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BY 116: EXAM 3

skeletal muscle
attaches to axial and appendicular skeleton; stabilizes and moves diarthritic joints; group as to which movement performed and body region 
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cardiac muscle
muscle around heart chambers; moves blood into the systemic and pulmonary arterial circuits 
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visceral/smooth muscle
muscle of hollow-tube organs; known as the muscular tunic; involuntary movement; moves fluids, or semi-solids, or air; two forms: longitudinal and circular 
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functional characteristics of all muscles:
excitability: the ability to receive and respond to stimuli; controlled through chemical messages that conduct action potentials; conductivity: the ability to receive a stimulus and transmit a wave of excitation (electrochemical activity) contractibility: the ability to shorten forcibly when stimulated; extensibility: the ability to be stretched or extended; elasticity: the ability to bounce back to original length 
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skeletal muscle location and purpose:
gross locations around the skeleton; common purpose for skeletal movement and stability; superficial: primary movers; deep: postural muscles; intercostals and diaphragm: ventilation muscles 
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additional physiological benefits of skeletal muscle:
thermoregulation - heat producer; skeletal muscle pump - assist blood return to the heart from lower leg veins; produces a metabolic waste useful in determining the renal fitness (creatinine); major storage site of amino acids and glucose; contributes to acid/base regulation; correlates and health and longevity 
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skeletal muscle is ideally ________% of male total mass.
30-45% 
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skeletal muscle is ideally ______% of female total mass.
25-35% 
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3 major components of muscle:
water, protein, glycogen 
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during exercise what is always produced? what affect does it have on the body?
lactic acid; drops body pH 
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2 tendon attachments:
origin and insertion 
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origin
stable attachment, on what we pull lever towards 
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insertion
on lever that is going to move; always across a moveable joint 
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muscle fascicle
bundle of fibers; have fiber-type specialization and distribution 
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muscle fiber
cylindrical, striated, multi-nucleated 
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perimysium
bundle muscle fascicles together 
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epimysium
bundles entire muscle together 
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endomysium
holds fiber together 
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fascicle has how many types of fiber?
one 
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every muscle has how many types of fiber?
all 3 
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sarcoplasmic reticulum
stores calcium 
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sarcolemma
keeps everything in cell 
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T-tubules
connects sarcolemma to sarcoplasmic reticulum 
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a powerful muscle has _______ mitochondria
less 
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actin
contractile, rope-like 
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myosin
molecular motor protein 
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sarcomere
functional unit of force production within a single fiber; repetitive striated pattern 
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Z-lines
define 1 sarcomeric unit 
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M-line
middle of a sarcomere 
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A-band
containing all the myosin and some actin; has region of overlap 
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I-band
containing only the actin on both sides of Z-line 
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H-zone
containing only myosin and M-line 
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what part of the sarcomere gets shorter in muscle contraction?
Z-line to Z-line 
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region of overlap
contains myosin and actin; all muscles have some overlap, but how much depends; training affects the amount of overlap 
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procedural steps in skeletal muscle physiology:
latent period; contraction phase; relaxation phase 
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latent period
resting/beginning tone; always presence of muscle tone; neural - neurological work is the start of coupling 
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contraction phase
tension always increases, which is how we know it will shorten; maximum tension is limitless 
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relaxation phase
elongation; extensible and return to relaxed state; will eventually fail with repetition (fatigue) 
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4 areas of neural work for skeletal muscle contraction:
relay area/spinal cord (most basic); primary motor cortex; premotor and supplementary cortices; prefrontal cortex and parietal cortices 
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primary motor cortex
initiates; precentral cortex in frontal lobe; 
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premotor and supplementary cortices
assembly of plan 
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premotor cortex
excitatory; analysis of all muscles in limb 
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supplementary cortex
inhibitory; analyses muscles not part of movement; inhibits additional movements from happening 
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prefrontal cortex
cognitive brain; generate idea and motivation 
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parietal cortices
sensory interpretation area 
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direct basal nuclei
excitatory; directly to motor cortex but need information from premotor cortex 
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indirect basal nuclei
inhibitory; to thalamus to inhibit neurotransmitters not needed; then to motor cortex 
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cerebellum
remembering body movement (motor memory); influences how plan gets through brainstem (coordination) 
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upper motor neuron
2 pathways to exit spinal cord; divided into 2 systems 
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2 systems of upper motor neuron:
pyramidal; extra pyramidal 
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pyramidal system
main neuron pathway for controlling muscle; path to primary movers; 2 tracts: lateral (90%; crossover in brainstem; go to major muscles) and medial (goes to deep muscles) 
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extra pyramidal system
supportive; 4 different nuclei; send to postural muscles so they support movement 
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lower motor neuron
upper motor neuron releases glutamate (always excitatory) to lower motor neuron; responsible for guiding to muscle fibers prepared to contract; to motor end plate 
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motor unit size
number of fibers lower motor neuron is reliable for; distinguishes type of movement 
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lower number of myofibrils = _______ movement
finer 
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order of muscle events:
ACh release onto motor end plate; ACh opens nicotinic Na+ channel; depolarizing AP wave conducts down T-tubules; AP activates DHP gate; DHP gate opens Ca channels of SR; Ca binds to troponin, displacing tropomyosin from the myosin-actin binding site; actin/myosin crossbridge cycling and the power stroke; sarcomere shortening; lever movement from the insertion to origin or stabilize joint; lever movement from insertion to origin or stabilize joint 
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DHP gate
micromolecular door connecting T-tubules to SR 
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tropomyosin
interferes with actin and myosin binding 
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actin/myosin crossbridge cycling and the power stroke:
1) myosin at 45 degrees; no ATP; 2) ATP to binding site; 3) ATP quickly used to elongate hinge (90 degrees), binds to next closest actin site; 4) kicks out phosphorus, no longer has energy to stay at 90 degrees, returns to resting; contraction; 5) kick ADP by another ATP; begins again 
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total time from through to contraction:
1/2 sec; neural is fast; muscular/ crossbridge cycling slower 
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the muscle shortens to ________ its capability
100% 
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what happens to sarcomere during contraction?
