Exam 2 review.docx

Cardio Review Know the major components of blood and their basic function Hematocrit (RBC) – carries oxygen Hemoglobin – protein found in RBC, has Iron (Fe) that binds to O2 RBC – erythrocytes – produced in bone marrow, denucleated – cannot replicate or produce proteins Plasma (water, proteins, nutr...

Cardio Review Know the major components of blood and their basic function Hematocrit (RBC) – carries oxygen Hemoglobin – protein found in RBC, has Iron (Fe) that binds to O2 RBC – erythrocytes – produced in bone marrow, denucleated – cannot replicate or produce proteins Plasma (water, proteins, nutrients, hormones) - Buffy coat (WBC/platelets) – immune support WBC -Neutrophils (most common) – phagocytes – eats bacteria Eosinophils – attack eukaryote cells (worms) Basophils – alarm cells (histamine) Lymphocytes – T cells, B Cells “learning cells” attack viruses mostly Macrophage in tissue (monocytes) – big eater, lots of different things Globulins – antibodies Fibrinogen – clotting Albumin – protein, transporting, maintaining osmolarity (osmosis) of the blood Sickle cells – cresent shape due to abnormal hemoglobin. Doesn’t flow through the body well, typically gets stuck in the spleen during filtration of RBC. Can have low oxygen due to not able to hold onto oxygen Understand the role of arachidonic acid, cyclooxygenase, thrombin, fibrinogen and platelets in the response to vascular damage. Arachidonic acid – inflammation (gets blocked by SAID) Cyclooxygenase – inflammatory chemical (NSAID blocks this pathway) Type of arachidonic acid Fibrinogen – clotting Platelets – clotting Megakaryocyte membranes pinch off to form platelets. Response – 1. Vessel will spasm 2. Platelets will plug up the hole 3. Fibrinogen turns into fribin (net around the platelets) to form the clot. Intrinsic pathway – damaged within the tissue activates Extrinsic pathway – outside the vessel activates Bunch of proteins that effects Thrombin – takes fibrinogen and turns into fibrin Fibrin – fiber around the clot (forms the clot) Plasmin – will dissolve the clot – breaks down Fibrin Eicosanoids Arachidonic acids – inflammation pathways Know what SAIDs and NSAIDs target. SAIDS – steroidal anti-inflammatory drugs – blocks all the pathways More powerful, more side effects Ex: cortisol NSAIDS – non-steroidal anti-inflammatory drugs – blocks part of the pathways Less powerful, less side effects Ex: Ibuprofen, aspirin Know the major differences between veins and arteries. Veins – carries blood to the heart (low level oxygen) Arteries – carries blood from the heart (high level oxygen) Know the basic structure of the heart: Chambers, valves, major vessels, direction of blood flow, oxygenation. Atria – upper chamber (entry) – both squeeze at same time Ventricals – lower chamber (exit) – both squeeze at same time Vena Cava – superior/inferior – from body to Right Atria (de-oxygenated) Right AV Valve – Tricuspid Right Atria Semi-lunar valve (pulmonary) Pulmonary Artery (de-oxygenated) Pulmonary Vein (oxygenated) Left Atria L AV – Bicuspid / mitral valve L ventricle Semi-lunar valve (aortic) Aorta Coronary artery – lead around the heart to “feed” the heart Straited, involuntary, intercalated discs to allow electrical activity through muscle tissue Understand electrical conduction through the heart. Sinoatrial node (SA) (pacemaker) – generates action potential Contraction from top down (atria to ventricles) AV node singled to Purkinje fibers (bottom of heart) activates from bottom-up contraction. Know the major nodes and fibers. SA Nodes AV Nodes Purkinje fibers Know the major differences between normal action potentials and cardiac action potentials. Cardiac action potential Sodium influx (deplorization) Calcium influx at the peak to maintain depolarization. Longer action potential to prevent restimulation of the heart Potassium channels close Know what each wave in the ECG corresponds to. P = Signals SA node firing. Electrical activity across the atrium (contract atrium) QRS = electrical activity from purkinje fibers up (ventricles contracting) (atrium relaxing) T = repolarizing of the heart (ventricles relax) “Lub”- closing of AV valves – Ventricles are contracting – QRS wave “Dub”- Semilunar valves