0991781 2CE74 Klauchek s v Lifanova e v Et Al Particular Problems of Physi

VOLGOGRAD STATE MEDICAL UNIVERSITYA STATE BUDGETARY EDUCATIONAL INSTITUTION

FOR HIGHER PROFESSIONAL EDUCATIONOF THE MINISTRY FOR PUBLIC HEALTH

AND SOCIAL DEVELOPMENTOF THE RUSSIAN FEDERATION

DEPARTMENT OF NORMAL PHYSIOLOGY

GUIDE BOOK

PRACTICAL MANUAL IN NORMAL PHYSIOLOGY

PARTICULAR PROBLEMS OF PHYSIOLOGY

For 2nd year students of MD-programme

Volgograd, 2012

1

УДК 612(07)P 29

Edited by: Full Member of the Russian Academy of Medical Sci-ences, MD, Professor V. I. Petrov

Reviewed by:

V. F. Kirichuk Honored Worker of Science of RF,MD, Professor,Head of Human Physiology Departmentof Saratov State Medical University

V. S. Nikolsky MD, Professor,Head of Normal Physiology Departmentof Stavropol State Medical Academy

P 29

Particular problems of physiology. Guide book. Practical manual in normal physiology / S. V. Klauchek et al. – Volgograd: Vol-gSMU, 2012. – 152 p.

Compiled by: Klauchek S. V., Lifanova E. V., Khvastunova I. V., Kudrin R. A., Akhundova R. E., Doletsky A. N., Schmidt S. A.

This manual summarizes the practical tasks of human physiology of digestive system. It caters for teachers and students in the English-s-peaking medium of higher medical educational institutions.

ISBN 978-5-94424-190-0 © Volgograd State Medical University

© Klauchek S. V., Lifanova E. V., Khvas-tunova I. V., Kudrin R. A., Akhundo-va R. E., Doletsky A. N., Schmidt S. A.

© Publishing House "Print", 2012

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CONTENT

Content 3

Physiology of digestive system 5

Practical class 1. Principles of alimentary processes regulation. Di-gestion in the mouth and in the stomach. Regulation of these pro-cesses

5

Practical class 2. Digestion in the small intestine. Bile, its compo-sition and participation in digestion. Digestion in the large intes-tine. Intestinal motility and its regulation. Physiology of the liver. Antitoxic function of the liver. Gastrointestinal hormones

14

Practical class 3. Concluding class devoted to the themes “Meta-bolic rate and energy expenditure. Thermoregulation” “Food and nutrition. Vitamins”, “Physiology of the digestive system” (inter-mediate oral examination).

18

Physiology of blood 22

Practical class 1. Physical and chemical properties of the blood. Functions and composition of blood. Red blood cells

22

Practical class 2. Cellular elements of blood. White blood cells. Platelets

28

Practical class 3. Blood types. Hemostasis 33

Physiology of respiratory system 38

Practical class 1. Basic stages of respiration. External respiration 38

Practical class 2. Regulation of respiration. Special aspects of res-piration

48

Practical class 3. Concluding class devoted to the themes “Physi-ology of blood system”, “Physiology of respiratory system” (inter-mediate oral examination)

58

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Physiology of cardiovascular system 63

Practical class 1. Properties of cardiac muscle 63

Practical class 2. Functional diagnostic of cardiac activity. Electro-cardiography

66

Practical class 3. Regulation of cardiac activity 74

Practical class 4. Basics of hemodynamic 78

Practical class 5. Regulation of vascular tone. Circulation through special regions

85

Practical class 6. Concluding class devoted to the theme “Physiol-ogy of cardiovascular system” (intermediate oral examination)

90

Physiology of excretion 94

Practical class 1. Water and electrolytes exchange 94

Practical class 2. Physiology of kidneys. Disorders of water and electrolytes exchange

95

Practical class 3. Concluding class devoted to the themes “Water and electrolytes exchange”, “Physiology of kidneys. Disorders of water and electrolytes exchange” (intermediate oral examination)

96

Test questions 98

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PHYSIOLOGY OF DIGESTIVE SYSTEM

Practical class 1. Principles of alimentary processes regula-tion. Digestion in the mouth and in the stomach. Regulation of these processes.

Questions for discussion1. Physiological basis of hunger and satiety. Physiology of di-

gestion.2. Elementary functional anatomic considerations. The main

items in the study of the physiology of the digestive system.3. Functional anatomy of the digestive system. The essence of

digestion and classification of digestive processes.4. Nerve supply of the gastrointestinal tract (GIT). Gastroin-

testinal tract reflexes.5. Principles of regulation of alimentary processes.6. Digestion in the mouth. Functional anatomy of the salivary

glands.7. Mouth and its role in digestion. Esophagus. Mastication.8. Salivary glands. Composition and functions of saliva.9. Mechanism and control of salivary secretion. Deglutition.10. Swallowing. Lower esophageal sphincter.11. Motor disorders of the esophagus (achalasia, aerophagia,

intestinal gas).12. Functional anatomy of stomach. Digestion in stomach.13. Functions of stomach. Some important cells in the gastric

glands.14. Composition and functions of gastric juice and mechanism

of secretion. Control of gastric secretion.15. Four phases of gastric secretion. Emotion and gastric secre-

tion.16. Gastric motility and emptying.17. Regulation of gastric motility and emptying.

5

Practical works1. Studying of operations on the animals used for researches

of digestive functions.2. Splitting of starch by enzyme of the saliva.3. Studying of secretion of gastric juice on bread, meat and

milk.

Books recommended1. Ganong W. F. Review of Medical Physiology. 12th ed; Mc-

Graw-Hill Companies, Inc., 2001. – P. 453-462, 472-480.2. Guyton A. C., Hall J. E. Textbook of Medical Physiology,

12th ed; W. B Saunders, 2005. – P. 718-737.

Practical work 1. Studying of operations on the animals used for researches of digestive functions.

Objective: studying of advantages and disadvantages of some well known and traditional operations in digestive physiology.

Technique.1. Sham feeding . The esophagus is divided in the neck

and the two ends are brought to the surface of the neck. Now, when the animal feeds, food comes out through the wound and does not reach the stomach.

In this animal, if a concomitant gastric fistula (which is a permanent hole made through the anterior abdominal wall and anterior wall of the stomach, so that the cavity of the stomach communicates with the exterior through the hole) be made various studies can be made. For example, during sham feeding the secretion of the stomach (psychic juice) can be collected through the fistula. That, in this animal, vagotomy abolishes the psychic phase of gastric secretion can be shown,

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proving, that the psychic juice depends upon the presence of intact vagus nerves.

Figure 1. Sham feeding.

Result:

Conclusion:

2. Pavlov pouch . This was devised by the great Russian physiologist Ivan Pavlov in 1898. This is a pouch, cut out from the body of the stomach (fig.) in such a way that the cavity of the pouch is separated from the main cavity of the stomach by double layers of mucous membrane. The pouch

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however retains its nerve and blood supply intact. The pouch communicates with the exterior by a permanent fistula made through the anterior abdominal wall.

Food may be eaten and it will be seen now that the pouch is also secreting. Thus, gastric juice which is secreted as a result of stimulus by food and yet is not contaminated by food, can be collected.

Figure 2. Pavlov pouch.

Result:

Conclusion:

3. Heidenhein pouch is a denerved pouch, the pouch having no communication with the parent cavity. Heidenhain pouch also communicates with the exterior by fistula and gastric secretions collected from it.

Presence of food, particularly the partially digested protein in the original portion of stomach, evokes secretion

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from this (Heidenhein) pouch, (which has no neural or direct communication with the original part) proving that the stimulus to the pouch cannot be mediated by nerves but must be mediated via blood, i. e., it is a chemical (gastrin) coming via the arterial supply to the Heidenhain pouch. Similarly, histamine or pentagastrin can evoke secretion in a Heidenhain pouch. The secretion of the pouch is uncontaminated by the food.

Figure 3. Heidenhain pouch.

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Figure 4. Comparative characteristic of Pavlov pouch and Heidenhein pouch. (A) – Innervated Pavlov pouch. (B) Vagally denervated Heidenhein pouch. (C) This shows Heidenhein pouch during operation. (D) – This shows cannula position at the end of operation.

Result:

Conclusion:

Practical work 2. Amylolysis by the enzyme of sali-va.

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Objective: prove that amylase of saliva split the starch to saccharides (dextrins and maltose) under body temperature. Remember that amylase of saliva acts only on boiled starch.

Technique. Take 4 test-tubes; put 6 ml of 1 % boiled starch into 3 of them, put 6 ml of raw starch into the fourth test-tube. Put 1 ml of distilled water into the first test-tube; put 1 ml of saliva into the second and fourth; put 1 ml of well boiled saliva into the third one.

Put the test-tubes into the thermostat with the tempera-ture 37-38° for 5-10 min. Divide the contents of test-tubes into two portions; make qualitative reactions on starch and saccha-rides.

Qualitative reaction on starch: put 1-2 drops of fluid iodine solution into the examined liquid. You can see blue staining in the first, third and fourth test-tubes; it indicates the existence of the starch. There is no staining in the second test-tube.

Qualitative reactions on saccharides: put 3 ml 10 % NaOH and 1 ml 1% CuS04 into the test-tubes with the exam-ined liquid; heat it and indicate brown staining in the second test-tube (reaction on saccharides). Write down the results and make a conclusion.

Result:

№ of test-tube

Mixed components 1. Qualitative reaction on starch Conclusion

2. Qualitative reactions on glucose

1. 6 ml of boiled starch

1 ml of distilled water

1.2.


1 ml of saliva

1.2.

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1 ml of boiled saliva

1.2.

4. 6 ml of unboiled starch

1 ml of saliva

1.2.

Conclusion:

Practical work 3. Studying the gastric juice secretion on bread, meat and milk.

Objective: convince of the adaptive nature of the gastric gland secretion.

Technique: using tables and 3 crayons make 2 graphs: curves of the gastric juice secretion and its digestion volume using equal quantity of meat, bread and milk.

Determine what are the differences between the gastric juice secretion and its digestion volume using meat, bread and milk for food (quantity, duration, acidity, maximum secretion by the hour).

Analysis of curves of the gastric juice secretion on meat, bread and milk.

Food is an adequate stimulus for gastric secretion. The secretion reaction of the stomach becomes apparent in the functional adaptation of gastric glands to various foods. Individual adaptation of the secretory apparatus of the stomach to different food depends on the quality of food product, its quantity and dietary habits.

Albuminous food is the most effective secretion agent. Proteins and products of their digestion have the most strong

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secretion effect. The strong secretion of the gastric juice starts by the second hour after eating meat. Prolonged meat diet leads to the increase of the gastric secretion on all food stimuli, increase of acidity and digestion volume of the gastric juice.

Carbohydrate food (bread) – is the most weak secretion agent. There are a few chemical agents of secretion in the bread; that is why the peak of gastric secretion is seen by the first hour (reflex secretion), then it decreases steeply and then it keeps at the same level for a long time. Prolonged carbohydrate diet decrease acidity and digestion volume of the gastric juice.

The action of the fats of milk on the gastric secretion consists of two stages:braking and existent. That is why the peak of gastric secretion is seen just by the end of the third hour. Prolonged fat diet increases the gastric secretion on food stimulus due to the second stage. The digestion volume of the gastric juice after the fat diet is lower then after the meat diet but is higher then after the carbohydrate food. Thus you can see the indexes of gastric juice secretion on meat, bread and milk.

INDEX/LEVEL MAXIMUM MEDIUM MINIMUM

Quantity of the gastric juice

Meat Bread Milk

Prolongation of secretion

Bread Meat Milk

Acidity of the gastric juice

Meat Milk Bread

Digestion volume Bread Meat Milk

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Write down the results and make a conclusion about the dependence of the quantity of the gastric juice, its acidity and proteolytic activity on quantity and consistence of eaten food.

Result:

Conclusion:

Practical class 2. Digestion in the small intestine. Bile, its composition and participation in digestion. Digestion in the large intestine. Intestinal motility and its regulation. Physi-ology of the liver. Antitoxic function of the liver. Gastroin-testinal hormones.

14

Questions for discussion1. Composition and function of pancreatic juice.2. Mechanism of secretion of pancreatic juice.3. Control of secretion of pancreatic juice.4. Anatomic considerations of the liver. Functions of the liver.5. Functional anatomy of the liver and the biliary tract.6. Functions of the liver. Antitoxic function of the liver.7. Composition of liver bile and gall bladder bile.8. Functions of gall bladder. Functions of bile.9. Secretion and excretion of bile. Control of secretion and

control of excretion.10. Synthesis of plasma proteins. Bile.11. Bilirubin metabolism and excretion. Jaundice. Other sub-

stances conjugated by glucuronyl transferase. Other sub-stances excreted via bile.

12. Composition and properties of bile. Functions of the gall-bladder. Regulation of biliary secretion.

13. The effects of cholecystectomy. Visualizing the gallblad-der. Gallstones.

14. Digestive and absorptive functions of the small intestine.15. Anatomic considerations of the small intestine.16. Succus entericus: (i) composition and its functions; (ii) con-

trol of succus entericus secretion.17. Cavital and membrane hydrolysis of nutrients in the small

intestine.18. Digestion and absorption of carbohydrate, protein and fat.

Absorption of water, minerals and vitamins.19. Movements of the small intestine.20. Digestion in the large intestine. Microflora of the large in-

testine.21. Anatomic considerations of the colon.22. Motility and secretion of the colon. Movements of the large

intestine. Defecation.

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23. Small intestinal and colon transit time. Mechanisms of ab-sorption of proteins, carbohydrates, lipids in the colon. Ab-sorption in the colon.

24. Feces. Intestinal bacteria.25. Blind loop syndrome.26. Dietary fiber.27. Defecation.28. The effects of colectomy. Constipation. Megacolon. Diar-

rhea.

Practical works1. Digestion of protein by gastric juice.2. Bile action on the fats.


Graw-Hill Companies, Inc., 2001. – P. 481-496.2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology,

12th ed; W.B Saunders, 2005. – P. 738-769.

Practical work 1. Digestion of protein by the gastric juice.

Objective: determine the optimality conditions of pepsin action.

Technique. put into 6 test-tubes equal quantity of cut frog's muscle (fibrin). Then put the gastric juice in the first and in the second test-tubes; boiled gastric juice – into the third test-tube; the solution of pepsin in water – into the fourth test-tube; the solution of pepsin in soda – into the fifth test-tube; weak hydrochloric acid (0,5 %) - int the sixth test-tube. Put the second test-tube into the bottle with ice, and the others – into thermostat with the temperature 37-40° C for 40 min. Then

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take out the test-tubes and carry out the Biuret test. Put 10 drops of caustic soda and 5 drops of blue vitriol to the solution.

You'll see blue and violet staining if there are proteins in the solution. Products of protein digestion – albumose and peptones – give red staining. Complete the table.

Write down the results and make a conclusion about the optimally conditions of pepsin action.

Result:

№ of test-tube

Mixed compounds Conditions of carrying out the

experiment

Biuret test Conclusion

1. Protein; 2 ml of the gastric juice

37-40° C, 40 min. (thermostat)

2. Protein; 2 ml of the gastric juice

-1-0° C, 40 min. (bottle with ice)

3. Protein; 2 ml of the boiled gastric juice


4. Protein; 2 ml of the solution of pepsin in water


5. Protein; 2 ml of the solution of pepsin in soda


6. Protein; 2 ml of 0,5 % hydrochloric acid


Conclusion:

Practical work 2. Bile action on the fats.

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Objective: get acquainted with the bile action on fat filtration and emulsification.

Technique: filters, put in the funnels, moisten with bile (the first one) and with water (the second filter). Put the funnels into the vials and pour fats into them.

Fat filtrates rather quickly through the filter moisten with bile, and doesn't go through the second filter.

Put 3 ml of bile, 0,5 ml of soft oil and 1 ml of water into the third vial, shake it up thoroughly. You'll get trice emulsion.

Write down the results and make a conclusion.Results:

Conclusion:

Practical class 3. Concluding class devoted to the themes “Metabolic rate and energy expenditure. Thermoregula-tion”, “Food and nutrition. Vitamins”, “Physiology of the digestive system” (intermediate oral examination).

Questions for discussion(Metabolic rate and energy expenditure. Thermoregula-

tion)1. Bomb calorimeter and calorific values of different items of

food. Methods for determining metabolic rate: (a) direct calorimetry; (b) indirect calorimetry: (i) respiratory quo-tient; (ii) energy equivalent of utilized oxygen; (iii) Bene-

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dict-Roth spirometer (close circuit method); (iv) open cir-cuit method.

2. Values of metabolic rate. Basal metabolic rate: (i) defini-tion; (ii) normal values; (iii) factors determining metabolic rate; (iv) applied physiology.

3. Importance of thermoregulation. Normal body temperature. Sources of heat & channels of heat loss.

4. Mechanism of thermoregulation in exposure to cold.5. Mechanism of thermoregulation in a hot environment.6. Applied physiology: fever, antipyretics, pyrogens, heat

stroke, heat exhaustion, hypothermia.

Questions for discussion(Food and nutrition. Vitamins)

1. Importance of food. Principles of dietetics.2. Balanced diet. Some common foods. Applied physiology.

Dietary standards for man.3. Vitamins and its significance in nutrition. Vitamins. Classi-

fication. role of vitamins.

Questions for discussion(Physiology of the digestive system)

1. Study of the physiology of the digestive system. Nerve sup-ply of the gastrointestinal tract (GIT). Gastrointestinal re-flexes.

2. Functional anatomy of the salivary glands.3. Composition and functions of saliva.4. Mechanism and control of salivary secretion. Applied phys-

iology.5. Functional anatomy of the stomach.6. Composition and functions of gastric juice and mechanism

of gastric secretion.7. Control of gastric secretion.

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8. Functional anatomy of the digestive system. Gastrointesti-nal hormones.

9. Mouth and its role in digestion. Esophagus. Mastication.10. Salivary glands. Composition and functions of saliva.11. Mechanism and control of salivary secretion.12. Swallowing. Lower esophageal sphincter. Motor disor-

ders of the esophagus (achalasia, aerophagia, intestinal gas).

13. Functional anatomy of the stomach. Digestion in the stom-ach. Functions of the stomach. Some important cells in the gastric glands.

