Clinical Physiology: An Examination Primer

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Preface......Page 9
Cell membrane......Page 11
Classification of membrane proteins......Page 12
Classification of cell membrane receptors......Page 13
Types of intercellular junctions......Page 14
Cell adhesion molecules......Page 15
Classification of transport mechanisms......Page 16
Diffusion across a membrane......Page 17
Kinetic characteristics shared by facilitated diffusion and active transport processes......Page 18
Ion channel flow rates......Page 19
Classification of ion channels......Page 20
Endoplasmic reticulum......Page 22
Mitochondria......Page 23
Lysosomes......Page 24
Cytoskeleton......Page 25
Functions of microfilaments......Page 26
Structure of cilia......Page 27
Recommended Further reading......Page 28
Osmolality and tonicity......Page 29
Components of extracellular fluid......Page 30
Extracellular fluid volume......Page 31
Options for extracellular fluid volume replacement......Page 32
Properties of arginine vasopressin (antidiuretic hormone; ADH)......Page 33
Antidiuretic effects of arginine vasopressin......Page 34
Physiological role of sodium......Page 35
Abnormalities in sodium metabolism......Page 36
Functions of potassium......Page 37
Renal excretion of potassium......Page 38
Magnesium......Page 39
Bibliography......Page 40
Bronsted–Lowry definitions......Page 41
Factors affecting body acid–base balance......Page 42
Henderson–Hasselbach equation......Page 43
A scheme for the assessment and management of acid–base abnormalities......Page 44
Acid–base disorders......Page 45
Renal compensation mechanisms......Page 46
Components of an arterial blood gas analyser......Page 47
Acidosis......Page 48
Anion gap......Page 49
Pathophysiology of metabolic alkalosis......Page 50
Metabolic acidosis......Page 51
Clinical effects of acidosis......Page 52
Bibliography......Page 53
Functional components of the kidneys......Page 54
The renal circulation......Page 56
Autoregulation......Page 57
Processes involved in urine production......Page 58
Glomerular filtration......Page 59
Glomerular filtration rate......Page 60
Tubular function......Page 61
Proximal convoluted tubule (65%–75%)......Page 62
Renal sodium excretion......Page 63
Natriuretic peptides......Page 64
Atrial natriuretic peptide......Page 65
PATHWAY FOR GLOMERULAR FEEDBACK......Page 66
Loop of Henle......Page 67
Counter-current multiplier......Page 68
Renal function tests......Page 70
Tests of renal tubular function......Page 71
Diuretics......Page 72
Micturition......Page 73
Urodynamic assessment of micturition......Page 74
Bibliography......Page 75
Introduction......Page 76
Mechanisms to reduce body heat......Page 77
Measurement of body heat production......Page 78
Effects of hypothermia......Page 79
Pathogenesis of fever......Page 80
The fetal circulation......Page 81
Afferent limb......Page 82
Effects of blood loss......Page 83
Blood pressure......Page 84
Short-term regulation......Page 85
Endothelins......Page 86
Renin–angiotensin mechanism......Page 87
Stimulation of the renin–angiotensin–aldosterone mechanism......Page 88
Effects of angiotensin II......Page 89
Vascular mechanisms......Page 90
Angiotensin II-receptor blockers......Page 91
Determinants of cardiac output......Page 92
Measurement of cardiac output......Page 94
Starling\'s law of the heart (length–tension relationship)......Page 96
Ventricular contractility......Page 97
Determinants of venous return to the heart......Page 98
Differences between pulmonary capillary wedge pressure and left ventricular end-diastolic pressure......Page 99
The relationship of heart rate to contractility......Page 100
Adaptive mechanisms that allow maintenance of cardiac output in the presence of factors predisposing to congestive heart failure......Page 101
Determinants of myocardial oxygen consumption......Page 102
Features of coronary blood flow......Page 103
The properties of cardiac muscle......Page 104
Types of blood vessels......Page 105
Capillary exchange......Page 106
Functions of the lymphatic system......Page 107
Properties of endothelium......Page 108
Procoagulants......Page 109
Antithrombotic......Page 110
Physiological functions of the components of the extracellular matrix......Page 111
