BMSN2202 Life Science II

Year 2, 5 Year Curriculum

Tutorial 2 Physiology
2016-02-17
1030-1120

2016-02-24
1030-1120

1
 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

2
 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

3
Q1. If a vessel were to dilate to twice its previous radius,
and if pressure remained constant, blood flow through
this vessel would
a. increase by a factor of 16
b. increase by a factor of 4
c. increase by a factor of 2
d. decrease by a factor of 2

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 Physical laws describing blood flow
The flow of blood through the vascular system: depends in
part on the difference in pressure at the two ends of the tube
If the pressure at one end > at the other, blood flows from the
region of higher to the region of lower pressure
Blood flow P/resistance
L = length of vessel
h = viscosity of blood
Blood flow = r = radius of vessel

Vessel length and blood viscosity do not vary significantly in

normal physiology
Major physiological regulators of blood flow through an organ:
mean arterial pressure, vascular resistance to flow
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http://hyperphysics.phy-astr.gsu.edu/hbase/ppois2.html#bl
 Blood flow =

E.g. original flow rate= 100 cm3/ sec, then:

Double length flow= 50 cm3/ sec increase by a factor of ____
Double viscosity flow= 50 cm3/ sec e.g.
Double pressure flow= 200 cm3/ sec -14 = 1 24 = 16
Double radius flow= 1600 cm3/ sec -24 = 16 44= 256

A change in radius has a dramatic effect!

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Q2. The greatest resistance to blood flow occurs in
a. Large arteries
b. Medium-size arteries
c. Arterioles
d. Veins

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 Blood flow =

At a given mean arterial pressure, blood can be diverted

from one organ to another by variations in the degree of
vasoconstriction and vasodilation of small arteries and
arterioles
tube radius
(i.e. by variations in _________________)

Q2. The greatest resistance to blood flow occurs in

a. Large arteries
b. Medium-size arteries
c. Arterioles Smallest arteries;
- contain smooth
_____________:
muscle
d. Veins which can relax increase vessel radius (__________)
vasodilation ;
OR contract decrease vessel radius (______________)
vasoconstriction

Provide the greatest resistance to blood flow

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 Q3. Blood flow to an organ is largely determined by the
degree of vasoconstriction or vasodilation of its __________.
arterioles

The rate of blood flow to an organ can be ___________

increased by
dilation of its arterioles and can be ___________
decreased by
constriction of its arterioles.

Q4. An increase in contractile force above the intrinsic tone

leads to ______________.
vasoconstriction A decrease in contractile force
below the intrinsic tone leads to ____________.
vasodilation

Arteriolar smooth muscle possesses a large degree of __________________

spontaneous contractile activity
_______________________ (i.e. contraction independent of any neural,
hormone, or paracrine input)

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 Mechanisms controlling vasoconstriction
and vasodilation in arterioles
Two kinds of mechanisms: local controls and extrinsic controls
Local controls: mechanisms by which organs and tissues alter
their own arteriolar resistances independent of nerves/
hormones (___________________
self-regulating their blood flows)
changes caused by autocrine/ paracrine agents
e.g. active hyperemia, flow autoregulation, reactive hyperemia

Extrinsic controls: regulation by the ___________________

ANS

and ______________________
Endocrine system

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Q5. Distinguish between active hyperemia and reactive hyperemia.

Active hyperemia: An increase in blood flow that occurs in skeletal

muscles and other organs as a result of ___________________________
increased tissue metabolism

O2,
increased metabolic activity
_______________ arteriolar dilation increased
metabolites _____________ _______ blood
________of organ in organ in organ flow to organ
interstitial fluid

e.g. CO2, H+, adenosine, K+, Cause arteriolar smooth

bradykinin, eicosanoids, nitric oxide muscle to relax

Reactive hyperemia: A transient increase in organ blood flow that occurs

following a brief period of ______________________________________
occlusion of blood supply

Blood supply O2, arteriolar dilation

____________
Occlusion ______ blood
increased
to organ metabolites __________in
increased released flow to organ
__________ in organ IF affected organ

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 Flow autoregulation:

O2,
___________ ___________ Restoration of
Blood flow metabolites,
_______ in ________ in blood flow toward
to organ vessel-wall
organ organ normal in organ
stretch in organ

Note:
Active hyperemia:
Local control of organ blood flow in response to
increases in metabolic activity
_______________________________ do not differ in major
VS Flow autoregulation: mechanisms (which involve
Local control of organ blood flow in response to _____________________)
local metabolic factors

_______________________________
decreases in blood pressure

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 less
Q6. Parasympathetic system is more important than the sympathetic
system in the control of total peripheral resistance. True/ False

Most arterioles receive a rich supply of ________________

sympathetic post-ganglionic
nerve fibers (release mainly ________________)
non-adrenaline
binds to _______-adrenergic
alpha receptors on vascular smooth muscle
cause _____________
vasoconstriction

______________________
parasympathetic endings in arterioles:
always promote _______________.
vasodilation

HOWEVER,
the great majority of blood vessels receive sympathetic but not
parasympathetic input.

