NURS 231 PATHOPHYSIOLOGY FINAL EXAM QUESTIONS AND ANSWERS LATEST 2024- PORTAGE LEARNING, Exams of Nursing

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NURS 231 PATHOPHYSIOLOGY FINAL EXAM

QUESTIONS AND ANSWERS LATEST 2024-

PORTAGE LEARNING

Version 1

1. The definition of pharmacology is: a. the study of the formulation of drugs b. the study of farming techniques c. the study of drugs including the actions and effects in living systems d. the study of pharmacy
2. Useful drugs have which of the following properties and attributes? a. Affinity, toxicity and specificity b. Potency, selectivity and specificity c. Potency, toxicity and efficacy d. Toxicity, efficacy and formulation
3. Potency refers to: a. a drug's ability to produce effect b. the narrowness of a drug's range of action c. the amount of drug required to produce an effect d. a drug's ability to produce adverse reactions
4. The approved (generic) name of a drug is: a. a name that is protected by copyright b. a precise description of the drug's chemical composition and molecular structure c. the name used to market the drug d. the official drug name assigned by the manufacturer and approved by local regulatory authority
5. Drugs are classified by all of the following methods, except: a. clinic use b. chemical formula c. manufacturer d. mechanism of action

6. Over-the-counter drugs are available: a. in general stores and supermarkets b. from a pharmacy assistant c. with a prescription d. in pharmacies, supermarket and general stores
7. In what source would you find information about specific drugs relevant to a particular country? a. Pharmacopoeias b. Compendiums c. Encyclopedias d. Formularies
8. If a drug binds to beta2 adrenoceptors and does not act at any other receptors (even in higher doses), that drug would be described as exhibiting high: a. affinity b. specificity c. selectivity d. potency
9. Which of the following is not a primary target of drug action? a. carriers b. enzymes c. hormones d. receptors
10. Type 4 receptors are: a. ligand-gated channels b. G-protein coupled c. nuclear d. kinase linked
11. Which factor is considered to be a part of the pharmaceutical phase of drug administration? a. dissolution b. absorption c. excretion d. metabolism

12. The correct sequence of pharmacokinetic phases a drug may pass through: a. administration, inhalation, absorption and excretion b. formulation, absorption, metabolism and excretion c. disintegration, absorption, elimination and expiration d. absorption, distribution, metabolism and excretion
13. Bioavailability is defined as the: a. proportion of dose reaching the receptor intact b. proportion of dose reaching the system circulation intact c. proportion of dose metabolised by the liver d. proportion of dose excreted by the kidneys
14. Which factor cannot directly affect the rate of metabolism? a. genetic mutation b. age c. route of administration d. disease state
15. Which of the following statements is true of the elimination process? a. Unchanged molecules may be excreted b. Cardiac failure leads in increased excretion c. The distal tubule is the main site of active secretion d. Alkalinisation of the urine may promote excretion of basic drugs

Version 2

1. What are the 3 key concepts?
   1. Proteins
   2. Homeostasis
   3. Cell membrane
2. How does a synapse work (4)?
   1. Action potential arrives at axon terminal
   2. Voltage gated calcium channels open and calcium enters the axon terminal
   3. Calcium entry causes synaptic vesicles to release neurotransmitters by exocytosis
   4. Neurotransmitter diffuses across the synaptic cleft and binds to specific receptors on the postsynaptic membrane
3. What are the 2 divisions of the ANS?
   1. Sympathetic
   2. Parasympathetic
4. What is the role of the sympathetic nervous system (3)?

1. Fight or flight
2. Turns on when you are stressed or exercising
3. Increases heart rate, causes sweating, increased respiration, etc
4. What is the role of the parasympathetic nervous system (2)?
5. Rest and digest
6. Causes digestion, urine release, etc
7. What are similarities of the sympathetic and parasympathetic systems (3)?
8. Both are automatic
9. Both part of the motor (efferent) division of the PNS
10. They control smooth muscle, cardiac muscle, and glands
11. Where is smooth muscle commonly found (5)?
12. Digestive system
13. Respiratory tract
14. Reproductive system
15. Urinary tract
16. Small blood vessels
17. Where does the parasympathetic division arise from (3)?
18. Cranial nerves and spinal nerves
19. Sacral spinal nerves 2, 3, and 4
20. Cranial nerves 3, 7, 9, and 10
21. Where does the sympathetic division arise from (2)?
22. Spinal nerves only
23. All thoracic spinal nerves and lumbar nerves 1 and 2
24. What does the ANS innervate in general (3)?
25. Cardiac muscle
26. Smooth muscle
27. Glands
28. What is the somatic nervous system in terms of synapses and neurotransmitters (4)?
29. A single neuron from CNS to effector organs (skeletal muscles)
30. Only one synapse in the pathway
31. Acetylcholine is the neurotransmitter
32. Ach is stimulatory, causing muscle to contract
33. What is a ganglion? A group of neuron cell bodies in the peripheral nervous system.
34. What is the parasympathetic nervous system in terms of synapses and neurotransmitters (7)?
35. Two neuron chains from CNS to effector organs (cardiac muscle, smooth muscle, glands)
36. Has a ganglion in the pathway
37. The first synapse is in the ganglion
38. A second neuron comes out of the ganglion, which makes a synapse with the effector organ.
39. Therefore, there are 2 neurons and 2 synapses in the pathway
40. The neurotransmitter is acetylcholine at both synapses, which can be

