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Phase 1 Med (Liv) > ILA > Flashcards

ILA Flashcards

1
Q

What causes the upstroke in the nerve action potential graph?

A

By sodium ions rushing into the cell

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2
Q

What causes the downstroke in the nerve action potential graph?

A

By potassium ions rushing out of the cell

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3
Q

Which group of spinal nerves innervates the biceps reflex?

A

C5/C6

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4
Q

Which group of spinal nerves innervates the ankle reflex?

A

S1/S2

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5
Q

Which group of spinal nerves innervates the knee jerk?

A

L3/L4

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6
Q

Which group of spinal nerves innervates the triceps reflex?

A

C7/C8

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7
Q

Name 4 cells which are present in the CNS

A
  • Astrocytes
  • Ependymal cells
  • Microglia
  • Oligodendrocytes
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8
Q

Which descending motor tract originates in the cerebral cortex and synapses in the spinal cord?

A

Corticospinal tract

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9
Q

Where does the spinothalamic tract decussate?

A

The spinal cord

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10
Q

What kind of fibres does the vagus nerve compromise of?

A

Parasympathetic motor and sensory fibres

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11
Q

What is the function of DNA helicase?

A

Unwind the two strands of DNA

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12
Q

Where do free RNA nucleotides form weak hydrogen bonds with a DNA strand during transcription?

A

The nucleus

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13
Q

What does RNA polymerase do?

A

Joins together the free RNA nucleotides by phosphodiester bonds

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14
Q

How does pre-mRNA become mRNA?

A

By splicing to remove introns

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15
Q

What does a spliceosome do?

A

Does splicing

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16
Q

What does topoisomerase do?

A

Uncoils the DNA

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17
Q

Where does translation happen?

A

In the cytoplasm

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18
Q

Briefly outline translation of mRNA

A
  • mRNA binds to ribosome
  • tRNA with AA complimentary binds to a codon of mRNA sequence
  • The codon and anti-codon become bound loosely by hydrogen bonding
  • Another tRNA binds, allowing a peptide bond to form between AA’s
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19
Q

What is mis-sense?

A

When a single nucleotide changes, resulting in a codon which codes for a different AA

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20
Q

What is a single nucleotide polymorphism (SNP)?

A

A variation in a single nucleotide that occurs at a specific position in the genome, where each variation is present to some degree within a population. This can be in exons or introns

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21
Q

Where can SNP be used?

A

Paternity tests. It is an example of mis-sense

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22
Q

What is non-sense?

A

Adds a stop codon in the genetic sequence

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23
Q

What is the problem with sickle cell anaemia?

A
  • Abnormality in haemoglobin S
  • Erythrocytes become stiff and crescent shaped
  • Only last 10-20 days (10% compared to standard)
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24
Q

How does cold/damp affect people with sickle cell anaemia?

A

Leads to vasoconstriction, hence amplifying the pain of blocking blood vessels

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25
Q

What proportion of the body is water in men and women?

A
  • 60-65% in men

- 55-60% in women

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26
Q

What is the split between ICF and ECF in the body?

A

2/3 is ICF, 1/3 IS ECF

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27
Q

What is one of the main components of ECF?

A

Dissolved sodium ions

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28
Q

What are further divisions of ECF?

A
  • 25% interstitial
  • 8% plasma
  • Rest is transcellular
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29
Q

Where can fluid be found?

A

In epithelial lined spaces

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30
Q

What percent of sodium in the body is locked up in the bone crystal?

A

Around 30%

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31
Q

What percentage of sodium in the body is exchangeable?

A

70%

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32
Q

What percentage of the total body sodium is held in the ECF?

A

50%

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33
Q

Define osmolality

A

A measure of the osmoles (Osm) of solute per kilogram of solvent. The units are osmol/kg or Osm/kg

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34
Q

Define oncotic pressure

A

A form of osmotic pressure exerted by proteins, particularly albumin, in a blood vessel’s plasma, that usually tends to pull water into the circulatory system

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35
Q

Define osmosis

A

The movement of water molecules from an area which is less concentrated to an area which is more concentrated

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36
Q

What is albumin?

A

A protein produced in the liver that keeps fluid from leaking out of blood vessels and nourishes tissues

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37
Q

What happens if albumin levels are low?

A
  • Water not drawn into blood vessels
  • Fluid surrounds tissue
  • Fluid shift (when body fluids more between fluid compartments)
  • Conditions such as oedema
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38
Q

What is fluid shift?

A

When body fluids move between fluid compartments

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39
Q

What is oedema?

A

The excess of tissue/interstitial fluid collecting in tissues of the body

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40
Q

How does albumin work?

A

By binding to water

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41
Q

What are insensible losses?

A

Uncontrolled/unmeasurable amount of fluids on a daily basis

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42
Q

What contributes to insensible losses?

A

Urine, faeces, sweat, respiratory tract and trans-epidermal evaporation

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43
Q

What can cause increased osmolality?

A

An increase in sodium ions

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44
Q

What does an increase osmolality do to osmoreceptors?

A

Stimulates them in the hypothalamus

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45
Q

What happens after osmoreceptors are stimulated?

A
  • Stimulates the posterior pituitary gland to release ADH
  • The ADH targets the collecting ducts of the kidneys with aquaporins
  • The second messenger model occurs
  • More water reabsorption, darker urine, increase plasma volume, reduced osmolality
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46
Q

What happens when there is a decrease osmolality?

A
  • Osmoreceptors are inhibited
  • Inhibition of ADH
  • Less water reabsorption, paler urine, decreased plasma volume, increases osmolality
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47
Q

What does the hypothalamus do in relation to water control?

A

Makes ADH

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48
Q

What does the posterior pituitary gland do in relation to water control?

A

Releases ADH

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49
Q

What does an increase in water mean in terms of ADH?

A

Release of ADH

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50
Q

What does a decrease in water mean in terms of ADH?

A

Inhibition of ADH

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51
Q

Where is angiotensin produced?

A

The liver

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52
Q

Where is renin produced?

A

Kidneys

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53
Q

What chemical helps convert angiotensinogen into angiotensin I?

A

Renin

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54
Q

Where is ACE produced?

A

Lungs

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55
Q

What chemical helps convert angiotensin I into angiotensin II?

A

ACE

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56
Q

What are the 3 main jobs of angiotensin II?

A
  • Arteriolar vasoconstriction (increase BP)
  • Acts of posterior pituitary to release ADH so there is water absorption at the collecting duct
  • Acts of vortex of adrenal gland for aldosterone secretion. Allows tubular Na/Cl ion reabsorption. K ions excretion and water retention
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57
Q

Where is renin secreted?

A

When there is low blood pressure in the kidneys

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58
Q

What does medication for hypertension tend to inhibit?

A

ACE, as when it’s secreted it tends to raise blood pressure

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59
Q

What happens when the volume of water in the blood pressure is too low?

A

The hypothalamus is stimulated to alarm the body of thirst, so more water is consumed

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60
Q

What happens in the case of dehydration?

A

Increased solute, increases ECF osmolality, water goes to ECF from ICF, ADH released, thirst centre stimulated

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61
Q

What happens when there is a water excess?

A

Reduced ECF osmolality, water moves from ICF to ECF, less ADH released, urine volume increases, no thirst stimulation

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62
Q

Define cardiac output

A

The amount of blood pumped by the heart per minute. It is a good indicator of fitness levels

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63
Q

What is the formula and units for cardiac output?

A
  • Cardiac output = heart rate x stroke volume

- It has units of litres per minute

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64
Q

What could increase cardiac output?

A

An increased heart rate or stroke volume

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65
Q

Name 7 factors which increase blood pressure

A
  • Smoking
  • High BMI
  • Lack of physical activity
  • Too much sodium
  • Too much alcohol
  • Stress
  • Older age
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66
Q

Describe how an increase in blood pressure leads to an increased cardiac output

A
  • Greater blood pressure
  • Reduced rate of flow through vessels
  • Greater heart rate for same stroke volume
  • Increased cardiac output
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67
Q

What is Starling’s law of the heart?

A

Stroke volume of the heart increases (until a limit) in response to an increase in the volume of blood in the ventricles, before contraction, when all other factors remain constant

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68
Q

What is preload?

A

The end diastolic volume that stretches the ventricle of the heart to its greatest dimensions under variable physiologic demands

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69
Q

What is afterload?

