Professional Documents
Culture Documents
Q0001:In a ventricular pacemaker cell; what phase of the action potential is affected by NE?
Phase 4; NE increases the slope of the prepotential; allowing threshold to be reached sooner; and increases the rate of firing.
Physiologic dead space is the total dead space of the respiratory system.
Q0003:What three organs are necessary for the production of vitamin D3(cholecalciferol)?
LH has no effect on the production of adrenal androgens; ACTH stimulates adrenal androgen production.
1. CHF ;2. Vena caval obstruction or constriction ;3. Hepatic cirrhosis ;4. Renal artery stenosis
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1. Inhibin ;2. Estradiol (E2) ;3. Androgen-binding protein ;4. Meiosis inhibiting factor (in fetal tissue) ;5. Antimullerian hormone
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Q0007:What is the term for the negative resting membrane potential moving toward threshold?
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Right vagus innervates the SA node and the left vagus innervates the AV node
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Q0009:How does ventricular repolarization take place; base to apex or vice versa?
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Q0010:What is the term for any region of the respiratory system that is incapable of gas exchange?
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Anatomical dead space; which ends at the level of the terminal bronchioles.
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Q0011:What four factors shift the Hgb-O2 dissociation curve to the right? What is the consequence of this shift?
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Increased CO2; H+; temperature; and 2; 3-BPG levels all shift the curve to the right; thereby making the O2 easier to remove (decreased affinity) from the Hgb molecule.
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Q0012:What two factors result in the apex of the lung being hypoperfused?
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Decreased pulmonary arterial pressure (low perfusion) and less-distensible vessels (high resistance) result in decreased blood flow at the apex.
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1:1. Remember; the flow through the pulmonary circuit and the systemic circuit are equal.
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Q0014:To differentiate central from nephrogenic diabetes insipidus; after an injection of ADH; which will show a decreased urine flow?
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Duodenum
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Q0016:What wave is the cause of the following venous pulse deflections?;? The rise in right atrial pressure secondary to blood filling and terminating when the tricuspid valves opens
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V wave
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Q0017:What wave is the cause of the following venous pulse deflections?;? The bulging of the tricuspid valve into the right atrium
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C wave
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Q0018:What wave is the cause of the following venous pulse deflections?;? The contraction of the right atrium
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A wave
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1. Provide antibacterial action ;2. Lubricate ;3. Begin CHO digestion ;4. Begin fat digestion
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Q0020:When a person goes from supine to standing; what happens to the following?;? Dependent venous pressure
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Increases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
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Q0021:When a person goes from supine to standing; what happens to the following?;? Dependent venous blood volume
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Increases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
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Q0022:When a person goes from supine to standing; what happens to the following?;? Cardiac output
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Decreases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate.
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Q0023:When a person goes from supine to standing; what happens to the following?;? BP
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Decreases;Remember; the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate;;-------------------------------------------------------------------------------
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Q0024:When does the hydrostatic pressure in Bowman's capsule play a role in opposing filtration?
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It normally does not play a role in filtration but becomes important when there is an obstruction downstream.
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Q0025:What happens to intrapleural pressure when the diaphragm is ontracted during inspiration?
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Q0027:If the pH is low with increased CO2 levels and decreased HCO3- levels; what is the acid-base disturbance?
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Q0028:What is the term that refers to the number of channels open in a cell membrane?
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Q0029:What are the five tissues in which glucose uptake is insulin independent?
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1. CNS ;2. Renal tubules ;3. Beta Islet cells of the pancreas ;4. RBCs ;5. GI mucosa
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Q0030:Place in order from fastest to slowest the rate of gastric emptying for CHO; fat; liquids; and proteins.
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Q0031:Is most of the coronary artery blood flow during systole or diastole?
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Diastole. During systole the left ventricle contracts; resulting in intramyocardial vessel compression and therefore very little blood flow in the coronary circulation.
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Q0032:What modified smooth muscle cells of the kidney monitor BP in the afferent arteriole?
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The JG cells
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1. Increase compliance ;2. Decrease surface tension ;3. Decrease probability of pulmonary edema formation
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Q0034:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenolytic; gluconeogenic; lipolytic; glycolytic; and stimulated by hypoglycemia
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Epinephrine
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Q0035:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenolytic; gluconeogenic; lipolytic; glycolytic; proteolytic; and stimulated by hypoglycemia and AAs
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Glucagon
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Q0036:Name the hormoneglucagon; insulin; or epinephrine;? Glycogenic; gluconeogenic; lipogenic; proteogenic; glycolytic; and stimulated by hyperglycemia; AAs; fatty acids; ketosis; ACh; GH; and Beta-agonist
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Insulin
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Q0037:Is the hydrophobic or hydrophilic end of the phospholipids of the cell membrane facing the aqueous environment?
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Hydrophilic (water-soluble) end faces the aqueous environment and the hydrophobic (water-insoluble) end faces the interior of the cell.
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Q0038:What type of muscle is characterized by no myoglobin; anaerobic glycolysis; high ATPase activity; and large muscle mass?
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Dihydrotestosterone
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Q0041:With a decrease in arterial diastolic pressure; what happens to;? Stroke volume?
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Decreases
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Decreases
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Q0043:With a decrease in arterial diastolic pressure; what happens to;? Heart rate?
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Decreases
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Q0044:What linkage of complex CHOs does pancreatic amylase hydrolyze? What three complexes are formed?
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Amylase hydrolyzes alpha-1; 4-glucoside linkages; forming alpha-limit dextrins; maltotriose; and maltose.
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Heart rate determines the diastolic interval; and contractility determines the systolic interval.
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Q0046:On a graphical representation of filtration; reabsorption; and excretion; when does glucose first appear in the urine?
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At the beginning of splay is when the renal threshold for glucose occurs and the excess begins to spill over into the urine.
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Q0047:What is the relationship between preload and the passive tension in a muscle?
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They are directly related; the greater the preload; the greater the passive tension in the muscle and the greater the prestretch of a sarcomere.
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Q0048:What is the rate-limiting step in the synthetic pathway of NE at the adrenergic nerve terminal?
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Q0049:How many days prior to ovulation does LH surge occur in the menstrual cycle?
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Q0050:How are flow through the loop of Henle and concentration of urine related?
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As flow increases; the urine becomes more dilute because of decreased time for H2O reabsorption.
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60%
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Q0052:How do elevated blood glucose levels decrease GH secretion? (Hint: what inhibitory hypothalamic hormone is stimulated by IGF-1?)
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Somatotrophins are stimulated by IGF-1; and they inhibit GH secretion. GHRH stimulates GH secretion.
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Q0053:What segment of the nephron has the highest concentration of inulin? Lowest concentration of inulin?
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Terminal collecting duct has the highest concentration and Bowman's capsule has the lowest concentration of inulin.
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Q0054:What type of resistance system; high or low; is formed when resistors are added in a series?
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Q0055:What hormones; secreted in proportion to the size of the placenta; are an index of fetal well-being?
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hCS and serum estriol; which are produced by the fetal liver and placenta; respectively; are used as estimates of fetal wellbeing.
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Q0056:What primary acid-base disturbance is caused by an increase in alveolar ventilation (decreasing CO2 levels) resulting in the reaction shifting to the left and decreasing both H+ and HCO3- levels?
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Respiratory alkalosis (summary: low CO2; low H+; slightly low HCO3-)
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Q0057:What respiratory center in the caudal pons is the center for rhythm promoting prolonged inspirations?
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Q0058:What area of the GI tract has the highest activity of brush border enzymes?
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Jejunum (upper)
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Q0059:What is the term to describe the increased rate of secretion of adrenal androgens at the onset of puberty?
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Adrenarche
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Q0060:What period is described when a larger-than-normal stimulus is needed to produce an action potential?
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T3 has a greater affinity for the nuclear receptor and therefore is considered the active form.
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1. Lowers surface tension; so it decreases recoil and increases compliance ;2. Reduces capillary filtration ;3. Promotes stability in small alveoli by lowering surface tension
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Q0063:What is the only important physiological signal regulating the release of PTH?
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Q0064:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH decreased; Ca2+ increased; Pi increased
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Q0065:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH increased; Ca2+ decreased; Pi decreased
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Q0066:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH decreased; Ca2+ decreased; Pi increased
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Primary hypoparathyroidism
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Q0067:What endocrine abnormality is characterized by the following changes in PTH; Ca2+; and inorganic phosphate (Pi)? ;? PTH increased; Ca2+ increased; Pi decreased
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Primary hyperparathyroidism
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Q0068:What is the amount in liters and percent body weight for the following compartments? ;? ECF
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Q0069:What is the amount in liters and percent body weight for the following compartments? ;? Interstitial fluid
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Q0070:What is the amount in liters and percent body weight for the following compartments? ;? ICF
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Q0071:What is the amount in liters and percent body weight for the following compartments? ;? Vascular fluid
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Q0072:What is the amount in liters and percent body weight for the following compartments? ;? Total body water
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Q0073:What hormone is secreted by the placenta late in pregnancy; stimulates mammary growth during pregnancy; mobilizes energy stores from the mother so that the fetus can use them; and has an amino acid sequence like GH?
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Q0074:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 increased
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Graves disease (Increased T4 decreases TRH and TSH through negative feedback.)
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Q0075:What thyroid abnormality has the following?;? TRH increased; TSH decreased; T4 decreased
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Secondary hypothyroidism/pituitary (Low TSH results in low T4 and increased TRH because of lack of a negative feedback loop.)
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Q0076:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 decreased
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Tertiary hypothyroidism/hypothalamic (Low TRH causes all the rest to be decreased because of decreased stimulation.)
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Q0077:What thyroid abnormality has the following?;? TRH increased; TSH increased; T4 decreased
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Primary hypothyroidism (Low T4 has a decreased negative feedback loop; resulting in both the hypothalamus and the anterior pituitary gland to increase TRH and TSH release; respectively.)
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Q0078:What thyroid abnormality has the following?;? TRH decreased; TSH decreased; T4 increased
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Secondary hyperthyroidism (Increased TSH results in increased T4 production and increased negative feedback on to hypothalamus and decreased release of TRH.)
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Q0079:What two stress hormones are under the permissive action of cortisol?
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Q0081:What prevents the down-regulation of the receptors on the gonadotrophs of the anterior pituitary gland?
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The oncotic pressure of plasma promotes reabsorption and is directly proportional to the filtration fraction.
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Q0085:Why is the base of the lung hyperventilated when a person is standing upright?
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The alveoli at the base are small and very compliant; so there is a large change in their size and volume and therefore a high level of alveolar ventilation.
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Q0086:By removing Na+ from the renal tubule and pumping it back into the ECF compartment; what does aldosterone do to the body's acid-base stores?
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The removal of Na+ results in the renal tubule becoming negatively charged. The negative luminal charge attracts both K+ and H+ into the renal tubule and promotes HCO3- to enter the ECF and results in hypokalemic alkalosis.
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Q0087:What hormone causes contractions of smooth muscle; regulates interdigestive motility; and prepares the intestine for the next meal?
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Motilin
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Q0088:What two vessels in fetal circulation have the highest PO2 levels?
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Q0089:How many days prior to ovulation does estradiol peak in the menstrual cycle?
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C-peptide levels
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Q0091:What is the term for the total volume of air moved in and out of the respiratory system per minute?
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Increase in urinary excretion of HCO3-; shifting the reaction to the right and increasing H+
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Q0094:In the systemic circulation; what blood vessels have the largest pressure drop? Smallest pressure drop?
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Arterioles have the largest drop; whereas the vena cava has the smallest pressure drop in systemic circulation.
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IGF-1
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Decrease in surface area and increase in membrane thickness (Palv O2 > PaO2)
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1. Increased synthesis and secretion of oxytocin ;2. Increased release of PIF by the hypothalamus ;3. Inhibition of GnRH (suppressing FSH/LH) ;4. Milk secretion
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Q0098:A migrating myoelectric complex is a propulsive movement of undigested material of undigested material from the stomach to the small intestine to the colon. During a fast; what is the time interval of its repeats?
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It repeats every 90 to 120 minutes and correlates with elevated levels of motilin.
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Q0099:With an increase in arterial systolic pressure; what happens to;? Stroke volume?
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Increases
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Q0100:With an increase in arterial systolic pressure; what happens to;? Vessel compliance?
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Decreases
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Q0101:With an increase in arterial systolic pressure; what happens to;? Heart rate?
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Decreases
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Enterokinase
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Trypsin
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Trypsin
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Q0105:In a ventricular pacemaker cell; what phase of the action potential is affected by ACh?
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Phase 4; ACh hyperpolarizes the cell via increasing potassium conductance; taking longer to reach threshold and slowing the rate of firing.
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Q0107:What is the term for the summation of mechanical stimuli due to the skeletal muscle contractile unit becoming saturated with calcium?
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Tetany
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Q0108:What form of renal tubular reabsorption is characterized by low back leaks; high affinity of a substance; and easy saturation? It is surmised that the entire filtered load is reabsorbed until the carriers are saturated; and then the rest is excreted.
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Q0109:In an adrenergic nerve terminal; where is dopamine converted to NE? By what enzyme?
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Q0110:Is the clearance for a substance greater than or less than for inulin if it is freely filtered and secreted? If it is freely filtered and reabsorbed?
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Filtered and secreted: Cx > Cin (i.e; PAH). Filtered and reabsorbed: Cx < Cin (i.e; glucose); where Cx = clearance of a substance and Cin = clearance of inulin.
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Q0111:What is the term for the load on a muscle in the relaxed state?
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LH
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LVEDV and LVEDP (left ventricular end-diastolic volume and end-diastolic pressure; respectively)
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Q0114:What stage of male development is characterized by the following LH and testosterone levels?;? LH pulsatile amplitude and levels increase; with increased testosterone production.
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Puberty
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Q0115:What stage of male development is characterized by the following LH and testosterone levels?;? Both LH and testosterone levels drop and remain low.
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Childhood
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Q0116:What stage of male development is characterized by the following LH and testosterone levels?;? LH secretion drives testosterone production; with both levels paralleling each other.
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Adulthood
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Q0117:What stage of male development is characterized by the following LH and testosterone levels?;? Decreased testosterone production is accompanied by an increase in LH production.
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Aged adult
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Q0118:What primary acid-base disturbance is caused by a loss in fixed acid forcing the reaction to shift to the right; thereby increasing HCO3- levels?
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Q0119:When referring to a series circuit; what happens to resistance when a resistor is added?
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Because the chronic inhibition of dopamine (PIF) on the release of prolactin from the anterior pituitary gland is removed; thereby increasing the secretion of prolactin.
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Q0121:Why is the clearance of creatinine always slightly greater than the clearance of inulin and GFR?
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NH4+(ammonium)
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Q0123:Regarding the venous system; what happens to blood volume if there is a small change in pressure?
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Because the venous system is more compliant than the arterial vessels; small changes in pressure result in large changes in blood volume.
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In the RBC; remember; you need carbonic anhydrase for the conversion; and plasma does not have this enzyme.
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Q0126:From the fourth month of fetal life to term; what secretes the progesterone and estrogen to maintains the uterus?
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The placenta
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Calcium and ATP are required for packaged macromolecules to be extruded from the cell.
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Q0128:What is the best measure of total body vitamin D if you suspect a deficiency?
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Q0129:What hormone is required for 1; 25-dihydroxy-vitamin D (1; 25-diOH-D) to have bone resorbing effects?
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PTH
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Bone deposition increases with increased Ca2+ or PO 4concentrations; whereas resorption (breakdown) is increased when there are low levels of Ca2+ or PO4-.
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Q0131:The opening of what valve indicates the termination of isovolumetric relaxation phase of the cardiac cycle?
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Opening of the mitral valve indicates the termination of the isovolumetric relaxation phase and the beginning of the ventricular filling phase.
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Q0132:Why is there a decrease in the production in epinephrine when the anterior pituitary gland is removed?
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The enzyme phenyl ethanolamine N-methyltransferase (PNMT); used in the conversion of epinephrine; is regulated by cortisol. Removing the anterior pituitary gland decreases ACTH and therefore cortisol.
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Q0133:Name the period described by the following statement: no matter how strong a stimulus is; no further action potentials can be stimulated.
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Estrogens are 18-carbon steroids. (Removal of one carbon from an androgen produces an estrogen.)
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Q0135:True or false? The alveolar PO2 and PCO2 levels match the pulmonary end capillary blood levels.
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True. Because of intrapulmonary shunting; there is a slight decrease in PO2 and increase in PCO2 between the pulmonary end capillary blood and the systemic arterial blood.
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The main drive shifts from central chemoreceptors (CSF H+) to peripheral chemoreceptors monitoring low PO2 levels.
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Q0137:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; decrease; ICF; no change; body; no change
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Q0138:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; increase; ICF; increase; body; decrease
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Q0139:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; decrease; ICF; decrease; body: increase
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Q0140:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF: increase; ICF: no change; body: no change
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Q0141:Describe what type of fluid is either gained or lost with the following changes in body hydration for the ECF volume; ICF volume; and body osmolarity; respectively;? ECF; increase; ICF; decrease; body; increase
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ACTH
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T4; because of the greater affinity for the binding protein; T4 has a significantly (nearly fifty times) longer half-life than T3.
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The resting membrane potential of the cell is -90 mV because of the intracellular proteins.
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Q0146:If the radius of a vessel is decreased by half; what happens to the resistance?
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Q0148:What form of diabetes insipidus is due to an insufficient amount of ADH for the renal collecting ducts?
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Central/neurogenic diabetes insipidus; in the nephrogenic form there is sufficient ADH available; but the renal collecting ducts are impermeable to its actions.
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Q0149:Name the three methods of vasodilation via the sympathetic nervous system.
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1. Decrease alpha-1 activity ;2. Increase Beta-2 activity ;3. Increase ACh levels
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Q0150:What hormone is characterized by the following renal effects?;? Calcium reabsorption; phosphate excretion
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PTH
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Q0151:What hormone is characterized by the following renal effects?;? Calcium excretion; phosphate excretion
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Calcitriol
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Q0152:What hormone is characterized by the following renal effects?;? Calcium reabsorption; phosphate reabsorption
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Vitamin D3
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True. Elevated plasma levels of progesterone can raise the body temperature 0.5 to 1.0F.
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2 to 4 hours
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True; cortisol inhibits glucose uptake in most tissue; making it available for neural tissue use.
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100%; the percentage of blood flow through the pulmonary and systemic circulations are equal.
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Q0158:Name the Hgb-O2 binding site based on the following information;? Least affinity for O2; requires the highest PO 2 levels for attachment (approx. 100 mm Hg)
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Site 4
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Q0159:Name the Hgb-O2 binding site based on the following information;? Greatest affinity of the three remaining sites for attachment; requires PO2 levels of 26 mm Hg to remain attached
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Site 2
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Q0160:Name the Hgb-O2 binding site based on the following information;? Remains attached under most physiologic conditions
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Site 1
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Q0161:Name the Hgb-O2 binding site based on the following information;? Requires a PO2 level of 40 mm Hg to remain attached
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Site 3
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Q0162:Which three factors cause the release of epinephrine from the adrenal medulla?
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1. Exercise ;2. Emergencies (stress) ;3. Exposure to cold ;;(The three Es)
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Q0163:How many ATPs are hydrolyzed every time a skeletal muscle cross-bridge completes a single cycle?
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Q0164:Why would a puncture to a vein above the heart have the potential to introduce air into the vascular system?
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Venous pressure above the heart is subatmospheric; so a puncture there has the potential to introduce air into the system.
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High volume; watery solution; sympathetic stimulation results in thick; mucoid saliva.
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Duodenum
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Q0167:Why is the apex of the lung hypoventilated when a person is standing upright?
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The alveoli at the apex are almost completely inflated prior to inflation; and although they are large; they receive low levels of alveolar ventilation.
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alpha-Cells; glucagon has stimulatory effects on -cells and inhibitory effects on -cells.
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1. Competition for carrier with similar chemical substances ;2. Chemical specificity needed for transportation ;3. Zero-order saturation kinetics (Transportation is maximal when all transporters are saturated.) ;4. Rate of transportation faster than if by simple diffusion
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Secretin stimulates the pancreas to secrete a HCO3--rich solution to neutralize the acidity of the chyme entering the duodenum.
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Because RPF is markedly decreased; while GFR is only minimally diminished; this results in an increase in FF (remember FF = GFR/RPF).
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Liver (hepatocytes)
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Production of HCO3-; shifting the reaction to the left and thereby decreasing H+
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Q0175:What enzyme found in a cholinergic synapse breaks down ACh? What are the byproducts?
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Acetylcholinesterase breaks ACh into acetate and choline (which gets resorbed by the presynaptic nerve terminal).
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Q0176:What hormone; produced by Sertoli cells; if absent would result in the formation of internal female structures?
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MIF
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Q0177:What happens to the lung if the intrapleural pressure exceeds lung recoil?
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Q0179:What type of muscle contraction occurs when the muscle shortens and lifts the load placed on it?
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Isotonic contraction
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Q0180:What type of potential is characterized as being an allor-none response; propagated and not summated?
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Action potential
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Q0181:What primary acid-base disturbance is caused by a gain in fixed acid forcing the reaction to shift to the left; decreasing HCO3- and slightly increasing CO2?
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Metabolic acidosis (summary: low pH; high H+; and low HCO3-)
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The renal circulation has the smallest AV O2 (high venous PO2) difference in the body because of the overperfusion of the kidneys resulting from filtration.
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GnRH
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1. Increased tube radius ;2. Increased velocity ;3. Decreased viscosity ;4. Increased number of branches ;5. Narrowing of an orifice
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Q0187:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona glomerulosa
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Aldosterone;Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
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Q0188:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona fasciculata
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Cortisol;Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
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Q0189:What is the major hormone produced in the following areas of the adrenal cortex?;? Zona reticularis
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DHEA (androgens);Remember; from the outer cortex to the inner layer; Salt; Sugar; Sex. The adrenal cortex gets sweeter as you go deeper.
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They are inversely related. If ventilation increases; there will be a decrease in PCO2 levels and vice versa.
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Q0192:Is T3 or T4 responsible for the negative feedback loop on to the hypothalamus and anterior pituitary gland?
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T4; as long as T4 levels remain constant; TSH will be minimally effected by T3.
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Membrane depolarization is the stimulus to open these slow channels; and if they are prevented from opening; it will slow down the repolarization phase.
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Q0194:Increased urinary excretion of what substance is used to detect excess bone demineralization?
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Hydroxyproline
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Q0197:Do the PO2 peripheral chemoreceptors of the carotid body contribute to the normal drive for ventilation?
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Under normal resting conditions no; but they are strongly stimulated when PO2 arterial levels decrease to 50 to 60 mm Hg; resulting in increased ventilatory drive.
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Q0198:What determines the overall force generated by the ventricular muscle during systole?
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The number of cross-bridges cycling during contraction: the greater the number; the greater the force of contraction.
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From the adrenal medulla; NE is mainly derived from the postsynaptic sympathetic neurons.
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When calcium is removed from troponin and pumped back into the SR; skeletal muscle contraction stops.
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ICF volume decreases when there is an increase in osmolarity and vice versa.
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Fructose; both glucose and galactose are actively absorbed via secondary active transport.
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Surface tension; the force to collapse the lung; is greatest at the end of inspiration.
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Q0204:What adrenal enzyme deficiency results in hypertension; hypernatremia; increased ECF volume; and decreased adrenal androgen production?
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17-alpha-Hydroxylase deficiency
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Q0205:In reference to membrane potential (Em) and equilibrium potential (Ex); which way do ions diffuse?
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Ions diffuse in the direction to bring the membrane potential toward the equilibrium potential.
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Q0206:Under normal conditions; what is the main factor that determines GFR?
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Q0207:The closure of what valve indicates the beginning of the isovolumetric relaxation phase of the cardiac cycle?
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Closure of the aortic valve indicates the termination of the ejection phase and the beginning of the isovolumetric relaxation phase of the cardiac cycle.
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Q0208:What vessels in the systemic circulation have the greatest and slowest velocity?
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The aorta has the greatest velocity and the capillaries have the slowest velocity.
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Q0209:Thin extremities; fat collection on the upper back and abdomen; hypertension; hypokalemic alkalosis; acne; hirsutism; wide purple striae; osteoporosis; hyperlipidemia; hyperglycemia with insulin resistance; and protein depletion are all characteristics of what disorder?
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Carbonic anhydrase
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Q0211:True or false? The parasympathetic nervous system has very little effect on arteriolar dilation or constriction.
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True
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Q0212:What three lung measurements must be calculated because they cannot be measured by simple spirometry?
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TLC; FRC; and RV have to be calculated. (Remember; any volume that has RV as a component has be calculated.)
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Q0213:What is the venous and arterial stretch receptors' function regarding the secretion of ADH?
425
They chronically inhibit ADH secretion; when there is a decrease in the blood volume; the stretch receptors send fewer signals; and ADH is secreted.
426
427
Granulosa cell
428
429
FSH
430
431
3 to 4 days
432
433
Subatmospheric pressure acts to expand the lung; positive pressure acts to collapse the lung.
434
Q0218:What hormone constricts afferent and efferent arterioles (efferent more so) in an effort to preserve glomerular capillary pressure as the renal blood flow decreases?
435
AT II
436
Q0219:Why is there a minimal change in BP during exercise if there is a large drop in TPR?
437
Because the large drop in TPR is accompanied by a large increase in cardiac output; resulting in a minimal change in BP.
438
439
Insulin increases total body stores of protein; fat; and CHOs. When you think insulin; you think storage.
440
441
Renshaw neuron
442
443
444
Q0223:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Percentage of original filtered volume left in the lumen
445
446
Q0224:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Percentage of Na+; Cl-; K+ left in the lumen
447
448
Q0225:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Osmolarity
449
300 mOsm/L
450
Q0226:What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron?;? Concentration of CHO; AA; ketones; peptides
451
452
453
454
455
456
457
458
459
Anemic patients have a depressed O2 content because of the reduced concentration of Hgb in the blood. As for polycythemic patients; their O2 content is increased because of the excess Hgb concentrations.
460
Q0231:What term describes the volume of plasma from which a substance is removed over time?
461
Clearance
462
Q0232:If capillary hydrostatic pressure is greater than oncotic pressure; is filtration or reabsorption promoted?
