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

VOLGOGRAD STATE MEDICAL UNIVERSITY A STATE BUDGETARY EDUCATIONAL INSTITUTION FOR HIGHER PROFESSIONAL EDUCATION OF THE MINISTRY FORPUBLIC HEALTH AND SOCIAL DEVELOPMENT OF 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 Sciences, MD, Professor V. I. Petrov Reviewed by: V. F. Kirichuk Honored Worker of Science of RF, MD, Professor, Head of Human Physiology Department of Saratov State Medical University MD, Professor, Head of Normal Physiology Department of Stavropol State Medical Academy V. S. Nikolsky P 29 Particular problems of physiology. Guide book. Practical manual in normal physiology / S. V. Klauchek et al. – Volgograd: VolgSMU, 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-speaking medium of higher medical educational institutions. ISBN 978-5-94424-190-0 © Volgograd State Medical University © Klauchek S. V., Lifanova E. V., Khvastunova I. V., Kudrin R. A., Akhundova R. E., Doletsky A. N., Schmidt S. A. © Publishing House "Print", 2012 2 CONTENT Content Physiology of digestive system Practical class 1. Principles of alimentary processes regulation. Digestion in the mouth and in the stomach. Regulation of these processes 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. Physiology of the liver. Antitoxic function of the liver. Gastrointestinal hormones Practical class 3. Concluding class devoted to the themes “Metabolic rate and energy expenditure. Thermoregulation” “Food and nutrition. Vitamins”, “Physiology of the digestive system” (intermediate oral examination). Physiology of blood Practical class 1. Physical and chemical properties of the blood. Functions and composition of blood. Red blood cells Practical class 2. Cellular elements of blood. White blood cells. Platelets Practical class 3. Blood types. Hemostasis Physiology of respiratory system Practical class 1. Basic stages of respiration. External respiration Practical class 2. Regulation of respiration. Special aspects of respiration Practical class 3. Concluding class devoted to the themes “Physiology of blood system”, “Physiology of respiratory system” (intermediate oral examination) 3 3 5 5 14 18 22 22 28 33 38 38 48 58 Concluding class devoted to the themes “Water and electrolytes exchange”. Basics of hemodynamic Practical class 5. Properties of cardiac muscle Practical class 2. Circulation through special regions Practical class 6.Physiology of cardiovascular system Practical class 1. Regulation of vascular tone. Physiology of kidneys. Regulation of cardiac activity Practical class 4. “Physiology of kidneys. Water and electrolytes exchange Practical class 2. Concluding class devoted to the theme “Physiology of cardiovascular system” (intermediate oral examination) Physiology of excretion Practical class 1. Disorders of water and electrolytes exchange Practical class 3. Electrocardiography Practical class 3. Functional diagnostic of cardiac activity. Disorders of water and electrolytes exchange” (intermediate oral examination) Test questions 63 63 66 74 78 85 90 94 94 95 96 98 4 . Composition and functions of gastric juice and mechanism of secretion. 15. Questions for discussion 1. Salivary glands. 5 . Digestion in the mouth and in the stomach. Functional anatomy of stomach. Mouth and its role in digestion. 2. 10. 13. Control of gastric secretion. Gastric motility and emptying. The main items in the study of the physiology of the digestive system. Swallowing. 7. Elementary functional anatomic considerations. The essence of digestion and classification of digestive processes. Functions of stomach. Gastrointestinal tract reflexes. Regulation of gastric motility and emptying. Emotion and gastric secretion. Principles of alimentary processes regulation. Composition and functions of saliva. Four phases of gastric secretion. Digestion in stomach. Functional anatomy of the digestive system. 16.PHYSIOLOGY OF DIGESTIVE SYSTEM Practical class 1. 14. Nerve supply of the gastrointestinal tract (GIT). Functional anatomy of the salivary glands. 3. Physiology of digestion. Principles of regulation of alimentary processes. Some important cells in the gastric glands. aerophagia. 6. Mechanism and control of salivary secretion. intestinal gas). Motor disorders of the esophagus (achalasia. 11. 12. Physiological basis of hunger and satiety. Digestion in the mouth. 8. Lower esophageal sphincter. 4. Esophagus. Deglutition. 17. Regulation of these processes. 9. 5. Mastication. meat and milk. Objective: studying of advantages and disadvantages of some well known and traditional operations in digestive physiology. That. Books recommended 1. 6 . in this animal. Ganong W. Inc. 2. Practical work 1.Practical works 1.. Hall J. Splitting of starch by enzyme of the saliva. if a concomitant gastric fistula (which is a permanent hole made through the anterior abdominal wall and anterior wall of the stomach. McGraw-Hill Companies. 2001. during sham feeding the secretion of the stomach (psychic juice) can be collected through the fistula. Studying of operations on the animals used for researches of digestive functions. 1. F. food comes out through the wound and does not reach the stomach. B Saunders. C. W. 3. 472-480. – P. For example. Now. Guyton A. Textbook of Medical Physiology. so that the cavity of the stomach communicates with the exterior through the hole) be made various studies can be made. – P. vagotomy abolishes the psychic phase of gastric secretion can be shown. 12th ed. Technique. 2005. The esophagus is divided in the neck and the two ends are brought to the surface of the neck. 718-737. Studying of secretion of gastric juice on bread. Review of Medical Physiology. 2. when the animal feeds. Sham feeding . E. 12th ed. 453-462.. Studying of operations on the animals used for researches of digestive functions. In this animal. The pouch 7 . This is a pouch. cut out from the body of the stomach (fig. Pavlov pouch . that the psychic juice depends upon the presence of intact vagus nerves. Sham feeding.proving. Result: Conclusion: 2.) 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. This was devised by the great Russian physiologist Ivan Pavlov in 1898. Figure 1. Heidenhein pouch is a denerved pouch. Heidenhain pouch also communicates with the exterior by fistula and gastric secretions collected from it. Pavlov pouch. the pouch having no communication with the parent cavity. Result: Conclusion: 3. evokes secretion 8 . can be collected.however retains its nerve and blood supply intact. Presence of food. The pouch communicates with the exterior by a permanent fistula made through the anterior abdominal wall. Figure 2. Thus. particularly the partially digested protein in the original portion of stomach. gastric juice which is secreted as a result of stimulus by food and yet is not contaminated by food. Food may be eaten and it will be seen now that the pouch is also secreting. . Heidenhain pouch. it is a chemical (gastrin) coming via the arterial supply to the Heidenhain pouch. e.from this (Heidenhein) pouch. histamine or pentagastrin can evoke secretion in a Heidenhain pouch. The secretion of the pouch is uncontaminated by the food. i. (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. 9 . Similarly. Figure 3. Comparative characteristic of Pavlov pouch and Heidenhein pouch. (A) – Innervated Pavlov pouch. Amylolysis by the enzyme of saliva. 10 .Figure 4. (C) This shows Heidenhein pouch during operation. Result: Conclusion: Practical work 2. (D) – This shows cannula position at the end of operation. (B) Vagally denervated Heidenhein pouch. Remember that amylase of saliva acts only on boiled starch. Qualitative reaction on starch Conclusion test2. put 1 ml of well boiled saliva into the third one. 1. There is no staining in the second testtube. heat it and indicate brown staining in the second test-tube (reaction on saccharides). 2. Put the test-tubes into the thermostat with the temperature 37-38° for 5-10 min. 6 ml of boiled starch 6 ml of boiled starch 1 ml of distilled water 1 ml of saliva 1. Qualitative reaction on starch: put 1-2 drops of fluid iodine solution into the examined liquid. put 1 ml of saliva into the second and fourth. Write down the results and make a conclusion. 2. make qualitative reactions on starch and saccharides. 2. You can see blue staining in the first. Technique. Result: № of Mixed components 1. third and fourth test-tubes. 11 . it indicates the existence of the starch. Take 4 test-tubes.Objective: prove that amylase of saliva split the starch to saccharides (dextrins and maltose) under body temperature. Qualitative reactions on saccharides: put 3 ml 10 % NaOH and 1 ml 1% CuS04 into the test-tubes with the examined liquid. Qualitative reactions on tube glucose 1. Divide the contents of test-tubes into two portions. put 6 ml of raw starch into the fourth test-tube. Put 1 ml of distilled water into the first test-tube. put 6 ml of 1 % boiled starch into 3 of them. bread and milk. The secretion reaction of the stomach becomes apparent in the functional adaptation of gastric glands to various foods. Food is an adequate stimulus for gastric secretion. Objective: convince of the adaptive nature of the gastric gland secretion. 2. Technique: using tables and 3 crayons make 2 graphs: curves of the gastric juice secretion and its digestion volume using equal quantity of meat.3. bread and milk. duration. 4. bread and milk for food (quantity. Albuminous food is the most effective secretion agent. Individual adaptation of the secretory apparatus of the stomach to different food depends on the quality of food product. Conclusion: Practical work 3. meat and milk. maximum secretion by the hour). acidity. 6 ml of boiled starch 6 ml of unboiled starch 1 ml of boiled saliva 1 ml of saliva 1. 2. Proteins and products of their digestion have the most strong 12 . Analysis of curves of the gastric juice secretion on meat. 1. Determine what are the differences between the gastric juice secretion and its digestion volume using meat. Studying the gastric juice secretion on bread. its quantity and dietary habits. Thus you can see the indexes of gastric juice secretion on meat.secretion effect. then it decreases steeply and then it keeps at the same level for a long time. increase of acidity and digestion volume of the gastric juice. Prolonged carbohydrate diet decrease acidity and digestion volume of the gastric juice. INDEX/LEVEL MAXIMUM MEDIUM Bread Meat Milk Meat MINIMUM Milk Milk Bread Milk Quantity of the gastric Meat juice Prolongation of secretion Acidity of the gastric juice Digestion volume Bread Meat Bread 13 . bread and milk. Prolonged meat diet leads to the increase of the gastric secretion on all food stimuli. The strong secretion of the gastric juice starts by the second hour after eating meat. Carbohydrate food (bread) – is the most weak secretion agent. Prolonged fat diet increases the gastric secretion on food stimulus due to the second stage. 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. 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. that is why the peak of gastric secretion is seen by the first hour (reflex secretion). There are a few chemical agents of secretion in the bread. Antitoxic function of the liver. 14 . Gastrointestinal hormones. Intestinal motility and its regulation. Digestion in the large intestine. Physiology of the liver. Digestion in the small intestine. Result: Conclusion: Practical class 2. Bile.Write down the results and make a conclusion about the dependence of the quantity of the gastric juice. its composition and participation in digestion. its acidity and proteolytic activity on quantity and consistence of eaten food. 5. Digestion and absorption of carbohydrate. Control of secretion and control of excretion. 6. 9. Synthesis of plasma proteins. Regulation of biliary secretion. Functions of the gallbladder. 20. 4. Anatomic considerations of the colon. 11. 10. 17. 13. 18. Secretion and excretion of bile. 19. Digestion in the large intestine. Composition and function of pancreatic juice. 16. 21. 14. 12. 22. Succus entericus: (i) composition and its functions. Functions of gall bladder. Functions of the liver. Microflora of the large intestine. Functions of bile. Digestive and absorptive functions of the small intestine. protein and fat. Movements of the large intestine. Anatomic considerations of the liver. Absorption of water. Motility and secretion of the colon. Functional anatomy of the liver and the biliary tract. Anatomic considerations of the small intestine. Other substances excreted via bile. Cavital and membrane hydrolysis of nutrients in the small intestine. Functions of the liver. Mechanism of secretion of pancreatic juice. 7. Composition and properties of bile. 3. 8. Jaundice. 2. Gallstones. 15 .Questions for discussion 1. 15. Control of secretion of pancreatic juice. Movements of the small intestine. Defecation. Composition of liver bile and gall bladder bile. Other substances conjugated by glucuronyl transferase. minerals and vitamins. Antitoxic function of the liver. Bilirubin metabolism and excretion. Bile. Visualizing the gallbladder. (ii) control of succus entericus secretion. The effects of cholecystectomy. Ganong W.. Blind loop syndrome.int the sixth test-tube. J. C. Intestinal bacteria. Defecation. weak hydrochloric acid (0. Inc. Put the second test-tube into the bottle with ice. Then 16 . Technique. carbohydrates. 2. 12th ed. Mechanisms of absorption of proteins. E. McGraw-Hill Companies. Practical works 1. Digestion of protein by gastric juice. F. 27. Constipation. Megacolon. Dietary fiber.5 %) . Objective: determine the optimality conditions of pepsin action. Absorption in the colon. – P. 28. W. A. Textbook of Medical Physiology. 481-496. and the others – into thermostat with the temperature 37-40° C for 40 min. the solution of pepsin in soda – into the fifth test-tube. Hall.Small intestinal and colon transit time. 23. Bile action on the fats. Review of Medical Physiology. 25. 2001. Guyton. Books recommended 1. Digestion of protein by the gastric juice.. Feces. The effects of colectomy. 2. 738-769.B Saunders. the solution of pepsin in water – into the fourth testtube. boiled gastric juice – into the third test-tube. put into 6 test-tubes equal quantity of cut frog's muscle (fibrin). 12th ed. Then put the gastric juice in the first and in the second test-tubes. 24. – P. Practical work 1. 26. 2005. lipids in the colon. Diarrhea. Protein. 2 ml of the solution of pepsin in water 5. 40 min. 2 ml of 0. Protein. (thermostat) -1-0° C. Write down the results and make a conclusion about the optimally conditions of pepsin action. (thermostat) 37-40° C. Protein. Complete the table. 2 ml of the solution of pepsin in soda 6. 2 ml of the gastric juice 2. 40 min. 40 min. 40 min. You'll see blue and violet staining if there are proteins in the solution. Products of protein digestion – albumose and peptones – give red staining. Protein. 40 min. (thermostat) 37-40° C. Protein. 2 ml of the boiled gastric juice 4. Bile action on the fats. (bottle with ice) 37-40° C. 17 . (thermostat) Biuret test Conclusion Conclusion: Practical work 2. Protein. Result: № of Mixed compounds testtube 1.5 % hydrochloric acid Conditions of carrying out the experiment 37-40° C. Put 10 drops of caustic soda and 5 drops of blue vitriol to the solution. 40 min.take out the test-tubes and carry out the Biuret test. 2 ml of the gastric juice 3. (thermostat) 37-40° C. Concluding class devoted to the themes “Metabolic rate and energy expenditure. Thermoregulation”.Objective: get acquainted with the bile action on fat filtration and emulsification. Fat filtrates rather quickly through the filter moisten with bile. Vitamins”. Write down the results and make a conclusion. Methods for determining metabolic rate: (a) direct calorimetry. You'll get trice emulsion. put in the funnels. Questions for discussion (Metabolic rate and energy expenditure. moisten with bile (the first one) and with water (the second filter). “Food and nutrition. (b) indirect calorimetry: (i) respiratory quotient. 0. Results: Conclusion: Practical class 3. (ii) energy equivalent of utilized oxygen. Put the funnels into the vials and pour fats into them.5 ml of soft oil and 1 ml of water into the third vial. Technique: filters. and doesn't go through the second filter. Put 3 ml of bile. Bomb calorimeter and calorific values of different items of food. shake it up thoroughly. “Physiology of the digestive system” (intermediate oral examination). (iii) Bene18 . Thermoregulation) 1. 5. (iv) applied physiology. Balanced diet. Control of gastric secretion. Mechanism of thermoregulation in a hot environment. 7. Classification. (ii) normal values. pyrogens. 2. Functional anatomy of the stomach. (iv) open circuit method. 4. Basal metabolic rate: (i) definition. Vitamins and its significance in nutrition. Composition and functions of saliva. (iii) factors determining metabolic rate.2. 3. heat exhaustion. Mechanism and control of salivary secretion. Gastrointestinal reflexes. Applied physiology. 4. Normal body temperature. 19 1. role of vitamins. Sources of heat & channels of heat loss. Functional anatomy of the salivary glands. 2. dict-Roth spirometer (close circuit method). Importance of food. Nerve supply of the gastrointestinal tract (GIT). Vitamins. 3. . hypothermia. Values of metabolic rate. Composition and functions of gastric juice and mechanism of gastric secretion. Questions for discussion (Physiology of the digestive system) Study of the physiology of the digestive system. Applied physiology: fever. Questions for discussion (Food and nutrition. Vitamins) 1. 