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JKC Med Phys Spring '24 > Exam 3 Review > Flashcards

Exam 3 Review Flashcards

1
Q

Name 4 things the kidneys excrete?

A

Urea
Creatinine
End products
Metabolites

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2
Q

Name 6 things the kidneys regulate?

A

waste
BP
acid/base
Electrolytes
Hormones
Water

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3
Q

Name the layers of the kidneys from superficial to deep

A

capsule
cortex
medulla
pelvis

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4
Q

Kidneys get ____ of your CO

A

22%

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5
Q

The renal artery splits into ____, ___ and _____

A

interlobar
arcuate
interlobULar

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6
Q

Where can you find the peritubular artery?

A

around the tubules

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7
Q

What are the two types of capillary arteries?

A

Glomerular and peritubular capillaries

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8
Q

In the glomerular artery, is the hydrostatic pressure high or low/

A

high hydrostatic pressure

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9
Q

If you increase flow into the afferent glomerular capillary, what happens?

A

GFR increases

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10
Q

What is the order of flow through the nephron

A

-Bowman’s capsule/glomerulus
-Proximal tubule
-Loop of Henle (thin, thin, thick)
-Macula Densa
-Distal Tubule
-Cortical collecting tubule
-Medullary collecting tubule
-Collecting duct

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11
Q

What are the two types of nephrons?

A

juxtamedullary and cortical nephrons

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12
Q

Cortical nephrons are ____

A

common

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13
Q

What is the responsibility of the juxtamedullary nephron?

A

concentration of urine

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14
Q

Which type of nephrons have vasa recta?

A

juxtamedullary nephrons

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15
Q

**What is the formula for urinary excretion

A

excretion = filtration - reabsorption + secretion

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16
Q

Define filtration

A

out of capillaries into bowman’s capsule

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17
Q

define reabsorption

A

from the Bowman’s capsule to the peritubular capillaries

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18
Q

Define secretion

A

out of the capillaries into the tubules

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19
Q

_____ is 100% filtered

A

creatinine

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20
Q

_____ are initially filtered but then get reabsorbed partially

A

electrolytes

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21
Q

What two substances should you remember together?

A

Amino acids and glucose

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22
Q

what 3 main end products are excreted?

A

urea
uric acid
creatinine

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23
Q

a high GFR will (increase/decrease) removal of waste

A

increase

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24
Q

how many liters of plasma in your body?

A

3 Liters

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25
Q

At a normal GFR how many liters can your body filter in one day?

A

180 Liters

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26
Q

Kidneys filter your plasma _____ in one day

A

60X

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27
Q

What two things does filtrate NOT contain?

A

proteins or RBCs

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28
Q

The GFR represents _____% of your renal plasma flow

A

20

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29
Q

The glomerular capillary membrane is (negatively/positively) charged. What layer?

A

negatively charged

endothelium

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30
Q

What is the job of the glomerular capillary membrane?

A

prevents proteins from crossing

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31
Q

What are the 3 layers of glomerular capillary membrane?

A

endothelium
basement membrane
epithelium

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32
Q

Which layer of the glomerular capillary membrane has the large holes in it?

A

basement membrane

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33
Q

Which layer of the glomerular capillary membrane has podocytes?

A

epithelium

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34
Q

What three substances have the same filterability as water?

A

sodium
glucose
insulin

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35
Q

What three components make up the GFR? What is the net filtration pressure?

A

Glomerular hydrostatic pressure (60)
Bowman’s Capsule Pressure (-18)
Glomerular colloid osmotic Pressure (-32)

10

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36
Q

The Glomerular hydrostatic pressure is ____

A

(60)

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37
Q

Bowman’s Capsule Pressure is ___

A

(-18)

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38
Q

Glomerular colloid osmotic Pressure ____

A

(-32)

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39
Q

When the filtration coefficient is low, the GFR (increase/decreases)

A

decreases

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40
Q

kidney stones are a result of an (increased/decreased) bowman’s capsule pressure, and GFR (increases/decreases)

A

increased bowman’s capsule pressure

so GFR decreases

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41
Q

When the afferent arteriole dilates, what happens in terms of blood flow and GFR

A

increased blood flow, and GFR increases

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42
Q

Decreased GFR can be a result of what conditions?

