Intracellular: Inside the cell K and PO and Mg;

Extracellular: Outside the cell Na, Cl, Bicarbonate, Oxygen, glucose, amino
acids; carbon dioxide
egulation o! Body "unctions: #omeostasis: constant conditions in the internal
en$ironment
Ner$ous %ystem : sensory, CN%, motor, autonomic
Endocrine system: secrete hormones that target organ
I! regulation is changed:
#y&o'alemia: decrease K; &erson can be &araly(ed
#y&er'alemia: increase K; !unction o! heart can be im&aired
Ex: Calcium decreases: tetanic contraction
Negati$e !eedbac' : stimulation that causes o&&osite a)ect
Ex: blood &ressure increases, causes it to come do*n;
Positi$e !eedbac': stimulation *ill cause the change in the same direction
Ex: Bleeding +same direction,
Ex: Physiological &ositi$e !eedbac': blood clotting, child birth, o&ening o!
sodium channels
-rans&ort o! substances: .i)usion and /cti$e trans&ort:
.i)usion: random molecular mo$ement o! substances; 'inetic energy
%im&le: 'inetic mo$ement o! molecules *ithout carrier &roteins
"acilitated 0 has carrier &rotein +in same direction as gradient not
o&&osite,; rate o! di)usion reaches maximum 1 2max
/cti$e trans&ort 0 /-P needed +against concentration gradient,; carrier
&roteins needed
2oltage 3ating: negati$e inside, outside sodium gates close; K inside
Chemical 3ating: acetylcholine
%odium4Potassium Pum&: &um& Na out and K in; electrogenic
5hen 6 K bind on outside and 7 Na bind on inside, /-Pase !unction o! &rotein
become acti$ated
Proteins: structural and !unctional
%tructural: microtubules &ro$ide cytos'eleton o! cellular organelles; 8brillar
&roteins
"unctional: tubular4globular !orm; en(ymes o! the cell; mobile in cell 9uid
Cell: contains :;4<=> *ater; Basic unit o! all organism
4 Characteristic o! the cell *all :
o ?i&id Bilayer 0 &hos&holi&ids and glyco&rotein and cholesterol ; !orm calyx
around cell
4 Organelles
o ?ysosomes 0 intracellular digesti$e system o! the cell; &hagocytosis
o E: ibosomes: granular4 synthesis o! &roteins ; agranular4 synthesis o!
hormones and li&ids
o Mitochondria 0 synthesis o! source o! energy +CO6, #6O, /-P,;
&o*erhouse
o Peroxisomes 0 sel!4re&lication and contain oxidases; hydrogen &eroxide
oxidation; detoxi8cation
4 Cell .i$ision 0 Mitosis
o ?i!e cycle o! a cell : Inter&hase and then mitosis
o % &hase: .N/ synthesis
o Mutations: cancer@abnormal &rotein in cell; abnormal cell !unction, cell
death
o Pro&hase, Meta&hase /na&hase, telo&hase
4 .N/
o Basic structure : nitrogenous base, &hos&horic grou& and sugar
o Bases: adenine guanine thymine and cytosine +connected by hydrogen
bond,
o .i) bet*een N/ and .N/ : uracil instead o! thymine; ribo and not deoxy;
N/ need &romoter !or initiation
o rN/, tN/ 0 anticodon, mN/: codon
o .N/ to N/ 0 transcri&tion; N/ to Proteins 0 translation
o .N/ mutations 0 s&ecial en(ymes re&air but some might not beABmight
end u& in cancer or death
o Pe&tidyl trans!erase: &rotein in ribosome !orming &e&tide bonds bet*een
amino acids
4 Control o! 3ene "unction:
o 3enetic regulation: degree o! acti$ation o! genes controlled
.N/ strand: o&eron; genes res&onsible !or !orming en(ymes:
structural genes; &romoter: essential !or acti$ating the o&eron
Band o! nucleotides in middle o! &romoter: re&ressor o&erator
Negati$e !eedbac' control o! o&eron: by re&ressor &rotein
binding at re&ressor o&erator or acti$ator &rotein to brea'
bond *@ acti$ator o&erator
o En(yme regulation: acti$ity le$els o! already !ormed en(ymes in cell
