What do Enkephalins do in the GI tract?

Stimulation smooth muscle contraction.

Recall that VIP causes smooth muscle relaxation. What is the tonicity of saliva? Hypotonic. What does misoprostol do? It is a prostaglandin analog that inhibits the prostaglandin receptors and thus inhibits gastric acid secretion from parietal cells. What does Ranitidine do? It is an H2 receptor antagonist. So it prevents histamine from binding and thus lower gastric acid secretion. What symptoms are associated with pyloric stenosis? More common in males. Usually presents in 2-3 weeks of age. Regurgitation Relentless projectile vomiting What do slow waves do to the GI tract?

Increase tension levels. Testosterone is

These can cause peak waves of contraction. How are testosterone and estrogen produced in females? produced by the theca cells in response to LH. From the theca cells it diffuses to the granulosa cells.

There FSH causes the granulosa cells which have aromatase to convert the testosterone to estradiol. What is Glipizide? Glipizide is an example of a sulfonylurea. Stimulates the closing of the inward rectifier K-ATP channel in beta-cells. So get insulin release. Note. Deoxyhemoglobin is a better buffer for protons than oxyhemoglobin. What does aspirin do to COX-1 and COX-2? Irreversibly binds to COX-1 and COX-2. Which clotting factors on dep. on vit. K? All of the clotting factors around and including factor X are vitamin K dependent. (Factor 2, which is prothrombin, VII, IX and X as well as proteins C and S). Who secretes tissue plasminogen activator and what does it do? Endothelial cells secrete tPA which causes conversion of plasminogen to plasmin which degrades fibrin clots. Note. Heparin increases PTT, Warfarin increases PT. What does heparin complex with? Anti-thrombin. It increases the activity of the enzyme many fold. Describe the indirect and the direct Coombs test. Direct - Collecting the fetal blood and detecting anti-Rh Ab on it. Indirect - Collecting maternal serum and detecting Anti-Rh Ab.

The terminology of direct and indirect is with reference to getting access to the patient, the fetus, who is at risk of hemolytic disease of the newborn. What is RhoGAM? This is Anti-Rh Ab. Give to mother prior to first birth and it will prevent autoimmunization by the mother. So this medication with destroy any Fetal Rh-positive RBC in the maternal blood. What do Protein C and cofactor protein S do? these are anti-coagulating factors. These induce cleavage of VIIIa and Va (these are the additionals). What is direct and indirect with respect to bilirubin? Direct is conjugated bilirubin. Indirect is unconjugated bilirubin. What is the hemoglobin sub unit setup of the adult forms, the fetal, and the embryonic forms? HbA1 = alpha and beta. HbA2 = alpha and delta. HbF = alpha and gamma. Hb Gower = zeta and epsilon Hb Portland = zeta and gamma. What is Hb Barts? Four gamma chains. This binds oxygen tightly an doesn't release well to tissues. What you see in fetal alpha thal. Hb Barts disease is Hydrops Fetalis.The compensatory mech to deal with Hb Barts causes edema. What is HbH? Heinz bodies. These are four beta chains. These precipitate out. What you see in adult alpha thal. When do you see signs for alpha and beta thal? birth. Alpha thal - second trimester in

Beta thal - 6 months after birth. What is Hb Lepore? Fusion of delta and beta genes. So get severe anemia. What is the pathology of Crigler-Najjar syndrome? No UDP glurconyl transferase. So will have increase in unconjugated bilirubin. This is a severe condition. What is the pathology of Gilbert syndrome? Decrease bilirubin glurcoronidation. So will have increase in unconjugated bilirubin. This is a mild condition.

Really Gilbert syndrome is just a mild version of Crigler-Najjar syndrome. What is the pathology of Dubin-Johnson syndrome? Defect in conjugated bilirubin transporter. So will have increase in conjugated bilirubin. Importantly, will have normal liver enzyme levels. What are gastrin secreting cells found? In the antrum of the stomach and also in the duodenum and the jejunum. So not just in the stomach! What is the pathology of Celiac disease? cells and flattened microvilli. Gluten IgA induced hyperplasia of crypt

