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medical sciences > Module 1.03 > Flashcards

Module 1.03 Flashcards

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USMLE® Step 1 flashcards
1
Q

How is alcohol metabollised?

A

ethanol –> acetaldehyde –> acetate
catalysts: alcohol dehydrogenase, acetaldehyde dehydrogenase

at each arrow NAD+ –> NADH

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2
Q

Explain the breakdown of haemoglobin to form billirubuin

A

1) haemoglbin is broken down into haem and globin by macrophages in the liver and spleen
2) haem is the split into iron and unconjugated billirubin
3) unconjucated billirubin binds to albumin in the blood to the liver where it is conjugated with amino acids
4) billirubin is excreted into bile

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3
Q

what are the functions of the gall bladder?

A
  • storage of bile
  • releases bile during meal times- stimulated by CCK
  • conc of bile –> water absorbed from lumen of gall bladder
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4
Q

what is the blood supply to the gall bladder?

A
  • cystic artery –> branches off right hepatic artery
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5
Q

what is the innervation of the gall bladder?

A

parasympathetic- vagus nerve

sympathetic - coeliac plexus

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6
Q

what are cells in the endocrine pancreas and what do they secrete?

A

alpha cells -> glucagon
beta cells -> insullin
Delta cells -> somastatin
F cells -> pancreatic polypeptide

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7
Q

what are the cells of the exocrine pancreas?

A
  • acinar cells produce the enzymes

- ductal cells secrete bicarbonate

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8
Q

how do acinar cells make enzymes?

A

Acinar cells make enzymes at rER and modifies by golgi apparatus and is stored in zygomen granules

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9
Q

what is the blood supply to the pancreas (arterial and venous) ?

A

Arterial:

  • pancreatic branches of splenic artery
  • head is additionally supplied by pancreaticduodenal anterior artery

Venous:

  • pancreatic branches of the splenic vein
  • head drains to SMT branches of hepatic vein
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10
Q

what are the 3 ways a hormone travels in the body?

A

endocrine - targets a distant cell and travels by blood
paracrine - targets a local cell via extracellular fluid
autocrine - targets itself

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11
Q

what is the blood supply to the spleen (venous and arterial)?

A

Arterial:

  • 5 branches supplying diff parts of organ
  • no astomoses, so vascular segments

Venous

  • splenic vein
  • combines with superior mesenteric artery to form hepatic portal vein
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12
Q

what is the location of the spleen?

A
  • intraperitoneal
  • Upper L abdomen, L hypochondrium
  • between ribs 9-11
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13
Q

what does the red pulp and white pulp consist of?

A
  • red pulp: venous sinouse, radial arterioles, central arterioles
  • white pulp: germinal follicase, periarticular lymphatic sheath, marginal zone
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14
Q

what are the ligaments of the spleen?

A
  • gastrosplenic, connects spleen to greater curvature of stomach, anterior to hillium
  • splenorenal, posterior to hillium and connects to kidney
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15
Q

describe the two phases of drug metabolism

A

phase 1: hydrolysis, oxidation or reduction to introduce or exposes polar groups, making it thus more reactive. Oxidation is catalysed by cytochrome P450 enzymes.

phase 2: conjugation (that is, the attachment of an ionised group to the drug) , always is a transferase enzyme, increase water solubiity for renal excretion (usually decreases pharmalogical activity) . These metabolic processes usually occur in the hepatocyte cytoplasm.

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16
Q

what is a pro drug?

A

metabolised to an active form (usually activated by phae 1)

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17
Q

what receptors do lipid soluble and water soluble hormones attract to?

A

water soluble -> membrane bound receptors

lipid soluble -> nuclear receptors

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18
Q

describe the process of lipid metabolism

A

beta oxidation to produce acetyl CoA which then enters the krebs cycle

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19
Q

explain bile synthesis

A

hepatocytes secrete bile -> billary caniculli -> common hepatic duct -> joins cystic duct to form common bile duct -> ampulla of vater into duodenum

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20
Q

what are the functions of the liver?

A

bile secretion, billirubin metabolism, carbohydrate metabolism, lipid metabolism, protein metabolism, drug metabolism

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21
Q

describe the triangular (left and right) ligaments in the liver?

A

-attaches the left and right to diaphragm

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22
Q

what is the coronary ligament (posterior and anterior)?

A
  • posterior and anterior unite to form triangular ligaments on left and right
  • creates bar area
  • superior surface of liver to inferior surface of diaphragm
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23
Q

describe the falciform ligament of the liver?

A
  • splits liver into left and right lobe

- attaches anterior sirface of liver to the anterior abdominal wall

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24
Q

what are the 3 main ligaments of the liver?

A

falciform, coronary, triangular

25
Q

how many functional sections of the liver are there?

A

8

26
Q

what nerves supply the liver?

A

parasympathetic - vagus nerve

sympathetic - coeliac plexus

27
Q

where is the liver located?

A
  • mainly right hypochondrium
28
Q

what is glissons capsule?

A
  • fibrous layer which surround the liver

- made up of a large right lobe and smaller left lobe

29
Q

what is the characteristics of an anatomical lobule in the liver?

A
  • hexagonal shaped
  • drains to a central vein
  • periphery of lobule has the portal triad
30
Q

what does the portal triad contain?

A

Arteriole – a branch of the hepatic artery entering the liver
Venule – a branch of the hepatic portal vein entering the liver
Bile duct – branch of the bile duct leaving the liver

31
Q

what is the blood supply to the liver?

