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General Principles and Sensory Physiology Somatic Sensations: I. General Organization, the Tactile and Position Senses Somatic sensations: II. Pain, Headache, and Thermal Sensations X. The Nervous System: B. The Special Senses The Eye: I. Optics of Vision The Eye: II. Receptor and Neural Function of the Retina The Eye: III. Central Neurophysiology of Vision The Sense of Hearing The Nervous System: C.
Motor and Integrative Neurophysiology Gastrointestinal Physiology Propulsion and Mixing of Food in the Alimentary Tract Secretory Functions of the Alimentary Tract Digestion and Absorption in the Gastrointestinal Tract Metabolism and Temperature Regulation Metabolism of Carbohydrates and Formation of Adenosine Triphosphate Lipid Metabolism The Liver as an Organ Energetics and Metabolic Rate Endocrinology and Reproduction Pituitary Hormones and Their Control by the Hypothalamus Thyroid Metabolic Hormones Insulin, Glucagon, and Diabetes Mellitus Pregnancy and Lactation These action poten.
This interaction activates myosin light chain to the Nernst equation. Secondary active transport. The energy of side Y. The total volume of sides X and Y will not required to move calcium ions against their concentra. The sodium extracellular concentration by the protein troponin C. An increase in 1 3. Like skeletal muscle. In is dictated by the potassium Nernst potential in normal skeletal muscle. The various ions Q.
As the twitch fre. Negatively charged Q ions must move out of the cell outward to achieve an equilibrium po. Vm has reached which there is no net movement of that ion across threshold potential and has triggered the opening of the cell membrane. The maximal contraction. The cyclic with solute concentration. Because of the slow cross-bridge of individual muscle fibers. Under these conditions. Although the relatively slow 2 1. These 2 3. The distance between Z disks in axon diameter.
Ion S is a positively the physical characteristics of the axon e. The rate of simple diffusion is linear cyclase induces smooth muscle relaxation.. As potential can be initiated in an axon. This in. Only the I band decreases in length as the muscle con. Myelination increases the ments do not change during contraction. Because the cytosol into the extracellular fluid and repolarization of positively charged R ion has an equilibrium poten.
At very high twitch frequencies. This process involves a conformational change TMP13 pp. Botulinum toxin an- in membrane depolarization and contraction. Atropine is a muscarinic ACh re- pendent kinases. Neither atropine nor halothane has any effect on the TMP13 p. Curare blocks the nicotinic ACh receptor and causes one of the enzymes activated by cyclic nucleotide-de. The length-tension relationship in TMP13 pp.
The delay between ity of contraction. This passive tension accounts for an in- junction fatigue. Smooth muscle does not express troponin. Administration of this drug would increase the myosin light chain phosphatase. These fibers are smaller in size and are inner. They typically have a more dative muscles. This damage prevents the firing TMP13 p. Overexertion can cause and ligaments.
Tensilon is a readily reversible acetylcholinesterase in. Although the macro-motor units 3 8. Another factor that affects the velocity of TMP13 p. Vm ap. Although it is a presynaptic de. The increase in postsynaptic depolar.
The on the frequency at which they are stimulated. Vm is farthest from ENa at inactivation rate. ENa is close to 60 millivolts. Vm is closest to the equilibrium poten. In a intrinsic Vmax.
Vm is closest tated diffusion. Vm is relatively close to EK. In nerve cells. Both port event. In part B. This phenomenon. Compared with type I muscle fibers. If ENa is very positive 4 9. Antibodies against the B reflects the net diffusion of water. Osmosis occurs from solutions of high water concen- fect.
Of the choices provided. This by halogenated anesthetics. Calsequestrin is a the plasma membrane. This ATP-de. This revers. Intestinal smooth muscle. It is factor of 3. Because action potential.
The reason maximal centration gradients into the cytosol. In addition. Trace B best illustrates the its a rhythmical slow-wave potential that transiently change in PNa that occurs during an action potential. Trans- proteins in individual muscle fibers decreases. This increase in calcium concentra- 5 5. Although they are typical of smooth TMP13 pp. When a muscle is inactive for an ex.
The concentration difference has tripled. Trace C but if the amplitude is sufficient. When the intracellular TMP13 p. An example of active tension decreases is that interdigitation of actin this type of secondary co-transport is the transport of and myosin filaments decreases when the muscle is glucose into intestinal epithelial cells.
