NEET MDS Lessons
Physiology
- PATHOPHYSIOLOGY OF THE CONDUCTION SYSTEM
- Cardiac arrhythmias = deviation from normal rate, rhythm
- Heart block (types) = conduction system damage
- Complete Heart Block = 3rd degree block
- idioventricular beat (35-45/min)
- Atria at normal sinus rhythm
- Periods of asystole (dizziness, fainting)
- Causes = myocardial infarction of ventricular septum, surgical correction of interseptal defects, drugs
- Incomplete Heart Block = 2nd degree block
- Not all atrial beats reach ventricle
- Ventricular beat every 2nd, 3rd, etc. atrial beat, (2:1 block, 3:1 block)
- Incomplete Heart Block = 1st degree block
- All atrial beats reach ventricle
- PR interval abnormally long = slower conduction
- Bundle branch blocks (right or left)
- Impulses travel down one side and cross over
- Ventricular rate normal, QRS prolonged or abnormal
- Complete Heart Block = 3rd degree block
- Fibrillation
- Asynchronous contractions = twitching movements
- Loss of synchrony = little to No output
- Atrial Fibrillation
- Irregular ventricular beat & depressed pumping efficiency
- Atrial beat = 125 - 150/min, pulse feeble = 60 - 70/min
- Treatment = Digitalis - reduces rate of ventricular contraction, reduces pulse deficit
- Ventricular Fibrillation
- Almost no blood pumped to systemic system
- ECG = extremely bizarre
- Several minutes = fatal
- Treatment = defibrillation, cardiac massage can maintain some cardiac output
- Heart block (types) = conduction system damage
Graded Contractions and Muscle Metabolism
The muscle twitch is a single response to a single stimulus. Muscle twitches vary in length according to the type of muscle cells involved. .
Fast twitch muscles such as those which move the eyeball have twitches which reach maximum contraction in 3 to 5 ms (milliseconds). [superior eye] and [lateral eye] These muscles were mentioned earlier as also having small numbers of cells in their motor units for precise control.
The cells in slow twitch muscles like the postural muscles (e.g. back muscles, soleus) have twitches which reach maximum tension in 40 ms or so.
The muscles which exhibit most of our body movements have intermediate twitch lengths of 10 to 20 ms.
The latent period, the period of a few ms encompassing the chemical and physical events preceding actual contraction.
This is not the same as the absolute refractory period, the even briefer period when the sarcolemma is depolarized and cannot be stimulated. The relative refractory period occurs after this when the sarcolemma is briefly hyperpolarized and requires a greater than normal stimulus
Following the latent period is the contraction phase in which the shortening of the sarcomeres and cells occurs. Then comes the relaxation phase, a longer period because it is passive, the result of recoil due to the series elastic elements of the muscle.
We do not use the muscle twitch as part of our normal muscle responses. Instead we use graded contractions, contractions of whole muscles which can vary in terms of their strength and degree of contraction. In fact, even relaxed muscles are constantly being stimulated to produce muscle tone, the minimal graded contraction possible.
Muscles exhibit graded contractions in two ways:
1) Quantal Summation or Recruitment - this refers to increasing the number of cells contracting. This is done experimentally by increasing the voltage used to stimulate a muscle, thus reaching the thresholds of more and more cells. In the human body quantal summation is accomplished by the nervous system, stimulating increasing numbers of cells or motor units to increase the force of contraction.
2) Wave Summation ( frequency summation) and Tetanization- this results from stimulating a muscle cell before it has relaxed from a previous stimulus. This is possible because the contraction and relaxation phases are much longer than the refractory period. This causes the contractions to build on one another producing a wave pattern or, if the stimuli are high frequency, a sustained contraction called tetany or tetanus. (The term tetanus is also used for an illness caused by a bacterial toxin which causes contracture of the skeletal muscles.) This form of tetanus is perfectly normal and in fact is the way you maintain a sustained contraction.
Treppe is not a way muscles exhibit graded contractions. It is a warmup phenomenon in which when muscle cells are initially stimulated when cold, they will exhibit gradually increasing responses until they have warmed up. The phenomenon is due to the increasing efficiency of the ion gates as they are repeatedly stimulated. Treppe can be differentiated from quantal summation because the strength of stimulus remains the same in treppe, but increases in quantal summation
Length-Tension Relationship: Another way in which the tension of a muscle can vary is due to the length-tension relationship. This relationship expresses the characteristic that within about 10% the resting length of the muscle, the tension the muscle exerts is maximum. At lengths above or below this optimum length the tension decreases.