6. antipyretics. Some common foods. Dietary standards for man. 5. Mechanism of thermoregulation in exposure to cold. 3. Principles of dietetics. heat stroke. Applied physiology. Importance of thermoregulation. 6. Mechanism and control of salivary secretion. 9. HCl secretion. Four phases of gastric secretion. Control of secretion and control of excretion. Functions of HCl. Pepsinogen secretion. Emotion and gastric secretion. 20 . 10. Functional anatomy of the liver and the biliary tract. Some important cells in the gastric glands. Control of gastric secretion. 16. Composition and function of pancreatic juice. Digestive and absorptive functions of the small intestine. Composition and functions of saliva. Composition of liver bile and gall bladder bile. Functions of bile. 18. Digestion in the stomach. Regulation of gastric motility and emptying. Gastrointestinal hormones. Functional anatomy of the digestive system. 11. minerals and vitamins. aerophagia. Esophagus. 25. Functions of the stomach. Swallowing.8. Mechanism of pancreatic juice secretion. 20. proteins and fats. Motor disorders of the esophagus (achalasia. (ii) control of succus entericus secretion. digestion and absorption of carbohydrates. Composition and functions of gastric juice and mechanism of secretion. Other functions of the stomach. Peptic ulcer. 24. 14. 13. 21. 22. Control of pancreatic juice secretion. 23. Secretion and excretion of bile. Duccus entericus: (i) composition and its functions. 17. Lower esophageal sphincter. 19. intestinal gas). Absorption of water. 15. Regulation of gastric secretion. Salivary glands. Mouth and its role in digestion. Mastication. Functions of the gall bladder. 12. Gastric motility and emptying. Functional anatomy of the stomach. Mechanisms of absorption of proteins. Defecation. 28. carbohydrates. 36. 33. 37. Diarrhea. Mastication. Absorption in the colon. Effects of colectomy. Anatomic considerations of the colon. 30. Effects of cholecystectomy. 38. Movements of the large intestine. Adynamic ileus. 27. Small intestinal and colon transit time. Composition and properties of pancreatic juice. Intestinal bacteria. Anatomic considerations and functions of the liver. Malabsorption syndrome. Megacolon. Bile. Dietary fiber. 31. Motility and secretion of the colon. 21 . Visualizing the gallbladder. Composition and properties of bile. Regulation of intestinal secretion. 34. Functions of the gallbladder. 32. Constipation. Anatomic considerations of intestinal mucus. Anatomic considerations of the pancreas. Mechanical obstruction of the small intestine. 35. Regulation of pancreatic juice secretion. Regulation of biliary secretion. lipids. Gallstones. Defecation. Synthesis of plasma proteins. Feces. 29. Movements of the small intestine. Blind loop syndrome. Intestinal motility (characteristics of the types of contraction). Movements of the stomach. Deglutition.26. Erythrocyty sedimentation rate (ESR). Stages of development. features of chemical composition. Plasma proteins. 13. Physical and chemical properties of blood. Applied physiology. Determination of erythrocytes quantity. its determination. 18. Origin plasma proteins. its quantity. Specific gravity of blood. Hemolysis. Quantity of blood in human organism. Chemical structure. 5. Erythropoiesis. Questions for discussion 1. 3. Methods of hemoglobin quantity determination. its relative constancy. regulation of its constancy. 12. Reaction of Hb. 14. hemoglobin compounds. Red cells fragility. Hemoglobin chemistry and synthesis. Functions of blood. 15. 11. Catabolism of Hb. Factors required for synthesis of Hb. their spectral analysis. Viscosity of blood. Hemoglobin. Osmotic resistance of erythrocytes. Abnormalities of Hb production. functions. 9. 22 . 4. 10. Blood composition. 8. Importance of erythropoiesis. Red blood cells. 16. their structure. Hypoproteinemia. composition. Physiological blood-replaceable solutions. methods of its determination. 7. Osmotic pressure of blood. 19. its physiological role. methods of its determination. Blood plasma. 17.PHYSIOLOGY OF BLOOD SYSTEM Practical class 1. Functions and composition of blood. Erythrocytes. 6. Types of hemolysis. 2. Inc. Easy movements of both hands thumbs grind in integumentary glass to the accounting chamber before appearance color newtonian rings.. 2005..02 ml. E. 2. that corresponds 0. 3. Determination of erythrocyte count in a sample of blood. Carefully mix. Books recommended 1. Determination of erythrocytes sedimentation rate. Dilution in the test-tube 1/200. Type by the pipette from the hemometer of Sali the prepared blood up to the mark. 1. Review of Medical Physiology. Hemoglobin in the fetus. Having wiped off end of a capillary by sponge (cotton wool) move the collected blood in the test-tube with a dilute solution. – P 382-390. W. Technique. J. Objective: acquaintance with a technique of calculation of erythrocytes’ number. 2. Determination of osmotic fragility of erythrocytes. B Saunders.85-1 % solution NaCl (physiological solution). 2001. 522-524. Hemolysis. The dilute liquid for erythrocytes is 0. 515-519. Hall. McGraw-Hill Companies. – P. 12th ed. F. Practical works Determination of erythrocyte count in a sample of blood. Practical work 1. 12th ed. 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 23 . Guyton. A. Ganong W. C.20. 4. Textbook of Medical Physiology. Column of blood should be integral and not contain vesicles of air. 499-500. In test-tube pour 4 ml of a dilute solution. Average number of erythrocytes in 1 L of blood in females (3.7) х 1012 /L. causing the beginning of erythrocytes hemolysis. in males (4. Knowing. i.e.1 mm between the central plate and integumentary glass. where Х – number of erythrocytes in 1 мм3 of blood. The liquid itself will fill in a chink by thickness of 0.plate of the chamber). Average quantity of erythrocytes in one small square A/80. 24 . that makes 80 small squares. Count up number of erythrocytes A in the large squares located on a diagonal. Make a conclusion. Put the chamber under the large increase of microscope and start calculation. as on the left and top border of square». multiple the found number by 4000 and by 200.0-5. During calculation it is necessary to be guided by the Egorov’s rule: «Concerning to given square those are counted erythrocytes. by dilution. Determination of osmotic fragility of erythrocytes. that volume of a part of the chamber above one small square is equal 1/4000 мм3. Objective: to determine concentration of NaCl solution. which lay as inside. Х = (A х 4000 х 200) /80.7-4.0) х 1012 /L. Result: Conclusion: Practical work 2. not taking out test-tubes from a support.8 % – in second etc. in each test-tube pour 5 ml of NaCl solution of decreasing concentration (0.4 0. % 0. mix and shake all test-tubes and place in a support according to numbers. transparent “laked” (“varnished”) blood. Up to 0.9 % in first test-tube.2 Coloring of received solution Erythrocytes sediment Conclusion Borders of stability In the column “conclusion” you need to note. examine their contents in light. In those test-tubes.3 0. In those test-tubes.2 %) In each test-tube with the help of pipette add 3 drops of blood without fibrinogen or citrate blood. which concentration of NaCl solution corresponds 25 . In an hour carefully. number them.5 0.7 0. the erythrocytes are not present. where has taken place partial hemolysis. In the column “borders of stability” note. 0.Technique. In those test-tubes.9 0. the division of contents into two layers has not taken place. the solution above erythrocytes sediment is painted in red color. Take 8 test-tubes. where hemolysis has not taken place. Results of the realized experiment arrange in to the following table: Concentrati on of NaCl solution. contents are divided into two layers: from above transparent colorless solution and below layer of erythrocytes. whether has taken place hemolysis in given test-tube and what is its character – complete or partial.6 0. where has taken place complete hemolysis.8 0. Thermal hemolysis. in which test-tubes has taken place complete or partial hemolysis. 1. Technique. Contents of the first test-tube appear opaque. 2. Objective: to get acquainted with various kinds of hemolysis. Both test-tubes put before a window or artificial light source (for example before electric lamp). In 30 minutes note. In each test-tube add 2-3 drops of blood without fibrinogen and mix and shake them. in one of them pour 5 ml of physiological solution. Conclusion: Practical work 3. on the contrary. transparent “varnish” (“laked”) blood. The heating to higher temperature can cause coagulation. Then in each test-tube add 4-5 drops of blood and mix well. Take test-tubes and number them. 3. In each test-tube pour 5 ml of physiological solution. then in first – 1 % solution of an acetic acid. Hemolosis. Chemical hemolysis. and in the second one. Pour in clean test-tube 10 ml of physiological solution and 1 ml of blood without fibrinogen. in second – 4-5 ml of ammonia solution. Take two test-tubes. Warm in hot-water heating at 600 C until hemolysis takes place. and in another the same quantity of aqua distillate.to minimal erythrocytes osmotic stability and which – maximal. 26 . Osmotic hemolysis. Objective: acquaintance with a technique of definition of erythrocytes sedimentation rate (ESR). Technique. The ESR of a healthy man is 1-10 mm/h and the value for women is 2-15 mm/h. Determination of erythrocytes sedimentation rate. 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. Result: 27 . Then collect citrate up to the mark P (50) and blow down it on a watch crystal. a capillary of the Panchenkov’s device wash out by 5 % sodium citrate solution. what is the height of formed top column of plasma in the capillary.Result: Conclusion: Practical work 4. More rapid ESR is a sign of a morbid condition. Make an injection of a finger and in the same capillary twice collect blood up to mark K (0). The non-specific mechanisms of immunity. quantity. 8. Platelets. Differential leukocyte count. 5. 6. Cellular elements of blood. Eosinophils. Determination of differential leukocytes count. Morphology of the WBCs. 10. Function of platelets. Count and morphology. Classification of lymphocytes. Neutrophils. Immunity. Leukocytes. 11. functions. Functions of the WBCs. White blood cells. their types functions. Normal values for the cellular elements in human body. The specific mechanisms of immunity. 2. White blood cells (the leukocytes). Questions for discussion 1. 28 . 3. 4. Monocytes. Total count and classification. Determination of leukocytes quantity. Phagocytosis. Practical works 1. Platelets (Throbocytes). 9. their structure. Determination of total leukocyte count in a sample of blood.Conclusion: Practical class 2. 2. Lymphocytes. Calculation of color index and hemoglobin contents in one erythrocyte (HCE). Basophils. 3. 4. Determination of hemoglobin concentration. 7. 29 . 2001. for that the received data multiply by 10. Color of a liquid of the standards compare at daylight in passed rays.. Textbook of Medical Physiology. C. then by pipette from hemometer of Sali collect 0. Hall. and a middle one – laboratory. – P 392-411. In laboratory test-tube pour 0. Each time after addition of water mix contents of the test-tube by the glass stick. from which two extreme are soldered up and contain standard solutions of hematin chlorid. 2. Determination of hemoglobin concentration.1 % solution of a hydrochloric acid up to the first lower mark. 500-515. .. to what division of a scale corresponds lower meniscus of a liquid (the value of division of a scale is equal 0.1 % solution of a hydrochloric acid transforms to the brown colored hematin chlorid. 2005.2 g%). Hemometer of Sali has 3 test-tubes of an identical diameter. J. Hemoglobin of blood under action of 0. B Saunders. holding in the extended hand at the level of eyes. F. 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. Inc. – P.Books recommended 1. 12th ed. A. The determination of hemoglobin quantity is made by a calorimeterical method. Objective: acquaintance with a technique of calculation of hemoglobin quantity in human blood.02 ml of the prepared blood and drop in same test-tube. Guyton. McGraw-Hill Companies. W. E. Quantity of hemoglobin at registration in the form of the analysis write down in grams per 1 L. Review of Medical Physiology. Technique. Ganong W. 12th ed. Practical work 1. Determine. Calculation of a color index and hemoglobin contents in one erythrocyte (HCE).05. 30 . in males – 132-164 g/L. 1. 2.Make a conclusion.85-1. Technique. Result: Conclusion: Practical work 2. Recently along with the color index calculate more reliable value – hemoglobin contents (pg) in one erythrocyte (1 pg = 1-12 g). Objective: acquaintance with a method of calculation of the color index and HCE. Normal value of the color index ( CI) equals 0. Make a conclusion. The color index expresses the average hemoglobin contents in one erythrocyte. Normal concentrations of hemoglobin: in females 115-145 g/L. 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. Column of blood should be integral and not contain vesicles of air. The diluting liquid for leukocytes is 3 % solution of the acetic acid. Determination of total leukocyte count in a sample of blood.Hb contents in one erythrocyte (HCE) = foundquantityofHb foundquantityoferythrocytes 3. For it is enough to connect by a ruler the value of the found quantity of hemoglobin and counted up erythrocytes. The dilution in the test-tube is 1/20. Technique. Objective: acquaintance with a technique of calculation of leukocytes’s quantity. Result: Conclusion: Practical work 3. In a test-tube pour 0.4 ml of the diluting solution. By easy movements of the thumbs of both hands grind in integumentary glass to the accounting chamber before 31 . 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. Determination the color index and HCE without calculation is possible with the help of nomogram. Collect by a pipette from hemometer of Sali the prepared blood up to a mark. Carefully mix. that corresponds 0.02 ml. Determination of differential leukocytes count.appearance of color newtonian rings. that volume of a part of the chamber above one small square equals 1/4000 мм3 multiple the found number by 4000 and by 20.0) х 109/L. Put the chamber under small magnification of microscope and start the calculation.e. Count up number of leukocytes B in 25 large squares. The liquid itself will fill in a cleft by thickness 0.09. that makes 400 small. i. Result: Conclusion: Practical work 4. Objective: acquaintance with a technique of differential leukocyte count. Average quantity of leukocytes in one small square B/400. colored by the method of Romanovsky-Gimsa place 32 . Technique.1 mm between the central plate and integumentary glass. Normal value of leukocytes in 1 L of blood in man (4. The smear of blood that was prepared beforehand. by dilution. Make a conclusion. Knowing. 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). having put on it previously a drop of immersion oil. % Neutrophils metamyelocytes Myelocytes segmented Eosinophils Basophils Agranulocytes. along long edges of a preparation. 33 Monocytes stab . then the found quantity of leukocytes of each kind will correspond to their percentage in blood. in an initial part of smear closer to the end. % Lymphocytes 4-9 0 0-1 1-5 4570 1-5 0-1 20-40 0-10 Conclusion: Practical class 3. Count exactly 100 squares from general number of leukocytes. Therefore calculation of leukocytes makes on edges of smear.on a little microscopic table. Granulocytes settle down on edges of smear. Blood types. Determine the kind of each leukocyte and write down in the beforehand prepared hemogram table (or press a key of the calculating machine with the corresponding name of a leukocyte’s kind). Hemostasis. lymphocytes – a little bit farther from edges. Immersion object (90) dip into the drop of oil. Result: Differential leukocyte count (leukogram) Total number of leuko cytes (x109/ L) Granulocytes. F.and B-antigens. Other agglutinogens. Textbook of Medical Physiology. 7. Books recommended 1. The ABO system. 499-500. Guyton. 3. Blood groups. 519-527. 12th ed. E. The rhesus (Rh) system. – P 413-429. 2. Hemostasis. Review of Medical Physiology. A. Ganong W. The non-specific mechanisms of immunity. 12. McGraw-Hill Companies. basic rule of blood type compatibility determination. Determination of ABO-blood groups. 3. B Saunders.Questions for discussion 1. Anticlotting mechanisms. 8. Abnormalities of hemostasis. 5. Immunity. Blood formation and regulation of the blood system. The clotting mechanism. C. Inc. The Rh Group. 12th ed. 2. J. Transfusion of blood. – P. Compatibility of blood types.. Inheritance of A. Hall. Factors which accelerate clotting. Anticoagulants. 10. Blood types. Practical works 1. 9. 2. 4. 6. 34 . The specific mechanisms of immunity. Determination of clotting time by Sucharev’s method. 2001. W. 13. Hemolytic disease of the newborn. 2005. Phagocytosis. Determination of Rhesus-blood groups. 11.. Transfusion reactions. Result: Conclusion: Practical work 2. The free displacement of blood specifies. 