So have decrease in absorption of nutrients due to these mucosal lesions. Describe all the functions of CCK. CCK is the ONLY hormone that will decrease gastric emptying. It causes the gallbladder to contract AND the sphincter of Oddi to relax. What is gastroparesis? Damage to vagus nerve so have erratic and delayed emptying of gastric contents. What is the result of giving secretin to a patient with Zollinger-Ellison syndrome? Will get an INCREASE in gastric. secretin inhibits antral gastric, but stimulates gastric secretion in patient with ZES. How are somatostatin cells signaled to release somatostatin? Acid acts directly on somatostatin cells. How can you have exudative diarrhea? Mucosal problems in GI tract. Note: Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as E. coli or other forms of food poisoning. What is GIP stimulated by? This is the only hormone to be stimulated by fats, carbs, and proteins. Normally what are the relative amounts of conjugated and unconjugated bilirubin in the body? Normally have more unconjugated bilirubin since only the liver can conjugate and doing so will not all be done in one pass. What gastrointestinal hormones are tropic to the gastric mucosa? CCK, gastrin, and somatostatin. What is the pathology of HbS? Have point mutation in beta-subunit in which have conversion of glutamine to valine. What is factor 4? Calcium. What is factor 1? Fibrinogen. What is factor 3? What does it do? Thromboplastin. This stimulates the extrinsic pathways! So this is the tissue factor.

What does H. Pylori convert in the intestines? Urea to ammonia. During this conversion also have the production of CO2. What does Omeprazole do? It is a PPI. In inhibits the H/K ATPase pump. Which part of the GI tract is obstructed in Hirchsprung disease? The distal colon. Note: this includes the sigmoid colon. What is the gastroileal reflex? Relation of the ileocecal sphincter. What are two names of GIP?Gastrin inhibiting peptide Glucose-dependent insulinotropic peptide. What are the symptoms of over secretion of VIP? Watery diarrhea, hypokalemia, achlorhydria (no production of gastric acid). What enzyme(s) can activate the zymogens of themselves? Trypsin and Pepsin. What three substances synergistically work together to increase acid secretion? Gastric, Ach, and Histamine. How is mannitol handled by the kidney? What can it be used for clinically? It is freely filtered by the kidney. It is used as an osmotic diuretic. So it is a treatment for excessive water intake. So will have less reabsorption and more fluid loss. What do thiazide diuretics do? Act to inhibit the Na/Cl co-transporter reabsorption in the early distal tubule. What is the only sensation that is sensed in the ureter? Pain. How is creatinine handled by the kidney? Have complete filtration and some secretion. What can the Na/H exchanger in the PT also exchange for with Na? NH4+ How much reabsorption occurs in the PT? How much in the descending limb? 2/3 in the PT 1/3 in the descending limb Where do you have free water reabsorption? Where is it dependent on ADH? Free reabsorption in the PT and descending limb. DCT and collecting duct is dependent on ADH. What is the equation to determine the amount filtered? The amount excreted by the kidney? Filtered: GFR x plasma concentration. Excreted: urine flow x urine concentration. What is the pathology of Liddle's syndrome? on the collecting duct in the principal cells. What is the pathology of Bartter syndrome? transporter in the thick ascending limb. Can ubiquinate the ENaC channels Defect in the Na/K/Cl/Cl

Will see increase in renin levels since will have low sodium since not reabsorbing.

Recall: this transporter is what furosemide works on. What is the pathology of Gitelman syndrome? Defect in the Na/Cl transporter in the DCT. Recall: this is what thiazide works on. What type of medicine transporter (doing secretion) do you have in the kidney? In the PT have an organic acid transporter. This transports out organic acids like Penicillin. What is the equation for filtration fraction? FF = GFR/Plasma flow. Where are the only locations where sodium and water are passively reabsorbed? (assume ADH is present). PT and DT. What happens to sodium levels with SIADH? Have hyponatremia since holding back so much water and diluting the sodium. What is the amount of sodium excreted per day equal to? The amount of sodium consumed in the diet each day. What is the relationship between the specific gravity of urine and amount of sodium? Inversely related. What is the tubular osmolarity in comparison to the plasma osmolarity at the collecting duct? Tubular osmolarity is 1/3 plasma osmolarity. What is the equation for fractional excretion? Excretion rate / filtered load. Where in the nephron is calcium reabsorbed? In the DCT. So if give a thiazide diuretic, will have enhancement of calcium reabsorption. The calcium is controlled by PTH. What rule do you use to remember TBW, ICF, and ECF volumes? for TBW-ICF-ECF. 60-40-20 rule

TBW is 60% of total body weight. How is PAH handled by the kidney? PAH is filtered and secreted. What is the equation for RPF? RBF x plasma Plasma = 1-hematocrit. How can NSAID affect GFR? NSAID will decrease prostaglandins. Prostaglandins usually decrease the amount of vasoconstriction during a sympathetic response. So if block prostaglandins with NSAID, will get more vasoconstriction and will get decrease in GFR. What is the equation for the filtration fraction of water? Urine flow rate / GFR. What happens to the amount of bicarb in the blood when in chronic renal failure? It goes down and you get metabolic acidosis. The reason is that normally put out H or NH4 and it gets make into CO2 which goes into the cell and get bicarb. In renal failure this doesn't happen and get acidosis.