close – Ventricles are relaxed - T wave Know what systolic and diastolic pressure represents and how to calculate pulse pressure and MAP Diastolic – heart relaxing “dilating” Systolic – heart contracting “Squeezy” Understand the relationship between resistance, flow and pressure. Baroreceptor – measure pressure If there is an increase in pressure activate the parasympathetic Systolic = high pressure Changes most during exercise Diastolic = low pressure Better measurement of overall pressure Pulse pressure – difference between systolic and diastolic (ex: 120/80 = 40) MAP – Mean arterial pressure – average pressure of heart Closer to the diastolic due to heart being mostly relaxed Sound heard on BP is from the heart relaxing. Synthesize concepts to understand the overall cardiac cycle. Know CO, HR, SV, venous return, peripheral resistance, contractility, preload, afterload, EDV, ESV and CO = Cardiac output – how much the heart is pushing out HR = heart rate SV = stroke volume EDV = End diastolic volume – heart is most relaxed (T Wave) right after dub sound ESV = End systolic volume – heart is most contracted (QRS) right after lub sound SV = EDV – ESV CO = SV x HR understand how changing one of these will alter the others. Also know the equations CO = SV x HR, SV = EDV – ESV. Factors to consider = EDV filling time, how much blood is returning (venous return), contractility, vaso constriction (afterload) EDV increase = SV increase = CO increase (filling time/venous return) ESV decrease = SV increase = CO increase (Contractility) ESV increase = SV decrease = CO Decrease (Afterload) Parasympathetic is regulating the heart with decreasing Longer-slower depolarization Vagus nerve Sympathetic system – increase heart rate Sympathetic nerve Know the basic difference between the 3 layers of blood vessels. Tunica externa Tunica media Tunica intima Arteries More muscular (regulating pressure) Veins Low pressure Stretchy (high capacity) Understand the role of precapillary sphincters and what regulates local blood flow. Cappilaries Continuous Small or no holes for facilitated movement Fenestrated Larger holes for more transported items (larger) (kidneys) Sinusoid Largest gaps – cells get through (liver/spleen) 2 pressures Osmosis – higher pressure outside than inside Water wants to come in the bed Blood pressure – hydrostatic pressure High at arterial end Arterial causes Net going out As you go down vessels in the venous osmotic takes over Regulate Temperature, oxygen regulate sphincters by squeezing to prevent backflow. When oxygen is sufficient it closes When oxygen is needed it opens sphincters Local and global and hemoglobin. Flow = change in pressure over resistance Increase pressure at beginning = increase in flow More constricted vessel = increase resistance = decrease flow Basic understanding of lymph fluid, vessels and nodes. Capillary beds – where the exchange of materials occur Upper body, Hepatic vein, Renal vein Varicose veins – Veins are stretched Know the differences between lymph and blood vessels. Understand the role of prostaglandins, histamine, NO, ANP, angiotensin II, aldosterone, renin in blood pressure regulation. Understand how the cardio vascular system reacts to changes in pressure, oxygen / CO2 levels and pH. Understand the importance of coronary blood flow and what can occur if it is blocked. atherosclerosis Plaques from in the blood vessels Vessel becomes less flexible causing decrease blood flow Know stroke, MI, thrombosis, angina pectoris, heart failure. MI -Myocardial Infarction – causes loss of blood supply to cause death of muscle tissue in the heart Angina Pectoris – chest pain from partial obstruction of coronary blood flow Heart failure – heart is failing to pump out enough Causing enlarged heart (ventricle) due to extra workload Thrombosis – clot causing artery to occlude Understand how the cardiovascular system reacts to exercise. In fetal stage Ductus arteriosus/foramen ovale – duct in the heart to flow from pulmonary artery to aorta Murmur – issue with valves not closing properly causing backflow. Endocrine Review For each hormone know: Where it’s released from, it’s target, effect at target, regulation of release List of hormones to know: ADH – Antidiuretic (retain fluids) reabsorbs water Oxytocin – “feel good mood” increase contraction during labor along with lactation during breast feeding ACTH – regulates cortisol levels --- pituitary gland TSH – thyroid stimulating hormone – metabolism GH – Growth hormone Prolactin – milk production FSH – released by pituitary gland from hypothalamus Males – sperm production Females – development of eggs LH – released by pituitary gland from hypothalamus signal Males – testosterone - negative feedback to stop GnRH Females - progesterone ANP – atrial natriuretic hormone – lower blood pressure. Targets kidneys epinephrine/norepinephrine, - increase cardiac output cortisol, - Stress --- anti-inflammatory aldosterone – salt/water balance androgens – growth and reproduction EPO – kidneys, promote red blood cells production Renin – production of protein angiotension – increase blood pressure Leptin – regulate body weight “fat cells” Melatonin - sleep Calcitonin – controls level of calcium in blood gastrin, secretin, CCK – digestion and appetite insulin, -- decrease sugar level glucagon, --- increase sugar level beakdown glycogen to glucose in liver estrogen, progesterone, testosterone Pineal gland – melatonin – sleep – regulated by light Pituitary gland – Thyroid – hormone does cross the membrane (lipophilic) Thyroid hormone – metabolism Calcitonin – blood calcium high – calcium into the bone T3 and T4 – iodine Decrease iodine – TSH increase – keep trying to release – causing enlarged thyriod Parathyroid – release calcium from the bones from calcitonin Adrenal gland – Pancreas gland – Insulin – released when blood sugars are high – stores sugar (liver and muscles) – glycogen - Beta Glucagon – sugars are released when sugars are low from liver - Alpha Understand the basic difference between steroid hormone and peptide / amine hormone communication Steroid hormones – cross membranes to talk to inside of cells. Altering transcription of genes Amine – altered amino acid Peptide – small chains amino acid Protein – large chains of amino acid ***All these talk to cell service receptors – don’t cross the membrane*** Thyroid hormone can cross due to being lipophilic Testosterone and estrogen also can cross Know the differences between anterior and posterior pituitary structure and hormone release Both communicate with hypothalamus Anterior – hormones released in the blood travel to anterior pituitary where hormones are released. Released from – Luteinizing hormone (LH) - gonads - developing gametes and sperm FSH – gonads – release of hormones TSH – thyroid – Metabolism PRL – mammary glands – production of milk GH – muscles/bones – promotes growth ACTH – adreno cortex – increase release of cortisol (stimulate adreno cortex) Posterior – cellbodies found in hypothalamus – hormone release posterior. Released from neurons ADH – antidiuretic hormone – retain water due to dehydration – kidneys Osmolarity (saltier) Blood pressure goes down Oxytocin – contractions, milk release, “love hormone” Understand the difference between positive and negative feedback Negative feedback – tells the gland to stop due to having enough hormones Positive feedback – tells gland to keep producing more Know the layers of the adrenal cortex that each hormone is released from (aldosterone, cortisol and androgens) Adrenal Medulla – epinephrine – Reticularis – androgens – secondary sex characteristics – masculine (too much) / feminine (low) Fasciculata – glucocorticoids – cortisol Increase synthesis of new glucose from liver (proteins/fats) Anti-inflammatory Glomerulosa – kidneys – mineracorticoids (salt) – aldosterone Salt reabsorption Understand that steroid hormones and made from cholesterol. Also know that estrogen is made from testosterone Understand the role of these hormones in the listed diseases. Pituitary gland Hypersecretion of growth hormone (GH) Acromegaly – thickening bones and soft tissue Gigantism Hyposecretion of GH Pituitary dwarfism Thyroid Goiter – enlarged thyroid due to overstimulation due to high level TSH. Graves/Hashimoto – body mimics thyroid hormone (too high metabolism) Treatment – inactivate the thyriod Low iodine Parathyroid Hypoparathyroidism Low calcium – tetany – fatal Hyperparathyroidism Tumor – bones