ࡱ> 7 UbjbjUU "d7|7|Ul  4T @LLLLL'''$Y y '''''C LLӎCCC' L LC'CC1  L@ pw]8 P08` C  PHYSIOLOGY PRINCIPLES OF CELLULAR FUNCTION. Regarding CSF (page 612) Production 50 100ml /day no, volume is 150mL but production is about 550mL/day Drained through choroids plexus no, formed in choroid plexus, drained in arachnoid villi Greater protein content than blood no, bugger all protein Content essentially same as brain ECF yes Regarding body fluid composition, which is approximately 40% of bodyweight ICF b ECF TBW plasma Which penetrates CSF fastest H2O, CO2, O2 Na, K, Cl N2O HCO3 The main buffer in the interstitium is protein haemaglobin phosphate ammonia HCO3 Which of the following is 20% of total body weight ECF ICF TBW Blood volume Regarding the function of the smooth endoplasmic reticulum; which is incorrect steroid synthesis drug detoxification / cytochrome P450 protein synthesis role in carbohydrate metabolism Regarding ICF; which is incorrect Na+ of 135 K+ of 140 Mg2+ of 58 Ca2+ of 0.0001 PO4- of 75 In which component does a solution of 5% dextrose dissolve ECF ICF Interstitial fluid Intravascular Transcellular The concentration of ICF vs ECF lower Mg++ higher PO4 Regarding the composition of CSF production is 50-100 mls per day no, production about 550mL/day has the same composition as cerebral ECF yes higher conc. of K+ with respect to plasma no, about half higher concentration of protein no, almost no protein Regarding CSF Composition is esentially the same as brain ECF true CSF production is ~150mls per day false 1 litre 5% dextrose given intravenously distrubutes predominantly to: Intracellular compartment Interstitial compartment Extracellular compartment Intravascular compartment Transcellular fluid The main buffer in the interstium is Protein Haemoglobin Phosphate Ammonia HCO3 Total body water increases with age is typically 45% of bodyweight is typically 63 % of body weight is greater in men than women is composed largely of interstitial fluid With the addition of 1 litre of 5% dextrose intravenously to which compartment is it mainly distributed intracellular interstitial extracellular transcellular vascular Regarding the composition of ECF versus ICF . ECF has decreased magnesium increased phosphate increased potassium decreased sodium ECF compared to ICF has increased potassium decreased phosphate increased phosphate decreased sodium A fit healthy 20 y/o male lose 1 litre of blood the haematocrit falls immediately this is a 35 % blood loss plasma protein synthesis is not increased Anion gap is Sodium + potassium bicarbonate due to organic protein ions and phosphate ions increased in hyperchloremic metabolic alkalosis Ratio of HCO3- ions to carbonic acid at pH of 7.1 is 1 10 0.1 100 0.01 With the loss of 1 litre of blood haematocrit falls immediately iron resorption is not increased this equals 35 % plasma volume loss baroreceptors increase parasympathetic output red cell mass normalises within 2 weeks What is the hydrogen ion concentration at a pH of 7.4 0.0001meq/L 0.00004 meq/L 0.0004 meq/L 0.0002 meq/L 0.00002 meq/L Regarding basic physiological measures all of the following are true EXCEPT osmolarity is the number of osmoles per litre of solution pH is the log to the base 10 of the reciprocal of hydrogen ion concentration carbon has a molecular mass of 12 dalton osmolarity is measured by freezing point depression one equivalent of Na+ is 23g/L ECF compared with ICF has A higher K+ concentration A lower PO4 2- concentration A higher Mg++ concentration A lower NA concentration Regarding CSF composition is the same as brain CSF means ECF i think. CSF production is 50-100 mL/day no, 550mL/day The protein content of CSF is higher than plasma no The K+ concentration in CSF is greater than in plasma no NERVES AND MUSCLES EPSP is different to AP in that: Propagated All or none Something about overshoot None of the above Most important ion for cardiac RMP Na Ca K Cl Calmodulin is involved in Smooth muscle relaxation Smooth muscle contraction Skeletal muscle contraction Skeletal muscle relaxation Regarding resting membrane potential Hyperkalemia makes the membrane potential more negative Amplitude of the action potential is dependent on Na permeability Increased K permeability makes resting potential more positive Regarding velocity of conduction of nerves, Velocity is proportionate with diameter Some C type nerves may be myelinated With local anasthetic sensory nerves are always affected before motor nerves Bradykinin name is derived from its action eg. It decreases heart rate contracts visceral muscle contracts smooth vascular muscle is not related with pain and pain sensation Smooth muscle; underlying oscillatory depolarisations are due to Ca influx K influx Cl influx Na influx Na efflux Regarding smooth muscle contraction; calmodulin causes smooth muscle contraction causes smooth muscle relaxation sustains contraction in smooth muscle Nerve fibre types; which is correct Gamma is to motor muscle spindles Beta is to motor muscle spindles Alpha is to motor muscle spindles Nerve fibres increasing the diameter increases the conduction velocity Regarding cardiac muscle there are no Z bands resembles skeletal intercalated discs are loosely attached gap junctions resist the flow of ions Smooth muscle contraction is due to Na+ influx Ca++ influx Cl- efflux Na+ efflux Cl- infux Calmodulin is involved in smooth muscle contraction smooth muscle relaxation myocardial contractility With respect to the cardiac action potential The plateau of repolarisation phase may be up to 200 times longer than the depolarisation phase. Unlike the nerve action potential there is no overshoot .In contracting skeletal muscle The H zone increases The I zone decreases The A zone increases With regards to membrane potential the Donan effect relies on non-diffusable ions the exterior of the cell is negative