H zone gets shorter; I band gets shorter; overlap gets larger; A band does not change 
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why does the A band not change during contraction?
it represents all myosin  
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sliding filament theory
myosin is stable; actin moves; A band staying the same during contraction shows this 
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satiety
satisfied with original task; proprioceptor tells you when you're done; feedback to prevent any further contraction; muscles break down ACh 
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muscle response to neural inhibition:
Ach destroyed at motor end plate by ACh-esterase; Ca is returned (pumped) into SR - requires ATP; myosin/actin uncoupling and blocked by tropomyosin; sarcomere elongates/ afferent spinal frequency (proprioception) slows; sarcolemma potential returns to resting 
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large muscle diameter = __________ sarcomeres
more 
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muscle fiber types:
slow-twitch oxidative (type I); fast-twitch oxidative (type IIa); fast-twitch glycolytic (type IIb) 
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slow-twitch oxidative (type I)
red muscle; slowest time to development o max tension; slow myosin ATPase activity; small diameter = not as powerful; longest contraction duration; moderate Ca-ATPase activity in SR; fatigue-resistance endurance; most used; used in postural muscles - highest on deep axial skeletal muscles; oxidative, aerobic, numerous large mitochondria; dark red color 
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what give muscles a red color?
myoglobin 
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fast-twitch oxidative (type IIa)
red muscle; intermediate time to development of max tension; fast myosin ATPase activity; medium diameter = medium power; short contraction duration; fatigue-resistance; used for standing and walking -limbs and trunk; glycolytic, but becomes more oxidative with endurance training; red color; most abundant; best of 2 fibers 
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fast-twitch glycolytic (type IIb)
fastest time to development of max tension; fast myosin ATPase activity; large diameter = powerful; short contraction duration; high Ca-ATPase activity; easily fatigues; least used; used for jumping - used for powerful movements; glycolytic, more anaerobic than fast-twitch oxidative type; pale color because no myoglobin; little or no mitochondria; 
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hyperplasia
adding new cells; not seen to happen 
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hypertrophy
enlarge cells you already have 
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satellite cells
precursor cells 
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exercise research shows that muscle always increases how?
in size 
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muscle mass
adaptation to resistance and aerobic training 
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does increase in size of a muscle fiber cause fiber type switching?
tested in chickens: inconclusive studies; human studies: research showing possible conversion from type IIa to the best fiber for that training 
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what is the best way to have all 3 fiber types?
always mix in endurance and resistance 
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resting muscle tone
tension on muscle at rest; determine by the length-tension relationship 
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length-tension relationship
optimal key is full range of motion; increase length = too little force; decrease length = too much force 
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resting muscle tone produced by spindle fiber reflex:
extrafusal muscle fibers at resting length; sensory neuron is tonically active; spinal cord integrates function; alpha motor neurons to extrafusal fibers receive tonic input from muscle spindles; extrafusal fibers maintain a certain level of tension even at rest 
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intrafusal fibers
deep fibers 
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extrafusal fibers
superficial fibers 
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spindle fiber reflex
helps adjust force production 
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spindles
whenever extrafusal contracts and relaxes sent to afferent nerve 
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frequency of afferent fiber =
frequency of alpha motor units 
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low weight, low resistance, high repetition does what?
builds speed; full range of motion 
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deep tendon reflexes =
activating a stronger spindle fiber reflex 
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golgi tendon reflex
protective reflex; shuts down muscle; if stretch on tendon is excessive, it sets off an alarm and inhibits glutamate signal from activating; muscle goes relaxes in middle of movement; protects against tearing of muscle 
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tetanus
maximum tension 
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unfused tetanus
builds slowly with rest periods; begin cycling when maximum is reached; happens quickly; each fiber given chance to rest from contraction; in more oxidative fibers; allows more sustainability 
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fused tetanus
no cycling; all or none; can't hold for long; begin losing muscle contraction 
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fatigued muscle
failed muscle; applied stimulus, but muscle can't generate tension 
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is tetanus achievable?
