Physiology

Front 1

What cell type produces PTH?
What cell type produces calcitonin? (FA p283, FA p284)

Back 1

-PTH-chief cells of parathyroid
-calcitonin-parafollicular cells (C cells) of thyroid

Front 2

Explain the relationship between renin, angiotensin, and aldosterone. (FA p440)

Back 2

-Renin converts angiotensinogen to angiotensin I
-Angiotensin I is converted to Angiotensin II by ACE (ACE also blocks bradykinin)
-Angiontensin II stimulates aldosterone release from the adrenal gland

Front 3

Which part of the cochlea is sensitive to high-frequency sound? (FA p398)

Back 3

Cochlear membrane=scuba flipper: narrow/stiff at the base (high frequency) and wide/flexible at the apex (low frequency)
-hearing loss in the elderly-high frequency--->low frequency

Front 4

What are the steps in the conversion of vitamin D to its active form in the body? (FA p284)

Back 4

Vitamin D3 from sun exposure in skin. D2 ingested from plants. Both converted to 25-OH vitamin D in liver and to 1,25 (OH)2 vitamin D (active form) in kidney

Front 5

Which part of the brain is responsible for attention / alertness? (FA p381) (Hint: lesion results in coma)

Back 5

-reticular activating system (midbrain)
-lesion leads to reduced levels of arousal and wakefulness (ex. coma)

Front 6

-What drugs regulate the secretion of gastric acid? (FA p307)

Back 6

-prostaglandins/misoprostol inhibit cAMP--->;inhibits H+ secretion
-atropine inhibts ACh binding to M3 receptor (competitive antagonist)--->;inhibits H+ secretion
-cimetidine inhibits histamine binding to H2 receptor (competitive antagonist)--->;inhibits H+ secretion
-omeprazole-H+/K+ ATPase inhibitor--->;inhibits H+ secretion

Front 7

-What endogenous hormones regulate the secretion of gastric acid?

Back 7

-Increased by histamine (via increased cAMP), ACh (via Gq), gastrin (GRP stimulates gastrin release)
-Decreased by somatostatin (via Gi), GIP, prostaglandin (via Gi), secretin

Front 8

What are the common causes of anion gap acidosis? (FA p443)

Back 8

MUDPILES:
<span style=" font-weight:600;"><span style="font-weight:400;">-M<span style="font-weight:400;">ethanol (formic acid)
-Uremia
-Diabetic ketoacidosis
-Paraldehyde or Phenformin
-Iron tablets or INH
-Lactic acidosis
-Ethylene glycol (oxalic acid)
-Saclicylates

Front 9

In what phase of meiosis is primary oocyte arrested until just prior to ovulation?
In what phase of meiosis is an oocyte arrested until fertilization?

Back 9

Arrested in prophase of meiosis I until ovulation

Arrested in Metaphase of meiosis II until fertilization

Front 10

What electrolyte abnormality a/w excess free water intake, coma

Back 10

-low serum Na+

Front 11

What electrolyte abnormality a/w flattened T waves on EKG, ST segment depression, prominent U waves, PAC and PVC's

Back 11

-low serum K+

Front 12

What electrolyte abnormality a/w kidney stones, abdominal pain

Back 12

-high serum Ca2+

Front 13

What electrolyte abnormality a/w decreased reflexes--> respiratory arrest

Back 13

-high serum Mg2+

Front 14

What electrolyte abnormality a/w peaked T waves on EKG

Back 14

-high serum K+

Front 15

What electrolyte abnormality a/w dehydration, delirium, coma

Back 15

-high serum Na+

Front 16

What electrolyte abnormality a/w neuromuscular irritability

Back 16

-low serum Mg2+

Front 17

What is pulse pressure? What is the equation for mean arterial pressure (MAP)?

Back 17

-Pulse Pressure=systolic pressure - diastolic pressure

-MAP=CO x TPR
or
-MAP = 2/3 diastolic pressure + 1/3 systolic pressure

Front 18

What are the different zones of the adrenal cortex?

Hormones in each zone of the adrenal cortex and in the adrenal medulla?

