1. Know the location of the heart & its coverings
(fibrous & serous pericardium); which layer is the outer layer of the heart
wall?
2. Also know the 3 layers of the heart wall & the tissue composition of each
layer.
3. Know the basic function of each of the four chambers (atria & ventricles) of the heart.
4. Also know the major blood vessels associated with each chamber.
5. Which side of the heart serves as the pulmonary circuit pump & systemic circuit pump, & what is the function of each circuit? Know where blood is going or coming from as it enters & exits each chamber of the heart.
6. Which blood vessels provide the heart with its own blood supply (coronary circulation?
7. What is the cause of angina pectoris & myocardial infarction? Why is cell death in the myocardium so dangerous?
8. What are the names of the 2 atrioventricular valves? What is their function? What is the function of the chordae tendineae?
9. What is the function of the aortic & pulmonary semilunar valves?
10. What is meant by the term functional syncytium as applied to cardiac muscle fibers? What are intercalated discs?
11. Know the basic similarities & differences between cardiac & skeletal muscle fiber contraction.
12. Know the sequence of excitation of autorhythmic cardiac cells. Where are the pacemaker cells located?
13. Where is the oinly electrical connection between atria and ventricles?
14. What are arrhythmias? What is fibrillation & how might it be corrected?
15. How can the basic intrinsic rhythm of the heart be modified (accelerated
& inhibited) & what specific cell types are involved?
16. Know the basic components of an electrocardiogram (ECG or EKG).
17. Definitions: systole, diastole, & quiescent period.
18. Definitions: cardiac output, stroke volume, cardiac reserve, end diastolic
volume, end systolic volume, preload contractility, afterload.
19. What physiological chemicals (hormones, ions) are involved in regulation of heart rate?
20. Disorders: tachycardia, bradycardia, congestive heart failure.
21. Know the 3 layers (tunics) of blood vessel walls. In what type of blood vessel is the
tunica media thickest? In which
vessel type is the tunica externa thicker?
22. Which layer of blood vessel walls is responsible for
vasoconstriction &
vasodilation?
23. What types of tissue are found in each tunic?
24. Know the different types of arteries (elastic
(conducting), muscular
(distributing), and arterioles), and the
relative size of each.
25. Know the basic differences among the 3 types of
capillaries (continuous, fenestrated and sinusoidal) and where each might be
found.
26. Where are venous valves found & what is their
function?
27. Where are precapillary sphincter muscles found? What is a
thoroughfare
channel & where are they located?
28. What is an anastomosis, where are they found, &
what is its function?
29. Define blood flow, blood pressure &
resistance. What are the three
main sources of resistance?
30. What are normal values for arterial, venous &
capillary pressure?
31. Distinguish among systolic pressure, diastolic
pressure, pulse pressure & mean arterial pressure.
32. Briefly describe some neural & chemical controls
for regulation of blood pressure.
Briefly describe renal regulation of blood pressure.
33. What are some of the causes of hypotension &
hypertension?
34. Distinguish between metabolic & myogenic controls
for blood flow.
35. What are the forces regulating blood flow through
capillaries?
36. What are the four processes that comprise respiration? Which of these are the responsibility of the respiratory system?
37. Nose & paranasal sinuses: external nose (external nares, nasal septum), nasal cavity (internal nares, nasal conchae, nasal respiratory mucosae).
38. Where are the paranasal sinuses located (bones)? What is sinusitis & what is its cause?
39. Position, Function & Epithelium composition of: pharynx, nasopharynx, oropharynx, laryngopharynx.
40. What are the functions of the larynx? What is the function, location and composition of the epiglottis?
41. How do the vocal folds and the glottis produce the voice? What is laryngitis and what causes it?
42. What are the layers of the tracheal wall? What is the function of each? What is the carina?
43. The bronchial tree: primary divisions and tissue composition of each.
44. What cell types are present in the alveoli and the alveolar walls? What is the function of each?
45. Lung gross anatomy: cardiac notch, lobes, bronchopulmponary segments, lobules. What is the difference between the left & right lungs?
