Final Quiz: Hematology, Immune System, Nutrition, GI, Renal

What are the two main components of blood?

Formed elements and plasma

What are some examples of formed elements?

RBC, WBC, platelets

What is the relative concentration of formed vs plasma?

45% formed, 55% plasma

What is hematocrit and who has more?

% of red blood cells, men have more (45 vs 40)

What is anemia?

Low amount of quality RBCs

What type of WBC is not found in blood?

Macrophages

Platelets used for and produced by what?

Clotting, produced by Megakaryocytes

Hemoglobin binds how many oxygen molecules?

4

What hormone is secreted from the kidneys to stimulate RBC proliferation in marrow?

Erythropoietin

Transportation of O2 is primarily (98.5%) by what?

Hemoglobin binding

Transportation of CO2 by what three factors?

As bicarbonate (60%), hemoglobin (30%), dissolved in blood (10%)

What is partial pressure?

The % contribution to pressure that a particular gas brings

Why is oxygen brought in and carbon dioxide expelled?

Pressure gradients (moves high to low)

What is the equilibrium constant?

Ratio of products to reactants at equilibrium (A+B—AB)

What is oxygen hemoglobin dissociation curve?

• What do the shifts indicate?

As partial pressure of O2 increases, so does the saturation of hemoglobin

• Right means less binding of O2 to hemoglobin at a given pressure, Left means more

How does oxygen hemoglobin dissociation curve shift for the given conditions?

• Increased Temp

• Decreased pH

• Increased CO2

• Shift right

• Shift right

• Shift right

Why would there be a plateau in the curve from 60 to 100 mmHg?

Why is there a steep beginning?

Safety net

Oxygen starved tissues can retain O2 at low partial pressures

Hemoglobin without bound O2 has a higher affinity for what?

CO2

Blood resists changes in pH, so it is known as a what?

Buffer

CO2 transported as bicarbonate via a reaction that is initiated by what molecule?

Carbonic anhydrase

What are the two primary organs of the immune system and what do they do?

Bone marrow produces WBCs, Thymus is site of WBC maturation

WBC travel through what system? What is a primary site of filtration?

Lymphatic system, the nodes

What are the types of immunity?

1. Innate (at birth, non-specific)

2. Acquired/Adaptive (not inherited, specific)

What are the categories of innate contributors?

1. Surface barriers (skin, mucus, body fluids)

2. non-cellular components 

3. cellular components

What is a non-cellular component?

Functions to enhance WBC, Ex- platelets

What is a cellular component?

• All are non-lymphocytes except what?

WBCs

• NK cells

What are dendritic cells?

Type of WBC that presents antigens to T and B cells to activate them, links innate and acquired immunity

Acquired/Adaptive immunity is primarily due to what cells?

B cells- humoral immunity (produce antibodies)

T cells- cellular immunity (direct attack)

Myeloid cells produce what?

Lymphoid cells produce what?

Granulocytes and Monocytes

B cells, T cells, NK cells

What is an antigen and antibody?

Antigen- foreign substance eliciting an immune response

Antibody- protein produced due to presence of antigen that will bind and counteract it

Both B and T cells are activated by what?

T cells

B cells from - -, bind the -. After that, - - cells signal for B cell proliferation, which differentiate into - and - cells

Bone marrow, antigen. Helper T, plasma and memory B

What do plasma and memory B cells do?

Plasma cells produce antibodies; memory B cells respond to repeated exposure by differentiating into more effective plasma cells

T cells have to go to - to -. Their main function is to recognize - - and - immune system. 

Thymus, mature. Antigen fragments, regulate

What are the four types of T cells?

1. Helper T- stimulate Cytotoxic T and B cell multiplication

2. Cytotoxic T- destroy cells via release of lymphotoxins

3. Suppressor T- inhibit cytotoxic T

4. Memory T- recognize pathogens after initial exposure

1st line of defense is --, 2nd is -, 3rd is - and - 

Bodily surfaces, Phagocytes (innate), Lymphocytes and Antibodies (learned)

Tell me about….

• Vaccines

• Allergies

• Pathogen introduced as an antigen for stronger future responses

• Body treats non-pathological antigens as threat

How do aging and exercise affect immune function?

Decreased bone marrow and thymus shrinkage with age, moderate exercise is beneficial for immunosurveillance (acutely) and mitigates effect of aging (chronic)

The common bile duct and pancreatic duct fuse together to form the - - - at the -

Ampulla of vater, duodenum

Anything that enters the bloodstream from the digestive system must first be processed where?

