Physio block 4

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Physio block 4
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2011-04-12 20:24:48
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Physio block 4
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  1. What are the 3 hormones that the kidney secretes?
    • renin
    • erythropoietin
    • 1,23 Vitamin D (active form)
  2. Which nephrons serve to create concentrated urine?
    Juxtamedullary nephrons
  3. What structure in the Juxtamedullary nephrons serves to create concentrated urine?
    Vasa recta
  4. What is the name for the peritubular capillaries in a juxtamedullary nephron?
    Vasa recta
  5. What part of the glomerular capillary presents the most significant barrier to filtration of plasma proteins?
    basement membrane --lamina rara interna, lamina densa, lamina rara externa
  6. What is attached to the basement membrane by foot processess that allows for filtration slits?
    Podocytes
  7. In exercising muscles why are K+ released ?
    for vasodilation purposes
  8. What are 3 loop diuretics?
    • Furosemide
    • Bumetenide
    • Ethacrynic acid
  9. Where do loop diuretics act?
    thick ascending limb of Henle
  10. Thiazide diuretics act where?
    early DCT
  11. What are 2 thiazide diuretics?
    • chlorothiazide
    • Hydrochlorothiazide
  12. Where do K+ sparing diuretics act?
    Late DCT
  13. What are 3 K+ sparing diuretics?
    • spironolactone
    • Triamterene
    • Amiloride
  14. What are some conditions that causes hyperkalemia?
    • exercise
    • cell lysis
    • insulin deficiency
    • acidosis
    • alpha adrenergic receptors
    • beta 2 adrenergic antagonists
    • hyperosmolarity
  15. What conditions hypokalemia?
    • insulin excess
    • beta 2 adrenergic agonist
    • alpha adrenergic antagonist
    • alkalosis
    • Hypoosmolarity
  16. Which cells reabsorb K+ in the DCT?
    alpha intercalated cells
  17. Which cells secrete K+ in the DCT?
    principal cells
  18. How does aldosterone stimulates secretion of K+?
    • Na+ enters principal cell
    • forces Na/K ATPase pump to pump Na out K in
    • High conc. of K+ in the cell creates a gradient for secretion of K+
  19. How do diuretics like loop diuretics and thiazide diuretics stimulate secretion of K+?
    • inhibited reabsorption of Na+ upstream of principal cells creates a gradient of Na for principal cell uptake
