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Transcript
)‫ كل العبارات أدناه صحيحة و يمكن تغيير عباراتها لتصبح (خطأ) أو إبقاؤها لتبقى (صح‬:‫مالحظة هامة‬
‫ أو حذف بعض كلماتها أو عباراتها على‬MCQ ‫ ) و يمكن ترتيبها على شكل‬True or false ‫(أي‬
) Match or short assay ( ‫) بل حتى يمكن عمل‬Blanks ‫شكل فراغات (أي‬
First: CNS, PNS, ANS and Special sences
1.
The term nucleus in CNS refers to a clearly defined mass of neuron cell
bodies
2.
The term substantia in CNS refers to a less distinct borders than nuclei
3.
The term locus in CNS refers to a small but well defined mass of neuron
cell bodies
4.
The term ganglion refers to collection of neuron cell bodies found in PNS
5.
Tract is a set of fibers that project from one structure and synapses on a
second structure
6.
The term nerve refers to PNS
7.
Nerve is a bundle of axons projecting from CNS to a muscle or gland or
from a sense organ to CNS
8.
Bundle is a collection of axons that run together but may not share the
same origin or destination
9.
Commissure is any collection of axons that connect one side of the brain
with the other side
10. Gyrus is a ridge on the surface of the cerebrum or cerebellum
11. Sulcus is a groove on the surface of the cerebrum or cerebellum
12. Fissure is a deep groove on the surface of the cerebrum or cerebellum
13. Central nervous system (CNS) refers to cerebellum, cerebrum, brain stem
and spinal cord
14. Peripheral nervous system (PNS) is either somatic or autonomic
15. In CNS, gray matter is organized on the surface of the brain in lamina
16. In CNS, white matter is organized centrally
17. In CNS, white matter constitutes the majority of brain mass
18. In PNS, gray matter is centrally located
19. In PNS, white matter is organized on the surface
20. Motor areas are concerned with voluntary control of movement
21. Sensory areas are concerned with conscious awareness of sensation
22. Association areas are concerned with integration and emergent properties
23. Each hemisphere is concerned with the opposite of the body
24. Primary motor cortex (Brodmann 4) is located in the precentral gyrus of
frontal lobe
25. Primary motor cortex (Brodmann 4) is concerned with conscious control of
motor execution
-1-
26. Pyramidal cells give rise to the corticospinal tracts
27. Somatotopy means that human body is mapped (motor or sensory
homunculus)
28. Premotor cortex (Brodmann 6) is concerned with learned motor skills
(patterned or repetitious)
29. Broca’s area (Brodmann 44/45) directs muscles of the tongue, throat and
lips
30. Broca’s area (Brodmann 44/45) is concerned with motor planning for
speech related activity
31. Frontal eye field (Brodmann 8) is concerned with voluntary movement of
the eyes
32. Primary somatosensory cortex (Brodmann 1, 2 & 3) is located in parietal
lobe (postcentral gyrus)
33. Postcentral gyrus is concerned with somatic senses: pain, temperature,
touch and proprioception
34. Somatosensory association area (Brodmann 5 & 7) integrates various
somatic sensory inputs
35. Primary visual cortex (Brodmann 17) is located in occipital lobe
36. Primary visual cortex (Brodmann 17) has a sensory function with largest
cortical representation
37. Visual association areas (Brodmann 18 & 19) are concerned with
interpretation of visual stimuli and past visual experiences
38. Primary auditory cortices (Brodmann 41) are located in superior margin of
temporal lobe
39. Primary auditory cortices (Brodmann 41) are concerned with pitch, rhythm
and loudness of voice
40. Auditory association area (Brodmann 42 & 43) are concerned with
recognition of stimuli as specific auditory experiences (e.g., speech)
41. Olfactory cortex is located in medial aspects of temporal lobe (piriform
lobe or uncus)
42. Gustatory cortex (Brodmann 43) is located in parietal lobe deep to the
temporal lobe
43. Sensory association areas analyze, recognize and act on sensory in puts
44. Prefrontal cortex (Brodmann 11 & 47) is located in anterior portion of
frontal lobe
45. Prefrontal cortex (Brodmann 11 & 47) is concerned with intelligence,
complex learned behavior and personality
46. Prefrontal cortex (Brodmann 11 & 47) is concerned with understanding
written and spoke language
47. General interpretation area encompasses parts of temporal, parietal and
occipital lobes
-2-
48. General interpretation area generally found on the left side
49. General interpretation area is concerned with storage of complex sensory
memories
50. Language areas are bilaterally located
51. Wernicke’s area is located in posterior temporal lobe on left side
52. Wernicke’s area is concerned with sounding out unfamiliar words
53. Affective language areas are located contralateral to Broca’s and
Wernicke’s areas
54. Affective language areas are concerned with nonverbal and emotional
components of language
55. Molecular layer of cerebral cortex (layer I) lacks cell bodies
56. Layers II & III of cerebral cortex are pyramidal cells that project to and
receive projections from other cortical regions
57. Layer IV of cerebral cortex represents stellate cells that receive most of
thalamic input and project locally to other lamina
58. Layer V & VI of cerebral cortex represent pyramidal neurons that project to
subcortical regions such as the thalamus, brainstem, and spinal cord, and other
cortical areas
59. Basal ganglia are caudate, putamen and globus pallidus
60. Basal ganglia receive inputs from most cortical structures and project to
motor cortex via the thalamus
61. Functions of basal ganglia are starting, stopping and monitoring movement
and inhibition of unnecessary movement
62. Diencephalon represents the core of forebrain surrounded by cerebral
hemispheres
63. Diencephalon involves three bilateral structures (thalamus, hypothalamus
and epithalamus)
64. Thalamus is comprised of multiple interconnected nuclei that receive
specific afferent projections and project (relay) processed information to
particular cortical areas
65. Hypothalamus is located below thalamus between optic chiasm and
mammillary bodies
66. Hypothalamus is connected to the pituitary via infundibulum
67. Hypothalamus is the visceral control center of the body
68. Hypothalamus is concerned with autonomic control (e.g., BP, HR)
69. Hypothalamus is concerned with emotional response (e.g., fear, sex drive)
70. Hypothalamus is concerned with regulation of body temperature
71. Hypothalamus is concerned with regulation of feeding
72. Hypothalamus is concerned with regulation of thirst
73. Hypothalamus is concerned with regulation of circadian rhythm
74. Hypothalamus is concerned with control of endocrine function
-3-
75. Epithalamus represents pineal body and choroid plexus
76. Pineal body controls sleep-cycle and produces melatonin
77. Choroid plexus is concerned with production of cerebral spinal fluid (CSF)
78. Brain stem is organized into midbrain, pons and medulla oblongata
79. Brain stem functions in autonomic behavior
80. Brain stem functions as pathway for fiber tracts
81. From brain stem, cranial nerves originate
82. Midbrain structures are: cerebral peduncles, corpora quadrigemina,
substantia nigra, red nucleus and reticular formation
83. Cerebral peduncles are fiber tracts connecting cerebrum with inferior
structures
84. Corpora quadrigemina are superior and inferior colliculi
85. Substantia nigra is a nucleus of dopamine neurons
86. Color of substantia nigra is due to melanin (dopamine precursor)
87. Red nucleus is concerned with motor reflexes
88. Pons lies between midbrain and medulla
89. Pons is comprised mostly of conducting fibers
90. Pons is a connection between higher brain areas and spinal cord
(longitudinal projections)
91. Pontine nuclei relay information between motor cortex and cerebellum
