Phsyiology Flashcards
What ph and electrolyte abnormalities are associated with hypokalaemia
Alkalosis
Remember K acts like H
Aciduria
May cause hyponatraemia
Glucagon effect on the heart
Positively inotropic
Pathway of CSF
- Lateral ventricles (via foramen of Munro)
- 3rd ventricle
- Cerebral aqueduct (aqueduct of Sylvius)
- 4th ventricle
- Subarachnoid space (via foramina of Magendie and Luschka)
- Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
Acute phase proteins
CRP
procalcitonin
ferritin
fibrinogen
alpha-1 antitrypsin
caeruloplasmin
serum amyloid A
haptoglobin
complement
Negative phase proteins
albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein
Which receptor does noradrenaline mainly bind to?
A1
The production of HCL
Features of vWD
Normal PT
High APTT due to 8 def
Action and cell that produces gastrin
G cells in antrum of the stomach
Increase HCL, pepsinogen and IF secretion, increases gastric motility, trophic effect on gastric mucosa
Action and cell that produces CCK
I cells in upper small intestine
Increases secretion of enzyme-rich fluid from pancreas, contraction of gallbladder and relaxation of sphincter of Oddi, decreases gastric emptying, trophic effect on pancreatic acinar cells, induces satiety
Action and cell that produce secretin
S cells in upper small intestine
Increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct cells, decreases gastric acid secretion, trophic effect on pancreatic acinar cells
Site of action of furosemide and % of sodium secreted
Ascending limb of loop of Henle
Na+/K+ 2Cl - carrier
Up to 25%
Site of action of Thiazides and % of sodium secreted
Distal tubule and connecting segment
Na Cl
3-5%
Site of action of Spiro and % of sodium secreted
DistalDCT/Cortical collecting tubule
Na/K ATPase
1-2%
VIP cell production and function
Small intestine, pancreas
Stimulates watery secretions by pancreas and intestines, vasodilates, inhibits acid and pepsinogen secretion
SS cell and function
D cells in the pancreas and stomach
Decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion
inhibits trophic effects of gastrin, stimulates gastric mucous production
Which part of the GI tract has the highest K secretions
Rectum- hence villous adenoma cause hypokalaemia
Vital capacity
Is the maximal volume of air that can be forcibly exhaled after a maximal inspiration.
Which vitamin/mineral is absorbed independent of pancreatic function
Folate
TXA MOA
Inhibition of plasmin
Factors causing renin section
Hypotension causing reduced renal perfusion
Hyponatraemia
Sympathetic nerve stimulation
Catecholamines
Erect posture
What produces renin
Juxtaglomerular cells
PE ABG
Resp alkalosis with hypoxia
What stimulates insulin release
Glucose
Amino acid
Vagal cholinergic
Secretin/Gastrin/CCK
Fatty acids
Beta adrenergic drugs
What does low Mg cause
Low Ca
Space LPs occur at
SUB ARACH SPACE
BETWEEN L3 and L4
Which hormones increase and decrease appetite 1
Obesity hormones
leptin decreases appetite
ghrelin increases appetite
Best marker of eGFR
Inulin
How is dead space measured
Fowlers method
Production of hormones in adrenals
Glomerular- aldosterone
Fasiculata - cortisol
Reticularis- sex hormones
Constitution of fluid in an adult
60% total body weight is water
40% of total body weight is intracellular fluids
20% of body weight is extracellular fluids
Stress response after surgery
Increase sympathetic- increase CO, vasoconstriction
Relaxation of GI
Release of renin
Increased GH, renin, glucagon, ACTH, Aldo, prolactin
Insulin, testo, oestrogen decreased
Cause of HTN in raised ICP
Sympathetic stimulation
Bleeding classification
<15- <750ml
-30- 1500ml- UO <20-30ml/hr, RR 20-30
-40- 2000ml - UO 5-15ml/hr, RR 30-40
>40- >2000ml- >140HR, RR >35, UO <5ml
Drug that increases a vagotomic stomach gastric emptying, when is it useful
Erythromycin
Diabetic gastropathy
Tx of urinary incontinence
Urge- detrusor muscle in these patients is unstable- demonstrate overactivity- Bladder training >6/52, if fails for oxybutynin (antimuscarinic drugs) then sacral nerve stimulation.
Stress- due to damage to supporting structures, or sphincter dysfunction
Pelvic floor exercises 3/12, if fails consider surgery.
Causes of reduced vital capacity
- Pulmonary fibrosis/infiltration/oedema/effusions
- Weak respiratory muscles e.g. MG, GBS, myopathies
- Skeletal abnormalities e.g. chest wall abnormalities
Normal TV
It is normally 500mls in males and 340mls in females.
Inspiratory reserve volume
The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration. 3000mls.
