Block E

Question 1

functions of kidneys

Answer 1

*-regulation of water and inorganic ion balance
-removal of metabolic waste products from blood and excretion in urine
-removal of foreign chemicals in the blood and excretion in urine
-gluconeogenisis

Question 2

how many nephron in the kidneys

Answer 2

2.5million in the 2

Question 3

nephron functional components

Answer 3

tubular component and vascular component

Question 4

what does glomerular filtrate do

Answer 4

drains into bowman’s space and then into proximal convolutes tubule

Question 5

how do endothelium allow small molecules through

Answer 5

they have pores

Question 6

what does podocytes having a negative charge do

Answer 6

it along with the basement membrane stops proteins getting through into tubular fluid

Question 7

what does JGA do

Answer 7

helps regulate renal blood flow, GFR and also indirectly modulates sodium balance and systemic BP

Question 8

how do the kidneys reduce renal pressure

Answer 8

intrarenal redistribution of pressure and increased absorption of salt and water

Question 9

what does a decreased pressure in renal arterioles and sympathetic activity lead to

Answer 9

renin and angiotensin II production

Question 10

what does angiotensin II affect in the kidneys

Answer 10

causes direct constriction of renal arterioles. stimulation of aldosterone synthesis- sodium absorption and increase in intravascular blood volume

Question 11

what is the principal factor controlling angiotensin II levels

Answer 11

renin release

Question 12

decreased circulating volume stimulates renin release via

Answer 12

decreased BP, decreased salt, decreased renal perfusion pressure

Question 13

what does aldosterone stimulate

Answer 13

sodium reabsorption and potassium excretion by the renal tubule

Question 14

how does aldosterone exert indirect negative feedback on RAAS

Answer 14

by increasing ECV and lowering plasma (K+)

Question 15

pharmacologic treatment of cardiovascular disease

Answer 15

directs, sympatholytics, calcium channel blockers, direct-acting vasodilators

Question 16

classification of diuretics

Answer 16

all indirectly prevent the re-absorption of water in kidneys
loop diuretics- furosemide supplemented with spironolactone or amiloride
thiazides- bendroflumethiazide
potassium sparing diuretics- not acting directly on sodium channels

Question 17

loop diuretics mechanism of action

Answer 17

inhibiting the Na/K/2cl co-transporter

Question 18

thiazide diuretics mechanism of action

Answer 18

inhibit the sodium-chloride transporter in the distal tubule, because this transporter only reabsorbs 5% of filtered sodium these diuretics are less efficacious than loop in producing diuresis and natriuresis

Question 19

liver function

Answer 19

-major role in protein, carbohydrate and lipid homeostasis
-stores glycogen, vitamins and iron
-contains an extensive reticuloendothelial system for the synthesis and breakdown of blood cells
-liver cells metabolise, detoxify and excrete both endogenous and exogenous compounds

Question 20

how are liver diseases identified

Answer 20

liver function tests (LFTs), complete blood count, CT scans, MRIs, ultrasounds, liver biopsy

Question 21

how are liver diseases managed

Answer 21

limiting alcohol, maintaining healthy weight, drinking more water

Question 22

how are liver diseases treated

Answer 22

hepatitis- antiviral drugs
liver inflammation- steroids
blood pressure medication
antibiotics

Question 23

how is hepatitis A spread

Answer 23

contact with contaminated food or water, symptoms may clear up without treatment, recovery a few weeks

Question 24

how is hepatitis B spread

Answer 24

can be acute or chronic, spread through bodily fluids, is treatable but no cure

Question 25

how is hepatitis C spread

Answer 25

can be acute or chronic, spread through contact with blood of someone with hepatitis C, often doesn't cause symptoms in early stage but can lead to permanent liver damage

Question 26

what is hepatitis D

Answer 26

serious form of hepatitis that only develops in people with hepatitis B

Question 27

how is hepatitis E spread

Answer 27

by drinking contaminated water, generally clears up on its own in a few weeks without any lasting complications

Question 28

treating hepatitis

Answer 28

interferons- don't directly kill viral or cancerous cells, they boost the immune system response stimulating T cells and other immune system cells to attack anti-viral drugs- ombitsdvir with paritaprevir and ritonavir sofosbuvir- inhibits the hepatitis C virus NS5B protein

