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MRCS A(My Own) > Physiology > Flashcards

Physiology Flashcards

1
Q

Exchangeable bone calcium is mediated by

A

Osteocytes

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2
Q

Extracellular Ca levels are

A

2.2 to 2.6 mmol /L

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3
Q

Ca imp in how many processes mainly and they are

A

4 processes
Nerve and muscle excitation
Muscle contraction
Clotting
Secretions

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4
Q

Parathormone is

A

A 84 amino acids polypeptide

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5
Q

Initial phase of Ca release from bone by PTH action is?
Longer term, release is by?

A

Osteocytes releasing exchangeable bone calcium
Osteoclast activity

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6
Q

PTH and VitD site of action on kidney

A

Pth .. DCT
Vit D… PCT

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7
Q

Vit D conversion is stimulated by

A

PThH and low phosphate
Not calcium levels directly

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8
Q

Calcitonin site of secretion

A

Parafollicullar cells of thyroid

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9
Q

Action of PTH, Vit D and calicitonin on phosphate in kidney

A
  1. PTH.. Reduces Phospate renal absorption
  2. 1, 25 vit D…. Increases Phospate renal absorption
  3. Calcitonin: Decreases Phospate renal absorption

2 and 3 have same action on Calcium in kidney
1 has opposite in kidney

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10
Q

Congenital cause of hypoparathyroidism?

A

Di George syndrome

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11
Q

Which one is rare and common between hypo and hyperparathyroidism

A

Hypoparathyroidism is rare while hyper is common

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12
Q

Differentiate between tertiary and secondary hyperparathyroidism

A

Both have high pth
Secondary has low or normal calcium
tertiary has high calcium

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13
Q

Mnemonic for hypercalcemia

A

Stones, bones, abdominal growns, and psychiatric overtones

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14
Q

Only hyperparathyroidism with low or normal calcium levels

A

Secondary hyperparathyroidism

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15
Q

Al dosterone acts on

A

Distal nephron
Perform Na resorption and release of K
Deficiency Causes hyponatraemia and hyper kalaemia

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16
Q

Types of cells based on regenerative capacity

A

Labile(skin, esophagus,vagina and intestine)
Stable(liver, renal tubular epithelium)
Permanent(nerve, striated muscle cells and cardiac cells

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17
Q

2 functions of vWF

A
  1. Platelet adhesion
  2. it binds and stabilizes the procoagulant protein factor VIII
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18
Q

Treatment of VWD

A
  1. desmopressin (DDAVP)
  2. recombinant vWF
  3. vWF/factor VIII (vWF/FVIII) concentrates
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19
Q

ECG of Hypokalaemia

A

U waves

Small or absent T waves (occasionally inversion)

Prolonged PR interval

ST depression

Long QT interval

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20
Q

Retrograde ejaculation

A

Damage to upper urinary centre in the bladder

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21
Q

Auto regulation of blood flow to brain is at what CPP??

A

60 to 160 mm Hg

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22
Q

Timing of loss of consciousness and irreversible damage after interrupted blood flow to brain

A

3 sec
2 to 3 mins for latter

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23
Q

Cerebral perfusion pressure in severe head injuries depends upon

A

ICP
CPP= MAP-ICP

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24
Q

At what pressure below which O2 levels start affecting cerebral flow

A

8kpa

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25
Q

Places in Brain where capillaries are fenestrated

A
  1. Third and fourth ventricles ( vomiting centre in 4th and also Ag2 acts here)
  2. Posterior lobe of pituitary
  3. Hypothalamus (release of inhibitory hormones in portohypophyseal system)
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26
Q

Different transport mechanism and the molecules passing through them in BBB
1. Lipid soluble
2. Carrier Proteins
3. Trans and endocytosis
4. Efflux pump

A

The molecules in these categories are
1. CO2, O2, Hormones, Anesthetics and alcohol
2. Sugar and Amino acids
3. Insulin and Albumin
4. To extrude unwanted lipid molecules

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27
Q

Total CSF Volume

A

Total: 130 to 150ml
40ml in ventricles
100ml in spinal cord

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28
Q

Rate of CSF Production

A

500ml per day

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29
Q

Normal CSF Pressure

A

0.5 to 1 kpa
70 to 180 m of H2O

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30
Q

What happens when CPP falls below 50 and 30 mmHg

A

Below 50: cerebral is chemical
Below 30: Death

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31
Q

Measurement of PT, APTT and Thrombon time

A

PT for extrinsic pathway
APTT for intrinsic
Thrombin time for common pathway

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32
Q

Which one acts on vitk dependent factors

A

Warfarin

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33
Q

Vasoconstriction in coagulation is initiated by

A

Thromboxane A2
Serotonin

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34
Q

Platelet adherence vs aggregation mechanism

A

Adherence when vWF of endothelium attaces to G1b of platelets
Aggregation by ThA2 and ADP release and two platelets attaches together byGP2b/GP3a receptors

