NEET MDS Lessons
Physiology
COPD and Cancer
A. Chronic Obstructive Pulmonary Disease (COPD)
1. Common features of COPD
a. almost all have smoking history
b. dyspnea - chronic "gasping" for air
c. frequent coughing and infections
d. often leads to respiratory failure
2. obstructive emphysema - usually results from smoking
a. enlargement & deterioration of alveoli
b. loss of elasticity of the lungs
c. "barrel chest" from bronchiole opening during inhalation & constriction during exhalation
3. chronic bronchitis - mucus/inflammation of mucosa
B. Lung Cancer
1. squamous cell carcinoma (20-40%) - epithelium of the bronchi and bronchioles
2. adenocarcinoma (25-35%) - cells of bronchiole glands and cells of the alveoli
3. small cell carcinoma (10-20%) - special lymphocyte-like cells of the bronchi
4. 90% of all lung cancers are in people who smoke or have smoked
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Damage to Spinal Nerves and Spinal Cord |
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Damage |
Possible cause of damage |
Symptoms associated with innervated area |
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Peripheral nerve |
Mechanical injury |
Loss of muscle tone. Loss of reflexes. Flaccid paralysis. Denervation atrophy. Loss of sensation |
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Posterior root |
Tabes dorsalis |
Paresthesia. Intermittent sharp pains. Decreased sensitivity to pain. Loss of reflexes. Loss of sensation. Positive Romberg sign. High stepping and slapping of feet. |
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Anterior Horn |
Poliomyelitis |
Loss of muscle tone. Loss of reflexes. Flaccid paralysis. Denervation atrophy |
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Lamina X (gray matter) |
Syringomyelia |
Bilateral loss of pain and temperature sense only at afflicted cord level. Sensory dissociation. No sensory impairment below afflicted level |
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Anterior horn and lateral corticospinal tract |
Amyotrophic lateral sclerosis |
Muscle weakness. Muscle atrophy. Fasciculations of hand and arm muscles. Spastic paralysis |
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Posterior and lateral funiculi |
Subacute combined degeneration |
Loss of position sense. Loss of vibratory sense. Positive Romberg sign. Muscle weakness. Spasticity. Hyperactive tendon reflexes. Positive Babinski sign. |
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Hemisection of the spinal cord |
Mechanical injury |
Brown-Sequard syndrome |
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Below cord level on injured side |
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Flaccid paralysis. Hyperactive tendon reflexes. Loss of position sense. Loss of vibratory sense. Tactile impairment |
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Below cord level on opposite side beginning one or two segments below injury |
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Loss of pain and temperature |
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The hepatic portal system
The capillary beds of most tissues drain into veins that lead directly back to the heart. But blood draining the intestines is an exception. The veins draining the intestine lead to a second set of capillary beds in the liver. Here the liver removes many of the materials that were absorbed by the intestine:
- Glucose is removed and converted into glycogen.
- Other monosaccharides are removed and converted into glucose.
- Excess amino acids are removed and deaminated.
- The amino group is converted into urea.
- The residue can then enter the pathways of cellular respiration and be oxidized for energy.
- Many nonnutritive molecules, such as ingested drugs, are removed by the liver and, often, detoxified.
The liver serves as a gatekeeper between the intestines and the general circulation. It screens blood reaching it in the hepatic portal system so that its composition when it leaves will be close to normal for the body.
Furthermore, this homeostatic mechanism works both ways. When, for example, the concentration of glucose in the blood drops between meals, the liver releases more to the blood by
- converting its glycogen stores to glucose (glycogenolysis)
- converting certain amino acids into glucose (gluconeogenesis).
- it's the individual pressure exerted independently by a particular gas within a mixture of gasses. The air we breath is a mixture of gasses: primarily nitrogen, oxygen, & carbon dioxide. So, the air you blow into a balloon creates pressure that causes the balloon to expand (& this pressure is generated as all the molecules of nitrogen, oxygen, & carbon dioxide move about & collide with the walls of the balloon). However, the total pressure generated by the air is due in part to nitrogen, in part to oxygen, & in part to carbon dioxide. That part of the total pressure generated by oxygen is the 'partial pressure' of oxygen, while that generated by carbon dioxide is the 'partial pressure' of carbon dioxide. A gas's partial pressure, therefore, is a measure of how much of that gas is present (e.g., in the blood or alveoli).