excitatory or inhibitory

7. The Ach binds to a nicotinic receptor at the first synapse, and a muscarinic receptor on the second synapse
8. What is the sympathetic nervous system in terms of synapses and neurotransmitters (7)?
9. Two neuron chains from CNS to effector organs (cardiac muscle, smooth muscle, glands)
10. Has a ganglion in the pathway
11. The first synapse is in the ganglion
12. A second neuron comes out of the ganglion, which makes a synapse with the effector organ.
13. Therefore, there are 2 neurons and 2 synapses in the pathway
14. The neurotransmitter is acetylcholine (excitatory) at the first synapse, and norepinephrine (excitatory or inhibitory) at the second synapse.
15. The Ach binds to a nicotinic receptor at the first synapse, and the NE binds to an alpha or beta receptor at the second synapse
16. Explain the following parasympathetic effect for the eye:
17. Receptor type
18. Neurotransmitter
19. Excitatory or inhibitory
20. Effect
21. When effect would occur
22. Muscarinic
23. Acetylcholine
24. Excitatory
25. Causes the circular smooth muscle of the iris to contract, making the pupil smaller
26. In bright light or resting situations
27. Explain the following parasympathetic effect for the bronchioles:
28. Receptor type
29. Neurotransmitter
30. Excitatory or inhibitory
31. Effect
32. When effect would occur
33. Muscarinic
34. Acetylcholine
35. Excitatory
36. Causes the smooth muscle of the bronchioles to contract, causing the bronchioles to constrict. This decreases air entry.
37. When the body is at rest
38. Explain the following parasympathetic effect for the GI tract:
39. Receptor type
40. Neurotransmitter

3. Excitatory or inhibitory
4. Effect
5. When effect would occur
6. Muscarinic
7. Acetylcholine
8. Excitatory
9. Causes the smooth muscle of the GI tract to contract, causing peristalsis.
10. When food is being digested and moved through the GI tract
11. Explain the following parasympathetic effect for the bladder wall:
12. Receptor type
13. Neurotransmitter
14. Excitatory or inhibitory
15. Effect
16. When effect would occur
17. Muscarinic
18. Acetylcholine
19. Excitatory
20. Causes the smooth muscles of the bladder wall to contract, causing urination
21. When urination occurs
22. Explain the following parasympathetic effect for the GI sphincters:
23. Receptor type
24. Neurotransmitter
25. Excitatory or inhibitory
26. Effect
27. When effect would occur
28. Muscarinic
29. Acetylcholine
30. Inhibitory
31. Causes the sphincters (rings of smooth muscle) to relax and open
32. When you are ready for food to move down the GI tract
33. Explain the following parasympathetic effect for the bladder sphincters:
34. Receptor type
35. Neurotransmitter
36. Excitatory or inhibitory
37. Effect
38. When effect would occur
39. Muscarinic
40. Acetylcholine
41. Inhibitory

4. Causes the sphincters in the urethra to relax, allowing for urination
5. During urination Explain the following parasympathetic effect for the heart:
6. Receptor type
7. Neurotransmitter
8. Excitatory or inhibitory
9. Effect
10. When effect would occur
11. Muscarinic
12. Acetylcholine
13. Inhibitory
14. Causes the cardiac muscle to relax, slowing down the heart rate.
15. Used during rest and digest activities Explain the following sympathetic effect for the eye:
16. Receptor type
17. Neurotransmitter
18. Excitatory or inhibitory
19. Effect
20. When effect would occur
21. Alpha 1
22. Norepinephrine
23. Excitatory
24. Causes the radial smooth muscle of the iris to contract, causing the pupil to dilate
25. Occurs in dark lighting or in stressful/high-energy situations Explain the following sympathetic effect for the GI tract sphincters:
26. Receptor type
27. Neurotransmitter
28. Excitatory or inhibitory
29. Effect
30. When effect would occur
31. Alpha
32. Norepinephrine
33. Excitatory
34. Causes the sphincters (rings of smooth muscle) to contract, closing the sphincters
35. When you are not undergoing digestion Explain the following sympathetic effect for the bladder sphincters:
36. Receptor type
37. Neurotransmitter
38. Excitatory or inhibitory
39. Effect
40. When effect would occur
41. Alpha 1
42. Norepinephrine
43. Excitatory

4. Causes the sphincters to contract, closing the sphincters
5. This effect stops urination from occurring Explain the following sympathetic effect for the heart:
6. Receptor type
7. Neurotransmitter
8. Excitatory or inhibitory
9. Effect
10. When effect would occur
11. Beta 1
12. Norepinephrine
13. Excitatory
14. Causes the cardiac muscle to contract, increasing the heart rate and the strength of contractions
15. Occurs in fight or flight situations Explain the following sympathetic effect for the GI tract:
16. Receptor type
17. Neurotransmitter
18. Excitatory or inhibitory
19. Effect
20. When effect would occur
21. Beta 2
22. Norepinephrine
23. Inhibitory
24. Causes the smooth muscle to relax, slowing the movement of food through the GI tract
25. Occurs in high-energy situations Explain the following sympathetic effect for the bronchioles:
26. Receptor type
27. Neurotransmitter
28. Excitatory or inhibitory
29. Effect
30. When effect would occur
31. Beta 2
32. Norepinephrine
33. Inhibitory
34. Causes the smooth muscle of the bronchioles to relax, resulting in bronchiole dilation to increase oxygen entry
35. High energy situations Explain the effect of the ANS on male external genitalia during erection (5).
36. Blood needs to enter the penis for it to become erect.
37. Blood vessel diameter is controlled by the parasympathetic in this case.
38. The neurotransmitter is acetylcholine, which binds to muscarinic receptors on smooth muscle of blood vessels.
39. The acetylcholine has an inhibitory reaction, causing the smooth muscle to relax.
40. This opens up the diameter of blood vessels that go to the penis, allowing blood to flow into it.

Explain the effect of the ANS on male external genitalia during ejaculation (4).

