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BMS 752 (Medical Physiology) > Respiratory > Flashcards

Respiratory Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the functional unit of the kidney

A

the nephron

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2
Q

deoxyhemoglobin

A

hemoglobin that is less that fully saturated with O2

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3
Q

what stops the filtration of very large anionic molecules (proteins) through the filtration barrier

A

expression of negatively charged glycoproteins on the endothelial cells

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4
Q

respiratory driving force equation

A

driving force = Patm - Palv

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5
Q

surface tension

A

the force acting at an air/water interface resulting from water having a greater attraction itself that air

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6
Q

which of the following is NOT a partial compensation for fluid loss

a. A retention of water from the kidney that can actually in some case cause a hypo-osmotic plasma (< 290 mOsm/kg H 2 O)

b. The increase in sympathetic nervous stimulation of the kidney acting on Beta receptors on the JG cells increase the release of rennin and thus angiotensin II

c. An increase in the permeability of the collecting duct to urea to facilitate the osmotic gradient in the interstitial fluid of the kidney

d. A massive vasoconstriction occurs that essentially block blood flow to the kidneys in order to shunt blood to more important organs such as heart and brain.

A

d, A massive vasoconstriction occurs that essentially block blood flow to the kidneys in order to shunt blood to more important organs such as heart and brain.

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7
Q

describe the process of ventilatory feedback from hypoventiliation

A

hypoventilation increases PCO2, decreases pH and PO2 (indirectly)

chemoreceptors detect change

stimulate CPG to increase ventilation

increased ventilation

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8
Q

what enzymes are responsible for the movement of Na and K out of the tubule in the ascending loop of henle

A

Na and K move with Na/K/2Cl symporter

Na alone is by Na/H antiporter

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9
Q

nearly all of what two substances is reabsorbed in the PCT

A

glucose and AA

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10
Q

what are the three main parts of inspiration and expiration

A

action on the chest wall

change in intrapleural pressure

change in alveoli

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11
Q

what diuretics work on the collecting duct

A

amiloride and triamterene

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12
Q

how many oxygen binding sites are present in hemoglobin

A

4

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13
Q

what is the action of hydrochlorothiazide that helps control blood pressure

A

decrease in intravascular fluid that will decrease the amount of preload to the heart to decrease stroke volume and cardiac out put

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14
Q

decreasing surface tension has what effect on collapsing pressure

A

it increases it

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15
Q

what forces control the production of ultrafiltration

A

starling forces

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16
Q

what would a creatinine plasma level of = 1.2 indicate

1.3-1.6

>/= 1.7

A

normal

borderline or increased creatinine due to muscle mass

renal disease

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17
Q

what are mesangial cells

A

smooth muscle cells that remove proteins and trapped residues from the basement membrane to keep the filter from getting clogged

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18
Q

what will stimulate the release of natriuretic peptide

what will the effect be on GFR and RBF

A

increase GFR, no effect on RBF

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19
Q

three main ways the pressure in the glomerular capsule (PGC) can be altered

A

changing the resistance in the afferent arteriole

changing the efferent arteriole resistance

changing the renal arteriole pressure

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20
Q

what is the typical GFR

how much of that volume is reabsorbed

A

125 mL/min

99%

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21
Q

how does PCO2 effect pH

A

increasing PCO2 will increase the amount of HCO3 in the blood and increase pH

decreasing PCO2 will increase the amount of H+ in blood, decreasing pH

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22
Q

where is the juxaglomerular apparatus found

what are three cells found there

A

between the distal tubule and the afferent arteriole

macula densa

extraglomerular messangial cells

renin/angiotensin producing cells

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23
Q

what is the action of intercalated cells and principle cells on K

A

principle cells uptake K from the BL via Na/K, then it is secreted through passive diffusion

Intercalated cells reabsorb K from the tubule via H+/K ATPase

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24
Q

solubility coefficient of O2 in water is inversely proportional to what

A

temperature

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25
Q

why is innervation of the kidney necessary

A

to regulate RBF, GFR, salt and H2O reabsorption

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26
Q

wha stimulus with stimulate the release of endothelian

what is the effect on GFR and RBF

how does it accomplish this

A

increased tensions in the vessel wall, angiotensin, decreased ECFV

decrease in both

constriction of the efferent and afferent arterioles

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27
Q

what are the starling forces

A

hydrostatic pressure in the artery

osmotic pressure in the artery

hydrostatic pressure in the tubule

osmotic pressure in the tubule

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28
Q

five specific functions of mesangial cells

A

provides structural support to the glomerular capillaries

secretes extracellular matrix

acts as a phagocyte

secretes prostaglandins and pro-inflammatory cytokines

influences GFR by regulating blood floow

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29
Q

descrive how PP CO2 changes throughout the body

A

alveolar PP CO2 40mmHg

maintains alveoli –> pulmonary veins –> systemic arteries

increases to around 46mmHg at the cells

maintains through systemic veins and pulmonary arteries

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30
Q

what makes up the pleural sac

A

the visceral and parietal pleural with the intrapleural space between

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31
Q

of the three nerves that control respiration (phrenic, external intercostal, internal intercostal) which one is active only during active expiration

A

the internal intercostal nerve

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32
Q

by what means of cellular transport are proteins reabsorbed

what happens to them once they are reabsorbed

A

endocytotis

they are digested and leave the cell via the basolateral membrane

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33
Q

what is the normal VT

what is a normal number of breaths/minute

based on this what is a normal tidal volume

A

500mL

12

6000mL/minute

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34
Q

what is the difference between lung volume and lung capacities

A

volume can not be broken into more parts

capacity is the sum of two volumes

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35
Q

minute volume VE defintion and equation

A

the amount of air that flows in and out of the ventilatory system in one minute

VE = VT x number of breaths

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36
Q

what are the four static lung capacities

A

inspiratory

vital

functional residual capacity

total lung capacty

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37
Q

inulin clearance is equal to what

A

GFR

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38
Q

what is the functional difference between the respiratory and conducting zones

A

the conducting zone is a passage for air, the respiratory zone is where gas exchange happens

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39
Q

what provides sympathetic innervation to the kidnets

A

the celiac plexus through the aorticorenal ganglia

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40
Q

what is the function of renalase

why is this important

A

degrade catecholamines and allow them to be removed from the kidney

it stops vasocontrictions from dopamine and NE

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41
Q

why is the osmotic pressure of the bowmans capusle typically a nonfactor in filtration

A

because there should be relatively little protein the space

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42
Q

what is the difference in ANP and BNP, aside from where they are produced

A

ANP has a higher affinity, BNP is longer lived

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43
Q

where temm-horsfall proteins are secreted

A

thick loop of henle

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44
Q

What happens at the chest wall during expiration

A

negative feedback from increased Palv decreases neural drive

inspiratory muscles relax

chest wall collapses

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45
Q

explain this formula

clearance ratio = Cx/Cinulin

A

the clearance ratio of substance x is equal to the clearance ratio over clearance of inulin

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46
Q

describe the indirect effects of increasing PO2

A

increased PO2 will cause Hb that is bound protons or CO2 at the tissues to release CO2 at the lungs (haldane)

carbaminohemoglobin formed at the tissues by the relative lack of oxygen will dissociate with increased PO2

both increase the Hb affinity for O2, which will increase O2 loading

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47
Q

content formula

A

content = capacity(percent saturation)

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48
Q

how can mesangial cells influence filtration

A

by changing the surface area for diffusion

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49
Q

normal tidal volume

A

500

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50
Q

what is the function of a podocytes

A

they wrap around capillaries and glomerular capsule to produce filtration slits that filter blood

