Physiology

The Cell

Nuclei contain steroid receptors

Estradiol acts directly on nucleus to produce physiologic effects
Clear vesicles contain Ach & glutamate
Granulated vesicles contain catecholamines
Active zones site of extensive exocytosis
Microtubules associated w/ kinesin
Proteins secreted by the cells are found in vesicles & secretory granules
GABA A channels has a single pore surrounded by 5 protein subunits
GABA A receptor a ligand-gated ion channel
GABA A receptor expected to decrease anxiety
GABA B receptor coupled to a heterotrimeric G protein
Mineralocorticoid receptor does not span the cell membrane seven times
Serotonin a synaptic NT that is not a peptide, polypeptide or protein
Loss of expression of the gene for fos-B expected to reduce maternal behavior
Cytosol compartment of the cell where glycolysis occurs
Cytochrome c involved in the regulation of apoptosis
Cell membrane in some tissues permit transport of glucose at greater rate in the presence of insulin

Membrane Transport

Filtration primary force moving water molecules from blood plasma to interstitial fluid
Passive diffusion water movement from alveoli to capillaries
Passive diffusion movement of oxygen from alveoli into the blood in pulmonary capillaries
Simple diffusion movement of O2, CO2, chloride ions & urea
Simple diffusion - movement of Na+ into nerve cells as they conduct an impulse
Facilitated diffusion carrier mediated; entry of glucose in most cells
Facilitated diffusion type of transport along gradients but is carrier mediated
Carrier proteins bind w/ molecules or ions to be transported
Carrier proteins - conformational changes happen to allow substances to pass through the other side
2nd messengers mediate the intracellular responses to many different hormones & NTs
Secondary active transport glucose is transported in the small intestine from lumen into the mucosal cell
Secondary active transport moves Na+ down its conc. Gradient, moves co-transported solute up a gradient
Secondary active transport increasing intracellular iodine due to the action of Na/I symporter
Co-transport system w/ Na+ - glucose absorption from the intestinal mucosal cell
Na+-Glucose co-transport use of Na+ & glucose in ORESOL takes advantage of this transport through the cell
Na-K pump important because it prevents cells from swelling & bursting
Bicarbonate major CO2 transport in the blood
Osmotic flow into the body cells if the patient is given an infusion of an isotonic solution

Membrane Potential

Axon hillock part of neuron where action potential originates

Action potential of a neuron terminated by efflux of K
 Potassium its transport is responsible for rapid repolarization of membrane
Initial segment part of a neuron that has the highest conc. of Na+ channels / mm2 of cell membrane
Initiation of action potential in skeletal muscle by stimulating its motor nerve requires the release of Ach
Action potential of skeletal muscle spreads inward to all parts of the muscles via T-tubules
Membrane hyperpolarization likely not to be involved in production of LTP
A drug that the entry of arginine into neurons not expected to enhance noradrenergic transmission
Magnitude of resting membrane potential is mainly due to potassium influx
Plateau in cardiac muscle action potential most probably due to the continuing calcium entry into the cell
Fast inhibitory postsynaptic potentials (IPSPs) interact w/ other fast & slow potentials to move the membrane
potential of the postsynaptic neuron toward or away from the firing level
When gamma motor neuron discharge at the same time as alpha motor neuron discharge to muscle
- the number of impulses in spindle Ia afferents is greater than when alpha discharge alone is
Net increase in Na+ influx excitatory transmitter causes an increase in the permeability of the postsynaptic
membrane to all ions and the resulting depolarization is due to this
Resting membrane potential changed from -80mv to -90mv : permeability of membrane in K+ may

General Principles, Law & Equation

Poiuseuilles law influence of the radius of vessel is apparent

Poiuseuilles law capillaries do not easily rupture in spite of high pressure against its thin walls
Not true of Poiuseuilles law can be directly applied to the vascular system
Ficks law in thickness of membrane would the rate of net diffusion of a substance across the membrane
Law of Laplace
Bernoullis principle
Hiltons law sensory nerve supplying joint also supplies the muscle moving the joint & skin overlying

Receptors, Sensory Organs & Reflexes

Pacinian corpuscles rapidly adapting touch receptors

Incorrectly paired hair cells : olfactory mucous membranes
Inverse stretch reflex disynaptic reflex w/ a single interneuron inserted between afferent & efferent limbs
Not a characteristic of reflex action may involve somatic or visceral responses, but never both simultaneously
Withdrawal reflexes are not absent several months after transaction of the spinal cord
Biopsy of gastric mucosa test that will give most information about cause of severe loss of vibration sensitivity
Dorsal root C fibers stimulation might be expected to produce itching
Adaptation to sensory stimulus produces diminished sensation when stimulus is applied repeatedly over time
C fibers has the slowest conduction velocity
C fibers mediates itch and tickle sensation
A fibers more sensitive to pressure than C fibers reason for loss of motor function w/o loss of pain
sensation (nerve in the arm)
Not a characteristic of conditioned reflexes failure to form conditioned reflexes when the conditioned
stimulus is unpleasant to the animal
Back of scapula the distance by which 2 touch stimuli must be separated to be perceived as 2 separate
stimuli is greatest on this area
Correctly paired
- rods & cones : eye
 - receptors sensitive to sodium : taste buds
- receptors sensitive to stretch : carotid sinus
- Glomus cells : carotid body

