Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MET2 > MET2 Revision3 > Flashcards

MET2 Revision3 Flashcards

1
Q

Explain what happens to serum Ca2+ levels during acidosis and alkalosis [2]

A

Acidosis: causes Ca2+ to increase

Alkolosis: causes Ca2+ to decrease

Ca2+ and H+ bind to same place on albumin: acidosis the H= competes with Ca2+ and causes more ionised Ca2+ in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain the importance of Ca2+ in cardiac AP [1]

How does low

A

Calcium is involved in maintaining the plateau phase:
- Na in
- Ca out.

Extracellular Ca2+: blocks the voltage gated Na channels in the cardiac cell membrane.

Low Ca2+ levels: less blockade of VGNaCs = tachyarrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Parathyroid hormone (PTH) is secreted from which gland? [1]

Effect of PTH secretion? [3]

A

PTH from parathyroid

PTH causes: overall increase in Ca2+ serum levels by:

  • Increased renal Ca2+ reabsorption.
  • Increased bone Ca2+ release.
  • Increased gut absorption via release of vitamin D (1,25vitD).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What inhibits the release of PTH? [1]

A

Ca2+ levels being too high (-ve feedback)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the effect of Ca2+ binding to Ca2+ sensing receptor on parathyroid? [3]

A

Ca2+ binds to Ca2+ sensing receptor on parathyroid. Causes:
* Reduces PTH secretion
* Increases breakdown of stored PTH in vesicles
* Suppresses transcription of PTH gene.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the activated form of vitamin D? [1]

A

1α,25-dihydroxyvitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What effect does the inactivaton of CaSR have? [1]

What effect does the overactivation of CaSR have? [1]

A

What effect does the inactivaton of CaSR on parathyroid gland have? [1]
Hypercalcemia: no -ve feedback

What effect does the overactivation of CaSR on parathyroid gland have? [1]
Hypocalcaemia: too much -ve feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why does PTH cause an increase in phosphate excretion?

A

Bone is broken down to release Ca2+, but also P is released

Therefore the kidney needs to excrete P to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Effect of PTH on

a) Kidney [2]
b) Bone [2]
c) Intestine [2]

A

Effect of PTH on

a) Kidney: decreases Ca2+ excretion AND increases P excretion (one is broken down to release Ca2+, but also P is released. Therefore the kidney needs to excrete P to compensate)
b) Bone: Increases Ca2+ and phosphate reabsorbtion
c) Intestine: Increases Ca2+ and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which areas of nephron cause reabsorbtion of Ca2+ dependently / independently of PTH? [3]

A

PCT: independent
LoH: independent
DCT: PTH dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain how Ca2+ is reabsorbed at PCT [2]

A

At PCT:
- independent of PTH
- Driven by NaKCl2 channel causing a voltage gradient paracellularly which Ca2+ flows (coupled with Na+ reabsorbtion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain how Ca2+ is reabsorbed at LoH [2]

A

Driven by voltage gradient: Para/transcellular
Coupled with Na+ reabsorbtion: NKCC2 channel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do thiazide diuretics raise serum calcium?

A

Increase Ca2+ reabsorbtion into the blood / raises Ca2+ serum levels:

  • Blocks Na/Cl symporter on luminal side
  • This drops the Na conc. In tubular cell
  • This creates Na diffusion gradient
  • Na diffusion increases from capillary into tubular
    cell - across Na/Ca exchanger -> takes Na into cell and transports Ca2+ into blood. -> increase in blood Ca levels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Effect of PTH on:

  • NaPi transporters (and therefore P reabsorbtion)? [1]
  • Vit. D activation? [1]
  • PCT GNG? [1]
  • Na/H20/HCO3- reabsorbtion? [1]
A
  • Down-regulation of NaPi transporters: Reduced phosphate reabsorption
  • Vitamin D Activation Stimulation of 25(OH) D3 –> 1,25(OH)2 D3 (inactivates 1,25-dihydroxyvitamin D)
  • Proximal tubule gluconeogenesis
  • Inhibits sodium/water/bicarbonate reabsorption via effects on Na/H exchanger and Na/K ATPase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What effect does PTH have on bone tissue? [2]

A

COME BACK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where do you find vit. D receptors? [2]

Role of vit D? [2]

A

Receptors: nucleus and cytoplams
Role: Upregulates Ca2+ transporters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Effect of PTH on bone remodelling xx

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The conversion of vit. D to WHAT is regulated? [1]

The conversion of vit. D to WHAT is unregulated? [1]

What are the enzymes used for each? [2]

A

Conversion of vit D to 25(OH)D in the liver is an unregulated process, under the action of p450 enzymes. The half life of 25(OH)D is 2-3 weeks.

