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Physiology
UWORLD Round 1 2020
| Question | Answer |
|---|---|
| What bone-related condition is associated with Hyperthyroidism? | Increases bone turnover with net bone loss, potentially ledain to Osteoporosis |
| Does Hyper- or Hypothyroidism lead to Osteoporosis? | Hyperthyroidism |
| How does hyperthyroidism lead to osteoporosis? | Driven by T3, which stimulates osteoclast differentiation, increased bone resorption, and release of calcium |
| What are the 3 effects of T3 in the bone? | 1. Stimulation of Osteoclast differentiation 2. Increased bone resorption 3. Release of calcium |
| What is a common physical result of pregnancy? | Significant plasma expansion and widespread vasodilation, leading to increased renal plasma flow and GFR |
| How much approximately is serum Creatinine reduced in pregnant women? | 0.4 mg/dL |
| Is serum creatinine levels increased of decreased during pregnancy? | Decreased |
| Why does the "leveling" serum creatinine concentration in a pregnant woman to levels of non-pregnant individual indicates significant renal dysfunction? | Pregnant women have a reduced serum creatinine level of 0.4 mg/dL, so, the pregnant level of serum creatine should not reach, non-pregnant serum creatine level (normal) |
| What hydrodynamic condition is due to the loss of sodium and/or water? | Hypovolemia |
| What is the effect on RBC concentration and albumin in a patient with hypovolemia? | Increase RBC concentration and Albumin, as both of these blood component are trapped i the intravascular space |
| Where are RBCs and albumin trapped in the body? | Intravascular space |
| What is the association between hypovolemia and uric acid? | Hypovolemia leads to increase absorption of uric acid in the proximal renal tubule, leading to increased serum [uric acid] |
| What is a common condition that leads to increased serum uric acid concentration? | Hypovolemia |
| Where in the nephron is uric acid most likely absorbed? | Proximal renal tubule |
| How does Gas exchange occur? | Occurs between alveoli and pulmonary capillary blood, and depends on both perfusion and diffusion |
| A healthy individual is either Perfusion -limited or Diffusion-limited? | Perfusion-limited |
| What does been perfusion-limited indicate? | 1. Healthy indictiatual 2. Equal partial pressure of Oxygen and Carbon dioxide |
| PCO2 = PO2 | Perfusion-limited |
| Which are situation is which gas exchange becomes Diffusion-limited? | Emphysema and Pulmonary fibrosis |
| What does Diffusion-limited entails? | Large gradient between alveolar and capillary Partial pressure of oxygen |
| Which partial pressure is mostly affected in Diffusion-limited profile, PCO2 or PO2? | P O2 |
| Which partial pressure, PCO2 or PO2, is less affected by diffusion-limited situations? | PCO2 |
| Why does PCO2 is less affected than gradient of PO2 in diffusion-limited conditions? | CO2 has a much greater (200x) diffusing capacity than oxygen. |
| What is the normal alveolar partial pressure of oxygen (PO2)? | 104 |
| What is the normal alveolar partial pressure of oxygen (PCO2)? | 40 |
| What is the normal capillary partial pressure of oxygen? | 70 |
| What is the normal capillary partial pressure of carbon dioxide? | 40 |
| What does a rightward shift tin the Cardiac Volume-Pressure loop? | Increased preload or End-Diastolic volume |
| What action can cause a rightward shift in the Cardiac Volume-Pressure loop? | Infusion of normal saline |
| What are minor or slight changes in increase in Preload? | Increase in Afterload due to LV stretching causing an increase in Stroke Volume (SV) |
| What is increased directly by IV fluid infusion by the Frank-Starling curve? | Intravascular en Left-Ventricular end-diastolic volumes |
| What are some mechanical and anatomical changes in the myocardium due to increased preload? | Increase in Preload leads to stretching the myocardium and increases the End-Diastolic sarcomere length, leading to an increase in volume and CO |
| What condition is seen with End-Diastolic sarcomere length? | Increased preload |
| What vessels provide the major amount of pleural fluid? | Parietal intercoastal microvessels |
