NEET MDS Lessons
Physiology
Blood Transfusions
- Some of these units ("whole blood") were transfused directly into patients (e.g., to replace blood lost by trauma or during surgery).
- Most were further fractionated into components, including:
- RBCs. When refrigerated these can be used for up to 42 days.
- platelets. These must be stored at room temperature and thus can be saved for only 5 days.
- plasma. This can be frozen and stored for up to a year.
safety of donated blood
A variety of infectious agents can be present in blood.
- viruses (e.g., HIV-1, hepatitis B and C, HTLV, West Nile virus
- bacteria like the spirochete of syphilis
- protozoans like the agents of malaria and babesiosis
- prions (e.g., the agent of variant Crueutzfeldt-Jakob disease)
and could be transmitted to recipients. To minimize these risks,
- donors are questioned about their possible exposure to these agents;
- each unit of blood is tested for a variety of infectious agents.
Most of these tests are performed with enzyme immunoassays (EIA) and detect antibodies against the agents. blood is now also checked for the presence of the RNA of these RNA viruses:
- HIV-1
- hepatitis C
- West Nile virus
- by the so-called nucleic acid-amplification test (NAT).
Cell, or Plasma, membrane
- Structure - 2 primary building blocks include
protein (about 60% of the membrane) and lipid, or
fat (about 40% of the membrane).
The primary lipid is called phospholipids, and molecules of phospholipid form a 'phospholipid bilayer' (two layers of phospholipid molecules). This bilayer forms because the two 'ends' of phospholipid molecules have very different characteristics: one end is polar (or hydrophilic) and one (the hydrocarbon tails below) is non-polar (or hydrophobic):
- Functions include:
- supporting and retaining the cytoplasm
- being a selective barrier .
- transport
- communication (via receptors)
Blood Pressure
Blood moves through the arteries, arterioles, and capillaries because of the force created by the contraction of the ventricles.
Blood pressure in the arteries.
The surge of blood that occurs at each contraction is transmitted through the elastic walls of the entire arterial system where it can be detected as the pulse. Even during the brief interval when the heart is relaxed — called diastole — there is still pressure in the arteries. When the heart contracts — called systole — the pressure increases.
Blood pressure is expressed as two numbers, e.g., 120/80.
Blood pressure in the capillaries
The pressure of arterial blood is largely dissipated when the blood enters the capillaries. Capillaries are tiny vessels with a diameter just about that of a red blood cell (7.5 µm). Although the diameter of a single capillary is quite small, the number of capillaries supplied by a single arteriole is so great that the total cross-sectional area available for the flow of blood is increased. Therefore, the pressure of the blood as it enters the capillaries decreases.
Blood pressure in the veins
When blood leaves the capillaries and enters the venules and veins, little pressure remains to force it along. Blood in the veins below the heart is helped back up to the heart by the muscle pump. This is simply the squeezing effect of contracting muscles on the veins running through them. One-way flow to the heart is achieved by valves within the veins
Exchanges Between Blood and Cells
With rare exceptions, our blood does not come into direct contact with the cells it nourishes. As blood enters the capillaries surrounding a tissue space, a large fraction of it is filtered into the tissue space. It is this interstitial or extracellular fluid (ECF) that brings to cells all of their requirements and takes away their products. The number and distribution of capillaries is such that probably no cell is ever farther away than 50 µm from a capillary.
When blood enters the arteriole end of a capillary, it is still under pressure produced by the contraction of the ventricle. As a result of this pressure, a substantial amount of water and some plasma proteins filter through the walls of the capillaries into the tissue space.
Thus fluid, called interstitial fluid, is simply blood plasma minus most of the proteins. (It has the same composition and is formed in the same way as the nephric filtrate in kidneys.)
Interstitial fluid bathes the cells in the tissue space and substances in it can enter the cells by diffusion or active transport. Substances, like carbon dioxide, can diffuse out of cells and into the interstitial fluid.
Near the venous end of a capillary, the blood pressure is greatly reduced .Here another force comes into play. Although the composition of interstitial fluid is similar to that of blood plasma, it contains a smaller concentration of proteins than plasma and thus a somewhat greater concentration of water. This difference sets up an osmotic pressure. Although the osmotic pressure is small, it is greater than the blood pressure at the venous end of the capillary. Consequently, the fluid reenters the capillary here.
Control of the Capillary Beds
An adult human has been estimated to have some 60,000 miles of capillaries with a total surface area of some 800–1000 m2. The total volume of this system is roughly 5 liters, the same as the total volume of blood. However, if the heart and major vessels are to be kept filled, all the capillaries cannot be filled at once. So a continual redirection of blood from organ to organ takes place in response to the changing needs of the body. During vigorous exercise, for example, capillary beds in the skeletal muscles open at the expense of those in the viscera. The reverse occurs after a heavy meal.
The walls of arterioles are encased in smooth muscle. Constriction of arterioles decreases blood flow into the capillary beds they supply while dilation has the opposite effect. In time of danger or other stress, for example, the arterioles supplying the skeletal muscles will be dilated while the bore of those supplying the digestive organs will decrease. These actions are carried out by
- the autonomic nervous system.