A

less blood flow
lower filtration coefficient
kidney stones
CKD
HTN

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43
Q

Less blood flow is due to afferent (dilation/constriction) and/or efferent (dilation/constriction)

A

afferent constriction

efferent dilation

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44
Q

What two hormones decrease GFR?

A

norepinephrine and epinephrine

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45
Q

Sympathetic stimulation (increases/decreases) GFR

A

decreases

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46
Q

Renal artery pressure is the same as ?

A

systemic arterial pressure

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47
Q

resistance is determined by what 3 arterioles?

A

interlobULar
afferent/efferent

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48
Q

T/F: Kidneys regulate their own renal blood flow

A

TRUE

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49
Q

Angiotensin II ____ both afferent and efferent arterioles. Which one does it exert the greatest effect?

A

constricts

mainly EFFERENTS

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50
Q

Angiotensin II (increases/decreases) GFR and (increases/decreases) renal blood flow

A

increases GFR

decreases renal blood flow

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51
Q

what is the MOA for Ace inhibitors? What is the end result on BP and GFR?

A

prevent AT1 from converting to AT2

lowers BP and lowers GFR

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52
Q

The macula densa is most receptive to ____ concentration

A

sodium chloride

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53
Q

the macula densa controls ______ and _____

A

renal blood flow and GFR

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54
Q

Macula densa affects the (afferent/efferent/both) arterioles

A

both

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55
Q

If the macula densa senses low sodium, what happens?

A

it will dilate the afferent arterioles and release renin

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56
Q

if the afferant arterioles is dilated the GFR will be (higher/lower)

A

higher GFR

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57
Q

In a higher GFR, (more/less) sodium filtered so that you can reabsorbed (more/less) later

A

more sodium

more

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58
Q

What effect does renin have? Does the GFR increase or decrease

A

constricts Efferent arterioles

GFR increases

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59
Q

What is the flow chart look like for GFR regulation. Draw it

A
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60
Q

Which is more important, reabsorption or secretion?

A

reabsorption is more important

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61
Q

____ and ____ are poorly absorbed, so they will be present in urine

A

urea and creatinine

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62
Q

What are the top two electrolytes that are reabsorbed?

A

glucose and bicarb

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63
Q

What does transcellular mean?

A

across the cell, aka through it

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64
Q

What does paracellular mean?

A

next to cell, aka between two cells

This is going through “tight junctions”

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65
Q

where does ultrafiltration/bulk flow occur?

A

out of the lumen of the nephron and in between the capillaries and tubules

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66
Q

active transport requires ____

A

ATP

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67
Q

Secondary active transport requires ____

A

glucose

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68
Q

What is the most important ATPase pump?

A

sodium/potassium ATPase pump

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69
Q

what are the two glucose co-transporters?

A

SGLT2 and SGLT1.

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70
Q

Which glucose co-transporter does the bulk of the glucose? where is it located?

A

SGLT2

proximal convoluted tubule

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71
Q

the SGLT co-transport system is what kind of transport? What is the primary part?

A

secondary transport

sodium is the primary part

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72
Q

Counter transport helps to ???

A

preserve energy

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73
Q

Sodium passively diffuses from _____ into _____

A

lumen

tubular cell

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74
Q

sodium is actively transported from _____ to _____

A

tubule cell to blood.

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75
Q

When sodium is coming in via counter transport, it can spin the door so ____ ions can leave. no energy required

A

Hydrogen

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76
Q

Once you hit your reabsorption max, you ____ the rest

A

excrete

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77
Q

_____ is the max reabsorbable load for glucose

A

375 mg/min

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78
Q

T/F: If substances are passively absorbed, they have a transport maximum.

A

False!

passively absorbed substances are time dependent

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79
Q

What is another name for time dependent transport?

A

gradient-time transport

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80
Q

What is the exception for passive absorption?

A

sodium reabsorption

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81
Q

Bulk of Na and water is reabsorbed in the _____

A

proximal convoluted tubule

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82
Q

Besides water and sodium, ___, ____ and ____ are also reabsorbed in the PCT

A

bicarb, glucose and amino acids

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83
Q

In the PCT ______ and _____ increase in concentration

A

urea and creatinine

NOT reabsorbed at all in the PCT

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84
Q

What is important about the descending LOH reabsorption?

