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Doctors Academy - Physiology COPY Flashcards

1
Q

What physiological responses to do you get post surgery?

A

Reduce water and produce glucose

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2
Q

What proportion of salivary gland secretions is secreted from the submandibular and parotid glands

A

25% parotid
majority submandibular

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3
Q

what is the mechanism of action of glucocorticoids

A

they bind to intracellular glucocorticoid receptors located on the nucleus

(made from cholesterol in the adrenal cortex)

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4
Q

Which main group of receptors does adrenaline bind to

A

Adrenaline binds to Alpha 1, alpha 2, beta 1, beta 2 but has more of an action on Beta 1 & 2

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5
Q

Which receptor does Nor adrenaline a selectively bind to?

A

Alpha 1

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6
Q

Which receptor does dobutamine selectively bind to?

A

Beta 1

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7
Q

Which receptor does dopamine selectively bind to?

A

D-1 and D-2

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8
Q

what is the effect of receptors binding to Alpha 1

A
  • vasoconstriction (leads to increase BP and increased contractility of the heart)
  • Prostate contraction
  • bladder relaxation
  • pupil dilation (constriction of radial muscles)
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9
Q

what is the effect of receptors binding to Beta 1

A
  • Heart - This is a positive ionotrope for the heard - increased cardiac contractility and Heart Rate
  • Kidneys - Increased angiotensin and Increased renin secretion which lead to increased BP

Summary: Increased HR, heart contractility and BP

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10
Q

what is the effect of receptors binding to beta 2

A
  • bronchodiltion
  • decreased GI motility and tone.
  • Also acts on the liver to activate gluconeogenisis
  • relaxes uterine muscle wall
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11
Q

what is the effect of receptors binding to D-1

A

renal and spleen vasodilation

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12
Q

what is the effect of receptor binding to D2

A

inhibits release of nor adrenaline

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13
Q

what is the equation to measure renal plasma flow

A

Renal plasma flow = PAH (Urine) x urine flow / PAH (Artery) - PAH (vein)

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14
Q

which clotting factors does warfarin affect

A

2, 7, 9, 10 and protein C + S

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15
Q

Which of the following is the equivalent of cardiac preload?

A

End diastolic Volume

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16
Q

How is MAP calculated

A

MAP= Diastolic pressure+ 1/3(Systolic pressure- Diastolic pressure)

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17
Q

How is Cerebral Perfusion Pressure calculated

A

CPP = MAP - ICP

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18
Q

What does TXA inhibit

A

Plasmin

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19
Q

what is the antidote to midazolam toxicity

A

flumazenil

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20
Q

what is the antidote to systemic effects of priolocaine?

A

Methylene Blue

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21
Q

What laboratory test can be done to identity a fluid as CSF

A

Beta 2 transferrin assay

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22
Q

what therapeutic agent is commonly used in the treatment of carcinoid syndrome

A

Octerotide

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23
Q

What is the action of somatostatin and where is it released

A

released by the pancreas

  • decreases pancreatic and gastric secretions
  • inhibits growth hormone
  • delays gastric emptying
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24
Q

What is the action of gastrin

A

Stimulates gastric acid secretion and incrases gastric motility

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25
Q

What is the action of CCK and where is it released

A

Released from Duodenum (I cells in upper small intestine)

increases pancreatic secretions
stimulates gall bladder contraction and bile release
decreases gastric emptying

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26
Q

What is the action of secretin and where is it released

A

released from S cells in upper small intestine

  • stimulates pancreatic secretions of water and bicarb
  • decreasees gastric acid secreition
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27
Q

what is the action of VIP and where is it released

A

released in small intestine / pancreas

stimulates pancreatic secretions
decreases gastric acid secretion

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28
Q

What is the action of Alpha 2 agonists

A

relaxes smooth muscle tone of the GI tract and decreases motility

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29
Q

What are the 4 zones of the adrenal gland and what do they excrete

A

From outer to inner: GFRm ACD

  1. Zona glomerulosa - aldosterone
  2. Zona Foliculata - Glucocorticoid
  3. Zona Reticularis - dehydroepiondosterone
  4. Medula - Epinephrine + nor epinephrine
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30
Q

