Physiology Flashcards
Exchangeable bone calcium is mediated by
Osteocytes
Extracellular Ca levels are
2.2 to 2.6 mmol /L
Ca imp in how many processes mainly and they are
4 processes
Nerve and muscle excitation
Muscle contraction
Clotting
Secretions
Parathormone is
A 84 amino acids polypeptide
Initial phase of Ca release from bone by PTH action is?
Longer term, release is by?
Osteocytes releasing exchangeable bone calcium
Osteoclast activity
PTH and VitD site of action on kidney
Pth .. DCT
Vit D… PCT
Vit D conversion is stimulated by
PThH and low phosphate
Not calcium levels directly
Calcitonin site of secretion
Parafollicullar cells of thyroid
Action of PTH, Vit D and calicitonin on phosphate in kidney
- PTH.. Reduces Phospate renal absorption
- 1, 25 vit D…. Increases Phospate renal absorption
- Calcitonin: Decreases Phospate renal absorption
2 and 3 have same action on Calcium in kidney
1 has opposite in kidney
Congenital cause of hypoparathyroidism?
Di George syndrome
Which one is rare and common between hypo and hyperparathyroidism
Hypoparathyroidism is rare while hyper is common
Differentiate between tertiary and secondary hyperparathyroidism
Both have high pth
Secondary has low or normal calcium
tertiary has high calcium
Mnemonic for hypercalcemia
Stones, bones, abdominal growns, and psychiatric overtones
Only hyperparathyroidism with low or normal calcium levels
Secondary hyperparathyroidism
Al dosterone acts on
Distal nephron
Perform Na resorption and release of K
Deficiency Causes hyponatraemia and hyper kalaemia
Types of cells based on regenerative capacity
Labile(skin, esophagus,vagina and intestine)
Stable(liver, renal tubular epithelium)
Permanent(nerve, striated muscle cells and cardiac cells
2 functions of vWF
- Platelet adhesion
- it binds and stabilizes the procoagulant protein factor VIII
Treatment of VWD
- desmopressin (DDAVP)
- recombinant vWF
- vWF/factor VIII (vWF/FVIII) concentrates
ECG of Hypokalaemia
U waves
Small or absent T waves (occasionally inversion)
Prolonged PR interval
ST depression
Long QT interval
Retrograde ejaculation
Damage to upper urinary centre in the bladder
Auto regulation of blood flow to brain is at what CPP??
60 to 160 mm Hg
Timing of loss of consciousness and irreversible damage after interrupted blood flow to brain
3 sec
2 to 3 mins for latter
Cerebral perfusion pressure in severe head injuries depends upon
ICP
CPP= MAP-ICP
At what pressure below which O2 levels start affecting cerebral flow
8kpa
Places in Brain where capillaries are fenestrated
- Third and fourth ventricles ( vomiting centre in 4th and also Ag2 acts here)
- Posterior lobe of pituitary
- Hypothalamus (release of inhibitory hormones in portohypophyseal system)
Different transport mechanism and the molecules passing through them in BBB
1. Lipid soluble
2. Carrier Proteins
3. Trans and endocytosis
4. Efflux pump
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
Total CSF Volume
Total: 130 to 150ml
40ml in ventricles
100ml in spinal cord
Rate of CSF Production
500ml per day
Normal CSF Pressure
0.5 to 1 kpa
70 to 180 m of H2O
What happens when CPP falls below 50 and 30 mmHg
Below 50: cerebral is chemical
Below 30: Death
Measurement of PT, APTT and Thrombon time
PT for extrinsic pathway
APTT for intrinsic
Thrombin time for common pathway
Which one acts on vitk dependent factors
Warfarin
Vasoconstriction in coagulation is initiated by
Thromboxane A2
Serotonin
Platelet adherence vs aggregation mechanism
Adherence when vWF of endothelium attaces to G1b of platelets
Aggregation by ThA2 and ADP release and two platelets attaches together byGP2b/GP3a receptors
Initiating intrinsic vs extrinsic pathways
Intrinsic via normal blood components like vessel injury and exposed collagen of connective tissue