46. What is the function of the pulmonary and bronchial circulations?
47. What is the function and composition of the pleurae? What is pleurisy?
48. What is the relationship among atmospheric pressure, intrapulmonary pressure and intrapleural pressure?
49. Respiratory Volumes: tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume.
50. Respiratory Capacities: inspiratory capacity, vital capacity, total lung capacity.
51. Dead space: anatomical dead space, alveolar dead space, total dead space.
52. What are the major types of hypoxia & the causes of each?
53. How are oxygen and carbon dioxide transported in the blood?
54. Describe the carbonic acid-bicarbonate buffer system in the blood.
55. Where are the control centers for breathing located in the brain?
56. What is the cause of chronic obstructive pulmonary disease (COPD)? What is the cause of tuberculosis?
1. Heart Location: extends 12-14 cm within mediastinum, from 2nd rib to 5th intercostal space; Pericardium: double-walled sac enclosing heart (fibrous pericardium: outer dense connective tissue layer; serous pericardium: deep to fibrous pericardium (parietal layer: lines internal surface of fibrous pericardium; visceral layer (epicardium) – deep to parietal layer; outer layer of heart wall))
2. epicardium: visceral layer of serous pericardium; often accumulates fat; myocardium: cardiac muscle deep to epicardium (branched cardiac muscle cells linked by connective tissue fiber bundles (collagen & elastin)); endocardium: thin inner myocardial surface; sheet of endothelium (squamous epithelium) resting on connective tissue
3. right atrium receives deoxygenated blood from superior vena cava (from areas above diaphragm), inferior vena cava (from areas below diaphragm), & coronary sinus (from myocardium); left atrium receives oxygenated blood from pulmonary veins (4, from lungs); right ventricle pumps blood into pulmonary trunk (to lungs); left ventricle pumps blood into aorta (to systemic circulation/body tissues)
4. see # 3
5. pulmonary circuit pump: right side of heart; systemic circuit pump: left side of heart
6. coronary arteries: arise from the base of the aorta; coronary arteries & branches (interventricular, circumflex & marginal arteries) carry oxygenated blood to myocardium of atria & ventricles; cardiac veins: carry deoxygenated blood from myocardium to coronary sinus, which empties into right atrium
7. angina pectoris: chest pain due to short deficiency of blood supply to myocardium; myocardial infarct (MI, heart attack or coronary): can result from prolonged blockage; proper circulation to myocardium is critical; blockage of coronary arterial circulation can be serious/fatal
8. tricuspid valve: prevents backflow of blood from right ventricle to right atrium; bicuspid valve: prevents backflow of blood from left ventricle to left atrium; chordae tendinae: anchored to AV valves & pulled by papillary muscles to close valves following ventricular filling
9. aortic semilunar valve: prevents blood from flowing back into left ventricle following ventricular contraction; pulmonary semilunar valve: prevents blood from flowing back into right ventricle following ventricular contraction
10. cardiac muscle cells coupled by gap junctions & cardiac muscle contracts as an organ unit (all or none); intercalated discs: connections between plasma membranes of adjacent cells (composed of desmosomes & gap junctions)
11. cardiac muscle has sustained intervals between contraction (absolute refractory period of ~ 250 ms, compared to 1-2 ms for skeletal muscle due to calcium ion influx); cardiac autorhythmic cells can spontaneously depolarize, while skeletal muscle cells require neural stimulation; impulses do not spread from cell to cell in skeletal muscle, while gap junctions propogate impulses between cardiac muscle cells
12. SA node -> AV node -> AV bundle -> bundle branches -> Purkinje fibers; pacemaker cells at SA node
13. electrical connection between atria & ventricles: cells within AV bundle
14. arrhthmias: irregular heart rhythms; fibrillation: rapid & irregular contractions; defibrillation: electrical shock to heart to reset rhythm
15. Sympathetic division of ANS (cervical & upper thoracic chain ganglia): increases heart rate (stimulated by cardioaccelatory center in medulla oblongata); Parasympathetic division of ANS (vagus nerve): decreases heart rate (stimulated by cardioinhibitory center in medulla oblongata)