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35
Q

Initiating intrinsic vs extrinsic pathways

A

Intrinsic via normal blood components like vessel injury and exposed collagen of connective tissue
Extrinsic via Tissue thromoplastin released by damaged cells only

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36
Q

All soluble coagulation factors are produced by liver except

A

Factor VIII, CA, platelet factors and thromoplastin

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37
Q

Fibrinolytic mechanism is

A

TPA converts Plasminogen to Plasmin
Plasmin converts Fibrin to FDP

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38
Q

Protein C and S inhibits which factors

A

VIII and V

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39
Q

Adequate platelet counts for surgery
Spontaneous bleeding below which level

A

70k
20k

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40
Q

Normal bleeding time

A

1 to 8 minutes

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41
Q

BT de0ends upon

A

Platelet count
Platelet function
Vascular response to injury

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42
Q

If APTT is d3ranged than which factor will be definitely normal

A

Factor VII

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43
Q

What is Kaolin cephalin clotting time KCCT

A

Test for intrinsic and common pathway independent of platelets

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44
Q

Normal blood viscosity is maintained by

A

NO
PGI2
Antithrombin III ( heparin acts on it)

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45
Q

Drugs of coagulation and their receptors they act on
1. Aspirin
2. Heparin
3. Clopidogrel
4. Abciximab
5. Warfarin

A
  1. Thromboxane A2 inhibitor thus inhibits platelet Aggregation
  2. Antithrombin III activator thus inhibit adherence
  3. ADP thus inhibits aggregation
  4. Gp2B/3A thus inhibits platelet adherence to each other
  5. Vit k oxidase inhibitor thus inactivated of vit k dependent factors
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46
Q

Gastric mucosa protectant are

A
  1. Sucralfate
  2. Bismuth chelate (effective against H pylori)
  3. Misoprostol( PGE2 analogue)
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47
Q

Indications for surgery in ulcer cases

A
  1. Unhealed ulcer
  2. Failure to heal after sessions of treatment
  3. Possible Malignancy
  4. Complications like bleeding g or perforation
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48
Q

Upper esophageal sphincter is formed by

A

Cricopharyngeus muscle

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49
Q

Some facts regarding calcium metabolism

A
  1. Calcitonin is not essential for it
  2. ptPTH converts 25OH to 1 25 diOH
  3. PTH causes hyperphosphetemia
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50
Q

Some points regarding cardiac cycle

A

RMP is -90
Plateau is due to Ca influx
Rapid depolarization is due to Na influx
Rapid repolarizatiin is due to k efflux

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51
Q

Points regarding Metaplasia

A

Reversible
Conversion from one mature cell type to another
Can be Physiological

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52
Q

Serum osmolality formula

A

2(Na+K)+urea+glucose

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53
Q

P THis releasedby

A

chiefcells of PT Gland

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54
Q

PTH affect on Kidney for calciumat which site

A

on DCT

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55
Q

where is majorityof Fe is found in body

A

Hb

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56
Q

Beta blockers relation to renin

A

cldecrease renin secretion

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57
Q

vasopressor in which kind of shock

A

More in septic than neurogenic

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58
Q

Causes of Pseudo hypo natremia

A

Hyperlipidaemia and multiple myeloma are known to cause a pseudohyponatraemia, this is due to raised protein.

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59
Q

Active vs passive absorption ofwater in intestine

A

Active in jejunum with aminoacids and glucose
Passive in ileum with Na diffusion

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60
Q

Opioid receptors in the CNS

A

periaqueductal grey matter, limbic system, substantia gelatinosa)

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61
Q

What is the approximate volume of bile to enter the duodenum per 24 hou

A

Between 500 mL and 1.5 L of bile enters the small bowel daily

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62
Q

Nausea effect on gastric acid secretion

A

Nausea inhibits gastric secretion via higher cerebral activity and sympathetic innervation.

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63
Q

Drug Which inhibit the release of insulin.

A

Beta blockers inhibit the release of insulin.

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64
Q

Endocrine parameters reduced in stress response:

A

Endocrine parameters reduced in stress response:
InsulinTestosteroneOestrogen

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65
Q

Secretions of Gastric

A

Chief of Pepsi cola = Chief cells secrete PEPSInogen

Parietal cells: secrete HCl, Ca, Na, Mg and intrinsic factor
Chief cells: secrete pepsinogen
Surface mucosal cells: secrete mucus and bicarbonate

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66
Q

Glucagon

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.
It increases plasma glucose and ketones.