| Pleural fluid is drain via the: | Parietal pleura lymphatics |
| Under normal conditions, from where does the pleural fluid enter the the pleural space? | Via filtration from the systemic circulation, primary from the intercoastal microvessels of the Parietal pleura |
| How does pleural fluid exit the Pleural space? | Via stomata thought the Parietal pleura lymphatics |
| Which part of the nephron is always impermeable to water? | Ascending limb of the loop of Henle |
| What is a key characteristic of the Ascending limb of the loops of Henle? | Impermeable to water |
| Which nephron part is impermeable to water regardless of the vasopressin levels? | Ascending limb of the loop of Henle |
| Where does the reabsorption of electrolytes by the Na/K/2Cl co-transporter occur in the nephron? | Thick ascending limb of the loop of Henle |
| What does the reabsorption of electrolytes in the thick ascending limb of the loop of Henle contribute to? | Corticomedullary concentration gradient |
| What vitamins are usually insufficient in breast milk? | Vitamin D and vitamin K |
| Which vitamin should be supplemented in a newborn purely breastmilk fed? | Vitamin D |
| What mineral (metal) should be added and supplemented in babies > 4 months, until proper solid food intake? | Iron |
| What produces an S3 sound? | Occurs to sudden limitation of ventricular movement during passive ventricular filling in diastole |
| What does a S3 sound in a person over 40 year old possibly indicate? | Abnormal ventricular cavity enlargement such as occurs in severe MR, chronic AR, and/or DCM |
| What extra sound may be found in a 55 year old man with severe mitral regurgitation? | S3 sound |
| What kind of effusion is seen in heart failure? | Transudative pleural effusion |
| What causes the Transudative pleural effusion in Heart failure? | Increase in pulmonary capillary hydrostatic pressure |
| How does Light criteria characterize Transudative effusions? | Low protein and Low Lactate dehydrogenase (LDH) content compared to serum values |
| Why do DM type 1 patients are at greatest risk of Hypoglycemic events? | The exogenous insulin will continue to be absorbed form the injection site despite falling glucose levels |
| What added factor of long-standing diabetes that lead to rapid hypoglycemia? | Decreased glucagon secretion |
| What chemicals and neurotransmitters that activate muscarinic receptors? | ACh and Cholinergic agonists |
| What is the result of activation of muscarinic receptors by ACh and cholinergic agonists? | Peripheral vasodilation due to synthesis of Nitric Oxide (NO) in endothelial cells |
| Activation of Muscarinic receptors in the vascular smooth causes relaxation or contraction? | Relaxation |
| What is the role of Glucagon? | Stimulates hepatic glycogenolysis and gluconeogenesis |
| What are some known actions of Insulin? | 1. Increases peripheral glucose uptake 2. Inhibits lipolysis and ketoacid formation 3. Suppresses glucagon release |
| How is serum glucose homeostasis achieved? | By the opposing effects of insulin and glucagon |
| What ar Pneumoconiosis? | Diseases resulting from the inhalation of the fine dust particles that reach the respiratory bronchioles and alveoli |
| How are fine dust particles, as seen in Pneumoconiosis, cleared from the respiratory tract? | Alveolar macrophages through phagocytosis |
| What is a collateral damage due to excessive Macrophage activity in the lungs? | Increased secretion of cytokines, which result in progressive pulmonary fibrosis |
| How is Thyroid Hormone Resistance described? | Characterized by decrease sensitivity of peripheral tissues to Thyroid hormone due to a defect in the Thyroid hormone receptor |
| What endocrine condition is seen with elevated T3, T4, and TSH? | Thyroid Hormone Resistance |
| What are conditions are commonly developed after TH resistance? | Goiter and ADHD |
| What maneuver is often used to terminate PSVT? | Carotid Sinus Massage |
| What is the initial action of the Carotid Sinus Massage? | Increase in Parasympathetic tone |
| Physiology of the Carotid Sinus Massage: | 1- Stimulates the baroreceptors and increases the firing rate from the carotid sinus ---> 2- Increase in Parasympathetic output ---> 3- Withdrawal of sympathetic output to the heart and peripheral vasculature |