A

EXTREMELY permeable to water

aka the water is leaving

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85
Q

The ascending LOH is (highly/not at all) permeable to water

A

0% permeability to water

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86
Q

_____ leaves at the ascending LOH. What does this result in?

A

sodium

concentrated urine, LOTS of reabsorption happens here

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87
Q

Where do loop diuretics work? What transporter is involved?

A

Ascending LOH

1Na-2Cl-1K transporter.

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88
Q

The macula densa is located where?

A

first part of the distal tubule

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89
Q

What is happening at the distal tubule?

A

Dilutes urine, aka reabsorbing the rest of the ions like Sodium-Chloride, Bicarb, and Calcium

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90
Q

The distal tubule is impermeable to ____ and ____

A

water and urea

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91
Q

Where do thiazide diuretics work?

A

distal tubule

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92
Q

principal cell are responsible for ___ and ____ into the blood, and ____ out

A

sodium and water

potassium out

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93
Q

intercalated cells are responsible for ____ in and ____ out

A

K and bicarbonate are reabsorbed

Hydrogen excreted out

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94
Q

Principal cells are where _____ and ______ work (types of medication)

A

aldosterone antagonists and sodium channel blockers

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95
Q

_____ is the final determinant of urine concentration

A

Medullary collecting duct

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95
Q

____ is the only site where ADH works

A

Medullary collecting duct

96
Q

_____ is the only place urea is permeable

A

Medullary collecting duct

97
Q

The higher the ADH, the more ____ reabsorbed

A

water

98
Q

_____ + ____ = concentrated urine

A

High ADH + Hyperosmotic renal medulla

99
Q

Describe the process of the countercurrent mechanism

A
  1. There is only one place in the loop of Henle that is permeable to water: descending loop.
  2. Essentially, in the ascending loop, you just keep pumping solutes into the medulla (outside)
  3. When new filtrate flows into the descending loop, it pushes water out to dilute the medulla (outside)
  4. As this process repeats you are left with a hyperosmotic medulla, since water can only flow into the medulla at the descending loop.
  5. The entire time, the medulla cannot send solutes back into the loop. It is a one way street.
  6. The main solute that makes the medulla hyperosmotic is urea. (requires ADH)
100
Q

Medullary blood flow is very (fast/slow) so the solutes don’t flow away via ____

A

slow

blood

101
Q

Describe the role of the Vasa Recta in countercurrent multiplier

A

Because the medulla is so concentrated with solutes, some it flows into the Vasa Recta.
However, this makes it hyperosmotic as it continues to gain solute but lose water.
As it goes up the loop, the Vasa Recta is permeable to water unlike the loop of Henle, so it reabsorbs water and gets rid of solute (aka undoing what happened in the beginning).
This ensures that all the hard work of concentrating the medulla via the loop of Henle is not lost.
Blood gets hyperosmotic as it descends, but it is reversed as it ascends, so pretty much nothing changed and no solute is lost.

102
Q

What is the main cause of prerenal acute renal failure?

A

hypoperfusion

103
Q

What is the main common cause of intrarenal acute renal failure?

A

abnormalities of vessls or glomeruli

104
Q

what is the main common cause of postrenal acute renal failure?

A

Kidney stones

105
Q

Acute renal failure can lead to _____ and _____

A

hyperkalemia and metabolic acidosis

106
Q

What are the top 3 main causes of prerenal acut renal failure?

A
  1. Volume depletion
  2. Cardiac Failure
  3. Peripheral vasodilation/shock

anything that causes not enough blood flow to kidneys or not enough pressure to get blood to the kidneys

107
Q

is prerenal acute renal failure reversible?

A

Reversible, unless renal blood flow is < 25%

108
Q

How do the kidneys adjust in prerenal acute renal failure?

A

temporarily slowing GFR

109
Q

Give some examples of glomerular capillary/vessel damage

What type of acute renal failure?