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67
Q

Furosemide acts on

A

Furosemide and bumetanide are loop diuretics that act by inhibiting the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl.

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68
Q

sign ofacute hypocalcemia epi after Parathyroid removal

A

neuromuscular irritability and laryngospasm.

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69
Q

Site of Fe absorption

A

Iron is best absorbed from the proximal small bowel (duodenum and jejunum) in the Fe2+state

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70
Q

.investigation of choice for upper airway compression.

A

Flow volume loop is the investigation of choice for upper airway compression.

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71
Q

Central chemoreceptors: Respond to

A

Central chemoreceptors: Respond to increased H+ in BRAIN INTERSTITIAL FLUID to increase ventilation.

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72
Q

Most imp urinary buffer

A

Phosphate is the most important urinary buffer. Its concentration is raised relative to that of plasma

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73
Q

inotrope of choice in septic shock.

A

Noradrenaline

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74
Q

equivalent of cardiac preload

A

EDV

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75
Q

Tranexamic acid inhibits

A

Tranexamic acid inhibits plasmin and this prevents fibrin degradation.

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76
Q

Rx of Massive bleeding for a patient on warfarin

A

Humem PT complex and vitk

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77
Q

Pneumonic for increase aniongap acidosis

A

Causes of increased anion acidosis: MUDPILES

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

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78
Q

Hormones decreased in post operative Period

A

Insulin and thyroxine often have reduced levels of secretion in the post operative period

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79
Q

Base Excess

A

The base excess increases in metabolic alkalosis and decreases (or becomes more negative) in metabolic acidosis,

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80
Q

statements related to the coagulation cascade is true

A

he extrinsic pathway is the main path of coagulation. Heparin inhibits the activation of factors 2,9,10,11. The activation of factor 10 is when both pathways meet. Thrombin converts fibrinogen to fibrin. During fibrinolysis plasminogen is converted to plasmin to break down fibrin.

Improve

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81
Q

Extrinsic pathway is activated by

A

Damaged tissue factors

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82
Q

Normal Gap Acidosis

A

Normal Gap Acidosis: HARDUP

H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

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83
Q

Causes of hyperCa

A

Mnemonic for the causes of hypercalcaemia:

CHIMPANZEES

Calcium supplementation
Hyperparathyroidism
Iatrogentic (Drugs: Thiazides,Lithium)
Milk Alkali syndrome
Paget disease of the bone
Acromegaly and Addison’s Disease
Neoplasia
Zolinger-Ellison Syndrome (MEN Type I)
Excessive Vitamin D
Excessive Vitamin A
Sarcoidosis

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84
Q

Increased FRC causes

A

Increased FRC:

Erect position

Emphysema

Asthma

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85
Q

Drug causing Hyperkalemia
Rx of it too

A

Heparin
Salbutamol

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86
Q

Prolonged vomiting causes which Acid-Base disorder

A

Metabolic Alkalosis

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87
Q

NormaI Stroke vol

A

55 - 100 ml

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88
Q

Triad of Wernicke encephalopathy:

A

Triad of Wernicke encephalopathy:

Acute confusion

Ataxia

Ophthalmoplegia

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89
Q

Wernicke-Korsakoff psychosis

A

. [1]

Korsakoff amnestic syndrome is a late neuropsychiatric manifestation of WE with memory loss and confabulation; sometimes, the condition is referred to as Wernicke-Korsakoff syndrome (WKS) or Wernicke-Korsakoff psychosis

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90
Q

Proteus causes which stone

A

Struvite

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91
Q

Bainbridge reflex

A

The Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood.

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92
Q

normal intracranial pressure is between 7 and 15 mm Hg. The brain can accommodate increases up to

A

The brain can accommodate increases up to 24 mm Hg, thereafter clinical features will become evident.

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93
Q

SIADH - drug causes

A

SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics

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94
Q

Lithium causes

A

Lithium can cause diabetes insipidus

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95
Q

useful agent in diabetic gastropathy.

A

Erythromycin

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96
Q

Obesity hormones

A

Obesity hormones

leptin decreases appetite

ghrelin increases appetite

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97
Q

GGhrelin is produced by

A

It is produced mainly by the fundus of the stomach and the pancreas.

