Anatomy & Physiology for Health Professions An Interactive Journey, 2E Bruce J Colbert Instructor Ma

Anatomy & Physiology for Health Professions An Interactive Journey, 2E By Bruce J. Colbert

Email: Richard@qwconsultancy.com

CONTENTS Preface iv Acknowledgments v Chapter 1 Introduction to Anatomy and Physiology: Learning the Language 1 Chapter 2 The Human Body: Reading the Map 15 Chapter 3 Biochemistry: The Basic Ingredients of Life 31 Chapter 4 The Cells: The Raw Materials and Building Blocks 43 Chapter 5 Tissues and Systems: The Inside Story 59 Chapter 6 The Skeletal System: The Framework 77 Chapter 7 The Muscular System: Movement for the Journey 95 Chapter 8 The Integumentary System: The Protective Covering 111 Chapter 9 The Nervous System (Part I): The Information Super Highway 127 Chapter 10 The Nervous System (Part II): The Traffic Control Center 145 Chapter 11 The Senses: The Sights and Sounds 165 Chapter 12 The Endocrine System: The Body’s Other Control System 181 Chapter 13 The Cardiovascular System: Transport and Supply 199 Chapter 14 The Respiratory System: It’s a Gas 225 Chapter 15 The Lymphatic and Immune Systems: Your Defense Systems 249 Chapter 16 The Gastrointestinal System: Fuel for the Trip 273 Chapter 17 The Urinary System: Filtration and Fluid Balance 295 Chapter 18 The Reproductive System: Replacement and Repair 317 Chapter 19 The Journey’s End: Now What? 343 Test Bank 361 Answer Key 461 Contents iii

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

PREFACE This Instructor’s Resource Manual, companion to Anatomy and Physiology for Health Professions, Second Edition is designed to assist instructors in effectively using the textbook. Each chapter of the instructor’s manual includes learning objectives and a content abstract, which summarizes the material covered in the student edition. Teaching strategies, practical activities, and interesting “Factoids” are provided to enhance the learning of anatomy and physiology. Videos and animations relating to the chapter content are listed in the Instructor’s Resource Manual and included on the Instructor’s Resource DVD.

Student DVD and Companion Website

An interactive student package accompanies Anatomy and Physiology for Health Professions, Second Edition and contains a host of interactive study aids. The videos and animations help students visualize the content they are learning. Interactive exercises, games, and activities provide students with extra practice to master the chapter content.

Workbook This corresponding workbook is the perfect companion, helping students identify the essential content and master the critical concepts. The workbook features crossword puzzles, concept maps, multiple-choice, matching, fill-in-the blank and labeling exercises.

Instructor’s Resource DVD The DVD provides many resources in an electronic format. It includes the complete 2001-question test bank that allows instructors to design customized quizzes and exams. It also includes a PowerPoint lecture package that contains key discussion points, along with color images, animations, and videos. This package allows instructors to customize the materials to meet their specific course needs. The Instructor’s Resource DVD also contains PowerPoint content to support instructors who wish to use Personal Response Systems. Finally, it contains a complete image library that includes every photograph and illustration contained in the book.

Online Course Management Systems Instructors who wish to facilitate online courses will be able to access a wide array of resources together in one convenient place for both students and faculty. Our course can be housed within any Learning Management System (i.e., Blackboard, eCollege, Angel). It features interactive modules, tests and quizzes, text and image PowerPoints of varying levels of complexity, animations, videos, case studies, and more. Faculty can customize course content, build online tests, create assignments, enter grades, post announcements, and communicate with students. Please contact your Pearson sales representative for a demonstration.

Acknowledgments

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ACKNOWLEDGMENTS The authors would like to express our appreciation to the following people for their valuable contributions to the supplements:

Instructor’s Resource Manual Debra S. McKinney, RN, BSN TESST College of Technology Alexandria, Virginia Jennifer Esch, BS, PA-C Bryant and Stratton College Milwaukee, Wisconsin

PowerPoint Lectures Debra S. McKinney, RN, BSN TESST College of Technology Alexandria, Virginia

Test Bank Nina Beaman, MS RNC CMA Bryant and Stratton College Richmond, Virginia Joy Harden, RN, BSN, CNOR, MBA Virginia College Mobile, Alabama

Companion Web Site and Student DVD Margaret N. Anfinsen, RN, MSN Southwest Florida College Fort Myers, Florida Minda Brown, RMA Pima Medical Institute Colorado Springs, Colorado Joy Harden, RN, BSN, CNOR, MBA Virginia College Mobile, Alabama Mary Warren-Oliver, BA Gibbs College Vienna, Virginia

Workbook Nadine Forbes, M.S. Johns Hopkins University Baltimore, Maryland .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Classroom Response System Joel Scott, LMT Blue Cliff Career College Mobile, Alabama

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 1 INTRODUCTION TO ANATOMY AND PHYSIOLOGY: LEARNING THE LANGUAGE

LEARNING OBJECTIVES ➯ Understand the term Anatomy and Physiology and its various related areas ➯ Construct and define medical terms using word roots, prefixes, and suffixes ➯ Explain the concept and importance of homeostasis

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Medical Assisting Professional Profile 2. Medical Records and Health Information Technician Professional Profile 3. Medical Specialties 4. Medical Transcription Professional Profile 5. Vital Signs

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Chapter Introduction A. Medical terminology is the language of health professionals.

B. This chapter lays the foundation for this language and for an introduction to anatomy and physiology (A & P).

C. Future chapters build on this foundation to help students understand anatomy and physiology and become fluent in the language.

II. Anatomy and Physiology A. Anatomy 1. Anatomy is the study of internal and external structures of the human body.

2. Anatomy is Greek for “to cut apart.”

3. Microscopic anatomy studies the structures that can only be seen with magnification, like a microscope. a. Cytology is the study of cells. b. Histology is the study of tissues.

4. Macroscopic anatomy is the study of structures visible to the naked eye. a. Study of the skeletal system b. Looking at an X-ray B. Physiology 1. Physiology focuses on the functions and vital processes of body structures.

2. Physiology is the study of how anatomical structures function.

3. Physiology deals with all the vital processes of life and is more complex than anatomy with more subspecialties. a. Human physiology b. Animal physiology c. Cellular physiology d. Neurophysiology C. Putting it all together 1. Anatomy focuses on structures and how body structures are put together.

2. Physiology is the study of how these different structures work together to make the body function as a whole.

3. The design of the structure is often related to its function.

4. Human anatomy and physiology forms the foundation for all medical practice.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

III. The Language A. Medical terminology 1. Each medical term has a basic structure on which to build, called a root word.

2. Prefixes and suffixes added to root words change or alter the meaning.

B. Forming medical terms 1. If a suffix begins with a vowel, drop the vowel in the combining form.

2. When using prefixes, put the word parts in the order you say the definition; for example before birth is prenatal.

C. Abbreviations 1. The medical profession uses abbreviations extensively.

2. Abbreviations are useful in simplifying long, complicated terms for diseases, diagnostic procedures, and therapies.

IV. The Measurement Systems A. Two major systems of measurement used in the world today: 1. The U.S. Customary System (USCS) a. Used in the United States and Myanmar b. Based on the British Imperial System (English system) c. Different designations for length, weight, and volume d. Difficult to use because there is no common base and no relationship between units 2. The metric system (System International [SI]) a. Used everywhere else, especially in health care, science, and pharmaceutical companies b. Based on the power of 10 c. Relationship between units V. Language of Disease A. Disease is a condition in which the body fails to function normally.

B. Eating habits, smoking, inherited traits, trauma, cancer, environmental factors, and aging can cause disease.

C. Signs and symptoms of disease 1. Signs are definitive, objective, obvious indicators of wellness or an illness. a. Vital signs b. Lab values 2. Symptoms are more subjective and difficult to measure, like pain.

3. A syndrome is a group of signs and symptoms that commonly occur with a specific disease.

D. Other disease terms 1. Diagnosis is the identification of a disease.

2. Prognosis is the prediction of the outcome of a disease.

3. Etiology is the cause of the disease.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

VI. Homeostasis A. Homeostasis is the physiologic process that monitors and maintains a stable internal environment.

B. Negative feedback 1. The feedback opposes the stimulus, bringing variable back to normal range.

2. Example: The hypothalamus in the brain uses a negative feedback loop to control body temperature and maintain homeostasis.

C. Positive feedback 1. Increases the magnitude of a change instead of resisting change.

2. This kind of process is also known as a vicious cycle.

3. Not homeostasis.

4. An example of useful positive feedback is the recurrent contractions of the uterus during childbirth.

CLASSROOM ACTIVITIES 1. Make flash cards for students to learn to define medical terminology.

Put root words on blue paper, suffixes on red paper, and prefixes on yellow paper. Then tape one of each to the board, asking students to define the term.

Remove the suffix or prefix, replace it with another one, and ask them to define how the term changed.

2. Have students give examples of signs or symptoms of a disease.

3. Have students give examples of negative or positive feedback loops, or give them examples and have them decide if the example is negative or positive feedback loop.

TEACHING STRATEGIES 1. Take every opportunity to use medical terminology, and have students dissect the word to determine what it means.

2. When medical terminology is used, have students learn the abbreviations that apply to that term.

3. Jeopardy! is a wonderful game to play to teach students medical terminology.

Categories can include root words, prefixes, suffixes medical terms, abbreviations, and medical definitions.

FACTOIDS 1. Many medical terms originate from the Latin language. Prior to the 1970s, students entering medical fields were encouraged to take Latin in high school. Latin is an extremely difficult language to learn, and few high schools even offer this subject today.

2. Hospitals regulate abbreviations used in medical documentation to maintain legality of the record. Each hospital has a standardized list of acceptable abbreviations, including things like HOB (head of bed), ROM (range of motion), HS (bedtime), and QID (four times a day). .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ETHICAL DILEMMAS 1. It is virtually impossible to understand the meaning of every medical term—no matter how long you are in the profession—because you will always run into a new word you’ve not heard before. Have students discuss the ethical consequences of “guessing” what a term means when you don’t want to take the time to look the term up and learn exactly what it refers to.

2. Hospitals are required to have a legally acceptable list of abbreviations that can be used in patient documentation. Ask students to explain what could happen if an abbreviation was used that others didn’t understand. Have students explain both the legal and ethical considerations of following this acceptable list of abbreviations.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 1–1 Answers, p. 4 1. G 2. M 3. M 4. G 5. M Test Your Knowledge 1–2 Answers, p. 8 1. Acrocyanosis: blue extremities (condition of blue extremities) 2. Nephrologist: one who studies the kidneys 3. Cytomegaly: enlarged cells 4. Dermatitis: skin inflammation 5. Appendectomy: removal of the appendix 6. Removal of the stomach: gastrectomy 7. Disease of the bones: osteopathy 8. Electrical recording of the heart: electrocardiogram or EKG or ECG 9. Inflammation of the joints: arthritis 10. One who studies the nervous system: neurologist Test Your Knowledge 1–3 Answers, p. 13 1. a. vital sign b. not a vital sign c. vital sign d. not a vital sign e. not a vital sign f. vital sign g. vital sign 2. c 3. a 4. b ANSWERS TO THE CASE STUDY, P. 16 a. Where exactly in the hospital was the patient taken? To the intensive care unit b. Describe the patient’s color, heart rate, and breathing. Patient’s extremities are bluish, his heart rate is fast, and he is having shortness of breath. c. What is the medical term for what the x-ray is showing? Cardiomegaly d. What future facial surgery will he need? A nose job or rhinoplasty.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS FOR REVIEW QUESTIONS, P. 16 Multiple Choice 1. c, 2. b, 3. b, 4. b, 5. d, 6. b, 7. c Fill in the Blank 1. arthroscope 2. Anatomy; physiology 3. liver; enlarged 4. vital 5. positive feedback (vicious cycle)

Short Answer 1. A diagnosis is the process of pinpointing the underlying cause of symptoms and signs, whereas a prognosis is the predicted outcome of the disease.

2. A phagocyte is a cell that ingests bacteria, viruses, and cellular debris.

(Literally, a swallowing cell.)

3. Negative feedback is a process in which the body attempts to reverse any change in physiology, bringing the variable back to “normal.”

Positive feedback is a vicious cycle. Positive feedback enhances a change in physiology, usually making the situation worse.

4. There are many examples of homeostasis in the body. All physiological variables are controlled by homeostasis, including blood pressure, blood pH, blood sugar, body temperature, and hormone levels, to name a few. All are regulated by negative feedback. For example, if blood pressure falls below normal levels, your body increases the heart rate and causes vasoconstriction. Increased heart rate and vasoconstriction increase blood pressure back toward normal. On the other hand, if blood pressure rises, the heart rate will decrease, and vasodilation will occur, decreasing blood pressure.

5. Jose has broken his leg. His symptoms may include pain, swelling, bruising, and decreased range of motion. The etiology is excessive mechanical forces that caused bone damage. His prognosis is that he will recover after rest and treatment. Treatment is immobilization for several weeks, rest, and perhaps surgery, depending on the severity of the break.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name ____________________________ CHAPTER 1 – WORKSHEET Multiple Choice 1) The study of body structures is A) anatomy.

B) physiology.

C) pathology.

D) etiology.

2) The study of body functions is A) anatomy.

B) physiology.

C) pathology.

D) etiology.

3) The study of disease is A) cytology.

B) histology.

C) physiology.

D) pathology.

4) The physiological process that maintains a state of balance in the body is A) homeostasis.

B) idiopathic.

C) communicable.

D) pathological.

Fill in the Blank For each of the following abbreviations, please write out the whole term.

5) PRN_____________________________________________________ 6) SOB_____________________________________________________ 7) A&P_____________________________________________________ 8) BP______________________________________________________ 9) DX______________________________________________________ 10) NPO____________________________________________________

Worksheet – p. 1 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Matching Please match the following word parts with the appropriate definition.

11) _____ graphy 12) _____ cardi/o 13) _____ sub14) _____ hyper15) _____ arthr/o 16) _____ -logist 17) _____ brady18) _____ micro19) _____ -megaly 20) _____ -oma 21) _____ endo22) _____ hist/o 23) _____ cyt/o 24) _____ rhin/o 25) _____ path/o

A. Below B. Small C. Tumor D. Above normal E. Process of recording F. Tissue G. Specialist H. Cell I. Disease J. Nose K. Within L. Slow M. Joint N. Heart O. Enlargement

Worksheet – p. 2 of 2 .

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 1—Worksheet 1) A 2) B 3) D 4) A 5) as needed 6) short of breath 7) anatomy & physiology 8) blood pressure 9) diagnosis 10) nothing by mouth 11) E 12) N 13) A 14) D 15) M 16) G 17) L 18) B 19) O 20) C 21) K 22) F 23) H 24) J 25) I

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name____________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the arteries or common pulse points in the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 2 THE HUMAN BODY: READING THE MAP

LEARNING OBJECTIVES ➯ List and describe the various body positions ➯ Define the body planes and associated directional terms ➯ Locate and describe the body cavities and their respective organs ➯ List and describe the anatomical division of the abdominal region ➯ Identify and locate the various body regions

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Body Positions 2. MRIs 3. Radiologic Technology Professional Profile 4. Surgical Technology Professional Profile 5. Ultrasound Interactive Labeling Activities 1. Body Cavities 2. Body Positioning

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Mapping the Human Body A. Body positions 1. To standardize the orientation for the study of anatomy, the anatomical position was developed: stand erect, face forward, feet apart, arms at side, palms forward 2. Supine: faceup 3. Prone: facedown 4. Trendelenburg: head lower than feet 5. Fowler’s: sitting at 45 degrees II. Directional Terms and Planes of Section A. Directional terms 1. Depends on comparison to other body parts 2. The point of reference is always from the patient’s point of view and is not dependent on which way the patient is facing you 3. Terms usually come in pairs a. Superior (cranial or cephalic): above, toward the head b. Inferior (caudal): below, toward the tail c. Medial: toward the midline d. Lateral: toward the side (away from the midline) e. Anterior (ventral): toward the front, belly f. Posterior (dorsal): back, toward the back g. Proximal: near the origin h. Distal: far from the origin i. Internal: inside the body j. External: near the outside of the body k. Superficial: near the surface l. Deep: far from the surface m. Central: near center of body n. Peripheral: near edges of body B. Body planes 1. Transverse or horizontal plane: divides body into superior and inferior parts 2. Sagittal plane: divides body into right and left pieces 3. Median or midsagittal plane: divides body into right and left halves 4. Frontal or coronal plane: divides body into anterior and posterior parts III. Body Cavities A. House and protect organs 1. Anterior cavity a. Divided by the diaphragm b. Thoracic cavity .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

i. The thoracic cavity is superior to the diaphragm ii. Contains heart, lungs, blood vessels c. Abdominopelvic cavity: inferior to diaphragm. i. Abdominal cavity a. Superior to imaginary line at pelvis b. Contains abdominal organs: stomach, intestines, liver, gallbladder, pancreas, and spleen ii. Pelvic cavity a. Inferior to imaginary line at pelvis b. Contains pelvic organs such as the urinary bladder, reproductive system, rectum, and anus 2. Dorsal cavity a. Cranial cavity houses the brain b. Spinal cavity houses the spinal cord 3. Many smaller cavities throughout the body IV. Body Regions A. The abdominal region divided into nine quadrants 1. Epigastric is superior to the umbilical region.

2. The right and left hypochondriac is lateral to epigastric.

3. Umbilical region is located in the center, over the umbilicus.

4. Right and left lumbar regions are located on either side of the umbilical region.

5. The hypogastric region lies inferior to the umbilical area.

6. The left and right iliac regions are located on either side of the hypogastric region.

B. It is simpler to divide the abdominal region into four quadrants with the center line of the inferior/superior and left/right division being the umbilicus; quadrants are generally abbreviated.

1. Right lower quadrant (RLQ): appendix 2. Right upper quadrant (RUQ): liver, gallbladder 3. Left lower quadrant (LLQ): rectum 4. Left upper quadrant (LUQ): spleen C. Additional body regions: every body part has a technical name

CLASSROOM ACTIVITIES 1. Have students demonstrate various body positions by moving their extremities into the various positions.

2. Play “Go to the Head of the Class.” Have all students start in the back of the classroom. Every time they answer a question correctly, they can move one seat forward until eventually they reach the head of the class. Rewards can be extra credit points, food, or privileges.

3. Play “Pin the tail on the anatomy.” Have students look for the body part based only on the technical name, or have blindfolded students directed to the point on the “body” by other students using only .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

directional terms.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

TEACHING STRATEGIES 1. Give students the names of organs, and ask them to identify in what body cavity the organs would be located.

2. The game “Operation” can be a wonderful teaching tool for body cavities, organs, and anatomical divisions. Play a game where students must answer questions related to the chapter to win a chance to remove one of the “organs” in the game board. Questions should include things like, “What is that organ called in real life?” or “What is the name for the body cavity where that organ is located?” If they successfully remove the organ without making the buzzer go off, they get to draw a card that awards them “money.” At the end of the game, they can use the money they’ve earned to buy rewards like extra credit points.

FACTOIDS 1. Species with a vertebral column are classified as vertebrates and include fish, amphibians, reptiles, birds, and mammals. The various planes apply to veterinary medicine as well, and add the term “rostral” to refer to the direction toward the nose. Dorsal and ventral describe the sides closest to the sky and closest to the ground in animals. The terms anterior and posterior are not necessarily the same as ventral and dorsal in four-legged animals or invertebrates like lobsters.

2. A sagittal plane divides the body into right and left, but does not have to run down the center of the body—it can divide the body at any point. If the plane does run down the center of the body, dividing the body in half, it is a midsagittal plane.

3. Ipsilateral means on the same side, whereas contralateral means on the opposite side.

ETHICAL DILEMMAS 1. Imagine that the doctor told you to surgically prepare the left hypochondriac region of the abdomen for surgery, and you didn’t know where that region was located. Ask students how they would go about finding out where that area was located. Ask them to discuss the ethics of “guessing” the location and potential consequences.

2. What obligation do you have to your patient to understand the information provided in this chapter? What consequences could occur if you fail to meet your obligation?

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 2–1 Answers, p. 26 1. Person should be standing face forward, palms out as in Figure 2-1.

2. Best body position for following circumstances a. Getting a back massage: prone b. Eating in a hospital bed: Fowler’s c. Watching television in bed: Fowler’s d. Watching the stars at night: supine 3. Give the opposite directional term a. Superior: inferior b. Posterior: anterior c. Caudal: cephalic (cranial) d. Ventral: dorsal e. Distal: proximal f. External: internal g. Superficial: deep h. Peripheral: central i. Medial: lateral 4. superficial 5. proximal; distal 6. superior 7. peripheral or pedal 8. central cyanosis Test Your Knowledge 2–2 Answers, p. 29 1. transverse or horizontal 2. anterior (ventral); posterior (dorsal) 3. midsagittal 4. Identify the major body cavity in which the following organs are located. a. Heart: thoracic or pericardial b. Spinal cord: spinal, dorsal, or vertebral c. Stomach: abdominal d. Lungs: thoracic or pleural e. Reproductive organs: pelvic f. Brain: cranial 5. nervous Test Your Knowledge 2–3 Answers, p. 35 1. oral 2. axillary 3. umbilical 4. lumbar 5. patellar 6. spleen or liver .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO CASE STUDY, P. 36 a. right knee b. center of the chest (breastbone area) c. left arm d. no stomach pain e. in front of elbow f. feet ANSWERS TO REVIEW QUESTIONS, P. 37 Multiple Choice 1. a, 2. d, 3. d, 4. d, 5. a, 6. d Fill in the Blank 1. anatomical 2. supine 3. inferior; superior 4. brain 5. peripheral or acrocyanosis 6. midsagittal Short Answers 1. The organs found in the abdominal cavity are the liver, stomach, pancreas, spleen, gallbladder, small intestine, and part of the large intestine.

2. In the prone position a person is lying facedown. In the supine position a person is lying faceup. In Fowler’s position, a person is sitting up at a 45 to 60 degree angle.

3. There are three superior regions in the abdominal cavity. The medial superior region is the epigastric (above the stomach) region. The lateral superior regions are the hypochondriac (under the ribs) regions.

Inferior to those three regions are two lateral regions, the lumbar regions, and a medial region, the umbilical region. The three most inferior regions are two lateral regions, the iliac regions and one medial region, the hypogastric (under the stomach) region.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name__________________________________ CHAPTER 2 – WORKSHEET Multiple Choice 1) In this position, a patient is lying on their back, faceup.

A) Prone B) Supine C) Trendelenburg D) Fowler’s 2) In this position, a patient is lying on their stomach, facedown.

A) Anatomical B) Trendelenburg C) Prone D) Supine 3) In this position, a patient is lying with the head of the bed lower than the feet.

A) Trendelenburg B) Prone C) Fowler’s D) Anatomical 4) A patient is standing erect, with face forward, feet parallel, arms hanging to the side, and palms facing forward. What position is this patient in?

A) Supine B) Anatomical C) Fowler’s D) Prone 5) A patient has a slightly blue discoloration to the fingers and toes. This is an example of _____ cyanosis.

A) central B) peripheral C) lateral D) sagittal Fill in the Blank 6) _____ The plane divides the body into left and right portions.

7) The _____ plane divides the body into anterior and posterior parts.

8) Another name for the midsagittal plane is the _____ plane.

9) The _____ plane divides the body into superior and inferior parts.

10) The cranial and spinal cavities are both part of the larger _____ cavity.

11) The thoracic and abdominal cavities are part of the larger _____ cavity.

Worksheet – p. 1 of 2 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Matching Please match the following terms with the correct definition.

12) _____ Sternal 13) _____ Pedal 14) _____ Pubic 15) _____ Axillary 16) _____ Cervical 17) _____ Epigastric 18) _____ Thoracic 19) _____ Gluteal 20) _____ Lumbar 21) _____ Oral 22) _____ Buccal 23) _____ Antecubital 24) _____ Digital 25) _____ Nasal

A. Foot region B. Neck region C. Cheek region D. Breastbone region E. Finger region F. Chest region G. Nose region H. Genital region I. Buttock region J. Superior central portion of the abdomen K. Front of the elbow L. Low back region M. Mouth region N. Armpit region

Short Answer/Essay 26. List three organs that might be found in the abdominal cavity. _________________________________________________________ _________________________________________________________ _________________________________________________________ 27. Give one example of an organ found in the thoracic cavity. _________________________________________________________ _________________________________________________________ _________________________________________________________

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 2—Worksheet 1) B 2) C 3) A 4) B 5) B 6) sagittal 7) frontal/coronal 8) median 9) horizontal/transverse 10) dorsal 11) ventral 12) D 13) A 14) H 15) N 16) B 17) J 18) F 19) I 20) L 21) M 22) C 23) K 24) E 25) G 26) Answers will vary, but may include stomach, intestines, liver, kidneys, bladder, etc.

27) Answers will vary, but may include heart, lungs, esophagus, etc.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name LABELING ACTIVITY #1 INSTRUCTIONS: Please label the cavities in the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY #1 ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name LABELING ACTIVITY #2 .

INSTRUCTIONS: Please label the following regions.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY #2 ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 3

BIOCHEMISTRY: THE BASIC INGREDIENTS OF LIFE

LEARNING OBJECTIVES ➯ Differentiate between atoms, elements and ions ➯ Define pH, acids, and bases and their role in the body ➯ Describe chemical bonding and the role of water ➯ Describe the properties of a solution ➯ Distinguish among the types of biological molecules ➯ Explain metabolism ➯ Explain cellular respiration ➯ Explain the role of enzymes in physiology

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Biochemist Professional Profile Animations 1. Carbohydrates 2. DNA 3. Lipids 4. Proteins Interactive Activities 1. Cellular Metabolism

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues pvidroed.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Atoms, Elements, and Ions A. Element: the smallest unit of matter 1. Retains chemical properties 2. Abbreviated using first two letters of technical name 3. Trace elements: elements the body needs in small amounts B. Molecule: two or more elements joined together C. Atom: smallest unit of an element 1. Nucleus a. Protons: positively charged particles b. Neutrons: neutral or noncharged particles 2. Electrons: negatively charged particles that circle nucleus D. Ions 1. Atoms that gain or lose electrons 2. Polar: charged 3. Gain electron, negative charge 4. Lose electron, positive charge 5. Electrolytes: physiologically important ions found in the body.

E. Acids and bases 1. pH: based on concentration of hydrogen ions 2. Measures relative strength of acids and bases 3. pH < 7 is acid; pH = 0 is neutral; pH > 7 is basic (alkaline) 4. Strong acids and bases are harmful to living tissue.

5. Acid/base balance is carefully regulated primarily by the renal and respiratory systems.

II. Bonding A. Elements bound together to form molecules B. Three types of bonds 1. Ionic bonds: one atom gains electrons the other loses them. Molecule is polar.

2. Covalent bond: atoms share electrons equally. Nonpolar.

3. Polar covalent: atoms share electrons unequally. Polar.

III. Water A. Chief liquid in biological systems B. Polar covalent—unique characteristics 1. Molecules classified based on relationship to water a. Hydrophilic: will mix with water; literally “water loving” b. Hydrophobic: will not mix with water; literally “water fearing” 2. Hydrogen bonds a. Weak bond between hydrogen on one molecule and oxygen on another b. Increased heat capacity, water heats up and cools off more slowly than air C. Solution

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

1. One substance dissolved in another 2. Solute: what’s dissolved 3. Solvent: the dissolver 4. Concentration: amount of solute in solution IV. Biological molecules A. Molecules found in living systems B. Contain mainly carbon, hydrogen, and smaller amounts of oxygen, nitrogen, phosphorous C. Four classes 1. Carbohydrates a. Two hydrogens and one oxygen for each carbon b. Used mainly for energy storage c. Hydrophilic d. Classification i. Monosaccharides: simple sugars, five to six carbons ii. Disaccharides: two monosaccharides bound together iii. Polysaccharides: chain of monosaccharides; starches; glycogen stored in the liver for energy 2. Lipids a. Two hydrogens for every carbon, very little oxygen b. Hydrophobic c. Used for energy storage, communication, protection d. Classification i. Fats and oils: glycerol and three fatty acid chains; familiar ii. Waxes: fatty acid chains and alcohol; most hydrophobic substance in body iii. Phospholipid: phosphate “head” hydrophilic; fatty acid “tails” hydrophobic; in cell membrane iv. Steroids: ringed lipids 3. Proteins a. Long chains of amino acids b. Have nitrogen in molecule c. Very versatile in function d. Structure determined by amino acid order 4. Nucleic acids a. RNA and DNA b. Long chains of nucleotides c. Genetic molecules V. Metabolism A. All the chemical reactions that take place in cells 1. Anabolism: making large molecules from small ones; dehydration synthesis 2. Catabolism: breaking down large molecules into small; hydrolysis

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. Enzymes 1. Most chemical reactions too slow to sustain cells 2. Enzymes speed up (catalyze) reactions a. Protein molecules b. Not used up in reaction c. Molecules bind to enzyme and are carried through reaction d. Characteristics i. Specificity: only certain reactions can be sped up ii. Competition: molecules can compete for enzyme iii. Inhibition: enzyme can be prevented from working iv. Saturation: enzymes can be filled up C. Cellular energy and ATP 1. Cellular respiration a. Uses glucose and oxygen b. Makes carbon dioxide and water as waste c. Makes lots of ATP 2. ATP a. A nucleotide (adenine) and three phosphates b. Remove one phosphate, release energy to use to run metabolism

CLASSROOM ACTIVITIES 1. Assign students in the roles of enzymes and substrates. Have them act out enzyme activity. Demonstrate specificity, competition, inhibition, and saturation.

2. Provide students with descriptions of a number of molecules. Using the characteristics of biological molecules; ask students to classify the molecules.

TEACHING STRATEGY 1. Many biological molecules and their characteristics are familiar to students. Use as many familiar examples as possible to illustrate the characteristics of different classes of biological molecules.

FACTOID 1. Fat has nearly twice as many calories as carbohydrates or proteins.

ETHICAL DILEMMA 1. Fat is needed by the body for many vital functions such as a properly functioning immune system. However, it gets a very bad rap because of our diet-conscious society and a negative association with the word fat. This can cause some people to

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

engage in nonhealthy diets because they do not understand the need for fat intake and the various types of fats. Do you think a campaign should be launched to better explain this?

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 3–1 Answers, p. 47 1. atom 2. ions 3. electrolytes 4. solute; solvent 5. acid, decrease Test Your Knowledge 3–2 Answers, p. 50 1. biological 2. amino acids 3. lipids 4. a. hydrophilic b. hydrophobic c. hydrophobic 5. energy Test Your Knowledge 3–3 Answers, p. 53 1. b 2. a 3. c 4. removed ANSWERS TO THE CASE STUDY, P. 54 A. Diuretics have side effects, including depletion of the electrolyte potassium. The chief side effect of low potassium is heart palpitations.

B. She needs a potassium supplement and counseling concerning the dangerous practice of using diuretics to lose weight.

C. Diuretics help rid the body of excess water and are therapeutic in a number of conditions, but are not to be used for weight loss, as this is not a true weight loss, and this practice has potentially dangerous side effects.

ANSWERS TO REVIEW QUESTIONS, P. 55 Multiple Choice 1. d, 2. b, 3. c, 4. c, 5. d Fill in the Blank 1. ions 2. polar covalent

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. electrolytes 4. water 5. metabolism 6. ATP Short Answer 1. Element: smallest unit that retains chemical characteristics, Atoms: smallest unit of element; Molecule: two or more elements bound together; Ion: atoms that gain or lose electrons.

2. Ionic bond: one atom loses electrons while other gains them; polar. Covalent bond: atoms share electrons equally; nonpolar. Polar covalent: atoms share electrons unequally; polar.

3. Carbohydrates: have two hydrogens and one oxygen for each carbon; used for energy storage; hydrophilic. Lipids: two hydrogens for every carbon, very little oxygen; used for energy storage and protection; hydrophobic. Proteins: long chain of amino acids, have nitrogen in molecule, very versatile. Nucleic acids: chains of nucleic acids, genetic molecules.

4. Water is a polar covalent molecule with hydrogen bonding between molecules. It carries a charge. Its heat capacity is very high, causing water to heat up and cool down much more slowly than air. Polar molecules can mix with water, whereas nonpolar molecules cannot. Water is important to biological systems because it is the chief solvent in cells and tissues.

5. Enzymes are protein molecules that speed up biological reactions. The molecules bind to a site on the enzyme and are carried through the reaction. The enzyme is not used up during the reaction. Enzymes are very specific, speeding up only certain reactions. They can also be saturated (filled up), they can be inhibited (blocked), and molecules can compete for individual enzymes.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________ CHAPTER 3—WORKSHEET Multiple Choice 1) Which of the following is a characteristic of enzymes?

A) Saturation B) Lipid C) Used up during reaction D) Nonspecific 2) Proteins are made of long chains of A) nucleic acids.

B) amino acids.

C) lewis acids.

D) citric acids.

3) This type of bond is nonpolar.

A) Hydrogen B) Polar-covalent C) Ionic D) Covalent 4) _____ surround the atomic nucleus.

A) Electrons B) Protons C) Neutrons D) Plutons 5) The point of cellular respiration is to make A) water.

B) glucose.

C) ATP. D) metabolism.

6) Molecules that have one oxygen for each carbon are called A) proteins.

B) carbohydrates.

C) lipids.

D) nucleic acids.

7) The amount of solute dissolved in solvent is A) solution.

B) anabolism.

C) concentration.

D) pH.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Worksheet – p. 1 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Fill in the Blank 8) A _____ is a ringed lipid. Cholesterol is one example.

9) Measure of acidity of solutions is _____.

10) Hydrophobic molecules will not _____ with water.

11) Glycogen, an energy storage molecule, is this type of molecule: _____.

(Be specific.)

12) _____ molecules are important in function of cell membranes.

13) _____ reactions are the chief reactions of catabolism.

14) Filling of enzyme binding sites is called _____.

15) This class of biological molecule is always hydrophobic _____.

Matching 16. _____ Element 17. _____ Ion 18. _____ Monosaccharide 19. _____ Wax 20. _____ Electrolyte 21. _____ Trace element 22. _____ Molecule 23. _____ Polysaccharide 24. _____ Solute 25. _____ Solution

A. Fatty acid with alcohol B. Biologically important ion C. What is dissolved in solution D. Smallest unit that retains chemical characteristics E. Solute dissolved in solvent F. Sugar with 5 to 6 carbons G. Biologically important element H. Charged atom or molecule I. Many sugars linked together J. Two or more elements bound together

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 3—Worksheet 1) A 2) B 3) D 4) A 5) C 6) B 7) C 8) steroid 9) pH 10) mix, dissolve 11) polysaccharide 12) Phospholipid 13) Hydrolysis 14) saturation 15) lipids 16) D 17) H 18) F 19) A 20) B 21) G 22) J 23) I 24) C 25) E

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 4 THE CELLS: THE RAW MATERIALS AND BUILDING BLOCKS

LEARNING OBJECTIVES ➯ List and describe the various parts of a cell and explain their functions ➯ Describe the type of active and passive transport within cells ➯ Explain the process of cellular mitosis ➯ Explain cellular respiration ➯ Differentiate between bacteria, viruses, fungi, and protozoa

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Cell Structure 2. Cytology Professional Profile 3. Lab Technician Professional Profile 4. Proper Hand Washing and Gloving Techniques

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction: Overview of Cells A. The cell is the building block of all living things.

B. Cells come in different sizes, shapes, and types.

II. Cell Structure A. Cell membrane 1. Functions a. The cell membrane is the boundary that possesses a definite shape and actually holds the cell contents together, acting as a protein covering. b. A cell membrane allows material in and out of the cell. c. Cell membranes are selectively permeable because they choose what gets in and out of the cell.

2. Structure a. Phospholipid bilayer keeps hydrophilic substances from crossing. b. Proteins function as markers, channels, or carriers.

3. Transport methods a. Passive transport requires no extra form of energy to complete. i. Diffusion a. The most common form of passive transport; a substance of higher concentration travels to an area of lesser concentration ii. Osmosis a. Movement of water across a semipermeable membrane b. Water will move from an area of low solute concentration to an area of high solute concentration. c. The greater the concentration of solute, the greater the osmotic pressure, or pull, it exerts to bring in water. iii. Filtration a. Differs from osmosis in that pressure is applied to force water and its dissolved materials across a membrane b. Selectivity determined by size of holes in filter. iv. Facilitated diffusion a. Substance moves down its concentration gradient with the help of a carrier molecule. i. Carrier is protein molecule with binding site ii. Carrier is like enzyme system-specificity, saturation, inhibition, competition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Active transport requires some addition of energy to make it happen. i. Active transport pumps a. Use carrier molecule b. “Pump” substance against concentration gradient c. Require the addition of energy in the form of ATP to move a substance ii. Endocytosis (–) the substances are moved into cell using vesicles. a. Phagocytosis is the name for this process if a solid particle is being transported. b. Pinocytosis is the name for this process if water is being transported. iii. Exocytosis is transport of things out of the cell in a vesicle.

B. Cytoplasm is the gel-like substance composed of water, nutrients, and electrolytes; contains organelles.

C. Nucleus 1. The “brain of the cell” dictates the activities of the organelles in the cell.

2. Has a double-walled nuclear membrane, with large pores allowing certain materials to pass in and out, while preventing other materials from entering.

3. Chromatin is a material found in the nucleus, containing DNA. a. A combination of DNA and proteins b. DNA contains the blueprints, specifications, for the creation of new cells; genes c. Chromatin will eventually form chromosomes, which contain genes.

4. Nucleolus a. Spherical body made up of dense fibers b. Major function is to synthesize the ribonucleic acid (RNA) that forms ribosomes D. Organelles 1. Ribosomes a. Found on the endoplasmic reticulum or floating around in the cytoplasm. b. Made of RNA (ribonucleic acid) c. Assists in making enzymes and other protein substances needed for cell repair and reproduction.

2. Centrosomes a. Contain centrioles that are involved in the division of the cell b. Centrioles are tubular in shape and usually found in pairs.

3. Mitochondria a. Tiny bean-shaped organelles b. Act as the power plant to provide up to 95% of the body’s energy needs for cellular repair, movement, and reproduction c. If a cell needs more power, it increases the number of mitochondria in the cell. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. Endoplasmic reticulum a. A series of channels set up in the cytoplasms that are formed from folded membranes b. Has two distinct forms i. Rough endoplasmic reticulum has a sandpaper-like surface, with ribosomes on the surface; responsible for synthesis of protein. ii. Smooth endoplasmic reticulum has no ribosomes and appears smooth; synthesizes lipids and steroids.

5. Golgi apparatus a. Looks like a bunch of flattened membranous sacs b. Processes and stores proteins, makes vesicles 6. Lysosomes a. Vesicles containing powerful enzymes that take care of cleaning up intracellular debris and other waste b. Destroy harmful bacteria by participating in the process of phagocytosis to maintain health 7. Other interesting parts a. The cytoskeleton is a network of microtubules and interconnected filaments that provide shape to the cell and mobility to the cell and its contents. b. Flagella are whip-shaped tails that move some cells, like sperm, to other locations. c. Cilia are short, microscopic, hair like projections located on the outer surface of some cells. They move particles using a wavelike motion.

III. Cell Energy and ATP, the Energy Molecule A. ATP 1. ATP is made up of a base, a sugar, and three phosphate groups.

2. The phosphate groups are held together by high-energy bonds.

3. Energy is released each time a bond is broken, turning ATP to ADP. 4. ATP becomes ADP (two bonds), which can then pick up another bond, storing more energy, so the process can begin again.

B. Cellular respiration 1. To make ATP, cell must “burn” glucose.

2. Oxygen is required.

3. Carbon dioxide and water are waste products.

4. Happens mainly in the mitochondria.

IV. Mitosis and the cell cycle A. Asexual reproduction is cell division without the involvement of another cell 1. Cellular reproduction is the process of making a new cell 2. Also known as cell division

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. The cell cycle 1. The life cycle of a cell 2. Interphase, about 90% of the cell’s life. Cell is making DNA and organelles and getting ready to reproduce.

3. Mitotic phase is when the nucleus and cytoplasm divide. a. Mitosis is the division of nuclear material. b. Cytokinesis is the division of cytoplasm and organelles.

4. Asexual division in cells: mitosis a. Involves copying all the chromosomes (46) and dividing them equally between the new cells b. Has four phases i. Prophase: nucleus disappears, chromosomes become visible, spindle forms ii. Metaphase: chromosomes line up in center of cell iii. Anaphase: chromosomes split and pull away iv. Telophase: nucleus reappears, chromosomes become invisible, spindle disappears 5. Cytokinesis a. Splitting of cytoplasm and cell membrane after telophase of mitosis b. Results in two identical daughter cells 6. Functions of mitosis a. Growth of bone, for example b. Tissue replacement of red blood cells, for example V. Cancer Cells A. When the body is healthy, cells grown in an orderly fashion.

B. Sometimes conditions are altered that trigger changes in the way cells reproduce.

C. This wild, uncontrolled reproduction can lead to too many cells being produced with a lump, or tumor, being created.

1. Benign (slow-growing, non-life-threatening) or 2. Malignant (rapid-growing, life-threatening, likely to spread to other tissues or metastasize) VI. Microorganisms A. Bacteria 1. Prokaryotic cells have no nucleus, few organelles.

2. Reproduce rapidly 3. Bacteria can be harmful, as in the case of pathogens, or they can be harmless and essential for life.

4. Certain bacteria in the intestines help to digest food, and some help to synthesize vitamin K, which we need for blood clotting.

5. Sensitive to antibiotics

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. Viruses 1. Infectious particles that have a core containing genetic material that is surrounded with a protective protein coat called a capsid 2. Cannot grow, eat, or reproduce by themselves. They must enter another cell and hijack that cell to grow and reproduce.

3. Do not respond to antibiotics 4. Can stay dormant in the body and become active later in life C. Fungi 1. Fungi, the plural form of fungus, can be a one-cell or multicelled organism.

2. Plantlike organisms with tiny filaments, called mycelia, which travel out from the cell to find and then absorb nutrients 3. Fungi spread through the release of spores.

4. Noninfectious fungi, such as mushrooms, exist.

5. Examples of fungal infections include athlete’s foot and thrush (candidiasis).

D. Protozoa 1. Protozoa are one-celled animal-like organisms that can be found in water and soil.

2. Disease caused by these microorganism can result from swallowing them or from being bitten by insects that carry them in their bodies.

CLASSROOM ACTIVITIES 1. Have students view cells in a microscope and discuss what they see, along with the function of the organelles.

2. Discuss the difference in treatment for bacteria, viruses, fungi, and protozoa. Have students discuss different diseases caused by each of these microorganisms.

TEACHING STRATEGIES 1. To make a cell come alive, so that students can visualize and better understand its function, have students “play the role” of organelles. Several students can join hands and form a circle representing the cell membrane. Other students can carry out active transport or passive transport through the cell membrane, which will also demonstrate selective permeability of the cell wall.

2. Provide students with functions and have them relate what organelle performs this function.

FACTOIDS 1. Aristotle (384–322 BC) was known for his experimental approach and numerous dissections. He was drawn to animal classification to discover aspects of connection between the soul and the human body. Some of his animal classifications still stand today. One of his famous thoughts is a foreshadowing of Mendelian genetic concepts.

2. The microscope opened up new doors in the field of biology, by allowing scientists to gaze into a new world: the cellular world. Galileo is credited with the invention of the .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

microscope. Two of the main pioneers in microscope usage were Athanasius Kircher and Antonie von Leeuwenhoek.

ETHICAL DILEMMAS 1. DNA can be very helpful in solving crimes. For that reason, some have suggested that everyone’s DNA be collected as soon as they are born and stored in a directory. In this manner, when a crime is committed or a crisis like 9/11 occurs, everyone’s DNA will already be in the database for comparison. Is this something we should do?

2. With advances in medicine, many diseases can be diagnosed based solely on DNA. Should a pregnancy be aborted if the fetus is known to carry a fatal disease? What if they will eventually contract a disease like breast cancer or Huntington’s? Should insurance companies have access to DNA results, perhaps raising the cost of life insurance or health insurance if it turns out that a person’s DNA results show the likelihood of contracting a disease?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 4–1 Answers, p. 67 1. diffusion 2. low; high 3. filtration 4. diffusion 5. facilitated diffusion 6. Tell whether the following processes are active or passive a. active b. passive c. passive d. active e. passive Test Your Knowledge 4–2 Answers, p. 73 1. What organelle is described in each of the following statements? a. nucleus b. endoplasmic reticulum c. mitochondria d. Golgi apparatus (bodies) e. flagellum Test Your Knowledge 4–3 Answers p. 76 1. b 2. a 3. c 4. d .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO CASE STUDY, P. 81 a. protozoa b. fungus c. virus ANSWERS TO REVIEW QUESTIONS, P. 81 Multiple Choice 1. d, 2. b, 3. b, 4. d, 5. d Matching Nucleus, d; Cell membrane, c; Golgi Apparatus, b; Mitochondria, a; Cytoplasm, e; Lysosome, f.

Short Answer 1. Diffusion: solute moves from high concentration to low concentration; osmosis: water moves from area of low solute concentration to area of high solute concentration; facilitated diffusion: molecule moves from high to low concentration with help of carrier protein; filtration: pressure forces water and dissolved substances through a membrane 2. Viruses need cells because viruses to do not have organelles, so they cannot reproduce nor do any other cell functions without hijacking our cells.

3. Passive transport does not need ATP, cellular energy. For a cell to use active transport, it must spend ATP. 4. During cellular respiration glucose is broken down. Oxygen is needed to make ATP. Water and carbon dioxide are given off, and many molecules of ATP are made.

5. Bacteria are cells without a true nucleus or organelles. Viruses are not even cells; they have a nucleic acid core and a protein coat. They cannot reproduce on their own.

Fungi are plantlike organisms that may be multicellular or unicellular. They reproduce using spores. Protozoa are animal-like cells that are found in soil and water.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________ CHAPTER 4 – WORKSHEET Matching Please match the following types of cell membrane transport with the appropriate description.

1) _____ Diffusion 2) _____ Osmosis 3) _____ Filtration 4) _____ Phagocytosis 5) _____ Active transport pumps 6) _____ Facilitated diffusion A. Movement of water across a semipermeable membrane from areas of low solute concentration to high solute concentration B. A special kind of diffusion that uses a carrier protein C. Carriers that force substances into areas where they are already highly concentrated D. Movement of substances from areas of high to low concentration E. A cell “engulfs” a solid particle and draws it inside F. Pressure is used to force water and dissolved substances across a membrane; small particles pass through, and large particles do not Please match the following organelles with the appropriate description.

7) _____ Nucleus 8) _____ Golgi apparatus 9) _____ Ribosomes 10) _____ Mitochondria 11) _____ Cell membrane 12) _____ Centrosomes 13) _____ Cilia 14) _____ Flagella 15) _____ Lysosomes 16) _____ DNA 17) _____ Cytoplasm A. Manufacture proteins B. “Hairlike” projections on the surface of some cells C. A long whip-shaped tail attached to sperm cells D. The chemical that makes our genes E. The gel-like material inside the cell membrane F. The “brain” of the cell G. Determines which substances can enter the cell H. Produce ATP I. Are involved in cell division J. Packages cell products for “shipping” K. Contain powerful enzymes that can destroy bacteria and wastes .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Worksheet – p. 1 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

True or False 18) T F Energy is required to complete passive transport.

19) T F Chromosomes are typically found in the Golgi apparatus.

20) T F All substances pass easily through the cell membrane.

21) T F Cells use exocytosis to swallow up solid particles like bacteria.

Multiple Choice 22) These substances act like “carrier molecules” that facilitate chemical reactions.

A) Enzymes B) ATP molecules C) DNA molecules D) Glucose 23) Which of the following is not an example of active transport?

A) Exocytosis B) Phagocytosis C) Diffusion D) Pinocytosis Fill in the Blank 24) Cells convert glucose into ATP in a process called _________________ Short Answer/Essay 25. Explain why breathing is necessary for cellular respiration to occur. __________________________________________________________ __________________________________________________________ __________________________________________________________

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 4—Worksheet 1) D 2) A 3) F 4) E 5) C 6) B 7) F 8) J 9) A 10) H 11) G 12) I 13) B 14) C 15) K 16) D 17) E 18) F 19) F 20) F 21) F 22) A 23) C 24) Cellular respiration 25) We inhale oxygen because it is necessary for the breakdown of glucose to produce ATP. Carbon dioxide develops as a waste product of ATP production. We exhale this carbon dioxide to remove it from the body.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the cell parts in the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 5 TISSUES AND SYSTEMS: THE INSIDE STORY

LEARNING OBJECTIVES ➯ Explain the relationship between cells, tissues, organs, and organ systems ➯ List and describe the four main types of tissue and variations within each type ➯ Identify and describe the various body membranes ➯ List and describe the main functions of the body systems

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Video 1. Histotechnology Professional Profile Animation 1. Body Systems 2. Tissue Repair

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. Cells are the basic building blocks of our bodies.

B. Tissues are collections of cells united to perform a function.

C. Organs are collections of tissues designed to perform particular functions.

D. Organs that work together to perform major specific activities, often with the help of accessory structures, form what we call a system.

II. Tissues—four main types A. Epithelial tissue 1. Covers and lines 2. Tightly packed cells forming a sheet 3. No blood vessels 4. Well innervated 5. Has obvious top and bottom 6. Classified by shape a. Flat or scalelike cells—squamous b. Cube shaped—cuboidal c. Column-like—columnar d. Stretchy and variably shaped—transitional e. Single layer—simple f. Multiple layer—stratified g. Looks like multiple layers but is single layer—pseudostratified 7. Membranes a. Membranes are sheetlike structures found throughout the body that perform special functions b. Epithelial membrane possess a layer of epithelial tissue and a bottom layer of a specialized connective tissue c. Epithelial membranes can be classified into three general types i. Cutaneous—skin; covers body surface ii. Serous—double-layered membrane; line body cavities a. Visceral—covers organs surface b. Parietal—lines body cavity c. Potential space between layers iii. Mucous—lines tubes exposed to external environment; secretes mucus B. Connective tissue 1. The most common of the tissues, found scattered throughout the body more than any other form.

2. Functions a. Mechanical support b. Nutrient storage c. Fluid storage d. Defense 3. Has extensive extracellular matrix that is nonliving .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. Classification based on types of cells and type of matrix a. Connective tissue proper i. Loose—soft, weblike tissue ii. Dense—tightly packed fibers in matrix b. Cartilage—cells in holes in gel-like matrix c. Blood—cells in liquid matrix d. Bone—cells in holes in calcium matrix 5. Synovial membrane a. In joints b. Secretes lubrication fluid C. Muscle tissue 1. Provides the means for movement by and in the body 2. Has the ability to shorten itself (contractility) 3. There are three types of muscle tissue: a. Skeletal i. Attached to bones; voluntary movement ii. Striated—has striped appearance iii. Cylindrical fibers (cells) with many nuclei iv. Voluntary b. Cardiac i. Walls of the heart ii. Striated iii. Branched, interlocking, uninucleate cells iv. Involuntary c. Smooth i. Walls of tubes and hollow organs ii. Not striated (smooth) iii. Uninucleate cells, shorter and wider than skeletal muscle fibers iv. Involuntary D. Nervous tissue 1. Control system 2. There are two types of nerve cells: a. Neurons—the conductors of information b. Glia (or neuroglia)—support and connection cells 3. The membranes that cover the brain and spinal cord are called meninges.

4. Many nerves have an insulating layer called the myelin sheath.

III. Tissue Repair A. Multistep process 1. Inflammation—redness, heat, swelling, pain 2. Clotting and scab formation 3. Organization a. Fibroblasts lay down collagen b. Blood vessels form c. Granulation tissue .

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4. Result a. Regeneration—replacement with original tissue b. Scarring—replacement with scar tissue B. Regeneration ability depends on tissue type 1. Excellent—bone, blood, epithelium 2. Fair—cartilage, skeletal muscle, dense connective tissue 3. Terrible—nervous, cardiac muscle IV. Organs A. An organ is the result of two or more types of tissue organizing in such a way as to accomplish something that the tissues cannot do on their own.

B. The body cannot survive without organs known as vital organs.

C. Organs work as part of a system.

V. Systems A. A system is formed by organs that work together to accomplish something more complex than what a single organ can do on its own.

B. Each system is interrelated, often depending on each other for the proper functioning of the body.

C. Skeletal system 1. Functions of the skeletal system a. Provides support and structure to the body b. Protects organs c. Provides movement d. Stores a variety of minerals e. Produces blood cells 2. The main components of the system are bones, joints, ligaments, and cartilage D. Muscular system 1. Voluntary muscles a. Movement created by conscious thought, like scratching your nose b. Skeletal muscles attached to your bones 2. Involuntary muscles a. Perform without conscious thought b. Classified as smooth muscle or cardiac muscle c. Found in blood vessels, airways, and organs E. Integumentary system 1. The body’s first line of protection is the skin.

2. Skin is one part of the integumentary system.

3. Functions a. Temperature regulation b. Sense of touch c. Glands in the skin help to lubricate and waterproof your skin and inhibit the growth of unwanted bacteria. d. Production of vitamin D when exposed to sunlight 4. The main components include skin, hair, sweat glands, sebaceous glands, and nails. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

F. Nervous system 1. The main parts of the nervous system include the spinal cord, brain, peripheral nerves, and nerve cells.

2. The three main functions of the nervous system are: a. Receiving messages (sensory input) b. Processing and interpreting messages c. Acting on messages (motor output) G. Endocrine system 1. The endocrine system acts as a control center for virtually all the body’s organs.

2. Endocrine glands release chemicals called hormones that are circulated via the cardiovascular system, regulating the metabolic processes and utilizing metabolites for growth and production.

3. The main components of the endocrine system are the hypothalamus, pineal, pituitary, thyroid, parathyroid, thymus, adrenal glands, pancreas, and gonads, plus a large variety of hormones H. The cardiovascular system 1. Also called the circulatory system, this is the main transportation system to each cell of our body.

2. The main components are the heart, arteries, veins, capillaries, and blood.

I. The respiratory system 1. Functions a. Supplies the cells with oxygen and removes carbon dioxide b. Filters, warms, and moistens the air we breathe c. Mucous lining of the airway helps trap foreign particles and germs d. Maintains the proper acid–base balance 2. The main parts of this system include the pharynx, larynx, trachea, bronchial tubes, lungs, and alveoli.

J. The lymphatic system 1. Functions a. Responsible for helping to maintain proper fluid balance and protect from infection b. Special structures, called lymph nodes, act as filters to capture unwanted infectious agents. c. Specialized white blood cells, called lymphocytes, fight infection.

2. Major parts of this system include lymph vessels, lymph ducts, lymph nodes, thymus gland, tonsils, and spleen.

K. The digestive system 1. Often called the gastrointestinal (GI) system, the digestive system mechanically and chemically breaks down raw material (food) into usable substances, which are absorbed and transported to cells 2. Functions a. Ingestion b. Digestion (breakdown) c. Absorption of nutrients .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

d. Solid waste removal 3. The main parts of this system include the mouth, pharynx, esophagus, stomach, intestines, and accessory organs.

L. Urinary system 1. Functions a. Elimination of waste products, electrolytes, drugs, and other toxins b. Fluid regulation c. Blood pressure regulation d. Regulation of red blood cells e. Electrolyte balance f. pH balance 2. The kidneys, ureters, urinary bladder, and urethra are all important parts of this system.

M. Reproductive system 1. Reproductive system is often combined with the urinary system to make the genitourinary system, or GU system.

2. The purpose of this system is reproduction.

3. The main female parts of this system include the: ovaries, uterus, fallopian tubes, vagina, and vulva.

4. For men, the main parts are the testes, epididymis, penis, urethra, and several accessory glands.

CLASSROOM ACTIVITIES 1. Have students play “Name that body system.” Make a list of body organs, and pull one card at a time, asking students to name the organ system where it would be found.

Examples might include the stomach, bladder, brain, vertebrae, gluteus maximus, etc.

This can be done in teams or individually. Students earn points that can be converted into bonus points or privileges.

2. List body parts and have students tell you whether they are cells, organs, tissues, membranes, or body systems.

3. Write a key to the tissues or a flowchart decision tree, listing characteristics of tissues and ways to distinguish one tissue from another.

TEACHING STRATEGIES 1. Although this book discusses each system individually, this is an excellent chapter for helping students recognize that all the body systems are actually very dependent on one another. Explaining how the respiratory system affects the cardiovascular system, how anemias affect the respiratory system, the need for proper endocrine control to maximize functioning of the nervous system, and so forth can help them recognize the interrelationship of all the organ systems.

2. Connective tissue plays a vitally important role in most of the organ systems. Helping students recognize the different types of connective tissue and the role of each will help them better understand interplay that is more complex. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. An Internet search on the keyword “histology” yields numerous websites that illustrate and explain the various types of cells and tissue.

FACTOIDS 1. The first four types of tissues to arise from the fertilized egg in the developing zygote are the epithelial, connective, muscular, and nervous tissues. From that point onward, these four cells develop into the fetus, developing specialized functions and creating all the necessary components of a human being.

2. Histology is essentially microanatomy, or the study of microscopically small components of the human body. Robert Hooke first discovered the cell in 1665, and the word cell comes from cellula, Latin for small compartment.

ETHICAL DILEMMAS 1. Organ transplantation is very common, but there are still some cultures that believe the body should remain intact. Is it ethically acceptable not to donate healthy organs?

2. Should organ donation be legally mandated to save lives?

3. It is possible to produce tissues in the lab. In the wrong hands, what kind of problems could this create?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 5–1 Answers, p. 91 1. c 2. b 3. a 4. c 5. b 6. d Test Your Knowledge 5–2 Answers, p. 94 1. b 2. b 3. a 4. d 5. b 6. c

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Test Your Knowledge 5–3 Answers, p. 109 List the correct system 1. respiratory 2. urinary 3. skeletal 4. nervous and sensory 5. immune and lymphatic 6. cardiovascular 7. GI or digestive 8. integumentary

ANSWERS FOR CASE STUDY, P. 110 This patient has a rapid heart rate, rapid respiration rate with shortness of breath, and bluish extremities. He has a history of smoking and diabetes and is moderately overweight. He does not have a fever. The patient is clearly having respiratory problems and perhaps cardiovascular problems. The diabetes is perhaps an endocrine problem.

He should be referred to a cardiologist and a lung doctor (pulmonologists) right away to deal with his acute problems. A respiratory therapist will probably treat him. Eventually he might see an endocrinologist for his diabetes. He might eventually need to see an oncologist (cancer doctor) if it turns out that he has lung cancer from smoking.

ANSWERS TO REVIEW QUESTIONS, P. 110 Multiple Choice 1. a, 2. b, 3. c, 4. b, 5. d, 6. b, 7. c

Fill in the Blank 1. nervous 2. muscular or skeletal 3. connective 4. visceral 5. endocrine 6. skeletal

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Short Answer 1. cells, tissues, organs, systems 2. Epithelium has no blood vessels, has a distinct top and bottom, and has no extracellular matrix. Connective tissue is often well vascularized, usually has no distinct top or bottom, and has an abundant extracellular matrix.

3. Synovial membranes are connective tissue membranes that line joint cavities and lubricate them. Cutaneous membranes are epithelial membranes with a layer of connective tissue that covers the body. Serous membranes are double-layered epithelial membranes that line body cavities and cover organs. There is a potential space between the layers. Mucous membranes are epithelial membranes that line body spaces that are exposed to the environment. These membranes secrete mucus.

4. The three types of muscle tissue are skeletal, cardiac, and smooth. Skeletal muscle is striated, voluntary muscle found attached to bones. Cardiac muscle is involuntary, striated muscle found in the wall of the heart. Smooth muscle is involuntary, unstriated muscle found in the walls of hollow organs.

5. Arthritis-skeletal; Hepatitis-digestive; Pneumonia-respiratory; Osteoporosis-skeletal; Urinary tract infection-urinary.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________________ CHAPTER 5 – WORKSHEET Multiple Choice 1) This type of tissue covers and lines most of the body.

A) Connective B) Epithelial C) Nervous D) Muscle 2) This type of tissue holds things together and provides structure and support.

A) Connective B) Epithelial C) Nervous D) Muscle 3) This type of tissue can shorten itself.

A) Connective B) Epithelial C) Nervous D) Muscle 4) This type of tissue can send and receive messages.

A) Connective B) Epithelial C) Nervous D) Muscle 5) This is a two-layered membrane that lines body cavities and has fluid between the layers.

A) Mucous B) Cutaneous C) Serous D) Muscular 6) This type of membrane that is found between the bones of a joint.

A) Synovial B) Serous C) Mucous D) Cutaneous 7) This type of membrane is found lining all openings to the outside world (including organs of the digestive system and respiratory system).

A) Synovial B) Mucous C) Serous D) Muscular Worksheet – p. 1 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

8) Which of the following is not made of connective tissue?

A) Bone B) Blood C) Muscles D) Fat 9) Atherosclerosis, impaired wound healing, and gangrene are all possible complications of A) melanoma.

B) diabetes.

C) meningitis.

D) septicemia.

10) College students and military recruits in crowded situations are at higher risk for developing A) melanoma.

B) diabetes.

C) meningitis.

D) septicemia.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Matching Please match each term with the best description.

11) _____ Meningitis 12) _____ Membrane 13) _____ Melanoma 14) _____ Squamous 15) _____ Cuboidal 16) _____ Columnar 17) _____ Simple 18) _____ Stratified 19) _____ Pseudostratified 20) _____ Smooth 21) _____ Cardiac 22) _____Skeletal 23) _____Voluntary 24) _____Involuntary A. A type of skin cancer with a very high mortality rate B. A cell that is tall and thin, like a column C. An epithelium with more than one cell layer stacked on top of one another D. A cell that is flat and irregularly shaped E. The type of muscle that is found in the heart F. The type of muscle found attached to the bones G. Inflammation of the membranes surrounding the brain and spinal cord H. An epithelium that looks like it has several layers, when it really does not I. A cell that is cube shaped J. A type of muscle that is not under conscious control K. A sheetlike structure that has a specific function L. The type of muscle found in blood vessels and hollow organs M. An epithelium with only one cell layer N. A type of muscle that is consciously controlled Worksheet – p. 2 of 3 Short Answer/Essay 25. List the steps in tissue repair. __________________________________________________________ __________________________________________________________ __________________________________________________________ Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 5—Worksheet 1) B 2) A 3) D 4) C 5) C 6) A 7) B 8) C 9) B 10) C 11) G 12) K 13) A 14) D 15) I 16) B 17) M 18) C 19) H 20) L 21) E 22) F 23) N 24) J 25) Inflammation, clotting, scab formation, organization, scarring, or regeneration.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the membranes and mucosa in the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 6

THE SKELETAL SYSTEM: THE FRAMEWORK

LEARNING OBJECTIVES ➯ Describe the functions of the skeletal system ➯ Identify and describe the anatomy and physiology of bone ➯ Locate and describe the various bones within the body ➯ Differentiate between bone, cartilage, ligaments, and tendons ➯ Locate and describe the various joints and types of movement

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Arthritis 2. Osteoporosis 3. Radiologic Technology Professional Profile Animations 1. Effects of Fractures 2. Function and Classification of Joints 3. Hip Displacement 4. How Bone Fractures Heal 5. Knee Displacement 6. Movement of Joints 7. Skeletal Movements Interactive Labeling Activities 1. Bones of the Skull 2. Major Bones of the Skeletal System 3. Parts of the Bone

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. Function 1. Provides support and allows us to move 2. Protects the soft body parts, produces blood cells, and acts as a storage unit for minerals and fat II. Bone A. Composed of nonliving minerals such as calcium and phosphorous, but are alive B. The word skeleton comes from the Greek, meaning “dried up body.”

C. Classified according to their shape 1. Long bones—bones are longer than they are wide 2. Short bones—equal in width and length 3. Flat bones—thinner and can be either flat or curved 4. Irregular bones—odd in shape, and include the hipbone D. Basic Bone Anatomy—ex. long bone 1. Periosteum a. Outer covering of tough fibrous connective tissue b. Contains blood vessels, lymph vessels, and nerves c. Acts as anchor points for ligaments and tendons 2. Epiphysis and diaphysis a. Both ends of a long bone increase in size to form the epiphysis. b. The region running between two epiphyses is called the diaphysis. c. The diaphysis is hollow; called the medullary cavity, it acts as a storage area for the yellow bone marrow. i. Red marrow makes red blood cells. ii. Yellow marrow has a high fat content and can convert to red marrow in an emergency.

E. Bone tissue 1. Two types a. Compact i. Dense, hard tissue normally composing the shafts of long bones; found as the outer layer of the other bone types ii. Microscopic cylindrical shaped units called osteons, or haversian systems a. Mature bone cells (osteocytes) form concentric circles around blood vessels. b. The area around the osteocyte is filled with bone matrix. c. Osteons run parallel to each other with blood vessels connecting them 2. Spongy a. Arranged in bars and plates called trabeculae b. Irregular holes between the trabeculae give the bone a spongy appearance. c. Spongy bone is lined by endosteum, which has the same function and similar structure to periosteum. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

F. Surface structure of bones 1. Bone is not perfectly smooth.

2. Projections act as points of attachment for muscles, ligaments, or tendons.

3. Grooves and depressions act as pathways for nerves and blood vessels.

4. Projecting structures and depressions can work together as joining or articulation points to form joints, such as the ball-and-socket joint in your hip.

G. Bone growth and repair 1. Ossification: formation of bone in the body 2. Types of cells involved in bone formation and growth a. Osteoprogenitor cells: nonspecialized cells found in the periosteum, endosteum, and central canal of compact bones. b. Osteoblasts are cells that actually form bones. c. Osteocytes are mature bone cells that were originally osteoblasts. d. Osteoclasts tear down bone material and help move calcium and phosphate into the blood.

3. Bone development and growth a. Bone development begins when you are an embryo through intramembranous and endochondral ossification. i. In intramembranous ossification bone develops between two sheets composed of fibrous connective tissue. a. Cells from connective tissue turn into osteoblasts and form a matrix. b. Other osteoblasts create compact bone over the surface of the spongy bone. c. Once the matrix surrounds the osteoblasts, they become osteocytes. d. Skull bones and clavicle are examples. b. Endochondral ossification occurs when shaped cartilage is replaced by bone. i. Periosteum surrounds the diaphysis of the cartilage model as the cartilage itself begins to break down. ii. Osteoblasts come into this region and create spongy bone; primary ossification center. iii. Osteoblasts begin to form compact bone under the periosteum. iv. Osteoclasts break down the spongy bone of the diaphysis to create the medullary cavity. v. Secondary ossification centers develop in the epiphyses. c. Epiphyseal Plate i. After you are born, the epiphysis of your long bones continues to grow. ii. A thin band of cartilage forms an epiphyseal plate (growth plate) between the primary and secondary ossification centers. iii. Growth stops when plate turns to bone—closure. iv. Controlled by hormones. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. Bone repair a. Hematoma forms; inflammation b. Soft callus forms (cartilage) c. Bony callus forms d. Remodeling III. Cartilage A. Cells called chondrocytes B. Chondrocytes in holes (lacunae) in gel-like matrix C. Location and functions 1. The flexible part of your nose and ears are cartilage.

2. Makes a flexible connection between bones, as between the ribs and sternum, allowing chest flexion during deep breathing 3. Cartilage acts as a cushion between bones; articular cartilage is located on the ends of bones and acts as a shock absorber, preventing the ends from grinding together during movement.

IV. Joints A. When two or more bones join, an articulation or joint is formed.

B. Many joints must be held together, yet still be movable, which is accomplished by special connective tissue called ligaments.

C. Tendons are cordlike structures that attach muscle to bone.

D. Joints can be classified by function or structure.

1. Function a. Immobile b. Move a little c. No movement 2. Structure a. Fibrous: bones joined by short connective tissue strands b. Cartilaginous: bones united by cartilage c. Synovial: bones united by fluid filled joint cavity i. Pivot joint—turnstile movement in the neck and forearm ii. Ball-and-socket joint—hip and shoulder iii. Hinge joint—allow up and down movement in the knees and elbows iv. Gliding joint—wrists and ankles v. Saddle joint—shaped like a saddle found in the thumb vi. Ellipsoidal joint—oval-shaped bone end fitting into an elliptical cavity in the other bone so there is movement from one plane to another but no rotation, found in the fingers and toes E. Movement classification 1. Flexion—decreasing the angle of joint 2. Extension—increasing angle of a joint 3. Plantar Flexion—pointing toes down 4. Dorsiflexion—bending the foot up toward the body 5. Abduction—moving away from the body’s midline 6. Adduction—moving toward the midline of the body .

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7. Inversion—turning the foot inward toward other foot 8. Eversion—turning the foot outward away from opposing foot 9. Supination—turning hand palm up 10. Pronation—turning hand palm down 11. Circumduction—circular arm movement 12. Rotation—spinning on axis 13. Protraction—drawing part forward 14. Retraction—drawing part backward V. Bones of the Skeleton A. Two main divisions of the skeleton 1. Axial skeleton—bones of the thorax, spinal column, hyoid bone, bones of the middle ear, and skull. They protect the body organs and are composed of 80 bones. a. The skull—many bones forming brain case and facial structures b. The thorax—ribs and sternum, protects thoracic cavity c. The Spinal Column i. Also called vertebral column, houses the spinal cord, the superhighway for information coming to and from the central nervous system ii. The individual bones or vertebrae are numbered and classified according to the body region where they are located. a. 7 cervical vertebrae in the neck area b. 12 thoracic vertebrae in the chest area c. 5 lumbar vertebrae in the waist area d. 5 sacral vertebra below the waist e. 3 to 5 small fused bones at the very end that form the coccyx 2. Appendicular skeleton—these are the bones of your arms, legs, hips, and shoulders and are comprised of 126 bones a. The appendicular region consists of the arms and legs. b. Half the bones in the body are located in the hands and feet.

VI. Common Disorders of the Skeletal System A. Aging affects the cartilage and bones; although a natural process, it can sometimes be slowed.

1. Composition of cartilage changes as we age, becoming more brittle and yellow due to calcification; this can lead to arthritis, an inflammatory process of the joints, reducing flexibility and decreasing range of motion.

2. Bone mass decreases with age. Beginning in our 50s the breakdown of bone is greater than the buildup. a. Osteoporosis: light, weak, porous bones. More common in women, but can be diagnosed in men. b. Treatment and prevention of osteoporosis i. Even though bone loss is a natural aging process, it can be slowed by a healthy lifestyle. ii. Proper calcium intake during the formative years and through adulthood decreases the risk of osteoporosis. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

iii. Vitamin D is important because it allows the body to absorb ingested calcium from the digestive tract. iv. Exercise, especially weight-bearing, plays a vital role in developing, and maintaining strong bones. v. Drink less coffee. vi. Quit smoking. vii. Medication B. Bone fractures 1. A hairline fracture looks like a piece of hair on the x-ray. It is a fine fracture that doesn’t completely break or displace the bone.

2. Simple or closed fracture—a break with minimal displacement and no tear in the skin 3. Greenstick fractures are incomplete breaks often found in children 4. Spiral fracture—caused by a twisting motion to the bone 5. Comminuted fracture—when the bone fragments or splinters 6. Compound or open fracture—when the bone protrudes through the skin, with the potential of infection from exposure.

CLASSROOM ACTIVITIES 1. Have students stand up in class and point to or describe a bone. The next student in line has to name the bone, and then point to another one for the next student to name.

Go around the room doing this until the first student names a bone.

2. Point to a joint in the body, and have students name the type and function of the bone.

3. Play Simon Says with the class, calling out movement classifications and having them do the proper movement. For example, “pronate your hand” or “abduct your left leg.”

TEACHING STRATEGIES 1. Using a skeleton to demonstrate bones and types of joints is very helpful. In lieu of a skeleton, some excellent poster sized pictures of the human skeleton are available.

2. When teaching the vertebral bones, a memory trigger is to teach students we have breakfast at 7 (number of cervical vertebrae), lunch at 12 (number of thoracic vertebrae), and dinner at 5 (number of lumbar vertebrae).

3. When teaching the bones of the lower leg, it can be confusing trying to remember which bone is the fibula and which is the tibia. The bigger word (more letters) is the smaller bone—so the fibula is the smaller of the two lower leg bones, whereas the tibia is a shorter word but applies to the bigger bone.

4. When teaching the bones of the forearm, remind students that we check a radial pulse at the juncture of the thumb and wrist—the same side where the radius bone is located.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

FACTOIDS 1. This is a weird little fact. Did you know that it is perfectly legal to sell human bones?

Although certain antique specimens are protected, all other human bones are salable.

Prior to 1985, the main supplier of human material for medical use was India. There are even websites (http://www.apocalypse.org/pub/u/hilda/ssd/humbn.html) selling human bone jewelry. Care to buy a bone necklace?

2. The human skeleton has many of the same functions as the skeletons of other animals. Dogs have 319 bones, and cats have 230 bones.

3. The largest bone in the human body is the pelvis, composed of six bones joined together. The longest bone is the femur, making up almost one-quarter of the body’s total height. The smallest bone is the stirrup in the ear, hardly larger than a grain of rice.

Cartilage rots faster than bone, so after death, skulls of skeletons have no nose or ears because they are made of cartilage.

4. There are more than 20 bones in each foot. Foot bones grow faster than any other bones in the body.

ETHICAL DILEMMAS 1. A procedure called limb lengthening can be done for those with short stature. The procedure basically requires fracturing the bone at the epiphyseal (growth) plate and inserting a metal plate. A screw, located exterior to the body, is turned daily, separating the metal plates to allow the bone to build continuously, adding height, until the desired inches have been added to the bone. It is possible to add several inches in height with this surgery, but it takes approximately 1 month per inch of height. No weight bearing is allowed until the metal plate and screw are removed and the bone is completely healed.

Although this procedure will help short-stature children grow taller, is it ethical to put them through such a painful procedure?

2. Leukemia can be fatal. Many new treatments have improved the odds for survival, not the least of which is bone marrow transplantation. The best match for a bone marrow transplant is a sibling. In some cases, a parent has chosen to have a baby so the stem cells can be removed from the umbilical cord to be used for bone marrow transplantation into a sick child. Is it ethical to have a baby just so the umbilical stem cells can be used to save another child in the family?

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 6–1 Answers, p. 121 1. Answer shown top to bottom: Proximal epiphysis (B) Spongy bone (D) Compact Bone (E) Medullary cavity (F) Periosteum (C) Diaphysis (A), this is on left side of figure Epiphyseal plate (G) Distal Epiphysis (B) 2. Red bone marrow is found in spongy bone and is responsible for red blood cell production (hemopoiesis).

3. There are several functions of bone in your body: support (as a framework for the body), mineral storage (calcium and phosphorus), blood cell production (red bone marrow), energy storage (yellow bone marrow), protection of internal organs (skull, ribs, vertebral column), and helping in body movements (muscle attachment and joints).

4. b 5. a 6. c Test Your Knowledge 6–2 Answers, p. 124 1. a 2. d 3. b 4. c 5. d 6. a Test Your Knowledge 6–3 Answers, p. 128 1. d 2. b 3. d 4. b 5. a 6. a Test Your Knowledge 6–4 Answers, p. 138 1. d 2. c 3. c 4. d 5. b 6. b .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO CASE STUDY, P. 139 a. She appears to have osteoporosis. b. There is decreased bone density, holes in the bones, and bone weakness. c. She should stop smoking, drink less coffee, take a calcium supplement with vitamin D, and begin an exercise program if possible. There are also several osteoporosis drugs on the market. Perhaps one of them would help.

ANSWERS TO REVIEW QUESTIONS, P. 140 1. a 2. b 3. b 4. d 5. b 6. b Fill in the Blank 1. There are many large appendicular bones: femur, pelvis, humerus, scapula, tibia, fibula, ulna, and radius.

2. Cartilage is found in many places in the body: ears, nose, thoracic cage, joints, between vertebrae, larynx, and trachea.

3. synovial fluid 4. osteoblasts 5. osteoclasts 6. touching or reduced or immobilized

Short Answer 1. Tendons attach muscle to bone. Ligaments attach bone to bone.

2. A cartilage model is first surrounded by a bone collar. This causes the deterioration of cartilage inside the bone. Periosteal bud invades, bringing blood vessels and cells.

Medullary cavity forms, as does primary ossification center. Bone continues to replace cartilage. Secondary ossification center forms in epiphysis.

3. Joints can be classified functionally as immovable, slightly movable, or freely moving.

Joints can be classified structurally as fibrous (united by connective tissue strands), cartilaginous (united by cartilage), or synovial (united by fluid filled joint cavity).

4. Flexion—decreasing the angle of joint; Extension—increasing angle of a joint; Plantar flexion—pointing toes down; Dorsiflexion—bending the foot up toward the body; Abduction—moving away from the body’s midline; Adduction—moving toward the midline of the body; Inversion—turning the foot inward toward other foot; Eversion turning the foot outward away from the opposing foot; Supination— turning the hand palm up; Pronation—turning the hand palm down; Circumduction—circular arm movement; Rotation—spinning on axis; Protraction—drawing part forward; Retraction— drawing part backward .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. Forensic pathologists can use many types of characteristics to tell age, sex, or health.

The presence of an epiphyseal plate indicates the skeleton has not reached the end of puberty and is still growing. Male skeletons are “masculinized” with denser bones, more obvious surface features, and a narrower pelvis than female skeletons. Some disorders such as arthritis, osteoporosis, and tuberculosis, as well as nutritional status, cause changes in bone matrix or anatomy. Movement sculptures bone so experts can often tell the type of work done by a person.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name__________________________________________________ CHAPTER 6 – WORKSHEET Multiple Choice 1) These bones are oddly shaped (like jigsaw puzzle pieces).

A) Long bones B) Short bones C) Irregular bones D) Flat bones 2) The outer covering of a bone is called A) endosteum.

B) osteon.

C) periosteum.

D) trabeculae.

3) Which kind of bone cell tears down bone to release calcium and phosphate into the blood?

A) Osteoprogenitor cells B) Osteoclasts C) Osteoblasts D) Osteocytes 4) Which type of joint is filled with fluid?

A) Cartilaginous joint B) Synovial joint C) Fibrous joint D) Endohydrous joint 5) The hip is an example of a __________ joint.

A) ball-and-socket B) hinge C) pivot D) saddle Fill in the Blank 6) The _____ is the long, narrow portion of a long bone.

7) The process of bone formation is called _____.

8) The thin band of cartilage where bone growth occurs is called the _____.

9) The flexible tissue that acts as a cushion between bones is called _____.

Worksheet – p. 1 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Matching Please match each term with the appropriate definition.

10) _____ Flexion 11) _____ Abduction 12) _____ Adduction 13) _____ Pronation 14) _____ Extension 15) _____ Plantarflexion 16) _____ Supination 17) _____ Dorsiflexion 18) _____ Inversion 19) _____ Eversion A. Straightening a joint B. Turning the hand so the palm faces downward C. Pointing the toes down D. Moving toward the body’s midline E. Bending a joint F. Turning the sole of the foot inward G. Turning the hand so the palm faces upward H. Turning the sole of the foot outward I. Moving the foot so the toes point up J. Moving away from the body’s midline Please match each statement with the type of bone it best applies to. Letters will be used more than once.

