BMSN2202LifeScienceII

Year2,5YearCurriculum
Tutorial2Physiology
20160217
10301120

20160224
10301120

1
 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

2
 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

3
Q1.Ifavesselweretodilatetotwiceitspreviousradius,
andifpressureremainedconstant,bloodflowthrough
thisvesselwould
a. increasebyafactorof16
b. increasebyafactorof4
c. increasebyafactorof2
d. decreasebyafactorof2

4
 Physicallawsdescribingbloodflow
Theflowofbloodthroughthevascularsystem:dependsin
partonthedifferenceinpressureatthetwoendsofthetube
Ifthepressureatoneend>attheother,bloodflowsfromthe
regionofhighertotheregionoflowerpressure
Bloodflow P/resistance Resistance l /r4
L =lengthofvessel
Bloodflow= =viscosityofblood
r =radiusofvessel

Vessellengthandbloodviscositydonot varysignificantlyin
normalphysiology
Majorphysiologicalregulatorsofbloodflowthroughanorgan:
meanarterialpressure,vascularresistancetoflow

5
http://hyperphysics.phyastr.gsu.edu/hbase/ppois2.html#bl
 Bloodflow=

E.g.originalflowrate=100cm3/sec,then:
Doublelength flow=50cm3/sec increasebyafactorof16
Doubleviscosity flow=50cm3/sec
e.g.
Doublepressure flow=200cm3/sec 14 =1 24 =16
Doubleradius flow=1600cm3/sec 24 =16 44=256
Achangeinradiushasadramaticeffect!

Q1.Ifavesselweretodilatetotwiceitspreviousradius,andifpressure
remainedconstant,bloodflowthroughthisvesselwould
a. increasebyafactorof16
b. increasebyafactorof4
c. increasebyafactorof2
d. decreasebyafactorof2

6
Q2.Thegreatestresistancetobloodflowoccursin
a. Largearteries
b. Mediumsizearteries
c. Arterioles
d. Veins

7
 Bloodflow=

Atagivenmeanarterialpressure,bloodcanbediverted
fromoneorgantoanotherbyvariationsinthedegreeof
vasoconstriction andvasodilation ofsmallarteriesand
arterioles
(i.e.byvariationsin vesselradius,r)

Q2.Thegreatestresistancetobloodflowoccursin
a. Largearteries
b. Mediumsizearteries
c. Arterioles Smallestarteries;
containsmoothmuscle:
d. Veins whichcanrelax increasevesselradius(vasodilation);
ORcontract decreasevesselradius(vasoconstriction)
Providethegreatestresistancetobloodflow
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 Q3.Bloodflowtoanorganislargelydeterminedbythe
degreeofvasoconstrictionorvasodilationofits__________.
arterioles
Therateofbloodflowtoanorgancanbe___________by
increased
dilationofitsarteriolesandcanbe___________by
decreased
constrictionofitsarterioles.

Q4.Anincreaseincontractileforceabovetheintrinsictone
vasoconstriction
leadsto______________.Adecreaseincontractileforce
vasodilation
belowtheintrinsictoneleadsto____________.

Arteriolarsmoothmusclepossessesalargedegreeofspontaneous
contractileactivity (i.e.contractionindependentofanyneural,
hormone,orparacrineinput)

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Q5.Distinguishbetweenactivehyperemiaandreactivehyperemia.
Increasedbloodflow

10
 Mechanismscontrollingvasoconstriction
andvasodilationinarterioles
Twokindsofmechanisms:localcontrolsandextrinsiccontrols
Localcontrols:mechanismsbywhichorgansandtissuesalter
theirownarteriolarresistancesindependentofnerves/
hormones(selfregulatingtheirbloodflows)
changescausedbyautocrine/paracrineagents
e.g.activehyperemia,flowautoregulation,reactivehyperemia

Extrinsiccontrols:regulationbytheautonomicnervous
systemandendocrinesystem

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Q5.Distinguishbetweenactivehyperemiaandreactivehyperemia.