The rapid increase in PNa closely parallels the rapid This slow wave does not stimulate contraction itself. The student should thus recognize 6 6. Drawing these three TMP13 pp. Smooth muscle can contract in response to U nit I I tension and passive tension. Double vision commonly oc- ACh to be released from its terminal at the neuro. To answer this question. Both actin and myosin are important components of TMP13 p.
The muscle weakness usually causes decrease in the calcium-calmodulin complex should symptoms of double vision diplopia and drooping attenuate the contraction of smooth muscle. A the day goes on. The major symptom is muscle in the face of high calcium levels.
The muscle ac. Decreased ATP levels would be expected to de. This change in calcium elevated. The muscle membrane reaches a threshold monly associated with a spastic weakness of the legs. Note that ac. Choice eyelids ptosis. The Choice B: ATP is required for smooth muscle contrac. Choice A: Increasing the frequency of muscle sensitivity of smooth muscle can be attributed to dif. Muscle hy- by the actions of myosin light chain kinase MLCK. The maximum velocity of short- 6 3. Active tension cannot be cardiac muscle and skeletal muscle require an action measured directly: Smooth muscle con.
Choices B. The presence of anti-ACh antibodies D: Patients cium-calmodulin complex binds with MLCK. Multiple sclerosis choice E is com- depolarize. Smooth muscle contraction tension of a little more than grams and an active uses less energy and lasts longer compared with that tension of a little more than 50 grams. Choice C: The cal. Smooth muscle tive tension equals total tension minus passive ten. The ACh binds to and opens cat.
During maximal sympa. Which statement best rate of conduction of the cardiac action potential? What is the likely heart rate?
Use her lead II recording below to answer Questions 34 and The QRS voltage was 0. Questions 41—43 trode is the A year-old woman had an ECG recorded at a local emergency department after an automobile accident.
What is the mean electrical axis of his QRS? Smith had an ECG at a local hospital. What is his mean electrical axis in the frontal plane? The following the heart ECG was obtained. Use lead I for the calculation. What is his likely diagnosis? Her ECG shows a lar fibrillation. During the episodes. Which condition is likely in someone with atrial fibril- bered that the QRS deflection was large and positive lation?
After about 30 seconds of fainting. What is his likely condition? What is the likely diagnosis? The ECG technician remem. He reports 0. What is his diagnosis? What is the Based on the the ventricle above ECG tracing.
Her ECG tracing is shown above.
Use Dropped beat this tracing to answer Questions 63 and Standard lead II is shown above. The physician ordered an ECG. Which statement best describes this con. Questions 78 and 79 The stroke volume can be determined from the figure, which is the volume change during the C-D 8.
By using this formula, you potential, the potassium permeability of ventricular can determine that the cardiac output is millili- muscle greatly increases, which causes a more negative ters per minute. The heart rate for this patient is 40 beats per At point B the isovolumic contraction phase begins, minute. This heart rate is slow, which would occur in a which closes the A-V valves. The closing of these valves trained athlete.
A fever would increase heart rate. Ex- causes the first heart sound. The vibration of the ventricular walls makes this 1 0. An excess potassium concentration in the extracellular 4. Stroke volume is milliliters, and the decrease in resting membrane potential of the cardiac end-systolic volume at point D is milliliters. Thus, muscle fibers. An abundance of calcium is bound 1 2.
This nition occurs just after the ventricular pressure exceeds calcium is necessary for contraction of cardiac muscle, the atrial pressure, which causes the A-V valves to me- and its strength of contraction depends on the calcium chanically close.
The second heart sound occurs when concentration surrounding the cardiac myocytes. At the aortic and pulmonary valves close. This effect is important 6. Multiplication of the ejec- tial in the cardiac muscle fibers.
As the membrane po- tion fraction by the end-diastolic volume provides the tential decreases, the intensity of the action potential stroke volume, which is 50 milliliters in this problem. Excess calcium ions in the blood greater than the end-systolic volume and has a value of and sympathetic stimulation and increased norepi- milliliters.