20) _____ Contains trabeculae 21) _____ Contains cylindrical structures called osteons 22) _____ Is light, and provides room for red bone marrow 23) _____ Is dense and very strong 24) _____ Is typically found on the outer surface of a bone 25) _____ Is typically found in internal areas of a bone A. Compact bone B. Spongy bone

Worksheet – p. 2 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Short Answer/Essay 26. At approximately what age do a person’s bones begin breaking down faster than they are built up? (In other words, at what age can a person expect to begin losing bone mass?) __________________________________________________________ __________________________________________________________ __________________________________________________________ 27. List the steps in bone repair. __________________________________________________________ __________________________________________________________ __________________________________________________________ 28. Explain the difference between a ligament and a tendon. __________________________________________________________ __________________________________________________________ __________________________________________________________

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 6—Worksheet 1) C 2) C 3) B 4) B 5) A 6) diaphysis 7) ossification or osteogenesis 8) growth plate (epiphyseal plate) 9) cartilage 10) E 11) J 12) D 13) B 14) A 15) C 16) G 17) I 18) F 19) H 20) B 21) A 22) B 23) A 24) A 25) B 26) People begin to lose bone mass in their 50s 27) Hematoma formation/inflammation; soft callus; bony callus; remodeling 28) A ligament connects bones to each other. A tendon connects muscles to bones.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram of a joint.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 7 THE MUSCULAR SYSTEM: MOVEMENT FOR THE JOURNEY

LEARNING OBJECTIVES ➯ Differentiate the three major muscle types ➯ Explain the difference between voluntary and involuntary muscles ➯ Identify and explain the components of a muscle cell ➯ Describe the cellular activities required for muscle movement ➯ Identify specific skeletal muscles

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Kinesiology Professional Profile 2. Massage Therapy Professional Profile 3. Massage Therapy Techniques 4. Muscle Atrophy 5. Muscular Dystrophy 6. Occupational Therapy Professional Profile 7. Physical Therapy Professional Profile Animations 1. Muscle Contraction 2. Muscle Groups

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________________ Concept Map INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. The muscular system allows for movement.

1. External motion of the arms and legs 2. Internal motion including the movement of the digestive system, the cardiovascular system, and the respiratory system B. Different types of muscles allow for both external and internal movement.

II. Overview A. Muscle is a general term for all contractile tissue.

1. Contraction—muscle tissue becomes short and thick because of a nerve impulse.

2. Relaxation when impulse ends 3. Alternating contraction and relaxation causes movement.

B. Muscle tissue is constructed of bundles of these fibers, approximately the thickness of human hair.

III. Types of muscles A. Skeletal muscle 1. Attached to bones; provide movement for the body 2. Tendons—fibrous tissues that attach skeletal muscles to bones 3. Striated-look striped 4. Voluntary—movement is controlled by conscious thought 5. Contraction and relaxation a. Contraction—shortening of muscle b. Primary mover (or agonist)—chief muscle causing movement c. Synergist—assists the primary mover d. Antagonist—oppose agonist e. Attachments i. Point of origin—attached to the stationary bone ii. Point of insertion—attached to the moving bone f. All movement is a result of contraction of primary movers and relaxation of opposing muscles. g. Action—insertion moves toward origin 6. Types of movements a. Rotation—circular movement that occurs around an axis b. Abduction—movement away from midline c. Adduction—movement toward the midline d. Extension—increasing the angle between two bones connected at a joint e. Flexion—decreasing the angle between two bones 7. Movement at the cellular level a. Muscle Fibers i. Each muscle cell is an elongated fiber. ii. Several muscle fibers can be bundled together to form a specific muscle segment. iii. Each muscle fiber contains several subunits called myofibrils. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

iv. Specialized ER called sarcoplasmic reticulum are also present. b. Sarcomeres i. Sarcomeres are the functional contractile units of each fiber. ii. Each sarcomere has two types of threadlike structures called thick and thin myofilaments. iii. Thick myofilaments are made up of the protein myosin. iv. Thin myofilaments are made up of the protein actin. v. Actin myofilaments have binding sites for myosin “heads.” vi. Repeating units of actin and myosin cause striated appearance. c. Muscle Contraction i. Acetylcholine, a neurotransmitter, is released from the nervous system. ii. Acetylcholine opens sodium channels on muscle fiber surface. iii. Sodium ions flow into muscle fiber, and it becomes excited. iv. The sodium causes calcium to be released from the sarcoplasmic reticulum, which causes contraction by causing myosin heads to bind to actin filaments (crossbridge formation). v. Energy is needed for contraction and relaxation. a. ATP (adenosine triphosphate) b. Helps the myosin heads form and break the crossbridges with actin vi. Calcium is stored away from the actin and myosin in the sarcoplasmic reticulum (SR) during relaxation of the muscle. d. Muscular fuel i. Oxygen and glucose to make ATP ii. Glycogen stored in muscle can be converted to glucose. iii. Fat can be stored for energy. iv. Muscle blood supply and color. a. Higher demand muscles also have a greater blood supply to carry much-needed oxygen. b. The greater blood supply gives them a darker color. e. Muscles and body temperature i. Muscles produce heat. ii. Producing heat is important in maintaining body temperature. iii. Shivering f. Rigor Mortis i. When a body dies, all the stored calcium is unable to be pumped back out of the muscles. ii. Excess calcium remains in the muscles throughout the body and causes muscle fibers to shorten and stiffen the whole body. iii. Shortage of ATP also contributes.

8. Rules for naming skeletal muscle a. Muscle location, number of origins, action, size, location of attachments, shape, direction of fibers, combination of all b. Examples: gluteus maximus, biceps brachii, deltoid .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

9. Skeletal muscles of specific regions 10. Specific skeletal muscles B. Smooth muscle 1. Also called visceral muscle 2. Found in hollow organs (except heart) and tubes, such as blood vessels 3. Involuntary muscles; slower than skeletal muscles 4. Action a. Enlarging the diameter of a blood vessel is called vasodilation. b. Decreasing the diameter of a blood vessel is called vasoconstriction. c. Sphincters—close tubes C. Cardiac muscle 1. In heart wall 2. Involuntary 3. Fibers are shorter and receive a richer supply of blood than any other muscle in the body.

4. Intercalated disks—link fibers; causing one fiber to contract and then pull the next one into a contraction, creating a domino effect 5. Cardiac muscle does not repair itself, leading to scarring.

IV. Muscle Tone A. Tonus (muscle tone)—partial contraction of a muscle with resistance to stretching B. Hypertrophy—increased muscle size C. Atrophy—muscle wasting from disuse V. Common Muscular System Disorders A. Myalgia: pain or tenderness in a muscle B. Fibromyalgia: affects women under 40 but is not fully understood; symptoms include aches, pains, and muscle stiffness with specific tender points; cause is unknown but is linked with chronic fatigue syndrome.

C. Ataxia: irregular muscle action with lack of coordination D. Paralysis: partial or total loss of function in voluntary muscles; can be either flaccid or rigid paralysis E. Spasm or cramp: involuntary sudden and violent contraction of a muscle for a prolonged period of time F. Sprains: tears or breaks in ligaments G. Strains: actual tears in muscles or tendons H. Shin splints: inflammatory condition of the extensor muscles and surrounding tissues of the lower leg; often found in runners I. Hernia: tear in the muscle wall through which an organ of the body protrudes J. Tendinitis: inflammation of tendons K. Electromyography: a diagnostic test in which a muscle or group of muscles are stimulated with an electrical impulse, causing contraction, allowing the strength of the contraction to be measured L. Neuromuscular disorders 1. Myasthenia gravis a. Gradually increasing profound muscle weakness b. Drooping eyelid frequently the first symptom .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

2. Muscular dystrophy a. Inherited muscular diseases b. Muscle fibers degenerate c. Progressive muscular weakness occurs 3. Guillain-Barré syndrome a. Disorder of the peripheral nervous system that causes flaccid paralysis and the loss of reflexes b. Ascends from the feet and progressing to the head c. Paralysis peaks in 10 to 14 days and then subsides gradually 4. Tetanus a. Creates rigid paralysis, and any minor stimulus causes muscles to go into a major spasm b. Caused by toxins produced by a bacteria found in the ground and can be spread by any type of puncture, not just a rusty nail 5. Botox a. Botulism is a potentially deadly disease resulting from food poisoning with the Clostridium botulinum bacteria. b. Science can utilize botulinum toxins for medical and cosmetic treatment. c. Small amounts of botulinus toxin are injected into facial muscles to stop previously untreatable facial twitching by paralyzing the muscles. d. Toxin also is used to treat wrinkles without surgery; known as Botox injections.

CLASSROOM ACTIVITIES 1. Have students stand and bend a joint, then discuss what muscles are required for that action as well as the antagonist movement that changes the joint back to the original position.

2. Play round robin, going around the room and asking students to name the muscles as you point to them. Keep going around the room until all muscles are covered. This game can also be used as a group oral quiz—encouraging all students to study hard to avoid bringing down the group average.

TEACHING STRATEGIES 1. Chicken carcasses can be wonderful teaching tools for the muscular system.

Comparing skeletal muscles to organ muscles, such as intestines or heart, can clearly show the differences between smooth muscles and skeletal muscles. Turkey carcasses frequently even have cardiac muscle to compare. By examining actual muscles, students can more easily understand their structure and function.

2. Relate form to function, explaining why the different muscle types need different anatomies to perform their different functions.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

FACTOIDS 1. Studies show that muscle fatigue has no relationship to the central nervous system or failed neuromuscular transmission. Muscle fatigue is caused by contractile failure of the muscles involved.

2. The body has over 600 muscles, and they come in various sizes and shapes to allow them to perform different functions. Some of the biggest and strongest muscles are in the back, near the spine, helping to maintain upright posture and providing the power to lift and push things. A lifetime of abuse to the back muscles can result in serious and painful problems, sometimes triggered by a task as simple as picking up a pencil: the “straw that broke the camel’s back.” Careful attention to lifting and moving, especially as we approach middle age when back injury becomes more prevalent, can help prevent debilitating injury.

ETHICAL DILEMMAS 1. Discuss the ethical dilemma of the need for transplantable organs and the lack of supply. Should organ donation be mandated? Should everyone who qualifies for a transplant receive one, despite the ability to pay?

2. Should people who destroy their organs through poor lifestyle choices (liver damage from alcohol abuse, heart damage from obesity/smoking) qualify for a transplant? What about income, insurance, and ability to pay—do these factors influence choices?

3. A controversy in the transplant community involves who can donate organs.

Currently, only those who are brain dead can donate vital organs such as the heart or lungs. However, some feel that many transplantable organs are being lost because those who have had life support withdrawn but are not legally brain dead cannot donate.

Should this be allowed? What about prisoners sentenced to death: should they donate organs instead of being put to death by the state?

4. There are several ways to increase muscle strength, including using drugs like steroids or growth hormone. Is it ethical for athletes to use these substances? Why or why not? If it’s not ethical, why do so many resort to banned substances?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 7–1 Answers, p. 147 1. c 2. d 3. b 4. c Test Your Knowledge 7–2 Answers, p. 151 1. rotation 2. flexion or adduction 3. extension or abduction 4. agonist or primary mover .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. point of origin Test Your Knowledge 7–3 Answers, p. 155 1. actin 2. calcium; ATP 3. sarcomere 4. acetylcholine 5. myosin; actin Test Your Knowledge 7–4 Answers, p. 158 1. hamstrings 2. quadriceps; pelvis; patella and tibia 3. sternocleidomastoid 4. gastrocnemius 5. biceps brachii; triceps brachii 6. hamstrings ANSWERS TO THE CASE STUDY, P. 165 a. Guillain-Barré b. Respiratory arrest c. Must monitor respiration rate, blood oxygen and carbon dioxide, and pulse rate d. Disuse of muscles leads to atrophy. e. This patient will be helpless soon. Everything must be done for the patient. f. It is usually possible to recover from Guillain-Barré, but it may take months of rehabilitation depending on the severity of the disease.

ANSWERS TO REVIEW QUESTIONS, P. 166 Multiple Choice 1. a, 2. b, 3. d, 4. b, 5. c, 6. b, 7. b Fill in the Blank 1. spasm/cramp 2. paralysis 3. hernia 4. glycogen 5. myalgia 6. biceps brachii Short Answer 1. The three major muscle types are skeletal, cardiac, and smooth. The diaphragm (and dozens of others) is a skeletal muscle. Cardiac muscle is found in the heart wall.

Examples of smooth muscle are the walls of the respiratory and digestive systems and the walls of blood vessels. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

2. The origin is the stationary muscle attachment. The insertion is attached to the bone that moves. The action generally moves the insertion toward the origin.

3. Muscles may be names based on size (gluteus maximus), shape (deltoid), fiber direction (external oblique), action (adductor longus), number of attachments (triceps brachii), location of attachments (sternocleidomastoid), location in body (biceps femoris), or a combination (pectoralis major).

4. Skeletal muscle contracts when sodium ion channels open because of stimulation of the muscle because of the release of ATP from the nervous system. This stimulation causes the release of calcium from sarcoplasmic reticulum. This free calcium, in the presence of ATP, allows myosin heads to repeatedly form, break, and reform crossbridges with actin filaments. The repeated connect and disconnect of the myofilaments (actin and myosin) pulls the actin along the myosin, shortening the sarcomere and shortening the muscle itself.

5. From our list, the muscles are the hamstrings (flexor muscles that originate on the pelvis and insert on the tibia) and the quadriceps (extensor muscles that originate on the pelvis and insert on the tibia and patella).

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________ CHAPTER 7 – WORKSHEET Multiple Choice 1) The two threadlike proteins that slide to generate a muscle contraction are A) actin and myosin.

B) myosin and acetylcholine.

C) ATP and calcium.

D) calcium and actin.

E) acetylcholine and ATP. 2) The thick protein filaments in a muscle cell are made of A) actin.

B) myosin.

C) ATP. D) calcium.

E) acetylcholine.

3) The thin protein filaments in a muscle cell are made of A) actin.

B) myosin.

C) ATP. D) calcium.

E) acetylcholine.

4) This substance, which is stored in sarcoplasmic reticulum, allows crossbridges to form between actin and myosin.

A) Actin B) Myosin C) ATP D) Calcium E) Acetylcholine 5) This substance is an energy molecule. Its function in muscle contraction is to allow myosin heads to attach and reattach to actin, causing sliding of the protein filaments.

A) Actin B) Myosin C) ATP D) Calcium E) Acetylcholine 6) This substance is released by the nervous system and excites muscle cells (resulting in muscle contraction).

A) Actin B) Myosin C) ATP D) Calcium E) Acetylcholine

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Worksheet – p. 1 of 3 Fill in the Blank 7) The point of _____ is the end of the muscle that is attached to a stationary bone.

8) The point of _____ is the end of the muscle attached to a moving bone.

9) A(n) _____ is a test in which a muscle group is stimulated with an electrical impulse that causes contraction.

Matching Please match each muscle with the appropriate action.

10) _____ Biceps brachii 11) _____ Triceps brachii 12) _____ Deltoid 13) _____ Diaphragm 14) _____ Hamstrings 15) _____ Quadriceps 16) _____ Tibialis anterior 17) _____ Gastrocnemius A. Abducts the shoulder B. Points toes downward C. Flexes the elbow D. Flexes the knee E. Extends the knee F. Extends the elbow G. Main muscle of breathing H. Dorsiflexes foot Please match each disease with the appropriate description.

18) _____ Strain 19) _____ Cramp 20) _____ Shin splints 21) _____ Myasthenia gravis 22) _____ Fibromyalgia syndrome 23) _____ Muscular dystrophy 24) _____ Tetanus A. A sudden, intense, involuntary muscle contraction B. A disorder caused by autoimmune attack of the neuromuscular junction C. Pain and inflammation in the anterior lower leg, often associated with running D. An acute muscle injury caused by overstretching E. Progressive muscle weakness and muscle fiber disintegration caused by a genetic defect F. Progressive descending muscle spasms, caused by a particular type of wound infection G. A disorder with chronic, bilateral pain in 11 of 18 specific locations .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Worksheet – p. 2 of 3 Short Answer 25. What muscle is the antagonist to the quadriceps? What action does this antagonist perform? __________________________________________________________ __________________________________________________________

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 7 – Worksheet 1) A 2) B 3) A 4) D 5) C 6) E 7) origin 8) insertion 9) electromyogram (EMG) 10) C 11) F 12) A 13) G 14) D 15) E 16) H 17) B 18) D 19) A 20) C 21) B 22) G 23) E 24) F 25) The antagonist to the quadriceps is the hamstrings. The hamstrings flex the knee (while the quadriceps extend the knee).

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_____________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the facial muscles in the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 8

THE INTEGUMENTARY SYSTEM: THE PROTECTIVE COVERING

LEARNING OBJECTIVES ➯ Discuss the functions of the integumentary system ➯ List and describe the layers of the skin ➯ Explain the healing process of skin ➯ Describe the structure and growth of hair and nails ➯ Explain how the body regulates temperature through the integumentary system

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Decubitus Ulcer 2. Eczema 3. EMT–Paramedic Professional Profile 4. Nursing Professional Profile 5. Skin Cancer Animations 1. Burns 2. Pressure Sores 3. Wound Repair Interactive Labeling Activities 1. Hair Follicle 2. Integumentary System

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction/System Overview A. Comprised of the skin and its accessory components, including hair, nails, and associated glands B. Functions 1. Protects from pathogens 2. Balances fluid levels 3. Stores fatty tissue for energy supply 4. Produces vitamin D (with help from the sun) 5. Provides sensory input 6. Helps to regulate body temperature II. The Skin A. The skin is the largest organ, weighing approximately 20 pounds and covering an area about 20.83 square feet on an adult B. A cross-section of skin reveals three layers: 1. Epidermis a. The outside layer of skin; five sublayers, stratified squamous epithelium b. No blood vessels c. Deepest layer: stratum basale, new cells born every 2 to 4 weeks d. Surface layer: stratum corneum i. Dead cells—flat, scaly, keratinized epithelial cells ii. Sloughed off iii. Replaced by cells from stratum basale e. Melanocytes, make pigment melanin 2. Dermis a. Inferior to epidermis b. Connective tissue c. Contains accessory structures i. Capillaries ii. Involuntary muscles iii. Lymph vessels iv. Hair follicles v. Sudoriferous (sweat) glands a. Two main types i. Apocrine: secrete at the hair follicles in the groin and anal region as well as the armpits; active around puberty and may act as sexual attractant ii. Eccrine glands: greater numbers on palms, feet, forehead, and upper lip; temperature regulation b. Body has 3 million sweat glands c. Sweat has no odor, but bacteria degrade the substances in the sweat over time into chemicals that give off strong smells commonly known as body odor vi. Sebaceous glands (oil) a. Secrete sebum (oil) .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Sebum keeps skin from drying out and (because of its acid nature) helps destroy some pathogens on skin’s surface d. Small “fingers” of tissue project from the surface of the dermis and anchor this layer to the epidermal layer.

3. Subcutaneous fascia a. Deepest layer of skin b. Elastic and fibrous connective tissue and fatty tissue c. Insulation and attachment C. Skin color 1. Melanocytes a. Located deep in the epidermis b. Produce melanin, skin pigment c. Skin color determined by distribution and abundance of melanin, not number of melanocytes 2. Carotene, another form of pigment, gives a yellowish hue to skin.

3. A pinkish hue derives from the hemoglobin in the blood.

4. Affect of disease on skin color a. When liver disease occurs, the body can’t break down bilirubin; the buildup of bilirubin gives the skin a yellow color. b. Malfunctioning adrenal gland can cause the skin to turn bronze because of excessive melanin. c. Excessive bruising could indicate skin, blood, or circulatory problems. d. Cyanosis, or a blue coloring, results from a drop in oxygenation.

III. Skin Healing A. Blood clots, on skin surface, exposed to air—becomes scab B. Repair progresses in same way as generalized tissue repair C. The wound ideally starts to heal from the inside out.

IV. Burns A. Heat, chemicals, electricity, and radiation can cause burns.

B. Classification 1. Depth a. First-degree burns damage only the outer layer, or epidermis. i. Only epidermis ii. Redness, pain, no blister iii. No scarring b. Second-degree burn i. Entire epidermis, portion of dermis ii. Blistering iii. Scarring iv. Often need medical attention c. Third-degree burn i. All three layers ii. Black, brown, tan, or white iii. Little pain initially iv. Destroys accessory structures .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

v. Must have medical attention d. Fourth-degree burn i. Most severe ii. Penetrates to bone 2. Amount of area damaged: the rule of nines a. Head and neck: 9% b. Each upper limb: 9% (X 2 = 18%) c. Front of trunk: 18% d. Back of trunk and buttocks: 18% e. Perineum (including anus and urogenital region): 1% f. Each lower limb 18% (X 2 = 36%) C. Clinical concerns 1. Bacterial infections 2. Fluid loss 3. Heat loss D. Treatment for severe burns 1. Damaged skin must be removed.

2. Skin grafting a. Autografting is using the patient’s own skin. b. Heterografting uses other sources.

V. Nails A. Specialized epithelial cells originating from the nail root B. Keratinized C. The cuticle: fold of tissue that covers the nail root D. Nail body: visible portion E. The pink color of the nail comes from the vascularization of the tissue under the nails, whereas the white half-moon–shaped area, or lunula, is a result of the thicker layer of cells at the base.

F. Nails can be used to assess peripheral perfusion.

1. Pink color is clinically significant.

2. If you pinch one of your fingers, the pink color should return within 5 seconds (usually within 3 seconds) if you have good perfusion, after you release the pressure.

3. If the normal color takes longer to return, it may indicate a problem.

4. Diabetes can cause reduced blood flow to the extremities, a condition called peripheral vascular disease (PVD).

5. Blood clots or vascular spasm can decrease blood flow, as can hypothermia, making peripheral refill slower.

6. Reduced levels of oxygen can cause a blue color to nail beds.

VI. Hair A. Purpose of hair 1. Body temperature regulation 2. Sensor 3. Protect eyes and nose from foreign objects B. Anatomy of a hair .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

1. Hair made of keratin 2. Shaft: visible portion of hair; dead cells 3. Root extends down into the dermis to the follicle 4. Follicle: cells grow and divide there 5. A sebaceous gland is associated with each hair follicle.

6. Sebum production decreases with age.

C. Hair color and texture 1. Dependent on the amount of melanin you produce 2. The more melanin, the darker the hair 3. White hair occurs in the absence of melanin.

4. Red hair is the result of hair that has melanin with iron in it.

5. Flat hair shafts produce curly hair, whereas round hair shafts produce straight hair.

6. The life span of hair is dependent on location: Eyelashes last 3 to 4 months; hair on the head lasts 3 to 4 years.

D. Forensics and hair 1. Hair can reveal to a pathologist if an individual ingested certain drugs or other substances, such as lead or arsenic.

2. Trace amounts of ingested substances can become part of the hair’s composition.

3. Analysis of a hair sample can reveal what and how long ago toxins or drugs were ingested.

4. The longer the length of hair, the longer the record of what was consumed by that individual.

VII. Temperature Regulation A. Change in size of blood vessels 1. Vasodilation exposes heated blood to external cooling air.

2. Vasoconstriction keeps cooling of blood to a minimum in cold temperatures.

B. Sweat glands excrete water onto the skin’s surface, allowing cooling through evaporation.

C. Shivering: muscle contractions produce heat.

D. Hairs on your skin stand erect when arrector pili muscles contract, causing goose bumps; these hairs insulate you from cooler surroundings.

VIII. Diseases of the Skin A. Melanoma: deadliest form of skin cancer B. Lesion: any pathological change in skin C. Other disorders

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CLASSROOM ACTIVITIES 1. There are products that, when applied to the skin, will cause the skin to glow under black lights. Have students apply one of these products to the skin and then perform a thorough hand washing. Once their hands are dry, have them hold their hands under the black light. This is an excellent way of demonstrating good hand washing versus not-so good hand washing.

2. Have students discuss their experience with sunburns or other first— and seconddegree burns. Have them explain what it felt like, how they treated it, and how long the injuries lasted.

3. Have students compare the differences in their hair texture, oil, growth, and so on, allowing students to see the different types of hair common to people of different races and cultures.

TEACHING STRATEGIES 1. When discussing one of the functions of the skin—protection or a barrier against pathogen invasion, for example—make the point that the best protection against infection is an intact integumentary system. Discuss how much easier pathogens can enter the body if there is a break in the skin. Good skin care, when caring for others, is essential to keeping the health care provider safe. This includes good hand washing, application of skin creams or oils to prevent cracking, and using warm water for hand washing to prevent chapping.

2. Another function of the skin is temperature regulation. Discuss the importance of allowing heat to escape from the body. What treatments are effective in lowering a client’s fever?

FACTOIDS 1. The word integument comes from the Latin meaning “to cover.”

2. New shoes may cause the skin of the foot to blister. This is because the epidermis separates from the dermis and tissue fluid may collect in the space.

ETHICAL DILEMMAS 1. The greatest ethical dilemma that comes from the integumentary system arises from skin color. What possible reason could anyone have for drawing conclusions about a person based on his or her skin color?

2. Some predict that within the next hundred years, we will all have the same skin color as interracial marriages continue. Do you believe this is true?

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 8–1 Answers, p. 176 1. a. epidermis b. dermis c. subcutaneous fascia (hypodermis) 2. a. prevention of fluid loss b. prevention of infection c. vitamin D production d. temperature regulation e. sensory input f. fat storage 3. d 4. c 5. c Test Your Knowledge 8–2 Answers, p. 182 1. b 2. c 3. b 4. d ANSWERS TO THE CASE STUDY, P. 188 She has a contact dermatitis, probably caused by poison ivy. The vesicles have begun to form around her eyes because of contact spreading. When she scratches the vesicles on her legs and then rubs her eyes, she spreads the poison ivy.

ANSWERS TO REVIEW QUESTIONS, P. 188 Multiple Choice 1. a, 2. b, 3. c, 4. d, 5. b Fill in the Blank 1. epidermis; dermis; hypodermis 2. eccrine; apocrine 3. sebum 4. freckles 5. bilirubin

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Short Answer 1. The skin has several functions. It functions as a barrier against bacteria entering the body. The skin, when exposed to sun, produces vitamin D. Because the skin is keratinized, it is waterproof and helps prevent fluid loss. Body fluids can only pass through the skin as sweat. The skin also helps control body temperature. Blood vessels in the skin dilate, sending more blood to the skin if your temperature rises. You also sweat to increase evaporative cooling. Blood vessels in the skin constrict, decreasing blood flow to the skin, if your body temperature falls. Fat storage as well as sensory input are also skin functions.

2. The epidermis is composed of stratified squamous epithelial cells. In the deepest sublayer, the basal layer (stratum basale), the cells are living. All the cells of the epidermis are born in the basal layer. After the cells are born, they move toward the surface layer, the horny layer (stratum corneum). As they move toward the surface, the cells die and become filled with keratin. Dead cells are sloughed from the surface of the skin and replaced every 2 to 4 weeks.

3. Melanin is a pigment that shields the nuclei of skin cells from UV radiation. The source of most UV radiation is sunlight. So, as sunlight exposure increases, so does your body’s attempt to protect against UV damage.

4. Burns are classified by depth and extent. Burn depth is divided into four classes.

First-degree burns are superficial damaging only the epidermis. Second-degree burns are more serious, damaging the epidermis and part of the dermis. First- and seconddegree burns are partial thickness burns. Third-degree burns burn through the epidermis and the dermis, completely destroying the skin. Fourth-degree burns destroy muscle and bone. Third- and fourth-degree burns are full thickness burns. Extent of a burn is expressed as percentage of body burned. The rule of nines is used to estimate the percentage of the body that is burned.

5. There are several skin accessory structures. Sweat glands secrete water either to regulate body temperature or as a sexual attractant. Hair follicles produce hair and are associated with arrector pili muscles, which create goose bumps when the air is cold.

Sebaceous glands, which secrete sebum (oil) to lubricate the skin, are also associated with hair follicles.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________ CHAPTER 8 – WORKSHEET Multiple Choice 1) The outermost layer of the skin is called the A) dermis.

B) epidermis.

C) hypodermis (subcutaneous fascia).

D) superficial fascia.

2) The pigment responsible for skin color is A) melanin.

B) keratin.

C) collagen.

D) elastin.

3) Which skin layer contains hair follicles, sweat glands, sebaceous glands, and nerve endings?

A) Dermis B) Epidermis C) Hypodermis (subcutaneous fascia) D) Superficial fascia 4) The _____ sweat glands are found in the groin, armpits, and anal region. They become active around puberty.

A) eccrine B) apocrine C) endocrine D) alopecia 5) The innermost layer of the skin is called the A) dermis.

B) epidermis.

C) hypodermis (subcutaneous fascia).

D) necrotizing fascia.

6) The fibrous protein that makes up your hair, fingernails, and toenails is called A) melanin.

B) keratin.

C) collagen.

D) elastin.

7) New hair cells divide and grow in the hair A) shaft.

B) root.

C) follicle.

D) sebaceous gland.

Worksheet – p. 1 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

8) These glands produce an oily substance that keeps the skin and hair from over drying. The oily substance also has antibacterial properties.

A) Sudoriferous glands B) Sebaceous glands C) Sweat glands D) Lymph glands 9) Which hair color develops because of the complete absence of melanin production?

A) Black B) Red C) White D) Gray 10) Straight hair is a result of hair shafts that are _____.

A) square B) round C) flat D) triangular 11) Which of the following statements about the epidermis is not true?

A) The epidermis does not contain any blood vessels.

B) The epidermis does not contain any nerve cells.

C) The outer layer of the epidermis is composed of dead cells that are constantly sloughing.

D) The epidermis is the location where sweat glands and sebaceous glands can be found.

12) Which layer of the epidermis is responsible for producing new cells?

A) Stratum corneum B) Stratum basale C) Stratum lucidum D) Stratum spinosum Fill in the Blank 13) The cells in the skin that produce pigment are called _____.

14) The sebaceous glands secrete an oil called _____.

15) Cells that pull together the edges of a healing wound are called _____.

16) The white portion half-moon at the base of each nail is called the _____.

17) A nurse pinches her client’s fingernail and measures how long it takes for the blanched color to return to a normal pink. She has just assessed this client’s peripheral _____.

Worksheet – p. 2 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

18) Red hair is because of altered melanin that contains _____.

19) The _____ muscles attach to hair. When these muscles contract, the hair stands erect.

20) The hypodermis contains _____ cells, called lipocytes.

21) A bleeding wound will eventually form a clot. The top portion of this clot is exposed to air and hardens, forming a(n) _____.

Short Answer/Essay 22. Please list three functions of the skin. __________________________________________________________ __________________________________________________________ __________________________________________________________ 23. What kind of problems could develop if skin wounds healed from the outside in (instead of from the inside out)? __________________________________________________________ __________________________________________________________ __________________________________________________________ 24. Describe two ways the skin can help cool the body when it is too hot. __________________________________________________________ __________________________________________________________ __________________________________________________________ 25. Describe two ways the skin can help retain heat when it is cold outside. __________________________________________________________ __________________________________________________________ __________________________________________________________

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 8 – Worksheet 1) B 2) A 3) A 4) B 5) C 6) B 7) C 8) B 9) C 10) B 11) D 12) B 13) melanocytes 14) sebum 15) fibroblasts 16) lunula 17) perfusion (blood flow) 18) iron 19) arrector pili 20) fat 21) scab 22) Answers may include: Creating a barrier that prevents pathogens from entering the body; preventing excessive fluid loss; storing fatty tissue for energy supply; producing vitamin D (when exposed to sunlight); providing sensory input; helping to regulate body temperature 23) If wounds healed from the outside in, bacteria and other pathogens could get trapped in the healing wound and cause an infection.

24) Sweat cools the body by evaporation; Dilation of blood vessels in the dermis brings blood close to the body surface so the air can cool it.

25) Goose bumps (hairs that are raised by contraction of the arrector pili muscles) create an insulating space between the air and the skin; Constricting blood vessels in the dermis divert blood away from the body surface so that the air will not cool it.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name____________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 9

THE NERVOUS SYSTEM (PART I): THE INFORMATION SUPER HIGHWAY

LEARNING OBJECTIVES ➯ List and describe the components and basic operation of the nervous system ➯ Contrast the central and peripheral nervous systems ➯ Define the parts and functions of the nervous tissue ➯ Discuss the anatomy and physiology of the spinal cord ➯ List and describe various nervous system disorders of the nerves and spinal cord

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Carpal Tunnel Syndrome 2. C-Spine Injuries 3. Electroneurodiagnostician Professional Profile 4. Epidural Placement Animations 1. Brain 2. Multiple Sclerosis 3. Nerves in the Arm 4. Nerves in the Leg 5. Neuromuscular Contraction 6. Neuroreflex Arc 7. Neurosynapse 8. Spinal Cord

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction/Basic Operations A. The brain and spinal cord make up the central nervous system (CNS).

B. Everything outside the brain and spinal cord is part of the peripheral nervous system (PNS).

C. The input side of the nervous system is the sensory system.

D. The output side of the nervous system is the motor system.

1. Somatic nervous system controls skeletal muscle; voluntary movements.

2. Autonomic nervous system controls smooth muscle, cardiac muscle, glands: It is comprised of two branches: a. The parasympathetic system that deals with resting body functioning b. The sympathetic nervous system, which controls the fight-or-flight response system II. Nervous tissue A. Neuroglia: specialized cells in the nervous system; perform support functions 1. The CNS has four types of glial cells: a. Astrocytes: metabolic and structural support cells b. Microglia: remove debris c. Ependymal cells: cover and line cavities of the nervous system d. Oligodendrocytes: make a lipid insulation called myelin 2. The PNS has two types of glial cells: a. Schwann cells: make myelin for the PNS b. Satellite cells: support cells B. Neurons 1. Carry out control functions of nervous system 2. Each part of a neuron has a specific function. a. Body: cell metabolism b. Dendrites: receive information from the environment c. Axon: generates and sends signals to other cells d. Axon terminal: emits signal from the cell e. Synapse: transmits signal to receiving cell 3. Classification of neurons a. Function i. Sensory neurons: input ii. Motor neurons: output iii. Interneurons (association neurons): communication between neurons b. Structure i. Bipolar: has two processes, one axon and one dendrite ii. Unipolar: has one process, split into central and peripheral projection iii. Multipolar: has many processes, usually one axon and many dendrites 4. How neurons work a. Excitable cells: can carry a charge; have membrane potential .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

i. Each time charged particles flow across a cell membrane, a tiny charge is generated. ii. All three types of muscle cells are excitable cells, as are many gland cells. iii. Excitable cells are like miniature batteries, able to generate tiny currents simply by changing the permeability of their membranes. b. Action potential i. Polarized: cell with charge across the membrane when at rest; more negative inside than out ii. Depolarization: charge across membrane becomes more positive a. Cell is stimulated, sodium channels open b. Sodium ions (positively charged) flow into cell c. Cell becomes more positive (depolarized) iii. Repolarization: membrane potential returns toward negative a. Sodium gates close after less than a millisecond b. Potassium gates open c. Potassium (also positively charged) leaves the cell taking its positive charge with it d. Cell becomes more negative iv. Hyperpolarization: cell becomes more negative than at rest v. All-or-none: an action potential in the cell moving through depolarization, repolarization, and hyperpolarization; does not change size vi. Refractory period: time during which the cell cannot accept another stimulus c. Local potential i. The size of the stimulus determines the excitement of the cell ii. Many sensory cells work via local potentials, which is one way the CNS tells the size of the environmental change iii. May add together to form action potential iv. Not all-or-none d. Impulse conduction i. Movement of an action potential down an axon ii. Speed of impulse conduction is determined by the amount of myelin and the diameter of the axon a. Myelin i. Lipid insulation formed by oligodendrocytes and Schwann cells ii. Myelinated axons look white; unmyelinated are gray iii. Unmyelinated axon—the action potential can only flow down the axon by depolarizing each and every centimeter of the axon iv. Myelinated axons—there are nodes of Ranvier, or bare spots, located periodically, and only the nodes must depolarize, impulse skips node to node .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Diameter of the axon—wider is faster c. Small, unmyelinated axons have speeds as low as 0.5 meters/second, whereas large-diameter myelinated axons may be as fast as 100 meters/second e. Synapses i. Chemical synapses a. When the action potential arrives at the axon terminal, the terminal depolarizes and calcium gates open. b. Calcium flows into the cell. c. Calcium flow triggers a change in the terminal; tiny sacs in the terminal, called vesicles, release their contents from the cell. d. Vesicles are filled with molecules called neurotransmitters used to send the signal from the neuron across the synapse to the next cell in line. e. Neurotransmitters bind to the cell receiving the signal and opening or closing gates, while some excite the receiving cell and some calm it down. f. The last step in the transfer of information is to clean up, removing the neurotransmitter from the synapse to prevent it from binding to the receiving cell. ii. Electrical synapses a. Some cells need no chemicals to transmit information from one cell to another. b. These synapses are electrical synapses, transferring information freely because they have special connections called gap junctions. c. Such connections can exist between any types of excitable cells. d. They are found in the intercalated discs between cardiac muscle fibers. iii. Neuromuscular junction a. Neuromuscular junction is a chemical synapse, a specialized synapse between somatic (voluntary) motor neurons and the skeletal muscles they innervate. b. Skeletal muscle i. Neurotransmitter: acetylcholine, opens sodium channels, causes skeletal muscle to depolarize so the muscle contracts ii. Acetylcholinesterase: enzyme responsible for cleaning up the synapse III. Spinal Cord and Spinal Nerves A. Hollow tube running inside the vertebral column, from the foramen magnum to the second lumbar vertebrae .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. 31 segments, each with a pair of spinal nerves named for the corresponding vertebrae C. The spinal cord ends at L2 in a pointed structure called the conus medullaris.

1. Hanging from the conus medullaris is the cauda equina (horse’s tail).

2. The spinal nerves L2 through the coccygeal nerves dangle loosely, floating in a bath of cerebral spinal fluid (CSF).

D. The spinal cord has two widened areas, the cervical and lumbar enlargements, which contain the neurons for the limbs.

E. Meninges 1. Protective covering of both the brain and spinal cord 2. Three distinct layers a. Dura mater: tough, fibrous outermost layer b. Arachnoid mater: wispy, filamentous middle layer c. Pia mater: innermost layer, fused to surface of CNS 3. Meningeal spaces a. Epidural space: between spinal cord and vertebrae b. Subdural space: between dura mater and arachnoid mater, small amount of fluid c. Subarachnoid space: between arachnoid mater and pia mater; filled with cerebrospinal fluid F. Internal anatomy of the spinal cord 1. Spinal cord is divided in half by an anterior median fissure (deep groove) and a posterior median sulcus (shallow groove).

2. Interior of the spinal cord is then divided into a series of sections of white matter columns and gray matter horns.

3. Horns a. The dorsal horn, involved in sensory functions b. The ventral horn, involved in motor function c. The lateral horn, involved in autonomic functions d. Horns are the regions where the neurons have their cell bodies.

4. Columns also have a ventral, dorsal, and lateral aspect acting as nerve tracts/pathways/axons running up and down the spinal cord to and from the brain.

5. The commissures connect left and right halves of the cord.

6. The central canal is a cavity in the center of the spinal cord filled with CSF. 7. The spinal roots project from both sides of spinal cord in pairs, fused to form spinal nerves a. The dorsal root, with the embedded dorsal root ganglion, a collection of sensory neurons, carries sensory information. b. The ventral root is motor.

8. Spinal nerves a. Nerves are the connection between the CNS and the outside environment. b. Nerves are therefore part of the PNS. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

c. All nerves consist of bundles of axons, blood vessels, and connective tissue. d. Nerves connected to the spinal cord are called spinal nerves, each named for the spinal cord segment to which it is attached. e. All spinal nerves are mixed nerves, carrying both sensory and motor information. f. Cervical, lumbar, and sacral nerves in complex projection are called plexus.

9. Reflexes a. Simplest form of motor output the body can make b. Generally protective, keeping the body from harm c. Involuntary, and usually the response gets bigger as the stimulus gets bigger d. Familiar reflexes: withdrawal reflex, which allows you to pull your hand away from a hot stove; the vestibular reflex, which keeps you vertical; and the startle reflex, which causes you to jump at loud sounds e. Reflexes can often occur without your brain being involved, involving only your spinal cord IV. Common Disorders of the Nervous System (see also Chapter 10) A. Peripheral neuropathy 1. Encompasses a number of disorders involving damage to peripheral nerves 2. Symptoms vary depending on whether the sensory, motor, or autonomic function is affected.

3. Symptoms include muscle weakness, decreased reflexes, numbness, tingling, paralysis, pain, abnormal sweating, digestive abnormalities, and difficulty controlling BP. 4. Nongenetic neuropathy can be caused by systemic disease, trauma, or infection and autoimmune disorders.

B. Spinal trauma 1. Even though the spinal cord is protected, it can be damaged by trauma.

2. The spinal cord can be partially or completely severed, crushed, or bruised; bruises may resolve with time.

3. Spinal cord injury usually results in paralysis and sensory loss below the injury.

4. Cervical injury may result in quadriplegia and, if the diaphragm is paralyzed, respiratory arrest.

5. Damage in thoracic spinal cord or inferior causes paraplegia; patients can move their arms.

C. Guillain-Barré syndrome 1. Guillain-Barré syndrome (GBS) is a paralysis caused by inflammation of peripheral nerves.

2. Develops over variable time periods, causing weakness and ascending paralysis of the limbs, face, and diaphragm 3. Severe cases require a ventilator to support breathing until paralysis resolves.

4. Cause is unknown, but it frequently occurs after a viral infection; may also be an autoimmune disorder. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. Disorder is temporary, but many clients require rehabilitation after recovery D. Myasthenia gravis 1. Autoimmune disorder 2. The immune system attacks and destroys acetylcholine receptors at the neuromuscular junction.

3. Motor neurons can’t communicate with muscles.

4. Eye muscles are usually the first affected; some clients experience difficulty swallowing, chewing, or talking.

5. The disease is progressive, course of disease varies.

6. Treatment includes cholinesterase inhibitors, corticosteroids, immunosuppressant drugs, and plasma exchange; a few clients spontaneously recover.

E. Botulism 1. Botulism is a form of paralysis caused by toxins produced by the bacterium Clostridium botulinum.

2. Botulism can be produced by ingesting the toxin in food or can result from wound infection.

3. The bacteria grow most commonly in improperly prepared canned food, especially home-canned food.

4. The toxin keeps neurotransmitters from being released at the neuromuscular junction, causing paralysis.

5. Initial symptoms include visual disturbances, slurred speech, dry mouth, and muscle weakness; paralysis will spread to limbs and respiratory muscles.

6. Botulism is treated with antitoxin and supportive care.

F. Meningitis 1. Meningitis is an infection, from either viruses or bacteria, of the meninges.

2. Bacterial meningitis is a potentially fatal infection. a. The bacteria first infect the upper respiratory tract and then travel to the meninges. b. At-risk individuals include the elderly, immunosuppressed patients, very young children, and college students who live in dorms. c. Survivors of meningitis often have severe neurological impairment, including deafness and severe brain damage.

3. Viral meningitis is a much milder version of the disease caused by viruses that enter the mouth.

G. Carpal tunnel syndrome 1. Inflammation and swelling of the tendon sheathes surrounding the flexor tendon of the palm.

2. It is caused by repetitive motion such as typing on a keyboard.

3. Because of the inflammation, the median nerve is compressed, producing tingling sensations or numbness of the palm and first three fingers.

CLASSROOM ACTIVITIES .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

1. Demonstrate reflex action by tapping with a reflex hammer on the various trigger points, such as just below the patella. Have students watch the result when the proper area is stimulated, then have them practice the maneuver. Discuss reflexes and why they are important. Discuss the effect of a patient in a vegetative state who demonstrates these reflexes, making family believe he or she is more aware of his or her surroundings than is actually the case.

2. Demonstrate how nerves accommodate a continuous sensation versus how they can potentiate sensation. For instance, make a hot water bottle or a heating pad as warm as possible without causing a burn. Have students rest it on a forearm for about 20 minutes. Point out how the temperature seems to drop as the neurons become accustomed to the temperature. Discuss the effects this can have on heat/ice therapy and how it might make the client vulnerable to injury. Then have students gently stroke back and forth using just the tip of one finger over exactly the same area of the forearm where the heat source had been. After about 10 minutes, this gentlest of touches begins to burn and become painful. Discuss why this occurs.

TEACHING STRATEGIES 1. The nervous system is very complex. Helping students understand the differences between the sympathetic and parasympathetic nervous system requires examples of real-life situations that they can understand.

2. If students are to administer medications, a thorough understanding of how different medications affect different parts of the nervous system is essential. Talk about how anesthetics, analgesics, antidepressants, sedatives, and other types of drugs affect the nervous system.

FACTOIDS 1. The human brain has about 100 billion neurons.

2. Neurons range in size from 4 microns to 100 microns wide. If you were to watch a surgery that opened the spinal cord, you would see dozens of white, almost wormlooking, nerves traverse down the cord, one on top of the other, forming a cord that could be compared to a phone trunk.

ETHICAL DILEMMAS 1. Research indicates that stem cells may resolve spinal trauma by regrowing attachments between severed nerves. However, many Christians believe that stem cell research is morally wrong. Is stem cell research morally, ethically permissible if it can resolve spinal trauma, Parkinson’s, and other disease processes?

2. Many people watched the care and rehabilitation Christopher Reeves received.

However, most quadriplegics and paraplegics can’t afford that level of care and are often placed in nursing homes, where they receive minimal care. Doesn’t everyone deserve the same level of care? Is it feasible to expect the public health care system to support this level of care? .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 9–1 Answers, p. 199 1. b 2. b 3. c 4. b 5. b Test Your Knowledge 9–2 Answers, p. 201 1. c 2. b 3. b 4. a 5. b Test Your Knowledge 9–3 Answers, p. 205 1. c 2. d 3. c 4. c 5. b Test Your Knowledge 9–4 Answers, p. 212 1. b 2. b 3. b 4. c 5. a ANSWERS TO THE CASE STUDY, P. 214 Bill’s most likely injury is to the cervical spinal cord. A spinal cord injury is mostly likely because he is paralyzed on both sides of his body. A brain injury would leave him paralyzed on only one side, typically. That he cannot breathe points to a high cervical injury. Impulses are not moving from his brain to his cervical plexus, where the phrenic nerve connects. Thus he cannot breathe on his own.

ANSWERS TO REVIEW QUESTIONS, P. 215 Multiple Choice 1. b, 2. a, 3. d, 4. b, 5. c, 6. b, 7. b, 8. c

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Fill in the Blank 1. diameter; myelin 2. Action 3. columns; horns 4. CSF; subarachnoid 5. reflex 6. ventral/anterior Short Answer 1. As a neuron is stimulated, sodium channels open and sodium rushes in, bringing positive charges into the cell. The cell becomes more positive, or depolarized. With a brief delay, sodium channels shut, preventing more sodium from entering the cell. Then potassium channels open, allowing potassium to leave the cell. Because potassium is also positively charged, it takes positive charges with it, making the neuron more negative. The neuron is repolarizing. If potassium continues to rush out of the cell, the cell will become more negative than at rest. The cell is then hyperpolarized.

2. An action potential reaches the axon terminal and depolarizes it. Voltage-gated calcium channels open, and calcium rushes into the cell. The calcium coming into the cell triggers exocytosis of vesicles containing neurotransmitter. The neurotransmitters leave the cell, diffuse across the synaptic cleft, and bind to the receptors on the receiving cell. The receiving cell undergoes some kind of permeability change. Then cleanup occurs.

3. The bones of the skull and vertebrae protect the CNS. In addition, three layers of meninges protect the CNS. The outer layer is the dura mater. The middle layer is the arachnoid mater, and the inner layer is the pia mater. CSF is contained in the subarachnoid space and in the hollow spaces inside the CNS. 4. There are four CNS neuroglia. Astrocytes are general support cells.

Oligodendrocytes make myelin. Ependymal cells line cavities. Microglia destroy debris.

In the PNS, there are two types of neuroglia: satellite cells are general support cells; Schwann cells myelinate axons.

5. A spinal cord injury at C2 would cause quadriplegia and sensory loss from the neck down. Patients with this injury would likely be ventilator dependent because of paralysis of the diaphragm. A spinal cord injury at T3 would cause paralysis of some thoracic and abdominal muscles and paraplegia as well as loss of sensation from the chest down.

Patients would be able to breathe on their own but might have some difficulty with coughing or shortness of breath because of paralysis of thoracic and abdominal muscles. A spinal cord injury at L2 would cause paraplegia and sensory loss below the waist.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________ CHAPTER 9 – WORKSHEET Fill in the Blank 1) _____ are specialized cells that do all the support activities for the nervous system.

2) _____ are cells that carry out all the control functions for the nervous system.

3) The _____ are the protective membranes that surround the brain and spinal cord.

4) The fluid surrounding the brain and spinal cord is called _____ .

Matching Please match each branch of the nervous system with the appropriate definition.

5) _____ Central nervous system 6) _____ Peripheral nervous system 7) _____ Sensory system 8) _____ Motor system 9) _____ Autonomic nervous system 10) _____ Somatic nervous system 11) _____ Sympathetic nervous system 12) _____ Parasympathetic nervous system A. Composed of the nerves B. Controls voluntary muscle movements C. Carries instructions from the brain down to the body tissues D. Controls smooth and cardiac muscle (internal organs) E. Involved in resting and digesting F. Composed of the brain and spinal cord G. Involved in “fight-or-flight” response H. Carries information about the environment up to the brain Please match each term with the appropriate definition.

13) _____ Synapse 14) _____ Dendrite 15) _____ Neurotransmitter 16) _____ Axon 17) _____ Myelin 18) _____ Action potential A. The portion of the neuron that receives information from the environment B. The portion of the neuron that conducts action potentials C. The tiny space between the neuron sending the signal and the cell receiving the signal D. Special chemicals used to send a signal across the synapse E. A wave of depolarization and repolarization that travels down an axon F. A lipid sheath that surrounds and insulates the axon Worksheet – p. 1 of 2 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Multiple Choice 19) Which is the outermost layer of the meninges?

A) Pia mater B) Dura mater C) Arachnoid mater 20) Which is the innermost layer of the meninges?

A) Pia mater B) Dura mater C) Arachnoid mater 21) What diagnostic test involves collecting a sample of CSF? A) Electroencephalogram B) Cognitive testing C) Lumbar puncture Short Answer/Essay 22. A patient has just received an injection into the epidural space. Where is the epidural space located? (In other words, where was the medication injected?) __________________________________________________________ __________________________________________________________ __________________________________________________________ 23. A patient has been diagnosed with a subarachnoid hemorrhage. Describe exactly where blood is collecting in this patient’s head. __________________________________________________________ __________________________________________________________ __________________________________________________________ 24. Which disease is characterized by an autoimmune attack on myelin in the CNS? __________________________________________________________ __________________________________________________________ __________________________________________________________ 25. What viral disease can cause destruction of motor neurons in the spinal cord? __________________________________________________________ __________________________________________________________ __________________________________________________________

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 9 – Worksheet 1) Neuroglia (glial cells) 2) Neurons 3) meninges 4) CSF (cerebrospinal fluid) 5) F 6) A 7) H 8) C 9) D 10) B 11) G 12) E 13) C 14) A 15) D 16) B 17) F 18) E 19) B 20) A 21) C 22) Outside the dura mater; between the dura mater and the vertebra 23) Below the arachnoid mater; between the arachnoid mater and pia mater 24) Multiple sclerosis 25) Polio

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 10

THE NERVOUS SYSTEM (PART II): THE TRAFFIC CONTROL CENTER

LEARNING OBJECTIVES ➯ Organize the hierarchy of the nervous system ➯ Locate and define the internal and external structures and their corresponding functions of the brain ➯ List and describe the cranial nerves and their functions ➯ Describe the sensory and motor functions of the brain with related structures ➯ Contrast the parasympathetic and sympathetic branches of the autonomic nervous system ➯ Discuss some representative diseases of the nervous system

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Absence Seizure 2. Alzheimer’s Disease 3. Autism 4. Bipolar Disorder 5. Complex Partial Seizure 6. Dissociative Identity Disorder 7. Epilepsy 8. Generalized Tonic–Clonic Seizure 9. Obsessive–Compulsive Disorder 10. Panic Attacks 11. Parkinson’s Disease 12. Pharmacy Professional Profile 13. Schizophrenia Animations 1. Delirium 2. PET scan 3. Shock 4. Stroke

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name____________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction—The Brain and Cranial Nerves A. The brain and cranial nerves represent the major control systems of the nervous system.

B. The brain acts more as the main processor and director of the entire system.

C. The cranial nerves leave the brain and go to specific body areas, where they receive information and send it back to the brain (sensory), and the brain sends instructions to move (motor) II. The Brain A. At the top of the spinal cord, beginning at the level of the foramen magnum and filling the skull, is the brain B. External anatomy 1. Cerebrum a. Largest part of the brain b. Divided into the right and left hemisphere by the longitudinal fissure c. Divided from the cerebellum by the transverse fissure d. Convoluted surface of the cerebrum is not smooth. i. Ridges (gyri) and grooves (sulci) ii. Increase surface area of the brain iii. Most sulci are extremely variable in their locations among humans. e. Lobes i. Lobes are named for the skull bones that cover them and occur in pairs, one in each hemisphere. ii. Frontal: anterior, separated from the rest of the brain by the central sulci, responsible for motor activities, conscious thought, and speech iii. Parietal: posterior to frontal lobes, involved with body sense perception, primary taste, and speech iv. Occipital: posterior to parietal lobes, responsible for vision v. Temporal: inferior lobes, separated by the lateral sulci, involved in hearing and integration of emotions vi. Insula: deep inside the temporal lobes, autonomic functions f. On either side of the central sulcus are two gyri, the precentral gyrus, anterior to the central sulcus, and the postcentral gyrus, posterior to the central sulcus. g. Speech areas i. Broca’s: frontal area, motor for speech ii. Wernicke’s: parietal, understanding language h. Information is contralateral, meaning the right side of the body is controlled by the left side of cerebrum, and vice versa.

2. Cerebellum a. Posterior to the cerebrum b. Divided into hemispheres by a raised ridge called the vermis c. Surface is convoluted. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

d. Cerebellum is involved in sensory and motor coordination and balance.

3. Brain stem a. A stalk like structure inferior to and partially covered by the cerebrum b. Three sections i. Medulla oblongata: continuous with the spinal cord, responsible for impulses that control heartbeat, respiration, and blood vessel diameter ii. Pons: superior to the medulla oblongata iii. Midbrain: most superior portion of the brain stem, completely covered by cerebrum C. Internal anatomy 1. White matter of the brain is surrounded by grey matter 2. Cortex: layer of grey matter surrounding the white matter a. Cerebral cortex b. Cerebellar cortex 3. Nuclei: deep grey matter surrounded by white matter 4. Ventricles a. Cavities in the brain b. Continuous with the central canal of the spinal cord and the subarachnoid space of both the brain and the spinal cord i. Lateral ventricles (ventricles 1 and 2) in cerebrum; ii. Third ventricle is in the diencephalon (a region between the cerebrum and brain stem) iii. Fourth ventricle in the inferior part of the brain between the medulla oblongata and the cerebellum c. CSF circulation and hydrocephalus i. The ventricles of the brain, the central canal of the spinal cord, and the subarachnoid space surrounding both the brain and spinal cord are filled with CSF. ii. Filtered from blood in the ventricles by tissue called choroid plexus. iii. Made in lateral ventricles, flows through a tiny opening into the third ventricle and then through another opening into the fourth ventricle then into the central canal of the spinal cord and the subarachnoid space. Returns to the blood via special “ports” between subarachnoid space and blood spaces in the dura mater iv. Balance of CSF made and CSF reabsorbed by the blood is very important. v. Too much CSF causes pressure inside the skull to rise and eventually crushes brain tissue. vi. Hydrocephalus: water on the brain, too much CSF a. Can be caused by blockage of the narrow passages because of trauma, a birth defect, tumor, or decreased reabsorption of CSF .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Can be treated by medication or, more commonly, a shunt surgically placed to drain fluid to the heart or abdominal cavity 5. Cerebrum a. Lobes (frontal, parietal, temporal, and occipital) are clearly visible. b. On either side of the central sulcus are two gyri, the precentral gyrus anterior to the central sulcus and the postcentral gyrus posterior to the central sulcus. c. Right and left hemispheres are connected by several white matter pathways surrounding the lateral ventricles called the corpus callosum, the fornix, and the anterior commissure.

6. Diencephalon a. Inferior to cerebrum, not visible from the exterior b. Thalamus, hypothalamus, pineal body, and pituitary gland c. Third ventricle and a number of nuclei that are part of the basal nuclei and limbic system d. Specific nuclei of the diencephalon are responsible for controlling hormone levels, hunger and thirst, body temperature, sleep–wake cycles, and flow of information around the brain.

7. Cerebellum a. Cerebellum has a grey matter cortex and a white matter center, known as the arbor vitae (tree of life). b. Cerebellum also has nuclei that coordinate motor and sensory activity. c. Cerebellum essentially fine-tunes voluntary skeletal muscle activity and helps in the maintenance of balance.

III. Cranial Nerves A. Like the spinal cord that has spinal nerves, the brain has nerves called cranial nerves.

B. Input and output pathways for the brain C. There are only 12 pairs of cranial nerves, all but two of which arise from the brain stem.

D. Some are mainly sensory, others are mainly motor, and some are mixed nerves.

E. Cranial nerves are much more specialized than spinal nerves.

F. Cranial nerves carry sensory and motor information for the head, face, and neck as well as visual, auditory, smell, and taste sensations IV. Somatic Sensory System A. Includes fine touch, crude touch, vibration, pain, temperature, and body position.

B. Comes into both the brain and the spinal cord.

C. To attach meaning to the sensation, it must get to the brain for interpretation.

1. Somatic sensory information comes into the spinal cord via the dorsal root.

2. Tracts in the white matter of the spinal cord carry information to brain. a. Dorsal column tract carries fine touch and vibration information to the cerebral cortex. b. Spinothalamic tract carries temperature, pain, and crude touch to the cerebral cortex. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

c. Spinocerebellar tract carries information about posture and position to the cerebellum.

D. Information eventually reaches somatic sensory cortex (SS) 1. Postcentral gyrus of the parietal lobe 2. Has maps that correspond to body parts; contralateral 3. Neurons in the SS cortex allow conscious sensation 4. Size of map determined by sensitivity of body part E. Somatic sensory association area 1. In parietal lobe; postcentral gyrus 2. Allows for interpretation of somatic sensory information 3. SS cortex notes location and type of sensation; SS association area interprets information.

V. Motor System A. The motor system is also a hierarchy, working in parallel with the SS system, with two obvious differences 1. Information moves in the opposite direction from brain to spinal cord 2. The motor system has two divisions: the somatic motor system and the autonomic nervous system.

B. Premotor and prefrontal areas, frontal lobes, plan movements C. The plan from these two areas is sent to the primary motor cortex.

D. The primary motor cortex 1. Precentral gyrus in the frontal lobe, just anterior to the SS cortex 2. Map of the body; contralateral 3. The size of the map is proportional to the amount of movement control.

E. Subcortical structures 1. The plan for movement leaves the motor cortex and connects with neurons in the thalamus, located in the diencephalon.

2. The thalamus, basal nuclei, and cerebellum are part of a complicated motor coordination loop.

3. Here, movement must be fine-tuned, posture and limb position are judged, other movements are turned off, and movement and sensation are integrated.

F. Spinal cord tracts 1. Direct pathways: corticospinal and corticobulbar a. Information carried from motor cortex to ventral horn motor neurons or motor nuclei of brain stem b. Motor neurons project to skeletal muscles via the cranial nerves or the ventral roots and spinal nerves send orders to the skeletal muscles to carry out the planned movement. c. Fine-tuning of reflexes 2. Indirect pathways a. Project from subcortical structures, including cerebellum, thalamus, and basal nuclei b. Coordination of movements G. Role of the Cerebellum .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

1. Both motor and sensory inputs and outputs from the cerebral cortex, thalamus, basal nuclei, and spinal cord 2. Compares planned movement to actual and fixes any mismatch 3. Functions are subtle VI. Autonomic Nervous System A. Involuntary motor system: controls organs and glands B. Anatomy 1. Neurons in lateral horn of spinal cord 2. Autonomic neurons do not project directly to muscles, but make a synapse in a ganglion outside the CNS 3. Ganglion: group of nerve cell bodies outside of the CNS 4. A second motor neuron, called a postganglionic neuron, projects to the muscle.

5. No autonomic neurons in the cervical spinal cord C. Two subdivisions 1. Sympathetic division a. Fight-or-flight response, charged with responding to emergencies b. Increase heart rate, BP, and sweating, also causes dry mouth— symptoms of an adrenaline rush c. Preganglionic neurons in the thoracic and first two lumbar segments of the spinal cord d. Ganglia form a pair of chainlike structures that run parallel to the spinal cord (paravertebral ganglia) e. Postganglionic cells release the neurotransmitter norepinephrine 2. Parasympathetic division a. “Resting and digesting” because it has the opposite effect of the sympathetic division b. Responsible for everyday activities as well as reversing the sympathetic effects c. Decreased heart rate, respirations, and blood pressure and increased digestive activity, including salivation and stomach activity d. Preganglionic neurons of the parasympathetic system are in brain stem and sacral spinal cord. e. Ganglia are near target organs f. Postganglionic neurons release acetylcholine.

VII. Limbic System A. Series of nuclei in the cerebrum, diencephalon, and superior brain stem B. Mood, emotion, and memory C. One nucleus helps attach emotion to movement; another coordinates emotion and the sense of smell; still another is responsible for storing and retrieving information VIII. Reticular System A. The reticular system is a diffuse network of nuclei in the brain stem that is responsible for “waking up” the cerebral cortex.

B. Reticular system activity is vital for the maintenance of conscious awareness of surroundings. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

C. General anesthesia inhibits the reticular system, rendering surgery patients unconscious.

D. Injury because of ischemia, trauma, or drugs can damage the reticular system and lead to coma.

IX. Common Disorders of the Nervous System (see also Chapter 9) A. Paralysis 1. Paralysis: inability to control voluntary movements 2. Paralysis can be spastic or flaccid. a. Spastic: i. Muscle rigidity, increased muscle tone (hypertonia),and overactive reflexes (hyperreflexia) ii. Caused by interruption of communication between brain and ventral horn neurons iii. Strokes, head injuries, and spinal cord injury can cause spastic paralysis. b. Flaccid paralysis i. Floppy muscles (hypotonia) and decreased reflexes (hyporeflexia) ii. Caused by damage to the nerves; impulses cannot get to the muscles from the motor neuron iii. Flaccid paralysis occurs with peripheral injury or disorders like polio or Guillain-Barré syndrome.

B. Cerebral palsy (CP) 1. Movement disorders that are not progressive and that occur in young children 2. Spastic paralysis 3. Improper development or damage to the motor system of the brain 4. Symptoms range from minor motor loss to significant motor deficits, including the inability to walk or speak 5. Intelligence may or may not be affected, depending on the cause of CP C. Cerebral vascular accident (CVA) 1. CVA, or stroke, is caused by interruption of blood flow to a portion of the brain because of hemorrhage or a blood clot.

2. If oxygen supply is disrupted long enough, brain cells will die.

3. Symptoms vary, depending on area affected, and can include paralysis, inability to speak, blindness, loss of memory, lack of sensation.

4. Symptoms appear suddenly or can be a series of small, minor strokes; these ministrokes are called transient ischemic accidents (TIAs) D. Subdural hematoma 1. A subdural hematoma is a pool of blood between the dura mater and arachnoid mater in the subdural space.

2. They are caused by head injuries that rupture tiny blood vessels, causing them to bleed.

3. A large or growing hematoma can cause brain damage by increasing pressure in the skull. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. Some (small ones) resolve themselves; others require surgery to relieve the pressure.

E. Huntington’s disease 1. Huntington’s disease is a progressive, genetic disorder causing deterioration of neurons in the basal nuclei and eventually the cerebral cortex.

2. The disease begins with wide mood swings, memory disturbances, writhing movements of the hands or face, or clumsiness; eventually, difficulty swallowing, speaking, and walking as well as memory loss, psychosis, and loss of cognitive function will occur.

3. There is no cure, and most clients die from injuries, infections, or other complications.

4. Genetic testing can identify those at risk.

CLASSROOM ACTIVITIES 1. For a fun discussion, talk about the science fiction writers’ concept of brain transplants. If someone else’s brain was transplanted into your skull, would you still be you, or would you be the person who contributed the brain in a new body? Defend your position.

2. Make flash cards with body actions on one side and the location of the brain that controls that action on the other side. Show one flash card to the group and have them tell you the location of the control of that action. You can also ask students to explain where the location of control is as they function in the classroom—writing notes, speaking, drawing pictures, shifting in their seats, and so on.

3. Make a chart with a column for each part of the brain and then place appropriate actions in the proper column. Map things like planning dinner, taking a jog, talking with friends on the phone, studying anatomy, feeling pain, listening to music, and watching TV.

TEACHING STRATEGIES 1. Discuss with students the differences in male and female brains. Explain that men are more mathematical and logical, whereas women are more verbal and better at English skills. Does this mean girls can’t do math? Does it mean boys shouldn’t be encouraged to discuss feelings? Have students support their beliefs.

2. Have students explain the purpose of the fight-or-flight response, explaining why pupils dilate and decreased gastric acid production occurs. Why is this response important? Relate the fight-or-flight response to stress, both chronic and acute.

FACTOIDS 1. The cerebellum was once thought only to assist with motor functions, acting to help other motor regions function. However, during the last decade, further research indicates that the cerebellum is like a powerful computer capable of contributing to .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

motor and mental dexterity, both required for the emergence of fluent human language.

It reaches full structural growth by age 15 to 20.

2. The average human brain weighs about 1400 grams (3 lbs.). Removed from the skull, it looks like a large, pinkish-grey walnut. If the bumps and grooves of the brain were spread out on the floor, it would measure approximately 324 square inches—about the size of a page of a newspaper. Just like fingerprints, the gyri and sulci on the cerebral cortex are different in every brain.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ETHICAL DILEMMAS 1. We talk a lot about confidentiality in health care. Regulations such as HIPAA legislate confidentiality for medical records. Yet, if a child is admitted to the hospital with a subdural hematoma and child abuse is suspected, we are mandated to report it. Isn’t this a breach of confidentiality? Why is this breach okay? Discuss other situations in which it is okay to breach confidentiality.

2. If you had a child in the first grade and you found out that a child with severe cerebral palsy was going to join the class, how would you feel? Does the presence of CP indicate or predict level of intelligence?

3. Suppose you or someone you loved had a brain tumor. The tumor could be removed, but it would mean losing all your memories. Would you remove it? How would you advise a loved one? What if you lost the ability to speak? Understand the spoken language? The written language?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 10–1 Answers, p. 223 1. d 2. c 3. d 4. c 5. c 6. b Test Your Knowledge 10–2 Answers, p. 229 1. c 2. c 3. b 4. c Test Your Knowledge 10–3 Answers, p. 233 1. a 2. a 3. b 4. c 5. b Test Your Knowledge 10–4 Answers, p. 237 1. a 2. b 3. b 4. b

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO THE CASE STUDY, P. 241 His left frontal lobe is damaged. You can tell because he has lost motor control on the right side but has retained sensation on the right. The motor system is in the frontal lobe, whereas somatic sensory is in the parietal lobe. Also, the cerebral cortex is contralateral, so loss of movement on the right side of the body would indicate damage to the left side of the brain. He should be able to understand language because his parietal lobe (Wernicke’s area) is undamaged, but actually speaking may be difficult because of damage to Broca’s area in the frontal lobe.

ANSWERS TO REVIEW QUESTIONS, P. 242 Multiple Choice 1. c, 2. d, 3. a, 4. c, 5. b, 6. b, 7. b, 8. d Fill in the Blank 1. basal nuclei 2. vision 3. descending; ascending 4. limbic system 5. medulla oblongata 6. basal nuclei/thalamus Short Answer 1. There are 12 pairs of cranial nerves but 31 pairs of spinal nerves. Cranial nerves are attached to the brain, whereas spinal nerves are attached to the spinal cord. Cranial nerves may be sensory, motor, or mixed, whereas spinal nerves are all mixed. Cranial nerves often have specialized functions, but spinal nerves all carry the same kind of information.

2. The sympathetic nervous system controls fight-or-flight response, readying the body to expend energy. The parasympathetic is resting and digesting. The sympathetic neurons are thoracolumbar, whereas the parasympathetic neurons are craniosacral.

The sympathetic ganglia are paravertebral, parallel to the spinal cord, whereas the parasympathetic ganglia are near the target organs. The sympathetic postganglionic neurons release norepinephrine, and the parasympathetic postganglionic neurons release acetylcholine.

3. The cerebral cortex generates the movement plan and sends orders directly to the ventral horn motor neurons. In addition, the cortex sends the planned movements to subcortical structures such as the thalamus, basal nuclei, and cerebellum. The subcortical structures finetune and coordinate the movement plan, send information down the spinal cord, and correct the orders originally sent by the cerebral cortex if necessary.

4. Somatic sensory information is sensed by receptors in your skin and joints. That information is transferred along a spinal nerve to the dorsal root and to the neuron cell body in the dorsal root ganglion. The information is carried into the spinal cord and enters one of the ascending spinal cord tracts. These tracts take the information to .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

various parts of the brain. Conscious sensation is eventually mapped in the somatic sensory cortex, in the postcentral gyrus, and compared with other information by the somatic sensory association area, allowing understanding. (If the sensory information is on your face or head, the spinal cord is not involved. Information goes into the brain stem via cranial nerves, into a nucleus, and then to the brain.)

5. Movement plans are made in the premotor area and sent to the primary motor cortex in the precentral gyrus. Orders are sent directly from the primary motor cortex to the ventral horn motor neurons. The motor neurons send the orders to skeletal muscles, and they contract. The orders are sent via the ventral roots and spinal nerves. In addition, orders are sent from primary motor cortex to subcortical structures, including the basal nuclei, thalamus, and cerebellum. These nuclei form a complex neural loop that coordinates movements, sending corrective signals down the spinal cord to the ventral horn motor neurons. (If the movements are facial or head movements, the spinal cord is not involved. The motor neurons are in brainstem nuclei and communicate with muscles via cranial nerves.)

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name____________________________________________ CHAPTER 10 – WORKSHEET Matching Please match each portion of the brain with the appropriate description.

1) _____ Cerebrum 2) _____ Cerebellum 3) _____ Brain stem 4) _____ Frontal lobe 5) _____ Parietal lobe 6) _____ Occipital lobe 7) _____ Temporal lobe 8) _____ Hypothalamus 9) _____ Corpus callosum 10) _____ Ventricles A. Collection of white matter that connects the left and right hemispheres B. Fluid-filled cavities in the brain C. Coordinates muscular activity D. Responsible for vision E. Responsible for hearing and language comprehension F. The part of the diencephalon that controls the endocrine system and regulates appetite, thirst, and body temperature.

G. Responsible for body sense H. Responsible for motor function, behavior, emotions, and thinking I. Controls vital functions like breathing and heart rate J. The largest part of the brain; divided into left and right hemispheres Short Answer/Essay 11–13. List the three portions of the brain stem. (3 points) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Fill in the Blank 14) The grooves on the surface of the brain are called _____ .

15) The ridges on the surface of the brain are called _____ .

16) The left side of the brain controls the _____ half of the body.

17) The grey matter on the surface of the brain is called the _____ .

18) In _____ paralysis, the muscles are floppy and reflexes are decreased or absent.

Worksheet – p. 1 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Multiple Choice 19) Which cranial nerve is responsible for transmitting smell information?

A) Olfactory B) Optic C) Vestibulocochlear D) Vagus 20) Which cranial nerve is responsible for transmitting visual information?

A) Olfactory B) Facial C) Optic D) Trigeminal 21) Which cranial nerve transmits information about hearing and balance?

A) Hypoglossal B) Vagus C) Vestibulocochlear D) Accessory 22) Which cranial nerve controls eye movements?

A) Optic B) Oculomotor C) Vagus D) Vestibulocochlear 23) Which cranial nerve is responsible for autonomic motor control of the internal organs?

A) Vestibulocochlear B) Abducens C) Hypoglossal D) Vagus 24) The primary motor cortex is located in the A) frontal lobe.

B) parietal lobe.

C) occipital lobe.

D) brain stem.

25) The primary somatic sensory cortex is located in the A) frontal lobe.

B) parietal lobe.

C) occipital lobe.

D) brain stem.

Worksheet – p. 2 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

26) This disease is characterized by resting tremors, slow movement, and “cogwheel” rigidity.

A) Cerebral palsy B) Multiple sclerosis C) Parkinson’s disease D) Alzheimer’s disease 27) This disease is characterized by progressive memory loss and dementia.

A) Parkinson’s disease B) Alzheimer’s disease C) Lou Gehrig’s disease D) Huntington’s disease 28) When a child exhibits a permanent, nonprogressive set of motor deficits, this is called A) multiple sclerosis.

B) hydrocephalus.

C) cerebral palsy.

D) Alzheimer’s disease.

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 10 – Worksheet 1) J 2) C 3) I 4) H 5) G 6) D 7) E 8) F 9) A 10) B 11-13) medulla oblongata, pons, and midbrain 14) sulci 15) gyri 16) right 17) cortex 18) flaccid 19) A 20) C 21) C 22) B 23) D 24) A 25) B 26) C 27) B 28) C

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 11

THE SENSES: THE SIGHTS AND SOUNDS

LEARNING OBJECTIVES ➯ Distinguish general and special senses ➯ Describe the internal and external anatomy and functions of the eye ➯ Describe the internal and external anatomy and functions of the ear ➯ Discuss the process involved with the senses of taste, smell, and touch ➯ Contrast the types of pain and the pain response ➯ Explain several common disorders of the eye and ear

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Audiologist Professional Profile 2. Cataracts 3. Cold Therapy Procedures 4. Conjunctivitis 5. Heat Therapy Procedures 6. Ophthalmic Medications 7. Ophthalmology and Optician Professional Profile 8. Otitis Media 9. Tympanic Membrane Thermometer Measurements Animations 1. The Adolescent Ear 2. The Child’s Ear 3. The Ear 4. The Eye 5. The Middle Ear Interactive Activities 1. The Ear 2. The Eye

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. All input from the environment must be taken in by the senses and interpreted by the brain to be understood and appreciated.

B. Senses that gather sensory input are also protective in nature and need to be highly integrated with the quick-response nervous system for our survival.

C. Special senses include 1. Vision 2. Hearing 3. Smell 4. Taste D. The additional senses of touch, pain, pressure, temperature, position, balance, and feelings of hunger and thirst are important to our survival.

E. Senses monitor and detect changes in the environment, sending this information to the brain via sensory (afferent) neurons.

F. The brain interprets the information and makes the appropriate motor, or efferent, response.

II. Sight A. External anatomy of the eye.

1. Orbit: cone-shaped cavity formed by the skull; it houses and protects the eyeball.

2. Muscles connect the eyeball to the orbit and allow rotary movement.

3. The eyelids a. Close over the eye to protect it from light, foreign particles, and impact injury b. Eyelashes in the eyelid help to prevent gross particles from entering the eye c. Contain sebaceous glands 4. Conjunctiva: protective membrane over the exposed surface of the eyeball that acts as a protective covering 5. The lacrimal apparatus a. Produces and stores tears b. Contains the lacrimal gland and its corresponding ducts B. Internal anatomy of the eye 1. Two chambers of fluid that help to protect the eye. The fluids of the eye are called humors a. Aqueous humor is watery; bathes the iris, pupil, and lens; fills the anterior and posterior chambers b. Vitreous humor is a clear, jellylike fluid that occupies the entire cavity behind the lens 2. The eye has three layers a. Sclera i. The outermost layer, a tough fibrous tissue that serves as a protective shield .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ii. Contains the cornea, transparent to allow light to pass through, and curved to bend the entering light to focus it on the retina b. Choroid i. The middle layer, a highly vascularized and pigmented region that provides nourishment to the eye ii. Contains the iris and the pupil: a. Iris: the colored portion of the eye that controls the opening b. Pupil: the opening c. Retina i. A delicate membrane that continues posteriorly and joins the optic nerve ii. Contains two types of light-sensing receptors called rods and cones a. Rods are active in dim light and do not perceive color. b. Cones are active in bright light and perceive color. iii. Receptors contain photopigments that cause a chemical change when light hits them, causing impulses to be sent to the optic nerve.

III. Hearing A. The ear is responsible for hearing and maintaining equilibrium, or sense of balance.

B. Sound vibrations are received usually via the air and translated into an interpretable sound via the eighth cranial nerve.

C. The ear has three divisions 1. External ear a. The outer projection—the part we can see—called the pinna or auricle b. Canal leading into the middle ear, called the auditory canal or external auditory meatus c. Earwax, called cerumen, secreted by the ceruminous glands to lubricate and protect the ear d. Eardrum, or tympanic membrane, at end of canal where the external ear ends 2. Middle ear a. Also called tympanic cavity; contains three small bones, or ossicles i. Bones of the ear are named according to their shape ii. Hammer, or malleus, is attached to the tympanic membrane iii. Anvil, or incus, is attached to the hammer iv. Stirrup, or stapes, connects to a membrane called the oval window that begins the inner ear b. Ossicles are joined so they can amplify the sound waves the tympanic membrane receives from the external ear; ossicles can amplify sound up to 22 times the original level c. Once amplified, sound waves are transmitted to the fluid in the inner ear d. Eustachian tubes i. Allow air pressure on either side of the eardrum to be equalized .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ii. Connect the nose and throat to the middle ear iii. Equalization of pressure allows eardrum to vibrate freely with incoming sound waves; sudden pressure changes, as when flying in an airplane, can affect this area and cause ears to “pop.”

3. Inner ear, or labyrinth a. Oval window transmits sound waves into the inner ear. b. Inner ear is divided into three separate, hollow, bony spaces that form a maze, or labyrinth—also called bony labyrinth c. Three areas include the cochlea, the vestibule chamber, and the semicircular canals. d. Cochlea is responsible for sense of hearing. i. A bony spiral or snail shell–shaped entrance to the internal ear ii. Connected to the oval window membrane iii. Contains fluids called perilymph and endolymph, which help transmit the sound iv. Sound is carried to tiny, hairlike receptors that are stimulated and conduct the signal to the brain via the vestibulocochlear nerve. e. Also in the inner ear are the semicircular canals that contain sensory input related to equilibrium.

IV. Taste A. The sense of taste is called the gustatory sense.

B. Taste receptors are located on the tongue and are called taste buds.

C. The five tastes are sweet, sour, salty, bitter, and umami (the taste of glutamates).

D. Taste preferences change with the body’s needs.

E. Refinement of food taste is primarily dependent on the sense of smell.

V. Smell A. The sense of smell arises from the receptors located in the olfactory region or the upper part of the nasal cavity.

B. We “sniff ” to bring the smell into the area where it can be interpreted.

C. Taste and smell are closely related, and pleasant food odors initiate digestive enzymes.

VI. Touch A. Touch receptors are small, rounded bodies called tactile corpuscles located in the skin, especially concentrated in the fingertips and the tip of the tongue.

B. Temperature sensors are also located in the skin, with separate sensors for heat and cold; adaptation occurs when sensory stimulation is continually applied, changing the body’s perception of temperature.

C. Pain 1. Pain is a very important protective sense, the body’s way of making us pay attention to danger.

2. Pain is the most widely distributed sense, found in skin, muscle, joints, and internal organs.

3. Pain receptors are branching nerve fibers called free nerve endings.

4. Types of pain .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

a. Referred pain: originates in an internal organ and is felt in another region of the skin; example: liver and gallbladder pain may be felt in the right shoulder b. Phantom pain: pain felt in an area that no longer exists, such as following an amputation 5. Pain receptors a. Pain receptors do not adapt; you feel pain as long as the stimulus is there. b. Pain threshold is probably different in different individuals.

VII. Common Disorders of the Eye and Ear A. Disorders of the eye 1. Conjunctivitis: inflammation of membrane that lines the eye; can be acute or chronic, caused by pathogens or irritants, and is sometimes called pink eye 2. Cataract: clouding of the lens; incidence may increase with increased exposure to sunlight a. Untreated, can lead to blindness b. Cataract surgery was one of the earliest surgical procedures, dating back to ancient Greece.

