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UWORLD + FA Review

Effects on myocardium function after an MI: Sharp decrease in Cardiac output due to loss of function of zone of ht myocardium
On a Cardiac Function Curve, an MI wuld show what changes? A decrease in both the slope and the maximal height of the line
During which part of the cardiac cycle (a beat) does most of the Left Ventricular perfusion occurs? Diastole
Why is there minimal LV perfusion during Systole? Dut to the high systolic intraventricular pressure and wall stress on the LV.
What is the most important limiting factor for anytime of blood supply? The duration of diastole.
A short diastolic time means: Shorter time for blood to reach the intended area, thus limiting the perfusion.
What is a common condition that shortens the duration of diastole? Exercise as it produces tachycardia
Increased heart rate = shorter time of ventricular relaxation --> short diastole --> less blood perfusion.
What is Hemosiderin? The iron from the RBCs taken up by alveolar macrophages and stored.
What color is usually found in Hemosiderin slides? Brown-pigment
What condition is associated with Hemosiderin filed alveolar macrophages? Congestive heart failure
What are two Class 4 antiarrhythmics? Verapamil and Diltiazem
What kind of arrhythmia is often treated with Class IV antiarrhythmics? PSVT
Mode of action of Verapamil and Diltiazem? Blockage of Calcium channels in slow-response cardiac tissue, slowing phase 4 (spontaneous depolarization) and Phase 0 (upstroke)
What is the overall result in impulse conduction as patient is treated with a Calcium channel blocker? Reduces impulse conduction velocity in the SA and AV nodes.
Phase 4 in Cardiac Pacemaker AP represents: Spontaneous Depolarization
Class IV antiarrhythmics slow down which Phase? Phase 4 or "Spontaneous Depolarization" and Phase 0 (upstroke)
What kind of antiarrhythmics Increase the Refractory period? K+ channel blockers, especially Class III and Class IA antiarrhythmics, as these prolong REPOLARIZATION
Class III (amilidorone) and Class IA (quinidine) antiarrhythmics prolong the______________________ of the cardiomyocyte, which Class IV antiarrhythmics (Verapamil) slow down ______________________ Repolarization (class III and IA); Spontaneous Depolarization (class IV)
The Rough ER is : Covered by ribosomes and is involved in the transfer of proteins to the cell membrane and extracellular space, attached to a transcoding.
The RER (rough endoplasmic reticulum) has well developed _______________________ pancreatic and Plasma cells. Protein-secreting
The Smooth Endoplasmic Reticulum does not have attached _____________, and funciotos in _________________, _____________, and ______________________. Ribosomes; Lipid synthesis, carbohydrate metabolism, and detoxification of harmful substances.
Free Ribosomes location: Floating in the Cytosol
What is the role of Free Ribosomes? Responsible for translating proteins found within the cytosol, nucoulsl, peroxisome matrix and nuclear-encoded mitochondrial proteins
Renal Blood Flow (RBF) definition: Volume of blood that flows through the kidney per unit time and can be calculated by dividing the renal plasma flow by (1-hematocrit)
What value closely resembles RPF? PAH clearance
PAH clearance = RPF
RPF = (urine [PAH] x urine flow rate) =------------------------------------- plasma [PAH]
RBF = (PAH clearance) = ---------------------------- (1- hematocrit)
Irregular chaotic electrical activity within the ATRIA and presents with absent P-waves, irregularly irregular R-R intervals and narrow QRS. Dx? Atrial Fibrillation
What is the pacemaker in atrial fibrillation? AV node
What is affected in the ECG by abnormal Bundle Brunch conductivity? Duration of QRS complex
The Purkinje system takes over as Pacemaker: It takes over when heart rate is less than 40 bpm.
IV fluids will increase : The intravascular volume and the LVEDV.
An increase in Preload by IV fluids causes: A stretch in the myocardium and increased End-diastolic sarcomere length, leading to an increase in stroke volume and cardiac output.
Polycythemia definition: Erythrocytosis with a level > 52% in men and >48% in women.