Extrinsic via Tissue thromoplastin released by damaged cells only
All soluble coagulation factors are produced by liver except
Factor VIII, CA, platelet factors and thromoplastin
Fibrinolytic mechanism is
TPA converts Plasminogen to Plasmin
Plasmin converts Fibrin to FDP
Protein C and S inhibits which factors
VIII and V
Adequate platelet counts for surgery
Spontaneous bleeding below which level
70k
20k
Normal bleeding time
1 to 8 minutes
BT de0ends upon
Platelet count
Platelet function
Vascular response to injury
If APTT is d3ranged than which factor will be definitely normal
Factor VII
What is Kaolin cephalin clotting time KCCT
Test for intrinsic and common pathway independent of platelets
Normal blood viscosity is maintained by
NO
PGI2
Antithrombin III ( heparin acts on it)
Drugs of coagulation and their receptors they act on
1. Aspirin
2. Heparin
3. Clopidogrel
4. Abciximab
5. Warfarin
- Thromboxane A2 inhibitor thus inhibits platelet Aggregation
- Antithrombin III activator thus inhibit adherence
- ADP thus inhibits aggregation
- Gp2B/3A thus inhibits platelet adherence to each other
- Vit k oxidase inhibitor thus inactivated of vit k dependent factors
Gastric mucosa protectant are
- Sucralfate
- Bismuth chelate (effective against H pylori)
- Misoprostol( PGE2 analogue)
Indications for surgery in ulcer cases
- Unhealed ulcer
- Failure to heal after sessions of treatment
- Possible Malignancy
- Complications like bleeding g or perforation
Upper esophageal sphincter is formed by
Cricopharyngeus muscle
Some facts regarding calcium metabolism
- Calcitonin is not essential for it
- ptPTH converts 25OH to 1 25 diOH
- PTH causes hyperphosphetemia
Some points regarding cardiac cycle
RMP is -90
Plateau is due to Ca influx
Rapid depolarization is due to Na influx
Rapid repolarizatiin is due to k efflux
Points regarding Metaplasia
Reversible
Conversion from one mature cell type to another
Can be Physiological
Serum osmolality formula
2(Na+K)+urea+glucose
P THis releasedby
chiefcells of PT Gland
PTH affect on Kidney for calciumat which site
on DCT
where is majorityof Fe is found in body
Hb
Beta blockers relation to renin
cldecrease renin secretion
vasopressor in which kind of shock
More in septic than neurogenic
Causes of Pseudo hypo natremia
Hyperlipidaemia and multiple myeloma are known to cause a pseudohyponatraemia, this is due to raised protein.
Active vs passive absorption ofwater in intestine
Active in jejunum with aminoacids and glucose
Passive in ileum with Na diffusion
Opioid receptors in the CNS
periaqueductal grey matter, limbic system, substantia gelatinosa)
What is the approximate volume of bile to enter the duodenum per 24 hou
Between 500 mL and 1.5 L of bile enters the small bowel daily
Nausea effect on gastric acid secretion
Nausea inhibits gastric secretion via higher cerebral activity and sympathetic innervation.
Drug Which inhibit the release of insulin.
Beta blockers inhibit the release of insulin.
Endocrine parameters reduced in stress response:
Endocrine parameters reduced in stress response:
InsulinTestosteroneOestrogen
Secretions of Gastric
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
Glucagon
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.
Furosemide acts on
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.
sign ofacute hypocalcemia epi after Parathyroid removal
neuromuscular irritability and laryngospasm.
Site of Fe absorption
Iron is best absorbed from the proximal small bowel (duodenum and jejunum) in the Fe2+state
.investigation of choice for upper airway compression.
Flow volume loop is the investigation of choice for upper airway compression.
Central chemoreceptors: Respond to
Central chemoreceptors: Respond to increased H+ in BRAIN INTERSTITIAL FLUID to increase ventilation.