463
464
465
The chief cells of the parathyroid gland release PTH in response to hypocalcemia.
466
Q0234:At the base of the lung; what is the baseline intrapleural pressure; and what force does it exert on the alveoli?
467
Intrapleural pressure at the base is -2.5 cm H2O (more positive than the mean); resulting in a force to collapse the alveoli.
468
469
Normal thyroid hormones levels in the plasma are necessary for proper secretion of GH. Hypothyroid patients have decreased GH secretions.
470
471
Membrane depolarization is the stimulus to open these channels; which are closed in resting conditions.
472
Q0237:What hormones are produced in the median eminence region of the hypothalamus and the posterior pituitary gland?
473
None; they are the storage sites for ADH and oxytocin.
474
475
Isovolumetric contraction
476
477
alpha2-Receptors
478
479
480
481
T3 increases both heart rate and cardiac output by increasing the number of Beta-receptors and their sensitivity to catecholamines.
482
Q0242:Why will turbulence first appear in the aorta in patients with anemia?
483
Because it is the largest vessel and has the highest velocity in systemic circulation
484
Q0243:What is the origin of the polyuria if a patient is dehydrated and electrolyte depleted?
485
If the polyuria begins before the collecting ducts; the patient is dehydrated and electrolyte depleted. If the polyuria originates from the collecting ducts; the patient is dehydrated with normal electrolytes.
486
487
488
Q0245:What are the two factors that affect alveolar PCO2 levels?
489
490
491
Exogenous steroids suppress LH release and result in Leydig cell atrophy. Testosterone; produced by Leydig cells; is needed for spermatogenesis.
492
493
Semipermeable membrane; a selectively permeable membrane allows both water and small solutes to pass through its membrane.
494
495
Peroxidase; which is also needed for iodination and coupling inside the follicular cell
496
497
498
Q0250:What term is described as the prestretch on the ventricular muscle at the end of diastole?
499
500
Q0251:What peripheral chemoreceptor receives the most blood per gram of weight in the body?
501
502
503
11-Beta-Hydroxylase deficiency results in excess production of 11-deoxycorticosterone; a weak mineralocorticoid. It increases BP; Na+; and ECF volume along with production of adrenal androgens.
504
Q0253:What is the term for diffusion of water across a semipermeable or selectively permeable membrane?
505
506
507
508
509
0.2
510
511
Osteocyte
512
513
514
Q0258:What happens to the resistance of the system when a resistor is added in a series?
515
Resistance of the system increases. (Remember; when resistors are connected in a series; the total of the resistance is the sum of the individual resistances.)
516
517
Surface tension; in the alveoli; it is a force that acts to collapse the lung.
518
519
In the supraoptic nuclei of the hypothalamus; it is stored in the posterior pituitary gland.
520
521
522
523
True. In the distal colon; sweat glands; and salivary ducts; aldosterone has sodium-conserving effects.
524
Q0263:What form of hormone is described as having membrane-bound receptors that are stored in vesicles; using second messengers; and having its activity determined by free hormone levels.
525
526
Q0264:What forms of fatty acids are absorbed from the small intestine mucosa by simple diffusion?
527
528
Q0265:What is the term for the day after the LH surge in the female cycle?
529
Ovulation
530
Q0266:The opening of what valve indicates the beginning of the ejection phase of the cardiac cycle?
531
Opening of the aortic valve terminates the isovolumetric phase and begins the ejection phase of the cardiac cycle.
532
533
Nodes of Ranvier
534
Q0268:What disorder of aldosterone secretion is characterized by;? Increased total body sodium; ECF volume; plasma volume; BP; and pH; decreased potassium; renin and AT II activity; no edema?
535
536
Q0269:What disorder of aldosterone secretion is characterized by;? Decreased total body sodium; ECF volume; plasma volume; BP; and pH; increased potassium; renin; and AT II activity; no edema?
537
538
539
1. Concentration (greater concentration gradient; greater diffusion rate) ;2. Surface area (greater surface area; greater diffusion rate) ;3. Solubility (greater solubility; greater diffusion rate) ;4. Membrane thickness (thicker the membrane; slower the diffusion rate) ;;Molecular weight is clinically unimportant
540
541
8 to 25 hours
542
Q0272:What is the name of the force that develops in the wall of the lungs as they expand?
543
Lung recoil; being a force to collapse the lung; increases as the lung enlarges during inspiration.
544
545
Day 14
546
Q0274:How does sympathetic stimulation to the skin result in decreased blood flow and decreased blood volume? (Hint: what vessels are stimulated; and how?)
547
A decrease in cutaneous blood flow results from constriction of the arterioles; and decreased cutaneous blood volume results from constriction of the venous plexus.
548
549
Increase in erythropoietin and increase in 2; 3-BPG; also called 2; 3-diphosphoglycerate (2; 3-P2Gri) (increase in glycolysis)
550
Q0276:What female follicular cell is under LH stimulation and produces androgens from cholesterol?
551
Theca cell
552
553
554
555
Axon hillock
556
Q0279:If free water clearance (CH2O) is positive; what type of urine is formed? And if it is negative?
557
If positive; hypotonic urine (osmolarity <300 mOsm/L); if negative; hypertonic urine (osmolarity > 300 mOsm/L)>>
558
559
560
Q0281:What is pumped from the lumen of the ascending loop of Henle to decrease the osmolarity?
561
NaCl is removed from the lumen to dilute the fluid leaving the loop of Henle.
562
563
True. Sarcoplasmic calcium-dependent ATPase supplies the energy to terminate contraction; and therefore it is an active process.
564
565
1. Increased solubility ;2. Increased concentration gradient ;3. Decreased thickness of the membrane
566
567
CCK stimulates the pancreas to release amylase; lipase; and proteases for digestion.
568
569
570
Q0286:Is excretion greater than or less than filtration for net secretion to occur?
571
572
573
Hypokalemic metabolic alkalosis occurs from vomiting because of the loss of H+; K+; and Cl-.
574
575
Follicular phase is estrogen-dependent with increased FSH levels; while the luteal phase is progesterone-dependent.
576
Q0289:Name the lung measurement based on the following descriptions;? The amount of air that enters or leaves the lung system in a single breath
577
578
Q0290:Name the lung measurement based on the following descriptions;? The maximal volume inspired from FRC
579
Inspiratory capacity
580
Q0291:Name the lung measurement based on the following descriptions;? Additional volume that can be expired after normal expiration
581
582
Q0292:Name the lung measurement based on the following descriptions;? Maximal volume that can be expired after maximal inspiration
583
584
Q0293:Name the lung measurement based on the following descriptions;? Volume in the lungs at the end of passive expiration
585
586
Q0294:Name the lung measurement based on the following descriptions;? Additional air that can be taken in after normal inspiration
587
588
Q0295:Name the lung measurement based on the following descriptions;? Amount of air in the lungs after maximal expiration
589
590
Q0296:Name the lung measurement based on the following descriptions;? Amount of air in the lungs after maximal inspiration
591
592
Q0297:What growth factors are chondrogenic; working on the epiphyseal end plates of bone?
593
Somatomedins (IGF-1)
594
595
596
Q0299:True or false? All of the hormones in the hypothalamus and anterior pituitary gland are water soluble.
597
True
598
599
Thyroid hormones increase serum glucose levels by increasing the absorption of glucose from the small intestine.
600
Q0301:Is the bound form or free form of a lipid-soluble hormone responsible for the negative feedback activity?
601
Free form determines hormone activity and is responsible for the negative feedback loop.
602
603
604
Q0303:Are the following parameters associated with an obstructive or restrictive lung disorder: decreased FEV1; FVC; peak flow; and FEV1/FVC; increased TLC; FRC; and RV?
605
Obstructive lung disorders. The opposite changes (where you see decrease exchange it for increase and vice versa) are seen in a restrictive pattern.
606
607
Hypoventilation; which increases CO2; shifting the reaction to the right and increasing H+
608
Q0305:During puberty; what is the main drive for the increased GH secretion?
609
610
611
Subthreshold potential
612
613
614
615
Mitral valve closure indicates the termination of the ventricular filling phase and beginning of isovolumetric contraction.
616
617
618
Q0310:At the apex of the lung; what is the baseline intrapleural pressure; and what force does it exert on the alveoli?
619
Baseline apical intrapleural pressure is -10 cm H2O (more negative than the mean) resulting in a force to expand the alveoli.
620
621
True. Increased renin and AT II levels occur as a result of the decreased production of aldosterone.
622
623
1. Decrease the radius of the vessel ;2. Increase the length of the vessel ;3. Increase the viscosity ;4. Decrease the number of parallel channels
624
625
Estriol
626
Q0314:What term is an index of the effort needed to expand the lungs (i.e; overcomes recoil)?
627
628
629
630
Q0316:Using Laplace's relationship regarding wall tension; why is the wall tension in an aneurysm greater than in the surrounding normal blood vessel's wall?
631
The wall tension is greater because the aneurysm has a greater radius than the surrounding vessel.
632
633
634
635
Diffusion rate is indirectly proportional to membrane thickness and is directly proportional to membranes surface area.
636
637
ADH is secreted in response to increased plasma osmolarity and decreased blood volume.
638
Q0320:What vessels have the largest total cross-sectional area in systemic circulation?
639
Capillaries
640
Q0321:How many days before the first day of menstrual bleeding is ovulation?
641
642
643
Under resting conditions expiration is considered a passive process; therefore; no muscles are used. In the active state the abdominal muscles can be considered the major muscle of expiration.
644
645
646
647
648
Q0325:What cells of the kidney are extravascular chemoreceptors for decreased Na+; Cl-; and NaCl?
649
Macula densa
650
651
652
653
654
Q0328:What is it called when levels of sex steroids increase; LH increases; and FSH increases?
655
656
657
658
659
660
Q0331:What is the name of the regulatory protein that covers the attachment site on actin in resting skeletal muscle?
661
Tropomyosin
662
Q0332:Which way does the Hgb-O2 dissociation curve shift in patients with CO poisoning?
663
The pathologic problem with CO poisoning is that CO has 240 times as much affinity for Hgb molecule as does O2; reducing the carrying capacity and shifting the curve to the left; making it difficult to remove the CO molecule from Hgb.
664
665
Glomerular capillary pressure (increased glomerular capillary pressure; increased GFR and vice versa)
666
667
Hypoventilation results in an increase in PCO2 levels and therefore an increase in blood flow.
668
669
The parafollicular cells of the thyroid (C cells) release calcitonin in response to hypercalcemia.
670
Q0336:What is the term for the amount of blood in the ventricle after maximal contraction?
671
Residual volume
672
673
674
675
676
Q0339:The clearance of what substance is the gold standard of renal plasma flow?
677
Para-aminohippurate (PAH)
678
Q0340:What bile pigment is formed by the metabolism of bilirubin by intestinal bacteria; giving stool its brown color?
679
Stercobilin
680
681
Bronchoconstriction is associated with parasympathetic stimulation (ACh); and catecholamine stimulation is associated with bronchodilation (why epinephrine is used in emergency treatment of bronchial asthma.)
682
Q0342:What are the growth factors released from the liver called?
683
Somatomedins
684
Q0343:Regarding skeletal muscle mechanics; what is the relationship between velocity and afterload?
685
An increase in the afterload decreases velocity; they are inversely related. (V equals 1 divided by afterload.)
686
687
The ECF compartment always enlarges when there is a net gain in total body water and decreases when there is a loss of total body water. Hydration status is named in terms of the ECF compartment.
688
Q0345:What are the six substances that promote the secretion of insulin?
689
1. Glucose ;2. Amino acid (arginine) ;3. Gastrin inhibitory peptide (GIP) ;4. Glucagon ;5. beta-Agonists ;6. ACh
690
Q0346:Does O2 or CO2 have a higher driving force across the alveolar membrane?
691
O2 has a higher driving force but is only one-twenty-fourth as soluble as CO2. CO 2 has a very small partial pressure difference across the alveolar membrane (47-40 = 7 mmHg); but it is extremely soluble and therefore diffuses readily across the membrane.
692
693
Urinary 17-ketosteroids
694
695
Resistance and vessel length are proportionally related. The greater the length of the vessel; the greater the resistance is on the vessel.
696
Q0349:Is filtration greater than or less than excretion for net reabsorption to occur?
697
698
699
Hormone-sensitive lipase; which breaks down triglyceride into glycerol and free fatty acid
700
701
False
702
703
Yes; it decreases fat and muscle uptake of glucose; thereby increasing blood glucose levels.
704
Q0353:True or false? Somatic motor neurons innervate the striated muscle of the bulbospongiosus and ischiocavernous muscles and result in ejaculation of semen.
705
True
706
707
As the name indicates; there is no change in volume but there is an increase in pressure.
708
709
Yes; they stimulate the growth of mammary tissue but block milk synthesis. At parturition; the decrease in estrogen lifts the block on milk production.
710
Q0356:What two factors lead to the development of the bends (caisson disease)?
711
Breathing high-pressure nitrogen over a long time and sudden decompression result in the bends.
712
Q0357:In what type of circuit is the total resistance always less than that of the individual resistors?
713
Parallel circuit
714
715
Luteal phase
716
Q0359:What happens to total and alveolar ventilation with;? Increased rate of breathing?
717
With an increased rate of breathing the total ventilation is greater than the alveolar ventilation. Rapid; shallow breathing increases dead space ventilation with little change in alveolar ventilation. (This is hypoventilation).
718
Q0360:What happens to total and alveolar ventilation with;? Increased depth of breathing?
719
With an increased depth of breathing both the total and alveolar ventilation increase;This concept is always tested on the boards; so remember it.
720
Q0361:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol decreased; ACTH increased
721
722
Q0362:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol increased; ACTH increased
723
724
Q0363:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol increased; ACTH decreased
725
Primary hypercortisolism
726
Q0364:What pathophysiologic disorder is characterized by the following changes in cortisol and ACTH?;? Cortisol decreased; ACTH decreased
727
728
Q0365:What happens to flow and pressure in capillaries with arteriolar dilation? Arteriolar constriction?
729
Capillary flow and pressure increase with arteriolar dilation and decrease with arteriolar constriction.
730
Q0366:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR increased ; RPF increased ; FF normal; capillary pressure increased
731
732
Q0367:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR increased ; RPF decreased ; FF increased ; capillary pressure increased
733
734
Q0368:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR decreased ; RPF increased ; FF decreased ; capillary pressure decreased
735
736
Q0369:What has occurred to the renal arterioles based on the following changes in the GFR; RPF; FF; and glomerular capillary pressure?;? GFR decreased ; RPF decreased ; FF normal; capillary pressure decreased
737
738
739
740
741
Follicular phase
742
Q0372:What determines the effective osmolarity of the ICF and the ECF compartments?
743
The concentration of plasma proteins determines effective osmolarity because capillary membranes are freely permeable to all substances except proteins.
744
Q0373:What region of the brain houses the central chemoreceptors responsible for control of ventilation?
745
746
747
Cholera toxin irreversibly activates the cAMP-dependent chloride pumps of the small and large intestine; producing a large volume of chloride-rich diarrhea.
748
Q0375:Name the phase of the ventricular muscle action potential based on the following information;? Slow channels open; allowing calcium influx; voltage-gated potassium channels closed; potassium efflux through ungated channels; plateau stage
749
Phase 2
750
Q0376:Name the phase of the ventricular muscle action potential based on the following information;? Slight repolarization secondary to potassium and closure of the sodium channels
751
Phase 1
752
Q0377:Name the phase of the ventricular muscle action potential based on the following information;? Fast channels open; then quickly close; and sodium influx results in depolarization
753
Phase 0
754
Q0378:Name the phase of the ventricular muscle action potential based on the following information;? Slow channels close; voltage-gated potassium channels reopen with a large influx of potassium; and the cell quickly repolarizes
755
Phase 3
756
Q0379:Where in the kidney are the long loops of Henle and the terminal regions of the collecting ducts?
757
758
759
Water
760
Q0381:What type of hormone is described as having intracellular receptors; being synthesized as needed; mostly bound to proteins; and having its activity determined by free hormone levels?
761
762
Q0382:What are the three stimuli that result in the reninangiotensin-aldosterone secretion?
763
1. Low pressure in the afferent renal arteriole ;2. Low sodium sensed by the macula densa ;3. Increased beta-1-sympathetic stimulation of the JG cells
764
765
The p50 value does not change in either anemia or polycythemia; the main change is the carrying capacity of the blood.
766
Q0384:What hormone level peaks 1 day before the surge of LH and FSH in the female cycle?
767
Estradiol
768
769
770
Q0386:Up to how many hours post ejaculation do sperm retain their ability to fertilize the ovum?
771
Up to 72 hours; the ovum losses its ability to be fertilized 8 to 25 hours after release.
772
773
Voltage-gated channel
774
775
1. Increased glucose uptake by fat cells ;2. Increased triglyceride uptake by fat cells ;3. Increased conversion of CHOs into fat ;4. Decreased lipolysis in fat tissue ;5. Decreased ketone body formation
776
Q0389:True or false? In a skeletal muscle fiber; the interior of the T-tubule is extracellular.
777
True. They are evaginations of the surface membranes and therefore extracellular.
778
Q0390:Under resting conditions; what is the main determinant of cerebral blood flow?
779
780
Q0391:On the venous pressure curve; what do the following waves represent?;? A wave?
781
782
Q0392:On the venous pressure curve; what do the following waves represent?;? C wave?
783
784
Q0393:On the venous pressure curve; what do the following waves represent?;? V wave?
785
786
787
788
Q0395:True or false? The blood stored in the systemic veins and the pulmonary circuit are considered part of the cardiac output.
789
False. Cardiac output refers to circulating blood volume. The blood in the systemic veins and the pulmonary circuits are storage reserves and therefore are not considered in cardiac output.
790
Q0396:What hormone disorder is characterized by the following abnormalities in sex steroidsdecreased ; LHdecreased ; and FSHdecreased ?;? Sex steroids ; LH ; FSH
791
Pituitary hypogonadism
792
Q0397:What hormone disorder is characterized by the following abnormalities in sex steroids; LH; and FSH?;? Sex steroids increased ; LH decreased ; FSH decreased ?
793
794
Q0398:What hormone disorder is characterized by the following abnormalities in sex steroidsdecreased ; LHincreased ; and FSHincreased ?;? Sex steroids ; LH ; FSH ?
795
796
797
1. Flow independent of BP ;2. Flow proportional to local metabolism ;3. Flow independent of nervous reflexes
798
Q0400:What is the fastest-conducting fiber of the heart? Slowest conduction fiber in the heart?
799
800
801
Afterload
802
Q0402:What follicular cell possesses FSH receptors and converts androgens into estradiol?
803
Granulosa cells
804
Q0403:What are the primary neurotransmitters at the following sites?;? Postganglionic sympathetic neurons
805
NE
806
Q0404:What are the primary neurotransmitters at the following sites?;? Chromaffin cells of the adrenal medulla
807
Epinephrine
808
Q0405:What are the primary neurotransmitters at the following sites?;? Brainstem cells
809
Serotonin
810
Q0406:What are the primary neurotransmitters at the following sites?;? The hypothalamus
811
Histamine
812
Q0407:What are the primary neurotransmitters at the following sites?;? All motor neurons; postganglionic parasympathetic neurons
813
ACh
814
Q0408:What are the primary neurotransmitters at the following sites?;? Autonomic preganglionic neurons
815
ACh
816
817
818
819
Acid is needed for the activation of pepsin and therefore needed for protein digestion.
820
Q0411:What is the term for the amount of blood expelled from the ventricle per beat?
821
Stroke volume
822
823
False. It does increase uterine synthesis of prostaglandins; which increase uterine contractions.
824
Q0413:Why does carbon monoxide diffusion in the lung (DLCO) decrease in emphysema and fibrosis but increase during exercise?
825
DLCO; an index of lung surface area and membrane thickness; is decreased in fibrosis because of increased membrane thickness and decreased in emphysema because of increased surface area without increase in capillary recruitment; in exercise there is an increase in surface area due to capillary recruitment.
826
827
Aromatase
828
829
Inulin
830
831
832
833
834
835
836
837
Hyperventilation; which decreases CO2; shifting the reaction to the left and decreasing H+
838
839
Viscosity and resistance are proportionally related. The greater the viscosity; the greater the resistance is on the vessel.
840
Q0421:T3 increases bone ossification through synergistic effect with what hormone?
841
GH
842
Q0422:Name the ventricular muscle membrane channel;? Closed at rest; depolarization causes channels to open slowly
843
844
845
846
Q0424:Name the ventricular muscle membrane channel;? Closed at rest; depolarization causes channels to open quickly; will not respond to a second stimulus until cell is repolarized.
847
848
Q0425:Name the ventricular muscle membrane channel;? Open at rest; depolarization is stimulus to close; begin to reopen during the plateau phase and during repolarization
849
850
851
852
853
Since CO2 is 24 times as soluble as O2; the rate at which CO2 is brought to the membrane determines its rate of exchange; making it perfusion-limited a gas. For O2 the more time it is in contact with the membrane; the more likely it will diffuse; making it diffusion-limited.
854
Q0428:What is the term for the potential difference across a cell membrane?
855
856
Q0429:What adrenal enzyme deficiency can be summed up as a mineralocorticoid deficiency; glucocorticoid deficiency; and an excess of adrenal androgens?
857
858
859
860
861
862
863
864
865
T3
866
867
Hypokalemic metabolic acidosis occurs in colonic diarrhea because of the net secretion of HCO3- and potassium into the colonic lumen.
868
Q0435:What two AAs act as excitatory transmitters in the CNS; generating EPSPs?
869
870
Q0436:What are the three mechanisms of action for atrial natriuretic peptide's diuretic and natriuretic affects?
871
1. Dilation of the afferent arteriole ;2. Constriction of the efferent arteriole ;3. Inhibition of reabsorption of sodium and water in the collecting ducts
872
Q0437:In a parallel circuit; what happens to resistance when a resistor is added in parallel
873
874
Q0438:What component of the ANS is responsible for movement of semen from the epididymis to the ejaculatory ducts?
875
876
877
O2 affinity increases with a decrease in the p50; making O2 more difficult to remove from the Hgb molecule.
878
Q0440:If the ratio of a substance's filtrate and plasma concentrations are equal; what is that substance's affect on the kidney?
879
If the ratio of the filtrate to plasma concentration of a substance is equal; the substance is freely filtered by the kidney.
880
Q0441:What does a loss of afferent activity from the carotid sinus onto the medulla signal?
881
A loss of afferent activity indicates a decrease in BP; and an increase in afferent activity indicates an increase in BP.
882
883
884
Q0443:True or false? Menstruation is an active process due to increased gonadal sex hormones?
885
886
887
Relaxation of the diaphragm increases the intrapleural pressure (becomes more positive).
888
Q0445:What component of the renin-angiotensin-aldosterone axis increases sodium reabsorption in the proximal convoluted tubules and increases thirst drive?
889
AT II
890
Q0446:What large-diameter vessel has the smallest crosssectional area in systemic circulation?
891
The aorta
892
Q0447:Excess bone demineralization and remodeling can be detected by checking urine levels of what substance?
893
894
895
No change in length
896
897
Shortens
898
899
Shortens
900
901
Shortens
902
Q0452:What happens to the following during skeletal muscle contraction?;? Actin and myosin lengths
903
No change in length
904
905
1. Increased amino acid uptake by muscles ;2. Decreased protein breakdown ;3. Increased protein synthesis
906
Q0454:What is the main mechanism for exchange of nutrients and gases across a capillary membrane?
907
908
909
Onset of bleeding
910
Q0456:Name the muscle type based on the histological features;? Actin and myosin in sarcomeres; striated; uninuclear; gap junctions; troponin:calcium binding complex; T tubules and SR forming dyadic contacts; voltage-gated calcium channels
911
Cardiac muscle
912
Q0457:Name the muscle type based on the histological features;? Actin and myosin in sarcomeres; striated; multinuclear; lacks gap junctions; troponin:calcium binding; T tubules and SR forming triadic contacts; highest ATPase activity; no calcium channels
913
Skeletal muscle
914
Q0458:Name the muscle type based on the histological features;? Actin and myosin not in sarcomeres; nonstriated; uninuclear; gap junctions; calmodulin:calcium binding; lacks T tubules; voltage-gated calcium channels
915
Smooth muscle
916
Q0459:Name the valve abnormality based on the following criteria;? Back-filling into the left atrium during systole; increased v-wave; preload; left atrial volume; and left ventricular filling
917
Mitral insufficiency
918
Q0460:Name the valve abnormality based on the following criteria;? Systolic murmur; increased preload and afterload; decreased aortic pulse pressure and coronary blood flow
919
Aortic stenosis
920
Q0461:Name the valve abnormality based on the following criteria;? Diastolic murmur; increased right ventricular pressure; left atrial pressure; and atrial to ventricular pressure gradient; decreased left ventricular filling pressure
921
Mitral stenosis
922
Q0462:Name the valve abnormality based on the following criteria;? Diastolic murmur; increased preload; stroke volume; and aortic pulse pressure; decreased coronary blood flow; no incisura; and peripheral vasodilation
923
Aortic insufficiency
924
Q0463:Circulating levels of what hormone cause the cervical mucus to be thin and watery; allowing sperm an easier entry into the uterus?
925
Estrogen
926
Q0464:What hormone controls relaxation of the lower esophageal sphincter during swallowing?
927
VIP is an inhibitory parasympathetic neurotransmitter that results in relaxation of the lower esophageal sphincter.
928
Q0465:What is the term for the difference between systolic and diastolic pressures?
929
Pulse pressure
930
Q0466:What hormone; produced by the Sertoli cells; is responsible for keeping testosterone levels in the seminiferous tubules nearly 50 times that of the serum?
931
Androgen-binding protein
932
933
True
934
935
Osteoblasts; which in turn stimulate osteoclasts to break down bone; releasing Ca2+ into the interstitium. (Remember; blasts make; clasts take.)
936
937
938
939
Increasing blood flow is the only way to increase O2 delivery in the coronary circulation because extraction is nearly maximal during resting conditions.
940
Q0471:What is the term for the load a muscle is trying to move during stimulation?
941
Afterload
942
943
Menses
944
Q0473:What is the term for the force the ventricular muscle must generate to expel the blood into the aorta?
