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eMRCS questions > Phsyiology > Flashcards

Phsyiology Flashcards

1
Q

What ph and electrolyte abnormalities are associated with hypokalaemia

A

Alkalosis
Remember K acts like H

Aciduria
May cause hyponatraemia

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2
Q

Glucagon effect on the heart

A

Positively inotropic

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3
Q

Pathway of CSF

A
  1. Lateral ventricles (via foramen of Munro)
  2. 3rd ventricle
  3. Cerebral aqueduct (aqueduct of Sylvius)
  4. 4th ventricle
  5. Subarachnoid space (via foramina of Magendie and Luschka)
  6. Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
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4
Q

Acute phase proteins

A

CRP
procalcitonin
ferritin
fibrinogen
alpha-1 antitrypsin
caeruloplasmin
serum amyloid A
haptoglobin
complement

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5
Q

Negative phase proteins

A

albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein

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6
Q

Which receptor does noradrenaline mainly bind to?

A

A1

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7
Q

The production of HCL

A
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8
Q

Features of vWD

A

Normal PT
High APTT due to 8 def

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9
Q

Action and cell that produces gastrin

A

G cells in antrum of the stomach

Increase HCL, pepsinogen and IF secretion, increases gastric motility, trophic effect on gastric mucosa

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10
Q

Action and cell that produces CCK

A

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

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11
Q

Action and cell that produce secretin

A

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

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12
Q

Site of action of furosemide and % of sodium secreted

A

Ascending limb of loop of Henle
Na+/K+ 2Cl - carrier
Up to 25%

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13
Q

Site of action of Thiazides and % of sodium secreted

A

Distal tubule and connecting segment
Na Cl
3-5%

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14
Q

Site of action of Spiro and % of sodium secreted

A

DistalDCT/Cortical collecting tubule
Na/K ATPase
1-2%

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15
Q

VIP cell production and function

A

Small intestine, pancreas

Stimulates watery secretions by pancreas and intestines, vasodilates, inhibits acid and pepsinogen secretion

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16
Q

SS cell and function

A

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

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17
Q

Which part of the GI tract has the highest K secretions

A

Rectum- hence villous adenoma cause hypokalaemia

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18
Q

Vital capacity

A

Is the maximal volume of air that can be forcibly exhaled after a maximal inspiration.

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19
Q

Which vitamin/mineral is absorbed independent of pancreatic function

A

Folate

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20
Q

TXA MOA

A

Inhibition of plasmin

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21
Q

Factors causing renin section

A

Hypotension causing reduced renal perfusion
Hyponatraemia
Sympathetic nerve stimulation
Catecholamines
Erect posture

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22
Q

What produces renin

A

Juxtaglomerular cells

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23
Q

PE ABG

A

Resp alkalosis with hypoxia

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24
Q

What stimulates insulin release

A

Glucose
Amino acid
Vagal cholinergic
Secretin/Gastrin/CCK
Fatty acids
Beta adrenergic drugs

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25
Q

What does low Mg cause

A

Low Ca

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26
Q

Space LPs occur at

A

SUB ARACH SPACE
BETWEEN L3 and L4

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27
Q

Which hormones increase and decrease appetite 1

A

Obesity hormones
leptin decreases appetite
ghrelin increases appetite

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28
Q

Best marker of eGFR

A

Inulin

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29
Q

How is dead space measured

A

Fowlers method

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30
Q

Production of hormones in adrenals

A

Glomerular- aldosterone
Fasiculata - cortisol
Reticularis- sex hormones

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31
Q

Constitution of fluid in an adult

A

60% total body weight is water
40% of total body weight is intracellular fluids
20% of body weight is extracellular fluids

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32
Q

Stress response after surgery

A

Increase sympathetic- increase CO, vasoconstriction
Relaxation of GI
Release of renin

Increased GH, renin, glucagon, ACTH, Aldo, prolactin

Insulin, testo, oestrogen decreased

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33
Q

Cause of HTN in raised ICP

A

Sympathetic stimulation

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34
Q

Bleeding classification

A

<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

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35
Q

Drug that increases a vagotomic stomach gastric emptying, when is it useful

A

Erythromycin
Diabetic gastropathy

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36
Q

Tx of urinary incontinence

A

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.