Back 18

GFR

-Zona Glomerulosa-aldosterone
-Zona Fasciculata-cortisol and sex hormones
-Zona Reticularis-sex hormones

-Adrenal Medulla-catecholamines

Front 19

Clara cells in respiratory tract function

Back 19

secrete clara cell secretory protein (CCSP) which inhibits neutrophil recruitment and activation
detoxification of inhaled toxins via CYP450 mechanism

Front 20

Function of type II pneumocytes

Back 20

produce surfactant
divide and differentiate into type I pneumocytes to replace damaged cells

Front 21

PPAR-gamma nuclear receptor function

Back 21

increased adiponectin, FA transport protein, insulin receptor substrate
increased GLUT-4 transporter
activated by TZD's (pioglitazone) for type II DM treatment

Front 22

Function of adiponectin

Back 22

cytokine secreted by fat tissue
low in type II DM and increased by TZD's

Front 23

function of haptoglobin

Back 23

binds to free Hemoglobin, so in hemolytic anemia the haptoglobin level will be decreased. Hemolytic anemia will also have an elevated LDH (specfically LDH-1)

Front 24

function of neurophysin

Back 24

carrier proteins for oxytocin and vasopressin (ADH, increases water and urea reabsoprtion in medullary collecting duct) which are produced in the paraventricular and supraoptic nuclei
point mutation would result in hereditary central diabetes insipidus

Front 25

sources of elastase

Back 25

neutrophils and alveolar macrophages
balanced by alpha-antitrypsin, which if deficient may lead to panacinar emphysema

Front 26

androgens synthesized in the ovary are converted to estradiol by which cell type?

Back 26

granulosa cells (GE) because they contain aromatase, under control of FSH

the theca interna cells are producing androgens (TA); under control of the LH

Front 27

which vitamins are low in breast milk?

Back 27

vitamin D and K
supplement vitamin D in dark skinned individuals with little sun exposure
vitamin K is given as an IM injection at birth to prevent hemorrhagic disease of the newborn
vitamin K will be formed when the gut is colonized by bacteria

Front 28

MOA of caspases in apoptosis

Back 28

they contain cysteine and are able to cleave aspartic acid residues (cystein-aspartate proteases)

Front 29

Gap junctions formed by what proteins?

Back 29

connexins

Front 30

inhibition of uterine contractions by stimulating what receptors?

What adrenergic receptor is responsible for pupillary dilitation?

Back 30

tocolysis is result of Beta-2 stimulation

mydriasis is due to alpha-1 stimulation on ocular pupillary dilator muscle

Front 31

hormone responsible for gallbladder contraction and what stimulates its release

Back 31

CCK from I cells of the duodenum and jejnum
fatty acids and amino acids stimulate release
CCK also causes pancreatic enzyme secretion

Front 32

patient presents with hemolytic anemia, hypercoagulable state and decreased blood counts

Back 32

suspect paroxysmal nocturnal hemoglobuinuria
deficiency of CD55 and CD59 due to lack of GPI anchoring protein
CD55 and CD59 are responsible for preventing complement mediated lysis of RBC's
hemolysis occurs throughout the day just have dark colored urine in the morning due to concentration overnight
most patients die from thrombosis (e.g. Budd Chiari syndrome)

Front 33

healthy 3 yo white boy has poor intestinal absorption of lysine, arginine, ornithine and cystine.

Greatest risk of developing what?

Back 33

Patient has cystinuria (aminoaciduria, defective transporter of dibasic amino acids including arginine, ornithine and lysine)
Cystine kidney stones
UA will show hexagonal cystine crystals
cystine is the only one that is likely to precipitate due to pKa, risk factors are low urine pH, urine supersaturation
present with colicky flank pain and hematuria
Sodium cyanide-nitroprusside test will detect cystine's sulfhydryl groups and is diagnostic (urine turns red-purple)

Front 34

Overview the conduction of sound

Back 34

sound --> tympanic membrane
moves the osciccles which transfer sound to the oval window which causes frequency changes in the basilar membrane (flexible) and causes hair cell bending against the tectorial membrane (rigid) leading to hyperpolarization/depolarization of the auditory nerve
High frequency sound is lost first

Front 35

Chloride shift in RBC's at different oxygenation pressures

Back 35

in arterial blood (higher pH) chloride is shifted out of RBC by bicarbonate
in venous blood, Chloride re-enters the RBC (low pH)

2,3-DPG decreases the affinity of Hb for O2 because deoxyhemoglobin is stabilized by ionic binding of 2,3 DPG

Front 36

left shift in the hemoglobin oxygen dissociatin curve indicates what?

What are some causes?

Back 36

increased O2 affinity (think lungs)
increased pH
decreased 2,3 DPG (DPG stabalizes deoxyhemoglobin)
decreased temperature

Front 37

right shift in hemoglobin oxygen dissociation curve indicates what?

Causes?

Back 37

decreased O2 affinity
increased H+ (decreased pH, tissues)
Increased 2,3 DPG (stabalizes deoxyhemoglobin)
increased temperature (near muscles)
2,3DPG increased by hypoxemia, chronic lung disease, anemia, and CHF. High altitude increases 2,3DPG as well

Front 38

most common causes of metabolic alkalosis?
Blood gas findings?