945
Afterload
946
Q0474:What happens to the tonicity of the urine with increased ADH secretion?
947
The urine becomes hypertonic because of water reabsorption in the collecting duct.
948
Q0475:What form of renal tubular reabsorption is characterized by high back leak; low affinity for substance; and absence of saturation and is surmised to be a constant percentage of a reabsorbed filtered substance?
949
Gradient-time system
950
Q0476:What type of circuit is described when the total resistance is always greater than the sums of the individual resistors?
951
Series circuit
952
Q0477:What hormone excess brings about abnormal glucose tolerance testing; impaired cardiac function; decreased body fat; increased body protein; prognathism; coarse facial features; and enlargements of the hands and feet?
953
954
955
The V/Q ratio increases; since the area is ventilated but hypoperfused as a result of the occlusion.
956
Q0479:What hormone has the following effects: chondrogenic in the epiphyseal end plates of bones; increases AA transport for protein synthesis; increases hydroxyproline (collagen); and increases chondroitin sulfate synthesis?
957
GH; especially IGF-1. GH also increases the incorporation of thymidine in DNA synthesis and uridine in RNA synthesis.
958
Q0480:True or false? Bile pigments and bile salts are reabsorbed in the gallbladder.
959
False
960
Q0481:What component of an ECG is associated with the following?;? Conduction delay in the AV node
961
PR interval
962
963
QRS complex
964
965
P wave
966
967
T wave
968
969
Renal circulation
970
Q0486:Near the end of pregnancy; what hormone's receptors increase in the myometrium because of elevated plasma estrogen levels?
971
Oxytocin
972
Q0487:What respiratory center in the rostral pons has an inhibitory affect on the apneustic center?
973
974
975
LH
976
Q0489:What primary acid-base disturbance is cause by a decrease in alveolar ventilation (increasing CO2 levels) resulting in the reaction shifting to the right and increasing H+ and HCO3- levels?
977
Respiratory acidosis (summary: high CO2; high H+; slightly high HCO3-)
978
979
2.0 or greater
980
Q0491:What is the term for the negative resting membrane potential becoming more negative?
981
982
Q0492:What type of resistance system (i.e; high or low) is formed when resistors are added in parallel?
983
984
985
986
987
988
989
Coronary circulation
990
991
992
Q0497:In the water deprivation test; does a patient with reduced urine flow have primary polydipsia or diabetes insipidus?
993
Primary polydipsia; patients with diabetes insipidus will continue to produce large volumes of dilute urine.
994
Q0498:True or false? There is an inverse relationship between fat content and total body water.
995
True; the greater the fat; the less the total body water.
996
Q0499:What is the role of the negative charge on the filtering membrane of the glomerular capillaries?
997
998
Q0500:What cardiac reflex is characterized by stretch receptors in the right atrium; afferent and efferent limbs via the vagus nerve; and increased stretch leading to an increase in heart rate via inhibition of parasympathetic stimulation?
999
Bainbridge reflex
1000
Q0501:Where in the GI tract does the reabsorption of bile salts take place?
1001
1002
1003
1. Plicae circularis (3 times) ;2. Villi (30 times) ;3. Microvilli (600 times)
1004
Q0503:Does physiologic splitting of the first heart sound occur during inspiration or expiration? Why?
1005
Splitting of the first heart sound occurs during inspiration because of the increased output of the right ventricle; delaying the closure of the pulmonic valve.
1006
Q0504:How much dietary iodine is necessary to maintain normal thyroid hormone secretion?
1007
150 mcg/day is the minimal daily intake needed. Most people ingest 500 mcg/day.
1008
1009
CSF H+ levels; with acidosis being the main central drive; resulting in hyperventilation (the opposite being true with alkalosis)
1010
Q0506:What result occurs because of the negative alveolar pressure generated during inspiration?
1011
1012
1013
1014
Q0508:What happens to free hormone levels when the liver decreases production and release of binding proteins?
1015
Free hormone levels remain constant; and the bound hormone level changes with a decrease in binding hormones.
1016
1017
Estrone
1018
Q0510:What changes does more negative intrathoracic pressure cause to systemic venous return and to the pulmonary vessels?
1019
Promotes systemic venous return into the chest and increases the caliber and volume of the pulmonary vessels
1020
1021
1022
Q0512:True or false? Right-sided valves close before the valves on the left side of the heart.
1023
False. Right-sided valves are the first to open and last to close.
1024
1025
Alkaline phosphatase
1026
Q0514:What is the order of attachment of O2 to Hgb-binding sites in the lung? Order of release from the binding sites in the tissue?
1027
1028
Q0515:What hormone is secreted into the plasma in response to a meal rich in protein or CHO?
1029
Insulin
1030
Q0516:What happens to blood flow and pressure downstream with local arteriolar constriction?
1031
With arteriolar constriction both the flow and pressure downstream decrease.
1032
Q0517:What occurs when the lower esophageal sphincter fails to relax during swallowing due to abnormalities of the enteric nervous plexus?
1033
Achalasia
1034
1035
1036
Q0519:What component of the ANS is responsible for dilation of the blood vessels in the erectile tissue of the penis; resulting in an erection?
1037
1038
Q0520:What muscle type is characterized by low ATPase activity; aerobic metabolism; myoglobin; association with endurance; and small muscle mass?
1039
Red muscle
1040
Q0521:What happens to diastolic and systolic intervals with an increase in sympathetic activity?
1041
Systolic interval decreases secondary to increased contractility; diastolic interval decreases secondary to an increase in heart rate.
1042
Q0522:Circulating levels of what hormone in men is responsible for the negative feedback loop to the hypothalamus and the anterior pituitary gland regulating the release of LH?
1043
Testosterone
1044
1045
They are inversely proportional to each other; as pulse pressure increases; compliance decreases.
1046
1047
1048
Q0525:What two factors result in the base of the lung being hyperperfused?
1049
Increased pulmonary arterial pressure (high perfusion) and more distensible vessels (low resistance) result in increased blood flow at the base.
1050
Q0526:True or false? Without ADH the collecting duct would be impermeable to water.
1051
1052
Q0527:How does ventricular depolarization take place; base to apex or vice versa?
1053
1054
1055
PTH increases Ca2+ reabsorption in the DCT of the kidney and decreases PO4- reabsorption in the PCT.
1056
1057
1058
Q0530:Insulin-induced hypoglycemia is the most reliable (by far not the safest) test for what hormone deficiency?
1059
GH deficiency
1060
1061
1062
1063
Macula densa
1064
Q0533:If the AV difference is positive; is the substance extracted or produced by the organ?
1065
A positive AV difference indicates that a substance is extracted by the organ; and a negative difference indicates that it is produced by the organ.
1066
Q0534:What is used as an index of the number of functioning carriers for a substance in active reabsorption in the kidney?
1067
Transport maximum (Tm) occurs when all function carriers are saturated and therefore is an index of the number of functioning carriers.
1068
Q0535:Why is there a transcellular shift in K+ levels in a diabetic patient who becomes acidotic?
1069
The increased H+ moves intracellularly and is buffered by K+ leaving the cells; resulting in intracellular depletion and serum excess. (Intracellular hypokalemia is the reason you supplement potassium in diabetic ketoacidosis; even though the serum levels are elevated.)
1070
Q0536:True or false? Catechol-O-methyl transferase (COMT) is not found in smooth muscle; liver; and the kidneys.
1071
False. That is precisely where COMT is found; it is not found in adrenergic nerve terminals.
1072
1073
IGF-1 (somatomedin C)
1074
Q0538:What receptor is in the smooth muscle cells of the small bronchi; is stimulated during inflation; and inhibits inspiration?
1075
1076
Q0539:True or false? Thyroid hormones are necessary for normal menstrual cycles.
1077
1078
Q0540:What component of the cardiovascular system has the largest blood volume? Second largest blood volume?
1079
The systemic veins have the largest blood volume; and the pulmonary veins have the second largest blood volume in the cardiovascular system. They represent the reservoirs of circulation.
1080
1081
Creatinine
1082
1083
1084
1085
1086
Q0544:How does cell diameter affect the conduction velocity of an action potential?
1087
The greater the cell diameter; the greater the conduction velocity.
1088
Q0545:in a ventricular pacemaker cell; what phase of the action potential is effected by NE
1089
phase 4
1090
1091
1092
Q0547:what three organs are necessary for the production of vitamin D3 (cholecalciferol)
1093
skin;liver;kidney
1094
1095
1096
1097
1098
1099
1100
1101
Right vagus innervates SA node (*need the right nerve to control the important node*);Left vagus innervates AV node
1102
Q0552:how does ventricular repolarization take place; base to apex or vice versa
1103
1104
Q0553:what is the term for any region of the respiratory system that is incapable of gas exchange
1105
1106
1107
1108
Q0555:what two factors result in the apex of the lung being hypoperfused
1109
1110
1111
1:01
1112
Q0557:to differentiate central from nephrogenic diabetes insipidus; after an injection of ADH; which will show decreased urine flow
1113
central
1114
1115
duodenum
1116
Q0559:what wave is the cause of the following venous pulse deflection: rise in right atrial pressure secondary to blood filling and terminating when the tricuspid valve opens?;the bulging of the tricuspid valve into the right atrium?;the contraction of the right atrium?
1117
1118
1119
1120
1121
inc;inc;dec;dec;**carotid sinus reflex attempts to COMPENSATE by increasing TPR and heart rate
1122
Q0562:when does the hydrostatic pressure in Bowman's capsule play a role in opposing filtration
1123
1124
Q0563:what happens to intrapleural pressure when the diaphragm is contracted during inspiration
1125
1126
1127
1128
1129
1130
Q0566:if the pH is low with increased CO2 levels and decreased HCO3 levels; what is the acid-base disturbance
1131
1132
Q0567:what is the term that refers to the number of channels open in a cell membrane
1133
conductance
1134
Q0568:what are the five tissues in which glucose uptake is insulin dependent
1135
1136
Q0569:place in order from fastest to slowest the rate of gastric emptying for CHO; fat; liquids; proteins
1137
liquids;CHO;protein;fat
1138
Q0570:is most of the coronary artery blood flow during systole or diastole
1139
diastole
1140
Q0571:what modified smooth muscle cell of the kidney monitors BP in the afferent arteriole
1141
juxtaglomerular cells
1142
1143
1144
1145
epi
1146
1147
glucagon
1148
Q0575:glycogenic;gluconeogenic;lipogenic;proteogenic;glycoly tic;and stimulated hy hyperglycemia; aa's; fatty acids; ketosis; ACh; GH; and beta agonists
1149
insulin
1150
Q0576:what type of muscle is characterized by no myoglobin; anaerobic glycolysis; high ATPase activity; and large muscle mass
1151
1152
Q0577:what percentage of CO2 is carried in the plasma as HCO3?;as carbamino compounds?;as dissolved CO2?
1153
90%;5%;5%
1154
1155
dihydrotestosterone
1156
Q0579:with a decreased arterial diastolic pressure; what happens to stroke volume?;TPR?;heart rate?
1157
all decrease
1158
Q0580:what linkage of complex CHOs does pancreatic amylase hydrolyze? What three complexes are formed?
1159
1160
1161
1162
Q0582:on a graphical representation of filtration; reabsorption; and excretion; when does glucose first appear in urine
1163
1164
1165
direct;the greater the preload; the greater the passive tension and the greater the prestretch of a sarcomere
1166
Q0584:what is the rate-limiting step in the synthetic pathway of NE at the adrenergic nerve terminal
1167
1168
1169
1 day prior
1170
Q0586:how are flow through the loop of Henle and concentration of urine related
1171
as flow increases; the urine becomes more dilute because of decreased time for H2O reabsorption
1172
1173
60%
1174
1175
somatotrophins are stimulated by IGF-1 and they inhibit GH secretion;GHRH stimulates GH secretion
1176
Q0589:what segment of the nephron has the highest concentration of inulin?;lowest conc?
1177
1178
Q0590:what type of resistance system; high or low; is formed when resistors are added in series
1179
high
1180
Q0591:what hormones; secreted in proportion to the size of the placenta; are an index of fetal well being
1181
hCS and serum estriol; which are produced by the fetal liver and placenta; respectively; are used as estimates of FETAL well being
1182
Q0592:what primary acid-base disturbance is caused by an increase in alveoloar ventilation (decreasing CO2 levels) resulting in the reaction shifting to the left and decreasing both the H and HCO3 levels
1183
1184
Q0593:what respiratory center in the caudal pons is the center for rhythm promoting prolonged inspirations
1185
1186
Q0594:what area of the GI tract has the highest activity of brush border enzymes
1187
jejunum
1188
1189
T3
1190
1191
1192
Q0597:1. PTH dec; Ca inc; Pi inc;2. PTH inc; Ca dec; Pi dec;3. PTH dec; Ca dec; Pi inc;4. PTH inc; Ca inc; Pi dec
1193
1194
Q0598:1. TRH dec; TSH dec; T4 inc;2. TRH inc; TSH dec; T4 dec;3. TRH dec; TSH dec; T4 dec;4. TRH inc; TSH inc; T4 dec;5. TRH dec; TSH inc; T4 inc
1195
1. graves;2. secondary hypo (pituitary);3. tertiary hypo (hypothalamic);4. primary hypo;5. secondary hyper
1196
Q0599:what two stress hormones are under the permissive action of cortisol
1197
1198
1199
dec 1/16
1200
Q0601:what preventgs the down regulation of the recptors on the gonadotrophos of the anterior pituitary
1201
1202
1203
1204
1205
cortisol
1206
1207
reabsorption
1208
Q0605:why is the baes of the lung hyperventialted when a person is standing upright
1209
alveoli are small and very compliant; so there is a large change in their size and volume and therefore a high level of alveolar ventilation
1210
Q0606:by removing Na from the renal tubule and pumping it back into the ECF compartment; what does aldosterone do to the body's acid base stores
1211
removal of Na creates a net negative charge in the renal tubule -> promotes entry of K and H and promotes HCO3 to go to plasma -> produces hypokalemic alkalosis
1212
Q0607:what hormone causes contraction of smooth mucle; regulates interdigestive motility; and prepares intestine for next meal
1213
motilin
1214
Q0608:what two vessels in fetal circulatin have the highest PO2 levles
1215
1216
Q0609:how many days prior to ovulation does estradiol peak in the menstrual cycle
1217
2 days prior
1218
1219
C-peptide
1220
Q0611:what is the term for the total volume of air moved in and out of the respiratry system per minute
1221
1222
1223
1224
1225
1226
Q0614:in the systemic circulation; what blood vessels have the largest pressure drop?;smallest pressure drop?
1227
arterioles;vena cava
1228
1229
IGF-1
1230
1231
1232
1233
increased synthesis and secretion of oxytocin;increased release of PIF from hypothalamus;inhibition of GnRH;milk secretion
1234
Q0618:a MMC is a propulsive mov't of undigested material from the stomach to the small intestine; to the colon. during a fast; what is the time interval of its repeats
1235
1236
1237
inc;dec;dec
1238
1239
enterokinase;trypsin;trypsin
1240
Q0621:in a ventricular pacemaker cell; what phase of the action potential is affected by ACh
1241
phase 4
1242
1243
1244
Q0623:what is the term for the summation of mechanical stimuli due to the skeletal muscle contractile unit becoming saturated with calcium
1245
tetany
1246
Q0624:what form of renal tubular reabsorption is characterized by low back leaks; high affinity of a substance; and easy saturation? It is surmised that the entire filtered load is reabsorbed until the carriers are saturated; and then the rest is excreted
1247
1248
1249
1250
Q0626:is the clearance for a substance greater than or less than for inulin if it is freely filtered and secreted? if it is freely filtered and reabsorbed?
1251
1252
Q0627:what is the term for the load on a muscle in the relaxed state
1253
1254
1255
1256
Q0629:in males..;1. LH pulsatile amplitude and levels increase; with increased testosterone?;2. both LH and testosterone levels drop and remain low?;3. LH secretion drives testosterone production; with both paralleling eachother?;4. decreased testosterone and increased LH?
1257
1258
Q0630:why is the clearance of creatinine always slightly greater than the clearance of inulin and GFR?
1259
1260
Q0631:what primary acid-base disturbace is caused by a loss in fixed acid forcing the reaction to shift to the left; thereby increasing HCO3 levels
1261
1262
Q0632:when referring to a series circuit; what happens to resistance when a resistor is added
1263
increases
1264
1265
the chronic inhibition of dopamine (PIF) on the release of prolactin from the anterior pituitary gland is removed; thereby increasing the release of prolactin
1266
1267
NH4
1268
Q0635:regarding the venous system; what happens to blood volume if there is a small change in pressure
1269
venous system is more compliant -> small changes in pressure result in large changes in blood volume
1270
1271
3 and 4
1272
1273
RBC
1274
Q0638:from the fourth month of fetal life to term; what secretes the progesterone and estrogen to maintain the uterus
1275
placenta
1276
1277
Ca and ATP
1278
Q0640:what is the best measure of total body vitamin D if you suspect a deficiency
1279
serum 25-OH-D
1280
1281
PTH
1282
1283
deposition
1284
Q0643:the opening of what valve indicates the terminatino of isovolumetric relaxation of the cardiac cycle
1285
mitral valve
1286
Q0644:why is there a decrease in the production in epi when the anterior pituitary gland is removed
1287
PNMT used in the conversion of epi; is regulated by cortisol; removing the anterior pituitary gland decreases ACTH and therefor cortisol
1288
Q0645:name the period described by the following: no matter how strong a stimulus; no further action potentials can be stimulated
1289
1290
1291
1292
Q0647:T or F? the alveolar PO2 and PCO2 levels match the pumonary end capillary blood levels
1293
true- because of intrapulmonary shunting; there is a slight decrease in PO2 and increase in PCO2 between the pulmonary end capillary blood and the systemic arterial blood
1294
1295
1296
Q0649:1. ECF dec; ICF no change; body no change;2. ECF inc; ICF inc; body dec;3. ECF dec; ICF dec; body inc;4. ECF inc; ICF no change; body no change;5. ECF inc; ICF dec; body inc
1297
1. loss of isotonic fluid (diarrhea; hemorrhage);2. gain of hypotonic fluid (water intoxication);3. loss of hypotonic fluid (dehydration);4. gain of isotonic saline;5. gain of hypertonic fluid
1298
1299
ACTH
1300
1301
T4- because the greater affinity for the binding protein; T4 has a significantly longer half life than T3 (50x)
1302
1303
intracellular proteins
1304
1305
1306
1307
increased 16x
1308
1309
NE
1310
1311
central/neurogenic
1312
1313
1314
Q0658:1. Ca reabsorption and phosphate excretion;2. Ca excretion and phosphate excretion;3. Ca reabsortpion and phosphate reabsorption
1315
1316
1317
yes
1318
1319
2-4 hours
1320
1321
1322
1323
1324
1325
100%
1326
Q0664:HGb binding site?;1. least affinity for O2; requires highest PO2 (100);2. greatest affinity for attachment; requires PO2 of 26;3. remains attached under most conditions;4. requires a PO2 of 40
1327
1328
Q0665:which three factors cause the release of epi from adrenal medulla
1329
1330
Q0666:how many ATPs are hydrolyzed every time a skeletal muscle cross-bridge completes a single cycle
1331
one
1332
Q0667:why would a puncture to a vein above the heart have the potential to introduce air into the vascular system
1333
1334
1335
high volume;watery
1336
1337
duodenum
1338
1339
alveli at apex are almost completely inflated prior to inflation -> they receive low levels of alveolar ventilation
1340
1341
alpha;glucagon has stimulatory affects on beta cells and inhibitory effects on delta cells
1342
1343
1. comp for carrier;2. chemic specificity;3. zero-order saturation;4. rate of transportation faster than if by simple diffusion
1344
1345
1346
1347
because RPF is markedly decreased; while GFR is only; minimally dec --> inc FF (=GFR/RPF)
1348
1349
efflux of potassium
1350
1351
liver
1352
1353
1354
1355
1356
Q0679:what hormone; produced by sertoli cells; if absent would result in the formation of internal female structures
1357
MIF
1358
Q0680:what happens to the lung if the intrapleural pressure exceeds lung recoil
1359
1360
1361
1362
Q0682:what type of muscle contraction occurs when the msucle shortens and lifts the load placed on it
1363
isotonic
1364
Q0683:what type of potential is characterized as being an all or none; propagated and not summated
1365
action potential
1366
Q0684:what primary acid-base disturbace is cuased by a gain in fixed acid forcing the reaction to shift to the left; decreasing HCO3 and inc CO2
1367
1368
Q0685:pregnant woman in 3rd trimester has normal BP when standing and sitting. When supine BP drops to 90/50;what is the dx?
1369
1370
Q0686:35 y/o man has high BP in arms and lowBP in his legs;what is the dx
1371
1372
Q0687:5 y/o boy presents weith a systolic murmur and a wide fixed split S2. what is the dx
1373
ASD
1374
Q0688:During a game a young football player collapses and dies immediately. What is the most likely type of cardiac dz
1375
hypoertrophic cardiomyopathy
1376
Q0689:pt has a stroke after incurring multiple long bone fractures in trauma stemming from a MVA. What caused the infarct
1377
fat emboli
1378
Q0690:elderly woman presents with a headache and jaw pain. labs show elevated ESR. what is teh dx
1379
temporal arteritis
1380
Q0691:80 y/o man presents w/ systolic crescendodecrescendo murmur. What is the most likely cause?
1381
aortic stenosis
1382
Q0692:Man starts a medication for hyperlipidemia. He then develops a rash; pruritis; and GI upset. What drug was it
1383
Niacin
1384
Q0693:Pt developes a cough and must discontinue captopril. What is a good replacement drug and why doesn't it have the same side effects?
1385
losartan; an angiotensin II receptor antagonist; does not increase bradykinin as captopril does.
1386
1387
1) Internal jugular Vein (lateral);2) Common carotid Artery (medial);3) Vagus Nerve (posterior);mneu: VAN
1388
Q0695:In the majority of cases; the SA and AV nodes are supplied by this carotid artery?
1389
1390
Q0696:80% of the time the Right coronary artery is "dominant"; suppplying the left ventricle via the _________ branch
1391
1392
Q0697:cardiac output =
1393
SVxHR
1394
Q0698:During exercise; CO increased as a result of an increased in _____. After prolonged exercise; CO increased as a result of an increased in ____
1395
SV;HR
1396
Q0699:cardiac output =
1397
SVxHR
1398
Q0700:During exercise; CO increased initially as a result of an increased in ____. After prolonged exercise; CO increased as a result of an increased in ____.
1399
SV;HR
1400
1401
1402
1403
1404
1405
systolic-diastolic
1406
Q0704:pulse pressure
1407
stroke volume
1408
1409
1)=CO/HR;2)=EDV-ESV
1410
1411
1)Right Coronary aa (RCA);2)Left main coronary aa (LCA);3)Circumflex artery (CFX);4) Left anterior descending aa (LAD;5) Posterior descending aa (PD);6) Acute marginal aa
1412
1413
1414
1415
increased
1416
1417
decreased
1418
1419
increased
1420
1421
increased
1422
1423
decreased
1424
1425
increased
1426
1427
increased
1428
1429
increased
1430
1431
increased
1432
1433
decreased
1434
1435
decreased
1436
1437
decreased
1438
1439
decreased
1440
1441
decreased
1442
1443
increased
1444
1445
increased
1446
1447
increased
1448
1449
increased
1450
Q0726:ventricular EDV
1451
Preload
1452
1453
afterload
1454
1455
afterload
1456
1457
preload
1458
1459
afterload
1460
1461
Preload
1462
Q0732:Starling Curve: Force of _______ is proportional to initial length of cardiac mm fiber (preload)
1463
contraction
1464
1465
1466
1467
1468
1469
1470
1471
1472
1473
1474
1475
1) SV/EDV;2) EDV-ESV/EDV
1476
1477
EF
1478
1479
55
1480
1481
1)exercise;2)CHF + digitalis;3)CHF
1482
1483
QxR
1484
1485
1)=P/Q;2)8nxl/r(^4)
1486
1487
hematocrit
1488
Q0745:increased ______ in;1) Polycythemia;2) Hyperproteinemic states (e.g; multiple myeloma);3) hereditary spherocytosis
1489
viscosity
1490
1491
proportional
1492
1493
inversely proportional
1494
1495
1) (+) inotropy;2) (-) inotropy;3) (increased ) blood volume;4) (decreased ) blood volume
1496
1497
1)isovolumetric contraction;2) aortic valve opens;3) ejection;4) aortic valve closes;5) isovolumetric relaxation;6) mitral valve opens;7)ventricular filling;8) mitral valve closes
1498
Q0750:Name the phase of the cardiac cycle;period between mitral valve closure and aortic valve opening.
1499
isovolumetric contraction
1500
1501
isovolumetric contraction
1502
Q0752:Name the phase of the cardiac cycle: period between aortic valve opening and closing
1503
systolic ejection
1504
Q0753:Name the phase of the cardiac cycle: period between aortic valve closing and mitral valve opening
1505
isovolumetric relaxation
1506
Q0754:Name the phase of the cardiac cycle: period just after mitral valve opening
1507
rapid filling
1508
Q0755:Name the phase of the cardiac cycle: period just before mitral valve closure
1509
slow filling
1510
1511
S1
1512
1513
S2
1514
1515
S3
1516
1517
S4
1518
1519
S3
1520
Q0761:this heart sound AKA "atrial kick" is associated with a hypertrophic ventricle
1521
S4
1522
1523
Atrial contraction
1524
1525
1526
1527
1528
1529
1530
Q0766:when the aortic valve closes before the pulmonic this heart sound abnormality results
1531
S2 splitting
1532
1533
inspiration
1534
Q0768:Paradoxical splitting (S2 split increasd upon expiration is associated with what?
1535
aortic stenosis
1536
1537
--
1538
Q0770:cardiac mm contraction is dependent on extracellular ________; which enters the cells during plateau of action potential and stimulates ______ release from the cardiac mm sarcoplasm reticulum.
1539
1540
Q0771:In contrast to skeletal mm; cardiac mm action potential has a plateau; which is due to ____ influx.