What is the BBB not not v permeable to
H+
Which cells produces the most TNF
Macrophages
TNF effects
TNF-alpha binds to both the p55 and p75 receptor- an induce apoptosis
Endothelial effects - platelet activating factor, IL-1 and prostaglandins
TNF promotes the proliferation of fibroblasts and their production of protease and collagenase
Systemic effects- pyrexia, increased acute phase proteins, cachexia
Hormones released in islet of langerhans
Beta cells Insulin (70% of total secretions)
Alpha cells Glucagon
Delta cells Somatostatin
F cells Pancreatic polypeptide
Tx of diarrhoea post ileal resection
Malabsorption of bile salts is a common cause of diarrhoea following ileal resection. A normal small bowel study and CRP effectively excludes active crohns
administration of cholestyramine (bile salt binding agent)
Half life of insulin
<30mins
Tx of refeeding syndrome
10 kcal/kg/day increasing to full needs over 4-7 days
Start immediately before and during feeding: oral thiamine 200-300mg/day, vitamin B co strong 1 tds and supplements
Give K+ (2-4 mmol/kg/day), phosphate (0.3-0.6 mmol/kg/day), magnesium (0.2-0.4 mmol/kg/day)
Drugs causing relaxation of LOS
Alcohol
Nicotine
Theophylline
Botulism
Electrolytes in parotid gland secretions
Levels of sodium and chloride are lower than plasma, potassium and bicarbonate levels are higher
Phases of wound healing
Haemostasis- erythrocytes and platelets, vasospasm and platelet plug
Inflammation- neutrophils migrate (impaired in diabetes) growth factor, fibroblasts and macrophages
Regeneration- fibroblasts produce a collagen network.
Angiogenesis occurs and wound resembles granulation tissue.
Remodelling -During this phase fibroblasts become differentiated (myofibroblasts)- nd these facilitate wound contraction.
Causes of increased anion gap
M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol -anti freeze
S - Salicylates
When is pleural space pressure equal to atmospheric
Valsava manourvre
% of Ca reabsorbed in normal kidneys
95%
Most important urinary buffer
Phosphate- most similar pKa
Causes of a left shift in O2 dislocation curve
The curve is shifted to the left when there is a decreased oxygen requirement by the tissue. This includes:
1. Hypothermia
2. Alkalosis
3. Reduced levels of DPG:
DPG is found in erythrocytes and is reduced in non exercising muscles, i.e. when there is reduced glycolysis.
4. Polycythaemia
Receptor for metoclopramide
D2 + 5HT3
Dobutamine receptor
B1
What can put people at risk of refeeding syndrome
Low BMI
Alcohol abuse
Chemo
Diuretics
Antacids
In trauma scenario what is best determinate of CBF
Intra CP
Carbimazole MOA
inhabit thyroid peroxidase enzyme
Strongest action of PTH
Increasing absorption in SI
What is reabsorbed at PCT
95% of amino acids
66% of filtered water
Volume of pancreatic secretions in 24 hours
1500ml
Respiratory centres and their action
Medullary respiratory centre-Inspiratory and expiratory neurones. Has ventral group which controls forced voluntary expiration and the dorsal group controls inspiration. Depressed by opiates.
Apneustic centre-Lower pons
Stimulates inspiration - activates and prolongs inhalation
Overridden by pneumotaxic control to end inspiration
Pneumotaxic centre- Upper pons, inhibits inspiration at a certain point. Fine tunes the respiratory rate.
Factors affecting ventilation rates
Peripheral chemoreceptors: located in the bifurcation of carotid arteries and arch of the aorta. They respond to changes in reduced pO2, increased H+ and increased pCO2 in ARTERIAL BLOOD.
Central chemoreceptors: located in the medulla. Respond to increased H+ in BRAIN INTERSTITIAL FLUID to increase ventilation. NB the central receptors are NOT influenced by O2 levels.
Lung receptors
Stretch receptors: respond to lung stretching causing a reduced respiratory rate
Irritant receptors: respond to smoke etc causing bronchospasm
J (juxtacapillary) receptors
PTH half life
10 mins
Calcitonin cells and Moa
Secreted by C cells of thyroid
Inhibits intestinal calcium absorption
Inhibits osteoclast activity
Inhibits renal tubular absorption of calcium
Excess Glucocorticoids causes..
Osteonecrosis
OP
Hypok
Growth retardation
Normal ICP
7-15mmHg
JVP waves
a- atrial contraction
c- closure and curving of tricuspid into RA
x- atrial relaXation
v- Venous filling of RA
y- atrial emptYing
Causes of hyperuricaemia
Increased synthesis
Lesch-Nyhan disease
Myeloproliferative disorders
Diet rich in purines
Exercise
Psoriasis
Cytotoxics
Decreased excretion
Drugs: low-dose aspirin, diuretics, pyrazinamide
Pre-eclampsia
Alcohol
Renal failure
Lead
Drugs causing hyperuriaemia
As a result of reduced excretion of urate
‘Can’t leap’
C iclosporin
A lcohol
N icotinic acid
T hiazides
L oop diuretics
E thambutol
A spirin
P yrazinamide
Different blood products and uses
Packed red cells Used for transfusion in chronic anaemia and cases where infusion of large volumes of fluid may result in cardiovascular compromise. Product obtained by centrifugation of whole blood.