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51
Q

four vasodilators of the kidney

A

prostaglandins

NO

bradykinin

natriuretic peptides

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52
Q

what happens at the alveoli during inspiration after the intrapleural space changes volume

A

increased volume of the alveoli

decreased Palv

increased driving force (Patm - Palv)

increased air flow into alveoli

increase Palv

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53
Q

what is the negative feedback mechanism that stops increased ventilation in reponse to hypoventilation

A

increased PCO2, decreased pH, increase PO2

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54
Q

hypoventilation will result in what

A

decreased pH, leading to respiratory acidosis

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55
Q

how are lung volumes measured

A

spirometry

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56
Q

where are the most of the proteins absorbed in the kidney

A

PCT

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57
Q

which of the following about aldosterone is NOT true

  • *a**. High serum K+ levels increase the secretion of aldosterone by action on adrenal cells
  • *b**. Low sodium in the tubular fluid increases indirectly stimulate aldosterone by the secretion of renin
  • *c**. Aldosterone stimulates the secretion of hydrogen ion by intercalated cells in the collecting ducts
  • *d**. None of the above, all are true about aldosterone.
A

d, all of the above are true

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58
Q

what effect will increased PCO2 and decreased PO2 have on pulmonary arteries

what will be the effect of the action at the arteries

A

increased smooth muscle contraction, causing vasoconstriction

increases vascular resistnace, decreasing perfusion

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59
Q

where are the rate-limiting enzymes in the process of organic cation secretion

A

on apical membrane (OC/H and MDR1)

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60
Q

four functions of ANP/BNP

A

decreased vascular resistance

decreased central venous pressure

increased natriuresis

decreased cardiac output

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61
Q

what effect will a right shift have on SO2 of hemoglobin

A

there will be a lower SO2 at the same PO2

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62
Q

what will cause a right shift on a O2 affinity curve

A

increased temp

decreased pH

increased PCO2

increased 2,3 - BPG

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63
Q

why would a failing kidney change the theraputic window of a drug

A

because unless the kidneys can excrete the drug it can stay in the blood and increase the amount circulating

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64
Q

explain this equation

Q = deltaP/R

A

renal blood flow equals the mean arterial-venous pressure to the organ divided by the resistance through the organ

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65
Q

how can VA be increased/decreased without changing minute ventilation

A

taking few, deeper breaths will allow for high alveolar ventiliation than many shallow breaths

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66
Q

what is the direct effect of increased PCO2

A

increased CO2 loading

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67
Q

two ways to alter afferent arteriole resistance with their effects

A

decreased resistance through dilation: increase PGC and GFR

increased resistance through constriction: decreased PGC and GFR

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68
Q

what will the effect of sympathetic innervation be on renin producing cells

what are two consequences of that

A

increases renin secretion

increase in systemic BP

increase in K secretion in urine

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69
Q

what effect will a left shift have on SO2

A

there will be higher SO2 at the same PO2

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70
Q

what is the effect of theraputic doses of glucocorticoids have on GFR and RBF

A

increases both

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71
Q

what is the function of NO in the capillaries

what about endothelian 1

A

NO is a vasodilator

endothelian is a vasoconstrictor

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72
Q

what is the main symporter found at the BL membrane in the first half of the PCT

why is it important

A

Na/K

it maintains the Na gradient

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73
Q

what is absorbed in the intial distal loop of henle

what is this strucutre impermable to

A

Na, Cl, and Ca

impermeable to H2O

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74
Q

four important factors in determining GFR

A

Starling forces

permability of the glomerular capilary

surface area of the capilaries

plasma flow rate

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75
Q

what percent of CO2 is bound to plasma

Hb

HCO3

A

5%

5%

90%

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76
Q

what surrounds the nephron

A

peritubular capillaries

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77
Q

what structure is effected by mygoenic and tubuloglomerular feed back

A

the radius of the afferent tubules

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78
Q

what is the effect of stimulation on central and peripheral chemoreceptors

A

increasing ventilation due to increased PCO2 or decreased PO2

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79
Q

describe the process of tubuloglomerular feedback in repsonse to high GFR

A

NaCl increase is detected by the macula densa

macula releases ATP and adenosine

signaling to the afferent arterioles to constrict

constriction decreases GFR

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80
Q

T/F VA and blood flow to the pulmonary capilliaries (Q) a inversely correlated

A

false, Q is directly related to VA

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81
Q

what is the action of the surface tension of pure water on alveoli

what does the body do to combat this

A

it has an inward force that will collapse alveoli

produces surfactant to decrease surface tension

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82
Q

what does EPO do

A

increases red blood cell production

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83
Q

how does the sympathetic innervation of tubular cells create “natures little IV”

this is important in what speficic disese process

A

by increasing NaCl absorption

shock

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84
Q

how is clearance corrected for body size

A

clearnance * 1.73m2/body surface area in m2

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85
Q

what is the driving force behind the absorption of water in the descending loop of henle

A

the gradient created by absorption of NaCl in the ascending loop

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86
Q

Where is most of the glucose absorbed

A

PCT

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87
Q

what happens to the osmolality of the tubular fluid as it moves towards the macula densa

what morphological feature allow for this to happen

A

it decreases and NaCl is actively pumped out

the loop of henle gets thicker to accomodate more mitochondria to fuel Na/K pumps

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88
Q

what diuretic would mimic liddle syndrome

what would the pathologcial effects be

A

amiloride (inhibits ENaC)

metabolic acidosis

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89
Q

two ways altering renal arteriolar pressure will change PGC

A

increased BP leads to a transient increase in PGC and GFR

decreased BP leads to transient decrase in PGC and GFR

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90
Q

what is the effect of histamine on RBF

A

increase RBF through decreasing resistance in the afferent and efferent arterioles

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91
Q

what do peripheral chemoreceptors repsond to

central?

A

peripheral: direct and indirectly to changes in PCO2

Central: only indirect response to changes in PCO2

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92
Q

male and female Hb concentration ranges

A

males 130-160 g/L

femailes 120-150 g/L

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93
Q

which of the following are potential sites for K+ secretion in the nephron

a. Proximal tubule

b. Ascending loop of Henle
c. Distal convoluted tubule and collecting duct
d. Proximal convoluted tubule and distal convoluted tubule

A

c. Distal convoluted tubule and collecting duct

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94
Q

ELIF carbamino effect

A

carbaminehemoglobin is formed with Hb and CO2 in low PO2 conditions. It will hold on to CO2 as long as the PCO2 is high (such as around cells) and release it in areas of low PCO2 (such as in the alveoli)

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95
Q

capacity vs content

A

capacity is the amount that something can hold

content is the actualy amount something is holding

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96
Q

what happens during hypoventilation

what is the result

A

the amount of CO2 produced exceed the amount blown off

arterial PCO2 increases (hypercapnia)

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97
Q

what are the primary respiratory muscles

A

diaphragm

internal and external intercostals

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98
Q

what is measured by dyanmic lung volumes

A

rate of air flow

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99
Q

what pump on the basolateral membrane is the primary actor for reabsorption in the PCT

A

Na K pump

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100
Q

why do intercalated cells have a lot fo mitochrondria

A

the need lots of ATP the run the H+ ATPase that they use to fuel cell transport and regulate acid-base balance

