of ACTH on adrenal cortex?
stimulates cholesterol desmolase thereby increasing steroid
synthesis; also upregulates own R
Q2125:control of aldosterone secretion?
tonically--ACTH; also Ang II stimulates aldosterone synthase
(corticosterone--> aldosterone)
Q2126:4 actions of glucocorticoids
1. stim gluconeogenesis; 2. anti inflamm; 3.
immunosuppressive; 4. upregulate alpha 1 R on arterioles
Q2127:how do glucocorticoids stimulate gluconeogenesis?
1. increase protein catabolism in mm (more aa available);
2)decrease glucose utilization and insulin sensitivty of fat; 3)
increase lipolysis (more glycerol available)
Q2128:how are glucocorticoids anti-inflammatory?
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
Q2129:Name the dz: Increased ACTH; hypoglycemia;
hyperpigmentation; ECF volume contraction
Addison's disease
Q2130:how is secondary adrenocortical insufficiency different
from Addison's?
no hyperpigmentation; no volume contraxn ;hyperKalemia;
metab acidosis
Q2131:Conn's syndrome leads to?
HTN; hypokalemia; metab alkalosis; dec'd renin
Q2132:name the dz: decreased cortisol and aldosterone;
increased adrenal androgens; virilization; suppression of gonad
function
21 hydroxylase deficiency
Q2133:name the dz: decreased androgen and glucocorticoid
levels; increased aldosterone; hypoglycemia; lack of pubes
17 hydroxylase deficiency
Q2134:3 major cell types and their main export in islets of
Langerhans?
alpha--glucagon; beta--insulin; delta--somatostatin; gastrin
Q2135:what do delta cells islets of Langerhans secrete?
somatostatin; gastrin
Q2136:what stimulates glucagon release from alpha cells?
decreased blood glucose
Q2137:3 actions of glucagon
1. increase blood glucose; 2. increase blood FA; ketoacids; 3.
increase urea production
Q2138:mechanism of insulin secretion?
glucose binds GLUT 2 on beta cell membrane-->
depolarization of membrane--> Ca channel opens; influx -->
insulin secretion
Q2139:why get hyPOtension in uncontrolled DM?
high [glucose] exceeds Tm in kidney so urine is very sugary--
>osmotic diuretic
Q2140:what stimulates secretion of PTH?
dec'd Ca; mildly dec'd Mg (severe hypoMg inhibits PTH
secretion!)
Q2141:"goal" of PTH
increase calcium; decrease phosphate
Q2142:4 actions of PTH
1. increase bone reabsorp; 2 inhibit renal phosphate
reabsorp.(PCT); 3. increase renal Ca reabsorp; 4. stimulate
production of active vit D
Q2143:Albright's hereditary osteodystrophy
pseudohypoparathyroidism cause by defective Gs in kideny
and bone-->end organ resistance to PTH
Q2144:how does chronic renal failure lead to hypocalcemia?
increased GFR--> increased sr phosphate which complexes
with Calcium; thereby decreasing free Ca; also decreased vit D
Q2145:"goal" of vit D
increase calcium and phosphate in ECF for bone
mineralization
Q2146:Calcitonin: a) where b)stim'd by c)action
a)parafollicular thyroid cells; b) increased sr Ca; c) inhibit
bone reabsorp.
Q2147:what do Leydig cells make?
testosterone
Q2148:why can't Leydig cells make glucocorticoids and
mineralocorticoids?
no 21 beta hydroxylase or 11 beta hydroxylase
Q2149:significance of 5 alpha reductase?
enzyme that converts testosterone to DHT; found in
accessory sex organs like the prostate
Q2150:significance of finasteride?
inhibits 5alpha reductase (can tx BPH)
Q2151:FSH acts on Sertoli cells to?
stimulate production of inhibin which has negative feedback
effect on FSH
Q2152:what do theca cells make?
androgens which are converted to estrogens by aromatase in
granulosa cells
Q2153:2 causes of end organ ADH resistance
1. drugs (Li!!! Inhibits Gs); 2. severe hypercalcemia (inhibits
AC)
Q2154:which diuretics can also be used for treatment of acute
mountain sickness?
carbonic anhydrase inhibitors like acetazolamide (metabolic
acidosis to combat respiratory alkalosis)
Q2155:why get HTN in 11beta hydroxylase deficiency?
the precursor that the enzyme would act on is a weak
mineralocorticoid
Q2156:Factors that affect hormone binding protein synthesis
Estrogen increases binding proteins; androgens decrease
binding proteins. In pregnancy there's increased total
hormones with normal levels of free hormone.