14. Composition and functions of gastric juice and mechanism of secretion.

15. Control of gastric secretion. Four phases of gastric secre-tion. Emotion and gastric secretion.

16. Pepsinogen secretion. HCl secretion. Functions of HCl. Regulation of gastric secretion.

17. Gastric motility and emptying. Regulation of gastric motili-ty and emptying.

18. Peptic ulcer. Other functions of the stomach.19. Composition and function of pancreatic juice.20. Mechanism of pancreatic juice secretion.21. Control of pancreatic juice secretion.22. Functional anatomy of the liver and the biliary tract.23. Composition of liver bile and gall bladder bile. Functions

of the gall bladder.24. Functions of bile. Secretion and excretion of bile. Control

of secretion and control of excretion.25. Digestive and absorptive functions of the small intestine.

Duccus entericus: (i) composition and its functions; (ii) control of succus entericus secretion. digestion and absorp-tion of carbohydrates, proteins and fats. Absorption of wa-ter, minerals and vitamins.

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26. Mastication. Deglutition. Movements of the stomach.27. Movements of the small intestine. Movements of the large

intestine. Defecation.28. Anatomic considerations of the pancreas. Composition and

properties of pancreatic juice. Regulation of pancreatic juice secretion.

29. Anatomic considerations and functions of the liver. Synthe-sis of plasma proteins. Bile.

30. Composition and properties of bile. Functions of the gall-bladder. Regulation of biliary secretion. Effects of chole-cystectomy. Visualizing the gallbladder. Gallstones.

31. Anatomic considerations of intestinal mucus. Intestinal motility (characteristics of the types of contraction).

32. Regulation of intestinal secretion. Malabsorption syn-drome.

33. Adynamic ileus. Mechanical obstruction of the small intes-tine.

34. Anatomic considerations of the colon.35. Motility and secretion of the colon.36. Small intestinal and colon transit time. Mechanisms of ab-

sorption of proteins, carbohydrates, lipids. Absorption in the colon. Feces. Intestinal bacteria.

37. Blind loop syndrome. Dietary fiber. Defecation.38. Effects of colectomy. Constipation. Megacolon. Diarrhea.

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PHYSIOLOGY OF BLOOD SYSTEM

Practical class 1. Physical and chemical properties of blood. Functions and composition of blood. Red blood cells.

Questions for discussion1. Functions of blood. Blood composition.2. Quantity of blood in human organism, its relative constan-

cy.3. Viscosity of blood, methods of its determination. Specific

gravity of blood.4. Osmotic pressure of blood, methods of its determination,

regulation of its constancy.5. Blood plasma, its quantity, composition.6. Physiological blood-replaceable solutions.7. Plasma proteins, its physiological role.8. Origin plasma proteins.9. Hypoproteinemia.10. Erythropoiesis. Stages of development. Importance of ery-

thropoiesis. Applied physiology.11. Red cells fragility. Hemolysis. Types of hemolysis. Osmot-

ic resistance of erythrocytes, its determination.12. Erythrocytes, their structure, features of chemical composi-

tion, functions. 13. Erythrocyty sedimentation rate (ESR).14. Determination of erythrocytes quantity.15. Hemoglobin. Chemical structure, hemoglobin compounds,

their spectral analysis. Methods of hemoglobin quantity de-termination.

16. Hemoglobin chemistry and synthesis. Catabolism of Hb.17. Factors required for synthesis of Hb.18. Reaction of Hb.19. Abnormalities of Hb production.

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20. Hemoglobin in the fetus.

Practical works1. Determination of erythrocyte count in a sample of blood.2. Determination of osmotic fragility of erythrocytes.3. Hemolysis.4. Determination of erythrocytes sedimentation rate.


Graw-Hill Companies, Inc., 2001. – P. 499-500, 515-519, 522-524.

2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology, 12th ed; W. B Saunders, 2005. – P 382-390.

Practical work 1. Determination of erythrocyte count in a sample of blood.

Objective: acquaintance with a technique of calculation of erythrocytes’ number.

Technique. The dilute liquid for erythrocytes is 0,85-1 % solution NaCl (physiological solution). In test-tube pour 4 ml of a dilute solution. Type by the pipette from the hemometer of Sali the prepared blood up to the mark, that corresponds 0,02 ml. Column of blood should be integral and not contain vesicles of air. Having wiped off end of a capillary by sponge (cotton wool) move the collected blood in the test-tube with a dilute solution. Carefully mix. Dilution in the test-tube 1/200.

Easy movements of both hands thumbs grind in integumentary glass to the accounting chamber before appearance color newtonian rings. By a glass stick collect a drop of the diluted blood and place in the accounting chamber (on the end of a groove which is sideways from the central

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plate of the chamber). The liquid itself will fill in a chink by thickness of 0,1 mm between the central plate and integumentary glass. Put the chamber under the large increase of microscope and start calculation.

Count up number of erythrocytes A in the large squares located on a diagonal, that makes 80 small squares. During calculation it is necessary to be guided by the Egorov’s rule: «Concerning to given square those are counted erythrocytes, which lay as inside, as on the left and top border of square». Average quantity of erythrocytes in one small square A/80. Knowing, that volume of a part of the chamber above one small square is equal 1/4000 мм3, multiple the found number by 4000 and by 200, i.e. by dilution.

Х = (A х 4000 х 200) /80, where Х – number of erythrocytes in 1 мм3 of blood.

Make a conclusion.Average number of erythrocytes in 1 L of blood in

females (3,7-4,7) х 1012 /L; in males (4,0-5,0) х 1012 /L.

Result:

Conclusion:

Practical work 2. Determination of osmotic fragility of erythrocytes.

Objective: to determine concentration of NaCl solution, causing the beginning of erythrocytes hemolysis.

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Technique. Take 8 test-tubes, number them, in each test-tube pour 5 ml of NaCl solution of decreasing concentration (0,9 % in first test-tube, 0,8 % – in second etc. Up to 0,2 %)

In each test-tube with the help of pipette add 3 drops of blood without fibrinogen or citrate blood; mix and shake all test-tubes and place in a support according to numbers. In an hour carefully, not taking out test-tubes from a support, examine their contents in light. In those test-tubes, where hemolysis has not taken place, contents are divided into two layers: from above transparent colorless solution and below layer of erythrocytes. In those test-tubes, where has taken place partial hemolysis, the solution above erythrocytes sediment is painted in red color. In those test-tubes, where has taken place complete hemolysis, the division of contents into two layers has not taken place, the erythrocytes are not present, transparent “laked” (“varnished”) blood.

Results of the realized experiment arrange in to the following table:

Concentration of NaCl solution, %

Coloring of received solution

Erythrocytes sediment

ConclusionBorders of

stability

0,90,80,70,60,50,40,30,2

In the column “conclusion” you need to note, whether has taken place hemolysis in given test-tube and what is its character – complete or partial. In the column “borders of sta-bility” note, which concentration of NaCl solution corresponds

25

to minimal erythrocytes osmotic stability and which – maxi-mal.

Conclusion:

Practical work 3. Hemolosis.

Objective: to get acquainted with various kinds of hemolysis.

Technique.1. Osmotic hemolysis.Take two test-tubes, in one of them pour 5 ml of

physiological solution, and in another the same quantity of aqua distillate. In each test-tube add 2-3 drops of blood without fibrinogen and mix and shake them. Both test-tubes put before a window or artificial light source (for example before electric lamp). Contents of the first test-tube appear opaque, and in the second one, on the contrary, transparent “varnish” (“laked”) blood.

2. Chemical hemolysis.Take test-tubes and number them. In each test-tube

pour 5 ml of physiological solution, then in first – 1 % solution of an acetic acid, in second – 4-5 ml of ammonia solution. Then in each test-tube add 4-5 drops of blood and mix well. In 30 minutes note, in which test-tubes has taken place complete or partial hemolysis.

3. Thermal hemolysis.Pour in clean test-tube 10 ml of physiological solution

and 1 ml of blood without fibrinogen. Warm in hot-water heating at 600 C until hemolysis takes place. The heating to higher temperature can cause coagulation.

26

Result:

Conclusion:

Practical work 4. Determination of erythrocytes sed-imentation rate.

Objective: acquaintance with a technique of definition of erythrocytes sedimentation rate (ESR).

Technique. a capillary of the Panchenkov’s device wash out by 5 % sodium citrate solution. Then collect citrate up to the mark P (50) and blow down it on a watch crystal. Make an injection of a finger and in the same capillary twice collect blood up to mark K (0). Both portions of blood let out on the watch crystal mix with presented there sodium citrate. The received by this way mixture of blood with citrate in the 4/1 ratio collect in capillary up to the mark 0 and put in a support. In an hour note, what is the height of formed top column of plasma in the capillary.

The ESR of a healthy man is 1-10 mm/h and the value for women is 2-15 mm/h. More rapid ESR is a sign of a morbid condition.

Result:

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Conclusion:

Practical class 2. Cellular elements of blood. White blood cells. Platelets.

Questions for discussion1. White blood cells (the leukocytes). Total count and classifi-

cation. 2. Leukocytes, their types functions.3. Determination of leukocytes quantity. Differential leuko-

cyte count.4. Morphology of the WBCs.5. Neutrophils. Eosinophils. Basophils. 6. Monocytes. Lymphocytes. Classification of lymphocytes. 7. Functions of the WBCs. Normal values for the cellular ele-

ments in human body.8. Immunity. The non-specific mechanisms of immunity.

Phagocytosis. The specific mechanisms of immunity.9. Platelets (Throbocytes), their structure, functions, quantity.10. Count and morphology. 11. Function of platelets.

Practical works1. Determination of hemoglobin concentration.2. Calculation of color index and hemoglobin contents in one

erythrocyte (HCE).3. Determination of total leukocyte count in a sample of

blood.4. Determination of differential leukocytes count.

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Graw-Hill Companies, Inc., 2001. – P. 500-515.2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology,

12th ed; W. B Saunders, 2005. . – P 392-411.

Practical work 1. Determination of hemoglobin con-centration.

Objective: acquaintance with a technique of calculation of hemoglobin quantity in human blood.

Technique. The determination of hemoglobin quantity is made by a calorimeterical method.

Hemometer of Sali has 3 test-tubes of an identical diameter, from which two extreme are soldered up and contain standard solutions of hematin chlorid, and a middle one – laboratory. In laboratory test-tube pour 0,1 % solution of a hydrochloric acid up to the first lower mark, then by pipette from hemometer of Sali collect 0,02 ml of the prepared blood and drop in same test-tube. Hemoglobin of blood under action of 0,1 % solution of a hydrochloric acid transforms to the brown colored hematin chlorid. On the expiry of 5-6 minutes add to the received solution by drops aqua distillate so long as color of a researched solution equalizes with color of the standards. Each time after addition of water mix contents of the test-tube by the glass stick. Color of a liquid of the standards compare at daylight in passed rays, holding in the extended hand at the level of eyes.

Determine, to what division of a scale corresponds lower meniscus of a liquid (the value of division of a scale is equal 0,2 g%). Quantity of hemoglobin at registration in the form of the analysis write down in grams per 1 L, for that the received data multiply by 10.

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Make a conclusion. Normal concentrations of hemoglobin: in females 115-145 g/L; in males – 132-164 g/L.

Result:

Conclusion:

Practical work 2. Calculation of a color index and hemoglobin contents in one erythrocyte (HCE).

Objective: acquaintance with a method of calculation of the color index and HCE.

Technique.1. The color index expresses the average hemoglobin

contents in one erythrocyte.Normal value of the color index (CI) equals 0,85-1,05.

It can be calculated using the following formula:

Color index (CI) = [ foundquantityofHb / normalquantityofHb ][ foundnumberofEr / normalnumberofEr ]

Having determined in patient’s blood hemoglobin quantity and number of erythrocytes calculate using the mentioned above formula the color index. Make a conclusion.

2. Recently along with the color index calculate more reliable value – hemoglobin contents (pg) in one erythrocyte (1 pg = 1-12 g).

30

Hb contents in one erythrocyte (HCE) = foundquantityofHb

foundquantityoferythrocytes

3. Determination the color index and HCE without calculation is possible with the help of nomogram. For it is enough to connect by a ruler the value of the found quantity of hemoglobin and counted up erythrocytes.

Result:

Conclusion:

Practical work 3. Determination of total leukocyte count in a sample of blood.

Objective: acquaintance with a technique of calculation of leukocytes’s quantity.

Technique. The diluting liquid for leukocytes is 3 % solution of the acetic acid. In a test-tube pour 0,4 ml of the diluting solution. Collect by a pipette from hemometer of Sali the prepared blood up to a mark, that corresponds 0,02 ml. Column of blood should be integral and not contain vesicles of air. Having wiped off the end of a capillary by a sponge (cotton wool) move the collected blood in the test-tube with the diluting solution. Carefully mix. The dilution in the test-tube is 1/20.

By easy movements of the thumbs of both hands grind in integumentary glass to the accounting chamber before

31

appearance of color newtonian rings. By a glass stick collect a drop of the diluted blood and place in the accounting chamber (on the end of a groove which is situated sideways from the central plate of the chamber). The liquid itself will fill in a cleft by thickness 0,1 mm between the central plate and integumentary glass. Put the chamber under small magnification of microscope and start the calculation.

Count up number of leukocytes B in 25 large squares, that makes 400 small.

Average quantity of leukocytes in one small square B/400. Knowing, that volume of a part of the chamber above one small square equals 1/4000 мм3 multiple the found number by 4000 and by 20, i.e. by dilution.

Make a conclusion.Normal value of leukocytes in 1 L of blood in man (4,0-

9,0) х 109/L.Result:

Conclusion:

Practical work 4. Determination of differential leukocytes count.

Objective: acquaintance with a technique of differen-tial leukocyte count.

Technique. The smear of blood that was prepared be-forehand, colored by the method of Romanovsky-Gimsa place

32

on a little microscopic table, having put on it previously a drop of immersion oil. Immersion object (90) dip into the drop of oil. Granulocytes settle down on edges of smear, lymphocytes – a little bit farther from edges. Therefore calculation of leuko-cytes makes on edges of smear, along long edges of a prepara-tion, in an initial part of smear closer to the end. Determine the kind of each leukocyte and write down in the beforehand pre-pared hemogram table (or press a key of the calculating ma-chine with the corresponding name of a leukocyte’s kind). Count exactly 100 squares from general number of leukocytes, then the found quantity of leukocytes of each kind will corre-spond to their percentage in blood.

Result:

Differential leukocyte count (leukogram)

Total num-ber of leukocytes(x109/

L)

Granulocytes, %

Agranulocytes, %Neutrophils Eosinophils Basophils

Mye

locy

tes

met

amye

locy

tes

stab

segm

ente

d

Lym

phoc

ytes

Mon

ocyt

es

4-9 0 0-1 1-545-70

1-5 0-1 20-40 0-10

Conclusion:

Practical class 3. Blood types. Hemostasis.

33

Questions for discussion1. Blood types.2. The ABO system.3. Transfusion of blood. Transfusion reactions.4. Inheritance of A- and B-antigens.5. Other agglutinogens.6. The Rh Group.7. Compatibility of blood types, basic rule of blood type com-

patibility determination.8. Hemolytic disease of the newborn.9. Blood formation and regulation of the blood system. Blood

groups. The rhesus (Rh) system. Immunity. The non-specif-ic mechanisms of immunity. Phagocytosis. The specific mechanisms of immunity.

10. Hemostasis. The clotting mechanism. Factors which accel-erate clotting.

11. Anticlotting mechanisms.12. Anticoagulants.13. Abnormalities of hemostasis.

Practical works1. Determination of clotting time by Sucharev’s method.2. Determination of ABO-blood groups.3. Determination of Rhesus-blood groups.


Graw-Hill Companies, Inc., 2001. – P. 499-500, 519-527.2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology,

12th ed; W. B Saunders, 2005. – P 413-429.

34

Practical work 1. Determination of clotting time by Sucharev’s method.

Objective: to get acquainted with one of techniques co-agulation time definition.

Technique. Blood for research is taken from a finger after removal of the first drop. In a dry capillary for ESR col-lect column of blood of height 25-30 mm. Blood by an inclina-tion a capillary move in its middle (at once switch on stop-watch). Holding a capillary by two fingers shake it at a corner of 35-40 degrees in both sides. The free displacement of blood specifies, that the coagulation has not started yet. The begin-ning of coagulation is characterized by delay of movement of blood at an inclination of a capillary. In internal walls of a cap-illary there are small clots. The complete coagulation of blood corresponds to the moment of a complete stop of movement of blood.

In normal condition the beginning of coagulation is from 30 seconds up 2 minutes.

In normal condition the end of coagulation is from 3 minutes up 5 minutes.

Result:

Conclusion:

Practical work 2. Determination of ABO-blood groups.

35

Objective: to get acquainted with a technique of deter-mination of blood type.

Technique. On a white plate place on a drop of stan-dard serum of first, second and third types. Then transfer by clean corner of an object-plate prepared blood alternately to all drops of serum. The drop of serum should be more drop of blood. The reaction of agglutination comes in 1-5 minutes, and at presence of agglutination the drop becomes transparent, and erythrocytes stick together as nubbins.

The absence of agglutination in all drops of serum means that there is absence agglutinogens in researched ery-throcytes, that is the property of 1-st type erythrocytes.

If has taken place agglutination with serum of 1st and 3rd

types containing accordingly α-β- and α-agglutinins, erythro-cytes of researched blood contain A-agglutinogen, i. e. belong to the second type.

If agglutination has taken place with serum 1st and 2nd

types containing α-β- and β-agglutinins, researched blood be-longs to third type, i.e. erythrocytes contain B-agglutinogen.

If agglutination has taken place in all three drops of serum, researched blood belongs to 4th type, i. e. erythrocytes contain A- and B-agglutinogens.

Result:

Conclusion:

36

Practical work 3. Determination of Rhesus-blood groups.

Objective: acquaintance with a technique of determina-tion of blood group in the Rhesus system.

Technique. On a white plate place on a drop of special standard serum and researched blood. In 5 minutes determine presence or absence of agglutination. In case of positive reac-tion in a solution occur fine flakes, and at negative contents is homogeneous.

Result:

Conclusion:

37

PHYSIOLOGY OF RESPIRATORY SYSTEM

Practical class 1. Basic stages of respiration. External respi-ration.