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98
Q

Early vs late dumping syndrome

A

E: dueto increase in gastric emptying andcausing osmosis loss of intestine L: Rapid swings in insulin causing rebound hypoglycemia

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99
Q

Iron metabolism

Absorption

A

Increased by vitamin C, gastric acid

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100
Q

Absorption of Fe is decreased by

A

proton pump inhibitors, tetracycline, gastric achlorhydria, tannin (found in tea

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101
Q

Fe Excretion is done in

A

Lost via intestinal tract following desquamation

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102
Q

Factors reducing renin secretion

A

Drugs: beta-blockers, NSAIDs

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103
Q

Factors stimulating renin secretion

A

Erect posture
This is the one I did’nt know

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104
Q

chronotrope vs inotrope

A

positive inotropic (increases contractility), chronotropic (increases heart rate)

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105
Q

Adrenaline actsvia which mechanism

A

cAMP to increase intracellular Calcium Levels

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106
Q

milrinone

A

Phosphodiesterase inhibitors such as milrinone act specifically on the cardiac phosphodiesterase and increase cardiac outpu

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107
Q

Adrenaline in lower and higher doses

A

Adrenaline works as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses.

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108
Q

Skeletal muscle small to large

A

MyofibriL&raquo_space;> fibres&raquo_space;> Fasiculi

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109
Q

Covering of skeletal muscle
Fibre
Fasiculi
Muscle

A

Endonysium
Perimysium
Epimysium

Superficial to all this is a deepfascia which extends the lengthof muscle and attach to the bone.

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110
Q

Thick and thin filaments of skeletal muscle

A

Thick is made of myosin protein
thin is made of actin protein

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111
Q

A and I bands of filaments on microscope

A

A is thick and thin filaments both myosin
I band just have thinfilaments

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112
Q

Myosin structure

A

Ahead and Tail
Head attaches to actin and also has ATP on it

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113
Q

Ca binding protein in skeletal muscle

A

Troponin

114
Q

which band size remains the same during muscle contraction

A

Aband
while I and Z band shortens

115
Q

which protein blooks the myosin binding site on actin

A

Tropomyosin in a resting muscle fibre aka in absence of Ca

116
Q

Oxygen debt

A

Amount of O2 required to remove Lactic acidfrom muscles

117
Q

Mean GFR

A

130ml/min Per 1. 73 m^2 in men and 120 in women

118
Q

Accepted range of GfR is

A

70-190 mL/min Per 1.73m^2

119
Q

GFR starts to decline after which age and with whatrate

A

after 40 years
0.5 to1 ml/min

120
Q

GFR increase by 50% during

A

Pregnancy due to vol expansion

121
Q

Which drug increases plasma Creatinine

A

Cimetidine and Trimethoprim

122
Q

Most accurate laboratory techniqueto Asses GFR is

A

Inulin Clearance

123
Q

Which partof Kidney is most sensitive to ischemia

A

Tubules dueto energy dependent mechanisms

124
Q

. Growth Hormone secretion is mostduring

A

Deep sleep

125
Q

GH. in children

A

stimulates skeletal growth

126
Q

GGH causes skeletal growth with aid , of

A

Insulin like growth factor

127
Q

GH in adulthood

A

Increase Lipo and glycogenolysis
Increase protein synthesis
Decrease glucose uptake by cells and increase protein uptake

128
Q

Flow of fluid in a cannula depends upon

A

PoiseUille’s lawwhich states
Maximum flow is achieved by a short length, large diameter, Low viscosity fluid and high pressure.

129
Q

Clearance of drug is measured by which formula

A

Clearance (mL/ min)=( UxV)/ P
Here
U=Urine conc in mg/ml
V= Urine production in ml/min
P= plasma conc in mg/ml

130
Q

Antibodies of Hashimoto Thyroidit is

A

Anti-microsomaL antibodies also called Ab against thyroid peroxidase
Antithyroglobulin

131
Q

Hashimoto is which type

A

Autoimmune

132
Q

Hashimoto occurence

A

10x More in women
30-50 years of age

133
Q

Hashimoto is associated with

A

Pernicious anemia and celiac disease

134
Q

Anti centromere Ab
Anti mitochondrial Ab
Found in

A

CREST syndrome
Primary Biliary chOlangitis

135
Q

cANCA vs pANCA

A

C in granulaomatosis with polyangitis
P in chrugg strauss

136
Q

Bone Tomor metastasis -

A

From five primary tumors
1. Prostate
2 Breast
3 Thyroid
4 Renal
5. Lung

137
Q

Lytic vs sclerotic lesions of bony metastasis

A

Prostate is purely sclerotic
other four( breast,lung,renal and thyroid) are mixed

138
Q

Hypocalcemia due to high output ileal stoma is due to

A

Hypomagnesemia

139
Q

Ca and vit D are absorbed in

A

Proximal small bowel

140
Q

What is Bainbridge reflex

A

The Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood.