35 . In normal condition the beginning of coagulation is from 30 seconds up 2 minutes. In internal walls of a capillary there are small clots. Objective: to get acquainted with one of techniques coagulation time definition. Blood for research is taken from a finger after removal of the first drop. In a dry capillary for ESR collect column of blood of height 25-30 mm. The complete coagulation of blood corresponds to the moment of a complete stop of movement of blood. Technique. In normal condition the end of coagulation is from 3 minutes up 5 minutes. Blood by an inclination a capillary move in its middle (at once switch on stopwatch). Holding a capillary by two fingers shake it at a corner of 35-40 degrees in both sides.Practical work 1. Determination of clotting time by Sucharev’s method. The beginning of coagulation is characterized by delay of movement of blood at an inclination of a capillary. that the coagulation has not started yet. Determination of ABO-blood groups. On a white plate place on a drop of standard serum of first. researched blood belongs to 4th type.e. Result: Conclusion: 36 . If has taken place agglutination with serum of 1st and 3rd types containing accordingly α-β. Then transfer by clean corner of an object-plate prepared blood alternately to all drops of serum. researched blood belongs to third type. and erythrocytes stick together as nubbins. that is the property of 1-st type erythrocytes. i. e.Objective: to get acquainted with a technique of determination of blood type. erythrocytes of researched blood contain A-agglutinogen.and B-agglutinogens. The drop of serum should be more drop of blood.and β-agglutinins. If agglutination has taken place in all three drops of serum. i.and α-agglutinins. and at presence of agglutination the drop becomes transparent. The reaction of agglutination comes in 1-5 minutes. The absence of agglutination in all drops of serum means that there is absence agglutinogens in researched erythrocytes. second and third types. If agglutination has taken place with serum 1 st and 2nd types containing α-β. erythrocytes contain A. Technique. belong to the second type. erythrocytes contain B-agglutinogen. i. e. Objective: acquaintance with a technique of determination of blood group in the Rhesus system. In case of positive reaction in a solution occur fine flakes. On a white plate place on a drop of special standard serum and researched blood. Determination of Rhesus-blood groups. In 5 minutes determine presence or absence of agglutination. Technique. and at negative contents is homogeneous.Practical work 3. Result: Conclusion: 37 . Questions for discussion 1. 10. Principles of respiration system structure. 7. Respiratory muscles and pulmonary ventilation. Respiratory minute volume and its changes at different loading. Air Passages. 2. 5. Gas exchange in the lungs. Anatomy of the lungs. Biomechanics of inspiration and expiration. methods of its measurement. Work of breathing. Lung Volumes. Elastic properties of the lungs. Dead space. its composition. “Dead space” and efficient lungs ventilation. External respiration. Mechanism of external respiration. its basic stages. Differences in ventilation and blood flow in different parts of the lung. Respiration. 6. 3. Partial pressure of O 2 and CO2 in alveolar air and in blood. The Bronchi and their innervations. Methods of their measurement. Ventilation/Perfusion ratios. Compliance of the lungs and chest wall. 38 . Residual volume. 8. The vital capacity and its composing components. Basic stages of respiration. 9. 4.PHYSIOLOGY OF RESPIRATORY SYSTEM Practical class 1. Intrapleural pressure. Diffusion across the alveolocapillary membrane. 11. External respiration. Surfactant. Effect of variations in respiratory rate and depth on alveolar ventilation. Alveolar surface tension. Pulmonary circulation. Respiratory muscles. Composition of the alveolar air. 625-648. Ganong W. hemoglobin dissociation curve. 12th ed. 13. Guyton A. Review of Medical Physiology. depth and respiratory minute volume at rest and at physical loading. E. 3. Saunders. F.. – P. make 2-3 deep inhalations and exhalation and. – P. Technique. 2005. Objective: to become familiar with a technique of lungs volumes and vital capacity measurement. Gases transport by blood: transport of O 2 by blood. C. tissues liquid and in cells.Effects of decreasing or increasing the ventilation/perfusion ratios on the PCO2 and PO2 in an alveolus. Practical works Measurement of vital capacity (VC) of lungs and its fractions. a tip wipe by cotton wool with spirit. B. Pulmonary embolization. 2. 2. Gas exchange between blood and tissues. 2001. Gas transports between the lungs and the tissues. correlation CO2 and O2 transport. Factors affecting the affinity of hemoglobin for oxygen. 1. 432-472. 14. Books recommended 1. Textbook of Medical Physiology. Measurement of vital capacity (VC) and its fractions. 12. Analysis of spirogram. Pulmonary hypertension. W. Practical work 1. Hall J. McGraw-Hill Companies. 12th ed.. having inhaled maximum 39 . Partial pressure of O 2 and CO2 in blood. Measurement of frequency. The spirometer (lung-tester) result in a zero position. Transport of CO2 by blood. Significance of carboangydrase. Inc. the measurement is carried out not accurately and is necessary to repeat it. without jerks. quietly breathe.through a mouth in the spirometer. which turns out at measurement usually is called as factual vital capacity (FVC). make a probably deep exhalation in spirometer. For example up to 3000 ml. Measurement of the expiratory reserve volume. which is determined by multiplication of height in men – by 25. The difference between the first parameter (3000) and the last one (for example. The value of VC. After it close the plug. Measurement of the inspiratory reserve volume. After 5-6 breathes note on a scale volume of exhaled air and divide it into the breathes number. Volume of exhaled air in the spirometer is the expiratory reserve volume Having measured the tidal volume. lift a bell of spirometer. and make a probably deep breath from the spirometer. having made a little quiet breathes. Result the spirometer in a zero position. From a cover take out a plug. make some quiet respiratory movements and after the next exhalation take the tip in a mouth and make a probably deep exhalation in spirometer. Result the spirometer in a zero position and. having taken the tip in a mouth. Measurement of the tidal volume.deeply. after a usual breath should take in a mouth the tip. and exhalation . and an inhalation make through a nose. If the divergence exceeds 10 %. and in women – by 20. Received value corresponds to vital capacity (VC). For an estimation of a 40 . The examinee. calls as predicted vital capacity (PVC). the inspiratory reserve volume and the expiratory reserve volume add them and compare to already received vital capacity. 1500) is the inspiratory reserve volume – 1500 ml. The value of VC. An exhalation make slowly. The work is carried out with the help of spirograph. The measurement needs to be done three times: in a sitting position 41 . which corresponds to the physical development data of the man. Objective: study dependence of the external breath basic parameters on physical loading. Measure in examinee the respiratory minute volume (RMV) and breath frequency using the spirograph. With this purpose the following ratio is determined: FVCx 100 / PVC Using the results of comparison it is necessary to make the appropriate conclusions. 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).development degree of the external breath apparatus the value of PVC is necessary compare to that value. Results: Conclusion: Practical work 2. depth and respiratory minute volume at rest and at physical loading. Measurement of frequency. Technique. during run on the spot. 42 . having divided RMV by breath frequency. 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. Results: Table Conditions of the experiment Sitting at rest During walking During run on the spot Value of RMV Breath freque ncy Avera ge breath depth The quantity of air which doesn’t participate in gas exchange Alveo lar ventil ation volum e Conclusion: Practical work 3. The data should be written down in the table. Technique. Compare results of three measurements and make conclusions about influence of exercising on the basic parameters of breath. during walking on the spot at the speed 120 steps per one minute. Then make the following calculations: find the average value of breath depth.of the examinee. Then find alveolar ventilation volume. Analysis of spirogram Objective: to become familiar with a technique of the man’s spirogram analysis. Measurement of the tidal volume – TV. Measure a distance from the bottom border of a quiet exhalation up to border of the maximal exhalation.1. The received number multiple by 20 (ml). 6. Measurement of the breath frequency – BF. Measurement of vital capacity – VC. Measurement of the expiratory reserve volume – ERV. received number multiple by 20. 4. 1st method – lead lines of borders of the maximal inhalation and exhalation in parallel each other and measure distance between them. RMV = TV х BF. 3. 8. Measure a distance from the top border of a quiet inhalation up to the top border of the maximal inhalation. Find border of the maximal inhalation by the peak of a curve on spirogram. Find border of the maximal exhalation. Measure by a compasses or by a ruler a distance from top up to the bottom border of quiet breath in mm. 2nd method – add values TV+ IRV + ERV. 5. The speed of movement of a paper tape during recording of spirogram is equal 50 mm / min. 9. As 1 mm corresponds to 20 ml of air. The data received by both methods should coincide. 2. Parallel to the top border also averaged out lead a line of the bottom border of quiet breath (quiet exhalation). The received number multiple by 20 (ml). 7.02 min. Find record of quiet breath and lead a line of the top border (quiet breath – inhalation) – average out. 43 . Measurement of the respiratory minute volume – RMV. Measurement of the inspiratory reserve volume – IRV. 1 mm corresponds 0. The received number multiple by 20. Measurement of the predicted vital capacity (PVC) for the patient.022 . Percentage of using VC – percentage ratio between TV and VC. VP is a ratio between the VC and the body weight. Calculation of a vital parameter – VP.052 – age (years) х 0. Normal values in men VP = 60.6 11. whose data are written down in spirogram using the following formulas: • For men PVC = height (cm) х 0.3. 44 . Normal value is 12-15 %.041 – age (years) х 0. in women = 52.6 • For women PVC = height (cm) х 0.10. 12.018 – 2. 2-6 s=1. surname______________________________________ Height___________Weight____________Sex_____________ Complaints_________________________________________ Indexes Breath frequency Tidal volume Inspiratory reserve volume Expiratory reserve volume Residual volume Vital capacity Predicted vital capacity Total lung capacity Functional reserve capacity Inhalation volume Ratio between inhalation and exhalation Respiratory minute volume Alveolar ventilation of lungs Maximal ventilation of lungs Vital parameter Percentage of VC using FVC1 Normal value BF=10-20 per a minute TV=300-900 ml 1520% VC IRV=1500-2000 ml 50% VC ERV=1000-1500 ml 30% VC RV=1200 ml VC=2-5 L PVC=2-5 L TLC=RV+VCL=32006200 ml FRC=ERV+RV=22002700 ml IV=TV+IRV=18002900 ml K=inhalation 1-5 s / exhalation 1.Results: Table of the functional examination Date_______________________________________________ Name.2 RMV=4-10 L/min AVL=75 % RMV MVL=50-120 L/min VP VC % FVC1=70-80 % VC 45 Practically . The measurements which are usually made are as follows: 1. 3. measures of flow can be made either absolutely (e. 2. the shape of which is reproducible for any individual but varies considerably between different lung diseases. and from these we can calculate how effectively and how quickly the lungs can be emptied and filled. thus generating a flow-volume curve (Figure 2).FVC2 FVC3 Reserve of respiration Arterial blood pressure Heart beating rate FVC2=80-90 % VC FVC3=90-100 % VC RR=MVL-RMV ABP=120/80 mm Hg HBR=75 b/min. 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. A poorly performed maneuver is usually characterized by poor reproducibility. g. 46 . a spirometer is a device used to measure timed expired and inspired volumes. Complementary data Measurement of Ventilatory Function Conventionally. 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. peak expiratory flow) or as a function of volume. 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. A spirogram is thus a volume-time curve and Figure 1 shows a typical curve. Alternatively. the volume recorded by the spirometer is less than that displaced by the lungs. 47 .4. All indices of ventilatory function should be reported at body temperature and pressure saturated with water vapor (BTPS). Both indices have a wide range of normality but are usually reproducible in a given subject provided the FVC is reproducible. PEF (peak expiratory flow) is the maximal expiratory flow rate achieved and this occurs very early in the forced expiratory maneuver. 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. 6. because when the patient blows into a ‘cold’ spirometer. Unfortunately FEF25-75 % has a wide range of normality. If this is not done the results will be underestimated. 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 %). and is difficult to interpret if the VC (or FVC) is reduced or increased. is less reproducible than FEV1. 5. Normal maximal expiratory and inspiratory flow-volume curve Conclusion: Practical class 2. forced expired volume in one second (FEV1) and forced expiratory flow over the middle half of the FVC (FEF25-75 %). Questions for discussion 48 . the right panel is a spirogram from a dry wedge-bellows spirometer with expired volume upward. Regulation of respiration.Figure 1. Normal spirogram showing the measurements of forced vital capacity (FVC). Respiratory neurons. Respiratory cycle. The left panel is a typical recording from a water-sealed (or rolling seal) spirometer with inspired volume upward. Respiratory center. Figure 2. Control systems. changes in ventilation. Emphysema. • Effects of sleeping. Regulation of respiration. Neural control of breathing. Role of chemoreceptors (central and peripheral). Medullary systems. 19. Respiratory center. Ventilatory responses to the changes in asid-base balance. Cystic fibrosis. 10. Hormonal effects on respiration. • Afferents from proprioceptors. Response curve. 8. 16. 23. 13. 5. • Afferents from “Higher centers”. Pneumothorax (open and closed). Chemoreceptors in the brain stem. 20. Other respiratory abnormalities. 12. 49 . 22. 11. 9. Effects of exercises. Non-chemical effects on respiration. • Coughing and sneezing. 15. 21. 2. 18. 7. Ventilatory responses to oxygen lack. 4. Breathe holding. • Respiratory effects of baroreceptor stimulation. Asthma. Pontine and vagal influences. Effects of hypoxia on the CO2. Ventilatory responses to CO2. • Responses mediated by receptors in airways and lungs. four categories of hypoxia. Regulation of respiration. • Respiratory components of visceral reflexes.1. Pontine and vagal influences. Hypoxia. 6. 17. 14. 3. Carotid and aortic bodies. Effects of H+ on the CO2 response. Set the writer capsule so that it touched the surface of the kymograph. • Cheyne-Stokes respiration. B Saunders. 12th ed. Practical work 1. Technique. F. Record respiratory movements during slow rotation of the kymograph drum.. • Periodic breathing. J. Guyton. 12th ed. Hall.• Asphyxia. Review of Medical Physiology. 50 . E. 24. • Mechanical respirators. – P P. Objective: to study the influences of some reflex and humoral factors. W. McGraw-Hill Companies. A. 2. Inc. on frequency and depth of breathing using method pneumography. Practical works 1. fill it with air and combine it with a Marey's capsule. 649-672. Textbook of Medical Physiology. 2001. – P. Measurement of stop breathing at different conditions. Artificial respiration. 432-472. • Drowning. 2. 2005. Books recommended 1. Ganong W. C. as well as the coordination processes in the central nervous system. Influence of some factors on regulation of breath. Protective reflexes in breathing: a) to strengthen the chest pneumograph cuff test.. • Mouth to mouth breathing. Influence of some factors on regulation of breath. 1. There is a breathholding. Continue to breathe normally.Results: Conclusion: b) the subject has to take water in his mouth and not swallowing it. Have you changed your breath and why? Repeat the experience by swallowing water during exhalation. Then swallow water during inhalation. Why? Results: 51 . 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. after a few seconds. Results: 52 . Results: Conclusion: b) the subject has to produce a very deep breathing (hyperventilation) during 1 minute. apnea occurs.Conclusion: 2. and why. How did it change? Usually. Then stop the hyperventilation and record your normalbreathing. recording of breathing at the same time. How change your breath after a delay. 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. Conclusion: c) remove the capsule of Marey from pneumograph and make running in place during 1 minute. Have you changed it? Results: Conclusion: 3. and then record the breath. Influence of the processes of breathing movement coordination acts on the character of breathing: a) record the breath of the subject. How to change your breath? Results: 53 . Quickly restore the communication the subject and capsule of Marey. giving him the job insert the thread through the eye of a needle. 54 . Measurement of stop breathing at different conditions. Results: Conclusion: Check out the results and conclusions. In conclusions you should explain the observed changes of respiration.Conclusion: b) record the breathing during the rhythmic conversation (poetry reading). Total conclusion: Practical work 2. In results of work you should schematically show the possible changes in the nature of respiration (graphics). 