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Viva > october > Flashcards

october Flashcards

1
Q

prox tubule

A

The proximal tubule
reabsorbs water, sodium, chloride, potassium,
bicarbonate, calcium, glucose, urea, phosphate
and any filtered proteins

The thick ascending limb reabsorbs sodium,
potassium, chloride and bicarbonate and secretes
hydrogen ions.

Reabsorption of sodium chloride, bicarbonate and
calcium takes place in the distal tube, and potassium and hydrogen ions are secreted into the
lumen

Aldosterone
stimulates sodium reabsorption and potassium
secretion by the principal cells of the cortical
collecting ducts. ADH increases the permeability
of cortical and medullary collecting ducts
to water.

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2
Q

principle

A

Principal aSALTed a student

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3
Q

potassium handling

A

https://teachmephysiology.com/urinary-system/ion-balance/external-balance-potassium/#:~:text=within%20the%20body.-,Renal%20Handling%20of%20Potassium,potassium%20secretion%20and%20potassium%20reabsorption.&text=Potassium%20is%20freely%20filtered%20at,most%20of%20it%20is%20reabsorbed.

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4
Q

sodium handlign

A

https://en.wikipedia.org/wiki/Renal_
sodium_reabsorption#:~:text=Renal%20reabsorption%20
of%20sodium%20(Na,inhibited%20by%20atrial%20natriuretic%20peptide.

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5
Q

calcium handling

A

More than 95% of filtered calcium is reabsorbed along the renal tubules. In the proximal tubules, 60% of filtered calcium is reabsorbed by passive mechanisms. In the thick ascending limb, 15% of calcium is reabsorbed by paracellular diffusion through paracellin-1 (claudin-16)

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6
Q

midaz dose

A

IV 0.1mg/kg

PO 0.5mg/kg

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7
Q

midaz effect

A

decrease HR and SVR 10%

decreased TV increased RR

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8
Q

lamina

A
  • Adelta–>laminae 2,5, C fibers—>2 (P+H) 2 at 2 fast at 5

*

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9
Q

ANS structure

A

ANS

  • SNS-efferent cell bodies in lateral grey column and in peripheral ganglion of T1-L2
  • PSNS-efferent Brainstem CNs 3,7,9,10 and sacral primary rami—>pelvic splanchnic nerves

Exit as myelinated the ganglia then unmyelinated
Ganglia 2.5cm from midline for SNS and very close to organ for PSNS

SNS-mass effect

  • exit lat grey column—>white rami communicans 3 options in the Sympathetic trunk
    1. Synapse at that ganglion in white rami communicans
    2. Travel upon down trunk to ganglions above # cervical ganglion
    3. Pass through and synapse with a more distal ganglion
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10
Q

nerve AP

A

-70

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11
Q

ciral

A

quart nitrogen

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12
Q

dextro levo

A

the optical rotation of plane-polarized light.

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13
Q

QTc

A

QTc=Qt/squareroot of RR

The QT interval is longer when the heart rate is slower and shorter when the heart rate is faster. So it’s necessary to calculate the corrected QT interval (QTc) using the Bazett formula: QT interval divided by the square root of the R-R interval.

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14
Q

prolonged QT

A

Slow conduction due to

Hypokalaemia
Hypomagnesaemia
Hypocalcaemia
Hypothermia
Myocardial ischemia
ROSC Post-cardiac arrest
Raised intracranial pressure
Congenital long QT syndrome
Medications/Drugs
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15
Q

aldosterone

A

reab Na at expense of K and H

-trigger is high K, acisosis, ATII

upreg NaK basolat in principle
upreg Epithelial NaCh in CD

Acting on the nuclear mineralocorticoid receptors (MR) within the principal cells of the distal tubule and the collecting duct of the kidney nephron, it upregulates and activates the basolateral Na+/K+ pumps, which pumps three sodium ions out of the cell, into the interstitial fluid and two potassium ions into the cell from the interstitial fluid. This creates a concentration gradient which results in reabsorption of sodium (Na+) ions and water (which follows sodium) into the blood, and secreting potassium (K+) ions into the urine (lumen of collecting duct).
Aldosterone upregulates epithelial sodium channels (ENaCs) in the collecting duct and the colon, increasing apical membrane permeability for Na+ and thus absorption.
Cl− is reabsorbed in conjunction with sodium cations to maintain the system’s electrochemical balance.
Aldosterone stimulates the secretion of K+ into the tubular lumen.[11]
Aldosterone stimulates Na+ and water reabsorption from the gut, salivary and sweat glands in exchange for K+.
Aldosterone stimulates secretion of H+ via the H+/ATPase in the intercalated cells of the cortical collecting tubules
Aldosterone upregulates expression of NCC in the distal convoluted tubule chronically and its activity acutely.[12]