141
Q

Type of action potential in SA node andAV

A

Continues type

142
Q

Why atropine doesn’t have any effect on the Transplanted HR

A

Bcz of denervation of SA node

143
Q

How heart rate is formed in transplanted ones

A

Through circulating adrenaline from medulla

144
Q

Phase IVc of cardiac cycle is

A

Atrial systole
15% of remaining ventricular filling

145
Q

Isovolumetric contraction is which phase

A

Phase I

146
Q

Diff blw phase IIa and IIb of cardiac cycle

A

a: pressure in vertricle more than aorta and pul vessel

147
Q

4th heart sound

A

Due to forceful atrial contraction against stiff ventricles like in HCM and HF

148
Q

3rd heart sound

A

Rapid ventricular filling

149
Q

Which JVP wave is synchronous to pulse wave of carotid

A

C wave

150
Q

Cardiac index

A

CO per squaremetre of body surface area

151
Q

Restrictive vs obstructive pattern of prib

A

R: Fev1/FevC normal
O: Fev1/ FevC decreased

152
Q

Total lung capacity

A

(IC + FRC or IRV + VT + ERV + RV

153
Q

Which anesthetic agent can be used as continuous infusion

A

Propofol

154
Q

Which fluid can cause anaphylaxis

A

Dextran 40 and 70

155
Q

Which fluid is sued in septic shock

A

Dextran 70 and 40
Bcz They inhibit platelet aggregation and leucocyte plugging in the microcirculation. Thereby improving flow through the microcirculation, primarily of use in sepsis.

156
Q

Normal fasting blood glucose levels
Normal post meal

A

70 mg/dL (3.9 mmol/L) and 100 mg/dL (5.6 mmol/L).
90 to 150 mg/dL (5.0 to 8.3 mmol/L

157
Q

Peripheral chemoreceptors vs central respond to

A

P: Dec PO2
Inc PCO2 & Dec pH

C: Dec in pH and Inc in CO2

158
Q

Normal anion gap

A

10-18 mmol/L

159
Q

Normal gap acidosis causes

A

Normal Gap Acidosis: HARDUP

H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

160
Q

Uremia causes which type of acidosis

A

increased anion gap acidosis

161
Q

Lactic acidosis type A vs B

A

A is due to perfusion disorders
B is due to Metabolic

162
Q

which Drug causes type B lactic acidosis

A

Metformin

163
Q

opiate cause which type of acid-base disorder

A

Respiratory acidosis

164
Q

A complication of metabolic acidosis is

A

Hyperkalemia

165
Q

How much fluid enters small bowel

A

2000 mI through oral
8000 ml through small bowel secretions

166
Q

Crypts of Lieberkuhn are

A

Glands found in the epithelial lining. They contain
Stem cells to produce new cells to replenish the cells lost due to abrasion
Enteroendocrine cells to synthesise and secrete hormones.

167
Q

Channels and their location
AQP-1 :
AQP-2
SGLT2

A

Loop of henle
: Collecting duct
Collecting duct

168
Q

Hormones of adrenal cortex

A

Adrenal cortex mnemonic: GFR - ACD

169
Q

dehydroepiandrosterone (DHEA) is secreted from

A

DHEA possesses some androgenic activity and is almost exclusively released from the adrenal gland.

170
Q

Aldosterone secretion is raised by

A

angiotensin II, potassium, and ACTH levels

171
Q

Aldosterone causes

A

retention of Na+ in exchange for K+/H+ in distal tubule

172
Q

Aldosterone acts on

A

Coll3cting tubule cell to increase the transcription of Na+/K+-ATPase and ENaC (epithelial sodium channels

173
Q

Secretion of aldosterone is raised by

A

Increase in plasma concentration of Angiotensin-II
Increase in plasma K+ concentration
Decrease in plasma pH (acidosis)
Decreased blood pressure, as detected by atrial stretch receptors

174
Q

Which enzyme catalyses the final step on the synthesis pathway for cortisol?

A

11Beta hydroxylase

175
Q

Thickest layer of adrenal gland

A

Zona Fasiculata

176
Q

Zona Fasciculata is made up of

A

parenchymal cells known as spongiocytes

177
Q

The most common adrenal enzyme deficiency is

A

21β-hydroxylase deficiency,
Production of Cortisol and Aldosterone are reduced, causing a raised ACTH secretion.