A

The pressure against which the heart must work to eject blood during systole

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70
Q

What are the four stages of the cardiac cycle (in order)?

A
  • Filling phase
  • Isovolumetric contraction
  • Outflow phase
  • Isovolumetirc relaxation
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71
Q

What occurs in the filling phase?

A

The ventricles fill during diastole and atrial systole

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72
Q

What happens during isovolumetric contraction?

A

The ventricles contract, building up pressure ready to pump blood into the aorta/pulmonary trunk

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73
Q

What occurs in the outflow phase?

A

The ventricles continue to contract, pushing blood into the aorta and the pulmonary trunk. Also known as systole

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74
Q

What happens in isovolumetric relaxation?

A

The ventricles relax, ready to refill with blood in the next filling phase

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75
Q

When does myocardial perfusion happen?

A

Diastole

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76
Q

What happens in the filling phase (detailed)?

A
  • Both atria and ventricles relaxed
  • Blood flows into atria from veins then into ventricles
  • At the end of diastole, atria contract, pushing a small amount of blood into ventricles
  • Pressure of ventricles > pressure of atria so AV valves close
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77
Q

What happens in isovolumetric contraction (detailed)?

A
  • At start of contraction, both sets of valves are shut

- Start of systole increase ventricular pressure

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78
Q

What happens in the outflow phase (detailed)?

A
  • When pressure of ventricles > aorta/pulmonary trunk, the valves of these valves open
  • Blood is pumped from the heart into the great arteries
  • Ventricles begin to relax, change in pressure compared to aorta causes valves to close
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79
Q

What happens in isovolumetric relaxation (detailed)?

A
  • At the end of outflow phase both sets of valves are closed again
  • Ventricles begin to relax, reducing pressure in ventricles so AV valves open
  • Cycle begins again
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80
Q

What is the purpose of coronary arteries?

A

Supply oxygenated blood to the heart muscle

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81
Q

What is the purpose of coronary veins?

A

Remove deoxygenated blood from the heart muscle

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82
Q

Where do the two coronary arteries arise from and how are they distinguished?

A
  • Arise from the aorta just beyond the semi-lunar valves

- Distinguished into left and right

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83
Q

What happens in diastole, linked to the coronary arteries?

A

Increased aortic pressure above valves forces blood into coronary arteries

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84
Q

Where do most coronary veins converge to and where does it drain into?

A
  • They converge to form the coronary venous sinus

- Drains into the right atrium

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85
Q

What are the branches of the right coronary artery and where do they join with branches of the left coronary artery?

A
  • Right marginal branch and posterior intraventricular artery
  • Join on the left hand side
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86
Q

What are the names of the two branches of the left coronary artery?

A

Circumflex artery (posterior) and the left anterior descending (LAD)

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87
Q

Where does the nodal branch supply?

A

The SAN

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88
Q

What happens when there is an occlusion of the LAD?

A
  • It provides major blood supply to the septum between ventricles
  • May lead to a ‘block’ of impulse conduction between atria and ventricles (LBBB/RBBB)
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89
Q

What happens when there is an occlusion of the right coronary artery?

A
  • Supplies the AVN and sinus of the heart

- Can lead to conduction abnormalities

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90
Q

Name 4 preventative things that can be done to reduce heart problems

A
  • Limit alcohol consumption
  • Reduce stress
  • Aim for a healthy weight
  • Physical activity daily
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91
Q

How can LBBB/RBBB be detected?

A

By ECG’s to detect any ventricular fibrillation

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92
Q

What symptom is linked with hypoxia?

A

Confusion

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93
Q

Name 4 reasons for a low pp of oxygen

A
  • Damaged tissue
  • Anaemia
  • High altitude
  • COPD
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94
Q

Name a reason for a too high pp of oxygen

A
  • Too much oxygen e.g. gas canister
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95
Q

Where is air held when it enters through the nose?

A

The nasal cavity

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96
Q

Where does the air go after the nasal cavity?

A

The pharynx then the larynx

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97
Q

What is the name of the opening of the trachea?

A

The glottis

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98
Q

What branches from the trachea?

A

The two primary bronchi

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99
Q

What does the bronchi deviate into?

A

The bronchioles

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100
Q

What happens in the alveoli and how does it happen?

A
  • Oxygen is transferred into the blood in exchange for carbon dioxide
  • Air travels through alveolar ducts into the alveolar sac where it is met with capillary networks
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101
Q

What consists of the upper airways?

A
  • Nose/nasal passage
  • Paranasal sinuses
  • Pharynx (nasopharynx, oropharynx, laryngopharynx)
  • The portion of the larynx above the vocal cords
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102
Q

What consists of the lower airways?

A
  • The portion of the larynx below the vocal folds
  • Trachea
  • Bronchi
  • Bronchioles
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103
Q

Where is the greatest resistance to airflow?

A

The mediu sized bronchi

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104
Q

What do chemoreceptors do?

A

Detect changes in blood pH

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105
Q

What is the apneustic centre of the pons responsible for?

A

The ‘stimulating’ part, helps control rate of breathing

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106
Q

What is the pneumotaxic centre of the pons responsible for?

A

The ‘limiting’ part, helps control rate of breathing

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107
Q

What happens when carbon dioxide levels rise in arterial blood?

A
  • Vasodialtion in arteries
  • Heart rate increases
  • Better blood flow/tissue perfusion
  • Better oxygen delivery
  • Blood flow to the heart and brain increases
  • Higher respiratory rate as higher carbon dioxide levels
  • Allows body to release more carbon dioxide whole increasing oxygen intake
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108
Q

What is normal respiration normally driven by?

A

Carbon dioxide levels in arteries

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109
Q

What happens during inspiration?

A
  • Diaphragm contracts and pulls downwards
  • Intercostal muscles contract and pull upwards
  • Increase size of thoracic cavity
  • Decrease in thoracic pressure
  • Air moves into the lungs down a pressure gradient
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110
Q

What happens during expiration?

A
  • Lungs recoils to force air out
  • Intercostal muscles relax
  • Diaphragm relaxes moving higher into the thoracic cavity
  • Causes greater pressure in thorax, creating a pressure gradient
  • Passive process
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111
Q

What is respiratory failure?

A
  • When the respiratory system fails in oxygenation of carbon dioxide elimination
  • May be classified as either hypodermic or hypercapnic
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112
Q

What is type I respiratory failure?

A
  • Consists of hypoxemia solely
  • Carbon dioxide levels may be normal or low
  • Caused by lack of synchronisation between ventilation and perfusion within the body
  • Caused by conditions which affects oxygenation
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113
Q

What is type II respiratory failure?

A
  • This is both hypoxemia and hypercapnia
  • Usually caused by inadequate alveolar ventilation
  • Carbon dioxide levels build up but can’t be eliminated
  • Caused by increased airways resistance, reduction in breathing effort
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114
Q

What does the upper GI tract consist of?

A

Pharynx, oesophagus, stomach and duodenum

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115
Q

Where is the pharynx located?

A

Behind the mouth and nasal cavity and above the oesophagus and larynx.

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116
Q

What is the function of the pharynx?

A
  • Its muscular walls function in the process of swallowing

- Serves as a pathway for the movement of food from the mouth to oesophagus

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117
Q

What is the purpose of the oesophagus?

A
  • Where the food passes by peristaltic contractions, from the pharynx to the stomach
  • Serves as the conduit for food and liquids that have been swallowed into the pharynx to reach the stomach
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118
Q

What happens to the epiglottis during swallowing?

A
  • Tilts backwards to prevent food going down the larynx and lungs
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119
Q

What is the stomach and what is its functions?

A
  • Muscular organ which is involved in the second phase of digestion, following mastication
  • Done by digestive enzymes and HCl
  • Stomach muscles contract periodically, churning food to enhance digestion
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120
Q

What is the pyloric sphincter?

A

A muscular valve that opens to allow food to pass from the stomach to the small intestine

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121
Q

What does the pyloric sphincter do?

A

Controls the passage of partially digested food (chyme) from the stomach into the duodenum

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122
Q

What are the functions of the duodenum?

A
  • Senses changes in pH
  • Receives chyme from the stomach
  • Plays a vital role in the digestion of chyme (neutralises acid) in preparation for absorption in the small intestine
  • Allows entrance of bile via bile & pancreatic duct
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123
Q

What are serotonin inhibitor drugs used for?