Questions for discussion1. Principles of respiration system structure.2. Respiration, its basic stages. Anatomy of the lungs. Air

Passages. The Bronchi and their innervations. Pulmonary circulation.

3. External respiration. Respiratory muscles and pulmonary ventilation. Intrapleural pressure. Elastic properties of the lungs.

4. Mechanism of external respiration. Biomechanics of inspiration and expiration.

5. Lung Volumes. The vital capacity and its composing components. Methods of their measurement. Residual volume.

6. Respiratory minute volume and its changes at different loading, methods of its measurement. “Dead space” and efficient lungs ventilation. Effect of variations in respiratory rate and depth on alveolar ventilation.

7. Respiratory muscles. Compliance of the lungs and chest wall.

8. Alveolar surface tension. Surfactant, its composition.9. Work of breathing. Differences in ventilation and blood

flow in different parts of the lung. Dead space.10. Gas exchange in the lungs. Partial pressure of O2 and CO2

in alveolar air and in blood. Composition of the alveolar air.

11. Diffusion across the alveolocapillary membrane. Ventilation/Perfusion ratios.

38

12. Effects of decreasing or increasing the ventilation/perfusion ratios on the PCO2 and PO2 in an alveolus. Pulmonary hypertension. Pulmonary embolization.

13. Gas transports between the lungs and the tissues. Gas exchange between blood and tissues. Partial pressure of O2

and CO2 in blood, tissues liquid and in cells.14. Gases transport by blood: transport of O2 by blood; hemo-

globin dissociation curve. Transport of CO2 by blood. Sig-nificance of carboangydrase; correlation CO2 and O2 trans-port. Factors affecting the affinity of hemoglobin for oxy-gen.

Practical works1. Measurement of vital capacity (VC) of lungs and its

fractions.2. Measurement of frequency, depth and respiratory minute

volume at rest and at physical loading.3. Analysis of spirogram.

Books recommended1. Ganong W. F. Review of Medical Physiology. 12th ed;

McGraw-Hill Companies, Inc., 2001. – P. 625-648.2. Guyton A. C., Hall J. E. Textbook of Medical Physiology,

12th ed; W. B. Saunders, 2005. – P. 432-472.

Practical work 1. Measurement of vital capacity (VC) and its fractions.

Objective: to become familiar with a technique of lungs volumes and vital capacity measurement.

Technique. The spirometer (lung-tester) result in a zero position, a tip wipe by cotton wool with spirit, make 2-3 deep inhalations and exhalation and, having inhaled maximum

39

deeply, make a probably deep exhalation in spirometer. An exhalation make slowly, without jerks. Received value corresponds to vital capacity (VC).

Measurement of the tidal volume. Result the spirometer in a zero position and, having taken the tip in a mouth, quietly breathe, and an inhalation make through a nose, and exhalation - through a mouth in the spirometer. After 5-6 breathes note on a scale volume of exhaled air and divide it into the breathes number.

Measurement of the inspiratory reserve volume. From a cover take out a plug, lift a bell of spirometer. For example up to 3000 ml. After it close the plug. The examinee, having made a little quiet breathes, after a usual breath should take in a mouth the tip, and make a probably deep breath from the spirometer. The difference between the first parameter (3000) and the last one (for example, 1500) is the inspiratory reserve volume – 1500 ml.

Measurement of the expiratory reserve volume. Result the spirometer in a zero position, make some quiet respiratory movements and after the next exhalation take the tip in a mouth and make a probably deep exhalation in spirometer. Volume of exhaled air in the spirometer is the expiratory reserve volume

Having measured the tidal volume, the inspiratory reserve volume and the expiratory reserve volume add them and compare to already received vital capacity. If the divergence exceeds 10 %, the measurement is carried out not accurately and is necessary to repeat it.

The value of VC, which turns out at measurement usually is called as factual vital capacity (FVC).

The value of VC, which is determined by multiplication of height in men – by 25, and in women – by 20, calls as predicted vital capacity (PVC). For an estimation of a

40

development degree of the external breath apparatus the value of PVC is necessary compare to that value, which corresponds to the physical development data of the man. With this purpose the following ratio is determined:

FVCx 100/PVC

Using the results of comparison it is necessary to make the appropriate conclusions.

Results:

Conclusion:

Practical work 2. Measurement of frequency, depth and respiratory minute volume at rest and at physical load-ing.

Objective: study dependence of the external breath basic parameters on physical loading.

Technique. The work is carried out with the help of spirograph. To get acquainted with the description of the device and principle of its functioning is possible in a practical work edited by Kullanda (page 99).

Measure in examinee the respiratory minute volume (RMV) and breath frequency using the spirograph. The measurement needs to be done three times: in a sitting position

41

of the examinee, during walking on the spot at the speed 120 steps per one minute, during run on the spot.

Then make the following calculations: find the average value of breath depth, having divided RMV by breath frequency. Then find alveolar ventilation volume, for this average volume of «dead space» (150 ml in males and 100 ml in females) multiple by breath frequency and received number subtract from RMV value. The data should be written down in the table. Compare results of three measurements and make conclusions about influence of exercising on the basic parameters of breath.

Results:Table

Conditions of the experiment

Value of

RMV

Breath freque

ncy

Average

breath depth

The quantity of air which doesn’t

participate in gas exchange

Alveolar

ventilation

volume

Sitting at restDuring walkingDuring run on the spot

Conclusion:

Practical work 3. Analysis of spirogram

Objective: to become familiar with a technique of the man’s spirogram analysis.

Technique.

42

1. Find record of quiet breath and lead a line of the top border (quiet breath – inhalation) – average out. Parallel to the top border also averaged out lead a line of the bottom border of quiet breath (quiet exhalation).

2. Measurement of the tidal volume – TV. Measure by a compasses or by a ruler a distance from top up to the bottom border of quiet breath in mm. As 1 mm corresponds to 20 ml of air, received number multiple by 20.

3. Measurement of the inspiratory reserve volume – IRV. Find border of the maximal inhalation by the peak of a curve on spirogram. Measure a distance from the top border of a quiet inhalation up to the top border of the maximal inhalation. The received number multiple by 20.

4. Measurement of the expiratory reserve volume – ERV. Find border of the maximal exhalation. Measure a distance from the bottom border of a quiet exhalation up to border of the maximal exhalation. The received number multiple by 20 (ml).

5. Measurement of vital capacity – VC.6. 1st method – lead lines of borders of the maximal

inhalation and exhalation in parallel each other and measure distance between them. The received number multiple by 20 (ml).

7. 2nd method – add values TV+ IRV + ERV. The data received by both methods should coincide.

8. Measurement of the breath frequency – BF. The speed of movement of a paper tape during recording of spirogram is equal 50 mm / min, 1 mm corresponds 0,02 min.

9. Measurement of the respiratory minute volume – RMV. RMV = TV х BF.

43

10. Measurement of the predicted vital capacity (PVC) for the patient, whose data are written down in spirogram using the following formulas:• For men PVC = height (cm) х 0,052 – age (years) х

0,022 - 3,6• For women PVC = height (cm) х 0,041 – age

(years) х 0,018 – 2,611. Calculation of a vital parameter – VP. VP is a ratio

between the VC and the body weight. Normal values in men VP = 60, in women = 52.

12. Percentage of using VC – percentage ratio between TV and VC. Normal value is 12-15 %.

44

Results:Table of the functional examination

Date_______________________________________________Name, surname______________________________________Height___________Weight____________Sex_____________Complaints_________________________________________

Indexes Normal value PracticallyBreath frequency BF=10-20 per a minuteTidal volume TV=300-900 ml 15-

20% VCInspiratory reserve volume

IRV=1500-2000 ml 50% VC

Expiratory reserve volume

ERV=1000-1500 ml 30% VC

Residual volume RV=1200 mlVital capacity VC=2-5 LPredicted vital capacity

PVC=2-5 L

Total lung capacity TLC=RV+VCL=3200-6200 ml

Functional reserve capacity

FRC=ERV+RV=2200-2700 ml

Inhalation volume IV=TV+IRV=1800-2900 ml

Ratio between inhalation and exhalation

K=inhalation 1-5 s / exhalation 1,2-6 s=1,2

Respiratory minute volume

RMV=4-10 L/min

Alveolar ventilation of lungs

AVL=75 % RMV

Maximal ventilation of lungs

MVL=50-120 L/min

Vital parameter VPPercentage of VC using

VC %

FVC1 FVC1=70-80 % VC

45

FVC2 FVC2=80-90 % VCFVC3 FVC3=90-100 % VCReserve of respiration RR=MVL-RMVArterial blood pressure

ABP=120/80 mm Hg

Heart beating rate HBR=75 b/min.

Complementary dataMeasurement of Ventilatory Function

Conventionally, a spirometer is a device used to measure timed expired and inspired volumes, and from these we can calculate how effectively and how quickly the lungs can be emptied and filled.

A spirogram is thus a volume-time curve and Figure 1 shows a typical curve. Alternatively, measures of flow can be made either absolutely (e. g. peak expiratory flow) or as a function of volume, thus generating a flow-volume curve (Figure 2), the shape of which is reproducible for any individual but varies considerably between different lung diseases. A poorly performed maneuver is usually characterized by poor reproducibility.

The measurements which are usually made are as follows:

1. VC (vital capacity) is the maximum volume of air which can be exhaled or inspired during either a forced (FVC) or a slow (VC) maneuver.

2. FEV1 (forced expired volume in one second) is the volume expired in the first second of maximal expiration after a maximal inspiration and is a useful measure of how quickly full lungs can be emptied.

3. FEV1/VC is the FEV1 expressed as a percentage of the VC or FVC (whichever volume is larger) and gives a clinically useful index of airflow limitation.

46

4. FEF25-75 % is the average expired flow over the middle half of the FVC maneuver and is regarded as a more sensitive measure of small airways narrowing than FEV1.

Unfortunately FEF25-75 % has a wide range of normality, is less reproducible than FEV1, and is difficult to interpret if the VC (or FVC) is reduced or increased.

5. PEF (peak expiratory flow) is the maximal expiratory flow rate achieved and this occurs very early in the forced expiratory maneuver.

6. FEF50% and FEF75 % (forced expiratory flow at 50 % or 75 % FVC) is the maximal expiratory flow measured at the point where 50% of the FVC has been expired (FEF50 %) and after 75% has been expired (FEF75 %). Both indices have a wide range of normality but are usually reproducible in a given subject provided the FVC is reproducible.

All indices of ventilatory function should be reported at body temperature and pressure saturated with water vapor (BTPS). If this is not done the results will be underestimated, because when the patient blows into a ‘cold’ spirometer, the volume recorded by the spirometer is less than that displaced by the lungs.

47

Figure 1. Normal spirogram showing the measurements of forced vital capacity (FVC), forced expired volume in one second (FEV1) and forced expiratory flow over the middle half of the FVC (FEF25-75 %). The left panel is a typical recording from a water-sealed (or rolling seal) spirometer with inspired volume upward; the right panel is a spirogram from a dry wedge-bellows spirometer with expired volume upward.

Figure 2. Normal maximal expiratory and inspiratory flow-volume curve

Conclusion:

Practical class 2. Regulation of respiration. Respiratory center. Respiratory cycle. Respiratory neurons.

Questions for discussion

48

1. Regulation of respiration. Respiratory center. Pontine and vagal influences.

2. Neural control of breathing.3. Control systems.4. Medullary systems.5. Pontine and vagal influences.6. Regulation of respiration. Role of chemoreceptors (central

and peripheral).7. Carotid and aortic bodies.8. Chemoreceptors in the brain stem.9. Ventilatory responses to the changes in asid-base balance.10. Ventilatory responses to CO2.11. Ventilatory responses to oxygen lack.12. Effects of hypoxia on the CO2. Response curve.13. Effects of H+ on the CO2 response.14. Breathe holding.15. Hormonal effects on respiration.16. Non-chemical effects on respiration.

• Responses mediated by receptors in airways and lungs.• Coughing and sneezing.• Afferents from “Higher centers”.• Afferents from proprioceptors.• Respiratory components of visceral reflexes.• Respiratory effects of baroreceptor stimulation.• Effects of sleeping.

17. Effects of exercises, changes in ventilation.18. Hypoxia, four categories of hypoxia.19. Pneumothorax (open and closed).20. Asthma.21. Emphysema.22. Cystic fibrosis.23. Other respiratory abnormalities.

49

• Asphyxia.• Drowning.• Periodic breathing.• Cheyne-Stokes respiration.

24. Artificial respiration.• Mouth to mouth breathing.• Mechanical respirators.

Practical works1. Influence of some factors on regulation of breath.2. Measurement of stop breathing at different conditions.


McGraw-Hill Companies, Inc., 2001. – P. 649-672.2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology,

12th ed; W. B Saunders, 2005. – P P. 432-472.

Practical work 1. Influence of some factors on regu-lation of breath.

Objective: to study the influences of some reflex and humoral factors, as well as the coordination processes in the central nervous system, on frequency and depth of breathing using method pneumography.

Technique.1. Protective reflexes in breathing:a) to strengthen the chest pneumograph cuff test, fill it

with air and combine it with a Marey's capsule. Set the writer capsule so that it touched the surface of the kymograph. Record respiratory movements during slow rotation of the kymograph drum.

50

Results:

Conclusion:

b) the subject has to take water in his mouth and not swallowing it. Continue to breathe normally. Then swallow water during inhalation. Have you changed your breath and why? Repeat the experience by swallowing water during exha-lation.

Results:

Conclusion:

c) during the recording of respiratory movements bring the unexpected cotton wool soaked in ammonia to the nose of the subject and hold it during 2-3 seconds. There is a breath-holding. Why?

Results:

51

Conclusion:

2. Influence of high and low content of CO2 on the breath:

a) hold your breath as possible after a deep inhalation during the recording of respiratory movements. How change your breath after a delay, and why;

Results:

Conclusion:

b) the subject has to produce a very deep breathing (hy-perventilation) during 1 minute, recording of breathing at the same time. Then stop the hyperventilation and record your nor-malbreathing. How did it change? Usually, after a few seconds, apnea occurs.

Results:

52

Conclusion:

c) remove the capsule of Marey from pneumograph and make running in place during 1 minute. Quickly restore the communication the subject and capsule of Marey, and then record the breath. Have you changed it?

Results:

Conclusion:

3. Influence of the processes of breathing movement coordination acts on the character of breathing:

a) record the breath of the subject, giving him the job insert the thread through the eye of a needle. How to change your breath?

Results:

53

Conclusion:

b) record the breathing during the rhythmic conversa-tion (poetry reading).

Results:

Conclusion:

Check out the results and conclusions.In results of work you should schematically show the

possible changes in the nature of respiration (graphics). In con-clusions you should explain the observed changes of respira-tion.

Total conclusion:

Practical work 2. Measurement of stop breathing at different conditions.

54

Objective: to determine the effect of carbon dioxide in the blood at the time of any breath-holding.

Technique. 1st test – the subject should hold his breath at the time of quiet breathing. 2nd test – the subject should hold his breath at the time of expiration. The researcher should mark the time to start of spontaneous breathing (inhaling moment) with the help of stopwatch.

1. The subject has to produce hyperventilation, after which the researcher should determine the time of breath again.

2. The subject has to make a running in place and then hold his breath. Mark, how long he can hold his breath. The in-tervals between the tests should be about 5-10 minutes. Com-pare the results.

Check out the results and conclusions.

Results:

Conclusion:

Tasks

1. Who from two arguing rights? One asserts – «lungs extend, and consequently in them air enters», the second – «air enters into the lungs, and consequently they extend».

55

2. At some diseases the stretchability of lungs tissue decreases in 5-10 times. What clinical symptom is typical for such diseases?

3. How the difference in a percentage exhaled and alveolar air will change, if the man will breathe in a gas mask?

4. Explain the mechanism of oxygen utilization factor increase in a working muscle in comparison with a condition of rest.

5. It is necessary to the man to pass on the bottom of a reservoir. In such situation, if there are no special adaptations, breathe through tube, which end leaves water. There are three tubes. Length of each one is 1 meter, and internal diameter accordingly 68 mm, 30 mm, 5 mm. What tube needs to be used. Prove your answer by the appropriate calculation.

56

6. About thirty years ago the reason of illness newborn that died at once after birth being be not capable to make a breath was opened. The solution was found, when have begun to compare homogenates from the lung tissue such children and children died of other reasons. In these homogenates measured and compared among themselves some physical-chemical parameter. What is this – this parameter? And what means change of its value?

7. At narrowing respiratory ways the flow of air becomes turbulent. It requires significant expenses of energy and patient breathes difficulty. The condition is improved, if air replace oxygen-helium mixture (in it instead of nitrogen there is the same quantity of helium). Explain the reason of the patients condition improvement.

Practical class 3. Concluding class devoted to the themes “Physiology of blood system”, “Physiology of respiratory system” (intermediate oral examination).

Questions for discussion

57

(Physiology of blood system)1. Functions of blood. Blood composition.2. Quantity of blood in human organism, its relative constan-

cy.3. Viscosity of blood, methods of its determination. Specific

gravity of blood.4. Osmotic pressure of blood, methods of its determination,

regulation of its constancy.5. Blood plasma, its quantity, composition.6. Physiological blood-replaceable solutions.7. Plasma proteins, its physiological role.8. Origin plasma proteins.9. Hypoproteinemia.10. Erythropoiesis. Stages of development. Importance of ery-

thropoiesis. Applied physiology.11. Red cells fragility. Hemolysis. Types of hemolysis. Osmot-

ic resistance of erythrocytes, its determination.12. Erythrocytes, their structure, features of chemical composi-

tion, functions. 13. Erythrocyty sedimentation rate (ESR).14. Determination of erythrocytes quantity.15. Hemoglobin. Chemical structure, hemoglobin compounds,

their spectral analysis. Methods of hemoglobin quantity de-termination.

16. Hemoglobin chemistry and synthesis. Catabolism of Hb.17. Factors required for synthesis of Hb.18. Reaction of Hb.19. Abnormalities of Hb production.20. Hemoglobin in the fetus.21. White blood cells (the leukocytes). Total count and classifi-

cation. 22. Leukocytes, their types functions.