controlled
En(yme inhibition is negati$e !eedbac' control
Crossing control bet*een &urines@&yrimidines; i! increase, other
decrease
4 /ction Potential
o esting membrane &otential : de&ends on the di)erence o! sodium and
&otassium 4C;m$
o %odium outside and &otassium inside originally 4 %odium &otassium
&um&, im& in maintenence o! the di)erence
o 7 molecules o! sodium going out and 6 molecules o! &otassium going in
o Inside is negati$e and this much change in order !or action &otential
o .e&olari(ation 0 In9ux o! sodium +NaD,
o e&olari(ation 0 Potassium goes out +KD,
Muscles
4 %'eletal +E;>, and %mooth muscle +F;>,
4 Elementary structure o! muscle
o 7;;; /ctin and F=;; Myosin 8laments
I bands: light bands o! actin 8laments
/ bands: dar' bands o! myosin 8laments
o elationshi& bet*een these t*o 8laments &ro$o'e contraction
o Muscle Contraction: action &otential tra$el along ner$e; ner$e secrete N-
acetylcholine; o&en acetylcholine gated channels; Na go into muscle 8ber
+causing action &otential,; muscle de&olari(es; sarco&lasmic reticulum
release calcium to contract actin@myosin
4 Myosin 8lament structure:
o G &oly&e&tide chains: 6 hea$y chains +tail,, E light chains +head,
4 /ctin 8lament: actin, tro&omyosin, tro&onin
o 34actin molecules attached to /.P
4 /-P necessary !or contraction
4 %mooth muscles:
o Multi4unit: each 8ber o&erate inde&endent o! others, inner$ated by single
ner$e
Ex: ciliary muscle o! eye, iris muscle o! eye, &iliorector muscles
o %ingle4unit
Many 8bers contracting together as single unit, Hoined by ga&
Hunctions
/'a syncytial smooth muscle@$isceral smooth muscle
No tro&onin, contain calmodulin !or contraction
Drugs that mimic acetylcholine-like action : methacholine, carbachol, nicotine
Drugs that inactives acetylcholinestrases : neostigmine, &hysostigmine ,
diiso&ro&yl 9uro&hos&hate
#eart
4 /ction &otential in cardiac muscle: MP: 4<=m$@D6;m$
4 Contraction o! muscle de&end on calcium outside
4 Cardiac Cycle:
o .iastole: relaxation *hen heart 8ll *ith blood; $al$es o&en
F@7: ra&id 8lling; 6@7: moderate 8lling; 7@7: atrial contraction; 6;>
8lling o! $entricle
o %ystole: contraction
o End .iastolic 2olume +E.2,: FF;4F6; m?
o %tro'e $olume out&ut: :; m?
o End %ystolic 2olume: =; m?
4 #y&er'alemia: increase K; heart is 9accid
4 #y&ocalcemia: Calcium decrease; tetanic contraction
4 /2 bundle: #iss bundle
4 Pur'inHe "ibers:
4 %/ node: :6, internode 8bers
4 esting membrane &otential: 4==m$
4 -hreshold !or action &otential: 4E;m$
4 .elay transmission delay im&ortant because allo* time !or atria to em&ty blood
into $entricles
4 .elay o! ;BFG seconds !rom sinus node to /2 node
4 Ecto&ic Pacema'er: &acema'er else*here than sinus node
4 %to'es /dam %yndrome: delayed &ic'u& o! heartbeat
4 2agal stimulation: acetylcholine decrease rate o! rhythm o! sinus node and slo*
transmission o! cardiac im&ulse into $entricles; 2entricular esca&e
EK3:
4 /trial de&olari(ation: P *a$e
4 2entricular de&olari(ation: I% com&lex
4 2entricular re&olari(ation: %- segment and - *a$e
4 ?ead F: le!t arm &ositi$e
4 ?ead 6: right arm and le!t leg *ith leg &ositi$e
4 ?ead 7: le!t arm and le!t leg *ith leg &ositi$e
4 Mean I% 2ector: net di)erence bet*een D and 4 &ea's o! I%; a$erage: D=C
degrees
4 .ecreased $oltage o! I% com&lex is old myocardial artery in!arctions
4 #olter Monitoring: recording 6E hours; arrhythmias
Cardiac /rrhythmias:
4 -achycardia: !ast heart rate, more than F;; beats &er minute, caused by