A

Anti-sickness medications

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124
Q

What is gastro-oesophageal reflux?

A

When HCl from the stomach leaks up into the oesophagus

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125
Q

What is gastro-oesophageal reflux caused by?

A

Due to the sphincter at the bottom of the oesophagus becoming weakened, hence allowing reflux

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126
Q

What is an oesophageal motility disorder (EMD)?

A

A medical disorder where there is difficulty swallowing, regurgitation of food, and a spasm-type pain which can be brought on by an allergic reaction to certain foods

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127
Q

Which enzymes helps form carbonic acid from water and carbon dioxide in parietal cells?

A

Carbonic anhydrase

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128
Q

What happens to H ions in partial cells?

A

They move into the lumen of gastric pit in a K/H ion ATPase pump. K ions move into the parietal cells

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129
Q

What happens to bicarbonate ion after dissociation in the parietal cell?

A

It is part of a dual-transport channel with Cl ions, with bicarbonate moving into the blood and Cl ions moving into the parietal cell

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130
Q

What does Cl ions do when they are in the parietal cells?

A

Diffuse into the lumen of the gastric pit

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131
Q

What is the secondary source of hydrogen ions in the parietal cells?

A

Dissociation of water

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132
Q

What are the three substances which stimulate parietal cells and which one directly affects them?

A
  • Gastrin, histamine and acetylcholine

- Histamine is the only one which directly affects

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133
Q

What do goblet cells do in the stomach?

A

Secrete mucus which protects the stomach lining

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134
Q

What do parietal cells do in the stomach?

A

Produce and secrete gastric acid

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135
Q

What do chief cells do in the stomach?

A

Secrete pepsinogen (a protease precursor)

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136
Q

What do D cells do in the stomach?

A

Secrete somatostatin which inhibits acid secretion

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137
Q

What do G cells in the stomach do?

A

Secrete gastrin which stimulates acid secretion

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138
Q

What is the Angle of His?

A

The acute angle created between the cardia at the entrance to the stomach and oesophagus

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139
Q

What are the names of the mucous membrane layers of the stomach and duodenum?

A

Gastric and duodenal mucosa

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140
Q

What is the pre-epithelial layer of protection?

A

A mucus-bicarbonate barrier, secreted from parietal cells, create a pH gradient maintaining the epithelial cell surface at near neutral pH

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141
Q

What is the purpose of surfactants in the stomach?

A

Prevents against water-soluble agents from reaching and damaging the epithelium

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142
Q

Name two things which contribute to intact epithelium lining

A
  • Rapid cell turnover

- Enzymes which hydrolyse proteins (pepsin/pepsinogen)

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143
Q

What may be a symptom of indigestion?

A

Reflux

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144
Q

Where does the liver lie?

A

In the right hypochondrium

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145
Q

What percentage of the cardiac output is the hepatic blood supply?

A

25%

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146
Q

What percentage of the hepatic blood flow is from the portal vein?

A

75%

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147
Q

How many segments is the liver divided into?

A

8

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148
Q

What is the functional hepatic unit of the liver?

A

The acinus

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149
Q

When is cholecystokinin released?

A

In response to the presence of amino acids in the gut

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150
Q

Which system is acetylcholine part of?

A

The parasympathetic system

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151
Q

By what system is the enteropancreatic reflex done by?

A

Parasympathetic system

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152
Q

Which type of jaundice is commonly caused by gallstones in the common bile duct?

A

Obstructive

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153
Q

Name the organ which is situated within the duodenal loop

A

Pancreas

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154
Q

Which enzyme catalysed the formation of conjugated bilirubin?

A

UDP glucoronyl transferase

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155
Q

What produces stercobilinogen in the gut?

A

Bacterial enzyme hydrolysis

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156
Q

How is urobilinogen returned to the liver?

A

By the enterohepatic circulation

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157
Q

What cells secrete glucagon?

A

The alpha islet cells

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158
Q

What cells secrete insulin?

A

The beta islet cells

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159
Q

Which hormone stimulates the breakdown of glycogen?

A

Glucagon

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160
Q

Which cells secrete pancreatic polypeptide?

A

F islet cells

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161
Q

What is the central structure in a hepatic lobule?

A

The tributary of the hepatic vein

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162
Q

What system are the Kupffer cells part of in the liver?

A

The reticuloendothelial system

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163
Q

Which type of jaundice causes an increased serum unconjugated bilirubin and increased faecal urobilinogen?

A

Pre-hepatic

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164
Q

What is the cause of physiological jaundice of a newborn?

A

Excess breakdown of foetal haemoglobin

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165
Q

Give 4 causes of obstructive jaundice

A
  • Cirrhosis
  • Hepatitis
  • Gallstones
  • Carcinomas
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166
Q

What is Gilbert’s syndrome?

A

An elevated level of unconjugated bilirubin in the bloodstream

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167
Q

Give 4 functions of the liver

A
  • Glycogen storage
  • Storing vitamins A, D, E & K
  • Production of cholesterol
  • Conversion of T4 into T3
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168
Q

Where is urobilinogen produced?

A

Intestine

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169
Q

How is the liver divided?

A
  • Into the right, left and caudate lobes

- The right and left lobes are further divided into the anterior and posterior elements

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170
Q

How is the common bile duct formed?

A

From the common hepatic duct (from liver) and the cystic duct (from the gallbladder)

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171
Q

What are the components of the hepatobiliary system?

A

Liver, gallbladder and bile ducts

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172
Q

What is significant about the flow in the portal triad?

A

The bile within the bile duct travels in the opposite direction to the blood in the portal vein and hepatic artery

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173
Q

What are the horizontal divisions of the midline of the body?

A

Subcostal (upper) and inter tubercular (lower)

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174
Q

What are the vertical divisions of the middle of the body?

A

Midclavicular

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175
Q

What does the common bile duct and the pancreatic duct from?

A

The hepatopancreatic ampulla of Vater

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176
Q

What is a space of Disse?

A

Between a sinusoid and a hepatocyte. It has movement of blood through it

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177
Q

What is pre-hepatic (haemolytic) jaundice?

A

Caused as a result of haemolytic or accelerated breakdown of erythrocytes, leading to an increase in production of bilirubin

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178
Q

What is hepatocellular jaundice?

A

Usually caused by drugs and alcohol, it is as a result of liver disease of injury. It is partially hereditary

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179
Q

What is post-hepatic (obstructive) jaundice?

A

Occurs as a result of an obstruction in the bile duct. This prevents bilirubin movement into the liver.

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180
Q

Why do the whites of eyes go yellow in patients with jaundice?

A

Due to bilirubin having a affinity for elastin

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181
Q

Which type of jaundice causes dark urine and dark stools?

A

Hepatocellular

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182
Q

Which type of jaundice causes dark urine and pale stools?

A

Post-hepatic

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183
Q

Which type of jaundice causes normal urine and brown stools?

A

Pre-hepatic

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184
Q

What happens to haem in bilirubin metabolism?

A

The enzyme haem oxygenate splits it into iron ions (which are recycled) and biliverdin

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185
Q

What happens to globin in bilirubin metabolism?

A

The amino acids are recycled

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186
Q

Which enzyme converts biliverdin into unconjugated bilirubin?

A

Biliverdin reductase

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187
Q

What are the stages of converting unconjugated bilirubin into conjugated bilirubin in bilirubin metabolism?

A
  • Travels to liver
  • Combines with albumin
  • Catalysed with UDP glucoronyl transferase (adding glucoronic acid)
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188
Q

How does conjugated bilirubin get converted into urobilinogen in bilirubin metabolism?

A

By movement into the duodenum

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189
Q

What happens to the urobilinogen when it’s in the intestine in bilirubin metabolism?

A
  • Gets converted into urobilin

- Gets converted into stercobilinogen by bacterial enzyme hydrolysis

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190
Q

What happens to urobilin in bilirubin metabolism?

A

Half goes back into bile, while the other half goes into urine

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191
Q

What happens to stercobilinogen in bilirubin metabolism?

A

It gets converted into stercobilin, which is excreted in the faeces

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192
Q

What are the functions of the frontal lobe?

A

Motor, problem solving, language, personality

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193
Q

What is the function of the anterior portion of the frontal lobe?