58

23. Determination of leukocytes quantity. Differential leuko-cyte count.

24. Morphology of the WBCs.25. Neutrophils. Eosinophils. Basophils.26. Monocytes. Lymphocytes. Classification of lymphocytes.27. Functions of the WBCs. Normal values for the cellular ele-

ments in human body.28. Immunity. The non-specific mechanisms of immunity.

Phagocytosis. The specific mechanisms of immunity.29. Platelets (Throbocytes), their structure, functions, quantity.30. Count and morphology.31. Function of platelets.32. Blood types.33. The ABO system.34. Transfusion of blood. Transfusion reactions.35. Inheritance of A- and B-antigens.36. Other agglutinogens.37. The Rh Group.38. Compatibility of blood types, basic rule of blood type com-

patibility determination.39. Hemolytic disease of the newborn.40. Blood formation and regulation of the blood system. Blood

groups. The rhesus (Rh) system. Immunity. The non-specif-ic mechanisms of immunity. Phagocytosis. The specific mechanisms of immunity.

41. Hemostasis. The clotting mechanism. Factors which accel-erate clotting.

42. Anticlotting mechanisms.43. Anticoagulants.44. Abnormalities of hemostasis.

Questions for discussion(Physiology of respiratory system)

59

1. Principles of respiration system structure.2. Respiration, its basic stages.3. Mechanism of external respiration. Biomechanics of

inhalation and exhalation.4. Intrapleural pressure, its nature and role in external

respiration mechanism. Changes of intrapleural pressure during phases of respiratory cycle.

5. The vital capacity and its composing components. Methods of their measurement. Residual volume.

6. Respiratory minute volume and its changes at different loading, methods of its measurement. «Dead space» and efficient lungs ventilation.

7. Atmospheric and exhaled air content. Alveolar air like inner medium of human organism. Concept about partial pressure of gases.

8. Gases exchange in lungs. Partial pressure of O2 and CO2 in alveolar air and in blood.

9. Gases exchange between blood and tissues. Partial pressure of O2 and CO2 in blood, tissue liquid and in cells.

10. Gases’ transport by blood: transport of O2 by blood; haemoglobin dissociation curve, its characteristic; oxygen capacity of blood; transport of CO2 by blood; significance of carboanhydrase; correlation CO2 and O2 transport.

11. Regulation of respiration. Respiratory center. Pontine and vagal influences.

12. Neural control of breathing.13. Control systems.14. Medullary systems.15. Pontine and vagal influences.16. Regulation of respiration. Role of chemoreceptors (central

and peripheral).17. Carotid and aortic bodies.18. Chemoreceptors in the brain stem.

60

19. Ventilatory responses to the changes in asid-base balance.20. Ventilatory responses to CO2.21. Ventilatory responses to oxygen lack.22. Effects of hypoxia on the CO2. Response curve.23. Effects of H+ on the CO2 response.24. Breathe holding.25. Hormonal effects on respiration.26. Non-chemical effects on respiration.

• Responses mediated by receptors in airways and lungs.• Coughing and sneezing.• Afferents from “Higher centers”.• Afferents from proprioceptors.• Respiratory components of visceral reflexes.• Respiratory effects of baroreceptor stimulation.• Effects of sleeping.

27. Effects of exercises, changes in ventilation.28. Hypoxia, four categories of hypoxia.29. Pneumothorax (open and closed).30. Asthma.31. Emphysema.32. Cystic fibrosis.33. Other respiratory abnormalities.

• Asphyxia.• Drowning.• Periodic breathing.• Cheyne-Stokes respiration.

34. Artificial respiration.• Mouth to mouth breathing.• Mechanical respirators.

61

PHYSIOLOGY OF CARDIOVASCULAR SYSTEM

Practical class 1. Properties of cardiac muscle.

Questions for discussion1. Anatomic considerations of the heart.

1. Morphology of cardiac muscle.2. Electrical properties.

11. Resting membrane potential.12. Action potential.

1. Correlation between muscle fiber length and tension.

2. Cardiac hypertrophy.3. Metabolism of the heart.

2. Properties of the cardiac muscle.1. Automaticity of the heart. Anatomical substratum

and nature of automaticity (characterize the conduction system).

2. Speed of spread of cardiac excitation.3. Action of pacemaker and contractile cardiac cells.

Their characteristic and comparison.3. The heart as a pump.

1. Mechanical events of the cardiac cycle.4. Events in late diastole.5. Atrial systole.6. Ventricular systole.7. Early diastole.8. Length of systole and diastole.

1. Methods of measurement of cardiac output.6. Cardiac output in various conditions.7. Factors controlling cardiac output.

62

8. Relations of tension to length in cardiac muscle.9. Factors affecting end-diastolic volume.10. Myocardial contractility.

4. Integrated control of cardiac output.5. Arterial pulse.6. Atrial pressure changer and the jugular pulse.7. Heart sounds.8. Murmurs.

Practical works1. Automaticity of heart and its dependence on temperature.2. Analysis of conduction system of heart (Stannius’s

experiment).


McGraw-Hill Companies, Inc., 2001. – P. 528-530, 545-555.

2. Guyton A. C., Hall J. E. Textbook of Medical Physiology, 12th ed; W. B. Saunders, 2005. – P. 382-390.

Practical work 1. Automaticity of heart and its de-pendence on temperature.

Objective: to be convinced that the physiological processes, including automaticity of heart, noticeably depend on temperature.

Technique. Remove the brain and destroy the spinal cord at the frog. Open the chest and expose the heart. Count the rate of heart beating per one minute. Write down some normal heart beating on a tape of a kymograph. Then, continuing record, plentifully water heart with a physiological solution at temperature 50 C. Mark changes of frequency and force of

63

heart beating. Further act on heart at first with solution at temperature 250 C, and then – 34-350 C (but not higher than 350

C), each time marking changes of heart beating frequency.Write down the results (heart beating frequency). Make

a conclusion about influence hypothermia and hyperthermia on automaticity of heart.

Results:

Conclusion:

Practical work 2. Analysis of conduction system of heart (Stannius’s experiment).

Objective: to reveal localization of the basic centers of automaticity in heart, presence of an automaticity gradient and leading role of sinoatrial node (Remack node in frog) in chronotropic function of heart.

Technique. Remove the brain and destroy the spinal cord at the frog. Open the chest and nake heart. Count the rate of heart beating per one minute. Put on the first ligature between venous sinus and atrium. Describe the state of heart and count the number of sinus contractions. Not waiting of restoration of atria and ventricles contractions and not removing first ligature put on the second one between atria and ventricles. Describe the state of heart and count number of atria and ventricles contractions per one minute. Put on the third ligature – tie up a top of heart (lower one third of ventricle)

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describe the state of heart. Stimulate a top of heart with an injection, note its reaction. Draw the schemes of putting on of Stannius’s ligature on frog’s heart. Write down results (change of heart beating). Make conclusions about dependence the rate of heart beating on localization of the automaticity centers of heart.

Results:

Conclusion:

Practical class 2. Functional diagnostic of cardiac activity. Electrocardiography.

Questions for discussion1. Electrocardiography.

1. Standard leads normal electrocardiogram in human (I, II, III).2. Unipolar (V1-V6) leads.3. Waves of ECG, nature of its waves, clinical significance.4. Fundamentals of the electrophysiology of the heart (cardiac action potential, the physiological basis of the shape of the cardiac action potential; the fast channels and the slow channels; spread of activation; volume conductor).5. Correlation of the action potential with the clinical EEG waves.

2. The cardiac vector.

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3. Cardiac arrhythmias.1. Normal sinus rhythm (NSR).2. Bradycardia and tachycardia.3. Nature of sinus arrhythmia.

4. Abnormal pacemakers.1. Complete (third-degree) heart block:

• idioventricular rhythm;• AV nodal block;• infranodal block;• Stockes-Adams syndrome.

◦ Incomplete heart block:• first-degree heart block;• second-degree heart block;• Wenckebach phenomenon.

◦ Right or left bundle branch block.◦ Hemiblock or fascicular block.◦ Bifascicular or trifascicular block.

5. Ectopic foci of excitation6. Atrial arrhythmias.

◦ Causes of atrial extrasystole, atrial tachycardia, atrial flutter, atrial fibrillation.◦ Consequences of atrial arrhythmias.

7. Ventricular arrhythmias.◦ Paroxysmal ventricular tachycardia.◦ Ventricular fibrillation.

8. Accelerated AV conduction:◦ Wolff-Parkinson-White syndrome.◦ Lown-Ganong-Levine syndrome.

9. Electrocardiographic findings in other cardiac and systemic disease.1. Myocardial infarction.

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2. Effects of changes in the ionic composition of the blood.

Practical worksPractical work 1. Analysis of ECG (electrocardiogram).


McGraw-Hill Companies, Inc., 2001. – P. 530-544.2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology,

12th ed; W. B Saunders, 2005. – P P. 382-390.

Practical work 1. Analysis of ECG (electrocardio-gram).

Objective: acquaint with registration of electrical activ-ity of heart, learn bases of registration ECG at standard leads and analysis of electrocardiogram.

Technique.1. Definition of heart beating frequency on the dura-

tion cardiointerval. Measure in millimeters distance from one top of R wave up to the following top R wave.

Determine the duration R-R of an interval in seconds. For this purpose it is necessary multiple quantity of millimeters (the R – R interval) by 0,02 (speed tape moving 50 mm per second, hence, value of one division of 1 mm is equal 1/50 – 0,02 seconds). For determination of the hear beating rate per 1 minute it is necessary 60 (there is 60 seconds in one minute) di-vide into duration of R-R interval in seconds.

2. Amplitude-temporary characteristic of waves and intervals at rest. Measure amplitude (voltage) of ECG waves

67

in three standard leads in mm. Transfer result in millivolts (1 mV – 10 mm). Bring the data in the table.

The wave amplitude is measured in mm from the wave top to its basis up to isoelectric line. Measure the duration of R, Т waves; of QRS complex and the duration of Р-Q and Q-Т in-tervals, in mm.

Transfer results to seconds, multiplying the received value by 0,02. The data to bring in the table. The measurement of the wave duration and intervals is carried out at the second standard lead.

The waves are measured:• P wave – from the beginning up to the end of P

wave;• Q wave – from the beginning up to the end of Q

wave;• R wave – from the beginning up to the end of R

wave;• S wave – from the beginning up to the end of S

wave;• Т wave – from the beginning up to the end of Т

wave;• QRS complex – from the beginning of Q wave up

to the end of the S wave;• P-Q segment – from the beginning of the Р wave

up to the beginning of Q wave;• P-Q interval – from the beginning of the Р wave up

to the end of Q wave;• Q-Т segment – from the beginning of the Q wave

up to the beginning of Т wave;• Q-Т interval – from the beginning of the Q wave

up to the end of Т wave;

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• S-Т segment – from the beginning of the S wave up to the beginning of Т wave;

• S-Т interval – from the beginning of the S wave up to the end of Т wave.

3. Estimation of an orientation of a vector (or elec-trical axis of heart) in a frontal plane. Construct the Einthoven’s triangle (the equilateral triangle with the side = 10 cm, directed by top downwards). The basis of a triangle corre-sponds to the first standard limb lead, left side (aVR) – the sec-ond lead, right side (aVL) – the third lead. From tops of a trian-gle build up heights on the opposite sides and mark the center of a triangle in the point of crossing of middle lines.

Measure the QRS complex value at the first standard lead. The value of Q and S waves take with the negative sign (minus, «–»), and R wave – with the positive sign (plus, «+»). The value of waves is determined in mm. Calculate the arith-metic sum of these waves. Similarly measure value of the QRS complex at the III standard lead. Calculate the arithmetic sum.

The summary value of the QRSI complex lay on the top side of the triangle. If this value is positive, it is laid to the right from the middle point, if negative, to the left.

The summary value of the QRSIII complex lay on the right side of the triangle. If it is positive, it is laid downwards from the middle point, if negative – upwards.

Construct perpendicular lines to the top of the I-st and the III-rd vectors that they would be crossed. The crossing point connect with the center of a triangle and receive the sum-mary value of the vector in the Ist and IIIrd standard leads and direction of electrical axis of heart. For its definition in degrees build up the straight, parallel to the basis line through the cen-ter of the triangle and measure by an protractor the angle be-tween the middle line and the received vector (the angle α).

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Table 1

Element of ECG

Duration(in IInd lead)

Voltage

Ist lead IInd lead IIIrd lead

mm s mm mV mm mV mm mVP wave

Q waveR waveS waveT waveQRS complex

- - - - - -

P-Q segment - - - - - -P-Q interval - - - - - -Q-T segment - - - - - -Q-T interval - - - - - -S-T segment - - - - - -S-T interval - - - - - -

Table 2

SectorThe position of the vector of the electrical axis of the heart

From 00 up 900 Deflection of the vector to the leftFrom 00 up 200 Horizontal position of the vectorFrom 300 up 600 Normal positionFrom 700 up 900 Vertical position of the vectorFrom 900 up 1800 Deflection of the vertical axis to the right

Check up correctness of definition of the electrical axis using the six-axial scheme. For this purpose lead a circle in radius 5 cm and divide it into 12 sectors. To the right side mark positive values (30, 60, 90, 120, 150, 180 degrees), to the left side negative values (fig. 1).

On the axis of the I lead lay on the arithmetic sum of QRS waves in the I lead taking into account the received sign (positive or negative). On the axis of the III lead lay on the arithmetic sum of QRS waves received in the III standard lead. Build up perpendiculars from the end of the received vectors.

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Connect the point of crossing with the center of the circle. It will be the direction of the electrical axis of the heart.

Table 3Example Your results

The value of the waves in the Ist

lead (in mm)

Q = –2R = +15S = –3

Σ = +10

The value of the waves in the II-Ird lead (in mm)Q = –1R = +10S = –4

Σ = +5

The value of the waves in the Ist

lead (in mm)Q = R = S =

Σ =

The value of the waves in the II-Ird lead (in mm)Q = R = S =

Σ =

Example– I +10 +

aVR aVL– –

II III

+5

+ +

aVF

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Results:

72

–90–120 –60

–150 –30

±180 0

150 30

120 6090

Conclusion:

Practical class 3. Regulation of cardiac activity.

Questions for discussion1. Cardiac innervation. Influences of sympathetic and

parasympathetic nerves on the heart.

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2. The heart nerves tone. Mediators in the heat (chemical nature, influences).

3. Vasomotor control. Afferents to the vasomotor area. Somatosympathetic reflex. Baroreceptors. Carotid sinus and aortic arch. Buffer nerve activity.

4. Atrial stretch receptors. Role of baroreceptors in endocrine defense of extracellular fluid volume. Bainbridge reflex. Left ventricular receptors.

5. Normal heart rate and its variations. Mechanism of control of heart rate. Reflex regulations: centers, sympathetic and parasympathetic supply.

6. The reflexes: reflexes arising from the systemic arteries (baroreceptor reflex; chemoreceptor reflex); reflexes arising from the heart: baroreceptors are present in the left ventricle; coronary chemoreflex (Bezoldjarisch reflexes); atrial receptors (Bainbridge reflex).

7. Influences from the Higher Centers. Limbic system, emotion and the heart rate.

8. Chemical regulation of the heart rate.9. Thermal regulation.10. Conditions affecting the heart rate: physiological: muscular

exercise; sinus arrhythmia; rage and panic; a meal; posture; pregnancy;athletes; sleep; pathological: fever, circulatory shock, paroxysmal tachycardia, thyrotoxicosis.

11. Heart block and myxedema, viral infections, enteric fever.

Practical works1. Reflexes of the heart.

• Ashner's oculocardiac reflex.• Reflexes of baroreceptors (pressure receptors) from the

carotid sinus zone.• Hering-Breier reflex.

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Practical work 1. Reflexes of the heart.

Objective: to be convinced that the stimulation of some receptor zones reflex influences on the heart activity through the centers of sympathetic or vagus nerves. This influence is shown or in rate decreasing and weakening of heart beating, or in rate increasing and strengthening of heart beating.

Ashner's oculocardiac reflex.Technique. The work is carried out in the man. Count

by pulse the rate of heart beating per 1 minute in sitting state. Then count pulse at once after moderate pressing on eyeballs by fingers during 15-20 seconds, then quickly let off fingers. Count pulse in 5 minutes after experiment. Fix the character of the frequency change of the heart beating rate. The experiment can be carried out with registration of electrocardiogram.

Results:

Conclusion:

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Reflexes of baroreceptors (pressure receptors) from the carotid sinus zone.

Technique. The work is carried out in the man The examinees lays on the back completely relaxed Grope the pulsation of common carotid artery in the depth of the neck at front edge of the muscle sterno-clavicular-mastoideus. The ramification of carotid artery and carotid sinus are located at the level of the top border of the thyroid cartilage. Densely press artery to vertebra for two seconds. Count the pulse rate before pressing carotid artery and at once after pressing. Do not squeeze simultaneously both carotid artery. The experiment can be carried out with registration of electrocardiogram. Results of experiment write down in the report in your writing book and make the conclusions.

Results:

Conclusion:

Hering-Breier reflex.Technique. The afferent nerve fibers from lungs’

mechanoreceptors travel to the regulation centers in medulla oblongata. The inhalation causes the suppression of vagus nerve and acceleration of cardiac activity. The exhalation causes the stimulation of vagus nerve and deceleration of cardiac activity.

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Record the ECG in the second standard lead or count the pulse rate at usual breath. Then do a deep breath and delay of breath with registration of the ECG. Repeated record of ECG make at the state of the maximal exhalation. Estimate duration of intervals (P-T; Q-T; T-P; R-R) or pulse rate.

Results:

Conclusion:

Practical class 4. Basics of hemodynamic.

Questions for discussion1. General structure of the vascular tree (segments of blood

vessels-major divisions). Functions of the individual segments.

2. Biophysical considerations. Flow, pressure and resistance. Arterial and arteriolar circulation. Velocity flow of blood.

3. Arterial pressure. Methods of measuring blood pressure. Auscultatory method. Palpation method.

4. Normal arterial blood pressure and factors determining the blood pressure. Regulation of blood pressure.

5. Physiological conditions (sex, meals, emotion, exposure to cold, muscular exercise, sleep) affecting blood pressure.

6. Pathological conditions (chronic elevation of blood pressure, cardiovascular shock, drug) affecting blood pressure.

7. Blood pressure in different segments of the vascular tree.

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8. Interrelationship between the diameter of the blood vessel and the velocity of the flowing blood (diameter-velocity relationship).