1. Erection is controlled by the sympathetic nervous system.
2. Neurotransmitter is norepinephrine, which binds to alpha 1 receptors on smooth muscle.
3. It has an excitatory effect, causing smooth muscle to contract.
4. Peristalsis occurs, which moves sperm through the penis. What is the role of the sympathetic division on the adrenal medulla (6)?
5. Adrenal gland sits on top of the kidneys.
6. There is one neuron and synapse in the pathway from the spine to the adrenal gland.
7. Sympathetic releases acetylcholine, which binds to nicotinic receptors on adrenal gland.
8. The adrenal medulla produces norepinephrine and epinephrine.
9. These go through the blood, and norepinephrine binds to beta 1 receptors on the heart, causing it to contract more frequently and increase strength of contraction
10. Norepinephrine also goes to other organs and acts the same way the neurotransmitter does What are differences between the effects of neurotransmitters and hormones (2)?
11. Hormones have a slower effect
12. Hormones effects last longer What is the role of the sympathetic division on the blood vessels (6)?
13. Acts at the second synapse
14. Neurotransmitter is norepinephrine
15. Binds to alpha receptors on smooth muscle of blood vessels, causing an excitatory effect
16. Smooth muscle contracts, constricting blood vessels
17. Blood pressure increases
18. To achieve the opposite effect, turn off the norepinephrine and allow the smooth muscle to relax What is the role of the sympathetic division on thermoregulation (4)?
19. When systemic body temp rises, sympathetic nerves dilate the skin's blood vessels, allowing heat to escape
20. Sweat glands are activated to cool the body
21. When body temp drops, the sympathetic constricts blood vessels to prevent heat loss
22. This stimulates contraction of arrector pili muscles attached to hair follicles, which erects hairs and produces "goosebumps" What are 2 effects drugs can have on receptors?
23. Drugs can block receptors so that the neurotransmitter cannot bind and cause the normal effect.
24. Drugs can bind onto the receptor and "mimic" the effect of the neurotransmitter, doing the same thing the neurotransmitter does Explain asthma in terms of drugs effects (7).

1. Parasympathetic causes bronchioles to constrict
2. Neurotransmitter is acetylcholine, which binds to a muscarinic receptor, causing smooth muscle to contract
3. Bronchioles constrict, making it hard to breathe
4. Sympathetic causes bronchioles to dilate
5. Neurotransmitter is norepinephrine, which binds to beta 2 receptors, causing smooth muscle to relax
6. Bronchioles dilate
7. Therefore, you want a drug to bind onto the beta 2 receptors and mimic the effects of norepinephrine Explain high blood pressure in terms of drugs effects (5).
8. Parasympathetic slows the heart rate
9. Acetylcholine binds to muscarinic receptors, causing the cardiac muscle to relax
10. Sympathetic increases heart rate and increases strength of contraction, which increases blood pressure
11. Norepinephrine binds to beta 1 receptors, causing cardiac muscle to contract
12. You want a drug to target beta 1 receptors and block them so that norepineprhine cannot bind. What are the functions of the cardiovascular system? Responsible for transporting blood throughout the body, which carries oxygen, nutrients, wastes, hormones, etc. What is the pathway of blood through the heart (6)?
13. Deoxygenated blood goes to the heart through the superior and inferior vena cava
14. Right atrium, through the tricuspid valve, into the right ventricle
15. Pulmonary artery to the lungs (pulmonary circuit)
16. Oxygenated blood returns to the heart through pulmonary veins
17. Left atrium through the mitral valve into the left ventricle
18. Aorta into systemic circulation How does the heart pump (3)?
19. Both atria contract at the same time while the ventricles relax, and the valves are open
20. The valves close and the ventricles contract
21. The valves in the pulmonary artery and the aorta will open What do heart valves do (2)?
22. Prevent backflow
23. Ensure unidirectional travel of blood through the heart What are the heart valves (2)?
24. Atrioventricular valves between atria and ventricles
25. Semilunar valves between ventricles and major arteries

What are the AV valves (2)?

1. Tricuspid (right AV valve) between right atria and ventricle
2. Mitral (left AV, bicuspid) between left atria and ventricle What are the semilunar valves (2)?
3. Pulmonary semilunar between right ventricle and pulmonary trunk
4. Aortic semilunar between left ventricle and aorta How do you set the basic rhythm of the heart (4)?
5. The sinoatrial nodes (SA nodes) are responsible for setting a rhythm.
6. They are often known as pacemakers, and are cardiac muscle cells that are part of the heart wall.
7. Sit right below where the vena cava comes in.
8. Send an electrical signal (action potential)( through gap junctions. What is the intrinsic conduction pathway (5)?
9. The sinoatrial (SA) node (pacemaker) generates impulses
10. The impulses pause (0.1 s) at the atrioventricular (AV) node.
11. The atrioventricular bundle connects the atria to the ventricles.
12. The bundle branches conduct the impulses through the interventricular septum.
13. The subendocardial conducting network depolarizes the contractile cells of both ventricles. What cells are involved in controlling the heart rhythm (3)?
14. Cardiac muscle controlled by ANS.
15. If pacemaker cells are damaged, the AV cells can takeover.
16. AV cells will drop the heart rate to about 20-40 bpm, so it is not life sustaining. How do you modify the basic rhythm of the heart (4)?
17. The vagus nerve (parasympathetic) influences the SA and AV nodes.
18. The heart rate will slow down when Ach binds to muscarinic receptors.
19. Spinal nerves (sympathetic) influences the SA node, AV node, and other ventricular muscles.
20. The heart rate will increase and the strength of contraction will increase when Ne binds to beta 1 receptors. How does an action potential work in the cardiac pacemaker region of the heart (3)?
21. Pacemaker potential: This slow depolarization is due to both opening of sodium channels and closing of potassium channels.
22. Depolarization: The action potential begins when the pacemaker potential reaches threshold. Depolarization is due to calcium influx through calcium channels.
23. Repolarization: Due to calcium channels inactivating and potassium channels opening. This allows potassium efflux, which brings the membrane potential back to its most negative voltage. How does an action potential work in the contractile portion of the heart (3)?