ADDISONS
Low blood sugar (worse in children due to loss of glucocorticoid’s glucogenic effects)
Low blood sodium, due to loss of production of the hormone aldosterone, to the kidney’s inability to excrete free water in the absence of sufficient cortisol, and also the effect of corticotropin-releasing hormone to stimulate secretion of ADH.
High blood potassium, due to loss of production of the hormone aldosterone.
Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells)
Metabolic acidosis (increased blood acidity), also is due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule is linked with acid/hydrogen ion (H+) secretion. Absent or insufficient levels of aldosterone stimulation of the renal distal tubule leads to sodium wasting in the urine and H+ retention in the serum.

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16
Q

temp control

A

bulb of krause–.Post poles (polar bear)

bulb of raffiki is warm. ant pot senses local warming of blood->sweat

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17
Q

skin shunt

A

between arteries and veins, shunting blood directly into the venous plexuses

When body temperature equals
or exceeds 30°C, sympathetic activity to the skin
decreases under the control of anterior hypothalamus. is results in vasodilatation, especially of
arteriovenous anastomoses, and is enhanced by bradykinin released by sweat glands activated by cholinergic sympathetic bres. e fall in total vascular
resistance triggers an increase in cardiac output,
and a massive increase in skin blood ow accommodated in the dilated arteriovenous shunts and
venous plexus. is provides a large area for heat
transfer between the skin and the environment. e
cutaneous blood ow can increase 30-fold in heat
stress and decrease 10-fold in cold stress

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18
Q

ketamine

A

Ketamine rec Ach, Nicotinic, Na at high dose

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19
Q

gauge pressure

A

Gauge P: = P above or below atmospheric pressure

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20
Q

CSF alter with drugs

A

CAi acetazolamide

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21
Q

Spironloactone

A

hyponatraemia hyperkalaemia, acidosis

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22
Q

VWF desmopressin

A

increased release

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23
Q

measure ICP

A

EVD, codmann catheter easy but shit

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24
Q

protein C

A

These proteins that APC inactivates, Factor Va and Factor VIIIa,

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25
Q

VWF prod in endo

A

in endo
stored in endothelium and in PL

suports factor 8

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26
Q

dense granules

A

The dense granules of human platelets contain adenosine diphosphate (ADP), adenosine triphosphate (ATP), ionized calcium (which is necessary for several steps of the coagulation cascade), and serotonin.[6]

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27
Q

alpha granules

A

Contents include insulin-like growth factor 1, platelet-derived growth factors, TGFβ, platelet factor 4 (which is a heparin-binding chemokine) and other clotting proteins (such as thrombospondin, fibronectin, factor V,[3] and von Willebrand factor).[4]

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28
Q

pulmoanary art

A

The pulmonary artery catheter is frequently referred to as a Swan-Ganz catheter,

25/10

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29
Q

echo PAP

A

RAP+4V^2

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30
Q

CVP trace level

A

5cm below sternal notch at 30 degrees

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31
Q

sens

A

proportion of diseased that get postive test.

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32
Q

inductor

A

Used in defibrillators to prolong the discharging rate so that the current is
delivered over several milliseconds, allowing a critical mass of the
myocardium to depolarize.

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33
Q

collegiate

A

Boiling point increases in proportion to the molar concentration of the solutes

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34
Q

due point

A

Dew point temperature is defined simply as the
temperature at which water vapor, when cooled, will
begin to condense to the liquid phase, so it is the
most useful humidity parameter when dealing with
condensation problems.

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35
Q

low prevalence and PPV

A

high FP–>low PPV yes

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36
Q

Sagm

A 
Saline
Adenine
Substrate for ATP synthesis
Glucose
Substrate for RBC glycolysis
Mannitol
37
Q

Cai

A

Some diuretics[9] inhibit the activity of carbonic anhydrase in proximal convoluted tubules and prevent reabsorption of bicarbonates from renal tubules. Lowered reabsorption of bicarbonates results in decreased activity of the apical sodium hydrogen exchanger, causing diuresis due to retention of sodium in the renal tubules. Acetazolamide is a carbonic anhydrase inhibitor. Other examples are;

38
Q

assumptions of PCWP

A
  • PAOP = LAP
  • West zone 3
  • End expiratory
  • Normal PVR
  • Normal MV function
  • Normal intrathoracic pressures
  • Operator consistent
  • Normal ventricular compliance
39
Q

transducer resistance

A

How does a transducer work?
• As the substance absorbs atmospheric water there is a change in electrical resistance or
capacitance
• This depends on the ambient humidity

40
Q

SVP

A

The partial pressure that a vapour will exert if the liquid and the vapour of the liquid are
in equilibrium

41
Q

HME

A

A hygroscopic substance is one that readily attracts water from its surroundings, through either absorption or adsorption.

