CR EOYS3

Question 1

how do calcium channel blockers work?

what are the two major types? & mech of action for each

Answer 1

• block Ca entry to vascualr smooth muscle and myocardial cells: interrupt excitation-contraction coupling

types:

• *1. dihydropyridine CCBs**: vasodilate dominately. reduced systemic vascular resistance
• *2. non dihydropyridine CCBs:** reduce HR, contractility, conduction. may worsen heart failure tho

Question 2

what is the green?

Answer 2

costodiaphragmatic recess :)

Question 3

what is the nerve supply to the

i) diaphragmatic pleura? [2]
ii) mediastinal pleura? [1]

Answer 3

i) diaphragmatic pleura: intercostal and phrenic nerves
ii) mediastinal pleura: phrenic nerve

Question 4

what is the nerve supply to the

i) diaphragmatic pleura? [2]
ii) mediastinal pleura? [1]

Answer 4

i) diaphragmatic pleura: intercostal and phrenic nerves
ii) mediastinal pleura: phrenic nerve

Question 5

what are major classes of antihypertensive agents? (5)

Answer 5

1. angiotension converting enzyme inhibitors (ACE inhbitors): block conversion of angiotension I to II

2. angiotension II receptor blockers

3. dihydropyridine calcium channel blockers:

4. thiazide diuretics: inhibit Na-Cl contransporter in DCT = natriuresis

5. loop diuretics: Inhibit Na-K-Cl cotransporter in loop of Henle = natriuresis

Question 6

what is effect of nitroglycerin (and glyceryl trinitrate) in low doses and high doses?

Answer 6

low dose:

• *- decreases preload
• decrease myocardial o2 demand**

high dose:

• *- decreases afterload
• decreaese myocardial o2 demand**

Question 7

Q

what is MOA for beta blockers for treating angina?

Answer 7

Beta Blockers

• *- B1 receptor antagonist:**
• causes reduced HR (@ SA node)
• decrease in o2 demand at SA node
• negative inotropic effect
• decrease BP
• decreased myocardial oxygen demand

Question 8

where is sensor for the hormonal control of BP?

Answer 8

JG cells

Question 9

what is angina and how do u treat?

Answer 9

angina - restricted blood supply to heart

Question 10

what is liddle syndrome / disease?

Answer 10

• enac channels undergo ubiquitination
• this causes inappropriately elevated sodium reabsorption in the distal nephron
• this makes have too much water retention and hypertension

Question 11

how can sympathetic action of JGA cause a positive feedback of reninn release?

Answer 11

This raises the possibility of positive feedback; sympathetic stimulation increases renin release, angiotensin then increases noradrenaline release which in turn increases renin release leading to hypertension

Question 12

which gland in olfactory cavity produces mucous? [1]

Answer 12

Bowmans glands

Question 13

what does activation of AT1 receptors cause to occur? [3]

Answer 13

AT1:

i) GCPR which increases Ca entry into smooth muscle & constriction to occur
ii) stimualtes noradrenaline release from sympathetic nerve terminlas (can increase BP via SNS too)
iii) found in cells of adrenal cortex: secretes aldosterone

Question 14

what is bradykinin & how do ACE inhibitors interact with them?

Answer 14

• bradykinin: 9 amino acid peptire
• ACE inhibitors: increase bradykinin levels by inhibiting its degradation
• causes a dry cough in patients who take ACE inhibitors (why people often stop taking them)
• can cause angioedema - occurs 5x higher in African descent: which is why ACE inhibitors are not the first line of drugs for treating hypertension

Question 15

why does changing resp. rate impact the excretion of co2 but not o2? [1]

Answer 15

pressure gradient for co2 is much less than for 02 (6 mmHg vs 60 mmHg) changing resp. rate can alter excretion of CO2 without significantly affecting uptake of O

Question 16

Q

what are the nasopharynx, oropharynx and laryngopharynx innervated by? [3] (theyre different)

Answer 16

nasopharynx: CN V2
oropharynx: CN IX
laryngopharynx: CN X

Question 17

at which structure does ithe internal laryngeal nerve and superior laryngeal artery enter larnyx?

Answer 17

Internal laryngeal nerve and superior laryngeal artery come through thyrohyoid membrane.

Question 18

Answer 18

Question 19

how many cartilages are there in the larynx?

which are the paired
which are the unpaired?

Answer 19

9 cartilages

three unpaired cartilages: epiglottis, thyroid and cricoid cartilage

three paired cartilages: arytenoid, corniculate and cuneiform

Question 20

what are J receptors?
where found?
stimulated by?
causes?

Answer 20

J receptors:

• location: alveolar walls
• stimulated by: enlargement of pulmonary capillaries / pulm. oedema
• causes: brachycardia, hypotension

Question 21

draw a graph of ventilation / perfusion of lungs

Answer 21

Question 22

Q

what is ventilation AND blood flow (perfusion) like in base v apex?

which (ventilation or blood flow) shows a steeper decline with height of lung?

Answer 22

• blood flow and ventilation are higher at the base of the lungs c.f apex
• blood flow (Q on graph) shows a steeper decline with height than ventilation

At the base, blood flow is greater than ventilation yet at the apex, blood flow is worse than ventilation

Question 23

what does hypoxia cause to occur to local blood vessels in alveoli?

Answer 23

hypoxia: causes vasoconstriction of the local blood vessels

If ventilation is reduced in one alveolus, then the capillaries around it constrict, and blood is redirected to better ventilated alveoli.

Question 24

what is the V/Q (ventilation: perfusion ratio) like at the

a) base of the lung
b) apex of the lung?