The Liver

What are the 5 layers of the intestinal tube and what do they do/contain? (list deep to superficial)

1. Mucosa- epithelium

2. Submucosa- glands, BV, nerves

3. Circular Smooth Muscle- contraction

4. Longitudinal Smooth Muscle- contraction

5. Serosa- connective tissue, BV

Name the two Plexi of the ENS, their function, and where they are situated

Myenteric Plexus: controls GI movement, between muscular layers

Submucosal Plexus: controls GI secretion and local bloodflow, in submucosal layer

In general, the - division of the ANS is excitatory (muscle contraction, gland secretion) and the - is inhibitory to GI processes

Parasympathetic, sympathetic

- is normally contracted, - is partially contracted, - is phasically contracted, and - is normally relaxed 

Sphincters, Blood vessels/airways, Stomach/Intestines, Esophagus/Bladder

GI smooth muscle contractions are usually described as “Syncytium”, what does that mean?

Widespread activation in all directions and simultaneous contraction if one nerve cells is stimulated past threshold

What cells create the “slow wave potential”?

• What stimuli enhances them to reach threshold?

Interstitial cells of Cajal

• Stretch, Acetylcholine

What are the two types of GI motility?

Peristalsis (moving) and Segmentation (mixing)

What are the three main macronutrients and what can they be broken down into?

Proteins (AA), Fats (FA), Carbohydrates (monosaccharides)

List what is digested and how for the mouth, stomach, small intestine, and large intestine!

M: Mechanical and chemical, Carbs+Fat

S: Mechanical and chemical, Carbs+Fat+Protein 

SI: Chemical, Carbs+Fat+Protein 

LI: None

List what is absorbed and how much for the mouth, stomach, small intestine, and large intestine!

M: None

S: None

SI: Carbs, Protein, Fat, Water (90%)

LI: Water (10%)

What are the three stages of swallowing?

Oral, Pharyngeal, Esophageal

What structure covers the larynx in swallowing?

What structure rises to cover the nose?

Epiglottis

Pharynx

Stomach emptying is triggered by - and -, inhibited by -

Stretch and Hormones (Ghrelin, Motilin), Cholecystokinin (CCK)

Stomach secretions occur in “- -”. What are the four cells in there?

“Gastric Pits”

1. Mucous Neck Cells- mucus

2. Parietal Cells- HCl, intrinsic factor

3. Chief Cells- pepsinogen, gastric lipase

4. G cells- gastrin

CCK in the small intestine inhibits - -, and stimulates release at the - and - (into duodenum)

Gastric emptying, pancreas and gallbladder

The enterocytes of the small intestine contain - and - (covered in -) for absorption, which increase - -. 

• The former has what three things on it?

• Sugar and Amino Acids absorbed into -, Fats into -

Villi and Microvilli (enzymes), Surface Area

• Blood vessels, smooth muscle, lacteals

• Capillaries, Lacteals

SI transit time is roughly - hrs and LI is - hrs

3-5, 3-10

Are the sphincters of the LI voluntary or involuntary?

Internal is involuntary, External is voluntary

Carbohydrates

• Function

• Types

• % intake

• Examples

• Energy for brain and body

• Simple (quick energy) and Complex

• 40-60%

• Bread, pasta, fruit, starchy veggies, dairy, candy, energy drinks

Protein

• Function

• % intake

• Examples

• Builds antibodies, enzymes, hormones

• 10-15%

• Eggs, meat, dairy, nuts, beans

Fat

• Function

• Types

• % intake

• Examples

• Organ protection, temp reg, hormone production + reg, vitamin absorption

• Saturated and unsaturated

• 20-35%

• Butter, Cheese, Oil, Nuts, Seeds

What are the functions of vitamins?

Energy production and metabolism, immune function, blood clotting, growth and development

Which vitamins are fat soluble vs water soluble?

FS: ADEK

WS: BC

What are minerals important for and what are the two main types?

Building material for bones, influence nerve and muscle functioning, regulate water balance, assist in enzyme + hormone production

• Macrominerals, Trace minerals

What are the reasons to stay hydrated and how much is recommended?

Body temp regulation, delivery of nutrients/waste products to and from cells, infection prevention, joint lubrication

• 64 oz/day

Inadequate sleep does what to hunger/satiety?