with respect to the interior the membrane potential tends to push chloride ions out of the cell potassium leaks out against a concentration gradient it can be derived by measuring the chloride concentration and using the Nernst equation Na+/K+ ATPase hydrolyses ADP to ATP extrudes 3 Na+ from the cell for every 2 K+ in consists of an alpha, beta and gamma sub-unit lies on the ECF side of the membrane is potentiated by the drug ouabain With regard to the action potential of a neuron with an RMP of 70mV the firing level is likely to be-30mV the overshoot will not extend much past 0mV the absolute refractory period occupies only 10% of repolarisation chloride influx will restore the membrane potential increasing the external chloride ion concentration increases the RMP In skeletal muscle the immediate energy source for contracting is GTP troponin T inhibits the interaction with myosin the myosin is contained entirely within the A band the heads of actin contain the ATP hydrolysis site tropomysin is made up of 3 sub-units In smooth muscle the alternating sinusoidal RMP is due to calcium influx sodium influx potassium influx chloride influx potassium efflux The special feature of the contraction of smooth muscle is that actin is not involved myosin is not involved calcium is not involved ATP is not the energy source The membrane potential is unstable With respect to the cardiac action potential unlike nerve action potential there is no overshoot plateau and repolarisation may be 200 times larger than depolarisation phase the resting membrane potential is 90mV sodium channels are progressively inactivated in phase 2 it is usually 20 ms in duration Upon stretching intestinal smooth muscle it hyperpolarises the tension is due to elastic forces only it depolarises relaxation occurs it is an example of a multi-unit smooth muscle Upon skeletal muscle contraction the H zone increases the I zone decreases the A zone decreases the A and I zone increase none of the above All of the following are true of skeletal and cardiac muscle EXCEPT they both have striations they have high resistance gap junctions With respect to smooth muscle, calmodulin acts to curtail contraction acts to stimulate contraction acts to limit relaxation acts to stimulate relaxation NERVOUS SYSTEM Question about dorsal column + spinothalamic tracts Question about neural connections regarding balance (involving cerebellum and optic tracts) The main inhibitory neurotransmitter of the spinal cord is glycine GABA Ach Dopamine Substance P Vestibular nerve has direct connections to cerebellum oculomotor nuclei cortex Which area has the best visual acuity fovea centralis optic disc area with maximal rods The hypothalamus is essential for movement visual acuity renal function The main inhibitory neurotransmitter of the spinal cord is glycine GABA Ach DA Substance P The kappa receptor is involved in spinal analgesia is responsible for dysphoric reactions and hallucinations is responsible for euphoria, dependence, and analgesia What does presynaptic inhibition require? contact of an inhibitory neurone Which penetrates CSF fastest H2O-CO2-O2 CO2-O2-N2O this one I think Which of the following is incorrect Pain and temperature travel in the ventral spinothalamic tract The most visually sensitive part of the eye is the Optic disc Fovea centralis Area with maximal rods The major inhibitory transmitter in the spinal cord is Glutamate GABA Glycine Aspartate ACh The major inhibitory substance of the spinal cord is GABA Glutamate Aspartate Glycine None of the above The sensation for cold is relayed by the thalamus is transmitted by the dorsal columns is an uncrossed sensory modality is mediated by substance P fluxes is mediated by A alpha fibres Alpha 1 stimulation will lead to contraction of bladder trigone and sphincter bronchial smooth muscle contraction pupillary constriction increased AV conduction skeletal muscle vasodilation Anterolateral dissection of the spinal cord is associated with loss of ipsilateral loss of pain ipsilateral loss of temperature ipsilateral hyperreflexia contralateral vibration loss With regards to CSF composition it is similar to the ECF of the brain yes Which of the following have a specific beta effect on smooth muscle contraction adrenaline noradrenaline isoprenaline MAO breaks down seretonin tryptophan glycine GABA Glutamate In the formation of adrenaline COMT produces adrenaline from noradrenaline Phenylalanine is converted to tyrosine Seretonin is a vital intermediate step Dopamine is two noradrenaline molecules side by side Dopa is formed from dopa decarboxylase (True) acetylcholinesterase forms acetylcholine from acetate is produced by the liver functions only in nerve endings is involved in GABA metabolism none of the above All the following are neurotransmitters EXCEPT seretonin glutamate adenosine insulin glucagon Inhibitory neurotransmitters increase the post synaptic conductance to sodium chloride sodium and magnesium magnesium all of the above Which of the following is true contraction of cardiac muscle is about as long as its action potential A subject is injected with a substance that caused : slight increase in HR; no change in BP; did not impair ejaculation; decreased sweating; pupillary dilatation. It was most likely nicotinic antagonist nicotinic agonist alpha blocker muscarinic antagonist METABOLISM The liver produces all, EXCEPT Complement Albumin Gamma Globulins Fibrinogen Coagulation factors Vitamin D; which is incorrect undergoes 1 hydroxylation in the liver All plasma proteins are synthesised in the liver except plasminogen albumin gammaglobulins complement Which is INCORRECT muscle utilises fat in strenuous exercise initially get a rise in BSL secondary to increased gluconeogenesis insulin secretion decreases initially muscle utilises glycogen stores Regarding cholesterol, which is