What value is used to differentiate from Absolute and Relative erythrocytosis? RBC mass
What does a normal RBC mass value indicate about Erythrocytosis? Plasma volume contraction as the cause of the Polycythemia
Relative Polycythemia: - Normal RBC mass
What are some causes of Relative Polycythemia? 1. Dehydration 2. Excessive diuresis
Absolute Polycythemia reveals a: True increase in RBC mass
Secondary Absolute Erythrocytosis: 1. Only RBC increases; normal WBC and platelets 2. Hypoxia; EPO-producing tumors
What is the MCC of Primary Absolute Polycythemia? Polycythemia Vera
What happens in Renal Artery Stenosis? 1. Hypoperfusion 2. Activation of the RAAS
What are the actions of Angiotensin II (AT II)? - Arteriolar vasoconstriction - Increases Aldosterone and ADH production
In Renal Artery Stenosis the Affected Kidney produces: Renal Hypoxia and, Increased Renin output
What are the final effects seen in the Unaffected (good) kidney in Renal artery stenosis? 1. Increase in Na+ excretion 2. Decrease in Renin Output
The cascade of effects seen in Unilateral Renal Artery Stenosis, produce what final effect in affected kidney? Improved GFR
Leydig cell: Stimulated by ----> LH Secretes ------> Testosterone
Sertoli cell: Stimulated by -----> FSH Secretes ---- Inhibin B
Which node is the normal pacemaker in a healthy individual? SA node
In cases of SA node been damaged, what are other "replacement" conduction pacemakers? AV node (afib) bundle of His, and Purkinje fibers
In a 3 AVB, what is the pacemaker in charge? AV node
Pacemakers below the AV node and bundle of His? Take over when HR is below 20 bpm with abnormally shaped QRS complexes.
What are the 2 main causes of Normal A-a gradient hypoxemia? 1. Hypoventilation 2. Low inspired fraction of Oxygen
What are conditions associated with Hypoventilation-induced hypoxemia? - Obesity Hypoventilation syndrome - Neuromuscular disease
What condition is associated with Low Inspired fraction of oxygen, thus causing Hypoxemia? High altitude
What are the 3 main categories of Elevated A-a gradient Hypoxemia? 1. Right -to - left shunts 2. V/Q mismatch 3. Impaired diffusion
Cardiac septal defects and Pulmonary edema are examples of: Right to left shunts that cause Elevated A-a gradient hypoxemia
What are conditions associated with V/Q mismatch? -Pulmonary embolism - COPD
Impaired diffusion in lungs is seen with Interstitial lung disease
What is a sign of Hypoventilation? [PaCO2] > 45 mm Hg while awake (patient is keeping the CO2 inside)
MVP is audible as the _______________________, just before _________________. Mitral Valve Opens; Diastolic filling.
Everytime GFR halves, ___________________________________. Serum Creatine doubles
What is the function of Neprilysin? Breakdown of Natriuretic peptides and AT-2.
What is caused by the inhibition of Neprilysin? Activation of ANP/BNP and AT II
What are the combined effects of Neprilysin inhibitor and ARBs in treatment of Heart failure? 1. Optimize the Positive effects of Natriuretic peptides (vasodilation, dirures) 2. Blocking the negative effects of AT II (vasoconstriction and fluid retention)
ARBs treatment is beneficial as it: Blocks the negative effects of AT II, such as vasoconstriction and Fluid retention
What effects are enhanced by inhibiting Neprilysin? Positive effects of Natriuretic peptides such as Vasodilation and diuresis.
Where is Proinsulin cleaved? Pancreatic B-cells secretory granules
What are the breakdown products of Proinsulin? Insulin and C-peptide
Where would you find Preproinsulin in the B-pancreatic cell? Rough Endoplasmic Reticulum
Dobutamine injection would cause an increase in ______________. Contractility.