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101
Q

what is the Pip found at FCR

what is the force created

A

-4 relative to atm (756 mmHg)

inward forces from the chest wall and lung

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102
Q

what is the boht effect in relation to O2 unloading with increased PCO2

A

increasing PCO2 will increase the amount of H+ and decrease pH

decreasing pH decreases Hb O2 affinity

increases O2 offloading

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103
Q

what would albumin in the urine indicate

A

high pressure, kidney failure

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104
Q

lung compliance is inversely related to what

what is the significance

A

elasticity

as the lung loses compliance the inward elastic force also increases

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105
Q

solubility coefficient formula

A

C = kP

C molar concentration of gas

k henrys law constatnt at specific temp

P partial pressure of gas

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106
Q

what is the function of vagus nerve fibers in the kidney

A

unknown, possibly afferent fibers

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107
Q

how does VA effect Alveolar PO2 and PCO2

what about RER

A

increased VA will bring more oxygen into the alveoli

RER will determine how much oxygen is taken up and how much CO2 is produced

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108
Q

given the Hb concentration, arterial and venous O2 saturation, and O2 consumption how would you determine…

cardiac output

A

ficks principle

VO2 = CO(SO2Arterial - SO2Venous)

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109
Q

FEV1.0/FVC x 100

A

indirect measure of the rate of air flow through the ventilitory system

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110
Q

why does transpulmonary pressure increase when the chest wall expands

what is the result

A

the intrapleural space increases in volume, decreasing the PIP and increasing the outward force on the lungs

the visceral pleural will pull on the alveoli

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111
Q

where are the renin/angiotensin cells in the juxtaglomerular apparatus

what is their function

A

near the afferent tubule

secretion of hormones into the blood based on renal blood pressure

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112
Q

what does it mean to say the VRG causes nerve stimulation to respiratory muscles to “ramp up”

A

as inspiration continues the frequency of nerve impulses increases

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113
Q

when measure static lung volume what is not taken into account

A

the time it takes to move air in or out

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114
Q

internal respiration

what is the byproduct

A

use of O2 in mitchondria to generate ATP

CO2

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115
Q

what enzymes are responsible for pumping Na out of the blood in the ascending loop of henle

what about Cl

A

Na/K pump

Cl/K symporter

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116
Q

patient presents with chronic kidney disease. What lab value would indicate the greatest absolute decrease in GFR?

A

a rise in plasma creatinine levels from 1mg/dl to 2mg/dl

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117
Q

four lung volumes

A

Tidal volume

inspiratory reserve volume

expiratory reserve volume

residual volume

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118
Q

what will the effect increased PO2 have on the bronchioles

pulmonary arterioles

A

weak constriction of the bronchioles

dialation of the arteries

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119
Q

what enzymes are repsonsible for moving OAs into tubular cells from blood

what enzymes are responsible for moving OAs into tubular fluid

what is the common factor in each

A

OAT1, 2, 3

MRP2 and OAT4

OAT enzymes are ketogluterate antiporters

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120
Q

what is the primary function of intercalated cells

two types of intercalated cells and their function

A

regulation of acid base balance

alpha (reabsorbs HCO3 in acidosis)

beta (reabsobs H+ in alkalosis)

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121
Q

what is the effect of the haldane effect and carbamino effect on O2 unloading with decreased PO2

A

both will decrease Hb affinity for O2

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122
Q

two types of ventilation as they relate to neural control

A

quiet and active ventilation

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123
Q

what effect will increased PCO2 and decreased PO2 have on bronchioles

what effect will the action of the bronchioles have

A

decreased smooth muscle activity, leading to brochodilation

decreased resistance and increased ventiliation

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124
Q

T/F the descending limb of henle is impermable to water

A

false, the ascending limb is impermeable

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125
Q

Haldane effect

A

because deoxygenated Hb has a higher affinty for CO2 than oxygenated Hb, it will accept more CO2 and allow for CO2 to be transported from the cells to the lungs, where the CO2 will be released as Hb becomes oxygenated

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126
Q

what is the function of the DRG during quiet and active expiration

A

inhibition of inspiratory neurons

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127
Q

what is the function of phosphate that is filtered and remains in urine

A

buffering pH

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128
Q

how does BNP/ANP increase GRF

A

dilation of the afferent arterioles

constriction of the efferent arterioles

increase in glomerular hydrostatic prssure

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129
Q

why is PIP usually negative

A

because the elastic recoil of the chest wall and the lungs pull the viseceral and parietal pleura in different directions, increasing volume and decreasing pressure

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130
Q

what does the bohr effect mean in practical terms

A

at the cells there is a higher concentration of CO2

high CO2 produces more carbonic acid

more acid means lower pH

lower pH forces O2 to dissassociate from Hb

allows for offloading O2 at cells

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131
Q

PAH clearance is equal to what

A

RPF

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132
Q

how would RER changed if metabolism was primarily anaerobic?

aerobic?

A

anaerobic = glycolysis = increased RER

aerobic = fatty acid oxidation = decreased RER

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133
Q

define clearance of a solute

A

the virtual volume of blood plasma volume per unit of time inflow needed to supply the amount of solute that appears in the renal veins or in the urine

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134
Q

what types of waste products are excreted by the kidneys

A

urea

uric acid

creatinine

metabolites of hormones (vitamins)

bilirubin

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135
Q

normal FRC

A

2200

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136
Q

explain this forula

PUF = PGC - (PBS + πGC)

A

the pressure of ultra filtrate is equal to the hydrostatic pressure of the glomerular capilaries minus the sum of the pressure in bowmans space and the osmotic pressure of the glomerular capillary

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137
Q

what GFR value would be considered kidney failure

kidney disease

normal

A

0-15 ml/min

15-60

60-120

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138
Q

why is the amount of O2 dissolved in plasma largely ignored

A

because it is very small compared to the amount bound to hemoglobin

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139
Q

what would increased levels or atrial and brain natruiretic peptide be indicative of

A

congestive heart failure

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140
Q

what type of hemoglobin has oxygen bound at almost all binding sites

A

oxyhemoglobin

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141
Q

what is the gold standard substance to determine GFR

is it commonly used in clinic? why?

A

inulin

because it has to be IV injected

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142
Q

mechanics of ventilation formula

A

movement = Driving force/resistance

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143
Q

what are the bones of the chest cavity

A

rib cage, sternum, thoracic vertebrae

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144
Q

why is there a brush boarder in nephron cels

A

to increase surface area and allow for more Na/K pumps

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145
Q

when proteins are allowed to pass through holes in capillaries, what stops them from passing through the basement membrane

A

the fact that fenistrations in the basement membrane are too small to allow them to pass (25-65 nm)

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146
Q

where does most of the action happen in the kidney

A

in the PCT

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147
Q

what substances are absorbed in the distal tubule and collecting duct

A

NaCl (8%)

variable amounts of H, K, and H2O inreaction to dehydration, alkalosis, or acidosis

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148
Q

is Palv normally positive or negative?

what is the PIP in comparison

what does this do to PTP

A

alveolar pressure is positive

intraplural pressure is less that Palv

that means that at baseline PTP will be positive

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149
Q

what is is the effect of renal artery stenosis due to atherosclerosis on renal function and blood pressure

  1. An increase in blood pressure due to stimulation of the rennin-angiotensin-aldosterone system which in turn will initially cause a transient increase in GFR
  2. reabsorption of sodium and water resulting in an increase in preload that can increase BP
  3. After the initial period, a further increased constriction of the afferent andefferent arterioles ensues which results in the retention of fluid and an increase blood pressure
  4. all of the above results from renal artery stenosis
A

4, all of the above

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150
Q

what mediates H2O absorption in the later DCT

A

the effect of ADH on APQ2 on the apical and APQ3 and 4 on the BL membrane

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151
Q

what are the gradients that are at work in CO2/O2 loading

what about off loading

A

alveoli –> plasma

plasma –> RBCs

RBCs –> Hb

it is the same, CO2/O2 will desaturate in plasma first

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152
Q

how would the lung react to decreased blood pH?