yes, we just rarely take out muscles there 
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do we exercise until fatigued?
no, we exercise until tired 
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motor unit
all muscle fibers innervated by a nerve; no 2 are the same; chosen for a specific motor group; recruit based on need 
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motor unit recruitment
muscle memory and proprioceptive feedback 
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motor neuron
excitable to a specific group of fibers of the same type; 
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motor neuron conduction speed is faster with what type of fiber?
fast-twitch fiber units 
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2 types of work:
muscle work (W_m) and load work (W_l) 
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work of muscle =
force muscle can produce * distance between fulcrum and insertion point 
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work of load =
load mass * distance between load and fulcrum 
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if W_m = W_l is there mvoement?
no; we are stabilizing load; working isometrically, not isotonic 
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if W_m > W_l is there movement?
yes, in the direction toward the origin 
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concentric movement/contraction
lessening the angle 
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eccentric movement
increasing the angle 
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W_m < W_l
overwhelmed/beyond muscle capacity; where it can't go anymore 
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what to be training in _________% of what maximum is
60-80 
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lever systems can give advantage or disadvantage to what?
amount of muscle work needed to stabilize or move a load 
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first class lever
muscle advantage; equal distance from fulcrum to load and fulcrum to muscle; example = neck extenders, load is gravity on chin, it is one of the strongest muscles 
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second class lever
muscle advantage; like a wheelbarrow; load in middle and muscle and fulcrum are equal distances from load; example is ankle joint (plantar, gastrocnemius) 
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third class lever
muscle disadvantage; muscle near fulcrum at end, long distance, then load; load has advantage because of big distance, muscle at disadvantage because of small distance; majority 
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power in movement is inversely proportionate to what?
range of motion 
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what is gained by having inefficient muscle work?
not built for brute force (power), but for speed of movement 
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stronger muscles have ________ range of motion
smaller 
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strength =
1 / flexibility (ROM) 
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principle of why we have third class levers?
humans aren't constructed for strength; we are constructed to generate speed 
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most rapid movement is when load is the _________
smallest 
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isometric
speed = 0 
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isotonics
build muscle mass faster 
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fuel utilization:
ATP pool (10 sec) --> Creatine Phosphate pool (1 min) --> glucose stores ----> blood glucose ---> lipid 
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limitation of energy used
blood flow and oxygen intake 
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creatine phophate
re-synthesizes ATP 
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2 hormones important to exercise:
epinephrine (increases with exercise and activates adipose tissues; responsible for available sugar) and cortisol (increases blood glucose) 
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caffeine ______ fuel availability
accelerates 
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reasons for fatigue:
lactic acid threshold theory; inorganic phosphate theory; Ca-K theory; injury and pain theory 
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lactic acid threshold theory
correlated data; stress test - different intensities in stages; take blood sample and measure lactic acid at stages; for untrained people: lactic acid increased rapidly, then plateaued, didn't make it long; trained: more gradual increase higher before plateau and held plateau for longer; lactic acid gives sugar to muscles, the build up of lactic acid at end is worse than during exercise; weakly associated with fatigue 
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inorganic phosphate theory
same curve as lactic acid 
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Ca-K theory
same curve as lactic acid 
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injury and pain theory
pain threshold is higher in trained/athletes; subjects used pain charts; trained: CSF has higher endorphins (antipain) that was produced quicker and in higher qualities; took 3 weeks-a month to change 
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central fatigue
in nervous system; drive and boredom; miscommunication; uncoordinated, must think a lot 
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central pattern generator
connection in CNS; take over autorhythmic movements; grow autorhythmic connection between CNs and muscle; very powerful 
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locations of smooth muscle:
lumen of hollow organs; blood vessels; bronchi; segmented valves (sphincter muscles); iris and ciliary eye muscles; arrector pili 
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smooth muscles anatomy
elongated-spindle; non-striated; single nucleus; long sheaths, layered or circular patterns forming constrictors; usually middle layer of tissue (muscularis); myofibrils are not organized into sarcomeres, but instead into dense bodies creating banding patterns; have a caveolae similar to SR in skeletal muscle; a lot of mitochondria = highly aerobic; gap junctions relay Ca signals between cells 
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caveolae
in smooth muscle; similar to SR in skeletal muscle; Ca source 
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physiological types of smooth muscle:
single and multi-unit 
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multi-unit
are not electrically linked, and each cell must be stimulated independently; rarest and for fine control; varicosity releases neurotransmitters as AP comes down; allows for control of a single cell 
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varicosity
where stored neurotransmitters are; release NT as AP comes down; allows for control of single cell 
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single-unit
connected by gap junctions, and the cells contract as a single unit; varicosity only found on one side of smooth muscle on surface; relayed to gap junctions; activate multiple cells at once; coordinated/whole muscle contraction; more frequent 
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neural activity in smooth muscle physiology
rest = parasympathetic: ACh; action = sympathetic; respond to 2+ signals in order to become excited 
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cholinergic receptors - smooth muscle
parasympathetic; primary muscarinic - 5 types, 3 are excitatory/contracting and 2 are inhibitory/relaxing 
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adrenergic receptors
alpha: 1-4, mostly excitatory; beta: 1-3, 2 are excitatory, 1 is inhibitory 
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smooth muscle excitation second messenger
causes release of Ca 
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local activators - smooth muscle excitation
mechanical, stretched, open Ca channel 
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slow wave
blood vessels; ligand Ca channels 
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pacemaker
constant peak; glands; squeeze to release channels; stretch Ca channels 
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smooth muscle excitation-contraction coupling
smooth muscles do not have blocking agent; release internal Ca and external Ca (Ca influx); CaM activates MLCK; MLCK activates myosin; same cross bridge cycling as skeletal muscle; relaxing muscle = reverse, take P off 
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MLCK
responsible for phosphate on myosin 
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purpose of blood flow:
generates opportunity to exchange nutrients 
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part of cardiovascular system:
blood (hematopoietic system); centralized heart; blood vessels 
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red bone marrow
gives blood cellular component 
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pulmonary system
right pump of heart; generates blood flow; low pressure, high perfusion 
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systemic circuit
left pump of heart; generates higher pressure; high pressure, high perfusion 
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arteries
leave heart, goes to capillaries; resistant to pressure - thick walls of smooth muscles; high pressure 
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veins
go to heart; low pressure; not as much structural need to be strong, so they are weaker 
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2 parts of venous system:
superficial (what you can see); deep(run through skeletal muscles) 
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which is slower moving: arterial or venous system?
