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202 > Anatomy and Physiology > Flashcards

Anatomy and Physiology Flashcards

1
Q

How can hormones exert their affect when they bind to a receptor?

A

1) regulate rate of enzymatic reactions
2) regulate transport of ions and molecules across cell membrane
3) regulate gene expression and synthesis of proteins
4) regulate electrical signalling pathways

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2
Q

What is hyperfunction in endocrine disorders?

A

Increase in related hormone

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3
Q

What is hypofunction in endocrine disorders?

A

Reduction in related hormone

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4
Q

Example of hypofunction endocrine disorders?

A

Hypothyroidism
Hypopituitarism
Diabetes mellitus

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5
Q

Example of hyperfunction endocrine disorders?

A

Acromegaly
Hyperthyroidism

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6
Q

Which hormones are tyrosine derivatives?

A

Catecholamines
Thyroid hormones

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7
Q

How are peptide hormones synthesised and stored?

A

Made in advance
Stored in secretory vesicles

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8
Q

How are steroid hormones synthesised and stored?

A

Synthesised on demand from precursors, so not stored

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9
Q

How are catecholamine hormones synthesised and stored?

A

Made in advanced
Stored in secretory vesicles

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10
Q

How are thyroid hormones synthesised and stored?

A

Made in advanced
Precursor stored in secretory vesicles

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11
Q

How are peptide hormones released from the parent cell?

A

Exocytosis

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12
Q

How are steroid hormones released from the parent cell?

A

Simple diffusion

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13
Q

How are catecholamine hormones released from the parent cell?

A

Exocytosis

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14
Q

How are thyroid hormones released from the parent cell?

A

Simple diffusion

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15
Q

How are peptide hormones transported in the blood?

A

Dissolved in plasma

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16
Q

How are steroid hormones transported in the blood?

A

Bound to carrier proteins

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17
Q

How are catecholamine hormones transported in the blood?

A

Dissolved in plasma

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18
Q

How are thyroid hormones transported in the blood?

A

Bound to carrier proteins

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19
Q

Half-life of peptide hormones?

A

Short

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20
Q

Half-life of steroid hormones?

A

Long

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21
Q

Half-life of catecholamine hormones?

A

Short

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22
Q

Half-life of thyroid hormones?

A

Long

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23
Q

Location of peptide hormone receptors?

A

Cell membrane

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24
Q

Location of steroid hormone receptors?

A

Usually cytoplasm or nucleus

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25
Q

Location of catecholamine hormone receptors?

A

Cell membrane

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26
Q

Location of thyroid hormone receptors?

A

Nucleus

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27
Q

Response when peptide hormones bind to a receptor?

A

Activation of second messenger system

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28
Q

Response when steroid hormones bind to a receptor?

A

Activation of genes for transcription and translation

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29
Q

Response when catecholamine hormones bind to a receptor?

A

Activation of second messenger systems

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30
Q

Response when thyroid hormones bind to a receptor?

A

Activation of genes for transcription and translation

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31
Q

Examples of peptide hormones?

A

Insulin
Parathyroid hormone

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32
Q

Examples of steroid hormones?

A

Oestrogen
Androgens
Cortisol

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33
Q

Examples of catecholamine hormones?

A

Adrenaline
Noradrenaline

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34
Q

Examples of thyroid hormones?

A

Thyroxine (T4)

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35
Q

Where is the hypothalamus located?

A

The thalamus in the brain

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36
Q

What connects the brain to the pituitary?

A

A stalk called infundibulum

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37
Q

What are the two parts of the pituitary gland?

A

Anterior and posterior

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38
Q

Which part of the pituitary is a true endocrine gland?

A

Anterior

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39
Q

What is the sella turcica?

A

A bone socket at the base of the skull which houses the pituitary gland

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40
Q

What is the hypothalamic pituitary axis?

A

A complex function unit that serves as a major link between the endocrine and nervous system

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41
Q

The sella turcica is part of which bone?

A

Sphenoid

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42
Q

What do neurons do in the hypothalamus?

A

Synthesis of trophic hormones to release to the pituitary

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43
Q

How are trophic hormones carried to the pituitary?

A

The hypophyseal portal system

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44
Q

What are tropic hormones?

A

Hormones that act on other endocrine glands to synthesise or release a hormone

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45
Q

How many tropic hormones does the hypothalamus secrete?

A

Seven

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46
Q

How many hormones and synthesised and secreted from the anterior pituitary?

A

Six

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47
Q

What are the six hormones secreted from the anterior pituitary?

A

Thyroid stimulating hormone
Andrenocorticotropic hormone
Luteinising hormone
Follicle stimulating hormone
Prolactin
Growth hormone

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48
Q

What is endocrine-axis feedback loop?

A

Where the hormone is regulated by the concentration of hormone in the blood

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49
Q

What is an endocrine axis-driven feedback long loop?

A

The last hormones in the pathway feeds back to the hypothalamus/anterior pituitary

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50
Q

What is an endocrine axis-driven feedback short loop?

A

Pituitary hormone feedback to the hypothalamus

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51
Q

Why is the posterior pituitary not a true endocrine organ?

A

It does not make hormones, only stores them

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52
Q

How many hormones are stored in the posterior pituitary?

A

Two

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53
Q

Which hormones are stored in the posterior pituitary?

A

Oxytocin
Antidiuretic hormone

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54
Q

How are hormones transported to the posterior pituitary?

A

Down nerve cell axons in vesicles

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55
Q

What can cause an endocrine disorder?

A

Issues with feedback systems
Genetic disorders
Infection or disease (often autoimmune)
Injury to endocrine gland
Endocrine tumour

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56
Q

What is a primary endocrine disorder?

A

Cause of disorder is in the target endocrine gland

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57
Q

What is a secondary endocrine disorder?

A

Cause of disorder is in the anterior pituitary

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58
Q

What is a tertiary endocrine disorder?

A

Cause of disorder is in the hypothalamus

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59
Q

Normal plasma glucose range?

A

5-7.8mmol/L

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60
Q

Normal plasma glucose range when fasting?

A

4-5.4 mmol/L

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61
Q

Normal plasma glucose range two hours after eating?

A

<7.8mmol/L

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62
Q

Factors that affect glucose absorption?

A

Rate of digestion
Rate of gastric emptying
Rate of absorption in small intestine

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63
Q

How is the liver involved in removing excess glucose?

A

Blood with high glucose concentration enters hepatic portal system
Blood enters liver
Excess glucose removed, facilitated by insulin

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64
Q

What is glycaemic index?

