Kines 203 Exam 2 PDF

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Kines 203 Exam 2

Chapter 10

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The heart is located between the lungs with the apex pointing to the left Heart layers: o Endocardium- inner most layer o Myocardium- heart muscle o Epicardium -outside the myocardium o Pericardium – sac that surrounds the heart Heart chambers o Atria: upper chambers. Receive blood from lungs or body o Ventricles: lower, pumping chambers. Pump blood out o Septum: wall that separates the atria and ventricles. Between the atria (thinner) it is called the interatrial septum. Between the ventricles (thicker) it is called the interventricular septum. Blood flow: o Pulmonary circuit: right side to lungs (blue) o Systemic circuit: left side to body (red) o Body to superior/inferior vena cava to R atrium o R atrium to R ventricle to pulmonary artery to lungs o Lungs to pulmonary vein to L atrium to L ventricle o L ventricle to aorta to body

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Heart valves o All values are one way to prevent backflow o Atrioventricular (AV) valves: ▪ Tricuspid: between right atria and right ventricle. Three flaps ▪ Bicuspid (mitral): between left atria and left ventricle. Two flaps o Semilunar valves: ▪ Pulmonic valve: between right ventricle and pulmonary artery ▪ Aortic valve: between left ventricle and aorta o Once valves tighten, they prevent backflow in the heart from one area to the next. Heart murmur is when one or more valves do not stay tightly closed and blood sloshes back.

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o Heart sounds: o Systole (rate of heart contraction) vs diastole (relaxation of heart) o S1 = lub sound is made when valves between the chambers close o S2 = dupp valves to aorta and pulmonary artery close o Nervous system, hormones (epinephrine makes heart rate faster, norepinephrine slows it down), stress, and drugs all control rate Heart rate: number of contractions per minute (60-100 beats/minute is normal for adults) Pulse: wave of pressure when the ventricles contract. Can be measured in the carotid artery in neck, brachial artery in upper arm, radial artery in wrist. Femoral pulse in groin, popliteal pulse behind knee, dorsal pedal pulse on top of foot, tibial pulse behind medial malleolus) Heart’s electrical system: runs via input from nervous system o SA (sinoatrial) node is the pacemaker (sets rate). When the node is stimulated by the brain, the rate is set o Heart rate can drop very quickly, get lightheaded or dizzy, or pass out. In older people, look at installation of a pacemaker ECG (electrocardiography- study of measuring electric activity) measures the heart's electrical activity Normal sinus rhythm:

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o PQRST complex Flatlining means they have no electrical activity of the heart Blood pressure o Force exerted by blood against the wall of a blood vessel o Measured in an artery with a cuff called a sphygmomanometer o Systolic (rate of contraction) /diastolic (rate of relaxation) : 120/80 mm of mercury is a normal measure. Normally measured in brachial artery o Measured in mmHG The vascular system: o Arteries: carry blood away from heart (red in textbooks, larger than veins, carry oxygenated blood) ▪ Thick walls with blood high in O2 except pulmonary arteries which carry deoxygenated blood

