Week 1 (Not Path stuff)

Question 1

Intracellular fluid is 2/3rds

Extracellular fluid is 1/3, which can be broken down into Interstitial fluid (3/4ths) and Plasma (1/4th)

^** There can also be a 3rd space which is ____ fluid that is part of the extracellular space and occurs if fluid that moves out of normal compartments into other spaces like epithelial secretions, synovial, CSF, etc…

The plasma can be even further broken down into venous (80%) and Arterial (20%) and the ARTERIAL portion is what makes up the _____, which is the volume of arterial blood effectively perfusing the tissues

The cell membrane between ECF and ICF is ____ permeable and NOT permeable to most electrolytes

The cell membrane between the plasma and the interstitial fluid (both part of the extracellular fluid) is _____ permeable

Answer 1

Transcellular

ECV (Effective circulating volume)

Water

Ion (small ions to be more specific)

Question 2

Extracellular fluid is made up of mainly ___ and ____ ions and intracellular is mainly ____

Answer 2

Na+ and Cl- (and some Bicarb), K+ (and some Phosphate-PO, and Protein)

Question 3

Edema is swelling produced by expansion of the ____ fluid volume due to altered starling forces

The fluid moves from the vascular space to the interstitial space due to decreased capillary oncotic pressure, and realize that now since they vascular space is hypovolemic (less volume), the body tries to fix it via causing Na+ and water retention (even though its bad)

Non-pitting edema is due to swollen cells from increased ____ volume and ___ (Does or Does Not?) respond to a diuretic

Pitting edema is due to increased _____ fluid volume, and _____ (does or does not?) respond to a diuretic

Answer 3

Interstitial

ICF (Intracellular), DOES NOT

Interstitial, DOES

Question 4

There is sympathetic innervation on the smooth muscles causing ____ arteriole constriction and also there is innervation to the ____ cells that cause the release of renin

^** Systems invoked if under perfusion or decreased volume occurs

Answer 4

Afferent, granular

Question 5

The efferent nervous control of the bladder and urethra consists of the ____ fibers from the sacral micturition center S2-S4 (____ nerve) is ____-micturition due to the stimulation of the detrusor muscle constriction and inhibition of contraction of the internal urethral sphincter

The Sympathetic fibers via the ___ nerve ____-micturition via inhibiting the detrusor muscle constriction and promoting constriction of the internal urethral sphincter

^** Both of these are involuntary responses, but also remember this is voluntary somatic motor neuron innervation via the ___ nerve that allows us to constrict the ____ urethral sphincter

Answer 5

Parasympathetic, pelvic, PRO

Hypogastric, OPPOSE

Pudendal, external

Question 6

Remember, there are 3 distinct layers of the glomerular membrane

1) Fenestrated capillary ____ cells which is permeable to water and dissolved solutes
2) _____ which repels negatively charged (anionic) compounds
3) ____ epithelium which have slit pores between to restrict large molecules

Answer 6

1) Endothelium
2) Basement membrane
3) Podocytes

Question 7

GFR = Kf (ultrafiltration coefficient) x Puf (ultrafiltration pressure)

^** Kf = How many holes x surface area

So in primary glomerular disease, which destroys glomeruli, can ___ the GFR since it decreases the surface area (part of the Kf coefficient) available for filtration

The Puf (net filtration pressure) is calculated via ____

Also remember Kf can be lowered via contraction of the ___ cells since it will decrease the surface area

You can change Puf by changing renal arterial blood pressure (pressure going into glomerular capillary) or the resistance to afferent or efferent arterioles

The body uses Auto-regulation to help guard the filtration system to make sure it is maintained at a certain level via changing resistance of afferent or efferent arterial

^** Decrease (constrict) the ___ arterioles if there is high pressure in order to lower GFR and decrease (constrict) the ____ if there is low pressure in order to increase GFR*********

Answer 7

Lower

Pgc - (Pbc + PIEgc)

Messangial cells

Afferent, Efferent

Question 8

If a patient has a blockage in the renal artery (stenosis), the kidney senses ____perfusion and in order to fix itself, the body will increase the renin-angiotensin and the ____ nervous systems will be stimulated

Both of these occur in order to ___ blood pressure (as a secondary outcome)

The efferent arteriole becomes restricted in order to maintain glomerular pressure/GFR since it was low before due to the stenosis and the afferent constricts as well to help divert the renal blood to more vital organs

Also, ____ reabsorption is increased

A problem would occur though if you gave the patient and ___ inhibitor since this would decrease the compensatory angiotensin II system and stops the efferent arterial from constricting, leading to NO maintenance of the GFR and therefore the GFR would become way to low

