Original Physiology Flashcards
1
Q
Where in the kidney is the main resorption site for all ions?
A
Proximal convoluted tubule
2
Q
What activates the intrinsic pathway of the clotting cascade?
A
Damaged endothelium
3
Q
What activates the extrinsic pathway of the clotting cascade?
A
Tissue factor
4
Q
What is cleaved to form Thrombin (IIa)
What activates this process?
A
Prothrombin (II)
Xa (Activated factor X)
5
Q
What is the action of thrombin (IIa)?
A
Fibrinogen —> fibrin
I –> Ia
6
Q
What is the lifespan of a RBC?
A
120 days
7
Q
What is the lifespan of a WBC?
A
2-5 days
8
Q
What is the lifespan of platelets?
A
5-9 days
9
Q
What LFT parameters are raised during pregnancy?
A
ALP; GGT
10
Q
What LFT parameters are reduced during pregnancy?
A
AST; ALT; bilirubin; albumin
11
Q
What is the trigger for ADH release?
A
High serum osmolality
12
Q
What is the weight of the non-pregnant uterus?
A
40-50g
13
Q
What is the weight of the pregnant uterus?
A
1200g
14
Q
What holds platelets together in the 1st stage of wound healing?
A
Fibrin
15
Q
By what proportion does oxygen consumption increase in pregnancy?
A
20%
OR
30 - 50 mls/min
16
Q
By what proportion does tidal volume increase in pregnancy?
A
40%
17
Q
By what proportion does minute ventilation increase in the first trimester of pregnancy?
A
50%
18
Q
What are the cardiovascular changes that occur during pregnancy?
A
Plasma vol up 45-50%
Cardiac output up 40%
Stroke volume up 30%
HR up 10% (15 beats/min)
Systemic vascular resistance (SVR) down 25%
19
Q
What causes the increase minute ventilation during pregnancy?
A
Progesterone - it is known to directly stimulate ventilation by sensitizing the CNS respiratory centres to CO2
20
Q
By what proportion does eGFR increase in pregnancy?
A
40%
21
Q
In what ways does vasopressin/ADH promote water retention?
A
1) Insertion of water channel proteins called aquaporins into the collecting duct and DCT
2) Increased activity of urea transport proteins in the collecting duct promoting urea flow out of the collecting duct and water via increased osmotic gradient
3) Increased sodium reabsorption across the ascending loop of Henle
22
Q
What lung parameters are unchanged in pregnancy?
A
FEV1 and FVC
Vital capacity
23
Q
At what point does fetal urine become a major contributor to amniotic fluid?
A
Week 16 - up until then the major contributors are placenta and fetal skin
24
Q
What are the only vitamins whose daily requirements don’t increase in pregnancy?
A
Vitamin D and vitamin K
25
At what gestation do the definitive alveolar form?
Week 36
26
Which lung volumes decrease in pregnancy?
*Total lung capacity
Residual volume
Functional residual capacity
Expiratory reserve volume
Inspiratory reserve volume
Diaphragm takes up space
Tidal volume increases (ERV/IRV around it)
Vital capacity stays the same
27
How is haemolytic disease of the newborn tested for?
Direct Coombs test
28
How does gestational diabetes affect free fatty acids and plasma ketones bodies?
Increased FFA and ketones bodies
29
By how many x is ALP increased in pregnancy?
x3
30
Oxygen consumptions increases by 20% in pregnancy, how much is this in ml/min?
50ml/min
31
By how much is total lung capacity decreased in pregnancy?
200ml decrease
32
What proportion of body calcium is stored in the skeletal system?
99%
33
At what gestation is dilutional anaemia at its greatest?
32/40
34
What is anuria?
<100ml produced in 24 hours
35
What is oliguria?
100-400ml or urine produced in 24 hours
36
What is normal urine output?
0.5-1ml/kg/hour, in infants 2ml/kg/hour
37
What is polyuria?
>3000ml produced in 24 hours
38
How do LFTs change in pregnancy?
Albumin falls
ALP can be x3 higher (because the placenta also produces it)
39
Which layer of the ovarian follicle is vascular?
Theca layer
40
For how long do follicles have to grow before they can be recruited into the menstrual cycle?
65 days
41
Once follicles have reached the antral phase (resting --- preantral --- antral ---- ovulatory phase) what hormone are they dependant upon for growth?
FSH
42
What drives cholesterol conversion to androgens, and in what cells?
LH drives
In Theca cells
43
What drives androgen conversion to estradiol, and in what cells?
FSH drives
Catalysed by aromatase in the granulosa cells
44
What are the features of a dominant follicle?