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o Arterioles: arteries to capillaries. Small arteries. o Capillaries: exchanges between blood/tissues. Smallest of all vessels. Where blood’s oxygen and carbon dioxide are exchanged. o Venules: capillaries to veins. Small veins. o Veins: carry blood to heart ▪ Thin walls with blood low in O2 except pulmonary veins carry oxygenated blood towards the heart Arteries have a big lumen (opening) and a thick wall of smooth muscle Veins have a big opening, but a much smaller wall of smooth muscle compared to arteries. Veins have one-way valves. Arteries increase blood flow more than veins Roots: o Cardio: heart o Atrio: atrium o Ventriculo: ventricle o Valvo: valve o Angio: vessel o Vaso: vessel o Artero: arteriole o Aorto: aorta o Veno: vein o Phlebo: vein Atherosclerosis: o Accumulation of fatty deposits (plaque) within the lining of an artery. Restriction of blood flow because fat deposits inside the lumen of the artery. Platelets stick together and blood has hard time getting through o Ischemia: restriction of lumen of the artery form normal blood flow o Dyslipidemia (bad fat condition- high cholesterol): predisposition for atherosclerosis ▪ High LDL (high cholesterol) o Smoking, poor diet, lack of exercise, stress, high blood pressure, family history is a big telling factor if you’ll get it- idiopathic Thrombosis/embolism o Thrombosis: blood clot (thrombus) within a vessel. Stationary o Embolism: blockage of a vessel (can be a thrombus, air, fat, bacteria, etc) that is carried in the bloodstream. When you get a blockage from something moving in the vessel. ▪ Pulmonary embolism: embolism in lung ▪ CVA (cerebrovascular accident)/stroke: embolism in brain Aneurysm o A ballooning out of the arterial wall. Can come from high blood pressure. Abdominal aorta or brain are the most dangerous places to have rupture. Can bleed out within minutes. o Rupturing can cause a hemorrhage. Only have 5 liters of blood. o Rupturing in the cerebral artery is a stroke

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o Dissecting aneurysm: rupture of the entire vessel where blood hemorrhages into the muscular layer of the arterial wall. Ruptures into the arterial wall. ▪ I.E John Ritter had an abdominal aortic aneurysm Hypertension (HTN) high blood pressure o Systolic pressure >140 mmHG o Diastolic pressure > 90mmHG o Left ventricular hypertrophy- left ventricle becomes larger and wall becomes thicker. This can be normal in an athlete but not normal adults. If you don’t have a high exercise lifestyle and have a normal blood pressure but you have left ventricular hypertrophy, this is a diagnosis for high blood pressure. o Diet and lifestyle can control HTN o # 1 cop death is not shot wounds, it’s cardiovascular diseases Coronary artery disease (CAD) o Results from atherosclerosis o CAD is atherosclerosis of the vessels that go to the heart. Buildup of plaque in the coronary arteries that go to the heart o Angina pectoris: chest pain \ o Diaphoresis: profuse sweating > These three are the symptoms of CAD o Dyspnea: difficulty breathing / o Diagnosis: ▪ ECG (electrocardiogram) ▪ Angiography – put camera in femoral artery near groin and look at arteries ▪ Echocardiography – ultrasound of heart ▪ Hs-CRP (high sensitivity C-reactive protein) – protein that’s released into bloodstream when there’s high cholesterol buildup of plaque o Once you have a single coronary artery that’s blocked 100% (some can be blocked 20%, 30%, etc). blood can’t get to the heart muscle and the heart muscle dies o Treatment: ▪ Nitroglycerin (given sublingually, under tongue) vasodilator, used to help pain, doesn’t make CAD go away ▪ Angioplasty: surgery that removes blockage ▪ PTCA (percutaneous transluminal coronary angioplasty): make incision in femoral artery in groin and put a camera tube up to find blockage and then put a catheter tube into the blockage and insert balloon into the artery to open it back up ▪ CABG (coronary artery bypass graft): ● Saphenous vein (lower leg) used first ● Internal mammary artery (chest) used second Myocardial infarction (muscle, heart, death) – heart attack o CAD can lead to complete occlusion of coronary artery o Necrosis can lead to infarct (death of tissue can lead to death of person) o Myocardial infarction (MI) = heart attack ▪ Precordial pain – chest pain ▪ Epigastric pain – stomach