16. ECG: P wave: atrial depolarization; QRS complex: ventricular dxepolarization; T wave: ventricular repolarization
17. Systole: contraction; Diastole: relaxation; quiescent period: period of total heart relaxation
18. Cardiac output (CO): CO = Stroke Volume (SV) x Heart Rate (HR); normal resting values: SV = 70 ml/beat; HR = 75 beats/min; CO = 5250 ml/min; SV = end diastolic volume (EDV) – end systolic volume (ESV); normal resting values: EDV = 120 ml; ESV = 50 ml cardiac reserve: difference between resting & maximal CO
19. epinephrine & norepinephrine: increases heart rate; thyroxine: slow sustained increase in heart rate; ions: calcium, sodium & potassium required for heart muscle contraction
20. tachycardia: abnormally rapid heart rate (> 100 beats/min); bradycardia: abnormally slow heart rate (< 60 beats/min); congestive heart failure (CHF): abnormally low cardiac output; due to many factors (weakening of heart muscle)
21. tunica interna (tunica intima): innermost tunic (layer) composed of endothelium (simple squamous epithelium); tunica media: middle tunic composed of smooth muscle cells & sheets of elastin fibers; tunica externa (tunica adventitia): outermost tunic composed of elastyic & collagen fibers; tunica media generally thickest layer in arteries; tunica externa generally thickest layer in veins
22. tunica media with smooth muscle fibers is responsible for vasoconstriction & vasodilation
23. see # 21
24. elastic (conducting) arteries: largest; thick-walled arteries near heart (aorta & major branches); muscular (distributing) arteries: intermediate in size; branch from elastic arteries to distribute blood to body organs; arterioles: smallest; lead from muscular arteries to capillary beds
25. continuous capillaries: most common type; endothelial cells joined by incomplete tight junctions (low permeability); abundant in skin & muscles (in brain, tight junctions are complete (blood-brain barrier)); fenestrated capillaries: similar to continuous; some endothelial cells contain pores or fenestrations (greater permeability); found where active absorption or filtration occurs (digestive system, kidneys); sinusoidal capillaries (sinusoids): highly modified, leaky capillaries (greatest permeability); fenestrated with fewer tight junctions & larger intercellular clefts; found only in certain organs (liver, bone marrow, lymphoid tissue & endocrine organs)
26. venous valves: formed from folds of tunica interna in veins; function as flaps that prevent backflow of blood, especially in limbs
27. precapillary sphincter: at root of metarteriole & capillary; acts as valve to regulate blood flow into capillary (constricts to send blood through bed (using vascular shunt)); thoroughfare channel: vessel intermediate in size between capillary & venule at venous end of capillary bed
28. Vascular Anastomoses: joining of vascular channels to provide alternative blood route (collateral channel); arterial anastomoses, venous anastomoses & arteriovenous anastomoses (metarteriole-thoroughfare channels) exist
29. Blood Flow: volume of blood flowing through a vessel, organ, or circulation in a given period (ml/min); Blood Pressure: pressure (force per unit area) exerted on the walls of a vessel by blood; Resistance: opposition to blood flow (friction); Blood viscosity, Blood vessel length, & Blood vessel diameter (most important source of resistance; decreased diameter = greater resistance) are sources of peripheral resistance
30. Arterial Blood Pressure: Systolic pressure: (~110-120 mm Hg); Diastolic pressure: (70-80 mm Hg); Venous Blood Pressure: ~ 0-20 mm Hg; Capillary Blood Pressure: ~ 20-40 mm Hg
31. Systolic pressure: pressure generated in aorta following (left) ventricular systole; Diastolic pressure: pressure in aorta following ventricular diastole (70-80 mm Hg); Pulse pressure: systolic pressure – diastolic pressure; Mean arterial pressure (MAP): average pressure in arterial system