92. Pons has nuclei for several cranial nerves: trigeminal (V), abducens (VI)
and facial (VII)
93. Medulla oblongata lies between pons and spinal cord
94. No obvious demarcation between medulla and spinal cord
95. Medulla oblongata is landmarked by pyramids (descending and decussating
corticospinal tracts)
96. Medulla oblongata has nuclei for several cranial nerves: hypoglossal (XII),
glossopharyngeal (IX), vagus (X), accessory (XI) and vestibulocochlear (VIII)
97. Medulla oblongata controls visceral motor function
98. Medulla oblongata contains the cardiovascular center: cardiac center and
vasomotor center
99. Medulla oblongata controls vomiting, hiccup, swallowing, coughing and
sneezing reflexes
100. Medulla oblongata contains the respiratory center that controls rate and
depth of breathing
101. Cerebellum is located dorsal to pons and medulla and caudal to occipital
lobe
102. Cerebellar hemispheres consists of posterior, anterior and flocolonodular
lobes
103. Cerebellar hemispheres are connected by vermis
-4-
104. Cerebellar peduncles are fiber tracts connecting brain stem and sensory
cortices with cerebellum
105. Cerebellum functions in precise timing of skeletal contraction
106. Within cerebellum, sensory and motor information is integrated
107. Limbic system is a group of cortical structures located on medial aspect of
the cerebral hemisphere and diencephalon with complex connectivity
108. Structures of limbic system are: upper part of brainstem, rhinencephalon,
septal nuclei, cingulate gyrus, parahippocampal gyrus (hippocampus), amygdale,
diencephalon structures (hypothalamus and anterior nucleus of the thalamus) and
fiber tracts (fornix and fimbria)
109. Limbic system functions in emotional and affective state
110. Reticular formation is a complex of nuclei and white matter
111. Reticular formation has disperse and widespread connectivity
112. Reticular formation is located in central core of medulla, pons and midbrain
113. Reticular formation functions in maintenance of wakefulness and attention
by coordination of all afferent sensory information
114. Reticular formation functions in coordination of muscle activity by
modulation of efferent motor information
115. Cerebrospinal fluid (CSF) is found in cerebral ventricles and central canal
of spinal cord
116. Cerebrospinal fluid (CSF) is produced by choroid plexuses
117. Gray matter in spinal cord lies centrally
118. In spinal cord, lateral horn of gray matter is found in thoracic and superior
lumbar regions only
119. Posterior (dorsal) and anterior (ventral) horns are found in all regions of
spinal cord
120. Anterior horn of spinal cord contains cell bodies of somatic motor neurons
121. Lateral horn of spinal cord contains cell bodies for autonomic (sympathetic)
motor neurons
122. Somatic and autonomic (sympathetic) motor neurons leave via ventral root
of spinal cord
123. Dorsal root ganglion contains cell bodies of sensory neurons
124. Sensory neurons project to spinal cord via dorsal root
125. Some sensory neurons enter white matter tracks of spinal cord and ascend,
others synapse with interneuron located in posterior horn
126. Spinal nerves are lateral fusion of ventral and dorsal roots
127. Most of spinal pathways decussate
128. Most of spinal pathways are poly-synaptic (two or three neurons)
129. Most of spinal pathways are mapped (position in cord reflects location on
body)
130. All of spinal pathways are paired
-5-
131. Dorsal column (fasciculi cuneatus and gracilis) is an ascending (sensory)
pathway which conveys senses of touch and proprioception
132. Spinothalamic (anterior and lateral) tracts are ascending (sensory) pathway
which convey senses of pain and temperature
133. Upper motor neurons are descending (motor) pathways having their cell
bodies in the brain
134. Lower motor neurons are descending (motor) pathways having their cell
bodies in anterior horn of spinal cord
135. Direct upper motor neurons are anterior and lateral (pyramidal)
corticospinal tracts
136. Indirect upper motor neurons are multi-neuronal as rubrospinal,
vestibulospinal, reticulospinal and tectospinal tracts
137. Structural components of peripheral nervous system are: sensory receptors,
peripheral nerves and ganglia and efferent motor endings
138. Mechanoreceptors are sensory receptors detecting touch, vibration, pressure
or stretch
139. Thermoreceptors are sensory receptors detecting temperature changes
140. Photoreceptors, which are sensory receptors detecting light energy, are
exclusively found in the retina
141. Chemoreceptors are sensory receptors detecting chemical in solution
142. Nociceptors are sensory receptors detecting pain
143. Proprioceptors are sensory receptors located in musculoskeletal organs
144. Most sensory receptors are simple (generalized)
145. Complex sensory receptors act as special senses as vision, audition,
olfaction or gestation
146. Free dendritic endings are unencapsulated sensory receptors as Merkel
discs and root hair plexus
147. Meisner’s corpuscles are encapsulated sensory receptors detecting low
frequency vibrations
148. Pacinian corpuscles are encapsulated sensory receptors detecting high
frequency vibrations
149. Ruffini’s corpuscles are encapsulated sensory receptors detecting deep
pressure
150. Muscle spindles are encapsulated sensory receptors detecting muscle
stretch
151. Golgi tendon organs are encapsulated sensory receptors detecting tendon
stretch
152. Varicosities are contacts between autonomic motor endings and visceral
effectors and organs, smooth and cardiac muscle
153. Cranial nerves that perform sensory functions only are: I, II and VIII
(olfactory, optic and vestibulocochlear) nerves
-6-
154. Cranial nerves that perform motor functions only are: III, IV, VI, XI and
XII (oculomotor, trochlear, abducens, accessory and hypoglossal) nerves
155. Cranial nerves that perform sensory and motor functions are V, VII, IX and
X (trigeminal, facial, glossopharyngeal and vagus) nerves
156. Human being has 31 spinal nerves: 8 cervical, 12 Thoracic, 5 Lumbar, 5
Sacral and 1 Coccygeal
157. Spinal nerves are named for the level of the vertebral column from which
the nerves exits
158. Dermatomes are areas of skin innervated by the cutaneous branch of a
single spinal nerve
159. All spinal nerves (except C1) have dermatomes
160. Dermatomes overlap
161. Reflex activity is a stimulus-response sequence that is unlearned,
unpremeditated and involuntary
162. Components of a reflex arc are: receptor, sensory neuron, integration
center, motor neuron and effector
163. Autonomi neurons are postganglionic driven by preganglionic neurons
whose cell bodies are in the spinal cord or brainstem
164. Preganglionic parasympathetic neurotransmitter is acetylcholine
165. Preganglionic sympathetic neurotransmitter is acetylcholine
166. Postganglionic parasympathetic neurotransmitter is acetylcholine
167. Postganglionic sympathetic neurotransmitter is nor epinephrine
168. Acetylcholine acts locally and it always has a stimulatory effect
169. Nor epinephrine spreads far and can exert its effects over long distances
when circulated in the blood
170. Adrenergic receptors are alpha (stimulatory) and beta (inhibitory, except in
the heart when it is excitatory)
171. Parasympathetic neuron has long preganglionic and short postganglionic
fibers
172. Sympathetic neuron has short preganglionic and long postganglionic fibers
173. Parasympathetic ganglion is located in visceral organ
174. Sympathetic ganglia lie close to spinal cord (sympathetic chain ganglia)
175. Parasympathetic division function in maintenance of function and energy
conservation
176. Sympathetic division functions in emergence and intense muscular activity
177. Pupil dilatation is a sympathetic response
