Download Physiology I – Concise Lecture Outline

1
Physiology I – Concise Lecture Outline
Lecture Outline 1 Contraction and Excitation of Skeletal Muscle
I.
Overview
A.
B.
II.
Types of Muscle
a.
Smooth
b.
Cardiac
c.
Skeletal
Functional Characteristics of Muscle Tissue
Skeletal Muscle
A.
Anatomy
B.
Cellular Organization
a. muscle fibers
b. myofibrils
C.
Molecular Organization
a. Sarcomere
i. A bands
ii. I bands
iii. H band
iv. I band
v. Z-disc
b. T-tubule system (Sarcoplasmic reticulum)
D.
Contractile filaments of the muscle
a. actin
b. myosin
c.
tropomyosin
d. troponin complex
e. Sliding filament mechanism
E.
Neuromuscular Junction
a. Components
i. motor neuron
ii. motor endplate
iii. synaptic trough
iv. synaptic cleft
b. Release of acetyl choline
III.
F.
Mechanism of Excitation-Contraction Coupling
G.
Control of contraction and relaxation
Muscle Mechanics
1
2
A.
Length-Tension relationships
B.
Force-velocity relationships
C.
Types of Muscle Contraction
a. isotonic
i. eccentric
ii. concentric
b. isokinetic
c.
IV.
isometric
Motor Unit
A.
Composition
B.
Function
C.
Types of Skeletal muscle
a. I: Slow oxidative
b. IIa: Fast Oxidative
c.
IIb: Fast glycolytic
V.
Frequency summation of twitches and tetanus
VI.
Sources of Energy for Muscle Contraction
A.
Creatine phosphate
B.
Glycolysis
C.
Oxidative Phosphorylation
D.
Muscle Fatigue
a. peripheral
b. central
Lecture Outline 2 Motor Functions of the Spinal Cord and Cord Reflexes
I.
II.
Spinal Cord
A.
Functions
B.
Motor Organization
a.
Sensory neurons
b.
Interneurons
c.
propriospinal fibers
d.
Motor neurons
Spinal Reflex and Reflex Arc
A.
Overview of Spinal Reflex and Reflex arc
B.
Categories of reflexes
a. autonomic or visceral
b. somatic
C.
Components of Reflex Arc
2
3
a. receptor
b. sensory neuron
c.
integration center
d. motor neuron
e. effector organ
D.
Types of Reflex Arcs
a. monosynaptic
b. polysynaptic
c.
ipsilateral
d. contralateral
E.
Sensory receptors of muscle
a. Examples
i. muscle spindle
ii. golgi tendon organ
b. Muscle spindle
i. static response
ii. dynamic response
iii. function
iv. Function of the gamma system
F.
Spinal Reflexes
a. Types
i. Stretch reflexes
ii. Golgi tendon reflexes
iii. Crossed extensor reflexes
iv. Superficial cord reflex
b. Transmission of Stretch Information to Higher Centers
c.
Withdrawal reflexes
Lecture Outline 3 Contraction and Excitation of Smooth and Cardiac Muscle
I.
II.
Smooth Muscle
A.
Anatomy
B.
Special Features
C.
Neuromuscular Junction
D.
Excitation-Contraction Coupling
E.
Regulation of smooth muscle contraction
F.
Relaxation of smooth muscle
G.
Regulation of calcium stores
Cardiac Muscle
3
4
A.
Anatomy
B.
Types of fibers
C.
Specialized cells of the cardiac conduction system
D.
Cardiac muscle as a functional syncytium
E.
T tubules arrangement
F.
Excitation-contraction coupling
G.
Cardiac action potentials
a. Fast response
b. refractory period
c.
Slow response
Lecture Outline 4 Cardiac Cycle
I.
Introduction
A.
Arrangement of cardiac muscle spirals
B.
II.
III.
IV.
V.
Differences between left and right ventricles
Review of the cardiac cycle
A.
Definition
B.
Effect of heart rate on the cardiac cycle
C.
Atria as pumps
D.
Ventricles as pumps
E.
Concepts associated with the cardiac cycle
F.
Aortic pulse pressure curve
G.
Electrocardiogram
H.
Heart sounds
Work output of the heart
A.
Stroke work output
B.
Two types of work
C.
Pressure-volume loop
Myocardial function
A.
Preload
B.
Afterload
C.
Contractility
D.
Heart rate
Cardiac energy
A.
Cellular adaptations
B.
Nutrients
D.
Determination of myocardial oxygen consumption
E.
Factors important in tension development
4
5
VI.
VII.
VIII.