| What are the 3 effects after an increase in parasympathetic activity due to Carotid Sinus Massage? | 1. Inhibition of SA node activity 2. Slowing conduction through the AV node 3. Prolongation of the AV node refractory period |
| Renal drug excretion is dependent on: | 1. Glomerular filtration 2. Renal Tubular secretion 3. Tubular reabsorption |
| How is renal drug reduced by a decrease in Glomerular filtration? | Reduced with low RBF, kidney disease, and high drug protein binding |
| What are actions of PTH? | 1. Increased bone resorption 2. increased serum calcium levels 3. Increased renal phosphate excretion |
| PTH increases or decreases the urinary excretion of phosphate? | Increased |
| Is serum calcium levels increased or decreased by PTH? | Increased |
| What is the direct effect of PTH on bone? | Increase bone resorption |
| What condition is often caused by chronic elevated PTH levels? | Osteoporosis |
| What is an common recombinant PTH analogue? | Teriparatide |
| What is MOA of Teriparatide? | Recombinant PTH analogue |
| How do intermittent administration of recombinant PTH-analogue help in preventing Osteoporosis? | Induces a greater increase in osteoblastic activity in proportion to osteoclast activity and net increase in bone formation |
| Which node is the normal pacemaker in a healthy individual? | SA node |
| Which cardiac pacemaker (node) has the fastest firing rate of all conductive cells? | SA node |
| Which are the other pacemakers that take precedence if the SA node is damaged? | AV node, bundle of His, and Purkinje fibers |
| What is the cardiac natural pacemaker in an individual with 3rd degree AV block? | AV node |
| Pacemakers below the AV node and His bundle have approximate what heart rates? | 20 beats/min |
| What causes an ASD? | Increased right-sided blood flow due to Left to right shunting |
| What are the clinical characteristics of an ASD? | Systolic ejection murmur and widely split, fixed S2 |
| How is the S2 sound in ASD? | Widely split, and fixed |
| What type of systolic ejection murmur is associated with ASD? | Pulmonic flow murmur |
| What are the components needed to synthesize Nitric oxide? | Arginine and Nitric oxide synthase |
| Arginine + Nitric oxide synthase ====> | Nitric oxide |
| What is a common indirect function of Arginine? | Serves as Vasodilator, since it is a precursor for Nitric Oxide |
| What condition is often co-treated with Arginine supplementation? | Stable angina |
| Does Arginine supplementation aids in Vasoconstriction or Vasodilation? | Vasodilation |
| What are the main associations and clinical features of PCOS? | Oligomenorrhea, Hirsutism, and polycystic ovaries |
| PCOS increases the risk of developing what type of malignancy? | Endometrial hyperplasia/carcinoma |
| Why is Endometrial carcinoma at increased risk in women with PCOS? | Chronic estrogen stimulation with decreased progesterone secretion |
| What is the result of the disruption in intraovarian steroidogenesis seen in PCOS? | Anovulatory cycles and results in chronic estrogen stimulation with decreased progesterone secretion |
| What factors in the Cardiac Pressure-Volume loop are INCREASED with heavy (strenuous) exercise? | Preload, Contractility, Stroke volume, and slight increase in Afterload |
| Are preload and afterload both increased, decreased, or individually modified with heavy exercise? | Both increased |
| The increase in Preload and contractility with heavy exercise lead to and increase in : | Stroke volume |
| Increase in preload, contractility, and SV, thus lead to an increase in: | Afterload |
| What is Creatine? | A waste product generated by the breakdown of creatine in the muscles, and is used to determine GFR |
| What waste product is used to determine GFR? | Creatine |
| Creatine generation or production is directly dependent on? | Muscle mass and meat intake |
| Increase in muscle mass will create an increase or decrease in Creatine production? | Increase |
| What type of diet leads eventually to a natural decrease in Creatinine? | Vegetarian diet |
| What conditions amongst healthy individual may represent reasons for major discrepancies in Creatine generation? | Muscle mass and meat intake |