178. Secretory inhibition is a sympathetic response
179. Stimulation of sweating is a sympathetic response
180. Increased heart rate is a sympathetic response
181. Dilatation of coronary vessels is a sympathetic response
182. Increased blood pressure is a sympathetic response
-7-
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Constriction of most vessels is a sympathetic response
Bronchiolar dilatation is a sympathetic response
Decreased activity of digestive system is a sympathetic response
Piloerection is a sympathetic response
Increased metabolic rate is a sympathetic response
Glucose is released into blood as a sympathetic response
Lipolysis is a sympathetic response
Increased alertness is a sympathetic response
Ejaculation is a sympathetic response
Vaginal reverse peristalsis is a sympathetic response
Pupils constriction is a parasympathetic response
Stimulation of secretory activity is a parasympathetic response
Increased salivation is a parasympathetic response
Decreased heart rate is a parasympathetic response
Constriction of coronary vessels is a parasympathetic response
Bronchiolar constriction is a parasympathetic response
Increased activity of digestive system is a parasympathetic response
Erection of penis or clitoris is a parasympathetic response
Vasodilatation is a parasympathetic response
Retina of the eye converts light energy into neuronal activity
Axons of the retinal neurons are bundled to form the optic nerves
Pupil is an opening that allows light to reach the retina
Iris is a circular muscle that controls the diameter of the pupil
Aqueous humor is the fluid behind the cornea
Sclera is the outermost layer that forms the eyeball
Extraocular muscles are attached to the eye and skull and allow movement
Conjunctiva is a membrane inside the eyelid attached to the sclera
Optic nerve is formed by axons of the retina leaving the eye
Cornea is a transparent surface covering the iris and pupil
Macula is the area of retina responsible for central vision
Fovea is the center of retina where most of the cones are present
Lens is a transparent surface that contributes to the formation of images
Ciliary muscles change the shape of the lens and allow focusing
Vitreous humor is more viscous than the aqueous humor
Vitreous humor lies between the lens and the retina
Retina is the inner most layer of cells at the back of the eye
Audition is a sense of hearing
Sound is an audible variation in air pressure (compressions)
Amplitude or intensity of sound is perceived as differences in loudness
Pitch of sound is the frequency of compressions per second
Unit of sound pitch is hertz (1 cycle/second)
-8-
224. Pinna is a funnel shaped outer ear made of skin and cartilage
225. Auditory canal is a channel leading from the pinna to the tympanic
membrane
226. Ossicles of middle ear transfer the movement of the tympanic membrane
into the oval window
227. Bones of middle ear are malleus (hammer), incus (anvil) and stapes
(stirrup)
228. Cochlea is filled with an incompressible fluid
229. More force is required to displace cochlear fluid than air
230. Bones in the middle ear amplify the pressure
231. Malleus is displaced in response to the movement of the tympanic
membrane
232. Bottom of tympanic membrane moves towards the inner ear and the top
moves towards the outer ear
233. Movement of malleus pulls the top of the incus towards the outer ear and
pushes the bottom towards the inner ear
234. Oval window is smaller than tympanic membrane and the same pressure
across a smaller area results in a greater force (like a spiked high heel)
235. Eustachian tube connects the air-filled middle ear to the mouth
236. Cochlea of inner ear converts the physical movement of the oval window
into neural signal
237. Vestibular apparatus is not part of the auditory system
238. Vestibular apparatus is involved in balance
239. Taste (Gustation) and smell (olfaction) have similar tasks
240. Taste (Gustation) and smell (olfaction) function in detection of
environmental chemicals
241. Taste (Gustation) and smell (olfaction) are required to perceive flavor
242. Taste (Gustation) and smell (olfaction) have strong and direct connections
to our most basic needs like thirst, hunger, emotion, sex, and certain forms of
memory
243. Taste (Gustation) and smell (olfaction) systems are separate and different
and only merge at higher levels of cortical function
244. Taste (Gustation) and smell (olfaction) have different chemoreceptors
245. Taste (Gustation) and smell (olfaction) use different transduction pathways
246. Taste (Gustation) and smell (olfaction) have separate connections to the
brain
247. Taste (Gustation) and smell (olfaction) have different effects on behavior
248. Basic gustation categories are salty, sour, sweet and bitter
249. Most foods have a distinctive flavor as a result of their taste and smell
occurring simultaneously
-9-
250. Sensory modalities like food texture, temperature and pain sensitivity may
also contribute to a unique food-tasting experience
251. Organs of taste are tongue, pharynx, palate and epiglottis
252. Bitter taste is perceived across the back of tongue
253. Sour taste is perceived on side closest to the back of tongue
254. Salty taste is perceived on side of tongue more rostral than sour
255. Sweet taste is perceived across front of tongue
256. Odors perceived to be noxious are often deleterious
257. Taste and sour taste stimuli may pass directly through an ion channel
258. Sour and bitter taste stimuli may bind to (and block) ion channels
259. Some sweet amino acids bind to (and open) ion channels
260. Sweet and bitter taste stimuli may bind to membrane receptors that activate
2nd messenger systems that in turn open or close ion channels
261. In salt receptor cells, Na+ increase within the cell depolarizes the membrane
and opens a voltage dependent Ca++ channel
262. In sour receptor cells, H+ ions block K+ channels
263. In sweet receptor cells, G-protein activates an effector enzyme adenylate
cyclase (cAMP produced)
264. In sweet receptor cells, cAMP causes K+ channels to be blocked
265. In sweet receptor cells, G-protein activates an effector enzymephospholipase C
266. In sweet receptor cells, Ca++ is released from intracellular storage
267. In olfactory receptor cells, 2nd messenger (cAMP or IP3) opens a Ca++
channel
268. In olfactory receptor cells, Ca++ influx does not cause NT release. It opens a
Cl- channel
Second: Cardiovascular system
269. Left ventricle is much larger and thicker than right one
270. Atrioventricular (AV) valves are closed during ventricular contraction
(systole)
271. Right AV valve is tricuspid
272. Left AV valve is bicuspid (mitral valve)
273. Chordae tendineae (heart strings) are collagen cords anchoring cusps to
papillary muscles
274. Semilunar (SL) valves open during ventricular contraction (systole)
275. There are no valves between atria and venae cavae and pulmonary veins
276. Atrial contraction compresses venous entry points (valve action)
277. Blood flow to myocardium occurs only during diastole
- 10 -
278. Angina pectoris is temporary deficient blood flow to the myocardium
279. Myocardial infarction (MI) is cardiac cell necrosis (cell death) due to O2
deficiency
280. Cardiac muscle initiates action potentials independent of nervous
innervation
281. Long refractory period in cardiac AP prevents tetanic contractions
282. Pace maker cells depolarize spontaneously
283. Autorhythmic cells have unstable resting membrane potential that drift
towards threshold
284. Ca2+ influx from extracellular space causes rising phase of AP in pace
maker cells
285. Sinoatrial (SA) node has the fastest rate of depolarization
286. Sinoatrial (SA) node causes the characteristic rhythm of the heart (sinus
rhythm)