Activehyperemia:Anincreaseinbloodflowthatoccursinskeletal
musclesandotherorgansasaresultofincreasedmetabolism

O2,
metabolic metabolites Arteriolar dilation ___ ___ blood
activity oforgan inorgan inorgan flowtoorgan
interstitialfluid

e.g.CO2,H+,adenosine,K+, Causearteriolarsmooth
bradykinin,eicosanoids,nitricoxide muscletorelax

Reactivehyperemia:Atransientincreaseinorganbloodflowthatoccurs
followingabriefperiodofocclusionofbloodsupply

Bloodsupply O2, Arteriolar

Occlusion ___ __ blood
toorgan metabolites dilation in
released flowtoorgan
occluded inorganIF affectedorgan

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 Flowautoregulation:

O2,
Arterial Arteriolar Restorationof
bloodflow metabolites,
pressurein dilationin bloodflowtoward
toorgan vesselwallstretch
organ organ normalinorgan
inorgan

Note:
Activehyperemia:
Localcontroloforganbloodflowinresponseto
donotdifferinmajor
increasesinmetabolicactivity
mechanisms(whichinvolve
VSFlowautoregulation: localmetabolicfactors)
Localcontroloforganbloodflowinresponseto
decreasesinbloodpressure

13
 less
Q6.Parasympatheticsystemismoreimportantthanthesympathetic
systeminthecontroloftotalperipheralresistance.True/False
=sumofallvascularresistanceswithinthesystemiccirculation

Mostarteriolesreceivearichsupplyofsympathetic postganglionic
nervefibers(releasemainlynoradrenaline) =norepinerphine
bindstoalphaadrenergicreceptorsonvascularsmoothmuscle
causevasoconstriction

Parasympatheticendings inarterioles:
alwayspromotevasodilation.
HOWEVER,
thegreatmajorityofbloodvesselsreceivesympathetic but
NOTparasympathetic input.
Extrinsiccontrol

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 Otherextrinsiccontrols
Hormones
Adrenaline:
bindstoalphaadrenergicreceptorsonarteriolarsmoothmuscle
vasoconstriction
bindstobeta2adrenergicreceptors mainlyinskeletalmuscles
vasodilation
AngiotensinII vasoconstriction
Vasopressin(ADH/Antidiuretichormone) vasoconstriction
Atrialnatriureticpeptide vasodilation

15
Q7.AngiotensinII
a. causesvasoconstriction.
b. stimulatesadrenalcortextosecretealdosterone.
c. isapartofthereninangiotensinsystem.
d. Alltheabove.

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 Endothelialcells
Smoothmusclerelaxationresultsfromthelocaleffectsofa
numberofmoleculesproducedbythevesselendothelium:
Nitricoxide (endotheliumderivedrelaxingfactor) vasodilation
Endotheliumofarteriolescontains
anenzymethatsynthesizesNO:
endothelialnitricoxidesynthase
Prostacyclin (PGI2) vasodilation
Endothelin1 (ET1) vasoconstriction

Sublingual glyceryltrinitrate (nitroglycerin)

treatmentofanginapectoris
Shearstress: theforcethattheflowingbloodexertsontheinnersurfaceofarterial
wall;increasesasbloodflowthroughvesselincreases Arterialvasodilation

17
 Q8.Whichofthetheseisaparacrineregulatorthat
stimulatesvasoconstriction?
a. Nitricoxide
b. Prostacyclin vasodilation
c. Bradykinin
d. Endothelin1

Specifically,theendotheliumoftunicainterna producesano.of
paracrineregulatorswhichcausesmoothmuscle oftunicamediato
eitherrelax/contract

18
Q9.Arethefollowingstatementsconcerningthecontrolofthe
bloodvesselscorrect?
a) Reactivehyperemiaisduetovasodilatationcausedbythe
accumulationofmetabolitesduringaperiodofexercise.
occludedbloodflow
b) Thediameterofthearteriolesisentirelyregulatedbythe
sympatheticnervoussystem.