Platelet rich plasma
Patients who are thrombocytopaenic and are bleeding or require surgery.
Low speed centrifuge
Platelet conc- for thrombocytopaenia
Administered to patients with thrombocytopaenia.
Fresh frozen plasma
Prepared from single units of blood.
Contains clotting factors, albumin and immunoglobulin.
Unit is usually 200 to 250ml.
Usually used in correcting clotting deficiencies in patients with hepatic synthetic failure who are due to undergo surgery.
Usual dose is 12-15ml/Kg-1.
Cryoprecipitate
Formed from supernatant of FFP.
Rich source of Factor VIII and fibrinogen.
Allows large concentration of factor VIII to be administered in small volume.
Most common causes of hypercalcaemia
Malignancy (most common cause in hospital in-patients)
Primary hyperparathyroidism (commonest cause in non hospitalised patients)
JVP wave pathologies
Absent a waves = Atrial fibrillation
Large a waves = Any cause of right ventricular hypertrophy, tricuspid stenosis
Cannon waves (extra large a waves) = Complete heart block
Giant cv waves = Tricuspid regurgitation
Slow y descent = Tricuspid stenosis, right atrial myxoma
Steep y descent = Right ventricular failure, constrictive pericarditis (high atrial pressure with low ventricle volume), tricuspid regurgitation
Drugs causing SIADH
A- analgesics- opioids, NSAIDs
Barbituates
Cycloph, chlorpromazine, carbamazpine
Diuretics- thiazides
Osmolality of the lumenal contents has the greatest effect on secretions from which of the structure
Jejenum
The secretions of the proximal small bowel are hugely and directly affected by lumenal content osmolality. This can contribute to some of the symptoms of dumping syndrome that can be seen following gastric surgery.
Neurotransmitters in autonomic nervous system
Noradrenaline
ACH in adrenal medulla
Where does the Monroe Kelly doctrine effect not work
As an infant- due to fontanelle
Cellular metabolism of glucose
Glucose enters the cell, subsequently a glycolytic process results in the generation of ATP and pyruvate
In the presence of oxygen, the pyruvate from the glycolytic process then enters the Krebs cycle
As the terminal step in the electron transport chain, oxygen is the terminal electron acceptor and creates water inside the mitochondria.
The oxidative pathways eventually yield a total of 36 ATP molecules
When oxygen is limited or absent, pyruvate enters an anaerobic pathway where can be converted into lactic acid. In addition to generating an additional ATP, this pathway serves to keep the pyruvate concentration low so glycolysis continues, and it oxidizes NADH into the NAD+ needed by glycolysis. In this reaction, lactic acid replaces oxygen as the final electron acceptor. The lactic acid produced diffuses into the plasma and is carried to the liver, where it is converted back into pyruvate or glucose via the Cori cycle
Factors effected by warfarin
2,7,9, 10 protein c
Causes of pseudohyponatraemia
Hyperlipidaemia and MM
How to calculate cerebral perfusion pressure
CPP= MAP- ICP
Calculate MAP
Diastolic +1/3 Systolic
Adrenaline effects on renin
Sympathetic stimulates JXG cells to release renin
Types of nerve fibres
Slow transmission of mechanothermal stimuli is transmitted via C fibres.
A γ fibres transmit information relating to motor proprioception, A β fibres transmit touch and pressure and B fibres are autonomic fibres.