32. Neural Controls:Vasomotor center: sympathetic neurons in medulla intergrate blood pressure control by altering cardiac output & blood vessel diameter; Baroreceptor-initiated reflexes: baroreceptors = pressure-sensitive mechanoreceptors that respond to changes in arterial pressure & stretch; Chemoreceptor-initiated reflexes: chemoreceptors respond to changing blood levels of oxygen, carbon dioxide & acidity; Higher brain centers: hypothalamus (e.g.: fight or flight response) via medulla; Chemical controls: Adrenal medulla hormones (epinephrine & norepinephrine) are vasoconstrictors & increase BP; Atrial natriuretic peptide (ANP) inhibits aldosterone & decreases BP; Antidiuretic hormone increases water reabsorption in kidneys & BP; Angiotensin II stimulates aldosterone & ADH release & increases BP; Endothelium-derived factors (endothelin, PDGF) are vasoconstrictors (increase BP); Nitric oxide (NO) is a vasodilator (decreases BP); Inflammatory chemicals (histamine, etc.) are vasodilators (decrease BP); Alcohol inhibits ADH release (decreases BP)
33. Hypotension: low blood pressure (systolic BP below 100 mm Hg); often due to individual variations, fluctuations; chronic hypotension may be indicative of poor nutrition; Hypertension: high blood pressure (sustained arterial pressure > 140/90); may occur acutely due to exercise, illness; chronic hypertension may be indicative of increased peripheral resistance (often due to vessel blockage); primary hypertension: most cases; no known cause (factors include diet, obesity, age, race heredity, stress & smoking); secondary hypertension: ~ 10% of cases; due to disorders such as arteriosclerosis & hyperthyroidism
34. metabolic controls: vasodilation by inflammatory mediators (histamine) or nitric oxide; myogenic controls: vasoconstriction & vasodilation by vascular smooth muscle to keep tissue perfusion constant despite pressure variations
35. capillary exchange of respiratory gases & nutrients: oxygen, carbon dioxide, most nutrients & cellular wastes pass between blood & interstitial fluid by diffusion; capillary hydrostatic pressure tends to force fluids through capillary walls; interstitial fluid hydroststic pressure pushes fluid back in; capillary colloid osmotic pressure: large molecules cannot move through capillary membrane; draw fluid in
36. pulmonary ventilation: ventilation or breathing; movement of air into & out of lungs (refreshes air in alveoli); external respiration: gas exchange (O2 loading & CO2 unloading) between blood & alveoli; transport of respiratory gases: transport of O2 & CO2 between lungs & body tissues (in blood); internal respiration: gas exchanges (O2 unloading & CO2 loading) between systemic blood & tissue cells; pulmonary ventilation & external respiration are the primary responsibility of the respiratory system
37. nasal cavity: posterior to external nose; divided by midline nasal septum (formed by septal cartilage anteriorly & vomer bone & perpendicular plate of ethmoid bone posteriorly), continuous with nasopharynx through internal nares; nasal conchae (superior, middle & inferior): mucosa-covered projections in walls of nasal cavity aid in trapping particles in air in mucus as air swirls through them; respiratory mucosa: pseudostratified ciliated columnar epithelium containing goblet cells (secrete mucus) resting on a lamina propria with mucus & serous glands
38. paranasal sinuses in: frontal, sphenoid, ethmoid & maxillary bones; sinusitis: inflamed sinuses; can be caused by spread of infection from nasal mucosae
39. nasopharynx: posterior to nasal cavity; continuous with nasal cavity through internal nares; air passageway; mucosa of pseudostratified ciliated columnar epithelium; oropharynx: posterior to oral cavity; continuous with oral cavity through fauces; extends from soft palate to epiglottis; air & food passageway; mucosa of stratified squamous epithelium; laryngopharynx: posterior to epiglottis; extends to larynx; continuous with esophagus posteriorly; air & food passageway; mucosa of stratified squamous epithelium
40. Larynx (voice box): provides a patent (open) airway; acts as switching mechanism to route food & air into appropriate passageways; houses vocal cords for speech production; epiglottis: flexible elastic cartilage extending from posterior aspect of tongue to thyroid cartilage; covered by mucosa with scattered taste buds; switching mechanism for air & food passageways
41. vocal folds (true vocal cords): vibrate from air moving up from lungs to produce sounds; glottis: medial opening through which air passes; laryngitis: inflammation of vocal folds; can be caused by overuse of voice, bacterial infection, dry air or tumors