A

A rating system for foods containing carbohydrates. How quickly food affects blood sugar levels

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65
Q

Foods with a high glycaemic index?

A

Sugary food/drink
White bread
Potatoes
White rice

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66
Q

Foods with a low/medium glycaemic index?

A

Some fruits and vegetables
Pulses
Whole grain foods

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67
Q

Is glucose normally excreted?

A

No

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68
Q

What does OGTT stand for?

A

Oral glucose tolerance test

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69
Q

What is an oral glucose tolerance test useeld for?

A

To diagnose diabetes mellitus or to look at insulin resistance

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70
Q

Oral glucose tolerance test procedure?

A

Fast for 8-12 hours before test
Blood glucose levels measured
Drink 75g glucose
Retest after two hours

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71
Q

Normal OGTT results?

A

Fast: <6mmol/L
Two hours later: <7.8mmol/L

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72
Q

Diabetic OGTT results?

A

Fast: >7mmol/L
After 2 hours: >11mmol/L

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73
Q

What type of hormone is insulin?

A

Peptide

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74
Q

How many amino acids are in insulin?

A

51

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75
Q

What is the molecular weight of insulin?

A

6KDa

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76
Q

Basic structure of insulin?

A

A and B chains held together by disulphide bonds

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77
Q

Is the action of insulin considered anabolic or catabolic?

A

Anabolic

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78
Q

Where is the pancreas?

A

Below the liver, behind the stomach

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79
Q

Approximate weight of the pancreas?

A

100g

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80
Q

What is the head of the pancreas attached to?

A

Duodenum

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81
Q

What is the tail of the pancreas attaches to?

A

Spleen

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82
Q

What percentage of the pancreas is exocrine?

A

98%

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83
Q

What are clusters of exocrine cells in the pancreas called?

A

Acini

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84
Q

What is exocrine tissue?

A

Relating to a gland that secretes outwardly through duct(s)

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85
Q

What do exocrine tissues in the pancreas release?

A

Pancreatic juice

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86
Q

How much pancreatic juice is released per day?

A

1L per day

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87
Q

What is the pH of pancreatic juice?

A

8

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88
Q

What does pancreatic juice contain?

A

Digestive enzymes and bicarbonate to buffer gastric acid released from the stomach

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89
Q

What percentage of the pancreas is endocrine?

A

2%

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90
Q

What are clusters of endocrine cells in the pancreas called?

A

Islets of Langerhans

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91
Q

What do islets of langerhans do?

A

Synthesise and secrete hormones into the blood via the pancreatic vein

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92
Q

Type of cells in the islets of langerhans?

A

Alpha
Beta
Delta

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93
Q

What percentage of cells in the islets of langerhans are alpha cells?

A

20%

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94
Q

What percentage of cells in the islets of langerhans are beta cells?

A

70%

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95
Q

What percentage of cells in the islets of langerhans are delta cells?

A

5%

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96
Q

What do alpha cells in the islets of langerhans secrete?

A

Glucagon

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97
Q

What do beta cells in the islets of langerhans secrete?

A

Insulin

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98
Q

What do delta cells in the islets of langerhans secrete?

A

Somatostatin

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99
Q

Insulin synthesis process?

A

1) insulin mRNA translated as a single chain precursor called preproinsulin
2) signal peptide removed during insertion to ER, generating proinsulin
3) in ER C-peptide is removed to form immature insulin
4) insulin and C-peptide packaged into vesicles in the Golgi
5) insulin matures
6) insulin exocytosed when beta cell stimulated

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100
Q

How is insulin stored?

A

In crystalline form
6 molecules of insulin around two molecules of zinc

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101
Q

Why is insulin stored in crystalline form?

A

Increased storage capacity
Reduced solubility
Increased half-life

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102
Q

What kind of feedback controls insulin secretion?

A

Negative

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103
Q

What is the main glucose transporter in humans?

A

GLUT1

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104
Q

How does glucose stimulate insulin secretion?

A

1) glucose transported into beta cells through plasma membrane transporters
2) glucose levels in cell increase
3) glucose in beta cells phosphorylated by glucokinase to glucose-6-phosphate
4) most glucose fully oxidised leading to rise in ATP
5) ATP sensitive potassium efflux channels inhibited by ATP
6) channels close
7) cell depolarises
8) depolarisation activates voltage-gated calcium channels
9) increase in calcium leads to exocytosis and release of insulin

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105
Q

Calcium channels in beta cells are controlled by?

A

Voltage

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106
Q

Potassium efflux channels in beta cells are controlled by?

A

ATP levels

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107
Q

What type of kinase is glucokinase?

A

A low-affinity hexokinase

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108
Q

What is glucose phosphorylated to in beta cells?

A

Glucose-6-phosphate

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109
Q

What kind of pattern is insulin secretion?

A

Biphasic

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110
Q

Describe biphasic insulin secretion?

A

Rapid first phase release
Prolonged second phase release

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111
Q

What is the rate limiting step in insulin secretion?

A

Glucokinase phosphorylation

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112
Q

What type of receptor is the insulin receptor?

A

Tyrosine kinase

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113
Q

What does insulin promote in the liver?

A

Glycogenesis
Lipogenesis
Glycolysis

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114
Q

What does insulin inhibit in the liver?

A

Glycogenolysis
Lipolysis
Gluconeogenesis

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115
Q

What does insulin promote in muscle?

A

Glucose transport (GLUT4)
Glycogenesis
Glycolysis
Lipogenesis
Protein synthesis
Amino acid transport

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116
Q

Where does insulin act?

A

Liver
Muscle
Adipose tissue

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117
Q

What does insulin inhibit in muscle?

A

Lipolysis
Protein catabolism

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118
Q

What does insulin promote in adipose tissue?

A

Glucose transport (GLUT4)
Lipogenesis

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119
Q

What does insulin inhibit in adipose tissue?

A

Lipolysis

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120
Q

What is Glycogenesis?

A

Glucose storage as glycogen

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121
Q

What is Lipogenesis?

A

Glucose storage as fat

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122
Q

What is glycolysis?

A

Glucose utilisation

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123
Q

What is glycogenolysis?

A

Breakdown of glycogen

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124
Q

What is Lipolysis?

A

Break down of fat

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125
Q

What is gluconeogenesis?

A

Generation of glucose

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126
Q

What is the main hormone involved in decreasing blood glucose?

