PHYSIOLOGY COMPREHENSIVE EXAM POINTERS

IV. NEUROMUSCULOSKELETAL SYSTEM(14)

● Neuromuscular junction events

1. Presynaptic terminal: choline acetyltransferase converts CoA & choline to

ACh. Synaptic vesicles stores ACh, ATP, Proteoglycan
2. Presynaptic terminal depolarize: opens calcium channels which inc calcium
permeability
3. Calcium uptake→ synaptic vesicle fuse with plasma membrane → ACh release
into synaptic clef
4. ACh diffuse to postsynaptic membrane & bind to nicotinic receptors
5. Depolarization of specialized muscle end plate (end plate potential in
postsynaptic membrane)
6. Depolarization of adjacent muscle membrane → action potential à contraction
7. Degradation of ACh by acetylcholine transferase to Acetyl-CoA & choline

● Steps in excitation-contraction coupling in skeletal muscle

1 Action Potentials in the muscle cell membrane initiate depolarization of the T tubules
2 Depolarization of T tubules
3 Intracellular calcium increases
4 Calcium binds to troponin C → **Cross bridge cycle
5 Relaxation → intracellular calcium concentration decrease
6 mechanism of tetanus: no ATP

**Cross Bridge Cycle

1 No ATP is bound to myosin
2 ATP then binds to myosin
3 Myosin displaced toward the plus end of actin
4 Myosin attaches to new site on actin → power force-generating stroke
5 The cycle repeats as long as calcium is bound to troponin C

● Temporal vs. spatial summation

TEMPORAL SUMMATION SPATIAL SUMMATION

Summing successive discharges from a Summing simultaneous postsynaptic

single presynaptic terminal, if occur potentials by activating multiple terminals
rapidly, adding to one another on widely space areas of neuronal
membrane

● Tonic sensory receptors vs. rate sensory receptors

TONIC SENSORY RECEPTORS RATE SENSORY RECEPTORS

Slowly adapting receptors Rapid adapting receptors

Detect continuous stimuli strength React to change in stimuli strength

Constantly apprise the brain of the status Predictive function

of the body in relation to its surrounding

Pain receptors Pacinian corpuscle, joint receptor

● Classification of nerve fibers

 ● Types of mechanoreceptors and sensation encoded

● Fast pain vs. slow pain

FAST PAIN SLOW PAIN

Felt w/in 0.1 sec afer stimulus Felt afer 1 sec or more; increases slowly over
many sec/mins

AKA sharp pain, pricking pain, AKA slow burning pain, aching pain, throbbing
acute pain, electric pain pain, nauseous pain, chronic pain

Not felt in most deep tissue Associated with tissue destruction can lead to
prolonged, unbearable suffering

Stimuli Mechanical or thermal Mostly Chemical; sometimes mechanical or

thermal

Pain fiber Aδ fibers Type C fibers

velocity 6-30 m/sec 0.5-2 m/sec

Path in spinal cord to Neospinothalamic Tract Paleospinothalamic tract

brain

localization Can be Localized more exactly Imprecise

Neurotransmitter Glutamate Substance P

● Fever
-set-point temperature: 37.1 °C
Pyrogen, increase IL-1 production → IL-1 increase production of prostaglandins →
 prostaglandins increase set-point temp → activation of heat-generating
mechanisms

● CSF formation and flow

- 150 ml present in ventricles
- 500 ml/day
- secreted from choroid plexuses

Lateral ventricles → third ventricles → aqueduct of Sylvius → fourth ventricle → two

lateral foramina of Luschka a midline foramen of Magendie → cisterna magna →
subarachnoid space → arachnoid villi → venous sinuses

● Errors of refraction and their correction

Emmetropia = normal vision
Hyperopia (can’t see near object) Myopia (can’t see far object)

Farsightedness Nearsightedness

Eyeball too short Eyeball too long

Light rays focus behind the retina Light rays to focus front of the retina

Convex lens Concave lens

Astigmatism = imperfect image ; cylindrical lens
Keratoconus = odd shaped, bulging cornea ; contact lens
Cataract = opaque lens ; surgical removal of lens
Presbyopia = loss of accommodation by lens

● Photochemistry of vision
11-cis retinal → all-trans retinal → metarhodopsin II → activation of G protein
(transducin) → activation of phosphodiesterase → decrease cCGMP → closure of Na+
channels → hyperpolarization → decreased glutamate release

● Effect of lesions in the optic pathway on the fields of vision

Cutting the optic nerve = blindness in the ipsilateral eye
Cutting the optic chiasm = heteronymous bitemporal hemianopia
Cutting the optic tract = homonymous contralateral hemianopia
Cutting the geniculocalcarine tract = homonymous hemianopia with macular sparing

● Pattern of vibration of the basilar membrane for different sound frequencies

BASE of the Basilar Membrane APEX of the Basilar Membrane

Near the oval & round window Near the helicotrema

Narrow & stiff Wide & compliant

High frequencies Low frequencies

● Sympathetic vs. parasympathetic system (physiologic anatomy, neurotransmitters, receptor

types, actions)
 ● Pharmacology of ANS
Drugs that act on ADRENERGIC Drugs that act on Drugs that stimulate or
effector organ CHOLINERGIC effector block sympathetic &
organ parasympathetic

Sympathomimetic drugs Parasympathomimic Drugs Stimulate autonomic

● Epinephrine ● Pilocarpine postganglionic neurons
● norepinephrine ● methacholine ● nicotine
● methoxamine
● phenylephrine (A) Parasympathetic Ganglionic blocking
● isoproterenol (B) Potentiating effect- Drugs
● albuterol (B2) anticholinesterase Drugs ● tetraethyl
● Neostigmine ammonium ion
Drugs that cause release of ● pyridostigmine ● hexamethonium
norepinephrine from nerve ● ambenonium ion
ending ● pentolinium
● ephedrine Block Cholinergic Activity
● tyramine at Effector Organ-
● amphetamine Antimuscarinic drug
● atropine
● homatropine
● scopolamine

Drugs that block Adrenergic Activity

Reserpine Prevent synthesis & storage of NP in synthetic nerve

ending

Guanethidine Block release of NP from sympathetic nerve ending

Phenoxybenzamine, Blocks alpha 1 & 2 adrenergic receptor

Phentolamine

Prazosin, Terazosin Block alpha 1 adrenergic receptor

Yohimbine Alpha 2 adrenergic receptor blocker

Propanolol Block beta 1 & 2 receptor

Metoprolol, atenolol, Block beta 1 receptor

Nebivolol