Answer 24

what is the V/Q (ventilation: perfusion ratio) like at the

a) base of the lung: less than 1 - around 0.6
b) apex of the lung: more than 1

Question 25

what is the difference to pulmonary arterial presure and pulmonary arterial resistnace when exercise is undertaken? [2]

Answer 25

- **pulmonary arterial pressure:** **increases** only **slightly** during exercise. - **pulmonary arterial resistance:** **greatly** **decreasing** during exercise (by dilating)

Question 26

define inspirtary and expiratory reserve volume

Answer 26

Inspiratory reserve volume is the volume of air you can draw into your lungs Expiratory reserve volume is the volume of air you can expel from your lungs

Question 27

how do you calculate alveolar ventilation? [1] whats the unit?[1] work out alveolar ventilation from information below Tidal volume is 500ml, and anatomic dead space is 150ml. If fresh air entering the lungs is therefore 350 ml, and resp rate is 12 breaths per minute,

Answer 27

**alveolar ventilation _ml per min_ : (tidal volume - dead space) x resp rate (breaths per minute)** alveolar ventilation is 12 x 350 = 4200 ml per minute. This is the effective ventilation that brings abut the exchange of O2 and CO2.

Question 28

what is the equation to work out o2 or co2 exchange in lung? [1]

Answer 28

**o2 or co2 exhancge = volume of alveolar ventilation X (room co2 / o2 - alveoli co2/ o2 / 100)**

Question 29

calculate the o2 and co2 exchanges for the below values. assume alveolar ventilation is 4.2 l/min Room o2 = 21% alveolar o2 = 14% Room Co2 = 0.04% alveolar Co2 = 5.5%

Answer 29

Co2 output = **4.2 X (5.5 - 0.04 / 100) = 0.231 L/min** O2 input: **4.2 X (21 - 14 / 100) = 0.294 L/min**

Question 30

what is intrapleural pressure a balance of? [2] what is intrapleural pressure normally? [1]

Answer 30

- the chest wall and lungs are locked together by the intrapleural fluid in the intrapleural space - at the end of exipration get opposing forces: * *a) lungs: elasticity is causing them to collapse b) chest wall: elasticity is causing to spring outwards** - generates a pressure = PPl intrapleural pressure usually negative with respect to the atmosphere and the air pressure in the alveoli

Question 31

how do you calculate compliance in respiratory physiology?

Answer 31

compliance = change in volume / change in pressure

Question 32

which two factors cause an increase in resp workload? [2]

Answer 32

compliance airway resistance

Question 33

what do u add to blood sample to measure hematocrit? [1] what method is used to display blood cells? (which stain?) [1]

Answer 33

what do u add to blood sample to measure hematocrit? [1] **anticoagulant, e.g. heparin** what method is used to display blood cells? (which stain?) [1] **wrights stain**

Question 34

name 3 types of cells that monocytes can differentiate into [3]

Answer 34

monocytes: - differentiate into **_macrophages_** & phagocytose stuff, **Kupffer** cells, **Langerhan** cells, **alveolar** **marcophages**

Question 35

label these parts of thymus histology :)

Answer 35

Question 36

label this bit of spleen :)

Answer 36

Question 37

label this bit of spleen :)

Answer 37

Question 38

what are the two branches found in palmar arches? where do they come from?^

Answer 38

superficial & deep palmar arches - Branches of both radial and ulnar arteries i) **Superficial** arch mainly from **ulnar artery.** ii) **Deep** arch mainly from **radial artery.**

Question 39

what is allen test? how do you perform?

Answer 39

allen test: assess hand vascularisation and impaired blood flo - compress both ulnar and radial arteries supplying wrist, then make a fist. - open hand, should look pale / white (keep compression). - Pressure released of either radial or ulnar arteries individually - capillary refill of **entire hand indicates patent artery and palmar arches**

Question 40

Answer 40

Question 41

Answer 41

Question 42

Answer 42

Question 43

at what point does external iliac artery --\> femoral artery? [1]

Answer 43

as soon it passes under the **inguinal ligament**

Question 44

where is the location you palpate for the femoral pulse? [1]

Answer 44

below inguinal ligament and mid-ingual point. This is half way between **pubic symphysis and anterior superior iliac spine**

Question 45

Answer 45

Question 46

describe the arterial supply to the nasal cavities [3]

Answer 46

Arterial supply to the nasal cavities: - from both the external and internal carotid arteries: i) branches from the external carotid artery via the **maxillary and facial arteries** ii) branches from the internal carotid artery via the **ophthalmic artery** venous drainage: i) branches to the maxillary and facial veins then drains to external jugular vein ii) branches to the opthalmic vein into the cavernous sinus

Question 47

Answer 47

Question 48

label A-C

Answer 48

A: **omohyoid** B: **SCM** C: **sternohyoid**

Question 49

Answer 49

**_Vestibular Folds –_** Mucous membranes encasing vestibular ligaments. Protective function. **_Rima Vestibuli –_** Space between vestibular ligaments **_Vocal Folds (Vocal Cords) –_** Mucous membranes encasing vocal ligaments _**Rima Glottidis** -_ Space between vocal ligaments **_Glottis –_ Vocal apparatus of larynx including vocal folds, ligaments and Rima Glottidis**

Question 50

which is the main cartilage that move for phonation? [1] which intrinisc muscle is not involved in movement of cartialge to produce phonation? [1]

Answer 50

The main cartilages that move for phonation are the **arytenoid cartilages** All of the intrinsic muscles, other than the **cricothyroid**, are involved in movement of cartilage to produce phonation.

Question 51

Answer 51