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PAM Semester 1 > Physiology Exam 3 > Flashcards

Physiology Exam 3 Flashcards

1
Q

How do kidneys regulate osmolarity of fluids?

A

Urine, water and solute concentrations

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2
Q

What ions does the kidney regulate plasma concentrations of?

A

Na+, K+, CA2+, Mg2+, Cl-, HCO3-, Phosphate and sulfate

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3
Q

What are commonly used treatments of end stage kidney failure?

A

Transplant and dialysis

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4
Q

What can the kidney remove?

A

Many drugs, drug metabolites, foreign or toxic substances

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5
Q

What hormones dos the kidney degrade?

A

Insulin, glucagon, parathyroid hormone

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6
Q

Where is ammonia synthtesized?

A

The kidney, where it plays a role in acid base homestasis

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7
Q

Where is Vitamin D3 synthesized?

A

Kidney

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8
Q

Where is EPO synthesized?

A

Kidney

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9
Q

How does the kidney playa role in regulating acid bas balance?

A

By altering renal H+ excretion and HCO3- reabsorption

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10
Q

How does the kideny regulate the volume of extracellular fluid?

A

By controlling Na+ and water excretion

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11
Q

How does the kidney help regulate arterial blood pressure?

A

By adjusting Na+ excretion and producing various substances such as renin that can affect the blood pressure.

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12
Q

What waste products of metabolism are elminated by the kidney?

A

Urea, uric acid, and creatinine

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13
Q

What is the main nitrogen containing end product of protein metabolism?

A

Urea

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14
Q

WHat is the end product of muscle metabolism?

A

Creatinine

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15
Q

What is the end product of purine metabolism?

A

Uric Acid

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16
Q

Where does the O2 ultimately go?

A

Mitochondria (ATP)

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17
Q

Where does gas exchange occur?

A

Alveolia and capillary

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18
Q

3 Factors that affect gas exchange

A

Surface area
respiratory membrane
blood supply (amount)

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19
Q

Trace the airway tree all the way to capillary

A 
Oral cavity 
Oropharnyx
larnyx
trachea
carina
primary
secondary
tertiary
smaller bronchioles
bronchioles
terminal bronchioles
respiratory bronchioles
Alveolar sacs
Alveoli
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20
Q

WHere do the respiratory bronchiles start?

A

when you start to see alveoli

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21
Q

What about alveoli make it goor for gas exchange

A

good blod supply

thin membrane

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22
Q

How do bronchioles shange their radius?

A

they use smooth muscle

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23
Q

At what size do the bronchioles start?

A

1mm

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24
Q

what are the 2 functional zones of ventilation?

A

respiratory

conducting

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25
Q

How many total generations of ther ventilatory functional zones are there?

A

23 brnaches
16 in the conducting
7 in the respiratory

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26
Q

Describe conducting zone

A

Anatomical dead space (150ml)
16 branches
upper zone
conducts air to the respiratory zone

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27
Q

Describe respiratory zone

A

Respiration through bronchioles and alveoli
350ml normal value of participating air space
7 branches
this is where gas exchange occurs

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28
Q

Describe dead space

A

where no respiration occurs

150ml normal value

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29
Q

normal tidal volume

A

500ml

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30
Q

What secretes mucous in lungs?

A

goblet cells

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31
Q

WHat are cilia extensions of?

A

plasma membrane

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32
Q

Describe mucous elevator

A

cilia brings mucous and particles up airway to oral cavity where they are swalloed
similar to mexican wave

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33
Q

Is there mucous and cilia in respiratory zone

A

no, only in the conducting zone

Macrophages are in respiratory zone

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34
Q

What is used to help keep respiratory zone clean

A

macrophages

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35
Q

Where is cartilage distribution in airway?

A

Cartilage gets less and less as you go down the conducting zone
none in respiratory zone
Cartilage is C shaped

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36
Q

Where is the smooth muscle distribution in the airway?

A

none at the top

lots in the bronchioles

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37
Q

What does smooth muscle do in the airway

A

Bronchoconstriction

bronchodilation

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38
Q

Where is there no goble cells, mucous, cilia, cartilage

A

Respiratory zone

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39
Q

What are muscles for inspiration

A

Diaphram
sternocleidomastoid
scalenes
external intercostal

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40
Q

Is inspiration active or passive?

A

active

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41
Q

Is expiration active or passive

A

passive (unless forced)

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42
Q

Describe expiration at rest

A

normal
passive
no energy expended
diaphragm relaxes recoil of lungs (which have elastic properties)

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43
Q

Describe forced expiration

A 
Cough, sneeze, balloon
Abdominal muscles
rectus abdominus
external obliques
internal intercostals
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44
Q

Describe the rib movement on respiration

A

Like a bucket handle
on inspiration they go up and out
on exhalation they go down and in

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45
Q

Describe pressure gradient fro inspiration vs expiration

A

Gas moves from high pressure to low pressure

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46
Q

How do we change pressure in the lungs

A

we change the volume which changes the pressure

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47
Q

how does pressure change on inspiration

A

the volume increases and the pressure drops which allows air to flow in

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48
Q

How does pressure change on expiration

A

teh volume decreases, the pressure then increases which expels air

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49
Q

What is the complete process for inspiration

A 
the inspiratory muscle contract
the diaphragm decends
the rib cage rises
THoracic cavity volume increases
the lungs are stretched
the intrapulmonary volume increases
the intrpulmonary  pressure decreases
Air then flows into the lungs down the pressure gradient
The air continnues until pressure equalizes at 0 atm
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50
Q

What is the complete process for expiration

A 
inspiratory muscles relax
diaphragm rises
rib cage descends
thoracic cavity volume decreases
intrpulmonary pressure increases
air flows out of lungs
down pressure gradient until 0 ATM
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51
Q

WHat shape is the diaphragm

A

concave when relaxed

flattens out when it contracts

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52
Q

What do muscles do on inspiration

A

diaphragm moves inferiorly and flattens out
intercostals increase latteraly
sternocleidomastoid and scalene help superiorly

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53
Q

what is the P in PO2and PCO2

A

partial pressure

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54
Q

What is the total pressure at sea level

A

760mmhg

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55
Q

what is percentage of oxygen on earth regardless of altitude

A

21% o2
79% nitrogen
1% everything else

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56
Q

What is PO2 when inhaled

A

160mmhg

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57
Q

What is PO2 in alveoli

A

104mmhg

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58
Q

what is PO2 in arterial blood?

A

95mmhg

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59
Q

What is the PO2 in the tissues/capillary

A

40mmhg

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60
Q

WHat happens when the arterial blood at 95mmhg reaches the capillaries at 40mmhg?

A

the O2 in the blood will go down the pressure gradient and into the tissue

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61
Q

What is the PO2 of the venous blood

A

40mmhg

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62
Q

Trace PO2 pressure through circulation

A 
inhaled 160mmhg
lungs 104
arterials 95
capillaries 40
venous 40
lungs 104
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63
Q

What happens to the deoxgenated blood when it gets back to the lungs in regards to pressure

A

the O2 inhaled at 160mmhg travels down the pressure gradient and oxygenates the blood returning to the lungs at 40mmg to restart the cycle.

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64
Q

What is the nitrogen air percentage inhaled and exhaled

A

79% for both, doesn’t change

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65
Q

What is O2 percentage in haled and exhaled

A

21% inhaled
15-18% back out
the more intense the exercise, the less the %

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66
Q

What is the CO2 percentage inhaled and exhaled

A

0.04% inhaled
3-5% back out
HIgher instenisty activity, higher percentage

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67
Q

What is H2O percentage in haled and exhaled

A

.46% in
.46% out
No change

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68
Q

WHat is co2 pressure in arterials

A

40%

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69
Q

What is CO2 pressure in capillaries

A

46%

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70
Q

Why don’t we need as much of a pressure gradient for CO2

A

it is more soluble

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71
Q

How does CO2 get back into blood i the tissue

A 
travels down pressure gradient
46% in tissue
40% in blood
travels through venous system
and exhaled
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72
Q

What prevents natrual airway collapse

A

the intrapleural sac
a negative pressure between the two pleurae
suction force
causes chest wall and lung to move together

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73
Q

with a pneumothroax, what does the loss of negative pressure allow?

A

it allows the recoil of the lungs to happen and the lungs collapse
lung pulls away from chest wall
lung becomes inefficeint due to loss of surface area

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74
Q

What does the alveolar cycle mimic?

A

the lung cycle

inhalation and exhalation

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75
Q

Trace alveolar cycle

A 
Inspiratory muscles contract
thoracic cavity expands
pleural pressure becomes more negative
transpulmonary pressure increases
lungs inflate
alveolar pressure becomes subatmospheric
air flows into the lungs until alveolar pressure equals atmospheric pressure
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76
Q

What does spirometry measure

A

lung volume

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77
Q

On a PFT report, what does a downward deflection represent?