178
Q

only source of oestrogen synthesis in postmenopausal women

A

conversion of adrenal androgens to oestrogen is the only source of oestrogen synthesis

179
Q

Dihydrotestosterone and estradiol are produced from testtorenone where

A

In peripheral tissue

180
Q

Clinical features of CAH

A

Virilisation of female babies
Neonatal salt-losing crisis
Hypotension
Hypoglycaemia
Hyponatraemia

181
Q

Hormones raised bs decreased in CAH

A

Raised: Androgen
Decreased: Mineralocorticoid and Glucocorticoid

182
Q

arteriole.
Sympathetic stimulation of the JGA of kidney via whichh adrenoreceptors.

A

β1

183
Q

Which drugs reduce renin secretion

A

beta-blockers, NSAIDs

184
Q

initial response to bleeding, even if of relatively small

A

splanchnic vasoconstriction mediated by activation of the sympathetic nervous system

185
Q

Max potassium absorption in kidney area

A

PCT

186
Q

increase the volume of pancreatic exocrine secretions?

A

CCK

187
Q

Enzyme secretion from pancreas

A

Secretin causes secretion of water and electrolytes
Cholecystokinin causes enzyme secretion

188
Q

Insulin and thyroxine levels in post operative phase

A

Insulin and thyroxine often have reduced levels of secretion in the post operative period

189
Q

Main cytokine of surgery

A

IL-6

190
Q

Rx of
1Septic shock
2Neurogenic shock
3Hypovolaemic shock
4Cardiogenic shock

A

Apart from cardiogenic shock all three 1st need ‘ fluid and on not increment we will give
1Vasopressors
2Inotropes
3Fluids
4inotropes, vasodilators and intra-aortic balloon pumps.

191
Q

Dopamine action

A

Dopamine causes dopamine receptor mediated renal and mesenteric vascular dilatation and beta 1 receptor agonism at higher doses.

192
Q

Diff between D1 and D2 dopamine receptors

A

D-1 renal and spleen vasodilatation
D-2 inhibits release of noradrenaline

193
Q

PTH level fall after parathyroidectomy after how long

A

10 minutes
Can be checked intraaop before closure

194
Q

PTH acts on bone where

A

Osteoblasts and then they activate osteoclast

195
Q

Salicylate acid base issue

A

Early respiratory alkalosis and late metabolic acidosis

196
Q

Watercompossition of body

A

The 60-40-20 rule:
60% total body weight is water
40% of total body weight is intracellular fluids
20% of body weight is extracellular fluids

197
Q

Mostcommon inpatient vs community cause of hypercalcemia

A

Malignancy (most common cause in hospital in-patients)
Primary hyperparathyroidism (commonest cause in non hospitalised patients)

198
Q

Which kind of antibodies in Grave

A

IgG against TSH receptors

199
Q

Composition of water in percent and lit of total body water
Total
ICF
ECF
Plasma
Interstitial fluid

A

Total…42L…100%
ICF…28L…60%
ECF…14L…40%
Plasma…3L…5%
Interstitial fluid…10L…24%

200
Q

Vagotomized stomach needs increase rate of emptying
What to give

A

Erythromycin

201
Q

Distal gastrectomy will cause decrease in which hormone

A

Gastrin

202
Q

Action of cholecystokinin in brain

A

Satiety

203
Q

CSF Composition

A

Glucose: 50-80mg/dl
Protein: 15-40 mg/dl
Red blood cells: Nil
White blood cells: 0-3 cells/ mm3

204
Q

circumoral parasthesia and muscular twitching after hyperventilation
Cause

A

Hypocalcemia due to metabolic alkalosis
Dec in ionized calcium levels

205
Q

four primary forces that determine fluid movement through a capillary membrane (Starlings forces):

A

Capillary pressure - forces fluid out of the capillary
Interstitial fluid pressure- which tends to force fluid inwards through the capillary membrane (when it is positive)
Plasma colloid osmotic pressure- favors influx into the capillary
Interstitial fluid osmotic pressure- favors efflux from the capillary into the interstitium1

206
Q

Acute phase proteins

A

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

207
Q

negative acute phase proteins

A

albumin

transthyretin (formerly known as prealbumin)

transferrin

retinol binding protein

cortisol binding protein

208
Q

Conduction velocity of heart areas
SA node
AV node
Ventricle

A

1m/sec
0.5m/sec
2 to 4 m/sec

209
Q

Chromatic cells

A

Present on adrenal medulla
Secrete both norad and adrenaline
innervated by the splanchnic nerves; the preganglionic sympathetic fibres secrete acetylcholine

210
Q

Catechoamines are derived from which amino avid

A

Tyrosine

211
Q

Tyrosine to noradrenaline and adrenaline journey

A

Tyrosine» catechoamine
Catecholamine&raquo_space;Dopamine by DOPA decarboxylase enzyme
After 2 more steps tomadrenaline and noradrenaline

212
Q

Which healing function is impaired due to diabetes

A

Migration of neutrophils

213
Q

Which fibers are responsible to register these stimuli
1high intensity mechanical stimuli
2 high intensity mechanothermal stimuli

A
  1. A γ
  2. C fibers
214
Q

Peripheral nociceptors innervation by

A

small myelinated fibres (A-delta) fibres thus fast transmission or
unmyelinated C fibres thus slow transmission

215
Q

Function of Aγ, Aβ and B fibers

A

A γ fibres transmit information relating to motor proprioception, A β fibres transmit touch and pressure and B fibres are autonomic fibres.