1. Depolarization is due to sodium influx through fast voltage-gated sodium channels. a positive feedback cycle rapidly opens many sodium channels, reversing the membrane potential. channel inactivation ends this phase.
2. Plateau phase is due to calcium influx through slow calcium channels. This keeps the cell depolarized because most potassium channels are closed.
3. Repolarization is due to calcium channels inactivating and potassium channels opening. This allows potassium efflux, which brings the membrane potential back to its resting voltage. What are heart sounds? Heart valves closing What is the first heart sound (3)?
4. Occurs as the AV valves close
5. Signifies a point when ventricular pressure rises above atrial pressure (beginning of ventricular systole)
6. Tends to be louder, longer, and more resonant than second sound What is the second heart sound (2)?
7. Occurs as the semilunar valves snap shut at the beginning of ventricular relaxation (diastole)
8. Results in a short, sharp sound What is an ECG? Electrocardiogram, measuring intrinsic conduction system (sum total of electrical activity of the heart). What does a normal ECG (sinus wave) look like (6)?
9. Atrial depolarization, initiated by the SA node, causes a P wave
10. With atrial depolarization complete, the impulse is delayed at the AV node.
11. Ventricular depolarization begins at apex, causing the QRS complex. Atrial repolarization occurs.
12. Ventricular depolarization is complete.
13. Ventricular repolarization begins at apex, causing the T wave.
14. Ventricular repolarization is complete. What is a junctional rhythm (2)?
15. SA node is non-functional, resulting in absent P wave.
16. AV node will take over and pace the heart at 40-60 bpm. What is a second-degree heart block (2)?
17. AV nodes fail to conduct some SA node impulses.
18. There are more P waves than QRS waves (usually 2 P for each QRS) What is ventricular fibrillation (4)?
19. Electrical activity is disorganized.
20. Action potentials occur randomly throughout the ventricles.

3. Results in chaotic, grossly abnormal ECG deflections.
4. Seen in acute heart attacks and after electrical shock. What is cardiac output? The amount of blood pumped out by each ventricle per minute (heart rate x stroke volume) What is the heart rate? Number of beats per minute What is the stroke volume? The amount of blood leaving the heart with a single contraction. What amounts are the heart rate, stroke volume, and cardiac output (3)?
5. Heart rate is about 75 bpm for adults
6. Stroke volume is about 70 mL per contraction
7. Heart rate and stroke volume multiply together to get a cardiac output of about 5.2 L per minute. How can you increase your cardiac output (2)?
8. Speed up heart rate.
9. Stroke volume goes down when heart speeds up. How can you decrease your cardiac output (2)?
10. Slow down heart rate.
11. Stroke volume goes up when heart slows. What is a way to increase stroke volume (4)?
12. Alter the strength of contraction.
13. Sympathetic produces Ne that binds to beta 1 receptors, opening up calcium channels.
14. Calcium floods in, opening up myosin binding sites so it can pull actin
15. The muscle contracts. What is another way the sympathetic system could increase stroke volume? Activate the adrenal gland How can you lower stroke volume? Inhibit sympathetic What is another way to increase stroke volume (3)?
16. Increase the end diastolic volume.
17. As ventricles are relaxed, they fill with blood
18. Can increase EDV by increasing venous return (amount of blood returning to heart) How can you increase venous return (3)?

1. Using skeletal muscles
2. Respiratory pump/breathing
3. Constricting veins How does using skeletal muscles increase venous return? Squeeze veins when contracting How does a respiratory pump/breathing increase venous return? Breathing in increases the size of the thoracic cavity, decreasing the pressure in the thoracic cavity and increasing pressure in the abdominal cavity, bringing more blood to the heart. How does blood volume affect cardiac output? Increased blood volume increases cardiac output and vice versa How can you increase venous return by altering blood volume (3)?
4. Increasing blood volume increases venous return
5. In order to increase blood volume, hormones are needed
6. Aldosterone and anti-diuretic hormone increase blood volume, while atrial natriuretic peptide decreases it How does aldosterone increase blood volume (2)?
7. Comes from adrenal glands and goes to kidneys
8. Increases water retention in the kidneys by causing reabsorption of sodium, with water following How does ADH increase blood volume (2)?
9. Comes from pituitary gland and goes to kidneys
10. Causes reabsorption of water. How does ANP decrease blood volume (2)?
11. Comes from atria of heart and goes to kidneys
12. Causes excretion of sodium, which goes from blood to urine, with water following What is systemic arterial blood pressure? The force blood is exerting on a blood vessel wall as it flows through, measured in mmHg. What is resistance? The opposing or resisting force on the flow of blood due to friction of blood as it rubs up against the walls of blood vessels. What is blood flow? The amount of blood flowing through an individual's blood vessel, an organ, or the entire vascular system, measured in mL/min.

What 3 important factors determine resistance?

1. Blood viscosity: Thicker has more resistance
2. Blood vessel diameter: constricted has more resistance.
3. Length of blood vessel: longer blood vessels have more resistance How is blood vessel length altered (2)?
4. Gaining weight (adding adipose tissue)
5. Amputation How is blood viscosity altered? Dehydration: Loss of water increases blood viscosity How can blood vessel diameter be influenced to increase BP (5)?
6. Sympathetic nervous system produces Ne that binds to alpha 1 receptors
7. Smooth muscle contracts, decreasing blood vessel diameter
8. This increases total peripheral resistance
9. This raises BP
10. Sympathetic can also activate the adrenal gland to produce epinephrine and Ne, which constrict blood vessels and raise BP How can blood vessel diameter be influenced to decrease BP (4)?
11. Inhibit sympathetic nervous system
12. Smooth muscle relaxes, dilating blood vessels.
13. Total peripheral resistance decreases.
14. BP lowers. What two hormones are vasoconstrictors?
15. ADH
16. Aldosterone What hormone is a vasodilator? ANP What is the indirect renin mechanism (9)?
17. Plays an important role in regulating blood pressure.
18. Triggered by a decrease in BP, detected by baroreceptors.
19. Sympathetic gets activated and causes kidneys to produce an enzyme called renin.
20. Renin converts an protein already in the blood, angiotensinogen, into angiotensin I
21. Angiotension converting enzyme (ACE) converts angiotensin I into angiotensin II
22. Angiotensin II is a powerful vasoconstrictor, and it stimulates the adrenal gland to produce aldosterone
23. Also goes to pituitary and stimulates it to produce ADH.
24. Causes you to be thirsty by going to the hypothalamus.
25. All of these things help increase blood volume, which increases BP. What is the direct kidney mechanism (3)?