More FSH receptors
More granulosa cells (producing estrogen)
Higher intracellular cyclic adenosine monophosphate lvels
Produces estrogen -> positive feedback causes LH surge.
FSH causes the dominant follicle to induce LH receptors, allowing it to survive, whilst the FSH levels falls and so the other small follicles die by atresia
45
Which hormone causes the completion of the first meiotic division of the oocyte after ovulation?
LH
46
What induces the 2nd meiotic division of the oocyte?
Fertilisation
47
What is the thickness of the endometrium during the luteal/secretory phase?
6mm
48
What is normal testicular volume?
15-30ml
49
How much cooler are the testes compared to core body temperature?
1.5-2 degrees
50
What cells line the tubules of the testes?
Sertoli
51
What are the cell stages of spermatozoa?
Spermatogonia --- primary spermatocytes --- secondary spermatocytes --- spermatids --- spermatazoon
52
How long is the epididymis?
5m (highly coiled)
53
How long does it take for the spermatozoa to pass through the epididymis?
8-14 days
54
What is the combined length of the male and female reproductive tract that a sperm must traverse in order to fertilise an oocyte?
30-40cm
55
To what pH does ejaculate raise the vagina to, and why?
Rises it from 3-4 to 7.2
This is because the motility of the sperm is inhibited by acidic pH
56
Where does capacitation occur, and what is its purpose?
Occurs in the presence of uterine or uterine tube fluid, usually in the ampulla of the tube.
It alters the surface of the sperm head to make it more responsive to signals in the immediate area of the oocyte
57
By how many litres does cardiac output increase in pregnancy?
30-50%, from 4.5L/min to 6L/min
58
When does the rise in cardiac output plateau during pregnancy?
24-30/40
59
By what proportion does heart rate increase in pregnancy?
10%
60
By how many mmHg does BP fall in pregnancy?
From 8-36/40:
Systolic falls by 5mmHg
Diastolic falls by 10mmHg
61
How does the axis of the heart change in pregnancy and why?
The axis is shifted anteriorly and to the left as a result of the upward displacement of the diaphragm by the enlarging uterus
62
What are the ECG changes in pregnancy?
L axis deviation: 15 degrees
Lead III - twi and Q wave
AVF - Q wave
63
How does the increase in ventilation in pregnancy affect blood gases?
pCO2 falls to 4.1 (normal 4.7-6.0)
64
How does the slightly lower pCO2 effect bicarbonate?
PCO2 fall causes the blood to becomes slightly alkaline, in response the bicarbonate levels fall to 19-20 (normal 22-26)
65
How does residual volume change in pregnancy?
From 1500ml (non-pregnant) to 1300ml
66
How does total lung capacity change in pregnancy?
From 5L (non-pregnant) to 4.8L
67
By how many ml/minute does oxygen consumption increase in pregnancy? And how is that distributed?
Increased by 50ml/min
---> 20ml/min to fetus
---> 6ml/min to increased cardiac output
---> 6ml/min to increased renal work
---> 18ml/min to increase in metabolic rate
68
By how much do the kidneys increase in size in pregnancy?
1cm
69
What is the glomerular filtration rate during pregnancy?
140-170ml/minute
70
How does U&Es change during pregnancy?
Urea falls to 3.1
Creatinine falls to 47
71
Why does sickness occur in pregnancy?
Gastrointestinal tone and motility are reduced by progesterone, resulting in delayed gastric emptying
This reduced motility also increases stool transit time, allowing more time for colon reabsorption of water, making constipation more common
72
Why are pregnant women more prone to gallstone formation?
Due to reduced gallbladder contractility
73
By what proportion does plasma volume increase in pregnancy?
At what gestation does it reach its peak?
45% (2600ml ---> 3800ml)
Expansion reaches its peak at 32/40
74
Which coagulation factors increase in concentration in pregnancy?
VII
VIII
X
75
Which coagulation factors are unchanged in pregnancy?
XI
XIII
76
What is the average milk production per day?
500-1000ml/day
Equilibrium in breastfeeding mothers is reached at approx. 3/52 whereby milk production is tailored to requirement
77
What is the energy content of 100ml breast milk?
75 kcal
78
Why is breast milk advantageous in babies with diarrhoea?
Because breastmilk has approx. 1/3rd to conc of sodium and chloride concentration compared to cows milk, and high solute load (as in cows milk) can exacerbate diarrhoea
79
What are the different types of lochia?
Lochia rubra - red
Lochia serosa - pink
Lochia alba - white
80
What promotes the formation of more myometrial gap junctions as labour approaches?