Also realize that due to the increased sympathetic activity and increased plasma angiotensin II, which both cause vasoCONSTRICTION, ____ are synthesized and released to oppose this in order to prevent damage from excess constriction and ___ BLOCK this synthesis, and can cause problems with renal function (especially in a patient with hypertension)

Answer 8

Hypo, sympathetic,

Increase

Na+

ACE

Prostaglandins, NSAIDs

Question 9

**** Renal clearance (Cx) = _____**

Creatinine clearance approximates ___

Plasma creatinine is ___ proportional to GFR

Answer 9

(U x V)/P

U = concentration of X in the urine
V = Urine volume
P = concentration of X in the plasma 

GFR

Inversely

Question 10

BUN and creatinine are freely filtered by the glomerulus, but the ____ can be reabsorbed by the tubules and ____ can NOT

A normal ratio is 10/1-20/1 which means there is about 10-20 times more urea (BUN) absorbed compared to Creatinine (CR)

If the ratio is more than 20/1 then that means way to much BUN is being reabsorbed and that means there is a ___ problem aka reduced renal perfusion due to HYPOvolemia and therefore the body is trying to reabsorb more water

If the ratio is less than 10/1 then it is an ____ problem since not enough Urea is being reabsorbed and this is most likely from renal damage (aka tubules are damaged)

Realize also if you have a pre-renal problem, the Fractional Excretion (which is how much Urine is being excreted aka how much of the fluid that makes it to the kidney, actually gets into the renal tubule) would go ____ aka below 1% (since not the fluid isn’ even getting to the kidney) and if you have a Intrarenal problem then it would go ____ aka above 2%

Answer 10

BUN, creatinine

Prerenal

Intrarenal

Down, up

Question 11

The FF (FIltration fraction) is the fraction of total renal plasma flow which is filtered through the glomerular membrane and is calculated as FF = ___

So if there is renal artery stenosis or loss of blood, both leading to hypoperfusion, then the RPF is to low so the FF must ____ in order to continue maintaining the GFR

Answer 11

GFR/RPF

^** RPF = Renal plasma flow

Increase

Question 12

Important sodium reabsorption mechanisms include

1) Proximal tubule:
A) ___transport with Glucose/amino acids/phosphate aka the ____ mechanism
B) ____transport with H+

^** There are drugs you can give to decrease the SGLT-2 Tmax causing an easier glucose amount reached to start being excreted in the urine, so patients with to high of glucose in the blood can decrease the glucose via excreting it

2) Thick ascending limb: ____ cotransport
3) Early distal convoluted tubule: Na+/___, ____transport
4) Late distal convoluted tubule and collecting duct: Luminal membrane channels

As we move down the tubules, the leakiness decreases causing less Cl- to be secreted and this causes the trans-luminal charge to go from + to more -

Answer 12

1)
A) Cotransport, SGLT-2
B) Countertransport

2) Na+/K+/2Cl-
3) Na/Cl Cotransport

Question 13

____ inhibits proximal tubule phosphate reabsorption leading to increased amounts of phosphate excreted in the urine

If someone overdoses on an acid (like aspirin or acetylsalicylate) then you can give them ____ in order to treat this due to the alkalinization of the urine that occurs, since HCO3 picks up the proton off the acid (H2CO3 - Carbonic acid) causing the acid to now become charged (since it lost its H+) and this causes the acid to stay in the tubular lumen and become excreted

Answer 13

PTH

HCO3 (Bicarbonate)

Question 14

Aldosterone stimulates Na ____, Cl ____, K ____ and H ____

If a patient has to much K in the blood (hyperkalemia) you can increase the delivery of ____ to the distal tubules/collecting ducts, and this increased Na concentration will cause more to be reabsorbed, and therefore more K+ to be ____ leading to a decrease of K+ in the blood

___ increases H2O and urea reabsorption so if a patient is dehydrated, ADH will increase and more aquaporin channels will be inserted

___ increases Na and H20 excretion

Answer 14

Reabsorption, reabsorption, secretion, secretion

^** AKA Na/Cl are reabsorbed and K/H is secreted

Na, secreted

ADH

ANP

Question 15

Acidosis = ___kalemia

If you have a diabetic patient aka they lack insulin, and you go out and eat a lot of K+, then it can pre-dispose you to ____kalemia since you need insulin to transfer the K+ into the cells, but this isn’t occurring since you don’t have enough insulin