Main hormone released from zone reticularis
dehydroepiandrosterone (DEA)
Vomiting centre and receptors
The vomiting centre is in part of the medulla oblongata and is triggered by receptors in several locations:
Labyrinthine receptors of ear (motion sickness)
Over distention receptors of duodenum and stomach
Trigger zone of CNS - many drugs (e.g., opiates) act here
Touch receptors in throat
Hypercapnia effect on blood flow in the brain
Vasodilation
ABG of low lyer at high altitude
Low pCO2 and O2
High HCO3
ABG of diarrhoea/fluid loss/ pancreatitis
Metabolic acidosis
Normal range ABG
pCO2- 4-6
po2- 10-14
HCO3- 22-26
Anion gap- 12-16
Difference between COPD too highly oxygenated and acute pneumonia ABG
Bicarb high in chronic COPD- due to comp
If acute pneumonia- no compensation
ECG findings hypokalaemia
Prolonged PR
ST dep
Flat T
U waves
ECG findings hyperkalaemia
Flat p
Tented T
Wide QRS
Ca effect on ECG
Hyper short QT
Hypo long qt
PE ECG features
Sinus tachy
S1 Q3 T3
Dopamine receptors
D1 D2
(a1,2 B1)
Effects of adrenal and dopamine receptors
α-1Vasoconstriction- ureters, uterus
α-2 negative feedback, decrease insulin, platelet aggregation
β-1 Increased cardiac contractility and HR
β-2 Smooth muscles relaxation- broncho
D-1 Renal and spleen vasodilatation
D-2 Inhibits release of noradrenaline
A adrenergic receptors on glucose meta
- Inhibits insulin
- Stimulates glycogenolysis in the liver and muscle
- Stimulates glycolysis in muscle
b adrenergic receptors on glucose meta
- Stimulates glucagon secretion
- Increase glucose uptake
- Stimulates ACTH
- Stimulates lipolysis by adipose tissue
Dose response of dopamine
@ Very low dose (<4μgm/kg/min) rises GFR & Na+ excretion (Renal dose is an obsolete concept)
@ Higher dose cz - β1 (+) - thus rises HR & contractility
@ Very high dose (>10 μgm/kg/min) cz α1(+) thus reduces tissue perfusion & GFR
Dobutamine systemic effects
Has both β 1,β 2 effects & will increase CO & cause decrease in systemic vascular resistance.
Hormonal effects on pancreatic juices
Secretin - causes secretion of water and electrolytes of pancreatic juice
Cholecystokinin -causes increase volume of enz.of pancreatic juice
Somatostatin- Secretion causes decrease the volume of pancreatic juice
Aldosterone- conserves electrolytes of pancreatic juice
Pancreatic tumour symptoms
Gastrinoma- PUD, ulceration, haematemesis
Glucagonoma- diarrhoea, anaemia, nicrolytic migrating erythema, high glucose
Somatostatinoma- obstructive jaundice, gallstones
Insulinoma- hypos
Insuline receptor type
Tyrosine kinase
Inhibitors of insulin
Beta blockers, a adrenergic, glucagon
Stimulates of insulin
Glucose, amino acids, FA
Secretin, gastrin, CCK
Beta adrenergic, vagal cholinergic
MEN 1
Parathyroid
Pancreatic tumour- insulinoma
Pituiatary- prolactinoma, ACTH, GH
Most commonly present with hypercalcaemia
MEN 2a
Phaeochromocytoma
Medullary thyroid cancer (70%) Hyperparathyroidism (60%)
MEN 2b
Phaeo
Medullary thyroid cancer
Marfanoid
Mucosal neuromas
Intrinsic pathway
Surface contact
Activates factor 12 then 11 then 9 then 10 through 8
Molecule types of coag factors
Most- serine proteases
V, VIII- glycoproteins
XIII- Transglutaminase
Factors heparin affects
2, 9, 10, 11
Factors warfarin affects
2, 7, 9, 10
Coag Factors DIC affects
1, 2, 5, 8, 11
Coag factors Liver disease affects
Factors 1(fibrinogen),2 (thrombin) ,5,7,9,10
Coag factors in each pathway
Intrinsic- 8,9,10,12
Extrinsic- 7
Common- 2,5,10
What affects just intrinsic pathway
Haemophillia
vWD
What affects intrinsic pathway
Heparin, haemophilia
vWF coag timings
APPT rise due to VIII low
MOA of LMWH (and fonda)
Activates anti- thrombin to inactivate Xa
MOA of heparin
Activates anti-thrombin to inactivate Xa and thrombin (2)
Massive bleed on warfarin tx
Stop warfarin, IV vit K, PCC
What precipitates sickle cell crisis
Dehydration, infection, hypoxia
Drugs causing aplastic anaemia
Indomethaicn
Sulphonamides
Penicillamine
Causes of severe thrombocytopenia
ITP- AI
DIC
TTP- ADAMTS13
Where is iron absolved
Duodenum and upper jejunum
Symptoms of vit A def
Night blindness
Symptoms of vit C def
- gingivitis, loose teeth
- poor wound healing
- bleeding from gums, haematuria, epistaxis
Vit B1 deficiency
Thiamine
Beri beri
Wernicke’s encephalopathy - ophthalmoplegia, ataxia and confusion
Korsakoff’s syndrome,
( irreversible psychosis characterized by amnesia confabulatn
Vit B2 def
Riboflavin
Glossitis
Dermatitis
Paryngitis
Vit B3 def
Niacin
Pellagra
Neck rash
Diarrhea, dermatitis, dementia
Vit B6 def
Pyridoxine
Microcytic anaemia
Vit B9 def
Folic acid
Pernicious anaemia
Macrocytic anaemia
Pregnant- birth defects
Vit B12 def
Colbalamin
Peripheral neuropathy
Mac anaemia
Causes of malabsorption
Intestinal causes of malabsorption
* coeliac disease
* Crohn’s disease
* Whipple’s disease
* Giardiasis
* brush border enzyme deficiencies (e.g. lactase insufficiency)
Pancreatic causes of malabsorption
* chronic pancreatitis
* cystic fibrosis
* pancreatic cancer
Biliary causes of malabsorption
Other causes
* biliary obstruction
* primary biliary cirrhosis
Diseases of collagen
Ehlers Danlos
Osteogenesis imperfecta
Which coag factors are most temp sensitive
Factor V and VIII
Average stroke volume
70ml
Bainbridge reflex
Atrial stretch receptors increase firing from increased preload causing increased HR
Production of adrenaline
The adrenal gland releases adrenaline in response to increased sympathetic discharge from preganglionic sympathetic fibres of the splanchnic nerves.