The conversion of vit D to 1,25(OH)D is highly regulated, via 1αhydroxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why would chronic infection (e.g from sarcoidosis / TB granuloma) cause hypercalcemia?

A
  • Macrophages produce vitamin D
  • Release of vitamin D is converted to 1 25 dihydroxyvitamin dby 1α hydroxylase
  • Causes increase in serum calcium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The major role of calcitriol (1,25 (OH) D) is [2]?

A

The major role of calcitriol is in increasing gut calcium and phosphate absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does negative feedback of activation of vitamin D receptor work?

A

In most cells there is a negative feedback inhibition: activation of the VDR inhibits the action of 1α hydroxylase (which converts vit D to active form), therefore reducing the amount of activated vitamin D able to bind to the VDR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

other vit d effects

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does the hormone FGF23 do? [1]
Which cells are they secreted from? [1]
What does FGF23 do to 1-a-hydroxylase? [1]

A

What does the hormone FGF23 do? [1]
Reduces serum P levels USED FOR WHEN GET P EXCRETED FROM FROM BONE BUT NEED TO EXCRETE VIA RENAL SYSTEM
It inhibits renal tubular reabsorption of phosphate

Which cells are they secreted from? [1]
Secreted by osteocytes

What does FGF23 do to 1-a-hydroxylase? [1]
reduces 1-a-hydroxylase: less activated vit. D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