venous system 
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performance of the cardiovascular system is measured as:
pressure (systolic and diastolic); heart rate, rhythm, and output; arterial/venous blood concentration 
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3 pressures that make up total BP:
cardiac output (forward; surging pressure into system); vessel radius (container pressure); blood volume and density (hydrostatic frictional pressure of system) 
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blood flow is dependent on what?
blood pressure 
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cardiovascular system must be _________
adjustable 
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the cardiovascular system is a parallel system. what does this mean?
every tissue gets some of blood flow from the main channel, so they all get the same nutrients, but not always the same amount of blood 
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what 2 organs are unique in blood flow?
brain and kidneys 
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brain and blood flow
needs consistent blood flow/pressure; if not, results in sleepiness and vomiting 
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kidneys and blood flow
filters blood; flow influences how much the kidneys can filter 
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blood pressure flows down what kind of gradient?
pressure gradient 
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blood flows in what kind of capillary patter?
parallel capillary pattern 
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blood flow is both _______ and _______ dependent
volume and speed 
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blood flow =
hydrostatic pressure gradient / resistance 
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systolic pressure
head pressure; adjustable and pulsatile; pressure difference between 2 points 
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diastolic pressure
resistive pressure; adjustable and continuous; want to be continuous; vessel radius + blood volume and density 
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why happens if you increase diastolic?
blood movement decreases; why you want to increase systolic instead 
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if resistance changes, how does blood flow change?
increase resistance, decrease flow 
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first Korotkoff sound:
systolic; vessel opened enough to get blood through 
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last Korotkoff sound:
diastolic; re-opened; can't hear anything after this 
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what influences can affect BP determination?
medication; hydration/fluid balance; diseases; resting heart rate; what position you're in; breathing pattern 
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which pressure is most adjustable?
systolic 
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MAP =
total peripheral resistance * cardiac output 
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mean arterial pressure (MAP)
average of all pressures; pressure average coming through away from heart  ?
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if total peripheral resistance increases what happens to MAP? why?
increases because of venous redistribution, blood is getting back faster, so it can pump faster; 
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you have good BP/flow when you have at least _____ head pressure
+10 
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pressure in system all the time?
diastolic
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your pulse is only present ____ of the time
1/3 
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your heart is resting ____ of the time
2/3 
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low frequency baroreceptor will:
lower parasympathetic -- increase HR; increase sympathetic -- vasoconstrict, raise contractility, raise SA node; decrease urine output --vasopressin 
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high frequency baroreceptor will:
increase parasympathetic -- slow SA node; decrease sympathetic -- vasodilate, reduce cardiac contractility; increase urine output 
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how does baroreceptor reflex work?
baroreceptor in aorta and internal carotid sends impulse along vagus nerve to brain; brain compares the timing difference to know if it is getting enough blood -- can adjust frequency if needed 
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MAP slowly influenced by what?
blood volume / consistency 
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MAp rapidly influence by what?
vessel radius / resistance 
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resistance affects what?
vein "preload" and artery "afterload" 
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vein "preload"
volume and pressure to fill heart 
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artery "afterload"
volume and pressure against heart emptying 
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if resistance leaving the heart increases what happens?
frequency decreases, which causes a response of increase in pressure; resistance loads heart and gives the brain a reason to increase BP 
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resilience
cardiac output; most stubborn and demanded on 
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faster resillence
more ejection, more output 
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more volume
more output 
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resilience changes what pressure?
