Directions:

1. Print your name on each page of the examination before you do anything else!  Do it now, and do it neatly.
2. You absolutely, positively MUST confine your answers to the spaces provided.  Failure to do so may result in an inaccurate evaluation of your knowledge.
3. Complete the exam using a PEN if you wish to retain the right to discussing your answers with Dr. K-I-A.

#1. Let’s get right to it!  Use I, D, or No  please:
MUST BE CONSISTENT ACROSS the table!
 

AGENT	HR	SV	TPR	VR	DP	PP	MAP
Epi	I	I	I	I	I	I	I
agonist	NoC	NoC/I	I	NoC/I	I	NoC or I	I
agonist	I	I	D	I	I	I	I
Muscarinic agonist	D	I	D	D	D	D	D
antagonist	D	I	NoC or I	Any ?	D	I	D
antagonist	NoC	NoC/D	NoC/D	NoC/D	NoC/D	NoC/D	NoC/D
Angiotensin II	NoC	I	I	I	I	I	I

#2. Consider the following ECG.  Complete the table below by indicating if the valves are OPEN or CLOSED and the other factors are I, D, or No at the three indicated points.

#3. For each of the phases of the ventricular muscle action potential, please indicate whether the conductances of Ca++ , Na+ , and K+  are I, D or are not involved, not different from resting Vm levels or changing during that phase – use No.

#4. Please LIST the steps in the intracellular mechanism that follows  receptor activation by NE and results in increased stroke volume.  Dr. K-I-A has done the first step for you.
 

1. NE binds to  receptor
2. NE-Receptor complex binds to G protein and this complex binds to and activates adenylyl cyclase
3. Cyclic AMP increases and binds to and activates Protein Kinase
4. Protein Kinase phosphorylates SR protein phospholamban and/or membrane CA++ channels so more Ca++ is available.
5. More cross bridges are formed so contractility and SV go up
 
 

#5. Please LIST the steps in the complete homeostatic response to a fall in BP (below the desired level).  You must indicate all neurotransmitters, receptors, effector organs, sensory structures involved in response to this change in pressure (pressure only).

1, Decreased BP ---> decreased baroreceptor nerve activity
2. Decreased depressor area activity
3. Decreased inhibition of pressor or increased pressor activity
4. increased sympathetic nerve activity (may say but not required ---> decreased parasymp to heart)
5. increased NE onto  receptors on heart ---> increased SV and HR
6. increased NE onto blood vessels ---> b2 and a1  --->increased TPR
7. increased SV and TPR ----> VR
8. all of this leads to increased BP  (may say TPR x CO = BP and all factors are going up)
9.  BP returns to normal and stimulus is negated.
 
 

#6. In the space below, draw an accurate representation of an arterial blood pressure tracing before and after administration of an i.v. dose of NE (applied at arrow):

Must show increased rate and DP, SP, and PP (and MAP)
 
 

 
Now describe the reasons for each of the following four changes in the tracing as a result of the actions of NE:
 
HR:      _ receptors increase HR_________
 PP:     __ receptor increases SV_________
 DP      ___increased HR and TPR = increased DP____________________
 MAP: ___increased HR and SV = increased CO and increased TPR_______
 
________________________________________________________
 
 

#7. Examine the axes below and fill in the plot.  We are interested in the correct shape of the plot which illustrates an important principle, not the actual numerical values.

 

ANY four of the following:
1.___NO (nitric Oxide)   Endothelin     Ischemia (or low O2)

2.    Adenosine or adenine nucleotides_____________________________

3. ______CO2  or decreased pH__________________________

4. _________myogenic_____________________
 

#8.     If the radius of one small artery doubles, the blood flow through that artery will increase by a factor of:
                                                Put a number here ?    ____16____
 

#9.     Briefly explain the one main  cardiovascular advantage and the resulting beneficial  consequences realized by a highly conditioned athlete that allows prolonged bouts of exercise:

increased SV allows for increased VR (and therefore CO) even with decreased TPR
_________________________________________________________________
 

#10.     Finally, let’s earn easy points by answering 20 Up- Downs with I, D, or No:
 

a.	As EDV increases, PP	a. ___I____
b.	As a subject’s lungs inflate, afferent vagal nerve activity	b. ___I____
c.	As blood leaves the capillaries, the velocity  of blood flow	c. ___I___
d.	As blood leaves the capillaries, blood pressure	d. ___D____
e.	As TPR increases, SP	e. __I____
f.	As plasma epinephrine increases, SA node  Na+ conductance	f. ___I____
g.	As arterial compliance decreases, DP	g. __I_____
h.	As atrial EDV increases, the rate of urine output	h. ___I____
i.	As atrial EDV increases, renal Na+ excretion  in the urine	i. ___I____
j.	As plasma renin increases, reanl Na+  reabsorption	j. ___I____
k.	As blood volume increases, plasma ADH	k. ___D____
l.	As blood volume decreases, plasma ANP	l. ___D____
m.	As plasma propranolol increases, the length of the ECG P wave to P wave interval	m. ___I____
n.	During stimulation of the efferent vagal nerve, SA node K+ conductance	n. ___I____
o.	As EDV decreases, VR	o. ___D____
p.	As plasma ADH levels increase, blood volume	p. ___I_____
q.	As renal blood flow decreases, plasma aldosterone	q. ___I____
r.	As TPR increases in a healthy individual,  CO	r. ___I_____
s.	As ventricular EDV increases, the number of cross bridges  formed in each ventricular muscle cell	s. ___I_____
t.	As plasma CO2 increases, medullary CSF pH	t. ___D_____