1541
Ca+
1542
Q0772:In contrast to skeletal mm; cardiac nodal cells ________ depolarize; resulting in automaticity
1543
spontaneously
1544
Q0773:In contrast to skeletal mm; cardiac myocytes are electrically coupled to each other by ________
1545
gap junctions
1546
Q0774:myocardial action potential occurs in atrial and ventricular myocytes and ________
1547
perkinje fibers
1548
Q0775:In a myocardial action potential; this phase is the rapid upstroke; when voltage gated Na+ channels open
1549
phase 0
1550
Q0776:In a myocardial action potential; this phase is the initial repolarization-inactivation of voltage0gated Na+ channels. Voltage gated K+ channels begin to open
1551
Phase 1
1552
Q0777:In a myocardial action potential; this phase is the plateu--Ca++ influx through voltage-gated Ca++ channels balances K+ efflux. Ca++ influx triggers another Ca++ release from sarcoplasmic reticulum and myocyte contraction.
1553
phase 2
1554
Q0778:In a myocardial action potential; this phase is the rapid repolarization--massive K+ efflux due to opening of voltage-gated slow K_ channels and closure of voltage gated Ca++ channels.
1555
Phase 3
1556
Q0779:In a myocardial action potential; this phase is the resting potential--high K+ permeability through K+ channels.
1557
phase 4
1558
1559
SA & AV nodes
1560
Q0781:In a pacemaker action potential this phase is the upstroke phase--it involves opening of voltage-gated Ca++ channels. These cells lack fast voltage-gated Na+ channels. Results in a slow conduction velocity that is used by the AV node to prolong transmission from the atria to ventricles.
1561
phase 0
1562
1563
phase 2
1564
Q0783:In a pacemaker action potential this phase; the slow diastolic depololarization results in membrane potential spontaneously depolarizing as Na+ conductance increases. This accounts for automaticity of SA and AV nodes. The slope of this phase in the SA node determines the heart rate. ACh decreases and catecholamines increasee the rate of diastolic depolarization decreasing or increasing heart rate respectively.
1565
phase 4
1566
1567
P wave
1568
1569
PR segment
1570
1571
QRS complex
1572
1573
QT interval
1574
1575
T wave
1576
1577
QRS complex
1578
1579
ST segment
1580
1581
U wave
1582
Q0792:this syndrome is caused by an accessory conduction pathway from atria to vetricle (bundle of kent); bypassing AV node. As a result; ventricles begin to partially depolarize earlier; giving rise to characteristic delta wave on ECG. May result in reentry current leading to supraventricular tachycardia [image p.223]
1583
Wolff-Parkinson-White syndrome
1584
Q0793:This ECG tracing has a chaotic and erratic baseline (irregularly irregular) with no discrete P waves in between irregularly spaced QRS complexes (pic. p 224)
1585
Atrial fibrillation
1586
Q0794:This ECG tracing has a rapid succession of identical; back to back atrial depolarization waves. The identical appearance accounts for the "sawtooth" appearance of the flutter waves. (pic. p 224)
1587
Atrial flutter
1588
1589
1590
Q0796:Progressive lenthening of the PR interval until a beat is "dropped" (a P wave not followed by a QRS complex). Usually asymptomatic. (pic. p 224)
1591
1592
Q0797:On ECG shows dropped beats that are not preceded by a change in the length of the PR interval. These abrupt; nonconducted P waves result in a pathologic condition. It is often found as a 2:1 block; where there are 2 P waves to 1 QRS response. May progress to 3rd degree block.(pic. p 225)
1593
1594
Q0798:In this condition; the atria and ventricles beat independently of each other. Both P waves and QRS complexes are present; although the P waves bear no relation to the QRS complexes. The atrial rate is faster than the ventricular rate. Usually treat with pacemaker.
1595
1596
Q0799:completely erratic rhythm with no identifiable waves. Fatal arrhythmia without immediate CPR and defibrillation. (pic. p 225)
1597
Ventricular Fibrillation
1598
Q0800:________receptor transmits via vagus nn to medulla (responds only to increase blood pressure)
1599
1600
1601
carotid sinus
1602
Q0802:decreased firing by aroreceptors during hypotension results in an increase in efferent ________ firing
1603
sympathetic
1604
Q0803:In a carotid massage; the increased pressure on carotid aa results in increased stretch and ____ in heart rate
1605
decrease
1606
1607
1608
1609
1610
Q0806:This chemoreceptor is responsible for Cushing reaction; response to cerebral ischemia; response to increase intracranial pressure leads to hypertension (sympathetic response) and bradycardia (parasympathetic response)
1611
Central chemoreceptor
1612
1613
liver
1614
Q0808:this organ gets the highest blood flow per gram of tissue
1615
kidney
1616
Q0809:this orgen has a large arteriovenous O2 differnece. Increased O2 demand is met by increased coronary blood flow; not by increased extraction of O2.
1617
heart
1618
Q0810:this is a good approximation of L atrial pressure and measured with a Swan-Ganz catheter
1619
1620
1621
autoregulation
1622
1623
heart
1624
1625
brain
1626
Q0814:Name the organ regulated by the local metabolites: Myogenic and tubuloglomerular feedback
1627
kidneys
1628
Q0815:Name the organ regulated by the local metabolites: hypoxia causes vasoconstriction
1629
lungs
1630
Q0816:_______ vasculature is unique in that hypoxia causes vasoconstriction (in other organs hypoxia causes vasodilation)
1631
pulmonary
1632
1633
skeletal mm
1634
Q0818:Name the organ regulated by the local metabolites: sympathetic stimulation most important mechanism--temp control
1635
skin
1636
1637
starling
1638
1639
1640
1641
1642
1643
1644
1645
1646
1647
[Pc-Pi)-(c-i)];capillary pressure -interstitial pressure ;;plasma colloid osmotic presure - interstitual fluid colloid osmotic pressures
1648
Q0825:Kf=
1649
1650
1651
edema
1652
1653
1654
1655
1656
1657
1658
Q0830:edema is commonly caued by ___ interstitial fluid colloid osmotic pressure;(give example)
1659
1660
1661
3 Ts;Tetrology;Transposition;Truncus
1662
Q0832:Children with this type of shunt may squat to increase venous return
1663
1664
1665
1666
Q0834:children with this type of shunt may squat to increase venous return.
1667
1668
1669
1670
1671
tetralogy of fallot
1672
1673
VSD
1674
Q0838:this congenital heart dz manifests itself with a loud S1 and a wide; fixed split S2
1675
ASD
1676
1677
PDA
1678
1679
VSD>ASD>PDA
1680
Q0841:Uncorrected VSD; ASD or PDA leads to progressive pulmonary hypertension. As pulmonary resistance increases; the shunt reverses from L to R to R to L; which causes late cyanosis (clubbing & polycythemia). [pic p. 228]
1681
eisenmenger's syndrome
1682
1683
1684
1685
pulmonary stenosis
1686
1687
boot shaped
1688
1689
VSD>ASD>PDA
1690
Q0846:Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)leading to separation of systemic and pulmonary circulations.
1691
1692
Q0847:Transposition is not compatable with life unless a _____is present to allow adequate mixing of blood;[pic p. 229]
1693
1694
1695
aorticopulmonary
1696
Q0849:this type of coarction of aorta is aortic stenosis proximal to insertion of ductus arteriosus (preductal)
1697
1698
Q0850:this type of coarction of aorta is aortic stenosis is distal to ductus arteriosus (postductal) it is associated with notching of the ribs; hypertension in upper extremities; weak pulses in lower extremities.
1699
1700
1701
3:01
1702
1703
1704
Q0853:In fetal period; shunt is right to left. In neonatal period; lung resistance decreases and shunt becomes L to R w/ subsequent RVH and failure. [pic p. 229]
1705
1706
1707
indomethacin
1708
Q0855:______ is used to keep a PDA open; which may be necessary to sustain life in conditions such as transposition of the great vessels
1709
PGE
1710
1711
1712
1713
ASD; VSD
1714
1715
1716
1717
coarctation of aorta
1718
1719
aortic insufficiency
1720
1721
1722
Q0862:Hypertension
1723
BP >140/90
1724
1725
1726
1727
essential
1728
1729
increased CO or TPR
1730
1731
renal
1732
1733
malignant
1734
1735
1736
1737
Atheromata
1738
Q0870:Hyperlipidemia signs;plaques or nodules composed of lipid-laden histocytes in the skin; especially the eyelids
1739
Xanthoma
1740
1741
Tendinous xanthoma
1742
1743
corneal arcus
1744
Q0873:This type of arteriosclerosis is in the media of the arteries; esp radial or ulnar. Usually benign.
1745
Monckeberg
1746
Q0874:This type of arteriosclerosis is hyalin thickening of small arteries in essential hypertension. Hyperplastic "onion skinning" in malignant hypertension.
1747
Arteriolosclerosis
1748
Q0875:This type of arteriosclerosis is when fibrous plaques and atheromas form in intima of arteries
1749
atherosclerosis
1750
1751
1752
1753
1754
1755
1756
1757
1758
Q0880:symptoms of atherosclerosis
1759
1760
1761
angina
1762
1763
stable angina
1764
1765
1766
1767
unstable/crescendo angina
1768
Q0885:most often acute thrombosis due to coronary artery atherosclerosis. Results in myocyte necrosis
1769
myocardial infarction
1770
Q0886:death from cardiac causes within 1 hour of onset of symptoms; most commonly due to a lethal arrythmia
1771
1772
Q0887:progressive onset of CHF over many years due to chronic ischemic myocardial damage
1773
1774
Q0888:infarcts occuring in loose tissues with collaterals; such as lungs; intestine; or follwing reperfusion
1775
1776
Q0889:infarcts occur in solid tissues with single blood supply; such as brain; heart; kidney and spleen.
1777
pale infacts
1778
Q0890:give order of highest frequency of coronary artery occlusion ;CFX; LAD; RCA
1779
LAD>RCA>CFX
1780
Q0891:symptoms of MI (give 4)
1781
diaphoresis; nausea; vomiting; severe retrosternal pain; pain in left arm or jaw; shortness of breath; fatigue; adrenergic symptoms.
1782
Q0892:How long ago did the MI occur?;Occluded artery but no visable change by light microscopy
1783
2-4 hours
1784
Q0893:How long ago did the MI occur?;Gross: dark mottling; pale with tetrazolium stain;Micro: coagulative nocrosis. coagulation bands visable. release of contents of necrotic cells into bloodstream and the begining of neutrophil emigration.
1785
1786
Q0894:How long ago did the MI occur?;Gross: hyperemic border; central yellow-brown softening;Micro: outer zone (ingrowth of granulation tissue); macrophages; & neutrophils
1787
5-10 D
1788
1789
7 weeks
1790
1791
ECG
1792
Q0897:This lab test rises after 4 hours and is elevated for 710D.
1793
troponin I
1794
1795
troponin I
1796
Q0899:This is predominantly found in myocardium but can also be relased from skeletal mm
1797
CK-MB
1798
Q0900:This is nonspecific and can be found in cardiac; liver and skeletal mm cells
1799
AST
1800
1801
transmural infarct
1802
1803
subendocardial infarct
1804
1805
transmural infact
1806
Q0904:This MI complication is the most important cause of death before reaching hosptial; it is common in the 1st few days
1807
cardiac arrhythmia
1808
1809
LV failure
1810
Q0906:This MI complication has a high risk of mortanilty and occurs when there is a large infarct
1811
cardiogenic shock
1812
Q0907:Rupture of ventricular free wall; interventricular septum; or paillary mm; usually occurs _____ post MI
1813
4-10D
1814
Q0908:This MI complication of an MI results in decreased CO; a risk of arrythmia; and embolus from mural thrombus
1815
aneurism formation
1816
Q0909:this MI complication is also known as a friction rub and occurs 3-5 D post MI
1817
fibrinous pericarditis
1818
Q0910:This MI complication is an autoimmune phenomenon resulting in fibrinous pericarditis; several weeks post-MI
1819
dresslers syndrome
1820
1821
1822
1823
systolic
1824
Q0913:In this type of cardiomyopathy; the heart looks like a baloon on chest x-ray
1825
1826
1827
1828
Q0915:this type of cardiomyopathy often involves an asymetric enlargement of the intraventricular septum
1829
hypertrophic cardiomyopathy
1830
1831
diastolic
1832
1833
autosomal dominant
1834
1835
hypertrophic cardiomyopathy
1836
1837
1838
1839
Beta blocker
1840
Q0921:major causes of this type of cardiomyopathy include sarcoidosis; amyloidoss; postratdiation fibrosis; endocarrdial fibroelastosis; and endomyocardial fibrosis (Loffler's)
1841
restrictive/obliterative cardiomyopathy
1842
1843
mitral regurgitation
1844
Q0923:Heart Murmurs: crecendo-decrescendo systolic ejection murmur following ejection click. radiates to carotids/apesx. "pulsus parvus et tardus" pulses weak compared to heart sounds
1845
aortic stenosis
1846
1847
VSD
1848
Q0925:Heart Murmurs;Late systolic murmur with midsystolic click. Most frequent valvular lesion
1849
mitral prolapse
1850
1851
aortic regurgitation
1852
Q0927:Heart Murmurs: follows opening snap. delayed rumbling late diastolic murmur.
1853
mitral stenosis
1854
1855
PDA
1856
Q0929:most common primary cardiac tumor in adults. Usually described as a "ball-valve" obstruction in the LA
1857
myxomas.
1858
1859
1860
Q0931:Most frequent primary cardiac tumor in children; associated with tuberous sclerosis
1861
rhabdomyomas
1862
1863
metasteses
1864
Q0933:Given the pathophysiology tell me the symptom of CHF;failure of LV output to increase during exercise
1865
dyspnea on exertion
1866
Q0934:Given the pathophysiology tell me the symptom of CHF: greater ventricular end-diastolic volume
1867
cardiac dilation
1868
Q0935:Given the pathophysiology tell me the symptom of CHF;Lv ventrical failure leads to increased pulmonary venous pressure which leads to pulmonary venous distention and transudation of fluid.
1869
1870
1871
pulmonary edema
1872
Q0937:Given the pathophysiology tell me the symptom of CHF: increase venous return in supine position exacerbates pulmonary vascular congestion
1873
1874
Q0938:Given the pathophysiology tell me the symptom of CHF: increased central venous pressure leading to increased resistance to portal flow.
1875
1876
Q0939:Given the pathophysiology tell me the symptom of CHF: RV failure leads to increased venous pressure which leads to fluid transudation
1877
1878
Q0940:embolus types
1879
Fat; Air; Thrombus; Bacteria; Amniotic fluid; Tumor;mneu: an embolus moves like a a FAT BAT
1880
Q0941:this type of emboli are associated with long bone fractures and liposuction.
1881
fat
1882
1883
1884
1885
amniotic fluid
1886
Q0944:this type of embolus is associated with chest pain; tachypnea; and dyspnea
1887
pulmoary embolus
1888
Q0945:compression of heart by fluid (i.e;blood) in pericardium; leading to decreased cardiac output and equilibration of pressures in all four chambers.
1889
cardiac tamponade
1890
Q0946:youre pt presents with hypotension; JVD; and distant heart sounds. He shows pulsus paradoxus and ECG shows electrical alternans
1891
cardiac tampanad
1892
Q0947:pulsus paradoxus
1893
(exaggeration of nml variation in the systemic arterial pulse volume with respiration-- becoming weaker with inspiration and stronger with expiration)
1894
Q0948:electrical alternans
1895
1896
1897
1898
Q0950:osler nodes
1899
1900
Q0951:Roth's spots
1901
1902
Q0952:Janeway lesions
1903
1904
1905
mitral valve
1906
1907
tricuspid valce
1908
Q0955:what are some of the complications associated with bacterial endocartitis (give 2)
1909
1910
Q0956:acute endocarditis has a rapid onset. It results from large vegetations on previously normal valves. It is most often caused by this bug.
1911
1912
Q0957:Subacute bacterial endocarditis has a more insidious onset. It consists of smaller vegetations on congentitally abnormal or diseased valves. It can be a sequela of dental procedures. Often caused by this bug
1913
1914
1915
1916
Q0959:In this condition; associated with lupus; vegetations develop on both sides of valve leading to mitral valve stenosis but do not embolize
1917
1918
1919
1920
1921
1922
1923
Fever;Erythema marginatum;Valvular damage;ESR (high);Redhot joints (polyartheritis);Subcutaneous nodules;St. Vitus' dance (chorea);mneu: FEVERSS
1924
Q0963:This is associated with Aschoff bodies; migratory polyarthritis; erythema marginatum; elevated ASO titers.
1925
Rheumatic heart dz
1926
1927
immune mediated
1928
1929
rheumatic heart dz;mneu: think of 2 RHussians with RHeumatic heart dz (Aschoff & Anischkow)
1930
Q0966:Aschoff bodies
1931
1932
Q0967:Anitschkow's cells
1933
activated histiocytes
1934
Q0968:This condition presents with pericardial pain; friction rub; ECG changes (diffuse ST elevation in all leads) pulsus paradoxus; distant heart sounds
1935
pericarditis
1936
Q0969:pericarditis can resolve without scarring however; scarring can lead to this
1937
1938
1939
serous pericarditis
1940
1941
fibrinous pericarditis
1942
1943
hemorrhagic
1944
Q0973:this dz disrupts the vasa vasora of the aorta with consequent dilation of the aorta and valve ring. It often effects the aortic root and results in calcification of ascending arch of the aorta
1945
1946
Q0974:This dz can result in aneurism of the ascending aorta or aortic arch and aortic valve incompetence.
1947
1948
Q0975:This Rx used for HTN has the adverse effect of HYPOKALEMIA; slight hyperlipidemia; hyperuricemia; lassitude; hypercalcemia; hyperglycemia
1949
hydrochlorothiazide (diuretic)
1950
Q0976:This Rx used for HTN has the adverse effect of potassium wasting; metabolic alkalosis; hypotension; ototoxicity
1951
loop diuretics
1952
Q0977:This sympathoplegic used in the tx of HTN has the adverse effect of dry mouth; sedation; severe rebound HTN
1953
clonidine
1954
Q0978:This sympathoplegic used in the tx of HTN has the adverse effect of sedation; positive Coomb's test
1955
methyldopa
1956
Q0979:This sympathoplegic used in the tx of HTN has the adverse effect of severe orthostatic hypotension; blurred vision; constipation; sexual disfunction
1957
hexamethonium
1958
Q0980:This sympathoplegic used in the tx of HTN has the adverse effect of sedation; depression; nasal stuffiness; diarrhea
1959
reserpine
1960
Q0981:This sympathoplegic used in the tx of HTN has the adverse effect of orthostatic and exercise hypotension; sexual dysfunction; diarrhea
1961
Guanethidie
1962
Q0982:This sympathoplegic used in the tx of HTN has the adverse effect of 1st dose orthostatic hypotension; dizziness; headache
1963
Prazosin
1964
Q0983:This sympathoplegic used in the tx of HTN has the adverse effect of impotence; asthma; bradycardia; CHF; AV block; sedation & sleep alterations
1965
B blockers
1966
Q0984:This vasodialator used in the tx of HTN has the adverse effect of nausea; headache; lupus-like syndrome; reflex tachycardia; angina; salt retension
1967
hydralazine
1968
Q0985:This vasodialator used in the tx of HTN has the adverse effect of hypertrichosis; pericardial effusion; reflex tachycardia; angina; salt retension
1969
minoxidil
1970
Q0986:This vasodialator used in the tx of HTN has the adverse effect of dizziness; flushing; constipation; nausea
1971
1972
Q0987:This vasodialator used in the tx of HTN has the adverse effect of cyaide toxicity (releases CN)
1973
nitroprusside
1974
Q0988:This ACE inhibitor used in the tx of HTN has the adverse effect of;Hyperkalemia; Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1975
Captopril;mneu:CAPTOPRIL-Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1976
Q0989:This angiotensin II receptor inhibitor has theadverse effect of fetal renal toxicity; hyperkalemia
1977
Losartan
1978
Q0990:This vasodialator used in the tx of HTN has the adverse effect of hypertrichosis; pericardial effusion; reflex tachycardia; angina; salt retension
1979
minoxidil
1980
Q0991:This vasodialator used in the tx of HTN has the adverse effect of dizziness; flushing; constipation; nausea
1981
1982
Q0992:This vasodialator used in the tx of HTN has the adverse effect of cyaide toxicity (releases CN)
1983
nitroprusside
1984
Q0993:This ACE inhibitor used in the tx of HTN has the adverse effect of;Hyperkalemia; Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1985
Captopril;mneu:CAPTOPRIL-Cough; Angioedema; Proteinuria; Taste changes; hypOtension; Pregnancy problems (fetal renal damage); Rash; Increased renin; Lower angiotensin II
1986
Q0994:The MOA of this drug used for severe HTN & CHF is that it increases cGMP leading to smooth mm relaxation. It vasodilates arterioles > veins resulting in a reduction of afterload
1987
hydralazine
1988
Q0995:Toxicity of this drug for severe HTN & CHF include compensitory tachycardia; fluid retension; & lupus like syndrome
1989
hydralazine
1990
1991
1992
Q0997:The MOA of these drugs is that they block voltagedependent L-type calcium channels of cardiac and smooth muscle and thereby reduce mm contractilty
1993
1994
Q0998:give the order of potency of the 3 CCBs (nifedipine; verapamil; diltiazem) in;1) the heart;2)vascular smooth mm
1995
heart-verapamil>diltiazem>nifedipine;vascular sm mm-;nifedipine>diltiazem>verapamil
1996
1997
1998
Q1000:These drugs produce a toxicity of cardiac depression; peripheral edema; flushing; dizziness; & constipation
1999
CCBs
2000
Q1001:These 2 drugs used for angina; pulmonary edema; and as an erection enhancer have a MOA of vasodilating by releasing NO in smooth mm; causing an increase in cGMP and smooth mm relaxation. They dialate vv>>arteries resulting in a decrease in preload
2001
2002
Q1002:toxicity of these drugs include tachycardia; hypotension; headache; "Monday dz" in industrial exposure; development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend; resulting intahycardia; dizziness; and headache.
2003
2004
2005
2006
2007
2008
Q1005:In order to reduce myocardial O2 consumption you need to decrease 1 or more of the determinants of MVO2 which are give 2(5)
2009
2010
2011
preload
2012
2013
afterload
2014
Q1008:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;EDV
2015
2016
Q1009:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;BP
2017
2018
Q1010:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;Contractility
2019
2020
Q1011:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;HR
2021
2022
Q1012:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;Ejection time
2023
2024
Q1013:For each of the determinants of myocardial O2 consumption (MVO2). 1) Give the effect that Nitrates have. 2) that B-blockers have.3) And that Nitrates + B-blockrs have;MVO2
2025
2026
Q1014:CCBs: Nifedipine is similar to ________ (nitrates or B blockers); Verapamil is similar to ________nitrates or B blockers)
2027
Nitrates ;B blockers
2028
2029
2030
2031
digitalis
2032
2033
CCBs;B blockers
2034
2035
Ryanodine
2036
2037
Ca++ sensitizers
2038
Q1020:This cardiac glycoside has 75% bioavalibility; is 2040% protein bound; has a half life of 40 hours and is excreted in the urine
2039
digoxin
2040
Q1021:the MOA of this drug is that it inhibits the Na+/K+ ATPase of the cardiac sarcomere; causing an increase in intracellular Na+. Na+-Ca++antiport does not function as efficiently; casing an increase in intracellular Ca++; leading to positive inotropy.
2041
digoxin
2042
Q1022:this drug may cause an elevated PR; a depressed QT; a scooping of ST segment; and a T-wave inversion on ECG
2043
digoxin
2044
Q1023:The clinical uses for this drug include 1) ________ due to increased contractility 2) _______ due to decreased conduction at AV node
2045
2046
2047
digoxin
2048
Q1025:Digoxins toxicities are increased by _________(decreased excretion); _______(potentiates drug's effects) ; and _________ (decreases digoxin clearance and displaces dignoxin from tissue binding sites
2049
2050
2051
2052
2053
Na+
2054
2055
Beta
2056
2057
K+
2058
Q1030:Thhs class of antiarrhthmics are local anesthetics. They act by slow or decreasd conduction. They decrese the slope of phase 4 ddepolarization and increase threshhold for firing in abnormal pacemaker cells.
2059
2060
2061
2062
2063
2064
2065
2066
Q1034:This class of antiarrhytmics has an increased AP duration; increased effective refractory period (EERP; increased QT interval. It can affect both atrial and ventricular arrhythmias
2067
IA
2068
Q1035:This member of class IA antiarrhytmics has toxicities that include (cinchonism-headache; tinnitis; thrombocytopenia; torsades de pointes due to prolonged QT interva)
2069
quinidine
2070
Q1036:This member of class IA antiarrhytmics has toxicities that include reverible SLE-like syndrome
2071
procainamide
2072
2073
2074
Q1038:this class of antiarrythmics acts to decrease AP duration. It effects ischemic or depolarized purkinje and ventricular tussue. It is useful in acute ventricular arrhytmias (especially post-MI) and i digitalis-induced arrhythmias.
2075
2076
Q1039:This class of antiarrhytmics has toxicities that include local anesthetic effects; CNS stimulation/depression; cardiovascular depression
2077
2078
2079
2080
Q1041:This class of antiarrhythmics has no effect on AP duration. It is useful in V-tachs that progress to VF and intractable SVT. Usually used only as last result in refractory tachyarrythmias.
2081
2082
2083
2084
2085
1) IA;2) IB;3) IC
2086
2087
2088
Q1045:This class of antiarrythmics acts by decreased cAMP; decreased Ca+ currents; and by supressing abnormal pacemakers by decreased slope of phase 4. The AV node is particularly sensitive resulting in increaed PR interval
2089
2090
2091
esmolol
2092
Q1047:Toxicities of this class of antiarrythmics include impotence; exacerbation of asthma; CV effects (bradycardia; AV block; CHF); CNS effects (sedation; sleep alterations). It may mask signs of hypoglycemia.
2093
2094
2095
2096
Q1049:This class of antiarrythmics acts by increased AP duration; increased ERP. It thends to increased QT interval. It is used when other antiarrhythmics fail.