incorrect? essential in cell wall synthesis plants have cholesterol but it is not absorbed by humans only found in animal cells Regarding fatty acid metabolism Fatty acids are broken down in mitochondria by beta-oxidation Regarding RQ, which is incorrect Average is about 0.82 RQ of brain tissue is approximately 1.0 RQ CHO = 1.0 RQ of CHO is greater than that of protein RQ of fat is 0.90 14. Regarding Ca++ metabolism, which is incorrect 1,25 DHCC is formed in the liver PTH acts on the distal tubule to decrease phosphate absorption Which is the largest in size Beta 1 globulin Fibrinogen Albumin Alpha globulin Haemoglobin The heat lost by the body at 21 degrees is due to sweating defecation urination radiation/conduction ENDOCRINOLOGY Regarding thyroid hormone acts on a cell surface receptor decrease metabolic rate increase Na/K atp-ase function increase affinity beta adrenergic receptor sensitivity, but not receptor number reduces cholesterol (LDL) receptors Regarding thyroid hormones They alter proportion of beta myosin heavy chains Increase number but not affinity of beta adrenergic receptors Decrease activity of Na/K ATP-ase Increase number of LDL-receptors Which of the following does not utilise the same receptor effector action insulin glucagon PTH ACTH All of the above Thyroid hormones; which is correct T3 acts at a nuclear receptor Which of the following is not a gastrointestinal hormone Secretin CCK VIP GIP ENP Parathyroid hormone; which is correct causes low PO4 released with rises in blood calcium levels blocks vitamin D synthesis Hypothyroidism causes cretinism myxoedema early genital development hair loss With regard to cortisol, which is incorrect It is predominantly metabolised in the liver It has a permissive action on vascular reactivity It has greater mineralocorticoid activity than glucocorticoid activity In DKA ketones accumulate because They are not buffered ???/products of glucose metabolism Insulin Increases the number of glucose transporters on the cell surface Regulates intracellular glucose metabolism Regarding thyroid hormones, which is incorrect They increase plasma cholesterol They increase the activity of Na-K ATPase They increase the number/affinity of Beta adrenergic receptors They alter the proportion of alpha myosin heavy chains They have a calorigenic action Regarding insulin it increases protein catabolism in muscle secretion is inhibited by somatostatin secretion is stimulated by phenytoin it causes decreased K+ uptake into adipose tissue it causes decreased protein synthesis Regarding glucagon it is secreted by the pancreatic B cells it increases glycogen formation it has a half life 30 minutes secretion is stimulated glucose it stimulates insulin secretion With regard to thyroid physiology T3 and T4 are metabolised in the spleen and bone marrow T3 and T4 bind and act at the same cell membrane receptor T4 is synthesised from tyrosine held in thyroglobulin T4 is more active than T3 T3 is bound to a complex polysaccharide in the plasma A deficiency of parathyroid hormone is likely to lead to hypophos phatemia the formation of kidney stones a self limiting illness neuromuscular hyperexcitability cystic bone disease With regard to adrenal physiology glucacorticoids exert their action by cGMP activation cortisol has negligible mineralocorticoid activity the largest steroid molecules are the oestrogens dopamine is secreted by the adrenal medulla the only glucacorticoid secreted in significant amounts is cortisol Insulin secretion is stimulated by all of the following EXCEPT mannose glucagon noradrenaline leucine acetylcholine Insulin is secreted by the A cells in the islets of Langerhans is a triple helical polypeptide is synthesised as a prohormone binds at cytoplasmic receptor sites causes K+ to leak out of cells Which of the following does not utilise the same receptor in its mechanism of action insulin glucagon PTH ACTH They all have the same mechanism of action Glucocorticoid effects; which are incorrect (question may have been slightly different?) increased protein catabolism increased glucose 6 phosphatase increased transamination / deamination of amino acids increased peripheral glucose utilisation decreased glycogen synthetase DIGESTION & ABSORPTION Regarding amino acid digestion Occurs equally fast in all parts of the small intestine Absorbed with H+/Na+/Cl- Vitamin A, K, D are absorbed in stomach duodenum terminal ileum proximal small bowel ascending colon Regarding fat digestion and absorbtion, all are correct EXCEPT It is largely completed in the duodenum its final destination depends on the size of FFA Transport is in cholymicrons FFA diffuse passively through the brush border pancreatic dysfunction may lead to steatorrhea Low protein diet, normal caloric intake; which effect is incorrect increased creatinine increased urea Absorption of amino acids; which is correct cotransported with ions L and D isomers are absorbed via different mechanisms greatest source is GIT mucosa Fat digestion; which is incorrect most occurs in the ileum colipase is needed to allow lipase to work lipase is in the stomach, but has no real role Where does vitamin A, D and K absorption occur proximal small bowel stomach terminal ileum dueodenum ascending colon With regard to fat metabolism micelles are formed in the brush border colipase is required for metabolism Iron absorption is increased by Vit C is constant regardless of need occurs in the proximal small bowel requires intrinsic factor With regard to protein digestion Protein digestion begins in the duodenum Pancreatic enzymes are most important Pepsinogen I/II ???????? Is largely completed in the small intestine Commences upon the action of saliva Regarding fat digestion Fat digestion begins in the duodenum Colipase is required for digestion Bile salts on their own are most important to emulsify fats Regarding