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The following clearance measurements tubular secretion of organic anions (C) A rise in plasma creatinine from 1 were made in a man after he took a (D) Alkalinize the urine by infusing a mg/dL to 2 mg/dL diuretic drug fluoxetine 10 mg discount. What percentage of NaHCO3 solution intravenously (D) A rise in plasma creatinine from 2 filtered Na did he excrete? Which of the following provides the mg/dL to 4 mg/dL Plasma [inulin] 1 mg/mL most accurate measure of GFR? Renin in synthesized by Urine [Na ] 70 mEq/L (C) Inulin clearance (A) Granular cells Urine flow rate 10 mL/min (D) PAH clearance (B) Intercalated cells (A) 1% (E) Plasma (creatinine) (C) Interstitial cells (B) 5% 13 purchase fluoxetine 20mg with mastercard. Hypertension was observed in a young (D) Macula densa cells (C) 10% boy since birth purchase 20mg fluoxetine with mastercard. Which of the (E) Mesangial cells (D) 50% following disorders may be present? The following determinations were (E) 99% (A) Bartter’s syndrome made on a single glomerulus of a rat 8 purchase fluoxetine 10mg online. Renal autoregulation (B) Gitelman’s syndrome kidney: GFR discount 20mg fluoxetine with mastercard, 42 nL/min; glomerular (A) Is associated with increased renal (C) Liddle’s syndrome capillary hydrostatic pressure, 50 mm vascular resistance when arterial blood (D) Nephrogenic diabetes insipidus Hg; hydrostatic pressure in Bowman’s pressure is lowered from 100 to 80 mm (E) Renal glucosuria space, 12 mm Hg; average glomerular Hg 14. In a person with severe central diabetes capillary colloid osmotic pressure, 24 (B) Mainly involves changes in the insipidus (deficient production or mm Hg. What is the glomerular caliber of efferent arterioles release of AVP), urine osmolality and ultrafiltration coefficient? Refresher osmolality of 1,200 mOsm/kg H2O, (A) Creatinine course for teaching renal physiology. Molecu- is about (D) Na lar physiology of renal p-aminohippu- (A) 100 mOsm/kg H2O (E) Urea rate secretion. Total body water is distributed in two major compart- filtration rate, angiotensin II and aldosterone, intrarenal ments: intracellular water and extracellular water. In an av- physical forces, natriuretic hormones and factors such as erage young adult man, total body water, intracellular wa- atrial natriuretic peptide, and renal sympathetic nerves. The corresponding figures for cretion in response to excess Na or Na depletion. Estro- an average young adult woman are 50%, 30%, and 20% of gens, glucocorticoids, osmotic diuretics, poorly reabsorbed body weight. The effective arterial blood volume (EABV) depends on the Volume Amount of indicator Concentration of indicator degree of filling of the arterial system and determines the at equilibrium. Electrical neutrality is present in solutions of electrolytes; to Na retention by the kidneys and contributes to the de- that is, the sum of the cations is equal to the sum of the an- velopment of generalized edema in pathophysiological ions (both expressed in milliequivalents). Cells are the loop of Henle and is secreted by cortical collecting duct typically in osmotic equilibrium with their external environ- principal cells. The amount of water in (and, hence, the volume of) perkalemia and excessive K excretion produces hy- cells depends on the amount of K they contain and, simi- pokalemia. Calcium balance is regulated on both input and output the ECF is determined by its Na content. Plasma osmolality is closely regulated by arginine vaso- controlled by 1,25(OH)2 vitamin D3, and the excretion of pressin (AVP), which governs renal excretion of water, and Ca2 by the kidneys is controlled by parathyroid hormone by habit and thirst, which govern water intake. Magnesium in the body is mostly in bone, but it is also an posterior pituitary gland, and acts on the collecting ducts important intracellular ion. The kidneys regulate the of the kidney to increase their water permeability. Filtered phosphate usually exceeds the maximal reabsorp- tive plasma osmolality (detected by osmoreceptors in the tive capacity of the kidney tubules for phosphate (TmPO4), anterior hypothalamus) and a decrease in blood volume and about 5 to 20% of filtered phosphate is usually ex- (detected by stretch receptors in the left atrium, carotid si- creted. Phosphate reabsorption occurs mainly in the proxi- nuses, and aortic arch). The kidneys are the primary site of control of Na excre- portant pH buffer in the urine. Only a small percentage (usually about 1%) of the fil- significant problem in chronic renal failure. The urinary bladder stores urine until it can be conve- critical importance in overall Na balance. Multiple factors affect Na excretion, including glomerular both autonomic and somatic nerves. The and lymph water (15% body fluid surrounding our body cells (the ECF) is constantly re- Intracellular water weight; 10.

