• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/445

Click to flip

445 Cards in this Set

  • Front
  • Back
How do you treat Alzheimer's disease?
Donepezil, rivastigmine, galantamine; memantine
What parasympathetic neurons will atropine NOT have an affect?
Muscles, esophageal sphincter tone (VIP), gastrin (GRP)
What neurons use VIP and what is its action? What neurons use GRP and what is its action?
VIP: relax esophageal sphincter; GRP: increase gastrin release (both are vagal)
What is oxybutynin's MOA and what is it used for?
Anticholinergic; urinary incontinence
What is the stimulation and inhibition for gastrin secretion?
Stimualted by: stomach distension => stimulates vagus nerve => release GRP, peptides in lumen; inhibited by: low pH
What is the only GI hormone that increases motility?
Gastrin
What are metabolic and non metabolic causes of cherry red macula?
Metabolic: Neimann-Pick, Tay-Sach's; non metabolic: central retinal artery occlusion
What is the other name for Gastric inhibitory polypeptide?
GLP
Does FREQUENCY or FORCE increase when you stimulate GI motility?
FORCE, not frequency
What is the basal electric pacemaker for the stomach vs small intestine?
Stomach is 3; small intestine is 12 & decreases as you go down the tract
What is the fastest substance to leave the stomach? Why?
Normal saline; same osmolality as blood and pH of 7
What inhibits the migrating motor complex?
Meals!
What is a pathologic proccess of migrating motor complexes?
Irritable bowel syndrome
What kind of saliva does parasympathetic and sympathetic nervous system produce?
Para: high volume, thin; symp: lower volume, thick
What monosaccharide is independent of sodium cotransport?
Fructose via GLUT5
What is triglyceride metabolized into by pancreatic lipase?
2-monoglyceride and 2 free fatty acids
What is the function of the colon?
Secrete potassium and bicarb, absorbs most of the water
What ions will be depleted with diarrhea? Why?**********
Bicarb and potassium (hypokalemia, metabolic acidosis); because the colon excretes potassium and bicarbonate
What hormone tells the colon to absorb sodium and excrete potassium?
Aldosterone
Does diarrhea produce an normal anion gap or anion gap metabolic acidosis? Why?
Non-anion gap, because chloride is excreted in the diarrhea to keep the anion gap normal
What are the only two causes of normal anion gap metabolic acidosis?
Diarrhea, renal tubular acidosis
How do you know it's invasive diarrhea?
Blood in stool, WBCs
What are three causes of decreased binding globulin and one cuase of increased?
Decreased: liver disease, androgens, nephrotic syndrome; increased: estrogen
What is the most accurate method of diagnosis pan-hypopituitarism?
Inject insulin, induce hypoglycemia (spikes cortisol, GH); inject arginine
What's the best way to test for acromegaly?
Give glucose, observe failure of GH to decrease in response to hyperglycemia
What is the ONLY peptide hormone that isn't water soluble (is bound to a carrier)?
IGF
What is the ONLY steroid hormone that is water soluble?
DHEA-sulfate
What hormone is cortisol permessive on?
Glucagon
What hormone is thyroxine permessive on?
Growth hormone
What's the only hormone from the HPAxis that isn't released in a puslsatile fashion?
Thyroid hormone
What drug must you use before leuprolide in metastatic prostate cancer?
Flutamide
What drugs can cause SIADH?
Sulfas, cyclophosphamide, carabamazapine
Dysfunction of what two organs can cause SIADH?
Brain or lungs
What's the major treatment for SIADH?
Fluid restriction
What does elevated 17 hydroxyprogesterone suggest?
21 alpha hydroxylase deficiency (congenital adrenal hyperplasia)
Is cortisol catabolic or anabolic?
Anabolic
Is growth hormone catabolic or anabolic?
Catabolic
What three organs does aldosterone have an affect?
Kidneys, salivary glands, colon
Where does PTH work on the kidney for calcium?
Distal tubule (same place as HCTZ)
Where does PTH work on the kidney for phosphate?
Proximal tubule
What does hydroxyproline in the urine indicate?
Bone breakdown; metabolism of the type I collagen!
What is the effect of abnormally high vitamin D levels?
Increases bone reabsorption, increasing calcium and phosphate
How do phosphate and calcium levels change in secondary hyper/hypo parathyroidism?
Hyper: both low; hypo: both are high
How do phosphate and calcium levels change in primary hyper/hypo parathyroidism?
Hyper: high calcium, low phosphate; hypo: low calcium, high phosphate
What protein is the storage form of thyroid hormone?
Thyroglobulin
What protein is the transport molecule for thyroid hormone?
Thryoid binding globulin
What would be the effect of thyroid hormone loss in a 1 month old? 6 year old? 12 years old?
Certinism in a neonate; dwarfism in an older kid because T4 is required to potentiate growth hormone; no puberty
What blood test do you do for acromegaly?
IGF-1
What kills someone with acromegaly?
Heart failure (HTN, hyperglycemia => accelerated coronary artery disease)
What is the initial tx for acromegaly?
First excise tumor, then follow up with pegvisomant / octreotide / bromocriptine if acromegaly persists
What is a good sertoli cell tumor marker?
Estradiol
What kind of antihypertensive post MI is most likely to cause erectile dysfunction?
Beta blockers
What hormone doe FSH and LH stimulate in the ovary?
LH stimulates progesteorne, FSH stimulates estrogen
Why doesn't lactation occur during pregnancy despite high prolactin levels?
Estrogen and progesterone block lactation
What prevents a breast feeding woman from ovulating?
Prolactin suppression of GnRH
What should you use to measure plasma volume? ECF volume? Total body water?
Plasma = albumin, ECF = inulin, TBW = tritiated water, urea
What is the effective osmolality of urea?
Zero
What is the mechanism of edema in cardiogenic and non-cardiogenic pulmonary edema?