Extrinsic control

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 Other extrinsic controls
Hormones
Adrenaline:
binds to _________-adrenergic
alpha receptors on arteriolar smooth muscle
vasoconstriction
binds to _________-adrenergic
betaz receptors
vasodilation
Angiotensin II vasoconstriction
Vasopressin (ADH/ Antidiuretic hormone) vasoconstriction
Atrial natriuretic peptide vasodilation

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Q7. Angiotensin II
a. causes vasoconstriction.
b. stimulates adrenal cortex to secrete aldosterone.
c. is a part of the renin-angiotensin system
d. All the above

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 Endothelial cells
Smooth muscle relaxation results from the local effects of a
number of molecules produced by the vessel endothelium:
_____________
NO (endothelium-derived relaxing factor) vasodilation
endothelium of arterioles contains an
an enzyme that synthesizes NO:
endothelial nitric oxide synthase
__________(PGI
Protacyclin
2) vasodilation
___________
Endothelin (ET-1) vasoconstriction

Sublingual glyceryl trinitrate (nitroglycerin)

treatment of _____________________
angina pectoris

Shear stress: the force that the flowing blood exerts on the inner surface of arterial
wall; increases as blood flow through vessel increases arterial vasodilation
__________________

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 Q8. Which of the these is a paracrine regulator that
stimulates vasoconstriction?
a. Nitric oxide
b. Prostacyclin
c. Bradykinin
d. Endothelin-1

Specifically, the endothelium of tunica interna produces a no. of

paracrine regulators which cause _________________
smooth muscle of tunica media to
either relax/ contract

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Q9. Are the following statements concerning the control of the
blood vessels correct?
a) Reactive hyperemia is due to vasodilatation caused by the
accumulation of metabolites during a period of exercise.
occluded blood flow

b) The diameter of the arterioles is entirely regulated by the

sympathetic nervous system. F, local factors, hormones

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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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 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

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Q10. Baroreceptors are located in the...

a. aorta and subclavian arteries.

b. aortic arch and carotid sinus.
c. aorta and carotid veins.
d. aorta and subclavian veins.
e. aorta and common iliac arteries

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 Arterial baroreceptors

Neural signals to
cardiovascular control
centre in medulla
Carotid sinus
baroreceptor
Aortic arch
baroreceptor
Common carotid arteries
Aorta

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http://www.as.wvu.edu/~rbrundage/chapter10b/img017.jpg
Q11. When the arterial baroreceptors decrease or increase their
rate of firing, what changes in autonomic outflow and
cardiovascular function occur?

Increase in arterial pressure

__________________ Increase firing

Decrease __________ outflow to Increase ______________

heart, arterioles, veins outflow to heart

________ heart rate ________ heart rate

________ventricular
contractility Net result:
- ________cardiac output (decrease heart
________ rate and stroke volume)
- ________ total peripheral resistance
return of BP toward normal
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 Q12. The baroreceptor reflex functions primarily as a short term
regulator of arterial blood pressure.
True/ False
Arterial baroreceptor reflex:
- Activated __________ by change in BP
rapidly restores the BP toward normal
- if BP deviates from normal operating point for > few days:
baroreceptors would ________ to this new pressure
(i.e. __________ frequency of action potential firing at any
given pressure)

The most important long term regulator of arterial pressure is the

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Renin-angiotensin-aldosterone system

4. vasopressin

2. 1.

Increase blood volume Increase blood volume

3.

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Q13. In response to exercise, the heart would be called upon to _____ the
amount of blood pumped, and this would be initiated by signals from
______ fibers.
A) increase; sympathetic
B) increase; parasympathetic
C) decrease; sympathetic
D) decrease; parasympathetic

Q14. In response to an elevation in blood pressure, the cardiac control center

would attempt to restore homeostasis primarily through

A) sympathetic stimuli to the

ventricular myocardium
B) sympathetic stimuli to the SA node
C) parasympathetic stimuli to the SA node
D) parasympathetic stimuli to the
ventricular myocardium

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Q15. The ANS is the main extrinsic control for cardiac activity, acting through
both sympathetic and parasympathetic fibers innervating the heart. This
control system is not symmetric--one part of the ANS has less control
over the heart. Which of the following statements is NOT correct?