9. Interrelationship between the velocity, total pressure and the lateral pressure of the flowing blood (velocity-pressure relationship).

10. Velocity and flow of the blood.11. Relationship between the pressure of the flowing blood

with the volume of the flow per unit time (pressure-flow relationship).

12. Resistance and capacitance vessels.13. Capillary circulation. Capillary pressure and flow.

Equilibration with interstitial fluid. Active and inactive capillaries.

14. Lymphatic circulation. Structure and functions.15. Interstitial fluid volume.16. Venous circulation. Venous pressure and flow. Thoracic

pump. Muscle pump. Venous pressure in the head.

Practical works1. Definition of blood pressure in man.

• Palpation method of Riva-Rocci.• Auscultatory method of Korotkov.

2. Dynamic tests of cardiovascular system.• Orthostatic test.• Dynamic (functional) test.




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Practical work 1. Definition of blood pressure in man.

Objective: to familiarize with indirect methods of definition of the blood pressure in the man.

Palpation method of Riva-Rocci.Technique. For measurement of the blood pressure is

used the sphygmomanometer. On a naked shoulder of the examinees to impose an inflatable rubber cuff so that it densely covers the shoulder, but does not press on the tissues. By one hand palpate the pulse in radial artery, and by another with the help of a rubber balloon force air in the cuff. Pressure in the cuff is judged by the indications of a manometer. In a cavity of the cuff create the pressure exceeding maximal (before disappearance of pulse), and then gradually lower pressure, opening the screw valve and letting out air from system. The moment of the pulse appearance in radial artery coincides with maximal (systolic) pressure in brachial artery.

Results:

Conclusion:

Auscultatory method of Korotkov.Technique. Impose the cuff on the naked shoulder

higher than elbow fovea. In elbow fovea find out pulsing brachial artery, on which place a phonendoscope. Create pressure in the cuff higher than maximal, at which the pulse

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disappears, then, turning the screw valve and letting out air from the cuff, by stethoscope or phonendoscope listen to tones of brachial artery in elbow fovea. The moment of disappearance of tones corresponds to systolic pressure. Continue, decrease pressure in the cuff and listen to increasing force of tones, and then mark gradual easing with their subsequent disappearance. The moment of tones appearance corresponds to diastolic pressure. The measurement repeat three times and take for a basis the minimal parameters. Measure blood pressure by the Riva-Rocci method and by the Korotkov’s method. Results write down in the table in your writing book.

Table 4Age, years

Arterial blood pressure, mm Hg Heart rate, beats per minuteFemales Males

10-20 115/75 118/75 90-6020-30 116/78 120/76 60-6530-40 125/80 124/80 65-6840-50 140/88 127/82 68-7250-60 155/90 135/85 72-8060-70 160/92 145/87 80-84

Results:

Conclusion:

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Practical work 2. Dynamic tests of cardiovascular system.

Objective: to familiarize with methods of research and estimation of a condition of cardiovascular system. The dynamics (functional) tests allow to determine reserve and adaptive resources of cardiovascular systems in practically healthy man (physiology of work, physiology of sports) and promote to revealing of the latent insufficiency of cardiovascular system in the process of diagnostics.

Orthostatic test.Technique. The examinee quietly lays in a horizontal

position for 2-3 minutes. Count the pulse it him during 15 seconds and the received value multiply by 4 (pulse rate for 1 minute). Measure the blood pressure by the Korotkov’s method. Not removing the cuff of sphygmomanometer from a shoulder, offer to the examinee quietly to rise. At once count the pulse (for 15 seconds and multiply by 4) and measure the blood pressure. The test is considered as normal, if at passage from a horizontal position to a vertical the maximal pressure raises at 10 mm Hg, and the minimal does not change or is a little bit lowered at 5-7 mm Hg. The favorable sign is the increase of pulse pressure (difference between systolic and diastolic pressure). Results of research to write down in the report and give them an estimation in conclusions.

Results:

Conclusion:

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Dynamic (functional) test.Technique. In the examinee in a sitting position several

times count a pulse rate for 10 second intervals before getting of stable parameters of a pulse rate. Then measure the blood pressure by the Korotkov’s method. Not removing the cuff of sphygmomanometer, offer to the examinee to make 20 deep curtseys or 60 jumps on the spot during 30 seconds. After loading the examinee sits and in him immediately count pulse for 10 seconds and quickly measure the blood pressure (measurement of all parameters should not occupy more than 40 seconds), and since 50-th second of the first minute after loading again count the pulse for 10 seconds continuously before returning it to initial value. After returning pulse to initial value the third time measure the blood pressure.

The approximate order of results record

Examinee _________________________________________ Sex __________ Age __________Initial parameters (before loading):Pulse rate, bits per 10 seconds __________ Arterial blood pressure, mm Hg __________After loading:

Table 5

Pulse rate1st minute,

bits/10 seconds

2nd minute, bits/10 seconds

3rd minute, bits/10 seconds

after 10 seconds 21 17 14after 20 seconds 17 13after 30 seconds 16 13after 40 seconds 16 12after 50 seconds 15 12

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after 60 seconds 19 14 –Arterial blood pressure,

mm Hg120/70 130/70 145/75

The omission of time in calculation of pulse on the first minute after loading is intended for measurement of blood pressure, for what 40 seconds are taken. Favorable it is possible to consider the following parameters: increase of pulse at 6-7 beats during 10 seconds at once after loading, increase of systolic pressure at 12-22 mm Hg, is possible increase of diastolic pressure at 5-7 mm Hg, pulse pressure is increased. The average time of pulse restitution (rehabilitation) is from 1 minute 40 seconds up 2 minutes 30 seconds, restoration of blood pressure goes a little bit more slowly. In the females more expressed shifts of parameters are marked. Draw a curve of a pulse rate dynamics after physical loading.

Results:

Examinee __________________________________________ Sex __________ Age __________Initial parameters (before loading):Pulse rate, bits per 10 seconds ___________Arterial blood pressure, mm Hg __________

After loading:

Table 6

Pulse rate1st minute,

bits/10 seconds

2nd minute, bits/10 seconds

3rd minute, bits/10 seconds

after 10 secondsafter 20 secondsafter 30 secondsafter 40 seconds

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after 50 secondsafter 60 seconds

Arterial blood pressure, mm Hg

Conclusion:

Practical class 5. Regulation of vascular tone. Circulation through special regions.

Questions for discussion1. Cardiovascular regulatory mechanisms. General plan of the

cardiovascular system reflexes.2. Innervation of vessels. Vasoconstrictor nerves, vessels’

tone. Neurogenic mechanisms of vasodilatation. Vasomotor center. Reflexogenic zones of the heart and vessels, their role in circulation regulation.

3. Local regulatory mechanisms.4. Autoregulation.5. Vasodilatator metabolites.6. Localized vasoconstriction.7. Substances secreted by the endothelium.8. Self-regulatory mechanism of constant blood pressure level

maintenance. Dilatation and constriction reflexes.9. Systemic regulation by hormones.10. Systemic regulation by the nervous system. Vasomotor

center.11. Circulation through special regions (cerebral circulation,

coronary circulation, splanchnic circulation, circulation of the skin).

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12. Circulation of lymph. Production of lymph. Mechanisms of lymph movement.

13. Adapting changes of cardiovascular system during physical loading. Significance of functional tests in cardiovascular system examination. Features of blood circulation in lungs, brain and features of systemic blood circulation.

Practical works1. Measurement of cardiac output by an indirect method at

rest and after physical loading.2. Calculation of peripheral vascular resistance at rest and

after physical loading.




Practical work 1. Measurement of cardiac output by an indirect method at rest and after physical loading.

Objective: to familiarize with a technique of cardiac output measurement.

Technique. cardiac output is one of the main indicative index of cardiovascular system functioning. The methods of cardiac output measurement can be divided into direct (direct Fick method, Grolmann’s method, Stuart-Hamilton’s method, indicator dilution method etc.) and indirect (Starr’s method, sphygmographic method, ballistographic). The Rather widespread method is the Starr’s method (1954). This mathematical method of cardiac output measurement consists of the special accounts using the special empirical formulas. In

85

the examinee measure the blood pressure by the Korotkov’s method and pulse rate. Then using the formula determine systolic (stroke) volume (SV):

SV = 100 + 0,5 PP – 0,6 DP – 0,6 A, where

SV – stroke volume,PP – pulse pressure (mm Hg),DP – diastolic pressure (mm Hg),A – age (years).

After definition of systolic volume it is easy to calculate cardiac output (CO) using the formula:

CO = SV х PR, where

CO – cardiac output,SV – stroke volume,PR – pulse rate.

In the healthy people the value of cardiac output can be significant fluctuated connected to sex, age, weight and height, and also with character of activity. In conditions of the basil metabolic rate cardiac output in healthy people equals 3,5-5 L per minute, at the same time the deflections do not exceed ±10% from the proper value of cardiac output (PCO – proper cardiac output). In the patients deflections of CO (cardiac output) at rest both to one, and to another side are expressed in the greater degree, than in healthy people. Therefore in each separate case it is accepted to express cardiac output at rest in percentage to PCO, which can be find out using the formula of Savitsky (1935):

PCO = BMR / 422, where

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PCO – proper cardiac outputBMR – basal metabolic rate in kcal.

The value of BMR is defined in the Harris-Benedict’s tables of the basal metabolic rate. At rest cardiac output fluctuation, found using the Starr’s method, should not exceed proper values at ±20 %.

After counting cardiac output and proper cardiac output compare the received values and estimate them.

Using the Starr’s method measure cardiac output after physical loading (20 curtsey's for 30 seconds) and compare its value with CO (cardiac output) at rest. Pulse and blood pressure measure every 30 seconds after loading and during 6 minutes. Then, having calculated cardiac output using received data draw a curve of cardiac output dynamic after loading. Make the appropriate conclusions.

Results:

Conclusion:

Practical work 2. Calculation of peripheral vascular resistance at rest and after physical loading.

Objective: To familiarize with a technique of calculation of PVR (peripheral vascular resistance).

87

Technique. The resistance rendered to flown blood by cardiovascular system, is called peripheral vascular resistance (PVR). At rest PVR changes over a wide range at the different people from 1400 up to 2500 dyn. cm2 (N. N. Savitsky, 1974), making the average value 1850 dyn. cm2. The PVR value is calculated according the Poiseuille equation (1839):

PVR = (ADP х 1333 х 60) / CO, where

PVR – peripheral vascular resistance, dyn. cm2

ADP – average dynamic pressure, mm Hg,1333 – coefficient for transformation mm Hg to dyn,60 – number of seconds in one minute,CO – cardiac output in ml.

The average dynamic pressure is calculated according the formula of N. N. Savitsky (1974):

ADP= 0,5 PP + DP, where

ADP – average dynamic pressure, mm Hg,PP – pulse pressure, mm Hg,DP – diastolic pressure, mm Hg.

For definition PVR at rest and after physical loading it is necessary in each separate case to measure in the examinee blood pressure by the Korotkov’s method and pulse rate per one minute. During calculation PVR after physical loading the mentioned parameters measure every 30 seconds for 6 minutes. Then draw a curve of PVR dynamics after loading. In normal conditions at loading the passableness of vessels is increased, the work of heart is improved, conditions of working are facilitated. The PVR value decreases in average at 20-30%. As

88

a rule, to the end of 3rd-6th minutes after loading the PVR value comes back to normal.

Compare, curve of PVR dynamics after loading to the same curve of pulse in functional test.

Results:

Conclusion:

Practical class 6. Concluding class devoted to the theme “Physiology of cardiovascular system” (intermediate oral examination).

Questions for discussion1. Anatomic considerations of the heart. Morphology of

cardiac muscle. Electrical properties. Resting membrane. Action of potentials.

2. Properties of the cardiac muscle. Automaticity of the heart. Anatomical substratum and nature of automaticity (characterize the conduction system). Speed of spread of cardiac excitation. Action of pacemaker and contractile cardiac cells. Their characteristic and comparison.

3. Basic properties of the heart muscle. «All or none» law, its relative character for heart muscle; excitability changes of the heart muscle during cardiac cycle, features of refractory period in the heart. Extrasystole. Starling’s law (the basic law of the heart). Speed of spread of cardiac excitation.

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4. Cardiac cycle and its phases. Blood pressure in heart cavities in different phases of cardiac cycle. Working of valves.

5. The heart as a pump. Mechanical events of the cardiac cycle. Events in late diastole. Atrial systole. Ventricular diastole. Early diastole. Length of systole and diastole.

6. Cardiac output and stroke volume of the heart at rest and during physical loading.

7. Electrocardiography. Standard leads normal electrocardiogram in human (I, II, III). Unipolar (V1–V6) leads. Waves of ECG, nature of its waves, clinical significance.

8. Electrocardiography. Action potentials of the heart muscle and its registration methods in human. Standard leads. Normal electrocardiogram in human, nature of its waves, clinical significance.

9. Cardiac innervation. Influences of sympathetic and parasympathetic nerves on the heart. The heart nerves tone. Humoral regulation of heart working. Mediators in the heat (chemical nature, influences).

10. Sympathetic and parasympathetic supply. The reflexes: Reflexes arising from the systemic arteries (baroreceptor reflex; chemoreceptor reflex). Reflexes arising from the heart: Baroreceptors are present in the left ventricle. Coronary chemoreflex (Bezoldjarisch reflexes). Atrial receptors (Bainbridge reflex). Influences from the Higher Centers. Limbic system, emotion and the heart rate.

11. General structure of the vascular tree (segments of blood vessels-major divisions). Functions of the individual segments. Biophysical considerations. Flow, pressure and resistance.

12. Methods of measuring blood pressure. Auscultatory method. Palpation method. Normal arterial blood pressure

90

and factors determining the BP. Regulation of BP. Physiological conditions (sex, meals, emotion, exposure to cold, muscular exercise, sleep) affecting blood pressure.

13. Blood pressure in different segments of the vascular tree. Interrelationship between the diameter of the blood vessel and the velocity of the flowing blood (diameter-velocity relationship).

14. Interrelationship between the velocity, total pressure and the lateral pressure of the flowing blood (velocity-pressure relationship). Velocity and flow of the blood. Relationship between the pressure of the flowing blood with the volume of the flow per unit time (pressure-flow relationship). Resistance and capacitance vessels.

15. Major factors determining blood pressure. Methods of blood pressure registration and measurement. Pressure in arteries, veins, capillaries. Rhythmic fluctuations of blood pressure owing to the heart working, breathing and changes of vasomotor center tone.

16. Flow of blood through the vessels. Linear velocity. Volume flow. Arterial pressure. Arterial pulse. Capillary circulation. Venous circulation. Venous pulse.

17. Capillary circulation. Capillary pressure and flow. Equilibration with interstitial fluid. Active and inactive capillaries. Venous circulation. Venous pressure and flow. Thoracic pump. Muscle pump. Venous pressure in the head.

18. Cardiovascular regulatory mechanisms. General plan of the cardiovascular system reflexes. Local regulatory mechanisms. Autoregulation. Vasodilatator metabolites. Localized vasoconstriction. Substances secreted by the endothelium. Systemic regulation by hormones. Systemic regulation by the nervous system. Vasomotor center.

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19. Innervation of vessels. Vasoconstrictor nerves, vessels’ tone. Neurogenic mechanisms of vasodilatation. Vasomotor center. Reflexogenic zones of the heart and vessels, their role in circulation regulation.

20. Self-regulatory mechanism of constant blood pressure level maintenance. Dilatation and constriction reflexes.

21. Humoral regulation of vessels tone.22. Circulation through special regions (cerebral circulation,

coronary circulation, splanchnic circulation, circulation of the skin).

23. Circulation of lymph. Production of lymph. Mechanisms of lymph movement.

24. Adapting changes of cardiovascular system during physical loading. Significance of functional tests in cardiovascular system examination. Features of blood circulation in lungs, brain and features of systemic blood circulation.

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PHYSIOLOGY OF EXCRETORY SYSTEM

Practical class 1. Water and electrolytes exchange

Questions for discussion1. Kidney’s role in organism.2. Cross anatomy of the kidney. The functional anatomy of

nephron (Renal corpuscle. Proximal tubule. Loop of Henle. Distal nephron).

3. Renal circulation. Pressure in renal vessels. Physiological aspects of renal circulation. Blood flow. Regulation of the renal blood flow. Function of the renal nerves. Autoregula-tion of renal blood flow. Regional blood flow.

4. Glomerular filtration. Glomerular filtration rate (GFR). Normal GFR. Control of GFR. Factors influencing the fil-tration. Applied physiology.

5. Tubular function. Mechanism of tubular reabsorbtion and secretion. Na+ reabsorbtion. Factors influencing Na+ reab-sorbtion.

6. Water reabsorbtion.7. Glucose reabsorbtion.8. Amino acid reabsorbtion.9. Bicarbonate reabsorbtion.10. Phosphate reabsorbtion.11. Potassium.12. Urea, uric acid.13. Tubuloglomerular feedback and glomerulotubular balance.14. Fanconi’s syndrome.


Graw-Hill Companies, Inc., 2001. – P. 675-689.

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2. Guyton A. C., Hall J. E. Textbook of Medical Physiology, 12th ed; W. B. Saunders, 2005.

Practical class 2. Physiology of kidneys. Disorders of water and electrolytes exchange

Questions for discussion1. Water excretion.2. Proximal tubule.3. Loop of Henle.4. Distal tubule.5. Collecting ducts.6. The countercurrent mechanism.7. Role of urea. Water diuresis. Water intoxication.8. Osmotic diuresis.9. Effects of disordered renal function.10. Emptying of the bladder. Anatomic considerations. Mic-

turition.11. Reflex control. Abnormalities of micturition. Effects of

deafferentation.12. Effects of denervation. Effects of spinal cord transection.13. Composition of urine (volume, specific gravity, color, reac-

tion).14. Alkaline tide. Microscopical examination.15. Renin angiotensin system. Effects of angiotensin. Applied

physiology.16. Factors controlling Na+ excretion by the kidney (changing

the GFR; aldosterone; Natriuretic factors).

Books recommended

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1. Ganong W. F. Review of Medical Physiology. 12th ed; Mc-Graw-Hill Companies, Inc., 2001. – P. 689-713.