Hemodynamics

5 L overall blood flow in an adult

35 45 % - blood volume when removed causes BP equal to zero
Blood volume characteristic most similar to the systemic & pulmonary circulation
Turbulent blood flow exhibits eddy current
caliber size of vessels & opening of new vascular channels vascular resistance of an organ
in vascular tone circulatory shock due to CO
HR & BP attributed to the sympathetic component of the ANS
Mean blood pressure increased when viscosity of the blood is increased
Prostacyclin vasodilator
Total peripheral resistance NOT during isotonic exercise
total peripheral resistance fainting
Central venous pressure expected to in normal individual who stands quietly in same position for 1 hour
Thirst stimulated by an in plasma osmolality and a in plasma volume
True of sympathetic vasoconstriction fiber produces arterial vasoconstriction in non-working muscles &
venous vasoconstriction of capacitance vessels
Difference bet. arterial & venous pressure & vascular resistance of the organ determine the amount of
blood flow to an organ
Compensatory mechanism during acute hemorrhage
- CNS ischemic response
- chemoreceptor response
- baroreceptor response
- NOT : renal-body fluid mechanism

Capillaries

Capillaries portion of circulatory system w/ the largest total cross sectional area
Capillaries, venules, arterioles, veins, arteries highest to lowest in terms of total cross-sectional area
Capillary blood flow increased when radius of the resistance vessels is

Arteries & Arterioles

Arterioles serve as stopcocks, where pressure drop occurs

Elastic arteries serve as windkessel & most distensible
Decreasing elastance not rue of arterial system in old age
Arteriolar vasodilation not a compensation in circulatory shock
Arteries of the total blood volume, it has the least amount

Veins & Venules

True of veins greater wall tension than arteries at the same pressure
Velocity of blood flow is higher in the veins than in the venules
Nitric Oxide

Nitric oxide activates guanylyl cyclase

Damage to endothelium interferes w/ the production of nitric oxide by the endothelium
Drug that inhibits NO synthase would be expected to raise blood pressure

Other Vasoactive Compounds

VIP activates protein kinase A

VIP causes relaxation of bronchial smooth muscle
Endothelin-1 activates phospholipase A2
Bradykinin activates phospholipase C
Substance P activates phospholipase C
Angiotensin II activates phospholipase C
Angiotensin II & Endothelin-1 cause vasoconstriction in vivo
Nitric oxide, VIP, Bradykinin, Substance P cause vasodilation in vivo

Pain

Pain sensation generated by impulses from naked or free nerve endings

Pain sensation most subjected to facilitation & inhibition in the CNS
Visceral pain can sometimes be relieved by applying an irritant to the skin
Cholinergic antagonists does not exert an analgesic effect
Causalgia is relieved by drugs that block alpha 1 adrenergic receptors
Episodes of severe phantom limb pain (right hand) PET scan study of cerebral cortex might be expected to
show projection of fibers from neighboring sensory areas into the right hand area of the left
somatic sensory area I
Anterolateral cordotomy performed producing relief of pain in the right leg, effective because it interrupts
the left lateral spinothalamic tract

Immunologic

IgD antigen recognition by B cells

IgE release of histamine from basophils & mast cells
IgG complement fixation
IgM complement fixation
HLA types of the donor & recipient single most important factor in determining whether to perform
a transplant between specific donor & recipient
Cells responsible for innate immunity activated commonly by carbohydrate sequences in bacterial cell walls

Muscular

Motor unit stimulation of a single nerve fiber excites anywhere from 3 to hundred skeletal muscle fibers
Calcium cation directly involved in the isotonic contraction of skeletal muscle
Myosin cross-bridges of the sarcomere in skeletal muscle are made up of
Intrafusal fibers T muscle spindles their efferents have a high conduction velocity
Gap junctions provide pathway for rapid spread of excitation from 1 cardiac muscle fiber to another
Functions of tropomyosin in skeletal muscle acting as a relaxing protein at rest by covering up the sites
 where myosin binds to actin
Contractile response in skeletal muscle produces more tension when muscle contracts isometrically than
when the muscle contracts isotonically

Skeletal

Bone collagen defective in osteogenesis imperfect

Osteoclasts defective in osteoporosis
In multiple rib fracture restrictive problem is due to reduced transmural pressure

