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1MBChB Revision > All Physiology Final Condensed > Flashcards

All Physiology Final Condensed Flashcards

1
Q

internal respiration

A

intracellular mechanisms which consume oxygen and release carbon dioxide

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2
Q

external respiration

A

sequence of events that lead to the exchange of oxygen and carbon dioxide
ventilation - exchange - transport - exchange

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3
Q

Boyle’s Law

A

as the volume of gas increases the pressure exerted by the gas decreases
i.e. air flows down a concentration gradient

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4
Q

lung to thorax linkage

A

negative intrapleural pressure and the intrapleural fluid cohesiveness (polarity dependent)

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5
Q

inspiration vs expiration

A

active process

passive process

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6
Q

what does a pneumothorax do to the pressures

A

abolishes the transmural pressure gradient

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7
Q

what causes lung recoil

A

elastic connective tissue and alveolar surface tension

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8
Q

surfactant

A

decreases surface tension

secreted by T2 alveoli

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9
Q

Law of LaPlace

A

smaller alveoli are more likely to collapse

surfactant has a greater affect on the smaller alveoli

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10
Q

forces keeping alveoli open

A

transmural pressure gradient
pulmonary surfactant
alveolar interdependence

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11
Q

forces promoting alveolar collapse

A

elasticity of the lungs

alveolar surface tension

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12
Q

major muscles of inspiration
accessory muscles
active expiratory muscles

A

diaphragm and external intercostals
sternocleidomastoid, scaleus and pectoral
abdominal muscles and internal intercostals

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13
Q

Tidal volume
Inspiratory reserve volume
expiratory reserve volume
residual volume

A

volume of air entering and leaving the lungs
extra vol of air that can be inspired above TV
extra vol of air that can be expired above TV
minimum vol of air that the remains in the lungs even after forceful expiration

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14
Q

inspiratory capacity
forced residual capacity
vital capacity
total lung capacity

A

max vol of air that can be inspired at the end of normal inspiration
vol of air left in the lungs at the end of normal expiration
max vol of air that can be moved out in a single breath following maximal inspiration
total vol of air that the lungs can hold –> not possible to be measured

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15
Q

spirometry

A

restrictive and obstructiev lung disease diagnosis
FVC = forced vital capatcity
FEV1 = forced expiratory volume in 1 second
FEV1/FVC normally >70%

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16
Q

primary determinant of airway resistance

A

radius of conducting airway

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17
Q

flow =

A

change in pressure /radius

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18
Q

what % energy expenditure is work of breathing

A

3%

increases when resistance increases and compliance decreases

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19
Q

pulmonary ventilation sum and meaning

A

TV x RR

air breathed out per min

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20
Q

alveolar ventilation

A

vol of air exchanged between the alveoli and atmosphere per minute
inspired air available for gas exchange
less than PV because of anatomical dead space

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21
Q

what is ADS and how to calculate

A

space not available for gas exchange

ADS = (RV - dead space vol) x RR

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22
Q

ventilation meaning

perfusion meanng

A

rate at which gas passes through the lungs

rate at which blood is passing through the lungs

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23
Q

alveolar dead space meaning

A

areas with inadequate perfusion

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24
Q

pulmonary arterioles vs systemic arterioles response to decreased oxygen

A

PA = vasoconstriction
SA = vasodilation
and vice versa

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25
Q

alveolar membrane gas exchange rate determined by

A

partial pressure
diffusion coefficient
surface area
thickness of the membrane

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26
Q

Dalton’s Law

A

partial pressure - total pressure exerted by a gas –> sum of the partial pressures of all the individual components in a gas mixture

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27
Q

what pressure does water vapour account for in the lungs

A

47mmHg

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28
Q

respiratory exchange ratio in a mixed diet

A

0.8

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29
Q

diffusion coefficient

A

solubility of gas in a membrane

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30
Q

large grandient between PAO2 and PaO2 means

A

problems with gas exchange or L to R shunt in the heart

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31
Q

Fick’s Law

A

amount of gas moved across a membrane is proportional to the SA and inversely proportional to the thickness of the membrane