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Major factors affecting arteriolar radius. Note that epinephrine can be a vasodilator or vasoconstrictors,
depending on the tissue.
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 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

21
Q10.Baroreceptorsarelocatedinthe...

a. aortaandsubclavianarteries.
b. aorticarchandcarotidsinus.
c. aortaandcarotidveins.
d. aortaandsubclavian veins.
e. aortaandcommoniliacarteries

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 Arterialbaroreceptors

Neuralsignalsto
cardiovascularcontrol
centreinmedulla
Carotidsinus
baroreceptor
Aorticarch
baroreceptor
Commoncarotidarteries
Aorta

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http://www.as.wvu.edu/~rbrundage/chapter10b/img017.jpg
Q11.Whenthearterialbaroreceptorsdecreaseorincreasetheir
rateoffiring,whatchangesinautonomicoutflowand
cardiovascularfunctionoccur?

Increaseinarterialpressure

Arterialbaroreceptors Increasefiring

Decreasesympathetic outflow Increaseparasympathetic

toheart,arterioles,veins outflowtoheart negligibleeffect
onventricular
contractility
decrease heartrate decrease heartrate (duetolittle
parasympathetic
decrease ventricular innervationof
contractility ventricles!)
Netresult:
decrease cardiacoutput(decrease
vasodilation heartrateandstrokevolume)
decrease totalperipheralresistance
Viceversa! ReturnofBPtowardnormal
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 Q12.Thebaroreceptor reflexfunctionsprimarilyasashortterm
regulatorofarterialbloodpressure.
True/False
Arterialbaroreceptorreflex:
activatedinstantly bychangeinBP
rapidlyrestorestheBPtowardnormal
ifBPdeviatesfromnormaloperatingpointfor>fewdays:
baroreceptorswouldadapt tothisnewpressure
(i.e.decrease frequencyofactionpotentialfiringatany
givenpressure)

Themostimportantlongtermregulatorofarterialpressureisthe !

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Reninangiotensinaldosterone system

4.vasopressin

2. 1.

Increasebloodvolume Increasebloodvolume
3.

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Q13.Inresponsetoexercise,theheartwouldbecalleduponto_____the
amountofbloodpumped,andthiswouldbeinitiatedbysignalsfrom
______fibers.
A. increase;sympathetic
B. increase;parasympathetic
C. decrease;sympathetic
D. decrease;parasympathetic

Q14.Inresponsetoanelevationinbloodpressure,thecardiaccontrolcenter
wouldattempttorestorehomeostasisprimarilythrough

A. sympatheticstimulitothe
ventricularmyocardium
B. sympatheticstimulitotheSAnode
C. parasympatheticstimulitotheSAnode
D. parasympatheticstimulitothe
ventricularmyocardium

27
Q15.TheANSisthemainextrinsiccontrolforcardiacactivity,actingthrough
bothsympatheticandparasympatheticfibersinnervatingtheheart.This
controlsystemisnotsymmetriconepartoftheANShaslesscontrol
overtheheart.WhichofthefollowingstatementsisNOT correct?

A. Thesympatheticdivisionhassignificantcontrolofheartratethroughits
actionattheSAnode.
B. Thesympatheticdivisionhassignificantcontrolofcontractilitythrough
itsactionontheventricularmyocardium.
C. Theparasympatheticdivisionhassignificantcontrolofheartratethrough
itsactionattheSAnode.
D. Theparasympatheticdivisionhassignificantcontrolofcontractility
throughitsactionontheventricularmyocardium.

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Q16.Whichofthefollowingwouldhelprestorehomeostasisinthefirstfew
momentsafterapersonsmeanarterialpressurebecameelevated?

