Exam 2 Flashcards
What is the role of Fibrinolytic Protein?
Degrades the clot when the wound has healed
What are J receptors sensitive to?
Pulmonary Edema
Where are the J receptors?
Near Capillaries in Alveoli
What accumulates in acute intermittent porphyria?
ALA, PBG
What cofactor do we need to burn the bridges of heme’s pyrrole rings?
Oxygen
A pt is taking lithium and has frequent diluted urine. What specific disease is this?
Nephrogenic DI
What two things do Th17 cells induce that leads to COPD?
IL-8
G/GM-CSF (from airway epithelial cells)
What do we look for to know if something is chloride responsive?
Urine Cl- is under 20
What are the causes of NAGMA?
Renal Tubular Acidosis (RTA)
Diarrhea
Renal Insufficiency
Ethylene Glycol toxicity
What is the cause of hypo chromic microcytic anemia?
Iron deficiency
What is the end product of ACE action in the lung?
Angiotensin 2
Deactivation of bradykinin
What does the PRG do?
Controls Length of inspiration (normal circumstances)
What happens to the urine when blood flow is increased to the vasa recta?
Frequent Urination
The PCT Carbonic Anhydrases work together with the NHE3 anti-porter to do what?
Reabsorb Bicarbonate and bring Na+ along for the ride.
What are the two storage forms of iron?
Ferritin and Hemosiderin
What kinds of things make RBF GFR and Peritubular capillary hydrostatic pressure all go up?
Bradykinins, NO, ANP, DA, Prostaglandins Dilating the Afferent Arteriole
What is the average value of Perfusion?
5 L/min
What is the role of the kinin cascade?
Vasodilation
Vascular Permeability
Increased Pain Response
What subunit is tugged on when iron moves into plane of its Hb ring?
F8 Histidine
What is the formula for Diffusion Rate?
Surface Area x Diffusion Coefficient x Pressure Gradient
/ Distance
What channels get water through the collecting tubule for reabsorption?
Aqp2
What are the primary ions of ECF vs ICF?
ECF: Sodium
ICF: Potassium
Pericytes become myofibroblasts, which deposit matrix. What two profibrotic factors activate them?
TGF-b
PDGF
What does the NLRP3 Receptor Do?
Recognizes Uric Acid (DAMP) for NF-kB Activation
What Transporter does a Loop Diuretic act on, and where is it?
NKCC2 (Na/K/Cl-) Co-Transporter in the Thick Ascending Limb
What is the “gold standard” Schilling test for?
Pernicious Anemia / Intrinsic Factor
Urodilatin is ANP’s cousin. Where does it come from?
Distal Tubule and Collecting Duct
What is the 60, 40, and 20 in the rule?
60 % body weight is water
40 is ICF
20 is ECF
What type of embryonic tissue is the Trigone from?
Intermediate Mesoderm (mesonephric ducts)
What is the relationship between ENaC and hypokalemia?
In the collecting tubule, sodium is exchanged out of the lumen in place of K (getting excreted.)
Aldosterone Receptor has the same effect
What is the Haldane Shift?
Presence of Oxygen reduces affinity of amine chain for CO2 for carbamino compounds
What receptors are responsible for producing a cough upon irritation or foreign bodies?
Rapidly adapting pulmonary stretch receptors
What forms the neck of the bladder, women urethras, and mens prostatic urethras?
Pelvic Part of the Urogenital Sinus
where is capillary hydrostatic pressure trying to drive fluid?
into the alveolus
When H2CO3 dissociates its Hydrogen, how is it buffered?
Deoxyhemoglobin (then carried in veinous blood)
What type of fluid change is high-salt intake?
Hypertonic Volume expansion
What does endothelin do to vasculature?
Constrict
What changes in the peritubular pressures happen with excess water?
Hydrostatic pressure increases
Oncotic pressure decreases
What mutation produces HbS?
B-Globin amino acid 6 Glutamic acid (-) to Valine (hydrophobic)
What is the difference between central and nephrogenic DI?
Central: Aint got no ADH
Nephrogenic: Kidneys dont respond to ADH
What is the formula for pressure according to LaPlace?
2(Tension) / Radius
What converts ferric to ferrous iron?
Ferric reductase (Dcytb / duodenal cytochrome-like b protein)
What does hepcidin act on to decrease blood iron?
Ferroportin
Mommy, where do renal corpuscles come from?
Why they come from the Mesonephric Tubules my dear!
In what disease is Hb iron in its ferric / Fe3 state?
Methemoglobinemia
What do you call it when you adapt to high altitude?
Physiologic Polycythemia
What is the average value of alveolar ventilation?
4 L/min
What activates and inhibits ALA synthase?
Activated by Iron (has a response element. DNA shit.)
Inhibited by heme.
What do granular cells do?
Bind adenosine from na/k ATPase on the macula densa to increase or decrease calcium for dilation / contraction
What is the mechanism of acute rejection?
Primary activation of T cells (Th1 and CTL)
What does the Renal Interstitium produce?
EPO depending on oxygen levels
What are the ratios of CO2 produced : O2 Consumed for each macronutrient?
Carbs? 1:1
Fat? 7:10
Protein? 9:10
What can we use to express HbF in sickle cell patients?
Hydroxyurea
What part of the posterior Pituitary are most ADH neuron cell bodies?
SON
What disease do you think someone has if they have photosensitivity and red urine and teeth?? oh yeah and hemolytic anemia but red urine and teeth holy shit
Congenital Erythropoietic Porphyria
When testing for HLA class II, what result would tell us that a transplant is good to go?
It does NOT react with the radioactive donor cells because they share the same MHCII that they’re presenting
What do you do to solve the ultrafiltration pressure (Puf)?
Pgc - Pbc - PIgc
How would you describe the cause of intra-hepatic jaundice?
Impaired hepatic uptake, conjugation, or secretion of conjugated bilirubin
What does ferroportin transport?
Ferrous Iron from Enterocyte Into Blood
Where to the lesser and least splanchnic nerves synapse?