Most imp urinary buffer
Phosphate is the most important urinary buffer. Its concentration is raised relative to that of plasma
inotrope of choice in septic shock.
Noradrenaline
equivalent of cardiac preload
EDV
Tranexamic acid inhibits
Tranexamic acid inhibits plasmin and this prevents fibrin degradation.
Rx of Massive bleeding for a patient on warfarin
Humem PT complex and vitk
Pneumonic for increase aniongap acidosis
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
Hormones decreased in post operative Period
Insulin and thyroxine often have reduced levels of secretion in the post operative period
Base Excess
The base excess increases in metabolic alkalosis and decreases (or becomes more negative) in metabolic acidosis,
statements related to the coagulation cascade is true
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
Extrinsic pathway is activated by
Damaged tissue factors
Normal Gap Acidosis
Normal Gap Acidosis: HARDUP
H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline
Causes of hyperCa
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
Increased FRC causes
Increased FRC:
Erect position
Emphysema
Asthma
Drug causing Hyperkalemia
Rx of it too
Heparin
Salbutamol
Prolonged vomiting causes which Acid-Base disorder
Metabolic Alkalosis
NormaI Stroke vol
55 - 100 ml
Triad of Wernicke encephalopathy:
Triad of Wernicke encephalopathy:
Acute confusion
Ataxia
Ophthalmoplegia
Wernicke-Korsakoff psychosis
. [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
Proteus causes which stone
Struvite
Bainbridge reflex
The Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood.
normal intracranial pressure is between 7 and 15 mm Hg. The brain can accommodate increases up to
The brain can accommodate increases up to 24 mm Hg, thereafter clinical features will become evident.
SIADH - drug causes
SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics
Lithium causes
Lithium can cause diabetes insipidus
useful agent in diabetic gastropathy.
Erythromycin
Obesity hormones
Obesity hormones
leptin decreases appetite
ghrelin increases appetite
GGhrelin is produced by
It is produced mainly by the fundus of the stomach and the pancreas.
Early vs late dumping syndrome
E: dueto increase in gastric emptying andcausing osmosis loss of intestine L: Rapid swings in insulin causing rebound hypoglycemia
Iron metabolism
Absorption
Increased by vitamin C, gastric acid
Absorption of Fe is decreased by
proton pump inhibitors, tetracycline, gastric achlorhydria, tannin (found in tea
Fe Excretion is done in
Lost via intestinal tract following desquamation
Factors reducing renin secretion
Drugs: beta-blockers, NSAIDs
Factors stimulating renin secretion
Erect posture
This is the one I did’nt know
chronotrope vs inotrope
positive inotropic (increases contractility), chronotropic (increases heart rate)
Adrenaline actsvia which mechanism
cAMP to increase intracellular Calcium Levels
milrinone
Phosphodiesterase inhibitors such as milrinone act specifically on the cardiac phosphodiesterase and increase cardiac outpu
Adrenaline in lower and higher doses
Adrenaline works as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses.
Skeletal muscle small to large
MyofibriL»_space;> fibres»_space;> Fasiculi
Covering of skeletal muscle
Fibre
Fasiculi
Muscle
Endonysium
Perimysium
Epimysium
Superficial to all this is a deepfascia which extends the lengthof muscle and attach to the bone.