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37
Q

Causes of reduced vital capacity

A
  1. Pulmonary fibrosis/infiltration/oedema/effusions
  2. Weak respiratory muscles e.g. MG, GBS, myopathies
  3. Skeletal abnormalities e.g. chest wall abnormalities
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38
Q

Normal TV

A

It is normally 500mls in males and 340mls in females.

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39
Q

Inspiratory reserve volume

A

The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration. 3000mls.

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40
Q

What is the BBB not not v permeable to

A

H+

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41
Q

Which cells produces the most TNF

A

Macrophages

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42
Q

TNF effects

A

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

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43
Q

Hormones released in islet of langerhans

A

Beta cells Insulin (70% of total secretions)
Alpha cells Glucagon
Delta cells Somatostatin
F cells Pancreatic polypeptide

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44
Q

Tx of diarrhoea post ileal resection

A

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)

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45
Q

Half life of insulin

A

<30mins

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46
Q

Tx of refeeding syndrome

A

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)

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47
Q

Drugs causing relaxation of LOS

A

Alcohol
Nicotine
Theophylline
Botulism

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48
Q

Electrolytes in parotid gland secretions

A

Levels of sodium and chloride are lower than plasma, potassium and bicarbonate levels are higher

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49
Q

Phases of wound healing

A

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.

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50
Q

Causes of increased anion gap

A

M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol -anti freeze
S - Salicylates

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51
Q

When is pleural space pressure equal to atmospheric

A

Valsava manourvre

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52
Q

% of Ca reabsorbed in normal kidneys

A

95%

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53
Q

Most important urinary buffer

A

Phosphate- most similar pKa

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54
Q

Causes of a left shift in O2 dislocation curve

A

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

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55
Q

Receptor for metoclopramide

A

D2 + 5HT3

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56
Q

Dobutamine receptor

A

B1

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57
Q

What can put people at risk of refeeding syndrome

A

Low BMI
Alcohol abuse
Chemo
Diuretics
Antacids

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58
Q

In trauma scenario what is best determinate of CBF

A

Intra CP

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59
Q

Carbimazole MOA

A

inhabit thyroid peroxidase enzyme

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60
Q

Strongest action of PTH

A

Increasing absorption in SI

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61
Q

What is reabsorbed at PCT

A

95% of amino acids
66% of filtered water

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62
Q

Volume of pancreatic secretions in 24 hours

A

1500ml

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63
Q

Respiratory centres and their action

A

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.

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64
Q

Factors affecting ventilation rates

A

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.

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65
Q

Lung receptors

A

Stretch receptors: respond to lung stretching causing a reduced respiratory rate
Irritant receptors: respond to smoke etc causing bronchospasm
J (juxtacapillary) receptors

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66
Q

PTH half life

A

10 mins

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67
Q

Calcitonin cells and Moa

A

Secreted by C cells of thyroid

Inhibits intestinal calcium absorption
Inhibits osteoclast activity
Inhibits renal tubular absorption of calcium

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68
Q

Excess Glucocorticoids causes..

A

Osteonecrosis
OP
Hypok
Growth retardation

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69
Q

Normal ICP

A

7-15mmHg

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70
Q

JVP waves

A

a- atrial contraction
c- closure and curving of tricuspid into RA
x- atrial relaXation
v- Venous filling of RA
y- atrial emptYing

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71
Q

Causes of hyperuricaemia

A

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

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72
Q

Drugs causing hyperuriaemia

A

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

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73
Q

Different blood products and uses

A

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.

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74
Q

Most common causes of hypercalcaemia

A

Malignancy (most common cause in hospital in-patients)

Primary hyperparathyroidism (commonest cause in non hospitalised patients)

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75
Q

JVP wave pathologies

A

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

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76
Q

Drugs causing SIADH

A

A- analgesics- opioids, NSAIDs
Barbituates
Cycloph, chlorpromazine, carbamazpine
Diuretics- thiazides

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77
Q

Osmolality of the lumenal contents has the greatest effect on secretions from which of the structure

A

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.

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78
Q

Neurotransmitters in autonomic nervous system

A

Noradrenaline

ACH in adrenal medulla

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79
Q

Where does the Monroe Kelly doctrine effect not work

A

As an infant- due to fontanelle

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80
Q

Cellular metabolism of glucose

A

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

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81
Q

Factors effected by warfarin

A

2,7,9, 10 protein c

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82
Q

Causes of pseudohyponatraemia

A

Hyperlipidaemia and MM

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83
Q

How to calculate cerebral perfusion pressure

A

CPP= MAP- ICP

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84
Q

Calculate MAP

A

Diastolic +1/3 Systolic

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85
Q

Adrenaline effects on renin

A

Sympathetic stimulates JXG cells to release renin

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86
Q

Types of nerve fibres

A

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.