1st test – the subject should hold his breath at the time of quiet breathing. Check out the results and conclusions. how long he can hold his breath. 1. and consequently in them air enters». and consequently they extend». Technique. The subject has to produce hyperventilation. after which the researcher should determine the time of breath again. 2. The researcher should mark the time to start of spontaneous breathing (inhaling moment) with the help of stopwatch. 2nd test – the subject should hold his breath at the time of expiration. The intervals between the tests should be about 5-10 minutes. The subject has to make a running in place and then hold his breath. Compare the results. the second – «air enters into the lungs. Mark. 55 . Results: Conclusion: Tasks 1.Objective: to determine the effect of carbon dioxide in the blood at the time of any breath-holding. Who from two arguing rights? One asserts – «lungs extend. What tube needs to be used. and internal diameter accordingly 68 mm. At some diseases the stretchability of lungs tissue decreases in 5-10 times. It is necessary to the man to pass on the bottom of a reservoir. which end leaves water. if there are no special adaptations. What clinical symptom is typical for such diseases? 3. There are three tubes. In such situation. Prove your answer by the appropriate calculation. breathe through tube.2. Explain the mechanism of oxygen utilization factor increase in a working muscle in comparison with a condition of rest. 5. 5 mm. Length of each one is 1 meter. How the difference in a percentage exhaled and alveolar air will change. 30 mm. if the man will breathe in a gas mask? 4. 56 . In these homogenates measured and compared among themselves some physical-chemical parameter. At narrowing respiratory ways the flow of air becomes turbulent. 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. Concluding class devoted to the themes “Physiology of blood system”. when have begun to compare homogenates from the lung tissue such children and children died of other reasons. It requires significant expenses of energy and patient breathes difficulty. Explain the reason of the patients condition improvement. The solution was found. What is this – this parameter? And what means change of its value? 7. The condition is improved. “Physiology of respiratory system” (intermediate oral examination). Questions for discussion 57 .6. if air replace oxygen-helium mixture (in it instead of nitrogen there is the same quantity of helium). Practical class 3. Stages of development. 14. Types of hemolysis. features of chemical composition. 13. White blood cells (the leukocytes). Reaction of Hb. regulation of its constancy. 12. Hemolysis. 16. Osmotic pressure of blood. Physiological blood-replaceable solutions. 9. Hemoglobin in the fetus. 17. Erythrocytes. Total count and classification. methods of its determination. Determination of erythrocytes quantity. 2. its physiological role. Abnormalities of Hb production. Specific gravity of blood. Origin plasma proteins.(Physiology of blood system) 1. its relative constancy. 7. their spectral analysis. Blood composition. 5. their structure. Chemical structure. 21. 8. Hemoglobin. 3. Erythrocyty sedimentation rate (ESR). Hemoglobin chemistry and synthesis. Functions of blood. Plasma proteins. 19. functions. methods of its determination. Catabolism of Hb. Blood plasma. their types functions. 22. 15. Quantity of blood in human organism. 11. 10. Erythropoiesis. composition. Leukocytes. Importance of erythropoiesis. its determination. Methods of hemoglobin quantity determination. 58 . Hypoproteinemia. 4. Viscosity of blood. 6. 18. its quantity. Osmotic resistance of erythrocytes. Applied physiology. Factors required for synthesis of Hb. 20. hemoglobin compounds. Red cells fragility. Abnormalities of hemostasis. Basophils. The rhesus (Rh) system. The specific mechanisms of immunity. Functions of the WBCs. Inheritance of A. Count and morphology. The ABO system. Immunity. 39. Transfusion of blood. 42. 26. Immunity. Phagocytosis. The non-specific mechanisms of immunity. Blood formation and regulation of the blood system. Questions for discussion (Physiology of respiratory system) 59 . Normal values for the cellular elements in human body. Differential leukocyte count. 40. 37. basic rule of blood type compatibility determination. 28. 38. Blood groups. Morphology of the WBCs. 41. Anticoagulants. functions. Classification of lymphocytes. 35. 36. Monocytes. Function of platelets. Eosinophils. Platelets (Throbocytes). 43. 25. The non-specific mechanisms of immunity. Lymphocytes. The Rh Group. Other agglutinogens.and B-antigens. Hemostasis. 29. Transfusion reactions. Determination of leukocytes quantity. 24. Blood types. 31. The specific mechanisms of immunity. Compatibility of blood types. their structure. 33. The clotting mechanism. Hemolytic disease of the newborn. Neutrophils. quantity.23. 27. Factors which accelerate clotting. Phagocytosis. 44. Anticlotting mechanisms. 32. 34. 30. 9. Control systems. Regulation of respiration. transport of CO2 by blood. Role of chemoreceptors (central and peripheral). Partial pressure of O2 and CO2 in blood. methods of its measurement. 15. tissue liquid and in cells. 8. 7.1. Gases exchange in lungs. Principles of respiration system structure. its nature and role in external respiration mechanism. Partial pressure of O2 and CO2 in alveolar air and in blood. Intrapleural pressure. Pontine and vagal influences. «Dead space» and efficient lungs ventilation. 60 . its basic stages. 16. oxygen capacity of blood. 10. Medullary systems. 17. Respiration. Respiratory minute volume and its changes at different loading. Concept about partial pressure of gases. Mechanism of external respiration. 3. Chemoreceptors in the brain stem. Alveolar air like inner medium of human organism. 6. Carotid and aortic bodies. Methods of their measurement. correlation CO2 and O2 transport. Respiratory center. Changes of intrapleural pressure during phases of respiratory cycle. significance of carboanhydrase. its characteristic. Atmospheric and exhaled air content. haemoglobin dissociation curve. 4. 18. Neural control of breathing. The vital capacity and its composing components. 5. 14. Gases’ transport by blood: transport of O 2 by blood. Residual volume. 11. Regulation of respiration. 13. Pontine and vagal influences. Gases exchange between blood and tissues. 12. 2. Biomechanics of inhalation and exhalation. 27. • Responses mediated by receptors in airways and lungs. Cystic fibrosis. Breathe holding. 31. Emphysema. 22. Effects of H+ on the CO2 response. Effects of exercises. • Afferents from proprioceptors. Ventilatory responses to the changes in asid-base balance. • Mouth to mouth breathing. • Respiratory effects of baroreceptor stimulation. Other respiratory abnormalities. 23. • Mechanical respirators. Response curve. changes in ventilation. 24. Hypoxia. • Afferents from “Higher centers”. 33. 29. • Drowning. four categories of hypoxia. • Asphyxia. 61 . 20. 25. 30. Hormonal effects on respiration. 26. • Periodic breathing. 34. Pneumothorax (open and closed).19. Effects of hypoxia on the CO2. 21. Ventilatory responses to CO2. Artificial respiration. • Respiratory components of visceral reflexes. • Effects of sleeping. 32. Non-chemical effects on respiration. 28. • Cheyne-Stokes respiration. Ventilatory responses to oxygen lack. Asthma. • Coughing and sneezing. Anatomical substratum and nature of automaticity (characterize the conduction system). Factors controlling cardiac output. 1. 6. 2. Cardiac output in various conditions. Anatomic considerations of the heart. Length of systole and diastole. 3. 2. 3. 3. 6. Cardiac hypertrophy. Mechanical events of the cardiac cycle. Metabolism of the heart. Correlation between muscle fiber length and tension. 1. 7. Their characteristic and comparison. 7. Automaticity of the heart. Morphology of cardiac muscle. The heart as a pump. Action of pacemaker and contractile cardiac cells. Early diastole. 12. Electrical properties. Ventricular systole. 5. 1. Action potential. 2. 1. 62 . Properties of cardiac muscle. Properties of the cardiac muscle.PHYSIOLOGY OF CARDIOVASCULAR SYSTEM Practical class 1. 11. Questions for discussion 1. 8. Speed of spread of cardiac excitation. 2. Events in late diastole. Methods of measurement of cardiac output. 1. Atrial systole. 4. Resting membrane potential. 4. 5. 6. 7. 8. 8. Relations of tension to length in cardiac muscle. 9. Factors affecting end-diastolic volume. 10. Myocardial contractility. Integrated control of cardiac output. Arterial pulse. Atrial pressure changer and the jugular pulse. Heart sounds. Murmurs. Practical works 1. Automaticity of heart and its dependence on temperature. 2. Analysis of conduction system of heart (Stannius’s experiment). Books recommended 1. Ganong W. F. Review of Medical Physiology. 12th ed; McGraw-Hill Companies, Inc., 2001. – P. 528-530, 545555. 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 dependence 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) 64 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 discussion 1. 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. 65 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 excitation 6. 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. 66 1.02 (speed tape moving 50 mm per second. McGraw-Hill Companies. 382-390. Books recommended 1. Measure in millimeters distance from one top of R wave up to the following top R wave. Technique. W. Determine the duration R-R of an interval in seconds. learn bases of registration ECG at standard leads and analysis of electrocardiogram.2. C. Inc. 12th ed. J. Effects of changes in the ionic composition of the blood. Definition of heart beating frequency on the duration cardiointerval. Analysis of ECG (electrocardiogram). F.. A. – P. Ganong W. Analysis of ECG (electrocardiogram). Hall. B Saunders. Textbook of Medical Physiology. 2. Amplitude-temporary characteristic of waves and intervals at rest. For determination of the hear beating rate per 1 minute it is necessary 60 (there is 60 seconds in one minute) divide into duration of R-R interval in seconds. 530-544. value of one division of 1 mm is equal 1/50 – 0. 2. 12th ed. 2001. Guyton. Measure amplitude (voltage) of ECG waves 67 . 2005. For this purpose it is necessary multiple quantity of millimeters (the R – R interval) by 0. E.. – P P. Review of Medical Physiology.02 seconds). Practical works Practical work 1. hence. Practical work 1. Objective: acquaint with registration of electrical activity of heart. • QRS complex – from the beginning of Q wave up to the end of the S wave. • Т wave – from the beginning up to the end of Т wave. of QRS complex and the duration of Р-Q and Q-Т intervals. Transfer results to seconds.02. The waves are measured: • P wave – from the beginning up to the end of P wave. Т waves. in mm. multiplying the received value by 0. 68 . The measurement of the wave duration and intervals is carried out at the second standard lead. • S wave – from the beginning up to the end of S wave. • P-Q segment – from the beginning of the Р wave up to the beginning of Q wave. Transfer result in millivolts (1 mV – 10 mm). • Q-Т interval – from the beginning of the Q wave up to the end of Т wave. • R wave – from the beginning up to the end of R wave. Measure the duration of R. The data to bring in the table. • Q wave – from the beginning up to the end of Q wave. The wave amplitude is measured in mm from the wave top to its basis up to isoelectric line. • P-Q interval – from the beginning of the Р wave up to the end of Q wave.in three standard leads in mm. Bring the data in the table. • Q-Т segment – from the beginning of the Q wave up to the beginning of Т wave. right side (aVL) – the third lead. For its definition in degrees build up the straight. The value of waves is determined in mm. to the left. «+»). If this value is positive. Construct the Einthoven’s triangle (the equilateral triangle with the side = 10 cm. Similarly measure value of the QRS complex at the III standard lead. if negative. Calculate the arithmetic sum of these waves. Construct perpendicular lines to the top of the I-st and the III-rd vectors that they would be crossed. The value of Q and S waves take with the negative sign (minus. if negative – upwards. it is laid to the right from the middle point. parallel to the basis line through the center of the triangle and measure by an protractor the angle between the middle line and the received vector (the angle α). and R wave – with the positive sign (plus. 3. Measure the QRS complex value at the first standard lead. it is laid downwards from the middle point. From tops of a triangle build up heights on the opposite sides and mark the center of a triangle in the point of crossing of middle lines. The summary value of the QRSI complex lay on the top side of the triangle. Estimation of an orientation of a vector (or electrical axis of heart) in a frontal plane. The crossing point connect with the center of a triangle and receive the summary value of the vector in the Ist and IIIrd standard leads and direction of electrical axis of heart. left side (aVR) – the second lead. The summary value of the QRSIII complex lay on the right side of the triangle. Calculate the arithmetic sum. directed by top downwards).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. • 69 . The basis of a triangle corresponds to the first standard limb lead. «–»). If it is positive. 180 degrees). 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). Build up perpendiculars from the end of the received vectors.Table 1 Element of ECG P wave Q wave R wave S wave T wave QRS complex P-Q segment P-Q interval Q-T segment Q-T interval S-T segment S-T interval Duration (in IInd lead) mm s Voltage Ist lead mm mV IInd lead mm mV IIIrd lead mm mV - - - - - - Table 2 Sector From 00 up 900 From 00 up 200 From 300 up 600 From 700 up 900 From 900 up 1800 The position of the vector of the electrical axis of the heart Deflection of the vector to the left Horizontal position of the vector Normal position Vertical position of the vector Deflection of the vertical axis to the right Check up correctness of definition of the electrical axis using the six-axial scheme. 150. For this purpose lead a circle in radius 5 cm and divide it into 12 sectors. 90. 120. 70 . 60. To the right side mark positive values (30. to the left side negative values (fig. On the axis of the III lead lay on the arithmetic sum of QRS waves received in the III standard lead. It will be the direction of the electrical axis of the heart. Table 3 Example The value of the waves in the Ist lead (in mm) Q = –2 R = +15 S = –3 Σ = +10 The value of the waves in the IIIrd lead (in mm) Q = –1 R = +10 S = –4 Σ = +5 The value of the waves in the IIIrd lead (in mm) Q= R= S= Σ= Your results The value of the waves in the Ist lead (in mm) Q= R= S= Σ= Example – aVR – II III +5 + aVF + I +10 + aVL – 71 .Connect the point of crossing with the center of the circle. Results: 72 . –90 –120 –150 –60 –30 ±180 0 150 120 90 Conclusion: 60 30 Practical class 3. Influences of sympathetic and parasympathetic nerves on the heart. 73 . Cardiac innervation. Regulation of cardiac activity. Questions for discussion 1. 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 works 1. Reflexes of the heart. • Ashner's oculocardiac reflex. • Reflexes of baroreceptors (pressure receptors) from the carotid sinus zone. • Hering-Breier reflex. 74 Books recommended 1. Ganong W. F. Review of Medical Physiology. 12th ed; McGraw-Hill Companies, Inc., 2001. – P. 574-606. 2. Guyton A. C., Hall J. E. Textbook of Medical Physiology, 12th ed; W. B. Saunders, 2005. – P. 382-390. 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: 75 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. 76 Palpation method. 3. Normal arterial blood pressure and factors determining the blood pressure. R-R) or pulse rate.Record the ECG in the second standard lead or count the pulse rate at usual breath. Pathological conditions (chronic elevation of blood pressure. T-P. emotion. cardiovascular shock. 5. Questions for discussion General structure of the vascular tree (segments of blood vessels-major divisions). 1. drug) affecting blood pressure. pressure and resistance. 4. sleep) affecting blood pressure. muscular exercise. Flow. 77 . Estimate duration of intervals (P-T. Auscultatory method. meals. Physiological conditions (sex. Velocity flow of blood. Q-T. Regulation of blood pressure. 7. Arterial pressure. Biophysical considerations. Methods of measuring blood pressure. Arterial and arteriolar circulation. Repeated record of ECG make at the state of the maximal exhalation. Then do a deep breath and delay of breath with registration of the ECG. Results: Conclusion: Practical class 4. Blood pressure in different segments of the vascular tree. Functions of the individual segments. exposure to cold. 6. Basics of hemodynamic. 2. 2001. Structure and functions. Interstitial fluid volume. Guyton A. Active and inactive capillaries. total pressure and the lateral pressure of the flowing blood (velocity-pressure relationship). Inc. • Palpation method of Riva-Rocci. – P. 16. C. Practical works 1. Equilibration with interstitial fluid. 2. 12th ed. Resistance and capacitance vessels. W. Interrelationship between the diameter of the blood vessel and the velocity of the flowing blood (diameter-velocity relationship). Ganong W. B. – P. • Dynamic (functional) test. Hall J. Venous pressure and flow. 13.8. Dynamic tests of cardiovascular system. Review of Medical Physiology. F. Muscle pump. 14. • Auscultatory method of Korotkov. 