Increases ghrelin (h) and decreases leptin (s)

Balanced meals are what?

¼ carbs, ¼ protein, ½ color

Balanced snacks are what?

Always meet 2/3 macronutrients

Don’t go more than - hrs without eating, eat within - hrs of waking

4, 1

What is the functional unit of the kidney?

Nephron

Renal tubule is for -, glomerular (bowman’s) capsule for -

Filtrate, blood

What is the pathway for blood in renal system?

Afferent arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries (vasa recta)

What is the pathway for filtrate in renal system?

Glomerular capsule → proximal convoluted tubule → loop of henle → distal convoluted tubule → collecting duct

What are the two types of nephrons, what percent is each, what are they for, unique element?

Cortical: 85%, for reabsorption/secretion

Juxtamedullary: 15%, for concentration/dilution of urine, has vasa recta

What are the four main processes of the nephron?

Filtration, Reabsorption, Secretion, Excretion

How does filtration occur?

Movement of fluids and solutes from glomerular capillaries to capsule (from AA to EA)

What is GFR? what does it indicate?

Glomerular filtration rate (125ml/min) is amount of filtrate formed in kidneys per minute

• important clinical metric of kidney health

GFR can be estimated and measured how?

Estimated by blood creatinine levels, measured by chemical tracer amount in blood/urine over time

What are the three pressures that predict GFR?

Glomerular hydrostatic pressure (+), blood colloid osmotic pressure (-), capsular hydrostatic pressure (-)

What are the four factors of control of GFR?

Myogenic mechanism, Tubuloglomerular feedback, Hormonal control, Neurologic control

Cardiovascular system requires vasoconstriction to raise BP, Renal system requires - of the - - to raise -

Vasodilation, afferent arteriole, GFR

Describe the myogenic mechanism!

Stretch-sensitive smooth muscle responds by vasoconstricting to decrease GFR within seconds (and vise versa)

Describe tubuloglomerular feedback!

Macula densa cells release vasoconstrictor molecules in response to increased electrolytes in loop and inhibit nitric oxide release from juxtaglomerular cells (decreases GFR, can do vise versa too), slower than MM

Describe hormonal control!

RAAS:

Angiotensinogen -renin→ Angiotensin I -ACE→ Angiotensin II → Adrenal gland → Aldosterone → Increased sodium reabsorption (BP)

ANP:

Released by mechanosensitive myocytes in atria to decrease BP, dilate AA (increases GFR)

Where does angiotensinogen originate? ACE?

Liver, lungs

Describe neurologic control!

Sympathetic NS activation vasoconstricts arterioles, net result is decreased GFR

What are primary and secondary active transport?

Primary requires ATP to go against gradient

Secondary uses energy generated from one ion moving with its gradient to move another against its gradient

What are the two types of transporters?

Symporter and antiporter

Be cognizant that each transporter has a -

maximum

The PCT reabsorbs what?

Absorbs glucose and amino acids completely, Na+ and water partially (65), 80% bicarbonate

The - holds the filtrate, it is bordered by - membrane on the inside and - membrane on the outside. Outside of these structures is the -

Lumen, apical, basolateral. Interstitium

What are the three mechanisms for Sodium reabsorption at the PCT?

Apical membrane: Na+/H+ antiporter, Na+/glucose symporter

Basolateral membrane: Na+/K+ pump

What are the two mechanisms for Glucose reabsorption at the PCT?

Apical membrane: Na+/glucose symporter

Basolateral membrane: facilitated diffusion via GLUT2

What are the two mechanisms for Amino Acids reabsorption at the PCT?

Apical membrane: Na+/AA symporter

Basolateral membrane: Facilitated diffusion

Facilitated diffusion goes from where to where?

BM to peritubular capillaries

What is the mechanism for Water reabsorption at the PCT?

Osmosis, movement through tight junctions and aquaporins on the membranes to move to peritubular capillaries

Loop of Henle: descending limb permeable to -, ascending limb to -

Water, solutes

Loop of Henle absorbs what % water, Na+/K+, bicarbonate?

15, 20-30, 10-20

Early DCT reabsorbs what?

Late DCT + collecting duct reabsorbs what?

• Na+, Cl-, Ca2+

• Na+/K+/H2O

What hormone regulates early DCT Ca2+ reabsorption?

Parathyroid hormone (+)