Thick and thin filaments of skeletal muscle
Thick is made of myosin protein
thin is made of actin protein
A and I bands of filaments on microscope
A is thick and thin filaments both myosin
I band just have thinfilaments
Myosin structure
Ahead and Tail
Head attaches to actin and also has ATP on it
Ca binding protein in skeletal muscle
Troponin
which band size remains the same during muscle contraction
Aband
while I and Z band shortens
which protein blooks the myosin binding site on actin
Tropomyosin in a resting muscle fibre aka in absence of Ca
Oxygen debt
Amount of O2 required to remove Lactic acidfrom muscles
Mean GFR
130ml/min Per 1. 73 m^2 in men and 120 in women
Accepted range of GfR is
70-190 mL/min Per 1.73m^2
GFR starts to decline after which age and with whatrate
after 40 years
0.5 to1 ml/min
GFR increase by 50% during
Pregnancy due to vol expansion
Which drug increases plasma Creatinine
Cimetidine and Trimethoprim
Most accurate laboratory techniqueto Asses GFR is
Inulin Clearance
Which partof Kidney is most sensitive to ischemia
Tubules dueto energy dependent mechanisms
. Growth Hormone secretion is mostduring
Deep sleep
GH. in children
stimulates skeletal growth
GGH causes skeletal growth with aid , of
Insulin like growth factor
GH in adulthood
Increase Lipo and glycogenolysis
Increase protein synthesis
Decrease glucose uptake by cells and increase protein uptake
Flow of fluid in a cannula depends upon
PoiseUille’s lawwhich states
Maximum flow is achieved by a short length, large diameter, Low viscosity fluid and high pressure.
Clearance of drug is measured by which formula
Clearance (mL/ min)=( UxV)/ P
Here
U=Urine conc in mg/ml
V= Urine production in ml/min
P= plasma conc in mg/ml
Antibodies of Hashimoto Thyroidit is
Anti-microsomaL antibodies also called Ab against thyroid peroxidase
Antithyroglobulin
Hashimoto is which type
Autoimmune
Hashimoto occurence
10x More in women
30-50 years of age
Hashimoto is associated with
Pernicious anemia and celiac disease
Anti centromere Ab
Anti mitochondrial Ab
Found in
CREST syndrome
Primary Biliary chOlangitis
cANCA vs pANCA
C in granulaomatosis with polyangitis
P in chrugg strauss
Bone Tomor metastasis -
From five primary tumors
1. Prostate
2 Breast
3 Thyroid
4 Renal
5. Lung
Lytic vs sclerotic lesions of bony metastasis
Prostate is purely sclerotic
other four( breast,lung,renal and thyroid) are mixed
Hypocalcemia due to high output ileal stoma is due to
Hypomagnesemia
Ca and vit D are absorbed in
Proximal small bowel
What is Bainbridge reflex
The Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood.
Type of action potential in SA node andAV
Continues type
Why atropine doesn’t have any effect on the Transplanted HR
Bcz of denervation of SA node
How heart rate is formed in transplanted ones
Through circulating adrenaline from medulla
Phase IVc of cardiac cycle is
Atrial systole
15% of remaining ventricular filling
Isovolumetric contraction is which phase
Phase I
Diff blw phase IIa and IIb of cardiac cycle
a: pressure in vertricle more than aorta and pul vessel
4th heart sound
Due to forceful atrial contraction against stiff ventricles like in HCM and HF
3rd heart sound
Rapid ventricular filling
Which JVP wave is synchronous to pulse wave of carotid
C wave
Cardiac index
CO per squaremetre of body surface area
Restrictive vs obstructive pattern of prib
R: Fev1/FevC normal
O: Fev1/ FevC decreased
Total lung capacity
(IC + FRC or IRV + VT + ERV + RV
Which anesthetic agent can be used as continuous infusion
Propofol
Which fluid can cause anaphylaxis
Dextran 40 and 70
Which fluid is sued in septic shock
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.
Normal fasting blood glucose levels
Normal post meal
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
Peripheral chemoreceptors vs central respond to
P: Dec PO2
Inc PCO2 & Dec pH
C: Dec in pH and Inc in CO2
Normal anion gap
10-18 mmol/L
Normal gap acidosis causes
Normal Gap Acidosis: HARDUP
H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline
Uremia causes which type of acidosis
increased anion gap acidosis
Lactic acidosis type A vs B
A is due to perfusion disorders
B is due to Metabolic
which Drug causes type B lactic acidosis
Metformin
opiate cause which type of acid-base disorder
Respiratory acidosis
A complication of metabolic acidosis is
Hyperkalemia
How much fluid enters small bowel
2000 mI through oral
8000 ml through small bowel secretions
Crypts of Lieberkuhn are
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.