Q2157:Site of synthesis of CRH
Paraventricular nucleus
Q2158:Site of synthesis of TRH
Paraventricular nucleus
Q2159:Site of synthesis of PIF
Arcuate nucleus
Q2160:Site of synthesis of GHRH
Arcuate nucleus
Q2161:Site of synthesis of GnRH
Preoptic region
Q2162:Site of synthesis of ADH
Supraoptic and paraventricular nuclei
Q2163:How do hypothalamic hormones reach the anterior
pituitary?
Hormones are released in the hypophyseal-portal system
Q2164:Hypothalamic hormones
GHRH; GnRH; PIF (dopamine); TRH; CRH; Somatostatin;
ADH; prolactin
Q2165:Anterior pituitary hormones
ACTH; TSH; LH; FSH; GH; prolactin
Q2166:Sheehan syndrome
Ischemic necrosis of the pituitary due to severe blood loss
during delivery. Causes hypopituitarism.
Q2167:Obstruction of pituitary stalk
Adenoma compresses pituitary stalk and decreases secretion
of anterior pituitary hormones except prolactin.
Q2168:What prevents downregulation of pituitary receptors?
Pulsatile release of hypothalamic hormones.
Q2169:Hyperprolactinemia
Results from dopamine antagonists or pituitary adenomas
that compress the pituitary stalk. Amenorrhea; galactorrhea;
decreased libido; impotence; hypogonadism
Q2170:What hormone controls release of cortisol and adrenal
androgens?
ACTH
Q2171:What hormone regulates release of aldosterone?
Angiotensin II and also potassium in hyperkalemia
Q2172:Layers of the adrenal cortex
From external to internal: glomerulosa (aldosterone);
fasciculata (cortisol); reticularis (androgens)
Q2173:Consequences of loss of zona glomerulosa
No aldosterone: loss of Na; decreased ECF; decreased blood
pressure; circulatory shock; death
Q2174:Consequences of loss of zona fasciculata
No cortisol: circulatory failure (cortisol is permissive for
cathecolamine vasoconstriction); can't mobilize energy stores
during exercise or cold (hypoglycemia)
Q2175:Consequences of loss of adrenal medulla
No epinephrine: decreased capacity to mobilize fat and
glycogen during stress. Not necessary for survival.
Q2176:What are the 17-OH steroids?
17OHpregnenolone; 17OHprogesterone; 11-deoxycortisol;
cortisol. Urinary 17OH steroids are an index of cortisol
secretion.
Q2177:What is the rate-limiting enzyme for steroid hormone
synthesis?
Desmolase - converts cholesterol into pregnenolone
Q2178:What are the 17-ketosteroids?
DHEA and androstenidione
Q2179:DHEA
Weak androgen 17-ketosteroid conjugated with sulfateto make
it water-soluble
Q2180:What is measured as an index of androgen production?
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.
Q2181:Stimulus for the zona glomerulosa
Angiotensin II and potassium in hyperkalemia stimulate
production of aldosterone
Q2182:Hormone responsible for negative feedback for ACTH
release
Cortisol
Q2183:Enzyme deficiencies that produce congenital adrenal
hyperplasia and low cortisol levels
21beta -OH; 11beta -OH and 17alpha -OH all result in low
cortisol levels.
Q2184:21beta -OH deficiency
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
Q2185:11beta -OH deficiency
Excess 11-deoxycorticosterone: Na and water retention; low-
renin hypertension. No cortisol (low 17OH steroids): skin
hyperpigmentation (due to excess ACTH); adrenal
hyperplasia; fasting hypoglycemia. Excess androgens (17-
ketosteroids): female pseudohermaphrodite; hirsutism
Q2186:17alpha -OH deficiency
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.