| What is the diastolic pressure in the Right atrium? | 0-6 mmHg |
| What is the average diastolic pressure in the Right Ventricle? | 15-30 mmHg |
| A catheter in a heart chamber shows a pressure of 22 mmHg. Where is the tip of the catheter located? | Right ventricle |
| A normal chamber diastolic pressure of 5 mmHg, most likely be found in the ______________________. | Right atrium |
| What does POMC stand for? | Proopriomelatycortin |
| What is POMC? | Polypeptide precursor that does through enzymatic cleave and modification to produce not only B-endorphins, but also ACTH and MSH |
| What anterior pituitary hormones are produced by POMC? | ACTH and MSH |
| What are the main derivatives of POMC? | B-endorphins, ACTH, and MSH |
| Beta-endorphins are derived from which endogenous opioid peptide? | POMC |
| Why do ACTH has some delta and mu-receptor activity? | It is derived from POMC |
| Common endogenous opioid peptide | POMC |
| What is Lactated Ringer solution? | An isotonic IV fluid type; crystalloid solution |
| What condition(s) is treated with Lactated Ringer solution? | Volume resuscitation (shock, hypovolemia) |
| An individual with critical hypovolemia will most likely be given which type of fluid, isotonic, hypotonic? | Isotonic |
| What are the two isotonic solutions used in Volume resuscitation moments? | Lactated Ringer solution and 0.9% (normal) saline |
| How is Isolated Systolic Hypertension defined? | Systolic pressure > 140 mm Hg with diastolic blood pressure < 90 mmHg |
| An elevated systolic pressure and a diastolic pressure of 89 mm Hg? | Isolated Systolic hypertension |
| What leads to Isolated systolic hypertension? | Age-related stiffness and decreased in compliance of the oarota and major peripheral arteries |
| What clearances are used to estimate GFR? | Inulin and Creatine |
| Inulin clearance estimates: | GFR |
| Creatine clearance estimates: | GFR |
| PAH clearance estimates: | RPF |
| What clearance measurement is used to estimate RPF? | PAH |
| (Inulin clearance) / (PAH clearance) = | Filtration factor |
| GFR/ RPF = | Filtration factor |
| What is the definition of Filtration factor (FF)? | Fraction fo the RPF that is filtered across the glomerular capillaries into Bowman's space |
| What is the normal FF in a healthy individual? | 20% |
| How is clearance measured? | (Urinary X content) (Urinary flow) / (serum X content) |
| What are some clinical manifestations of elevated serum aldosterone levels? | Hypertension, hypokalemia, and muscle weakness |
| What serum level helps to indicate the etiology or reason for Hyperaldosteronism? | Renin |
| A patient presents with hypertension and Hypokalemia, what lab measurements should be check to reach a possible diagnosis? | Renin and aldosterone |
| What type of Hyperaldosteronism is seen with elevated renin and elevated aldosterone? | Secondary hyperaldosteronism |
| Secondary (2) hyperaldosteronism present with high levels of: | Renin and aldosterone |
| What are some causes of Secondary hyperaldosteronism? | 1. Renovascular hypertension 2. Malignant hypertension 3. Renin-secreting tumor 4. Diuretic use |
| A Renin-secreting tumor will cause ______________ hyperaldosteronism. | Secondary hyperaldosteronism |
| Renovascular hypertension and Malignant hypertension are possible causes of what type of hyperaldosteronism? | Secondary hyperaldosteronism |
| How are the levels of renin and aldosterone in Primary hyperaldosteronism? | Decreased renin and elevated aldosterone |
| What are the main causes of Primary hyperaldosteronism? | 1. Aldosterone-producing tumor 2. Bilateral adrenal hyperplasia |
| A person with bilateral adrenal hyperplasia, will present hypokalemia or hyperkalemia? | Hypokalemia |
| An individual in hospital present HTN, Hypokalemia, and decreased levels of renin, and abdominal CT shows bilateral masses in the adrenal glands. Dx? | Primary hyperaldosteronism due to bilateral adrenal hyperplasia |
| What condition is known to cause HTN, hypokalemia, and is also seen with low levels of renin and aldosterone? | Cushing syndrome |
| What is Nitroprusside? | Short-acting agent that causes a balanced vasodilation of veins and arteries to decrease LV preload and afterload |