Aorticorenal Ganglia
What carries the Intrinsic factor-Cobalamin complex?
Transcobalamin II
What regulates Aqp2 in the Collecting Tubule?
ADH
What receptors does ADH act on for the Kidney?
v2
What three signals of tubuloglomerular feedback decrease GFR?
More NaCl delivered to macula dense
Increased ATP / Adenosine
Constriction of Afferent Arteriole
What happens to neutrophils with a folate / B12 deficiency?
Hyper-segmentation
This is Megaloblastic Microcytic Anemia
where does the plasma oncotic pressure drive fluid?
Into the capillary (away from the alveolus)
The whole formula of physical factors on GFR:
Kf: (conductivity x surface area) x Puf: (Pgc - Pbc - Pigc)
what are the two less important modulators of pulmonary blood flow?
Endothelin
Thromboxane A2
What is the significance of solving the Renal clearance of Inulin?
That there is your GFR, kinda like creatinine clearance except more accurate
What initiates the cascade of definitive kidney formation?
Pronephros
What type is acute intermittent porphyria?
Hepatic
What disease do you think someone has if they are photosensitive, with neurons symptoms and developmentally delayed?
Variegate Porphyria
A patient has degranulation of mast cells and cross-linking of mlgE. What phase of the immune response is this?
Immediate (minutes). See sneezing, pruruitis, rhinorrhea, etc
What gets knocked out with 11b deficiencies?
Aldosterone and Cortisol
What does the zona glomerulosa secrete?
Mineralocorticoids
What could cause central DI?
Damage to Pituitary or Hypthalamus
What is the defective enzyme in acute intermittent porphyria?
PBG Deaminase (in liver)
Since the embryo kidneys dont filter shit, what does?
the Placenta
What is defective, what type is, and what accumulates in Congenital Erythropoietic Porphyria?
Uroporphyrinogen III Synthase (in RBCs) deficiency
Erythropoietic
Uroporphyrinogen I and red Uroporyrin I (oxidation product)
How do we know if respiration has adequately compensated for something?
Change in PACO should be proportional to the change in Bicarbonate
How would you interpret a NORMAL FEV1/FVC Ratio?
Look at the FVC (Forced Vital Capacity)
Low: Restrictive
Normal: Normal
What three inflammatory mediators are used by the T cell in AKI?
IFN-y
IL-6
(decrease of) IL-4
What does ALA turn into, initiating phase 2 of Heme synthesis?
Porphobilinogen
What three hormones are inhibited by ANP?
Renin
Aldosterone
ADH / Vasopressin
Which glomerular arteriole does angiotensin II primarily act on?
Efferent Constriction, this means increase in filtration
Where is blood flow to the lungs lowest?
at the Apex
How do we get bilirubin?
From Biliverdin, from destroying heme.
One kidney has a dilated loop of henle. What is this.
Multicystic Dysplastic Kidney Disease
What is the rate-limiting step of the urea cycle?
Carbamoyl Phosphate Synthetase and NAG making carbamoyl phosphate from ammonia
What is the Pneumonic for Metabolic Alkylosis causes?
CLEVER PD:
Vomiting
Diuretics
Licorice
What is the major player of the DCT?
NCC (and PTH)
Sympathetics have more a1 receptors to stimulate on which glomerular arteriole?
Afferent
What does hyperaldosteronism do to K, and how is it regulated?
Leads to K loss
Hypokalemia reduces Aldosterone tho
Hyperkalemia Increases Aldosterone to get rid of it
Where is CPSase I and what activates it?
Mitochondria (urea cycle)
NAG
What is the Henderson Hasselbach equation?
pH = 6.1 + log (HCO3- / pCO2x0.03)
What does ALA Synthase use to make ALA in the first step of heme biosynthesis?
Glycine
Succinyl CoA
What is added and subtracted for tubular reabsorption?
Glomerular filtration - urinary excretion + amount secreted
What do alpha and beta cells do kn the collecting ducts?
Alpha cells Reabsorb HCO3-
Beta Cells Secrete HCO3-
What is the end-point of RBC metabolism, and when do we see it increase?
2,3-DPG
Chronic Hypoxia
What does the defective enzyme of albinism fail to convert?
Tyrosinase: Tyr to p-Hydroxyphenylpyruvate
What is the normal tidal volume of an adult?
500mL
What regulates phase I of heme biosynthesis?
ALA Synthase
What is the normal value for PCO2?
40
What is the antigen form of Type II vs Type III Hypersensitivity?
II: cell bound
III: Soluble and deposited
Decreased Pi, aka Phosphaturia, occurs with increased PTH. What does PTH act on to cause this in the kidney?
NPT2: increased urine excretion of Pi
What two diseases are linked to intra-hepatic jaundice?
Criggler-Najjar Syndrome
Gilbert Syndrome
What type of fluid change is hemorrhage, diarrhea, or vomiting?
Isosmotic volume contraction
Which transporter does ADH increase activity of?
NKCC2 in the thick ascending limb
What is the formula for PiO2?
(Partial Pressure Oxygen - 47) x %oxygen
PPO2 usually 760 unless otherwise stated
%O2 usually 21% unless otherwise stated
Pretty much 149.3 unless otherwise stated
What is the active form of folate?
THF
What do R-Binder Proteins Bind?
Dietary B12
What mediates the early stages of AKI?
Th17 Cells
What does the Total Lung Capacity look like in obstructive vs Restrictive lung patterns?
Obstructive: Normal or Increased
Restrictive: Decreased
What is the cause of pre-hepatic jaundice?
Increased Unconjugated Bilirubin production - internal hemorrhage, overwhelmed liver, maternal-fetal blood group issues…
How do you calculate physiologic dead space?
Tidal Volume x (Paco-Peco / Paco)
How does the kidney treat renal plaques?
Thinks its afferent vasoconstriction / Low GFR
Macula Densa does Angiotensin II to compensate
What happens if we don’t have DHF Reductase?
