* Date of Exam:
Wednesday Dec 17 at 12:40p.
* Format:
similar to prior exams.
* Material
covered: Chaps: 15, 16, 17, 18, 19, 20, 21, 25.
Refer to previous review
sheets to prepare for cumulative portion.
Good study help:
interavtive physiology on your CD.
In addition to this guide,
the final word for inclusion of test material is on your lecture handouts.
¯ What is plasma and how does it differ from interstitial fluid?
¯ The distinctions of the different cellular components of blood
¯ Red blood cell structure and function
¯ The importance of hemoglobin (Hb)
Know the
following terms: CBC, hematocrit, differential WBC. What are the normal values
for RBC counts, total WBC counts, and platelet counts.
* What
is the role of EPO?
* In
the context of recycling the hemoglobin from old RBC explain the roles of:
transferrin, ferritin, and bilirubin.
* Describe four causes of anemia.
* Know
what angiogenesis is.
* Describe
the processes involved in formation of platelet plugs.
* Describe
the actions of the drugs coumadin and tPA - for what conditions are they used?
Understand blood vessel compliance; fluid exchange across capillary
walls; blood (plasma, cell types); anemia, intrinsic vs. extrinsic blood clotting
cascades (no details of cascade); blood groups, Rh reactions; basic respiratory
anatomy
¯ The sum of all partial pressures gives the total pressure for a mixture of gases (DaltonÕs Law). This is how individual gas exchange occurs: gases move from areas of higher partial pressures to areas of lower partial pressures.
¯ Air moves down pressure gradients.
¯ Pressure gradients are caused by volume changes (BoyleÕs Law). This is how the respiratory system creates air movement: muscles create volume changes, which create pressure changes, which cause air movement (Fig. 17-5, 17-8, 17-9).
¯ Individual gases move down partial pressure gradients.
¯ Ventilation and perfusion are matched to ensure efficient exchange and delivery of gases (Fig. 17-16).
¯ Oxygen transport in the blood is largely due to hemoglobin (Hb).
¯ Hemoglobin (Hb)-oxygen binding affinity is affected by: pH, CO2, temperature, and 2,3-DPG. These changes are reflected in the oxygen-Hb dissociation curve (Figs. 18-8, 18-9, 18-10, 18-11).
¯ Most CO2 is converted into H+ and HCO3- by carbonic anhydrase inside RBCs (Fig. 18-13).The reaction is: CO2 + H2O ó H+ + HCO3-. Therefore, body pH is related to Pco2 and ventilation.
¯ Respiration is under the control of a central pattern generator in the medulla oblongata and the pons (Figs. 18-15, 18-16).
¯ Chemical factors (O2, CO2, and H+) affect ventilation via central and peripheral chemoreceptors (Figs. 18-17, 18-18, 18-19). We can also exert conscious control over breathing, but not past the point of chemoreceptor response.
Respiratory
Physiology
* Be
able to draw a diagram of the respiratory tree from the trachea through the
alveoli. What are the structural features of trachea, bronchi, bronchioles, and
alveoli?
* Be
impressed with the numbers given to illustrate the size and thickness of the
respiratory membrane - what structures are included in this membrane?
* Know
those gas laws.
* For
the case of oxygen and CO2 at 100 mg Hg partial pressure over water in
equilibrium, what accounts for the differences between CO2 and O2?
* Be
familiar with the muscles that drive inspiration and expiration, respectively.
* With
the aid of a diagram explain the importance of the pleural cavity to
ventilation of the lungs.
* Define
the terms: compliance, elastance, restrictive lung disease, and obstructive
lung disease. Give examples of condition which can cause the latter two.
* Explain
the importance of surfactant to lung ventilation.
* Define
and give approximate values for the following: residual volume, vital capacity,
tidal volume, inspiratory reserve volume.
* What
is the anatomic dead space of the respiratory system; its approximate volume -
the consequences for you if your tidal volume is only 200 ml instead of the
more normal 500 ml.