become soft, fragile, and deformed Calcium levels increase Adrenal Cushing syndrome – excess cortisol secretion Hypergycemia, hypertension, weakness, edema Rapid muscle and bone loss due to protein catabolism Abnormal fat deposition Moon face/buffalo hump Pancreas Diabetes Type 1 – juvenile – genetic – can’t produce Controlled by insulin pill/shot Type 2 – immune to insulin due to too much stimulation Damage from eating a lot of sugar Controlled by diet and exercise Renal Review Know the basic structure of the kidney and nephron Kidney: Ureter – tube leading to bladder Cortex – outer layer Medulla – inner layer Renal pyramids – the deeper in the medulla = increase urea. Osmosis water goes out (hypertonic) Nephron – Glomerular – collection of blood vessels covered by glomerular Blood empty contains here Filtration takes place Proximal convoluted – close to the beginning and all over the place Nephron loop (loop of henly) – Desending – permeable – water leaves Ascending – non-permeable – water cannot enter, reabsorb salt with energy. Distal convoluted tubules – Collecting duct – leads to pyramids and empties into the kidney bladder Final part of nephron Know the basic structure of the glomerulus (Bowman’s capsule) Podocytes – make slits where fluid is pushed through by pressure (filtration) Glomeruler filtration rate Understand the difference between filtration, secretion and reabsorption Filtration – fluid passes through a filter Based on size Mainly through pressure Body to the nephron Mainly due to blood pressure. Increase BP, Increase filtration Reabsorption – something we want to keep and bring back into the body Nephron to the body Secretion – same direction as filtration, certain molecules we get rid of Directed/specific Body to the nephron Understand the factors which regulate GFR Understand how clearance is used to measure kidney function How fast glomerual is filtering Typically the blood pressure affects this Measured by compound that gets filtered (not reabsorbed or secreted) Inuline (plant protein) Measuring amount of creatine in urine (it is an estimate of GFR) Understand where and how these major molecules are filtered, secreted and/or reabsorbed: Glucose, amino acids, Na+, K+, Ca++, H+ / HCO3- Proximal Convoluted Tubules – Reabsorbed – all sugars (glucose) and amino acids, mineral, vitamins, water Secretion – H+ (acid) Descending limb, loop of henly Reabsorbed – water Ascending limb – loop of henly Reabsorbed – NA+ Distal convoluted tubules – Reabsorbed – NA+ (requires aldosterone), HCO3 Secretion – H+(acid), K+ Collecting duct – Reabsorbed – Water (requires ADH) Understand the role of the medullary gradient in reabsorption of salt and water. Slide 9 Know the role of urea in maintaining that gradient. Urea sets up concentration gradient in medulla to help push out water and in salt? Understand the mechanism of action of ADH, aldosterone, angiotensin II, and renin Renin – BP is low, renin is secreted. Causes release of angiotensin Angiotensin II – active form “vessel tension” – increase BP, causes release of aldosterone Aldosterone – reabsorb salt, release ADH ADH – reabsorb more water Renin Angiotension II aldosterone ADH Understand how pH is regulated by the kidney Ions and bicarbinate levels – change equals long term problem Be able to diagnose the general cause of acidosis and alkalosis based on CO2 and HCO3- levels Vomiting – pH goes up (basic) / decrease secretion/decrease breathing (CO2 increase) Hyperventilation – pH goes up (basic) / CO2 goes down Diarrhea – pH goes down (acidic) / increase breathing (CO2 down) Asthma - pH goes down (acidic) / CO2 increase pH / CO2 same direction – metalbolic issue pH / Co2 opposite – breathing issue Digestive and Hepatic Review Know the major structures and organs in the digestive system and their major functions Mouth – break down food, saliva with enzymes to break down food Esophagus – muscular tube Stomach – food exposed to acid 3 layers of muscles Inner oblique smooth muscle Circular layer Longitudinal layer Mixture of food and acid – chine Lower esophageal sphincter or cardiac sphincter (between esophagus and stomach) Pyloric sphincter – regulating food leaving the stomach Gastric pits – Parietal cell – responsible