These cause the chromafin cells of the medulla to release adrenaline (which is preformed) by exocytosis.
Which drug does not interfere with cortisol levels but still provides treatment
Dexamethasone
If you have a patient with polymyalgia rheumatica and they are on long term prednisolone, you can replace the prednisolone with dexamethasone to undertake a short synacthen test.
Functional residual capacity
Volume left in lung after passive expiration
Factors affecting FRC
Increased FRC:
Erect position
Emphysema
Asthma
Decreased FRC:
Pulmonary fibrosis
Laparoscopic surgery
Obesity
Abdominal swelling
Muscle relaxants
When is urgent management of hypercalcaemia needed
> 3.5
Reduced consciousness
Severe abdo pain
Pre renal failure
What is used to measure renal plasma flow
PAH
RPF (in cc/min) x [PAH] in plasma = [PAH] in urine x urine flow rate V (in cc/min).
Rearranging, RPF = [PAH] in urine x urine flow rate V (in cc/min)/[PAH] in plasma.
Spleen components and function
In the red pulp, blood filled venous sinuses are found.
In the white pulp, reticuloendothelial cords and white lymphoid follicles are present.
CI for cell saver device
Infection or malignancy of graft
Stored blood affinity for oxygen
Less 2,3 DPG
Therefore has a higher affinity of O2 and reduces it release to metabolising tissues
Condition causing increased lung compliance
Emphysema- due to loss of alveolar walls and elastic tissues
Glucagon make up, cell that product it and what it responds to
Glucagon is a protein comprised of a single polypeptide chain.
Produced by alpha cells of pancreatic islets of Langerhans in response to hypoglycaemia and amino acids.
Onufs nucleus location and function
Onufs nucleus is located in the anterior horn of S2 and is the origin of neurones to the external urethral sphincter.
Tx of vWD bleeding
Desmopressin
Warfarin half life and metabolisms
Half life 40 hours
Metabolised in the liver
Small volume of distribution as protein bound
Heparin and LMWH electrolyte disturbance
Hyperkalaemia
Treatments of different shocks
Hypovolaemic- fluid resus
Septic- vasopressors
Neurogenic- fluid until 90 MAP
Cardiogenic- inotropes, vasodilators, pumps
ABG of high output ureterosigmoidostomy
In the large intestine, sodium is swapped for potassium, and chloride for bicarbonate, this causes hypokalaemia and acidosis.
What does the parietal cell secrete
HCl, Ca, Na, Mg and intrinsic factor
Where does the majority of water absorption occur in the GI
Jejunum
What does giving 5% dextrose do to the urine osmolarity
Decrease
Main component of thyroid colloid
Thyroglobulin
Catecholeamine derivatives
Tyrosine
it is modified by a DOPA decarboxylase enzyme to become dopamine
If someones normal BP is 120/80 and it drop to 110/70 what happens to the GFR
Nothing- auto regulated
Specific gravity of urine
Measure of concentrates in urine
Electrolyte abnormality of compartment syndrome
Hyperkalaemia
Muscle death will result in the release of potassium. It is also highly likely that there will be a degree of renal impairment, the result of which is that the serum potassium is likely to be high.
Location of arterial baroreceptors
Aortic arch and sinus
Synthesis of T3/T4
Thyroid actively concentrates iodide to twenty five times the plasma concentration.
Iodide is oxidised by peroxidase in the follicular cells to atomic iodine which then iodinates tyrosine residues contained in thyroglobulin.
Iodinated tyrosine residues in thyroglobulin undergo coupling to either T3 or T4.
Process is stimulated by TSH, which stimulates secretion of thyroid hormones.
The normal thyroid has approximately 3 month reserves of thyroid hormones.
Receptor of T3
T3 binds to a receptor on chromatin to induce protein synthesis.