Nitric oxide......Page 112
Determinants of blood viscosity......Page 113
Laminar flow......Page 114
Poiseuille\'s equation......Page 115
Left ventricular relaxation (diastole)......Page 116
Mechanism of cardiac muscle contraction and relaxation......Page 117
Role of calcium......Page 118
Cardiac action potential......Page 119
Conduction system......Page 121
Electrocardiograph......Page 122
Impulse initiation......Page 123
Bibliography......Page 124
Functional components of the respiratory system......Page 125
The upper respiratory tract......Page 126
Functional anatomy of the lower respiratory tract (Weibel)......Page 127
Respiratory epithelium......Page 128
Diffusion......Page 129
Diffusing capacity......Page 130
Physiological dead space......Page 131
Surfactant......Page 132
Chemoreceptors......Page 133
Effectors (respiratory muscles)......Page 134
Peripheral chemoreceptors......Page 135
Turbulent gas flow......Page 136
Pulmonary circulation......Page 137
Factors acting on the pulmonary vascular bed......Page 138
Factors involved in the production of pulmonary oedema......Page 139
Specific functional lung volumes......Page 140
Lung capacities......Page 141
Methods for the measurement of static lung volumes......Page 142
Flow–volume relationship......Page 143
Flow–pressure relationship......Page 145
Lung function testing......Page 146
Increased alveolar-arterial pO2 difference......Page 147
Bibliography......Page 148
Functions of plasma proteins......Page 150
Electrophoresis......Page 151
Acute phase reactants......Page 152
Plasma lipoproteins......Page 153
Structure of haemoglobin......Page 154
Oxyhaemoglobin dissociation curve......Page 155
Characteristics of oxygen binding by haemoglobin......Page 156
Co-operativity......Page 157
2,3-Diphosphoglycerate......Page 158
Erythropoietin......Page 159
Iron metabolism......Page 160
Iron absorption......Page 161
Features......Page 163
White blood cells......Page 164
Functions of white blood cells......Page 165
Blood transfusion principles......Page 166
Haemostasis......Page 167
Features......Page 168
Platelet granule types......Page 169
Haemostatic role of platelets......Page 171
International normalised ratio......Page 172
Coagulation cascade......Page 173
Control mechanisms of coagulation cascade......Page 175
Heparin......Page 176
Characteristics of low molecular weight heparins......Page 177
Protein C......Page 178
Thrombosis......Page 179
A screen for thrombophilic states......Page 180
Fibrinolytic system......Page 181
Structural features......Page 183
Splenic function......Page 184
Bibliography......Page 186
Cells of the nervous system......Page 187
Neurons......Page 188
Functions of oligodendrocytes......Page 189
Action potential......Page 190
Sequence of events in generation of an action potential......Page 192
Properties of the action potential......Page 194
Sodium pump......Page 195
Nernst equation......Page 196
The Gibbs–Donnan equilibrium......Page 197
Sequence of transmission at the neuromuscular junction......Page 198
Miniature end-plate potentials......Page 199
Characteristics of the perfect neuromuscular blocking agent......Page 200
Characteristics of the nicotinic receptor......Page 201
Known or postulated neurotransmitters......Page 202
Neuropeptide Y......Page 203
Modes of transmission......Page 204
Generation of postsynaptic potentials......Page 205
Reflexes......Page 206
General properties of reflexes......Page 207
Cerebral blood flow......Page 208
Cerebral energy consumption......Page 209
Functional areas......Page 210
Blood–brain barrier......Page 212
Mechanisms of transport across the blood–brain barrier......Page 213
Immunological privilege......Page 214
Cerebrospinal fluid......Page 215
Intracranial pressure......Page 216
The clinical effects of raised intracranial pressure......Page 217
Measurement of intracranial pressure......Page 218
Cerebral function......Page 219
Frontal lobes......Page 220
Functions......Page 221
Functional areas......Page 222
Limbic system......Page 223
Cerebellum......Page 224
Hypothalamus......Page 225
Pineal gland......Page 226
Reticular formation......Page 227
Spinal cord......Page 228
Spinal cord lesions......Page 229
Phases of the EEG......Page 230
Evoked potentials......Page 231
Components of the autonomic nervous system......Page 232