What clotting factors does Heparin affect

A

2 (Thrombin) & 10

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31
Q

What clotting factors does warfarin affect

A

2, 7, 9, 10

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32
Q

What clotting factors does DIC affect

A

1, 2, 5, 8, 11

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33
Q

What clotting factors does Liver disease affect

A

1, 2, 5, 7, 9, 10, 11

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34
Q

JVP wave:

What do the a, c, x v and y waves correspond to on the JVP waveform?

A

A wave - atrial contraction

C wave.- closure of tricuspid

X wave - atrial relaxation

V wave - venous filling

Y wave - Tricuspid opening

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35
Q

JVP Waveform:

What do absent A waves mean?

A

They are a sign of atrial fibrilation

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36
Q

JVP Waveform:

what do large a waves mean?

A
  • Right ventricular Hypertrophy
  • Tricuspid Stenosis
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37
Q

JVP Waveform:

what do cannon “a” waves represent

A

these are seen in complete heard block

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38
Q

JVP Waveform

what does a slow “y” descent mean

A
  • Tricuspid stenosis
  • Right atrial myxoma
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39
Q

JVP Waveform

What does a steep “y” descent mean?

A
  • Right ventricular failure
  • Constrictive pericarditi
  • Tricuspid regurgitation
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40
Q

In what organ are Oxyphil cells found?

A

Parthyroid gland

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41
Q

in what organs are chief cells found

A

The stomach and the parathyroid glands (here they produce PTH)

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42
Q

In what organ are principl cells found

A

Kidneys (in the collecting duct of the nephron)

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43
Q

In what organ are chromaffin cells found

A

adrenal medulla

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44
Q

where are parafolicular c cells found

A

in the tyroid

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45
Q

for what pathology is a metaiodobenzylguanidine scan used?

A

this is specifically used for identifying phaeochromocytomas. in general it is the investigation of choice for neuroendocrine cells

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46
Q

In what condition are Auer Rods found

A

Leukema (AML)

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47
Q

In what condition are Hurthle cells found ?

A

Hashimotos Thyroiditis

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48
Q

In what condiion are Orphan Annie Nuclei found

A

Papillary Thryoid cancer

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49
Q

In what conidion are asteroid bodies found

A

Sarcoidosis

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50
Q

In what organ are hassels corpuscles found

A

Thymus gland

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51
Q

In what part of lymphocytes are B cels and T cells made

A

B cells are made in the cortex and T cells are made in the paracortex

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52
Q

What drugs do you need to stop prior to surger and when do you need to stop them?

A
  1. Stop all anticoagulation prior to surgery
    1. Warfarin 5 days pre op
    2. Clopidogril 5-7 days pre op
  2. On the day of surgery stop:
    1. ACE inhibitors
    2. Diruetics
    3. Change steroids to IV Hydrocortisone
    4. NSAIDS

l

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53
Q

what type of drugs can you continue for surgery?

A
  1. Asthma medication
  2. Parkinsons medication
  3. antiepileptic medication
  4. cardiac mediation
  5. thryoid medication
  6. cancer medication
  7. immunosurpressents
  8. all analgesia except NSAIDS
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54
Q

Genetics

What is the inheritance pattern of Cystic Fibrosis and Sickle Cell disease?

A

Autosmoal resessive

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55
Q

Genetics

What is the inheritance pattern of haemophilla

A

x linked rescessive

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56
Q

if a joint aspiration shows positively birefringent rhomboid crystals under polarized light microscopy what is the diagnosis?