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32
Q

non-resp function of lungs

A

route for water loss and heat elimination
enhanced venous return
helps maintain acid base balance
enables speech and vocalisation
defence against inhaled foreign bodies
smell by nose
removes, modifies or inactivates various materials passing through the circulation

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33
Q

Henry’s Law

A

amount of gas dissolving in a vol at a constant temp is proportional to the partial pressure

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34
Q

what is the main deteminant of Hb saturation

A

PO2

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35
Q

oxygen delivery index =

A

oxygen content of arterial blood x cardiac index

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36
Q

Bohr effect

A 
shifting of sigmoid to right is 
incr temp 
incr 2,3-BP
incr in PO2 
incr in [H+]
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37
Q

HbF vs HbA

A 
F = 2 alpha, 2 gamma (higher affinity for O2 as less interaction with 2,3-BP)
A = 2 alpha, 2 beta
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38
Q

presence of myoglobin

A

muscle damage

found in cardiac and skeletal muscle

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39
Q

Haldane effect

A

removal of oxygen from Hb allows it to pick up CO2 genertaed H+

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40
Q

chloride shift

A

as bicarbonate moves out cell Cl moves in to maintain charge

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41
Q

what controls the rhythm of respiration

A

Pre-Botzinger complex

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42
Q

neurons above the medulla vs below medulla in resp

A 
above = prolong ventilation
below = cease ventilation
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43
Q

normal expiration
forceful expiration
normal inspiration

A

passive - gaps in firing of dorsal neurons
active - firing of ventral neurons
active - firing of dorsal neurons

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44
Q

pneumotaxic centre

apneustic centre

A 
terminates inspiration
prolongs inspiration (changes rhythm)
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45
Q

Hering-Bruer Reflex

A

pulmonary strech receptors only activated at high tidal volumes (cease inspiration)

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46
Q

what do peripheral chemoreceptors sense

A

tension of oxygen and carbon dioxide

[H+] in the body

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47
Q

what do central chemoreceptors sense

A

[H+] of the CSF
separated from body by the BBB
CSF contains less protein and so less change in ion concs and the BBB is impermeable to many ions

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48
Q

pacemaker potential

A

funny current
(slow Na influx)
decreased K efflux
transient Ca influx (T channels)

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49
Q

rising phase of nodal cells

A

Ca influx (L channels)

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50
Q

falling phase of nodal cells

A

K efflux

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51
Q

AVN cells are

A

slow condution
small in diameter
to increase nodal delay to allow atrial systole to precede ventricular systole

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52
Q 
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
A 
0 = fast Na influx
1 = transient K efflux
2 = Ca influx (L channels)
3 = K efflux
4 = resting membrane potential restored
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53
Q

what dominated on the SAN in resting conditions

A

vagal tone

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54
Q

ACh affect on HR and its opposite

A

ACh slows HR

Atropine incr HR - compeitive inhibitor

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55
Q

SAN and AVN - ANS supply

A

sympathetic and parasympathetic

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56
Q

what do desomsomes enrsure in cardiac cells

A

tension develops - as myosin and actin slide over one another

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57
Q

Role of calcium in contraction

A

Ca binds to troponin on actin
exposes the myosin binding site
allows contraction (slide over one another using ATP)
prolonged Ca influx = stronger contraction

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58
Q

Frank-Starling curve

A

more the ventricle is filled in diastole the greater the volume ejected

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59
Q

optimal length of cardiac vs skeletal muscle

A 
C = when contracting
S = when resting
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60
Q

normal length of systole and diastole

A 
S = 0.2s
D = 0.5s
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61
Q

an increase in the opening of calcium channels and so peak pressure leading to an increased length of systole is mediated by what

A

cAMP

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62
Q

5 events in cardiac cycle

A 
Passive filling
atrial contraction 
isovolumetric ventrciular contraction 
ventricular ejection 
isovolumetric ventricular relaxation
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63
Q

blood pressure definition

A

outwards (hydrostatic) pressure exerted by the blood on the blood vessel walls

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64
Q

pulse pressure range

A

30-50 (difference between systolic and diastolic)