1. Kidneys detect decrease in BP.
2. Kidney decreases its rate of filtration, decreasing the formation of urine.
3. This increases blood volume, increasing BP. How does the body monitor blood pressure and control BP when it goes up (6)?
4. Stimulus occurs: blood pressure increase (arterial blood pressure rises above normal range)
5. Baroreceptors in carotid sinuses and aortic arch are stimulated.
6. Increased impulses from baroreceptors stimulate cardioinhibitory center (and inhibit cardioacceleratory center) and inhibit vasomotor center.
7. Decreased sympathetic impulses to heart cause a decrease in heart rate, decrease in contractility, and decreased CO.
8. A decreased rate of vasomotor impulses allows vasodilation, causing a decrease in total peripheral resistance.
9. A decrease in CO and TPR return BP to homeostatic range. How does the body monitor blood pressure and control BP when it goes down (6)?
10. Stimulus: decreased BP (arterial BP falls below normal range)
11. Baroreceptors in carotid sinuses and aortic arch are inhibited.
12. Decreased impulses from baroreceptors activate cardioacceleratory center (and inhibit cardioinhibitory center) and stimulate vasomotor center.
13. Increased sympathetic impulses to heart cause increased heart rate, increased contractility, and increased CO
14. Vasomotor fibers stimulate vasoconstriction, causing increased total peripheral resistance
15. Increased CO and increased TPR return blood pressure to homeostatic range What is another mechanism for altering blood vessel diameter (3)?
16. The smooth muscle walls of blood vessels are sensitive to the level of oxygen, CO2, and hydrogen ions
17. If there is not enough oxygen or too much H ions or CO2, the blood vessels will dilate.
18. More blood can flow to the required area. What are the functions of the respiratory system (3)?
19. Bring in oxygen and get rid of carbon dioxide.
20. Acid-base balance.
21. Sound production What is the larynx (4)?
22. Connects pharynx to trachea.
23. Opening (glottis) can be closed by epiglottis or vocal cords.
24. Air passageway.
25. Prevents food from entering lower respiratory tract.

What is the trachea (3)?

1. Tube running from larynx and dividing into two main bronchi.
2. Houses vocal folds for voice production.
3. An air passageway that cleans, warms, and moistens incoming air. What is the bronchial tree (3)?
4. Right and left main bronchi that divide to form lobar and segmental bronchi and bronchioles
5. Air passageways connecting trachea with alveoli
6. Cleans, warms, and moistens incoming air What are the alveoli? Main sites of gas exchange What are the lungs (3)?
7. Paired organs composed of alveoli and respiratory passageways.
8. Surfactant reduces surface tension and helps prevent lung collapse.
9. Houses respiratory passages smaller than main bronchi. What are pleurae (3)?
10. Serous membranes
11. Lines thoracic cavity
12. Produces lubricating fluid and compartmentalizes lungs. What are the processes of the respiratory system (3)?
13. Pulmonary ventilation (breathing)
14. External respiration
15. Transport of respiratory gases What is pulmonary ventilation (3)?
16. Consists of inspiration and expiration
17. Inspiration moves air into the lungs from the atmosphere
18. Expiration moves air out of the lungs into the atmosphere What is external respiration (2)?
19. Oxygen diffuses from the lungs to the blood.
20. Carbon dioxide diffuses from the blood into the lungs. What is transport of respiratory gases (3)?
21. The cardiovascular system transports gases using blood as the transporting fluid.
22. Oxygen is transported from the lungs to the tissue cells of the body.
23. Carbon dioxide is transported from the tissue cells to the lungs. What is the pressure inside the lung (2)?
24. Intrapulmonary pressure
25. 760 mmHg What is the pressure inside the pleural cavity (2)?
26. Intrapleural pressure
27. 756 mmHg What occurs when you breath in (7)?
28. Diaphragm contracts and moves down.
29. Intercostals contract and your ribs move up and out.