The central autonomic network......Page 233
Components of the sympathetic system......Page 234
Predominant autonomic tone......Page 235
Termination of catecholamine action at receptors......Page 236
Classification of cholinergic receptors......Page 237
Valsalva manoeuvre......Page 239
Electromyogram......Page 240
Pain......Page 241
Pain perception......Page 242
Pain pathway to the CNS......Page 243
Gate control theory......Page 244
Endogenous opioids......Page 245
Sarcotubular functional proteins......Page 246
Myosin......Page 247
Excitation–contraction coupling......Page 248
Skeletal muscle fibres......Page 249
Muscle tension......Page 250
Exercise training......Page 251
Muscle spindle......Page 252
Optical characteristics of the eye......Page 254
Visual cycle......Page 256
Pupillary light reflex......Page 258
Middle ear......Page 259
Hearing process......Page 260
Audiometry......Page 262
Vestibular apparatus......Page 263
Balance mechanisms......Page 264
Functions of the Eustachian tube......Page 265
Bibliography......Page 266
Regulatory systems......Page 268
Response to hormone......Page 269
Mechanisms of endocrine disease......Page 270
Hormone receptors......Page 271
G-proteins (GTP-binding transducer proteins)......Page 272
Cyclic AMP pathway......Page 274
Sequence of events involving cyclic AMP as a second messenger......Page 275
Sequence of events involving the Ca2+ second-messenger system......Page 276
Steroid-hormone receptor mechanism......Page 277
Thyroid hormone synthesis......Page 278
Metabolic effects......Page 280
Hypothalamic–pituitary–thyroid axis......Page 281
Mechanisms of hyperthyroidism......Page 282
Neurohypophysis (posterior pituitary)......Page 283
Characteristics of hypothalamic releasing hormones......Page 284
Features of the hypophyseal portal tract......Page 285
Growth hormone......Page 286
Growth hormone actions......Page 287
Actions......Page 288
Structural features......Page 289
Glucocorticoids......Page 290
Adrenocorticotrophic hormone (ACTH)......Page 291
Actions of glucocorticoids......Page 292
Hypothalamic–pituitary–adrenal axis......Page 293
Cushing\'s syndrome......Page 294
Endocrine pancreas......Page 295
Skeletal muscle......Page 296
Protein metabolism......Page 297
Hypoglycaemia......Page 298
Adipose tissue......Page 299
Gonadotrophin releasing hormone......Page 300
Oestrogen actions......Page 301
Androgens......Page 302
Progestagen actions......Page 303
Testis......Page 304
Functions of Leydig cells......Page 305
Functional constituents of the adult ovary......Page 306
Phases......Page 308
Mechanisms of hypogonadism......Page 309
Functions of the placenta......Page 310
Calcium metabolism......Page 311
Components of plasma calcium......Page 312
Reabsorption of calcium......Page 313
Hypercalcaemia......Page 314
Functions of phosphate......Page 315
Parathyroid hormone (PTH)......Page 316
Vitamin D......Page 317
Vitamin D actions......Page 318
Bone function......Page 319
The components of bone......Page 320
Mechanism of bone repair......Page 321
Bone formation (osteoblast products)......Page 322
Articular cartilage......Page 323
Bibliography......Page 324
Functions of saliva......Page 326
Secretion of saliva......Page 327
Oesophageal phase......Page 328
Gastro-oesophageal competence......Page 329
Vomiting......Page 330
Functions of the stomach......Page 331
Mechanism of gastric acid secretion......Page 332
Cephalic phase......Page 334
Gastric acid secretion control mechanisms......Page 335
Effects of gastrin......Page 336
Paracrine......Page 337
Secretin......Page 338
Vasoactive intestinal peptide......Page 339
Digestion and absorption......Page 340
Lipid digestion......Page 341
Protein digestion......Page 342
Barrier function......Page 343
Liver......Page 344
Cells of the liver......Page 345
Kupffer cells......Page 346
Liver function......Page 347
Indicators of uptake, conjugation and excretion of anionic compounds......Page 348
Tests of synthetic function......Page 349
Pathway for bilirubin metabolism......Page 350
Bile......Page 351
Functions of bile salts......Page 352
Structural features......Page 353
Colonic motility......Page 355
Defaecation......Page 356
Factors in the maintenance of anal continence......Page 357
Recommended Further Reading......Page 358
Index......Page 359