Cardiogenic: increased capillary hydrostatic pressure; ARDS: increased capillary permeability
What binds to calcium in the sarcomere?
Troponin
What blocks myosin head from binding actin?
Tropomyosin
What causes myosin disassociation from actin? What causes the power stroke?
ATP binding causes disassocation; ATP cleavage to ADP cuases power stroke
Which muscle fiber type has a lot of mitochondria? Which type has a lot of glycolytic enzymes?
Red = mitochondria, white = glycolytic
Do smooth muscles have sarcomeres?
No
What does calcium bind to in skeletal, cardiac, and smooth muscle?
Cardiac & skeletal = troponin; smooth = calmodulin
What kind of T tubules are found in skeletal, cardiac, and smooth muscles?
Traid = skeletal, cardiac = diads, no t tubules in smooth muscles b/c it's an electrical syncitium
What is the MOA of cosyntropin?
ACTH analog
What part of the systemic vascular circuit has the smallest and largest crossectional area?
Smallest: aorta; largest: capillaries - because the higher the pressure in the vessel, the lower the resistance; in the lowest resistance area (capillaries) they have the highest crosssection area
What part of the systemic vascular circuit has the smallest and largest velocity?
Smallest: capillaries; highest: aorta
Flow equation
Q= delta P / R
What is the effect of anemia on blood viscosity and flow?
Anemia decreases viscosity, resulting in hyperdynamic flow
What is the effect of polycythemia on blood viscosity and flow?
Anemia increases viscosity, resulting in lower flow
What does Reynold's # > 2000 and < 2000 mean?
Less than 2000 = laminar flow, greater than 2000 = turbulent flow
What is the formula for Reynold's number
R = (density)*(velocity)*(length)/(viscosity) ; the higher the viscosity, the more laminar the flow
What is the effect of removing an organ on total resistance?
Increase in resistance (if you remove a resistance in parallel, then resistance goes up)
What is the effect of organ transplant on resistance and cardiac outout/heart rate?
Increase resistance, therefore causes a NORMAL bradycardia
What is LaPlace's law?
T = P*r
What is the main determinant of diastolic and systolic pressure?
Diastolic = TPR, systolic = SV
What artery should have the greatest pulse pressure?
Most distal
What is the alveolar pressure at the start of inspiration? End of inspiration?
negative at start; 0 at end (no flow)
What would you expect from fibrosing lung disease w/ regard to lung pressures?
Loss of ability to generate negative pressure during inspiration
At what point in inspiration is flow the highest?
Mid inspiration (most negative)
What is normal venous PCO2? PO2? Alveoalr PCO2, PO2?
Venous PCO2 is 45, O2 is 40; alveolar PCO2 is 40, O2 is 100
What's the best substance to measure diffusing capacity of the lung? Why?
Carbon monoxide; because it has the highest solubility
What test do you look at to dx carbon monoxide poisoning?
P50, NOT puls-sat (puls-sat cannot distinguish between monoxide and O2)
Do people with meningitis hyper or hypo ventiliate? Why?
They hyperventilate; because there is hydrogen from the bacteira in the CSF; causes low pH => stimulate respiratory center in medulla
If a normal person is given 100% O2, what happens to their ventilation rate? What is the controlling chemoreceptor?
No change in ventilation rate; still under central respiratory drive
What kind of breathing is caused by a stroke of the caudal pons?
Apneurisitic breathing
What kind of breathing is caused by mid brain lesions or increased ICP?
Biot's breathing (irregular periods of apnea, then several breaths of identical death)
What kind of breathing is cuased by CHF, high altitudes?
Cheyne-Stokes (cycles of high and low frequnecy between periods of apnea)
What is a normal A-a gradient?
5-10 mm Hg O2
What is the cause of hypoxemia with a 8 mmHg A-a gradient?
Hypoventilation (heroin, opiates)
What is the cause of hypoxemia with an A-a gradient >10 mmHg and isn't corrected by 100% O2?
Diffusion defect; pulmonary fibrosis, ARDS, neonatal respiratoyr distress syndrome, atelectasis
What is the cause of hypoxemia with an A-a gradient >10 mm Hg and is corrected by 100% O2?
Perfusoin defect; pulmonary embolism
Which lung is the more common site of foreign object inhalation?
Right, because it's wider and more vertical.
What side of the lung has 3 and which has 2 lobes? Which lobe has the lingula?
Right lung has 3 lobes, left lung has 2 lobes and the lingula (heart takes up space!).
At what level do the aorta, IVC, esophagus cross the diaphragm?
Muscles of inspriation?
Quiet breathing: diaphragm. Exercise: SCM, scalenes, diaphragm, external intercostals.
Muscles of expiration?
Quiet breathing: passive. Exercise: rectus abdominis, internal/external obliques, transversus abdominis, internal intercostals.
Conducting zone components?
Nose, pharynx, trachea, bronchi, bronchioles, and terminal bronchioles; "anatomic dead space."
Respiratory zone components?
Respiratory bronchioles, alveolar ducts, and alveoli.
Type I pneumocyte - what are they and what is their primary function?
97% of alveolar surface; line alveoli. Squamous; thin. Gas exchangers
Type II pneumocyte - what are they and what is their primary function?
Cuboidal; secrete surfactant (dipalmitoyl phosphatidylcholine). Decreases alveolar surface tension. Precursor to type II or other type II. Proliferate in lung damage.
Clara cell
Nonciliated, columnar cell; secretes surfactant component, degrades toxins. Reserve cell.
What lecithin-to-sphingomyelin ratio indicates fetal lung maturity?
Greater than 2.0.
Surfactant - what cell is it created by? Effect on alveolar surface tension, compliance, and work of inspiration?
Type II pneumocyte; decreases tension, increases compliance, decreases work of inspiration.
Effect of histamine on bronchioles?
Bronchoconstriction.