A

expiration

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78
Q

On a PFT report, what does a upward deflection represent?

A

Inspiration

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79
Q

PFT Inspiration categories

A

IRV Inspiratory reserve volume 3.1 liters

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80
Q

PFT expiratory categories

A

ERV expiratory reserve volume 1.2 liters
RV Residual volume 1.2 liters
FRC functional residual capacity 2.4 liters

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81
Q

PFT Both inspiratory and expiratory categories

A

VT tidal volume (500ml)
IC inspiratory capacity 3.6 liters
VC Vital capacity 4.8 Liters
TLC total lung capacity 6 liters

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82
Q

What is FVC?

A

Forced vital capacity
maximum amount of air forcibly exhaled at a maximum inhalation
4.8L

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83
Q

What is FEV1/FVC

A

Forced expired volume / forced vital capacity ratio
Percentage of FVC exhaled in 1 sec
80% is normal

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84
Q

What is FEV1

A

forced expiratory volume
Maximum volume of air forcibly exhaled in 1 second
4.0L

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85
Q

What is TLC

A 
Total lung capacity
The volume of air in the lungs at the end of maximum inspiration
Everything on graph combined
IRV+VT+ERV+RV=TLC
6L
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86
Q

WHat is VC

A

Vital capacity
Maximum volume of air that can be exhaled
IRV+VT+ERV=VC
4.8L

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87
Q

WHat is IC

A

Inspiratory capacity
Maximum amount of air inhaled at end of normal inspiration
VT+IRV=IC
3.6L

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88
Q

What is VT

A

Tidal volume
Volume of air inhaled and exhaled with each normal breath
500ml

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89
Q

What is FRC

A 
Funtional residual capacity
Volume of air remaining in lungs at the end of normal tidal volume
ERV+RV=FRC
2.4L
(Expiration)
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90
Q

WHat is RV

A

Residual Volume
Volume of air remaining in lungs after maximum exhalation
1.2L
(Exhalation)

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91
Q

What is ERV

A

Expiratory reserve volume
Maximum volume of air exhaled at end of tidal volume
1.2L
(exhalation)

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92
Q

What is IRV

A

Inspiratory reserv volume
Maximum volume of air inhaled at the end of normal inspiration
1.2L
(Inspiration)

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93
Q

Wha tis normal percentage for FEV1/FVC ratio

A

80%

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94
Q

WHat is normal FEF

A

25-75

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95
Q

In obstructive disorder what does FEV1/FVC ratio do

A

decrease

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96
Q

In obstructive disorder what does FVC do

A

Decrease or could be normal

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97
Q

In obstructive disorder what does FEV1 do

A

Decrease

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98
Q

In restrictive disorder what does FEV1/FVC do

A

Normal or increases

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99
Q

In restrictive disorder what does FEV1 do

A

decrease

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100
Q

In restrictive disorder what does FVC do

A

decrease

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101
Q

Examples of obstructive disorders

A

Emphysema
Chronic bronchitis
bronchiectasis
asthma

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102
Q

Examples of restrictive disorders

A 
intersitual lung disease
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
chestwall neurmuscular disease
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103
Q

Why dont lung disease spread to the other lung typically

A

lungs are seperatate and comparmentalized

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104
Q

Describe the restrictive disorder

A

Reduced expansion of lung parenchyma accompanied by decreased lung total capcacity

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105
Q

Describe obstructive disorder

A

Limitation of airflow due to partial or compele obstruction

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106
Q

WHat is minute ventilation

A 
tidal volume times respiration rate
ve=vt x f
example
500 x 12 = 6000
not really important compared to alveolar ventilation
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107
Q

What is alveolar ventilation

A 
subtract the dead space from the tidal volume
then multiply times respiration rate
example
500-150 =350
350 x 12 = 4200
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108
Q

How is alveolar vetilation calculated

A

by measuing a persons expired CO2

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109
Q

What happens to CO2 in hypoventilation?

A

retain more CO2

more CO2 in blood

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110
Q

What happens to CO2 in hyperventilation?

A

Blow off more CO2

Blood becomes more basic

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111
Q

What is hypernea

A

INcreased breathing and metaboic rate due to exercise

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112
Q

what is the relationship between PAco2 and alveolar ventilation

A

they are inversely related

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113
Q

What does lung compliance measure

A

distensibilty

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114
Q

Will it be harder or easier to breath if lung compliance is low

A

harder

it will be more difficult to inhale due to a stiffer lung

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115
Q

Will it be harder or easier to breath if lung compliance is high

A

it will be easier

less work to inflate the lung

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116
Q

how does gravity affect the alveoli in the lung

A

The weight of the lung compress the alveoli in the base of the lung

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117
Q

contrast the alveoli in the base of the lung verse the apex

A

at the base, they are small alveolus that can expand greatly and have high comliance

at the apex, alveolus are larger, respiration is poorer, they change very little in size and the compliance is low

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118
Q

WHat does surfactant do?

A

lowrs the surface tension and stabalizes alveoli at low lung volumes
it is like dish soap
reduces the tendency of alveoli to stick together
keeps alveoli from collapsing

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119
Q

What cells secrete surfactant

A

Type 2 endothelial cells

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120
Q

What kind of cells are type 1 endothelial cells

A

simple squamous

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121
Q

How does alveolar surface tension affect lung compliance

A

Increased surfactant = increased compliance
less surfactant = less compliance
increased comliance = increased volume at a givn pressure

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122
Q

Is ther more surfactnat in smaller or larger alveoli

A

Smaller alveoli have more surfactant
larger alveoli have less surfactant
this negates any pressure gradient and keeps the alveoli from collapsing

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123
Q

What are the cells of the alveoli

A

simple squamous epithlial
1 layer
flat squashed cells

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124
Q

Are the majority of the alveoulus type 1 or type 2 cells

A

type 1 cells make up majority

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125
Q

Are alveoli seperate or connected

A

they are all connected via pores

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126
Q

Why do alveoli have macrophages

A

they have no cilia or mucous

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127
Q

Select the correct statement about the physical factors influencing pulmonary ventilation.
A. A decrease in compliance causes an increase in ventilation.
B. B. A lung that is less elastic will require less muscle action to perform adequate ventilation.
C. C. As alveolar surface tension increases, additional muscle action will be required.
D. D. Surfactant helps increase alveolar surface tension

A

C. C. As alveolar surface tension increases, additional muscle action will be required.

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128
Q

Which of the following would best characterize pulmonary function in a patient with asthma?
A. Maximal expiratory airflow is increased from normal.
B. B. Residual volume is decreased from normal.
C. C. Forced vital capacity is increased from normal.
D. D. Resistance to airflow is increased from normal.
E. E. The FEV1/FVC ratio is increased.

A

D. D. Resistance to airflow is increased from normal.

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129
Q 
An individual has an alveolar ventilation of 6,000 mL/minute, a tidal volume of 600 mL, and a breathing rate of 12 breaths/minute. What is this individual’s anatomic dead space? 
A.	100 mL 
B.	B. 120 mL 
C.	C.150 mL 
D.	D. 200 mL
A

A. 100 mL

6000 = (600 - X)12 solve for X
6000 /12 = 500
500 = 600 - X
500 – 600 = -100
-100 = -X
X= 100
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130
Q

pressure at sea level vs alitutde

A

Sea level 760mmhg = PO2 = 160

Mt everest 253 mmhg = PO2 = 53

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131
Q

FIO2

A

21% O2

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132
Q

Whenis partial presure of O2 highest?

A

when it leaves the lungs

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133
Q

When is Partial pressure of CO2 highest

A

when it enters the lungs

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134
Q

How are distance and diffusion related

A

distance reduces efficiency of diffusion

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135
Q

What is lung diffusion capacity

A

the ability of the lungs to transfer gases

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136
Q

How does diffusion relate to hematocrit and blood volume

A

If you decrease hematocrit you will decrease diffusion capacity
if you decrease blood volume, you will decrease diffusion capacity
low cardiac output, anemia, blood loss

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137
Q

How much O2 does arterial blood carry?