FYI

A

Activating mutation in FGF23 - Autosomal dominant hypophosphataemic rickets
Tumour induced osteomalacia - paraneoplastic FGF23
Familial tumoral calcinosis - low levels FGF23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Explain 3 classes of symptoms seen in hypercalcemia
Hypercalcemia Symptoms **Neuropsychiatric disorders**: due to reduced membrane excitibility causing reduced nerve transmisison in the brain **GI abnormalities:** * Constipation / pancreatitis: reduced membrane excitibility causes less muscle contraction **Renal dysfunction:** * Nephrogenic Diabetes Insipidus: Ca2+ binds to CaSR in nephrone, which down regulates NaKCL2 symporter Renal stones & Renal failure due to XS Ca2+ in urine
26
What is primary cause of hypercalcemia? [1]
**Malignancy** in **parathyroid** **gland** is main cause, usually from bone metastasis
27
How do you treat hypercalcemia?
Expand plasma volume **IV saline**: reduces voltage gradient in tubular cells -> less Ca ++ reabsorbed Reduce Ca release from bone Treat underlying cause
28
What are primary, secondary and tertiary causes of hyperparathyroidism?
**Primary**: Parathyroid adenoma/carcinoma/hyperplasia **Secondary**: Physiological compensation for hypocalcemia or Vitamin D deficiency. Can create tertiary **Tertiary**: Autonomous PTH production following chronic secondary.
29
What pathology can primary hyperparathyroidism lead to and why? [2]
**hypercalcaemia** + **excess** **PTH** -> **osteoporosis**. (PTH) removes calcium from bones all patients with a parathyroid problem will eventually develop thin bones. Bones with osteoporosis due to parathyroid problems can ache and hurt because the PTH is actively destroying the bone. Bones with osteoporosis are fragile bones which are much more susceptible to fractures and breaks.
30
How can you ID if have primary Hyperparathyroidism? [4]
Neck USS **MIBI scan** CT scan Parathyroid Venous Sampling
31
How do you treat hypoparathyroidism acutely and chronically? [2]
**Acutely**: give Ca2+ **Chronically**: Give activated vit D: increased gut absorb
32
How would a patient with hyperparathyroidism present? [4]
Neuromuscular Excitability: **Cardiac tachyarrhythmia** **Tetany** **Seizures** **Psychiatric manifestations**
33
What would be overall causes of Hypocalcemia? [3]
PTH problems Vit D problems (e.g. nutritional deficiency) Compartment shifts
34
kidney, [] converts 25-hydroxyvitamin-D into 1,25-dihydroxyvitamin-D
kidney, **1-α-hydroxylase** converts 25-hydroxyvitamin-D into 1,25-dihydroxyvitamin-D
35
Label A-E
A: Renal artery B: Segmental arteries C: Interlobar arteries D: Arcuate arteries E: Interlobal arteries
36
Label A-D
A: Afferent arterioles B: Glomerulus C: Efferent arterioles D: Peritubular capillaries / vasa recta
37
38
Where do you examine for tenderness for kidneys (name / vert level) [2]
Renal Angle [1] Junction of 12th rib and lateral border of erector spinal [1]
39
What is the hepatorenal recess a potential space between? [2]
Potential space that separates the **liver** and the **right kidney** [2]
40
Hepatorenal recess can have fluid accumulate because of? [3]
**haemoperitoneum** (is the presence of blood in the peritoneal cavity) [1] **ascites** [1] **pancreatitis** [1]
41
Which structures lie adjacent to the anterior aspect of the right kidney: Label A B C D E
42
Which structures lie adjacent to the anterior aspect of the LEFT kidney A B C D E F G
43
What are the 3 main nerves associated with the kidney? [3]
Iliohypogastric Ilioinguinal Genitofemoral
44
Which is the only nerve of the lumbar plexus that passes through the psoas major? [1] Iliohypogastric Ilioinguinal Genitofemoral Lateral femoral cutaneous nerve Femoral nerve
Which is the only nerve of the lumbar plexus that passes through the psoas major? [1] Iliohypogastric Ilioinguinal **Genitofemoral** Lateral femoral cutaneous nerve Femoral nerve
45
Label each colour
Purple: **psoas major** Green: **Quadratus lumborum m** Red: **Transversus abdominis m.** Blue: **diaphragm**
46
Label A-C xx
A: **perinephtic fat** B: **renal fascia** C: **paranephric fat** Para = alongside Peri = surrounding or around
47
The renal fascia, commonly known as Gerota's fascia, is a collagenous connective tissue sheath which separates the [] fat from the [] fascia
The renal fascia, commonly known as Gerota's fascia, is a collagenous connective tissue sheath which separates the **perirenal fat** from the **pararenal fascia**
48
Label A-E
49
At which structure in the kidney is waste is drained into renal pelvis?
renal papilla
50
Which veins drain into the left renal vein? [3]
left gonadal (ovarian/testicular) vein, left inferior phrenic vein left adrenal veins.
51
What are the 3 layers of the ureter wall? [3]
Transitional epithelial mucosa Smooth muscle muscularis Fibrous connective tissue adventitia
52
How does urine reach the bladder?
Ureters **actively** **propel** urine to the bladder via response to smooth muscle stretch
53
Where are the 3 places that kidney stones get stuck in the ureters? [3]
Uteropelvic junction Pelvic inlet (and iliac vessels) Uterovesical junction
54
Ureter nerve supply: Which nerves are nerve due to kidney stones referred along? [2] Where is the pain common felt? [1] Why does the referred pain change? [1]
The loin pain is referred along the **ilioinguinal** and the **iliohypogastric** **nerves** (L1) As the stone descends the patient may start to feel pain descend over the groin and scrotum/labium majora **(“from loin to groin”)** This is because of the changing nerve segments and the pain is now referred through the **genitofemoral** **nerve** (L1,2)
55
What is the muscle of the bladder called? :)
Muscle of the bladder: detrusor muscle
56
Different role of internal and external urethral sphincter in males? [2]
**Internal urethral sphincter (males):** involuntary sphincter at the bladder-urethra junction (preventing retrograde ejaculation) **External urethral sphincter:** voluntary sphincter surrounding the urethra as it passes through the urogenital diaphragm
57
What is sympathetic innervation of bladder from? [1] What is the effect? [1] What is parasympathetic innervation of bladder from? [1] What is the effect? [1] What is somatic innervation of bladder from? [1] What is the effect? [1]
**Sympathetic** (hypogastric n; T12-L2) Stimulate contraction (closure) of the internal urethral sphincter Inhibit the detrusor muscle (prevents contraction and bladder emptying) **Parasympathetic** (S2-S4) Stimulate the detrusor muscle to contract Inhibits (opens) the internal urethral sphincters **Somatic** - external urethral sphincter (Pudendal n.S2-S4
58
Vit D ---(1)---> X ---(2)---> Y Name 1, 2 and X and Y [4]
Vit D---> **25(OH)D (25-hydroxyvitamin D₃)** ----> **1,25-dihydroxvitamin D(3)** 1: **P450** enyzmes (In the liver) 2: **1 alpha hydroxylase**
59
Label the blue and green arrows [2]
Blue arrows: segmental arteries Green arrows: interlobar arteries
60
Label the arteries
61
62
Where is a kidney stone in theis imaging? Uteropelvic junction Pelvic inlet Uterovesical junction
Where is a kidney stone in theis imaging? **Uteropelvic junction** Pelvic inlet Uterovesical junction
63
Where is a kidney stone in this imaging? Uteropelvic junction Pelvic inlet Uterovesical junction
Where is a kidney stone in theis imaging? **Uteropelvic junction** Pelvic inlet Uterovesical junction
64
Where is a kidney stone in theis imaging? Uteropelvic junction Pelvic inlet Uterovesical inlet
Where is a kidney stone in theis imaging? Uteropelvic junction Pelvic inlet Uterovesical inlet
65
Why might a non-contrast CT not show a kidney stone despite symptoms? [1]
When we do not find a shadow of a ureteral stone on the x-ray, this does not mean that there is no stone, as it depends on the **percentage of the presence of calcium in the composition of this stone**, as some types of stones do not give a shadow on the x-ray.

MET2 (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions