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Physiology
FA review Round 2 2020
| Question | Answer |
|---|---|
| What hematologic state is often associated with underlying malignancies? | Hypercoagulable state |
| A hypercoagulable state leads to development of: | DVT |
| What results of a pulmonary embolism? | Respiratory distress secondary to a V/Q mismatch caused by blood being shunting from the are where the PE is causing an infarction |
| What is the probably because of V/Q mismatch in a person with an underlying malignancy? | Pulmonary embolism |
| What are the cardiac effects of Norepinephrine? | Increase AV nodal conduction velocity through the AV node via increased Calcium influx into the cells |
| What catecholamine causes increased AV nodal conduction velocity? | Norepinephrine |
| Where are hemodynamic changes caused by NE? | Increase blood pressure, increased heart rate, and mild to no change in cardiac output |
| What is a severe dermatologic adverse effect of Warfarin? | Warfarin-induced skin necrosis |
| What patients are at higher risk of Warfarin-induced skin necrosis? | Protein C or Protein S deficient patients |
| Site of action of Warfarin | Liver |
| What laboratory level is used to measure the therapeutic effect Warfarin? | Prothrombin time |
| Which drug's therapeutic effect is measured by Prothrombin time? | Warfarin |
| What is often monitored in patients on Warfarin? | INR and PT |
| Which pathways affected by Warfarin? | Extrinsic Coagulation pathway |
| What are risk factor of Silicosis? | Exposure to rocks and minerals, such as sand and smoking |
| Which type of lung disease profile is seen with Silicosis? | Restrictive pattern |
| Which lung profile shows a decrease in all lung parameters, except for a normal or slightly elevated FEV1? | Restrictive pattern |
| Which is the featured or key finding in CXR of Silicosis patient? | "eggshell" calcifications in the Upper lobes |
| Do the "eggshell" calcification seen with Silicosis appear in the upper or lower lobes? | Upper lobes |
| Which 3 lung parameters are increased in Obstructive lung disease pattern? | RV, FRC, and TLC |
| Which 3 lung parameters are decreased in Obstructive lung diseases? | FEV1 >>FVC, FVE1:FVC |
| The "F" parameters(FEV1, FVC, FEV1:FVC) are increased or decreased in Obstructive lung diseases? | Decreased |
| Which is lung parameter is most decreased in Obstructive lung disease? | FEV1 |
| What is decrease in hypoglycemia? | ATP |
| Is ATP decreased or increased in state of hypoglycemia? | Decreased |
| A person in extreme fasting mode will present with: | Hypoglycemia and consequently low levels of ATP |
| What does a decrease in ATP cause in hypoglycemia state? | Prevent activation of K+ channels leading to prevention of the activation of Calcium channels that cause eventual insulin release by B-pancreatic cells |
| Overall, a decrease in _____ will lead to the inability to: | ATP: Secrete insulin by the Pancreatic B-cells |
| Which channels are unable to be activated in state of severe hypoglycemia? | Calcium channels due to low ATP levels |
| Trypsin is: | Released by the Pancreas and under normal circumstances the first enzyme in the protein digestive enzyme cascade in the GI tract |
| In a healthy person, what is the first enzyme released and involved in protein digestion in the GI tract? | Trypsin |
| Which organ secretes Trypsin? | Pancreas |
| What does te inappropriate conversion of Trypsinogen into Trypsin causes? | Autolysis and necrosis in Pancreatitis |
| What is the most feared complication of Diabetes mellitus type 1? | DKA |
| What are the electrolyte abnormalities seen in DKA? | 1. Hyperkalemia (pseudohyperkalemia) 2. Hyperglycemia 3. High anion gap metabolic acidosis |
| DKA develops high anion or normal anion-gap metabolic acidosis? | High-anion gap metabolic acidosis |
| What condition is seen with pseudohyperkalemia? | DKA |
| What causes the Vitamin K deficiency bleeding in a newborn? | Absence of intestinal flora, resulting of Vitamin-K dependent clotting factors deficiency |
| What are the Vitamin K dependent clotting factors? | II, VII, IX, and X, as well as Protein C and S. |
| In Vitamin K deficiency patients, which hematologic parameters are prolonged? | PT and PTT |
| Which is prolonged in Vit K deficiency, PT, PTT or both? | Both |
| How are the levels PC and BT in vitamin K deficiency? | Normal |
| What type of conditions affect BT and PC? | Platelet disorders |
| MOA of Thiazides | Inhibit the Sodium-Chloride cotransporter in the DCT |
| What are adverse effects seen with Thiazide diuretics? | 1. Hypokalemia 2. Hyponatremia 3. Hyperglycemia,-uricemia, -lipidemia 4. Metabolic alkalosis |
| What type of metabolic imbalance is produced by Thiazide diuretics? | Metabolic alkalosis |
| Thiazide diuretics cause metabolic acidosis or metabolic alkalosis? | Metabolic alkalosis |
| Is hyponatremia or hypernatremia an associated adverse effect of Thiazides? | Hyponatremia |
| Which two serum electrolytes are low (hypo-) by the use of Thiazide diuretics? | Hypokalemia and Hyponatremia |
| Tumor lysis syndrome produces hypocalcemia or hypercalcemia? | Hypocalcemia |
| Why is a person with TLS often given supplemental calcium? | TLS develops hypocalcemia |
| How is Tumor Lysis syndrome prevented? | Hydration, Rasburicase, and Allopurinol |
| What are some effects produced by Tumor Lysis syndrome? | 1. Acute kidney injury 2. Hypocalcemia 3. Hyperphosphatemia 4. Hyperuricemia 5. Hyperkalemia |
| Which serum value is seen decreased or low in Tumor Lysis syndrome? | Serum calcium |
| Which serum electrolytes are elevated or hyper in TLS? | Phosphate, uric acid, and Potassium |
| What is the physiological effect of Positive inotropic agents? | Increase myocardial contractility |
| What is an drug-category of positive inotropic agents? | B1-agonists |
| An increase in myocardial contractility is reflected in the Cardiac curve with: | Increase in height and slope |
| At what part of the nephron anatomy is glucose freely filtered? | Glomerulus |
| At normal conditions, glucose is reabsorbed completely in the: | Proximal Convoluted Tubule |
| At what point is glucose stert to be seen in urine sample? | Level 200-375 mg/dL |
| If the serum glucose levels are above 375 mg/dL, it means --> | Transport at the PCT is completely saturated |
| At which point is Glucose transporters at the PCT completely saturated? | 375 mg/dL |
| Meckel diverticulum results from: | Persistence of the Vitelline duct |
| The pathological persistence of the Vitelline duct results in development of what? | Meckel diverticulum |
| At which part of the GI tract do Meckel diverticulum originates? | Ileum |
| How is Meckel diverticulum presented? | Mostly in children less of 2 year old; 1. Melena, hematochezia, and abdominal pain |
| What conditions are causative of GI obstruction in Meckel diverticulum? | Intussusception and/or volvulus |
| The development of aortic stenosis leads to: | Increased LEFT VENTRICULAR MASS and SYSTOLIC PRESSURE resulting in delaying closing of the aortic valve |
| Which murmur is due to delay closure of the aortic valve? | Aortic stenosis |
| Aortic stenosis increases afterload or preload? | Afterload |
| What aspects of the heart anatomy and physiology are increased with Aortic stenosis (AS)? | 1. Left ventricular mass 2. Systolic pressure |
| Is systolic or diastolic pressure increased by Aortic stenosis? | Systolic pressure |
| What is a common H2-blocker? | Ranitidine |
| MOA of Ranitidine: | H2 blocker that irreversibly blocks G-s coupled H2 receptors to decrease H+ secretion by Parietal cells |
| What G-protein-linked second messenger receptor is blocked by Ranitidine? | H2 |
| Which are used for mild to moderate cases of GERD, PPIs or H2 blockers? | H2 blockers |
| Which are more potent, PPIs or H2-blockers? | PPI |
| What are some causes of a right-shit to the Oxygen-hemoglobin dissociation curve? | 1. Decreased pH (increase H+ concentration) 2. Increased temperature 3. High-altitude training 4. Increased PaCO2 5. Increased 2, 3-BPG |
| Training in the altitude will cause a Right or Left shift to the O2-Hb dissociation curve? | Right |