What is the equation for physiological dead space? vD = vT x (PaCO2 - PeCO2 / PaCO2) What can you not measure via spirometry? Anything that contains the residual volume in it. This is since spirometry can identify changes in lung volumes, not absolute lung volumes. Thus: TLC, RV, and FRC. What ratio is used to determine fetal maturity? Lecithin: sphingomyelin

This is an indicator of lung maturity and surfactant production. Where in the lung is ventilation the greatest? The base of the lung. What are the characteristics of a obstructive lung condition? FVC reduced < 70% of predicted value FEV 1.0 / FVC < 75% (always) TLC normal or above normal FRC normal or above normal What are the characteristics of a restrictive lung condition? of predicted value FEV 1.0 / FVC >= 75% TLC reduced FRC reduced What happens to compliance when you decrease the surface tension? Compliance is increased. This is most significant in the small alveoli. What receptors control respiration? Peripheral chemoreceptors that identify a pressure of oxygen lower than 60 mmHg. Important to remember that it is not a central receptor. What does hyperventilation do to cerebral vascular resistance? increases it! How does oxygen therapy help with cyanide poisoning? It doesn't. cyanide poisoning causes a change in cytochrome oxidase so it can't utilize oxygen even at high concentrations. What do asbestos and silicosis do to the lung? Produce interstitial fibrosis. This decreases the compliance of the lung and thus then decreases the TLC, RV, VC and increases the diameter of the alveoli due to the fibrosis. FVC reduced < 70%

What does old age do to the pulmonary compliance? How about mitral obstruction? Old age increases compliance. Mitral obstruction decreases compliance. What are central chemoreceptors sensitive to? What about peripheral chemoreceptors? Central: sensitive to CO2 and H. (So PCOR indiretly) Peripheral: sensitive to PCO2. (So PCO2 directly) What is the equation for oxygen content of blood? Percent saturation x blood volume x oxygen capacity (essentially hematocrit) What does asthma do to pulmonary compliance? Like emphysema it causes it to increase. What control pulmonary blood flow? Local PO2 in the alveolar air. So hypoxia will cause vasoconstriction to shunt blood away form the low levels of O2 so the blood is not wasted. What is oxygen saturation and PO2 (the axis on the Oxy-Hb dissoc curve) independent of? Hb concentration! What is the equation to determine the PO2? PO2 = 0.21 x total pressure What is the equation for compliance? C = V/P What is the difference between FRC and ERV? FRC includes RV while ERV does not. How is resistance related to change in radius of vessel? Resistance = 1/radius^4 What is the normal lecithin:sphingomyelin ratio? What is the abnormal ratio? Normal ratio: >2.0 Abnormal: <1.5 What happens to CO, DPG, arterial PO2 and oxygen content in anemia? DO and DPG increase. Arterial PO2 doesn't change because Hb conc. is indepen. of arterial PO2. Oxygen content decreases because are anemic. What is the normal range for PAO2? For PACO2? PAO2: 75-105 mmHg PACO2: 33-45mmHg Where in the lung do you have greater alveolar ventilation? At the base of the lung. Describe the affect of CO on the Oxy-Hb curve. Will be to the left and below normal. What are the two equations for alveolar ventilation? VA = (VT-VD) x breaths/min VA = VCO2/PACO2. What are three examples of conditions that are obstructive? emphysema, and chronic bronchitis. Asthma,

What equation in pulmonary uses cardiac output? Top VO2 is total body oxygen consumption.

CO = VO2 / (AO2 - VO2)

Bottom VO2 is venous O2. What affect does breathing pure oxygen have on arterial oxygen tension? significant amount.