IX.
Regulation of heart pumping
A.
Intrinsic regulation of cardiac output
B.
Extrinsic regulation of cardiac output
Terminology
A.
inotropic
B.
chronotropic
C.
bradycardia
D.
tachycardia
E.
hypoeffective heart
F.
hypereffective heart
Effect of ions on heart function
A.
potassium ions
B.
calcium ions
C.
sodium ions
Effect of temperature on cardiac function
Lecture Outline 5 Rhythmical Excitation of the Heart and Normal ECG
Rhythmical Excitation of the Heart
I.
Specialized systems of the heart
II.
Special excitatory and conductive system of the heart
A. Sinus node
B. Internodal pathways
C. Atrioventricular node
D. A-V bundle
E. Purkinje fibers
F. Transmission into cardiac muscle
G. Depolarization pattern in the ventricles related to the cardiac conduction system
Normal ECG
I.
The Use of the ECG
II.
The 12 Lead ECG
III.
A.
Standard limb leads
B.
Augmented leads
C.
Precordial leads
Organization of the Normal ECG
A.
Standardization
5
6
B.
Vectors
C.
Analysis of waveforms (Lead II)
D.
Waves recorded on the electrocardiogram (Lead II)
E.
Refractory periods in relation to ECG complexes
Lecture Outline 6 Abnormal ECG
I.
Lead of Axis
II.
Mean Electrical Axis of the Ventricular QRS
III.
A.
Introduction to normal MEA
B.
Normal ventricular conditions that cause axis deviation
Axis Deviations
A. Left axis deviation
B. Right axis deviation
IV.
V.
VI.
Abnormal voltage
A.
increase in voltage
B.
decrease in voltage
Prolonged and wide and bizarre QRS complexes
A.
Prolonged – hypertrophy
B.
Wide and bizarre – bundle branch block
Ischemia, Injury and Infarction
A.
Causes
B.
Diagnosis – Current of Injur
a.
J point as a point of reference
b.
S-T segment shift or Current of Injury
C.
Effect if Current of Injury on MEA
D.
Myocardial Infarction
Lecture Outline 7 ECG and Cardiac Arrhythmias
I.
II.
III.
Introduction to Arrhythmias
A.
Diagnosis of cardiac rhythms
B.
Origin of abnormal cardiac rhythms
C.
Causes of cardiac arrhythmias
D.
Location of a rhythmicity
Abnormal Sinus Rhythms
A.
Sinus tachycardia
B.
Sinus bradycardia
C.
Sinus arrhythmias
Abnormal Rhythms from Impulse Conduction Blocks
A.
Atrio -ventricular blocks
6
7
a. 1st degree
b. 2nd degree
c.
3rd degree
i. ventricular escape rhythm
ii. AV nodal escape rhythm
IV.
Wolff -Parkinson-White Syndrome
V.
Premature Contractions
A. Premature Ventricular contractions (PVC)
VI.
Reentry or Circul Movements
A.
Causes
B.
Examples
a. Paroxysmal tachycardias
b. Flutter and fibrillation
VII.
Cardiac arrest
Lecture Outline 8 Heart Sounds
I.
II.
III.
IV.
V.
VI.
Causes of hypertrophy
A.
Trained athletes
B.
Continuous stress
Types of hypertrophy
A.
Pressure overload – concentric hypertrophy
B.
Volume overload – eccentric hypertrophy
Mechanisms of Heart Sounds
A.
Heart Sounds and murmur defined
B.
Mechanisms of heart sounds
Areas for Auscultation
A.
Atrio -ventricular valves
B.
Semilunar valves
C.
Phonocardiogram
Normal Heart Sounds
A.
First heart sound
B.
Second heart sound
C.
Third heart sound
D.
Fourth heart sound
Types of Murmurs
A.
Systolic murmurs
7
8
VII.
B.
Diastolic murmurs
C.
Mitral prolapse
Valvular lesions
A.
Causes
a. Rheumatic fever
b. Congenital
c.
VIII.
IX.
Old age
Heart Murmurs caused by Valvular Lesions
A.
Aortic valve – stenosis and regurgitation
B.
Mitral valve – stenosis and regurgitation
Exercise in patients with valvular lesions
A.
Mild cases
B.
Moderate to severe cases
Lecture Outline 9 Vascular Flow and Resistance
I.
II.
III.
IV.
V.
VI.
Introduction: the circulation
A.
Functions
B.
Systemic circulation
C.
Pulmonary circulation
Characteristics of segments of the Circulatory System
A.
Physical properties
B.
Distribution of blood volumes
C.
Cross-sectional areas and velocity of flow
D.
Blood pressure in the various portions of the circulation
E.
Basic theory of circulation function
Pressure vs. Flow
A.
Flow equation
B.
Effect of vessel diameter on blood flow
Resistance to blood flow
A.
Resistance
B.
Physiological regulation of flow
C.
Circuit resistance
Types of blood flow
A.
Laminar flow
B.
Turbulent flow
D.
Reynold’s number
Rheological properties of blood
8
9
A.
Viscosity vs. the hematocrit
B.
Fahraeus-Lindquist effect
Lecture Outline 10 Vascular Distensibility and Functions
I.
II.
III.
IV.
Introduction
A.
Distensibility
B.
Compliance
Vascular Distensibility and Compliance
A.
Distensibility and compliance of selected vessels
B.
Pressure-volume curves
C.
Delayed compliance
Arterial Pulse Pressure
A.
Introduction
B.
Abnormal pulse contours
C.
Radial pulse –characteristics
D.
Transmission of pressure pulses
E.
Indirect Method of Measurement of Arterial Blood Pressure
Veins and Their Functions
A.
Venous pressures
B.
Venous resistance and peripheral venous pressure
C.
Effect of Gravitational (hydrostatic) Pressure on venous return
D.
Veins – venous return to the heart
E.
Veins as blood reservoirs
Lecture Outline 11 Microcirculation and the Lymphatic System
I.
II.
III.
IV.
Introduction: Exchange of fluid between blood and tissues
A.
Pattern of flow
B.
Function of arterioles and capillaries
C.
Structure of the capillary wall
Flow of Blood in the capillaries – vasomotion
A.
Blood flow in capillaries
B.
Average function of the capillary system
Exchange of Nutrients and Other Substances between Blood and Interstitial Fluid
A.
Types of capillaries
B.
Diffusion through a capillary membrane
The Interstitium and Interstitial Fluid
A.
Solid Structures
B.
Gel
9
10
C.
V.
VI.
Free fluid in the interstitium
The Role of Proteins in Controlling Plasma and Interstitial Fluid Volumes
A.
Introduction
B.
Factors affection bulk flow across the capillary endothelium
C.
Starling Equilibrium for capillary exchange
Lymphatic System
A.
Lymph channels of the body
B.
Terminal lymphatic capillaries and their permeability
C.
Formation of lymph
D.
Role of the lymphatic system in controlling Interstitial fluid protein concentration,
interstitial fluid volume and interstitial pressure
Lecture Outline 12 Local Blood Flow
I.
II.
Introduction
A.
Relationship of flow to tissue metabolism
B.
Variations in local blood flow
C.
Importance of local blood flow
D.
Mechanisms for regulation
Mechanisms of blood flow control
A.
Acute control
a. Vasodilator theory
b. Oxygen demand theory
III.
B.
Special acute control mechanisms
C.
Long-term blood flow regulation – response to hypoxia
Hormonal regulation of the circulation
A.
Vasoconstrictor agents
B.
Vasodilator agents
C.
Effects of different ions on vascular control
Lecture Outline 13 Nervous Regulation of the Circulation - Rapid Control of Arterial Blood
Pressure
I.
Nervous Regulation of the Circulation
A.
ANS – most important in control of circulation
B.
Vasomotor Center – Sympathetic vasoconstrictor system
C.
Sympathetic vasomotor tone
D.
Control of heart by vasomotor tone
E.
Control of vasomotor tone by higher nervous centers
F.
Norepinephrine and the adrenal medulla
G.
Sympathetic vasodilator system
10
11
II.
Role of the Nervous System – Rapid arterial blood pressure control
A.
Increased arterial pressure during exercise and stress
B.
Reflex mechanisms for maintaining normal arterial pressure
C.
Chemoreceptor influence
D.
Atrial and pulmonary arterial stretch reflexes
E.
Central nervous system control
F.
Special nervous control of arterial pressure
Lecture Outline 14 Long-Term Regulation of Arterial Blood Pressure
I.
II.
III.
IV.
Introduction: Comparison of Rapid and Long -Term Blood Pressure Regulation
A.
Rapid blood pressure control
B.
Long-term blood pressure control
Renal Body Fluid System of Arterial Pressure Control
A.
Pressure diuresis
B.
Pressure natriuresis
C.
Renal output curve
D.
Pressure regulation “infinite gain principle”
E.
Two determinates of long – term blood pressure regulation
F.
Failure of TPR changes to affect long – term blood pressure
G.
Effect of fluid volume in the regulation of arterial blood pressure
H.
Importance of salt in the renal – body pressure regulation
Renin-Angiotensin-Aldosterone Mechanism
A.
Components of the Renin-Angiotensin system
B.
Effect of renin-angiotensin in maintaining normal blood pressure
Summary of Integrated Arterial Blood Pressure Regulation
A.
B.
C.
Rapid (Acute) pressure control mechanisms
Intermediate pressure control mechanisms
Long-term mechanisms for arterial pressure regulation
Lecture Outline 14 Regulation of Cardiac Output and Venous Return
I.
II.
Introduction
A.
Cardiac output must equal venous return
B.
Resting cardiac output values
C.
Cardiac index
D.
Relationship of cardiac output to metabolism
E.
Age relationship to cardiac output
Regulation of Cardiac Output by Venous Return
A.
Frank-Starling mechanism
C.
Normal regulation of cardiac output
11
12
III.
Cardiac Function Curve
A.
Intrinsic
B.
Sympathetic stimulation
C.
Hypereffective heart
D.
Hypoeffective heart
IV.
Nervous System Regulation of Cardiac Output during Exercise
V.
Factors That Alter Cardiac Output and Venous Return
VI.
A.
High cardiac output conditions
B.
Low cardiac output conditions
C.
Factors that determine venous return
D.
Venous return curve
Analysis of Cardiac Output
Lecture Outline 15 Coronary Circulation
I.
Coronary Circulation
A.
Physiologic Anatomy of the Coronary Blood Supply
B.
Normal Coronary Blood Flow
D.
Control of Coronary Blood Flow
Lecture Outline 16 Pulmonary Circulation, Pulmonary Edema and Pleural Fluid
I.
II.
III.
IV.
Introduction
A.
Function of lung
C.
Function of the pulmonary circulation
Physiological Anatomy of the Pulmonary Circulation
A.
Right Ventricle
B.
Pulmonary vessels
C.
Bronchial circulation
D.
Lymphatic system
Blood Pressures in the Pulmonary System
A.
Pressure Curve in the right ventricle
B.
Pressures in the pulmonary artery
C.
Pulmonary arterial pulse pressure
D.
PMAP
E.
Pulmonary capillary pressure
F.
Left atrial and pulmonary venous pressures
Blood Volumes in the lungs
A.
Lungs as blood reservoirs
12
13
B.
V.
VI.
VII.
Blood Flow Through Lungs and its Distribution
A.
Effect of diminished alveolar oxygen
B.
ANS control of blood flow
C.
Effect of hydrostatic pressure on blood flow
Effect of Increased Cardiac Output on Pulmonary Circulation
A.
During exercise
B.
Q = P/R
C.
Decreased resistance
D.
Pressures remain relatively low for the cardiac output
Effect of Heart Failure on Left Atrial Pressure and the Pulmonary Circulation
A.
VIII.
IX.
X.
Shift of blood between the pulmonary and systemic circulations
Left Ventricular failure
Pulmonary Capillary Dynamics
A.
Nature of pulmonary capillaries
B.
Dynamics of fluid exchange
Pulmonary Edema
A.
Causes
B.
Pulmonary Interstitial fluid edema vs. Pulmonary Alveolar edema
C.
Pulmonary edema safety factor
Fluids in the Pleural Cavity
A.
Negative pressure in the pleural fluid
B.
Pleural effusion
Lecture 17 Pulmonary Ventilation
I.
II.
III.
Introduction to Respiratory Function
A.
Gas exchange
B.
Acid-base balance
C.
Phonation
D.
Metabolism
Functions of Respiratory Passageways
A.
Nasal cavity “air conditioning functions”
B.
Mucous coat and cilia
C.
Pharynx & Larynx
D.
Trachea, bronchi & bronchioles
E.
Control of bronchiolar musculature
Mechanics of Pulmonary Ventilation
A.
Muscles that cause lung expansion
13
14
IV.
V.
B.
Respiratory pressures
C.
Compliance of lungs
Effect of the Thoracic Cage on Lung Expansion
A.
Compliance of Thorax and lungs together
B.
Work of Breathing (lungs)
C.
Work of Breathing (thorax)
Pulmonary Volumes and Capacities
A.
Spirometry – pulmonary volumes
B.
Pulmonary capacities
VI.
Minute Respiratory Volume
VII.
Alveolar Ventilation
A.
Quiet breathing
B.
Dead space
C.
Rate of Alveolar Ventilation
Lecture Outline 18 Physical Properties of Gas Exchange
Diffusion of Oxygen and Carbon Dioxide through the Respiratory Membrane
I.
