Physiology
II - PB 3325
Course
Director: Mrs. Kay Brashear
STUDY
GUIDE
Exam 2
Lecture
material from lecture outline 2 and 3 will also be covered on this exam.
This
means anything concerning the ECG can be found on the exam.
Lecture Outline 4 Arrhythmias
1. How do you
determine
if an arrhythmia originates in the atrium, A-V node or in the ventricle?
2. Be able to list the
supraventricular arrhythmias. (bradycardia, tachycardia, sinus
arrhythmias:
non-respiratory and respiratory.)
3. Know the characteristics
of the three atrioventricular blocks:
first degree
second degree
third degree
4. What is an ectopic
focus and what does it cause?
How are a compensatory
pause and pulse deficit related to an ectopic focus?
5. What is reentry and
what kinds of arrhythmias are caused by reentry?
6. What is Wolf-Parkinson-White
Syndrome? the bundle of Kent? delta wave?
7. Know the major arrhythmias
associated with reentry. Paroxysmal tachycardia, flutter and
fibrillation.
Lecture Outline 5 Heart Sounds
1. Know the
difference
between concentric and eccentric hypertrophy. How does the
ventricle
change with each type of hypertrophy. What are the major causes
of
each type of hypertrophy?
2. Know the areas for
auscultation for sounds associated with the closure of all four valves.
3. Know the characteristics
of the four heart sounds: S1, S2, S3 & S4.
4. What causes S2 to
split? Which valve closes first?
5. What is a gallop rhythm?
6. What sounds are associated
with a mild and severe mitral prolapse?
7. For Aortic stenosis
and regurgitation, know if the murmur occurs in diastole or systole and
the location for auscultation. Can you describe the characteristics of
the murmur ( harsh, blowing, machinery, low frequency, etc.? ( Remember
the W's : where, when and what kind of sound) What are the
primary
pathologies associated with stenosis? regurgitation?
8. For mitral stenosis
and regurgitation, know if the murmur occurs in diastole or systole and
the location for auscultation. What are the primary pathologies
associated
with stenosis? regurgitation? Can you describe the
characteristics
of the murmur?
9. Know the left to right
shunts, when and where you would hear a murmur.
10. Know the characteristics
of a right to left shunt.
Case Studies:
Use the following case studies to determine if you understand the major murmurs.
Case A
During a physical
you
notice that there is an audible murmur at the apex of the heart. The
murmur
is best heard with the bell of the stethoscope or the low frequency
setting.
The murmur is detected during ventricular diastole. The ECG
indicates
left atrial hypertrophy.
What is your diagnosis?
Case B
During a physical you hear a murmur at the second intercostal space just to the right of the sternum. The murmur is loud and harsh and is detected during ventricular systole. The ECG shows a wide QRS complex that has a higher than normal voltage. What is your diagnosis? In addition to the murmur, what else might be associated with this murmur?
Answer: Case A
Both atrial stenosis and regurgitation are auscultated at the apex of the heart. Both also are best heard with the bell of the stethoscope or low frequency setting. If the murmur is detected during ventricular systole it must be mitral stenosis. The murmur associated with mitral regurgitation is detected during ventricular systole. Both conditions will cause atrial hypertrophy.
Answer: Case B
The second
intercostal
space, right of sternum is the auscultatory site for the aortic
semilunar
valve. The harsh, loud systolic sound is characteristic of aortic
stenosis. The ECG evidence is related to left ventricular hypertrophy
resulting
from aortic stenosis. usually, if the chest is palpated a thrill can be
felt.
Lecture
Outline 6 Vascular Flow and Resistance
Lecture exam review based
on the material in Guyton and on the lecture outline. Check Dr.
Parker's
notes for other concepts, diagrams or numerical data that you need to
know.
1.
Know the functions of the circulation.
2.
Know the two circulations and the divisions of the circulatory tree.
3.
How does the structure of blood vessels relate to the function of the
vessels?
a. what are resistance vessels?
b. capacitance vessels?
4.
Know the volumes of blood in each section of the circulatory tree.
5.
How does a change in the total cross-sectional area of part of the
circulatory
tree affect velocity of flow?
6.
What is the formula for velocity? Know how to calculate blood velocity
through a section of artery or vein given blood flow and cross
sectional
area for the section.
7.