Question 29

fatty liver disease

Answer 29

alcohol fatty liver disease, caused by heavy alcohol consumption non-alcohol fatty liver disease, caused by unknown

Question 30

what happens if fatty liver diseases are left unmanaged

Answer 30

both types can cause liver damage, leading to cirrhosis and liver failure. diet and other lifestyle changes can often improve symptoms and reduce risk of complications

Question 31

pioglitazone

Answer 31

improves the sensitivity of hepatic tissue to insulin. they are synthetic ligands for PPARs, they alter the transcription of genes, influencing carbohydrate and lipid metabolism- resulting in changed amounts of protein synthesis and therefore metabolic changes

Question 32

autoimmune hepatisis

Answer 32

causes immune system to attack liver, causing inflammation. left untreated can lead to cirrhosis and liver failure

Question 33

primary biliary cirrhosis

Answer 33

results from damage to the bile ducts in liver, causing build up of bile. PBC can lead to cirrhosis and liver failure

Question 34

primary sclerosing cholangtis

Answer 34

infammatoru condition that causes gradual damage to bile ducts. they eventually become blocked, causing bile to build up in liver which can lead to cirrhosis or liver failure

Question 35

prednisolone

Answer 35

increases the concentration of neutrophils; decreases T&B lymphocytes, monocytes, eosinophils and basophils. decrease in cytokine release, including decrease in IL-2 and TNF alpha

Question 36

azathioprine (AZA)

Answer 36

immunosuppressive agent that acts through its effects as an antagonist of purine metabolism, resulting in the inhibition of DNA, RNA and protein synthesis

Question 37

liver cancers

Answer 37

first develop in liver. if cancer starts elsewhere then spreads to liver it'd called secondary liver cancer. most common liver cancer= heptocellular carcinoma, tends to develop as several small spots of cancer in liver but can start as a single tumour also

Question 38

how are liver cancers treated

Answer 38

surgery, chemotherapy and pharmacotherapy

Question 39

mechanism of action of immune checkpoint inhibitors

Answer 39

two signals are required to initiate the activation of T cells. first signal involves the binding of a MHC to a TCR on T-cells. second signal arises with the binding of the APC ligands CD80 or CD86 to CD28 on T cells

Question 40

what is cholestasis

Answer 40

impairment of bile formation and/or bile flow, which may clinically present with fatigue, pruritus, dark urine, pale stools and in its most overt form jaundice and signs of fat soluble vitamin deficiencies

Question 41

cholesterol synthesis

Answer 41

synthesised primarily in the liver, occurs in the cytoplasm and ER. the HMG-CoA reductase reaction is rate-limiting

Question 42

functions of cholesterol

Answer 42

cell membranes, sex hormones, hormones released by the adrenal glands, production of bile acids

Question 43

dangers of high cholesterol levels

Answer 43

atherosclerosis- increased coronary heart disease risk -> heart attack, angina -stroke -peripheral vascular disease

Question 44

statins mechanism of action

Answer 44

inhibit an early rate and limiting step in cholesterol biosynthesis, inhibiting hepatic cholesterol synthesis results in increased expression of the LDL receptor gene. Decreased free cholesterol causes membrane-bound regulatory proteins to be cleaved and translocated to the nucleus to bind the sterol responsive element of the LDL receptor gene. This enhances transcription and increases the synthesis of LDL receptors It also reduces the degradation of LDL receptors

Question 45

what are statins

Answer 45

competitive inhibitors of HMG-CoA reductase, decreased cholesterol synthesis, increased expression of the LDL receptor gene. reduced LDL levels documented in reducing fatal and nonfatal CHD events, strokes and total mortality

Question 46

statins effects on triglycerides and lipoprotein levels

Answer 46

-Decrease triglycerides in hypertriglyceridemic-> 35-45% -Increase HDL-C ->Normal patients: 5-10% ->Low patients: 15-20% -Decrease LDL-C ->20-55% -Non-lipid lowering effects ->Endothelial function (Enhances production of nitric oxide) ->Anti-inflammatory ->Reduce venous thromboembolic events- 43%

Question 47

averse effects of statins

Answer 47

Hepatotoxicity -Elevated hepatic transaminase values -One case of liver failure per million person-years of use Myopathy -One death per million prescriptions caused by rhabdomyolysis