absorption, which is incorrect Glucose absorption is an example of secondary active transport Galactose is absorbed by the same mechanism as glucose Fructose is absorbed by facilitated diffusion Insulin regulates glucose absorption in the intestine Which is true of faeces 50 ml is produced per day on average it is chiefly formed from protein breakdown products solids form 75% of its composition the solid portion contains 30% bacteria the brown colour is due to melanin Which of the following is a nutritionally essential amino acid glycine histidine tryptophan tyrosine cysteine With respect to absorption in the gut vitamins A, D and K are absorbed in the small intestine With regards to cholesterol which of the following is FALSE it is present in animals plants contain cholesterol it is essential to the structure of the cell membrane it is a precursor to bike acids Concerning pancreatic secretions the pancreas secretes gastrin pH is 6.0 it contains anti-trypsin molecules it contains an enzyme converting polysaccharides to monosaccharides Gastric emptying takes 1-3 hours The majority of water ingested or secreted in the bowel is usually absorbed in the stomach / duodenum jejenum ileum ascending colon descending colon Protein digestion commences upon activation of saliva is largely completed by the small intestine Where are the vitamins A, D, E and K absorbed stomach proximal small bowel colon distal small bowel ileum Where are Vits A,D,K absorbed stomach proximal small bowel terminal ileum duodenum ascending colon Where is most fat absorbed GASTROINTESTINAL SYSTEM The liver synthesizes all of the following except Albumin Fibrinogen Complement Gamma globulins What causes increased gastric acid, mucosal proliferation GIP Gastrin Regarding pancreatic enzymes/juice all are correct, EXCEPT trypsin inhibits trypsinogen is rich in bicarbonate has a PH of 8.0 Swallowing voluntary first, than reflex Gastric emptying occurs in approximately 2 hours depends on osmotic pressure in the duodenum depends on PH in the duodenum is slowed down with metaclopramide Gall bladder functions; which is correct responds to CCK secretes cholesterol secretes lecithin increases the pressure of the biliary system alkalinises bile acids Regarding gastric emptying occurs in 1-3 hours is not related to pH in the duodenum duodenal pressure is not important The pH of pancreatic secretions is 5.0 6.0 7.0 7.5 6.5 What role does the autonomic nervous system have in the GIT permissive regulatory essential Secretin causes increased gastric motility increased volume of secretions an enzyme rich secretion Gastric emptying is not related to pH in duodenum duodenal pressure is not important normally takes 1-3 hours to empty Which cells secrete intrinsic factor Chief cells G cells K cells S cells Parietal Which cells secrete intrinsic factor G cells Chief cells Parietal cells K cells S cells 109) With regard to the parasympathetic nerve supply of the gut it is essential non-essential modulatory passive Intrinsic factor is produced by the gastric parietel cells BLOOD 16 2,3 DPG levels are increased in stored blood chronic hypoxia decreased temperature hypocarbia acidosis 29 2,3, DPG is decreased in all except. polycythemia testosterone acidosis left shift of O2 dissociation curve stored blood With regards to lymph has no clotting factors its protein content is dependant on the area it is from is not dependant on the colloid pressure of the capillary Regarding haemaglobin Fe3+ binds oxygen HbF has no beta chain Globin is synthesised from porphyrin What causes a reduction in Hb-O2 affinity acidosis increased 2,3-DPG increased temperature growth hormone all of the above Regarding the rhesus blood group system; which is correct 50% of people are Rh positive C, D and E are the most antigenic ? Regarding Hb Fe3+ binds O2 HbF has no beta chain Globin is synthesized from porphyrin With regards to lymph has no clotting factors its protein content depends on the area it is from is not dependant on the colloid pressure of the capillary 2,3 DPG levels increase in all of the following circumstances except Chronic hypoxia Androgens Natriuesis Regarding the resus antigen/system Rh+ve individuals have C, D, E antigens 50% caucasions are D +ve Do not develop anti-D antibodies without exposure of D-ve individuals to D+ve red cells Regarding granulocytes All have cytoplasmic granules Basophils are identical to mast cells Eosinophils phagocytose viruses Neutrophils have a half life of 4 days Increased 2,3 DPG occurs with all the following EXCEPT chronic hypoxia acidosis androgens thyroid hormones none of the above The major mechanism for transporting CO2 in the blood is carboamino groups dissolved in blood by Henrys law haemoglobin bicarbonate none of the above The haemoglobin dissociation curve moves up and to the left with increased H+ concentration hypothermia increased 2,3 DPG hypercarbia all of the above Which statement concerning iron is FALSE iron is absorbed in the duodenum it is the major component of myoglobin excess can de associated with diabetes Regarding iron it is absorbed in the duodenum 70 % is present in myoglobin a deficiency can cause diabetes the amount absorbed ranges between 10-20% mobilferin binds less iron in iron deficiency Haemoglobin the globin portion is a porphyrin the difference between haemoglobin and myoglobin is haeme foetal haemoglobin has no beta chains Which of the following is the largest fibrinogen haemoglobin albumin gamma globulin alpha 1 antitrypsin The liver synthesises all of the following EXCEPT albumin fibrinogen gamma globulins complement erythropoetin THE HEART Regarding isovolumetric contraction phase of cardiac cycle Aortic valve is open Associated with decreasing intra-aortic pressure Mitral valve is open Backflow in aorta regarding ECG ST is refractory period PR is atrial systole R wave on ECG