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▪ Pallor (greyish, blueish, pale color to skin) ▪ Diaphoresis – profuse sweating ▪ Nausea, dyspnea- difficulty breathing ▪ Fatigue, anxiety o ECG o CBC (complete blood count) with cardiac workup ▪ CK (creatine kinase) ● Enzyme increase when muscle cells are damaged ● CK-MB increases indicate MI ▪ Tn (troponin) ● Protein increases when muscle cells are damaged ● TnT and TNI increases indicate MI Arrhythmia o Irregular heart beat (rate or pattern) o Bradycardia (slow heart rate) vs tachycardia (fast heart rate) vs heart block o Fibrillation- heart quivers. Don’t have enough of a contraction to measure it. Use AED. Still have some electric activity o Treatments ▪ Cardioversion ▪ Defibrillation ▪ Pacemaker – used in elderly people in bradycardia usually ▪ Implantable cardioverter-defibrillator (ICD) ▪ Ablation (sono, cryo, electro) – destroys the nervous system pathway. Lasers that destroy pathways from one part of the heart to the other. Heart failure o Heart fails to empty effectively because it is not pumping enough blood o Can lead to pulmonary edema: not exchange oxygen between heart and lungs can cause a build of edema around the lungs o Congestive heart failure (CHF) ▪ Cyanosis – blueing of skin ▪ Dyspnea – difficulty breathing ▪ Syncope – passing out ▪ Shock (ex cardiogenic, hypovolemic- shock you get when you have a decreased volume, a pool of blood, septic) ▪ Edema (weight gain, fluid retention) in limbs, face. Pitting edema: push in on swelling, fingerprint stays behind Congenital heart disease o Septal defect: blood leaks back into lungs (foramen ovale remains open). Babies born with hole in septum ▪ Cyanosis, syncope, clubbing of fingers o Murmur: failure of valve to open or close properly o Patent ductus arteriosus (PDA): vessel in fetus that bypasses the lungs fails to close at birth. When baby is born and vessel doesn’t close o Coarctation of aorta: narrowing of aorta that restricts blood flow. Babies born with blue hands

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Rheumatic heart disease o Streptococcus infection damages the heart valve (starts as strep throat) o Affects mitral valve most often o Scar tissue causes stenosis o Usually leads to valve replacement o Incidence has declines with antibiotic use Disorders of the veins: o Varicose veins: twisted and swollen. Common in legs, valves in veins no longer work) o Hemorrhoids: varicose veins in the rectum and anus. Straining during constipation can lead them to become twisted and swollen. o Phlebitis: inflammation of veins caused by injury, infection, valve damage, poor circulation (diabetes) o Deep vein thrombosis (DVT): blood clot formation in the deep veins, usually in legs The lymphatic system o Widely distributed system with multiple functions o Circulation: return excess fluid and proteins back to the bloodstream o Immunity: lymph nodes filter lymph as it passes through the body in the cervical axillary, mediastinal and inguinal regions Roots: o Lympho: lymph o Lymphadeno: lymph node o Lymphangio: lymph vessel o Spleno: spleen o Thymo: thymus o Tonsilo: tonsil Lymphadenitis: enlarged lymph node as a result of injury or infection. If you feel a lymph node, it’s enlarged. o Mononucleosis Lymphangitis: inflammation of lymph vessels due to bacterial infection (S/S: red streaks) Lymphedema: swelling of tissue with lymph caused by removal or obstruction o Breast cancer (axillary lymph nodes) Lymphoma: neoplastic disease/tumor

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Blood circulates through the vessels to bring blood and oxygen to cells and carry away carbon dioxide and waste products Blood distributes body heat and carries hormones and antibodies for immunity Total adult volume is 5L or 5.2 quarts of blood Whole blood = 55% plasma, 45% blood cells o ~90% of plasma is water with a pH of 7.4

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Blood cells o All produced in red bone marrow o Erythrocytes (RBC) ▪ 5 million/mcL o Leukocytes (WBC) ▪ 5,000-10,000/mcL o Thrombocytes (platelets) ▪ 150,000-450,000/mcL

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Agranulocytes: monocyte and lymphocyte, no grains in them Granulocytes: eosinophil, neutrophil, basophil Erythrocytes: o Most numerous of all blood cells o Small disc shape with no nucleus o Carry oxygen to cells via hemoglobin o Average lifespan: 120 days o Production is made in the bone marrow and regulated by EPO (erythropoietin) made by the kidneys Leukocytes o Main function is phagocytosis (a white blood cell surrounds a pathogen, swallows it, and digests it) and protection o 5 types identified in standing by their nuclei o Granulocytes ▪ Neutrophils (phagocytosis) present when there's an infection. Attackers. ▪ Eosinophils (allergic rx) higher number when allergies are present ▪ Basophils (allergic rx) higher number when allergies are present o Agranulocytes ▪ Lymphocytes (immunity) ● T cells and B cells ▪ Monocytes (phagocytosis) Thrombocytes o Hemostasis: prevention of blood loss