A

20ml of O2 per Deciliter

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138
Q

What is O2 bound hemoglobin called

A

oxyhemoglobin

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139
Q

What is no O2 bound to hemoglobin called

A

deoxyhemoglobin

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140
Q

What is CO2 bound hemoglobin called

A

carboxyhemoglobin

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141
Q

How is oxgen transported % wise

A
  1. 5 % is bound in hemoglobin

1. 5% dissolved in plasam

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142
Q

WHere does the O2 bind to hemoglobin

A

it binds to the iron that is in the Heme

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143
Q

Where does the CO2 bind in hemoglobin

A

it binds to the globin

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144
Q

What happens as more and more O2 binds to Hemoglobin

A

it causes more and more CO2 unbinding

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145
Q

What happens as more and more CO2 binds to hemoglobin

A

it causes more and more O2 to unbind

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146
Q

What is the plateua phas ein the oxyhemoglobin dissociation curve

A 
Loading phase (lungs)
where there is a high affinity for hemoglobin in the lungs
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147
Q

What is the steep phase of the hemoglobin dissociation curve

A 
unloading phase (tissues / capillaries)
Low affnity for hemoglobin in tissues
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148
Q

What causes sigmoidal shape in hemoglobin dissociation curve graph

A

The cooperative binding

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149
Q

What does a right shift on the graph represent

A

increases oxygen unloading

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150
Q

What does a left shift on the graph represent

A

increased oxygen loading

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151
Q

What is p50 for hemoglobin

A

the 50% saturation rate of hemoglobin

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152
Q

What are factors that can cause right shift on the hemoglobin dissocation graph (increased unloading)

A 
INcreased Temperature
INcreased CO2
INcreased H+
INcreased BPG 
increased workload
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153
Q

How is most of the CO2 in the blood transported

A

in the plasma as bicarbonate
60-70%
30% is bound to hemglobin as carbamino
10% is dissolved in the plasma

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154
Q

What is carbonic anhydrase reaction

A 
CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-
CO2 combines with H2O
and using carbonic anhydrase
makes carbonic acid
Carbonic acid then dissociates into H+ and bicarbonate
Occurs in the Red blood cells
This equation occurs in the tissues/capillaries
the reverse occurs in thelungs
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155
Q

What happens t the charge when HCO3- leaves the red blood cell

A

a Cl- ion enters to balance the charge

KNown as chloride shift

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156
Q

What is chloride shift

A

when a HCO3 leaves a red blood cell and a cl- enters in oreder to balance the charge

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157
Q

where does this equation occur?

CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-

A

in the tissue/capillaries
Forward in lungs,
backwards in tissues
the reverse equation occurs in the lungs

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158
Q

Where does this equation occur?

H+ + HCO3- ↔ H2CO3 ←CA→ H2O + CO2

A

In the lungs
Forward in lungs,
backwards in tissues
the reverse occurs in the tissus/capillaries

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159
Q

What is reverse chloride shift

A

the HCO3 enters the red blood cell while a cl ion leaves

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160
Q

Which of the following increases oxygen unloading from hemoglobin?
A. increased carbon dioxide in the tissue
B. increased oxygen levels in the tissue
C. increased blood pH
D. decreased metabolism
E. decreased temperature

A

A. increased carbon dioxide in the tissue

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161
Q

Which of the following will most likely lead to decreased oxygen exchange at the respiratory membrane in a healthy individual?
A. Increased cardiac output, low atmospheric PO2
B. Increased pulmonary capillary recruitment, exercise
C. Decreased O2 diffusion distance in the alveolar–capillary membrane
D. Decreased alveolar PO2

A

D. Decreased alveolar PO2

162
Q 
If alveolar ventilation is held constant, which of the following predicted changes in alveolar oxygen and carbon dioxide tensions would occur when metabolic rate is increased? 
PACO2      PAO2 
A Increases Increases 
B Increases Decreases 
C Increases No change 
D Decreases Decreases
A

B Increases Decreases

163
Q

What is the differnec betweent he bronchiole circulation and the pulmonary circulation

A

they are seperate
Bronchial circulation is to nourish the conducting airways
Pulmonary circulation is gas exchange

164
Q

What is the primary function of bronchiole circulation

A

to nourish conducting zone

165
Q

What is the primary function of pulmonary circultion

A 
Primary is gas exchange
Secondary are
flitering (thrombi)
Metabolic organ (ACE)
Blood source (10% volume)
166
Q

What are secondary functions of pumonary circulation

A 
Primary is gas exchange
Secondary are
flitering (thrombi)
Metabolic organ (ACE)
Blood source (10% volume)
167
Q

as cardiac output decreases, what happens to resistance in the vascular system

A

it is inverse

it increases

168
Q

as cardiac output increases, what happens to resistance in the vascular system

A

it is inverse

it decreases

169
Q

is the pulomnary circuit high pressure or low pressure

A

unlike systemic circuit

the pulmonary ciruit is low pressure

170
Q

is pulmonary circuit normally dialated or constricted

A

Pulmonary circuit is normally dialated

systemic circuit is normally constricted

171
Q

which side has greater cardic output, the left or the right

A

Neither, they are equal
Pressures differ
volumes are the same

172
Q

What can increase capillary recruitment in the lungs

A

increased cardiac output

173
Q

How does pulmonary circulation help decrease resistance when arterial pressure rises

A 
Capillary recruitment
Capillary distention
Due to more capillaries
capillaries in parallel
more distented capillaries
174
Q

What does capillary recruitment do in the lungs

A 
when cardiac output increases, capillary recruitment can effect a marked decrease in pulmonary vascular resistance
Due to more capillaries
capillaries in parallel
more distented capillaries
helps decrease pulmonary edema
175
Q

What does capillary distetion do in lungs?

A

increases capillary surface area
increase gas exchange
helps decrease pulmonary edema

176
Q

When does pulmonary vascular resistance increase?

A 
At hig and low lung volumes
At low volumes
extra alveolar compress
at high lung volumes
alveolar vessles compress
177
Q

What are factors that can effect fluid exchange in the capillaries

A

alveolar surface tension which enhances filtration

Alveolar pressure which opposes filtration

178
Q

Which enhances filtration?
Alveolar surface tension
or
Alveolar pressure

A

Alveolar surface tension

179
Q

Which opposes filtration?
Alveolar surface tension
or
Alveolar pressure

A

Alveolar pressure

180
Q

WHat helps to keep the alveoli dry and avoid edema

A

a low pulmonary capillary hydrostatic pressure

181
Q

what is the most frequent cause of pulmonary edema

A

increased capillary hydrostatic pressure

this is due to abnormally high pulmonary venous pressure

182
Q

what is the second major cause of pulmonary edema

A

First is increased capillary hydorstatic pressure

second is noncardiogenic and is due to increasd alveolar tension

183
Q

How is blood flow distributed in the lungs

A

Blood flow is more copius at the base and dimishes towards the apex

184
Q

How many zones are there for blood flow in the lungs

A 
3 zones
zone 1 is at top (apex)
   no perfusion, no gas exchange
Zone 2 is in middle
   a little, but not a lot of gas exchange
Zone 3 is at base
   Largest rate of blood flow
   Best gas exchange occurs here
185
Q

How does gravity affect the the perfusion, and ventilation ratio in the lung

A

In the apex, there is hig ventilation but poor perfusion
this gives a high number for ratio
in the base there is low ventilation but good perfusion
gives a low number for ratio

186
Q

What does low oxygen tension in the lungs cause

A

pulmonary vasoconstriction

187
Q

what does regional hypoxia in the lungs cause

A

regional vasoconstriction which isolates poorly ventilated areas

188
Q

What dos general hypoxia cause in the lungs

A

General hypoxia causes vasoconstriction thoughout the lungs,

in other vessels outsod eof the lungs, hypoxia causes vasodialation

189
Q

WHen you have hypoxia why do the lungs vasoconstrict

A

This increases resistance and pilmonary artery pressure

190
Q

When do the lungs change ventilation to match changes in perfusion

A

decreased blood flow and less co2 in the Alveoli is the stimulus for the bronchioles to constrict.
this reduces the air flow so tht it matches the blood flow

191
Q

When do the lungs change perfusion to match changes in ventilation

A

decreased airflow which reduces PO2 in blood vessels which causes vasoconstriction
this results in decreased bloodflow to match the decreased air flow

192
Q

What happens to ventilation perfusion ratio if there is an airway Obstruction

A

In normal airway, airway is open, capillaries are open, there is good gas exchange, minimal shunting of air or blood (wasted air/blood)

In obstruction
this causes low ventilation / perfusoin ratio
we are underventilated compared to ou blood flow
increases wasted blood (shunting)
increases venous admixture

193
Q

What happens to ventilation perfusion ratio if there is an capillary obstruction

A

In normal airway, airway is open, capillaries are open, there is good gas exchange, minimal shunting of air or blood (wasted air/blood)

This will cause a high ventilation / perfusion ratio
over ventilated compared to blood flow
this will increase wasted air (psyiological dead space)

194
Q

Which of the following would be predicted to occur in a healthy individual, who has a 50% increase in his cardiac output?