BUT if you have a shunt in the lungs the affect becomes minimal. What is the technical definition of physiologic dead space? Alveolar dead space + Anatomical dead space. So physiological dead space is always greater than either of them. This will help you save time on questions. What happens to hematocrit, Arterial PO2 and Hb sat at high altitude? Hematocrit increases. Arterial PO2 and Hb saturation both decrease. Describe the pathology of Duchenne muscular dystrophy. disease seen in 3-6 yo boys. Have elevated creatine phosphokinase levels. the dystrophin protein forms a link between the cytoskeleton and the extracellular matrix. What uniquely happens to smooth muscle for contraction? Phosphorylation of myosin light chains. How is the function of the T-tubules different in cardiac and skeletal muscle? In cardiac muscle the T-tubules activate DHP receptors which causes calcium release from the lumen of the t-tubule to enter and open up the sarcoplasmic reticulum. In skeletal muscle t-tubules activate the DHP receptors which causes release of calcium from the sarcoplasmic reticulum directly. So in cardiac muscle have calcium activated calcium release that do not have in skeltal muscle. What mRNA level increases an hour after exercise? What happens to myoglobin oxygen saturation an hour after exercise. VEGF (vascular endothelial growth factor). This increases capillary and endothelial growth in muscle. Myoglobin oxygen saturation is decreased. What allows smooth muscle to generate various degrees of tension with a standard amount of calcium? Myosin light chain phosphatase. So my removing phosphate groups it can decrease tension. What dictates the maximum velocity of shortening of muscle? ATPase activity. Sex-linked recessive

What is the optimal interdigitation in skeletal muscle? 2.0-2.3 micrometers. What factors will affect the load that a muscle can lift? Frequency of muscle contraction and muscle hypertrophy. What does an increased anion gap mean? Think about it. Anion gap = Na - (HCO3Cl) When have increase in acid, will have less HCO3 and a larger anion gap. Just remember this and you can answer all the questions of it. What is the tonicity of diarrhea? Isotonic! So will lose fluid from the extracellular compartment. What tracker do you use to measure ECF? Inulin. What is a good rule to remember for the HH equation? For every 10 greater product have a 1.0 pH. Since log (10) is 1 and are adding it to 6.1. What does lipoprotein lipase do? It is on the surface of endothelial cells and degrades triacylglycerides in chylomicrons and releases the FA. What is the amount of insensible loss of water daily? 800mL. What is the numerical count down you use to determine HR on an ECG strip? 300150-100-75-60-50 What is the time scale of the large bars on an ECG? 0.2 seconds. Where in the heart an parasym directly innervate? The SA and AV nodes and the atria. The have muscarinic receptors. It cannot innervate the ventricles. What type of receptors do smooth muscle arterioles have? Alpha 1. What type of receptors do skeletal muscle arterioles have? Beta 2. What is the equation for velocity? Velocity = flow / cross-sectional area. What are the three equations for MAP? MAP = CO x TPR MAP = Diastole + 1/3 Pulse Pressure (diff between systole and diastole) MAP = 2/3 diastole + 1/3 systole. What is the equation for flow? Q = Pressure / resistance. This is the same as... CO = MAP / TPR What does pulse pressure essentially equal? SV. What does pulmonary wedge pressure measure? LA pressure. What does the PR interval tell you? About the AV node. Also tells about its sym and parasym modulation. What is the isoelectric point on an ECG? The S-T segment.

What causes depolarization in cardiac muscle and in the nodes? muscle = sodium going in

Cardiac

Nodes = calcium going in. In the nodes the sodium is the funny current that makes the whole thing cyclical. Where in the heart is the conduction velocity the fastest and the slowest? Fastest in the Purkinje fibers and slowest in the AV node. In which segment of the cardiac AP is electric diastole? Segment 4. This is when the AP is flat. What type of receptors do you have on the heart? B1. What is a chronotropic effect versus a dromotropic effect? Chronotropic change in HR. Primarily at the SA node. Dromotropic - change in conduction velocity. Primarily at the AV node. To decrease this just increase calcium inward and potassium out. This will elongate the cardiac AP. What type of connection is at the intercalated disks in cardiac cells? Gap junctions. What is the equation for ejection fraction? SV/EDV (It is usually around 55%) How does digitalis work as a positive inotrope? It inhibits the Na/K pump with then inhibits indirectly the Na/Ca pump. This causes to have a relative higher concentration in the cell and increase/ prolong contraction. Another name for digitalis is Ouabain. What happens when you have decrease stretch in the carotid baroreceptors? This causes decreased firing of the carotid sinus nerve and get a sym response. So normally have a high firing rate. What are the two questions for cardiac output? CO = SV x HR CO = O2 consumption / O2 pul vein - O2 pul artery Pul vein measured at peripheral artery. Pul artery is mixed venous blood. Describe the four heart sounds. 1 - closing of the AV valves. 2 - Closing of the semi-lunar valves. 3 - Blood flowing form atria to ventricle. 4 - Atrial systole. What are the three variables in venous pule waves? Describe each. systole. A - atrial