A

Pseudogout (calcium pyrophosphate crystals)

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57
Q

if a joint aspiration sample shows negitively birefringent needle shaped crystals on light microscopy what is the diagnosis

A

gout (sodium urate crystals)

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58
Q

What are the causes of gynocomastia

A
  • Testicular tymour
  • Hyperthryoidism
  • liver cirrhosis
  • acromegaly
  • Kallman’s, Klinefelter’s syndrome
  • ectopic tumour secretion
  • haemodialysis

Drug causes: (DISCKO)

D - digoxin

I - isoniazid

S - spirolactone

K - ketoconizole

O - oestrogen

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59
Q

what is the best measure of left ventiruclar contracility

A

Ejection fraction (if <30% be concenered)

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60
Q

What are the features of MEN type 1

A

Three P’s

  1. Parathyroid pathology : Parathyroid adenomas
  2. Pituitary pathology - prolantinoma / ACTH / Growth hormone
  3. Pancreas pathology - pancreatic tumour
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61
Q

what is the most common presentation of MEN type 1

A

hypercalcameia

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62
Q

what are the classic featres of MEN type 11a

A
  • Phaeocrhomocytoma (high BP)
  • Medullary Thryoid cancer (Hypercalcaemia)
  • Hyperparathyroidism
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63
Q

what are the classic features of MEN 11b

A

Same as MEN 11a + mucosal neuromas

  • Phaemochromocytoma
  • Medullary thyroid cancer
  • hyperparathyroidism
  • Mucosal neuromas
64
Q

what are the classic features found on a post splenectomy blood film?

A
  • Howell jolly bodies
  • heinz bodies
  • Poikilocytes (target cells)
  • pappenheimer bodies
  • Erythrocyte containing siderotic granules
65
Q

What physiological changes do you get in responce to Cardiogenic shock? i.e. what happens to Systemic vascular resistance, HR, cardiac output etc

A

increased SVR (vasoconstriction in response to low BP)

increased HR (sympathetic response)

Increased Pulmonary Pressures

decreased cardiac output

decreased blood pressure

66
Q

What physiological changes do you get in responce to hypovolemic shock?

A

blood volume depletion

increased SVR

increased HR

decreased cardiac output

decreased blood pressure

67
Q

What physiological changes do you get in responce to septic shock? i.e. what happens to Systemic vascular resistance, HR, cardiac output etc

A

reduced SVR

increased HR

normal/increased cardiac output

decreased blood pressure

69
Q

What part of the adrenal glands do phaeochormocytomas affect?

A

THe medulla of the adrenal gland

70
Q

What are the symptoms of an acute haemolytic transfusion reaction and how would you diagnose this?

A

Symptoms include: Fever, Loin pain tachycardia and low BP.

Diagnosis: Direct Coombes test

71
Q

What is the most common cause of hypercalcaemia in inpatients

A

Most Common - Malignancy

Second most common - primary hyperparathyroidism

72
Q

Which receptor do Clonadine and Methyldopa selectively bind to?

73
Q

Which receptor does Salbutamol selectively bind to?

74
Q

What is the effect of subtances binding to Alpha 2 receptors?

A

Relaxes smooth muscle tone of GI tract and decreased motility

75
Q

What diuretics act on the:

  • Proximal convuluting tubule
  • Ascending Limb
  • Proximal Distal Convoluting tubule
  • Distal Convuliting Tubule
  • Collecting Duct
A
  • PCT: Manitol and Dopamine
  • Ascending Limb: Furosomide
  • Proximal DCT: Thiazides
  • Distal DCT: Spironolactone
  • Collecting Duct: Vasopressin antagonists
76
Q

What substances are reabdorbed in the:

  • Proximal convuluting tubule
  • Ascending Limb
  • Proximal Distal Convoluting tubule
  • Distal Convuliting Tubule
  • Collecting Duct
A

Proximal Convoluting Tubule:

  • Antibiotics
  • Glucose
  • Bicarb
  • Amino acids

Descending Limb: Water

Ascending Limb: Sodium Chloride

Proximal DCT: Calcium

Distal DCT: sodium + potassium

77
Q

What would move the o2 dissociation curve to the left and to the right?