A

Insulin

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127
Q

What is the main hormone involved in increasing blood glucose?

A

Glucagon

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128
Q

What other hormones are involved in increasing blood glucose levels?

A

Adrenaline
Cortisol
ACTH
Growth hormone
Thyroxine

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129
Q

What type of hormone is glucagon?

A

Peptide

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130
Q

How many amino acids in glucagon?

A

29

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131
Q

Glucagon acts on which receptor?

A

Glucagon receptor

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132
Q

What type of receptor is the glucagon receptor?

A

GsPCR

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133
Q

Where does glucagon act?

A

Liver
Adipose tissue

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134
Q

What does glucagon promote in the liver?

A

Glycogenolysis
Gluconeogenesis

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135
Q

What does glucagon promote in adipose tissue?

A

Lipolysis for Gluconeogenesis

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136
Q

How does cortisol help increase blood glucose?

A

Promotes Gluconeogenesis
Breakdown of skeletal muscle protein to provide substrates for Gluconeogenesis
Enhance Lipolysis
Counteracts the affects of insulin

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137
Q

How does exercise affect glucose homeostasis?

A

Increases glucagon, noradrenaline, adrenaline and cortisol

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138
Q

How is glucagon related to exercise in glucose homeostasis?

A

Increased glucagon increases Glycogenolysis and Gluconeogenesis in the liver.
Meaning more glucose for anaerobic exercise

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139
Q

How is cortisol related to exercise in glucose homeostasis?

A

Increases Gluconeogenesis during aerobic exercise when carbohydrate resources are depleting

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140
Q

How does exercise affect fat metabolism?

A

Increased cortisol, growth hormone, noradrenaline and adrenaline increase lipase enzyme activity which increases Lipolysis

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141
Q

Groups of steroid sex hormones?

A

Androgens
Oestrogens
Progestogens

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142
Q

What are androgens?

A

Male sex hormones

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143
Q

What are oestrogens and progestogens?

A

Female sex hormones

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144
Q

Types of androgens?

A

Dihydrotestosterone
Testosterone

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145
Q

Types of oestrogens and progestogens?

A

Oestradiol
Progesterone

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146
Q

What is dihydrotestosterone produced from?

A

Testosterone by the enzyme 5alfa-reductase

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147
Q

What types of hormones are sex hormones?

A

Steroids

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148
Q

What does dihydrotestosterone do?

A

Critical in sexual differentiation of the embryo and subsequent sexual development and maintenance of masculine characteristics

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149
Q

Does dihydrotestosterone act locally or systemically?

A

Locally

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150
Q

There is testosterone produced?

A

Testes

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151
Q

Does testosterone act locally or systemically?

A

Both

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152
Q

What does testosterone do?

A

Critical for generation of sperm and development and maintenance of masculine characteristics

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153
Q

Where is oestradiol generated?

A

Ovaries

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154
Q

What is oestradiol generated from?

A

Androgens by the enzyme aromatase

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155
Q

What does oestradiol do?

A

Controls the development and maintenance of feminine characteristics and stimulates the growth of the egg follicle

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156
Q

What does progesterone do?

A

Stimulates the growth of the endometrial lining of the uterus in order to prepare it for pregnancy

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157
Q

What does the hypothalamus synthesise and secrete in relation to the reproductive system?

A

Gonadotropin-releasing hormone (GnRH)

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158
Q

What does GnRH stand for?

A

Gonadotropin-releasing hormone

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159
Q

What does the anterior pituitary synthesise and secrete in relation to the reproductive system?

A

Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)

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160
Q

What does FSH stand for?

A

Follicle-stimulating hormone

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161
Q

What does LH stand for?

A

Luteinising hormone

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162
Q

FSH and LH act on the gonads to promote?

A

Sex hormone production
Gametogenesis

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163
Q

What do the testes produce?

A

Testosterone
Spermatozoa

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164
Q

What do the ovaries produce?

A

Oestradiol
Progesterone
Ova

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165
Q

What is gametogenesis?

A

Production of gametes

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166
Q

What causes puberty?

A

Signalled by high pulses of gonadotropin-releasing hormone

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167
Q

Average age of puberty onset in males?

A

12 years old

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168
Q

What does gonadotropin-releasing hormone stimulate the release of?

A

LH
FSH

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169
Q

What controls the negative feedback loop in the male reproductive system?

A

Testosterone
Inhibin

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170
Q

What is inhibin?

A

A peptide hormone that controls the release of GnRH, FSH and LH in a negative feedback loop (along with testosterone)

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171
Q

Hormonal control of the testes?

A
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172
Q

Diagram of testes?

A
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173
Q

Key parts of the testes?

A

Seminiferous tubules
Rete testis
Epididymis
Vas deferens

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174
Q

What happens at the seminiferous tubules?

A

Site of spermatogenesis

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175
Q

What happens at the rete testis?

A

Sperm concentrated here

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176
Q

What happens at the epididymis?

A

Sperm is stored here

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177
Q

What is the vas deferens?

A

Ducts that transport sperm from the epididymis to the ejaculatory ducts

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178
Q

What cells are present in the seminiferous tubules?

A

Leydig cells
Sertoli cells

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179
Q

What do Leydig cells respond to?

A

Luteinising hormone

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180
Q

What do Leydig cells do?

A

Produce testosterone

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181
Q

What does testosterone make the Sertoli cells secrete?

A

Production of factors that promote spermatogenesis

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182
Q

What do the Sertoli cells form?

A

The testes/blood barrier

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183
Q

What do Sertoli cells do?

A

Provide nutrients and factors to the developing germ cells

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184
Q

What do Sertoli cells respond to?

A

FSH

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185
Q

What do Sertoli cells secrete?

A

Chemical signals needed for proliferation and differentiation of germ cells
Inhibin
Seminal fluid

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186
Q

What does seminal fluid contain?

A

Androgen-binding protein (ABP)

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187
Q

What does Androgen-binding protein do?

A

Binds testosterone to maintain a high concentration in the tubules which is essential for spermatogenesis

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188
Q

What are germ cells called? (male reproductive system)

A

Spermatogonia

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189
Q

Process of spermatogenesis?

A

Spermatogonia divide mitotically and meiotically and then differentiate into spermatozoa
Germ cells move away from basement membrane and towards lumen of seminiferous tubule

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190
Q

Does long does the process of spermatogenesis take?

A

60-64 days

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191
Q

Where does inhibin act on?

A

Posterior pituitary

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192
Q

Average age of puberty onset in females?