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A cleft palate may be hereditary or a complication of some The respiratory system is particularly vulnerable to infectious dis- disease (e buy fluoxetine 20mg without a prescription. A cleft lip is a genetically based developmental disor- highly social proven fluoxetine 20 mg, and the warm fluoxetine 20 mg, moistened environment along the der in which the two sides of the upper lip fail to fuse fluoxetine 10mg fast delivery. Injury and trauma palates and cleft lips can be treated very effectively with cos- are also frequent problems best fluoxetine 10mg. Cystic fibrosis is a genetic disorder that af- fects the respiratory system, as well as other systems of the body, Developmental Problems and accounts for approximately 1 childhood death in 20. The ef- fect of this disease on the respiratory system is usually a persistent of the Respiratory System inflammation and infection of the respiratory tract. Birth defects, inherited disorders, and premature births com- Pulmonary alveoli are not developed sufficiently to sus- monly cause problems in the respiratory system of infants. Thus, extrauterine life cleft palate is a developmental deformity of the hard palate of prior to that time is extremely difficult even with life-support- the mouth. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 17 Respiratory System 627 (a) FIGURE 17. The right side of the thorax appears uniformly dark because it is filled with air; the spaces between the ribs are also greater than those on the left, be- cause the ribs are released from the elastic tension of the lungs. The left lung appears denser (less dark) because of shunting of blood from the right to the left lung. Choking on a foreign object is a common serious trauma to the respiratory system. More than eight Americans choke to death each day on food lodged in their trachea. A simple proce- dure termed the abdominal thrust (Heimlich) maneuver can save the life of a person who is choking (fig. Stand behind the victim or the victim’s chair and wrap (b) your arms around his or her waist. If the victim is lying down: (nosebleeds) because the prominent nose can be easily bumped 1. With one of your hands on top of the other, place the blood pressure or diseases such as leukemia. Press into the victim’s abdomen with a quick upward pneumothorax can result from an external injury, such as a stab- thrust. A severely diseased lung, as in em- physema, can create a pneumothorax as the wall of the lung de- If you are alone and choking, use whatever is available to teriorates along with the visceral pleura and permits air to enter apply force just below your diaphragm. Respiratory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 628 Unit 6 Maintenance of the Body nately vaccines are available. Sinusitis can be quite painful if the drainage ducts from the sinuses into the nasal cavity become blocked. Tonsillitis may involve any or all of the tonsils and frequently follows other lingering diseases of the oral or pharyn- geal regions. Laryngitis is inflammation of the larynx, which often produces a hoarse voice and limits the ability to talk. Tracheo- bronchitis and bronchitis are infections of the regions for which they are named. Severe inflammation in these areas can cause smaller respiratory tubules to collapse, blocking the pas- sage of air. Pneumonia is an acute infection and inflammation of lung tissue accompanied by exudation (accumulation of fluid). It is usually caused by bacteria, most commonly by the pneumococcus bacterium. Tuberculosis is an inflammatory disease of the lungs contracted by inhaling air sneezed or coughed by someone who is carrying active tuberculosis bacteria. Asthma is a disease that affects people who are allergic to certain inhaled antigens. It causes a swelling and blocking of lower respiratory tubes, often FIGURE 17.