Oestrogen
increased myometrial gap junctions allow the transmission of chemical and electrical signal and so promote coordinated contraction
81
Which COX increases rapidly at the onset of labour?
COX-2 - this increases prostaglandin synthesis
82
What brings about cervical ripening?
Prostaglandins and interleukin 8 cause neutrophils to be attached to the cervix where they release collagenase, leading to proteolysis of the collagen fibres of the cervix, making it softer and more stretchy
83
What is the equation for cardiac output?
Cardiac output = stroke volume x heart rate
84
How is cardiac output measured in a fetus and why?
Cardiac output ina fetus = combined ventricular output
Measured like this because int eh fetal circulation blood is shunted across the ductus venosus, foramen ovale and ductus arteriosus, meaning that the SV for each ventricle isn't equal.
85
What proportion of blood does the RV receive?
Two thirds
86
What proportion of blood does the LV receive?
One third
87
How does the fetal heart differ from the adult heart?
1) Smaller amount contractile tissue
2) Myofibrils are arranged in a less organised manner
3) Less compliant (i.e. more stiff) owing to the constraining effects of the lung and chest in teh absence of air
88
What is the principle way in which a fetus can increase their cardiac output? And why?
Increased HR
Because of the factors that make the fetal heart different from the adult heart, it has very little functional reserve, and therefore limited capacity to increase stroke volume
89
What is the main source of fuel of the cardiac fetus? Compared to adults?
Lactate and carbohydrates
In adults the main source is long chain fatty acids
90
What is the definition of a deceleration?
A decrease of 15 beats/min for at least 15 seconds
91
What is an early deceleration?
Deceleration that occurs during uterine contractions
92
What is a variable deceleration?
Deceleration that occur without a regular pattern in terms of relation to contractions, length and depth
93
What is a late deceleration?
Deceleration:
-which STARTS BEFORE the peak of the contraction
-its NADIR occurs AFTER the peak of contraction
94
What does the ductus venosus shunt between?
Shunt from the umbilical vein to the IVC
95
What does the foramen ovale shunt between?
From the RA to the LA
96
What does the ductus arteriosus shunt between?
From the RV to the pulmonary artery to the aorta
97
What happens when the mixed oxygenated blood enters the fetal RA?
high velocity oxygenated blood:
pushed through the foremen ovale towards the left ventricle/side
low velocity deoxygenated blood: towards the right
98
What is the purpose of the ductus arteriosus?
Allows blood to bypass the immature lungs
99
What maintains the patency of the ductus arteriosus?
By the vasodilatory effects of prostaglandins - PGE1 and PGE2 - an dprostacyclin (PGI2)
100
What causes the ductus arteriosus to close?
The fall in pulmonary pressure (resulting in there being less pressure to push blood from the pulmonary artery across the ductus arteriosus into the aorta it connects with)
The rise in systemic pressures
101
When on average does the ductus arteriosus close?
2 days after birth
102
When does the ductus venosus usually close?
1-3 weeks after birth in a term infant
103
What are the 5 stages of lung development?
1. Embryonic
2. Pseudoglandular
3. Canalicular
4. Saccular
5. Alveolar
104
When does embryonic lung development occur, and what happens?
Conception to 7 weeks
Formation of main bronchi and bronchopulmonary segments
105
When does pseudoglandular lung development occur, and what happens?
7-17 weeks
Branching of airways and vessels
106
When does canalicular lung development occur, and what happens?
17-27 weeks
Formation of the acini - the gas-exchanging parts of the lung
107
When does saccular lung development occur, and what happens?
28-36 weeks
Enlargement of the peripheral airways, thinning of airway walls to form terminal sacs
108
When does alveolar lung development occur, and what happens?
36 weeks to 2 years post-birth
Formation of the definitive alveoli
109
How many alveoli will form per acinus?
1000
110
What is thought to be the purpose of fetal breathing movements?
To regulate lung growth by lung fluid regulation and lung cell growth
111
Which types of cell produce surfactant?
Type II pneumocytes
112
When does platelet production begin?
At week 6 in the yolk sac
At week 8 in the liver
113
When does the predominant Hb switch from fetal Hb to adult Hb?
Between birth and 12 months postnatally
114
At what gestation are B cells seen in the circulation?
Week 12
115
At what gestation are mature T cells seen in the circulation?
Week 14
116
When do intestinal villi start to develop?
Week 7
117
What is the swallowing rate at term?
250ml/day
118
What is the volume of amniotic fluid in pregnancy?
Week 12 - 50ml
Week 16 - 150ml
Week 34 - 1000ml (having increased 50ml/week from week 16)
Term - 500ml
119
What blood results are seen in DIC?
