1. Extreme challenges to an animal’s physiology allow us to explore and better understand the function of systems in the body.   Please address the following questions regarding the initial reflexive changes (before acclimatization) that occur in response to ascent to altitude.

1. Outline the initial global reflexes that occur in response to the low PO₂ at high altitude. Be sure to include all components of the reflex arcs for cardiovascular and respiratory systems.

1. Compare these global reflexes to local reflexes occurring in the lungs.

How do the global and local reflexes address the optimization of the ventilation : perfusion ratio (keeping it close to 1)

Describe the mechanisms for providing energy to the skeletal muscle cell during exercise (immediate, short-term, etc.).

If a cell has muscarinic cholinergic receptors, you know it is NOT

a. smooth muscle.

b. skeletal muscle.

c. an endocrine gland.

d. cardiac muscle.

e. an adipose cell

A. A patient has a tidal volume of 800cc, his dead space volume is 150cc. What is the volume of gas that is involved in gas exchange at the alveolar level during each breath? Please show all work.

B. What problem might a person with a respiratory disorder encounter while traveling via airplane that has an air pressure equivalent to an altitude of 8000 feet?

Case Scenario

Mrs Lee is a 60 years old woman. She is the housewife and lives with his husband and son in the public estate. Last week, she went to the wet market for buying food and groceries. She slipped fall on the street. Her right upper arm and armpit region were hit on the kerb. She went home and massage the armpit and upper arm immediately with massage oil. However pain over upper arm and armpit were still. At evening severe bruising was noted over upper arm and also the axilla. Mrs Lee was admitted to A&E department. She complaint numb over upper arm and could not move her wrist. Her X-ray indicated fractures over proximal part of humerus and she was sent to the ward for further treatment. The examination showed that her shoulder movement was limited due to pain elicited and muscle weakness. Numbness was also noted over upper arm, forearm and dorsum of the right hand. Sensory test showed that diminished sensation, only pain sensation was intact. She had weakness in wrist movement. Right hand grip was normal.

Please answer according to the following guidance:

1. According to Mrs Lee condition, please indicate the structures that were involved in this accident?

a) List out the fracture sites along the humerus with Mrs Lee presentation and the bony landmarks.

b) List out the artery (arteries) and vein (veins) involved in this accident

c) List out the nerve (nerves) that would be involved in this accident

2. What is/are movement limitation that Mrs Lee would come across and please explain the reason underneath.

3. Please describe the sensation issue of Mrs Lee and explain the type/mode of injury resulting in present condition.

In what ways is a phagocyte a tiny container of disinfectants?

A mother brings her three-year-old son into the emergency room of a local hospital. The boy is crying hysterically. The mother says that earlier that day the boy was playing in the back yard with his older sisters. He had gone over to pick a rose off of a rosebush when he suddenly started screaming and crying. There is a region of swelling and redness on his arm and the doctor who examines him says that it looks like the boy was stung by a bee. On physical examination, he is afebrile, with a heart rate of 102 bpm, blood pressure of 90/62 mm Hg, and respiratory rate of 24 breaths per minute and has difficulty breathing. The doctor says that the boy appears to be having a severe allergic reaction to the sting, and he treats him with SC Epinephrine. The mother asks why her son’s arm is swollen and the Dr. says it is because of fluid accumulation.

1. Describe the process of inflammation that might have led to swelling? 2. Enumerate the mediators of pain, edema, and redness? 3. Describe the vascular and cellular changes during inflammation? 4. Mention the type of shock the child is presented with and Why epinephrine is an ideal choice in this setting and elaborate its mechanism of action? 5. Plot the Drug response curve (DRC) of Epinephrine (Agonist) with and without the presence of Beta-blocker (antagonist). 6. What type of hypersensitivity reaction is seen in this child? This type of hypersensitivity reaction is due to the crosslinking of which immunoglobulin on mast cell surfaces? 7. Which cytokines promote class switching of B lymphocytes to IgE?

Case Scenario

Mr. Chan (40 years old) is a computer programmer and needs to spend long periods on computer work during daily work. He went to the clinic and complaint that he has neck pain over the past two months. He also had the feeling of pain and numbness radiate from the neck into the right shoulder and right arm, and numbness over his thumb. Physical examination revealed pain and numbness was mainly over right deltoid and biceps brachii muscles, and over the lateral side of the thumb. Report from the magnetic resonance imaging showed that the spinal canal in his cervical vertebral column was narrowed. After initial management, the doctor sent Mr. Chan to your team for further follow up. Your supervisor told you to give Mr. Chan an introduction of the spinal structure at neck region.

Please answer according to the following guidance:

1. List the name and numbers of vertebral column in 5 regions. Compare and contrast three main characteristics of typical cervical vertebra, thoracic vertebra, and lumbar vertebra.

2. How does the intervertebral foramen formed and what contents can be found in the vertebral canal?

3. How many cervical spine nerves do we have? When a cervical spinal nerve exits the spinal cord through the intervertebral foramen, what’s the relationship of this nerve with its corresponding vertebra? How about the relationship of the spinal nerves in thoracic and lumbar regions with their corresponding vertebrae?

4. In Mr. Chan’s case, name the nerve roots which were compressed that resulted in the pain and numbness. State the reasons that support your answer.

Draw a diagram that illustrates lipid digestion and absorption, make sure you include where these steps are occurring and the important role of bile! Make sure it is clearly labeled and include a brief description for any sequences and processes.

2. Compare and contrast the physiology occurring at the respiratory membrane of the alveoli with that of the filtration membrane of the renal corpuscle. You can highlight their anatomical similarities and differences, but your entire answer should be directed at physiological processes and functions.

A person eats a grapefruit and drinks a large cup of coffee AND a cup of orange juice for breakfast (I guess they were thirsty). All these items are acidic! How will the respiratory and renal systems respond? Include a description of how the respiratory system detects the error signal and activates its response.

How blood changes as a result of moving through pulmonary capillaries compared to blood moving through the capillaries of the nephron? Need anatomical differences in the capillaries and/or capillary beds (pulmonary versus nephron), and physiological changes that blood experiences (ex: pH, respiratory gases,etc).

Case scenario

Mr. C, 50 years old, is an amateur soccer player who regularly plays with his friends over weekend. He has chronic anterior right hip pain and weakness over his groin region for 5 years. One day, when he was playing soccer, he was injured by another player who crushed on him from lateral side of his left leg. Then, he fell down on the grassland after twisting his left knee and ankle due to the crush. He started to feel pain and weakness over his left leg from knee to ankle. He could not move his left leg to stand up. When he fell down, he fell on the leg of that player which caused pain, swelling, numbness and weakness over the posterior side of his own left leg. Then, he was send to the emergency room of a nearby hospital. The doctor of the emergency room of the hospital assessed his legs and arranged X-ray check for him. Your supervisor asked you to identify all key anatomical structures in the initial assessment that are related to his hip, knee and ankle discomfort according to the above information. You need to provide clear rationale to support your answers when you report to your supervisor. Please answer according to the following guidance:

1. What nerve (nerves) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

2. What artery (arteries) and vein (veins) are involved in his problems mentioned above? Please list out accordingly and support with corresponding reasons.

3. What lower limb functional movements that can be affected according to his leg conditions? Why?