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65
Q

MAP calculations and normal range

A

[(2 x diastolic) + systolic]/3
1/3 pulse pressure + diastolic
70-105

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66
Q

MAP of what is needed to perfuse vital organs

A

60

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67
Q

short term and long term control of MAP

A

Short term = baroreceptor reflex

Long term = hormones and blood volume

68
Q

resistance to flow is proportional and inversely proportional to …

A

proportional to blood viscosity and length of blood vessel

inversely proportional to radius of blood vessel

69
Q

adrenaline on A vs B2 and were are they predominant

A 
A = vasocontriction - skin, gut, kidney arterioles 
B2 = vasodilation - cardiac and skeletal muscle
70
Q

humoral agents causing vasoconstriciton

A

serotonin
TXA2
endothelin

71
Q

humoral agents causing vasodilation

A

histamine
bradykinin
nitrous oxide

72
Q

production of NO

A

eNOS (enzyme) from L arginine

NO diffuses and activates cGMP (secondary messenger) to bring about vascular smooth muscle relaxation

73
Q

endothelial vasodilators

A

anti-thrombotic
anti-inflammatory
anti-oxidant

74
Q

endothelial vasoconstrictors

A

pro-thrombotic
pro-inflammatory
pro-oxidants

75
Q

venous return is determined by

A

venomotor tone (sympathetic)

76
Q

another name for ADH

A

arginine vasopressin

77
Q

describe RAAS

A

renin released from kidneys
renin binds to angiotensin –> angiotensin I
angiotensin I converted to angtiotensin II by ACE
angiotensin II stimulates aldosterone release from adrenal cortex

78
Q

where is ACE produced

A

pulmonary vascular endothelium

79
Q

what is the rate limiting step in RAAS

A

renin release

80
Q

where is renin released from

A

juxtaglomerular apparatus of the kidneys

81
Q

what controls the RAAS system

A

renal artery hypotension
stimulation by renal sympathetic nerves
decreased Na concentration in renal tubular fluid

82
Q

when is NP released

A

due to cardiac distension or neurohormonal stimuli

83
Q

ANP vs BNP

A

ANP = 28 AA synthesised and stored in atrial muscle, released in response to atrial distension (hypervolaemic)
BNP = 32 AA synthesised by ventricles and brain - prepro-BNP –> pro-BNP –> BNP
serum BNP and N terminus of prepro-BNP can be measured in suspected heart failure

84
Q

where is ADH stored

A

posterior pituatry

85
Q

what do you give in
cardiogenic shock
anaphylatic shock
septic shcok

A

no fluids - inotropes
adrenaline
vasopressors

86
Q

ATP is a potent …

A

vasodilator

87
Q

grey or white matter is very sensitive to hypoxia

A

grey

88
Q

what arteries form the circle of Willis

A

basilar and carotid

89
Q

when does autoregulation to the brain fail

A

when MAP isnt between 60-160mmHg

if less than 50mmHg then brain damage quickly ensues

90
Q

cranial perfusion pressure =

A

MAP - ICP (intracreanial pressure - normally 8-13mmHg)

91
Q

pulmonary circulation pressure and resistance

A

20-25mmHg

10% of that of the systemic circulation

92
Q

where do precapillary sphincters regulate blood flow

A

mesentery

93
Q

how are exchangable proteins moved across the capillary wall

A

by vesicular transport

94
Q

Net filtratuion pressure =

A

(Pc + PIi) - (PIc + Pi)

95
Q

how does excess fluid return to the circulation

A

via lymph and lymphatics

96
Q

causes of oedema

A

raised capillary pressure
reduced plasma osmotic pressure
lymphatic insufficiency
changes in capillary permeability

97
Q

4 layers of GI tract wall and what do they contain

A

mucosa - mucous membrane containing the lamina propria and the muscularis mucosae

submucosa - connective tissue containing the large blood and lymph vessels, glands and submucous plexus

muscularis externa - circular muscle layer containing the myenteric plexus, longitudinal muscle layer

serosa - connective tissue

98
Q

smooth muscle in the GI tract is electrically coupled by

A

gap junctions

99
Q

how are GI pacemaker cells modulated

A

by enteric and autonomic

100
Q

what is force in the GI tract related to

A

number of action potentials

101
Q

where are the ICCs

A

in between the smooth muscle layers coupling together and with the smooth muscle

102
Q

slow waves can be referred to as

A

basal electronic rhythm - rate varied along the tract

103
Q

excitatory and inhibitory influences on the GI tract

A 
E = incr gastric, pancreatic and small intestine secretions, blood flow and smooth muscle contraction 
I = relaxation of some sphincters and receptive relaxation of the stomach
104
Q

