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Physiology Flashcards

1
Q

where does ivabradine act and what are it’s common uses?

A

SA Node → blocks funny current → decreases HR

  • idiopathic sinus tach
  • systolic HF when BB don’t reduce HR
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2
Q

how does hyperkalemia look on the EKG?

A

“increases repolarization”

  • sharp-spiked T waves
  • short QT
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3
Q

how does hypokalemia look on the EKG?

A

“decreases repolarization rate”

  • U waves
  • prolonged QT
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4
Q

how does hypercalcemia look on the EKG?

A

decreased QT

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5
Q

how does hypocalcemia look on the EKG?

A

increased QT

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6
Q

what are the 3 key differences in cardiac vs skeletal muscle physiology?

A

cardiac:

  • extracellular Ca+ is involved
  • magnitude of SR Ca+ released can be altered → increase in contractility
  • 2 mechanisms to remove Ca+ from the cytosol (SERCA + Na/Ca Exchanger)
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7
Q

what are the causes of an elevated osmolar gap?

A

ethanol
methanol
ethylene glycol
acetone
mannitol

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8
Q

normal lung volumes and capacities:

Vt, IRV, ERV, RV

IC, FRC, VC, TLC

A

Vt: 0.5 L

IRV: 3.5 L

ERV: 1.5 L

RV: 1.2 L

IC: 4 L

FRC: 2.7 L

VC: 5.5 L

TLC: 6.7 L

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9
Q

Normal value for PBS (hydrostatic pressure in the bowman space)

A

8 mmHg

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10
Q

Normal value for PGC (hp in the glom capillary)

A

45 mmHg

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11
Q

Normal value for πGC (oncotic pressure in the glomerular capillary)

A

24 mmHg

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12
Q

Normal value for πBS (oncotic pressure in the bowman space)

A

0 mmHg

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13
Q

Normal GFR

A

120 ml/min or 180 L/day

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14
Q

formula for filtration fraction

A

FF = GFR / RPF

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15
Q

formula for net transport rate or mass balance

A

filtered load - excretion rate

(GFR x Px) - (V x Ux)

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16
Q

clearance formula

A

Clearance of X = ER/Px = (V x Ux)/Px

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17
Q

Tm for glucose

A

375 mg/min

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18
Q

formula to estimate RPF from RBF

A

RPF = RBF (1-Hct)

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19
Q

what is the net transport of inulin

A

no tubular modification
what is filtered is excreted
(no reabsorption, no secretion)

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20
Q

what is the net transport of manitol

A

no tubular modification
what is filtered is excreted
(no reabsorption, no secretion)

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21
Q

what is the net transport of bicarbonate?

A

fully reabsorbed

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22
Q

what is the net transport of PAH

A

freely filtered + secreted until TM

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23
Q

what is the net transport of creatinine

A

freely filtered + secreted until TM

(very little is secreted the TM is very low)

serves as a marker of GFR

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24
Q

what is the net transport of urea

A

partially reabsorbed

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25
Q

most common cause of apneustic breathing

A

lesions to the caudal pons

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26
Q

most common cause of cheyene-stokes breathing

A

congestive heart failure
midbrain lesions

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27
Q

common clinical uses for hyperbaric chamber?

A
  • carbon monoxide poisoning
  • compromised tissue grafts
  • gas gangrene
    (clostridium perfringens, staph aureus, vibrio vulnificus)
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28
Q

formula for free water clearance

A

Clearance = V - (UosmxV/Posm)

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29
Q

expected ↑HCO3 in respiratory acidosis (↑CO2)

A

1 : 0.1

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30
Q

expected ↓HCO3 in respiratory alkalosis (↓CO2)

A

1 : 0.2

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31
Q

calculate adequate compensation for respiratory acidosis

A
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32
Q

calculate adequate compensation for respiratory alkalosis

A
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33
Q

calculate adequate compensation for metabolic acidosis

A

winter’s formula

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34
Q

calculate adequate compensation for metabolic alkalosis

A

“summer’s formula”

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35
Q

causes of metab acidosis with HIGH ANION GAP

A
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36
Q

causes of metab acidosis with NORMAL anion gap

A
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37
Q

effects of Fanconi

A

defect in proximal tubule

  • metabolic acidosis
  • hypophosphatemia
  • hypokalemia
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38
Q

effects of bartter syndrome

A

defect in thick ascending limb

  • hypercalciuria
  • secondary aldosteronism
    • metabolic alkalosis
    • hypokalemia
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39
Q

effects of gitelman syndrome

A

defect in distal tubule

  • hypocalciuria
  • hypercalcemia
  • metabolic alkalosis
  • hypokalemia
  • hypomagnesemia
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40
Q

effects of liddle syndrome

A

gain of function in ENaCs

  • hypertention
  • hypokalemia
  • metabolic alkalosis
  • low aldosterone
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41
Q

effects of SAME

A

cortisol actives mineralocorticoid receptors / hereditary deficiency (cortisol in mineralocorticoid receptor)

high aldosterone effects:

  • metabolic alkalosis
  • hypokalemia
  • hypertention

low serum aldosterone

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42
Q

causes of HYPERkalemia

A
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43
Q

pathologies associated with MEN 1

A

Pancreatic endocrine tumors

Parathyroid adenomas

Pituitary tumors

(3Ps)

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44
Q

pathologies associated with MEN 2A

A

Medullary thyroid cancer

Pheocromocytoma

Parathyroid adenomas/hyperplasia

(2P’s)

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45
Q

pathologies associated with MEN 2B

A

Medullary thyroid cancer

Pheocromocytoma

Mucosal neuromas

(1P)

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46
Q

wide slitting of S2

pathophysiology + causes

A

abnormal delay in the closure of S2

anything that causes a delay in RV emptying:

pulm stenosis, RBBB

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47
Q

fixed splitting of S2

pathophysiology + causes

A

equal splitting in inspiration and expiration

ASD!!!!

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48
Q

paradoxical splitting of S2

pathophysiology + causes

A

delayed aortic valve closure (inspiration: split elimintated, expiration: split is heard)

delay in LV emptying:

aortic stenosis, LBBB

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49
Q

what are the 3 effects of ANG II (besides vasoconstriction and aldosterone secretion)?

A

⊕ ADH release from posterior pituitary

↑ Na reabsorbtion in proximal tubule

↑ thirst

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50
Q

what is addison’s disease

A

primary adrenal insufficiency (addison’s adrenals are shot)

lack of cortisol, aldosterone, adrenal androgens

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51
Q

what is conn syndrome?

A

primary hyperaldosteronism

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52
Q

what is a paraganglioma

A

extra-adrenal pheochromocytoma

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53
Q

what is kussmaul breathing and when does it present?

A

deep rapid breating in order to compensate for acidosis seen in DKA

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54
Q

Sign? What does this indicate?

A

stippled epiphysis

hypothyroidism in children

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55
Q

🚩 TSI antibodies

A

graves disease

56
Q

🚩 TPO antibodies

A

hashimoto’s thyroiditis

57
Q

effect of hypercalcemia on the kidney

A

nephrogenic diabetes insipidus

(ADH resistance –> volume loss)

58
Q

sign? what does this indicate?

A

osteitis fibrosa cystica

(hypercalcemia, HIGH PTH)

59
Q

🚩 metacarpal or metatarsal bones missing

A

pseudohypoparathyroidism

(especially if accompanied by short stature, and mental retardation)

60
Q

acetazolamide

drug type

A

CA inhibitor

61
Q

what are the respiratory system changes expected with age

A

↔ TLC
↑ RV ↑ FRC
the rest ↓

(TV ↓ but respirations ↑ so ventilation does not change)

“senile enphysema”

62
Q

what is the expected decline in GFR with age

due to what?

A

1 mL/min per year after 30

due to glomerulosclerosis (glom destruction and decreased number of glomeruli)

63
Q

what happens to BP and HR during inspiration?

A

BP decreases (less LV output)

HR increases (low BP decreases vagal flow from the heart and that decreases HR)

64
Q
A

hypotonic fluid loss

  • dehydration
  • diabetes incipidus
  • alcoholism
65
Q
A

isotonic fluid gain

  • excess aldosterone
  • isotonic fluid infusion (saline)
  • isotonic colloid (stays in the vascular space)
66
Q
A

isotonic fluid loss

  • diarrhea
  • vomiting
  • hemhorrage
  • loss of isotonic urine
67
Q
A

hypertonic fluid loss

  • pathologic adrenal insufficiency
68
Q
A

hypotonic fluid gain

  • primary polydipsia
  • hypotonic infusion (dextrose in water)
  • SIADH (causes retention of water with no solutes)
69
Q
A

hypertonic fluid gain

  • salt
  • hypertonic infusion (extracell distribution)
  • hypertonic manitol infusion
  • hyperglicemia
70
Q

McCune-Albright Syndrome

A

gain-of-function mutation in Gprotein –> elevades cAMP –> increased secretion of hormones

  • precocius puberty
  • poluostotic fibrous dysplasia
  • cafe-au-lait sking pigmentation

↓ FSH/LH + ↑ estrogen

71
Q

what substances can be used to calculate volume for the following compartments:

TBW

A

TBW: urea, tritated water

72
Q

what substances can be used to calculate volume for the following compartments:

ECF

A

ECF:

innulin, manitol, sucrose, radioactive sodium

73
Q

what substances can be used to calculate volume for the following compartments:

PV

A

PV:

RISA, evan’s blue

74
Q

how to calculate volume using tracers

A

V = A / C

A (amount of tracer remaining)

C (concentration in given compartment)

75
Q

which are the only postganglionic sympathetic neurons that release Ach?

onto what receptors?