A. Adecreaseinbaroreceptoractionpotential(AP)frequency
B. AdecreaseinAPfrequencyalongparasympatheticneuronstoheart
C. AnincreaseinAPfrequencyalongsympatheticneuronstoheart
D. AdecreaseinAPfrequencyalongsympatheticneuronstoarterioles
E. Anincreaseintotalperipheralresistance

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Q17.Damagetowhichofthefollowingpartsofthebrainwouldcausethe
bodytohavelesscontrolovercardiacactivity?
A. cerebralcortex
B. thalamus
C. basalnuclei
D. medullaoblongata

Q18.Increasedinputfromthebaroreceptorstothecardiaccontrolcenter
wouldcausewhichofthefollowingtooccur?
A. Increasedsympatheticstimulationanddecreasedparasympathetic
stimulation
B. Decreasedsympatheticstimulationandincreasedparasympathetic
stimulation ventricularcontractility;vasodilation; HR
C. Increaseinbothsympatheticandparasympatheticstimulations
D. Decreaseinbothsympatheticandparasympatheticstimulations

30
Q19.Korotkoff soundsareproducedby:
A. closingofthesemilunarvalves
B. closingoftheAVvalves
C. theturbulentbloodflowofbloodthroughanartery
D. elasticrecoilofaorta
Notthelupdupsoundsproduced
byclosingofheartvalves!

Amanualsphygmomanometer 31
 volume
Q20.Cardiacoutputisthe_______ofbloodeachventriclepumps
heartrate
perminuteandequaltheproductof__________and
strokevolume
______________.
a. Increasedbystimulationofthe
___________nervestothe
sympathetic
End
diastolic Contractility Afterload heartandby_______________
adrenaline
volume (themainhormoneliberated
fromadrenalmedulla);
b. Decreasedbystimulationof
parasympathetic
________________nervesto
theheart.
Adrenaline fortreatingcardiacarrest
increaseperipheralresistance
(vasoconstriction);
increasecardiacoutput

32
Q21.TheFrankStarlinglawoftheheartsaysthatthehigherthe
enddiastolicvolume,the
=volumeofbloodinventriclesjustbeforecontraction

A. lowerthecardiacoutput Whentheventriclehasbeenfilledto
B. highertheendsystolicvolume agreaterdegreeduringdiastole:
thegreaterthestretch
C. lowerthebloodpressure ventricle contracts moreforcefully
D. higherthestrokevolume duringsystole

33
Q22.Withrespecttotheeffectoncardiacoutput,theterm
preloadrefersto
A. theforcedevelopedbythemyocardialcellsduring
ventricularsystole
B. thebloodpressureintheaortaandpulmonarytrunkduring
ventricularsystole
C. theamountoftensiondevelopedinthemyocardiumbefore
itcontracts
D. anythingthatdecreasesstrokevolume

34
Q23.Strokevolumeisregulatedbyallofthefollowingexcept

A. enddiastolicvolume. EDV SV
B. cardiacoutput.
C. contractility. contractility SV
D. peripheralresistance. peripheralresistance
afterload
SV

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Q24.Whichofthefollowingwouldnotincreasestrokevolume?

A. increasedvenousreturn EDV SV
B. increasedsympatheticstimulationofthemyocardiumcontractility
C. increasedenddiastolicvolume (FrankStarlingmechanism)
D. increasedarterialbloodpressure Baroreceptorreflex contrac lity
E. increasedafterload SV
=thearterialpressuresagainstwhichtheventriclepumps

36
 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

37
 Q25.Thecerebralvesselsaresensitivetothecarbondioxide
concentration ofarterialblood.Whenthecarbondioxide
concentrationrisesasaresultofinadequateventilation
dilate
(hypoventilation),thecerebralarterioles_________.
Conversely,whenthearterialcarbondioxidefallsbelow
constrict
normalduringhyperventilation,thecerebralvessels_______.