3. Glaucoma: increased pressure in the fluid of the eye, which interferes with optic nerve function; occurs in 20% of adults over 40, and 15% result in blindness 4. Presbyopia: occurs when the ciliary muscles age, causing weakness, and pupil size decreases, reducing light coming into the retina and resulting in farsightedness 5. Hyperopia: objects up close appear blurred (farsightedness) 6. Myopia: objects at a distance appear blurred (nearsightedness) 7. Amblyopia: also called a lazy eye; occurs in childhood; results in poor vision because one eye does more work than the other 8. Diagnosing other problems using the eye a. Condition of the eyes can help in diagnosis of a variety of nonvisual diseases. b. Yellow tint to the conjunctiva (jaundice) can indicate liver disease. c. REM (rapid eye movement) is a stage of sleep and can be measured in sleep studies to help diagnose sleep disorders. d. Responsiveness of the pupil to light can help diagnose neurological problems (PERLA).

B. Disorders of the ear 1. Otitis media: infection of the middle ear 2. Labyrinthitis: inflammation of the inner ear, often caused by high fevers, resulting in vertigo 3. Ménière’s disease: a chronic inflammation that affects the labyrinth and leads to progressive hearing loss and vertigo 4. Deafness: partial or complete hearing loss caused by many conditions ranging from inflammation or scarring of anything from the tympanic membrane to the auditory nerve 5. Tinnitus: ringing in the ear, sometimes caused by taking too much aspirin .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CLASSROOM ACTIVITIES 1. Ask students to discuss common sense. Is it part of the sensory system? What about ESP—is that a special sense? Does it really exist?

2. Divide the class into two groups. Have one group blindfold themselves and the other group act as guides, leading the blindfolded students around the classroom or corridors.

Give both groups an opportunity to experience blindness. Next, have one group wear headphones or earplugs to experience hearing loss, while the other group tries to talk to them. Then have the groups exchange roles. Finally, hold a discussion about caring for patients with sensory loss and what it was like to experience these losses, even temporarily. Ask how the method they use to care for patients will change based on these experiences.

3. Have students use nose plugs to block their sense of smell. Then blindfold them and ask them to identify various foods. Make sure to determine there are no food allergies before doing this experiment. Use foods such as bananas, peanut butter, and broccoli— foods with distinctive tastes. Also ask students to distinguish between food with similar textures but different flavors, apple and raw potato, for example.

TEACHING STRATEGIES 1. Have students trace the passage of an image through the various components of the eye, to the brain, discussing where images are decoded in the brain and how these decoded images give us a sense of our surroundings. Talk about perceptions, and use optical illusions to demonstrate how perception creates reality. For instance, hold up the FedEx logo for the class to look at for a few minutes. Then ask them to find the arrow in the image. Discuss how you must look at the logo differently to find that arrow and how most people have never seen it.

2. Discuss the sense of isolation that can come from hearing loss in the elderly. Ask students to think about times when they were in a group, and two people in the group were whispering back and forth. Didn’t they feel isolated? How would it feel to live in a world where you couldn’t read lips and had no idea what people were saying to one another? How does that affect patient care, especially when caring for the elderly?

3. Make students aware of the increase in hearing loss in young people because of playing loud music. Discuss the value of enjoying music at loud levels versus the value of their ability to hear.

4. Demonstrate eye tests like the Ishihara color blindness chart or the Snellen distance chart—pediatric, illiterate, and adult.

FACTOIDS 1. Excessive exposure to loud noise can damage the tiny hairs in the cochlea and lead to hearing loss. Generally, this type of hearing loss is reversible, except in cases of very loud noises. However, repeated exposure can cause permanent damage and hearing loss, known as noise-induced hearing loss. Seventeen percent of middle and high school students have some degree of hearing loss, mostly in higher pitches. Those who attend frequent concerts have an even higher rate of hearing loss. One student studied .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

showed hearing impairment after listening to high-intensity rock music for 88 hours in a 2-month span, whereas a protected left ear showed no change. The damage to the right ear was permanent.

2. The leading cause of blindness in the United States is primarily agerelated eye diseases like glaucoma and macular degeneration, diabetic retinopathy, and cataracts.

Legal blindness is defined as visual acuity with best correction of worse than or equal to 20/200.

ETHICAL DILEMMAS 1. You’re riding in a car with a friend who has a really powerful stereo system. Being a medical professional, you know that you are risking your hearing if you listen to music at the level your friend likes to play it. What do you do?

2. Suppose you attend school with a person suffering from a sensory loss, such as blindness or deafness. Should that person with a disability be given special allowances?

Relate the story of Helen Keller (blind, deaf, and mute), who graduated from Radcliffe University by having her assistant/teacher spell out all her textbooks into her hand.

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 11–1 Answers, p. 253 1. a 2. c 3. d 4. b 5. b Test Your Knowledge 11–2 Answers, p. 257 1. c 2. c 3. pinna 4. cerumen 5. hammer 6. incus 7. stapes ANSWERS TO THE CASE STUDY, P. 263 a. The patient has ringing in his ears and is dizzy and sick to his stomach. He is having trouble hearing as well. b. Ménière’s disease c. His inner ear is affected. We can tell that because he is dizzy, which suggests the semicircular canals as well as the cochlea are affected.

ANSWERS TO REVIEW QUESTIONS, P. 264 Multiple Choice .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

1. c, 2. a, 3. b, 4. b, 5. d, 6. b, 7. a Fill in the Blank 1. hearing; balance 2. malleus; incus; stapes or hammer, stirrup and anvil 3. cone 4. gallbladder or liver 5. cataracts Short Answer 1. Special senses are senses found in particular regions of the body and usually have an organ associated with them. For example, vision is associated with the eye. General senses such as touch are more scattered throughout the body. They do not have a particular organ associated with them.

2. The five basic tastes are bitter, sweet, salt, sour and umami. Taste is very dependent on smell. Many foods have very little taste and can only be recognized by the sense of smell.

3. Adaptation occurs when a sensory receptor gets used to a signal. For example, heat and cold receptors get used to a particular temperature when they have been at that temperature for a while. That’s why washing your hands in lukewarm water feels like hot water if you have been outside for a while in the cold.

4. Light rays pass through the cornea, are partially focused by the curvature of the cornea and then pass through the pupil into the eye. The lens, which can change shape, further focuses the light rays. If the eye is functioning properly, the light is focused on the macula lutea of the retina, the place of sharpest focus. Rods and cones react to the light and send the information down the optic nerves. The information eventually reaches the primary visual cortex and visual association areas in the occipital lobe of the brain.

5. Sound waves enter the external canal and vibrate the tympanic membrane. Ossicles in the middle ear (attached to the tympanic membrane) amplify the sound. The movement of the bones against the window causes vibration of the fluid in the inner ear, which causes the vibration of hair cells (sensory neurons). Nerve impulses are sent to the temporal lobe of the brain via the vestibulocochlear nerve (VIII).

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________________ CHAPTER 11 – WORKSHEET Matching Please match each structure of the eye with the appropriate description.

1) _____ Iris 2) _____ Pupil 3) _____ Sclera 4) _____ Cornea 5) _____ Aqueous humor 6) _____ Vitreous humor 7) _____ Retina 8) _____ Rods 9) _____ Cones 10) _____ Conjunctiva 11) _____ Optic nerve 12) _____ Lens 13) _____ Orbit 14) _____ Lacrimal gland 15) _____ Ciliary muscles A. The sensory receptors that can perceive color B. The cone-shaped cavity in the skull that houses and protects the eyeball C. A watery fluid that fills the front part of the eyeball D. The sensory receptors that function in dim light E. Produces tears F. Carries sensory information from the eye to the brain G. A protective membrane that covers the exposed surface of the eyeball H. The innermost layer of the eye; contains sensory receptors for vision I. The colored portion of the eye that controls the size of the pupil J. The white, outer coating of the eyeball K. A jellylike fluid that fills the entire eye cavity behind the lens L. A specialized portion of the sclera at the front of the eye that is clear and allows light to enter the eye M. The opening in the center of the iris that lets in light N. Control the thickness of the lens to help focus light on the retina O. A clear disk inside the eye that focuses light on the retina Multiple Choice 16) Which of the following is an example of a special sense?

A) Vision B) Temperature C) Pain D) Pressure .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

17) Which of the following is an example of a visceral sense?

A) Vision B) Nausea C) Touch D) Hearing

Worksheet – p. 1 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

18) The olfactory receptors are located in the A) eyes.

B) nose.

C) skin.

D) internal organs.

19) Nociceptors are the sensory receptors for A) pain.

B) temperature.

C) pressure.

D) smell.

Matching Please match each structure of the ear with the appropriate description.

20) _____ Pinna 21) _____ Auditory canal 22) _____ Tympanic membrane 23) _____ Ossicles 24) _____ Stapes 25) _____ Malleus 26) _____ Oval window 27) _____ Cochlea 28) _____ Semicircular canals 29) _____ Eustachian tube 30) _____ Endolymph A. The eardrum; separates the external ear from the middle ear B. The place where the ossicles touch the cochlea C. The outer, visible portion of the ear D. The portion of the inner ear involved in the sense of equilibrium E. The tube that carries sound to the eardrum and contains glands that produce earwax F. Connects the middle ear to the throat and helps equalize middle ear pressure G. The bone that touches the oval window H. A set of three tiny bones that amplify and transmit sound vibrations I. The fluid found inside the inner ear J. The bone that touches the eardrum K. The portion of the inner ear that detects sound

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 11 – Worksheet 1) I 2) M 3) J 4) L 5) C 6) K 7) H 8) D 9) A 10) G 11) F 12) O 13) B 14) E 15) N 16) A 17) B 18) B 19) A 20) C 21) E 22) A 23) H 24) G 25) J 26) B 27) K 28) D 29) F 30) I

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_____________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 12

THE ENDOCRINE SYSTEM: THE BODY’S OTHER CONTROL SYSTEM

LEARNING OBJECTIVES ➯ Discuss the functions of the various endocrine glands ➯ Describe the purpose and effects of hormones within the body ➯ Explain mechanisms of control of hormone levels ➯ Differentiate between hormonal and humoral control ➯ Explain common diseases of the endocrine system

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Diabetes 2. Dietician Professional Profile 3. Effects of Aging on the Endocrine System 4. Insulin 5. Phlebotomy Professional Profile Animations 1. Hyperglycemia 2. Hypoglycemia 3. Hypothalamic Pituitary Axis and Negative Feedback

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name___________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction—Organization of the Endocrine System A. The endocrine system works with nervous system.

B. The endocrine system a slower, more subtle control system.

C. Although the endocrine system acts slowly, the effects last longer than those of the nervous system.

II. Endocrine Organs A. Organs and glands that secrete chemical messengers into the bloodstream B. Exocrine glands secrete out of the body, like sweat glands, not part of endocrine system C. Many glands, such as the hypothalamus and pancreas, have multiple functions.

D. Organs such as the heart, small intestine, and stomach can also secrete hormones; however, they are not primary endocrine organs.

III. Hormones A. The chemical messengers released by endocrine glands B. Released into the bloodstream and travel all over the body, some affecting millions of cells simultaneously C. Hormones’ effects last for minutes or even hours or possibly days.

D. Many hormones are secreted continuously, with the amount secreted changing as needed.

E. Hormones work by binding to receptors on target cells.

1. Extracellular: bind to receptors on cell surface a. Mainly modified amino acids or proteins b. Change permeability, changing enzyme activity inside cell 2. Intracellular: bind to receptors inside cell a. Steroids: lipids; can pass through cell membrane b. Interact with DNA, very potent, carefully regulated c. Tightly regulated in body F. Hormone names 1. Most hormones are named according to location or function.

2. If you learn the meanings of their names, you can usually tell something about the hormone.

3. Most hormones are known by their abbreviations because their names are long.

IV. Control of Endocrine Activity A. Many endocrine organs secrete hormones continuously.

B. The amount of hormone secreted changes based on situational demands.

C. Most hormones have a set point.

D. The body’s control systems (endocrine and nervous system) work to keep levels at or near ideal.

1. Negative feedback counteracts a change.

2. If hormone levels rise, negative feedback will turn off the endocrine organ that is secreting the hormone when set point is achieved.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

E. Endocrine organs function in three basic ways to maintain hormone levels or body function.

1. Neural control a. Some hormones are directly controlled by the nervous system. b. Example: sympathetic control of adrenal gland 2. Hormonal control a. Hierarchy of hormonal control: one gland is controlled by the release of hormones from another gland up the chain, etc. b. Orders are sent from one organ to another, as in a relay race. c. Negative feedback controls the flow of orders via hormones from one part of the chain to the other. d. Example: pituitary control of adrenal gland 3. Humoral control a. Some endocrine organs directly monitor the body’s internal environment by monitoring the body fluids and respond accordingly. b. Humoral pertains to body fluids or substances—hence the name humoral control. c. Example: pancreatic control of blood glucose V. Hypothalamus A. Located in the diencephalon, is an important link between the two control systems B. Controls much of the body’s physiology, including hunger, thirst, fluid balance, and body temperature C. Controls the pituitary gland and thus most other glands in the endocrine system VI. Pituitary A. The pituitary is also a part of the diencephalon.

B. Called the “master gland” because of its role in controlling other endocrine glands C. Acts mainly only under orders from the hypothalamus D. The pituitary is split into two segments: the posterior pituitary and the anterior pituitary.

1. Posterior pituitary a. The posterior pituitary is an extension of the hypothalamus. b. Hypothalamic neurons specialized to secrete hormones instead of neurotransmitters extend their axons through a stalk in the posterior pituitary c. These neurons secrete two hormones: antidiuretic hormone (ADH) and oxytocin. d. Although these hormones are secreted by the pituitary, they are made by the hypothalamus. i. ADH a. Decreases urination, which decreases fluid lost, increasing body fluid volume b. ADH is secreted when the hypothalamus senses decreased blood volume or increased blood osmolarity (solids suspended in blood). .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

c. ADH circulates through the bloodstream and targets the kidneys specifically, causing them to absorb more water. d. ADH is very important in long-term control of blood pressure, especially during dehydration. e. Caffeine and alcohol turn off ADH production. ii. Oxytocin a. Oxytocin is important in maintaining uterine contractions during labor and is involved in milk production in nursing mothers. b. Oxytocin function in males is unknown.

2. The anterior pituitary a. The anterior pituitary makes and secretes a number of hormones under hormonal control of the hypothalamus (with the exception of growth hormone). b. Pituitary hormones usually control the secretion of hormones by another endocrine gland.

VII. Thyroid Gland A. Located in the anterior portion of the neck and is butterfly shaped B. Hormones secreted 1. Thyroxine (T3) and Triiodothyronine (T4) a. Secreted under pituitary orders b. Control cell metabolism and growth c. Contains iodine d. Clinically important; too little or too much can cause serious symptoms 2. Calcitonin, involved in calcium storage VIII. Parathyroid Glands A. Embedded in posterior surface of thyroid gland B. They produce parathyroid hormone (PTH), which regulates the levels of calcium in the bloodstream.

C. If calcium levels get too low, the parathyroid glands are stimulated to release PTH, which stimulates bone-dissolving cells and releases calcium into the bloodstream.

IX. Thymus Gland A. The thymus gland is located in the upper thorax.

B. It plays an important function in the immune system.

C. It produces a hormone called thymosin, which helps with the maturation of white blood cells during childhood to fight infection.

X. Pineal Gland A. In diencephalon B. Its full function remains unknown.

C. Produces the hormone melatonin; may trigger sleep by peaking at night and causing drowsiness XI. Pancreas A. Responsible for maintaining blood sugar levels at or near a set point of 70 to 105 B. When blood sugar rises, the pancreas releases insulin.

C. When blood sugar drops, the pancreas releases glucagon. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

D. Glucose levels affect cells.

1. Cellular respiration 2. Fluid balance E. Diabetes mellitus (DM) 1. Characterized by abnormally high blood glucose levels 2. Type 1 diabetes (insulin-dependent diabetes mellitus, IDDM, juvenile onset) a. Caused by destruction of insulin-producing cells of the pancreas b. Requires daily insulin injections 3. Type 2 diabetes (non-insulin-dependent diabetes mellitus, NIDDM, late onset) a. Caused by insensitivity of the body’s tissues to insulin b. Can sometimes be treated with a carefully controlled diet and a weight loss regimen 4. In both types of DM, elevated blood sugar must be controlled. a. High glucose levels cause the kidneys to work overtime to secrete the excess sugar. b. Increased urination (polyuria), dehydration leading to increased thirst (polyhydramnios), and hunger are the most common symptoms. c. Weight loss as the body searches for other sources of energy. d. Acid is produced because of abnormal metabolism; blood acidity worsens, leading to tissue and organ damage. e. Lack of treatment leads to coma and death.

XII. Adrenal Glands A. Pair of small glands that sit on the kidneys like baseball caps B. Two regions: 1. The adrenal cortex is the outer layer. a. Adrenal cortex makes dozens of steroid hormones known collectively as adrenocorticosteroids, released under the direct stimulation of the anterior pituitary. b. Many of these hormones are so important that a decrease in production could be fatal relatively quickly. c. Each of these hormones has a specific function, including regulation of fluids, electrolytes, blood sugar, reproduction, secondary sex characteristics, cell metabolism, growth, and immune system function 2. Adrenal medulla is the middle of the gland. a. Adrenal medulla releases two hormones: i. Epinephrine (formally known as adrenalin) ii. Norepinephrine (both a hormone and a neurotransmitter) b. These hormones increase the duration of the effects of the sympathetic nervous system; effects of hormones last longer than a neurotransmitter. c. Effects include increased heart rate, blood pressure, and respiration along with profuse sweating and dry mouth.

XIII. Gonads A. The gonads include 1. Testes 2. Ovaries .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. Their chief function is to produce and store gametes.

1. Eggs 2. Sperm C. They also produce a number of sex hormones that control reproduction.

1. Testosterone in men 2. Estrogen in women XIV. Common Disorders of the Endocrine System A. Anabolic steroid abuse 1. Anabolic steroids cause large increase in muscle mass.

2. Some athletes use them to increase performance or to enlarge muscles faster than they can by only working out.

3. Numerous side effects B. Hashimoto’s disease 1. Hypothyroidism resulting from autoimmune attack of the thyroid gland 2. The cause is unknown.

3. The thyroid may swell, causing painful swallowing.

4. It is most common in women between 30 and 50 years old and is treated with daily synthetic hormones C. Graves’ disease 1. Hyperthyroidism resulting from autoimmune attack on thyroid gland 2. Symptoms include insomnia, bulging eyes, and jitteriness.

3. Treatment involves decreasing hormone secretion by destroying the thyroid with radioactive iodine; surgery is indicated if treatment is not effective.

4. After treatment, synthetic thyroid hormone is necessary because the thyroid no longer functions properly, if at all.

D. Pheochromocytoma 1. A pheochromocytoma is a tumor of the adrenal gland that causes increased epinephrine secretion.

2. Symptoms are similar to an adrenaline rush, including severe headaches, excessive sweating, racing heart, anxiety, abdominal pain, heat intolerance, and weight loss.

3. They are rarely cancerous but must be removed or the effects of excessive epinephrine production will be fatal.

E. Addison’s disease 1. Addison’s disease is caused by insufficient production of the adrenocorticosteroid cortisol.

2. The deficiency causes weight loss, muscle weakness, fatigue, low blood pressure, and excessive skin pigmentation.

3. Aldosterone may also be deficient.

4. Many causes of Addison’s are autoimmune.

5. It is treated with hormone replacement.

F. Cushing’s syndrome 1. Cushing’s syndrome is caused by oversecretion of cortisol.

2. Symptoms include upper body obesity, round face, easy bruising, weakened bones, fatigue, high blood pressure, and high blood sugar. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. Women may have excessive facial hair and irregular periods; men have decreased fertility and sex drive.

4. It may be a side effect of medical use of steroids, like prednisone, or may be because of primary tumors, lung tumors, adrenal tumors, or one of several genetic disorders 5. Treatment depends on the underlying cause; hormone replacement may be required.

CLASSROOM ACTIVITIES 1. Divide students into groups and assign each group one of the endocrine glands.

Have them create a class presentation covering the location of the gland, the hormones it secretes, the function of each hormone, the effect of over- or underproduction of each hormone, and so on. Encourage students to design visual aids and show their creativity.

2. Have students stand in a circle and demonstrate negative and positive feedback by depositing pennies in baskets held by each student. First, they will demonstrate positive feedback by repeatedly dropping pennies into the basket on their left until something turns off the feedback loop. Next, have them demonstrate negative feedback by giving one penny to the person with the fewest pennies until setpoint (or the average number of pennies) is achieved in each basket.

TEACHING STRATEGIES 1. Discuss the overall role of hormones, glands, and the endocrine system on maintaining homeostasis. Help students to grasp concepts like negative and positive feedback, humoral control, endocrine control, and other concepts.

2. Once students understand the basics, review the individual glands and their functions. Students need to understand that although we discuss glands individually to help them learn, the glands are all interrelated and work together continuously to keep the body in balance.

FACTOIDS 1. The body is in a continuous state of hunger, intermittently relieved by eating. The hypothalamus regulates food intake and controls feelings of hunger and satiety. Some children are unable to control this sense of hunger. They have a genetic disease called Prader-Willi syndrome. The chromosomal deficiency comes from the father, resulting in children who have an insatiable hunger. No matter how much they are fed, children with Prader-Willi syndrome are always hungry. Parents must lock the refrigerator and cabinets to control their eating habits. It is an uncommon disorder, occurring in 1 in 15,000 children.

2. You have over 30 hormones regulating things such as hunger, satiety, sleep, body temperature, the metabolism of food products, weight balance, stress response, energy/activity levels, and growth rate. Each one of these hormones is continuously measuring and reacting to changes in your body. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ETHICAL DILEMMAS 1. Height is largely a product of genetics, in the absence of disease or malnutrition. If Mom and Dad are below-average height, their children are likely to be of below-average height. Some parents were teased mercilessly or picked on by their peers because they were small. They don’t want their children to suffer this fate, so they have growth hormone administered to them. The administration of growth hormone can have many side effects. Is administering growth hormone to children to make them average, or above-average, height a good idea?

2. The use of steroids for performance enhancement in athletes is a controversial issue.

The Olympic Committee has all athletes tested for steroid use. Why is use of steroids a problem? If you could make millions of dollars as an athlete in a professional sports league, and all you had to do to succeed was take hormones, would you do it? How can we encourage athletes to value their current and future health over the millions of dollars they could make today?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 12–1 Answers, p. 273 1. c 2. c 3. c 4. c 5. b Test Your Knowledge 12–2 Answers, p. 277 1. c 2. a 3. b 4. b Test Your Knowledge 12–3 Answers, p. 281 1. c 2. c 3. b 4. a Test Your Knowledge 12–4 Answers, p. 286 1. c 2. d 3. c 4. d

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO THE CASE STUDY, P. 290 1. He has type 2 diabetes (NIDDM).

2. His kidneys will be damaged if he is not treated.

3. A healthier diet and increased exercise may effectively control type 2 diabetes. A number of medications can also decrease his blood glucose if a change in diet is unsuccessful.

ANSWERS TO REVIEW QUESTIONS, P. 290 Matching 1. f 2. a 3. i 4. e 5. g 6. d 7. j 8. d 9. b 10. h Multiple Choice 1. a, 2. b, 3. c, 4. b, 5. b, 6. d, 7. d Fill in the Blank 1. raises 2. increases or regulates 3. Oxytocin 4. adrenal medulla 5. pituitary; adrenal 6. pituitary or hypothalamus 7. thymosin or growth hormone

Short Answer 1. Neurotransmitters are short-lived, short-distance chemical signals secreted by neurons that change the permeability of nearby cells. Hormones are long-lived, longdistance chemical signals secreted by endocrine organs into the bloodstream to travel to distant target cells.

2. Negative feedback is a process that controls hormone levels by preventing the endocrine gland from secreting more hormone, when hormones reach the desired levels. As hormone levels rise, feedback causes the gland to decrease hormone production.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. Anabolic steroids should be banned for performance enhancement because they give some competitors unfair advantages. More important, they are very powerful hormones with serious side effects, including metabolic and immune disorders. The levels of these hormone are so tightly controlled by the body that interfering with them artificially can cause serious problems.

4. Neural control is the control of an endocrine gland by the nervous system. For example, neurotransmitters released by the sympathetic nervous system signal the release of hormones from the adrenal medulla. Humoral control is control of hormone levels by blood chemistry. For example, the pancreas can measure blood glucose levels and secrete insulin when glucose levels are high and glucagon when glucose levels are low. Input from the nervous system is not necessary for humoral control.

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Name_____________________________________________ CHAPTER 12 – WORKSHEET Multiple Choice 1) The adrenal gland releases epinephrine after being stimulated by the sympathetic nervous system. This is an example of A) humoral control.

B) neural control.

C) hormonal control.

2) Thyroid hormone production is regulated by TSH (a hormone produced by the pituitary). This is an example of A) humoral control.

B) neural control.

C) hormonal control.

3) The pancreas monitors blood sugar and adjusts production of its hormones appropriately. This is an example of A) humoral control.

B) neural control.

C) hormonal control.

4) Which of the following is not part of the endocrine system?

A) Thyroid gland B) Pituitary gland C) Sweat gland D) Adrenal gland 5) Hormones produced by the hypothalamus include A) thyrotropin-releasing hormone (TRH).

B) growth-hormone-inhibiting hormone (GHIH).

C) corticotropin-releasing hormone (CRH).

D) All of the above 6) Which of the following hormones is not produced by the anterior pituitary?

A) Thyroid-stimulating hormone (TSH) B) Adrenocorticotropic hormone (ACTH) C) Growth hormone (GH) D) Antidiuretic hormone (ADH) 7) Alcohol turns off this hormone.

A) TSH B) ACTH C) ADH D) GH

Worksheet – p. 1 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

8) Acromegaly is a result of A) excess growth hormone secretion.

B) excess cortisol secretion.

C) deficient growth hormone secretion.

D) deficient cortisol secretion.

9) This hormone increases milk production by the breasts.

A) ACTH B) Oxytocin C) Prolactin D) FSH 10) ACTH is a hormone that stimulates the _____ gland.

A) thyroid B) adrenal C) pituitary D) pineal 11) The addition of iodine to table salt helps make sure every person gets enough dietary iodine to produce _____.

A) insulin B) thyroid hormones C) adrenaline D) testosterone 12) This condition develops when the immune system attacks and destroys the thyroid gland.

A) Hashimoto’s disease B) Cushing’s syndrome C) Graves’ disease D) Addison’s disease 13) This condition develops when antibodies attack the TSH receptors, resulting in increased secretion of T3 and T4.

A) Hashimoto’s disease B) Cushing’s syndrome C) Graves’ disease D) Addison’s disease 14) The thyroid gland is located in the A) brain.

B) abdomen.

C) chest.

D) neck.

Worksheet – p. 2 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Fill in the Blank 15) The chemical messengers released by the endocrine glands are called _____.

16) Hormone effects last _____ than the effects of neurotransmitters.

17) _____ is a powerful class of hormones that can pass through the cell membrane and interact directly with a cell’s DNA. 18) When a body characteristic becomes abnormal, _____ feedback counteracts the change.

19) The _____ is the part of the brain responsible for controlling the pituitary gland.

20) The _____ gland is also known as the “master gland.”

Short Answer 21. Please list three hormones produced by the thyroid gland. Then provide the function for each hormone. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Matching Please match each gland with the best description of its function.

22) _____ Hypothalamus 23) _____ Pituitary 24) _____ Pineal 25) _____ Thymus 26) _____ Thyroid 27) _____ Parathyroid 28) _____ Pancreas 29) _____ Adrenal 30) _____ Ovaries 31) _____ Testes A. Regulates female characteristics B. Regulates body metabolism C. Regulates blood sugar D. Increases blood calcium levels E. Controls the pituitary gland F. Helps the body cope with stressful situations G. Regulates male characteristics H. Also known as the “master gland” I. Helps white blood cells mature J. Helps regulate sleep/wake cycles by inducing drowsiness

Worksheet – p. 3 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 12 – Worksheet 1) B 2) C 3) A 4) C 5) D 6) D 7) C 8) A 9) C 10) B 11) B 12) A 13) C 14) D 15) hormones 16) longer 17) Steroids 18) negative 19) hypothalamus 20) pituitary 21) T3 and T4 stimulate body metabolism; calcitonin decreases blood calcium.

22) E 23) H 24) J 25) I 26) B 27) D 28) C 29) F 30) A 31) G

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 13 THE CARDIOVASCULAR SYSTEM: TRANSPORT AND SUPPLY LEARNING OBJECTIVES ➯ Identify structures and functions of the cardiovascular system ➯ Trace the blood flow through the vessels and chambers of the heart ➯ Explain the coronary circulation of the heart ➯ Describe the contraction of the heart and the conduction system ➯ Differentiate between arteries, veins, and capillaries ➯ List the major components of blood and their functions ➯ Discuss the importance of blood typing ➯ Explain the process of blood clotting ➯ Explain regulation of blood pressure ➯ Describe various cardiovascular diseases MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Angina 2. Cardiovascular Technology Professional Profile 3. Coronary Artery Disease 4. Heart Attacks 5. Leukemia 6. Shock 7. Sickle Cell Anemia 8. Virtual Tour of the Heart Animations 1. Aortic Abdominal Aneurysm 2. Blood Clotting 3. Cardiac Cycle 4. Cardiogenic Shock 5. Congestive Heart Failure 6. Dysrhythmias 7. Septic Shock 8. The Heart 9. Vessels of the Abdomen and Trunk 10. Vessels of the Arm 11. Vessels of the Head and Neck 12. Vessels of the Leg Interactive Exercises 1. The Circulatory System 2. The Heart .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name __________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction—Components of the Cardiovascular System A. Transports nutrients and oxygen to the cells in the body while carbon dioxide and waste products of cell’s metabolism is removed B. The major components include the heart, blood, and a network of blood vessels.

C. The pump that circulates the transport medium (blood) is the heart.

D. Arteries carry blood away from the heart and branch into smaller vessels called arterioles, which become capillaries, where nutrients and gases are exchanged; capillaries become venules that enlarge and become veins.

E. Veins differ from arteries because they carry blood back to the heart, have a higher level of carbon dioxide, and have thinner walls; they are more numerous and have a larger capacity.

II. General Structure and Functions of the Heart A. The heart is surrounded by a serous membrane known as the pericardium.

1. The fibrous pericardium is the tough outer layer.

2. The parietal pericardium is fused to the inner surface of the fibrous pericardium.

3. The visceral pericardium is fused to the surface of the heart.

4. Between the visceral and serous pericardium is a fluid-filled potential cavity called the pericardial cavity.

5. The visceral and parietal pericardium make up the serous pericardium.

B. The heart wall consists of three layers.

1. The outer layer, the epicardium, is the visceral pericardium.

2. The middle layer, the myocardium, is cardiac muscle.

3. The inner layer, the endocardium is epithelium.

C. The heart is the size of your fist, located slightly left of the center of the chest.

D. The base of the heart is proximal to the head; the apex of the heart is distal.

E. While the heart is a single organ, it is easier to understand if you think of it as two pumps working together.

1. The right side collects blood from the body and sends it to the lungs.

2. The left side collects blood from the lungs and sends it to the rest of the body.

F. There are four chambers in the heart.

1. Two upper chambers are atria.

2. Two lower chambers are ventricles.

3. Ventricle walls thicker and more muscular than atrial walls.

4. Separation of the right and left sides a. Interatrial septum: separates atria b. Interventricular septum: separates ventricles G. Blood vessels and blood flow 1. Veins: bring blood back to heart a. Superior and inferior vena cavae: from body to right atrium b. Pulmonary veins: from lungs to left atrium 2. Arteries: take blood from the heart a. Pulmonary artery: carries from right ventricle to lungs b. Aorta: carries blood from left ventricle to body .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

H. Valves: prevent blood from flowing backward 1. Atrioventricular valves: between atrium and ventricle on same side a. Have cusps and chordae tendineae attaching them to papillary muscles b. Tricuspid: on right side c. Bicuspid (mitral): on left side 2. Semilunar valves: between ventricles and arteries a. No chordae tendineae b. Pulmonary semilunar valve: between right ventricle and pulmonary artery c. Aortic semilunar valve: between left ventricle and aorta III. The Cardiac Cycle A. Heart movements, the cardiac cycle, are divided into two phases.

1. Systole is contraction; chambers are pumping.

2. Diastole is relaxation; chambers are filling.

3. Typically the cardiac cycle refers to movements of the ventricles.

B. Systole 1. Right ventricle is full of blood, the heart contracts (systole). a. Pressure builds. b. Pressure closes tricuspid valve and opens semilunar valve. c. Blood leaves right ventricle and enters pulmonary artery.

2. Left ventricle is the same, but blood is pumped to body out of the aorta.

C. Diastole 1. Right ventricle is empty at end of diastole.

2. Right atrium is filling from superior and inferior vena cavae. a. Pressure is higher in filled atrium than in empty ventricle. b. Pressure is higher in blood vessel than in empty ventricle. c. Pressure opens tricuspid valve. d. Pressure closes pulmonary semilunar valve. e. Blood flows from atrium into ventricle, filling it.

3. Left side of heart is the same situation, left ventricle is filling.

D. Tracing the flow of blood 1. Blood flows from the body to the right atrium via the superior and inferior vena cavae.

2. It passes through the tricuspid valve into the right ventricle.

3. Blood leaves the right ventricle through the pulmonary valve.

4. Blood flows to the lungs via the pulmonary artery where it is oxygenated.

5. From the lungs, blood returns to the left atrium via the pulmonary vein.

6. It then passes through the bicuspid or mitral valve into the left ventricle.

7. It passes through the aortic valve, into the aorta, to the body.

IV. Coronary Arteries A. A portion of the newly oxygen-enriched blood leaving the heart is diverted from the aorta by the right and left coronary arteries.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

B. These arteries continuously divide into smaller branches, forming a web of interconnections known as anastomoses to consistently supply the heart muscle with a rich supply of blood.

C. Regular aerobic exercise increases the density of these blood vessels, and the number of anastomoses increases, as does the number of locations.

D. The right coronary artery provides blood for the right ventricle, posterior portion of the interventricular septum, and inferior parts of the heart.

E. The left coronary artery provides blood to the left lateral and anterior walls of the left ventricle and portions of the right ventricle and interventricular septum.

V. Cardiac Muscles and Continuous Contractions A. Cardiac muscle cells have specialized connections called intercalated discs.

B. Electrical impulses, ions, and various small molecules can readily travel throughout the heart.

C. Result is smooth, rapidly traveling contraction.

VI. Electrical Conduction A. The cardiac muscle is autorhythmic; it can contract without nerve impulses or hormones.

B. Specialized cardiac cells create and distribute electrical current that causes a controlled and directed contraction of the heart.

C. These specialized cells are called nodes or nodal cells.

1. These cells are connected to each other and to the conducting network.

2. Nodal cells are divided into two groups. a. Sinoatrial (SA) node i. Located in the wall of the right atrium, near the entrance of the superior vena cava ii. Generates an electrical impulse at approximately 70 to 80 impulses per minute b. Atrioventricular (AV) node i. Where the atria and ventricles meet ii. Cells in AV node generate an electrical impulse at a rate of 40 to 60 beats per minute. c. SA node sends its impulse to the AV node before the AV node can send a signal; however, the AV node acts as backup if the SA node fails to fire, resulting in a slower heart beat because the AV node fires fewer impulses per minute.

D. Movement of electrical impulses 1. Movement of electrical impulse in the myocardium is done by specialized conducting cells.

2. Once an electric impulse is generated at the SA node, it travels to the AV node.

3. There is a bit of a signal delay, allowing the atria to fill with blood before contraction occurs.

4. Once the charge hits the AV node, it travels through the AV bundle, or bundle of His. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. The impulse travels down the right and left bundle branch in the interventricular septum.

6. These branches spread across the inner surface of both ventricles.

7. The impulse travels into the Purkinje cells to carry the impulse to the contractile muscle cells of the ventricles.

8. The contraction begins at the apex, and the wave of contraction smoothly continues up the ventricle, squeezing out all the blood.

E. Electrocardiogram (ECG or EKG) 1. Because myocardial contraction is an electrical event, that charge can actually be detected on the surface of the body by using an EKG. 2. Normal EKG has three distinct waves representing specific heart actions. a. P wave is first wave representative of the impulse generated by the SA node and depolarization of the atria before they contract. b. QRS complex represents the depolarization of the ventricles that occurs right before the ventricles contract. c. Because of the greater muscle action of the ventricles in relation to the atria, the QRS wave is greater in size than the P wave. d. T wave represents repolarization of the ventricles, where they rest before the next contraction. e. Repolarization of the atria occurs during the QRS complex but is overshadowed by the ventricular activity. f. There are set ranges for height, depth, and length of each of the waves, and changes or additions to these parameters are called cardiac arrhythmias.

VII. Blood A. Blood is a fluid form of connective tissue.

B. The amount of blood in the body depends on size and sex; generally, the body contains 4 to 6 liters of blood, or about 7% to 9% of total body weight C. Blood has three functions.

1. Transportation: oxygen, nutrients, and hormones, carbon dioxide and other waste products 2. Regulation: pH (levels of acidity or alkalinity) and electrolyte values, body temperature, and fluid balance 3. Protection: infection, blood clotting D. Blood composition 1. Plasma a. Yellowish, straw-colored liquid that comprises about 55% of the blood’s volume b. 90% water; the other 10% contains nutrients, salts, oxygen; hormones, etc. c. Proteins are an important group of dissolved substances that include i. Albumin; aids in keeping the correct amount of water in the blood ii. Fibrinogen: needed for blood clotting iii. Globulins: form antibodies for protection from infection 2. Formed elements .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

a. Red blood cells (RBCs) or erythrocytes i. Created by red bone marrow through a process called hemopoiesis because they lack a nucleus to reproduce themselves ii. Similar to a doughnut in shape iii. Transport oxygen with the aid of an iron-containing red pigment called hemoglobin iv. Help to transport carbon dioxide from the cells to the lungs for removal b. White blood cells (WBCs) or leukocytes i. Guard against infection; two main types ii. Polymorphonuclear granulocytes originate from red bone marrow and include neutrophils, eosinophils, and basophils a. Neutrophils are most aggressive WBC when bacteria attempt to destroy tissue b. Eosinophils combat parasitic invasions and a variety of body irritants that lead to allergies c. Basophils are believed to be involved with allergic reactions iii. Mononuclear agranulocytes originate from lymphoid and myeloid tissue a. Monocytes are found in higher than normal amounts when chronic infection occurs. b. Lymphocytes protect from infection by producing antibodies that inhibit or directly attack invaders. c. Thrombocytes, or platelets i. Smallest formed elements, responsible for the blood’s ability to clot ii. Can release serotonin, which can cause smooth muscle constriction and decreased blood flow E. Blood types and transfusions 1. Antigens, substances that stimulate the immune system to produce antibodies 2. Antigens are typically foreign proteins introduced into the body through wounds, blood transfusions, and so on.

3. Because these were not originally found in the body, they are non-self antigens.

4. Self-antigens exist on the cell membrane of every cell.

5. The reaction between antigens and antibodies is called the antigen–antibody reaction, which is the basis of the immune response.

6. Antibodies often react with the antigens that caused them to form, and the antigens stick together in little clumps; called agglutination.

7. Although there are over 50 different antigen types, the main focus in blood typing is on A, B, and Rh antigens.

8. Type A blood is very common. a. Approximately 41% of the American population has type A. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. “A” represents a specific type of self-antigen found on the cell membrane of the RBCs. c. If a person is born with type A blood, no antibodies are created to fight it, so there are no anti-A antibodies, but there are anti-B antibodies.

9. Type B blood a. Type B RBCs possess type B self-antigens. b. The plasma contains anti-A antibodies. c. If a person with type B blood were given type A blood, anti-A antigens would attack the RBCs and destroy them because they see the cells as foreign material; the antibodies cause agglutination, resulting in serious harm and even death.

10. Type AB blood a. Type AB blood contains both A and B self-antigens. b. Type AB blood has neither A nor B antibodies in the plasma. c. Because there are no A or B antibodies, people with type AB blood are called universal recipients because they can accept any type of blood type transfusion.

11. Type O blood a. Type O RBCs contain no A or B antigens, but its plasma contains both A and B antibodies. b. Type O blood can be given to anyone and people with type O are universal donors.

12. Rh factor a. Special blood antigens were first found in the blood of Rhesus monkeys and were labeled Rh factor. b. Found in 85% of the white and 88% of the black population of the United States c. People with this antigen are Rh positive; people without it are Rh negative. d. As a result, people are either A, B, AB, or O negative or positive. e. If the father is Rh positive and the mother is Rh negative, and the baby inherits the father’s Rh factor, the mother will develop anti-Rh antibodies; this baby will be okay, but any future babies may be attacked by the antiRh antibodies if that baby has the Rh-positive trait in its blood.

VIII. Blood Clotting A. The cardiovascular system is a closed and pressurized system.

B. If a break or leak in the system couldn’t be stopped, you would lose a large amount of blood.

C. Several substances in blood plug leaks.

D. Hemostasis, clotting, is accomplished through a chain of events.

1. When the inner wall of a vessel is damaged, an underlying collagen fiber becomes exposed.

2. Platelets that are floating in the blood begin to attach to that rough, damaged site. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. The attached platelets release several chemicals that draw more platelets, creating a platelet plug.

4. The platelets secrete serotonin, which causes blood vessels to spasm, decreasing blood flow to that area.5. Within 15 seconds, blood clotting (coagulation) begins. a. With the help of calcium ions and 11 different plasma proteins, a chain reaction starts. b. One of the clotting proteins, prothrombin, produced by the liver with the help of vitamin K, is converted to thrombin. c. Thrombin transforms fibrinogen, dissolved in the blood, into a solid, hairlike form called fibrin. d. Fibrin forms a netlike patch at the site of the injury, snagging more blood cells and platelets; within 3 to 6 minutes, a clot is created. e. Once the clot is formed, it begins to retract and pulls the edges of the damaged tissue together, allowing the edges to regenerate the necessary epithelial cells to make a permanent repair; the clot is dissolved over time when it is no longer needed.

E. Clotting gone bad 1. The clotting reaction must be stopped, or clotting would continue unchecked.

2. A rough surface on smooth blood vessel allows platelets to begin “sticking,” forming a clot called a thrombus.

3. A thrombus in a coronary artery can partially or totally block blood flow to a portion of the heart, causing a heart attack.

4. Part of the thrombus can break off and travel (called an embolus) until it gets stopped by a small vessel, partially or completely blocking the vessel and affecting blood flow.

5. A cerebral embolus would cause a stroke; a pulmonary embolus would affect oxygenation.

6. Aspirin, heparin, or Coumadin can be taken to decrease the risk of clot formation; streptokinase is a “clot buster.”

IX. Blood Vessels A. Blood leaves the heart through the aorta, which branches into large vessels called arteries.

B. Arteries divide into smaller and smaller vessels, the smallest of which are called arterioles.

C. Arterioles feed into capillaries that form capillary beds in the body’s tissues, allowing oxygen and nutrients to diffuse into the cells and picking up carbon dioxide and waste products for removal.

D. Blood continues the journey from capillaries to small vessels called venules.

E. Venules combine into veins, which eventually combine into great veins that empty back into the heart.

F. Walls of blood vessels 1. For most blood vessels, the walls are composed of three layers, often called coats or tunics. a. Tunica interna .

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i. Innermost layer ii. Composed of a loose layer of connective tissue made up of squamous epithelial cells iii. Compacting of the epithelial cells provides a smooth surface so blood can easily pass through. b. Tunica media i. Middle layer ii. Thicker and composed mainly of smooth muscle, elastic tissue, and collagen iii. By contracting or relaxing these muscles, this layer controls the diameter of the vessel to meet certain needs of the body at a given time. iv. Sympathetic nervous system determines the body’s need and changes diameter of blood vessels. c. Tunica externa i. Outermost layer ii. Composed of mostly fibrous tissue, its job is to provide vessel support and protection.

2. The differences in the structure of the blood vessels vary, depending on their job. a. Arteries versus veins i. Possess much thicker walls than veins because arteries are closer to the heart and have to deal with higher pressures ii. Larger arteries contain complete sheets of elastic tissue, elastic laminae, in their middle walls to help deal with increased pressure. iii. Lumen in veins is larger than in arteries and also contains valves that prevent backward flow of blood. iv. Relaxation and contraction of muscles that surround veins help to “milk” the blood toward the heart. b. Capillaries i. Composed of only the tunica interna, with a diameter of only 0.008 mm (slightly larger than the diameter of a single RBC) that allows easy movement of oxygen and nutrients through the wall, while carbon dioxide and wastes can move into the blood. ii. All the body’s cells require a total of approximately 250 mL of oxygen, producing 200 mL of carbon dioxide every minute when the body is at rest. iii. Capillary beds a. Composed of two types of blood vessels: a vascular shunt, which is a main road connecting the arteriole to the venule, and true capillaries, which make the actual exchanges with tissue cells. b. True capillaries can be considered the on and off ramps from and to the vascular shunt. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

c. Precapillary sphincters are composed of smooth muscle and act as tollbooths, either allowing or stopping blood flow as they contract and open. d. If it is allowed through, it travels to the true capillaries and to cells; otherwise the blood travels through the vascular shunt.

X. Blood Pressure A. Measuring blood pressure 1. Important diagnostic test, performed with a stethoscope and sphygmomanometer 2. Balloonlike cuff is inflated and squeezes the brachial artery shut.

3. As cuff deflates, the stethoscope, placed over the brachial artery, allows listener to hear the first sound (systole) of blood flow returning to the artery.

4. The last sound (diastole) indicates there is no longer any pressure required for blood to flow through the artery.

5. Pressure is measured using a column filled with mercury, a round pressure gauge, or a digital readout.

B. Regulation of blood pressure 1. Cardiac output: heart rate _ stroke volume a. Heart rate: beats per minute b. Stroke volume: amount of blood pumped per beat i. Blood volume ii. Force of contraction c. Autonomic nervous system changes heart rate and contractile force. d. Ions, hormones, and body temperature can alter heart rate. e. Age, sex, and exercise can all affect heart rate.

2. Peripheral resistance a. Blood vessel diameter b. Sympathetic innervation to tunica media causes vasoconstriction c. Smaller diameter = higher pressure 3. Blood volume a. Fluid volume b. ADH and other hormones XI. Cardiovascular Disorders A. Pump problems 1. Cor pulmonale a. An older term for a condition in which the right side of the heart can’t move blood efficiently because of heart muscles working harder than they normally do. b. Muscles on the right side become too large and can no longer pump efficiently. c. Polycythemia (thick blood because of elevated RBC levels) or constricted pulmonary vessels can cause the heart to work harder. d. Cor pulmonale occurs in 85% of patients with COPD. 2. Congestive heart failure (CHF), now referred to as heart failure. .

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a. Can affect the left or right side of the heart b. Pumping action of the heart cannot overcome resistance in the blood vessels, and the increased pressure allows fluid to leak from the vessels and into the tissues. c. In right-sided CHF, the left pump is working normally, but the right side cannot take all the returning blood, and the blood begins to back up. d. Symptoms may include enlarged liver, spleen, and carotid arteries as well as swelling of the feet, ankles, and/or hands. e. In left-sided CHF, the right side is pumping normally, but the left side cannot take all the blood being delivered, so blood begins to back up in the lungs. f. Fluid leaks out of the vessels when pressure becomes too high, resulting in pulmonary edema. g. Symptoms can include shortness of breath, wet-sounding cough, and hypoxia.

3. Valve problems a. Two types of valve problems i. Valve is too small (stenosis) ii. Valve is too large, allowing backflow of blood (insufficiency) b. Clots can form in the damaged valve, which can detach and flow through the blood vessels and lead to pulmonary embolus or stroke. c. Papillary muscles attach to the undersides of the cusps of the valve, and damage to these areas allows backflow of blood into the atria when the ventricle contracts.

B. Vessel problems 1. Arteriosclerosis, or hardening of the arteries, occurs to some extent to all of us as we age. a. Results from thickening of the interna b. Causes involved vessels to become less flexible or even brittle, increasing risk of rupture and likelihood of high blood pressure.

2. Atherosclerosis is a potentially life-threatening condition in which fatty deposits called plaques build up on the inner lining of blood vessels. a. Blood flow can then become greatly or completely blocked by this buildup. b. Plaque is composed of cholesterol. c. Any blood vessel can be susceptible to atherosclerosis, but coronary and cerebral arteries are particularly susceptible. d. Heredity is one factor for atherosclerosis, and it is a common side effect of diabetes.

3. Infarction a. If blood flow is restricted in one or more coronary arteries, heart muscle may become oxygen-starved with the result of dying myocardial tissue. b. Dying myocardial tissue is labeled a myocardial infarction, or heart attack. .

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i. True heart attack occurs when there is an insufficient supply of blood from the coronary artery to the tissues of the heart. ii. Could result from plaque buildup in arteries decreasing flow or a piece of plaque that breaks off and occludes the artery. iii. A clot that forms and blocks the artery can be another scenario. iv. If the limiting of blood is sufficient to kill heart tissue, the condition is called a myocardial infarction (MI). v. Most MIs start out slowly, with little or no pain (silent MI), and may progress over hours, days, or even weeks. c. Symptoms may include chest pain, chest heaviness, and pain in the left shoulder, neck, jaw, or radiating down the left arm. i. Nausea, heartburn, weakness, clamminess, diaphoresis, shortness of breath, and dizziness can also be warning signs. ii. Denial can delay treatment. iii. The first hour is the most important. iv. Call 911 and chew an aspirin immediately because research shows this increases survival rates. d. Blockage of blood flow to the brain can cause a cerebral vascular accident (CVA) or stroke. e. Reduced blood flow leads to tissue injury, called ischemia.

4. Aneurysm a. A localized weakened area of blood vessel wall that may have been caused by a congenital defect, disease, or injury b. Appears to be a familial tendency for abdominal aortic aneurysms c. Often no symptoms, but when aneurysm continues to expand it can rupture, causing hemorrhage; if it is a major artery, an individual can bleed out in a matter of minutes d. Surgical intervention can remedy the situation if detected early.

C. Blood problems 1. Secondary polycythemia: chronic low levels of oxygen cause the body to produce more erythrocytes to transport more oxygen; primary polycythemia can be because of bone marrow cancer 2. Anemia is a condition with less-than-normal RBCs or an abnormal or deficient amount of hemoglobin. a. Common symptoms include pale skin, mucous membranes, and nail beds, fatigue and muscle weakness, shortness of breath, and/or chest pain. b. Sickle cell anemia i. Inherited condition in which RBCs and hemoglobin molecules cannot form properly ii. Resultant RBCs are crescent-or sickle-shaped and tend to rupture. iii. As cells are destroyed, the body is stimulated to produce more RBCs, resulting in immature cells because of the high production rate. .

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iv. Ruptured cells clog up small vessels, and thicker blood from the high number of RBCs leads to increased clotting and impaired ability to carry oxygen.

3. Leukemia, usually because of bone marrow cancer, results in high numbers of white blood cells; the WBCs are immature and ineffective.

4. Leukocytosis is often caused by an infection and also results in a high WBC count.

5. Leukopenia is a low WBC count as the result of drugs or chronic infection.

6. Hemophilia is an inherited blood condition that prevents healthy blood clotting.

7. Thrombocytopenia is a condition in which there are fewer than normal circulating platelets. a. If the count is low enough, even routine acts of moving can lead to bleeding. b. Causes include liver dysfunction, decreased levels of vitamin K, radiation exposure, and bone marrow cancer.

CLASSROOM ACTIVITIES 1. Demonstrate rhythm strips reflecting different types of arrhythmias, such as atrial fibrillation, ventricular fibrillation, and sinus bradycardia. Have students discuss what the heart is doing when a particular arrhythmia is present.

2. Assign each student a formed element in the blood. For a big class, also assign a blood type antigen, including the presence of Rh factor. Have each student prepare a report, using visual aids, explaining the purpose of the formed element, where it is produced, and disorders affected by the excessive or diminished quantity of that type of cell. Have each student present their report to the class.

TEACHING STRATEGIES 1. Help students to trace the flow of blood as well as the flow of the electrical impulse through the heart. Students should learn to associate the electrical impulse visible on the EKG with the various stages of contraction in the heart.

2. Take a blood specimen and, using Wright stain, view it under a microscope. Discuss the components that make it identifiable.

FACTOIDS 1. A simple and inexpensive test for elevated WBC counts could be used as a predictor of impending heart attacks in women. Inflammation plays a role in strokes and heart attacks, perhaps by weakening blood vessels and causing atherosclerotic buildup.

Another marker of inflammation is the C-reactive protein, but WBC counts are easier and cheaper to perform and are just as accurate a predictor.

2. More than 60 million Americans have some form of cardiovascular disease. It is the leading cause of nonaccidental death in this country. Major risk factors include high blood pressure, high cholesterol, diabetes, obesity and overweight, smoking, inactivity, .

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heredity, age, and male gender. Contributing factors include stress, postmenopausal drops in hormonal levels, and heavy alcohol consumption. It has been shown that people who are overweight and carry most of their weight around their middle are at higher risk for heart attacks than those who carry their weight distributed over their frame.

ETHICAL DILEMMAS 1. You’re invited to a friend’s house for Thanksgiving dinner. After dinner, your friend’s father complains of “heartburn,” saying his left arm is tingling and he feels short of breath. You’re pretty sure he’s having a heart attack and recommend he call 911. He says, “No, it will go away in a minute. I just ate too much.” Do you override his wishes and call 911 anyway? What do you do?

2. This friend’s father collapses. As you examine him, you realize he’s not breathing and has no pulse. You have your friend call 911 (if you haven’t called them already). As you prepare to do CPR, your friend tells you that this man is HIV positive. You don’t have a one-way valve/mask with you and will have to perform mouth-to-mouth directly. Do you perform CPR now, or do you wait for EMS to arrive?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 13–1 Answers, p. 300 1. d 2. d 3. d 4. left ventricle 5. right Test Your Knowledge 13–2 Answers, p. 305 1. b 2. b 3. c 4. b Test Your Knowledge 13–3 Answers, p. 310 1. a 2. b 3. b 4. albumin 5. mononuclear agranulocytes Test Your Knowledge 13–4 Answers, p. 314 1. a 2. a 3. b 4. c .

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Test Your Knowledge 13–5 Answers, p. 319 1. c 2. d 3. d 4. tunica interna; tunica media; tunica externa 5. tunica media ANSWERS TO THE CASE STUDY, P. 326 a. I would suspect the patient is either having a heart attack or angina and is at least in the early stages of COPD. b. The patient needs a complete physical to find out what is going on. Perhaps medication could prevent a more serious heart condition from developing. Most of my suggestions would involve lifestyle changes. He needs to exercise and lose some weight, give up smoking, and eat better.

ANSWERS TO REVIEW QUESTIONS, P. 326 Multiple Choice 1. c, 2. b, 3. a, 4. b, 5. c, 6. b, 7. c, 8. b Fill in the Blank 1. a. help maintain body’s fluid balance b. assist cardiovascular system in distributing nutrients and oxygen, hormones, and removal of waste products c. help prevent infection and disease 2. ischemia 3. sphincters 4. Vitamin K 5. Septum 6. increase 7. increase 8. red blood cells

Short Answer 1. Blood pressure is controlled by controlling cardiac output, peripheral resistance, and blood volume. Cardiac output, a combination of heart rate and stroke volume, is influenced by the autonomic nervous system, by ions, and by temperature. Peripheral resistance, the resistance to flow in a blood vessel, is controlled by changing blood vessel diameter. Smaller diameter causes higher pressure. Sympathetic innervation of the tunica media controls blood vessel diameter. Blood volume is a function of fluid volume. Fluid volume is generally controlled by hormones, which control urination.

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2. Blood flows from the right atrium through the tricuspid valve into the right ventricle; from the right ventricle through the pulmonary valve into the pulmonary arteries; from the pulmonary arteries into the lungs; from the lungs through the pulmonary veins back to the left atrium; from the left atrium through the bicuspid (mitral) valve and into the left ventricle; from the left ventricle through the aortic valve and into the aorta.

3. Type A blood has A antigens and anti-B antibodies, type B blood has B antigens and anti-A antibodies, Type O blood has no antigens and both anti-A and anti-B antibodies and type AB has both A and B antigens and no antibodies.

4. When a wound is bleeding, blood loss must be controlled. First the vessels constrict.

Then platelets are activated, becoming sticky and forming a water soluble plug in the wound. Then fibrinogen is converted to fibrin during clotting, make the platelet plug insoluble and forming a clot.

5. There are three types of formed elements: red blood cells, white blood cells and platelets. Red blood cells transport oxygen, white blood cells fight infection, and platelets form clots to prevent blood loss.

6. Iron is important in your diet because you need iron to make hemoglobin, the molecule responsible for transporting oxygen in your blood.

7. The direction of the wave of contraction is important because the wave must allow the atria to contract before the ventricles so that the atria can pump blood into the ventricles. The wave also must travel from the apex of the ventricles toward the base of the heart so that blood is pushed up toward the vessels exiting the ventricles, like pushing toothpaste toward the opening of the tube. The Cardiovascular System: Transport and Supply 217

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Name_______________________________________________ CHAPTER 13 – WORKSHEET Multiple Choice 1) The tissue that divides the left and the right sides of the heart is called the A) atrioventricular valve.

B) apex.

C) septum.

D) base.

2) The _____ is considered the pacemaker of the heart.

A) sinoatrial node B) atrioventricular node C) Purkinje fiber D) bundle branch 3) Which type of blood vessel carries blood away from the heart?

A) Artery B) Vein C) Capillary D) Anastomosis 4) What color would you expect oxygenated blood to be?

A) Bright red B) Bluish C) Green 5) The serous membrane that surrounds the heart is called the A) endocardium.

B) pericardium.

C) myocardium.

D) lipocardium 6) The inner lining of the heart is called the A) endocardium.

B) pericardium.

C) myocardium.

D) epicardium.

7) Which blood vessel carries blood from the heart to the lungs?

A) Aorta B) Vena cava C) Pulmonary artery D) Pulmonary vein

Worksheet – p. 1 of 3

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8) To which chamber of the heart does the aorta attach?

A) Right atrium B) Right ventricle C) Left atrium D) Left ventricle 9) Which blood type is considered the universal donor?

A) Type A B) Type B C) Type AB D) Type O Fill in the Blank 10) The upper chambers of the heart are called _____.

11) _____ is the phase of the cardiac cycle the heart contracts.

12) A person with type A blood will have anti-_____ antibodies in their plasma.

Matching Please match each term with the appropriate description.

13) _____ Plasma 14) _____ Erythrocyte 15) _____ Leukocyte 16) _____ Thrombocyte A. A red blood cell B. The liquid portion of blood C. A platelet D. A white blood cell Please match each type of cell with the appropriate function.

17) _____ Erythrocyte 18) _____ Thrombocyte 19) _____ Neutrophil 20) _____ Lymphocyte 21) _____ Eosinophil 22) _____ Basophil A. Performs phagocytosis B. Produces antibodies C. Helps with blood clotting D. Secretes heparin E. Involved in parasitic infections F. Carries oxygen

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Worksheet – p. 2 of 3 Short Answer 23. Please list three substances that the blood transports. __________________________________________________________ __________________________________________________________ __________________________________________________________ 24. Please list two possible causes of anemia. __________________________________________________________ __________________________________________________________ __________________________________________________________

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 13 – Worksheet 1) C 2) A 3) A 4) A 5) B 6) A 7) C 8) D 9) D 10) atria 11) Systole 12) A 13) B 14) A 15) D 16) C 17) F 18) C 19) A 20) B 21) E 22) D 23) Answers will vary, but may include: oxygen, carbon dioxide, nutrients, antibodies, hormones, and waste products 24) Answers will vary, but may include: iron deficiency, vitamin deficiency, inherited traits (as in sickle cell), bone marrow dysfunction, improper formation of blood cells, and hemorrhage

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 14 THE RESPIRATORY SYSTEM: IT’S A GAS

LEARNING OBJECTIVES ➯ List and state the basic functions of the components of the respiratory system ➯ Differentiate between respiration and ventilation ➯ Explain how the respiratory system warms and humidifies inhaled air ➯ State the purpose and function of the mucociliary escalator ➯ Discuss the process of gas exchange at the alveolar level ➯ Describe the various skeletal structures related to the respiratory system ➯ Explain the actual process and regulation of ventilation ➯ Discuss several common respiratory system diseases

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Allergic Rhinitis 2. Apnea 3. ARDS 4. Asthma 5. COPD 6. Oxygen-Delivery Devices 7. Perfusionist Professional Profile 8. Respiratory Therapist Professional Profile 9. Tuberculosis Animations 1. Airway Burns 2. Asthma 3. Gas Exchange in the Lungs 4. Pneumonia 5. Pneumothorax 6. The Lungs Interactive Exercise 1. The Respiratory System

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name__________________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. The respiratory system’s primary function is to transport oxygen from the environment and get it into the bloodstream to be used by cells, tissues, and organs to sustain life.

B. The respiratory system moves 12,000 quarts of air per day into and out of the lungs.

C. The respiratory system also removes waste gas—carbon dioxide— from the body to the environment so it doesn’t build up in the bloodstream.

D. Cellular respiration depends on a continuous supply of oxygen, found in abundance in the air we breathe.

E. Using oxygen produces the by-product carbon dioxide, which would become toxic if allowed to build up in the bloodstream.

F. The respiratory system is closely related to the cardiovascular system, and these two systems are sometimes together called the cardiopulmonary system.

G. Major components of the respiratory system 1. A thoracic cage that houses, protects, and facilitates function for the system 2. Upper and lower airways that conduct, or move, gas throughout the system 3. Two lungs that serve as the vital organs 4. Terminal air sacs called alveoli surrounded by a network of capillaries that allow gas exchange 5. Muscles of breathing II. Ventilation and Respiration A. Ventilation is the bulk movement of air down to the terminal air sacs, or alveoli, of the lungs.

B. Respiration is the process of gas exchange: oxygen is added to the blood, and carbon dioxide is removed.

1. External respiration: movement of oxygen from the alveoli to the blood 2. Internal respiration: movement of oxygen from the blood to the cells III. The Upper Respiratory Tract A. The upper airways begin at the nares, or nostrils, and end at the vocal cords.

B. The functions of the upper airways include 1. Heating or cooling air to body temperature 2. Filtering 3. Humidifying 4. Sense of smell, or olfaction 5. Producing sounds, or phonation 6. Ventilation, or conducting gas to lower airways

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C. The nose 1. Opening of respiratory system 2. Rigid structure comprised of cartilage and bone 3. Three main regions within the space behind the nose, called the nasal cavity, including a. Vestibular region i. Located inside the nostrils ii. Nose hairs, called vibrissae, covered with sebum iii. Sebum helps trap particles and keeps the hairs soft and pliable b. Olfactory region i. Responsible for the sense of smell ii. Roof of the nasal cavity c. Respiratory region i. Lined with mucous membranes and richly supplied with blood ii. Air is warmed to body temperature and moistened iii. Three scroll-like bones, or turbinates a. Split incoming air into three channels, providing more surface area b. Make incoming air current more turbulent, bringing more air in contact with the mucous membranes for warming and humidifying 4. The nose is responsible for one-half to two-thirds of the total airway resistance in breathing.

5. There would be less resistance and less work if the tube were larger.

6. Therefore, mouth breathing predominates during stress, exercise, or nasal congestion because the oral cavity is larger and creates less resistance.

D. Mucociliary escalator 1. Airways lined with respiratory mucosa-pseudostratified ciliated columnar epithelium with goblet cells.

2. Goblet cells and submucosal glands are interspersed and produce about 100 mL of mucus per day.

3. The mucus resides as two layers. a. A watery layer called the sol layer houses the cilia so they stay flexible and can move the layers. b. The top layer is the gel layer that is more viscous and sticky, trapping small particles.

4. Cilia function a. Cilia act as tiny oars resting in the watery sol layer. b. They propel the gel layer and its trapped debris to be expelled. c. In the nose, the debris is propelled toward the nasal cavity; if located in the lungs, debris is propelled toward the oral cavity to be coughed or swallowed. d. Smoking paralyzes this escalator.

E. Sinuses 1. Air-filled cavities in facial bones .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

2. Drain into nasal cavity 3. These cavities help prolong and intensify sound produced by the voice and help to lighten the weight of the head.

4. We are not born with sinuses but they develop as we do, accounting for the change in facial features as we age.

5. Sinuses also help to warm and moisten air.

F. Pharynx 1. Hollow muscular structure lined with epithelial tissue starting behind the nasal cavities.

2. Divided into three sections a. Nasopharynx i. Uppermost section beginning behind nasal cavities ii. Lined with respiratory mucosa; passage for air only iii. Contains lymphatic tissue called the adenoids and passageways into the middle ear called the eustachian tubes b. Oropharynx i. Center section of the pharynx located behind the oral, or buccal, cavity ii. Lined with stratified squamous epithelium; food, liquid, and air pass here iii. Air breathed through the mouth and nose passes through this section iv. Uvula and soft palate v. During swallowing, the uvula and soft palate move ina posterior and superior position to protect the nasopharynx from the entry of food or liquid vi. Tonsils a. Part of the lymph system b. Palatine tonsils are located in the oropharynx, as are the lingual tonsils at the back of the tongue. c. Pharyngeal tonsils (adenoids) in nasopharynx c. Laryngopharynx i. Lowermost portion of the pharynx ii. Opens into both the esophagus (digestive system) and the larynx (respiratory system) G. Larynx (voice box) 1. Semirigid structure composed of cartilage connected by muscles and ligaments that provide movement of the vocal cords to control speech 2. Thyroid cartilage: The Adam’s apple is the largest of the cartilages found in the larynx.

3. The cricoid cartilage: inferior border, provides structure and support in an exposed area of the airway 4. Epiglottis a. A leaf-shaped fibrocartilage, flaplike structure over the glottis (opening that leads into the larynx and eventually the lungs) .

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b. Closes during swallowing to prevent food from entering the lungs, food that is swallowed travels into the esophagus, while air travels into the larynx c. This is called the glottic or swallowing mechanism and closes the glottis tightly, forcing food and fluid to enter the esophagus d. When we breathe, air can enter the larynx or the esophagus but prefers the larynx because of pressure differences.

5. Vocal cords a. Act as the dividing line between the upper and lower airways b. Upper airway ends at the vocal cords c. Lower airway starts below the vocal cords IV. Lower Respiratory Tract A. Trachea 1. The lower respiratory tract resembles an upside-down tree, often called the tracheobronchial tree.

2. From the vocal cords, air enters the trachea, or windpipe, extending to the 6th thoracic vertebrae.

3. C-shaped cartilage is found in the anterior portion of the trachea to provide rigidity and protection for the exposed airway in the neck.

4. The esophagus sits in the opening of the C-shaped cartilage in the posterior part of the neck, allowing the esophagus to expand when swallowing larger chunks of food.

5. The trachea is the largest bronchus and can be thought of as the trunk of the tree.

B. Mainstem bronchi 1. The trachea begins branching, or bifurcating, at the center of the chest into the left and right mainstem bronchi (bronchus is the singular form), sometimes called the primary bronchi.

2. The site of bifurcation is called the carina.

3. The right mainstem branches off at a 20 to 30 degree angle from the midline of the chest.

4. The left mainstem branches off at a more pronounced 40 to 60 degree angle.

5. This is important because the lesser angle of the right mainstem branching allows foreign bodies that are accidentally breathed in to more often lodge in the right lung.

6. An endotracheal, or breathing, tube placed too far in may be placed in the right mainstem, and only the right lung will expand, which is why an x-ray must be done following tube placement.

C. Branching of the bronchi 1. Bronchi must branch into the five lobular bronchi that correspond to the five lobes of the lung.

2. Each lung lobe is further divided into specific segments, and the next branching of bronchi is called the segmental bronchi.

3. From the trachea to the segmental bronchi, the tissue layer is the same. a. Inner epithelial layer contains the mucociliary escalator .

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b. Middle layer is the lamina propria layer, which contains smooth muscle, lymph, and nerve tracts c. Third layer is the protective and supportive cartilaginous layer 4. The branching becomes more numerous and smaller, extending deep into the lung segment.

5. Cartilaginous rings become more irregular and eventually fade away.

6. Near gas exchange regions, the airways simplify to make it easier for gas molecules to pass through.

D. Bronchioles 1. Bronchioles average only 1 mm in diameter.

2. There is no cartilage layer, and the epithelial layer becomes pseudostratified ciliated cuboidal—short, squat cells as opposed to columns.

3. The cilia, goblet cells, and submucosal glands are almost all gone.

4. There is no gas exchange yet.

E. Terminal bronchioles 1. Terminal bronchioles (generation 16) have an average diameter of 0.5 mm.

2. There are no goblet cells, cartilage, cilia, or submucosal glands at this point.

3. This is the end of the conducting areas.

F. Respiratory bronchioles 1. The next airway beyond the terminal bronchioles; gas exchange can occur here.

2. The epithelial lining is simple cuboidal cells interspersed with pancakelike cells called squamous pneumocytes.

G. Alveolar duct 1. Alveolar ducts originate from the respiratory bronchioles.

2. Walls of the alveolar ducts are completely made up of squamous cells, arranged in a tubular configuration.

3. These give rise to alveolar sacs.

H. Alveoli 1. The alveoli are the terminal air sacs.

2. Surrounded by numerous pulmonary capillaries; together make up the functional unit of the lung known as the alveolar capillary membrane 3. Adults have 300 to 600 million alveoli, with a total of 80 m2 surface area for oxygen molecules to diffuse across into the capillaries.

4. Blood from the right heart enters the pulmonary capillaries, high in carbon dioxide and low in oxygen.

5. Conversely, the concentration of carbon dioxide is low in the alveoli, and there is a large amount of oxygen.

6. Gas exchange takes place, and the pulmonary capillary blood increases in oxygen concentration, travels to the left heart to be circulated to the body.

I. Alveolar capillary membrane 1. First layer is the liquid surfactant layer that lines the alveoli a. Surfactant lowers surface tension, preventing the alveoli from collapsing. b. Lack of surfactant can cause stiff lungs that resist expansion. .

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c. Surfactant develops late in fetal development, thus premature babies may have inadequate surfactant levels. d. Artificial surfactant replacement therapy can instill surfactant into the lungs of premature babies to prevent collapse or rupture of alveoli.

2. Alveolar epithelium a. A tissue layer composed of simple squamous cells of two types i. Type I cells, thin pancakelike cells, squamous pneumocytes, allowing easy gas molecule movement ii. Type II cells, or plump granular pneumocytes, produce surfactant and aid in cellular repair iii. Type III cells, or wandering macrophages, ingest foreign particles as they wander through the alveoli b. Pores of Kohn are small holes between alveoli to allow movement of macrophages from one alveolus to another.

3. Interstitial space a. Separates the basement membrane of alveolar epithelium from the basement membrane of the capillary endothelium and contains interstitial fluid b. Space is so small that the membranes of the alveoli and capillary appear fused. c. If too much fluid gets into this space (interstitial edema) it separates, making it harder for gas exchange to occur.

4. The fourth component is the capillary endothelium.

V. Housing of the Lungs and Related Structures A. The lungs reside in the thoracic cavity and are separated by a region called the mediastinum, which contains the esophagus, heart, great vessels, and trachea.

B. Breathing in and out causes the lungs to move within the thoracic cavity.

C. To prevent irritation of the lungs moving against the thorax, each lung is wrapped in a sac, or serous membrane, called the visceral pleura.

D. The thoracic cavity and the upper side of the diaphragm are also lined with a similar membrane called the parietal pleura.

E. Between the two pleura is a pleural space (intrapleural space) that contains a slippery liquid called pleural fluid, reducing friction of breathing.

VI. Lungs A. Conical shaped with rounded peaks (apex) extending 1 to 2 inches above the clavicle B. The bases of the lungs rest on the right and left hemidiaphragm; the right lung base is a bit higher to accommodate the liver.

C. The medial surface of the lung has a deep, concave cavity that holds the heart, called the cardiac impression, which is deeper on the left.

D. The hilum is the area where the root of each lung is attached, containing the main bronchus, pulmonary artery and vein, nerve tracts, and lymph vessels E. The right lung has three lobes—upper, middle, and lower— divided by the horizontal and oblique fissures. .

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F. The left lung has only one fissure, the oblique fissure, and therefore has only two lobes—upper and lower.

G. The lingula is an area of the left lung that corresponds with the right middle lobe.

H. The left lung has only two lobes because the largest part of the heart is located in the left lung area.

I. The right lung is larger, with 66% of gas exchange occurring here.

VII. Protective Bony Thorax A. Bone and cartilaginous frame providing freedom of movement B. Rib cage, sternum, and thoracic vertebrae to which each rib attaches VIII. How We Breathe A. The respiratory control center is the medulla oblongata.

B. Inspiration is an active process in which the diaphragm is sent a signal via the phrenic nerve, causing it to contract and flatten and increasing thoracic cavity space.

C. The increase in thoracic cavity volume decreases pressure creating a lower pressure in the lungs than in the atmosphere, and air rushes into the lungs.

D. The external intercostal muscles also assist by moving the ribs up and outward to increase total volume in the thoracic cavity.

E. Exhalation is a passive act caused by a return of the diaphragm to a resting state, decreasing the space in the thoracic cavity, pushing air out.

F. Respiratory rate 1. Carbon dioxide levels in blood normally control respiratory rate.

2. If carbon dioxide levels rise in the blood, it means you are not ventilating, or “blowing off” enough CO2, and your medulla oblongata will send signals to the respiratory muscles to increase the rate and depth of breathing.

G. Accessory muscles 1. During increased activity, we need more oxygen and must move more air.

2. Accessory muscles are used to help pull up the rib cage to make an even larger space in the thoracic cavity.

3. Accessory muscles a. Scalene muscles in the neck b. Sternocleidomastoid c. Pectoralis major d. Pectoralis minor muscles H. Assisted exhalation 1. Although exhalation is usually passive, there are times when exhalation may need to be assisted, such as in certain diseases.

2. Accessory muscles of exhalation assist in more forceful and active exhalation by increasing abdominal pressure.

3. The main accessory muscles of exhalation are the abdominal muscles that push up the diaphragm and the back muscles that pull down and compress the thoracic cage.

IX. Pulmonary Function Testing A. Measures lung function in terms of volumes and capacities 1. Volumes actually measured 2. Capacities calculated from volumes .

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B. Measuring lung volumes 1. Patient is instructed to a. First, breathe normally b. Then, take a maximum deep breath followed by a maximum exhalation c. Various volumes are recorded while the patient is doing this 2. Lung volumes and capacities a. Tidal volume (VT)—the amount of air that moves into or out of the lungs in a normal breath b. Functional residual capacity (FRC)—The volume of air remaining in the lungs at the end of a normal expiration c. Inspiratory reserve volume (IRV)—The amount of air that can be forcefully inhaled after a normal inspiration d. Expiratory reserve volume (ERV)—The amount of air that can be forcefully exhaled after a normal expiration e. Residual volume—The volume of air remaining in the lungs after a maximum expiration f. Vital capacity—The maximum amount of air that can be moved into and out of the respiratory system in a single respiratory cycle C. Measuring flows 1. Important indicator of obstructive diseases 2. Total flows are measured, as are a. Peak flows b. Flows at various points of the exhalation X. Common Disorders of the Respiratory System A. Atelectasis 1. Atelectasis is a condition in which the air sacs of the lungs are either partially or totally collapsed.

2. The cause may be a patient who can’t, or won’t, take deep breaths to fully expand the lungs and keep the passageways open.

3. This can be due to surgery or thoracic cage injury.

4. Deep breathing is essential to the expansion of the airways and to the production of surfactant, which helps keep the small alveolar sacs open between breaths.

5. Patients who can’t cough up secretions are also at risk for atelectasis, and the buildup of secretions can lead to pneumonia within 72 hours.

B. Pneumonia 1. Pneumonia is a lung infection that is usually caused by bacteria, virus, or fungi.

2. Pneumonia results in inflammation of the infected area with an accumulation of cell debris and fluid.

3. Some pneumonias actually destroy lung tissue.

4. Severe pneumonia can result in death.

C. Chronic obstructive pulmonary disease (COPD) 1. COPD is a general disease resulting in difficulty evacuating air from the lungs, large amount of secretions, and lung damage. .

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2. COPD refers to one, or a combination, of the following a. Asthma i. A potentially life-threatening lung condition resulting in constriction of the airways, called bronchospasm ii. Difficult to get air in and even more difficult to get air out of the lungs, called gas trapping, resulting in an inability to get fresh, oxygenated air in; the patient breathes the same air repeatedly iii. Lower oxygen levels and increased carbon dioxide levels occur in the blood. iv. Inflammatory process causes increased secretions, blocking the airways (mucus plugging) and further reducing the passage of air to the alveoli. v. It can be reversed and managed with medications such as bronchodilators and steroids. b. Emphysema i. An irreversible condition in which the alveolar air sacs are destroyed ii. Damaged alveoli make gas diffusion difficult, if not impossible. iii. The lung itself becomes fragile and can easily rupture, like a worn tire. iv. Escaped air flows through the rupture into the thoracic cavity, further inhibiting gas exchange. v. Most common cause of emphysema is smoking. c. Chronic bronchitis i. A potentially reversible lung disease ii. Disease process includes inflamed airways and large amounts of sputum production. iii. As inflammation progresses, airways swell, and the inner diameter gets smaller, making air exchange difficult and increasing the work of breathing. iv. This causes increased oxygen use and increased carbon dioxide production.

D. Pneumothorax 1. A pneumothorax is a condition in which there is air outside the lungs, in the thoracic cavity.

2. Air can enter the thoracic cavity through a hole in the lung or in the thorax.

3. Causes include stab or gunshot wounds or disease processes that damage the lungs.

4. The air from the external environment fills the space meant for the lungs and prevents lung expansion required for breathing.

5. This can be a life-threatening condition and must be treated immediately with a chest tube, sucking the air from the thoracic cavity like a vacuum.

E. Pleural effusion 1. A pleural effusion is the buildup of fluid in the pleural space between the parietal and visceral pleura. .

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2. The fluid may be pus (empyema), serum from blood (hydrothorax), or blood (hemothorax).

3. Gravity tends to push fluids to the bases of the pleural space and can have the same effect as a pneumothorax, restricting lung expansion.

4. Pleural effusions can be treated with antibiotics or by inserting a needle into the collection of fluid and aspirating it.

F. Tuberculosis 1. Tuberculosis, or TB, is an infectious disease, thriving in high oxygen areas such as the lung.

2. TB bacteria can lay dormant for years before multiplying.

3. Unchecked, TB can cause massive lung damage.

4. TB is treated with medication, but there is concern about a new form of TB that is resistant to traditional medications.

G. Symptoms of lung disease 1. There are many symptoms of lung disease, but the most common include a. Dyspnea (difficulty breathing) b. Tachypnea (rapid respiratory rate) c. Cyanosis (a blue coloring to lips and nail beds) d. Retractions (use of accessory muscles of breathing) e. Tachycardia (rapid heart rate) f. Polycythemia (increased RBC count) H. Smoking 1. The major, preventable cause of respiratory disease is smoking 2. The annual number of smoking-related deaths in the United States is equal to a jumbo jet filled with passengers crashing with no survivors every day—450,000 people per year.

CLASSROOM ACTIVITIES 1. In pairs, have students count one another’s respiratory rate while sitting in class.

Next, have students exercise—jumping jacks, running a flight of stairs, for example.

Have them count one another’s respiratory rate after exercising. Have each pair share the respiratory rates before and after exercise. Why did the rates change, and what was going on in the lungs after exercising?

2. Play round robin. Have all the students stand up. Call on one student at a time to name a respiratory structure, in order, starting with the nose and ending with the alveolar-capillary membrane. Any student who cannot name the next structure must sit down. The last student, or students, standing are the winners.

TEACHING STRATEGIES 1. Name various respiratory disorders and ask students to state whether they are respiration or ventilatory problems. Each student must be able to defend his or her selection. .

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2. Have students put the entire picture together of the respiratory and cardiovascular systems. Have them trace the movement of oxygen through the respiratory system, into the cardiovascular system, to the tissues where oxygen is dispensed and carbon dioxide is collected, and then trace the path of the carbon dioxide until it is blown off by the respiratory system.

