Human Physiology (Biol 236)
Exam Outline

It is to be understood that you will have read the corresponding sections of the textbook for lecture topics that we have covered!

Chapter 7 & 8 Outline (Blood and cardiovascular physiology ) updated Tue Nov 5th, 2019
• Know the basic anatomy of the heart, its valves, and the systemic and pulmonary blood circuits.
• What is ventricular systole versus ventricular diastole?
• What is asytole? 
• What are the heart sounds lub (or S1) and dub (or S2)? 
• What is the difference between an "innocent murmur" and a "pathologic murmur"?
• What is aortic stenosis, mitral stenosis, and rheumatic heart disease?
• What are the 3 septal defects we discussed (patent foramen ovale, ductus arteriosus, and ventricular septal defect)?
• Know the heart's conduction system (SA-node, AV-node, Bundle of HIS, and purkinje fibers)
• Understand the basics of the pacemaker cells of the SA-node. How are pacemaker myocardial cells depolarized? Repolarized? (remember the primary roles of Na+. Ca+2, and K+)
• Understand how action potentials are stimulated in waves, from spontaneous depolarization in the SA node pacemaker cells) through the rest of the conduction cycle (AV-node, Bundle of HIS, and purkinje fibers).
• Understand how sympathetic stimulation and parasympathetic stimulation of cardiac pacemaker myocardial cells either increases or decreases heart rate. What neurotransmitters and receptors are involved?
• Understand the waves of an EKG (P, QRS, and T)
• What is an arrhythmia? What is tachcardia and bradycardia? 
- What are some treatments for tachycardia? How do they work? (Ca+2 and Na+ channel blockers, propanolol and atenolol)
- What are some treatments for bradycardia? How do they work? (dobutamine, digitalis, MAO-I's)
• Know the basics of blood pressure (systolic versus diastolic BP) and how to measure BP using manual blood pressure cuff.
• How does venous return (of blood to the heart) influence end diastolic volume (EDV)? 
• What is cardiac output? How do the following influence cardiac output?
- EDV
- ventricular stretch (Frank Starling's law)
- heart contractility
- stroke volume
- heart rate
- arterial vessel resistance (TPR) 
• What are agents that can increase heart rate and cardiac output in someone that has bradycardia?
- epinephrine, digitalis, MAO-I's, dobutamine
• What are agents that can decrease heart rate and cardiac output in someone that has tachycardia?
- Na+ and Ca+2 channel blockers, beta blockers (propanolol and atenolol)

• Understand the 3 ways that the body regulates (through negative feedback systems) blood pressure:
1. Baroreceptor reflex
a) Heart baroreceptor responses to increased blood pressure. What is ANP? What does it do to glomerular filtration rate in the kidenys? What does that do to urine output? To blood volume and blood pressure?
b) Baroreceptors in the aortic arch and carotid arteries sense changes in arterial blood pressure, and signal the medulla oblongata (with its cardiac and vasomotor centers) to respond.

- If blood pressure drops below normal, what does sympathetic stimulation by medullla cause to happen to heart rate, diameter of systemic arterioles, and ultimately blood pressure? 

- If blood pressure rises above normal, what does parasympathetic stimulation by medullla cause to happen to heart rate, diameter of systemic arterioles, and ultimately blood pressure? 

2. Hypothalamus & ADH release 
— What is the hypothalamic "set point" range for normal blood osmolarity?
— What happens if blood osmolarity increases above the set point? 
• What does ADH do to water reabsorption in the kidneys? What does this do to urine output? To blood volume and pressure? To blood osmolarity?
• What is diabetes insipidus? 

3. What is the basic response of the renin-angiotensin-aldosterone system when blood pressure is too low?
• What is the "sensor" of low lood pressure in this system?
• What is the response of the juxtaglomerular apparatus of the kidneys to sensing low blood volume and blood pressure?
• What is the effect of renin on the liver? (What substance does the liver convert in to angiotensin 1?)
• What product from the liver goes to the lungs, and what enzyme converts it into angiotensin 2?
• What affect does angiotensin 2 have on the adrenal cortex? On arterial vessels?
• What does aldosterone do to reabsorption of salt (and then water as a byproduct) at the kidney nephron tubules? What does this do to urine output? To blood volume and pressure?
• What is Addison's disease? What are symptoms (clinical presentation)?
• What is Conn's syndrome? What are symptoms (clinical presentatyion)?
• What are ACE inhibitors?

• Know the following vocabulary:
- hypovolemia
- hypotension
- hypervolemia
- hypertension
- atherosclerosis
- thrombus
- embolism
- ischemia
- arteriosclerosis
- aneurysm
• Know the effects of the following on secondary hypertension:
- hypervolemia (such as with excess water consumption, excess ADH, or with Conn's syndrome)
- Stress
- pheochromocytoma
- atherosclerosis
- renal artery disease (abnormal renin or angiotensis 2 secretion)
- pre-eclampsia
• Know some treatments for hypertension reviewed in lecture.
- diuretics (like thiazides or furoseminde)
- atenolol & propanolol
- calcium channel blockers (like verapamil) and Na+ channel blockers
- ACE inhibitors (like captopril or enalapril)
- angiotensin 2 receptor antagonists (like losartan)
• Know the differences between the different types of circulatory shock discussed, and how the body responds.
- hypovolemic shock
- septic shock (see Clinical App Online) 
- anaphylactic shock
- congestive heart failure 

Blood Physiology
• Know, for water balance, what the major sources of water intake versus water loss are.
• Know the components of whole blood (plasma and cells)
For RBC's
know following: jaundice, erythropoietin, erythropoiesis, polycythemia, and anemia.
• Know the different anemias we discussed (iron deficiency, pernicious, aplastic, renal, and autoimmune hemolytic).
• What is the risk of an Rh - mother carrying an Rh+ child? (see autoimmune hemolytic anemia (or erythroblastosis fetalis)
• If I gave you a fictitious blood typing test, could you tell what the blood type was?
For WBCs
• Know which WBCs are granulocytes versus agranulocytes
• Know the relative frequency with which you see the WBCs in the blood. (remember the mneumonic of Never Let Monkeys Eat Bananas)
• know leukocytosis, leukemia, and leukopenia

See the following Clinical Applications and other Readings:
• Clinical App Pg 259 and Online - valve problems in the heart
• Clinical App Pg 263 and Online - Arrhythmias
• Clinical App Pg 276 and Online - ACE inhibitors used for treating hypertension
• Clinical App Pg 254 and Online - anemia
• Clinical App Pg 256 and Online - autoimmune hemolytic anemia

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