Two functions of Angiotensin-converting enyme (ACE)?
Degrades bradykinin, converts A-I to A-II.
Kallikrein function?
Activates bradykinin.
Collapsing pressure formula
P=2*(surface tension)/(radius)
Residual volume
Air in the lung after maximal expiraiotn; cannot be measured on spirometry.
Expiratory reserve volume
Air that can be breathed out after tidal volume.
Tidal volume
Air that move sinto lung with each quiet inspiration, usually 500 mL.
Inspiratory reserve volume
Air in exess of tidal volume that m oves into lung on maximum inspiraiton
Vital capacity formula
VC = TV + IRV + ERV
Functional reserve capacity formula
FRC = RV + ERV (volume in lungs after normal expiration)
Inspiratory capacity formula
IC = IRV + TV
Total lung capacity formula
TLC = IRV + TV + ERV + RV = VC + RV
Definition of a capacity versus volume
Capacity is the addition of 2 or more volumes.
Physiological dead space (Vd) definition
Physiological dead space = anatomical dead psace of conducting airways plus functional dead space in alveoli
What part of the healthy lung is largest contributor to functional dead space?
Apex of healthy lung.
Physiological dead space (Vd) formula
(Vd)=(Vt)*(PaCO2-PeCO2)/(PaCO2) PaCO2 = arterial PCO2, PeCO2 = expired air PCO2
At what volume is the inward pull of the lung balanced by the outward pull of the chest? What is the system pressure at this point?
FRC; the pressure is the same as atmospheric.
At FRC, what is the alveolar and airway pressure? At FRC, what is the the intrapleural pressure?
Alveolar/airway: 0, intrapleural is negative.
Compliance formula
C = V/P
What three conditions decrease lung compliance?
Pulmonary fibrosis, insufficent surfactant, pulmonary edema.
What is the O2 affinity of the taut and relaxed forms of hemoglobin?
Taut has low affinity (periphery); relaxed as high affinity (pulmonary capillaries).
What type of cooperativity and allostery does hemoglobin demostrate?
Positive cooperativity (higher affinity as more O2 binds) and negative allostery.
Effect of chloride, H+, CO2, 2,3-BPG, and temperature on hemolgobin's O2 affinity.
As all go up, hemoglobin's O2 affinity decreases (favors TAUT); right shift to decrease O2 unloading in tissues.
Does HbA or HbF have lower affinity for 2,3-BPG? Implication?
HbF has a lower affinity for 2,3-BPG, therefore it has higher O2 binding affinity.
How does the myoglobin O2 binding curve differ from hemoglobin?
Myoglobin doesn't show positive cooperativity; lacks sigmoidal appearance.
Effect of altitude and exercise on the oxygen-hemoglobin dissociation curve?
As both increase, there is a decrease in binding affinity (right shift).
Effect of carbon monoxide on hemoglobin oxygen saturation?
Increases due to positive cooperativity.
Effect of increased PO2 or PCO2 on pulmonary vasculature?
Pulmonary vascular constricts with increasing PCO2 and dilates with increasing PO2 (opposite of the body, to increase ventilation/perfusion efficiency).
Is the lung usually perfusion or diffusion limited?
Perfusion limited in healty individuals; only way to increase O2 is to increase blood flow.
Name 3 examples of perfusion limited states or compounds.
O2 (in normal health), CO2, N2O.
Name 3 examples of diffusion limited states or compounds.
O2 (emphysema, fibrosis), CO.
Is a healthy person diffusion or perfusion limited in exercise?
Perfusion limited.
Diffusion V(gas) formula
(A/T)*(Dk)*(P1-P2) where A= area, T = thickness, and (Dk)(P1-P2) is the difference in partial pressures.
What disease decreases area of diffusion in the lung?
Emphysema.
What disease increasing the membrane thickness for diffusion in the lung?
Pulmonary fibrosis.
Normal pulmonary artery pressure? Pulmonary HTN pressure?
10-14 mmHg (normal); > 25 mmHg (pulmonary HTN) or > 35 mmHg (exercise).
Pulmonary vascular resistance formula
PVR = [P(pulmonary artery)-P(L atrium)]/(cardiac output)
Resistance formula
8*(blood viscosity)*(vessel length)/(pi*radius^4)
Pressure formula
delta P = Q(Flow) * R(Resistance)
O2 content formula
(O2 binding capacity * % saturation) + dissolved O2
Normal hemoglobin amount (g/dL) in blood?
15 g/dL
1 gram of hemoglobin results can bind how many mL O2?
1.34 mL
O2 binding capcaity formula
(Normal Hb amoutn in blood ; generally 15 g/dL)*(1.34 mL O2)
Effect of decreased hemoglobin amount (g/dL) on O2 content, O2 saturation, and arterial PO2?
No effect on O2 saturation or arterial PO2; decreased O2 content.
Alveolar gas equation
PAO2 = PIO2 - PaCO2/R
Alveolar gas approximation
PAO2= 150 mmHg - PaCO2/0.8
Normal A-a (alveolar-arterial) gradient value
10-15 mmHg
Causes of increased A-a gradient
Increased in hypoxemia (shutning, V/Q mismatch, fibrosis).
Effect of exercise on venous PO2?
Decreases.
Oxygen delivery to tissue formula
Cardiac output * oxygen content of blood
V/Q ratio of apex and base of the lungs?
Apex: 3 (wasted ventilation), base: 0.6 (wasted perfusion
Where is ventilation greatest in the lungs? Where is perfusion greatest in the lungs?
Both are greatest at the base.
What part of the lung does tuberculosis perfer? Why?
The apex, because it thrives in a high O2 environment (excess ventilation).
Cause of a V/Q of zero?
Airway obstruction (shunt)
Effect of 100% O2 on PaO2 with a physiological shunt?
No increase in PaO2.
Cause of a V/Q of infinity?
Flow obstruction (phsyiological dease space).