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87
Q

Main hormone released from zone reticularis

A

dehydroepiandrosterone (DEA)

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88
Q

Vomiting centre and receptors

A

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

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89
Q

Hypercapnia effect on blood flow in the brain

A

Vasodilation

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90
Q

ABG of low lyer at high altitude

A

Low pCO2 and O2
High HCO3

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91
Q

ABG of diarrhoea/fluid loss/ pancreatitis

A

Metabolic acidosis

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92
Q

Normal range ABG

A

pCO2- 4-6
po2- 10-14
HCO3- 22-26
Anion gap- 12-16

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93
Q

Difference between COPD too highly oxygenated and acute pneumonia ABG

A

Bicarb high in chronic COPD- due to comp
If acute pneumonia- no compensation

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94
Q

ECG findings hypokalaemia

A

Prolonged PR
ST dep
Flat T
U waves

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95
Q

ECG findings hyperkalaemia

A

Flat p
Tented T
Wide QRS

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96
Q

Ca effect on ECG

A

Hyper short QT
Hypo long qt

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97
Q

PE ECG features

A

Sinus tachy
S1 Q3 T3

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98
Q

Dopamine receptors

A

D1 D2
(a1,2 B1)

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99
Q

Effects of adrenal and dopamine receptors

A

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

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100
Q

A adrenergic receptors on glucose meta

A
  • Inhibits insulin
  • Stimulates glycogenolysis in the liver and muscle
  • Stimulates glycolysis in muscle
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101
Q

b adrenergic receptors on glucose meta

A
  • Stimulates glucagon secretion
  • Increase glucose uptake
  • Stimulates ACTH
  • Stimulates lipolysis by adipose tissue
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102
Q

Dose response of dopamine

A

@ 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

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103
Q

Dobutamine systemic effects

A

Has both β 1,β 2 effects & will increase CO & cause decrease in systemic vascular resistance.

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104
Q

Hormonal effects on pancreatic juices

A

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

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105
Q

Pancreatic tumour symptoms

A

Gastrinoma- PUD, ulceration, haematemesis

Glucagonoma- diarrhoea, anaemia, nicrolytic migrating erythema, high glucose

Somatostatinoma- obstructive jaundice, gallstones

Insulinoma- hypos

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106
Q

Insuline receptor type

A

Tyrosine kinase

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107
Q

Inhibitors of insulin

A

Beta blockers, a adrenergic, glucagon

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108
Q

Stimulates of insulin

A

Glucose, amino acids, FA
Secretin, gastrin, CCK
Beta adrenergic, vagal cholinergic

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109
Q

MEN 1

A

Parathyroid
Pancreatic tumour- insulinoma
Pituiatary- prolactinoma, ACTH, GH

Most commonly present with hypercalcaemia

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110
Q

MEN 2a

A

Phaeochromocytoma
Medullary thyroid cancer (70%) Hyperparathyroidism (60%)

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111
Q

MEN 2b

A

Phaeo
Medullary thyroid cancer
Marfanoid
Mucosal neuromas

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112
Q

Intrinsic pathway

A

Surface contact
Activates factor 12 then 11 then 9 then 10 through 8

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113
Q

Molecule types of coag factors

A

Most- serine proteases
V, VIII- glycoproteins
XIII- Transglutaminase

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114
Q

Factors heparin affects

A

2, 9, 10, 11

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115
Q

Factors warfarin affects

A

2, 7, 9, 10

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116
Q

Coag Factors DIC affects

A

1, 2, 5, 8, 11

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117
Q

Coag factors Liver disease affects

A

Factors 1(fibrinogen),2 (thrombin) ,5,7,9,10

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118
Q

Coag factors in each pathway

A

Intrinsic- 8,9,10,12
Extrinsic- 7
Common- 2,5,10

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119
Q

What affects just intrinsic pathway

A

Haemophillia
vWD

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120
Q

What affects intrinsic pathway

A

Heparin, haemophilia

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121
Q

vWF coag timings

A

APPT rise due to VIII low

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121
Q

MOA of LMWH (and fonda)