Hyperventilation causes Decrease in PaCO2
Hypoventilation causes Increase in PaCO2
A decrease of HCO3- is seen with: Metabolic Acidosis
What enzyme is overproduced or expressed in Sarcoidosis? 1-a-hydroxylase
Elevated levels of 1-a-hydrolase produces: 1. 1, 25 -(OH)2 Vitamin D 2. Hypercalcemia
Airway resistance: At each level of the the lower respiratory tract is inversely related to the total cross-sectional areas of all the airway at that level
Airway resistance in the trachea is: High, and then reaches a peak at the medium-sized bronchi
Where is the total cross-sectional area of the airways the minimum? Medium-size bronchi
Airways resistance is the lower in the Terminal bronchioles
Calcium is most important in the process of contraction and relaxation in which type of muscle? Cardiac and Smooth muscle cells.
Myocyte depolarization causes: Activation of the L-type Calcium-channel at the plasma membrane
The activation of the L-type Ca2+ channels in the plasma membrane causes: INFLUX of Extracellular calcium that activates sarcoplasm RyR channels, including the release of additional Calcium from the Sarcoplasmic reticulum.
The released Calcium from the Sarcoplasmic Reticulum: 1. Binds to Troponin in cardiac muscle 2. Binds to Calmodulin in Smooth muscle
As Sarcoplasmic Reticulum release Calcium is attached to either Troponin or Calmodulin, in cardiac and smooth muscle, respectively, it allows for: Actin and myosin to interact and cause contraction.
Sarcoplasmic Ca2+ binds to Troponin in __________________ cells. Cardiac
Sarcoplasmic Ca2+ bins to Calmodulin in _________________ cells. Smooth Muscle
After initial influx of Extracellular calcium via the L-type Ca2+-channels, what receptor is activated and causes? Sarcoplasmic RyR receptor; allow for release of additional Sarcoplasmic Calcium.
What process of interaction is unique to Skeletal muscle contraction process? Mechanical Coupling
What is Mechanical Coupling in Skeletal muscle? The direct interaction between L-type Ca2+ channels and RyR sarcoplasmic receptors, that cause the release of Sarcoplasmic Calcium.
Which type of muscle tissue is less impacted by the influx of Calcium across the plasma membrane? Skeletal muscle
What receptors are blocked by Class IV antiarrhythmics? L-type Calcium channel
Class IV antiarrhythmics have a little to no effect on _________________ muscle, due to__________________________. Skeletal Muscle; It is not affected greatly by the influx of extracellular calcium across the plasma membrane.
Serum FSH in menopause is: Elevated due to resistant ovarian follicles and lack of feedback mechanism form Inhibin.
How are the levels of Estrogen and Progesterone in Menopause? Low (decreased) due to decreased ovarian function
Menopause: Occurs on average of 51 years old and is diagnosed retrospectively after 12 months of amenorrhea.
What is B-endorphin? Endogenous opioid peptide that is derived from Proopiomelanocortin (POMC).
What is POMC: Polypeptide precursor that goes through enzymatic cleavage and modification to produce B-endorphins, ACTH, and MSH.
What are the products made from POMC? B-endorphin, ACTH and MSH.
The CFTR protein is a: Transmembrane ATP-gated Cl- channel
Defective CFTR gene is clinically presented with: Thick, plugging mucus and elevated sodium and chloride levels in sweat.
Transport of glucose is done by: Facilitated Diffusion
Facilitated diffusion is done: By a protein and does not require ATP (energy)
What are the proteins used in Glucose transport? GLUT 1-5
What kind of Transport mechanism requires a protein and energy? Active transport
Simple diffusion: Does not require energy neither a protein.
Movement of particles along the concentration gradient with out use of energy or proteins. Simple diffusion
Examples of Simple diffusion: Oxygen (O2) and carbon dioxide (CO2)
Characteristics of Active Transport: 1. Movement against concentration gradient 2. Most energy required is provided by ATP hydrolysis 3. Ex: Glucose against gradient via Na+/glucose symporter.
What are the three variables that affect Total Oxygen Content? 1. Hemoglobin (Hb) concentration 2. Oxygen Saturation of Hemoglobin (SaO2) 3. Partial pressure of oxygen dissolved in blood (PaO2)
How does anemia alter or change Total Oxygen Content? Decreased Hb concentration with normal SaO2 and PaO2.