 Pulm Blood Flow       Cap Recruitt        PulmVasc Resist
A Increases			 Increases 		Decreases 
B Increases			 Increases		 Increases 
C Increases 			No Change 		Decreases 
D No change 			Increases 		No change
A

A Increases Increases Decreases

195
Q

Which of the following best characterizes alveoli that are well ventilated but are poorly perfused?
A. They are most likely to occur with a partially plugged airway.
B. They are most likely to occur at the base of the lung.
C. PO2 is high in these alveoli, while PCO2 is low.
D. PO2 is low in these alveoli, while PCO2 is high.
E. Both PO2 and PCO2 are normal.

A

C. PO2 is high in these alveoli, while PCO2 is low.

196
Q

Most of the oxygen in the pulmonary capillaries is delivered to the heart from the base rather than from the apex of the lungs. This is primarily due to the fact that
A. the high V/Q ratio occurs at the base of the lungs.
B. the base of the lungs receives more ventilation than the apex.
C. the base of the lungs has a higher blood flow than the apex.
D. more shunted blood occurs at the lung apex.
E. the PO2 is lower in capillary blood leaving the lung apex than at the base.

A

C. the base of the lungs has a higher blood flow than the apex.

197
Q

WHere are the respiratory centers?

A

The medulla and the Pons

198
Q

What are the two respiratory cneters in the medulla

A

DRG and VRG
DRG or dorsal respiratory group
is in nucleus of the tractus solitirus
primarily for inspiration

VRG or ventilatory respiratory group
is in the nucleus ambiguos and nucleus retroambiguos
it has both inspiratory and expiraotry neurons
VRG expiration is active, unlike normal expiration which is passive

VRG is larger

199
Q

WHat is the DRG

A

DRG or dorsal respiratory group
is in nucleus of the tractus solitirus
primarily for inspiration

200
Q

What is VRG

A

VRG or ventilatory respiratory group
is in the nucleus ambiguos and nucleus retroambiguos
it has both inspiratory and expiraotry neurons
VRG expiration is active, unlike normal expiration which is passive

VRG is larger

201
Q

Describe role of phrenic nerve

A

Somatic nerve in charge of respiration
Controls diaphragm
c3,4,5, keep the diaphragm alive

202
Q

WHat are the two types of chemo receptors

A

central and peripheral
THese are not sensitive to changes in O2
dont detect O2 changes until around 40mmhg
Very sensitive to CO2

203
Q

Describe peripheral chemoreceptors

A

Carotid sinus
aortic arch
Receptors for CO2, H+ and O2

204
Q

Describe Central chemoreceptors

A

IN lungs
Receptors for CO2 mainly
but also H+

205
Q

What are the three types of receptors in the lungs

A

Chemoreceptors
mechanoreceptors
muscle propioceptors

206
Q

What do muscle proprioceptors do in the lung

A

They are used for the feed forward mechanism

207
Q

Describe the mechanoreceptors in the lung

A

Stretch receptors
J receptors (juxtaposed)
activated by engourgment of pulmonary capillaries
Irritant receptors
Typically stimulate respiratory cneter but can
depress it

208
Q

Where does voluntary control of respiration come from

A

cerebrum
hold breath
breath faster or slower

209
Q

How is everything relayed to the respiratory centers in pons and medulla

A 
signals are relayed to spinal motor nerves
ie the phrenic nerve
then they are relayed to
diaphragm
intercostals
acessory muscles
muscles of respiration
210
Q

describe neural reflexes in the control of breathing

A

as CO2 goes up, minute vetilation goes up
(linear relationship, straight line)
CO2 is powerful stimulus for ventilation

O2 is not the same, it needs to drop a really long ways to have any changes in ventilation
(to around 40mmhg)

Central and peripheral chemoreceptors detect the changes
they respond to changes in arterial blood gases
and
H+ ion concentrations

211
Q

Talk about the blood brain barriers role in ventilation

A

The BBB is impermeable to H+ and HCO3
It is permeable to CO2
this can cause rapid changes in acid base status
The more CO2, the more ventilation

212
Q

CO2 in relation to ventilation

A

the more CO2 the more ventilation

213
Q

The increase in ventilation from moderate exercise in a healthy individual is caused by:

A. an increase in lactic acid production.
B. an increase in arterial PCO2.
C. a decrease in arterial PO2.
D. a decrease in the pH of brain extracellular fluid.
E. an increase in limb joint and muscle receptor excitation.

A

E. an increase in limb joint and muscle receptor excitation.

214
Q

A patient suddenly has a decrease in her arteriolar PO2. Which of the following statements best describe the ventilatory response to the decreased arteriolar PO2?

A. The response is mediated by both peripheral and central O2 chemoreceptors.
B. The response is mediated by peripheral O2 chemoreceptors.
C. The response is mediated by O2-sensitive chemoreceptors in skeletal muscle.
D. The response is mediated by O2-sensitive chemoreceptors in the alveolar capillary membrane.

A

B. The response is mediated by peripheral O2 chemoreceptors.

215
Q

A newborn inhales and stimulates the stretch receptors in the airway smooth muscle.
This will:
A. inhibit inspiration and stimulate expiration.
B. stimulate depth of breathing and oxygen uptake in the lung. C. inhibit depth of breathing and stimulate shallow breathing.
D. stimulate depth and rate of breathing.

A

A. inhibit inspiration and stimulate expiration.

216
Q

A 50-year-old man with a persistent cough and difficulty breathing is referred
by his family physician for pulmonary function tests. The test results show
that the forced vital capacity (FVC), forced expired volume in 1 s (FEV1), and
functional residual capacity (PRC) are all significantly below normal. Which
of the following diagnosis is consistent with these pulmonary function test
results?

A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fibrosis

A

D. Pulmonary fibrosis

217
Q
  1. A 19-year-old man is taken to the emergency department after being stabbed
    in the right side of the chest. ‘Ihe entry of air through the wound resulted in a
    pneumothorax on the right side of his chest What difference between the right
    and left sides of the chest would be apparent on a plain chest x-ray?

A. ‘Ihe lung volume on the right would be larger
B. The position of the diaphragm on the right would be higher
C. The thoracic volume on the right would be larger
D. There would be no dllferences in thoracic geometry

A

C. The thoracic volume on the right would be larger

218
Q

A 28-year-old man is involved in a high-speed motor vehicle accident in which
he suifers multiple rib fractures. On arrival at the emergency department. he
is conscious but in severe pain. His respiratory rate is 34 breaths/min, and his
breathing is labored. His blood pressure is 110/95 mm Hg, and his pulse is 140
beats/min. His arterial Po2 is 50 mm Hg, and he is unresponsive to supplemental 0 1
• His arterial Pco2 is 28 mm Hg. What is the most likely cause of this
patient’s hypoxemia?

A. Alveolar hypoventilation
B. High ventilation/perfusion (V / Q) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V/Q ratio
A

D. Intrapulmonary shunt

219
Q

A 16-year-old girl is found unconscious in the street. She has no visible injuries
but is cold and is taking shallow breaths at a rate of 6-8 per minute. An arterial blood gas analysis recorded in the emergency department shows that her
Po2 is 55 mm Hg and her Pco2 is 75 mm Hg. What is the most likely cause of
hypoxemia in this patient?

A. Alveolar hypoventilation
B. High ventilation/perfusion (V / Q ) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V/ Q ratio
A

A. Alveolar hypoventilation

220
Q

A 62-year-old man with a history of COPD is admitted to the hospital due to
acute deterioration in lung function as a result of a viral chest infection. An
anal}’5is of arterial blood gases shows that his Po2 is 60 mm Hg and his Pco1 is
70 mm Hg. His exhaled minute ventilation rate is two times higher than that of
a normal individual of the same age and body size. He has hypercapnea. despite
having an increased exhaled minute ventilation rate because his

A. alveolar ventilation is increased
B. dead space ventilation is increased
C. VT is increased
D. ventilation/perfusion (V / Q) ratio is decreased
E. intrapulmonary shunt is increased
A

B. dead space ventilation is increased

221
Q

A 40-year-old woman presented with dyspnea, hematuria, and right flank pain.
CT scans revealed a renal tumor, with an extensive venous thrombus that hadnvaded the inferior vena cava. Fragments of the thrombus had entered the
lungs and were blocking several major branches of the pulmonary arteries.
Aasuming that there was no change in VT or respiratory rate, what effect would
these pulmonary emboli have on arterial blood gases within the first few minutes of their occurrence?

A. Decreased Pco2 and decreased Po2
B. Decreased Pco2 and increased Po2
C. Increased Pco2 and decreased Po2
D. Increased Pco2 and increased Po2
E. No change in Pco2 or Po2
A

C. Increased Pco2 and decreased Po2

222
Q

A 9-ycar-old boy decided to find out for how long he could continue to breathe
into and out of a paper bag. After approximately 2 minutes, his friends noticed
that he was breathing very rapidly so they forced him to stop the experbnent.
What change in arterial blood gas composition was the most potent stimulus
for this boy’s hyperventilation?