Activation of H1 receptors stimulates IP3 formation while the H2 receptor is linked to activation of adenylate cyclase purchase fluoxetine 10mg with amex. Autoradiography and receptor mRNA studies have shown H1 receptors to be located in most of the brain areas innervated by the ascending histaminergic axons best fluoxetine 20 mg, e generic fluoxetine 10 mg on-line. Their presence in the cerebellum is not accompanied by appropriate histaminergic innervation order 10 mg fluoxetine fast delivery. Very few are found in the striatum but this region does show a high density of H2 receptors discount 10mg fluoxetine mastercard. H2 receptors are also found with H1 in the cortex, hippocampus and limbic areas, but not in the hypo- thalamus. Although basically presynaptic the H3 receptor is also found postsynaptically in the striatum and cerebral cortex (Pollard et al. Although histamine generally inhibits neuronal firing in the cerebral cortex through H1 receptors it causes a H1-mediated excitation in the hypothalamus. It also appears to potentiate NMDA currents although the receptor type has not been established. In the hippocampus it has been shown to block the long-lasting hyperpolarisation (accommodation) that normally follows neuronal firing and is mediated through a Ca2‡-activated K‡ conduction. From time to time it has been suggested that histamine has some role in a number of behaviours and motor activity while the established and marked sedative effect of H1 receptor antagonists, mentioned at the start of this section, has consistently been considered to indicate a role for histamine in arousal and the sleep±waking cycle (see Chapter 22). Histamine release in the hypothalamus is higher during the active waking than the quiescent phase of behaviour, whether this is associated with darkness (in rats) or light (rhesus monkey). The firing rate of histamine neurons is also higher during arousal OTHER TRANSMITTERS AND MEDIATORS 271 Figure 13. Current knowledge does not justify presentation of a schematic histaminergic synapse. In the cat the H1 antagonist mepyramine increases the slow-wave sleep pattern while direct injection into the hypothalamus of histamine itself, or an inhibitor of histamine-N-methyltransferase to stop histamine breakdown, produces the opposite effect, but it is still sensitive to mepyramine. Such H1-induced waking effects have not been so clearly established in 272 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION humans. In contrast to these excitatory effects elevating brain histamine levels with metoprine, an inhibitor of histamine-N-methyltransferase protects rodents against maximal electroshock although the specificity of the effect remains to be established. Agonists and antagonists at the H3 autoreceptors, which should decrease and increase histamine release, have been shown to augment and reduce slow-wave sleep in rats and cats. There are in fact numerous demonstra- tions of this using tests which require visual±motor coordination such as vigilance tasks and finger tapping. Since the slowing of such function could result from retarding information processing in the visual cortex it is interesting that the latency of com- ponents of the evoked potential, which follows presentation of a changing (reversing) black and white checkerboard pattern, is prolonged significantly in humans by the H1 antagonist diphenhydramine, which enters the brain, but not by terfenedine which does not (Tharion, McMenemy and Rauch 1994). There is also some evidence that histamine may be involved in food and water intake and thermoregulation (see Hough and Green 1983). NEUROSTEROIDS Neurosteroids differ from nearly all the other transmitters and mediators in that they are lipid-soluble and can easily cross the blood±brain barrier. Thus it is necessary to distinguish those steroids that are produced in the brain from those that find their way there from the circulation after being released from the adrenal cortex or gonads. There are many natural and synthetic steroids that have some effect on neuronal function and can be considered neuroactive but few are actually produced in the brain to act on neurons, i. This also applies to tetrahydrodeoxycorticosterone for although it is formed by reduction of deoxycorticosterone within the brain, its synthesis depends on that steroid coming from the blood. The chemical structures and interrelationship of the neurosteroids listed in (b) and (c) above are shown in Fig. PREG and DHEA are known as 3b-hydroxy-D5-steroids and are also found in peripheral glands as intermediaries between cholesterol and active steroids such as PROG and testosterone. It seems that cholesterol may be the starting point of neurosteroid synthesis in the brain. Cytochrome P450scc, the specific hydroxylase needed for cleavage of the cholesterol side-chain to give PREG, has been found widely in white matter and in myelinating oligodendrocytes, but not in neurons. Enzymes are present for the conversion of PREG to PROG and both are reduced in glia and neurons. This does not occur with DHEA and very little is known of either its synthesis or metabolism. Neurosteroids are widely and fairly evenly distributed in the brain with few note- worthy localisations but the concentration of the conjugated forms (sulphated and reduced) of PREG and DHEA can exceed that of the parent compounds.

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