Corresponds to Na influx yes Corresponds to Ca influx no, this is later and slower Corresponds to Ca efflux no later and slower still Fasting energy for the heart comes from gluconeogenesis amino acids glucose FFA glycerol In a healthy male who is running O2 extraction can increase 600% maximal heart rate depends on fitness maximal heart is independent of age cardiac output can increase 1500% systolic BP rises and diastolic BP falls or stays the same In A man with congestive heart failure, what is the most likely cause? increased rennin production decreased blood pressure increased albumin increased atrial pressure decreased angiotensin II`production Regarding the cardiac action potential Unlike the nerve action potential there is no overshoot The plateau phase is based on K+ efflux The plateau phase can be up to 100 x longer than depolarisation The relative refractory period prevents tetanus Slowest conducting cardiac tissue is Purkinje System AV node Atrial Pathways Ventricular muscle Bundle of His Regarding autonomous innervation of the heart SA node and AV node are mainly supplied by sympathetic nervous system Sympathetic stimulation maximally increases cardiac output by 30% Parasympathetic stimulation can decrease cardiac output by up to 80% Regarding the blood supply of the heart the heart receives 15% of the CO at rest left ventricular supply may be decreased by tachycardia A fit 20 yo male can increase SV during strenuous exercise; which is correct increase < 200% increase 300% increase 500% increase 400% increase 700% Cardiac muscle; which is correct calcium release from sarcoplasmic reticulum initiates contraction relative refractory period is longer than absolute refractory period time of contraction is less than action potential it can display tetanus A 42 yo male presents with chest pain. It is attributed to coronary vessel vasoconstriction. What is the most likely cause alpha 1 adrenoreceptor agonist activity hypoxia In a normal state, which is the hearts principal energy source glucose In the fasting state, which of the following meets most of the hearts basic caloric requirements free fatty acids glucose lactate protein A fit 20 year old male undertaking strenuous exercise can increase SV <200% increase SV 300% increase SV 500% increase SV 400% increase SV 700% If the autonomic supply is removed from the heart HR 150/min HR 40/min Decreased contractility The cardiac output during exercise can increase by 200% 500% 700% 300% 600% During isovolumetric contraction mitral valve opens decreased aortic pressure may have reversed flow in the aorta Cardiac output is changed accordingly in all of the following circumstances except Increased by up to 700% in exercise Increased on eating Decreased by sleep The slowest conducting type of cardiac tissue is Bundle of His Ventricular muscle Purkinje system Atrial pathways AV node Work of the heart is best approximated by Heart rate x ejection fraction Regarding the blood supply of the heart The heart recieves 15% of CO at rest Left ventricular supply may be decreased by tachycardia Regarding cardiac output in exercise It can increase 200% It can increase 500% It can increase 700% It can increase 300% It can increase 400% In exercise in a fit healthy young male Stroke volume increases less than 200% Stroke volume increases more than 300% Stroke volume increases more than 400% Stroke volume increases more than 700% Isovolumetric ventricular contraction Occurs directly post atrial systole Bradykinin is named after its effect on the heart stimulates cutaneous smooth muscle constriction stimulates GI smooth muscle constriction Under basal conditions the percentage of the hearts caloric needs met by fat is 70% 60% 50% 40% 30% With respect to the cardiac cycle isovolumetric contraction phase immediately follows the phase of atrial systole Myocardial contractility is decreased by all of the following EXCEPT acidosis barbituates hypercarbia bradycardia glucagon Cardiac output is decreased by sleep exercise pregnancy in the first trimester sitting from a lying position all of the above With regard to the cardiac cycle phase 1 represents atrial systole the aortic valve opens at the beginning of phase 2 the T wave of the ECG occurs during phase 4 the second heart sound is due to mitral valve closure the c wave is due to tricuspid valve opening With regard to the 12 lead ECG lead 11 is at 90 degrees for vector analysis V2 is placed in the 3rd left interspace Septal Q waves are predictable in V2 +130 degrees is still a normal axis the standard limb leads record the potential difference between 2 limbs With regard to cardiac action potentials cholinergic stimulation increases the slope of the pre-potential the resting membrane potential is increased by vagal stimulation phase 0 and phase1 are steepest in the AV node the Twave is the surface ECG manifestation of phase 1 the action potential in the AV node is largely due to calcium fluxes The most rapid conduction of electrical impulses occurs in the AV node Atrial pathways Bundle of His Purkinje system Ventricular system The R wave of the ECG is due to calcium influx chloride influx sodium influx potassium efflux chloride efflux THE CIRCULATION Proportion of cardiac output that goes to kidneys 10% 15% 25% 35% 50% Which organ receives the following blood flow Heart 250ml/min Liver 2000ml/min Kidney Skin Regarding flow Proportionate to viscosity Proportionate to length Proportionate to pressure difference at 2 ends of tube Proportionate to mean pressure in tube If tube diameter is increased from 1 to 2 cm Flow is doubled Flow is halved Resistance is doubled Resistance is increased 16x Resistance is decreased 16x Resistance in a narrow tube is inversely proportional to average pressure in tube length of tube viscosity pressure gradient When blood goes to systemic capillaries there is a shift