A. Dcacased Pco2
B. Decreased Po2
C. Decreased pH
D. Increased Pco2
E. Increased Po2
F. lncrcaacd pH
A

D. Increased Pco2

223
Q

A 54-ycar-old woman with advanced emphysema due to many years of cigarette smoking is admitted to the hospital because of severe peripheral edema
and shortness of breath. On physical examination, there is jugular venous distension and a widely split second heart sound with a loud pulmonic sound. A
differential diagnosis of right heart failure and pulmonary hyperte1U1ion is confirmed by cardiac cathetmzation. The results of her arterial blood gas analpiis
show Po2 = 55 mm Hg, Pco2 = 75 mm Hg, and pH = 7.30. What is the most
lilccly cause of pulmonary hypertension in this patient?

A. Decreased alveolar Po2
B. Decreased lung compliance
C. Decreased parasympathetic neural tone
D. Increased alveolar Pco2
E. Increased thoracic volume
F. Increased sympathetic neural tone
A

A. Decreased alveolar Po2

224
Q

A group of medical students is experimenting with a peak flow meter in the
respiratory phy&iology laboratory. Two students decide to compete to see which
of them can blow the hardest into the device. Which of the following mwcles is
most effective at producing a maximal expiratory effort such as this?

A. Diaphragm
B. External intercostal muscles
C. Internal intercostal muscles
D. Rectus abdominus
E. Sternocleidomastoid
A

D. Rectus abdominus

225
Q

A 22-year-old man was involved in a :6.ght in which he received a severe blow
to the head. On arrival at the emergency department. he was unconscious and
initially received assisted ventilation via a manual bag-valve device. An analysis
of his arterial blood gases shows:
Po2 =45mmHg
Pco2 = 80 mm Hg
pH=7.05
HC0,-=27 mM
In what form was most col being transported in his arterial blood?

A. Bicarbonate ions
B. Carbaminohemoglobin comp

A

A. Bicarbonate ions

226
Q

A 67-year-old woman involved in a motor vehicle accident lost 1 L of blood
became of an open fracture of her left femur. Paramedics were able to prevent
further bleeding. What changes to her intracellular fluid (ICF) and extracellular
fluid (ECF) volumes would be observed 15 minutes after this blood loss?

A. ECF volume smaller; ICP volume unchanged
B. ECF volume smaller; ICF volume smaller
C. ECF volume unchanged; ICF volume unchanged
D. ECF volume unchanged; ICF volume smaller

A

A. ECF volume smaller; ICP volume unchanged

227
Q

1he following pressure measurements were obtained from within the glomerulus of an experimental animal:
Glomerular capillary hydrostatic pressure = 50 mm Hg
Glomerular capillary oncotic pressure = 26 mm Hg
Bowman’s space hydrostatic pressure = 8 mm Hg
Bowman’s space oncotic pressure = 0 mm Hg
Calculate the glomerular net ultrafiltration pressure (positive pressure favors
filtration; negative pressure opposes filtration).

A. +16mmHg
B. +68mmHg
C. + 84mmHg
D. Omm.Hg
E. -16mmHg
F. -68mmHg
G. -84mmHg
A

A. +16mmHg

228
Q

A novel drug aimed at treating heart failure was tested in experimental animals.
The drug was rejected for testing in humans because it caused an unacceptable
decrease in the glome.rular filtration rate (GFR). Further analysis showed that
the drug caused no change in mean arterial blood pressure but renal blood 1low
(RBF) wu increased. The filtration fraction wu decreased. What mechanism is
most likely to explain the observed decrease in GFR?

A. Afferent arteriole constriction
B. Afferent arteriole dilation
C. Efferent arteriole constriction
D. Efferent arteriole dilation

A

D. Efferent arteriole dilation

229
Q

A healthy 25-year-old woman was a subject in an approved research study. Her
average urinary urea excretion rate was 12 mglmin, measured over a 24-hour
period. Her average plasma urea concentration during the same period was
0.25 mg/mL. What is her calculated urea clearance?

A. 0.25 mL/min
B. 3mUmin
C. 48mUmin
D. 288 mLlmin

A

C. 48mUmin

230
Q

A 54-year-old woman received. a life-saving kidney transplant 6 months ago
and had been well until the p8$1 few days. She now reports severe fatigue and
dizziness upon standing. Urinalysis is positive for glucose, and there is excessive excretion of HC03 - and phosphate. In which segment of the nephron is
function most likely to be abnormal?

A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. Collecting duct

A

A. Proximal tubule

231
Q

A resident in internal medicine was called to the hospital room of an 85-yearold patient in the middle of night. The man was sitting up in bed coughing. and
was severely short of breath. Crackles heard in both lungs suggested pulmonary
ed.ema. Which diuretic is most appropriate for this patient?

A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide diuretic
D. Potassium-sparing diuretic

A

B. Loop diuretic

232
Q

A 46-year-old. woman visited her family physician because she was urinating
many times a day and was constantly thirsty. She was evaluated in the hospital to find out the cause of her severe polydipsia and polyuria. She was not
given any :6.uids for 6 hours before testing, and no change in urine osmolarity
was measured during this period. A nonpressor ADH agonist was then given,
which produced a rapid increase in urine osmolarity. Which diagnosis is most
likely to account for this patient’s polydipsia and polyuria?

A. Central. diabetes insipidus
B. Compulsive overconsumption of water 
C. Nephrogenic diabetes insipidus
D. 'fype 1 diabetes mellitus
E. 'fype 2 diabetes mellitus
A

A. Central. diabetes insipidus

233
Q

A 61-year-old woman with moderate renal insufficiency ate a large amount of
prunes in an effort to treat chronic constipation. She was unaware that prunes
have high potassium content and the meal caused her serum potassium concentration to double. Which of the following short-term intravenous infusions
would be most effective at reducing her serum pot&.S5ium concentration?

A. or.-Adrenoceptor agonist
B. Aldosterone antagonist
C. Dilute hydrochloric acid
D. Insulin/glucose
E. Parathyroid hormone
A

D. Insulin/glucose

234
Q

A 3-month-old infant presented with persistent vomiting and was lethargic.
Arterial blood gas analysis shomd the following results:
Pao2 = 88 mm Hg
Pacoi = 44 mm Hg
pH = 7.60
[HCO,-J = 36 mEq/L
Base excess = + 12 mEq/L
Which of the following primary acid-base disturbances is present?

A. Respiratory alkalosiJ
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosill

A

C. Metabolic alkalosis

235
Q 
The results of an arterial blood gas analysis of a 56-year-old man with a history
of heavy smoking are as follows:
Pao2 = 60 mm Hg
Paco2 = 60 mm Hg
pH = 7.33
[HCO,-J = 32mEq/L
Base excess = + 8 mEq/L
The patient has a partially compensated

A. mpiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosiJ
D. metabolic acidosiJ

A

B. respiratory acidosis

236
Q

How much Cardiac output does kidney receive

A

about 20% of cardiac output at rest

Kidney is highly vascular

237
Q

How is the kidney innervated

A

Sympathetic nerve fibers
cause constriction of renal vessels and decres reanl blood flow
Play a role in increasing sodium reabsorption
play a role in renin release

Also has afferent sensors that help drtermine stretch of vessels
mechano, chemical, baro help determine BP

238
Q

Trace blood supply through kidney

A 
Heart
aorta
renal artery
segmetnal artery
lobar artery
interlobar artery
arcuate artery
cortical radiate artery
afferent artery
Glomeulus
Efferent artery
peritubular capillary
(juxtamedullary nephron) vasa recta
cortical radiate vein
arcuate vein
interlobar vein
renal vein
inferior vena cava
239
Q

What are the two nephrons

A

cortical

juxtamedullary

240
Q

Describe the cortical nephron

A

Majority of this nephron is in cortex
has a short loop of Henle
glomerulus is in out cortex

241
Q

Describe juxtamedullary nephron

A 
Majority of nephron is in medulla
top is cortec
glomerulus is in deep cortex
has long loop of henle
salt conserving nephron
important in urine concentration
has a vasa recta
when blood flow is reduced, more blood is sent to these nephrons to help conserve extracellular fluids
242
Q

where do the collecting ducts come out

A

they exit the medullary pyramid at the papilla

243
Q

What is the functional unit of the kidney

A

the nephron

244
Q

How many nephrons in a kidney

A

approx 1 million

245
Q

how are arid animals different than humans

A

they have a greater concentration of juxtamedullary nephrons to help them reclaim more water

246
Q

Where is renin porduced

A

the juxtaglomerular apparatus

247
Q

Wherer is the juxtaglomerular apparatus

A

where the afferent arteriole meets the glomerulus

248
Q

What types of cells are in the juxtaglomerulus apparatus

A

Macula densa cells
monitor fluid composition in tubule

mesangial cells
transmit inromation from macula densa cells to granular cells

granular cells
these ar modified smooth muscle cells
They synthesize and release renin (hypotension)