A

Higher cognitive function and personality

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194
Q

What is the function of the posterior portion of the frontal lobe?

A

Motor and premotor areas

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195
Q

Where is Broca’s area and what is it’s function?

A
  • Inferior frontal gyrus

- Important for language production (frontal lobe, dominant hemisphere)

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196
Q

What is present in the temporal lobe and what’s its functions?

A
  • Primary auditory cortex, hippocampus, amygdala and Wernicke’s area
  • Involved in short term memory, equilibrium and emotion
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197
Q

Where is Wernicke’s area and what is it’s function?

A
  • Superior temporal gyrus of the left hemisphere

- Linked to understanding spoken word

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198
Q

Where is the primary sensory area of the brain?

A

Parietal lobe

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199
Q

Which side is the dominant parietal lobe and what is it’s functions?

A
  • Usually the left side

- Important for perception and interpretation

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200
Q

What is the function of the non-dominant parietal lobe?

A

Visuospatial functions

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201
Q

Where is the occipital lobes and what are their functions?

A
  • Posterior aspect of the brain

- Involved in motor control of equilibrium, posture and co-ordination

202
Q

What are some of the components of the brain stem?

A
  • Ascending and descending tracts
  • Cranial nerve nuclei
  • Reticular formations
203
Q

Which cranial nerves arise from the brainstem?

A

3-12

204
Q

What are the descending tracts of the brain?

A

Pathways by which motor signals are sent from the brain to the lower motor neurones

205
Q

How do LMN cause muscle movement?

A

LMN directly innervate muscles to produce movement

206
Q

Where do pyramidal tracts originate and what do they do?

A
  • Originate in cerebral cortex

- Carry motor fibres to the spinal cord and brainstem

207
Q

How can pyramidal tracts be divided?

A

Into corticospinal and corticobulbar

208
Q

Where do corticospinal tracts supply?

A

All the body except the head and neck

209
Q

Where do corticospinal tracts begin and where do they have input from?

A
  • Begins in the cerebral cortex

- Has input from primary motor cortex, premotor cortex, supplementary motor cortex and somatosensory cortex

210
Q

What happens when the corticospinal tracts separate?

A
  • Run as corona radiate

- Converge and travel through the internal capsule at the basal ganglia

211
Q

What extra happens with the motor fibres when the corticospinal tracts separate?

A

The motor fibres pass through crus cerebra of midbrain, pons and into medulla with the peduncles

212
Q

How can the corticospinal tracts divide?

A

Into lateral corticospinal tracts and anterior corticospinal tracts

213
Q

What is the pathway of the lateral corticospinal tracts and where are they present?

A
  • Cross over at the medulla
  • Descend into spinal cord
  • Terminate on the ventral form, synapsing with LMN
  • Mainly present in limbs
214
Q

What is the pathway of the anterior corticospinal tracts and where are they present?

A
  • Remains ipsilateral
  • Terminates at ventral horn of the cervical and upper thoracic segments of the spine
  • Mainly present in axial muscles
215
Q

Where do corticobulbar tracts supply?

A

The head and neck

216
Q

What is the pathway of the corticobulbar tracts?

A
  • Begins in the cerebral cortex
  • Separates as the run as corona radiate
  • Cornverges and travels through internal capsule at basal ganglia
  • Terminates at brainstem on the motor nuclei of cranial nerves
  • LMN carry motor signals to muscles of face & neck
217
Q

Where do extrapyramidal tracts originate?

A

The brainstem

218
Q

Where do extrapyramidal tracts carry motor fibres to?

A

To the spinal cord

219
Q

What are the extrapyramidal tracts responsible for?

A

Involuntary and automatic control of all musculature

220
Q

Name the 4 tracts which the extrapyramidal tracts can divide into

A
  • Tectospinal
  • Rubrospinal
  • Vestibulospinal
  • Reticulospinal
221
Q

What are tectospinal tracts responsible for?

A

Head turning in response to stimuli (superior colliculus - head/eye movements)

222
Q

What are rubrospinal tracts responsible for?

A

Assits in motor functions (red nucleus (midbrain) - limb flexors)

223
Q

What are vestibulospinal tracts responsible for?

A

Muscle tone and posture (vestibular nuclei - posture and balance)

224
Q

What are reticulospinal tracts responsible for?

A

Spinal reflexes (reticular formation (midbrain) - posture and locomotion)

225
Q

Where do extrapyramidal tracts synapse?

A

All with LMN, no synapses with the descending pathways

226
Q

Where are the cell bodies of the extrapyramidal tracts?

A

In cerebral cortex or brainstem. Axons remain in CNS

227
Q

Which areas are supplied by the anterior cerebral artery?

A
  • Most midline portions of frontal lobes
  • 4/5ths of the corpus callosum
  • Superior medial parietal lobes
  • Anterior limb of the internal capsule
  • Anteromedial portion of the cerebrum
228
Q

Which areas are supplied by the middle cerebral artery?

A
  • Majority of the lateral surface of the hemisphere

- Deep structures of the anterior hemisphere

229
Q

Which areas are supplied by the posterior cerebral artery?

A
  • Occipital lobe
  • Posterior temporal lobe
  • Medial surfaces of the thalamus
  • Walls of the 3rd ventricle
  • Choroid plexus
230
Q

What is the function of the upper motor neurones?

A
  • Movement control
  • Muscle tone
  • Spinal reflexes
  • Spinal autonomic functions
  • Transmission of sensory information to higher centres
231
Q

What is the function of the lower motor neurones?

A
  • Control of all voluntary movement
  • Acts as a link between UMN and muscles
  • Directly innervates muscles to produce a movement
232
Q

What are the characteristics of UMN weakness?

A
  • Broad, increased muscle tone (spasticity)
233
Q

What are the characteristics of LMN weakness?

A
  • Decreased muscle tone
  • Muscle paralysis
  • Weakness
234
Q

What is the CNS?

A

Brain and spinal cord

235
Q

What is the PNS?

A

Nerves, which are bundles of axons

236
Q

What is a tract?

A

A bundle of axons in the CNS

237
Q

What does nervous tissue in the CNS and PNS consist of?

A

Glial cells and neurones

238
Q

What is the function of glial cells?

A

Provide a framework for tissue that supports the neurone and its activities

239
Q

What is the nucleus (neuro)?

A

A localised collection of neurone cell bodies in the CNS

240
Q

What is the ganglion?

A

A localised collection of neurone cell bodies in the PNS

241
Q

What is sensory information?

A

Receiving information about the environment around

242
Q

What is motor information?

A

Generating responses

243
Q

How does sensory information travel towards the CNS?

A

Through then PNS nerves in specific division known as afferent (sensory) branch of the PNS

244
Q

What is the somatic nervous system responsible for?

A

Conscious perception and voluntary motor responses. This means the contraction of muscle

245
Q

What is the autonomic nervous system responsible for?

A

Responsible for involuntary control of the body, usually for the sake of homeostasis

246
Q

When can sensory input be possible for autonomic functions?

A

Sweating when warm - homeostatic and autonomic

247
Q

How can the autonomic nervous system be divided further?

A

Into sympathetic and parasympathetic branches

248
Q

Briefly describe an action potential

A
  • More K channels open than Na channels
  • Stimulus allows opening of some of the Na channels
  • Inside more positive than outside
  • More Na allowed in
  • Once the peak is met, more K channels are opened, allowing movement out fo the neurone
  • Na/K ATPase pump swap ions around
249
Q

Name the 5 types of sensory receptors

A
  • Mechanoreceptors
  • Thermoreceptors
  • Nociceptors
  • Electromagnetic receptors
  • Chemoreceptors
250
Q

What effect will a lesion above decussation have?

A

Contralateral effects

251
Q

What effect will a lesion below decussation have?

A

Ipsilateral effects

252
Q

What is the anatomical location of the kidneys?

A

In the retroperitoneal space

253
Q

How does the urine pass through the ureter?

A

By peristalsis

254
Q

What cell type is the ureter lined by?

A

Transitional epithelium

255
Q

What is the outermost layer of the kidneys?

A

The capsule

256
Q

What percent of the cardiac output passes through the kidneys?

A

25%

257
Q

What substance shouldn’t be found in the glomerular filtrate of a healthy individual?