287. Sinoatrial (SA) node is located in right atrial wall
288. Atrioventricular (AV) node is located in interatrial septum near tricuspid
valve
289. Diameter of fibers in AV node is smaller than SA node
290. Atrioventricular (AV) node slows impulse conduction 0.1 sec
291. AV node permits completion of atrial contraction
292. Impulse passes from AV node to bundle of His
293. Atrioventricular bundle is the bundle of His
294. Atrioventricular bundle (bundle of His) is located in inferior interatrial
septum
295. Bundle of His transmits impulse from atria to ventricles
296. Bundle of His is very short
297. Bundle of His branches to form bundle branches
298. Bundle branches course interventricular septum toward apex of heart
299. Purkinje fibers reach apex then branch superiorly into ventricular walls
300. Impulses in purkinje fibers move faster than cell to cell contact
301. Purkinje fibers ensures greater pumping efficacy
302. Arrhythmias are uncoordinated contractions of atria and ventricles
303. Fibrillation means rapid, irregular contractions
304. Ectopic focus is excitable tissue other than SA node controls heart
contractions
305. Heart block is damage to AV node
306. In heart block, impulse cannot reach ventricles
307. Cardioaccelatory center in medulla is sympathetic NS control that
innervate SA and AV nodes
308. Cardioinhibitory center sends PS innervation to SA and AV nodes via X
nerve to slow HR
- 11 -
309. In ECG, P wave represents depolarization moving from SA node through
atria
310. QRS complex represents ventricular depolarization that precedes
contraction
311. T wave represents ventricular repolarization
312. T wave spreads out more than QRS complex because repolarization is
slower than depolarization
313. P-R interval lasts from beginning of atrial excitation to ventricular
excitation
314. P-R interval includes atrial depolarization and contraction
315. P-R interval represents passage of impulse through intrinsic conduction
system
316. P-R interval lasts 0.16 sec.
317. Q-T interval lasts from ventricular depolarization through repolarization
318. Q-T interval includes time of ventricular contraction
319. Total time of cardiac cycle is 0.8 sec.
320. Time of atrial systole is 0.1 sec.
321. Time of ventricular systole is 0.3 sec.
322. Time of quiescent period is 0.4 sec.
323. 70% of ventriclular filling occurs prior to atrial contraction
324. Ventricular filling occurs during mid-to-late diastole
325. During ventricular filling, AV valves are open and semilunar valves are
closed
326. Atrial systole occurs during ventricular filling
327. Ventriclular depolarization (QRS wave) occurs during ventricular filling
328. During ventricular systole, AV valves close and semilunar valves are also
closed
329. In isovolumetric contraction phase, BP in aorta and pulmonary trunk
exceeds intraventricular pressure
330. In isovolumetric contraction phase, pressure in ventricles increases without
volume changing
331. In ventricular ejection phase, intraventricular pressure exceeds pressure in
large vessels
332. In ventricular ejection phase, semilunar valves open
333. In ventricular ejection phase, blood is propelled out of ventricles
334. In ventricular ejection phase, atria begin to fill with blood
335. Isovolumetric relaxation occurs during early diastole
336. T wave occurs during isovolumetric relaxation
337. During isovolumetric relaxation, intraventricular pressure drops
338. During isovolumetric relaxation, blood in vessels outside heart begins to
flow back into ventricles
- 12 -
339. During isovolumetric relaxation, semilunar valves close and aortic pressure
increases resulting in dicrotic notch
340. During isovolumetric relaxation, semilunar valves close and AV valves
still closed
341. In sound 1 of heart sounds, AV valves close
342. Sound 1 of heart sounds refers to the onset of systole
343. Sound 1 of heart sounds is louder and longer than sound 2
344. In sound 2 of heart sounds, semilunar valves close
345. Sound 2 of heart sounds refers to the beginning of ventricular diastole
346. Sound 2 of heart sounds is short and sharp sound
347. The pause after sound 1 sound 2 of heart sounds refers to the quiescent
period
348. Sounds of separate heart valves can be differentiated
349. Timing of heart valves' sounds is: mitral, tricuspid, aortic semilunar and
then pulmonary semilunar in succession
350. Cardiac Output (CO) is the amount of blood pumped by each ventricle per
minute
351. Cardiac Output (CO) = Stroke volume X Heart rate
352. Stroke volume is the volume of blood pumped out of each ventricle per
beat
353. Stroke volume is the difference between EDV and ESV
354. EDV is determined by length of ventricular diastole and amount of venous
pressure
355. Normal EDV is about 120 ml
356. ESV is determined by arterial pressure and force of ventricular contraction
357. Normal ESV is about 50 ml
358. Preload is the degree of stretch prior to ventricular contraction
359. Preload is the most important factor affecting EDV
360. The greater the stretch of cardiac fibers, the greater the force of contraction
361. Volume and speed of venous return increase stretch of cardiac fibers
362. Slow heart rate increases stretch of cardiac fibers by providing much time
for filling
363. Contractility is increased independent of muscle stretch
364. Increased Ca2+ into cardiac cells, increases contractility and volume ejected
from heart
365. Increased contractility decreases ESV
366. Afterload refers to arterial blood pressure
367. Normal pressure in aorta is 80 mm Hg and in pulmonary trunk 10 mm Hg
368. Afterload is not normally a factor in healthy individuals
369. Afterload may have an adverse effect in individuals with hypertension
370. Sympathetic postganglionic neurons release NE at cardiac targets
- 13 -
371. Action of NE at cardiac targets is mediated by ß1 adrenergic receptors