how would the kidneys

A

increasing respirations to blow off CO2

decreasing secretion of HCO3

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153
Q

what is the carbamino effect as it related to decreased PO2 and Hb affinity

A

deoxygenated Hb will form carbaminohemoglobin, which has a low affinity for oxygen but doesn;t hold on to CO2 well

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154
Q

describe the bohr effect (reddit)

A

in areas of high PCO2, increased H+ will make it more likely for Hb to release O2

in areas of low PCO2, decreased H+ will make it more likely for Hb to pick up O2

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155
Q

what is the effect of PCO2 on smooth muscle during venitliation

A

stimulates smooth muscle to dilate or constrict brochial diamter

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156
Q

functional reserve capacty equation and defintion

A

the amount of air remaining in the lungs after normal expiration

FRC = ERV + RV

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157
Q

what are the two effects of dopamine in the kidney

A

naturesis

vasodilation

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158
Q

what are the SNS hormones that will vasoconstrict

what wll reverse their effect

A

Epi and NE

renalase

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159
Q

what is the direct effect of increased PO2 on Hb loading

A

direct: increased O2 loading due to increased PO2

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160
Q

T/F there are no cellular elements and very little protein typically found in ultrafiltrate

A

true

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161
Q

what much O2 can be bound to 1g of Hb when saturated

A

1.34 mL O2

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162
Q

wjhat is the function of angiotensinogen

A

regulated BP and Na/K balance

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163
Q

what happens during hyperventillation

what is the result

A

ventilation exceeds cellular PCO2

arterial PCO2 drops (hypocapnia)

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164
Q

what stops the process of expiration

A

negative feed back from decreased Palv

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165
Q

what would glucose in the urine indicate

A

hyperglycemia, failure of glucose reabsorption

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166
Q

external respiration

A

exchange of O2 and Co2 between the atmopshere and the body

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167
Q

what is the direct effect of decreased PCO2 on Hb O2 loading

A

decreased PCO2 will cause more CO2 to be offloaded to allow for more O2 binding

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168
Q

what stimulus will cause the secretion of ANP and BNP

A

stretch in the atria

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169
Q

name three structures that are not normally allowed through the filtration barrier of the nephron

A

RBCs

WBCs

platelets

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170
Q

expiratory reserve volume (ERV)

A

the amount of air greater than tidal volume that is expelled during forceful expriation

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171
Q

what does the SNS respond to produce vasoconstriction of the kidney

what is the effect on GFR and RBF

A

decreased extracellular fluid volume

both will decrease

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172
Q

what is normal resting renal blood flow

what is that in percent of cardiac output

A

1.2L/min

around 20-25%

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173
Q

What are the generalized functions of the kidney

A

excretion of waste

regulation of fluid volume and content

balance electrolytes

react to changes in pH along with resp

Produce and secrete hormones

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174
Q

what type of cellular transport is used for NaCl reabsorption in the ascending loop

what happens to NaCl in the tubule as it approaches the macula densa

A

passive transport

it diffuses out of the tubule into the interstitium

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175
Q

which of the following will cause a decrease in renin secretion from the kidney

a. Decreased fluid and solute delivery to the macula densa
b. Hemorrhage
c. Intervenous infusion of isotonic saline
d. Narrowing of the renal artery

A

c. Intervenous infusion of isotonic saline

176
Q

ventiliation

A

breathing

177
Q

Dorsal respiratory group (DRG)

A

a medullary respiratory center with mostly inspiratory neurons and few expiratory

178
Q

what is the direct effect of decreased PO2 on O2 unloading

A

decreased PO2 in tissues increases the chance that O2 will unload

179
Q

what structures are contained in the nephron

A

renal capsule

proximal tubule

loop of henle (distal, ascending, thick)

distal tubule

collecting system

180
Q

four factors that will increase GFR

A

increase in arterial BP

vasodilation of the afferent arteriole

vasoconstriction of the efferenet arteriole

increase renal blood flow

181
Q

why do JM nephrons have a long loop of Henle

A

to take advantage of countercurrent ion regulatioin

182
Q

hypercapnia

A

PCO2 is greater than normal in blood

183
Q

FEV1.0

A

the amount of air that can be expired in one second from total lung capacity

184
Q

describe the process of ventilatory feed back from hyperventiliation

A

decreased PCO2, increased pH, increased PO2

chemoreceptors detect

CPG decreases ventilation

185
Q

where are the extraglomerular messnagial cells found in the juxtaglomerular apparatus

what is their function

A

near the macula densa

their function is unknown

186
Q

what diuretics act on the PCT

A

acetazolamide

manitol

187
Q

what is the PP of O2 in the pulmonary veins?

CO2

when and does that change, and by how much

A

100 mmHg

40 mmHg

at the cells

O2 down to 40mmHg, CO2 upto 46mmHG

188
Q

what would albumen or glucose in the urine indicate

A

diabetic neuropathy

189
Q

bohr effect

A

the presence high levels of CO2 in blood will produce more H+ ions and decrease pH, decreasing O2 affinity and allowing for CO2 uptake

190
Q

what stimulus will release angiotensin II

what will the efect be on GFR and RBF

A

decreased extracellular volume

decreased GFR and RBF

191
Q

why is the solubilty of CO2 relevant clincially

A

because CO2 is very soluble our bodies are very good at getting rid of it

192
Q

what will the effect of angiotensin II be on BP and ECFV

A

will constrcit the afferent and efferent arterioles to increase them both

193
Q

tidal volume

A

the amount of air moved during one normal breath

194
Q

what would happen to blood flow (Q) when VA decreases

what happens to VA if Q decreases

A

nothing, they don’t effect one another

195
Q

what is the function of the renal corpuscle

A

produces ultra-filtrate from blood in the glomerular capilaries that ends up in the glomerular space

196
Q

how are Na and Cl transported across the cell membrane in the 2nd PCT

A

transcellular and paracellularly

197
Q

what is the process for excretion of organic cations

A

OCT enzymes transport OC from blood

OC/H+ antiporter and MDR1 transport them out

198
Q

what two neurotransimitters are secreted by the sympathetic neurons of the kidney

A

norepinephrine and dopamine

199
Q

what is the correct order of blood flow through vessels inside the kidney

A

afferent arterioles

glomerulus

efferent arterioles

pertubular capiliarries

200
Q

laplace law for airway resistance

A

air flow = (Patm - Palv)πr4/8nl

201
Q

what determines the amount of O2 dissolved in plasma

A

alveolar PO2

202
Q

what is the effect of NO on the action of angiotensin II, NE, and Epi

A

it will decrease the amount of vasoconstriction

203
Q

where is are the macula densa found

what is their function

A

superior border of the thick loop of henle

detects NaCl concentration in the distal tubule

204
Q

when PTP increases, what will be the ultimate end result at normal physiologic conditon

A

increase in alveolar volume

205
Q

what will the effect of ATP in the interstitial fluid be

A

in tubuloglomerular feedback it constricts afferent arterioles to decrease GFR and RBF

in some conditions it can stimulate NO and increase GFR and RBF

206
Q

Daltons law

A

the total prssure exerted by a gas on the walls of its container is equal to the sum of partial pressure from each gas

207
Q

explain this formula

Ex = Fx - Rx + Sx

A

excretion rate of a substance is equal it is filtration rate minus the reabsorption rate plus the secretion rate

208
Q

what effect will the increase of bradykinin have on the release of NO and prostaglandins

A

it will stimulate the release of both, which will further incrased GFR and RBF

209
Q

inspiratory reserve volume (IRV)

