4. Describe the different processes that provide ATP within the muscles for intense exercise of short duration and for endurance exercise.

Please give a detailed answer. Add supportive equation if possible.

3. Describe the control of cardiovascular function during exercise including local control, the metaboreflex, central control and baroreceptor resetting.

Please give a detailed answer. Add supportive equations if possible.

1. Explain why the HCO3VCO2 buffering system is so effective in controlling the pH of the extracellular solution. Include in your answer the role of haemoglobin in buffering of the H+ ions derived from CO2 in the blood.

Please give a detailed explanation. Add supportive equations if possible.

Drinking a glass of water, or drinking anything, seems like such a simple, voluntary movement. Yet, it involves so much muscle and nerve interaction. Can you go into some detail on the nerves that are involved. How about the cranial nerve that allows us to swallow?

18a. Define the following:

Homeostasis

Set point.

20b. State the mechanism of optimization using the terms stimulus, receptor, control center, effector, and response in your answer.

30f. State the function of goblet cells and whether they are endocrine or exocrine glands.

31b. Explain why the answer in 31a makes epithelial tissue structurally ideal for creating barriers.

31c. State the name of the extracellular matrix of epithelial tissue.

31d. State the function of 31c.

31e. State what forms 31c.

32a. Define the location of the apical, lateral, and basal portions of epithelial cells.

32b. State within which portion of 3a you would find cilia or microvilli.

32c. State the difference between cilia and microvilli in terms of function.

32d. State on which portion of 3a you would find cell-to-cell junctions be located.

32e. State which portion of 3a touches the basement membrane.

34a. Define regeneration/renewal and explain the functional significance of renewal to epithelial tissue.

35a. Explain the difference between simple and stratified epithelium in terms of structure and function.

35b. Explain the difference between simple squamous and simple cuboidal/columnar epithelium in terms of structure and function.

36a. Explain the difference between keratinized versus non-keratinized stratified squamous in terms of structure and function.

Case 4

Seth Johnson is a 54 year old college physics professor with a history of coronary artery disease who was admitted to the hospital for increasing lower extremity edema, abdominal swelling, and shortness of breath. Professor Johnson noted a 30-pound weight gain over the past month, and during the past week he has had three-pillow orthopnea.

Professor Johnson is in moderate respiratory distress in the hospital. His skin is cool, pale, and clammy. His pulse is 95, irregular, and weak. His respirations are 28, regular, adequate volume, labored, with bilateral rales. His blood pressure is 140/80. His abdomen is enlarged, and lower extremities are remarkable for pitting edema. His physician orders laboratory tests, results are as follows:

Plasma Na+: 133 mEq/L (normal 136-140 mEq/L) Plasma K+: 6.0 mEq/L (normal 3.5-5.3 mEq/L)
Plasma Cl-: 93 mEq/L (normal 98-108 mEq/L)
Plasma HCO3-: 16 mEq/L (normal 24 mEq/L)
Plasma Creatinine: 3.7 mg/dLL (normal 0.7-1.5 mg/dL) Plasma PO43-: 6.8 mg/dL (normal 2.7-4.5 mg/dL)

pCO2: 36 mmHg (normal 40 mmHg)
Blood urea nitrogen: 101 mg/dL (normal 7-22 mg/dL) pH: 7.25
SpO2: 96%

Upon evaluation of the findings, Professor Johnson’s physician diagnoses him with both congestive heart failure and acute renal failure.

Questions:

14.Discuss Professor Johnson’s signs and symptoms in the context of his diagnoses (edema, weight gain, skin, pulse, respiration, shortness of breath, blood pressure).

15.Discuss Professor Johnson’s electrolyte levels in the context of his diagnoses (Na+ K+ PO43-). Why are these findings common in acute renal failure? When a health care practitioner reads these values, what might they expect in terms of his behavior or ability to move? (Hint for PO43-: it binds with calcium, so the effects of high phosphate are similar to those of low calcium)

16.Why are congestive heart failure and renal failure often found together?