This level decreases in any of the S-A node and the A-V node increase. In addi- kind of cardiac failure and increases markedly during tion, the permeability of cardiac muscle to calcium in- sympathetic stimulation. Increased permeabil- 1 5. Isovolumic contraction occurs TMP13 p. As the sodium leaks into the TMP13 p. This is the thresh- 1 6. However, the A-V bundle myofibrils have a slow rate of conduction because their 2 3.
An in- mal atrial and ventricular muscle. In addition, their slow creased potassium permeability causes a hyperpolar- conduction is partly caused by diminished numbers of ization of the S-A node, which causes the heart rate to gap junctions between successive muscle cells in the decrease. Calcium permeability is highest during phase 2, and 1 7. The total 2 5. It arrives at the A-V node at 0.
It does 2 6. In contrast, the rate of firing of the A-V nodal fi- the rate of upward drift of the membrane potential to bers are 40 to 60 times a minute, and the sinus node the threshold level for self-excitation, thus increasing fires at 70 to 80 times per minute.
If the sinus node is the heart rate. The last place that the impulse arrives 2 7. Then there is a total delay hyperpolarization of the A-V node, which will decrease of 0.
Increases in sodium permeability will lowing the impulse to arrive at the ventricular septum actually partially depolarize the A-V node, and an in- at 0. Purkinje fibers have a rhythm of 15 the voltage in lead III is equal to the voltage in lead II, to 40 beats per minute. Therefore, lead III has more difficult for the membrane potential to reach its correct axes for this question.
Increases in sodium and calcium permeabil- ity and norepinephrine levels increase the membrane 4 1. However, it does III not cause acetylcholine release at the sympathetic end- — ings because they contain norepinephrine. Parasym- pathetic stimulation causes acetylcholine release. The sympathetic nervous system firing increases in the per- meability of the cardiac muscle fibers, the S-A node, and the A-V node to sodium and calcium. This calculation In this case the voltage in lead II is 0.
The lead I voltage is TMP13 p. Right 3 6. The correct the beginning of the Q wave and continues to the end answer is therefore left bundle branch block. A rightward angulation of the heart will cause a rightward shift in the mean electrical axis. Pul- 3 8. This diagnosis can be de. The limb leads are ventricle.
The TMP13 p. When we analyze the currents of injury. In lead V2. Aortic valve insufficiency and systemic hypertension will cause a left axis shift.
The QRS width is not greater than 0. The chest leads ized in a patient with a damaged cardiac muscle or in are used to determine whether it is an anterior or pos- a patient with a normal cardiac muscle. The area of the terior infarct. At the J point the entire ventricle is depolar- base or inferior part of the ventricle. Because the QRS complex is 0. QRS voltages but the current of injury voltages. Systemic hypertension. High extracellular potassium and sympathetic stimulation.
Because the aVF lead has a posi. Pulmonary hyperten- sion causes a rightward shift in the axis and is therefore 5 9.
The el- TMP13 p. A longer refractory period tends to prevent indicates a conduction block. ECG mean electrical axis. The atria exhibit circus movements. A-V block is occurring. The P waves are missing or are very weak. This is not a plot of the which indicates that there is a leftward axis deviation. They which occurs during chronic systemic hypertension.
The negative mass on the right side of the heart. The 25 rate in the ven- degrees. U nit I I I Pulmonary hypertension increases the ventricular and the resultant vector is nearly vertical.
This ECG regular heart rate. If wave in the ECG. The mean electrical axis of the pre. The ventricles pick up the new rhythm. P waves are present in each of these instanc. QRS waves are dropped. The mechanism by which this phenomenon is believed to occur is by a re-entrant circus movement feedback pathway that sets up an area III of local repeated self—re-excitation.
Once again notice blocked before entering the atrial muscle. Then the paroxysm usually ends as suddenly as it began and the pacemaker shifts back to the S-A node.
The atria exhibit circus movements and often are rate. This ECG shows istration increases the irritability of the heart. During travels around the heart. The ECG shown is ventricular paroxysmal tachycardia. This is very characteristic of a ventric- ular irritable locus. In first-. In this figure the P-R interval is refractory period is long. Notice the rapid heart weak. Exposure of the heart when the P-R interval exceeds a value of 0. P waves are still associated with each QRS complex.
If the first degree block. This rhythm. An increased is initiated by an ectopic focus somewhere in the atria. The P waves seem to be totally dissociated from the QRS 7 4.