Q2187:decreased 17OH-steroids increased ACTH; decreased
blood pressure; decreased mineralocorticoids; increased 17-
ketosteroids
21beta -OH deficiency
Q2188:decreased 17OH-steroids increased ACTH; increased
blood pressure; decreased aldosterone; increased 11-
deoxycorticosterone; increased 17-ketosteroids
11beta -OH deficiency
Q2189:decreased 17OH-steroids increased ACTH; increased
blood pressure; decreased aldosterone; increased 11-
deoxycorticosterone; decreased 17-ketosteroids
17alpha -OH deficiency
Q2190:Stress hormones
GH; Glucagon; cortisol; epinephrine
Q2191:Actions of GH in stress situations
Mobilizes fatty acids by increasing lipolysis in adipose tissue
Q2192:Actions of glucagon in stress situations
Mobilizes glucose by increasing liver glycogenolysis
Q2193:Actions of cortisol in stress situations
Mobilizes fat; carbs and proteins
Q2194:Actions of epinephrine in stress
Mobilizes glucose via glycogenolysis and fat via lipolysis.
Q2195:Metabolic actions of cortisol
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.
Q2196:Permissive actions of cortisol
Enhances glucagon (without cortisol --> fasting
hypoglycemia); enhances epinephrine (without cortisol --
>hypotension)
Q2197:alpha -MSH
Stimulates melanocytes and causes darkening of skin.
Synthesized along with ACTH from pro-opiomelanocortin.
Q2198:increased cortisol; decreased CRH; decreased ACTH;
no hyperpigmentation
Primary hypercortisolism
Q2199:decreased cortisol; increased CRH; increased ACTH;
hyperpigmentation
Addison disease - primary hypocortisolism
Q2200:increased cortisol; decreased CRH; increased ACTH;
hyperpigmentation
Secondary hypercortisolism
Q2201:decreased cortisol; increased CRH; decreased ACTH;
no hyperpigmentation
Secondary hypocortisolism
Q2202:decreased cortisol; decreased CRH; decreased ACTH;
no hyperpigmentation; symptoms of excess cortisol
Steroid administration
Q2203:Cushing syndrome
Protein depletion; weak inflammatory response; poor wound
healing; hyperglycemia; hyperinsulinemia; insulin resistance;
hyperlipidemia; osteoporosis; purple striae; hirsutism;
hypertension; hypokalemic alkalosis; buffalo hump
Q2204:Actions of aldosterone
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.
Q2205:Addison disease
increased ACTH; hyperpigmentation; hypotension (no
aldosterone; no cortisol); hyperkalemic metabolic acidosis (no
aldosterone); loss of body hair (no androgens); hypoglycemia;
increased ADH secretion
Q2206:Causes of secondary hyperaldosteronism
CHF; vena cava constriction; cirrhosis; renal artery stenosis
Q2207:Primary hyperaldosteronism
Na and water retention; hypertension; hypokalemic metabolic
alkalosis; decreased renin and angiotensin; no edema due to
pressure diuresis and natriuresis.
Q2208:Primary hypoaldosteronism
Na and water loss; hypotension; hyperkalemic metabolic
acidosis; increased renin and angiotensin II; no edema
Q2209:Secondary hyperaldosteronism
increased renin and angiotensin II; increased Na and water
retention in venous circulation; edema
Q2210:Factors that influence ADH secretion
increased osmolarity --> increased ADH secretion; decreased
blood volume --> baroreceptors --> medulla --> increased
ADH secretion
Q2211:Actions of ADH
Inserts water channels in luminal membrane of collecting
ducts; increases reabsorption of water.
Q2212:Central diabetes insipidus
Not enough ADH secreted. Dilute urine is formed in spite of
water deprivation. Responds to injected ADH.
Q2213:Nephrogenic diabetes insipidus
ADH is secreted but ducts are unresponsive to it. Dilute urine
is formed in spite of water deprivation or injected ADH.
Q2214:SIADH
Excessive secretion of ADH in spite of low osmolarity.
Concentrated urine is formed.
Q2215:decreased permeability of collecting ducts; increased
urine; decreased urine osmolarity; decreased ECF; increased
osmolarity
Diabetes insipidus
Q2216:increased permeability of collecting ducts; decreased
urine; increased urine osmolarity; decreased ECF; increased
osmolarity
Dehydration
Q2217:increased permeability of collecting ducts; decreased
urine; increased urine osmolarity; increased ECF; decreased
osmolarity
SIADH
Q2218:decreased permeability of collecting ducts; increased
urine; decreased urine osmolarity; increased ECF; decreased
osmolarity
Primary polydipsia
Q2219:Actions of ANP
Atrial stretch or increased osmolarity --> ANP secretion -->
dilation of afferent; constriction of efferent --> increased
GFR --> natriuresis; also decreases permeability of collecting
ducts to water.