78
Q

what is the mode of action of bisphosphinates?

A

decreases osteoclast activity by inhibiting osteoclast progenitor development and promotign osteolast appoptosis

79
Q

What type of hypersensitivity reaction is Asthma / Hay fever and what is the cell mediator responsible?

A

Type 1 reaction - IgE responsible

80
Q

What type of hypersensitivity reaction is autoimmune haemolytic anemia and what is the cell mediator responsible?

A

Type 2 - IgG and IgM mediated

81
Q

What type of hypersensitivity reaction is SLE and what is the cell mediator responsible?

A

Type 3 - IgG, IgA and IgM mediated

82
Q

What type of hypersensitivity reaction is Graft vs host disease and what is the cell mediator responsible?

A

Type 4 - T cell mediated

83
Q

what are the 3 phases of gastric acid secretion and which produces the most acid?

A
  1. Cephalic phase (smell / taste of food) - 30% acid production
  2. Gastric Phase (Distension of the stomach) - 60% acid production
  3. Intestinal Phase (food in duodenum) - 10% acid production
84
Q

What are the hormonal changes in cushings disease and what are the common features?

A

Increased Cortisol and Incrased ACTH

  • weight gain
  • increased gluconeogenisis
  • bitemporal vision loss
85
Q

What are the hormonal changes that occur in addisons disease and what are the common features

A

Low aldosterone and Low cortisol –> Low Sodium and high potassium

  • Fatigue
  • weight loss
  • pigmentation
86
Q

What are the hormone changes in Conns syndrome and what are the common features?

A

High aldosterone

  • high sodium –> water retention
  • HTN
  • Low potassium –> muscle weakness and cramps
87
Q

What do you give to a patient with Von Willebrands Disease pre operatively?

A

Desmopressin

88
Q

Where is the majority of iron found in the body?

A

haemoglobin

89
Q

what is the normal value for ICP ?

90
Q

what is the normal value for Cerebral perfusion pressure?

91
Q

What effect does CO2 have on the vessels of the brain

A

vasodilation

92
Q

what ventilatory action should be taken in a patient with a head injury and high ICP ?

A

Controlled hyperventilation

94
Q

What electrolyte disturbances cause torsades de pointes and what is the treament?

A

Hypokalemia and Hypomagnesemia

Treatment: IV Magnesium sulphate

95
Q

which acute phase protein is most likely to increase in a patient with severe sepsis?

96
Q

what is the most important urinary acid base buffer

97
Q

How does PTH incraese serum calcium levels

A

it activtes vitamin D to increase absorbtion of calcium from the small intestine

98
Q

what is the cause of pernicious anemia

A

Autoimmune antibodies to pariatal cells

99
Q

what do pariatal cells secrete?

A

They secrte intrinsic factor and HCL

100
Q

what can low intrinsic factor cause

101
Q

What are the features of Type 1 and Type 2 respiritory disease

A

Type 1 = Low O2, Normal or low CO2

Type 2 = Low O2, High CO2

102
Q

What type of lung disease is present with an FEV/FVC ratio of <70%? and what are some expamples of causes?

A

Obstructive lung disease

E.g. COPD, Asthma, bronchiectasis, CF

103
Q

What type of lung disease would be present if the FEV / FVC ratio was >70% and what are some example causes?

A

Restrictive lung disease

E.g. fibrosis, sarcoidosis, CCF, Obesity

104
Q

if the question gives a history of a male with multiple recent chest infections and no vas defferens what do they have?

A

Cystic fibrosis

105
Q

in DIC what clotting factors are rapidly consumed?

A

Factor 5 and 8

106
Q

which drugs lead to decreased renin secretion

A

betal blockers

NSAIDS

107
Q

What is the substrate of renin

A

angiotensinogen

108
Q

what is the typical value for GFR?