Because we have TMP13 p. First-degree A-V block causes a lengthened P-R inter- lar filling time is very short. The basic shape TMP13 p. This ECG is not characteristic of atrial may be a few seconds or even several weeks.
The P wave is usually visible in this arrhyth. The to be occurring in this ECG. A shortened forward into the ventricles at the same time. The new flutter because there is only one P wave for each QRS pacemaker of the heart is distal to the point of blockade complex.
If the point of initiation is near the A-V node. There is also no ST is characteristic of some types of A-V block. Which set of physiological changes would be to occur in response to standing up from a supine expected in response to moving from a supine to an position?
Her mean arterial pressure of hypertension stands up from a supine position. Which set an examination. Further tests infused arm? Further tests indicate that he has renovascular hyper-. U nit I V Wall Concentration tension as a result of stenosis in the left kidney. Which set of changes would be expected to occur in What would be the approximate flow through the vessel response to constriction of the carotid artery?
He has a mean blood pressure of a muscle vascular bed. His plas- culation would be expected? He reports fatigue and occasional muscle cramps. Her arterial pres- position. Moving from a supine to a standing position sure is mm Hg, and her renal venous pressure is results in a transient decrease in arterial pressure that is 5 mm Hg. She also has a plasma colloid osmotic pressure detected by arterial baroreceptors located in the aortic. U nit I V of 25 mm Hg and a glomerular capillary hydrostatic arch and carotid sinuses.
Which set of cardiovascular pressure of 50 mm Hg. The drug low- Which mechanism would Pressure Gradient Radius Viscosity best explain the decrease in arterial pressure?
It is estimated that he has lost approximately Which set of changes would be expected in It is estimated that the patient has lost approximately response to hemorrhage in this man? His mean blood pressure is 65 mm Hg, and his heart rate is elevated as a result of activa- Sympathetic Total Peripheral tion of the chemoreceptor reflex. An increase cava into the heart and inflated to increase atrial pres- in which of the following is most likely to occur in this sure by 5 mm Hg.
He has capillary filtration rate? He also has a pulse pressure of 35 mm Hg nerves and a hematocrit of Which set of microcirculatory changes would be expected in the infused arm? WB Saunders. Which set of changes heart rate is Her put increases to maximal values. She has pale skin. Jones CE. Coleman TB: Circulatory Physiology: Which occur? What would you expect to he has angina caused by myocardial ischemia. In this patient. His pulmonary wedge pressure was normal.
Assume the patient is What is the diagnosis? What condition is present? Arterial pressure normally occur? What is the diag. The relatively low pitch is heard maximally over the sec. The chest The arterial blood oxygen content is normal. The data indicated that the patient had severely decreased chest radiograph shows an enlarged heart.
A murmur of Other ond intercostal space to the right of the sternum. What initial therapy do you recommend? He has pale skin. Assume systolic pressure is 48 mm Hg. He has pallor. The increase in pH. An- 5. In patients with moderate aortic regurgitation mation. Metabolic ceptors leads to an increase in sympathetic outflow to factors that enhance cerebral blood flow include in- the heart and peripheral vasculature and a decrease in creases in carbon dioxide. I is converted to angiotensin II by a converting enzyme.
Activation of the arterial barore. The increased vascular resistance decreases capillary hydrostatic pressure and water permeability vascular conductance and blood flow. The increase in sympathetic activity and decrease in parasympathetic 8. Angiotensin an increase in plasma renin activity or renin release. The increase in resistance. Activation of the baroreceptors results in a decrease in parasympathetic activity or vagal tone The diameter by arterial baroreceptors located in the carotid bifurca.
The reduction in leads to an increase in capillary filtration rate. The two major retaining hormone that increases arterial pressure. Nitric oxide increases blood flow by an acute fall in arterial pressure that is sensed by arte. Infusion of histamine into TMP13 pp. The decrease An increase in stroke volume increases systolic TMP13 pp. Decreased dient across the capillary wall. Increasing ves.
The two major fac- decrease in arteriolar resistance would lead to an in. The pressure and diastolic pressure. The enhanced mediately flows backward into the pulmonary artery sympathetic activity results in constriction of periph- and then into the lung and left atrium. The filtration centration gradient wall would all increase the net coefficient is the product of capillary surface area and movement of sodium across the capillary wall.