of ions from red cells to plasma Hematocrite is unchanged compared to arterial blood PH increases cell size decreases Cl goes from red cells into interstitium Regarding wall tension and dilation in vessels mean pressure increases as radius increases Flow through a narrow tube is proportional to viscosity length average pressure in the tube pressure gradient What is common to all capillary beds? all are patent are 10-20 mm in diameter have a continuous basement membrane have intracellular fenestrations The part of the CVS with the largest total cross-sectional area is Arteries The large veins The capillaries Regarding capillaries Arterioles have a lower ratio of smooth muscle to diameter than large arteries Capillary flow is regulated by precapillary sphincters and metarterioles Have the largest cross-sectional area Contain 8% of the total blood volume Lymph Has an increased protein content compared with plasma Has a differing protein in different areas Fats cannot enter lymph Has no lymphocytes Contains no clotting factors EDRF shares a similar mechanism of action to GTN activates adenyl cyclase is the common pathway in the action of adenosine and histamine antagonises the action of thromboxane is synthesised by a magnesium dependent enzyme All of the following explain venous blood flow EXCEPT oncotic pressure gradient smooth muscle contraction skeletal muscle contraction the pumping of the heart intrathoracic pressure variations The c wave of the jugular pulse is due to atrial systole atrial contraction against a closed tricuspid valve in complete block the increase in intrathoraci pressure during expiration transmitted pressure due to tricuspid bulging in isovolumetric contraction the rise in pressure before the tricuspid valve opens in diastole The poiseuille-Hagen formula tells us that longer tubes can sustain higher flow rates flow is directly proportional to resistance flow will be doubled by a 20 % increase in vessel diameter turbulent flow is predicted in high velocity vessels why the venous capacitance is important in cardiac output The greatest percentage of the circulating volume is contained within capillaries large arteries pulmonary circulation the heart venules and veins Which of the following organs receive the largest amount of the bloods circulation per kg of tissue heart kidney brain liver adrenal All capillaries have a diameter of 10-20 mm a basement membrane Regarding Poiselle-Hagen flow in vessels , the flow in a vessal is proportional to pressure difference between the two ends radius viscosity With respect to isovolumetric contraction of the ventricle it is associated with decreasing aortic pressure aortic back flow open mitral and tricuspid valves open aortic and pulmonary valves none of the above The part of the cardiovascular system with the largest cross sectional surface area is arteries capillaries large veins aorta vena cava The systemic circulation peripherally has decreased red cell size decreased pH increased chloride decreased HCO3- How can the pressure be reduced in the femoral vein skeletal muscle pump action increased cardiac output decreased cardiac output What percentage of the blood is contained within the venous system 40 50 65 70 30 RESPIRATORY PHYSIOLOGY Asccending to altitude Partial pressure nitrogen decreases Decreasing CO2 and decreased pH inhibit respiration Regarding volumes of lungs Ventilation greatest in middle zone Perfusion greatest at the base VQ directly proportional to gas exchange VQ inversely proportional to gas exchange Causes of pulmonary vasoconstriction Altitude Exercise Regarding ventilation Anatomical deadspace is 1ml/kg Lung units with high VQ have decreased alveolar minute ventilation Increased RR decreases anatomical dead space Regarding ventilation At the end of inspiration chest wall recoils and pulls lungs back to original position Airway resistance is independent on lung volumes is equal in inspiration and expiration decreases while breathing through the nose decreases with forced expiration Compliance is different in inspiration compared with expiration independent of lung volume decreased with age decreased with emphysema Regarding the Respiratory Quotient (RQ) RQ brain = 0.95 RQ fat = 0.95 RQ Carbohydrates= 0.95 RQ brain > 0.95 RQ brain < 0.95 What is de oxygen pressure in the bronchioli at an altitude where barometric pressure is 500 mm Hg, breathing 30% O2 60 mm Hg 70 mm Hg 80 mm Hg 90 mm Hg 100 mm Hg If compliance of the lung is 30 mL/cm H20 and the average tidal volume is 600 mL, the pressure change per breath is: 0.2 cm H20 0.5 cm H20 2 cm H20 18 cm H20 20 cm H20 What causes a decrease in airway resistance (similar question ?) breathing through nose small lung volume exhale forcefully Which of the following decreases pulmonary vascular resistance altitude What effects will be noticed after 10 minutes of hypoxia (pO2 50 mm Hg) decreased pH increased pCO2 NB: no option available on changes in O2 saturation In walking down the street, what causes an increased respiratory rate decreased PO2 increased PCO2 decreased pH none of the above What causes a decrease in airway resistance breathe through nose small lung volume exhale forcefully Given that the intrathoracic pressure changes from 5cmH2O to 10 with inspiration and a TV of 500 mls, what is the compliance of the lung? .01 .1 1.0 10 100 Compliance is Dependant on lung volume Surfactant Increases compliance Is produced by type 1 pneumocytes Is absorbed by type 2 pneumocytes Residual volume in a 70kg man most closely approximates litre 2.0 litre 3.0 litre 4.0 litre 5.0 litre Permanent high altitude is associated with all of the following EXCEPT increased arterial blood HCO3- increased arterial blood 2,3 DPG increased pulmonary artery pressure increased alveolar ventilation could have a normal PaCO2 With regard to the distribution of pulmonary blood flow