42. Trachea (windpipe): wall composed of mucosa (pseudostratified ciliated epithelium with goblet cells producing mucus to moisten air & trap particles), submucosa (connective tissue with seromucous glands) & adventitia (connective tissue reinforced with hyaline cartilage C-rings for support & to allow stretch of the esophagus during swallowing); carina: extension of last tracheal cartilage; marks split of trachea into primary bronchi
43. right & left primary (principal) bronchi; secondary (lobar) bronchi; tertiary (segmental) bronchi; bronchioles; terminal bronchioles; tissue composition of wall changes as tubes become smaller: cartilage support structures change from rings to irregular plates; epithelium changes from pseudostratified columnar to columnar to cuboidal in terminal bronchioles; amount of smooth muscle increases
44. type I cells: participate in gas exchange with pulmonary capillaries; type II cells: secrete a fluid containing surfactant that coats the alveolar walls; alveolar macrophages (dust cells): engulf bacteria & large particles
45. left lung: 2 lobes; cardiac notch (impression): concave depression in left lung to accommodate heart; right lung: 3 lobes; bronchopulmonary segments: pyramid shaped tissue segments within each lung (10 in each lung); lobule: small hexagonal subdivisions of bronchopulmonary segments
46. pulmonary circulation: pulmonary arteries (deliver systemic venous blood to lungs to be oxygenated) & pulmonary veins (deliver freshly oxygenated blood from respiratory zones of lungs to heart); bronchial circulation: bronchial arteries: provide systemic blood to lung tissues (supply blood to all lung tissues except alveoli (alveoli are served by pulmonary circulation)
47. pleurae: membranes surrounding & protecting lungs within pleural cavity; aid in breathing; pleurisy: inflammation of pleura; often caused by pneumonia
48. intrapulmonary (intra-alveolar) pressure (Palv): pressure within alveoli of lungs; rises & falls with breathing, but always equalizes with Patm; intrapleural pressure (Pip): pressure within pleural cavity; also varies with breathing, but is always about 4 mm Hg less than Palv (negative with respect to both intrapulmonary & atmospheric pressures)
49. tidal volume (TV): air volume that moves into & out of the lungs with each breath (~ 500 ml); inspiratory reserve volume (IRV): air volume that can be forcibly inspired beyond tidal volume (~ 1900-3100 ml); expiratory reserve volume (ERV): air volume that can be forcibly expired beyond tidal volume (~ 700-1200 ml); residual volume (RV): air remaining in lungs after forced exhalation (~ 1200 ml)
50. inspiratory capacity (IC): TV + IRV; vital capacity (VC): TV + IRV + ERV; total lung capacity (TLC): VC + RV (~ 4200-6000 ml)
51. anatomical dead space: air trapped in conducting zone; alveolar dead space: air caught in nonfunctional alveoli; total dead space: sum of anatomical & alveolar dead space; dead space volume: ~ 150 ml of 500 ml tidal volume
52. anemic hypoxia: too few red blood cells, abnormal hemoglobin or hemoglobin deficiency; ischemic hypoxia: blocked circulation (blood clot or congestive heart failure); histotoxic hypoxia: metabolic poisons (cyanide) impair ability to use oxygen; hypoxic hypoxia: reduced oxygen partial pressure (due to pulmonary disease, low oxygen in air, or carbon monoxide poisoning (CO competes with oxygen for hemoglobin binding))
53. oxygen: ~98% bound to iron of heme group in hemoglobin in RBCs, ~2% dissolved in plasma; carbon dioxide: ~70% as bicarbonate ion in plasma, ~20% bound to amino acids of globin chains of hemoglobin, ~7-10% dissolved in plasma
54. blood buffer system maintains blood pH within 7.35-7.45 range; if pH decreases, excess H+ combines with bicarbonate ion to form carbonic acid (weak acid -> raises pH); if pH increases, carbonic acid dissociates, releasing H+ ions (lowers pH)
55. respiratory centers: medulla oblongata (generates respiratory rhythm) & pons
56. COPD: obstructive emphysema: marked by enlargement of alveoli & destruction of alveolar walls; chronic bronchitis: chronic excessive mucus production by lower respiratory tract as well as inflammation & fibrosis; tuberculosis (TB): caused by bacterial infection (Mycobacterium tuberculosis)