A

125ml / min

109
Q

what percentage of sodium is reabsorbed within the nephron

A

90%

(65% in the PTC, 10% in DCT, 25% in loop of henle)

110
Q

what is the equation for calculating GFR?

A

GFR = (Urine concentration x urine volume) / plasma concentration

111
Q

what are the 4 phases of wound healing and what cells are predominantly present in each

A
  1. Haemostasis (Seconds / minutes): Platlets
  2. Inflammation (days): Neutrophils
  3. regeneration (Weeks): Fibroblasts
  4. remoddeling (years): myofibrobasts
112
Q

Define the following terms regarding lung capacity:

  1. Tidal Volume
  2. Inspiratory reserve volume
  3. Expiratory reserve volume
  4. REsidual volume
  5. Functional residual capacity
  6. Vital Capacity
  7. Total lung capacity
  8. Forced vital capactiy
A
  1. Tidal Volume - volume of air inspired and expired during each ventilatory cycle at rest
  2. Inspiratory reserve volume - maximum volume of air that can be forcibly inhailed following normal inspiration
  3. Expiratory reserve volume - maximum volume of air focibly exhailed following normal expiration
  4. Residual volume - volume of air remaining in the lungs after a maximal expiration
  5. Functional residual capacity - volume of air remaining in the lungs at the end of a normal expiration
  6. Vital Capacity - maximum volume of air forcibly exhailed after maximal inspiration
  7. Total lung capacity - volume of air in the lungs at the end of maximal inspiration
  8. Forced vital capactiy - volume of air that can be maximally forecfully exhailed
113
Q

What does a FEV/FEC ratio of <70% indicate and give examples of conditions that would cause this?

A

Obstructive respiratory cause

e.g. COPD, Asthma, Bronchiectasis, CF

114
Q

What does a FEV/FEC ratio of >70% indicate and give examples of conditions that would cause this?

A

Restrictive disease

e.g. fibrosis, sarcoidosis, CCF, obesity

115
Q

What causes the first, second, third and fourth heart sounds?

A

First: AV valves shutting (heard best at the apex)

Second: Closure of aortic and pulmonary valves

Third: Rapid ventricular filling

Fourth: Ventricular distention due to stiff ventricles and foreful atrial contraction. This is a sign of ventricular hypertrophy or HF

116
Q

how does arterial carbon dioxide levels affect cerebral blood flow?

A

high carbon dioxide levels increase cerebral blood flow

117
Q

what are the causes of hypercalcaemia

A

Mnemonic for the causes of hypercalcaemia:

CHIMPANZEES

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison’s Disease
N eoplasia
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

118
Q

what is the pathophysiology of graves disease?

A

IgG antibodies are formed against the TSH receptors on the thyroid gland

119
Q

how does hyperventilation affect calcium levels and what symptoms does it cause?

A

Hyperventilation causes decreased calcium levels which leads to twitching and peri oral parasthesia

120
Q

what are the causes of severe and moderate thrombocytopenia?

A

Causes of severe thrombocytopenia

  • ITP
  • DIC
  • TTP
  • haematological malignancy

Causes of moderate thrombocytopenia

  • heparin induced thrombocytopenia (HIT)
  • drug-induced (e.g. quinine, diuretics, sulphonamides, aspirin, thiazides)
  • alcohol
  • liver disease
  • hypersplenism
  • viral infection (EBV, HIV, hepatitis)
  • pregnancy
  • SLE/antiphospholipid syndrome
  • vitamin B12 deficiency
121
Q

what proportion of calcium filtered at the glomerulus will be reabsorbed by the renal tubles

122
Q

what factors increase gastric acid secretion

A

Vagal nerve stimulation

Gastrin release

Histamine release (indirectly following gastrin release) from enterchromaffin like cells