| How does altitude training cause a rightward shift to the O2-Hb dissociation curve? | Increase EPO secreted by the Cortical and Upper medullary cells of the kidney, leading to increased RBC production and improved blood oxygen carrying capacity |
| What is the most common cause of Acute Respiratory alkalosis? | Panic attacks |
| Respiratory alkalosis is associated with Hyperventilation or Hypoventilation? | Hyperventilation |
| A person hyperventilating will develop Respiratory acidosis or alkalosis? | Respiratory alkalosis |
| Respiratory acidosis development is associated with Hypoventilation or hyperventilation? | Hypoventilation |
| Which metabolic/respiratory disorder is described with: - High pH - Low PCO2 - relative normal HCO3- | Respiratory alkalosis |
| List of causes of Respiratory Alkalosis: | 1. Panic attacks 2. Hypoxemia (high altitude) 3. Salicylate toxicity (early) 4. Tumor 5. Pulmonary embolism |
| Late or early salicylate toxicity is associated with Respiratory alkalosis? | Early |
| Which neuromuscular condition is often associated with Hashimoto disease? | Myasthenia gravis |
| What is Myasthenia gravis? | Cytotoxic (type II) hypersensitiviry reaction caused by antidobies against Postsynaptic ACh receptors of the NMJ |
| What are the classic symptoms of Myasthenia Gravis? | Generalized weakness, diplopia, ptosis, and difficulty chewing |
| Which receptors are attacked by autoimmune antibodies in Myasthenia gravis? | Postsynaptic ACh receptors in the NMJ |
| What are the two conditions associated with prolonged QT interval? | 1. Romano-Ward syndrome 2. Lange-Nielsen syndrome |
| Which prolonged QT conditions is associated with sensorineural deafness? | Lange-Nielsen syndrome |
| Which is the autosomal dominant (AD) condition is characterized with prolonged QT interval? | Romano-Ward syndrome |
| What is the key features characteristic of Lange-Nielsen syndrome? | Sensorineural deafness |
| What are actions of von Willebrand factor (vWF)? | 1. Platelet adhesion 2. Carrier molecule for factor VIII |
| What are lab findings of vW disease? | 1. Reduced Ristocetin-induced platelet aggregation 2. Prolonged PTT |
| Inulin clearance is used to calculate --> | GFR |
| Net resorption of substance (BUN) causes: | Underestimation of GFR |
| Net secretion of substance (Cr) causes: | Overestimation of GFR |
| DVT and Pulmonary embolisms are risk factors or causes of what type of metabolic/respiratory disorder? | Respiratory alkalosis |
| What is the cause of Polymyositis? | Endomysial inflammatory infiltrates with CD8+ T cells |
| What are the clinical characteristics of Polymyositis? | Symmetrical, proximal muscle weakness, and no cutaneous involvement |
| Which inflammatory myopathy is often seen with a Paraneoplastic syndrome? | Polymyositis |
| What cells are attacked in Polymyositis? | Endomysial inflammatory infiltrates with CD8+ T cells |
| What are the MCC os ARDS? | Pneumonia, sepsis, aspiration, trauma, and Pancreatitis |
| CXR of ARDS | Ground glass opacities and lung lobe consolidation usually bilateral |
| What are clues to diagnostic of ARDS? | 1. Hx of Alveolar insult 2. PaO2/FiO2 < 300 3. CXR --> Bilateral ground glass opacities |
| Anemia due to RBC production problems will present with a __________ reticulocyte count. | Low |
| Which cause of anemia are seen with a low Reticulocyte count? | Those involving problem in RBC production |
| What causes the S3 sound in the heart? | Vibrations of the ventricular wall at it reaches its elastic limit during rapid filling in states or volume overload and/or ventricular enlargement |
| What cardiac states or conditions lead to development of S3? | Volume overload and Ventricular enlargement |
| Maneuvers to increase or accentuate S3, are intended to: | Increase Preload |
| What are some common maneuvers that increase preload? | 1. Abrupt Squatting 2. Passive leg raising 3. Volume expansion |
| Abrupt squatting will increase Preload or Afterload? | Preload |
| Low doses of At II cause (in RAAS): | VasoCONSTRICTION if the EFFERENT arteriole |
| What are the consequences of Vasoconstriction of the efferent arteriole? | 1. Decreased Renal Plasma Flow (RPF) 2. Increase GFR 3. Overall increase in FF |