A) The sympathetic division has significant control of heart rate through its
action at the SA node.
B) The sympathetic division has significant control of contractility through its
action on the ventricular myocardium.
C) The parasympathetic division has significant control of heart rate through
its action at the SA node.
D) The parasympathetic division has significant control of contractility
through its action on the ventricular myocardium.
limited effect

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Q16. Which of the following would help restore homeostasis in the first few
moments after a persons mean arterial pressure became elevated?

a. A decrease in baroreceptor action potential frequency

b. A decrease in action potential frequency along parasympathetic neurons
to heart
c. An increase in action potential along sympathetic neurons to heart
d. A decrease in action potential frequency along sympathetic neurons to
arterioles
e. An increase in total peripheral resistance

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Q17. Damage to which of the following parts of the brain would cause the
body to have less control over cardiac activity?
A) cerebral cortex
B) thalamus
C) basal nuclei
D) medulla oblongata

Q18. Increased input from the baroreceptors to the cardiac control center
would cause which of the following to occur?
A) Increased sympathetic stimulation and decreased parasympathetic
stimulation
B) Decreased sympathetic stimulation and increased parasympathetic
stimulation decrease ventricular contractibility ==> heart rate decreases
C) Increase in both sympathetic and parasympathetic stimulations
D) Decrease in both sympathetic and parasympathetic stimulation

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Q19. Korotkoff sounds are produced by:
a. Closing of the semilunar valves
b. Closing of the AV valves
c. The turbulent blood flow of blood through an artery
d. Elastic recoil of aorta

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 Q20. Cardiac output is the _______ of blood each ventricle
pumps and equal the product of ________ and
______________.
- increased by stimulation of the
___________ nerves to the
End-
diastolic Contractility Afterload heart and by __________ (the
volume main hormone liberated from
adrenal medulla);

- decreased by stimulation of
_____________ nerves to the
heart.
Adrenaline for treating _____________
- increase peripheral resistance
(vasoconstriction);
- increase cardiac output

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Q21. The Frank-Starling law of the heart says that the higher the
end diastolic volume, the

A) lower the cardiac output When the ventricle has been filled to
B) higher the end systolic volume a greater degree during diastole:
the greater the ________
C) lower the blood pressure ventricle _____________ more
D) higher the stroke volume forcefully during systole

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Q22. With respect to the effect on cardiac output, the term
preload refers to
A) the force developed by the myocardial cells during ventricular
systole
B) the blood pressure in the aorta and pulmonary trunk during
ventricular systole
C) the amount of tension developed in the myocardium before it
contracts
D) anything that decreases stroke volume

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Q23. Stroke volume is regulated by all of the following except

A) end-diastolic volume.
B) cardiac output.
C) contractility.
D) peripheral resistance.

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Q24. Which of the following would not increase stroke volume?

A) increased venous return

B) increased sympathetic stimulation of the myocardium
C) increased end diastolic volume
D) increased arterial blood pressure
E) increased afterload

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 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

36
 Q25. The cerebral vessels are sensitive to the carbon dioxide
concentration of arterial blood. When the carbon dioxide
concentration rises as a result of inadequate ventilation
(hypoventilation), the cerebral arterioles _________.
Conversely, when the arterial carbon dioxide falls below
normal during hyperventilation, the cerebral vessels _______.

Hypoventilation
____ cerebral blood flow
___________

Hyperventilation
____ cerebral blood flow
___________

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Q26. When ambient temperature is low, sympathetic nerves
stimulate cutaneous ______________; cutaneous blood
flow is _________, so that _______ heat will be lost from
the body.

As temperature warms, cutaneous arterioles in the hands

and feet _________ as a result of __________ sympathetic
nerve activity. Continued warming causes ___________ of
arterioles in other areas of the skin. If the resulting
increase in cutaneous blood flow is not sufficient to cool
the body, sweat gland secretion may be stimulated.
__________ helps cool the body as it evaporates from the
surface of skin. The sweat gland also secrete ___________,
a polypeptide that stimulates ___________.

38
 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

39
Q27. The normal path of impulse conduction in the heart is:
A. SA node - Purkinje fibers - AV node - AV bundle - bundle branches
B. SA node - AV node - Purkinje fibers - AV bundle - bundle branches
C. SA node - AV node - bundle branches - AV bundle - Purkinje fibers
D. SA node - AV node - AV bundle - bundle branches - Purkinje fibers

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 Q28. An ECG measures ________.
a. blood pressure
b. the electrical activity of the heart
c. blood volume
d. the pumping action of the heart

https://www.ole.bris.ac.uk/bbcswebdav/institution/Faculty%20of%20
Medicine%20and%20Dentistry/MB%20ChB/Hippocrates%20Year%203
%20Medicine%20and%20Surgery/Cardiology%20- 41
%20ECG/page_12.htm
Q29. Which of the following lead placements best describes,
"Fifth intercostal space at the midclavicular line"?