what do the myenteric and submucous plexuses regulate

A 
Myenteric = motility and sphincters
Submucosal = epithelia and blood vessels
105
Q

local, short and long reflexes examples

A 
peristalsis
intestino-intestinal inhibitory reflex (distension causes inhibition of muscle activity in adjacent areas)
gastroileal reflex (vago-vagal reflex - incr gastric activity causes incr propulsive activity in terminal ileum)
106
Q

what happens to the propulsive segment in response to distension

A

longitundinal muscle relaxes - release of VIP and NO from inhibitory motoneurone
circular muscle contracts - release of ACh and substance P from exitatory motoneurone

107
Q

what happens to the receiving segment in response to distension

A

longitudinal muscle contracts - release of ACh and substance P from exitatory motoneurone
circular muscle relaxes - release of VIP and NO from inhibitory motoneurone

108
Q

what do the ANS and CNS regulate in terms of obesity

A 
ANS = activity of the neuroendocrine activity 
CNS = energy balance through behaviour
109
Q

lesioning the
- ventromedial hypothalamus
- lateral hypothalamus
causes:

A 
ventromedial = obesity 
lateral = leanness
110
Q

CCK

A

satiation signal
secreted from enteroendocrine cells in D and J
stimulates hindbrain
released in proportion to lipids and proteins

111
Q

PYY (3-36)

A

satiation signal
secreted from endocrine mucosal L cells
inhibits motility and slows emptying, reducing food intake

112
Q

GLP-1

A

satiation signal
pro-glucagon gene released from L cells in response to food ingestion
inhibits gastric emptying, reducing food intake

113
Q

OXM

A

satiation signal
released from oxynitic cells and L cells
after meal to suppress appetite

114
Q

Obestatin

A

released from cells in the stomach and duodenum

115
Q

ghrelin

A

hunger signal
released from oxynitic cells
levels increase before meals and decrease after meals

116
Q

what hormones relay fat store to the brain

A

leptin (made and released from fat cells) –> reduced levels mimic starvation causing an unrestrained appetite. circulated in proportion to adiposity. pleiotrophic hormone. can develop resistance

insulin (made and released from pancreatic cells) - circulates in proportion to adiposity

117
Q

obesity drugs

A

orlistat - inhibits pancreatic lipase decreaseing TAG absorption
liraglutide - GLP-1 receptor agonist

118
Q

orad vs caudad stomach

A 
O = tonic contractions, oxynitic gland area
C = phasic contractions, pyloric gland area
119
Q

duodenal factors

A

fat
acid
hypertonicity
distension

120
Q

HCl

A

oxynitic secretion
activates pepsin to pepsinogen
denatures proteins and kills microorganisms

121
Q

Pepsinogen

A

oxynitic secretion

inactive precursor of pepsin

122
Q

Intrinsic factor and gastroferrin

A

oxynitic secretion

bind vit B12 and Fe2+ respectively

123
Q

Histamine

A

oxynitic secretion

stimulates HCl secretion

124
Q

mucus

A

oxynitic secretion

protective

125
Q

gastrin

A

pyloric secretion

stimulates HCl secretion

126
Q

somatostatin

A

pyloric secretion

inhibits HCl secretion

127
Q

mucus

A

pyloric secretion

protective

128
Q

what cranial nerve controls the cephallic phase

A

vagus

129
Q

what produces mucosa

A

prostaglandins - reduce acid secretion and increase mucus and bicarbonate secretions and increase mucosal blood flow

130
Q

what triggers the MMC (migrating motor complex) and what suppresses it

A

motilin

gastrin and CCK

131
Q 
what cells secrete:
gastrin 
CCK
secretin
motilin
GIP
GLP-1
ghrelin
A 
G cells - gastrin 
I cells - CCK
S cells - secretin
M cells - motilin 
K cells - GIP
L cells - GLP-1
Gr cells - ghrelin
132
Q

what enzyme catalyses the conversion of inactive proteases to active ones in the mucosal cells