2097
2098
Q1050:This class III antiarrythmic has toxicities which include torsades de pointes and excessive beta block
2099
sotalol
2100
Q1051:This class III antiarrythmic has toxicities which include new arrhytmias& hypotension
2101
bretylium
2102
Q1052:This class III antiarrythmic has toxicities which include PULMONARY FIBROSIS; HEPATOTOXICITY; HYPOTHYROIDSIM/HYPERTHYROIDISM; corneal deposits; skin depsits resulting in photodermatiitis; neurologic effects; constipation; CV effects (bradycardia; heart block; CHF
2103
amiodarone;mneu: remember to check PFTs; LFTs; and TFTs when using amiodarone.
2104
2105
2106
Q1054:The MOA of this class of antiarrythmics is primarily on AV nodal cells. They decreased conduction velocity; increased ERP; increased PR interval.
2107
2108
2109
2110
Q1056:Toxicity of this class of antiarrythmics can include constipation; flushing; edema; CV effects (CHF; AV block; sinus node depression; & torsades de pointes.
2111
2112
Q1057:Other antiarrythmics: this antiarrhythmic is the drug of choice in diagnosing/abolishing AV nodal arrhythmias
2113
adenosine
2114
Q1058:Other antiarrythmics: this antiarrhythmic depresses ectopic pacemakers; especially in digoxin doxicity
2115
K+
2116
Q1059:Other antiarrythmics: this antiarrhythmic is effective in torsades de pointes and digoxin toxiciity
2117
Mg+
2118
2119
2120
2121
2122
2123
2124
2125
2126
2127
increased catecholamines (high activity of Ca pump in SR);increased [Ca]i;decreased [Na]e;digitalis admin (increases intracellular Na which leads to increased [Ca]i)
2128
2129
2130
2131
2132
2133
2134
Q1068:resistance/pressure/flow formula
2135
change in P = Q x R;Q = flow; R = resistance;R= 8 x viscosity x length/;pi radius ^4;*viscostity increased in;polycythemia; high protein and hereditary spherocytosis
2136
Q1069:JVP waves
2137
a: atrial contraction;c: RV contraction(when tricuspid bulges back into RA);v: increased atrial pressure due to atrial filling against closed tricuspid valve
2138
2139
cardiac muscle;-> AP has a plateau ;-> nodal cells SPONTANEOUSLY depolarize [automaticity];-> myocytes are electrically coupled via gap jxns;**contraction is due to extracellular Ca
2140
2141
phase O: rapid upstroke (Na);1: intial repol (inactivation of Na channels);2: plateau (Ca influx balances slowly increasing K efflux);3: rapid repol (massive K efflux due to slow K channels and closure of Ca channels);4: resting potential (K and Ca leak currents + Na/K ATPase and Na/Ca exchanger)
2142
2143
phase 0: upstroke due to Ca channels; NO fast Na channels;2: no plateau (pointy);4: slow diastolic depol (I-f accounts for automaticity of SA/AV nodes);**slope of phase 4 in SA node determines heart rate**
2144
2145
accessory conduction pathway from atria to ventricle;bypasses the AV node;**see a DELTA WAVE before QRS complex;can lead to SVTs
2146
2147
2148
2149
mobitz type 1;->progressive lengthening of PR until a beat is dropped. asymptomatic;mobitz type 2;->dropped beats not proceeded by change in PR length. is symptomatic: 2 P waves to 1 QRS
2150
2151
atria and ventricles beat independantly;P waves have no relation to QRS;atrial rate > ventricular;*Tx = pacemaker;rate of ventricular beat: 30-45;stroke volume is increased (high pulse pressure)
2152
2153
2154
2155
Pc = capillary fluid pressure;-> fluid out of capillary;Pi = interstitial fluid pressure;-> fluid into capillary
2156
2157
pi-c: plasma colloid osmotic p;-> moves fluid into capillary;pi-i: interstitial colloid p;-> moves fluid out of capillary
2158
2159
2160
2161
VSD (#1 congenital anomaly);ASD (loud S1; fixed split S2);PDA (close w/indomethacin)
2162
Q1082:teratology of Fallot
2163
PROVe;Pulmonary a. stenosis (Px feature);RVH;Overriding aorta (overrides VSD);VSD;*pts suffer 'cyanotic spells';caused by anteriosuperior displacement of aorta
2164
2165
aorta leavse RV and pulm trunk leaves LV (posterior);not compatible with life unless shunt is present to mix systemic and pulm circulations (VSD; pDA or pFO)
2166
Q1084:coarctation of aorta
2167
infants: aortic stenosis proximal to insertion of DA;adults: distal to DA;-> notching of ribs; HTN in upper extremities; weak pulses in lower extremities;-> 3:1 male to female ratio;**ass'd with Turner Syndrome
2168
Q1085:patent DA
2169
in fetal pd; shunt R to L (bypasses pulmonary circulation);birth = lung resistance drops and shut becomes L to R which causes RVH and R heart failure;*continuous machine like murmur;patency = low O2 tension; PGE
2170
2171
22q11: truncus arteriosus; teratology of fallot;Ts21: ASD or VSD;rubella: septal defects; pDA;turner's: coarctation of aorta;marfan's: aortic insufficiency;mom w/DM: transposition of great vessels
2172
Q1087:monckeburg arteriosclerosis
2173
2174
Q1088:arteriolosclerosis
2175
hyaline thickening of small arteries due to essential hypertension;ONION SKINNING in malignant HTN
2176
2177
2178
Q1090:primitive embryonic heard dilates into five areas (starting at weeks 5-8):
2179
from cranial to caudal;-truncus arteriosus: proximal aorta and proximal pulm artery;-bulbus cordis: smooth parts of right ventricle and LV;-primitive ventricle: RV; LV;-primitive atrium: RA and LA;-sinus venosus (R and L): smooth part of RA; coronary sinus; oblique vein
2180
2181
aberrant development of aortico-pulmonary septum [which should normally divide aorta and pulmonary trunk]
2182
2183
6 paired aortic arches at 1st;->arch 3: common carotids;->4: aorta and proximal subclavian artery;->6: DA and pulmonary trunk
2184
Q1093:developent of veins
2185
vitelline veins: ductus venosus carries O2 blood from placenta to fetus;L umbilical vein: ligamentum teres hepatis;R umbilical vein: regresses
2186
Q1094:paradoxical emboli
2187
originate in the venous circulation and pass through pFO or ASD to produce symptoms on arterial side
2188
Q1095:situs inversus
2189
all body's organs are transposed ;associated with Kartagener's syndrome [immotile cilia]
2190
Q1096:Eisenmerger's syndrome
2191
change of L to R to R to L shunt secondary to increasing pulmonary HTN;often result of chronic response to VSD
2192
2193
decreased TPR leads to increased CO (increased HR and SV);diastolic bp falls b/c blood rapidly exits arterial system;but mean bp is relatively normal b/c regulating mechanisms are normal
2194
2195
increases (b/c arteries have hardened; need to push harder [higher systolic bp] to get the blood out)
2196
2197
Libman-Sacks;->small granular vegetations consisting of fibrin develop on mitral and aortic valves;->leads to aortic stenosis
2198
Q1100:premortum thrombus
2199
look for Lines of Zahn (composed of platelets);->b/c has formed over a period of time;often due to atrial fibrillation
2200
2201
gradual loss of myocytes;->small patches of fibrosis and vacuolization;->usually in subendocardial area (poorly perfused)
2202
2203
subclavian artery compressed btwn scalenus anterior and the rib;=pain and tingling on affected side
2204
2205
wide pulse pressure;->resting CO is increased due to increased SV and HR;also see tachycardia
2206
2207
2208
2209
arteriolar rarefaction;=dissolution and loss of arterioles;-due to long term over-perfusion of tissues;also; arteriolar wall to lumen ratio INCREASES (thicker wall)
2210
Q1106:syphilitic aneurysm
2211
massive dilation of aortic root with absence of atherosclerosis;histo = plasma cell lesion in vasa vasorum that supply the aorta [eventually obliterate it and cause aneurysm]
2212
Q1107:cyanosis
2213
2214
2215
decreased arterial pressure;small; quiet heart;hypotension; tachypnea; tachycardia; increased JVP;*pulsus paradoxus
2216
Q1109:signs of pericarditis
2217
sharp; knife like pain;->usually related to breathing;diffuse STEs and upright T waves;pericardial rub MAY be present
2218
2219
2220
2221
wide pulse pressure (160/80);systemic pressure drops during diastole b/c blood flows back thru aorta into LV
2222
2223
ischemic heart disease;*in younger patients; the nonatherosclerotic causes are more common;->hypertrophy; MVP; myocarditis; dilated cardiomyopathy; etc
2224
Q1113:Kawasaki disease
2225
'mucocutaneous lymph node syndrome';leading cause of acquired heart disease in kids in the US;all sizes of arteries affected;*risk of coronary artery aneurysm
2226
2227
2228
Q1115:Dressler's syndrome
2229
2230
Q1116:dilated cardiomopathy
2231
90% of all cardiomyopathies;Alcohol; Beriberi; Coxsackie B; Cocaine; Chagas'; Doxorubicin toxicity [chemo]; peripartum; hemochromatosis;-> SYSTOLIC dysfunction
2232
Q1117:hypertrophic cardiomyopathy
2233
often asymmetric; involves intraventricular septum;50% familial (AD);sudden death in young athletes;loud S4**; strong apical impulse; systolic murmur;treat with B-blockers;> DIASTOLIC dysfunction
2234
Q1118:restrictive/obliterative cardiomyopathy
2235
2236
Q1119:MR
2237
2238
Q1120:AS
2239
crescendo-decrescendo systolic; following an ejection click;LV >> aortic pressure in systole;radiates to carotids; apex;*pulsus parvus et tardus*
2240
Q1121:VSD
2241
holosystolic
2242
Q1122:MVP
2243
2244
Q1123:AR
2245
2246
Q1124:MS
2247
delayed rumbling late diastolic;follows opening snap;LA >> LV during diastole (takes a lot to open the stenotic MV);**tricuspid stenosis murmur gets louder with INSPIRATION** (b/c more blood to lungs)
2248
Q1125:pDA murmur
2249
2250
2251
2252
2253
2254
Q1128:virchow's triad
2255
2256
2257
compression of heart by fluid leads to low CO;equilibration of pressures in all 4 chambers**;hypotension; high JVP; pulsus paradoxus
2258
Q1130:Aschoff bodies
2259
=granulomas with giant cells;found in rheumatic heart disease;also see Anitschkow's cells (activated histiocytes)
2260
Q1131:hydralazine
2261
increases cGMP: sm musc relaxation;vasodilates arterioles > veins;REDUCED AFTERLOAD;SEs: tachycardia; fluid retention; lupus like syndrome
2262
Q1132:CCBs
2263
block L-type Ca channels;->reduced cardiac contractility;nifedipine better vascular sm muscle;verapamil better heart muscle;SEs: cardiac depression; edema; flushing; constipation
2264
2265
release NO in smooth muscle: increased cGMP ;veins >> arteries;REDUCED PRELOAD;for angina; pulmonary edema
2266
Q1134:digoxin
2267
inhibits Na/K/ATPase;->increased Na-i leads to increased Ca-i (b/c Na won't come in using Na/Ca antiport);EKG changes;>low QT; scooping of ST; T wave inversion*;used for CHF; a-fib (low AV);SEs;-> n/v; van gogh vision; arrhymthmias
2268
2269
increased [ ] with renal failure;hypokaleima potentiates effects (low K = more K out; Na in);quinidine decreases clearance;*treat Dig toxicity with K+ admin (or Mg+)
2270
2271
acebutolol and pindolol;not recommended for pts with angina (can exacerbate)
2272
2273
verapamil;->1st gen CCB that has strong negative inotropic effect;dilitiazem;->mild to mod negative inotrope;*amlodipine and felodipine are used in CHF pts (can actually increase contractility)
2274
Q1138:treatment of WPW
2275
don't use an agent that slows AV node conduction (will increase propensity to go to bypass tract);DO use ibutilide (K channel blocker);->disrupts reentry circuits and increases refractory period of the bypass tract
2276
2277
dilitiazem (IV);-inhibits Ca into vascular sm muscle and myocardium;-AV node blocker;*amiodarine takes 1-3 weeks to work properly
2278
2279
endocardial cushion defect (??);or maybe ASD/VSD;20% have congenital cardiac abnormalities
2280
2281
capillaries (have the largest cross-sectional area);velocity from highest to lowest;aorta > vena cavae > large veins > small arteries > arterioles > small veins > venules > capillaries
2282
Q1142:Churg-Strauss syndrome
2283
aka allergic granulomatosis and angiitis;variant of PAN--> ass'd with asthma and eosinophilia;vascular lesions; granulomas; GI vasculitis
2284
2285
affects small/med arteries;->esp GI tract and kidneys;fibrinoid necrosis of vessels w/ polys; eos; monos;often young adult males;Tx: steroids; cyclophosphamide
2286
2287
hypoxia causes dilation of small arterioles and arteries;also: low blood viscosity; decreased PVR; low splanchnic blood flow
2288
2289
rhabdomyoma;composed of cells that resemble skeletal muscle;**common in kids with tuberous sclerosis
2290
2291
blocks re-uptake of NE
2292
2293
50% (greatest fall in bp occurs as blood goes thru arterioles);highest ratio of wall to cross-sectional area to lumen crosssectional area
2294
Q1148:leukocytoclastic angiitis
2295
=microscopic PAN;smaller affected vessels;vasculitis w/hemorrhage to skin (palpable purpura);many fragmented neutrophils;*penicillin is a common trigger
2296
2297
2298
2299
4th week;(heart forms and starts beating almost immediately);6th week = heart is fully formed (so difficult to prevent congenital malformations b/c heart forms so early)
2300
2301
smooth muscle cells in media of arterioles;leads to increase in intracellular Ca [smooth muscle contraction]
2302
2303
ostium primum (most common type in general is the ostium secundum);can also be associated with tricuspid and mitral valve abnormalities;*L-R shunts with late cyanosis (when reversal occurs)
2304
2305
pressure that exists when heart has been stopped and blood has been redistribuited equally;as MSFP increases; there is more venous return to heart;**venous system is important blood reservoir (normal fxn can be resored w/20% of blood loss)
2306
2307
adenosine;(ATP degrades to adenosine);adenosine then dilates vessels allowing increased coronary blood flow
2308
2309
develops years after transplant;intimal thickening of coronary arteries w/out atheroma formation or inflammation;leads to progressive stenosis;chest pain DOES NOT accompany the ischemia--> sudden death;**can't be prevented with current immunosuppresive Tx
2310
2311
2312
2313
mitral valve prolapse and aortic root dilatation ;[occur late in adolescence or adulthood]
2314
Q1158:___% of those with ischemic heart disease will present with death
2315
25%
2316
2317
A BEAM;atenolol; betaxolol; esmolol; acebutalol; metroprolol;non-selective: labetalol (also adds alpha 1); timolol; nadolol
2318
2319
2320
2321
the fetal iliac arteries (supply unoxygenated blood to the placenta);umbilical vein takes newly oxygenated blood from placenta to fetal liver then to IVC via the ductus venosus
2322
2323
2324
2325
2326
2327
lymphatic malformations resembling hemangiomas;-->a feature of Turner syndrome that contributes to the 'webbed neck';(and remember; Turner is associated with coarctation of the aorta)
2328
2329
dyslipidemia
2330
Q1166:ovary drainage
2331
R ovary = ovarian vein to IVC;L ovary = ovarian vein to RENAL VEIN to IVC
2332
2333
beta blocker (metoprolol);Sx: sustained apical impulse; loud S4; systolic ejection murmur;echo = systolic anterior motion of mitral valve; assymetic LVH; early closing of aortic valve
2334
Q1168:appearance of amyloidosis
2335
2336
Q1169:TPR
2337
2338
2339
2340
2341
blood flow normal in upper and lower body ;but there is increased arterial pressure in upper body;->lower vascular resistance in lower body (b/c resistance = pressure / flow)
2342
2343
RVH
2344
Q1173:endocardial fibroelastosis
2345
probably related to intrauterine viral infection (mumps);thickened endocardium w/fibrous and elastic tissue;LV is most commonly involved;other findings = mural thrombi; flattened trabeculae and stenosed valves;*infantile and adolescent forms
2346
2347
popliteal artery;-divides into anterior tibial; posterior tibial and peroneal;-emerges from superficial femoral artery
2348
2349
prominent RV impulse;systolic ejection murmur heard in pulmonic area;fixed split S2;*due to abnormal L-R shunt [creates volume overload on R side]
2350
2351
RV ;[a saddle PE causes acute cor pulmonale with abrupt RV dilation];*acute cor pulmonale is a surgical emergency
2352
2353
between the epicardium [visceral pericardium] and parietal pericardium;(aka the pericardial space)
2354
2355
mexiletine;(class IB anti-arrhythmic for treatment of VT);Na channel blocker and shortens AP duration
2356
Q1179:Which hormone increases HCl secretion by parietal cells; pepsinogen secretion by chief cells?
2357
Gastrin
2358
2359
Stimulates gall bladder contraction and relaxes sphincter of Oddi to allow pancreatic enzyme secretion.
2360
2361
CCK
2362
Q1182:Which hormone is stimulated by low pH to increase pancreatic bicarb secretion and increase bile production (and decrease gastric H production?)
2363
Secretin
2364
2365
GIP
2366
2367
Motolin
2368
Q1185:Which hormone is turned on when the acid in the stomach is below pH3 to inhibit basically everything?
2369
Somatostatin
2370
2371
TSH and GH
2372
Q1187:Action of Histamin?
2373
2374
Q1188:Tumor of non alpha and non beta islet cells of the pancrease that causes watery diarrhea secretes this:
2375
VIP (VIPoma)
2376
Q1189:Which hormone relaxes intestinal sm mm; increases pancreatic bicarb secretion; and stimulates intestinal secretion of electrolytes and water?
2377
VIP
2378
Q1190:This hormone is released from vagal nerve endings to mediate the release of gastrin.
2379
GRP
2380
2381
2382
2383
I cells
2384
2385
decreases it.
2386
2387
2388
2389
body/corpus
2390
2391
2392
2393
submandibular
2394
Q1198:Which hormone is the primary regulator of bicarb secretion from the pancreas?
2395
secret
2396
2397
alpha
2398
Q1200:actions of gastrin?
2399
2400
2401
sm peptides; amino acids in stomach lumen; stomach distention; vagus (via GRP)
2402
2403
I cells of duodenum
2404
2405
1. stim gallbladder contraction and Oddi relaxation; 2) stim pancreatic enzyme secretion; 3) potentiates secretin-induced stim of pancreatic bicarb secretion; 4) stim growth of exocrine pancrease; 5) inhibits gastric empyting
2406
2407
small peptides; amino acids; fatty acids and monoglycerides (not TGs b/c can't cross intestinal membrane)
2408
Q1205:actions of secretin?
2409
1. stim pancreatic bicarb (potentiated by CCK) and inc'd growth of exocrine pancrease; 2) stim bicarb and H2O secretion by liver and inc'd bile production; 3) inhibits H+ by gastric parietal cells
2410
2411
2412
2413
1. stimulates insulin release (this is why oral glucose better!) 2. inhibits H+ secretion
2414
2415
fatty acids; amino acids; oral glucose (only GI hormone that responds to fat; protein; and carbs!)
2416
2417
vagal stimulation
2418
Q1210:effect of His on GI
2419
increased H+ secretion directly and indirectly by potentiating effects of gastrin and vagal stim
2420
Q1211:actions of VIP?
2421
2422
2423
2424
Q1213:gastroileal reflex?
2425
2426
Q1214:gastrocolic reflex?
2427
2428
Q1215:composition of saliva
2429
high K+; HCO3-; low NaCl (hypotonic; unless made rapidly); alpha amylase; lingual lipase; kallikrein
2430
2431
2432
2433
2434
2435
always ISOTONIC; more bicarb than in plasma; if low flow rate--high Na Cl; if high flow rate--high Na HCO3-
2436
2437
2438
2439
2440
2441
facilitated diffusion
2442
2443
2444
2445
no activation of pancreatic proteases b/c it converts tyrpsinogen into trypsin and tryspin then cleaves all the others
2446
2447
2448
2449
cause steatorrhea b/c apo B necessary for transporting chylomicrons out of intestinal cells
2450
2451
2452
2453
toxin binds R in luminal membrane; activates AC which causes increase cAMP--> lumenal Cl- channels open. Na and H2O follow Cl--> secretory diarrhea!!
2454
2455
2456
2457
increased motility; increased secretions; increased relaxation of sphincters (except LES which contracts); increased gastrin release
2458
2459
2460
2461
2462
Q1232:Sources of gastrin
2463
2464
Q1233:Actions of gastrin
2465
2466
Q1234:Source of secretin
2467
2468
2469
2470
Q1236:Actions of secretin
2471
2472
Q1237:Source of CCK
2473
2474
2475
2476
Q1239:Actions of CCK
2477
Inhibits gastric emptying; stimulates pancreatic enzyme secretion; stimulates contraction of the gallbladder and relaxation of sphincter of Oddi.
2478
Q1240:Source of GIP
2479
Duodenum
2480
2481
2482
Q1242:Actions of GIP
2483
2484
2485
Stretch stimulates contraction; electrical syncytium with gap junctions; pacemaker activity
2486
2487
Acid in the duodenum (secretin); fat in the duodenum (CCK); hypoerosmolarity in duodenum; distension of duodenum
2488
2489
2490
2491
2492
2493
2494
2495
2496
2497
Low in NaCl because of reabsorption; High in K and HCO3 because of secretion; alpha-amylase begins digestion of carbs; fluid is hypotonic due to NaCl reabsorption and impermeability of ducts to water
2498
Q1250:Parietal cells
2499
Located in the middle part of the gastric glands. Secrete HCl and intrinsic factor.
2500
Q1251:Chief cells
2501
Located in the deep part of the gastric glands. Secrete pepsinogen which is converted to pepsin by acid medium. Pepsin begins digestion of proteins to peptides
2502
2503
Located in the superficial part if the gastric glands (gastric pits). Secrete mucus and HCO3. Secretion is stimulated by PGE2
2504
2505
High in H+; K+ and Cl-; low in Na+. Vomiting produces metabolic alkalosis and hypokalemia.
2506
2507
2508
2509
CO2 is extracted from the blood and combined into H2CO3 by carbonic anhydrase. H+ ions are exchanged by the proton pump for K+ ions (active antitransport)
2510
Q1256:Pancreatic amylase
2511
2512
Q1257:Pancreatic lipase
2513
Needs colipase which displaces bile from surface of micelles. Lipase digests triglycerides to two free fatty acids and one 2monoglyceride
2514
Q1258:Cholesterol esterase
2515
2516
Q1259:Pancreatic proteases
2517
Trypsinogen is converted to trypsin by enterokinase --> chymotrypsinogen is converted to chymotrypsin by trypsin -> procarboxypeptidase is converted to carboxypeptidase by trypsin
2518
2519
Isotonic due to permeability of ducts to water and high in HCO3. Stimulated by CCK and secretin.
2520
2521
Cholic acid and chenodeoxycolic acid. Synthesized in the liver from cholesterol.
2522
2523
Bile acids (cholic and deoxycholic) are conjugated with glycine and taurine which mix with cations to form salts.
2524
2525
Formed by deconjugation of bile salts by enteric bacteria deoxycholic acid (from cholic acid) and lithocolic acid (from chenodeoxycholic acid). Lithocholic acid is hepatotoxic and is excreted.
2526
Q1264:Enterohepatic circulation
2527
Bile acids are reabsorbed only in the distal ileum. Resection or malabsoption syndromes lead to steatorrhea and cholesterol gallstones.
2528
2529
Conjugated bile acids (cholic and chenodeoxycholic); billirubin; lecithin and cholesterol.
2530
2531
Glucose and galactose via active secondary Na cotransporter. Fructose is absorbed independently
2532
2533
2534
2535
Micelles diffuse to the brush border then digested lipids (2monoglycerides; fatty acids; cholesterol and ADEK vitamins) diffuse into enterocytes. Triglycerides are resynthesized and packaged as chylomicrons with apoB48. Leave the intestine via lymphatics to thoracic duct.
2536
Q1269:source of gastrin
2537
2538
Q1270:source of CCK
2539
2540
Q1271:source of secretin
2541
s cells; duodenum
2542
Q1272:action of gastrin
2543
2544
Q1273:action of CCK
2545
2546
Q1274:action of secretin
2547
2548
Q1275:regulation of gastrin
2549
decreased when stomach pH <1.5;increased when stomach is distended; presence of AA and peptides;increased in vagal stimulation
2550
Q1276:regulation of CCK
2551
2552
Q1277:regulation of secretin
2553
2554
Q1278:source of somatostatin
2555
2556
2557
2558
2559
2560
2561
2562
2563
2564
Q1283:regulation of GIP
2565
2566
2567
oral
2568
Q1285:source of VIP
2569
2570
Q1286:action of VIP
2571
increases intestinal water absorption ;relaxation of intestinal smooth muscle and sphincters
2572
Q1287:regulation of VIP
2573
2574
Q1288:what is VIPoma
2575
non-alpha; non-beta islet cell pancreatic tumor that secrete VIP --> copious watery diarrhea
2576
Q1289:action of NO on GI tract
2577
2578
2579
2580
2581
mucosal cells;stomach;duo
2582
2583
2584
2585
2586
2587
2588
2589
2590
2591
2592
2593
2594
2595
G cells (antrum)
2596
2597
2598
2599
S cells (duodenum)
2600
2601
2602
2603
2604
2605
2606
2607
2608
2609
2610
2611
2612
2613
2614
2615
2616
2617
2618
2619
2620
2621
2622
2623
Binds B12
2624
2625
decreased stomach pH
2626
2627
2628
2629
2630
2631
2632
2633
2634
2635
2636
2637
2638
2639
2640
2641
Low pH
2642
2643
Vagal input
2644
2645
Histamine;ACh;Gastrin
2646
2647
Somatostatin;GIP;Prostaglandins
2648
2649
2650
2651
Secretin
2652
2653
2654
2655
2656
2657
2658
2659
2660
2661
2662
2663
Starts digestion;Hydrolyzes alpha-1;4 linkages to give maltose; maltotriose; and alpha-limit dextrans
2664
2665
2666
2667
Duodenal lumen
2668
2669
Duodenum
2670
2671
Jejunum
2672
2673
2674
2675
2676
2677
2678
2679
2680
2681
2682
2683
2684
2685
2686
2687
2688
2689
2690
2691
2692
2693
2694
2695
2696
Q1349:treatment of SIADH?