Hypoventilation
cerebralbloodflow
headache

Hyperventilation
cerebralbloodflow
dizziness

38
Q26.Whenambienttemperatureislow,sympatheticnerves
stimulatecutaneous______________;cutaneousblood
vasoconstriction
less
flowis_________,sothat_______heatwillbelostfrom
reduced
thebody.

Astemperaturewarms,cutaneousarteriolesinthehands
decreased
andfeet_________asaresultof__________sympathetic
dilate
nerveactivity.Continuedwarmingcauses___________of
dilation
arteriolesinotherareasoftheskin.Iftheresulting
increaseincutaneousbloodflowisnotsufficienttocool
thebody,sweatglandsecretionmaybestimulated.
Perspiration
__________helpscoolthebodyasitevaporatesfromthe
bradykinin
surfaceofskin.Thesweatglandalsosecretes__________,
vasodilation
apolypeptidethatstimulates___________.

39
 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

40
Q27.Thenormalpathofimpulseconductionintheheartis:
A. SAnode Purkinjefibers AVnode AVbundle bundlebranches
B. SAnode AVnode Purkinjefibers AVbundle bundlebranches
C. SAnode AVnode bundlebranches AVbundle Purkinjefibers
D. SAnode AVnode AVbundle bundlebranches Purkinjefibers

41
 Q28.AnECGmeasures________.
A. bloodpressure
B. theelectricalactivityoftheheart
C. bloodvolume
D. thepumpingactionoftheheart

https://www.ole.bris.ac.uk/bbcswebdav/institution/Faculty%20of%20
Medicine%20and%20Dentistry/MB%20ChB/Hippocrates%20Year%203
%20Medicine%20and%20Surgery/Cardiology%20 42
%20ECG/page_12.htm
Q29.Whichofthefollowingleadplacementsbestdescribes,
"Fifthintercostalspaceatthemidclavicular line"?

A. V1
B. V2
C. V4
D. Noneoftheabove

43
 Q30.Whichofthefollowingstatementsis/arecorrect?
A. Thefirstdeflection,thePwave,correspondstocurrentflows
duringatrialdepolarization
B. Theseconddeflection,theQRScomplex,istheresultof
ventriculardepolarization
C. Thefinaldeflection,theTwave,istheresultofventricular
repolarization
D. AtrialrepolarizationisusuallynotevidentontheECGbecauseit
occursatthesametimeastheQRScomplex
E. Allarecorrect

44
http://media1.web.britannica.com/ebmedia/95/26995004E5839E67.jpg
 Topicstocover
Localcontrolofbloodflow
Vascularfunction&controlmechanisms
Cardiacfunction&controlmechanisms
Specialcirculations
ECGmeasurement
Heartattacks&failure
Circulatoryshock
Hypertension&orthostatichypotension

45
Q31.Whichofthefollowingstatement(s)is/aretrue?
A. Heartfailureoccurswhenthecardiacoutputisinsufficienttomaintain
thebloodflowrequiredbythebody.
B. Examplesofcausesofheartfailureincludeaorticvalvestenosis,
hypertensionandhypervolemia.
C. Failureofleftventriclemayraisetheleftatrialpressureandproduces
pulmonarycongestionandedema. shortnessofbreathandfatigue
D. Failureofrightventricleresultsin
increasedrightatrialpressure,which
producescongestionand
edemainthesystemiccirculation.
E. Alloftheabove.

46
 47
https://www.studyblue.com/notes/note/n/chapter24/deck/5788192
 Q32.Whichofthefollowingisacompensatoryresponsethatoccursduring
congestiveheartfailure?
A. Increasedreninsecretion AsCO renalperfusion
B. Activationofthereninangiotensinaldosteronesystem
C. Increasedsaltandwaterretention
D. Increasedexcretionofsodiumandwaterbykidneys
Reduced

Fluidretentioninitiallyisanadaptive
responsetodecreasedcardiacoutput.
However,problemsemergeasthefluid
retentionprogresses!