    • -increased Na reabsorption causes increased K+ secretion
  20. Alkalosis causes increases or decreases K+ secretion?
    increases K+ secretion
  21. Acidosis increases or decreases K+ secretion?
    decreases
  22. When is phosphaturia and cAMP in urine seen?
    high levels PTH
  23. What are the findings in pseudoparathyrodism?
    • high PTH
    • no cAMP in urine
    • no phosphaturia
  24. A defect where would produce pseudoparathyrodism?
    • Gs protein
    • Adenyly cyclase
  25. How does PTH inhibits phosphate absorption?
    Na+/phosphate transporter is inhibited
  26. What is the only diuretic that increases calcium absorption?
    thiazide
  27. What hormone affects reabsorption of urea?
    ADH
  28. What are the 3 actions of ADH?
    • -increases water permeability of principal cells in the DCT and CD
    • -increases Na+/Cl-/K+ cotransporter of the thick ascending limb
    • -increases urea absorption in the inner medullary CD
  29. What kind of receptors are present on the basolateral membrane of peritubular capillary for ADH?
    V2 receptors
  30. PTH and ADH use what kind of receptor/signalling cascade?
    G protein/cAMP/protein Kinase A
  31. ADH uses what type of aquaporin?
    Aquaporin
  32. What is the diluting segment?
    thick ascending limb
  33. What are the loop diuretics?
    • furoseramide
    • bumatenide
    • erthcrynic acid
  34. What are the K+ sparing diuretics?
    • Spironolactone
    • triamterene
    • Amiloride
  35. What is the cortcal diluting segment?
    Early DCT
  36. ADH antagonist?
    Demeclocycline
  37. ADH acts on what cells in the late DCT and Collecting duct?
    Principal cells
  38. How is Nephrogenic Diabetes treated?
    with thiazide diuretics
  39. What is the action of Thiazide diuretcs?
    • stop Na+ absorption in the early DCT
    • decrease GFR
    • increased Na+ and H20 absorption in PCT
  40. How is central or Neurogenic Diabetes Insipidus treated?
    dDAVP---ADH analog
  41. What are the diluting segments of the nephron?
    • thick ascending limb
    • early DCT
  42. In the presence of ADH is the water clearance positive or negative?
    negative
  43. In the absence of ADH, is the water clearance positive or negative?
    positive
  44. What hormone could cause clearance of H20 to be zero?
    Loop Diuretics---furosemide, bumatenide, ethacrynic acid
  45. In what segment of the nephron is free water generated?
    thick ascending limb
  46. What effect do loop diuretics have on the absorptions or calcium, magnesium, sodium?
    they inhibit them
  47. What is the normal range of arterial pH?
    7.37-7.42
  48. What is the pH range that is compatible with life?
    6.8-8.0
  49. What catalyzes the formation of carbonic acid?
    carbonic anhydrase
  50. What are the fixed acids?
    • sulfuric--from methionine, cystein
    • phosphoric acid---phosphilipids
  51. The buffering capacity is greatest where?
    within one unit of the pk
  52. In respiratory acidosis, is there hypocalcemia or hypercalcemia?
    hypercalcemia
  53. In respiratory alkalosis is there hypo or hypercalcemia?
    hypocalcemia
  54. Why does acid-base disturbance produce changes in Ca conc.?
    • Because H binds to albumin which leaves Ca free in plasma---hypercalcemia
    • In alkalosis--no H binds to albumin so Ca binds to albumin producing Alkalosis
  55. What is the most significant intracellular buffer?
    Hemoglobin
  56. Hemoglobin in its oxygenated or deoxygenated form is a more effective buffer?
    What purpose does it serve?
    • -deoxygenated
    • - as Hb becomes deoxygenated, it takes up CO2 which reacts with H20 to produce H+..which is buffered by the deoxygenated Hb
  57. What are two mechanisms for excreting fixed H+?
    • -as NH4+
    • - as urinary phosphate
  58. Excretion of H+ is accompanied by what?
    synthesis and reabsorption of HCO3-
  59. Where is HCO3- reabsorbed?
    In the proximal tubule
  60. What produces isotonic urine?
    loop diuretics
  61. The excretion of H+ in the late DCT and Collecting Duct is accomplished thru what 2 mechanisms?
    • H+ ATPase stimulated by aldosterone
    • H+/K+ ATPase
  62. Which cells secrete H+ in the late DCT and Collecting Duct?
    alpha intercalated cells
  63. Metabolic acid-base disturbances involve what?
    HCO3-
  64. Respiratory acid-base disturbances involve what?
    CO2
  65. When the acid-base disturbance is metabolic, what is the compensatory response?
    respiratory
  66. When the acid-base disturbance is respiratory, what is the compensatory response?
    renal (metabolic)
  67. What are two Beta 2 agonists?
    • Isoproterenol
    • Albuterol
  68. Do high or low lung volumes increases the resistance to airflow?
    High lung volumes
  69. What effect on resistance does viscosity have?
    viscosity increases resistance
  70. Hypoxia causes what in pulmonary circulation?
    vasoconstriction
  71. Hypoxia in coronary circulation causes what?
    vasodilation
  72. What happens to the alveoli in an infant with RDS?
    alveoli collapse due to absence surfactant
  73. Spirometry cannot measure which volume?
    residual volume
  74. What is vital capacity?
    • Inspiratory reserve volume
    • tidal volume
    • Expiratory reserve volume
  75. What is functional residual capacity?
    Residual volume + expiratory reserve volume
  76. Highest airway resistance is where?
    medium-sized bronchi
  77. What growth factor is released in exercising muscle to decrease diffusion distant for Oxygen between capillaries and tissues?
    Vascular endothelial Growth Factor (VEGF)
  78. Tingle body macrophages are characteristic of what?
    Benign reactive lymphadenitis
  79. What cells secrete renin?
    juxtaglomerular cells
  80. What glycoprotein is present on platelet that interacts with GpIb on the vascular endothelium?
    GpIa
  81. What factor along with Gp Ib helps in adhesion of platelets to exposed collage?
    von Willebrand Factor
  82. What is the most potent activator of platelets?
    Thrombin
  83. What activates phospholipase c in platelets?
    Thrombin
  84. Binding of thrombin to platelets does what?
    activates Phospholipase C
  85. What are the products of Phospholipase C action?
    • DAG
    • IP3
  86. Activation of protein kinase C in platelets causes what?
    release of platelet granules
  87. IP3 released in platelets serves what functions?
    • release of Ca which binds to MLCK--shape change
    • activation of Phospholipase A--arachidonic acid--Thromboxane A2--->platelet aggregation