typically there is a zone at the apex which is not perfused the mean pulmonary arterial pressure is 8 mmHg hypoxia leads to pulmonary dilation the net balance of the Starling forces keep the alveoli dry in some areas flow is determined by the arterial/alveolar pressure difference With regard to pulmonary gas exchange transfer of nitrous oxide is perfusion limited diffusion is inversely proportional to the partial pressure gradient the diffusion rate for CO2 is double that of O2 at altitude the profound systemic hypoxemia favours oxygen diffusion transfer of O2 is diffusion limited Which of the following is associated with the least increase in airway pressure forced expiration nasal breathing very low lung volumes Surfactant increases compliance is produced by type 1 pneumocytes A permanent inhabitant at 4,500 feet has a high alveolar PO2 has a decreased 2,3, DPG is highly sensitised to the effects of hypoxia shows increased ventilation may have a normal HCO3- What is the PO2 of alveolar air with a CO2 of 64 and a respiratory quotient of 0.8 35 52 69 72 80 What is the compliance of a lung if a balloon is blown up with 500ml of air with a pressure change from 5 to 10 0.1 1 10 100 200 When walking at a steady pace the increase in respiratory rate is due to decreased PO2 increased CO2 increased pH increased pH CSF none of the above Which of the following are a cause of increased pulmonary vascular resistance altitude forced expiration What is the maximal volume left in the lung after maximal forced expiration 0.5 1.0 2.0 3.0 3.5 Compliance is dependent on lung volume Pulmonary vascular resistance increases as venous pressure rises is increased at both low and high lung volumes is decreased by histamine increases with recruitment is increased by muscular pulmonary arterioles which regulate flow to various regions of the lungs Compliance of the lung is reduced by all the following EXCEPT fibrosis consolidation emphysema alveolar oedema high expanding pressures In control of ventilation the medullary chemoreceptors respond to decreased O2 tension CO2 tension H+ concentration H+ conc and CO2 tension H+conc, CO2 tension and PO2 Laplaces law explains the observed elastic recoil of the chest explains the tendency of small alveoli to collapse determines the change in volume per unit change in pressure tells us the pressure is inversely proportional to tension all of the above The Haldane effect refers to the shape of the CO2 dissociation curve the carriage of O2 according to Henrys law the chloride shift that maintains electrical neutrality the dissociation constant for the bicarbonate buffer system the increased capacity for deoxygenated blood to carry CO2 The anatomic dead space varies with minute ventilation is typically 150 mls will increase in COPD is alveolar minus the physiological dead space all of the above Regarding the diffusing capacity of the lung O2 passage is diffusion limited Diffusion is directly proportionate to the surface area of the alveolocapillary Membrane and inversely proportionate to thickness RENAL SYSTEM Regarding the bladder There is a relatively constant wall tension as volume increases There is an increasing pressure if volume increases Sympathetic nerves initiate micturiction Urge to void occurs at 150 mls Regarding renal H+ handling Increased H+ ingestion causes increased H+ secretion Increased H+ ingestion causes decreased HCO3 secretion ECF K is inversely proportionate to ECF H+ Regarding permeability and transport in the nephron Thin ascending loop of Henle is permeable for water Thin ascnding loop of Henle has largest permeability for NaCl Thin descending loop of Henle is impermeable to water Collecting tubule only minimally permeable for water In the kidney, Na is mostly reabsorbed with HCO3 glucose Cl Ca K Regarding the bladder the urge to void occurs at 50 mL there is a relatively constant pressure as volume increases sympathetic nerves to the bladder initiate micturition Composition of normal urine; which is correct no protein constant SG of 1.010 pH is acidic urine output typically 500 mL/day Regarding the renal handling of H+/ K+ H+/K+ are inversely proportional With regard to renal handling of K+ It is reabsorbed proximally and secreted into the distal tubule It is absorbed and secreted proximally With regard to the kidney Has optimum autoregulation over a range of 60 - 100 mmHg Medullary blood flow is greater than cortical blood flow Prostaglandins decrease medullary blood flow Prostaglandins increase cortical blood flow Regarding the bladder The urge to void occurs at 50mls There is a relatively constant pressure as volume increases Sympathetic nerves to the bladder initiate micturition The filtration fraction of the kidney is 0.1 0.2 0.3 0.4 0.5 In the kidney, Na+ is mostly reabsorbed with: HCO3 Glucose K+ CA++ Cl Within the bladder the first urge to void is at 400 mls intravesical pressures can remain constant over a range of volumes voiding reflex is dependent on sympathetic control parasympathetic reflex controls external urethral sphincter The hypothalamus is essential for renal function With a fall in systemic blood pressure GFR falls more than renal plasma flow There is efferent arteriolar constriction The filtration fraction falls There is no efferent arteriolar constriction GFR does not change What is the filtration fraction of the kidney ( GFR/RBF ) 0.1 0.2 0.3 0.4 0.5 The osmolarity of the pyramidal papilla is 400 800 1200 1600 2000 What is the major stimulus for the secretion of ADH hyperosmolarity Hypokalemic metabolic alkalosis is associated with carbonic anhydrase inhibition diuretic use chronic diarrohea Which of the following would be best used for measuring GFR radiolabelled albumin inulin deuterium oxide tritium oxide mannitol Given the following values calculate the GFR: Plasma PAH 90: Urine PAH 0.3: Plasma inulin 35: urine