We cant regenerate THF from DHF
What Receptor type does the JG apparatus have?
B1
What does the reticulo-endothelial system do?
Degrades Hemoglobin into Globin and Heme
What is the significance of lead poisoning to cytochromes?
Cytochromes contain heme
Without them, ATP synthesis and energy metabolism is fucked.
What two steps are we looking for in the Schilling Test
1) If radioactive B12 is absorbed
2) If radioactive B12 is absorbed with Intrinsic Factor Help
How does Colchicine treat gout?
Decreases movement of granulocytes to the affected areas
What are the three main components of Net Acid Excretion and how would you calculate it?
NH3 and Titratable Acid Flows - HCO3 Flow`
What do Th17 cells use to induce factors of COPD?
IL-17
IL-22
Ux (v) =
Urine excretion of something (x)
What defective enzyme does secondary PKU fail to convert?
Phe to Tyr
What enzyme turns biliverdin into Bilirubin?
Biliverdin Reductase
We say that central chemoreceptors are indirectly sensitive to CO2, but what are they ACTUALLY sensitive to?
H+ (from CO2 reacting with water to form carbonic anhydrase intermediate).
What type of curve do you use for Hb vs Mb?
Hb: Sigmoid
Mb: Hyperbolic
Where can you find chromatin cells?
Medulla of the suprarenal gland
Where is the K in hypo/hyperkalemia?
Outside of the cell
Shift into cell = hypokalemia
What is produced with ferritin breakdown?
Hemosiderin
IL-4 and IL-13 work together to do what?
Induce M2 Macrophages
What gets knocked out with 21b deficiencies?
Cortisol and aldosterone
What separates the urogenital sinus and anorectal canal?
Urorectal Septum
What is the big role that dendritic cells play in acute graft rejection?
They’re the snitch: travel to the lymph nodes to activate the primary immune response and delayed-type hypersensitivity reactions of T cells
All the tyrosinemias fail to get Phe to its end goal of what?
Fumarate
What do the glomerular arterioles do during the myogenic feedback reflex?
Efferents Dilate
Afferents Constrict
Both of these lower GFR
Which end of the capillary favors absorption?
Venule end
what is the normal overall direction of starling forces in the lung?
into the alveoli
Where is CPSase II and what activates it?
Cytosol
PRPP (pyrimidine synth)
What is the normal oxygen diffusion capacity of the lung?
21 ml O2/min/mmHg
Dark urine and elevated blood Conjugated Bilirubin. What is this?
Post-Hepatic Jaundice
Rejection symptoms weeks to months following a transplant. What type of hypersensitivity is this?
IV (acute)
What parts extend into the medulla of the kidney?
Loop of Henle, Collecting Ducts
Albumin is a colloid. How do these work for replacement therapy?
They hang out in the intravascular space and pull water in from the extravascular spaces. Relies totally on their high oncotic pressure
What type of fluid change is SIADH?
Hyposmotic Volume Expansion
How much O2 vs CO2 is exchanged every minute?
250 mL O2
200 mL CO2
What causes nutcracker syndrome?
Traction of SMA (superior mesenteric a)
Compression of LRV (left renal v)
What does it mean if the given bicarbonate is greater than the delta delta gap?
Its HAGMA and Metabolic Alkalosis?
What does free bilirubin do to overcome its insolubility?
Binds to Albumin
What do we get from globin breakdown vs Heme breakdown?
Globin: amino acids
Heme: nothing
where is blood pressure highest in the lungs?
at the base
What amino acids are not taken up in Cystinuria?
Ornithine, Cystine, Arginine, Lysine (dibasic)
What effect does ATP have on Iron?
Maintains Ferrous Fe2+ State rather than Ferric Fe3+
Which end of the capillary favors filtration?
Arteriole end
What is Hephaestin?
Cofactor for Ferroportin
What are the two components of the Metanephros and what do they come from?
Ureteric Bud (from mesonephric duct) Metanephric Blastema (from nephrogenic cord)
What two cytokines control renal fibrosis and tissue repair?
IL-10
TGF-b
What gets knocked put with 17a deficiencies?
Cortisol and Androgens
Which cells are responsible for the stretching and relaxing of transitional epithelium?
Umbrella Cells
What does the Scavenger Receptor Class A Receptor do?
Recognizes HSPs (DAMP) for NF-kB Activation
Where is the most proximal location you would find transitional epithelium?
Calyces
What do you multiply DL(CO) by to get the DL(O2)?
1.23
What does DMT1 transport?
Ferrous Iron into Enterocyte
Pt looked at a snail the wrong way and now has a genitourinary tract disease. Whats the worst that could happen?
Fibrosis, calcification, cancer of the bladder
This is Schistosoma Hematobium
Where does Aldosterone act?
Thick Ascending Limb of Henle!!!
Distal Tubule
Collecting Duct
What protein directly controls Hepcidin (and therefore ferroportin)?
HFE
What does the Pre-Botzinger Complex do?
Determines the Timing of the respiratory Rhythm
What lung volume decreases when supine?
FRC
What are the two components of the Trigone?
Mesonephric and Ureteric Ducts
They blend into the back of the bladder
What does the macula densa, like, do?
Senses NaCl levels for the JG apparatus
What macrophages do inflammation vs tissue repair?
M1 is inflammation,
M2 is tissue repair
How would you describe the cause of post-hepatic jaundice?
Problems with Bilirubin excretion
What effect does Hypoxic Vasocosnstriction have on VQ ratios of the lung?
Evens them out, redirecting blood away from hypoxic regions
A pt is experiencing a Type IV rejection a year after transplant. What is the main characteristic of this pathology?
Thickening and fibrosis of graft vessels (also graft atrophy) from indirect response.
How much dissolved oxygen is in the blood?
0.3mL / 100mL
What two ingredients are necessary for RBC production?
Folate (folic acid)
B12 (Cobalamin)
What two things would you give a T-Cell to become a Th17 cell?