Neurologic

40 % - percentage of human genes involved in the formation & function of the nervous system
Histamine not synthesized in postganglionic sympathetic neurons
Primary auditory cortex located in the superior part of temporal lobe
Cerebral cortex, thalamus & cerebellar cortex regular rhythmic fluctuations in electrical activity are observed
Insular cortex on the left side perception of disgust appears to depend on this area
Retrograde amnesia commonly precipitated by a blow on the head
Representational atmosphere is the right cerebral hemisphere in most right handed individuals
Representational hemisphere better than categorical hemisphere at recognition of objects by their form
Corpus callosum interhemispheric transfer of learning
Multiple sclerosis antibodies against myelin
Dopamine deficiency best documented hypothesis for acute confucional state or delirium
Law of specific nerve energies relate to intensity discrimination
True of phantom limb some receptors are still functioning

Autonomic Nervous System

Sympathetic adrenergic stimulation results in vasoconstriction of all tissues

Parasympathetic division of ANS postganglionic fibers are short & are close to or within the organ innervated
Parasympathetic stimulation on the heart slowing the heart

Brain Lesions

Lesion of mamillary bodies loss of recent memory

Lesion of Brocas area in the categorical hemisphere slow speech
Lesion of Wernickes area (posterior end of superior temporal gyrus) in categorical hemisphere causes
patients to talk rapidly but make little sense
Effects of bilateral loss of hippocampal function
loss of ability to encode events of recent past in long-term memory
Loss of cholinergic neurons in the nucleus basalis of Meynert & related areas of the forebrain
loss of recent memory

Hypothalamus

Hypothalamus satiety; water intake; shivering

Hypothalamus required for rhythmic breathing
Mediobasal hypothalamus location for the cell bodies of the principal histaminergic neurons in the brain
Pituitary Gland

B-Endorphin pituitary hormone considered an opioid peptide

Action of prolactin milk production
Prolactin hormone not made up of alpha & beta-subunits
Melanin-concentrating hormone a gain-of-function mutation in this gene expected to cause obesity in human
Growth hormone increased plasma glucose level
Growth hormone receptor requires dimerization to exert its effects
Cachexia NOT a characteristic of hypopituitarism
Cortisol NOT synthesized in both endocrine glands & the brain
Castration cells found in the anterior pituitary
Melatonin secretion would probably NOT be increased by stimulation of the optic nerve
Melatonin an indole

Abnormalities

Cretinism thyroid hormone deficiency

Achondroplasia fibroblast growth factor receptor 3 gene defect

Frontal Lobe

Frontal lobe - experimental neurosis; site of working memory

Temporal Lobe

Temporal lobe audition; visual association; recognition of faces

Parietal Lobe

Lesion of the parietal lobe of the representational hemisphere unilateral inattention & neglect

Basal Ganglia & Amygdala

Amygdala emotional memories

Amygdala fear
Planning voluntary movement primary function of the basal ganglia
Substantia nigra part of the basal ganglia that is most likely damaged in paralysis agitans

Midbrain

Medial lemniscus above the midbrain high-frequency stimulation of this area does not produce the alerting
response
Periaqueductal region at top of midbrain localized lesion in this structure would be expected to produce
prolonged coma

Medulla

Medulla oblongata fine control of BP; swallowing

Medulla maintains the basic rhythm of respiration

Spinal Cord
 Spinal cord primitive sexual reflexes
Complete sectioning of anterior (ventral) spinal nerve roots loss of motor activity
Ventral spinothalamic tract impulses for the sensation of touch are conducted to the CNS via this pathway
Loss of reflexes during spinal shock immediately following resection of the spinal cord in man
Patient w/ transected spinal cord frequently have a negative nitrogen balance because they are paralyzed
below the level of transaction

Sleep, EEG

REM sleep characterized by slow high voltage regular EEG

Primary visual cortex blood flow not increased in REM sleep
Narcolepsy triggered by abnormalities in hypothalamus
Pons REM sleep
Alpha (8-13 Hz) the dominant EEG rhythm observed w/ electrodes over the occipital lobes in a healthy, alert
adult sitting w/ eyes closed

Alzheimers Disease

Alzheimers disease affects beta-amyloid protein

Alzheimers disease not caused by overexpression of a trinucleotide repeat

Parkinsons Disease

Therapeutic effect of L-dopa its effect in Parkinsons disease eventually wears off because the dopaminergic
neurons in the substantia nigra continue to degenerate

Huntingtons Disease

Huntingtons disease affects basal ganglia; associated with increased number of CAG trinucleotide repeats

Schizophrenia

Schizophrenia a disease believed that the mesocortical system of dopaminergic neurons is hyperactive

Peripheral Innervation

Sensation felt in the right hand cannot be produced by stimulation of the hand area of the sensory cortex on
the right side of the body

Visual

Visual accommodation involves contraction of the ciliary muscle

Fovea region of highest visual acuity
Parafoveal region has the greatest concentration of rods
Myopic when light rays come to focus behind the retina
Myopia long anteroposterior diameter of the eyeball
Strabismus failure of visual changes to fall on corresponding points in the retina
Cones does not contain cation channels that are activated by mechanical distortion, producing depolarization
Abnormal color vision 20x more common in men than women
Abnormal color vision - most cases are caused by an abnormal recessive gene on the x chromosome
 Area V3A of visual cortex not involved in color vision
1.33 diopters refractive power if the focal distance of a lens is 0.75 m
Lebers hereditary optic neuropathy a disease due to a mutation in the mitochondrial genome
Vitamin A precursor for the synthesis of retinene1
Myopia corrective lenses required should diverge the light rays
Light reflex a pupillo-constrictor reflex
Focal point a child is able to focus sharply in an object 10 cm away, distance called

Auditory

Decibels measurement for sound intensity

Direction of nystagmus is vertical when a subject is rotated w/ the head tipped sideways
Otoliths : semicircular canals not correctly paired
Human planum temporale generally larger in musicians w/ perfect pitch than in musicians w/o perfect pitch
In the utricle, tip links in hair cells are involved in the regulation of distortion-activated ion channels
Perilymph
Endolymph
Basilar membrane of the cochlea vibrates in a pattern determined by the form of the travelling wave in the
fluids in the cochlea
Affected hair cells fail to shorten when exposed to sound when the damage to outer hair cells is greater than
the damage to the inner hair cells
Postrotatory nystagmus caused by continued movement of endolymph in the semicircular canals, w/
consequent bending of the cupula & stimulation of hair cells
Mutation of the gene for barttin patient evaluated for deafness, found to have an elevated plasma rennin,
although BP is 118/75 mm Hg
Correctly paired
- tympanic membrane : manubrium of malleus
- helicotrema : apex of cochlea
- foot plate of stapes : oval window
- basement membrane : cochlea

Olfactory

Impulses generated by olfactory receptors in the nasal mucous membrane pass to the mitral cells & from
there directly to the olfactory cortex
High beta-arrestin content in olfactory neurons does not the ability to discriminate many different odors
Adhesion molecule deficiency causes the combination of diminished sense of smell & hypogonadism
Correctly paired
-alpha gusducin : sweet taste
- alpha gusducin : bitter taste
- nucleus tractus solitaries : BP
- Ebeners glands : taste acuity
Insular cortex : smell not correctly paired

Gustatory

Taste sensation not generated by impulses initiated in naked nerve endings

 Taste most strongly associated w/ aversive conditioning
Impulses generated in the taste buds reach the cerebral cortex via the thalamus
Saliva hypotonicity relative to plasma

Thyroid Gland

Deiodinase enzyme responsible for oxidizing iodide

Deiodination major route of thyroid hormone metabolism
Thyroid peroxidase enzyme necessary for organification of iodide
Thyroid binding globulin most important carrier protein of the thyroid hormone
T3 only 20 % produced by thyroid gland; 10x more potent than T4; formed from T4 by deiodination
T4 majority comes from secretion of thyroid gland
Thyroxine a prohormone
Thyroxine primarily involved in the regulation of metabolic rate
Effect of thyroid hormone in the body - the requirement for vitamins
Iodine metabolism & transport iodine occupies 65 % weigth of T4
Methimazole causes an in thyroid size & a in plasma T4
Metabolic rate least affected by an in the plasma level of TBG
Ferritin not essential for normal biosynthesis of thyroid hormones
Cyclic GMP in thyroid cells least affected by injections of TSH
Graves Disease antibodies that stimulate TSH receptors
Not correctly paired Hashimotos thyroiditis : antibodies against TSH
Thyroid hormone receptors bind to DNA as a heterodimer w/ the retinoid X receptor
Iodination of tyrosyl residues of thyroglobulin iodination occurs in the microvilli apex before
thyroglobulin is exocytosed in the lumen
Thiourylenes such as methimazole blocks the coupling of monoiodotyrosine & diiodotyrosine & the iodination
of thyroglobulin
Tyroidal uptake of radioactive iodine affected by T3, TSH, methimzaole, iodine content of the diet
Tyroidal uptake of radioactive iodine - NOT affected by calcitonin
Most likely to bring improvement in exophthalmos administration of drugs that inhibit the production of
T lymphocytes

Hyperthyroidism

Hyperthyroidism due to circulating antithyroid antibodies w/ TSH activity condition least likely that the TSH
response to TRH will be greater than normal

Hypothyroidism

Hypothyroidism due to a primary abnormality in the hypothalamus a young woman has puffy skin, hoarse
voice, low plasma TSH conc. but increases markedly when given TRH
Hypothyroidism due to disease of thyroid gland is associated w/ plasma levels of cholesterol

Parathyroid Gland

plasma Ca levels causes formation of 24,25-dihydroxycholecalciferol

Lungs not involved in the regulating plasma Ca levels
Regulates plasma Ca levels kidneys, skin, liver, intestine
 Plasma Ca conc. exerts the greatest effect on parathyroid hormone secretion
1, 25 Dhydroxycholecalciferol affects intestinal Ca absorption through a mechanism that includes
alterations in the activity of genes
parathyroid hormone secretion expected to find in a patient whose diet has been low in Ca for 2 months
Some types of cancer tend to the plasma Ca level
Pseudohypoparathyroidism a disease in which plasma PTH often elevated
PTH & PTHrP activate the same receptor, but their effects are different because there is an additional receptor
in the body that responds to PTH but not to PTHrP
Patient w/ parathyroid deficiency 10 days after inadvertent damage to parathyroid glands during surgery
- would probably have plasma Ca level, muscular excitability & a characteristic spasm of muscles
Of the upper extremity (Trousseaus sign)

Impulse Conduction of the Heart

SA node is the pacemaker of the heart because of its rate of impulse function
SA node discharge rate faster than natural self-excitatory discharge of either A-V node or purkinje fibers
AV node takes over if SA node ceases to act as pacemaker
AV node cardiac tissue that has the slowest conduction velocity
Purkinje system has the fastest conduction speed
Purkinje system speeds up the conduction of impulses
Special Purkinje Fibers rapid transmission is caused by a very high level of permeability of gab junctions at
intercalated discs between successive cells

Cardiac Receptors

Carotid bodies receptors responsible for the increase in ventilation caused by intravenous lactic acid
Injection of drug that stimulates carotid bodies expected to cause in PCO2 of arterial blood
Activation of receptors for ANP increases target cell guanyl cyclase activity
Bradycardia may result from stimulation of the vagus nerve in the neck
pressure in carotid sinus decreased sympathetic discharge to arterioles
Carotid sinus massage sometimes stops supraventricular tachycardia because it increases vagal discharge
to the conducting tissue between the atria & ventricles

Heart Sounds

S1 result of the closure of A-V valves; occurs during isovolumetric contraction

S2 result of the closure of aortic & pulmonic valves; occurs during isovolumetric relaxation
S4 caused by ventricular filling

Cardiovascular

Cardiac index ratio of cardiac output & body surface area

Congestive heart failure edema results from peripheral resistance
Pulse pressure greatest in the aorta
Inactivation of RAS not a mechanism causing peripheral edema in CHF
TOF increase pressure in the right ventricle
When calcium combines w/ troponin C the inhibitory influence of the troponin-tropomyosin complex on
striated muscle contraction is removed
 All-or-none law response of the ventricular muscle upon effective stimulation is due to rapid junctional
transmission
Long refractory period of cardiac muscle membrane explains why stretching the muscle makes the
contraction more forceful
Constriction of the ascending aorta expected to cause an in ANP secretion from the heart
Opening of K channels contribute to repolarization phase of the action potential of ventricular muscle fibers
Dicrotic notch on aortic pressure curve caused by closure of the aortic valve
LV work performed substantially greater than that by the RV because in LV the afterload is greater
Starlings law of the heart explains the in cardiac output that occurs when venous return is
Drug that stimulates production of VEGF receptors might be of value in the tx of coronary artery disease
Pressure differential between the heart & aorta least in the left ventricle during systole
Injection of tissue plasminogen activator most beneficial during 2nd hour after occlusion of coronary artery
Paroxysmal atrial fibrillation least likely to cause fainting

ECG

Sinuatrial node normally has the most prominent prepotential

PR interval corresponds to atrial depolarization & conduction through AV node
Speed the conduction of impulses important function of cardiac Purkinje system
Primary AV block prolong PR interval
Bigeminy PVC occurring every other beat
2nd degree heart block the ventricular rate is lower than the atrial rate
Acute myocarditis
- pronlonged PR interval
- ST segment depression
- inverted T-wave
- NOT : significant Q wave

Valvular Heart Disease

Aortic stenosis - perfusion of coronary arteries

Aortic insufficiency bounding Corrigan pulse
Mitral stenosis diastolic murmur loudest over the apex of the heart

Hypertension

Essential hypertension associated w/ early increase in cardiac load

Essential hypertension plasma rennin activity most likely to be lower than normal
Pulmonary hypertension loud, snapping 2nd heart sound
Malnutrition not an associated risk factor for HPN
Nephrosclerosis not an atherosclerotic complication of HPN
Chronically secretion of posterior pituitary gland least likely to cause sustained hypertension

Atherosclerosis

Role of inflammation in production of atherosclerosis possible examples of molecular mimicry

Hematologic
 Heparin prevents clotting by blocking conversion of prothrombin to thrombin
Bleeding time significantly longer in hemophilia
Hematocrit of 41% - means that 41% of the total blood volume is made up of red & white cells & platelets
In normal human blood the iron is mostly in hemoglobin
Lymphocytes are part of the bodys defense against cancer
Primarily a function of blood plasma
- transport of hormones
- maintenance of red cell size
- transpost of chylomicrons
- transport of antibodies
- NOT: transport of oxygen
Thalassemia the structure of hemoglobin produced are normal but their amount reduced
Angiotensin II coverting enzyme plasma protein NOT synthesized primarily by the liver
Hb dissociation curve shifts to the left does NOT occur as blood passes through the systemic capillaries
Umbilical artery normally has a low pO2
circulating lymphocytes least expected to see during prolonged space flight
Number of RBC in peripheral blood takes longest to return to normal after 1 L of blood removed from px
Bicarbonate - most common form of CO2 transport in the blood
Amount of Hb in the blood has the greatest effect on the ability of blood to transport oxygen
Arterial Na+ concentration variation does NOT affect respiration

Lymphatics

Lymphatic flow from the foot increased by massaging the foot

Respiratory

500 mL normal tidal volume at rest

Concentration gradient not a factor affecting the rate of gas exchange through respiratory membrane
IRV, TV, ERV, RV
IC, FRC
VC, TLC
Lung where Angiotensin II is produced
Atmosphereic pressure minus intra-alveolar pressure driving pressure w/c causes air to flow into the lungs
During inspiration intra-alveolar pressure transiently goes below atmospheric pressure
Respiratory bronchiole to the alveolar sac site of actual oxygen-carbon dioxide exchange
Surfactant lipoprotein mixture secreted by type II alveolar pneumocytes for facilitating lung expansion
Air expelled from the lungs when the intrapulmonic pressure rises above the atmospheric pressure
Similar distensibility common feature of pulmonary and systemic circulation
Hyperpnea resulting from moderate exercise may be due to joint movement
Hypoxic hypoxia breathing atmospheric air at high altitude
Walls of the airway it is where the receptors for the Hering-Breuer reflex are located
1.1 L approximate amount of gas left in the lungs after maximal forced expiration in a normal woman
Main respiratory control neurons send out regular bursts of impulses to inspiratory muscles during
quiet respiration
Spontaneous respiration ceases after transaction of the brain stem at caudal end of medulla
 Apnea expected when stimulating central (proximal) end of a cut vagus nerve
Intractable hiccups sometimes respond on injection of dopamine antagonists
Pulmonary fibrosis would be expected to produce cyanosis
anatomic dead space deleterious effect probably NOT be produced by chronic cigarette smoking
Acetazolamide drug most useful in treating high-altitude illness
Compensated metabolic acidosis plasma pH & plasma HCO3, normal PCO2

Vetilation-Perfusion

alveolar ventilation - the blood pH because it the PCO2 in the alveoli

Ventilation lower at the apex true of ventilation-perfusion properties of the lungs in an upright postion
Increase in ventilation/perfusion ratio can be seen with a decrease in tidal volume
Unchanged pO2 effect of pulmonary embolus in the arterial blood gases
CO2 retention - most likely to occur during ventilatory failure

Bronchial Asthma

Airway resistance - in asthma

Ratio of FEV1 / FVC < 75% - pulmonary function test most useful in diagnosis of bronchial asthma
Asthmatic attack
- earliest changes seen in ABG
- airway obstruction due to combination of edema secretions & bronchospasm
- decreased pulmonary compliance is the most important abnormality leading to ventilator failure
- NOT : abnormalities of ventilation-perfusion ratio are important causes of hypoxia
Childhood asthma
- often allergic to ASA (aspirin)
- significant hereditary component
- many children go on to outgrow it
- NOT : associated w/ parental smoking

Gastrointestinal

During swallowing LES relaxes due to adrenergic neurons

Smooth muscle of the GIT relaxation caused by adrenergic
Gastric secretion increased by stomach distention
Intrinsic factors excreted in the parietal cells of the stomach
Not correctly paired F cells : gastrin
Myenteric or Ganglion Cells of Auerbach local peristaltic reflex
Meissners plexus or Submucosal plexus GIT secretion & blood flow
Complete denervation of small intestine has little effect on the resting rate of intestinal peristalsis
Protein greater degree of digestion in the stomach
Ferrying main function of micelles in fat absorption
Enterostatin local hormone produced in the intestinal mucosa which activates prolipase to lipase
Short & medium FA chain absorbed by the stomach among digested food
Steatorrhea malabsorption of lipids
Encopresis water content in the proximal colon may percolate around the hard retained stool
Pathway for short-chain FA intestinal mucosal cell hepatic portal vein blood systemic venous blood
 Drugs & toxins that cAMP content of intestinal mucosa cause diarrhea because they Cl secretion into
the intestinal lumen
Hypoglycemia partly a cause of symptoms in Dumping syndrome
Dumping syndrome discomfort after meals in pxs w/ intestinal short circuits such as anastomosis of jejunum

to the stomach

Hepatic

Liver has the most permeable capillaries

Bile secretion stored in the gallbladder
After hepatectomy there is an expected rise in the blood level estrogen
Glucoronyl transferase deficiency (immaturity basis) in liver major patho-physiologic basis for
physiologic jaundice in NB