increased body tem&erature, stimulation o! heart by sym&athetic ner$es or toxic
conditions o! heart
4 Bradycardia: slo* heart rate, lo*er than G; beats &er minute
4 %inus /rrhythmia: heart rate $aries *@ &hases o! res&iration; accelerate during
ins&iration and decelerate during ex&iration; not &athological
4 /2 bloc':
o Prolonged P Inter$al: 8rst degree bloc'
o %econd degree bloc': P inter$al 7:F
o -hird degree: F;;, com&lete /2 bloc'
4 Extrasystole: &remature beat, contraction be!ore normal time
4 Paroxysmal -achycardia: ra&id heart rate *ith irregulations
4 sym&athetic 0 increase o! heart rate !reJuency1 chronotro&ic, increase strength
o! contraction 1 inotro&ic
4 Parasym&athetic 0 o&&osite o! sym&athetic
4 normal axis o! heart 47;o to DFF; +a$erage D=C,
o K47; le!t $entricular hy&ertro&hy
o KDFF; right $entricular hy&ertro&hy
4 in!arction 1 necrosis o! &art o! heart !rom ischemia
o &ain in chest and arm
o ele$ation o! %- segment acute in!arction
o dee& I in!arction L scar tissue
4 /trial 8brillation 0 sa*4toothed
4 $entricular 8brillation 4 Electrocon$ersion 1 de8b as treatment
/n obese F: yrs old male &atient &resent *ith small 8rm testes, a small &enis, little
axillary and !acial hair, a(oos&ermia, gyecomastia, and ele$ated le$el o! &lasma
gonadotro&insB #e has had diMculty in social adHustment throughout high school,
but this has *orsended and he has been re!erred !or genetic and endocrine
screeningB -he 'aryoty&e !rom &eri&heral blood leu'ocytes *ould most li'ely sho*
ho* many barr bodiesN
B klinefelter = xxy, 1 barr body
O$er the *ee'end, 67 yrs old students attend a &arty *ith drin' a large amount o!
alcoholB -he li$er metaboli(es the alcohol to acetaldehydeABBA *here does
oxidation occurN
C Peroxisomes
/ =Eyrs old man *ith history o! coronary atheroscleorotic disease &resents to the
emergency de&artment *ith sym&toms o! a heart attac'B %tudies re$eal that his le!t
anterior descending artery is com&letely bloc'ed by a thrombusB 5hat &athological
change in the myocytes *ould su&&ort an irre$ersible cell inHuryN
!itochondrial dys"unction, s#ecially increased u#take o" calcium
by the mitochondria
/ &atient ha$e o&en, clean, granulating *ound o! the armB #e does not desire
reconstructi$e surgeryB -his *ound e$entually healB -he acti$e contractile !orce
generate by *hich cellN
D !yofbroblasts
/ F= yrs old boy &resent in the emergency room *ith &aroxysms o! dys&nea, cough
and *hee(ingB #is &arents indicate that he has had these Oattac'P during the &ast
*inter and that they ha$e *orsened and become more !reJuents during the s&ring
allergy seasonsB 5hich o! the cell ty&es is correctly matched to a !unction it may
&er!orm in this &atientQs diseaseN
!ast cells, edema
/ :F year old man &resent to his &rimary care &hysician com&laining o! chronic
cough and *hee(ingB #e is a smo'er !or yearsB / tissue sam&le ta'en !rom his lung
re$eal large cells *ith ingested carbon &article loosely attached to the e&ithelial
cells o! the al$eoli or lying !reeAABB*hat ty&e o! cellN
$ $lveolar macro#hage derived "rom blood monocytes
/ blood sam&le is &ro$ided to a laboratory researcherB #e isolates the macro&hages,
stains them and examines them microsco&icallyB R&on the examinationABB
ABBdescri&tionN
Presence o" more than one nucleolus
/ Cellular &hysiologist &er!orms ex&eriments to monitor the cellular acti$ities and
metabolism as monocytes mature into macro&hagesB .uring maturation *hich o!