42
Q

HME

A

What are the disadvantages of the HME?
• Inefficiency with prolonged use
• Increased dead space
• Infection risk e.g. pseudomonas

43
Q

warm bath

A

What is a hot water bath humidifier?
• Is an active system, in that dry gases bubble through water which is heated to 60°C (to
inhibit microbial contaminiation)
o Can deliver fully saturated gases

44
Q

How do substances cross a capillary?

A

How do substances cross a capillary?
• Diffusion through intercellular clefts and fenestrations, determined by Fick’s law
• Bulk flow/ultrafiltration, determined by Starling forces
• Pinocytosis
• Brain has carrier-mediated transport (no intercellular clefts)

45
Q

IVF cooling

A

An administration of fluids 1 L at room temperature may reduce a mean temperature by approximately 0.25℃.

46
Q

dilute and conc urine

A

decrease in peritubular capillary oncotic pressure post IVF

–During water excess, the fluid leaving the loop of Henle, osmolality 100 mOsmol/kg H2O-without ADH—>dee out dilute urine.
-IVF to urine output (increased Hp and decreased oncotic)
-Glomerulotubular balance ensures a return to homeostasis by increasing free water excretion (the mechanism is triggered by a decrease in peritubular capillary oncotic pressure; it decreases the rate of water resorption from the proximal tubule).
PRODUCTION OF CONCENTRATED URINE During water deprivation, the distal convoluted tubule reabsorbs sodium and chloride but remains impermeable to water, and the fluid leaving the tubule still has an osmolality of less than 100 mOsmol/kg H2O. ADH changes the permeability of the collecting duct wall so that it becomes permeable to water. In the presence of ADH, tubular fluid leaving the cortical collecting duct has an osmolality of 300 mOsmol/kg H2O (the same as cortical interstitial fluid osmolality). With ADH, the medullary collecting duct reabsorbs much water because of the high medullary interstitial fluid osmolality produced by the loop of Henle, and a small volume of concentrated urine of osmolality 1400 mOsmol/kg H2O is excreted (the obligatory urine loss). Urea accounts for half of the osmolality of this concentrated urine and sodium, chloride, potassium, creatinine and other solutes account for the remainder (Figure 7.16).

47
Q

shunt admix

A

Normal shunt fraction in healthy adults breathing room air is said to be close to 0% (probably 0.4-1%)
Normal venous admixture is usually about 3% of the cardiac output

48
Q

USS

A

20kHz

20mHz in medical

49
Q

gel

A

decreases reflection at interface of two dramatically diff densities. density stepdown

50
Q

clopidog

A

P2Y12

51
Q

propofol ph

A

Its pH is 7 and pKa in water is 11;

All phenols irritate skin and mucous membrane. Thus, propofol being an alkylphenol is expected to cause pain in spite of the fact that it is almost isotonic

52
Q

luso

A

relax

53
Q

dromo

A

peledrome

54
Q

stages of anaesthesia

A 
S1 onset-->loc
S2 Loc-->eyelash lost
S3 eyelash lost-->apnoe
-P1 eyes move
-P2 larynx
-P3 IC
-P4 -apneo
S4 apnoea-->death
55
Q

MAC95

A

1.3MAC

56
Q

levo

A

ATP dep K ch open–>VD

57
Q

Iga

A

tears

58
Q

IGE

A

parasites

59
Q

GABA

A

pres and post synapitic in brain alone

60
Q

ANS

A

pregang myelinated

61
Q

Artline elderly

A

• In elderly radial trace will look less different to aortic: = due to lower vascular compliance
which causes the pressure wave to travel faster and be less distorted.
• Changes to Aortic contour with ageing:
‣ slower upstroke (decreased contractility)
‣ Higher peak due to lower aortic compliance

62
Q

amsorb

A

CaOH caCl CaSO4

63
Q

size Glom

A

7000kdalton

64
Q

size hep

A

15kda

65
Q

MTP definition

A

Massive transfusion is defined as

replacement of >1 blood volume in 24 hours, or
>50% of blood volume in 4 hours (adult blood volume is approximately 70 mL/kg), o