| Administration of AT II will cause a decrease or increase in GFR? | Increase |
| Which arteriole is targeted by low doses of AT II? | Efferent |
| What are the two types of Calcium channel blockers? | Dihydropyridine and Non-dihydropyridine |
| Which Ca2+ channel blockers work on the heart? | Non-dihydropyridine |
| What are the two most common Non-dihydropyridine Calcium channel blockers? | Verapamil and Diltiazem |
| Which Ca2+ channel blocker work on Vascular Smooth muscle? | Dihydropyridines |
| What is the ending of most if not all Dihydropyridine calcium channel blockers? | -dipine |
| If the antiarrhythmic blocks the phase 0 of the atrial Action potential, it is most likely what type of Calcium channel blocker? | Non-dihydropyridine |
| Amlodipine and Nifedipine are what type of Ca2+ channel blockers? | Dihydropyridine |
| Female growth spurt is seen in which Tanner stage? | Tanner stage 3 |
| What are female characteristics are seen in Tanner stage 3? | 1. Growth spurt 2. Breast contour elevates 3. Areolar enlargement 4. Axillary hair develops 5. Dark, coarse, curly hair over the mons pubis |
| Which phase are oocytes arrested from birth to ovulation? | Prophase I |
| In which phase of oocytes are arrested from ovulation to fertilization? | Metaphase II |
| Which phases or parts of respiration have negative intrapleural pressure? | During INSPIRATION and Passive Expiration |
| Which respiration part is seen with positive intrapleural pressure? | Forced expiration |
| What happens to airflow in moments of Positive Intrapleural pressure? | Airway compression will limit air flow. |
| When is intra-alveolar pressure equal to atmospheric pressure? | In moments of NO NET flow of air between the lungs and the atmosphere |
| Which are exocrine enzymes secreted by Pancreas? | alpha-amylase, lipases, proteases, and trypsinogen in an isotonic fluid |
| What cells secrete exocrine enzymes by the Pancreas? | Pancreatic acinar cells in a NaCl solution |
| What occurs to chloride and bicarbonate levels in Pancreatic secretions? | At low flow states (rest) Cl- is increased; At high flow states (during digestion) HCO3- is increased |
| What are effects of LSD intoxication? | Visual hallucinations Anxiety and depression Delusions Nausea, weakness Paraesthesias Dilated pupils |
| How are vital signs in LSD intoxication? | Remain normal |
| Which drug intoxication is seen with normal vital signs? | LSD |
| Which formula is used to determine proper respiratory compensation metabolic acidosis? | Winter's formula |
| What is the Winter's formula equation? | PCO2 = 1.5 x ([HCO3-]) +8 +/-2 |
| A PCO2 must fall or raise the range of Winter's formula in order to properly compensate metabolic acidosis? | Fall |
| Which condition is seen with metabolic acidosis and increased levels of Ketones? | DKA |
| What type of metabolic acidosis is seen with DKA? | High anion gap metabolic acidosis |
| How do Prostaglandins affect the glomerular rates? | DILATE the AFFERENT arteriole leading to Increased GFR |
| How do NSAIDs affect the glomerular rate? | CONSTRICT the AFFERENT arteriole leading to Decrease GFR |
| Is GFR increased or decreased by the use of NSAIDs? | Decreased |
| Which drugs are known to dilate the afferent glomerular arteriole? | Prostaglandins |
| Indomethacin constrict or dilate the afferent arteriole? | Constrict |
| How is the nephron affected by rapid ingestion of water after a significant volume depletion? | Decrease the reabsorption of urea from the Medullary Collecting duct |
| What electrolyte imbalance is seen with the rapid ingestion of water? | Hyponatremia |
| What does hyponatremia caused by rapid ingestion of water causes in the kidneys? | Increase the excretion of water and urea in urine |
| What neurotransmitter stimulates the adrenal medulla to secrete Catecholamines? | Acetylcholine |
| What catecholamines are secreted by the adrenal medulla? | Norepinephrine, Epinephrine, and Dopamine |
| Catecholamines secreted by Adrenal medulla in response to: | Direct stimulation by Preganglionic sympathetic neurons |
