BRS Physiology

330 Pages·2014·21.977 MB·English

by  Linda S. Costanzo PhD

Physiology
S i x t h E d i t i o n
0002069208.INDD 1 2/13/2014 2:34:54 PM
0002069208.INDD 2 2/13/2014 2:34:55 PM
ii i
Physiology
S i x t h E d i t i o n
Linda S. Costanzo, Ph.D.
Professor of Physiology and Biophysics
Medical College of Virginia
Virginia Commonwealth University
Richmond, Virginia
0002069208.INDD 3 2/13/2014 2:34:56 PM
Publisher: Michael Tully
Acquisitions Editor: Crystal Taylor
Product Development Editors: Stacey Sebring and Amy Weintraub
Production Project Manager: David Saltzberg
Marketing Manager: Joy Fisher-Williams
Designer: Holly Reid McLaughlin
Manufacturing Coordinator: Margie Orzech
Compositor: SPi Global
6th Edition
Copyright © 2015, 2011, 2007, 2003, 1998, 1995 Wolters Kluwer Health.
351 West Camden Street Two Commerce Square
Baltimore, MD 21201 2001 Market Street
Philadelphia, PA 19103
Printed in China
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in
any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any
information storage and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals
as part of their official duties as US government employees are not covered by the above-mentioned copyright.
To request permission, please contact Lippincott Williams & Wilkins at 2001 Market Street, Philadelphia, PA
19103, via email at [email protected], or via website at lww.com (products and services).
9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Costanzo, Linda S., 1947- author.
Physiology / Linda S. Costanzo. — Sixth edition.
p. ; cm. — (Board review series)
Includes index.
ISBN 978-1-4511-8795-3
I. Title. II. Series: Board review series.
[DNLM: 1. Physiological Phenomena—Examination Questions. 2. Physiology—Examination Questions.
QT 18.2]
QP40
612'.0076—dc23
2013045098
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no warranty, expressed or implied,
with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the practitioner; the clinical
treatments described and recommended may not be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage
set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions. This
is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration
(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care
provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at [phone] or fax
orders to [phone]. International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins
customer service representatives are available from 8:30 am to 6:00 pm, EST.
0002069208.INDD 4 2/13/2014 2:34:56 PM
For Richard
And
for Dan, Rebecca, and Sheila
And
for Elise and Max
0002069208.INDD 5 2/13/2014 2:34:56 PM
Preface
The subject matter of physiology is the foundation of the practice of medicine, and a firm grasp
of its principles is essential for the physician. This book is intended to aid the student prepar-
ing for the United States Medical Licensing Examination (USMLE) Step 1. It is a concise review
of key physiologic principles and is intended to help the student recall material taught during
the first and second years of medical school. It is not intended to substitute for comprehensive
textbooks or for course syllabi, although the student may find it a useful adjunct to physiology
and pathophysiology courses.
The material is organized by organ system into seven chapters. The first chapter reviews
general principles of cellular physiology. The remaining six chapters review the major organ
systems—neurophysiology, cardiovascular, respiratory, renal and acid–base, gastrointestinal,
and endocrine physiology.
Difficult concepts are explained stepwise, concisely, and clearly, with appropriate illustra-
tive examples and sample problems. Numerous clinical correlations are included so that the
student can understand physiology in relation to medicine. An integrative approach is used,
when possible, to demonstrate how the organ systems work together to maintain homeostasis.
More than 130 full-color illustrations and flow diagrams and more than 50 tables help the stu-
dent visualize the material quickly and aid in long-term retention. The inside front cover con-
tains “Key Physiology Topics for USMLE Step 1.” The inside back cover contains “Key Physiology
Equations for USMLE Step 1.”
Questions reflecting the content and format of USMLE Step 1 are included at the end of
each chapter and in a Comprehensive Examination at the end of the book. These questions,
many with clinical relevance, require problem-solving skills rather than straight recall. Clear,
concise explanations accompany the questions and guide the student through the correct steps
of reasoning. The questions can be used as a pretest to identify areas of weakness or as a posttest
to determine mastery. Special attention should be given to the Comprehensive Examination,
because its questions integrate several areas of physiology and related concepts of pathophysi-
ology and pharmacology.
New to this edition:
■ Addition of new full-color figures
■ Updated organization and text
■ Expanded coverage of cellular, respiratory, renal, gastrointestinal, and endocrine
physiology
■ Increased emphasis on pathophysiology
Best of luck in your preparation for USMLE Step 1!
Linda S. Costanzo, Ph.D.
vi
0002069208.INDD 6 2/13/2014 2:34:56 PM
Acknowledgments
It has been a pleasure to be a part of the Board Review Series and to work with the staff at
Lippincott Williams & Wilkins. Crystal Taylor and Stacey Sebring provided expert editorial
assistance.
My sincere thanks to students in the School of Medicine at Virginia Commonwealth
University/Medical College of Virginia, who have provided so many helpful suggestions for
BRS Physiology. Thanks also to the many students from other medical schools who have taken
the time to write to me about their experiences with this book.
Linda S. Costanzo, Ph.D.
vviiii
0002069208.INDD 7 2/13/2014 2:34:56 PM
Contents
Preface vi
Acknowledgments vii
1. CELL PHYSIOLOGY 1
I. Cell Membranes 1
II. Transport Across Cell Membranes 2
III. Osmosis 4
IV. Diffusion Potential, Resting Membrane Potential, and Action
Potential 7
V. Neuromuscular and Synaptic Transmission 12
VI. Skeletal Muscle 16
VII. Smooth Muscle 20
VIII. Comparison of Skeletal Muscle, Smooth Muscle, and
Cardiac Muscle 22
Review Test 23
2. NEUROPHYSIOLOGY 32
I. Autonomic Nervous System (ANS) 32
II. Sensory Systems 36
III. Motor Systems 48
IV. Higher Functions of the Cerebral Cortex 54
V. Blood–Brain Barrier and Cerebrospinal Fluid (CSF) 55
VI. Temperature Regulation 56
Review Test 58
3. CARDIOVASCULAR PHYSIOLOGY 66
I. Circuitry of the Cardiovascular System 66
II. Hemodynamics 66
III. Cardiac Electrophysiology 71
IV. Cardiac Muscle and Cardiac Output 76
V. Cardiac Cycle 85
viii
0002069208.INDD 8 2/13/2014 2:34:57 PM