- the partial pressure exerted by each gas in a mixture equals the total pressure times the fractional composition of the gas in the mixture. So, given that total atmospheric pressure (at sea level) is about 760 mm Hg and, further, that air is about 21% oxygen, then the partial pressure of oxygen in the air is 0.21 times 760 mm Hg or 160 mm Hg.
Serum Proteins
Proteins make up 6–8% of the blood. They are about equally divided between serum albumin and a great variety of serum globulins.
After blood is withdrawn from a vein and allowed to clot, the clot slowly shrinks. As it does so, a clear fluid called serum is squeezed out. Thus:
Serum is blood plasma without fibrinogen and other clotting factors.
The serum proteins can be separated by electrophoresis.
- The most prominent of these and the one that moves closest to the positive electrode is serum albumin.
- Serum albumin
- is made in the liver
- binds many small molecules for transport through the blood
- helps maintain the osmotic pressure of the blood
- The other proteins are the various serum globulins.
- alpha globulins (e.g., the proteins that transport thyroxine and retinol [vitamin A])
- beta globulins (e.g., the iron-transporting protein transferrin)
- gamma globulins.
- Gamma globulins are the least negatively-charged serum proteins. (They are so weakly charged, in fact, that some are swept in the flow of buffer back toward the negative electrode.)
- Most antibodies are gamma globulins.
- Therefore gamma globulins become more abundant following infections or immunizations.
Carbohydrates:
- about 3% of the dry mass of a typical cell
- composed of carbon, hydrogen, & oxygen atoms (e.g., glucose is C6H12O6)
- an important source of energy for cells
- types include:
- monosaccharide (e.g., glucose) - most contain 5 or 6 carbon atoms
- disaccharides
- 2 monosaccharides linked together
- Examples include sucrose (a common plant disaccharide is composed of the monosaccharides glucose and fructose) & lactose (or milk sugar; a disaccharide composed of glucose and the monosaccharide galactose)
- polysaccharides
- several monosaccharides linked together
Examples include starch (a common plant polysaccharide made up of many glucose molecules) and glycogen (commonly stored in the liver)
Control of processes in the stomach:
The stomach, like the rest of the GI tract, receives input from the autonomic nervous system. Positive stimuli come from the parasympathetic division through the vagus nerve. This stimulates normal secretion and motility of the stomach. Control occurs in several phases:
Cephalic phase stimulates secretion in anticipation of eating to prepare the stomach for reception of food. The secretions from cephalic stimulation are watery and contain little enzyme or acid.
Gastric phase of control begins with a direct response to the contact of food in the stomach and is due to stimulation of pressoreceptors in the stomach lining which result in ACh and histamine release triggered by the vagus nerve. The secretion and motility which result begin to churn and liquefy the chyme and build up pressure in the stomach. Chyme surges forward as a result of muscle contraction but is blocked from entering the duodenum by the pyloric sphincter. A phenomenon call retropulsion occurs in which the chyme surges backward only to be pushed forward once again into the pylorus. The presence of this acid chyme in the pylorus causes the release of a hormone called gastrin into the bloodstream. Gastrin has a positive feedback effect on the motility and acid secretion of the stomach. This causes more churning, more pressure, and eventually some chyme enters the duodenum.
Intestinal phase of stomach control occurs. At first this involves more gastrin secretion from duodenal cells which acts as a "go" signal to enhance the stomach action already occurring. But as more acid chyme enters the duodenum the decreasing pH inhibits gastrin secretion and causes the release of negative or "stop" signals from the duodenum.
These take the form of chemicals called enterogastrones which include GIP (gastric inhibitory peptide). GIP inhibits stomach secretion and motility and allows time for the digestive process to proceed in the duodenum before it receives more chyme. The enterogastric reflex also reduces motility and forcefully closes the pyloric sphincter. Eventually as the chyme is removed, the pH increases and gastrin and the "go" signal resumes and the process occurs all over again. This series of "go" and "stop" signals continues until stomach emptying is complete.