Also if you perscribe a B-adrenergic blocker (like epinephrine) to treat a patient with hypertension, it also can lead to _____kalemia since Beta-adrenergic agonists help move the K+ out from the ECF into the cells

Answer 15

Hyper

Hyper

Hyper

Question 16

KNOW PAGE 64 *****

1) If someone has hyperaldosteronism…. That means they have a shit load of aldosterone, which causes increased Na+ reabsorption and H+ and K+ secretion and more Na+ is absorbed, so Cl and H20 follow it leading to INCREASED extracellular Na/H20 and DECREASED extracellular K+…. Also the H+ secretion causes ACIDIC urine and ALKALITIC extracellular fluid

^** So in conclusion, you get ____natremia, ____kalemia, and _____osis

2) Acidosis, H+ are ___ and K+ is ____ leading to possible hyperkalemia
3) Alkalosis is opposite ^*
4) Hyperkalemia causes K+ ____ and H+ ____ leading to possible ___osis
5) Hypokalemia is oppsoite ^**

Answer 16

WORK THROUGH THE PROBLEMS

1) Hypernatremia, Hypokalemia, Metabolic Alkalosis
2) Secreted (in order to increase the pH), reabsorbed
3) ^**
4) Secreted, Reabsorbed, acidosis
5) ^**

Question 17

Low volume, high concentrated urine can be due to ___ ADH and this is seen in SIADH and Dehydration

High volume and dilute urine can be due to ___ ADH and this is seen in Diabetes Insipidus and Volume expansion

Answer 17

High

Low

Question 18

If the Plasma Osmolarity is LOW

1) Urine Osmo/Plasma Osmo is greater than 1, its ____
2) Urine Osmo/Plasma Osmo is less than 1, it’s ____

If the Plasma Osmolarity is HIGH

3) Urine Osmo/Plasma Osmo is greater than 1, its ____
4) Urine Osmo/Plasma Osmo is less than 1, it’s ____

**** If Uosm > Posm, Ch20 is - and that means pure water is being retained

Answer 18

1) SIADH
2) Primary Polydipsia
3) Dehydration
4) Neuro (Central) Diabetes Insipidus

Question 19

A patient with acidemia aka to much H+ in blood, will have ___ free plasma Ca2+ (aka hypercalcemia)since it gets displaced on the plasma proteins and a patient with Alkalemia, who has low H+ levels in the blood, will have a ____ free plasma Ca2+ concentration (aka hypocalcemia)

A patient with acidosis will also have ____kalemia and ____natremia since K+ and Na+ are exchanged for H+ and the opposite is occurring for alkalosis

Answer 19

Increased, decreased

Hyperkalemia and Hypernatremia

Question 20

If a patient is hypOventillating, then that means less fresh air is reaching the alveoli and instead of fresh air, now you get CO2 accumulating in the alveoli sacs, and this eventually decreases the gradient of CO2 diffusion and eventually CO2 stops diffusing out of the blood into the capillaries, leading to INCREASED blood CO2… So in other words, hypOventilation = ____ PaCO2… Now that there is more PaCO2 in the blood, which shifts the equation to the RIGHT, causing an ____ in H+ concentrations leading to ACIDOSIS (aka decreased pH)…. So now we know that the patient has RESPIRATORY ACIDOSIS, and in order to compensate, the kidneys REABSORB more ____ in order to balance out the pH levels

If the patient is hypERventillating, then that means you are blowing off a lot of CO2, and there is increased diffusion at the alveoli causing a DECREASED amount of CO2 in the blood, and therefore the equation shifts to the left, meaning a decreased H+ concentration aka increased pH and in order to compensate, the body is going to SECRETE more HCO3-

In metabolic acidosis, there is to little HCO3- causing the equation to shift to the RIGHT and in order to compensate for this decreased bicarb and therefore acidic environment (aka decreased pH) you would want to ____ventilate in order to blow off CO2

In metabolic alkalosis, you have increased HCO3- and therefore a left shifted equation, so you want to ____ventilate in order to compensate

Normal Ph is ___, Normal HCO3 is ___ and Normal PCO2 is ____

Answer 20

Increased, increase, HCO3-

HYPERventilate

HYPOventilate

7.4, 24, 40

Question 21

The anion gap is used for ____ and is calculated via ___ and the normal range is 8-11 mEq/l

If high, that means the HCO3- is replaced by an unmeasures anion (like lactate, ketoacidosis, poisining, etc…)

^** MUDPILES

Answer 21

Metabolic acidosis, Na - Cl + HCO3