2697
2698
2699
~25%
2700
2701
2702
Q1352:over what range of pressures does renal blood flow remain constant (autoregulation)
2703
2704
2705
use PAH; which is both filtered and secreted by renal tubules (so that~none in renal veins); this is the effective RPF
2706
Q1354:filtration fraction?
2707
GFR/RPF (normal~0.20)
2708
2709
(carbonic anhydrase inhibitor) works in PCT to inhibit resorption of HCO3- (w/o bicarb; don't have H+ needed for Na-H antiport) (N.B. can also tx acute mountain sickness)
2710
2711
early PCT--Na resorb.coupled with glucose; aa; phosphate; etc; mid/late PCT--Na resorb.w/ Cl-
2712
2713
in CCD
2714
2715
2716
2717
2718
2719
only in PCT. ~15% of filtered phosphate excreted (imp for buffering later on)
2720
2721
PTH inhibits phosphate resorb. in PCt via inc'd AC->cAMP. (get phosphaturia and inc'd urinary cAMP)
2722
2723
loop diuretics
2724
2725
2726
2727
hyperkalemia inhibits NH3 synthesis (RTA type 4); dec'd H+ excretion; hyPOkalemia--stim NH3 synthesis
2728
2729
ECF volume contraction-->HCO3- resorb; contraction alkalosis (N.B. in vomiting; met alk made worse if ECF vol contracts!)
2730
Q1366:why might you get tingling; numbness; muscle spasms in respiratory alkalosis?
2731
signs/symptoms of hypocalcemia; b/c H+ and Ca2+ compete for protein binding sites and dec'd H+ means more bound Ca and less free Ca (~hypocalc.)
2732
2733
insulin deficiency--> shift of K+ out of cells; hyperkalemia; insulin-->shift of K+ into cells; hypokalemia
2734
Q1368:what happens to osmolarity of ECF if person is infused with isotonic saline solution?
2735
2736
Q1369:what happens to osmolarity of ECF if person has loss of isotonic fluid? (example)
2737
2738
2739
incresaes
2740
2741
2742
2743
decreases
2744
2745
2746
2747
2748
2749
2750
2751
decrease (ICF shrinks to accomodate the increased osmolarity in ECF; this dilutes out the plasma protein)
2752
2753
protein increases;hct stays same b/c fluid leaves rbcs to offset fuid loss
2754
2755
decreases;stays same
2756
2757
plasma protein increases;hct increases (from decreased ECF volume and rbc swelling from water entry)
2758
Q1380:how does vasoconstriction of renal arterioles affect RBF? how is this achieved?
2759
decreases RBF;SNS
2760
2761
preferentially constricts efferent arterioles unless it is a situation where there is a massive hemorrhage. then; so much AII is released that it constricts both efferent and afferent arterioles
2762
2763
2764
2765
increases it
2766
2767
2768
2769
decreases
2770
2771
2772
2773
2774
2775
2776
2777
nothing
2778
2779
nothing
2780
2781
decreases it
2782
2783
2784
2785
2786
2787
2788
2789
2790
2791
2792
2793
2794
2795
HCO3 is in the lumen and combines with H that is secreted into the lumen --> H2CO3;Carbonic anhydrase --> H20 + CO2 ;which re-enters the tubule and reforms as H2CO3 with CA ;the H is then secreted into the lumen and the HCO3 is reabsorbed
2796
2797
NKCC pump (blocked by furosemide): aids in reabsorbing Na; Cl; K ;K flows back out into lumen and the gradient drives the absorption of Mg and Ca ;also aids in the running of the NKCC pump
2798
2799
no
2800
2801
2802
2803
actively reabsorbs Na; Cl ;Ca absorption is controlled by PTH receptors found here
2804
2805
Na is reabsorbed in exchange for K/H (regulated by ALDOSTERONE!!!) ;reabsorption of water regulated by ADH (aquaporins)
2806
2807
2808
2809
2810
2811
1-alpha hydroxylase
2812
2813
2814
2815
2816
2817
2818
2819
vasodilate the afferent arterioles (that's why NSAIDS can --> ARF by inhibiting PG)
2820
2821
more H is secreted
2822
2823
DCT
2824
2825
PCT to decrease PO4 reabsorption ;DCT to increase Ca reabsorption ;stimulates 1-alpha hydroxylase in PCT
2826
2827
lung
2828
2829
2830
2831
2832
2833
2834
2835
2836
2837
increased glomerular pressure; increased peritulbuar pressure; increased RPF; increased GFR
2838
2839
decreased glomerular pressure; decreased peritulbuar pressure; decreased RPF; decreased GFR
2840
2841
decreased glomerular pressure; increased peritubular pressure; increased RPF; decreased GFR
2842
2843
increased glomerular pressure; decreased peritulbuar pressure; decreased RPF; increased GFR; increased FF
2844
2845
Oncotic pressure increases because filtered fluid increases protein concentration. Oncotic pressure is resposible for peritubular reabsorption
2846
2847
45 mmHg
2848
2849
27 mmHg
2850
2851
10 mmHg
2852
2853
120 ml/min
2854
2855
600 ml/min
2856
2857
2858
2859
2860
2861
Vasoconstriction of the efferent arteriole more than afferent -> maintains GFR
2862
Q1432:Filtered load
2863
Rate at which a substance filters into Bowman's capsule = FL = GFR x Free plasma concentration
2864
2865
Excretion = filtered load + (amount secreted - amount reabsorbed) = filtered load + transport OR urine concentration X urine flow rate
2866
Q1434:Characteristics of a Tm system
2867
Carriers become saturated; carriers have high affinity; low back leak. The filtered load is reabsorbed until carriers are saturated - the excess is excreted.
2868
2869
2870
2871
375 mg/min. Represents the maximum filtered load that can be reabsorbed when all carriers in the kidney are saturated (end of splay region).
2872
2873
At normal glucose levels; the amount filtered is the same as the amount reabsorbed. At threshold (beginning of splay); the excretion curve starts to ascend and the amount filtered exceeds the amount reabsorbed.
2874
2875
2876
2877
Carriers are not saturated; carriers have low affinity; high back leak
2878
2879
2880
2881
2882
2883
At low plasma concentration secretion is 4 times the filtered load. When carriers become saturated; secretion reaches a plateau and the amount excreted is proportional to the amount filtered.
2884
2885
Net transport rate = filtered load - excretion rate = (GFR X Px) - (Ux X V)
2886
2887
GFR and RBF are maintained constant within the autoregulatory range. Urine flow is directly proportional to blood pressure due to pressure natriuresis and pressure diuresis.
2888
2889
It's the volume of plasma cleared of a substance over time. Clearance = excretion / Px = Ux X V / Px
2890
2891
At normal glucose levels; clearance is zero. Above treshold levels; clearance increases as plasma concentration increases but never reaches GFR as there's always glucose reabsorption.
2892
2893
A constant amount of inulin is cleared regardless of plasma concentration (parallel line to x axis). Inulin clearance is equal to GFR because it's not secreted nor reabsorbed. If GFR increases; clearance increases (line shifts upward); and vice versa.
2894
2895
A constant amount of creatinine is cleared regardless of plasma concentration; but creatinine clearance is more than GFR because some is always secreted.
2896
2897
As plasma concentration increases; clearance decreases because carriers that mediate active secretion become saturated. At normal levels; PAH clearance = RPF because all is excreted.
2898
2899
GFR is equal to inulin clearance because it's only filtered and none is secreted nor reabsorbed. Cin = GFR = Uin X V / Pin
2900
2901
Creatinine production = creatinine excretion = filtered load of creatinine = [Cr]p X GFR. Creatinine is filtered and secreted; not reabsorbed.
2902
2903
Inulin becomes more concentrated as it passes through the tubules because water is being reabsorbed and not inulin.
2904
2905
Inulin clearance because it's filtered but not secreted nor reabsorbed.
2906
2907
PAH clearance because some is filtered and the remaining is all secreted.
2908
2909
2910
2911
2912
2913
Water is being eliminated. Hypotonic urine is being formed to increase plasma osmolarity.
2914
2915
Water is being conserved. Hypertonic urine is being formed to lower plasma osmolarity.
2916
2917
V - (Uosm(V) / Posm)
2918
2919
PAH
2920
2921
2922
2923
Glucose
2924
2925
Creatinine; PAH
2926
2927
2928
2929
Secondary Na/glucose cotransporter; secondary Na/amino acid cotransporter; secondary Na/H countertransporter
2930
Q1466:What substances are reabsorbed in the proximal tubule and how much?
2931
Na (2/3 of filtered load); glucose (100%); amino acids (100%); HCO3 (indirectly; 80%); H20 (2/3); K (2/3); Cl (2/3)
2932
2933
At the beginning and end is isotonic with plasma but only 1/3 of the filtered load.
2934
2935
2936
2937
2938
2939
2940
2941
Descending limb is permeable to water so water difuses out and intraluminal osmolarity increases to 1;200mOsm Ascending limb is impermeable to water and Na is actively pumped out by Na/K/2Cl pump so fluid becomes hypotonic. Flow is slow; anything that increases flow; decreases capacity to concentrate urine.
2942
2943
Impermeable to water unless ADH is present. ADH increases permeability to H20 and urea to concentrate urine. Tight junctions with little back-leak.
2944
2945
2946
2947
Aldosterone increases Na receptors in the membrane and increases primary transport by Na/K ATPase. Secondary transport of Na and secretion of K.
2948
2949
2950
2951
Reabsorption of Na and secretion of K (stimulated by aldosterone); acidification of the urine (secretion of H and creation of HCO3)
2952
2953
H2PO4- (dihydrogen phosphate) (tritratable acid) buffers 33% of secreted H. NH4+ (amonium) (nontritratable acid) buffers the remaining secreted H.
2954
2955
High concentration of ECF H --> H diffuses to ICF --> K diffuses to ECF --> hyperkalemia
2956
2957
Low concentration of ECF H --> H diffuses to ECF --> K diffuses to ICF --> hypokalemia
2958
2959
2960
2961
2962
2963
2964
2965
2966
2967
2968
2969
2970
2971
2972
2973
2974
2975
Hypokalemia
2976
2977
Hyperkalemia
2978
Q1490:What is the difference in potassium dynamics between acute and chronic alkalosis?
2979
Acute alkalosis --> increased intracellular K; Chronic alkalosis --> decreased intracellular K
2980
Q1491:What is the difference in potassium dynamics between acute and chronic acidosis?
2981
Acute acidosis --> decreased renal K excretion; positive K balance; Chronic acidosis --> increased renal K excretion; negative K balance
2982
2983
Hypoventilation --> increased PaCO2 --> increased H and slight increased in HCO3 --> decreased pH
2984
2985
Hyperventilation --> decreased PaCO2 --> decreased H and HCO3 --> increased pH
2986
2987
Gain of H or loss of HCO3 --> decreased HCO3 --> decreased pH. To see if gain of H or loss of HCO3 check anion gap.
2988
2989
Loss of H or gain in HCO3 --> increased HCO3 --> increased pH. To see if gain of H or loss of HCO3 check anion gap.
2990
2991
2992
Q1497:increased pH; increased HCO3; increased PCO2; decreased PO2; alkaline urine
2993
2994
Q1498:decreased pH; increased PCO2; increased HCO3; decreased PO2; acid urine
2995
2996
Q1499:increased pH; decreased PCO2; decreased HCO3; normal PO2; alkaline urine
2997
2998
Q1500:decreased pH; decreased PCO2; decreased HCO3; normal PO2; acid urine
2999
3000
3001
PAG = 12
3002
3003
3004
3005
Loss of HCO3 (as in diarrhea) causes increases absorption of solutes and water; increasing Cl. Therefore decreased HCO3 and increased Cl with a plasma anion gap of 12.
3006
3007
3008
Q1505:TBW indicators
3009
3010
Q1506:ECF indicators
3011
3012
Q1507:PV indicators
3013
3014
Q1508:100 mM glucose =
3015
100 osm
3016
Q1509:100 nM NACL
3017
200 mOsm/L
3018
Q1510:Filtered Load =
3019
3020
Q1511:Excretion:
3021
3022
Q1512:Clearance Concept
3023
3024
Q1513:Clearance Calculation
3025
C= U*V/Ps;Cs: Clearance of substance;U: urine concetration of substance;V: Urine flow;P: Plasma concentration
3026
3027
3028
3029
Creatinine
3030
3031
3032
3033
3034
3035
vasa recta
3036
Q1519:Filtration fraction
3037
GFR/RBF
3038
Q1520:Filtration
3039
3040
Q1521:Myogenic autoregulation
3041
Increase in arterial pressure; stretches vessel wall leading to an icnrease in calcium movement and contraction
3042
Q1522:Tubuloglomerular feedback
3043
decrease in arterial pressure causes decrease in GFR; decreasing NACL to macula densa; Therefore efferent arteriolar resistnace Increases in response to HIGH angiotensin II.
3044
3045
3046
3047
3048
3049
3050
3051
3052
Q1527:Proximal Tubule
3053
3054
3055
Na/H antiport;Cl/Anion antiport ;Na/K Atpase;*Water follows non Cl reabsorption and icnreases tubular fluid of Cl.
3056
3057
Secreted
3058
3059
Reabsorbs 15% GFR;Tbublular fluid volume DECREASES ;Tubular fluid osmolarity INCREASES
3060
3061
break
3062
Q1532:Reabsorption of Na
3063
3064
Q1533:Reabsorption of K
3065
3066
Q1534:Reabsorption of Ca
3067
3068
Q1535:Reabsorption of MG
3069
3070
Q1536:SECRETION of H
3071
3072
3073
3074
3075
Thiazide diuretics
3076
Q1539:LAte Tubule
3077
3078
Q1540:Secretion of K determines
3079
total excretion
3080
Q1541:Collecting Duct
3081
3082
3083
DCT
3084
3085
3086
3087
inversely related
3088
3089
3090
3091
3092
3093
3094
3095
3096
3097
3098
3099
opsmotic diuresis
3100
Q1551:ANP will
3101
Increase GFR;Decrease REnin; angio II; aldosterone; NACL and H2o reapbsortopn; ADH secretion
3102
Q1552:ADH will
3103
Increase H20 reabsorption; decrease urine flow and Increase urine osmolarity
3104
3105
3106
3107
3108
Q1555:Decrease in Ventilation
3109
3110
3111
Metabolic response
3112
3113
Just know
3114
3115
3116
3117
3118
3119
3120
3121
respiratory bronchioles;
3122
3123
3124
3125
terminal bronchioles.
3126
3127
goblet cells
3128
Q1565:Pneumocytes;%'s
3129
3130
3131
3132
3133
-secrete pulmonary surfactant;-serve as precursors to type I cells and other type II cells. Type II cells
3134
3135
3136
3137
3138
3139
3(segmental) bronchus ;- 2 arteries (bronchial ;and pulmonary) in the center - veins and lymphatics drain along the borders.
3140
3141
the heart. The relation of the ;pulmonary artery to the ;bronchus at each lung hilus ;is described by RALS ;Right Anterior; Left ;Superior.
3142
3143
-T8: IVC;-T10: esophagus; vagus (2 trunks);-At T12: aorta (red); thoracic duct (white); azygous vein (blue).
3144
3145
the shoulder.
3146
3147
Inspirationexternal intercostals; scalene muscles; sternomastoids;Expirationrectus abdominis; internal and external obliques; transversus abdominis;internal intercostals.
3148
3149
-Surfactant;-ACE;-Prostaglandins;-histamine;-Kallikrein
3150
Q1576:Surfactant;aka
3151
3152
Q1577:Collapsing pressure =
3153
2T/R;T=tension;R= radius
3154
3155
Kallikrein
3156
Q1579:role of Kallikrein
3157
activates bradykinin
3158
3159
3160
3161
3162
Q1582:role of surfactant/mech
3163
3164
Q1583:TLC =
3165
IRV + TV + ERV + RV
3166
Q1584:VC =
3167
TV + IRV + ERV
3168
3169
VC
3170
Q1586:IRV + TV + ERV + RV
3171
TLC
3172
3173
3174
3175
3176
3177
3178
3179
a hypoxic vasoconstriction that shifts blood away from ;poorly ventilated regions of lung to well-ventilated regions of lung.
3180
3181
O2 (normal health);-CO2;-N2O;Gas equilibrates early along the length of the capillary. Diffusion can be increased only if blood ?ow increased .
3182
3183
O2 (exercise; emphysema;?brosis);-CO;-Gas does not equilibrate by the time blood reaches the end of the capillary.
3184
3185
Normal pulmonary artery pressure = 1014 mm Hg; or >35 mm Hg during exercise;-pulmonary HTN25 mm Hg
3186
3187
Primaryunknown etiology; poor prognosis;;Secondary usually caused by COPD; also can be caused by L R shunt.
3188
Q1595:O2 content =
3189
3190
3191
O2 content of arterial blood decreased as [Hgb] falls;but O2 saturation and arterial PO2 do not.
3192
3193
3194
3195
-1 g Hgb can bind 1.34 mL O2;-Hgb amount in blood is 15 g/dL;-O2 binding capacity 20.1 mL O2 / dL.
3196
3197
-hypoxemia; causes include ;shunting; high V/Q mismatch; ?brosis (diffusion block)
3198
3199
3200
Q1601:Haldane effect
3201
3202
Q1602:Bohr effect
3203
3204
3205
1. Acute increased in ventilation;2. Chronic increased in ventilation;3. increased erythropoietin ;4. increased 2;3-DPG ;5. Cellular changes (increased mitochondria);6. increased renal excretion of bicarbonate to ;compensate for the respiratory alkalosis;7. Chronic hypoxic pulmonary vasoconstriction results in RVH
3206
3207
3208
3209
3210
3211
associated with bullae can rupture pneumothorax;often in young; otherwise healthy males.
3212
Q1607:associated with bullae can rupture pneumothorax;often in young; otherwise healthy males.
3213
Paraseptal emphysema
3214
Q1608:Emphysema ;pathology
3215
increased elastase activity;Enlargement of air spaces and decreased recoil resulting from destruction of alveolar ;walls.
3216
3217
Hypertrophy of mucus glands in the bronchioles Reid index = gland depth / total thickness of bronchial wall; in COPD; Reid index > 50%.
3218
Q1610:Reid index
3219
gland depth / total thickness of bronchial wall; in COPD; Reid index > 50%.
3220
Q1611:Bronchiectasis ;pathology
3221
3222
Q1612:Bronchiectasis ;complications
3223
3224
Q1613:causes of Bronchiectasis
3225
Associated with bronchial obstruction; CF; poor ciliary motility; Kartageners ;syndrome.
3226
Q1614:Asthma triggers
3227
3228
3229
a. Poor muscular effortpolio; myasthenia gravis;b. Poor structural apparatusscoliosis; morbid obesity
3230
3231
1. (ARDS) 2. Neonatal RDS ;3. Pneumoconioses ;4. Sarcoidosis;5. Idiopathic pulmonary ?brosis;6. Goodpastures syndrome;7. Wegeners granulomatosis;8. Eosinophilic granuloma
3232
3233
3234
3235
3236
3237
Diffuse alveolar damageincreased alveolar capillary permeability protein-rich leakage into alveoli. Results in formation of intra-alveolar hyaline membrane.
3238
3239
3240
Q1621:Sleep apnea;types
3241
Central sleep apneano respiratory effort;Obstructive sleep apnearespiratory effort ;against airway obstruction.
3242
Q1622:Sleep apnea;define
3243
3244
Q1623:Sleep apnea;complications
3245
3246
Q1624:Asbestosis;mech
3247
3248
Q1625:asbestos;wrt malignancy
3249
3250
3251
Asbestosis Mainly affects lower lobes. Other pneumoconioses ;affect upper lobes (e.g; coal worker's lung).
3252
3253
Asbestosis and smoking greatly;increased risk of bronchogenic cancer (smoking not additive with mesothelioma).
3254
Q1628:Asbestosis;histo
3255
Ferruginous bodies in lung (asbestos ?bers coated with hemosiderin). Ivory-white pleural plaques
3256
3257
3258
3259
3260
3261
3262
3263
3264
Q1633:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-Absent/decreased over affected area ;-decreased ;decreased ;-Toward side of lesion
3265
Bronchial obstruction
3266
Q1634:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-decreased over effusion ;-Dullness ;-decreased ;NC
3267
Pleural effusion
3268
Q1635:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-May have bronchial ;breath sounds over lesion;Dullness ;-increased ;-NC
3269
Pneumonia (lobar)
3270
Q1636:Breath Sounds; Resonance; Fremitus; Tracheal Deviation;-decreased ;-Hyperresonant ;-Absent ;-Away from side of lesion
3271
Pneumothorax
3272
Q1637:Lung cancer;complications
3273
SPHERE of complications;-Superior vena cava syndrome;Pancoasts tumor;-Horners syndrome;-Endocrine (paraneoplastic);-Recurrent laryngeal symptoms;(hoarseness);-Effusions (pleural or ;pericardial)
3274
3275
3276
3277
3278
3279
3280
3281
3282
3283
3284
3285
3286
3287
3288
3289
3290
3291
3292
Q1647:Lung cancer histology;Neoplasm of neuroendocrine ;Kulchitsky cells small dark ;blue cells
3293
3294
3295
3296
Q1649:Lung cancer histology;Clara cells type II pneumocytes multiple densities on x-ray of chest.
3297
3298
3299
3300
3301
Both Types: Clara cells type II pneumocytes multiple densities on x-ray of chest.
3302
3303
3304
3305
3306
3307
Adenocarcinoma: Bronchial
3308
3309
Adenocarcinoma: Bronchial
3310
3311
Adenocarcinoma: Bronchoalveolar
3312
3313
3314
3315
3316
3317
3318
3319
3320
3321
3322
3323
Carcinoid tumor
3324
Q1663:Lung cancer characteristics;most common. Brain (epilepsy); bone (pathologic fracture); and liver (jaundice;hepatomegaly).
3325
Metastases
3326
3327
cough; hemoptysis; bronchial ;obstruction; wheezing; pneumonic coin lesion on x-ray ?lm.
3328
Q1665:cough; hemoptysis; bronchial ;obstruction; wheezing; pneumonic coin lesion on x-ray ?lm.
3329
Lung cancer
3330
3331
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus; causing ;Horners syndrome.
3332
Q1667:Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus; causing ;Horners syndrome.
3333
Pancoasts tumor
3334
Q1668:Kulchitsky cells
3335
Enterochromaffin (EC) cells (Kulchitsky cells) are a type of enteroendocrine cell[1] occurring in the epithelia lining the lumen of the gastrointestinal tract. also implicated in the origin of small cell lung cancer.
3336
Q1669:Lambert-Eaton syndrome;findings
3337
progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles; the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
3338
Q1670:Lambert-Eaton syndrome;causes
3339
3340
Q1671:progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles; the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
3341
Lambert-Eaton syndrome
3342
3343
oat-cell carcinoma
3344
3345
Small-cell carcinoma
3346
3347
Lobar - Pneumococcus usually;Bronchopneumonia - S. aureus; H. ?u; Klebsiella; S. pyogenes;Interstitial (atypical) pneumonia - viruses (RSV; adenoviruses); Mycoplasma;Legionella; Chlamydia
3348
3349
3350
Q1676:Bronchopneumonia Characteristics
3351
Acute in?ammatory in?ltrates ;from bronchioles into ;adjacent alveoli; patchy ;distribution involving 1 ;lobes
3352
3353
Diffuse patchy in?ammation ;localized to interstitial areas ;at alveolar walls; distribution involving 1 lobes
3354
3355
Lobar
3356
Q1679:Which type of pneumona;Acute in?ammatory in?ltrates ;from bronchioles into ;adjacent alveoli; patchy ;distribution involving 1 ;lobes
3357
Bronchopneumonia
3358
Q1680:Which type of pneumona;Diffuse patchy in?ammation ;localized to interstitial areas at alveolar walls; distribution involving 1 lobes
3359
Interstitial (atypical);pneumonia
3360
3361
Lobar
3362
3363
Bronchopneumonia
3364
3365
3366
3367
3368
3369
3370
Q1686:Interstitial pneumonia;aka
3371
atypical pneumonia
3372
Q1687:atypical pneumonia;aka
3373
Interstitial ;pneumonia
3374
3375
Bronchopneumonia
3376
3377
Bronchopneumonia
3378
3379
Bronchopneumonia
3380
3381
Bronchopneumonia
3382
3383
Localized collection of pus within parenchyma; usually resulting from bronchial ;obstruction (e.g; cancer) or aspiration of gastric contents (especially in patients ;predisposed to loss of consciousness; e.g; alcoholics or epileptics).
3384
3385
3386
3387
increased protein content; cloudy. Due to malignancy; pneumonia; collagen vascular disease;trauma.
3388
3389
Transudate
3390
3391
Transudate
3392
3393
Transudate
3394
3395
Transudate
3396
3397
Exudate
3398
3399
Exudate
3400
3401
Exudate
3402
3403
Exudate
3404
3405
Exudate
3406
3407
Exudate
3408
3409
Exudate
3410
3411
3412
3413
3414
3415
3416
3417
3418
3419
3420
3421
3422
3423
Allergy.
3424
3425
3426
3427
Isoproterenol
3428
3429
3430
Q1716:Asthma drugs;Isoproterenol;toxicity
3431
3432
3433
3434
3435
beta 2 agonist relaxes bronchial smooth muscle (beta 2). Use during acute exacerbation.
3436
3437
3438
Q1720:Asthma drugs;Salmeterol;toxicity
3439
3440
3441
Salmeterol
3442
3443
Theophylline
3444
3445
Methylxanthine - likely causes bronchodilation by inhibiting phosphodiesterase; thereby decreased ;cAMP hydrolysis.
3446
Q1724:Asthma drugs;Theophylline;tioxicity
3447
3448
Q1725:Asthma drugs;Usage is limited because ;of narrow therapeutic index (cardio and neuro toxicity).
3449
Methylxanthines: Theophylline
3450
3451
Ipratropium
3452
3453
3454
3455
Prevents release of mediators from mast cells. Effective;only for the prophylaxis of asthma. Not effective ;during an acute asthmatic attack.