123
Q

what are the causes of hyperkalaemia

A
  • Acute renal failure
  • Drugs:
    • potassium sparing diuretics
    • ACE inhibitors
    • angiotensin 2 receptor blockers
    • spironolactone
    • ciclosporin
    • heparin
  • Metabolic acidosis
  • Addison’s
  • Tissue necrosis/rhabdomyolysis: burns, trauma
  • Massive blood transfusion
124
Q

what substances stimulate insulin release

A

Glucose

Amino acid

Vagal cholinergic

Secretin/Gastrin/CCK

Fatty acids

Beta adrenergic drugs

125
Q

what is the main componant of colloid in the thyroid gland

A

thyroglobulin

126
Q

what is the bainbridge reflex

A

this is theincrease in heart rate mediated via the atrial stretch receptors that occurs following a rapid infusion of blood

127
Q

at what level does the aorta bifurcate to give the common iliac arteries

128
Q

What is the treatment of colorectal liver metastasis?

A

Chemotherapy followed by surgical resection

129
Q

What nerve innervates the SAN

A

No singular nerve innervates the SAN. It is innervated by a complex plexus of nerves

130
Q

What do you seen on histology of amyloidosis?

A

apple green birefringence with polarised light

131
Q

What is the treatment for malignant hyperthermia

A

Dantrolene

132
Q

What is the mechanism of action of renin?

A

It hydrolysis angiotensinogen to angiotensin 1

133
Q

From what cells is renin released?

A

Juxtomedullary cells of the kidney

134
Q

What is the most common cause of hyper-chloraemic acidosis?

A

Iatrogenic causes - over resuscitation with normal saline

135
Q

What drug is contraindicated in broad complex tachycardia

136
Q

What factors increase and decrease gastric acid secretion

A

Factors increasing production include:

Vagal nerve stimulation

Gastrin release

Histamine release (indirectly following gastrin release) from enterchromaffin like cells

Factors decreasing production include:

Somatostatin (inhibits histamine release)

Cholecystokinin

Secretin

137
Q

What electrolyte abnormality is most commonly seen in diarrhoea

A

Hypokalaemia

139
Q

What are the causes of high anion gap acidosis

A

M - Methanol
U - Uraemia
D - DKA / Any ketoacidosis
P - Paraldehyde/phenformin
I - Iron / Isoniazid
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates

140
Q

What are the causes of a normal anion gap acidosis

A

Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula

Renal tubular acidosis

Drugs: e.g. acetazolamide

Ammonium chloride injection

Addison’s disease

141
Q

How does adrenaline affect renin secretion

A

It causes increased renin secretion

142
Q

What are Desmoid tumours?

A

Desmoids are proliferations of myofibroblasts and tend to arise from aponeurotic structures Improve

143
Q

what substance acts of the medulla of the adrenal gland to stimulate adrenaline release?

144
Q

what is the half life of insulin

145
Q

what substance is used in the treatment of people with von willabrand factor who are bleeding

A

desmopressin

146
Q

what is the treatment of hypercalcaemia

A

Calcitonin and IV bisphospinates

147
Q

what substances do pariatal cells secrete

A

Hydrochloric acid

Calcium

Magnesium

Sodium

Intrinsic factor

148
Q

what acid base disturbance does a PE cause

A

respiratory alkalosis

149
Q

what is the treatment for a dystonic reaction?

A

procyclidine

150
Q

Which part of the loop of Henley is impermeable to water?

A

The ascending limb

151
Q

What condition is HPV 8 associated with?

A

Karposis sarcoma

152
Q

What condition would you suspect with a raised V/Q

A

PE

a raised V/Q indicates there is a blocked blood vessel in the lungs

153
Q

What is virchows triad?

A
  1. Hypercoagulobility
  2. Endothelial damage
  3. Venous stasis
154
Q

What factors decreases renin secretion

A
  1. Beta blockers
  2. NSAIDS
155
Q

What is the most common inherited bleeding disorder?

A

Von willebrands disease

156
Q

What substance is used to measure anatomical dead space

157
Q

What are psomomma bodies

A

These are clusters of calcifications

MRCS Other (19 decks)

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