A

11 years old

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193
Q

What is menstruation?

A

When the uterine lining is shed if fertilisation does not take place

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194
Q

Phases of the menstrual cycle?

A

Follicular phase
Ovulatory phase
Luteal phase
Menstruation

195
Q

What happens in the follicular phase?

A

A follicle develops into a mature follicle

196
Q

What is a follicle? (reproductive)

A

Small structure in the ovary that contains one immature egg (oocyte)

197
Q

What is a mature follicle? (reproductive)

A

Fluid-filled sac containing the oocyte

198
Q

How long does the follicular phase last?

A

9-23 days

199
Q

What happens in the ovulatory phase?

A

Release of the oocyte

200
Q

How long does the ovulatory phase last?

A

1-3 days

201
Q

What happens in the luteal phase?

A

The development of the corpus luteum

202
Q

Where is the thyroid gland found?

A

Anterior neck, below the larynx

203
Q

What is an enlarged thyroid gland called?

A

Goitre

204
Q

Shape of the thyroid gland?

A

Butterfly-shaped

205
Q

What connects the two lobes of the thyroid gland?

A

Isthmus

206
Q

What are the two thyroid hormones?

A

Thyroxine (T4)
Triiodothyronine (T3)

207
Q

What does T3 stand for?

A

Triiodothyronine

208
Q

What does T4 stand for?

A

Thyroxine

209
Q

XX see chromosomes create?

A

Female

210
Q

XY see chromosomes create?

A

Male

211
Q

What causes testes for form in an embryo?

A

SRY gene activates a transcription factor that activates the pathway at around 7 weeks

212
Q

What does the SRY gene do?

A

The SRY gene provides instructions for making a protein called the sex-determining region Y protein

213
Q

What are the names of the two sets of ducts in an embryo that are to do with sexual differentiation?

A

Wolffian ducts
Mullerian ducts

214
Q

Which embryo ducts develop into the male reproductive tract?

A

Wolffian ducts

215
Q

Which embryo ducts develop into the female reproductive tract?

A

Mullerian ducts

216
Q

What does SRY induce the expression of?

A

Anti-mullerian hormone (to get rid of Mullerian ducts)
Testosterone
Dihydrotestosterone

217
Q

How is dihydrotestosterone produced?

A

From testosterone by the enzyme 5a-reductase

218
Q

What does dihydrotestosterone do?

A

Sexual differentiation in embryo and subsequent sexual development and maintenance of masculine characteristics

219
Q

Where does dihydrotestosterone work?

A

Locally

220
Q

Where is testosterone made?

A

In the testes

221
Q

What does testosterone do?

A

Generation of sperm and development and maintenance of masculine characteristics

222
Q

Where does testosterone work?

A

Systemically and locally

223
Q

What does oestradiol do?

A

Controls the development and maintenance of feminine characteristics and stimulate the growth of the egg follicle

224
Q

What does progesterone do?

A

Stimulates the growth of the endometrial lining of the uterus in order to prepare it for pregnancy

225
Q

What does the hypothalamus secrete (reproductive endocrinology)?

A

Gonadotropin-releasing hormone (GnRH)

226
Q

What does the anterior pituitary secrete (reproductive endocrinology)?

A

Follicle stimulating hormone (FSH) and Luteinising hormone (LH)

227
Q

What is GnRH?

A

Gonadotropin-releasing hormone

228
Q

What is FSH?

A

Follicle stimulating hormone

229
Q

What is LH?

A

Luteinising hormone

230
Q

Male gonads?

A

Testes

231
Q

Female gonads?

A

Ovaries

232
Q

Principle functions of gonads?

A

Produce steroidal sex hormones Gametogenesis

233
Q

What causes puberty?

A

High pulses of gonadotropin-releasing hormone

234
Q

What does the release of GnRH do?

A

Stimulates the release of FSH and LH from the pituitary gland

235
Q

Hormonal regulation of the male reproductive system?

A

Hypothalamus secretes GnRH -> GnRH causes pituitary gland to secrete FSH and LH -> FSH acts on testes to begin spermatogenesis and LH to produce testosterone -> testosterone and inhibin control release of GnRH and FSH/LH through a negative feedback mechanism

236
Q

What is inhibin?

A

A peptide hormone that controls the release of GnRH and FSH/LH

237
Q

What do the seminiferous tubules do?

A

Site of spermatogenesis Make up 80% mass of the testes

238
Q

What do the rete testis do?

A

Sperm are concentrated here

239
Q

What does the epididymis do?

A

Store sperm

240
Q

What does the vas deferens do?

A

It is duct that transports sperm from the epididymis to the ejaculatory ducts

241
Q

Two main types of cell in the seminiferous tubules?

A

Leydig cells Sertoli cells

242
Q

What do leydig cells do?

A

Respond to LH to produce testosterone

243
Q

What does testosterone do to the Sertoli cells?

A

Stimulates the production of factors that promote spermatogenesis

244
Q

Where are the leydig cells located?

A

Surround the seminiferous tubules

245
Q

Where are the Sertoli cells located?

A

Beneath the basement membrane of the seminiferous tubules and form the blood/testes barrier

246
Q

What do Sertoli cells do?

A

Provide nutrients and factors to developing germ cells Respond the FSH to produce chemical signals for proliferation and differentiation of germ cells Secrete inhibin Secrete seminal fluid which contains androgen-binding protein (ABP) that binds testosterone to maintain a high concentration in tubules

247
Q

What is ABP?

A

Androgen-binding protein It binds testosterone to maintain a high concentration in the seminiferous tubules

248
Q

Process of spermatogenesis?

A

Germ cells called spermatogonia divide mitotically and meiotically and differentiate into spermatozoa Germ cells move away from the basement membrane, towards the lumen of seminiferous tubules

249
Q

How long does spermatogenesis take?

A

60-64 days

250
Q

How many sperm on average are made per day?

A

30 million

251
Q

Hormonal control of spermatogenesis?

A

Hypothalamus releases GnRH -> GnRH causes release of FSH and LH from pituitary gland -> LH acts on leydig cells to produce testosterone -> testosterone and FSH act on Sertoli cells to facilitate spermatogenesis and release inhibin -> testosterone acts on hypothalamus and pituitary as a negative feedback mechanism whereas inhibin only acts on the pituitary

252
Q

Hormonal control of female reproductive system?