249
Q

What are mesangial cells

A

Located in the juxtaglomerulus apparatus
mesangial cells
transmit inromation from macula densa cells to granular cells

250
Q

What aremacula densa cells

A

Located in the juxtaglomerulus apparatus
Macula densa cells
monitor fluid composition in tubule

251
Q

What are granular cells

A

Located in the juxtaglomerulus apparatus
granular cells
these ar modified smooth muscle cells
They synthesize and release renin (hypotension)

252
Q

What are the three basic processes in urine formation

A

glomerular filtration
Tubular reabsoption
Tubular secretion

253
Q

Describe glomerular filtration

A

20% of plasma is filtered while other 80@ flows through efferent arteriole into peritubular capillaries
approx 180 liters a day
body plasma is filtered about 65 times per day

Primarily a physical process and does not require pumps

254
Q

Describe tubular reabsorption

A

of the 180 liters that is filtered i glemerulus
178.5 is reabsorbed
the other 1.5 liters is excreted as urine

255
Q

Describe tubular secretion

A

Route of substance to enter the renal tubules

mechanisms for selectively eliminating substances from the plasma

256
Q

Excreted = ???

A

Excreted = filtered - reabsorbed +secreted

257
Q

What is reabsorption

A

movement of solutes from the tubule back into the blood

you are reabsorbing solutes into the blood

258
Q

What is seceretion

A

Secretion is the movement of solutes from the peritubular capillary inthe the tubule

259
Q

In glomerular filtration, what is ultra filtrate

A

small moelcules but restricts passage of larger molecules

260
Q

In glomerular filtration, what is filtered

A 
low molecular weight substances that are dissolved in plasma
various polar molecules like
glucose
amino acids
ions
peptides
drugs
waste products like urea and creatinine
261
Q

In glomerular filtration, what is non filtered

A

Large proteins
blood cells

proteinuria is hallmark of glomerular filtration barrier disorder

262
Q

What does proteinuria signify

A

hallmark of glomerular filtration barrier disorder

263
Q

What are the three layers of gloermular filtration

A

endothelium (bottom layer)
fenestrated

Basment layer (middle)
   negatively charged proteins get repelled

visceral layer of bowman capsule (top)
podocytes, filtratin slit, filtration of small proteins

264
Q

Trace filtration pathway in glomerulus

A 
Capillary
endothelium
basement membrane
visceral layer of bowmans capsule (between podocytes)
into bowmans capsule
265
Q

What happens to large moleules and negatively charge proetins in glomerular filtration

A

theyt cannot get across filtration barrier

266
Q

What is the dominant force that influences filtration

A

capillary hydrostatic pressure

the pressure of blood i the capillaries will force molecules across

267
Q

Where is filtration and absorbption in a skeletal muscle capillary

A

filtration occurs at the arterial end and absorption occurs at the venous end

268
Q

WHat is the dominant force in the glomerulus

A

Filtration
Filtration occurs along the entire length of capillary
filtration rate is highest at the afferent end and lowest at the effernet end
this is due to colloid osmostic pressure
an increase in solutes helps keep fluids in the nephron

269
Q

What affects renal blood flow

A

hormones
extrinsic neural stimulation
local regulatory factors

270
Q

how is optimal renal blood flow maintained

A

autoregulation (intrinsic / local)

THis maintains a constant blood flow to renal system despite changes in MAP

271
Q

What happens to renal arteries when perfusion is low

A

renal arteries dilate

272
Q

what happens to renal arteries when perfusion is raised

A

renal arteries constrict

273
Q

What is pressure of renal blood lfow

A

80-180

274
Q

When map is 80 -180, what will GFR be

A

125 ml/min

275
Q

At what MAP pressure does GFR cease

A

50 and below

276
Q

Trace pressure through renal system in descending order

A 
Renal artery
affernet arteriole
glomerular capsule
effernet arteriole
peritubular capilary
intrarenal vein
renal vein
277
Q

Where is the greatest slow down of blood in teh renal system

A

The afferent and effernet arteriole is where the greatest vascular resistance is
this is the greatest slowdown of blood

278
Q

Why is glomerular resistance greater than other systems

A

prescence of efferent arteriole as oppossed to a veinule

this helps to facilitate glomerular filtration

279
Q

What is the major forces that determines glomerular filtration

A

glomerular capillary pressure

280
Q

what are the forces involved in glomerular filtration

A

Favor
glomerular capillary pressure 55mmhg

oppose
plasma colloidal osmotic pressure 35mmhg
bowman capsule hydrostatic pressure 15mmhg
35 +10 =45

55-45 = 10

difference in filtration pressures
net filtration pressure 10mmhg in favor

281
Q

what happens to filtration when we get hypo tensive

A

filtration drops off
this helps to keep fluid in the blood to maintain volume and pressure
This is under extrinsic control

282
Q

what happens to filtration when we get hypertensive

A

filtration increases
this helps to reduce volume by trying to pull more fluid out and reduce pressure
This is under extrinsic control

283
Q

what are the two intrinsic mechanisms of renal autoregulation

A

myogenic mechanism

tubuloglomerular feedback

284
Q

Describe the process of the intrinsic mechanism for renal autoregulation : myogenic mechanism

A

When BP is elevated
increase in pressure stretches affrent arteriole walls
this activates stretch cation channels in smooth muscle
this causes intrcellular calcium to rise
this results in smooth muscle contraction
reducing lumen and diameter
increasing resistance and decreasing flow
this all helps counteract increase in BP

285
Q

Describe the process of the intrinsic mechanism for renal autoregulation : tubuloglomerular feedback

A

When GFR is increased due to increased arterial pressure
more NaCl is absorbed by the macula densa
macula densa cells then secrete ATP to the mesangial cells
mesangial cells metabolize ATP to adenosine
Adenosine stimulate granular cells
Granular cells stimulation cause constriction
this causes constriction of nearby affernet arteriole
this reduces GFR
(negative feedback system)

286
Q

Does renal autoregulation affect eh afferent or effernet arteriole

A

the afferent

287
Q

What are the renal extrinsic regulation mechanisms

A

Sympathetic nerve stimulation

Hormones and chemicals

288
Q

Describe the sympathetic nerve stimulation in renal extrinsic regulation

A

vasoconstriction of eitehr afferent or effernet arteriole
this decreases blood flow
this can be activated under stressful conditions like cold, hemmorhage, pain, etc
this is an emergency mechanism to help increase
total peripheral resistance
MAP
cardiac output

289
Q

Describe the chemicals and hormones that vasoconstrict in renal extrinsic regulation

A 
adenosine
angiotensin II
enothelium
epi
norepi
ADH
290
Q

Describe the chemicals and hormones that vasodialate in renal extrinsic regulation

A 
ANP
Dopamine
HIstamine
Kinins
Nitric oxide
prostaglandins
291
Q

what are the renal prtective measures

A

sustained release of renal vasodialators
these prostaglandins oppose the constrictor effect from sympathetic nerve stimulation
this prevents too severe of a reduction in renal blood flow

292
Q

Changes in the glomerular capillary hydrostatic pressure profoundly affect the GFR

What happens with

constriction of afferent arteriole

A

reduced renal blood flow
reduced glomerular capillary pressure
reduced GFR filtration rate

293
Q

Changes in the glomerular capillary hydrostatic pressure profoundly affect the GFR

What happens with

Constriction of efferent arteriole

A

reduced renal blood flow
increased glomerular capillary pressure
increased GFR filtration rate

294
Q

Changes in the glomerular capillary hydrostatic pressure profoundly affect the GFR

What happens with

Afferent arteriole Dialation

A

increased renal blood flow
increased glomerular capillary pressure
increased GFR filtration rate

295
Q

Changes in the glomerular capillary hydrostatic pressure profoundly affect the GFR

What happens with

Efferent arteriole Dialation

A

INcreased renal blood flow
decreased GFR capillary pressure
decreased glomerular filtration rate

296
Q

WHat is reabsorption

A

Goes from tubules back into blood

297
Q

What is secretion

A

goes from blood into tubules

298
Q

What is reabsorbed in the proximal convoluted tubule,

what is secreted

A

resabosrption (tube to blood)
everything except nh4+

Secretion (blood to tube)
urea
uric acid
creatinine
H+
NH4+
some drugs
299
Q

What is reabsorbed in the Distal convoluted tubule,

what is secreted

A

Reabsorbed (tube to blood)
H+, K+, NH4+

Secreted (blood to tube)
Na+, Cl-, HCO3-, H2O

300
Q

What is reabsorbed in the Ascending limb (FAT)(goes to collecting duct)
what is secreted