What areas of the circulation have the largest cross-sectional area?
8.
In what part of the circulation does blood flow cease to be pulsatile?
9.
Where is the largest decrease in blood pressure and the pulse pressure?
10.
What controls flow? cardiac output?
11.
Know the equations for Flow and Resistance. (The formula explains the
concept)
12.
Know which variable in the flow equation is the most important as far
as
the human body is concerned.
13.
How do vasoconstriction and vasodilation affect resistance to flow?
14.
What is a PRU and what is normal for the systemic circulation?
pulmonary
circulation?
15.
Know how to calculate resistance based on series or parallel
arrangement.
16.
What are the characteristics of laminar flow? of turbulent
flow?
What causes turbulent flow?
17.
Know what the Reynold’s number is and how it is used.
18.
Know the relationship between blood hematocrit and viscosity.
19.
What effect does the diameter of a vessel have on viscosity? (
Fahraeus-Lindquist
effect)
Lecture
Outline 7 – Vascular Distensibility and Blood Pressure
Lecture exam review based
on the material in Guyton and on the lecture outline. Check Dr.
Parker's
notes for other concepts, diagrams or numerical data that you need to
know.
1. Know the
definition
of distensibility. Why is distensibility important to flow? Be
able
to calculate distensibility.
2. Know the definition
of compliance. Why is compliance important? Be able to calculate
vascular
compliance.
3. Be able to answer
questions about the Volume-Pressure Curves.
4. What is delayed compliance?
why is it important in the circulation?
5. Know how stroke volume
and compliance are related to pulse pressure
what happens
to the pulse pressure if they are changed?
6. Review the abnormal
pulse pressure contours. Know the causes for a weak pulse, strong
pulse, pulsus paradoxus, and pulse deficit.
7. Know how a pulse pressure
is transmitted through the systemic circulation. What causes
damping
of a pulse pressure?
8. Know how to
calculate pulse pressure and mean arterial pressure. What are the
two factors that determine the MAP?
9. Know Korotkoff
sounds – What causes them? - How are they used in the auscultatory
method
of taking arterial blood pressure?
10. Why does aging affect
the systolic pressure? diastolic pressure? MAP?
11. What is the right
atrial pressure or central venous pressure? What should that
recorded
pressure be? What factors determine the RAP or CVP?
12. Describe the resistance
in the venous system. What are some of the causes of resistance
in
the venous system?
13. What is the average
pressure in the venous system?
14. What is mean systemic
filling pressure (MSFP) ? What is its importance?
15. What is the effect
of intrathoracic pressure on venous resistance?
16. Know how hydrostatic
pressure operates in both the arterial and venous system.
17. Know the impediments
to venous return to the heart.
18. What are the specific
venous blood reservoirs? What factor can change the volume of
blood
in the venous blood reservoirs?
Lecture
8 – Microcirculation
Lecture exam review based
on the material in Guyton and on the lecture outline. Check Dr.
Parker's
notes for other concepts, diagrams or numerical data that you need to
know.
1. Know the pattern
of
flow through a capillary bed.
2. Know the function
of all of the components of a capillary bed beginning with an arteriole.
3. Know the structure
of a capillary wall and how the structure relates to flow through the
capillary.
4. Describe the characteristics
of capillary blood flow.
5. Know the different
types of capillary beds and where they occur.
6. What are the three
factors listed in the outline that affect diffusion through a capillary?
7. Know the structure
of the interstitial space (solid structures, gel & free fluid)
8. What is the role of
plasma proteins and interstitial fluid in controlling plasma and
interstitial
fluid volumes?
9. Know what bulk
fluid flow is.
10. Know Starling’s
law of the capillary. How does each of the factors affect the
direction
of flow? How does the filtration coefficient of the tissue affect
bulk flow?
11. Know how to
calculate bulk fluid flow, to get net reabsorption, or net filtration.
12. Know how changes
in either arteriole or venous pressures affect capillary net filtration
or net reabsorption.
13. Know the lymphatic
system general anatomy and how lymph is formed.
14. What are the factors
listed on the lecture outline that affect the rate of lymph flow?
15. How does the lymphatic
system affect bulk fluid flow?
16.. Know how the
lymphatic system acts as a safety system to prevent edema.
Copyright, Kay
Brashear
and James B. Parker, 1999