A

Vasculitis, cholesterol, acute glomerulonephritis (GN)

intrarenal

110
Q

Give an example of renal tubular epithelium damage

What type of acute renal failure?

A

Acute tubular necrosis (ATN)

intrarenal

111
Q

Give two examples of renal interstitium damage

What type of acute renal failure?

A

Acute pyelo (UTI going up to the kidneys themselves)
Acute interstitial nephritis (drugs or immune)

intrarenal

112
Q

What are three examples of postrenal acute renal failure?

A

Bilateral obstruction of ureters/renal pelvis due to clots or stones
Bladder obstruction
Obstruction of Urethra

113
Q

In a male patient, what are two examples of postrenal acute renal failure?

A

Some sort of stone

prostate

114
Q

At what point does it become visible that your nephrons are dying?

A

start showing signs of renal failure once you have lost 25% of them

115
Q

What are the top 5 causes of ESRD?

A

DM
HTN
Infections
Vascular diseases
(Obesity plays a role in both DM and HTN)

116
Q

As you start to lose nephrons, your kidney become _____

A

scarred

117
Q

What is the most common form of kidney disease?

A

Nephrosclerosis

its is benign but irreversible

118
Q

What chronic renal disease is immune complex mediated?

A

glomerulonephritis

119
Q

What kind of nephrons have vasa recta?

A

juxtamedullary

120
Q

What is the MCC of nephrotic syndrome in children?

A

minimal change disease

121
Q

what is minimal change disease caused by? What is an obvious factor?

A

caused by damage to your glomeruli

protein will be present in the urine

122
Q

Chronic renal failure is amplified by ____ and ______

A

HTM and DM

123
Q

What is chronic glomerulonephritis?

A

It’s characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, which can lead to a reduction in the glomerular filtration rate (GFR) and retention of uremic toxins

124
Q

Myenteric plexus is also know as _____ plexus

A

Auerbach’s plexus

125
Q

Myenteric/Auerbach’s plexus is responsible for ????

A

GI movement/peristalsis

126
Q

Submucosal plexus is also known as ____ plexus

A

Meissner’s plexus

127
Q

Submucosal/Meissner’s plexus is responsible for ???

A

Secretions/blood flow

128
Q

Where is the primary parasympathetic cut off point?

A

transverse colon

129
Q

Sacral parasympathetic is _____ to ____

A

transverse colon to anus

130
Q

What transmitter excites the GI tract?

A

Acetylcholine

131
Q

What transmitter inhibits the GI tract? What levels?

A

Norepinephrine

L5-T2??? need to double check this fact

132
Q

Gastrin is secreted to break down ____

A

proteins

133
Q

Where is gastrin found?

A

at the bottom of the stomach, G cells

134
Q

What is the inhibitor of gastric emptying?

A

CCK

135
Q

CCK is released in response to _____. What does it release?

A

fat

releases bile

136
Q

______ secretes everything except gastric acid

A

secretin

137
Q

______ inhibits gastric acid

A

gastric inhibitor peptide (GIP)

138
Q

GI blood flow uses ____ circulation

A

splanchnic

139
Q

GI blood flow flows through the ______ on return

A

portal vein

140
Q

_____ and _____ get absorbed earlier than fats

A

carbs and proteins

141
Q

What are the two main arteries off the aorta?

Which one is most important?

A

**Superior mesenteric artery and Inferior mesenteric artery

142
Q

_____ are the functional unit of the liver

A

lobules

143
Q

What is the order of liver blood flow?

A
  1. Portal veins
  2. Sinusoids
  3. Central veins
  4. Hepatic veins
  5. IVC
144
Q

_____ cells eat toxins/bacteria as the blood flows through them. (aka the detox part of your liver.

A

Kupffer cells

145
Q

food + gastric secretions =

A

chyme

146
Q

The _____ is the end of the stomach, and it prevents you from dumping your entire meal into your intestines immediately.

A

pylorus

147
Q

What are the two different types of gastric glands?

A

Chief cells

parietal cells

148
Q

____ cells are associated with pepsin

A

chief cells

149
Q

parietal cells are associated with ____ and _____

A

HCl and intrinsic factor

150
Q

pyloric glands mainly just secrete ____

A

gastrin

151
Q

The presence of _____ specifically is one of the indicators for your duodenum to slow gastric emptying. What two hormones are associated with it?