| What type of metabolic/respiratory disorder is seen with vomiting? | Metabolic alkalosis |
| What are consequences of Vomiting? | Loss of stomach HCl and extracellular volume, resulting in decreased ECF and contraction metabolic alkalosis |
| What type of patients are often seen with OSA? | Obese patients |
| What is the first or initial step for OSA diagnosis? | Polysomnography |
| What condition is diagnosed by Polysomnography? | OSA |
| ACE inhibitors role in the glomerulus: | Dilate both the afferent and efferent arterioles, with preference to the efferent |
| Which type of drugs dilate efferent >> afferent arterioles? | ACE inhibitors |
| Dilation of efferent arteriole causes: | Decrease in GFR |
| What is another name for Enterokinase? | Enteropeptidase |
| What cells produce Enterokinase? | Epithelial cells of the duodenal lumen that activates trypsinogen into trypsin |
| What is the overall role of Trypsin? | Activates many proenzymes |
| What is the essential function of Enterokinase? | Chemical digestion of complex lipids and proteins |
| What is the cause of Cholecystitis? | Obstruction of biliary duct system at the level of the Cystic duct |
| What type of second messenger is used by Glucagon? | cAMP |
| Glucagon: | Relies on a G-protein-coupled receptor (GPCR) that activates adenylyl cyclase to produce an increase in intracellular cAMP |
| PTH and Calcitonin use __________ as second messenger. | cAMP |
| Very short-acting IV drug used to treat SVT | Adenosine |
| What are some common adverse effects of Adenosine? | Flushing, hypotension, chest pain, bronchospasm, and an impending sense of doom |
| What is the MOA of Adenosine? | Increased efflux of K+ leading to hyperpolarizing the cell and decreased Calcium current, decreasing AV node conduction |
| What occurs during vigorous exercise in association to metabolism? | Creates lactic acid, lowering pH in the pulmonary arteries |
| What causes the decrease in pH in the pulmonary arteries? | Lactic acid synthesis due to vigorous exercise |
| Which is the only vessel with deoxygenated blood? | Pulmonary artery |
| What is the initial and main damage or insult leading to pathophysiology of ARDS? | Alveolar insult |
| What is pathophysiology of ARDS? | Alveolar insult leading to cytokine secretion causing capillary endothelial damage and increase permeability. |
| What do the slow waves of GI tract determine? | Frequency of contractions of GI tract |
| What are the slow waves of the GI tract? | Rhythmic depolarization and repolarization of the smooth muscle cells within the muscularis propria of the stomach and intestine |
| What nervous system stimulation causes increase in Amplitude of slow waves? | Parasympathetic nervous system |
| SNS stimulation causes what to slow waves of the GI tract? | Decrease amplitude to the waves |
| Which pathogen commonly causes meningitis in children? | N. meningidis |
| What is severe consequence of N. meningidis meningitis? | Waterhouse-Friderichsen syndrome |
| What are some characteristics fo Waterhouse-Friderichsen syndrome? | Adrenal failure, septic shock, DIC, and petechiae |
| What are two common signs used to diagnose Meningitis? | 1. Brudzinksky's sign 2. Kerning sign |
| What condition is diagnosed with (+) Brudzinski sign? | Meningitis |
| What is the Brudzinski's sign? | Severe neck stiffness cause of patient's hips and knees to flex when the neck is flexed |
| What is the Kerning sign? | Severe stiffness of hamstrings cause inability to straighten the leg when the hip is flexed to 90 degrees |
| Why are patients with an underlying malignancy are prone to develop a Pulmonary embolism? | Creates a hypercoagulable state |
| What is caused by PE? | V/Q mismatch due to blood being shunted away form ara where the pulmonary embolism is causing an infarction |
| What is the ECG association of Pulmonary embolism? | S1Q3T3 abnormality |
| What condition is associated with Lines of Zahn? | Pulmonary embolism |
| Postmortem or before death pulmonary embolisms are seen with Lines of Zahn? | Prior death PE |
Created by:
rakomi
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