  88. What is the difference between primary and secondary hemeostasis?
    • Primary--platelet adhesion, aggregation
    • Secondary--coagulation
  89. Tenase complex cleaves what bond in Factor X?
    Arginine--Isoleucine
  90. What glycoprotein is used for platelets to aggregate?
    Gp IIb
  91. What activates factor XII?
    Kalikrein
  92. What activates Factor VII in Extrinsic pathway?
    Tissue Factor
  93. What is the function of tissue factor complex?
    Cleaves VII --->VIIa
  94. Tissue factor and tenase complex cleave what bond in Factor X?
    arginine--isoleucine
  95. What vitamin is needed for carboxylation of gamma-carboxy glutamyl residue?
    Vitamin K
  96. Which factor acts as a transglutaminase?
    Factor XIII
  97. What factor acts as a cofactor to Xa and Prothrombin?
    Factor V---Leiden
  98. What factor activates factor XIII?
    Thrombin
  99. What protein is involved in the dissolution of the secondary hemostatic plug?
    plasmin
  100. What degrades active plasmin in blood?
    alpha-2-antiplasmin
  101. Pepsinogen is normally bound to what?
    Fibrin
  102. Activators of plasminogen cleave what bond on the plasminogen molecule?
    Arg-valine
  103. What are 3 activators of Plasminogen?
    • Hageman factors
    • tPA
    • uPA---urokinase
  104. What are the 2 major inhibitors of clotting?
    • Anti-Thrombin III
    • Alpha 2 macroglobulin
  105. Anti-Thrombin III inhibits what factors?
    7, 9,10,11,12
  106. What is the mode of action of Heparin?
    Heparin binds to ATIII which allows ATIII to inhibit factors 7,9,10,11,12
  107. What agent inhibits Heparin?
    Protamine
  108. Deficiency of ATIII could lead to what?
    Venous thromboembolism
  109. What activates Protein C?
    Thrombin and Thrombomodulin
  110. Protein C acts with what other protein?
    Protein S
  111. Protein S + Protein C acts to inhibit what clotting factors?
    V and VII
  112. Von Willebrand disease is said to be a disease of the intrinsic pathway, why?
    because vWF carries factor VIII
  113. What is defective in von Willebrand Disease?
    platelet to collagen adhesion via Gb- Ib
  114. Bernard-Soulier Syndrome is characterized by absence of what?
    What is the characteristic shape of platelets?
    • -absence of Gp-bI
    • --giant platelets
  115. A Disorder in which Gp-IIb is deficient is called?
    Glanzmann's Thrombocytopenia
  116. Whats the common form of inherited Hypercoagubility?
    deficiency of factor V--Leiden
  117. PTT tests the function of which pathway?
    intrinsic
  118. PT tests the function of which pathway?
    extrinsic
  119. What effect does Angiotensinogen II have on GFR?
    Constricts efferent arteriole so it increases GFR
  120. Increased blood flow thru the afferent arteriole would have what effect on the arterioles?
    constriction of afferent arteriole---> maintaining GFR
  121. What hormone mediates the uptake of Urea?
    Aldosterone
  122. What 2 substances are used to measure GFR?
    • Creatinine
    • Inulin
  123. Why are Creatinine and Inulin used to measure GFR?
    because they are neither reabsorbed nor secreted
  124. If GFR is high, what is the conc of creatinine in the serum?
    low
  125. If the GFR is low, what is the concentration of creatinine in the serum?
    High
  126. What is used to measure RBF?
    creatinine
  127. What is used to measure RPF?
    BUN/PAH
  128. What is used to measure afferent arteriole?
    creatinine
  129. What is used to measure efferent arteriole?
    BUN/PAH
  130. If you are dependent on filtration what test should be followed?
    creatinine
  131. If you are dependent on secretion, what test should be followed?
    BUN
  132. If a drug is totally filtered what is it dependent on?
    GFR---> creatinine
  133. If a drug is secreted what is it dependent
    GFR
  134. What causes Fanconi's syndrome?
    faulty Na transporter protein in PCT
  135. High urine, CA, Mg, PO4, aa, glu are characteristic of what condition?
    Fanconi's syndrome
  136. Macula Densa senses what?
    osmolarity
  137. Glutaminase is located where?
    late collecting duct
  138. Spironolactone blocks what?
    aldosterone receptor
  139. Triamterene and amelioride block what?
    sodium channels
  140. What is the difference in skeletal and smooth muscle with regards to Ca2+ action?
    • skeletal muscle--Ca binds to troponin c
    • smooth muscle--Ca binds to calmodulin
  141. Vascular smooth muscles have what ADH receptor, VI and V2?
    VI
  142. Streptococcus pyogens produces what that increases body temperature?
    IL-1
  143. CFTR is what type of gated channel?
    ATP
  144. What are neurophysins?
    carrier-proteins used to transport hormones along a tract
  145. In what condition would one see Osteitis Fibrous Cystica?
    Renal failure
  146. How would renal failure cause Osteitis Fibrosa Cystica?
    • decreased Ca absorption due to low vitamin D
    • increased PTH hormones
  147. Pulsatile release of GnRH is used to treat what?
    infertility
  148. What factors stimulate the secretion of ADH?
    increased osmolarity and decreasedblood volume
  149. Which ETC complexes utilize iron?
    Complex I thru IV
  150. Which complex utilizes Cu in the ETC?
    IV

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