3. The pleural cavity gets bigger (volume is increased).
4. The pressure decreases in the pleural cavity.
5. Because there is less pressure pushing on the lungs, they expand, increasing the volume.
6. When the lung volume increases, the pressure inside the lungs decreases.
7. The atmospheric pressure remains the same, so air will rush into the lungs. What occurs when you breath out (7)?
8. Diaphragm relaxes and moves up.
9. Intercostals relax and your ribs move down and in.
10. The pleural cavity gets smaller (volume is decreased).
11. The pressure increases in the pleural cavity.
12. Because there is more pressure pushing on the lungs, they shrink, decreasing the volume.
13. When the lung volume decreases, the pressure inside the lungs increases.
14. The atmospheric pressure remains the same, so air will rush out of the lungs. What is the composition of gases in the atmosphere and lungs (4)?
15. The composition of the atmosphere is nitrogen, oxygen, and carbon dioxide.
16. Nitrogen is 78.6%, oxygen is 20.9%, and carbon dioxide is 0.04% in the atmosphere.
17. You can take the percentage of an element and multiply it by 760 mmHg to calculate a partial pressure.
18. In the alveoli, there is a mixing of old and new gases. When you breathe in fresh air, it mixes with stale air in your lungs, so the pressure in the alveoli is different. What is the process of internal and external respiration in regards to oxygen (5)?
19. In the alveoli, the oxygen is 104 mmHg.
20. The oxygen moves from the alveoli into the plasma through simple diffusion.
21. By the time the blood leaves the alveoli, it has a value of 100 (you cannot get to 104 because the hemoglobin is saturated at 100).
22. The partial pressure of oxygen as it leaves the lungs is then 100.
23. It reaches the tissue and when it leaves the tissue, it has a value of 40. It reaches the lungs with this value. What is the process of internal and external respiration in regards to carbon dioxide (5)?
24. Deoxygenated blood approaches the lungs and has a value of 45.
25. The alveoli have a value of 40, so the CO2 will diffuse into the alveoli from the blood.
26. By the time the blood leaves the lungs, it has a value of 40.
27. It reaches the tissue, which has a value of 45.
28. By simple diffusion, the CO2 leaves the tissue and goes into the bloodstream.
29. It leaves the tissue with a value of 45. What is the process of internal and external respiration in regards to exercise (2)?
30. When you exercise, the tissue oxygen drops to 20, so the blood can give off more oxygen to the tissue.
31. When it leaves, it has a value of 20 instead of 40. What is the role of hemoglobin in oxygen transport (5)?
32. Hemoglobin consists of heme (iron) and is a protein.
33. It has globin (two alpha and two beta polypeptide chains) and four heme groups.
34. One hemoglobin carries 4 oxygen molecules that attach to iron.
35. Found in RBCs.

5. If the PO2 of the plasma is 100, the hemoglobin is saturated (carrying the max amount of oxygen). How is carbon dioxide transported in the blood moving away from the lungs (8)?
6. As blood approaches the tissue, the hemoglobin is saturated with oxygen and the PO2 value is 100.
7. Some oxygen will dissolve in the plasma.
8. Most of the oxygen leaves the hemoglobin and diffuses across into the tissue, freeing up hemoglobin.
9. The tissue gives off CO2 into the plasma. About 7% dissolves in the plasma.
10. 23% enters the RBC and combines with hemoglobin to form carbamino-hemoglobin.
11. The other 70% combines with water to form carbonic acid (H2CO3), which breaks down to give us bicarbonate ions (HCO3-) and hydrogen ions. This is a very slow reaction.
12. The few hydrogen ions will attach to spare hemoglobin (not to the iron, but to the amino acids of the globin).
13. The bicarbonate ions move out of the RBC and into the plasma. In exchange, chloride ions go in the opposite direction and move into the RBC. This is the chloride shift. How is carbon dioxide transported in the blood moving towards from the lungs (9)?
14. Blood arrives at the alveoli of the lungs. It has lots of hydrogen ions and carbon dioxide attached to it.
15. Some oxygen diffuses into the plasma, and the rest enters the RBC.
16. Once in the RBC, the oxygen binds to iron of hemoglobin.
17. The hydrogen ions and CO2 are dumped out of the RBC
18. Some CO2 dissolves in the plasma. Some diffuses into the alveoli.
19. The rest is in the plasma as bicarbonate, which goes into the RBC.
20. The chloride ions will go out of the RBC, and the hydrogen ions will be displaced by the oxygen coming in.
21. The hydrogen ions combine with the bicarbonate in the RBC to form carbonic acid.
22. With the addition of water and carbonic anhydrase, the carbonic acid breaks down into CO2 and enters the alveoli. What is the normal pH of blood? 7.35-7. What are the two types of blood pH problems not caused by the lungs?
23. Metabolic acidosis
24. Metabolic alkalosis What is metabolic acidosis (2)?
25. Blood pH is less than 7.35.
26. May be caused by too many hydrogen ions or not enough bicarbonate ions. Why might you have too many hydrogen ions in your blood? You have drunk excessive amounts of alcohol Why might you have too few bicarbonate ions in your blood? You are suffering from diarrhea (there is lots of bicarb in the GI tract to neutralize stomach acid) What does metabolic acidosis do to the CNS (2)?

1. Depresses it
2. Causes coma, which can lead to death What can the lungs do to attempt to fix metabolic acidosis (3)?
3. Want to push the equation towards creating CO2 and water
4. Increased breathing rate (hyperventilate)
5. This is quite quick What is metabolic alkalosis (2)?
6. Blood pH is greater than 7.45.
7. Might be caused by too few hydrogen ions or too many bicarbonate ions in the blood Why might you have too many bicarbonate ions in the blood? Overtaking medications such as Tums or other antacids, which contain large amounts of bicarbonate Why might you have too few hydrogen ions in the blood? Severe vomiting (you lose stomach acid) What does metabolic alkalosis do to the CNS (2)?
8. Overexcites it.
9. Causes muscle spasms, convulsions, and can lead to death. What can the lungs do to attempt to fix metabolic alkalosis (3)?
10. Want to push the equation towards the generation of hydrogen ions.
11. The additional bicarbonate ions are not a problem because they leave the RBC in exchange for chloride, so they do not change the charge of the plasma.
12. Breathing rate slows (hypoventilation). How is respiration controlled via carbon dioxide, oxygen, and hydrogen ions (6)?
13. In the aortic arch and carotid sinuses are peripheral chemoreceptors that look at O2, CO2, and H+ values in arterial blood.
14. They are connected to nerves that take information to the medulla and pons of the brain.
15. Chemoreceptors are mostly interested in a lack of oxygen.
16. Central chemoreceptors in the brain only respond to hydrogen ions that come from changes in CO2 levels.
17. Send out messages along the intercostal nerve and phrenic nerve, which supply the intercostal muscles and diaphragm respectively.
18. The muscles will respond to increase or decrease respiration rate. How is respiration controlled if you are exercising (4)?
19. Too many hydrogen ions would be in the blood due to production of lactic acid.
20. The hydrogen ions would not be detected by the chemoreceptors because they are not due to CO2.
21. The blood brain barrier stops hydrogen ions from getting into the brain, but it cannot stop CO2 (it diffuses).
22. The peripheral receptors will deal with the excess CO2 and lack of oxygen (PCO2 up to 43 or PO2 under 60). What are the functions of the digestive system (4)?
23. Take in food
24. Break food down into smaller units
25. Absorb the units
26. Eliminate waste

What are the major processes that occur during digestive system activity (6)?