A

fats

CCK and GIP

152
Q

The pancreas functions as both ????

A

an endocrine and exocrine gland

153
Q

acini cells are associated with ____

A

bicarb

154
Q

The pancreas is associated with _____, ____ and _____ that break down proteins

A

trypsin + chymotrypsin + carboxypolypeptides

155
Q

trypsin + chymotrypsin + carboxypolypeptides all start out as _______. What changes that?

A

inactivated

are activated by the HCl in the stomach acid

156
Q

What enzyme is associated with breaking down carbs?

A

pancreatic amylase

157
Q

What 3 pancreatic enzymes are responsible for breaking down fats?

A

Pancreatic lipase + Esterase + Phospholipase

158
Q

How does the SI increase surface area?

A

Valvulae Conniventes (3x)

Villi (10x)

Brush border Microvilli (20x)

total: 1000X increase in surface area

159
Q

What are the three monosaccharides?

A

Glucose
Fructose
Galactose

160
Q

Which simple sugar is the sweetest?

A

fructose

161
Q

Which simple sugar is not found solo in nature? What is it always a part of?

A

galactose

lactose

162
Q

What are the two components of sucrose?

A

glucose + fructose

163
Q

What are the two components of lactose?

A

galactose + glucose

164
Q

What are the two components of maltose? Where is it commonly found?

A

glucose + glucose

beer, cereals, germinating seeds

165
Q

Which disaccharide is the least sweet?

A

Lactose

166
Q

Which disaccharide is the most common?

A

sucrose

167
Q

What are two common polysaccharides?

A

starch and glycogen

168
Q

What are the TWO sources of amylase?

A

salivary amylase and pancreatic amylase

169
Q

Hydrolysis is used for the breakdown of ______, _____ and ______.

A

COMPLEX carbs
polysaccharides
triglycerides to 3 FAs and glycerol

170
Q

how are triglycerides broken down? what are the components? via what enzyme?

A

triglycerides to 3 FAs + glycerol

pancreatic LIPASE

171
Q

emulsification happens via _____

A

bile acids

172
Q

_____ + _____ = emulsified fat droplets

A

bile acids + agitation

173
Q

emulsified fat + _____ = fatty acids and 2-monoglycerides

A

pancreatic lipase

174
Q

once triglycerides are broken down, _____ are formed

A

micelles

175
Q

Draw the diagram for protein digestion

A
176
Q

When talking about lipoproteins, the density refers to ____

A

how much PROTEIN is in it

177
Q

Which type of cholesterol is considered “bad”

A

LDL (has a low density of protein aka a high density of fats)

178
Q

Which type of cholesterol is considered “good”

A

HDL

179
Q

Where are most triglycerides stored?

A

as adipose cells or in the liver

180
Q

What is achalasia?

A

hypercontractile lower esophageal sphincter

181
Q

Name two causes of the peptic ulcer disease?

A

H. pylori infection

excess NSAID use

182
Q

What are the two main causes of pancreatitis?

A

gallstones

binge drinking alcohol

183
Q

non-tropical sprues = ______ disease. How does it work? How is it mostly commonly transmitted?

A

celiac disease

gluten kills the villi in the your SI

familial inheritance

184
Q

tropical sprues is caused by ???? How is it treated?

A

bacteria

treat with abx

185
Q

UC is a subtype of _____. Where does it most commonly affect?

A

IBD

sigmoid colon and rectum

186
Q

What is the normal body temp?

A

98.6

187
Q

a person commonly gains heat from _____ and _____

A

metabolic processes

environment

188
Q

what are the four main ways you lose heat?

A

**radiation, convection, conduction, evaporation

189
Q

_____ can boost how much heat you lose

A

Sympathetics

190
Q

The majority of heat loss is through _____

A

radiation: 60%

191
Q

convection heat loss, lose heat through _____

A

air currents

think like an over

192
Q

conduction heat loss, lose heat through _____

A

touching an object or air

think like elctricity

193
Q

evaporation heat loss, lose heat through _____

A

sweat

194
Q

What is the main method of losing heat when it is too hot outside?