Thrombocytopenia
Prolonged APTT
Low fibrinogen
120
Which equation is used for eGFR?
MDRD (modification of diet in renal disease) equation
121
What factors are included in the eGFR equation?
Age
Creatinine
Gender
Ethnic group
122
How does tidal volume change in pregnancy?
40% increase
123
What is the equation for stroke volume?
SV = EDV - ESV
124
What is the size of the dominant ovarian follicle at the time of ovulation?
20mm
125
What is the equation for vital capacity?
Vital capacity = inspiratory capacity + expiratory reserve volume
126
What is the function of bile salts?
Absorption of fats
127
What is total blood volume in pregnancy?
5.6L
128
What is the maintenance fluid volume requirement?
30ml/kg/day
129
What is the anion gap?
The difference between the concentrations of the body's cations and anions
130
What causes an increase anion gap?
Lactic acidosis
Ketoacidosis
Hypoalbuminaemia
131
What is the normal pH/base excess of fetus'?
Base excess in vein = -1-9
pH in vein = 7.17-7.48
Base excess in artery = -2.5-10
pH in artery = 7.05-7.38
132
By how much does osmolarity decrease in pregnancy? And as a result of what?
10mOsm/L
As a result of progesterone
133
On what type of receptors doe PTH act on?
G protein-coupled receptor
134
Which hormone is important for placental Ca2+ transport?
PTHrP
135
Where is calcitonin produced?
C cells in the thyroid
136
What is the action of calcitonin?
Act to decrease circulating calcium by:
1. Preventing osteoclast actions
2. Decreased reabsorption of Ca2+ and phosphate from the PCT
3. Decreased C2+ absorption from the GIT
137
Where is vitamin D produced?
Skin, decidua, placenta
138
What autosomal dominant traits put you at increased risk of parathyroid cancer?
MEN1
MEN2A
139
What is the age of peak bone mineral density?
25
140
What are the osteoblast modulators?
PTH
Oestrogen
Glucocorticoids
Thyroid hormone
141
What are the osteoclast modulators?
TNF
IL-1/IL-6
GM-CSF
142
When does ossification occur during pregnancy?
3rd trimester
143
What is the A wave of the JVP?
Atrial systole
144
What is the X wave of the JVP?
Occurs at the end of atrial systole
145
What is the C wave of the JVP?
Ventricular systole
146
What is the V wave of the JVP?
Atrial filling against closed tricuspid valve
147
What is the Y descent of the JVP?
Occurs when tricuspid valve opens
148
What is the 1st heart sound?
Atrioventricular valve closure (at the start of ventricular systole)
149
What is the 2nd heart sound?
Semilunar valve closure (at the end of ventricular systole)
150
What is the 3rd heart sound?
Occurs at the beginning of ventricular diastole, due to rapid ventricular filling.
Common in pregnancy
151
What is the 4th heart sound?
Atrial systole
Absent in AF
152
What does pre-load depend on?
1. Intrathoracic pressure
2. Total blood volume
3. Gravity
4. Calf muscle action
5. Venous return
153
What does after-load depend on?
Arterial resistance
154
What is Starling's Law?
1) Force of contraction proportional to fibre length
2) Fibre length is proportional to stretch of ventricular muscle
3) Ventricular dilatation is proportional to venous return
Increased venous return
Increased stretching
Increased contraction
Stroke volume increases in proportion to the increase in blood volume in the ventricles
155
Where are baroreceptors found?
Carotid sinus
Aortic body
Floor of 4th ventricle
156
What are baroreceptors?
Sensitive to pressure, inhibitory in nature
157
What chemicals cause the vasodilation that occurs in pregnancy?
1. Increased NO
2. Decreased ADMA
3. Increased prostacyclin(PGI2)
158
What factors effect ventilation?
Airway compliance
Airway resistance
159
What is minute volume (MV)?
The total volume of gas entering the lung per minute
TMV = TV x RR
160
What is TV in ml/kg?
7ml/kg - i.e. approx. 500ml
161
What does a left shift on an oxygen dissociation curve indicate?
Higher affinity for O2
162
What factors cause a left shift on an oxygen dissociation curve?
CO
Fetal Hb
Decreased 2,3-DPG
163
What does a right shift on an oxygen dissociation curve indicate?
Decreased affinity for O2
164
What factors cause a right shift on an oxygen dissociation curve?
Hyperthermia
Acidosis
Hypercapnia
165
How long does gastric and intestinal emptying take?