FACTOIDS 1. For us to speak, we must first expel air from the lungs using all the structures found in the lower airway. As air moves over the vocal cords, the vocal cords cut the air into a series of rapid puffs (ranging from 32 cycles per second for a low bass to 3,136 cycles per second for a high-pitched sound). Normal speaking range is 98 to 262 cycles per second. It is these puffs of air that make sound, not the vibration of the vocal cords— much like clapping your hands makes a noise. The columns of air created vibrate at a natural frequency. The shorter the pipe, the higher pitched the sound; in this case, the pipe is the passage from the larynx to the lips and works on much the same principle as blowing across the top of an open bottle—the shorter the bottle, the higher the pitch.

The length of the passage from larynx to lips creates tone of the voice. Finally, to form intelligible sounds, the tongue, lips, and mouth must move to turn the sound into recognizable words.

2. The lungs contain almost 1,500 miles of airways and 300 million alveoli. Every minute, you breathe in 13 pints of air. Humans breathe in air and breathe out carbon dioxide; plants take in carbon dioxide and release oxygen.

ETHICAL DILEMMA 1. When I worked in the neonatal intensive care unit, we had a baby born to a mother who had been smothered with a pillow by the baby’s father. The mother was brain dead but kept alive long enough to deliver her baby. If the mother’s brain was destroyed by lack of oxygen, what do you think happened to the baby, who also suffered from oxygen deprivation? Should the mother have been kept alive to deliver her baby, or should they both have been allowed to die together? As it turns out, the baby had almost continuous seizures because of brain damage, and it died within 24 hours of birth.

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 14–1 Answers, p. 339 1. d 2. a 3. c 4. c 5. d Test Your Knowledge 14–2 Answers, p. 343 1. d 2. d 3. c .

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4. d 5. b 6. b Test Your Knowledge 14–3 Answers, p. 350 1. d 2. b 3. a 4. d 5. a 6. a Test Your Knowledge 14–4 Answers, p. 356 1. b 2. d 3. d 4. d 5. c

ANSWERS TO THE CASE STUDY, P. 360 a. This could be an asthma flare-up, given his history, and also pneumonia because he has had a bad cold for several days. b. Medication to bronchodilate (open) the airways and fluids and oxygen for the cyanosis are indicated. If this is a bacterial pneumonia, antibiotics could also be indicated. c. Decrease in heart rate and breathing toward normal, decreased use of accessory muscles, improvement in skin color (less cyanosis), and less or a clearing of secretion production would suggest treatment was working.

ANSWERS TO REVIEW QUESTIONS, P. 361 Multiple Choice 1. d, 2. b, 3. b, 4. d, 5. c, 6. a Fill in the Blank 1. bronchioles 2. olfaction; phonation 3. cilia; sol; gel 4. sinuses 5. increase; in

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Short Answer 1. The inner layer of the bronchus is the epithelial layer, (mucociliary escalator or pseudostratified ciliated columnar cells). A middle layer contains smooth muscle, lymph, and nerves. The outer layer is the cartilaginous layer.

2. The blood entering the pulmonary capillaries from the pulmonary arteries is oxygen poor and carbon dioxide rich. The air in the alveoli is oxygen rich and carbon dioxide poor. So, there is net diffusion of oxygen from the alveoli into the capillaries and carbon dioxide from the capillaries into the alveoli down the concentration gradients for both chemicals. Thus oxygen enters the bloodstream, and carbon dioxide leaves the bloodstream in the lungs.

3. Surfactant is vitally important. It prevents collapse and adhesion of alveoli when air leaves the lungs. Without surfactant, alveoli would quickly become damaged. Surfactant also prevents overexpansion of the alveoli during inspiration.

4. A nerve impulse is sent from the medulla oblongata down the spinal cord to the phrenic nerve to the diaphragm. The diaphragm contracts. When the diaphragm contracts, it flattens, increasing thoracic and lung volume. When the volume increases, the pressure in the lungs decreases to lower than atmospheric pressure. Air flows down the pressure gradient into the lungs. This is the mechanism of inspiration. It is an active process, requiring contraction of the diaphragm. Expiration is a passive process. When the nerve impulse shuts off, the diaphragm contracts, decreasing the volume and increasing the pressure in the lungs. Air is pushed out of the lungs by this increased pressure.

5. The wall of the tracheobronchial tree has three major changes as you move from conducting to respiratory zone. The amount of cartilage decreases, the epithelium changes from respiratory mucosa, to cuboidal epithelium to simple squamous epithelium, and the amount of smooth muscle decreases. There is no cartilage or smooth muscle in the respiratory zone.

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Name___________________________________________________ CHAPTER 14 – WORKSHEET Matching Please match each term with the appropriate description.

1) _____ Pharynx 2) _____ Larynx 3) _____ Epiglottis 4) _____ Trachea 5) _____ Bronchi 6) _____ Bronchioles 7) _____ Alveoli 8) _____ Turbinates 9) _____ Pleura 10) _____ Nasal cavity 11) _____ Diaphragm A. The airway that extends from the larynx to the bronchi B. The membrane that surrounds the lungs, decreasing the friction of breathing C. Very small airways D. The air sacs at the terminal ends of the airways E. The throat F. Warms and moistens inhaled air; region that detects smells G. The primary muscle of breathing H. The voice box I. The large airways that branch off of the trachea J. A flap of cartilage that closes off the airways during swallowing K. Three scroll-like bones that split inhaled air into several smaller channels causing turbulent flow Multiple Choice 12) This portion of the pharynx connects to the nasal cavity and contains the adenoids.

A) Oropharynx B) Nasopharynx C) Laryngopharynx D) Hypopharynx 13) This portion of the pharynx connects to the mouth.

A) Oropharynx B) Nasopharynx C) Laryngopharynx D) Hypopharynx 14) This portion of the nasal cavity is responsible for detecting smells.

A) Respiratory region B) Olfactory region C) Vestibular region D) Palatine region .

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Worksheet – p. 1 of 3 15) This portion of the nasal cavity contains coarse hairs that filter out particles.

A) Respiratory region B) Olfactory region C) Vestibular region D) Palatine region 16) This process involves moving air in and out of the lungs.

A) Respiration B) Ventilation C) Annihilation D) Gas exchange 17) The process of involves exchanging oxygen and carbon dioxide with the bloodstream.

A) Respiration B) Ventilation C) Annihilation D) Consumption Fill in the Blank 18) The process where oxygenated blood exchanges gases with the tissues is called _____.

19) The _____ is the point where the trachea bifurcates, forming the bronchi.

20) _____ is a phospholipid that lowers the surface tension of the alveoli, preventing them from collapsing.

21) Normally, breathing rate is determined by the level of _____ in the blood.

Short Answer/Essay 22. Explain how the mucociliary escalator helps prevent foreign material from getting into the lungs. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 23. Which phase of breathing (inhalation or exhalation) is considered active? Which phase is considered passive? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 24. Describe the process of inhalation (in other words, describe the changes in the body that result in inspiration). ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Worksheet – p. 2 of 3 .

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25. Describe the process of exhalation (in other words, describe the changes in the body that result in exhalation). ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Worksheet – p. 3 of 3

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ANSWER KEY Chapter 14 – Worksheet 1) E 2) H 3) J 4) A 5) I 6) C 7) D 8) K 9) B 10) F 11) G 12) B 13) A 14) B 15) C 16) B 17) A 18) internal respiration 19) carina 20) Surfactant 21) carbon dioxide 22) Mucus is sticky and traps foreign particles. Then the cilia sweep the mucus out and away from the lungs.

23) Inhalation is active. Exhalation is passive.

24) Inhalation begins when signal is sent through the phrenic nerve, triggering the diaphragm to contract. As the diaphragm contracts, it flattens, increasing the volume of the chest cavity. This causes the pressure to drop inside the chest cavity, and air rushes in.

25) Exhalation begins when the diaphragm relaxes, resuming its resting dome shape.

The elastic tissue of the lungs also recoils. Together, these actions make the chest cavity smaller. The pressure inside the chest cavity rises, and air is forced out.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_____________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 15

THE LYMPHATIC AND IMMUNE SYSTEMS: YOUR DEFENSE SYSTEMS

LEARNING OBJECTIVES ➯ List and describe the major components of the immune system and their function(s) ➯ Explain the antigen–antibody relationship ➯ Name and describe the functions of the blood cells responsible for protecting the body from invasion ➯ Discuss how inflammatory responses and fevers relate to infection ➯ Compare innate immunity to adaptive immunity ➯ Describe the function of lymphocytes and helper cells in the immune response ➯ List and describe several common diseases of the immune system

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Allergic Rhinitis 2. Leukemia 3. Lymphatic Drainage Massage Therapy 4. Nuclear Medicine Professional Profile 5. Pharmacy Professional Profile 6. Proper Hand Washing Technique 7. Treatment of Severe Allergic Reactions with the EpiPen Animations 1. Anaphylaxis 2. Fever 3. The Lymphatic System

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Name____________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. The immune and lymphatic systems work to protect the body from pathogens that can produce disease.

B. Without these systems, the body cannot survive for long.

C. If pathogens try to enter the body, they must first get past the barriers, such as intact skin and the secretions of mucous membranes.

D. If the pathogen does get into the body, the body recognizes it as not belonging.

E. This stimulates a series of responses to neutralize the pathogen.

F. Weapons include special cells and powerful chemicals of the immune and lymph systems.

G. Chemicals stimulate inflammatory and cleanup responses.

II. Lymphatic System A. Transport system and barracks of the immune system B. Works closely with the cardiovascular system C. Four functions 1. Recycling fluids lost from the cardiovascular system 2. Transporting pathogens to the lymph nodes where they can be destroyed 3. Storage and maturation of some types of white blood cells 4. Absorption of glycerol and fatty acids from food D. Structures of the lymphatic system 1. Lymph capillaries: smallest pipes in system a. Parallel to blood capillaries b. Lymph capillaries form a network between cells of connective tissues. c. Filled with lymphatic fluid, or simply lymph d. Empty into lymphatic vessels 2. Lymphatic vessels a. Similar to veins and have valves b. Body movement and contraction of smooth muscles propel lymph through the system. c. Large lymphatic vessels empty into lymph nodes.

3. Lymph nodes a. Are small—encapsulated bodies divided into sections b. Range in size from as small as a pinhead to as large as an olive c. Many lymph vessels empty into each node. d. Consist of sections of lymphatic tissue containing WBCs known as lymphocytes e. Lymphatic tissue is surrounded by lymphatic sinuses filled with lymph fluid. f. Filter and destroy pathogens using the WBCs g. Concentrated in the cervical, axillary, inguinal, pelvic, abdominal, thoracic, and supratrochlear areas; adenoids and tonsils, the spleen, and the thymus also contain lymph tissue

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4. Lymphatic trunks a. Lymphatic vessels exiting lymph nodes empty into one of several lymphatic trunks. b. Named for their location, they include the lumbar, intestinal, intercostal, bronchomediastinal, subclavian, and jugular trunks. c. Empty into one of two collecting ducts 5. Collecting ducts a. Lumbar, intestinal, and intercostal trunks empty into the thoracic duct, a large duct that runs from the abdomen up through the diaphragm and into the left subclavian vein; more than two-thirds of the lymphatic system drains into this duct. b. Bronchomediastinal, subclavian, and jugular trunks empty into the right lymphatic duct, a smaller duct within the right thorax, which empties into the right subclavian vein.

6. The circulation of lymphatic fluid follows this pattern, beginning and ending in the bloodstream. a. Blood to tissue b. Tissue to lymphatic capillaries c. Lymphatic capillaries to lymphatic vessels d. Lymphatic vessels to lymph nodes e. Lymph nodes to lymphatic vessels f. Lymphatic vessels to lymphatic trunks g. Lymphatic trunks to collecting ducts h. Collecting ducts to subclavian veins, reentering the bloodstream 7. Cancer a. Cancer cells spread around the body via the lymphatic system. b. Stages i. No spread from origin ii. Spread to local tissues iii. Spread to lymph nodes and/or blood iv. Spread to distant organs 8. Spleen a. A spongy organ in the upper left quadrant of the abdomen b. Blood sinuses surround islands of white pulp containing lymphocytes and islands of red pulp containing both RBCs and WBCs. c. Spleen functions to remove and destroy old, damaged, or fragile RBCs. d. Also filters pathogens from bloodstream and destroys them e. Not an essential organ and can be surgically removed; removal in children can severely compromise immunity but has far less effect on adults.

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9. Thymus a. Soft organ located between the aortic arch and sternum b. Very large in children because of all the new infections it must handle c. Gets smaller or even disappears in adults as the immune system fully matures in its ability to fight infection d. Packed with lymphocytes, which mature into a type of WBC called a T lymphocyte e. Also secretes a hormone that stimulates maturation of the T lymphocytes in lymph nodes III. Immune System A. The immune system provides the weapons and the troops to protect the body from invasion B. It consists of cells, chemicals, and barriers that protect against pathogens C. Some processes are active, some passive, some inborn, and others change with experience.

D. Antigens 1. Cell surface identification molecules 2. Each living thing has unique cell surface antigens.

3. Self- and non-self-recognition are the heart of how the immune system functions.

4. A well-functioning immune system ignores self-antigens and attacks non-self antigens.

E. Antibodies 1. Proteins that bind to antigens, eventually destroying them 2. One of the most potent weapons of the immune system 3. Antibodies are called into action when a foreign antigen invades the body.

F. Innate immunity 1. Front line of defense against invasion 2. Body’s inborn ability to fight infection 3. Prevents invasion, or if the invasion occurs, it takes steps to prevent the spread of infection 4. Can recognize non-self but cannot specifically identify invaders 5. Collection of crude mechanisms, like weapons of mass destruction, killing pathogens and healthy tissue alike G. Adaptive immunity 1. Targets specific invaders and spares healthy tissue as much as possible 2. Remembers invaders from previous encounters and prepares for future invasion, improving the response with experience by learning and changing 3. Works together with innate immunity.

IV. Components of the Immune System A. Physical barriers exist to act as first-line defense.

1. Anything that prevents invaders from getting inside the body prevents infection.

2. Physical barriers are located in areas most likely to be invaded. .

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3. Skin and the mucous membranes of the eyes, digestive, respiratory, and reproductive systems 4. These surfaces are difficult to penetrate and are packed with WBCs and lymph capillaries to trap invaders.

5. Fluids associated with physical barriers, including tears, saliva, urine, mucous secretions, and sweat, contain chemicals that act as barriers.

6. Barriers are part of innate immunity.

B. WBCs (leukocytes) 1. Responsible for defending against invaders 2. Originate in the bone marrow; move to other parts of the body 3. Not released into the bloodstream until they are needed 4. Types of WBCs a. Polymorphonuclear granulocytes: cells with granules in their cytoplasm i. Neutrophils a. Phagocytosis b. Born in the bone marrow and are the most common leukocyte in the bloodstream c. First responders at the site of invasion, cleaning up the area by ingesting pathogens and releasing chemicals that increase tissue damage and inflammation, stimulating immune response d. Neutrophils are part of innate immunity. ii. Basophils a. Release chemicals to promote inflammation b. Enter infected tissue from the bloodstream c. Numbers are low unless an active infection is present d. Mast cells are not mobile and are stationed throughout the body, always found in connective tissue, and when stimulated they release chemicals. e. Basophils and mast cells are part of innate immunity. iii. Eosinophils a. Break down the chemicals released by basophils and mast cells, reducing inflammation b. Numbers are generally low unless an infection or allergy is present c. Play a part in fighting infection from parasitic worms d. Eosinophils are part of innate immunity. b. Agranulocytes, or mononuclear cells: cells with no granules in their cytoplasm i. Macrophages a. Modified monocytes, a type of agranulocyte, which leave the bloodstream and enter tissues b. Phagocytic, active in the later stages of an infection c. Macrophages release chemicals that stimulate the immune system .

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d. Display antigens e. Part of innate immunity; trigger adaptive immunity ii. Dendritic cells a. Modified monocytes b. Weakly phagocytic c. Most important role of dendritic cell is as antigendisplaying cell (ADC) i. Ingest foreign cells, placing the foreign antigens into their cell membrane, then cruise the lymph nodes displaying the foreign antigen, looking for lymphocytes that match the antigen ii. This is an important trigger of adaptive immunity. iii. ADCs are the red flags that alert adaptive immunity to respond. iii. Lymphocytes a. Natural killer (NK) cells i. Part of innate immunity ii. Releases chemicals to kill any cells displaying foreign antigens—pathogenic or your own cells iii. NK cells wipe out any infected cell in the body. b. T lymphocytes i. Type of adaptive immunity called cell mediated immunity ii. Kill infected cells and release immune stimulating chemicals iii. Helper T cells activate parts of adaptive immunity iv. Regulatory T cells regulate immune response v. Memory T cells remember pathogens after exposure c. B Lymphocytes i. Responsible for the part of adaptive immunity; antibody-mediated immunity ii. Plasma cells produce antibodies to non-self antigens iii. Memory B cells remember pathogens C. Chemicals 1. Cytokines a. Proteins produced by damaged tissues and WBCs b. Stimulate immune response; increasing inflammation, stimulating lymphocytes, and enhancing phagocytosis c. Involved in both innate and adaptive immunity 2. Interferon a. A cytokine produced by cells that have been infected by a virus b. Binds to neighboring, uninfected cells and stimulates them to produce chemicals that may protect these cells from viruses .

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c. Has also had some success as an anticancer drug, but is still experimental 3. Tumor necrosis factor (TNF) a. A cytokine produced by WBCs that stimulates macrophages b. Causes cell death in cancer cells c. New classes of drugs that inhibit TNF have been successful in treating rheumatoid arthritis.

4. Interleukins a. Many cytokines are types of molecules called interleukins. b. At least 10 interleukins are involved in nearly every aspect of innate and adaptive immunity c. Have been used with moderate success to treat some forms of cancer 5. Complement cascade a. A complex series of reactions that activates 20 proteins that are usually inactive unless activated by a pathogen invasion b. Cause lysis of bacterial cell membranes, stimulation of phagocytosis, attraction of WBCs to site of infection, clumping of cells with foreign antigens, and alteration of the structure of viruses c. Complement cascade is part of both innate and adaptive immunity.

D. Inflammation 1. The inflammatory response is a familiar weapon.

2. Symptoms include pain, swelling, heat, and redness.

3. Deliberate action of the body in response to any tissue damage 4. Response helps to wall off the damaged area to prevent further spread and allow the battle to focus at this site—called margination.

5. When tissue is damaged, cells release histamine, a cytokine, that attracts WBCs to the site, increases the permeability of capillaries, and causes local vasodilation; extra fluid causes swelling.

6. More blood comes to the site, causing heat.

7. WBCs destroy pathogens and clean away dead cells.

8. Increase in fluid and cells in the area increases pressure and creates pain.

9. Inflammation is an innate immune mechanism but plays an important part in adaptive immunity.

10. Inflammation is a two-edged sword; too much inflammation, particularly in closed spaces, can cause more tissue damage than the original injury or infection.

11. Widespread inflammation, called anaphylaxis, can be fatal.

E. Fever 1. Immune system releases cytokines that promote inflammation and immune response 2. One of the cytokine targets in the brain is the hypothalamus, responsibleor setting and maintaining body temperature.

3. Effect of cytokine is elevated temperature set point, or a fever.

4. Rise in body temperature is a deliberate attempt by immune system to destroy pathogens by “baking” them out. .

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V. Innate Immunity A. First, the pathogen must get past physical and chemical barriers; most pathogens are kept out.

B. The presence of a foreign antigen is detected by neutrophils, which ingest the foreign antigen, destroying it and releasing chemicals that attract other WBCs to the site of infection, stimulating inflammation.

C. The release of cytokines and stimulation of inflammation attract macrophages and natural killer cells to the infection site.

D. Macrophages phagocytize infected cells, and NK cells use chemicals to destroy infected cells; both cells release chemicals to further stimulate inflammation, activate more immune cells, and trigger the complement cascade.

E. Pathogens are under attack from phagocytosis, noxious chemicals, membrane rupture, clumping, and even alteration of molecular structure.

F. Chemicals signal the hypothalamus to raise body temperature.

G. This is crude warfare, with innate immunity destroying anything non-self without surgical strikes or specific weapons, just a desperate attempt to defeat the invaders.

H. In some cases, this is enough, but often innate immunity is buying time for adaptive immunity.

I. Innate immunity stimulates adaptive immunity.

J. When phagocytic cells ingest pathogens, they display the foreign antigen on their cell membrane, essential to activate B and T cells.

VI. Adaptive Immunity A. Adaptive immunity fights pathogens specifically.

B. This part of the system has memory, learns from experience, and recognizes specific pathogens.

C. B and T lymphocytes remember pathogens and mount specific responses to those pathogens if they meet again.

D. Because of adaptive immunity, immunizations are able to prevent illness.

E. Innate and adaptive immunity work hand in hand, each needing the other to function effectively.

F. To function, lymphocytes must be able to recognize pathogens and to ignore the body’s own tissues G. Lymphocytes must be selected through positive or negative selection.

1. Positive selection a. Lymphocytes that recognize and bind to antigens are allowed to survive. b. Lymphocytes that don’t do this do not survive.

2. Negative selection a. Some lymphocytes recognize and bind to the body’s own antigens and must be destroyed before they can destroy healthy cells. b. Negative selection is the destruction of self-recognizing lymphocytes.

3. Lymphocytes develop, mature, and are selected when you are young; they begin as undifferentiated cells with the potential to become anything. a. During the maturation process, they become differentiated, growing to be specialized cells with a special function. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Undifferentiated lymphocytes are produced in the bone marrow, and some migrate to the thymus, destined to become T cells. c. Other lymphocytes develop and mature in the bone marrow to become B cells. d. Lymphocytes, once specialized, wait in the lymph node for a pathogen they recognize. e. They can remain in suspended animation for a long time.

H. Lymphocyte activation, wake-up call for lymphocytes 1. When the innate immune system phagocytizes infected cells, the pathogen’s antigens are displayed on the outside of the cell, making them visible to specialized lymphocytes that then become activated and destroy them.

2. This is the beginning of adaptive immunity.

I. Lymphocyte proliferation, production of lymphocytes 1. Only a few lymphocytes recognize each pathogen, but hundreds of thousands are needed to attack an infection.

2. There are two types of proliferation. a. Proliferation of helper T cells i. Helper T cells help other lymphocytes, so there must be many of these cells before other lymphocytes are activated. ii. Helper T cells are stimulated to divide by binding to antigenpresenting cells and by stimulation by cytokines. b. Helper T cells continue to divide, then help the proliferation of B cells and other types of T cells. c. AIDS i. Caused by HIV infection of helper T cells ii. Causes a failure of activation and proliferation of both B and T cells J. Lymphocyte activity 1. B cells a. Antigen-displaying cells send out a signal calling for the weapons of adaptive immunity. b. B cells are responsible for antibody-mediated immunity, fighting pathogens by making and releasing antibodies to attack a specific pathogen. c. B cells develop into plasma cells and memory B cells; antibodies are made by plasma cells and released into the bloodstream. i. Primary response a. Antibodies bind to antigens of infecting cells, destroying the pathogen by inactivating the antigen, causing clumping of antigens, activating complement cascade, and releasing chemicals to stimulate the immune system and enhance phagocytosis. b. Antibody-mediated mechanisms destroy pathogens and further stimulate both adaptive and innate immunity, .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

continually increasing response to pathogens until they are all destroyed. ii. Secondary response a. Memory B cells are stored in lymph nodes until they are needed. b. Memory cells mount a faster response if exposed to a pathogen seen before. c. Responsible for the immune system’s ability to improve with experience 2. T cells (four types) a. Helper T cells b. Cytotoxic T cells i. Activity of cytotoxic T cells is known as cellmediated immunity because the cytotoxic T cells are responsible for the death of pathogens or pathogen-infected cells directly. ii. Cytotoxic T cells release a cytokine called perforin, which causes infected cells to develop holes in their membranes and die. iii. Cytotoxic T cells also release other cytokines that stimulate both innate and adaptive immunity, especially attracting macrophages to the site of infection to dispose of cellular debris. iv. Response of cytotoxic T cells is the primary response of cellmediated immunity. v. Some T cells give rise to memory T cells. c. Regulatory T cells i. Immunity is controlled largely by positive feedback, so something must act to turn off the response when the threat is over. ii. Regulatory T cells are the off switch for the immune system. iii. Regulatory T cells are not fully understood and were discovered only recently. iv. Evidence suggests they directly inhibit B cells and cytotoxic T cells, releasing cytokines that decrease immune and inflammatory response. v. Malfunction of regulatory T cells is implicated in some types of allergy, asthma, and autoimmune diseases. d. Memory T cells i. Help to recognize the infection upon reexposure K. Acquiring immunity 1. Natural active immunity: creation of memory cells resulting from actual infection 2. Artificial active immunity: creation of memory cells resulting from vaccination (deliberate exposure to weakened pathogen) 3. Natural passive immunity: immunity transferred across the placenta during fetal development 4. Artificial passive immunity: a patient is injected with antibodies for a pathogen VII. Putting the Immunity Picture Together .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

A. An army of pathogens wants to invade your body.

B. First, they must get past the body’s barriers.

C. If they enter the body, immune cells (neutrophils, macrophages, basophils, etc.) are stimulated and chemicals (cytokines) are released that stimulate inflammation and phagocytosis.

D. Macrophages and other cells that have ingested some of the invaders are now wering foreign antigens, move to the lymphatic system, and search the lymph nodes for T and B cells that will recognize the intruder.

E. Helper T cells are activated and cause the proliferation of B cells and cytotoxic T cells, as well as releasing chemicals to further stimulate phagocytosis and inflammation.

F. B cells produce antibodies that destroy invaders and further stimulate immune response.

G. Cytotoxic T cells destroy invaders directly and release chemicals that further stimulate immune response.

H. Immune response, both innate and adaptive, will continue to be stimulated until the feedback loop is stopped, at least in part by regulatory T cells.

I. Memory B cells and T cells will be stored in lymph nodes for later use if another army of these same types of pathogens invade J. Macrophages and other phagocytic cells will clean up the debris left by the warfare waged by the immune system, and the body will return to normal.

VIII. Disorders of the Immune System A. Immunodeficiency disorders 1. Patients with any of several different types of immunodeficiency disorders have underactive immune systems.

2. The immune system doesn’t respond properly to invasion and doesn’t protect patients from infection.

3. Minor infections can be fatal; clients get ill very easily and recover slowly.

4. Causes of immunodeficiency can be chemicals, viruses, genetics, radiation exposure, or even medications.

5. Immune-compromised clients include those with AIDS, SCID, leukemia, and some anemias; chemotherapy patients; and those taking immune-suppressing medications after organ transplants.

B. Autoimmune disorders 1. Autoimmune disorders are the opposite of immunodeficiency disorders, occurring when the immune system attacks some part of the body.

2. The body fails to ignore self and destroys its own tissues.

3. There are hundreds of different disorders, each affecting a different system.

4. Treatment is frequently with immunosuppressant drugs, but they may not be successful, and side effects can be severe.

5. Examples of autoimmune disorders a. Rheumatoid arthritis (joint linings) b. Multiple sclerosis (myelin sheath in CNS) c. Lupus erythematosus (every tissue, perhaps DNA) d. Type 1 diabetes (beta cells in pancreas) .

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e. Myasthenia gravis (acetylcholine receptors in skeletal muscle) f. Graves’ disease (thyroid gland) g. Addison’s disease (adrenal gland) C. Hypersensitivity reactions 1. Hypersensitivity reactions, or allergies, occur when the immune system mounts an overactive response to a foreign antigen, often treating a harmless antigen like an invading pathogen.

2. Local hypersensitivity reactions, such as hay fever, hives, or rashes, are generally mild and not life threatening (asthma is a local reaction but is more serious).

3. Systemic hypersensitivity reactions, or anaphylaxis, are life threatening because mast cells and basophils release immunestimulating chemicals throughout the body, causing vasodilation and leading to dangerously low blood pressure and heart failure.

4. Hives and asthma may also accompany anaphylactic reactions.

CLASSROOM ACTIVITIES 1. Assign each student a part of the immune system. For instance, one person could be a B lymphocyte, one person could be a T lymphocyte, and so on. Select a few students to play the role of a pathogen. Have students act out the events that occur within the immune system when a pathogen attempts to invade. One student could play the skin, trying to keep a pathogen from getting by. When the pathogen manages to get past the barrier, other students could demonstrate attempts to neutralize the pathogen.

2. Have students trace the flow of lymph from the time fluid leaks from the blood vessels until it is returned to the bloodstream.

TEACHING STRATEGIES 1. The immune system is so complex, it can be difficult to help students understand how all the components function together. To understand how the system works together, it is vital they first understand each individual component then understand that one component does not function alone; rather, immunity occurs because all the components work to complement one another.

2. Once the lymph and immune systems are understood, revisit the lymph system to help students see how it contributes to the immune system.

FACTOIDS 1. The lymphatic system is not a closed system, has no central pump, and functions as a low-pressure system. As a result, lymph fluid circulates very slowly and is somewhat dependent on muscle contraction and gravity to move it through the system. Rhythmic contractions of the lymph vessel walls also help draw fluid into the lymphatic capillaries.

2. Scientists at the Salk Institute have discovered a molecule named “survivin,” which presents in a lot of cancer cells. It is believed responsible for turning normal cells into .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

cancer cells without invoking the immune system. It will likely be a focus of future pharmacology because survivin seems to be responsible for allowing cancer cells to survive and multiply.

ETHICAL DILEMMAS 1. If a patient with HIV develops cancer of an organ, should he or she receive an organ transplant? Some people believe that organs for transplantation should be reserved for those people with the longest life expectancy, others feel that HIV patients cannot survive the immunosuppression that is required for transplant recipients, while still others feel that organ transplantation should be an option for HIV patients.

2. You are caring for a 29-year-old woman who is diagnosed with Hodgkin’s lymphoma.

It is an early-stage diagnosis, and the doctor states the chance of recovery is greater than 90%. The doctor outlines the treatment plan so the client fully understands the procedures and risks. She says she does not wish to undergo treatment and prefers to let God heal her. The doctor explains there is almost a certain prognosis of death if she doesn’t receive treatment. The client says she will take her chances. What are your ethical obligations to this patient?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 15–1 Answers, p. 370 1. d 2. d 3. c 4. b 5. b 6. d 7. b Test Your Knowledge 15–2 Answers, p. 372 1. b 2. d 3. c 4. c Test Your Knowledge 15–3 Answers, p. 376 1. d 2. c 3. d 4. d 5. c Test Your Knowledge 15–4 Answers, p. 383 .

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1. a 2. b 3. c 4. b Test Your Knowledge 15–5 Answers, p. 387 1. c 2. c 3. a 4. c ANSWERS TO THE CASE STUDY, P. 391 The doctor might initially suspect that John has AIDS because John has a mysterious illness and is a former IV drug user. AIDS is ruled out because John’s Tcell count is normal. However, increased neutrophil, basophil, and eosinophil concentrations suggest an infection or allergy. Given John’s symptoms, the doctor should expect a sinus infection secondary to allergic rhinitis (hay fever).

ANSWERS TO REVIEW QUESTIONS, P. 392 Multiple Choice 1. d, 2. b, 3. a, 4. b, 5. b, 6. d, 7. b Fill in the Blank 1. adaptive or acquired 2. NK cells 3. helper T cells 4. mast cells 5. Positive 6. allergies (hay fever) Short Answer 1. The regions of the body containing lymph nodes are cervical, axillary, inguinal, pelvic, abdominal, thoracic, and supratrochlear areas. Adenoids and tonsils, the spleen, and the thymus also contain lymph tissue.

2. The circulation of lymphatic fluid follows this pattern: blood to tissue, tissue to lymphatic capillaries, lymphatic capillaries to lymphatic vessels, lymphatic vessels to lymph nodes, lymph nodes to lymphatic vessels, lymphatic vessels to lymphatic trunks, lymphatic trunks to collecting ducts, collecting ducts to subclavian veins, reentering the bloodstream. Thus, lymph fluid starts in the bloodstream and ends in the bloodstream after being filtered.

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3. Neutrophils: perform phagocytosis, ingest pathogens and cellular debris, and release chemicals that increase tissue damage and inflammation, stimulating immune response.

Basophils: release chemicals to promote inflammation. Eosinophils: counteract the activities of basophils and mast cells, breaking down the chemicals released by basophils and mast cells, thereby reducing inflammation. Macrophages: phagocytic, active in the later stages of an infection; release chemicals that stimulate the immune system. Dendritic cells: weakly phagocytic, antigen-displaying cell (ADC); ingest foreign cells, placing the foreign antigens into their cell membrane, then cruise the lymph nodes displaying the foreign antigen, looking for lymphocytes that match the antigen. Natural killer cells: releases chemicals to kill any cells displaying foreign antigens, pathogenic or the body’s own. T lymphocytes: cell-mediated immunity. Cytotoxic T cells: kill infected cells and release immune-stimulating chemicals. Helper T cells: activate parts of adaptive immunity. Regulatory T cells: regulate immune response. Memory T cells: remember pathogens after exposure. B lymphocytes: antibody-mediated immunity.

Plasma cells: produce antibodies to non-self antigens. Memory B cells: remember pathogens.

4. Innate immunity is inborn. It cannot recognize specific pathogens or remember pathogens it has encountered before. Adaptive immunity recognizes specific pathogens and remembers pathogens once exposed. The ability to remember specific pathogens allows adaptive immunity to improve with experience. Adaptive immunity mounts a stronger, faster response the second time it meets a pathogen.

5. Anti-inflammatory medications decrease inflammation. Inflammation is an important part of innate immunity, and chemicals released during inflammation stimulate adaptive immunity as well. Without inflammation, then, immune response is decreased.

6. Leukemia and lymphoma often result in large numbers of immature, ineffective white blood cells. These ineffective WBCs crowd out mature WBCs, decreasing immune response. Chemotherapy drugs often target rapidly dividing cells. WBCs are rapidly dividing cells. Thus, some forms of chemotherapy decrease the numbers of WBCs available to fight infection.

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Name___________________________________ CHAPTER 15 – WORKSHEET Multiple Choice 1) The smallest lymphatic vessels are called A) lymph trunks.

B) lymph capillaries.

C) lymph ducts.

D) microlymphatics.

2) This lymphatic vessel empties directly into the left subclavian vein.

A) Thoracic duct B) Right lymphatic duct C) Lymph capillary D) Lymph trunk 3) This is a spongy organ located in the left upper quadrant of the abdomen.

A) Thymus B) Tonsils C) Spleen D) Adenoids 4) This organ gets smaller with age and may even disappear in adults.

A) Thymus B) Tonsils C) Spleen D) Adenoids 5) Imagine that you are a drop of lymph moving through the lymphatic system. Which of the following correctly traces your path from the tissues to the bloodstream?

A) Thoracic duct, lymph node, lymph capillary, subclavian vein, lymphatic vessel B) Lymph capillary, lymphatic vessel, lymph node, lymphatic vessel, lymph trunk, thoracic duct, subclavian vein C) Lymph trunk, lymph capillary, subclavian vein, lymphatic vessel, lymph node, thoracic duct, subclavian vein D) Lymph capillary, subclavian vein, lymph node, lymphatic vessel, lymph trunk, thoracic duct 6) _____________ are chemicals produced by damaged tissues and WBCs that stimulate the immune response.

A) Cytokines B) Antigens C) Adenoids D) Lymphatics 7) Symptoms of _____________ include pain, swelling, redness, and heat.

A) HIV B) inflammation C) lymphoma D) leukemia .

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Worksheet – p. 1 of 3 Fill in the Blank 8) _____________ are molecules on the outer surface of a cell that identify it as being “friend or foe.”

9) _____________ are proteins produced by the body that bind to foreign cells/substances.

10) _____________ immunity is the body’s inborn ability to fight infection.

11) _____________ immunity targets specific invaders and is able to remember them in case of future invasion.

12) The _____________ cascade is a complex series of reactions that activates several different pathogen-fighting proteins in the blood.

Matching Match each of the following organs with the appropriate description.

13) _____ Lymph node 14) _____ Spleen 15) _____ Tonsils 16) _____ Thymus A. Structures in the throat that contain lymphatic tissue B. Secrete(s) a hormone that helps T lymphocytes mature C. Filters pathogens out of lymph D. Remove(s) old, damaged RBCs and filters pathogens from bloodstream Match each type of cell with the appropriate function.

17) _____ Neutrophil 18) _____ Basophils and mast cells 19) _____ Macrophages 20) _____ T lymphocytes 21) _____ B lymphocytes A. Release chemicals like histamine that promote inflammation B. Directly kill infected cells and remember past infections C. Release antibodies and remember past infections D. Perform phagocytosis early in infection E. Perform phagocytosis later in infection; display foreign antigens to stimulate other cells in the immune system Short Answer/Essay 22. List four functions of the lymphatic system. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Worksheet – p. 2 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

23. List three chemicals that are types of cytokines. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 24. List three ways the complement cascade is helpful in fighting infection. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 25. Describe the four different stages of cancer. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 15 – Worksheet 1) B 2) A 3) C 4) A 5) B 6) A 7) B 8) Antigens 9) Antibodies 10) Innate 11) Adaptive 12) complement 13) C 14) D 15) A 16) B 17) D 18) A 19) E 20) B 21) C 22) Recycling fluids lost by the cardiovascular system; transporting pathogens to lymph nodes for destruction; storage and maturation of some WBCs; absorption of glycerol and fatty acids from food 23) Interferon, tumor necrosis factor (TNF), interleukins 24) Answer may include: lysis of bacterial membranes; attracting WBCs to the site of infection; stimulating phagocytosis; clumping of cells with foreign antigens; alteration of virus structure 25) Stage 1—no spread; stage 2—spread to local tissues; stage 3—spread to lymph nodes; stage 4—spread to distant organs

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 16

THE GASTROINTESTINAL SYSTEM: FUEL FOR THE TRIP

LEARNING OBJECTIVES ➯ Locate and describe the functions of the main organs of the digestive system ➯ Locate and describe the functions of the accessory organs of digestion ➯ Differentiate between ingestion and digestion and between chemical and mechanical processing of food ➯ Trace the journey of a bolus of food from the mouth to the anus ➯ Discuss the structure of teeth ➯ Describe the various enzymes and chemicals needed for digestion ➯ Describe common disorders of the gastrointestinal system

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Anorexia 2. Bulimia 3. Dental Assistant and Dental Hygienist Professional Profile 4. Diabetes 5. Dietician Professional Profile 6. Eating Disorders 7. GERD Animations 1. Appendicitis 2. Swallowing a Bolus of Food 3. The Digestive System Interactive Activities 1. The Digestive System 2. The Intestinal Wall

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_____________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. The gastrointestinal system has the following functions.

1. Take in (ingest) raw materials 2. Break down (digest) raw material to usable elements a. Chemically b. Mechanically 3. Absorb elements.

4. Eliminate what isn’t usable.

B. These functions are accomplished through an array of amazing main and accessory organs, with food traveling through what is essentially a tube until waste products are eliminated.

C. The digestive tract, often called the alimentary tract or canal, is a muscular tube that contains the organs of digestion.

D. The tube begins with the mouth and ends at the anus.

E. Between these two points are the pharynx, esophagus, stomach, small intestine, and large intestine.

F. Accessory organs of digestion include the teeth, salivary glands, liver, pancreas, and gallbladder.

II. Functions of the Gastrointestinal Tract A. Ingestion (food enters the mouth) B. Mastication (mechanically grinding food with the teeth and tongue, beginning the process of physically breaking it down) C. Digestion (the chemical act of breaking down food into small molecules) D. Secretion (acids, buffers, enzymes, and water aid in the breakdown of food) E. Absorption (once food is broken down physically and chemically, it can be absorbed through the lining of the digestive tract) F. Excretion or defecation (elimination of waste products) III. Components of the GI Tract A. Mouth and oral cavity 1. Mouth leads to the buccal cavity.

2. Lips, or labia, act as the door to this cavity.

3. Hard and soft palates create the roof.

4. Tongue acts as the floor. a. The tongue is a muscular structure that provides taste stimuli to the brain, determines temperature, manipulates food, and aids in swallowing. b. As the tongue moves food around in the oral cavity, saliva is added to moisten and soften food, while teeth crush the food. c. The tongue pushes the food into a ball-like mass, called a bolus, so it may be swallowed or passed to the pharynx. d. The lingual frenulum, a membrane under the tongue, keeps you from swallowing your tongue and aids in speaking. e. The tongue’s base (area of attachment) and the uvula are barriers to the next part of the system, the pharynx. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. The uvula aids in swallowing, directing food toward the pharynx, and blocking food from entering your nasal cavity.

6. The cheeks form the walls of the buccal cavity.

7. This area receives, tastes, mechanically breaks down, and begins the process of chemical breakdown of food, adding liquid or saliva.

8. Salivary glands a. Controlled by the autonomic nervous system b. Large parotid salivary gland is found slightly inferior and anterior to each ear; swell when you get mumps. c. Ducts from these glands empty into upper portion of oral cavity. d. Smallest salivary glands, the sublingual glands, are under the tongue. e. Submandibular salivary glands are located along both sides of the inner surface of the mandible, or lower jaw.

9. Saliva a. Salivary glands produce 1 to 1.5 liters of saliva daily. b. Small amounts of saliva keep the mouth moist, but the idea or presence of food increases production significantly. c. Saliva is 99.4% water and contains antibodies, buffers, ions, waste products, and enzymes. d. Enzymes act as organic catalysts to speed up chemical reactions. e. One enzyme, salivary amylase, speeds chemical activity of carbohydrate breakdown. f. After eating, saliva cleans the oral surfaces, reducing the amount of bacteria that grows in the mouth.

10. Teeth a. A baby’s first teeth are the deciduous teeth, falling out in time. b. First tooth erupts around 6 months of age; lower central incisors grow first; all 20 are in place by 21/2 years. c. Between 6 and 12 years, deciduous teeth fall out and are replaced by 32 permanent teeth. d. Wisdom teeth appear by age 21. e. Types of teeth i. Incisors, located at the front of the mouth; blade-shaped; used to cut food ii. Canine teeth for holding, tearing, or slashing food; also known as eyeteeth or cuspids; located next to incisors iii. Bicuspids, or premolars; transitional teeth iv. Molars have flattened tops; bicuspid and molars crush and grind food. f. Structure of teeth i. Teeth have a crown, neck, and root. ii. Crown is visible and covered by the hardest biologically manufactured substance, enamel. iii. Neck is the transitional section that leads to the root. .

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iv. Most teeth are made up of dentin, mineralized bonelike substance. v. Next layer is connective tissue, pulp, located in the pulp cavity. vi. Pulp cavity contains blood vessels and nerves providing nutrients and sensation; nerves and blood vessels get to the pulp cavity via the root canal. vii. Root is nestled in a bony socket and is held in place by fibers of the periodontal ligament. viii. Cementum covers dentin of root; helps secure periodontal ligament. ix. Cementum is a soft version of bone. x. Healthy gums, or gingiva, help hold teeth in place. xi. Epithelial cells form a tight seal around the tooth to prevent bacteria from coming into contact with the tooth’s cementum.

B. Pharynx 1. Three parts to the pharynx a. Nasopharynx is primarily part of the respiratory system, blocked by the soft palate. b. Oropharynx is located at the back of the tongue. c. Laryngopharynx is a passageway for food, water, and air.

2. The epiglottis covers the trachea to prevent food from entering the lungs, forcing food into the opening for the esophagus.

C. Esophagus 1. Esophagus is approximately 10 inches long and is connected to the stomach.

2. It extends from the pharynx, through the thoracic cavity, through the diaphragm, connecting to the stomach in the peritoneal cavity.

3. Esophagus is a collapsed tube until a bolus of food is swallowed.

4. Rhythmic contractions, called peristalsis, push food down the esophagus.

5. Esophageal walls are lined with stratified squamous epithelium that secretes mucus to make the walls slippery and resistant to abrasion, temperature extremes, and irritation.

6. A muscular ring at the top of the esophagus, called the pharyngoesophageal sphincter, relaxes to open the esophagus so food can enter.

7. At the entrance to the stomach is the lower esophageal sphincter, or cardiac sphincter, opening the door to the stomach and closing to prevent acidic gastric juices from splashing into the esophagus and causing heartburn.

8. The whole process of swallowing food takes about 9 seconds on average; fluid takes less time.

D. Walls of the alimentary canal from the esophagus onward 1. Innermost layer, the mucosa, lines the lumen of the canal a. Composed mostly of surface epithelium with some connective tissue and a thin, smooth muscle layer surrounding it b. Possesses cells that secrete digestive enzymes to break down food and goblet cells that secrete mucus for lubrication 2. Submucosa .

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a. Next layer, composed of soft connective tissue b. This layer contains blood vessels, lymph vessels, lymph nodes (called Peyer patches, similar to tonsils), and nerve endings.

3. Muscularis externa a. Composed of two layers of smooth muscle b. Innermost layer of muscle encircles canal; outer layer is longitudinal in nature, so it lies in the direction of the canal c. Stomach is surrounded by a third layer of oblique smooth muscle.

4. Serosa a. Outermost layer, composed of a single thin layer of flat, serous fluid producing cells supported by connective tissue b. Called the visceral peritoneum in most of the canal c. Fluid secreted keeps outer surface of intestine moist and allows frictionfree movement of digestive organs against the abdominopelvic cavity d. Esophagus differs in that it has only a loose layer of connective tissue called the adventitia.

5. Peritoneum serous membrane in abdominal cavity a. Visceral—covers organs b. Parietal—lines abdominal cavity c. Peritoneal cavity—potential space between layers d. Retroperitoneal—organs not covered with visceral peritoneum but in abdominal cavity e. Mesentery—drapes of peritoneum that anchor and protect organs E. Stomach 1. The stomach is located in the left side of the abdominal cavity, under the diaphragm, and is covered completely by the liver.

2. It is approximately 10 inches long with a diameter that depends on amount of food ingested.

3. It can hold up to 4 liters when filled.

4. Rugae, or folds, help the stomach expand and contract.

5. The stomach has four functions. a. Temporary holding area for received food b. Secretes gastric acids and enzymes that mix with food, performing chemical digestion c. Regulates the rate partially digested food (a thick, heavy, creamlike liquid called chyme) enters the intestine d. Absorbs small amounts of water and substances on a very limited basis (the stomach does absorb alcohol) 6. It takes about 4 hours for the stomach to empty following a meal. a. Liquids pass through fairly quickly b. Carbohydrates move through quickly c. Proteins take more time to pass through d. Fats take the longest, usually between 4 and 6 hours 7. The stomach is divided into four regions. a. Cardiac region surrounds lower esophageal sphincter .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Fundus, laterally and slightly superior to the cardiac region, temporarily holds food as it enters the stomach c. Body is the midportion of the stomach d. The two curved parts of the body are the lesser curvature (concave) and the greater curvature (larger convex curve) e. Funnel-shaped, terminal end is called the pylorus, where most of the work of the stomach is performed; food passes through the pyloric sphincter into the small intestine 8. The muscular action of the stomach works like a cement mixer, achieved by three layers of muscles: longitudinal, circular, and oblique a. Stomach churns food as it mixes with gastric juices excreted by gastric glands in the gastric pits of the columnar epithelial lining of the stomach b. Stomach works food toward the pyloric sphincter through peristaltic activity of the muscles c. Chemical and physical digestion occur here.

9. Gastric juice is comprised of hydrochloric acid (HCl), pepsinogen, and mucus. a. About 1500 mL are produced daily by gastric glands. b. Pepsinogen is secreted by the chief cells; HCl is secreted by parietal cells combining to produce pepsin, the chief digestive enzyme. c. Pepsin breaks down protein; HCl breaks down connective tissue. d. HCl has a pH of 1.5 to 2, effective at killing pathogens. e. Mucous cells generate a thick layer of mucus to shield from effects of stomach acids f. Stomach also secretes intrinsic factor, allowing vitamin B12 to be absorbed g. Three phases of gastric juice production: i. Cephalic phase: sensory stimulation (sight or smell of food) stimulates parasympathetic nerves via the medulla oblongata, stimulating release of gastrin; gastrin travels through bloodstream and reaches stomach, stimulating gastric gland activity. ii. Gastric phase: two-thirds of gastric juices secreted as food enters the stomach and distends the walls, signaling the brain to secrete more gastric fluid. iii. Intestinal phase: food enters duodenum, which distends and senses the acidity, causing intestinal hormones to be released and slowing gastric gland secretions; brain is signaled to help the slow down; this lasts until the bolus leaves the duodenum.

10. Stomach activity is controlled by parasympathetic nervous system, particularly the vagus nerve.

11. Vagus nerve stimulation increases motility and secretory rates of gastric glands.

12. Rate of chyme movement is important.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

a. If chyme moves too quickly, food particles may not be sufficiently mixed with gastric juices, leading to insufficient digestion; unneutralized chyme can cause erosion of the intestinal lining.

F. Small intestine 1. Small intestine is located in the central and lower abdomen.

2. It functions as the major organ of digestion because it is where most food is digested.

3. Small intestine is small in diameter, not length.

4. Small intestine is the longest section of the alimentary canal, with an average length of 6 to 20 feet and a diameter ranging from 4 cm where it connects to the stomach to 2.5 cm where it meets the large intestine.

5. Small intestine function a. Walls of small intestine secrete digestive enzymes, important for final stages of chemical digestion, and two hormones that stimulate the pancreas and gallbladder and control stomach activity. b. Eighty percent of the absorption of usable nutrients occurs when chyme meets the mucosal walls. c. Amino acids, fatty acids, simple sugars, vitamins, and water are all absorbed here. d. Remaining 20% is absorbed in the stomach. e. Residual chyme not utilized in small intestine is sent to the large intestine for removal from the body.

6. Three regions of the small intestine a. Duodenum i. Approximately 25 cm long, located near the head of the pancreas ii. Derives name from duo (two) and denum (ten), which equals 12—the number of finger widths long that this organ is (10 inches) iii. Duodenal function a. Pyloric valve is important, allowing small portions of chyme to enter the duodenum; small intestine can process only small amounts of food at a time. b. Pancreas and gallbladder add secretions—bile from the gallbladder and pancreatic juice from the pancreas; cholecystokinin, CCK, secreted by small intestine, stimulates gallbladder activity. c. Bile emulsifies fat, dispersing it in water. d. Pancreatic juice contains sodium bicarbonate, which neutralizes the acidic chyme. e. Muscular action occurs in two ways: segmentation causes the mixing of chyme and digestive juices like a cement mixer; peristalsis moves food toward large intestine. b. Jejunum is the middle section, approximately 2.5 m long. c. Terminal end is the ileum, 2 m long; it attaches to the large intestine at the ileocecal valve. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

7. Digestive enzymes a. Necessary to complete chemical digestion; produced by exocrine cells b. Lactase, maltase, and sucrase are needed to digest double sugars, called disaccharides. c. Internal lipase is needed for certain types of fats. d. Mechanical and chemical irritation of acidic chyme, plus distention of the intestinal walls, causes localized reflex action that releases the enzymes and the two hormones.

8. Wall of the small intestine a. Has circular folds called plicae circulares and fingerlike protrusions into the lumen called villi b. Villi also have outer layers of columnar epithelial cells that possess microscopic extensions known as microvilli. c. Villi are tightly packed together, giving a velvety texture and appearance. d. Purpose of the microvilli, villi, and circular folds is to provide an incredible increase in the surface area of the small intestine to almost the size of a tennis court, increasing the efficiency of the absorption of nutrients.

9. Villi a. Each villus contains a network of capillaries and a lymphatic capillary called a lacteal. b. Intestinal glands are located between villi. c. Capillaries absorb and transport sugars (the result of carbohydrate digestion) and amino acids (the result of protein digestion) to the liver for further processing before being sent throughout the body. d. Glycerol and fatty acids (obtained from fat digestion) are absorbed by the villi, are converted into a lipoprotein, and travel on to the lacteal, where it becomes a white, milky substance called chyle. e. Chyle goes directly into the lymphatic system for distribution throughout the body.

G. Large intestine 1. Beginning at the junction of the small intestine, the ileocecal orifice, and extending to the anus is the large intestine.

2. Large intestine borders the small intestine.

3. Functions a. Water absorption b. Absorption of vitamins produced by the healthy bacteria in large intestine c. Compaction of waste products for elimination 4. No villi; little nutrient absorption occurs here 5. Approximately 5 feet long and 2.5 inches in diameter, the large intestine has three main regions. a. Cecum .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

i. Pouch-shaped structure that receives any undigested food and water from the ileum ii. Appendix is attached to the cecum a. A 3-inch long, slender, hollow, dead-ended tube lined with lymphatic tissue, unknown function b. Blocked or inflamed appendix causes appendicitis and must be treated with either antibiotics or surgical removal iii. Some water used in digestion and electrolytes are reabsorbed in the cecum and ascending colon; water absorbed in a small amount but is essential to maintaining normal fluid balance b. Colon i. Four sections of the colon a. Ascending colon travels up the right side to the level of the liver. b. Transverse colon travels across the abdomen just below the liver and the stomach. c. Descending colon bends downward near the spleen and travels to the left side, becoming the sigmoid colon. d. Sigmoid colon extends to the rectum. ii. Rectum opens to the anal canal that leads to the anus. iii. Anal sphincter opens and closes to allow the passage of solid waste (feces) from the colon to the outside world.

6. Peristalsis a. Continues in large intestine but at a slower rate b. As these slower intermittent waves move fecal matter toward the rectum, water is removed, turning it from a watery soup to a semisolid mass. c. As rectum fills with feces, a defecation reflex occurs, which causes rectal muscles to contract and the anal sphincter to relax. d. If fecal matter moves through too rapidly, not enough water is removed, and diarrhea occurs. e. If fecal matter remains too long in the large intestine, too much water is removed, and constipation occurs.

7. Bacteria a. Bacteria in the bowel help break down indigestible materials. b. Produce B complex vitamins and most of the vitamin K needed for proper blood clotting IV. Accessory Organs A. Liver 1. The liver weighs 1.5 kg, is located inferior to the diaphragm, and is the largest glandular organ in the body and the largest organ in the abdominopelvic cavity.

2. This organ performs many functions vital to life.

3. It is divided into a large right lobe and a smaller left lobe; the right lobe has two smaller inferior lobes. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. It receives about 11/2 quarts of blood every minute from the hepatic portal vein (carrying blood full of the end products of digestion) and hepatic artery (providing oxygen-rich blood).

5. Functions of the liver a. Detoxifies the body of harmful substances such as certain drugs and alcohols b. Creates body heat c. Destroys old blood cells and recycles their usable parts while eliminating unneeded parts such as the pigment bilirubin, eliminated in bile, and giving feces its distinctive color d. Forms blood plasma proteins, such as albumin and globulin e. Produces the clotting proteins fibrinogen and prothrombin f. Creates the anticoagulant heparin g. Manufactures bile, needed for the digestion of fats h. Stores and modifies fats for more efficient use by the body’s cells i. Synthesizes urea, a by-product of protein metabolism, so it can be eliminated by the body j. Stores the simple sugar, glucose, as glycogen; when the blood sugar level falls below normal, the liver reconverts glycogen to glucose and releases enough of it into the bloodstream to bring blood sugar levels back to an acceptable concentration k. Stores ions, vitamins A, B12, D, E, and K l. Makes cholesterol 6. Bile a. Secretion of the hormone secretin stimulates bile production, a critical liver digestive function. b. Salts found in bile act like a detergent, breaking fat up into tiny droplets, called emulsification, making the work of digestive enzymes easier. c. Bile helps absorb fat from the small intestine and transports bilirubin and excess cholesterol to the intestine for elimination, d. Bile leaves the liver via the hepatic duct, travels through the cystic duct to the gallbladder, and is stored there until needed by the small intestine.

B. Gallbladder 1. The gallbladder is a sac-shaped organ, 3 to 4 inches long, located under the liver’s right lobe.

2. While storing bile, it absorbs much of its water content, making bile 6 to 10 times more concentrated; if overconcentrated, bile salts may solidify, forming gallstones.

3. Fatty foods in the duodenum cause the release of CCK. 4. This release causes the smooth muscle walls of the gallbladder to contract, squeezing bile into the cystic duct, through the common bile duct, and into the duodenum.

C. Pancreas 1. The pancreas plays a role in digestion and is an endocrine gland. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

2. The pancreas is 6 to 9 inches long, located posterior to the stomach, extending laterally from the duodenum to the spleen.

3. Exocrine portion secretes buffers and digestive enzymes through the pancreatic duct to the duodenum.

4. Buffers are needed to neutralize the acidity of the chyme, with a pH ranging from 7.5 to 8.8, saving the intestinal walls from damage.

5. Secretory action is activated by the release of hormones from the duodenum.

6. Digestive enzymes of the pancreas a. Carbohydrase: works on sugars and starches b. Lipase: works on lipids c. Proteinase: breaks down proteins d. Nuclease: breaks down nucleic acids V. Common Disorders of the Digestive System A. Symptoms of digestive disorders usually include some or all of the following: 1. Vomiting a. Vomiting is a protective mechanism that rids the digestive tract of an irritant or overload of food that stimulates sensory fibers, sending a signal to the vomiting center in the brain. b. Motor impulses are sent to the diaphragm and abdominal muscles to contract, squeezing the stomach muscles and cardiac sphincter at the esophageal opening, and contents are regurgitated.

2. Diarrhea a. Results when the fluid contents in the small intestine are rushed through the large intestine without reabsorbing enough water b. Rapid movement reduces nutrient and electrolyte absorption and can cause serious problems.

3. Constipation a. Opposite of diarrhea. b. Feces pass too slowly through the colon, and too much water is absorbed. c. Stool becomes hard, dry, and difficult to pass. d. Constipation does not refer to the frequency of defecation but to the hard consistency of the stool.

4. Abdominal pain B. Peptic ulcer disease 1. Peptic ulcer disease can affect the lining of the esophagus, stomach, or duodenum.

2. Most common region is the upper part of the small intestine, or duodenum.

3. Caused by an imbalance in the juices of the stomach that produce more acid than normal and erode the mucosal lining of the digestive tract.

4. Helicobacter pylori is a bacteria implicated in many ulcers; it causes an open wound in the stomach lining, which is exacerbated by exposure to digestive juices and stomach acids.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CLASSROOM ACTIVITIES 1. Call on students to describe the sequential components of the GI tract. The first student will discuss the teeth, the next will discuss the tongue, the next will discuss the cheeks or saliva, and so on.

2. Assign each student to do a written or oral presentation on an anatomical component of the digestive tract (esophagus, small intestine, etc.) or a physiological component (peristalsis, gastric secretions, etc.).

TEACHING STRATEGIES 1. Help students understand the functions of the digestive tract by making each part “come alive” through active descriptions of the various components. This will make the anatomy and physiology of the GI tract more memorable.

2. Use anatomical models or diagrams to demonstrate the various components of the GI tract. Whenever possible, discuss pathophysiology in relation to the various components.

3. Discuss the problems associated with obesity. Introduce the new American Food Guide Pyramid and talk about the requirements for a healthy diet.

FACTOIDS 1. When diagnosing cholecystitis, doctors know to look for the 4Fs: female, fat, forty, and fair-skinned. Overweight white women in their 40s are the most likely group to develop gallbladder problems.

2. The surgical procedure known as stomach stapling can be accomplished in several different ways. One procedure involves placing a “lap band” around the stomach to slow the emptying of the stomach; the client feels full for longer periods than prior to surgery, and appetite is reduced. In another procedure, the surgeon removes a small section of the stomach and bypasses a large part of the bowel to reduce the number of calories absorbed and minimize the size of the stomach, so the client feels full longer. These are just two of the different procedures that can be performed.

ETHICAL DILEMMAS 1. A variety of disease processes involving the GI tract require removal of large parts of the bowel. This results in malabsorption syndromes. Clients with malabsorption syndrome require the administration of IV nutrients, such as hyperalimentation and interlipids, to keep them alive. However, a serious side effect of these concentrated IV nutrients is often liver damage. Should these clients be given IV nutrients, or should they be allowed to die from the disease that required the removal of the bowel? What is the ethical requirement for discussing these surgeries with the client prior to removal of the bowel?

2. Obesity has become a serious problem for many Americans. With the rise in obesity and the focus our society places on appearance, a lot of Americans are choosing to undergo stomach-stapling procedures. What requirements are we ethically expected to enforce prior to agreeing to perform these types of surgeries? Should there be an age .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

limit on who can have this surgery, or is it permissible to perform surgery on young children? What age limit would be appropriate?

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 16–1 Answers, p. 404 1. c 2. a 3. b 4. d 5. crown; neck; root Test Your Knowledge 16–2 Answers, p. 411 1. c 2. b 3. c 4. c 5. parasympathetic/autonomic Test Your Knowledge 16–3 Answers, p. 417 1. b 2. c 3. d 4. a Test Your Knowledge 16–4 Answers, p. 421 1. b 2. c 3. b 4. d ANSWERS TO THE CASE STUDY, P. 426 1. no 2. heartburn (acid reflux) 3. digestion or control of acid 4. The opening from the stomach to the esophagus is on the right, so lying on the right side would promote reflux, making it worse.

5. He should not eat so much; make sure he eats earlier in the evening and lies on his back with his head elevated.

ANSWERS TO REVIEW QUESTIONS, P. 426 Multiple Choice 1. c, 2. a, 3. c, 4. d, 5. d Fill in the Blank 1. Segmentation; peristalsis 2. appendix .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. pancreas 4. Emulsification 5. constipation Short Answer 1. Chyme is partially digested acidic food that moves from the stomach into the small intestine. Chyle is lipoprotein absorbed into the lymph system in the lacteals of the small intestine.

2. The bacteria in the large intestine help digest undigestible material and produce B vitamins and vitamin K. If these bacteria escape the alimentary canal, they cause serious infections.

3. The liver performs many roles in the digestive process. Because all the nutrients from digestion end up in the liver, the liver is involved in lipid, protein, and carbohydrate metabolism, making and storing molecules. The liver also produces bile, which is necessary for digestion of fats in the small intestine.

4. You can live without a gallbladder. Many people have their gallbladders removed because of gallstones and live for years afterward. The gallbladder is only a storage organ for bile. The liver actually makes bile and will continue to do so even after the gallbladder is removed.

5. There are four basic tissue types in the canal. The innermost layer is the mucosa, the next layer is the submucosa, the third layer is the muscularis externa and the outermost layer is the serosa. The esophagus differs in that it contains only a loose layer of connective tissues called the adventitia. Each part of the digestive system has differences in the anatomy of the mucosa depending on the function. The stomach has an extra layer of muscles. Some organs are also retroperitoneal and are not surrounded by serosa.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________ CHAPTER 16 – WORKSHEET Multiple Choice 1) The gastrointestinal tract is also known as the _____ canal.

A) accessory B) alimentary C) anoesophageal D) absorptodigestive 2) Which of the following is an enzyme found in the saliva?

A) Peptidase B) Lipase C) Amylase D) Lactase 3) Teeth are made of a bone like substance called A) cartilage.

B) dentin.

C) duodenum.

D) ostium.

4) The innermost layer of the GI tract wall is called the A) mucosa.

B) submucosa.

C) muscularis externa.

D) serosa.

5) The funnel-shaped end of the stomach that connects to the duodenum is called the A) fundus.

B) body.

C) pylorus.

D) cardiac region.

Fill in the Blank 6) The _____ glands include the parotid, sublingual, and submandibular glands.

7) A baby’s first teeth are called _____ teeth.

8) The muscular “door” between the esophagus and stomach is called the_____.

9) The_____ is a serous membrane in the abdominopelvic cavity.

Worksheet – p. 1 of 3 .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Multiple Choice 10) Which of the following is not a portion of the small intestines?

A) Duodenum B) Jejunum C) Ileum D) Cecum 11) Infection with _____ is a risk factor for developing peptic ulcers.

A) salmonella B) H. pylori C) E. coli D) gonorrhea 12) The_____ are protrusions into the lumen in the small intestine that create an increased surface area for nutrient absorption.

A) villi B) rugae C) sphincters D) uvula 13) GERD is a disease characterized by A) gastric acid washing backward up into the esophagus.

B) malabsorption of wheat gluten.

C) autoimmune attack on the bowel.

D) the formation of stones in the gallbladder.

14) Inflammation of the gums is called A) gingivitis.

B) cholecystitis.

C) ulcerative colitis.

D) gastroenteritis.

Worksheet – p. 2 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Matching Match each structure with the appropriate function.

15) _____ Oral cavity 16) _____ Esophagus 17) _____ Stomach 18) _____ Small intestine 19) _____ Large intestine 20) _____ Liver 21) _____ Gallbladder 22) _____ Pancreas 23) _____ LES 24) _____ Anus 25) _____ Epiglottis A. Begins mechanical breakdown of food through mastication B. The valve that prevents stomach contents from washing back up into the esophagus C. Prevents food from entering the trachea during swallowing D. Produces sodium bicarbonate (which neutralizes acid) and several digestive enzymes E. Produces hydrochloric acid and pepsinogen to begin digestion of food F. Produces bile, detoxifies the body, forms plasma proteins, stores nutrients, makes cholesterol G. Opens and closes to control the passage of feces to the outside world H. Carries food from the throat to the stomach I. Where the majority of digestion and absorption take place J. Stores bile K. Absorbs water from fecal matter before defecation

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 16 – Worksheet 1) B 2) C 3) B 4) A 5) C 6) salivary 7) deciduous 8) lower esophageal sphincter (cardiac sphincter) 9) peritoneum 10) D 11) B 12) A 13) A 14) A 15) A 16) H 17) E 18) I 19) K 20) F 21) J 22) D 23) B 24) G 25) C

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 17

THE URINARY SYSTEM: FILTRATION AND FLUID

LEARNING OBJECTIVES ➯ Present an overview of the organs and functions of the urinary system ➯ Describe the internal and external anatomy and physiology of the kidneys ➯ Discuss the importance of renal blood flow ➯ Describe the process of urine formation ➯ Trace the pathway of reabsorption or secretion of electrolytes and other chemicals ➯ List and discuss the importance of hormones for proper kidney function ➯ Describe the anatomy and physiology of the bladder and the process of urine removal from the body ➯ Discuss several common disorders of the urinary system

BALANCE MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Kidney Stones 2. Renal Failure 3. Ultrasound Procedure 4. Ultrasound Technician Professional Profile 5. Urinalysis Animations 1. Blood Loss and Blood Pressure regulation 2. Hypovolemic Shock 3. Renal Blood Flow 4. Rennin-Angiotensin System 5. The Urinary System Interactive Activities 1. Kidneys 2. The Urinary Bladder

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. Purification plant, cleaning the blood of waste materials B. Controls electrolyte and fluid balances C. The kidneys filter blood, reabsorb and secrete ions, and produce urine.

D. Without these important functions, death occurs within a few days.

II. System Overview A. Anatomical 1. Two kidneys: bean-shaped organs located in the superior dorsal abdominal cavity that filter blood and make urine 2. Ureter: tube that carries urine from each kidney to the urinary bladder 3. Urinary bladder: expandable sac that holds urine; located in the inferior ventral pelvic cavity 4. Urethra: tube that transports urine from the bladder to the outside of the body B. Physiological 1. The job of the urinary system is to make urine, thus controlling the body’s fluid and electrolyte balance and eliminating waste products.

2. Three processes in urine production a. Filtration b. Reabsorption c. Secretion III. Kidney A. External anatomy 1. Renal capsule: fibrous layer of connective tissue covering 2. Renal hilum: indentation that gives the kidney its bean shape a. Renal arteries bring blood. b. Renal veins take the filtered blood away. c. The ureter also attached at the hilum.

B. Internal anatomy 1. The kidney can be divided into three layers: a. Renal cortex, outer layer i. Grainy in appearance and has little obvious structure to the naked eye ii. Where blood filtration occurs b. Renal medulla, middle layer i. Contains a number of triangular, striped areas called renal pyramids ii. Renal pyramids are composed of collecting tubules for the urine that is formed in the kidney. iii. Adjacent pyramids are separated by narrow renal columns— extensions of cortical tissue. c. Renal pelvis, inner layer i. A funnel, divided into two or three large collecting cups called major calyces .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ii. Each major calyx is divided into several minor calyces, forming cup-shaped areas around the tips of the pyramids to collect the urine that continually drains through the pyramids. iii. Kidney is essentially a combination of a filtration and collection system. iv. Blood is filtered by millions of tiny filters in the cortex, and the filtrate flows through tiny tubules in the medulla and collects in renal pelvis. v. Renal pelvis is essentially an enlarged proximal portion of the ureter that empties into the ureter tube, where urine is carried to the bladder.

2. Blood vessels a. Good blood supply to the kidney is essential for proper function. b. A network of blood vessels traverses kidney tissue. c. A single renal artery enters each kidney at the hilum, branching into five segmental arteries. d. Segmental arteries branch into lobar arteries. e. Lobar arteries branch into interlobar arteries, which pass through the renal columns. f. Arcuate arteries originate from the interlobar arteries and arch around the pyramids in the renal medulla. g. Cortical radiate (interlobular) arteries branch off arcuate arteries and give rise to afferent arterioles. h. Afferent and efferent arterioles i. Each afferent arteriole leads to a ball of capillaries called a glomerulus. ii. Efferent arterioles leave from the glomerulus and travel to a specialized series of capillaries called the peritubular capillaries and vasa recta. iii. Peritubular capillaries wrap around the collecting tubules of the nephron. i. Blood flow out of the kidney i. From each set of peritubular capillaries, blood flows out the cortical radiate veins. ii. From there, the blood flows out a series of veins that are the direct reverse of the arteries with the exception that there are no segmental veins. iii. The blood finally leaves the kidney via the renal vein.

IV. Nephron A. The functional unit of the kidney; consisting of millions of microscopic filters and tubules B. The nephron can be divided into two distinct parts.

1. The renal corpuscle, a filter a. Blood enters the renal corpuscle via the glomerulus, a ball of capillaries. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. Surrounding the glomerulus is a double-layered membrane called the glomerular capsule, or Bowman’s capsule. c. Layers of the glomerular capsule are similar to layers of a serous membrane. i. Visceral layer: inner layer surrounds the glomerular capillaries and is made of specialized squamous epithelial cells called podocytes; combined with the capillary walls, this makes for a very efficient filter ii. Parietal layer: outer layer, simple squamous epithelium and completes the container of the filter d. Blood flows into the glomerulus and everything but blood cells and a few large molecules, mainly proteins, are pushed from the capillaries across the filter and into the glomerular capsule. e. Material filtered from the blood into the glomerular capsule is called glomerular filtrate. f. If blood or protein leaks into urine, it can indicate a kidney filtration problem.

2. The renal tubule a. The rest of the nephron is a series of tubes known as renal tubules. b. Glomerular filtrate travels from the glomerular capsule into the first part of the renal tubule, the proximal tubule. c. Wall of the proximal tubule is made of cuboidal epithelium with microvilli. d. From the proximal tubule, glomerular filtrate flows into the nephron loop (or the loop of Henle). e. Nephron loop consists of the descending loop (similar in structure to the proximal tubule) and the ascending loop (simple cuboidal epithelium). f. Glomerular filtrate travels from the nephron loop to the distal tubule. g. Wall of the distal tubule is like that of the ascending branch of the nephron loop. h. From the distal tubule, glomerular filtrate flows into one of several collecting ducts, made of cuboidal epithelium. i. Collecting ducts lead to minor calyces, then to major calyces, the renal pelvis, and the ureter. j. At this point, the glomerular filtrate is urine.

C. Renal blood vessels associated with the nephron 1. Blood vessels are in close proximity to the nephrons because certain substances within the filtrate must be brought back into the bloodstream.

2. Blood approaches the nephron via the afferent arteriole.

3. Blood flows from the afferent arteriole into the glomerulus.

4. Blood flows from the glomerulus via the efferent arteriole into the peritubular capillaries and vasa recta, a series of blood vessels surrounding the renal tubule.

5. These surrounding blood vessels allow for reabsorption back into the bloodstream from the filtrate that is within the tubular system.

6. Blood leaves the nephron via the cortical radiate veins. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

V. Urine Formation A. The kidney controls fluid and electrolyte balance by controlling urine volume and composition.

B. To form urine, the nephron must perform three processes.

1. Glomerular filtration a. Fluid and molecules are filtered from the glomerular capillaries into the glomerular capsule. b. The filtrate flows into the renal tubule. c. Moves fluid and chemicals into the nephron from blood.

2. Reabsorption and secretion. a. Reabsorption: substances pass from the renal tubule into the peritubular capillaries and return to the bloodstream b. Secretion: substances pass through the peritubular capillaries into the renal tubule and leave the body as urine. c. Control the concentration of chemicals and volume of urine C. Glomerular filtrate is chemically similar to blood, whereas urine is chemically different.

D. Some substances, like glucose, are completely reabsorbed, whereas substances like metabolic waste products (urea and creatinine) are almost completely secreted in urine.

VI. Regulation of Filtration A. Filter size determines what gets through the filter 1. The podocytes and capillary walls of the renal corpuscle create a filter with fixed openings.

2. Plasma and many of the substances dissolved in plasma pass through the filter.

3. Blood cells, platelets, and large molecules can’t get through filter, remaining in the bloodstream.

B. Pressure—higher pressure on one side of the filter than on the other allows chemicals to be pushed though the filter.

1. Autoregulation keeps filtration rate constant over minor changes in blood pressure.

2. Autoregulation can be overridden. a. Because the kidney regulates fluid volume, works with the cardiovascular system to regulate blood pressure. b. Glomerular filtration can decrease to conserve fluid when blood pressure falls or increase if blood pressure rises. c. Sympathetic nervous system can control urine production through the adrenal medulla, and the secretion of epinephrine or norepinephrine, by vasoconstriction of the afferent arteriole, decreasing glomerular filtration; thus, urine output decreases during fight-or-flight responses.

VII. Control of Tubular Reabsorption and Secretion A. Tubular reabsorption and secretion control the chemistry and volume of urine B. Tubular reabsorption and secretion are affected by tubule permeability.

1. Each section of the tubule can reabsorb and secrete different substances. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

2. Molecules move across membranes through several different methods.

3. Results in dramatic differences in which molecules are reabsorbed or secreted in each part of the tubule C. Tubular reabsorption and secretion uses countercurrent circulation.

1. Ions move across cell membranes from higher to lower areas of concentration.

2. Countercurrent circulation in the nephron is possible because of the concentration gradient, with low ion concentration at the beginning of the descending loop and high concentration at the tip of the loop, as well as the differences in permeability between the descending loop (water) and ascending loop (ions).

3. Filtrate flows into the descending loop, reabsorbing water and increasing the concentration of ions; as the filtrate enters the ascending loop, fluid is concentrated because of water loss, the membrane is permeable to only ions, and ions move across the membrane.

D. Reabsorption and secretion are also affected by several hormones that regulate blood pressure.

1. Antidiuretic hormone (ADH) a. Made by the hypothalamus b. Secreted from the posterior pituitary when BP decreases or ionic concentration increases c. ADH increases permeability of distal tubules and the collecting duct. d. More water is reabsorbed. e. Less urine is produced. f. Blood volume increases, osmotic concentration decreases, and blood pressure rises. g. Alcohol and caffeine inhibit ADH production, increasing urine production.

2. Aldosterone a. An adrenocorticosteroid secreted by the adrenal cortex b. Secreted when plasma sodium decreases or plasma potassium increases c. Increases the reabsorption of sodium ions and secretion of potassium ions—increasing serum sodium levels, decreasing serum potassium levels—by the distal tubule and ascending limb of the nephron loop d. As sodium is reabsorbed, water is also reabsorbed, decreasing urine volume.

3. Atrial natriuretic peptide (ANP) a. Secreted by the atria of the heart when blood volume increases b. Decreases sodium reabsorption and thus increases urination 4. Renin-angiotensin-aldosterone a. Series of chemical reactions that regulate blood pressure b. Decrease in blood flow to the kidney causes a special group of cells near the glomerulus, the juxtaglomerular apparatus, to secrete renin into the bloodstream. c. Renin converts angiotensinogen (made by liver) into angiotensin I. .

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d. Another enzyme made by the lungs, angiotensin-converting enzyme (ACE), converts angiotensin I to angiotensin II, e. Increasing thirst, increasing ADH secretion, increasing aldosterone secretion, and causing vasoconstriction f. Blood pressure is increased by higher fluid volume. g. Kidneys, lungs, and liver work together to regulate blood pressure.

VIII. Urinary Bladder and Urination Reflex A. Glomerular filtrate flows out the collecting duct, into the minor calyces, and then into the major calyces forming the pelvis.

B. Once in pelvis, the filtrate is urine; no further change in chemistry.

C. Urine collects in the renal pelvis and flows down the ureters to the urinary bladder, where it is stored.

D. Urinary Bladder 1. Small, hollow organ posterior to the pubic symphysis and retroperitoneal 2. Lined with transitional epithelium, the only epithelium stretchy enough to expand as the bladder fills 3. The ability to stretch is enhanced by a series of pleats called rugae.

4. The bladder has a muscular wall consisting of several layers of circular and longitudinal smooth muscles covered by connective tissue and parietal peritoneum.

E. Urination reflex 1. As urine accumulates, the bladder fills and stretches.

2. This stretch triggers the urinary reflex and the need to void to empty the bladder.

3. Urination was thought to be a spinal reflex, but new research indicates it is controlled by the brain.

4. When the bladder is full, signals are sent from the bladder to the spinal cord to the pons that send parasympathetic signals down the spinal cord, causing contraction of the muscular walls of the bladder, and the bladder empties.

F. Urination 1. Urine leaves the bladder via the urethra, a thin, muscular tube lined with several different types of epithelium along its length.

2. Part of the brain can inhibit urination by controlling the internal urethral sphincter, a valve at the junction of the bladder and the urethra, and the external urethral sphincter, a valve that is part of the muscles of the pelvic floor.

3. Sympathetic stimulation of these sphincters prevents urine from leaving the body.

4. Although you have little control over bladder contraction, you have good control over the sphincters starting from age 2 (slightly later in boys).

IX. Common Disorders of the Urinary System A. Analgesic nephropathy 1. Overuse or abuse of drugs can severely affect renal function because the kidney excretes most medications after the liver breaks them down.

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2. Analgesic nephropathy is caused by long-term use of pain relievers, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and especially if combined with caffeine, codeine, or acetaminophen.

3. OTCs can cause chronic kidney damage, leading to kidney failure.

B. Chronic renal failure (CRF) 1. CRF is an ongoing, progressive disease of the kidney.

2. Progression may be controlled by treating the underlying cause of the damage or controlling BP and cholesterol.

3. CRF can lead to end-stage renal disease (ESRD), the final stage of renal failure.

4. Treatment for ESRD is dialysis or transplantation.

C. Diabetes insipidus 1. Diabetes insipidus (DI) is an endocrine disorder characterized by too little ADH or insensitivity of the kidney to ADH. 2. The result is copious amounts of urine being produced, dehydration, and rising sodium levels as the body tries unsuccessfully to conserve water; if not treated, it can be fatal.

3. The opposite of this disorder is water intoxication: clients have uncontrollable thirst and drink so much water they create dangerously low sodium because of the volume of water diluting it; can lead to brain damage or death.

D. Diabetic nephropathy 1. Diabetes mellitus (DM) is characterized by high glucose levels from inadequate, or lack of, insulin.

2. The high glucose levels disrupt the osmotic balance of blood.

3. The kidneys work hard to remove excess glucose, and urine output is high.

4. Over time, the kidney is damaged, known as diabetic nephropathy, beginning with a thickening of the filter surface of the glomerular capsule, eventually leading to breakdown of kidney tissue, destroying the filtering ability.

5. Substances that would normally not pass through, like protein and blood, begin to appear in urine.

6. Kidney function deteriorates.

7. Diabetics can prevent the onset of kidney damage by controlling their blood sugar levels, preventing high blood pressure, and reducing blood cholesterol levels.