TGFb
IL-6
What is directly responsible for decreasing iron in the blood?
Hepcidin
What influences sodium reabsorption in the DCT?
Angiotensin II
How are HLA Ags genetically repressed?
Co-Dominantly
What two things increase the expression of P and E Selectins for leukocyte rolling?
IL-1
TNF
What enzyme do we use to enter phase 2 of heme synthesis?
ALA dehydratase. It makes Porphobilinogen :)
Why do CHF patients get edema?
Heart failure lowers output, which is sensed as low pressure. Increase in fluid to try to compensate.
What infiltrates chronically inflamed areas?
Activated T Cells
M1 Macrophages
What rate-limiting enzyme conjugates bilirubin with UDP-Glucaronic Acid?
UDP Glucuronyl Transferase
a pt has cirrhosis, diabetes, arthritis, and hepatocellular carcinoma. what do we think?
Iron overloading / HH
What is the most common cause of microcytic anemia?
Iron Deficiency
What is the last product we have in heme synthesis before going into phase 3?
Coproporphyrinogen III
What amino acids are not taken up in Hartnup disease?
Tryptophan (non polar)
Lead poisoning is going to turn off two really important enzymes having to do with heme synthesis, what are they? hint: each contain a metal
ALA Dehydratase (Contains Zn) Ferrochelatase (Contains Fe)
What lung volume works to dilute toxic inhaled gases?
FRC
What starling force balance favors absorption?
Plasma Colloid Oncotic Pressure > capillary blood p.
What is the difference between direct and indirect allorecognition?
Direct: T Cells recognize donor APCs.
Indirect: T Cells hear about it from their own APCs
What receptor is increased on mast cells 4-12 hours into an immune response?
Fce
Where does Urodilatin act?
Medullary part of the Collecting Duct
When the Collecting tubule forms metanephric vesicles and those vesicles form metanephric tubules…. What do the proximal and distal ends of those metanephric tubules become?
Proximal end: Glomerular Capsule
Distal: PCT, DCT, Nephron Loop
How does H+ get moved to the lumen of the PCT in order to wrangle us some bicarbonate?
Its exchanged with Lumenal Na+ that we can put into the blood via the Na/K ATPase
What values change in metabolic acidosis / alkalosis?
HCO3 and pH change in the Same Directions
Where does urea permeability increase in the presence of ADH?
Inner Medullary Collecting Duct
What would you do to distinguish a mixed pattern lung disease vs air trapping?
Mixed: TLC is Down
Air Trapping: TLC is normal but Residual Volume is Up
What two things do the M2 macrophages secrete for tissue repair in the kidneys?
Arginase-1
IL-10
What kind of transporters are found on the Proximal Straight Tubule?
Sodium-Glucose Co-Transporters
An immediate rejection response is obviously hyper acute. What type of hypersensitivity is this?
II
What creates the starling force known as plasma colloid osmotic pressure?
Large proteins in the vessel attract and hold water
What does carbonic anhydrase do?
Converts CO2 to H2CO3 (later, bicarbonate)
What type of lung disease needs the TLC to confirm?
Restrictive
What shift of the oxygen Hb curve do we see in methemoglobinemia?
Left
What cells are in patients with AKI?
Neutrophils
M1 Monocytes
What is damaged to result in apneusis?
Pons / PRG
What are the three transitions of epithelium type throughout the urethra?
Starts as Transitional near the bladder
Majority become Pseudostratified Columnar
Distally is Stratified Squamous
How much CO2 is carried in the blood?
50mL / 100mL
What do IL-10 and CSF-1 work together to do?
Conversion of M1 to M2 Macrophages
What kind of acidosis is GOLDMARK for?
High Anion Gap Acidosis
What is added and subtracted for urinary excretion?
Amount filtered - Amount reabsorbed + Amout Secreted
What is generated by phosphates’ buffering of urine acidification?
New HCO3-
What type of polycythemia sees an increased EPO?
Secondary
What neurotransmitter is depleted in ammonia toxicity?
Glutamate
What type of fluid change is dehydration, DI, or alcoholism?
Hyperosmotic Volume Contraction
Sometimes we’ll inject babies with tin-mesoporphyrin. Why?
It inhibits heme oxygenase, so we dont break down heme and get all this bilirubin / jaundice business
What blood gas levels would you expect with a low vs high VQ Ratio?
Oxygen is high and CO2 is low in Big VQ Ratios
Oxygen is Low and CO2 is High is little VQ Ratios
What is the “first line of defense” in the Alveoli?
M2 Macrophages
What is the NaCl value we judge tonicity of solutions around?
0.85%
What is the standard value of the Respiratory Quotient (R)?
0.8
What is the input into bowmans space?
GFR x Px
When is the functional and definitive kidney formed?
Week 9 - 10
Why is blood group O the universal donor?
It doesn’t have Ags on it, so it would cause an immune response in the host. That being said, it has antibodies that would initiate compliment if other blood groups came into its neighborhood.
What hormone induces the release of aldosterone?
Angiotensin
What happens to RBF, GFR, and pressure when the Efferent Arteriole is Dilated?
RBF is Up
GFR is Down
Pressure is Up
The descending loop of henley is surrounded by a different endothelium type. What is ti?
Continuous
Calcium ions inhibit the CYP1a gene. What receptor do they bind to start this signal?
CaSR
What do we use to make Hydroxymethylbilane from Porpholilinogen?
Porphobilinogen Deaminase
How does pH affect albumin-Ca binding?
Acidemia frees the calcium / decreases binding
Alkalemia increases binding and lowers free Ca2+
What hormonal difference is there between primary and secondary adrenal insufficiency?
Primary: Cortisol AND aldosterone down
Secondary: Cortisol down but raas is fine. It knocks out ACTH, not the whole adrenal gland.
What does tubuloglomerular feedback act on?
Distal Tubule
What does Ferric Reductase need as a cofactor?
Vitamin C
Since the embryo kidneys dont filter shit, what do they even do?