Effect of 100% on PaO2 with a flow obstruction?
Increases PaO2, if the obstruction is less than 100%.
In what form is most CO2 transported in the blood?
Bicarbonate
Name the three forms of CO2 transport in the blood.
Bicarbonate (90%), carbaminohemoglobin (5%), dissolved CO2 (5%).
Does CO2 favor binding the taut or relaxed form of hemoglobin?
Taut (O2 has been unloaded).
Haldane effect
As hemoglobin is oxygenated in the lungs, it loses affinity to H+ and favors CO2 formation.
Bohr effect
In peripheral tissue as H+ increases (pH decreases), unloading O2 is favored (right shift).
Chloride shift
Cl-/HCO3- exchanger; in the periphery Cl- is high in the RBC and low in the plasma, in the lung Cl- is low in the RBC and high in the plasma
Acute response to high altitude
Decrease in PO2 results in a increase in ventilation and a decrease in PCO2 (respiratory alkalosis).
Chronic response to high altitude
Increased hematocrit (via EPO), increase 2,3-BPG, increase mitochondria, increased renal excretion of bicarbonate to compensate for respiratory alkalosis Chronic hypoxic pulmonary vasoconstriction results in RVH.
Reponse to exercise
Increased CO2 production, increased O2 consumption, increased ventilation rate to meet O2 demand; V/Q ratio from apex to base becomes more uniform, increase pulmonary blood flow due to increased cardiac output, decreased pH due to lactic acid, no change in PaO2 or PaCO2 but increase in venous CO2 content.
Ureter location relative to uterine artery and ductus deferns
Under (retroperitoneal)
Human % body water
60%
ECF vs ICF volume distribution
2/3rds ICF, 1/3rd ECF
ECF volume distribution
1/4th plasma, 3/4ths interstitial
Normal serum osmolality
290 mOsm
Charge of the glomerular podocytes
Negative due to heparan sulfate
Glomerular capillary type
Fenestrated (size barrier)
Clearance formula (Cx)
Cx = Ux*V/Px (Ux = urine osm, Px = plasm osm, V = urine flow rate)
Cx < GFR means?
Net reabsorption
Cx > GFR means?
Net secretion
Cx = GFR
Filterable, no reabsorption or secretion.
GFR calculation
Use x=inulin Cx=Ux*V/Px
Normal GFR value
100 mL/min
Effective renal plasma flow (ERPF) formula
Use x=PAH Cx=Ux*V/Px
Renal blood flow (RBF) formula
RBF = RPF/(1-hematocrit) ERPF unerestimates RPF by ~10%.
Filtration fraction formula
FF = GFR/RPF *RENAL PLASMA FLOW, not renal blood flow
Normal filtration fraction value
FF = 20%
Filtered load formula
Filtered load = GFR * plasma concentration
Best substance to estimate GFR? Best substance to estimate RPF?
GFR = creatinine or inulin; RBF = PAH
Effect on NSAIDs on afferent arteriole
Prevent prostaglandins from dilating thus distrubting filtration fraction and GFR regulation.
Does angiotensin II preferentially constrict the afferent or efferent arteriole?
Efferent; increses GFR and decreases RPF thus increases FF.
Excretion rate formula
Excretion rate = V * Ux
Effect of afferent arteriole constriction on RPF, GFR, and FF
Decrease RPF, GFR, no change of FF
Effect of efferent arteriole constriction on RPF, GFR, and FF
Decrease RPF, increase GFR, increase FF
Effect of increased plasma protein concentration on RPF, GFR, and FF
No change on RPF, decrease GFR and decrease FF
Effect of decreased plasma protein concentration on RPF, GFR, and FF
No change on RPF, increase GFR and increase FF
Effect of ureter constricction on RPF, GFR, and FF
No change on RPF, decrease GFR and decrease FF.
Where does isotonic absorption occur in the nephron
PCT
Effect of PTH and AT-II on the PCT
PTH inhibits sodium/hosphate cotransport, increasing phosphate exretion. AT-II stimulates sodium/hydrogen exchanger, increasing sodium/water reabsorption (contraction alkalosis).
% Na absorbed at the PCT, DCT, TAL, CT
PCT = 65-80%, DCT = 5-10%, TAL = 10-20%, CT = 3-5%
Where are amino acids reabsorbed in the nephron
PCT
Where is glucose reabsorbed in the neprhon
PCT via SGLT
Is water or salt permeable in the thin vs thick loop of henle
Thin: water permeable, salt impermeable. Thick: water impermeable, salt permeable.
Effect of PTH on the DCT
Increases calcium reabsorption via calcium/sodium exchanger.
Function of intercalated vs principal cell
Intercalated cell secretes H+ via an ATPase; principal cell secretes potassium.
Effect of ADH on the nephron
Increases water and urea reabsorption via luminal aquaporins at the medullary collecting tubule.
Where is urine most hypotonic assuming ADH is present?
Distal convoluted tubule
Tubular fluid to plasma concentration ratio TF/P >1
When solute is reabsorbed less quickly than water (urea, chloride), when solute is not absorbed at all (inulin, mannitol, creatinine) or there is a net secretion (PAH)
Tubular fluid to plasma concentration ratio TF/P <1
When solube is reabsorbed more quickly than water (glucose, amino acids, HCO3, phosphate).
Tubular fluid to plasma concentration ratio TF/P =1
When solute and water are reabsorbed at the same rate (potassium, sodium).
Three stimuli for renin secretion
Low blood pressure (JG cells at afferent arteriole), beta-1 adrenergic stimulation, low salt delivery to macula densa (DCT/TAL border).
Two functions of ACE
Degrades bradykinin, converts A-I to A-II.
Angiotensin II functions
Affects baroreceptor function; limits reflex bradycardia which would normally accompany its pressor effects. Stimulates thirst. Constricts efferent arteriole to increase GFR and FF (lowers RBF). Increaes aldosterone and ADH release. Contraction alkalosis via stimulating proximal tubule Na/H activity.
