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).
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
Red blood cell cycle:
RBCs enter the blood at a rate of about 2 million cells per second. The stimulus for erythropoiesis is the hormone erythropoietin, secreted mostly by the kidney. RBCs require Vitamin B12, folic acid, and iron. The lifespan of RBC averages 120 days. Aged and damaged red cells are disposed of in the spleen and liver by macrophages. The globin is digested and the amino acids released into the blood for protein manufacture; the heme is toxic and cannot be reused, so it is made into bilirubin and removed from the blood by the liver to be excreted in the bile. The red bile pigment bilirubin oxidizes into the green pigment biliverdin and together they give bile and feces their characteristic color. Iron is picked up by a globulin protein (apotransferrin) to be transported as transferrin and then stored, mostly in the liver, as hemosiderin or ferritin. Ferritin is short term iron storage in constant equilibrium with plasma iron carried by transferrin. Hemosiderin is long term iron storage, forming dense granules visible in liver and other cells which are difficult for the body to mobilize.
Some iron is lost from the blood due to hemorrhage, menstruation, etc. and must be replaced from the diet. On average men need to replace about 1 mg of iron per day, women need 2 mg. Apotransferrin (transferrin without the iron) is present in GI lining cells and is also released in the bile. It picks up iron from the GI tract and stimulates receptors on the lining cells which absorb it by pinocytosis. Once through the mucosal cell iron is carried in blood as transferrin to the liver and marrow. Iron leaves the transferrin molecule to bind to ferritin in these tissues. Most excess iron will not be absorbed due to saturation of ferritin, reduction of apotransferrin, and an inhibitory process in the lining tissue.
Erythropoietin Mechanism:
Myeloid (blood producing) tissue is found in the red bone marrow located in the spongy bone. As a person ages much of this marrow becomes fatty and ceases production. But it retains stem cells and can be called on to regenerate and produce blood cells later in an emergency. RBCs enter the blood at a rate of about 2 million cells per second. The stimulus for erythropoiesis is the hormone erythropoietin, secreted mostly by the kidney. This hormone triggers more of the pleuripotential stem cells (hemocytoblasts) to follow the pathway to red blood cells and to divide more rapidly.
It takes from 3 to 5 days for development of a reticulocyte from a hemocytoblast. Reticulocytes, immature rbc, move into the circulation and develop over a 1 to 2 day period into mature erythrocytes. About 1 to 2 % of rbc in the circulation are reticulocytes, and the exact percentage is a measure of the rate of erythropoiesis.
The nephron of the kidney is involved in the regulation of water and soluble substances in blood.
A Nephron
A nephron is the basic structural and functional unit of the kidneys that regulates water and soluble substances in the blood by filtering the blood, reabsorbing what is needed, and excreting the rest as urine.
Its function is vital for homeostasis of blood volume, blood pressure, and plasma osmolarity.
It is regulated by the neuroendocrine system by hormones such as antidiuretic hormone, aldosterone, and parathyroid hormone.
The Glomerulus
The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole of the renal circulation. Here, fluid and solutes are filtered out of the blood and into the space made by Bowman's capsule.
A group of specialized cells known as juxtaglomerular apparatus (JGA) are located around the afferent arteriole where it enters the renal corpuscle. The JGA secretes an enzyme called renin, due to a variety of stimuli, and it is involved in the process of blood volume homeostasis.
The Bowman's capsule surrounds the glomerulus. It is composed of visceral (simple squamous epithelial cells; inner) and parietal (simple squamous epithelial cells; outer) layers.
Red blood cells and large proteins, such as serum albumins, cannot pass through the glomerulus under normal circumstances. However, in some injuries they may be able to pass through and can cause blood and protein content to enter the urine, which is a sign of problems in the kidney.
Proximal Convoluted Tubule
The proximal tubule is the first site of water reabsorption into the bloodstream, and the site where the majority of water and salt reabsorption takes place. Water reabsorption in the proximal convoluted tubule occurs due to both passive diffusion across the basolateral membrane, and active transport from Na+/K+/ATPase pumps that actively transports sodium across the basolateral membrane.
Water and glucose follow sodium through the basolateral membrane via an osmotic gradient, in a process called co-transport. Approximately 2/3rds of water in the nephron and 100% of the glucose in the nephron are reabsorbed by cotransport in the proximal convoluted tubule.
Fluid leaving this tubule generally is unchanged due to the equivalent water and ion reabsorption, with an osmolarity (ion concentration) of 300 mOSm/L, which is the same osmolarity as normal plasma.
The Loop of Henle
The loop of Henle is a U-shaped tube that consists of a descending limb and ascending limb. It transfers fluid from the proximal to the distal tubule. The descending limb is highly permeable to water but completely impermeable to ions, causing a large amount of water to be reabsorbed, which increases fluid osmolarity to about 1200 mOSm/L. In contrast, the ascending limb of Henle's loop is impermeable to water but highly permeable to ions, which causes a large drop in the osmolarity of fluid passing through the loop, from 1200 mOSM/L to 100 mOSm/L.
Distal Convoluted Tubule and Collecting Duct
The distal convoluted tubule and collecting duct is the final site of reabsorption in the nephron. Unlike the other components of the nephron, its permeability to water is variable depending on a hormone stimulus to enable the complex regulation of blood osmolarity, volume, pressure, and pH.
Normally, it is impermeable to water and permeable to ions, driving the osmolarity of fluid even lower. However, anti-diuretic hormone (secreted from the pituitary gland as a part of homeostasis) will act on the distal convoluted tubule to increase the permeability of the tubule to water to increase water reabsorption. This example results in increased blood volume and increased blood pressure. Many other hormones will induce other important changes in the distal convoluted tubule that fulfill the other homeostatic functions of the kidney.
The collecting duct is similar in function to the distal convoluted tubule and generally responds the same way to the same hormone stimuli. It is, however, different in terms of histology. The osmolarity of fluid through the distal tubule and collecting duct is highly variable depending on hormone stimulus. After passage through the collecting duct, the fluid is brought into the ureter, where it leaves the kidney as urine.
Exchange of gases:
- External respiration:
- exchange of O2 & CO2 between external environment & the cells of the body
- efficient because alveoli and capillaries have very thin walls & are very abundant (your lungs have about 300 million alveoli with a total surface area of about 75 square meters)
- Internal respiration - intracellular use of O2 to make ATP
- occurs by simple diffusion along partial pressure gradients
Hyperventilation
- Treatments :Rebreath air, hold breath (Increase CO2)
Give oxygen for Hypoxemia
The Nervous System Has Peripheral and Central Units
- The central nervous system (CNS) is the brain and spinal column
- The peripheral nervous system (PNS) consists of nerves outside of the CNS
- There are 31 pairs of spinal nerves (mixed motor & sensory)
- There are 12 pairs of cranial nerves (some are pure sensory, but most are mixed)
The pattern of innervation plotted on the skin is called a dermatome
The Nervous System Has Peripheral and Central Units
- The central nervous system (CNS) is the brain and spinal column
- The peripheral nervous system (PNS) consists of nerves outside of the CNS
- There are 31 pairs of spinal nerves (mixed motor & sensory)
- There are 12 pairs of cranial nerves (some are pure sensory, but most are mixed)
The pattern of innervation plotted on the skin is called a dermatome