8. This is the leading cause of kidney disease in America.

E. Glomerulonephritis 1. Glomerulonephritis is inflammation of the glomerulus.

2. Glomerulosclerosis is scarring of the glomerulus.

3. Both cause damage to the delicate filter apparatus.

4. When the filter is damaged, blood cells and blood proteins enter the filtrate and eventually appear in urine.

5. Removal of waste products is decreased, and electrolyte balance is usually abnormal because of the change in urine chemistry.

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6. There are many causes, including bacterial infection, diabetic nephropathy, systemic lupus erythematous (SLE), and genetic disorders such as Alport syndrome and Goodpasture’s syndrome.

F. Urinary tract infection (UTI) 1. UTI is caused by the movement of fecal bacteria into the urinary tract.

2. Symptoms may include frequent, painful urination, bloody or cloudy urine with an unusual odor, and low abdominal/pelvic pain caused by bladder spasm.

3. Treatment should begin promptly to avoid kidney damage from infection traveling from the bladder to the kidney.

4. UTIs are more common in women because their urethra is shorter.

5. Drinking plenty of water may help.

6. Once diagnosed, UTI is treated with antibiotics and increased fluid intake.

G. Kidney stones 1. Kidney stones result when substances in the urine crystallize in the renal tubule, often because the concentration of the molecule is higher than normal.

2. The cause of stones is frequently a mystery.

3. Stones can be because of excess calcium, uric acid, or caused by kidney infections.

4. Some people are more susceptible than others.

5. Some stones pass unnoticed; larger or irregularly shaped stones may lodge in the tubule, obstructing flow and irritating nearby tissues.

6. Symptoms include blood in the urine and severe flank pain.

7. Stones may move on their own or may be treated with increased fluid intake, lithotripsy (shock waves to break the stone), or surgery.

8. Clients are asked to filter their urine to look for the passage ofstones, some as small as sand.

H. Polycystic kidney disease (PKD) 1. PKD is a genetic disorder.

2. Large cysts form in the kidneys.

3. One form of PKD is so serious patients die in infancy.

4. The more common form is an adult-onset disorder characterized by decreasing kidney function as normal nephrons are destroyed by cysts.

5. As more cysts develop, the kidneys get very large—one is recorded to have weighed 22 pounds.

6. There is no cure except kidney transplant.

I. Hemolytic uremic syndrome 1. Hemolytic uremic syndrome is a disorder caused by an infection with the bacteria E. coli, typically from eating undercooked meat.

2. The bacterium infects the digestive tract and releases toxins, which destroy RBCs. 3. The damaged RBCs lodge in blood vessels in the kidney, blocking them and preventing blood flow to the nephron.

4. Without treatment, permanent kidney damage may result.

5. An incorrect blood transfusion of the wrong type of blood can have much the same effect. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CLASSROOM ACTIVITIES 1. Using models and diagrams, have students trace the progress of urine creation, starting with blood entering the kidney and finishing with the urination reflex and micturition.

2. Assign each student a portion of the kidney and have him or her create a presentation for the class. Encourage the use of visual aids.TEACHING STRATEGIES 1. Explaining the anatomy and physiology of the urinary system can be challenging.

Describe the anatomy first, and then start with introductory physiology, gradually increasing the complexity of the introduction as students grasp each concept.

2. If you have access to a microscope and urine dip sticks, have students collect their own urine specimen. Take a small amount of urine and spin it in the centrifuge. Remove the cells that fall to the bottom of the test tube and examine them under the microscope.

Next, using the remaining urine, dip the urine to test for blood or other abnormal components. Finally, have students examine the specific gravity of urine and discuss what makes urine more or less concentrated.

FACTOIDS 1. Every parent faces the challenges of potty training their children. One mistake parents can make that complicates the process is beginning the training too young.

Children do not gain control of their urinary sphincter until they reach the age of 2. Boys develop control later than do girls, and it is not uncommon for boys to wet the bed until the age of 7 or 8.

2. Urinary incontinence is a common problem for middle-aged women, especially those who have delivered several children vaginally. The process of pushing the baby out can weaken the vaginal wall, causing prolapse of the bladder into the vagina and weakening the bladder muscle. Incontinence is commonly seen as stress incontinence, with leakage when the woman coughs, laughs forcefully, or sneezes.

ETHICAL DILEMMAS 1. There are many stories of kidneys and other organs being sold on the black market.

A donor may claim to be voluntarily donating a kidney when in fact he or she has been compensated by the recipient. Sometimes a “broker” becomes involved, locating people who are willing to donate an organ in return for cash payment. In such cases, the broker usually pays the donor only a small fraction of the total fee. Why is this considered unethical behavior?

2. Should wealthy people be given available organs ahead of average people? Why or why not?

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ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 17–1 Answers, p. 438 1. b 2. d 3. b 4. c 5. c Test Your Knowledge 17–2 Answers, p. 443 1. a 2. b 3. a 4. d 5. b Test Your Knowledge 17–3 Answers, p. 448 1. c 2. a 3. b 4. c ANSWERS TO THE CASE STUDY, P. 451 Jane’s diagnosis is overactive bladder. The other possibilities can be ruled out for the following reasons: no glucose rules out diabetes; no bacteria, blood, or leukocytes rules out urinary tract infection.

ANSWERS TO REVIEW QUESTIONS, P. 451 Multiple Choice 1. b, 2. d, 3. d, 4. b, 5. c, 6. a, 7. b, 8. b Fill in the Blank 1. proximal tubule 2. nephron loop 3. atrial natriuretic peptide 4. pons 5. aldosterone 6. renal pelvis Short Answer 1. There are several regulators of kidney function: Autoregulation keeps filtration relatively constant even as blood pressure changes, protecting the filter from momentto-moment changes in blood pressure. .

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The sympathetic nervous system controls filtration by release of epinephrine and norepinephrine from the renal medulla. Increased sympathetic response causes constriction of the afferent arteriole, decreasing glomerular filtration.

Antidiuretic hormone (ADH) is made by the hypothalamus and secreted from the posterior pituitary when BP decreases or ionic concentration increases.

ADH increases permeability of distal tubules and the collecting duct, causing more water to be reabsorbed and increasing blood pressure.

Aldosterone increases the reabsorption of sodium ions and secretion of potassium ions by the distal tubule and ascending limb of the nephron loop in response to decreased blood sodium. Urine volume also decreases.

Atrial natriuretic peptide is secreted by the atria of the heart when blood volume increases. ANP causes increased urination and decreased sodium reabsorption.

The renin-angiotensin-aldosterone system kicks in when blood flow to the kidney decreases. The kidney secretes renin. Renin converts angiotensinogen (from the liver) into angiotensin I. Angiotensin I is converted to angiotensin II by angiotensin-converting enzymes in the lungs. Angiotensin II causes vasoconstriction, increased thirst, ADH secretion, and aldosterone secretion. All these mechanisms increase blood pressure.

2. The three processes necessary for urine formation are filtration, reabsorption, and secretion. Filtration is the movement of substances from plasma into the renal corpuscle. Most substances, except cells and large molecules, are filtered from blood.

Reabsorption is the movement of substances from the renal tubules into the blood vessels surrounding the nephron. Substances that are reabsorbed are retained by the body. Tubular secretion is the movement of substances into the renal tubule from the bloodstream. Substances that are secreted leave the body in urine.

3. The bladder is lined with transitional epithelium with rugae. It has a muscular wall consisting of several layers of circular and longitudinal smooth muscle and is covered by connective tissue and parietal peritoneum.

4. Urination is controlled by neurons in the pons. As the bladder fills, stretch receptors signal neurons in the pons, which cause increased contraction of the smooth muscle in the bladder walls. This portion of urination is involuntary. Actual urination is controlled by sympathetic control of a pair of sphincters. You have some voluntary control of the sphincters.

5. A single renal artery enters each kidney at the hilum, branching into five segmental arteries that branch into lobar arteries, which branch into interlobar arteries, which pass through the renal columns. Arcuate arteries branch from the interlobar arteries and arch around the pyramids in the renal medulla. Cortical radiate (interlobular) arteries branch off arcuate arteries and give rise to afferent arterioles. Each afferent arteriole leads to a ball of capillaries called a glomerulus. Efferent arterioles leave from the glomerulus and travel to a specialized series of capillaries called the peritubular capillaries and vasa recta. From each set of peritubular capillaries, blood flows out the cortical radiate veins.

From there, the blood flows out a series of veins that are the direct reverse of the arteries with the exception that there are no segmental veins. The blood finally leaves the kidney via the renal vein.

6. Most kidney disorders are characterized by too much or too little urine production or abnormalities in urine chemistry. Damage to the filtering apparatus, from diabetic .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

nephropathy or glomeronephritis, causes blood and proteins to show up in the urine.

Diabetes mellitus and insipidus both cause increase in urine volume. In DM it’s because the body is making more urine trying to get rid of excess glucose. In DI it’s because of the body’s inability to control output because of ADH abnormalities. Disorders that cause damage to the filter will cause chemistry changes. Disorders that damage the tubule or the kidney in general will cause changes in volume. In end-stage renal disease, urine output may cease altogether as kidneys fail to function at all.

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Name__________________________________________________ CHAPTER 17 – WORKSHEET Matching Match each structure with the appropriate description.

1) ____ Kidney 2) _____ Ureters 3) _____ Urethra 4) _____ Bladder 5) _____ Nephron 6) _____ Glomerulus 7) _____ Bowman’s capsule 8) _____ Hilum 9) _____ Renal pelvis 10) _____ Renal medulla 11) _____ Renal cortex A. The place where urine is stored until urination B. The “notch” in each kidney where the renal artery, renal vein, and ureter attach C. A “ball of capillaries” within each nephron D. The bean-shaped organs that produce urine E. Funnels urine from the kidney into the ureter F. The tubes that connect the kidneys to the bladder G. The microscopic kidney structure that filters the blood H. Collects fluid filtered through glomerulus I. The middle layer of the kidney J. The outer layer of the kidney K. The tube that drains the bladder Multiple Choice 12) Fluid passing from the glomerulus into the glomerular capsule is undergoing A) filtration.

B) reabsorption.

C) secretion.

D) anticipation.

13) Fluid normally found inside the glomerular capsule is called A) blood.

B) plasma.

C) urine.

D) filtrate.

14) When substances are removed from renal tubules and returned to the blood stream, this is called A) filtration.

B) reabsorption.

C) secretion.

D) precipitation. .

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Worksheet – p. 1 of 3 15) This hormone is secreted by the hypothalamus when blood pressure decreases or ionic concentration increases; it results in increased reabsorption of water in the nephron.

A) Aldosterone B) Atrial natriuretic peptide C) Antidiuretic hormone D) Adrenaline 16) This hormone is secreted by the adrenal cortex and affects sodium and potassium processing by the nephron.

A) Aldosterone B) Atrial natriuretic peptide C) Antidiuretic hormone D) Adrenaline 17) Tubular reabsorption and secretion is dependent on a special type of circulation around the nephron loop called _____ circulation.

A) osmotic B) countercurrent C) active D) reverse 18) The descending nephron loop is permeable to A) water.

B) ions.

C) proteins.

D) sugar.

19) The ascending nephron loop is permeable to A) water.

B) ions.

C) proteins.

D) sugar.

20) The process of urine formation involves A) glomerular filtration.

B) tubular reabsorption.

C) tubular secretion.

D) All of the above 21) In producing urine, the kidney is able to A) control the body’s fluid and electrolyte balance.

B) eliminate waste products.

C) control blood pressure.

D) All of the above

Worksheet – p. 2 of 3 .

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22) The_____ bring blood directly to the glomerulus.

A) afferent arterioles B) efferent arterioles C) lobar arteries D) peritubular capillaries Fill in the Blank 23) The_____ -angiotensin-aldosterone system helps to regulate blood pressure.

24) The nephron loop is also known as the loop of_____.

25) The process of_____ ensures that minor changes in blood pressure do not affect the kidneys’ filtration rate.

Worksheet – p. 3 of 3

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 17 – Worksheet 1) D 2) F 3) K 4) A 5) G 6) C 7) H 8) B 9) E 10) I 11) J 12) A 13) D 14) B 15) C 16) A 17) B 18) A 19) B 20) D 21) D 22) A 23) renin 24) Henle 25) autoregulation

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name__________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 18

THE REPRODUCTIVE SYSTEM: REPLACEMENT AND REPAIR

LEARNING OBJECTIVES ➯ Differentiate mitosis from meiosis ➯ Locate and describe the male and female reproductive organs ➯ Describe the function of the male and female reproductive organs ➯ Discuss the phases of the menstrual cycle ➯ Discuss the effects of hormonal control on the male and female reproductive systems ➯ Describe the stages of labor and delivery ➯ Explain common disorders of the male and female reproductive systems

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. Breast Cancer 2. Down Syndrome 3. Erectile Dysfunction 4. Fetal Lie 5. Infant Delivery 6. Infant Delivery by C-Section 7. Midwife Professional Profile 8. Placenta 9. Postpartum Assessment 10. Premenstrual Syndrome 11. Vasectomy Animations 1. Cellular Division 2. Fertilization of the Sperm and Egg Cell 3. Female Reproductive System 4. Male Reproductive System 5. Oogenesis 6. Spermatogenesis Interactive Activities 1. Female Reproductive System 2. Male Reproductive System

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name_______________________________________________ CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. Cells and tissues may be damaged or may simply wear out.

B. Asexual reproduction or mitosis: process by which cells make exact copies of themselves C. Sexual reproduction: reproduction that produces new individuals D. Without this ability, the human species would die out, and the journey for the human race would end.

II. Cellular Reproduction A. Basis for all more complex reproduction B. Process of making a new cell C. Cell division, because one cell divides into two cells when it reproduces D. Cells can only come from other cells.

E. Asexual reproduction: cells make identical copies of themselves without the involvement of another cell F. Most cells can reproduce themselves, whether they are animal, plant, or bacterial cells.

III. Eukaryotic Cells A. The cells that make up the human body B. Have a nucleus, cellular organelles, and usually several chromosomes in the nucleus C. Genetic material of the cell is DNA, bundled into “packages” of chromatin known as chromosomes.

D. Because chromosomes carry all the instructions for the cells, all cells must have a complete set after reproduction.

E. These instructions include how the cell is to function within the body and blueprints for reproduction.

F. Some cells, like plants cells have one chromosome, whereas humans have 46 chromosomes.

IV. Mitosis A. Eukaryotic cells must go through a complicated process to reproduce B. Human cells must duplicate all 46 chromosomes, make sure each cell gets all the chromosomes, and duplicate all of the organelles C. Mitosis: The process of sorting chromosomes so that each new cell gets the right number of copies of all genetic material D. Only way eukaryotic cells can reproduce asexually E. Mitosis, asexual cellular reproduction, serves many purposes 1. Cell replacement: both routine and repair 2. Growth: bone, muscle mass, and organ V. Meiosis A. Sexual reproduction is essential to perpetuation of species 1. Offspring are not identical to parents 2. Involves the union of a cell from one organism with a cell from another organism of the same species to form a unique new organism .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. In animals, females produce eggs, males produce sperm, and these special cells are gametes B. Gametes are produced by meiosis, also called reduction division because the daughter cells produced at the end of meiosis have half as many chromosomes as the original.

C. The daughter cell fuses with the gamete from another organism, which also has half as many chromosomes, forming a cell that has the total number of chromosomes needed.

D. In humans the total number of chromosomes needed is 46.

1. The 46 chromosomes are paired, so there are 23 pairs of chromosomes.

2. Each pair consists of one from the father and one from the mother.

3. Chromosomes are matched according to size, shape, and the genes they carry.

4. The chromosome pairs are numbered.

5. The 23rd pair is the sex chromosome, so named because it determines the sex of the baby. a. XX is female b. XY is male c. The father determines the sex of the baby because the mother can only contribute X chromosomes.

6. Down syndrome a. Common birth defect that causes short stature, heart defects, increased risk of leukemia, Alzheimer’s disease, and mental retardation b. Caused by the presence of an extra chromosome 21 in a patient’s cells c. Some time during meiosis, usually in the mother, chromosomes fail to separate, leaving some daughter cells without a chromosome 21 and others with two chromosomes 21 d. If the egg with the extra chromosome is fertilized, the resulting fetus will have three chromosomes 21 instead of two. e. The probability of a baby with Down syndrome increases in women over 35, although new research shows that men over 50 are also at increased risk for the birth of a child with Down syndrome.

VI. The Human Life Cycle A. Mitosis and meiosis are absolutely necessary parts of the human life cycle, needed for cell replacement, repair, and production of new organisms.

B. Eggs and sperm, with only half as many chromosomes as other cells, are produced by meiosis in specialized organs known as gonads (testes and ovaries).

C. Fertilization: during sexual reproduction, the gametes unite and combine their genetic material.

D. The fertilized egg, a zygote, has 46 chromosomes.

E. The zygote reproduces millions of times via mitosis and develops within the female to change from an embryo to a fetus.

VII. The Human Reproductive System A. Reproductive organs are called genitalia.

B. Genitalia are divided into .

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1. Primary genitalia (gonads that produce gametes) 2. Secondary genitalia (other structures that aid in the reproductive process) VIII. Female Reproductive System A. Anatomy 1. The primary genitalia are the ovaries. a. Ovaries are paired structures, about 3 cm long, in the peritoneal cavity. b. There is one ovary on each side of the uterus. c. Ovary is covered by a fibrous capsule called the tunica albuginea, made of cuboidal epithelium. d. Interior of the ovary is divided into the cortex, which contains the eggs, and the medulla, which contains blood vessels, nerves, and lymphatic tissue surrounded by loose connective tissue. e. Anatomy of the cortex is relatively complicated and is described during the discussion of physiology. f. Several ligaments suspend or anchor each ovary. i. Mesovarium suspends the ovary. ii. Suspensory ligament attaches the ovary to the lateral pelvic wall. iii. Ovarian ligament anchors the ovary to the uterine wall. g. Blood vessels, the ovarian artery, and the ovarian branch of the uterine artery travel through the mesovarium and suspensory ligament, supplying the ovary with oxygenated blood.

2. The secondary genitalia are the fallopian tubes, the uterus, the vagina, and the external genitalia called the vulva. a. Fallopian tubes i. The passageway for the egg to get to the uterus ii. Begin as a large funnel, the infundibulum, surrounded by ciliated projections called fimbria; the infundibulum leads to a widened area, the ampulla, followed by a longer, narrower portion known as the isthmus; uterine tubes are connected to the superior portion of the uterus iii. The tube is constructed of sheets of smooth muscle lined with highly folded ciliated simple columnar epithelium; the outside of the tube is covered by visceral peritoneum and suspended by a mesentery known as the mesosalpinx. b. Uterus i. In the pelvic cavity posterior and superior to the urinary bladder and anterior to the rectum ii. Major portion of the uterus is called the body; rounded superior portion between the uterine tubes is the fundus, and narrow inferior portion is the isthmus. iii. Cervix is a valvelike portion of the uterus that protrudes into the vagina; the cervical canal communicates with the vagina. iv. Uterine ligaments a. The mesometrium attaches the uterus to the lateral pelvic walls. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

b. The combination of the mesometrium and mesovarium is called the broad ligament. c. The lateral cervical ligaments attach the cervix and vagina to the lateral pelvic walls. d. The uterus is anchored to the anterior wall of the pelvic cavity by the round ligaments. v. Layers of the uterine wall a. Perimetrium, outermost layer, the visceral peritoneum b. Myometrium, middle layer, smooth muscle c. Endometrium, inner lining, mucosa layer of columnar epithelium and secretory cells with two divisions i. Basal layer, responsible for regenerating the uterine lining each month ii. Functional layer sheds about every 28 days during menstruation vi. Uterine blood supply a. Endometrium is highly vascular. b. Blood is supplied by the uterine artery, which branches from the internal iliac arteries on each side. c. Uterine arteries split into arcuate arteries, supplying the myometrium, and radial arteries, which supply blood to the endometrium. i. Straight, radial arteries supply the basal layer. ii. Spiral radial arteries supply the functional layer, decaying and regenerating every month as part of the menstrual cycle and undergoing spasms that contribute to the shedding of the endometrium each month. d. Blood returns to circulation via a network of venous sinuses. vii. Endometriosis a. Endometrial tissue escapes uterus b. Implants in abdominal cavity c. Builds up and decays each month with hormonal changes d. Causes scar tissue, reproductive problems, digestive problems e. Most common cause of infertility c. Vagina i. A tube, approximately 10 cm long, running from the uterus to the outside of the body ii. Receives penis during intercourse and allows for passage of menstrual fluid out of the uterus iii. Vagina is also known as the birth canal because its primary function is to allow the movement of a baby out of the uterus during childbirth .

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iv. External opening of the vagina may be covered by a perforated membrane, the hymen d. External genitalia i. Collectively known as the vulva ii. Labia majora a. Rounded fat deposits that meet and protect the rest of the vulva b. Labia majora meet anteriorly to form the mons pubis, both covered by pubic hair. iii. Pudendal cleft a. Opening between the two labia majora b. Vestibule located within contains the urethra and vagina c. Several glands surround the vestibule to keep it moist. iv. Lateral border of the vestibule is formed by the thin labia minora, which meet anteriorly to form the prepuce. v. Clitoris a. Posterior to the prepuce is the clitoris, a small erectile structure, 2 cm in diameter b. Like the penis, the clitoris engorges with blood during sexual arousal; increases in diameter, not length c. The clitoris has a shaft, a body, and a glans (tip). e. Mammary glands i. Milk production glands housed in the breasts ii. At puberty, estrogen and progesterone stimulate breast development in girls. iii. In adult females, the breast consists of 15 to 20 glandular lobes and lots of adipose tissue. iv. Each lobe is divided into smaller lobules, which house milksecreting sacs called alveoli when a woman is lactating. v. Milk made in the alveoli travels through a series of ducts and sinuses, eventually reaching the nipple. vi. Milk production is controlled by the hormone prolactin.

B. Physiology 1. The female reproductive physiology is closely tied to a regulated cycle.

2. This cycle is normally regulated by hormones.

3. The menstrual cycle a. Approximately 28 days, involving the ovaries and uterus b. Ovarian cycle involves the monthly maturation and release of eggs from the ovary. c. Uterine cycle consists of the monthly buildup, decaying, and shedding of the uterine lining. d. Cycles begin during puberty and end in menopause in a woman’s 40s or 50s. .

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e. Goal is to release an egg for fertilization and preparation of the uterus to receive the fertilized egg, nourishing the fertilized egg should pregnancy result. f. If pregnancy doesn’t result, the uterine lining sheds and the cycle begins again. g. Menses i. Menstrual cycle begins with the first day of menses. ii. Menstruation is the actual shedding of the endometrium, the “period” itself. iii. Menses refers to the time during which a woman is menstruating. iv. Menses usually lasts 4 to 5 days but can be longer or shorter in different women and can vary month to month in the same woman. h. Follicular or proliferative phase i. During this time, the endometrium is proliferating and the follicles are maturing in the ovary. ii. Follicle is an egg and associated helper cells. iii. Once menses is over, the endometrium begins to proliferate, readying itself for the egg that has been released from the ovary (ovulation). iv. From days 1 to 14 the oocyte, or egg cell, undergoes a number of developmental changes, getting ready for ovulation on day 14. i. Luteal or secretory phase i. If the oocyte is fertilized by sperm, it implants in the thickened endometrium. ii. If it doesn’t implant within a few days, the endometrium begins to decay, and menstruation occurs within 2 weeks. iii. The time between ovulation and menses is called the luteal, or secretory, phase because of the development of a structure called the corpus luteum in the ovary and the beginning of secretion in the uterus.

4. Oogenesis a. The process of egg production is called oogenesis. b. Oogenesis begins with the birth of oogonia, or egg stem cells, in the ovary. c. Oogonia undergo mitosis, producing millions of primary oocytes. d. Women have all the eggs they will ever have 5 months before they are born. e. Primary oocytes i. Primary oocytes, because they are born via mitosis, still have 46 chromosomes. ii. They must undergo meiosis to become gametes. iii. Primary oocytes stay in a kind of suspended animation until puberty, when they finish developing. f. Primordial follicles .

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i. Primary oocytes surrounded by helper cells, called granulosa cells. ii. Hormonal signals during puberty cause some primordial follicles to enlarge and increase the number of granulosa cells. iii. These enlarged cells are called primary follicles. g. Secondary follicles i. At puberty, one primary follicle will become a secondary follicle ii. Secondary follicle will not complete its development unless it is ovulated and fertilized. iii. Just before ovulation, the secondary follicle fills with fluid and moves toward the surface of the ovary. iv. The fimbria of the uterine tubes brushes the surface of the ovary, causing the follicle to rupture. v. When the follicle ruptures, the egg (actually an oocyte) is released into the peritoneal cavity, and the fimbria pull it toward the funnel, drawing it into the uterine tube. h. Fertilization i. As the egg travels down the uterine tube, it will either be fertilized or not. ii. If there are sperm present in the uterine tube and all the conditions are right, the sperm will penetrate the egg, fertilizing it, and triggering the rest of the egg development. iii. The successfully fertilized egg has 46 chromosomes and is now called a zygote. iv. The zygote enters the uterus and implants into the proliferated endometrium, stopping the woman from menstruating. v. The ruptured follicle left behind in the ovary will become the corpus luteum and secrete hormones to help maintain the thickened endometrium to nourish the embryo. i. Unfertilized eggs i. If zygote is not fertilized, it will not implant in the uterus. ii. The uterine lining will begin to degenerate, and the women will have her period. iii. The corpus luteum will become a corpus albicans and eventually disappear.

C. Hormonal control 1. Hormones from the hypothalamus, pituitary, and ovary control the female cycle.

2. Hierarchical control with negative feedback 3. Four hormones control the menstrual cycle: estrogen and progesterone from the ovary, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary.

4. Puberty a. Estrogen and progesterone levels increase at puberty. .

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b. The release of gonadotropin-releasing hormone (GnRH) from the hypothalamus causes an increase in the secretion of LH and FSH from the pituitary. c. FSH initiates the development of primary follicles each month, whereas LH triggers ovulation.

5. Follicular (proliferative) phase a. During the follicular phase, estrogen levels continue to rise as more and more is secreted by the developing follicle, stimulating proliferation of uterine lining. b. Estrogen exerts a positive influence on the hypothalamus, increasing the secretion of GnRH, thus increasing LH and FSH. c. This positive feedback loop continues, raising hormone levels until ovulation occurs.

6. Luteal (secretory) phase a. Once ovulation occurs, the feedback loop reverses itself. b. The corpus luteum begins to secrete progesterone as well as a little estrogen. c. Estrogen, under the influence of progesterone, exerts negative feedback on the hypothalamus and pituitary, decreasing GnRH, LH, and FSH secretion. d. Progesterone also exerts negative feedback on the hypothalamus and pituitary. e. Thus, during the luteal or secretory phase, LH, FSH, and estrogen levels drop while progesterone levels rise. f. These hormonal changes prevent another egg from maturing. g. For about 10 days after ovulation, progesterone levels remain high as the corpus luteum continues to secrete the hormone. h. Progesterone’s effect on the uterus is to maintain the buildup of the endometrium and to decrease uterine contractions. i. If no pregnancy results, the corpus luteum degenerates, and progesterone is no longer produced. j. Decreasing progesterone levels cause degeneration of the endometrium, followed by menstruation. k. Decreased progesterone levels release the hypothalamus and pituitary from their inhibitory effects, FSH and LH levels begin to rise, and the cycle begins again.

7. Pregnancy a. If pregnancy does result, the implanted fertilized egg secretes a hormone called human chorionic gonadotropin (HCG). b. HCG stimulates the corpus luteum to keep secreting progesterone and a little estrogen to maintain the uterine lining. c. At about 3 months gestation, the placenta begins to secrete its own progesterone and estrogen, thus becoming an endocrine organ.

IX. Male Reproductive System .

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A. Anatomy 1. The testes are the primary genitalia, producing the male gamete, sperm.

2. Unlike female genitalia, the primary male genitalia are external.

3. Secondary genitalia include the penis (sperm delivery organ), epididymis, vas deferens, urethra (sperm ducts), and several accessory glands, including the prostate gland, the seminal vesicles, and the bulbourethral glands.

4. Primary genitalia a. Testes or testicles i. Paired organs suspended in a sac called the scrotum, hanging on both sides of the penis ii. Each testis is surrounded by a serous membrane, called the tunica vaginalis, originating from the peritoneum. iii. Deep in the tunica vaginalis is the tunica albuginea. iv. The inside of the testes is divided into 250 to 300 wedges called lobules, each of which contain 1 to 4 seminiferous tubules. v. Seminiferous tubules are made of epithelium and areolar tissue and contain sperm stem cells and sperm helper cells called Sertoli cells or nurse cells.

5. Secondary genitalia a. Penis i. The penis is a sperm-delivery organ. ii. The attached portion of the penis is called the root; the freely moving part is called the shaft or body. iii. The tip of the penis, the glans penis, is covered by a loose section of skin called the foreskin unless a man has been circumcised. iv. Internally, the penis contains the urethra, which is a transport passage for both sperm and urine, and three erectile bodies, tubes with a spongelike network of blood sinuses. b. Epididymis i. The epididymis is a comma-shaped duct on the posterior and lateral part of the testes. ii. The tube is highly coiled and, if unraveled, would measure 6 meters long. iii. It is made of pseudostratified ciliated epithelium and smooth muscle. iv. Sperm mature here. c. Vas deferens i. The vas deferens is a short tube, only 45 cm long. ii. It is lined with ciliated pseudostratified epithelium, like the epididymis, but has a thick smooth muscle layer and is surrounded by a connective tissue layer called the adventitia. iii. Runs from the scrotum to the penis via a relatively complicated pathway .

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a. From the anterior part of the scrotum as a pair of tubes, one on each side, into the abdominal wall (through the inguinal canal) and pelvic cavity, medially over the urethra and along the posterior bladder wall b. Posterior to the bladder, the vas deferens joins the seminal vesicle to form the ejaculatory duct, which then passes through the prostate gland and empties into the urethra. c. Between the scrotum and the inguinal canal, the vas deferens runs through a tube, with blood vessels and nerves, collectively called the spermatic cord. d. Accessory glands i. There are three accessory glands in the male reproductive system. a. Seminal vesicles, highly coiled posterior to the bladder, made of pseudostratified epithelium, smooth muscle, and connective tissue b. Prostate gland, a chestnut-sized gland surrounding the urethra just inferior to the bladder made up of a dense mass of connective tissue and smooth muscle with embedded glands. c. Bulbourethral glands, pea-sized glands inferior to the prostate B. Physiology 1. Sperm production is a continuous process from puberty until death. a. Sperm production, called spermatogenesis, is much less complicated than ovulation. i. Spermatogonia, sperm stem cells, undergo mitosis to form primary spermatocytes. ii. Primary spermatocytes form two secondary spermatocytes. iii. Spermatocytes complete meiosis to form spermatids. iv. Spermatids go through a period of development to form immature spermatozoa (sperm). b. Takes place in the testes in the seminiferous tubules. i. Spermatogonia line up against the walls of the tubules. ii. Mature sperm cluster near the lumen of the tubules. c. Sperm then travel from the seminiferous tubules to the epididymis where the sperm spends about 2 weeks maturing and gaining the ability to swim.

2. Hormonal control of male reproduction a. Testosterone is the most important sex hormone. i. In utero, HCG secreted by the placenta stimulates embryonic secretion of testosterone, masculinizing the fetus; those not exposed to testosterone become female. ii. After birth there is little testosterone secreted until puberty. .

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iii. At puberty, two hormonal changes occur that signal the beginning of maturity. a. Testosterone secretion by the testes increases. b. Testosterone enhances GnRH, and therefore FSH and LH, further enhancing testosterone production, creating a major positive feedback loop (prior to puberty, testosterone inhibits GnRH, but at puberty, the feedback loop reverses). iv. Testosterone secretion at puberty brings about the male secondary sexual characteristic development, including a. Body, facial, pubic hair growth b. Deepening of the voice c. Increased muscle and bone mass b. LH and FSH in males i. LH and FSH in males stimulate gamete development. ii. Regulated in the same way in males as in females iii. GnRH is released from the hypothalamus, which stimulates LH and FSH secretion from the pituitary. c. Estrogen i. Just as women have some testosterone, men have some estrogen. ii. The balance between the two hormones is important.

3. Erection and ejaculation a. Erection: the erectile bodies in the penis (spongelike tissue with blood spaces) become engorged with blood, stiffening and expanding the penis. b. Ejaculation: the expulsion of semen—sperm and assorted chemicals i. Smooth muscle contracts throughout the ducts and glands of the male reproductive system and propels the sperm from the epididymis into the vas deferens, and into the pelvic cavity; as the sperm passes the seminal vesicles, sugar and chemicals are added to the sperm. ii. Sperm and chemicals enter the ejaculatory duct, passing though the prostate gland, where fluid is added, liquefying the semen and protecting the sperm from the acid environment of the vagina by secreting an alkaline substance. iii. The semen passes by the bulbourethral gland, adding mucus to the semen. iv. Finally, the semen enters the urethra and is carried outside the body. v. If a man is having sexual intercourse (coitus) with a woman and ejaculates, the sperm enter the vagina and make their way into the uterine tubes. vi. The female reproductive system is not hospitable to sperm, and many sperm will not survive the journey. vii. If there is an egg waiting to be fertilized, sperm will find the egg and attempt to penetrate it for fertilization. .

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viii. New research suggests that the egg is not a passive participant in fertilization but may actually engulf the sperm and even choose which sperm to allow inside. ix. One sperm, and only one sperm, will fertilize the egg.

X. Pregnancy A. Pregnancy occurs when an egg is fertilized by the sperm and implants in the uterus.

B. The development period is called the gestation period, approximately 40 weeks.

C. A baby born before 36 to 37 weeks gestation is called a premature baby.

D. The first 8 weeks of gestation, the developing infant is called an embryo, when the organs and systems are fundamentally formed.

E. After 8 weeks, the infant is called a fetus.

F. The growing fetus is nourished by a spongy structure called a placenta, attached to the fetus and the mother by the umbilical cord.

G. The fetus is encased in a membranous sac called the amnion, containing amniotic fluid.

H. Labor is the process by which the fetus is delivered through from the uterus through the vagina.

1. Labor consists of three stages. a. Dilation stage; uterine smooth muscles begin to contract, moving the fetus down the uterus, causing the cervix to begin to dilate b. Second stage-delivery i. Cervix is fully dilated to 10 cm, and the fetus is actually delivered. ii. Generally, the head presents first, called crowning, and the baby’s mouth is suctioned before it takes its first breath to prevent mucus from entering the respiratory tract. iii. A breech presentation: buttocks appear first instead of the head c. Last stage of labor, the placental stage, is the delivery of the placenta from final uterine contractions.

XI. Contraception A. The prevention of pregnancy is termed contraception and can be accomplished by a number of means, including an intrauterine device (IUD), spermicidal agents, birth control pills, or shields such as condoms or diaphragms.

B. Sterilization of the male can be accomplished by a procedure called a vasectomy in which the vas deferens are tied off to prevent sperm from traveling out of the penis during sexual intercourse.

C. Females may be sterilized via tubal ligation: the fallopian tube is cut or tied shut, preventing the sperm from getting to the egg and the egg from traveling to the uterus.

XII. Common Diseases of the Female Reproductive System A. Amenorrhea: absence of menstruation B. Dysmenorrhea: painful or difficult menstruation C. Premenstrual syndrome (PMS): a variety of symptoms affecting many systems of the body

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D. Vaginitis: inflammation of the vagina usually caused by a microorganism such as bacteria or yeast; many infections are caused by sexually transmitted diseases (STDs) that can be bacterial, viral, or fungal E. Cervical cancer: cancer of the cervix, diagnosed by a Pap test (named after George Papanicolaou), a smear of scrapings of the cervical cells to detect the presence of cancer cells F. Ectopic pregnancy: implantation of a growing embryo in the uterine tubes G. Abruptio placenta: premature separation of the placenta from the uterine wall, can result in fetal death if the baby isn’t quickly delivered H. Postpartum depression: a psychological state occurring after the delivery of the baby; may result in the mother harming herself or the baby in serious cases I. Mastitis: inflammation of the breast occurring at any age in males and females, but usually associated with lactating females J. Breast cancer 1. Breast cancer is the leading cause of death in women between the ages of 32 and 52, killing about 46,000 women a year.

2. Men can also get breast cancer, but at a lower rate—estimated to be 1,000 cases in 2003 (compared to 182,000 female cases).

3. Treatment may include any combination of complete mastectomy, lumpectomy, partial mastectomy, chemotherapy, or radiation therapy.

4. Breast self-exam is the most important preventative measure, and all women should perform an exam monthly.

XIII. Common Diseases of the Male Reproductive System A. Erectile dysfunction disorder (EDD): the penis is unable to achieve a full erection; treatment includes medications to increase blood flow to the penis; inability to develop an erection is called impotency B. Cryptorchidism: failure of testes to descend into the scrotal sac; will result in infertility if uncorrected C. Hydrocele: an abnormal collection of fluid within the testes.

D. Benign prostatic hypertrophy (BPH): enlargement of the prostate gland, commonly seen in males over age 50 E. Prostate cancer: a slow-growing cancer that also affects males in this age group and can be detected by a PSA test; early diagnosis increases survival rates

CLASSROOM ACTIVITIES 1. Have students trace the passage of sperm and ovum as they pass through the reproductive organs.

2. Have students write a paper and present it to the class. Suggested topics: teen pregnancy, HIV/AIDS, STDs, vasectomies, tubal ligations, various contraceptives, infertility issues.

TEACHING STRATEGIES 1. Many students are sexually active, and some buy into silly myths they learned in their teen years. Use this opportunity to shine the light of reason into these myths. Some .

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myths include the idea that you can’t get pregnant the first time you have sex, that conception can’t occur if the man withdraws before ejaculation, and that contraceptives (especially condoms) protect them from all sexually transmitted diseases.

2. Some students may be uncomfortable talking about this topic in a mixed group of men and women. Keeping the language professional and tone of voice matter of fact and dealing with students’ questions honestly and openly can help make the situation more comfortable.

FACTOIDS 1. Sexually transmitted diseases (STDs), once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STDs affect more than 13 million men and women at a cost in excess of $10 billion dollars annually (http://www.niaid.nih.gov/factsheets/stdinfo.htm).

2. If you took all the DNA strands in your body and linked them together, they would measure 6 to 8 feet.

ETHICAL DILEMMAS 1. Convicted pedophiles occasionally get the option of early release from prison if they agree to chemical castration, involving the injection of Depo Provera, which reduces the man’s ability to get an erection. Is this an ethically acceptable practice? What about the mother who is repeatedly convicted of child abuse—should she be forced to receive hormones to prevent pregnancy to keep her from abusing another child?

2. Pregnant women who abuse drugs negatively affect the health of their unborn fetus.

Some localities arrest mothers when they come to the hospital to deliver their babies, or when they come in for prenatal care, if they have drugs in their system. Is this an ethical approach to the problem? Some say if mothers fear being arrested, they will fail to seek medical care prenatally or when it’s time to deliver. What do you think is right? How do we solve the problem and keep the fetus safe? What if the mother abuses alcohol and delivers a child with fetal alcohol syndrome—would you arrest her? What if the mother smokes?

3. Some people believe it is cruel and unnecessary to circumcise baby boys. Others point to the high rate of penile cancer in uncircumcised men as a good reason to circumcise all baby boys. Those on the other side of the coin say we don’t do preventative mastectomies to pubescent girls; there shouldn’t be a need to circumcise boys. What do you think?

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 18–1 Answers, p. 461 1. c 2. b 3. d 4. c 5. b .

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Test Your Knowledge 18–2 Answers, p. 467 1. d 2. b 3. c 4. b 5. b Test Your Knowledge 18–3 Answers, p. 470 1. b 2. c 3. b 4. c 5. b Test Your Knowledge 18–4 Answers, p. 472 1. c 2. c 3. b 4. b 5. d Test Your Knowledge 18–5 Answers, p. 476 1. b 2. d 3. a 4. b Test Your Knowledge 18–6 Answers, p. 479 1. b 2. a 3. d 4. b ANSWERS TO THE CASE STUDY, P. 485 Maria’s rather vague symptoms could be caused by many different problems. The doctor could try ultrasound, CAT scan, MRI, or even x-ray to look for problems in Maria’s abdomen. Pain in her abdomen and back could be the result of a tumor or a herniated disk or many other problems. The doctor might suggest a colonoscopy to check for problems in her digestive system or a cystoscopy to check for abnormalities in the urinary bladder. The doctor should also do a Pap smear.

However, Maria’s symptoms mainly point to endometriosis, the abnormal growth of endometrial tissue outside the uterus. Her pain and other symptoms are part of a group of often vague symptoms associated with endometriosis, the most common cause of infertility. Unfortunately, the only way to tell for sure if Maria has endometriosis is with a laparoscopy, exploratory abdominal surgery. .

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ANSWERS TO REVIEW QUESTIONS, P. 485 Multiple Choice 1. b, 2. a, 3. d, 4. c, 5. a, 6. d Fill in the Blank 1. erection; ejaculation 2. seminal vesicles; prostate 3. Meiosis (reduction/division) 4. negative 5. fertilization 6. Endometriosis Short Answer 1. Sperm are made in the seminiferous tubules of the testes. They mature in the epididymis. From the epididymis, sperm flow up the vas deferens and into the body.

They pass the seminal vesicles and enter the urethra. Then sperm travel through the prostate and eventually out the end of the penis during ejaculation. The sperm will travel up the vagina into the uterus, eventually reaching the fallopian tubes, where fertilization takes place if an egg is present.

2. Four hormones control the female reproductive cycle: estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). (The levels of LH and FSH are controlled further by GnRH from the hypothalamus.)

At puberty, estrogen and progesterone are secreted by the ovary, increasing LH and FSH secretion from the pituitary. FSH stimulates follicles to mature, and LH stimulates ovulation.

The follicular (proliferative) phase of the menstrual cycle is characterized by increased estrogen, which causes increased FSH and LH, which causes increased estrogen, in a massive positive feedback loop. This positive feedback loop causes ovulation and proliferation of the endometrium.

Once ovulation occurs, the feedback loop reverses itself. This begins the luteal (secretory) phase. The leftover ruptured follicle secretes progesterone and a bit of estrogen. Progesterone causes the feedback loop to become negative. Thus, LH, FSH, and estrogen secretion decrease. Therefore, another follicle doesn’t mature; another egg doesn’t ovulate; and the lining of the uterus is maintained for about 10 days. After 10 days, the progesterone levels decrease and the endometrium is shed if fertilization has not occurred. The decrease in progesterone levels also allows estrogen, LH, and FSH to rise again, eventually stimulating ovulation, and the cycle begins again.

3. Labor consists of three stages. In the dilation stage, the uterine smooth muscle begins to contract, thereby moving the fetus down the uterus and causing the cervix to begin to dilate. When the cervix is completely dilated (10 centimeters), the second stage (expulsion) begins, during which the baby is actually delivered. The last stage of labor is the placental stage, in which the placenta or afterbirth is delivered because of final uterine contractions.

4. Eggs and sperm, with only half as many chromosomes as other cells, are produced by meiosis in the gonads, testes in males and ovaries in females. Fertilization occurs, .

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resulting in a zygote. The zygote undergoes millions of rounds of mitosis and development within the female to change from an embryo to a fetus (the infant that is not born yet). Eventually after years of mitotic growth an adult is formed. That adult is capable of making eggs and sperm, and the cycle continues.

5. The process by which eggs are produced is called oogenesis. Oogenesis begins with the birth of oogonia, or egg stem cells, in the ovary. The oogonia undergo mitosis, producing millions of primary oocytes during fetal development. Primary oocytes undergo meiosis. The primary oocytes stay in a kind of suspended animation until puberty, when they finish developing. These primary oocytes eventually are surrounded by helper cells, called granulosa cells. Once surrounded by granulosa cells, the primary oocyte and surrounding cells are known as primordial follicles. These primordial follicles stay dormant until puberty. Hormonal signals during puberty cause some primordial follicles to enlarge and increase the number of granulosa cells. These enlarged cells are then called primary follicles. Once a girl reaches puberty, one primary follicle will become a secondary follicle. The secondary follicle will not complete its development unless it is ovulated and fertilized.

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Name_________________________________________________ CHAPTER 18 – WORKSHEET Multiple Choice 1) The reproductive structures that produce gametes are called the A) primary genitalia.

B) secondary genitalia.

C) tertiary genitalia.

D) quaternary genitalia.

2) The _____ is the inner lining of the uterus, which proliferates each month and is shed if pregnancy does not occur.

A) cervix.

B) endometrium.

C) myometrium.

D) fundus.

E) body.

3) The muscular layer of the uterus is called the A) cervix.

B) endometrium.

C) myometrium.

D) fundus.

E) body.

Matching Match each of the following female structures with the appropriate description.

4) _____ Uterus 5) _____ Ovaries 6) _____ Fallopian tubes 7) _____ Vagina 8) _____ Mammary glands 9) _____ Clitoris 10) _____ Perineum 11) _____ Vulva 12) _____ Hymen 13) _____ Follicle 14) _____ Corpus luteum A. Produce female hormones and eggs B. Receives the penis during intercourse C. A membrane that may surround the opening to the vagina D. The “womb”; the location where pregnancy develops E. Carry eggs from the ovaries to the uterus F. The area between the vagina and the anus G. An egg and its associated helper cells H. Produce milk after a baby is born I. The remnants of the follicle after ovulation; secretes progesterone J. Erectile tissue that becomes engorged with sexual arousal K. A collective term for all the external female genitals .

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Worksheet – p. 1 of 2 Matching Match each phase of the female cycle with the appropriate description.

15) _____ Follicular (proliferative) phase 16) _____ Ovulation 17) _____ Luteal (secretory) phase 18) _____ Menses A. When the endometrial lining is shed; a portion of the follicular phase B. Period of time from ovulation until menstruation; Corpus luteum develops in the ovary, and the uterus begins secretion C. Period of time where follicles are maturing in the ovary and endometrium is proliferating D. When the ovary releases a mature egg (oocyte) Matching Match each structure with the appropriate description.

19) _____ Testes 20) _____ Epididymis 21) _____ Scrotum 22) _____ Vas deferens 23) _____ Urethra 24) _____ Penis 25) _____ Prepuce 26) _____ Prostate gland 27) _____ Seminal vesicles 28) _____ Bulbourethral gland A. The sac of skin that contains the testes B. Produce sperm and testosterone C. The tube that carries sperm from the scrotum up into the pelvic cavity D. The “foreskin” that covers the glans penis E. The donut-shaped gland that surrounds the urethra; produces seminal fluid F. Two tiny, pea-sized glands located inferior to the prostate G. A dual-purpose tube that serves as the exit for seminal fluid and urine to leave the body H. The comma-shaped structure at the back of each testis where sperm mature I. Two highly coiled glands located posterior to the bladder; secrete seminal fluid J. Composed of erectile tissue; engorges with blood during sexual arousal; facilitates delivery of sperm into the female reproductive tract Worksheet – p. 2 of 2

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ANSWER KEY Chapter 18 – Worksheet 1) A 2) B 3) C 4) D 5) A 6) E 7) B 8) H 9) J 10) F 11) K 12) C 13) G 14) I 15) C 16) D 17) B 18) A 19) B 20) H 21) A 22) C 23) G 24) J 25) D 26) E 27) I 28) F

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name________________________________________________________ LABELING ACTIVITY INSTRUCTIONS: Please label the following diagram.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LABELING ACTIVITY ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Chapter 19 THE JOURNEY’S END: NOW WHAT?

LEARNING OBJECTIVES ➯ Discuss the relationship between forensic science and anatomy and physiology ➯ Relate the anatomy and physiology changes in the process of aging ➯ Describe the concept of wellness and personal choices ➯ List and describe wellness concepts for each body system ➯ Discuss cancer prevention and treatment ➯ Dazzle your friends with amazing anatomy and physiology facts

MULTIMEDIA FOUND ON THE POWERPOINT LECTURE OUTLINE Videos 1. AIDS 2. Audiology 3. Autism 4. Carpal Tunnel Syndrome 5. Criminalist Professional Profile 6. Eating Disorders 7. Gonorrhea 8. Herpes 9. Mental Health Professional Profile 10. Physician Assistant Professional Profile 11. Skin Cancer Animation 1. Lead Poisoning

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name CONCEPT MAP INSTRUCTIONS: Fill in the empty boxes with an appropriate term using the clues provided.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

LECTURE OUTLINE I. Introduction A. The basics of anatomy and physiology you have learned will act as a foundation for life encounters, both personal and professional.

B. This chapter looks at a small example of how anatomy and physiology play important roles in many areas.

II. Forensic Science A. Forensic science is the application of science to law.

B. A forensic scientist often searches for and examines physical traces to establish or exclude a criminal suspect and their association to a victim.

C. Both physical science (such as anatomy and physiology) and social sciences are used by a forensic scientist.

D. What we have learned.

1. Ancient Egyptians were stricken with TB, by examining the ends of long bones of skeletal remains of ancient Egyptians 2. Primitive surgery; 400-year-old drill hole in skull from Jamestown, Virginia E. Techniques 1. Video skull–face superimposition allows experts to mark a skull with pins at 30 specific structural landmarks and generate a computer comparison of those 30 points to a picture of that person when alive.

2. Dental records can be compared to the teeth, if found, in a skull for identification purposes.

3. Hair a. A person’s health and habits b. Can reveal the race of an individual c. DNA and blood type can be discerned. d. Stores information about substances a person ingested or was exposed to; because hair grows slowly, it can act as a timeline.

4. Fingerprints a. No two fingerprints are exactly alike. b. Even identical twins have different fingerprints. c. Fingerprints were discovered in the 1600s and were first used in 1880 to solve crimes.

5. DNA fingerprinting a. DNA can be used to identify individuals. b. Sampled from blood, semen, bones, or even a very tiny soft tissue sample c. DNA molecules are split into pieces and separated using electrical currents, and samples from known individuals of interest are compared to DNA found at the scene. d. It is now standard to use this technology to solve rape and murder cases. e. Helped determine that Thomas Jefferson or a male relative did father children with his slave, Sally Hemmings. f. Use to identify many of the victims from the 9/11 terrorist attack. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

III. Geriatrics A. Increase in elderly populations because of 1. Safer workplaces 2. Healthier lifestyles 3. Effective vaccines and medications 4. Access to improved health care B. Geriatric patients differ in many ways from other populations.

C. The term elderly can be misleading; classification system 1. 65 to 75—younger old 2. 76 to 84—older old 3. Over age 85—elite old D. We do not age uniformly.

E. General 1% decline in function of most body systems per year after age 30.

1. Decrease in the ability to maintain homeostasis 2. Decrease in the ability to handle stressors 3. Disease processes may accelerate the loss of body reserves 4. Declines in vision, hearing, and, possibly, mental abilities 5. Total body water declines, leading to faster dehydration and slower excretion rates of Medications.

6. From age 20 to 70, there is a loss of lean body mass.

7. Increase in body fat 8. Bone density usually peaks at age 35. a. Women may experience a 1% to 2% loss of bone in the first 5 years following menopause. b. In general, we see a 1% decline in bone mass between the ages of 55 and 70. c. After age 70, bone loss is 0.5% per year.

9. Gustatory changes; barriers to good nutrition, including a. Loss of teeth b. Difficulties swallowing c. Decrease in salivary secretions d. Decreases in digestive juices and secretion e. Decreased nutrition absorption f. Decreased bowel function g. Decreased taste perception F. Brain and nervous system 1. The elderly have slower reaction time, increasing the likelihood of motor vehicle accidents, falls, burns, and other accidents.

2. Pain is often a problem in the elderly, leading to an overall decrease in the quality of life, including impaired sleep, decreases in socialization, confusion, depression, malnutrition, polypharmacy, and impaired ambulation.

3. This leads to increasing health care costs.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

G. Pain management 1. Geriatric patients are often undermedicated for pain because they are debilitated, cognitively impaired, have a history of substance abuse, or are unable to effectively relate how they feel.

2. Sometimes poor pain management is the result of health care professionals who cannot recognize indicators of pain.

3. Behavioral changes related to pain include a. Changes in personality, such as becoming agitated, quiet, withdrawn, sad, confused, depressed, and/or grumpy b. Loss of appetite c. Screaming, swearing, name calling, grunting, and/or noisy breathing d. Crying, rocking, fidgeting e. Splinting or rubbing a sore area, wincing f. Cold, clammy, pale skin H. Cardiovascular system 1. Changes in the aging cardiovascular system include a. Calcification of the heart valves, decreasing their efficiency b. Lessening of flexibility of blood vessels, leading to clogging c. Inability to deal with blood pressure changes, resulting in elevated blood pressure d. Decrease in cardiac output e. A 25% decrease in maximum heart rate I. Genitourinary system 1. Between ages 20 and 80, we lose about 50% of our renal function.

2. This becomes especially significant when you think of the number of medications this age group uses.

3. Reduced metabolism of medications can lead to an accumulation of the drug to harmful or toxic levels.

4. There is an increase in incontinence (loss of bladder control) in this age group.

J. Integumentary system 1. Changes in the integumentary system in the elderly include a. Loss of skin elasticity b. Increased skin delicacy c. Multiple skin lesions d. Increased incidence of skin cancer 2. Sun exposure, smoking, and medications like corticosteroids can accelerate these changes.

K. Polypharmacy 1. Polypharmacy, the administration of many drugs at the same time, is a major concern in this age group.

2. Contributing factors include the fact that they may see many specialists for a variety of diseases, and no one doctor oversees the process.

3. These multiple diseases have competing therapeutic needs, and the combinations of drugs potentially causing lifethreatening situations. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. Aging can also affect the rate of drug absorption, distribution, metabolism, and excretion from the body.

IV. Wellness A. Personal choices affect health B. Eating properly, exercising within reason, smoking, using drugs and alcohol, and living or working in a dangerous environment are allimportant decisions.

C. Individual accountability and informed choices are key concepts in deciding your lifestyle.

D. Peer pressure can be negative or positive.

E. Read and critically analyze what you read: there is a lot of “junk” science available that is more opinion than fact.

F. Stress 1. Stress is a natural part of life—a good and necessary evil because it is a motivator, helping you to protect yourself 2. When stress becomes chronic, and you can’t effectively deal with it, it can affect some or all of your body’s various systems to varying degrees.

3. Stress imbalance can cause eating disorders, digestive problems, decreased immune response, decreased memory and work capacity, sleep problems, joint and muscle aches, heart problems, and personality changes.

4. Some can be life threatening.

G. The whole patient 1. When assessing a patient, we too often look at the disease instead of the whole picture.

2. The whole picture includes not only other systems of the body but also the mental and spiritual aspects of a person.

3. Mental illness carries a stigma, but it’s no different than other diseases requiring help to resolve.

H. Skeletal system wellness 1. Diet is extremely important to the growth and protection of your bones.

2. A diet rich in calcium and vitamins helps maintain good bone growth and development.

3. Weight-bearing exercises are beneficial as well.

I. Muscular system wellness 1. Proper exercise and diet will help develop and maintain properly functioning muscles.

2. There are many types of muscle training programs, and it is important to find what is best for your needs and outcome.

3. Muscle enhancement drugs are dangerous and have serious side effects.

J. Integumentary system wellness 1. Proper diet and hydration is important for the functioning of the integumentary system.

2. Smoking causes premature aging of the skin.

3. Some sun exposure produces vitamin D, but limiting the amount of sun exposure is important to prevent skin cancer; minimize time in the sun between 10 a.m. and 4 p.m. when the sun is the most powerful, cover as much skin as .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

possible, protect the eyes with sunglasses, and use a good sunblock to reduce risk.

4. Some forms of skin cancer are treatable; others can be lethal.

K. Cardiovascular system wellness 1. A heart-healthy diet low in saturated fats and high in fiber, rich in fruit and vegetables, will maintain an optimally healthy cardiovascular system.

2. The proper level of regular exercise helps tone the heart muscle for proper functioning; walking 30 minutes a day, three or four times a week, individualized to specific requirements, is all that’s required.

3. Tobacco, alcohol, and other drugs can have a negative affect on this and other systems.

L. Respiratory system wellness 1. Smoking a. Number one preventable cause of respiratory disease b. Increases the occurrence of lung infections and colds as well as sinus infections c. Associated with 80% of all lung cancers d. Affects the heart, reducing available oxygen to the heart muscle e. With alcohol consumption, increases the occurrence of stomach and mouth cancers 2. Outdoor and indoor pollution can lead to respiratory problems.

3. Respiratory damage can be caused by occupational hazards.

4. The lungs respond to irritants by narrowing the airways to minimize exposure, leading to breathing difficulties.

M. Gastrointestinal wellness 1. A proper diet is critical for growth, development, and general health.

2. Lack of nutrients, leading to malnourishment, can adversely affect health.

3. Vitamin and mineral supplements can be helpful, but it is best if the diet contains all essential ingredients.

4. Fat-soluble vitamins (A, D, E, and K) can build up in the body to toxic levels if taken in excess.

N. Endocrine system wellness 1. Proper diet and exercise assist the endocrine system.

2. Performance-enhancement drugs, like anabolic steroids used to increase strength and endurance, can have serious side effects including kidney damage, liver damage, increased risk of heart disease, irritability, and aggressive behavior.

3. Women taking steroids can develop facial hair and deeper voices in addition to the other effects.

4. Some of these effects can be permanent.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

O. Sensory system wellness 1. Proper diet, hearing and sight protective devices, and periodic eye and ear exams are needed for sensory system wellness.

2. Wearing hearing protection during loud noise extends the functional life of your ears; damage to the ear is cumulative.

3. Protective eyewear should be worn any time there is risk of eye injury, including polarized sunglasses when glare from the sun could damage the unprotected eyes.

P. Immune system wellness 1. Proper diet and exercise are important to optimal functioning of the immune system.

2. The best way to protect yourself and your patients is with hand washing; for hand washing to be effective, it requires running warm water, soap, and friction lasting for at least 20 to 30 seconds; singing, “Row, Row, Row Your Boat” twice takes about 20 seconds and is a good timing device—especially for teaching children how to wash their hands.

3. Wash your hands before and after contact with patients, eating, using the bathroom, and any time your hands become soiled.

4. Standard Precautions Guidelines a. Another way to protect yourself and others from the spread of pathogens is by following Standard Precautions Guidelines. b. These guidelines assume that everyone is potentially infectious. c. Follow standard guidelines, like wearing gloves whenever you are in contact with bodily secretions.

5. Current immunizations a. Keeping immunizations current is another protective device for the immune system. b. Immunization schedules are recommended by the Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). c. Immunizations are not given only during childhood; influenza vaccinations should be received yearly, tetanus toxoid vaccinations every 5 to 10 years, and everyone working in health care should be immunized against hepatitis. d. Immunizations are particularly important to the very young and very old, who are most susceptible to disease.

6. Antibiotics a. Proper use of antibiotics is also important to maintaining immune system wellness. b. Overuse of antibiotics can lead to problems. c. Antibiotics are not effective against viruses and can harm normal bacteria such as those located in the intestines. d. Overuse of antibiotics in children can lead to improperly developed immune systems. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

e. Taking antibiotics improperly and not following the directions on the label can lead to the development of “superbugs” by allowing a few bacteria to survive and alter their DNA—making them resistant to that particular drug; this can lead to outbreaks of drug-resistant infections.

Q. Reproductive system 1. Pregnancy a. Mothers who smoke tend to have low-birth-weight infants, an increased risk for premature births, and a higher rate of SIDS (sudden infant death syndrome). b. Secondhand smoke is dangerous in the home, leading to slower lung development in children and increased incidence of bronchitis, asthma, and ear infections (otitis media). c. It is important to provide the pregnant mother with important vitamins, minerals, and nutrients for the developing fetus and to maintain the health of the mother. d. Calcium is particularly important because if the diet is lacking in calcium, the fetus will rob calcium from the mother’s teeth and bones, decreasing the integrity of her system. e. Spina bifida, a congenital condition of the fetus, can be prevented by adequate intake of folic acid (B complex). f. Alcohol must be avoided in pregnancy because of its effect on the fetus’s nervous system.

2. Sexually transmitted diseases (STDs) a. STDs are a growing problem and can have serious effects on the reproductive system and lethal effects on the body. b. Various diseases and organisms can be transmitted through unprotected sex (including oral sex). c. Although condoms are not foolproof, they are the best means for reducing the risk of transmitting STDs; the only foolproof method is abstinence.

R. Cancer prevention and treatment 1. All body systems can be invaded by cancer.

2. Cancer is the runaway reproduction and spread of abnormal cells, a very complicated disorder.

3. Each type of cancer is named for the type of cell running amok and has its own unique characteristics.

4. Medical science continues to learn more about cancer every year and develop better treatments.

5. However, early detection is the best predictor of outcome.

6. Cancer triggers a. Any number of triggers can make a cell cancerous, including genes, radiation, sunlight exposure, smoking, fatty foods, viruses, and chemical exposures. b. Some, like genes and viruses, can’t be avoided; others can be reduced by changing lifestyle; melanoma risk is greatest for those living closest to .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

the equator; melanoma can be prevented by decreasing exposure to UV light. c. Many types of cancers can be prevented or managed with a healthy diet and exercise.

S. Amazing facts 1. Senior citizens are more prone to food poisoning because of decreased senses of smell and taste and reduced acidity of digestive juices.

2. Nerve impulses can travel up to 426 feet per second!

3. Approximately 450,000 people die annually from smokingrelated diseases; this is equivalent to a jumbo jet full of people crashing every day without any survivors.

4. A healthy kidney filters 180 quarts of fluid every day, and it is only 4 inches long, 2 inches wide, and 1 inch thick.

5. Hair grows a quarter inch per day—faster during the day and during the summer months.

6. You use about a half pint of oxygen per minute at rest.

7. Your heart beats over 36 million times a year!

8. You possess over 16,000 miles of capillaries!

9. Everyone has one nare larger than the other!

10. Viruses are constantly mutating, so immunity doesn’t last a lifetime!

11. You have from 10,000 to 150,000 hairs—just on your head! Each strand of hair can support approximately 100 grams of weight so, at least in theory, a full head of hair could support the weight of two African elephants!

12. African hair grows more slowly than European hair and is more fragile. Asian hair grows fastest and possesses the greatest amount of elasticity. Asians also tend to be bald less than Africans or Europeans.

13. Research suggests that vitamins and minerals from natural food sources are better utilized than synthetic pills, but pills are better than nothing.

14. The horns on a bull are composed of the same material that makes up your finger- and toenails.

15. You have about a quarter of a million sweat glands on your feet 16. Based on current research of fibroblasts and their ability to double before they lose their ability to accurately divide, we have the potential to live to 120 years of age.

17. Your eyes can see approximately 7 million shades of color.

18. Urine is sterile, so it can be used to clean out a wound.

19. The ability to roll your tongue into a tube is inherited, and not everyone can do it.

20. Cavities and poor oral hygiene can lead to diabetes and heart attacks; some experts believe daily flossing can add 6.4 years to your life because bacteria growing in the mouth can escape into the bloodstream and cause problems in other parts of the body; a person with poor oral hygiene has a 4 times greater risk of a stroke and 14 times greater risk of a heart attack.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

21. Current research indicates that stomach cancer, affecting 24,000 Americans annually, may originate from bone marrow cells that enter the stomach to repair damage to the stomach lining.

22. A recent study showed that individuals who walk uphill clear fats from their blood faster, whereas downhill hiking reduces sugars more readily and improves glucose tolerance; hiking of any kind removes LDLs; this research may affect exercise recommendations for various conditions.

23. CIPA (congenital insensitivity to pain with anhidrosis) is a rare genetic disorder that affects the development of small nerve fibers that transmit the sensation of pain, heat, and cold to the brain; there are only 17 known cases in the United States; clients with CIPA are at great risk of injury, such as from burns, because they don’t know they’re in danger; because they don’t feel heat or cold, they don’t sweat! Biting their tongue when eating is common.

CLASSROOM ACTIVITIES 1. Assign students to watch an episode of CSI on TV, or record it and bring it to class to watch. Discuss the types of tests and studies done on the show and the reality of this level of investigation.

2. Have students bring pictures of their grandparents to class. The pictures should represent their grandparents at different ages. Discuss the visible signs of aging seen in the pictures.

TEACHING STRATEGIES 1. Have fun with this module. Allow discussions to follow whatever path the students take. The section of this chapter you emphasize will depend on the program you’re teaching and the needs of the students.

2. Use this opportunity to also discuss how the students’ health will affect their clients, and review the need to reduce communicable illnesses by following the wellness recommendations in this chapter.

FACTOIDS 1. Did you know our noses grow as we age? It’s true. Because the nose is largely cartilage, and connective tissue loosens as we age, the nose actually grows longer as we age.

2. Refer to all the facts at the end of this chapter—they’re interesting and fun to discuss in class.

ETHICAL DILEMMAS 1. We have an aging population, sometimes referred to as the graying of America, because the baby boomers are on the cusp of becoming seniors. It is certainly an accepted fact that the older we grow, the more medical care we require. At the same .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

time, there is a serious nursing shortage, predicted to worsen in the next 10 years because many nurses are baby boomers and will retire. How do we handle this situation?

2. With the many concerns regarding terrorism, it has been suggested that we should have a national database of DNA fingerprints. Many people have serious concerns about this breach of individual privacy.

Discuss the ethics of this suggestion.

ANSWERS TO TEST YOUR KNOWLEDGE Test Your Knowledge 19–1 Answers, p. 494 1. c 2. d 3. b 4. d 5. b Test Your Knowledge 19–2 Answers, p. 498 1. d 2. c 3. b 4. a Test Your Knowledge 19–3 Answers, p. 509 1. d 2. c 3. a 4. c 5. a ANSWERS TO THE CASE STUDY, P. 511 Because Riga and Mortis are identical twins, their DNA will be identical, so DNA fingerprinting will not be able to prove who is the real murderer. However, identical twins generally do not have identical fingerprints. If there were fingerprints left at the scene, they might show who the guilty party is.

ANSWERS TO REVIEW QUESTIONS, P. 511 Multiple Choice 1. b, 2. c, 3. d, 4. b, 5. b

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Fill in the Blank 1. age; sex; activity level 2. A; D; E; K 3. genital warts 4. Pap test Short Answer 1. Skin cancer can be prevented by avoiding UV exposure. Methods include applying sunscreen; wearing a hat, long sleeves, and pants; and keeping out of the sun during peak hours.

2. Abstinence (no sex) or monogamy (sex with only one partner who is not having sex with others) are the best ways to prevent STDs. Some STDs can also be prevented by the use of a condom, but many STDs can be transmitted despite condom use.

3. Hand washing is the best way to prevent the spread of infection. In addition, following the Standard Precautions Guidelines, having current immunizations, and taking antibiotics properly can help prevent spread of infection.

4. Forensic science uses both the physical and social sciences to solve crimes by such methods as detailed anatomical studies, chemical analysis of fluids, fingerprints, and DNA fingerprinting.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Name______________________________________________________ CHAPTER 19 – WORKSHEET Multiple Choice 1) Mrs. S., your 85-year-old neighbor, always seems to wear a gallon of perfume. Based on your understanding of the normal aging process, you know that this is probably because A) her sense of smell has deteriorated with age. She cannot smell the perfume unless she wears a lot.

B) her cognitive function has deteriorated with age. She no longer understands what a normal amount of perfume is.

C) her muscle coordination has deteriorated with age. When she puts on perfume, she no longer has good control over what comes out of the bottle.

D) the multiple medications that are commonly taken by elderly individuals can interact with perfume, intensifying its aroma.

2) Compared to the male pelvis, the female pelvis A) is wider.

B) is lighter.

C) has a larger pubic angle (of 100 degrees or greater).

D) All of the above 3) As an individual ages, they generally A) lose muscle mass.

B) gain fat.

C) lose bone density.

D) All of the above 4) The senses of smell and taste naturally_____ as we age.

A) improve B) deteriorate C) stay the same D) disappear entirely Fill in the Blank 5) _____ records can be compared to teeth in the skull to help identify a body.

6) If a shaft of hair still has the follicle attached, it may contain_____ that can be further analyzed.

7) During DNA_____ , DNA molecules are split into pieces, separated using electric currents, and then compared to DNA samples from known sources (relatives of victim, suspects in crime, etc.).

8) After the age of 30, we generally see a_____ % per year decline in the function of most body systems.

9) Bone density usually peaks at age_____ in males and females.

10) In some geriatric patients, changes in their sense of taste and smell may cause orange juice to taste _____.

11) Many geriatric patients have slower_____ times. This can result in increased risk for motor vehicle accidents, falls, and other accidents. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Worksheet – p. 1 of 2 12) Cardiovascular changes in the elderly include_____ cardiac output.

13) Between the ages of 20 and 80, we lose about_____ % of our renal function.

14) The administration of many drugs at the same time is called_____ .

15) A diet rich in the mineral_____ is important to help maintain strong bones.

16) To help protect your skin from the sun, try to minimize sun exposure between the hours of _____ and_____.

17) Current recommendations suggest that you try to get at least 30 minutes of exercise, _____ to_____ days a week.

18) _____ is the number one preventable cause of respiratory disease 19) _____ -soluble vitamins (like vitamins A, D, E, and K), can build up to toxic levels in the body if taken in excess.

20) Women taking_____ can develop facial hair and deeper voices.

True or False 21) T F Identical twins will have identical fingerprints.

22) T F In the elderly, skin elasticity increases.

23) T F Spina bifida can be prevented with adequate dietary folic acid.

Short Answer/Essay 24. List two factors that could create barriers to good nutrition in geriatric populations. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 25. List two behavioral changes that could indicate a geriatric patient’s pain control is inadequate. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Worksheet – p. 2 of 2

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY Chapter 19 – Worksheet 1) A 2) D 3) D 4) B 5) Dental 6) DNA 7) fingerprinting 8) one 9) 35 10) metallic 11) reaction 12) decreased 13) 50 14) polypharmacy 15) calcium 16) 10 a.m. and 4 p.m.

17) 5; 7 18) Smoking 19) Fat 20) steroids 21) F 22) F 23) T 24) Answers may include: loss of teeth, difficulty swallowing, decreased saliva, decreased digestive juices, decreased absorption of nutrients, decreased bowel function 25) Answers may include: change in personality, decreased appetite, screaming, swearing, grunting, noisy breathing, crying, rocking, fidgeting, splinting or rubbing sore area, wincing, skin that is cold, clammy, or pale

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

TEST BANK CHAPTER 1 Multiple Choice Choose the one alternative that best completes the statement or answers the question ________.

1. Gross Anatomy is also known as a. Microscopic Anatomy b. Pathologic Anatomy c. Macroscopic Anatomy d. Diagnostic Anatomy 2. An example of Gross Anatomy would be ________. a. Viewing an x-ray b. Using a microscope c. Performing a complete cellular blood count d. Determining the etiology of a disease 3. The study of Physiology deals with ________. a. Disease b. Genetics c. Structures d. Functions 4. The potential outcome of a disease is the ________. a. Etiology b. Diagnosis c. Prognosis d. Treatment 5. The study of disease is known as ________. a. Neurology b. Pathophysiology c. Microbiology d. Cytology 6. The three basic parts of a medical term include ________. a. Prefix, word root, suffix b. Suffix, base, meaning c. Prefix, stem, ending d. Base, word root, stem 7. What system is known as the mathematical language of Anatomy and Physiology? a. Abbreviation system b. Metric system c. English system d. Customary system 8. Which of the following is not a vital sign? a. Heart Rate b. Temperature c. Pain .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

d. Respiratory rate 9. When the physician has documented several signs and symptoms, he will be able to make a/an ________. a. Prognosis b. Etiology c. Cytology d. Diagnosis 10. A recording of the electrical activity of a skeletal muscle is a(n) ________. a. electrocardiogram b. electromyogram c. mamogram d. mammogram 11. The adjustments that maintain a stable environment within the body are known as ________. a. Homeostasis b. Metabolism c. Syndrome d. Pathology 12. Taking an MRI of the knee is considered gross anatomy because it is ________. a. Difficult b. Visually unpleasant c. Has 144 steps d. Is large scale 13. The body uses feedback loops to maintain homeostasis. The response that opposes an action is known as a/an ________. a. Depressing feedback loop b. Negative feedback loop c. Positive feedback loop d. Affirmative feedback loop 14. Positive feedback is necessary in which of the following situations? a. Blood pressure b. Coughing c. Bleeding d. Childbirth 15. Vital signs include all of the following except ________. a. Coloring b. Heart rate c. Respirations d. Temperature 16. RBC is the abbreviation for ________. a. Really bad cut b. Red and blue circulation c. Red blood cells d. Ruptured blood clot .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

17. The indicators that are essential for human life include all of the following except ________. a. Coloring b. Heart rate c. Respirations d. Temperature 18. Which is not a definition for disease? a. Not at ease b. A condition in which the body fails to function normally c. Anything that is a normal structure or function d. Anything that upsets normal structure or function 19. The term tachycardia means ________. a. Fast heart rate b. Slow heart rate c. Rhythmic heart rate d. Study of the heart rate 20. Which is not a symptom of metabolic syndrome? a. High triglycerides b. Low HDL level c. High blood pressure d. Vomiting and diarrhea 21. A sign that could be an indication of diabetes is breath that smells like ________. a. Fruity flavored chewing gum b. Clay or starchy paste c. Sweat d. Maple 22. The prefix hyper means ________. a. Small b. Above normal c. Below normal d. Within 23. The suffix oma means ________. a. Cutting into b. Enlargement of c. Surgically forming an opening d. Tumor 24. The suffix algia means ________. a. Inflammation b. Cell c. Pertaining to d. Pain 25. The abbreviation for a stroke is ________ and the letters stand for ________. a. CPR, cardiopulmonary resuscitation b. CAD, coronary artery disease c. CVA, cerebrovascular accident .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

d. CVA, cardiovascular accident 26. Most fevers are the body’s way of ________. a. Killing all pathogens b. Breaking up the cells of the pathogens c. Making an inhospitable environment for pathogens to survive d. Preventing pathogens from reproducing 27. Sweating at night may indicate ________. a. Tuberculosis b. Hodgkin’s disease c. Riboflavin deficiency d. Skin cancer 28. According to the rules of medical terminology, hepatitis is defined as ________. a. Liver failure b. Inflammation of the liver c. Cirrhosis d. Blood clotting 29. The abbreviation used for twice a day is ________. a. TAD b. TID c. p.r.n d. BID 30. Volumes expressed as ounces, pints, quarts, gallons, pecks, bushels, or cubic feet are examples of the ________. a. Metric system b. English system c. Scientific notation d. International system 31. The diagnostic procedure is begun by first determining the ________. a. Prognosis b. Syndrome c. Chief complaint d. Laboratory tests 32. ________ is the branch of medicine that studies the characteristics, causes, and effects of disease. a. Anatomy b. Physiology c. Pathology d. Ornithology 33. The term osteoma can be defined as ________. a. Cutting of the skin b. Tumor of the bone c. Tumor of the eye d. Cutting into the eye

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34. The normal heart rate for an adult is ________ beats per minute. a. 10–30 b. 70–120 c. 90–170 d. 60–100 35. The ________ is the prediction of the outcome of a disease. a. Prognosis b. Diagnosis c. Acute determination d. Syndrome 36. Disease-producing microorganisms that invade the body are known as ________. a. Neogenic b. Aerobic c. Cytophrenic d. Pathogenic 37. A condition in which the body fails to function normally is ________. a. Disease b. Physiology c. Nosocomial d. Epidemiology 38. The cause of a disease is called its ________. a. Disease b. Pathology c. Nosocomial d. Etiology 39. A specific group of signs and symptoms that are related to a specific disease is known by which of the following names? a. Diagnosis b. Chief complaint c. Syndrome d. Relapse 40. A patient with Syndrome X can exhibit which of the following common conditions? a. High blood sugar levels, low blood pressure, high blood level of HDL b. High blood sugar levels, high blood pressure, high triglycerides c. Low blood sugar levels, low blood pressure, high triglycerides d. Low blood sugar levels, high blood pressure, low blood level of HDL 41. A patient who has metabolic syndrome is at an increased risk for all of the following except ________. a. Diabetes b. Heart attack c. Horner’s Syndrome d. Stroke

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42. ________ is the physiological process that monitors and maintains a stable internal environment or equilibrium. a. Homeostasis b. Negative feedback loop c. Positive feedback loop d. Metabolism 43. ________ is a mechanism in our body that continually senses the internal and external environment and the body makes adjustments to maintain homeostasis. a. Homeostasis b. Negative feedback loop c. Positive feedback loop d. Metabolism 44. ________ is known as a “vicious cycle.” In most cases, this is harmful if the vicious cycle cannot be broken; sometimes it is necessary for a process to run to completion. a. Homeostasis b. Negative feedback loop c. Positive feedback loop d. Metabolism 45. Which of the following are examples of a sign? a. Temperature b. Pulse c. Pain d. a and b 46. All of the following are symptoms except ________. a. Pain b. Respiratory rate c. Dizziness d. Itchiness Short Answer Write the word or phrase that best completes each statement or answers the question.

1. ____________ anatomy represents the study of the structures visible to the unaided or naked eye.

2. The study of cellular structure is called ____________.

3. ____________ is the study of structure.

4. ____________ is the study of how structures work.

5. The study of disease is called ____________.

6. The word root in pericarditis is ____________.

7. A record of the breast is a ____________.

8. ____________ is the combining form for nose.

9. The process of recording the electrical activity of the heart is a(an) ____________.

10. ____________ means “fear of.”

11. Forming a surgical opening in the colon is called ____________.

12. One who studies nerves is a ____________.

13. A group of signs and symptoms is known as a ____________. .

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14. If blood sugar falls, the body uses negative feedback to ____________ blood sugar.

15. The ideal normal value of a variable is known as the _______________.

16. Breath that smells fruity may be an indication of ________.

17. Spoon-shaped finger nail beds may indicate a(n) ________ deficiency in the body.

18. If a patient has had a “nose job” you would say in medical terms that they had a(n) ________, which means surgical repair of the nose.

19. The combining form for ________ is gastro and adding the suffix itis (which means inflammation) makes the medical term gastritis.

20. Changes in objective measurable values such as temperature (________) and subjective patient perceptions (symptoms) can indicate disease is present.

21. The suffix tomy means ________.

22. The prefix ________ indicates “above normal.”

23. The cycle of ever-increasing uterine contractions due to an ever-increasing release of oxytocin is an example of ________.

24. The word ________ is constructed using the definition “one who studies cells.”

25. The area of biology that focuses on the function and vital processes of the various structures making up the human body is ________.

26. The ________ is the prediction of the outcome of a disease.

27. Syndrome X is essentially a syndrome that is created as a result of poor diet and lack of ________.

28. Another name for Syndrome X is the ___________ syndrome.

29. The artery found near the elbow is called the _________ artery.

30. The average internal body temperature in centigrade is _______ degrees.

31. The body temperature is controlled by the _______________.

32. The abbreviation for immediately is ________.

33. The abbreviation for nothing by mouth is _____________ 34. The abbreviation for the technique to be performed on a pulseless and nonbreathing patient is ______.

35. ACLS stands for __________ 36. The study of tissue samples is known as ________.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Anatomy in Greek means to cut apart. ____ 2. Anatomy focuses on the function and vital processes of the human body. ____ 3. Macro means small. ____ 4. A bacterial infection is the prognosis for a Staph infection. ____ 5. Negative feedback is bad for the body because it increases a change away from normal. ____ 6. Tachycardia means a slow heart rate. ____ 7. Glyc/o is the combining form for sugar. ____ 8. Leuk/o is the combining form for cell. ____ 9. Hyp/o means above normal. ____10. An appendectomy means the surgical removal of the appendix. ____11. Stat means right away or immediately. .