Q2220:Delta cells of the pancreas
Between alpha and beta cells; represent 5% of islets. Secrete
somatostatin.
Q2221:Alpha cells of the pancreas
Near the periphery of the islets; represent 20%. Secrete
glucagon.
Q2222:Beta cells of the pancreas
In the center of the islets; represent 60-75%. Secrete insulin
and C peptide.
Q2223:Insulin receptor
Has intrinsic tyrosine kinasae activity. Insulin receptor
substrate binds tyrosine kinase; activates SH2 domain
proteins: PI-3 kinase (translocation of GLUT-4); p21RAS.
Q2224:Tissues that require insulin for glucose uptake
Resting skeletal muscle and adipose tissue
Q2225:Tissues independent of insulin for glucose uptake
Brain; kidneys; intestinal mucosa; red blood cells; beta cells of
the pancreas.
Q2226:Anabolic hormones
Insulin; GH/IGF-1; androgens; T3/T4; IGF-1 (somatomedin
C)
Q2227:Effects of insulin on potassium
Increases Na/K ATPase uptake of K. Insulin + glucose used
to treat hyperkalemia.
Q2228:Mechanism of insulin release
Glucose enters beta cells and is metabolized --> increased
ATP --> closes K channels --> increased depolarization -->
increased Ca influx --> exocytosis of insulin.
Q2229:Factors that stimulate secretion of insulin
Glucose; arginine; GIP; glucagon
Q2230:Factors that inhibit insulin release
Somatostatin; norepinephrine via alpha 1 receptors
Q2231:increased glucose; increased insulin; increased C
peptide
Type 2 diabetes
Q2232:increased glucose; decreased insulin; decreased C
peptide
Type 1 diabetes
Q2233:decreased glucose; increased insulin; increased C
peptide
Insulinoma
Q2234:decreased glucose; increased insulin; decreased C
peptide
Factitious hypoglycemia (insulin injection)
Q2235:Actions of somatomedin C
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.
Q2236:Secretion of GH
Pulsatile during non-REM sleep; more frequent in puberty
due to increased androgens; requires thyroid hormones;
decreases in the elderly.
Q2237:Factors that stimulate GH secretion
Deep sleep; hypoglycemia; exercise; arginine; GHRH; low
somatostatin
Q2238:Factors that inhibit GH secretion
Negative feedback by GH on GHRH; positive feedback on
somatostatin by IGF-1
Q2239:Dwarfism
Due to GH insensitivity during prepuberty
Q2240:Acromegaly
Due to excess GH in postpuberty. Enlargement of hands; feet
and lower jaw; increased proteins; decreased fat;
visceromegaly; cardiac insuficiency.
Q2241:Composition of bone
Phosphate and calcium precipitate forming hydroxyapatite in
osteoid matrix.
Q2242:Actions of PTH
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.
Q2243:Clinical features of primary hyperparathyroidism
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.
Q2244:Clinical features of primary hypoparathyroidism
decreased plasma Ca and increased plasma phosphate;
hypocalcemic tetany due to increased excitability of motor
neurons.
Q2245:increased PTH; increased Ca; decreased phosphate
Primary hyperparathyroidism. Causes: parathyroid adenoma
(MEN I and II); ectopic PTH tumor (lung squamous CA)
Q2246:decreased PTH; decreased Ca; increased phosphate
Primary hypoparathyroidism. Cause: surgical removal of
parathyroid.
Q2247:increased PTH; decreased Ca; increased phosphate
Secondary hyperparathyroidism due to renal failure (no active
vitamin D; decreased GFR)
Q2248:increased PTH; decreased Ca; decreased phosphate
Secondary hyperparathyroidism. Causes: deficiency of
vitamin D due to bad diet or fat malabsorption.
Q2249:decreased PTH; increased Ca; increased phosphate
Secondary hypoparathyroidism due to excess vitamin D.
Q2250:Vitamin D synthesis
Dietary and skin cholecalciferol is hydroxylated by 25-
hydroxylase in the liver and activated to 1;25 di-OH
cholecalciferol by 1-alpha hydroxylase in the proximal
tubules.