216
Q

JVP waves

A

JVP
3 Upward deflections and 2 downward deflections

Upward deflections
a wave = atrial contraction
c wave = ventricular contraction
v wave = atrial venous filling

Downward deflections
x wave = atrium relaxes and tricuspid valve moves down
y wave = ventricular filling

217
Q

Normal value of
EDV
ESV
Stroke volume

A

End diastolic volume 130-160ml
End systolic volume 60 ml
Stroke volume is 70ml

218
Q

What is Incisrua

A

Pressure wave associated with closure of the aortic valve increases aortic pressure. The pressure dip before this rise can be seen on arterial waveforms and is called the incisura.

219
Q

What is ferritin

A

Apoferritin + Fe+3 ion

220
Q

maximum voluntary ventilation

A

The maximum voluntary ventilation is the maximal ventilation over the course of 1 minute.

221
Q

Salbutamola beta agonist can be used for the Rx of which type of electrolyte disorder emergency

A

Hyperkalemia

222
Q

How unfractionated and low-molecular weight heparin can cause hyperkalaemia.

A

caused by inhibition of aldosterone secretion

223
Q

ECG changes seen in hyperkalaemia include

A

tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

224
Q

Causes of hyperkalaemia

A

Acute renal failure

Drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**

Metabolic acidosis

Addison’s

Tissue necrosis/rhabdomyolysis: burns, trauma

Massive blood transfusion

225
Q

Plasma potassium levels are regulated by a number of factors including

A

aldosterone, acid-base balance and insulin levels.

226
Q

When to give prednisolone in hypercalcemia

A

sarcoidosis, myeloma or vitamin D intoxication.

227
Q

Ecg change of hypercalcemia

A

Short QTc interval

228
Q

Which IV bisphosphinate is Used for malignancy associated hypercalcaemia

A

Zolendronate

229
Q

If both B12 and folate defi then what to treat 1st

A

B12

230
Q

Rx of Vit B12 in absence of neurological symptoms

A

1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

231
Q

Causes of vitamin B12 deficiency

A

pernicious anaemia

post gastrectomy

poor diet

disorders of terminal ileum (site of absorption): Crohn’s, blind-loop etc

I

232
Q

Features of vitamin B12 deficiency

A

macrocytic anaemia
sore tongue and mouth
neurological symptoms: e.g. Ataxia
neuropsychiatric symptoms: e.g. Mood disturbances

233
Q

Few imp points to e
Remember about calcium

A

Hyper can be caused by malignancy and thiazide diuretic
Hypocan be caused respiratory alkalosis

234
Q

Very 1st process to occur in wound healing

A

Platelet degranulation which leads to hemostasis

235
Q

JVP and associated diseases

A

Jugular venous pressure

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
Prominent v waves = Tricuspid regurgitation
Slow y descent = Tricuspid stenosis, right atrial myxoma
Steep y descent = Right ventricular failure, constrictive pericarditis, tricuspid regurgitation

236
Q

Kussmaul’s sign

A

paradoxical rise in JVP during inspiration seen in constrictive pericarditis

237
Q

non-pulsatile JVP is seen

A

superior vena caval obstruction

238
Q

Steep y descent in JVPcauses

A

Right ventricular failure, constrictive pericarditis, tricuspid regurgitation

239
Q

Atrial repolarization occurs on ECG in

A

QRS complex
PR segment(not interval)

240
Q

Normal corrected Q-Tc interval

A

is less than 0.44 seconds.

241
Q

What shouldn’t be found in normal. CSF

A

RBC!!!

242
Q

If there is a mass then how much CSF can be lost after which pressures will rise

A

usually 100- 120ml of CSF lost)

243
Q

Anatomical dead space is measured by

A

Fowlerville method

244
Q

Anatomical vs physiological deas space increases by

A

Anatomical :Standing, increased size of person, increased lung volume and drugs causing bronchodilatation e.g. Adrenaline
Physiological: Increases in ventilation/perfusion mismatch e.g. PE, COPD, hypotension

245
Q

Minute ventilation vs Alveolar Ventilation

A

Minute ventilation is the total volume of gas ventilated per minute.