2. Thoracic pump. Textbook of Medical Physiology. Lymphatic circulation. McGraw-Hill Companies. E. Capillary pressure and flow. Capillary circulation. 11. Saunders. 78 . Venous pressure in the head. Velocity and flow of the blood. 9. 12th ed. 12. 15. 382-390.. • Orthostatic test. Interrelationship between the velocity. Definition of blood pressure in man. 10. Venous circulation. 556-606.. 2005. Relationship between the pressure of the flowing blood with the volume of the flow per unit time (pressure-flow relationship). Books recommended 1. Technique. and then gradually lower pressure. Objective: to familiarize with indirect methods of definition of the blood pressure in the man. Impose the cuff on the naked shoulder higher than elbow fovea. Palpation method of Riva-Rocci.Practical work 1. but does not press on the tissues. For measurement of the blood pressure is used the sphygmomanometer. In a cavity of the cuff create the pressure exceeding maximal (before disappearance of pulse). opening the screw valve and letting out air from system. Results: Conclusion: Auscultatory method of Korotkov. Technique. In elbow fovea find out pulsing brachial artery. Pressure in the cuff is judged by the indications of a manometer. at which the pulse 79 . Create pressure in the cuff higher than maximal. On a naked shoulder of the examinees to impose an inflatable rubber cuff so that it densely covers the shoulder. The moment of the pulse appearance in radial artery coincides with maximal (systolic) pressure in brachial artery. on which place a phonendoscope. Definition of blood pressure in man. and by another with the help of a rubber balloon force air in the cuff. By one hand palpate the pulse in radial artery. decrease pressure in the cuff and listen to increasing force of tones. Table 4 Age. years 10-20 20-30 30-40 40-50 50-60 60-70 Arterial blood pressure. The moment of tones appearance corresponds to diastolic pressure. by stethoscope or phonendoscope listen to tones of brachial artery in elbow fovea.disappears. The moment of disappearance of tones corresponds to systolic pressure. Measure blood pressure by the Riva-Rocci method and by the Korotkov’s method. mm Hg Females Males 115/75 118/75 116/78 120/76 125/80 124/80 140/88 127/82 155/90 135/85 160/92 145/87 Heart rate. beats per minute 90-60 60-65 65-68 68-72 72-80 80-84 Results: Conclusion: 80 . turning the screw valve and letting out air from the cuff. and then mark gradual easing with their subsequent disappearance. Continue. then. The measurement repeat three times and take for a basis the minimal parameters. Results write down in the table in your writing book. Measure the blood pressure by the Korotkov’s method. The favorable sign is the increase of pulse pressure (difference between systolic and diastolic pressure). and the minimal does not change or is a little bit lowered at 5-7 mm Hg. physiology of sports) and promote to revealing of the latent insufficiency of cardiovascular system in the process of diagnostics. The test is considered as normal. offer to the examinee quietly to rise. Results of research to write down in the report and give them an estimation in conclusions. At once count the pulse (for 15 seconds and multiply by 4) and measure the blood pressure. The dynamics (functional) tests allow to determine reserve and adaptive resources of cardiovascular systems in practically healthy man (physiology of work. Count the pulse it him during 15 seconds and the received value multiply by 4 (pulse rate for 1 minute). Not removing the cuff of sphygmomanometer from a shoulder.Practical work 2. Orthostatic test. Technique. Results: Conclusion: 81 . The examinee quietly lays in a horizontal position for 2-3 minutes. Dynamic tests of cardiovascular system. if at passage from a horizontal position to a vertical the maximal pressure raises at 10 mm Hg. Objective: to familiarize with methods of research and estimation of a condition of cardiovascular system. bits/10 seconds 21 2nd minute. The approximate order of results record Examinee _________________________________________ Sex __________ Age __________ Initial parameters (before loading): Pulse rate. 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. bits/10 seconds 17 17 16 16 15 3rd minute. offer to the examinee to make 20 deep curtseys or 60 jumps on the spot during 30 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.Dynamic (functional) test. Not removing the cuff of sphygmomanometer. mm Hg __________ After loading: Table 5 Pulse rate after 10 seconds after 20 seconds after 30 seconds after 40 seconds after 50 seconds 1st minute. Technique. bits/10 seconds 14 13 13 12 12 82 . Then measure the blood pressure by the Korotkov’s method. After returning pulse to initial value the third time measure the blood pressure. bits per 10 seconds __________ Arterial blood pressure. 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). pulse pressure is increased. restoration of blood pressure goes a little bit more slowly. The average time of pulse restitution (rehabilitation) is from 1 minute 40 seconds up 2 minutes 30 seconds. bits/10 seconds . is possible increase of diastolic pressure at 5-7 mm Hg. bits/10 seconds 2nd minute. Favorable it is possible to consider the following parameters: increase of pulse at 6-7 beats during 10 seconds at once after loading. bits per 10 seconds ___________ Arterial blood pressure. Results: Examinee __________________________________________ Sex __________ Age __________ Initial parameters (before loading): Pulse rate. In the females more expressed shifts of parameters are marked. increase of systolic pressure at 12-22 mm Hg. mm Hg 19 120/70 14 130/70 – 145/75 The omission of time in calculation of pulse on the first minute after loading is intended for measurement of blood pressure.after 60 seconds Arterial blood pressure. for what 40 seconds are taken. bits/10 seconds 3rd minute. Draw a curve of a pulse rate dynamics after physical loading. mm Hg __________ After loading: Table 6 Pulse rate after 10 seconds after 20 seconds after 30 seconds after 40 seconds 83 1st minute. splanchnic circulation. 8. Vasodilatator metabolites. vessels’ tone. 4. Vasomotor center. Autoregulation. Substances secreted by the endothelium. Innervation of vessels. Vasomotor center. Questions for discussion Cardiovascular regulatory mechanisms. Localized vasoconstriction. Vasoconstrictor nerves. 2. circulation of the skin). 6. Circulation through special regions. Systemic regulation by hormones. 7. coronary circulation. their role in circulation regulation. 5. Neurogenic mechanisms of vasodilatation. 9. mm Hg Conclusion: Practical class 5. Circulation through special regions (cerebral circulation. Regulation of vascular tone. General plan of the cardiovascular system reflexes. 1. Reflexogenic zones of the heart and vessels. Self-regulatory mechanism of constant blood pressure level maintenance. 84 . 3. 11. Systemic regulation by the nervous system. 10.after 50 seconds after 60 seconds Arterial blood pressure. Dilatation and constriction reflexes. Local regulatory mechanisms. Production of lymph. C. Measurement of cardiac output by an indirect method at rest and after physical loading. 382-390. Textbook of Medical Physiology. 12th ed. In 85 . The methods of cardiac output measurement can be divided into direct (direct Fick method. indicator dilution method etc. Grolmann’s method. Books recommended 1. McGraw-Hill Companies.) and indirect (Starr’s method. Measurement of cardiac output by an indirect method at rest and after physical loading.. Significance of functional tests in cardiovascular system examination. Ganong W. F. sphygmographic method. B. Technique. Review of Medical Physiology. Practical works 1. Objective: to familiarize with a technique of cardiac output measurement. Stuart-Hamilton’s method. Hall J. 2.. 13. – P. 12th ed. 2. ballistographic). cardiac output is one of the main indicative index of cardiovascular system functioning. Guyton A. W. Saunders. Inc. Features of blood circulation in lungs. This mathematical method of cardiac output measurement consists of the special accounts using the special empirical formulas. The Rather widespread method is the Starr’s method (1954). Calculation of peripheral vascular resistance at rest and after physical loading. 556-606. Practical work 1. E. Adapting changes of cardiovascular system during physical loading. brain and features of systemic blood circulation. – P. Mechanisms of lymph movement. Circulation of lymph.12. 2005. 2001. 6 DP – 0.5-5 L per minute. PR – pulse rate. In the healthy people the value of cardiac output can be significant fluctuated connected to sex. A – age (years). than in healthy people. DP – diastolic pressure (mm Hg).the examinee measure the blood pressure by the Korotkov’s method and pulse rate. and to another side are expressed in the greater degree. SV – stroke volume. After definition of systolic volume it is easy to calculate cardiac output (CO) using the formula: CO = SV х PR. where 86 . PP – pulse pressure (mm Hg).6 A. In the patients deflections of CO (cardiac output) at rest both to one. Then using the formula determine systolic (stroke) volume (SV): SV = 100 + 0. In conditions of the basil metabolic rate cardiac output in healthy people equals 3. age. and also with character of activity. Therefore in each separate case it is accepted to express cardiac output at rest in percentage to PCO.5 PP – 0. where SV – stroke volume. at the same time the deflections do not exceed ±10% from the proper value of cardiac output (PCO – proper cardiac output). where CO – cardiac output. weight and height. which can be find out using the formula of Savitsky (1935): PCO = BMR / 422. Results: Conclusion: Practical work 2. 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.PCO – proper cardiac output BMR – basal metabolic rate in kcal. After counting cardiac output and proper cardiac output compare the received values and estimate them. Then. Make the appropriate conclusions. Objective: To familiarize with a technique of calculation of PVR (peripheral vascular resistance). Pulse and blood pressure measure every 30 seconds after loading and during 6 minutes. having calculated cardiac output using received data draw a curve of cardiac output dynamic after loading. At rest cardiac output fluctuation. should not exceed proper values at ±20 %. found using the Starr’s method. Calculation of peripheral vascular resistance at rest and after physical loading. 87 . The value of BMR is defined in the Harris-Benedict’s tables of the basal metabolic rate. the work of heart is improved. mm Hg. where PVR – peripheral vascular resistance. is called peripheral vascular resistance (PVR). At rest PVR changes over a wide range at the different people from 1400 up to 2500 dyn. PP – pulse pressure. mm Hg. CO – cardiac output in ml. cm2. making the average value 1850 dyn. Savitsky. The resistance rendered to flown blood by cardiovascular system. conditions of working are facilitated. DP – diastolic pressure. 1974).Technique. mm Hg. dyn. N. Savitsky (1974): ADP= 0. N. cm2 (N. The PVR value decreases in average at 20-30%. cm2 ADP – average dynamic pressure. mm Hg. Then draw a curve of PVR dynamics after loading. In normal conditions at loading the passableness of vessels is increased. As 88 . The average dynamic pressure is calculated according the formula of N. During calculation PVR after physical loading the mentioned parameters measure every 30 seconds for 6 minutes. 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. 60 – number of seconds in one minute. The PVR value is calculated according the Poiseuille equation (1839): PVR = (ADP х 1333 х 60) / CO. where ADP – average dynamic pressure.5 PP + DP. 1333 – coefficient for transformation mm Hg to dyn. Basic properties of the heart muscle. Electrical properties. 89 . Morphology of cardiac muscle. 2. Anatomical substratum and nature of automaticity (characterize the conduction system). features of refractory period in the heart. 1. Compare. curve of PVR dynamics after loading to the same curve of pulse in functional test. Resting membrane. 3. Speed of spread of cardiac excitation. Speed of spread of cardiac excitation. Properties of the cardiac muscle. to the end of 3 rd-6th minutes after loading the PVR value comes back to normal. «All or none» law. Concluding class devoted to the theme “Physiology of cardiovascular system” (intermediate oral examination). Questions for discussion Anatomic considerations of the heart. Automaticity of the heart.a rule. Their characteristic and comparison. excitability changes of the heart muscle during cardiac cycle. Results: Conclusion: Practical class 6. Extrasystole. Starling’s law (the basic law of the heart). Action of pacemaker and contractile cardiac cells. its relative character for heart muscle. Action of potentials. influences). Blood pressure in heart cavities in different phases of cardiac cycle. Sympathetic and parasympathetic supply. Functions of the individual segments. 11. pressure and resistance. Ventricular diastole. Reflexes arising from the heart: Baroreceptors are present in the left ventricle. The reflexes: Reflexes arising from the systemic arteries (baroreceptor reflex. 10. 5. Working of valves. II. Influences of sympathetic and parasympathetic nerves on the heart. chemoreceptor reflex). clinical significance. Normal arterial blood pressure 4. Atrial systole. Waves of ECG. Coronary chemoreflex (Bezoldjarisch reflexes). Flow. Atrial receptors (Bainbridge reflex). 7. The heart nerves tone. Standard leads normal electrocardiogram in human (I. Electrocardiography.Cardiac cycle and its phases. Events in late diastole. Biophysical considerations. Influences from the Higher Centers. Standard leads. Length of systole and diastole. Palpation method. Normal electrocardiogram in human. Early diastole. III). Electrocardiography. clinical significance. emotion and the heart rate. Mechanical events of the cardiac cycle. Unipolar (V1–V6) leads. 90 . Mediators in the heat (chemical nature. General structure of the vascular tree (segments of blood vessels-major divisions). 8. 6. Auscultatory method. nature of its waves. nature of its waves. Limbic system. The heart as a pump. 9. Cardiac output and stroke volume of the heart at rest and during physical loading. Humoral regulation of heart working. 12. Methods of measuring blood pressure. Cardiac innervation. Action potentials of the heart muscle and its registration methods in human. Venous circulation. Physiological conditions (sex. Rhythmic fluctuations of blood pressure owing to the heart working. Localized vasoconstriction. 16. Flow of blood through the vessels. Venous circulation. Arterial pressure. Capillary circulation. Capillary pressure and flow. Relationship between the pressure of the flowing blood with the volume of the flow per unit time (pressure-flow relationship). Systemic regulation by the nervous system. Interrelationship between the diameter of the blood vessel and the velocity of the flowing blood (diameter-velocity relationship). Venous pressure and flow. Interrelationship between the velocity. Regulation of BP. Venous pulse. Thoracic pump. capillaries. 18. Linear velocity. Major factors determining blood pressure. Cardiovascular regulatory mechanisms. Pressure in arteries. breathing and changes of vasomotor center tone. exposure to cold. Muscle pump. emotion. 13. sleep) affecting blood pressure. Vasomotor center. muscular exercise.and factors determining the BP. General plan of the cardiovascular system reflexes. veins. Substances secreted by the endothelium. Methods of blood pressure registration and measurement. Equilibration with interstitial fluid. total pressure and the lateral pressure of the flowing blood (velocity-pressure relationship). Blood pressure in different segments of the vascular tree. Capillary circulation. 14. Velocity and flow of the blood. 91 . Venous pressure in the head. Systemic regulation by hormones. Resistance and capacitance vessels. Volume flow. 17. Vasodilatator metabolites. Autoregulation. 15. Arterial pulse. meals. Active and inactive capillaries. Local regulatory mechanisms. 92 . Circulation through special regions (cerebral circulation. Vasomotor center. Production of lymph. 21. their role in circulation regulation. Circulation of lymph. 22. Mechanisms of lymph movement. Neurogenic mechanisms of vasodilatation. Dilatation and constriction reflexes. circulation of the skin). splanchnic circulation. 20. coronary circulation. Features of blood circulation in lungs.19. 24. Reflexogenic zones of the heart and vessels. Humoral regulation of vessels tone. 23. Self-regulatory mechanism of constant blood pressure level maintenance. Vasoconstrictor nerves. vessels’ tone. brain and features of systemic blood circulation. Innervation of vessels. Adapting changes of cardiovascular system during physical loading. Significance of functional tests in cardiovascular system examination. 12th ed. 10. Glomerular filtration.. Physiological aspects of renal circulation. Blood flow. Autoregulation of renal blood flow. Cross anatomy of the kidney. 93 . 14. 6. Review of Medical Physiology. 13. Glucose reabsorbtion. Regulation of the renal blood flow. The functional anatomy of nephron (Renal corpuscle. McGraw-Hill Companies. Tubular function. 2001. Loop of Henle. 9. Mechanism of tubular reabsorbtion and secretion. Fanconi’s syndrome. Normal GFR. Applied physiology. Factors influencing Na+ reabsorbtion. Potassium. – P. 8. Pressure in renal vessels. Inc. Na+ reabsorbtion. F. Function of the renal nerves. Bicarbonate reabsorbtion. Phosphate reabsorbtion. Tubuloglomerular feedback and glomerulotubular balance. Proximal tubule. 