systolic
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cardio center of brain
medulla 
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prehypertensive BP
120-135 / 80-85 mmHg 
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stage 1 hypertensive BP
139-150 / 90-95 mmHg; resistive pressure went up, lowering frequency difference, so brain interprets it as not having enough leading to the body increasing systolic 
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stage 4 hypertension
severe and life-threatening; 210/120 mmHg; can rupture -- rupturing aneurysms; can cause kidney and brain failure 
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vasodilation results in what?
large diameter, large volume, lower BP, slower movement, increase exchange 
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vasoconstriction results in what?
small diameter, small volume, higher BP, faster movement, decrease exchange 
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Boyle's low in relation to blood flow
p1x v1 = p2 x v2 or r1 x v1 = r2 x v2 
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change in radius does what to resistance?
decrease radius, increases resistance; increase radius, decrease resistance 
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cycles =
filling (diastole) + emptying (systole) 
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result of HR increasing?
increase in output; 
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what is the first and fastest way to increase BP?
increase HR 
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cardiac output =
HR x stroke volume 
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ways to control vessels:
distal and local 
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controlling vessels distally
control outside of local area; by brain (rapid and intense; sympathetic; norepinephrine) and hormones (vasopressin; epinephrine; renin angiotensin II system) 
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what hormones are always present when vessels vasoconstrict?
vasopressin; epinephrine; renin angiotensin II system 
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controlling vessels locally:
at the tissue; histamine (dilate and constrict); ATP (constrict); cytokines; O2 (constrict if too high); CO2 (dilate if high); H+/acid (dilation) 
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how cardiac output affects MAP:
HR; rhythms; output 
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rhythm
individual events that occur in order throughout one cardiac cycle; responsible for emptying; gives stroke volume 
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pericardium
outer serous membrane 
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myocardium
muscular chambers, septum 
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endocardium
cuspid and semilunar valves, chordae tendinae, papillary muscles 
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SA node
primary pacemaker; only pacemaker connected to brain and hormones; purpose is to relay signal to trigger atria to contract; relays signal to AV node 
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normal resting HR
60-99; parasympathetic system (ACh) 
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tachycardia
HR greater that 100; excessive HR 
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bradycardia
HR less than 60; inefficienct 
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AV node
pauses signal for (.012-.02 sec); release into ventricular walls; pauses so chance to close valves/cuspids 
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what happens if AV node doesn't pause signal long enough?
inefficient 
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what happens if AV nodes pauses signal for too long?
heart panics and does what it wants; 
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AV pacing will be consistent at _____ bpm
60 
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bundle branches
left and right are synchronized; signal for contraction 
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purkinje fibers
in apex; penetrate muscle to stimulate to contract; 
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pacemakers of heart:
SA node; AV node; ventricular foci 
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ventricular foci
triggered if contracting of apex is too slow, delayed, or block; lowers PVC 
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what makes excitation-contraction coupling of the heart unique?
step 2 - plateau; cell floods will Ca++, used to removed tropomyosin; starts from an outside source; gives the heart muscle a longer time to contract; longer refractory period (can't stimulate heart to contract again to make sure ventricles finish contracting ; Ca induced Ca release 
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fibrillation
excessive rate and ineffective pump; absence of heart pumping; life threatening 
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flutter
HR of 250 or higher; not working together 
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spasim
if HR over 350 
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how do you calculate MAP?
total peripheral resistance x cardiac output; diastolic + 1/3(systolic - diastolic) 
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PR interval
cuspid valves close; end of diastole 
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QRS complex
bundle branches to purkinje fibers; begin ventricle systole 
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ST segment
ventricle fully depolarized; ejection; must not dip 2mm above or below base line 
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low ST segment represents what?
coronary artery disease 
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high ST represents what?
hypertension 
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QT segment
complete ventricle systole; stroke volume; 
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T wave
repolarizing; ventricle diastole; end of contraction and the beginning of rest 
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what does it mean if the Q wave is downward and the T wave is inverted?
heart attack 
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between end of T wave and beginning of P wave
whole heart diastole; passive blood illing; heart is resting; 
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P wave
depolarization of SA node, which kicks off all other events; atria systole; 
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absence of P wave could mean what?
junctional rhythm; 60 bpm, won't change with exercise 
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too many P waves could mean what?
high risk of stroke because flutters 
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End Diastolic Volume (EDV)
starting volume; begins when valves close in PR interval 
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what influences determine EDV?
preload 
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what influences determine ESV?
afterload 
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End Systolic Volume (ESV)
remaining volume in heart after ejection 
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stroke volume =
(EDV-ESV) / cycle 
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pneumonia
inflammation in alveoli in lungs; increase fluid movement out of capillaries an into tissue (increase fluid pressure); fluid squeezing capillary; volume exiting lung = left preload 
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hypercholesterolemia
cause of atherosclerosis 
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atherosclerosis
increase afterload; increase volume staying in heart;/ESV; decrease in stroke volume 
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how do you increase SV by decreasing ESV?
increase HR to increase preload; stretch ventricle volume; increase cardiac muscle tension =contractility 
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contractility
activate adrenergic beta with epinephrine ; heart contracts more forcefully; more fluid leaves 
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Frank-Sterling Law
states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant. 