- local controls in the capillary beds
- 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.
PHYSIOLOGY OF THE BRAIN
- The Cerebrum (Telencephalon) Lobes of the cerebral cortex
- Frontal Lobe
- Precentral gyrus, Primary Motor Cortex, point to point motor neurons, pyramidal cells: control motor neurons of the brain and spinal cord. See Motor homunculus
- Secondary Motor Cortex repetitive patterns
- Broca's Motor Speech area
- Anterior - abstract thought, planning, decision making, Personality
- Parietal Lobe
- Post central gyrus, Sensory cortex, See Sensory homunculus, size proportional to sensory receptor density.
- Sensory Association area, memory of sensations
- Occipital Lobe
- Visual cortex, sight (conscious perception of vision)
- Visual Association area, correlates visual images with previous images, (memory of vision, )
- Temporal Lobe
- Auditory Cortex, sound
- Auditory Association area, memory of sounds
- Common Integratory Center - angular gyrus, Parietal, Temporal & Occipital lobes
- One side becomes dominent, integrats sensory (somesthetic, auditory, visual) information
- The Basal nuclei (ganglia)
- Grey matter (cell bodies) within the White matter of cerebrum, control voluntary movements
- Cauadate nucles - chorea (rapi, uncontrolled movements), Parkinsons: (dopamine neurons of substantia nigra to caudate nucles) jerky movements, spasticity, tremor, blank facial expression
- The limbic system - ring around the brain stem, emotions(w/hypothalamus), processing of olfactory information
- Frontal Lobe
- The Diencephalon
- The Thalamus - Sensory relay center to cortex (primitive brain!)
- The Hypothalamus
- core temperature control"thermostat", shivering and nonshivering thermogenesis
- hunger & satiety centers, wakefulness, sleep, sexual arousal,
- emotions (w/limbic-anger, fear, pain, pleasure), osmoregulation, (ADH secretion),
- Secretion of ADH, Oxytocin, Releasing Hormones for Anterior pitutary
- Linkage of nervous and endocrine systems
- The Mesencephalon or Midbrain -
- red nucleus, motor coordination (cerebellum/Motor cortex),
- substantia nigra
- The Metencephalon
- The Cerebellum -
- Performs automatic adjustments in complex motor activities
- Input from Proprioceptors (joint, tendon, muscles), position of body in Space
- Motor cortex, intended movements (changes in position of body in Space)
- Damping (breaking motor function), Balance, predicting, inhibitory function of Purkinji cells (GABA), speed, force, direction of movement
- The Pons - Respiratory control centers (apneustic, pneumotaxic)
- Nuclei of cranial nerves V, VI, VII, VIII
- The Cerebellum -
- Myelencephalon
- The Medulla
- Visceral motor centers (vasomotor, cardioinhibtory, respiratory)
- Reticular Formation RAS system, alert cortex to incoming signals, maintenance of consciousness, arousal from sleep
- All Afferent & Efferent fibers pass through, crossing over of motor tracts
- Corpus Callosum: Permits communication between cerebralhemispheres
- The Medulla
- Generalized Brain Avtivity
- Brain Activity and the Electroencephalogram(EEG)
- alpha waves: resting adults whose eyes are closed
- beta waves: adults concentrating on a specific task;
- theta waves: adults under stress;
- delta waves: during deep sleep and in clinical disorders
- Brain Seizures
- Grand Mal: generalized seizures, involvs gross motor activity, affects the individual for a matter or hours
- Petit mal: brief incidents, affect consciousness but may have no obvious motor abnormalities
- Chemical Effects on the Brain
- Sedatives: reduce CNS activity
- Analgesics: relieve pain by affecting pain pathways or peripheral sensations
- Psychotropics: alter mood and emotional states
- Anticonvulsants: control seizures
- Stimulants: facilitate CNS activity
- Memory and learning
- Short-term, or primary, memories last a short time, immediately accessible (phone number)
- Secondary memories fade with time (your address at age 5)
- Tertiary memories last a lifetime (your name)
- Memories are stored within specific regions of the cerebral cortex.
- Learning, a more complex process involving the integration of memories and their use to direct or modify behaviors
- Neural basis for memory and learning has yet to be determined.
- Brain Activity and the Electroencephalogram(EEG)
- Fibers in CNS
- Association fibers: link portions of the cerebrum;
- Commissural fibers: link the two hemispheres;
- Projection fibers: link the cerebrum to the brain stem
Phases of cardiac cycle :
1. Early diastole ( also called the atrial diastole , or complete heart diastole) : During this phase :
- Atria are relaxed
- Ventricles are relaxed
- Semilunar valves are closed
- Atrioventricular valves are open
During this phase the blood moves passively from the venous system into the ventricles ( about 80 % of blood fills the ventricles during this phase.