Bile contains:
- bile acids. These amphiphilic steroids emulsify ingested fat. The hydrophobic portion of the steroid dissolves in the fat while the negatively-charged side chain interacts with water molecules. The mutual repulsion of these negatively-charged droplets keeps them from coalescing. Thus large globules of fat (liquid at body temperature) are emulsified into tiny droplets (about 1 µm in diameter) that can be more easily digested and absorbed.
- bile pigments. These are the products of the breakdown of hemoglobin removed by the liver from old red blood cells. The brownish color of the bile pigments imparts the characteristic brown color of the feces.
Levels of Organization:
CHEMICAL LEVEL - includes all chemical substances necessary for life (see, for example, a small portion - a heme group - of a hemoglobin molecule); together form the next higher level
CELLULAR LEVEL - cells are the basic structural and functional units of the human body & there are many different types of cells (e.g., muscle, nerve, blood)
TISSUE LEVEL - a tissue is a group of cells that perform a specific function and the basic types of tissues in the human body include epithelial, muscle, nervous, and connective tissues
ORGAN LEVEL - an organ consists of 2 or more tissues that perform a particular function (e.g., heart, liver, stomach)
SYSTEM LEVEL - an association of organs that have a common function; the major systems in the human body include digestive, nervous, endocrine, circulatory, respiratory, urinary, and reproductive.
There are two types of cells that make up all living things on earth: prokaryotic and eukaryotic. Prokaryotic cells, like bacteria, have no 'nucleus', while eukaryotic cells, like those of the human body, do.
The defecation reflex:
As a result of the mass movements, pressure is exerted on the rectum and on the internal anal sphincter, which is smooth muscle, resulting in its involuntary relaxation. Afferent impulses are sent to the brain indicating the need to defecate. The external sphincter is voluntary muscle and is controlled by the voluntary nervous system. This sphincter is relaxed along with contraction of the rectal and abdominal muscles in the defecation reflex
Glomerular filtration
Kidneys receive about 20% of cardiac output , this is called Renal Blood Flow (RBF) which is approximatley 1.1 L of blood. Plasma in this flow is about 625 ml . It is called Renal Plasma Flow (RPF) .
About 20 % of Plasma entering the glomerular capillaries is filtered into the Bowman`s capsule .
Glomerular filtration rate is about 125 ml/min ( which means 7.5 L/hr and thus 180 L/day) This means that the kidney filters about 180 liters of plasma every day.
The urine flow is about 1ml/min ( about 1.5 liter /day) This means that kidney reabsorbs about 178.5 liters every day .
Filtration occurs through the filtration unit , which includes :
1- endothelial cells of glomerular capillaries , which are fenestrated . Fenestrae are quite small so they prevent filtration of blood cells and most of plasma proteins .
2- Glomerular basement membrane : contains proteoglycan that is negatively charged and repels the negatively charged plasma proteins that may pass the fenestrae due to their small molecular weight like albumin . so the membrane plays an important role in impairing filtration of albumin .
3- Epithelial cells of Bowman`s capsule that have podocytes , which interdigitate to form slits .
Many forces drive the glomerular filtration , which are :
1- Hydrostatic pressure of the capillary blood , which favours filtration . It is about 55 mmHg .
2- Oncotic pressure of the plasma proteins in the glomerular capillary ( opposes filtration ) . It is about 30 mm Hg .
3- Hydrostatic pressure of the Bowman`s capsule , which also opposes filtration. It is about 15 mmHg .
The net pressure is as follows :
Hydrostatic pressure of glomerular capillaries - ( Oncotic pressure of glomerular capillaries + Hydrostatic pressure of the Bowman capsule):
55-(35+10)
=55-45
=10 mmHg .
Te glomerular filtration rate does not depend only on the net pressure , but also on an other value , known as filtration coefficient ( Kf) . The later depends on the surface area of the glomerular capillaries and the hydraulic conductivity of the glomerular capillaries.
Nucleic Acids:
- Two major types: DNA
- RNA (including mRNA, tRNA, & rRNA)
- Both types have code which specifies the sequence of amino acids in proteins
- DNA = archival copy of genetic code, kept in nucleus, protected
- RNA = working copy of code, used to translate a specific gene into a protein, goes into cytoplasm & to ribosomes, rapidly broken down
- Nucleic acids are made of 5 nucleotide bases, sugars and phosphate groups
- The bases make up the genetic code ; the phosphate and sugar make up the backbone
- RNA is a molecule with a single strand
- DNA is a double strand (a double helix) held together by hydrogen bonds between the bases
- A = T; C= G because:
- A must always hydrogen bond to T
- A = T; C= G because:
C must always hydrogen bond to G