A

nothing is reabsorbed, is impermeable to H2O

Secreted
Na+, K+, Cl-

301
Q

What is reabsorbed in the descending limb (skinny)

what is secreted

A

Reabsorbed
Urea

Secreted
H2O

302
Q

What is reabsorbed in the Collecting Duct,

what is secreted

A

nothing is reabsorbed
unless there is ADH or aldosterone

Secretion
Urea, H2O

303
Q

Where in tubular reabsorption is water reabsorbed

A

all regions of tubule
except the Ascending limb
The DCT and collecting duct only when ADH and aldosterone is present
99% of all water is reabsorbed

304
Q

Where in tubular reabsorption is sodium reabsorbed

A

65% is reabsorbed in the PCT
25% in the ascending limb
some in DCT and collecting duct
99% of sodiumis reabsorbed

305
Q

Where in tubular reabsorption is glucose reabsorbed

A

100% of glucose is reabsorbed in the PCT

Zero in urine

306
Q

Where in tubular reabsorption is urea reabsorbed

A

in the PCT
50% is reabsorbed
50% is excreted

307
Q

Where in tubular reabsorption is phenol reabsorbed

A

100% is excreted

308
Q

what is load dependence or glomerulotubular balance

A

when we increase the filter load of sodium
this stimulates the increase in sodium reabsorption
helps us from losing too much sodium

309
Q

Describe the promixal convoluted tubule

A

nonregulated reabsorption (no hormones)
70% on sodium and H2O
all glucose

many microvilli
many mitochondriA
Leaky tight junctions
sodium potassium pump works to reabsorb sodium
glucose, amino acids, phosphate are transported by their carriers

310
Q

Describe the collecting ducts

A

tight junctions
less mitochondria
smaller fewer microvilli
more regulated than PCT

311
Q

Which parts of nephron have hormone recptors

A

DCT and collecting ducts

this allows aldosterone and ADH to bind

ADH allows for more water reabsorption

aldosterone increases sodium reabsorption
Aldosterone increases potassium and H+ ion secretion

312
Q

What are the two cells in the late part of the DCT

A

Principle cells
these reabsorb sodium and cause potassium secretion
aldosterone increases these

alpha intercalated cells
important for potassium reabsorption and acid base balance

313
Q

What are the most importatn things that are secreted (blood to tubule)

A

H+ ions
K+
CL-

314
Q

what is the primary site for potassium excretion

A

DCT

collecting duct

315
Q

Where are many durgs and toxins secreted and eliminated from teh blood

A

PCT

316
Q

Descibe Ascending limb

A 
Fat
goes to collecting duct
impermeable to water
permeable to slats
vasa recta
317
Q

Descibe descending limb

A

skinny
permeable to water
impermeable to salts

318
Q

Which limb has more concentration of solutes

A

the Descending limb
water is pulled out in descendin limb leaving salts behind
more concentration at bottom

319
Q

How do we get water out of the collecting duct

A

ADH binds to receptors on collecting duct
there is a secondary messenger cascade
cAMP is secondary messenger
this intiates the synthesis of aqua porins
aquaporins increase
more water moves across and is reabsorbed

Without ADH, the collecting ducts are more or less water impermeable

320
Q

WHat is used to assess renal clearance

A

inulin

used to figure out GFR

321
Q

Describe renal titration curve

A 
Every substance has a threshold
as concentration of glucose increases, there comes a point where you start to excrete glucose
all transporters ar ebeing used (TM)
all other glucose gets excreted
IE diabetes
322
Q

Describe involutary micutrition reflex

A

stertch receptors
detect filling of bladder
affernet signal is sent to spinal cord
signal returns to bladder from spinal cord via parsympathetic nerve fibers
efferent signal excite the detrusor muscle
efferent signla relaxes internal urethral sphincter
urin is involuntarily voided if not inhibited by the brain

323
Q

Describe voluntary micturition control

A

Stretch receptors detect filling of the bladder
the pons receives signals from the stretch receptors

if it is ok to urinate,
pins sends signals to spinal interneurons
thi then excites detrusor muscle,
relaxes internal urethral sphincter
urine is voided

if it is not ok to urinate yet
signals from the cerebrum excite spinal interneurons
this keeps the urethral sphincter contracted
urine is retained in the bladder

324
Q

What is the skeletal muscle involved in the bladder

A

External urethral sphinter

325
Q

Is internal urethral sphincter voluntary or involuntary

A

involuntary

smooth muscle

326
Q

what is the somatic nerve fiber that relaxes the external sphincter

A

pudendal nerve

327
Q

Dilation of efferent arterioles results in

A. an increase in glomerular blood flow.
B. an increase in glomerular capillary pressure.
C. an increase in GFR.
D. an increase in hydrostatic pressure in the urinary space of the Bowman capsule.

A

A. an increase in glomerular blood flow.

328
Q

The main driving force for water reabsorption by the proximal tubule epithelium is

A. active reabsorption of amino acids and glucose.
B. active reabsorption of Na+.
C. active reabsorption of water.
D. the high colloid osmotic pressure in the peritubular capillaries.

A

B. active reabsorption of Na+.

329
Q

According to the tubuloglomerular feedback mechanism, an increase in tubular fluid NaCl delivery to the macula densa will result in

A. a decrease in glomerular filtration rate in the same nephron.
B. an increase in glomerular blood flow of the same nephron.
C. an increase in proximal tubular sodium and water reabsorption.
D. an increase in renin secretion.

A

A. a decrease in glomerular filtration rate in the same nephron.

330
Q

describe fluid compartmetns of the body (%)

A

60% water in males
33% is ICF (2/3)
27% is ECF (1/3)

Third space fluid or intersitual fluid
CSF, lymph, vitreous,aqueous, synovial, peritoneal, pericardial
slow to adapt

as we age we lose muscel and gain fat
this causes us to lose water as we age

331
Q

What are cations

A

(+)

332
Q

What are anions

A

(-)

333
Q

What happens when you add hypotonic solution to body

A

ICF and ECF increase evenly

334
Q

WHat happens when you add Hypertonic solution tothe body

A

ICF decreases

ECF increases

335
Q

What happens when you add isotonic solution to the body

A

ECF increases

ICF remains the same

336
Q

What is the normal intake of fluids

A

60% drink
30% food
10% metabolism

337
Q

What is the normal loss of fluid

A

Sweat 8%
Urine 60%
Feces 4%
Swet and expiration 28%

338
Q

What is minmum urine output daily

A

400ml

minimu we need to rid the body of nitrogenous waste

339
Q

What are the two neuron secretory cells in the anterior hypothalamus

A

Supraoptic nucleus
Oxytocin

Paraventricular nucleus
ADH

340
Q

Where is ADH made

A

In the anterior hypothalamus in the paraventricular cells,

it is then sent ot he posterier pituitary via the hypothalmicneurohypophyseal tract where it is stored until needed

341
Q

What is the main mechanism controlling ht release of ADH

A

plasma osmolarity

342
Q

How does plasma osmolarity control the release of ADH

A

when plsama osmolarity rises, neurons called osmoreceptor cells located in the anterior hypothalamus shrink
this stimulates production of ADH

343
Q

What is normal osmolarity

A 
280 mOsm
above 280 ADH increase proportionally
The thirst threshold is 290
but only when there is appreciable water deficit
it is a negative feedback loop
344
Q

describe the negative feedback loop of ADH and dehydration

A 
Dehydration occurs
elevates blood osmolarity
stimulates hypothalmic osmoreceptors
stimulates ADH release fromposterior pituitary
then either A or B

A= this triggers thrist mechanism, water is ingested, H2O increases, dehydration ceases (negative feedback loop)

B= stimulates DCT and collecting duct
increases water reabsorption
reduces urine volume
at same time increases ratio of sodium to water in urine
sodium decreases
dehydration decreases
(negative feedback loop)
345
Q

What are the two mechanisms for thrist

A

increased osmolarity
Stimulate hypothalmic osmoreceptors

reduced blood pressure
Renin
angiotensin II
stimulates hypothalmic receptors

Both trigger thirst

346
Q

What does an increase in blood volume do to ADH

A

it inhibts ADH

a decrease would stimulate ADH

347
Q

What does an decrease in blood volume do to ADH

A

it stimulates ADH

severe blood loss cause a large increase in ADH
this causes vasoconstriction which helps counteract low BP

348
Q

Where are the two blood volume receptors at

A

stretch receptors in the right atrium

pulmonary veins in the pericardium

349
Q

What are the effects of angiotensin II

A

stimulates thirst

cuases vasoconstriction

stimulates adrenal cortex to produce aldostreone
Sodium reabsorbtion

stimulates hypothalamus to porduce ADH
water reabsorbtion

350
Q

Renin angiotensin aldosterone pathway

A

Decrease in arterial blood volume
kidneys porduce renin
liver produces angitensinogen
renin and angiotensinogin combin to form
angiotensin I, which then travels to the lungs
in the lungs it combines with angiotensin converting enzyme (ACE)
creating angiotensin II

351
Q

where is ACE made

A

ACE is made in the lungs

in the pleural epithelial cells

352
Q

WHat is ANP

A

Atrial natiuretic peptide
released form atria
release is stimulated by blood volume expansion
(atrial stretch)
increases sodium excretion
helps bring blood volume back down to normal

353
Q

What is ANP mechanism

A 
Volume increases
atria stretches
triggers ANP release
ANP causes vasodilation
inhibts aldosterone production
inhibits renin production
increases sodiumexcretion
increases water excretion
354
Q

Where is most of our potassium

A

within the cells

ICF

355
Q

what effect does insulin have on potassium

A

it can cause it to enter the cells

356
Q

What can cause potassium to leave thecells

A

digitalis
truama
infection

357
Q

What is the major cause of potassium imbalance

A

abnormal renal potassium secertion

358
Q

Which of the following results in thirst?