2. Guyton, A. C., Hall, J. E. Textbook of Medical Physiology, 12th ed; W. B Saunders, 2005.

Practical class 3. Concluding class devoted to the themes “Water and electrolytes exchange”, “Physiology of kidneys. Disorders of water and electrolytes exchange” (intermedi-ate oral examination).

Questions for discussion1. The significance of excretory system in adaptive reactions

of the organism. Kidneys’ role in the human body. Physio-logical aspects of renal circulation. The significance of the topic for applied medicine.

2. Kidney’s role in organism. Cross anatomy of the kidney. The functional anatomy of nephron. Renal corpuscle. Prox-imal tubule. Loop of Henle. Distal nephron.

3. Renal circulation. Pressure in renal vessels. Physiological aspects of renal circulation. Blood flow. Regulation of the renal blood flow. Function of the renal nerves. Autoregula-tion of renal blood flow. Regional blood flow.

4. Tubular function. Mechanism of tubular reabsorbtion and secretion. Na+ reabsorbtion. Factors influencing Na+ reab-sorbtion. Water reabsorbtion. Glucose reabsorbtion. Amino acid reabsorbtion.

5. Water excretion. Proximal tubule. Loop of Henle. Distal tubule. Collecting ducts. The countercurrent mechanism.

6. Glomerular filtration. Glomerular filtration rate (GFR). Normal GFR. Control of GFR. Factors influencing the fil-tration. Applied physiology.

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7. Tubuloglomerular feedback and glomerulotubular balance. Fanconi’s syndrome.

8. Role of urea. Water diuresis. Water intoxication. Osmotic diuresis. Effects of disordered renal function.

9. Emptying of the bladder. Anatomic considerations. Mic-turition. Reflex control. Abnormalities of micturition. Ef-fects of deafferentation. Effects of denervation. Effects of spinal cord transection.

10. Composition of urine (volume, specific gravity, color, reac-tion). Alkaline tide. Microscopical examination. Renin an-giotensin system. Effects of angiotensin. Factors control-ling Na+ excretion by the kidney (changing the GFR; aldos-terone; Natriuretic factors).

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TEST QUESTIONS

Multiple Choice

1. Which of the following is not a function of the kidneys?(a) excretion of metabolic wastes. (b) maintaining proper plasma volume.(c) secreting aldosterone to regulate sodium.(d) maintains proper osmolarity of body fluids.(e) assisting in maintaining the proper acid-base balance of the body.

ANSWER: c

2. Which of the following is not a function of the kidneys? (a) they contribute significantly to long-term regulation of arterial blood pressure by maintaining the proper plasma volume.(b) they act directly on the interstitial fluid, the fluid that bathes the cells, to maintain constancy in its composition.(c) they excrete the metabolic waste products.(d) they assist in maintaining the proper acid-base balance of the body.(e) they secrete several hormones.

ANSWER: b

3. The functional unit of the kidney is the11. glomerulus.12. nephron.13. medulla.14. pyramid.15. juxtaglomerular apparatus.

ANSWER: b

4. The specialized nephron capillary bed where filtration occurs is the3. afferent arteriole.4. efferent arteriole.5. glomerulus.

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6. peritubular bed.7. None of these answers.

ANSWER: c

5. Which of the following statements about juxtamedullary nephrons is incorrect?(a) their glomeruli lie in the renal medulla.(b) they are important in the ability of the kidneys to concentrate urine.(c) their loops of Henle dip deep into the medulla.(d) their peritubular capillaries form vasa recta.(e) they are not the predominant type of nephron found in human kid-neys.

ANSWER: a

6. Which of the following is not associated with juxtamedullary nephrons?(a) glomeruli located in medulla.(b) long loops of Henle.(c) peritubular capillaries form vasa recta.(d) collecting duct in medulla.(e) important role in the ability of the kidneys to produce urine of varying concentration.

ANSWER: a

7. Below is a listing of nephron components and associated structures:1. descending limb of loop of Henle2. Bowman's capsule3. collecting tubule4. ascending limb of loop of Henle5. distal tubule6. proximal tubule

Indicate the correct flow of filtrate through these structures:(a) 4, 6, 5, 3, 2, 1

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(b) 2, 6, 1, 4, 5, 3(c) 2, 5, 6, 3, 1, 4(d) 3, 2, 6, 1, 4, 5(e) 2, 1, 4, 3, 5, 6

ANSWER:

8. The peritubular capillaries.(a) supply nutrients and O2 to the tubular cells.(b) take up the substances that are reabsorbed by the tubules.(c) supply substances that are secreted by the tubules.(d) All of these answers.(e) None of these answers.

ANSWER: d

9. Which nephron structure is especially important in the kidney's ability to produce urine of varying concentration?

• Bowman' capsule.• proximal tubule.• distal tubule.• loop of Henle.• glomerulus.

ANSWER: d

10. Vasa recta are associated with13. afferent arterioles.14. efferent arterioles.15. cortical nephrons.16. juxtamedullary nephron.17. renal papillae.

ANSWER: d

11. The renal process whereby substances are selectively transferred from the peritubular blood into the renal tubule is

• filtration.

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• secretion.• reabsorption.• excretion.• None of these answers.

ANSWER: b

12. The blood that flows through the kidneys is(a) normally about 20 to 25% of the total cardiac output.(b) all filtered through the glomeruli.(c) all used to supply the renal tissue with O2 and nutrients.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: a

13. The glomerular filtration rate(a) averages 125 ml/min.(b) averages 75 liters/day.(c) represents 60 to 65% of the cardiac output.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: a

14. The glomerular filtrate (a) is a protein-free plasma.(b) is formed as a result of passive forces acting across the glomerular membrane.(c) does not contain foreign compounds because these substances are secreted by special transport mechanisms in the proximal tubule in-stead.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

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15. The filtration coefficient(a) is a measure of the surface area and permeability of the glomerular membrane.(b) is a constant value.(c) can be varied by contraction of the podocytes and mesangial cells.(d) Both (a) and (b) above.(e) Both (a) and (c) above.

ANSWER: e

16. Filtrate passes through all of these except(a) glomerular capillary pores.(b) basement membrane.(c) podocytes.(d) filtration slits.(e) None of these answers.

ANSWER: c

17. The glomerular capillary blood pressure in the nephron is 78 mm Hg. The Bowman's capsular hydrostatic pressure is 24 mm Hg. The col-loidal osmotic pressure is 18 mm Hg. The net filtration pressure is ___ mm Hg.(a) 18(b) 26(c) 36(d) 42(e) 78

ANSWER: c

18. Changes in the glomerular filtration rates are accomplished through29. autoregulation.30. myogenic activity.31. vasoactive responses in the afferent arteriole.32. Both (a) and (b) above.33. All of these answers.

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ANSWER: e

19. Which factor would reduce the net filtration pressure the most?13. vasodilation of the afferent arteriole.14. vasocontraction of the efferent arteriole.15. a large increase in blood colloid osmotic pressure.16. a low capsular hydrostatic pressure.17. a high glomerular hydrostatic pressure.

ANSWER: c

20. Which of the following statements concerning the process of glomeru-lar filtration is correct?(a) Bowman's capsule hydrostatic pressure opposes filtration.(b) the glomerular filtration rate is limited by a Tm.(c) all of the plasma that enters the glomerulus is filtered.(d) Two of these answers.(e) All of these answers.

ANSWER: a

21. Glomerular filtration(a) occurs in the loop of Henle.(b) is the process by which plasma water, electrolytes, and small mole-cules, which enter Bowman's capsule, are separated from blood cells and protein, which remain in the glomerular capillaries.(c) is the process by which a substance is transported from the tubular fluid to the peritubular capillaries.(d) Both (a) and (b) above.(e) None of these answers.

ANSWER: b

22. Which of the following factors would decrease the GFR?(a) a fall in plasma protein concentration.(b) an obstruction such as a kidney stone in the tubular system, which increases Bowman's capsule hydrostatic pressure.(c) vasodilation of the afferent arterioles.

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3. (d) Two of these answers.(e) All of these answers.

ANSWER: b

23. The macula densa(a) consists of specialized tubular cells in the juxtaglomerular appara-tus.(b) consists of specialized arteriolar smooth-muscle cells in the juxta-glomerular apparatus.(c) secretes renin.(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: a

24. Which of the following is involved in autoregulation of the GFR?(a) a myogenic mechanism in which the afferent arteriole automatical-ly constricts when it is stretched(b) a tubulo-glomerular feedback mechanism in which vasoactive chemicals released from the juxtaglomerular apparatus bring about af-ferent arteriolar vasoconstriction(c) sympathetically induced vasoconstriction of the afferent arterioles(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

25. Which of the following forces oppose glomerular filtration?(a) blood colloid-osmotic pressure.(b) Bowman's capsule hydrostatic pressure.(c) glomerular-capillary blood pressure.(d) Both (a) and (b) above.(e) Both (b) and (c) above.

ANSWER: d

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26. Afferent arteriolar vasoconstriction __________ blood flow into the glomerulus, which causes the glomerular-capillary blood pressure to __________, leading to a(n) __________ in the net filtration pressure and a resultant __________ in the GFR.(a) increases, increase, increase, increase(b) decreases, decrease, decrease, decrease(c) increases, increase, decrease, decrease(d) decreases, decrease, increase, increase(e) None of these answers.

ANSWER: b

27. The myogenic mechanism5. causes the afferent arteriole to constrict when blood pressure is too

high.6. may result from stretching of vascular smooth muscle.7. Is an autoregulatory mechanism.8. Both (a) and (b) above.9. All of these answers.

ANSWER: e

28. Stimulation of the macula densa cells9. results in vasodilation of the afferent arteriole.10. results in vasoconstriction of the afferent arteriole.11. increases GFR.12. Both (a) and (b) above.13. Both (a) and (c) above.

ANSWER: b

29. Extrinsic control of the GFR(a) is mediated by sympathetic nervous system input to the afferent ar-terioles.(b) is aimed at the regulation of arterial blood pressure.(c) does not require a special mechanism but occurs as part of the baroreceptor reflex.(d) Both (a) and (b) above.

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(e) All of these answers.

ANSWER: e

30. When arterial blood pressure is elevated above normal, which of the following compensatory changes in renal function occur as a result of the baroreceptor reflex?(a) afferent arteriolar vasoconstriction(b) afferent arteriolar vasodilation(c) reduction in GFR(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: b

31. Tubular reabsorption(a) refers to the movement of a substance from the peritubular capil-lary blood into the tubular fluid.(b) occurs by either active or passive transport.(c) involves the process of transepithelial transport.(d) Both (b) and (c) above.(e) All of these answers.

ANSWER: d

32. Which of the following statements regarding tubular reabsorption is incorrect? Tubular reabsorption(a) refers to the movement of a substance from the tubular fluid to the peritubular capillary blood.(b) is important for the conservation of substances important to the

body, such as Na+, Cl-, glucose, and amino acids.(c) can occur by active or passive transport mechanisms.(d) involves the process of transepithelial transport.(e) takes place only in the proximal tubule.

ANSWER: e

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33. Tubular reabsorption(a) involves the movement of substances from the peritubular capillar-ies into the tubular fluid.(b) involves the movement of substances from the tubular fluid into the peritubular capillaries.(c) is considered to be active if any one of the five steps of transep-ithelial transport is active.(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: e

34. Tubular reabsorption involves• active transport.• cotransport.• facilitated diffusion.• countertransport.• All of these answers.

ANSWER: e.

35. Which of the following is not a step in transepithelial transport?(a) movement of the substance through the cytosol of the tubular cell(b) movement of the substance across the glomerular capillary wall(c) movement of the substance across the luminal membrane of the tubular cell(d) movement of the substance through the interstitial fluid(e) movement of the substance across the basolateral membrane of the tubular cell

ANSWER: b

36. The Na+-K+ ATPase transport system that plays a pivotal role in much of tubular reabsorption is located in the(a) luminal membrane of tubular cells.(b) basolateral membrane of tubular cells.(c) podocytes.

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(d) glomerular capillary membrane.(e) basement membrane.

ANSWER: b

37. Which is reabsorbed by the proximal convoluted tubule?4. sodium.5. amino acids.6. glucose.7. All of these answers. 8. None of these answers.

ANSWER: d

38. Into which structure does most reabsorption occur?• proximal convoluted tubule.• glomerulus.• distal convoluted tubule.• loop of Henle.• None of these answers.

ANSWER: a

39. Glucose is not normally found in the urine because:• does not get filtered out of glomerulus.• it is not found in the blood. • it is reabsorbed by renal tubule cells usually.• it is kept in the blood.• None of these answers.

ANSWER: c

40. The proximal tubule(a) reabsorbs about 65% of the filtered water.(b) is not the site of action of renin.(c) is the location where glucose is reabsorbed.(d) reabsorbs about 65% of the filtered water and is the location where glucose is reabsorbed.

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ANSWER: e

41. Tubular maximum (Tm)(a) is the maximum amount of a substance that the tubular cells can actively transport within a given time period.(b) is the maximum rate at which a substance is filtered at the glomerulus.(c) occurs when the membrane carrier becomes saturated.(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: d

42. Tm is the maximum(a) rate of glomerular filtration.(b) rate a substance can be reabsorbed because of saturation of the car-rier molecule.(c) rate of urine excretion.(d) rate a substance can be cleared from the blood.(e) percentage of renal blood flow that can be converted to filtrate.

ANSWER: b

43. The renal threshold is the(a) maximum amount of a particular substance that can be excreted in the urine per unit of time.(b) maximum amount of a particular substance that the tubular cells are capable of actively reabsorbing per unit of time.(c) plasma concentration of a particular substance at which its Tm is reached and the substance first appears in the urine.(d) maximum amount of waste products that can be concentrated in the urine per unit of time.(e) maximum amount of water that can be osmotically absorbed across the tubules per unit of time.

ANSWER: c

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44. Which of the following plasma constituents is not regulated by the kidneys?(a) glucose

(b) Na+

(c) H+

(d) phosphate (e) water

ANSWER: a

45. Reabsorption of chloride7. is active.8. is passive.9. is dependent on the amount of sodium reabsorbed.10. Both (a) and (b) above.11. Both (b) and (c) above.

46. Select the major waste product of nitrogen metabolism.(a) plasma proteins.(b) urea.(c) glucose.(d) PO4.

(e) amino acids.

ANSWER: b

47. Given the following data for substance X (GFR = 125 ml/min, Tm = 125 mg/min, at a plasma concentration of 200 mg/100 ml), how much of substance X is filtered, reabsorbed, and excreted? (a) 200 mg/min filtered, 125 mg/min reabsorbed, 75 mg/min excreted(b) 250 mg/min filtered, 125 mg/min reabsorbed, 125 mg/min excret-ed(c) 125 mg/min filtered, 125 mg/min reabsorbed, 0 mg/min excreted(d) 250 mg/min filtered, 200 mg/min reabsorbed, 50 mg/min excreted(e) None of these answers.

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ANSWER: b

48. The juxtaglomerular apparatus(a) secretes renin in response to sodium depletion or plasma volume reduction.(b) is a thickened region of specialized cells at a point where the distal tubule comes into intimate contact with the afferent and efferent arte-rioles of the same nephron.(c) is where reabsorption of sodium occurs.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

49. The normal glucose concentration in the plasma is about________ mg per 100 ml.(a) 30(b) 60(c) 100(d) 180(e) 250

ANSWER: c

50. Which statement regarding sodium reabsorption is not accurate?• it plays a role in glucose, amino acid, and urea reabsorption in the

proximal tubule.• it is under hormonal control in the distal tubule.• in the loop of Henle, it contributes to the formation of concentrated

urine.• approximately 0.5% of sodium is reabsorbed on a daily basis.• aldosterone is a key hormone involved in facultative reabsorption.

ANSWER: d

51. The juxtaglomerular apparatus

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(a) is a combination of specialized tubular and vascular cells at a point where the beginning of the distal tubule comes into intimate contact with the afferent and efferent arterioles of the same nephron.(b) secretes aldosterone.(c) secretes renin.(d) Both (a) and (b) above.(e) Both (a) and (c) above.

ANSWER: e

52. Aldosterone

(a) stimulates Na+ reabsorption in the distal and collecting tubules.(b) is secreted by the JG apparatus.

(c) stimulates K+ secretion in the distal tubule.(d) Both (a) and (b) above.(e) Both (a) and (c) above.

ANSWER: e

53. Aldosterone secretion(a) occurs in the kidney.(b) is stimulated by angiotensin II.(c) is controlled by the concentration of Cl-.(d) All of these answers.(e) None of these answers.

ANSWER: b

54. Na+ reabsorption(a) uses 80% of the energy requirement of the kidney.(b) is under control of the hormone aldosterone in the distal portions of the nephron.(c) is linked to the reabsorption of water, Cl-, glucose, amino acids, and urea.(d) Both (a) and (b) above.(e) All of these answers.

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ANSWER: e

55. The greatest percentage of Na+ reabsorption takes place in the(a) proximal tubule.(b) loop of Henle.(c) distal tubule.(d) collecting tubule.(e) renal pelvis.

ANSWER: a

56. When blood volume becomes abnormally low25. sodium reabsorption is diminished.26. dilute urine is formed.27. renin catalyzes the conversion of angiotensinogen.28. aldosterone is secreted by the kidney.29. All of these answers.

ANSWER: c

57. Angiotensin I(a) is formed as a result of activation of angiotensinogen by renin.(b) is transformed into angiotensin II as a result of converting enzyme action in the lungs.(c) acts on the adrenal cortex to stimulate aldosterone secretion.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

58. Sodium reabsorption in the distal portions of the nephron is stimulated by(a) atrial natriuretic peptide.(b) vasopressin.(c) angiotensin II.(d) aldosterone.(e) renin.

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ANSWER: d

59. Which of the following is not attributable to atrial natriuretic peptide (ANP)?(a) ANP is released from the cardiac atria when the ECF volume is re-duced.

(b) ANP inhibits Na+ reabsorption in the distal parts of the nephron.(c) ANP inhibits renin secretion by the kidneys.(d) ANP inhibits aldosterone secretion by the adrenal cortex.(e) ANP inhibits sympathetic nervous activity to the heart and blood vessels.

ANSWER: a

60. The energy requirement for glucose reabsorption is used to

(a) run the Na+-K+ ATPase pump.