Produce Amniotic fluid
What diseases are associated with Increased Hb affinity for oxygen?
Polycythemia
Methemogloinemia
What is the role of intercalated cells?
a: Seretes Hydrogen and Reabsorbs HCO3-
b: Reabsorbs Hydrogen and Secretes HCO3-
What is a normal A-a O2 gradient?
Less than 20
Why does blood pressure go up in 11b deficiencies, even though aldosterone is down?
Buildup of DOC
What gene is mutated in genetic (classical) Hereditary Hemochromatosis?
HFE
What is the end product of Renin action?
Angiotensin 1
What tissue types are the Vascular and Urinary Poles?
Vascular: Endothelium
Urinary: Epithelium
What are hepcidin, ferroportin, and absorption levels like when iron is low?
Hepsidin is also low
Ferroportin and absorption is up
What removes infants’ bilirubin before the liver starts workin on its own?
Placenta
What creates the Folate trap (into N5-methyl-THF)?
Lack of B12 - Needed to transfer that methyl group away
What is the role of urothelial plaques?
Form Impermeable barrier to the hypertonic urine
What type of peritubular capillaries surround the PCT and DCT?
Cortical (Fenestrated)
What type of Hb is increased in methemoglobinemia
Met-Hb
What type of embryonic tissue is the bladder epithelium from?
Endoderm (urogenital sinus)
What is the most common porphyria in the US, and what kind is it?
Prophyria Cutanea Tarda, Hepatoerythropoietic
How does sympathetic stimulation affect GFR?
Decreases it
What two things do the M1 macrophages use for inflammation in the kidneys?
TNF-a
IL-6
Th17 cells are fucking narcissists that secrete IL-17. It cant even activate neutrophils directly lol what does it need to have actually do the job for them?
Chemokine CCL20 (aka MIP-3)
What does THF do?
DNA synthesis for RBCs
What three transplants will you recognize in a question stem as not needing blood group matching?
- Cornea
- Heart Valve
- Bone / Tendon Grafts
Calculate Osmolarity for acidosis / alkalosis purposes
(2 x Na) + (BUN/2.8) + (glucose/18)
What crucial thing does the Fetal cortex secrete to maintain pregnancy?
DHEA (converted to estradiol via placenta)
What type of embryonic tissue is the bladder submucosa and muscular form?
Splanchnic Mesoderm
What does it mean if the given bicarbonate is less than the delta delta gap?
Its both HAGMA and NAGMA combined to a super-acidosis
What do Slowly Adapting Pulmonary Airway Receptors do?
Prevent / discontinue inhalation in infants and exercising adults
What are chromaffin cells derived from?
NCCs
What is the normal value for HCO3-?
24
What does the RAGE Receptor do?
Recognizes HMGB1 (DAMP) for NF-kB activation
What is defective and what type is Variegate Porphyria?
Protoporphyrinogen IX deficiency
Hepatic
What enzyme deficiency causes secondary PKU?
Dihydrobiopterin Reductase
What immune products (of arachidonic acid) are almost completely removed from lung circulation?
Prostaglandin E2 and F2a
Leukotrienes
What happens to RBF, GFR, and pressure when angiotensin II squeezes the Efferent Arteriole?
RBF Down
GFR up
Pressure Down
Why is the right kidney lower?
Liver
What are the two forms of conjugated bilirubin?
Monoglucuronide
Diglucuronide
What exports HCO3- from the cell, and where does it go?
Chloride
to the lungs, to convert back to CO2
What induces not only bronchospasm, but mucous production in chronic asthma?
Leukotrienes C4, D4, E4
Where are central chemoreceptors located?
Ventral surface of the Medulla
What type of hypersensitivity do patients with anti-glomerular basement membrane Abs have?
II
Where is SPB stored?
Intracellular Lamellar bodies
What is defective, what type is, and what accumulates in Porphyria Cutanea Tarda? (pct)
Uroporphyrinogen Decarboxylase deficiency
Uroporphyrinogen III, turning into Uroporphyrin I
Hepatoerythropoietic
What ions are driven back into the blood by potassium, powered by the NKCC2?
Mg2+ and Ca2+
What effect does 2,3-BPG have on Hb / O2 binding?
Reduces oxygen affinity
What does Fe3 bind for transport to target tissues?
Transferrin
What is the aldosterone receptor a transcription factor for?
ENaC
Na/K ATPase
What is the partial pressure of water vapor when calculating the inspired partial pressure of Oxygen?
47
What does enzyme 11b-HSD2 do?
Prevents Cortisol from activating aldosterone receptor
What does Methotrexate act on?
Inhibits Dihydrofolate Reductase to inhibit DNA synthesis
Cant turn into THF, obviously.
What is the mechanism of chronic rejection?
M2 Macrophages and T cells
What starling forces work to push / pull inward to the glomerulus (reabsorb)?
P(bc) : Hydrostatic pressure of bowmans
pi(gc) : Oncotic glomerular pressure
Where does the urogenital ridge form?
Either Side of the Aorta
What is the renal fascia continuous with?
Inferior diaphragmatic fascia
Define Apneusis
Breathing being stuck in inspiration
What converts ferrous to ferric iron?
Ferroxidase
cerruloplasmin
What are the humoral mechanisms of graft rejection?
Th2: IL-4, IL-5, IL-10
What two techniques measure residual volume?
Body Plethysmography
Nitrogen Washout
What is the main protein associated with B12 Deficiency?
Intrinsic Factor (facilitates absorption)
What starling force balance favors filtration?
Capillary Blood Pressure > plasma colloid oncotic p.
Why does fetal Hb have such a higher affinity for O2?
It doesn’t bind well to 2,3-BPG (which lowers O2 Affinity)
What does a Folate or B12 deficiency lead to?
Megaloblastic Macrocytic Anemia
What is deficient in Criggler-Najjar Syndrome?
UDP-GT
The Carotid body needs a cofactor. What is it?
Dopamine
What does P50 represent?