3456
3457
1. Nonspeci?c beta -agonists ;2.beta 2 agonists ;3. Methylxanthines;4. Muscarinic antagonists ;5. Cromolyn ;6. Corticosteroids;7. Antileukotrienes
3458
Q1730:Cromolyn ;toxicity
3459
Toxicity is rare.
3460
3461
Beclomethasone; prednisone
3462
3463
inhibit the synthesis ;of virtually all cytokines. Inactivate NFB; the ;transcription factor that induces the production of ;TNF-alpha ; among other in?ammatory agents.
3464
3465
Beclomethasone; prednisone
3466
3467
Zileuton;Za?rlukast; montelukast
3468
3469
3470
3471
Zileuton
3472
3473
3474
3475
Za?rlukast; montelukast
3476
3477
Za?rlukast; montelukast
3478
Q1740:Expectorants;names
3479
-Guaifenesin (Robitussin);;-N-acetylcystine
3480
Q1741:Guaifenesin;aka
3481
Robitussin
3482
Q1742:Robitussin;aka
3483
Guaifenesin
3484
3485
Removes excess sputum but large doses necessary; does not suppress cough re?ex;Expectorants
3486
3487
Guaifenesin
3488
3489
N-acetylcystine
3490
3491
Mucolytic can loosen mucus plugs in CF patients;also used as an antidote for acetaminophen overdose
3492
3493
N-acetylcystine
3494
Q1748:What is the epithelium of the bronchi? What are some causes of ciliary dyskinesia?
3495
Pseudostratisfied ciliated columnar cells with goblet (mucus secreting) cells;Primary ciliary dyskinesia: AR disorder that renders cilia unable to beat;Secondary ciliary dyskinesia: cigarette smoking.
3496
3497
Bronchi: many layers of SMCs; cartilage is present; pseudostratified columnar; densely ciliated; diameter is independent on lung volume;Bronchioles: 1-3 layers of SMCs; no cartilage; simple columnar with few ciliated cells; diameter depends on lung volume.
3498
3499
Conducting bronchioles because they are arranged in series. Small airways are aligned in parallel; which reduces resistance greatly (1/= 1/R1+ 1/R2;).
3500
3501
Surfactant; alveolar epithelium (mostly type I pneumocytes); BM; and capillary epithelium.
3502
Q1752:What vertebral level does the trachea begin? What vertebral level does the trachea bifurcate?
3503
The trachea begins just inferior to the cricoid cartilage; C6; and ends at the sternal angle (T4) level where it bifurcates.
3504
3505
Vd = Vt * ((PACO2 - PECO2)/PACO2) ;Vt = tidal volume;PACO2 = PCO2 of alveolar gas;PECO2 = PCO2 of expired air
3506
3507
3508
Q1755:Which of the following can be measured by spirometry?;Tidal volume; total lung capacity; functional residual capacity; residual volume; vital capacity?
3509
Tidal volume and vital capacity. All other volumes listed contain residual volume which cannot be measured.
3510
3511
PV= k. Increasing lung volume decreases the pressure which allows atmospheric air to flow in the lungs (down a pressure gradient).
3512
3513
Inspiration: diaphragm and during exercise or respiratory distress: external intercostals; scalenes; sternocleidomastoids;Expiration: normally expiration is passive; but during exercise: internal intercostal; innermost intercostal; and abdominal muscles
3514
3515
Airway resistance: air molecules colliding with wall = friction;Compliance resistance: expansion of alveolar and paranchyma tissue;Tissue resistance: parietal and visceral pleura friction
3516
3517
Intrathoracic pressure increases which compresses airways and reduces airway diameter. Reduced airway diameter is the primary source of resistance.
3518
Q1760:Compliance work (resistance) is the energy required to overcome the intrinsic elastic recoil of the lungs. It accounts for 75% of the total work in breathing. Is compliance work increased or decreased in emphysema?
3519
Emphysema destroys lung paranchyma. Compliance work is decreases and inspiration is easy. Expiration is difficult.
3520
3521
Elastance will increase in restrictive lung diseases. Elastance = resist deformation. Is is inversely proportional to compliance. E = change in P/change in V.
3522
3523
Lung compliance (distensibility) is increased in emphysema and the tendency of the lungs to collapse decreases. The lungchest wall system will seek a higher FRC until the two opposing forces (tendency of the chest wall to expand and collapsing force of lung) reach a new equilibrium.
3524
3525
3526
3527
Phophatidylcholine (phospholipid) synthesized by type II alveolar cells and reduces surface tension by disrupting the intermolecular forces between liquid molecules. Lecithin:sphingomyelin ratio greater than 2:1 reflects mature levels of surfactant in the fetus.
3528
Q1765:What is Dalton's law of partial pressure? What is the partial pressure of oxygen in dry air; inspired air; alveolar air; systemic arterial blood; and venous blood?
3529
Partial pressure = total pressure * concentration of gas;O2: 160; 150; 100; 100; 40;CO2: 0; 0; 40; 40; 46
3530
3531
D = change in P * A * S / T;A = surface area;S = solubility coeff. of oxygen;T = distant oxygen must diffuse across pulmonary membrane
3532
Q1767:How is V/Q optimized for the most efficient gas exchange (ventilation matches perfusion)?
3533
3534
3535
V/Q at rest is 0.8. During exercise; V/Q approaches 1.0 and is more efficient. Under perfused areas become more perfused due to increased PA blood pressures and under ventilated areas become more ventilated (apices).
3536
Q1769:In terms of V/Q; whats the difference between a shunt and dead space?
3537
In a shunt V/Q approaches 0; e.g. airway obstructions;In dead space V/Q approaches infinity; e.g. pulmonary embolism occluding a pulmonary artery.
3538
Q1770:An A-a gradient greater than ____ mmHg indicates a pathological condition. How are both PAO2 and PaO2 calculated?
3539
3540
3541
Arterial partial pressure of oxygen in arterial blood is approximately 100 mmHg. At this PP; Hb is 100% bound. In venous blood; the PP of oxygen is 40 mmHg. At this PP; Hb is 75% bound to hemoglobin.
3542
Q1772:What are some causes of hypoxia with an increase in A-a gradient? Normal A-a gradient?
3543
Increased A-a: ventillation; perfusion; or diffusion defects; RL shunts;Normal A-a: CNS depression; phrenic nerve lesion; upper airway obstruction (?)
3544
Q1773:How come the pH of venous blood only drops to 7.26 (from 7.4) despite the large offloading of H+ (via CO2 + H20 yielding H + HCO3)? (In other words; who is buffering the H+ so efficiently)
3545
3546
3547
Cl ions are taken up by RBCs in exchange for HCO3. HCO3 is transported to the lungs via plasma. This is how CO2 is transported to the lungs.
3548
Q1775:20% of CO2 is transported in the blood by Hb. What is the Bohr effect?
3549
3550
Q1776:Where in the medulla is the respiratory center located? What part controls inspiration? Expiration?
3551
Reticular formation. Inspiration and the basic rhythm for breathing is controlled by the dorsal respiratory group. Expiration (not active in normal breathing) is controlled by the ventral respiratory group.
3552
3553
Apneustic center: lower pons; stimulates deep and prolonged inspiratory gasp;Pneumotaxic center: upper pons; inhibits inspiration; thus; regulating volume and rate
3554
3555
Central chemoreceptors respond to acidosis (high CO2 levels) in the CSF and in response they increase ventilation (breathing rate).
3556
Q1779:What do peripheral chemoreceptors in the carotid (via CNIX) and aortic (via CNX) bodies respond to?
3557
3558
3559
3560
3561
Lung stretch receptors. When stimulated by distention of the lungs they produce a reflex decrease in breathing frequency.
3562
3563
Initially; decrease PaO2 stimulates hyperventilation via peripheral chemoreceptors. This causes respiratory alkalosis. The increase pH inhibits the central chemoreceptor induction of hyperventilation. Meanwhile; the kidney excretes HCO3 in response to resp. alkalosis (1-3 days). When pH returns to normal; peripheral chemoreceptors can again stimulate hyperventilation.
3564
3565
Engorgement of the pulmonary capillaries stimulate the J receptors which then cause rapid; shallow breathing.
3566
Q1784:A claustrophobic girl is stuck in an elevator. Her vision becomes blurry and she feels dizzy; why?
3567
Hyperventilation decreases PaCO2. PaCO2 is a potent vasodilator for cerebral arteries. The decrease in oxygen delivery to the brain causes these symptoms.
3568
3569
Large-diameter airways. Mediate cough; sneeze and bronchoconstriction in response to noxious substances.
3570
3571
3572
3573
1) Hyperventilation;2) Renal hypoxia induces EPO = polycythmemia;3) Increased anaerobic metabolism increases 2;3-BPG production = right shift of Hb dissociation curve;4) Pulmonary hypoxic vasoconstriction = pulmonary hypertension
3574
3575
Is: abnormal pattern of breathing characterized by groups of quick; shallow inspirations followed by regular or irregular periods of apnea;Cause: damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla due to uncal or tentorial herniation. Or opioid use.
3576
3577
Is: periodic breathing amid higher PaCO2 to stimulate breathing. Characterized by oscillation of ventilation between apnea and tachypnea;Causes: head trauma.
3578
3579
Bodies response to metabolic acidosis. Rapid; deep breathing to expire CO2. Often occurs in type I diabetic patients experiencing ketoacidosis.
3580
Q1791:How is FEV1; FVC; and FEV1/FVC affected in asthma and COPD? How about in fibrosis?
3581
FEV1 is greatly reduced. FVC is reduced. FEV1/FVC is reduced;Fibrosis: FEV1 is reduced. FVC is greatly reduced. FEV1/FVC is either normal or increased.
3582
3583
Clara cells are located in the bronchioles and they secrete a component of surfactant; metabolize toxins; and release Cl ions into the lumen (cGMP-guanylate cyclase ion channel).
3584
3585
Type I pneumocytes are simple squamous epithelium joined by tight junctions (zonula occludens) that line alveoli and have no mitotic capacity;Type II pneumocytes are large and cuboidal shaped cells. They secrete surfactant (stored in lamellar bodies). They are stem cells that regenerate type I and type II pneumocytes.
3586
3587
These alveolar pores are found within interalveolar septae and equalize pressure within alveoli.
3588
3589
BCs: LTC4; LTD4; PGF; TxA2; and parasympathetic stimulation;BDs: PGE2; sympathetic stimulation (Beta-2 agonists).
3590
3591
3592
3593
Muscular; barrel-shaped chest; severe hypoxemia with cyanosis; hypercapnia leading to respiratory acidosis; RV failure; and systemic edema.
3594
Q1798:Tidal volume
3595
Volume of air that enters and leaves the lung in a single cycle. 500ml
3596
3597
3598
Q1800:Inspiratory capacity
3599
3600
3601
3602
3603
3604
Q1803:Residual volume
3605
3606
Q1804:Vital capacity
3607
3608
3609
3610
Q1806:Total ventilation
3611
3612
Q1807:Dead space
3613
3614
3615
3616
3617
3618
3619
3620
Q1811:Alveolar ventilation
3621
3622
Q1812:Lung recoil
3623
Force that collapses the lung. As the lung enlarges; recoil increases and vice versa.
3624
Q1813:Intrapleural pressure
3625
Normally -5 cmH2O. Force that expands the lung. The more negative; the more lung expansion.
3626
3627
Glotis is open but no air is flowing - alveolar pressure = 0. Intrapleural pressure and lung recoil are equal but opposite. Gravity decreases intrapleural pressure at the apex and increases it at the bases. Apex alveoli are more distended.
3628
3629
Diaphragm contracts; intrapleural pressure becomes more negative. Expansion of alveoli makes alveolar pressure negative causing air to flow into the lungs.
3630
3631
Intrapleural pressure and recoil are the same but opposite. Alveolar pressure returns to zero and air stops flowing in.
3632
3633
Diaphragm relaxes; intrapleural pressure increases; lung recoil collpases the lung. Alveoli compress tha air and alveolar pressure becomes positive and air flows out of the lungs until alveolar pressure is back to zero. Lung recoil and intrapleural pressure become equal but opposite.
3634
3635
3636
3637
Does not allow intraalveolar pressure to return to zero at the end of expiration. The larger lung volume prevents atelectasis.
3638
3639
It's the change in volume with a change in pressure. Increased compliance means more air flows in with a given change in pressure. Decreased compliance means the opposite. The steeper the slope of the lung inflation curve; the greater the compliance. Emphysema = very compliant; fibrosis = not compliant.
3640
3641
1) the tissue's collagen and elastin fibers and 2) the surface tension (greatest component)
3642
Q1822:Functions of surfactant
3643
Lowers lung recoil and increases compliance (decreased surface tension) more in small alveoli than large alveoli; reduces capillary filtration forces reducing tendency to develop edema.
3644
3645
Low surfactant --> increased recoil; decreased compliance (a greater change in intrapleural pressure is necessary to inflate the lungs); alveoli collapse (atelectasis); more negative intrapleural pressures promote capillary filtration (pulmonary edema)
3646
Q1824:Airway resistance
3647
R = 1/r4; first and second bronchi have less radius than alveoli; therefore more resistance. Ach increases resistance (bronchoconstriction); catecholamines decrease resistance (bronchodilation)
3648
3649
increased lung volume --> increased radius --> decreased resistance. The more negative the intrapleural pressure; the less resistance
3650
3651
increased TLC; increased RV; increased FRC; decreased FEV1; decreased FVC; decreased FEV1/FVC
3652
3653
decreased TLC; decreased RV; decreased FRC; decreased FEV1; decreased FEV; increased FEV1/FVC
3654
3655
3656
3657
3658
3659
3660
3661
3662
3663
3664
3665
decreased PACO2 --> increased PAO2 (hyperventilation); increased PACO2 --> decreased PAO2 (hypoventilation)
3666
3667
3668
3669
3670
3671
0.3 volumes %; 0.3ml per 100ml of blood. Determines PO2 which acts to keep oxygen bound to Hb
3672
3673
PO2 and the affinity of the individual attachment sites. The higher the affinity; the less PO2 is needed to keep it attached
3674
3675
3676
Q1839:Site 4 of hemoglobin
3677
3678
Q1840:Site 3 of hemoglobin
3679
Oxygen is attached at 40mmHg. More affinity than site 4; less affinity than site 2.
3680
Q1841:Site 2 of hemoglobin
3681
Oxygen is attached at 26mmHg which is p50. More affinity; second site to be saturated.
3682
Q1842:Site 1 of hemoglobin
3683
Oxygen remains attached under physiologic conditions. Highest affinity; first site to be saturated.
3684
3685
3686
3687
decreased CO2; decreased 2;3BPG; hypothermia; alkalosis; HbF; methemoglobin; carbon monoxide; stored blood
3688
3689
3690
3691
H+ ions from dissociated H2CO3 which stimulate central chemoreceptors. H2CO3 is proportional to PCO2 of CSF
3692
Q1847:Central chemoreceptors
3693
Sense [H+] which is proportional to PCO2 and H2CO3 of the CSF (not systemic)
3694
Q1848:Peripheral chemoreceptors
3695
Carotid bodies (afferents via IX); aortic bodies (afferents via X). Monitor PO2 and [H+/CO2]
3696
3697
Peripheral chemoreceptors sense PaO2 (dissolved oxygen) once PaO2 falls to 50-60mmHg.
3698
3699
Peripheral chemoreceptors are the main drive for ventilation eventhough PaCO2 is increased.
3700
3701
PaO2 and PACO2 are normal; therefore neither peripheral nor central chemoreceptors respond.
3702
3703
Apneustic center in the caudal pons promotes prolonged inspiration. Pneumotaxic center in the rostral pons inhibits apneustic center. Efferents are from the medulla to the phrenic nerve (C1-C3) to the diaphragm
3704
Q1853:Differences in ventilation between the base and the apex of the lung
3705
Base intrapleural pressure is -2.5; alveoli are compliant and small with a small volume of air but are underventilated due to too much blood flow; Apex pressure is -10; alveoli are large and stiff and contain a large volume of air but are overventilated due to limited blood flow
3706
Q1854:Differences in blood flow between the base and the apex of the lung
3707
Blood vessels of the apex are less distended; have more resistance and receive less blood flow. Blood vessels of the base are more distended; have less resistance and receive more blood flow
3708
3709
Blood flow is higher than ventilation; the relationship is less than 0.8; the bases are underventilated; increased shunts
3710
3711
Blood flow is lower than ventilation; the relationship is more than 0.8; the apex are overventilated; increased dead space
3712
3713
Under 0.8 (at the bases) lungs are underventilated and less gas exchange takes place; therefore PACO2 and end-capillary PCO2 will be higher and PAO2 and end-capillary PO2 will be lower.
3714
3715
A decrease in PAO2 causes vasoconstriction and shunting of blood through that segment.
3716
3717
Blood flow decreases; therefore increased Va/Q --> decreased PACO2; increased PAO2
3718
3719
Ventilation decreases; therefore decreased Va/Q --> increased PACO2; decreased PAO2
3720
3721
Regions of the lung where blood is not ventilated. Low Va/Q relationship.
3722
3723
Regions of the lung where there's no blood flow in spite of ventilation. High Va/Q relantionship
3724
3725
3726
3727
3728
3729
5-10 mmHg
3730
Q1866:Hypoventilation
3731
decreased PAO2 but diffusion and A-a gradient are normal. Perfusion-limited defect.
3732
3733
3734
3735
There's a lung problem where A-a gradient is below normal; therefore diffusion isn't normal
3736
3737
Due to structural problem (increased thickness or decreased surface area). A-a gradient is more than normal. Supplemental oxygen compensates structural deficit but increased A-a gradient remains. Fibrosis; emphysema.
3738
3739
Its measured with CO because it's a diffusion-limited gas. Structural problems decrease CO uptake. It's an index of surface area and membrane thickness.
3740
3741
decreased Va/Q. Ther is an increased A-a gradient that is unresponsive to supplemental O2. Atelectasis or ARDS.
3742
3743
increased Right atrial PO2; increased right ventricular PO2; increased pulmonary artery PO2; increased pulmonary blood flow and pressure
3744
3745
No change in right atrial PO2; increased right ventricular PO2; increased pulmonary artery PO2; increased pulmonary flow and pressure
3746
3747
No change in right atrial PO2 nor right ventricular PO2; increased pulmonary artery PO2; increased pulmonary flow and pressure
3748
3749
intrinsic
3750
3751
PTT
3752
Q1877:Factor XII;activates?
3753
XI
3754
3755
Intrinsic
3756
3757
PTT
3758
Q1880:Factor XI;activates?
3759
3760
3761
intrinsic
3762
Q1882:Factor IX;PTT or PT
3763
PTT
3764
Q1883:Factor IX;activates?
3765
3766
3767
extrinsic
3768
3769
PT
3770
Q1886:Factor VIIa;Activates?
3771
3772
Q1887:Tissue factor;activates?
3773
3774
3775
3776
3777
common
3778
Q1890:Thrombin;activates?
3779
Fibrinogen
3780
3781
XIIIa
3782
3783
3784
Q1893:inactivates;thrombin;IXa;Xa;XIa
3785
Antithrombin III
3786
Q1894:activated by heparin
3787
Antithrombin III
3788
3789
tPA
3790
3791
plasminogen activates C3
3792
3793
3794
3795
3796
3797
3798
3799
3800
3801
3802
3803
3804
3805
3806
3807
Ineffective erythropoiesis
3808
Q1905:Corrected reticulocyte count greater than or equal to 3%: Bone marrow status
3809
Effective erythropoiesis
3810
3811
45%
3812
3813
3814
3815
3816
3817
3818
3819
3820
Q1911:How long does it take for reticulocyte count to increase after blood loss?
3821
5-7 days.
3822
3823
3824
3825
3826
3827
3828
3829
3830
3831
3832
3833
Microcytic
3834
Q1918:Sign: Dark blue iron granules around the nucleus of developing normoblasts
3835
3836
3837
Microcytic
3838
3839
Sideroblastic; so Microcytic
3840
3841
Sideroblastic; so microcytic
3842
3843
3844
3845
3846
Q1924:Type of anemia: TB
3847
Chronic inflammation; so anemia of chronic disease; so;Early: Normocytic with low reticulocyte count;Later: Microcytic
3848
3849
3850
3851
3852
3853
3854
3855
3856
3857
3858
3859
Macrocytic megaloblastic
3860
3861
non-megaloblastic macrocytic;or ;normocytic with a normal reticulocyte count and an extrinsic RBC defect
3862
3863
Macrocytic non-megaloblastic
3864
3865
Macrocytic non-megaloblastic
3866
3867
Macrocytic non-megaloblastic
3868
3869
Normocytic;Reticulocyte count;-Less than one week: low;More than one week: normal
3870
3871
3872
3873
3874
3875
3876
3877
3878
3879
3880
3881
3882
3883
3884
3885
3886
3887
3888
3889
3890
3891
3892
3893
3894
3895
3896
3897
3898
3899
3900
3901
3902
3903
3904
3905
3906
3907
3908
3909
3910
3911
3912
3913
3914
3915
Drug-induced and/or immune so;Normocytic hemolytic anemia with normal reticulocyte count
3916
3917
Red cell fragmentation syndrome so;Normocytic hemolytic anemia with normal reticulocyte count
3918
3919
Red cell fragmentation syndrome so;Normocytic hemolytic anemia with normal reticulocyte count
3920
3921
Red cell fragmentation syndrome so;Normocytic hemolytic anemia with normal reticulocyte count
3922
3923
Red cell fragmentation syndrome so;Normocytic hemolytic anemia with normal reticulocyte count
3924
3925
3926
3927
3928
3929
hb = (1/3)hct
3930
3931
hemoblobin by 1;hematocrit by 3
3932
3933
iron deficiency
3934
3935
GI bleed
3936
Q1969:RDW: Definition
3937
3938
3939
3940
3941
3942
3943
3944
3945
-Alcoholism;-Hemoglobinopathy
3946
3947
3948
3949
3950
3951
Iron deficiency
3952
3953
3954
3955
Low hemoglobin
3956
3957
Iron deficiency
3958
3959
3960
3961
3962
3963
3964
3965
3966
3967
3968
3969
Transferrin
3970
3971
Increased transferrin synthesis by liver; so decreased iron stores in the bone marrow.
3972
3973
Decreased transferrin synthesis by liver; so increased iron stores in the bone marrow.
3974
3975
Serum iron/TIBC
3976
Q1989:Normal TIBC
3977
300
3978
3979
3980
3981
HbA
3982
3983
HbA2
3984
3985
HbF
3986
3987
Bugs increase reproduction with iron; so body assumes there is a bacterial infection; and keeps iron away from bacteria;Iron is normally stored in macrophages in bone marrow. It's kept away from RBCs.
3988
3989
Mitochondria of RBC
3990
3991
Succinyl CoA + Glycine (catalyzed by ALA synthetase) yields delta-ALA;all in the mitochondria
3992
3993
Inhibitor of muscle.
3994
3995
Tetanus
3996
3997
delta-ALA synthesis
3998
3999
ALA synthase
4000
4001
4002
4003
Overloaded mitochondria
4004
4005
Can't form CoA; so can't form succinyl CoA; so can't do first reaction of heme synthesis.
4006
4007
4008
4009
4010
4011
4012
4013
-black Americans;-Greeks;-Italians
4014
4015
95%
4016
4017
2%
4018
4019
1%
4020
4021
Autosomal recessive
4022
Q2012:alpha-thalassemia: pathogenesis
4023
4024
4025
4026
4027
Silent carrier
4028
4029
4030
4031
Four beta chains form making HbH. Found in electropheresis;Called HbH disease
4032
4033
Four gamma chains form making Hb Bart. Found in electropheresis. Called hydrops fetalis.
4034
4035
1. Increased alpha thalassemia rates;2. Increased spontaneous abortions due to Hb Bart;3. Increased choriocarcinoma
4036
Q2019:alpha-thalassemia: treatment
4037
4038
4039
beta by itself: normal number of beta chains;beta with a + sign: not making enough; but are making;beta with a 0: not making it at all
4040
4041
autosomal recessive
4042
4043
4044
4045
HbA
4046
4047
4048
4049
4050
Q2026:beta-thalassemia: treatment
4051
none
4052
4053
4054
4055
4056
4057
4058
4059
Prussian Blue
4060
4061
4062
4063
4064
4065
4066
4067
4068
4069
4070
4071
-Workers from automobile factory or moonshine makers or pottery painters;-Abdominal colic;-Diarrhea;-Neuropathy (slapping gait; drops (radial; ulnar palsies); claw hand
4072
Q2037:What is the disease: Serum Iron (low); TIBC (high); % iron saturation (low); Serum ferritin (low)
4073
Iron deficiency
4074
Q2038:What is the disease: Serum Iron (low); TIBC (low); % iron saturation (low); Serum ferritin (high)
4075
4076
Q2039:What is the disease: Serum Iron (normal); TIBC (normal); % iron saturation (normal); Serum ferritin (normal)
4077
Thalassemia
4078
4079
Iron overload
4080
4081
Iron overload
4082
4083
Iron overload
4084
Q2043:What is the disease: Serum Iron (high); TIBC (low); % iron saturation (high); Serum ferritin (high)
4085
4086
Q2044:What do B12 and folate deficiencies most immediately not allow production of?
4087
4088
4089
4090
4091
Megaloblasts
4092
4093
4094
4095
N5-methyl-Tetrahydrofolate
4096
4097
4098
4099
Methionine
4100
4101
Methionine
4102
4103
High
4104
4105
4106
4107
Folate deficiency
4108
4109
5-fluorouracil (which inhibits thymidylate synthase);Methotrexate and TMP-SMX (which both inhibit DHF reductase); Phenytoin (which inhibits intestinal conjugase); Oral contraceptives and alcohol (which both inhibit of uptake of monoglutamate in jejunum; but alcohol also inhibits the release of folate from the liver)
4110
4111
4112
4113
Methylmalonic acid
4114
4115
B12 deficiency
4116
4117
4118
4119
Dementia; demyelination of posterior columns (proprioception and vibratory sensation) and lateral corticospinal tract (upper motor neuron problems)
4120
4121
TSH to rule out hypothyroidism and B12 to rule out B12 deficiency
4122
4123
Animal products
4124
4125
R factor
4126
4127
4128
4129
4130
4131
Terminal ileum
4132
4133
Bile salts and vitamin B12 (both due to reabsorption problems in terminal ileum)
4134
4135
Pernicious anemia
4136
4137
4138
Q2070:What is achlorhydria?