(b) run the Na+-glucose co-transport carrier.(c) synthesize renin, which controls glucose reabsorption.(d) maintain the Tm for glucose.(e) produce aldosterone-induced protein, which increases the perme-ability of the proximal tubular cells to glucose.

ANSWER: a

61. Atrial natriuretic peptide3. is secreted by the heart when atrial pressure is high.4. results in an increased glomerular filtration rate.5. inhibits aldosterone activity.6. Both (a) and (b) above.7. All of these answers.

ANSWER: e

62. Which of the following does not play a role in Na+ reabsorption?(a) renin.(b) vasopressin.

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(c) angiotensinogen.(d) aldosterone.(e) atrial natriuretic peptide.

ANSWER: b

63. The distal and collecting tubules are the site of (a) the co-transport carriers for glucose and amino acid reabsorption.(b) the organic ion secretory systems.(c) aldosterone and vasopressin action.(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: c

64. Water reabsorption is under the control of vasopressin(a) along the entire length of the nephron.(b) only in the loop of Henle.(c) only in the distal and collecting tubules.(d) only in the proximal tubule.(e) only in the glomerulus.

ANSWER: c

65. Water reabsorption(a) occurs passively by osmosis in the proximal tubule.(b) is under the control of vasopressin in the distal and collecting tubules.(c) occurs by active transport in the distal and collecting tubules.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

66. Which of the following statements concerning water reabsorption is correct?(a) water reabsorption is under control of vasopressin throughout the length of the nephron.

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(b) the ascending limb of the loop of Henle is always impermeable to water.(c) vasopressin makes the distal and collecting tubules impermeable to water.(d) fifteen percent of the filtered water osmotically follows the absorp-

tion of Na+ and other solutes in the proximal tubule.(e) water reabsorption is passive in the early portions of the nephron but is active in the distal portions of the nephron.

ANSWER: b

67. Water reabsorption(a) cannot occur from any portion of the nephron in the absence of va-sopressin.(b) occurs to the greatest extent in the proximal convoluted tubule.(c) is under vasopressin control in the proximal tubule.(d) is under vasopressin control in the distal and collecting tubules.(e) Both (b) and (d) above.

ANSWER: e

68. Urea(a) is the waste product with the smallest molecular size in the glomerular filtrate.(b) is in greater concentration at the end of the proximal tubule than in other body fluids.(c) has a clearance rate greater than GFR.(d) Both (a) and (b) above are correct.(e) All of these answers.

ANSWER: d

69. Urea(a) reabsorption occurs passively.(b) is only 50% reabsorbed in the proximal tubule.(c) is a waste product of protein metabolism.(d) Both (b) and (c) above.

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ANSWER: e

70. Urea(a) is a waste product resulting from the breakdown of protein.(b) is passively reabsorbed at the end of the proximal tubule down a urea concentration gradient created by the osmotic-induced reabsorp-tion of water from the proximal tubule.(c) recycling between the late portion of the collecting tubule and the long loops of Henle contributes to medullary hypertonicity.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: e

71. When the extracellular fluid becomes too acidic, the tubular secretion of (a) no ionic substance is affected.(b) hydrogen ions decreases.(c) hydrogen ions increases.(d) sodium ions decreases.(e) sodium ions increases.

ANSWER: c

72. Tubular secretion(a) refers to the movement of a substance from the peritubular capil-lary blood into the tubular lumen.(b) can occur by active or passive transport mechanisms.

(c) of K+ occurs in the distal and collecting tubules and is stimulated by aldosterone.(d) of organic anions and cations occurs in the proximal tubule by two distinct types of carriers.(e) All of these answers.

ANSWER: e

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73. Tubular secretion(a) involves transepithelial transport.(b) is the movement of a substance from the peritubular capillary blood into the tubular fluid.(c) always occurs by active transport.(d) Both (a) and (b) above.(e) Both (b) and (c) above.

ANSWER: d

74. Tubular secretion is important(a) in the renal regulation of hydrogen ion concentration.(b) for the elimination of metabolic waste products from the body.(c) in the renal regulation of sodium balance.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: a

75. Tubular secretion of foreign substances such as drugs generally occurs in the(a) Bowman's capsule.(b) loop of Henle.(c) proximal tubule.(d) collecting duct.(e) glomerulus.

ANSWER: d

76. Potassium(a) is actively reabsorbed in the proximal tubule.(b) is actively secreted in the distal and collecting tubules.(c) secretion is controlled by aldosterone.(d) Both (b) and (c) above.(e) All of these answers.

ANSWER: e

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77. Which substance is normally secreted into the tubule2. hydrogen ions.3. potassium ions.4. organic ions5. Both (a) and (b) above.6. All of these answers.

ANSWER: e

78. Which of the following stimulates aldosterone secretion?

(a) an increase in plasma K+.

(b) a decrease in plasma K+.(c) activation of the renin-angiotensin pathway.(d) Both (a) and (c) above.(e) Both (b) and (c) above.

ANSWER: d

79. Plasma clearance is the(a) time required to filter blood in the glomerulus.(b) amount of a substance appearing in the urine in one minute of time.(c) amount of a substance that is filtered in one minute of time.(d) amount of a substance secreted in one minute of time.(e) volume of plasma that is completely cleared of a substance by the kidneys in one minute of time.

ANSWER: e

80. If a substance has a plasma concentration of 150 mg/ml and a urine concentration of 1.7 mg/ml, and the urine flow rate is 1.3 ml/min, what is the clearance of this substance?(a) 15 ml/min.(b) 196 ml/min.(c) 0.4 ml/min.(d) can not be determined with these data.

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(e) None of these answers.

ANSWER: e

81. Inulin is (a) filtered, not reabsorbed, but secreted.(b) filtered, not reabsorbed, and not secreted.(c) filtered, reabsorbed, and not secreted.(d) filtered, reabsorbed, and secreted.(e) not filtered.

ANSWER: b

82. The plasma clearance of a substance can be used to calculate the glomerular filtration rate (GFR) if that substance is freely filtered at the glomerulus and(a) secreted and reabsorbed by the tubules.(b) neither reabsorbed nor secreted by the tubules.(c) secreted by the tubules.(d) reabsorbed by the tubules.(e) None of these answers.

ANSWER: b

83. Which of the following statements concerning the medullary vertical osmotic gradient is incorrect?(a) the loops of Henle of juxtamedullary nephrons establish a medullary vertical osmotic gradient by means of countercurrent multi-plication.(b) the vasa recta enable the medulla to be supplied with blood while conserving the medullary vertical osmotic gradient by means of coun-tercurrent exchange.(c) the countercurrent system establishes and maintains a medullary vertical osmotic gradient ranging from 300 to 1,200 mosm/liter.(d) he collecting tubules of the juxtamedullary nephrons but not the cortical nephrons descend through the medullary vertical osmotic gra-dient before emptying into the renal pelvis.

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(e) the medullary vertical osmotic gradient permits excretion of urine of differing concentrations by means of vasopressin-controlled, vari-able H2O reabsorption from the final tubular segments.

ANSWER: d

84. The ________ establish the medullary vertical osmotic gradient by means of countercurrent multiplication.(a) loops of Henle of juxtamedullary nephrons(b) loops of Henle of cortical nephrons(c) vasa recta of juxtamedullary nephrons(d) vasa recta of cortical nephrons(e) vasopressin-secreting cells

ANSWER: a

85. The ascending limb of the loop of Henle of a juxtamedullary nephron(a) actively transports NaCl out of the lumen into the interstitial fluid.(b) is highly impermeable to H2O.(c) is always impermeable to H2O.(d) Both (a) and (b) above.(e) Both (a) and (c) above.

ANSWER: e

86. Which of the following does not contribute to the establishment of a vertical osmotic gradient in the interstitial fluid of the renal medulla?(a) the renin-angiotensin-aldosterone system(b) countercurrent multiplication in the long loops of Henle of jux-tamedullary nephrons(c) urea recycling between the late portion of the collecting tubule and the long loops of Henle

ANSWER: a

87. The tubular fluid is __________ as it enters Bowman's capsule, __________ at the beginning of the loop of Henle, __________ at the

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tip of the loop, and __________ as it leaves the loop to enter the distal tubule.(a) isotonic, hypertonic, hypertonic, isotonic (b) isotonic, isotonic, hypotonic, hypotonic(c) isotonic, isotonic, hypertonic, hypotonic(d) hypertonic, hypotonic, hypertonic, isotonic(e) None of these answers.

ANSWER: c

88. What mechanisms are responsible for producing concentrated urine?• the juxtamedullary nephrons become active.• the counter-current mechanism pulls out much water.• vasopressin causes facultative water reabsorption in distal tubule.• Both (a) and (b) above.• All of these answers.

ANSWER: e

89. The vertical osmotic gradient in the kidney (a) is established and maintained by the countercurrent system.(b) makes it possible to put out urine of variable concentration de-pending on the needs of the body by varying the degree of water per-meability of the distal portions of the nephron.(c) is found in the renal cortex.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

90. The ascending limb of the loop of Henle is where(a) NaCl passively leaves the tubular fluid down its concentration gra-dient.(b) NaCl is actively transported into the interstitial fluid, leaving water behind because the tubular cells are not permeable to water.

(c) K+ is secreted.

(d) aldosterone stimulates Na+ reabsorption.

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(e) None of these answers.

ANSWER: b

91. The ascending limb of the loop of Henle(a) actively transports NaCl into the surrounding interstitial fluid.(b) is impermeable to water.(c) is found in the renal cortex.(d) drains into the proximal convoluted tubule.(e) Both (a) and (b) above.

ANSWER: e

92. Which part of the juxtamedullary nephron is responsible for establish-ing the vertical osmotic gradient in the medulla of the kidney?(a) collecting duct(b) afferent arteriole(c) loop of Henle(d) juxtaglomerular apparatus(e) distal tubule

ANSWER: c

93. Select the incorrect statement about ADH.(a) It is also called vasopressin.(b) It is not secreted if the body consumes large amounts of water.(c) It is produced by the distal convoluted tubule.(d) It is secreted if the body fluids become hypertonic.(e) It stimulates reabsorption of water.

ANSWER: c

94. Which of the following statements concerning the loop of Henle of juxtamedullary nephrons is correct?(a) the ascending limb of the loop of Henle is freely permeable to H2O and NaCl.(b) the filtrate is isotonic as it enters the loop of Henle, hypertonic at the tip of the loop, and hypotonic as it leaves the loop of Henle.

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(c) the descending limb of the loop of Henle actively transports NaCl out of the tubule into the interstitial fluid.(d) All of these answers.(e) None of these answers.

ANSWER: b

95. Which of the following statements concerning the countercurrent sys-tem is incorrect?(a) the loops of Henle of juxtamedullary nephrons are responsible for establishing a vertical osmotic gradient in the interstitial fluid of the renal medulla by countercurrent multiplication.(b) the active NaCl pump of the ascending limb of Henle's limb can establish a 1,200 mosm/liter concentration difference between the as-cending and descending limbs at any given horizontal level.(c) by means of countercurrent exchange, the vasa recta preserve the vertical osmotic gradient while supplying blood to the medullary tis-sue.(d) the collecting tubules of all nephrons utilize the driving force of the vertical osmotic gradient to accomplish variable H2O reabsorption under the control of vasopressin, which governs their permeability.(e) the filtrate is isotonic as it enters the loop of Henle, hypertonic at the tip of the loop of Henle, and hypotonic as it leaves the loop of Henle.

ANSWER: b

96. Vasopressin(a) secretion is stimulated by a water deficit.(b) increases the permeability of the distal and collecting tubules to water.(c) increases the permeability of the late portion of the collecting tubule to urea.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: e

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97. Vasopressin(a) is produced in the hypothalamus.(b) increases the permeability of the distal and collecting tubules to water.(c) secretion is stimulated by a water deficit in the body.(d) Both (b) and (c) above.(e) All of these answers.

ANSWER: e

98. Vasopressin(a) can completely halt urine production during periods of water depri-vation to conserve water for the body.(b) activates the cyclic AMP second-messenger system within the tubular cells.(c) renders the distal and collecting tubules impermeable to water.

(d) increases Na+ reabsorption by the distal portions of the nephron.(e) stimulates the active salt pump of the ascending limb of the loop of Henle to establish the medullary vertical osmotic gradient.

ANSWER: b

99. Vasopressin secretion(a) induces the kidneys to produce a small volume of concentrated urine.(b) is stimulated when the body fluids are hypertonic.(c) is inhibited when the arterial blood pressure is dangerously low.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

100. The osmoreceptors contributing to water balance are located in the (a) adrenal cortex.(b) hypothalamus.(c) juxtaglomerular apparatus.(d) renal cortex.

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(e) renal medulla.

ANSWER: b

101. The __________ and __________ enable the kidneys to produce urine of varying concentrations and volumes depending on the body's needs.

(a) Na+-K+ ATPase pump, co-transport carriers(b) juxtaglomerular apparatus, vasa recta(c) podocytes, peritubular capillaries(d) medullary vertical osmotic gradient, vasopressin(e) renin-angiotensin-aldosterone system, renal pyramids

ANSWER: d

102. The segment of the nephron that is not permeable to H2O even in the presence of vasopressin is the(a) proximal tubule.(b) ascending limb of the loop of Henle.(c) descending limb of the loop of Henle.(d) distal tubule.(e) collecting tubule.

ANSWER: b

103. Which of the following is a potential consequence of kidney disease?(a) cardiac disturbances(b) skeletal abnormalities(c) anemia(d) acidosis(e) All of these answers.

ANSWER: e

104. Excretion (a) is the removal of substances that were filtered at the glomerulus or secreted but not reabsorbed.

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(b) is the process by which a substance moves from the peritubular capillary blood to the tubular fluid.(c) conserves substances that are important to the body.(d) occurs by active transport of substances into the urinary bladder.(e) is controlled by sympathetic activity.

ANSWER: a

105. Urine moves from the kidneys to the urinary bladder through the ureters(a) by active transport.(b) passively by the force of gravity.(c) by peristaltic contraction of the smooth muscle of the ureters.(d) when the bladder empties and creates a negative pressure that pulls the urine to the bladder.(e) None of these answers.

ANSWER: c

106. Micturition10. is the process of emptying the bladder.11. is a parasympathetic reflex.12. is initiated when stretch receptors in the bladder wall are excited.13. Both (a) and (b) above.14. All of these answers.

ANSWER: e

107. The urinary bladder(a) is a temporary storage site for urine.(b) wall is stretched by 200 to 400 ml of urine, which stimulates stretch receptors that initiate the micturition reflex.(c) contracts when parasympathetic nerves stimulate it.(d) All of these answers.(e) None of these answers.

ANSWER: d

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108. When the bladder wall is distended as a result of urine accumulation, the stretch receptors are stimulated and send afferent impulses to the spinal cord that(a) stimulate parasympathetic nerves, which return to the bladder and cause it to contract.(b) inhibit the motor neurons that normally keep the external urethral sphincter closed. (c) stimulate nerves that go to the kidney and prevent glomerular fil-tration until the bladder is empty.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

109. When the bladder of an infant is filled with urine, the(a) stretch receptors in the bladder wall are inhibited.(b) parasympathetic nerve supplying the bladder is inhibited, allowing the bladder to relax.(c) motor neuron supplying the external urethral sphincter is stimulat-ed, causing the sphincter to open.(d) motor neuron supplying the external urethral sphincter is inhibited, allowing the sphincter to open. (e) parasympathetic nerve supplying the internal urethral sphincter is stimulated, causing the sphincter to close.

ANSWER: d

110. The process of preventing micturition in spite of initiation of the reflex involves(a) the cerebral cortex.(b) voluntary stimulation of the motor neuron supplying the external urethral sphincter.(c) voluntary stimulation of the internal urethral sphincter via its parasympathetic nerve supply.(d) Both (a) and (b) above.(e) All of these answers.

ANSWER: d

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111. Which of the following does not occur during the micturition reflex in a baby?(a) the motor neuron supplying the external sphincter is stimulated.(b) the parasympathetic nerve supply to the bladder is stimulated.(c) the internal urethral sphincter mechanically opens due to changes in the shape of the bladder.(d) the external urethral sphincter is relaxed.(e) the bladder contracts.

ANSWER: a

True/False

112. The kidneys are the organs that are primarily responsible for maintain-ing constancy of the volume and electrolyte composition of the inter-nal fluid environment.

ANSWER: True

113. The kidneys keep the urine volume and composition essentially con-stant.

ANSWER: False

114. The three major processes involved in urine formation are filtration, reabsorption, and excretion.

ANSWER: False

115. The afferent arteriole is the blood vessel that carries blood to the glomerular capillaries.

ANSWER: True

116. Only juxtamedullary nephrons contain a juxtaglomerular apparatus.

ANSWER: False

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117. The group of cells located where the distal tubule comes into contact with the afferent and efferent arterioles of the same nephron is known as the juxtaglomerular apparatus.

ANSWER: True

118. In the kidney, blood is filtered in the cortex, drains through the renal pelvis into the renal medulla, and from there travels in the ureter to the urinary bladder.

ANSWER: False

119. Glomerular filtration occurs primarily by active transport.

ANSWER: False

120. Twenty-five percent of the cardiac output goes to the kidneys because of their tremendous nutrient requirement for the active transport of

Na+.

ANSWER: False

121. Plasma proteins are normally filtered in the nephron.

ANSWER: False

122. All of the plasma that enters the glomerulus is normally filtered into Bowman's capsule except for the plasma proteins.

ANSWER: False

123. The glomerular filtrate is almost identical in composition to the plas-ma.

ANSWER: True

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124. The vast majority of the filtered fluid is reabsorbed.

ANSWER: True

125. In general, the substances in the filtrate that need to be conserved are selectively reabsorbed whereas the unwanted substances that need to be eliminated fail to be reabsorbed.

ANSWER: True

126. Glomerular filtration occurs by active transport of Na+, which then creates an osmotic gradient for the filtration of water.

ANSWER: False

127. The glomerular filtrate contains only substances that are not needed by the body.

ANSWER: False

128. The Bowman's capsule hydrostatic pressure opposes filtration.

ANSWER: True

129. Blood pressure in the glomerular capillaries is the same as in capillar-ies elsewhere in the body.

ANSWER: False

130. The glomerular capillary blood pressure is higher than capillary pres-sure elsewhere in the body primarily because the afferent arteriole has a larger diameter than the efferent arteriole.