A

Albumin

258
Q

Name 4 substances which may be found in the glomerular filtrate of a healthy individual

A

Glucose, uric acid, creatine and potassium

259
Q

If the renal clearance fo a substance is 250ml/min, then what must happen to it?

A

It must be secreted by the nephron

260
Q

What is angiotensin I converted by renin from?

A

Angiotensinogen

261
Q

Name 2 illness which may cause pre-renal acute kidney injury

A
  • Cellulitis

- Chronic liver failure

262
Q

What causes anaemia in chronic renal failure?

A

Reduced production of erythropoietin

263
Q

What is the chemical formula of aldosterone and what kind of hormone is it?

A
  • C25H28O5

- Steroid hormone

264
Q

What is aldosterone’s main function?

A

On the collecting duct to increase Na reabsorption

265
Q

What is the secretion rhythm of aldosterone?

A

Diurnal

266
Q

Where is aldosterone secreted from?

A

The adrenal cortex

267
Q

Where is renin secreted from?

A

The juxtaglomerular cells

268
Q

What is renin secreted in response to?

A

Beta-adrenergic receptors on the JGC

269
Q

What is the role of the macula densa in response to changes in Na delivery?

A

The macula densa stimulates renin release in response to changes in Na+ delivery to distal tubules

270
Q

Drugs which inhibit renin can be used for what?

A

To control hypertension

271
Q

What is the function of atrial naturetic peptides (ANPs)?

A

Act on the renal collecting tubules to promote Na excretion

272
Q

What is the part of the uterus which lies above the entrance of the Fallopian tubes?

A

The fundus

273
Q

What is the epithelium of the vagina?

A

Non-keratinised stratified squamous epithelium

274
Q

What reproductive hormone is secretly directly into the portal system?

A

Gonadotrophin-releasing hormone

275
Q

What is the event which induces ovulation?

A

Increasing plasma oestrogen which triggers a surge of LH

276
Q

What is secondary amenorrhea?

A

Absence of menstrual bleeding in a woman for 3 or more months in a woman who hasn’t been pregnant, lactating, having cycle suppression (birth control) or in menopause

277
Q

When does the Morula stage of embryonic development occur?

A

Before blastocyst formation

278
Q

Where does in vivo fertilisation take place?

A

Fallopian tubes

279
Q

Which hormone is created by the corpus luteum?

A

Progesterone

280
Q

What stimulates the corpus luteum to produce progesterone?

A

hCG

281
Q

What is the outermost layer of the ovarian follicle?

A

Stromal cells

282
Q

What is oligomenorrhoea?

A

Infrequent menstrual periods

283
Q

What is hirsutism?

A

Unwanted, male-pattern hair growth in women

284
Q

Name 4 symptoms which are associated with PCOS

A
  • Oligomenorrhoea
  • Hirsutism
  • Obesity
  • Depression
285
Q

What is the anatomical position of the kidneys?

A

Left - T11-L2

Right - T12-L3 (lower due to liver)

286
Q

What are the layers of the kidney?

A
  • Renal capsule (tough fibrous capsule)
  • Perineal fat (collection of extraperiotoneal fat)
  • Renal fascia (encloses the fascia and suprarenal glands)
287
Q

What is the outer cortex composed of?

A

Renal corpuscles and the proximal & distal convoluted tubules

288
Q

What is a medullary ray?

A
  • A structure in the renal cortex
  • Collection of loop of Henle tubules and collecting ducts that originate from the nephrons which have their renal corpuscles in the outer part of the cortex
  • Giving a striated appearance to cortex
289
Q

What is the structure of the inner medulla of the kidney?

A
  • 20 inverted pyramids
  • Cross sectional view of the medulla
  • Tubular structures: Loop of Henle, collecting ducts and blood vessels
290
Q

What is the function of the inner pelvis of the kidney?

A
  • Space where urine drains into

- Contains the fat and urine collecting system

291
Q

What epithelium is the inner pelvis of the kidney lined by?

A

Transitional epithelium

292
Q

What is the structure of the inner pelvis of the kidney?

A
  • Continuous with collecting ducts proximally and ureters distally
  • Tips of the medullary pyramids project into the renal pelvis collecting duct
293
Q

What is the structure of the ureters?

A
  • Retroperitoneal tubes which extend from the renal pelvis at the hilum of the kidney to the bladder
294
Q

What artery supplies the abdominal section of the ureters?

A

Renal artery & testicular/ovarian artery

295
Q

What artery supplies the pelvic section of the ureters?

A

The superior and inferior vesicle arteries

296
Q

Which nerves supply the ureters?

A

Testicular, renal and hypogastric nerve plexus

297
Q

Which nerve supplies the external sphincter of the urethra?

A

Pudendal nerve (somatic)

298
Q

Where is the external sphincter of the urethra located?

A

After prostate

299
Q

What is the type of nerve supply to the internal sphincter of the urethra?

A

Sympathetic

300
Q

Where is the internal sphincter of the urethra located?

A

Just after the bladder

301
Q

What is the structure of the bladder?

A
  • Organ of the urinary system situated anteriorly in the pelvic cavity
  • It is hollow, highly distensible and round
302
Q

What is the function of the bladder?

A
  • Collection
  • Temporary storage
  • Expulsion of urine
303
Q

What is the vasculature of the bladder?

A

The internal iliac

304
Q

What is the outflow of the bladder controlled by?

A
  • The internal and external urethral sphincter

- Specialised smooth muscle walls (detrusor muscle)

305
Q

Give two properties of the detrusor muscle

A
  • Has sympathetic and parasympathetic innervation

- Contracts to force urine into urethras

306
Q

What is the nerve innervation of the bladder?

A
  • Sympathetic - hypogastric (T12-L2)
  • Parasympathetic - pelvic (S2-S4)
  • Somatic - pudendal nerve (S2-S4)
307
Q

What is the epithelium of the urethra?

A

Stratified columnar epithelium

308
Q

What is the structure of pre-prostatic (intramural) urethra for males?

A
  • Begins at the internal urethral orifice, located at the neck of the bladder
  • It passes through the wall of the bladder and ends at prostate
309
Q

What is the structure of prostatic urethra for males?

A
  • Passes through the prostate gland
  • The ejaculatory ducts (containing spermatozoa from the testes, and seminal fluid from the seminal vesicle glands) and the prostatic ducts drain into the urethra here
310
Q

What is the structure of membranous urethra for males?

A
  • Passes through the pelvic floor, and the deep perineal pouch.
  • It is surrounded by the external urethral sphincter, which provides voluntary control of micturition
311
Q

What is the structure of the spongy urethra for males?

A
  • Passes through the bulb and corpus spongiosum of the penis, ending at the external urethral orifice.
  • In the glans penis, the urethra dilates, forming the navicular fossa.
  • The bulbourethral glands empty into the proximal urethra.
312
Q

How long is the urethra in females?

A

4cm

313
Q

What is the structure of the urethra in females?

A
  • Begins at the neck of the bladder and passes inferiorly through the perineal membrane and muscular pelvic floor
  • Opens directly onto the perineum between labia minora
  • Anterior to vaginal opening
  • No internal sphincter
314
Q

What happens to urine once it has been produced by the nephron of the kidney?

A

Drains into the renal pelvis via the collecting ducts

315
Q

What to the ureters exist as a continuation of?

A

The renal pelvis within the hilium of the kidney

316
Q

What is the ureteropelvic junction?

A

The point at which the renal pelvis narrows into the ureter

317
Q

What is the position of the ureters as the position of the psoas major?

A

Retroperitoneal

318
Q

In what position do the ureters descend down the abdomen?

A

On the anterior surface of the psoas major

319
Q

What happens at the area of the sacroiliac joints?

A
  • The ureters cross the pelvic brim and enter the pelvic cavity.
  • Also cross the bifurcation of the common iliac arteries
320
Q

Where do the ureters run once within the cavity?

A
  • Run down the lateral pelvic walls
  • Turn anteromedially at the ischial spines and move transversely towards the bladder (Ischial spines)
  • Upon reaching the bladder wall the ureters pierce its lateral aspect in an oblique manner. One way valve: High intramural pressures collapses ureters preventing backflow
321
Q

What are the segments of the nephron?

A
  • Renal corpuscle: The filter
  • Proximal convoluted tubule: Reabsorption of solutes
  • Loop of Henle: Concentration of urine
  • Distal convoluted tubule: Absorption of water and solutes
  • Collecting duct: Reabsorption of water and controlling acid and ion balance
322
Q

What is the structure of the glomerulus?