the !ollo*ing statement is trueN
B Cellular activities increase
/ EG years old *oman undergoes an abdominal hysterectomy !or a 8broid uterusB
-he surgeon reJuest a !ro(en section o! the tumor, *hich is de!erred because o! the
lesionQs degree o! cellularityB 5hich o! the !ollo*ing criteria *ill be used by the
&athologist in determining benignancy $ersus malignancy in &ermanent sectionsN
$ !itotic rate
Both, ?amber aton myasthenticn ?EM% L M3B In ?EM%, autoantibodies attached
$olateg4gated calcium channels in the &resyna&tic membrane at the neuromuscular
HunctionB In M3, autoantigidies attach the &ostsyna&tic acetylcholine channelsB
*hich o! th !ollo*ing ex&erimental mani&ulation should be di)erentiate bet*een the
t*o desease mechanismBN
a% !easure the amount o" $ch released in res#onse to motor
nerve stimulation%
In the e$alati o! a 7; ye old male athlete *ho is &re&aring to run a marathonB -he
9o*ing statement are true o! smooth muscle are o&&sedd to the s'eletal muscleN
b% Contraction in smooth much last longer and is slo&er%
/ &aetient has muscular *ea'nessB #is &arents and sister not ha$e *ea'ness B Sou
sus&ect .uchenneQs muscular dystro&hyB -his is an exam&le o!:
c% '-linked recessive inheritance (because #arents do not carry
d)*
66 yr oldB Clinical tests indicate thymoma and the &resence o! circulation
antibodies to /ch rece&torsB / &ossible diagnosis is
d% !yastenia gravis%
Malignanat hy&erthermiaAB*hich entails ele$ated core body term&aeratueB
%'eletal muscle rigidity nd ele$ated blood cardbon dioxide le$elB Based on these
obserysm *hch mutation o! the gene li'ely to beN
e% $bnormal activation o" the calcium release channels o" the
sacro#lasmic recituclum%
Both, ?ambert4 eaton myasthenic syndrome +?EM%, and myastenia gra$is +M3,
cause muscle *ea'ness and both disease are autoimmuneB In ?EM%, autoantibodies
attac' $oltage gate calcium channels in the &resyna&tic membrane at the
neuromuscular Hunction, in M3 autoantibodies attac' the &ostsyna&tic acetylcholine
channels, *hich o! the !ollo*ing ex&erimental mani&ulation could be di)erentiate
bet*een t*o disease mechanismN
"% !easure the amount o" acetylcholine release in res#onse to
mother nerve stimulation
In the e$aluation o! a 7; yrs old male athlete *ho is &re&aring to run a marathon,B
-he s'eletal smooth muscles are com&aredA*hich o! the !ollo*ingAN
g% Contraction in smooth muscle last longer and is slo&er
/ &atient has muscular *ea'nessB #is &arents and sister so not ha$e *ea'ness, but
this motherQs brother has *ea'ness you sus&ected .uchenne muscular dystro&hyB
-his exam&le o!N
h% '-linked recessive inheritance
/ 66 yrs old *oman com&lains o! !atigue o! the muscles in her !ace eyes and
tongueB Clinical test indicate thymona and the &resence o! circulating antibodies to
acetylcholine rece&torsB / &ossible diagnosis isN
i% !yastenia gravis
Malignant hy&erthermia is a relati$ely rare genetic disorder, !ound in a&&roximately
F in F;;;; indi$idual a)ected indi$idual can exhibit a li!e threatening res&onse to
inhalation anesthetic, *hich entails ele$ate core body tem&erature, s'eletalAB
+% $bnormal activation o" the calcium release channels o" the
sarco#lasmic reticulum%
/ GF yrs old &atient *ith history o! rheumatic heart disease is !ound to ha$e atrial
8brillation+/", !or *hich she is treated *ith .igoxinB -reatment *ith dioxin con$erts
her /" to a normal sinus rhythm and most li'ely in a decrease in *hich o! the
!ollo*ingN
C ,he conduction velocity in atrioventricular ($-* node
/ =7 yrs old healthy male undergoes an exercise stress test, running on a treadmill
until a maximum exertion is obtainedB 5hich o! the !ollo*ing statement correctly
describes e)ect autonomic ner$e acti$ity on the cardio$ascular acti$ity on such a
healthy subHectN
B .nhibition o" #arasym#athetic nerves increases heart rate
/ &atient is admitted to the hos&ital !ollo*ing a 'ni!e *ound to the abdomen *hich
results in extensi$e bleeding into the abdomenB -he arterial &ressure at admission