A

Hypothalamus secretes GnRH -> GnRH causes pituitary gland to secrete FSH and LH -> FSH and LH stimulate ovaries to produce oestrogen for follicular development and ovulation -> oestrogen controls release of GnRH and FSH/LH through a negative feedback mechanism

253
Q

Menstrual cycle definition?

A

The monthly cycle of release of the oocyte and the preparation of the endometrial lining of the uterus for pregnancy which is then shed if fertilisation does not take place

254
Q

What are the three phases of the menstrual cycle?

A

Follicular phase Ovulatory phase Luteal phase

255
Q

Main cells of the follicle?

A

Granulosa cells Theca cells

256
Q

What do theca cells do?

A

Respond to LH and synthesise testosterone

257
Q

What do granulosa cells do?

A

Respond to FSH to synthesise oestradiol from testosterone They acts as nurse cells to the oocyte

258
Q

How many follicles develop each month?

A

10-25

259
Q

What causes all but one of the follicles to die?

A

A drop in FSH

260
Q

What causes follicle growth?

A

FSH increase

261
Q

What hormone causes ovulation?

A

LH increase

262
Q

Why happens during ovulation?

A

The oocyte is released into the Fallopian tube

263
Q

What is the corpus luteum?

A

The follicle after the oocyte has been released The granulosa cells greatly enlarge

264
Q

What does the corpus luteum do?

A

Produces progesterone which stimulates the growth of the endometrial lining to prepare for pregnancy It also releases oestrogen and inhibin

265
Q

Hormonal control of menstrual cycle?

A

Hypothalamus releases GnRH -> GnRH stimulates pituitary to releases FSH and LH -> FSH and LH stimulate follicles to produce low levels of oestradiol and also produce inhibin -> low levels of oestradiol inhibit GnRH to keep FSH and LH levels low causing menstruation -> LH and FSH levels increase which increase oestradiol which thickens the uterine lining -> GnRH is secreted causing LH and FSH levels to rise -> resulting in ovulation around a day later -> LH stimulates growth of corpus luteum -> corpus luteum releases oestradiol and progesterone that blocks GnRH and LH and FSH causing endometrium to further develop

266
Q

What does the combined pill contain?

A

Oestrogen and a progestogen (synthetic progesterone)

267
Q

How does the contraceptive pill work?

A

Suppresses the release of FSH and LH

268
Q

What does human chorionic gonadotropin (HCG) do?

A

Generated by the developing embryo to ensure survival of corpus luteum

269
Q

Where does fertilisation occur?

A

In the Fallopian tube

270
Q

When can fertilisation occur?

A

Within a couple of days of ovulation

271
Q

What is the zona pallucida?

A

the thick transparent membrane surrounding a mammalian ovum before implantation

272
Q

How does fertilisation occur?

A

Sperm binds to zona pallucida -> triggers acrosomal reaction causing acrosomal enzymes to be released -> enzymes digest a path through zona pallucida -> when a sperm penetrates zona pallucida a reaction occurs to harden the zona pallucida to prevent entry of more sperm -> sperm DNA (the head) enters the oocyte which is now called a zygote

273
Q

What is a zygote?

A

The cell formed by the union of two gametes

274
Q

Fertilisation to implantation?

A

Zygote undergoes mitotic division resulting in 16-32 totipotent cell conceptus -> after 3/4 days conceptus reaches uterus -> totipotency is lost and conceptus differentiates and develops into blastocyst -> blastocyst embeds in wall of uterus

275
Q

What are trophoblasts?

A

A layer of tissue surrounding the blastocyst Provides nutrients to the developing embryo for the first three months

276
Q

What do trophoblasts release and why?

A

Human chorionic gonadotropin (HCG) to ensure survival of corpus luteum so it can continue to produce progesterone and oestradiol for the first three months to maintain the pregnancy

277
Q

What do pregnancy tests detect?

A

HCG

278
Q

How soon can a pregnancy test work?

A

After implantation (6-12 days after fertilisation)

279
Q

What happens to trophoblasts at 3 months?

A

They differentiate into the placenta and stop making HCG and instead produce progesterone and oestradiol Placenta takes over the job of corpus luteum which degenerates due to fall in HCG

280
Q

Name a common cause of miscarriage around 3 months?

A

When the switch between the corpus luteum and the placenta goes wrong

281
Q

Where is oxytocin produced?

A

Hypothalamus and then stored in posterior pituitary

282
Q

Process of oxytocin release?

A

Baby pushes against cervix causing activation of stretch receptors -> stretch receptor send message to hypothalamus to release more oxytocin This is positive feedback

283
Q

What does oxytocin do?

A

Causes contractions of smooth muscle of the uterus pushing baby further down birth canal

284
Q

Why may oxytocin be given to a patient?

A

To induce labour To accelerate labour To stop bleeding after deliver (routine after caesarean-delivery)

285
Q

What type of receptors do LH and FSH bind to?

A

GPCR

286
Q

Process of oogenesis?

A

1) during foetal development oogonia divide mitotically
2) 7 months after conception then stop dividing
3) a third differentiate into primary oocytes
4) start to replicate their DNA ready for meiosis
5) cells wait in meiotic arrest until puberty
6) at puberty cells undergo meiotic division
7) second meiotic division occurs after ovulation and is completed after fertilisation

287
Q

When does oogenesis begin?

A

During foetal development

288
Q

What does the contraceptive implant contain?

A

Progestogens (etonogestrel)

289
Q

Ovulation disordered account for what percentage of infertile couples?

A

25%

290
Q

How can endometriosis cause infertility?

A

Tissue that usually only grows in the uterus starts to grow in other areas. This growth may obstruct the tubes or affect the lining of the uterus.

291
Q

Uterine or cervical causes of infertility?

A

Benign polyps or tumours
Uterine abnormities
Cervical stenosis
Abnormal mucus

292
Q

What is the most common cause of female infertility?

A

Polycystic ovary syndrome

293
Q

How does PCOS cause infertility?

A

Increased androgen and LH secretion

294
Q

Symptoms of PCOS?

A

irregular periods or no periods at all
difficulty getting pregnant (because of irregular ovulation or no ovulation)
excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
weight gain
thinning hair and hair loss from the head
oily skin or acne

295
Q

What is premature ovarian insufficiency?

A

Premature loss of ova due to genetic problems or environmental insults, such as, chemotherapy

296
Q

What does surgery for infertility usually do?

A

Unblocks any blockages. Can be used in males and females

297
Q

What is a varicocele?

A

A varicose vein in the testicles that interferes with sperm development

298
Q

Types of assisted conception?