inulin 0.25: Urine flow 1 ml/min: Hct 40% 120 150 180 240 400 Where in the renal tubules does the intratubular and interstitial osmolality hold the same values thick ascending loop of Henle thin descending loop of Henle distal convoluted tubule collecting duct none of the above With respect to the GFR it can be equated to creatinine clearance With respect to the renal handling of potassium potassium is reabsorbed actively in the proximal tubule In the kidneys sodium is mostly reabsorbed with chloride bicarbonate glucose potassium calcium The absorption of sodium in the proximal tubule reabsorbs 80% of the filtered sodium causes increasing hypertonicity is powered by Na+/H+ ATPase shares a common carrier with glucose all of the above With regard to osmotic diuresis urine flows are much less than in a water diuresis vasopressin secretion is almost zero the concentration of the urine is less than plasma increased urine flow is due to decreased water reabsorption in the proximal tubule and loop of Henle osmotic diuresis can only be produced by sugars such as mannitol Renal acid secretion is affected by all the following EXCEPT PaCO2 K+ concentration Carbonic anhydrase Aldosterone Calcium Glucose reabsorption in the kidney is a passive process closely associated with potassium the same in all nephrons occurs predominantly in the distal tubule resembles glucose reabsorption in the intestine Which of the following is the most permeable to water thin ascending loop of Henle distal convoluted tubule thin descending loop of Henle cortical portion of collecting tubule thick ascending limb of the loop of Henle With regard to urea it moves actively out of the proximal tubule it plays no part in the establishment of an osmotic gradient in the medullary pyramids all of the tubular epithelium is impermeable to urea except the inner medullary portion of the collecting duct a high protein diet reduces the ability of the kidney to concentrate urine vasopressin has no effect on the movement of urea across tubular epithelium Where in the kidney is the tubular fluid isotonic with the renal interstitium PCT DCT Proximal LH Distal LH What is the osmolality of the interstitium at the tip of the papilla 200 800 1200 2000 What is the osmolality of the interstitium at the tip of the renal papilla 200 800 1200 2000 3000 In the kidney, Na is mostly reabsorbed with HCO3 Glucose K+ Ca2+ Cl- ACID-BASE BALANCE Regarding blood buffers. What is HCO3:H2CO3 ratio at PH 7.4? (table 39.5) 10 16 1 20 0.9 Regarding the anion gap Difference between cations including Na and anions including Cl- and HCO3 Increased in hypochloremic acidosis secondary to NH4 ingestion Decreased with decreased Mg/Ca Decreased when albumin is increased It consists mostly of HPO4, SO4 and organic acids Which H+ concentrations are compatible with life (Table 39.1 Ganong) 0.0004 meq 0.0004 meq meq 0.0002 meq 0.0008 meq Which agent is most likely to produce the following blood gas result: pH 7.51, HCO3 50, pCO2 45 diuretic chronic diarrhoea carbonic anhydrase inhibitor Regarding the anion gap it is the difference between cations not including Na and K and anions not including HCO3 it consists mainly of HPO4, SO4 and organic acids it is increased in hyperchloraemic acidosis due to ingestion of NH4Cl it is decreased when albumin is increased it is decreased when Ca/Mg are decreased In respiratory acidosis, what would be the first metabolic compensatory response bicarbonate retention / elevation Which substance does not represent an acid load to the body Fruit DKA CRF Ingestion of acid salts All of the following represent an acid load to the body EXCEPT DKA CRF Fruit Ingestion of acid salts Which agent is most likely to produce the following blood gas result : pH 7.51 HCO3 50 PCO2 45 diuretic chronic diarrhoea carbonic anhydrase inhibitor Hypokalaemic metabolic acidosis may be associated with Carbonic anhydrase inhibitors Diuretic use Chronic diarrhoea The ratio of HCO3- ions to carbonic acid at pH 7.1 is 1 10 0.1 Regarding the anion gap It is the difference between cations including sodium and anions including Cl and HCO3 It is increased in hyperchloraemic acidosis secondary to ingestion of NH4Cl It is decreased when Ca/Mg decreased It consists mostly of HPO4 2- ,SO4 2- and organic acids It is decreased when albumin is increased In a patient with a plasma pH of 7.1 the HCO3-/H2CO3 ratio is 20 10 1 0.1 0.2 Which of the following best describes the changes found in uncompensated respiratory alkalosis decreased pH, HCO3- and PaCO2 increased pH and lowHCO3- and PaCO2 decreased pH and HCO3- and normal PaCO2 increased pH low HCO3- and normal PaCO2 decreased pH increased HCO3- and normal PaCO2 In chronic acidosis the major adaptive buffering system in the urine is carbamino compounds bicarbonate ammonium histidine residues phosphate The following blood gases represent pH 7.32, pCO2 31mmHg and HCO3-20mmol/L primary metabolic acidosis primary respiratory alkalosis a picture consistent with diuretic abuse mixed respiratory acidosis, metabolic acidosis partly compensated metabolic acidosis The following gases are associated with PCO2 45 pH 7.57 HCO3- 30 acetazolamide treatment diuretic use diarrhoea  -a)*PSTU/VWghCD~  8 F G g | } ~ j k ^ _ :;QcdOJQJ_HmHsHOJQJOJQJ\_H5OJQJ\_H OJQJ_HCJT-F*TU&/<GPV))  )$$ & F<<1$ )$$ & F< 1$41$UVW 3Fgh %4C )$$ & F<<1$ )$$ & F< 1$)CDeq~ G } ~ 2 M g )$$ & F< 7<1$ )$$ & F<<1$ )$$ & F< 1$)   0 P r % 4 B Q ` j k )$$ & F< 1$) )$$ & F<<1$ " 7 L ^ _ *Z>c )$$ & F< 1$) )$$ & F<<1$c+:;;p,d )$$ & F< 1$) )$$ & F<<1$}~;< UVG H !!I"J"####$$$% %f%g%"&#&&&[(l(m(n(((?)@)x))**,,,,\-OJQJ_HmHsH5OJQJ_H_HOJQJ5OJQJ\_H OJQJ_HOJQJ\_HP6BOj}~;<b) )$$ & FI<1$ )$$ & FI 1$41$ )$$ & F<<1$Lu3Np Hj )$$ & FI 1$) )$$ & FI<1$@AO EQ^jv) )$$ & FI 1$ )$$ & FI<1$}?o, 1UV4 )$$ & FI 1$) )$$ & FI<1$4i)]  $ 5 G H !!B!w! 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