12. 4. Urea. 7. Glomerular filtration rate (GFR). Factors influencing the filtration. Water and electrolytes exchange Questions for discussion 1. Amino acid reabsorbtion. Water reabsorbtion. Distal nephron). Control of GFR. Books recommended 1. Ganong W. Kidney’s role in organism. 11. 2. 5. Renal circulation.PHYSIOLOGY OF EXCRETORY SYSTEM Practical class 1. 675-689. Regional blood flow. 3. uric acid. 12th ed.. 11. Emptying of the bladder. Disorders of water and electrolytes exchange Questions for discussion 1. E. The countercurrent mechanism. Water diuresis. Water intoxication. 13. Physiology of kidneys. Practical class 2. Microscopical examination. 3. Abnormalities of micturition. C. 14. 7. Reflex control. Role of urea. Effects of disordered renal function. Natriuretic factors). Hall J. Osmotic diuresis. Micturition. 6. Applied physiology. reaction). B. Effects of angiotensin. Anatomic considerations.2. color. 15. Textbook of Medical Physiology. 5. W. Effects of deafferentation. Saunders. 8. Guyton A. 9. Collecting ducts. 16. 12. specific gravity. Books recommended 94 . Effects of spinal cord transection. 4. 2. Proximal tubule. Alkaline tide. Factors controlling Na+ excretion by the kidney (changing the GFR. 2005. 10. Water excretion. Composition of urine (volume. Loop of Henle. Distal tubule. aldosterone. Renin angiotensin system. Effects of denervation. Normal GFR. Hall. Control of GFR. Glucose reabsorbtion. Regulation of the renal blood flow. – P. Proximal tubule. J. Amino acid reabsorbtion. “Physiology of kidneys. Disorders of water and electrolytes exchange” (intermediate oral examination). Blood flow. Factors influencing the filtration. 4. Loop of Henle. Glomerular filtration rate (GFR). 3. Water excretion. Regional blood flow.. Kidney’s role in organism. Tubular function. The significance of excretory system in adaptive reactions of the organism. 689-713. F. 2005. McGraw-Hill Companies. Factors influencing Na+ reabsorbtion. Cross anatomy of the kidney. Renal circulation. Renal corpuscle. Function of the renal nerves. Guyton. Practical class 3. C. Autoregulation of renal blood flow. Distal nephron. Mechanism of tubular reabsorbtion and secretion. 5.. E. 6. Inc. 2. B Saunders. Physiological aspects of renal circulation. Applied physiology. Physiological aspects of renal circulation. The significance of the topic for applied medicine. Review of Medical Physiology. The countercurrent mechanism. Ganong W. Textbook of Medical Physiology. 2001. Collecting ducts.1. Questions for discussion 1. Loop of Henle. 12th ed. Proximal tubule. The functional anatomy of nephron. 12th ed. Concluding class devoted to the themes “Water and electrolytes exchange”. 2. Pressure in renal vessels. A. Water reabsorbtion. 95 . Na+ reabsorbtion. W. Distal tubule. Glomerular filtration. Kidneys’ role in the human body. Osmotic diuresis. Effects of deafferentation. 9. Microscopical examination. 8. Fanconi’s syndrome. Factors controlling Na+ excretion by the kidney (changing the GFR. Composition of urine (volume. Effects of denervation. Effects of angiotensin. Effects of disordered renal function. Micturition. Anatomic considerations. Water diuresis. color. 10. 96 . Alkaline tide. Tubuloglomerular feedback and glomerulotubular balance. Role of urea. Water intoxication. Natriuretic factors). Emptying of the bladder.7. reaction). Renin angiotensin system. aldosterone. specific gravity. Abnormalities of micturition. Reflex control. Effects of spinal cord transection. TEST QUESTIONS Multiple Choice 1. 15. ANSWER: b 4. (b) maintaining proper plasma volume. (e) assisting in maintaining the proper acid-base balance of the body. pyramid. 12. (c) they excrete the metabolic waste products. (d) maintains proper osmolarity of body fluids. The functional unit of the kidney is the 11. 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. to maintain constancy in its composition. 13. ANSWER: b 3. (c) secreting aldosterone to regulate sodium. 4. afferent arteriole. glomerulus. 5. 14. juxtaglomerular apparatus. (e) they secrete several hormones. the fluid that bathes the cells. nephron. The specialized nephron capillary bed where filtration occurs is the 3. efferent arteriole. medulla. (d) they assist 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) excretion of metabolic wastes. glomerulus. (b) they act directly on the interstitial fluid. 97 . (c) their loops of Henle dip deep into the medulla. (e) they are not the predominant type of nephron found in human kidneys. (d) collecting duct in medulla. ANSWER: c 5. 1 98 . (b) long loops of Henle. (b) they are important in the ability of the kidneys to concentrate urine. Which of the following is not associated with juxtamedullary nephrons? (a) glomeruli located in medulla. Bowman's capsule 3. ANSWER: a 6. collecting tubule 4. (c) peritubular capillaries form vasa recta. (d) their peritubular capillaries form vasa recta. distal tubule 6. 5. 7. Which of the following statements about juxtamedullary nephrons is incorrect? (a) their glomeruli lie in the renal medulla. ANSWER: a 7. (e) important role in the ability of the kidneys to produce urine of varying concentration. ascending limb of loop of Henle 5. None of these answers. Below is a listing of nephron components and associated structures: 1. 2. 6. peritubular bed. 3. descending limb of loop of Henle 2.6. proximal tubule Indicate the correct flow of filtrate through these structures: (a) 4. Vasa recta are associated with 13. ANSWER: d 10. (d) All of these answers. 5. cortical nephrons. 3. (e) None of these answers. renal papillae. • proximal tubule. 2. 4. 6. (a) supply nutrients and O2 to the tubular cells. (b) take up the substances that are reabsorbed by the tubules. ANSWER: d 11. 6. 6. afferent arterioles. 1. 6 ANSWER: 8. 1. 99 . 5. • distal tubule. • glomerulus. 1. ANSWER: d 9. 5 (e) 2. Which nephron structure is especially important in the kidney's ability to produce urine of varying concentration? • Bowman' capsule. 17. 4 (d) 3. 16. efferent arterioles. 4. 4. (c) supply substances that are secreted by the tubules. juxtamedullary nephron. 3 (c) 2. 14. 1.(b) 2. • loop of Henle. The peritubular capillaries. 15. 3. The renal process whereby substances are selectively transferred from the peritubular blood into the renal tubule is • filtration. 5. (c) represents 60 to 65% of the cardiac output. The glomerular filtrate (a) is a protein-free plasma. (d) Both (a) and (b) above. The glomerular filtration rate (a) averages 125 ml/min. None of these answers. (b) averages 75 liters/day. (e) All of these answers. ANSWER: a 14. (b) all filtered through the glomeruli. (d) Both (a) and (b) above. excretion. (e) All of these answers. (b) is formed as a result of passive forces acting across the glomerular membrane. reabsorption. ANSWER: b 12.• • • • secretion. ANSWER: a 13. The blood that flows through the kidneys is (a) normally about 20 to 25% of the total cardiac output. ANSWER: d 100 . (e) All of these answers. (c) does not contain foreign compounds because these substances are secreted by special transport mechanisms in the proximal tubule instead. (d) Both (a) and (b) above. (c) all used to supply the renal tissue with O2 and nutrients. 30. autoregulation. ANSWER: c 17. (d) filtration slits. (c) can be varied by contraction of the podocytes and mesangial cells. The colloidal osmotic pressure is 18 mm Hg. The Bowman's capsular hydrostatic pressure is 24 mm Hg. The filtration coefficient (a) is a measure of the surface area and permeability of the glomerular membrane. (c) podocytes. ANSWER: e 16. (b) basement membrane. 31. 32. Both (a) and (b) above. vasoactive responses in the afferent arteriole. 33. (b) is a constant value.15. (d) Both (a) and (b) above. (e) Both (a) and (c) above. The net filtration pressure is ___ mm Hg. All of these answers. The glomerular capillary blood pressure in the nephron is 78 mm Hg. myogenic activity. (e) None of these answers. Filtrate passes through all of these except (a) glomerular capillary pores. Changes in the glomerular filtration rates are accomplished through 29. (a) 18 (b) 26 (c) 36 (d) 42 (e) 78 ANSWER: c 18. 101 . (b) an obstruction such as a kidney stone in the tubular system. 102 . which remain in the glomerular capillaries. (c) all of the plasma that enters the glomerulus is filtered. (e) All of these answers. ANSWER: b 22. are separated from blood cells and protein. ANSWER: c 20.ANSWER: e 19. ANSWER: a 21. electrolytes. (b) is the process by which plasma water. Glomerular filtration (a) occurs in the loop of Henle. Which of the following factors would decrease the GFR? (a) a fall in plasma protein concentration. vasodilation of the afferent arteriole. (d) Both (a) and (b) above. (d) Two of these answers. a high glomerular hydrostatic pressure. a large increase in blood colloid osmotic pressure. which enter Bowman's capsule. Which of the following statements concerning the process of glomerular filtration is correct? (a) Bowman's capsule hydrostatic pressure opposes filtration. 15. 17. (c) vasodilation of the afferent arterioles. (c) is the process by which a substance is transported from the tubular fluid to the peritubular capillaries. a low capsular hydrostatic pressure. (b) the glomerular filtration rate is limited by a Tm. vasocontraction of the efferent arteriole. Which factor would reduce the net filtration pressure the most? 13. 16. which increases Bowman's capsule hydrostatic pressure. and small molecules. 14. (e) None of these answers. (c) secretes renin. (b) consists of specialized arteriolar smooth-muscle cells in the juxtaglomerular apparatus. ANSWER: b 23. (e) Both (b) and (c) above. (e) All of these answers.3. (b) Bowman's capsule hydrostatic pressure. ANSWER: d 25. (d) Both (a) and (b) above. Which of the following is involved in autoregulation of the GFR? (a) a myogenic mechanism in which the afferent arteriole automatically constricts when it is stretched (b) a tubulo-glomerular feedback mechanism in which vasoactive chemicals released from the juxtaglomerular apparatus bring about afferent arteriolar vasoconstriction (c) sympathetically induced vasoconstriction of the afferent arterioles (d) Both (a) and (b) above. (e) Both (b) and (c) above. (d) Two of these answers. Which of the following forces oppose glomerular filtration? (a) blood colloid-osmotic pressure. ANSWER: d 103 . (e) All of these answers. (c) glomerular-capillary blood pressure. (d) Both (a) and (c) above. ANSWER: a 24. The macula densa (a) consists of specialized tubular cells in the juxtaglomerular apparatus. decrease. Both (a) and (b) above. Afferent arteriolar vasoconstriction __________ blood flow into the glomerulus. 7. ANSWER: b 29. 13. increase (b) decreases. Both (a) and (b) above. increase. 9. Extrinsic control of the GFR (a) is mediated by sympathetic nervous system input to the afferent arterioles. 11. results in vasodilation of the afferent arteriole. 12. (c) does not require a special mechanism but occurs as part of the baroreceptor reflex. increase. Stimulation of the macula densa cells 9. decrease. 104 . may result from stretching of vascular smooth muscle. increase. All of these answers. increases GFR. leading to a(n) __________ in the net filtration pressure and a resultant __________ in the GFR. 10. results in vasoconstriction of the afferent arteriole. Is an autoregulatory mechanism. decrease. increase. ANSWER: b 27. 6. The myogenic mechanism 5. decrease (d) decreases. 8. increase (e) None of these answers. which causes the glomerular-capillary blood pressure to __________. Both (a) and (c) above. (d) Both (a) and (b) above. causes the afferent arteriole to constrict when blood pressure is too high. decrease. decrease (c) increases. (b) is aimed at the regulation of arterial blood pressure. ANSWER: e 28.26. (a) increases. such as Na+. 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. (b) occurs by either active or passive transport. (d) involves the process of transepithelial transport. 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.(e) All of these answers. (e) takes place only in the proximal tubule. Tubular reabsorption (a) refers to the movement of a substance from the peritubular capillary blood into the tubular fluid. (c) involves the process of transepithelial transport. ANSWER: d 32. When arterial blood pressure is elevated above normal. and amino acids. ANSWER: e 105 . (d) Both (b) and (c) above. glucose. ANSWER: e 30. (c) can occur by active or passive transport mechanisms. (e) Both (b) and (c) above. Cl-. (b) is important for the conservation of substances important to the body. ANSWER: b 31. (e) All of these answers. ANSWER: e. 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. (b) basolateral membrane of tubular cells. (d) Both (a) and (c) above.33. Tubular reabsorption involves • active transport. (c) is considered to be active if any one of the five steps of transepithelial transport is active. • countertransport. • cotransport. ANSWER: e 34. 106 . (c) podocytes. Tubular reabsorption (a) involves the movement of substances from the peritubular capillaries into the tubular fluid. (b) involves the movement of substances from the tubular fluid into the peritubular capillaries. • facilitated diffusion. 35. (e) Both (b) and (c) above. • All of these answers. 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. None of these answers. 8. ANSWER: a 39. ANSWER: b 37. The proximal tubule (a) reabsorbs about 65% of the filtered water. amino acids. • None of these answers. (c) is the location where glucose is reabsorbed. 6. All of these answers. Into which structure does most reabsorption occur? • proximal convoluted tubule. Glucose is not normally found in the urine because: • does not get filtered out of glomerulus. ANSWER: d 38. sodium. • it is kept in the blood. 107 . • loop of Henle. (d) reabsorbs about 65% of the filtered water and is the location where glucose is reabsorbed. ANSWER: c 40. 5. (b) is not the site of action of renin. • it is reabsorbed by renal tubule cells usually.(d) glomerular capillary membrane. Which is reabsorbed by the proximal convoluted tubule? 4. • distal convoluted tubule. • glomerulus. • it is not found in the blood. (e) basement membrane. 7. glucose. • None of these answers. Tm is the maximum (a) rate of glomerular filtration. (b) is the maximum rate at which a substance is filtered at the glomerulus. (c) rate of urine excretion. ANSWER: b 43. Tubular maximum (Tm) (a) is the maximum amount of a substance that the tubular cells can actively transport within a given time period. (d) Both (a) and (c) above. ANSWER: c 108 . (c) occurs when the membrane carrier becomes saturated. (b) maximum amount of a particular substance that the tubular cells are capable of actively reabsorbing per unit of time. ANSWER: e 41. The renal threshold is the (a) maximum amount of a particular substance that can be excreted in the urine per unit of time.(e) All of these answers. (e) percentage of renal blood flow that can be converted to filtrate. ANSWER: d 42. (e) Both (b) and (c) above. (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. (b) rate a substance can be reabsorbed because of saturation of the carrier molecule. (d) rate a substance can be cleared from the blood. at a plasma concentration of 200 mg/100 ml). reabsorbed. Both (b) and (c) above. 9. (a) plasma proteins. and excreted? (a) 200 mg/min filtered. 0 mg/min excreted (d) 250 mg/min filtered. 10. Select the major waste product of nitrogen metabolism. 50 mg/min excreted (e) None of these answers. Tm = 125 mg/min. 8. 125 mg/min reabsorbed. 109 . ANSWER: b 47. 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 chloride 7. is passive. 200 mg/min reabsorbed. (b) urea. 46. 125 mg/min reabsorbed. (e) amino acids. (d) PO4. 125 mg/min excreted (c) 125 mg/min filtered. Both (a) and (b) above. is active. (c) glucose. is dependent on the amount of sodium reabsorbed.44. how much of substance X is filtered. 11. 75 mg/min excreted (b) 250 mg/min filtered. Given the following data for substance X (GFR = 125 ml/min. 125 mg/min reabsorbed. (e) All of these answers. ANSWER: d 49.ANSWER: b 48. The normal glucose concentration in the plasma is about________ mg per 100 ml. The juxtaglomerular apparatus (a) secretes renin in response to sodium depletion or plasma volume reduction. it contributes to the formation of concentrated urine. (a) 30 (b) 60 (c) 100 (d) 180 (e) 250 ANSWER: c 50. (d) Both (a) and (b) above. ANSWER: d 51.5% of sodium is reabsorbed on a daily basis. amino acid. • in the loop of Henle. • approximately 0. The juxtaglomerular apparatus 110 . (c) is where reabsorption of sodium occurs. and urea reabsorption in the proximal tubule. Which statement regarding sodium reabsorption is not accurate? • it plays a role in glucose. • aldosterone is a key hormone involved in facultative reabsorption. (b) is a thickened region of specialized cells at a point where the distal tubule comes into intimate contact with the afferent and efferent arterioles of the same nephron. • it is under hormonal control in the distal tubule. (d) Both (a) and (b) above. (c) stimulates K+ secretion in the distal tubule. (d) All of these answers.(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. Na+ reabsorption (a) uses 80% of the energy requirement of the kidney. (c) is linked to the reabsorption of water. ANSWER: e 53. (b) is stimulated by angiotensin II. ANSWER: b 54. (c) is controlled by the concentration of Cl-. (b) secretes aldosterone. (b) is secreted by the JG apparatus. Aldosterone secretion (a) occurs in the kidney. (e) Both (a) and (c) above. (c) secretes renin. (d) Both (a) and (b) above. and urea. (e) All of these answers. 