A

the amount of air greater than tidal volume taken in during forced inspiration

210
Q

what are ions that can be excreted into urine

A

Na

K

Cl

HCO3

H+

Ca

P

211
Q

why is the Na/K pump necessary to the reabsorption of solute in the thick loop of henle

A

it maintains a low intracellular Na gradient to fuel transport from the tubule

212
Q

where does H2O reabsorption happen in the loop of henle

what cellular protein is responsible for this

A

exclusively in the thin descending loop of henle

aquaporin 1

213
Q

normal total lung capacity

A

5700

214
Q

what is the location of dysfunction in Gitelman syndrome

what is the mechaniism

A

intitla DCT

failure of the Na/CL symporter

215
Q

why would hyperventilation cause syncope

A

as PCO2 drops the neural drive to breathe is decreased

216
Q

what is the transcellular route of Na reabsorption in the 2nd PCT

A

parallel operation of Na/H antiporter and Cl anion antiporter

217
Q

describe the haldane effect (reddit)

A

deoxygenated Hb will be more likely to bind to CO2, which allows it to pick up CO2 at the cells

oxygenated Hb will be less likely to pick up CO2 to encourage full O2 loading

218
Q

can yhou determine the SO2 from PO2

A

use the graph

219
Q

three dyanmic lung volumes

A

FEV1.0

FVC

FEV

220
Q

inspiratory capacity definition and equation

A

the amount of air taken into the lungs from FRC on maximum inspiration

VT + IRV

221
Q

what are three factors that can stimulate the action of rate-limiting enzymes in secretion of organic cations

A

PKA, PKC, androgens

222
Q

what is the effect of ADH on the later DCT

A

decreased ADH will down regulate APQ’s on the apical and Bl membranes, causing decreased H2O reabsorptiond and diuresis

223
Q

67% of what substances filtered by the nephron are reabsorbed in the PCT

A

H2O, Na, Cl, K, others

224
Q

what provides negative feed back during inspiration

A

increasing Palv will inhibit inspiration

225
Q

what enzyme is active in the intital segment of the DCT at the apical membrane

BL membrane

A

Na/Cl symport

Na/k pumps, Cl passive transport channels

226
Q

what is the driving force for ventilation

A

the pressure difference between the atmosphere and the alveoli

227
Q

three differences between superficial and juxtamedullay nephrons

A

JM nephrons have a long loop of henle

their primary job is to concentrate or dilute urine

has vasa recta

228
Q

what is the relationship between RBF and RPF

A

RBF = RPF/1-hematocrit

229
Q

what are normal GFR values for males and females

A

125 ml/min

110 ml/min

230
Q

what amount of O2 will dissolve in plasma at sea level

A

3mL O2 per liter of blood at alveolar PO2 100mmHg

231
Q

what is the normal pH of urine

what causes this

A

5.5

H+/K ATPase antiport excnages H in the tubule for K in the cell

232
Q

what is the indirect effect of decreased PCO2 on O2 loading

A

decreased PCO2 means thre will be less H+ produced, raising pH

increased pH increases O2 binding

233
Q

what condition would you expect to be present in a patient with the following symptoms

pH 7.34, PCO2 46mmHg, Resp Rate 15, HCO3 25 meq/L

A

respiratory acidosis that is being compensated by the renal system

234
Q

five examples of sensory inputs that feed into the central pattern generator

A

central chemoreceptors

peripheral chemoreceptors

pulmonary stretch receptors

irritant receptors

proprioceptors

235
Q

what differentiates principle cells from intercalated cells

A

moderate invaginations of the basolateral membrane

main function is the the reabsorption of NaCl and secretion of K

236
Q

where are central chemoreceptors

peripheral

A

central in the central nervous system

peripheral in blood vessels

237
Q

what is the RPF in a normal adult

A

600-700ml/min

238
Q

functional residual capacity (FRC)

A

the amount of air present in the lungs after passive expiration

239
Q

what are two things that can modulate autoregulation

A

sympathetic tone and hormones

240
Q

what does a left shift on an O2 affinity curve represent

right shift?

A

increased Hb O2 affinity

decreased affinity

241
Q

if a drug causes vasoconstriction of the efferent arteriole _with no effec_t on the afferent arteriole, what is the expected trend in GFR and RBF compared to normal

A

GFR will increase and RBF will decrease

242
Q

quiet ventiliation

A

inspiration is active, expiration is passive

243
Q

what is the ventilation/perfusion ratio

A

the amount of alveolar ventilation related to the amount of blood in the pulmonary capiliaries

244
Q

normal IRV

A

3000

245
Q

what is the basic process of urine formation

A

ultrafilatration of plasma

reabsorption of water and solutes

secretion

excretion

246
Q

why is Cl transported instead of organic anions or HCO3

A

because most of the proteins and HCO3 have already be reabsorbed

247
Q

what would be the result of decreased renal blood flow from cardiogenic shock

A

acute tubular necrosis if enough cells are destroyed which can escalate into renal failure

248
Q

What is the equation used to determine fuel source

A

%VO2FAT = 1 - RER/0.3

249
Q

what forces are working to expand the chest wall at functional residual capacity

A

elastic recoil of the chest wall

250
Q

normal RV

A

1200

251
Q

what are two cell types in the DCT

what are their functions

A

principle and intercalated

principle reabsorb NaCl and H2O, secrete K into tubule

incalated cells secrete H+ or HCO3 for acid base balance

252
Q

what is the location of dysfunction barter syndrome

what is the mechanism

A

ascending loop of henle

problems withthe Na/K/2Cl pump

253
Q

what will the kidney do in response to hypotension

A

decrease GFR to conserve water

254
Q

what is the haldane effect as it related to decreased PO2

A

Once O2 has been offloaded and PO2 is decreased, Hb has an increased affinity for CO2

255
Q

why can urinalysis detect certain drugs

A

because some substances are secrete into the PCT and not reabsorbed

256
Q

what is the structure of the renal corpuscle

A

fenestrated capillaries surrounded by podocytes

257
Q

how is Na pumped cross the basolateral membrane in the 2nd PCT

CL

A

Na K pump

Cl/K symporter

258
Q

total lung capacity equation

A

VT + ERV + IRV + RV

259
Q

describe the equation

GFR = Kf * PUF

A

the glomerular filtration rate is equal to the product of hydraulic conductivity and surface area (Kf) times the pressure of ultrafiltrate

260
Q

why is creatinine used to determine GFR

A

freely filtered at a reletively stead concentration of 1mg/dL

almonst non is reabsorbed, secreted, or metabolized by the nephron

261
Q

normal ERV

A

1000

262
Q

which is more soluble in water, O2 or CO2

A

CO2, x20 more soluble

263
Q

what happens at the intrapleural space during expiration

A

collapsing chest wall decreases pull on parietal pleura

increased PIP

decrease in transpulmonary pressure (decrease driving force)

264
Q

transchest wall formula

A

PCW = PIP - Patm

265
Q

what covers the epithelial cells of the renal corpuscle

what disease process might effect this layer and how

A

a basement membrane

can be thickened by DM

266
Q

how is CO2 transported in blood

A

dissolved in plasma

bound to Hb

HCO3

267
Q

what is the direct effect of peripheral chemorecptors

A

they detect changes in PCO2 and in pH and send signals to the CPG

268
Q

active ventilation

A

inspiration and expiration are both active

269
Q

what percent of total O2 in blood is dissolved in plasma

A

1.5%

270
Q

what are the starling forces that oppose filtration

A

hydrostatic pressure in the tubule

osmotic pressure in the the capillary

271
Q

what determines the composition of ultrafiltrate

A

the characteristics of the glomerular filtration barrier (endothelium, basement membrane, podocytes)