A

Intrauterine insemination (IUI)
In vitro fertilisation (IVF)

299
Q

What is intrauterine insemination?

A

Sperm is placed in the uterus using a fine plastic tube

300
Q

What is in vitro fertilisation?

A

Sperm and egg are mixed outside the body and out back into the uterus

301
Q

Do egg/sperm donors have to provide information about this identity?

A

Yes, since 1st April 2005

302
Q

Average length of the menstrual cycle?

A

24-35 days

303
Q

How long does the zygote stage last?

A

First 24 hours after union of egg and sperm. Ends when the first cell division takes place

304
Q

When does the zygote become an embryo and until when?

A

24 hours-8 weeks after fertilisation

305
Q

When does the embryo become a foetus?

A

8 weeks

306
Q

What do ovulation tests detect?

A

LH

307
Q

Signs of ovulation?

A

Changes in cervical fluid (usually watery/stretchy when ovulating)
Increase in body temperature
Changes in cervical position or firmness

308
Q

During ovulation the cervix is?

A

High, soft and open

309
Q

Before and after ovulation the cervix is?

A

Low, hard and closed

310
Q

What percentage of total body mass is the brain?

A

2%

311
Q

What percentage of the body’s total resting energy is used for the brain?

A

20%

312
Q

Can the adult CNS regenerate?

A

No

313
Q

Who discovered evidence of the blood brain barrier?

A

Ehrlich and Lewandowsky

314
Q

How was evidence for the blood brain barrier founded?

A

Intravenous injection of dyes that stained other tissues but not the brain

315
Q

What is the blood brain barrier?

A

A network of blood vessels that form a physical and chemical barrier between the brain parenchyma and systemic circulation

316
Q

Main type of cell that makes up the blood brain barrier?

A

Brain capillary endothelial cells

317
Q

Cells involved in the blood brain barrier?

A

Brain capillary endothelial cells
Pericytes
Astrocytes
Neuronal cells

318
Q

Anatomy of brain capillary endothelial cells?

A

Have tight junctions, which prevent paracellular transport of small and large (water soluble) compounds from the blood to the brain

319
Q

Function of pericytes at the blood brain barrier?

A

Phagocytosis

320
Q

Barriers to drug delivery across the blood brain barrier?

A

1) endothelium surrounded by basement membrane
2) tight junctions
3) enzymatic barriers
4) efflux barriers

321
Q

Enzymatic barrier to drug delivery across the blood brain barrier?

A

Various enzymes highly expressed in brain capillary endothelial cells which convert some drugs their inactive metabolites

322
Q

Examples of drugs that are converted to inactive metabolites by enzymes at the blood brain barrier?

A

Arachidonic acid
Testosterone
Progesterone
Desipramine

323
Q

Efflux barriers to drug delivery across the blood brain barrier?

A

Efflux pumps are P-glycoprotein and multidrug resistance-associated proteins
They recognise a wide variety of drugs

324
Q

Transport pathways across the blood brain barrier?

A

1) paracellular aqueous pathway
2) transcellular lipophilic pathway
3) transport proteins
4) receptor-mediated transcytosis
5) adsorptive transcytosis

325
Q

What types of molecules can cross the blood brain barrier via the paracellular pathway?

A

Water-soluble agents

326
Q

What types of molecules can cross the blood brain barrier via the transcellular lipophilic pathway?

A

Lipid-soluble agents

327
Q

Examples of drugs/molecules that cross the blood brain barrier via transport proteins?

A

Glucose
Amino acids
Nucleosides
Vinca alkaloids
Cyclosporin
Azathioprine

328
Q

Examples of drugs/molecules that cross the blood brain barrier via receptor-mediated transcytosis?

A

Insulin
Transferrin

329
Q

Examples of drugs/molecules that cross the blood brain barrier via adsorptive transcytosis?

A

Albumin
Other plasma proteins

330
Q

Passive diffusion across the blood brain barrier depends on?

A

Molecular weight
Lipophilicity

331
Q

What molecular weight can diffuse across the blood brain barrier?

A

<400/500Da

332
Q

Ideal logP to permeate the blood brain barrier?

A

1.5-2.5

333
Q

Can polar/charged molecules permeate the blood brain barrier?

A

Generally not

334
Q

What percentage of small drug molecules do not cross the blood brain barrier?

A

98%

335
Q

What percentage of large drug molecules do not cross the blood brain barrier?

A

100%

336
Q

Four categories of CNS disorders that consistently respond to small, lipophilic drugs?

A

Affective disorders
Chronic pain
Epilepsy
Migraine

337
Q

Ways that it may be possible to bypass the blood brain barrier?

A

Intrathecal
Nose to brain

338
Q

How are brain capillary epithelial cells different to other capillary cells?

A

Don’t have pores

339
Q

What is in the telencephalon?

A

Cerebral hemispheres
White matter
Subcortical structures

340
Q

What is in the diencephalon?

A

Thalamus
Hypothalamus
Other structures

341
Q

Parts of the brain stem?

A

Midbrain
Pons
Medulla oblongata

342
Q

What day of gestatIon are the six divisions of the adult CNS apparent in the foetus?

A

50 days

343
Q

What is the initial embryonic structure of the brain?

A

Neural tube

344
Q

Basic embryonic development of the brain?

A

Neural tube -> primary brain vesicles -> secondary brain vesicles -> adult brain structured and neural canal regions

345
Q

What are the three primary brain vesicles?

A

Prosencephalon
Mesencephalon
Rhombencephalon

346
Q

What is the forebrain primary brain vesicle?

A

Proscencephalon

347
Q

What is the midbrain primary brain vesicle?

A

Mesencephalon

348
Q

What is the hindbrain primary brain vesicle?

A

Rhombencephalon

349
Q

What are the five embryonic secondary brain vesicles?

A

Telencephalon
Diencephalon
Mesencephalon
Metencephalon
Myelencephalon

350
Q

What secondary brain vesicles does the prosencephalon become?

A

Telencephalon
Diencephalon

351
Q

What secondary brain vesicle does the mesencephalon become?

A

Stays as mesencephalon

352
Q

What secondary brain vesicles come from the rhombencephalon?

A

Metencephalon
Myelencephalon

353
Q

What is the mesencephalon?

A

Midbrain

354
Q

What is the metencephalon?

A

Pons
Cerebellum

355
Q

What is the myelencephalon?

A

Medulla oblongata

356
Q

When does folding of the cerebral hemispheres begin during embryonic development?