How are Hb, SaO2, and PaO2 affected in high altitude situations? All 3 variables are decreased
Describe alteration in Hb, SaO2 and PaO2 in Polycythemia? PaO2 and SaO2 are normal, but there is an increase oxygen content due to increase production of RBCs.
What vessel has the most deoxygenated blood? Coronary sinus (venous)
What are the two vessels that have the greatest difference in O2 levels? Aorta (O2-richest) and Coronary venous sinus (O2-poorest)
Where is the Ectopic electrical foci in the development of Atrial fibrillation? Pulmonary veins
Defective or damage electrical conduction near the Pulmonary veins, will be reflected in the development of? Atrial fibrillation
Atrial Flutter is due to: Disruption of electrical impulse int eh area between the Crista terminalis and the Tricuspid valve annulus, known as the Cavotricuspid isthmus.
What is the approximate K+ levels in the different parts of the nephron? Bowman Capsule-- 100% Late PCT ---- 35% Ascending Loop of Henle and DCT ------ 5-10 % Medullary Collecting Ducts ----110% (1005 +10%)
What is the normal A-a gradient range? - 4-15 mm Hg
Explain difference of the slight decrease in pO2 levels between the Alveolar Capillary blood and the Systemic Arterial blood. Mixing of Oxygenated blood from the Pulmonary veins with Deoxygenated blood for the bronchial circulation and Thebesian veins
What blood vessels provide Deoxygenated blood to the Alveolar capillary O2-rich (only) blood? The Bronchial circulation and the Thebesian veins.
V/Q mismatch has two main categories: 1. Dead Space Ventilation 2. Intrapulmonary Shunt
Describe the physiology of Dead Space Ventilation: - Good (adequate) ventilation - NO perfusion
What is an example of Dead Space Ventilation: Pulmonary Embolism
What are examples of Intrapulmonary shunts? Pneumonia and Pulmonary edema
Describe the physiology of Intrapulmonary shunt: 1. Bad (NO) ventilation 2. Adequate (good) perfusion
What is the cause of Pneumoconiosis? Diseases resulting form the inhalation of fine particles that reach the respiratory bronchioles and alveoli (Most distal areas)
How are particles removed by body in cases of Pneumoconiosis? Cleared by alveolar macrophages, as they are phagocytosed.
How are substances (dust) cleared in the Nasal passage and Pharynx? By cough and sneezing
How are substances cleared in the Bronchi and Proximal bronchioles? Cleared by Mucociliary transport
What is the result of Vitamin K deficiency? Impaired factor carboxylation
Vitamin K deficiency lead to bleeding in which areas? Intracranial, GI, cutaneous, umbilical and surgical site bleeding.
Suspect of Vitamin K deficiency when: 1. Newborn with spontaneous bleeding 2. Parents refusing vaccinations 3. Parents opting for "natural" births due to religious beliefs.
Germinal Matrix fragility: Responsible for IVH in Premature infants
What is Dead Space? Space where there is no gas exchange
Increase heart rate causes ______________________ to Dead space. No change
What would occur in a person with tachypnea in respect to Dead Space ratio? The increased in Respiratory rate will lead to an decrease in tidal volume, thus and the Dead Space ratio would increase.
The lung volume is _________________ in pulmonary fibrosis. Decreased.
Hypobaric hypoxia; Decreased inhaled pO2 is the pathogenesis of? High Altitude Sickness
What are the physiological responses to High Altitude sickness? 1. Hyperventilation --> Increase blood oxygenation, lowers pCO2 2. Erythrocytes: Increase in 2,3-BPG production 3. Kidneys: Increase EPO production and increase in Bicarbonate excretion.