Q2251:Actions of 1;25 di-OH cholecalciferol
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.
Q2252:Osteomalacia
Underminerilized bone in adults due to vitamin D deficiency
leads to bone deformation and fractures. Low calcium leads to
secondary hyperparathyroidism.
Q2253:Rickets
Underminerilized bone in children due to vitamin D deficiency
leads to bone deformation and fractures. Low calcium leads to
secondary hyperparathyroidism.
Q2254:Excess vitamin D
Leads to bone reosprtion and demineralization
Q2255:Synthesis of thyroid hormones
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.
Q2256:Structure of thyroid hormones
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.
Q2257:Secretion of thyroid hormones
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.
Q2258:Transport of thyroid hormones
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.
Q2259:Activation and degradation of thyroid hormones
5' monodeiodinase activates T4 into T3. 5-monodeiodinase
inactivates T4 into reverse T3.
Q2260:Actions of thyroid hormones
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.
Q2261:Effects of hypothyroidism in newborns
decreased dendritic branching and myelination lead to mental
retardation.
Q2262:Effects of hypothyroidism in juveniles
Cretinism results in decreased bone growth and ossification --
> dwarfism. Due to lack of permissive action on GH.
Q2263:Control of thyroid hormone secretion
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.
Q2264:Effects of TSH
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.
Q2265:decreased T4; increased TSH; increased TRH
Primary hypothyroidism; increased TSH is the more sensible
index
Q2266:decreased T4; decreased TSH; increased TRH
Pituitary (secondary) hypothyroidism
Q2267:decreased T4; decreased TSH; decreased TRH
Hypothalamic (tertiary) hypothyroidism
Q2268:increased T4; increased TSH; decreased TRH
Pituitary (secondary) hyperthyroidism
Q2269:increased T4; decreased TSH; decreased TRH
Graves disease
Q2270:Pathophysiology of iodine deficiency
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.
Q2271:Clinical features of hypothyroidism
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
Q2272:Clinical features of hyperthyroidism
increased metabolic rate with heat intolerance and sweating;
increased apetite with weight loss; muscle weakness; tremor;
irritability; tachycardia; exophthalmos.
Q2273:Leydig cells
Stimulated by LH; produce testosterone for peripheral tissues
and Sertoli cells. Testosterone provides negative feedback for
LH secretion by pituitary.
Q2274:Sertoli cells
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.
Q2275:decreased sex steroids; increased LH; increased FSH
Primary hypogonadism or postmenopause.
Q2276:decreased sex steroids; decreased LH; decreased FSH
Pituitary hypogonadism or constant GnRH infusion
(downregulates GnRH receptors of pituitary.
Q2277:increased sex steroids; decreased LH; decreased FSH
Anabolic steroid therapy. LH supression causes Leydig cell
atrophy with decreased Leydig testosterone which
suppresses spermatogenesis.
Q2278:increased sex steroids; increased LH; increased FSH
Pulsatile infusion of GnRH
Q2279:Fetal development of male structures
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.
Q2280:Characteristics of sub-threshold potentials
Proportional to stimulus strength; not propagated;
decremental with distance; summation
Q2281:Characteristics of action potentials
Independent of stimulus strength; propagated unchanged in
magnitude; summation not possible
Q2282:Factors that affect conduction velocity of the action
potential
Cell diameter and amount of myelination are directly
proportional to conduction velocity
Q2283:Absolute refractory period
No stimulus can depolarize the cell
Q2284:Relative refractory period
A large stimulus can depolarize the cell
Q2285:Neuromuscular transmission
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
Q2286:Excitatory postsynaptic potentials
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
Q2287:Inhibitory postsynaptic potentials
increased gCl or increased gK hyperpolarize the cell and lower
threshold for depolarization
Q2288:Electrical synapse
Action potential transmitted from one cell to the next via gap
junctions; without synaptic delay and in both directions.
Cardiac muscle; smooth muscle.
Q2289:Sarcomere A band
Contains overlapping actin and myosin. Does not shorten
during contraction.
Q2290:Sarcomere H zone
Contains thick myosin filaments. Shortens during contraction.
Q2291:Sarcomere I band
Contains thin actin filaments. Shortens during contraction.
Q2292:Sarcomere Z line
Within the I band.
Q2293:Sarcomere M line
Within the H zone.