II.
III.
Physics of Diffusion and Gas Pressures
A.
Effect of the concentration gradient
B.
Gas pressure in a Mixture of gasses
C.
Pressures of gases in water and tissues
D.
Vapor pressure of water
E.
Diffusion of gases through fluids
F.
Diffusion of gases through tissues
Composition of Alveolar Air
A.
Factors that determine the composition of Alveolar Air
B.
Rate of alveolar air renewal
C.
Oxygen concentration and partial pressure in the alveoli
D.
Carbon dioxide concentration and partial pressures in alveoli
E.
Expired air
Diffusion of Gas Through the Respiratory Membrane
A.
Respiratory unit
B.
Respiratory of pulmonary membrane
C.
Factors that determine gas diffusion through the respiratory membrane
D.
Diffusion capacity of the respiratory membrane
E.
Ventilation-Perfusion ratio
Lecture Outline 19 Transport of Oxygen and Carbon Dioxide in Blood and Body Tissues
14
15
I.
Pressure of Oxygen and Carbon Dioxide in Lungs, Blood and Tissues
A. Uptake of oxygen by pulmonary blood
B. Transport of oxygen in arterial blood
C. Diffusion of oxygen from capillaries to interstitial fluid
D. Diffusion of oxygen from capillary to cells
E. Diffusion of carbon dioxide
II.
III.
Transport of Oxygen in Blood
A.
Oxygen-Hemoglobin dissociation curve
B.
Role of Hemoglobin as a “buffer” of tissue oxygen levels
C.
Metabolic use of oxygen by cells
D.
Transport of oxygen in the dissolved state
F.
Hemoglobin and carbon monoxide
Transport of Carbon Dioxide
A.
Chemical forms
B.
Carbon dioxide dissociation curve
C.
Carbon dioxide transport and pH
D.
Respiratory exchange ratio or Respiratory Quotient
Lecture Outline 20 Regulation of Respiration
I.
II.
Introduction
A.
Basic elements of respiratory control
B.
Two types of respiratory control
The Respiratory Center
A. Neurogenic control
B. Dorsal respiratory group
C. Pneumotaxic center
D. Apneustic center
E. Alternate mechanisms for respiratory control
a. Cortex
b. Other brain areas
III.
IV.
V.
Reflex Control
A.
Stretch receptors
B.
Hering-Breurer inspiration reflex
Chemical Control
A.
Types of receptors
B.
Central receptors
Peripheral Chemoreceptors
A.
Decrease in oxygen levels below 60 mm. Hg.
15
16
VI.
VII.
VIII.
B.
Hydrogen ions
C.
Carbon dioxide
D.
Low oxygen environments
E.
Quantitative effect of low oxygen on alveolar ventilation
F.
Effect of low oxygen when arterial carbon dioxide and hydrogen ions remain
normal
Regulation of Respiration During Exercise
A.
Brain
B.
Proprioceptors in joints
C.
Input directly from muscles
D.
Memory
Other Receptors
A.
Irritant receptors
B.
C fibers or J fibers
Periodic Breathing – Cheyne-Stokes Breathing
Lecture Outline 21 Aviation, Acceleration and High Altitude
I.
II.
Effect of Low Oxygen on the Body
A.
Barometric pressures at different altitudes
B.
Alveolar partial pressure of oxygen at different altitudes
C.
Effect of breathing pure oxygen on alveolar oxygen levels at different altitudes
D.
Acute effects of hypoxia
E.
Acclimation to low partial pressures of oxygen
F.
Natural acclimation of natives living at thigh altitudes
G.
Chronic mountain sickness
H.
Acute mountain sickness
Effects of Acceleratory Forces on the Body
A.
Measurement of acceleratory forces
B.
Effects of positive G force
C.
Effects of negative G force
D.
Anti-G suits
E.
Effects of linear acceleratory forces on the body
Physiology of Deep Sea Diving and other Hyperbaric Conditions
I.
II.
Introduction
A.
Physiological effects of water pressure
B.
Relationship of sea depth to pressure and air volume
C.
Effect of depth on volume of gas – Boyle’s law
Effect of partial Pressure of Gases on the Body
16
17
III.
IV.
A.
Nitrogen narcosis
B.
Oxygen toxicity
C.
Carbon dioxide toxicity at great depths
Decompression of Diver
A.
Volume of nitrogen dissolved in body fluids at different depths
B.
Decompression sickness
C.
Barotrauma
Hyperbaric Oxygen Therapy
A.
High pressure oxygen
B.
Treatment
C.
Oxygen toxicity
17