A

Activates anti- thrombin to inactivate Xa

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122
Q

MOA of heparin

A

Activates anti-thrombin to inactivate Xa and thrombin (2)

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123
Q

Massive bleed on warfarin tx

A

Stop warfarin, IV vit K, PCC

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124
Q

What precipitates sickle cell crisis

A

Dehydration, infection, hypoxia

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125
Q

Drugs causing aplastic anaemia

A

Indomethaicn
Sulphonamides
Penicillamine

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126
Q

Causes of severe thrombocytopenia

A

ITP- AI
DIC
TTP- ADAMTS13

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127
Q

Where is iron absolved

A

Duodenum and upper jejunum

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128
Q

Symptoms of vit A def

A

Night blindness

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129
Q

Symptoms of vit C def

A
  • gingivitis, loose teeth
  • poor wound healing
  • bleeding from gums, haematuria, epistaxis
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130
Q

Vit B1 deficiency

A

Thiamine
Beri beri

Wernicke’s encephalopathy - ophthalmoplegia, ataxia and confusion
Korsakoff’s syndrome,
( irreversible psychosis characterized by amnesia confabulatn

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131
Q

Vit B2 def

A

Riboflavin

Glossitis
Dermatitis
Paryngitis

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132
Q

Vit B3 def

A

Niacin

Pellagra
Neck rash
Diarrhea, dermatitis, dementia

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133
Q

Vit B6 def

A

Pyridoxine

Microcytic anaemia

134
Q

Vit B9 def

A

Folic acid

Pernicious anaemia
Macrocytic anaemia
Pregnant- birth defects

135
Q

Vit B12 def

A

Colbalamin
Peripheral neuropathy
Mac anaemia

136
Q

Causes of malabsorption

A

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

137
Q

Diseases of collagen

A

Ehlers Danlos
Osteogenesis imperfecta

138
Q

Which coag factors are most temp sensitive

A

Factor V and VIII

139
Q

Average stroke volume

A

70ml

140
Q

Bainbridge reflex

A

Atrial stretch receptors increase firing from increased preload causing increased HR

141
Q

Production of adrenaline

A

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.

142
Q

Which drug does not interfere with cortisol levels but still provides treatment

A

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.

143
Q

Functional residual capacity

A

Volume left in lung after passive expiration

144
Q

Factors affecting FRC

A

Increased FRC:
Erect position
Emphysema
Asthma

Decreased FRC:
Pulmonary fibrosis
Laparoscopic surgery
Obesity
Abdominal swelling
Muscle relaxants

145
Q

When is urgent management of hypercalcaemia needed

A

> 3.5
Reduced consciousness
Severe abdo pain
Pre renal failure

146
Q

What is used to measure renal plasma flow

A

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.

147
Q

Spleen components and function

A

In the red pulp, blood filled venous sinuses are found.

In the white pulp, reticuloendothelial cords and white lymphoid follicles are present.

148
Q

CI for cell saver device

A

Infection or malignancy of graft

149
Q

Stored blood affinity for oxygen

A

Less 2,3 DPG
Therefore has a higher affinity of O2 and reduces it release to metabolising tissues

150
Q

Condition causing increased lung compliance

A

Emphysema- due to loss of alveolar walls and elastic tissues

151
Q

Glucagon make up, cell that product it and what it responds to

A

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.

152
Q

Onufs nucleus location and function

A

Onufs nucleus is located in the anterior horn of S2 and is the origin of neurones to the external urethral sphincter.

153
Q

Tx of vWD bleeding

A

Desmopressin

154
Q

Warfarin half life and metabolisms

A

Half life 40 hours
Metabolised in the liver
Small volume of distribution as protein bound

155
Q

Heparin and LMWH electrolyte disturbance

A

Hyperkalaemia

156
Q

Treatments of different shocks

A

Hypovolaemic- fluid resus

Septic- vasopressors

Neurogenic- fluid until 90 MAP

Cardiogenic- inotropes, vasodilators, pumps

157
Q

ABG of high output ureterosigmoidostomy

A

In the large intestine, sodium is swapped for potassium, and chloride for bicarbonate, this causes hypokalaemia and acidosis.

