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EDIC MCQ > General Physiology > Flashcards

General Physiology Flashcards

1
Q

Accompanying electrolyte disturbance with hypercalcaemia?

A
  • Hypomagnesaemia
  • Hypophosphataemia
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2
Q

Causes of hypercalcaemia?

A

90% - Primary hyperparathyroidism and malignancy

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3
Q

What is hypercalcaemia?

A

Ionised calcium > 14mg/dL or 3.5mmol/L

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4
Q

Signs & symptoms of hypercalcaemia?

A
  • Polyuria
  • Polydipsia
  • Dehydration
  • Anorexia
  • Nausea
  • Muscle weakness
  • Confusion
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5
Q

Renal tubular reabsorption of Magnesium is stimulated by what hormone?

A

PTH - Parathyroid hormone

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6
Q

Renal tubular reabsorption of Magnesium is inhibited by?

A

Hypercalcaemia

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7
Q

Proximal tubular reabsorption of phosphate is inhibited by?

A

PTH - Parathyroid hormone

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8
Q

ECG changes relating to hypercalcaemia?

A
  • Shorted QT interval
  • Osborn waves
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9
Q

What is Tumour Lysis Syndrome?

A

This causes massive cellular lysis in cancer.

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10
Q

Features of tumour lysis syndrome include?

A
  • Hypocalcaemia ( Precipitation with phosphate)
  • Hyperkalaemia
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11
Q

Management of tumour lysis syndrome?

A
  • Hydration
  • Rasburicase (Increases the formation of allantoin from uric acid)
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12
Q

Causes of TLS-related AKI with renal failure?

A
  • Hyperuricaemia
  • Hyperphosphataemia
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13
Q

Cardiac effect of hypercalcaemia?

A
  • Shortening of myocardial action potential
  • Shortened QT interval
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14
Q

What is pseudo-hypoxaemia?

A

Artifactual condition reported in patients with Leukocytosis & Thrombocytosis. This should be suspected where saturations do not match with ABG saturations.

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15
Q

Classification of post-traumatic seizure?

A
  • Early PTS - Within 7 days of injury
  • Late PTS - AFter 7 days of injury
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16
Q

Risk factors for post-traumatic seizures?

A
  • GCS < 10
  • Subdural, extradural & intracerebral haematoma
  • Depressed skull fracture
  • Penetrating head injury
  • Young age
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17
Q

Lactic acidosis is associated with ?

A
  1. Raised anion gap
  2. Serum chloride is usually normal
    3.
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18
Q

Properties of strong ion difference?

A
  1. Strong ion difference is reduced in acidosis
  2. Normal value is 42mEq/L
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19
Q

D-Lactic acidosis?

A
  1. It is a rare cause of metabolic acidosis
  2. Present in short gut syndrome
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20
Q

L-lactate acidosis?

A
  1. Accumulates in humans
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21
Q

What is the Henderson-Hasselbalch equation in relation to bicarbonate buffer system?

A
  1. pH = 6.1 + HCO3-/(0.03 x pCO2)
  2. 6.1 = pK
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22
Q

How do you calculate Strong Ion Difference?

A
  1. SID = (Na + K) - (Cl + Lactate)
  2. Normal value = 42mEq/L
  3. SID in Normal Saline is 0
  4. SID is reduced in metabolic acidosis
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23
Q

Non-volatile acids in the body ?

A
  1. These acids cannot be excreted by the lungs
  2. Excretes 80mEq/L of non-volatile acids / day
  3. Usually from metabolism of protein
  4. Primarily cleared by the kidney
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24
Q

Lactic acid?

A
  1. About 1,500mmol/day
  2. Metabolised by the liver
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25
Q

Oxidation reactions?

A
  1. The atom losses an electron
  2. Example of an oxidising agent: Fluorine - Reduced in the process
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26
Q

Reduction reactions?

A
  1. The atom gains an electron
  2. Example of a reducing agent: Sodium - Oxidised in the process
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27
Q

Hydrogen ion concentration?

A
  1. Present on the ECF
  2. Approximately 40nanoEq/L
28
Q

Anion gap?

A
  1. Normal 8-16mEq/L
29
Q

PCT functions?

A
  1. Carbonic acid formation (CO2+H2O)
  2. Carbonic acid formation catalyzed by Carbonic anhydrase
  3. Dissociates into H+ & HCO
30
Q

Intracellular buffer systems?

A
  1. Protein (Important IC buffer system)
  2. Hb accounts for 60-70% of IC buffering
31
Q

Intracellular and extracellular pH?

A
  1. Intracellular pH is slightly lower than ECF pH
  2. Venous blood 7.35 (Due to CO2)
  3. Arterial blood 7.40
32
Q

Oxyntic cells int the stomach?

A
  1. pH = 0.8
33
Q

ECF anions?

A
  1. Chloride is the most abundant in ECF
34
Q

Glutamine renal metabolism?

A
  1. production of ammonium ion & HCO3
35
Q

Urinary pH

A
  1. The lowest is 4.5
  2. Hydrogen ion buffered with PO & NH3 buffer systems
  3. There is net addition of HCO3 to blood due to buffer
36
Q

ECF buffer system?