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A to A in pressure-volume loop
cardiac cycle 
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what point in the pressure-volume loop is EDV?
b
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v
d
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what 2 major things do we need blood for?
transport and exchange; protect blood pressure with hemostasis / immune physiology 
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transport and exchange to the tissue:
nutrients; electrolytes; gases; proteins; blood cells: erythrocytes (RBCs), leukocytes (WBCs), thrombocytes (platelets) 
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transport and exchange away from tissue:
heat; metabolic waste 
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what is blood composed of?
55% plasma volume; <1% white cells; 42% packed red cell volume 
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plasma is composed of what?
water; electrolytes; organic molecules (amino acids, proteins, glucose, lipids, nitrogenous waste); trace elements and vitamins; heat; gases 
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4 tests to determine if you have diabetes:
random glucose test; fasting glucose test; glucose tolerance test; sampling blood for insulin 
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random glucose test
check glucose level in blood after not eating; 126-200 mg/dL is worrisome 
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fasting glucose test
patient hasn't eaten in12+ hours; take blood and test glucose levels; if 125mg/dL might be diabetes 
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glucose tolerance test
patient fasts; given glucose drink; take blood and check glucose level every 30 minutes; 
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type one diabetes
no insulin; usually diagnosed early; autoimmune 
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type 2 diabetes
could be low insulin levels and can be fixed with diet and exercise or they have insulin, but it is ineffective (insulin resistance); also known as delayed onset diabetes 
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why does lipid need to be controlled in blood?
cholesterol 
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optimal blood cholesterol level:
at or below 200mL/dL, with a 3 LDL:1 HDL ratio 
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forms of nitrogen waste:
urea; ammonia; bilirubin 
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urea
hydrophobic; passes easily around body; main waste in urine 
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blood clotting mechanism:
prothrombin to thrombin 
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thrombin
activates fibrinogen into fiber to form clot; activates plasminogen to plasmin that destroys clots 
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hematopoiesis
the process of blood being composed of formed blood cells 
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stem cell
origin of all cells 
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myeloid stem cell
makes all RBCs, platelets, and all phagocytic cells 
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thrombopoietin
comes from the liver; 1 death = 1 replacement; growth factor 
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neutrophil
phagocyte; may rise in cancer patients or when you have an infection 
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lymphoid system
adaptive immune system 
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3 types of exchange:
bulk flow; diffusion; transcytosis 
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bulk flow
push H2O and nutrients into tissues from blood; venous absorption and wastes out; filtration then absorption 
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what capillary pressure difference creates bulk filtration?
more hydrostatic pressure on outside than colloid pressure 
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what capillary pressure difference creates bulk absorption?
less hydrostatic pressure on outside than colloid pressure 
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net filtration pressure is greater than new reabsorption pressure, so where does the extra filtered volume go?
lymphatic system 
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nephron
functional unit of kidney 
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the medulla forms what?
salt gradient 
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types of exchange from kidney:
filtration (movement from blood to lumen), reabsorption (from lumen to blood), secretion (from blood to lumen 
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net filtration pressure =
hydrostatic pressure (P_cap) - (P_filtrate + P_colloidal) 
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glomerular filtration rate (GFR)
100-125 ml/min with NFP of 10 mmHg 
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erythropoietin
growth signal to make more RBCs when O2 levels are down 
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JG cells produce what?
renin 
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what happens when you combine renin and angiotensin?
angiotensin I is released into circulation 
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angiotensin I combines with angiotensin converting enzymes on cells to activate what? what does this do?
angiotensin II; causes whole BP to go up, vasoconstriction, and increases GFR 
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what does angiotensin II release at adrenal cortex?
aldosterone, which acts on kidney nephrons to increase blood sodium, decrease blood potassium, increase blood osmolarity, increase blood volume, increase BP, and increase GFR 
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what should happen if the entering pressure volume produced a high load volume?
try to restrict volume 
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what should happen if the load volume is too low?
boost pressure, don;t let it leave as quickly; increasing filtration 
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transcytosis
across cell; couple secondary transport with Na+ and another molecule 
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transport maxium
the max amount before sodium becomes saturated; enough to make sure we recover everything else 
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counter-current multipllier
H20 reabsorbed (descending) and ion reabsorbed (ascending); follows the osmotic shift; in medulla - caused be salt concentration 
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how does pH balance when its too acidic?
distal segment does more secretion work; acid gets out of blood and into interstitial space; CO2 and H2O diffuse into tubule cell with CA to form carbonic acid (H2CO3); carbonic acid breaks down into acid (H+) going to urine and base (HCO3) which goes to blood to act as a buffer 
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how does pH balance when it is too alkaline?
get more bicarbonate (HC03) into urine and more acid in blood 
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diffusion moves down gradient from _____ to _______
high to low 
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diffusion rate is dependent on:
(gradient x solubility x permeability x surface area) / membrane thickness 
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amount exchanged depends on:
gradient strength; blood flow rate; saturation level 
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how does the body handle the CO2 waste?