4139
Atrophic gastritis of the body and fundus leading to ;lack of acid which leads to gastric adenocarcinoma;AND;bacterial overgrowth from stasis
4140
4141
4142
4143
Polyglutamate
4144
4145
Intestinal conjugase
4146
4147
Phenytoin
4148
4149
4150
4151
4152
4153
4154
4155
Folate deficiency
4156
4157
Pancytopenia
4158
Q2080:Schilling's test
4159
1. Give radioactive B12 by mouth;2. 24 hour urine collection;3. If nothing comes out; can't reabsorb B12;4. Then give radioactive B12 and intrinsic factor together by mouth;5. 24 hour urine collection. If something comes out; it's pernicious anemia. If not; go to step 6;6. Give broad-spectrum anti-biotic. If you see B12 in the urine; you have bacterial overgrowth. If not; go to step 7;7. Take pancreatic extract with radioactive B12. If you get B12 in the urine; they have chronic pancreatitis. If not; it could be Crohn's disease; a worm; or some other cause. 4160
4161
1. Ferritin goes down;2. Iron decreases; TIBC increases; % iron sat decreases;3. Mild normocytic anemia;4. Microcytic anemia
4162
4163
4164
4165
Idiopathic
4166
4167
4168
4169
Hepatitis C
4170
4171
Parvovirus
4172
Q2087:Mechanisms of hemolysis
4173
4174
4175
4176
Q2089:What are some causes of RBCs being phagocytosed at the cords of Bilroth?
4177
IgG or c3b on the surface;or Howell-Jolly bodies inside; or an abnormal shape (such as spherical or sickle cell)
4178
4179
Unconjugated bilirubin
4180
4181
Jaundice; which is due to unconjugated bilirubin due to macrophages phagocytosing red blood cells.
4182
4183
1) Congenital bicuspid aortic valve;2) IgM binding to surface and activating complement system
4184
4185
Hemoglobin
4186
4187
Haptoglobin
4188
4189
4190
4191
1. preprohormone synthesized in rER; 2. signal peptides cleaved--> prohormone transported to Golgi; 3. more cleavage in golgi and HORMONE then packaged in secretory granules
4192
Q2097:amine hormones
4193
4194
4195
4196
4197
4198
4199
hormone + R--> Gq --> PLC --> DAG and IP3 --> PKC
4200
4201
4202
Q2102:"children" of POMC
4203
4204
4205
prolactin
4206
4207
4208
4209
4210
4211
4212
4213
1. dec'd glucose uptake into cells; 2. inc'd lipolysis; 3. inc'd protein synthesis in mm; 4. inc'd production of IGF
4214
4215
inc'd protein synthesis! In chondrocytes--> growth spurt; in mm-->inc'd lean body mass; inc'd organ size
4216
4217
tonic inhibition by dopamine (which is stimulated by PRL); TRH increases PRL secretion
4218
4219
1. stim milk production; 2. stim breast development (w/estrogen); 3. inhibits ovulation via GnRH inhibition; 4. inhibits spermatogenesis
4220
4221
4222
4223
4224
4225
4226
Q2114:Wolff-Chaikoff effect?
4227
4228
Q2115:significance of propylthiouracil?
4229
inhibits peroxidase enzyme (which first catalyzes oxidation of I- to I2;and then other steps); used for treatment of hyperthyroidism
4230
4231
iodinated thyroglobulin is taken back into follicular cells; digested and T3; T4 released into circulation. Leftover MIT; DIT deiodinated by thyroid deiodinase
4232
4233
4234
4235
4236
Q2119:effect of TH on heart?
4237
upregulates beta 1 R
4238
Q2120:effect of TH on O2 consumption?
4239
increases b/c of upregulation of Na-K ATPase (which uses ATP;which comes from O2;kinda)
4240
4241
4242
4243
4244
4245
(innermost) zona reticularis (b/c you should be really particularis of your sex partners)
4246
4247
stimulates cholesterol desmolase thereby increasing steroid synthesis; also upregulates own R
4248
4249
4250
4251
4252
4253
1. increase protein catabolism in mm (more aa available); 2)decrease glucose utilization and insulin sensitivty of fat; 3) increase lipolysis (more glycerol available)
4254
4255
induce synthesis of lipocortin (inhibits PLA2); inhibit production of IL-2; thereby inhibit proliferation of T cells; inhibit relase of His and serotonin from mast cells; platelets
4256
Q2129:Name the dz: Increased ACTH; hypoglycemia; hyperpigmentation; ECF volume contraction
4257
Addison's disease
4258
4259
4260
4261
4262
Q2132:name the dz: decreased cortisol and aldosterone; increased adrenal androgens; virilization; suppression of gonad function
4263
21 hydroxylase deficiency
4264
Q2133:name the dz: decreased androgen and glucocorticoid levels; increased aldosterone; hypoglycemia; lack of pubes
4265
17 hydroxylase deficiency
4266
Q2134:3 major cell types and their main export in islets of Langerhans?
4267
4268
4269
somatostatin; gastrin
4270
4271
4272
4273
1. increase blood glucose; 2. increase blood FA; ketoacids; 3. increase urea production
4274
4275
glucose binds GLUT 2 on beta cell membrane--> depolarization of membrane--> Ca channel opens; influx --> insulin secretion
4276
4277
4278
4279
4280
Q2141:"goal" of PTH
4281
4282
4283
1. increase bone reabsorp; 2 inhibit renal phosphate reabsorp.(PCT); 3. increase renal Ca reabsorp; 4. stimulate production of active vit D
4284
4285
4286
4287
increased GFR--> increased sr phosphate which complexes with Calcium; thereby decreasing free Ca; also decreased vit D
4288
Q2145:"goal" of vit D
4289
4290
4291
4292
4293
testosterone
4294
4295
4296
4297
enzyme that converts testosterone to DHT; found in accessory sex organs like the prostate
4298
Q2150:significance of finasteride?
4299
4300
4301
4302
4303
4304
4305
4306
Q2154:which diuretics can also be used for treatment of acute mountain sickness?
4307
carbonic anhydrase inhibitors like acetazolamide (metabolic acidosis to combat respiratory alkalosis)
4308
4309
4310
4311
Estrogen increases binding proteins; androgens decrease binding proteins. In pregnancy there's increased total hormones with normal levels of free hormone.
4312
4313
Paraventricular nucleus
4314
4315
Paraventricular nucleus
4316
4317
Arcuate nucleus
4318
4319
Arcuate nucleus
4320
4321
Preoptic region
4322
4323
4324
4325
4326
Q2164:Hypothalamic hormones
4327
4328
4329
4330
Q2166:Sheehan syndrome
4331
Ischemic necrosis of the pituitary due to severe blood loss during delivery. Causes hypopituitarism.
4332
4333
Adenoma compresses pituitary stalk and decreases secretion of anterior pituitary hormones except prolactin.
4334
4335
4336
Q2169:Hyperprolactinemia
4337
Results from dopamine antagonists or pituitary adenomas that compress the pituitary stalk. Amenorrhea; galactorrhea; decreased libido; impotence; hypogonadism
4338
4339
ACTH
4340
4341
4342
4343
4344
4345
No aldosterone: loss of Na; decreased ECF; decreased blood pressure; circulatory shock; death
4346
4347
No cortisol: circulatory failure (cortisol is permissive for cathecolamine vasoconstriction); can't mobilize energy stores during exercise or cold (hypoglycemia)
4348
4349
No epinephrine: decreased capacity to mobilize fat and glycogen during stress. Not necessary for survival.
4350
4351
17OHpregnenolone; 17OHprogesterone; 11-deoxycortisol; cortisol. Urinary 17OH steroids are an index of cortisol secretion.
4352
4353
4354
4355
4356
Q2179:DHEA
4357
4358
4359
Urinary 17-ketosteroids. In females and prepubertal males is an index of adrenal 17-ketosteroids. In postpubertal males is an index of 2/3 adrenal androgens and 1/3 testicular androgens.
4360
4361
4362
4363
Cortisol
4364
Q2183:Enzyme deficiencies that produce congenital adrenal hyperplasia and low cortisol levels
4365
21beta -OH; 11beta -OH and 17alpha -OH all result in low cortisol levels.
4366
4367
No aldosterone: loss of Na; decreased ECF; decreased blood pressure in spite of high renin and angiotensin II; circulatory shock; death. No cortisol (low 17OH steroids): skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; hypotension (persmissive for catecholamines); fasting hypoglycemia. Excess androgens (17-ketosteroids): female pseudohermaphrodite; hirsutism
4368
4369
Excess 11-deoxycorticosterone: Na and water retention; lowrenin hypertension. No cortisol (low 17OH steroids): skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; fasting hypoglycemia. Excess androgens (17ketosteroids): female pseudohermaphrodite; hirsutism
4370
4371
Excess 11-deoxycorticosterone and low aldosterone (no AII): Na and water retention; low-renin hypertension. No cortisol: skin hyperpigmentation (due to excess ACTH); adrenal hyperplasia; corticosterone partially compensates low cortisol levels. No 17-ketosteroids: male pseudohermaphrodite; no testosterone; no estrogen.
4372
Q2187:decreased 17OH-steroids increased ACTH; decreased blood pressure; decreased mineralocorticoids; increased 17ketosteroids
4373
4374
Q2188:decreased 17OH-steroids increased ACTH; increased blood pressure; decreased aldosterone; increased 11deoxycorticosterone; increased 17-ketosteroids
4375
4376
Q2189:decreased 17OH-steroids increased ACTH; increased blood pressure; decreased aldosterone; increased 11deoxycorticosterone; decreased 17-ketosteroids
4377
4378
Q2190:Stress hormones
4379
4380
4381
4382
4383
4384
4385
4386
4387
4388
4389
1) Protein catabolism and delivery of amino acids; 2) lipolysis and delivery of fatty acids and glycerol 3) gluconeogenesis raises glycemia; also inhibits glucose uptake.
4390
4391
Enhances glucagon (without cortisol --> fasting hypoglycemia); enhances epinephrine (without cortisol ->hypotension)
4392
Q2197:alpha -MSH
4393
Stimulates melanocytes and causes darkening of skin. Synthesized along with ACTH from pro-opiomelanocortin.
4394
4395
Primary hypercortisolism
4396
4397
4398
4399
Secondary hypercortisolism
4400
4401
Secondary hypocortisolism
4402
Q2202:decreased cortisol; decreased CRH; decreased ACTH; no hyperpigmentation; symptoms of excess cortisol
4403
Steroid administration
4404
Q2203:Cushing syndrome
4405
Protein depletion; weak inflammatory response; poor wound healing; hyperglycemia; hyperinsulinemia; insulin resistance; hyperlipidemia; osteoporosis; purple striae; hirsutism; hypertension; hypokalemic alkalosis; buffalo hump
4406
Q2204:Actions of aldosterone
4407
increased Na channels in lumen of principal cells; increased activity of Na/K ATPase of principal cells --> increases Na reabsorption. Also increased secretion of K and H leading to hypokalemic metabolic alkalosis.
4408
Q2205:Addison disease
4409
increased ACTH; hyperpigmentation; hypotension (no aldosterone; no cortisol); hyperkalemic metabolic acidosis (no aldosterone); loss of body hair (no androgens); hypoglycemia; increased ADH secretion
4410
4411
4412
Q2207:Primary hyperaldosteronism
4413
Na and water retention; hypertension; hypokalemic metabolic alkalosis; decreased renin and angiotensin; no edema due to pressure diuresis and natriuresis.
4414
Q2208:Primary hypoaldosteronism
4415
Na and water loss; hypotension; hyperkalemic metabolic acidosis; increased renin and angiotensin II; no edema
4416
Q2209:Secondary hyperaldosteronism
4417
increased renin and angiotensin II; increased Na and water retention in venous circulation; edema
4418
4419
increased osmolarity --> increased ADH secretion; decreased blood volume --> baroreceptors --> medulla --> increased ADH secretion
4420
Q2211:Actions of ADH
4421
Inserts water channels in luminal membrane of collecting ducts; increases reabsorption of water.
4422
4423
Not enough ADH secreted. Dilute urine is formed in spite of water deprivation. Responds to injected ADH.
4424
4425
ADH is secreted but ducts are unresponsive to it. Dilute urine is formed in spite of water deprivation or injected ADH.
4426
Q2214:SIADH
4427
4428
Q2215:decreased permeability of collecting ducts; increased urine; decreased urine osmolarity; decreased ECF; increased osmolarity
4429
Diabetes insipidus
4430
Q2216:increased permeability of collecting ducts; decreased urine; increased urine osmolarity; decreased ECF; increased osmolarity
4431
Dehydration
4432
Q2217:increased permeability of collecting ducts; decreased urine; increased urine osmolarity; increased ECF; decreased osmolarity
4433
SIADH
4434
Q2218:decreased permeability of collecting ducts; increased urine; decreased urine osmolarity; increased ECF; decreased osmolarity
4435
Primary polydipsia
4436
Q2219:Actions of ANP
4437
Atrial stretch or increased osmolarity --> ANP secretion --> dilation of afferent; constriction of efferent --> increased GFR --> natriuresis; also decreases permeability of collecting ducts to water.
4438
4439
4440
4441
4442
4443
In the center of the islets; represent 60-75%. Secrete insulin and C peptide.
4444
Q2223:Insulin receptor
4445
Has intrinsic tyrosine kinasae activity. Insulin receptor substrate binds tyrosine kinase; activates SH2 domain proteins: PI-3 kinase (translocation of GLUT-4); p21RAS.
4446
4447
4448
4449
Brain; kidneys; intestinal mucosa; red blood cells; beta cells of the pancreas.
4450
Q2226:Anabolic hormones
4451
4452
4453
4454
4455
Glucose enters beta cells and is metabolized --> increased ATP --> closes K channels --> increased depolarization --> increased Ca influx --> exocytosis of insulin.
4456
4457
4458
4459
4460
4461
Type 2 diabetes
4462
4463
Type 1 diabetes
4464
4465
Insulinoma
4466
4467
4468
Q2235:Actions of somatomedin C
4469
Increases cartilage synthesis at epiphyseal plates (increased bone length). Also increased lean body mass. Protein-bound and long half-life correlates with GH secretion. Also called IGF-1.
4470
Q2236:Secretion of GH
4471
Pulsatile during non-REM sleep; more frequent in puberty due to increased androgens; requires thyroid hormones; decreases in the elderly.
4472
4473
4474
4475
4476
Q2239:Dwarfism
4477
4478
Q2240:Acromegaly
4479
Due to excess GH in postpuberty. Enlargement of hands; feet and lower jaw; increased proteins; decreased fat; visceromegaly; cardiac insuficiency.
4480
Q2241:Composition of bone
4481
4482
Q2242:Actions of PTH
4483
Rapid actions: increases Ca reabsorption in distal tubules and decreases phosphate reabsorption in proximal tubules; thus lowering blood phosphate and lowering solubility product which leads to bone resorption and raises plasma Ca. Slow actions: increases number and activity of osteoclasts (via osteoclast activating factor released by osteoblasts); increases activity of alpha-1 hydroxylase in the proximal tubules which increases active vitamin D and absorption of Ca and phosphate in the instetines.
4484
4485
increased plasma Ca and decreased plasma phosphate; phosphaturia; polyuria; calciuria (filtered load of Ca exceeds Tm); increased serum alkaline phosphatase; increased urinary hydroxyproline; muscle weakness; easy fatigability.
4486
4487
decreased plasma Ca and increased plasma phosphate; hypocalcemic tetany due to increased excitability of motor neurons.
4488
4489
Primary hyperparathyroidism. Causes: parathyroid adenoma (MEN I and II); ectopic PTH tumor (lung squamous CA)
4490
4491
4492
4493
Secondary hyperparathyroidism due to renal failure (no active vitamin D; decreased GFR)
4494
4495
Secondary hyperparathyroidism. Causes: deficiency of vitamin D due to bad diet or fat malabsorption.
4496
4497
4498
Q2250:Vitamin D synthesis
4499
Dietary and skin cholecalciferol is hydroxylated by 25hydroxylase in the liver and activated to 1;25 di-OH cholecalciferol by 1-alpha hydroxylase in the proximal tubules.
4500
4501
Increases Ca binding proteins by intestinal cells which increases intestinal reabsorption of Ca and phosphate. Also increases reabsorption of Ca in the distal tubules. Increased serum Ca promotes bone deposition.
4502
Q2252:Osteomalacia
4503
Underminerilized bone in adults due to vitamin D deficiency leads to bone deformation and fractures. Low calcium leads to secondary hyperparathyroidism.
4504
Q2253:Rickets
4505
Underminerilized bone in children due to vitamin D deficiency leads to bone deformation and fractures. Low calcium leads to secondary hyperparathyroidism.
4506
Q2254:Excess vitamin D
4507
4508
4509
1) Iodine is actively transported into follicle cell; 2) thyroglobulin is synthesized in the RER; glycosylated in the SER and packaged in the GA; 3) Peroxidase is found in the luminal membrane and catalizes oxidation of I-; iodination of thyroglobulin and coupling to form MITs and DITs; 4) iodinated thyroglobulin is stored in the follicle lumen.
4510
4511
T4 has iodine attached to carbons 3 and 5 of both fenol rings; T3 has iodide attached to carbons 3 and 5 of the amino terminal fenol ring and the 3 prime carbon of the hydroxyl end fenol ring; reverse T3 has iodide in carbon 3 of the amino terminal fenol ring but not carbon 5.
4512
4513
Iodinated thyroglobulin is endocytosed from the lumen of the follicles into lysosomes. Thyroglobulin is degraded into amino acids; T3; T4; DITs and MITs. T4 and T3 are secreted in a 20:1 ratio. DITs and MITs are deiodinated and iodine is recycled.
4514
4515
99% is bound to TBG; 1% is free. T4 has greater affinity for TBG and a half-life of 6 days. T3 has greater affinity for nuclear receptor and is the active form with a 1 day half-life. 50:1 T4/T3 ratio in periphery.
4516
4517
5' monodeiodinase activates T4 into T3. 5-monodeiodinase inactivates T4 into reverse T3.
4518
4519
increased metabolic rate by increased Na/K ATPase except in brain; uterus and testes; essential for brain maturation and menstrual cycle; permissive for bone growth; permissive for GH synthesis and secretion; increased clearance of cholesterol; required for activation of carotene; increased intestinal glucose absorption; increased affinity and number of beta 1 receptros in the heart.
4520
4521
4522
4523
Cretinism results in decreased bone growth and ossification -> dwarfism. Due to lack of permissive action on GH.
4524
4525
Circulating T4 is responsible for negative feedback of TSH by decreasing sensitivity to TRH. T4 is converted to T3 in the thyrotroph to induce negative feedback.
4526
Q2264:Effects of TSH
4527
Rapid actions: increased iodide trapping; increased synthesis of thyroglobulin; increased reuptake of iodinated thyroglobulin; increased secretion of T4; late effects: increased blood flow to thyroid gland; increased hypertrophy of follicles and goiter.
4528
4529
4530
4531
4532
4533
4534
4535
4536
4537
Graves disease
4538
4539
Thyroid makes less T4 and more T3 so actions of T3 may be normal but low levels of T4 stimulate TSH secretion with development of goiter. Thus euthyroid with goiter.
4540
4541
decreased basal metabolic rate with cold intolerance; decreased cognition; hyperlipidemia; nonpitting myxedema (mucopolysacchride accumulation around eyes retains water); physiologic jaundice (increased carotene); hoarse voice; constipation; anemia; lethargy
4542
4543
increased metabolic rate with heat intolerance and sweating; increased apetite with weight loss; muscle weakness; tremor; irritability; tachycardia; exophthalmos.
4544
Q2273:Leydig cells
4545
Stimulated by LH; produce testosterone for peripheral tissues and Sertoli cells. Testosterone provides negative feedback for LH secretion by pituitary.
4546
Q2274:Sertoli cells
4547
Stimulated by FSH; produce inhibins (inhibits secretion of FSH); estradiol (testosterone is converted by aromatase); androgen binding proteins and growth factors for sperm. Responsible for development of sperm in males. Also MIH in male fetus.
4548
4549
4550
4551
4552
4553
Anabolic steroid therapy. LH supression causes Leydig cell atrophy with decreased Leydig testosterone which suppresses spermatogenesis.
4554
4555
4556
4557
LH --> Leydig cells --> testosterone --> Wolffian ducts (internal male structures: epididymis; vasa deferentia and seminal vesicles). Testosterone + 5-alpha reductase --> dihydrotestosterone --> urogenital sinus and external organs. MIH by Sertoli cells --> regression of Mullerian ducts and female structures.
4558
4559
4560
4561
4562
4563
Cell diameter and amount of myelination are directly proportional to conduction velocity
4564
4565
4566
4567
4568
Q2285:Neuromuscular transmission
4569
Action potential travels down axon and opens pre-synaptic Ca channels --> calcium influx --> release Ach vesicles --> Ach diffuses and attaches to nicotinic ion channels --> increased gNa --> end-plate depolarization (local) spreads to areas with voltage-gated Na channels --> depolarization of muscle fiber
4570
4571
Transient subtreshold depolarizations due to increased gNa -> summation reaches axon hillock at the junction of cell body and axon --> voltage-gated Na channels depolarize the axon
4572
4573
increased gCl or increased gK hyperpolarize the cell and lower threshold for depolarization
4574
Q2288:Electrical synapse
4575
Action potential transmitted from one cell to the next via gap junctions; without synaptic delay and in both directions. Cardiac muscle; smooth muscle.
4576
Q2289:Sarcomere A band
4577
Contains overlapping actin and myosin. Does not shorten during contraction.
4578
Q2290:Sarcomere H zone
4579
4580
Q2291:Sarcomere I band
4581
4582
Q2292:Sarcomere Z line
4583
4584
Q2293:Sarcomere M line
4585
4586
Q2294:Actin
4587
Structural protein of the thin filaments; contains attachment sites for myosin cross-bridges.
4588
Q2295:Myosin
4589
Structural protein of the thick filaments; contains crossbridges that attach to actin. Has ATPase activity to terminate actin-myosin cross-bridges. ATP decreases actin-myosin affinity.
4590
Q2296:Tropomyosin
4591
Part of thin filaments. Covers the actin attachment sites for the myosin cross-bridges
4592
Q2297:Troponin
4593
Part of thin filaments; binds calcium; which moves tropomyosin out of the way exposing actin binding sites for cross-bridges.
4594
4595
4596
Q2299:Rigor mortis
4597
Depletion of ATP - cycling stops with myosin attached to actin - (muscle contracted).
4598
4599
Action potential travels down T-tubules --> activates dihydropiridine voltage sensors --> foot processes are pulled aways from ryanodine calcium release channels of sarcoplasmic reticulum --> calcium is released --> calcium attaches to troponin --> tropomyosin moves exposing actin binding sites for myosin cross-bridges --> myosin binds actin --> myosin ATPase breaks down cross bridges producing active tension and shortening --> contraction terminated by active pumping of Ca into the sarcoplasmic reticulum.
4600
Q2301:Myosin ATPase
4601
Hydrolizes ATP to supply energy for active tension and shortening. ATP decreases myosin-actin affinity
4602
4603
Supplies energy to terminate contraction and pump Ca back into sarcoplasmic reticulum.
4604
4605
Sarcoplasmic reticulum. No extracellular calcium is involved because it doesnt have voltage-gated Ca channels.
4606
4607
Sarcoplasmic reticulum and extracellular. Cardiac and smooth muscle have voltage-gated calcium channels.
4608
Q2305:Tetanus
4609
Multiple action potentials increase release of calcium thus increasing contraction. Muscle cells have a short refractory period.
4610
Q2306:Preload
4611
Stretch prior to contraction. increased preload --> increased prestretch of the sarcomere --> increased passive tension
4612
Q2307:Afterload
4613
The load the muscle is working against. increased afterload -> increased cross-bridge cycling --> increased active tension
4614
4615
Sarcomere length
4616
4617
4618
Q2310:Isomertric contraction
4619
Active tension is produced but length stays the same. Afterload is greater than active tension; load not moved.
4620
4621
Calcium binds troponin --> tropomysion exposes actin sites -> myosin cross-bridges bond to actin --> myosin ATPase generates energy to break cross-bridge link --> cycle repeats -> active tension. The more cross-bridges that cycle; the greater the active tension.
4622
Q2312:Total tension
4623
4624
4625
It's a function of the number of cross-bridges capable of crosslinking with actin. Negative parabola.
4626
Q2314:What is L0?
4627
The optimum length to produce maximum active tension. Beyond L0; muscle is overstretched; below L0; it's understretched.
4628
Q2315:Isotonic contraction
4629
Muscle contracts and shortens to move the load. Occurs when total tension equals the load.
4630
4631
Isovolumetric contraction. Active tension is generated. Equivalent to isometric contraction of skeletal muscle.
4632
4633
increased ATPase activity --> increased velocity; increased muscle mass --> increased force generated; increased afterload --> decreased velocity
4634
4635
increased frequency of action potentials; increased recruitment; increased preload and increased afterload --> increased force and work
4636
4637
Factors that regulate force and work are preload; afterload and contractility (which is altered by hormones). No summation nor recruitment.
4638
4639
Large mass; high ATPase activity (fast muscle); anaerobic glycolysis; low myoglobin
4640
4641
Small mass; low ATPase activity (slower muscle); aerobic metabolism (mitochondria); high myoglobin.
4642
4643
Actin and myosin form sarcomeres; sarcolema lacks junctional complexes; each fiber innervated; troponin binds calcium; high ATPase activity; triadic contacts by T-tubules at A-I junctions; no calcium channels on membrane
4644
4645
Actin and myosin form sarcomeres; gap junctions; electrical syncytium; troponin binds calcium; intermediate ATPase activity; dyadic contacts by T-tubules near Z-lines; voltagegate calcium channels.
4646
4647
Actin and myosin not organized in sarcomeres; gap junctions; electrical syncytium; calmodulin binds calcium; low ATPase activity; lacks T-tubules; voltage-gated calcium channels.
4648