| Nitroprusside increases or decreases LV preload and afterload? | Decrease |
| What is the result of Nitroprusside balanced vein/artery vasodilation? | Maintenance of stroke volume (SV) and Cardiac Output (CO) at lower LV pressure |
| How do Incretins function? | Stimulating insulin release following consumption of oral glucose |
| How do the spikes in insulin due to incretin compare to regular serum glucose elevations? | Incretin-stimulated insulin release is INDEPENDENT of the increase in insulin secretion brought on by elevations in blood glucose level. |
| What are common incretins? | GIP and GLP-1 |
| GIP and GLP-1 are examples of: | Incretins |
| What reaction associated with development of vitamin D is possible by sunlight exposure? | 7-dehydrocholesterol ----> Cholecalciferol (D3) in skin |
| Which organ is the only one seen with hypoxic vasoconstriction? | Lungs |
| How are pulmonary vascular beds unique in development of Pulmonary Arterial Hypertension? | Tissue hypoxia results in vasoconstrictive response |
| How do pulmonary capillary vascular beds cause pulmonary vasoconstriction? | Vasoconstriction occurs in the small muscular pulmonary arteries to divert flow away from under-ventilated lung regions and toward well-ventilated lung areas to minimize ventilation - perfusion mismatch, leading to move to more efficient overall gas exchange |
| In which part of the nephron reabsorb the entire glucose under normal concentrations? | Proximal renal tubules |
| What is the threshold of glucose, leading to glucosuria? | 200 mg/dL |
| At what plasma glucose concentration glucosuria begins? | 200 mg/dL |
| What is the purpose of Coronary autoregulation? | Allows coronary blood flow to be primarily driven by myocardial oxygen demand over a wide range of perfusion pressures |
| What is the vessel pressure range of coronary autoregulation? | 60-140 mm Hg |
| What product are release by myocardium to perform or accomplish coronary autoregulation? | Adenosine and Nitric Oxide |
| What products are release by cardiac myocyes in response to myocardial hypoxia, that produce coronary autoregulation? | Adenosine and Nitric Oxide |
| What produces and releases nitric oxide (NO) in myocardial hypoxia? | Synthesized by endothelial cells in response to chemical mediators and mechanical stress |
| What produces adenosine in events of myocardial hypoxia? | Released by cardiac myocytes as ATP is broken down for energy |
| What type of metabolic acidosis is produced by infusion of excessive normal saline? | Non-anion gap metabolic acidosis |
| What are the effects on Cl-, HCO3 and blood pH, in cases of excessive infusion of normal saline? | Excess intravascular Cl- causes intracellular shifting of HCO3 to reduce serum HCO3- and decrease blood pH |
| Is serum bicarbonate increased or decreased in metabolic acidosis due to excessive infusion of normal saline? | Decreased |
| What causes the decrease in HCO3 in the serum in excessive infusion of normal saline? | The excessive intravascular Cl- causes intracellular shift of bicarbonate leading to decrease in serum HCO3- |
| In the setting of Hypothyroidism, what is the most common cause of Congenital Goiter? | Transplacental passage of Maternal anti-thyroid medications (PTU) |
| A hyperthyroid mother gives birth to a baby with high TSH and low thyroxine, and neck mass enlargement. Dx? | Congenital hypothyroidism with goiter due to transplacental passage of anti-thyroid medications |
| What are the 3 main causes of Congenital goiter in setting of Hypothyroidism? | 1. Transplacental passage of antithyroid medications 2. Genetic defect in Thyroid hormone production 3. Excessive or deficient maternal iodine |
| What enzyme is inhibited by PTU? | Thyroid peroxidase |
| What endocrinological condition is often treated with PTU? | Hyperthyroidism |
| In the setting of Hyperthyroidism, what is the MCC of Congenital goiter? | Transplancenal TSH-receptor -stimulating antibodies |
| What is caused by the transplacental passage of TSH receptor-stimulating antibodies? | Neonatal Graves disease with goiter |
| What volumes and capacities are increased in Obstructive lung diseases? | RV and TLC, and as consequence increase a RV/TLC ratio |