The Partial Pressure of Oxygen when 50 of Hb is saturated
What transducer the messages from the macula densa to the JG apparatus?
Mesangial Cells
What are the cellular mechanisms of graft rejection?
Th1: IL-2, IFN-y
What does Acute Intermittent porphyria present with?
Stomach pain
Neurological dysfunction
What regulates (lowers) Ferroportin levels?
Hepcidin
What cofactor de we need to throw in for step I of heme biosynthesis? Sure would suck if we didnt have it, if you know what anemia
Vit B6, aka Pyridoxal Phosphate
Which kind of pulmonary receptor produces tachypnea?
J Receptors
What does the clotting cascade generate that attracts neutrophils and monocytes?
Fibrin and Fibrinopeptides
What Ig is translocated across the airway epithelium?
IgA
How much of the Renal Plasma Flow is Filtered?
like 20%. This is the GFR divided by the total RPF
What is the final step of nitrogen removal?
Oxidative Deaminase
What is the formula for Alveolar partial pressure of oxygen (PAo2)?
PiO2 - PaCO2/0.8
When do we see the pronephros form and when does it end?
Early Week 4 - Mid/Late 4th Week
Where does ADH act on?
Distal Tubule and Collecting Duct
Which type of RTA is hyperkalemic?
4
Which airway layer is the mechanism of the mucous elevator in?
Sol Layer (aqueous)
What is elevated in the blood with gout?
Urate
What does Heme Oxygenase do?
Destroys the bridges between the pyrrole rings of heme
Form Biliverdin
What serum increases are found in intra-hepatic jaundice?
ALT
AST
What urobilinogen products are found in the urine vs feces?
Urobilin in the urine
Sterocobilin in the feces
How does [anion] affect calcium?
Higher [anion] decreases [ionized calcium]
What does the zona reticularis secrete?
Sex hormones
There are two parts of the VRG. What do they do?
Rostral: Inspiration, Phrenic
Caudal: Expiration, Upper Airway / Others
What does intrinsic factor do?
Carries B12 to Ilium
What does emphysema and COPD do to pulmonary compliance?
Increases it
Urinary concentration of something (Ux) =
Concentration / volume
What do mesangial cells do?
Stop the Pop (prevents glomerular dissension from high BP)
What does ADH do to principle cells?
Inserts Aqp2 for water re-uptake in late DCTd
What is impaired in Type 2 (proximal) Renal Tubular Acidosis?
Proximal HCO3- Secretion
What congenital renal abnormality can obstruct the ureter, and what does this cause?
Accessory Renal Vessels
Can Lead to Hydronephrosis, or Ischemia of end arteries are damaged
What is the formula for Pulmonary Blood Pressure?
CO x PRV (pulmonary vascular resistance)
The bladder is continuous with the allantois. What is the significance of this?
It constricts to become the Ucharus, which then becomes the Median Umbilical Ligament
The NKCC2 Transporter is only part of the equation in creating electrical potential in the Thick Ascending Limb, whats the other part?
Na/K ATPase: Both brink K+ into the cell, and work in tandem to bring Na into the blood.
What counters the Gibbs-Donnan effects to save the cells from exploding with water?
Sodium Potassium Pump: 3 Sodium out 2 K in
A pt has urine escaping from the umbilical orifice. What is this?
Urachal Fistula
What do natriuretic peptides do to glomerular blood vessels to increase GFR and filtered sodium?
Dilates the Afferents
Constricts the Efferents
What do ACE inhibitors do to GFR?
Well since angiotensin II constricts the efferent arteriole and increases GFR, i guess an ace inhibitor would do the fucking opposite.
What builds up in Alkaptonuria to give black coloring to urine?
Homogentisic Acid
What forms mens spongy urethras and women’s vaginal vestibule lining?
Phallic Part of the Urogenital Sinus
What would you do to calculate the percentage of filtered load of sodium per day?
Filtered Load - Excretion all over
Divide that by the filtered load
What are medullary / cortical rays made from?
Collecting ducts and straight tubules
What does Porphobilinogen turn into?
Hydroxymethylbilane
Why does Inhibiting ENaC lower urine pH and make the body more basic?
Hydrogen Follows Potassium
What is deficient in fetal jaundice?
UDP-GT Enzyme
What is the principle regulator of EPO?
Hypoxia Inducible Factor (HIF)
What should you stop eating to prevent gout?
Purines (beans, spinach, lentils)
Alcohol, Meat, Seafood
What do K+ Sparing Diuretics Act on?
ENaC and PTH Receptor
When we’ve identified metabolic acidosis, we need the anion gap. How is this calculated?
[Na] - ([Cl] + [HCO3])
What does the pronephros leave for the mesonephros?
Its Ducts!
What is the transporter associated with hyperammonemia, what is its cofactor, and its inheritance pattern?
ornithine transcacrboxylase
Requires NAG
X-Linked
Where do you find the detrusor m.?
Surrounding the urinary bladder
What does a Left Shift in an oxygen dissociation curve represent?
Increased Hb Affinity for oxygen
What is the most common type of Hb?
HbA (a2b2)
What type of lung disease might respond to a bronchodilator?
Obstructive
What kind of shift would you expect in an oxygen dissociation curve in a pt with anemia?
Right shift
What type of DI can be treated with Desmopressin?
Central
What mediates the late stage of AKI?
Th1 Cells
What does pH do to K?
Acidosis shifts K+ out of cells (hyperkalemia)
Alkalosis shifts it into the cell (hypokalemia)
What enzyme cleaves inactive Vit D to other Inactive 24,25-OH vitamin D?
24-hydroxylase
What intermediate of the TCA cycle is depleted in ammonia toxicity?
a-Ketoglutarate
What does a bigger anion gap mean for pH?
Bigger anion gap means more acidic
When Treg cells aren’t working against inflammation, they’re releasing IL-10 and TGF-b. What do these do?
Activate M2 Macrophages for fibrosis and repair
How much O2 is carried in the blood?
20mL / 100mL
What two events do negatively charged proteins cause?