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o Coagulation: blood clotting ▪ When a vessel is injured, platelets stick together to form a plug then release substances to stimulate clotting cascade. (when chemical mediators are released by the damaged tissue and they bring these factors to the area to promote hemostasis and coagulation) ▪ 12 clotting factors are inactive until injury ▪ Last step of cascade is a conversion of fibrinogen to fibrin to trap blood cells and form blood clot ▪ Serum is produced from the plasma after the blood coagulates Blood types o Proteins on the surface of RBCs determine blood type (more than 20 identified) o ABO system: A, B, AB, O ▪ O- is the universal donor ▪ AB+ is the universal recipient o Rhesus system: Rh+, Rho Cross-matching: compatible blood typing The immune system o Goal: attack specific disease o Antigens: foreign particle that provokes an immune response o Antibodies: protect against foreign particles Innate immunity (nonspecific, based on genetics) o Skin as a barrier o Cilia o Mucus o Lymphoid tissue – B and T cells o Phagocytes - WBC o Reflexes (coughing and sneezing) o Bactericidal body secretions (tears) Adaptive immunity (specific, life exposures) o Cell-mediated immunity (quick) ▪ T cells (thymus gland): attack foreign cell directly ▪ Macrophages: aid T-cells o Humoral immunity (long term) ▪ B cells (bone marrow): multiply into plasma cells to produce antibodies or immunoglobulins (Ig) to inactivate antigens. Building antibodies. ▪ Chicken pox parties: herd immunity Types of adaptive immunity o Natural adaptive ▪ Active: contact with antigen ▪ Passive: mother to fetus (placenta or breast milk) o Artificial adaptive ▪ Active: vaccines ▪ Passive: immune serum from people or animals Suffixes: o Emia: condition of blood

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o Penia: decrease in, deficiency of o Poiesis: formation, production Roots for blood: o Myelo: marrow o Hemo: blood o Erythro: RBC o Leuko: WBC o Lympho: lymphocyte o Thrombo: blood clot o Thrombocyto: thrombocyte, platelet o Immuno: immunity Roots for chemistry: o Azoto: nitrogen o Calci: calcium o Ferro: iron o Sidero: iron o Kali: potassium o Natri: sodium o Oxy: oxygen Anemias: decrease in hemoglobin causing insufficient oxygen delivery o Decrease # of RBC, decrease size of RBC (microcytic), decrease hemoglobin (hypochromic) Coagulation disorders: decrease in platelets causing clotting problems Neoplasms: blood cancers Anemia: o Dx: CBC (complete blood count), MCV (mean cell volume), reticulocytes o Sx: fatigue, SOB, pallor, irritability, heart palpitations o Types: ▪ Aplastic (RBC destruction) ▪ Nutritional (decreases in folate, iron, vit B12) ▪ Pernicious (lack of vit B12 absorption) ▪ Sideroblastic (iron does not make hemoglobin) ▪ Sickle cell (RBC mutation in A population) ▪ Thalassemia (Mediterranean population) ▪ Hemorrhagic (blood loss, aka hypovolemic) Thrombocytopenia: decrease in platelets o Causes: anemia, infection, cancer o Petechiae (looks like a hickey), ecchymosis (bruising), purpura (dark purple spots on skin) DIC (disseminated intravascular coagulation) o Causes: infection, cancer, injury, allergy (surgery) o Widespread clotting, then hemorrhage. Your body clots very quickly, then body realizes that it clotted too much so the clots break down and hemorrhage Hemophilia