Stimulation and suppression of prolactin
TRH stimulates
Dopamine suppresses
Where is iron absorbed
Duodenum- most
And jejunum
Pre renal uraemia vs ATN
Urine sodium
<20 PRU
>30 ATN
PRU- responds to fluids
ATN- doesn’t
When does the O2 curve shift to the right
The curve is shifted to the right when there is an increased oxygen requirement by the tissue
This includes:
Increased temperature
Acidosis
Increased DPG:
C O2
A cidosis
2,3-DPG
E xercise
T emperature
Causes of increased TLCO
Asthma
Haemorrhage
Left-to-right shunts, Polycythaemia
What respiratory factors are affected by pain
V/Q
FRC- decreased
Minute vent volume
Tidal volume
Volume of dextrose vs saline staying intravascular
Dex 1/12th of volume
Saline 1/4
What condition increases FRC
Empyshema - more compliant lungs
Where the majority of glucose is reabsorbed in kidney
SGLT2 receptor in S1/2 segment of PCT
SGLT1 transporter
Main in GI tract
High affinity low capacity
1 glucose and 2 Na
SGLT2 transporter
In kidney
Responsible for 90% of glucose - SGLT1 10%
Required 1 glucose to 1Na
What generate I2 in thyroid
Thyroid peroxidase
What produces thyroglobulin
Follicular epithelial
What inhibits lactation in pregnancy
Progesterone
Vital capacity is equal to
IRV+TV+ERV
3+0.5+1.5
Complete cord transaction sx
Areflexia- can become hyper after weeks
Incontinence
Flaccid paralysis
Triple flexion response- usually after days/weeks - flexion of hip, knee and dorsi
Oxygen affinity in stored blood
Reduced DPG so increased affinity
High Na, dry membranes, increased urinary frequency
DI
HR change with inspiration, pressure on eye, after meal and pressure on SA node
Inspiration- increases HR decreased BP
Eye- decreases
After meal- increase
Pressure- decrease
Thyroid hormones effects on glucose, adrenergic receptors
Increase glucose availability- increase absorption, glycogenolysis, lipolysis
Increase B adrenergic expression
Site of testosterone production in med
Intersitital cells or Leydig
Function of Sertoli
Aid development of sperm cells
Produce anti Mullerian hormone
pH of saliva, conc of K , osmolarity and where it is produced
Low acidic 6-7.4
Higher K
Lower Na Cl
Hypotonic
Acinar cells
Cardiac index equal to
CO /BSA
What does the JXG cells produce and what cells type
Renin
Smooth muscle cell
Normal PR
0.12-0.2
Normal mean pulmonary arterial pressure
15mmHg
Where is angiotensinogen produced
Liver
What blood vessels are most sensitive to nitrates
Large veins
Atrial flutter vs fib
Flutter- regular, saw tooth- 2:1, 3:1
Fib- irregular, no p
Normal lung values for 70kg
IRV 3L
TV 0.5L
ERC- 1L
VC- 4.5L
TLC 5-6L
hcG effect on hormones
Increase oestrogen and progesterone
Prolactin
Inhibits
Where is oestrogen and progesterone produced in pregnancu
Initially corpus leuteum
Then placenta
Na, Cl, K, proteins intracellular vs extra
More Na extra
Cl extra
K Inta
Proteins intra
CI and oxygen delivery post major surgery
Increase
Correlate well with outcome
O2 and CO2 effects on Cerebral blood flow
Hypoxia increase
Hypercapnia increase
By autoregulaiton
Fluid in DCT in comparison to plasma
Hypotonic
Phases of cardiac potetnail
0- influx of Na
1- efflux of K (Na close)
2- slow influx of Ca (K continue)
3- efflux of K (Ca close)
4- Na/Ca efflux, K influx - resting
Which channel is mainly responsible for resting membrane potential
K
What can you find in urine of phaeo
VMA
Glucose
Normal PEFR
Above 500L/min men
400L/min women
What hormone is overproduced in Prader willi
High Ghrelin
Vasodilatory substance produced by endothelial cells via metabolism of Argenine
Nitric oxide
NOT NITROUS
Calcitonin MOA
Block osteoclast
Stop break down of bone
Minor- inhibit kidney reabsorption
Neuronal fibres responsible for pain
A delta - immediate
C- slow
A beta neuronal fibres
Large myelinated- light touch
A alpha neuronal fibres
Proprioception
Golgi
B neuronal fibres
Pre ganglionic Autonomic
C neuronal fibres
Pain
Unmyelinated
Postganglionic fibres
A delta fibres
Pain receptors
Cold receptors
Motor neurons classfication of fibres
A- Aa- Extrafusal
B- Ab
y- Ay- intrafusal
What motor protein controls cilia- absence causes what condition
Dynein
Absent in Kartangers
Factors affecting rate of volume leaving stomach
Volume of stomach contact and composition
Isotonic - maximum
Hypertonic- slower
Faster laying down
Fat- slower
Blood volume % of body weight
7%
Inhbitory neurtransmitters
Glycine
GABA
Serotonin
Where pain impulses are modified
By descending tracts inputting on dorsal horn