158
Q

What does the parietal cell secrete

A

HCl, Ca, Na, Mg and intrinsic factor

159
Q

Where does the majority of water absorption occur in the GI

A

Jejunum

160
Q

What does giving 5% dextrose do to the urine osmolarity

A

Decrease

161
Q

Main component of thyroid colloid

A

Thyroglobulin

162
Q

Catecholeamine derivatives

A

Tyrosine
it is modified by a DOPA decarboxylase enzyme to become dopamine

163
Q

If someones normal BP is 120/80 and it drop to 110/70 what happens to the GFR

A

Nothing- auto regulated

164
Q

Specific gravity of urine

A

Measure of concentrates in urine

165
Q

Electrolyte abnormality of compartment syndrome

A

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.

166
Q

Location of arterial baroreceptors

A

Aortic arch and sinus

167
Q

Synthesis of T3/T4

A

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.

168
Q

Receptor of T3

A

T3 binds to a receptor on chromatin to induce protein synthesis.

169
Q

Stimulation and suppression of prolactin

A

TRH stimulates
Dopamine suppresses

170
Q

Where is iron absorbed

A

Duodenum- most
And jejunum

171
Q

Pre renal uraemia vs ATN

A

Urine sodium
<20 PRU
>30 ATN

PRU- responds to fluids
ATN- doesn’t

172
Q

When does the O2 curve shift to the right

A

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

173
Q

Causes of increased TLCO

A

Asthma
Haemorrhage
Left-to-right shunts, Polycythaemia

174
Q

What respiratory factors are affected by pain

A

V/Q
FRC- decreased
Minute vent volume
Tidal volume

175
Q

Volume of dextrose vs saline staying intravascular

A

Dex 1/12th of volume
Saline 1/4

176
Q

What condition increases FRC

A

Empyshema - more compliant lungs

177
Q

Where the majority of glucose is reabsorbed in kidney

A

SGLT2 receptor in S1/2 segment of PCT

178
Q

SGLT1 transporter

A

Main in GI tract

High affinity low capacity
1 glucose and 2 Na

179
Q

SGLT2 transporter

A

In kidney

Responsible for 90% of glucose - SGLT1 10%

Required 1 glucose to 1Na

180
Q

What generate I2 in thyroid

A

Thyroid peroxidase

181
Q

What produces thyroglobulin

A

Follicular epithelial

182
Q

What inhibits lactation in pregnancy

A

Progesterone

183
Q

Vital capacity is equal to

A

IRV+TV+ERV
3+0.5+1.5

184
Q

Complete cord transaction sx

A

Areflexia- can become hyper after weeks
Incontinence
Flaccid paralysis

Triple flexion response- usually after days/weeks - flexion of hip, knee and dorsi