* How
is an efficient balance maintained between the ventilation of alveoli and the
blood supply to the alveoli (matching ventilation to perfusion)?
* What
forces drive the exchange of CO2 and O2 between the blood of the pulmonary
capillaries and the alveoli? What are normal values for arterial pO2 and pCO2 -
how are these values measured?
* What
is meant by blood oxygen saturation?
* Draw
the oxygen dissociation curve for hemoglobin using accurate units for the 2 axes
of the graph.
* Describe
the effects on the position of the oxygen dissociation curve of: reduced pH,
higher 2,3 DPG concentrations, and increased temperature. Do these effects have
physiological value?
* How
does the fetus rob the maternal circulation of the oxygen it needs?
* Name
the 4 types of the ABO blood group system; explain the basis of who can give
blood to whom.
* Explain
the genesis of Hemolytic Disease of the Newborn: what combo of mother and fetus
can give rise to this; what causes the destruction of the fetal RBC; what
treatment of Rh- mothers avoids the problem altogether?
* Explain
the mechanisms involved in transporting CO2 produced by the tissues in the
blood (carbonic anhydrase?).
* Explain
how the central chemoreceptors in the medulla of the brain monitor respiration
in order to make adjustments in lung ventilation.
* Bronchitis
and emphysema are both COPD diseases - compare the abnormalities in lung
structure associated with each.
* Define:
FEV1. FRC.
¯
The nephron is the
functional unit of the kidney.
¯
The three basic
processes of the urinary system are:
filtration (F), reabsorption (R), and secretion (S). These processes are
related to excretion (E) by the equation:
E = F - R + S.
¯
Filtration is under
three types of control (myogenic, tubuloglomerular feedback, and reflex) that
regulate blood flow through the renal arterioles.
¯
Reabsorption and
secretion involve protein transporters.
Therefore, these processes exhibit saturation, specificity, and
competition [º Ch. 4, 5]
¯ Clearance (mL/min) is an abstract concept that describes renal handling of a substance based only on blood and urine analysis. This is a tricky concept, but Clearance is widely used in clinical settings.
Ch. 20 Fluid
and Electrolyte Balance
¯
The kidneys regulate
water and electrolyte balance by altering urine concentration and ion
excretion.
¯
Vasopressin (ADH) from
the posterior pituitary controls water reabsorption in the collecting duct.
¯
Aldosterone from the
adrenal cortex controls Na+ reabsorption in the distal nephron.
¯
There are two controls
for aldosterone release: direct and indirect. Direct: Increased K+.
Indirect: Renin released from
glomelular cells in response to decreased blood pressure.
¯
The
renin-angiotensin-aldosterone pathway is one of the most complex pathways in
this textbook. Know about it, but donÕt sweat the details.
¯
When faced with a
challenge involving osmolarity and volume, the body deals with osmolarity
changes first.
¯
Familiarize yourself
with the distinctions between the different types of acidosis and alkalosis.
Show the hallmarks for each as well as the compensations. You can use the
changes in the CO2 + H2O ó H+ + HCO3- equation
to characterize each form of acid-base disturbance.
* Clearly distinguish between the 3 major body fluid compartments. Which are ECF components. Be able to describe the major differences in composition between the 3 compartments and the ease with which solutes pass between the 3.
* Define
terms (SPELLING OUT AN ACRONYM IS NOT A DEFINITION): GFR, homeostasis,
interstitial fluid, ICF, transport epithelium, saturation kinetics of transport
across epithelia, aquaporin channels, ADH.
* Body
fluid composition
* Groan,
be able to label accurately the parts of a nephron and its associated blood
supply if you are presented with an unlabeled diagram of same. Also be able to
provide a one-line description of the role of each part.
* Give
an overview of the 3 processes responsible for nephron function.
* Describe
the opposing forces responsible for net filtration of plasma from the
glomerular caps into the Bowman's capsule. Describe the structure of the
membrane separating these two fluid filled vessels and its permeability.
* Reabsorption
in the nephron
* Diagram
the structures and processes involved in Na reabsorption from the tubule to the
peritubular capillaries.