Atrial naturetic peptide
Stimulates cGMP vasodilation; increases sodium excretio. Decreases renin, increases GFR.
Is ADH release more dependent on volume loss or osmolality decrease?
More dependent on volume loss.
How can NSAIDS induce caute renal failure?
Prevent vasodilation of afferent arteriole, preventing GFR maintence.
What two mormones are produced in the kidney
EPO and 1,25-(OH)2 Vitamin D
1,25-(OH)2 vitamin D function
Increases intestinal absorption of calcium and phosphate.
What hormone stimulates 1,25-(OH)2 vitamin D synthesis
PTH.
Two effects of PTH on the nephron
Increases phosphate excretion (via PCT Na/PO4- cotransporter inhibition), and increases calcium reabsorption (via DCT calcium/sodium exchanger).
PGE2 effect on nephron
Dilates the afferent arteriole.
Aldosterone effects
Increases sodium reabsorption (principal cells), increases potassium secretion (principal cells), increases H+ secretion (intercalated cells); hypokalemic metabolic alkalosis.
Effect of A-II on the CNS.
Stimulates thirst via the hypothalamus
Six factors that shift potassium out of cells (causing hyperkalemia)
Beta antagonists (decrease Na/K-ATPase), cell lysis, digitalis (inhibits Na/K-ATPase), hyperosmolarity, acidosis/severe exercise (increases K/H+ exchanger), insulin (decrease Na/K-ATPase) deficiency.
Four factors that shift potassium into cells (causing hypokalemia)
Beta agonists / insulin (increase Na/K-ATPase), alkalosis (decreases H/K+ exchanger), hypoosmolarity. (INsulin shifts potassium IN).
Henderson-Hasselbach equation
pH = pKa + log [HCO3/(0.03*PCO2)]
Winter's formula for respiratory compensationi reponse to metabolic acidosis
PCO2 = 1.5 * (HCO3) + 8 +/- 2
For every 0.7 mm Hg increase in PCO2, how much mEq/L HCO3 increases?
1
Retroperitoneal structures; mnemonic?
SAD PUCKER; suprarenal gland, aorta and IVC, duodenum (2,3,4), pancreas (except tail), ureters, colon (ascending and descending), kidneys, esopahgus, rectum
Basal electric rhythm of stomac, duodenum and ileum
Stomach 3/min, duodenum 12/min => ileum 8-9/min
Is the inner muscular layer circumferential or longitudinal?
Circumferential
Order of contents of the femoral triangle
Lateral to medial; nerve-artery-vein-lymphatics
Contents of femoral sheath
Vein and artery and lymph nodes; NOT the nerve
Gastrin source
G-cell of stomch antrum
Gasrin action
Increase gastric acid secretion (via ECL cells), increase gastric mucosa, increase motility
Gastrin regulation
Increas release due to stomach distention, alkalinization, amino acids, peptides, vagus nerve. Decrease due to acidic stomach pH.
What two aminoacids are potent stimulators of gastrin?
Phenylalanine and tryptophan
CCK source
I-cells of duodenum/jejunum
CCK action
Increase pancreatic protein secretion, increase gallbladder contraction, decrease gastric emptying, relaxes sphincter of Oddi
CCK regulation
Increased by fatty acids, amino acids
Secretin source
S cells of the duodenum
Secretin action
Increase pancreatic HCO3 secretion, decrease gastric acid secretion, increase bile (liquid) secretion
Secretin regulation
Increased by fatty acids and acid in lumen of duodenum
What pH do pancreatic enzymes work at ideally?
Basic
Somatostation source
D_cells (pancreatic islet,s GI mucosa)
Somatostatin action
Decrease gastric acid and pepsinogen secretion; decrease pancreatic and small intestine fluid secretion, decrease gallbaldder contraction and decrease insulin/glucagon release
Somatostation regulation
Increased by acidity and decrease by vagal stimulation
Glucose-dependent insulinotropic peptide (GIP) source
K-cells (duodenum, jejunum)
Glucose-dependent insulinotropic peptide (GIP) action
Exocrine: decrease gastric H+ secretion; endocrine: increase insulin release
Glucose-dependent insulinotropic peptide (GIP) regulation
Increased by fatty acids, amino acids, oral glucose (NOT INJECTED GLUCOSE)
Vasoactive intestinal polypeptide source
Parasympathetic ganglia
Vasoactive intestinal polypeptide action
Increase intestinal watre and electrolyte secretion, relaxation of smooth muscles and sphincters
Vasoactive intestinal polypeptide regulation
Increased by GI distention and vagal stimulation; decreased by adrenergic output
Nitric oxide effect on LES
Decreases tone; loss of NO is implicated in achalasia
Motilin source
Small intestine
Motilin action
Produces migrating motor complexes (MMCs)
Motilin regulation
Increases in fasting state
Intrinsic factor source
Parietal cells
Intrinsic factor action
Binds B12 in duodenum, uptake at terminal ileum
Gastric acid source
Parietla cells
Gastric acid regulation
Increased by hiastmine, Ach, gastrin; lowered by somatostatin, GIP, prostaglandin, secretin
Pepsin source
Chief cells
Pepsin regulation
Increased by vagal stimulation, local acid
What converts pepsinogen to pepsin?
Stomach acidity, then autocatalyzation
Normal saliva tonicity
Hypotonic
Effect of high flow rates on saliva tonicity
Isotonic
Saliva ionic composition
High bicarb, low K, increase in Cl and Na as flow rates increase, decrease K+
Pancreatic juice ionic composition
High Na, inverse relationshpi between HCO and Cl as flow rate increases, low K
How do vagal cells stimulate G-cells?
Via GRP, NOT Ach - muscarinic antaognists have no affect!
What ist he tonicity of pancreatic fluid?