is G=B7; mm#g *ith a ra&id, *ea' &ulseB Com&ared to the normal ner$e im&ulse in
the carotid sinus ner$es and ion the sym&athetic ner$es are changed in *hat *ayN
C Carotid sinus nerve im#ulses are decreased, sym#athetic are
increased
/ 8rst year medical student is as'ed to identity that &art o! the EC3 trac'ing *hich
corres&ond to conduction o! an im&ulse !rom %/ node through the /2 nodeB 5hich
o! the !ollo*ing is correctN
B P-/ interval
-*o &atients are admitted to the intensi$e care until a!ter acute e&isode o! 3I
bleeding ha$e lo*ered each o! their hematocrit le$el !rom E=degree to 7; degreeB
Neither &atient is currently acti$ely bleedingB -he 8rst &atient has no heart disease,
the second has signi8cant aortic stenosisB 5hat normal &rotecti$e res&onse *ould
be im&aired in the second &atient that could increase the ris' o! death in the e$ent
o! another e&isode o! bleedingN
$ .nability o" augment cardiac out#ut by increase heart rate and
contractibility
/ =< yrs old male &atient in heart !ailure im&ro$e mar'edly a!ter using a drug that
increase the intro&ic state o! his heartB 5hich o! the !ollo*ing change is &rimarily
res&onse !or the im&ro$ement in her conditionN
C $n increase in end diastolic volume
/ !emale &atient comes to the emergency room o! your hos&ital because he has a
di)use erthymatous rush in$ol$ing nearly all his bodyB #is total 5BC count is greater
than F;;,;;; cells mmT7B #e also com&lains o! bone &ain, ser$er irritability,
*ea'ness, !atigue, nauseas and $omiting, consti&ation, &hoto&hobia, and &olyuria,
his EC3 sho*s shortening o! the I- inter$al &rolongation o! the P inter$al and
nons&eci8c - *a$e changeB -he most li'ely cause o! his sym&toms isN
$ 0y#ercalcemia1
E< yrs old man &resents to the emergency de&artment com&laining o! chest &ain
and shortness o! breathB /n electro cardiogram sho*s ischemia o! the &osterior
myocardiogramN 5hich lead are li'ely a)ectedN
D -1 and -2 Interior +74=,
/ 6= yrs old male re&orts e&isodic Os&ellsP characteri(ed by &al&ations, s*eating,
ner$ousnes and !eeling o! anxietyB On examination the manQs blood &ressure is
FG=BC= mm hg &lasma nore&inerhine is E=; &g m? normal, &lasma e&ine&hrine is
FF= &g m?, and 6E hr urinary 2M// isA
C Pheochromocytoma
/ == yrs old man de$elo&s an acute myocardial in!arction because o! the sudden
occlusion o! the le!t anterior descending coronary arteryB -he area o! myocardial
necrosis *ithin the $entricle can be described asN
/ Coagulative necrosis
%e$eral days !ollo*ing a myocardial in!raction, a == yrs old male de$elo&s the
sudden onset o! a ne* &ansystolic murmur along *ith a diastole 9o* murmurB
5or'u& re$eal increase le!t atrial &ressure that de$elo& and extend into diastoleB
. /u#ture o" a #a#illary muscle
/ := year old male become acutely short o! breath &resent *ith the combination o!
hy&otension ele$ated Hugular $enous &ressure and muUed heart soundB -his triad
sym&tomsABB
C Cardiac tam#onade
/ E= yr sold *oman &resent *ith the acute onset o! le!t hemi&aresis and !acial
droo&B / cerebral angiogram demonstrates occlusion o! the right middle cerebral
arteryB -he most common source !or an embolus that could &roduce these acute
sym&toms is theBB
$ 3e"t atrium
/n auto&sy heart !rom a E yr old boy *@ a &remortem history o! cyanotic congenital
heart disease dis&lays right $entricular hy&er&lasia, &ulmonary stenosis, $entricular
se&tal de!ect, and dextro&osition o! the aortaB 5hat term best de8nes this disorder:
tetralogy o" 4allot
FC yr !reshman !ootball &layer colla&ses during &reseason *or'outs on $ery hot
a!ternoon; has no &rior medical history other than recent u&&er res&iratory
in!ection; ta'en to E but cannot be re$i$ed; auto&sy *@ enlarged heart that sho*s
myocyte disarray; *hich is most li'ely cause o! death:
D hy#ertro#hic cardiomyo#athy
6C yr old !emale *@ rheumatic !e$er during childhood *@ diastolic o&ening sna& *@
late diastolic murmur:
mitral stenosis