272
Q

transpulmonary pressure formula

A

PTP = Palv - PIP

273
Q

how does changes in PCO2 arterial effect central chemoreceptors

A

it will increase PCO2 in the CSF, increasin pH and causing a repsonse to be sent to the CPG

274
Q

what will the effect increased PCO2 have on the bronchioles

pulmonary arterioles

A

dialtion (increased VA)

weak constriction (decreasedQ)

275
Q

what percent of the VT doesn’t make it to the alveoli

A

30%

276
Q

if protein is filtered where is it reabsorbed in the kidney

A

the proximal tubule

277
Q

what is the role of the kidneys in regulating pH

A

during acidosis the kidneys will hold on to HCO3

during alkalosis the kidneys will excrete HCO3

278
Q

what are four apical symporters found in the 1st PCT

A

Na/glucose

Na/AA

Na/Pi

Na/Lactate

279
Q

what would be consequence of lost surfactant in the lungs

be specific

A

small alveoli would have a higher collapsing pressure

higher pressure in the small alveoli would drive air out into larger alveoli with a lower pressure

280
Q

what stimulus will produce bradykinin

what will the effect be on GFR and RBF

A

increased prostafglandins and decreased acetylchloline

increase in both

281
Q

what happens to PGC and πGC as the ultrafiltrate passes through the nephron

why is this relevant

A

PGC decreases

pi GC increases

promotes reabsorption in the peritubular capillaries

282
Q

hypoxia

A

P02 is lower than normal in tissue

283
Q

three vasoconstrictors in the kidney

A

SNS

angiotensin II

endothelian

284
Q

what substance is not absorbed in the DCT

what is the consequence of this

A

Na contentration decreases

285
Q

what is the effect of dopamine on RBF

A

increases

286
Q

FVC

A

the amount of air that can be expelled from TLC

287
Q

four criteria to determine if a substance can be used to calculate GFR

A

freely filtered

no absorbed or secreted

not metabolized or produced by the kidney

does not alter GFR

288
Q

what will the effect decreased PO2 have on the bronchioles

pulmonary arterioles

A

weak dilation

constriction

289
Q

why would BNP be a good test for CHF

A

increased stretch on the vessel walll will increase BNP production

BNP as a long half life

290
Q

why would renal failure cause anemia

A

because mesangial cells in the kidney produce EPO, and as the kidneys fail those cells loose their secretory capacity

291
Q

what is the function of calcitrol

where is it produced

A

allows for normal absorption of Ca from the GI tract and deposiiton of Ca in bone

it is converted from vitamin D in the proximal tubules

292
Q

what is the function of atrial natriuretic peptide

A

it attempts to decrease fluid volume in response to excessive stretch in the atria

293
Q

what will the effect decreased PCO2 have on the bronchioles

pulmonary arterioles

A

constriction

weak dilation

294
Q

molecules below what size are freely filtered in the nephon

what size will prohibit free filtration

A

<20 angstroms

>42 angstroms

295
Q

what starts the process of expiration after inspiration

A

negative feedback from increased Palv

296
Q

what is the inspiratory functino of the VRG

Expiratory

A

ramp up the frequency of action potentials

stimulate motor neurons to expiratroy muscles

297
Q

what is the cut off of FEV1.0/FVC that would indicate ventilatory obstruction

A

+80%, no obstruction

<80%, possible obstruction

298
Q

how can hypersecetion of PTH effect other systems

A

hyperseceretion of PTH can increase the amount of PTH produced, which can cause more calcium to be released

299
Q

anatomical dead space VD

A

the conduction region, where gas exchange doesn;t occur

300
Q

surface tension formula

A

P = 2T/r

collapsing pressure, surface tension, radius

301
Q

which of the following is NOT a component of the filtration barriers in the glomerulus

  1. podocytes
  2. basement membrane
  3. capillary endothelium
  4. all of the above are part of the filtration barrier of the glomerulus
A

4, they are all barriers

302
Q

what is the function of the pontine respiratory center

A

possibly to facilitate transition between inspiration and expiration

303
Q

where in the PCT is Na absorbed

HCO3

CL

A

the first 1/2

first 1/2

last 1/2

304
Q

what is the effect of norepinehprine and dopamine on the kidney

what will be the effect

A

vasoconstrcitons through alpha adenoreceptors on the afferent arterioloe

dcreased in RBF and GFR

305
Q

how does the effect of gravity effect the perfusion to those alveoli

A

alveoli with a low VA need less perfusion and have a lower Q to maintain a raio of 1

306
Q

T/F there is significant parasympathetic innervaion to the kidney

A

false, there is none

307
Q

what two substance are reabsrbed in the loop of henle, along with the percent of what is in filtrate

A

25% of filtered NaCl

15% of filtered H2O

308
Q

aside from production of hormones, what other important endocrine function does the kidney play

A

ir regulates clearance of hormones which can indirectly influence endocrine function

309
Q

hypooxemia

A

PO2 is lower than normal in arterial blood

310
Q

what influences smooth muscle contractility in the lungs

A

PO2 and PCO2

311
Q

what will increase RBF

what will decrease RBF

which of the two trumps the other

A

vasodilation

vasoconstriction

vasoconstriction

312
Q

why is the amount of solute in the renal veins less important than the amount removed from blood

A

because solute in the veins is recycled

313
Q

where is most of the H2O absorbed

A

PCT

314
Q

what is the effect of decreasing temperature on Hb O2 affinity

A

decreasing temperature increases Hb affinty for O2

315
Q

explain this formula

Cx = (Ux * V)/Pax

A

clearance of a substance is equal to the amount in urine times the volume of urine per day divided by the arterial concentration

316
Q

what stops cesllls in the PCT from brust

A

Na K pump

317
Q

Hypocapnia

A

PCO2 is lower than normal in blood

318
Q

what will caused a left shift of an O2 affinty curve

A

decreased temp

increased pH

decreased PCO2

decreased 2,3 - BPG

319
Q

what happens at the intrapleural space after the chest wall expands during inspiration

A

chest all pulls on the parietal pleura

PIP decreases because volume increases

Transpulmonary pressure increases

320
Q

what force is collapsing the lung at FRC

A

elastic recoil of the lungs

321
Q

what is the effect of sympathetic tone if the content of the extracellular fluid is nomal

A

there is minimal effect

322
Q

why is high compliance in lung tissue important

A

because low compliance means that it will take greater force to expand the alveoli

323
Q

what happens to the the charge of tubular fluid as it passes through the thick loop of Henle

why is this important

A

it acquires a positive charge

the voltage is important for the reabsorption of cations like magnesium

324
Q

what is the conducting zone

A

the airway from the larynx down to the terminal bronchioles

325
Q

how much O2 is used by the body each day

how much CO2

A

90 gallons

72 gallons

326
Q

what diuretics act on the thick asceening loop of henle

A

furosemide and bumetanide

327
Q

what percent of the ventilatory system is the conducting zone

the respiratory zone

A

30%

70%

328
Q

two types of collecting tubule cells

A

principle cells

intercalated cells

329
Q

transchest wall prssure

A

the inward force of elastic lung recoil and force due to negative intrapleural pressure that decreases lung volume

330
Q

what happens after the central pattern generator processes sensory, pontine, and cortical repsonses

A

it inhibits or stimulates neurons in the DRG and VRG to regulate breathhin rhythem

331
Q

what is the filtration fraction

how is it calculated

A

the portion of blood that is shunted away from the glomerulus

GFR/RBF

332
Q

what is a condition that will allow GFR and RBF to not be related in parallel

A

renal response to atrial natruetic peptide

333
Q

explain this equation

RPF = CPAH/EPAH

A

renal plasma flow

334
Q

given the Hb concentration, arterial and venous O2 saturation, and O2 consumption how would you determine…