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____12. A telescope views small objects. ____13. Cutting into a vein is called phlebotomy. ____14. Disease is a condition in which the body fails to function normally. ____15. Pain is a vital sign.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Discuss how using abbreviations can either help or hinder communication among health care professionals. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Discuss how behaviors and environmental factors can contribute to disease. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Define homeostasis. How is a control center important in maintaining homeostasis? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. What are “vital signs” and why are they called “vital?” _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Discuss positive and negative feedback loops. _____________________________________ _____________________________________ _____________________________________ _____________________________________ CHAPTER 2 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Knowing the exact body region of a sign or symptom can help a health care worker determine the a. Proper diagnosis b. Patient’s size c. Extent of injury d. Proper medication 2. A body in the prone position is a. Face up .

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b. On left side c. On right side d. Face down 3. A plane is an imaginary line dividing the body into a. Squares b. Sections c. Organs d. Tissues 4. Directional terms are used as ____________ within the body. a. Vertical points b. Horizontal points c. Lateral points d. Reference points 5. The midsagittal plane divides the body into which parts? a. Superior and inferior b. Internal and external c. Right and left d. Anterior and posterior 6. If –emia means ”blood” then this term means high blood glucose. a. hyperglycemia b. hypercholesterolemia c. hyperlipidemia d. hyperbacteremia 7. What directional term would you use to indicate the ankle if the knee is your point of reference? a. External b. Distal c. Internal d. Proximal 8. A young girl falls while riding her bicycle. Initially she seems fine, but later she is complaining of severe tibial pain. Where is her pain? a. Her foot b. Her lower leg c. Her knee d. Her thigh 9. The heart and lungs are located in the ____________ cavity. a. Posterior b. Abdominal c. Pelvic d. Thoracic 10. Dorsal cavities contain which organs? a. Diaphragm b. Brain and spinal cord c. Stomach d. Pancreas .

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11. The hypochondrial region is located beneath the __________? a. Ribs b. Heart c. Stomach d. Liver 12. A woman involved in a high speed car accident initially seems fine, but soon develops difficulty breathing. You suspect she is bleeding into one of her body cavities.

Given her symptoms, which one? a. Cranial b. Spinal c. Thoracic d. Abdominal 13. The space within the mouth is known as the ____________ cavity a. Nasal b. Orbital c. Cranial d. Oral 14. The belly button is located in which region? a. Epigastric b. Umbilical c. Iliac d. Hypogastric 15. Pain in the ____________ quadrant can be a sign of appendicitis. a. RUQ b. LUQ c. RLQ d. LLQ 16. Which test gives the greatest detail of tissue structures? a. MRI b. EKG c. Blood test d. X-ray 17. Cyanosis is a condition that is usually a result of low levels of ________ within the body. a. Blood b. Oxygen c. Saline d. Calcium 18. The cervical spine contains how many vertebrae? a. 12 b. 7 c. 5 d. 3

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19. By placing your fingers at the T5 vertebra, you can locate which organ? a. Spleen b. Kidney c. Lung d. Brain 20. The type of scan that provides a series of cross-sectional slices of the body is ________. a. MRI b. Ultrasound c. CT scan d. Sonography 21. Blood is most commonly drawn from ________. a. Deep veins b. Central veins c. Superficial veins d. Deep arteries 22. Jugular venous distention is visible in the ________ area. a. Neck b. Chest c. Brain d. Lungs 23. The Fowlers’ position facilitates ________. a. Sleeping b. All treatments c. Dizziness d. Breathing 24. An injury to the abdominopelvic cavity could include injury to ________. a. The brain b. The heart c. Spleen d. The sternum 25. A patient with peripheral cyanosis needs ___. a. Oxygen b. White blood cells c. Insulin d. Potassium 26. The danger of a hernia is ________. a. Internal bleeding b. Blood flow is restricted to the portion of the organ protruding c. When an umbilical hernia becomes an inguinal hernia d. When the muscle protrudes through an organ 27. The supine position ________. a. Describes the body lying face upward b. Is also called the anatomical position c. Describes the body lying face downward .

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d. Both a and b 28. Because humans stand and move upright, the term “dorsal” can be used in place of the term ________. a. Inferior b. Posterior c. Anterior d. Distal 29. A ________ section would divide the eyes from the back of the head. a. Sagittal b. Frontal c. Transverse d. Midsagittal 30. ________ devices use a narrowly focused Xray beam that circles rapidly around the body. a. Magnetic resonance imaging (MRI) b. X-ray c. Ultrasound d. Computed tomography (CT) scanning 31. The prone position ________. a. Describes the body lying face upward b. Is also called the anatomical position c. Describes the body lying face downward d. Both b and c 32. The ________ cavity contains the heart, lungs, and large blood vessels. a. Thoracic cavity b. Abdominopelvic cavity c. Cranial cavity d. Spinal cavity 33. The skin is ________ to the bones. a. Superficial b. Medial c. Inferior d. Deep 34. The opposite of superficial is ________. a. Deep b. Inferior c. Posterior d. Medial 35. A section that would divide the body into mirror images would be ________. a. A frontal section b. A cross section c. A midsagittal section d. A transverse section

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36. The liver can be found ________. a. In the right upper quadrant (RUQ) b. In the epigastric region c. In the hypogastric region d. Both a and b 37. The ankle is a ________ structure. a. Central b. Peripheral c. Thoracic d. Superior 38. If you like to sleep on your stomach, you prefer sleeping in the ________ position. a. Supine b. Prone c. Orthoptic d. Abdominal 39. The ________ vertebrae are located in the neck. a. Sacral b. Thoracic c. Cervical d. Cranial 40. The lungs are ________ to the heart. a. Medial b. Lateral c. Superficial d. Infraorbital 41. A plane dividing a body into upper and lower portions is a ________ plane. a. Sagittal b. Coronal c. Midsagittal d. Transverse 42. Trendelenburg position may be contraindicated in patients with ________. a. Cerebral injury b. Hypertension c. Skin disease d. None of the above 43. Cyanosis causes what coloration of the skin? a. Red b. Blue c. Black d. White 44. Cyanosis is usually the result of low levels of ________ in the blood. a. Carbon dioxide b. Nitrogen c. Oxygen d. Carbon monoxide .

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45. Which of the following is much more serious than the other conditions? a. Acrocyanosis b. Central cyanosis c. Peripheral cyanosis d. None of the above 46. The most common type of radiologic diagnostic modality is the ________. a. X-ray b. CT scan c. MRI d. Ultrasound 47. The thoracic and abdominopelvic cavities are separated by the ________. a. Ribs b. Spinal cord c. Diaphragm d. Sternum 48. The large, dome-shaped muscle called the diaphragm is used for ________. a. Circulation b. Digestion c. Reproduction d. Breathing 49. A patient is complaining of pain and the doctor suspects appendicitis. In which quadrant is the pain located? a. RUQ b. RLQ c. LUQ d. LLQ 50. Your patient complains of pain in the area of the liver. In which quadrant is the pain located? a. LUQ b. LLQ c. RUQ d. RLQ 51. The doctor has ordered a study to look at the action of heart valves. Which procedure has he ordered? a. X-ray b. CT Scan c. MRI d. Ultrasound 52. A patient is scheduled to undergo a test and has stated that she has had surgery for a valve replacement. Which procedure could be contraindicated in this situation? a. X-ray b. CT Scan c. MRI d. Ultrasound .

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Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The ____________ position is lying with the head lower than the feet.

2. The ____________ position is with the bed or examination table elevated 45-60 degrees.

3. The transverse (horizontal) plane divides the body into superior and ____________ areas.

4. ____________ refers to body parts located away from the midline.

5. The ____________ plane divides the body into anterior and posterior sections.

6. ____________ means towards the back of the body.

7. ____________ refers to body parts close to a point of reference on the body.

8. ____________ means on the outside.

9. The word meaning at or towards the body surface is ____________.

10. The opposite of dorsal is ____________.

11. The nose is ____________ to the eyes and ____________ to the mouth.

12. If your hands and feet are swollen with fluid, you are said to have ____________ edema.

13. Death of tissue is called ____________.

14. The anterior surface of the elbow is called ____________.

15. Antiperspirant sprays are used in the ____________ region.

16. The ________ position is laying face upward.

17. The wrist is ________ to the hand and ________ to the elbow.

18. When the head is lower than the heart, gravity increases the blood flow and therefore increases the ________ pressure.

19. Left and right always refers to the ________ left and right.

20. Digital oxygen sensors would be placed on a __________.

21. Patients are more prone to aspirate vomitus into their lungs in the Trendelenburg position and therefore should not ________ within two to four hours of being placed in that position.

22. The ______________region of the arm is usually where blood pressures are taken.

23. Pain in the general stomach area can indicate a variety of problems, including an ulcer, heart attack, appendicitis, ________ , or liver problems.

24. One of the problems with an X-ray film is that it is a two ________ view of a specific area.

25. A ________ is a tear in the muscle wall that can allow a structure (usually an organ) to protrude through it.

26. The ________ regions are located on either side of the epigastric region and contain the lower ribs.

27. The ________ position is sitting in bed with the head of the bed elevated 45 to 60 degrees.

28. Placing patients with secretions in the bases of their lungs in the ________ position helps drain those segments of the lungs.

29. ________ imagers use magnetic energy to produce cross sectional images of body structures. .

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30. A patient is placed in a supine position and instructed to raise his or her right leg while the practitioner places a hand on the patient’s right thigh and gives a slight opposing downward force. This procedure is known as the ________ test.

31. ________ is a condition of bluish colored skin that is usually the result of low levels of oxygen in the blood.

32. The ________ region is where the thigh meets the trunk and is also called the groin region.

33. The Psoas test is used to test for _______________.

34. Death of the tissue is termed ____________.

35. Heart failure can cause the back-up of fluid into the venous system thus causing the ________ veins to become engorged with extra blood.

36. A hernia of the “belly button” would be termed an _____________ hernia.

37. The opposite of distal is ___________________.

38. The opposite of deep is ______________.

39. Cyanosis found in the hands and feet would be called __________ 40. An X-ray is a ________ dimensional view of a specific area.

41. A CT scan creates a ________ dimensional view of structures in the body.

42. A patient is in the Intensive Care Unit, has just had brain surgery and is suffering from an increased intracranial pressure. The ________ position is contraindicated in this situation.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The anatomical position is a human being standing erect facing forward with feet parallel and arms hanging at the side with palms facing backward. ____ 2. The Fowler’s position is the best position for patients having trouble breathing. ____ 3. The prone position is best for the pelvic exam. ____ 4. Cranial means superior. ____ 5. Medial means to the side. ____ 6. Computed tomography (CT) scanning uses a narrowly focused x-ray beam that circles rapidly around the body. ____ 7. A CT scan can show the true depth of a quarter-sized tumor shown on regular x-ray. ____ 8. Peripheral refers to the torso and head. ____ 9. The opposite of superficial is lateral. ____10. The cranial cavity houses the brain. ____11. An orbital injury can cause damage to sight. ____12. The pubic area is used for cardiopulmonary resuscitation. ____13. Digital means fingers and toes. ____14. Cervical means relating to the knee. ____15. Brachial means lower leg.

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Essay Write your answer in the space provided or on a separate sheet of paper.

1. List two organs or structures found in each of the RUQ, LUQ, RLQ, and LLQ. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. List and explain the major body planes and sections. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. If a patient complains of pain, what questions should you ask? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Give the common name for the following body regions: femoral, gluteal, lumbar, antebrachial and cervical. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Give the opposite of: caudal, distal, external, superficial, and posterior. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 3 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. The smallest unit that retains the chemical properties of a particular type of matter is a(n) ________. a. Atom b. Molecule c. Element d. Ion 2. Atoms or molecules which carry a charge are called ________. a. Elements b. Protons c. Neutrons d. Ions .

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3. In a person with diabetes, blood may often become acidic. What blood pH might you expect in a person with untreated diabetes? a. 7.4 b. 10.5 c. 6.0 d. 13.2 4. Which of the following is a characteristic of an covalent bond? a. Electrons are shared b. Electrons are donated c. The molecule is always polar d. Protons are involved in the bond 5. The molecule paraffin has the formula C20H44. What does that tell you about the molecule? a. It is a protein b. It is hydrophobic c. It is a nucleic acid d. It is polar 6. In a solution, the ______________ is dissolved in the _________________. a. molecule, element b. solute, solvent c. solvent, solute d. element, molecule 7. Glycogen is a polysaccharide made of long chains of glucose. Glucose is a ________. a. Polysaccharide b. Disaccharide c. Monosaccharide d. Saccharin 8. This type of lipid molecule is important in the structure and function of cell membranes ________. a. Wax b. Phospholipid c. Triglyceride d. Estrogen 9. The building blocks of proteins are ________. a. Nucleic acids b. Amino acids c. Oleic acids d. Lewis acids 10. The chief type of reaction used during catabolism is ________. a. Dehydration synthesis b. Hydrolysis c. Hydration d. Hydrogen bonding .

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11. What do anabolic steroids do when taken as medication? a. Destroy tissue b. Fight infection c. Build up tissue d. Increase fertility 12. These molecules speed up the rate of biological reactions ________. a. Proteins b. Enzymes c. Antibodies d. ATP 13. During this series of reactions, your cells use glucose to make energy ________. a. Metabolism b. Enzyme catalyzed c. Cellular respiration d. Blood clotting 14. This high energy molecule is made and spent by cells during metabolism ________. a. ATP b. ADP c. AMP d. A&P 15. Which of the following has the highest energy? a. ATP b. ADP c. AMP d. A&P 16. A dietary source for iodine is ________: a. celery b. sea food c. beef d. pork 17. A symptom of fluorine deficiency is ________: a. acne b. hair loss c. dental cavities d. low blood pressure 18. A lack of the ability of the body to carry oxygen may be due to a deficiency in ________: a. iron b. copper c. zinc d. gold 19. The molecule that is stored in the liver to be used for extra energy is ________: a. glucose b. glycogen c. hemoglobin .

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d. lipids 20. Glucose is used by the cells during a series of chemical reactions called ________: a. krebs cycle b. cellular ventilation c. cellular perfusion d. cellular respiration Short Answer Write the word or phrase that best completes each statement or answers the question.

1. Two or more elements joined together is a(n) __________________.

2. The nucleus of an atom contains protons and _______________.

3. The _____________ scale is used to measure the strength of acids and bases.

4. A molecule that will mix with water is called ___________________.

5. A molecule with the molecular formula CH2O is a ________________.

6. ____________________ are lipid molecules arranged in rings.

7. These types of molecules may be used for energy storage, movement and protection against infection ______________________.

8. _________________ are the types of molecules involved in cell control and genetics.

9. All the chemcial reactions in a cell are collectively referred to as _________________.

10. Enzymes can only take particular substrates through particular reactions, because enzymes are ___________________.

11. Cellular respiraton requires both glucose and ________________.

12. _____________________ molecules have nitrogen in their backbone.

13. The fluid in your body is mainly _________________.

14. To digest food your body needs special molecules called ___________ that help break down large molecules.

15. This molecule has a hydrophilic head and hydrophobic tails _______________.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Ions are hydrophobic. ____ 2. Physiologically important ions are called trace elements. ____ 3. Water has hydrogen bonds, which give it its unique properties. ____ 4. Lead is a biological molecule. ____ 5. Covalent bonds are polar. ____ 6. A solution with pH 8 is basic. ____ 7. Water can store more heat than air. ____ 8. Disaccharides are a type of lipid. ____ 9. All steroids are unhealthy. ____10. Many carbohydrates are energy storage molecules. ____11. Proteins have peptide bonds. ____12. Dehydration synthesis can happen easily at room temperature. ____13. Enzymes can be inhibited. ____14. During cellular respiration, no ATP is made. .

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____15. Chemistry is not important in anatomy and physiology.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Distinguish between the major types of chemical bonds. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Explain the function of enzymes. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Explain the molecular differences between carbohydrates, lipids and proteins. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the structure of an atom. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Explain metabolism. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 4 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. The organelles that provide 95% of the body’s energy are ________. a. Ribosomes b. Mitochondria c. Adenosines d. Cytoplasma 2. Sperm cells are able to move in a swimming motion by the use of ____________. a. Centrioles b. Cilia c. Vesicles d. Flagella .

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3. The molecule made by mitochondria that provides the power to the cell is ________. a. ATP b. RNA c. ADP d. DNA 4. A series of channels found within the cytoplasm that is formed from folded membrane is ________. a. Golgi apparatus b. Facilitated diffusion c. Endoplasmic reticulum d. Cell membrane 5. Given that they have lots of golgi, salivary glands and pancreatic cells must perform which functions? a. Lipid synthesis b. DNA synthesis c. Protein synthesis d. Secretion and storage 6. The process of cleaning debris and waste from the cell is carried out by ________. a. Lysosomes b. Lipids c. Filaments d. Ribosomes 7. The cell receives its shape from a network of microtubules and filaments known as the ________. a. Cytoskeleton b. Endoskeleton c. Exoskeleton d. Microskeleton 8. ____________ are short, hair-like projections found on the outer surface of specific cells. a. Capsids b. Vesicles c. Cilia d. Flagella 9. The most important molecules for making the cell membrane selectively permeable are ________. a. Proteins b. Phospholipids c. Cholesterol d. ATP 10. When all the carrier molecules are full and no more molecules can be carried across the cell membrane, this is called ________. a. Inhibition b. Saturation c. Competition .

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d. Specificity 11. Which microorganism has the ability to become part of the cell and is then much harder to destroy? a. Virus b. Fungi c. Bacteria d. Protozoa 12. Which molecule is least likely to be able to pass through a cell membrane without help? a. H2O b. CH4 c. C6H12O6 d. C7H16 13. The process of allowing substances into and out of the cell is controlled by the ________. a. Nucleus b. Cell membrane c. Lysosomes d. Golgi apparatus 14. The cells that make up the human body are called ________. a. Mitotic cells b. Meiotic cells c. Eukaryotic cells d. Chromosomal cells 15. What section of the cell cycle is actually devoted to cell division? a. Interphase b. Cellphase c. Duophase d. Mitosis phase 16. When the body performs cellular respiration, food is changed into a form of energy called ________. a. RNA b. ADP c. DNA d. ATP 17. An organism that produces disease is known as a(n) ________. a. Organelle b. Pathogen c. Magnetosome d. Centriole 18. Which microorganism is spread by the release of spores? a. Bacteria b. Virus c. Fungi d. Protozoa .

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19. Which disease is caused by a protozoan? a. Candidiasis b. Shingles c. Malaria d. Strep 20. The substance commonly transported during facilitated diffusion is ________. a. Glucose b. Sodium c. Cytoplasm d. Potassium 21. All of the following can reproduce asexually except ________. a. Animal cells b. Plant cells c. Viruses d. Bacteria 22. The mitosis phase has four divisions; when do the chromosomes split? a. Anaphase b. Metaphase c. Prophase d. Telephase 23. Cancer is diagnosed by a variety of techniques, including all of these except ________. a. Biopsy b. Blood test c. Chemotherapy d. Imaging 24. Micro-organisms that live within or on us normally are collectively called ________. a. Cancer cells b. Normal flora c. Epithelial cells d. White blood cells 25. Bacterial cells have no nucleus or organelles and reproduce easily through a process known as ________. a. Chromatin b. Eukaryosis c. Interphase d. Binary fission 26. Which of these is not a function of the cell membrane? a. Protein synthesis b. Regulation of what moves into and out of the cell c. Identifying the cell d. Holding the cell together

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27. These are called the “power plants” of the cell ________. a. Ribosome b. Mitochondria c. Golgi apparatus d. Lysosomes 28. Which of these is not part of a cell? a. The plasma membrane b. The interstitial fluid c. The cytoplasm d. The nucleus e. All of the above are part of the cell 29. These organelles contain powerful enzymes that take care of cleaning up intracellular debris and other waste ________. a. Ribosomes b. Smooth endoplasmic reticulum c. Mitochondria d. Lysosomes 30. This is the site of protein synthesis in the cell ________. a. Mitochondria b. Lysosomes c. Ribosomes d. Golgi apparatus 31. This organelle consists of tiny flattened sacs that help process and package chemicals in the cell ________. a. Ribosome b. Mitochondria c. Golgi apparatus d. Lysosome 32. These are extremely fine hair-like structures on the surface of the cell ________. a. Cilia b. Microvilli c. Flagella d. Rough endoplasmic reticulum 33. This is the movement of water from an area of lower solute concentration to an area of higher concentration through a membrane ________. a. Osmosis b. Diffusion c. Filtration d. Dialysis 34. During this phase of mitosis, the chromosomes split and the spindles pull them apart ________. a. Telophase b. Anaphase c. Metaphase d. Interphase .

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35. During this phase of mitosis, chromosomes are aligned in the center of the cell ________. a. Telophase b. Anaphase c. Metaphase d. Prophase 36. This general process is utilized by the cells for the intake of liquid and food when the substance is too large to diffuse across the cell membrane ________. a. Pinocytosis b. Endocytosis c. Exocytosis d. Phagocytosis 37. ________ are unique because they cannot grow, “eat,” or reproduce by themselves. a. Bacteria b. Fungi c. Protozoans d. Viruses 38. 90% of the cell’s life is spent in this phase during the cell cycle ________. a. Interphase b. Prophase c. Anaphase d. Metaphase e. Telophase 39. Examples of fungal infections are ________. a. Athlete’s foot b. Thrush c. Common cold d. a and b only 40. Malaria is caused by which of the following types of infections? a. Viral b. Bacterial c. Protozoan d. Fungal 41. Signs and symptoms of bacterial infection may include ________. a. High fever b. Rapid pulse c. Pain and swelling d. All of the above Short Answer Write the word or phrase that best completes each statement or answers the question.

1. Parts of the cell are called ____________.

2. Because all substances cannot pass easily through it, cell membranes are known as _______________________ membranes. .

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3. ____________ is the process in which a substance travels from an area of higher concentration to an area of lower concentration.

4. The process of blocking a carrier is called ______________________.

5. _______________ is a process in which water will travel across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration.

6. When a cell membrane actively surrounds a solid substance and forms a vesicle which moves into the cell, this is called ____________.

7. The ____________ is the control center of the cell.

8. ____________ act as power plants in the cell.

9. ____________ are whip-like tails that help cells move.

10. Normal ____________ are bacteria that are normal in the body.

11. ____________ are pathogens that are surrounded by capsids.

12. When cells make copies of themselves without the involvement of another cell, it is called ____________.

13. The process of sorting the chromosomes so that each new cell gets the right number of copies of all the genetic material is called ____________.

14. The phase in which the chromosomes become visible is ____________.

15. The word for non-cancerous is ____________.

16. ________ are tiny building blocks of all matter which combine to form molecules.

17. ________ is the process in which water travels through a selectively permeable membrane to equalize concentrations of a solute.

18. ________ involves using pressure to force water and its solutes through a membrane.

19. The ________ is a series of channels in the cytoplasm.

20. ________ are microscopic, hair-like projections on the outer surface of some cells.

21. A ________ packages and delivers proteins.

22. Any time a new cell is made, it is made by a process of ________.

23. The brief portion of the cell cycle that is devoted to actual cell division is the ________ phase.

24. The phase in which the chromosomes split and the spindles pull apart is ________.

25. Viruses cannot grow, eat, or reproduce by themselves, but must enter another ________ to do its cellular activities.

26. Bacteria, which are prokaryotes, grow rapidly and reproduce by splitting in ________.

27. Following the analogy in your book, consider ribosomes the manufacturing plant for building materials used for ________ and repair.

28. The breaking off and spreading of malignant cells is called ________.

29. Benign tumors typically grow slowly, and push ________ cells out of the way.

30. Without mitosis, your body would not be able to grow, or replace old or ________ cells.

31. Viruses can stay dormant in the body and become ________ once again, later in life.

32. Examples of fungal infections are athlete’s foot and a mouth fungus called ________ or candidiasis. .

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33. The ability of a substance to “pull” water toward an area of higher concentration of the solute is called ________.

34. Mitosis is the division and sorting of the genetic material, while ________ is the division of the cytoplasm.

35. An organism that produces disease is called a(n) ________.

36. Viruses have their genetic material surrounded by a protective protein coat called a ________.

37. Bacterial infections are treated with ________, chemicals that can kill the prokaryotic bacteria without harming eukaryotic cells.

38. ________ differs from osmosis in that pressure is applied to force water and dissolved materials across a membrane.

39. A spherical body made up of dense fibers called the ________ is found within the cell nucleus.

40. The ________ is a network of microtubules and interconnected filaments that provide shape to the cell and allow the cell and its contents to be mobile.

41. Fungi can spread through the release of ________.

42. ________ are bacteria that live within or on us and are normally harmless.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The stomach is an organelle. ____ 2. Proteins prevent ions from crossing cell membranes. ____ 3. The ability of a substance to pull water towards an area of higher concentration of the solute is filtration. ____ 4. Cellular respiration makes carbon dioxide as a waste product. ____ 5. If water is transported across a cell, it is known as phagocytosis. ____ 6. Cytoplasm is composed of water, nutrients, and electrolytes. ____ 7. Chromatin is found in the nucleus. ____ 8. All cells have cell membranes. ____ 9. The centriole is a whip-like organelle used for cell movement. ____10. The Golgi apparatus has powerful enzymes that can eat cellular debris. ____11. Lysis means to break down. ____12. Metastasis is spreading of benign cancer cells. ____13. Some bacteria are not pathogenic. ____14. The four phases of mitosis are prophase, metaphase, anaphase, and telophase. ____15. Telophase occurs when the chromosomes line up in the center of the cell.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Compare and contrast active and passive transport. _____________________________________ _____________________________________ _____________________________________ _____________________________________ .

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2. Describe how isotonic, hypotonic, and hypertonic salt solutions affect osmotic pressure. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Discuss the characteristics of carrier mediated transport. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Discuss the levels of organization in the human body from smallest to largest. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Discuss how cancer is mitosis run amok. _____________________________________ _____________________________________ _____________________________________ _____________________________________ CHAPTER 5 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Cells that are arranged in several layers are called ____________ cells. a. Cuboidal b. Stratified c. Columnar d. Squamous 2. The lining of the urinary bladder is composed of which type of cell? a. Simple squamous b. Transitional c. Simple cuboidal d. Simple columnar 3. This connective tissue has cells in lacunae in a gel-like matrix ________. a. Cartilage b. Areolar c. Regular d. Reticular 4. Muscle tissue possesses contractility, also known as the ability to ________. a. Swell b. Mutate c. Shorten d. Strengthen .

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5. This connective tissue has cells in a mineral matrix ________. a. Cartilage b. Reticular c. Bone d. Blood 6. Which membrane is the largest organ of the integumentary system? a. Cutaneous b. Mucous c. Parietal d. Visceral 7. The colon is an organ included in which body system? a. Gastrointestinal b. Cardiovascular c. Integumentary d. Reproductive 8. Which of the following is considered a nonvital organ? a. Heart b. Gallbladder c. Lung d. Liver 9. The production of blood cells occurs within which body system? a. Cardiovascular b. Muscular c. Endocrine d. Skeletal 10. Which type of muscle lines the blood vessels and airways of the body? a. Rough b. Glia c. Smooth d. Striated 11. Your skin, after it is exposed to sunlight, will produce which vitamin? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D 12. Processing and interpreting information, motor functions and sensory functions are responsibilities of which body system? a. Muscular b. Nervous c. Sensory d. Endocrine 13. Balance is the responsibility of which sensory organ? a. Ear b. Eye c. Nose .

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d. Throat 14. What is the first step in wound healing? a. Regeneration b. Inflammation c. Organization d. Scarring 15. Which of the following tissues regenerates well? a. Cardiac muscle b. Nervous Tissue c. Smooth Muscle d. Bone 16. An example of a synovial joint would be the ________. a. Axis b. Brachial c. Temporal d. Knee 17. The movement of food is a function of ________ muscles. a. Involuntary b. Sensory c. Cardiac d. Striated 18. Maintaining the proper acid-base balance of the blood is carried out by which body system? a. Skeletal b. Respiratory c. Musculoskeletal d. Integumentary 19. T-Lymphocytes are specialized cells produced for which function? a. Producing red blood cells b. Genetic reproduction c. Saliva production d. Fighting infection 20. Mucous is ________. a. The type of membrane b. The material that collects in the corner of the eye c. The actual substance secreted by membranes d. The substance secreted by synovial membranes 21. Specialized infection-fighting WBCs are produced by the ________ system. a. Cardiovascular b. Lymphatic c. Integumentary d. Endocrine

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22. A patient who has difficulty conceiving most likely has a problem in the ________ system. a. Nervous b. Urinary c. Reproductive d. Cardiovascular 23. One of the functions of the endocrine system is to help you deal with stresses produced by ________. a. Trauma b. Dizziness c. Sleeplessness d. Nausea 24. The term tachypnea means ________. a. Fast breathing b. Fast heart rate c. Fast blood pressure rise d. Fast spike in temperature 25. The body’s largest organ is ________. a. The liver b. The brain c. The large intestine d. The skin 26. The skeletal system includes all but which of the following? a. Bones b. Cartilage c. Ligaments d. All of the above are included in the skeletal system 27. This type of muscle tissue is found in the stomach ________. a. Skeletal b. Voluntary c. Smooth d. Cardiac 28. This type of muscle tissue is found in the heart ________. a. Skeletal b. Voluntary c. Smooth d. Cardiac 29. Which of the following is not a gland in the endocrine system? a. Thyroid b. Pituitary c. Hypothalamus d. Salivary

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30. Which of these organs is a primary organ of the digestive system? a. Liver b. Pancreas c. Small intestine d. Both a and c 31. This type of tissue provides rapid communication between various parts of the body ________. a. Epithelial b. Connective c. Muscle d. Nervous 32. This type of tissue covers the body and lines many of the parts of the body ________. a. Epithelial b. Connective c. Muscle d. Nervous 33. This is the most common tissue and is found throughout the body more than any other form ________. a. Epithelial b. Connective c. Muscle d. Nervous 34. This type of tissue specializes in movement of the body ________. a. Epithelial b. Connective c. Muscle d. Nervous 35. This type of tissue can be classified by the shape and arrangement of its cells ________. a. Epithelial b. Connective c. Muscle d. Nervous 36. The ________ system transports water, oxygen, and a variety of nutrients and other substances necessary for life to the cells, and transports waste products away from the cells. a. Cardiovascular b. Urinary c. Digestive d. Respiratory

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37. When cells are arranged in a scale-like or flat arrangement, they are referred to as ________. a. Squamous b. Cuboidal c. Columnar d. Transitional 38. Which of the following epithelial membranes is the largest organ of the integumentary system? a. cutaneous b. parietal c. visceral d. mucous 39. Which of the epithelial membranes encases individual organs? a. parietal b. mucous c. visceral d. cutaneous 40. Which membrane lines the wall of the thoracic cavity? a. cutaneous b. parietal c. mucous d. visceral Short Answer Write the word or phrase that best completes each statement or answers the question.

1. When similar cells act together to perform a function, they are called a ____________.

2. Any avascular tissue with no extracellular matrix and an obvious top surface is __________________ tissue.

3. This tissue is a single layer of plate-like cells ______________________________.

4. Muscle tissue that is striated is called skeletal or ____________.

5. A torn ligament involves damage to ________________ connective tissue.

6. Membranes that cover the brain and spinal cord are called ____________.

7. The membrane layer that wraps around individual organs is called ____________.

8. Nervous tissue has two types of cells _______________ and glia.

9. Adipose tissue is more commonly known as _______________.

10. Tissue healing begins with cells called ______________________ which draw the edges of the wound together.

11. The ____________ system delivers oxygen to the bloodstream.

12. The ____________ system acts as a storm drain and protects the body.

13. The ____________ system is the main storage for calcium.

14. The ____________ system provides sensory information from the external world.

15. The ____________ system rids the body of carbon dioxide.

16. In a serous membrane, the membrane layer that lines cavities is called ________.

17. The combining form for joints is ________. .

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18. The combining form for vein is ________.

19. The limbs are part of the ________ skeleton.

20. The skin and hair are parts of the ________ system.

21. ________ are the sites of exchange between blood and tissue.

22. Special structures called lymph nodes act as filters to capture unwanted ________.

23. Hormones produced by the ________ system help you to deal with general stress and stress produced by infection and trauma.

24. The ________ system helps regulate the number of red blood cells and the acidbase and electrolyte balance of blood.

25. The ________ layer lines the wall of the cavities in which organs reside.

26. A membrane associated with connective tissue is the ________ membrane.

27. Skeletal muscle is described as ________ because of its striped appearance.

28. ________ are conscious (and unconscious) feelings or an awareness of conditions that occur inside and outside of the body.

29. The membranes associated with covering the brain and spinal cord are called ________.

30. The branchlike formations that receive sensory information are called ________.

31. The ________ layer, which also produces serous fluids, wraps around the individual organs.

32. The body’s first line of protection is its ________.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Squamous cells are column-like. ____ 2. Stretchy epithelial tissue is called transitional. ____ 3. Mucus lubricates tissue. ____ 4. Connective tissue is the most common tissue. ____ 5. Blood is a connective tissue. ____ 6. Involuntary muscle tissue is called skeletal muscle. ____ 7. Swelling is always a negative symptom which should be prevented at all costs. ____ 8. Nervous tissue regenerates well. ____ 9. A mucous membrane is a double layered membrane with a potential space between the layers. ____10. The liver is part of the urinary system. ____11. The cardiovascular system is one of the body’s control systems. ____12. Veins carry blood away from the heart. ____13. The esophagus is in the gastrointestinal system. ____14. Nitrogen waste is usually eliminated through the integumentary system. ____15. Hormones are chemicals which circulate in the bloodstream.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain the relationship between cells, tissues, organs and systems. _____________________________________ _____________________________________ .

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_____________________________________ _____________________________________ 2. Choose one system and list the parts of that system. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Distinguish between connective and epithelial tissue. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the steps in wound healing. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Compare and contrast cardiac, smooth, and skeletal muscle. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 6 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Which type of bone is cube-shaped in appearance? a. Short b. Long c. Regular d. Irregular 2. The ends of long bones are known as the ____________. a. Medulla b. Periosteum c. Diaphysis d. Epiphyses 3. A narrow ridge of bone is known as the ____________. a. Crest b. Head c. Spine d. Condyle 4. A ____________ is a groove or shallow depression on the surface of a bone. a. Facet b. Sinus .

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c. Fossa d. Meatus5. An ____________ is a mature bone cell. a. Osteoprogenitor b. Osteoblast c. Osteoclast d. Osteocyte 6. Compact bone is created over the surface of spongy bone by ____________. a. Osteoprogenitors b. Osteoclasts c. Osteons d. Osteoblasts 7. Bone growth will continue for as long as the ____________ plate exists. a. Diaphyseal b. Epiphyseal c. Osteon d. Medullary 8. ____________ is the type of connective tissue that helps to cushion the ends of long bones. a. Spongy bone b. Cartilage c. Bone marrow d. Synovium 9. This type of joint is held together by connective tissue strands ________. a. Gliding b. Synovial c. Cartilaginous d. Fibrous 10. What type of joint is formed when an oval shaped bone fits into an elliptical cavity? a. Pivot b. Gliding c. Hinge d. Ellipsoidal 11. The joints of the hips and shoulders are examples of ____________ joints. a. Pivot b. Fibrous c. Ball and socket d. Saddle 12. This movement occurs when you turn your foot toward the other foot ________. a. Eversion b. Inversion c. Pronation d. Flexion 13. The primary ossification center in long bones is located in the ________. a. Epiphyses b. Diaphysis .

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c. Articular cartilage d. Central Canal 14. The bone disease ____________ is a degenerative disorder, characterized by thinning bones. a. Osteoporosis b. Osteitis c. Osteomyelitis d. Osteosarcomas 15. The last stage in bone repair is ________. a. Remodeling b. Bony callus formation c. Soft callus formation d. Hematoma formation 16. Which mineral is included in the composition of bone? a. Iodine b. Calcium c. Potassium d. Iron 17. The spinal column and bones of the middle ear are part of the ________ skeleton. a. Superior b. Axial c. Inferior d. Appendicular 18. Lordosis is a(n) ________ curvature of the lower back and is commonly called ________. a. Left lateral, swayback b. Posterior, swayback c. Anterior, swayback d. Anterior, hunchback 19. Your textbook lists eight causative agents for bone and joint disorders other than osteoporosis and arthritis. Which of these is not one of them? a. Nutritional disorders b. Degenerative disorders c. Tumors d. Osteomalacia 20. ________ is a nutritional disorder caused by a vitamin D deficiency. a. Osteomalacia b. Rickets c. Scurvy d. Both a and b 21. Scoliosis is an example of what classification of disorders? a. Infection b. Congenital c. Trauma d. Secondary .

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22. If the body is not in balance, regardless of the cause, spinal curvatures may be exaggerated, leading to ________. a. Kyphosis b. Scoliosis c. Lordosis d. All of the above 23. Which of these is not a type of arthritis? a. Rheumatoid b. Osteo c. Septic d. Cruciate 24. A bone fracture in your arm would be part of the ________ division of the skeleton. a. Thoracic b. Appendicular c. Axial d. Spinal 25. This refers to the shaft of a long bone ________. a. Epiphyses b. Periosteum c. Diaphysis d. Endosteum 26. This is the strong, fibrous connective tissue covering the bone ________. a. Epiphyses b. Periosteum c. Diaphysis d. Endosteum 27. This term refers to the ends of a long bone ________. a. Epiphyses b. Periosteum c. Diaphysis d. Endosteum 28. This membrane lines the spongy bone ________. a. Epiphyses b. Periosteum c. Diaphysis d. Endosteum 29. This is the location in the bone where hemopoiesis occurs ________. a. Epiphyses b. Periosteum c. Diaphysis d. Medullary cavity 30. The microscopic cylindrical-shaped unit of compact bone is called ________. a. The endosteum b. The cancellous c. The osteon .

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d. The trabeculae 31. The bar and plate-like tissue of spongy bone are called ________. a. Flagellite b. Osteocytes c. Osteon d. Trabeculae 32. Bone-building cells are called ________. a. Osteoblasts b. Osteoclasts c. Osteocytes d. Hemopoietics 33. The skeleton can still grow as long as there is cartilage left in the ________. a. Haversian system b. Diaphysis c. Epiphyseal plate d. Chondrocytes 34. An abnormal side-to-side curve in the vertebral column is called ________. a. Lordosis b. Kyphosis c. Scoliosis d. Convexities 35. This is the number of pairs of true ribs ________. a. 12 b. 14 c. 5 d. 7 36. These joints permit the widest range of movement ________. a. Hinge b. Pivot c. Saddle d. Ball and socket 37. This bone condition occurs most frequently in postmenopausal women with calcium deficiencies ________. a. Rickets b. Osteomalacia c. Osteoporosis d. Paget’s disease 38. Ensuring that young children had a sufficient amount of vitamin D would prevent ________. a. Rickets b. Osteomalacia c. Osteoporosis d. Paget’s disease

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39. Another name for a compound fracture is ________. a. An open fracture b. A closed fracture c. A comminuted fracture d. An impacted fracture 40. ________ is a general term used to describe an inflammatory process of a joint or joints. a. Arthritis b. Osteoarthritis c. Gout d. Bursitis 41. ________ is a degenerative condition that is a result of simple “wearing out” of a joint from a sports injury, trauma, repetitive motion, obesity, or just the aging process. a. Rheumatoid arthritis b. Osteoarthritis c. Gout d. Bursitis 42. ________ is a chronic, systemic disease that is believed to be an autoimmune condition affecting the connective tissue of the body. a. Gout b. Bursitis c. Septic arthritis d. Rheumatoid arthritis 43. ________ is the result of the infective process of a pathogen that was introduced to a joint from a penetrating wound or a blood-borne pathogen. a. Rheumatoid arthritis b. Gout c. Septic arthritis d. Arthritis 44. A cleft palate is an example of which of the following? a. Congenital disorder b. Degenerative disorder c. Infection d. Nutritional disorder 45. Osteoporosis is an example of which of the following? a. Congenital disorder b. Infection c. Degenerative disorder d. Nerve disorder 46. Signs and symptoms of osteoarthritis include which of the following? a. Joint develops a crooked deformation b. Greater range of motion c. Painful swelling of affected joint d. a and c only .

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47. This is a common sports injury caused by twisting of the leg, or an anterior or posterior blow when the leg is planted or bearing weight ________. a. Cruciate ligament tears b. Gout c. Osteomalacia d. Osteoporosis Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The hollow region in the bone is the ____________ cavity.

2. Tarsals are examples of ____________ bones.

3. Vertebrae are examples of ____________ bones.

4. Spongy bone tissue is arranged in bars and plates called ____________.

5. The production of red blood cells is known as ____________.

6. An articulating end of a bone that is rounded and enlarged is called a ____________.

7. A hollow area is a ____________.

8. A tube or tunnel-like passageway through bone is a ____________.

9. The larger version of a tubercle located only on the femur is the ____________.

10. ____________ is the term used to describe the formation of bone in the body.

11. Broken bones will not knit together unless they are ______________.

12. The clavicle and skull bones form via __________________ ossification.

13. Until embryonic week 8 most of your skeleton is made of this tissue ________________.

14. When joints become inflamed, this is called ____________.

15. ____________ means to move away.

16. The end of the bone is called the ________.

17. A special form of connective tissue that can withstand a fair amount of flexing, tension, and pressure is ________.

18. When joints become inflamed, it is called ________.

19. When two or more bones meet, we have an ________.

20. ________ describes increasing the angle of a joint.

21. Cruciate ligament tears are treated with rest, immobilization, and/or ________ intervention.

22. Pain medication can include non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen. These drugs reduce ________, thus reducing pain and swelling.

23. Because of the continual breakdown of old and creation of new bone, adults actually need more calcium in their diets than do ________.

24. Osteoporosis is a metabolic problem with slow, progressive decrease in bone ________.

25. A compound or ________ fracture is particularly nasty because deep tissue has the potential to be exposed to bacteria once the bone is set into place, increasing the chance for infection.

26. A patient should see the doctor for any obvious bone deformity or misalignment of a ________. .

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27. Very tough, whitish bands that connect from bone to bone are called ________.

28. Another term for the production of red blood cells is ________.

29. ________ is a chronic, systemic disease that is believed to be an autoimmune condition affecting the connective tissue of the body.

30. ________ bones are fairly equal sized in width and length, similar to a cube, and are mostly found in your wrists and ankles.

31. ________ joints are found in your knees and elbows.

32. If a bone is crushed to the point that it becomes fragmented or splintered, that is classified as a ________ fracture.

33. The ________ in women is different than in men. This fact can be used to identify the sex of a skeleton, such as in a murder case or an archeological find.

34. Osteoporosis research is showing that ________, especially weight bearing and impact forms, improves bone density.

35. ________ is a condition in which the upper portion of the spine exhibits a posterior curve, producing what is commonly called a humpback or hunchback.

36. ________ is a lateral curvature of the spine.

37. ________ is an anterior curve of the lower back and is commonly called swayback.

38. A fine fracture that does not completely break or displace the bone is a ________ fracture.

39. A ________ or closed fracture is a break without a puncture to the skin.

40. An individual in an accident who has a bone that is severely twisted may receive a ________ fracture.

41. ________ fractures are incomplete breaks, which more often occur in children because they have softer, more pliable bone than adults.

42. A fracture in which the bone is pushed through the skin is referred to as a ________ or open fracture.

43. Tendonitis or tendinitis often occurs in conjunction with ________.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Bending your knee is an example of joint extension. ____ 2. The deltoid muscle moves the arm away from the body. It is a flexor. ____ 3. Supination turns the palm downward. ____ 4. One hundred twenty-six bones comprise the appendicular skeleton. ____ 5. The appendicular skeleton includes bones of the thorax, spinal column, hyoid bone, bones of the middle ear, and skull. ____ 6. The tarsals are the toe bones. ____ 7. There are twelve thoracic vertebrae. ____ 8. The skull has mainly synovial joints. ____ 9. Once you reach puberty bone stops regenerating. ____10. The heel of the foot is known as the acromion process. ____11. The patella is the kneecap. ____12. Bone is covered by endosteum. ____13. The lining of a freely moving joint is cartilage only. ____14. Fibrous joints are not freely moving. .

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____15. Arthritis is mainly caused by cracking your knuckles and slouching.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain the microanatomy of compact bone. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Describe how the body makes new bone. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. List five types of bone disorders. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. List three types of joint disorders. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Explain the steps in bone repair. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 7 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Thin myofilaments are called ________. a. Z bars b. Myosin c. Myofibril d. Actin 2. Muscles may be named using the following ________. a. Speed b. Action c. Age d. Myofilament type .

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3. When the nervous system signals a muscle to contract ____________ ion channels open. a. Phosphorus b. Sodium c. Myosin d. Actin 4. Skeletal muscle produces body movement as well as maintains our ____________ as we sit. a. Strength b. Vasodilation c. Vasoconstriction d. Posture 5. The _____________________ is the prime elbow flexor. a. Biceps femoris b. Biceps brachii c. Triceps brachii d. Flexor digitorum 6. The _____________________ muscle is located on the front of the lower leg. a. Gastrocnemium b. Latissimus dorsi c. Tibialis anterior d. Hamstrings 7. Which type of muscle will not regenerate once it is severely damaged? a. Smooth b. Visceral c. Cardiac d. Skeletal 8. Which term is used to designate muscle pain? a. Myalgia b. Ataxia c. Paralysis d. Spasm 9. Which disorder affects the peripheral nervous system usually with ascending paralysis starting in the feet? a. Muscular dystrophy b. Guillain-Barré syndrome c. Myasthenia gravis d. Tetanus 10. Striated muscles, which appear to have stripes, are in which type of muscle? a. Skeletal b. Internal c. Visceral d. Smooth

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11. Blood is pumped through the heart by which type of muscle? a. Skeletal b. Smooth c. Cardiac d. Visceral 12. The stationary attachment of the muscle is called the ____________. a. Point of movement b. Point of insertion c. Point of control d. Point of origin 13. The only muscle that possesses both voluntary and involuntary abilities is the ________. a. Heart b. Lung c. Diaphragm d. Brain 14. Rotation occurs when you have movement around a/an ________. a. Axis b. Vessel c. Vertebrae d. Ball and socket 15. The muscle movement that enables a joint to bend is the ________. a. Flexion b. Flexor c. Extension d. Extensor 16. Muscle cells are made up of ________. a. Z bars b. Myosin c. Myofibrils d. Actin 17. The myofilaments used during muscle contractions will return to their resting state when the ________ relax. a. Sarcomeres b. Myosin c. Actin d. Z Bars 18. When the nervous system signals a muscle to contract, the ________ ion channels open. a. Phosphorus b. Sodium c. Myosin d. Actin

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19. Skeletal muscles are able to contract ________ times faster than smooth muscle. a. 20 b. 40 c. 50 d. 60 20. Approximately ________ percent of the body’s weight comes from its muscles. a. 15 b. 50 c. 65 d. 80 21. The part of the muscle that attaches to the bone that is stationary is called the ________. a. Point of movement b. Point of insertion c. Point of control d. Point of origin 22. The symptom of shin splints is ________. a. Patellar displacement b. Swelling in the wrist c. Pain in the tibia d. Bruising of the shins 23. Myasthenia gravis is a(n) ________ disorder. a. Malignant b. Genetic c. Myosin d. Autoimmune 24. The etiology of fibromyalgia is ________. a. Unknown b. Acute injury c. Sudden, involuntary muscle spasms d. Bacterial infection 25. Duchenne muscular dystrophy is a(n) ________ defect in muscle protein a. Autoimmune b. Genetic c. Unknown d. Acute 26. The bacteria clostridium tetani release a toxin that ________. a. Relaxes muscles and tightens ligaments b. Causes intermittent muscle spasms c. Causes the patient to go into shock d. Keeps muscles constantly contracted 27. Which of the following is not a symptom of myopathy? a. Weakness b. Genetics c. Stiffness .

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d. Spasm 28. Atrophy means muscles ________. a. Have increased growth b. Waste away c. Will be scarred d. Develop excessively in childhood 29. The toxin used in Botox to treat wrinkles is ________. a. Botulinum toxin b. Clostridium tetani c. Staph d. Acetylcholine 30. A severe muscle strain can cause all of the following symptoms except ________. a. Complete loss of movement b. Swelling c. Severe pain d. Fever 31. The location of pain is confined to tender points in ________. a. Muscular dystrophy b. Tetanus c. Myasthenia gravis d. Fibromyalgia 32. Another name for a voluntary muscle is ________. a. Striated muscle b. Cardiac muscle c. Skeletal muscle d. Both a and c 33. This type of muscle tissue contains striations. a. Voluntary muscle b. Cardiac muscle c. Smooth muscle d. Both a and b 34. Another name for visceral muscle is ________. a. Cardiac muscle b. Voluntary muscle c. Smooth muscle d. Striated muscle 35. Strength training causes ________. a. Muscle atrophy b. A decrease in blood vessels to a muscle c. Muscle hypertrophy d. A decrease in the number of mitochondria in a muscle cell 36. In the bending of the elbow ________. a. The triceps brachii is the synergist b. The biceps brachii is the prime mover c. The biceps brachii is the antagonist .

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d. The brachialis is the prime mover 37. The triceps brachii and the biceps brachii ________. a. Are synergistic for each other b. Both have their origin in the forearm c. Are antagonist to each other d. Both have their insertions in the shoulder 38. Intercalated discs are found in ________. a. Striated muscle b. Cardiac muscle c. Smooth muscle d. All of the above 39. Wasting away or deterioration of muscle is called ________. a. Hypertrophy b. Ankylosis c. Atrophy d. Myositis 40. ________ is an injury that is the result of overuse, overstretching, or forcible stretching of a muscle beyond its functional capacity. It sometimes involves a tendon or ligament. a. Avulsion b. Sprain c. Shin splints d. Strain 41. A strong, tough strand or cord of dense connective tissue that serves as an attachment for muscle to bone is ________. a. A ligament b. Cartilage c. Adipose tissue d. A tendon 42. Endurance training results in ________. a. Muscle atrophy b. An increase in blood vessels to a muscle c. Muscle hypertrophy d. An increase in muscle fibers 43. The movement that is opposite of flexion is ________. a. Abduction b. Rotation c. Extension d. Supination 44. ________ provides the energy to help the myosin heads form and break the crossbridges with actin. a. ATP b. Calcium c. Potassium d. Vitamin D .

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45. All of the following can be used in naming a muscle except ________. a. Location of attachments b. Size c. Action d. Shape e. Color 46. Pectoralis major is located in or near the ________. a. Elbow b. Chest c. Upper portion of the thigh d. Front of lower leg 47. Symptoms of tendinosis include which of the following? a. Pain b. Tenderness c. Stiffness d. All of the above 48. A common running-related inflammatory injury of the extensor muscles and surrounding tissues of the lower legs is called ________. a. Shin splints b. Tendinitis c. Muscle sprain d. Myopathy 49. The majority of fibromyalgia patients are ________. a. Men b. Women c. Children d. Elderly 50. This bacteria releases a toxin that keeps muscles constantly contracted and causes tetanus. a. Meningitis b. E. Coli c. Staphylococcus aureus d. Clostridium tetani 51. Which of the following conditions can be the result of prolonged physical activity, excessive fluid/electrolyte loss, or menstruation? a. Tetanus b. Fibromyalgia syndrome c. Cramps/spasms d. Strains/tendinitis 52. Progressive fluctuating muscle weakness, often starting in the facial or eye muscles are signs and symptoms of which disease? a. Mitochondrial myopathy b. Fibromyalgia syndrome c. Myasthenia gravis d. Duchenne muscular dystrophy .

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53. Progressive descending muscle spasm, rigidity, stiffness and pain, especially in the jaw are signs and symptoms of which disease? a. Tetanus b. Fibromyalgia syndrome c. Cramps/spasms d. Strains/tendinitis Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The 3 types of muscle are cardiac, skeletal, and ____________.

2. ____________ attach bone to bone.

3. The end of the muscle that is attached to the moving bone is the ____________.

4. Muscles that cause movement in the opposite direction of the prime mover when they contract are called ____________.

5. The muscle that controls breathing is the ____________.

6. A muscle that bends a joint is called a ____________ muscle.

7. Where is the sternocleidomastoid attached? sternum, mastoid process & ____________ 8. Motor neurons release the neurotransmitter ____________.

9. During muscle contraction myosin heads bind to ______________.

10. Increased muscle growth is called ____________.

11. Muscles convert ____________ to glucose.

12. ____________ means muscle pain or tenderness.

13. ____________ is a condition of muscle wasting.

14. ____________ is a bacterial infection that causes rigid paralysis.

15. ____________ describes increasing the angle of a joint.

16. ________ is the study of muscles and movement.

17. When blood vessels get larger in diameter, it is called ________.

18. When the body dies, excess calcium remains in the muscles and causes the ________ fibers to shorten and stiffen the body.

19. During an asthma attack, the smooth muscles in the airways of the lungs ________, causing the patient to have difficulty getting air in and out.

20. Tetanus is a muscle disease caused by an untreated bacterial infection of a ________.

21. The majority of fibromyalgia syndrome patients are ________.

22. Vasoconstriction can cause blood pressure to ________.

23. Vasodilation can cause the blood pressure to ________.

24. Some muscular diseases can cause ________, which is a condition of irregular muscle movement and lack of muscle coordination.

25. The main skeletal muscle that controls our breathing is the ________.

26. An ________ is a test in which a muscle group is stimulated with an electrical impulse that causes a contraction.

27. When excess calcium remains in the musclesthroughout the body and causes the muscle fibers to shorten (contract) and stiffen the whole body, ________ has set in. .

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28. ________ are donut-shaped muscles that act as doorways to let materials in and out by alternately contracting and relaxing.

29. A common running-related inflammatory injury of the extensor muscles and surrounding tissues of the lower legs is called ________.

30. ________ or tendinitis is a degenerative disease leading to breakdown and scarring of tendons, that appears to be caused by the failure of tendons to repair themselves after injury.

31. The sarcomere has the actin and myosin filaments arranged in repeating units separated from each other by dark bands called Z________.

32. ________ (also known as lock jaw) is a muscle disorder caused by an untreated bacterial infection of a wound.

33. Muscle strains are injuries caused by overstretching the ________ or the muscles themselves.

34. ________ is a degenerative disease leading to breakdown and scarring of tendons.

35. Cramps or ________ are a sudden, severe involuntary muscle contraction.

36. ________ cause pain in the tibia region.

37. ________ is a potentially deadly disease caused by food poisoning with the Clostridium botulinum bacteria.

38. Strains (tears) or ________ can be caused by an acute injury or chronic overuse or disease.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Smooth muscle is found in the stomach. ____ 2. Ligaments attach muscle to bone. ____ 3. The rectus femoris is in the arm. ____ 4. Abduction moves a muscle away from midline. ____ 5. Extension decreases the angle between 2 bones. ____ 6. Vasoconstriction makes vessels smaller. ____ 7. Cardiac muscle is only found in the heart. ____ 8. Hypertrophy is muscle wasting. ____ 9. Ataxia is partial or total loss of the ability to move muscles. ____10. Sprains are tears or breaks in ligaments. ____11. Guillain-Barré syndrome is a disorder of the peripheral nervous system. ____12. An electromyograph records electrical activity in muscles. ____13. A hernia is caused when tendons become inflamed. ____14. The pectoralis major muscle is named for its action. ____15. Smooth muscle is voluntary muscle.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain the steps underlying skeletal muscle contraction. _____________________________________ _____________________________________ _____________________________________ .

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_____________________________________ 2. Explain why corpses become stiff. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. List the rules for naming muscles _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the structure of a sarcomere. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Compare and contrast myasthenia gravis, muscular dystrophy, Guillain-Barré Syndrome and tetanus. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 8 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. What is the layer of skin that we can see? a. Subcutaneous fascia b. Epidermis c. Stratum basale d. Dermis 2. Patches of melanin found on the skin form ____________. a. Melanocytes b. Freckles c. Bilirubin d. Carotene 3. The condition of yellow jaundice occurs when the body builds up excess a. Carotene b. Melanin c. Bilirubin d. Freckles

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4. Collagenous and elastic fibers of the ____________ make it possible for the skin to flex with movement of the body. a. Dermis b. Subcutaneous c. Epidermis d. Fascia 5. ____________ sweat glands become active at puberty. a. Sebaceous b. Apocrine c. Salivary d. Eccrine 6. The skin is attached to the muscles of the body by the ____________ layer. a. Epidermis b. Dermis c. Hypodermis d. Subcutaneous 7. Connective tissue of the skin is developed from ____________. a. Melanocytes b. Fibroblasts c. Collagen d. Fascia 8. What is the degree of burn in which all three layers of skin have been destroyed and the victim feels no pain? a. First b. Second c. Third d. Fourth 9. The “rule of ____________” is a system devised to assess the amount of body surface affected by a burn. a. Injury b. Nines c. Many d. Five 10. After a severe burn, a patient may require a/an ____________, in which skin is removed from an unaffected area of his body and moved to the burned area. a. Antibacterial patch b. Heterograft c. Donor site d. Autograft 11. Epidermal cells are sloughed off from the ________. a. Basal layer b. Clear layer c. Horny layer d. Dermal layer .

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12. Specialized epithelial cells originating from the nail ____________ form your nails. a. Root b. Cells c. Bed d. Base 13. What color would you expect to see at a healthy nail bed? a. Blanche b. White c. Pink d. Tan 14. By the time epidermal cells reach the surface of the epidermis they are filled with ________. a. Keratin b. Carotene c. Lunula d. Granulosa 15. The integumentary system plays an important role in regulating the body’s ____________. a. Environment b. Composition c. Elasticity d. Temperature 16. Medication placed into the skin is called ________. a. Intravascular b. Intramuscular c. Intracutaneous d. Intraspinal 17. ________ is a disease in which there is reduced blood flow to the extremities. a. PVD b. Jaundice c. Dermatitis d. RBC 18. Which of the following is not a fungal infection? a. Tinea pedis b. Tinnitus corporis c. Tinea cruris d. Tinea corporis 19. Fourth degree burns penetrate ________. a. To the muscle b. To the subcutaneous tissue c. To the skin d. To the bone

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20. Jaundice is caused by a build-up in the body of ________. a. Carotene b. Bilirubin c. Melanin d. Bile 21. Pubic lice are often called ________. a. Bugs b. Sex bugs c. Nits d. Crabs 22. Treatment for Herpes is ________. a. Antivirals b. Antibiotics c. Steroids d. Medicated cream 23. Diabetes is a disease that may cause reduced blood flow to the extremities. This condition is known as ________. a. Keloid b. Folliculitis c. Peripheral vascular disease (PVD) d. Dermatitis 24. Plantar warts are found ________. a. On children’s hands and fingers b. Around the mouth and nose c. On the genitals d. On the sole of the foot 25. A lesion can include all of the following except ________. a. Wound b. Injury c. Single patch of skin d. Infected follicle 26. A condition that has a “bulls-eye” macule/papule is ________. a. Scabies b. General warts c. Acne d. Lyme disease 27. Tinea capitis, tinea corporis, tinea pedis, and tinea cruris are caused by ________. a. Bacteria b. Mites c. Fungi d. Ringworms 28. Causes of alopecia (baldness) include ______. a. Chemotherapy and other medications b. Aging and heredity factors c. Scalp infections .

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d. All of the above 29. Which statement is not true of the epidermis? a. It is a stratified squamous epithelium. b. It is composed mostly of connective tissue. c. It is the outermost layer of skin. d. It contains the stratum corneum.

30. The stratum corneum ________. a. Is composed of mostly dead cells b. Is the innermost layer of the epidermis c. Contains melanocytes which give the skin color d. Both b and c 31. The skin tans in response to sunlight because of the release of ________. a. Keratin b. Melanin c. Sebum d. Collagen 32. ________ is a chronic skin condition marked by thick, flaky, red patches of various sizes, covered with white, silvery patches. a. Psoriasis b. Atopic dermatitis (eczema) c. Herpes zoster d. Seborrheic dermatitis 33. ________ is an eruption of extremely painful vesicles that occur in a band-like pattern along the course of a spinal nerve pathway. a. Scabies b. Pediculosis c. Herpes zoster d. Acne vulgaris 34. The treatment of cellulitis includes ________. a. Incision and drainage b. Antibiotics c. Antifungal medications d. All of the above 35. Which of the following is not found in the dermis of the skin? a. Connective tissue b. Nerve endings c. Melanocytes, which give the skin color d. Sweat glands 36. The layer of epithelial tissue under the fingernail, actually part of the epidermis, is called ________. a. The nail body b. The cuticle c. The lunula d. The nail bed .

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37. This type of gland secretes oil for the skin and hair. a. A sebaceous gland b. A sudoriferous gland c. An eccrine gland d. An apocrine gland 38. Burns that are characterized by blisters, severe pain, and swelling are classified as ________. a. First-degree burns b. Second-degree burns c. Third-degree burns d. Fourth-degree burns 39. The rule of nines is used to ________. a. Determine the depth of burns b. Determine the color of burns c. Determine the body surface area burned d. Both a and b 40. This skin infection is also called furuncles. a. Tinea b. Impetigo c. Warts d. Boils 41. This skin infection is caused by a papilloma virus. a. Tinea b. Impetigo c. Warts d. Boils 42. Individuals with a malfunctioning adrenal gland may have what color of skin? a. Blue b. Red c. Yellow d. Bronze 43. Folliculitis is inflammation of the hair follicles and is usually caused by what type of bacteria? a. Streptococcus b. Staphylococcus c. Mycobacterium d. E. Coli 44. Chicken pox is caused by the ________ virus. a. Herpes varicella b. Herpes zoster c. Herpes simplex type 1 d. Herpes simplex type 2

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45. Fever blisters or cold sores are caused by the ________ virus. a. Herpes varicella b. Herpes zoster c. Herpes simplex type 1 d. Herpes simplex type 2 46. Genital herpes is caused by the ________ virus. a. Herpes varicella b. Herpes zoster c. Herpes simplex type 1 d. Herpes simplex type 2 47. Shingles is caused by the ________ virus. a. Herpes varicella b. Herpes zoster c. Herpes simplex type 1 d. Herpes simplex type 2 48. ________ are normally found on children’s hands and fingers. a. Plantar warts b. Common warts c. Genital warts d. None of the above 49. ________ are found on the sole of the foot and tend to grow inward exhibiting a smooth surface. a. Plantar warts b. Common warts c. Genital warts d. None of the above 50. ________ are highly contagious and sexually transmitted. a. Plantar warts b. Common warts c. Genital warts d. None of the above 51. ________ is the most common type of fungal skin infection and is highly contagious. a. Tinea corporis b. Tinea unguium c. Tinea cruris d. Tinea pedis 52. ________ is a fungal infection of the groin and scrotal areas that mainly affects men. a. Tinea corporis b. Tinea unguium c. Tinea cruris d. Tinea pedis

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53. ________ is incorrectly called ringworm. a. Tinea corporis b. Tinea unguium c. Tinea cruris d. Tinea pedis 54. ________ is a condition in which a fungal infection is involved with either fingernails or toenails. a. Tinea corporis b. Tinea unguium c. Tinea cruris d. Tinea pedis 55. Cellulitis is an inflammatory condition of the skin and subcutaneous tissue caused by what bacteria? a. Streptococcus b. Staphylococcus c. Mycobacterium d. E. Coli 56. A burn victim comes into your local Emergency Room and you are helping to assess the extent of their burns. In your assessment, you notice that the patient has burns on their head and neck, their right arm, right leg, and the front of the torso. You determine that the patient has burns over ________ % of their body. a. 45 b. 63 c. 54 d. 36 Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The layer in which epidermal cells are born is known as the ____________.

2. The outermost surface of the skin is known as the ____________.

3. _________ are responsible for your skin color.

4. ____________ glands secrete oil.

5. Fat cells are known as ____________.

6. Cells which can develop into connective tissue are called ____________.

7. Two factors when assessing burns are ____________ and area damaged.

8. A first degree burn penetrates through the _________________.

9. Sublingually means under the ____________.

10. Hair is composed of fibrous protein called ____________.

11. ________ is the substance that gives skin a yellow hue.

12. Hair stands on end in an attempt to regulate ________________.

13. A ____________ is a crack or groove in the skin.

14. This __________________ layer of the skin regenerates easily after injury.

15. A boil is also called a ____________.

16. The basal layer of the epidermis is known as ________.

17. The front of the trunk is considered to be ________% of the skin surface area. .

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18. Hair is composed of fibrous protein called ________.

19. When blood vessels get larger in diameter it is known as ________.

20. When blood vessels get smaller in diameter it is known as ________.

21. A ________ is a small, raised, round area on the skin that sometimes itches.

22. Warts, or ________, are caused by the papilloma virus.

23. Alopecia is the term for any type of ________ loss.

24. Lyme disease involves multiple body systems as a result of a bacterial ________ that is spread by the bite of a deer tick.

25. Severe burns require healing at an intensity the body ________ normally achieve on its own.

26. Trapped sebum can stagnate and dry out, becoming darkened. This is called a ________.

27. Ideally a wound heals from the inside, working its way toward the outside or ________.

28. When accessing burns, there are two factors: the ________ of the burn and the size of the area burned.

29. Initially the patient with third degree burns will feel no ________.

30. Herpes is a lifelong virus that produces skin inflammation (lesions) in the form of ________.

31. As bilirubin builds up in the body, ________ occurs, giving the skin a deeper yellow color.

32. ________ is characterized by the “bull’s eye” rash as a result of a bacterial infection that is spread via the bite of the deer tick.

33. ________ is a condition in which a fungal infection is involved with either fingernails or toenails.

34. A mass of excessive scar tissue that has a raised and firm, irregular shape is called a(n) ________.

35. The hair that you see is called the shaft, and the root extends down into the dermis to the ________.

36. The sebaceous gland secretes ________, an oily substance that coats the follicle and works its way to the skin’s surface.

37. Tiny mites that burrow into the skin to lay eggs cause a condition known as ________.

38. ________ is the body’s attempt to get as much “hot” blood exposed to a cooler surrounding environment so the heat radiates away from the body.

39. Turning and padding are important in the prevention of decubitus ________.

40. Excessive bruising could indicate skin, ________, or circulatory problems as well as physical abuse.

41. Folliculitis presents with formations of small ________ that surround the follicle.

42. Warts or ________ are caused by the papilloma virus, which causes a hypertrophy of the keratin cells in the skin.

43. Cellulitis, if left untreated, can lead to life threatening conditions such as ________.

44. A first-degree burn has damaged only the ________ layer of skin, the epidermis, and is classified as a partial-thickness burn.

45. A fourth-degree burn goes all the way to the ________. .

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46. A second-degree burn involves the entire depth of the ________ and a portion of the dermis and can cause blistering.

47. A third-degree burn affects all three of the skin ________ and is classified as a fullthickness burn.

48. A ________ is a classic example of a firstdegree burn.

49. ________ is the term for an infestation with lice that is the result of direct contact with a person infested with lice or sharing objects that may be infested.

50. ________ is the term for any type of hair loss, and can be acute or chronic.

51. A ________ is a pathologically altered piece of tissue that can include a wound or injury of a single infected patch of skin.

52. ________ or hives are itchy wheals surrounded by a red inflamed area.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The stratum basale is the outermost surface of the skin. ____ 2. Carotene gives a bluish hue to the skin. ____ 3. Second degree burns involve the entire depth of the epidermis and a portion of the dermis. ____ 4. First degree burns affect all three of the skin layers. ____ 5. Each upper limb is considered 9% of the body skin surface area. ____ 6. Keratinization softens cells. ____ 7. The part of the hair that you see outside the body is the follicle. ____ 8. The white, half-moon shaped area of your finger nail is called the cuticle. ____ 9. An infected blackhead is a pustule. ____10. As your temperature rises during activity, your body signals blood vessels to constrict. ____11. Muscles in your skin are called arrector pili. ____12. The most dangerous type of skin cancer is basal cell carcinoma. ____13. A polyp is a small tumor with a stem. ____14. A vesicle is a small, fluid-filled, raised spot on the surface of the skin. ____15. Eczema is a disorder that results primarily from an allergic reaction.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Distinguish between first, second and third degree burns. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Explain the journey of an epidermal cell from birth to death. _____________________________________ _____________________________________ _____________________________________ _____________________________________ .

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3. Describe how transdermal medication works. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. How do we assess peripheral perfusion? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. How is hair used in forensics? _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 9 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. The part of the nervous system which is located outside the brain and spinal cord is called the ____________ system. a. Endocrine b. Central nervous c. Sensory d. Peripheral nervous 2. The autonomic system is divided into which two systems? a. Somatic, autonomic b. Sympathetic, parasympathetic c. Motor, sensory d. Input, output 3. Myelin is a lipid insulation produced by the ________. a. Microglia b. Oligodendrocytes c. Astrocytes d. Ependymal cells 4. Which part of the neuron is responsible for cell metabolism? a. Body b. Dendrite c. Axon d. Synapse

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5. Neurons with the ability to monitor the environment are called ____________ neurons. a. Accessory b. Motor c. Sensory d. Output 6. Neurons are able to generate tiny electrical currents by changing the ____________ of their membranes. a. Composition b. Shape c. Pathway d. Permeability 7. If a cell is more positively charged than it is when resting, it is said to be ________. a. Refractory b. Repolarized c. Depolarized d. Polarized 8. A cell which is more negatively charged than at rest is ________. a. Polarized b. Hyperpolarized c. Depolarized d. Refractory 9. Impulses are conducted rapidly if ____________ is present. a. Calcium b. Sodium c. Myelin d. Spinal fluid 10. Which of the following is a medical disorder in which the myelin in the CNS has been destroyed ________. a. Multiple sclerosis b. Muscular dystrophy c. Guillain-Barré’ syndrome d. Myasthenia gravis 11. The nerves going to the upper limbs join the spinal cord at the ____________ region. a. Cervical b. Thoracic c. Lumbar d. Sacral 12. The third, innermost layer of the meninges is called the ________. a. Dura mater b. Arachnoid mater c. Pia mater d. Epidural mater .

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13. Medication is often injected into the ____________ space to alleviate pain. a. Vertebral b. Epidural c. Subdural d. Subarachnoid 14. Which part of the spinal cord carries sensory information? a. Commissure b. Ventral root c. Column d. Dorsal root 15. Which spinal cord tracts carry sensory information? a. Superficial b. Ventral c. Ascending d. Inferior 16. Acute treatment for spinal cord injury includes ________. a. Ice b. Heat c. Immobilization d. Physical therapy 17. Which of the following is not one of the three broad categories of causes in peripheral neuropathy? a. Trauma b. Paralysis c. Systemic d. Infection/autoimmune 18. A quadriplegic with damage high in the cervical spinal cord may have a paralyzed diaphragm, such that the patient cannot ________ on his own. a. Breathe b. Swallow food c. Close their eyes d. Speak 19. The autonomic nervous system is a subdivision of the ________. a. Central nervous system b. Sympathetic nervous system c. Peripheral nervous system d. Parasympathetic nervous system 20. Dendrites ________. a. Are usually highly branched b. Carry impulses away from the cell body c. Are usually surrounded by myelin d. All of the above

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21. Sensory neurons are also called ________. a. Interneurons b. Input neurons c. Output neurons d. Glia cells 22. Neurons that carry information between neurons are called ________. a. Interneurons b. Efferent neurons c. Motor neurons d. Afferent neurons 23. This type of glia cell produces myelin for cells in the brain ________. a. Microglia b. Oligodendrocytes c. Astrocytes d. Interneurons 24. Inflammation of the membranes covering the brain and spinal cord is called ________. a. Encephalitis b. Meningitis c. Blepharitis d. Polyneuritis 25. This type of glia cell attacks microbes and removes debris. a. Microglia b. Oligodendrocyte c. Astroglia d. Neurilemma 26. Which of the following statements is not true of multiple sclerosis? a. It is considered a myelin disorder. b. Patients may have disturbances in vision, balance, speech, or movement. c. Most patients are initially diagnosed with relapsing-remitting MS, but at least 50% of them will progress to the chronic progressive form. d. It affects 2,000–4,000 people in the U.S. 27. When a cell becomes stimulated (excited) ________. a. The interior of the neuron becomes more negative b. Sodium gates in the cell membrane close c. Sodium gates in the cell membrane spring open d. The entire neuron remains at rest 28. The outermost of the meninges is the ________. a. Pia mater b. Choroid plexus c. Arachnoid mater d. Dura mater

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29. Loss of motor and sensory control of the trunk of the body and lower extremities as a result of a spinal cord injury describes __________. a. Peripheral neuropathy b. Quadriplegia c. Paraplegia d. A slipped disk 30. This disease is characterized by ascending paralysis ________. a. Myasthenia gravis b. Polio c. Guillain Barré syndrome d. Charcot Marie Tooth disorder 31. This disease is characterized by progressive fluctuating muscle weakness starting in the facial or eye muscles ________. a. Myasthenia gravis b. Polio c. Guillain Barré syndrome d. Charcot Marie Tooth disorder 32. Patients who have an injury to their cervical spinal cord segment and are paralyzed in all four limbs are known as ________. a. Paraplegics b. Quadriplegics c. Suffering from Guillain Barré syndrome d. None of the above 33. Patients with injuries to the thoracic spinal cord segment with two paralyzed legs are said to be ________. a. Paraplegics b. Quadriplegics c. Suffering from Guillain Barré syndrome d. None of the above 34. A potentially fatal condition is an infection of the meninges called ________. a. Polio b. Meningectomy c. Meningitis d. All of the above 35. This inflammatory condition is a result of repetitive motion and leads to numbness in the palm and fingers ________. a. carpal tunnel syndrome b. meningitis c. myasthenia gravis d. botulism 36. An injection of a local anesthetic into the spinal column is called a (an) ________. a. epiphysis b. epidural c. subdural d. cutaneous .

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37. Spinal root directional terms are ________: a. anterior and posterior b. superior and inferior c. Dorsal and ventral d. distal and proximal Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The ____________ branch of the nervous system deals with maintenance of homeostasis.

2. The glial cells which remove debris are called ____________.

3. The ___________ horn contains motor neurons.

4. There are ____________ pairs of thoracic nerves.

5. The spinal ____________, projecting from both sides of the spinal cord in pairs, fuse to form spinal nerves.

6. Branches and recombinations of nerves are called ____________.

7. ____________ are the simplest form of motor output.

8. During this phase of the action potential __________________, sodium ions are flowing into a cell.

9. The ________________ tract carries pain and temperature information.

10. The input side of the nervous system is known as ____________.

11. The period when a cell is unable to accept another stimulus is the ____________ period.

12. Bare spots between adjacent cells are called nodes of ____________.

13. Tiny sacs at nerve terminals, called ____________, release contents from the cell when calcium flows in.

14. ____________ inhibit the release of pain neurotransmitters.

15. The membrane that is like a spider web is called ____________.

16. The lipid ________ increases actin potential conduction speed.

17. Guillain-Barré syndrome is a rapid onset paralysis caused by inflammation of ________ nerves.

18. Repetitive motion can cause ________ in the wrists.

19. A ________ is a group of nerve cell bodies outside the CNS. 20. Preganglionic neurons release the neurotransmitter ________.

21. Following a spinal cord injury, the difference between being able to breathe on your own or requiring a ________ is literally a matter of centimeters.

22. Bruises to the spinal cord may resolve with time and rehabilitation, but a severed, or crushed spinal cord is usually a ________ injury.

23. A very common form of peripheral neuropathy caused by repetitive motion is ________.

24. Epidural injections of steroids are sometimes prescribed for patients with chronic lower back injuries to relieve pain, and ________.

25. The most common systemic disorder that causes peripheral neuropathy is ________. .

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26. The whole series of permeability changes within the cell and the resultant changes in charge across the cell membrane is called the ________.

27. Between adjacent glial cells on axons are tiny bare spots called ________.

28. The neurotransmitter group ________ inhibit release of pain neurotransmitters.

29. The ________ is located in a hollow tube running inside the vertebral column from the foramen magnum to the second lumbar (L2) vertebrae.

30. ________ is caused by an autoimmune attack on the myelin in the central nervous system.

31. Guillain Barré syndrome is the autoimmune destruction of the ________ nervous system myelin and often occurs after a viral infection.

32. ________ is an autoimmune attack of the acetylcholine receptor at the neuromuscular junction.

33. ________ is caused by destruction of ventral horn motor neurons by poliomyelitis virus.

34. ________ is usually mechanical injury to spinal cord tissue.

35. ________ damage to peripheral nerves may be due to injury or illness.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The autonomic system controls voluntary movement. ____ 2. Oligodendrocytes make myelin. ____ 3. Potassium ions move across neurons during depolarization. ____ 4. There are eight cervical nerves. ____ 5. The segments of the spinal cord are named for their function. ____ 6. Guillain-Barré’ syndrome is incurable. ____ 7. SSRI’s prevent the clean up of a neurotransmitter. ____ 8. The peripheral nervous system is everything outside the brain and spinal cord. ____ 9. Myasthenia gravis is an autoimmune disorder in which the immune system attacks and destroys acetylcholine receptors. ____10. A synapse is a junction between two nodes of Ranvier. ____11. Electrical synapses use neurotransmitters to send information to other cells. ____12. Dendrites generate and send signals to other cells. ____13. Action potentials are “all or none.” ____14. Cell bodies are myelinated. ____15. Myelinated axons are white.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain how multiple sclerosis affects the body. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. List the steps in chemical synaptic transmission. _____________________________________ .

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_____________________________________ _____________________________________ _____________________________________ 3. Define the purpose of the following cells: microglia, oligodendrocytes, astrocytes, Schwann cells, and ependymal cells. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. List the three phases of the action potential. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. List the meninges and explain their anatomy. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 10 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. What is the largest part of the brain? a. Cerebellum b. Cerebrum c. Brain stem d. Hypothalamus 2. The grooves and ridges of the brain are known as ____________. a. Hemispheres b. Lobes c. Convolutions d. Meninges 3. Heart beat, breathing, and the cardiovascular system are controlled by the ____________. a. Medulla oblongata b. Midbrain c. Cerebellum d. Cerebrum 4. The internal anatomy of the brain has which structure? a. White matter only b. White matter surrounded by gray matter c. Gray matter only d. Gray matter surrounded by white matter .

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5. The right and left hemisphere of the cerebrum are connected by the ____________. a. Postcentral gyrus b. Precentral gyrus c. Corpus callosum d. Ventricles 6. Which structure in the diencephalon relays information to the cerebrum? a. Thalamus b. Hypothalamus c. Pineal body d. Pituitary gland 7. What cranial nerve is chiefly responsible for eye movements? a. Olfactory b. Facial c. Hypoglossal d. Oculomotor 8. What number cranial nerve is the vagus nerve? a. X b. II c. VIII d. XII 9. To what sense does somatic sensation refer? a. Taste b. Touch c. Smell d. Vision 10. Which tract carries fine touch and vibration to the cerebral cortex? a. Dorsal column tract b. Spinothalamic tract c. Spinocerebellar tract d. Ventral column tract 11. Once touch information is sent to the brain, understanding will occur in the ____________ area. a. Sensory association relay b. Ganglionic association c. Somatic sensory cortex d. Somatic sensory association 12. After a plan for movement has been developed, it leaves the ____________ and connects with neurons in the thalamus. a. Nuclei b. Limbic system c. Motor cortex d. Spinal tract

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13. Where are the neurons for the autonomic system located? a. Corpus callosum b. Spinal cord and brain stem c. Cerebral cortex d. Inside neurotransmitters 14. A woman falls down a flight of stairs carrying a large box. She is admitted to the hospital paralyzed on the right side and unable to speak. Where is her injury? a. Spinal cord b. Temporal lobe c. Frontal lobe d. Brainstem 15. During surgery, general anesthesia inhibits the ____________, causing unconsciousness in the patient. a. Reticular system b. Basal nuclei c. Limbic system d. Hypothalamus 16. Which of these is a type of paralysis? a. Spastic b. Bivalvular c. Reflexive d. Radical 17. Some patients with a severe case of ________ must be kept on a ventilator until the paralysis resolves. a. Guillain Barré syndrome b. Muscular dystrophy c. Multiple sclerosis d. Amyotrophic lateral sclerosis 18. A subdural hematoma would be between the ________. a. Arachnoid mater and subarachnoid b. Dura mater and the arachnoid mater c. Dura and vertebral column d. Arachnoid and pia mater 19. A brain injury with swelling and bleeding with possible severe hemorrhaging (hematoma) is known as a(n) ________. a. Concussion b. Contusion c. TIA d. CVA 20. Which of the following statements is not true of the cerebellum? a. It is considered the “little brain.” b. It lies under the occipital lobe of the cerebrum. c. It is responsible for sensory and motor coordination and balance. d. It helps regulate water balance and sleep cycles. .