A

Six months

357
Q

What are the five lobes of the brain?

A

Frontal
Parietal
Temporal
Occipital
Insula

358
Q

What are sulci?

A

Grooves on the cerebral hemispheres

359
Q

What are gyri?

A

Bumps on the cerebral hemispheres

360
Q

What are fissures?

A

Deep sulci

361
Q

What does the central sulcus separate?

A

Frontal lobe from parietal lobe

362
Q

What does the parieto-occipital sulcus separate?

A

Occipital lobe from parietal lobe

363
Q

What does the lateral sulcus separate?

A

Parietal and frontal lobes from the temporal lobe

364
Q

What does the median longitudinal fissure separate?

A

The two hemispheres

365
Q

What does the transverse cerebral fissure separate?

A

Cerebral hemispheres from the cerebellum

366
Q

What is the prefrontal cortex involved in?

A

Complex cognitive, such as:
Differential conflicting thoughts
Consequences of actions
Task managing
Social control
Personality
Working memory
Object recall

367
Q

What disorders can be associated with the prefrontal cortex?

A

Schizophrenia
ADHD
Substance misuse disorders

368
Q

Motor areas of the brain?

A

Primary motor cortex
Premotor cortex
Frontal eye field
Broca’s area

369
Q

Purpose of the primary motor cortex?

A

Allows conscious control of precise, skilled, skeletal muscle movements

370
Q

What is in the primary motor cortex?

A

Large pyramidal cells project to contralateral motor neurons, to control the opposite side of the body

371
Q

What Brodmann area is the primary motor cortex?

A

4

372
Q

Where is the premotor cortex?

A

Frontal lobe
Anterior to the primary motor cortex

373
Q

Premotor cortex function?

A

Receives processed sensory information
Involved in planning movements

374
Q

Where is the frontal eye field?

A

Frontal lobe
Anterior to premotor cortex

375
Q

Purpose of the frontal eye field?

A

Controls voluntary eye movements

376
Q

Where is Broca’s area?

A

Frontal lobe
Anterior to inferior premotor cortex. Usually in the left hemisphere

377
Q

Purpose of Broca’s area?

A

Controls speech production

378
Q

Purpose of the primary somatosensory cortex?

A

Responsible for conscious awareness of the overall somatic sensation of the other side of the body

379
Q

What lobe of the brain are motor areas found?

A

Frontal cortex

380
Q

What lobe of the brain area the sensory areas found?

A

Parietal

381
Q

Where is the sensory association cortex found?

A

Parietal lobe
Posterior to primary sensory cortex

382
Q

Purpose of the sensory association cortex?

A

Integrated different sensory inputs to sensory recognition

383
Q

Two auditory areas of the brain?

A

Primary auditory cortex
Auditory association area

384
Q

Sensory areas of the brain?

A

Primary somatosensory cortex
Sensory association cortex
Primary auditory cortex
Auditory association area
Gustatory cortex
Vestibular cortex
Olfactory cortex

385
Q

Areas in the occipital lobe?

A

Primary visual cortex
Visual association area

386
Q

Purpose of Wernickes area?

A

Understanding language

387
Q

Three types of white matter fibres?

A

Association
Commissural
Projection

388
Q

How are white matter fibres classified?

A

According to their types of connections

389
Q

What are white matter association fibres?

A

Connections within one hemisphere of the cerebral cortex

390
Q

What are white matter commissural fibres?

A

Connections between hemispheres

391
Q

What are white matter projection fibres?

A

Connections between cortex and caudal areas

392
Q

An example of commissural white matter?

A

Corpus callosum

393
Q

Examples of projection white matter?

A

Internal capsule
Corona radiata

394
Q

What are the basal forebrain nuclei?

A

A cholinergic system located anterior and dorsal to the hypothalamus

395
Q

Function of the basal forebrain nuclei?

A

The basal forebrain cholinergic nuclei provide the main cholinergic input to prefrontal cortices, the hippocampi, and amygdala. These structures are highly relevant for the regulation and maintenance of many cognitive functions, such as attention and memory

396
Q

Types of neurons in basal forebrain nuclei?

A

Cholinergic

397
Q

Function of the basal ganglia?

A

Its main function is related to motor refinement, acting as a tonically active break, preventing unwanted movements to start. Much of this involves reducing the excitatory input to the cerebral cortex. This prevents excessive and exaggerated movements.

398
Q

The five nuclei of the basal ganglia?

A

caudate nucleus
putamen
subthalamic nucleus
globus pallidus
substantia nigra

399
Q

Examples of deep grey matter?

A

Basal forebrain nuclei
Basal ganglia

400
Q

The thalamus forms the superior lateral walls of which ventricle?

A

Third ventricle

401
Q

What is the only sensory input that does not pass through the thalamus?

A

Olfactory

402
Q

Where is the thalamus located?

A

Between the cerebral cortex and the midbrain

403
Q

Function of the thalamus?

A

relay motor and sensory signals to the cerebral cortex

404
Q

Overall function of the hypothalamus?

A

To maintain homeostasis

405
Q

Hypothalamic functions?

A

Controls the autonomic nervous system
Physical response to emotion
Body temperature
Hunger and satiety
Water balance and thirst
Sleep-wake cycles through the suprachiasmatic nucleus
Endocrine system

406
Q

Another name for the suprachiasmatic nucleus?

A

Biological clock

407
Q

What does the suprachiasmatic nucleus control the release of?

A

Melatonin from the pineal gland

408
Q

What does the pineal gland secrete?

A

Melatonin

409
Q

Three regions of the brain stem?

A

Midbrain
Pons
medulla oblongata

410
Q

The spinal cord enters the skull though which opening?

A

Foramen magnum

411
Q

What is the medulla oblongata responsible for?

A

Vital functions e.g. Cardiac, respiratory
Some reflexes

412
Q

Where is the reticular activating system found?

A

Midbrain, pons, medulla oblongata and part of the thalamus

413
Q

Purpose of the reticular activating system?

A

Levels of wakefulness and enables people to pay attention

414
Q

Purpose of the cerebellum?

A

Coordinate movements (memory movements e.g. cycling)
Posture
Equilibrium

415
Q

What lines the ventricles of the brain?

A

Ependymal cells

416
Q

What are brain ventricles filled with?

A

CSF

417
Q

How many brain vertricles are there?

A

4

418
Q

Names of the brain ventricles?