A
  • roughly 25% from hepatic artery proper
  • roughly 75% from the hepatic portal vein, which has nutrients from small intestine
  • venous drainage from hepatic vein formed from central veins, the hepatic veins drain to vena cava
32
Q

where is the gall bladder located anatomically?

A
  • entirley surrounded by peritoneum
  • inferior to the liver
  • posterior to transverse colon and proximal duodenum
33
Q

what 3 parts are the gall bladder split into?

A
  • fundus- the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line.
  • body- largest part and is the main body
  • Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree
34
Q

what is hartmanns pouch?

A
  • mucousal fold in the neck of the gall bladder where gall stones tend to collect
35
Q

what are the anatomical space surrounding the liver?

A

Subphrenic
Subhepatic
Hepatorenal (Morrison’s pouch)

36
Q

what kpuffer cells?

A
  • found in liver
  • Specialised immune cells which function as macrophages and can act as antigen-presenting cells, break down haemoglobin and ingest and breakdown RBCs.
37
Q

describe the lining of the gall bladder

A

The mucosa of the gallbladder is lined by a simple columnar epithelium with microvilli.

38
Q

describe the process that causes bile secretion

A

CCK is secreted by enteroendocrine cells after eating, due to the presence of fats and amino acids in the small intestine, to produce CCK which stimulates the contraction of the gallbladder.

39
Q

what are the enzymes found in pancreatic juice?

A
  • trypsin
  • chymotrypsin
  • carboxypeptidase
  • pancreatic lipase
40
Q

what pancreatic exocrine secretions made up of?

A
  • Enzymes synthesised by acinar cells grouped into lobules

* An alkaline fluid secreted by the ductular epithelial cells

41
Q

what happens in the cephallic phase of digestion?

A
  • thought, sight, smell of food causes a vagal nerve reflex
  • causes acinar cells and ductal cells to secrete pancreatic juice
  • vagal stimulation causes gastrin to enter circulation and cause pancreatic enzyme secretion
42
Q

What happens in the gastric phase of digestion?

A
  • gastro-pancreatic reflex, distension of stomach causes stimulation of stretch receptors to vause vagal stimulation that nerves travel to the pancreas
43
Q

How is CCK involved in the intestinal phase of digestion?

A
  • CCK is secreted in response to lipids such as monoglycerides and free fatty acids, amino acids and peptides, but not to carbohydrates or hydrochloric acid in the chyme. Its enters circulation and stimulates pancreatic enzymes and also potentiates the action of secretin.
  • CCK is synthesised by I cells in the jejunal and duodenal muscousa
44
Q

How is secretin involved in the intestinal phase of digestion?

A
  • secretin is released when HCl in the chyme enters the small intestine from the stomach
  • Secretin enters the circulation and is delivered to the pancreatic duct cells where it stimulates bicarbonate and, consequently, fluid secretion
  • Bile salts and lipids are much weaker stimulants of secretin secretion than hydrochloric acid
  • Secretin is synthesised by S cells in the duodenal mucosa
45
Q

how is the entero-pancreatic reflex involved in the intestinal phase of digestion?

A
  • The entero-pancreatic reflex is stimulated by the presence of lipid, peptides and amino acids in the small intestine
  • The nutrients stimulate vagovagal reflexes with afferent and efferent pathways in the vagal nerves.
46
Q

how is the liver involved in carbohydrate metabolism?

A
  • Glycogen synthesis and storage

- gluconeogenesis

47
Q

How is the liver involved in protein metabolism?

A
  • nitrogen component of amino acid is delivered to liver via portal vein and is removed through transamination and deamination (ammonia is a product of deamination and is quickly removed off through urea as it is toxic)
  • synthesis of plasma proteins
  • production of all coagulation factors: prothrombin, fibrinogen and factors V, VII, IX, X and XIII
48
Q

lipids in liver stuff

A
  • synthesis of triglycerides
  • synthesis and catabolism of cholesterol
  • Synthesis of fatty acids by the liver using intermediates from the breakdown of sugars, some amino acids and other fatty acids, when there is excessive carbohydrate intake.
49
Q

what are the main functions of the liver?

A

The liver is a critical organ in the human body that is responsible for an array of functions that help support metabolism, immunity, digestion, detoxification, vitamin storage among other functions.

50
Q

define catabolism

A

breaking down into smaller molecules

51
Q

define anabolism

A

building up complex molecules

52
Q

define paracrine and autocrine signalling

A

paracrine- hormone released into extracellular fluid and only works with in the vicinity
autocrine- hormone released into extracellular fluid but acts on the cell releasing the signal

53
Q

what are 3 classes of hormones depending on their chemical structure?

A
  • amino acid derived hormone
  • peptide hormones
  • lipid derived hormones
54
Q

what is a second mesenger system?

A
  • for water soluble hormones such as peptide hormones it allows a response from the cell without the hormone being able to pass through the phospholipid bilayer
  • done with a receptor on cell membrane
55
Q

how do steriod hormones act on a cell?

A
  • steriod hormones are derived from cholestrol so they are lipid soluble
  • this means they are able to pass through the phospholipid bilayer of a cell and recpetors are found inside the cell
56
Q

define agonist and antagonist

A

agonist - molecule that bind to receptor and induces post receptor events
antagonist - bind to receptor but does not trigger any post receptor events (to stop action of hormone by blocking receptor)

57
Q

what are 4 types of physical fitness?

A
  • cardiorespiratory endurance
  • muscular strength
  • balance coordination
  • flexibility
58
Q

what is the NHS safe limit of alcohol per week reccomendation?

A

14 units per week (spread evenly across week)

medical sciences (11 decks)

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