17.Which acid-base disorder does he have? What caused it? What is the compensation? (identify laboratory values)

Case 5

Daniel Purcel was diagnosed with type 1 diabetes mellitus when he was 12 years old. He is now a nursing student. He has managed to control his diabetes throughout school. However, when he began his clinicals, his regular schedule of meals and insulin injections was completely disrupted. One morning, Daniel completely forgot to take his insulin. At 7am he drank orange juice and ate two doughnuts. At 8am he drank more juice because he was very thirsty. He mentioned to a fellow student that he felt confused, weak, and that his heart was racing. At 9:06 am, he fell unconscious. He was transferred immediately to the emergency room, where the following information was obtained:

Blood pressure: 90/40
Pulse: 130, regular, strong
Respirations: 32, regular rhythm, deep, labored (“Kussmaul”) Plasma glucose: 560 mg/dL (normal fasting 70-110 mg/dL) Plasma HCO3-: 8 mEq/L (normal 24 mEq/L)
Plasma ketones: ++ (normal none)
Arterial PO2: 112 mmHg (normal 100 mmHg)
Arterial PCO2: 20 mmHg (normal 40 mmHg)
Arterial pH: 7.22

The physician determined that Daniel was in diabetic ketoacidosis. He was given an intravenous infusion of isotonic saline and insulin. Later, after his blood glucose had decreased to 175 mg/dL, glucose was added to the infusion. Daniel stayed in the hospital overnight. By the next morning, his blood glucose, electrolytes, and blood gas values were normal.

Questions:

18.Which acid-base disorder did Daniel have? What caused it? Why did he present with Kussmaul respirations? Explain these all in the context of the laboratory test results.

19.How did Daniel’s failure to take insulin cause this acid-base disorder?

20.Explain Daniel’s thirst, low blood pressure, tachycardia, confusion, and weakness.

21.Explain the basis for the treatments provided (saline, insulin, and glucose).

Case 6

Ross Adams is a 17 year old football player in high school. While walking to the sideline, Ross took off his helmet and appeared confused. Falling to his knees, he began to vomit. He complained of severe head pain, nausea, and vertigo. His coach called 911.

When the EMTs arrived, he was alert and oriented. The EMTs asked whether he had fallen or been hit on the head, and he reported that he was hit a couple times over the last couple days, but not in the last few minutes. His skin was pale, cool, and moist. His pulse was 54, regular, and strong. His respiration was 16, abnormal rhythm, shallow, and labored. His blood pressure was 157/102 mmHg. His right pupil was 5mm and nonreactive to light, and his left pupil was 3mm and minimally reactive. Recognizing the signs of increased intracranial pressure, the EMTs immediately transported him to the nearest emergency department.

Upon arrival at the emergency department, he vomited again. His blood pressure was 200/100 mmHg and his pulse was 48. His reflexes were intact. A nurse administered mannitol 1g/kg rapidly by intravenous push.

A CT image of the brain revealed an acute 1.3 cm subdural hematoma in the left hemisphere. At this point, Ross became unresponsive. He was taken to the operating room for an emergent craniectomy and decompression.

Questions:

22.Which of the signs and symptoms indicated that Ross had increased intracranial pressure? For each, why?

23.Why did Ross’s blood pressure continue to rise?

24.Why was mannitol administered? What does it accomplish and how does it work?

25.How does a subdural hematoma compare with an epidural hematoma, a subarachnoid hemorrhage, or intracerebral hemorrhage in terms of cause and manifestation?

Case 1

Cindy Brown is a 80 year old widow who was brought into the emergency room one evening by her brother. Early in the day, Mrs. Brown had seen bright red blood in her stool. She continued with her daily activities: she cleaned her house in the morning, had lunch with her daughter, and volunteered at the local library. However, the bleeding continued all day, and she started feeling light-headed. By dinnertime she decided to ask her brother for help. Mrs. Brown does not smoke or drink alcoholic beverages. She takes aspirin, as needed, for arthritis.

In the emergency room, Mrs. Brown is confused and anxious. Her skin is pale, cool, and moist. Her pulse is 116, regular, and weak. Her respirations are 22, regular, normal volume, and unlabored. Her blood pressure is 90/60 supine. The nurse takes a standing blood pressure as well, and it is 75/45. Her hematocrit is 29%.