ANSWER: True

131. If a kidney stone blocked the renal pelvis and consequently caused a build-up of fluid pressure in the tubules and Bowman's capsule, the

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net filtration pressure across the glomerular capillary membrane would increase.

ANSWER: False

132. Because of autoregulation, changes in mean arterial blood pressure be-tween the range of 80 to 180 mm Hg do not directly produce changes in the GFR.

ANSWER: True

133. Autoregulation of the GFR is accomplished by activation of the sym-pathetic nervous system.

ANSWER: False

134. The glomerular capillary wall contains filtration slits formed by the clefts between the foot processes of adjacent podocytes.

ANSWER: False

135. The pores in the glomerular membrane are too small for albumin to pass through.

ANSWER: False

136. The kidneys receive a disproportionately large share of the cardiac output for the purpose of adjusting and purifying the plasma.

ANSWER: True

137. Autoregulation is important to prevent unintentional shifts in the GFR that could lead to dangerous imbalances of fluid, electrolytes, and wastes.

ANSWER: True

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138. Sympathetic vasoconstriction of the afferent arterioles and a resultant fall in the GFR occur as part of the baroreceptor reflex response when the blood pressure is too low.

ANSWER: True

139. Contraction of mesangial cells closes off a portion of the filtering cap-illaries, which leads to a decrease in GFR if the filtration pressure re-mains unchanged.

ANSWER: True

140.When a substance is reabsorbed, it moves from the tubular fluid into the peritubular capillaries.

ANSWER: True

141. By tubular secretion, substances leave the blood and enter the tubular portion of the nephron.

ANSWER: True

142. In active reabsorption, all of the steps involved in transepithelial trans-port are active.

ANSWER: False

143. Transepithelial transport occurs only for substances that are actively reabsorbed.

ANSWER: False

144. The Tm represents the maximum amount of a particular substance that can be excreted in the urine per unit of time.

ANSWER: False

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145. The amount of glucose filtered is directly proportional to the plasma glucose concentration at all plasma glucose concentrations.

ANSWER: True

146. The amount of glucose reabsorbed is directly proportional to the plas-ma glucose concentration at all plasma glucose concentrations.

ANSWER: False

147. The renal threshold represents the maximum amount of a particular substance that the tubular cells are capable of actively reabsorbing per unit of time.

ANSWER: False

148. For a substance to be actively reabsorbed, all of the steps of transep-ithelial transport require energy expenditure.

ANSWER: False

149. The tubular cells display a Tm for urea.

ANSWER: False

150. The renal threshold for glucose is well above the normal plasma glu-cose concentration, but the renal threshold for PO4 is equal to the nor-mal plasma PO4 concentration.

ANSWER: True

151. During acidosis, H+ secretion increases.

ANSWER: True

152. The secretion of aldosterone stimulates the tubular reabsorption of sodium and the tubular secretion of potassium.

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ANSWER: True

153. A rise in ECF K+ concentration leads to increased excitability of heart muscle, possibly producing fatal cardiac arrhythmias.

ANSWER: True

154. The Na+ cotransport system in the proximal tubule facilitates elimina-tion of foreign organic compounds from the body.

ANSWER: False

155. ACE inhibitor drugs promote diuresis by blocking the conversion of angiotensin I into angiotensin II.

ANSWER: True

156. Water reabsorption cannot occur from any portion of the nephron in the absence of vasopressin.

ANSWER: False

157. Vasopressin increases H2O reabsorption in the proximal tubule.

ANSWER: False

158. The secretion of vasopressin increases if the extracellular fluid be-comes hypertonic.

ANSWER: True

159. Urea is passively reabsorbed down the osmotic gradient created by ac-

tive Na+ reabsorption.

ANSWER: False

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160. Tubular secretion involves the movement of substances from the per-itubular capillary blood into the tubular fluid.

ANSWER: True

161. The liver converts many foreign organic compounds into an anionic form that can be secreted by the organic anion secretory system.

ANSWER: True

162. Angiotensinogen is produced by the kidney.

ANSWER: False

163. Tubular reabsorption and tubular secretion are highly selective pro-cesses, whereas glomerular filtration is not.

ANSWER: True

164. The clearance rate for a substance that is filtered and secreted but not reabsorbed is greater than the GFR.

ANSWER: True

165. The clearance rate for inulin is greater than the GFR.

ANSWER: False

166. A plasma clearance of 135 ml/min for a substance when the GFR is 125 ml/min indicates that net secretion of the substance occurs.

ANSWER: True

167. If a substance is filtered and secreted but not reabsorbed its plasma clearance rate is always less than the GFR.

ANSWER: False

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168. The osmolarity of the medullary interstitial fluid always equilibrates with the descending limb of the loop of Henle.

ANSWER: True

169. The driving force for H2O reabsorption across all permeable segments of the kidney tubule is an osmotic gradient.

ANSWER: True

170. The receptor sites for vasopressin binding are located on the basolater-al border, yet the end result is an increase in H2O permeability of the luminal border of the tubular cells.

ANSWER: True

171. In the tubular segments permeable to H2O, solute reabsorption is al-ways accompanied by comparable H2O reabsorption.

ANSWER: True

172. ADH release is the main stimulus for the secretion of aldosterone.

ANSWER: False173. The permeability and transport properties of the loops of Henle of jux-

tamedullary nephrons are important in establishing the vertical osmot-ic gradient in the renal medulla.

ANSWER: True

174. NaCl is actively transported from the descending limb of the loop of Henle to establish the medullary osmotic gradient.

ANSWER: False

175. When tubular fluid enters the distal tubule, it is hypotonic.

ANSWER: True

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176. Aldosterone promotes water reabsorption by controlling the reabsorp-tion of salt.

ANSWER: True

177. The presence of vasopressin acts to prevent the reabsorption of water from the distal and collecting tubules.

ANSWER: False

178. Because of countercurrent multiplication, the loop of Henle is able to establish a vertical osmotic gradient in the renal medulla ranging from 300 to 1,200 mosm/liter, despite the fact that the active salt pump of the ascending limb is only able to produce a 200 mosm/liter osmotic gradient at each horizontal level.

ANSWER: True

179. A pure loss or gain of H2O that is not accompanied by comparable solute deficit or excess in the body leads to changes in ECF osmolari-ty.

ANSWER: True

180. Changes in the osmolarity of the extracellular fluid are detected by os-moreceptors in the hypothalamus.

ANSWER: True

181. Acute renal failure may be reversible, whereas chronic renal failure is not reversible.

ANSWER: True

182. Urine moves from the kidneys to the urinary bladder through the ureters passively by the force of gravity.

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ANSWER: False

183. The micturition reflex controls bladder emptying in adults.

ANSWER: False

184. When urine is eliminated from the body, the sphincter muscles in the urethra relax.

ANSWER: True

185. During the micturition reflex, the motor neuron supplying the external urethral sphincter is stimulated.

ANSWER: False

186. The average rate of urine formation is 1 ml/min.

ANSWER: True

187. The epithelial lining of the bladder passively stretches to accommo-date a larger volume during bladder filling.

ANSWER: False

188. One can deliberately prevent urination in spite of the micturition re-flex by voluntarily inhibiting the parasympathetic supply to the blad-der to halt bladder contraction.

ANSWER: False

189. Vasopressin is secreted from the anterior pituitary gland.

ANSWER: False

190. The smooth muscle of the bladder is innervated by parasympathetic fibers.

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ANSWER: True

Fill in the Blank

191. The functional unit of the kidneys is the ____________.

ANSWER: nephron

192. Urine is eliminated from the bladder through the _________.

ANSWER: urethra

193. The two regions of the kidney are an outer ___________ and an inner ______________.

ANSWER: cortex, medulla

194. Tubular __________ and tubular __________ are selective processes that occur in the nephron.

ANSWER: reabsorption, secretion

195. GFR = _____________ x _______________.

ANSWER: Kf, net filtration pressure

196. The specialized cells of the ____________ within the ___________ detect changes in the rate at which fluid is flowing past them through the tubule. In response, they secrete vasoactive chemicals that influ-ence the GFR by making adjustments in the caliber of the _________ arterioles. This is known as the ____________ feedback mechanism.

ANSWER: macula densa, juxtaglomerular apparatus, afferent, tubulo-glomerular

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197. The energy-dependent step in Na+ reabsorption involves the ________________ located at the ______________ membrane of the tubular cell.

ANSWER: Na+-K+ pump, basolateral

198. ________ is a group of intrinsic mechanisms in the kidneys that pre-vent changes in the GRF.

ANSWER: autoregulation

199. If the plasma concentration of substance X is 200 mg/100 ml and the GFR is 125 ml/min, the filtered load of this substance is ____________.

ANSWER: 250 mg/min

200. If the Tm for substance X is 200 mg/min, how much of the substance will be reabsorbed at a plasma concentration of 200 mg/100 ml and a GFR of 125 ml/min? ____________ How much of substance X will be excreted? ______________________

ANSWER: 200 mg/min, 50 mg/min

201. The plasma concentration of a particular substance at which its Tm is reached and the substance first starts appearing in the urine is known as the ______________.

ANSWER: renal threshold

202. Each tuft of glomerular capillaries is held together by ________ cells.

ANSWER: mesangial

203. The _______ transforms many foreign organic compounds into ionic form, which facilitates their elimination from the body because such

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conversion enables them to be secreted by the organic anion transport system.

ANSWER: liver

204. On the average, of the 125 ml/min of plasma filtered, ______________ ml/min is reabsorbed, and ______________ ml/min is excreted as urine.

ANSWER: 124, 1

205. By reabsorption, substances leave the tubules of the nephrons and re-turn to the blood in the ________.

ANSWER: peritubular capillaries

206. The plasma clearance of the harmless foreign compound _____________ is equal to the GFR.

ANSWER: inulin

207. The plasma clearance of the organic anion ________________ is equal to the renal plasma flow.

ANSWER: para-aminohippuric acid

208. _________ are water channels in the tubular cells of the nephron.

ANSWER: Aquaporins

209. ___________ % of the filtered H2O is variably reabsorbed under the control of the hormone ______________ in the distal and collecting tubules.

ANSWER: twenty, vasopressin

210. Vasopressin is also known as ______________, indicative of its effect on the kidneys.

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ANSWER: antidiuretic hormone

211. _________ is an actively reabsorbed substance that does not have a tubular maximum for reabsorption.

ANSWER: sodium

212. ________________ is increased urinary output of H2O with little or no increase in excretion of solutes; _____________________ refers to increased excretion of both H2O and solutes.

ANSWER: water diuresis, osmotic diuresis

213. __________________ renal failure has a rapid onset but may be re-versible; ________________ renal failure is slow, progressive, and ir-reversible.

ANSWER: Acute, chronic

214. _________ % of the renal tissue can adequately perform all excretory and regulatory functions of the kidney.

ANSWER: twenty-five

215. _______________ is the inability to prevent the discharge of urine.

ANSWER: urinary incontinence216. Two means by which substances can enter the renal tubules are

_________ and _________. Two means by which substances can leave the kidney tubules are __________ and __________.

ANSWER: glomerular filtration, tubular secretion, tubular reabsorption, urine excretion

217. Body fluids are ________ at 300 mosm/liter.

ANSWER: isotonic

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218. The micturition reflex is initiated by stimulating ________ receptors in the bladder.

ANSWER: stretch

219. The micturition reflex center is located in the __________ region of the spinal cord.

ANSWER: sacral*

Matching

220. Match renal function with correct characteristic.(a) movement of substances from the peritubular capillary blood into the

tubular lumen(b) movement of substances from the glomerular capillary blood into the

tubular lumen(c) everything filtered or secreted that is not subsequently reabsorbed(d) movement of substances from the tubular lumen into the peritubular

capillary blood_____ glomerular filtration _____ tubular reabsorption _____ tubular secretion_____ urine excretion

ANSWER: b, d, a, c

221. Match the correct statement about sodium reabsorption.(a) sodium reabsorption in the distal and collecting tubules (b) sodium reabsorption in the proximal tubule (c) sodium reabsorption coupled with chloride reabsorption in the loop of

Henle

_____ Plays a pivotal role in the reabsorption of glucose, amino acids, H2O, Cl-, and urea._____ Is subject to hormonal control.

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_____ Plays a critical role in the kidneys' ability to produce urine of varying concentrations and volumes._____ Is important in the regulation of ECF volume.

_____ Represents 67% of Na+ reabsorbed.



ANSWER: b, a, c, a, b, c, a

222. Match renal structure or activity with correct characteristic.(a) Collecting tubules empty into this structure.(b) Stores the urine.(c) Passage of substances from the peritubular into the tubular lumen.(d) Carries blood to the glomerulus.(e) Tuft of capillaries that forms the filtrate.(f) Passage of protein-free plasma into Bowman's capsule.(g) Urine is forced through this structure by peristalsis.(h) Collects the glomerular filtrate. (i) Passage of substances from the tubular lumen into the peritubular capil-

laries.(j) Functional unit of the kidney.(k) Supplies the renal tissue with O2 and nutrients.(l) Carries blood from one capillary network to another capillary network.(m) Tube through which urine leaves the body.(n) Variable water and sodium reabsorption occur here under hormonal con-

trol.(o) Responsible for the vertical osmotic gradient in the medulla of the kid-

ney.(p) Glucose and amino acid reabsorption occur here.

____ afferent arteriole ____ renal pelvis ____ tubular reabsorption ____ tubular secretion ____ glomerular filtration ____ distal and collecting capillaries tubules ____ Bowman's capsule

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____ peritubular capillary ____ ureter ____ proximal tubule ____ loop of Henle ____ urethra____ efferent arteriole ____ urinary bladder ____ glomerulus ____ nephron

ANSWER: d, a, i, c, f, n, h, k, g, p, o, m, l, b, e, j

223. Indicate whether the first item in the statement increases, decreases, or has no effect on the second item by filling in the appropriate letter us-ing the following answer code.

(a) increases(b) decreases(c) has no effect on

Increased osmolarity of body fluids _____ vasopressin secretion.Decreased vasopressin secretion _____ H2O reabsorption.

Decreased Na+ in body fluids (Na+ depletion) _____ renin secretion.Increased renin secretion _____ angiotensin I activation.Increased vasopressin secretion _____ urinary output.Increased angiotensin II activation _____ aldosterone secretion.

Increased aldosterone secretion _____ Na+ reabsorption.

Increased vasopressin secretion _____ Na+ reabsorption.

ANSWER: a, b, a, a, b, a, a, c

224. Indicate which substance in the top column undergoes the process in the lower column by writing the appropriate letter in the blank.

(a) K+

(b) glucose(c) inulin(d) plasma protein(e) urea

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(f) H+

_____ Filtered and actively reabsorbed but not secreted_____ Filtered and passively reabsorbed. _____ Filtered and secreted, but not reabsorbed. _____ Filtered and both actively re-absorbed and actively secreted._____ Filtered but not reabsorbed or secreted._____ Not filtered.

ANSWER: b, e, f, a, c, d

225. Match urinary system feature with correct characteristic.

(a) urea(b) creatinine(c) uric acid(d) Na+

(e) glucose

_____ reabsorbed when H+ is secreted_____ a nitrogen waste product from RNA metabolism_____ a detoxified ammonia compound _____ protein metabolite of skeletal muscle tissue_____ reabsorbed actively and passively

ANSWER: d, c, a, b, e

226. Indicate whether the factor in question would ultimately lead to an in-

crease, or a decrease in Na+ reabsorption by means of the renin-an-giotensin-aldosterone mechanism.

(a) an increase in Na+ reabsorption

(b) a decrease in Na+ reabsorption

_____ a precipitous fall in arterial blood pressure as during hemor-rhage

_____ a reduction in total Na+ load in the body

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_____ a reduction in ECF volume

ANSWER: a, a, a

227. Match chemicals below with the correct characteristic.(a) renin(b) angiotensinogen(c) angiotensin I(d) angiotensin II(e) aldosterone(f) atrial natriuretic peptide

_____ Directly stimulates Na+ reabsorption by the distal and collect-ing tubules.

_____ Is acted upon by renin. _____ Is secreted by the adrenal cortex. _____ Is produced by the liver._____ Is acted upon by converting enzyme._____ Its secretion is directly stimulated by angiotensin II.

_____ Stimulates K+ secretion by the distal and collecting tubules._____ Is secreted from the granular cells of the renal juxtaglomerular

apparatus.

_____ It inhibits Na+ reabsorption by the renal tubules.

_____ Its secretion is directly stimulated by a low plasma K+ concen-tration.

_____ Is a potent constrictor of arterioles.

ANSWER: e, b, e, b, c, e, e, a, f, e, d

228. Indicate whether the portion of the tubule in question is permeable or impermeable to the substance in question using the following answer code:

(a) permeable(b) impermeable

The ascending limb of Henle's loop is ______ to H2O.

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The descending limb of Henle's loop is ______ to H2O.The vasa recta is ______ to salt and ______ to H2O.The distal and collecting tubules in the absence of vasopressin are ______ to H2O.The distal and collecting tubules in the presence of vasopressin are ______ to H2O.

ANSWER: b; a; a, a; b; a

Essay Questions

1. Explain how glomerular filtration rate is regulated.

2. Describe the mechanisms by which the kidney produces concentrated urine.

3. Compare and contrast renal actions at the proximal and distal tubule.

4. Describe micturition in an adult and baby.

5. What are the pathological effects of renal failure?

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For notes

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For notes

150

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Particular problems of physiologyЧастные вопросы физиологии

Guide book. Practical manual in normal physiologyРуководство к практическим занятиям по нормальной физиологии

Под редакцией академика РАМНВ. И. Петрова

Ответственный редактор — Клаучек Сергей Всеволодович

Дизайн — Кудрин Р. А.Вёрстка — Кудрин Р. А.

Подписано в печать 29.06.2012.Формат 60х84 1/16. Печать офсетная.

Усл. печ. л. 8,8. Тираж 200 экз. Заказ 681.

Отпечатано в типографии издательства ООО «Принт».400120, Волгоград, ул. Кузнецкая, 71а

Тел./факс: +7 (8442) 94-44-80, 93-13-53.

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0991781 2CE74 Klauchek s v Lifanova e v Et Al Particular Problems of Physi