A
  1. HCO3 - Most important
  2. pKa of HCO3 = 6.1
37
Q

Hydrogen ion excretion in the renal tubules ?

A
  1. Sodium-Hydrogen exchanger
  2. This is an active process
  3. Energy is provided by passive diffusion of Na
38
Q

The excretion of Hydrogen ion is increased by ?

A
  1. Metabolic acidosis
  2. Respiratory acidosis
  3. Aldosterone
  4. Angiotensin
  5. Hypokalaemia
39
Q

Bicarbonate reabsorption occurs at what sites in the kidney?

A
  1. PCT (80-90%)
  2. DCT
  3. CD

Occurs in all parts except the descending and thin ascending LoH

40
Q

What is the equation for pH?

A

pH = -log [H+]
Normal H+ = 0.00000004mEq/L

41
Q

Hydrogen ions in ECF?

A

It is very low

42
Q

What is the isohydric principle?

A

All buffers in the body are in equilibrium with the same hydrogen ion concentration

43
Q

Protein C & S?

A
  1. Naturally occuring antocoagulants
  2. Vitamin K dependent factors
44
Q

What is a Newtonian fluid?

A
  1. If it has constant viscosity regardless of flow
  2. Water is a Newtonian fluid
  3. Non-newtonian fluids viscosity varies with flow - Blood is an example
45
Q

Activated clotting time (ACT)?

A
  1. It is done on whole blood
  2. It is less sensitive to minor deficiencies in clotting factors
  3. Affects the intrinsic and common pathway (Factors < 5% of normal)
    4 ACT dose-response relationship is linear with high dose of Heparin
46
Q

APTT ?

A
  1. Performed on plasma
  2. More sensitive than ACT for minor deficiencies
  3. At high Heparin levels, APTT doesn’t have a linear relationship
47
Q

What is the main cause of mitral stenosis?

A

Rheumatic heart disease in 99% of cases.

48
Q

Epidemiology of mitral stenosis ?

A
  1. 25% pure mitral stenosis
  2. Two third are female
  3. More common in developing countries
49
Q

What is epidemiology?

A

This is the distribution, pattern and determinants of health and disease in a defined population.

50
Q

Signs & symptoms of mitral stenosis?

A
  1. Elevated right heart pressures
  2. Elevated PAOP
  3. Right parasternal heave
  4. RVH + RAD on ECG
  5. Palpable 1st heart sound apex
  6. Pulmonary HTN + Palpable 2nd HS
51
Q

What are the divisions of the bundle of His?

A
  1. Right bundle branch
    2 left bundle branch (Ant + Post fascicles)
52
Q

What is bifascicular block?

A

Combination of right and left hemi-block. It could be left anterior or posterior

Could progress to trifascicular block needing permanent pacemaker

RBBB and LAD indicates bifascicular block

53
Q

Contrast between left anterior and posterior hemiblock.

A
  1. Left ant hemiblock causes LAD on ECG
  2. Left post hemiblock causes RAD on ECG
54
Q

Reversal of life threatening bleeding secondary to Warfarin?

A
  1. Prothrombin complex conc
  2. FFP can be used in addition
55
Q

Diagnosis of congenital heart disease?

A
  1. Hepatosplenomegally may be an important clue
  2. Patent ductus arteriosus is associated with congenital rubella
  3. Rate of spontaneous closure of VSD is > 50%
56
Q

What is cholinergic crisis?

A

This can be induced by overdose of acetylcholinesterase inhibitors (Edrophonium for treatment of myasthenia gravis).

57
Q

Mechanism of action of acetylcholinesterase in cholinergic crisis?

A
  1. Increased acetylcholine at muscarinic receptors.
  2. Stimulation of effector organ - (Abdominal colic, sweating, miosis & lacrimation)
58
Q

Mechanism of action of GH?

A
  1. Acts on GH/cytokine/superfamily of receptors
  2. Functios via Janus Kinases/signal transducers and activation of transcription pathway (JAK-STAT)
59
Q

How many zones does the adrenal cortex have?

A

It has 3 zones

  1. Zona glomerulosa
  2. Zona fasciculata
  3. Zona reticularis
60
Q

Secretions of the the adrenal cortex zones ?

A

Zona glomerulosa: Outtermost layer producing the mineralocorticoid aldosterone

Zona fasciculata produces the glucocorticoids - Cortisone, Corticosterone and deoxycorticosterone

Zona reticularis - Androgens, DHEA, DHEA sulphate and androstenedione

61
Q

What is the most physiologically active glucocorticoid?

A

Cortisol

62
Q

Adrenal gland?

A
  1. Adrenal cortex
  2. Adrenal medula
63
Q

Adrenal medulla?

A
  1. Main secretion - Adrenaline
  2. Some noradrenaline
  3. Modified post-ganglionic neuron
  4. Catecholamine release mediated by pre-ganglionic sympathetic nerve fibres from T5-T11
  5. Mediated by cholinergic nicotinic transmission
64
Q

There are to portal venous systems in the body ?

A
  1. Hepatic
  2. hypophyseal
65
Q

What is the most abundant store of iron in the body?

A

Haemoglobin

EDIC MCQ (12 decks)

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