for releasing HCl (hydrochloric acid) Chief cell – responsible for the main enzyme (pepsin) Pepsinogen gets release, when in contact with acid becomes pepsin Intestines -small – most absortion occurs Nucleic acid from DNA from food, water, fats, carbs, minerals - large(colon) – package for excretion. Does absorb little, water, vitamins and minerals - Cecum – processing of fibrous materials. -vermiform appendix – mostly non- functional. Let vegetation ruminate to break material down further. Pancreas – helps with digestion. release the following amylase (breaks down carbs) , protease (breaks down protein), lipases (breaks down lipids), bicarbonate (base to neutralize acids) Liver – helps with digestion – makes bile Gallbladders – helps with digestion – storage bin for the liver. Release bile Bile – emulsifier – breaks down fat to mix with water. Made from cholesterol Know the main components of the major layers of the upper digestive tract Smooth muscle squeezing down Contractions Peristalsis – “squeeze and pull down” Know the basic role of CCK, PYY, leptin and ghrelin in controlling appetite / hunger Understand where and how the major nutrients are digested and absorbed: Carbs, Proteins, Fats, Water, vitamins and minerals Carbs –Moutch – Amylase – breaks down into smaller sugars. Gets broken down into monosaccharides before absorption. All monosaccharides get turn into glucose in the liver. Proteins – Stomach – acid and pepsin , pepsin breaks into smaller peptides then into amino acids Fats – Small intestine – emulsion into micelles chylomicrons (triglycerides) inside golgi apparatus the lymphatic system to the body then to the liver to repackaged into HDL/LDL. Know the major sphincters of the digestive system, how they are regulated and their function Understand the activation and role of CCK, secretin, GIP and gastrin CCK – Activate liver and pancrease / deactivate the stomach Secretin – activate liver and pancreas / deactivate the stomach Gastrin – activates stomach to increase contractions and secretions (HCL and pepsin) Know the function of chief, parietal and mucous cells secretions (HCl, pepsinogen / pepsin, mucous) Know the major functions of the liver Understand the basics of hemoglobin breakdown and bilirubin / urobilinogen formation Know these enzymes and components: amylase, trypsin, peptidase, lipase, micelles, chylomicrons, LDL, HDL Chylomicrons liver lipoproteins (LDL/HDL) LDL – low density lipoprotein – mostly fat – fat/cholesterol going out to the body – negative effects (bad) HDL – high density lipoprotein – mostly protein – grab fat/cholesterol to bring back to liver to destroyed (good) Cephalic phase – see/smell food to start activating the stomach Gastric phase – release of gastrin from the stomach to further increase muscular contractions of stomach Intestinal phase – feedback and shut down the stomach to prevent stomach from emptying. Fiber forces body to absorb bile, causing the body to use more cholesterol to decrease cholesterol in the body. Ketone body build up if a person is starving or low carb diet. Due to low protein and fats. Leptine – sensation of feeling full Ghrelin – feel hungry sending single to NPY Minerals – non living (atoms) – regulate enzymes Calcium – bone health, neuro transmission, muscle contraction Chlorid – stomach acid Potassium, Sodium – electrolytes Florid – teeth Iodine – thyroid Iron – red blood cells Vitamens – living organisms – complex – regulate enzymes Water soluble – need to take regularly Vit B – energy step for citric acid cycle, B12 and folic acid (b9) for development Vit C – antioxidant, connective tissue. Deficiency – Scurvy Fat soluble – can build up Vit A – vision Vit D – calcium absorption, bone health Vit E – antioxidants Vit K - clotting Reproduction Review Know the major structure of the male and female reproductive system and their basic functions: testis, epididymis, vas deferens, prostate, seminal vesicles, bulbourethral glad, urethra, penis, ovaries, fallopian tubes, uterus, vagina, labia, clitoris Testis – sperm production Scrotum – sack that holds testis (regulate temperature) Epididymis – sperm matures and stores Vas deferens – carries sperm Prostate gland – produces most of semen. Seminal vesicles – produces semen. Bulbourethral gland – pre-ejaculate – clear – lubrication – clear urethra Should have no sperm Urethra – carries urine Penis – Corpus spongiosum – urethra goes through Corpus cavernosum – fills with blood (bag of blood) Sperm – FSH – stimulate production of sperm LH – stimulate testosterone Negative feedback on GnRH by testosterone to shut down LH/FSH Uterus – Baby developes Endometrium – vascular layer – egg implants. Myometrium – muscle contraction Cervix – entrance to uterus Vagina – muscular tube to uterus Labia – erectile tissue Bartholins Glands around here for lubrication Clitoris – primary erectile tissue (female penis) Ovaries – eggs are made Fallopian tube – tube to send to uterus Eggs – meiosis is started before birth – continues at puberty – finished when met with sperm Know what occurs in each of the phases of the menstrual cycle, including the hormones involved, the endometrial changes and what occurs in the ovaries Menstrual cycle – typical is 28 days. Day 0 is first day of bleeding Day 14 – ovulation (fertile few days before) Follicular phase – egg release from follicle is ovulation (usually around day 14) Luteal phase – follicle sticks around. Corpus luteum – Corpus albicans – Degrading corpus – progesterone stops due to this phase. Hormones – FSH – stimulates the follicle LH - talks to corpus luteum to release estrogen and progesterone Progesterone causes endometrium to become thick. Estrogen – positive feedback Estrogen/progesterone – inhibit LH/FSH (negative feedback) All these spike before ovulation Know the basic events of fertilization, initial development and implantation -gametes are made through meiosis – chromosomes are split in half. (23 chromosomes) Understand the role of LH and FSH in sperm formation and testosterone release Immune Review Know the major different WBC and their basic functions Basophil – release histamine Neutrophil – kills bacteria Eosinophil – kills eukaryotic Macrophage – “big eater” “cops on patrol” present in all sites, but very little. Needs helps (recruits) Natural killer cells – notice own cells when they are damaged, cells that are odd (fighting cancers) T Cells – learned response – developed in the thymus B Cells – learned response – developed in bone marrow Know the basic differences between the innate and adaptive immune response Innate – kill unwanted cells as a group, non-specific, not learning anything. Adaptive immune response – learning response, specific to foreign invaders macrophage eat a foreign body show image to outside areas using MHC proteins activate specific immune response (T-Cells) Understand the role of the compliment system Series of proteins that help in destruction of foreign invaders Activation can leads to inflammation, can form membrane attack complexes (make holes in cells)---target bacterial cells. Can be activated directly by foreign invaders and antibodies Know how the immune system reacts after injury Cut foreign invaders enter basophil cells release histamine (vessel dilation and permeability) white blood cells stick to surface go through blood vessel eating up foreign invaders Understand the roles of macrophages, helper T cells, cytotoxic T cells, B cells memory cells and antibodie T Cells – made in born marrow – matured in the thymus T Helper Cells (CD4 Cells) – activated when bind to MHC II – Release chemicals to activate other cells B cells and cytotoxic T cells Cytotoxic T cells (CD8 cells) – look for cells that are infected to Helper cells make copies of itself for future defense. 4’s binds to MCH II, 8 binds to MCH I B Cells – produce the antibodies Plasma cells – pumping out antibodies Memory cells – for future infections Causes agglutination (sticking) IgM – ABO blood typing (pentagon shape) – immunity at birth, does not cross placenta IgG – Can cross placenta. Attacks RH (+/-) antibodies. Not immune at birth. IgA – secreted antibody (saliva/tears/nasal) IgE – basophil cells – Histamine (allergic responses) Antibodies – bind to antigens Antigens – flag sticking out of MCH II Passive – antibodies are given (through treatments) – the body does not produce the antibodies themselves. Active – body learns about something and takes care of it. (naturally or artificially)