185
Q

Oxygen affinity in stored blood

A

Reduced DPG so increased affinity

186
Q

High Na, dry membranes, increased urinary frequency

A

DI

187
Q

HR change with inspiration, pressure on eye, after meal and pressure on SA node

A

Inspiration- increases HR decreased BP

Eye- decreases

After meal- increase

Pressure- decrease

188
Q

Thyroid hormones effects on glucose, adrenergic receptors

A

Increase glucose availability- increase absorption, glycogenolysis, lipolysis

Increase B adrenergic expression

189
Q

Site of testosterone production in med

A

Intersitital cells or Leydig

190
Q

Function of Sertoli

A

Aid development of sperm cells

Produce anti Mullerian hormone

191
Q

pH of saliva, conc of K , osmolarity and where it is produced

A

Low acidic 6-7.4

Higher K
Lower Na Cl

Hypotonic

Acinar cells

192
Q

Cardiac index equal to

A

CO /BSA

193
Q

What does the JXG cells produce and what cells type

A

Renin

Smooth muscle cell

194
Q

Normal PR

A

0.12-0.2

195
Q

Normal mean pulmonary arterial pressure

A

15mmHg

196
Q

Where is angiotensinogen produced

A

Liver

197
Q

What blood vessels are most sensitive to nitrates

A

Large veins

198
Q

Atrial flutter vs fib

A

Flutter- regular, saw tooth- 2:1, 3:1

Fib- irregular, no p

199
Q

Normal lung values for 70kg

A

IRV 3L
TV 0.5L
ERC- 1L
VC- 4.5L
TLC 5-6L

200
Q

hcG effect on hormones

A

Increase oestrogen and progesterone

Prolactin

Inhibits

201
Q

Where is oestrogen and progesterone produced in pregnancu

A

Initially corpus leuteum

Then placenta

202
Q

Na, Cl, K, proteins intracellular vs extra

A

More Na extra
Cl extra

K Inta
Proteins intra

203
Q

CI and oxygen delivery post major surgery

A

Increase

Correlate well with outcome

204
Q

O2 and CO2 effects on Cerebral blood flow

A

Hypoxia increase

Hypercapnia increase

By autoregulaiton

205
Q

Fluid in DCT in comparison to plasma

A

Hypotonic

206
Q

Phases of cardiac potetnail

A

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

207
Q

Which channel is mainly responsible for resting membrane potential

A

K

208
Q

What can you find in urine of phaeo

A

VMA

Glucose

209
Q

Normal PEFR

A

Above 500L/min men
400L/min women

210
Q

What hormone is overproduced in Prader willi

A

High Ghrelin

211
Q

Vasodilatory substance produced by endothelial cells via metabolism of Argenine

A

Nitric oxide

NOT NITROUS

212
Q

Calcitonin MOA

A

Block osteoclast

Stop break down of bone

Minor- inhibit kidney reabsorption

213
Q

Neuronal fibres responsible for pain

A

A delta - immediate
C- slow

214
Q

A beta neuronal fibres

A

Large myelinated- light touch

215
Q

A alpha neuronal fibres

A

Proprioception

Golgi

216
Q

B neuronal fibres

A

Pre ganglionic Autonomic

217
Q

C neuronal fibres

A

Pain

Unmyelinated

Postganglionic fibres

218
Q

A delta fibres

A

Pain receptors
Cold receptors

219
Q

Motor neurons classfication of fibres

A

A- Aa- Extrafusal
B- Ab
y- Ay- intrafusal

220
Q

What motor protein controls cilia- absence causes what condition

A

Dynein

Absent in Kartangers

221
Q

Factors affecting rate of volume leaving stomach

A

Volume of stomach contact and composition

Isotonic - maximum
Hypertonic- slower

Faster laying down
Fat- slower

222
Q

Blood volume % of body weight

A

7%

223
Q

Inhbitory neurtransmitters

A

Glycine
GABA
Serotonin

224
Q

Where pain impulses are modified

A

By descending tracts inputting on dorsal horn

225
Q

Reabsorption of phosphate in kidneys

A

P with Na in PCT in renal tubule cells

226
Q

Most important factor for increasing resp rate

A

Increase H+ in CSF

227
Q

Location of muscarinic vs nicotinic receptors

A

Nicotonic- CNS and NMJ
Muscle
Adrenal medulla
Pre to post ganglion- para and symp

Muscarinic- peripheral organs and CNS
Cardiac
Sweat in symp

228
Q

Valsalva manoeuvre and effects

A

Forced expiration against closed glottis

Increase intrathroacic pressure

Decreased return to RA

Reduced CO

229
Q

Initial screening test and confirmation for acromegaly

A

IGF1 screening

Glucose tolerance- confirm

230
Q

Cause of air emboli

A

Lap surgery
Open heart surgery
Central venous catheter
Massive transfusion

231
Q

Maltose digestion

A

By maltase into 2 glucose molecules

232
Q

Aldosterone action in GI, salivary and sweat glands

A

Na and water reabsorption for K

233
Q

Primary motor cortex location

A

Precenteal gyrus

234
Q

Location of somatosensory cortex

A

Postcentral cortex

235
Q

Main stimulation of peripheral chemo

A

PO2

236
Q

Main factor determining rate of urine prodcution

A

Tubular function

As GFR usually constant

237
Q

Which cells secrete IF

A

Parietal

238
Q

SVR regulation mainly by

A

Arterioles

239
Q

Normal QT

A

0.4

240
Q

Drugs causing prolonged QT

A

QT MAK

Quinine
TCA
Macrolides
Amiodarone
Ketoconazole

241
Q

Progesterone effects on respiration

A

Increases resp rate
Decrease pCO2

242
Q

CSF composition compared to plasma

A

0.5% of protein
Lower K, Ca, HCO3, glucose

243
Q

Pituitary acidophils and basophils produce

A

Acidophils- GH, prolactin

Basophils- TSH, LH, FSH, ACTH

244
Q

What arterial factors directly affect CBF

A

pH not PCO2

PO2

245
Q

Where is aldosterone produce

A

Glomerulosa

246
Q

Na reabsorption in DCT

A

10%

By Na/Cl symporter

247
Q

Na reabsorption in ascending

A

Na/K/2Cl

Symporter

248
Q

What produced PTH

A

PTH chief cells

249
Q

FSH function in men

A

Stimulates testicular growth
Production of androgen binding protein by sertoli

(not responsible for testosterone)