CO2+H20 --> HCCO3 ---> H+ + HCO3 H+ will change blood pH 
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respiration
diffusion of gases 
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2 types of respiration:
alveolar; tissue 
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requirements of respiration:
RBC development; ventilation mechanics; blood flow 
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alveolar pressure of oxygen:
100 mmHg 
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alveolar pressure of CO2:
35 mm Hg 
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know the importance of Dalton's and Henry's laws to capillary respiration
gases will diffuse (Dalton's) and dissolve (Henry's) until equilibrated 
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ventilation
movement of air in and out of the lungs 
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type 2 alveoli
produce surfactant (reduce water tension)  
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what limits gas exchange?
anything limiting air volume or increasing thickness 
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changes in lung volumes =
changes in alveolar pressure 
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2 things most stimulatory for breathing:
increase in blood CO2 and increase in acid 
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applying Boyle's law to ventilation:
P1V1=P2V2; enlarging the thoracic cavity decreases the pressure and increasing volume; relaxing the thoracic cavity increases pressure and decreases volume 
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RBC's circulate at what?
cardiac output rates (5L/min) 
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RBC production:
ATP, vitamin B12, iron, EPO (growth), 3% released per day 
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RBC destruction:
spherical shape change; iron recycling; globulin catabolism; heme-bilirubin-bile 
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oxygen loading
must supply enough oxygen for tissues to perform aerobic ATP synthesis; saturated 
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carbon dioxide unloading
clear CO2 in water to preserve pH of plasma; most as bicarbonate (70%) 
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P_VO2 =
40mmHg 
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why does oxygen enters RBC?
because it has high specificity to hemoglobin 
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oxygen helps CO2 ________ by ________
unloading by loading 
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tissue respiration
gas exchange at the tissues; blood comes fully saturated with oxygen (20% dissolved, 80% bound to hemoglobin); tissues must be able to unload oxygen and acquire CO2; for us to be able to unload O2, must be able to displace from hemoglobin, so CO2 must enter RBC - combines to form H2CO3; once H2CO3 forms, it dissociates into HCO3 and transports in plasma, H+ is used to displace O2 on hemoglobin, some CO2 will also displace O2; once CO2 and acid displaces oxygen, it diffuses 
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alveolar respiration
gas exchange in lungs; O2 enters RBC because of gradient and unloads CO2 and H+ by its loading to hemoglobin; as CO2 moves from plasma into alveoli, it forced bicarbonate into RBA which reacts with displaced H+ to reform carbonic acid (with help of carbonic anhydrase); dissociates into CO2 and H2O 
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what does hemostasis do?
protect against pressure loss; protect pressure loss protects volume loss; protecting volume loss protects total circulation; protecting total circulation protects capillary exchange 
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2 types of vessel breaks:
arterial and venous vessel breaks 
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arterial vessel break
reduce stroke volume delivery; fast pressure and volume loss 
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venous vessel break
reduce cardiac preload return; slower pressure and volume loss 
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hemostasis requires:
about 200,000 / microliter platelets; coagulation plasma proteins, and Calcium 
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Steps of hemostasis:
vessel damage (stimulate vasoconstriction and vasodilation); platelet work- adhesion/ aggregation degranulation against wall of vessel; fibrin clot formation - intrinsic (inside) and extrinsic (outside) vessel; consolidation and wound retraction - epithelialization (requires immune function) - thrombin to activate fibrinogen into fibrin to form fibrous weaving; clost resolution - fibrinolysis - coagulation and fibrinolysis occur simultaneously 
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intrinsic clot formation pathway:
hageman to prothrombin to activate thrombin 
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extrinsic clot formation pathway:
tissue thromboplastin to activate prothrombin into thrombin 
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pros and cons to 2 pathways of clot formation:
pro: patch to vessel wall on both sides; con: clot inside become increased resistance to blood flow 
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fibrinolysis
thrombin also activates plasminogen to destroy fibrin clots; tPA will also form plasminogen like thrombin, but more effectively 
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why do you need a clotting system:
to prevent RBC and O2 loss; to prevent protein and osmotic loss; to prevent fluid and pressure loss; the prevent circulation loss and death 
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what happens when you have deficient hemostasis?
hemorrhage and volume loss 
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what happens when you have excessive hemostasis?
thrombosis and obstruction 
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classical signs of inflammation:
swelling, pain, heat, redness, and disturbed function 
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goal accomplished by inflammation:
process of making WBCs 
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myeloid
produce nonspecific phagocytes 
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non-specific phagocytes
majority of WBCs; neutrophils (majority), eosinophils, basophils, and monocytes 
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inflammation
reaction to any bodily injury (physical, chemical, or electrical) 
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perks of inflammation:
excess filtration prevents invasion of the blood and leads to increased lymph flow; waste and debris will be filtered and removed through the lymph node drainage 
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steps of inflammation:
injury; tissue necrosis leading to antigen release; antigen recognized by phagocytes; phagocytes release histamine to stimulate full inflammatory response; increase capillary permeability and bulk flow filtration; neutrophils accumulate in the area near injury to find the margin and change shape to leave cell; neutrophils become phagocytic cells and isolate the injured area by surrounding the cells (granuloma); neutrophil becomes antigen presenting cell (APC) by putting antigen particles on receptor outside of cell - MHC class 2 receptors 
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what happens once neutrophils leave the blood vessel?