Channels and their location
AQP-1 :
AQP-2
SGLT2
Loop of henle
: Collecting duct
Collecting duct
Hormones of adrenal cortex
Adrenal cortex mnemonic: GFR - ACD
dehydroepiandrosterone (DHEA) is secreted from
DHEA possesses some androgenic activity and is almost exclusively released from the adrenal gland.
Aldosterone secretion is raised by
angiotensin II, potassium, and ACTH levels
Aldosterone causes
retention of Na+ in exchange for K+/H+ in distal tubule
Aldosterone acts on
Coll3cting tubule cell to increase the transcription of Na+/K+-ATPase and ENaC (epithelial sodium channels
Secretion of aldosterone is raised by
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
Which enzyme catalyses the final step on the synthesis pathway for cortisol?
11Beta hydroxylase
Thickest layer of adrenal gland
Zona Fasiculata
Zona Fasciculata is made up of
parenchymal cells known as spongiocytes
The most common adrenal enzyme deficiency is
21β-hydroxylase deficiency,
Production of Cortisol and Aldosterone are reduced, causing a raised ACTH secretion.
only source of oestrogen synthesis in postmenopausal women
conversion of adrenal androgens to oestrogen is the only source of oestrogen synthesis
Dihydrotestosterone and estradiol are produced from testtorenone where
In peripheral tissue
Clinical features of CAH
Virilisation of female babies
Neonatal salt-losing crisis
Hypotension
Hypoglycaemia
Hyponatraemia
Hormones raised bs decreased in CAH
Raised: Androgen
Decreased: Mineralocorticoid and Glucocorticoid
arteriole.
Sympathetic stimulation of the JGA of kidney via whichh adrenoreceptors.
β1
Which drugs reduce renin secretion
beta-blockers, NSAIDs
initial response to bleeding, even if of relatively small
splanchnic vasoconstriction mediated by activation of the sympathetic nervous system
Max potassium absorption in kidney area
PCT
increase the volume of pancreatic exocrine secretions?
CCK
Enzyme secretion from pancreas
Secretin causes secretion of water and electrolytes
Cholecystokinin causes enzyme secretion
Insulin and thyroxine levels in post operative phase
Insulin and thyroxine often have reduced levels of secretion in the post operative period
Main cytokine of surgery
IL-6
Rx of
1Septic shock
2Neurogenic shock
3Hypovolaemic shock
4Cardiogenic shock
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.
Dopamine action
Dopamine causes dopamine receptor mediated renal and mesenteric vascular dilatation and beta 1 receptor agonism at higher doses.
Diff between D1 and D2 dopamine receptors
D-1 renal and spleen vasodilatation
D-2 inhibits release of noradrenaline
PTH level fall after parathyroidectomy after how long
10 minutes
Can be checked intraaop before closure
PTH acts on bone where
Osteoblasts and then they activate osteoclast
Salicylate acid base issue
Early respiratory alkalosis and late metabolic acidosis
Watercompossition of body
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
Mostcommon inpatient vs community cause of hypercalcemia
Malignancy (most common cause in hospital in-patients)
Primary hyperparathyroidism (commonest cause in non hospitalised patients)
Which kind of antibodies in Grave
IgG against TSH receptors
Composition of water in percent and lit of total body water
Total
ICF
ECF
Plasma
Interstitial fluid
Total…42L…100%
ICF…28L…60%
ECF…14L…40%
Plasma…3L…5%
Interstitial fluid…10L…24%
Vagotomized stomach needs increase rate of emptying
What to give
Erythromycin
Distal gastrectomy will cause decrease in which hormone
Gastrin
Action of cholecystokinin in brain
Satiety
CSF Composition
Glucose: 50-80mg/dl
Protein: 15-40 mg/dl
Red blood cells: Nil
White blood cells: 0-3 cells/ mm3
circumoral parasthesia and muscular twitching after hyperventilation
Cause
Hypocalcemia due to metabolic alkalosis
Dec in ionized calcium levels