| What lung volume ratio is decreased in COPD? | FEV1/FVC |
| What leads to the increase in RV and Total lung capacity in COPD? | Air-trapping |
| "Air-trapping" is seen with Obstructive or Restrictive lung disease profile? | Obstructive lung disease profile |
| Which spirometric measurements are decreased in COPD? | FVC, FEV1, and FEV1/FVC ratio |
| Maximal inspiration + Normal (end) inspiration = | FVC |
| The end of maximal expiration depicts which lung volume? | Residual volume |
| Maximal inspiration + Maximal expiration = | TLC |
| What condition is the patient known as euthyroid and do not require treatment? | Thyroxine-binding globulin deficiency |
| What are the lab values seen with Thyroxine-binding globulin deficiency? | 1. Low total T4 2. Normal free T4 and TSH levels |
| How are the levels of free T4 and TSH on Thyroxine-binding globulin deficiency? | Normal |
| Which thyroid hormone level is low in Thyroxine-binding globulin deficiency? | Total T4 |
| Which is low in Thyroxine-binding globulin, Total T4, free T4, none, or both? | Total T4 |
| What is the definition of Hypoxemia? | Low arterial partial pressure of oxygen (PaO2) |
| What are the 5 major causes of Hypoxemia? | 1. Alveolar hypoventilation 2. Low partial pressure of inspired oxygen 3. Ventilation - Perfusion mismatch 4. Diffusion impairment 5. Right-to-Left shunting |
| Which causes of hypoxemia have a normal A-a gradient? | Alveolar hypoventilation and Low Partial Pressure of Inspired oxygen |
| What is the normal A-a gradient range? | 4--15 mm Hg |
| Does a V/Q mismatch condition causing hypoxemia has a normal or increased A-a gradient? | Elevated |
| Which 3 causes of hypoxemia are seen with elevated A-a gradient? | Ventilation/Perfusion mismatch Diffusion impairment Right-to-Left shunting |
| What is a possible complication of using citrate anticoagulants in blood transfusions? | They can chelate plasma calcium, leading to hypocalcemia, leading to peripheral neuromuscular excitability (paraesthesias, muscle spasms) |
| Citrate anticouagalnte-induce hypocalcemia is most often seen with slow or rapid transfusions? | Rapid blood transfusions |
| What type of patients are at higher risk of Citrate-induced hypocalcemia, even at slow transfusion rates? | Hepatic insufficiency, because citrate is metabolized in the liver |
| TSH from the anterior pituitary stimulates: | Thyroid gland to produce T4 and a small amount of T3 |
| What is the active form of Thyroid hormone? | T3 |
| Which is the inactive form or state of TH? | reverse T3 |
| TSH secretion is under positive or negative feedback? | Negative feedback by TH on the hypothalamus an pituitary |
| What is the major determinant of Diastolic Blood pressure? | Systemic Vascular Resistance (SVR) |
| What is the major determinant of Pulse pressure? | Stroke Volume (SV) |
| What is the change in Diastolic Blood pressure during exercise? | Reduction In SVR leads to a slight/or no change in DBP |
| What occurs to to pulse pressure during exercise? | Increase stroke volume (SV) lead to increased Pulse Pressure and increased systolic blood pressure |
| Which blood pressure, systolic or diastolic, is changed or affected more by heavy aerobic exercise? | Systolic blood pressure |
| Is SVR increased or decreased by aerobic exercise? | Decreased |
| What is an important clinical feature of Congenital Hypothyroidism? | Not present at birth due to the transplacental transfer of small amount so maternal T4 |
| What is the MCC of Congenital Hypothyroidism? | Abnormal Thyroid gland development or location, and identifiable with elevated TSH and decreased thyroxine levels |
| How is Primary Hyper-PTH characterized or identified? | Over-secretion of PTH despite normal (or increased) serum Calcium levels |
| If an individual is seen with elevated PTH and also mild hypercalcemia, what is a possible diagnosis? | Primary hyperparathyroidism |
| How doe PTH raise serum Ca2+ and lower serum Phosphate? | 1. Increased bone resorption (freeing Calcium and Phosphate) 2. Increasing renal reabsorption of Ca2+ 3. Decrease In proximal tubular reabsorption of phosphate |