Back 38

high pH, high pCO2, and high HCO3

loss of hydrogen from body (vomiting, serum chloride decreases --> urinary chloride decrease)
thiazie and loop diuretics (increase renal loss of Na+, followed by Cl- loss, reabsorption of HCO3 to maintain electric neutrality, contraction alkalosis, low total body chloride but may appear elevated due to loss of volume)
increased aldosterone secretion (Conn syndrome) due to increased K+ and H+ loss --> relative increase in HCO3, this is the only one that is saline-resistant metabolic alkalosis

Front 39

Substance P

Back 39

pain neurotransmitter in the peripheral and central NS
substance P also regulates mood, anxiety and stress behavior
Capsaicin reduces pain by decreasing levels of substance P

Front 40

elastin fibers in alveolar wall are stretched easily and recoil to original shape, this is due to what?

Back 40

interchain crosslinkes involving lysine residues
tropoelastin is secreted into ECM where it interacts with fibrillin (microfibril, mutated in Marfans)
the lysine residues are covalently bound to form a desmosine crosslink giving resilient properties

Front 41

type of gland that develops at puberty that releases sweat that is initially odorless until acted upon by bacteria of skin

Back 41

Apocrine glands, innervated by adrenergic fibers of SNS
Holocrine - sebaceous glands, discharge of the entire secretory cell
Eccrine (merocrine) - present through skin throughout most of body and secrete watery fluid rich in Na and Cl ("sweat")

Front 42

Carbon monoxide poisoning arterial blood levels of:
PaO2
carboxyhemoglobin
methemoglobin

Back 42

PaO2 is normal
Carboxyhemoglobin is elevated (40%)
Methemoglobin is normal
CO binds to Hb w/ higher affinity than O2 and reduces O2 release in tissues (leftward shift)
hypoxia seen is similar to anemia due to ddecrease in oxygen carrying capacity of the blood (but worse because of leftward shift)

Front 43

Airway resistance is highest where?

Back 43

localized to medium and small sized bronchioles
maximum in the 2nd to 5th generation (23 total) airways including segmental bronchi
minimial resistance in the bronchioles

Front 44

56 yo smoker w/ COPD has cyanosis and expiratory wheezes, he recieves supplemental O2 and his respiratory rate decreases and he becomes confused. This decline resulted from decreased stimulation of what receptors?

Back 44

Peripheral chemoreceptors in the carotid body (innervated by CN IX)
in patients w/ long term COPD, their respiratory drive is controlled by O2 and not by CO2 like in healthy individuals. The increased O2 was sensed by peripheral chemoreceptors --> respiratory depression and worsening of symptoms
Central chemoreceptors (medullar) - respond to pH (CO2)
Peripiheral (aortic arch and carotid body) respond to O2

Front 45

Concentrations of what molecules change as you progress through the PCT

Back 45

increased concentratin - PAH, creatinine, inulin, and urea

Decreased - bicarbonate, glucose, and amino acids

Front 46

neurophysins a/w synthesis and post translational modification of what hormones?

Back 46

oxytocin and vasopressin (ADH)
produces in paraventricular and supraoptic nuclei and released into circulation from posterior pituitary gland

Front 47

Conductive hearing loss
Rinne?
Weber?
Causes?

Back 47

Rinne - abnormal in affected ear (B>A)
Weber - localizes to affected ear
Causes - cerum impaction, cholesteatoma, otosclerosis, tumors, TM rupture, otitis media

Front 48

Sensorineural hearing loss
Rinne?
Weber?
Causes?

Back 48

Rinne - normal in both ears (A > B)
Weber - localizes to unaffected ear
Causes - menieres disease, acoustic neuroma, presbycusis, ototoxic drugs (aminoglycosides)

Front 49

Maneuvers to change intensity of heart murmurs
Respiration

Valsalva or standing

Squatting, passive leg raise

Handgrip exercise

Back 49

Respiration - R sided murmurs increase /w inspiration. L side murmurs louder during expiration

Valsalava - mumurs diminish, except HCM and MVP

Squatting - most murmurs louder, except HCM and MVP

Handgrip - murmur of MR, VSD, and AR become louder
HCM decreases

Front 50

system that maintains muscle length during contraction?

Feedback system that monitors and maintains muscle force?

Back 50

muscle spindle system is feedback system that monitors and maintains muscle length (deep tendon reflexes)

Golgi tendon organ (GTO) monitors and maintains muscle force. They are very sensitive to increases in muscle tension but insensitive to passive stretch. If a muscle exerts too much force the GTO's inhibit contraction of the muscle and cause sudden muscle relaxation (heavy lifters dropping weight)