MV (ml/min)= tidal volume x Respiratory rate (resps/min).

Alveolar ventilation is the volume of fresh air entering the alveoli per minute.

Alveolar ventilation = minute ventilation - Dead space volume

246
Q

Monroe-Kelly Doctrine focuses on which thing’s level to regulate ICP?…

A

Loss of CSF

247
Q

How Carbimazole acts

A

Carbamizole converts to Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin

248
Q

Which diseases cause increase TLCO

A

Transfer factor
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
low: everything else

249
Q

Normal TLCO occurs in which pathological conditions

A

Chest wall abnormalities
pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis

250
Q

Which diseases increase TLCO and due to what reason

A

Good pasture and Wegner granulomatosis
As they both cause pul hemorrhage

251
Q

Hormones secreted by islets of langerhans

A

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

252
Q

Role of somatostatin

A

Pancrearic fistula as decrease pancreatic exocrine secretion
variceal bleeding
and treatment of acromegaly.

253
Q

Somatostatins are secreted by how many regions

A

D cells of the pancreatic islets
gut (enterochromaffin cells)
brain tissue.

254
Q

Which Thyroid related hormone acts via nuclear receptor

A

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

255
Q

Glucose storage forms in liver and adipocytes

A

In liver and skeletal muscle glucose is stored as glycogen,
and In fat cells (adipocytes) it is stored as triglycerides

256
Q

Spleen develops inutero when

A

dorsal mesogastrium at around 5 weeks gestation.

257
Q

Effect of chronic pancreatitis on Vit B12 and folic

A

Vit B12absorption will be Dec
Folic acid will not be affected

258
Q

Mass on DRE with diarrhea
Which electrolyte abnormality

A

Hypokalemia as rectal secretions are rich in POTASSIUM

259
Q

Primary bile salts vs sec salts

A

Primary: Cholate and chenodeoxycholate.
Sec: deoxycholate and lithocholate. Of these deoxycholate is reabsorbed, whilst lithocholate is insoluble and excreted.

260
Q

Which sec bile salts are reabsorped and which one gets excreted

A

Deoxycholate is reabsorbed
Lithocholate is insoluble and excreted.

261
Q

Medullary respiratory centre are depressed by

A

Opiates

262
Q

Ventral and dorsal group of neurons of medullary respiratory centre controls

A

Ventral:controls forced voluntary expiration
Dorsal: controls inspiration.

263
Q

Apneustic centre vs pneumotaxic centre location

A

A in lower pons
P in upper pons

264
Q

Function of apneustic centre

A

Stimulates inspiration - activates and prolongs inhalation
Locat4d in lower pons

265
Q

Pneumotaxic centre of respiration

A

Upper pons, inhibits inspiration at a certain point.
Fine tunes the respiratory rate.

266
Q

Causes of pseudohyponateemia

A

Hyperlipidaemia and multiple myeloma are known to cause a pseudohyponatraemia, this is due to raised protein.

267
Q

most common cause of hyponatremia in surgery is

A

most common cause in surgery is the over administration of 5% dextrose

268
Q

Secretion of insulin is increased by

A

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

269
Q

Gram positive vs gram negative infection bynwhich blood products

A

Neg by PCV
Pos by Platelets

270
Q

Miicturition is centrally controlled by

A

Pons

271
Q

Stress urinary incontinenc Rx

A

Pelvic floor exercises 3/12, if fails consider surgery.

272
Q

Urge incontinence RX

A

Bladder training >6/52, if fails for oxybutynin (antimuscarinic drugs) then sacral nerve stimulation

273
Q

Burch Colposuspension is used in

A

Burch Colposuspension is used to treat stress urinary incontinence.

274
Q

Drug therapy for women with overactive bladder

A

oxybutynin (or solifenacin if elderly

275
Q

Metoclopramide mechanism of action

A

Metoclopramide acts directly on the smooth muscle of the LOS to cause it to contract.

276
Q

Endocrine parameters reduced in stress response:

A

Insulin
Testosterone
Oestrogen

277
Q

Urine specific gravity is increased by

A

Hypovolemia

278
Q

main component of colloid in the thyroid gland?

A

Thyroglobulin

279
Q

Substances p3rmeable to BBB
Non-permeable

A

Permeable:
CO2
O2
GLUCOSE
BARBITURATES

280
Q

Which substanc3 is not permeable to BBB

A

Hydrogen ion a dnd other highly dissociative ions

MRCS A(My Own) (28 decks)

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