A

enterokinase

133
Q

what are the exocrine secretions of the pancreas

A

digestive enxymes

aqueaous NaHCO3- solution

134
Q

whats the only enzyme that can break the alpha 1,6 linkages

A

isomaltose

135
Q

primary vs secondary lactase insufficiency

congenital

A 
primary = lack of lactase persistance allele
secondary = damage/infection to proximal small intestine
congenital = rare autosomal recessive disorder
136
Q

undigested lactose causes

A

acidication of the colon and increase in osmotic load

137
Q

glucose absorption is mediated by …

A

SGLT1 secondary transport - symport of Na and glucose into the cell

138
Q

fructose absorption is mediated by …

A

GLUT 5

139
Q

monosaccharide exit mediated by …

A

GLUT 2

140
Q

what active enzymes are endopeptidases and what is the product

A

trypsin
chymotrypsin
elastase
–> oligopeptides

141
Q

what active enzymes are exopeptidases and what is the product

A

carboxypeptidase A
carboxypeptidase B
–> single amino acids

142
Q

what enzyme completes protein digestion

A

pancreatic proteases

143
Q

cytoplasmic peptidases

A

hydrolyse di and tri peptides

144
Q

cystinuria and Hartnup disease

A

C = B0AT1
H = b0+AT
Na dependent and Na independent protein absorption on the brush border

145
Q

gastric lipase

A

secreted in response to gastrin

produces fatty acids and diacylglycerol

146
Q

pancreatic lipase

A

secreted from acinar cells in response to CCK which also stimulates bile flow

147
Q

procolipase activated by …

A

trypsin

148
Q

Ca absorption

A

passive

regulated by 1,25 dihydroxyvitamin D3 and parathyroid hormone

149
Q

absorption of iron

A

ferrous form (Fe2+) binds to gastroferrin which reduces it to the absorbable ferric form (Fe3+)

150
Q

what takes up vit B12 in the saliva

A

hepatocorin

151
Q

functions of the colon

A

release K, HCO3 and mucus

absorb Na, Cl and H2O and short chain fatty acids

152
Q

what mediates electrolyte absorption by osmosis

A

colonocytes

153
Q

mechansisms for water reabsorption of water

A

Na/glucose cotransport - causes simultaneous absorption of Cl

Na/AA cotransport - NHE2 and NHE3 contribute to the movement of Na across the membrane, NHE1 is a pH housekeeper

Na/H exchange - stimulated by luminal HCO3- - regulated by cGMP, cAMP and Ca

Parallel Na/H and Cl/HCO3- exchange

ENaC - epithelial sodium channels - aldosterone opens them, places them in the membrane and increases their synthesis

154
Q

CFTR activation is …

A

secondary due to the generation of secodary messengers such as cGMP, cAMP, and Ca

155
Q

causes of diarrhoea

A

impaired absorption of NaCl
excessive secretions
hypermotility
non-absorbable or poorly absorbable solutes in the intestinal lumen

156
Q

emesis is coordinated by …

A

VC in the medulla oblongata

157
Q

how does vomiting come about

A

stimulus –> enterochromaffin cells in mucsa release mediators like 5-HT –> depolarisation of sensory afferent terminals in mucosa –> AP discharge from vagal afferents to brainstem –> coordination of vomiting

158
Q

what does the CTZ lack and where is it

A

lacks a BBB

area postrema

159
Q

what is the NTS

A

nucleus tractus solitarus

160
Q

what does fat metabolism involve

A

processing chylomicron remnants
synthesis of lipoproteins and cholesterol
ketogenesis in starvation

161
Q

what does protein metabolism involve

A

synthesis of plasma proteins
transamination and deamination of AA
conversion of ammonia to urea

162
Q

what are secondary bile acids conjugated with in the liver

A

glycine or taurine

163
Q

what do resins do

A

bind to bile salts and prevent their reabsorption –> lowers LDL

164
Q

what is CYP450

A

haem protein in the ER of liver hepatocytes mediating oxygenation reactions

165
Q

what are theraputic options for encephalopathy

A

lactulose

antibiotics

1MBChB Revision (12 decks)

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