A colonoscopy shows that the bleeding came from a herniation in the colonic wall. Mrs. Brown’s physician orders a normal saline infusion, which the nurse starts, and a blood sample to be drawn to be typed to prepare for a blood transfusion. Mrs. Brown receives two units of whole blood, and is admitted for observation. She is instructed not to take aspirin.

Questions:

1. Describe the body’s sequence of events that led to Mrs. Brown becoming light-headed and needing to seek help.

2. Discuss the physiological reason for each of the signs that you assessed (skin, pulse, respiration, blood pressure, hematocrit).

3. Discuss the rationale behind each of the treatments provided (normal saline, blood transfusion, no aspirin).

4. Had her blood loss been more severe, Mrs. Brown might have received a low dose of dopamine. Why is low-dose dopamine helpful in the treatment of hypovolemic shock?

Module 1 Case

This case was written by David A. Sandmire, MD and was edited for content for use in this class.

Chief Complaint: 8-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house.

History: A 13-year-old female was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns and excessive smoke inhalation.

In the emergency room, the patient was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU).

The patient regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.

The patient began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

Questions:

1. Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?

1. What are differences between connective and epithelial tissues?
2. What is a similarity between nervous and muscle tissues?

Identify four places on your body that each exemplify one of the four different types of human body tissue. What part of your body do you associate with what kind of tissue?

1. What in an antigen?

2. What are the main differences between innate and adaptive immunity?

3. What are the three lines of defense? State their function and give examples of each one.

4. What is humoral immunity? Which cells are involved in humoral immunity?

5. What is an antibody? Which cell produces it?

6. What is cell-mediated immunity?

Case 1

A 26-year-old female complained of severe, dull, aching pain, and cramping in the lower abdomen. There were no other physical findings. A laparoscopy revealed the presence of ectopic endometrial tissue on the uterine wall and ovaries. Danazol (a synthetic androgen and inhibitor of gonadotropins), 600 mg/day, was prescribed for up to nine months to inhibit ovulation, suppress the growth of the abnormal endometrial tissue, and achieve appreciable symptomatic relief, with a 30% possibility of conception after withdrawal of the therapy.

• What is this condition called?
• What causes it?
• Why do you think oral hormonal contraceptives could also be used as a treatment – how can they help reduce the patients pain?
• Hormonal contraceptive therapy is also used to prevent pregnancy. Describe three ways oral contraceptive pills can prevent fertilization and pregnancy.

Case 2

A 67-year-old retired male went to his doctor, complaining initially of leg pain that started in his lower back, which then radiated down across the side of his thigh and over the front of his knee. Subsequently, he developed pain that radiated from his back to his front at two different levels: at the chest through the level of his nipples and also at the umbilicus.

His physician performed a history and physical, followed by laboratory tests. He discovered a hard nodule on his prostate and an elevation in several of the blood tests. His PSA (prostate specific antigen), an enzyme secreted by normal prostate tissue (0-4 ng/ml) was 450. Alkaline phosphatase was also elevated at 157 U/L, an indication of bone involvement.

A bone scan was ordered to visualize the bone involvement. (This test uses a calcium analogue attached to a radioactive tag. A special scanner can pick up images of this radioactivity and create an anatomical picture of the skeletal system. The radiation shows up as black spots on the film.)

Usually prostate cancer's growth is initially influenced by the presence of testosterone. If testosterone is removed by castration, the cancer will often shrink for some period of time before the remaining fraction of testosterone-independent cancer cells grow.

This gentleman was not interested in castration and asked if there was another way to treat this. He was treated was a single shot of a drug which is slowly released into the body over a three month time period. Within that time the patient noticed marked relief in his pain.

• What is the diagnosis of this gentleman?
• Why would the scan show bone abnormalities?
• Which endocrine organs are responsible for serum (blood) calcium levels?
• Describe a mechanism by which a drug could act on the anterior pituitary to lower the testosterone level in the human body.

actions of these muscles

Muscle                                       origin                                          insertion                            action