Isotonic
Level of CL and HCO3 in pancreatic fluid with low and high flow
Low flow => high Cl, high flow => high HCO3
Enzyme composition of pancreatic secretions
amylase, lipase, phospholipase A, colipase; tryspin, chymotryspin, elastase, carboxypeptidase
Where is trypsinogen activated?
Brush border by enterokinase/enteropeptidase
Amylase hydrolyzes what bonds? Produces what sugar type?
Disaccharaides; maltose and alpha-limit dextras; hydroylyzes 1-4 alpha glycosidic linkages
Where is iron absorbed
Duodenum
What transporter uptakes glucose from the GUT lumen
SGLT
What transporter moves glucose from gut epithelial cells to the blood
GLUT 2
What transporter uptakes fructose from the GUT lumen
GLUT 5
What does the D-xylose absorption test tell you?
Distinguiishes GI mucosal damage from other causes of malabsorption
What is the role of the fetal adrenal gland?
Fetal lung maturation and surfactant production
Describe the venous drainage of the left and right adrenal gland
Left: adrenal => L renal vein => IVC; Right: adrenal => IVC
Embryological origin of anterior and posterior pituitary gland?
Anterior: ectoderm; posterior: neuroectoderm
Anterior pituitary acidophil cells
GH and prolactin
Anterior pituitary basophil cells
B-FLAT: FSH, LH, ACTH, TSH
What three hormones have structural simularity to TSH?
LH, FSH, and hCG (alpha subunit)
What subunit determines the hormone specificity of TSH/LH/FSH/hCG?
Beta subunit
What is the relative location of beta cells and alpha cells in Islet of Langerhans?
Beta is central, alpha is peripheral
What three factors increase insulin release?
Hyperglycemia, GH, coritsol
What two factors decrease insulin release?
Hypoglycemia, somatostatin
What is the effect of alpha and beta agonists on insulin release?
Alpha agonists inhibit; beta agonists stimulate
How do you make a differential between exogenous insulin use and endogenous insulin production?
C-peptide is present only in endogenous insulin
What are the effects of insulin on the body
Increase GLUT4 (skeletal muscle, adipose), increase glycogen synthesis, increase triglyceride synthesis and storage, increase sodium retention, inrease protein synthesis, increase potassium uptake and amino acid uptake by cells.
What tissue does not need inuslin for glucose intake?
Brain, RBCs, intestine, cornea, kidney, liver
What cell type is absolutely dependent on glucose for metabolism (cannot utilize ketone bodies)
Erythrocytes
What three factors inhibit glucagon release
Hyperglycemia, insulin, somatostatin
What are the effects of glucagon on the body
Increase glycogenolysis/gluconeogenesis, increase lipolysis and ketone production, inhibition of insulin and glucagon release
What is the effect of prolactin on the hypothalamus?
Inhibits GnRH release
What is the effect of prolactin on the body?
Stimulates milk production, inhibits ovulation and speramtogenesis by inhibiting GnRH release
What hormone stimulates prolactin release?
TRH
What drug is used to treat prolactinomas?
Bromocriptine (dopamine agonist)
What stimulates growth hormone release?
Exercise and sleep
What inhibits growth hormone release?
Somtatostatin and hyperglycemia
What is the effect of growth hormone on the body?
Stimulates linear growth and muscle mass via somatomedin (IGF); increases insulin resistance (diabetogenic).
What stimulates cortisol release?
ACTH, chronic stress
What is the effect of coritsol on the body?
Maintains blood pressure (upregulates alpha-1 receptors), inhibits bone formation, immunosuppression/anti-inflammatory, increases insulin resistance, increases gluconeogenesis/lipolysis/proteolysis
How does cortisol cause anti-inflammatory/immunosuppression?
Inhibits phospholipase A2, inhibits integrin expression (neutrophilia), blocks mast cell degranulation, lowers WBC count (not neutrophils), blocks IL-2 production
What are the effects of PTH on the body?
Increase bone reabsorption (inc calcium and phosphate), increase renal reabsorption of calcium, inhibit renal reabsorption of phosphate, increase 1-alpha hydroxylase activity (increase vitamin D3/calcitriol)
What electrolyte deficiency causes hypopituitarism (low PTH secretion)?
Hypomagnesemia
Causes of hypomagnesemia
diarrhea, aminoglycosides, loop diuretics, alcohol abuse
What cell produces RANK-L?
Osteoblasts
Function of RANK-L
Stimulates monocytes to form osteoclasts
What cell does PTH act upon?
Osteoblasts
What hormone release is stimulated by hypophosphatemia?
Vitamin D3
What is the inactive form of vitamin D?
24,25-Vitamin D
Effect of vitamin D on the body?
Stimulates calcium and phosphate absorption from the GI, increase bone resoprtion, inhibits PTH release
What factors cause an increase in Vitamin D3 production?
PTH, hypocalcemia, hypophosphataemia
What factor inhibits Vitamin D3 production?
1,25-Vitamin D negative feedback
What is the effect of calcitonin on the body?
Inhibits bone resoprtion (acts on osteoclasts)
Which endocrine hormones use the cAMP signaling pathway?
FSH, LH, ATH, TSH, CRH, hCG, ADH (V2), MSH, PTH, calcitonin, GHRH, glucagon, histamine (H2) (FLAT CHAMP)
Which endocrine hormones use the cGMP signaling pathway?
ANP, nitric oxide
Which endocrine hormones use the IP3 signaling pathway?
GnRH, oxytocin, ADH (V1), TRH, histamine (H1), angiotensin II, gastrin (GOAT)
Which endocrine hormones use the tyrosine kinase signaling pathway?
Insulin, IGF, FGF, PDGF
Which endocrine hormones use the JAK/STAT signaling pathway?
Prolactin, GH, cytokines (IL-2,6,8)
Which endocrine hormones use the nuclear receptor signaling pathway?