Q2294:Actin
Structural protein of the thin filaments; contains attachment
sites for myosin cross-bridges.
Q2295:Myosin
Structural protein of the thick filaments; contains cross-
bridges that attach to actin. Has ATPase activity to terminate
actin-myosin cross-bridges. ATP decreases actin-myosin
affinity.
Q2296:Tropomyosin
Part of thin filaments. Covers the actin attachment sites for
the myosin cross-bridges
Q2297:Troponin
Part of thin filaments; binds calcium; which moves
tropomyosin out of the way exposing actin binding sites for
cross-bridges.
Q2298:What happens if calcium is removed to the
sarcoplasmic reticulum?
Muscle goes back to resting state. Removal of calcium
requires ATP.
Q2299:Rigor mortis
Depletion of ATP - cycling stops with myosin attached to
actin - (muscle contracted).
Q2300:Muscle contraction steps
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.
Q2301:Myosin ATPase
Hydrolizes ATP to supply energy for active tension and
shortening. ATP decreases myosin-actin affinity
Q2302:Sarcoplasmic calcium-dependent ATPase
Supplies energy to terminate contraction and pump Ca back
into sarcoplasmic reticulum.
Q2303:Source of calcium for skeletal muscle contraction
Sarcoplasmic reticulum. No extracellular calcium is involved
because it doesn’t have voltage-gated Ca channels.
Q2304:Source of calcium for heart and smooth muscle
contraction
Sarcoplasmic reticulum and extracellular. Cardiac and smooth
muscle have voltage-gated calcium channels.
Q2305:Tetanus
Multiple action potentials increase release of calcium thus
increasing contraction. Muscle cells have a short refractory
period.
Q2306:Preload
Stretch prior to contraction. increased preload --> increased
prestretch of the sarcomere --> increased passive tension
Q2307:Afterload
The load the muscle is working against. increased afterload --
> increased cross-bridge cycling --> increased active tension
Q2308:What is the best measure of preload?
Sarcomere length
Q2309:Preload-length tension curve
It’s a function of the legth of the relaxed muscle. A positive
parabola.
Q2310:Isomertric contraction
Active tension is produced but length stays the same.
Afterload is greater than active tension; load not moved.
Q2311:How is active tension produced?
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.
Q2312:Total tension
Passive (preload) tension + active (afterload) tension
Q2313:Active tension curve
It's a function of the number of cross-bridges capable of cross-
linking with actin. Negative parabola.
Q2314:What is L0?
The optimum length to produce maximum active tension.
Beyond L0; muscle is overstretched; below L0; it's
understretched.
Q2315:Isotonic contraction
Muscle contracts and shortens to move the load. Occurs when
total tension equals the load.
Q2316:Most energy demanding phase of cardiac cycle
Isovolumetric contraction. Active tension is generated.
Equivalent to isometric contraction of skeletal muscle.
Q2317:Relationship between load; muscle force and muscle
velocity
increased ATPase activity --> increased velocity; increased
muscle mass --> increased force generated; increased
afterload --> decreased velocity
Q2318:Regulation of skeletal muscle force and work
increased frequency of action potentials; increased
recruitment; increased preload and increased afterload -->
increased force and work
Q2319:Regulation of cardiac and smooth muscle force and
work
Factors that regulate force and work are preload; afterload and
contractility (which is altered by hormones). No summation
nor recruitment.
Q2320:Characteristics of white muscle
Large mass; high ATPase activity (fast muscle); anaerobic
glycolysis; low myoglobin
Q2321:Characteristics of red muscle
Small mass; low ATPase activity (slower muscle); aerobic
metabolism (mitochondria); high myoglobin.
Q2322:Characteristics of skeletal muscle
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
Q2323:Characteristics of cardiac muscle
Actin and myosin form sarcomeres; gap junctions; electrical
syncytium; troponin binds calcium; intermediate ATPase
activity; dyadic contacts by T-tubules near Z-lines; voltage-
gate calcium channels.
Q2324:Characteristics of smooth muscle
Actin and myosin not organized in sarcomeres; gap junctions;
electrical syncytium; calmodulin binds calcium; low ATPase
activity; lacks T-tubules; voltage-gated calcium channels.

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Physiology & Pathophysiology - 2000

Physiology & Pathophysiology - 2000

Physiology & Pathophysiology - 2000