A

(postganglionic sympathetic cholinergic neurons)

nerve fibers that innervate sweat glands

M3 receptors

76
Q

what changes in volumen & osmolality are expected in:

pregnancy

A

isotonic fluid gain (retention of both salt and water)

77
Q

oocytes arrests

A
  1. Prophase I (until it is “chosen” in the monthly cycle and resumes meosis I to become a secondary oocyte + polar body)
  2. Metaphase II (until fertalized in to become a mature oocyte and polar body)
78
Q

familial glucocorticoid deficiency

A

genertic disorder with loss-of-dunction mutation in ACTH receptor gene

79
Q

🚩 hypotention with tachicardia

A

drop in SVR due to vasodilation

80
Q

🚩 bradicardia with hypertention

A

baroreflex response to vasoconstrictor

81
Q

what acid base disturbance does a PE cause? why?

A

dead space –> large v/q missmatch –> hypoxemia –> increases resp drive –> hyperventilation –> resp alkalosis

82
Q

🚩 holosystolic murmur along lower left sternal border + palpable thrill

A

(in newborns)

can be associated with failure to thrive and signs of heart failure

VDS

83
Q

neuronal excitability in HYPERcalcemia?

A

DECREASED

(Ca block Na channels)

84
Q

neuronal excitability in HYPOcalcemia?

A

INCREASED

(Ca blocks Na channels)

85
Q

what is the function of the golgi tendon organ in muscle contraction?

A

propioceptive:

detects changes in muscle tension and inhibits muscle contraction

(to prevent damage)

86
Q

what is the function of the muscle spindle fibers in muscle contraction?

A

propioceptive:

detects changes in muscle length and activates muscle contraction

(reflex testing)

87
Q

function of A-delta nerve endings

A

temperature and pain

88
Q

function of pacinian and ruffini’s corpuscles

A

P (rapid)

R (slow)

touch, proprioception, vibration

innervated my myelinated A-beta fibers

89
Q

what vitamins and minerals are absent in breast milk

A

vitamin D & K

vitamin K –> given IM at birth

vitamin D –> exclusively breast fed must supplement, mixed/formula already contains vitamin D

90
Q

what is the effect of hypoxemia on aldosterone?

A

INHIBITS

91
Q

function of FGF23

A

secreted by osteocytes

  • downregulates Na/Phosphate transp in PT –> more excretion of phosphate
  • inhibits activation of vitamin D –> less uptake of phosphosrus in the intestine

LOWERS SERUM PHOSPHORUS (secreted in response to hyperphoshpahtemia)

92
Q

🚩 valvulopathy with bounding femoral and carotid pulses

decrecendo diastolic murmur

head bobbing

A

aortic regurgitation

93
Q

🚩 fixed splitting of P2

A

ASD

atrial septal defect

94
Q

light criteria

A

p/s protein > 0.5

p/s LDH > 0.6

pleural LDH > 2/3 upper limit of normal serum LDH

95
Q

markers of bone resorption

(osteoclastic activity)

A

hydroxiproline

telopetides

96
Q

markers of bone mineralization

(osteoblastic activity)

A

serum alkiline phosphatase

PINP (N-terminal propeptide of type I collagen)

97
Q

IV fluids of choice for:

volume resuscitation

A

ISOTONIC

  • normal saline (0.9)
  • Lactated Ringer
  • Albumin (more expensive, not first line)
    *SBP, HRS
98
Q

IV fluids of choice for:

free water deficit

A

HYPOTONIC

  • dextrose 5% in water
  • 0.45 saline (half normal)
99
Q

IV fluids of choice for:

maintenance hydration

A

dextrose 5% in 0.45% saline

100
Q

IV fluids of choice for:

sever symptomaic hyponatremia

A

HYPERTONIC

  • 3% saline
101
Q

🚩 hypocalcemia following blood transfusion

A

calcium chelation by citrate anticoagulant

seen in high rate transfusions OR low rate with impaired liver function

102
Q

normal ejection fraction

A

≥50%

103
Q

pulsus paradoxus

seen in?