Arterial and venous O2 capacity

A

capacity = Hb g/L

convert 0.00134 L/g

multiply by the concentration of hemoglobin

335
Q

what will happen if there is a decrease in ATP and adenosine

how does this change in the presence of NO

what about angiotensin II

A

vasodilation of the afferent arteriole

NO will decrease vasoconstriction caused by ATP and adenosie

Angiotensin II will increase the vasoconstrictive effects of adenosine

336
Q

what is the primary function of the juxaglomerular apparatus

A

regulation of filtration rate and renal blood flow by detecting the amount of NaCl in filtrate and changes in renal blood pressure

337
Q

what determines the O2 capacity of blood

A

the concentration of hemoglobin

338
Q

three factors that determine alveolar PO2 and PCO2

A

partial pressures in the ambient air

alveolar ventilation

RER

339
Q

hyperventilation will cause what response in regard to pH

A

increased pH, leading to respiratory alkalosis

340
Q

what does tubuloglomerular feed back respond to

A

changes in NaCl in the intertubular fluid

341
Q

ventral respiratory group (VRG)

A

a medullary respiratory center with expiratory and inspiratory neurons

342
Q

why is important that the peritubular capillaries be have low hydrostatic pressure compared to the glomerular capilaries

A

because the peritubular capilaries need to reabsorb and then secrete substances based on need

343
Q

four factors that influence Hb affinity for O2

A

temperature

pH

PCO2

2,3 - BPG

344
Q

what is the function of the peritubular capillaries

A

deliver substances and O2 to the nephron and allow for reabsorption

345
Q

given the Hb concentration, arterial and venous O2 saturation, and O2 consumption how would you determine…

arterial and venous O2 content

A

capacity = Hb

content = capacity(SO2)

346
Q

what to tamm horsfall proteins do

A

normally they are a defense against bacteria in the nephron, but the also form casts that can trap substances

347
Q

of the starling forces, which is the primary driving force behind filtration

A

hydrostatic pressure in the arteries

348
Q

what stimulus will increase NO production

what is the effect

A

increased shear stress, histamine, bradykinin

increased in GFR, increase in RBF

349
Q

what would it mean if a substance had clearance ratio of 1

less that one

greater than one

A

the substance is filtered and not reabsorbed

the substance could not be filtered or is filtered then reabsorbed

the substances is filtered and secreted

350
Q

Partial pressure of a gas

A

PP = %gas(Patm)

351
Q

how do chemoreceptors regulate ventilation

A

they send signals to the central pattern generator which regulates rate and depth

352
Q

why is the clearance of P-aminohippurate of note

A

clearance of PAH almost equals renal plamsa flow, and RPF = RBF

353
Q

what effect does gravity have on air flow to alveoli

A

some alveoli are more completely ventilated than others

354
Q

how does Na move out of the later segments of the DCT

what is the driving force behind this movement

what other ion does the effect

A

diffusion through ENaC channel

negative charge inside the DCT cell

it sets up a gradient for Cl paracellular transport

355
Q

when loading or unloading O2/CO2, what gradient will become saturated first

A

Hb, then RBCs, then plasma

356
Q

the solubility of oxygen in water is directly proportional to what

A

the partial pressure of oxygen in the air

357
Q

normal IC

A

3500

358
Q

where does 70% of the absorption in the nephron happen

A

the proximal tubule

359
Q

what happens to the lung if transpulmonary pressure is 0

A

the lungs will collapse because of the elastic recoil of the lungs

360
Q

compare and contrast carbaminohemoglobin to carboxyhemoglobin

A

both have compounds other than O2 bound in significant quantities

Carbaminohemoglobin has CO2

Carboxyhemoglobin has CO

361
Q

what is the inspiratory function of the DRG

A

produces a firing pattern based on stretch of the lungs

inhibits inspiratory muscles

362
Q

five reasons why RBF is important

A

Indirectly determines GFR

modifies the rate of solute and water reabsorption be proximal tubule

participates in the concentration and dilution of urine

delivers O2, nutrients, and hormones to renal cells

delivers substrates for excretion

363
Q

in what ways is autoregulation of renal blood flow maintained

A

changes in vascular resistance in the afferent and efferent arterioles

364
Q

what diuretic would mimic gitelman syndrome

what would be the pathlogical effects of this

A

thaizaide

hypocaluria

365
Q

what is the primary ventilatory stimulus

A

systemic arterial and pulmonary vein PCO2

366
Q

two types of nephrons

A

superficial

juxamedullary

367
Q

what is the only factor that will change to alter airway resistance

A

increasing or decreasing radius

368
Q

how is the kidney a source of drug interaction

give an example

A

certain drugs can cause the preferential secretion of acids or bases

diuretics can increase the secretion of aspirin, an acid, and decrease secretion of basic drugs like amphetamines

369
Q

what diuretic would mimc barter syndrome

what would the pathologic effects be

A

lasix (inhibition of Na/K/2Cl symporter)

salt wasting, metabolic acidosis

370
Q

normal resting plasma flow

A

650 mL/min

371
Q

what is the relationship between Palv, PIP, and PTP

A

Palv is higher than PTP

both decrease during inspiration and increase during expiration

graphically the space between them is the PTP

372
Q

hyperoxia

A

PO2 is greater than normal in tissue

373
Q

what causes a detrimental accumulation of fluid by the kidneys in response to decreased ejection fraction in kidney faiilure

A

heart failure will cause a decrease in BP, which will trigger baroreceptors in the vasculature and kidneys, resulting in a decreased RBF and GFR to increase BP

this overrides the signals from the kidney that would elimiinate fliud

374
Q

what does the haldane effect mean in practical terms

A

binding O2 to Hb decreases its affinity for CO2

375
Q

what hormone opposes the function of calcitrol

A

PTH

376
Q

what three organs work to maintain blood pH

A

lungs, kidneys, liver

377
Q

where is the location of dysfunctionin liddle syndrome

what is the mechanism

A

later DCT

hyperactive ENaC

378
Q

what would cause increase in ventiliation/perfusion ratio (Example)

decrease (example)

A

a decrease in perfusion (Q) with no increase in VA (PE)

A decrease in VA with no increase in Q (airway obstruction)

379
Q

where is the central pattern generator

what does it do?

A

in the medulla

control the firing pattern of inspiratory neurons in the VRG and DRG similar to pacemaker cells

380
Q

four types of hemoglobin

A

oxyhemoglobin

deoxyhemoglobin

carbaminohemoglobin

carboxyhemoglobin

381
Q

which of the following is NOT true in regards to atrial and brain natruretic peptide

  1. produced in the ventricles
  2. increases cardiac output
  3. serum BNP is a valuable index of cardiac stretch
  4. promotes sodium extretion
A

2, increases cardiac output

382
Q

two mechanisms responsible for autoregulation of renal blood flow

A

myogenic response to arterial pressure

tubuloglomerular feedback

383
Q

two respiratory centerns in the medulla

one in the pons

A

ventral and dorsal respiratory groups

pontine respiratoey group

384
Q

what does sympathetic innervation of the kidneys react to the produce vasoconstriction of renal blood vessels

if vasoconstriction is excessive, what can happen

A

decrease in renal blood flow

acute tubular necrosis

385
Q

why are cations more likely to be filtered than anions

A

because the glycoproteins on the basement membrane are negatively charged, so anions would be repelled and cations would be attracted

386
Q

describe the sequence of autoregulation inresponse to increased GFR (8)