When metabolism in a tissue is increased for ity and decreased parasympathetic nerve activity. The left atrium and ventricle increases stroke volume and combination of enhanced sympathetic activity and de- systolic pressure.
The decrease in arterial pressure activates baroreceptors. The shunt. The net pressure for fluid movement across a be an important stimulus for vascular endothelial capillary wall is promoted by increases in capillary growth factor and the growth of blood vessels in solid hydrostatic pressure and positive interstitial colloid tumors.
One of the important factors that increases peripheral vasoconstriction and an increase in total growth of new blood vessels is VEGF. A decrease TMP13 pp. Moder- A decrease in capil- TMP13 pp. Angiotensin II stimulates aldosterone and pulse pressure. The combined increase in systolic creased vagal tone also leads to an increase in heart rate. The enhanced ing of blood from the aorta results in a low diastolic sympathetic activity leads to an increase in total periph- pressure.
U nit I V and interstitial hydrostatic pressure. During hemorrhage. An increase in arteriole re- sistance would decrease capillary hydrostatic pressure. The increase in sympathetic nerve activity leads leads to an increase in extracellular fluid volume. The increased reabsorption of sodium and water activity.
The in. The increase in venous flow. In this a neural reflex to minimize the fall in blood pressure. Because blood flow is proportional to the These metabolites dilate pressure gradient across the vessel and to the fourth blood vessels.
The chemoreceptors are chemosensitive cells that are sure is 5 mm Hg. An increase in plasma colloid crease in sympathetic activity. Angiotensin II is a vasoconstrictor and a pow- would increase 4 to the fourth power. The major cause for normal. A fourfold increase in vessel diameter or radius dykinin. The decrease in parasympathetic plasma potassium concentration.
Because the aorta TMP13 p. The A twofold increase in intercellular TMP13 pp. When the cerebrospinal fluid pressure A decrease in the production of these factors would tend to decrease arterial pressure. Angioten- ent across the capillary wall. The net pressure in The increase in tissue oxygen concentra.
Increases in capillary hydrostatic pres- TMP13 pp. A decrease in plasma colloid osmotic pressure would increase filtration rate. An increase in venous A decrease in arteriolar diameter would de- pressure.
Increases hydrostatic pressure. The CNS ischemic results in pooling of blood in the lower extremities response includes enhanced sympathetic activity. The pooling of blood in creased parasympathetic activity. The compliance of The increase Because the capillary wall is relatively increases in sodium and water excretion.
The fall U nit I V rate. In Plasma sodium concentration would have no effect on filtration. Plasma colloid The ability of erally be low to normal in this patient.
Pumping TMP13 pp. Hemorrhage and decreased venous return TMP13 pp. Pulse pressure is directly propor. The two main ample. The artery because it is about 8 times as distensible and aorta has the highest velocity of blood flow. Both events lead TMP13 pp. The heart rate also increases. In this ex- stolic pressure is called the pulse pressure.
The net filtration pressure in in stroke volume increase pulse pressure. Changing intrapleural pressure to of carbon dioxide. Infusion of a nitric oxide In progressive shock due to hem. The excess blood volume termining cardiac output.
The temic filling pressure increases markedly. In this example the mean systemic pressure. Changing orrhage. An excess central fluid volume also results in this problem. Taking a patient off of a ventilator.
The formula for cardiac often will overstretch the sarcomeres of the heart. This results in an increase in the venous return.
During maximal sympa- TMP13 pp. In tension. Decreases in arterial pressure will reduce The optimal therapy is to replenish the electrolytes that were lost as a result of Note that this formula only applies to the linear portion TMP13 pp. The best therapy is to replenish TMP13 pp. An increase in right atrial pressure would filling pressure is 7 mm Hg and the right atrial pressure decrease venous return and increase venous hydrostatic is 0 mm Hg.
Among those are surgically a balanced electrolyte solution is the therapy of choice. Pregnancy and the presence of ascitic fluid these values in the previous formula indicates that in the abdomen would tend to compress the vena cava the resistance to venous return is 1. Using pressure. Decreased parasympathetic stimulation of the heart TMP13 pp.
Increased sympathetic stimulation of the heart riolar vasodilation and thus increased venous return. During exercise for 1 hour. Some of these During exercise there is also a decrease in crease blood volume and decrease the vascular com. Beriberi causes increased cardiac output because creasing heart rate and contractility. Cardiac tamponade. The hematocrit level is high in poly. A-V fistulae also to the tissues. Parasympathetic stimulation does not the intestinal flow decreases significantly.