Reabsorption of phosphate in kidneys
P with Na in PCT in renal tubule cells
Most important factor for increasing resp rate
Increase H+ in CSF
Location of muscarinic vs nicotinic receptors
Nicotonic- CNS and NMJ
Muscle
Adrenal medulla
Pre to post ganglion- para and symp
Muscarinic- peripheral organs and CNS
Cardiac
Sweat in symp
Valsalva manoeuvre and effects
Forced expiration against closed glottis
Increase intrathroacic pressure
Decreased return to RA
Reduced CO
Initial screening test and confirmation for acromegaly
IGF1 screening
Glucose tolerance- confirm
Cause of air emboli
Lap surgery
Open heart surgery
Central venous catheter
Massive transfusion
Maltose digestion
By maltase into 2 glucose molecules
Aldosterone action in GI, salivary and sweat glands
Na and water reabsorption for K
Primary motor cortex location
Precenteal gyrus
Location of somatosensory cortex
Postcentral cortex
Main stimulation of peripheral chemo
PO2
Main factor determining rate of urine prodcution
Tubular function
As GFR usually constant
Which cells secrete IF
Parietal
SVR regulation mainly by
Arterioles
Normal QT
0.4
Drugs causing prolonged QT
QT MAK
Quinine
TCA
Macrolides
Amiodarone
Ketoconazole
Progesterone effects on respiration
Increases resp rate
Decrease pCO2
CSF composition compared to plasma
0.5% of protein
Lower K, Ca, HCO3, glucose
Pituitary acidophils and basophils produce
Acidophils- GH, prolactin
Basophils- TSH, LH, FSH, ACTH
What arterial factors directly affect CBF
pH not PCO2
PO2
Where is aldosterone produce
Glomerulosa
Na reabsorption in DCT
10%
By Na/Cl symporter
Na reabsorption in ascending
Na/K/2Cl
Symporter
What produced PTH
PTH chief cells
FSH function in men
Stimulates testicular growth
Production of androgen binding protein by sertoli
(not responsible for testosterone)
LH function in med
Production of testosterone by leydig
Factors affecting prolactin levels
Dopamine inhibits
Hypothalamus has dopamine secreting neurons - under control
Oestrogen inhibits dopamine
Prolactin increases with stress and trauma
Factors causing inaccuracy of pulse ox levels
Increased skin pigmentation - bilirubin
Arrythmia
Hypotension
Vasoconstriction
Nail varnish
Venous pO2 at rest
5kPa
How much CO received by skin
5%
Dendrites vs axons
Dendrites towards body
Axons away
ECG features of hypothermia
J waves
Which branches are conducting zones vs exchange zone in resp
First 16- conducting
Last 7 exchange
% of O2 dissolved in plasma
1.5-2 %
Main function of colon
Na and water absorption
Na/K - active
Water passive
Where is calcitonin produced
C cells of thyroid
What substances increase renal flow rate
Prostaglandins - dilate afferent arteriol
AG2- constrict efferent
Glucocorticoids and NO- dilate afferent
Enzyme produced in duodenum
CCK, secretin, VIP(also panc), SS (also panc +stoamch)
Hagen Poiseuille law
Flow= (pie x pressure x radius ^4)/ 8x viscosity x length
Flow is directly prop to pressure, radius ^4
Inversely to length and viscosity
CO2 effects on O2 curve
Decreased CO2 shifts to left
Bohr effect
What pO2 measured
O2 dissolved in plasma
CO effects on cells
Binds to cytochrome system causing cellular dysfunction
Does not readily dissociate
What causes spread of AP in muscles
T tubes
Where is Ca released from in muscles after AP
Sarcoplasmic reticulum into cytoplasms
Where is DHEA produced
Adrenal cortex
How to measure FRC
Helium wash out
What directly activated pepsinogen
pH and pre existing pepsin
ST segment length
0.08
Calculating FRC
RV + ERV
Intra aortic ballon pump moa and physiological effects
Inflates during diastole - increasing coronary perfusion
Deflates in systole - decreasing after load via vacuum increasing CO
Normal volume of pleural fluid
10-20ml
Where Ca is absorbed and factors effecting absorption
Duodenum and jejenum
Phytic acid
Fatty acid- reduced absorption
Physiological vs anatomical shunt
Anatomical- blood is returned via the pulmonary veins without passing through the pulmonary capillaries, thereby bypassing alveolar gas exchange
Physiological- anatomical and blood goes through non perfused alveoli
% of left ventricle supplied by RCA
1/3- inferior
% of CO to bronchial
2%
Patient is dehydrated, which part of nephron will contain hypotonic solution
End of ascending limb due to reabsorption of Na
What structure carries Right Bundle Branch
Moderator band
Septomarginal trabecular
Absoption of iron
More efficient in Fe2+
Physiological pH in 3+ state