Workoverloadontheheart!

48
Q33.Whichofthefollowingis/aretrueaboutheartattack?
A. Incoronaryarterydisease,changesinoneormoreofthecoronary
arteriescauseinsufficientbloodflowtotheheart.Ifsevereenough,the
resultmaybedeathofthatportionoftheheart amyocardialinfarction/
heartattack.
B. Regularexerciseisprotectiveagainstheartattacks.
C. Thesymptomsofmyocardialinfarctionincludeprolongedchestpain,
oftenradiatingtotheleftarm,nausea,vomiting,sweating,weaknessand
shortnessofbreath.
D. DiagnosisofheartattackcanonlybemadebyECGchangestypicalof
infarction False! e.g.

Alsobymeasurementofcertain
proteinmarkersinplasma!
Proteinspresentincardiacmuscleand
leakoutintobloodwhenmuscleis
damaged
Mostcommonmarker:
creatininekinase(CK)
49
Q34.Whichofthefollowingstatementsregardinghypertensionare
correct?Pleaseselectallthatapply.
A. Hypertensionischaracterizedbyapersistentarterialbloodpressurein
excessof140/90mmHg
B. Hypertensionassociatedwithanothermedicalconditioniscalled
primaryhypertension Primary/essentialHT=HTofunknowncause
secondary
C. Hypertensionseeninrenaldiseaseisclassifiedassecondary
hypertension
D. Theriseinbloodpressureseeninhypertensionismainlycausedbyan
increaseincardiacoutput totalperipheralresistance

50
Q35.Whichofthefollowingisamanifestationoforthostatichypotension?
A. Apatient'spulseis80whensheissupine,but96whenshesitsup.
B. Apatient'spulseis76whenheissupine,but88whenhesitsup.
C. Apatient'sbloodpressureis132/80whensheissupine,but106/78
whenshesitsup.
D. Apatient'sbloodpressureis150/100whenheisupright,but134/90
whenheliesdown.

Lyingtoastandingposition:
ashiftofbloodfromveinsofthoraciccavity
toveinsinlowerextremitiesduetogravity
reducesvenousreturn,SV,CO&BP

Baroreceptorreflextriggered
tocorrectthechange

Theconsensusdefinitionisadropof > 20mm

Hgsystolic, 10mmHgdiastolic,orboth!

51
Q36.Histaminereleasecausingvasodilationisacauseof_____shock.
a. Neurogenic Asaresultofasevereallergicreaction
b. Anaphylactic widespreadreleaseofhistamine
c. Septic vasodilation
decreasetotalperipheralresistance
rapidfall inBP

Q37.Lossofsympatheticnervoussystemstimulifollowingadiving
accidentwouldleadto_____shock.
a. Neurogenic Usuallybecauseofupperspinalcorddamage/
spinalanesthesia
b. Cardiogenic
Resultsfromcardiacfailure
c. Hypovolemic
(e.g.infarction,severecardiacarrhythmias,
valvedamage)

52
Q38.Achildsuffersseconddegreeburnsto30%ofhisbody.Themedic
shouldsuspect_____shock.
A. Cardiogenic
B. Obstructive
C. Hemorrhagic
Duetolowbloodvolume,whichmightbecausedby
D. Hypovolemic
hemorrhage,severedehydration,orburns

Q39.Whichofthefollowingarecardiovascularreflexesthathelpto
compensateforcirculatoryshock? accompaniedbyBPandCO
A. Sympatheticreflexactivatedbybaroreceptor
reflex,leadingtoincreasedheartrate
B. Decreasedbloodflowtodigestivetract duetosympatheticnervestimulation
andskinduetovasoconstriction blooddivertedtoimportantorgans
C. Decreasedbloodflowthroughkidneys likethebrainandtheheart
stimulatingreninsecretionandactivation
ofthereninangiotensinaldosteronesystem saltandwaterretention

53