| What are the main cardiorespiratory responses to heavy exercise? | Increase in heart rate, Cardiac output, and Respiratory Rate in order to balance the increased total tissue oxygen consumption and CO2 produced |
| Why do HR, CO, and RR are increased during aerobic exercise? | To balance the increased total tissue oxygen consumption and carbon dioxide production |
| Is Carbon dioxide (CO2) produced more or less during exercise? | More CO2 |
| Which gas values are most affected by Cardiorespiratory changes due to exercise? | Venous blood gas values: 1. Venous oxygen is decreased 2. Venous dioxide is increased |
| What venous blood gas value is increased by exercise? | Venous dioxide |
| Is Venous oxygen decreased or increased in exercise? | Decreased |
| Which is most affected in respect to blood gas changes, the ABGs or VBGs, in exercise? | Venous blood gases |
| What is the principal muscle of inspiration? | Diaphragm |
| What nerve innervates the diaphragm? | Phrenic nerve |
| What are the origin roots of the Phrenic nerve? | C3-C5 |
| What muscle is innervated by the Phrenic nerve and arises from C3-C5 nerve rootlets? | Diaphragm |
| Which muscles are involved in achieving ACTIVE EXPIRATION? | Internal intercostals and abdominal muscles |
| What respiratory activation is aided by the internal intercostals and abdominal muscles? | Active expiration |
| How is passive expiration different from active expiration? | Passive expiration is largely achieve by passive recoil, while active expiration requires involvement of the abdominal muscles and internal intercostal muscles. |
| What is the kidney compensation for Metabolic acidosis? | Completely reabsorbed filtered bicarbonate (HCO3-) and excreting excess H+ in the urine |
| An increase in HCO3- reabsorption by the kidney will cause an increase or decrease in blood pH? | Increase |
| In renal metabolic acidosis compensation, what happens to the excreted H+? | It is buffered by phosphate and ammonium (NH4+), which allows for large amounts of acid to be excreted without precipitously dropping the pH |
| What is used to buffered the excrete H+ in compensating metabolic acidosis? | Phosphate and Ammonium (NH4+) |
| Which cells produce EPO? | Peritubular fibroblasts in the renal cortex |
| What condition specifically drives up the production of EPO by Peritubular fibroblasts in the renal cortex? | Response to decreased renal oxygen delivery |
| A decrease in oxygen delivery to the kidneys, will likely induce: | Increase EPO synthesis by the renal cortex |
| EPO acts on: | Erythrocyte precursor in the Bone marrow to increase RBC production |
| What type of anemia is often produced by CKD patients that have damaged renal EPO-producing cells? | Normocytic anemia |
| What are the Transverse tubules (T-tubules)? | Invaginations of the Sarcolema that transmit polarization signals to the sarcoplasmic reticulum to trigger the release of Calcium and induce muscle contraction |
| What muscle fibers are characterized by uniform distribution of T-tubules? | Striated muscle cells |
| What does the uniform distribution of T-tubules in striated muscle fibers ensure? | Each myofibril contracts at the same time, which is necessary for efficiency contraction |
| What are some normal hormonal changes occurring in males as they age? | Slow decline gonadal testosterone production, a compensatory rise in LH, and rising levels of sex hormone-binding globulin |
| What are nonspecific symptoms seen in normal aging men? | 1. Decrease ejaculate volume 2. Increased erectile latency and sexual refractory time 3. Moderately impaired erectile dysfunction |
| With increasing age of a man, testosterone --> | Decreases with a compensatory rise in LH and leading to a rise of sex-hormone binding globulin |
| What are changes in respiration in physical exercise? | 1. Increased minute ventilation ( Increase Tidal Volume & RR) 2. Reduced physiologic dead space 3. Increased V/Q mismatch 4. Increased extraction of oxygen by skeletal muscle leading to a decreased mixed venous oxygen content |
| What is the effect on Ventilation-Perfusion ratio by physical aerobic exercise? | Increase in V/Q ratio |
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rakomi
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