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21. The somatic nervous system carries impulses from the brain and spinal cord to ________. a. Cardiac muscle tissue b. Skeletal muscles c. Smooth muscles d. All of the above 22. A mild brain injury is commonly known as a ________. a. Contusion b. Hemorrhage c. Hematoma d. Concussion 23. A ________, which is swelling and bleeding at the site of injury, is more serious than a concussion. a. Convulsion b. Hemorrhage c. Hematoma d. None of the above 24. A ________ is caused by disruption of blood flow to a portion of the brain due to either hemorrhage or blood clot. a. Cerebrovascular accident b. Stroke c. a and b only d. None of the above 25. A mini stroke is known as a ________. a. TIA b. Transient necrotic attack c. Stroke d. a and b only 26. A ________ is a pool of blood between any of the layers of meninges and the skull. a. Contusion b. Hemorrhage c. Hematoma d. Concussion 27. This is the most common cause of dementia among people 65 years or older ________. a. Alzheimer’s disease b. Parkinson’s disease c. Dementia d. Travis’ disease 28. Which fissure divides the brain into a left and right hemisphere? a. transverse b. longitudintal c. medial d. sagital .

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29. The lobe responsible for vision ________: a. occipital b. frontal c. parietal d. medial 30. The lobe responsible for taste ________: a. frontal b. parietal c. temporal d. occipital 31. This structure is responsible for the secretion of melatonin ________. a. pituitary gland b. thalamus c. hypothalamus d. pineal body 32. Hydocephalus is a result of an excess of what fluid? a. blood b. CSF c. CNS d. ALS 33. A group of nerve cell bodies outside the CNS is called a ________. a. ganglion b. glia c. dendrites d. axons 34. The system that controls mood ________. a. reticular b. somatic c. sympathetic d. limbic 35. A non-progressive movement disorder exhibiting classic spastic paralysis a. muscular dystrophy b. Huntington’s disease c. cerebral palsy d. CVA Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The cerebrum is divided into ____________ hemispheres.

2. The ____________ lobes are responsible for conscious thought.

3. Damage to the _____________ lobes leads to sensory perception problems.

4. Heartbeat is controlled in the ____________.

5. The size of the map of a body part in the postcentral gyrus is determined by the _____________ of the body part.

6. Hydrocephalus is treated by medication and by inserting a ____________. .

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7. Cross communication between the right and left sides of the brain is through the ____________.

8. The diencephalon includes the ____________, hypothalamus, pineal body, and pituitary gland.

9. The pineal body secretes the hormone ____________.

10. Dizziness is one symptom of damage to the _________________ cranial nerve.

11. The XII cranial nerve, the ____________, is under the tongue.

12. A ____________ is a group of nerve cell bodies outside the CNS. 13. Preganglionic neurons release the neurotransmitter ____________.

14. A stroke is also known as a ____________.

15. An accumulation of blood between the dura mater and arachnoid space is called a ____________.

16. Emotions are integrated in the ________ lobes.

17. Brain cavities are called ________.

18. The X cranial nerve is the ________ nerve.

19. Brain damage similar to that caused by traumatic brain injury is caused by a lack of oxygen, strokes, or brain ________.

20. The ventricles of the brain, the central canal of the spinal cord, and the subarachnoid space, surrounding both parts of the CNS, are all filled with ________(CSF).

21. The ________ nerve is sensory cranial nerve, responsible for hearing and balance.

22. The ________ is an anatomical/physiologic protective structure of the brain believed to consist of walls of capillaries in the CNS and surrounding glial membranes.

23. ________(CP) is a permanent, non-progressive set of motor deficits diagnosed in infants and young children, generally thought to be due to damage to the motor cortex.

24. The ________ division of the autonomic nervous system controls the flight-or-fight response.

25. ________ is a condition of excess CSF in brain due to trauma, birth defects, tumors, etc.

26. Damage to brain tissue due to mechanical injury, lack of oxygen, or brain hemorrhage causes ________ brain injury.

27. Risk factors for ________ include premature birth, low birth weight, developmental abnormalities, and perinatal brain injury.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Gyri and sulci are known as convolutions. ____ 2. Parietal lobes are responsible for vision. ____ 3. The pons is inferior to the medulla oblongata. ____ 4. The midbrain is the most superior portion of the brainstem. ____ 5. The diencephalon controls hormone levels. ____ 6. Thirst is regulated in the thalamus. ____ 7. Respiratory arrest is a clear sign of brain damage after a fall. ____ 8. The optic nerve controls smell. ____ 9. Pain is perceived in the skin. .

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____10. The limbic system controls emotions and moods. ____11. The parasympathetic system controls the “fight or flight” response. ____12. A brain tumor in the frontal lobe might cause significant changes in personality. ____13. Paralysis is the inability to control voluntary movement. ____14. Cerebral palsy usually begins after age 50. ____15. Ministrokes are called “TIAs.” Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain why cerebral spinal fluid balance is important in the brain. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. List the twelve cranial nerves. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Explain how we interpret touch. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain why hands, lips, and head have so many neurons. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. List five common effects of a stroke. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 11 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Which of the following is listed as one of our visceral senses? a. Touch b. Pain c. Hunger d. Heat .

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2. The ____________ of the eye works similarly to the shutter of a camera. a. Eyelid b. Lens c. Cornea d. Iris 3. Your tears act as a lubricant and ____________ to protect the eyes from microorganisms. a. Antiseptic b. Moisture c. Bath d. Glaze 4. The cornea is found within the ____________ of the eye. a. Sclera b. Choroid c. Retina d. Conjunctiva 5. The eye receives most of its nourishment from the vessels within the ____________. a. Retina b. Sclera c. Conjunctiva d. Choroid 6. The vision center of the brain is located in the ____________ lobe. a. Optic b. Occipital c. Temporal d. Hypothalamus 7. Light passes to the eye through what opening? a. Eyeball b. Lens c. Pupil d. Iris 8. To help diagnose sleep disorders, doctors will measure which stage of sleep? a. REM b. Myopia c. PERLA d. Amblyopia 9. What are the three tiny bones located in the middle ear? a. Pinnas b. Cerumen c. Ossicles d. Cochleas 10. The ____________ contain sensors necessary for equilibrium. a. Cochlea b. Semicircular canals c. Vestibule .

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d. Incus 11. The bony labyrinth is another name for the ____________. a. Auditory nerve b. Outer ear c. Middle ear d. Inner ear 12. The process of sound waves traveling to the brain is known as ____________ conduction. a. Sound b. Sensorineural c. Bone d. Neural 13. ____________ is the name given for the distinct taste of glutamates. a. Gustatory b. Umami c. Meniere d. Tinnitus 14. Tactile corpuscles is the name given to the receptors for which sense? a. Taste b. Smell c. Hearing d. Touch 15. Experiencing pain in the right shoulder due to liver disease is an example of ____________ pain. a. Referred b. Disguised c. Phantom d. Pseudo 16. Amblyopia develops most commonly in ________. a. Adults b. Children c. Patients with astigmatism d. The elderly 17. A patient who has itching in the ears due to a buildup of ear wax could be said to have too much ________. a. Cerumen b. Fluid c. Eustachian d. Cochlea 18. Clouding of the eye lens caused by protein clumping is called ________. a. Blepharitis b. A cataract c. Clouding d. Astigmatism .

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19. Receptors of the ________ senses receive the signal of nausea. a. Visceral b. Cutaneous c. Accommodation d. Labyrinthitis 20. Cataract formation is attributed to all of these except ________. a. Aging b. Gender c. Congenital defects d. Trauma 21. In diabetic retinopathy, increased blood sugar damages the ________ in the retina of the eye. a. Sclera b. Lens c. Conjunctiva d. Blood vessels 22. All of the following are symptoms of otitis media except ________. a. Sinus infection b. Pus c. Edema d. Pain 23. Sight can be considered ________. a. A general sense b. A special sense c. A chemoreceptor d. Both b and c 24. Which of the following is not associated with the retina? a. Rods b. Lens c. Cones d. Photopigments 25. The external ear ends at the ________. a. Auricle b. Tympanic membrane c. External auditory canal d. Tragus 26. Which of the following is not a bone of the middle ear? a. Cochlea b. Stapes c. Incus d. Malleus 27. Which of the following structures in the inner ear is the organ of hearing? a. Bony labyrinth b. Semicircular canal c. Vestibule .

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d. Cochlea 28. A defect of the ________ results in difficulty in visual detection of color and fine detail. a. Lens b. Cones c. Rods d. Cones and rods 29. The sense of touch can be considered ________. a. A general sense b. A special sense c. A chemoreceptor d. Both b and c 30. Receptors used to locate body parts are considered ________. a. A special sense b. A chemoreceptor c. A thermoreceptor d. A proprioceptor 31. Which of the following is not one of the three layers of tissue that forms the eyeball? a. Conjunctiva b. Sclera c. Choroid d. Retina 32. The sensor receptive cells in the retina that function best in dim light and enable night vision are the ________. a. Iris b. Pupil c. Rods d. Cones 33. An inflammation of the thin, transparent membrane covering the visible portion of the sclera and lining the inside of the eyelids results in ________. a. Conjunctivitis b. Choroiditis c. Cornea abrasion d. Lens distortion 34. A cloudy or opaque area in the normally clear lens of the eye is called a ________. a. Stye b. Detachment c. Cataract d. None of the above 35. Vision impairment as a result of old age and the loss of elasticity in the lens is called ________. a. Astigmatism b. Myopia c. Presbyopia d. Diplopia .

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36. A chronic disease of the inner ear marked by a recurring syndrome of vertigo, tinnitus, and progressive hearing loss is called ________. a. Cholesteatoma b. Otosclerosis c. Meniere’s disease d. Mastoiditis 37. Which of the following is attributed to the development of cataracts? a. Trauma b. Congenital defects c. Aging d. All of the above 38. If left untreated, cataracts can lead to what? a. Blindness b. Presbyopia c. Myopia d. Hyperopia 39. Farsightedness is also known as ________. a. Hyperopia b. Myopia c. Presbyopia d. Amblyopia 40. Farsightedness that is due to the aging process is known as ________. a. Hyperopia b. Myopia c. Presbyopia d. Amblyopia 41. Nearsightedness is also known as ________. a. Hyperopia b. Myopia c. Presbyopia d. Amblyopia 42. Lazy eye is also known as ________. a. Hyperopia b. Myopia c. Presbyopia d. Amblyopia 43. Swimmer’s ear is also known as ________. a. External otitis b. Otitis Media c. Internal otitis d. None of the above 44. Symptoms of otitis media include all of the following except ________. a. Pus b. Arthralgia c. Edema .

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d. Pain 45. A feeling of dizziness and or whirling in space is called ________. a. Vertigo b. Purulence c. Eczema d. Tinnitus 46. Ringing in the ears is also known as ________. a. Vertigo b. Purulence c. Eczema d. Tinnitus Short Answer Write the word or phrase that best completes each statement or answers the question.

1. Skin is the location of receptors for your sense of _________________.

2. The ____________ is the colored part of the eye.

3. The vitreous humor is in the ____________ chamber of the eye.

4. The globe-shaped organ of vision is the ____________.

5. The ____________ is the opening through which light passes into the eye.

6. ____________ is a disease characterized by increased pressure in the eye.

7. The _______________ contains light-sensitive neurons.

8. Lazy eye is called ____________.

9. The signals from the eye are carried on this cranial nerve __________________.

10. Pink eye is called ____________.

11. What you perceive as taste is mainly affected by this sense ____________________.

12. The bones of the middle ear are the malleus, incus, ____________.

13. The ____________ is the external part of the ear.

14. The eardrum is also called the ____________ membrane.

15. The tubes that connect the middle ear to the pharynx are called ____________ tubes.

16. Nearsightedness is called ________.

17. If the eye cannot focus on nearby objects, the condition is called ________ or hyperopia.

18. A clouded lens is called a ________.

19. There are times when an optometrist needs to dilate the pupils for better ________ of inner eye parts during the exam.

20. Acute conjunctivitis is commonly called ________ aureus.

21. In glaucoma, peripheral vision is reduced, which eventually progresses to ________ vision and then blindness.

22. Otitis media can perforate the ________ membrane (eardrum).

23. Labyrinthitis is an inflammation of the ________ ear and is usually caused by infections and can cause vertigo.

24. Hyperopia is when the eye cannot focus properly on ________ objects.

25. Tinnitus can occur as a result of chronic exposure to loud ________. .

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26. The ________ or colored part of the eye helps regulate the amount of light that enters the eye.

27. The projecting part of the ear which collects and directs sound waves into the auditory canal is called the pinna or ________.

28. ________ (farsightedness) occurs when the eye cannot focus properly on nearby objects.

29. The ________ begins in the inner ear and carries the amplified vibrations from the tympanic ossicles.

30. Continued sensory stimulation causes some sensors to desensitize in an interesting phenomenon called ________.

31. Pain receptors are also called ________.

32. Pain is felt for as long as the stimulus is there that is c.ausing it or unless a person is under ________.

33. The ________ glands produce tears, spread over the eye surfaces by blinking, which are needed for constant cleansing and lubrication.

34. The sclera contains a specialized portion called the ________, which is transparent to allow light rays to pass into the eye.

35. ________ is caused by increased pressure in the fluid of the eye, which interferes with optic nerve functioning.

36. ________ is an inflammation of the membrane that lines the eye characterized by pink or red swollen eyes.

37. The acute infective phase of conjunctivitis is commonly called ________.

38. A ________ is a condition in which the lens loses its flexibility and transparency and light cannot pass through the clouded lens.

39. ________ is caused by increased pressure in the fluid of the eye, which interferes with optic nerve functioning.

40. ________ is an acute infection of the middle ear, commonly caused by a bacteria or virus, and is frequently found in infants and young children.

41. ________ is frequently associated with an upper respiratory infection such as the common cold.

42. If left untreated, otitis media can cause a perforation of the ________ or eardrum.

43. ________ is an inflammation of the inner ear and is usually caused by infections.

44. ________ is a chronic condition that affects the labyrinth and leads to progressive hearing loss and vertigo.

45. ________ can be either partial or complete and is caused by a variety of conditions, ranging from inflammation and scarring of the tympanic membrane to auditory nerve and brain damage.

46. Clinically, ________ can occur as a result of chronic exposure to loud noises, Meniere’s disease, some medications, wax build-up, or various disturbances to the auditory nerve.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The malleus is the outer ear. ____ 2. The sense of smell is called gustatory. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

____ 3. Sound is transmitted to the brain by hair cells. ____ 4. The signal is carried from the ear to the brain by the optic nerve. ____ 5. Bacteria from the nasal cavity can travel to the ear. ____ 6. Lacrimal glands are endocrine glands. ____ 7. Tears act as an antiseptic to decrease germs in the eyeball. ____ 8. The vitreous humor is watery. ____ 9. Rods are active in dim light. ____10. Photopigments undergo chemical changes when light hits them. ____11. The innermost layer of the eye is the cornea. ____12. Ciliary muscles surround the lens in the eye. ____13. The lens is located behind the pupil. ____14. PERLA stands for pupils, equal, rotating to the light, and accommodating. ____15. REM sleep refers to rapid eye movement.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. List the five senses and their organs. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Describe how your eye is like a camera. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Follow the path of sound from air to the brain. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Describe why children get otitis media. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Describe referred and phantom pain. _____________________________________ _____________________________________ _____________________________________ _____________________________________

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CHAPTER 12 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Which of the endocrine organs can effectively control the pituitary gland? a. Pancreas b. Hypothalamus c. Thyroid d. Pineal 2. Chemical messengers released directly into the bloodstream, with the ability to affect cells for hours or days, are called ________. a. Neurotransmitters b. Dendrites c. Hormones d. Sensory cells 3. A specific type of hormone called ____________ have the ability to interact directly with the cell’s DNA. a. Adrenaline b. Protein c. Sebum d. Steroids 4. A standard level, known as the ____________, is necessary to maintain the body’s homeostasis. a. Set point b. Target level c. Norm d. Quotient 5. When a patient is experiencing a fever, the ____________ resets the body’s temperature set point. a. Brain b. Hypothalamus c. Adrenal gland d. Pituitary gland 6. Which of the following hormones are directly controlled by the nervous system? a. Oxytocin b. Cortisol c. Epinephrine d. Insulin 7. One way in which the body will cope with increased stress is to increase the secretion of a. Cortisol b. Norepinephrine c. Oxytocin d. Prolactin

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8. Which hormone, produced by the pituitary gland, is responsible for decreased urination? a. Prolactin b. Antidiuretic hormone c. Adrenocorticotropic hormone d. Luteinizing hormone 9. The ____________ is part of the diencephalon and is commonly called the “master gland.” a. Adrenal b. Pineal c. Thyroid d. Pituitary 10. The ____________ is divided into a posterior and anterior segment. a. Thyroid b. Thymus c. Pituitary d. Adrenal 11. A stature disorder in which the body produces either too much or too little growth hormone is a disorder of which endocrine gland? a. Anterior pituitary b. Posterior pituitary c. Adrenal medullla d. Adrenal cortex 12. Thyroxin and triiodothyronine, hormones necessary for cell metabolism, are produced in the ____________ gland. a. Pituitary b. Adrenal c. Thymus d. Thyroid 13. ____________ gland is important in regulating the blood glucose. a. Thymus b. Pancreas c. Pineal d. Thyroid 14. The ____________ glands are located above each kidney. a. Thyroid b. Adrenal c. Pineal d. Ovaries 15. What is the name of the condition in which the body is not producing adequate amounts of insulin? a. Diabetes mellitus b. Diabetes insipidus c. Dwarfism d. Hyperthyroidism .

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16. ________ steroids are a class of molecules that cause an increase in muscle mass. a. Anti-inflammatory b. Anabolic c. NSAIDs d. Metabolic 17. Cushings’ disease causes weight ________ and Graves’ causes weight ________. a. Gain, loss b. Loss, loss c. Loss, gain d. Gain, gain 18. The release of norepinephrine and epinephrine into the blood stream increases all of these except ________. a. Respiration b. Saliva c. Pulse or heart rate d. Blood pressure 19. Prednisone can be used as an anti-inflammatory drug to treat ________. a. Severe allergies b. Rheumatoid arthritis c. Other chronic conditions d. All of the above 20. The typical onset of type I diabetes is before ________. a. Puberty b. Age 40 c. Age 5–6 d. Age 10 21. A woman is in labor but the uterine contractions stop. This could be caused by insufficient ________ (a hormone). a. Oxytocin b. ADH c. Pituitary hormone d. Melatonin 22. A deficiency in the release of vasopressin (antidiuretic hormone [ADH]) by the posterior pituitary gland causes ________. a. Hypoglycemia b. Dwarfism c. Diabetes insipidus d. None of the above 23. Treatment of diabetes mellitus includes ________. a. A controlled diet and exercise b. Insulin administration if needed c. Blood and urine testing d. All of the above

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24. Hypersecretion of GH that causes overgrowth of the hands and feet, abnormal thickening of the bones of the face, and excessive overgrowth of soft tissue, occurring in adulthood, is called ________. a. Acromegaly b. Gigantism c. Dwarfism d. All of the above 25. Damage to the pituitary gland, which causes hypopituitarism, can result from ________. a. Radiation b. Surgical removal c. Tumors d. All of the above 26. The master gland of the endocrine system is the ________. a. Thyroid gland b. Pituitary gland c. Adrenal gland d. None of the above 27. Insulin and glucagon are produced by the ________. a. Pancreas b. Thymus c. Adrenal cortex d. None of the above 28. Hypersecretion of cortisol causes ________. a. Addison’s disease b. Cushing’s syndrome c. Myxedema d. None of the above 29. Insufficient secretion of PTH by the parathyroid gland is called ________. a. Hyperpituitarism b. Hypoparathyroidism c. Hyperparathyroidism d. Hypopituitarism 30. The syndrome caused by hypersecretion of the adrenal cortex, which results in excessive circulating cortisol levels, fatigue, muscular weakness, and changes in body appearance is called ________. a. Cushing’s syndrome b. Hashimoto thyroiditis c. Addison’s disease d. None of the above 31. Which of the following statements is not true of the endocrine system? a. The organs of the endocrine system are widely dispersed in the body. b. All organs in the endocrine system are glands. c. Endocrine glands secrete their products into ducts leading to body cavities. d. Endocrine glands produce hormones. .

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32. Dwarfism can be caused by a ________. a. Hypersecretion of ACTH b. Hyposecretion of ACTH c. Hypersecretion of growth hormone d. Hyposecretion of growth hormone 33. Which of the following is not true of oxytocin? a. It is produced in the thyroid gland. b. It causes the contractions of the uterus during labor. c. It is one of the few hormones that is regulated by a positive feedback loop. d. It stimulates “milk letdown” in nursing mothers.

34. Which of the following is true of the adrenal medulla? a. It responds to stimuli from the sympathetic nervous system. b. It helps produce the “fight-or-flight” response. c. It releases epinephrine. d. All of the above are true of the adrenal medulla.

35. Which of the following is not true of the thymus gland? a. It is located in the neck. b. It is an endocrine gland. c. It produces thymosin. d. It is important in the body’s immune system.

36. Which of the following is not true of the pineal gland? a. It is located in the brain. b. It produces melatonin. c. It helps regulate the body’s “biological clock.” d. All of the above are true of the pineal gland.

37. A condition that is characterized by the production of large amounts of very dilute urine is called? a. Diabetes insipidus b. Diabetes mellitus c. Gestational diabetes d. Juvenile diabetes 38. A condition that is characterized by a decrease in pituitary function caused by tumors, surgery, radiation, or head injury is called ________. a. Hyperpituitarism b. Cushing’s syndrome c. Hypopituitarism d. Addison’s disease 39. Which of the following hormones are not affected by hypopituitarism? a. ACTH b. LH c. GH d. Oxytocin

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40. An overproduction of pituitary hormones is called ________. a. Cushing’s syndrome b. Addison’s disease c. Hyperpituitarism d. Hypopituitarism 41. An over-production of cortisol causes ________. a. Cushing’s syndrome b. Addison’s disease c. Graves’ disease d. Hyperpituitarism 42. All of the following are symptoms of Cushing’s syndrome except ________. a. Upper body obesity b. Round face c. Easy bruising d. Hypoglycemia 43. Fatigue, feeling cold, dry skin, brittle nails, and leg cramps are all symptoms of which disease? a. Hyperthyroidism b. Hypothyroidism c. Addison’s disease d. Cushing’s syndrome 44. Sweating, muscle tremors, tachycardia, and irritability are symptoms of which disease? a. Hyperthyroidism b. Hypothyroidism c. Addison’s disease d. Cushing’s syndrome 45. Which of the following are early symptoms of hypoglycemia? a. Nervousness b. Weakness c. Difficulty speaking d. All of the above 46. Symptoms of Addison’s disease include all of the following except ________. a. Low blood pressure b. High blood pressure c. Weight loss d. Excessive skin pigmentation 47. In children, failure to attain normal height or abnormally slow growth are symptoms of ________. a. Gigantism b. Dwarfism c. Type II diabetes d. None of the above

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Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The liver breaks down glycogen into ____________.

2. If a diabetic checks her blood sugar and is hypoglyecemic she should take some _____________.

3. ____________ hormone stimulates tissue growth.

4. The pancreas secretes insulin and ____________.

5. A patient experiences agitation, increased heart rate and blood pressure. She thinks she is going insane. She has a hormone imbalance called _____________________.

6. Chemical messengers released by endocrine glands are called ____________.

7. ____________ moves calcium into bones.

8. ____________ feedback increases the magnitude of change.

9. The ideal value for a body characteristic is called a ____________.

10. If a person is dehydrated they will secrete less ________________ hormone from the posterior pituitary.

11. ____________ hormone stimulates sperm production.

12. Uterine contractions are increased by the hormone ____________.

13. The ____________ gland is located in the upper thorax.

14. The ___________________ secretes several vital steroid hormones.

15. The ____________ within the brain controls hormone levels, but is not called the master gland.

16. ________ is due to a decrease in insulin secretion or decreased sensitivity to insulin.

17. The ________ gland secretes thyroxine.

18. ________ tissue uses glucose from blood to form fat.

19. Addison’s disease is caused by insufficient production of ________ corticosteroids.

20. Appropriate blood glucose levels are vital for cellular ________.

21. If GH secretion is insufficient during childhood, children do not grow to the standard height. This is a type of ________.

22. If stress becomes chronic, the secretion of ________ and cortisol, becomes pathological.

23. Hypopituitarism causes loss of any or all anterior ________ hormones, including ACTH, GH, LH, and TSH, causing a variety of symptoms.

24. Stature disorders result in well-below average height (called ________ ) or wellabove normal height (called gigantism).

25. Cushing’s syndrome is caused by over-secretion of ________.

26. The adrenal cortex makes dozens of steroid hormones known collectively as ________.

27. Glucagon puts glucose into the bloodstream mainly by directing the liver to release glucose stored in the form of ________.

28. The ________ is largely responsible for maintaining blood sugar (glucose) levels at or near a set point.

29. The adrenal glands are split into two regions: the adrenal cortex, an outer layer, and the ________, the middle of the gland. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

30. ________ triggers our sleep by peaking at night and causing drowsiness.

31. The ________ gland, located in the anterior portion of your neck, is responsible for secreting the hormones thyroxine (T4) and triiodothyronine (T3), under orders from the pituitary gland 32. If any of the body’s dozens of homeostatic values become seriously disrupted, the control systems work to bring them back to set point. This process is called ________.

33. One special class of hormones, ________, is particularly powerful because they can bind to sites inside cells by passing easily through the target cell membrane.

34. The male gonad is responsible for secreting the hormone ________.

35. ________, the most common cause of hyperthyroidism, is also an autoimmune disorder.

36. Hypopituitarism is characterized by the loss of any or all ________ pituitary hormones.

37. Stature disorders that result in well-belowaverage height are called ________.

38. Oversecretion of growth hormone (GH) in adults, after bones have stopped growing, causes ________.

39. The most common cause of hypothyroidism is ________.

40. A common symptom of hyperthyroidism is ________.

41. A ________ is the enlargement of the thyroid and can be the result of either hypothyroidism or hyperthyroidism.

42. ________ is the primary side effect of insulin therapy.

43. ________ is caused by insufficient production of adrenal corticosteroids.

44. ________ causes excess cortisol in response to stressors.

45. ________ levels are increased during periods of stress.

46. Chronic stress causes both physiological and ________ changes.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Sweat glands are endocrine glands. ____ 2. Melatonin is released by the pineal gland. ____ 3. Ovaries secrete estrogen. ____ 4. Glucagon lowers blood sugar. ____ 5. Hormonal targets are distant from secretion in the endocrine system. ____ 6. Follicle Stimulating Hormone is secreted in the ovaries. ____ 7. Cortisol is secreted by the adrenal gland. ____ 8. Renin is secreted by the anterior pituitary. ____ 9. Prolactin stimulates milk production. ____10. Restlessness is a symptom of hyperthyroidism. ____11. Hypoglycemia is high blood sugar. ____12. Left untreated, diabetes mellitus can be fatal. ____13. Epinephrine is also known as adrenalin. ____14. Norepinephrine is both a hormone and a neurotransmitter. ____15. Prednisone is used to prevent organ rejection.

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Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain how one endocrine gland is controlled by another. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Explain the control of blood sugar by pancreatic hormones. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Why is the use of injected steroids so dangerous? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. What is the purpose of a set point in the body? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Describe how the thyroid and parathyroid glands interact. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 13 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Blood vessels that carry blood away from the heart are called ________. a. Arteries b. Arterioles c. Veins d. Capillaries 2. Blood is pumped to the body during this part of the cardiac cycle ________. a. Atrial systole b. Atrial diastole c. Ventricular systole d. Ventricular diastole

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. What is the name of the structure that separates the lower chambers of the heart? a. Atrial mitral valve b. Ventrical SA node c. Interatrial septum d. Interventricular septum 4. What is the vessel that brings blood to the heart from the trunk and pelvic region? a. Superior vena cava b. Inferior vena cava c. Superior aorta d. Inferior artery 5. What is another name for the left atrioventricular valve? a. Atrial valve b. Bicuspid valve c. Tricuspid valve d. Semilunar valve 6. Which section of the heart receives blood from the right coronary artery? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle 7. The group of pacemaker cells near the entrance of the superior vena cava form the ____________. a. Bundle of His b. Atrioventricular node c. Myocardium d. Sinoatrial node 8. Which cranial nerve releases a neurotransmitter that can decrease the pulse and force of contraction? a. Abducens b. Vagus c. Hypoglossal d. Trochlear 9. If heart rate decreases, what happens to blood pressure? a. nothing b. It depends on other conditions c. It increases d. It decreases 10. If a patient has been infected by parasites, which white blood cell would be elevated in the bloodstream? a. Eosinophil b. Basophil c. Neutrophil d. Monocyte

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11. Which cells are involved in the production of antibodies? a. Monocytes b. Lymphocytes c. Erythrocytes d. Platelets 12. Jill is Rh negative. Her first baby was Rh negative. She is pregnant again, but the baby is Rh positive. Without medical treatment, will her antibodies attack the baby’s blood? a. yes b. no c. probably not since her first child is Rh negative d. probably yes since her first child is Rh negative 13. Capillary beds are fed by the a. Capillaries b. Venules c. Arterioles d. Platelets 14. If the innermost wall of a vessel is damaged, the ____________ begin the repair by attaching to the damaged site. a. Fibrin b. Platelets c. Fibrinogen d. Thrombin 15. What clotting protein, produced by the liver, begins the clotting process? a. Thrombin b. Prothrombin c. Fibrin d. Fibrinogen 16. What color will blood exhibit if it has a high oxygen content? a. Blue b. Colorless c. Bright red d. Purple 17. The pH value measures the levels of ________. a. WBC’s and RBC’s b. Electrolytes c. Antigens and antibodies d. Acidity and alkalinity 18. Which WBC is effective in defending the body against parasites? a. Eosinophil b. Basophil c. Neutrophil d. Monocyte

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19. What is the most common blood type among Americans? a. A b. B c. O d. AB 20. Peripheral vascular disease (PVD) is caused by ________. a. Hypertension b. Hypotension c. Angina d. Atherosclerosis 21. Leukemia is usually due to bone marrow cancer, and creates a higher number of ________ than normal. a. WBCs b. Platelets c. RBCs d. Thrombocytes 22. Which of the following is not a cause of thrombocytopenia? a. Vitamin K deficiency b. Bone marrow cancer c. Liver dysfunction d. Proper spleen function 23. Ischemia of the myocardium causes ________. a. Myocardial infarction b. Angina c. Heart failure d. A murmur 24. The term for the stoppage of blood flow is ________. a. Homeostasis b. Hemosclerosis c. Hemothrombus d. Hemostasis 25. A substance that decreases the body’s ability to clot is ________. a. Aspirin b. Vitamin K c. Vitamin A d. Enzyme 26. The ________ nervous system signals blood vessels to constrict. a. Parasympathetic b. Central c. Sympathetic d. Peripheral

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27. In terms of their location or movement, an embolus is a ________ clot, and a thrombus is a ________ clot. a. Stationary, stationary b. Floating/moving, stationary c. Floating/moving, floating/moving d. Stationary, floating/moving 28. The bicuspid or mitral valve is the valve ________. a. Between the left atrium and left ventricle b. That opens from the right ventricle into the artery c. Between the right atrium and right ventricle d. That opens from the left ventricle into the artery 29. Which of the following is not a white blood cell? a. Neutrophil b. Thrombocyte c. Lymphocyte d. All of the above are white blood cells 30. This is the approximate number of red blood cells in one cubic millimeter of blood. a. 1 million b. 3 million c. 5 million d. 7 million 31. The role of hemoglobin in the red blood cell is to ________. a. Carry oxygen b. Carry carbon dioxide c. Carry hormones d. Both a and b above 32. This clotting disorder is an inherited disorder. a. Thrombosis b. Thrombocytopenia c. Hemophilia d. Embolism 33. This is a condition where an artery has become abnormally widened because of a localized weakness in the arterial wall. a. An aneurysm b. Ischemia c. Gangrene d. Phlebitis 34. Another name for “hardening of the arteries” is ________. a. Angina pectoris b. Myocardial infarction c. Arteriosclerosis d. Embolism

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35. This is a condition usually found in the legs where blood pools in the veins because the veins have become dilated and distorted. a. An aneurysm b. Phlebitis c. Varicose veins d. Gangrene 36. A heartbeat that is below 60 beats per minute is called ________. a. Tachycardia b. Bradycardia c. Sinus dysrhythmia d. Fibrillation 37. A person with type A blood ________. a. Has anti-A antibodies b. Has A antigens c. Has anti-B antibodies d. Both b and c above 38. The blood type considered the universal donor is type ________. a. A b. B c. O d. AB 39. The condition in which the patient experiences chest pain with exertion is ________. a. Angina pectoris b. Coronary artery disease c. Myocardial infarction d. Congestive heart failure 40. The condition in which a reduction in the quantity of either red blood cells or hemoglobin exists is ________. a. Anemia b. Thrombocytopenia c. Leukemia d. Polycythemia 41. Signs and symptoms of right-sided heart failure include all of the following except ________. a. Jugular vein distention b. Pulmonary edema c. Edema or swelling of hands and feet d. Splenomegaly 42. Which of the following is a sign or symptom of left-sided heart failure? a. Jugular vein distention b. Edema or swelling of hands and feet c. Pulmonary edema d. Hepatomegaly

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43. Cardiac tamponade may result from ________. a. Pericarditis b. Endocarditis c. Heart failure d. Hypertension 44. Congestive heart failure is now called ________. a. Pericarditis b. Endocarditis c. Heart failure d. Hypertension 45. This drug commonly reduces or eliminates angina pectoris due to its ability to increase blood flow to the cardiac muscles by dilating coronary blood vessels. a. Epinephrine b. Lasix c. Oxygen d. Nitroglycerin 46. Abnormal heart rhythms are called ________. a. Arrhythmias b. Sinus rhythm c. Bradycardia d. Tachycardia 47. ________ is a condition in which chronic low levels of oxygen (due to lung disease or living in high altitudes) cause the body to produce more than normal amounts of erythrocytes to transport more efficiently the smaller amounts of available oxygen. a. Primary polycythemia b. Primary erythrocytopenia c. Secondary polycythemia d. Secondary erythrocytopenia 48. ________ is caused by bone marrow cancer stimulating an over-production of erythrocytes. a. Primary polycythemia b. Primary erythrocytopenia c. Secondary polycythemia d. Secondary erythrocytopenia 49. ________ is a blood condition in which there is a less than normal number of red blood cells or there is abnormal or deficient hemoglobin. a. Sickle cell anemia b. Leukemia c. Leukocytosis d. Anemia 50. ________ is an inherited condition in which red blood cells and hemoglobin molecules do not form properly. a. Sickle cell anemia b. Leukemia c. Leukocytosis .

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d. Anemia 51. ________ is usually due to bone marrow cancer, and is a condition in which a higher than normal number of white blood cells are produced. a. Sickle cell anemia b. Leukemia c. Leukocytosis d. Anemia 52. ________ also exhibits as a situation in which there is a higher than normal number of white blood cells. In this case, the cause is often an infection that is being fought. a. Sickle cell anemia b. Leukemia c. Leukocytosis d. Anemia Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The ____________ is the tip of the heart, distal to the head.

2. The bicuspid valve is also called the ____________ valve.

3. Cardiac output is determined by heart rate and __________________.

4. The ____________ side of the heart pumps blood to the lungs.

5. During a severe hemorrhage, blood vessels will ______________ causing an increase in peripheral resistance in an attempt to raise blood pressure.

6. Red blood cells are called ____________.

7. Type ____________ is the universal recipient of blood donations.

8. The middle layer of the vessel is the tunica ____________.

9. After leaving the AV node, the electrical impulse spreads to the _________________.

10. In an EKG, the __________________ wave corresponds to atrial depolarization.

11. ____________ is the process in which neutrophils surround and ingest invaders.

12. ____________ is the prevention of bleeding.

13. The smallest arteries are ____________.

14. During ventricular systole, the __________________ valves are closed.

15. The epicardium is also the ________________________.

16. The sinoatrial node is also called the ________.

17. ________ is the chemical symbol for mercury.

18. ________ defend against parasites.

19. A lower number of white cells than normal is ________.

20. Tissue death is called ________.

21. Extremely low blood pressure, as in shock, can affect blood profusion to vital organs and cause tissue damage and ________.

22. Peripheral vascular disease is a condition caused by plaque buildup called atherosclerosis in the ________ arteries.

23. In a blood transfusion, if the patient receives blood of the wrong blood type, the donor’s antigens and the recipient’s antibodies ________ and cause serious harm or death. .

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24. The medication nitroglycerin increases blood flow to cardiac muscle by vasodilation of the ________ blood vessels.

25. Women who smoke and use oral contraceptives are at a higher risk of formation of thrombi in the blood vessels, which can break off to become ________.

26. ________ is a type of blood cancer that can cause increased WBCs. 27. When an infection occurs, the body produces a ________ than normal number of neutrophils, which are one type of WBC. 28. The first hour of a myocardial infarction (heart attack) is critical, so emergency services should be called immediately even if the patient ________ they are having a heart attack.

29. Anemia is a blood condition in which there are fewer than normal RBCs or there is an abnormality or deficiency of ________.

30. Antibodies often react with the antigens that caused them to form, and the antigens stick together, or ________, in little clumps.

31. A high-fat and high-salt diet, age, obesity, smoking, stress, and decreasing flexibility of the blood vessels can all contribute to ________.

32. A type of clot called a ________ can partially or totally block blood flow to a portion of the heart, resulting in a coronary thrombosis, which can cause a heart attack.

33. ________ is a condition in which there are fewer than normal circulating platelets.

34. Since type AB doesn’t contain plasma anti-A antibodies or anti-B antibodies, it can’t clump with any donated blood that contains A or B antigens. Because of this, a type AB person is labeled a ________.

35. Basophils are important because they secrete the chemical ________, which helps to keep blood from clotting as it courses through blood vessels.

36. A ________ is a result of blood leaking backward due to a faulty heart valve or a narrowed valve opening.

37. ________ is a narrowing of a valve and can be caused by rheumatic fever, congenital origin, or the aging process.

38. An ________ is a weakening and distortion of the walls of an artery and can be caused by hypertension or trauma.

39. ________ is often called chest pain and is caused by ischemia of the myocardium, as a result of poor blood perfusion of the heart tissue.

40. Coronary artery disease or CAD is an insufficient blood flow to the heart tissue. It is usually due to ________ but may be due to clot(s) in a coronary artery.

41. An ________ is a clot that has moved or traveled and can be caused by thrombophlebitis, venous stasis, or contraceptives.

42. ________ is a chronic increase in pressure and can be caused by heredity, diet, or smoking.

43. ________ can be caused by conditions or situations that lead to a decreased blood flow to the heart tissue, and leads to ischemia or necrosis.

44. ________ veins are dilated and distorted blood veins that are normally found superficially in the legs but can also be found in the rectum.

45. ________ may be caused by decreased red blood cell (RB) production.

46. ________ is an inherited bleeding disorder. .

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47. ________ is a less than normal level of platelets, that may be due to leukemia, or bone marrow aplasia.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. All arteries carry oxygenated blood. ____ 2. Arteries have thinner walls than veins. ____ 3. It is called systole when the heart contracts. ____ 4. The vagus nerve increases heart rate. ____ 5. The ventricles are contracted during the QRS interval of the EKG. ____ 6. Plasma is a yellowish fluid. ____ 7. Monocytes are erythrocytes. ____ 8. Type AB has no antigens. ____ 9. The innermost layer of the blood vessel is the tunica interna. ____10. During the final stage of clotting the clot becomes water soluble. ____11. During severe dehydration, blood pressure rises. ____12. A floating embolus is a thrombus. ____13. Decreased blood flow to tissues is called ischemia. ____14. Atherosclerosis is caused by plaque. ____15. Heart valves close when their tissue is depolarized.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Draw the ECG tracing and describe what P, QRS, and T indicate. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Trace the flow of blood throught the heart from superior and inferior vena cave to aorta. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Discuss why an O negative mother should be concerned about her second pregnancy. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the clotting process. _____________________________________ _____________________________________ _____________________________________ _____________________________________ .

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5. Explain the factors that influence blood pressure. _____________________________________ _____________________________________ _____________________________________ CHAPTER 14 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. During metabolism, your body produces the waste product ____________. a. Oxygen b. Nitrogen c. Carbon monoxide d. Carbon dioxide 2. The process of gas exchange between air and blood is called a. Ventilation b. External respiration c. Internal respiration d. Respiration 3. The respiratory system terminates at the a. Alveoli b. Bronchus c. Bronchioles d. Lungs 4. What region contains the coarse nasal hairs? a. Pharyngeal b. Vestibular c. Olfactory d. Laryngeal 5. ____________ cells are responsible for the production of mucus. a. Goblet b. Epithelial c. Cilia d. Basal 6. The vocal cords are located in the ____________. a. Nasal cavity b. Larynx c. Oropharynx d. Laryngopharynx 7. The trachea extends from the larynx to the ____________ vertebrae. a. 2nd cervical b. 1st thoracic c. 6th thoracic d. 4th lumbar 8. Type II cells that line the alveoli are responsible for the production of a. Carina b. Surfactant .

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c. Carbon dioxide d. Nitrogen 9. The diaphragm is covered by a serous membrane called the ____________. a. Visceral membrane b. Visceral pleura c. Musculo-serous membrane d. Parietal pleura 10. The area of the left lung that corresponds to the right middle lobe is ____________. a. Lingula b. Hilum c. Carina d. Sternum 11. Which region of the brain controls breathing? a. Hypothalamus b. Cerebrum c. Medulla oblongata d. Occipital 12. All of these muscles aid ventilation except _______________ . a. Abdominal b. Pleural c. Accessory d. Respiratory 13. _____________________ is the amount of gas moved during normal ventilation. a. Inspiratory reserve volume b. Vital Capacity c. Tidal Volume d. Expiratory reserve volume 14. When the diaphragm contracts, lung volume ______________________. a. Decreases b. Increases c. Stays the same d. Changes depending on circumstances 15. The _______________ nerve carries impulses to the diaphragm. a. Phrenic b. Vagus c. Diaphragmatic d. Thoracic 16. Due to the structure of the ________, a large amount of moisture is added to the respiratory system every day. a. Nares b. Trachea c. Conchae d. Eustachian tube 17. The “clean-up” cells are located in the ________ layer of alveolar membrane. a. Surfactant .

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b. Epithelial c. Interstitial space d. Capillary endothelium 18. The kidneys attempt to increase hemoglobin levels in the body by the release of ________. a. Iron b. Oxygen c. Erythrocytes d. Erythropoietin 19. The diaphragm receives help from the ________ muscles in the activity of breathing. a. Pleural b. Thoracic c. Accessory d. Respiratory 20. Pleural effusion with pus is a(n) ________. a. Hydrothorax b. Empyema c. Emphysema d. Eczema 21. A lack of lung surfactant causes ________ lungs that resist expansion. a. Floppy b. Inflamed c. Infected d. Stiff 22. The majority of cases of chronic bronchitis are caused by a. Asthma b. Allergies c. Smoking d. Fungi 23. Which of the following is not part of the upper respiratory tract? a. Trachea b. Larynx c. Pharynx d. Nose 24. Which of the following is not part of the lower respiratory tract? a. Trachea b. Larynx c. Bronchi d. Lungs 25. Which of the following is not a subdivision of the pharynx? a. Tracheopharynx b. Nasopharynx c. Oropharynx d. Laryngopharynx .

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26. This structure is not a part of the larynx ________. a. Thyroid cartilage b. Vocal cords c. Epiglottis d. Eustachian tubes 27. The first respiratory structures without cartilage as a supporting tissue are ________. a. Primary bronchi b. Secondary bronchi c. Bronchioles d. Alveolar ducts 28. The movement of air into and out of the lung is called ________. a. Evacuation b. Perspiration c. Respiration d. Ventilation 29. The exchange of gases between the cells and the blood is called ________. a. Evacuation b. Perspiration c. Respiration d. Ventilation 30. The amount of air that can be forcibly taken in after normally inhaling is called ________. a. Tidal volume b. Residual volume c. Inspiratory reserve volume d. Expiratory reserve volume 31. A collection of air or gas in the thoracic cavity, as the result of a stab wound or gunshot wound to the chest describes a condition called ________. a. Emphysema b. Bronchiectasis c. Pneumoconiosis d. Pneumothorax 32. ________ is a destructive disease of the alveoli and the adjacent capillary walls resulting in chronic dyspnea, cough, and the characteristic barrel chest. a. Emphysema b. Bronchiectasis c. Pneumoconiosis d. Pneumothorax 33. Which of the following is not a respiratory structure? a. Larynx b. Esophagus c. Bronchi d. Nose .

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34. The two most important respiratory control centers are located in this part of the brain ________. a. Medulla oblongata b. Pons c. Cerebral cortex d. Cerebellum 35. Chemoreceptors that help regulate breathing can be found ________. a. In the medulla oblongata b. In the carotid artery c. In the aorta d. Both b and c 36. Labored or difficult breathing is referred to as ________. a. Apnea b. Dyspnea c. Eupnea d. Cheyne-Stokes respiration 37. Shortness of breath is called ________. a. Dyspnea b. Eupnea c. Orthopnea d. Wheezing 38. ________ is a condition in which there is air inside the thoracic cavity and outside of the lungs. a. Pleuritis b. Pleurisy c. Pneumothorax d. Hemothorax 39. ________ is a condition in which there is an excessive build-up of fluid in the pleural space between the parietal and visceral pleura. a. Pneuothorax b. Pleural effusion c. Pulmonary edema d. Empyema 40. ________ is pus in the pleural space. a. Hemothorax b. Pleural effusion c. Hydrothorax d. Empyema 41. ________ is blood in the pleural space. a. Hemothorax b. Pleural effusion c. Hydrothorax d. Empyema

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42. ________ is distinguished by having reversible airway narrowing and airway hyperreactivity; and is most commonly characterized as an inflammatory process. a. Asthma b. Emphysema c. Chronic bronchitis d. Bronchiectasis 43. ________ is characterized anatomically as the permanent, abnormal enlargement of distal airway spaces and destruction of the alveolar walls. a. Asthma b. Emphysema c. Chronic bronchitis d. Bronchiectasis 44. ________ is associated with a chronic productive cough, enlargement of mucous glands, and hypertrophy of the airway smooth muscle ________. a. Asthma b. Emphysema c. Chronic bronchitis d. Bronchiectasis 45. The inability to get air out of the lungs is known as ________. a. Hyperinflation b. Bronchospasm c. COPD d. Gas trapping 46. Which of the following drugs has as its basic purpose to reduce the work of breathing, increase the oxygen content of the blood, and reduce the work of the heart? a. Antivirals b. Insulin c. Oxygen d. Antibiotics 47. Which drug provides rapid relief of an acute situation of airway narrowing? a. Bronchodilators b. Steroids c. Oxygen d. Antibiotics Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The trachea branches into ____________.

2. The bronchi branch into ____________.

3. The part of the respiratory system that carries air but has no gas exchange capability is called the ____________________ zone.

4. The process of gas exchange is known as ____________.

5. Air filled cavities in the facial bones are known as ____________.

6. Food is prevented from entering the trachea by the ____________.

7. The windpipe is known as the ____________. .

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8. The site of bifurcation in the bronchi is called the ____________.

9. Premature infants are often in danger due to a lack of __________________ in the lungs.

10. As CO2 levels rise, pH decreases and ____________ rate increases.

11. The alveoli consists of _____________ cells.

12. The oropharynx is lined with _________________ epithelium.

13. A young woman dives into the surf, hitting her head and causing a spinal cord injury.

She is in respiratory arrest. Her injury is most likely above this spinal cord segment _______________.

14. The motor neurons for ventilation are in this brain region ______________________.

15. Red blood cell numbers are controlled by a hormone released by the _______________.

16. Oxygen is abbreviated as the chemical sign ________.

17. Carbon dioxide is abbreviated as ________.

18. The smallest blood vessels are known as ________.

19. Producing sound is known as ________.

20. Olfaction is the sense of ________.

21. The vocal cords are found in the ________.

22. The liquid ________ layer lines the alveoli.

23. Red blood cells are known as ________.

24. Chronic obstructive pulmonary disease (COPD) is a global term for the conditions of emphysema, and chronic ________.

25. In pleural effusion, if the fluid in the pleural space has pus, it is known as ________.

26. There has been recent concern about a multi drug-________ form of TB that does not respond to the usual TB drugs and that has a high mortality rate.

27. The terms “iron-poor” blood or “tired blood” come from the fact that a patient with low levels of iron tires easily due to low ________ levels.

28. Excessive secretions and fluid, such as in pneumonia, act as barriers and reduce the ________ in the blood.

29. Bloody fluid found in the pleural cavity/space is called a ________.

30. In susceptible individuals, ________ causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and in the early morning.

31. The lungs reside in the thoracic cavity and are separated by a region called the ________, which contains the esophagus, heart, great vessels, and trachea.

32. Swallowed materials pass through the ________ to get to the stomach.

33. A ________ is a condition in which there is an excessive build-up of fluid in the pleural space between the parietal and the visceral pleura.

34. The ________, or breastbone, is centrally located on the anterior portion of the thoracic cage and is comprised of the manubrium, body, and xiphoid process.

35. During increased physical activity or in disease states in which more oxygen is required, ________ are used to help pull up your rib cage to make an even larger space in the thoracic cavity.

36. ________ is a respiratory infection causing pressure, pain and often a headache. .

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37. The nasopharynx contains lymphatic tissue of the immune system, called the ________, and passageways to the middle ear called eustachian tubes.

38. The major pathology of the upper airways include ________ or allergies of the sinuses, nose, or throat.

39. ________, or sore throat, causes discomfort especially when swallowing.

40. ________, or an inflamed voice box, is characterized by hoarseness and loss of speech.

41. ________ is a condition in which the alveoli of the lungs are either partially or totally collapsed.

42. ________ is a lung infection that can be caused by a virus, fungus, bacterium, aspiration, or chemical inhalation.

43. ________ is defined as the presence of productive cough during 3 months of the year for 2 consecutive years, provided that other causes of chronic sputum production are excluded.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The upper respiratory tract begins at the nares and ends at the trachea. ____ 2. The nasal cavity is divided into right and left halves by a septum. ____ 3. The pontine respiratory group is the chief respiratory center. ____ 4. Respiratory mucosa is ciliated cuboidal epithelium with goblet cells. ____ 5. The oropharynx is behind the mouth. ____ 6. The major type of alveolar cell is Type II, or granular pneumocytes. ____ 7. The hormone erythropoietin is released in the lungs. ____ 8. Inspired objects usually lodge in the left lung. ____ 9. The thoracic cavity and the upper side of the diaphragm are lined with the visceral pleura. ____10. The hilum is the area where the root of each lung is attached. ____11. The thoracic cage consists of twelve pairs of elastic arches of bone called ribs. ____12. The cerebrum controls breathing. ____13. The dome-shaped muscle that acts to ventilate is the diaphragm. ____14. The portion of the sternum where CPR is performed is the xiphoid process. ____15. Atelectasis is the situation in which the air sacs collapse.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. List the changes in the layers of the wall of the respiratory system from conducting zone to respiratory zone. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Why do we breathe through our noses? _____________________________________ _____________________________________ .

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_____________________________________ _____________________________________ 3. Discuss how the angle of branching of the bronchi makes a difference in which lung receives aspirations. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the mechanism of ventilation. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Discuss the effect of surfactant. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 15 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. In addition to storage of white blood cells the lymphatic system is also responsible for a. Producing pathogens to fight infections b. Producing fluids to supplement the cardiovascular system c. Production of some types of white blood cells d. Maturation of some types of red blood cells 2. Lymph nodes can be described as a. Small encapsulated bodies b. Patches of cytokines c. Immature antibodies d. Organelles of immunity 3. Lymphatic trunks from the lumbar region empty into the a. Left lymphatic duct b. Right lymphatic duct c. Sacral duct d. Thoracic duct 4. Which structure will sometimes disappear in adults? a. Sinus b. Spleen c. Thymus d. Pancreas 5. Unique molecules found on the outer surface of cell membranes are called a. Antigens .

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b. Antibodies c. Interferon d. Cytokines 6. Innate immunity triggers a series of mechanisms that target specific pathogens; the mechanisms are called a. Passive immunity b. Helper cells c. Activation cells d. Adaptive immunity 7. The body has both physical and chemical ____________ to prevent invaders from entering. a. Cells b. Barriers c. Nodes d. Cytes 8. The first leukocytes to arrive at the site of damage are the a. Neutrophils b. Basophils c. Mast cells d. Dendrite cells 9. The ____________ cells release antibodies to destroy cells that carry non-self antigens. a. Mast b. B-lymphocytic c. T-lymphocytic d. Natural killer 10. What is the cytokine which is produced to stimulate macrophages and cause death of cancer cells? a. Interferon b. Interleukin c. Cytokinase d. Tumor necrosis factor 11. What name is given to the series of reactions responsible for activation of twenty normally inactive proteins? a. Complement cascade b. Inflammatory response c. Margination selection d. Differentiation process 12. For your body to launch an effective response to invading pathogens, innate immunity must join forces with the a. Lymphatic system b. Cardiovascular system c. Adaptive immunity d. Hypothalamus .

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13. There are two types of proliferation, one for ____________ and one for all other types of lymphocytes. a. Natural killer cells b. B-cells c. Helper T-cells d. Dendritic cells 14. ____________ are essential for the reproduction of B cells and other types of cells. a. Memory B-cells b. Helper T-cells c. Cytotoxic T-cells d. Regulatory T-cells 15. Once the threat of invasion is over, the ____________ are responsible for “turningoff” the response. a. Memory B-cells b. Regulatory T-cells c. Cytotoxic T-cells d. Helper B-cells 16. The HIV virus targets ________ cells. a. Natural killer cells b. B-cells c. Helper T-cells d. Dendritic cells 17. It is because of adaptive ________ that people normally get chicken pox only once. a. Immunity b. WBCs c. Antibodies d. Antigens 18. Barriers include all of the following except ________. a. Mucous membranes b. Skin c. Sebaceous glands d. Nails 19. Which stage of cancer would mean it had spread to nearby tissues? a. Stage four b. Stage seven c. Stage two d. Stage five 20. Which of the following is not one of the immune system’s components? a. Barrier b. NSAID c. Inflammation d. Chemical

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21. The ________ gland is larger in children because they are exposed to many new infections. a. Thymus b. Thyroid c. Thalamus d. Tinnitus 22. In rheumatoid arthritis, the immune system attacks the ________. a. Pleural membrane b. Mucous membrane c. Synovial membrane d. Myelin membrane 23. The ________ in the chest is part of the lymphatic system and helps T lymphocytes mature. a. Pharyngeal tonsils b. Spleen c. Palatine tonsils d. Thymus 24. The spleen is a lymph organ that filters blood and also acts as a reservoir for ________. a. Water b. Fat c. Interstitial fluid d. Blood 25. Getting a flu shot to protect against the flu is an example of ________. a. Natural passive immunity b. Natural active immunity c. Artificial active immunity d. Artificial passive immunity 26. The fetus receives antibodies from the mother which last several weeks after birth.

This is an example of ________. a. Natural passive immunity b. Natural active immunity c. Artificial active immunity d. Artificial passive immunity 27. If you have had the chicken pox once, you will not get chicken pox again. This is an example of ________. a. Natural passive immunity b. Natural active immunity c. Artificial active immunity d. Artificial passive immunity 28. If you are exposed to hepatitis A and have not been vaccinated against it, you may receive antibodies from another person. This is an example of ________. a. Natural passive immunity b. Natural active immunity c. Artificial active immunity .

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d. Artificial passive immunity 29. A cytokine produced by cells in response to invasion by a virus is ________. a. Complement b. Interferon c. Interleukin d. Mucus 30. The group of diseases that occur when antibodies develop and begin to destroy the body’s own cells is ________. a. Immunodeficiency diseases b. Autoimmune diseases c. Immunocompetent diseases d. Diseases of the reticuloendothelial system 31. The activated lymphocytes must make thousands of copies of themselves in order to fight off the thousands of pathogens reproducing in the body. This reproduction of lymphocytes is called ________. a. Lymphocyte proliferation b. Lymphocyte activation c. Differentiation d. Immunization 32. HIV infection and subsequently AIDS, is characterized by severe decrease in immune function, particularly ________. a. Memory B-cells b. Neutrophils c. Helper T-cells d. Plasma cells 33. If the body is exposed to the same pathogen in the future, memory cells allow the body to mount a much faster response to the invasion known as the ________ response. a. Primary b. Secondary c. Tertiary d. Quaternary 34. What kind of cells produce antibodies? a. T cells b. B cells c. NK cells d. Neutrophils 35. Which of these is an autoimmune disease? a. c and d only b. Influenza c. Rheumatoid arthritis d. Systemic lupus erythematosus (SLE) 36. In this stage of cancer, spread to distant tissues and organs is present ________. a. Stage I b. Stage II .

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c. Stage III d. Stage IV 37. In this stage of cancer, no spread from the origin is present ________. a. Stage I b. Stage II c. Stage III d. Stage IV 38. In this stage of cancer, spread to nearby lymph nodes is present ________. a. Stage I b. Stage II c. Stage III d. Stage IV 39. This stage of cancer is often terminal ________. a. Stage I b. Stage II c. Stage III d. Stage IV 40. The signs and symptoms of inflammation include all of the following except ________. a. Cold b. Pain c. Swelling d. Redness 41. Symptoms of rheumatoid arthritis include ________. a. Joint stiffness b. Symmetrical joint damage c. Decreased range of motion d. All of the above 42. Signs and symptoms of allergies can include all of the following except ________. a. Weight loss b. Wheezing c. Upper respiratory infections d. Hives Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The ____________ system is the transport system for pathogens and white blood cells.

2. Lymph capillaries empty into lymphatic ____________.

3. The ____________ is a lymphatic organ that destroys red blood cells.

4. The ____________ is the soft organ between the aortic arch and sternum.

5. Any organism that invades your body and causes disease is a ____________.

6. ____________ immunity is your body’s inborn ability to fight infection.

7. ____________ are molecules on the outer surface of cells.

8. ____________, or white blood cells, defend the body. .

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9. ____________, and mast cells, release chemicals to promote inflammation.

10. Vaccination triggers ________________________ immunity.

11. Ultimately the cause of death in AIDS patients is ___________________.

12. Walling off an infected area is called ____________.

13. Selection of lymphocytes which react to antigens is called _______________ selection.

14. Redness, heat, swelling and pain are signs of ____________.

15. The reproduction of activated B cells is called _____________________.

16. ________ fight parasitic worms.

17. ________ means to break down or destroy.

18. Cancers that are diagnosed after they have already spread to other organs are much more likely to be ________.

19. There are several different types of leukemia based on the ________ of WBCs and the nature of the patient’s symptoms.

20. When the hypothalamus causes a rise in body temperature during an illness, it is purposely trying to destroy the invading ________.

21. Symptoms of leukemia are caused by decreased function of WBCs (if the cells are immature) and decreased ________ of RBCs and platelets.

22. In ________ disorders, the body fails to recognize “self” and destroys its own tissue.

23. The inflammatory response is the same, whether it is a mechanical injury, a wound infection, damage due to a pathogen, or ________ throat.

24. A rise in body temperature is one way the immune system deliberately tries to kill a ________.

25. The lumbar, intestinal, and intercostal trunk all empty into the ________ duct, a large duct that runs from the abdomen up through the diaphragm and into the left subclavian vein.

26. Cells have molecules on the outer surface of their membranes to distinguish whether they are friend or foe. These molecules are called ________.

27. Complement ________ is a complex series of reactions that activate 20 proteins that are usually inactive in the blood unless activated by a pathogen invasion.

28. If an invader has an opportunity to enter the body, white blood cells, or ________, are responsible for defending the body against invaders.

29. ________ are proteins produced by damaged tissues and white blood cells that stimulate immune response in a variety of ways, including increasing inflammation, stimulating lymphocytes, and enhancing phagocytosis.

30. ________ is characterized by four cardinal signs: swelling, pain, heat, and redness.

31. The destruction of self-recognizing lymphocytes is known as ________.

32. ________ arthritis is an autoimmune disorder in which the immune system attacks the synovial membrane of a patient’s joints.

33. Cytotoxic T cells release a cytokine called ________, which causes infected cells to develop holes in their membranes and die.

34. ________ is staged and prognosis is determined by the amount of metastasis, tumor characteristics, and lymph node involvement.

35. ________ is a cancer of the bone marrow and blood, characterized by the overproduction of white blood cells. .

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36. Inflammation that becomes systemic and is caused by allergic reactions to insect stings, nuts, or shellfish is called ________.

37. ________ is the rise in body temperature as a deliberate attempt by the immune system to destroy the pathogens that have invaded the body.

38. ________ disorders occur when the immune system attacks some part of the body.

The body fails to recognize “self” and destroys its own tissue as if it were an invader.

39. ________ arthritis is an autoimmune disorder in which the immune system attacks the synovial membrane of patient’s joints.

40. Systemic lupus erythematosis (SLE) is an ________ disorder in which the immune system attacks a variety of structures in the body.

41. Acquired immune deficiency syndrome (AIDS) is an immune ________ disorder caused by infection with the human immunodeficiency virus (HIV).

42. ________ are caused by the overreaction of the immune system to typically harmless antigens, like mold, pollen, or animal fur.

43. ________ is caused by the uncontrolled proliferation of lymphocytes.

True/False Write ‘T’ if the statement is true and ’F’ if the statement is false. ____ 1. Antigen displaying cells are infected by pathogens so they can display the antigens. ____ 2. Fever is caused by neurotransmitters released by pathogens. ____ 3. Innate immunity improves with experience. ____ 4. Antigens are the body’s weapons against disease. ____ 5. Lymph nodes contain blood sinuses, and red and white pulp. ____ 6. All lymphocytes are part of adaptive immunity. ____ 7. Macrophages are part of innate immunity. ____ 8. Memory B cells remember pathogens. ____ 9. An increase in cell number is called proliferation. ____10. The Human Immunodeficiency Virus (HIV) targets CD-2 cells. ____11. Natural immunity is acquired during vaccination. ____12. Macrophages ingest invaders. ____13. Autoimmune disorders are the opposite of immunodeficiency disorders. ____14. A hypersensitivity reaction is also called an allergy. ____15. T lymphocytes are responsible for adaptive immunity known as antibody mediated immunity.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Describe why nodes are located near lungs, digestive, and reproductive organs. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Discuss how cancer is staged. _____________________________________ .

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_____________________________________ _____________________________________ _____________________________________ 3. How does self vs. non-self recognition affect the immune system? _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Compare and contrast innate vs. adaptive immunity. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Explain why HIV causes severe immune deficiency by attacking one type of cell. _____________________________________ _____________________________________ _____________________________________ _____________________________________

CHAPTER 16 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. The digestive tract begins at the oral cavity and ends at the ________. a. Pharynx b. Colon c. Anus d. Appendix 2. Which of the following is a function of the oral cavity? a. Starch digestion b. Protein digestion c. Peristalsis d. Nutrient absorption 3. An abnormally formed ____________ will interfere with the development of clear speech. a. Molar b. Frenulum c. Vermiform d. Duodenum 4. The smallest of the salivary glands are the ________. a. Sublinguals b. Submandibulars c. Parotids d. Subbuccals .

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5. The ____________ teeth are blade shaped and used for cutting food. a. Incisor b. Canine c. Bicuspid d. Molar 6. The ____________ is used by both the digestive and respiratory systems. a. Epipharynx b. Oropharynx c. Nasopharynx d. Larynx 7. The esophagus differs from the rest of the alimentary tract in that it possesses no ________. a. Adventitia b. Muscularis c. Mucosa d. Serosa 8. The stomach has four regions, the area that connects with the small intestine is called the a. Fundus b. Body c. Pylorus d. Cardiac region 9. The stomach releases the hormone ____________ to aid in digestion. a. Pepsin b. HCL c. Secretin d. Gastrin 10. What is the last section of the small intestine, before it empties into the large intestine, called? a. Duodenum b. Stomach c. Jejunum d. Ileum 11. Which hormone is responsible for inhibiting the release of gastric juice? a. SIP b. Pepsin c. CCK d. Gastrin 12. This organ has an extra layer of muscle ________. a. Stomach b. Colon c. Liver d. Spleen

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13. The appendix is attached at which area? a. Colon b. Anus c. Cecum d. Rectum 14. Which organ is responsible for the production of bile? a. Liver b. Stomach c. Small intestine d. Large intestine 15. Hepatocytes receive blood from both the hepatic artery and the _______________ a. Hepatic vein b. Hepatic portal vein c. Hepatic portal artery d. Hepatic capillaries 16. The ________ is the base, or floor of the mouth. a. Tongue b. Soft palate c. Labia d. Hard palate 17. The structure responsible for the absorption of excess water is the ________. a. Stomach b. Large intestine c. Liver d. Spleen 18. Enzymes are necessary for digestion; ________ is produced to break down fats. a. Nuclease b. Lipase c. Carbohydrase d. Maltase 19. The type of hernia where the stomach protrudes through the diaphragm and into the thoracic cavity is ________. a. Hiatal b. Hepatic c. Cholecystic d. Celiac 20. Pancreatitis can be caused by all but one of the following? a. Gallbladder disease b. Excessive pancreatic enzyme activation c. Lithotripsy d. Excessive alcohol consumption 21. Which of these is not one of the causes of dental caries? a. Carbohydrate-rich diet b. LDL c. Poor dental hygiene .

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d. Lack of regular dental visits 22. Lactose intolerant patients cannot digest the ________ in milk. a. Protein b. Sugar c. Fat d. Cholesterol 23. Hepatitis can be caused by any of the following except ________. a. The common cold b. An infectious agent c. A toxin d. Shared needles 24. A colostomy may be the appropriate treatment for ________. a. Hyperactive peristalsis b. Allowing healing after surgery c. Chronic constipation d. None of the above 25. ________ is a form of chronic inflammatory bowel disease. a. Gastroenteritis b. Irritable bowel syndrome c. Crohn’s disease d. Peritonitis 26. ________ is caused by a viral and/or bacterial infection and/or inflammation of the stomach and small intestine. a. Gastroenteritis b. Peritonitis c. Irritable bowel syndrome d. Crohn’s disease 27. Polyposis is a small tumor with a pedicle in the mucous membrane of the ________. a. Stomach b. Small intestine c. Duodenum d. Colon 28. The punching bag-shaped structure hanging down from the soft palate is called the ________. a. Frenulum b. Papillae c. Uvula d. Palatine tonsil 29. This type of tooth is responsible for crushing and grinding. a. Incisor b. Canine c. Premolar d. Molar

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30. This substance is the outer covering of the shell of the tooth in the crown. a. Cementum b. Enamel c. Dentin d. Pulp 31. Most of the interior of the tooth is made of this substance. a. Cementum b. Enamel c. Dentin d. Gingiva 32. This condition is the cracking and associated inflammation found on the lips and corners of the mouth are not caused by cancer, but rather can be traced to infections, allergies, or even to nutritional deficiency. a. Periodontitis b. Dental caries c. Gingivitis d. Cheilitis 33. Which of the following is not a salivary gland? a. Sublingual gland b. Submandibular gland c. Submaxillary gland d. Parotid gland 34. This enzyme is produced by the salivary glands and begins the chemical digestion of carbohydrates ________. a. Salivary amylase b. Salivary maltase c. Salivary sucrase d. Salivary lactase 35. The order of the segments of the small intestine from the stomach to the large intestine is which of the following? a. Ileum, jejunum, duodenum b. Duodenum, ileum, jejunum c. Jejunum, duodenum, ileum d. Duodenum, jejunum, ileum 36. This structure increases the surface area of the lining of the small intestine ________. a. Peptase b. Lacteals c. Villi d. Chyle 37. Pancreatic juice contains enzymes that help digest ________. a. Carbohydrates b. Fats c. Proteins d. All of the above .

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38. The order in which material passes through the large intestine is ________. a. Descending colon, transverse colon, ascending colon, cecum b. Ascending colon, cecum, transverse colon, descending colon c. Cecum, descending colon, transverse colon, ascending colon d. Cecum, ascending colon, transverse colon, descending colon 39. The process of carbohydrate digestion begins in the ________. a. Mouth b. Stomach c. Small intestine d. Large intestine 40. Which of the following is the end product of protein digestion? a. Fatty acids b. Glycerol c. Simple sugars d. Amino acids 41. Protein digestion begins in the ________. a. Mouth b. Stomach c. Small intestine d. Large intestine 42. Which of the following is the end product of fat digestion? a. Amino acids b. Glycerol c. Simple sugars d. Both a and b 43. An acute or chronic inflammation of the stomach is called ________. a. Colitis b. Stomatitis c. Gastritis d. Gastric ulcer 44. A ________ is an ulcer occurring in the lower portion of the esophagus, stomach, and duodenum caused by the breakdown of the mucosal membrane by the acid of gastric juices and pepsin. a. Duodenal ulcer b. Stomatitis c. Gastritis d. Peptic ulcer 45. ________ is/are varicose veins of the rectum. a. Rectitis b. Hemorrhoids c. Colostomy d. None of the above

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46. A hernia or out-pouching of intestines into the inguinal region of the body is called a(n) ________ a. Diaphragmatic hernia b. Umbilical hernia c. Inguinal hernia d. Hiatal hernia 47. ________ is inadequate absorption of nutrients from the intestinal tract. It is caused by a variety of diseases and disorders of the pancreas and gallbladder. a. Cystic fibrosis b. Malabsorption syndrome c. Pancreatitis d. Hepatitis 48. ________ is an infectious or inflammatory process of the peritoneum. a. Colitis b. Hepatitis c. Pancreatitis d. Peritonitis 49. ________ are small growths that contain a pedicle or foot-like attachment in the mucous membranes of the large colon. a. Diverticulitis b. Ulcerative colitis c. Polyps d. Inflammatory bowel disease Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The gastrointestinal system takes in, or ____________, raw materials.

2. The gastrointestinal system breaks down, or ____________, materials.

3. Another name for the digestive tract is the ____________ tract.

4. During swallowing, the _______________ prevents food from entering the nasal cavity.

5. The action of chewing is known as ____________.

6. Materials are eliminated from the digestive tract by ____________.

7. The small intestine has projections on the surface of its epithelial cells known as ______________ which increase surface area.

8. Internally, the teeth are made of ____________.

9. The ____________ is a flap of tissue that covers the airway to the lungs.

10. Deciduous teeth are commonly called ____________ teeth, because they fall out.

11. The rhythmic, muscular contraction of the digestive system is known as ____________.

12. Partially digested food is known as ____________.

13. The chief digestive enzyme in the stomach is ____________.

14. The _____________________ phase of gastric activity begins when you see or smell food.

15. The peritoneum has drapes of membrane known as ____________________. .

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16. The digestive tract begins in the mouth and ends at the ________.

17. Inflammation of the appendix is called ________.

18. ________ is the muscle action that mixes chyme with digestive juices.

19. The condition of stones in the gallbladder is ________.

20. The esophagus does not have a mucus barrier to protect it. Chronic acid ________ causes inflammation and then ulceration, and if left untreated, can progress to esophageal cancer.

21. A gallstone can lodge in the bile ________, causing extreme pain that may radiate to the right shoulder (an example of referred pain).

22. Excessive consumption of alcohol can cause ________.

23. Periodontal disease is the major cause of tooth loss in ________.

24. When fluids in the small intestine are rushed through the large intestine before the water is adequately re-absorbed, ________ is the result.

25. Heartburn occurs when the lower esophageal sphincter doesn’t close properly, allowing gastric juices back into the ________.

26. Stomach ulcers are likely due to defective gastric mucosa or a weak pyloric ________.

27. Stones can form from substances in the bile while it is stored in the gallbladder. This condition is called ________.

28. ________, also known as dental cavities, is the gradual decay of teeth that can result in inflamed tissue.

29. The tongue pushes the food into a ball-like mass called a ________ so it can be passed on to the pharynx.

30. A large ________ salivary gland is found slightly inferior and anterior to each ear.

These are the ones that swell up and make you look like a chipmunk when you get the mumps.

31. The first set of teeth are called ________ teeth, and they fall out in time.

32. ________ is an acute or chronic inflammation of the stomach due to infection, spicy foods, excess acid production, stress, alcohol, aspirin consumption, or heavy smoking.

33. The nasopharynx is blocked by the soft palate, and a flap of tissue called the ________, a part of the larynx, covers the airway to the lungs as the trachea rises during swallowing.

34. Dental ________ are a result of microorganisms attacking tooth enamel.

35. ________ disease is the major cause of tooth loss in the adult population.

36. ________ is the term for a loss of appetite.

37. ________ is the inflammation of the gallbladder.

38. ________ is the formation of stones or calculi in the gallbladder or common bile duct.

39. ________ is a chronic inflammatory disease of the liver, leading to irreversible scarring and destruction of active liver tissue.

40. ________ disease is a form of chronic inflammatory bowel disease affecting the ileum and/or colon.

41. ________ reflux disease is the erosion of the esophageal lining due to acid reflux, often due to a weakened lower esophageal sphincter. .

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42. ________ is the inflammation of the gums that may lead to tooth loss.

43. ________ is the discharge of purulent material from dental tissue.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. The oral cavity is lined with stratified squamous epithelium. ____ 2. Canine teeth are transitional teeth. ____ 3. The hardest biologically manufactured substance is enamel. ____ 4. The oropharynx is lined with respiratory mucosa. ____ 5. The stomach can increase its diameter because of rugae. ____ 6. Directly after leaving the stomach, materials go to the jejunum. ____ 7. Pepsin is one of very few enzymes which are active at very low pH. ____ 8. The final door of the stomach that needs to open for chyme to travel to the small intestine is the fundus. ____ 9. The descending colon is the first part of the large intestine. ____10. The liver stores Vitamins A, B12, K, and C. ____11. The pH of chyme is usually 7.5-8.8. ____12. Cholelithiasis means high cholesterol. ____13. Cirrhosis A, B, C, D, and E are viruses that damage the liver. ____14. Salivary amylase digests proteins. ____15. Gastrin is released when chyme enters the duodenum.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. List the organs of the alimentary canal in order from mouth to anus. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Explain the hormonal control of digestion. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Define and describe GERD. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Discuss the function of each of the parts of the alimentary canal. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Describe the anatomy of the peritoneum. How is peritoneum different from other serous membranes? .

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_____________________________________ _____________________________________ _____________________________________ CHAPTER 17 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Without functioning kidneys, fluid and ion ___________ would kill you in a matter of days. a. Imbalance b. Equilibrium c. Reactions d. Impurities 2. The kidneys are covered by a layer of connective tissue called the ________. a. Renal pelvis b. Renal sinus c. Renal capsule d. Renal hilum 3. What are the vessels that lead to the glomeruli? a. Arcuate arteries b. Afferent arterioles c. Efferent arterioles d. Renal arterioles 4. Blood leaves the kidney through the ________. a. Efferent arterioles b. Hepatic vein c. Renal nephron d. Renal vein 5. Glomerular filtrate is chemically most similar to ________. a. Urine b. Plasma c. Lymph d. Cytoplasm 6. The first section of the nephron loop glomerular filtrate encounters is the ________. a. Ascending loop b. Distal tubule c. Descending loop d. Proximal tubule 7. What is the most common cause of prolonged vasoconstriction in the kidney? a. Increased blood pressure b. Decreased blood pressure c. Antidiuretic hormone d. Diabetes mellitus 8. What are the three processes necessary for the formation of urine? a. Intake, concentration, and output b. Chemical, muscular, and neural action .

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c. Filtration, reabsorption, and secretion d. Arterioles, nephrons, and venules 9. If blood pressure drops below normal range, what should happen to glomerular filtration rate, to compensate? a. It should decrease b. It should increase c. It should stay the same d. It depends on the situation 10. ____________ is the mechanism used to protect the glomerulus from minor changes in blood pressure. a. Filtration b. Saturation c. Autoregulation d. Selection 11. Anything that will affect reabsorption and secretion in the kidney will affect urine ________. a. Chemistry b. Flow c. Accumulation d. Filtration 12. Hormones that regulate blood pressure also affect a. Number of nephrons b. Permeability of glomerular capsule c. Reabsorption and secretion d. Ureters and urethra 13. Which steroid is secreted by the adrenal cortex to increase reabsorption of sodium ions? a. Antidiuretic hormone b. Aldosterone c. Adrenalin d. Angiotensin 14. New research has shown that urination is actually controlled by the ________. a. Kidney b. Bladder c. Pons d. Ureters 15. Urinary tract infections are often caused by ____________ bacteria in the urinary tract. a. Symbiotic b. Fecal c. Abdominal d. Intestinal 16. Bowman’s capsule, the renal membrane that surrounds the glomerulus, is also called the ________. a. Renal corpuscle .

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b. Glomerular capsule c. Renal tubule d. Glomerular filtrate 17. Substances are moved through a filter by differences in ________ across the filter. a. Pressure b. Openings c. Tubules d. Vessels 18. Which part of the renal tubular system reabsorbs or secretes the most substances? a. Distal Tubule b. Collecting duct c. Proximal Tubule d. Descending loop 19. Substances that are reabsorbed or secreted in the ascending loop include ________. a. Sodium b. Potassium c. Chloride d. All of the above 20. The patient with diabetes insipidus will have copious amounts of ________ urine. a. Toxic b. Concentrated c. Cloudy d. Dilute 21. One of the most important risk factors for kidney disease is ________. a. Hypertension b. ACE inhibitors c. Hypotension d. Vasodilation 22. Kidney stones can be caused by any of the following except ________. a. Kidney infection b. Calcium c. Uric acid d. Potassium 23. The only cure for end-stage renal disease is ________. a. Peritoneal dialysis b. Lithotripsy c. Blood transfusion d. Kidney transplant 24. Ischemia of the kidneys (as well as any other organ) is tissue injury from too little ________ to the tissues. a. Hormones b. Oxygen c. Glucose d. Water .

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25. Which of the following is not a function of the urinary system? a. Removing waste products from the blood b. Maintaining the proper electrolyte balance in the blood c. Maintaining the proper pH level of the blood d. All of the above are functions of the urinary system 26. Which of the following statements is untrue of the kidneys? a. The right kidney is slightly higher than the left kidney. b. The kidneys are outside the peritoneal cavity. c. The kidneys are surrounded by a layer of fat. d. The kidneys are effected by blood pressure.