pH of stomach converts to 2+
Which hormone can act as contrcaption in post part period
Prolactin
As inhibits LH/FSH
Types of skin receptors
Meckels- slow- pressure
Pacinian- rapid- vibration- deeper dermis
Free nerve - acute and chronic pain
Meissner- rapid- light touch and vibration
Ruffni- slow- streching of skin
Macula densa vs JXG
Macula- DCT
Sense Na
Release PG to JXG to cause renin release
Afferent- JXG
Sense BP
Release Renin
Where is CSF produced and by what
Choroid plexus
Specialised ependymal
Exercise effects of SBP and DBP
SBP- increase
DBP- decrease
Pain effect on myocardial blood flow
Decrease
Dorsal vs ventral root ganglion contents
Dorsal- cell bodies of afferent
Ventral- cell bodies of efferent
Where second and third order neurons synapse for pain pathway
Thalamus
Kupffer cell function
Recycle old red blood cells - to use haemoglobin for iron and bilirubin
Problem with creatine as measure of GFR
Secreted so overestimates
But lab underestimates plasma creatine so cancel each other
Where is fat absorbed
Proximal intestine
What maintains volume in DI
Thirst
Organ with greatest blood flow per 100g
Kidney
Where transection occurs to stop breathing
Below medulla
HR of transplanted heart
Vagus nerve transected so usually tachy
Which hormone is the main cause of hyperglycaemia post trauma
Adrenaline
Red flags of sepsis
> 130 HR
/= 25 RR
<90
2 lactate
Normal obs for infants
100-150 bpm
25-35 rr
>1.5 UO
80-100 BP
WCC- 6-15
Structure of bone
Woven- primary- unmineralised collagen unorganised
Lamellar- secondary- mineralised organised
Lamellar:
Spongy and compact bone
Compact- osteon
Concentric layers of lamellar
Lacunar gaps in-between -containing osteocytes- canaliculi join lacunar
Middle- Haversian canal- volkam join this
Types of ossification
Endochondral ossification – Where hyaline cartilage is replaced by osteoblasts secreting osteoid. The femur is an example of a bone that undergoes endochondral ossification.
Intramembranous ossification – Where mesenchymal (embryonic) tissue is condensed into bone. This type of ossification forms flat bones such as the temporal bone and the scapula.
Temp thermoregulation fails
30
Most common cause of TIA
atheroscleorsis at carotid bifurication
Amount of Na and glucose in Hartmann
131
0
What can cause a decreased anion gap
Hypoalbuminaemia
HyperCa, Mg
Major fat in LDL, what binds to receptor
Cholestrol
Apolipoprotein B attaches to receptor LDLR
Involved in cholestrol transport - HDL reverse
Formed from vLDL
Permanent cell and examples
Cannot replicate
Neurone and erythrocytes
What substances are trasnported by fac diffusion vs active acorss placenta
Glucose facilitated
Amino acids, steroids, nucleotides, water soluble vitamins- Active
Early vs late complications of radiotherapy
Early
Skin reaction
BM failure
GI reaction
Infertility
Late
Secondary malignancy
Hypothyroid
Cauda equina but pacemaker in situ
CT myelogram
Oocyte, ovum
Ooocyte developing
Ovum mate
Dextrose isotonic vs hypotonic
Isotonic on delivery- quickly metabolised to become hypotonic
Stages of cell cycle
Pro- chromosomes form adn spindle attaches
Meta- middle of cell
Ana- tubules drag to opposite sides of cell
Telo- new membranes
Hexamethonium MOA
Non depolarising
Blocks post synaptic autonomic
Cause of prolonged thrombin time
Hypofibrinogenaemia
Or heparin
Initial collagen in wound healing
Type 3
1 later
Which cells store heparin
Mast cells
Where does CVP tip lie
Lower SVC
Hiradrrentitis suppurata
Chronic disease of apocrine sweat glands
MOA of organophosphates
Hyperpolarisation- decrease HR
Omental patch blood supply
Has own blood supply - so not free flap
Ventral vs lateral corticospinal tract
Lateral- larger- limbs
Ventral- small, neck and limb
What causes menstruation
Progesterone withdrawal
Capacitisation of sperm
Allows them to move
Oestrogen production in pre vs post menopausal
Pre- ovaries
Post- peripheries - aromatase lead
SOB and chocolate coloured blood after delivery of what local
Prilocaine
Cause methaglobinaemia
Wells score components
Active cancer
Bedridde, major surgery <12w
Calf swelling more than the other
Prev DVT
Immobilisation
Pitting oedema
Localised tenderness
Entire leg swollen
Superfiical veins
Examples of accessory muscle in respiration
Scalene, pec major, traps
EIC
Rotation in malrotation and location of organs
Only 90 anticlockwise
Caecum on left, rest on right
Number of paranasal sinuses and most prone to infection
4
Maxillary- next to teeth