T3/T4, Vitamin A
Which endocrine hormones use the cytosolic receptor signaling pathway?
Vitamin D, estorgen, testosterone, cortisol, aldosterone, progesterone
How are sex steroids transported in the cytoplasm?
Sex hormone binding globulins (SHBG)
What is the effect of elevated SHBG in men?
Lowers free testosterone resulting in gynectomastia
What is the effect of lowered SHBG in women?
Raises free testosterone resulting in hirsutism
What causes an increase in SHBG in women?
Pregnancy, oral contraceptives
Why don't women display hyperthyroidism with an elevated T4 in pregnancy?
Elevated SHBG results in normal levels of free T4 / normal TSH / euthyroid
What are the effects of T3 on the body?
Bone growth (GH synergy), CNS maturation, increase B1 receptors in heart (CO/HR/contracility), elevated BMR (via N/K-ATPase upregulation), increase glycogenolysis/gluconeogenesis/lipolysis
How is T3/T4 transported in the blood?
TBG (thyroxine-binding globulin)
What form of T3/T4 is active?
The free form (not bound to TBG)
What situations cause an increased and decreased TBG level?
Increased TBG in pregnancy or oral contraceptive use; decreased TBG in hepatic failure
What enzyme converts T4 to T3 in the periphery?
5'-deiodoinase
What enzyme is responsible for organification and oxidation of iodide and coupling of MIT/DIT?
Peroxidase
What is the Wolff-Chaikoff effect?
Transient decrease in T3/T4 due to excess ingestion of iodide, which inhibits iodide pump activity (NIS)
What is the effect of perchlorate and pertechnetate on the thyroid?
Inhibits NIS thus uptake of iodidine by the thyroid
******* calories per gram of protein, carbohydrate, alcohol, fat
protein = 4 calories/g, carb = 4, alcohol = 7, fat = 9
Where do ovarian tumors metastasize to?
Para-aortic lymph nodes (retroperitoneal)
Where do testicular tumors metastasize to?
Para-aortic lymph nodes (retroperitoneal)
Where do vaginal tumors metastasize to? (remember 1/3rd vs 2/3rds)
upper 1/3rd: obturator, external iliac, and hypogastric nodes; lower 2/3rds: superficial inguinal
Is the left or right testicle more prone to have varicoceles?
Left
What ligament is the ovarian artery found in?
Suspensory ligmanet of the ovaries
What ligament is the uterine artery found in?
Cardinal ligment
What structures does the ligmanet of the ovary connect
Ovary to uterus
What is the epithelial layer is found on the ovary, fallopian tube, uterus, endocervix, ectoservix, and vagina?
Ovary: cuboidal, FT: columnar, uterus: columnar, endo: columnar, ecto: stratified squamous, vagina: startified squamous
What part of the nervous system is responsible for erection, emission, ejaculation?
Para: erection, symp: emission, ejaculation: pudendal
What is the function of spermatogonia?
Maintain germ cell pool, produce primary spermatocytes
What is the function of Sertoli cells?
Produce inhibin, androgen-binding protein, maintain blood-testes barrier, nourish spemratogenesis
Does testicular temp go up or down with varicocele? Effect on Sertoli cells?
Temp goes up, so spermatogenesis is downregulated (inhibin goes down too)
What is the function of the Leydig cell?
Secrete testosterone; unaffected by temperature. Due to LH
What is the ploidy of spermatogonium, primary spermatocyte, secondary speramtocyte, and a spermatid?
2N (diploid), 4N (diploid), 2N (haploid), N (haploid)
What is the function of testosterone?
Differentiation of Wolfian structures, growth spurt, close epiphyseal plates (aromatized to estrogen), libido
What is the function of DHT?
External genetalia differentation prostate growth, male pattern balding, sebaceous gland activity
What estrogen is produced by a healthy placenta?
Estriol
What is the most potent form of estrogen?
Estradiol
What is the function of estrogen?
Increase SHBG, increase HDL, lowers LDL, endometrial proliferation, feed back on FSH/LH, LH surge
What hormone blocks lactation during pregnancy despite high prolactin levels?
Estrogen
What ovarian cell produces androstenedione/progesterone? Estrogen?
Andro/proges: theca interna cells, estrogen: granulosa cells
What cells do FSH and LH stimulate in the ovary/testis?
Ovary: FSH is granulosa, LH is theca cells; testes: FSH is Sertoli, LH is Leydig
What is the function of progesterone?
Secretory (luteal) phase of endomertrium, decrease muscle tone, increase body temp, increase tidal volume respiratory alkalosis), thicken cervical mucus, inhibit LH/FSH, downregualte estrogen receptor expressivity
If a woman has a 35 day cycle, when did she ovulate?
Day 21 (35-14)
Is the luteal or follicular phase constant in length? What is the length?
Luteal phase is constant; 14 days
What defines oligomenorrhea vs polymenorreha?
>35 day cycle is oligo, <21 day cycle in poly
What thyroid condition causes menorrhagia vs amenorrhea?
Hypo: menorrhagia, hyper: amenorrhea
Production of what substance signals ovluation has occurred?
Progesterone
What is the cell cycle stage of preovulatory oocytes? Of oocytes after ovulatioN?
Preovulatory: prophase I, postovluatory: metaphase II
What ist he ploidy of oocytes arrested before ovulation?
4N (diploid)
What even triggers an oocyte to complete meiosis II?
Fertilization
Where does fertilization usually occur?
Ampulla of the fallopian tube
What hormonal changes stimulate lacation after delivery?
Decreased progesterone induces lactation; inhibition of prolactin removed
What is the function of prolactin?
Produces milk; inhibits GnRH
What is the function of oxytocin?
Milk letdown and uterine contractions
What cell produces beta-HCG?
Syncytiotrophoblast of the placenta
What is the function of beta-HCG?