A

Capillary tuft from the end of an afferent arteriole within the Bowman’s capsule

323
Q

What is the structure of the Bowman’s capsule?

A

Double walled capsule in which fluid moves into from the capillaries (Fluid Glomerulary fluid)

324
Q

What is the capillary tuft supported by?

A

Mesangial cells which contain smooth muscle

325
Q

What is the function of the smooth muscle which supports the capillary tuft?

A
  • Structural support for the capillary and production of extracellular matrix protein
  • Contraction of muscle in the glomerulus tightens the capillaries and reduces the glomerular filtration rate.
  • Mesangium is also involved in the phagocytosis of glomerular basement membrane breakdown products
326
Q

How many layers are there in the basement membrane of the glomerular capillaries?

A

3

327
Q

What are the 3 layers of the basement membrane of the glomerular capillaries and what are their functions?

A
  • The glomerular capillary wall. (Fenestrated, Holes covered by fibrils which prevent loss of proteins)
  • The basement membrane. (Double thickness as composed of BM of capillary and podocytes, Charged against –ve ions)
  • The podocyte foot processes.
328
Q

What transporter is present in the PCT of the kidney and why?

A
  • Na/K pump (cotransport)

- Creates conc gradient for Na which is the driving factor

329
Q

What are the two cell types in the juxtaglomerular apparatus?

A
  • Endothelium of afferent arteriole

- Macula dense

330
Q

What is the function of the endothelium of the afferent arteriole of in the kidney?

A
  • Sense BP changes

- Secretes renin in response to a reduction in BP: increases water absorption and so raises BP

331
Q

What is the function of the macular densa of the kidney?

A
  • Detects changes in sodium levels
  • If the filtration is slow, more Na is absorbed
  • Sends signal to reduce afferent arteriole resistance and increase filtration
332
Q

What is the epithelia of the proximal convoluted tubule?

A

Cuboidal epithelium with microvilli to increase SA for reabsorption

333
Q

Give 3 features of the proximal convoluted tubule

A
  • Contain lots of mitochondria for the reabsorption of Na and K by active transport
  • Also absorb small proteins, glucose, AA, most hormones
  • Contain lysosomes which break down absorbed proteins
334
Q

What is the pathway of the loop of Henle?

A

Each loop dips down into the medulla and returns to the cortex to form the distal convoluted tubule

335
Q

What is the basic structure and function of the descending limb of the loop of Henle

A

Thin (Water absorption by osmosis concentrates urine)

336
Q

What is the basic structure and function of the ascending limb of the loop of Henle

A

Thick. Ions reabsorbed by active transport. Leaves waste and water

337
Q

What is the blood supply of the loop of Henle?

A
  • Afferent arteriole (from corpuscle)
  • Peritibular capillaries
  • Vasa recta
  • Renal veins
  • IVC
338
Q

What is the permeability of descending limb of the loop of Henle?

A
  • Permeable to water
  • Osmolality in filtrate increases as water moves out by osmosis
  • Impermeable to salts
  • Salts remain: osmolality increases
339
Q

What is the permeability of ascending limb of the loop of Henle?

A
  • Impermeable to water

- Na+ reabsorbed by diffusion and active transport (selection in thicker segment)

340
Q

What is the epithelium of the distal convoluted tubule?

A

Cuboidal epithelium

341
Q

What is the main function of the distal convoluted tubule?

A
  • Regulating acid base balance
  • Acidifies urine by secreting hydrogen ions
  • Exchanges urinary sodium for body potassium
342
Q

What is the epithelium of the collecting duct?

A

Cuboidal epithelium (plumper than loop of Henle and tubules)

343
Q

What do the distal ends of the collecting ducts combine to form?

A

The papillae ducts

344
Q

What is the function of principle cells of the collecting duct?

A
  • Responds to aldosterone - exchanges sodium for potassium

- Responds to ADH - increased water absorption by inserting more aquaporins into apical membrane of cell

345
Q

What is the function of the intercalated cells of the collecting duct?

A

Exchanges hydrogen ions for bicarbonate ions

346
Q

What is the function of the renal pelvis?

A

Collecting ducts drain into the renal pelvis

347
Q

What is the epithelium of the renal pelvis?

A
  • Transitional epithelium/urothelium
  • Stratified
  • Can stretch in response to distension, lines tubes of the urinary tract
348
Q

What is the process of glomerular filtration?

A
  • Glomerular filtration is the passage of fluid from the blood into Bowman’s space to form the filtrate.
  • The distal part of the nephron (tubule) is responsible for secretion and reabsorption.
  • As the filtrate travels along the nephron, the cells lining the tubule selectively remove molecules from the filtrate and place them into the blood.
  • Tubular secretion occurs mostly in the PCT and DCT where unfiltered substances are moved from the peritubular capillary into the lumen of the tubule.
349
Q

What reaction does renin facilitate?

A

That of angiotensinogen to angiotensin I

350
Q

Where is angiotensinogen from?

A

The liver

351
Q

Where is renin from?

A

The juxtaglomerular apparatus in the kidneys

352
Q

What reaction does ACE facilitate?

A

That of angiotensin I to angiotensin II

353
Q

Where is ACE from?

A

The lungs

354
Q

Give 5 effects of angiotensin II

A
  • Aldosterone release from the adrenals
  • ADH from the posterior pituitary
  • Sympathetic activity (vasoconstriction)
  • Thirst
  • Reabsorbs Na, Cl, K excretion in DCT
355
Q

Briefly describe the action of ADH

A
  • Lack of water sensed by osmoreceptors in hypothalamus
  • Impulse send to post. pituitary to release ADH
  • ADH binds to receptors at collecting ducts
  • Aquaporins inserted
  • Increased water asborption at collecting ducts
356
Q

Where are osmoreceptors found?

A

Hypothalamus

357
Q

Where is vasopressin (ADH) released from?

A

Posterior pituitary

358
Q

What is pre-renal kidney failure?

A

Anything that decreases the blood flow to the kidney

359
Q

What is renal kidney failure?

A

Damage to the internal structure and function of the kidney

360
Q

What is post renal kidney failure?

A

Obstruction of the urinary tract

361
Q

What can cause chronic renal failure?

A

Commonly caused by conditions which strain the kidneys e.g. hypertension, diabetes, kidney inflammation

362
Q

What part embryologically are the reproductive organs developed from?

A

The intermediate mesoderm

363
Q

What are the two ducts which are present embryologically which eventually form the reproductive tract?

A
  • Mesonephric ducts (Wolffian ducts)

- Paramesonephric ducts (Müllerian ducts)

364
Q

Which ducts remain embryologically in females?

A

Müllerian ducts

365
Q

What happens to the genital chord in females and when?

A
  • Fuse to form the uterus and vagina

- Begins in the third month

366
Q

What happens to the parts outside the genital cord embryologically in females?

A

Remain separate and each forms the Fallopian tube

367
Q

What happens embryologically at around 5 months in the female reproductive system?

A

A ring-like constriction marks the position of the cervix of the uterus, with this thickening at around the 6th month

368
Q

Where are gonads from embryologically?

A

The urogenital ridge

369
Q

When do the reproductive systems begin to differentiate after fertilisation?

A

Around the 6/7th week

370
Q

What do women lack which allows the formation of the female reproductive tract?

A

The SRY gene and MIH (Müllerian inhibiting hormone)

371
Q

What are the structures of the vulva?

A
  • Mons pubis
  • Labia majora
  • Labia minora
  • The vestibule
  • Bartholin’s glands
  • The clitoris
  • The vagina
372
Q

What is the mons pubis?

A

A fat pad at the anterior of the vulva, which is covered in pubic hair

373
Q

What are the labia majora?

A

Two hair-bearing external folds, embryonically derived from labioscrotal swellings. They fuse posteriorly and extend anteriorly to the mons pubis

374
Q

What are the labia minora?

A

Two hairless folds of skin, embryologically derived from urethral folds. They lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris and extend posteriorly either side of the vaginal opening. They fuse again posterior to the vestibule, creating a fold of skin called the fourchette

375
Q

What is the vestibule?

A

The area between and surrounding the labia. The external vaginal orifice (vaginal opening) and urethra open into the vestibule

376
Q

What are Bartholin’s glands?