66
Q

MTP trigger

A

4 in 4 and expecting more

67
Q

packed cell lesion

A

strucutral, functional

68
Q

FFP

A

deficient in labile products 5,8

69
Q

normal LVEDP

A 
normal PCWP=10
The median (interquartile range) LVEDP was 19 mm Hg
70
Q

protamine

A

1mg:100IU

71
Q

heparin assessment

A

The Activated Clotting Time (ACT) was first described by Hattersley in 1966 and is essentially a point of care test (POCT) of coagulation that is used to monitor the anticoagulant effect of unfractionated heparin (UFH) in patients on cardio-pulmonary bypass

72
Q

clexane

A

antiXa

73
Q

codncution

A

heat or electricity is directly transmitted through the material

74
Q

Co2 analysis

A

Mainstream devices
— need time to heat up to avoid condensation on the heater
— add dead space and weight to the circuit
prediction of PaCO2 from ETCO2 is variable (the major limiting factors = pulmonary blood flow and V/Q mismatch) and ETCO2 may be misleadingly different in conditions with significant V/Q mismatch
Sidestream devices
— can result in a time delay
— prone to blocking as not in line with gas flow
— may be inaccurate if low tidal volumes as fresh gas may be entrained (e.g. paediatrics)
— analysed circuit gases can also leak to the environment
utility in neonates and children may be impaired because of small tidal volumes

75
Q

Cardiac output measurement can be performed:

A 
Invasively
Pulmonary Artery Catheter
Thermodilution
Fick Principle
TOE
Arterial waveform analysis
PiCCO
Vigileo
76
Q

NIBP

A

Device for Indirect Non-Invasive Automatic Mean Arterial Pressure (DINAMAP).

77
Q

Tramadol talent

A

In fact, tramadol is pharmacologically a “partial agonist.”2 In contrast, tapentadol is a full mu agonist with a binding affinity 18 times less than that of morphine, but is only 2- to 3-times less potent than morphine

78
Q

wet bulb

A

nil difference in 100% humidity

79
Q

ach bind sites

A

Nicotinic acetylcholine receptors (AChRs) are activated by ACh binding to two sites located on different α subunits.

80
Q

PTC

A

3 second tetanic stimuli ! 3 ~ 6 second delay ! supramaximal stimuli at 1 Hz !
count number of twitches
Post-tetanic facilitation of NMJ persists for ~ 6 minutes

81
Q

free water clearance

A

In the physiology of the kidney, free water clearance (CH2O) is the volume of blood plasma that is cleared of solute-free water per unit time. An example of its use is in the determination of an individual’s state of hydration. Conceptually, free water clearance should be thought of relative to the production of isoosmotic urine, which would be equal to the osmolarity of the plasma. If an individual is producing urine more dilute than the plasma, there is a positive value for free water clearance, meaning pure water is lost in the urine in addition to a theoretical isoosmotic filtrate. If the urine is more concentrated than the plasma, then free water is being extracted from the urine, giving a negative value for free water clearance. A negative value is typical for free water clearance, as the kidney usually produces concentrated urine except in the cases of volume overload by the individual.

82
Q

preload

A

Ventricular filling and therefore preload is increased by:
Increased central venous pressure that can result from decreased venous compliance (e.g., caused by sympathetic activation of venous smooth muscle) or increased thoracic blood volume. The latter can be increased by either increased total blood volume or by venous return augmented by increased respiratory activity, increased skeletal muscle pump activity, or by effects gravity (e.g., head-down tilt).
Increased ventricular compliance, which results in a greater expansion of the chamber during filling at a given filling pressure.
Increased atrial force of contraction resulting from sympathetic stimulation of the atria or from increased filling of the atria and therefore increased atrial contractile force through the Frank-Starling mechanism.
Reduced heart rate, which increases ventricular filling time.
Increased aortic pressure, which increases the afterload on the ventricle, reduces stroke volume by increasing end-systolic volume, and leads to a secondary increase in ventricular preload.
Pathological conditions such as ventricular systolic failure and valve defects such as aortic stenosis, and aortic regurgitation (pulmonary valve stenosis and regurgitation have similar effects on right ventricular preload).

83
Q

transcription

A

The outer (cytosolic) face of the rough endoplasmic reticulum is studded with ribosomes that are the sites of protein synthesis.

Within all cells, the translation machinery resides within a specialized organelle called the ribosome.

84
Q

Mg dose PET

A

4g 1g per hour

85
Q

adeonsie met

A

RBC vasc endo deaminatedx

86
Q

N20 haem

A

cobalt ion in B12 nil methionine synthetase nil folate

87
Q

Nad inf

A

0.05-0.5mcg/kg.min

88
Q

addisons

A

fludrocortison

89
Q

labetalol

A

1:3 and 1:7 following oral and intravenous (IV) administration, respectively

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