A

Lateral (1 and 2)
Third ventricle
Fourth ventricle

419
Q

What connects the lateral ventricles to the third ventricle?

A

Intraventricular foramen

420
Q

What connects the third ventricle to the fourth ventricle?

A

Cerebral aqueduct

421
Q

What shape are the lateral ventricles?

A

C-shaped

422
Q

Where are the lateral ventricles found?

A

The cerebral hemispheres

423
Q

What separates the lateral ventricles?

A

Septum pellucidum

424
Q

Where is the third ventricle found?

A

Diencephalon (epithalamus, thalamus, subthalamus, and hypothalamus)

425
Q

Where is the fourth ventricle found?

A

Hindbrain

426
Q

What connects the ventricles to the subarachnoid space?

A

Three openings:
Paired lateral apertures in the sides and median aperture in the roof

427
Q

What are ventricles in the brain?

A

Continuous central hollow cavities that lie deep within the brain. Filled with CSF and lined by ependymal cells

428
Q

Purpose of ependymal cells?

A

Move CSF by cilia

429
Q

What protects the brain?

A

Skull
Meninges
Cerebrospinal fluid
Blood-brain barrier

430
Q

Purpose of the meninges?

A

Cover and protect the CSF
Protects blood vessels
Contains CSF
Forms partitions in the skull

431
Q

How many layers of the meninges?

A

Three

432
Q

What are the three layers of the meninges?

A

Dura mater
Arachnoid mater
Pia mater

433
Q

How does penicillin cross the blood-brain barrier to treat meningitis?

A

The BBB integrity is disrupted due to inflammation so it can get through

434
Q

How many bones make up the skull?

A

22

435
Q

How many bones in the skull are facial bones?

A

14

436
Q

How many bones in the skull are cranial bones?

A

8

437
Q

What is the strongest layer of the meninges?

A

Dura mater

438
Q

What does arachnoid mater look like?

A

Web-like

439
Q

What is the dura mater made up of?

A

Two layers of fibrous connective tissue

440
Q

Where are dural venous sinuses found?

A

Between the two layers of the Dura mater

441
Q

Function of the dural venous sinuses?

A

Drain blood away from the brain to the heart

442
Q

What are sections of dura mater called?

A

Dural septa

443
Q

The four dural septa?

A

falx cerebri
tentorium cerebelli
falx cerebelli
diaphragma selae

444
Q

Purpose of dural septa?

A

Limit excessive movement of the brain

445
Q

Where is the falx cerebri located?

A

between the two cerebral hemispheres

446
Q

Where is the falx cerebelli located?

A

separates the two hemispheres of the cerebellum

447
Q

Where is the tentorium cerebelli located?

A

separates the occipital and temporal lobes of the cerebrum from the cerebellum and brainstem

448
Q

What is the diaphragma sellae?

A

flat piece of dura mater with a circular hole allowing the vertical passage of the pituitary stalk

449
Q

Where is the arachnoid mater found?

A

The middle layer of the meninges

450
Q

What are the layers of the meninges?

A

Dura
Arachnoid
Pia

451
Q

What separates the dura mater from the arachnoid mater?

A

Subdural space

452
Q

What does the subarachnoid space contain?

A

CSF and large blood vessels

453
Q

What are arachnoid villi?

A

small protrusions of the arachnoid mater into the outer membrane of the dura mater

454
Q

Purpose of arachnoid villi?

A

CSF reabsorption
one-way valves for the flow of CSF into venous blood

455
Q

Where is pia mater found?

A

The innermost layer of the meninges

456
Q

Anatomy of pia mater?

A

Delicate vascularised connective tissue that clings tightly to brain

457
Q

Where is CSF produced?

A

Choroid plexuses

458
Q

Where are choroid plexuses located?

A

In brain ventricles

459
Q

Where is the subarachnoid space?

A

Between arachnoid and pia mater

460
Q

Composition of CSF?

A

Water solution formed from blood plasma. It has less protein and different ion concentrations to blood plasma. Kept at a constant volume

461
Q

Purpose of CSF?

A

Gives buoyancy to CNS structures
Protects CNS from trauma
Nourishes brain
Carries chemical signals

462
Q

How is the composition of CSF controlled?

A

Ependymal cells use ion pumps. They also cleanse CSF by removing waste

463
Q

What is the normal volume of CSF?

A

~150ml

464
Q

How often is CSF replaced?

A

Every eight hours

465
Q

Circulatory path of CSF?

A

1) produced in ventricles by choroid plexus
2) flows through ventricles and into subarachnoid space via median and later apertures
3) flows through subarachnoid space
4) absorbed into dural venous sinuses via arachnoid villi

466
Q

What causes hydrocephalus?

A

Obstructions in CSF circulation or drainage

467
Q

Why is hydrocephalus less likely to cause brain damage in newborns?

A

Unfused skull bones allow enlargement of head

468
Q

How to treat hydrocephalus?

A

Draining with a ventricular shunt to abdominal cavity (ventriculoperitonel shunt)

469
Q

What is the epidural space?

A

Cushion of fat and network of veins in space between vertebrae and spinal dura mater

470
Q

Where do the dural and arachnoid membranes extend to?

A

Sacrum- beyond the end of the cord at L1/2

471
Q

Where is a lumbar puncture usually performed?

A

L2-5

472
Q

What is the conus medullaris?

A

the terminal end of the spinal cord, which typically occurs at the L1 vertebrae

473
Q

What is the name of the end of the spinal cord?

A

Conus medullaris

474
Q

What is the filum terminale?

A

delicate filament, about 20 cm. in length, prolonged downward from the apex of the conus medullaris

475
Q

What is the filum terminale made of?

A

Pia mater

476
Q

Anatomy and function of denticulate ligaments?

A

bilateral triangular lateral extensions of pia mater that anchor the spinal cord to the dura mater

477
Q

What are denticulate ligaments made of?

A

Pia mater

478
Q

What limits the duration and frequency of action potentials?

A

Refractory periods

479
Q

What does EPSP stand for?

A

Excitatory postsynaptic potential

480
Q

What do EPSEs do?

A

Increase the firing of action potential on the postsynaptic membrane

481
Q

What does IPSE stand for?

A

Inhibitory postsynaptic potential

482
Q

What do IPSEs do?

A

Decreasede the firing of action potential on the postsynaptic membrane

483
Q

What is a paroxysmal depolarising shift?

A

Abnormal fluctuations of the neuronal membrane voltage
A sustained depolarisation

202 (6 decks)

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