A

Located either side of the vaginal orifice, these glands secrete lubricating mucus from small ducts during sexual arousion

377
Q

What is the clitoris?

A

Located under the prepuce and embryologically derived from the genital tubercle. The clitoris is formed of erectile corpora caverosa tissue, which becomes engorged with blood during sexual stimulation

378
Q

What is the vagina?

A

A distensible muscular tube, which has roles in sexual intercourse, childbirth and menstruation

379
Q

What is the cervix?

A

The lower portion of the uterus. It connects the vagina with the main body of the uterus, acting as a gateway between them

380
Q

What are the two regions of the cervix?

A

The ectocervix and the endocervical canal

381
Q

What is the ectocervix?

A

The portion of the cervix that projects into the vagina

382
Q

What is the histology of the ectocervix?

A

Stratified squamous non-keratinising epithelium

383
Q

What does the external os mark?

A
  • Opening in the ectocervix

- Marks the transition from the ectocervix to the endocervical canal

384
Q

What is the endocervical canal (or endocervix)?

A

The more proximal, and ‘inner’ part of the cervix

385
Q

What is the histology of the endocervix?

A

A mucus-secreting simple columnar epithelium

386
Q

What is the internal os?

A

Where the endocervix ends, and the uterine cavity begins

387
Q

What are the functions of the cervix?

A
  • The passage of sperm into the uterine cavity

- To maintain sterility of the upper female reproductive tract

388
Q

What is the uterus?

A

A thick-walled muscular organ capable of expansion to accommodate a growing foetus

389
Q

How is the uterus connected to the vagina and uterine tubes?

A
  • It is connected distally to the vagina

- Laterally to the uterine tubes

390
Q

What are the three parts of the uterus?

A
  • The fundus
  • Body
  • Cervix
391
Q

What is the structure of the fundus of the uterus in the female reproductive tract?

A

Top of the uterus, above the entry point of the uterine tubes

392
Q

What is the function of the body of the uterus in the female reproductive tract?

A

Usually the site for implantation of the blastocyst

393
Q

What is the function of the cervix of the uterus in the female reproductive tract

A
  • Lower part of uterus linking it with the vagina

- Structurally and functionally different to the rest of the uterus

394
Q

What are the three tissue layers which the fungus and the body of the uterus are compromised of?

A
  • Peritoneum
  • Myometrium
  • Endometrium
395
Q

What is the structure of the peritoneum of the fundus and body of the uterus?

A
  • A double layered membrane

- Continuous with the abdominal peritoneum

396
Q

What is the structure of the myometrium of the fundus and body of the uterus?

A
  • Thick smooth muscle layer

- Cells of this layer undergo hypertrophy and hyperplasia during pregnancy in preparation to expel the foetus at birth

397
Q

What is the structure of the endometrium of the fundus and body of the uterus?

A
  • Inner mucous membrane lining the uterus

- Can be further divided into the deep stratum basalis and the superficial stratum functionalists

398
Q

What is the structure of the deep stratum basalis of the endometrium?

A
  • Changes little throughout the menstrual cycle

- Not shed at menstruation

399
Q

What is the structure of the superficial stratum functionalis of the endometrium?

A
  • Proliferates in response to oestrogen
  • Becomes secretory in response to progesterone
  • Shed during menstruation
  • Regenerates from cells in the stratum basalis layer
400
Q

What is the function of the uterine tubes?

A

To assist in the transfer and transport of the ovum from the ovary, to the uterus

401
Q

What is the histology of the inner mucosa of the uterine tubes?

A
  • Ciliated columnar epithelial cells

- Peg cells (non-ciliated secretory cells)

402
Q

What do the ciliated columnar epithelial cells of the inner mucosa of the uterine tubes do?

A

Waft the ovum towards the uterus and supply it with nutrients

403
Q

What is the function of the smooth muscle layer of the uterine tubes?

A
  • Contracts to assist with transportation of the ova and sperm
  • Muscle is sensitive to sex steroids, and thus peristalsis is greatest when oestrogen levels are high.
404
Q

What is the structure of the fimbriae of the uterine tubes?

A

Finger-like, ciliated projections which capture the ovum from the surface of the ovary

405
Q

What is the structure of the infundibulum of the uterine tubes?

A

Funnel-shaped opening near the ovary to which fimbre are attached

406
Q

What is the structure and function of the ampulla of the uterine tubes?

A
  • Widest section of the uterine tubes

- Fertilisation usually occurs here

407
Q

What is the structure of the isthmus of the uterine tubes?

A

Narrow section of the uterine tubes connecting the ampulla to the uterine cavity

408
Q

Where is the Pouch of Douglas found?

A
  • Also known as recto-uterine pouch

- Between rectum and uterus

409
Q

What ligament joins the ovary and uterus?

A

Utero-ovarian ligament

410
Q

What ligament joins the ovary and abdomen?

A

Suspensory ligament

411
Q

What ligament joins the pelvis and uterus?

A

Broad ligament

412
Q

What is the position of the uterus compared to the vagina?

A

It is anteverted

413
Q

What is the position of the uterus compared to the cervix?

A

It is anteflexed

414
Q

What happens when FSH binds to granulosa cells?

A
  • Stimulates follicle growth
  • Permits conversion of androgens to oestrogen
  • Stimulates inhibit secretion
415
Q

What happens when LH acts on theca cells?

A

Stimulates production and secretion of androgens

416
Q

What happens to the HPG axis when there is moderate oestrogen levels?

A

Negative feedback on the HPG axis

417
Q

What happens to the HPG axis when there is high oestrogen levels in the absence of progesterone?

A

Positive feedback on the HPG axis

418
Q

What happens to the HPG axis when there is moderate oestrogen levels in the presence of progesterone?

A

Negative feedback on the HPG axis

419
Q

What is the function of inhibin?

A

Selectivley inhibits FSH at the anterior pituitary

420
Q

Briefly describe what happens in the follicular stage of the ovarian cycle

A
  • Follicles begin to mature and prep to release an oocyte
  • Follicle begins to develop independently
  • Low steroid/inhibin levels, little -ve feedback on HPG, so increase in FSH and LH levels
  • Stimulates follicle growth and oestrogen production
  • Oestrogen becomes high enough to initiate +ve feedback on HPG
  • Levels of GnRH and gonadotrophin increases
  • Only reflected in LH levels due to inhibin
421
Q

Briefly describe what happens in the ovulation stage of the ovarian cycle

A
  • Responding to LH surge, follicle ruptures and mature oocyte is assisted to Fallopian tube by fimbria
  • Follicle remains lutenised, secreting oestrogen and now progesterone, giving -ve feedback on HPG
  • This, with inhibin stalls the cycle in case of fertilisation
422
Q

What is the corpus luteum?

A

The tissue in the ovary that forms at the site of a ruptured follicle following ovulation.

423
Q

What is the function of the corpus luteum?

A

Produces oestrogen, progesterone and inhibin to maintain conditions for fertilisation and inmplatation

424
Q

Briefly describe what happens in the luteal stage of the ovarian cycle

A
  • At the end of the cycle, in the absence of fertilisation, the corpus luteum spontaneously regresses after 14 days. There is a significant fall in hormones, relieving negative feedback, resetting the HPG axis ready to begin the cycle again.
  • If fertilisation occurs, the syncytiotrophoblast of the embryo produces human chorionic gonadotrophin (HcG), exerting a luteinising effect, maintaining the corpus luteum. It is supported by placental HcG and it produces hormones to support the pregnancy. At around 4 months of gestation, the placenta is capable of production of sufficient steroid hormone to control the HPG axis.
425
Q

Where do the theca cells lie?

A

Outside of the egg

426
Q

Where do the granulosa cells lie?

A

They are the main body of the egg

427
Q

What is the function of the proliferative phase?

A

Prepares the reproductive tract for fertilisation and implantation. Runs alongside the follicular phase

428
Q

What happens in the proliferative phase of the menstrual cycle?

A
  • Oestrogen initiates the fallopian tube formation, thickening the endometrium
  • Increased growth and motility of the myometrium
  • Production of a thin alkaline cervical mucus (to facilitate sperm transport)
429
Q

What happens in the secretory phase of the menstrual cycle?