372. Upon stimulation of ß1 adrenergic receptors, pacemaker RMP is brought
closer to threshold (depolarized)
373. Stimulation of ß1 adrenergic receptors increases heart rate
374. Stimulation of ß1 adrenergic receptors increases Ca2+ influx into contractile
cells
375. Stimulation of ß1 adrenergic receptors increases ESV
376. Parasympathetic division decreases heart rate
377. Parasympathetic activity is mediated by acetycholine
378. Acetycholine hyperpolarizes (inhibits) SA node
379. Vagal tone means that the effect of parasympathetic division predominates
on AV node
380. Dominant parasympathetic effect is to reduce activity of AV node by 25
beats/min
381. Hormones of adrenal medulla increases HR and contractility
382. Decreased Ca2+ concentrations causes depressed heart function
383. Increased Ca2+ concentrations causes heart irritability
384. Age has inverse relation with heart rate
385. Female has faster heart rate
386. Heart rate is increased during exercise
387. SV and muscle mass are increased in athlete
388. Heart rate is lowered when body temperature is cold
389. Blood flow is the volume of blood flowing through a given structure per
unit time (ml/min)
390. Blood pressure is the force per unit area (mm Hg)
391. Resistance is the opposition to flow
392. Resistance to blood flow is generally encountered in the systemic circuit
(peripheral resistance)
393. Resistance to blood flow is increased with increase in blood viscosity
394. Blood viscosity is the thickness related to formed elements
395. Resistance to blood flow is increased with increase in the total blood
vessels length
396. Resistance to blood flow is increased with decrease in blood vessel
diameter
397. Resistance to blood flow = 1/r4
398. In healthy humans, diameter is the greatest source of resistance
399. Blood Flow (F) = ∆P/PR (Difference in blood pressure between two
points/peripheral resistance)
400. Blood pressure results when flow opposed by resistance
401. Blood pressure is the highest in aorta and the lowest in right atrium
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402. Blood pressure is affected by compliance, distensibility and volume of
blood forced into the arteries near heart
403. Systolic pressure is about 120 mm Hg
404. Diastolic pressure is about 70 - 80 mm Hg
405. Pulse pressure is the difference between systolic and diastolic pressure
406. Mean arterial pressure (MAP) = diastolic pressure + 1/3 pulse pressure
407. Venous return is aided by respiratory pump and muscular pump
408. For venous return, muscular pump is more important than respiratory pump
409. During venous return, contraction of skeletal muscle surrounding veins
compress vein and backflow is prevented by valves
410. During venous return, blood moves in direction of heart
411. Blood pressure = Cardiac output X Peripheral resistance
412. Cardiac output is directly related to blood volume
413. Reduced parasympathetic control increases HR and enhances cardiac
output
414. Increased sympathetic activity increases contractility of heart
415. Increased sympathetic activity reduces ESV and increases stroke volume
416. Increased sympathetic activity releases epinephrine into blood stream from
adrenal medulla which increases heart rate
417. Increased sympathetic activity increases activity of respiratory and
muscular pumps
418. Increased sympathetic activity increases venous return by increasing EDV
and stroke volume
419. Vasomotor fibers are sympathetic efferents that innervate smooth muscle of
arterioles resulting in vasoconstriction
420. Vasomotor center regulates blood vessel diameter
421. Baroreceptors located in carotid sinuses, aortic arch and walls of all large
vessels
422. Baroreceptors stretching inhibits vasomotor center
423. Baroreceptors stretching causes dilation of arteries and veins
424. Arteriole dilation reduces peripheral resistance
425. Venodilation shifts blood to venous reservoirs, decreases venous return and
cardiac output
426. Baroreceptors inhibit sympathetic NS and stimulate parasympathetic NS
427. Stimulation of baroreceptors decreases HR and contractile force
428. Carotid sinus reflex protects blood supply to brain
429. Aortic reflex maintains supply to systemic circuit
430. Chemoreceptors respond to changes in O2 and CO2 concentrations and pH
431. Chemoreceptors are located in carotid and aortic arch and carotid sinus
432. Chemoreceptors are primarily involved in control of respiratory rate and
depth
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433. Adrenal medulla hormone NE is a vasoconstrictor
434. Adrenal medulla hormone EPI increase cardiac output by increasing
cardiac muscle contractility
435. Atrial natriuretic peptide (ANP) reduces blood pressure by antagonizing
aldosterone
436. Atrial natriuretic peptide (ANP) reduces blood pressure by increasing water
excretion from kidney
437. Antidiuretic hormone (ADH) increases blood pressure by increasing water
absorption
438. Antidiuretic hormone (ADH) at high concentrations, causes
vasoconstriction
439. Angiotensin II causes vasoconstriction of systemic arterioles
440. Angiotensin II causes release of aldosterone from adrenal cortex
441. Endothelium-derived factors endothelin is vasoconstrictor
442. Endothelium-derived factors prostaglandin-derived growth factor (PDGF)
is vasoconstrictor
443. Endothelium-derived factors Nitrous oxide (NO) is fast acting local
vasodilator
444. Histamine is an inflammatory chemical causes vasodilatation by increasing
capillary permeability
445. Alcohol reduces blood pressure
446. Alcohol inhibits ADH release and increases loss of water in urine
447. Alcohol increases vasodilation (skin) by depressing vasomotor center
448. Increased BP increases amount of filtrate entering tubules
449. Direct action of the kidney in BP is by regulation of blood volume
Third: Muscle and Nerve
I. Muscle
450.