1. Ingestion
2. Mechanical breakdown: chewing via mouth, churning via stomach, and segmentation via small intestine
3. Propulsion: swallowing via oropharynx and peristalsis via stomach, esophagus, Si, and LI.
4. Digestion
5. Absorption
6. Defecation What is the histology of the alimentary canal (3)?
7. Mucosa layer: In contact with food. Layer of epithelial tissue (simple columnar), some places form glands that are found in submucosa, and contains a thin layer of smooth muscle called the muscularis mucosae that allows for small local movement.
8. Submucosa: Rich supply of blood vessels, lymph vessels, and nerves. Important in absorption.
9. Muscularis externa: Two layers of smooth muscle (one circular, one longitudinal) that cause peristalsis What is the enteric nervous system (8)?
10. Long reflexes involve the CNS and short reflexes occur entirely within the GI wall.
11. Internal stimuli are changes in GI tract stretch or in lumen pH, nutrients, or solute concentrations.
12. Internal stimuli detected by chemoreceptors, osmoreceptors, or mechanoreceptors.
13. Visceral afferent messages go to the CNS.
14. Local (intrinsic) nerve plexus also gets message and sends it to effectors (smooth muscles or glands).
15. Response occurs to cause a change in contractile or secretory activity.
16. External stimuli is sight, smell, taste, or thought of food.
17. Sends a message to CNS, which sends an extrinsic visceral (autonomic) efferent message to local nerve plexus and does the same thing. What is the structure of carbs (3)?
18. Polysaccharides (largest)
19. Disaccharides (two units joined together)
20. Monosaccharides (smallest) What are the 3 kinds of monosaccharides?
21. Glucose
22. Fructose
23. Galactose What are the 3 kinds of disaccharides?
24. Sucrose (fructose and glucose)
25. Lactose (galactose and glucose)
26. Maltose (glucose and glucose) What are the 2 kinds of polysaccharides?
27. Starch: plants
28. Glycogen: animals What is the structure of proteins (2)?

1. Chains of amino acids
2. Dipeptides and tripeptides are usually broken down into individual amino acids to absorb What is the structure of lipids (3)?
3. Triglycerides are made of a three-carbon glycerol backbone and three fatty acids.
4. This can be broken down into a monoglyceride (three carbon backbone with one fatty acid) and two fatty acids.
5. Very slow to break down because they are insoluble or slightly soluble in polar solvents (they are hydrophobic/do not like water) What is the structure of nucleic acids (2)?
6. Made of nucleotides.
7. Nucleotides consist of a sugar, phosphate group, and nitrogenous base. How does food first reach the stomach (4)?
8. Starts with the mouth, where salivary amylase starts breakdown of polysaccharides.
9. Food leaves the mouth and goes down the esophagus, which joins to the stomach.
10. The esophagus is lined with stratified squamous epithelium.
11. The upper third of the esophagus is skeletal muscle, the middle is skeletal and smooth, and the lower third is smooth. Describe the anatomy of the stomach (4).
12. Three layers of muscle: longitudinal, circular, and oblique.
13. Needs an extra layer of muscle due to churning
14. Mucosal layer has rugae (large folds) in the inner layer that increase surface area to allow for stretching when stomach is filled.
15. Rugae have holes called gastric pits that lead down into glands. What are the glands of the stomach (6)?
16. Made of simple columnar epithelium.
17. Cells near the neck are called mucous neck cells that produce mucus to protect the stomach lining from acid.
18. Stomach secretes gastrin.
19. Stomach secretes HCl that activates pepsinogen for pepsin to break down proteins
20. Stomach produces lipase that attacks lipids
21. Stomach produces intrinsic factor that absorbs vitamin B12 (important in RBC production) What cells secrete HCl and intrinsic factor? Parietal cells How do parietal cells cause HCl secretion (4)?
22. Hydrogen ions and bicarbonate ions are generated from dissociation of carbonic acid produced from CO2 and H2O by carbonic anyhydrase.
23. H+/K+ ATPase pumps H+ into the lumen and K+ into the cell. K+ Returns to the lumen through membrane channels.
24. HCO3 (bicarbonate) leaves the cell in exchange for interstitial fluid chloride.
25. Chloride diffuses through membrane channels into lumen. What cells secrete pepsinogen? Chief cells What cells secrete hormones, such as gastrin, and paracrines? Enteroendocrine cells

What is the anatomy of the small intestine (5)?