A) V1
B) V2
C) V4
D) None of the above

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 Q30. Which of the following statements is/are correct?
a. The first deflection, the P wave, corresponds to current flows during
atrial depolarization
b. The second deflection, the QRS complex, is the result of ventricular
depolarization
c. The final deflection, the T wave, is the result of ventricular repolarization
d. Atrial repolarization is usually not evident on the ECG because it occurs
at the same time as the QRS complex
e. All are correct

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http://media-1.web.britannica.com/eb-media/95/26995-004-E5839E67.jpg
 Topics to cover
Local control of blood flow
Vascular function & control mechanisms
Cardiac function & control mechanisms
Special circulations
ECG measurement
Heart attacks & failure
Circulatory shock
Hypertension & orthostatic hypotension

44
Q31. Which of the following statement(s) is/are true?
a. Heart failure occurs when the cardiac output is insufficient to maintain
the blood flow required by the body.
b. Examples of causes of heart failure include aortic valve stenosis,
hypertension and hypervolemia.
c. Failure of left ventricle may raise the left atrial pressure and produces
pulmonary congestion and edema.
d. Failure of right ventricle results in
increased right atrial pressure, which
produces congestion and
edema in the systemic circulation.
e. All of the above.

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 46
https://www.studyblue.com/notes/note/n/chapter-24/deck/5788192
 Q32. Which of the following is a compensatory response that occurs during
congestive heart failure?
a. Increased renin secretion
b. Activation of the renin-angiotensin-aldosterone system
c. Increased salt and water retention
d. Increased excretion of sodium and water by kidneys

Fluid retention initially is an adaptive

response to decreased cardiac output
-however, problems emerge as the fluid
retention progresses!

work overload on the heart!

47
Q33. Which of the following is/are true about heart attack?
a. In coronary artery disease, changes in one or more of the coronary
arteries cause insufficient blood flow to the heart. If severe enough, the
result may be death of that portion of the heart- a myocardial infarction/
heart attack.
b. Regular exercise is protective against heart attacks.
c. The symptoms of myocardial infarction include prolonged chest pain,
often radiating to the left arm, nausea, vomiting, sweating, weakness and
shortness of breath.
d. Diagnosis of heart attack can only be made by ECG changes typical of
infarction

Also by measurement of certain

protein markers in plasma!
-Proteins present in cardiac muscle and
leak out into blood when muscle is
damaged
-Most common marker:
_____________________
48
Q34. Which of the following statements regarding hypertension are
correct? Please select all that apply.
a) Hypertension is characterized by a persistent arterial blood pressure in
excess of 140/90 mm Hg
b) Hypertension associated with another medical condition is called
primary hypertension
c) Hypertension seen in renal disease is classified as secondary
hypertension
d) The rise in blood pressure seen in hypertension is mainly caused by an
increase in cardiac output

49
Q35. Which of the following is a manifestation of orthostatic hypotension?
A) A patient's pulse is 80 when she is supine, but 96 when she sits up.
B) A patient's pulse is 76 when he is supine, but 88 when he sits up.
C) A patient's blood pressure is 132/80 when she is supine, but 106/78 when
she sits up.
D) A patient's blood pressure is 150/100 when he is upright, but 134/90
when he lies down.

Lying to a standing position:

- a shift of blood from veins of thoracic cavity
to veins in lower extremities.
reduces venous return

The consensus definition is a drop of ____ mm

Hg systolic,_____ mm Hg diastolic, or both!

50
Q36. Histamine release causing vasodilation is a cause of _____ shock.
a. Neurogenic As a result of a severe __________ reaction
b. Anaphylactic widespread release of histamine
c. Septic ___________
decrease total _______________
rapid _____ in BP

Q37. Loss of sympathetic nervous system stimuli following a diving

accident would lead to _____ shock.
a. Neurogenic Usually because of upper spinal cord damage/
spinal anesthesia
b. Cardiogenic
Results from cardiac failure
c. Hypovolemic
(e.g. infarction, severe cardiac arrhythmias,
valve damage)

51
Q38. A child suffers second degree burns to 30% of his body. The medic
should suspect _____ shock.
a. Cardiogenic
b. Obstructive
c. Hemorrhagic
Due to _____________, which might be caused by
d. Hypovolemic
hemorrhage, severe dehydration, or burns

Q39. Which of the following are cardiovascular reflexes that help to

compensate for circulatory shock? accompanied by ______________________
a. Sympathetic reflex activated by baroreceptor
reflex, leading to increased heart rate
b. Decreased blood flow to digestive tract
and skin due to vasoconstriction
c. Decreased blood flow through kidneys
stimulating renin secretion and activation
of the renin-angiotensin-aldosterone system

52