* Explain
the importance of Na reabsorption to reabsorption of everything else in the
tubule (water and solutes)
* Secretion
in the nephron - what is it in contrast to reapsorption? What types of solutes
are secreted?
* Plasma
clearance of solutes (PCV values): in what units are these values given.
* What
measurements on plasma and urine are needed to calculate a solute's PCV value.
* What
is unique about the clearance of inulin and why does this make it useful for
calculating a person's GFR
* What
is creatinine and why is its PCV usually used to measure a person's GFR
* Physiological
regulatory systems of the kidney
* With
the aid of a diagram fully explain the mechanism by which vasopressin regulates
the total [solute] in the ECF.
* Pee
lab:
* Explain
the procedures used to measure urine flow rates and osmolarities.
* Explain
the mechanism by which vasopressin regulates the osmolarity of the ECF.
Aquaporin?
* Describe
the principle and advantages of countercurrent flow in: preventing heat loss
from appendages and permitting the adjustment of urine flow and concentration.
In detail explain how the different properties of the 2 limbs of the Loop of
Henle of the nephron contribute to the formation of an osmolar gradient in the
ECF of the medulla of the kidney.
* Vasa
recta.
* The
kidney in acid/base balance:
* How
does the kidney contribute to pH homeostasis of the ECF in acidosis?
* Be
able to define the terms: metabolic acidosis and respiratory acidosis. What
pathologies might cause each and what is responsible for the shift in ECF from
the normal pH of 7.4?
Ch. 21
Digestion
¯
The four digestive
processes are: digestion,
absorption, motility, and secretion.
¯
The three phases of
digestion are: cephalic phase, gastric phase, intestinal phase.
¯
Digestion of
carbohydrates, proteins, and fats takes place in multiple regions of the GI
tract. Digestion of each type of
biomolecule requires specific enzymes and is sensitive to pH.
¯
Absorption processes
differ for each biomolecule, but absorption of most nutrients takes place in
the small intestine.
¯
Motility involves
peristaltic and segmental contractions of the GI tract smooth muscle. Motility
is under nervous, hormonal, and local chemical control.
¯ The GI tract secretes 7L of fluid a day. These secretions include: fluids rich in ions, enzymes, and mucus. Ion secretion and absorption in the digestive system are similar to ion transport in the kidneys.
¯
There are two reflex patterns
that are involved in the regulation of GI function: short reflexes and long reflexes.
¯
Numerous digestive
hormones also control GI function.
* If
confronted with a figure of the digestive ssytem, with only the cell types
labeled, be able to fill in the nature of the secretions and the
hormones/paracrines controlling secretions.
* Describe
the nature of the barrier that protects the stomach mucosa from the pH 2
contents of the lumen.
* Explain
how H. pyloris and NSAID drugs lead to ulcer formation.
* Describe
the digestion and absorption of dietary fat in the small intestine.
* Know
the functions and sources of secretion of the GI hormones: gastrin, secretin,
and cholecystokinin.
* Mucus
(had to get this in here): explain: type of cell in gut producing mucus,
chemical composition and physical characteristics, the structure of mucin (the
glycoprotein in mucus) and why it is highly suited to its function.
* Define/explain:
flatus, gases in flatus, reason why more is produced when eating foods high in
indigestible fiber,.
¯ ATP for muscle contractions comes from aerobic metabolism, phosphocreatine, and glycolytic metabolism.
¯ During exercise, the catabolic hormones (glucagon, cortisol, catecholamines, and growth hormone) dominate. Insulin levels remain low.
¯ Exercise intensity is indicated by oxygen consumption.
¯ The respiratory and cardiovascular systems alter their activity to ensure that efficient oxygen and nutrients are delivered to exercising tissues.
¯ Moderate exercise can improve your immune system and decrease the risk of certain health problems.
* How do you
determine the optimum level of training?
* What variable
serves as a good indicator for monitoring intensity?
* What molecule
signals the end of aerobic activity?