451.
452.
453.
454.
455.
456.
457.
458.
459.
460.
461.
One function of skeletal muscle is temperature homeostasis
Sarcomere is the functional unit of skeletal muscle
A-band is composed of thick filaments
I-band is composed of the light isotropic bands
H-band is visible only in relaxed muscle
M-line bisects H-band
Z-disc is connecting thin filaments together
Myosin is composed of tail and two globular heads
Tropomyosin blocks binding sites on actin
Troponin is composed of three subunits TnT, TnC and TnI
TnI is the inhibitory protein that binds actin
Sarcotubular system means sarcolemma and sarcoplasmic reticulum
- 16 -
462.
463.
464.
465.
466.
467.
468.
469.
470.
471.
472.
473.
474.
475.
476.
477.
478.
479.
480.
481.
482.
483.
484.
485.
486.
487.
488.
489.
490.
491.
Sarcoplasmic reticulum is the Ca2+ stores in skeletal muscle
Motor end plate is the neuromuscular junction
Rigor mortis occurs due to absence of ATP after death
Contraction and relaxation of skeletal muscles requires ATP
Motor units in human beings are either slow oxidative or fast glycolytic
Red muscles response is slow with long latency
White muscles response is quick with short latency
Gross movement requires few large size motor units
Fine and graded movement requires numerous small size motor units
In isotonic contraction, muscle changes in length and moves load
In isometric contraction, tension increases and muscle length is constant
Fatty acids are the major source of energy at rest
Oxygen debt gives an explanation of pant
Exhaustion is a state of fatigue
Lmax is an optimum resting sarcomere length
To is a maximum active isometric tension
Sarcolemma is the plasma membrane of muscle fiber
Syncytium of cardiac muscle is due to intercalated discs and gap junctions
Presence of plateau phase is due to influx of Ca2+ ions
Late rapid repolarization phase is due to closure of Ca2+ channels
Myogenic contraction is originated inside the muscle
Prepotential is the pacemaker potential
Calmodulin in smooth muscle replaces troponin
Contraction in response to stretch is a unique property of smooth muscle
Plasticity of smooth muscle means stress-relaxation
Tone (tonus) means a continuous state of partial contraction
Single-unit smooth muscle is found in the wall of hollow viscera
Multi-unit smooth muscle is found in the iris of eye
Muscle fiber is the muscle cell
Cardiac muscle source of energy is only aerobic
II. Nerve
492. Neurons confer the unique functions of the nervous system while glia are
the supporting elements
493. Glia are 10 times as many as neurons.
494. Astrocytes are the glial cells that also participate in information processing
in the brain
495. Astrocytes are the most abundant, most versatile glial cells in CNS.
496. Astrocytes have a role in making exchange between capillaries and neurons
in CNS
- 17 -
497. Astrocytes have a role in guiding migration of young neurons and in
synapse formation in CNS
498. Astrocytes regulate extracellular space in CNS
499. Mopping up leaked potassium ions is a function of astrocytes
500. Restricting and recycling neurotransmitters is a function of astrocytes
501. Microglia migrate toward injured CNS neurons and transform into special
type of macrophages
502. Microglia are the scavenger cells that get rid of microorganisms or neural
debris in CNS.