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o Causes: genetically x-linked (mom-son). Typically missing clotting factor 7 or 8 out of 12 o Lack of clotting due to missing factor Neoplasms (leukemia) o Sx: anemia, fatigue, splenomegaly, hepatomegaly, bleeding/bruising. Unexplained fever, unexplained weight loss, night sweats are tell tale signs of cancers. o Causes: unknown, exposures, heredity, viruses o Types: ▪ Myelogenous, Myeloblastic, Myelocytic (bone marrow) ● AML (acute): poor prognosis ● CML (chronic o Philadelphia chromosome (Ph) o Part of chromosome #22 shifts to #9 ▪ Lymphogenous, lymphoblastic, lymphocytic (B cells) ● ALL (acute): high remission rate. * makes up 1/3 of all childhood cancers * ● CLL (chronic): rarest, slowest growing ▪ Acute refers to it coming on very quickly but if it’s diagnosed early it has many good treatment options. Hodgkin disease ▪ Lymphatic cancer of B cell (cervical nodes 1st) ▪ Reed-sternberg cells found in nodes ▪ Sx: wt loss, fever, night sweats, pruritus (itchiness) ▪ Tx: radiation/chemo with high success rate Non-Hodgkin Lymphoma (NHL) ▪ More common and higher morality ▪ Can be B or T cells. More widespread throughout the body ▪ Prevalent in older adults or those with AIDS or immunosuppressed systems ▪ Tx: chemotherapy, bone marrow transplant. Hypersensitivity: overreaction of the immune system in the forms of allergy, autoimmune disease and transplant reactions Two types of hypersensitivities: o Allergies and anaphylactic reaction o Allergies: ▪ Reaction to allergen ▪ Causes: pollen, dander, dust animals, food ▪ Hayfever sx: rhinitis, urticaria, sneezing, watery eyes, itchy eyes, angioedema (similar to hives). Does not have a respiratory aspect o Anaphylactic reaction: ▪ Respiratory collapse ▪ Causes: drugs, vaccines, food (shellfish, dairy, tree nuts), animal bites ▪ Pallor, wheezing, shortness of breath ▪ Tx: epinephrine, oxygen, antihistamines, corticosteroids

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Immunodeficiency o Failure of the immune system that can be congenital or acquired o AIDS caused by HIV (attacks T cells) and Dx with a CD4 count less than 200/mcL o AIDS opportunistic infections ▪ Pneumocystis jirovecii: fungal pneumonia ▪ Candida albicans: yeast/oral thrush ▪ Cryptosporidium: GI protozoa, grows in stomach and small intestine ▪ Kaposi’s sarcoma: skin cancer (black and purple spots all over skin) Autoimmune disorders o Immune response to own body tissue of primarily unknown causes ▪ System lupus erythematosus (SLE) ▪ Systemic sclerosis ▪ Sjogren syndrome ▪ Pernicious anemia ▪ Rheumatoid arthritis ▪ Graves disease ▪ Myasthenia gravis ▪ Fibromyalgia ▪ Rheumatic heart disease

Kinesiology 203 Assignment #7 Chapter 12 and 13 Chapter 12 (Respiratory System) 1. What is the difference between the parietal and visceral pleural? Parietal is the outer pleura and the visceral is the inner pleural

2. List the flow of air from the outside of the body through the lungs. Nose/mouth, nasopharynx, oropharynx, laryngopharynx, larynx, trachea, bronchi, bronchioles, alveoli 3. What are the glottis and epiglottis? The glottis is the opening between the vocal cords. The epiglottis is the cartilage at the top of the larynx that moves back and forth while eating. 4. Ventilation is the combination of inspiration and expiration. What three muscles aid in ventilation? What nerve controls the diaphragm? The diaphragm, the external intercostals, and internal intercostals all help with ventilation. The phrenic nerve controls the diaphragm. 5. What is the medical term for coughing? Expectoration 6. What is the difference between hyperventilation and hypoventilation? What happens to blood pH during these two abnormal types of breathing? Hyperventilation is when too much carbon dioxide is exhaled, the blood then becomes too alkaline. Hypoventilation is when too little carbon dioxide is exhaled, and the blood becomes too acidic. 7. List three pathogens that can cause pneumonia. Streptococcus pneumoniae, haemophilus influenzae, klebsiella p...