Venous return of the Mean systemic filling pressure increases and the veins systemic filling pressure is increased by factors that in. Car- creasing cardiac output.
The skeletal muscle hibition will reduce resistance to venous return. The following mecha- nisms increase resistance to venous return: Cardiac output decreases in diac output decreases in patients with myocardial patients with hypovolemia.
Decreased levels of HDL will Some of these include myo- compliance. In- ularly the atria. Moderate anemia will cause an arteriolar vaso- TMP13 p.
Increased blood volume and skeletal pressure in the pericardial space. Norepinephrine Breathing against a negative effectively weaken the heart and thus decrease cardiac pressure will shift the cardiac output curve to the left. A-V fistulae also cause a decreased resis- tance to venous return. Cardiac output which increases the pressure in the pericardial space. Playing a trumpet or positive pressure creased venous compliance decreases the venous breathing tremendously increases the intrapleural pres.
Nitroglycerin causes for the coronary artery system. The contraction of the cardiac muscle around the Venous constriction and oxygen use. Some depresses the curve. This will reduce the The use of beta sympathetic blockers not and increases the heart rate. Dur- strength of cardiac contraction and increases the ing exercise there also is an increased release of nor- heart rate.
Coronary and cerebral stimulation will inhibit the effects of excess sympa- blood flow are spared from any decrease. Chelation therapy with EDTA and increased dietary calcium have little to do with cardiac function. A low adenosine level will probably only ACE inhibition prevents Reverse thetic output on the heart.
Oxy- TMP13 p. Cardiac tamponade rotates the Although histamine causes arteriolar vasodilation. An increase not a decrease in flow clearly decreases. Small portions of the ad. Decreased para- during exercise. Surgically opening the chest and under. In this way the plateau of the Starling epinephrine and epinephrine by the adrenal glands. Isometric exercise should be avoided occurs. High not low potassium increases systolic phase of the cardiac cycle. Adenosine Isometric exercise increases blood pressure markedly is formed as adenosine triphosphate degrades to and can be harmful.
Infusion of adenosine or local release TMP13 p. Beta receptor blockers not TMP13 pp. The increased sympathetic output also Cardiac contractility decreases after a myocar. This dium excretion. In this TMP13 pp. The increased blood sure. This results in increases in venous return dial infarction. Because of The epicardial coronary chest.
This causes a decrease in coronary flow. This results do not want to do is infuse whole blood or an electro- in a slight decrease in epicardial flow. The patient can also breathe oxygen. One thing you slight constriction of the epicardial vessels. Furosemide can the subendocardial vessels have more beta receptors.
A decrease in mean arterial failure. This gives a total maximum the feet and ankles. Placing tourniquets on all four limbs decreases the central Dyspnea usually will occur only in the early be increased in patients with cardiogenic shock with stages of compensated failure. Because of the low creased glomerular filtration rate. Other causes of death are pulmo.
During heart failure. The excess a release of atrial natriuretic factor. One of the pressure also results in decreases in glomerular hy- results is a sympathetic vasoconstriction not vaso.
A weakened heart causes a The kidneys bosis. It is important to interrupt This can be constrict. This decreased oxygen weakens the heart blood. Air hunger. Furosemide causes venodilation. The kidneys decrease their urinary output put decreases because of weakness of the heart and of sodium and water to increase the blood volume.
In con- and thus further decreases cardiac output. Depletion of norepinephrine in the and the venous return of blood back toward the endings of the cardiac sympathetic nerves is another heart thus increases right atrial pressure. The excess blood volume often overstretches the Blood can actually be removed in moderate quanti.
Mean monary capillary pressure and the mean pulmonary systemic filling pressure increases not decreases. The patient also has orthopnea. These both reduce excess fluid in the lungs. This situation increases the id deterioration in patients with acute pulmonary mean systemic filling pressure. The decreased arterial pressure. Heart rate factor that causes weakness of the heart.
Sympathetic inhibition and venous dilation both coronary blood flow and further weakens the heart decrease the mean systemic filling pressure.
The patient it could cause an increase in pulmonary artery pres- has air hunger.