A
  1. GRF increase
  2. increase flow through the tubule
  3. flow past the macula densa increases
  4. paracrine stimulation from macula to afferent arteriole
  5. afferent arteriole constricts
  6. increased resistnace
  7. decreased hydrostatic pressure in the glomerulus
  8. decreased GFR
387
Q

what percent of plasma is shunted and not filtered through the glomerulus

A

15-20%

388
Q

what structures are innervated by sympathetic nerves in the kidney

A

renin producing glandular cells

389
Q

what are three functions of norepinephrine on the kidney

A

increase in renin production (beta adrenergic receptors)

increase in NaCl and water reabsorption

vasoconstriction via alpha adrenergic pathways

390
Q

what do chemoreceptors that regulate breathing respond to

A

pH, PCO2, PO2

391
Q

residual capacity (RV)

A

the amount of air left in the lungs after ERV

392
Q

how is a positve ion balance maintained in the body

negative

A

positive = excretion < intake

negative = excretion > intake

393
Q

lung elasticity is dependant on what two factors

A

elastin fibers in the alveolar wall

alveolar surface tension

394
Q

respiratory structures in the chest cavity

A

lungs

chest wall

intrapleural space

395
Q

what pump reabsorbs Na in the 1st 1/2 of the PCT

What is a secondary effect of this

A

Na/H+

places HCO3 into the interstitium

396
Q

two ways altering efferent arteriole resistance can effect PGC

A

decreased resistance throght dialtion: decreased PGC and GFR

increased resistnace through constriction: increased PGC and GFR

397
Q

since atmospheric pressure doesn’t change drastically how is the driving force of respiration changed during ventilation

A

the alveolar pressure is altered by altering the alveolar volume

398
Q

RER definition and equation

A

the ratio of CO2 priduced to O2 consumed during the process of mitochondrial respiration

RER = VCO2/VO2

399
Q

what happens at the alveoli during expiration

A

decreased PTP decreases outward force on visceral pleura

alveolar volume increases

Palv decreases

decreased driving force (Patm - Palv)

decreased air flow into the alveoli

400
Q

where is the majority of Cl reabsorbed in the PCT

A

the DCT

401
Q

what happens to ventillation as PCO2 increases?

decreases?

A

increasing PCO2 increase minute ventilation

decreasing PCO2 decreases minute ventilation

402
Q

what three factors feed into the central pattern generator

A

sensory input

pontine regulation

voluntary control from the cortex

403
Q

what is the function of adenosine in the kidneys

what is its effect on GFR and RBF

A

vasoconstriction

decrease in both

404
Q

where is atrial natriuetic peptide produced

BNP?

A

the atria

the ventricles

405
Q

how is PAH used to test renal blood flow

A

PAH IV is given

PAH is filtered almost completely bt the kidney

the clearance of PAH divided by the extraction of PAH is an indirect measure of the RPF

406
Q

what are the three hormones secreted by the kidneys

A

renin, calcitrol, erythropoietin

407
Q

normal vital capacity

A

4500

408
Q

T/F O2 binding to hemoglobin is non-reversible

A

false

409
Q

lung compliance formula

A

lung compliance = deltaV/delta(Palv - PIP)

410
Q

Alveolar ventilation (VA) defintion and equation

A

the amount of air that reaches the alveoli in one minute

VA = f(VT - VD)

411
Q

what is the purpose of gas exchange

A

to take CO2 out of blood and replace it with O2

to collect CO2 from cells and replace it with O2

412
Q

between what MAP does renal blood flow remain constant

what happens to GFR in this range

A

80-180

it remains basically the same

413
Q

Henry’s Law

A

the quantity of gas that will dissolve in a liquid is proportional to the the partial pressure of the gas above the liquid and its solubilty coefficient

414
Q

how can the kidneys regulate blood pressure

A

regulate water and Na reabsorption

producing renin for the RAA cycle

415
Q

how does 2,3 - BPG(DPG) affect Hb affinty for O2

A

it binds to deoxygenated Hb to stop O2 from rebinding at the cells to allow for more O2 delivery tocells

416
Q

vital capacity defintion and equation

A

the total amount of air moved during forced inspiration or expiration

VT + ERV +IRV

417
Q

what are some buffered forms of hydrogen formed in the renal tubules that are in urine

a. Titratable acid such as phosphate (monobasic)
b. Water a byproduct of the addition of hydrogen and biocarbonate through action with carbonic anhydrase
c. Ammonium ion by the addition of the hydrogen ion to ammonia generated by the catabolism of glutamine
d. All of the above are forms of the hydrogen ion in excreted urine

A

d. All of the above are forms of the hydrogen ion in excreted urine

418
Q

collapsing pressure

A

the pressure needed to collapse alveoli

419
Q

what diuretics act on the DCT

A

thiazides

420
Q

partial pressure

A

the pressure exerted by one gas in a mixture

421
Q

what is the respiratory zone

A

respiratory broncioles and alveli

422
Q

glycosylation

how would you assess this in a patient

A

a reaction in the glycoproteins on the basement membrane that decreases their ability to repel anionic proteins

HbA1c levels or fasting glucose, along with albumin in the urine

423
Q

Transpulmonary pressure

A

the combined force fo negative intrapleural pressure and elastic chest wall recoil that acts to expand the chest wall

424
Q

describe how PP O2 changes throughout the body

A

air starts at 160mmHg

alveoli –> pulmonary veins –> systemic arteries steady at 100 mmHg

decreases to around 40 mmHg at cells

maintains 40mmHg through venous circulation back to heart

425
Q

where does reabsorpton of NaCl happen in the loop of henle

where does it not occur

A

the thick and thin loops

no the descending limb

426
Q

why does there need to be high hydrostatic pressure in the glomerular capillaries

A

because there need to be pressure to push all the filtrates out of blood

427
Q

what are the three anatomical strucutures of the filtration barrier in the renal corpus

A

fenestrated epithelium

basement membrane

podocyte from bowmans capsule

428
Q

what happens in the chest wall during inspiration

A

motor neuron stimulation

inspiratory muscles contract

chest wall expands

429
Q

what is the function of renin

A

renin promotes the production of angiotensinogen from the liver, which is converted to angiotensin in the kidneys

430
Q

what is the indirect effect of peripheral chemo receptors

A

detects decreased PO2 (below 60mmHg) and sends signals to CPG

431
Q

what is the effect of PO2 on smooth muscle in the lungs

A

it will act on the pulmonary arterioles to regulate Q

432
Q

by what two methods is oxygen transported in blood

A

dissolved in plasma

bound to hemoglobin

433
Q

where would a right shift (decreased oxygen affinity) be useful

why

what about left shift

A

at the cells

so O2 will dissociate from Hb

at the lungs, because you want to maximize O2 saturation

434
Q

boyles law equation and meaning

A

P1V1 = P2V2

as volume increases, pressure decreases, and vice versa

435
Q

T/F obstruction doesn;t change vital capacity

A

true

436
Q

what is the process of exretion of organic anions into the tubules

A

intracellular ketogluterate is exchanged into the tubular fluid for OA with OAT1, 2, 3

ketoglutarate in the tubule fluid is exchanged with OA by OAT4 and MRP2

437
Q

Gitelman’s syndrome is a genetic defect that affects the thiazide sensitive Na + /Cl - symporter in the distal convoluted tubule.

Which of the following would be observed in these patients?

a. Salt wasting
b. Hypokalemia
c. Hypocalcuria
d. All of the above would be observed in a patient with Gitelman’s syndrome

A

d. All of the above would be observed in a patient with Gitelman’s syndrome

BMS 752 (Medical Physiology) (13 decks)

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