503. Ependymal cells line the central cavities of brain and spinal cord.
504. Oligodendrocytes are the myelinating glia in CNS that form myelin sheath
505. Schwann cells produce myelin sheath and neurilemma in peripheral
neurons
506. Satellite cells surround cell bodies in PNS and have many functions as
astrocytes in CNS
507. Nerve type Aα has the largest diameter and fastest conduction velocity
508. Somatic motor and proprioceptive nerve fibers are of Aα nerve type.
509. Sensory fibers of fine touch and fine pressure are of Aβ nerve type
510. Motor fibers to muscle spindle are of Aγ nerve type.
511. Sensory fibers of acute pain are of Aδ nerve type.
512. Sensory fibers of crude touch are of Aδ nerve type.
513. Sensory fibers of cold are of Aδ nerve type.
514. Preganglionic autonomic nerve fibers are of B nerve type.
515. Nerve type C has the smallest diameter unmyelinated fibers
516. Sensory fibers of chronic pain are of C nerve type .
517. Sensory fibers heat are of C nerve type .
518. Sensory fibers of gross pressure are of C nerve type .
519. Sensory fibers of postganglionic sympathetic fibers are of C nerve type
520. The membrane interior of all living cells is negative in relation to the
membrane exterior
521. Resting membrane potential present in muscle, nerve and all living cells
522. Action potential present only in excitable tissues
523. RMP of nerve cell is –70 mV
524. RMP of skeletal muscle is –90 mV
525. RMP of cardiac muscle is –85 mV
526. RMP of smooth muscle is variable but nearly about –50 mV.
527. Na+ ions are much abundant extracellularly than intracellularly
528. Cl– ions are much abundant extracellularly than intracellularly
529. K+ ions are much abundant intracellularly than extracellularly
530. Phosphates and proteins are
much abundant intracellularly than
extracellularly
- 18 -
531. Na+-K+ ATPase pump extrudes 3 Na+ions outside and intrudes 2 K+ ions
inside the cell
532. Fast sodium channels are inactive at rest.
533. Fast sodium channels are voltage gated channels
534. K+ efflux results in diffusion potential which is the major factor responsible
for RMP
535. Local responses are not "all or none" responses
536. Action potentials in neurons are "all or none" responses
537. Threshold stimuli induce action potential.
538. Subthreshold stimuli may not affect the membrane potential or cause only
local responses
539. Supramaximal stimuli induce the same effects as threshold stimuli
540. Depolarization phase is due to activation of all fast Na+ channels
541. Repolarization phase in neuron is mainly due to fast inactivation of Na+
channels
542. Hyperpolarization phase is due to slow closure of K+ channels
543. In absolute refractory period, Na+ channels cannot be reactivated
immediately after previous activation
544. In relative refractory period, stronger stimulus is needed to induce new, but
weaker, action potential
545. Ca++ ions stabilize the membrane by increasing threshold potential toward
more positive position
546. Lack of Ca++ results in tetanus
547. Action potential is triggered in axon hillock and transmitted along the axon
548. Myelin sheath provides insulation and, hence, increases conduction velocity
549. Electrotonic flow of current is very fast but, in neurons, gradually subsides
550. Successive action potentials are time consuming (0.1 millisecond for each)
551. Saltatory conduction is quicker because it is jumping from node to node
552. Orthodromic conduction is one of the benefits of absolute refractory period
553. Synaptic vesicles store neurotransmitter substance in the presynaptic
membrane
554. Post synaptic membrane contains no synaptic vesicles.
555. Neurotransmitters bind their specific receptors on the postsynaptic
membrane.
556. Within the synaptic cleft, neurotransmitters must be inactivated by
degradation, reuptake, diffusion, or bioconversion.
557. One-way conduction from pre- to post-synaptic neurons is one of properties
of synapses
558. Neurotransduction from electrical to chemical signal.is one of properties of
synapses
559. About 0.5 ms synaptic delay is one of properties of synapses
- 19 -
560. All-or-none rule is not one of the properties of synaptic potentials.
561. Spatiotemporal summation is one of properties of synapses
562. Arrival of impulses from numerous synaptic knobs on the same neuron at
the same time is called spatial summation
563. Arrival of multiple successive impulses at the same synaptic knob is called
temporal summation.
564. Occlusion means that the sum of activities of several neurons working
together is less than the sum of their activities when they work separately
565. Continuous recurrent weak synaptic potentials may cause habituation of
postsynaptic neuron
566. Continuous recurrent strong stimulations accompanied by other weak
stimulations may cause sensitization of postsynaptic neuron
567. Acetylcholine is one of small molecule, rapidly acting transmitters
568. Adrenaline is one of small molecule, rapidly acting transmitters
569. Serotonine is one of small molecule, rapidly acting transmitters
570. Dopamine is one of small molecule, rapidly acting transmitters
571. Histamine is one of small molecule, rapidly acting transmitters
572. Noradrenaline is one of small molecule, rapidly acting transmitters
573. γ-aminobutyric acid "GABA" is one of small molecule, rapidly acting
transmitters
574. Glycine is one of small molecule, rapidly acting transmitters
575. Glutamate is one of small molecule, rapidly acting transmitters
576. Aspartate is one of small molecule, rapidly acting transmitters
577. Nitric oxide "NO is one of small molecule, rapidly acting transmitters
578. Hypothalamic-releasing hormones are of neuropeptide, slowly acting
transmitters
579. Pituitary peptides are of neuropeptide, slowly acting transmitters
580. Peptides that act on gut and brain are of neuropeptide, slowly acting
transmitters.
581. Neurotransmitter molecule must be synthesized and stored in the
presynaptic neuron
582. Neurotransmitter molecule must be released by the presynaptic neuron
upon stimulation
583. ACh is the neurotransmitter for neuromuscular junction
584. ACh is the neurotransmitter for preganglionic neurons of the sympathetic
and parasympathetic PNS
585. ACh is the neurotransmitter for postganglionic neuron of the
parasympathetic PNS
586. ACh is the neurotransmitter for basal forebrain and brain stem complexes
587. ACh synthesis is catalyzed by choline acetyl transferase enzyme (CAT).
588. Acetylcholine degradation is by acetylcholinesterase enzyme (ACE).
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589. ACh nicotinic receptors are present in neuromuscular junction
590. ACh nicotinic receptors are present in sympathetic ganglia and many parts
of CNS
591. ACh muscarinic receptors are present in smooth muscles and glands.
Fourth: Renal
592. About 25% of the resting cardiac output ﴾1.25 L\min﴿ supplies the renal
tissue
593. Much greater blood flow to the renal cortex ﴾97%﴿ than to its medulla
594. The structural and functional unit of kidney is called nephron
595. proteins can not exit the glomerular basement membrane
596. Production of erythropoietin hormone is a function of kidney
597. One functions of kidney is regulation of bone metabolism
598. Renal clearance = GFR – tubular reabsorption + tubular secretion
599. Glomerular filtration is passive non-selective process
600. About 20% of renal plasma flow is filtered by glomerular filtration
601. Normal GFR = 125 ml\min
602. Out of the 180 L of filtered plasma, about 179 L are reabsorbed by renal
tubules
603. A substance used to measure GFR must not be stored, or metabolized by
kidney.
604. A substance used to measure GFR must not be produced, secreted or
reabsorbed by renal tubules.