- Oncotic Gradient for Water to move into the cell
2. Electric Gradient for Charges into the cell
What is epispadias?
Your pee hole is on the wrong side of the genital tubercle. Its supposed to go on the ventral side, dummy!
What is the relationship between extracellular Pi and Ca++?
Inverse
What forms direct vs indirect bilirubin?
Direct: Diazo reagent reacts with Soluble Bilirubin
Indirect: Made soluble with 50% methanol then Diazo
What would you look for to identify damage to the glomerular basement membrane?
Albumin in the urine
Where is the location of type 1 2 and 3 Renal Tubular Acidosis?
- Distal Tubules
- Proximal Tubules
- Adrenal
Where is the final concentration of urine done?
Cortical and Medullary Collecting Ducts
What two drugs would you give a baby for Type I Criggler-Najjar?
Oral Calcium Phosphate and Bicarbonate
Heme Oxygenase Inhibitors
What color is a hemosiderin bruise?
Reddish-Brown
How does Allopurinol treat gout?
Inhibits Xanthine oxidase
What values change in respiratory acidosis / alkalosis?
PACO2 and pH change in Opposite Directions
What do you do to solve the ultrafiltration coefficient (Kf)?
Conductivity x Surface Area
Which glomerular arteriole would you dilate to increase filtration?
Afferent
What makes up inspiratory capacity?
Inspiratory reserve volume and a normal breath out
What is the Embryonic origin of Exstrophy of the Bladder?
Defective closing of the ventral abdominal wall. It exposes the posterior bladder wall mucosa
How much dissolved CO2 is in the blood?
3.0mL / 100mL
How do we test for Class I HLA ags?
Anti-Sera with Anti-HLA Abs are tested on cells to see if they activate compliment. If so, we detect stain
What does poor Vitamin b12 ABSORPTION lead to?
Pernicious Anemia
What are the causes of HAGMA?
Oxoproline
D-Lactate
What is the mechanism of hyperacute rejection?
Pre-existing Abs and Compliment
What is the final conversion of heme synthesis?
Protoporphyrin IX to heme
What promotes differentiation of M1 macrophages?
IFN-y
What clinical manifestation do ACE inhibitors have on bradykinin?
Productive Cough
If you had to compare ALA to a neurotransmitter, what would it be?
GABA. Thats why its neurotoxic
What cell type is target of aldosterone and where is it found?
Principal Cells
Collecting Ducts
What does prostaglandin do to vasculature?
Dilation
What is the normal value of the anion gap?
12
Where does urinary cAMP come from?
the PCT that cant use it with PTH around
what is the greatest of the starling forces in the lung?
capillary hydrostatic pressure
What type of hypersensitivity is Systemic Lupus Erythematosus?
III
What surfactant protein is particularly important, according to Dr. Karius?
SPB
What is the only recessive Porphyria we care about?
Congenital Erythropoietic Porphyria
What do the first vs definitive renal arteries come from?
First: Common Iliacs
Definitive: Abdominal Aorta
What happens to the permanent kidneys as the metanephros degrades?
They ascend into the abdomen like balloons and rotate 90 degrees
What diuretic might you give someone with kidney stones and why?
Thiazide Diuretics: Enhance Ca++ Uptake in PCT and DCT
What is the relationship between pH and Hb?
Lower pH lowers oxygen-Hb binding affinity
What iron transformation follows heme degradation?
Oxidized from Ferrous to Ferric
What type of endothelium is found in the glomerulus (in terms of permeability)?
Fenestrated
What type of polycythemia Increases total blood volume and especially viscosity?
Primary (vera)
A pt has HTN, Renal Hemorrhage, calculi, and a UTI. What is happening inside their kidneys?
The tissue is being crushed by cysts
What genetic disease creates Low EPO?
Primary Polycythemia (vera)
What Receptor type do the NaKATPase pump and vasoconstriction have?
a1
What trigger of ADH secretion uses interneurons to communicate rather than sensory neurons?
Increased Osmolality / Osmoreceptors
What induces bronchospasm and vasodilation in chronic asthma?
Prostaglandins E2, D2, F2
Easy stores urotehlial plaques when they’re endocytose?
Fusiform Vesicles
what is the main regulator of pulmonary blood flow?
NO
Renal Clearance (C) is how much plasma is cleaned of something per unit time. How would you calculate it?
Take the excretion rate (Ux x V) and divide it by its concentration in plasma (Px)
Where do each of the steps of heme biosynthesis take place?
- Mitochondrion
- Cytosol
- Mitochondrion
What condition would you treat with a carbonic anhydrase inhibitor?
Respiratory Alkylosis: Puts the Bicarbonate in the Urine
If the inferior poles of the developing kidney fuse, what happens?
The IMA artery prevents its ascent and it looks like a horseshoe
What is impaired in Type 1 (classica) Renal Tubular Acidosis?
Hydrogen Ion Secretion by a-Intercalated Cells
What might have caused Hypochromic Anemia?
Deficient transport via Transferrin
What enzyme in pyrimidine synthesis is linked to hyperammonemia?
CPSII
What does insulin do to K?
Shifts it into the cell = hypokalemia
via Na/K ATPase
Where does PTH act on the nephron?
DCT
What does the zona fasciculata secrete?
Glucocorticoids
What are hepcidin, ferroportin, and absorption levels like when iron is high?
Hepcidin is also high
Ferroportin and absorption are low
where is tissue hydrostatic pressure trying to drive fluid?
into the alveolus (it became negative somehow)
How would you name a neurological porphyria vs a skin / photosensitivity one?
Acute Hepatic (neurological) Erythropoietic (skin and photosensitivity)
What two cells secrete SP-A and SP-D?
Type II Alveolar Cells
Club Cells
What is produced in excess with Hyperammonemia?
Carbamoyl Phosphate
Urinary flow rate (V) =
Urine volume / time
What enzyme cleaves regular 25-OH vitamin D to its active 1,25-OH form?