Gastric emptying - 2-6 hours
Intestinal emptying - 3-5 hours
166
What is transit time through the large bowel?
24-150 hours
167
What does the macula densa measure, and where is it found?
Measures sodium concentration
Macula densa found in the ascending loop of Henle
168
What are the ascending impulses from bladder during bladder filling?
Bladder wall receptors ---> pelvic splanchnic nerve ---> sacral root S2-S4 ---> lateral spinothalamic tract ---> higher centres
169
When do the primordial follicles appear in-utero?
At 6 months gestation
170
What are the two phases of follicular growth?
Pre-antral - independant of FSH
Antral (Graafian) - dependant on FSH
171
How long is
Initiation
Recruitment
Selection
?Resting --> initiation (longer)
Initiation --> recruitment 65 days
Recruitment --> selection 5 days
Selection --> ovulation 10 days
80 days total
(375 days??)
'once initiated, follies take approximately 65 days to reach the size at which they can be recruited into a menstrual cycle...'
172
How long in the period between pre-antral follicle and ovulation?
80 days
173
Where do primordial germ cells originate?
Originate in the yolk sac, and then migrate into the ovaries
174
What controls the proliferative phase of the menstrual cycle?
Oestrogen produced by the Graafian follicle
175
What controls the secretory phase of the menstrual cycle/
Corpus luteum
176
How long does the corpus luteum persist in pregnancy?
Remains active throughout pregnancy
Luteo-placental shift is approx 7-8/40
177
What body mass is required for menarche?
48kg, with 17% of it being fat
178
What are the normal semen parameters?
Volume = 1.5ml
Sperm count per ml >15million
Sperm per ejaculate >33 million
Vitality >55%
pH 7.2-7.6
Motility >38%
Progressive motility >31%
Normal morphology >3%
179
What is the space between the pubic symphysis joint in pregnancy?
Up to 9mm
180
In generating an action potential, what is depolarisation due to?
Rapid opening of voltage-gated Na+ channels
181
In generating an action potential, wha is repolarisation due to?
Slow opening of the voltage-gated K+ channels
Closure of voltage-gated Na+ channels
182
What MAP is required to maintain cerebral perfusion?
>70mmHg
183
Describe the pre-ganglionic/post-ganglionic fibres of the SNS and PNS?
SNS pre-ganglionic fibres - cholinergic
PNS pre-ganglionic fibres - cholinergic
SNS post-ganglionic - adrenergic (except sweat glands that are cholinergic)
PNS post-ganglionic - cholinergic
184
What are the 4 cells types of the epidermis?
Keratinocytes
Melanocytes
Langerhans cells
Merkel cells
185
What are the layers of the epidermis?
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
186
What changes occur to the skin during pregnancy?
1. Striae gravidarum
2. Chloasma
3. Increased skin pigmentation
4. Linea nigra
5. Increased activity of the sebaceous and sweat glands
187
What is the osmolality of amniotic fluid?
275mOsm/L
188
At term how much urine does the fetus produce?
800-1200ml/day
189
How many ml is the first fetal breath?
10-60ml
190
What do the first and second fetal inspiratory efforts require in terms of pressure?
1st inspiratory effort requires a transpulmonary pressure of 60cmH20
2nd inspiratory effort requires a transpulmonary pressure of 40cmH20
191
What are the first fetal breaths triggered by?
Hypercapnia and hypoxia resulting fro partial occlusion of umbilical cord, and is promoted by 1) tactile stimulation; 2) decreased skin temperature
192
What are the risk factors for RDS?
1. Male
2. C-section
3. Perinatal asphyxia
4. Maternal diabetes
5. 2nd twin in an twin pregnancy
193
What causes the ductus arteriosus to close?
Rapid rise in pO2 at birth causing smooth muscle contraction and fall in prostaglandin levels
194
Where does foetal erythropoiesis take place?
3/40 - placenta and yolk sac
4/40 - liver and endothelium of blood vessels
End of first trimester - bone marrow and spleen
195
When do primips/multips first begin to feel movement?
Primips - at 18 weeks
Multips - at 16 weeks
196
How many lobules are there in each placenta?
40-60
197
What are the pressures in the umbilical artery/umbilical vein/maternal spiral artery?
Umbilical artery = 50mmHg
Umbilical vein = 20mmHg
Maternal spinal artery = 70mmHg
198
When do vernix and lanugo hair start to develop in the fetus?
Week 20
199
At what gestation does the fetus shed lanugo?
Week 36
200
What is avergae weight gain/week of the fetus?
<28/40 = 100g/week
>28/40 = 200g/week
201
Where a platelets produced?
Megakaryocytes