250
Q

LH function in med

A

Production of testosterone by leydig

251
Q

Factors affecting prolactin levels

A

Dopamine inhibits

Hypothalamus has dopamine secreting neurons - under control

Oestrogen inhibits dopamine

Prolactin increases with stress and trauma

252
Q

Factors causing inaccuracy of pulse ox levels

A

Increased skin pigmentation - bilirubin

Arrythmia

Hypotension

Vasoconstriction

Nail varnish

253
Q

Venous pO2 at rest

A

5kPa

254
Q

How much CO received by skin

A

5%

255
Q

Dendrites vs axons

A

Dendrites towards body
Axons away

256
Q

ECG features of hypothermia

A

J waves

257
Q

Which branches are conducting zones vs exchange zone in resp

A

First 16- conducting

Last 7 exchange

258
Q

% of O2 dissolved in plasma

A

1.5-2 %

259
Q

Main function of colon

A

Na and water absorption

Na/K - active

Water passive

260
Q

Where is calcitonin produced

A

C cells of thyroid

261
Q

What substances increase renal flow rate

A

Prostaglandins - dilate afferent arteriol

AG2- constrict efferent

Glucocorticoids and NO- dilate afferent

262
Q

Enzyme produced in duodenum

A

CCK, secretin, VIP(also panc), SS (also panc +stoamch)