Pancreas

A cells glucagon
B cells insulin
D cells somatostatin
Glucose increases plasma insulin by a process that involves GLUT 2
Type I DM antibodies against B cells
Pancreatic exocrine cells - chymotrypsinogen
After IV administration of large dose of insulin return of low blood sugar level to normal is delayed in
combined adrenal medullary insufficiency & glucagon deficiency
No change or a rise in the plasma insulin level not produced by total pancreatectomy
Pancreatic juice has the highest pH compared to gastric juice, bile, saliva or secretions of intestinal glands
Total pancreatectomy will result to Vit. E deficiency, hyperglycemia, metabolic acidosis, absorption of AA
Total pancreatectomy will NOT result to weight gain
Effect of total pancreatectomy steatorrhea, plasma levels of free FA, plasma pCO2
Effect of total pancreatectomy - no change or rise In the plasma glucagon level

Insulin

Insulin increases absorption of glucose by increasing entry of cells in tissue

Insulin secretion of this hormone does not increase at night
Insulin does not the output of glucose from the liver
Insulin hepatic glycogenesis
Insulin protein synthesis
Insulin - entry of of glucose into skeletal muscle
GLP-1 (7-36) amide probably stimulates insulin secretion after a meal rich in carbohydrates

Glucagon

Glucagon not normally found in the adrenal glands

Glucagon normally found in the brain, pancreas, GIT, plasma
Glucagon increases glycogenolysis in the liver cells but ACTH does not because the membranes of liver cells
Contain receptors different from those in adrenocortical cells
 Activation of Gs in target cells mechanism by which glucagon produces an in the plasma glucose conc.
Glucagon secretion stimulated by the meal a meal rich in proteins containing amino acids that stimulate
insulin secretion but low in CHO does not cause hypoglycemia

Small Bowel

Small intestine major water-conserving area of the GIT

Large Bowel

Removal of entire colon in the blood level of ammnonia in pxs w/ cirrhosis of the liver
Colon site for maximum absorption of short-chain FA produced by bacteria
Gastrocolic reflex in infants, defecation often follows a meal, the cause of colonic contractions

Urinary

Normal GFR 20 % of cardiac output

Kidney has the greatest blood flow per 100 gram of tissue
Kidney most powerful of all buffer system; long-term control of blood pressure
Dehydration - the plasma concentration of vasopressin, angiotensin II, aldosterone & NE
Dehydration does NOT plasma concentration of atrial natriuretic peptide
5% glucose solution body water should be replaced in a px who has become dehydrated
Low level of type 2 11 B-hydroxysteroid dehydrogenase activity px loves licorice & eats some at least
3x a week
Clearance of filtered substance which is freely filtered is less than that of inulin there is net reabsorption
of the substance in the tubules
Urine flow during osmotic dieresis osmolality of urine approaches that of plasma because an increasingly
large fraction of excreted urine is isotonic proximal tubular fluid
Liddles syndrome a gain-of-function in the gene for epithelial Na+ channel is associated w/ Na+ retention &
Hypertension w/ normal or low plasma aldosterone level
Epithelial Na+ channel mutation in the gene of this protein is associated w/ Liddles syndrome

Proximal Convoluted Tubule

Proximal tubule site of active transport system that makes it possible for the kidneys to excrete
Proximal tubule area where greatest fraction of filtered water is absorbed in the presence of vasopressin
Proximal tubule site of glucose reabsorption

Loop of Henle

Loop of Henle site at which tubular fluid osmolality exceeds that of plasma by greatest amount

Distal Convoluted Tubule

Distal tubule site where furosemide acts

Cotical Collecting Duct

Cortical collecting tubule area where greatest fraction of filtered water absorbed in absence of ADH
Cortical collecting tubule site at which thiazide acts
 Cortical collecting duct site where aldosterone exerted its greatest effect
Cortical & medullary collecting ducts site where K+ is secreted

Renin

Renin powerful vasoconstrictor

Renin secreted by juxtaglomerular cells
plasma rennin activity least likely to contribute to beneficial effects of ACE inhibitors in tx of CHF
Administration of drug that blocks B-adrenergic receptors would NOT be expected to rennin secretion
Px on low sodium diet for 8 days when given an IV injection of captopril, a drug that inhibits ACE, one would
expect her BP to fall because her peripheral resistance would fall