four primary forces that determine fluid movement through a capillary membrane (Starlings forces):
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
Acute phase proteins
CRP
procalcitonin
ferritin
fibrinogen
alpha-1 antitrypsin
caeruloplasmin
serum amyloid A
haptoglobin
complement
negative acute phase proteins
albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein
Conduction velocity of heart areas
SA node
AV node
Ventricle
1m/sec
0.5m/sec
2 to 4 m/sec
Chromatic cells
Present on adrenal medulla
Secrete both norad and adrenaline
innervated by the splanchnic nerves; the preganglionic sympathetic fibres secrete acetylcholine
Catechoamines are derived from which amino avid
Tyrosine
Tyrosine to noradrenaline and adrenaline journey
Tyrosine» catechoamine
Catecholamine»_space;Dopamine by DOPA decarboxylase enzyme
After 2 more steps tomadrenaline and noradrenaline
Which healing function is impaired due to diabetes
Migration of neutrophils
Which fibers are responsible to register these stimuli
1high intensity mechanical stimuli
2 high intensity mechanothermal stimuli
- A γ
- C fibers
Peripheral nociceptors innervation by
small myelinated fibres (A-delta) fibres thus fast transmission or
unmyelinated C fibres thus slow transmission
Function of Aγ, Aβ and B fibers
A γ fibres transmit information relating to motor proprioception, A β fibres transmit touch and pressure and B fibres are autonomic fibres.
JVP waves
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
Normal value of
EDV
ESV
Stroke volume
End diastolic volume 130-160ml
End systolic volume 60 ml
Stroke volume is 70ml
What is Incisrua
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.
What is ferritin
Apoferritin + Fe+3 ion
maximum voluntary ventilation
The maximum voluntary ventilation is the maximal ventilation over the course of 1 minute.
Salbutamola beta agonist can be used for the Rx of which type of electrolyte disorder emergency
Hyperkalemia
How unfractionated and low-molecular weight heparin can cause hyperkalaemia.
caused by inhibition of aldosterone secretion
ECG changes seen in hyperkalaemia include
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
Causes of hyperkalaemia
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
Plasma potassium levels are regulated by a number of factors including
aldosterone, acid-base balance and insulin levels.
When to give prednisolone in hypercalcemia
sarcoidosis, myeloma or vitamin D intoxication.
Ecg change of hypercalcemia
Short QTc interval
Which IV bisphosphinate is Used for malignancy associated hypercalcaemia
Zolendronate
If both B12 and folate defi then what to treat 1st
B12
Rx of Vit B12 in absence of neurological symptoms
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
Causes of vitamin B12 deficiency
pernicious anaemia
post gastrectomy
poor diet
disorders of terminal ileum (site of absorption): Crohn’s, blind-loop etc
I
Features of vitamin B12 deficiency
macrocytic anaemia
sore tongue and mouth
neurological symptoms: e.g. Ataxia
neuropsychiatric symptoms: e.g. Mood disturbances
Few imp points to e
Remember about calcium
Hyper can be caused by malignancy and thiazide diuretic
Hypocan be caused respiratory alkalosis
Very 1st process to occur in wound healing
Platelet degranulation which leads to hemostasis
JVP and associated diseases
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
Kussmaul’s sign
paradoxical rise in JVP during inspiration seen in constrictive pericarditis
non-pulsatile JVP is seen
superior vena caval obstruction
Steep y descent in JVPcauses
Right ventricular failure, constrictive pericarditis, tricuspid regurgitation
Atrial repolarization occurs on ECG in
QRS complex
PR segment(not interval)
Normal corrected Q-Tc interval
is less than 0.44 seconds.
What shouldn’t be found in normal. CSF
RBC!!!