C - ventricular systole. V - ventricular filling What events are occurring during ventricular ejection? Atria is filling and the Twave is starting! How do histamine and bradykinin produce edema? Arteriolar dilation and venous constriction. What does serotonin do cardiac wise? Increases arteriolar constriction and prevents blood flow. What are the three organs have have blood flow autoregulation? Brain, heart and kidney. How much sym innervation does the skin have? A lot. Which is the major modular or coronary and cerebral circulation flow? Local metabolites practically control everything. ANS plays a minor role. What is hCG structurally similar to? hCG is similar to LH. Can use hCG to cause ovulation. What factors are released from the placenta during the gestational weeks? Increase in hPL, Decrease in hCG, Increase in CRH to make cortisol, Increase in renin, Increase in TBG (thyroxine binding globulin). What hormones give the changes in male puberty? Testosterone, not DTH. What does steroidogenic acute regulatory protein do? It beings cholesterol into the mito for steroid biosyn. How does pulsatile GnRH behave? What about continuous GnRH? Pulsatile is an agonist. Continuous is an antagonist. In menopause what hormones are higher?FSH is higher than LH. What do low and high levels of estrogen do to LH? Low levels of estriol inhibit LH. High levels of estriol have a positive feedback affect on LH and cause ovulation. How is prolactin a contraceptive when breast feeding? What would a prolactin tumor do in males? Prolactin decreases the syn and release of GnRH. So it is a contraceptive when breast feeding. In males the prolactin tumor would get less LH and get infertility. Recall that LH binds to the Leydig cells and produces testosterone. What do progesterone and estrogen do to the endometrium? Progesterone gives proliferation.

Estrogen gives maturation. When do cortisol levels increase naturally? At night. What are the FSH and LH levels during pregnancy? They are low. What does estriol do to serum cholesterol levels? Decreases them. What will administration of an GnRH agonist do to the GnRH receptors? Down regulate the receptors! How do glucocorticoids affect bone formation? Glucocorticoids, like cortisol, inhibit bone formation. What molecular pathway does GH activate? JAK-STAT. How does PTH affect serum calcium and phosphate levels? Increase in calcium levels (via increase in calcium reabsorption) and a decrease in serum phosphate levels (via phosphate excretion). How is insulin a treatment for hyperkalemia? Insulin increases the activity of the Na/K pump. So if hyperkalemic will put potassium into the cell. How does HbF interact with 2,3-DPG? It doesn't bind to it due to the gamma subunits on HbF. So doesn't give up oxygen. What do angio II and prostaglandins do to the kidney? Angio II will constricts the efferent arteriole to increase GFR. This makes sense since aldo will want to reabsorb sodium and this can be done best with an increased GFR. This however, also decreases the RPF. So this works with the sym response of prostaglandins. Prostaglandins vasodilate the afferent arteriole, which also helps increase the GFR. Prostaglandins are released in sym response. What happens to the heart filling with inspiration? Get more blood going into the right heart and less in the left. So a holosystolic murmur will be better heard with inspiration when it is of tricuspid origin. What does normal exercise do to TPR? Serious exercise? Normal exercise: TPR increases. Serious exercise: TPR decreases. What is the equation for alveolar PO2? 150 - (1.25 PaCO2). This is arterial CO2. What is the equation for net acid excretion? (Urine titratable acid + urine NH4 urine HCO3) x (urine flow) How do hair cells depolarize? With potassium going INTO them. What is the normal value for pulmonary wedge pressure? Less than 12 mmHg. What happens to fine motor skills with hypoglycemia? Lose them. How do you move the equal pressure point closer to the mouth? By increasing the inspired volume. Alveolar-arterial gradient.

What is Ranitidine? An H2 blocker. What does parasym do to the AV node? Increase its refractory period. What does hyperglycemia do to urine flow? Increase it by acting as an osmotic diuretic. What is the equation for rejection fraction? SV/EDV What is 1dL equal to in mL? 100mL What is pulse paradocus? Seen in cardiac tamponade. In which have abnormally large decrease in systolic pressure with inspiration. Where is secretin produced? By the S-cells in the duodenum. What is wrong with the bleeding time in people with hemophillia? Nothing. They have no problem with their platelets, so normal bleeding time. But recall they will have a prolonged PTT. What does an AV shunt do to venous return? Increase it. Where do B12 and IF bind? In the duodenum. How do you determine the Tmax for glucose? Plasma glucose - glucose excreted. What happens to the rate of NH3 production in acidosis? It increases to can get rid of protons via the H/NH4 exchanger.