Erythropoietin

Erythropoietin secreted by cells in the peritubular capillary bed

Erythropoietin acts on some but not all stem cells in bone marrow

Aldosterone

Aldosterone kaliuresis
Aldosterone mole for mole, has the greatest effect on Na excretion
Aldosterone increased by injection of ACTH
Aldosterone primarily involved in the regulation of extracellular fluid volume
Aldosterone in its action in cells, it increases transport of ENaCS from the cytoplasm to cell membrane
High plasma Na NOT a characteristic of primary hyperaldosteroidism
Aldosterones action on electrolyte excretion is noted in the sweat gland
Abnormal aldosterone synthase high circulating aldosterone but low circulating cortisol; glucocorticoid tx
lowers his circulating aldosterone & BP
Primary hyperaldosteroidism
- low plasma rennin activity
- normal plasma ACTH
- hypertension
- low plasma K

Vasopressin

Vasopressin mole for mole, has the greatest effect on plasma osmolality
Arginine vasopressin primarily involved in the regulation of extracellular fluid osmolality
Vasopressin hormone that exerts the least effect on growth
Vasopressin - movement of aquaporin-2 from cytoplasm to cell membrane of collecting duct cells
Vasopressin does NOT dilate arterioles in the skin
Vasopressin secretion - by pressure in the right atrium
ADH helps regulate blood pressure mainly through regulation of peripheral resistance
ADH most important factor in water conserving effect is in permeability of collecting ducts to water

Metabolic

Ionized form most important functional form of calcium

Overflow mechanism of phosphate metabolism if levels are > 1 mmol/L, renal phosphate excretion &
 absorption is in equilibrium
Radiation & conduction greatest amount of heat is lost from the body through this when an individual is
naked in a room in which the air temp. is 21 C & the humidity 80 %
Metabolism of 10 g of protein would produce approximately 41 kcal
A man w/ respiratory quotient (RQ) of 70 has been eating a high-fat diet
C:550 ; P:80; F:65 daily intake in grams of CHO, CHON and fat best for a healthy 80-kg male construction
worker
LDL major lipoprotein source of cholesterol used in cells
Metabolism of 1 mol of long chain FA produces the most high-energy phosphate compounds
1 mol of alanine produces most glucose when metabolized in the body
A drug that inhibits hormone sensitive lipase would not produce an increase in the plasma level of free FA
Uric acid primary & secondary gout
Produced only by large amounts of glucocorticoids inhibition of the inflammatory response
Gluconeogenesis cortisol
Not correctly paired FFA mobilization : dehydroepiandrosterone
Calcium absorption increased by 1.25-dihydroxycholecalciferol
When LDL enters cells by receptor-mediated endocytosis
- formation of cholesterol from mevalonic acid
- intracellular conc. of cholesteryl esters
- in transfer of cholesterol from the cell to HDL
- in the rate of synthesis of LDL receptors
- NOT: in the cholesterol in endosomes

Epinephrine & Norepinephrine

Epinephrine increased glycogenolysis in skeletal muscle

Epinephrine muscle glycogenolysis
Epinephrine has a direct chronotropic effect on the heart
Epinephrine causes in cardiac rate
Norepinephrine has the shortest plasma half-life
Catecholamines acts on -adrenergic receptors
Catecholamines - constrict coronary arteries by direct action on these blood vessels

Storage Disease

Tay-Sachs disease a lysosomal storage disease

Vitamins

Vitamin D increases absorption of calcium

Vitamin B1 Beriberi
Folic acid spina bifida

Reproductive

Testosterone secretion by testes under the control of sympathetic innervations

Testosterone favors but limit hair growth
Testosterone produced mainly by Leydig cells
 Anabolic effect of testosterone increase in protein synthesis
hCG maximum rate of secretion occurs during the 1st trimester
NOT correctly paired progesterone : plasma glucose level
Estrogen its secretion least affected by a in ECF volume
Androgen & FSH required in the full development & function of the seminiferous tubules
Puberty does not normally occur < 8 because hypothalamus fails to secrete GnRH in pulsatile fashion
Decidual cells found in the uterus
Relaxin NOT a steroid
fat in the buttocks NOT a male secondary sexual characteristic
ACTH in the fetus probably triggers the onset of labor

Sildenafil

Sildenafil inhibits phosphodiesterase found in the penis & retina

Siildenafil produces transient inability to distinguish between blue & green
Sildenafil causes transient difficulty w/ color perception because related isoforms of phosphodiesterase
are found in the retina & penis

Pregnancy

Benign physiologic changes during pregnancy

- heartburn
- hemorrhoids
- deep thigh pain
- NOT : epistaxis
Secreted by placenta
- human placental lactogen
- hCG
- oxytocin
- NOT : glucocorticoids

Clinical Conditions

Management of malignant hyperthermia

- cooling the patient w/ ice
- administration of muscle relaxants (spasmolytics)
- administration of KCL
- NOT : administration of diuretics
Fever production of endogenous pyrogens directly altering the hypothalamic temperature set-point
Myasthenia gravis symptoms may be transiently improved by neostigmine

Mediacations

Chlopromazine a tranquilizer
Prazosin not expected to increase sympathetic discharge or mimic the effects of increased sympathetic
discharge