Doctors Academy - Physiology COPY Flashcards
What physiological responses to do you get post surgery?
Reduce water and produce glucose
What proportion of salivary gland secretions is secreted from the submandibular and parotid glands
25% parotid
majority submandibular
what is the mechanism of action of glucocorticoids
they bind to intracellular glucocorticoid receptors located on the nucleus
(made from cholesterol in the adrenal cortex)
Which main group of receptors does adrenaline bind to
Adrenaline binds to Alpha 1, alpha 2, beta 1, beta 2 but has more of an action on Beta 1 & 2
Which receptor does Nor adrenaline a selectively bind to?
Alpha 1
Which receptor does dobutamine selectively bind to?
Beta 1
Which receptor does dopamine selectively bind to?
D-1 and D-2
what is the effect of receptors binding to Alpha 1
- vasoconstriction (leads to increase BP and increased contractility of the heart)
- Prostate contraction
- bladder relaxation
- pupil dilation (constriction of radial muscles)
what is the effect of receptors binding to Beta 1
- 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
what is the effect of receptors binding to beta 2
- bronchodiltion
- decreased GI motility and tone.
- Also acts on the liver to activate gluconeogenisis
- relaxes uterine muscle wall
what is the effect of receptors binding to D-1
renal and spleen vasodilation
what is the effect of receptor binding to D2
inhibits release of nor adrenaline
what is the equation to measure renal plasma flow
Renal plasma flow = PAH (Urine) x urine flow / PAH (Artery) - PAH (vein)
which clotting factors does warfarin affect
2, 7, 9, 10 and protein C + S
Which of the following is the equivalent of cardiac preload?
End diastolic Volume
How is MAP calculated
MAP= Diastolic pressure+ 1/3(Systolic pressure- Diastolic pressure)
How is Cerebral Perfusion Pressure calculated
CPP = MAP - ICP
What does TXA inhibit
Plasmin
what is the antidote to midazolam toxicity
flumazenil
what is the antidote to systemic effects of priolocaine?
Methylene Blue
What laboratory test can be done to identity a fluid as CSF
Beta 2 transferrin assay
what therapeutic agent is commonly used in the treatment of carcinoid syndrome
Octerotide
What is the action of somatostatin and where is it released
released by the pancreas
- decreases pancreatic and gastric secretions
- inhibits growth hormone
- delays gastric emptying
What is the action of gastrin
Stimulates gastric acid secretion and incrases gastric motility
What is the action of CCK and where is it released
Released from Duodenum (I cells in upper small intestine)
increases pancreatic secretions
stimulates gall bladder contraction and bile release
decreases gastric emptying
What is the action of secretin and where is it released
released from S cells in upper small intestine
- stimulates pancreatic secretions of water and bicarb
- decreasees gastric acid secreition
what is the action of VIP and where is it released
released in small intestine / pancreas
stimulates pancreatic secretions
decreases gastric acid secretion
What is the action of Alpha 2 agonists
relaxes smooth muscle tone of the GI tract and decreases motility
What are the 4 zones of the adrenal gland and what do they excrete
From outer to inner: GFRm ACD
- Zona glomerulosa - aldosterone
- Zona Foliculata - Glucocorticoid
- Zona Reticularis - dehydroepiondosterone
- Medula - Epinephrine + nor epinephrine
What clotting factors does Heparin affect
2 (Thrombin) & 10
What clotting factors does warfarin affect
2, 7, 9, 10
What clotting factors does DIC affect
1, 2, 5, 8, 11
What clotting factors does Liver disease affect
1, 2, 5, 7, 9, 10, 11
JVP wave:
What do the a, c, x v and y waves correspond to on the JVP waveform?
A wave - atrial contraction
C wave.- closure of tricuspid
X wave - atrial relaxation
V wave - venous filling
Y wave - Tricuspid opening
JVP Waveform:
What do absent A waves mean?
They are a sign of atrial fibrilation
JVP Waveform:
what do large a waves mean?
- Right ventricular Hypertrophy
- Tricuspid Stenosis
JVP Waveform:
what do cannon “a” waves represent
these are seen in complete heard block
JVP Waveform
what does a slow “y” descent mean
- Tricuspid stenosis
- Right atrial myxoma
JVP Waveform
What does a steep “y” descent mean?
- Right ventricular failure
- Constrictive pericarditi
- Tricuspid regurgitation
In what organ are Oxyphil cells found?
Parthyroid gland
in what organs are chief cells found
The stomach and the parathyroid glands (here they produce PTH)
In what organ are principl cells found
Kidneys (in the collecting duct of the nephron)
In what organ are chromaffin cells found
adrenal medulla
where are parafolicular c cells found
in the tyroid
for what pathology is a metaiodobenzylguanidine scan used?
this is specifically used for identifying phaeochromocytomas. in general it is the investigation of choice for neuroendocrine cells
In what condition are Auer Rods found
Leukema (AML)
In what condition are Hurthle cells found ?
Hashimotos Thyroiditis
In what condiion are Orphan Annie Nuclei found
Papillary Thryoid cancer
In what conidion are asteroid bodies found
Sarcoidosis
In what organ are hassels corpuscles found
Thymus gland
In what part of lymphocytes are B cels and T cells made
B cells are made in the cortex and T cells are made in the paracortex
What drugs do you need to stop prior to surger and when do you need to stop them?
- Stop all anticoagulation prior to surgery
- Warfarin 5 days pre op
- Clopidogril 5-7 days pre op
- On the day of surgery stop:
- ACE inhibitors
- Diruetics
- Change steroids to IV Hydrocortisone
- NSAIDS
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what type of drugs can you continue for surgery?
- Asthma medication
- Parkinsons medication
- antiepileptic medication
- cardiac mediation
- thryoid medication
- cancer medication
- immunosurpressents
- all analgesia except NSAIDS
Genetics
What is the inheritance pattern of Cystic Fibrosis and Sickle Cell disease?
Autosmoal resessive
Genetics
What is the inheritance pattern of haemophilla
x linked rescessive
if a joint aspiration shows positively birefringent rhomboid crystals under polarized light microscopy what is the diagnosis?
Pseudogout (calcium pyrophosphate crystals)
if a joint aspiration sample shows negitively birefringent needle shaped crystals on light microscopy what is the diagnosis
gout (sodium urate crystals)
What are the causes of gynocomastia
- 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
what is the best measure of left ventiruclar contracility
Ejection fraction (if <30% be concenered)
What are the features of MEN type 1
Three P’s
- Parathyroid pathology : Parathyroid adenomas
- Pituitary pathology - prolantinoma / ACTH / Growth hormone
- Pancreas pathology - pancreatic tumour
what is the most common presentation of MEN type 1
hypercalcameia
what are the classic featres of MEN type 11a
- Phaeocrhomocytoma (high BP)
- Medullary Thryoid cancer (Hypercalcaemia)
- Hyperparathyroidism