2. Atrial systole : During this phase :
- Atria are contracting
- Ventricles are relaxed
- AV valves are open
- Semilunar valves are closed
- Atrial pressure increases.the a wave of atrial pressure appears here.
- P wave of ECG starts here
- intraventricular pressure increases due to the rush of blood then decrease due to continuous relaxation of ventricles.
The remaining 20% of blood is moved to fill the ventricles during this phase , due to atrial contraction.
3. Isovolumetric contraction : During this phase :
- Atria are relaxed
- Ventricles are contracting
- AV valves are closed
- Semilunar valves are closed
- First heart sound
- QRS complex.
The ventricular fibers start to contract during this phase , and the intraventricular pressure increases. This result in closing the AV valves , but the pressure is not yet enough to open the semilunar valves , so the blood volume remain unchanged , and the muscle fibers length also remain unchanged , so we call this phase as isovolumetric contraction ( iso : the same , volu= volume , metric= length).
4. Ejection phase : Blood is ejected from the ventricles into the aorta and pulmonary artery .
During this phase :
- Ventricles are contracting
- Atria are relaxed
- AV valves are closed
- Semilunar valves are open
- First heart sound
- Intraventricular pressure is increased , due to continuous contraction
- increased aortic pressure .
- T wave starts.
5. Isovolumetric relaxation: This phase due to backflow of blood in aorta and pulmonary system after the ventricular contraction is up and the ventricles relax . This backflow closes the semilunar valves .
During this phase :
- Ventricles are relaxed
- Atrial are relaxed
- Semilunar valves are closed .
- AV valves are closed.
- Ventricular pressure fails rapidly
- Atrial pressure increases due to to continuous venous return. the v wave appears here.
- Aortic pressure : initial sharp decrease due to sudden closure of the semilunar valve ( diacrotic notch) , followed by secondary rise in pressure , due to elastic recoil of the aorta ( diacrotic wave) .
- T wave ends in this phase
The pituitary gland is pea-sized structure located at the base of the brain. In humans, it consists of two lobes:
- the Anterior Lobe and
- the Posterior Lobe
The Anterior Lobe
The anterior lobe contains six types of secretory cells All of them secrete their hormone in response to hormones reaching them from the hypothalamus of the brain.
Thyroid Stimulating Hormone (TSH)
TSH (also known as thyrotropin) is a glycoprotein The secretion of TSH is
- stimulated by the arrival of thyrotropin releasing hormone (TRH) from the hypothalamus.
- inhibited by the arrival of somatostatin from the hypothalamus.
TSH stimulates the thyroid gland to secrete its hormone thyroxine (T4).
Some develop antibodies against their own TSH receptors making more T4 causing hyperthyroidism. The condition is called thyrotoxicosis or Graves' disease.
Hormone deficiencies
A deficiency of TSH causes hypothyroidism: inadequate levels of T4 (and thus of T3 )..
Follicle-Stimulating Hormone (FSH)
FSH is a heterodimeric glycoprotein Synthesis and release of FSH is triggered by the arrival from the hypothalamus of gonadotropin-releasing hormone (GnRH).
FSH in females :In sexually-mature females, FSH (assisted by LH) acts on the follicle to stimulate it to release estrogens.
FSH in males :In mature males, FSH acts on spermatogonia stimulating (with the aid of testosterone) the production of sperm.
Luteinizing Hormone (LH)
LH is synthesized within the same pituitary cells as FSH and under the same stimulus (GnRH). It is also a heterodimeric glycoprotein
LH in females
In sexually-mature females, LH
- stimulates the follicle to secrete estrogen in the first half of the menstrual cycle
- a surge of LH triggers the completion of meiosis I of the egg and its release (ovulation) in the middle of the cycle
- stimulates the now-empty follicle to develop into the corpus luteum, which secretes progesterone during the latter half of the menstrual cycle.
LH in males
LH acts on the interstitial cells (also known as Leydig cells) of the testes stimulating them to synthesize and secrete the male sex hormone, testosterone.
LH in males is also known as interstitial cell stimulating hormone (ICSH).
Prolactin (PRL)
Prolactin is a protein of 198 amino acids. During pregnancy it helps in the preparation of the breasts for future milk production. After birth, prolactin promotes the synthesis of milk.
Prolactin secretion is
- stimulated by TRH
- repressed by estrogens and dopamine.
Growth Hormone (GH)
- Human growth hormone (also called somatotropin) is a protein
- The GH-secreting cells are stimulated to synthesize and release GH by the intermittent arrival of growth hormone releasing hormone (GHRH) from the hypothalamus. GH promotes body growth
In Child
- hyposecretion of GH produces dwarfism
- hypersecretion leads to gigantism
In adults, a hypersecretion of GH leads to acromegaly.
ACTH — the adrenocorticotropic hormone
ACTH acts on the cells of the adrenal cortex, stimulating them to produce
- glucocorticoids, like cortisol
- mineralocorticoids, like aldosterone
- androgens (male sex hormones, like testosterone
Hypersecretion of ACTH cause of Cushing's disease.