605. A substance used to measure GFR must not affect GFR or RBF by itself
606. Endogenous substance like creatinine can be used to measure GFR
607. Renal blood flow = renal plasma flow / (1-hematocrit)
608. Renal blood flow = CPAH \ EPAH X (1-hematocrit)
609. Juxtaglomerular apparatus aid in autoregulation of GFR
610. Podocytes represent the visceral layer of Bowman’s capsule
611. Glomerular filtration rate = clearance of inulin
612. GFR = Kf * (PG + ΠB – PB - ΠG)
613. When RBF increases, GFR also increases
614. When filtration fraction increases, GFR also increases
615. Vasoconstriction of afferent arterioles decreases GFR
616. Slight vasoconstriction of efferent arterioles increases GFR
617. Severe vasoconstriction of efferent arterioles decreases GFR
618. Strong sympathetic activity decreases GFR
619. Severe hemorrhage decreases GFR
620. Cerebral ischemia decreases GFR
621. Adrenaline decreases GFR
- 21 -
622. Nor-adrenaline decreases GFR
623. Angiotensin II decreases GFR
624. Aspirin decreases GFR
625. Endothelin decreases GFR
626. Nitric oxide increases GFR
627. Prostaglandin increases GFR
628. Bradykinin increases GFR
629. Macula densa contains osmoreceptors that are sensitive to changes in
concentration of NaCl
630. Juxtaglomerular cells are specific smooth muscle cells in the wall of
afferent arterioles
631. Renin is produced by juxtaglomerular cells in response to any increase in
GFR or RBF
632. Tubular reabsorption is a highly selective process that may be passive or
active
633. Some substances are completely reabsorbed like amino acids and glucose
634. Some substances are mostly reabsorbed like bicarbonates and some other
electrolytes
635. Some substances (like water ..) are mostly reabsorbed in the presence of
specific hormones
636. Some substances (like sodium ions..) are mostly reabsorbed in the presence
of specific hormones
637. Some substances are 50% reabsorbed (and 50% excreted) like urea
638. Some substances are about completely excreted like creatinine
639. Some substances are about completely excreted like some drugs and
poisons
640. Renal threshold of a substance equals its transport maximum over GFR
(=Tm\GFR)
641. Transport maximum of glucose is about 325 mg\min
642. Ideal renal threshold of glucose is about 260 mg\100 ml
643. the actual renal threshold for glucose is about 180 mg\100 ml
644. Sympathetic activity leads to increase in tubular reabsorption of sodium
ions
645. Aldosterone increases reabsorption of sodium ions and excretion of
potassium ions
646. Adrenal insufficiency (Addison's disease) results in excessive sodium loss
and potassium retention
647. Adrenal hyperactivity (Cushing syndrome) results in sodium retention and
potassium depletion
648. Angiotensin acts directly (or indirectly) to increase sodium ions
reabsorption
- 22 -
649. Vasopressin increases water reabsorption and urine concentration
650. Atrial natriuretic peptide decreases sodium and water reabsorption
651. Parathyroid hormone increases calcium and magnesium ions reabsorption
652. Parathyroid hormone decreases phosphate reabsorption
653. Normal ECF osmolarity is about 280-300 mosm\L
654. When Posm decreases; kidneys excrete large amounts of diluted urine
655. When Posm increases; kidneys excrete small amounts of highly concentrated
urine
656. Net ultrafiltration pressure = + 10 mmHg
657. The human body must get rid of not less than 600 mosm of metabolic
wastes per day
658. The minimum obligatory urine volume is 0.5 L\day
659. Diabetes insipidus occurs when kidney losses its ability to produce
concentrated urine.
660. Descending limbs of Henle's loop are called countercurrent multipliers
661. Ascending vasa recta are the countercurrent exchangers
662. The major bulk of tubular reabsorption of water and solutes (about 65%)
occurs in proximal tubules
663. The major active reabsorption occurs in thick ascending Henle’s loop
664. About 15% of water reabsorption occurs in thin descending Henle’s loop
665. The thin descending Henle’s loop is impermeable to solutes
666. About 5% of reabsorption processes of electrolytes occur in distal
segments.
667. Recirculation of urea is responsible for about 40% of the process of urine
concentration
668. Vasopressin secretion is stimulated by decreased blood volume
669. Vasopressin secretion is stimulated by decreased blood pressure
670. Vasopressin secretion is stimulated by nausea and vomiting
671. Vasopressin secretion is stimulated by morphine
672. Vasopressin secretion is stimulated by nicotine.
673. Vasopressin secretion is inhibited by increased blood volume
674. Vasopressin secretion is inhibited by increased blood pressure
675. Vasopressin secretion is inhibited by alcohol intake
676. Increased osmolarity stimulates the thirst center in brain stem
677. Thirst center is stimulated by decreased ECF volume
678. Thirst center is stimulated by decreased blood pressure
679. Thirst center is stimulated by angiotensin II
680. Thirst center is stimulated by dryness of mouth, pharynx and esophagus
681. Thirst center is inhibited by decreased ECF osmolarity
682. Thirst center is inhibited by increased ECF volume
683. Thirst center is inhibited by increased blood pressure
- 23 -
684. Thirst center is inhibited by gastric distension
685. Decreased osmolarity stimulates salt appetite center in the brain stem
686. Pressure induced increase in Na+ excretion is called pressure natriuresis
687. Normal [H+] in ECF is only 0.00000004 mol\L
688. Bicarbonate buffer system is the most important buffer system in ECF
689. When HCO3¯ decreases; pH is decreased and there will be metabolic
acidosis
690. When PCO2 increases; pH is decreased and there will be respiratory
acidosis
691. When HCO3¯ increases; pH is increased and there will be metabolic
alkalosis
692. When PCO2 decreases; pH is increased and there will be respiratory
alkalosis
693. Phosphate buffer system is important buffer system in intracellular and
renal tubular fluids
694. Protein buffer systems are the most available intracellular buffer systems
but also work extracellularly
695. Ammonium buffer system is the last choice buffer system in renal tubules
696. Ammonium is formed from metabolism of glutamine inside renal tubular
cells
697. Osmotic diuretics act basically on proximal tubules by increasing tubular
fluid osmolarity
698. Urea is an example of osmotic diuretics
699. Mannitol is an example of osmotic diuretics
700. Sucrose is an example of osmotic diuretics
701. Loop diuretics are strong diuretics acting on thick ascending Hemle’s loop
702. Loop diuretics are strong diuretics acting by blocking 1Na+2Cl¯1K+
secondary active transport
703. Furosemide is an example of loop diuretics
704. Ethacrynic acid is an example of loop diuretics
705. Bumetanide is an example of loop diuretics
706. Thiazides act on early distal tubules
707. Thiazides act by blocking Na+-Cl¯ cotransport
708. Chlorothiazide is an example of thiazides
709. Carbonic anhydrase inhibitors act on proximal tubules and intercalated cells
of distal tubules
710. Carbonic anhydrase inhibitors act by inhibition of enzyme carbonic
anhydrase
711. An example of carbonic anhydrase inhibitors is acetazolamide (diamox)
712. Competitive aldosterone inhibitors act on cortical collecting tubules
- 24 -
713. Competitive aldosterone inhibitors act by competing with aldosterone and
blocking its receptors
714. Example of competitive aldosterone inhibitors is spironolactone (K+
sparing)
715. Na+ channels blockers act on collecting tubules
716. Na+ channels blockers act by blocking Na+ channels
717. An example of Na+ channels blockers is amiloride
718. An example of Na+ channels blockers is triametrene
- 25 -