NEET MDS Lessons
Physiology
Acute Obstructive Disorders
1. Heimlich maneuver
2. Bypass, tracheostomy w/catheter to suck up secretion
SPECIAL VISCERAL AFFERENT (SVA) PATHWAYS
Taste
Special visceral afferent (SVA) fibers of cranial nerves VII, IX, and X conduct signals into the solitary tract of the brainstem, ultimately terminating in the nucleus of the solitary tract on the ipsilateral side.
Second-order neurons cross over and ascend through the brainstem in the medial lemniscus to the VPM of the thalamus.
Thalamic projections to area 43 (the primary taste area) of the postcentral gyrus complete the relay.
SVA VII fibers conduct from the chemoreceptors of taste buds on the anterior twothirds of the tongue, while SVA IX fibers conduct taste information from buds on the posterior one-third of the tongue.
SVA X fibers conduct taste signals from those taste cells located throughout the fauces.
Smell
The smell-sensitive cells (olfactory cells) of the olfactory epithelium project their central processes through the cribiform plate of the ethmoid bone, where they synapse with mitral cells. The central processes of the mitral cells pass from the olfactory bulb through the olfactory tract, which divides into a medial and lateral portion The lateral olfactory tract terminates in the prepyriform cortex and parts of the amygdala of the temporal lobe.
These areas represent the primary olfactory cortex. Fibers then project from here to area 28, the secondary olfactory area, for sensory evaluation. The medial olfactory tract projects to the anterior perforated substance, the septum pellucidum, the subcallosal area, and even the contralateral olfactory tract.
Both the medial and lateral olfactory tracts contribute to the visceral reflex pathways, causing the viscerosomatic and viscerovisceral responses.
Physiology - science that describes how organisms FUNCTION and survive in continually changing environments
A heart rate that is persistently greater than 100bpm is termed tachycardia. A heart rate that is persistantly lower than 60 pulse per min is termed bradycardia. Let's examine some factors that could cause a change in heart rate:
- Increased heart rate can be caused by:
- Increased output of the cardioacceleratory center. In other words, greater activity of sympathetic nerves running to the heart and a greater release of norepinephrine on the heart.
- Decreased output of the cardioinhibitory center. In other words, less vagus nerve activity and a decrease in the release of acetylcholine on the heart.
- Increased release of the hormone epinephrine by the adrenal glands.
- Nicotine.
- Caffeine.
- Hyperthyroidism - i.e., an overactive thyroid gland. This would lead to an increased amount of the hormone thyroxine in the blood.
- Decreased heart rate can be caused by:
- Decreased activity of the cardioacceleratory center.
- Increased activity of the cardioinhibitory center.
- Many others.
Oxygen Transport
In adult humans the hemoglobin (Hb) molecule
- consists of four polypeptides:
- two alpha (α) chains of 141 amino acids and
- two beta (β) chains of 146 amino acids
- Each of these is attached the prosthetic group heme.
- There is one atom of iron at the center of each heme.
- One molecule of oxygen can bind to each heme.
The reaction is reversible.
- Under the conditions of lower temperature, higher pH, and increased oxygen pressure in the capillaries of the lungs, the reaction proceeds to the right. The purple-red deoxygenated hemoglobin of the venous blood becomes the bright-red oxyhemoglobin of the arterial blood.
- Under the conditions of higher temperature, lower pH, and lower oxygen pressure in the tissues, the reverse reaction is promoted and oxyhemoglobin gives up its oxygen.
Bleeding Disorders
A deficiency of a clotting factor can lead to uncontrolled bleeding.
The deficiency may arise because
- not enough of the factor is produced or
- a mutant version of the factor fails to perform properly.
Examples:
- von Willebrand disease (the most common)
- hemophilia A for factor 8 deficiency
- hemophilia B for factor 9 deficiency.