111 . (b) is under control of the hormone aldosterone in the distal portions of the nephron. glucose. (e) Both (a) and (c) above. (e) None of these answers. Aldosterone (a) stimulates Na+ reabsorption in the distal and collecting tubules. (d) Both (a) and (b) above. ANSWER: e 52. Cl -. amino acids. The greatest percentage of Na+ reabsorption takes place in the (a) proximal tubule. sodium reabsorption is diminished. (c) angiotensin II. (b) is transformed into angiotensin II as a result of converting enzyme action in the lungs. ANSWER: a 56. Sodium reabsorption in the distal portions of the nephron is stimulated by (a) atrial natriuretic peptide. (e) renin. All of these answers. When blood volume becomes abnormally low 25. 29. 28. 26. 27. (d) Both (a) and (b) above. ANSWER: d 58. Angiotensin I (a) is formed as a result of activation of angiotensinogen by renin. (d) collecting tubule. (d) aldosterone. renin catalyzes the conversion of angiotensinogen. dilute urine is formed. 112 . (c) distal tubule.ANSWER: e 55. (c) acts on the adrenal cortex to stimulate aldosterone secretion. (e) renal pelvis. (b) vasopressin. (b) loop of Henle. aldosterone is secreted by the kidney. ANSWER: c 57. (e) All of these answers. 113 . is secreted by the heart when atrial pressure is high. inhibits aldosterone activity. 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 reduced. 7. 6. (d) ANP inhibits aldosterone secretion by the adrenal cortex. (b) run the Na+-glucose co-transport carrier. The energy requirement for glucose reabsorption is used to (a) run the Na+-K+ ATPase pump. ANSWER: e 62. ANSWER: a 60. Which of the following does not play a role in Na+ reabsorption? (a) renin. (b) ANP inhibits Na+ reabsorption in the distal parts of the nephron. (b) vasopressin. ANSWER: a 61.ANSWER: d 59. Both (a) and (b) above. 4. (c) ANP inhibits renin secretion by the kidneys. All of these answers. results in an increased glomerular filtration rate. 5. (e) ANP inhibits sympathetic nervous activity to the heart and blood vessels. (d) maintain the Tm for glucose. which controls glucose reabsorption. (c) synthesize renin. (e) produce aldosterone-induced protein. which increases the permeability of the proximal tubular cells to glucose. Atrial natriuretic peptide 3. (d) aldosterone. (c) occurs by active transport in the distal and collecting tubules. (b) the organic ion secretory systems. The distal and collecting tubules are the site of (a) the co-transport carriers for glucose and amino acid reabsorption. (b) only in the loop of Henle. ANSWER: b 63. Water reabsorption is under the control of vasopressin (a) along the entire length of the nephron. ANSWER: d 66. (d) Both (a) and (c) above. Which of the following statements concerning water reabsorption is correct? (a) water reabsorption is under control of vasopressin throughout the length of the nephron. (c) only in the distal and collecting tubules. (e) Both (b) and (c) above. (d) Both (a) and (b) above. (c) aldosterone and vasopressin action. ANSWER: c 65. ANSWER: c 64. (e) only in the glomerulus. (e) atrial natriuretic peptide. Water reabsorption (a) occurs passively by osmosis in the proximal tubule. 114 . (b) is under the control of vasopressin in the distal and collecting tubules. (e) All of these answers.(c) angiotensinogen. (d) only in the proximal tubule. (d) Both (a) and (b) above are correct. (d) fifteen percent of the filtered water osmotically follows the absorption of Na+ and other solutes in the proximal tubule. (d) Both (b) and (c) above. Urea (a) reabsorption occurs passively. (e) All of these answers. ANSWER: d 69. (c) is a waste product of protein metabolism. (e) water reabsorption is passive in the early portions of the nephron but is active in the distal portions of the nephron. 115 .(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. (c) is under vasopressin control in the proximal tubule. (b) is only 50% reabsorbed in the proximal tubule. ANSWER: b 67. ANSWER: e 68. Water reabsorption (a) cannot occur from any portion of the nephron in the absence of vasopressin. (b) occurs to the greatest extent in the proximal convoluted tubule. Urea (a) is the waste product with the smallest molecular size in the glomerular filtrate. (e) Both (b) and (d) above. (c) has a clearance rate greater than GFR. (b) is in greater concentration at the end of the proximal tubule than in other body fluids. (d) is under vasopressin control in the distal and collecting tubules. (d) Both (a) and (b) above. (d) of organic anions and cations occurs in the proximal tubule by two distinct types of carriers. When the extracellular fluid becomes too acidic. Tubular secretion (a) refers to the movement of a substance from the peritubular capillary blood into the tubular lumen. (e) All of these answers. (e) sodium ions increases. the tubular secretion of (a) no ionic substance is affected. ANSWER: e 70. (c) hydrogen ions increases. (c) of K+ occurs in the distal and collecting tubules and is stimulated by aldosterone. (b) can occur by active or passive transport mechanisms. (e) All of these answers. (b) hydrogen ions decreases. ANSWER: c 72. (b) is passively reabsorbed at the end of the proximal tubule down a urea concentration gradient created by the osmotic-induced reabsorption of water from the proximal tubule. ANSWER: e 71. (d) sodium ions decreases. (c) recycling between the late portion of the collecting tubule and the long loops of Henle contributes to medullary hypertonicity.(e) All of these answers. ANSWER: e 116 . Urea (a) is a waste product resulting from the breakdown of protein. (b) loop of Henle. Potassium (a) is actively reabsorbed in the proximal tubule. (e) Both (b) and (c) above. Tubular secretion (a) involves transepithelial transport. (b) is the movement of a substance from the peritubular capillary blood into the tubular fluid. (e) glomerulus. (c) always occurs by active transport. ANSWER: d 76. Tubular secretion is important (a) in the renal regulation of hydrogen ion concentration. (d) Both (a) and (b) above. ANSWER: a 75.73. (c) proximal tubule. (b) for the elimination of metabolic waste products from the body. ANSWER: e 117 . Tubular secretion of foreign substances such as drugs generally occurs in the (a) Bowman's capsule. (b) is actively secreted in the distal and collecting tubules. (e) All of these answers. (d) Both (b) and (c) above. (c) in the renal regulation of sodium balance. (e) All of these answers. ANSWER: d 74. (d) Both (a) and (b) above. (c) secretion is controlled by aldosterone. (d) collecting duct. (e) Both (b) and (c) above. what is the clearance of this substance? (a) 15 ml/min. Which substance is normally secreted into the tubule 2.7 mg/ml. (d) can not be determined with these data.3 ml/min. 3. (c) amount of a substance that is filtered in one minute of time. (c) 0. (d) amount of a substance secreted in one minute of time. 4. hydrogen ions. ANSWER: d 79. Plasma clearance is the (a) time required to filter blood in the glomerulus. (b) a decrease in plasma K+. (e) volume of plasma that is completely cleared of a substance by the kidneys in one minute of time. ANSWER: e 80. Which of the following stimulates aldosterone secretion? (a) an increase in plasma K+. (d) Both (a) and (c) above. Both (a) and (b) above.4 ml/min. and the urine flow rate is 1. 6. 118 . potassium ions.77. If a substance has a plasma concentration of 150 mg/ml and a urine concentration of 1. ANSWER: e 78. (c) activation of the renin-angiotensin pathway. (b) 196 ml/min. (b) amount of a substance appearing in the urine in one minute of time. All of these answers. organic ions 5. not reabsorbed. but secreted. and secreted. (c) filtered. 119 . Inulin is (a) filtered. (e) None of these answers.(e) None of these answers. reabsorbed. (d) reabsorbed by the tubules. (e) not filtered. (d) he collecting tubules of the juxtamedullary nephrons but not the cortical nephrons descend through the medullary vertical osmotic gradient before emptying into the renal pelvis. and not secreted. and not secreted. ANSWER: b 82. (b) filtered. reabsorbed. (b) neither reabsorbed nor secreted by the tubules. 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 multiplication. ANSWER: e 81. (d) filtered. (c) secreted by the tubules. (c) the countercurrent system establishes and maintains a medullary vertical osmotic gradient ranging from 300 to 1. ANSWER: b 83.200 mosm/liter. (b) the vasa recta enable the medulla to be supplied with blood while conserving the medullary vertical osmotic gradient by means of countercurrent exchange. not reabsorbed. 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. The ________ establish the medullary vertical osmotic gradient by means of countercurrent multiplication. The tubular fluid is __________ as it enters Bowman's capsule. (e) Both (a) and (c) above. (b) is highly impermeable to H2O. __________ at the beginning of the loop of Henle. The ascending limb of the loop of Henle of a juxtamedullary nephron (a) actively transports NaCl out of the lumen into the interstitial fluid. variable H2O reabsorption from the final tubular segments. 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 juxtamedullary nephrons (c) urea recycling between the late portion of the collecting tubule and the long loops of Henle ANSWER: a 87. __________ at the 120 .(e) the medullary vertical osmotic gradient permits excretion of urine of differing concentrations by means of vasopressin-controlled. (c) is always impermeable to H2O. (d) Both (a) and (b) above. ANSWER: d 84. (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. ANSWER: e 86. leaving water behind because the tubular cells are not permeable to water. and __________ as it leaves the loop to enter the distal tubule. 121 . ANSWER: d 90. (d) Both (a) and (b) above. • All of these answers. hypertonic. (c) K+ is secreted. (e) All of these answers. hypertonic. isotonic (b) isotonic. The ascending limb of the loop of Henle is where (a) NaCl passively leaves the tubular fluid down its concentration gradient. isotonic. isotonic. (d) aldosterone stimulates Na+ reabsorption. • Both (a) and (b) above. hypertonic. The vertical osmotic gradient in the kidney (a) is established and maintained by the countercurrent system. ANSWER: c 88. hypotonic. (c) is found in the renal cortex. (a) isotonic. isotonic (e) None of these answers.tip of the loop. hypotonic (d) hypertonic. • vasopressin causes facultative water reabsorption in distal tubule. ANSWER: e 89. • the counter-current mechanism pulls out much water. hypotonic (c) isotonic. (b) makes it possible to put out urine of variable concentration depending on the needs of the body by varying the degree of water permeability of the distal portions of the nephron. (b) NaCl is actively transported into the interstitial fluid. What mechanisms are responsible for producing concentrated urine? • the juxtamedullary nephrons become active. hypertonic. hypotonic. The ascending limb of the loop of Henle (a) actively transports NaCl into the surrounding interstitial fluid. (b) It is not secreted if the body consumes large amounts of water. (b) is impermeable to water. ANSWER: b 91. Select the incorrect statement about ADH. 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. Which part of the juxtamedullary nephron is responsible for establishing 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. (e) Both (a) and (b) above. (c) It is produced by the distal convoluted tubule. (e) It stimulates reabsorption of water. (c) is found in the renal cortex. (d) drains into the proximal convoluted tubule. and hypotonic as it leaves the loop of Henle. hypertonic at the tip of the loop. (d) It is secreted if the body fluids become hypertonic.(e) None of these answers. 122 . (a) It is also called vasopressin. (b) the filtrate is isotonic as it enters the loop of Henle. ANSWER: e 92. ANSWER: c 94. (b) increases the permeability of the distal and collecting tubules to water. hypertonic at the tip of the loop of Henle. (c) by means of countercurrent exchange. (e) None of these answers. (e) the filtrate is isotonic as it enters the loop of Henle. (c) increases the permeability of the late portion of the collecting tubule to urea. and hypotonic as it leaves the loop of Henle. ANSWER: b 96. (e) All of these answers. ANSWER: b 95. Which of the following statements concerning the countercurrent system 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 ascending and descending limbs at any given horizontal level.(c) the descending limb of the loop of Henle actively transports NaCl out of the tubule into the interstitial fluid. (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. ANSWER: e 123 . Vasopressin (a) secretion is stimulated by a water deficit. (d) Both (a) and (b) above. the vasa recta preserve the vertical osmotic gradient while supplying blood to the medullary tissue. which governs their permeability. (d) All of these answers. (c) is inhibited when the arterial blood pressure is dangerously low. (c) renders the distal and collecting tubules impermeable to water. (b) increases the permeability of the distal and collecting tubules to water. Vasopressin (a) can completely halt urine production during periods of water deprivation to conserve water for the body. The osmoreceptors contributing to water balance are located in the (a) adrenal cortex. (c) juxtaglomerular apparatus. (d) renal cortex. (d) increases Na+ reabsorption by the distal portions of the nephron. (d) Both (a) and (b) above. Vasopressin (a) is produced in the hypothalamus. ANSWER: d 100. ANSWER: b 99. (e) All of these answers. (b) is stimulated when the body fluids are hypertonic. (b) hypothalamus. (d) Both (b) and (c) above. (e) stimulates the active salt pump of the ascending limb of the loop of Henle to establish the medullary vertical osmotic gradient. Vasopressin secretion (a) induces the kidneys to produce a small volume of concentrated urine. (b) activates the cyclic AMP second-messenger system within the tubular cells. (c) secretion is stimulated by a water deficit in the body. ANSWER: e 98. (e) All of these answers. 124 .97. (e) collecting tubule. 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: b 101.(e) renal medulla. renal pyramids ANSWER: d 102. ANSWER: e 104. Excretion (a) is the removal of substances that were filtered at the glomerulus or secreted but not reabsorbed. vasa recta (c) podocytes. (c) descending limb of the loop of Henle. vasopressin (e) renin-angiotensin-aldosterone system. The segment of the nephron that is not permeable to H2O even in the presence of vasopressin is the (a) proximal tubule. peritubular capillaries (d) medullary vertical osmotic gradient. (d) distal tubule. ANSWER: b 103. (b) ascending limb of the loop of Henle. (a) Na+-K+ ATPase pump. co-transport carriers (b) juxtaglomerular apparatus. The __________ and __________ enable the kidneys to produce urine of varying concentrations and volumes depending on the body's needs. 125 . (c) conserves substances that are important to the body. (e) is controlled by sympathetic activity. Urine moves from the kidneys to the urinary bladder through the ureters (a) by active transport. The urinary bladder (a) is a temporary storage site for urine. is a parasympathetic reflex. ANSWER: a 105. 13. (b) passively by the force of gravity. which stimulates stretch receptors that initiate the micturition reflex. (c) contracts when parasympathetic nerves stimulate it. (b) wall is stretched by 200 to 400 ml of urine. (e) None of these answers. ANSWER: c 106. (d) occurs by active transport of substances into the urinary bladder. 11. (d) when the bladder empties and creates a negative pressure that pulls the urine to the bladder. ANSWER: d 126 . (c) by peristaltic contraction of the smooth muscle of the ureters. 12. is the process of emptying the bladder. Micturition 10. ANSWER: e 107.(b) is the process by which a substance moves from the peritubular capillary blood to the tubular fluid. Both (a) and (b) above. All of these answers. is initiated when stretch receptors in the bladder wall are excited. (d) All of these answers. (e) None of these answers. 