1. Has circular folds that contain villi and microvilli
2. These increase surface area for increased absorption and for more production of enzymes to break down food.
3. Tissue that lines the SI is simple columnar epithelium.
4. Broken down lipids go into the lacteal (lymph system) and everything else goes into the capillaries, so the SI has a large supply of lymph and blood vessels.
5. Patches of lymphoid tissue resides in the mucosal layer called mucosa associated lymphoid tissue. This is to protect the SI from microorganisms that migrate from the large intestine. What glands make up the small intestine (5)?
6. Duodenal glands: rich in bicarbonate ions to neutralize stomach acid
7. Paneth cells: at the base, produce antimicrobial chemicals like lysozyme
8. Goblet cells: Secrete mucus
9. Enteroendocrine cells: Produce hormones (main ones being CCK, GIP, and secretin)
10. Enterocytes: Absorptive cells that absorb nutrients. Covered in the microvilli and produce enzymes. What enzymes do enterocytes produce in the SI (8)?
11. Dextrinase and glucoamylase (chops oligosaccharides into disaccharides maltose)
12. Maltase (chops maltose into glucose)
13. Sucrase (chops sucrose into monosaccharides)
14. Lactase (chops lactose into monosaccharides)
15. Aminopeptidase (chops polypeptide chain at amino end)
16. Nucleosidases (chops off nucleotide bases)
17. Phosphatases (chops off phosphates of nucleotides)
18. Membrane-bound enteropeptidase (takes trypsinogen and converts it to trypsin) List the following for gastrin:
19. Role
20. Site of production
21. Stimulus
22. Target organ
23. Activity
24. Regulates stomach secretion and motility.
25. Stomach mucosa (G cells)
26. Food (partially digested proteins) in stomach and acetylcholine released by nerve fibers.
27. Stomach (parietal cells), small intestine, ileocecal valve, and large intestine.
28. Increases HCl secretion, stimulates gastric emptying, stimulates contraction of intestinal muscle, and relaxes ileocecal valve, and stimulates mass movements. List the following for secretin:
29. Role
30. Site of production
31. Stimulus
32. Target organ
33. Activity

1. Inhibits gastric secretion
2. Duodenal mucosa.
3. Acidic chyme and partially digested proteins and fats.
4. Stomach, pancreas, and liver.
5. Inhibits gastric gland secretion and gastric motility, increases output of pancreatic juice rich in bicarbonate ions, potentiates CCK's action, and increases bile output. List the following for CCK:
6. Role
7. Site of production
8. Stimulus
9. Target organ
10. Activity
11. Inhibits gastric secretions.
12. Duodenal mucosa.
13. Fatty chyme and partially digested proteins.
14. Stomach, liver, pancreas, gallbladder, and hepatopancreatic sphincter.
15. Inhibits stomach's secretory activity, potentiates secretin's actions on the liver and pancreas, increases output of enzyme-rich pancreatic juice, stimulates gallbladder to contract and expel stored bile, and relaxes sphincter to allow entry of bile and pancreatic juice into duodenum. List the following for gastric inhibitory peptide:
16. Role
17. Site of production
18. Stimulus
19. Target organ
20. Activity
21. Inhibits gastric secretion.
22. Duodenal mucosa.
23. Fatty chyme.
24. Stomach and pancreas (beta cells)
25. Inhibits HCl production and stimulates insulin release. What is the role of the pancreas in digestion (8)?
26. Produces trypsinogen, chymotrypsinogen, and procarboxypeptidase.
27. Trypsinogen is activated by membrane-bound enteropeptidase and then activates more trypsinogen, converts chymotrypsinogen into chymotrypsin, and converts procarboxypeptidase into carboxypeptidase.
28. Trypsin and chymotrypsin attack polypeptides and make shorter chains.
29. Carboxypeptidase chops off individual amino acids at the carboxylic acid end.
30. Lipase is produced and breaks down lipids into two free fatty acids and a monoglyceride.
31. Amylase is produced to break down carbohydrates.
32. Ribonuclease and deoxyribonuclease break down nucleotides.
33. The pancreas produces bicarbonate ions. What does the gall bladder release (5)?
34. Bile salts that help digest lipids.
35. Bile salts are secreted into the dudoenum (first part of SI)

3. As bile salts travel through the SI, they allow lipid digestion and absorption to occur.
4. 95% of bile salts are reabsorbed by the ileum (last part of SI)
5. Reabsorbed bile salts travel via the hepatic portal vein back to the liver, where they are recycled. Only 5% of bile salts are newly synthesized each time. How do carbohydrates get absorbed (6)?
6. Pancreatic amylase breaks down starch and glycogen into oligosaccharides and disaccharides
7. Brush border enzymes break oligosaccharides and disaccharides into monosaccharides.
8. To cross into the simple columnar epithelial cell, glucose and galactose are co- transported across the apical membrane of the enterocyte. This active transport uses the sodium concentration gradient established by the sodium-potassium pump in the basolateral membrane.
9. Glucose and galactose will build up inside the cell until it is at a high concentration. It will then exit the basolateral membrane by facilitated diffusion and enter the blood.
10. The sodium will leave the cell via the Na/K pump.
11. Fructose gets in and out both by facilitated diffusion. How are proteins absorbed (4)?
12. Pancreatic proteases break down proteins and protein fragments into smaller pieces and some individual amino acids.
13. Brush border enzymes break protein fragments into amino acids.
14. Amino acids are co-transported across the apical membrane of the enterocyte. This active transport uses the Na concentration gradient established by the Na/K pump in the basolateral membrane.
15. Amino acids exit across the basolateral membrane via facilitated diffusion and enter the blood. How do lipids get absorbed (7)?
16. Emulsification: Bile salts in the dudoenum break large fat globules into smaller fat droplets, increasing the surface area available to lipase enzymes.
17. Digestion: Pancreatic lipases hydrolyze triglycerides, yielding monoglycerides and free fatty acids.
18. Micelle formation: Free fatty acids and monoglycerides assemble with bile salts, forming micelles. Micelles carry contents to enterocytes.
19. Diffusion: Fatty acids and monoglycerides diffuse from micelles into enterocytes.
20. Chylomicron formation: Fatty acids and monoglycerides are re-combined and packaged with other fatty substances (such as fat soluble vitamins A, D, E, and K) with proteins to form chylomicrons.
21. Chylomicron transport: Chylomicrons are extruded from enterocytes by exocytosis, enter lacteals, and are carried away from the intestine into lymph.
22. Lymph eventually drains back into the venous bloodstream. What is the role of the digestive tract in terms of vitamins, electrolytes, and water absorption? The large intestine absorbs them. What is the role of the large intestine in the digestive process? It is full of microorganisms that help it break down undigested particles, keep harmful microbes, out, absorb electrolytes and water, etc.