If there is a mass then how much CSF can be lost after which pressures will rise
usually 100- 120ml of CSF lost)
Anatomical dead space is measured by
Fowlerville method
Anatomical vs physiological deas space increases by
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
Minute ventilation vs Alveolar Ventilation
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
Monroe-Kelly Doctrine focuses on which thing’s level to regulate ICP?…
Loss of CSF
How Carbimazole acts
Carbamizole converts to Methimazole prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin
Which diseases cause increase TLCO
Transfer factor
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
low: everything else
Normal TLCO occurs in which pathological conditions
Chest wall abnormalities
pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis
Which diseases increase TLCO and due to what reason
Good pasture and Wegner granulomatosis
As they both cause pul hemorrhage
Hormones secreted by islets of langerhans
Beta cells Insulin (70% of total secretions)
Alpha cells Glucagon
Delta cells Somatostatin
F cells Pancreatic polypeptide
Role of somatostatin
Pancrearic fistula as decrease pancreatic exocrine secretion
variceal bleeding
and treatment of acromegaly.
Somatostatins are secreted by how many regions
D cells of the pancreatic islets
gut (enterochromaffin cells)
brain tissue.
Which Thyroid related hormone acts via nuclear receptor
T3 binds to a receptor on chromatin to induce protein synthesis.
Glucose storage forms in liver and adipocytes
In liver and skeletal muscle glucose is stored as glycogen,
and In fat cells (adipocytes) it is stored as triglycerides
Spleen develops inutero when
dorsal mesogastrium at around 5 weeks gestation.
Effect of chronic pancreatitis on Vit B12 and folic
Vit B12absorption will be Dec
Folic acid will not be affected
Mass on DRE with diarrhea
Which electrolyte abnormality
Hypokalemia as rectal secretions are rich in POTASSIUM
Primary bile salts vs sec salts
Primary: Cholate and chenodeoxycholate.
Sec: deoxycholate and lithocholate. Of these deoxycholate is reabsorbed, whilst lithocholate is insoluble and excreted.
Which sec bile salts are reabsorped and which one gets excreted
Deoxycholate is reabsorbed
Lithocholate is insoluble and excreted.
Medullary respiratory centre are depressed by
Opiates
Ventral and dorsal group of neurons of medullary respiratory centre controls
Ventral:controls forced voluntary expiration
Dorsal: controls inspiration.
Apneustic centre vs pneumotaxic centre location
A in lower pons
P in upper pons
Function of apneustic centre
Stimulates inspiration - activates and prolongs inhalation
Locat4d in lower pons
Pneumotaxic centre of respiration
Upper pons, inhibits inspiration at a certain point.
Fine tunes the respiratory rate.
Causes of pseudohyponateemia
Hyperlipidaemia and multiple myeloma are known to cause a pseudohyponatraemia, this is due to raised protein.
most common cause of hyponatremia in surgery is
most common cause in surgery is the over administration of 5% dextrose
Secretion of insulin is increased by
Glucose
Amino acid
Vagal cholinergic
Secretin/Gastrin/CCK
Fatty acids
Beta adrenergic drugs
Gram positive vs gram negative infection bynwhich blood products
Neg by PCV
Pos by Platelets
Miicturition is centrally controlled by
Pons
Stress urinary incontinenc Rx
Pelvic floor exercises 3/12, if fails consider surgery.
Urge incontinence RX
Bladder training >6/52, if fails for oxybutynin (antimuscarinic drugs) then sacral nerve stimulation
Burch Colposuspension is used in
Burch Colposuspension is used to treat stress urinary incontinence.
Drug therapy for women with overactive bladder
oxybutynin (or solifenacin if elderly
Metoclopramide mechanism of action
Metoclopramide acts directly on the smooth muscle of the LOS to cause it to contract.
Endocrine parameters reduced in stress response:
Insulin
Testosterone
Oestrogen
Urine specific gravity is increased by
Hypovolemia
main component of colloid in the thyroid gland?
Thyroglobulin
Substances p3rmeable to BBB
Non-permeable
Permeable:
CO2
O2
GLUCOSE
BARBITURATES
Which substanc3 is not permeable to BBB
Hydrogen ion a dnd other highly dissociative ions