LH stimulates the _________________ and produce _______________. Theca Internal -------> Progesterone
What cells is stimulated by FSH? What is produced? FSH stimulates the Granulosa cell to produce Estrogen
______________ ---> Granulosa cell -------> Estrogen FSH
LH -----> ______________________ ----------> __________ Theca interna; Progesterone
Gastin: - Secreted by G cells in the Gastric antrum and duodenum - Role: Increase Gastric H+ secretion
Somatostatin: - Secreted by D cell sin the Pancreatic islets and gut mucosa - Function: Decrease secretion of most GI hormones
CCK: Secreted by I cells in the Small intestine - Function: Increase Pancreatic enzyme and HCO3- secretion
Secretin: Secred by S cells ijn the Small intestine Function: Increase Pancreatic HCO3- secretion, and decrease Gastric H+ secretion
GIP: Secreted by K cells in the small intestine Function: Increase insulin release and Decrease gastric H+ secretion
Motilin: Secreted by M cells in the Small intestine Funtin: Increase GI motility
Which GI hormones cause a decrease in Gastric H+ secretion? Secretin, GIP, and possibly somatostatin
Increase in Pancreatic enzyme and high bicarbonate secretion is seen with? CCK
What is the unique role or function of GIP? Increase the release of Insulin
What GI hormone is secreted by I cells in the Small intestine? CCK
K cells in the small intestine secrete? GIP; increase insulin release + decrease in gastric H+ secretion
Where are the G-cells the secrete Gastrin? Antrum of Stomach and duodenum
What area is commonly infected by H. pylori in the stomach architecture? Antrum of Stomach
What is hepcidin? Polypeptide synthesized in the liver that acts a central regulator of Iron homeostasis
What is a key protein involved in the homeostasis and regulation of Iron? Hepcidin
What causes elevation in Hepcidin levels? 1. High iron levels 2. Inflammatory conditions
What conditions cause a decrease or low Hepcidin levels? 1. Hypoxia and, 2. Increased erythropoiesis
Low levels of Hepcidin cause ---p> Increase intestinal iron absorption and stimulate iron release by macrophages
What protein allows the passage of Iron for the Gut lumen into the Enterocyte? DMT-1
Transferrin is found as a dimer in the _________________. Bloodstream
What protein, involved in Iron regulation and transport, allow for entrance of Iron into bloodstream either from the Enterocyte or macrophage? Ferroportin-1
What structure transports iron in the blood? Transferrin
Hepcidin is synthesized in the ________________. Liver
What is the Tm of glucose (TmG)? 375
At what concentration is there first glucose in the urine? 200
What is the threshold of glucose? 200
Where does ADH act in the Nephron? Medullary segment of the Collecting ducts
WHat is the role of ADH in the nephron? Increased urea and water reabsorption, allowing the production of maximally concentrated urine
Muscarinic receptors may be activated by: 1. ACh and, 2. Cholinergic agonists
The activation of muscarinic receptors result in : Peripheral vasodilation due the synthesis of Nitric Oxide in the endothelial cells, which lead to vascular smooth muscle relaxation (hypotension)
M1 receptors have their effects in the______________. Brain
Stimulation of the M1 receptors cause: 1. Memory formation 2. Cognitive functioning
Inhibition of M1 receptors cause: Confusion
M2 receptors are found primarily in the_____________. Heart
What are the effects seen in M2 receptor stimulation? Decreases Heart rate and atrial contraction
What are the inhibitory effects of M2 receptor inhibition? Increase heart rate and contractility
In which organs are M3 receptors located? Peripheral vasculature, Lungs, Bladder, Eyes, GI, and Skin
What are the effects of Peripheral vasculature M3 receptor stimulation? 1. Smooth muscle relaxation 2. Vasodilation 3. Hypotension
What happens if peripheral vasculature M3 receptors are inhibited? - Smooth muscle contraction - Vasoconstriction - Hypertension
Hypotension would be treated by M3 receptor stimulation or inhibition? Inhibition
Lung M3 receptor stimulation causes ________________--, while its inhibition produces ___________________. Bronchoconstriction; Bronchodilation
What are the effects produced by stimulation of the M3 receptors found in the eyes? 1. Pupillary Sphincter muscle contraction (miosis) 2. Ciliary muscle contraction (accomodation)
Inhibition of the Muscarinic (M3) receptors in the eye, causes: Mydriasis, cycloplegia, acute angle glaucoma in elderly patients
Increase stimulation of M3 skin receptors cause? Inhibition? Stimulation increased sweat production; Inhibition increases body temperature due to lack of sweating
What are the effects of GI M3 receptor stimulation? 1. Increased peristalsis 2. Increase salivary and gastric secretions
Constipation, dry mouth, and decreased acid production can be due to inhibition of _______________________. Gastrointestinal M3 receptors.