A. Decreased plasma levels of angiotensin II
B. Distension of the stomach
C. Heart failure
D. Hypotonic volume expansion

A

C. Heart failure

359
Q

Which of the following will stimulate the release of ADH from the posterior pituitary?

A. A low plasma osmolality
B. Atrial natriuretic peptide
C. Decreased stretch of carotid sinus baroreceptors
D. Stretch of the left atrium of the heart

A

C. Decreased stretch of carotid sinus baroreceptors

360
Q

A 45-year-old man has a disease that destroyed the outer part of his adrenal cortex. Which of the following would be expected in this patient?

A. Decreased sodium appetite
B. Hypertension
C. Increased extracellular fluid volume
D. Increased plasma potassium concentration

A

D. Increased plasma potassium concentration

361
Q

What is an acid

A

any chemical that gives up a H+

362
Q

What is a base

A

Any chemical that accepts a H+

363
Q

What happens at ph of 6.8 and below

A

CNS depression
coma
death

364
Q

What happens at ph of 8.0 or above

A 
excitation of the nercous system
muscle tetany
convulsions
respiratory arresst
death
365
Q

what are 2 sources of acid

A

Respiratory Acid
CO2
H2co3

Nonvolatile acid / nonrespiratory acid
Lacric acid
ketones

366
Q

What are 2 major buffering systems

A

Chemical buffering system
Bicarbonate (CO2) most importatn
phosphate
protein

Physiological buffering system
Respiratory CO2 excretion (quick)
Renal hydrgogen ion excretion (slow)

367
Q

How do chemical buffers maintain the normal blood ph

A

respiratory
disposes of CO2
if we start to get acidic, we blow off CO2

Kidneys
elimniates H+ ions
if we start to get acidic 
we excrete H+ ions
form bicarb
put bicab bak into blood

Diet can effect ph

368
Q

What do the kidneys excrete to help maintain acid base balance

A

acid

H+ ions

369
Q

What are alpha intercalated cells for

A

they secrete H+ to teh blood

a for acid

370
Q

What are Beta intercalated cells for

A

they secret bicarb

b for bicarb

371
Q

How do the kidneys play a general role in maintaining acid base homeostasis

A

the kidneys excrete excess acid

the kidneys regulate blood ph by reabsorbing filtered bicarbonate

372
Q

What does NH4+ do

A

gets rid of H+ ions in the urine

373
Q

describe ammonium ions

A

they get rid of H+ ions in the urine
they are formed rom glutamate
they ae secreted into the tubular urine

374
Q

What are factors that can lead to increased H+ secretion by the kidney tubule epithilium

A 
Decreased intracellular pH
increased arterila blood pco2
CA activity
sodium reabsorption
K+ decrease
increased aldosterone
375
Q

What is compensation mechanism for respiratory acidosis

A

kidneys increase H+ excretion

376
Q

What is compensation mechanism for respiratory alkalosis

A

kidneys increase HCO3- excretion

377
Q

What is compensation mechanism for metabolic acidosis

A

alveolar hyperventilation

kidneys increase H+ excretion

378
Q

What is compensation mechanism for metabolic alkalosis

A

Alveolar hypoventilation

kidneys increase HCO3- excretion

379
Q

Describe things that lead to metabolic acidosis

A 
Kidney failure, cant excrete acid
excess keytones, diabetes
accumulation of non respiratory acid
prolonged diahrrea
prolonged vomiting
380
Q

Describe things that lead to metabolic alkalosis

A

gastric drainage
vomiting
loss of acids

381
Q

What is metabolic acidosis

A

a condition in which the tissue and blood ph is abnormally low due to an increase in non volatile acids

382
Q

In the defense of acid-base balance, which of the following processes takes the longest time for completion?

A. Buffering by bone
B. Distribution and buffering in the extracellular fluid
C. Renal excretion of acid
D. Respiratory compensation

A

C. Renal excretion of acid

383
Q

Mixed venous blood has a lower pH than arterial blood (e.g., 7.35 vs. 7.40). The main reason for the lower pH of venous blood is its

A. higher bicarbonate concentration.
B. higher carbonic acid concentration.
C. higher oxygen content.
D. lower oxygen content.

A

B. higher carbonic acid concentration.

384
Q

You get your final exam result back and are over the moon with how well you did. To celebrate you gorge on lots of pizza and have a few too many alcoholic beverages. That night you throw up your stomach contents. As a result, you may be in a state of:

A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis

A

D. Metabolic alkalosis

385
Q

How is intracellular ph regulated

A

cellular ph is maintained by extruding H+ ions
must take in HCO3- at the same rate as H+ going out
Same as at systemic level

386
Q

What are respiratory acidosis and alkalosis caused by

A

altered levels of PaCO2

387
Q

things that can cause respiratory acidosis

A

begin to accumulate CO2
decreased rate of breathing
aiway obstruction
decreased gas exchange

388
Q

things that can cause respiratory alkalosis

A

Decrease in acids

decrease in CO2
anxiety
fever
poisoning
high altitude
hyperventilation

decrease in H2co3
Decrease in H+

389
Q

pH PCO2 HCO3-
Metabolic Acidosis ↓ ↓ ↓↓
Metabolic Alkalosis ↑ ↑ ↑↑
Respiratory Acidosis ↓ ↑↑ ↑
Respiratory Alkalosis ↑ ↓↓ ↓

A

pH PCO2 HCO3-
Metabolic Acidosis ↓ ↓ ↓↓
Metabolic Alkalosis ↑ ↑ ↑↑
Respiratory Acidosis ↓ ↑↑ ↑
Respiratory Alkalosis ↑ ↓↓ ↓

390
Q

What is the key physiological buffer

A

Bicarbonate carbon dioxide system

onley works in an open system
can remove CO2 through hyperventilation
kindeys excrete H+ ions
Kidneys put bicarb back into blood

391
Q

What is the bicarbonate system based on

A

the strong buffering capacity of the respiratory system

392
Q

Does the respiratory or chemical system neutralize more acid

A

Respiratory system neutralizes 2-3 times as much acid as chemical buffers can

393
Q

What are 3 methods of compensation

A

metabolic - immediate
quick acid relase

pulmonary - minutes to hours
CO2 expelled or retained

renal - hours to days
H+ increased to form acids
H+ excreted trhough ammonium

394
Q

Time period for respiratory compensation to a metabolic disorder

A

begins within 30 mintues
complete within 12 - 24 hours

PCO2 should move in same direction as bicarb

395
Q

metabolic compensation for respiratory disorders

A

immediate small change in HCO3
if porblem persists
much larger change in HCO3
takes 3-5 days

396
Q

What is delta ratio

A

Change in anion gap divided by change in bicarb
less than 1 normal metabolic acidosis
1 to 1 = uncompensated metabolic acidosis
1 to 2 or over 2 = metabolic alkalosis with metabolic acidosis

397
Q

what is the acid that doesnt effect anion gap

A

HCL

398
Q

What are causes of high anion gap over 30

A 
lactic acidosis
ketoacidosis
uremia
toxic alcohol ingestion
slicylate lactic acid
acetaminophen
pyroglutamic acid
fromic acid
oaxlic acid
ethlene glycol
399
Q

4 conditions that adversely effect anion gap

A

hypoalbuminemia
hypyerkalemia
hypermagneseia
hypercalcimeia

400
Q

which acid base disorder is anion gap typically asociated with

A

metabolic acidosis

401
Q

what is unmeasured but typically responsible for anion gap

A

albumin
use corrected anion gap whenalbumin is not normal
normal albumin is 4.5

PAM Semester 1 (16 decks)

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