1a Hydroxylase (in PCT) aka CYP1a
What byproduct of burning heme’s pyrrole bridges is taken up by Hb?
CO. Carbon Monoxide.
What two things do donor cells have that are used to attack the recipient?
FasL (binds recipient Fas)
Granzymes and perforin
What adrenergics favor hyper vs hypokalemia?
a-Adrenergic agonists favor Hyperkalemia
B2-Adrenergics favor Hypokalemia
A patient has vesicles and bull on the skin of exposed areas not to mention wine-red urine. What is this?
PCT
How to chemoreceptors respond to H+?
Increases firing
Acts like its low oxygen / high CO2
Chovstek and Trousseau signs check for twitching and spasming. What are these symptoms consistent with?
Hypocalcemia
Where is intrapleural pressure lowest, or more negative, in the lung?
Apex
What makes up FRC?
Residual volume and Expiratory Reserve Volume
What do dendritic cells do in kidney immune response?
Th1 and Th17 differentiation
What type of mesoderm is the uro-genital system derived from?
Intermediate Mesoderm
What enzyme is responsible for the great and final step of heme synthesis?
Ferrochelatase. It uses Protoporphyrin IX to make heme.
Say your renal tubules are doing you a favor and doing the kidneys job for it just for like, 6-10 weeks. When they eventually bail, where do they go?
Females, they’re just gone.
Males, they become Efferent Ductules
What are the collecting vs excretory portions of the embryonic kidney?
Collecting: Uteric Bud
Excretory: Metanephric Blastema
What about ammonia toxicity causes the brain to swell?
Astrocyte swelling from pH imbalance
A pt has liver cirrhosis, skin pigmentation, and DM. What do we think?
Iron Overloading
What do thiazide diuretics act on?
Inhibit NCC (Na / Cl- Cotransporter) so they stay in the lumen
What is the active form of vitamin D?
1,25-OH
What does the vesicle part of the urogenital sinus form?
Most of the Bladder
What are the products of B12 interacting with N5-Methyl-THF?
Methyl-Cobalamin (B12-CH3)
THF (FH4)
Where does the nephrogenic cord come from?
the Urogenital Ridge
What is type 4 (the most common) Renal Tubular Acidosis?
Hyperkalemic
Lack of Aldosterone or response to it
If calcium and active vit D inhibit CYP1a, whats the only thing that activates it?
PTH, which makes sense. its very pro-calcium.
What is the uric acid transporter during acidemia?
URAT1
What does the endosome use to dock onto the mitochondria and transfer its iron?
DMT1
What is divided in the respiratory quotient?
CO2 produced / O2 Consumed (higher)
How does [plasma protein] affect calcium?
Increased increases it
Why is blood group AB the universal acceptor?
It doesn’t have Abs to recognize Antigens on foreign blood. It has Ags though, and those would be recognized by every other blood group it gets donated to.
What makes Type I Criggler-Najjar so bad?
It gives babies severe hyperbilirubinemia, that can cause encephalopathy (kernicturus) and brain damage
What happens when the interstitial osmolarity of the kidney is reduced?
More water stays in the urine
How would you interpret an FEV1/FVC Ratio?
Lower: Obstructive
Normal: Restrictive or normal
Saline and lactated ringers are crystalloids. Where does it go and how does it work?
Stays in the ECF and distributes itself around
We know all about the metanephros and its famous Uteric Bud. What what is the future of this Bud, its stalk, and its cranial part?
Penetrates. The plastema, that is. to be the renal Pelvis.
Stalk becomes the Ureter
Cranial Part becomes Collecting Tubules
What is the formula for plasma osmolality?
2 x Plasma[na+]
What is responsible for platelet activation and clot formation in ventilator-associated lung injury?
Neutrophil Netosis
What does the DRG do?
Generates a breathing pattern appropriate to the circumstances
What two things accumulate in lead poisoning?
ALA
Protoporphyrin IX
What kind of things make RBF, GFR, ptchp all go down?
Sympathetics and Ace Inhibitors Squeezing the the Afferent Arteriole
What is released by damaged graft tissues that causes vasodilation and permeability?
Bradykinin
FHH is a mutation of the CaSR gene in the parathyroid and ascending limb. What does this do to calcium concentrations?
Lower in the Urine: Hypocalciuria
Higher is the serum: Hypercalcemia
How do you calculate the Delta Delta Gap (delta HCO3)?
24 - the change in anion gap from 12
Bowmans capsule has two layers with a space in between. What makes up the layers?
Visceral: Podocytes
Parietal: Simple Squamous
What organ does heme biosynthesis (other than bone marrow)?
Liver
Where are Uroplakin proteins deposited to form plaques?
Superficial / umbrella cell layer of urothelium
What is the primary circulating form of THF?
N5-Methyl-THF
In a microcytotoxicity test, what what does stained or unstained cells mean?
If the dye builds up inside the cells, that means pre-formed Abs are present.
What maintains the tubuloglomerular feedback?
JG apparatus, sensing NaCl
What receptors does ADH act on for blood vessels?
v1
What color is a bilirubin bruise?
Orange
What effect does the sympathetic nervous system have on sodium and water?
Catecholamines favor sodium reabsorption
What is the cause of Pernicious Anemia?
Intrinsic Factor Deficiency
Where does tissue oncotic pressure drive fluid?
into the alveolus
What vessels carry Veinous Admixture?
Extra-Alveolar Capillaries
What type of fluid change is adrenal insufficiency?
Hyposmotic Volume Contraction
Why is HLA-1 Ags the strongest barriers to transplantation?
They’re expressed on every nucleated cell
What is the most important site of K secretion by the kidney, and hence the target of K+ Sparing Diuretics?
(Collecting Tubule)
What starling forces work to push / pull out of the glomerulus (filtration)?
P(gc) : glomerular capillary hydrostatic pressure. Big.
pi(bc) : bowmans oncotic pressure, its like zero.
What transporter does the macula densa use?
Na/K/2Cl- Transporter