the are not allowed back in so they die, which increases the WBC production in the body 
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B-lymphocyte = ______-mediated immunity
antibody 
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naive B-cells
have never seen the antigen they are specific for; don;t get destroyed 
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activation of a B-cell
signal 1- when B-cell comes in contact with the antigen it is specific for; signal 2 - cytokine signals from the Th cell 
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clonal expansion of B-cells
B-cells divide and produce like B cells to recognize the same antigen; they have antibody switching, so the new B-cells are better at seeing the antigen 
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cell differentiation of B-cells
plasma cells produce antibodies that can be secreted by exocytosis and can go places cells cannot; "antibody missiles" 
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B-cell antigen destruction:
opsonization: particles are are targeted for destruction by an immune cell known as a phagocyte; neutralization: defends a cell from an antigen or infectious body by inhibiting or neutralizing any effect it has biologically; complement activation: IgG enzyme activates complement protein 1 causing a cascade, which forms a membrane attack complex (MAC) - a pore in cell allowing water into cell and causing lysis 
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T cells
protection form our own cells that are no longer acting like self cells 
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2 varieties of T cells:
CD4 (Th) and CD8 (Tc) 
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T cell precursor
goes to thymus; if it recognizes and binds to MHC2 cells - becomes Th; if it recognizes/binds to MHC1: if it kills cell, T cell is killed; if it does not kill the cell, it becomes Tc 
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Tc cell activation
looks for abnormalities in self cells; if it binds weakly, there is nothing wrong with the cell and Tc moves on; if there is something wrong, Tc will bind strongly and kill cell; Th cells provide cytokine signals for Tc cells, but Tc cells are not dependent on Th and can self activate; Tc cells then expand and differentiate 
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AIDS and T-cells
attack Th cells, once they reach a critically low level, there is too few left to activate a response, causing many opportunistic infections that can become deadly 
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T-cells are ______ mediated immunity
cell 
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cytotoxic T-cell killing
produce clone cells responding to virus infected cells, cancer cells, or cells no longer showing MHC1; onced attached to cell, they secrete cytotoxic perforin that creates holes in the membrane allowing digestion of cell components (like DNA) that will eventually lead to apoptosis; cloned Tc cells will die off, but some remain as memory cells 
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purpose of the endocrine system
control and maintain homeostasis; can be turned on in time of stress; balances metabolism 
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primary endocrine organs / glands:
pineal; pituitary; thyroid; parathyroid; thymus; adrenal; corpus luteum 
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secondary endocrine organs:
hypothalamus; heart; lungs; blood vessels; liver; pancreas; gastric and intestinal mucosa; kidney; skin; gonads 
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Cannon's postulates:
the nervous system has the supreme role in preserving physiological "fitness"; the body's fitness requires a constant, but adjustable method of control; any chemical control signal can have multiple effects in the body as a whole, but will be specific to a given tissue 
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endocrine reflex pathways:
input signal, sensory awareness of physiological variables and environmental conditions --> sensor/receptor --> afferent pathway --> integrating center --> efferent pathway --> target of effector --> response 
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observable forms of endocrine reflexes:
simple; neurohormone; neuroendocrine 
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simple endocrine reflex
integrating center to efferent signal to effectors to response; correction terminates reflex -- feedback response 
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neurohormone endocrine reflex
chemical signal produced in neurons in hypothalamus but secreted into blood supply then to gland or effector to generate a response; oxytocin and vasopressin are examples 
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neuroendocrine endocrine reflex
neurons in hypothalamus makes signal; sends to endocrine integrating center in pituitary if hypothalamus send releasing signal, it will release into blood stream to gland or effector to generate a response 
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hormone definition
a chemical secreted and circulated capable to recognize a target and change cellular processes 
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chemical types of hormones and their benefits:
amines: can be made and destroyed quickly, fast acting, and short lived (about 1 hour); steroids: hydrophobic and can go anywhere blood goes and into any cell, lasts for days; peptide and glycoproteins: most abundant, acts specifically, can circulate without the need of plasma proteins, last about 3-5 hours 
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hormone-hormone interactions:
antagonism: 2 or more hormones with opposite physiological effect, not same target, but same variable is adjusted up or down; synergism: 2 hormones or more, same variable adjusted greater than each would be individually; permissiveness: 2 or more hormones present to have full physiological effect. individually, some work, most do not; redundancy: 2 or more hormones control same variable, but usually don't appear at the same time 
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why is it important to regulate plasma volume, blood electrolytes, and glucose?
plasma volume is required for blood pressure and flow; blood electrolytes are required for nerve impulses, muscle contractions, and plasma membrane transport; blood glucose is required for ATP synthesis and all tissues, but CNS is primarily sensitive to hypoglycemia
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