Maintains the corpus luteum for 1st trimester by acting like LH; pregnancy test
What pathological states are associated with elevated beta HCG?
Choriocarcinoma, hydatidiform moles, gestational trophoblastic tumors
What is the source of progesterone throughout the whole pregnancy?
1st trimester: corpus luteum; 2nd and 3rd trimester: placenta
What hormone is looked at to determine if menopause has occurred?
FSH
What is the effect of menopause on the body?
Low estrogen: hirsutism, hot flashes, vaginal atrophy, osteoporosis, increase coronary artery disease
What can make menopause happen earlier?
Smoking
What artery supplies the SA and AV nodes?
Right coronary artery
Cardiac output formula
CO=SV*HR
Fick's principle equation (cardiac output)
(Rate of O2 consumption)/(Arterial O2 content - venous O2 content)
MAP formula
MAP = CO* TPR
MAP in terms of pressures
MAP = 2/3rd diastolic + 1/3rd systolic
Pulse pressure formula
Systolic pressure - diastolic pressure
Ejection fraction formula
EF = (EDV-ESV)/EDV
Normal ejection fraciton
>55%
delta Pressure formula
P = Q*R
Resistance formula
R= P/Q = 8*viscosity * length / (pi*radius^4)
What causes increas ein blood viscosity?
Polycythemia, hyperproteinemia states (multiple myeloma), hereditary spheorcytosis
JVP components; what are the a, c, v, x, and y waves?
a: atrial contraction, c: RV contraction, v: increase RA pressure due to filling agianst closed tricuspid; x descent: artrial relaxation and downward movement of tricuspid; y descent: blood flow from RA to RV
What two conditions can cause paradoxial splitting?
LBBB, aortic stenosis (P2 > A2)
What two conditions cause wide splitting?
Pulmonic stenosis, RBBB
What condition is S3 normal in?
Children and pregnancy
What pathology is S3 associated with?
Congestive heart failure, mitral regurgitaiton
What pathology is S4 assoicated with?
Ventricular hypertrophy
What murmur is found at the right 2nd intercostal space?
Aortic stenosis
What murmur is found at the left 2nd intercostal space?
Pulmonic stenosis
What pansystolic murmurs are found at the left parasternal (4th intecostal) area?
VSD, tricuspid regurg
What diastolic murmur is found at the left parasternal (4th intecostal) area?
Tricuspid stenosis
What systolic murmur is found at the left 5th intercostal space?
Mitral regurgitation
What diastolic murmur is found at the left 5th intercostal space?
Mitral stenosis
What is the effect of inspiration on heart sounds?
Increases right sided sounds
What is the effect of expiration on heart sounds?
Increases left sided heart sounds
What is the effect of hand grip on murmur intensity?
Increase mitral regurg, VSD; decreases MVP and HCM
What is the effect of valsalva on murmur intensity?
Increase HCM and MVP, decreases other murmurs
What is the effect of rapid squatting on murmur intensity?
(increase systolic resistance, increase VR); decrease MVP and HCM
What cardiac cells depolarize with sodium vs calcium?
Sodium: purkinje, ventricle, atrial; calcium: AV and SA nodes
What is phase 0?
Depolarization phase (Ca or Na)
What is the P wave?
Atrial depolarization
What is the PR interval? What is a normal value?
Conduction delay through AV node; < 200 msec
What is the QRS complex?
ventricular depolarization
What is the QT interval?
Mechanical contraciton of ventricles
What is the T wave?
Ventricular repolarization
What does T wave inversion indicate?
Recent MI
When does atrial repolarization happen on the EKG?
QRS complex
What causes a U wave?
Hypokalemia, bradycardia
What is the speed of conduction in atrial, ventricles, AV node, prukinje?
Purk > atria > ventricles > av node
What is the pacemaker speed of ventricles/his/Purkinje, AV, and SA?
SA > AV > his/purkinje/ventricles
What factors cause ANP release?
Increase BV and atrial pressure
What is the effect of ANP?
Increases cGMP => vasodilates arterioles, constricts efferent & dilates afferent renal arteriole, increase GFR and inhibits sodium reabsorption
What type of pressure changes does the aortic arch respond to?
Only to INCREASE in BP
What type of pressure changes does the carotid sinus respond to?
Increase AND decrease in BP
What nerve innervates the carotid sinus? Aortic arch?
IX = carotid, X = aortic
What is the effect of a carotid massage on heart rate? Why?
Increase stimulation of CN IX => increase parasympathetic outflow => decrease heart rate
What is the effect of hypotension on heart rate? Why?
Decrease stimualtion of CN IX => increase sympathetic outflow => increase heart rate
What do the carotid and aortid bodies sense?
Decreases in PCO2, increaes in PCO2, and decreases in pH
What do central chemoreceptors sense?
Change sin pH and PCO2 (NOT O2)
What is the Cushing reaction?
Increase ICP => constricts arterioles => cerebral ischemia => hypertension => reflex bradhycardia ( triad: hypertnesion, bradycardia, respiratory depression)
What organ has the largest ateriovenous difference (O2 extraction)?
Heart
Normal RA pressure?
< 5
Normal RV pressure?
5 diastolic, 25 systole
Normal pulmonary artery pressure?
<25 systolic, 10 diastolic
What does pulmonary capillary wedge pressure measure?
Left atrial pressure
Normal LA pressure?
< 12
Normal LV pressure?
130 systolic, 10 diastolic
What metabolites determine heart blood flow?
Adenosine, O2, NO
What metabolites determine brain blood flow?
CO2 (pH)
What metabolites determine skeletal muscle blood flow?
Lactate, adenosine, potassium
What is the effect of hypoxia on pulmonary arterioles?
Vasoconstrict
What is the most important regulator of skin blood flow?
Sympathetic regulation (temperature control)
What kind of pathology can increase Kf (filtration constant)?
Burns, disruption of vasculature, toxins, inections