A
  • Runs alongside the luteal phase
  • Progesterone stimulates thickening of the endometrium into a glandular secretory form
  • Further thickening of the myometrium
  • Reduction of motility of the myometrium
  • Thick acidic cervical mucus production (a hostile environment to prevent polyspermy)
  • Changes in mammary tissue and other metabolic changes.
430
Q

What is the function of menses?

A

Marks the beginning of a new menstrual cycle

431
Q

What is coitus?

A

Sexual intercourse that results in deposition of sperm in the vagina at the level of the cervix

432
Q

Briefly describe the transport of sperm in the female reproductive tract

A
  • Sperm deposited at the cervix
  • Must travel to the ampulla
  • Oxytocin stimulates uterine contraction which aids in transporting the sperm
  • Capacitation of the sperm occurs
  • Allows penetration of the zona pellucida
433
Q

What is capacitation of sperm?

A
  • Reorganises the sperm cell membrane and results in the tail movement changing from a beat-like action to a thrashing whip-like action to help propel the sperm forward
  • The changes in cell membrane exposes acrosome enzymes (allows penetration)
434
Q

What is the structure of DNA when a gene sequence is coded?

A

Single stranded DNA

435
Q

What is the structure of DNA when a promotor sequence is coded?

A

Single stranded DNA

436
Q

What binds to tRNA in translation?

A

Specific amino acids

437
Q

What is the transcriptome compromised of?

A

mRNA

438
Q

Where does alternative splicing, producing different gene products occur?

A

On mRNA

439
Q

What is the structure of a protein with two peptide chains held together by cross links?

A

Quaternary structure

440
Q

What is the significance of cis/trans and L/D isomers as proteins?

A

Differ in tertiary structure

441
Q

Give two examples of secondary proteins

A

Alpha helixes and beta sheets

442
Q

What causes sickle cell anaemia?

A

An autosomal recessive inherited condition substituting an amino acid in the beta globin chain

443
Q

What happens to the haemoglobin in sickle cell anaemia in hypoxia?

A

It polymerises

444
Q

What causes sickling in sickle cell anaemia?

A

By binding to the cytoskeleton

445
Q

How do sickle cells cause capillary occlusion?

A

By binding to and activating endothelial cells, causing inflammation

446
Q

How can sickle cell disease be treated?

A

With hydroxyurea because it increases synthesis of foetal haemoglobin

447
Q

What are the three components of total body water and how is the volume divided?

A
  • Intracellular (28L)
  • Interstitial (11L)
  • Intravascular (3L)
448
Q

Name one component which is used to calculate osmolality

A

Urea

449
Q

Give an example of insensible loss

A

Sweating due to fever

450
Q

What are the consequences of a low blood albumin?

A
  • Causes a decrease in oncotic pressure

- Water diffuses from the blood into the interstitial fluid

451
Q

Where is ADH synthesised?

A

The hypothalamus

452
Q

Where is aldosterone synthesised?

A

The adrenal cortex

453
Q

Where is the principle site of renin production?

A

Juxtaglomerular cells

454
Q

What does renin allow the conversion of?

A

Angiotensinogen to angiotensin I

455
Q

What is the physiological response to excess water consumption in a short period?

A
  • Osmolality falls
  • ADH secretion stops
  • Increased urine volume
456
Q

How can the relationship between the cardiac output and blood pressure be described in the autonomic nervous system?

A

Parasympathetic nerves increase peripheral blood vessel diameter thereby decreasing vascular resistance and decreasing blood pressure

457
Q

When does atrial and ventricular systole happen?

A

Together

458
Q

What does an increase in left atrial end systolic pressure indicate?

A

Mitral valve stenosis

459
Q

What does an increase in left ventricular end diastole pressure indicate?

A

Left heart failure

460
Q

What is the function of the ductus arteriosus in the foetal cardiovascular system?

A

Allows blood to bypass the foetal lungs by shunting it from the pulmonary artery to the aorta

461
Q

What is the equation for cardiac output?

A

Heart rate x stroke volume

462
Q

What is pulmonary oedema in the presence of normal central venous pressure a sign of?

A

Left heart failure

463
Q

What is severe pulmonary hypertension a cause of?

A

Right heart failure

464
Q

What are some symptoms of biventricular failure?

A
  • Shortness of breath
  • Severe peripheral oedema
  • Ascites after a heart attack
465
Q

What is the normal pathway of conduction through the heart?

A
  • SAN
  • Contraction of atria
  • AVN
  • Bundle of His
  • Purkinje fibres
  • Contraction of ventricles
466
Q

Which artery most frequently supplies the AVN?

A

The left coronary artery

467
Q

What do chemoreceptors sense?

A

PaCO2 levels

468
Q

What two centres are important in the control of human breathing?

A

Pons and medulla oblongata

469
Q

Where does the larynx’s main motor function come from?

A

The recurrent laryngeal nerve

470
Q

Where should an emergency chest drain take place?

A

The second intercostal space below the second rib

471
Q

What is a difference in structure between the left and right bronchi?

A

The right main bronchus is more vertically disposed than the left main bronchus

472
Q

How thick is the gas exchange surface of the lung and is it active or passive?

A
  • 1 micron thick

- Mostly passive

473
Q

What happens to the diaphragm during inspiration?

A

Contracts and descends

474
Q

Define the physiological dead space?

A

The volume of air in the trachea that doesn’t contribute to gas exchange plus the volume of air in the alveoli that doesn’t contribute to gas exchange

475
Q

What does hypoxia in the lung cause and why?

A

If part of the lung has low oxygen, you don’t want to send blood there as it can’t pick up oxygen

476
Q

What factors does arterial PaCO2 depend on?

A

A constant, the production of carbon dioxide and alveolar ventilation

477
Q

What is the equation for arterial PaCO2?

A

PaCO2 = (k x production of carbon dioxide) / alveolar ventilation

478
Q

What is the oxygen dissociation curve influenced by?

A

Changing affinity for sequential oxygen molecule binding

479
Q

What happens in respiratory acidosis?

A
  • PaCO2 initially rises

- PO2 is stable roughly

480
Q

Define FEV1

A

The volume of air expelled after one second of forced expiration

481
Q

What does the carbon monoxide single breath transfer measure?

A

Gas exchange into the alveolar capillary

482
Q

What happens to the lungs at ascent?

A
  • Pressure of inspired oxygen falls

- CO2 goes down as you hyperventilate

483
Q

What are the features of pulmonary oxygen toxicity (Lorraine Smith effect)

A
  • Shortness of breath
  • Cough
  • Chest tightness
  • Substernal pain
484
Q

Where is somatostatin secreted from?

A

D cells

485
Q

Where is histamine secreted from?

A

Enterochromaffin cells (ECL)

486
Q

Where is gastrin secreted from?

A

G cells

487
Q

What is the function of intrinsic factor?

A
  • Produced in the stomach

- Allows absorption of vitamin B12 in the terminal ileum

488
Q

What is the function of R proteins?

A

Carry out protection of vitamin B12 from degradation by stomach acid

489
Q

How do NSAIDs irritate the stomach?

A

By inhibition of gastrointestinal mucosal cycle-oxygenase activity (COX)

490
Q

What do NSAIDs lead to the production of?

A

Prostaglandins

491
Q

How many layers of muscle are there in the stomach wall?

A

3

492
Q

What is the change in cell type seen in the lower oesophagus after prolonged reflux of acid?

A

Stratified squamous to columnar

493
Q

What is the action of the proton pump on the parietal cells of the stomach?

A

K into cell, H out of cell

494
Q

What stimulates the release of acetylcholine from parietal cells?

A

The vagus nerve (parasympathetic system)

495
Q

Where does the common bile duct drain?

A

The duodenum

496
Q

What supplies atrial blood to the jejunum?

A

The superior mesenteric artery

497
Q

What is the first location that fat is acted upon by lipase enzymes when passing through the GI tract?

A

The oral cavity

498
Q

Name 4 things which are present in the portal hepatis

A
  • Left & right hepatic ducts
  • Left & right hepatic arteries
  • Portal veins
  • Hepatic branch of vagus nerve
499
Q

What are the structures classed as the foregut in embryology?

A
  • Lower 1/3 of oesophagus
  • Proximal 2 parts of duodenum
  • Gallbladder
  • Pancreas
500
Q

Where is pepsinogen produced?

A

Chief cells

Phase 1 Med (Liv) (13 decks)

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