14. (d) Both (a) and (b) above. ANSWER: d 109.108. (b) voluntary stimulation of the motor neuron supplying the external urethral sphincter. When the bladder of an infant is filled with urine. ANSWER: d 110. (b) parasympathetic nerve supplying the bladder is inhibited. causing the sphincter to close. the stretch receptors are stimulated and send afferent impulses to the spinal cord that (a) stimulate parasympathetic nerves. causing the sphincter to open. (d) Both (a) and (b) above. (c) motor neuron supplying the external urethral sphincter is stimulated. (c) stimulate nerves that go to the kidney and prevent glomerular filtration until the bladder is empty. (e) parasympathetic nerve supplying the internal urethral sphincter is stimulated. (e) All of these answers. the (a) stretch receptors in the bladder wall are inhibited. (c) voluntary stimulation of the internal urethral sphincter via its parasympathetic nerve supply. (d) motor neuron supplying the external urethral sphincter is inhibited. ANSWER: d 127 . (b) inhibit the motor neurons that normally keep the external urethral sphincter closed. which return to the bladder and cause it to contract. When the bladder wall is distended as a result of urine accumulation. allowing the bladder to relax. allowing the sphincter to open. The process of preventing micturition in spite of initiation of the reflex involves (a) the cerebral cortex. (e) All of these answers. ANSWER: a True/False 112. and excretion.111. (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. The kidneys are the organs that are primarily responsible for maintaining constancy of the volume and electrolyte composition of the internal fluid environment. Which of the following does not occur during the micturition reflex in a baby? (a) the motor neuron supplying the external sphincter is stimulated. The kidneys keep the urine volume and composition essentially constant. ANSWER: False 114. Only juxtamedullary nephrons contain a juxtaglomerular apparatus. (d) the external urethral sphincter is relaxed. ANSWER: False 115. (e) the bladder contracts. The afferent arteriole is the blood vessel that carries blood to the glomerular capillaries. ANSWER: True 116. reabsorption. ANSWER: False 128 . ANSWER: True 113. The three major processes involved in urine formation are filtration. ANSWER: True 129 . blood is filtered in the cortex. Twenty-five percent of the cardiac output goes to the kidneys because of their tremendous nutrient requirement for the active transport of Na+. In the kidney. drains through the renal pelvis into the renal medulla. All of the plasma that enters the glomerulus is normally filtered into Bowman's capsule except for the plasma proteins. ANSWER: False 120. The glomerular filtrate is almost identical in composition to the plasma.117. ANSWER: False 121. Glomerular filtration occurs primarily by active transport. ANSWER: False 122. ANSWER: False 123. ANSWER: True 118. 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. Plasma proteins are normally filtered in the nephron. ANSWER: False 119. and from there travels in the ureter to the urinary bladder. the 130 . ANSWER: False 127. ANSWER: True 131. Blood pressure in the glomerular capillaries is the same as in capillaries elsewhere in the body. The vast majority of the filtered fluid is reabsorbed. The glomerular capillary blood pressure is higher than capillary pressure elsewhere in the body primarily because the afferent arteriole has a larger diameter than the efferent arteriole. ANSWER: True 125. which then creates an osmotic gradient for the filtration of water. 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: False 128. The glomerular filtrate contains only substances that are not needed by the body. Glomerular filtration occurs by active transport of Na +.124. ANSWER: False 130. If a kidney stone blocked the renal pelvis and consequently caused a build-up of fluid pressure in the tubules and Bowman's capsule. ANSWER: True 126. ANSWER: True 129. The Bowman's capsule hydrostatic pressure opposes filtration. In general. Because of autoregulation. Autoregulation of the GFR is accomplished by activation of the sympathetic nervous system. ANSWER: False 136. electrolytes. ANSWER: True 131 . ANSWER: True 137. Autoregulation is important to prevent unintentional shifts in the GFR that could lead to dangerous imbalances of fluid. The pores in the glomerular membrane are too small for albumin to pass through. changes in mean arterial blood pressure between the range of 80 to 180 mm Hg do not directly produce changes in the GFR. and wastes. The glomerular capillary wall contains filtration slits formed by the clefts between the foot processes of adjacent podocytes. ANSWER: False 132.net filtration pressure across the glomerular capillary membrane would increase. ANSWER: True 133. ANSWER: False 135. ANSWER: False 134. The kidneys receive a disproportionately large share of the cardiac output for the purpose of adjusting and purifying the plasma. ANSWER: False 144. By tubular secretion. ANSWER: False 143.When a substance is reabsorbed. ANSWER: True 140. it moves from the tubular fluid into the peritubular capillaries. Transepithelial transport occurs only for substances that are actively reabsorbed. Contraction of mesangial cells closes off a portion of the filtering capillaries. 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: False 132 . which leads to a decrease in GFR if the filtration pressure remains unchanged. substances leave the blood and enter the tubular portion of the nephron. ANSWER: True 139. In active reabsorption.138. ANSWER: True 142. ANSWER: True 141. all of the steps involved in transepithelial transport are active. The Tm represents the maximum amount of a particular substance that can be excreted in the urine per unit of time. ANSWER: False 147. The renal threshold for glucose is well above the normal plasma glucose concentration. The secretion of aldosterone stimulates the tubular reabsorption of sodium and the tubular secretion of potassium. The renal threshold represents the maximum amount of a particular substance that the tubular cells are capable of actively reabsorbing per unit of time. The amount of glucose reabsorbed is directly proportional to the plasma glucose concentration at all plasma glucose concentrations. all of the steps of transepithelial transport require energy expenditure. The tubular cells display a Tm for urea. but the renal threshold for PO 4 is equal to the normal plasma PO4 concentration. H+ secretion increases. During acidosis. The amount of glucose filtered is directly proportional to the plasma glucose concentration at all plasma glucose concentrations. ANSWER: True 152. ANSWER: False 150.145. ANSWER: True 151. ANSWER: True 146. 133 . ANSWER: False 148. For a substance to be actively reabsorbed. ANSWER: False 149. A rise in ECF K+ concentration leads to increased excitability of heart muscle. ANSWER: True 154. Vasopressin increases H2O reabsorption in the proximal tubule. ACE inhibitor drugs promote diuresis by blocking the conversion of angiotensin I into angiotensin II. ANSWER: False 155. The secretion of vasopressin increases if the extracellular fluid becomes hypertonic. ANSWER: True 159. ANSWER: True 156. The Na+ cotransport system in the proximal tubule facilitates elimination of foreign organic compounds from the body. Water reabsorption cannot occur from any portion of the nephron in the absence of vasopressin. ANSWER: False 134 .ANSWER: True 153. possibly producing fatal cardiac arrhythmias. ANSWER: False 158. Urea is passively reabsorbed down the osmotic gradient created by active Na+ reabsorption. ANSWER: False 157. ANSWER: False 163. ANSWER: False 166. ANSWER: True 161. whereas glomerular filtration is not. Tubular secretion involves the movement of substances from the peritubular capillary blood into the tubular fluid. Tubular reabsorption and tubular secretion are highly selective processes. ANSWER: True 167. The clearance rate for a substance that is filtered and secreted but not reabsorbed is greater than the GFR. The liver converts many foreign organic compounds into an anionic form that can be secreted by the organic anion secretory system. 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 165. If a substance is filtered and secreted but not reabsorbed its plasma clearance rate is always less than the GFR. ANSWER: True 162. The clearance rate for inulin is greater than the GFR. Angiotensinogen is produced by the kidney. ANSWER: True 164.160. ANSWER: False 135 . ANSWER: True 174. ANSWER: True 169. ADH release is the main stimulus for the secretion of aldosterone. The receptor sites for vasopressin binding are located on the basolateral border. When tubular fluid enters the distal tubule. solute reabsorption is always accompanied by comparable H2O reabsorption. The permeability and transport properties of the loops of Henle of juxtamedullary nephrons are important in establishing the vertical osmotic gradient in the renal medulla. ANSWER: False 175. ANSWER: False 173. The osmolarity of the medullary interstitial fluid always equilibrates with the descending limb of the loop of Henle. In the tubular segments permeable to H2O. ANSWER: True 170. ANSWER: True 171.168. NaCl is actively transported from the descending limb of the loop of Henle to establish the medullary osmotic gradient. it is hypotonic. The driving force for H2O reabsorption across all permeable segments of the kidney tubule is an osmotic gradient. ANSWER: True 172. ANSWER: True 136 . yet the end result is an increase in H2O permeability of the luminal border of the tubular cells. 200 mosm/liter. The presence of vasopressin acts to prevent the reabsorption of water from the distal and collecting tubules. Aldosterone promotes water reabsorption by controlling the reabsorption of salt. ANSWER: True 180. Because of countercurrent multiplication. whereas chronic renal failure is not reversible. 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. Urine moves from the kidneys to the urinary bladder through the ureters passively by the force of gravity. 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 osmolarity. 137 . Changes in the osmolarity of the extracellular fluid are detected by osmoreceptors in the hypothalamus. ANSWER: True 182. ANSWER: True 177. Acute renal failure may be reversible. ANSWER: False 178.176. ANSWER: True 179. the loop of Henle is able to establish a vertical osmotic gradient in the renal medulla ranging from 300 to 1. ANSWER: True 181. The smooth muscle of the bladder is innervated by parasympathetic fibers. The micturition reflex controls bladder emptying in adults. Vasopressin is secreted from the anterior pituitary gland. ANSWER: False 186. ANSWER: True 187.ANSWER: False 183. When urine is eliminated from the body. the motor neuron supplying the external urethral sphincter is stimulated. ANSWER: False 190. The average rate of urine formation is 1 ml/min. ANSWER: True 185. ANSWER: False 188. the sphincter muscles in the urethra relax. 138 . During the micturition reflex. ANSWER: False 189. ANSWER: False 184. The epithelial lining of the bladder passively stretches to accommodate a larger volume during bladder filling. One can deliberately prevent urination in spite of the micturition reflex by voluntarily inhibiting the parasympathetic supply to the bladder to halt bladder contraction. juxtaglomerular apparatus. net filtration pressure 196. ANSWER: Kf. Tubular __________ and tubular __________ are selective processes that occur in the nephron. they secrete vasoactive chemicals that influence the GFR by making adjustments in the caliber of the _________ arterioles. ANSWER: cortex. tubuloglomerular 139 . ANSWER: reabsorption. afferent. This is known as the ____________ feedback mechanism. GFR = _____________ x _______________. secretion 195.ANSWER: True Fill in the Blank 191. medulla 194. The specialized cells of the ____________ within the ___________ detect changes in the rate at which fluid is flowing past them through the tubule. ANSWER: macula densa. The two regions of the kidney are an outer ___________ and an inner ______________. The functional unit of the kidneys is the ____________. ANSWER: urethra 193. In response. ANSWER: nephron 192. Urine is eliminated from the bladder through the _________. The _______ transforms many foreign organic compounds into ionic form. ANSWER: autoregulation 199. the filtered load of this substance is ____________. If the plasma concentration of substance X is 200 mg/100 ml and the GFR is 125 ml/min. 50 mg/min 201. ANSWER: mesangial 203. ________ is a group of intrinsic mechanisms in the kidneys that prevent changes in the GRF. ANSWER: renal threshold 202. Each tuft of glomerular capillaries is held together by ________ cells. 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. 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 ______________. basolateral 198. The energy-dependent step in Na+ reabsorption involves the ________________ located at the ______________ membrane of the tubular cell.197. If the Tm for substance X is 200 mg/min. ANSWER: 250 mg/min 200. which facilitates their elimination from the body because such 140 . ANSWER: Na+-K+ pump. _________ are water channels in the tubular cells of the nephron. Vasopressin is also known as ______________. and ______________ ml/min is excreted as urine. On the average. ANSWER: 124. ANSWER: peritubular capillaries 206. ______________ ml/min is reabsorbed. indicative of its effect on the kidneys. vasopressin 210. ANSWER: para-aminohippuric acid 208. ANSWER: Aquaporins 209. The plasma clearance of the harmless _____________ is equal to the GFR. ___________ % of the filtered H2O is variably reabsorbed under the control of the hormone ______________ in the distal and collecting tubules. ANSWER: twenty. By reabsorption. substances leave the tubules of the nephrons and return to the blood in the ________. 141 foreign compound . 1 205. ANSWER: liver 204. The plasma clearance of the organic anion ________________ is equal to the renal plasma flow. of the 125 ml/min of plasma filtered.conversion enables them to be secreted by the organic anion transport system. ANSWER: inulin 207. Body fluids are ________ at 300 mosm/liter. osmotic diuresis 213. and irreversible. _____________________ refers to increased excretion of both H2O and solutes. _________ is an actively reabsorbed substance that does not have a tubular maximum for reabsorption. ANSWER: Acute. _________ % of the renal tissue can adequately perform all excretory and regulatory functions of the kidney. urine excretion 217. _______________ is the inability to prevent the discharge of urine. progressive. ANSWER: twenty-five 215. ANSWER: sodium 212. tubular secretion. Two means by which substances can leave the kidney tubules are __________ and __________. ________________ renal failure is slow. __________________ renal failure has a rapid onset but may be reversible. ANSWER: glomerular filtration. ANSWER: urinary incontinence 216. chronic 214. tubular reabsorption. ANSWER: isotonic 142 .ANSWER: antidiuretic hormone 211. Two means by which substances can enter the renal tubules are _________ and _________. ANSWER: water diuresis. ________________ is increased urinary output of H2O with little or no increase in excretion of solutes. 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. 143 _____ 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. _____ Represents 25% of Na+ reabsorbed. _____ Represents 8% 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 capillaries. (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 control. (o) Responsible for the vertical osmotic gradient in the medulla of the kidney. (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 144 ____ ____ ____ ____ ____ ____ ____ ____ ____ 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 using 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 145 f.(f) H+ _____ Filtered and actively reabsorbed but not secreted _____ Filtered and passively reabsorbed. c. e. a. _____ Filtered and both actively re-absorbed and actively secreted. ANSWER: b. _____ Filtered and secreted. c. Indicate whether the factor in question would ultimately lead to an increase. (a) an increase in Na+ reabsorption (b) a decrease in Na+ reabsorption _____ a precipitous fall in arterial blood pressure as during hemorrhage _____ a reduction in total Na+ load in the body 146 . e 226. but not reabsorbed. b. _____ Filtered but not reabsorbed or secreted. or a decrease in Na + reabsorption by means of the renin-angiotensin-aldosterone mechanism. d 225. (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. a. _____ Not filtered. Match urinary system feature with correct characteristic. _____ a reduction in ECF volume ANSWER: a. _____ Is secreted from the granular cells of the renal juxtaglomerular apparatus. c. _____ Its secretion is directly stimulated by a low plasma K + concentration. b. _____ Stimulates K+ secretion by the distal and collecting tubules. e. _____ Is secreted by the adrenal cortex. e. 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. e. b. (a) renin (b) angiotensinogen (c) angiotensin I (d) angiotensin II (e) aldosterone (f) atrial natriuretic peptide _____ Directly stimulates Na+ reabsorption by the distal and collecting tubules. a. _____ It inhibits Na+ reabsorption by the renal tubules. d 228. _____ Is acted upon by renin. _____ Is acted upon by converting enzyme. 147 . a 227. a. e. ANSWER: e. f. Match chemicals below with the correct characteristic. _____ Is produced by the liver. _____ Its secretion is directly stimulated by angiotensin II. _____ Is a potent constrictor of arterioles. 4. a. a. What are the pathological effects of renal failure? 148 . The distal and collecting tubules in the absence of vasopressin are ______ to H2O. Describe the mechanisms by which the kidney produces concentrated urine. Compare and contrast renal actions at the proximal and distal tubule. b. 3. Describe micturition in an adult and baby. The vasa recta is ______ to salt and ______ to H2O. a Essay Questions 1. The distal and collecting tubules in the presence of vasopressin are ______ to H2O. ANSWER: b. 5. a. Explain how glomerular filtration rate is regulated.The descending limb of Henle's loop is ______ to H2O. 2. For notes 149 . For notes 150 . For notes 151 . 400120. И. Заказ 681./факс: +7 (8442) 94-44-80. Подписано в печать 29. ул.06. Печать офсетная. Тираж 200 экз.2012. Петрова Ответственный редактор — Клаучек Сергей Всеволодович Дизайн — Кудрин Р. Формат 60х84 1/16. л. 152 . 71а Тел. 8. А. Волгоград. Отпечатано в типографии издательства ООО «Принт». 93-13-53. Кузнецкая. Practical manual in normal physiology Руководство к практическим занятиям по нормальной физиологии Под редакцией академика РАМН В.Particular problems of physiology Частные вопросы физиологии Guide book.8. печ. Вёрстка — Кудрин Р. Усл. А.