A

↓SBP > 10 mmHG during INSPIRATION

Seen in: pea COAT

  • Pericarditis
  • Croup / COPD
  • OSA
  • Asthma
  • Tamponade
104
Q

murmur, seen in

A

crescendo-decrescendo murmur

AORTIC STENOSIS

105
Q

murmur, seen in

A

HOLOSYSTOLIC MURMUR

MR, TR, VSD

106
Q

murmur, seen in

A

late crecendo murmur with mid systolic click

MVP

107
Q

murmur, seen in

A

early diastolic, descrecendo

AORTIC REGURGITATION

108
Q

murmur, seen in

A

continuous machine like murmur

PDA

109
Q

murmur, seen in

A

delayed rumbling murmur, with opening snap

MITRAL STENOSIS

110
Q

what is the pathophysiology of resistance to thyroid hormone? how do these patients present?

A

resistance to TH in the hypothalamic-pituitary axis

labs: high T3, T4, TSH (no negative feedback)

clinical: hypo, eu, hyper thyroid
* *goiter**, ADHD/ADD

111
Q

what is rT3 derived from?

A

conversion of T4 into rT3

112
Q

newborns with congenital hypothyroidism present asympotamic due to the placental transfer of what hormone?

A

T4

113
Q

🚩 newborn with ectopically located, small thyroid gland just above the hyoid

A

congenital hypothyroidism

(nL or low T4, high TSH)

114
Q

euthyroid sick syndrome

(cause + labs)

A

low T3 syndrome

transient “hypothyroidism” in an acutely ill patient

pathophysiology: suppresed conversion of T4-T3 as a protective/compensatory mechanism, increased conversion of T4-rT3

labs: early –> Low T3, nL T4, TSH
late –> Low T3, T4, TSH

115
Q

why are serum T3 levels normal in primary hypotthyroidism

A

destruction of thyroid gland leads to decreased production of T4 and T3 but T4 is converted to T3 in the tissues (normal function) therefore we have normal T3, low T4 and because T4 is low we have little negative feedback and high TSH

116
Q

DHT induces the differentiation of which structures?

A

external male genitalia

  • scrotum
  • penis
  • prostate
117
Q

what is the effect of thyroid hormone on bone

A

T3 stimulates osteoclasts, increase bone resorption

118
Q

what is the effect of thyroid hormone on lipids?

A

promotes LDL receptor expression

119
Q

NMDA receptor

A

under -70 closed (blocked by Mg)

over -70 Mg moves, allows it to to be bound by aspartate/glutamate to open the channel

nonselective cations (Na, Ca)

120
Q

function of the following nucleus of hte hypothalamus:

lateral nucleus

A

HUNGER

121
Q

function of the following nucleus of hte hypothalamus:

ventromedual nucleus

A

SACIETY

122
Q

function of the following nucleus of hte hypothalamus:

anterior nucleus

A

COOLING

(parasympathetic)

123
Q

function of the following nucleus of hte hypothalamus:

posterior nucleus

A

HEATING

(sympathetic)

124
Q

function of the following nucleus of the hypothalamus:

suparoptice and paraventricular

A
125
Q

function of the following nucleus of hte hypothalamus:

preoptic nucleus

A

releases GnRH

thermorregulation, sexual behavior

126
Q

kallmann syndrome

A

failure of the GnRH producing neurons to migrate from olfactory pit

127
Q

what is the effect of activating M3 receptors?
what’s the exception?

A

PNS receptors –> increase G couples proteins –> increase in intracelullar calcium –> contraction of smooth muscles

exception: vasculature (causes NO mediated dilation)
M3 causes increased synthesis of NO in the endothemlium, diffused into smooth muscle and inhibits contraction by activating MLCP

128
Q

3 histologic changes that occur in the liver with age

A

increased hepatocyte size

increased poliploidy

accumulation of lipofuscin (brown atrophy)

formation of lipid droplets in setllate cells

129
Q

VIPoma “triad”

A

pancreatic cholera (secretory diarreah) WDHA syndrome

  • Watery Diarrhea
  • Hypokalemia
  • Achlorydria
130
Q

acid-base disturbance in CKD

A

high anion gap metabolic acidosis with respiratory compensation

131
Q

refeeding syndrome

A

acute hypophosphatemia caused by the reintroduction of carbohydrates to amalnourished patient (depleted phosphate levels) which cause the redistribution of phosphate into hepatic and muscle cells for glycolysis.

sx: muscle weakness, arrhythmias, congestive heart failure

132
Q

hungry bone syndrome

A

increased bone formation after parathyroidectomy as tx of hyperparathyroidism, which causes acute hypophosphatemia and hypocalcemia in the early postoperative period

133
Q

where is magnesium primarily reabsorbed?

A

thiack ascending loop

134
Q

familia hypocalciuric hypercalcemia

A

defect in CaSR → no inhibition of Ca reabsorption (NKCC) in the thick ascending loop: hypercalcemia, hypocalciuria

135
Q

electrolyte disturbances that cause nephrogenic DI?

A
  • hyper*calcemia
  • hypo*kalemia

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