A

evaporation aka sweating

195
Q

____ is responsible for overall temperature regulation

A

hypothalamus

196
Q

When you sweat slowly (like after a jog), you (can/cannot) reabsorb the sodium you normally lose.

A

can reabsorb the sweat you lose

197
Q

When you sweat profusely, you lose a lot of sodium. What is a common way to replenish?

A

pedialyte/gatorade help with people who are sweating A LOT

198
Q

When you are too hot, the body adapts in what 3 ways?

A

Vasodilation
Sweat
Slowing metabolic processes

199
Q

When you are too cold, the body adapts in what 3 ways?

A

Shivering
Piloerection (goosebumps/hair)
Increased metabolic processes

200
Q

Overall, you are more sensitive to ____ than ____. 10x more receptors.

A

cold: 10x more receptors.

hot

201
Q

What is a fever due to?

A

Increased set point within the hypothalamus due to endogenous pyrogens, like IL-1 and IL-6.

202
Q

What two endogenous pyrogens are responsible for a fever?

A

IL-1 and IL-6.

203
Q

Do platelets have a nucleus?

A

NO!

204
Q

What is normal platelet count?

A

150K-450K

205
Q

What is a low platelet count called?

A

Thrombocytopenia

206
Q

What is a high platelet count called?

A

thrombocytosis

207
Q

What is the 1/2 life of a platelet?

A

8-12 days

208
Q

How are the majority of platelets removed?

A

by the spleen

209
Q

What is the triggering factor for platelet plugs?

A

exposed collagen from damaged vascular wall

210
Q

Collagen makes plts sticky and causes them to leak ____, ____ and _____

A

vWF, ADP, and thromboxane A2.

211
Q

How long does it take to make a platelet plug?

A

15-20 seconds

212
Q

platelet plug transitions into a clot when ???

A

you start activating fibrin

213
Q

generally your body in in an _____

A

anticoagulant state

214
Q

A ruptured vessel/damaged blood cells trigger ______

A

prothrombin activator

215
Q

What is the rate-limiting step in clotting?

A

Availability of activator

216
Q

Prothrombin activator activates ???? What does it need for this process?

A

prothrombin into thrombin

presence of sufficient Calcium ions

217
Q

Where is prothrombin made?

A

in the liver

218
Q

Thrombin converts ????

A

fibrinogen to fibrin

219
Q

Where is fibrinogen made?

A

in the liver

220
Q

Extrinsic pathway thinking ????? what is the lab measuring?

A

triggered by damage to walls

PT

221
Q

Intrinsic pathway thinking ????? What lab measurement?

A

damage to the RBCs themselves

aPTT

222
Q

What is the helpful analogy for extrinsic vs intrinsic?

A
223
Q

Draw the diagram for extrinsic and intrinsic factors

A
224
Q

Which factors does PT measure?

A

Measures 1, 2, 5, 7, 10 (AKA common pathway + extrinsic)

225
Q

Which factors does aPTT measure?

A

Measures 1, 2, 5, 8, 9, 11, 12 (AKA common pathway + intrinsic)

226
Q

How does heparin work?

A

it amplify Antithrombin 3 by 100x

227
Q

What is the role of antithrombin 3

A

blocking and inactivation of thrombin. (Factor 2)

228
Q

Plasmin came from _____.

A

plasminogen

229
Q

____ can eat fibrin

A

plasmin

230
Q

What is hemophilia related to? What can it cause?

A

eficiency of factor VIII (8) and causes large vessel bleeding

231
Q

What does DIC stand for? Describe what happens.

A

DIC = disseminated intravascular coagulation

A trigger causes you to clot everywhere
You clot too much, you run out
Now you bleed everywhere.

232
Q

a venous emboli will go to the _____

A

lungs

233
Q

arteriole emboli tend to go the ___ and ____

A

brain and kidneys

234
Q

Factor 1 is ____

A

fibrinogen

235
Q

Factor 2 is _____

A

prothombin

236
Q

Factor 3 is _____

A

tissue factor

237
Q

Which clotting factor is vit K dependent?

A

factor 10

(Stuart-Prower factor)

JKC Med Phys Spring '24 (18 decks)

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