27. The outermost layer of the kidney is called the ________. a. Renal pelvis b. Renal medulla c. Renal cortex d. Calyx 28. The innermost layer of the kidney is called the ________. a. Renal pelvis b. Renal medulla c. Renal cortex d. Calyx 29. Which of the following parts of the kidney is actually an expansion of the upper end of the ureter? a. Renal pelvis b. Renal medulla c. Renal cortex d. Calyx 30. Which of the following is considered the first segment of the renal tubules? a. Glomerulus b. Proximal convoluted tubule c. Distal convoluted tubule d. Collecting tubule 31. Which of the following structures drains into the collecting ducts? a. Glomerulus b. Proximal convoluted tubule c. Distal convoluted tubule d. Loop of Henle 32. Even though this structure is part of the circulatory system, it is included in the discussion of the urinary system ________. a. Glomerulus b. Proximal convoluted tubule c. Renal pelvis d. Loop of Henle

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33. The juxtaglomerular apparatus of the kidneys release a hormone ________. a. Called antidiuretic hormone b. That dilates blood vessels c. That causes vasoconstriction d. That increases the absorption of chloride from the filtrate 34. The process by which most of the material in the nephron moves back into the blood is called ________. a. Filtration b. Reabsorption c. Secretion d. Micturition 35. This hormone would tend to decrease the amount of urine produced. a. Antidiuretic hormone b. Aldosterone c. Atrial natriuretic hormone d. Both a and b 36. This hormone would tend to increase the amount of urine produced ________. a. Antidiuretic hormone b. Aldosterone c. Atrial natriuretic hormone d. Both a and b 37. The tube that carries urine out of the kidney is called the ________. a. Urethra b. Collecting tube c. Ureter d. Bladder 38. The tube that carries the urine out of the body is called the ________. a. Urethra b. Collecting tube c. Trigone d. Ureter 39. The process by which urine is passed out of the body is called ________. a. Urination b. Voiding c. Mastication d. Both a & b 40. Severe pain, hematuria, fever, chills, nausea, and urinary urgency are symptoms of ________. a. Kidney stones b. Polycystic kidney disease c. Ischemic nephropathy d. Diabetic nephropathy

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41. Enlarged cystic kidneys, hypertension, UTI, dilute urine, liver cysts, pain, hematuria, and aneurysm are symptoms of ________. a. Kidney stones b. Polycystic kidney disease c. Ischemic nephropathy d. Diabetic nephropathy 42. This condition is caused by chronic hyperglycemia ________: a. Kidney stones b. Polycystic kidney disease c. Ischemic nephropathy d. Diabetic nephropathy 43. Copious, dilute urine is a symptom of ________. a. Uremia b. Renal failure c. Diabetes insipidus d. Urinary tract infection 44. Painful urination, urinary frequency, nighttime urination, and foul smelling, cloudy urine are symptoms of ________. a. Uremia b. Renal failure c. Diabetes insipidus d. Urinary tract infection 45. Frequent urination without pain or infection is a symptom of ________. a. An overactive bladder b. Hemolytic uremic syndrome c. Urinary tract infection d. Uremia 46. High blood pressure is a common disease that can affect the kidneys. One way of treating high blood pressure is to decrease blood volume by decreasing body water.

This can be accomplished by using what kind of drug? a. Blood thinners b. ACE stimulators c. Diuretics d. Dopamine 47. Urine leaves the kidneys through the ________. a. Urethra b. Ureters c. Bladder d. None of the above 48. Urine leaves the bladder through the ________. a. Urethra b. Ureters c. Kidneys d. None of the above .

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Short Answer Write the word or phrase that best completes each statement or answers the question.

1. The ____________ carries urine from each kidney to the urinary bladder.

2. The space inside the kidney is called the renal ____________.

3. The collecting ducts empty into _________________.

4. Blood enters the renal corpuscle via the ____________.

5. There are no __________________ veins in the kidney.

6. The ________________are striped areas of the renal medulla.

7. All of the ___________________ in glomerular filtrate is typically reabsorbed and won’t be in urine.

8. Long term use of non-steroidal anti-inflammatory drugs causes ____________ nephropathy.

9. ____________ is an endocrine disorder characterized by too little anti-diuretic hormone or the insensitivity of the kidney to ADH. 10. The ____________ is the functional unit of the kidney.

11. The ___________ ___________ ___________ system is a series of chemical reactions that regulate blood pressure.

12. ____________ means to crush stones.

13. The ascending nephron loop is permeable only to _________________.

14. Sympathetic output causes _________________ glomerular filtration.

15. PKD stands for ____________ disease.

16. ________ moves fluid and chemicals into the nephron.

17. ________ is the movement of molecules from high to low concentrations.

18. ________ is the movement of water across a semipermeable membrane.

19. Blood flows to the glomerulus via the ________ arteriole.

20. Blood flows from the glomerulus into the ________ arteriole.

21. In both glomerulosclerosis and glomerulonephritis, there is decreased waste product removal and the electrolyte ________ is abnormal.

22. An infection with the bacteria E. Coli , usually from eating undercooked ________, can cause hemolytic uremic syndrome.

23. Renal failure is also known as ________ disease, kidney disease, or kidney failure.

24. When blood flow to the nephrons decreases for a period of time, the oxygen being delivered to the nephron also decreases leading to tissue injury. This injury is classified as ________.

25. Nephropathy is a term for kidney disease especially when there is damage to the nephron’s ________ apparatus.

26. There is no cure for PKD except kidney ________.

27. It is not uncommon for trauma patients to ________ a trauma only to sustain organ damage due to ischemia.

28. The glomerulus is protected from minor changes in blood pressure by a mechanism called ________.

29. ________ is a general term for kidney disease particularly damage to the filtering apparatus of the nephrons. .

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30. The second factor that affects tubular reabsorption and secretion is a special type of circulation around the nephron loop, called ________ circulation.

31. ________(ADH) is made by the hypothalamus and secreted from the posterior pituitary when blood pressure decreases or blood ionic concentration increases.

32. ________ is inflammation of the glomerulus.

33. ________ is a common condition with symptoms of urinary urgency, nighttime urination, and urinary frequency with or without incontinence, but without pain or obvious urinary pathology such as hematuria or UTI. 34. The indentation that gives the kidney its bean-shaped appearance is called the ________.

35. Each afferent arteriole leads to a ball of capillaries called a ________.

36. Renal pyramids are separated by narrow ________, which are extensions of the cortical tissue.

37. Kidney stones are caused by increased urine concentration, infection, and kidney disease. They can be made of ________ and uric acid crystals.

38. ________ kidney disease is a genetic disorder that causes large cysts to form in the kidney.

39. ________ nephropathy is caused by decreased blood flow to the kidneys.

40. Diabetic ________ is a type of kidney disease caused by diabetes mellitus.

41. Drug-induced ________ is a type of kidney disease caused by drugs toxic to kidney tissue, especially contrast dyes and NSAIDs. 42. ________ is scarring of the glomerulus.

43. ________ is a blood condition that accompanies kidney disease and appears to be due to the accumulation of organic wastes in the blood stream.

44. ________ uremic syndrome is a disorder caused by an infection with the bacteria E. Coli , typically from undercooked meat.

45. Acute renal failure is a rapid decrease in kidney function, as measured by blood urea and ________ levels, that develops over minutes or days.

46. ________ renal failure is defined as an ongoing, progressive kidney disease of three months or more.

47. ________ is the inability to control urination.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Medulla means inner portion. ____ 2. The functional unit of the kidney is the neuron. ____ 3. More than 40 gallons of blood are filtered every 24 hours. ____ 4. Filtration is controlled by changing pressure. ____ 5. A sphincter controls the release of urine. ____ 6. The ureter is the tubing that transports urine from the bladder to the outside of the body. ____ 7. Diabetes mellitus is caused by production of too little insulin or by insensitivity to insulin. ____ 8. The visceral layer of the glomerular capsule is made of specialized cells called podocytes. .

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____ 9. The urge to urinate is caused by skeletal muscle contraction. ____10. Antidiuretic hormone is secreted by the kidneys. ____11. Aldosterone is a steroid. ____12. Water is reabsorbed in the descending loop. ____13. Caffeine promotes the working of antidiuretic hormone. ____14. Atrial natriuretic peptide has the opposite affect of ADH ____15. The urinary bladder serves as a reservoir for urine.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Explain how blood loss affects the kidney. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. List and explain three hormones which can regulate kidney function. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Describe how filtration is regulated. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain how diabetes mellitus affects the kidneys. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. Describe how kidney stones are caused. _____________________________________ _____________________________________ _____________________________________ _____________________________________

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CHAPTER 18 Multiple Choice Choose the one alternative that best completesthe statement or answers the question.

1. Which pair of chromosomes would result in the birth of a male? a. XX b. XY c. YY d. XZ 2. In the human life cycle, the fertilized egg is called a ________. a. Zygote b. Gonad c. Embryo d. Fetus 3. Which of the following is an example of primary genitalia in a female? a. Oviducts b. Vagina c. Ovaries d. Testes 4. The outermost layer of the uterus is called the ________. a. Perimetrium b. Myometrium c. Endometrium d. Exometrium 5. The glands that are responsible for the production of milk are called the ________. a. Skenes glands b. Mammary glands c. Lacteal glands d. Myometrial glands 6. What are the primary genitalia in a male? a. Epididymis b. Ureter c. Seminal vesicles d. Testes 7. Menstruation is the term given to the actual shedding of the ________. a. Perimetrium b. Myometriun c. Endometrium d. Exometrium 8. The release of a mature egg from the ovary is called ________. a. Ovulation b. Fertilization c. Menses d. Menopause

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9. How many chromosomes will you find in a successfully fertilized egg? a. 21 pairs b. 46 pairs c. 23 pairs d. 16 pairs 10. Of the hormones necessary for menstruation, which one comes from the ovary? a. Follicle stimulating hormone b. Estrogen c. Luteinizing hormone d. Testosterone 11. In utero, the fetus is nourished by the ________. a. Umbilical cord b. Amniotic fluid c. Placenta d. Amnion 12. Labor is divided into stages; in which stage will the baby actually be delivered? a. 1st b. 2nd c. 3rd d. 4th 13. Sperm mature in the ________. a. Seminal Vesicles b. Epididymis c. Testes d. Seminiferous tubles 14. Prior to puberty, testosterone _______________ FSH and LH. a. Inhibits b. Releases c. Has no effect on d. Catalyzes 15. The movement of semen out of the penis is known as ________. a. Erection b. Arousal c. Ejaculation d. Semen ejection 16. Females have all the eggs they will ever have by the age of ________. a. 4 months in utero b. 8 months c. Puberty d. 13 years 17. Breast cancer occurs in the ________ glands. a. Genital b. Mammary c. Vulvar d. Endocrine .

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18. The reproductive cells are called ________. a. Ova b. Sperm c. Gametes d. All of the above 19. This coiled tube is a comma-shaped structure that lies along the top of and behind the testis ________. a. Seminiferous tubule b. Ductus deferens c. Ejaculatory duct d. Epididymis 20. The gonads include ________. a. The ova in the female and sperm in the male b. The penis in the male and the vulva in the female c. The testes in the male and the ovaries in the female d. Both a and c are gonads 21. After ovulation, the ruptured follicle is transformed into the hormone-secreting structure called the ________. a. Corpus luteum b. Antrum c. Graafian follicle d. Granulose cells 22. Which of the following is not a function of estrogen? a. Development and maturation of the female reproductive organs b. Initiation of the first menstrual cycle c. Appearance of pubic hair and breast development d. All of the above are functions of estrogen 23. The smooth muscle layer of the uterus is called the ________. a. Endometrium b. Fundus c. Cervix d. Myometrium 24. The part of the uterus that lies above the point where the uterine tubes attach is called the ________. a. Body b. Cervix c. Fundus d. Myometrium 25. The narrow, lower part of the uterus is called the ________. a. Body b. Cervix c. Fundus d. Myometrium .

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26. Which of the following is not true of the vagina? a. It is part of the female external genitalia. b. It receives sperm during intercourse. c. It is the last part of the birth canal. d. All of the above are true of the vagina.

27. The phase of the menstrual cycle that directly precedes ovulation is called ________. a. The secretory phase b. The proliferative phase c. Menses d. Menarche 28. Which of the following is the hormone most responsible for stimulating immature ovarian follicles to start growing? a. Estrogen b. Progesterone c. Follicle-stimulating hormone d. Luteinizing hormone 29. Which of the following is the hormone most responsible for ovulation? a. Estrogen b. Progesterone c. Follicle-stimulating hormone d. Luteinizing hormone 30. The absence of normal menstruation is called ________. a. Dysmenorrhea b. Amenorrhea c. Dysfunctional uterine bleeding d. Endometriosis 31. Failure of the testes to descend into the scrotal sac is called ________. a. Hydrocele b. Cryptorchidism c. Prostatitis d. None of the above 32. An abnormal collection of fluid within the testes is called ________. a. Hydrocele b. Cryptorchidism c. Prostatitis d. None of the above 33. This blood test is for prostate cancer ________. a. PAP b. SAP c. PSA d. ASP

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34. This type of cancer is the most common nonskin form of cancer that affects American men ________. a. Testicular cancer b. Breast cancer c. Melanoma d. Prostate cancer 35. This disorder increases with age and is relatively common, with 50% of men between the ages of 40 and 70 having some degree of this disorder ________. a. Erectile dysfunction b. Incontinence c. Prostatitis d. Melanoma 36. A baby born before 37 weeks gestation is considered ________. a. Full-term b. Late c. Premature d. None of the above 37. One of the most important procedures to detect breast cancer at an early, more treatable stage is regular ________. a. Pap tests b. Breast self-examinations c. Testicular self-examinations d. None of the above 38. Signs and symptoms of PMS include all of the following except ________. a. Constipation b. Fatigue c. Mental confusion d. Feeling of euphoria 39. Signs and symptoms of breast cancer include which of the following? a. Bloody, brown or serous nipple discharge b. Noticeable lump c. Changes in breast tissue d. All of the above 40. Signs and symptoms of postpartum depression include ________. a. Fatigue b. Anxiety c. Feeling of worthlessness d. All of the above 41. A procedure in which the amniotic sac is punctured and fluid is withdrawn is called a(n) ________. a. Amniocentesis b. Abdominocentesis c. Thoracentesis d. None of the above .

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42. This syndrome is a genetic disorder that can result in a broad range of malfunctions of the male reproductive system, from complete lack of external or internal male genitalia to patients with ambiguous genitalia to patients who have typical male genitalia but are sterile. a. Testosterone deficiency b. Androgen insensitivity syndrome c. BPH d. ED Short Answer Write the word or phrase that best completes each statement or answers the question.

1. In animals, females produce eggs and males produce ____________.

2. ________________ stimulates ovulation.

3. After ovulation, estrogen _______________ GnRH secretion.

4. During the _____________ phase, the endometirum is building up.

5. Reproductive organs are called ____________.

6. Another name for oviducts is ____________ tubes.

7. The ruptured follicle left behind in the ovary during ovulation will become the ____________ and secrete hormones to help maintain the thickened endometrium.

8. The ____________ gland surrounds the urethra.

9. ____________ is the most important male hormone.

10. The ____________________ are posterior to the bladder in males.

11. ______________ is a mixture of sperm, sugar, water and electrolytes.

12. The final stage of labor is the _____________ stage.

13. The developing embryo secretes the hormone _______________ telling the woman’s body that she is pregnant.

14. The implantation of endometrial tissue outside of the uterus is called _______________.

15. The most common cause of male urinary symptoms is __________________________.

16. Patients with Down syndrome have an extra copy of chromosome ________.

17. The female gonads are the ________.

18. The fertilized egg is known as the ________.

19. The breasts are also known as ________ glands.

20. A ________ is an abnormal collection of fluid in the testes.

21. Down Syndrome patients have a wide range of ________ abilities.

22. A common blood test called prostate-specific antigen, (PSA) can help detect ________ cancer.

23. Erectile dysfunction medications such as Viagra and Levitra increase the likelihood of erection by increasing ________ accumulation in the erectile tissue.

24. Women have some natural ________ hormone, and males have some natural estrogen hormone.

25. The possibility of having a baby with Down Syndrome increases dramatically in females over ________ years of age. .

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26. Prostate cancer is the most common cancer (of non-skin cancers) affecting ________ in this country.

27. When menstrual disorders lessen a woman’s quality of life, they may be diagnosed with ________.

28. Treatment of erectile dysfunction depends on the ________ cause.

29. Vaginitis is the inflammation of the vagina, usually caused by microorganisms such as bacteria or ________.

30. There is a testes-blood barrier to prevent the ________ system from destroying sperm, which the white blood cells would recognize as invaders.

31. ________ is the expulsion of semen (sperm and assorted chemicals) from the urethra.

32. Following birth, the baby is often fed with breast milk. One of the complications is ________ which is an inflammation of the breast.

33. When cells make identical copies of themselves without the involvement of another cell, the process is called ________.

34. The external female genitalia are known as the ________.

35. The uterine tubes, which are about 4 inches long and not attached to the ovaries, begin as a large funnel, the infundibulum, surrounded by ciliated projections, the ________.

36. The process of sorting the chromosomes so that each new cell gets the right number of copies of all of the genetic material is called ________.

37. The ________ layer of the uterus sheds about every 28 days when a woman has her period.

38. ________ is the continued proliferation, decay and bleeding of endometrial tissue in the abdominal and pelvic cavities that can cause scarring and damage to the organs.

39. The ________ is the area between the vagina and the rectum.

40. The ________ glands are milk production glands housed in the breasts.

41. ________ is the absence of menstruation.

42. ________ is painful menstruation.

43. The exact cause of PMS is not determined but may be due to irregular levels of estrogen or ___________ 44. Signs and symptoms of ________ include hematuria, dysuria, painful intercourse, and excessive menstrual bleeding.

45. ________ cancer is the most common malignancy among women and the leading cause of death between ages 40–55.

46. ________ cancer may have a genetic predisposition, and current research shows a connection with the HPV and early and frequent sexual activity.

47. ________ is an inflammation of the vagina caused by infection, irritation, or menopause.

48. ________ is a condition in which the placenta separates from the uterus.

49. ________ pregnancy is also known as a tubal pregnancy.

50. Benign prostatic ________ is the non-cancerous enlargement of the prostate and is the most common cause of lower urinary tract symptoms in men.

True/False .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Just before ovulation, estrogen levels drop. ____ 2. Normally, an adult human has 23 chromosomes. ____ 3. GnRH is released by the pituitary gland. ____ 4. The union of genetic material is called fertilization. ____ 5. The external genitalia of the female are known as the uvula. ____ 6. HCG is secreted by the ovary. ____ 7. The functional layer of endometrium is shed when a woman has her period. ____ 8. The prepuce is a small erectile structure in women. ____ 9. The epididymis is superior to the testis. ____10. LH and FSH stimulate sperm production and maturation. ____11. Erection is caused by muscle contraction in the penis. ____12. The spermatic cord consists of the seminal vesicles and seminiferous tubules. ____13. The testes are outside of the abdominopelvic cavity. ____14. The female reproductive system is hospitable to sperm. ____15. An egg may be fertilized by more than one sperm.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Trace the path of a sperm during ejaculation. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Discuss endometriosis. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. List and briefly explain the function of hormones controlling female reproduction. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. Explain the role of testosterone in male reproduction. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. List the phases of the female reproductive cycle and briefly define them. _____________________________________ _____________________________________ _____________________________________ _____________________________________ .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CHAPTER 19 Multiple Choice Choose the one alternative that best completes the statement or answers the question.

1. Forensic science is the application of science to ________. a. Medicine b. Biology c. Crime d. History 2. What part of long bones contain high levels of oxygen? a. Medulla b. Ends c. Shaft d. Marrow 3. What common food reacts with pewter and was once thought to be poisonous? a. Tomatoes b. Apples c. Figs d. Bananas 4. The male and female skeleton differ in what manner? a. Females have a wider pelvis b. Males have a wider pelvis c. Females have fewer rib bones d. Males have more rib bones 5. A timeline containing substances someone ingests, or becomes exposed to, can be found in the ________. a. Hair b. Bones c. Teeth d. Eyes 6. Fingerprints were first suggested to be an aid in solving various crimes in ________. a. 1910 b. 1782 c. 1604 d. 1880 7. DNA fingerprinting is performed in which manner? a. Blotting digits on paper b. Splitting DNA molecules c. Dusting the scene with powder d. Dusting cells for very small prints 8. Patients between the ages of 76 and 84 are classified as ________. a. Elite old b. Younger old c. Older old d. Beginning old .

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9. The hallmark sign of aging is the body’s decreased ability to ________. a. Adapt to stressors b. Maintain homeostasis c. Maintain hair color d. Maintain skin elasticity 10. What is a common food that may taste metallic to the geriatric patient? a. Tomato juice b. Orange juice c. Apple juice d. Grape juice 11. What are some of the potential behavior changes related to pain? a. Euphoria b. Increased mobility c. Increased energy d. Agitation and confusion 12. A healthy human brain will continue to develop until the approximate age of ________. a. 50 b. 60 c. 25 d. 35 13. A decrease in the function of the ____________ can lead to accumulation of medication in the geriatric patient. a. Kidneys b. Heart c. Lungs d. Vessels 14. Seeing multiple doctors at the same time can lead to ________. a. Loss of insurance b. Carcinoma c. Polypharmacy d. Increased agitation 15. Carpal tunnel syndrome is a result of damage to the ____________ nerve. a. Carpal b. Lateral c. Median d. Radial 16. Disease processes, along with aging, will ________ the loss of body reserves affecting recovery after surgery. a. Accelerate b. Decrease c. Slow d. Diminish

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17. The elderly are increasingly more difficult to medically evaluate due to the three major changes in the patients. Which of the following is not one of them? a. Worsening vision b. Decreased hearing c. Increased memory d. Possible mental abilities 18. Which lifestyle choice adversely affects the cardiovascular system, as well as other systems? a. Illegal drug use b. Smoking c. Drinking alcohol d. All of the above 19. The best way to protect yourself and others from spreading or getting infections is to ________. a. Wear gloves for every patient encounter b. Wash hands before and after each patient c. Take large doses of vitamin C d. Wear a lab coat over your clothes or uniform when with patients 20. If a fetus does not get enough calcium in the mother’s diet, the fetus ________. a. Gets it from converting other nutrients b. Breaks down his/her own bones that had developed so far c. Does not get enough calcium and may not develop properly because of the lack d. Gets it from the mother’s bones and teeth, weakening them 21. Which of these is not a common behavioral change due to pain? a. Being grumpy b. Swearing c. Having a loss of appetite d. Increased social interaction 22. Smoking mothers have a tendency toward ________. a. Babies of lower birth weights b. Premature births c. A higher rate of SIDS d. All of the above 23. For several hundred years it was believed that ________ were poisonous. a. Grapes b. Poppy seeds c. Tomatoes d. Watermelons 24. A skull fragment found in a 400-year-old trash dump at this settlement provided evidence that skull surgery had been performed on a patient ________. a. Mexico City, Mexico b. Cairo, Egypt c. Beijing, China d. Jamestown, Virginia .

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25. Currently, the geriatric patient group called the older old are identified as ________. a. Age 55 to 64 b. Age 65 to 75 c. Age 76 to 84 d. Age 85 and older 26. ________ can reveal the race of an individual. a. Hair b. Eyes c. Digestive organs d. Clothing 27. Bone density usually reaches its greatest peak around age ________. a. 35 b. 45 c. 55 d. 65 28. Interest in fingerprints has been around for a long period of time. Their uniqueness was discovered in the ________. a. 1200s b. 1500s c. 1600s d. 1800s 29. A technique called video skull–face superimposition was used to identify ________. a. Josef Mengele b. Tutankhamen, “King Tut” c. Both a and b d. None of the above 30. An older patient may lose up to ________ neurons a day. a. 100 b. 1,000 c. 10,000 d. 100,000 31. Proof that the ancient Egyptians were stricken with ________ was discovered by examining their skeletons. a. Tuberculosis b. Anthrax c. Cancer d. Parkinson’s disease 32. Often, geriatric patients are undermedicated for ________. a. Pain b. Hypertension c. Diabetes d. Osteoporosis

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33. One common occupational condition related to repetitive motion, such as typing on a keyboard, playing a piano, or hammering, is known as ________. a. Lock jaw b. Carpal tunnel syndrome c. Incontinence d. Osteoporosis 34. DNA fingerprinting techniques have been used to identify ________. a. Victims of the World Trade Center b. Thomas Jefferson’s children c. Josef Mengele d. All of the above 35. As an individual ages, he or she may lose which of the following? a. Muscle mass b. Neurons c. Bone density d. All of the above 36. The number of taste buds decreases by about ________ percent as the body ages. a. 20 b. 50 c. 30 d. 40 37. Which of the following is a barrier to proper nutrition? a. Tooth loss b. Difficulty swallowing c. Decreased saliva d. All of the above 38. Which of the following can be a trigger to make a cell cancerous? a. Genes b. Radiation c. Sunlight exposure d. All of the above 39. Between the ages of 20 and 80, we lose about ________ percent of our renal function. a. 25 b. 50 c. 40 d. 30 40. The aging process affects the integumentary system in all of the following ways except ______. a. Increased skin elasticity b. Increased skin delicacy c. Multiple skin lesions d. Increases in skin cancer

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41. Aging can affect the rates of drug ________. a. Absorption b. Metabolism c. Excretion d. All of the above 42. Approximately ________ percent of all lung cancers can be traced to smoking. a. 60 b. 70 c. 80 d. 90 43. Which of the following vitamins is needed for proper night vision and helps to resist infections? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D 44. Which of the following vitamins is needed to promote strong bones and teeth? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D 45. Which of the following vitamins is needed to promote healthy muscular growth? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D 46. Which of the following vitamins is needed to aid in absorption of iron? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D 47. Which of the following vitamins is needed for proper blood clotting? a. Vitamin K b. Vitamin C c. Vitamin E d. Vitamin D 48. Which of the following vitamins is needed to promote muscle growth, and may reduce the risk of Parkinson’s disease? a. Vitamin K b. Vitamin C c. Vitamin E d. Vitamin D

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Short Answer Write the word or phrase that best completes each statement or answers the question.

1. Tuberculosis is detectable in the lungs, brain, kidneys, and the ends of long ____________.

2. The female pelvis, in general, has a pubic angle of ____________ degrees or greater.

3. Since hair grows relatively slowly, it can contain a ____________ of substances that an individual ingested or was exposed to.

4. Forensic scientists can use the molecule found in the nucleus of our cells, ____________, to identify individuals.

5. The use of multiple medications by the elderly is known as ____________.

6. Integumentary problems can be reduced by not ____________ and limiting exposure to the ____________.

7. There is a ____________% decrease in the function of most body systems each year, beginning around the age of thirty.

8. In the absence of disease, the brain continues to mature up to the age of ____________.

9. Repetitive motion can lead to a condition called ____________.

10. Approximately 80% of all lung cancers can be traced to ____________.

11. ____________ is the most deadly form of skin cancer.

12. Vitamin ____________ is needed for proper blood clotting.

13. The human papilloma virus causes genital ____________.

14. The metal ____________ has been detected in the bones of medieval skeletons and can be traced to eating from pewter plates.

15. Whether skeletal remains are of a man or a woman can be determined by examining the ____________.

16. The hallmark sign of aging is the decreasing ability to maintain ________.

17. A drug taken by a patient with impaired renal function, such as an elderly person, may not be metabolized correctly by the kidneys. This may cause an ________ of the drug.

18. Carpal tunnel syndrome is a common occupational condition that is related to ________ movements.

19. Analgesics are stronger and last ________ in the elderly patients.

20. The lung’s initial response to an inhaled irritant is to ________ or restrict the airway and minimize the inhalation of more irritant, even though this makes breathing difficult.

21. Aging affects the rates of a drug’s absorption, its distribution through the body, the metabolism of the medication, and the ________ of the drug from the body.

22. Many triggers can make a cell cancerous, such as exposure to sunlight, radiation, and ________.

23. Cancer treatment often involves ________ as much of the cancer as possible, and then following up with radiation and/or chemotherapy to kill any cancer or cancer cells remaining in the body.

24. ________ is the treatment of cancer with chemicals that kill rapidly dividing cells.

25. ________ cause(s) cauliflower-like growths on the penis and vagina. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

26. ________, the administration of many drugs at the same time, is a major concern for the elderly.

27. Many types of cancer can be prevented or managed with a healthy diet and ________.

28. The congenital condition of ________ can be prevented by a dietary supplement of a member of the vitamin B complex, folic acid.

29. Fingerprints are actual ________ that form a pattern on the anterior surface of the hands and also on the plantar surface of the feet.

30. The ________ pelvis is more funnel shaped and is heavier and stronger, with a pubic angle of 90 degrees or less.

31. Bone scouring is the destruction of the smooth bone surface as a result of colonization by the tuberculosis ________.

32. During the aging process, there is a decrease in the total body water for both males and females. The clinical significance of this is that older patients have a tendency to ________ more rapidly.

33. The senses of taste and smell ________ as a natural process of aging.

34. Within the cardiovascular system, the aging process causes such changes as ________ of heart valves, which decreases their efficiency.

35. Within the cardiovascular system, we also see a lessening in the ________ of blood vessels, which leads to increased blood pressures.

36. There is an increase of ________, which is the loss of bladder control, in the elderly population.

37. ________ is the administration of many drugs at the same time.

38. Smoking affects the heart by reducing the availability of ________ to the heart muscle.

39. Smoking with alcohol consumption leads to a(n) ________ in stomach and mouth cancers.

40. ________ steroids are used to increase strength and endurance rapidly and to build muscle mass.

41. Smoking mothers tend to have babies of ________ birth weights, a tendency toward premature births, and a higher rate of sudden infant death syndrome (SIDS).

42. The sexually transmitted disease ________ has symptoms of fluid-filled vesicles on the penis and blisters in and around the vagina.

43. The sexually transmitted disease ________ has symptoms of purulent discharge from the urethra, dysuria, and urinary frequency in males; and purulent vaginal discharge, abnormal menstrual bleeding, and possible sterility in females.

44. The sexually transmitted disease ________ can be asymptomatic.

45. The sexually transmitted disease ________ is a systemic disease that can lead to lesions, lymph node enlargement, nervous system degradation, and chancre sores.

46. This sexually transmitted disease ________ creates cauliflower-like growths on the penis and vagina.

True/False Write ‘T’ if the statement is true and ‘F’ if the statement is false. ____ 1. Forensic science is the application of science to law. .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

____ 2. The infamous Nazi Mengele has never been found. ____ 3. Forensic DNA evidence is the only way to identify the sex of the victim. ____ 4. The race of the individual can be determined by examining their hair. ____ 5. In children is it nearly impossible to tell the sex of a skeleton. ____ 6. The most common cause of respiratory illness is genetic disorders. ____ 7. Identical twins will have the same fingerprints. ____ 8. Forensic science has conclusively proved that Thomas Jefferson did not father children with his slave, Sally Hemmings. ____ 9. From ages 20 to 70 we see a loss of lean body mass due to up to 30% loss in the number of muscle cells, atrophy of muscle cells, and a general decrease in muscle strength. ____10. As we age, our gustatory senses become stronger to compensate for hearing and vision loss. ____11. Often geriatric patients are under-medicated for pain. ____12. A diet rich in sodium and vitamins helps to maintain good bone growth and development. ____13. It is important to stay well-hydrated. ____14. Due to its sterile nature, urine can be used to clean a wound. ____15. Spina bifida can be prevented by adequate ascorbic acid ingestion during pregnancy.

Essay Write your answer in the space provided or on a separate sheet of paper.

1. Discuss how forensic scientists solve mysteries. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 2. Discuss how vitamin deficiencies affect health. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 3. Explain how DNA is used to solve crimes or identify remains. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 4. List five symptoms of sexually transmitted diseases. _____________________________________ _____________________________________ _____________________________________ _____________________________________ 5. List five behavioral choices to improve health. _____________________________________ .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

_____________________________________ _____________________________________ _____________________________________

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

ANSWER KEY

CHAPTER 1 Multiple Choice 1. c 2. a 3. d 4. c 5. b 6. a 7. b 8. c 9. d 10. b 11. a 12. d 13. b 14. d 15. a 16. c 17. a 18. c 19. a 20. d 21. a 22. b 23. d 24. d 25. c 26. c 27. a 28. b 29. d 30. b 31. c 32. c 33. b 34. d 35. a 36. d

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37. a 38. d 39. c 40. b 41. c 42. a 43. b 44. c 45. d 46. b Short Answer 1. gross; macro 2. cytology 3. anatomy 4. physiology 5. pathology/pathophysiology 6. cardi 7. mammogram 8. rhin/o, nas/o 9. electrocardiography; EKG; ECG 10. phobia 11. colostomy 12. neurologist 13. syndrome 14. raise 15. set point 16. Diabetes mellitus; diabetes 17. Iron 18. Rhinoplasty 19. Stomach 20. Signs 21. Cutting into; cutting 22. Hyper; hyper23. Positive feedback 24. Cytologist 25. Physiology 26. Prognosis 27. Exercise 28. Metabolic 29. brachial 30. 37; thirty seven; thirty-seven 31. hypothalamus 32. STAT 33. NPO 34. CPR .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

35. Advanced Cardiac Life Support 36. histology True/False 1. True 2. False 3. False 4. False 5. False 6. False 7. True 8. False 9. False 10. True 11. True 12. False 13. True 14. True 15. False Essay 1. Using abbreviations saves space and time; however, if all health care professionals do not interpret the abbreviations in the same way, it can cause confusion.

2. Behaviors such as smoking or overeating can cause lung disease or obesity.

Environmental factors such as nuclear waste can cause cancer.

3. Homeostasis is the body’s ability to maintain an ideal normal value of a variable (set point). The control center stores the value and sends out orders to change the value when necessary.

4. Blood pressure, pulse, respirations, and temperature are vital signs. They are called vital signs because measuring them gives indication of vital, or life sustaining, processes in the body.

5. Positive feedback loops enhance any change, and negative feedback loops return the body to normal set points.

CHAPTER 2 Multiple Choice 1. a 2. d 3. b 4. d 5. c 6. a 7. b 8. b 9. d .

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10. b 11. a 12. c 13. d 14. b 15. c 16. a 17. b 18. b 19. c 20. c 21. c 22. a 23. d 24. c 25. a 26. b 27. a 28. b 29. b 30. d 31. c 32. a 33. a 34. a 35. c 36. d 37. b 38. b 39. c 40. b 41. d 42. a 43. b 44. c 45. b 46. a 47. c 48. d 49. b 50. c 51. d 52. c

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Short Answer 1. Trendelenburg 2. fowler’s 3. inferior 4. lateral 5. frontal; coronal 6. dorsal; posterior 7. proximal 8. external 9. superficial 10. ventral; anterior 11. inferior, superior 12. peripheral; pedal 13. necrosis 14. antecubital 15. axillary 16. Supine 17. Proximal; distal 18. Intracranial; cerebral 19. Patient’s 20. finger 21. Eat 22. brachial 23. Indigestion 24. Dimensional 25. Hernia 26. Hypochondriac 27. Fowler’s 28. Trendelenburg 29. Magnetic resonance 30. Psoas 31. Cyanosis 32. Inguinal 33. Appendicitis 34. Necrosis 35. Neck;Jugular 36. Umbilical 37. Proximal 38. Superficial 39. Peripheral; Acrocyanosis 40. Two; 2 41. Three; 3 42. Trendelenburg

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True/False 1. False 2. True 3. False 4. True 5. False 6. True 7. True 8. False 9. False 10. True 11. True 12. False 13. True 14. False 15. False Essay 1. Answers may vary. RUQ = liver, right kidney, colon, pancreas, gallbladder. LUQ = liver, spleen, left kidney, stomach, colon, pancreas. RLQ = colon, small intestine, major artery and vein to the right leg, ureter, appendix. LLQ = colon, small intestine, major artery and vein to the left leg, and ureter.

2. The frontal (coronal) plane is a lengthwise section that divides the body into anterior (ventral) and posterior (dorsal) sections. The sagittal plane is a lengthwise division that divides the body into right and left sections. A midsagittal plane divides the body into right and left halves. A transverse (horizontal) plane is a cross section that divides the body into inferior and superior sections.

3. Location, type, frequency, what causes it, what relieves it and duration.

4. femoral: thigh; gluteal: buttocks, lumbar: lower back, antebrachial: forearm and cervical: neck.

5. Cranial (cephalic), proximal, internal, deep, and anterior.

CHAPTER 3 Multiple Choice 1. c 2. d 3. c 4. a 5. b 6. b 7. c 8. b 9. b .

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10. b 11. c 12. b 13. c 14. a 15. a 16. b 17. c 18. a 19. b 20. d Short Answer 1. molecule; compound 2. neutrons 3. pH 4. hydrophilic 5. carbohydrate 6. steroids 7. proteins 8. nucleic acids 9. metabolism 10. specific 11. oxygen 12. protein 13. water 14. enzymes 15. phospholipids True/False 1. False 2. False 3. True 4. False 5. False 6. True 7. True 8. False 9. False 10. True 11. True 12. False 13. True 14. False 15. False .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Essay 1. In an ionic bond, one atom donates electrons to the other, the resulting molecule is polar. In a covalent bond, the atoms share electrons. If the electrons are shared equally, the resulting molecule is non-polar. If one atom holds more tightly to the electrons than the other, the molecule will be polar. That type of bond is called a polar covalent bond.

2. Enzymes speed up the rate of chemical reactions. The reactants bind to the active site of the enzyme. This makes the reactants more likely to react. They react and products are produced. The enzyme simply carries the reactants through the reaction.

The enzyme is unchanged. When the reaction is over, the enzyme releases the products and picks up more reactants and the reaction continues.

3. Carbohydrates contain one oxygen and two hydrogens for every carbon in the molecule. Lipids contain several hydrogens for every carbon in the molecule but very little oxygen. Proteins are long chains of amino acids. When the amino acids are linked together, they form a special bond called a peptide bond which contains nitrogen. All proteins have several nitrogens.

4. An atom has a nucleus with neutrons (neutral) and protons (positive). Electrons (negative) surround the nucleus.

5. Metabolism consists of all the chemical reactions taking place in your cells. Anabolic reactions make large molecules from small usually via dehydration synthesis. Catabolic reactions break down large molecules into small usually via hydrolysis.

CHAPTER 4 Multiple Choice 1. b 2. d 3. a 4. c 5. d 6. a 7. a 8. c 9. b 10. b 11. a 12. c 13. b 14. c 15. d 16. d 17. b 18. c 19. c 20. a .

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21. c 22. a 23. c 24. b 25. d 26. a 27. b 28. b 29. d 30. c 31. c 32. a 33. a 34. b 35. c 36. b 37. d 38. a 39. d 40. c 41. d Short Answer 1. organelles 2. selectively permeable; semipermeable 3. diffusion 4. inhibition 5. osmosis 6. phagocytosis 7. nucleus 8. mitochondria 9. flagella 10. flora 11. viruses 12. asexual reproduction 13. mitosis 14. prophase 15. benign 16. Atoms 17. Osmosis 18. Filtration 19. Endoplasmic reticulum 20. Cilia 21. Golgi apparatus 22. Cellular reproduction 23. Mitotic .

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24. Anaphase 25. Cell 26. Half 27. Remodeling 28. Metastasis 29. Healthy 30. Damaged 31. Active 32. Thrush 33. Osmotic pressure 34. Cytokinesis 35. Pathogen 36. Capsid 37. Antibiotics 38. Filtration 39. Nucleolus 40. Cytoskeleton 41. Spores 42. Normal flora True/False 1. False 2. False 3. False 4. True 5. False 6. True 7. True 8. True 9. False 10. False 11. True 12. False 13. True 14. True 15. False Essay 1. Active transport requires energy to begin the process, while passive transport happens without energy use—for example, filtration.

2. Water will move, through osmosis, from an area of lower solute concentration to an area of higher solute concentration. Thus, an isotonic salt solution would be stable, but water would move into the hypertonic salt solution and out of the hypotonic solution.

.

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3. Carrier mediated transport involves a protein aiding a substance across the cell membrane. The protein has a binding site into which the substance must fit, it is specific. Because the substance must bind to the carrier, the carrier can be saturated if there are more substances than there are available carriers. Substances can compete for the limited number of carriers and other substances can block, or inhibit carriers, preventing them from bringing substances across the membrane. These systems may be either passive or active.

4. An organelle is a part of the cell that does a specific job. Cells are the fundamental living unit. Tissues are groups of similar cells working together. Organs are different types of tissues working together. An organ system is a group of organs and other structures that work together. An organism is a living thing typically containing a number of different organ systems.

5. Cells which divide too rapidly or at inappropriate times form masses called tumors.

Cancer cells are cells that divide without any breaks and so rapidly that they form misshapen primitive cells. They disrupt the normal function of tissue and can threaten life.

CHAPTER 5 Multiple Choice 1. b 2. b 3. a 4. c 5. c 6. a 7. a 8. b 9. d 10. c 11. d 12. b 13. a 14. b 15. d 16. d 17. a 18. b 19. d 20. a 21. b 22. c 23. a 24. a .

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25. d 26. d 27. c 28. d 29. d 30. c 31. d 32. a 33. b 34. c 35. a 36. a 37. a 38. a 39. c 40. b Short Answer 1. tissue 2. epithelial 3. simple squamous 4. voluntary 5. dense regular 6. meninges 7. visceral 8. neurons 9. fat 10. fibroblast 11. respiratory 12. lymphatic 13. skeletal 14. sensory; nervous 15. respiratory 16. Parietal 17. Arthr/o 18. Phleb/o,;Ven/o; Ven/i 19. Appendicular 20. Integumentary 21. Capillaries 22. Particles; pathogens 23. Endocrine 24. Urinary 25. Parietal 26. Synovial 27. Striated 28. Sensations .

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29. Meninges 30. Dendrites 31. Visceral 32. Skin True/False 1. False 2. True 3. True 4. True 5. True 6. False 7. False 8. False 9. False 10. False 11. False 12. False 13. True 14. False 15. True Essay 1. Cells are the fundamental living unit. Tissues are groups of similar cells working together. Organs are different types of tissues working together. An organ system is a group of organs and other structures that work together.

2. Muscular—skeletal muscles. Integumentary—skin, hair follicles, sweat glands, nails, sensory receptors. Nervous— central nervous system (brain and spinal cord) and peripheral nervous system (nerves). Cardiovascular—heart, blood vessels (arteries, veins, and capillaries), blood. Respiratory—nasal cavities, pharynx, larynx, trachea, bronchi, lungs, alveoli. Lymphatic—lymphatic vessels and nodes, spleen, thymus.

Gastrointestinal— salivary glands, pharynx, esophagus, stomach, small intestine, liver, gallbladder, pancreas, large intestine. Urinary—kidneys, ureters, urinary bladder, urethra. Male reproductive—testes, epididymis, ductus defens, seminal vesicles, prostate, urethra, genitalia (penis and scrotum). Female reproductive—ovaries, uterine tubes, uterus, vagina, clitoris, labia, mammary glands. Endocrine—pituitary, thyroid, parathyroid, adrenal and thymus glands, kidneys, pancreas, testes/ovaries.

3. Connective tissue has cells in an extracellular, non-living matrix. It is found underlying other types of tissue. Epithelial tissue has no extracellular matrix and generally has a free surface and an obvious top and bottom.

4. When tissue is injured it releases chemicals which promote inflammation -redness, heat, swelling and pain. If bleeding occurs, then clotting will stop the bleeding.

Fibroblasts begin to lay down collagen which brings the edges of the wound together, and a delicate pink tissue is formed (organization). Once the wound has sealed, either the collagen will be replaced by the original tissue (regeneration) or it will not and a scar will form. .

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5. Skeletal muscle is voluntary muscle. It is striated, cylindrical in shape and has many nuclei in each cell. Smooth muscle is involuntary. It is spindle shaped and has no striations. Cardiac muscle, in the heart, is involuntary, but is striated. It is branched and is interlocking.

CHAPTER 6 Multiple Choice 1. a 2. d 3. a 4. c 5. d 6. d 7. b 8. b 9. d 10. d 11. c 12. b 13. b 14. a 15. a 16. b 17. b 18. c 19. d 20. d 21. b 22. d 23. d 24. b 25. c 26. b 27. a 28. d 29. d 30. c 31. d 32. a 33. c 34. c 35. d 36. d .

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37. c 38. a 39. a 40. a 41. b 42. d 43. c 44. a 45. c 46. d 47. a Short Answer 1. medullary 2. short 3. irregular 4. trabeculae 5. hemopoiesis; erythropoiesis 6. head 7. sinus 8. meatus, canal 9. trochanter 10. ossification; osteogenesis 11. reduced; touching 12. intramembranous 13. cartilage 14. arthritis 15. abduction 16. Epiphysis 17. Cartilage; ligaments; tendons 18. Arthritis 19. Articulation 20. Extension 21. Surgical 22. Inflammation 23. Children 24. Density 25. Open 26. Joint 27. Ligaments 28. Hemopoiesis 29. Rheumatoid arthritis 30. Short 31. Hinge 32. Comminuted 33. Pelvic girdle .

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34. Exercise 35. Kyphosis 36. Scoliosis 37. Lordosis 38. Hairline 39. Simple 40. Spiral 41. Greenstick 42. Compound 43. Bursitis True/False 1. False 2. False 3. False 4. True 5. False 6. False 7. True 8. False 9. False 10. False 11. True 12. False 13. False 14. True 15. False Essay 1. Compact bone is composed of osteons, cylinders of bone surrounding a central canal. The central canal contains blood vessels. Surrounding the central canal are rings of bone matrix (lamellae). On the edge of each lamella are lacunae containing osteocytes (mature bone cells). Osteocytes are connected to each other by canaliculi and each adjacent central canals are connected to each other by perforating canals.

2. Bones can be made in two ways, intramembranous ossification and endochondral ossification. In endochadral ossification cartilage turns to bone. A cartilage model is replaced by bone in a series of steps, starting first with the diaphysis and then moving to the epiphyses. In Intramembranous ossification a membrane turns to bone from the center out.

3. Congenital, degenerative, infection, nutritional, secondary, trauma, and tumors.

4. Degenerative, infection, inflammation, secondary, and trauma.

5. When bone is injured the tissue becomes inflamed. Since bone is so vascular, hemorrhage results and so a hematoma, or collection of clotted blood, happens next.

The hematoma is replaced by cartilage. A soft or fibrocartilage callus results. The fibrocartilage callus is replaced, via endochondral ossification , with a bone (hard) callus. Eventually the bone will be remodeled. .

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CHAPTER 7 Multiple Choice 1. d 2. b 3. b 4. d 5. b 6. c 7. c 8. a 9. b 10. a 11. c 12. d 13. c 14. a 15. b 16. c 17. a 18. b 19. c 20. b 21. d 22. c 23. d 24. a 25. b 26. d 27. b 28. b 29. a 30. d 31. d 32. d 33. d 34. c 35. c 36. b 37. c 38. b 39. c 40. d 41. d 42. b .

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43. c 44. a 45. e 46. b 47. d 48. a 49. b 50. d 51. c 52. c 53. a Short Answer 1. smooth 2. ligaments 3. insertion 4. antagonists 5. diaphragm 6. flexor 7. clavicle 8. acetylcholine 9. actin 10. hypertrophy 11. glycogen 12. myalgia 13. atrophy 14. tetanus 15. extension 16. Kinesiology 17. Vasodilation 18. Muscle 19. Constrict 20. Wound 21. Women 22. Increase 23. Decrease 24. Ataxia 25. Diaphragm 26. Electromyogram 27. Rigor mortis 28. Sphincters 29. Shin splints 30. Tendinosis 31. Lines 32. Tetanus 33. Tendons .

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34. Tendinosis 35. Spasms 36. Shin splints 37. Botulism 38. Tendinitis True/False 1. True 2. False 3. False 4. True 5. False 6. True 7. True 8. False 9. False 10. True 11. True 12. True 13. False 14. False 15. False Essay 1. Acetylcholine is released from motor neurons and binds to sodium channels on muscle, opening the channels. Sodium flows into the muscle exciting it. The excitation releases calcium from the sarcoplasmic reticulum, allowing myosin to bind repeatedly to actin. This causes the sarcomere to shorten and the muscle to contact. ATP provides the energy to help the myosin heads form and break the cross bridges with actin.

2. Calcium is stored in the muscles and cause them to stiffen and shorten. Also, ATP is not available to break the attachment of myosin heads.

3. Muscles may be named by size, shape, action, attachments, location, direction of fibers, number of origins or any combination of these rules.

4. A sarcomere unit has two types of myofilaments; thick (myosin) and thin (actin). The actin and myosin filaments are arranged in repeating units separated from each other by bands called Z lines, which give the striated appearance to skeletal muscle.

5. All are neuromuscular diseases, but they are also different. Myasthenia Gravis is a disease of gradually increasing profound muscle weakness—especially in the face—but tendon reflexes remain, and is an autoimmune disorder. Muscular Dystrophy is an inherited disease with degenerative and progressive muscle weakness. Guillain- Barré syndrome is a disorder of the peripheral nervous system that causes limp muscles and loss of reflexes, in an ascending manner. Tetanus creates rigid paralysis and is due to a bacterial infection.

.

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CHAPTER 8 Multiple Choice 1. b 2. b 3. c 4. a 5. b 6. c 7. b 8. c 9. b 10. d 11. c 12. a 13. c 14. a 15. d 16. c 17. a 18. b 19. d 20. b 21. d 22. a 23. c 24. d 25. d 26. d 27. c 28. d 29. b 30. a 31. b 32. a 33. c 34. b 35. c 36. d 37. a 38. b 39. c 40. d 41. c 42. d .

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43. b 44. a 45. c 46. d 47. b 48. b 49. a 50. c 51. d 52. c 53. a 54. b 55. b 56. c Short Answer 1. stratum basale 2. stratum corneum 3. melanocytes 4. sebaceous 5. lipocytes 6. fibroblasts 7. depth 8. epidermis 9. tongue 10. keratin 11. carotene or bilirubin 12. temperature 13. fissure 14. epidermal 15. furuncle 16. Stratum basale 17. 18; eighteen 18. Keratin 19. Vasodilation 20. Vasoconstriction 21. Wheal; hive 22. Verruca 23. Hair 24. Infection 25. Cannot 26. Blackhead 27. Surface 28. Depth 29. Pain 30. Vesicles .

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31. Jaundice 32. Lyme disease 33. Tinea unguium 34. Keloid 35. Follicle 36. Sebum 37. Scabies 38. Vasodilation 39. Ulcers 40. Blood 41. Pustules 42. Verruca 43. Septicemia 44. Outer 45. Bone 46. Epidermis 47. Layers 48. Sunburn 49. Pediculosis 50. Alopecia 51. Lesion 52. Urticaria True/False 1. False 2. False 3. True 4. False 5. True 6. False 7. False 8. False 9. True 10. False 11. True 12. False 13. True 14. True 15. False Essay 1. First—only the outer layer of skin, the epidermis, is damaged. Skin is red, with pain but no blistering. Second—the entire depth of the epidermis and a portion of the dermis is damaged. This condition is characterized with pain, redness, and blistering. Third degree burns affect all three layers. The colors may include black, brown, tan, red, or white. There is no pain as the pain receptors have been destroyed. .

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2. Cells are born in the basal layer. As they are pushed toward the surface, they die and fill up with the protein keratin and are sloughed off from the horny layer.

3. Medicines cross the skin from adhesive patches into the bloodstream.

4. The pink color of the nail bed is clinically significant in aiding in the assessment of perfusion. Capillary refill tests how quickly the perfusion returns to the nailbed after being pinched off.

5. Trace amounts of ingested substances can become part of the hairs’ composition and can be analyzed by forensic pathologists to determine what was consumed by that individual over a long period of time.

CHAPTER 9 Multiple Choice 1. d 2. b 3. b 4. a 5. c 6. d 7. c 8. b 9. c 10. a 11. a 12. c 13. b 14. d 15. c 16. c 17. b 18. a 19. c 20. a 21. b 22. a 23. b 24. b 25. a 26. d 27. c 28. d 29. c 30. c 31. a 32. b 33. a .

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34. c 35. a 36. b 37. c Short Answer 1. autonomic; parasympathetic 2. microglia 3. ventral 4. twelve 5. roots 6. plexuses 7. reflexes 8. depolarization 9. spinothalamic 10. sensory 11. refractory 12. ranvier 13. vesicles 14. endorphins 15. arachnoid mater 16. Myelin 17. Peripheral 18. Carpal tunnel syndrome; carpal tunnel 19. Ganglion 20. Acetylcholine ; Ach 21. Ventilator 22. Permanent 23. Carpal tunnel syndrome 24. Inflammation 25. Diabetes mellitus 26. Action potential 27. Nodes of Ranvier 28. Endorphins 29. Spinal cord 30. Multiple sclerosis 31. Peripheral 32. Myasthenia gravis 33. Polio 34. Spinal cord injury 35. Peripheral neuropathy True/False 1. False 2. True 3. False .

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4. True 5. False 6. False 7. True 8. True 9. True 10. False 11. False 12. False 13. True 14. False 15. True Essay 1. Myelin is destroyed in this disease process. Bare spots short circuit the flow of charged ions, decreasing current. This can disturb vision, speech, balance, and movement.

2. The action potential flows to the axon terminal depolarizing it. Voltage gated channels open and calcium flows into the terminal. The calcium flowing in causes exocytosis of neurotransmitter. The neurotransmitter binds to the postsynaptic cell, causing a permeability change. The neurotransmitter is removed from the synaptic cleft and the cells return to rest.

3. Microglia remove debris. Oligodendrocytes make CNS myelin. Astrocytes are metabolic and structural support cells. Ependymal cells cover and line cavities.

Schwann cells make PNS myelin.

4. Depolarization, repolarization, and hyperpolarization.

5. The dura mater is a thick, protective layer. The arachnoid mater is a delicate layer that acts as a shock absorber. The pia mater contains blood vessels that serve the brain and spine.

CHAPTER 10 Multiple Choice 1. b 2. c 3. a 4. b 5. c 6. a 7. d 8. a 9. b 10. a 11. d 12. c 13. b .

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14. c 15. a 16. a 17. a 18. b 19. a 20. d 21. b 22. d 23. c 24. c 25. a 26. c 27. a 28. b 29. a 30. c 31. d 32. b 33. a 34. d 35. c Short Answer 1. two; 2 2. frontal 3. parietal 4. medulla oblongata 5. sensitivity 6. shunt 7. corpus callosum 8. thalamus 9. melatonin 10. vestibulococchlear 11. hypoglossal 12. ganglion 13. acetylcholine 14. cerebral vascular accident; CVA 15. subdural hematoma 16. Temporal 17. Ventricles 18. Vagus 19. Hemorrhage 20. Cerebrospinal fluid 21. Vestibulocochlear 22. Blood brain barrier .

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23. Cerebral Palsy 24. Sympathetic 25. Hydrocephalus 26. Traumatic 27. Cerebral palsy True/False 1. True 2. False 3. False 4. True 5. True 6. False 7. False 8. False 9. False 10. True 11. False 12. True 13. True 14. False 15. True Essay 1. The brain is a delicate organ that requires a delicate fluid balance. Increased CSF can compress the brain. This is known as hydrocephalus.

2. I-Olfactory, II-Optic, III-Oculomotor, IV-Trochlear, V-Trigeminal, VI-Abducens, VIIFacial, VIII-Vestibulocochlear, IX-Glossopharyngeal, X-Vagus, XI-Accessory, XIIHypoglossal.

3. Sensory information goes to the thalamus, cerebellum, and cerebral cortex for processing. The somatic sensory association area in the cerebral cortex adds meaning to the sensation. Then the sense of touch is actually understood.

4. They need to perform more finely coordinated movements.

5. Blindness, memory loss, paralysis, muscle weakness, and lack of sensation on the contralateral (opposite) side of the stroke.

CHAPTER 11 Multiple Choice 1. c 2. d 3. a 4. a 5. d 6. b 7. c .

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8. a 9. c 10. b 11. d 12. b 13. b 14. d 15. a 16. b 17. a 18. b 19. a 20. b 21. d 22. a 23. b 24. b 25 b 26. a 27. d 28. b 29. a 30. d 31. a 32. c 33. a 34. c 35. c 36. c 37. d 38. a 39. a 40. c 41. b 42. d 43. a 44. b 45. a 46. d Short Answer 1. touch 2. iris 3. posterior 4. eyeball 5. pupil .

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6. glaucoma 7. retina 8. amblyopia 9. optic (II) 10. conjunctivitis 11. smell 12. stirrups 13. pinna; auricle 14. tympanic 15. eustacian 16. Myopia 17. Presbyopia 18. Cataract 19. Visualization 20. Pinkeye; pink eye 21. Tunnel 22. Tympanic 23. Inner 24. Nearby 25. Noises 26. Iris 27. Auricle 28. Hyperopia 29. Oval window 30. Adaptation 31. Nociceptors 32. Anesthesia 33. Lacrimal 34. Cornea 35. Glaucoma 36. Conjunctivitis 37. Pinkeye 38. Cataract 39. Glaucoma 40. Otitis media 41. Otitis media 42. Tympanic membrane 43. Labyrinthitis 44. Meniere’s disease 45. Deafness 46. Tinnitus True/False 1. False 2. False 3. True .

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4. False 5. True 6. False 7. True 8. False 9. True 10. True 11. False 12. True 13. True 14. False 15. True Essay 1. Sight—eye. Taste—tongue. Smell—nose. Touch—skin. Hearing—ears.

2. Images are brought in through a small hole called a pupil. The image moves through a lens and an imprint is made on the retina. Your brain almost immediately processes the impulse and registers the image.

3. Sound waves enter the external canal and vibrate the eardrum, or tympanic membrane, which vibrates the ossicles. The last ossicle (stapes) vibrates the oval window membrane. This causes cochlear fluid to vibrate hair cells on the organ of Corti.

A nerve impulse is sent to the temporal lobe of the brain, where it is interpreted as sound.

4. The Eustacian tubes are smaller in children and can harbor diseases. Further, some parents prop bottles of milk or formula, so that milk accumulates in the tubes. Milk provides a good breeding ground for microbes.

5. Sometimes pain is not felt at the location of trauma or illness. Sometimes pain is referred to another area. For example, liver pain can be felt in the shoulder. Phantom pain is pain that is felt in a body part that has been removed.

CHAPTER 12 Multiple Choice 1. b 2. c 3. d 4. a 5. b 6. c 7. a 8. b 9. d 10. c 11. a 12. d 13. b .

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14. b 15. a 16. b 17. a 18. b 19. d 20. b 21. a 22. c 23. d 24. a 25. d 26. b 27. a 28. b 29. b 30. a 31. c 32. d 33. a 34. d 35. a 36. d 37. a 38. c 49. d 40. c 41. a 42. d 43. b 44. a 45. d 46. b 47. b Short Answer 1. glucose 2. food; sugar 3. growth 4. glucagon 5. hyperthyroidism 6. hormones 7. calcitonin 8. positive 9. set point 10. antidiuretic .

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11. luteinizing 12. oxytocin 13. thymus 14. adrenal cortex 15. hypothalamus 16. Diabetes mellitus; diabetes 17. Thyroid 18. Adipose 19. Adrenal 20. Respiration 21. Dwarfism 22. Epinephrine 23. Pituitary 24. Dwarfism 25. Cortisol 26. Adrenal corticosteroids 27. Glycogen 28. Pancreas 29. Adrenal medulla 30. Melatonin 31. Thyroid 32. Negative feedback 33. Steroids 34. Testosterone 35. Graves’ disease 36. Anterior 37. Dwarfism 38. Acromegaly 39. Hashimoto’s thyroiditis 40. Graves’ disease 41. Goiter 42. Hypoglycemia 43. Addison’s disease 44. Chronic stress 45. Cortisol 46. Psychological True/False 1. False 2. True 3. True 4. False 5. True 6. False 7. True 8. False .

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9. True 10. True 11. False 12. True 13. True 14. True 15. True Essay 1. Some hormones are part of a hierarchy of hormonal control in which one gland is controlled by the release of hormones from another gland higher in the chain, which is controlled by another gland’s release of hormones yet higher in the chain. Negative feedback controls the flow of orders via hormones.

2. When blood sugar rises, the pancreas secretes insulin. Insulin helps move glucose into cells and promotes storage of glucose as glycogen in the liver, thus lowering blood sugar. If blood sugar drops, the pancreas releases glucagon. Glucagon causes the release of stored glucose from the liver, thus raising blood sugar.

3. Steroids are very powerful hormones which are tightly regulated. If steroids are injected, the levels of steroid secretion from the adrenal cortex will drop, causing an imbalance. If steroids are discontinued, then the adrenal cortex may not “gear up” quickly enough and a series of steroid defecits will occur. In addition, just the addition of steroids to the body causes many side effects because the hormones are so powerful.

4. The set point gives a balance to the body by establishing a homeostasis level. These values are considered “normal” values and the hypothalamus seeks to maintain the body’s blood pressure, temperature, etc. at these set points.

5. The parathyroid glands are located on the thyroid. The thyroid secretes calcitonin, which places calcium from the blood into the bones, and the parathyroids secrete parathyroid hormone which draws calcium from the bones into the blood.

CHAPTER 13 Multiple Choice 1. a 2. c 3. d 4. b 5. b 6. c 7. d 8. b 9. d 10. a 11. b 12. c 13. c 14. b .

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15. b 16. c 17. d 18. a 19. a 20. d 21. a 22. d 23. b 24. d 25. a 26. c 27. b 28. a 29. b 30. c 31. d 32. c 33. a 34. c 35. c 36. b 37. d 38. c 39. a 40. a 41. b 42. c 43. a 44. c 45. d 46. a 47. c 48. a 49. d 50. a 51. b 52. c Short Answer 1. apex 2. mitral 3. stroke volume 4. right 5. constrict 6. erythrocytes .

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7. AB 8. media 9. AV bundle 10. P 11. phagocytosis 12. hemostasis; clotting 13. arterioles 14. atrioventricular 15. visceral pericardium 16. Pacemaker 17. Hg 18. Eosinophils 19. Leukopenia 20. Infarction; necrosis 21. Death 22. Leg 23. Agglutinate 24. Coronary 25. Emboli 26. Leukemia 27. Higher 28. Denies 29. Hemoglobin 30. Agglutinate 31. Hypertension 32. Thrombus; Emboli 33. Thrombocytopenia 34. Universal recipient 35. Heparin 36. Murmur 37. Stenosis 38. Aneurysm 39. Angina 40. Atherosclerosis 41. Embolism 42. Hypertension 43. Myocardial Infarction; MI 44. Varicose 45. Erythrocytopenia 46. Hemophilia 47. Thrombocytopenia True/False 1. False 2. False 3. True .

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4. False 5. True 6. True 7. False 8. False 9. True 10. False 11. False 12. False 13. True 14. True 15. False Essay 1. P = atrial depolarization. QRS = atrial repolarization and ventricle depolarization.

T = ventricular repolarization.

2. Superior and inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semilunar valve, pulmonary artery, pulmonary arteioles, lung (capillaries), pulmonary venules, pulmonary vein, left atrium, bicuspid valve, left ventricle, aortic semilunar valve, aorta.

3. If an Rh negative mother conceives an Rh positive child, she may create antibodies against positive blood. In the second pregnancy, these antibodies may attack her second child if the child is positive. She may need to consider a vaccination to prevent this problem 4. Approximately 15 seconds from the time of initial injury, the actual clotting of blood begins. One of the clotting proteins, prothrombin, converts to thrombin. Thrombin transforms fibrinogen into fibrin. Fibrin forms a net which patches the injury site and snags more blood cells and platelets to form a clot.

5. The factors that influence blood pressure are blood volume, cardiac output, blood viscosity and peripheral resistance. Blood volume is the amount of blood in the system.

Less blood generally causes lower blood pressure. Cardiac output is the amount of blood being pumped by the heart each minute. Again, lower output causes lower pressure. Blood viscosity is the thickness of the blood. Higher viscosity causes higher pressure. Peripheral resistance is the resistance in the blood vessels to blood flow.

Constricted blood vessels have higher resistance and also higher pressure. Anything that influences these factors will also influence blood pressure such as body temperature or dehydration for examples.

CHAPTER 14 Multiple Choice 1. d 2. b 3. a 4. b 5. a .

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6. b 7. c 8. b 9. d 10. a 11. c 12. b 13. c 14. b 15. a 16. c 17. b 18. d 19. c 20. b 21. d 22. c 23. a 24. b 25. a 26. d 27. c 28. d 29. c 30. c 31. d 32. a 33. b 34. a 35. d 36. b 37. a 38. c 39. b 40. d 41. a 42. a 43. b 44. c 45. d 46. c 47. a Short Answer 1. primary bronchi; mainstem bronchi 2. bronchioles .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. conduction 4. respiration 5. sinuses 6. epiglottis 7. trachea 8. carina 9. surfactant 10. respiration 11. simple squamous 12. stratified squamous 13. C4 14. medulla oblongata 15. kidney 16. O2 17. CO2 18. Capillaries 19. Phonation 20. Smell 21. Larynx 22. Surfactant 23. Erythrocytes 24. Bronchitis 25. Empyema 26. Resistant 27. Oxygen; hemoglobin 28. Oxygen 29. Hemothorax 30. Asthma 31. Mediastinum 32. Esophagus 33. Pleural effusion 34. Sternum 35. Accessory muscles 36. Sinusitis 37. Adenoids 38. Infections 39. Pharyngitis 40. Laryngitis 41. Atelectasis 42. Pneumonia 43. Chronic bronchitis True/False 1. False 2. True 3. False .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. False 5. True 6. False 7. False 8. False 9. False 10. True 11. True 12. False 13. True 14. False 15. True Essay 1. The walls of the respiratory system change from conducting zone to respiratory zone.

There is abundant cartilage in the walls of the trachea and bronchi but no cartilage in the alveoli. The type of epithelium changes. The trachea is lined with respiratory mucosa the bronchioles with simple cuboidal and the alveoli with simple sqamous. The amount of smooth muscle also changes. The trachea has only posterior smooth muscle, the bronchioles have full layers, and the alveoli have none.

2. The nose and nasal cavity are designed to warm, moisten and filter air and trap particles. The mucus and ciliated mucosa in your nasal cavity trap particles and remove them from the respiratory system. The hairs around the nares prevent larger particles from entering the nose. The nasal conchae increase surface area to trap particles and warm and moisten air. The oral cavity is not set up to do any of the things the nasal cavity can do.

3. The right mainstem branches off at a 20-30 degree angle from the midline and the left at a 40-60 degree angle. Thus aspiration is more likely into the right lung.

4. During inspiration, the diaphragm contracts, the volume of the thoracic cavity and the lungs increases. This decreases the pressure inside the lungs (lower than atmospheric pressure) and air flows down the pressure gradient and into the lungs. Expiration is the reverse.

5. Surfactant lowers the surface tension when the alveoli are small, thus preventing alveoli collapse, but when you take a deep breath your alveoli get larger and the surfactant layer thins and becomes less effective, thus starting to increase surface tension. This prevents over-expansion or rupture of the alveoli. Surfactant develops late in pregnancies, so premature babies may not have sufficient levels when born.

Surfactant replacement therapy can instill surfactant into the lungs to maintain their function until the babies mature and produces it on their own.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

CHAPTER 15 Multiple Choice 1. c 2. a 3. d 4. c 5. a 6. d 7. b 8. a 9. b 10. d 11. a 12. c 13. c 14. b 15. b 16. c 17. a 18. d 19. c 20. b 21. a 22. c 23. d 24. d 25. c 26. a 27. b 28. d 29. b 30. b 31. a 32. c 33. b 34. b 35. a 36. d 37. a 38. c 39. d 40. a 41. d 42. a

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

Short Answer 1. lymphatic 2. vessels 3. spleen 4. thymus 5. pathogen 6. innate 7. antigens 8. leukocytes 9. basophils 10. artificial acquired active 11. infection 12. margination 13. positive 14. inflammation 15. proliferation 16. Eosinophils 17. Lysis 18. Fatal 19. Type 20. Pathogens 21. Numbers 22. Autoimmune 23. Strep/sore 24. Pathogen 25. Thoracic 26. Antigens 27. Cascade 28. Leukocytes 29. Cytokines 30. Inflammation 31. Negative selection 32. Rheumatoid 33. Perforin 34. Cancer 35. Leukemia 36. Anaphylaxis 37. Fever 38. Autoimmune 39. Rheumatoid 40. Autoimmune 41. Deficiency 42. Allergies 43. Lymphoma

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

True/False 1. False 2. False 3. False 4. False 5. False 6. False 7. True 8. True 9. True 10. False 11. False 12. True 13. True 14. True 15. False Essay 1. Microbes frequently enter the body through the lungs, reproductive, and digestive organs, so nodes are located at high-risk areas.

2. Cancer is staged and prognosis and treatment is determined by the amount of metastasis (spread). Stage 1, no spread from origin; Stage 2, spread to nearby tissues; Stage 3, spread to nearby lymph nodes; Stage 4, spread to distant tissues and organs. Stage 4 cancers are usually terminal.

3. The body needs to recognize its own tissues as “self.” If not, the immune system will attack the body’s cells, thinking they are non-self, and an auto-immune disorder develops.

4. Both innate and adaptive immunity defend the body against antigens. However, innate immunity is inborn and adaptive immunity comes from developing immunities as a result of encounters with antigens or vaccinations. Adaptive immunity remembers pathogens and improves with experience.

5. HIV selectively attacks helper T cells. The job of helper T cells is to activate T cells and B cells. As helper T cell numbers drop, fewer cytotoxic T cells and B cells are activated, decreasing adaptive immune response.

CHAPTER 16 Multiple Choice 1. c 2. a 3. b 4. a 5. a 6. b 7. d 8. c .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

9. d 10. d 11. c 12. a 13. c 14. a 15. b 16. a 17. b 18. b 19. a 20. c 21. b 22. b 23. a 24. b 25. c 26. a 27. d 28. c 29. d 30. b 31. c 32. d 33. c 34. a 35. d 36. c 37. d 38. d 39. a 40. d 41. b 42. b 43. c 44. d 45. b 46. c 47. b 48. d 49. c Short Answer 1. ingests 2. digests 3. alimentary; GI .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. uvula 5. mastication 6. defecation 7. microvilli 8. dentin 9. epiglottis 10. baby 11. peristalsis 12. chyme 13. pepsin 14. cephalic 15. mesentery 16. Anus 17. Appendicitis 18. Segmentation 19. Cholelithiasis 20. Reflux 21. Ducts 22. Hepatitis 23. Adults 24. Diarrhea 25. Esophagus 26. Sphincter 27. Cholelithiasis 28. Caries 29. Bolus 30. Parotid 31. Deciduous; baby 32. Gastritis 33. Epiglottis 34. Caries, cavities 35. Periodontal 36. Anorexia 37. Cholecystitis 38. Cholelithiasis 39. Cirrhosis 40. Crohn’s 41. Gastroesophageal 42. Gingivitis 43. Pyorrhea True/False 1. True 2. False 3. True 4. False .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

5. True 6. False 7. True 8. False 9. False 10. False 11. False 12. False 13. False 14. False 15. False Essay 1. Mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus.

2. Three hormones are primarily responsible for controlling digestion. Gastrin stimulates stomach activity and is released mainly when food enters the stomach (though some is released before then). CCK and secretin are released when food enters the duodenum.

They decrease stomach activity and increase secretion from the pancreas and liver, and bile release from the gallbladder.

3. GERD is GastroEsophageal Reflux Disease. The lower esophageal sphincter does not properly seal off and allows the acidic stomach contents to reflux into the esophagus, giving a burning sensation. If left untreated, it can cause serious damage to the esophagus.

4. The mouth mechanically breaks down food, tastes it, moistens it and begins starch digestion. The pharynx controls the swallowing reflex. The esophagus moves food to the stomach. The stomach stores food, breaks it down by mixing it with hydrochloric acid and begins protein digestion. The stomach also absorbs a small amount of nutrients. The small intestine does the bulk of absorption and digestion of food. The large instestine makes and stores feces and absorbs water and electrolytes. The anus allows defecation.

5. The peritoneum, like all serous membranes, has a visceral layer covering the organs, a parietal layer, lining the abdominal cavity, and a potential space between the layers.

It is different from other serous membranes because some abdominal organs are not covered by the membrane (retroperitoneal organs) and because the peritoneum has large sheets projecting from it that drape over the organs (mesentery).

CHAPTER 17 Multiple Choice 1. a 2. c 3. b 4. d 5. b 6. c 7. b .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

8. c 9. a 10. c 11. a 12. c 13. b 14. c 15. b 16. b 17. a 18. c 19. d 20. d 21. a 22. d 23. d 24. b 25. d 26. a 27. c 28. a 29. a 30. b 31. c 32. a 33. c 34. b 35. d 36. c 37. c 38. a 39. d 40. a 41. b 42. d 43. c 44. d 45. a 46. c 47. b 48. a Short Answer 1. ureter 2. sinus 3. minor calyces .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

4. afferent arteriole 5. segmental 6. pyramids 7. glucose 8. analgesic 9. diabetes insipidus 10. nephron 11. renin-angiotensin-aldosterone; renin angiotension aldosterone 12. lithotripsy 13. ions 14. decreases 15. polycystic kidney 16. Filtration 17. Diffusion 18. Osmosis 19. Afferent 20. Efferent 21. Balance 22. Meat 23. Renal 24. Ischemia 25. Filtering 26. Transplant 27. Survive 28. Autoregulation 29. Nephropathy 30. counter current 31. Antidiuretic hormone 32. Glomerulonephritis 33. Overactive bladder 34. Renal hilum 35. Glomerulus 36. Renal columns 37. Calcium 38. Polycystic 39. Ischemic 40. Nephropathy 41. Nephropathy 42. Glomerulosclerosis 43. Uremia 44. Hemolytic 45. Creatinine 46. Chronic 47. Incontinence

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

True/False 1. True 2. False 3. True 4. True 5. True 6. False 7. True 8. True 9. False 10. False 11. True 12. True 13. False 14. True 15. True Essay 1. Decreased blood flow to the kidney results in ischemia to the nephrons, and decreased oxygen delivery to the nephrons. The body will desperately fight to get blood pressure back to normal, causing widespread vasoconstriction. The afferent arterioles get smaller and smaller, decreasing blood supply to the nephrons. Eventually the kidneys will be damaged and kidney failure will result.

2. Antidiuretic Hormone-released by the posterior pituitary (made by hypothalamus), decreases urination. Aldosterone-released by the adrenal cortex, increases sodium reabsorption, decreases urination. Atrial natriuretic peptide-released by the heart, increases urination. Epirephrine-decreases filtration. Norepinephrine-same as epinephrine.

3. Just like screens and nets keep larger insects out of the house, filters are selective— allowing only smaller substances to go through the openings in the filter. Differences in pressure control the rate of filtration. The greater the pressure, the faster the filtration.

4. In an attempt to rid the body of high amounts of blood sugar, the kidneys are forced to filter sugar, overworking the kidneys. This can lead to kidney failure.

5. The kidney filters many chemicals. Substances in the urine crystallize in the renal tubule, often because the concentration of the molecule is higher than normal in the renal tubule. Stones can be made of many different chemicals including calcium or uric acid, or can be caused by kidney infection.

CHAPTER 18 Multiple Choice 1. b 2. a 3. c 4. a 5. b .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

6. d 7. c 8. a 9. c 10. b 11. c 12. b 13. b 14. a 15. c 16. a 17. b 18. d 19. d 20. c 21. a 22. d 23. d 24. c 25. b 26. a 27. b 28. c 29. d 30. b 31. b 32. a 33. c 34. d 35. a 36. c 37. b 38. d 39. d 40. d 41. a 42. b Short Answer 1. sperm 2. LH 3. inhibits 4. proliferation 5. genitalia 6. fallopian 7. corpus luteum .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

8. prostate 9. testosterone 10. seminal vesicles 11. semen 12. placental 13. HCG 14. endometriosis 15. benign prostatic hypertrophy; BPH 16. 21; twenty-one; twenty one 17. Ovaries 18. Zygote 19. Mammary 20. Hydrocele 21. Intellectual 22. Prostate 23. Blood 24. Testosterone 25. 35; thirty-five; thirty five 26. Men 27. PMS 28. Underlying 29. Yeast 30. Immune 31. Ejaculation 32. Mastitis 33. Asexual reproduction 34. Vulva 35. Fimbria 36. Mitosis 37. Functional 38. Endometriosis 39. Perineum 40. Mammary 41. Amenorrhea 42. Dysmenorrhea 43. Progesterone 44. Endometriosis 45. Breast 46. Cervical 47. Vaginitis 48. Abruptio placenta 49. Ectopic 50. Hyperplasia; hypertrophy

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

True/False 1. False 2. False 3. True 4. True 5. False 6. False 7. True 8. False 9. True 10. True 11. False 12. False 13. True 14. False 15. False Essay 1. Sperm move from the epididymis into the vas deferens, which then carries the sperm into the pelvic cavity. Semen enters the ejaculatory duct. The semen then enters the urethra and is carried outside the body. (Keep in mind that a number of glands are passed on this journey as well.)

2. Each month, women of child-bearing age shed and replace the endometrium.

Sometimes endometrial tissue gets outside the uterus and builds up and decays each month with the hormonal cycle. Women with endometriosis have abdominal and back pain around their period. Untreated endometriosis can lead to infertility.

3. Follicle stimulating hormone (FSH): stimulates follicle development. Luteinizing hormone (LH): stimulates ovulation. Progesterone: inhibits LH and FSH, maintains uterine lining. Estrogen: Stimulates development of endometrium and release of LH and FSH prior to ovulation.

4. Testosterone secretion in utero usually develops the typical male genitalia. If the fetus is insensitive to the androgens, he may have typical male genitalia but be sterile.

5. Menses: time during which menstruation occurs. Lining decays and leaves the uterus. Follicular or proliferative phase: endometrium is building up, follicle is maturing, between menses and ovulation. Luteal or secretory phase: corpus luteum forms, between ovulation and menses.

CHAPTER 19 Multiple Choice 1. c 2. b 3. a 4. a 5. a 6. d .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

7. b 8. c 9. b 10. b 11. d 12. a 13. a 14. c 15. c 16. a 17. c 18. d 19. b 20. d 21. d 22. d 23. c 24. d 25. c 26. a 27. a 28. c 29. c 30. b 31. a 32. a 33. b 34. d 35. d 36. b 37. d 38. d 39. b 40. a 41. d 42. c 43. a 44. d 45. b 46. c 47. a 48. c Short Answer 1. bones 2. 100; one hundred; one-hundred .

Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

3. timeline 4. DNA 5. polypharmacy 6. smoking, sun 7. 1 ; one 8. 50 ; fifty 9. carpal tunnel syndrome 10. smoking 11. melanoma 12. K 13. warts 14. lead 15. pelvis 16. Homeostasis 17. Accumulation 18. Repetitive 19. Longer 20. Constrict 21. Excretion 22. Smoking 23. Removing 24. Chemotherapy 25. Genital warts 26. Polypharmacy 27. Exercise 28. Spina bifida 29. Friction ridges 30. Male 31. Bacilli 32. Dehydrate 33. Deteriorate 34. Calcification 35. Flexibility 36. Incontinence 37. Polypharmacy 38. Oxygen 39. Increase 40. Anabolic 41. Lower 42. Herpes 43. Gonorrhea 44. Chlamydia 45. Syphilis 46. Genital warts

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition

True/False 1. True 2. False 3. False 4. True 5. True 6. False 7. False 8. False 9. True 10. False 11. True 12. False 13. True 14. True 15. False Essay 1. Answers may vary, but might include examination of hair, DNA, fingerprints, and skeletal remains.

2. Answers might include Vitamin A for vision; Vitamin B for cell and muscle growth; Vitamin C for iron absorption, bone and wound healing, and to bolster the immune system; Vitamin D for strong bones and teeth; Vitamin E for muscle and RBC growth; and Vitamin K for clotting.

3. If tissue or fluid is left at a crime scene or on a suspect’s personal items, that fluid may contain DNA. If it does, the DNA can be spilt into fragments and the fragments compared to the suspect’s and victim’s DNA. This procedure is called DNA fingerprinting. DNA fingerprinting can also be used to discover paternity or identify remains. As long as there is DNA available and a known sample for comparison, DNA fingerprinting is a reliable way to identify biological samples.

4. Vesicles/blisters, urinary pain and frequency, purulent discharge, abnormal menstrual bleeding, abdominal tenderness, genital burning and itching, swollen testes, bladder inflammation, pelvic pain, inflamed cervix, chancre sores, nervous system degradation, lymph node enlargement, and lesions/ growths.

5. Answers may vary, but might include not smoking, eating sensibly, exercising, avoiding sunlight overexposure, practicing safe sex, etc.

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Colbert , Ankney, Lee, Instructor’s Resource Manual for Anatomy and Physiology for Health Professions: An Interactive Journey, 2nd Edition