What is the relation between exercise and CO2 content of venous blood? Increased skeletal CO2 production that increases the CO2 content of venous blood, is seen with exercise.
Only ____________________ is increased during exercise. CO2 content in venous blood, due to increase Skeletal muscle CO2 production.
Thyroid surgery may cause: Postoperative Hypocalcemia due to accident removal or damage of the PTH glands.
Acute drop in PTH leads: 1. Decrease in Calcium and phosphate resorption from the bone 2. Decreased calcium reabsorption by the kidneys
Chvostek sign? Typical manifestation of Acute hypocalcemia, which very commonly cause perioral paresthesias.
WHat are the 2 main regulators of Calcium and Phosphate? 1. PTH: -- regulates minute to minute concentrations 2. Vitamin D: -- regulate levels over a longer time
A sudden imbalance or change in Phosphate or calcium will be counteracted by? PTH
Long-term Calcium and Phosphate regulation is done by: Vitamin D
PTH is produced by _________________- in the ________________ in response to _____________________. Chief cell in the PTH glands; Hypocalcemia
What are the primary effects of PTH? 1. Increased osteoclastic bone resorption --> Increase Ca2+ and phosphate into circulation 2. Increased Renal calcium reabsorption and reduces phosphate reabsorption 3. Increase the formation of 1,25-(OH) Vitamin D, which increases intestinal calcium reabsorption.
Stroke Volume (SV) = EDV - ESV
Ejection Fraction (EF) = SV = -------- EDV
Air Trapping and hyperinflation are commonly used terms when describing _____________. COPD
COPD patients have? Higher base lung volumes (Increase FRC) and increased Residual volume (RV)
Absolute volume of air in the lung that is not respired Residual volume
Residual volume is increased in ________ patients COPD
What lung volumes are increased in COPD? FRC, TLC, & RV
Inulin clearance closely estimates _____. GFR
Total Filtration Rate of Substance A = (Inulin Clearance) x (Plasma concentration of Substance A)
Net excretion is the difference of Total filtration rate of substance A from: Tubular Reabsorption of Substance A
Net Excretion Rate of Substance A = ([Inulin clearance] x[Plasma concentration]) -- (Tubular Reabsorption of substance A)
Conductive Hearing loss has: - Greater bone conduction (BC) than Air conduction (abnormal Rinne test) - Weber test --> lateralized to the affected ear
Greater bone conduction than Air conduction, means: Abnormal Rinne Test
If during the Weber test, the sound lateralizes to the affected ear, it most likely means what kind of hearing loss? Conductive hearing loss
Sensorineural Hearing Loss has: - Air conduction > Bone conduction (normal Rinne Test) - Weber test --> Lateralized to UNAFFECTED ear
What is the parameters of an normal Rinne Test? Air conduction greater than bone conduction
Abnormal Weber test: Sound/vibration will lateralized to the unaffected (normal) ear
Abnormal Rinne + Normal Webber --> Conductive hearing loss
Normal Rinee + abnormal Webber --> Sensorineural hearing loss
TPO (thyroid peroxidase) causes: 1. Oxidation of iodine to iodine 2. Iodination of thyroglobulin tyrosine residues, 3. Iodotyrosine coupling reaction that forms T3 and T4.
PAH is not_________________________________ At any part of the nephron.
Where is PAH tubular concentration the lowest? Bowman's space
what can cause isolated Systolic Hypertension? Age related stiffness and decrease in compliance of the aorta and major peripheral arteries.
Created by: rakomi



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