- hemophilia C for factor 11 deficiency
In some cases of von Willebrand disease, either a deficient level or a mutant version of the factor eliminates its protective effect on factor 8. The resulting low level of factor 8 mimics hemophilia A.
The Adrenal Glands
The adrenal glands are two small structures situated one at top each kidney. Both in anatomy and in function, they consist of two distinct regions:
- an outer layer, the adrenal cortex, which surrounds
- the adrenal medulla.
The Adrenal Cortex
cells of the adrenal cortex secrete a variety of steroid hormones.
- glucocorticoids (e.g., cortisol)
- mineralocorticoids (e.g., aldosterone)
- androgens (e.g., testosterone)
- Production of all three classes is triggered by the secretion of ACTH from the anterior lobe of the pituitary.
Glucocorticoids
They Effect by raising the level of blood sugar (glucose). One way they do this is by stimulating gluconeogenesis in the liver: the conversion of fat and protein into intermediate metabolites that are ultimately converted into glucose.
The most abundant glucocorticoid is cortisol (also called hydrocortisone).
Cortisol and the other glucocorticoids also have a potent anti-inflammatory effect on the body. They depress the immune response, especially cell-mediated immune responses.
Mineralocorticoids
The most important of them is the steroid aldosterone. Aldosterone acts on the kidney promoting the reabsorption of sodium ions (Na+) into the blood. Water follows the salt and this helps maintain normal blood pressure.
Aldosterone also
- acts on sweat glands to reduce the loss of sodium in perspiration;
- acts on taste cells to increase the sensitivity of the taste buds to sources of sodium.
The secretion of aldosterone is stimulated by:
- a drop in the level of sodium ions in the blood;
- a rise in the level of potassium ions in the blood;
- angiotensin II
- ACTH (as is that of cortisol)
Androgens
The adrenal cortex secretes precursors to androgens such as testosterone.
Excessive production of adrenal androgens can cause premature puberty in young boys.
In females, the adrenal cortex is a major source of androgens. Their hypersecretion may produce a masculine pattern of body hair and cessation of menstruation.
Addison's Disease: Hyposecretion of the adrenal cortices
Addison's disease has many causes, such as
- destruction of the adrenal glands by infection;
- their destruction by an autoimmune attack;
- an inherited mutation in the ACTH receptor on adrenal cells.
Cushing's Syndrome: Excessive levels of glucocorticoids
In Cushing's syndrome, the level of adrenal hormones, especially of the glucocorticoids, is too high.It can be caused by:
- excessive production of ACTH by the anterior lobe of the pituitary;
- excessive production of adrenal hormones themselves (e.g., because of a tumor), or (quite commonly)
- as a result of glucocorticoid therapy for some other disorder such as
- rheumatoid arthritis or
- preventing the rejection of an organ transplant.
The Adrenal Medulla
The adrenal medulla consists of masses of neurons that are part of the sympathetic branch of the autonomic nervous system. Instead of releasing their neurotransmitters at a synapse, these neurons release them into the blood. Thus, although part of the nervous system, the adrenal medulla functions as an endocrine gland.The adrenal medulla releases:
- adrenaline (also called epinephrine) and
- noradrenaline (also called norepinephrine)
Both are derived from the amino acid tyrosine.
Release of adrenaline and noradrenaline is triggered by nervous stimulation in response to physical or mental stress. The hormones bind to adrenergic receptors transmembrane proteins in the plasma membrane of many cell types.
Some of the effects are:
- increase in the rate and strength of the heartbeat resulting in increased blood pressure;
- blood shunted from the skin and viscera to the skeletal muscles, coronary arteries, liver, and brain;
- rise in blood sugar;
- increased metabolic rate;
- bronchi dilate;
- pupils dilate;
- hair stands on end (gooseflesh in humans);
- clotting time of the blood is reduced;
- increased ACTH secretion from the anterior lobe of the pituitary.
All of these effects prepare the body to take immediate and vigorous action.