263
Q

Hagen Poiseuille law

A

Flow= (pie x pressure x radius ^4)/ 8x viscosity x length

Flow is directly prop to pressure, radius ^4

Inversely to length and viscosity

264
Q

CO2 effects on O2 curve

A

Decreased CO2 shifts to left

Bohr effect

265
Q

What pO2 measured

A

O2 dissolved in plasma

266
Q

CO effects on cells

A

Binds to cytochrome system causing cellular dysfunction

Does not readily dissociate

267
Q

What causes spread of AP in muscles

A

T tubes

268
Q

Where is Ca released from in muscles after AP

A

Sarcoplasmic reticulum into cytoplasms

269
Q

Where is DHEA produced

A

Adrenal cortex

270
Q

How to measure FRC

A

Helium wash out

271
Q

What directly activated pepsinogen

A

pH and pre existing pepsin

272
Q

ST segment length

A

0.08

273
Q

Calculating FRC

A

RV + ERV

274
Q

Intra aortic ballon pump moa and physiological effects

A

Inflates during diastole - increasing coronary perfusion

Deflates in systole - decreasing after load via vacuum increasing CO

275
Q

Normal volume of pleural fluid

A

10-20ml

276
Q

Where Ca is absorbed and factors effecting absorption

A

Duodenum and jejenum

Phytic acid
Fatty acid- reduced absorption

277
Q

Physiological vs anatomical shunt

A

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

278
Q

% of left ventricle supplied by RCA

A

1/3- inferior

279
Q

% of CO to bronchial

A

2%

280
Q

Patient is dehydrated, which part of nephron will contain hypotonic solution

A

End of ascending limb due to reabsorption of Na

281
Q

What structure carries Right Bundle Branch

A

Moderator band

Septomarginal trabecular

282
Q

Absoption of iron

A

More efficient in Fe2+

Physiological pH in 3+ state
pH of stomach converts to 2+

283
Q

Which hormone can act as contrcaption in post part period

A

Prolactin
As inhibits LH/FSH

284
Q

Types of skin receptors

A

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

285
Q

Macula densa vs JXG

A

Macula- DCT
Sense Na
Release PG to JXG to cause renin release

Afferent- JXG
Sense BP
Release Renin

286
Q

Where is CSF produced and by what

A

Choroid plexus
Specialised ependymal

287
Q

Exercise effects of SBP and DBP

A

SBP- increase
DBP- decrease

288
Q

Pain effect on myocardial blood flow

A

Decrease

289
Q

Dorsal vs ventral root ganglion contents

A

Dorsal- cell bodies of afferent

Ventral- cell bodies of efferent

290
Q

Where second and third order neurons synapse for pain pathway

A

Thalamus

291
Q

Kupffer cell function

A

Recycle old red blood cells - to use haemoglobin for iron and bilirubin

292
Q

Problem with creatine as measure of GFR

A

Secreted so overestimates

But lab underestimates plasma creatine so cancel each other

293
Q

Where is fat absorbed

A

Proximal intestine

294
Q

What maintains volume in DI

A

Thirst

295
Q

Organ with greatest blood flow per 100g

A

Kidney

296
Q

Where transection occurs to stop breathing

A

Below medulla

297
Q

HR of transplanted heart

A

Vagus nerve transected so usually tachy

298
Q

Which hormone is the main cause of hyperglycaemia post trauma

A

Adrenaline

299
Q

Red flags of sepsis

A

> 130 HR
/= 25 RR
<90
2 lactate

300
Q

Normal obs for infants

A

100-150 bpm
25-35 rr
>1.5 UO
80-100 BP

WCC- 6-15

301
Q

Structure of bone

A

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

302
Q

Types of ossification

A

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.

303
Q

Temp thermoregulation fails

A

30

304
Q

Most common cause of TIA

A

atheroscleorsis at carotid bifurication

305
Q

Amount of Na and glucose in Hartmann

A

131
0

306
Q

What can cause a decreased anion gap

A

Hypoalbuminaemia
HyperCa, Mg

307
Q

Major fat in LDL, what binds to receptor

A

Cholestrol
Apolipoprotein B attaches to receptor LDLR

Involved in cholestrol transport - HDL reverse

Formed from vLDL

308
Q

Permanent cell and examples

A

Cannot replicate
Neurone and erythrocytes

309
Q

What substances are trasnported by fac diffusion vs active acorss placenta

A

Glucose facilitated

Amino acids, steroids, nucleotides, water soluble vitamins- Active

310
Q

Early vs late complications of radiotherapy

A

Early
Skin reaction
BM failure
GI reaction
Infertility

Late
Secondary malignancy
Hypothyroid

311
Q

Cauda equina but pacemaker in situ

A

CT myelogram

312
Q

Oocyte, ovum

A

Ooocyte developing
Ovum mate

313
Q

Dextrose isotonic vs hypotonic

A

Isotonic on delivery- quickly metabolised to become hypotonic

314
Q

Stages of cell cycle

A

Pro- chromosomes form adn spindle attaches
Meta- middle of cell
Ana- tubules drag to opposite sides of cell
Telo- new membranes

315
Q

Hexamethonium MOA

A

Non depolarising
Blocks post synaptic autonomic

316
Q

Cause of prolonged thrombin time

A

Hypofibrinogenaemia
Or heparin

317
Q

Initial collagen in wound healing

A

Type 3

1 later

318
Q

Which cells store heparin

A

Mast cells

319
Q

Where does CVP tip lie

A

Lower SVC

320
Q

Hiradrrentitis suppurata

A

Chronic disease of apocrine sweat glands

321
Q

MOA of organophosphates

A

Hyperpolarisation- decrease HR

322
Q

Omental patch blood supply

A

Has own blood supply - so not free flap

323
Q

Ventral vs lateral corticospinal tract

A

Lateral- larger- limbs
Ventral- small, neck and limb

324
Q

What causes menstruation

A

Progesterone withdrawal

325
Q

Capacitisation of sperm

A

Allows them to move

326
Q

Oestrogen production in pre vs post menopausal

A

Pre- ovaries

Post- peripheries - aromatase lead

327
Q

SOB and chocolate coloured blood after delivery of what local

A

Prilocaine

Cause methaglobinaemia

328
Q

Wells score components

A

Active cancer
Bedridde, major surgery <12w
Calf swelling more than the other
Prev DVT
Immobilisation
Pitting oedema
Localised tenderness
Entire leg swollen
Superfiical veins

329
Q

Examples of accessory muscle in respiration

A

Scalene, pec major, traps

EIC

330
Q

Rotation in malrotation and location of organs

A

Only 90 anticlockwise

Caecum on left, rest on right

331
Q

Number of paranasal sinuses and most prone to infection

A

4

Maxillary- next to teeth

332
Q
A

eMRCS questions (45 decks)

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